Raiza Farnataro lives in the bustling city of Barquisimeto, in the Bolivarian Republic of Venezuela, about five hours away from Caracas. Having lived with HIV for 18 years, she used to access treatment through the public health-care system. However, as the economic situation in the country worsened, medicine became scarce and she began fearing for her life. After two years without treatment, she travelled to the Colombian border, where she could either buy overpriced medicines from pharmacies or access donated medicines from nongovernmental organizations.

Ms Farnataro is just one among an estimated 62 000 people living with HIV in the country who started treatment but lack consistent access to antiretroviral medicines, according to the Venezuelan Network of Positive People. The fallout has been severe. Hospitalization rates among people living with HIV have soared and there are an estimated 20 to 30 AIDS-related deaths every day. By September 2018, an estimated 7700 Venezuelans living with HIV had joined the migrants streaming into neighbouring countries.

“The current humanitarian crisis is leading to a drastic and alarming regression of the national AIDS response that is comparable to, and even worse than, what was experienced at the beginning of the HIV epidemic in the 1980s,” said HIV activist Alberto Nieves of Citizens Action against AIDS (ACCSI). “Deaths, progressive deterioration of health, hunger, denial of access to health-care services and HIV treatment, discrimination, mass migration and xenophobia are the main implications of this crisis for all people with HIV in the country.”

In 2017, UNAIDS-commissioned research by ACCSI generated the first concrete evidence of shortages of antiretroviral medicines, other medicines and HIV reagents.

HIV prevention has also been undermined. Experts are concerned that irregular treatment access could fuel drug resistance in both the Bolivarian Republic of Venezuela and neighbouring countries. Only about a quarter of pregnant women are being screened for HIV and syphilis. Because of food shortages, some mothers living with HIV are opting to breastfeed.

Over the past two years, UNAIDS has coordinated with the Venezuelan Ministry of Health, civil society, the Pan American Health Organization (PAHO) and other United Nations entities and development partners to improve treatment access for adults and children living with HIV in the country, as well as people on the move. UNAIDS joined with civil society and PAHO to support the advocacy that resulted in a Global Fund to Fight AIDS, Tuberculosis and Malaria US$ 5 million allocation to the HIV component of a plan to coordinate support to combat HIV, tuberculosis and malaria in the country. 

UNAIDS, in partnership with Aid for AIDS International, received more than 60 tonnes of antiretroviral medicines, which were distributed to people through state-run dispensing centres. UNAIDS has also coordinated the donation and distribution of testing kits and breast-milk substitutes.

“Thanks to the support of UNAIDS, the Venezuela Network of Positive People and other strategic partners we managed to ensure that treatment was received and distributed in the country in 2018. Our efforts helped to reduce the impact of the crisis, assuring treatment to a significant percentage of people with HIV,” explained Aid for AIDS Executive Director Jesús Aguais. “Otherwise,” he added, “the tragedy would have been greater.”

This action has saved lives. Over the past six months Ms Farnataro has received her antiretroviral medicines through the public health system, thanks to the donation from Aid for AIDS International.

As a member of the Regional Inter-Agency Coordination Platform for Refugees and Migrants from Venezuela, UNAIDS also advocates for the rights and treatment access needs of migrants living with HIV. Priorities include the establishment of a civil society observatory to monitor access to health services and discrimination, distribution of communication materials around prevention, treatment and care and advocacy to address discrimination and xenophobia.

Amid all this, UNAIDS insists on the need to continue strengthening the country’s HIV response. “We need ongoing work with diverse national and international actors for the welfare of all Venezuelans, and to guarantee the health and quality of life of all people living with HIV in the Bolivarian Republic of Venezuela,” said the UNAIDS Country Director, Regina Lopez de Khalek. “We are working so that the country is not left behind in the global effort to end AIDS.”

PANAMA CITY/GENEVA, 28 January 2019—During a visit to the Good Samaritan Foundation and Home for people living with HIV in Panama, Pope Francis has urged people not to discriminate against their neighbours. The Good Samaritan Foundation and Home, or Casa Hogar El Buen Samaritano, is currently home to 16 people living with HIV aged from 16 to 60 years. They were among the first to be greeted by His Holiness during his visit.

“The Good Samaritan, whether in the parable or in all of your homes, shows us that our neighbour is first of all a person, someone with a real, particular face, not something to avoid or ignore, whatever his or her situation may be,” said Pope Francis.

