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Now 43 years old, Ariadne Ribeiro Ferreira, a trans woman working for UNAIDS in Brazil, advocates to leaders and speaks to media around the world. As she is an inspiration to colleagues, many are keen to learn more about Ariadne’s story.

From a young age, Ariadne sensed that she was different from those around her. “When my sister arrived, I understood, as a child, that I was like her,” Ariadne recalls.

Ariadne's situation, already challenging, became dangerous when her mother remarried. “My stepfather would beat me almost every day, berating me for my lifestyle,”  she recalls.

At just 13, Ariadne was forced to flee her home. "I had no choice," she remembers. Despite these difficulties, she was fortunate to have a caring grandmother who took her in and provided support. “My grandmother was different from the rest of the family. She was like a teacher to me,” Ariadne reflects. Her grandma had a transgender friend named Zeze, an activist who also inspired her.

At the age of eighteen while living with her grandmother, Ariadne’s life took a turn when she heard on the radio that a local hospital would begin offering sex change surgeries with state support. “My grandma was overjoyed at the news and danced for me,” Ariadne recalls with a smile. Shortly after Ariadne began her transition.

However, that same year she experienced a traumatic event when she contracted HIV after being raped. Despite this devastating ordeal, she refused to give up. She began treatment and continued her life with determination and resilience.

By the age of 24, she had completed all her surgeries, and she had been legally registered a woman. Ariadne officially changed her name on all her documents.

She pursued education to open up opportunities. “I had the chance to specialize at UNIFESP, the second-best university in Brazil. Since then, I have continued my education, earning a specialization, a master’s degree, and recently a Ph.D.”

Ariadne began her healthcare career in Itanhaém, where she worked in a peer education program at a health facility and contributed to a cooperation agreement with the State Government. “I focused on HIV prevention programs, gaining visibility as one of the few transgender professionals at the time,” she explains. “This recognition opened up new opportunities for me.”

Reflecting on her proudest achievements, Ariadne highlights her work with homeless individuals in São Paulo, Brazil and her role in establishing the state’s first shelter for homeless transgender people. Following these accomplishments, she joined UNAIDS in 2019, where she continues to advocate for transgender rights and supports people living with and affected by HIV, using her voice to uplift and empower others.

Ariadne's makes use of her extensive experience to champion the rights and well-being of everyone living with HIV, including UN staff. Working with UN Plus, she is pioneering innovative strategies to uphold dignity in every workplace.  Building a future free from stigma and discrimination, say Ariadne and UN Plus, is how to enable everyone to perform at their best, and to thrive.

After Evelyn Siula’s husband died, she knew she had to get tested for HIV. The result came back as positive.

"I had prepared myself mentally for either outcome, but it was still a shock."

She was jobless and with three children to care for.

The stigma and discrimination surrounding the virus meant that many people were scared to disclose their status. "I had three friends whose families rejected them because their HIV status became known,” Evelyn shares.

But Evelyn chose to break the silence early, starting by telling her young daughter. Family support played a crucial role in Evelyn’s journey. Her family stood by her, offering constant encouragement and strength, vital for getting through the many challenges.

Stigma followed Evelyn. She recalls a particularly painful moment: “At a community gathering, someone pointed at me and asked, ‘Can you believe she’s HIV-positive?’ It was one of the worst experiences being talked about like that.”

Evelyn became a strong advocate for people living with HIV, standing up to stigma everywhere, including in her church. At a gathering in a church, when a speaker criticized people living with HIV, she shared her own status as HIV-positive and as a church elder. Her openness has helped challenge stigma and gain support. Through her work she  learned that many fellow church members were struggling in silence, and so helped create the Livingstonia Synod Positive Christians group, known as LISAP+.

Despite her bold advocacy, Evelyn acknowledges how mental health challenges, particularly fear and anxiety, have affected her. “I have thoughts like: ‘What if something happens to me? What if I die?’ I worry about my children and how they would manage without me. These are the fears that raise my blood pressure.”

But over time, Evelyn’s diagnosis has become not just a challenge but also a source of strength.

Today, Evelyn works for UNAIDS and is the vice chair of the UN Plus Advisory Group. She is proud to show that people living with HIV are leading healthy and productive lives.

