National responses

GENEVA/MONACO, 11 April 2024— Winnie Byanyima, the Executive Director of UNAIDS—the organization leading the global fight against AIDS—met with HSH Prince Albert II of Monaco and HSH Princess Stéphanie of Monaco and government officials to strengthen Monaco’s collaboration with UNAIDS.

“Monaco is a long-standing and valued partner of UNAIDS. We continue to work together on our broad programme and also in key countries,” said Ms Byanyima. “What we particularly value is how Monaco shows such innovation in fighting HIV, and we learn from each other.”

During a visit to the Fight AIDS Monaco Association, Ms Byanyima and HSH Princess Stéphanie and Ms Byanyima met with volunteers, staff and members of the Association. Fight AIDS Monaco, founded in 2004 by Princess Stéphanie, supports people living with and affected by HIV in Monaco and the neighbouring area. They also fund projects in Madagascar, Burundi, South Africa, Mauritius, and more exceptionally Ukraine, Lebanon and Morocco.

“My heartfelt congratulations to the Fight AIDS Monaco team, celebrating your 20^th year – an important milestone- and one that shows your sustained commitment to ending AIDS,” said Ms Byanyima. “It is organizations like yours that make a difference for people’s overall well-being: a safe space to share, kindness and compassion when it is most needed.”

As they gathered around an AIDS memorial quilt, Princess Stéphanie said, “We are a small country, but we can achieve great things.” She then added, “Our foundation is a place where everyone is treated with dignity and without judgement. Fight AIDS Monaco is about giving life.”

Ms Byanyima also thanked Princess Stéphanie for her unwavering engagement as a UNAIDS Goodwill Ambassador and expressed her appreciation for the Princess’s work to address HIV-related stigma and discrimination.

Despite huge progress in the HIV response, globally AIDS still claimed a life every minute in 2022. Monaco’s Minister of Social Affairs and Health, Christophe Robino, stressed that his government’s low cases of new HIV infections was a victory but one not to be taken for granted.

“This is a cause that we need to tackle daily and one day we will be able to end AIDS but we must keep talking about it while it still exists,” Mr Robino said.

Since 1988, Monaco has been implementing an integrated policy on ending HIV as a public health threat. The policy has resulted in free, anonymous HIV screening centres as well as prevention and testing campaigns in schools and businesses. 

Earlier during her visit, Ms Byanyima had a working meeting with representatives from the Monegasque government and Fight AIDS Monaco.

Isabelle Berro Amedei, Minister of External Relations and Cooperation said, “Health is one of Monaco’s priorities and that includes the fight against HIV in partner countries. We lead cooperation efforts to support countries where HIV prevalence is high like South Africa, Madagascar and Mozambique.”

Monaco signed a framework agreement with UNAIDS in 2007 and has provided support for UNAIDS work in Haiti (2010-2013), Burundi (2014-2016) and South Africa since 2017. The government of Monaco, Fight AIDS Monaco and UNAIDS vowed to continue their close collaboration on ending AIDS and reiterated their commitment to the Global AIDS Strategy 2021-2026 focusing on ending inequalities to end AIDS.  

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.

FIGHT AIDS MONACO

Founded in 2004 by Princess Stéphanie of Monaco, Fight AIDS Monaco is a non-profit organization that helps people living with HIV. It also raises awareness about HIV prevention in schools and supports access to treatment and services in countries like Madagascar, Burundi, Mauritius and Ukraine. 

Two years of war in Ukraine have resulted in significant humanitarian consequences. Forty percent of the current population of Ukraine,14.6 million people, are in need of humanitarian assistance, 6.4 million refugees have fled the country, and more than 3 million people are internally displaced. People living with and affected by HIV continue to be vulnerable to the effects of the war, even as HIV services have been restored and are functional in most parts of the country.

Russian strikes have continued to wreak havoc on Ukrainian cities, causing death and destruction, impacting access to water, electricity, heating, and health services for millions of civilians.

