In response to a call by women living with HIV in Egypt for an increase in the availability of quality sexual and reproductive health services delivered free from stigma and discrimination, UNAIDS mobilized partners and engaged with Egypt’s national AIDS programme.

The result was a pilot project that ran from 2016 to 2018 in which almost 300 women across the country were provided with family planning, antenatal care, support during delivery, postpartum care and guidance on the prevention of mother-to-child transmission of HIV.

On 30 May, national stakeholders, including representatives of the Ministries of Foreign Affairs and Health and Population, civil society, academia and people living with and affected by HIV, gathered to highlight the key achievements, experiences and lessons learned from the pilot.

“I benefited from the project counselling service throughout my pregnancy. I started taking medicine, and, with follow-up, I had a child free from HIV, which I never thought was possible or an option,” said an Egyptian woman living with HIV.

The pilot project achieved outstanding results, reaching nearly double the number of people originally planned to be reached and building institutional expertise in sexual and reproductive health. Counselling and psychosocial support was provided by health professionals and supported by women living with HIV.

“This project is a continuation of the collaboration and fruitful partnership between UNAIDS and the Egyptian Government. We congratulate the Government of Egypt for addressing the needs of a highly marginalized population,” said Ahmed Khamis, the UNAIDS Country Manager for Egypt.

Dr Ahmed Khamis, UNAIDS Country Manager, gives the opening speech on the closing and final dissemination of key results of the “Enhancing Sexual and Reproductive Health of Women Living with HIV” pilot project; with Dr Alaa Eid, Under Secretary for Preventive Medicine, Ministry of Health and Population, H.E. Laurens Westhoff, Ambassador of the Netherlands in Cairo and Ambassador Seif-alla Kandeel, Director of UN Specialized Agencies, Ministry of Foreign Affairs (from left to right). Photo taken by Mohamed Ezz

The pilot programme was funded through financial support from the Embassy of the Netherlands in Egypt and covered the Giza and Gharbia Governates of Egypt and was later extended to the Dakahlia Governate.

“The Netherlands is strongly committed to curbing the spread of HIV worldwide as an integral part of our contribution towards the achievement of the Sustainable Development Goals. We are proud of our partnership with UNAIDS and the Egyptian Ministry of Health. The Netherlands Government is committed to participate in the next step,” said Laurens Westhoff, Ambassador of the Netherlands to Egypt.

As the next step, the Netherlands is finalizing an agreement for a scaled-up three-year project, doubling the number of women living with HIV reached.

“There is no silver bullet to combat HIV. It’s only through partnership that the challenges of awareness, attention and access to medicine can be tackled,” said Seif-Allah Kandeel, Director, United Nations Specialized Agencies, Egyptian Ministry of Foreign Affairs.

Stigma and discrimination and other human rights violations occur in health-care settings worldwide, barring people from accessing health services or enjoying quality health care. Such stigma and discrimination further increases the vulnerability of people living with and affected by HIV.

To discuss this problem, nearly 300 Egyptian medical students, representing 18 universities across Egypt, met with representatives of academia, civil society, the government and the Egyptian Medical Syndicate. With support from UNAIDS, the Egyptian branch of the International Federation of Medical Students’ Associations held a one-day consultation on HIV-related stigma and discrimination in health-care settings on 21 April in Cairo, Egypt.

“People living with HIV should have equal rights and opportunities. Denial of access to health-care services is unacceptable. Through this consultation, we aim to inform our national strategy with new interventions for addressing stigma and discrimination,” said Walid Kamal, the National AIDS Programme Manager for Egypt.

During the consultation, the participants took stock of the progress made in addressing stigma and discrimination and decided to hold an ongoing dialogue to identify actions to address stigma and discrimination in health-care settings.

“We are witnessing an unprecedented opportunity for addressing discrimination in health-care settings with political support and programmatic vision. While resources are scarce, we count on the support of medical students as leaders of tomorrow and the power of volunteerism to address this issue,” said Ahmed Khamis, the UNAIDS Country Manager for Egypt.

The participants agreed that accountability mechanisms need to be in place to monitor and evaluate interventions, ensuring that proper actions are taken by the relevant authorities to address rights violations in health-care settings.

