A new publication by UNAIDS and the World Health Organization (WHO) emphasizes the importance of integrating HIV and mental health services and other interventions, including linkages to social protection services, for people living with HIV and other vulnerable populations.

Mental health conditions increase the risk of HIV infection, and people living with HIV have an increased risk of mental health conditions, which are associated with lower retention in HIV care, increased risk behaviours and lower engagement with HIV prevention.

Furthermore, despite an increasing body of evidence showing that effective methods of prevention, screening and diagnosis of, and treatments for, common mental health conditions, including depression and anxiety, exist and can be implemented in low- and middle-income countries, services for mental health, neurological and substance use conditions are often not integrated into packages of essential services and care, including for HIV.

“We know that integration of screening, diagnosis, treatment and care for mental health conditions and psychosocial support with HIV services does not need to be expensive,” said Eamonn Murphy, UNAIDS Deputy Executive Director, a.i., Programme. “The integrated approaches that are people-centred and local context-specific ensure better HIV and overall health outcomes, well-being and quality of life.”

The publication is primarily intended for national and local policy-makers, global, regional, country and local programme implementers, organizations working in and providers of health, HIV, mental health and other relevant services, civil society and community-based and community-led organizations and advocates.

Although focus is on the integration of mental health with HIV services and other interventions, the considerations in the publication may be relevant to other services, including for HIV comorbidities such as tuberculosis, viral hepatitis and sexually transmitted infections.

“Our publication successfully brings together tools, best practices, case studies and guidelines that can help countries and facilitate the integration of interventions and services to address the interlinked public health challenges of mental health and HIV, all while improving access to care for persons who are the most vulnerable, such as adolescents and key populations,” said Meg Doherty, Director, Global HIV, Hepatitis and Sexually Transmitted Infections Programmes, WHO.

“With this joint UNAIDS/WHO publication, we hope we can collectively support countries, service providers and other practitioners, policy-makers, programme implementers and communities in their efforts to address HIV, mental health, neurological and substance use conditions for affected individuals in an integrated and impactful way,”  said Devora Kestel, Director, Mental Health and Substance Use, WHO.

Integration of mental health and psychosocial support with HIV services and interventions, including those led by communities, is one of the key priority actions included in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030. Both documents call for addressing the interlinked issues of HIV and mental health through integrated services by investing in robust, resilient, equitable and publicly funded systems for health and social protection, by reversing health and social inequalities and by ending stigma and discrimination.

The new publication stresses that the AIDS epidemic cannot end without addressing the mental health of people living with, at risk of or affected by HIV, ensuring equitable access to HIV services for people with mental health issues and conditions and achieving universal health coverage.

“Young people here don’t regularly access HIV services. I really want to invite my friends to get tested, but they are all so afraid. They don’t have enough information or support from their families and are scared about finding out their status,” said Andika Bayu Aji, a young person from West Papua, Indonesia.

The HIV epidemic among young people in Asia and the Pacific has largely been overlooked, even though about a quarter of new HIV infections in the region are among people aged 15–24 years. The vast majority of young people affected by HIV in the region are members of vulnerable populations—people living with HIV, gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs.

Like many countries in the region, Indonesia’s HIV infections among young people, which make up almost half of new infections, are attributed to stigma and discrimination, poor educational awareness of HIV, lack of youth-friendly services and social taboos.

“Young people far too often experience stigma and discrimination in health-care settings. Health-care workers are first-line responders. If the services are bad, young people won’t use them and they will tell other young people not to use them. We are limited by which clinics we can access because many, if not most, are not youth-friendly,” said Sepi Maulana Ardiansyah, who is known as Davi and is the National Coordinator for Inti Muda, the national network of young key populations in Indonesia.

A recent study conducted by Inti Muda and the University of Padjajaran found that the willingness of young people to access services in provinces like West Papua was very low, mainly due to the lack of youth-friendly services and the poor understanding of key population issues by health-care workers. Young people often face difficulty accessing services because of the remoteness of clinics and hospitals and encounter barriers such as the age of consent for testing.

