Since the start of the COVID-19 pandemic, Marcela Alcina, of the Latin American and the Caribbean Movement of Positive Women (MLCM+), has received more than 20 calls a day asking for help, either for food, medicine or advice on how to cope with the lockdown.

Yesenia Rodriguez (not her real name) made one of those calls. A Colombian by birth, she lived for more than 24 years in the Bolivarian Republic of Venezuela, but owing to the humanitarian crisis in that country, she had to return to Cali, Colombia, six months ago to access her treatment for HIV.

“There’s eight of us: my four children, my husband, my two grandchildren and me,” she said.

Ms Rodriguez does not have a job and needs help to feed her family and to access antiretroviral medicine. “I came back to Cali only to find myself living another crisis. My biggest concern is to get my antiretroviral medicines, but I don’t have access to health care in Colombia,” she said. “It’s been extremely tough for me and my partner, since we’re both living with HIV. My children and my husband are unemployed. Kids can’t put up with hunger the way we grown-ups do.”

Ms Rodriguez was put in contact with Yani Valencia of the Lila Mujeres Organization, part of the MLCM+ network. She was given a food package for her and her family, and she is being put in contact with someone who is able to ensure that she can access antiretroviral therapy. “I was about to pass out when they brought me these groceries, I was extremely happy.”

UNAIDS is recommending that, especially during the COVID-19 pandemic, people living with HIV keep necessary medical supplies on hand. The World Health Organization HIV treatment guidelines now recommend multimonth dispensing of three months or more of HIV medicines for most people at routine visits. However, according to a recent survey carried out by UNAIDS in Latin America and the Caribbean on the community needs of people living with HIV in the context of the COVID-19 pandemic, only one in 10 people reported having a three-month supply of antiretroviral therapy.

“We have met people who have no access to health care. A colleague of ours in Colombia borrowed a neighbour’s motorcycle to distribute medicines. We notice communities are overlooked quite often, but we must be a part of the answer. We couldn’t wait any longer, we had to do something,” said Ms Alcina.

Communities have played and continue to play a fundamental role in the AIDS response at the local, national and international levels. And now communities are playing a major role in the fight against COVID-19. MLCM+ has developed a network of 850 volunteers working in 17 countries in the region whose aim is to spread solidarity during the COVID-19 pandemic, keeping the focus on people living with HIV.

“We are distributing food and cleaning products, we are making masks that will later be distributed along with antiretroviral therapy, we are teaching people some prevention methods, we are giving condoms away and helping people find shelter in domestic violence situations,” said Ms Alcina.

MLCM+ is working across the region with UNAIDS, UN Women, the United Nations Population Fund and the United Nations Educational, Scientific and Cultural Organization, all of which are offering technical or financial support.

“UNAIDS provides us with resources, specialists and training webinars. The United Nations Educational, Scientific and Cultural Organization, on the other hand, helps us financially. That way, we are putting together a mechanism that intends to support the government’s actions, not replace them,” said Ms Alcina.

“We see how inequalities have become more evident during the COVID-19 pandemic. Inequality, and especially gender inequality, is exacerbated in times of crisis. Women living with HIV must be in the centre of the responses to both HIV and COVID-19, and must not be left behind,” said César Núñez, Director of the UNAIDS Regional Support Team for Latin America and the Caribbean.

Daniela de Barros, a Finance Assistant in the UNAIDS Country Office in Brazil, is also a UNAIDS Gender Focal Point for Latin America and the Caribbean.

She traces her interest and motivation to helping others and promoting equality back to a good deed in her childhood. “It was one of those dream-come-true situations. When my sister and I were younger, my parents couldn’t afford to pay for ballet classes. But their best friend’s sister ran a ballet studio and, one day, she invited us to start taking classes free of charge. From that point on, I never stopped dancing.” Ms de Barros says that dance has taught her to be disciplined, organized, focused and connected “body and soul” to her life and work.