“Medical ethics is a must among health-care providers. The Egyptian Medical Syndicate is organizing workshops and conferences to enforce ethics among health-care providers. I would like to remind you all of the rights of patients,” said Sherine Ghaleb, representative of the Egyptian Medical Syndicate.

The participants agreed to prioritize launching the Ministry of Health and Population’s stigma-free policy and integrating HIV-related stigma and discrimination in the module on ethics taught to all doctors who graduate in Egypt. They also agreed to give access to the accountability and investigation mechanism of the Egyptian Medical Syndicate to civil society organizations and people living with HIV in order to report violations and to roll out information on post-exposure prophylaxis in the curricula of medical schools.

The recommendations made during the consultation were endorsed by the National AIDS Programme and will be included in Egypt’s road map for addressing HIV stigma and discrimination in health-care settings. Progress of the road map will be monitored by a group that includes a strong representation from people living with HIV.

Morocco marks 30 years of its response to HIV in 2018, with much to celebrate. Concerted efforts in the country have resulted in a 42% reduction in new HIV infections since 2010, significantly greater than the decline across the Middle East and North Africa of just 4%. HIV treatment coverage has also increased in the country, from 16% in 2010 to 48% in 2016.

Morocco has also managed to keep HIV prevalence low among the general population (0.1%). However, there are areas of serious concern. Data show that HIV prevalence is high among populations at higher risk of HIV infection, such as female sex workers (1.3%), people who inject drugs (7.9%) and migrants (3%), showing the need to do more to reach key populations with HIV services. Morocco is scaling up efforts to reach key populations through combined prevention programmes, substitution treatment for people who use drugs and increasing HIV testing.

The Executive Director of UNAIDS, Michel Sidibé, visited Morocco to show his support to the 30-year response to HIV. During the visit he met with the President of the National Council of Human Rights (CNDH), the Secretary-General of the Ministry of Health, the Minister of Foreign Affairs and International Cooperation and the United Nations Resident Coordinator and Country Team.

He stressed the importance of the United Nations Country Team’s commitment to United Nations reform and to responding to HIV through the Joint Plan. He noted the importance of having a national strategy on human rights and HIV and congratulated the CNDH as a pioneer in the region. He praised the initiative of the CNDH for carrying out training in human rights and citizenship and highlighted the important role that Morocco can play in efforts to recruit 2 million community health workers in Africa and in encouraging the local production of medicines.

Mr Sidibé congratulated the Minister of Foreign Affairs and International Cooperation on the progress of the AIDS response under the leadership of King Mohammed VI, the government’s partnership with civil society and the increase in domestic funding for HIV.  

Mr Sidibé took part in the opening ceremony of the 12th meeting of the Association for the Fight against AIDS (ALCS) to celebrate the 30-year response. ALCS has been at the forefront of the response to HIV in Morocco, working on prevention for key populations, HIV counselling and testing, psychosocial support, advocacy, resource mobilization and introducing new innovations, including community screening and pre-exposure prophylaxis.

At the end of 2016, there were estimated to be 22 000 people living with HIV in Morocco, fewer than 1000 new HIV infections and fewer than 1000 AIDS-related deaths. UNAIDS is working closely with Morocco to expand innovative approaches to HIV prevention and testing for key populations, expand antiretroviral treatment services and their integration into the health system, implement a road map to eliminate mother-to-child transmission of HIV and implement a strategy for zero discrimination. UNAIDS also coordinates the United Nations Joint Support Plan and works to ensure the availability of strategic information and mobilize and implement grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria.

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A dynamic AIDS response characterized by partnership and passion across all sectors, and prioritizing youth and innovation, was celebrated in Algeria on World AIDS Day.

At a lively World AIDS Day commemoration filled with colour and song held in Algiers, key actors in Algeria’s AIDS response came together to reflect on the county’s successes, consider ongoing challenges and emphasize commitment towards ending AIDS by 2030.

Reacting rapidly to the challenges of HIV, Algeria’s response has consistently prioritized cross-sectoral action, community involvement and evidence and innovation within its strategies and policies. Significant results include a sustained low-level epidemic and free provision of antiretroviral therapy for 90% of people living with HIV.

