Since the United Nations High-Level Meeting on Ending AIDS in 2016, the young key populations’ movement and its visibility have grown considerably in Asia and the Pacific. Through their engagement with national and regional networks of key populations, more and more young people have taken up space in decision-making processes and in mobilizing resources to support local and national organizations. However, despite those important efforts, more needs to be done to meaningfully engage young key populations in the HIV response as leaders, beneficiaries and partners.

UNAIDS data from 2019 alarmingly shows that 27% of all new HIV infections in Asia and the Pacific were among young people. Young gay men and other men who have sex with men accounted for 52% of all new HIV infections among young people. Overall, 99% of new HIV infections among young people were among young key populations and their partners.

A side event held on the sidelines of the United Nations High-Level Meeting on AIDS, held in New York, United States of America, and online from 8 to 10 June, looked at the progress made and challenges in the HIV response and emphasized the critical role of young people in leading change and promoting successful and innovative approaches to the HIV response.

The speakers and panellists stressed that significant barriers exist for young key populations to access HIV testing, treatment and prevention services and routine sexual and reproductive health and rights services in the region. Those barriers include a limited availability of differentiated HIV services for young key populations, stigma and discrimination, punitive laws and other legal barriers that leave young key populations on the margins and out of reach of HIV services.  The COVID-19 pandemic continues to widen existing inequalities and service gaps, but thanks to the engagement of community-led organizations, populations at higher risk of HIV, including young key populations, were able to access essential HIV and health services.

The speakers and panellists noted that young people are showing us the way to revolutionize HIV prevention and increase the uptake of HIV services by implementing new strategies and innovations that cater to the specific needs of young people. During the COVID-19 pandemic, organizations led by and serving young people, such as the Lighthouse Social Enterprise in Viet Nam and the Human Touch Foundation in India, have been at the forefront of the HIV response, providing HIV services in partnership with the local government to the communities that need them the most.

The team at the Human Touch Foundation, a community-based organization in Goa, India, that provides care and support to adolescents living with HIV has, since the start of the COVID-19 pandemic, organized volunteers to deliver antiretroviral therapy to people’s doorsteps. Moreover, the organization played a critical role in getting the local government to waver public transport costs to ensure that people living with HIV had access to treatment. With the increased anxiety and depression brought on by the COVID-19 pandemic, the Human Touch Foundation offered psychosocial support services to adolescents living with HIV, both in the form of online counselling and in-person consultations.

Similarly, the Lighthouse Social Enterprise, a lesbian, gay, bisexual, transgender and intersex (LGBTI) organization led by young people based in Hanoi, Viet Nam, has been instrumental in providing differentiated service delivery to young key populations during the COVID-19 pandemic. Some of the services it provides at its clinic include HIV counselling and testing, post-exposure prophylaxis, pre-exposure prophylaxis and antiretroviral therapy. The Lighthouse Social Enterprise also established a referral service to ensure that young key populations are linked with other health services, such as sexually transmitted infection testing and treatment, mental health support and harm reduction services. What makes the Lighthouse Social Enterprise unique is that the clinic is entirely run by young people. Health-care workers are given training by the Lighthouse Social Enterprise team on LGBTI and key population needs and issues in order to ensure that services are youth-friendly and free from stigma and discrimination. Last year, the Lighthouse Social Enterprise provided services to more than 3000 members of young key populations in Viet Nam.

The side event was an opportunity for different organizations led by and serving young people working on HIV-related issues to share experiences and define common strategies to keep HIV on the political agenda at the national and municipal levels.

Quotes

For Vanessa Chaniago, a young transgender woman living in Jakarta, Indonesia, the first few months of the COVID-19 pandemic were filled with fear. “I was really struggling to make ends meet. I had been working for a civil society organization, which was a great place to learn and develop strong networks, but unfortunately the income was not sufficient to sustain me and my family. My income drastically declined,” she said.

According to a survey conducted by the Crisis Response Mechanism (CRM) Consortium of 300 lesbian, gay, bisexual, transgender and intersex (LGBTI) people in Indonesia, the COVID-19 pandemic has caused most LGBTI people to have experienced layoffs or reductions in income or to close their businesses. Most LGBTI people work in sectors with a higher risk of COVID-19: 20.5% in the beauty industry, 19.5% in the health sector and 12.8% in the service industry. Unfortunately, most of the respondents do not have long-term savings—30% would only be able to survive for two to three months on their savings, and 64% are not able to access loans.

