As global 2018 targets are unmet, Start Free, Stay Free, AIDS Free report shows that efforts need to focus on the countries falling behind

GENEVA/MEXICO CITY, 22 July 2019—A new report released today at the 10th  IAS Conference on HIV Science in Mexico City, Mexico, shows that the world is lagging behind in its commitment to end the AIDS epidemic among children and adolescents. The report, Start Free, Stay Free, AIDS Free, shows that the pace of progress in reducing new HIV infections among children and expanding access to treatment for children, adolescents and pregnant women living with HIV has slowed significantly and that global targets set for 2018 have been missed, despite important gains being made in some countries.  

Globally, around 160 000 children aged 0–14 years became newly infected with HIV in 2018. This is a major decrease from 240 000 new infections in 2010. However, the bold and important target set for 2018 was fewer than 40 000 new infections.

“The failure to reach the 2018 targets to reduce new HIV infections among children and adolescents and to widen access to life-saving treatment is both disappointing and frustrating,” said Gunilla Carlsson, UNAIDS Executive Director, a.i.  “We need to act quickly to turn this situation around and honour the commitment to end the AIDS epidemic for the next generation.”

Around 82% of pregnant women living with HIV now have access to antiretroviral medicines. There has been considerable progress among countries in eastern and southern Africa, with more than 90% of pregnant women accessing antiretroviral medicines in Ethiopia, Kenya, Uganda, United Republic of Tanzania and Zimbabwe and 95% or higher in Botswana, Malawi, Mozambique, Namibia and Zambia. This has resulted in a 41% reduction in new HIV infections among children, with remarkable reductions achieved in Botswana (85%), Rwanda (83%), Malawi (76%), Namibia (71%), Zimbabwe (69%) and Uganda (65%) since 2010. The progress made by these countries shows what can be achieved through strong political leadership, rapid policy adoption and concerted efforts by all stakeholders.

The report throws light on where gaps need to be filled to prevent new HIV infections occurring among children. For example, in eastern Africa, 10 000 of 26 000 new HIV infections among children in 2018 were the result of women not being retained on treatment throughout pregnancy and breastfeeding. In southern Africa, 17 000 of 53 000 new infections among children were the result of the mother becoming infected with HIV during pregnancy or breastfeeding. A total of 16 000 new infections could have been averted in southern Africa by retaining mothers on treatment throughout pregnancy and breastfeeding. In western and central Africa, almost 27 000 of the 44 000 new infections could have been averted if their mothers had accessed antiretroviral medicines.

“These new data show that many countries have made important progress toward reaching the 2020 targets, and yet others are lagging significantly behind,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “These stark disparities highlight the critical role of political commitment, rapid policy implementation and data-driven investments in accelerating impact.”

Country-level analysis of how mother-to-child transmission of HIV happens can provide vital information to shape national responses.

“Ending AIDS and achieving universal health coverage means leaving no one behind. Yet, too many children and adolescents with HIV are still missing out on the chance to grow up in full health as they can’t access treatment,” said Ren Minghui, the World Health Organization’s Assistant Director-General for Universal Health Coverage/Communicable and Noncommunicable Diseases. “We need to intensify our efforts to and keep our promise to these children.” 

Children living with HIV are also being left behind in HIV treatment scale-up and are not being diagnosed and treated early enough. An estimated 940 000 children aged 0–14 years were accessing treatment in 2018, double the number that were on treatment in 2010 but far short of the target of 1.6 million set for 2018.

Children living with HIV are still less likely to have access to HIV treatment than adults living with HIV, a disparity that is widening in some countries, especially in western and central Africa. As a result, the AIDS epidemic is still claiming the lives of many children aged 0–14 years. Children in this age group comprised 5% of all people living with HIV in 23 focus countries but accounted for 15% of people who died from AIDS-related illnesses in those countries in 2018. 

