Communities are essential to the sustainability of the HIV response

GENEVA, 26 February 2025—On Zero Discrimination Day, 1 March, everyone’s right to live a full and productive life with dignity is celebrated. Zero Discrimination Day highlights how people can become informed and promote inclusion, compassion, peace and, above all, it is a movement for positive change.

This Zero Discrimination Day, UNAIDS is Standing Together with communities. Communities are essential to the sustainability of the HIV response and to broader global health efforts. They must be financed and supported in their steadfast commitment to ensuring that all people living with and affected by HIV have access to the services they need and are treated with dignity and respect.

"The only way to end AIDS is by working together with communities. They build trust and reach people which many traditional health facilities find hard to reach—the most marginalized, and people who face stigma and discrimination,” said Christine Stegling, UNAIDS Deputy Executive Director. “To end AIDS by 2030, sustained investment and support for community-led responses is crucial.”

Community healthcare and support providers are too often faced with challenges—stigma, discrimination, criminalization, funding cuts, and political backlash—despite their primary role in ensuring that health services reach everyone in need, including the most vulnerable.

Compounding this, the current crisis caused by the shift in U.S. government funding has resulted in deep anxiety and pain for many community organizations as the future of life-saving community-led HIV prevention, treatment, care, and support programmes are at risk, despite the clear evidence of the positive impact of community-led services.

Community led services are essential to the sustainability of the AIDS response up to and beyond 2030, yet community-led responses are too often unrecognized, under-resourced and in some places even under attack. Crackdowns on civil society and on the human rights of marginalized communities are obstructing communities from providing HIV prevention and treatment services. The underfunding of community-led initiatives is leaving them struggling to continue operating as well as holding them back from expanding. If these obstacles are removed, community-led organizations can add even greater impetus to end AIDS as a public health threat by 2030.

“No society can thrive where discrimination exists,” said Marc Angel, Vice President of the European Parliament and a long-time HIV activist. “Every right denied, every barrier imposed weakens us all. On Zero Discrimination Day, let’s make it clear: equality is not an option—it’s a necessity. We stand together.”

On this year’s Zero Discrimination Day, UNAIDS calls on countries, donors and partners to fulfill their commitments and Stand Together to support communities as they work to build sustainable HIV responses by ensuring that:

• Community-led organizations are able to deliver life-saving services and advocate without discrimination or harassment.
• Community-led organizations can legally be registered in the country they are working in and receive sustainable funding.
• Communities are supported in providing health services to vulnerable and marginalized groups.
• Communities are supported and funded in work to monitor respect for human rights including ending the criminalization of key populations, stigma and discrimination and gender inequalities.
• Government health services include community representatives within their structures as partners in the development, implementation and monitoring of health programmes to ensure they are accessible and acceptable to people living with HIV and marginalized populations.

The sustainability of the AIDS response now and into the future is critical with communities at the centre. Now is the time to reaffirm global commitment to their leadership.

Adrian Lindayag, a Philippines actor, learned he was living with HIV in 2017. But even before then, he’d felt the weight of the disease.

“I’ve lost friends to AIDS, and that is because of the shame and stigma surrounding the virus… the lack of education because they were afraid to get tested. Or, if they did get tested, they just gave up on their dreams, gave up on their lives.”

At first, he only discussed his diagnosis with his family and medical team. But last year he made the decision to go public, becoming a LoveYourself U=U Ambassador.

U=U is short for Undetectable = Untransmittable. It means that when a person living with HIV, adheres to effective antiretroviral treatment, the virus in their blood reduces to a level that is undectable, bringing the chance of passing the virus on to zero.

“I honestly didn't know about the concept of U=U before learning about my HIV status. It was my doctor who told me about it, and it changed my life radically. It gave me hope that I'll be able to still live a normal and healthy life,” Mr. Lindayag explained.

Dr. Jakkrapatara Fair Boonruang is a research physician at the Institute of HIV Research and Innovation (IHRI) in Bangkok, Thailand. He reflects that U=U has transformed the way he counsels newly diagnosed patients.