Pope Francis travelled to Panama from 23 to 27 January to celebrate World Youth Day with young people from across the world. The visit to Casa Hogar El Buen Samaritano took place on the final day of his visit. His Holiness said that the work of the home confirms people’s faith by “anointing wounds, renewing hope and encouraging faith.” 

For 15 years, Casa Hogar El Buen Samaritano has provided comprehensive care and treatment to help people living with HIV recover their health and dignity and reconnect with their communities and families. It also provides HIV prevention education for thousands of people, including young people in schools and young people who may be at risk of HIV.  

The First Lady of Panama and UNAIDS Special Ambassador for AIDS in Latin America, Lorena Castillo de Varela, joined the visit, as did the Executive Director of UNAIDS, Michel Sidibé.

“Casa Hogar El Buen Samaritano embraces all people, regardless of their health or HIV status,” said Mr Sidibé. “Faith organizations like Buen Samaritano have an amazing ability to touch the lives of the people who are most difficult to reach and to remove the barriers of stigma and discrimination. Faith communities speaking out about HIV can move us closer to ending the AIDS epidemic,” he added.

UNAIDS works closely with the Catholic Church and the Holy See on shared goals, such as eliminating new HIV infections among children and increasing access to paediatric testing and treatment. Zero discrimination is key to achieving those goals.

Globally, significant gaps remain in preventing, diagnosing and treating HIV among children. In 2017, there were 180 000 new HIV infections among children globally. Just half (52%) of infants exposed to HIV worldwide received early infant diagnostic tests within the first two months of life and only 52% of children living with HIV had access to treatment in 2017.

The Vatican has convened a high-level discussion, Scaling Up Early Diagnosis and Treatment of Children and Adolescents, bringing together leaders of major pharmaceutical companies, multilateral organizations, donors and governments. While there is still ground to cover, there have been positive results in accelerating paediatric diagnosis and treatment. UNAIDS is continuing to work with all partners, including the Vatican, to scale up HIV services for children.   

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 the final morning of the 2019 World Youth Day Commemorations in Panama, Pope Francis will visit the Casa Hogar del Buen Samaritano. Named for the Biblical parable of the Good Samaritan, this shelter on the outskirts of Panama City offers comprehensive care to help people living with HIV recover and reintegrate into society.

Their only requirement for entry is need. As a policy, the home welcomes people regardless of sex, age, religion, occupation, sexual orientation, ability or geographical origin.

As volunteers zipped back and forth in feverish preparation for His Holiness yesterday, Buen Samaritano founder and Director, Father Domingo Escobar, took a moment to reflect on the evolution of the home.

It had begun as pastoral work carried out from the Parish of Santa Maria del Camino. People living with HIV—many of them homeless—would look to the church for comfort, counsel and food. The idea began to crystallize that the most marginalized needed more structured support. The Buen Samaritano Foundation and Home were founded 15 years ago with the broader vision of helping build a society free from discrimination, prejudice and stigmatization.

“I believe that it is necessary to highlight the dignity of the human being and to respect the other person, considering that we are all—as the Bible says—the Temple of the Holy Spirit… each one of us,” Father Escobar explained. 

Since its inception, the Buen Samaritano has served more than 300 residents. The combination of spiritual care with medical treatment is key. By bolstering their faith, patients steadily become more optimistic, more “enthusiastic” about taking their medicines and more confident that their treatment will work.   According to the Buen Samaritano Director, the most significant factors undermining people’s treatment adherence are lack of support and fear of prejudice.

“Because of fear of rejection and of discrimination they keep it to themselves and do not share it with family or with others,” he said.

In direct response to this challenge, one branch of the foundation evolved specifically to serve people living with HIV who live with their families but have limited resources. Apart from food and medicines, Buen Samaritano provides sensitization and training for family members, strengthening their ability to provide emotional support for their loved ones.

The foundation has also reached beyond HIV care and treatment to support prevention efforts through seminars and interventions for children, young people including youth at risk, and adults. Last year their prevention programmes reached more than 4500 people. Their Youth Information program promotes “sex education with values” in secondary schools.

UNAIDS has partnered with Buen Samaritano for many years, helping to broker the provision of antiretroviral medicines from the Ministry of Health, as well as partnering around visibility and advocacy.

The work of Father Domingo with underserved people living with HIV in Panama shows the incredible capacity of faith communities to build bridges, not only around treatment and care, but also around eliminating stigma and discrimination and prevention.