"We know how to prevent children from contracting HIV, and we know how to prevent the onset of AIDS in children if they do become infected. They need to be tested and linked to care and treatment as a matter of urgency, but we are missing these opportunities,” said Henrietta Fore, Executive Director of the United Nations Children’s Fund. “Knowing what to do is not enough. We must come together and act with renewed commitment to children and adolescents living with HIV and give them the best chance to survive and thrive.”    

For optimal outcomes, children who become infected with HIV must access treatment as quickly as possible. However, in 2018, only 63% of the 1.1 million infants exposed to HIV in the 23 countries worst affected by the epidemic were tested for HIV by the age of two months.

“In many ways, we as a community have settled for a substandard quality of care for children living with HIV,” said Chip Lyons, President and Chief Executive Officer, Elizabeth Glaser Pediatric AIDS Foundation, “We must not allow children to perpetually receive less than the basic standard of care we demand for adults. Especially when the ultimate consequence of that approach is that children and young people are dying of HIV at disproportionally and unacceptably high rates.”

The report also shows that the target of reducing the annual number of new HIV infections among young women and adolescent girls aged 15–24 years to less than 100 000 by 2020 is unlikely to be reached. Globally, new HIV infections among young women and adolescent girls were reduced by 25% between 2010 and 2018, to 310 000. While new HIV infections among adolescent girls and young women aged 15–24 years have declined by over 40% in Botswana, Burundi, Lesotho and South Africa, missing the global target has meant that 6000 adolescent girls and young women are still becoming infected with HIV every week.

The root factors driving the vulnerability of young women and girls to HIV infection are social, structural and behavioural and must be addressed in order to achieve sustainable prevention outcomes. Gender discrimination, gender-based violence, restricted access to opportunities and a lack of tailored services all compound their vulnerability to HIV. Effective responses prioritize an approach combining access to HIV and sexual and reproductive health services with social, structural and behavioural programmes.

“The disparity in viral load suppression rates among adolescents with HIV compared to adults is unacceptable and behoves the global community to advocate for more robust, potent antiretroviral therapy regimens for adolescents as well as to hasten efforts to prevent new infections in this critically vulnerable population,” said Fatima Tsiouris, Deputy Director of the Clinical and Training Unit and Prevention of Mother-to-Child Transmission Lead at ICAP, Columbia University.

The number of voluntary medical male circumcisions undertaken between 2015 and 2018 stood at over 11 million among all age groups, which means that at least 13 million procedures need to be carried out by 2020 in order to reach the target of voluntarily circumcising 25 million men and boys between 2015 and 2020.

UNAIDS and the United States President’s Emergency Plan for AIDS Relief launched the Start Free, Stay Free, AIDS Free framework in 2016 to build on the achievements of the Global Plan towards the elimination of new HIV infections among children by 2015 and keeping their mothers alive, which ended in 2014.      

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, 27 June 2019—UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) have signed a strategic framework for cooperation and collaboration to strengthen and accelerate support to countries’ efforts to end AIDS. The framework outlines the existing, wide-ranging scope of collaboration between the two organizations, and highlights specific areas for enhanced cooperation to help focus efforts and resources where they are needed most.

“The long-standing partnership between UNAIDS and the Global Fund has been instrumental in helping countries to halt and reverse their HIV epidemics,” said Gunilla Carlsson, UNAIDS Executive Director, a.i. “The new framework builds on this successful partnership and will deliver maximum impact for people on the ground, enhance country ownership and sustainability, and Fast-Track progress towards ending AIDS.”

Under the new framework, UNAIDS and the Global Fund will advocate for a more robust response to HIV, support each other’s activities and processes, and continue to provide strategic information, technical support and capacity building to countries. The two organizations will advocate for increased global and domestic funding, work to improve data collection and systems and ensure data is used strategically for decision making and implementation.

“Partnership is in the Global Fund’s DNA, and we will continue to work closely with UNAIDS to step up the fight against HIV and save millions of lives,” said Peter Sands, Executive Director of the Global Fund.

