Stepping up the role of faith-based organizations in the response to HIV can present new opportunities to save the lives of children living with HIV in western and central Africa, agreed the participants at a meeting held in Abuja, Nigeria, on 14–16 June.

The Regional Consultation on Early Diagnosis and Treatment for HIV-Positive Children: Strengthening the Engagement of Faith-Based Organizations saw more than 100 representatives of faith-based organizations, governments and organizations of people living with HIV come together to discuss the role of faith-based organizations in the response to HIV. The participants, who were mainly from the Democratic Republic of the Congo, Nigeria and Zimbabwe, agreed that churches, mosques, religious leaders and the health facilities they support are critical to ensuring that HIV among children is diagnosed and treated.

The participants developed plans to create demand for testing and treatment, as well as to support people living with HIV to stay in care. The participants also planned to build the capacity of faith-based service providers to deliver quality HIV services for children and discussed the strengthening of age-appropriate HIV and sexual health education in faith schools.

The event was organized by Caritas Internationalis, UNAIDS and the United States President’s Emergency Plan for AIDS Relief, with the support of Caritas Nigeria.

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The Democratic Republic of the Congo’s HIV catch-up plan shows that impressive results in the response to HIV can be made when partners work together.

Launched in December 2016, the western and central Africa catch-up plan aims to ensure that 4.5 million people living with HIV in the region will have access to HIV treatment by 2020. In support of the regional plan, the Democratic Republic of the Congo’s country plan—developed and implemented by the Ministry of Health and the National AIDS Commission—aims to increase the number of people on antiretroviral therapy in the country by 80 000 people, to more than 200 000 people by June 2018.

An intensive HIV testing campaign in the country has enabled 2 million people to know their status—essential to enabling people to access HIV treatment.

Coverage of antiretroviral therapy in the country stood at just 33% of people living with HIV in 2015, higher than the region’s coverage (28%), but much lower than the coverage in eastern and southern Africa (54%). According to government estimates, by April 2017, 34 000 more people were on treatment. The increase puts the country on track to reach the June 2018 target, which would see 73% of people living with HIV on treatment.

The encouraging increase in treatment coverage resulted from a range of partners—the Ministry of Health and the National AIDS Commission, United Nations agencies, the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief, among others—working together to finance and give technical support to the scale-up. By focusing on the three most affected provinces in the country, resources have been maximized where they are most needed.

Community-based antiretroviral medicine distribution points and community-based early warning systems have helped to reduce drug stock-out and improve the quality of HIV services. These community health services are among the best practices that have been scaled up to increase treatment coverage.

UNAIDS is working with countries to ensure that 30 million people living with HIV have access to treatment through meeting the 90–90–90 targets—whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads—by 2020.

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UNAIDS and the International Organisation of la Francophonie (IOF) have joined together to support HIV testing among young people in Togo as part of the ProTest HIV campaign. For 15 days in Togo’s capital Lomé, UNAIDS and partners promoted voluntary HIV testing, care and support for people living with HIV and broader HIV prevention programmes among youth and adolescents, including access to reproductive health, family planning and sexual health services.

More than 2300 adolescents and young people attended the various events. Up to 600 people took an HIV test and more than 5000 male and female condoms were distributed during the 15 days.

The campaign in Lomé was held in partnership with the Ministry of Development Planning, the Ministry of Health, the University of Lomé, Maison TV5 Monde and the IOF Regional Office for West Africa.

UNAIDS is working with countries to ensure that, by 2020, 90% of young people have the skills, knowledge and capacity to protect themselves from HIV.

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Patience Eshun, a widowed grandmother from Ghana who lost her daughter last year to HIV, knows how destructive HIV-related discrimination can be. “My daughter refused to go hospital to receive medicines. My daughter died because of the fear of stigmatization and discrimination,” she said.

Ms Eshun is one of thousands of widows living in Ghana who have experienced the effects of stigma and discrimination on people living with HIV. Ms Eshun and a group of women joined UNAIDS Deputy Executive Director Jan Beagle at a dialogue organized through the Mama Zimbi Foundation (MZF)—a nongovernmental organization that seeks to empower and support widows through its Widows Alliance Network (WANE) project—to discuss the challenges faced by widows and women living with HIV.

Ms Beagle visited Ghana to engage with the government and other stakeholders in light of Ghana’s Chairmanship of the UNAIDS Programme Coordinating Board.

In Ghana, women are among the people most affected by HIV. Prevalence among women aged 15–49 is nearly double that among men of the same age (2.0% versus 1.3%). Widows are among the poorest women in Ghana—their poverty is linked to the deprivation of their rights and lack of access to justice through discriminatory customs, traditions and religious codes. Widows in Ghana are often faced with legal regulations that do not support the protection of their rights. Widows regularly lose land and possessions and are evicted from their homes once they lose their spouse. For widows living with HIV, stigma and discrimination is often exacerbated.

Responding to these challenges, Akumaa Mama Zimbi, a Ghanaian women’s rights leader, television and radio talk show host, launched a network (WANE) to support sustainable socioeconomic development for widows. The project equips widows in Ghana with employable skills, human rights education, reproductive health and social integration programmes. Through WANE, more than 400 widow groupings have been formed in Ghana, with membership swelling to more than 8000 nationwide. The organization also provides small income generating and training workshops for widows in dressmaking, bread baking, beekeeping and small-scale farming.

