Women living with HIV including women from key populations continue to suffer widespread reproductive coercion, mistreatment, and neglect when seeking reproductive health services and rights around the world, a new report by the International Community of Women Living with HIV (ICW) has revealed today. The report was launched at a joint ICW/UNAIDS event at the 25^th International AIDS Conference taking place in Munich, Germany.

The report, Confronting Coercion: A global scan of coercion, mistreatment and abuse experienced by women living with HIV in reproductive and sexual health services, shows that women living with HIV face practices that undermine their bodily autonomy. Reproductive choices are monitored, and women are subjected to various coercive practices.

The report documents experiences of sexual and reproductive health and rights (SRHR) violations and violence faced by women living with HIV and women from key populations from more than 60 countries across 3 regions and offers concrete actions for the reduction of coercive practices.

“This report offers a chilling reality of what women living with HIV experience every day in their struggle to realize their full sexual and reproductive health rights,” said Charity T. Mkona, Global Coercion Scan Committee, ICW ISC Global Chairperson. "For women living with HIV who have been subjected to coercive practices, mistreatment or abuse, the ability to heal and realize their full sexual and reproductive health and rights, demands accountability and justice."

The report reveals that reproductive coercion and mistreatment of women and gender diverse people living with HIV in SRHR services are a common, persistent, and widespread issues that require urgent action. Women living with HIV who reported engagement in sex work, drug use, or had disabilities reported experiencing coercive practices at higher rates than other women living with HIV.

Younger women living with HIV and women living with HIV who were migrants were also more likely to have experienced coercive practices than older women and women who were not migrants. Women have reported experiencing a lack of confidentiality and consensual care, as well as inappropriate medical interventions, such as unnecessary caesarean sections and forced or coerced abortions. Denial of care, stigmatizing comments or insults, and various forms of abuse - verbal, emotional, physical and sexual - were also documented.

While information about sexual and reproductive health and rights of women may be supplied to them, it is not always accurate, comprehensive, or up-to-date to empower them to claim their rights and often does not reflect the realities of women's lives.

"To end coercive practices experienced by women living with HIV, we must recognize the systemic and entrenched nature of these violations and understands that reform requires a systemic sea change and culture shift that respects women's bodily autonomy.” Sophie Brion, Director of Global Programmes at ICW.

“In a world where significant scientific advancements have been made in the treatment of HIV—including breakthroughs that allow women living with HIV whose viral load is undetectable to give birth to HIV negative babies—it’s shocking that some health care workers are not informed that women living with HIV can give birth without transmitting the virus,” said Christine Stegling, UNAIDS Deputy Executive Director for Policy, Advocacy and Knowledge. “This lack of education and coercive practices, including the forced sterilization of women living with HIV, must stop immediately.”

ICW is calling on governments worldwide, including donors and ministries of health, to eliminate these harmful practices. The organization is also calling on governments to ensure that health systems support women living with HIV to realize their full right to health, including sexual and reproductive health and rights, bodily autonomy and rights to informed consent.

"This report issues a powerful call to action to put the autonomy, desires and needs of women living with HIV at the centre of their sexual and reproductive health care programmes." said Immaculate Owomugisha Bazare, Global Coercion Scan Committee,  ICW Global Steering Committee Member.

Background

The Confronting Coercion report was developed through a blend of qualitative and quantitative research, incorporating insights from a gendered analysis of recent Stigma Index 2.0 data, a desk review of literature, and a qualitative study involving women, trans and gender non-binary people living with HIV who shared experiences of reproductive coercion over the past 3 years. The qualitative part of the study looked at coercion, mistreatment and neglect related to the SRHR of women and gender diverse people living with HIV in HIV, SRH and maternity care settings.

UNAIDS has supported the development of the report to address systematic gender inequalities, in particular gender-based discrimination and violence against women living with HIV, which fuels the HIV epidemic.

Every pain yields a lesson, and every lesson transforms a person

Parisa's life was forever altered by HIV 25 years ago. The virus struck her family, snatching her husband's job and halting her child's education. Tragically, her husband passed away two years later, leaving Parisa to navigate the daunting landscape of loss and discrimination.

