Treatment coverage among children living with HIV lags behind adult treatment coverage in most of the sub-Saharan African countries with large HIV epidemics. Across all countries, treatment coverage among children living with HIV in 2019 was just 53% [36–64%], representing a global failure to provide life-sustaining care to 840 000 of the 1.8 million [1.3 million–2.2 million] children living with HIV.

As vertical infections decline, the proportion of children aged 5–14 years who are living with HIV has increased. Of the estimated 840 000 children living with HIV not on treatment in 2019, 560 000 of them were between the ages of 5 and 14 years. Efforts to find and treat these undiagnosed children living with HIV must be accelerated. One strategy is to ensure that children who have lost one or both parents to AIDS-related illnesses have been reached by integrating HIV testing services into programmes supporting orphans and other vulnerable children.

In addition, studies indicate that large proportions of people enrolled on HIV treatment have family members, including children, whose HIV status is unknown. Testing those family members through index testing that is rights-based and gender-sensitive can be an effective strategy for identifying older children living with HIV. Index family testing also improves timely linkages to care, with initiation rates of 42–96% reported in various studies. Such family-based approaches also enable parents and their children to access care jointly, which can improve retention.

The Democratic Republic of the Congo has been plagued by political instability since the 1990s and has seen widespread attacks against civilians, violence between ethnic factions, rape and other forms of sexual violence, and murder. Sexual violence against adolescent girls and young women is common.

Violence against women and girls continues to be a global pandemic that affects one in three women in their life. Violence against women is a major factor for contracting HIV—in areas with a high HIV burden, such as sub-Saharan Africa, women subjected to intimate partner violence are 50% more likely to be living with HIV. And men who are perpetrators of violence against women tend to be at a higher risk of HIV themselves and to use condoms less frequently, thus increasing the risk of HIV transmission.

According to the latest Demographic and Health Survey of the Democratic Republic of the Congo, HIV prevalence is three times higher among women aged 15–49 years (1.1%) than among men of the same age (0.4%) and twice as high among young women aged 15–24 years (0.46%) than among young men of the same age (0.22%).

RENADEF (Réseau National des ONG pour le Développement de la Femme), a platform of approximately 350 non-state groups working for women, is tackling this issue front and centre. As a subrecipient of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, RENADEF is running a project to strengthen awareness around sexual and reproductive health and rights, including HIV, to facilitate access to support services and to encourage behaviour change among adolescent girls and young women in 16 HIV high-burden provincial divisions.

In collaboration with health-care providers, almost 200 peer educators and mentors have been trained on sexual and reproductive health and more than 600 educational talks in different settings, including schools and communities, have been facilitated, reaching more than 6500 people, including 2500 girls.

“I was not informed about sexually transmitted infections and their consequences on my life, but I had the chance to participate in an awareness session organized by the peer educators and mentors in my neighbourhood; at the end of the session, I approached one of the sensitizers to explain my problem to her. She gave me advice and referred me to a health training, where I was taken care of for free and I feel good now,” said Nathalie Nyembwe (not her real name), who attended one of the educational talks.

The project also supports clinics giving psychosocial, legal and judicial support to survivors of sexual violence. Since 2018, clinics have been held that have provided psychological support to almost 5500 people and legal/judicial support to more than 3500 survivors of sexual violence.

The community sensitization, capacity-building of legal clinics and support for survivors of sexual violence have contributed to an increase in the reporting of rape.

“It’s particularly important, particularly as we reflect on our experience with COVID-19, that we acknowledge the important role that women have played to protect others from violence, to ensure continued support to vulnerable families and to ensure access to food and medicine. Women have provided invaluable support to keep people connected to neighbours, services and information, all the while ensuring that homes remain a safe space for children and families to continue to learn and grow socially,” said Susan Kasedde, the UNAIDS Country Director for the Democratic Republic of the Congo.