In addition, there have been 1,570 attacks on health facilities and 630 health facilities damaged.

According to the latest data from The Ukrainian Public Health Center, prior to the war, Ukraine had made significant progress in reducing HIV incidence (-47%) and AIDS-related mortality (-81%) since 2010. Despite the initial disruption to the national AIDS response at the onset of the war, the national AIDS program has gradually resumed routine operations.

As of the end of 2023, the number of patients on antiretroviral therapy (ART) was only slightly below the pre-war figure, standing at 118,348 (130,724 as of February 2022). Additionally, approximately seven thousand patients are known to receive ART abroad. In the last two years, the number of patients on opioid agonist therapy (OAT) increased by 38%, reaching 27,511 people. Pre-exposure prophylaxis (PrEP) more than doubled, reaching 12,354 people.

However, in eastern and southern occupied territories data is incomplete or not available. This is true of Donetsk, Luhansk, Zaporizhzhia, Kherson regions, AR Crimea, and the city of Sevastopol. The same occurred in 2023.  Despite these challenges, the surveillance system in the government-controlled areas remains operational, ensuring the completeness and quality of data on HIV prevention, testing and treatment services.

In addition, 9.6 million people in Ukraine are estimated to be at risk of or living with a mental health condition, and 3.9 million people are estimated to suffer from moderate to severe symptoms. And there has been an increase in gender-based violence.

Ukraine remains committed to the HIV response through a strong coalition of government, civil society, international organizations, and donors, first and foremost The United States President's Emergency Plan for AIDS Relief (PEPFAR) and The Global Fund to Fight AIDS, Tuberculosis, and Malaria. This collaboration has secured vital supplies of antiretroviral therapy (ARV), tuberculosis medicines, and opioid agonist therapy (OAT), ensuring uninterrupted HIV treatment and services.

UNAIDS Secretariat, Co-sponsors and UN agencies have joined forces to provide a unified response, ensuring that vulnerable populations, including those on the frontline and in the most severely affected areas, receive comprehensive support. This collaborative effort aims to bridge gaps and address the unique challenges faced by women, people living with HIV and key populations, including the delivery of crucial humanitarian aid and HIV services.

The past two years have been very challenging. Even though the country has managed to maintain HIV services, the unpredictability of what lies ahead has many fearing the worst. Support is needed to ensure sustainability of the AIDS response and to protect key populations affected by the enduring hardships of war.

For more information and more in-depth analysis, read the Situation Report (February 2024)

GENEVA, 5 February 2024—It is with profound sadness that UNAIDS learns of the passing of Dr Hage G. Geingob, President of the Republic of Namibia. President Geingob was a distinguished leader, a tireless advocate for social justice, and a steadfast supporter of efforts to end AIDS.

The Executive Director of UNAIDS, Winnie Byanyima, expressed her deep condolences, stating, "I am deeply saddened by the news of the passing of President Geingob. He was a true people’s leader, a leader I admired and whose guidance I benefitted from. My heart goes out to his family, especially his wife Monica Geingos, the First Lady of Namibia. Africa has lost a giant son. May he rest in peace.”

President Geingob was not only a statesman who was instrumental in the anti-apartheid movement, he was also a compassionate leader who was dedicated to improving the health and wellbeing of the people of Namibia and around the world. Most recently he proposed doubling the value of the cash transfers the Government of Namibia gives monthly to poor and vulnerable Namibians. He was a pan-Africanist leader who was committed to peace, democracy and a united Africa.

President Geingob's dedication to addressing the challenges posed by HIV and to fight inequality were evident throughout his tenure. Under his leadership, Namibia made significant strides in the fight against the HIV epidemic, creating a supportive legal and policy environment.

He positioned the Government of Namibia among the global AIDS leaders, funding more than 70% of the country’s HIV care and treatment from domestic resources. He helped lead global efforts to accelerate actions on Sustainable Development Goal 10 – Reducing Inequalities. Locally, he engaged communities and implemented effective strategies to prevent new infections and provide care and support to people affected by the virus.

