Quilts of various sizes, colours and shapes ripple like waves by the various entrances to the Durban International Conference Centre, hosting the 21st International AIDS Conference. Laid out or hung up, inscriptions vary from “Empower together we shall win” to “Positive link.” The AIDS Quilt Project is back in South Africa telling the story of the journey from Durban 2000—the last time the AIDS conference took place in the city—to Durban 2016.

In 2000, fewer than one million people had access to life-saving treatment and South Africa had the greatest number of people living with HIV.

“In 2016, we wanted to tell this journey and how we came from a time of loss and death and stigma and discrimination to where we are now, where we can talk about treatment and HIV, and we are much more open,” explained Kanya Ndaki, from the South African National AIDS Council. She added, “The quilts visually tell the story.”

Communities, schools, nongovernmental organizations, the health department and civil society partners submitted their decorated cloth panels from across the country. More than 450 in total were collected. Many grace the grounds of the conference, with a few quilts dating back to 2000.

“Blesser”

One quilt told the story of the sugar daddy phenomenon, known in South Africa as “blessers,” depicted schoolgirls in pigtails with an iPhone in hand and big purses next to a grey-haired man in a fancy car.

Young women and adolescent girls make more than 70% of new HIV infections in Sub-saharan Africa. A rate two and a half times greater than boys of the same age. Many point the finger at the fact that young women are having sex with much older partners unlike their male peers.

Prison story full of optimism

Ms Ndaki proudly showed off a quilt hanging prominently outside the entrance to the Global Village—a space open to the general public. “This quilt came from the Department of Correctional Services, a prison in Pretoria,” she said pointing to the long orange-hued panel. “Care for me, I care for you,” “Take courage,” “Love life” and “Condomize” grace the panel. Initially, prisoners were to sew different panels together, but in the end they designed their very own creation.

“It is a very powerful quilt and it was one of the ones displayed when government officials handed over the quilts to the South African National AIDS Council for the Durban AIDS Conference,” she said as two women posed for selfies with the quilt in the background.

Yoo (Ban) Soon-taek, the wife of the Secretary-General of the United Nations, visited the clinic for children living with HIV at the Republican Clinical Infectious Diseases Hospital in Saint Petersburg, Russian Federation, on 16 June and met with women affected by HIV. During her visit, Ms Ban was familiarized with how the clinic helps children living with HIV with medical and psychological problems.

Ms Ban was deeply moved by the special care provided to the children at the HIV clinic. She learned that more than 300 abandoned children living with HIV had been adopted over the years. Yevgeny Voronin, the hospital’s chief physician, shared the story of a girl who was preparing to leave after 13 years.

The Director of the Women’s and Children’s Health Department at the Ministry of Health, Yelena Baibarina, stated during the meeting with Ms Ban that the Russian Federation had significantly reduced mother-to-child transmission of HIV. Ms Baibarina also stressed that it was important for the Ministry of Health to collaborate with nongovernmental organizations representing people affected by HIV.

Maria Godlevskaya and Irina Yevdokimova, of the non-profit-making partnership EVA, told Ms Ban about their social network of women affected by HIV and the challenges they faced. They stressed the need for closer interaction between public health and nongovernmental organizations working with women at higher risk of HIV for early diagnosis of HIV and to prevent mother-to-child transmission.

Yulia Godunova, Executive Director of EVA, told Ms Ban she was expecting her second child. She said that her wish was that neither she nor her children would ever face stigma and discrimination associated with HIV.

Ms Ban, a mother of three and grandmother of four, said that women should be leaders for change, “because it’s hard to find better motivation than children. I admire what you are doing for the sake of your children. You bring about change in society. Thank you.” 

The Tangerine Community Health Centre is Asia’s first clinic to provide a full range of health-care and counselling services specifically for transgender people. Transgender people need access to a range of health, social protection and other support services that are tailored to them.

“At the Thai Red Cross Tangerine Community Health Centre we are committed to providing the highest attainable standard of health in an affordable and accessible manner for all transgender people,” said Praphan Phanuphak, Director of the Thai Red Cross AIDS Research Centre, in which the clinic is located.

UNAIDS Deputy Executive Director Luiz Loures visited the clinic with Mr Praphan, its founder, on 21 June. The clinic provides hormone counselling and therapy, sexual and reproductive health services, psychosocial counselling and HIV testing. Trained transgender personnel and gender-sensitive medical professionals manage and provide the services. While the clinic offers a full range of services, it encourages all clients to have an HIV test.

