United Republic of Tanzania

DAR ES SALAAM, 1 February 2023—Ministers and representatives from twelve African countries have committed themselves, and laid out their plans, to end AIDS in children by 2030. International partners have set out how they would support countries in delivering on those plans, which were issued at the first ministerial meeting of the Global Alliance to end AIDS in children.

The meeting hosted by the United Republic of Tanzania, marks a step up in action to ensure that all children with HIV have access to life saving treatment and that mothers living with HIV have babies free from HIV. The Alliance will work to drive progress over the next seven years, to ensure that the 2030 target is met.

Currently, around the world, a child dies from AIDS related causes every five minutes.

Only half (52%) of children living with HIV are on life-saving treatment, far behind adults of whom three quarters (76%) are receiving antiretrovirals.

In 2021,160 000 children newly acquired HIV. Children accounted for 15% of all AIDS-related deaths, despite the fact that only 4% of the total number of people living with HIV are children.

In partnership with networks of people living with HIV and community leaders, ministers laid out their action plans to help find and provide testing to more pregnant women and link them to care. The plans also involve finding and caring for infants and children living with HIV.

The Dar-es-Salaam Declaration on ending AIDS in children was endorsed unanimously.

Vice-President of the United Republic of Tanzania, Philip Mpango said, “Tanzania has showed its political engagement, now we need to commit moving forward as a collective whole. All of us in our capacities must have a role to play to end AIDS in children. The Global Alliance is the right direction, and we must not remain complacent. 2030 is at our doorstep.”

The First Lady of Namibia Monica Geingos agreed. “This gathering of leaders is uniting in a solemn vow – and a clear plan of action – to end AIDS in children once and for all,” she said. “There is no higher priority than this.”

Twelve countries with high HIV burdens have joined the alliance in the first phase: Angola, Cameroon, Côte d'Ivoire, the Democratic Republic of the Congo (DRC), Kenya, Mozambique, Nigeria, South Africa, the United Republic of Tanzania, Uganda, Zambia, and Zimbabwe.

The work will centre on four pillars across:

1. Early testing and optimal treatment and care for infants, children, and adolescents;
2. Closing the treatment gap for pregnant and breastfeeding women living with HIV, to eliminate vertical transmission;
3. Preventing new HIV infections among pregnant and breastfeeding adolescent girls and women; and
4. Addressing rights, gender equality and the social and structural barriers that hinder access to services.

UNICEF welcomed the leaders’ commitments and pledged their support. "Every child has the right to a healthy and hopeful future, but for more than half of children living with HIV, that future is threatened," said UNICEF Associate Director Anurita Bains. "We cannot let children continue to be left behind in the global response to HIV and AIDS. Governments and partners can count on UNICEF to be there every step of the way. This includes work to integrate HIV services into primary health care and strengthen the capacity of local health systems."

“This meeting has given me hope,” said Winnie Byanyima, Executive Director of UNAIDS. “An inequality that breaks my heart is that against children living with HIV, and leaders today have set out their commitment to the determined action needed to put it right. As the leaders noted, with the science that we have today, no baby needs to be born with HIV or get infected during breastfeeding, and no child living with HIV needs to be without treatment. The leaders were clear: they will close the treatment gap for children to save children’s lives.”

WHO set out its commitment to health for all, leaving no children in need of HIV treatment behind. “More than 40 years since AIDS first emerged, we have come a long way in preventing infections among children and increasing access to treatment, but progress has stalled,” said Dr Tedros Adhanom Ghebreyesus, WHO Director-General. “The Global Alliance to End AIDS in Children is a much-needed initiative to reinvigorate progress. WHO is committed to supporting countries with the technical leadership and policy implementation to realise our shared vision of ending AIDS in children by 2030.”

Peter Sands, Executive Director of The Global Fund, said, “In 2023, no child should be born with HIV, and no child should die from an AIDS-related illness. Let’s seize this opportunity to work in partnership to make sure the action plans endorsed today are translated into concrete steps and implemented at scale. Together, led by communities most affected by HIV, we know we can achieve remarkable results.”