UNAIDS acknowledges President Geingob's pivotal role in advancing the global AIDS response, both through his leadership within Namibia and his contributions to international collaborations. His efforts have left an indelible mark on the fight against AIDS, and his vision of ending AIDS in Namibia and across the world will continue to inspire the work of UNAIDS and its partners.

The entire UNAIDS family extends its deepest sympathies to his family, friends, and the people of Namibia during this difficult time. We honour President Geingob's memory and remain steadfast in our commitment to ensure that the progress achieved in the AIDS response continues to benefit people most in need.

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.

GENEVA, 13 July 2023—A new report released today by UNAIDS shows that there is a clear path that ends AIDS. This path will also help prepare for and tackle future pandemics and advance progress towards achieving the Sustainable Development Goals. The report, ‘The Path that Ends AIDS’, contains data and case studies which highlight that ending AIDS is a political and financial choice, and that the countries and leaders who are already following the path are achieving extraordinary results.

Botswana, Eswatini, Rwanda, the United Republic of Tanzania, and Zimbabwe have already achieved the “95-95-95” targets. That means 95% of the people who are living with HIV knowing their HIV status, 95% of the people who know that they are living with HIV being on lifesaving antiretroviral treatment, and 95% of people who are on treatment being virally suppressed. A further 16 other countries, eight of them in sub-Saharan Africa, the region which accounts for 65% of all people living with HIV, are also close to doing so.

“The end of AIDS is an opportunity for a uniquely powerful legacy for today’s leaders,” said Winnie Byanyima, Executive Director of UNAIDS. “They could be remembered by future generations as those who put a stop to the world’s deadliest pandemic. They could save millions of lives and protect the health of everyone. They could show what leadership can do.”

The report highlights that HIV responses succeed when they are anchored in strong political leadership. This means following the data, science, and evidence; tackling the inequalities holding back progress; enabling communities and civil society organizations in their vital role in the response; and ensuring sufficient and sustainable funding.

Progress has been strongest in the countries and regions that have the most financial investments, such as in eastern and southern Africa where new HIV infections have been reduced by 57% since 2010.

Thanks to support for and investment in ending AIDS among children, 82% of pregnant and breastfeeding women living with HIV globally were accessing antiretroviral treatment in 2022, up from 46% in 2010. This has led to a 58% reduction in new HIV infections among children from 2010 to 2022, the lowest number since the 1980’s.

Progress in the HIV response has been strengthened by ensuring that legal and policy frameworks do not undermine human rights, but enable and protect them. Several countries removed harmful laws in 2022 and 2023, including five (Antigua and Barbuda, the Cook Islands, Barbados, Saint Kitts and Nevis, and Singapore) that have decriminalized same-sex sexual relations.

The number of people on antiretroviral treatment worldwide rose almost fourfold, from 7.7 million in 2010 to 29.8 million in 2022.

However, the report also sets out that ending AIDS will not come automatically. AIDS claimed a life every minute in 2022. Around 9.2 million people still miss out on treatment, including 660 000 children living with HIV.

Women and girls are still disproportionately affected, particularly in sub-Saharan Africa. Globally, 4,000 young women and girls became infected with HIV every week in 2022. Only 42% of districts with HIV incidence over 0.3% in sub-Saharan Africa are currently covered with dedicated HIV prevention programmes for adolescent girls and young women.

Almost one quarter (23%) of new HIV infections were in Asia and the Pacific where new infections are rising alarmingly in some countries. Steep increases in new infections are continuing in eastern Europe and central Asia (a rise of 49% since 2010) and in the Middle East and North Africa (a rise of 61% since 2010). These trends are due primarily to a lack of HIV prevention services for marginalized and key populations and the barriers posed by punitive laws and social discrimination.

Funding for HIV also declined in 2022 from both international and domestic sources, falling back to the same level as in 2013. Funding amounted to US$ 20.8 billion in 2022, far short of the US$ 29.3 billion needed by 2025.