The framework highlights critical areas for enhanced collaboration which include HIV prevention and treatment access, community-led service delivery, gender, rights and community engagement and a special focus on accelerating progress in West and Central Africa. To measure progress towards the enhanced areas for collaboration a results matrix will be established.

UNAIDS will continue to analyse gaps in the response to HIV, support the development of national strategic plans and investment cases and address human rights and gender-related barriers to equitable access to health services. UNAIDS will also ensure that civil society are fully engaged in the response to HIV, particularly communities and key populations most affected by HIV.

The Global Fund will continue to attract, leverage and invest additional resources to end HIV. The Global Fund currently raises and invests nearly US$ 4 billion a year for the responses to HIV, tuberculosis and malaria, to support programmes run by local experts and leaders in countries and communities most in need.

UNAIDS urges donors to fully fund the Global Fund to Fight AIDS, Tuberculosis and Malaria at its sixth replenishment conference taking place in France in October 2019. This will enable countries, civil society and partners to implement an evidence-informed, people-centred and human-rights based response to HIV.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

The Organisation of African First Ladies against HIV/AIDS (OAFLA) has announced that it is to expand its scope of work to incorporate a broader range of development issues affecting the continent. OAFLA has also changed its name, to the Organization of African First Ladies for Development (OAFLAD), and adopted a vision of “A developed Africa with healthy and empowered children, youth and women”.

During its General Assembly, held in Addis Ababa, Ethiopia, on 11 February, the newly established OAFLAD endorsed its 2019–2023 strategic plan, which outlines the key thematic areas that the first ladies will be working on. These include a continued focus on reduction of new HIV infections and AIDS-related mortality, noncommunicable diseases, gender equality, women’s and youth empowerment, reproductive, maternal, newborn and child health, social security and social protection.

In a tribute to Michel Sidibé, the Executive Director of UNAIDS, the First Lady of Burkina Faso and Chair of OAFLAD, Sika Kaboré, said, “What we will remember from Michel Sidibé’s career is that we can reach ambitious targets if we believe in them, if we unite our forces strategically and if we keep our faith in our populations and in the African values of solidarity and sharing.” A number of first ladies added words of support and appreciation for Mr Sidibé’s leadership and engagement over many years, and he was awarded a certificate of appreciation.

“UNAIDS has worked hand in hand with the Organisation of African First Ladies against HIV/AIDS since that very first meeting in 2002. I had the privileged to be there then and I have the privilege to be with you still today. I urge you all to remain committed to ending AIDS, because together we can ensure a better future for our children and young people, and a generation free from AIDS,” said Mr Sidibé.

The first ladies committed to continue to work on one of their flagship campaigns, Free to Shine, a campaign to end AIDS among children, adolescents and young people and keep mothers healthy. To date, the campaign has been launched in 15 countries across Africa, many having integrated the campaign into their national HIV plans. UNAIDS is providing further funding to launch Free to Shine in Zimbabwe and Sierra Leone, with roll-out starting in 2019. 

The Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) presented its Sixth Replenishment Investment Case to donors and partners at a meeting held in New Delhi, India, on 8 February. The Investment Case calls for US$ 14 billion to be invested over three years to help save 16 million lives through programmes for HIV, tuberculosis and malaria.

The Global Fund estimates that investing today will cut the mortality rate for the three diseases in half and build stronger health systems by 2023. Full funding would enable the Global Fund to continue playing a critical role in the response to HIV, tuberculosis and malaria, accelerating progress towards universal health coverage and achieving the Sustainable Development Goals.

“Only with a fully funded Global Fund to Fight AIDS, Tuberculosis and Malaria can we reach the global targets set for HIV, tuberculosis and malaria,” said Tim Martineau, Deputy Executive Director of UNAIDS, Programme, ai. “UNAIDS is committed to continuing to work with the Global Fund to ensure that it meets its financial targets so that countries can end AIDS as a global health threat and save more lives.”