She has completed  Bachelor’s and Master’s degrees in business administration. “The day I graduated with my Master’s degree was extra special because I graduated alongside my eldest son. It’s rare for a mother and son to share such a moment.”

Evelyn encourages everyone to ensure they know their HIV status as the first step to taking control of their health: “Please get tested. It's just a status. If you're positive, follow the advice of your doctors. There is full life after testing HIV positive. Take your medication religiously, eat well, and live a healthy life.”

“Never stigmatize anyone,” says Eveyln, “because we are all one.”

Life became chaotic for Poon early. (Not his real name.)

As a gay teenager he was bullied at school by students and teachers. He moved in with his grandparents when his parents separated, but eventually left northern Thailand for Bangkok. There he survived through sex work.

Then Poon learned he was living with HIV. The weight of HIV prejudice merged with the stigma he already carried as a young gay man and sex worker. Some friends he made at a camp disclosed his HIV status online after an argument. He was diagnosed with major depressive disorder.

A partner introduced him to drug-use during sex. He went on to use multiple substances including methamphetamines and cocaine.

“Sex, drugs and alcohol are my escape,” he said.

This was one of the stories shared at the 6th Asia Pacific Chemsex Symposium (APCS). Held in Bangkok on November 6 and 7, the event brought together over 300 stakeholders from 27 countries. They shared their research and responses to a practice that remains largely hidden and not yet well understood. The event specifically explored pleasure as opposed to risk as an entry point for providing services.  

Chemsex—also called High Fun in several Asian countries—refers to the use of stimulant drugs during sexual activity. It lowers inhibitions and may increase risk-taking. There are several public health implications including higher rates of HIV and sexually transmitted infections (STIs), lower adherence to treatment, overdose and the fallout linked with intoxication.

In Asia Pacific four of every five new HIV infections are among people from key population communities including men who have sex with men or MSM, people who use drugs, people in prisons or other closed settings, sex workers and transgender people. Young people make up a quarter of all new HIV infections and in some countries around half of new infections are among youth ages 15 to 24.

Several countries in the region are facing an HIV prevention crisis with new infections among MSM either increasing or decreasing far too slowly. In 2023, 43% of new infections in Asia-Pacific were among MSM. At the same time, there is evidence that the practice of chemsex in this community ranges from 3% to 31% depending on the country. But although chemsex is most visible in the MSM community, it is practiced by people from all populations.   

“We are talking about sex and drugs—two topics that people call taboo,” said Brigitte Quenum, UNAIDS Regional Team Lead for Sciences, Systems and Services at the opening ceremony. “But as HIV has taught us, to reach people, we must confront the realities of their lives.”

Toolkit now available for Asia Pacific health workers

On day 2 of the symposium UNAIDS and UNODC launched the first-ever toolkit on chemsex for Asia Pacific clinical service providers. The toolkit was developed by the Australian Society for HIV, Viral Hepatitis and Sexual Health Medicine (ASHM). It is geared toward health workers in Asia and the Pacific working with men who have sex with men and transgender women.

"The increasing use of stimulant drugs in the region, including for ‘Chemsex’, poses significant health risks, including drug use disorders and various psychosocial challenges," said Masood Karimipour, Regional Representative of UNODC’s Office for Southeast Asia and the Pacific. "This UNAIDS-UNODC toolkit provides essential guidance for healthcare providers to address these challenges through evidence-based interventions. It emphasizes the importance of holistic, non-judgmental care that prioritizes the physical, psychological and social wellbeing of individuals, while ensuring access to harm reduction services and the prevention and treatment of drug use disorders within a comprehensive continuum of care."

The resource was created to support comprehensive clinical services in the region’s restrictive legal environments. Twenty-eight countries in Asia Pacific criminalise drug possession for personal use while 17 criminalise same-sex relations. Penalties for drug-related offences in the region are among the world’s harshest.

The toolkit was developed through consultation with clinicians, community representatives and government agencies. It covers chemsex basics as well as approaches to harm reduction, sexual health, and mental health services. It also covers different service delivery models including face-to-face, online and by communities. The toolkit offers guides and tools on topics such as initiating non-judgmental conversations and risk assessment.

“Stronger HIV prevention strategies tailored to chemsex are needed, along with expanded, inclusive services for sexual, physical and mental health,” said Suniya Taimour, UNAIDS’ Community-led Responses Advisor for Pakistan and Afghanistan.