PEPFAR's John Nkengasong, U.S. Global AIDS Coordinator, said he remains confident. "Closing the gap for children will require laser focus and a steadfast commitment to hold ourselves, governments, and all partners accountable for results. In partnership with the Global Alliance, PEPFAR commits to elevate the HIV/AIDS children's agenda to the highest political level within and across countries to mobilize the necessary support needed to address rights, gender equality and the social and structural barriers that hinder access to prevention and treatment services for children and their families."

EGPAF President and CEO, Chip Lyons, said that the plans shared, if implemented, would mean children were no longer left behind. “Often, services for children are set aside when budgets are tight or other challenges stand in the way. Today, African leaders endorsed detailed plans to end AIDS in children – now is the time for us all to commit to speaking up for children so that they are both prioritized and included in the HIV response.”

Delegates emphasized the importance of a grounds-up approach with local, national and regional stakeholders taking ownership of the initiative, and engagement of a broad set of partners. The alliance has engaged support from Africa REACH and other diverse partners and welcomes all countries to join.

“We have helped shape the Global Alliance and have ensured that human rights, community engagement and gender equality are pillars of the Alliance,” said Lilian Mworeko, Executive Director of the International Community of Women living with HIV in Eastern Africa on behalf of ICW, Y+ Global and GNP+. “We believe a women-led response is key to ending AIDS in children.”

Progress is possible. Sixteen countries and territories have already been certified for validation of eliminating vertical transmission of HIV and/or syphilis; while HIV and other infections can pass from a mother to child during pregnancy or while breastfeeding, such transmission can be interrupted with prompt HIV treatment for pregnant women living with HIV or pre-exposure prophylaxis (PrEP) for mothers at risk of HIV infection.

Last year Botswana was the first African country with high HIV prevalence to be validated as being on the path to eliminating vertical transmission of HIV, which means the country had fewer than 500 new HIV infections among babies per 100 000 births. The vertical transmission rate in the country was 2% versus 10% a decade ago.

UNAIDS, networks of people living with HIV, UNICEF and WHO together with technical partners, PEPFAR and The Global Fund unveiled the Global Alliance to end AIDS in children in July 2022 at the AIDS conference in Montreal, Canada. Now, at its first ministerial meeting, African leaders have set out how the Alliance will deliver on the promise to end AIDS in children by 2030.

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.

Following a one-week visit to Tanzania and Zanzibar to launch the 2022 Global World AIDS Day report; to commemorate World AIDS Day; and to see first-hand the extraordinary work of joint efforts by the government, partners and communities to end AIDS in Tanzania and Zanzibar, UNAIDS Executive Director Winnie Byanyima issued the following statement:

“I observed strong commitment from the Government of Tanzania, our partners and activists at the frontlines fighting the HIV epidemic.

In particular, I thank Tanzania for hosting the launch event of this year’s World AIDS Day report “Dangerous Inequalities” on 29th November in Dar es Salaam, and for inviting me to join the World AIDS Day commemoration on 1st December in Lindi, Tanzania.

For the report launch, I thank our guest of honour, Hon. Minister George Simbachawene, Minister of State in the Prime Minister’s Office, for committing to end inequalities to end AIDS in Tanzania. The civil society representative, Chair of the National Council for People Living with HIV, Ms Leticia Mourice Kapela, added the commitment of communities to the theme “Equalize”, as did Deputy Minister of Health, Hon. Godwin Modell, on behalf of the Ministry of Health.

We are honoured by Her Excellency President Samia Suluhu Hassan leading the World AIDS Day commemoration, and grateful for her Government’s commitment to ending the AIDS pandemic. H.E. President Hassan spoke powerfully on the need to overcome inequalities in the AIDS response and called on TACAIDS to reduce inequalities, prevent new HIV infections and address stigma and discrimination. I commend H.E. President Hassan for her country joining the Education Plus Initiative in the lead up to World AIDS Day.

I also congratulate Tanzania for being the first country to join the Global Alliance to End AIDS in Children and I thank H.E. President Hassan for agreeing to host and participate in the launch of the Alliance early next year. No baby should be born with HIV, and no child living with HIV should be without treatment.