Stigma and discrimination, and especially discrimination from health-care providers, discourages many young key populations from accessing HIV services. Concerns about privacy and confidentiality are some of the main challenges. Additional obstacles include that the opening hours of public clinics are often ill-suited to people’s daily routines, and the assumptions and attitudes of health-care workers can be judgemental, especially on issues around sexual orientation, gender identity and mental health.

Between 14 and 18 March, Inti Muda, with technical support from Youth LEAD and UNAIDS, organized a sensitization training of health-care workers in two cities, Sentani and Jayapura, in the West Papua region. More than 50 health-care workers participated. A few days before the training, Inti Muda organized a festival for more than 80 young people, joining in an effort to engage young people in the HIV response and generate demand for access to HIV services.

“Prior to this training, I didn’t know about the different needs of key populations, which hinders our ability to reach them. We learned about important techniques for reaching young people, such as providing youth-friendly counselling, digital interventions and encouraging them to get tested,” said Kristanti, from the District Health Office of Jayapura.

“I learned that the needs of young people are diverse. The training will allow us to improve our services to become youth-friendly, which is now our main priority,” added Hilda Rumboy, a midwife in charge of the HIV Services Department at the Waibhu Primary Health Centre.

The training and festival were supported by the Australian Department of Foreign Affairs and Trade (DFAT). The recent investment of AU$ 9.65 million set aside by the Australian Government from the sixth replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), including DFAT funding of AU$ 2 million previously committed to UNAIDS, is aimed at reducing the annual number of new HIV infections among key populations in Cambodia, Indonesia, Papua New Guinea and the Philippines.

“Ensuring young people and vulnerable groups have access to accurate, digestible information about how to prevent HIV, and that testing facilities are cheap and accessible, is crucial to ending the AIDS epidemic. We are proud to work with local communities and UNAIDS to increase availability of information on HIV, improve the reach and quality of medical services and encourage young people and vulnerable groups to get tested,” said Simon Ernst, Acting Minister Counsellor for Governance and Human Development at the Australian Embassy in Indonesia.

The training is based on the manual developed by Youth LEAD in 2021, which was financially supported by the Global Fund’s Sustainability of HIV Services for Key Populations in Asia Programme and the UNAIDS Regional Support Team for Asia and the Pacific. Under the DFAT grant for the next two years, Youth LEAD will expand the training to two more countries, Cambodia and the Philippines, supporting networks led by young people in the respective countries to roll out the training.

“Young people still encounter many challenges that prevent them from accessing the life-saving health care they need. The UNAIDS Country Office for Indonesia is working closely with the UNAIDS regional support team and DFAT to ensure that networks led by young people have the capacity and leadership capabilities to take control of the HIV response and to have direct involvement in creating safe spaces where young people can access HIV services free from stigma and discrimination,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

GENEVA, 19 January 2022—The Schwab Foundation for Social Entrepreneurship has announced that the Director of Innovation at UNAIDS, Pradeep Kakkattil, has been awarded a 2022 Social Innovators of the Year award. Mr Kakkattil received the prestigious award for his work in creating the Health Innovation Exchange (HIEx), a platform that links innovators, governments and investors and finds solutions to global health-care problems, from COVID-19 diagnosis to the cost of medicines.

“Today, one in every two people around the world don’t have access to basic health care, which is why social innovations and technologies are so critical to scale up services and address the ever-widening inequalities in access to health care,” said Mr Kakkattil.

During the COVID-19 pandemic, innovators and communities have demonstrated the potential of human ingenuity in responding to health challenges. By bringing health system actors to work closely with innovators and communities, HIEx has been able to fast-track the adoption of innovations and facilitate investments for scaling up innovations that particularly address the needs of the most vulnerable.

“HIV and COVID-19 have shown the price the world has to pay if we ignore investing in resilient health systems,” added Mr Kakkattil. “HIEx contributes to build trust between the public and private sectors to help identify challenges and rapidly implement proven technologies and innovations to maximize health impact.”

