“We are demanding that you step up and finally do your part,” said Yana Panfilova, a young female activist from Ukraine who is living with HIV, at the United Nations High-Level Meeting on AIDS in June 2021.

A leader of the regional adolescent-led movement Teenergizer, she emphasized the vulnerability of young people to HIV and the need to provide care and support to adolescents living with HIV and she called on world leaders to keep young people at the forefront of the AIDS response.

“If we are going to make real change, these four things must become a reality: comprehensive sexuality education in all schools, in all countries; psychosocial support and peer support for every adolescent with HIV and young key populations; community-led HIV services immediately as the reality, not the exception; and an HIV vaccine and a functional cure,” Ms Panfilova added.

All these recommendations are critical in eastern Europe and central Asia, which is facing the world’s fastest growing HIV epidemic. At end of 2020, there were 60 000 young people aged 15–24 years living with HIV in the region. Many young people remain unaware of their HIV status, and late HIV diagnosis remains a significant challenge in the region.

There are multiple barriers and obstacles in almost all countries in eastern Europe and central Asia for adolescents and young people to access HIV services and care. In many countries there is an absence of adolescent-centred HIV testing and counselling, there are requirements for parental consent for HIV services, there is a lack of access to modern contraceptives and there are confidentiality issues and stigma and discrimination. Harmful norms, taboos related to sexual and reproductive health, inequalities, gender-based violence, COVID-19-related obstacles and mental health problems are further barriers to access to HIV services.

Although significant progress has been achieved over the past 30 years in providing adolescents and young people in eastern Europe and central Asia with access to sexual education and other services, the level of knowledge about HIV prevention among people aged 15–24 years in the region remains low—as low as less than 3% in Tajikistan.

Different approaches have been used by civil society and community-led organizations to reach young people who are vulnerable to HIV. For example, the Dance4life project in Belarus, Kyrgyzstan, Kazakhstan, the Republic of Moldova, the Russian Federation and Ukraine reaches vulnerable young people with the Journey4Life Programme (J4L). J4L helps adolescents aged 14–18 years develop healthy interpersonal relationships that are free from violence and coercion and based on respect for gender equality and teaches them how to maintain their sexual and reproductive health, focusing on the prevention of HIV, unplanned pregnancy and sexually transmitted infections. It aims to reach 1400 young people by the end of 2021 in Kazakhstan and Kyrgyzstan, with support from UNAIDS and the United Nations Educational, Scientific and Cultural Organization.

A recent survey among adolescents run by Teenergizer showed that the availability of HIV treatment for adolescents is not enough to keep them alive. Treatment interruption is a significant reason why adolescents continue to die in the region. According to the survey, HIV-related fears, psychological vulnerability, treatment fatigue and stigma are significant risk factors for treatment interruption among adolescents. The survey noted that they need support from their peers, communities and doctors, and they often need professional psychological help. 

In her United Nations High-Level Meeting on AIDS speech, Yana Panfilova remembered Diana, who recently died of an AIDS-related illness. “This year, I was angry when we lost Diana. She was only 19, born with HIV. But she had pills that were impossible to take, no mental health support and no confidentiality. Like millions of people with HIV, she was killed by inequalities. Millions of people with HIV may have HIV pills, but they live in a world where their families and their societies do not accept them for who they are.”

Svetlana Izambayeva, who organizes It’s simple!  summer camps for children and adolescents living with HIV in the region, explained that adolescents living with HIV are often socially isolated and lonely—they are scared to talk about their diagnosis and fear for their future. The camp’s attendees receive psychological care and support, create networks and support others. 

“We need more political leadership, more data on adolescents and young people, more programmes to address the gaps and more funds for the youth response. But here in the region we already have a growing movement of adolescent and young leaders which we must nurture, fund and further support,” said Lena Kiryushina, the UNAIDS Youth Officer for eastern Europe and central Asia.