“We like to encourage everyone to have an HIV test and learn more about HIV prevention and treatment as part of a holistic approach to health care for transgender people,” said Krittima Samitpol, Supervisor of the Tangerine Community Health Centre.  

According to Thailand’s Bureau of Epidemiology, epidemiological surveys of transgender women at five sites report high HIV prevalence, ranging from around 9% to 17% in 2014. Despite the risk of HIV infection, many transgender people do not get tested for the virus and studies find only about a third know their HIV status.

Most transgender people in Thailand self-administer hormones they commonly purchase on the Internet or in local pharmacies. Without professional medical care, incorrect use of hormones can lead to liver, kidney and cardiovascular problems. At the Tangerine Community Health Centre, medical professionals oversee testosterone injections for transgender men and transdermal hormone creams and oral hormone therapy for transgender women.

The Political Declaration on Ending AIDS adopted in early June by United Nations Member States noted with alarm the slow progress made in reducing new HIV infections among specific populations.

“To end AIDS, the health and rights of key populations need to be at the centre,” said Mr Loures. “The Tangerine Community Health Centre is transforming the health choices for transgender people.”

The clinic opened in November 2015 and in its first five months received visits from nearly 250 transgender people. Around 80% of the visitors were tested for HIV and the 10% who tested positive were linked to treatment at either the Thai Red Cross AIDS Research Centre or public hospitals.

During his visit to the clinic, Mr Loures spoke with representatives of three community groups: the Thai Transgender Alliance, Service Workers In Group and Rainbow Sky.

During her first visit to the Russian Federation, the reigning Miss World, Mireia Lalaguna of Spain, and runner-up, Miss Russia 2015, Sofia Nikitchuk, showed their support for the 90–90–90 HIV treatment target by getting tested for HIV in Moscow. They encouraged everyone to do the same and know their HIV status.

The treatment target aims to ensure that, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads.

"I know how important it is for the world to end the AIDS epidemic by 2030,” said Ms Lalaguna. “This goal may seem ambitious, but if each of us does what we can—starting with learning our HIV status—then we will succeed.”

Ms Nikitchuk said, “I am proud to join the efforts of organizations and people in the Russian Federation and around the world who are working together to end the AIDS epidemic.”

On behalf of the Miss World Organization, Steve Douglas said, “Miss World is a contest that promotes beauty with a purpose and we support the important message of getting tested for HIV as the first step towards 90–90–90.”

The UNAIDS Regional Director for Eastern Europe and Central Asia, Vinay Saldanha, underscored that the world is witnessing a transformation in public attitudes to HIV infection, people who are living with HIV and HIV testing. “Everyone who is diagnosed with HIV should be provided with immediate access to HIV treatment and achieve viral suppression, so that HIV is no longer transmitted,” Mr Saldanha said.

“Our task is to ensure that everyone knows how to protect themselves from HIV. And if HIV infection has occurred, we need to provide treatment for people living with HIV to ensure that they live long and fruitful lives,” said Vadim Pokrovsky, Head at the Russian Center for AIDS Prevention and Treatment.

HIV activists in Sri Lanka are celebrating a landmark decision by the country’s Supreme Court that which prohibits HIV discrimination in education settings. 

Princey Mangalika, Executive Director of the Positive Women’s Network in Sri Lanka, said, “I would like to express my appreciation to the Supreme Court. This marks a momentously progressive step forward for the people living with HIV community in Sri Lanka.”

The Supreme Court issued the directive in response to a fundamental rights violation petition filed by Chandani De Soysa in February 2016. Ms De Soysa is from the rural community of Illukhena, Kuliyapitiya, in western Sri Lanka. She was left in difficult circumstances when she lost her husband last September. Ms De Soysa believed strongly that her five-year-old son was entitled to an education and tried to enrol him in the local school. However, the school system denied the boy entry because a rumour was circulating that his father had died of AIDS-related causes and that the boy was HIV-positive.

“I felt dead inside, when my child was not accepted into school, when my own neighbours discriminated against me without any human consideration, I felt lost,” said Ms De Soysa.

Even though it was a violation of her son’s human rights, Ms De Soysa agreed to him taking an HIV test. Although his status was confirmed as negative, the boy was still denied enrolment. Ms De Soysa visited a number of other schools in the area, but they all refused admission.

“It was not an easy decision to make, but I decided that for my child I would fight. I did not want any other parent or child to face such an unbearable situation,” said Ms De Soysa. With support from UNAIDS and the Positive Women’s Network, she filed her petition with the Supreme Court.

