The fifth Eastern Europe and Central Asia AIDS Conference took place in Moscow, Russian Federation, from 23 to 25 March and concluded by calling on governments, international organizations, the business community and religious and civil society organizations to Fast-Track the AIDS response in the region.

In his closing remarks, UNAIDS Deputy Director Luiz Loures made a strong call for the provision of evidence-informed HIV prevention and treatment services to close the gap in access to coverage for key populations.

The conference outcome statement, which was debated by the participants and the co-chairs of the three conference tracks—medicine and science, international cooperation and civil society—includes specific references to the need for evidence-informed HIV prevention programmes, including harm reduction, increased domestic funding and further support for civil society organizations. It also calls upon the governments of eastern Europe and central Asia to reaffirm their commitment to the target of ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals at the United Nations General Assembly High-Level Meeting on Ending AIDS, which will take place from 8 to 10 June in New York, United States of America.

Three panel discussions were organized during which speakers from Belarus, Brazil, Kazakhstan and the Russian Federation, as well as Ndaba and Kweku Mandela, engaged in a public discussion on key HIV issues, including HIV and sport, HIV and the mass media and the challenges of HIV public information campaigns today.

The conference brought together 2500 participants from 79 countries and featured more than 350 plenary and parallel presentations. The conference outcome statement included the proposal of the Government Russian Federation for the sixth Eastern Europe and Central Asia AIDS Conference to be held in Moscow in 2018.

A version of this story was first published on UNESCO.org.

Quarraisha Abdool Karim has been presented with a l’Oréal–UNESCO For Women in Science award for her contribution to the understanding of HIV and for her efforts to empower women to help prevent HIV infection in Africa.

Ms Abdool Karim has worked on HIV research for the past 25 years and her work has provided new insights into how the HIV epidemic spreads and affects adolescent girls and young women in Africa. Her knowledge of the science and the people affected by HIV in her native South Africa, which has the highest number of HIV infections in the world, has reinforced her determination to put HIV prevention in the hands of women, particularly adolescent girls and young women.

In 2002, at the height of AIDS denialism in South Africa, she and her husband cofounded CAPRISA, the Centre for the AIDS Programme of Research in South Africa.

Ms Abdool Karim has undertaken research on an anti-HIV gel for use by women before, during and after sex. In 2010, the CAPRISA 004 study, led by Ms Abdool Karim, showed that a gel containing the antiretroviral medicine tenofovir reduced the risk of HIV infection among women by 39%. Today, she continues to study HIV prevention options that will give women in higher-risk populations sustained protection against HIV.

“Until we have eradicated AIDS by finding a vaccine or a cure, then I think my job is not done,” said Ms Abdool Karim.

The L’Oréal-UNESCO For Women in Science programme was founded in 1998 with a simple aim: to ensure that women are fairly represented at all levels in science. Each year, the programme’s award is presented to five outstanding women researchers in recognition of scientific excellence and their potential for leading the global community in positive, productive directions.

“I would encourage young women who feel passionate about changing the world and making a difference to pursue a career in science,” said Ms Abdool Karim at the French Academy of Sciences, where she was presented with the award.

Since the start of the AIDS epidemic civil society has been at the forefront of the response to HIV—demanding access to treatment and HIV services, calling for the respect of human rights and supporting community-led HIV services.

Today the role of civil society remains more relevant than ever as the success of community efforts in providing HIV services, particularly to key populations, is becoming more widely recognized as essential to ending the AIDS epidemic.

Community efforts have proven critical in overcoming many of the major challenges in the AIDS response, including reaching people most affected by HIV with life-changing HIV services, providing support for adherence to treatment and other essential health services. Civil society engagement has also been critical in advocating for new resources, improving HIV programming, and moving progress forwards on human rights issues.

Despite the wide recognition of the important role communities play in responding effectively to HIV, community organizations are facing severe financial challenges and many are closing their doors.

A total of 40% of organizations responding to a recent UNAIDS survey reported that their funding had decreased since 2013. Two thirds expected flat or reduced funding in the future. The decline in funding is resulting in a decline in community services—89% of those who reported a decrease in funding also reported they had to scale down their services as a result.

Greater investment in civil society and community-based service delivery is critical to the Fast-Track approach. Outreach to key populations in low- and middle-income countries should grow to about 7.2% of total investments by 2020, and the estimated resource needs for community-based delivery of antiretroviral therapy should grow to about 3.8% of total investment.

