Women living with HIV in Rajasthan, India, have come together to lobby the State Government of Rajasthan for improved provision of social protection services. The Global Alliance for Human Rights and the Rajasthan Network of People Living with HIV organized an advocacy session in Jaipur on 15 May with more than 100 women living with HIV during which they presented their needs, including dairy booths for income generation and schooling for adolescents living with HIV.

In addition to the importance of access to social protection and economic opportunities, discussions were also held around the global 90–90–90 targets, the elimination of mother-to-child transmission of HIV by 2020 and ending AIDS by 2030. The Indian HIV/AIDS Act 2017 and its importance in protecting against discrimination and opening access to the law in the event of human rights violations against people living with and affected by HIV in India were also discussed.

The women living with HIV presented some heartening real-life stories on their struggle to look after their families. A widow with three children said, “I am facing stigma and discrimination in my family and I am fighting hard to ensure that my rights to property are protected so that I can continue to provide good care to my children. I am under a lot of pressure to withdraw, but I will not give up the fight.”

Many commitments were made during the session. “We commit ourselves to look for legal clearance in support of the allocation of dairy booths for 1000 women living with HIV in Rajasthan,” said Devi Singh Bhatti, a politician and former member of the Rajasthan Legislative Assembly.

Brijesh Dubey, of the Global Alliance for Human Rights and Rajasthan Network of People Living with HIV, concluded the event with a strong message to the officials of the Government of Rajasthan and other stakeholders present. “The Rajasthan Network of People Living with HIV will continue to focus its efforts on two major areas—firstly, the roll-out of the HIV/AIDS Act 2017 through the establishment of legal clinics and, secondly, ensuring access to quality livelihood options for people living with HIV, especially women and adolescents living with HIV.”

GENEVA, 10 May 2018— During my recent visit to South Africa, I listened carefully to you, I heard you. The HIV epidemic is inextricably linked to sexual and gender-based violence and the two can never be separated. We need the passion of advocates to move issues forward.

Let us come together and address sexual harassment and gender inequality. A transformative agenda to address sexual harassment and gender inequality is urgent. Let us work together towards it, let us spend our time and energy on this important agenda.

Speaking truth to power is at the core of civil society existence, therefore civil society should never feel threatened to silence because of fear of loss of resources (financial and otherwise). You are an autonomous and critical contributor to the AIDS response, we must preserve that always. Women and men at UNAIDS, in all their diversity, appreciate the support of civil society for standing together with them in solidarity, and in support of women’s equality and rights.

Let us unite the HIV movement around these issues. Working together, we can define a vibrant movement that addresses the intersections between HIV, sexual harassment and gender inequality. In collaboration with you, I am calling for a women’s meeting in Africa to forge the way forward on ending sexual harassment.

I heard you. I listened to all of you. I will act.

Michel Sidibé
Executive Director of UNAIDS
Under-Secretary-General of the United Nations

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The UNAIDS Executive Director, Michel Sidibé, has completed a five-day visit to three countries in southern Africa. The mission included high-level political discussions, the launch of the Lesotho HIV health and situation room and a frank and open dialogue with women activists about how to address sexual harassment and abuse.

Beginning in Lesotho, Mr Sidibé attended the launch of the HIV health and situation room with the Deputy Prime Minister, Monyane Moleleki. Special guest Naomi Campbell was invited by UNAIDS to join the two-day country visit to learn more about the HIV response.

The Lesotho HIV and health situation room shows real-time service delivery data, producing a comprehensive picture and understanding of Lesotho’s HIV epidemic. It enables quick feedback on results at the national and community levels and identifies bottlenecks in access to health-care services.

“The launch of the Lesotho HIV and health situation room gives us access to data to shape impactful and efficient health programmes. These are the kind of innovations that will bring services to those who need them most and ensure that no one is left behind by the AIDS response,” said Michel Sidibé, the UNAIDS Executive Director.

On the eve of the launch, Mr Sidibé and Ms Campbell visited the Queen II Hospital in Maseru, Lesotho, and met with young women living with HIV and others affected by the epidemic.

“I commend the Government of Lesotho and its partners for the progress made in the AIDS response. But the work is far from done. The reality is that we are not reaching adolescent girls and young women. I leave Lesotho today empowered, inspired, encouraged and determined to do all I can to highlight this critical issue,” said Ms Campbell.

In South Africa, Mr Sidibé addressed the Pan African Parliament and underlined the importance of integrated health approaches that were people-centred. He urged parliamentarians to commit more domestic funding for health services to increase the sustainability of the AIDS response and to put in place more preventative measures to improve people’s health. In addition, he called for laws to protect women and vulnerable groups. 