Undeterred by adversity, Parisa embarked on a relentless mission for human rights, determined to combat the pervasive stigma and discrimination surrounding HIV. Initially, she immersed herself in seminars and conferences, volunteering tirelessly at counselling centres, where she shared her own experiences to chip away at the stigma and discrimination.

Her unwavering dedication caught the attention of Dr Minoo Mohraz, the former director of the Iranian Research Centre for HIV/AIDS (IRCHA), who offered her a pivotal role in a Positive Club—a sanctuary for those grappling with similar challenges. Thus began Parisa's transformative journey, marked by a series of initiatives aimed at raising awareness, eradicating stigma and discrimination, and supporting her peers.
 

WHAT IS THE POSITIVE CLUB INITIATIVE? The Positive Club is a meeting place for people living with HIV, who run the club themselves, with supervision from Parisa and colleagues. At the club, people receive training in arts, and sports, and as peer educators.  The Positive Club initiative was one of the successful programmes aimed at promoting positive health, dignity, and HIV prevention; it has been running for over 12 years with support from UNAIDS in collaboration with national partners and civil society organizations. Through this initiative, over 10,000 people living with HIV have been supported across 25 Positive Clubs, empowering them through training classes, workshops on HIV prevention, care and treatment, counselling sessions, and psychosocial support.

Over the years, Parisa's efforts have been nothing short of extraordinary. From managing a Positive Club in Tehran to representing people living with HIV in various influential platforms, including Iran's Country Coordinating Mechanism, its Oversight Committee, and Global Fund, she has been a relentless advocate for change. 

Her initiatives have spanned diverse arenas, from radio shows and collaborations with filmmakers to training workshops for religious leaders and healthcare providers. Parisa's impact reverberates across borders, as she leverages regional platforms like MENA Rosa --the first regional network dedicated to women living with HIV in the Middle East and North Africa-- to exchange experiences and champion global efforts against HIV stigma and discrimination with a particular focus on Women living with and affected by HIV.

Amid the COVID-19 pandemic, Parisa's compassion for people living with and affected by HIV was once again evident. She mobilized support networks to provide essential supplies for Positive Club members and vulnerable families, ensuring that the crisis does not exacerbate the challenges faced by PLHIV.

Reflecting on the progress made over the last 25 years, Parisa acknowledged the remarkable strides in combating HIV-related stigma and discrimination. Efforts to eliminate HIV-related stigma and discrimination have been led by the UNAIDS Country Office for Iran, alongside national partners of the AIDS Control Programme. Notably, the first PLHIV Stigma Index study, conducted in 2010, laid the foundation for understanding the landscape of stigma in Iran. Subsequently, a second PLHIV Stigma Index study, was carried out by the network of PLHIV in collaboration with UNAIDS, Global Network of PLHIV (GNP+), International Community of Women Living with HIV (ICW), Johns Hopkins Medical University (JHMU), National AIDS Programme (NAP), and with financial support from Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) /UNDP. Parisa played an important role in implementing the Stigma Index 2.0 which provided updated insights.
 

COMPARING OF BOTH OF IRAN’S STIGMA INDEX STUDIES A comparison between the two Stigma Index studies conducted ten years apart, using updated methodologies, revealed promising changes. The prevalence of self-stigma among PLHIV decreased significantly from 80% to 40%. Similarly, the percentage of PLHIV refraining from seeking medical help has decreased from 80% to 19%, underscoring improved accessibility to healthcare services and increased health-seeking behaviour among affected individuals. Overall, reports of stigma and discrimination have decreased from 71% to 47%, reflecting tangible improvements in societal attitudes to HIV.

Parisa reflects on these notable shifts in HIV-related Stigma observed between the two studies. In the initial Stigma Index conducted a decade ago, internal stigma was predominant among PLHIV, followed by societal and healthcare provider stigma. However, in the subsequent study, internal stigma was significantly reduced, while stigma and discrimination from healthcare providers emerged as the most prevalent issue. The improvement observed in internal stigma among PLHIV could be partly attributed to the work of the empowering Positive Clubs. Additionally, this improvement highlights the importance of ongoing efforts to address stigma and discrimination comprehensively, with a particular focus on healthcare settings. By acknowledging these shifts and persisting in their efforts, UNAIDS Iran, Parisa and her colleagues remain committed to building a future free from the burdens of HIV-related stigma and discrimination.