Thia approach recognises that comprehensive health services can be lifesavers by using one point of contact to address multiple issues including physical, sexual and mental health as well as social issues. Poon is a living example. He has benefitted from a service package that has combined his HIV treatment with harm reduction interventions and psychiatric care. Today he is a 22-year-old university student with clear life goals who feels more empowered about his HIV status.

MHAMID AL GHIZLANE, 2 November 2024 — The Joint United Nations Programme on HIV/AIDS (UNAIDS) is pleased to announce the appointment of renowned Moroccan artist OUM as its National Goodwill Ambassador in Morocco. The prestigious announcement was made at the Taragalte Festival, held from November 1-3, 2024, in Mhamid El Ghizlane, where OUM proudly serves as the festival's ‘Godmother.’ OUM’s influence and commitment to social change will play a vital role in UNAIDS' efforts to combat HIV/AIDS in Morocco and beyond.

“OUM’s appointment as National Goodwill Ambassador is a powerful step forward in our efforts to fight against HIV in Morocco,” said Houssine El Rhilani, UNAIDS Country Director for Morocco. “Her artistic influence and commitment to social causes will help amplify our messages of prevention, tolerance, and support for people living with HIV.”

In her new role, OUM will work to promote awareness and education around HIV prevention. She will also focus on fighting against the stigma and discrimination faced by people living with HIV. “As an artist, I have a platform to reach many people. It is my duty to use my voice to advocate for people living with and affected by HIV who are often unheard,” said OUM. “I am honored to take on this role with UNAIDS and am committed to supporting the fight against HIV in Morocco.”

Morocco faces significant challenges in the fight against HIV, with approximately 23,000 people currently living with the virus. The National Integrated Strategic Plan for HIV, Viral Hepatitis, and STIs (2024-2030) outlines essential actions to strengthen HIV prevention efforts and improve access to care, particularly for populations most affected by HIV. OUM's role as an ambassador is vital in driving these efforts forward.

OUM is no stranger to social advocacy, having previously collaborated with various United Nations agencies. Her engagement includes speaking on international platforms and participating in initiatives promoting women's rights and education. The official ceremony for OUM’s appointment highlighted her commitment to raising awareness around HIV issues in Morocco. It featured speeches from local leaders, including representatives from the region of Zagora and the Ministry of Health and Social Protection. The festival itself serves as a cultural backdrop, emphasizing the power of music and art in promoting peace and social change.

As UNAIDS continues its mission to end AIDS as a public health threat by 2030, collaboration with influential figures like OUM is crucial. Her role as National Goodwill Ambassador will not only increase awareness but also inspire collective action to ensure that all people affected by HIV, regardless of their status, have access to the care and support 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.

In Togo, youth and adolescents living with HIV are stepping forward to lead the response against the AIDS epidemic. Through resilience, determination, and a collective vision, they have come together to form a new youth-led network called the Network of Positive Children, Adolescents and Youth Innovating for Renewal (REAJIR+), This grassroots initiative is dedicated to amplifying the voices of all children, adolescents and young people affected by HIV, and is a testament to the power of youth leadership in shaping their future. “We felt the need to create a space where young people living with HIV could be heard and represented,” says Sitsope Adjovi Husunukpe, Executive Director and one of the founding members of the network. “Many of us felt that our needs and concerns, although important, were not given priority in the development and implementation of policies and interventions relating to HIV prevention and care.”

The network’s creation was not without problems. In Togo, where leadership is often adult-driven, it took courage and determination to establish an organization run by and for young people. "Even though we faced difficulties, we knew we had to persist," explains Adjovi. "The environment wasn’t always supportive, but we kept believing in the vision of our network. We wanted to ensure that young people living with HIV, from all walks of life, had a space to advocate for their rights."

The need for young people to be involved in the response to HIV in Togo is clear. According to recent reports, only about 26% of young people aged 15-24 have enough knowledge about how to prevent HIV.[1] Children's performance in terms of adherence to HIV treatment is below the general average of 80.5%[2]. At the same time, 6,200 children aged 0 to 14 are living with HIV[3]. In Western and Central Africa, at least 16% of girls and 12% of boys aged 15-24 have sex before they turn 15[4]. These numbers show that more needs to be done to help young people understand HIV to protect themselves.

