The Yuetan Community Health Centre is nestled on a narrow lane in an old residential part of central Beijing, China. Its yard is packed with bicycles, rather than cars—an indication that the centre is serving people close to where they live.

“Through our centre and nine affiliated community health stations, we provide services to 150 000 people living in the Yuetan area,” said Du Xue Ping, Director of Yuetan Community Health Centre. “In addition to providing medicine, we also undertake health promotion, encouraging people to lead a healthy life. We know that prevention is far better than cure.”

The centre blends state-of-the-art Chinese medicine and Western medicine, serving 420 000 patients annually. It supports the community’s rapidly ageing population, overseeing two senior homes and staff who conduct home visits for seniors and people with mobility problems.

The facility is part of China’s highly regarded multitiered medical system, which has successfully brought life-saving services to people across the country. In this system, major diseases are handled in large hospitals and routine services are treated in community health centres. According to Chinese data, in 2015 there were more than 34 000 similar community health clinics providing essential health services to 706 million people in China. “Community health centres are the first line of defence in protecting people’s health,” said Michel Sidibé, Executive Director of UNAIDS. “The family-centred interface and clear bond between staff and patients exemplifies people-to-people connections.”

Mr Sidibé visited the community health centre to learn more about its holistic and comprehensive approach and how China’s community health system could help to inform the 2 million community health workers initiative, which was recently endorsed by the African Union.

In the 1970s, China’s community-based doctors dramatically improved access to health care in rural communities and were an inspiration to many other countries. China exported the model, sending teams of doctors and nurses to Africa.

“I know from my own personal experience the contributions China has made to primary health care in Africa,” said Mr Sidibé. “Chinese doctors provided crucial medical services to people in Mali where I am from.”

“The world can learn a lot from the Chinese experience,” said Mr Sidibé. “I am very impressed by the professionalism I witnessed here today.”

Mexico has taken steps to strengthen access to health-care services by lesbian, gay, bisexual, transgender and intersex (LGBTI) people. A new Ministry of Health code of conduct aims to put an end to stigma and discrimination based on gender identity and sexual orientation in all health centres in the country.

Establishing guidelines and specific actions for the provision of health-care services, the code of conduct will be implemented throughout the national health system to guarantee effective access to health by respecting the dignity and autonomy of LGBTI people.

The code of conduct provides for health personnel from public health facilities to be trained in avoiding discriminatory expressions and attitudes and to respect the confidentiality of patients. Among various provisions, it clearly stipulates that so-called treatment to “cure homosexuality or transexuality” must be avoided. It establishes that health centres should maintain a policy of zero tolerance for discrimination and must investigate accusations of discrimination. Health centres should also promote ongoing sexual and reproductive health and HIV prevention campaigns focused on LGBTI people.

The code of conduct was developed through a broad participatory process that included the Coordinating Committee of the National Institutes of Health and High Specialty Hospitals, the National Center for HIV Prevention and Control, Specialized Condesa Clinic of Mexico City, the National Council for Preventing Discrimination and representatives of civil society and LGBTI organizations.

The next steps include a training process on its practical application, with the involvement of civil society and community-based organizations. The implementation will have a pilot phase and will begin in the largest cities in the country.

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On 30 June, 12 United Nations entities released an unprecedented joint statement calling for ending discrimination in health-care settings and committing to work together to support Member States to provide health-care services free from stigma and discrimination. The statement is a powerful call to action for governments to do more to address discrimination in all its different forms and will contribute to the achievement of many of the Sustainable Development Goals, ensuring that no one is left behind.

Discrimination in health-care settings is directed towards some of the most marginalized and stigmatized populations, the very populations that states promised to prioritize through the 2030 Agenda for Sustainable Development and who are all too often excluded or left behind. 

Discrimination affects both the users of health-care services and health-care workers. It serves as a barrier to accessing health services, affects the quality of health services provided and reinforces exclusion from society for both individuals and groups. 

Many individuals and groups face discrimination on the basis of their age, sex, race or ethnicity, health status, disability or vulnerability to ill health, sexual orientation or gender identity, nationality, asylum or migration status, or criminal record, often experiencing intersecting or compounding forms of discrimination.

