A new report published by UNAIDS today shows the value of investing fully in the HIV response.

UNAIDS modelling shows that investing US$ 29 billion a year in the HIV response in low- and middle-income countries by 2025 will put the world back on track to end AIDS by 2030. The investment, paid for by both donors and the wealthier countries most impacted by the HIV pandemic, would result in annual new HIV infections falling dramatically, from 1.7 million in 2019 to 370 000 in 2025, and annual AIDS-related deaths falling from 690 000 in 2019 to 250 000 in 2025. The number of new HIV infections among children will drop from 150 000 in 2019 to less than 22 000 in 2025.

In 2016, countries agreed in the United Nations Political Declaration on Ending AIDS to invest US$ 26 billion in the HIV response by 2020. Resources in low- and middle-income countries peaked in 2017 but they started decreasing in 2018, with only US$ 19.8 billion available in 2019—just 76% of the 2020 target. As a result, none of the global programmatic targets set for 2020 were met. And the failure to achieve the targets has come at a tragic human cost: an additional 3.5 million people were infected with HIV and an additional 820 000 people died of AIDS-related illnesses between 2015 and 2020.

“We are not on track to end AIDS by 2030,” said Jose A. Izazola, UNAIDS Special Adviser, Resource Tracking and Finances. “But our modelling shows that spending wisely and focusing investment in the right place will have remarkable results and get us on track to end AIDS by 2030.”  

As a result of the failure to meet the 2020 targets, spending will have to be increased, to a peak of US$ 29 billion by 2025.

The investments will be made in a variety of areas. There will be substantially greater investments in HIV prevention services, for which investments will almost double, from the estimated US$ 5.3 billion expenditures in 2019 to US$ 9.5 billion in 2025, with a special focus on key populations, to stop the 1.7 million new HIV infections that still occur each year.

Huge gains can be made in the scale-up of HIV treatment at a low additional financial cost. Modelling shows that a modest 17% increase (an additional US$ 1.3 billion) in resources for testing and treatment by 2025 will enable a 35% increase in the number of people on treatment, to 32 million people.

Spending in societal enablers—factors rooted in society as a whole that modify the effectiveness of HIV programmes: access to justice and law reform, stigma and discrimination and gender equality, including gender-based violence—will more than double, from US$ 1.3 billion in 2019 to US$ 3.1 billion in 2025, and grow to 11% of total resource needs.

“We must not repeat the mistakes of the past,” added Mr Izazola. “The time to invest is now.”

The global health emergency caused by the COVID-19 pandemic has brought existing inequalities to the forefront, has exposed transgender and gender-diverse communities to a heightened risk of social exclusion, stigma and discrimination, has reduced access to health care and has caused financial insecurity.

“COVID-19 has created an existential threat to many transgender people in Asia and the Pacific. But trans-led organizations and groups have found creative ways to assist their communities, to offer support against social isolation and to support trans and gender-diverse people, especially those unable to work due to COVID-19. We recognize the importance of trans leadership and their response to communities greatly affected by the pandemic,” said Joe Wong, Executive Director of the Asia Pacific Transgender Network (APTN).

When COVID-19 reached India, Maya, a young transgender woman living with HIV volunteering at Basera Samajik Sansthan, a transgender-led community-based organization in Uttar Pradesh, was living in rented accommodation after being rejected by her family. “During the COVID-19 outbreak, my friends and I had to leave our homes because we couldn’t afford the rent,” she said. Basera Samjik Sansthan provided her and her friends with shared accommodation and supplied them with food and medicine. The community-led organization also established a peer support programme to help homeless transgender young people and provide them with hand sanitizer, masks and access to free HIV and COVID-19 testing.

Her testimony is part of a collection of stories published in Dignity amidst COVID-19: Trans Youth Leading The Response, developed by APTN and Youth LEAD, and supported by the UNAIDS Regional Support Team for Asia and the Pacific, to bring visibility to the voices and experiences of transgender and gender-diverse youth leaders and showcase the efforts of transgender-led organizations throughout the region during COVID-19.