On 22 July, the United Nations Economic and Social Council (ECOSOC) adopted a resolution on the Joint United Nations Programme on HIV/AIDS by consensus, at a hybrid meeting at the United Nations Headquarters in New York, United States of America, presided over by the Vice-President of ECOSOC, Collen Vixen Kelapile, the Permanent Representative of Botswana to the United Nations in New York.

At the meeting, the council considered the 2021 report of the UNAIDS Executive Director, Winnie Byanyima, which she introduced in person, and a report on governance issues by the UNAIDS Programme Coordinating Board (PCB), introduced by its Chair, Kalumbi Shangula, the Minister of Health and Social Services of Namibia.

Following the debate, the Deputy Permanent Representative of Namibia to the United Nations in New York, Helena Ndapewa Kuzee, presented a joint statement by Namibia and Thailand introducing the 2021 resolution on the Joint Programme. The two countries had co-facilitated the negotiations in Geneva, Switzerland, earlier in July in their capacity as, respectively, the Chair and Vice-Chair of the PCB.

They emphasized their gratitude to Member States for having ensured a consensus resolution that spoke to the critical leadership role of the Joint Programme’s Cosponsor and governance model for strategic coherence, through its coordination, results-based focus, inclusive governance and country-level impact. The resolution also recognized the importance of the 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030 and the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS, and the new 2025 targets to set direction for the response.

Namibia and Thailand cautioned that AIDS is far from over and expressed concern that there is a continuing shortfall in the financing of the HIV response, especially with respect to low- and middle-income countries, and that the COVID-19 pandemic has exacerbated existing inequalities and inequities within and among countries, including the lack of equitable and timely access to safe, quality, effective and affordable COVID-19 vaccines, diagnostics, medicines and medical products. This had created additional setbacks and pushed the AIDS response further off track.

Celebrating the 25 years since ECOSOC introduced the PCB nongovernmental organization delegation, a multicountry statement was made recognizing the important contribution of the delegation to the governance of the Joint Programme and noted that communities affected by HIV, particularly key populations, have a crucial place in the AIDS response and thereby also in United Nations meetings, where the delegation contributes to policy development and gives voice to complex issues. 

“I thank the ECOSOC Council for its foresight and out-of-the-box thinking when it created this unique multisectoral programme in the mid-1990s. Thank you for insisting on including people living with HIV and those most at risk of HIV infection at the centre of the United Nations’ global response, as well as in the governance of the Joint Programme through the nongovernmental organization delegation,” said Ms Byanyima, addressing the representatives of permanent missions in New York.

By Brigitte Quenum, UNAIDS Country Director for Côte d’Ivoire

It is with great sadness that I learned on 15 July 2021 of the death of Cyriaque Yapo Ako, one of the pioneers in the response to HIV in Côte d’Ivoire and in Africa as a whole.

A founding member of Ruban Rouge CI in 1994, he never stopped promoting the role of communities in the response to HIV. The Executive Director of RIP+ in the 2000s, he then contributed his expertise to several organizations, including the International Treatment Preparedness Coalition, African Men for Sexual Health and Rights and I CHANGE CI, and collaborated with several partners, including UNAIDS, Population Services International, the United States President’s Emergency Plan for AIDS Relief and the United Nations Development Programme, as a resource person for technical assistance.

As a founding member of Arc-en-Ciel in 2003, the first nongovernmental organization for gay men and other men who have sex with men in the AIDS response in Côte d’Ivoire, he advocated for the need to create a safe space for sexual minorities in Africa, in particular in Côte d’Ivoire, where gay men and other men who have sex with men were commonly subject to stigma, discrimination and violence.

His dynamism and activist spirit enabled him to speak out on behalf of the most marginalized and neglected people in the AIDS response.

