DAKAR/GENEVA, 16 January 2019—At a high-level meeting in Dakar, Senegal, UNAIDS, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) urged countries in western and central Africa to do more to stop new HIV infections among children and adolescents and increase HIV testing and treatment coverage.

In 2017, around 67 000 children (aged 0–9 years) and 69 000 adolescents (aged 10–19 years) became newly infected with HIV. Two thirds (46 000) of adolescents newly infected with the virus were girls. While progress has been seen in stopping new HIV infections among children in some countries—eleven countries registered a reduction of more than 35% between 2010 and 2017[1]—others, including Nigeria, which has the largest epidemic in the region, experienced no declines at all.

“Countries in western and central Africa have a real opportunity to create a positive change for children and young people,” said Michel Sidibé, Executive Director of UNAIDS. “Underlying issues including a lack of domestic investment, fragile health systems, user fees, gender inequality and widespread stigma and discrimination must urgently be addressed to remove barriers and save lives.”

In western and central Africa, close to 800 000 children and adolescents aged between 0 and 19 years were living with HIV in 2017—the second highest number in the world after eastern and southern Africa.

“The majority of children living with HIV in this region are not receiving care and treatment because they do not know they have HIV as they have not been tested,” said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa. “We can reverse that trend by focusing on a family-centered approach to HIV testing and treatment and by rolling out innovative point-of-care technologies that bring testing closer to the primary health facilities and the communities where children live.”

Less than half of all pregnant women living with HIV in the region (47%) had access to antiretroviral medicines to prevent transmission of the virus to their child and only 21% of infants exposed to HIV were tested for the virus within the first two months of life.

We should not lose anymore of Africa’s future to AIDS,” said Matshidiso Moeti, WHO Regional Director for Africa. “Effectively tackling HIV in children and adolescents needs strong and quality health services. By committing to universal health coverage, countries can fast-track progress towards an AIDS-free generation in western and central Africa.”

Although there has been some progress in antiretroviral therapy coverage for children in western and central Africa, which rose from 18% in 2014 to 26% in 2017, the region still has the lowest coverage in the world. Around 52 000 children and adolescents aged between 0 and 19 years died of AIDS-related illnesses in 2017—34 000 of whom died before they reached their fifth birthday.

In the 2016 United Nations General Assembly Political Declaration on Ending AIDS, countries from western and central Africa committed to work towards reducing the number of new HIV infections among children and young adolescents (under 15 years) to 6000 by 2020 and to ensuring access to treatment for 340 000 children and young adolescents (under 15 years) by 2020.

However, pledges to accelerate the HIV response have not been accompanied by a surge in resource mobilization. The total resources needed for an effective response in western and central Africa were 81% greater than the funds available in 2017.

Translating commitments into action requires engagement from political and community leaders, drastically scaling up investments, scaling up innovative technologies such as point-of-care for early infant diagnosis, differentiated service delivery strategies—including family testing and longer prescriptions for antiretroviral medicines—and task-shifting approaches applied to HIV care and treatment services for children across the region.

As part of concerted efforts to step up progress in the region, UNAIDS, UNICEF and WHO called a High-Level Meeting on the Elimination of Mother-to-Child Transmission of HIV and Universal Health Coverage of Paediatric HIV Testing and Treatment in West and Central Africa to unpack the challenges, share best practices and innovative approaches to address the persisting bottlenecks, agree on corrective actions and ensure commitment to action from countries and partners.

Hosted by the Government of Senegal, the meeting is being held in Dakar from 16 to 18 January 2019, bringing together ministers of health, experts, representatives of civil society and partners from across the region as well as high-level representatives of United Nations organizations, the African Union, the Economic Community of West African States and the Economic Community of Central African States.

During the meeting, countries and partners are expected to renew their commitment to the 2015 Dakar Call to Action for Accelerating the Elimination of New HIV Infections in Children and Access to Treatment for Children and Adolescents Living with HIV by 2020.