There is an opportunity now to end AIDS by increasing political will by investing in a sustainable response to HIV through financing what matters most: evidence-based HIV prevention and treatment, health systems integration, non- discriminatory laws, gender equality, and empowered community networks.

“We are hopeful, but it is not the relaxed optimism that might come if all was heading as it should be. It is, instead, a hope rooted in seeing the opportunity for success, an opportunity that is dependent on action,” said Ms Byanyima. “The facts and figures shared in this report do not show that as a world we are already on the path, they show that we can be. The way is clear.”

In 2022, an estimated:

• 39.0 million people globally were living with HIV
• 29.8 million people were accessing antiretroviral therapy
• 1.3 million people became newly infected with HIV
• 630 000 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.

In 1988, a group of activists came together in Fortaleza, the fifth largest city in Brazil and capital of Northeastern state of Ceará, to create the local chapter of the National Network of People Living with HIV and AIDS (RNP+CE). The aim was to ensure that people living with HIV could be guaranteed the right to care, treatment adherence, and legal assistance.

Currently, the NGO (Non-Government Organizations) also offers educational workshops, support for the combination prevention of sexually transmitted infections (STIs), and other activities for more than 1,000 registered people. Among them is Carlos Salmão, an HIV activist living in Fortaleza, who felt individually and collectively welcomed by the organization. "This support was very important to me and is fundamental for people living with HIV here in Ceará because it is a reference of the response to the AIDS epidemic. That is why I feel pleasure in contributing", he explains.

The RNP+CE was one of five Brazilian NGOs that received resources from the Fast-track Cities grants initiative, launched by UNAIDS in 2022. With the award, the organization developed actions around two objectives: increasing linkage and adherence of vulnerable key-populations to HIV prevention, diagnosis, and treatment by disseminating and sharing information with health professionals as well as the general public; and improving the knowledge of the Undetectable Equals Untransmittable (U = U) strategy in the city of Fortaleza by carrying out communication campaigns.

Project actions and participation of municipal government

The project involved 10 local HIV-positive activists in the development and implementation of the communication campaigns. They also were involved in preparing a seminar that brought together 120 people from civil society to dialogue about and to present to municipal government representatives proposals to improve the care for people living with HIV, based on the perspectives and actual needs of the users of public health services in Fortaleza. An additional theme of discussion was the challenges and the importance of guaranteeing a satisfactory level of adherence to HIV treatment to avoid abandonment.

Still as part of the project, a booklet on HIV, self-esteem and health was produced and distributed, providing practical information for people who receive a positive diagnosis for HIV. Additionally, in coordination with the municipal government, RNP + CE printed and distributed more than 3,000 copies of posters on HIV treatment adherence and on U = U. This material was displayed in places with high concentrations of people, such as bus terminals, reaching about 1.1 million people daily.

Participation of local government officials was a strategic element to the project’s success, as they are in direct contact with reality and the existing challenges. "We are still far from reaching an ideal level where there is less need to reinforce these [HIV] actions, but we are advancing in this direction through constant and well-structured work", says Carlos Paiva, coordinator of IST/AIDS at the Municipal Health Secretariat of Fortaleza.

Ariadne Ribeiro, UNAIDS Officer for Equality and Rights for All People, agrees and adds: "It is rewarding to see how the dialogue between communities, civil society, and the municipal government is moving towards a common goal, which is the improvement of public policies in the city of Fortaleza for people living with HIV and to end AIDS as a threat to public health."

Member States of the Association of Southeast Asian Nations (ASEAN) have reaffirmed their commitment to accelerate progress toward ending AIDS as a public health threat by 2030.

At the 40th and 41st ASEAN Summits under the Chairmanship of the Kingdom of Cambodia, Member States pledged to strengthen community-led responses and increase financing for the HIV response. Echoing the World AIDS Day call to “equalize” the AIDS response, country leaders also agreed to a comprehensive agenda to end the inequalities stalling progress.