From 2004 to 2009, he was the representative of people living with HIV and sexual minorities on the Country Coordinating Mechanism Côte d’Ivoire, where he made a significant contribution to defending people-centred HIV responses in the development of HIV applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

His participation in several international conferences contributed to the advocacy of the rights of people living with HIV and more broadly the rights of key populations. He defended his positions, notably through his participation in events such as the International Conference on AIDS and STIs in Africa (ICASA) in 2008 in Dakar, Senegal, ICASA 2011 in Addis Ababa, Ethiopia, ICASA 2013 in Cape Town, South Africa, and the 2016 International AIDS Society Conference in Durban, South Africa, with his contribution in the form of oral presentations and statements.

His passing is a great loss to all those involved in the AIDS response, especially those committed to defending the most vulnerable.

He was a friend, brother and colleague to many of us.

May his soul rest in peace.

“Communities must be allowed to sit in the driver’s seat and take control of their lives. They are not passengers that sit idle, but leaders capable of making changes,” said Aditya Wardhana, the Executive Director of the Indonesian AIDS Coalition (IAC). This is the motto that he lives by, a motto that drives the work of IAC and how communities and civil society are meaningfully engaged in the HIV response in Indonesia.

IAC is a community-led organization based in Jakarta and was recently appointed the second community Principal Recipient to implement the Global Fund to Fight AIDS, Tuberculosis and Malaria’s (Global Fund) grant for HIV in Indonesia for 2022–2023—a feat, since only a handful of community-based organizations nationally or regionally hold Global Fund Principal Recipient status.

“Often, communities are seen as beneficiaries of programmes or as patients, not as decision makers. The IAC has always strived to shake up this dynamic. We believe that being a Principal Recipient will give us greater control over the issues that impact our communities and will set the direction of the national HIV response that puts communities at the centre of it,” explained Mr Wardhana.

In Indonesia, there are still significant gaps in the HIV response. Treatment coverage is low, with only 26% of people living with HIV on treatment, prevention is still lagging and stigma and discrimination remains high. IAC has identified three priorities to improve the HIV response in Indonesia, which include recognizing community health workers as health workers, creating more sustainable financing to reduce reliance on external donors and reforming laws and policies that discriminate and lack redress mechanism for victims of discrimination.

Networks of people living with HIV deliver life-changing services to those most affected and provide support for adherence to treatment, prevention and other essential health services. The involvement of civil society has been crucial in successfully advocating for sustainable financial resources, improving HIV programming and advancing human rights.

Over the next couple of years, IAC will work on these priority issues with the support of civil society organizations, United Nations partners and other stakeholders. IAC will continue to manage the human rights and community system strengthening programme, supported by the Global Fund and the Ministry of Health. Community system strengthening and community-led monitoring are integral parts of the HIV response. The programme ensures that community-based organizations play an active role in monitoring access to services, community programme quality assurance and human rights violations.

Since the organization’s foundation, the UNAIDS Country Office for Indonesia has been an ally and key partner, supporting IAC throughout the Principal Recipient selection process. “We know how important the role of communities is at all levels of the HIV response. We will continue to support IAC by providing technical assistance and capacity-building, working in collaboration to promote the meaningful engagement of communities and civil society in the HIV response,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

IAC, with support from the United Nations Population Fund in Indonesia, will soon establish a peer-led HIV prevention programme for female sex workers, offering differentiated service delivery to increase the uptake of HIV prevention services. Through the programme, they will also empower communities through capacity-building initiatives to drive the greater involvement of civil society in decision-making, especially in forming policies that directly impact the health and well-being of communities and vulnerable populations. Moreover, IAC plans to integrate gender-based violence screening into its outreach programmes. A human rights-based approach is essential to ending AIDS as a public health threat. This approach will create an enabling environment for successful HIV responses and affirms the dignity of people living with or vulnerable to HIV.

IAC will be responsible for managing US$ 17 million to implement the above programmes, with eight organizations across Indonesia as subrecipients.

“We will dive deep into these challenges and hopefully change the landscape of the HIV response. We believe that a more participatory approach will re-energize communities and remind them why HIV is still important and how programmes designed by communities for communities can save lives. This is what we will work towards; this is how we will end AIDS by 2030,” said Mr Wardhana. 