“Besides all these important skills that I use all the time as a professional and as a mother of adolescent twins, I have also taken another important lesson from my ballet classes: I have learned how to connect with myself and meet my potential and my inner power,” she said. “Isn’t this what we want from such an important initiative like the UNAIDS Gender Action Plan? Empowerment and transformation for all women inside and outside this organization?”

From her role overseeing financial, administrative and operational aspects of the UNAIDS Country Office, Ms de Barros has seen that change management is crucial for maintaining staff motivation. “Although change generates some insecurity, in the end it can be a breath of fresh air. I have learned to recognize that change is important for organizations.”

Ms de Barros believes it is time that women were encouraged to be confident about achieving their goals. “The Gender Action Plan we have inside UNAIDS not only reinforces our self-confidence and courage, it also inspires men to support the women they work with,” she said.

Ms de Barros is sure that “UNAIDS chose her,” rather than the other way around. “I studied international relations and always wanted to work for the United Nations, but I confess I had never heard of UNAIDS until a friend of mine told me I should apply for the position,” she said. “I have grown a lot and learned so much from UNAIDS.”

She says that turning 40 years old has come with some significant changes for her and she now wants to engage in projects that can transform lives. For more than six months she’s been teaching ballet to other women and is just about to start what she describes as “a recently-born old wish”: teaching dance to young kids and adolescents from poor communities in Brasília, where she lives.

“I like to think of ballet as the realization of a Buddhist thought that says we see our external world from within, and that by working on our internal perspective, we can change the world outside. It is the power of dance and where it can take us. And this is what I want to teach children and women through the project.”

In June 2019, more than 3 million people took to the streets of São Paulo, Brazil, to celebrate lesbian, gay, bisexual, transgender and intersex (LGBTI) pride and to mark the 50th anniversary of the Stonewall riots, a turning point in the struggle for LGBTI rights. For gay entrepreneur Almir Nascimento, 2019 marked a return to involvement in the event’s organization after a 20-year break.

What prompted Mr Nascimiento’s pride comeback was a rising unease about the increasing number of new HIV infections in Brazil among young people, especially among young gay men and transgender women. For many years, he thought that the mobilization of the 1990s and the arrival of antiretroviral therapy would be enough to end the HIV epidemic.

“The epidemic was at its height when I first joined pride as one of the organizers in 1999 and 2000. Back then, it seemed to me that we had made significant achievements, and I thought it would be enough to stop HIV”, recalls Mr Nascimento. “But four to five years ago, I began to notice that a lot of young gay, bisexual and transgender people were getting infected with HIV again, and even worse they were dying of AIDS-related illnesses at a really young age. This situation motivated me to come back and support the parade organizers in promoting an open discussion about HIV and AIDS inside our community.”

In 2018, there were around 900 000 people living with HIV in Brazil, with new HIV infections up by more than 20% since 2010. While HIV prevalence in Brazil among the adult population is estimated to be 0.5%, among transgender people it stands at around 30% and among gay men and other men who have sex with men at round 18.3%.

Mr Nascimento is the owner of a gay sauna in São Paulo and says he has always made efforts to ensure that his customers have the knowledge and tools to prevent HIV and other sexually transmitted infections. He partners with the São Paulo health authorities to distribute free condoms, for example. More recently, health researchers have been welcomed to the sauna to recruit people interested in participating in pilot programmes for PrEP (pre-exposure prophylaxis), a pill that can prevent people becoming infected with HIV.

“There is no denying that gay men and transgender people are the most affected populations here in Brazil. And I realized that the lesbian, gay, bisexual and transgender parades, including the São Paulo one, no longer had effective HIV initiatives within their associations,” he says. “Because of that, we decided to call a meeting with the 27 parades representing each of Brazil’s state capitals and a dozen others from the most important cities in São Paulo State. Altogether, we estimate they reach over 18 million people every year.”

Because the numbers are so huge, Mr Nascimento believes there is not only an opportunity but also a responsibility to convey HIV prevention and zero discrimination messages to the LGBTI community.

“There is still resistance among some parade organizers to link the festivities with AIDS-related discussions because of the fear of stigma and discrimination. But everyone is together during these events and we must take advantage of that to generate candid discussions to educate people about HIV prevention, which can save lives.”