As a champion country of the Global Partnership for Action to Eliminate all Forms of HIV-Related Discrimination, the Democratic Republic of the Congo has a unique opportunity to strengthen its implementation of coordinated, comprehensive and scaled-up action involving a range of stakeholders and to build synergies on action on gender equality across sectors. 

US, UK and EU blocking proposals at WTO to help poorer countries get vaccines more quickly

One year on from the declaration of the COVID-19 pandemic, the People’s Vaccine Alliance is warning that developing countries are facing critical shortages of oxygen and medical supplies to cope with COVID-19 cases yet the majority have been unable to administer a single dose of a COVID-19 vaccine. In contrast rich nations have vaccinated their citizens at a rate of one person per second over the last month.

Many of these rich nations, including the US, UK and EU, are blocking a proposal by over 100 developing countries to be discussed at the World Trade Organisation (WTO) today, which would override the monopolies held by pharmaceutical companies and allow an urgently needed scale up in the production of safe and effective COVID-19 vaccines to ensure poorer countries get access to the doses they desperately need.

While more poor countries will see the arrival of doses in the coming days from the World Health Organisation’s COVAX facility, the amounts available mean only three per cent of people in those countries can hope to be vaccinated by mid-year, and only one fifth at best by the end of 2021.

Almost one million people worldwide have signed a call by the People’s Vaccine Alliance – a group of campaigning organisations including Oxfam, Frontline AIDS, UNAIDS, Global Justice Now and the Yunus Centre – for rich nations to stop protecting big pharma monopolies and profits over people’s lives. On 11 March protests will take place outside pharmaceutical headquarters as part of a global day of action by activists across the world.

Recent public opinion polls carried out by YouGov for the Alliance in the US, France, Germany and the UK found that on average, across these countries, more than two-thirds (69 per cent) of people thought that governments should ensure vaccine science and know-how is shared with qualified manufacturers around the world rather than remaining the exclusive property of a handful of pharmaceutical giants and that vaccine developers should be adequately compensated for this.

Oxfam International’s Executive Director, Gabriela Bucher, said: “Around the world, two and a half million lives have already been lost due to this brutal disease and many countries are battling without adequate medical care and no vaccines. By allowing a small group of pharmaceutical companies to decide who lives and who dies, rich nations are prolonging this unprecedented global health emergency and putting countless more lives on the line. At this crucial time, developing countries need support – not opposition.”

The Alliance warned that in South Africa, Malawi and other African nations history is in danger of repeating itself. Millions of people died in the early 2000’s because pharmaceutical monopolies had priced successful treatments for HIV/AIDS out of reach at up to $10,000 a year.   

Lois Chingandu, activist and Director of Evidence and Influence at Frontline AIDS, said: “Here in Zimbabwe, I have lost many dear friends, struggling to breathe in their last moments. It is a cruel irony that activists who fought tirelessly for free medicines for HIV/AIDS are now being killed by COVID-19 because, yet again, pharma profits are being put ahead of people’s lives.”

Pharma monopolies were eventually overruled allowing the mass production of cheap effective treatment for those living with HIV/AIDS, meaning millions of people are alive today who would otherwise have perished.

On 10-11 March, more than 100 developing countries, led by South Africa and India will again make the case at the WTO for a waiver of Trade-Related Aspects of Intellectual Property (TRIPS), which would remove legal barriers for more countries and manufacturers to produce the vaccines, protect their people and join the economic recovery ahead.

Nobel Laureate Professor Muhammad Yunus, one of the leaders of the People’s Vaccine Alliance said: “For the rich world, this proposed act of human solidarity to ensure that medicines and vaccines get to the whole human family simultaneously is in their own self-interest, not just an act of charity.

“We should act now. There is no going back. It is totally unfair that rich countries, who have enough vaccines to protect their citizens, are blocking the TRIPS waiver, which could help poorer countries get the vaccines they need.”

All the leading vaccine developers have benefited from billions of dollars in public subsidies, yet pharmaceutical corporations have been handed the monopoly rights to produce and profit from them.