Through her nearly two decades of hotline counselling experience, Parisa has witnessed a shift in attitudes, with increased awareness and openness surrounding HIV discourse. 

She credits grassroots campaigns and community-led initiatives for driving this transformation, paving the way for a more inclusive society.

In 2019, Iran joined the Global Partnership to Eliminate all forms of HIV-related stigma and discrimination, prioritizing a strong emphasis on interventions within communities, emergency/humanitarian settings, and healthcare facilities. With support from UNAIDS, protocols and training packages were developed to address stigma and discrimination in these critical areas. These efforts were carried out in close collaboration with national partners and civil society organizations, with training workshops being a key component of the initiative.
 

OVERVIEW OF GLOBAL PARTNERSHIP The Global Partnership for action to eliminate all forms of HIV-related stigma and discrimination is a critical vehicle for action to mobilise all countries to reach the political declaration and Global AIDS Strategy targets. It leverages partnerships to enhance coordination of interventions and funding; it provides knowledge and evidence-guided technical support; and increases accountability mechanisms and community leadership.

Parisa was actively involved in the implementation phase of these projects. Her contributions have been instrumental in advancing the work to eradicate HIV-related stigma and discrimination across humanitarian, healthcare, and community settings.

However, Parisa acknowledges the persistent challenges faced by PLHIV, from sporadic bouts of self-doubt to occasional rejections and the lingering shadows of depression and fear. Despite these hurdles, she remains steadfast in her belief that we can achieve a future free from stigma and discrimination.

As Parisa continues her tireless advocacy, her journey stands as a testament to the resilience of the human spirit and the power of collective action in fostering a world where every individual, regardless of their HIV status, is embraced with dignity and compassion. 

UNAIDS has played a pivotal role in the establishment and sustained operation of Positive Clubs for over a decade, catalyzing transformative changes in the lives of people living with HIV such as Parisa and in the fight against stigma and discrimination. Nonetheless, the journey towards eliminating stigma and discrimination remains unfinished, albeit considerably smoother and more steadfast with the collaborative efforts and political commitment of initiatives such as the Global Partnership.

Girls’ education as a tool to prevent HIV infection has been centered at the 1st African Union Pan-African Conference on Girls’ and Women’s Education in Africa. This followed African leaders designating education as the 2024 African Union theme of the year.

At a high-level side event hosted by the Education Plus Initiative on the first day of conference held at the African Union Commission in Addis Ababa, Ethiopia, leaders, girls’ and women’s networks and advocates called for greater investments in girls’ education.

“Some people claim that providing girls with secondary education is too expensive. Such claims fail to consider the exponentially higher cost of not educating them,” said UNAIDS Executive Director, Winnie Byanyima. “We can get all our girls and boys to complete secondary education; that should be our legacy."

UNICEF calculates that 34 million girls in sub-Saharan Africa are out of secondary school. According to the Global Education Monitoring (GEM) Report 2023, in all regions in Africa, there are more girls out of school at the secondary level than boys, with gender disparities worsening as children move up to higher levels of education in favour of boys over girls. In sub-Saharan Africa, less than half of adolescent girls complete secondary education, their percentage standing at 42% and there has been no progress at all in closing this gap in the past 20 years.  Sub-Saharan Africa is the region furthest from parity at the expense of girls, with no progress since 2011 at the lower secondary level and since 2014 in upper secondary.

Gender is a key factor linked to disparities in enrolment, retention, completion, and learning outcomes through social conditioning, gender-based differences in parental expectations and education-related investments, child marriages and early childbearing, female genital mutilation, child labour, gender-based violence, period poverty and discrimination.