By 2020, investment in community mobilization should increase three-fold to 3% of total resources in low- and middle-income countries to help civil society represent the interests of communities affected by HIV, and to drive ambition, financing and equity in the AIDS response. Social enablers—including advocacy, political mobilization, law and policy reform, human rights, public communications and stigma reduction—should reach 6% of total expenditure by 2020.

UNAIDS has issued two new reports highlighting the importance of investing in community action. Invest in Advocacy details important contributions by community based advocates and points to the need to increase investment to drive an accelerated and more equitable response to HIV. It also notes that a report from the UNAIDS-Lancet Commission on Ending the AIDS Epidemic described advocacy as a “global public good” deserving of support commensurate with its importance.

Stronger Together provides details of the evidence base for community-provided services achieving scale, delivering quality services, and producing results. The report notes guidance from the World Health Organization and others calling for increased engagement of communities to provide a range of HIV and other health-related services.*

In order for community-led services to continue it is essential that international organizations, development partners, governments, private funders and other partners increase investment in community advocacy and services in order to continue and scale up HIV services.

The crucial role of community responses will be among the issues highlighted at the Civil Society Hearing taking place on 6 April in New York. The Hearing is part of the lead up to the United Nations High Level Meeting on Ending AIDS which will take place from 8 to 10 June at the UN headquarters in New York. At the hearing, civil society representatives from around the world will speak to UN Member States about major issues in the AIDS response, including the need for increased financing, leaving no one behind, integration, innovation, and partnering between governments, the private sector and communities.

* The new reports build on other recent publications, Communities deliver and Community-based ART delivery which include more details on the success of community responses.

The fifth Eastern Europe and Central Asia AIDS Conference (EECAAC 2016) opened on 23 March in Moscow, Russian Federation, with discussions focusing on the urgent measures that countries and partners must take to get on the Fast-Track to end the AIDS epidemic by 2030.

The three-day conference, the largest forum on HIV in the region, unites over 2000 activists, scientists, experts, health-care professionals and community workers from over 70 countries. They will share best practices and strategies in the AIDS response.

EECAAC 2016 will also build on the commitments made in 2015 by the BRICS countries (Brazil, Russian Federation, India, China and South Africa) to contribute to enhanced international cooperation to support the efforts of countries to achieve their health goals. Among them is reaching the 90–90–90 treatment target by 2020, critical to ending the AIDS epidemic as a public health threat by 2030. 

Dmitry Medvedev, Prime Minister of the Russian Federation, conveyed in his official address to conference participants that “the issue of HIV infection goes far beyond the medical sphere, uniting multiple partners, from health professionals and scientists to civil society, governments and experts.”

Representing the Russian Government, Deputy Prime Minister Olga Golodets confirmed that the Russian Federation is contributing to the global effort to end the AIDS epidemic. She thanked UNAIDS for its constructive dialogue. “I am confident that together we can stop the AIDS epidemic,” she said. 

In his opening address to the conference, UNAIDS Executive Director Michel Sidibé expressed his support for the renewed urgent focus on the AIDS epidemic in the Russian Federation and across the region. “In line with the Sustainable Development Goals and leaving no one behind, we should have the courage to explore all progressive policy options in eastern Europe and central Asia. An urgent response is needed to break the trajectory of new HIV infections in the region and to get on the Fast-Track to end the AIDS epidemic by 2030,” he said.

Veronika Skvortsova, Minister of Health of the Russian Federation, emphasized that Russia has managed to achieve a fivefold reduction in the number of HIV-infected children born from mothers living with HIV in the past few years. "In 2006 the risk of vertical transmission of HIV was 10.5% ... According to 2015 data it is just 2%. Thus, 98% of children are born healthy," said Skvortsova.

Anna Popova, Conference Co-Chair and Head of the Russian Public Health Agency Rospotrebnadzor, expressed her hope that EECAAC 2016 continues the tradition of joining efforts for practical results to urgently increase the coverage of HIV prevention and treatment services.

Yana Panfilova spoke on behalf of adolescents living with HIV, “We are ready to be the leaders of tomorrow who will create a world where HIV will be only one small part of our full and productive lives!”

A number of countries in eastern Europe and central Asia are making progress towards the elimination of mother-to-child transmission of HIV. However, the same cannot be said about preventing new HIV infections. Estimates indicate that between 2000 and 2014, new HIV infections in the region rose from 100 000 to 140 000 per year. The low coverage of HIV treatment for people living with HIV also represents a major challenge for most countries.At the end of 2014, an estimated 1.5 million people were living with HIV in eastern Europe and central Asia, of which more than 70% live in the Russian Federation.

