As the Global Fund to fight AIDS, Tuberculosis and Malaria—one of the main donors for the HIV response in the last 20 years in Eastern Europe and Central Asia (EECA)—is moving away from funding the HIV response in EECA, the region is looking for ways to invest their available domestic resources in a much more cost-effective way.

“There are purely epidemiologic and economic arguments behind this transition,” said Dumitru Laticevschi, Regional Manager Eastern Europe and Central Asia Team, The Global Fund. “The economies here are considerably better for the same level of disease burden than the average in the world, that’s why it is expected that the region increasingly takes care of the epidemic by itself.”

The key challenge for the Global Fund, UNAIDS and other partners is to strengthen national responses and “to squeeze the problem to a size that is manageable for the governments to take over,” added Mr Laticevschi.

A series of HIV allocative efficiency studies conducted in 2014 in the region with support from the World Bank, UNAIDS Secretariat and some cosponsors, the Global Fund, USAID/PEPFAR and other partners, recommended countries to prioritize investment in the most cost-effective interventions to maximize health outcomes, including updating HIV testing and treatment protocols, reducing treatment costs, and optimizing service delivery. The studies were based on the Optima HIV mathematical modelling approach which has been applied in over 60 countries globally to help support HIV-related investment choices.

Recently, a new wave of the allocative studies was concluded in 11 countries of the region (Armenia, Azerbaijan, Belarus, Georgia, Kazakhstan, Kyrgyzstan, Moldova, Romania, Tajikistan, Ukraine, and Uzbekistan). Individual reports with a set of recommendations for each country, as well as a regional report with aggregated results from the eleven-country analysis are available here.

“We provided the technical support for these analyses,” said Sherrie Kelly, Team Lead HIV, TB, and Malaria Applications, Burnet Institute who supported the 2014 and 2019 studies in EECA. “We have the models in place and work with the national teams. The countries are the owners of the projects, data, and results. We are just the mathematical modelers.”

The modeling is informed by demographic, epidemiological, behavioural and other data, as well as expenditure estimates provided by national teams and available in the literature. The epidemic model is overlaid with a programmatic costing component and a resource optimization algorithm. Results are intensively discussed and validated by national teams and key stakeholders from respective countries. The UNAIDS Secretariat facilitated the entire process to ensure the capacity of national partners to facilitate optimized health spending was strengthened.

“We hope that the recommendations from the study will help our national partners to adjust National Strategic Plans and to focus on the most efficient, cost-saving interventions with maximum health outcomes and will not only save money, but will save people’s lives,” said Alexander Goliusov, UNAIDS Regional Director in EECA a.i..

Since the beginning, faith-based organizations (FBOs) have played an important role in the response to the HIV epidemic through their strong links with communities on the ground and their broad network of hospitals, clinics and other health facilities.

However, to unleash the full potential of these organizations, there is still a need to reinforce their capacities to adopt new policies and innovations, to improve their collaboration and coordination with partners in the HIV response and to further address HIV-related stigma and discrimination within faith communities.

The 2015 Lancet Special Edition on faith and health care highlighted two challenges:

• a lack of solid evidence about the scale, scope, reach, quality and effectiveness of FBO health service provision;
• significant gaps between certain aspects of faith and rights-based approaches to health care.

To address these challenges, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and UNAIDS in 2016 launched a two-year initiative to strengthen the capacity of faith-based leaders and organizations to advocate for and deliver sustainable HIV responses.

The new initiative

The new PEPFAR-UNAIDS initiative, launched in June 2020, aims to leverage global and country leadership by FBOs in the HIV response. It will build on achievements, results and lessons learned, maximising the use of capacity-building tools and resources developed from previous programmes.  

The initiative is designed as a consortium of longstanding FBO partners, working together to build and combine their strengths, promote evidence-based policy and practice and strengthen advocacy efforts.