“Many transgender people living with HIV were not able to afford transportation to medical centres to receive treatment during the COVID-19 outbreak,” said Della, a young transgender woman living with HIV from Indonesia who works for the Srikandi Sejati Foundation, whose testimony is also collected in the Dignity amidst COVID-19 series. The Srikandi Sejati Foundation established a community support programme that covered transport costs to medical centres to ensure that transgender people could access HIV services. It also implemented local workshops to support and empower transgender women in five districts in Jakarta with knowledge on COVID-19, HIV, mental health and adherence to antiretroviral therapy.

In Thailand, measures taken to curb the spread of COVID-19 and the consequent decline in tourism have forced many entertainment shows and venues to close, leaving many transgender people out of work. “The decline in tourism has heavily affected not only businesses but sources of income for transgender people. Many trans women have returned to rural areas to be with their families due to loss of employment,” said Garfield, a young transgender woman working for the Sisters Foundation, a transgender-led organization in Pattaya that provides a range of HIV services to transgender people, including check-ups for general health, HIV and sexually transmitted infections, hormone therapy and harm reduction. As described in the collection of stories, since the beginning of the pandemic, Garfield and other volunteers have been at the forefront of the COVID-19 relief efforts, distributing food supplies and hygiene products to transgender women.

Basera Samajik Sansthan, the Srikandi Sejati Foundation and the Sisters Foundation are all beneficiaries of the COVID-19 Community Support Fund established by APTN to support transgender people and community-based organizations to ease the burden of the COVID-19 pandemic in the region. APTN provided grants to 22 transgender-led and transgender-inclusive community groups and organizations across 14 countries, enabling them to assist more than 2300 people across Asia and the Pacific. The grant supported various initiatives, including access to essential supplies, food and personal protective equipment, social and mental health relief support, financial assistance and funding support to sustain organizations.

The community-led initiatives and outcomes of the response to COVID-19 are summarized in the Trans Resilience Report—Stories of Hope, Pain, and Survival from the Trans Movement during the COVID-19 Pandemic, developed with financial support from the UNAIDS Regional Support Team for Asia and the Pacific, and in APTN’s multi-week social media campaign.

“On International Transgender Day of Visibility, UNAIDS recognizes the indispensable contributions made by transgender communities in the HIV and COVID-19 response. The leadership and resilience of transgender and gender-diverse communities continues to be an inspiration for our region,” said Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific. UNAIDS will continue to work with APTN and transgender-led organizations to work towards a region where transgender people and gender-diverse people can thrive as equals.

Globally, the number of people living with HIV who died from tuberculosis (TB), a curable and preventable disease, has fallen from almost 600 000 deaths in 2010 to just over 200 000 in 2019, a fall of 63%. In 2016, a global target was set by the United Nations to reduce TB deaths among people living with HIV by 75% between 2010 and 2020. Nine countries (Djibouti, Eritrea, Ethiopia, India, Malawi, South Africa, Sudan, Thailand and Togo) achieved or exceeded the global target by the end of 2019, one year ahead of schedule.

Further progress towards the global targets has been made in making TB preventive treatment more available to people living with HIV. TB preventive treatment greatly reduces their risk of falling ill and dying from TB. In just two years—2018 and 2019—5.3 million people living with HIV received life-saving TB preventive treatment. That is already 88% of the 6 million target set for 2022 in the 2018 United Nations Political Declaration to End TB.

While progress in some countries is to be applauded, these successes mask the many inequalities and gaps that remain in providing the best integrated care for people living with HIV and TB. These gaps resulted in an estimated 208 000 preventable TB-related AIDS deaths in 2019—about one in three AIDS-related deaths.

“One of the greatest disparities in the global response to HIV and TB is in reaching children,” said Shannon Hader, UNAIDS Deputy Executive Director for Programme. “Much better tools to prevent, diagnose and treat TB and drug-resistant TB for young children are now available, but they are still not enough. Too many children are still not being reached with these new tools. Some health-care workers lack the confidence to manage TB among children living with HIV and, for fear of causing harm and a desire to be protective, they don’t always act. Children are being “protected to death”. We need to build confidence to manage TB and HIV in young children and reach transformational goals.”