I welcomed the opportunity to visit the Mukikute Harm Reduction programme in Tanzania, which gives hope and dignity to people who inject drugs. I was uplifted by the passion of this community to mobilize and empower.

I was equally grateful for the opportunity to meet with allies, including ZAPHA+ and the Zanzibar Key and Vulnerable Population Forum (ZKVP-Forum).

Over the past 12 years, Tanzania has been able to reduce new HIV infections by almost 50% and to cut AIDS related deaths by 50%. 86% of Tanzanians who live with HIV are on treatment. I congratulate Tanzania on their leadership in the AIDS response. Together, with the required commitment and resources, and by bringing an end to societal and economic inequalities, we can end AIDS as a public health threat by 2030.

In closing let me reiterate the commitments that I made to Tanzania and Zanzibar in our joint efforts, namely to:

1. Strengthen UNAIDS presence in Dodoma, the national government capital of Tanzania, to support TACAIDS, Ministry of Health and other Ministries in the AIDS response.
2. Collaborate with the Ministry of Health in hosting the Ministerial launch of the Global Alliance and the development of the country action plan.
3. Move forward Education Plus in Tanzania by ensuring that more children get enrolled in and complete secondary school.
4. Support Tanzania and Zanzibar in the funding request application for the Global Fund HIV/TB grant.
5. Support and strengthen collaboration between the governments of Tanzania and Zanzibar and networks of people living with HIV and other community groups that are vulnerable and at high risk for HIV infection.

I thank the government, civil society and partners of Tanzania and Zanzibar for my visit.

Tanzania became the 13^th African country to join the Education Plus Initiative, committing to provide greater investments to ensure boys and girls complete secondary school. 

Education Plus is an initiative spearheaded by UNAIDS to accelerate action and investments in education to prevent HIV. Evidence shows that completing secondary education reduces the risk of HIV infection and early pregnancy and improves their livelihoods and prosperity for girls and young women. The education Plus initiative is centred on empowering adolescent girls and young women and achieving gender equality in sub-Saharan Africa.

On 30 November 2022, during the HIV week commemoration, the Office of the Prime Minister, led by the Minister of State for Policy, Coordination and Parliamentary Affairs, Mr George Simbachawene, alongside the Deputy Minister of Health Dr Godwin Mollel, launched the initiative in Lindi region, Tanzania. 

"Young people aged 15-24 years make up one of the largest groups of new infections, among all new infections every year, approximately 30% are among people aged 15–24. That means for every 10 new infections, three are from this age group,'" said Mr. Simbawachane 

The launch of Education Plus in Tanzania will accelerate the ongoing country's adolescent education, health and wellbeing agenda.  Tanzania has been particularly affected by HIV. In 2021 around 1.7 million people were living with HIV; 74% of new HIV infections among young people aged between 15 and 24 were among young women, showing the disproportionate impact HIV is having on young women and girls.

Minister Simbachawene said the country would increase primary education opportunities for adolescents and enable them to stay in school by removing all barriers to completion of primary and secondary school education. Through the initiative, Tanzania will strengthen efforts to bring HIV education, reproductive health, and life skills to adolescents inside and outside of school.

The initiative comes at a time when Tanzania has made good progress in adopting global treaties and agreements to address gaps in education and health rights and increase opportunities for girls and boys. Most commitments have been translated into national policies and strategies, as demonstrated by the government’s commitment to offering free basic and secondary education. Tanzania has also adopted policy decisions to implement a re-entry program for children who drop out and to include comprehensive sexuality education into the curriculum. The country has also amended the HIV and AIDS Act to lower the age of consent for HIV testing and allow HIV self-testing.

The minister also pledged to do more to eliminate gender-based and sexual violence by providing youth-friendly education, skills building, and enhancing referrals by connecting youth to health and community services.

However, key gaps remain, with national surveys showing increased rates of teenage pregnancy, school dropouts, and high levels of gender-based violence. Around 27% of young women aged between 15 and 19 years already have a child or are pregnant and 50% of ever-married women aged between 15 and 49 report experiencing physical, sexual, or emotional violence.