Reflecting back on more than a year of the pandemic, Ms Chaniago said that the situation didn’t rapidly improve and instead got more challenging as time went on. “I decided to start a small business, selling beef rendang and other Indonesian street food. Opening a business during the pandemic wasn’t ideal, and not long after the opening I had to close down my store. Now I continue my small business on the streets.”

Ms Chaniago is determined to survive these trying times and she recognizes that many of her fellow transgender women face bigger hurdles. Many transgender people in Indonesia do not have identity cards, leaving them unable to access social support from the government. The CRM survey found that 51% of respondents did not receive social support from the government and those that tried to receive it faced many challenges in accessing it.  

On top of the socioeconomic struggles they face, discrimination and violence towards the LGBTI community continues—transgender women in Jakarta have even been pranked with aid packages filled with garbage. The CRM survey also found that violence against LGBTI people increased.

Keeping in touch virtually among the community has been essential. Ms Chaniago said, “I want to tell my fellow LGBTI peers that they are not alone. As a community, we must continue to help each other out and fight for what is right.” Unfortunately, the CRM survey found that the community cannot always turn to peers for support, as many don’t have devices or enough Internet data to contact their friends.

Despite the huge hardships, there is a strong sense of optimism and hope for a better life after the pandemic. To get there, however, the LGBTI community needs support, including form the government and the public.

“Everyone has been affected by COVID-19. In Indonesia, many vulnerable groups have struggled to survive not only the pandemic but the devastating impact of loss of livelihoods and income. UNAIDS works with partners to strengthen the protection of vulnerable groups from stigma and discrimination in order to increase equitable access to support and services,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The CRM Consortium consists of UNAIDS Indonesia and four national civil society organizations—Arus Pelangi, the Community Legal Aid Institute, Sanggar Swara and GWL-Ina. In addition to the survey, the CRM Consortium has mobilized resources for LGBTI people affected by the pandemic through the distribution of food packages, sanitation packages and rent allowances.

The results of the survey are highlighted in a video here.

Since school doors closed last March due to COVID-19, the majority of Jamaican students are still receiving tuition exclusively online. Social media and messaging services are more relevant than ever as a channel to share knowledge and resources with young people, as well as to receive their feedback.

The United Nations Children’s Fund (UNICEF) U-Report is an innovative message-based tool designed to engage with young people, provide them with information and give them an opportunity to weigh in on issues of national importance. Jamaica became the first Caribbean country to launch U-Report, joining a global movement of more than 5 million U-Reporters. UNAIDS Jamaica recently collaborated with UNICEF to find out what young people know, or don’t, about HIV. The 10-question quiz also provided correct information to the participants.

Almost 2000 young people responded to the survey, with just 214 achieving a perfect score. The quiz pointed to some worrying gaps in knowledge relating to both HIV basics and access to information on HIV prevention. One in 10 respondents mistakenly thought HIV could be transmitted by mosquitoes, for example. Almost one in three were not aware of the local solution for delivering school-based sex education, the Health and Family Life curriculum.

The results of the survey corroborate Jamaica’s most recent Knowledge, Attitude and Behaviour (KAB) survey results and demonstrate that there are still glaring HIV knowledge gaps among young people. The survey revealed that only 33% of young people between the ages of 15 and 24 years correctly identified the ways in which HIV can be transmitted. This was a 6% decline in knowledge levels as compared to the 2012 KAB survey. The 2017 study also found that 40% of respondents with multiple partners did not use a condom during their last sexual encounter.

“The results of the HIV U-Report quiz have reinforced the need for efforts to be made to address the decline in knowledge on information on HIV among young people in Jamaica,” said the UNAIDS Country Director for Jamaica, Manoela Manova. “Particularly in the context of COVID-19, it is critical that we innovate to ensure that this messaging and engagement takes place on digital platforms and with a view to ensuring that no child or young person is left behind.”