The participants of the International AIDS Society (IAS) Conference on HIV Science session on an HIV vaccine were welcomed by Lucy Stackpool-Moore, Director, HIV Programmes and Advocacy at the International AIDS Society, after which Susan Buchbinder, from the University of California, San Francisco, and the San Francisco Department of Public Health, made introductory remarks. Two recorded presentations were then shown, by Kevin De Cock and Gabriela Gomez, speaking, respectively, on the need for and role of an HIV vaccine and on modelling science around the requirements and impact of a putative vaccine.

UNAIDS’ Science Adviser, Peter Godfrey-Faussett, then moderated a lively panel discussion that included Yazdan Yazdanpanah, Kundai Chinyenze, Rachel Baggaley, Daisy Ouya, Jerome Singh and Paul Stoffels.

The first question was on whether a vaccine for HIV, if it arrived, would be too late in view of the other HIV prevention modalities available. The consensus was that a vaccine is still needed, especially in low- and middle-income countries and for key populations. The participants then discussed how good a vaccine would need to be. Relevant issues include efficacy and durability, but a priority is proof of concept of activity. The participants acknowledged that initial inconvenient dosing schedules are justified if it can be shown that a product is protective. Minimum efficacy probably needs to be in the region of 50–60% for products to be taken forward. 

The discussion also covered engagement by big pharma—Johnson & Johnson is currently the major company pursuing HIV vaccine research, in conjunction with diverse governmental, nongovernmental and clinical partners. It was emphasized that people and individual motivations drive the science, both for HIV prevention and treatment. 

Inevitably, the comparison of vaccine development for COVID-19 and HIV came up. The panellists emphasized, however, that the reasons for a lack of success so far in HIV was largely related to the complex nature of HIV itself.

The discussion ended on a note of realistic optimism, with acknowledgment of the benefits of scientific investment in HIV vaccine research to date, including for COVID-19, but with recognition that long-term commitment is still required. The results of the two ongoing phase three trials (Imbokodo and Mosaico) are eagerly awaited.

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At a session at the International AIDS Society (IAS) Conference on HIV Science, the participants discussed the new AIDS targets for 2025, which are included in the UNAIDS Global AIDS Strategy 2021–2026 and the 2021 United Nations Political Declaration on AIDS.

The session aimed to make the 2025 targets known more widely among the attendees of the conference. The panel was moderated by Luisa Frescura and introduced by Shannon Hader, the UNAIDS Deputy Executive Director of Programmes. The panel included Adele Benzaken, the Co-Chair of the target-setting process, Aleny Couto, Mandisa Dukashe, Birgit Poniatowski, Erik Lamontagne, Peter Ghys and José A. Izazola.

The different targets, including targets for services, integration and societal enablers, were discussed, framed within the Sustainable Development Goals, and the financial resources needed to achieve them in low- and middle-income countries were highlighted.

The global 2025 targets for the AIDS response are more granular than the targets for 2020. They recognize that societal, service and system enablers are needed to reach the high levels of service coverage and impact needed, while emphasizing the importance of integrating the HIV response to achieve universal health coverage and the Sustainable Development Goals.

The session heard that recommendations for prevention services are given in accordance with the specific needs of populations or groups and their risk of acquiring HIV, with a particular focus given to key populations. The participants also heard that testing and treatment services need to be scaled up in each and every subgroup in order to avoid them being left behind and hidden in the general average of coverage.

The participants noted that the ambitious targets are achievable and clearly show the way to reach a sustainable response to HIV globally.

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The International AIDS Society (IAS) Conference on HIV Science opened on 18 July. The participants were welcomed by Adeeba Kamarulzaman, the Chair of the IAS, and Hendrik Streeck, the local Chair of the conference, who held up UNAIDS as an example of the multisectoral approach that was needed for the response to COVID-19. The opening address was delivered by Angela Merkel, the Chancellor of Germany, which was followed by a panel discussion.  