“We are passionately committed to striving for advocacy of a comprehensive policy and legal direction for elevating the standards of widows, and all women, in Ghana. We need to empower women, and make sure men are also fully part of the discussion—we need to work together for a better future,” Ms Zimbi said.

During the meeting, Ogyedom Tsetsewah, a Queen Mother (traditional community leader) and advocate for women’s rights, explained that if a widow is facing injustice, she has little or no recourse within her community and within the courts, and that traditional leaders have an important role to play. “There is a clear role for traditional leaders in advocating with the national political leadership on the situation of widows and the critical importance of investing in social protection of widows to allow them to contribute to community resilience,” she said.

Women and young people shared their experiences of HIV-related discrimination and hardship. It was a very honest discussion, where many women shared their own impressions of experiencing friends being stigmatized and discriminated against, even by themselves. 

Ms Beagle commended the courage and resilience of the widows, while reflecting that, “Widows living with HIV often face triple discrimination: because they are widows, because they are women and because of their HIV status. Through economic empowerment, they become self-reliant and even leaders in their communities, can build awareness of HIV and stand up against stigma and discrimination.”

MZF is currently working on establishing a permanent location to provide vocational training, human rights education, reproductive health and social integration programmes for the daughters of vulnerable widows in Ghana. This initiative when implemented will provide skills and jobs for more than 3000 vulnerable young women.

UNAIDS Executive Director Michel Sidibé visited a generic medicine manufacturer in Abidjan, Côte d’Ivoire, on 24 March following his attendance at a meeting of francophone mayors on HIV. CIPHARM, the leading pharmaceutical company in Côte d’Ivoire, produces a number of medicines, ranging from antihistamines to antibiotics. During the visit, Ibrahim Diawara, the Chief Executive Officer of CIPHARM, told Mr Sidibé that the company wanted to begin the production of antiretroviral medicines.

UNAIDS has been encouraging the local production of antiretroviral medicines in Africa, the continent with the highest HIV burden. In western and central Africa, three out four people living with HIV do not have access to treatment.

Mr Sidibé committed UNAIDS’ help for CIPHARM to fulfil the norms of the World Health Organization for antiretroviral therapy production and to promote regional and local production.

Since 2014, the Economic Community of West African States has pursued a Regional Pharmaceutical Plan to strengthen its pharmaceutical industry and ensure the production of quality, safe and affordable medicines accessible by the region’s population. 

UNAIDS is working with countries to ensure that, by 2020, 30 million people living with HIV are accessing treatment.

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Francophone mayors gathered in Côte d’Ivoire’s capital, Abidjan, on 23 and 24 March to discuss the HIV responses in their cities. Abidjan’s Governor, Robert Beugré Mambe, and the Mayor of Paris, Anne Hidalgo, convened, with the help of UNAIDS, the two-day meeting with 20 mayors, mostly from western and central Africa.

The meeting comes more than two years after mayors from around the world signed the Paris Declaration to end the AIDS epidemic in their cities.

The mayors who signed the Paris Declaration committed to putting cities on the Fast-Track to ending the AIDS epidemic through a set of commitments. Those commitments include achieving the 90–90–90 targets, which will result in 90% of people living with HIV knowing their HIV status, 90% of people who know their HIV-positive status on treatment and 90% of people on treatment with suppressed viral loads. Several cities, including Paris, are already close to reaching 90–90–90.

Niamey (Niger), Nouakchott (Mauritania), Tunis (Tunisia), Antananarivo (Madagascar) and L’Acul (Haiti) signed the Paris Declaration in Abidjan, bringing the total number of signatory cities worldwide to 215.

During the opening ceremony, UNAIDS Executive Director Michel Sidibé congratulated Côte d’Ivoire for being one of the countries with the most cities to have signed the Paris Declaration.

In western and central Africa, three out of four people living with HIV do not have access to treatment. This is a sharp contrast with eastern and southern Africa, where average treatment coverage in 2015 was 54%. UNAIDS and partners have therefore launched a catch-up plan to ensure that 1.8 million people in eight western and central African countries access treatment. The plan, Mr Sidibé said, can only succeed with cities and mayors as focal points throughout the region.

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Ghana is the Chair of the UNAIDS Programme Coordinating Board (PCB) for 2017. The Minister of Health, Kwaku Agyeman-Manu, will chair the two PCB meetings in the year, with the President of Ghana, Nana Addo Dankwa Akufo-Addo, addressing the meeting in June.

“As Ghana takes the position as Chair of the Programme Coordinating Board, we will certainly work hard to justify the confidence reposed in us. We are committed to working closely with UNAIDS to achieve our collective goal of making our world AIDS-free by 2030,” said Mr Agyeman-Manu.