The announcement was made on the second day of the World Economic Forum’s Davos Agenda 2022, a virtual forum bringing global leaders together to focus on shaping solutions to the world’s most pressing challenges. Mr Kakkattil was among 15 Social Innovators of the Year awardees, who included a Brazilian entrepreneur using hip-hop to turn favela youth away from crime, a Dutch nurse revolutionizing home health care and a park ranger turned tech founder using Minecraft to revive Australia’s indigenous culture.

“The Social Innovators of the Year 2022 represent a new ecosystem of leaders who are driving change and shifting organizations and systems towards a more just, inclusive, sustainable future,” said Hilde Schwab, co-founder and Chairperson of the Schwab Foundation for Social Entrepreneurship.

The foundation was created in 1998 by Klaus and Hilde Schwab to support a new model for social change, combining the values of mission, compassion and dedication with the best business principles to serve the most disadvantaged and build a better society. For the past 20 years, the foundation has supported the world’s leading social entrepreneurs in their efforts to create a more just, equitable and sustainable world.

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.

Statement by Winnie Byanyima, Executive Director of UNAIDS, on the occasion of Universal Health Coverage Day

12 December 2021
Winnie Byanyima
Executive Director of UNAIDS
Under-Secretary-General of the United Nations

As we commemorate Universal Health Coverage Day 2021, the world is entering year three of the COVID-19 pandemic. The pandemic has reminded us that no one is safe until everyone is safe. It shows how pandemics expose intersecting inequalities among people, countries and communities.

Universal health coverage means that all individuals and communities can access the health services they need without suffering financial hardship. But with at least half the world’s population lacking access to essential health services even before the COVID-19 pandemic, there is much work to do.

We must urgently focus on three things:

• First, addressing the inequalities that prevent us from achieving universal health coverage and from ending AIDS.
  • We need people-centred data systems that highlight inequalities and prioritize work to address them.
  • We must put human rights at the centre. The Political Declaration of the United Nations High-Level Meeting on Universal Health Coverage in 2019 called on countries to “reach the furthest behind first”.
• Second, strengthening support to community-based and community-led responses.
  • Four decades of the AIDS response have demonstrated that such support is a crucial pillar for effective pandemic responses.
  • Community engagement should be an integral part of health systems.
• Third, bolstering investment in health, sustainable and innovative financing, and ambitious thresholds for financial commitments.
  • The Abuja Declaration, signed by African governments, to spend 15% of revenues on health is such an example.
  • To achieve universal health coverage and pandemic control, we need a paradigm shift in global health financing and investments in community-led, human rights-based, people-centred and gender transformative responses.

On this Universal Health Coverage Day, I call for support and urgent action to ensure health and rights for all.

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.

Representatives of ministries of health of the Commonwealth of Independent States (CIS) countries, health-care experts and representatives of UNAIDS and the World Health Organization (WHO) convened to discuss the priorities of CIS countries in addressing new pandemic challenges and other health-care issues in Minsk, Belarus, at the 34th meeting of the Council for Health Cooperation of the CIS. 

A memorandum on deepening cooperation between the Council for Health Cooperation of the CIS and the WHO European Office was signed during the meeting. “We are stronger when we are united. A global problem such as the COVID-19 pandemic cannot be solved by national measures only,” said Hans Kluge, the WHO Regional Director for Europe.

Igor Petrishenko, the Deputy Prime Minister of Belarus, noted the importance of joint operational decision-making, “so that there is consistency in the CIS on eliminating and counteracting the spread of COVID-19, as well as continuing vaccination and implementation of the Travelling without COVID-19 app within the CIS.”

The Minister of Health of the Russian Federation, Mikhail Murashko, noted that countering infectious diseases requires ensuring that health systems are stress-resistant. “They must quickly adapt to new challenges,” he stressed.

Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia, presented the new priorities for the HIV response in the region outlined in the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the new United Nations Political Declaration on AIDS, taking into account the COVID-19 pandemic.

He outlined the directions in the new strategy, on which there is consensus among all the CIS countries, among them: achieving the 95–95–95 targets by 2025, ending inequalities in access to HIV services and health technologies, the active engagement of civil society and community organizations and ensuring the financial sustainability of the HIV response.