With the support of the UNAIDS office in Brazil and other key partners, Mr Nascimento and the São Paulo LGBT Pride Parade Association are now preparing for the third LGBTI Youth Health and Prevention Meeting, to be held in November.

“After our first meeting in 2017 focusing on HIV prevention among young lesbian, gay, bisexual and transgender people, over a fifth of the participating parade associations have now started the same discussions in their cities. That’s what we want: that every pride president learns how to conduct them and that they hold their own meetings during pride week and indeed throughout the year.”

Although several countries in Latin America have shown impressive declines in HIV incidence, the number of new HIV infections in the region increased by 7% between 2010 and 2018, with 100 000 people contracting HIV in 2018.

Roughly half of the countries in the region saw increases in incidence between 2010 and 2018, with the largest increases occurring in Brazil (21%), Costa Rica (21%), the Plurinational State of Bolivia (22%) and Chile (34%). At the same time, there were impressive declines in El Salvador (–48%), Nicaragua (–29%) and Colombia (–22%).

Forty per cent of new HIV infections in Latin America in 2018 occurred among gay men and other men who have sex with men―key populations and their sexual partners account for the majority of new infections in the region.

New HIV infections in Brazil increased by more than 20% between 2010 and 2018, so it’s crucial that young Brazilians start talking about HIV and learn how to protect themselves. That’s the aim of a project led by the United Nations Children’s Fund (UNICEF).

Swiping through one of his social media accounts, Jonas da Silva checks out the latest parties and public events in Salvador. He is also chatting online with other young people. They talk about sex, how and if they use condoms with their partners, what they know about HIV prevention and if they have been tested for HIV. 

“What’s cool about the project is that we have young people talking to young people. We use our language and slang to address HIV,” he says. “This connection is vital. We can see they trust us, and this is when we know we have touched them with the information they need.”

He and another 30 young people have been trained to work as volunteers in the Viva Melhor Sabendo Jovem (VMSJ) Salvador project. Their goal is to raise awareness among other young people about the importance of HIV testing and prevention. For that, they need to be where their peers are—online and on the street.

The project follows the calendar of traditional street parties and festivals, especially those that attract a large concentration of young people. It also responds to specific demands from key populations by mapping public gatherings where young lesbian, gay, bisexual, transgender and intersex people hang out. With a colourful small truck—the Test Truck—Mr da Silva and his co-volunteers can provide privacy for people who want HIV counselling and testing.

Since the project launched in August 2018, more than 1000 young people aged between 16 and 29 years have been tested for HIV in around 30 outings for the truck. As part of a strategy to promote testing among adolescents and young people, the volunteers also facilitate workshops on HIV and other sexually transmitted infections and host talks about sexuality and sexual health in schools. These events reached more than 400 students in the first six months of the project.

“The VMSJ Salvador peer education methodology makes it possible to engage more young people in these activities. It also helps them to become aware of the importance of HIV prevention and care,” said Cristina Albuquerque, Chief of Health and HIV/AIDS for UNICEF in Brazil. “Young people who get tested during our activities congratulate the initiative and complain that they have very few of these opportunities around town.”

In 2018, according to Ministry of Health estimates, young people aged between 15 and 24 years represented almost 15% of all new HIV diagnoses in Salvador.

“For us, too, the volunteers, this experience is important because we also start to take better care of ourselves, to apply these prevention methods to our lives and to pass the message on to those around us, to our friends and family,” said Mr da Silva.

The project is implemented in partnership with GAPA Bahia―one of the oldest nongovernmental organizations dealing with HIV issues in the country―and counts on the support of the UNAIDS office in Brazil. The young volunteers all went through a rigorous selection process before undergoing a training programme that included topics such as human rights, counselling and information on HIV and other sexually transmitted infections. They were also trained on community-based programmes, the functioning of the public health system and HIV services available in Salvador. The initiative includes a continuous training strategy on related topics.

“One of the most important things I have learned is that we have to respect each other’s choices and that we are here only to assist with information and inputs that we consider most appropriate to that person’s history and behaviour”, said Islan Barbosa, another of the volunteers.