“U=U changed my clients’ lives,” he said. “Before, providers would advise them that antiretroviral treatment will keep them alive and healthy. But there was no sense of returning to who they were before the infections. U=U actually changes that. It means they can fully enjoy sexual intimacy, and mothers can deliver their babies without the fear of transmitting the virus. It has been a mantle of hope and empowerment.”

In 2014, Thai researchers joined peers in Australia and Brazil for the Opposites Attract Study. That research tracked couples in which one person was HIV-negative and the other was living with HIV but had achieved an undetectable viral load through successful treatment.  It confirmed that after two years of unprotected sex, there were no cases of HIV transmission between more than 300 couples. 

Although the U=U concept has been established as scientific fact for over a decade, the word has not gotten out to the wider world. Even some people living with HIV weren’t informed during counselling. Bella Aubree, an Indonesian activist, is one of them. When she learned her HIV status at age 16, she wondered whether she would die soon. She learned about U=U online and the message gave her hope.

“At the time I felt bored with taking ARVs (antiretroviral therapy) every day. But my motivation came from knowing at some point I will be undetectable, which means untransmittable,” she explained.

For Shan Ali, a Dostana Society peer counsellor from Pakistan, while the U=U concept has transformed his health and outlook, the knowledge hasn’t shifted attitudes among his family members.

“In Pakistan right now there are only two sets of people who know about U=U. One is the service providers and the other is people living with HIV. The general public has no idea,” Mr Ali explained. “I have tried bringing my family in for counseling, but they still discriminate towards me. They even make me eat with separate utensils. I feel very isolated and stigmatized. But in my work with community, I feel a sense of purpose.”

Karun Lama, a communications specialist for the Seven Alliance, is HIV-negative but lost both her parents to AIDS. For her, U=U holds the promise of a regular life and family with her boyfriend who is living with HIV.

“In India, where family and relatives' consent is very important, it was very difficult for us at first to make them understand because my partner's family and relatives were scared and concerned for me. They thought that my partner is putting my life at risk and he should get married to a person living with HIV only. But we've sensitized them about U=U and they have begun to understand that we can also live a life together happily and he won't transmit HIV if his viral load is undetectable,” Ms Lama said.

Eamonn Murphy, Regional Director of UNAIDS Asia Pacific and Eastern Europe Central Asia, saluted the courage of these and other community leaders working to raise awareness about the power of the U=U concept.

“Treatment saves lives. But it can also prevent new infections and transform the way we think about people living with HIV and how they see themselves,” said Mr Murphy. “This Zero Discrimination Day, we recognize the critical role of communities in spreading awareness, supporting adherence and challenging stigma and discrimination. We must ensure this essential work is facilitated and financed.”

With support from communities, researchers and UNAIDS Goodwill Ambassador for Asia and the Pacific, Miss Universe 2015, Pia Alonzo Wurtzbach, UNAIDS is leveraging the U=U message to help end HIV stigma and discrimination. On Zero Discrimination Day (1 March). UNAIDS welcomes everyone to join by sharing these messages and joining the U=U song and dance challenge on social media. #UequalsUDance #EndHIVstigma

Honduras' HIV response is experiencing critical disruptions due to the U.S. funding pause for many HIV services. Approximately 100 healthcare workers had stopped providing lifesaving services following the initial U.S. stop-work-order last month, reducing access to essential HIV services like testing, prevention, and treatment for people living with HIV. These interruptions in access to HIV services create great individual – and public - health risks. While some affected healthcare workers were instructed that they could resume work on 24 February, it is not clear how many of them returned to work.  It is estimated that approximately 20 000 people live with HIV in Honduras. The country’s HIV response relies on external financial support for prevention among key populations. The Global Fund, PEPFAR and USAID have been supporting the country’s efforts to end AIDS as a public health threat.

Read more

Sixteen new reports on the impact of the freeze of US foreign assistance on the global AIDS response were received from UNAIDS’ Country Offices during the week of 17-21 February. As of 21 February, at least one status report had been received from 55 countries, including 42 PEPFAR-supported and 13 that receive some US support.

