A chatbot named Eli that can answer questions about growing up, love, relationships and sexual health, including HIV prevention and treatment, has been launched on the VKontakte social network, adding to the resources for health available to young people in eastern Europe and central Asia.

Created by the United Nations Educational, Scientific and Cultural Organization (UNESCO) Institute for Information Technologies in Education (IITE), Eli answers questions on six topics—psychology, physiology, sex, relationships, family and health. The knowledge base was created by an editorial team in collaboration with health workers and psychologists using materials on, for example, sexual and reproductive health, psychological well-being and HIV prevention, testing and treatment from UNESCO, UNAIDS and other United Nations agencies.

A large proportion of Eli’s knowledge base is on HIV prevention, testing and treatment. In a dialogue with a user, Eli explains why young people who have sex may need to be tested for HIV, what kind of tests are available, where and how they can be done and why it is crucial to start antiretroviral therapy immediately if the test results show that the person is HIV-positive. Eli helps to overcome fears and concerns and motivates its users to seek medical help.

“The use of modern innovative information technologies is an indispensable element of successful HIV education and prevention among young people, and UNESCO remains the leader in this area,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Machine learning technologies were used to create the chatbot. Users can ask Eli a question of their own or choose one of the suggested questions. Artificial intelligence powers the response, taking into account possible connections—for example, when talking about sexually transmitted infections, Eli will give information about symptoms and diagnostic methods and will also tell the user what to do if his or her partner does not want to use protection.

Eli’s language combines expertise and respect for the user and its speech is as gender neutral as possible and free from stigma.

“Eli is an irreplaceable assistant for those who are growing up and discovering new feelings and relationships and who often need truthful information without edification and stereotypes. Eli is another step in implementing UNESCO's global strategy to empower girls and boys to increase their health literacy and to build and maintain healthy, respectful and rewarding relationships,” said Tigran Yepoyan, Head of ICT and Health Education at UNESCO IITE.

In the first week after its launch, more than 4000 people subscribed to the Eli VKontakte group and Eli answered more than 150 000 questions from 10 000 users. People also shared their feedback: “Cool and important topic!” “Eli learns and shares it with us! Go for it, Bot!” “This is very cool guys!”  “I would like to thank the creators of this project. You are doing great!”

Eli is available right now and instructions are available for those who have never used such a service.

Eli will serve as a prototype for the creation of similar chatbots in Russian and in the national languages ​​of Kazakhstan and Kyrgyzstan this year and in the languages of other countries in eastern Europe and central Asia in the future.

“There were no such diseases back in the day! AIDS came into being only because of college kids like you messing around,” shouted an old man at a group of students who were speaking to people about HIV prevention at China’s West Lake beauty spot. “Behave yourselves! We don't need to listen to your rubbish!”

In 2020, almost three years later, Zhao Honghui, the group leader and a medical student in his third year at Zhejiang University, still remembers every word, but he knew he didn’t do anything wrong. “I wanted to tell the old man that actually new HIV infections among old people are also increasing,” he said. “And that hatred and denial are never the solution to HIV.”

Recently, Mr Zhao had the opportunity to say what he had wanted to say and speak about all the experiences, good and bad, he had as a HIV prevention volunteer, speaking to a live online audience of more than 71 000 people from across China.

He and five other young HIV volunteers joined an online dialogue on youth and HIV organized by UNAIDS and Tencent, a Chinese technology company, one of a series of youth dialogues organized by the United Nations in China and Tencent to mark International Youth Day and the United Nations’ 75th anniversary that enabled Chinese young people to speak their minds about the Sustainable Development Goals.

In China, according to government statistics, new HIV infections among young people aged 15–24 years have been on the rise over the past few years. By inviting young volunteers to share their stories, the UNAIDS dialogue aimed to raise awareness among young people about the risk of HIV infection, tell them how to protect themselves and other people and encourage more young people to engage in HIV prevention work.

Mei Junyan, a second-year student from the South China University of Technology, shared his experience as a peer educator on sexuality education and HIV prevention. Sun Yinghui, from Zhongshan University, told the audience how her medical research team had looked at COVID-19’s impact on people living with HIV and how to help them address the challenges. “I see hope because the dialogue made me realize that I’m not alone in this battle,” said Ms Sun. “It’s an inspirational dialogue for all of us who are devoted to HIV prevention,” said Mr Mei.