The Global Fund’s Sixth Replenishment target of US$ 14 billion represents an increase of US$ 1.8 billion, or 15%, more than the US$ 12.2 billion raised during the Fifth Replenishment period.

UNAIDS will continue to strengthen its long-established partnership with the Global Fund to maximize the impact of the investments, accelerate inclusive people-centred responses and end AIDS as public health threat by 2030.

UNAIDS estimates that US$ 26.2 billion will be required for the AIDS response in 2020. In 2017, US$ 21.3 billion was available for the AIDS response in low- and middle-income countries, a shortfall of US$ 5 billion. UNAIDS urges both donors and funding from domestic sources to be scaled up to fill the gaps and end the HIV, tuberculosis and malaria epidemics by 2030 as part of Sustainable Development Goal 3.

Together, UNAIDS and the Global Fund have ensured that millions of people living with HIV have access to treatment and that the people most affected by the epidemic have the health and support services they need.

First announced during the 2003 State of the Union Address by the then President, George W. Bush, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) is celebrating its 15th anniversary in 2018. Over the past 15 years, PEPFAR has dramatically changed the landscape of the global response to HIV, and bipartisan support across successive administrations since its launch has continued to ensure that PEPFAR expands it work towards controlling the AIDS epidemic.

Launched with an initial budget of US$ 15 billion over its first five years, PEPFAR has gone on to commit US$ 70 billion to the AIDS response. The funding has had remarkable results: in 2017, PEPFAR was supporting 13.3 million of the 21.7 million people living with HIV on treatment, including 1 million children, and in May 2018 announced that more than 14 million were on treatment.

PEPFAR has funded major HIV prevention programmes. The preventative effect of voluntary medical male circumcision on HIV transmission has been ramped up by funding more than 15.2 million circumcisions since 2003. Prevention of mother-to-child transmission of HIV services have ensured that 2.2 million babies have been born HIV-free, while 85.5 million people have accessed HIV testing services, allowing the people taking the tests to start on treatment or access HIV prevention services to stay HIV-free.

PEPFAR’s work with children orphaned or otherwise made vulnerable by HIV resulted in more than 6.4 million children being supported by PEPFAR in 2017, while the PEPFAR DREAMS programme saw new HIV infections among adolescent girls and young women drop by 25–40% in those locations in which the programme was implemented.

On 27 September PEPFAR published its 2018 progress report, showing the progress made one year into its 2017–2020 strategy. PEPFAR supports the AIDS response in 53 countries—of those, 13 are already on track to control their HIV epidemics by 2020, while many more could still do so through scaling up resources and policies to ensure access to HIV prevention and treatment services.

“The contributions of PEPFAR have transformed the lives of people living with or affected by HIV around the world,” said Michel Sidibé, Executive Director of UNAIDS. “We are very proud of our longstanding partnership and look forward to continuing to work closely together to deliver results for men, women and children, particularly the most marginalized.”

Faith-based organizations have long played a critical role in the response to tuberculosis (TB). Many faith-based health service providers have implemented effective TB/HIV responses modelled on decades of work on TB. Today, faith-based organizations are delivering effective, high-quality TB/HIV services that complement national public health programmes in the countries most affected by TB and HIV.

Successful TB/HIV responses address both the biomedical and the social determinants that underpin these illnesses, such as poverty, inequality, situations of conflict and crisis, compromised human rights and criminalization. Children and adolescents are particularly vulnerable to infection and the impact of TB/HIV on their families. Because they have positions of trust at the heart of communities, faith-based organizations can provide services and support that extend beyond the reach of many public sector health systems.