At the same time qualified vaccine producers all over the world stand ready to produce more vaccines if they were allowed access to the technology and know-how now being held under lock and key by these companies. New capacity could be brought on stream within months. Suhaib Siddiqi, former director of chemistry at Moderna, producer of one of the first approved vaccines, said that with the blueprint and technical advice, a modern factory should be able to produce vaccines in at most three to four months.

France has called for the expansion of production in developing countries, and the US has moved to achieve the same domestically. But so far both countries continue to defend the monopolies of pharma corporations. 

To control the virus, enough doses of vaccines need to be produced in different geographies, priced affordably, allocated globally and widely deployed for free in local communities. Thus far, the world is failing on all four fronts.

Winnie Byanyima, Executive Director UNAIDS, said: “Amid so much personal selflessness, sacrifice and heroism, the People’s Vaccine Alliance denounces the hypocrisy, emptiness of human solidarity and myopic self-interest that defeats efforts to control the virus in countries. Only a truly global mobilization of vaccine production to rapidly scale-up the total number of low-cost doses available will get the job done.”

Nick Dearden, Director of Global Justice Now, said: “One year into the global pandemic, it’s an outrage that vaccine factories are lying idle, unable to produce COVID-19 vaccines because rich countries are prioritising the patents of pharmaceutical companies ahead of the lives of people across the world. A global suspension of patents is needed to speed up the production of these vaccines everywhere.”

Notes to editors:

• Drawing on data from OurWorldInData, Bloomberg, John Hopkins University and additional searches, of the 79 low and lower-middle income countries, as classified by the World Bank, the majority (at least 47 countries) are yet to vaccinate anyone. This figure is accurate as of 4 March and factors in reported planned deliveries of COVAX vaccines in the coming days even if vaccines are yet to be administered. We recognise that more unreported COVAX shipments may arrive in the interim.
• Since the start of 2021 high income countries have on average vaccinated citizens at a rate of one dose per second. This is based on the average daily COVID-19 vaccination doses administered between 1 January and 2 March 2021 and was drawn from OurWorldInData for countries classified as ‘High Income’ by the World Bank. An hourly rate was calculated by assuming countries are vaccinating 8 hours per day which was then divided into minutes and seconds. The average of these per second rates for these 68 high income countries was then calculated at 1.1 doses per second or 66 per minute. The average figure includes six High Income countries that have not yet begun vaccinating citizens.
• The YouGov poll results for the individual countries were: US – 69 per cent, France - 63 per cent, Germany 70 per cent and the UK 74 per cent, which gives a combined average across the countries of 69 per cent. All figures, unless otherwise stated, are from YouGov Plc.  Total sample size was 1,351 adults in the US, 1788 adults in the UK, 1010 adults in France and 2039 adults in Germany. Fieldwork was undertaken between 23 – 26 February 2021.  The survey was carried out online. The figures have been weighted and are representative of all adults (aged 18+) in each individual country of the US, UK, France and Germany.
• Last week, The Associated Press found factories on three continents whose owners said they could begin producing hundreds of millions of doses of COVID-19 vaccines on short notice, if only they had the blueprints and technical know how to do so.
• Countries like South Sudan, Yemen and Malawi have seen dramatic surges in cases in recent months. Malawi saw a 9500 per cent increase in cases as the South African mutation spread through the country and two of their cabinet ministers died in one day.

“It was hard for us before COVID-19, but it has become even harder now,” said Ayu Oktariani, the National Coordinator of the Indonesia Positive Network of Women Living with HIV (IPPI). For more than 10 years, she has been working with women and adolescents living with HIV who have been subjected to domestic violence in Indonesia, providing them with psychosocial support and counselling. Since the first COVID-19 outbreak, she has seen increased requests for help, as violence has escalated alarmingly.

Even before the COVID-19 pandemic, domestic violence was already one of the most significant human rights violations, but the pandemic has made a challenging situation even worse. Confinement is increasing the stress caused by security, health and money worries and is increasing the isolation of women with violent partners, separating them from the people and resources that can best help them.

