As we mark the International Day for the Elimination of Violence against Women, we commemorate and renew our global commitment to ending violence against women and other forms of gender-based violence. 

Violence against women remains one of the most persistent violations of human rights across the globe, undermining the health, dignity, security and autonomy of women and girls. Women who have been physically or sexually abused by their partners report higher rates of mental health issues, including depression and anxiety, higher use of alcohol and less control over sexual decision-making.

There is an undeniable link between violence against women and HIV. Studies show clearly that women living with HIV are more likely to have experienced violence, and women who have experienced violence are more likely to be living with HIV. In some regions, women who experience physical or sexual intimate partner violence are 1.5 times more likely to acquire HIV than women who have not experienced violence. Among marginalized populations, a high prevalence of violence is linked to higher rates of HIV infection, in particular among transgender women.

Violence or the fear of violence can it make very difficult for women to insist on safer sex and to use and benefit from HIV and sexual and reproductive health services. The fear of intimate partner violence is also an important barrier to the uptake of HIV testing and counselling, to the disclosure of HIV-positive status and to treatment uptake and adherence, including among pregnant women living with HIV. Violence against women living with HIV also manifests in health-care settings—women have even reported being sterilized against their will. 

Programmes that empower women and girls through integrated approaches that transform social and cultural norms and promote and implement laws and policies on violence against women, gender equality and HIV are incredibly effective. The uptake of such programmes, combined with political will to promote gender equality and end discrimination against women, are critical to addressing violence against women. UNAIDS remains committed to continuing to act urgently against violence against women as a human rights imperative and as a cause and consequence of HIV.

On 25 November, the International Day for the Elimination of Violence against Women kicks off the 16 Days of Activism against Gender-Based Violence, ending on 10 December, Human Rights Day. It is a time to commemorate and renew our commitment to ending violence against women and other forms of gender-based violence.

25 November 2018

Michel Sidibé

Executive Director of UNAIDS

Under-Secretary-General of the United Nations

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.

Report also calls for increased efforts to reach the 9.4 million people living with HIV who are not aware that they are living with the virus and the estimated 19.4 million people living with HIV who do not have a suppressed viral load

ABIDJAN/GENEVA, 22 November 2018—A new report from UNAIDS shows that intensified HIV testing and treatment efforts are reaching more people living with HIV. In 2017, three quarters of people living with HIV (75%) knew their HIV status, compared to just two thirds (67%) in 2015, and 21.7 million people living with HIV (59%) had access to antiretroviral therapy, up from 17.2 million in 2015. The report shows, however, that 9.4 million people living with HIV do not know they are living with the virus and urgently need to be linked to HIV testing and treatment services.

The report, Knowledge is power, reveals that although the number of people living with HIV who are virally suppressed has risen by around 10 percentage points in the past three years, reaching 47% in 2017, 19.4 million people living with HIV still do not have a suppressed viral load. To remain healthy and to prevent transmission, the virus needs to be suppressed to undetectable or very low levels through sustained antiretroviral therapy. And to effectively monitor viral load, people living with HIV need access to viral load testing every 12 months.

“Viral load testing is the gold standard in HIV treatment monitoring,” said Michel Sidibé, Executive Director of UNAIDS. “It shows that treatment is working, keeping people alive and well and keeping the virus firmly under control.”

The report outlines that access to viral load testing is mixed. In some parts of the world, getting a viral load test is easy and is fully integrated into a person’s HIV treatment regime, but in other places there may be only one viral load machine for the entire country.

World AIDS Day 2018 message by UNAIDS Executive Director, Michel Sidibé

“Viral load monitoring needs to be as available in Lilongwe as it is in London,” said Mr Sidibé. “HIV testing and viral load testing should be equal and accessible to all people living with HIV, without exception.”

In Côte d’Ivoire, the United States President’s Emergency Plan for AIDS Relief is supporting a national scale-up plan for viral load testing. In just three years, as the number of people on treatment doubled, 10 additional laboratories began viral load testing. Subsequently, viral load testing coverage increased from 14% in 2015 to 66% in 2017 and is projected to reach 75% by the end of 2018.