Mr Goliusov thanked the Russian Federation, which since 2013 has been providing financial assistance in strengthening health systems and counteracting HIV and other infectious diseases in five countries of the region, Armenia, Belarus, Kyrgyzstan, Tajikistan and Uzbekistan, having allocated more than US$ 49.5 million in financial assistance.

The participants decided to prepare and send to the Government of the Russian Federation a letter recognizing the efforts made under the framework of the regional programme of technical assistance in combating infectious diseases, including HIV, hepatitis and sexually transmitted infections, as highly effective, noting that they had directly reduced the HIV burden in the region, and requesting the Government of the Russian Federation to consider the continuation of the programme in 2022–2025.

UNAIDS also supported proposals from representatives of the Russian delegation on research on mental health and HIV and on oncological pathology among people living with HIV on antiretroviral therapy.

The CIS is a regional intergovernmental organization that was formed following the dissolution of the Soviet Union in 1991. It encourages cooperation in economic, political and military affairs and has certain powers relating to the coordination of trade, finance, law-making and security. The Council for Health Cooperation of the CIS consists of ministers of health and chief state sanitary doctors of the CIS member states. The council maintains relations with WHO, UNAIDS, the World Health Assembly and the United Nations Children’s Fund.

Many factors in society, including poverty, stigma, discrimination and persistent gender and socioeconomic inequalities, influence the health of individuals and communities, the participants heard at a side event at the United Nations High-Level Meeting on AIDS, being held in New York and online from 8 to 10 June.

At the event, Strengthening national social protection systems to adequately include people living with, at risk of, or affected by HIV to fast-track ending AIDS, speakers pointed out that it is at the intersections of multiple inequalities that the most vulnerable people lie. Compounding vulnerabilities hit the most marginalized and left behind people, and COVID-19 has brought those inequalities to the forefront.

The event highlighted promising country experiences. It showcased innovative approaches in enhancing access to social protection by people living with, at risk of and affected by HIV and brought together high-level representatives of governments, civil society, donors and academia to accelerate joint programming of HIV and social protection programmes to respond to COVID-19 and end AIDS by 2030.

The new global AIDS strategy aims to reduce the inequalities that drive the AIDS epidemic and acknowledges social protection’s central role in that. Social protection has the power to address the social and economic drivers of the HIV epidemic and to break down the barriers that people face in accessing HIV services. Social protection comprises public and private action to reduce risk, poverty and inequality, such as social safety nets, social security and labour market policies. It includes education, nutrition, housing, health and other social services.

Quotes

The Gboklè/Nawa/San Pedro region is the second largest economic hub in Côte d’Ivoire and one of the regions most affected by the HIV epidemic. The region attracts many workers because of its important economic and industrial activities, mainly related to the port and agriculture, as well as sex workers and other members of key populations.

A joint United Nations Development Programme (UNDP)/UNAIDS mission to the region from 16 to 20 April learned about the realities of the HIV response in the region in the context of COVID-19 and assessed how the response takes into account the needs of the most vulnerable.

The mission first paid a courtesy call on the region’s administrative and health authorities, and then quickly focused on the sites where services are offered to people living with HIV and key populations. In the health-care facilities visited, whether at the Regional Hospital of San Pedro, above, or at the health centre of APROSAM (Association pour la Promotion de la Santé de la Femme, de la Mère et de l’Enfant) nongovernmental organization, the mission team saw the commitment and determination of the health-care teams and the administrations of the facilities. “We have set up a quality assurance team within the hospital to guarantee services centred on the needs of each patient,” said Alexandre Kissiedou, the Director of the Regional Hospital of San Pedro.

The visit to APROSAM was one of the most captivating moments of the mission. During the visit, the mission team had in-depth discussions with representatives of a dozen associations, who had come to APROSAM’s headquarters to meet the mission delegation. Useful discussions took place with representatives of associations of people living with HIV and associations representing key populations, as well as with representatives of nongovernmental organizations working with young people.