According to a survey conducted by the International Community of Women Living with HIV in Asia and the Pacific (ICWAP) with support from the UNAIDS Regional Support Team for Asia and the Pacific, in June 2020 almost 30% of the respondents experienced some form of gender-based violence, including stigma and discrimination. In addition, more than 80% reported a lack of access to sexual and reproductive health services, including contraception.

In Indonesia, a report released by the National Commission on Violence against Women shows that the number of reported cases of violence against women living with HIV has significantly increased during the pandemic. “A few months ago, I was contacted by a woman living in a rural area, who was forced by her husband to have regular unprotected sex. She was unable to negotiate the use of condoms because of fear of violence,” said Ms Oktariani.

With other organizations in Indonesia, IPPI is developing a referral system that will guide women living with HIV who have been subjected to violence to women-led organization for legal advice and support. IPPI is also part of a national coalition that connects women and girls, including women living with HIV, to emergency services, including the police and justice and social services.

In Nepal, women living with HIV are faced with similar ordeals as a result of the COVID-19 pandemic. Sara Thapa Magar, the President of the National Federation of Women Living with HIV and AIDS (NFWLHA), Nepal, reflects on Lily’s (not her real name) story, a woman living with HIV who was beaten by her husband after she went to the local hospital to get refills of her antiretroviral therapy. The current circumstances, including limitations on access to helplines and disrupted public services, have made reporting of abuse and violence even harder.

NFWLHA has played a critical role in addressing these challenges by offering legal support to women like Lily subjected to domestic violence and providing relief packages to women and children living with HIV. “Despite these efforts, we are struggling to cope with the knock-on effects of the pandemic, and one of the main reasons is the lack of funds,” said Ms Magar. “Women-led organizations need to be continuously supported in our frontline role.”

Kousalya Periasamy, the founder of the Positive Women Network (PWN+), explains the multiple impacts of COVID-19 on the life of women living with HIV in India. “Many women and girls were afraid of going to the hospital to get their antiretroviral therapy refill and access general health services out of fear of COVID-19,” said Ms Periasamy. “Women living with HIV who had COVID-19 were not able to provide for and look after children if they had to be admitted into the hospital.” Given the need to communicate with local network partners and members, PWN+ established a WhatsApp group to ensure that women living with HIV had access to reliable information on HIV and COVID-19. PWN+ also mobilized support from different local organizations to donate food and supplies and handed out pamphlets containing HIV and COVID-19 information.

Sarah Feagan, a Board Member of ICWAP, works for a local agency in Australia, Living Positive Victoria (LPV). During the lockdown in Melbourne, “I worked to ensure women living with HIV remained connected and supported during COVID-19. Since I could not meet anyone in person, I kept in touch on the phone, linking them together via online workshops and other women living in similar areas to meet up without breaking the 5 km rule,” she said. She was able to offer financial support, food parcels and legal and emotional support thanks to LPV and other HIV organizations.

“On International Women’s Day, we commend all our sisters across Asia and the Pacific, who, like Ayu, Sara Thapa, Sarah and Kousalya, are establishing supportive mechanisms for women and girls living with HIV, even in the face of adversities,” said Sita Shahi, ICWAP Regional Coordinator.

During the COVID-19 pandemic, the UNAIDS Regional Support Team for Asia and the Pacific has joined hands with ICWAP to raise awareness about the needs and challenges of women living with HIV and to support the implementation of small local relief projects in Nepal, Malaysia and India. “COVID-19 is already testing us in ways most of us have never previously experienced. We must emerge renewed, with women living with HIV as a powerful force at the centre of the recovery,” said Eamonn Murphy, Director of the UNAIDS Regional Support Team for Asia and the Pacific.

Ingrid Bretón learned that she was living with HIV when she was 19 years old. It was 1994 and HIV treatment was not yet available in the Dominican Republic.