TB is especially difficult to diagnose among the youngest infants and children living with HIV—those less than two years of age. The most severe forms of TB—disseminated TB and TB meningitis—are common among this age group and they are life-threatening without prompt diagnosis and treatment. Major advances have been made in improving TB diagnosis for children. Child-friendly medicines for the treatment and prevention of TB are available at low cost from the Stop TB Partnership Global Drug Facility. The challenge is to take these innovations to the scale and quality needed to reach all children living with HIV in need.

The Rome Paediatric HIV & TB Action Plan, part of the UNAIDS and United States President’s Emergency Plan for AIDS Relief Faith Initiative, is closing the gaps for children living with HIV. It is a unique multistakeholder partnership that has stimulated unprecedented collaboration among the faith community, private sector, regulators, donors and others to accelerate the development and implementation of better diagnostic tests, preventive measure and treatments for HIV and TB among children living with HIV.

In 2019, less than half (49%) of the estimated 815 000 people living with HIV who also have TB disease were reported to be receiving both HIV treatment and TB treatment. This demonstrates that large gaps remain in screening, testing and treatment for both HIV and TB. To address this, national programmes need to go beyond traditional health facilities to find the missing millions of people who are still in need of treatment for HIV, TB or both. An integrated, community-based and person-centred approach is needed. Multidisease family and community screening for TB, HIV, COVID-19, high blood pressure, diabetes and other common conditions can be de-stigmatizing and can reduce costs for programmes and people. It is critical to encourage all people recently diagnosed with HIV, TB or COVID-19 to allow confidential screening of their family, household and community contacts, including children and young people.

Already, the clock is ticking for us to reach the ambitious new 2025 targets for TB and HIV laid out in the new global AIDS strategy for 2021–2026. Achieving these targets will place the world back on track to end AIDS and TB by 2030. A collaborative and integrated response to the pandemics of TB, HIV and COVID-19 is needed. The response must be rooted in affected communities and centred on the needs of the most affected people. Addressing the inequalities that drive TB and HIV will help to close the “deadly divide” between global commitments and the lived reality of TB- and HIV-affected communities. By ending inequalities, we can stop adults, young people and children living with HIV from dying of TB.

All (100%) of people living with HIV newly started on antiretroviral therapy should receive either tuberculosis (TB) preventive treatment (blue bar) or TB treatment (orange bar)—together, they represent “optimal TB care”. The green bar shows the percentage of people newly started on antiretroviral therapy who did not receive optimal TB care and are vulnerable to falling ill or dying from TB.

All people living with HIV who are newly enrolled on antiretroviral therapy should receive “optimal TB care”—either TB preventive treatment or TB treatment. Since 2012, the World Health Organization has recommended that all people newly diagnosed with HIV should be screened for TB. If they do not any have symptoms of TB (cough, coughing up blood, fever, night sweats, weight loss, chest pain, shortness of breath or fatigue) they should receive TB preventive treatment. If they have any TB symptoms, they should be fully investigated for TB disease. If they are found to have TB disease, they should be started on TB treatment immediately. If there is no evidence of TB disease, they should be started on TB preventive treatment.

TB is the commonest cause of hospitalization and death among people living with HIV. In 2019, TB was responsible for 208 000 (30%) AIDS-related deaths. Yet, TB is curable and preventable. TB preventive treatment reduces the risk of developing TB disease and can reduce deaths among people living with HIV by almost 40%. Without treatment, a person living with HIV who has TB disease is likely to die.

“For a moment, imagine with me. Imagine finding out that you acquired HIV from a boy who did not even know that he was positive and wouldn’t believe that you contracted it from him,” Akosua Agyepong, a youth leader from Ghana, said at a virtual event with key partners of a new flagship initiative, Education Plus.

Ms Agyepong shared her friend’s journey, an 18-year-old struggling to study, access treatment and beat the discrimination that young people living with HIV all too often face in homes, schools, health systems and the community. 

This experience, though, is not something of the past. In sub-Saharan Africa every week, an estimated 4500 adolescent girls and young women between the ages of 15 and 24 years acquire HIV, an epidemic that is fuelled by gender injustices and violence. Five in six new HIV infections among adolescents are among girls. Sub-Saharan Africa is also the region with the highest rates of child marriage and teenage pregnancy.