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.

A new regional civil society cooperation network for the Americas and the Caribbean to support nongovernmental organizations working to end AIDS was launched on 30 October in Quito, Ecuador. Launched by Coalition PLUS, the initiative will support coordination and capacity-building among community organizations involved in the AIDS responses of North, Central and South America and the Caribbean.

“Although we have HIV services available, people do not have access because they are criminalized and stigmatized. The community movement is helping us to end the conspiracy of silence about discrimination. We need civil society to increase efforts to achieve the progressive policies that will clear the way for us to end AIDS,” said Michel Sidibé, UNAIDS Executive Director.

Since 2014, Coalition PLUS—an international alliance of more than 100 nongovernmental organizations contributing to the AIDS response—has been building and strengthening mechanisms for regional collaboration. Such networks already exist in western Africa, central Africa, the Middle East and North Africa, the Indian Ocean and Europe.

The President of Coalition PLUS, Hakima Himmich, said that the network will increase access by organizations to new resources and approaches relevant to their local contexts. She noted that it was especially important to strengthen civil society’s capacity around addressing the needs of the most vulnerable.

“We have huge challenges around stigma and discrimination against entire populations. In order to achieve epidemic control, we must also address human rights,” said Ms Himmich.

UNAIDS data show that in 2017 key populations and their sexual partners accounted for three quarters of new HIV infections in Latin America and two thirds of new infections in the Caribbean. Gay men and other men who have sex with men and transgender women are disproportionately affected, with a few countries reporting HIV rates of above 15% among those communities.

The activities of the network in the region will be coordinated by the Kimirina Corporation, a Ecuadorian organization focused on people-centred combination prevention and advocacy. Amira Herdoiza, Director of the Kimirina Corporation, explained that the platform will place strong emphasis on coordinated research, skills-building and advocacy, particularly around issues affecting young people and key populations. 

“We need more multicountry research to show the nuances of our epidemics,” Ms Herdoiza said. “Through this network our organizations’ capacities to share and analyse data will be strengthened. We will also focus on sharing experiences and planning joint programmes.”

At present, there are three other members of the regional network: the Coalition of Quebec Community Organizations against AIDS in Canada; AIDES in the French Caribbean; and the Institute for Human Development in the Plurinational State of Bolivia. Other regional organizations are invited to be part of the initiative.

UNAIDS’ unwavering commitment praised by the President

GENEVA, 25 October 2018—The President of Botswana, Mokgweetsi E.K. Masisi, visited UNAIDS headquarters in Geneva, Switzerland, on 25 October 2018 to share Botswana’s vision on a key public health concern: HIV.

The President met the Executive Director of UNAIDS, Michel Sidibé, and congratulated UNAIDS for leading the AIDS agenda with humility and professionalism. 

“We continue to count on your stewardship,” said Mr Masisi. “Botswana stands ready to sprint the last mile to end AIDS as a public health threat.”

Two decades ago, AIDS ravaged the small southern African nation of 2 million. Today, despite having one of the highest rates of HIV in the world – 23% of adults live with HIV- Botswana has shown remarkable progress. New HIV infections have been reduced by 63% since the peak in 1996 and AIDS-related deaths have decreased to 4100 from 15 000 in 2008. It was the first country in the region to provide universal, free antiretroviral treatment to people living with HIV, paving the way for many other countries in the region to follow.

Mr Sidibé described the President as an advocate for the region. “Mr Masisi is bringing new energy and impetus to the AIDS response in Botswana with a focus on HIV prevention,” said Mr Sidibé. The President participated in a moderated dialogue along with a high-level delegation that included the Minister of International Affairs and Cooperation and the Minister of Health and Wellbeing as well as the First Lady of Botswana. During the discussions, the President described Botswana’s financial investments in health, HIV and its people.  He highlighted that mother-to-child HIV transmission is on the verge of being eliminated and that more than 80% of people living with HIV are on treatment.