“This year's UNAIDS theme for World AIDS Day (Live life positively—know your HIV status) reiterates the fact that HIV testing remains the only way to know your status and to adopt a healthy life plan,” said Eugène Aka Aouele, Minister of Health and Public Hygiene, Côte d’Ivoire.

Children and HIV and viral load testing

Viral load testing is particularly important for newborns, as HIV progresses much faster in children—peak mortality for children born with HIV is within two or three months of life. Standard rapid diagnostic testing is ineffective up until 18 months of age, so the only viable test for HIV for very young children is a virological test, which they need to receive within the first four to six weeks of life. However, in 2017, only half (52%) of children exposed to HIV in high-burden countries received a test within the first two months of life.

Important advances are being made. New point-of-care testing technologies—testing that takes place in an environment as close to the person as possible—have been shown to shorten the time it takes to return children’s test results from months to minutes, which is saving lives.

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The persistent barriers to knowing one’s status

The report shows that one of the biggest barriers to HIV testing is stigma and discrimination. Studies among women, men, young people and key populations have revealed that fear of being seen accessing HIV services, and if the person is diagnosed, fear that this information will be shared with family, friends, sexual partners or the wider community, was preventing them from accessing HIV services, including HIV testing.

For key populations—gay men and other men who have sex with men, transgender people, sex workers, people who use drugs, people in prisons and other closed settings and migrants—these barriers can affect access to an even greater extent. Stigma and discrimination, from society and health services, can deter members of key populations from accessing health care, while criminal laws can compound that discrimination, increase rates of violence and create additional barriers, including fear of arrest and harassment.

“In Côte d'Ivoire, HIV prevalence among sex workers is 11% and 13% for men who have sex with men and 9.2% for people who inject drugs,” said Pélagie Kouamé, President of the Network of Key Populations in Côte d’Ivoire. “We cannot leave key populations behind. Things must change and evolve so that we can come out from the shadows and no longer live in fear.”

Other barriers include violence or the threat of violence, especially among young women and girls. Parental consent laws and policies are also a barrier, since in some countries young people under the age of 18 years need parental consent to take an HIV test. In addition, services are often too far away and difficult to access or too expensive. There can also be delays or failures in returning HIV test results and delays in treatment initiation. In some countries, people do not seek HIV testing as they feel they are not at risk—in Malawi, one study found that among adolescent girls and young women (aged between 15 years and 24 years), considered to be at higher risk of HIV, more than half (52%) did not consider themselves at risk of HIV and so were unlikely to seek HIV testing services.

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Next generation of testing options

The report highlights how providing a variety of testing options and services, such as community-based testing and home-based testing, can help mitigate many of the logistical, structural and social barriers to HIV testing. They offer testing options for people who live far away from health services, do not have the constraints of inconvenient opening hours, which is particularly important for men and people from key populations, and do not come with the stigma and discrimination often perceived in traditional health and HIV services.

“We cannot not wait for people to become sick,” said Imam Harouna Koné, President of the Platform of Networks in the Fight Against AIDS. “We must go out to our communities and offer HIV testing and treatment services.”

The report outlines the importance of taking a five Cs approach: consent, confidentiality, counselling, correct test results and connection/linkage to prevention, care and treatment. “There isn’t a one size fits all approach to HIV testing,” said Mr Sidibé. “There are a number of different strategies needed to reach people at risk of HIV, including innovative approaches such as self-testing, where people may feel more comfortable that their privacy is respected.”

Another important step to take is to integrate HIV testing services within other health services, including maternal and child health services, services for tuberculosis and services for sexually transmitted infections and viral hepatitis. Tuberculosis is the leading cause of death of people living with HIV, accounting for one in three AIDS-related deaths; however, it is estimated that 49% of people living with HIV and tuberculosis are unaware of their coinfection and are therefore not receiving care.

Access to HIV testing is a basic human right, and UNAIDS is calling for a global commitment to remove the barriers preventing people from testing for HIV, which include eliminating HIV-related stigma and discrimination, ensuring confidentiality in HIV testing and treatment services, deploying an optimal mix of HIV testing strategies to reach the populations most in need, integration with other health services, removing policy and legal barriers hindering access to HIV testing and treatment, expanding access to viral load monitoring in low- and middle-income countries and ensuring access to early infant diagnosis for newborns.