“I lasted almost five years alive, but dead inside,” she remembers. “I went through every denial process that a newly diagnosed person goes through. Health centres did not want to assist me. I lived every kind of stigma and discrimination.”

In her town, La Romana, she was known as “the AIDS girl”.  It was impossible to find work.  

HIV treatment helped changed the trajectory of her life. With the guidance of her doctor, José Román, she became the first woman living with HIV in La Romana known to have given birth to an HIV-free baby. As she continued treatment it occurred to her that she was perfectly healthy and could live a more meaningful life.

“I thought to myself, “I am not getting sick, my hair is not falling off, I do not have sores, I do not have AIDS. I want to do things,”” Ms Bretón remembers.

In 2002 she formed the Paloma Group Foundation (La Fundación Grupo Paloma), which provides psychosocial support, legal assistance and job opportunities for people living with and affected by HIV in the eastern region of the country. The organization also plays a key advocacy role, bringing visibility to issues such as treatment adherence, prevention and stigma and discrimination.

One of the foundation’s innovations is an agriculture project that employs people living with HIV.

“It’s a beautiful process,” Ms Bretón says while walking through the sunny, red earth fields, past tomatoes, papayas and bananas. “The idea is that people living with HIV are able to move forward, working and providing for their families.”

The families with whom the Paloma Group Foundation works have been directly affected by the COVID-19 pandemic. The work of the foundation has been critical during this time. Its volunteers do home deliveries of food, medicine and clothing. The foundation is a source of connection and emotional support at a time when communities living with HIV are more isolated than ever due to social distancing measures.

The first Rapid Survey on the Needs of People Living with HIV in the Dominican Republic in the context of COVID-19 found that while 92% of respondents received their antiretroviral therapy, roughly one in six had less than one month’s supply left. Thanks to the advocacy of the UNAIDS Country Office for the Dominican Republic, protocols have now been amended so that people living with HIV and accessing treatment through the public health system can receive a three- to six-month supply of their medicine at one time.

The country office has urged the government to strengthen comprehensive care programmes, including through alliances with civil society. For example, the Paloma Group Foundation provided assistance to people living with HIV at the Francisco Gonzalvo Provincial Hospital during a five-month period in 2020 when medical personnel were not available at the La Romana facility.

The UNAIDS Country Office for the Dominican Republic has also called for particular attention to be given to the social protection and food security needs of people living with HIV who are in economically fragile situations. The office responded quickly to the fallout of COVID-19, offering support to the Paloma Group Foundation and other community organizations contributing to the national HIV response. UNAIDS’ comprehensive response included the provision of personal protective equipment and information specifically for the community of people living with HIV. The second stage of their response included mobilization of nutrition support.

“This was of great value to families given the economic crisis caused by COVID-19,” Ms Bretón says.

“Civil society plays the leading role of bringing awareness to communities and advocating on their behalf,” says the UNAIDS Country Director for the Dominican Republic, Bethania Betances. “As we respond to two pandemics—HIV and COVID-19—is it vital that they are at the decision-making table to help shape an effective, humane response.”

Watch: The extraordinary story of a woman living with HIV in the Dominican Republic

The Network of People Living with HIV in Senegal (RNP+) marked Zero Discrimination Day 2021 by hosting a dialogue on the extent and impacts of the stigma and discrimination faced by women and girls living with HIV in Senegal—a country in which the 2017 People Living with HIV Stigma Index showed one in two people living with HIV experienced stigma and/or discrimination from others.

“Discrimination continues to affect women and girls and this is the reason why they are often excluded from the labour market, are isolated in their communities or experience stigma in health centres. Key populations are also historically the target of discrimination in Senegal,” said Soukèye Ndiaye, the President of RNP+.

Various assessments undertaken in the country have revealed that women living with HIV face obstacles in accessing reproductive health services, that sex workers face high levels of stigma in health-care settings and that the economic and social vulnerability of women living with HIV is not sufficiently taken into account in HIV programmes.