Mr Sidibé left the parliamentary session to meet civil society activists concerned by UNAIDS' response to allegations of sexual harassment and abuse in the organization.

At a follow-up meeting the next day, Mr Sidibé and women activists met to discuss their concerns.

Mr Sidibé agreed with activists to issue a statement following the meeting. The statement begins:

‘During my recent visit to South Africa, I listened carefully to you, I heard you. The HIV epidemic is inextricably linked to sexual and gender-based violence and the two can never be separated. We need the passion of advocates to move issues forward.`

During his visit to South Africa, Mr Sidibé held separate meetings with the President, Cyril Ramaphosa, the Deputy President and South African National AIDS Council Chair, David Mabuza, and the Minister of Health, Aaron Motsoaledi. They discussed plans to increase the number of people on treatment by 2 million by 2020 and the need to empower local and provincial authorities to bring treatment and prevention services closer to vulnerable communities.

The last leg of Mr Sidibé’s visit saw him arrive in Lusaka, Zambia, to confer the 2018 UNAIDS Leadership Award upon Kenneth Kaunda for his efforts in strengthening the AIDS response.  

David Chipanta started his UNAIDS career in Liberia as the UNAIDS Country Director, where he helped to strengthen the national AIDS commission and national strategy framework. He is particularly proud of putting gender and ending sexual violence front and centre in the AIDS response in the country and giving the national network of people living with HIV more of a voice.

“What I found exciting was tackling the many barriers that surround access to HIV treatment, prevention, care and support,” he said. By barriers, he means the stigma, discrimination, poverty and inequalities that constrain people from accessing HIV services.

An economist by training, Mr Chipanta remarked, “We cannot forget the importance of all the things that relate to people’s lives—do they feel secure, do they have food, do they have a house, a family, a job?” Giving the example of Zambia, he described some people only taking their HIV medicine during the rainy season because food is more readily available then.

“It hit me that the peripheral stuff is very important, because without it HIV services will have a limited impact,” Mr Chipanta said. His current job as the UNAIDS Social Protection Senior Adviser in Geneva, Switzerland, focuses on just that—connecting people affected by HIV to social safety nets and improving livelihoods, as well as reducing poverty and improving education.

“UNAIDS has created more awareness about social protection services and the hurdles that people living with HIV face,” he said. For example, he explained that in Liberia and Sierra Leone, sex workers said they weren’t accessing social protection services because the administrators often treated them badly; in response, his office set up sensitivity training.

Another issue close to his heart is girls’ education. Keeping girls in school has been shown to lower HIV prevalence and is an important factor in increasing access to HIV treatment. “In low-income settings, we shone the light on the importance of cash transfers to keep girls in school,” Mr Chipanta said. His next challenge is advocating for more synergies with programmes for mentoring, empowerment and social support.

“As a person living with HIV, I never thought I would accomplish so much,” he said. In 1991, when he found out his HIV status in his native Zambia, he assumed that his life was over. “I thought, before I die, let me help others,” he added.

“I was personally motivated to work in the HIV field,” he said. “But I felt like I wanted to become an expert in my own right.”

Krittayawan (Tina) Boonto reflected on her 20 years at UNAIDS by also saying she couldn’t believe how far she had got. Ms Boonto started work in her native Thailand before moving to Geneva.

“It was supposed to be temporary, but I stayed seven years,” she said.

She then went to Indonesia as the Programme Coordination Adviser in 2005. She helped the Ministry of Health with technical support and accessing financial resources from the Global Fund to Fight AIDS, Tuberculosis and Malaria. That experience proved pertinent, because in 2010 she moved to Myanmar as the Senior Investment and Efficiency Adviser.

“The country was opening up at that time, so my field experience in other countries came in handy,” she said. For example, UNAIDS advocated to decentralize the provision of antiretroviral medicines so that people from rural areas could get their treatment at primary health-care centres without traveling to the main cities.

“It was so rewarding to be on the ground and witness the change.” According to Ms Boonto, antiretroviral medicine access shot up to more than 120 000 people accessing the medicines, up from 30 000 people in three years.

“That’s when I realized that it’s not just about money, it’s also about the willingness to change,” she said.

A year ago, she returned to Indonesia, but this time as the UNAIDS Country Director. It’s been challenging for her because despite the scale-up when she was in the country the first time, Indonesia lags behind its neighbours, such as Thailand and Myanmar, in terms of antiretroviral medicine access and reducing new HIV infections. “It ranks third after India and China in the region in terms of new HIV infections,” Ms Boonto said.