At the event, the UNAIDS Executive Director, Winnie Byanyima, while introducing Education Plus, a new game-changing initiative set up in response to those realities, made worse by the COVID-19 pandemic, implored the audience to reflect on those facts.

“Education Plus brings together governments to demonstrate leadership to make commitments to roll out secondary education that is free and calls on financial institutions and donor countries to support the leadership of African governments. It brings together girls’ movements, women’s movements, human rights movements, all those who care about the human rights of girls and the right to equal opportunity,” Ms Byanyima said.

“This situation is not inevitable. It can change, and it has been changing. We need leadership; we need solidarity; we need partnerships to change it,” she added.

Education Plus—led by the heads of UNAIDS, the United Nations Educational, Scientific and Cultural Organization, the United Nations Population Fund, the United Nations Children’s Fund and UN Women—calls for multisectoral commitments to ensure free quality secondary schooling for all girls and boys. It calls for guaranteed violence-free environments, access to comprehensive sexuality education, the fulfilment of sexual and reproductive health and rights and securing the economic empowerment of young women through successful school-to-work transitions.

Ministers of gender, education and health from African countries echoed the importance of the holistic approach of Education Plus, as did representatives of key partner institutions, including the African Union Commission, the African Development Bank, the European Union and the Global Partnership for Education. 

Khumbize Kandodo-Chiponda, the Minister of Health of Malawi, drew from her life experience, calling Education Plus a timely intervention. “It is very close to my heart because I was 16 years old when I got pregnant. So, I can put myself in the shoes of our girls, especially in rural areas. I was lucky that I had an opportunity to go back to school, and indeed stayed in school, graduated up to college,” she said. “Many of our young girls lack the same opportunity. So, I’m very happy about the Education Plus initiative.”  

Valentine Uwamariya, Rwanda’s Minister of Education, said that secondary education shouldn’t be a luxury. “To end the threat to the well-being of adolescent girls, including to protect them against HIV, completion of secondary education is key and quality of education means integrating comprehensive sexuality education, as Rwanda has done in the new competency-based curriculum.”

“Every girl deserves the right to an education that is not only inclusive but affordable, available and accessible, as well without fear of judgement and disrespectful treatment, so girls let’s power up!” said Hazel Jojo, a peer educator from Zimbabwe.

Vanessa Moungar, the Director of Gender, Women & Civil Society at the African Development Bank, called for smart investments. “We need to keep working with our governments so that investing in girls’ education is as much a priority as building roads and bridges.”

“We need more of these targeted interventions that tackle the root causes of gender inequality and have a direct pay-off,” said Franz Fayot, the Minister for Development Cooperation of Luxembourg. Véronique Tognifodé Mewanou, Benin’s Minister of Social Affairs and Microfinance and Chair of the African Union Specialized Technical Committee on Gender Equality, pledged support for the initiative.

In line with the initiative’s emphasis on placing the leadership of young women at the centre, the event was moderated by two young leaders, Jennifer Kayombo, from the United Republic of Tanzania, and Lorence Kabasele, from the Democratic Republic of the Congo. The event was hosted by the Governments of Benin and Luxembourg on 17 March and was held on the sidelines of the 65th session of the United Nations Commission on the Status of Women.

Among key backers of the initiative were Pauline Nalova Lyonga Egbe, Minister of Secondary Education, Cameroon, Sarah Mbi Enow Anyang, African Union Commissioner of Education, Science and Technology, and Innovation, Henriette Geiger, Director, Directorate on Human Development, Migration, Governance and Peace at the European Commission, and Alice Albright, the Chief Executive Officer of the Global Partnership for Education.

Education Plus—a chance to fully seize the transformative power of investing in adolescent girls and young women—will be launched during the Generation Equality Forum in Paris, France. 

Since school doors closed last March due to COVID-19, the majority of Jamaican students are still receiving tuition exclusively online. Social media and messaging services are more relevant than ever as a channel to share knowledge and resources with young people, as well as to receive their feedback.