On 16 March, the Botswana Court of Appeal ruled that the refusal by the government to register LEGABIBO, an organization of lesbian, gay, bisexual, transgender and intersex (LGBTI) people, was unconstitutional. The Court of Appeal thus upheld the November 2014 decision of the Botswana High Court on this matter. In its ruling on the case, the Court of Appeal highlighted the potential role of LGBTI organizations in public health and HIV efforts and ordered the Registrar of Societies to register it.

The ground-breaking decision concludes a four-year legal proceeding initiated in February 2012, when several individuals filed an application for the registration of LEGABIBO as an organization under the laws of Botswana. The government denied their application, arguing, among other things, that LGBTI rights were not recognized by the constitution. Activists challenged the decision in court.

In November 2014, the High Court ruled that the government’s refusal to register LEGABIBO violated the rights to freedom of expression, assembly and association protected by the country’s constitution. This was the first time a high jurisdiction in Africa had upheld freedom of assembly and association for LGBTI people. The government appealed against the ruling.

In the lead-up to the United Nations General Assembly High-Level Meeting on Ending AIDS, to be held in June, the decision by the Botswana Court of Appeal highlights the importance of advancing zero discrimination and of creating a legal and political space for the protection and involvement of LGBTI people and other key populations in the AIDS response. 

LEGABIBO’s mission is to promote the recognition, acceptance and protection of all human rights of the LGBTI community in Botswana. One of if its main objectives is to promote sexual health among LGBTI people. 

UNAIDS and the Global Health Workforce Alliance are launching an Agenda for Zero Discrimination in Health Care. The agenda supports a vision for a world where everyone, everywhere, enjoys health services without discrimination and where the health workforce is empowered to provide discrimination-free services to all.

Many people around the world face barriers to accessing quality health-care services and realizing the highest attainable standard of health. The multiple reasons for this vary across countries and communities. Even where health-care services are available and of good quality, people often experience or fear stigma and discrimination, which prevent them from accessing the health services they need and are entitled to receive.

A new report by Asia Catalyst produced in collaboration with eight community-based organizations in Cambodia, China, Myanmar and Viet Nam has documented discriminatory practices in health-care settings specifically against people living with HIV. Findings include experiences of involuntary HIV testing, involuntary disclosure of status, segregation, arbitrary additional expenses imposed due to HIV status and medical advice against pregnancy and for sterilization on the sole basis of HIV status.

The agenda offers a space for collaboration between countries, the World Health Organization, UNAIDS, other United Nations and intergovernmental organizations, professional health-care associations, civil society, academics and others to take coordinated action for achieving zero discrimination in health care.

The agenda will prioritize coherent joint actions in three critical areas:

• Political support: by increasing political commitment through mobilization of all key constituencies, to secure prioritization of this agenda at all levels.
• Implementation: by fostering scale-up of implementation of effective actions to achieve discrimination-free health care.
• Accountability: by promoting monitoring and evaluation frameworks and mechanisms to build evidence, monitor progress and ensure accountability.

The action plan outlines seven priorities; these include: building and sharing evidence and best practices; standard-setting; ensuring meaningful engagement of the people most affected by discrimination in the development, implementation and monitoring of policies and programmes; and strengthening the leadership of professional health-care associations.

A virtual community of practice has been created to mobilize more partners around the shared vision and action plan, to join contact ghwa@who.int. 

Quotes

Transgender people often face violence, unemployment and poverty, owing to ignorance and prejudice. Such stigma and discrimination places transgender women at a higher risk of HIV infection.

All people are equal and no one should be discriminated for any reason. “In our country it will take a lot to make this affirmation a reality,” the Peru’s Ombudsman Eduardo Vega Luna said in response to the situation. However, he called for “more awareness campaigns that encourage citizens to look at the future with hope and without violence and discrimination.”

One such activity was recently organized by United Nations organizations in Peru, including UNAIDS, UNDP, OHCHR and United Nations Information Centre, and civil society organizations, like PROMSEX, IESSDEH, Center for Interdisciplinary Studies in Sexuality, AIDS and Society of the Cayetano Heredia University, transgender people, the Magnum Foundation and the European Union. An exhibition, “Yo tengo derechos”, meaning “I have rights”, presented photographs taken by Danielle Villasana, an award-winning photojournalist whose work focuses on gender, identity, health and social politics. A recent graduate of the University of Texas, Austin, she has worked with transgender communities since 2012.