Her tactic has been to raise HIV awareness among decision-makers and stress to them that the epidemic is not under control. “We present data and push to keep HIV a priority,” she said. Recently, she has been knocking on doors to raise alarm bells about tuberculosis—a disease that remains one of the leading causes of death among people living with HIV, despite being treatable and preventable.

“It all boils down to political will and getting the autonomous country districts on board once the Ministry of Health approves,” she said. Not flinching, Ms Boonto said, “My job never lets me forget what I am working for: people living with HIV.” She added, “We are still relevant and are still much needed, and that is the greatest satisfaction of all.”

Satisfaction for Catherine Sozi has been observing the shift from, “How can we roll out treatment for so many people, to getting 21 million people on treatment in the space of 10 plus years,” she said. In her third stint in South Africa, she feels UNAIDS’ advocacy work has paid off. Recalling a conversation she had in Zambia with the government when she worked there 15 years ago, many feared that the money and support would not come if countries started to offer antiretroviral medicines. “I made the case that money would come based on the countries’ growing commitment and that we would work to get the prices down,” she said. In 2005, prices for antiretroviral medicines were high. “The governments listened to us and to civil society and, based on solid results in 2015, it suddenly looked feasible to put an end to AIDS,” Ms Sozi said.

As the Regional Director for the eastern and southern Africa region, she is thrilled by the positive energy in the region, despite the many challenges remaining. “A lot still needs to be done to stop new HIV infections, get even more people on treatment and have them stay on treatment, and that includes testing even more adolescents, children and adults for HIV, including key populations,” she said. Another big issue involves tackling rampant sexual violence, which leads in part to higher numbers of new HIV infections among girls and young women, she explained.

“In this case, a biomedical response won’t help. We need to change how we relate to households, the police and the legal system and get faith leaders, women activists, nongovernmental organizations and men involved to turn things around,” Ms Sozi said. Trained as a doctor in Uganda, she admits that her career has propelled her into a much wider arena than she had ever anticipated.

“The UNAIDS women’s leadership programme empowered me to become a leader and reassured me that I could manage a large, diverse staff as well as resources and still be technically strong,” she said.

Her four years as the UNAIDS Country Director in China, before her latest move to South Africa, proved to be very enriching on a personal and professional level. “As a family we had a wonderful time in a country that is in itself so diverse in all aspects,” she said. The commitment by the government and civil society to work on the epidemic was both invigorating and challenging.

One of her biggest accomplishments in Asia was her contribution to the China–Africa health dialogue. “For me, to support the South–South dialogue on China–Africa health cooperation meant a lot,” Ms Sozi said. “I see myself as a facilitator of change.”

MORE IN THIS SERIES

UNAIDS staff share global experience on AIDS through criss-crossing the world

It’s about the people we serve: UNAIDS staff connecting the world

Population growth and fast urbanization, fuelled by sustained immigration and accelerating mobility, are rapidly changing the socioeconomic and behavioural patterns of people in big cities.

Mumbai, a city of 12 million people, was one of the first cities to sign up to the Fast-Track cities initiative, launched in Paris on World AIDS Day 2014. Since then it has rapidly adopted measures to accelerate progress towards achieving the Fast-Track 90-90-90 treatment targets. However, the challenge today goes beyond scaling-up efforts to attain the 90-90-90 targets. Efforts to end AIDS must also focus on effective use of combination HIV prevention and eliminating the stigma and discrimination that impede universal access to health services.

The Mumbai District AIDS Control Society and UNAIDS brought together more than sixty participants from government, international and civil society organizations from 10 to11 April to identify innovative strategies to expand HIV prevention and treatment service coverage in the megacity.  

Participants noted that growing inequalities in the urban environment were forcing people to take risks to survive. Sex workers, people who inject drugs, men who have sex with men and transgender people (Hijras) who are already at higher risk of HIV infection are particularly negatively impacted by these trends.

Urban gentrification is pushing key populations out of areas where they had previously gathered making the task of delivering HIV services more complicated. As populations have become more dispersed and hidden, traditional HIV prevention outreach approaches using peer workers have become less effective.

Reflecting on these challenges, participants noted that with change came opportunity. More systematic compilation of data and granular analysis has helped identify locations and populations where risk and vulnerability are greatest. According to city officials, improved data and understanding is helping to refine their approach to HIV prevention interventions. New packages of services designed through the profiling of newly emerging risk behaviours are being planned.

To further Fast-Track the AIDS response, several new approaches have been introduced. Community-based HIV screening helps to accelerate diagnosis and treatment of people living with HIV.  Similarly, in growing slum areas mobile vans offering HIV testing services provide the opportunity to large numbers of people to know their HIV status.

