For Ruma Khatri, the social entrepreneurship initiative by Usha Multipurpose Cooperative Society Limited is an opportunity to earn a livelihood in the face of the COVID-19 pandemic and the resulting income loss.

“I have been working with the sex worker community supported by Usha Multipurpose for the past 10 years. I work at the parlour instituted by Usha. But due to the COVID-19 pandemic restrictions, I took part with the community in the production of sanitizer and masks through Usha to earn supplemental income. Through this social entrepreneurship project, I hope to set an example and further empower the sex worker community,” Ms Khatri said. Established with the support of the UNAIDS Solidarity Fund, Usha Multipurpose’s social entrepreneurship initiative engages sex workers in producing masks, hand sanitizer and personal protective equipment kits in Kolkata, India.

Sex workers in several parts of the world have faced a huge economic impact due to COVID-19-related restrictions on physical contact and movement. Additionally, the criminalization of sex work in many countries has disproportionately given way to stigma, discrimination, violence and inability to access essential health-care services. Sex workers have also been left out of financial and social support schemes by many governments. These factors, among others, make it challenging for sex workers to engage in supplemental income generation activities.

In response to these challenges, several grantees of the UNAIDS Solidarity Fund are supporting the economic capacity of sex workers across five pilot countries. The Solidarity Fund was set up to provide grant seed funding to empower social entrepreneurs from key populations to scale up existing or develop new business initiatives that can generate sustainable economic value and social impact for their communities.

In northern Uganda, the sex worker and lesbian, gay, bisexual, transgender and intersex communities supported by the Health and Rights Initiative (HRI) recently produced their first set of shea-based products and acquired new machinery to scale up production. Through comprehensive market analysis, they identified the potential of processing shea-nut seeds to create value-added products, such as lotions, bathing oils, soaps and hair oils.

“Small-scale production and sales of shea nut products change the outlook for the members of the sex worker community. Through the support of the UNAIDS Solidarity Fund, our organization can act as a safety net to protect the business and community members as they implement the joint enterprise,” said Lucy Akello, the Executive Director of HRI.

Above, beneficiaries of HRI with shea-based products produced through their social enterprise. Credit: Health Rights Initiative

While production of tangible items is one aspect, the Alliance of Women Advocating for Change (AWAC), also in Uganda, is empowering more than 20 adolescent girls and young women, especially those living with disabilities, to set up social enterprises built on skills such as tailoring and designing. Talking about the Make Her Visible project, Macklean Kyomya, the Executive Director of AWAC, said, “Adolescents and young women, including those with disabilities, are at particular risk due to the socioeconomic impact of COVID-19. Risks include heightened destitution, violence, stigma and discrimination. The Make Her Visible project supports their economic capacities to help them better respond to these challenges.” The young sex workers are also being trained in financial management involving credit and savings along with business plan development to effectively manage these enterprises.

Above, young women being trained in tailoring as a part of the 'Make Her Visible' social entrepreneurship project of AWAC. Credit: Alliance of Women Advocating For Change

Creating strategic market linkages has been the focus of India-based Asha Darpan, a female sex worker-led community-based organization that is creating micro-entrepreneurs out of sex workers based in Mumbai. Their Shakti project is focused on empowering women between the age of 18 and 49 years from urban and semi-urban settings and living in lower-middle class and poor environments to establish their own footwear manufacturing business. Devta Metri sees growth in the future of these enterprises. She said, “No one foresaw the COVID-19 pandemic. The need for sustainable income sources for the sex worker community was amplified when we saw a loss in income sources. My hope is to see our social enterprise grow. In the next few months, our aim is to increase sales of footwear we produce, make a name for Asha Darpan and provide a sustainable income source for the members.”