The ASEAN Leaders’ Declaration on Ending Inequalities and Getting on Track to End AIDS by 2030 is aligned with the 2021 UN Political Declaration on HIV and AIDS and the 2021–2026 Global AIDS Strategy and targets.

"We are now in an era where treatment and various options on HIV prevention can be made available and accessible, and it is important to shine a light on where inequalities and gaps continue to persist if ASEAN is to sustainably accomplish these targets,” said H.E. Ieng Mouly, Senior Minister and Chair of Cambodia’s National AIDS Authority.

In 2021 there were an estimated 1.9 million people living with HIV in ASEAN countries and an estimated 78,000 new HIV infections. In most ASEAN countries there are now rising epidemics among young gay men and other men who have sex with men and transgender people.

“Wherever communities are being left behind, ASEAN remains vulnerable to the social and economic fallout of HIV,” said UNAIDS Asia Pacific Regional Director, Taoufik Bakkali. “This Declaration is important and timely. It paves the way for countries to comprehensively address the large gaps in service coverage that remain in several countries, particularly for key populations.”

The ASEAN Declaration calls for focus on key and marginalized populations and explicitly addresses the needs of people living with HIV, men who have sex with men, transgender people, people who inject drugs, sex workers and their partners. It contains wide-ranging commitments, including concrete strategies to achieve the 95-95-95 testing and treatment targets. (By 2025, 95% of people living with HIV in all countries and communities to be aware of their status, 95% of all diagnosed people on treatment and 95% of those on treatment achieving viral suppression.)

End inequalities

ASEAN states have committed to better facilitate the participation of people living with HIV. They pledged to remove barriers to HIV services by improving policy and legal environments. This includes taking steps to reform discriminatory and punitive laws such as those that criminalize key populations and block adolescents from accessing HIV prevention, testing and treatment, and restrict the entry, stay, and residence of people living with HIV. Countries further agreed to take steps to eliminate stigma and discrimination against people living with HIV and key populations in healthcare, education, and workplace settings, as well as in communities.

Strengthen, support and sustain community-led responses

Governments said they would ensure the inclusion of people living with HIV, and communities most affected by HIV, in AIDS response planning, implementation and evaluation. Community organizations, and particularly community- and peer-led interventions, should be strengthened and scaled-up. States agreed to continue investing in community-led service delivery, including by adopting and implementing social contracting policies. They also promised to support community-led monitoring and research.

Finance and sustain the AIDS response

The alliance agreed to address HIV response financing shortfalls by raising sufficient domestic and international financial resources to fill gaps. At the same time, they committed to developing and implementing plans to transition from external to domestic funding.  They promised to work to improve efficiency in the use of existing financial resources, including through integration with health and humanitarian responses and universal health coverage mechanisms. They also agreed to regional cooperation for research, sharing good practices, joint interventions and to strategize for improved access to health commodities.

Grace Amodu was 7 years old when she found out she was living with HIV. Until then she had been told to take pills daily for malaria or for headaches but she grew tired of it. Screaming and kicking she told her brother that she was going to stop taking her medicine and that she wanted answers. Her mother took her aside and explained that she was born with HIV and that the treatment would keep her healthy like other kids.

She remembers crying a lot and refusing to leave the house.

To keep her from spiraling out of control her mom encouraged her to join a support group, which she says turned her life around.

As she proudly says she has two children who are both free of HIV. Taking her medication at the same time every day throughout her pregnancy and afterwards meant she was not going to transmit HIV to her babies. "When you take medicine it suppresses the virus and even though I feared my children may have HIV they both tested negative.”

She credits International Community of Women Living with HIV (ICW) Nigeria chapter for giving her hope and confidence.

“ICW was like a backbone, they were there for me like the colleagues, everyone around was standing for me, even the boss, Assumpta Reginald, was like a mother figure to me,” Ms Amodu said. “She held me by the hand telling me that, ‘You can do this and you can become a better person.’

As a result, Ms Amodu has become an HIV advocate and a community pharmacist.