Discrimination in health-care settings takes many forms and is often manifested when an individual or group is denied access to health-care services that are otherwise available to others. It can also occur through denial of services that are only needed by certain groups, such as women. Examples include specific individuals or groups being subjected to physical and verbal abuse or violence, involuntary treatment, breaches of confidentiality and/or denial of autonomous decision-making, such as the requirement of consent to treatment by parents, spouses or guardians, and lack of free and informed consent.

The agencies supporting the statement are the UNAIDS Secretariat, the Office of the United Nations High Commissioner for Refugees, the United Nations Children’s Fund, the World Food Programme, the United Nations Development Programme, the United Nations Population Fund, UN Women, the International Labour Organization, the United Nations Educational, Scientific and Cultural Organization, the World Health Organization, the Office of the High Commissioner for Human Rights and the International Organization for Migration.

China and Africa have come together to find new ways of improving access to health care. More than 30 Ministers of Health from across Africa joined the Vice-Premier of China Liu Yandong, and the Chinese Minister of National Health and Family Planning Commission Li Bin at the China-Africa Ministerial Conference on Health Cooperation. The event was held in Pretoria, South Africa on April 24 under the theme China-Africa Health Cooperation, From Commitments to Actions.

The Vice Premier of China talked about the long standing partnership between China and Africa in the field of health care and of China’s commitment to help build the health sector in developing countries and boost efforts for a broader future for China-Africa cooperation in health.

In his address, the UNAIDS Executive Director, Michel Sidibé, outlined three critical initiatives that need to be put in place. He said that, together with the African Union, partners should create a workforce of 2 million community health workers for Africa, learning from the Barefoot Doctors of China organization, which trains people on basic medicine to work in rural areas of China. Trilateral cooperation between China, Africa and UNAIDS should focus on disease surveillance for accelerating action to achieve Sustainable Development Goals 3. He added that UNAIDS will continue to support the scale-up of the local production of medicines and health commodities.

Following his speech, participants signed a five-point plan for China–Africa cooperation on health which focuses on improving access to health-care services through Chinese medical teams working in Africa and by strengthening public health preparedness and capacity-building, particularly through the African Centre for Disease Control. The plan also includes a special focus on key populations, women and young people and urges an increase in training opportunities for African and Chinese people. Increasing China–Africa cooperation, specifically around accelerated action for technology and local production, is also part of the plan.

During meetings with the Chinese Minister of Health, and the Uganda Minister of Health, Jane Aceng, Mr Sidibé emphasized how the China–Africa partnership can go beyond AIDS, to create sustainable solutions for social and economic development in Africa.

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The Bamrasnaradura Infectious Disease Institute in Nonthaburi is one of Thailand’s premier hospitals in AIDS treatment and care. Its waiting rooms welcome many patients. This month, people waiting for appointments will see on hospital screens stories about people living with HIV who overcame stigma thanks to support from their communities. Bamrasnaradura is one of around 1000 hospitals in Thailand that have joined the zero discrimination in health-care settings campaign.

The Ministry of Public Health of Thailand, the Thai Network of People Living with HIV/AIDS (TNP+) and UNAIDS launched the campaign on 2 March at Bamrasnaradura. 

“More than 30 years since HIV was detected in Thailand, stigma still remains a major challenge,” said Jessada Chokdamrongsuk, Director-General, Department of Disease Control, Ministry of Public Health. “Thailand is committed to ensuring health-care settings are safe and supportive environments.”

The campaign features a video with a short message from the popular Thai singer and UNAIDS National Goodwill Ambassador for Thailand, Chalatit Tantiwut, in which he encourages everyone to join the zero discrimination movement.

“Discriminating against anybody for any reason is always out of bounds,” said Mr Chalatit. “Making music is what I do best and I think it’s my duty to contribute to society and make some noise about zero discrimination.”

