Comoros

ANTANANARIVO/GENEVA, 27 March 2024—Despite progress across most of sub-Saharan Africa, UNAIDS warns that gaps in HIV prevention are driving new HIV infections in the Indian Ocean Countries (IOC) and several other countries in Africa. The critical gaps in HIV prevention were the focus of a workshop organized by UNAIDS and UNFPA which was hosted in Madagascar between 18 and 20 March to address some of the barriers to accelerating progress.

Insufficient focus on HIV prevention in a number of African countries including Egypt, Madagascar, Angola, Sudan and South Sudan has resulted in these countries not achieving the proportionate declines in new infections seen in the rest of the region.

For example, the increase in the number of new infections in a country like Madagascar for example, is in stark contrast to the downward trend in Botswana which has seen a 66% decline in new HIV infections since 2010 and 36% decline in AIDS-related deaths during the same period.  As a result, Botswana—along with Eswatini, Rwanda and Zimbabwe— are on the path to end AIDS having achieved the global 95-95-95 targets through strong HIV prevention and treatment interventions.

Madagascar, one of the poorest countries in the region, has been hit by cyclical natural disasters including drought and cyclones, making it difficult for the country to recover and mount an effective response to HIV. Madagascar recorded a 151% increase in the number of new HIV infections since 2010, and a 279% increase in AIDS-related deaths during the same period. In addition, just 18% of the estimated 70 000 people living with HIV in Madagascar had access to treatment in 2022, and 3200 people died of AIDS-related illnesses. Sudan and South Sudan are also falling behind on HIV prevention and treatment efforts. Inequalities are exacerbating people’s vulnerability to HIV.

“Local research indicates increases in new HIV infections among key populations, including people who use drugs, and among young women and girls. This could be attributable to many factors including drug routes, recurring cyclones and deep poverty in some areas that is making people more vulnerable to HIV infections,” said Professor Zely Randriamanantany, Madagascar’s Minister of Public Health. “We need our international partners to invest with us before it's too late. This prevention focus is very welcome indeed."

“It is clear from our visits to communities and from speaking to health specialists in Madagascar, that the HIV epidemic is changing. The persistent rise in new infections in Madagascar since 2010, for example, shows that it could spread rapidly if we do not stop it in its tracks immediately,” said Anne Githuku-Shongwe, UNAIDS Regional Director for Eastern and Southern Africa. “We know the path that ends AIDS. It’s not a miracle. It requires strong political and financial support.”

Gaps identified in some countries include a lack of data that would point to where HIV prevention efforts need to focus. Data gathering interventions are key to implementing evidence-informed and effective programmes. Some countries are also lacking commodities, including HIV testing kits and condoms.

“Inadequate investment in HIV responses is holding back ending AIDS as a public health threat,” said Jude Padayachy, UNAIDS Country Director for Comoros, Madagascar, Mauritius and Seychelles. “We need to accelerate the HIV response in the Indian Ocean Island states by ensuring all the basics—making sure people are informed about HIV and how to prevent it, and making sure people have access to HIV prevention services and commodities, such as condoms. We also need to make sure that people who are HIV-positive know their status and get the treatment they need.”

UNAIDS is committed to support countries to accelerate political leadership, investments and better data for prevention.

The meeting in Madagascar brought together HIV experts and programme leaders from a number of countries across Africa to learn from each other and to review and strengthen their national plans on HIV prevention to support countries in scaling up their HIV responses. The meeting included teams from Comoros, Egypt, Madagascar, Rwanda, Sudan and South Sudan.

Participants explored ways to improve data collection to help develop more of an understanding of the dynamics of their HIV epidemics to ensure an effective, evidence-informed, human rights-based response. They also drafted national assessments which will serve as a guide to facilitate dialogues with communities, governments, and partners. This will aid in refining strategies and setting priorities to implement ambitious HIV prevention plans. UNAIDS will continue to support countries in their internal assessments to strengthen their HIV responses.

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.

Oral pre-exposure HIV prophylaxis (PrEP) has been shown to be up to 90% effective in preventing HIV infection among people who take it consistently. However, the United States of America is the only country in which PrEP is licensed and recommended for use within HIV prevention programmes. 

In order to find ways to bridge the gaps between evidence and policy-making processes, UNAIDS, AVAC and WHO organized a meeting during the 2014 HIV Research for Prevention (HIV R4P) conference, which is taking place from 28 to 31 October in Cape Town, South Africa. HIV R4P is the world’s first scientific meeting dedicated exclusively to biomedical HIV prevention research.

Participants

The meeting brought together representatives of ministries of health and national AIDS councils from Kenya, Mozambique, South Africa, Uganda and Zimbabwe, PrEP researchers and participants from research and demonstration sites where PrEP is currently being delivered, funders and drug manufacturers, and HIV activists.