The U-Report social messaging tool has proved to be a quick and useful way to gather information that can be used to inform programmes and plans focusing on young people in Jamaica. UNICEF Jamaica has supported innovations to ensure that children and young people have access to education and support during COVID-19, including tele-mental health services, virtual instruction training for teachers and strategies to close the digital divide.

During COVID-19, virtual dialogues and behaviour change communication have been scaled up. A UNICEF-supported initiative aims to address the gaps in HIV and sexual and reproductive health knowledge for young people in Jamaica. The National Family Planning Board’s Adolescent Sexual and Reproductive Health Campaign focuses on teen health, including targeting sexually active teenagers with messages on condom use and dispelling myths about HIV transmission. The campaign disseminates sexual and reproductive health/HIV information through social media and uses animated characters to reach adolescents. The campaign also speaks about the benefits of abstinence and birth control. 

Ralph Ivan Samson, the President of Y-PEER Pilipinas, and his team of young volunteers have been working tirelessly throughout the COVID-19 pandemic to supply antiretroviral therapy to young people struggling to get refills. “How could I sleep at night knowing that community members were depressed and anxious about their refills. I had young people texting me they were down to their last couple of pills,” said Mr Samson, remembering the initial COVID-19 outbreak in the Philippines in March 2020. It was at this moment that he knew he had to do something.

Throughout the region, civil society organizations like Y-PEER Pilipinas began looking into ways of overcoming the barriers and challenges that prevent young people from accessing HIV services due to COVID-19 restrictions. For example, Y-PEER gained support from local governments with special travel passes to enable the delivery of antiretroviral therapy from the hospital straight to the doorsteps of young people living with HIV.

Y-PEER Pilipinas was one of several beneficiaries of the COVID-19 Emergency Relief Fund, a regional small-grants programme established by Youth LEAD to support initiatives led by young people across Asia and the Pacific during the COVID-19 pandemic. The COVID-19 relief fund supported 12 organizations led by young people in nine countries with various projects, including the delivery of antiretroviral therapy, hygiene products, opioid substitution therapy, emergency supplies and food, cash transfer programmes for businesses run by transgender people and housing for key populations.

Youth LEAD’s efforts to mobilize resources during the early days of the pandemic are a testament to young people rising up to the occasion and working in coordination with regional partners of the HIV response in Asia and the Pacific. In their efforts to raise funds, Youth LEAD relied on the findings of a regional assessment on the needs of young key populations and young people living with HIV during the COVID-19 pandemic conducted by the Inter-Agency Task Team on Young Key Populations Asia Pacific (IATT on YKP), a regional coordinating platform comprised of United Nations agencies and young key populations regional networks. The results of this assessment helped to inform the IATT on YKP and its regional and national partners on ways to support organizations led by young key populations during the COVID-19 response. The evidence gathered through the survey was used to inform preparedness response plans and local strategies on providing timely information on COVID-19 prevention, supporting the delivery of antiretroviral therapy and tackling stigma and discrimination. 

With the support received from Youth LEAD, Mr Samson and his team of volunteers provided condoms and lubricant and emergency supplies to young key populations and young people living with HIV across several provinces in the Philippines. The programme is known online as #GetCondomsPH, and a similar initiative led by young people from the COVID-19 Emergency Relief Fund supported the delivery of antiretroviral therapy to people’s doorsteps in Goa, India.

Aadi Baig, Programme Manager, and his team at Wasaib Sanwaro, an organization that works with gay men and other men who have sex with men and male sex workers in Pakistan, have also benefited from the COVID-19 Emergency Relief Fund. Mr Baig revealed a troubling picture of how the COVID-19 pandemic has made things worse for key populations. “The pandemic has created a greater divide among people, socially and economically, and has uncovered the lack of social security and protection programmes for key populations.”

With the support received, Wasaib Sanwaro donated food and supplies to key populations and provided basic HIV and COVID-19 training. Although there are limited funding schemes for organizations of young people across the region to access grants, regional networks of young people, such as Youth LEAD, Y-PEER and YVC, and the coordinated response by the IATT on YKP, which in 2020 was co-chaired by the UNAIDS Regional Support Team for Asia and the Pacific, the APCASO nongovernmental organization and the United Nations Development Programme, have stepped in to provide support.