The report demonstrates that implementing these measures will hugely advance progress towards ensuring that all people living with and affected by HIV have access to the life-saving services they need. 

In 2017 an estimated:

• 36.9 million [31.1 million–43.9 million] people globally were living with HIV
• 21.7 million [19.1 million–22.6 million] people were accessing treatment
• 1.8 million [1.4 million–2.4 million] people became newly infected with HIV
• 940 000 [670 000–1.3 million] people died from AIDS-related illnesses

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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.

In order to highlight the need for sustainable and affordable access to quality medicines, the Executive Director of UNAIDS, Michel Sidibé, spoke about the necessity of implementing the African Union Pharmaceutical Manufacturing Plan. Speaking at the opening ceremony of Africa Industrialization Week 2018 in Addis Ababa, Ethiopia, he called for close cooperation with regional economic communities in order to build production cooperation hubs and lead pharmaceutical regulatory harmonization in Africa.

Commitments on gender-based violence and the rights of women made at an event held on the margins of the United Nations General Assembly in September entitled Eliminating Sexual and Gender-Based Violence and Protecting the Health and Rights of Women and Children in Humanitarian Settings were discussed during meetings Mr Sidibé held with Smail Chergui, the Africa Union Commissioner for Peace and Security, and the African Union Special Envoy on Women, Peace and Security, Bineta Diop.

During the meetings, discussions were held on how to increase efforts in responding to HIV in conflict and humanitarian settings and the need to increase awareness on HIV testing and on sexual and gender-based violence. Mr Sidibé and Mr Chergui agreed to conduct a high-level joint mission to South Sudan to highlight the needs of people facing a higher risk of HIV in the country owing to gender-based violence and the protracted conflict.

Also during his visit to Ethiopia, which took place from 17 to 20 November, Mr Sidibe’s met with Ethiopia’s Prime Minister, Abiy Ahmed, who said, “I am committed to change the narrative of Africa and Ethiopia through ongoing reforms and agree to strengthen efforts on people-centred health development for Ethiopia.”

“Thank you for agreeing to champion ending AIDS in Ethiopia and across the continent,” said Mr Sidibé.

The President of Ethiopia’s agenda on gender and peace and the rehabilitation of street children was the topic of conversation in a meeting between the President, Sahle-Work Zewde, and Mr Sidibé.

During a discussion Mr Sidibé had with the Minister of Health of Ethiopia, Amir Aman, a collaborative project was developed that will be centred around strengthening resource mobilization, enhancing and sustaining a multisectoral response across all sectors, engaging young people and enhancing HIV programmes following the location–population approach.

UNAIDS International Goodwill Ambassador urges people to test for HIV and to seek treatment if necessary  

GENEVA, 23 November 2018—A little over one week before World AIDS Day, UNAIDS International Goodwill Ambassador Victoria Beckham has visited the organization’s Geneva, Switzerland, headquarters to support calls for people to know their HIV status and to seek treatment for HIV if necessary.

“I am really happy to be in Geneva to support UNAIDS in the run-up to World AIDS Day,” said Ms Beckham during her visit. “We need to make sure that people feel supported to take an HIV test by ending the stigma and discrimination still too often associated with the virus. Today, we have the medicines to keep people healthy and to stop the virus being transmitted. AIDS isn’t over yet, but it can be.”

UNAIDS estimates that there were around 36.9 million people living with HIV worldwide in 2017, with around 21.7 million people accessing life-saving medicines that keep people alive and well and stop the transmission of the virus. However, UNAIDS also estimates that around one in four people worldwide continue to be unaware that they are living with HIV.

During the visit, the UNAIDS Executive Director, Michel Sidibé, met with Ms Beckham to thank her for her support and to discuss the latest developments in the AIDS response.

“We have made a lot of progress in expanding access to treatment, but the number of people who don’t know their HIV status is still far too high,” said Mr Sidibé. “We have to make sure that people have access to testing services and are provided with treatment immediately if they need it. We also have to make sure that people have access to the full range of HIV prevention options to bring down the number of new HIV infections.”