The photographs in the exhibition—part of the United Nations Free and Equal campaign, which advocates for lesbian, gay, bisexual and transgender equality—showed transgender people with their colleagues and family members in their daily lives as students, artists, professionals and activists. In their testimonies for the exhibition, transgender people spoke about happiness, love and how they cope with daily struggles.

María del Carmen Sacasa, United Nations Resident Coordinator in Peru, said, “For us, the main human rights theme is non-discrimination. It’s not a minor issue, particularly when it comes to transgender people, who are rejected in many fields.”

The exhibition reminded people of one of the main human rights principles: discrimination is unacceptable. 

Isah Mohammed Takuma is married and has a one-year-old daughter. At 32, he is a university graduate and currently serves as the National Coordinator of the Association of Positive Youths Living with HIV/AIDS in Nigeria.

He says he draws daily inspiration from his personal experience to support HIV prevention efforts in Nigeria. “I was 19 when I first had sex. I thought one time was not enough to get infected with HIV,” he said.

Even when he started to fall sick, he simply could not believe that HIV was the cause of his health troubles. He was 23 when he tested HIV-positive and his life changed forever.

“It was a nightmare and I had to go through hurdles to recover. My CD4 count was low; my viral load was high. I was like a walking corpse,” Mr Takuma recalled.

Antiretroviral treatment soon put him back in good health. He returned to university and completed his studies much later than planned, but he was happy to be alive and healthy again.

At university, he started a support group for young people living with HIV. He told his story to peers as a way to prevent new HIV infections. “Many other people in my class got to know their HIV status because of my efforts, and I am really proud about that,” Mr Takuma said.

The Nigerian Government reports that more than 6.7 million people were tested for HIV in 2014 and that it continues its efforts to expand treatment, with coverage at 22% in 2014. The global treatment target set for 2020 is that 90% of people living with HIV are on life-saving antiretroviral therapy.

Despite the challenges that people living with HIV face in the country, Mr Takuma said the fact that he and his wife have an HIV-free child “tells the story of what Nigeria’s HIV response has done in the lives of many young people like me.”

Nigeria has the second largest HIV epidemic in the world. In 2014, 3.4 million people were living with HIV in the country, of which 380 000 were children below the age of 14. HIV prevalence among young women between the ages of 15 and 24 was 1.3% in 2014, almost twice as high as it was for their male counterparts.

Like Mr Takuma, Faith, 16, is passionate about advocating for HIV prevention among young people.

The soft-spoken and cheerful student was born with HIV but only got to know her status at the age of 10. However, she started on antiretroviral treatment when she fell ill two years ago.

She is now healthy and advocates for treatment for all. “I have even been on radio to speak about HIV,” she said. “We want adolescents and youth to understand that it is possible to have a normal life without any stress.”

“We also want to take part in international engagements to share our stories and be an inspiration to other girls and young people,” she said.

Faith views her involvement with the Association of Positive Youths Living with HIV in Nigeria as vital to ensuring that women and girls enjoy healthy and productive lives.

She aspires to graduate as a nurse to help save lives in Nigeria.

UNAIDS and the One Million Community Health Workers (1mCHW) initiative have announced a major strategic partnership to support the achievement of the 90–90–90 treatment target and to lay the foundation for sustainable health and development.

The new partnership emerged at a high-level meeting of eight African health ministers and other stakeholders in Addis Ababa, Ethiopia, held on 1 February, which focused on the 90–90–90 treatment target and human resources for health. The participants of the meeting called for the world to leverage the aim of achieving the 90–90–90 treatment target to strengthen human resources for health.

In his opening address, Marc Angel, UNAIDS champion for the 90-90-90 treatment target, told participants that increased human resources for health would be essential.     

“Achieving the 90-90-90 target requires health workers, specific expertise and laboratories equipped with the necessary materials,” said Mr Angel.

Jeffrey Sachs, director of the Earth Institute at New York’s Columbia University and founder of the 1mCHW initiative, emphasized his commitment to the 90–90–90 treatment target. As the United Nations Secretary-General’s Special Adviser on the Sustainable Development Goals (SDGs), Mr Sachs pledged to place 90–90–90 at the centre of advocacy for the SDGs.