This initiative is part of an ongoing effort by the Ministry of Thailand to tackle stigmatizing behaviours and attitudes among staff towards people living with HIV. A survey of 1600 Thai health-care workers showed that more than 60% of workers feared an HIV infection while performing routine tasks and 90% admitted to at least one stigmatizing attitude.

The Ministry of Public Health, with support from civil society, UNAIDS and the United States Agency for International Development, has developed a comprehensive stigma reduction programme that is gradually being scaled-up to include all public hospitals.

“Thailand is showing how to tackle HIV-related stigma and discrimination in hospitals and clinics, “said Tatiana Shoumilina, UNAIDS Country Director for Thailand. “This problem is persistent and pervasive in many parts of the world. Only by overcoming this challenge will we Fast-Track the response to HIV and end the AIDS epidemic as a public health threat.”

“Zero Discrimination Day on 1 of March is now a well-recognized event both in Thailand and globally,” said Apiwat Kwangkaew of TNP+. “However, I would like to urge people to practice zero discrimination every day. Fear of HIV transmission and prejudice against people living with HIV are holding back access to treatment and care, employment and education.”

Thailand’s HIV-related stigma reduction programme for health-care workers is one of the world’s most ambitious initiatives and it has been such a success that it is being adapted and implemented in other South-East Asian countries.

After a survey in 2014 of people living with HIV found that stigma and discrimination in health-care settings was a significant issue in Viet Nam, health officials started exploring best practices and the Thai model seemed a good example.

In Ho Chi Minh City, the Viet Nam Administration for AIDS Control, with support from UNAIDS, has started pilot-testing the programme. The initiative began with a survey of three hospitals in the city, which led to a programme for health workers tailored to the Vietnamese context. A training in how to capacitate health-care workers to reduce stigmatizing attitudes and behaviours is under way in the city from the 28 February to 3 March.

“We will conduct an assessment at the end of this pilot project. I hope the lessons learned from this pilot will help further improve the methodology of measuring HIV-related discrimination in health-care settings and programme approaches, so we can expand the practice nationwide,” said Hoang Dinh Canh, Vice-Director, Viet Nam Administration for AIDS Control.

The Lao People’s Democratic Republic is also adapting Thailand’s initiative and Myanmar has expressed an interest in a similar approach. Discrimination is a barrier to accessing health services for people living with HIV globally, which is why UNAIDS dedicated this year’s Zero Discrimination Day on 1 March to elimination discrimination in health-care settings.

GENEVA, 4 February 2017—On World Cancer Day, UNAIDS is calling for all women living with HIV to have access to information about the human papillomavirus (HPV) and to be offered cervical cancer screening and treatment if necessary.

Cervical cancer is preventable and, if caught early, treatable. However, around half of the estimated 500 000 women who are diagnosed with cervical cancer every year die from the disease. Nine out of 10 women who die from cervical cancer live in low- and middle-income countries. It is projected that this number could double by 2035 if cervical cancer prevention, screening and treatment efforts are not urgently scaled up.

Cervical cancer is the second most common cancer among women living in low- and middle-income countries, and women living with HIV are particularly affected. Women living with HIV are up to five times more likely to develop cervical cancer than women who do not have the virus, highlighting the importance of urgent access to cervical cancer screening, and treatment when needed, for all women living with HIV.

Most cervical cancer is caused by HPV. Women with healthy immune systems are likely to clear an HPV infection over time. However, women living with HIV have compromised immune systems and are far less likely to be able to clear an HPV infection. HPV infection has also been found to significantly increase the risk of HIV transmission for both men and women.

To effectively reduce deaths from cervical cancer, investments need to be made in health education, HPV vaccination for adolescent girls, screening, together with counselling and information, and access to treatment and care when needed. 

The relationship between HPV and HIV offers significant opportunities to reduce the impact of both viruses as existing HIV programmes could play a vital role in expanding cervical cancer prevention, screening and treatment services.

The United Nations Joint Global Programme on Cervical Cancer Prevention and Control and the Pink Ribbon Red Ribbon partnership are examples of successful alliances. Synergies must be leveraged further with a focused and integrated approach to saving women’s lives.

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.