The foundation provides a valuable contribution to the community, country and AIDS response. In Panama, an estimated 25 000 people are living with HIV. The country has achieved strong progress related to treatment and reducing mortality. Three-quarters (76%) of diagnosed people in Panama were on treatment by the end of 2017 and there were fewer than 1000 AIDS-related deaths. But with an estimated 1600 new infections that year, the need for strengthened prevention initiatives is clear. For Father Escobar the challenge requires all hands-on deck.

“We must all feel and understand that the task of prevention is a cross-cutting challenge,” the priest explained. “It has to be present in the family, in public policy, in childhood, for the youth and in pastoral work. It is a problem for all, and we can all contribute.”

Indigenous health worker Jijuké Hukanaru Karajá works as a nurse in the Indigenous Health District of Araguaia, named after one of Brazil’s major rivers located in the eastern Amazon basin. She has been working with indigenous peoples for many years and criss-crosses between Brazil’s cities and indigenous villages to provide crucial health services. Ms Karajá feels very proud to be a part of the Brazilian indigenous public health system, having followed in her father’s footsteps.

“I’ve worked in town and in my indigenous village with my own people, and it’s extremely gratifying to help them in this way,” she said.

Ms Karajá believes that being indigenous eases communication and cultural differences. HIV and syphilis prevalence remains low among indigenous peoples in Brazil, but she fears that growing interaction with nearby cities will change that.

Established in 2010, the indigenous health services deliver services to every indigenous community, regardless of their remoteness. An 800-strong team of doctors, nurses, health-care technicians, psychologists, advisers and indigenous health workers work tirelessly, covering huge distances. They carry out tests for HIV, syphilis and other sexually transmitted infections. According to Ms Karajá, indigenous communities welcome them.

“Testing always follows a series of talks and workshops in villages about prevention of HIV and other sexually transmitted infections, and so the whole process flows naturally,” she said. If anyone tests positive for HIV, immediate counselling is available. Importantly, in the scope of this unique system, all HIV response efforts incorporate cultural beliefs.

Over a decade ago, a groundbreaking project pioneered by Adele Benzaken, at the time a researcher at Fundação Alfredo da Matta in Manaus, received funding from the Bill & Melinda Gates Foundation to test more than 46 000 indigenous peoples within their own communities. Activities focused notably in Amazonas and Roraima, remote forested states that are home to more than half of the indigenous peoples in Brazil. Stopping gender-based violence and keeping children from being born with congenital syphilis and HIV were among their priorities.

“Before the project, this indigenous population had very little access to any kind of diagnosis, treatment and prevention,” remembers Ms Benzaken, who today runs the national STI, AIDS and Viral Hepatitis Department of the Ministry of Health in Brazil. “They were vulnerable and didn’t have access to programmes.”

In 2012, rapid testing became a public policy for Brazil’s indigenous and general population. In five years, rapid HIV test distribution to the 34 operating indigenous health districts almost tripled to 152 000 in 2017; syphilis rapid test distribution more than doubled to more than 65 000 in the same year.

By boat, road and foot, health workers travel across the vast territories to test, raise awareness and discuss preventive methods, such as condoms.

Brazil is home to almost 900 000 indigenous peoples, with indigenous lands representing more than 12% of the country. Altogether, the country has 305 ethnicities speaking 274 different languages. The largest ethic group among them are the Tikuna.

Vinicios Ancelmo Lizardo—or Pureenco, in his original Avaí indigenous name—works as a health worker mainly in the Amazon region. “To help my people, I have to help them understand what health really means to them,” he said. Before explaining HIV prevention to a group of Tikuna in their own language, he speaks to them about love, sex and freedom, and he makes them laugh by teaching them—with the help of a lifelike dildo—how a male condom should be used.

Mr Lizardo admits that breaking cultural barriers and building bridges between science and tradition is challenging. But he knows that as most indigenous communities can no longer stay isolated, they cannot be left behind.

To better support countries in Latin America and the Caribbean to Fast-Track their HIV and social protection programmes, UNAIDS and partners are training senior government and civil society representatives, including people living with HIV, from 14 countries in the region on the HIV and Social Protection Assessment Tool.

The training will train trainers, who will in turn train national stakeholders to undertake HIV and social protection assessments. Those HIV and social protection assessments will generate information that will assist countries to improve their ability to connect the AIDS response to social protection programmes and other programmes for alleviating poverty and exclusion.