The panel’s speakers drew parallels between the need for global solidarity for COVID-19, especially with regard to access to vaccines, and for HIV, recognizing that both viruses spread regardless of borders and need a global response. They also spoke about the imperative to not let the HIV response be slowed because of the COVID-19 pandemic. Repeated emphasis was made on the bi-directionality of COVID-19 and HIV investments, reminding the audience of the importance of investment in HIV science for developments in COVID-19.

Jens Spahn, Germany’s Federal Minister of Health, accepted that the global response to COVID-19 has been slow but stressed that political decisions had been made to increase global vaccine access, and supply would increase briskly in the coming months. Yvette Raphael, a South African activist living with HIV, recounted her struggle to fight stigma and discrimination relating to HIV, gender and race/ethnicity. She reminded the audience that scientific data relate to real people with human relationships. 

Soumya Swaminathan, the Chief Scientist at the World Health Organization, reflected on the priorities of primary health care and universal health coverage. Perhaps the most frequent and strongly felt sentiments concerned the need to combat misinformation and disregard for science. “Follow the science” was a phrase that resonated over the course of the rich discussion.

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The increase was largely due to disbursement of prior-year multilateral funds. Bilateral funding from donor governments, other than the U.S., continues a downward trend.

A new report from KFF (Kaiser Family Foundation) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) finds that donor government disbursements to combat HIV in low-and middle-income countries increased by US$377 million in 2020, reaching US$8.2 billion in 2020 compared to US$7.8 billion in 2019. Donor government funding supports HIV care and treatment, prevention, and other services in low- and middle-income countries.

The rise in funding is almost entirely the result of an increase in United States contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was due largely to the disbursement of prior-year funding. U.S. disbursements to the Global Fund are not expected to remain at this level in 2021.

The United States continues to be the largest donor to HIV, accounting for 76% of all donor government funding, followed by the United Kingdom (US$612 million, 7%), Japan (US$258 million, 3%), Germany (US$246 million, 3%), and France (US$216 million, 3%). As other donor governments continue to pull back bilateral funding, the United States accounts for an increasing share of overall funding for HIV from donor governments.

The report reflects prior-year political and funding decisions and does not fully capture the impact of COVID-19 on donor funding decisions.

“While many donor governments are beginning to bounce back from the pandemic, its global impact and related recession make future funding for HIV response unpredictable,” said KFF Senior Vice President Jen Kates. “Not only are some low- and middle-income countries experiencing a ‘third-wave’ of COVID-19, vaccines remain largely out of reach, potentially leading to greater funding needs for HIV and other health services.”

"We are at a critical stage in the AIDS response as countries are confronting the huge challenges posed by the COVID-19 pandemic," said Winnie Byanyima, Executive Director of UNAIDS. "But we do still have an opportunity to end the epidemic by 2030 if donors and countries alike commit to mobilize resources and prioritize health, human rights and equality which are the key components, not only to lead us out of the pandemics of HIV and COVID-19, but they are the cornerstone to economic recovery and security."

These data are included in a broader UNAIDS global report, which examines all sources of funding for HIV relief, including local governments, non-governmental organizations, and the private sector, and compares it to the resources needed to achieve goals related to testing and treatment.

The new report, produced as a long-standing partnership between KFF and UNAIDS for more than 15 years, provides the latest data available on donor government funding based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund, UNAIDS, and UNITAID.  “Donor government funding” refers to disbursements, or payments, made by donors.

By Mbulawa Mugabe, UNAIDS Country Director for South Africa

It is with great sadness that I received the news that the Executive Mayor of Johannesburg, Geoffrey Makhubo, passed away on 9 July 2021.

Having served in various senior positions in the Johannesburg Council and as the Member of the Mayoral Committee for Finance, Mr Makhubo was appointed Johannesburg Executive Mayor in December 2019, a position that he served with commitment and dedication.