“It is the first time that civil society is honoured with the visit of the country representatives of two United Nations agencies,” said Odette Koffi, the Executive Director of APROSAM, an association involved in the response to HIV, tuberculosis and malaria in the region. She also noted that civil society is truly committed to the HIV response but lacks the means to meet the needs of all.

“Income-generating activities are no longer working as they used to. Today we can’t even feed ourselves properly and we can’t take antiretroviral medicines on an empty stomach,” said Maya Rose Nean, the head of the local CERBAS association for women living with HIV, when describing how COVID-19 had impacted women living with HIV in the country.

Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire, speaking on behalf of the delegation, underlined the vital work of nongovernmental organizations in the HIV response and praised the commitment of civil society organizations, people living with HIV and key populations. She said that a dialogue between UNDP and UNAIDS will address some of the pressing needs discussed with civil society. A donation of 400 food and hygiene kits was made by UNDP and UNAIDS to vulnerable people living with HIV and key populations.

The last day of the mission focused on human rights, with a visit to the Elan d’Amour reception centre, above, which offers temporary accommodation to people living with HIV and people who are victims of stigma, discrimination and gender-based violence, including people who come from remote areas for care and/or to collect their antiretroviral therapy. The delegation then visited a legal clinic supported by UNDP. These visits allowed the delegation to get a good understanding of the realities of human rights in the region, but also to understand their implications for specific HIV-related vulnerabilities. As a result of these two visits, the two agencies agreed to consider a joint project to better address HIV and human rights issues in the region.

For both teams, this mission was a success. The various needs identified will be the subject of concerted action either between UNDP and UNAIDS or by working with other Cosponsors that can provide relevant solutions.

Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire, above left, met with the Prefect of the San Pedro department. 

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.

On 1 March, people around the world join together to celebrate Zero Discrimination Day, which this year highlighted the urgent need to take action to end inequalities.

In recent years, the Central African Republic has made the reduction of health inequalities a national priority. In mid-2019, 10 priority areas towards universal health coverage were established. These include the objective of ensuring that every citizen in the country has access to a health centre within 5 km of his or her home.

The country was the first to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, which through harnessing the combined power of, and using the unique skills of, governments, civil society and the United Nations aims to consign HIV-related stigma and discrimination to history.

To mark Zero Discrimination Day this year, the country organized several activities ahead of and during the day. A declaration recalling the government’s commitment to non-discrimination and equality was issued by the Minister of Health and Population on television and radio. “It is only by addressing inequalities that we can achieve the Sustainable Development Goals, including those related to well-being and health for all,” said Pierre Somse, the Minister of Health and Population.

Recent studies show that inequality and stigma are major obstacles to access to health services. For example, more than 80% of people living with HIV in the country report having experienced discrimination or stigma. “These challenges are further compounded by conflicts and attacks on populations and health personnel that deprive hundreds of thousands of our citizens of their rights, including the right to life, dignity and health,” Mr Somse added.

A civil society consultation was organized to flesh out the priorities for the elimination of stigma and discrimination in the country. A round-table meeting was also held on a national network of human rights journalists radio programme to raise awareness on the negative impact of stigma and discrimination as a major barrier to people taking up HIV prevention, treatment, care and support services. Speaking on the programme, Aminata Adoum, of the National Association of Women Lawyers, highlighted the work of her organization in supporting women living with HIV against discrimination and violence.

On Zero Discrimination Day 2020, health professionals, including professional organizations of doctors, nurses and midwives, as well as patients’ associations, signed a National Charter for Quality of Care and Patients’ Rights that sets the principles of humanism, ethics and respect for dignity to guide relations between patients and health-care providers. This year, the patients’ charter was posted in health facilities in the capital city, Bangui, and dedicated sensitization sessions on the charter took place for medical staff in two major health-care centres in the capital.

“This Zero Discrimination Day campaign is part of a comprehensive set of priority activities to address human rights barriers to HIV services that the country will be implementing over the next three years, including community-led monitoring of human rights violations, know your rights education, legal services, the development of anti-discrimination law and engagement with community leaders, legislators and opinion-makers,” said Patrick Eba, the UNAIDS Country Director for the Central African Republic.