These are thoughts echoed by Sanyu Hajjara Batte, the Executive Director of Lady Mermaid, which is supporting 168 female sex workers organized in 10 Women-Up groups in Uganda. “We have to support sex workers’ entrepreneurship skills if we truly want to create supplemental income sources for the community. Lady Mermaid is working to rebuild the sex worker community from COVID-19 pandemic effects through economic recovery programmes,” said Ms Batte. Through the grant received by the Solidarity Fund, sex workers are being trained in setting up demand-based social enterprises in areas including food selling, renewable charcoal-making, briquette-making, liquid soap-making and baking, among others. The initiative supports government registration, financial management and implementation to ensure sustainability of the enterprises.

Above, beneficiaries of Lady Mermaid engaged in briquette-making as a part of supplemental income generation through social entrepreneurship. Credit: Lady Mermaid

The Solidarity Fund grantees clearly highlight the ingenuity and leadership role that key population-led organizations and networks play when it comes to building community resilience and supporting communities during the pandemic. As the COVID-19 pandemic remains intertwined with daily realities, communities must be at the centre of pandemic response and preparedness. The response calls for critical action grounded in human rights principles, to protect the health and rights of sex workers. The provision of seed funding enables innovative business ideas owned by key populations to flourish and the creation of sustainable supplemental revenues to empower key populations most affected by the pandemic.

On the margins of a special session of the World Health Assembly on pandemic preparedness, the UNAIDS Health Innovation Exchange (HIEx) hosted a dialogue between key leaders from both the public and private sectors on the importance of innovations and investments for resilient health systems. The dialogue allowed policymakers to exchange ideas with leading investors and innovators on how to develop innovative models of funding and on ecosystem-building for scaling access to health care and connect financing partnerships to the essential innovations.

“COVID-19 was not just a wake-up call for our global pandemic preparedness, it was a wake-up call to every health system around the world that unless we truly embrace the technology that is at our fingertips, we will be killing many multiples of the number of victims claimed by COVID-19. Health care is one of the few industries left to make this transition, COVID-19 has given us the vital catalyst to do so,” said Joe Stringer, the Managing Partner of Octopus Ventures.

The COVID-19 pandemic has underscored the fragility of health systems around the world and highlighted the critical importance of building resilience. The special session of the World Health Assembly brought countries together to discuss a pandemic treaty, with hopes of agreeing on a new global architecture that can help prevent future outbreaks.

Averting future pandemics will require scaling up investments in building resilient health systems. The COVID-19 pandemic has demonstrated the potential of innovation, from the use of artificial intelligence for diagnosis, to rapid repurposing of telemedicine platforms to train health-care workers, to the development of new vaccines and therapeutics. It has also reinforced the importance of connecting communities and the public and private sectors in building trust and delivering on scale.

“We need to invest in innovations that can help rapidly scale up access to health care for all,” said Pradeep Kakkattil, the Director of the UNAIDS Office of Innovations and the co-founder of HIEx. “Creating a strong and functioning innovation ecosystem along with new financing models that leverage public and private investments for impact is essential to avert future pandemics and enable countries to reach their health goals,” he added.

Exploring through practical examples the role that innovations, including digital health solutions, can play in future-proofing health systems, the event showcased outstanding innovations with the potential to transform health-care systems. These high-potential innovations included a safe last mile transport solution for essential biologicals such as vaccines and medications (Blackfrog Technologies), a virtual platform that enables real-time clinical exchange and surgical collaboration (Proximie), an innovative lighting technology that sanitizes spaces (BIOVITAE), accessible diagnostic solutions (Molbio Diagnostics), drone-based logistics for health care (RigiTech) and real-time community data on health-care challenges and quality of services (Dure Technologies), among others. Despite diverse thematic areas, a common thread that connects these innovations is the underlying need to build solutions that address global health-care challenges and enhance pandemic preparedness.

“COVID-19 has taught us that innovative solutions to fighting pandemics are both essential and investible. Local innovators are best equipped to create these solutions for their own communities but often lack resources outside of mature innovation ecosystems, most notably access to early-stage capital,” said Andrew Nerlinger, the Managing Partner of the Global Health Security Fund. “The private sector can’t just sit back and watch. We need to support these innovators by actually investing while building confidence in other impact investors to do the same.”