More than forty years into the HIV response, Africa remains an epicenter of the AIDS epidemic with adolescent girls and young women being disproportionately affected. Every week 3100 adolescent girls and young women acquired HIV in sub-Saharan Africa. Every three minutes, an adolescent girl or young woman aged 15-24 years acquired HIV in 2022 in sub-Saharan Africa.  Adolescent girls and young women aged 15-24 years in the region were more than three times as likely to acquire HIV than their male peers in 2022.

UN agencies, African Union representatives, government ministers, and young women leaders called for accelerated actions to translate commitments to action through leveraging girls' education for gender equality and preventing HIV, child marriage, teenage pregnancies, violence, gender-related stigma and discrimination in Africa.

Speakers emphasized the connection between health and education. Ministers spoke about key policy reforms and best practices aimed at promoting girls' education, including creating safe and inclusive school environments, strategies to get girls into secondary school, and the readmission policy that addresses high dropout rates due to pregnancy.  UN co-leads emphasised the need for improved collection of data disaggregated by sex and other relevant population characteristics to better understand educational participation, progression, and learning, and using gender-sensitive data for policymaking and planning. 

Other issues highlighted included the integration of digital literacy programs into the secondary education and vocational training curriculum to facilitate smooth transitions from school to employment; integrate gender equality into all aspects of the education system, including curriculum-based comprehensive sexuality education  and life skills, address gender-based violence  within schools and discriminatory laws and practices, and access to information, non-discriminatory HIV and sexual and reproductive health services access.

Young women leaders spoke on the role of partnerships and young women's leadership. Participants highlighted the upcoming 30th anniversary of the Beijing Declaration as an opportunity moment to accelerate accountability and commitments, as well as the CSW Resolution 60/2, Women, the Girl Child and HIV and AIDS as significant mechanisms to address political and resource gaps so no woman or girl is behind in the HIV response.

Education Plus is a rights-based, gender-responsive action agenda to ensure adolescent girls and young women have equal access to quality secondary education, alongside key education and health services and support for their economic autonomy and empowerment.  Co-led by five UN agencies, the initiative builds on existing frameworks like the Transforming Education Summit, the Continental Education Strategy for Africa (CESA) and the Dakar Education for All (EFA) Declaration to push for access and completion of education for women and girls in Africa.

Quotes

On 19 June 2024, the United Nations General Assembly convened to evaluate the progress made in the response to the AIDS epidemic. The yearly session provided a platform for Member States to reflect on achievements, confront persistent barriers, and chart a course forward towards ending AIDS by 2030. The UN Secretary-General’s progress report formed the basis of the debate. 

Member States celebrated the significant achievements towards ending AIDS, while highlighting ongoing challenges that must be overcome to reach the promise of ending AIDS as a public health threat by 2030.   

The commitment to the 95-95-95 targets and the progress made in eliminating vertical transmission of HIV, especially through the use of decentralized community-based services, were highlighted as pivotal to the success of the HIV response.  

Many member states stressed the crucial role that promoting a human rights-centered approach has had in the fight against HIV. They highlighted the significance of comprehensive multi-sectoral responses, including education on sexuality and robust support for sexual and reproductive health and rights. They pointed to the harm of actions that undermine gender equality and LGBTQI+ rights. They emphasized the shared duty of every country to protect everyone’s human rights.  

The need for continued global solidarity and enhanced multilateral cooperation was emphasized as key to tackling the remaining challenges. Calls for increased domestic and international funding were echoed, noting that sustained investment is crucial to maintaining progress and for expanding access to innovative prevention and treatment options.  

The UN General Assembly annual review served as a poignant reminder of the collective responsibility to uphold the rights and dignity of all people affected by HIV. 

Inspired by the lessons learnt from the AIDS response, the upcoming Summit of the Future scheduled for September 2024 will explore how common challenges can be overcome. 

Against a backdrop of geopolitical shifts and economic uncertainties, the HIV response serves as a beacon of how multilateral solidarity saves and transforms lives. 

Key figures in the AIDS response came together at the 54th meeting of the UNAIDS Programme Coordinating Board (PCB) to discuss how to ensure that the gains from the HIV response can be sustained beyond 2030.