Mr Makhubo was a strong advocate in the response to HIV, and on World AIDS Day 2020 he urged communities to work together to end HIV-related stigma. UNAIDS is grateful for his leadership and commitment to public health and to the HIV response, and for his unwavering support for the Fast-Track cities initiative. Given his commitment to the urban health agenda, Mr Makhubo addressed the global Fast-Track cities conference in 2020 and was a panellist at the United Nations High-Level Meeting on AIDS Fast-Track cities side event in June 2021.

His death is a deep loss for the HIV community and the citizens of Johannesburg.

Mr Makhubo died from COVID-19 complications, following a positive test result in late June.

We extend our sincere condolences to Mr Makhubo’s colleagues, family and friends, and to the city of Johannesburg.

Like the rest of the world, COVID-19 has hit Côte d’Ivoire hard. As soon as the first cases of COVID-19 were confirmed in March 2020, a national response plan was developed by the government. Unfortunately, the restrictive measures to protect the population had an impact on the use of health services, including those related to HIV, threatening the fragile retention in care of people living with HIV. Pregnant and lactating women living with HIV and their children, one of the most vulnerable groups, have been particularly affected, and maintaining their access to services and care was essential to avoid undoing years of effort.

The United Nations Development Programme (UNDP) and UNAIDS joined forces to help retain 333 pregnant and lactating women living with HIV in antenatal, maternity and paediatric services in Abidjan. The project will provide, over nine months, 1000 food kits and 1000 hygiene kits to help beneficiaries with food assistance and help them protect themselves against COVID-19.  A food kit contains 20 kg of rice, six litres of oil, 10 pieces of soap and four boxes of children’s flour, and a hygiene kit contains two bottles of hydroalcoholic gel, two bottles of liquid soap and 50 surgical masks. The project also aimed to ensure that the women have access to the comprehensive package of services developed under Côte d’Ivoire’s prevention of mother-to-child transmission of HIV (vertical transmission) programme, to ensure that all exposed children of the project’s beneficiaries are screened early and have access to appropriate care and to document and share good practices.

One of the beneficiaries, Ouattara Maimouna, who has been living with HIV for five years and is a breastfeeding mother of three children, said, “Doctor, this gift was incredibly important to us. It has helped us a lot! This stock of food helps me feed my family. I cannot thank you enough, because I ran out of ways to sustain the small business that used to support my family.”

“About 700 hygiene kits and 700 food kits have been distributed since the project started in December 2020. The United States President’s Emergency Plan for AIDS Relief’s (PEPFAR) implementing partners unanimously indicate that the kits have contributed to the loyalty of pregnant and breastfeeding women to prevention of vertical transmission of HIV and paediatric care services, as well as to self-support groups,” said Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire.

At this stage of implementation, some lessons learned are already emerging. The project has been very well received by the beneficiaries because of their vulnerability, which has been aggravated by the COVID-19 crisis. The support has helped to increase their compliance with appointments at the various prenatal consultations, to improve the continuity of treatment and viral load testing for pregnant and breastfeeding women and to strengthen the link between women living with HIV and the staff providing both clinical and community care. The project also emphasizes the importance of taking into account the social component in the care of women in prevention of vertical transmission of HIV services.

The distribution of food and hygiene kits will continue until the end of 2021. Pregnant and breastfeeding women living with HIV have become more vulnerable in the midst of the response to COVID-19 and assistance strategies that respond to their specific sensitivities must be designed. “The mobilization of UNDP, UNAIDS, PEPFAR implementing partners and their nongovernmental organization partners has ensured a coalition of support for advocacy and the scaling up of outreach efforts to vulnerable populations,” added Ms Quenum. “While this one-time initiative is useful, efforts should be made to integrate other activities, such as nutrition promotion and the integration of a social component in the care of women living with HIV in vertical transmission services and other care sites.”

An HIV-sensitive and inclusive social protection assessment will start in the coming months in collaboration with the key ministries involved. Mobilization of funds for social aspects related to women living with HIV and advocacy for sustainable support measures will be required.