Recognizing the integral role that health innovations play in strengthening health systems, StartupBlink and HIEx launched the Coronavirus Resilience Innovation Map. It is a dynamic mapping of private sector innovations and start-ups that have strengthened the capacities of many countries in responding to health crises. The map also celebrates the locations where COVID-19-related innovations were created, with preliminary rankings of innovation output in 150 cities and 60 countries. The comprehensive database can allow investors, leaders and policymakers to connect with relevant innovators to identify gaps and advance shared health-care objectives.

In line with its role as a global health and innovation connector, HIEx also used the event to present a number of new initiatives, innovations and partnerships that will form key pieces of the future health innovation ecosystem, have a potential to work with countries to improve their health outcomes and that strengthen the HIEx partnership network.

HIEx and Tata Consultancy Services will partner on a Specialized and Proficient Integrated Network of Experts (SPINE) for health and well-being to leverage the expertise across sectors around the globe to leverage innovations and develop solutions for scaling access to health care. SPINE will be available to countries to prototype innovations to address their specific health challenges. 

HIEx will also partner with Health in your Hands, an initiative developed under the aegis of the United Arab Emirates’ Sustainable Development Goals (SDGs) Global Council SDG 3 initiative. The partnership will bring together the respective health innovation pipelines of the two entities to facilitate effective collaboration across innovators for scale and impact.

HIEx is a UNAIDS-initiated partnership platform bringing together policymakers, innovators and investors to leverage health innovations and investments to save and improve lives around the world. It fosters public–private partnerships that can help to scale proven technologies and innovations to maximize reach and health impact, especially for the most vulnerable communities.

Humanity is behind in eradicating AIDS by 2030. This delay is not due to a lack of knowledge, capacity or means, but to structural inequalities such as stigma and discrimination which are obstacles to access health services.

Viruses such as HIV or COVID-19 do not differentiate between people, but societies do. They stigmatize and discriminate against people living with HIV, mostly out of ignorance, because they are afraid of the disease.

Discrimination remains one of the biggest battlefields in the Central African Republic and this is why the country was the first in the world to join the Global Partnership to fight against all forms of HIV-related discrimination and stigma.

To make this Global Partnership a reality, a Zero Discrimination Platform was established. It is composed of about thirty partners representing ministries, the National AIDS Council, UN agencies, technical and financial partners, civil society, human rights organizations and other organizations. With UNAIDS support, the Platform called on Ozaguin, the "king of Central African rumba" to use music and art to convey its messages of tolerance and compassion.

At the launch ceremony for Ozaguin's new song against discrimination, which took place on 9 December 2021 at the 20,000-seat stadium in Bangui, he was also nominated as a spokesperson for the Platform.

On behalf of the First Lady of the Central African Republic, the Minister of Health and Population invited every one, and in particular all institutions and influential personalities, not only not to discriminate, but also to fight against discrimination and stigmatization. "We must collectively report discrimination and stigma as soon as we see it and set an example. Discrimination kills. It exacerbates emergencies and fuels pandemics," said Minister Pierre Somsé.

The leadership shown by communities that are victims of discrimination and stigmatization remains a source of inspiration. Their determination, courage and vision are a star in the firmament, as demonstrated by the moving testimony of Ms. Christine Wilikon, a member of the national network of people living with HIV (RECAPEV) during the ceremony. "The first reactions to knowing my positive HIV status were dismay, and a desire to end my life. Rejection by my family members amplified my mental and social disorientation. But the support and advice provided by my parish priest gradually led to my social reintegration through income-generating activities such as petty trade, agriculture and market gardening.”, Christine shared. Her brave words were received with a standing ovation. She urged all Central Africans to put an end to feelings of guilt and shame, and to get tested to know their HIV status and if necessary, take the treatment which is free. 