This dialogue served as the spearhead for the advocacy strategy that RNP+ will develop this year on human rights and gender issues in order to better respond to the expectations of its members and communities affected by HIV. This strategy will be accompanied by communication tools such as videos in several local languages and dialogue and sensitization sessions with key actors in the regions most affected by HIV.

During the dialogue, the participants were invited to support the RNP+ in this process. In particular, they were asked to become “champions” committed to making a better use of journalists, community radio and social networks to sensitize the general public to the challenges of discrimination.

Abdoulaye Ka, in charge of human rights issues at the National AIDS Control Council (CNLS), recalled the importance of continued collaboration between the state and non-state sectors. “Community organizations and networks have long been essential in the fight against AIDS because of their central role in raising awareness, informing, dispelling myths and misinformation and providing services to marginalized, vulnerable and discriminated against populations.”

The dialogue, which was supported by UNAIDS, brought together about 30 participants, including people living with HIV, representatives of women’s movements and key populations, human rights advocates, policymakers and health service providers in a meeting held both virtually and physically.

“In Senegal, we know that discrimination against people living with HIV is still a major stumbling block in all aspects of the HIV response. The United Nations Joint Team on AIDS has always placed human rights and gender considerations at the centre of its work and support,” said Demba Kone, the UNAIDS Country Director for Senegal.

On 1 March, people around the world join together to celebrate Zero Discrimination Day, which this year highlighted the urgent need to take action to end inequalities.

In recent years, the Central African Republic has made the reduction of health inequalities a national priority. In mid-2019, 10 priority areas towards universal health coverage were established. These include the objective of ensuring that every citizen in the country has access to a health centre within 5 km of his or her home.

The country was the first to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, which through harnessing the combined power of, and using the unique skills of, governments, civil society and the United Nations aims to consign HIV-related stigma and discrimination to history.

To mark Zero Discrimination Day this year, the country organized several activities ahead of and during the day. A declaration recalling the government’s commitment to non-discrimination and equality was issued by the Minister of Health and Population on television and radio. “It is only by addressing inequalities that we can achieve the Sustainable Development Goals, including those related to well-being and health for all,” said Pierre Somse, the Minister of Health and Population.

Recent studies show that inequality and stigma are major obstacles to access to health services. For example, more than 80% of people living with HIV in the country report having experienced discrimination or stigma. “These challenges are further compounded by conflicts and attacks on populations and health personnel that deprive hundreds of thousands of our citizens of their rights, including the right to life, dignity and health,” Mr Somse added.

A civil society consultation was organized to flesh out the priorities for the elimination of stigma and discrimination in the country. A round-table meeting was also held on a national network of human rights journalists radio programme to raise awareness on the negative impact of stigma and discrimination as a major barrier to people taking up HIV prevention, treatment, care and support services. Speaking on the programme, Aminata Adoum, of the National Association of Women Lawyers, highlighted the work of her organization in supporting women living with HIV against discrimination and violence.

On Zero Discrimination Day 2020, health professionals, including professional organizations of doctors, nurses and midwives, as well as patients’ associations, signed a National Charter for Quality of Care and Patients’ Rights that sets the principles of humanism, ethics and respect for dignity to guide relations between patients and health-care providers. This year, the patients’ charter was posted in health facilities in the capital city, Bangui, and dedicated sensitization sessions on the charter took place for medical staff in two major health-care centres in the capital.

“This Zero Discrimination Day campaign is part of a comprehensive set of priority activities to address human rights barriers to HIV services that the country will be implementing over the next three years, including community-led monitoring of human rights violations, know your rights education, legal services, the development of anti-discrimination law and engagement with community leaders, legislators and opinion-makers,” said Patrick Eba, the UNAIDS Country Director for the Central African Republic.

When the COVID-19 pandemic broke out in Phnom Penh, Em Ra, pictured above, was worried.

She lives with HIV and she only had supplies of medicine to last a month.