They also had good interactions with the guest speakers. UNAIDS China Goodwill Ambassador Huang Xiaoming, an actor, said it was not easy to be a volunteer. The Director of the Chinese Association of STD and AIDS Prevention and Control, Hao Yang, encouraged all the participants to continue what they are doing. He said peer education is complementary with school education and he encouraged students to do more volunteer work.   

One special guest was Andy Liu (not his real name). He contracted HIV five years ago, when he was 21 years old. Now he has an undetectable viral load after taking and adhering to antiretroviral therapy and has become a volunteer to help other people living with HIV. Unfortunately, however, he felt that had to turn his camera off to hide his identity, as stigma against people living with HIV is still prevalent in China. A touching moment came at the end of the dialogue when Mr Huang told Mr Liu that he hoped that one day he would not be afraid to show his face. He said he believes that day will come soon and he will continue to speak for people living with HIV and to advocate against stigma and discrimination.

Mr Zhao hopes the youth dialogue will become an annual event where young HIV volunteers can exchange ideas. “This dialogue is useful for us to know what other volunteers are doing and to learn from each other. I thank UNAIDS for providing this platform and I hope it can become a regular event,” he said.

Amakobe Sande, the UNAIDS Country Director for China, said that UNAIDS is committed to serving young people, together with the Chinese Government and community-based organization partners. “I hope the young people at today’s dialogue will inspire more people to join our efforts too. Together we can achieve an HIV-free generation. We can end AIDS as a public health threat.”

A virtual event held on the sidelines of the United Nations General Assembly used virtual reality and extended reality technology to connect the young delegates of YOUNGA—a youth forum initiative of the Office of the United Nations Secretary-General—with influential decision-makers and industry leaders. The discussion and the following interactive question-and-answer session on global challenges and how to create solutions for a more inclusive and sustainable world used three-dimensional avatars of each panellist and participant.

On the event’s panel were Tanaka Chirombo, representing the Global Network of Young People Living with HIV, Daniel Nagel, representing Youth Against AIDS, Dilnaz Kamalova, the co-creator of Sequence, an application that helps to monitor a person’s daily intake of medicines, and Praddep Kakkattil, the Director of Innovations at UNAIDS.

Social, technological and scientific innovations, from new medicines and testing tools to innovative community-led approaches, have been a crucial aspect of the HIV response since the beginning. As we are transitioning to a more virtual world, technologies such as applications, video games, social media platforms and new community-led approaches will be important to bridge the gap between people and HIV services, especially for hard-to-reach populations.

Convened by UNAIDS, the event showcased examples of social and technological innovations led by young people, saw a discussion on how to ensure that the voices of young people and innovative approaches led by young people are central in the next global AIDS strategy and sought to identify the critical factors for scaling up proven health innovations for all young people in need.

Community innovations have always been critical to the AIDS response, as they show the resilience and leadership of communities affected by HIV. Mr Chirombo highlighted how local networks of young people living with HIV have played a key role in improving service provision through the roll-out of innovative peer-support services and youth-led monitoring to assess HIV services. “Young people need to get involved and take the lead to see changes on the ground,” he said.

The importance of collaboration between networks of young people to leverage access to political space and resources for innovations was spoken about throughout the event. “We need to overcome silos, listen to each other and be open to new ideas and partnerships,” said Mr Nagel.

“We need to believe in the ideas we are developing and understand that adolescents and youth can make an impact and change the world,” said Ms Kamalova, who is also a Youth Ambassador for the United Nations Children’s Fund.

Mr Kakkattil spoke about how the AIDS response has been driven by innovations since its early years and about the power of activism to demand the scale-up of scientific and social innovations. “The Health Innovation Exchange, founded by the UNAIDS Secretariat, is a good example of how we can make efforts to connect communities, innovators, developers and investors to improve access to health,” he said.

The event, Youth-Led and Youth-Centered Health Innovations to Reduce Inequalities, was moderated by Gareth Jones, the Vice-Chair of the PACT. 

The UNAIDS Country Office for the Islamic Republic of Iran and the country’s branch of the International Federation of Medical Students’ Associations have been collaborating on new ways of making an impact on the national AIDS response since 2013.