During the PCB’s thematic segment, participants heard that the aim of sustainability is not to maintain the HIV response in its current form but to ensure the durability of the impact of the HIV response. This will require a shift in focus to long-term sustainability.

“Until there’s a cure or a vaccine, we will need to sustain the AIDS response beyond 2030, in every part of the world, in the north and in the south,” said Winnie Byanyima, UNAIDS Executive Director.  “Sustainability is at the heart of the vision of the Sustainable Development Goals (SDGs), with the commitment that the needs of the present are met without compromising the ability of future generations to meet their own needs.”

Remarks echoed by Florence Anam, co-Director of the Global Network of People Living with HIV (GNP+), “People living with HIV will be here in 2031 and beyond so for us the sustainability of the HIV response is a journey of transformation and not a destination with an end date,” she said.  “It matters that at the center of this process of change, mechanisms are in place for all who need treatment and prevention services and that this care is inclusive, devoid of stigma and discrimination.”

The strategies and delivery mechanisms required for scaling up prevention and treatment services and to ensure a stable enabling environment to reach the 2030 target will differ from those that will be needed for long-term sustainability. Leveraging societal enablers will be especially critical for sustainability, including minimizing HIV vulnerability and ensuring access to services in future decades. Rather than build incrementally on what is already in place, sustainability will demand transformations in human rights based, people-centred policies, programmes and systems.

In addition, sustainability requires action on the political, financial, and programmatic front – and across sectors. Not only health, but also gender equality and education so that the economic and societal drivers of new infections are tackled.

Michelle Bachelet, former President of Chile, in a video statement, said, “The combination of shared responsibility and country leadership is essential. Developing countries need to own the response and increase their self-reliance but global action is required to create an enabling environment for this to happen.”

Countries are being advised to prioritize the careful and effective integration of the HIV response in national health systems, with appropriate attention to reforms or modifications required for key and vulnerable populations. This transformation will increase efficiency, promote equity, maximize resource utilization and contribute to the dual goal of achieving and sustaining HIV epidemic control and strengthening human rights based, people-centred systems for health.

Together with its co-sponsors, partners such as PEPFAR and the Global Fund, and other stakeholders, the Joint United Nations Programme on HIV/AIDS are supporting countries to develop roadmaps to sustain their national AIDS responses.

"Sustainability road maps are critical, starting with the vision,” said Peter Sands, the Global Fund Director. “Strategic financing then needs to support the path to that vision, focused both on continuing to raise resources as well as using those that are available more efficiently. To optimize HIV and primary health care integration requires well- coordinated partnerships between governments, private sector companies, international organizations, and non-government organizations.”

John Nkengasong, U.S. Global AIDS Coordinator and head of PEPFAR, also stressed that gains in the HIV response are fragile and need to be sustained. "Today we find ourselves at a crossroads to 2030 where we go somewhere or we go nowhere,” he said. “2030 is critical because at that point the global community regardless of where people are sitting, either say we have done our best and we don’t know what else to do or do we say, ‘Yes, we can get to the finish line’...2030 is a mountaintop moment.”

Finally, sustainability will also require adapting measures and approaches in diverse settings, highlighting the importance of tailoring planning and implementation for specific contexts.

Four Albanian cities—Kolonja, Durrës, Pogradec, and Shkodra—have signed the Paris Declaration on AIDS committing to ending AIDS as a public health threatby 2030. By signing the declaration, the Mayors committed to achieving the 95-95-95 targets by 2025 and called on other municipalities in Albania, including the capital Tirana, to join this effort. 

The Albanian cities are the latest additions to the list of more than 550 other cities around the world that are part of the Fast-Track Cities initiative which aims to fast-track action at local level to improve the quality of life of people living with and affected by HIV. 

In order to fulfill their commitments, the cities have developed different plans of action based on their local circumstances. For instance, the Municipality of Durrës plans to increase investments in methadone maintenance therapy, aiming to expand the number of people benefiting from such services by 10% each year.  

The Municipalities of Pogradec and Kolonja are focused on raising awareness among migrant populations to increase HIV testing rates in these regions. As border cities with a significant male population migrating for work, ensuring these communities are well-informed and have access to necessary health services is crucial.  