“Empowering young people goes beyond raising awareness; it’s about unlocking their potential to drive change. When they take ownership of their advocacy, they become catalysts for progress, shaping solutions that resonate in their communities. By equipping them with the right tools, we invest in a future led by those who understand the challenges firsthand.” says Dr Yayé Kanny Diallo, UNAIDS Country Director for Togo and Benin.

Koffi Emmanuel Hounsime, the network’s president, echoes the importance of youth-led advocacy. “At the beginning, people questioned our legitimacy. They asked, ‘Who are you representing?’ But once we formalized our network and built our credibility, we gained respect. Now, when we speak, we speak with authority on behalf of youth living with HIV across the country.”

Despite these hurdles, the network remains committed to its mission. “We are working not just for ourselves but for the future generation of young people living with HIV,” says Adjovi. "We want to ensure that we have better support, better care improving our life quality, and that we feel empowered to take decisions concerning our own well-being."

The network has already made significant strides. It has actively participated in national HIV dialogues and contributed to the development of the new Global Fund HIV grant, ensuring that the priorities of adolescents and young people are included.

For these young leaders, creating the network is about more than just advocacy. It’s about survival, empowerment, and hope. Emmanuel reflects, “We didn’t just create this network to represent young people, we created it to change lives. Every day, we’re working to make sure that no young person living with HIV feels alone.”

RIO DE JANEIRO, BRAZIL, 29 October 2024—Today, at a special event organized for the G20 Joint Finance and Health Ministerial, the Brazilian government and experts from the Global Council on Inequality, AIDS and Pandemics backed calls for efforts to break the “inequality-pandemic cycle” that is fueling continued disease emergencies. Two crucial measures could enable the world to tackle current and future pandemics.

They urged leaders to recognise, for the first time in G20 history, inequality as a driver of pandemics, requiring both measurement and decisive action. They also championed boosting the development, production and supply of life-saving health products in every region of the world.

Evidence gathered by the Global Council on Inequality clearly demonstrates the inequality-pandemics cycle. Inequalities within countries and between them deepen the disruption and loss of life in current and recent pandemics, from AIDS to COVID, mpox and Ebola. Failure to address these inequalities is leaving communities across the world vulnerable and exposed to future outbreaks.  This presents an important opportunity for the G20, which sets the agenda for international financing, to focus attention and action on the social determinants of pandemics.

The dependence of countries across the Global South on medicine production in the Global North has also been shown to undermine pandemic responses. They are consistently last in line to receive life-saving vaccines and medicines, despite bearing much of the world’s disease burden.

Nísia Trindade, Brazil’s Minister of Health, who is also a member of the Global Council on Inequality, AIDS and Pandemics, declared: “By building production capacity in every region, we can learn from past mistakes by ensuring that medicines for neglected and socially determined diseases are made around the world and that capacity is available to respond swiftly to future outbreaks.”

Joseph E. Stiglitz, Nobel Prize Winning Economist, Co-Chair of the Global Council on Inequality, AIDS and Pandemics, explained: “Reforms in both the developed and developing countries and in international agreements and institutions, and investments which help broaden the production of medical products and reduce prices are vital to address market failures and accelerate access to medicines for the people in greatest need.”

Sir Michael Marmot, Professor of Epidemiology and Director of the Institute of Health Equity at University College London, Co-Chair of the Global Council on Inequality, AIDS and Pandemics noted: “The evidence is clear: social determinants increase the intensity of pandemics. The greater the inequality in society, the worse is the pandemic. But we also know we can intervene against these with education, social protection measures, and making societies more fair. Re-investing in the public good and upholding of human rights will make societies less vulnerable to pandemics.”

H.E. Monica Geingos, former First Lady of Namibia and Co-Chair of the Global Council on Inequality, AIDS and Pandemics set out: “To effectively end the AIDS pandemic and prepare for future health crises, we must confront the complex web of inequalities that exacerbate these challenges. Inequality encompasses more than just income disparities; it includes social, political, and health inequities that intersect in significant ways. The geopolitical landscape further complicates these dynamics, as nations characterized by pronounced inequality are disproportionately impacted by the responses to pandemics. This systemic inequality is often reinforced by international frameworks that perpetuate and deepen existing disparities, underscoring the urgent need for comprehensive and equitable approaches to health and governance.”