“The project represents an important response to HIV testing demands in the city, especially among key populations, who very often avoid using public health facilities for that purpose. We are taking HIV testing to where these people are,” said Ms Albuquerque.

Seven years after finding out that he was living with HIV, Jair Brandão was waiting for a medical appointment in a clinic in Recife, north-east Brazil, when a fellow patient informed him he could access psychosocial support at a nearby nongovernmental organization. Although it had taken him many years to accept his HIV status, he needed just three sessions of counselling to realize that he was meant to become an HIV activist.

“I was thrilled and scared at the same time, because I didn’t understand much about political spaces, nor about AIDS and health policies. I didn't know how to engage in political discussion,” recalls Mr Brandão, who two decades later is one of Brazil’s most influential HIV activists. “First, I had to accept myself as a person living with HIV, and this was one of the challenges. And then learn about the virus, take care of myself. Only after that did I start to learn about social and political issues.”

Mr Brandão says he believes that being an activist is natural for him. “Some people are born for that,” he says. “Being an activist is about being restless and not accepting injustices and violations of rights. I think I was born with this gift because I always led processes, even without knowing it was activism, and I was always concerned about helping and empowering others.”

After participating in three of the four United Nations high-level meetings on AIDS and in the 2018 high-level meeting on tuberculosis, Mr Brandão knows how difficult it is to engage in dialogues with other civil society peers and country representatives. His mother tongue is Portuguese, which is not an official United Nations language. “Speaking a foreign language is a major issue for us in Brazil, so we have to know at least Spanish. Very few activists know English fluently enough to be able to make interventions in these spaces.”

In July 2019, Mr Brandão was among the nongovernmental organization delegates at the High-Level Political Forum on Sustainable Development in New York, United States of America, representing RNP+ (the Network of People Living with HIV and AIDS) and his own nongovernmental organization, Gestos: Soropositividade, Comunicação e Gênero.

“It is essential for civil society to participate in the national implementation and monitoring processes of the 2030 Agenda for Sustainable Development effectively. We cannot achieve the Sustainable Development Goals without the full participation of civil society,” he says. “Defending the AIDS agenda also requires discussing other equally important and cross-cutting issues.”

Through his role as Project Adviser at Gestos and as a member of RNP+, Mr Brandão also leads the People Living with HIV Stigma Index 2.0 project in Brazil. With his peers at Gestos and other national networks of people living with HIV, and with the support of the United Nations Development Programme and UNAIDS, he helped train 30 people on interviewing techniques in seven Brazilian cities. In two months, they gathered information about HIV-related stigma and discrimination by conducting around 1800 interviews. The initial results will be released before the end of November.

“This process strengthened the activists who conducted the interviews because they could listen to and experience the stories that many people have been through and could not until now share with anyone,” he recalls. “We are in the fourth decade of the AIDS epidemic and still there is a lot of stigma and discrimination. The Stigma Index 2.0 is an instrument which gives us evidence of that in Brazil. We will be able to advocate for stigma-free, zero discrimination HIV policies and services.”

Mr Brandão says he believes in the power of collaboration and partnership to achieve social progress.

“The solidarity and spirit of community that helped create the AIDS movement must come back in our actions and hearts,” he says. “Rethinking strategies and creating new ways to bring about change is fundamental. Empowering new activists, especially young people, is critical. Young people need to be welcomed and open to receive information from experienced AIDS activists. It’s time to join forces, not to be divided.”

A dozen young people from nine different countries in Latin America came together in July at the 10th International AIDS Society Conference on HIV Science in Mexico City, Mexico, to develop new youth-friendly communications strategy related to HIV prevention for young gay men and other young men having sex with men.

Although the 12 had never met face-to-face before, they had held several virtual meetings to pave the way for the conference, organized by the Latin American HIV-Positive Youth Network (J+LAC), with support from the Pan American Health Organization/World Health Organization (PAHO/WHO), UNAIDS and UNICEF.   