Finally, the Municipality of Shkoder aims to foster a partnership with Podgorica in Montenegro to exchange experiences and best practices in developing the "Healthy Houses" model, which has been successful in the neighboring country. The "Healthy Houses" initiative is a free social service providing psychosocial support to citizens. It focuses on improving the quality of life, reducing risks, and offering support to socially vulnerable groups. The service addresses a range of issues, including HIV, domestic violence, addiction, services for LGBTQ+ peopleand others.  

Olimbi Hoxhaj, Executive Director of the Albanian Association of People Living with HIV, hopes that signing the Declaration and the follow-up actions will not only help prevent new HIV infectionsbut will also significantly reduce AIDS-related mortality.  

Albania has a low HIV-prevalence epidemic but faces an increasing number of new HIV cases. From 1993 to 2023, 1,716 cases were diagnosed, with 113 new cases in 2023 alone. Most HIV testing occurs in the late stages of infection (about 60% of new cases), meaning official figures do not fully represent the actual infection rate. 

The Minister of Health and Social Protection of Albania, Ogerta Manastirliu, emphasized that rapid diagnosis and treatment are key. “The whole fight in this aspect is timely diagnosis so that the treatment can start as soon as possible, and the infection is under control.” 

“While the European region continues to face political, economic, and healthcare challenges due to regional conflicts, migration, and other complexities, it is important to secure commitment from municipalities to advance progress towards the crucial HIV targets,” said Eamonn Murphy, UNAIDS Regional Director for Asia-Pacific and Eastern Europe and Central Asia. 

Technical assistance to all municipalities in developing their local programs was provided through the cooperation between the International Association of AIDS Care Providers (IAPAC), the Fast-Track Cities Institute (FTCI), UNAIDS and the Global Fund’s regional #SoS 2.0 project, which aims to ensure the sustainability of HIV services in 15 countries in Eastern Europe. "Since 2019, with our support, 21 municipalities from Southeast Europe have joined the Fast-Track Cities initiative," said Tetiana Deshko, Director of the International Programs Department at the Alliance for Public Health.

Propping up her round thick-framed glasses, Carole Perrette readjusted a painting in the art exhibit at UNAIDS headquarters in Geneva, Switzerland. For one month, more than twenty paintings crafted by her art therapy group will grace the sun-smacked lobby.

Ms Perrette, a painter and art therapist, has been leading workshops at the Geneva Association of People Living with HIV/AIDS (PVA) for its members since 2005 (minus a short break to focus on her career.)

She is thrilled UNAIDS is welcoming a selection of her “students’” pastels and vibrant watercolors.

"Completing a piece of artwork is such an accomplishment that this exhibit is an even greater honor,” Ms Perette said.

For painter and PVA member May* the art and painting therapy sessions allow her to feel free.

“We paint, we talk, we express ourselves and it is very liberating...I forget my daily troubles,” she said.

PVA-Geneva offers art therapy sessions weekly to all of its members. For the Director of PVA, the workshops are a key component of the mental health outreach the association does.

“As you can see from the variety of the paintings on display, people express themselves differently... from glorious sunsets to two fish kissing to renditions of blood cells,” said Rocco Senatore.

“Despite this diversity, the art therapy sessions unite the group, and most champion each other’s work,” he said.

Many eagerly attend the workshops because they do not feel judged. Yvan, a painter and PVA member, said he had difficulties coming to terms with his HIV status. “I kept all of this bottled up for a long time. The art therapy is my support network art wise and morally too.”

During a meet and greet session with the artists and UN staff, Mahesh Mahalingam, UNAIDS Chief of Staff, said that art has been used as a longstanding bridge to raise awareness in the HIV response. “Art and artists like yourselves were instrumental in bringing the world’s attention to HIV in ways that has not happened in any other disease,” he said. “Artists have made this disease humane and out of that it led to a movement that pushed for access to treatment for millions of people.”

Nodding approvingly, Dalia, artist and PVA member, turned to the group afterwards and said, “Just like our art therapy sessions, this is what solidarity is all about.”

*Person did not want to disclose full name.