The court’s directive, which was released on 28 April, stated that the right to an education of children living with or affected by HIV must be upheld, based on the country’s constitutional directive of universal access to education for children between the ages of 5 and 14 years old.

The Supreme Court also went a step further, reminding the state of its obligation to take necessary measures to protect, promote and respect the human rights of people living with HIV. This is the first court decision in South Asia to make a general pronouncement recognizing the human rights of all people living with HIV and sets a precedent for future cases in Sri Lanka challenging HIV discrimination experienced in settings other than education.

“I would like to give a special note of thanks to all the people out there who offered their support in various forms, from money, food, scholarships, to a simple word of encouragement. I cannot express in words my gratitude for this kindness,” said Ms De Soysa. “My son has a dream to be a doctor one day and I hope he will be an HIV specialist.”

While Ms De Soysa has won the right for her son to attend his local school, she has decided to send her son to a private school, Trinity College in Kandy, which prior to the court’s decision had offered a full scholarship. The school is the alma mater of cricket champion Kumar Sangakkara, who has championed people living with HIV and visited the school to raise awareness of HIV as part of the Think Wise campaign, a joint initiative by UNAIDS, the United Nations Children’s Fund and the International Cricket Council.

“This is a great day for social justice,” said Steve Kraus, Director of the UNAIDS Regional Support Team for Asia and the Pacific. “Sri Lanka’s highest court has stood up in support of people who are being left behind. From now on, no child can be denied access to education based on HIV.”

There have been other cases of children being denied school admission because of their association with HIV, which have been settled through mediation.

HIV-related stigma and discrimination continues to prevent people from accessing key education and health services and reduces employment opportunities. Research conducted by people living with HIV in 13 countries in Asia between 2009 and 2014 found that an average of 12% of HIV-positive people surveyed reported exclusion from social gatherings and activities and 23% said they had been verbally insulted, harassed or threatened.

Sri Lanka’s legal milestone is a big step forward for the rights of people affected by HIV in South Asia. Sindh Province in Pakistan has a comprehensive HIV law, but there is no such protection across the country. India’s courts have ruled to recognize the right to non-discrimination in several specific contexts, including schools; however, a national HIV law has yet to be passed by the parliament. 

The challenges of responding to HIV in western and central Africa have been outlined in a new report from Médecins Sans Frontières (MSF). The report, Out of focus: how millions of people in west and central Africa are being left out of the global HIV response, describes how stigma and discrimination, stock-outs of diagnostics and medicines, and unaffordable or poor-quality facilities are presenting major hurdles to access to HIV testing and treatment services.

Around 6.6 million people are estimated to be living with HIV in western and central Africa, more than half residing in Nigeria alone. The region accounts for one in five new HIV infections globally, one in four AIDS-related deaths and close to half of all children newly infected with the virus worldwide. An estimated 5 million people living with HIV in western and central Africa do not have access to life-saving HIV medicines.

UNAIDS is working with countries in the region to identify the locations and populations where HIV services need scaling up. Data from the region show that many people affected by HIV in western and central Africa live in and around city areas and that people at higher risk of HIV infection, include men who have sex with men, sex workers and people who inject drugs.

“The world will only end the AIDS epidemic by 2030 through an intelligent and focused deployment of resources that identifies the people and places most in need,” said UNAIDS Deputy Executive Director Luiz Loures. “We must reach people affected by HIV wherever they live and whoever they are, including in western and central Africa.”

UNAIDS is helping countries in western and central Africa to build the foundations for a better coverage of services to match needs. UNAIDS is also working with countries on a Fast-Track approach over the next five years to end the AIDS epidemic as a public health threat by 2030.

The Fast-Track approach includes achieving the 90–90–90 treatment target for 2020, whereby 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment have suppressed viral loads. Other Fast-Track Targets include zero infections among children and that 90% of women and men, especially young people and people living in high-prevalence settings, have access to HIV combination prevention and sexual and reproductive health services.

To achieve the targets, a rights-based approach that reaches everyone in need will be essential, particularly to overcome the barriers of stigma and discrimination that continue to prevent people from accessing HIV services. Global solidarity and shared responsibility will also be critical to respond to the particular challenges faced in western and central Africa to ensure that no one is left behind.

“Closing the treatment gap in western and central Africa will happen either now or never,” said Mit Philips, health policy adviser at MSF. “But it is unrealistic to think they can break the deadly status quo alone.”