Thanks to antiretroviral therapy, AIDS-related deaths have been reduced by more than 51% since the peak in 2004. In 2017, 940 000 people died from an AIDS-related illness worldwide, compared to 1.9 million in 2004. In 2017, however, there were 1.8 million new HIV infections.

In many regions of the world, women continue to be the worst affected by the epidemic and every week 6600 young women aged 15–24 years become infected with HIV. In sub-Saharan Africa, three in four new infections among adolescents aged 15–19 years are among girls, and young women aged 15–24 years are twice as likely to be living with HIV than men.

In other regions, the epidemic is concentrated among key populations, such as gay men and other men who have sex with men, sex workers, transgender people, people who inject drugs, prisoners and other incarcerated people and migrants.

It is estimated that around 35.4 million people worldwide have died from an AID-related illness since the start of the epidemic.

1 December 2018

This year marks the 30th anniversary of the first World AIDS Day. Thirty years of activism and solidarity under the banner of World AIDS Day. Thirty years of campaigning for universal access to life-saving services to treat and prevent HIV. But after 30 years, AIDS is still not over. We have miles to go.

World AIDS Day is a day to remember the millions of people who have lost their lives to AIDS-related illnesses, many of whom died because they couldn’t access HIV services, because of stigma, because of discrimination and because of criminalization of key populations.

On this World AIDS Day, UNAIDS is campaigning for people to know their HIV status and their viral load. In 2017, 9.4 million people were simply unaware that they are living with a potentially deadly, but treatable, disease. If people don’t know their HIV status, people who are living with HIV can’t start treatment, and people who are HIV-negative can’t get the knowledge and skills they need to keep that way. If people don’t know their HIV status, they can’t protect themselves, their families, their partners. If people living with HIV don’t know their viral load, they won’t be sure that the treatment is effective, protecting their health and stopping HIV transmission.

Live life positively. Know your HIV status.

Michel Sidibé

Executive Director of UNAIDS

Under-Secretary-General of the United Nations

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.

The First Lady of Botswana, Neo Masisi, visited UNAIDS headquarters in Geneva, Switzerland, on 24 October to discuss improving health outcomes for young people, especially adolescent girls.

The First Lady met the Executive Director of UNAIDS, Michel Sidibé, and UNAIDS staff members.

“We can work jointly to address issues affecting 8-18-year-olds to ensure that the future generation that will lead and build Botswana is healthy, HIV-free and is equipped with life skills,” said Ms Masisi.

Botswana has made important gains towards ending the AIDS epidemic, but action is needed to curb the recent rise in new HIV infections, particularly among young people—a total of 14 000 people became newly infected with HIV in 2017. Women and girls are particularly vulnerable: 67% of women experience gender-based violence and teenage pregnancy stands at 9.7%.    

Ms Masisi has been advocating for the empowerment of adolescent girls and young women to reduce their vulnerability. She listed social protection grants, economic programmes and promoting sexual and reproductive health as vital so that women live healthy and fulfilling lives.  

“You are in a strategic position to be a champion and driver of change for young women,” said Mr Sidibé. “UNAIDS is committed to support you and Botswana.”

GENEVA, 24 October 2018—The Prime Minister Thomas Thabane and the First Lady of Lesotho, Maesaiah Thabane, visited UNAIDS headquarters in Geneva, Switzerland, to advocate for the end of AIDS and reduce its impact on young people.

They met the Executive Director of UNAIDS, Michel Sidibé, and UNAIDS staff members. 

Around one in six people in Lesotho is living with HIV, one of the highest rates in the world. And more women are affected than men—27.7% of women are living with HIV, while 19.7% of men are. Progress has been made, with AIDS-related deaths declining from 15 000 in 2005 to about 5000 in 2017, but more needs to be done to prevent new HIV infections, notably from mother to child, with the mother-to-child transmission of HIV rate standing at 11.3%.

“We can and we will end new HIV infections among babies,” said Mr Thabane.

The First Lady meanwhile has been a champion of young people. She has shown strong commitment to reducing breast cancer and cervical cancer and pushing access to integrated reproductive health services. 

“If we want to reduce and end gender-based violence against women, we must send our girls to school and keep them there,” said Ms Thabane. “We must invest in girls.”