UN Plus, the association of United Nations (UN) staff members living with HIV has been re-established. 

Originally created in 2005 to advocate for the rights and well-being of UN staff members living with HIV around the world, the association paused its operations in 2021 due to global changes and funding challenges. Now, a newly established nine-member advisory committee from various UN entities and regions around the world is working again to ensure that UN staff members living with HIV have access to medications, health insurance benefits, and mental health support, as well as to actively combat HIV-related stigma and discrimination within the UN system.

“I want to express my gratitude for the admirable work that you are doing to revitalize the UN Plus mission,” said Winnie Byanyima, UNAIDS Executive Director. “Together we can make a difference, let’s ensure a safe, supportive UN environment for all, which must include people living with HIV,” she added.

As part of its revitalization efforts, UN Plus members conducted a global survey in late 2023 to understand the experiences and challenges of their colleagues living with HIV. 74 respondents from diverse backgrounds shared their experiences with stigma, discrimination, and health-related issues.   

The survey findings underscored that many UN workforce living with HIV still face workplace stigma and discrimination, which negatively affects their professional opportunities and personal well-being. Mental health concerns were also prominent, often stemming from issues related to their HIV status.

UN Plus will work closely with UN agencies, to develop and implement policies that specifically protect the rights of its staff living with HIV. This includes advocating for non-discriminatory hiring practices and career advancement opportunities.

John (JB) Bryant Collier, Chair of UN Plus Advisory Group stated that UN Plus will address those issues through a comprehensive plan informed by the survey findings. “UN Plus is committed to making UN workforce members living with HIV feel supported and empowered wherever they are in the world,” he said.

UN Plus plans to introduce training programs for UN staff members to raise awareness about HIV and HIV-related stigma and discrimination and mental health issues, as well as the importance of supportive workplace environments.

In addition, UN Plus will work to ensure that UN staff members living with HIV have access to the latest treatments and medications and will set up mechanisms for regular monitoring and reporting on their status and well-being, including periodic surveys and feedback sessions to continually adapt and improve the provision of support services.

The relaunch of UN Plus signifies a strong commitment to improving the work environment and overall well-being of UN workforce members living with HIV, and to ensuring they receive the support and resources necessary to thrive professionally and personally.

Azima has lived with HIV since childhood; she was abandoned by her parents and raised by her grandmother.

Today she is recognized as an inspirational community leader in the HIV response, including for the vital role she has played in tackling stigma as the first young woman in Uzbekistan to disclose her HIV-positive status.

"I am strong. I have a bright future ahead. And I will achieve my goals,” says Azima.

She has faced both positive and negative reactions since her disclosure. Throughout, Azima has remained a committed activist. She is especially thankful to her community of peer support, a group of children and young people living with HIV supported by UNICEF.

“In the end, the energy of the people who supported me was so strong that it helped me rise above other people's criticism,” she said.

As a peer educator, Azima works tirelessly to raise awareness about HIV.

Today, Azima is studying psychology at Fergana State University. This choice of future career was encouraged by her grandmother and inspired by a psychologist who worked in her support group.

Because of her HIV treatment, Azima cannot transmit HIV to her husband. Several months ago, she gave birth to an HIV-free baby girl.

She is thankful for her family. “My husband has always supported me,” says Azima.

Azima’s story exemplifies the progress made in Uzbekistan’s HIV response. Antiretroviral therapy is provided free of charge to all in need in Uzbekistan. The country is also making efforts to ensure all women living with HIV receive timely treatment, so that all babies will be born HIV-free. Coverage of pregnant women who receive antiretroviral treatment to prevent vertical transmission of HIV has been around 98% since 2016, according to the Uzbekistan Republican Center to fight AIDS.

“The rate of vertical HIV transmission in 2023 was 0.2%. We aim to reduce this figure to 0%. The Republic of Uzbekistan is on the verge of receiving an international certificate for the elimination of mother-to-child HIV transmission,” said Bahrom Igamberdiyev, Director of the Republican AIDS Center in Uzbekistan.