The United Nations Children’s Fund (UNICEF) U-Report is an innovative message-based tool designed to engage with young people, provide them with information and give them an opportunity to weigh in on issues of national importance. Jamaica became the first Caribbean country to launch U-Report, joining a global movement of more than 5 million U-Reporters. UNAIDS Jamaica recently collaborated with UNICEF to find out what young people know, or don’t, about HIV. The 10-question quiz also provided correct information to the participants.

Almost 2000 young people responded to the survey, with just 214 achieving a perfect score. The quiz pointed to some worrying gaps in knowledge relating to both HIV basics and access to information on HIV prevention. One in 10 respondents mistakenly thought HIV could be transmitted by mosquitoes, for example. Almost one in three were not aware of the local solution for delivering school-based sex education, the Health and Family Life curriculum.

The results of the survey corroborate Jamaica’s most recent Knowledge, Attitude and Behaviour (KAB) survey results and demonstrate that there are still glaring HIV knowledge gaps among young people. The survey revealed that only 33% of young people between the ages of 15 and 24 years correctly identified the ways in which HIV can be transmitted. This was a 6% decline in knowledge levels as compared to the 2012 KAB survey. The 2017 study also found that 40% of respondents with multiple partners did not use a condom during their last sexual encounter.

“The results of the HIV U-Report quiz have reinforced the need for efforts to be made to address the decline in knowledge on information on HIV among young people in Jamaica,” said the UNAIDS Country Director for Jamaica, Manoela Manova. “Particularly in the context of COVID-19, it is critical that we innovate to ensure that this messaging and engagement takes place on digital platforms and with a view to ensuring that no child or young person is left behind.”

The U-Report social messaging tool has proved to be a quick and useful way to gather information that can be used to inform programmes and plans focusing on young people in Jamaica. UNICEF Jamaica has supported innovations to ensure that children and young people have access to education and support during COVID-19, including tele-mental health services, virtual instruction training for teachers and strategies to close the digital divide.

During COVID-19, virtual dialogues and behaviour change communication have been scaled up. A UNICEF-supported initiative aims to address the gaps in HIV and sexual and reproductive health knowledge for young people in Jamaica. The National Family Planning Board’s Adolescent Sexual and Reproductive Health Campaign focuses on teen health, including targeting sexually active teenagers with messages on condom use and dispelling myths about HIV transmission. The campaign disseminates sexual and reproductive health/HIV information through social media and uses animated characters to reach adolescents. The campaign also speaks about the benefits of abstinence and birth control. 

Many people have been able to work from home during the COVID-19 pandemic and continue to be paid, but low-income workers often haven’t had that opportunity.

In Indonesia, the latest labour force survey results show that 29 million workers have been affected by the pandemic, with 24 million workers suffering from cuts in hours of work and income. Average wages were depressed by 5.2% between 2019 and 2020. Surveys conducted by the Indonesia AIDS Coalition show that the situation is similar for people living with HIV and key populations—more than 80% of 529 respondents had experienced a reduction or loss of income due to the pandemic.

To address the rising income inequality, the United Nations allocated a US$ 1.7 million funding package to bolster the economic empowerment of women and vulnerable populations in Indonesia and to help protect their livelihoods from the devastating socioeconomic fallout of the COVID-19 pandemic. In 2020, the UNAIDS Country Office for Indonesia worked with the International Labour Organization, the United Nations Development Programme and the Office of the United Nations High Commissioner for Refugees to mobilize the funding.

A joint project launched earlier this month will directly benefit and empower vulnerable groups, including women, people living with HIV, key populations, refugees, migrant workers and people in disadvantaged regions.

The one-year project offers support through training on entrepreneurship and business development and facilitates access to skills development and jobs. UNAIDS will work closely with civil society organizations to identify the beneficiaries and ensure that people living with HIV and transgender people and other key populations are among the approximately 3650 people to be supported by the project.

The Indonesia Positive Network is among the organizations that will be involved in the project. Meirinda Sebayang, the National Coordinator of the Indonesia Positive Network, appreciates the support of the project. “COVID-19 has amplified existing disparities, especially for the livelihoods of people living with HIV and key populations in Indonesia. In this difficult time, we learned that it is important to build trust and strong collaboration between communities, government, health services and United Nations partners, not only to ensure that essential services remain available but to ensure that our community is not left behind in the response and recovery from the socioeconomic impact of COVID-19,” she said.