In the Latin America and Caribbean region, HIV continues to seriously affect key populations, including transgender people and gay men and other men who have sex with men. The epidemic in the region is exacerbated by stigma and discrimination, unemployment, gender-based violence, limited access to quality education, health and social services, food insecurity and poverty. HIV-sensitive social protection helps to address stigma and discrimination and meet the multiple needs of people living with and affected by HIV in order to enhance their ability to access HIV and health services.

All 14 countries in the Latin America and Caribbean region reviewed in a 2018 rapid assessment of the status of HIV-sensitive social protection commissioned by UNAIDS have a social protection scheme that includes vulnerable people. However, only Argentina, Brazil, Guatemala and Peru explicitly include key populations.  

The training of trainers is taking place in Panama from 28 to 30 November.

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Surrounded by the stately centuries-old buildings of Quito’s Old City, a group of men are playing a modified game of Jenga. Each wooden brick they carefully extract from a tower corresponds to a sexual health lesson. There’s rapt attention while the peer educator demonstrates how a female condom is used. One table over, young people are gathered around for a male condom demonstration. People might stop by the tents for blood pressure or blood sugar tests, but they stay for the lively safer sex education.

This hands-on engagement is a result of collaboration between the Directors of Health and Social Inclusion for the Municipality of Quito and civil society organizations, including the Kimirina Corporation. Two years after becoming the first Andean city to sign the Paris Declaration to end the AIDS epidemic in cities, Quito has dramatically scaled up HIV testing and prevention programmes. Four hundred kilometres away, the city of Guayaquil is following suit, expanding HIV prevention and community testing.

Over the past year there has been a renewed emphasis on community testing, with concrete results. The proportion of newly diagnosed people being linked to health services has increased by a quarter in Quito and a third in Guayaquil.

“You are not just talking about the epidemic, but also using practical approaches,” UNAIDS Executive Director Michel Sidibé said during a visit to Ecuador on 30 October. “We are seeing people being educated, accessing services and getting tested. Anything we do with the support of the community is sustainable.”

This emphasis on community involvement is a key feature of the new Ecuador Multisectoral National Strategic Plan on HIV. During the plan’s symbolic launch on 30 October, Ecuador’s Public Health Minister, Veronica Espinosa, emphasized that the missions to end AIDS and to build a better society were one and the same.

“We are working to ensure a life without prejudice and the right to health for all without discrimination,” said Ms Espinsosa.

And the human rights-based approach to HIV services does not end with citizens of Ecuador. Ecuador has shown great leadership with regard to migrants, including guaranteeing health care for refugees and migrants living with HIV.

“You have opened your hands and heart to people coming from other places,” said Mr Sidibé. “By giving treatment access to people who could be left behind you are demonstrating that you set a high standard, not only for yourselves but for the world.”

A new regional civil society cooperation network for the Americas and the Caribbean to support nongovernmental organizations working to end AIDS was launched on 30 October in Quito, Ecuador. Launched by Coalition PLUS, the initiative will support coordination and capacity-building among community organizations involved in the AIDS responses of North, Central and South America and the Caribbean.

“Although we have HIV services available, people do not have access because they are criminalized and stigmatized. The community movement is helping us to end the conspiracy of silence about discrimination. We need civil society to increase efforts to achieve the progressive policies that will clear the way for us to end AIDS,” said Michel Sidibé, UNAIDS Executive Director.

Since 2014, Coalition PLUS—an international alliance of more than 100 nongovernmental organizations contributing to the AIDS response—has been building and strengthening mechanisms for regional collaboration. Such networks already exist in western Africa, central Africa, the Middle East and North Africa, the Indian Ocean and Europe.

The President of Coalition PLUS, Hakima Himmich, said that the network will increase access by organizations to new resources and approaches relevant to their local contexts. She noted that it was especially important to strengthen civil society’s capacity around addressing the needs of the most vulnerable.

“We have huge challenges around stigma and discrimination against entire populations. In order to achieve epidemic control, we must also address human rights,” said Ms Himmich.

UNAIDS data show that in 2017 key populations and their sexual partners accounted for three quarters of new HIV infections in Latin America and two thirds of new infections in the Caribbean. Gay men and other men who have sex with men and transgender women are disproportionately affected, with a few countries reporting HIV rates of above 15% among those communities.