However, challenges remain. “When you disempower a young girl through violence or unwanted sexual experience, she is affected for life,” Mr Masisi said. In order to curtail new HIV infections, the President committed to redefining the roles and engagement of young boys and men. Mr Masisi and Mr Sidibé then recognized former President Festus Mogae’s long-standing efforts to turn the country around from despair to hope when Botswana faced the HIV crisis initially.  

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.

Twenty-four young people gathered in Suva, Fiji, to take stock of the country’s progress in meeting the commitments in the 2016 United Nations Political Declaration on Ending AIDS and to identify what puts young people at risk of HIV.

The participants recognized that Fiji has taken important steps to establish laws and policies that enhance young people’s access to sexual, reproductive and HIV services. However, they noted that there are many factors that jeopardize young people’s health, including stigma and discrimination, limited access to condoms and a lack of harm reduction programmes for young drug users.

“Many young people have basic knowledge about HIV, its transmission and prevention. Many of them are not aware that antiretroviral treatment exists. It is critical that young people have access to information which is detailed and are informed on where they can obtain it,” said Swastika Devi, from the Reproductive Family Health Association of Fiji.

Greater technical and financial support for participation by young people in community responses to HIV was identified as important. The consensus from the group was that capacity-building of youth leaders should be supported, including leaders from communities, key populations and people living with HIV, in order to enhance their engagement in advocacy and decision-making.

The participants also agreed to form a sexual and reproductive health and rights youth network, which will finalize an advocacy road map focusing on their priority issues, which are youth-friendly services at clinics, developing a standard package of youth-centred services and comprehensive sexuality education that goes beyond puberty. The network has established contact with the Ministry of Health and Medical Services and Fiji’s national steering committee for World AIDS Day to strengthen youth-focused activities for World AIDS Day.

“The #UPROOT consultation has given us the reality of how the commitments in the 2016 United Nations Political Declaration on Ending AIDS affect young people in Fiji,” said Renata Ram, UNAIDS Country Director for Fiji. “Young people continue to be left behind in the AIDS response, despite being the age group most affected by the epidemic. The future of the HIV epidemic in Fiji will be determined by how we package our services towards young people. Failing to do so will push us further from ending AIDS.”

The consultation was part of the #UPROOT youth-led political agenda, launched by the PACT, a global coalition supported by UNAIDS of more than 80 youth organizations and networks working on HIV to respond to the barriers that put young people at risk of HIV. Similar #UPROOT meetings have taken place in Panama, Cameroon and Ghana.

A global coalition of more than 80 youth organizations working on HIV (the PACT), and Youth Voices Count (YVC) launched a poll to get a sense of what young people know about sexual reproductive health.

More than half of the 270,000 young people aged 10-24 from 21 countries who responded to the U-Report poll (54% of boys and young men, and 58% of girls and young women) sought HIV and other services at a health centre or clinic in the previous three months.  About 36% of young people aged 10-24 who did not seek services reported feeling uncomfortable visiting a health centre or clinic, and more than 28% of young people (both sexes) said they felt scared to seek services.

The poll with support from UNAIDS, UNICEF and UNFPA was complemented by an in-depth survey and interviews led by YVC, which showed that approximately 15% of those who accessed any sexual health services in the past 6 months experienced refusal or mistreatment because of their age, sexual orientation, gender identity or HIV status. And of those who felt mistreated because of their age, 55% identified as gay, bisexual, and 25% identified themselves as living with HIV. Further, 32% of young gay, bisexual men and other young men who have sex with men, and 50% of young transgender people, felt that they had been discriminated against because of their gender identity or sexual orientation. Finally,16% of young people who identified themselves as living with HIV said they had been mistreated because of their HIV status.

Although healthcare settings should be safe spaces for those receiving care, this is not the case. Policies and attitudes remain barriers to youth-friendly HIV and sexual and reproductive health services. Indeed, 37% of respondents who reported having visited a clinic were not willing to recommend doing so to their peers.