“First, I was afraid that the medicine could not be shipped to Cambodia, the second is that when we don’t have medicine for a few months we have to come to the clinic often,” she said. “This increases my expenses but also raises my chances of getting COVID-19.”

During a recent visit to the National Center for HIV/AIDS, Dermatology and STDs (NCHADS) clinic, her doctor, Prak Narom, informed her that she would qualify for multimonth dispensing of HIV treatment. “Because of COVID-19, a patient in good health who takes their treatment daily can be prescribed HIV medicine for more than three months, and for some patients we can give them up to six months,” he explained.

Ms Ra is one of thousands in Cambodia who can now pick up a stock of medicine in one visit. There are an estimated 73 000 people living with HIV in Cambodia and now nearly 50% of people on treatment have access to multimonth dispensing of HIV treatment. Before the pandemic, that number stood at 34%.

The multimonth dispensing of HIV treatment programme in Cambodia began in 2019, long before the COVID-19 pandemic, but it has proven to be a godsend.

“When we started multimonth dispensing, there were some challenges because we had a shortage of drugs, but today we have overcome that so we can give medicine to people for up to six months,” said Ly Penh Sun, Director of NCHADS, pictured above.

The UNAIDS Country Director for Cambodia, Vladanka Andreeva, had feared the worse when COVID-19 shut down the country. “The biggest and oldest HIV treatment site in the capital was repurposed to serve as a COVID-19 centre and our outreach activities had to cease with public venues closed to the public.”

But UNAIDS, with the national AIDS programme and communities, worked together and helped with moving people to another treatment site, while providing face coverings and hand sanitizer to people living with HIV. UNAIDS also advocated that people living with HIV be integrated in the emergency cash transfer programme. As a result, more than 2500 households benefitted.

And more importantly, UNAIDS and partners pushed to introduce the home delivery of treatment and the rollout of multimonth dispensing of HIV medicine at the national level.

“We have used COVID-19 as an accelerator to further scale up and promote the multimonth dispensing of medicine,” Ms Andreeva said, pictured above.

It has been so successful that Mr Narom can’t believe it.

“In the past we used to see 30 patients in the morning, but now with multimonth dispensing we can reduce that by half or more than half,” he said. “I can now spend more time with my patients and carry out more in-depth check-ups.”

When a person is unable to take antiretroviral therapy regularly, their viral load increases, impacting the person’s health, which can ultimately lead to death. Even relatively short-term interruptions to HIV treatment can have a significant negative impact on a person’s health and potential to transmit HIV.

UNAIDS is advocating that all countries, ministries of health and national AIDS programmes grant access to three months or more of antiretroviral therapy for all people living with HIV, including refugees and migrants.

As for Ms Ra, she has joined a Telegram group started by the clinic for people living with HIV in case they have questions about their health or their medicine.

Watch: COVID-19 spurs on multimonth dispensing of HIV treatment in Cambodia

Photo credit: UNAIDS/S.Dara

Faith-based organizations play a key role in all areas of the HIV response and provide a significant part of HIV-related health care through their networks of hospitals, clinics and community systems, particularly in high-burden countries. For this reason, UNAIDS and the United States President’s Emergency Plan for AIDS Relief (PEPFAR) launched a joint initiative to capitalize on the global and national leadership of faith-based organizations and to harness the power that a network of faith-based organizations could offer in some countries, including Côte d’Ivoire.

The UNAIDS–PEPFAR faith-based initiative was launched in Côte d’Ivoire on 14 October 2020 under the leadership of the Ministry of Health and Public Hygiene through the national AIDS control programme.

Following the national launch, several activities were initiated in the country as part of the initiative. These include the ongoing development of the Faith-Based Action Plan, under the leadership of the national AIDS control programme, which aims to ensure effective coordination and close monitoring of programmes, as well as synergy and complementarity in their implementation.