The activities of the network in the region will be coordinated by the Kimirina Corporation, a Ecuadorian organization focused on people-centred combination prevention and advocacy. Amira Herdoiza, Director of the Kimirina Corporation, explained that the platform will place strong emphasis on coordinated research, skills-building and advocacy, particularly around issues affecting young people and key populations. 

“We need more multicountry research to show the nuances of our epidemics,” Ms Herdoiza said. “Through this network our organizations’ capacities to share and analyse data will be strengthened. We will also focus on sharing experiences and planning joint programmes.”

At present, there are three other members of the regional network: the Coalition of Quebec Community Organizations against AIDS in Canada; AIDES in the French Caribbean; and the Institute for Human Development in the Plurinational State of Bolivia. Other regional organizations are invited to be part of the initiative.

There are still alarming levels of violence against transgender people, and a lack of recognition of their rights. During a visit to UNAIDS headquarters in Geneva, Switzerland, on 18 September, Marcela Romero and Venus Tejada, representatives of the Latin American and Caribbean Network of Transgender People (REDLACTRANS), shared the startling fact that transgender women in the region have a life expectancy of only 35 years.

During the visit, Ms Romero and Ms Tejada met with the UNAIDS Executive Director, Michel Sidibé, and spoke about REDLACTRANS’ work in 13 countries. A grant to REDLACTRANS from the Global Fund to Fight AIDS, Tuberculosis and Malaria helped to establish a centre that collects testimonies and follows up cases of human rights violations committed against transgender women in Latin America and the Caribbean.

“Stigma, discrimination and violence against sexual and gender minorities prevent them from accessing health services,” said Mr Sidibé. “Everyone has the right to health, no matter their gender or sexual orientation. For that, we need zero discrimination for everyone, everywhere.”

Ms Romero and Ms Tejada also presented Mr Sidibé with a copy of REDLACTRANS’ report, Waiting to die, which compiles cases of human rights violations against transgender people and gives recommendations to decision-makers.

“Stigma and discrimination is a barrier to the services we need to stay healthy. Some transgender women are dying due to lack of access to treatment. Without comprehensive health care, there are no equal rights nor true democracy,” said Ms Romero

Since its creation in 2006, REDLACTRANS has promoted the development of gender identity laws. In Argentina, the Plurinational State of Bolivia, three federal districts of Mexico and Uruguay, where gender identity laws have been enacted, transgender rights are increasingly enforced and, consequently, transgender people can access health-care services. Such laws have brought about positive changes in the services provided to transgender people and resulted in less stigma and discrimination in health-care settings. “Without identification, one cannot travel, register for school or access many services that are essential to function in society,” said Ms Tejada.

Ms Romero and Ms Tejada called on UNAIDS to address how forced migration, persistent inequalities and poverty affect the quality of life of transgender women.

Antiretroviral stock-outs are a serious public health problem in the Latin America region and represent an important risk to the sustainability of the HIV response, according to participants at AIDS2018.

On July 26, a session titled Sustainability of the response to HIV in Latin America; factors that impact access to drugs and health supplies addressed and analyzed the magnitude, the structural causes and the impact of stock-outs on the sustainability of the HIV response in Latin America. Participants discussed strategies to pave the way forward and highlighted best practices on joint purchases of antiretroviral (ARV) treatment like the PAHO/OMS strategic fund, which has helped prevent stock-outs.

In Latin America, one of the most important achievements in the HIV response has been the recognition that accessing HIV treatment is part of the right to health in the public health system, resulting in an increased number of people receiving antiretroviral treatment in recent years. However, a major challenge to fulfill the right to health is to guarantee uninterrupted supplies of ARV drugs and other essential health commodities.

According to the Pan American Health Organization (PAHO), in 2012 45% of the countries reported at least one stock-out episode; the figure had been 54% in 2010. Although some improvements are seen from 2010 to 2012, the region is still experiencing a high frequency of stock-outs.

Shortages of ARVs and other essential supplies result in changes and interruptions in patient treatment, threaten the lives of people with HIV and hamper the reduction of new HIV infections and AIDS-related deaths.

Participants at the session stressed the need for greater health system strengthening and joint procurement processes, including the incorporation of TRIPS flexibilities to reduce ARV costs, aligned with policies for simplified treatment regimens. According to participants, all these factors are essential to prevent and respond to stock-outs of ARVs and medical supplies.

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