"We go to the hospital and get medicine for people and give them to patients who are maybe not able to access their drugs because they have no transport fare or they are far away or due to the stigma in the hospital they don’t want to come to have nurses and doctors shout at them so we take these drugs down to their doorstep and give it to them,” she explained.

More than 90% of people living with HIV in Nigeria are on antiretroviral medicine but stigma and discrimination are still rampant.

For Ms Amodu the solution is simple. Give people the right information about HIV to break the cycle.

“We need to make people understand that you being HIV positive is not making you less of a human, you are also a human being and you deserve equal rights,” the 28-year-old said.

Stella Ebeh knows all about stigma. She started volunteering in 2004 helping people living with HIV like herself. Then she started working in a health center and became a public health officer. Over the years Ms Ebeh said she has cared for more than 7000 patients and also became a mentor-mother (giving HIV advice to pregnant women and counselling), and an anti-stigma ambassador.

She is very proud of overcoming stigma and as she called it, “walking on it,” but despairs that she is still not a full-time staff member. People living with HIV are very capable and yet we are often overlooked she said, adding, “I work like an elephant but eat like a rat.”

Patients pour in and out of the Marabara health centre on the outskirts of Abuja all day. Ms Ebeh goes from one person to another. She lingers a while with a pregnant woman who also prepares lunch on the premises, Ngozi Blessing.

Ms Ebeh insists on pregnant women taking all the precautions they can to give birth to healthy babies. Her husband and their five children are all HIV negative. Sadly, in Nigeria this is an exception.

Vertical transmission is 25% in the country - that is when a mother passes on the virus to her child during pregnancy or breastfeeding- a record high in the region.

UNAIDS Country Director Leopold Zekeng says this is unacceptable. For him it is a demonstration of the inequalities in terms of access to services.

“Two thirds of the 8 million women who get pregnant every year in Nigeria do not have access to PMTCT (prevention between mother to child transmission of HIV) services during ante-natal care,” he said.  

This is why Nigeria and UN organizations along with other partners are spearheading an effort to end AIDS in children.

Dr Akudo Ikpeazu, Director and National Coordinator, National AIDS and STDs Control Programme (NASCP) said that in the last 2 years they have done an enormous amount of work first trying to get a mapping to understand where all the women are having babies and where they receive ante-natal care if at all.

“A lot of them are in birth homes, they go to traditional birth attendants and many deliver at home and receive services at home and so we have a got new strategy which aims to find them where they are, ensure that they are treated, ensure that we can find them first, ensure that we can  test them, link them into treatment and count every single one that has gained access to care,” she said.

In other words, find all, test all, treat all and report all which happens to be Nigeria’s slogan encapsulating their strategy.

Once that vertical transmission tap, as she called it, is closed, then there will be a smaller pool of children to look after regarding treatment. Dr Ikpeazu said Nigeria intends to put in place an acceleration plan to have more children and adolescents on treatment and push for them to stay on treatment.

For Toyin Chukwuduzie, Director of Education as a Vaccine (EVA), HIV is one part of a larger equation.

“We see the number of unintended pregnancies, we see the burden of HIV especially among  adolescent girls, we also see the sexual and gender based violence happening in our society so these things are in existence, these things are happening, yet adolescents and young people don’t have the information they need to make decisions whether we are talking about schools, whether we are talking about health facilities or even in the homes where there are other adults so there are huge gaps,” she said.

The 35-year-old works with young people to fill those education gaps and build support. She is convinced that a main driver of these gaping holes are inequalities, one in particular.  

"I believe gender inequality is the root cause of many other inequalities so if had a magic wand gender inequality would be the one I would address the first because it’s key,” she said. “Addressing gender inequality is key to unlocking potential, potential of women and girls everywhere in this country.”

Hammering in her point, she added that despite everyone stressing the fact that young people are the force of the future Ms Chukwudize said, "If you are not providing that safe environment, if they are not healthy, if their dreams and aspirations are thrown off the path, how do they become the future that we want to see.”