While social media platforms are proving a cost-effective means to improve HIV awareness and connect people to prevention and treatment services, Mumbai authorities are convinced that more innovative communication strategies are also necessary. They plan to use social and mass communication media to mobilize support to ‘normalize’ AIDS as a chronic disease and prevent new HIV infections. HIV champions will target a range of different audiences including adolescents and young people to amplify HIV prevention messages.

All participants agreed that efforts to scale up access to HIV services need to be led at a faster pace as “there is no time to lose” to end AIDS by 2030.

Shiv Kumar, from Swasti Health Catalyst in India, decided to build a mobile and web application called Taaras (rapid progress). He had watched peer educators work with sex workers in Bangalore, India, and realized that he could make their jobs a lot simpler and more efficient. The south-east Indian city has become a major hub and, as a result, the population has boomed, as have sex workers. 

After seeing outreach workers, mostly former sex workers, lugging notebooks and jotting down information and recalling appointments and treatment pickups, he created an app that helps with data collection. “Icons and swipes allow outreach workers to enter all sorts of stuff and swipe and pick up where they left off,” Mr Kumar said. They can also text multiple recipients with reminders and invitations.

“Outreach can no longer be a one-way street. You have to engage the patient,” he said.

The app rolled out in five Indian states in English as well as four regional languages. Since its debut in March 2016, there are now more than 400 users following about 120 000 sex workers.

Bangalore outreach worker Natranity said that she has a lot less paperwork to deal with. “All the data of a particular person is now in one place, versus five or six registers that I had to consult,” she said. Her colleague, Abdul, agreed, “I see about 10 to 15 people a day and what saves me a lot of time is not asking the same questions over and over again, because I can consult their profile.”

The phones had their limits, they explained. “At the initial stage, it’s important to build trust to avoid any discomfort in case they think we are taking photos or recording them,” Natranity said. 

Prachi Patel, a technology developer at Swasti, sees Taaras as a bridge to an overall solution. “The app is a helper; outreach workers still do all the talking,” she said. A by-product of the app has been higher engagement with sex workers and an increase in reporting incidents of violence. For confidentiality, the app has a stress password that scrambles the data in the event that someone tries to access the information. 

UNAIDS Senior Adviser Philippe Lepère commends such efforts and believes e-health has a huge potential. Not only can it strengthen health systems, it also empowers people to manage their own care. Referring to the World Health Organization’s Guidelines on the use of antiretroviral drugs for treating and preventing HIV infection: recommendations for a public health approach, he said that they advocate using text messages to remind people to take their treatment and encourage newly diagnosed people to seek out services.   

For this to work, however, he stressed the importance of confidentiality and respect of the user. “Receiving an HIV-related SMS can have drastic consequences in some communities,” he explained. That's why, he said, the content and the frequency have to be ironed out beforehand. “Most importantly, it’s urgent to shift from pilot studies to a larger implementation of programmes at a sufficient scale that can then be integrated within health systems,” Mr Lepère said. 

“In certain countries, digital apps have flooded the market and the government has no way of accessing the data or doing any quality control,” he said. 

Hani Eskandar, from the International Telecommunications Union, definitely sees mobile phones as paving the way towards universal health coverage.

But, in his view, e-health systems are far from a reality. “Countries have not yet grasped the benefits of this, because they are still focused on vaccines and building hospitals rather than outreach,” he said. He is pushing for governments to rebuild infrastructures that integrate digital platforms.

“It's simple,” he said. “We need for mentalities to change at all levels and stop thinking that the phone is just a gadget.” 

A record 3000 delegates from more than 60 countries, including representatives of civil society, scientific institutions, the private sector and governments, gathered in Moscow from 18 to 20 April 2018 to participate in the Sixth Eastern Europe and Central Asia Conference on HIV/AIDS. The conference focused on four major tracks: prevention, science and treatment, civil society, and international cooperation.

Eastern Europe and central Asia is the only region where the number of new HIV infections and AIDS-related death are still on the rise. The conference provides a unique opportunity to take stock of progress and discuss the challenges and transformation needed to get the eastern Europe and central Asia region on track to end AIDS.

The keynote speakers at the opening ceremony included Michel Sidibé, UNAIDS Executive Director, Olga Golodets, Vice Prime Minster of the Russian Federation, Anna Popova, Head of Russia’s Federal Service for Consumer Protection and Human Wellbeing, Alexsey Tsoy, Deputy Minister of Health of Kazakhstan, Alexander Pankin, Deputy Minister of Foreign Affairs of Russia, Lyudmila Rastokina, a representative of the Kazakhstan’s Union of People Living with HIV, and representatives of the private sector and others.