Mr Sidibé expressed his full support, praising Lesotho for making significant progress in its HIV response. He said, “Ending AIDS begins with young people. That means engaging girls and boys and providing them with information through traditional and social media channels.”

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.

UNAIDS’ unwavering commitment praised by the President

GENEVA, 25 October 2018—The President of Botswana, Mokgweetsi E.K. Masisi, visited UNAIDS headquarters in Geneva, Switzerland, on 25 October 2018 to share Botswana’s vision on a key public health concern: HIV.

The President met the Executive Director of UNAIDS, Michel Sidibé, and congratulated UNAIDS for leading the AIDS agenda with humility and professionalism. 

“We continue to count on your stewardship,” said Mr Masisi. “Botswana stands ready to sprint the last mile to end AIDS as a public health threat.”

Two decades ago, AIDS ravaged the small southern African nation of 2 million. Today, despite having one of the highest rates of HIV in the world – 23% of adults live with HIV- Botswana has shown remarkable progress. New HIV infections have been reduced by 63% since the peak in 1996 and AIDS-related deaths have decreased to 4100 from 15 000 in 2008. It was the first country in the region to provide universal, free antiretroviral treatment to people living with HIV, paving the way for many other countries in the region to follow.

Mr Sidibé described the President as an advocate for the region. “Mr Masisi is bringing new energy and impetus to the AIDS response in Botswana with a focus on HIV prevention,” said Mr Sidibé. The President participated in a moderated dialogue along with a high-level delegation that included the Minister of International Affairs and Cooperation and the Minister of Health and Wellbeing as well as the First Lady of Botswana. During the discussions, the President described Botswana’s financial investments in health, HIV and its people.  He highlighted that mother-to-child HIV transmission is on the verge of being eliminated and that more than 80% of people living with HIV are on treatment.

However, challenges remain. “When you disempower a young girl through violence or unwanted sexual experience, she is affected for life,” Mr Masisi said. In order to curtail new HIV infections, the President committed to redefining the roles and engagement of young boys and men. Mr Masisi and Mr Sidibé then recognized former President Festus Mogae’s long-standing efforts to turn the country around from despair to hope when Botswana faced the HIV crisis initially.  

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.

New initiative launched to engage the military and other uniformed personnel in HIV awareness, prevention and treatment and eliminate sexual and gender-based violence by defence and security forces

BANGUI/GENEVA, 9 October 2018—UNAIDS has signed a memorandum of understanding (MoU) with the Ministry of National Defence and Reconstruction of the Army, the Ministry of Health and Population and the National AIDS Committee of the Central African Republic. The aim of the MoU is to reduce new HIV infections within the military and other uniformed personnel, reduce sexual violence and abuse by security and defence forces and increase uptake of HIV treatment, care and support services.  

The MoU comes at a critical time. The Central African Republic has the second highest HIV prevalence in central Africa, estimated at 4% in 2017. However, among uniformed personnel, HIV prevalence is double, at an estimated 7.8%. Knowledge of HIV among uniformed personnel in the Central African Republic is particularly low and reports of sexual abuse and violence by military personnel are widespread.

"We have a responsibility to protect all our people from violence and HIV, especially women and girls, who are the most vulnerable. By focusing on uniformed personnel, we aim to transform the relationship between the new army and the population, as a key to reconstruction,” said Faustin-Archange Touadéra, President of the Central African Republic.

Under the MoU the parties involved will mobilize national partners to respond to HIV and gender-based violence within the defence and security forces, reduce HIV prevalence and incidence and improve relations between the defence and security forces and the general population through integrated activities around HIV prevention and gender-based violence.

“This protocol is a first,” said Michel Sidibé, Executive Director of UNAIDS. “It translates Security Council resolution 1983 into concrete actions. It places prevention at the centre of our efforts to end gender-based violence as a cause and consequence of HIV. This is essential and complementary to all efforts to strengthen accountability for sexual violence in the Central African Republic.”

Special emphasis will be given to training and awareness-raising for defence and security forces using methods proven to be effective in reducing gender-based violence and preventing HIV. These include improving mechanisms to report sexual violence, support for survivors and ensuring access to effective HIV prevention tools. Social and psychosocial support programmes will also be made available for members of the defence and security forces and their families.