“The 90–90–90 effort of UNAIDS is historic: a rigorous, scientific and bold approach to end the AIDS epidemic,” Mr Sachs said. “The end of AIDS is within reach, and community health workers will play a pivotal role in empowering communities to end deaths from AIDS and to break the transmission of the virus. The 1 Million Community Health Worker campaign is honoured to join UNAIDS in its path-breaking programme.”

Cosponsored by UNAIDS, the African Union and Ethiopia’s Ministry of Health, the meeting revealed both strong support for the 90–90–90 treatment target and agreement that it offers a unique opportunity to recruit and mobilize hundreds of thousands of community health workers.

“Ethiopia will spare no efforts to reach the 90–90–90 treatment target,” said Kesetebirhan Admasu, Ethiopia’s Minister of Health. “We are determined to relegate AIDS to the books of history.”

To reach the 90–90–90 treatment target, the number of people accessing antiretroviral therapy will need roughly to double over the next five years. While HIV programmes have pioneered innovative strategies to enhance the efficiency of service delivery, it is clear that reaching the target will require expanding the number of health workers available to deliver HIV services.

However, many African countries, as well as countries in other regions, have an acute shortage of health workers. Although Africa accounts for 25% of the global health burden, the region is home to only 3% of all health workers.

To ease health worker shortages, the meeting focused on the importance of training and employing trained, provisioned, supervised and remunerated community health workers to expand access to HIV services. “We must reinforce the interface between communities and the service provider,” said UNAIDS Executive Director Michel Sidibé. “We need to use communities and civil society organizations to reach people who are difficult to reach.”

The 1mCHW campaign unites more than 150 organizations worldwide in a major global effort to recruit and deploy trained, equipped, supervised and remunerated community health workers, with particular attention to especially underserved rural communities.

Countries such as Ethiopia, Ghana and Malawi have already taken major steps to train and deploy community health workers to deliver community-based health services. Ethiopia, for example, has trained tens of thousands of health extension workers, who have substantially increased access to good-quality health services. Creation of the community health worker programme in Ethiopia has been associated with a 19-year increase in life expectancy over two decades. Ghana is in the process of deploying 20 000 community health workers in a national scale-up effort. 

Other countries are moving to emulate these successful national efforts to expand human resources for health. Lesotho, for example, is embarking on a national effort to create a cadre of health extension workers, with mentoring provided by Ethiopia and Malawi.

Much of the discussion during the one-day meeting focused on how the push to achieve the 90–90–90 treatment target can help drive a sustainable expansion of human resources for health. The global effort to achieve the 90–90–90 treatment target will involve the delivery of simplified, decentralized care to millions of healthy people living with HIV. Self-care, including through such innovations as peer-driven adherence clubs and community distribution of antiretroviral therapy, will play a vital role in the delivery of HIV chronic care management.

Community health workers will be essential for providing these simplified, decentralized services. The Fast-Track approach calls for a sharp increase in financing for community service delivery and an increase in the proportion of HIV services that are delivered through community channels from 5% currently to 30%.

The same community-centred models that will be critical for ending the AIDS epidemic as a public health threat also have a potentially key role to play in addressing the other health targets in the SDGs. Community health workers mobilized through the push to achieve the 90–90–90 treatment target can also help in the delivery of other important health services. Similarly, the chronic care models generated by HIV treatment scale-up are applicable to the management of the growing burden of noncommunicable diseases, such as hypertension and diabetes.

Although the road map for action is clear on 90–90–90 and the health workforce, financing remains a potential obstacle, as investments will be needed for training, supervision and compensation for community workers. There was agreement among health ministers and other participants that mobilizing the necessary investments for expanding the health workforce will require both increased domestic outlays and further increases in international assistance. Mr Sachs called for the creation of a fund for strengthening health systems.

“Here in Africa, we must commit our own domestic resources for health,” said Olawale Maiyegun, Director of Social Affairs for the African Union Commission. “We must live up to our commitments in the Abuja Declaration to dedicate at least 15% of our domestic budget to health.”

“Health is not a cost,” Mr Sidibé said. “Health is not expenditure. Health is an investment. If we scale up, we can bring the epidemic to an end. Yet if we don’t come up with the resources we need, AIDS will rebound, and all our investments in the last 30 years will be lost.”

In planning the meeting, the cosponsors worked with the World Health Organization, the African Society for Laboratory Medicine, the International Association of Providers of AIDS Care, the International Federation of Red Cross and Red Crescent Societies, the Office of the United States Global AIDS Coordinator, Columbia University, the Sustainable Development Solutions Network, the One Million Community Health Workers campaign and the Government of Luxembourg.