UNAIDS Deputy Executive Director Jan Beagle has visited Ghana to discuss the countries’ PCB chairmanship, as well as advances and challenges in the HIV response, with the government and other key stakeholders. Welcoming Ghana’s leadership on the PCB, Ms Beagle said, “As Chair, Ghana brings experience and energy to the Programme Coordinating Board. We are looking forward to Ghana’s leadership to drive forward the implementation of the UNAIDS 2016–2021 Strategy and to help us make the end of AIDS a reality.”

Ms Beagle’s visit to Ghana included discussions with the Vice-President of Ghana, Mahamudu Bawumia, the First Lady of Ghana, Rebecca Akufo-Addo, and the Minister of Foreign Affairs and Regional Integration, Shirley Ayorkor Botchway.

Ms Beagle also met with members of civil society, including people living with HIV, networks of widows, members of the United Nations country team and key development partners in the Ghanaian AIDS response.

Ghana has some 270 000 [230 000–330 000] people living with HIV and has made significant strides in its AIDS response through integrated multisectoral approaches. Results include a reduction of new HIV infections by 57% between 2000 and 2015 and of AIDS-related deaths by 33% in the same period, as well as the almost doubling of HIV testing among women since 2008.

Despite gains, overall HIV testing remains relatively low, in part owing to stigma and discrimination, but as more than 90% of pregnant women attend antenatal care, there are opportunities to increase levels of testing and treating all HIV-positive pregnant women. This could eliminate mother-to-child transmission of HIV (in 2015, some 2200 [1600–2900] babies were born with HIV in Ghana) and contribute to improving treatment coverage, which is currently at 34% [29–41%].

The first thing you notice about Colonel Alain Azondékon is that he is always moving. He is tall, head and shoulders above most people, and he uses his whole body to express his feelings. So it will come as no surprise to learn that he ends every sentence with, “Let’s go!”.

The Director of Camp Guezo, the paediatric HIV hospital in Cotonou, Benin, the Colonel has started a new movement for putting young people and families at the centre of care.

After observing traditional check-up visits, he noticed that the children were separated from their mothers by a curtain during the examination. He rearranged the furniture, making sure that the examination table was parallel to where the parents were sitting, so they could always be in eye contact with their little ones and with the doctors and nurses.

That was just the beginning. He noticed that the young people under his care needed more than medicines to lead healthy lives. He introduced psychosocial support to address the stress of living with HIV through adolescence and created a network of young people living with HIV, run by a young man who is also living with HIV.

Talking with the Colonel you get the sense that he has tried to think of everything. “A mother never comes alone,” he pointed out. “She has her children, sometimes the father comes and she has her handbag, which contains her “life”.”

The Colonel made sure that instead of chairs in the examination and therapy session rooms there were small sofas—enough places for the family as well as the mother and her handbag.

It’s the small details, as well as the big mandate, that have made Camp Guezo so successful. Children born with HIV have received care from birth. The paediatric hospital has been able to reduce mortality rates among children living with HIV from 30% to less than 5%.

Some of the patients are now adults with children of their own and have very little interest in moving to the regular health-care system.

“They sometimes call me Papa, and they ask why Papa do we have to go to the other clinic where they don’t know me,” he said.

Soon patients of Camp Guezo could find it easier to transition to other health-care facilities. The Colonel has been asked to help replicate this model in other clinics in Benin.   

“This is the kind of people-centred approach Africa and the world is looking for,” said Michel Sidibé, the Executive Director of UNAIDS, as he toured the centre. “Precious resources have been carefully put to work to keep families in a safe environment where they can get the care and support they need.” 

There are an estimated 69 000 people living with HIV in Benin. The number of new HIV infections among children continues to fall as pregnant women living with HIV gain access to life-saving antiretroviral medicines to stop babies from becoming infected during childbirth and breastfeeding.

The First Lady of Benin has launched a foundation to improve the lives of the most vulnerable women and children in the western African country, nestled between Nigeria and Togo. The foundation will work under the umbrella of six core values: solidarity, the family, respect for differences, integrity, humility and efficiency.

The Claudine Talon Foundation will take a holistic approach to improving health and social outcomes for women and children in Benin. It will focus on expanding maternal and paediatric health services, improving general hygiene and sanitation, increasing access to quality drinking water, improving standards of nutrition and raising literacy rates through a wider access to education. Activities will include increasing access to HIV testing in paediatric health centres and supporting organizations caring for orphans. It will also focus on ending discrimination for people living with and affected by HIV.

Benin has made significant progress in its AIDS response in recent years, particularly in reducing mother-to-child transmission of HIV and increasing access to life-saving antiretroviral medicines. Around half of all adults living with HIV in Benin currently have access to treatment. However, key populations are still disproportionately affected by HIV. The foundation hopes to break down the stigma preventing people from accessing life-saving HIV services.

The importance of scaling up support services for women and young people in Benin is evident. Estimates show that 39% of people live below the poverty line in the country and that 45% of the population is under the age of 15.

The Executive Director of UNAIDS, Michel Sidibé, was present at the launch and said that the humility and profound commitment of the First Lady to creating a fairer and more just society will improve the lives of women and children in Benin, restoring dignity, inspiring change and creating opportunity. The First Lady thanked Mr Sidibé and UNAIDS for the support given to the foundation and to the response to HIV in Benin.

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