The total number of students enrolled in secondary education is still below 50%, and for those in school, there is a high dropout rate, and some do not complete their schooling. The country has a low completion rate in secondary schools at 11.3%, and dropout in secondary schools due to pregnancy was reported at 4% in 2020.

Despite increased political will and significant achievements, women's and girls' vulnerabilities remain very high. Adolescent girls and young women in Tanzania continue to shoulder the burdens of domestic work, gender inequality in education, and harmful norms. Many are entrenched in cycles of poverty and extreme vulnerabilities.

At the launch, the government committed to strengthening policies to facilitate the provision of education and essential skills to prepare and equip young people for employment and other economic opportunities.  

The launch was attended by key partners including Dr Leonard Maboko, the Executive Director for Tanzania Commission for AIDS (TACAIDS) youth representative Pudensiana Mbwiliza; Permanent secretary office of the Prime Minister, Dr John Jingu and Hon Judith Nguli from Lindi Regional Commissioner’s office and Tanzania PEPFAR coordinator Jessica Greene;  representatives from  UNAIDS, UNESCO, International Labour Organisation (ILO), UNICEF and the World Health Organisation (WHO). 

The event brought together civil society organisations, young people’s networks, and representatives of people living with HIV and partners. Co-lead by five United Nations agencies working with governments, women’s and youth movements; the initiative is of even greater urgency as the COVID-19 pandemic has pushed millions of African girls out of school.

“My business suffered because of corona. Before corona, I would sell at least 10 egg trays a week. At the height of the pandemic, I was lucky if I could sell two trays,” lamented George Richard Mbogo, who is living with HIV, a father of two, and owns a chicken, egg and chips business in Temeke, a district in the southern part of Dar es Salaam, United Republic of Tanzania.

The COVID-19 crisis has adversely impacted the livelihoods of people living with HIV in the United Republic of Tanzania, exacerbating the challenges they face. These include HIV service delivery and widening social and economic inequalities.

“Corona has been a very difficult time. I lived with a lot of worry and stress. Driving a bodaboda (motorbike taxi) requires going into crowds and working closely with people. It has been difficult not to fall into anxiety and depression, balancing getting my HIV treatment and work. I had moments thinking of stopping taking my meds, but I didn’t,” said Aziz Lai, a motorcycle driver who also lives in Dar es Salaam. 

Although the colliding pandemics of HIV and COVID-19 are hitting the poorest and the most vulnerable the hardest, through national resource mobilization the COVID-19 crisis has created an opportunity for partners to mobilize in support of the communities they serve.

The collaborative efforts between the government, development partners, including the United States President’s Emergency Plan for AIDS Relief, USAID and UNAIDS, the National Council of People Living with HIV (NACOPHA) and community activists have been key in responding to COVID-19, providing information, services, social protection and hope to people living with HIV during these unprecedented and trying times.

One such initiative is Hebu Tuyajenge, run by NACOPHA and funded by USAID, which focuses on increasing the utilization of HIV testing, treatment and family planning services among adolescents and people living with HIV, strengthening the capacity of community organizations and structures and improving the enabling environment for the HIV response through empowering people living with HIV.

Caroline Damiani is a single mother of three who is living with HIV and keeps chicken and ducks for a living. “Hebu Tuyajenge gave us personal protective equipment, sanitizers, soap and buckets and education about COVID-19 and how to take care of ourselves in order to stay healthy during the pandemic,” she said.

Through community-based services that supplement facility-based care, people living with HIV have been linked to and kept on treatment during the crisis by critical peer-to-peer HIV services.

For Elizabeth Vicent Sangu, who has been living with HIV for 26 years, her “numbers” speak for themselves.

“From my community follow-ups, I have returned 80 people to the clinic for CD4 count testing, inspired 240 people to get tests, reported 15 gender-based violence cases and provided education to 33 groups, including youth and church groups,” she said, beaming with pride.

NACOPHA helped Ms Sangu to come to terms with her status and helped her on her own journey of self-empowerment.