“More than ever, it is important that faith communities and leaders are strong voices for people,” says Shannon Hader, UNAIDS Deputy Executive Director, Programme. “This means, in a time of COVID-19, recognizing that a call to action on COVID-19 and a call to action on HIV should be complementary and synergistic—they are not in opposition to each other. We will rely on faith partners to be strong and true voices of support for people living with HIV.”

Implementing partners and focus countries

All implementing partners have a solid track record of successfully implementing HIV-related activities; of partnership with UNAIDS and PEPFAR; and of working with inter-faith partners globally and at country level:

The implementing partners are:

• Academic Consortium led by St Paul’s University (Limuru, Kenya);
• African Christian Health Association Platform;
• Caritas Internationalis;
• Inter-Faith Network of Religious Leaders Living with or Personally Affected by HIV (INERELA+);
• Islamic Relief Worldwide;
• World Council of Churches – Ecumenical Advocacy Alliance;
• World Council of Churches – Ecumenical HIV and AIDS Initiatives and Advocacy.

Country-level activities will be carried out in Cameroon, Cote d’Ivoire, Democratic Republic of Congo, Kenya, Nigeria, the United Republic of Tanzania, Uganda and Zambia.

FBOs will align their activities to Faith Action Plans in support of national HIV response strategies. Experience shows that such an alignment results in a better coordinated and sustained participation of the faith sector in national responses to HIV.

“Our ability to partner with faith communities is part of a sustainable approach to address both HIV and COVID-19,” says Sandra Thurman, Chief Strategy Officer at PEPFAR.

Global level activities are aimed at increasing collaboration, visibility, and coordination of the contribution of faith-based organizations to the HIV response. Events will include an HIV Interfaith Conference on the theme of Resilience and Renewal (22-24 September 2020), implementation of the commitments made in the Rome Action Plan on Paediatric HIV, and the engagement of faith partners in the development of the new UNAIDS global strategy.

Adrian Jjuuko heads up the team at Human Rights Awareness and Promotion Forum (HRAPF) in Kampala, Uganda.

He is the dictionary definition of an ally—a heterosexual lawyer who defends people who live on the margins of Ugandan society: lesbian, gay, bisexual, transgender and intersex (LGBTI) people, sex workers, refugees, people who use drugs and women who are survivors of domestic violence.

Mr Jjuuko founded HRAPF in 2008 to create awareness of human rights and provide legal support to marginalized people, mostly members of the LGBTI community.

“This is not the favoured job of a lawyer in Uganda,” he laughed. “When young graduates come out of law school, most would choose commercial litigation. I chose this. I chose it because I love it,” he added.

HRAPF started out as an organization that represented marginalized people but increasingly took on cases from members of the LGBTI community. Mr Jjuuko said that this is because, in Uganda, LGBTI people “are generally not treated like citizens with rights—not by law, culture or religion.”

Because of the stigma around the work that HRAPF does, “other lawyers don’t think we are real lawyers,” said Mr Jjuuko. “You live with the professional discrimination,” he sighed.

Uganda is one of 13 countries in the eastern and southern African region that criminalizes same-sex sexual relations. Under the Penal Code, “carnal knowledge against the order of nature” between two males carries a potential penalty of life imprisonment.

Evidence shows that the more marginalized, stigmatized and criminalized people are, the higher their vulnerability to HIV and violence.

Roughly one quarter of the 580 000 new HIV infections in the region in 2019 were among key populations and their sexual partners.

In sub-Saharan Africa, one in three transgender women have been attacked and 28% raped at least once in their life.

HRAPF represented the 14 gay men, two bisexual men and four transgender women (known as the COSF20) who were arrested in late March 2020 when police raided the Children of the Sun Foundation premises, an LGBTI shelter on the outskirts of Kampala. They were between the ages of 18 and 25 years and had been thrown out of their homes because of their sexual orientation and/or gender identify.