In the past, the collaborations have included public awareness campaigns, educational workshops, field visits and week-long summer schools open to health-care students.

“The summer schools were more than inspiring, they made us confident about our next area of focus: acting against HIV-related stigma and discrimination,” said Aidin Parnia, one of the founders of the summer schools and of the Avecene Consultancy.

Started by people who had attended the summer schools, the Avecene Consultancy was formed to mobilize the accumulated knowledge and experience of the summer schools and to combine them with modern and up-to-date educational developments. The result is the REDXIR educational online platform, which uses games to change the attitude and behaviour of health-care students in order to bring about a future generation of discrimination-free health-care professionals.

Set in an imaginary world where the players are a young group that battles a mysterious enemy that symbolizes HIV-related stigma and discrimination, the goal of REDXIR is to fight back and defeat stigma and discrimination.

The 10 levels of the game are designed to challenge the students’ knowledge of HIV and their attitude and behaviour towards people living with the virus. For example, in the Blood Pressure level of the game, the students have to take the blood pressure of a person living with HIV to show that he or she can do so without discrimination. At higher levels, they should be able to take a blood sugar test and a blood sample for a routine laboratory test.

While some of the levels are performed virtually, others need action to be taken in the real world. For example, in the Do Not Be Silent level, the students must recognize discriminatory posts on social media, post #Zerodiscrimination below at least one of the social media feeds they see and comment on the reason why the content is discriminatory. In the Campaign level, the students participate as trainers in an HIV awareness campaign.

“New generations need new platforms. REDXIR, through its user-friendly approach where students are in direct contact with the target populations, has proved to be an effective way to help eliminate HIV-related stigma and discrimination in health-care settings,” said Parvin Kazerouni, the Head of the HIV Control Department of the Center for Communicable Disease Control of the Iranian Ministry of Health and Medical Education and the National AIDS Manager.

“REDXIR shows how creative and innovative approaches can embrace and support the novel ideas of young people to address issues such as stigma and discrimination,” said Fardad Doroudi, the UNAIDS Country Director for the Islamic Republic of Iran.

The UNAIDS country office provided technical and financial support for REDXIR. 

For the more than 3000 people, including 330 children and adolescents, living with HIV and on antiretroviral therapy in Goa, India, the COVID-19 outbreak is a time of worry—they are worried about COVID-19 and they are worried about being able to stay on their HIV treatment during the lockdown in India.

In order to respond to one of those worries, the team at the Human Touch Foundation, a community-based organization that provides care and support to children and adolescents living with HIV, has, since the start of the lockdown, organized a force of volunteers to deliver antiretroviral therapy to people’s doorsteps.

Health officials at the HIV clinics provide a list of people who need deliveries of antiretroviral therapy, after making sure that the beneficiaries consent. Alternatively, several beneficiaries connect with the Human Touch Foundation directly for a supply of medicine.

“Most people living with HIV are still hiding their HIV status and do not wish that we come directly to their homes for the delivery. With poor mobile connectivity, in many cases we have no option rather than make more than two trips, instead of asking their location with the villagers,” said Peter Borges, the founder and Chief Executive Officer of the Human Touch Foundation.

Along with antiretroviral therapy, the Human Touch Foundation also provides essential groceries—rice, lentils, grams, oil and milk—for children and adolescents living with HIV and their families. “Many children and adolescents are with anxiety and depression, mostly concerning their survival, due to loss of income of their families and scarcity of essential supplies,” said Mr Borges. Bars of soaps are also provided with the packages, distributed in collaboration with UNAIDS, Reckitt Benckiser, the Just Imagine Trust and the Rotary Club of Panaji Riviera.

The Human Touch Foundation is also offering online psychosocial support to children and adolescents living with HIV. “We have streamlined our communication through telecounselling and support. We have a staff team giving coordinating and rendering support to the field team through assessment of the family,” Mr Borges added.

Similar efforts are being undertaken in Bangalore to support people living with HIV. Champion in Me, a community-based organization that provides care, support and skills to adolescents and young people living with HIV, has built a support system to reach out to communities during the lockdown. A force of young volunteers has partnered with the Karnataka Network of Positive People to distribute medicines to 140 people and food provisions to 1200 people. “I praise the courage of our volunteers and supporters that came out to help people living with HIV, in a time of crisis. This is when our organizations and leaders have to stand tall and join efforts to make sure nobody is left behind,” said Elvis Joseph, the Director of Champion in Me.