Reports received over the past week show that waivers have led to the resumption of select clinical services, such as HIV treatment and prevention of vertical transmission, in many countries that are highly dependent on US funding. However, the durability of this resumption is unclear amid multiple reports that key US government systems and staff responsible for paying implementing partners are either offline or working at greatly reduced capacity.

Critical layers of national AIDS responses are ineligible for waivers, including many HIV prevention and community-led services for key populations and adolescent girls and young women. In addition, data collection and analysis services have been disrupted in numerous countries. Reports from UNAIDS’ Country Offices note that these interruptions have eroded the overall quantity and quality of HIV prevention, testing and treatment services. Human resources for health at health facilities are facing increased workloads, and patients are experiencing increased waiting times to receive life-saving services. US government statements to UN system organizations suggest US-funded programmes focused on gender equality and transgender populations may not resume.

Continue reading

Sixteen new reports on the impact of the freeze of US foreign assistance on the global AIDS response were received from UNAIDS’ Country Offices during the week of 17-21 February. As of 21 February, at least one status report had been received from 55 countries, including 42 PEPFAR-supported and 13 that receive some US support.

Reports received over the past week show that waivers have led to the resumption of select clinical services, such as HIV treatment and prevention of vertical transmission, in many countries that are highly dependent on US funding. However, the durability of this resumption is unclear amid multiple reports that key US government systems and staff responsible for paying implementing partners are either offline or working at greatly reduced capacity.

Critical layers of national AIDS responses are ineligible for waivers, including many HIV prevention and community-led services for key populations and adolescent girls and young women. In addition, data collection and analysis services have been disrupted in numerous countries. Reports from UNAIDS’ Country Offices note that these interruptions have eroded the overall quantity and quality of HIV prevention, testing and treatment services. Human resources for health at health facilities are facing increased workloads, and patients are experiencing increased waiting times to receive life-saving services. US government statements to UN system organizations suggest US-funded programmes focused on gender equality and transgender populations may not resume.

Continue reading

Honduras' HIV response is experiencing critical disruptions due to the U.S. funding pause for many HIV services. Approximately 100 healthcare workers had stopped providing lifesaving services following the initial U.S. stop-work-order last month, reducing access to essential HIV services like testing, prevention, and treatment for people living with HIV. These interruptions in access to HIV services create great individual – and public - health risks. While some affected healthcare workers were instructed that they could resume work on 24 February, it is not clear how many of them returned to work.  It is estimated that approximately 20 000 people live with HIV in Honduras. The country’s HIV response relies on external financial support for prevention among key populations. The Global Fund, PEPFAR and USAID have been supporting the country’s efforts to end AIDS as a public health threat.

Community-based organizations are struggling to fill the gap due to severe resource shortages, which compromise service quality and continuity at community level. Additionally, the disruption of prevention programs has increased the risk of new HIV infections, especially among key populations. This is compounded by the recent suspension of PrEP distribution for LGBTQ+ people, who are among the population disproportionately affected by HIV. The ongoing disruption to the country’s HIV response could reverse the progress Honduras has made in the past years in reducing new infections rates.

The funding pause has also halted multiple initiatives designed to ramp up the country’s HIV response, including the cancellation of targeted HIV prevention campaigns aimed at reducing new HIV infections especially among key populations. These programs were meant to be mainly led by local civil society organizations. UNAIDS has been working with both the government and community-led organizations in supporting the country to end AIDS through scientific and evidence-based technical interventions to end AIDS as a public health threat.

Due to the U.S. Government’s freeze of foreign assistance, 15,374 PEPFAR-funded HIV response staff across national and 27 priority districts have been affected, with an estimated HR cost of ZAR 4.6 billion (~USD 250 million), and approximately 222,000 people living with HIV, including 7,445 children under the age of 15, face disruptions in their daily antiretroviral therapy supplies.