The country has approved a "Roadmap for Implementing Measures to Achieve the Validation of the Elimination of Mother-to-Child Transmission of HIV for 2024-2026". This roadmap will be implemented with the participation of all partners, allowing Uzbekistan to reach its goal and obtain validation for the elimination of vertical transmission of HIV. An effective HIV response is a priority for both the government and civil society in Uzbekistan.

However, some critical challenges in the HIV response in Uzbekistan, particularly concerning HIV prevention, which are deeply rooted in societal norms and systemic inequalities.

These, according to the recently released Gender Assessment Report for Uzbekistan, include limits on women's decision-making power, leaving many women dependent on male relatives for important life choices, including healthcare decisions.

Despite the Government’s commitment and legislative efforts to address gender-based violence, underreporting remains a significant issue. The prevalence of early and arranged marriages also contributes to the limited autonomy of women, depriving many of them of educational and economic opportunities and impeding access to comprehensive sexual education. Cultural norms limit open discussions on reproductive health and prevention in many social contexts including family and educational settings.

As a result, the latest survey found that only 14% of women between 15 and 49 years old have comprehensive knowledge about HIV. This reduces to 10% for young women between 15 and 25 years old.  “Addressing these systemic issues requires comprehensive efforts to promote gender equality, ensure access to sexual and reproductive health and rights, and empower women economically. UNAIDS is working with partners to improve access to education and create an enabling environment for women to realize their full potential,” said Eamonn Murphy, UNAIDS Regional Director for Asia-Pacific and Eastern Europe and Central Asia.

Azima is stepping up her advocacy role, pointing out that openness and education are crucial in fighting stigma and advancing access to prevention, testing and treatment. She advises young women to disclose their HIV status to partners early in relationships and emphasizes the importance of adherence to treatment and of mutual support within families.

Azima will continue breaking stereotypes, promoting awareness, and embracing her journey with courage and determination. Azima exemplifies the learning that HIV responses succeed when we let communities lead.

Tackling inequalities is how the world will end AIDS, so it is vital to know what type of inequalities exist in each country and how are they affecting the national AIDS responses. That is what a new UNAIDS inequalities visualization tool is set out to measure.

The new tool will allow countries, development partners, civil society, academia, and advocates to see and measure the effects that different dimensions of inequalities have on the HIV response.

“One of the best ways to translate complex data is to show it visually. This tool allows the user to summarize critical inequalities in a snapshot,” said Mary Mahy, Director, Data for Impact Practice at UNAIDS.

Integrated in the UNAIDS AIDSinfo database, which is a repository of all HIV data globally, the new inequality platform brings together data from household surveys like Demographic and Health Surveys (DHS) and Population-Based HIV Impact Assessment (PHIA), plus surveys among key populations and UNAIDS epidemiologicalestimates. The tool measures inequalities by characteristics such as age, gender, wealth, education, geographic location and residence, and allows users to see the combined effects of up to three dimensions of inequality.

Some of the deepest, thorniest pandemic-driving inequalities continue to obstruct progress in the HIV response. Inequalities driving the AIDS pandemic are not inevitable. Policies can overcome them.

For example, in sub-Saharan Africa, adolescent girls and young women are 3 times as likely to acquire HIV as adolescent boys and young men.  To help overcome this inequality, countries need to offer prevention services that are adolescent-friendly and targeted at young women at highest risk of HIV acquisition.

Similarly, the new tool shows how access to services differs for residents of urban and rural areas, and how among key populations, younger people usually have lower access to HIV services that their older peers. In Zambia, for example, HIV treatment coverage among rural residents was 9% lower than residents of urban areas. In Malaysia, access to HIV testing among people who inject drugs who were younger than 25 years old was 50% lower than their older peers, and in Thailand, HIV prevalence among male sex workers has been consistently several times higher than female sex workers.

By using the evidence provided by this new tool, countries will be able to identify the inequalities affecting their epidemic and response and make the necessary changes in their policies and programmes to address them. UNAIDS will be updating the data in this tool on an annual basis, allowing countries to measure the effect of their policies and programmes as data become available.

Training videos have been developed to help users learn how to interact with the tool and make the best use of the data available.