This year’s theme for International Youth Day is Safe Spaces for Youth, highlighting the need of young people for safe spaces to come together, hang out, and participate in decision making processes as well as freely express themselves. This includes in healthcare settings, which should be places of safety and refuge, free from stigma, maltreatment, and violence.

Every day, approximately 1600 young people are infected with HIV, while one young person dies of AIDS-related illnesses every 10 minutes. Young women aged 15-24 are particularly affected. In sub-Saharan Africa, young women are twice as likely to be infected with HIV as their male counterparts. And young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, young sex workers and young people who inject drugs) are at a high risk of HIV around the world due to rights violations, discrimination, exclusion, criminalization and violence. Of the young people living with HIV globally, most do not know their status.

Download more slides like this from 2018 Global AIDS Update Miles to Go 

Sitting on center stage, clutching a microphone, Chinmay Modi along with a dozen young people answered questions about HIV during an all-youth panel session at the Amsterdam 2018 AIDS conference.

The 25-year-old born with HIV described his struggle accessing services. "In India, sex is a big taboo. A 16-year-old cannot buy condoms for example and parents need to give consent to be tested for HIV." He said educating children and parents is key. His greatest desire involves pushing for specific youth-focused services.

Dany Stolbunov from Ukraine echoed that sentiment, saying "Nothing for us, without us." He said that in his region stigma and discrimination kept people from even accessing services. He bemoaned the fact that young people in Ukraine have limited information and are not seen as a priority.  

HIV FACTS

In 2017, there were approximately 250 000 new HIV infections and 38 000 AIDS-related deaths among adolescents and 1.8 million adolescents living with HIV globally.

Adolescent girls in sub-Saharan Africa are disproportionately affected by new HIV infections, making up 56% of new HIV infections among adolescents globally.

HIV is a leading cause of death among adolescents (10-19 years).

"We are ready to fight for our rights," he added, explaining that young people have a voice and want to use it.

Bruna Martinez strongly believes that broad sexual education discussing gender, health issues and pleasure would not only limit stigma, it would also make teenagers fear HIV less.

"HIV should not be in a vacuum," she said. "We are a generation that can discuss sex and that's a great thing; so give us the tools that tip things in our favor."

All agreed that teenagers and young people have the most at stake in ending the HIV epidemic. Their demand is clear: go beyond scholarships by empowering us.

Melodi Tamarzians, the Dutch youth ambassador for sexual and reproductive health and rights, said, "Do not tick the youth box by giving us a token position." In her view, to enable young people, adults need to invest in them and give them advisory roles.

AIDS 2018 prided itself on giving a greater space to young people in Amsterdam. Youth and junior investigators made up more than one-third of the submissions presented at the conference, according to the conference organizer, the International AIDS Society (IAS.) In addition, young people got the most scholarships than at any other conference. And the Global Village (a free admission space by the conference area) featured the largest space conceived of and run by young people. It included a snack area, a mini-indoor football field, a safe-space theater area and youth-led activities, and booths such as a radio recording area, a youth against AIDS t-shirt stand and even an exhibit about the vagina.

Ms Martinez volunteered and then worked with the Amsterdam Youth Force that mobilized and organized other young people to make the youth space their own. "At this conference, we showed everybody that we could deliver," she said.

She hopes that this meaningful youth presence will carry over. "It's important that we are not being catered to but rather that we are recognized," she said, her AIDS 2018 lanyard laden with pins and stickers. She sees her recent stint with the Youth Force as a way to change things. "There are still so many young people getting infected with HIV and dying. It means we are failing and the system is not working," Ms Martinez said. In her view, HIV policy has to also come from the ground upwards. She emphasized peer-to-peer education and valuing local knowledge. Standing in front of a huge 'Let's face HIV together' she said, "We speak the language of the young people and we know what we are living, so acknowledge us fully."