The two initiatives—addressing inequality as a pandemic driver and the move to boost regional health product production— offer a unique opportunity for G20 leaders to take transformative action towards greater health equity and global health security, speakers agreed.

Winnie Byanyima, UNAIDS Executive Director and Convenor of the Inequality Council, remarked: "President Lula has put equality at the heart of Brazil’s G20 agenda. He is right. Inequalities need to be addressed urgently, and the production of medicines and vaccines expanded across the world, or the next pandemic will hit us even harder. G20 leaders here in Rio have the opportunity to transform the way the world responds to outbreaks and pandemics by tackling the inequalities which drive them. We are counting on G20 leaders to seize this moment to save lives and protect the health of everyone.”

Joe Phaahla, Deputy Minister of Health, South Africa, confirmed: “As we assume the G20 presidency in 2025, South Africa will continue to champion the agenda of universal health coverage through equity, solidarity and innovation.”

Tributes were paid to the Ministry of Health in Brazil for its leadership in advancing these critical issues at the G20, including proposing a new Global Coalition for Regional Production, Innovation and Equitable Access and including social determinants of pandemics in the work of the G20 Joint Health and Finance Ministers task force.

Notes for editors

Brazil proposes the establishment a Global Coalition for Regional Production, Innovation and Equitable Access Alliance for Regional Production and Innovation. It is bringing together a network of key actors, including countries, academia, private sector, and international organizations, for research and development and production of vaccines, medicines, diagnostics, and strategic supplies to combat diseases with strong social determinants and that mainly affect vulnerable populations. For more information on the G20 Health Working Group, see the G20 website: https://www.g20.org/en/tracks/sherpa-track/health

About the Global Council on Inequality, AIDS and Pandemics

The Council was established by UNAIDS in 2023 and is comprised of experts from academia, government, civil society and international development actors committed to implementing evidence-based solutions to address inequalities fuelling AIDS and other pandemics. It is chaired by Nobel Laureate Professor Joseph Stiglitz, Former First Lady of Namibia Monica Geingos, and Professor Sir Michael Marmot who chaired the Commission on Social Determinants of Health. Learn more at inequalitycouncil.org.

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 the heart of Kyiv, Ukraine’s capital city, where the echoes of war resonate daily, the community-based organisation Club Eney stands as a refuge for key populations affected by the war.

For many, Club Eney is not just a place to receive assistance, but a vital community offering essential support.

When Yaroslav, a web developer, divorced a year and a half ago he spiraled out of control using drugs. Ultimately, he ended up homeless. "I used to have a steady job, but everything fell apart," he said. Without a place to call home, he now relies on the streets for survival. "I need food, a place to wash, and someone to talk to while I look for work," he explained.

A friend introduced Yaroslav to Club Eney, and it quickly became a part of his daily routine. "I receive food packages, do my laundry, and can take a shower," he said. He also enjoys a warm cup of tea or coffee while chatting with the staff, many of whom have faced their own struggles. "They’ve offered me sessions with a psychologist, but I’m not ready yet. I need to sort out my thoughts first," he admitted.

Velta Parkhomenko, chair of Club Eney, was once a client of the organization herself, receiving harm reduction services such as clean needles and support. "I started as a peer consultant and am now chair of the organization, so I refer to my experience helping others,” she said.

Club Eney began as a community-based organization offering HIV prevention services to people who use drugs and other HIV affected communities in Kyiv.

For her Club Eney is much more than that. "We had a dream to be a place where people could access all the services they need in one place, all in one location,” she said.  

The organization has outreach workers in all districts of Kyiv, where they provide harm reduction services, HIV testing and other support.  If someone tests HIV positive, they have someone accompany the person to the clinic, so they start treatment as soon as possible.

With the war, Club Eney has taken on a bigger role.

Olesya, a mother of three, fled from the Chernihiv region to Kyiv just before the war escalated. Having previously sought help at Eney for gender-based violence, she returned, knowing it would provide safety and help with basic needs.

“Today, my whole family came to Eney to do laundry, get food and diapers, and even have a social worker look after my children,” Olesya explained. Recently, when her child fell ill and she needed to buy medicine, the club reimbursed her for the costs after she presented the receipts. “With everything being so expensive, this support means a lot to us,” she said.