As part of the work of the IATT on YKPs, a website that pools together COVID-19 resources for young key populations and showcases how young people have stepped up to respond to the COVID-19 pandemic was developed. The website also focuses on resources on the mental health of young key populations and the well-being of adolescents and young people at higher risk of HIV.

The most crucial aspect of all these activities was visibility, the visibility of young people, to ensure that young key populations and young people living with HIV had a voice during the pandemic. To keep the issues and needs of young key populations on the top of the advocacy agenda in the region, the IATT on YKP, with support from the UNAIDS Regional Support Team for Asia and the Pacific and Youth LEAD, held the first Spill the T with YKPs webinar—an online panel with young people from across the region that offered a platform for young people to talk about their initiatives and their roles in the COVID-19 response. The series continued through the collaboration of the IATT on YKP with partners and explored issues of young people’s leadership, mental health and sexual and reproductive health and rights. 

Adolescent girls and young women must boldly and unapologetically seek sexual and reproductive health and rights information and services. The stigma and harmful gender norms associated with sexual and reproductive health and rights are not going anywhere, says Nyasha Phanisa Sithole, a Zimbabwean sexual and reproductive health and rights leader.

“If you are afraid of stigma, then you will not be able to access these services because we are not going to have a stigma-free environment any time soon,” she says. 

Working as a sexual and reproductive health and rights advocate and a regional lead for young women’s advocacy, leadership and training at the Athena Network, Ms Sithole believes everyone has a role to play in changing the status quo and influencing decision-making.

“My story is common. It is that of a 16-year-old adolescent girl who needed access to HIV prevention commodities, but only had condoms available and, in rare cases, pre-exposure prophylaxis,” Ms Sithole says, reflecting on her experience as an adolescent.

Despite this common story, the need for comprehensive HIV, sexual and reproductive health and rights and sexual and gender-based violence services in the eastern and southern African region is critical.

Adolescent girls and young women aged 15–24 years account for 29% of new HIV infections among adults aged 15 years and older in the eastern and southern African region, when they only comprise 10% of the population. This means that there are 3600 new HIV infections per week among adolescent girls and young women in the region, which is more than double that of their male peers (1700 weekly).

The stigma and discrimination that young people face, particularly adolescent girls and young women, to access sexual and reproductive health and rights services creates barriers at various levels, including the individual, interpersonal, community and societal levels. 

Furthermore, documented health rights abuses include the unauthorized disclosure of health status, being denied sexual and reproductive health and rights services and related psychological violence.

In 2014, Ms Sithole went undercover as a secret client at a youth-friendly health centre in Harare, Zimbabwe’s capital city, in a district with residential areas and schools. The first person she encountered at the centre was a nosy security guard.

“He asked me: ‘What do you need?’ A health screening, I replied. Then he asked, “Asi wakarumwa?” Meaning, “Have you been bitten?” In Shona, this is street language for someone who has a sexually transmitted infection,” she recalls.

Had she not been well-informed, Ms Sithole says she would have felt scared. “It’s something that can scare you or put you off to say, “It’s just a security guard, why are they mocking me or my situation?” Because imagine if I really had a condition that I wanted to manage, what would happen then?” 

Ms Sithole said health-care workers sometimes look at adolescent girls and young women accessing sexual and reproductive health and rights services with disdain and judgement and ask, “How old are you and what do you need the condom or contraception for?”

Considering the stigma attached to accessing sexual and reproductive health and rights services, community organizations play a critical role for adolescent girls and young women. Organizations empower them with sexual and reproductive health and rights information and service referrals. 

However, COVID-19 greatly impacted how these organizations work in Zimbabwe, which enforced lockdown restrictions to curb the spread of the virus.

“I think all governments weren’t fair when they clamped down restrictions on each and every organization that was working in communities,” Ms Sithole says, adding that it negatively impacted young people’s access to sexual and reproductive health and rights services.

To mitigate these risks, the Global HIV Prevention Coalition, co-convened by UNAIDS and the United Nations Population Fund, came on board to provide financial and technical support to the Athena Network in 10 countries, including Zimbabwe, to establish What Girls Want focal people in each country. During the COVID-19 pandemic, the focal people, who are adolescent girls and young women, mobilized their peers to conduct dialogues via WhatsApp to discuss the issues they face and seek peer support.