The UNAIDS Joint Programme and partners agree that a new initiative is needed to accelerate and support action at the global, regional, country and community levels to urgently end AIDS among children, adolescents and mothers. To meet the needs of all stakeholders and ensure the engagement of all partners, we are undertaking a global consultation survey to gather ideas and opinions on what the priorities should be for ending AIDS among children, adolescents and mothers.

Eliminating vertical (mother-to-child) transmission of HIV and ending AIDS among children are among the global priorities highlighted in the new Global AIDS Strategy 2021–2026: End Inequalities, End AIDS.

In 2020, there were 1.7 million children living with HIV globally, almost half (46%) of whom were not on life-saving HIV treatment. In the same year, there were 150 000 new HIV infections among children. Most of these new child infections could have been prevented if adolescent girls and women had universal access to HIV testing, prevention and treatment services and the support they need to stay in prevention care or on HIV treatment throughout pregnancy and breastfeeding.

Over the past decade the Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, followed by the Start Free, Stay Free, AIDS Free 2016–2020 framework, helped to coordinate, accelerate, support and monitor the global response to HIV among children, adolescents and mothers. Significant progress was made from 2010 to 2020, with coverage of HIV treatment to prevent vertical transmission for pregnant women living with HIV increasing from 45% in 2010 to 85% in 2020 and with a 53% reduction in new child HIV infections over the same period. However, this progress was not enough to reach any of the global targets set for the end of 2020.

New targets have been set for ending AIDS among children, adolescents and mothers in the Global AIDS Strategy 2021–2026. Urgent and coordinated action is needed, from the global to the community levels, to reach these ambitious new targets, and we need your input on how best to accelerate action, especially at the community and country levels.

Please complete the online survey, which is available in English, French, Russian and Spanish, by 20 December.

• Consultation for English speakers - https://bit.ly/3DMkjJ2
• Consultation for French speakers - https://bit.ly/30MT7f7
• Consultation for Spanish speakers - https://bit.ly/3rBc27F
• Consultation for Russian speakers - https://bit.ly/3G13wm2

Members of parliament have reaffirmed their commitment to tackle all forms of HIV-related stigma and discrimination in Jamaica and to help enhance efforts to create an enabling environment for people living with and affected by HIV.

At a meeting co-hosted by UNAIDS and Juliet Cuthbert-Flynn, the Minister of State for Health and Wellness and Chair of the country’s Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, members of parliament, from both the ruling and opposition parties, came together to review evidence on stigma and discrimination in Jamaica and its impact on health outcomes and to craft a way forward in which their role as lawmakers can contribute to eliminating stigma, discrimination and violence.

Jamaica’s legal landscape poses substantial barriers for people living with and affected by HIV to access health services. For example, same-sex sexual relations are criminalized in Jamaica, which continues to represent a considerable deterrent for marginalized communities. Moreover, the country lacks general legislation against discrimination, a national human rights institute and a gender recognition law that could provide further protection for transgender and gender non-conforming people in Jamaica.

Harmful laws, policies and generalized stigma and discrimination against people living with and affected by HIV have a profound negative effect on people’s health outcomes and life prospects. The most recent Knowledge, Attitudes, Practices and Behaviour Survey and the People Living with HIV Stigma Index showed that only approximately 12% of the general population have accepting attitudes towards people living with HIV, while close to 60% of people living with HIV have feelings of self-stigma. A 2019 study about the economic survivability of transgender and gender non-conforming communities in Jamaica found  that experiences of workplace stigma and discrimination were widespread, with about 60% of survey respondents declaring such incidents. Furthermore, 71% of respondents felt that transgender and gender non-conforming people had a harder time getting jobs than cisgender people. Another study suggests that approximately 20% of lesbian, gay, bisexual and transgender people in Jamaica have been homeless at some point of their lives.