Since the onset of the war in February 2022, prices have skyrocketed for food, medicines and hygiene products and unemployment hovers above 17% pushing up demand at Club Eney and exacerbating other problems like drug addiction.

“In the last two years, we have provided help to over 40 000 people across the country. We are incredibly grateful that UNAIDS has supported us in filling the gaps and realising our dream," she said.

The Club Eney receives funding from the UNAIDS Humanitarian Fund, which supports various organizations, each addressing specific needs across different regions of Ukraine. Together, these projects enable local community organisations to deliver essential services, including HIV related services, and support to those who have been left behind, ensuring they receive the assistance they urgently need during this crisis.

“The war has greatly exacerbated social problems, pushing people from marginalized groups further to the edge of the state social system and leaving many without essential support. Thanks to the generous contributions from donors, primarily from the Netherlands, we can assist organizations like Club Eney in providing vital aid to these vulnerable populations,” said Gabriela Ionascu, UNAIDS Country director in Ukraine.

For Yaroslav, Club Eney has given hope. "I believe that everything will be okay for me because I see the people here at Club Eney who also used drugs but managed to turn their lives around,” he said. “So, I believe I can too."

Currently, there are over 3.4 million internally displaced people. A reported 143 591 people living with HIV were receiving treatment in 2023, close to the number before the invasion.

“Ukraine has succeeded in maintaining its HIV services, particularly the provision of antiretroviral therapy in government-controlled areas. However, the war, along with a range of humanitarian, social, and economic challenges, poses long-term risks to both the HIV response and the health system overall," said Eamonn Murphy, UNAIDS Regional Director for Eastern Europe and Central Asia. "To keep the epidemic under control, we must ensure that no one is left behind."

GENEVA, 21 October 2024—The Executive Director of UNAIDS Winnie Byanyima is calling for accelerated global solidarity to strengthen Madagascar’s response to HIV, including preventing new HIV infections and expanding access to treatment, to end AIDS as a public health threat. Ms Byanyima is visiting the country between 19–24 October to support its response to the HIV epidemic. Madagascar has seen dramatic increase in new HIV infections since 2010 and a 158% increase in AIDS-related deaths over the same period. UNAIDS is concerned about what appears to be a dramatic increase in new HIV infections. 

Ms Winnie Byanyima’s visit to Madagascar coincides with that of H.S.H Princess Stéphanie of Monaco, who is visiting Madagascar through the work that she does with Fight AIDS Monaco around the world, including in Madagascar, to end AIDS as a public health threat. Fight AIDS Monaco has been supporting Madagascar’s efforts to prevent new HIV infections, including ending stigma against people living with HIV and galvanising international solidarity to support efforts to end AIDS.

“Madagascar is experiencing a rapid increase in the number of new HIV infections in communities, in stark contrast to the regional trend where new HIV infections are declining,” said Ms Winnie Byanyima, Executive Director of UNAIDS. “Madagascar’s pandemic is driven by gaps in HIV prevention and glaring inequalities which must be urgently addressed.”

In 2023 there were an estimated 76 000 people living with HIV in Madagascar and around 3100 people died of AIDS-related illnesses. Gaps in data gathering and weak surveillance systems make estimating the scale of the pandemic difficult. Stockouts of HIV testing kits and limited access to testing facilities further hinder accurate data collection in communities.

In addition, the majority of people living with HIV do not have access to treatment. Only 22% of the estimated 76 000 people living with HIV in Madagascar had access in 2023.

In northern Manakara HIV testing campaigns by the Ministry of Health have shown urban HIV prevalence rates ranging from 3% to 18% among the population.  There is a need to strengthen comprehensive data gathering to better inform the national HIV response to effectively tackle the pandemic.  

UNAIDS has been actively supporting Madagascar’s HIV response, especially in strengthening the surveillance systems to ensure more accurate and comprehensive data collection. UNAIDS has also been supporting the implementation of HIV testing and counselling services and helping to expand access to antiretroviral therapy.

Madagascar is one of the most unequal countries in the world, a factor which is driving new HIV infections. In 2023, the World Bank estimated the country’s poverty rates at 62.6%. Madagascar has been hit by cyclical natural disasters including drought in the south and cyclones, making it difficult for the country to recover and mount an effective response to HIV.