At the national level, the National Coalition of People Living with HIV in India (NCPI+) is coordinating efforts with the National AIDS Control Organisation (NACO) and other partners, including UNAIDS, to ensure adherence to treatment and a continuum of care for people living with HIV.

“Since the lockdown started, the National Coalition of People Living with HIV in India established a good communication platform through WhatsApp and emails connecting the National AIDS Control Organisation and networks of people living with HIV to closely monitor challenges, find joint solutions and help coordination,” said Daxa Patel, the President of NCPI+ and the Secretary of the Gujarat State Network of People Living with HIV. As a result, NCPI+ has helped more than 45 000 people living with HIV in India to get home deliveries of antiretroviral therapy.

“HIV-affected communities have played an important role delivering antiretroviral therapy to people who were not able to collect it themselves. The Human Touch Foundation, Champion in Me and the National Coalition of People Living with HIV in India are just some examples of what can be done at the national, state or city level by communities themselves. Many local solutions have been put in place in a joint effort between the government, UNAIDS and community-based organizations to get medicines, food or soap delivered to those in need,” said Bilali Camara, the UNAIDS Country Director in India.

Many countries have laws or policies that prevent adolescents from accessing essential health services without the consent of a parent or guardian. The original intention may have been to protect minors, but these stipulations often have the opposite effect and increase the risk of HIV and other health problems among adolescents.

A large proportion of countries across all regions restrict access to HIV testing and treatment for adolescents. In 2019, for instance, adolescents younger than 18 years needed explicit parental consent in 105 of 142 countries in order to take an HIV test. In 86 of 138 reporting countries, they needed such consent to access HIV treatment and care. These kinds of laws and policies also may complicate or hinder adolescent access to pre-exposure prophylaxis (PrEP), a highly effective prevention tool.

Research in sub-Saharan Africa shows that in countries where the age of consent is 15 years or lower, adolescents are 74% more likely to have been tested for HIV in the past 12 months compared with countries where the age of consent is 16 years or higher—with girls especially benefiting from the easier access.

Country-level details on which countries have consent laws can be viewed on the UNAIDS Laws and Policies Analytics web page.

A new film about HIV in the Russian Federation by YouTuber and journalist Yuri Dud is stirring people’s interest about the epidemic in the country.

Since its release on 11 February, the video has been viewed by more than 14 million people, and the number of online searches about HIV and HIV testing has skyrocketed. According to Google Trends, the number of searches on where to buy an HIV test has increased by 4000% since the launch of the video—the highest level of interest in HIV and HIV testing in the past five years.

In the film, published on his YouTube channel, Mr Dud talks to people living with HIV, activists, experts and journalists. Through his interviews, the film voices some of the taboos surrounding HIV in Russian society, including condom use, and looks into the drug use epidemic in the country, the services available for people who use drugs and the lack of sex education, among other things.

It is clear in the film that younger people still lack basic information about HIV—things like the difference between HIV and AIDS, the effectiveness of treatment or even how the virus is transmitted are still mysteries for many in the country. “You can touch people living with HIV, exchange clothes, swim in the same pool, drink from the same mug, cuddle, kiss. It's stupid to be squeamish about people living with HIV. It is much better to be squeamish about unprotected sex and drugs. These are still the two main modes of HIV transmission,” said Mr Dud.

The popularity of the film has prompted government officials to take a closer look at the HIV epidemic and response.

“Yuri Dud’s film about HIV is undoubtedly useful. It provides a lot of important information and motivates people to get tested for HIV,” said Oleg Salagai, Deputy Health Minister, in his Telegram channel. Mr Salagai emphasized how the film draws attention to the issue of the stigma endured by people living with HIV. “HIV is not a death sentence anymore. It is very important that people living with HIV have access to HIV treatment to live a healthy and fulfilling life,” he wrote.

Mr Salagai was not the only government official reacting to the video.

Alexei Kudrin, the Head of the Accounts Chamber of the Russian Federation, promised to carry out a review of the effectiveness of HIV prevention and care programmes in the country. “This year, the Accounts Chamber will analyse the effectiveness of government resources allocated to people living with HIV in the Russian Federation,” he said.