Key messages

• PrEP is being used in several demonstration projects across eastern and southern Africa, covering a wide range of populations, including serodiscordant couples in Kenya and Uganda, sex workers in Zimbabwe and men who have sex with men in Kenya and South Africa.
• In order to be used more widely, PrEP must be part of a comprehensive prevention strategy with associated milestones and success indicators that have been defined with policy-makers. The Kenyan Prevention Roadmap already includes the possibility of PrEP.
• Costs and cost-effectiveness models remain key, as are the selection of populations for which PrEP should be offered and the choice of an appropriate delivery model. The Sisters clinics, which provide a dedicated service for sex workers in Zimbabwe, are acceptable to many sex workers and fit within a government strategy.
• The early stopping of the PROUD PrEP study demonstrates that within the sexual health services of the United Kingdom of Great Britain and Northern Ireland there is a strong demand for PrEP and that it is feasible to identify people at greatest risk.
• Demand is now beginning to grow in African communities and needs to be stimulated among those who would most benefit and would be most likely to use PrEP.
• Policy-makers in health and other government departments need more information on PrEP presented in a way that they can use, as well as opportunities to discuss their specific concerns, for example on PrEP safety studies or measures to improve adherence.
• More needs to be understood about the costing of PrEP. This demands greater understanding of who would use PrEP, how they would use it and where they would access it.

Two of the major networks of people living with HIV in the Indian Ocean region have merged. The decision, which is aimed at strengthening civil society participation in the AIDS response in the Indian Ocean islands, was announced during the 13th Indian Ocean Colloquium on HIV and Hepatitis, which concluded on 10 October in Saint-Gilles-les-Bains, Réunion.

Ravane+, which means uniting people living with HIV, and Femmes Positives Océan Indien will work together under a single network—Ravane Océan Indien—in advocating for the rights of people living with HIV and those most vulnerable to HIV infection. The network will focus on advocating for equitable health care and public services for people living with HIV and creating an enabling policy and legal environment for populations at higher risk of HIV infection, including men who have sex with men, sex workers and people who inject drugs.

The newly appointed President of Ravane Océan Indien, Ronny Arnephy, stressed that although each island has specific challenges in the HIV epidemic, having a common goal will bring greater opportunities for stronger advocacy and representation from civil society.

For the past 12 months, the two networks—with technical and financial support from UNAIDS and other partners—have been working together in refining the details of the merger, including defining the vision, operational modalities and workplan for 2015. 

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

Law confirms no restrictions on entry, stay or residence and guarantees access to treatment for all.

GENEVA, 24 July 2014—UNAIDS welcomes new HIV legislation in the Comoros that protects people living with HIV from all forms of discrimination and reinforces an enabling legal environment for prevention, treatment, care and support programmes.

The new law, which came into force in June 2014, explicitly protects the free movement of people living with HIV and prohibits any restriction on entry, stay or residence based on HIV status.

Among other provisions, the law guarantees that HIV treatment is available to nationals and non-nationals living with HIV. It also ensures that people in prisons and other closed settings have access to HIV prevention and treatment services. Mandatory HIV testing as a condition of employment and termination of employment because of a person’s HIV status are prohibited.

“More countries need to follow the bold and inclusive example of the Comoros, ensuring that no one is denied opportunities because of their HIV status,” said Michel Sidibé, Executive Director of UNAIDS. “Comprehensive HIV prevention and treatment programmes, underpinned by an enabling legal environment, will help make it possible to end the epidemic by 2030,” he added.

With the recent clarification received from the Government of the Comoros, UNAIDS counts 38 countries, territories and areas that still have HIV-related restrictions on entry, stay and residence.

UNAIDS Executive Director Michel Sidibé recently visited a centre in Moroni that primarily provides antenatal care for pregnant women and prevention of mother-to-child transmission of HIV. It is run by the Association comorienne pour le bien-être familial (ASCOBEF), a nongovernmental organization.

At the centre, women have access to health services early in pregnancy and are offered an HIV test so that, if they need it, they can get treatment for themselves and appropriate postnatal care for their infants. The work ASCOBEF does at the centre highlights the critical role that civil society plays in supporting the Government of the Comoros in its response to HIV.

During his visit, Mr Sidibé had the opportunity to meet with members of civil society whose organizations conduct HIV counselling and testing, awareness-raising and community mobilization. They discussed their activities and the challenges they face in providing comprehensive care for people living with HIV, including the limited support they get from other sectors.

“We must not tolerate the shrinking of a democratic space of nongovernmental actors. The role of civil society is essential,” said Mr Sidibé.

Mr Sidibé reiterated the important role of civil society in advocating a human rights approach, especially in the context of the post-2015 development agenda and the rights and gender action that is needed to ensure that no one is left behind.

UNAIDS Executive Director Michel Sidibé congratulated the President of the Comoros, Ikililou Dhoinine, on the leadership he has shown in the AIDS response and on a new law his country recently adopted that further protects people living with HIV. Their meeting took place in Moroni on 24 July 2014.

President Dhoinine highlighted that the new law confirms that there are no restrictions on entry, stay or residence for people living with HIV and guarantees access to antiretroviral treatment for all, showing his and his country’s commitment to strengthening the protection of people living with HIV.

President Dhoinine and Mr Sidibé also discussed the role that the Comoros can play in the regional HIV response as a State member of the Indian Ocean Commission. Mr Sidibé encouraged President Dhoinine to advocate national ownership, regional solidarity and increased domestic investment to sustain the AIDS response.

During his three-day visit to the country, Mr Sidibé met with the Vice-President, the President of the National Assembly and the First Lady. Mr. Sidibé also visited a prenatal care centre and met with civil society representatives.