In view of these pending challenges in the country’s HIV and human rights response, members of parliament explored creating a working group tasked with performing periodic reviews of relevant data, supporting the enactment of protective legislation, challenging harmful laws and policies and hosting permanent dialogues with communities of people living with and affected by HIV.

“We have a lot of work to do to ensure that all Jamaicans enjoy the full respect, protection and promotion of their rights. This meeting and its outcomes are a small step to achieving that goal, but a step that certainly is pointing us to the right direction on the role that members of parliament should play to end discrimination,” said Ms Cuthbert-Flynn.

These efforts, which aim to tackle deeply rooted misconceptions in society, require strong partnerships. As stated by Morais Guy, the Opposition Spokesperson on Health, who co-chaired the meeting, “The enhancement of people’s rights and collective efforts to ensure that every Jamaican can live a life free from stigma, discrimination and violence is not an issue of only one person, one entity or one political party. It is the business of all of us, to work in partnership for the dignity of all Jamaicans.” 

Members of parliament also discussed some of the challenges that they face as legislators to perform their duties, and the contributions that UNAIDS can make in facilitating a more efficient, effective and transparent law-making process in parliament. Moreover, options to mobilize and engage citizens at the community level to challenge stigma were also discussed in response to the critical need of raising more awareness, tolerance and respect towards people living with and affected by HIV.

“We are proud to partner with members of parliament to tackle stigma and discrimination in Jamaica and to provide all of the evidence, instruments and support that we can mobilize to leverage their role as allies and critical influencers in the future of the country,” said Manoela Manova, the UNAIDS Country Director for Jamaica. 

In a suburb of Nouakchott, Mauritania, a tent has gone up for an evening of counselling and HIV testing. Staff of the nongovernmental organization SOS Pairs Educateurs field questions, and people wanting to know their HIV status queue for a rapid test.

Mohammed Bilal, above, is supervising the evening event, along with peer educators, a nurse and a social worker. Pointing behind him to a small concrete house with a corrugated roof, he said that to keep all tests anonymous, people are given a number and they enter the makeshift office one by one. “We do counselling before the HIV test and after the person gets the results,” Mr Bilal said.

More than 70 men and women have opted to get a rapid test today.

In the El Mina neighbourhood, where the outreach event is taking place, Mr Bilal says that most people scrape by making a living, many women live alone raising children and most children don’t attend school. He grew up here and knows the community well. He and his team also know the needs of the people. For Mohammed Mouloid, above right, the Programme Coordinator at REMAP+, a network of people living with HIV, community outreach fills a big gap. During the COVID-19 restrictions, for example, they teamed up with SOS Pairs Educateurs, UNAIDS and others to distribute food kits.

Adjusting his glasses, Mr Mouloid said, “Before a person takes their medicine, they have two other priorities. The person has to eat first and find transportation to pick up their treatment. If both are not combined, then the third priority falls by the wayside and the person will never take their treatment.”

“Our biggest problem in Mauritania is stigma associated with HIV,” Mr Mouloid said, explaining that people living with HIV often drop out of treatment programmes. Only 40% of the 8500 people living with HIV in the country are on life-saving treatment. Mr Mouloid has lived with HIV for nearly 20 years and was one of the first people in Mauritania to take antiretroviral medicines, in 2004. “I have been married twice and have two children who are both HIV-negative, so I am a testament to living a healthy life, but things are tough in our society,” he said.

The HIV epidemic in Mauritania is concentrated in cities and among key populations. HIV prevalence among adults is around 0.3%, but is 9% among sex workers and 23% among gay men and other men who have sex with men. Mauritania criminalizes sex work and same-sex sexual relations, so people tend to hide. 

To reach out to key populations, SOS Pairs Educateurs, with the support of the United Nations and partners, recently opened a drop-in centre, above, in front of the bus station in the capital city (they have eight other drop-in centres around town). A television blasts in the corner as peer educators mill about chatting with a truck driver. A pilot project distributing HIV self-test kits that people can use in the privacy of their own home has also been undertaken. 