“Algeria has been a pioneer on AIDS in the region, and the response remains highly dynamic. Continued innovation—particularly through harnessing the power of the young, vibrant population—is maximizing gains made and contributing to broader development and rights outcomes,” said UNAIDS Deputy Executive Director Jan Beagle, who welcomed Algeria as a new member of the UNAIDS governing body, the Programme Coordinating Board, from 2017.

To build on the gains made, Ms Beagle noted areas for increased focus, including: access to services for the prevention of mother-to-child transmission of HIV; greater investment in programmes for key populations; and prioritization of women, girls and young people. “Sustained leadership, integration, evidence and rights-based and people-centred approaches that are adaptable at all stages in the life cycle are needed. Let us build on the progress made and continue to be passionate partners in Algeria’s collective efforts,” she said.

Emphasizing commitment to mobilize an accelerated response towards an AIDS-free generation, Ministry of Health Secretary-General Ali Rezgui said, “Young people are this country’s greatest asset. We must treasure them, listen to them and equip them with education, knowledge and tools to prevent HIV and drive forward Algeria’s AIDS movement.”

“Today we celebrate determination, perseverance and progress driven by a highly multisectoral, inclusive response. This model of joint action is critical for the achievement of the interconnected Sustainable Development Goals,” said Eric Overvest, United Nations Resident Coordinator in Algeria.

Commitment to continued collaboration and dynamism was evident through the active participation of young people at the World AIDS Day celebration. “It’s our dream to protect the world against HIV. With solidarity, prevention and knowledge, together we can end AIDS,” a group of schoolchildren sang loudly and clearly.

At a regional forum focusing on optimizing the demographic dividend in the Middle East and North Africa, lessons learned from the AIDS response were emphasized as critical to guiding investment and efforts for development responses for young people and women.

Representatives of government, international organizations, civil society, the media and others joined together in Algiers, Algeria, for a two-day forum organized by the United Nations Population Fund, the League of Arab States and the Government of Algeria. The forum explored how economic growth, comprehensive education and health and social systems that put young people and women at the centre can result in lower maternal mortality, higher life expectancy and gains across the Sustainable Development Goals.

UNAIDS Deputy Executive Director Jan Beagle opened the forum, emphasizing that the experiences of the multisectoral, multistakeholder and inclusive AIDS response can be leveraged for wide-reaching results.

“By investing in girls and young women, boys and young men at the critical stages in their lives, and building coalitions across sectors, we can end AIDS by 2030 and contribute to broader health, development, rights and gender outcomes in the region,” Ms Beagle said.

Ms Beagle stressed the importance of prioritizing awareness-raising and education among young people, ensuring a specific focus on women and girls and increasing synergies between health and development responses, including for tuberculosis, human papillomavirus and hepatitis C.

To address stigma and discrimination in the region, which hampers access to services, legal and policy environments need to promote change and protect the vulnerable and to enable the effective implementation of laws and policies. “The laws on the books need to be mirrored by the laws on the streets,” Ms Beagle said.

Political commitment for the AIDS response is growing in the region, but challenges persist, including in terms of low treatment coverage, preventing mother-to-child-transmission of HIV and the increase in HIV infections in some communities. The renewed political commitment expressed at the forum can help to counter those challenges. 

Ahmed was dismissed from his job as a plumber for a club in Giza, Egypt, in 2015 after his employer discovered he was living with HIV. Rather than remain silent, Ahmed decided to pursue legal action with the help of the Al Shehab Foundation for Comprehensive Development.

The Al Shehab Foundation is an Egyptian nongovernmental organization that defends the legal rights of marginalized people, including the rights of people living with HIV to work and access education and accommodation without discrimination. The legal action was supported by the International Development Law Organization, which works closely with UNAIDS through a memorandum of understanding.

In a historic decision for Egypt and the region, a court in Cairo ruled in Ahmed’s favour, stating that people living with HIV cannot be dismissed because of their HIV status. The court’s directive, issued in February 2016, stated that employment is a basic human right for all Egyptian citizens, regardless of their health condition, as long as they can still work.

This seminal court ruling has been applauded by civil society, activists and international development organizations engaged in the AIDS response in Egypt and across the Middle East and North Africa. The ruling sets an important legal precedent for future discrimination cases and is consistent with UNAIDS guidance and the Arab AIDS Strategy (2014 – 2020). 

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