To provide an opportunity to strengthen relationships and forge new partnerships, on 27 September the World Council of Churches–Ecumenical Advocacy Alliance, in collaboration with UNAIDS, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the United Nations Interagency Task Force on Religion and Development, hosted an interfaith prayer breakfast on the sidelines of the 73rd Session of the United Nations General Assembly in New York, United States of America. Keynote speakers and table discussions focused on the outcomes of the United Nations High-Level Meeting on Tuberculosis, which took place on 26 September, and examined how the longstanding experience of faith-based organizations in responding to TB/HIV can support the new declarations agreed by Member States during the historic high-level meeting.

The participants included faith leaders and health service providers from different religious traditions. Survivors of multidrug-resistant TB brought a powerful sense of urgency and reality to the discussion. The participants renewed their call to national governments to not only maintain, but increase, support in order to end AIDS and TB as public health threats by 2030.

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A new US$ 30 million partnership to help end cervical cancer led by the United States President’s Emergency Plan for AIDS Relief (PEPFAR), the George W. Bush Institute and UNAIDS will accelerate life-saving efforts in eight African countries.

Studies show that women living with HIV are four to five times more likely to develop invasive cervical cancer. However, the disease is preventable through screening and early treatment of precancerous lesions. Early detection and treatment of cervical cancer can dramatically increase a woman’s chance of survival—women with preinvasive lesions have a five-year survival rate of nearly 100%.

Because of the high prevalence of HIV in sub-Saharan Africa, and because women in sub-Saharan Africa are not screened or treated as early or frequently as women in other parts of the world, cervical cancer remains the number one cancer killer of women in the region.

To address the disproportionate risk of cervical cancer among women living with HIV and the need for increased rates of screening and treatment in sub-Saharan Africa, PEPFAR the George W. Bush Institute and UNAIDS recently announced a new partnership—the Partnership to End AIDS and Cervical Cancer—designed to effectively eliminate cervical cancer deaths among women living with HIV in sub-Saharan Africa within a generation. The partnership will build on successful efforts over the past seven years of the Pink Ribbon Red Ribbon initiative and, pending Congressional approval, will be supported by an initial investment of US$ 30 million from PEPFAR.

“When we confront suffering—when we save lives—we breath hope into devastated populations, strengthen and stabilize society, and make our country and the world safer,” said President George W. Bush. “This week, we are announcing the next phase of our partnership with the United States President’s Emergency Plan for AIDS Relief and UNAIDS: a plan to effectively eliminate cervical cancer amongst HIV-positive women within a generation.”

The partnership will focus its work in eight sub-Saharan African countries where the burdens of HIV and cervical cancer are high—Botswana, Lesotho, Malawi, Mozambique, Namibia, Swaziland, Zambia and Zimbabwe. There are about 6 million women living with HIV in those eight countries. More than 100 000 women are diagnosed annually with cervical cancer in sub-Saharan Africa.

“The partnership will allow us to screen for, and treat, precancerous lesions among women living with HIV like never before,” said Michel Sidibé, the Executive Director of UNAIDS. “The partnership’s new strategy, which includes cervical cancer screening every two years for women living with HIV over the age of 30 years, aims to reduce cervical cancer incidence by 95% among this population in eight sub-Saharan African countries.”

The partnership will engage with governments in each of the countries to ensure that women and girls living with HIV are a priority in national cervical cancer prevention and control programmes. It will also leverage the powerful advocacy of first ladies, ministers, civil society, global health leaders and funders to improve implementation efforts and speed progress against the goal of eliminating cervical cancer.

“Thanks to the generosity of the American people, the United States President’s Emergency Plan for AIDS Relief has saved the lives of millions of HIV-positive women around the world,” said Deborah Birx, United States Global AIDS Coordinator and Special Representative for Global Health Diplomacy. “We must ensure these same women—mothers, daughters, aunts, and grandmothers—who are living with HIV and thriving do not succumb to cervical cancer.”

The new partnership builds on the successful efforts of the Pink Ribbon Red Ribbon initiative. Since its inception in 2011, Pink Ribbon Red Ribbon and its partners have screened more than half a million women for cervical cancer in Botswana, Ethiopia, the United Republic of Tanzania and Zambia, treated almost 32 000 women for precancerous lesions and vaccinated almost 150 000 girls aged 9–13 years against human papillomavirus type 2.