The project also includes advocacy for policies that promote inclusion and respond to discrimination in the government, the private sector and trade unions. Through this sensitization and advocacy work, these sectors will be required to protect vulnerable groups from discrimination and exclusion from the job market, even beyond the COVID-19 recovery.

One year into the pandemic, it is crucial that United Nations agencies join forces to support vulnerable groups, which have been disproportionately impacted by COVID-19, in the recovery process.

“Many key populations affected by HIV work in informal settings and were seriously hit by the pandemic. While we may not be able to respond to every single need of the community, we aim to provide an example of how to support vulnerable communities in these stressful and critical times. We believe that through this project many people will receive the direct support and opportunities that are vital for the recovery of their livelihoods,” said Krittayawan Boonto, the UNAIDS Country Director for Indonesia.

The World Health Organization estimates that, globally, more than 1 billion people (15% of the world’s population) have a disability. Disability is increasing in prevalence due to ageing populations, trauma, accidents and chronic health conditions, including HIV, tuberculosis (TB) and COVID-19. 

Persistent discrimination against and exclusion of people with disabilities, in particular women and girls with disabilities, increases their vulnerability, including their risk of HIV infection. People with disabilities, in particular women and girls with disabilities, also experience barriers to accessing HIV services and are left behind in HIV policy-planning, programme development, service delivery and data collection.

People with disabilities face stigma and discrimination in families and communities, lack transport to health-care facilities and are faced with poor attitudes of health workers while seeking health care.

Since 2004, the AIDS Service Organization (TASO), based in the Mulago Hospital Complex in Kampala, Uganda, has attempted to reach out to people with disabilities. However, it has had limited success due to the complexities of community-based care.

In 2016, in response to these challenges, Positive Women with Disabilities (POWODU) was formed out of TASO to pay special attention to people with disabilities living with HIV in order to reduce AIDS- and TB-related deaths, stigma and discrimination and to promote sexual and reproductive health and rights.

POWODU is headed by Betty Kwagala, a formidable advocate, trainer and woman living with HIV who has 25 years’ experience serving as a counsellor at TASO Mulago. Ms Kwagala is a respected and well-known figure in the community, who has uplifted the lives of many people living with HIV in Uganda.

POWODU, in partnership with TASO Mulago, reaches out to people with disabilities in the urban districts of Kampala, Wakiso and Mukono. According to TASO’s client register, there are more than 13 000 people with disabilities in Kampala and Wakiso enrolled into HIV care. Seventy per cent are women and the majority are homeless.

HIV testing and TB screening are integrated into every POWODU community outreach. “The services are always offered near to where people with disabilities reside because of mobility and transport challenges,” says Ms Kwagala.

If a client tests positive for HIV, POWODU offers immediate initiation of HIV treatment, as per the Ministry of Health guidelines. If a sputum TB test is positive, POWODU will refer the case to the main laboratory for further investigation and proper management. POWODU will then follow up, and, with the support of a TB focal person, arrange pick up for the client in a TASO van to escort him or her to receive the appropriate health service.

Other services offered on site by POWODU include sensitization on adherence to both HIV and TB treatment, prevention of HIV, TB and COVID-19 and accurate information on sexual and reproductive health and rights among people with disabilities.

“The COVID-19 pandemic has led to clients who have been lost to follow-up because they are homeless or reside in informal settlements. The lockdown caused more challenges, such as lack of food and a significant disruption to the usual activities that give them some income, such as begging,” says Ms Kwagala.

During the COVID-19 lockdown, UNAIDS supported 200 people with disabilities living with HIV with food rations, personal protective equipment and personal hygiene kits. It also supported a project to equip 40 people with disabilities with skills on how to identify income-generating activities. They were provided with popcorn-making machines and groundnut grinders.

TASO members were provided with megaphones and sensitized members of their communities on HIV, TB, COVID-19, sexual and reproductive health and gender-based violence.

“POWUDU and TASO have shown remarkable resilience by putting people at the centre during the COVID-19 pandemic by ensuring that people with disabilities living with HIV are safe and not left behind,” says Jotham Mubangizi, UNAIDS Country Director, a.i., for Uganda.