Every year in Latin America, an estimated 100 000 people become newly infected with HIV—a number that has not changed over the past decade. In 2018, young people between the ages of 15 and 24 years accounted for one fifth of all new HIV infections in the region. Young gay men and other men who have sex with men, sex workers, transgender people and injecting drug users are particularly affected.

“We need to remind the world that we cannot talk about prevention without young people and make the world realize that we are involved and concerned,” said Kenia Donaire, a Honduran who was born with HIV.

UNAIDS, PAHO/WHO and UNICEF are strong advocates for the involvement of young people not only as beneficiaries of services but also as partners and leaders in the design, development, implementation and monitoring and evaluation of policies and programmes.

“Too often, young people are not at the decision-making tables creating the programmes they need to protect themselves from HIV. You have the potential to set an example on how young people can lead, advocate, create demand and deliver tailored services to end an epidemic that is the second leading cause of death among adolescents. We need new ways to communicate, generate demand and link young people at higher risk of HIV to services,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme.

Young people living with HIV in Latin America have been working together to design an HIV prevention communications strategy for young gay men and other young men having sex with men in the region. In advance of travelling to the conference, they worked together to map existing communications campaigns and initiatives on combination prevention of HIV and other sexually transmitted infections and discussed how to translate complex scientific content into effective key messages for their peers.

“Young men who have sex with men and other vulnerable youth need access to HIV prevention information in a way that makes sense to them,” said Maeve de Mello, regional advisor on HIV prevention at PAHO.  “We are very pleased to support this talented group of young people. Their personal experience and voices will better prepare us to address this public health concern in a way that adults alone cannot.”

At the conference they shared their ideas with leading health and communications experts and discussed digital strategies to reach young people with compelling messages on HIV prevention and ending stigma and discrimination.

“Learning about the latest advances and successful experiences in the response to HIV, while being able to learn what goes on from the other side of the screen from digital experts such as YouTube was a really enriching experience,” said Horacio Barreda, one of J+LAC coordinators. “We need a strategy that focuses on the needs and affinities of young gay people, who live their lives in the virtual and off-line worlds.”

“This is a successful start of an important journey through which we believe we will reach Latin American youth in all its diversity.”

The group now plans to bring their strategy and advice to key stakeholders in the response to HIV, including to ministries of health, United Nations agencies, and other partners.

GENEVA, 13 June 2019—UNAIDS welcomes the decision of the Constitutional Court of Colombia to remove the section of the criminal code that criminalizes HIV and Hepatitis B transmission. Overly broad criminalization of HIV transmission is ineffective, discriminatory and does not support efforts to prevent new HIV infections.

“Public health goals cannot be pursued by denying people their individual rights. The decision by the Constitutional Court of Colombia is a concrete step to ensure the law works for the HIV response, and not against it,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “UNAIDS will continue to advocate for a protective legal environment and the removal of punitive laws, policies, practices, stigma and discrimination that block effective responses to HIV.”

The Constitutional Court of Colombia established that the law violated the principles of equality and non-discrimination, as it singled out people living with HIV, stigmatising them and limiting their rights. The Court established that the law created a differential treatment that is not reasonable —and therefore constituted discrimination. The Court further established that such law violated the sexual rights of people living with HIV and it was ineffective to meet any public health objectives.

Overly broad and inappropriate application of criminal law against people living with HIV remains a serious concern across the globe. Nine jurisdictions in South and Central America and at least 77 others worldwide still criminalize HIV non-disclosure, exposure and transmission.

UNAIDS filed an intervention before the Constitutional Court of Colombia indicating that no data support the broad application of criminal law to HIV transmission to prevent HIV transmission. Rather, such application risks undermining public health goals and human rights protections. UNAIDS strongly commends the decision taken by the Constitutional Court to restore the dignity and rights of people living with HIV in Colombia.

In 2018, UNAIDS, the International Association of Providers of AIDS Care and the International AIDS Society convened an expert group of scientists who developed an Expert Consensus Statement on the Science of HIV in the Context of Criminal Law. The statement calls on the criminal justice system to ensure science informs the application of the law in criminal cases related to HIV. 

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.