“Since becoming a treatment advocate for Hebu Tuyajenge, I have received help with entrepreneurship and education about HIV. I have become a teacher for others. I have made others brave about living with HIV and getting tested,” she said.

The partnership between community advocates and health facilities has paid off.

“Both we and our patients were fearful initially, but due to information and education, things got better. We focused on providing hourly and daily information to patients about corona and made sure that people practised safe social distancing,” said Rose Mwamtobe, a doctor at the Tambukareli Care and Treatment Centre in Temeke.

“Not only in the United Republic of Tanzania, but globally, COVID-19 is showing once again the cost of inequality. Global health, including the AIDS response, is interlinked with human rights, gender equality, social protection and economic growth,” said Leopold Zekeng, UNAIDS Country Director for the United Republic of Tanzania.

“The key to ending AIDS and COVID-19 is for all partners to come together, on a country and global level, to ensure that we leave no one behind,” he said.

Unlike many other countries in the region and the world, no lockdown measures were put in place at the height of the COVID-19 pandemic in the United Republic of Tanzania. In June, all restrictions on movement and gatherings were lifted. Nevertheless, the restrictions impacted people’s health and livelihoods, especially those who work in the informal sector, most of whom are women.

Women such as Caroline Damiani, from Chamazi, an administrative ward in the Temeke district of Dar es Salaam.

While, according to the government, about 83% of the 1.7 million people living with HIV in the United Republic of Tanzania are on HIV treatment, this leaves around 300 000 people living with HIV vulnerable. It has been shown that people with underlying health conditions are more susceptible to severe COVID-19 disease.

Thus, COVID-19 is a particular concern for people living with HIV, for both people who are not on HIV treatment and those who are, in ensuring they have access to medicines and health facilities.

The COVID-19 pandemic throws into sharp relief existing inequalities, including gender inequality and economic inequality.

In Chamazi, many women make a living selling homemade food, such as buns, fish or ice cream, or selling groceries in small kiosks.

Ms Damiani, a single mother of three, says her business was greatly affected by the COVID-19 pandemic. “Many people no longer wanted to buy my buns or home-made ice cream. I also couldn’t go to the main market to sell because of the crowds and the risk it brought. I then decided to switch completely to selling groceries at a small kiosk and rearing ducks and chickens to sell,” says Ms Damiani.

Ms Damiani has been living with HIV since 1998. All her three children are HIV-negative. Her husband divorced her and married another woman due to her HIV status and pressure from his family. To date, she still does not know his status. She lives with her daughter and granddaughter as her sons each have their own families. Her daily routine now includes feeding her ducks and chickens, helping her granddaughter with her schoolwork, performing household chores and tending her kiosk.

Ms Damiani says the COVID-19 pandemic affected her mental health. “I don’t have many friends and I spend most of my time at home or at the church. My stress levels increased in the earlier days of the pandemic and I began to lose weight,” she says.

“Fortunately, I never stopped taking my HIV treatment due to the insistence of my doctors that I adhere to my treatment regimen,” she says. “I am now determined to show everyone that you can live a full and healthy life as long as you don’t stop taking your medication.”

“The education and support we received from the Hebu Tuyajenge project also greatly helped to alleviate my stress.”

Hebu Tuyajenge is an initiative of the National Council of People Living with HIV, with support from UNAIDS and funded through USAID.

It focuses on increasing the utilization of HIV testing, treatment and family planning services among adolescents and people living with HIV, strengthening the capacity of community organizations and structures and empowering people living with HIV. In the face of the COVID-19 pandemic its members educated people living HIV on how to protect themselves from  COVID-19.

“In my community, one of the biggest problems was the lack of education and information surrounding COVID-19. Most of us didn’t even know how to properly wash our hands to reduce the risk of catching the virus,” says Ms Damiani.

The Hebu Tuyajenge project is an example of how the government, development partners, civil society and community activists have been key in responding to COVID-19 in the United Republic of Tanzania, providing information, services, social protection and hope to people living with HIV during these unprecedented and trying times.

“The efforts by the government and other donors should continue. Things have now improved in the country because everyone is now aware of the pandemic and people continue to take precautions,” says Ms Damiani.