Sharif (he did not want to give his last name) explains that he stops by regularly to pick up condoms and get information from the counsellor. “I came here to know more about COVID-19 and other health risks,” he said. He said he had never taken an HIV test, which are provided for free, but was thinking about it.

According to the UNAIDS Country Director for Mauritania, El Mustapha Attighie, community outreach like this is a way to support vulnerable groups.

“Stigma hinders our response to HIV and if human rights are not respected and people are left behind, this increases the risks of HIV,” he said. He added that UNAIDS’ mandate clearly states advocating for rights and treatment for all and as a trained doctor he focuses the debate on people accessing health care.

He believes that Mauritania could end AIDS by 2030. “We have the opportunity to make this objective a reality,” he said. “Channel more money and means where the epidemic is, to quash it and also stop it from reaching a broader population.”

SOS Pairs Educateurs has expanded its activities to reach different populations. It founded a school for street children and children who have dropped out of school and organized trainings for girls in sewing as well as a teen dance group. “Here for many the reality is that you have little hope so by having kids succeed in school or on the dance floor, it boosts them and impacts the entire family,” said the SOS Pairs Educateurs Director, Djibril Sy, above. He grew up in El Mina and still lives there, saying that countless people have benefitted from its work in the past 20 years. “Aside from hope, we really try to instil a sense of self-worth,” he added, explaining now that he wants to give young people trainings in entrepreneurship.

Despite progress, western and central Africa represents 8% of the world population but is home to 12% of all people living with HIV globally and experiences 22% of all AIDS-related deaths in the world.

In 2001, Micheline Léon felt unwell. The then 33-year-old mother of three journeyed from her home in the small town of Corporand in central Haiti to a clinic in Cange. There she was diagnosed with HIV and tuberculosis.

Fortunately, three years earlier an organization called Zanmi Lasante—Haitian Creole for Partners in Health—had launched the HIV Equity Initiative. (Zanmi Lasante is the sister organization of the United States-based nonprofit health-care group Partners in Health.) This was one of the first projects in the world to effectively deliver antiretroviral therapy in poor, rural settings.

Twenty years later, Ms Léon is one of 2000 community health workers called accompagnateurs in the Zanmi Lasante network. Multiskilled teams of accompagnateurs are the link between patients and health facilities. They are also part of all HIV Equity Initiative discussions regarding patient care, treatment and social support.

Community health workers live in the areas where they work. They help to ensure that patients recover and stay healthy. Their main roles include medicine distribution and home visits, as well as linking people to care. They accompany patients to clinics and track those who have missed appointments. During the COVID-19 pandemic, the accompagnateurs were key to Zanmi Lasante’s care and treatment work. The home-based care and contact tracing skills refined in response to HIV are now being used for COVID-19.

Zanmi Lasante has a holistic approach to care that includes social services such as providing accommodation, food and transport. Community health workers help to coordinate all the support needed. They also serve the wider community by running educational campaigns on topics such as mental health and sexually transmitted infections.

Critically, the accompagnateurs empower and inspire people to take charge of their own health. Ms Léon is a role model within reach. Since starting treatment she has stayed adherent to it and her HIV viral load has remained undetectable since she began receiving viral load tests in 2017. She owns a small fruit and poultry business and sometimes spends time in Port au Prince, where she has a new grandson. She takes part in various group activities at the Zanmi Lasante site in Cange, including support groups, viral load classes and mothers’ clubs.

“The psychosocial support I received from Zanmi Lasante made me realize that my diagnosis was not a death sentence and I could go on and live a healthy and fulfilled life,” Ms Léon said.

Another stalwart Haitian HIV programme employs a community health approach. GHESKIO, the Haitian Study Group on Kaposi’s Sarcoma and Opportunistic Infections, was founded in 1982, the year before HIV was formally discovered. It is the world’s oldest HIV organization and has conducted research and provided clinical care over the past four decades.