First ladies across Africa are spearheading a campaign to stop children acquiring HIV, prevent AIDS-related deaths and keep mothers healthy across Africa.

The Free to Shine campaign was launched by the Organisation of African First Ladies Against HIV/AIDS (OAFLA) and the African Union on the sidelines of the 30th Ordinary Session of the African Union in Addis Ababa, Ethiopia. It was launched during OAFLA’s annual General Assembly, which this year included 20 first ladies from across Africa, joining under the theme of “Transforming Africa through prioritizing children, adolescents and mothers in the fight against HIV”.  

The Free to Shine initiative was inspired by the progress and commitment from across Africa on stopping new HIV infections among children and aims to build on this progress by uniting people and organizations at the local and global levels to advance progress in ensuring access to HIV services to end AIDS among children and keep mothers healthy.

The campaign’s goals include improving maternal and childhood HIV programmes across Africa by building networks and partnerships, advocating for domestic and global resource mobilization, raising awareness around HIV prevention and mobilizing support for childhood AIDS programmes in Africa by working with high-level international and regional bodies and forums.

The Free to Shine campaign, led by OAFLA and the African Union, is supported by UNAIDS, the World Health Organization, Abbott, the Elizabeth Glaser Pediatric AIDS Foundation, the United Nations Children's Fund, the United Nations Development Programme and AIDS Accountability International.

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New results from the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced on World AIDS Day 2017 show strong advances in scaling up HIV prevention and treatment.

UNAIDS recently reported that nearly 21 million people living with HIV are accessing antiretroviral therapy—more than half of the 36.7 million people living with HIV are now on life-saving treatment. PEPFAR’s latest data show that PEPFAR supported more than 13.3 million of those men, women and children.

PEPFAR’s new data also indicate that there have been significant declines in new HIV infections among adolescent girls and young women. In the 63 districts of 10 African countries implementing PEPFAR’s pioneering DREAMS (Determined, Resilient, Empowered, AIDS-free, Mentored and Safe) public–private partnership, the majority (65%) of the highest HIV burden communities or districts achieved a greater than 25% decline in new HIV infections among adolescent girls and young women. ‎Importantly, new HIV infections declined in nearly all DREAMS programme districts.

By the end of September 2017, PEPFAR had provided voluntary medical male circumcision to more than 15.2 million men and boys. This result was reached through the largest single-year increase (3.4 million) in new voluntary medical male circumcisions since the beginning of PEPFAR.

PEPFAR has supported more than 6.4 million orphans and other vulnerable children and their caregivers affected by HIV and has prevented HIV infection among 2.2 million babies born to women living with HIV.

The new data add to PEPFAR’s impact results released in the past year, which show that five African countries are approaching control of their HIV epidemics. They also highlight critical advances being made under the PEPFAR Strategy for Accelerating HIV/AIDS Epidemic Control (2017–2020), which was launched by United States Secretary of State Rex Tillerson at the 2017 United Nations General Assembly.

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GENEVA, 14 November 2017—UNAIDS welcomes the appointment of Peter Sands as the new Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

“The Global Fund is a critical partner for UNAIDS,” said Michel Sidibé, Executive Director of UNAIDS. “Mr Sands has the experience, leadership and vision needed to do the job and I very much look forward to working with him to improve the lives of millions of people around the world.”

UNAIDS has worked closely with the Global Fund since its inception in 2002. UNAIDS leverages its relationships and partnerships to assist countries in securing Global Fund resources, implementing grant programmes and overcoming bottlenecks. The Global Fund, in collaboration with other donors and governments, secures the resources to implement effective responses to HIV, tuberculosis and malaria.

Together, UNAIDS and the Global Fund have ensured that millions of people living with HIV have access to treatment and that people most affected by the epidemic have the health and support services they 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.