“Madagascar can scale up its response to HIV but urgently needs technical and financial support from the international community to ensure that HIV prevention commodities, including condoms, testing kits and antiretroviral treatment are available to everyone in need,” said Ms Byanyima.

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 a milestone decision, the Peruvian Congress has passed legislation that extends temporary health insurance coverage to migrants diagnosed with HIV and tuberculosis (TB). This law allows non-resident foreigners to access healthcare services through the public health insurance system (known by the Spanish acronym SIS) while they complete their immigration processes.

This law, which incorporates proposals from Law Bills 5253, 5554, and 7260, represents a significant step in reducing barriers for migrant populations, ensuring timely medical attention without the need for official residency documentation. Now, migrants affected by HIV or TB can receive vital healthcare services, including medical consultations and diagnostic exams, regardless of their immigration status.

The legislative breakthrough follows over two years of advocacy led by the Grupo Impulsor, a coalition that includes UNAIDS, alongside partners such as USAID’s flagship initiative Local Health System Sustainability Project (LHSS), IOM, UNHCR, the Peruvian Observatory of Migration and Health of the Peruvian University Cayetano Heredia (OPEMS-UPCH), Colectivo GIVAR, VENEACTIVA, the Peruvian TB Social Observatory, and Partners in Health.

Likewise, providing timely treatment for migrants with HIV or TB not only improves their quality of life but also reduces the risk of transmission, making it a crucial public health measure benefiting everyone. It also saves money: early care is far more cost-effective, preventing advanced cases that strain the health system.

A cost-benefit analysis reveals that Peru could save around 5 million soles ($1.33 million USD) annually by preventing new infections and another 54 million soles ($14.58 million USD) through avoiding productivity losses linked to AIDS and TB-related deaths.

Migrants living with HIV in Peru remain among the most discriminated groups in the country, with 70.7% reporting stigma, according to the Ministry of Justice and Human Rights. They also face heightened vulnerability due to xenophobia, violence, and exploitation—nearly half of them have experienced physical violence or sexual exploitation. Accessing healthcare is a major challenge, with only 2% of migrants with HIV covered by public health insurance, leaving the rest to pay out-of-pocket costs that many cannot afford.

“By extending health insurance to migrants, Peru is not only addressing these barriers but also aligning with global commitments, like the Sustainable Development Goals (SDGs), aimed at eradicating epidemics such as AIDS and TB by 2030”, says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “This legislative victory not only marks a turning point in health policy but also sets a precedent for future reforms, ensuring a more inclusive and equitable healthcare system for all.”

Protecting everyone’s rights protects public health.

In 2020, a gay Thai man living with HIV sparked controversy with a Facebook post. He was on antiretroviral therapy and had gotten lab tests to check the level of virus in his blood. Since his viral load was undetectable, he wrote, he was going to stop using condoms.

The public responded with a mix of contempt and disbelief. How could he? So selfish! So reckless! The resulting debate spilled from social media onto national radio and TV.

“There was a huge backlash,” remembered Dr Nittaya Phanuphak, the Executive Director of the Institute of HIV Research and Innovation (IHRI). She was telling the story from IHRI’s sunlit offices to teams from Botswana, Ghana, Ivory Coast, Jamaica, Mozambique, South Africa and Zambia. They’d come to Bangkok as part of a learning exchange coordinated by the Global Partnership for Action to Eliminate all Forms of HIV-related Stigma and Discrimination.

Dr Nittaya said that she and her father, Professor Praphan Phanuphak, thought it was their duty to contribute to the public discourse. While the man’s approach might have been unconventional, the science behind his statement was sound.

They would know. Professor Praphan diagnosed Thailand’s first HIV case in 1985 and dedicated his life to HIV research, service delivery and advocacy. He co-founded the Thai Red Cross AIDS Research Centre which in 2014 conducted cutting-edge research as part of the Opposites Attract Study. Done in Australia, Brazil and Thailand, that study tracked couples in which one person was HIV-negative and the other was living with HIV but had achieved an undetectable viral load through successful HIV treatment.  It confirmed that after two years of unprotected sex, there were no cases of HIV transmission between more than 300 couples. 