The main beneficiaries of the programmes and activities will be the defence and security forces in the Central African Republic, which include the military, the police, the gendarmerie, customs officials, water and forestry officers and the municipal police. The implementation of the MoU will also benefit the wider population through planned integrated activities between the military and civilians and through the impact of HIV prevention, treatment and care programmes and efforts to eliminate sexual and gender-based violence and abuse.

UNAIDS will provide leadership and technical support to the initiative and will mobilize its partners and Cosponsors, particularly organizations working on gender and health issues, to support the implementation of the activities outlined in the MoU. UNAIDS will also ensure effective collaboration between all project partners, including ensuring the active participation of civil society. It will also play a critical role in advocating for resources and supporting the monitoring, evaluation and documentation of the initiative.

The United Nations Multidimensional Integrated Stabilization Mission in the Central African Republic and the European Union Military Training Mission in the Central African Republic have committed to support the initiative.

The new commitments will play an important role in advancing the National Recovery and Peacebuilding Plan 2017–2021 in the Central African Republic and are part of ongoing efforts to implement United Nations Security Council resolution 1983, which underlines the importance of concerted efforts towards ending sexual and gender-based violence and responding to HIV in conflict and post-conflict settings.  
 

HIV data for the Central African Republic in 2017:

• 160 000 [130 000–190 000] people were living with HIV
• 53% of people living with HIV knew their HIV status
• 32% of people living with HIV were accessing antiretroviral therapy
• 8700 [7600–11 000] people became newly infected with HIV
• 15 000 [12 000–17 000] people died from AIDS-related illnesses

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.

World Mental Health Day is observed on 10 October each year. This year, UNAIDS is highlighting that governments need to do more to integrate mental health and HIV services.

People living with HIV are at a greatly increased risk of developing mental health conditions, often suffering from depression and anxiety as they adjust to their diagnosis and adapt to living with a chronic infectious disease.

People living with mental health problems can also be at higher risk of HIV. The risks are exacerbated by low access to information and knowledge of HIV, including how to prevent it, injecting drug use, sexual contact with people who inject drugs, sexual abuse, unprotected sex between men and low use of condoms.

“HIV affects the most vulnerable and marginalized in society, who are also disproportionally affected by mental health issues,” said Michel Sidibé, Executive Director of UNAIDS. “By integrating HIV and mental health services we will be able to reach more people with the specialist care and life-saving support they urgently need.”

Currently, very few health services are addressing the HIV-related needs of people living with mental health issues or the mental health issues of people living with HIV. This situation needs to change. Studies conducted over five continents have estimated that HIV prevalence among people living with severe mental disorders could be between 1.5% in Asia and up to 19% in Africa.

People living with HIV can experience mental health issues that can affect quality of life and stop them seeking health care, adhering to treatment and continuing in care. Studies across 38 countries show that 15% of adults and 25% of adolescents living with HIV reported depression or feeling overwhelmed, which could be a barrier to adherence to antiretroviral therapy.

In addition, treatment itself can cause a wide range of side-effects on the central nervous system, including depression, nervousness, euphoria, hallucinations and psychosis. Studies in Africa found a 24% prevalence of depression among people living with HIV.

Identifying mental health issues among people living with HIV is critical; however, far too often those go undiagnosed and untreated. There are many reasons for this, all of which need to be addressed. People may not want to reveal their psychological state to health-care workers for fear of stigma and discrimination and health-care workers may not have the skills or training to detect psychological symptoms or may fail to take the necessary action for further assessment, management and referral if symptoms are detected.

Mental health services should ensure access to voluntary and confidential HIV testing and counselling for people who may be at increased risk of HIV. Primary health-care providers must be trained to recognize and treat common mental health and substance-use disorders and refer people to expert care.

Prevention, testing, treatment and care services must meet the complex medical, psychological and social needs of people affected by HIV and mental health issues, which can be best managed through integrated programmes. Integrated approaches need to be across sectors and involve social, legal, health-care and educational services and engage community-based organizations.

Integrating mental health and HIV programming prevents new HIV infections and improves the health and well-being of people living with and affected by HIV.