A meeting at the 2018 International AIDS Conference, being held from 23 to 27 July in Amsterdam, Netherlands, has showcased how Kenya is responding to the challenges and opportunities on the way towards validation of the elimination of mother-to-child transmission of HIV in a high-burden context. 

Building on the Start Free Stay Free AIDS Free framework, specific attention is being given in Kenya to ensuring access to treatment for children and adolescents living with HIV, while addressing inequities, particularly among adolescent girls and young women.

The participants heard about the role of high-level champions—including community leaders, parents, religious leaders and other relevant stakeholders—highlighting the need for action at all levels, based on robust programmatic data.

Kenya has made significant progress in preventing new HIV infections among children, which fell from an estimated 13 000 in 2010 to 8000 in 2017. This has been possible through programmes such as the mentor mother initiative, which supports and cares for women living with HIV, the mother–baby pair approach, which synchronizes appointments for the mother and the child at the health facility, and audits of every child exposed to HIV in order to identify barriers in accessing health facilities.

The leadership of Margaret Kenyatta, the First Lady of Kenya, and her Beyond Zero Campaign have been instrumental in raising awareness on the importance of services to promote the health of mothers and children, including HIV prevention.

The participants heard, however, that more needs to be done to ensure that progress is equal across the country. Progress has been threatened by recent challenges, such as a health workers strike, which has affected antenatal care and testing coverage, and reduced community support, which has affected demand creation for HIV services.

The participants decided that there was an urgent need to scale up HIV programmes. This would be complemented by innovations in tracking the targets for paediatric and adolescent HIV and accounting for every mother and child. Furthermore, the resilience of the health system needs to be strengthened.

The meeting, held on 24 July, was jointly organized by the Ministry of Health of Kenya, UNAIDS and the Elizabeth Glaser Pediatric AIDS Foundation.

Quotes

The PACT, a global coalition of youth organizations working on HIV and sexual and reproductive health and rights, gathered in Amsterdam, Netherlands, on 24 July at the International AIDS Conference, a year after launching #UPROOT, a youth-led political agenda to end AIDS by 2030.

The session saw youth advocates share materials developed by #UPROOT to inspire and mobilize more young people to act at the country level to challenge harmful laws, advocate for youth participation in the AIDS response and build strategic and more resilient partnerships to end AIDS.

Discussions focused on persisting legal barriers that young people face to access services, including age of consent laws on HIV testing and treatment. In 2017, 73% of 125 countries reported having age of consent requirements for HIV testing, out of which 31% require consent for adolescents younger than 18 years old. The PACT, through the #UPROOT agenda, has developed a set of policy briefs aimed at youth advocates to tackle these legal and policy constrains to access services.

Young people’s participation in the HIV response was highlighted as a key determinant to ensure its effectiveness and sustainability. Youth participation in key decision-making spaces is still a challenge. A recent UNAIDS report, Youth and HIV: mainstreaming a three-lens approach to youth participation, suggests that “while young people participate in the development, consultation, validation or review of strategic documents that guide the HIV response at the country level, they participate much less frequently in spaces where decisions are made about the policy framework or resources invested in the HIV response.”

Greater technical and financial support to young people’s participation in community responses to HIV was also highlighted as a pending need of youth-led organizations and networks working on HIV.

Strengthening collaboration between medical students and young key populations to reform national medical curricula in order to tackle discrimination in health care was also a focus of the session. In 2017, under the #UPROOT agenda, the International Federation of Medical Students Associations signed a memorandum of understanding with youth organizations and networks, including networks of young key populations and young people living with HIV, to respond to discrimination in health care, resulting in stronger collaborations in several countries, including Egypt and Uganda.

All the resources developed by the #UPROOT agenda thus far, including guidance on youth organizing, advocacy and accountability in advancing the AIDS response and young people’s rights, will soon be available on an online action centre.

Quotes