GHESKIO has leveraged a community-based model to help Haiti respond to HIV and other public health crises. When the COVID-19 pandemic reached the country in March 2020, GHESKIO reinforced an existing programme—Distribution of ART in the Community—to ensure that clients living with HIV were provided with a three-month supply of medication. From a small room at the National Solidarity Association (ASON), a team packages medicines into plastic bags and pours over their client list. If a person is unable to come for their medicines, they’ll receive a home delivery.

GHESKIO also strengthened training activities for their multiskilled community health workers. In this way they provided social support for patients as well as home care for cases that did not require hospitalization.

“Our Community Unit played an essential role in the acceptance of new COVID-19 treatment centres in the impoverished, crowded slums,” said GHESKIO’s Program Coordinator, Patrice Joseph. “In collaboration with the Ministry of Health, we have strengthened contact tracing, case investigation and outbreak management for COVID-19.”

One of the newest community health workers is CV, a 35-year-old mother of three from Village de Dieu, a slum south of Port au Prince. She herself survived COVID-19. When she began feeling ill a community health worker accompanied her to get tested. Following five days at GHESKIO’s COVID-19 hospital, a community team conducted home visits to ensure her full recovery.

Now she works as a greeter at GHESKIO. She is also a GHESKIO community health agent, encouraging patients to come to scheduled visits. CV supports community sensitization around COVID-19 prevention by promoting sanitation and educating people about the importance of COVID-19 vaccination.

“I don’t take one day for granted,” she said.

“I have not been taking my meds for seven months,” said Carla Joseph (not her real name), a transgender woman living with HIV in Haiti. “I need a reliable, direct place that will not ask me for a referral letter … to get back into care.”

She is speaking to one of Haiti’s community-led monitoring (CLM) field officers from the Civil Society Forum Observatory, who over the past year have been working to learn more about how to connect diagnosed people to treatment and ensure that those already in care are better served.

“During the monitoring we met many clients waiting for their turn to be consulted and get their drug refilled,” said Elisabeth Jacques, a Community-Led Monitoring Field Coordinator. “Shouldn’t the services be at the best day and time for the patient?”

UNAIDS is supporting the community-led monitoring work being conducted by Haiti’s Civil Society Forum Observatory. Community-led monitoring is an accountability mechanism to improve people’s access to HIV services and the quality of care they experience. The process is led and implemented by communities of people living with HIV, key populations and other vulnerable groups.

This initiative is part of a coordinated effort by partners, including the Ministry of Public Health and Population and the United States Government through the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It aims to maintain and expand access to HIV services for Haiti’s estimated 150 000 people living with HIV, including 30 000 who are not yet aware of their status.

In its first report, the Civil Society Forum Observatory called attention to the need to improve client-centred services by extending service hours and reducing waiting times. It has also recommended an increase to six months for the supply of antiretroviral medicines dispensed to stable people living with HIV. Additionally, the community-led monitoring exercise unearthed a need to improve treatment literacy related to the concept of U = U (undetectable = untransmittable).

“We should build the capacity of civil society to do this sensitization work. They are more familiar with the clients. When someone is lost to follow-up, community members know how to speak to them and encourage them to come back. If we empower the community through community-led monitoring we can have a better handle of what’s going on,” said Soeurette Policar, the Coordinator of the Civil Society Forum Observatory.

The Head of HIV Prevention at the Ministry of Public Health and Population, Steve Mc Allan Smith, welcomed the recommendations. “Community-led monitoring will tell us how services are being rendered in the community and how people are experiencing those services from a client perspective. This approach will tell us how to tailor interventions to the specific needs of the patients. It will also help us address testing issues. But mostly it will help us retain people in care. Reaching the targets is really good,” he said. “But maintaining them long-term is what we are going for.”

Over the past year, the country has contended with intersecting crises. One month after the assassination of its president, Haiti endured a devastating earthquake, followed by a tropical storm. Worsening organized crime and an epidemic of kidnappings have had dire implications for the daily life of Haitians. In recent months a fuel shortage has made it even more difficult for people and organizations to conduct their affairs. And all this under the spectre of COVID-19.