Documented Impact on Services as of 20 February

• PEPFAR-funded Projects: Last week, PEPFAR-funded projects in South Africa received waiver letters, prompting a review of their activities. The CDC has communicated with beneficiary organizations, while USAID-supported partners remain closed.
• Service Disruptions: The closure of the TB/HIV Care clinic in Tshwane, Pretoria, has significantly impacted people living with HIV, particularly the homeless, of whom 70% are drug users.
• The halt in US Government support has led to a pause in the Ritshidze (“Saving Our Lives”) Community-led monitoring project. Established in 2019, the project monitors more than 400 public clinics and community healthcare centers, located in 27 priority districts and 8 provinces of South Africa. The facilities were chosen to cover nearly half of all people living with HIV on treatment in the country, with a focus on sites with large treatment cohorts and where the data show poor linkage and retention rates.

Human Rights, Key, and Vulnerable Populations

• People who use drugs: Service disruptions pose a high risk of needle sharing and antiretroviral interruptions due to the lack of referral letters required by some government facilities. This increases the risk of HIV viral rebound and transmission among the estimated 80,000 people who use drugs in the country.
• LGBTQ+ communities: Facilities like Engage Men’s Health, which support gay and bisexual men and men who have sex with men, remain closed. This closure heightens the risk of stigma, discrimination, and potential resurgence of new HIV infections among these marginalized populations.

Government convening and mitigation measures

• ART Dispensation: The Department of Health has implemented a 6-month antiretroviral therapy dispensation for eligible patients to reduce clinic visits and ease the workload on health workers.
• Telemedicine and Digital Health: Efforts are being made to strengthen telemedicine and digital health platforms for HIV prevention and treatment services.
• Private Sector and Civil Society Partnerships: The Department of Health is encouraging partnerships to support key populations' HIV services.

Full story

JOHANNESBURG/GENEVA, 25 February 2025—UNAIDS welcomes South Africa’s plan to put an additional 1.1 million people living with HIV on life-saving treatment by the end of 2025 as a significant step towards ending AIDS as a public health threat by 2030.

At the launch of the Close The Gap campaign in Soweto South Africa’s Minister of Health, Aaron Motsoaledi, said, “We should not accept that AIDS is here forever. It is not. We want to end it. It’s all in our hands and it depends on our will. We can stop it so that in future we can work on other diseases. We are taking the last mile.”

UNAIDS described the plan as inspiring.

“This plan protects the human rights of people living with HIV, offering them hope and an opportunity to live healthy and fulfilling lives by getting them onto life-saving medication,” said UNAIDS regional director for East and Southern Africa, Anne Githuku-Shongwe. “As South Africa embarks on this inspiring journey, be assured that UNAIDS will continue its strong partnership with the government of South Africa to ensure that everyone living with and affected by HIV is protected through proven scientific and evidence-based interventions.”

In South Africa, there were 7.7 million people living with HIV in 2023, with 5.9 million people already accessing lifesaving antiretroviral treatment which enables them to live healthy and productive lives. Without treatment, people living with HIV are at risk of contracting opportunistic life-threatening infections because of their weakened immune system. 

At the launch, Gordon Didiza, a young man living with HIV urged other men to test for HIV and to start treatment if necessary. “I am grateful for treatment because it has kept me alive and healthy since I was diagnosed with HIV,” Mr Didiza has also survived tuberculosis.

While South Africa has the highest number of people living with HIV in the world, it has already made enormous progress in expanding the number of people accessing treatment for HIV, resulting in a 66% decrease in AIDS-related deaths since 2010. New HIV infections have also fallen by 58%. When people are taking effective HIV medication they no longer transmit the virus, meaning that treatment rollout alongside other HIV combination prevention measures, contributes to lower rates of infection and future cost savings.

Domestic resources account for around 74% of South Africa’s HIV response, which demonstrates the political will and commitment of the country’s leadership to end the AIDS pandemic. However, many services still rely on funding from the US government which accounts for around 17% of the country’s financing for the AIDS response. The sudden 90-day pause to US foreign assistance is putting some services at risk, especially HIV prevention services for young women and adolescent girls and other marginalized communities. More than 800 young women and adolescent girls aged 15—24 become infected with HIV every week in South Africa.

UNAIDS is working closely with the South African government and other partners to mitigate the impact and ensure the continuity of HIV services.

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.