Caritas Côte d’Ivoire, which is a member of Caritas Internationalis, the organization in charge of implementing the social doctrine of the Catholic Church at the global and country levels, launched the GRAIL (Galvanizing Religious Actors for Better Identification and Linkage to Paediatric HIV) project on 9 February. This project will strengthen the involvement of faith-based organizations in accelerating the early diagnosis and treatment of children living with HIV in Côte d’Ivoire.

During the launch of the GRAIL project, a representative of the Ministry of Health and Public Hygiene welcomed the commitment of the Catholic Church in the national response to HIV and recalled the place of paediatric AIDS in national priorities.

“The COVID-19 pandemic that we are facing is a very worrying health and social emergency that requires a strong response. Many of the people affected are children living with HIV,” said Bruno Yedoh Essoh, the President of Caritas Côte d’Ivoire.

“Gaps in the diagnosis and care of children living with HIV are notable and an effective national partnership with faith-based organizations in Côte d’Ivoire can help fill these gaps,” said Jean-François Somé, a UNAIDS PEPFAR/Global Fund to Fight AIDS, Tuberculosis and Malaria Implementation Adviser who represented UNAIDS at the launch.

The GRAIL project will focus on training religious leaders and faith-based health service providers on paediatric HIV and on actions to reduce stigma and discrimination against people living with HIV, including children. The first session of a training workshop for religious leaders and faith-based health service providers on paediatric AIDS started immediately after the launch of the GRAIL project. Other training sessions are planned around the country.

Malohat Sharipova, pictured above, teaches in a primary school in Bohtar, Tajikistan, but in her spare time she works as an outreach worker for AFIF, a nongovernmental organization that helps people living with HIV, tuberculosis and key populations.

AFIF works closely with the regional AIDS clinics, providing outreach workers who support and work with people living with and affected by HIV. During the COVID-19 pandemic, AFIF’s outreach workers have provided people living with HIV with three-month supplies of antiretroviral medicines, food and personal protective equipment, including antiseptic, masks and gloves.

The outreach workers are trained to carry out screening to detect tuberculosis and hepatitis in people living with HIV and injecting drug users. “It is necessary to ask 10 to 12 questions on HIV and tuberculosis developed by specialists to determine the need for further diagnosis. If there are symptoms, a person is advised to undergo timely testing, either at the nearest medical centre or using a kit for self-testing, which we provide,” said Ikram Ibragimov, the Director of AFIF.

AFIF’s activities are supported by the Ministry of Health of Tajikistan and conducted within the UNAIDS Regional Cooperation Programme for Technical Assistance for HIV and Other Infectious Diseases in the Commonwealth of Independent States, funded by the Russian Federation. Since the beginning of the project in 2019, about 7500 people have undergone community-based testing.

Ms Sharipova has four children, two daughters who are married and have left home, an older son who works in another city and her youngest son, who is in the 11th grade in school.

“In 2010, my husband was admitted to hospital. Before that, he had been complaining of abdominal pain for a long time. I tried to persuade him to visit a doctor, but he didn’t. He was hospitalized when it got bad, was diagnosed with liver cirrhosis and died soon after. I got a call from the hospital, and they told me to get tested for HIV.”

“When they told me that I had HIV, I thought, “Thank God I'm still alive, I can walk and work.” After my husband’s death I needed to raise my children, support my mother-in-law, who I loved like a mother.”

She has been taking antiretroviral therapy since 2010. “I feel fine. Previously, it was necessary to take the pills strictly twice a day. Now doctors have prescribed a different scheme, so I can take medicine only once a day. I need to stay healthy for my children and be able to help them. I do not talk widely about my diagnosis, but I don’t hide it. I think I was seen by many at HIV prevention events and trainings.”

Ms Sharipova leads a group for women—“We have female consultants working with women and men work with men. When people first learn about their HIV-positive status, they usually feel confused and scared, do not know what to do next. We talk to them, invite them to our self-help groups, explain the therapy, the future. Sometimes it is challenging to work with them, but I always say: we must move forward, only forward.”

Photography: Nazim Kalandarov/UNAIDS