Community-based organizations in Dar es Salaam, United Republic of Tanzania, with assistance from UNAIDS, are supporting women who use drugs and their families to survive during these difficult times.

“Before the pandemic, life was simple and better. I used to do activities at the beach, such as cleaning fish, helping people load and clean their boats, and they would pay me. I would help my daughter wash her clothes; I would escort her to school and cook food for her. Life was simple,” said Doroth Hassan as she sits in the office of SALVAGE, a sister organization of the Tanzania Network for People who Use Drugs (TaNPUD), in Kigamboni, Dar es Salaam.

Ms Hassan would normally provide for herself and her daughter by doing sex work and other informal jobs, such as the work on the beach. But this has become a challenge since the onset of the COVID-19 pandemic.

“Now life has changed. I live in fear and worry. People who I worked for don’t want to pay, with the excuse that they have no cash because of the coronavirus. Everything changed. Life is tough. Clients disappeared, vanished. And the few who are still coming cheat; they pay less for sex,” said Ms Hassan.

She is not alone in her worry. Most of the women who use drugs in Dar es Salaam survive in the same way as Ms Hassan does, by doing sex work, trading and doing other jobs in the informal sector. They live in camps for people who use drugs or in informal and densely populated settlements.

With support from UNAIDS and other partners, local community-based organizations, including TaNPUD and SALVAGE, have been able to provide some relief to women in the camps and settlements in Dar es Salaam.

“TaNPUD raised awareness and SALVAGE provided buckets, soap and food with other hygiene materials to us and other women in the community. TaNPUD always advocates for our health rights,” said Oliver Kinanda, a person who previously used drugs and is now on opioid substitution therapy.

Ms Kinanda also volunteers at the Medication-Assisted Treatment (MAT) clinic in Temeke, where she lives. Here, she informs people on prevention of tuberculosis (TB) and takes samples from clients for TB screening. With the onset of COVID-19, however, her tasks have shifted.

“As a peer educator I have knowledge of prevention of COVID-19 and provide education and awareness. Together with other people who use drugs I also got help; for example, face masks,” said Ms Kinanda. She has also received information and support from other local community-based organizations, including donations to the community and the clients she works with in the Temeke MAT clinic.

Ms Hassan received the same support.

“TaNPUD is raising a voice on our behalf, and SALVAGE, as the sister organization of TaNPUD, supporting women, has been linking us to care and treatment with other services and providing shelter, food and hygiene support to us,” she said.

The support, distributed with financial and material assistance from UNAIDS, will help to alleviate some of the consequences of the global pandemic, even as the effects of COVID-19 are slowly wearing off in the United Republic of Tanzania.

Happy Assan, the Coordinator of TaNPUD, said this support has so far reached 55 families of women who use drugs in Dar es Salaam.

“The support covered food and hygiene needs. It also provided women with the ability to stay at home instead of going out, for example to do sex work, and to negotiate less risky sex. The support reduced fear and worry about meeting the food needs of families with children,” said Ms Assan.

Many of the women who use drugs are living with or at risk of HIV infection and depend on reliable access to treatment and care, including harm reduction services. Despite the support in the community, some services that the women who use drugs depend on have been halted.

“Harm reduction services have been interrupted; they are less. No condom distribution or other commodities, only needle and syringes distribution. At least now SALVAGE is helping with sanitary items. At hospital there is no other support; HIV treatment only,” explained Ms Hassan.

Ms Hassan and Ms Kinanda both recount facing increased stigma during the pandemic—some derived from unintended consequences of the support, since the face masks they received were a certain colour, making the wearer identifiable in the local community as a person who uses drugs. Stigma and discrimination at hospitals is also reportedly high, adding to the difficulties of accessing services. But most difficult is the financial loss because of the pandemic.

As Ms Kinanda puts it, “No clients, no pay. Financially it is hard because my clients say they have no cash because the coronavirus has affected their jobs. I continue providing awareness and education to the community and my family too. I financially suffer, but what can I do other than continue pushing on?”