Ms Sithole says governments should invest in policy change and development to create an enabling environment where adolescent girls and young women can access sexual and reproductive health and rights and HIV information and services.

Despite the stigma and discrimination attached to seeking sexual and reproductive health and rights services, Ms Sithole says adolescent girls and young women should realize their power and use their agency to get what they need.

“Think about your life because your life is more important than anything else. So, no matter what happens, if you know there is a service you can access, go for it,” she advises.

Communities of people living with HIV have been at the forefront of the community-led response to the COVID-19 pandemic. As part of that response, the Global Network of Young People Living with HIV (Y+ Global), with support from UNAIDS, has launched the Y+ Social Aid Fund for young people living with HIV.

The Y+ Social Aid Fund will be piloted in Nigeria and Malawi, where, with the support of national networks of young people living with HIV ,Y+ Global will offer financial support to young people living with HIV who have been impacted by COVID-19-related restrictions.

“Lockdowns, social instability and treatment interruptions during COVID-19 have further magnified the inequalities that exist in the societies of young people. With grants such as the Y+ Social Aid Fund, young people living with HIV will be able to access basic living essentials that will relieve a portion of the burden on their mental health,” said Igor Kuchin, the Y+ Global Board Chair.

COVID-19 and associated restrictions have had a severe negative impact on the lives of young people living with HIV. Adolescent girls and young women living with HIV are experiencing issues ranging from poor access to menstrual hygiene products to increased need for refuge from gender-based violence while in lockdown. In the 2020 World AIDS Day report, Prevailing against pandemics by putting people at the centre, 27 out of 28 countries surveyed reported that COVID-19 restrictions were impacting antiretroviral therapy initiation for people newly diagnosed with HIV.

“In the context of the COVID-19 pandemic, communities of young people living with HIV are once again leading responses and providing new examples of the solidarity, resilience and innovation that have driven and accelerated the HIV response since the beginning of the HIV pandemic,” said Suki Beavers, Director of the UNAIDS Department for Gender Equality, Human Rights and Community Engagement.

It is hoped that this initial roll-out to provide financial assistance to the most vulnerable young people living with HIV globally will be scaled up. UNAIDS is encouraging other partners and funders to support the scale-up of the Y+ Social Aid Fund in order to ensure that more young people living with HIV are able to access health care and other services during the COVID-19 crisis and beyond. 

A new television series for young people in the Kyrgyz language, School Elections, was launched online last week. During six 15–20-minute episodes, a girl, Ayana, who is living with HIV, tells her story of bullying, friendship and the fight for human dignity. The producers of the series hope that Ayana’s example will give hope to young people who face similar challenges.

“We have a simple idea to promote: you may differ from others in your health, appearance or level of wealth. But regardless of this, we all deserve respect, friendship, love and happiness. This series is about kindness and acceptance of others as they are,” said Azim Azimov, Head of Production at the Media Kitchen production studio and the main screenwriter of the series.

Starting on 6 November, new episodes will be aired weekly on YouTube and will also be broadcast on television, Instagram and the teens.kg youth project website. Additionally, each series has one to three interactive episodes—the leading actors invite the viewers to look at the problems raised in the series through the viewers’ eyes, experience each situation for themselves and make their own decisions.

According to the United Nations Educational, Scientific and Cultural Organization (UNESCO), more than 30% of students around the world experience various forms of bullying at the hands of their classmates. Students who are perceived as “different” are often subjected to bullying for reasons of appearance, health status, including HIV status, sexual orientation and gender identity, social status or the economic situation of the family.

“This series tells people about the complex issue in simple and understandable language, to show how strong-willed and honest young people can overcome ignorance, indifference, cruelty and injustice, inspire others and change life for the better,” said Tigran Yepoyan, UNESCO Regional Adviser on HIV, Education and Health.

“This series is a powerful new instrument for reducing stigma in our society, it not only shows the difficulties of living with HIV, discrimination and bullying but also motivates our adolescents not to be afraid to fight for dignity and justice and move forward towards their dreams,” said Meerim Sarybaeva, UNAIDS Country Director for Kyrgyzstan.

The official soundtrack of the series, which was supported by the UNESCO Institute for Information Technologies in Education and UNAIDS, was performed by the singer Ayim Ayilchieva.