Despite the overall increase in HIV-related deaths and infections, in the past two years the eastern Europe and central Asia region has made progress in a few areas. For example, Armenia and Belarus were validated by the World Health Organization as having eliminated mother-to-child transmission of HIV. Most countries of the region adopted the test and treat approach and the average cost of first-line antiretroviral treatment has dropped from almost US$ 2000 per person, per year to less than US$ 200 per person, per year.

A number of key challenges were highlighted at the conference, including the fact that only 3% of total HIV expenditures in the region go for programmes focused on key populations, including people who inject drugs, migrants, sex workers, transgender people, prisoners and men who have sex with men. The region also faces the triple epidemics of HIV, tuberculosis and hepatitis C virus which require an integrated approach to prevention, diagnosis and treatment.

The conference was organized by the Russian Federation’s Federal Service for Consumer Protection and Human Wellbeing and UNAIDS.

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Staff from Globo Television visited UNAIDS headquarters in Geneva, Switzerland, on their way to Cannes, France, for the 2018 Emmy Kids Awards. Globo and UNAIDS were nominated for an Emmy Kids Award in the digital category for the web series Young Hearts—I Just Want to Love, which focuses on a high school romance between a teenager living with HIV and his girlfriend. 

The series was a spin-off from Brazil’s longest running soap opera, Malhação—Seu Lugar No Mundo (Young Hearts—Your Place in the World), a production developed and broadcast by Globo. Among several teen love stories in the season, the one between Henrique and Camilla became a hit with the audience. The soap averages a daily audience of 24 million viewers, mainly pre-adolescents and their parents. UNAIDS, an official partner with Globo since 2015, gave technical advice and support to the writers of the show.

UNAIDS, Globo and Gshow produced the web spin-off, which is available on the Globo streaming platform. The five-episode web series became the third most watched original series on the platform, with almost 1 million views.

Michel Sidibé, UNAIDS Executive Director, congratulated Globo, explaining how media plays a key role in stopping HIV stigma and exclusion. He praised the Globo partnership for using edutainment to reach young people with compelling and relevant HIV information.

Emmanuel Jacobina, the writer of Young Hearts—Your Place in the World for the 2015–2016 season and the web series, said that the idea came from a conversation he had with the UNAIDS team about HIV in Brazil. It disturbed him, he said, that despite there being methods for prevention, tens of thousands of people still become infected with HIV each year in Brazil. As a result, the web series, he said, seemed the best place to push the debate further and speak bluntly about relationships, sexuality and HIV.

The Director of Corporate and Social Responsibility at Globo, Beatriz Azeredo, reiterated the company’s commitment to mobilize Brazilian society around major social issues with television series and public service announcements. Globo’s Director of Communications, Sergio Valente, noted Globo’s presence in more than 100 countries and said that it has a 99% reach in Brazilian homes.

Of the three nominees in the digital category, the award went to the Norwegian series Jenter (Young Girls), produced by NRK.

UNAIDS is working towards ensuring that 90% of young people have the skills, knowledge and capacity to protect themselves from HIV and have access to sexual and reproductive health services by 2020.

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Zambia has made good progress in its AIDS response. In 2016, the country had more than 800 000 people on HIV treatment, with 83% of pregnant women living with HIV accessing it. To better understand the progress, and the challenges, Michel Sidibé, UNAIDS Executive Director, visited the Chilenje health facility in Lusaka, Zambia, during a visit to the country from 5 to 7 March.

The Chilenje facility offers HIV treatment, a prevention of mother-to-child transmission of HIV programme and tailored services for adolescents and young people. At the facility’s youth-friendly space, peer educators facilitate service uptake by young people and reach out to schools and other groups within their community with counselling and sensitization.

“We need to build cities of the future where services are not only available to people, but they are also tailored to their needs. This is the rationale behind the Fast-Track cities initiative, of which Lusaka is an excellent example,” said Mr Sidibé during his visit.

The facility offers extended hours in the evening and weekends so that people who are unable to access health services outside of standard operating hours can access HIV treatment and other services.

“Young people often fall through the cracks of the health system for fear of judgement or stigma. Owing to the large number of adolescents and young people in our community, we have set up a youth-friendly space,” said Malinba Chiko, the Superintendent of the Chilenje health facility.

Earlier in the day, Mr Sidibé met with members of civil society, who raised the issue of access to HIV and sexual and reproductive health services for key populations, especially gay men and other men who have sex with men and sex workers. Mr Sidibé reiterated that civil society is at the heart of the AIDS response and, for it to be sustainable, the voice and decision-making of civil society are essential.