“After COVID-19 kicked in, it has been too difficult to get customers,” says Teddy Francis John, a sex worker from Zanzibar. Since the outbreak of COVID-19, she has faced increased difficulties to earn an income to provide for herself and her two children.

“Everything has become tough and I had to start a small business of selling alcohol—local brew,” she says. The business also helps her meet new clients, as they come to her for drinks and are less vigilant about social distancing guidelines.

Ms John used to live and work in Zanzibar town, but to better earn an income and avoid paying rent, she decided to move to a more rural area. Here, she says, she can more easily find new customers for her local brew.

Rehema Peter is facing a similar situation, just on the other side of the ocean on Tanzania Mainland. She lives in the crowded suburb of Temeke in Dar es Salaam and works as a sex worker and volunteers as a peer counsellor for people living with HIV and for people who use drugs.

Her clients were regulars who used to come to her house, or she would visit those she could trust in their homes. But when COVID-19 broke out, they stopped coming.

“Coronavirus made life very hard. Payment at work used to be little and when COVID-19 came it reinforced the situation. On the side of my partners [clients], they stopped visiting and calling me. The very few who used to visit me often, I called them, but they said they have no money because of COVID-19, as some stopped going to their jobs,” says Ms Peter.

At her job as a peer counsellor she was offered fewer shifts, meaning a lower income. Because she is a former drug user, she has received some support through the Tanzania Network for People who Use Drugs (TaNPUD), which has been supported by UNAIDS to distribute food and hygiene items to people who currently use drugs and people in recovery.

“I just try to be calm and find other means [of income]. I’m searching for additional organizations that can help or support me anyhow. I also try to prepare soap and oil from the knowledge that TaNPUD gave me and I sell it,” says Ms Peter.

Continued services

Both Ms Peter and Ms John are living with HIV and are on HIV treatment. Due to the advocacy and assistance of UNAIDS and other partners of the Tanzanian government, disruptions to HIV services have been minimal in the country. This is felt by both women.

“During this time, it has become difficult to get services in government health facilities; unless you go to a private hospital where you must have cash. However, there is no problem at all in getting HIV-related services, including my treatment,” says Ms John.

Ms Peter say she can now get three months multi-month dispensing of antiretroviral treatment—even up to six months—since the healthcare staff do not want congestion in the clinics. This has helped both women in adhering to their treatment.

Increased stigma

Both Ms Peter and Ms John have experienced an in increase in the stigma and social exclusion they also face as sex workers and as women living with HIV during the COVID-19 outbreak.

“As some people know that I am living with HIV, they tease me. They say ‘prepare yourself for death. People like you never heal. You must prepare for your final journey’” recounts Ms Peter. She has faced discrimination in the community, but her family stands by her.

Ms John also faced increased gossip and mocking of her because of her work.

“People in my surrounding communities started mocking me and others. They gossiped as to how I would earn a living as there are not going to be customers because of the COVID-19 outbreak.” Says Francis John

Despite the COVID-19 outbreak being declared over in Tanzania and despite their continued efforts to find other means of livelihood, earning an income is still hard for the two women, due to continued social distancing regulations.

“[It] has been very difficult to provide this service and this harmed us economically. I know COVID-19 has affected the whole world but it has affected sex workers more because of the nature of our services; it involves proximity,” says Ms John.

UNAIDS in collaboration with the Zanzibar Association of People living with HIV/AIDS (ZAPHA+), the Zanzibar HIV Control Program, the Zanzibar Ministry of Health and the local Shehia leadership, is supporting the government-led efforts to empower the most vulnerable, including people living with HIV, to prevent COVID-19 and other communicable diseases.

Recently, UNAIDS through ZAPHA+ donated bars of soap and buckets for handwashing stations to the Mtopepo* community, and personal protective equipment (PPE) such as surgical face masks and gloves to four health facilities in the district.

“UNAIDS believes that the ongoing COVID-19 prevention response has a lot to learn from the experiences of ZAPHA+ in serving communities,” said George Loy, UNAIDS National Programme Officer based in Zanzibar. “Working and supporting local communities is vital for preventing COVID-19 and other communicable diseases,” he added.