Poverty, gender-based violence and the discrimination faced by people living with HIV and key population communities undermine people’s ability to stay on treatment. The challenging socioeconomic and security context only makes things worse. According to PEPFAR data, almost 8000 Haitians came off HIV treatment last year.

However, as the UNAIDS Country Director for Haiti, Christian Mouala, noted, Haiti was able to successfully implement multimonth dispensing of antiretroviral medicines to 88% of people on HIV treatment during COVID-19. This was thanks to coordinated efforts under the leadership of the Ministry of Public Health and Population and the collaboration of many stakeholders, including Haitian civil society.

“The people and health system here are resilient and adaptable,” Mr Mouala said. “At this time community leadership must become even more central to developing and implementing strategies to ensure people enjoy the best possible HIV, health and social support services.”

Health is a right, but in Africa it is estimated that up to 38% of the population delay or forgo health care due to its high costs and out-of-pocket expenditures. Africa is the continent with the greatest proportion of the population not having access to social protection and adequate health care, and where human needs are the greatest.

Limited local production and dependence on external markets and financing are barriers to equitable access to medicines and other medical supplies in Africa. All African countries are net importers of medical and pharmaceutical products, with most of them importing between 70% and 90% of the medicines they consume. 

The advent of the COVID-19 pandemic and its devastating consequences in Africa demonstrate that there is still a long way to go in terms of implementation and domestication of the various international, continental, regional and national human rights instruments.

To address these shortcomings, the African Commission on Human and Peoples’ Rights (ACHPR) held the High-Level Regional Seminar on the Right to Health and Social Protection in Africa, in Dakar, Senegal, from 8 to 10 December. It aimed to raise awareness among member states, national human rights institutes, nongovernmental organizations and other partners on the issue of deficient health-care systems and insufficient social protection coverage, to share best practices regarding health-care systems and social protection and to formulate key recommendations for implementation.

“We should not have a handout, but solve our own health problems in Africa. Dependence on international financing makes progress vulnerable,” said Maria Teresa Manuela, an ACHPR Commissioner and a Special Rapporteur on the Rights of Women in Africa.

Financing the right to health is a strong area of collaboration between UNAIDS and ACHPR that will be crystallized in a report to be launched in 2022.

“Pandemics can be a catalyst for transformative financing reforms that uphold the right to health for those left behind. Lessons from the AIDS response and many other leadership examples in Africa need to be leveraged to further mobilize leadership and investments to end AIDS and other pandemics, end inequalities and accelerate realization of the right to health for all,” said Patrick Brenny, the Director of the UNAIDS Regional Support Team for Western and Central Africa. He encouraged stakeholders to generate evidence to demonstrate the impact on the right to health of financing strategies and proposed fiscal policies, to increase development assistance in more than 35 countries and to promote the greater participation of parliamentarians in the financing dialogue, bridging the gap with those who make fiscal decisions.

The COVID-19 pandemic has widened inequalities, claimed lives and disrupted HIV and tuberculosis (TB) services. It has affected the most vulnerable, including people living with, at risk of and affected by HIV. By reducing inequalities, social protection facilitates the uptake of HIV, TB and other essential health services. It improves adherence to HIV and TB treatment, reduces HIV risk and mitigates the social and economic impacts of HIV and COVID-19.

In 2015, all countries pledged to reduce inequalities within and between countries as part of the Sustainable Development Goals. This pledge is reinforced by the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the 2021 United Nations Political Declaration on AIDS. Governments must promote inclusive social and economic growth and access to social protection for vulnerable people, including key populations, people living with HIV and others.

A satellite session at the 2021 International Conference on AIDS and STIs in Africa showcased UNAIDS’ call to action on reducing inequalities in support of key populations, children, adolescents and people living with HIV accessing social protection benefits.

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