And the first Deputy Head of the State Duma Health Committee, Fedot Tumusov, invited members of parliament to watch the film and discuss to the HIV situation in the Russian Federation. He is also planning a round-table meeting in the State Duma to explore ways to improve access to HIV prevention and treatment.

“The public response to Mr Dud’s film is incredible. However, even such a successful action is not enough. We need consistent and long-term activities to raise HIV awareness coupled with programmatic actions to ensure access to HIV testing and treatment for all,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Eastern Europe and central Asia, of which the Russian Federation is a part, has the fastest growing HIV epidemic in the world. Most new HIV infections in the Russian Federation are among key populations, including people who inject drugs, despite the well-documented power of harm reduction programmes, where available, to reduce new HIV infections—insufficient access to sterile injecting equipment and the unavailability of opioid substitution therapy are stymying efforts in the country to prevent HIV infections among people who inject drugs.

There are approximately 24 000 young people aged 15–24 years living with HIV in Thailand. In 2018, young people accounted for nearly half of the 6400 new HIV infections in the country.

Thailand has made great strides in its AIDS response, providing antiretroviral therapy free of charge as part of its universal health coverage scheme. However, adolescents and young people living with HIV often fall out of care or do not receive the support they need to remain on treatment. Self-stigma, stigma and discrimination and transition from paediatric care to adult care are some of the challenges faced by adolescents and young people living with HIV.

To close this gap, three years ago the United Nations Children’s Fund (UNICEF) and other national partners led by the Thai Network of People Living with HIV created the Thai Network of Youth Living with HIV. The main objective was to empower adolescents and young people living with HIV to be agents of the change that they wanted to see in their lives. The network’s capacity was built to provide referral services, life-skills training and peer-to-peer support for adolescents and young people living with HIV.

Kritthanan Ditthabanjong, one of the first active members, is now Head of Corporate Communication at the network. Studying to become a journalist, he also works as a content editor for websites and magazines in Thailand and is a well-recognized young leader. Mr Ditthabanjong represents the network at public events and in the media, voicing the needs of young people living with HIV.

“I have publicly disclosed my HIV-positive status because I want other people to learn from my experiences and to give young people the information they need to lead healthy and dignified lives. I feel confident to speak out because I have support from my friends and community,” he said.

With technical and financial support from UNICEF and other partners, and through a variety of platforms and strategies, the network offers emotional support around receiving an HIV-positive diagnosis, provides HIV information to reduce self-stigma, builds coping skills and creates a supporting network to tackle stigma and discrimination. “Young people living with HIV need emotional support and a community they can trust,” said Mr Ditthabanjong.

Trained young leaders with the network provide counselling for young people living with HIV and link them to health facilities, hospitals and community-led services for HIV treatment and care. The young leaders also accompany young people living with HIV to medical appointments and carry out follow-up home visits to help them adhere to treatment.

The network uses social media to reach out to young people, providing information on HIV and promoting self-acceptance. Initiatives such as the online campaign Growing Up with HIV offer safe spaces that enable young people to ask questions about different topics, including HIV prevention and safe sex, and share opinions and thoughts.

“Growing Up with HIV allows young people to be part of our community and make them feel they are not alone,” continues Mr Ditthabanjong.

Mr Ditthabanjong engages in other campaigns and social media initiatives with UNICEF that address young people in general in Thailand but also allow him to bring in the voices and perspectives of young people living with HIV. He has recently joined Dare to Dream, a public campaign created by UNICEF for Thai young people to voice their opinions on education and what is required to prepare them for the transition to adulthood. “From a shy adolescent who did not wish to speak and constantly glanced at his counsellor for approval a few years ago, Mr Ditthabanjong followed a path with us and he was one of nine motivational speakers at the Dare to Dream youth campaign, a role model for young people in his country,” said a UNICEF staff member.

Mr Ditthabanjong concludes, “One day I had an interview on social media. As soon as I came off, I received a text from a young person who had recently been diagnosed with HIV. “My mum and dad do not accept me, and I want to kill myself,” he said. I phoned him, met him and convinced him to join our network. Now this person is doing well. Our work is impacting people’s lives.”