The support by UNAIDS will directly impact at least 2000 people in 480 households and is expected to indirectly benefit up to a total of 5000 people.

Fourteen volunteers, who are living with HIV, are being supported by UNAIDS to distribute the hygiene supplies, PPE and COVID-19 information materials in the community. The volunteers have been trained by ZAPHA+ to provide information on the coronavirus and other infectious diseases to the community.

*Mtopepo, a Shehia (sub-ward) in Magharibi district in the Urban/West region of Zanzibar, is an informal settlement with crowded living space and limited access to water and sanitation. This makes the residents particularly vulnerable to the spread of COVID-19.

GENEVA, 24 July 2020—UNAIDS is saddened by the death of the former President of the United Republic of Tanzania, Benjamin William Mkapa. Mr Mkapa was a bold and compassionate leader who worked to promote peace in eastern Africa and was committed to ending AIDS, being credited with much of the United Republic of Tanzania’s success in responding to HIV.

“I’ve learned with sadness that the former President of the United Republic of Tanzania, Benjamin Mkapa, has passed away,” said Winnie Byanyima, Executive Director of UNAIDS. “He was a tireless champion for peace and an AIDS-free Africa. UNAIDS pays tribute to him for his courage, his strength and his leadership.”

In 1999, he declared HIV a national disaster and quickly spearheaded the country’s national response to HIV by establishing the Tanzania Commission for AIDS. He also formed the Tanzania Parliamentarians AIDS Coalition (TAPAC) in 2001, which united the President and Prime Minister, members of parliament and other high-level politicians in the response to HIV.

Some of TAPAC’s key achievements include adopting progressive legislation on HIV and the creation of the Standing Committee on HIV/AIDS Affairs in 2008, which mainstreamed HIV in the work of the parliament. In addition to increasing the national AIDS budget, Tanzanian members of parliament, through TAPAC, raised funds for HIV projects to support nongovernmental organizations, people living with HIV and vulnerable populations.

During his farewell speech upon retirement, on the eve of World AIDS Day in 2005, Mr Mkapa bid the country farewell with a plea to all citizens to find out their HIV status. He asked people to take a voluntary HIV test in order to enable them to make informed decisions and to seek treatment if needed.

After his retirement, he continued to be actively involved in the AIDS response and became one of the founding members of the Champions for an AIDS-Free Generation, a distinguished group of former presidents and influential African leaders committed to ending AIDS.

He was the patron of the Benjamin William Mkapa Foundation which has reached millions of Tanzanians and continues to improve rural health services, health and the well-being of women, men and children, including people living with and affected by HIV.

UNAIDS expresses its deepest condolences to Mr Mkapa’s family and to all who knew and loved him. The AIDS response has lost one of its most committed champions.

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 United Republic of Tanzania has approved a change to the law that lowers the age of consent for HIV testing from 18 years to 15 years. The amendment to legislation also makes self-testing for HIV legal, also from the age of 15 years.

“These amendments will significantly accelerate our intention to meet the 90–90–90 goals, which aim at ending the AIDS epidemic by 2030,” said Ummy Mwalimu, Minister of Health, Community Development, Gender, Elderly and Children. The ministry was instrumental in tabling the amendments to the legislation.

The 90–90–90 targets are ambitious treatment targets to help end the AIDS epidemic. They aim to ensure that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people who know their HIV status will be on antiretroviral therapy and 90% of all people on antiretroviral therapy will be virally suppressed.

The changes to the law will contribute to improved access to HIV testing for adults aged 15 years and over.

At the end of 2018, the progress on the 90–90–90 targets in the United Republic of Tanzania was 78–92–87. In 2018, there were 72 000 new HIV infections in the country. While this is a 13% reduction from 2010, it is below the 28% reduction across eastern and southern Africa. 

“I congratulate the Government of the United Republic of Tanzania on its leadership and high-level political commitment to the AIDS response. UNAIDS will continue to work hand-in-hand with all our partners to ensure that access to HIV testing and treatment continues to expand,” said Leo Zekeng, UNAIDS Country Director in the United Republic of Tanzania.