“It’s a scientific fact,” Dr Nittaya said. “For me, I felt like we really needed to do something. We cannot just wait 50 years for this knowledge to gradually seep into Thai society.”

The “knowledge” to which she refers is the concept of undetectable = untransmittable, or U=U for short. Last year the World Health Organization further endorsed the principle, stressing that when a person’s viral load is undetectable there is zero chance of sexual transmission.

“Before, HIV treatment just meant longevity,” said Pan (not his real name), a person living with HIV. “But with U=U, now it is love without fear.”

Within three to six months a person who takes their HIV treatment as prescribed and receives viral load monitoring can confirm that they have achieved an undetectable viral load. This removes the self-stigma associated with having an “infectious” disease. For Thai HIV response stakeholders, this concept can also transform the public’s attitudes about people living with HIV, making it easier for them to live full, happy lives.

“If social perceptions can be brought in line with the reality of HIV treatment, we can remove the stigma around getting an HIV test or diagnosis,” said Eamonn Murphy, Regional Director of UNAIDS Asia Pacific and Eastern Europe Central Asia. “The more supportive the society, the more people we successfully treat and the fewer new infections.”

But for the U=U strategy to be fully utilized, work must be done to dispel myths and bolster confidence in science.

According to UNAIDS Country Director for Thailand, Dr Patchara Benjarattanaporn, a key step in the national process was bringing decision-makers together with relevant stakeholders, including voices from communities.

“They considered both global and local evidence,” she explained. “Now there is consensus about the science. U=U also conveys the message ‘you=you’, affirming that all individuals are equal and that people are more than their HIV status. It emphasizes the importance of ensuring people are fully informed about their options and respecting their right to make choices about their sexual health depending on their realities.”

At the opening ceremony of the eight-country learning exchange, Dr Niti Haetanurak, Department of Disease Control Deputy Director, noted that the U=U concept is a key element of Thailand’s “all of society” strategy to address the prejudice and rights violations people living with HIV face. Thailand has a National Costed Action Plan to Eliminate all forms of HIV-related Stigma and Discrimination. The Ministry of Public Health and Sub-National Committee on AIDS Rights Promotion and Protection under National AIDS Committee coordinate the effort. Community organizations play a leading role.

During the exchange the country teams visited the Service Workers in Group (SWING) Foundation which serves sex workers and IHRI’s Tangerine Clinic which primarily serves transgender people. Both have come up with innovative approaches to ensure groups that usually find it challenging to receive healthcare at state-run facilities can get HIV and sexually transmitted infection (STI) testing and treatment in a friendly environment.

A key strategy is training members of those very communities to provide certain services themselves. They can even start clients on treatment for HIV and some other conditions the same day they are diagnosed. This approach makes it less likely for people to disappear into the shadows after diagnosis, with a high chance of infecting others and eventually becoming ill.

“This community-led health model can be applied to any health condition or population. But this does not really address stigma and discrimination. It just bypasses it by opening up alternative service delivery outlets for people who want to avoid negative experiences elsewhere,” Dr. Nittaya said.  “We need to address the heart of the stigma as well. That is why we are working on using U=U as a tool to explore how we can shift attitudes.”

The Bangkok Metropolitan Administration (BMA) is integrating this concept into its work in healthcare settings and the workplace. A masterplan is in the works. One branch of the strategy will tackle employers requiring HIV testing in the pre-employment phase or targeting employees they find out are living with HIV. Another aspect of the approach is the integration U=U into all levels of HIV service delivery and ongoing healthcare worker sensitization. All staff in clinics and hospitals are trained, not just nurses and doctors.

The work doesn’t stop there, though. Describing the Bangkok society as “open”, Dr Tavida Kamolvej, Deputy Governor of Bangkok, said that the whole of society was ready for deeper conversations about inclusion and HIV. But how could these approaches be applied in other countries and cities that are not quite as tolerant or accepting, she was asked.

“If you are confronted with beliefs that might not allow open conversations about HIV, sexuality and sex, you can strategically make it about health literacy, dignity and care for all people. I think this is soft enough to make people aware about health and wellbeing,” Dr Tavida advised.

Click here to learn more about the recent eight-country learning exchange to eliminate all forms of HIV-related stigma and discrimination.