After years, their wait is over. The Association des Femmes Amazones Zen (AFAZ) has opened a drop-in centre in Lomé, the capital of Togo, where female sex workers can find refuge and help.

Funded by the United States President’s Emergency Plan for AIDS Relief through the Ending AIDS in West Africa project implemented by FHI 360, the centre opened last October, providing HIV prevention and testing services, the treatment of sexually transmitted infections, care for people living with HIV and assistance to survivors of gender-based violence.

Honorine Têlé Mensah, the coordinator of AFAZ, said that such drop-in centres bring many benefits for the community. The centre provides people with a place where they can listen, receive information and training and meet and share with others. It is a place where they can feel safe and free from discrimination and stigma. “By helping women to speak out and feel confident, we help them set an example for the community. In this way, the centre has an impact on the entire community,” she said.

But she has encountered difficulties. “Some people don’t want to get tested, and we sometimes lack nutritional kits to assist people living with HIV to stay on treatment and items such as reagents for HIV testing. Restrictions due to the COVID-19 pandemic have not helped either.” According to her, funding should be reviewed and the provision of items such as nutritional kits should be taken into account.

“I would like all AFAZ members in Togo to be able to benefit from drop-in centres and care centres like in Lomé,” she said. In the future, she would like the centre to grow. “It would be great if members could benefit from training in entrepreneurship or income-generating activities,” she said.

“Drop-in centers are often the only places where sex workers can access health care, legal advice and other services. They also provide a safe space for sex workers to gather, document abuses and mobilize for their rights,” said Eric Verschueren, UNAIDS Country Director for Togo. “UNAIDS supports the opening of more across the country.”

Located in Bole sub-city, the Bole drop-in centre is one of 12 such centres established in Addis Ababa, Ethiopia, to provide community-based comprehensive HIV services. It provides critical services and support for clients, including female sex workers, and has been a lifeline during the COVID-19 outbreak.

The centre offers a full range of integrated clinical services, including HIV testing and self-testing kits, the provision of oral pre-exposure prophylaxis (PrEP), antiretroviral therapy, the diagnosis and treatment of sexually transmitted infections, screening and referral for the treatment of tuberculosis, cervical cancer screening and treatment, and programmes to prevent and respond to gender-based violence, including access to post-exposure prophylaxis.

The drop-in centre is strategically located in one of the city’s hotspots to cater primarily for female sex workers and their children, young women and adolescent girls who are out of school, and men at higher risk of HIV infection.

It also offers consultations by mobile phone, with 31 cyber-educators trained to provide 15-minute counselling sessions with an accent on the prevention of both HIV and COVID-19. The programme has proved to be invaluable during the COVID-19 pandemic.

“I am truly inspired by the work being carried out at the Bole drop-in centre,” said UNAIDS Executive Director, Winnie Byanyima, when she met staff and clients during her recent visit to Ethiopia. “It is a great example of integrated community-led service delivery and is exactly the kind of programme that is key to ending AIDS as a public health threat by 2030.”

The centre is primarily funded by the United States President’s Emergency Plan for AIDS Relief, through the United States Agency for International Development, while UNAIDS has provided catalytic funding for the cyber-education programme, the promotion of PrEP among vulnerable groups of people and mental health counselling. This support will help to generate the uptake and continuation of needed services during the COVID-19 pandemic. Partners include Population Services International and a local nongovernmental organization called Integrated Service on Health and Development Organization.

As the measures taken to contain COVID-19 continue to bite, the Bole sub-city drop-in centre will remain a critical service for female sex workers and their families.

“During the COVID-19 lockdown, many sex workers found it difficult to work and the drop-in centre has been their only source of food,” said Sister Desta Franso, an antiretroviral provider and counsellor at the clinic.

Up to 20 female sex workers use the centre every day and around 140 women are receiving HIV medication. Treatment retention at around 94% is extremely high.

“I am so happy to be able to come here to get free medication and condoms,” says Mekdes Matiyos, a regular user of the clinic. “I can also just come to take a shower and rest whenever I need to, and I don’t have to pay.”