Police said the young people were violating social distancing rules that banned gatherings of more than 10 people in public spaces, restrictions imposed due to the lockdown in response to the COVID-19 outbreak.

However, they were not in a public place, but the place they called home.

Mr Jjuuko said this is one of many cases where COVID-19 restrictions are being used to violate human rights. The young people were arrested on the site on the suspicion of homosexuality and the charge was later changed at the police station to take advantage of the government restrictions.

It took Mr Jjuuko and his colleagues 43 days of applications, letters, meetings and court dates for HRAPF to be granted access to their clients; another two to actually see them; another five to get the charges dropped and the first 19 released, and yet another seven days for the final detainee to be released.

Mr Jjuuko and his colleagues had to hitch rides on cargo trucks en route to the prison, and use motorbikes and bicycles, to access their clients because of the restrictions placed on the operation of motor vehicles during the lockdown.

During the 50 days they spent in jail, the young people were subjected to gross human rights violations, such as beatings with wire, burning with pieces of firewood between their thighs, and, in one instance, an anal examination in a bid to “prove” homosexuality.

This is not the end, said Mr Jjuuko. HRAPF wants the prison authorities to dismiss the staff who perpetrated the violations and damages paid to the young men and women.

HRAPF’s work has turned from legal aid to humanitarian assistance, said Mr Jjuuko. The young people need food. A place to stay. It’s not enough to get them out of jail when they have no means and nowhere to go.

“The reason we do this is because no one else is doing it. There are basically no other legal aid service providers for LGBTI people. That is a feeling of contribution that you can’t take away.”

COVID-19 has made things even more difficult.

“We all need to come together and fight COVID-19 but we must not forget about marginalization and discrimination. How can we tailor our support to marginalized people? How do we protect people’s rights … think about people who need access to medicine and people who can’t use public transport? We need to think about the multiple dimensions of vulnerability,” he said.

UNAIDS continues to support the work of HRAPF to advance human rights and the right to health among key populations in Uganda. In 2020, it provided technical and financial support for a six-month project, which included sensitization meetings on HIV and human rights for key population groups from civil society, including information on the provision of free legal services to members of the community who are detained.

On the consequences of his work on his life, Mr Jjuuko shrugged and said, “It doesn’t matter. You just learn to live with it.” And in the same breath, he added,” As a lawyer, you must fight like a gladiator for your client to be protected.”

The National Department of Health has launched the first-ever virtual training for prescribers of antiretroviral therapy in Papua New Guinea. Using Google Classroom, 21 video lectures with a total of more than six hours of content, covering HIV treatment, care and service delivery guidelines, as well as monitoring and evaluation tools, are provided to the learners. The content includes video lectures and associated assessment materials, which have to be completed within seven days after enrolment.

Thirty days since the launch, 105 participants have been successfully enrolled, of whom 70% had been unable to participate in any refresher training for the past three years.   

Google Classroom requires an Internet-ready gadget—a smartphone, a laptop or a tablet— Internet access and a valid email address to be enrolled. Since some antiretroviral therapy prescribers do not have an email address, some local clinics have set up onsite classrooms where multiple trainees can join the online course from one computer, learning as a group.   

The National Department of Health has successfully got support from partners, including UNAIDS, the World Health Organization, USAID, United States Centre for Disease control, World Vision and FHI 360, to cover US$ 15 of Internet access per participant, using cards with a seven-day data plan from a nationwide Internet provider network. 

“Crises can also be opportunities and the impending COVID-19 crisis pressed us to find an innovative solution. The virtual antiretroviral therapy prescribers training shifted the goal posts, showing us that we could respond effectively and offer solutions. I am so proud of the partners that supported us in this and now we also have a more cost-effective way of training across the enormous geographic barriers that we find here in Papua New Guinea,”  said Peniel Boas, Manager, Sexually Transmitted Infection and HIV Programme, National Department of Health.

The participants provided positive feedback on the training. “I really enjoyed learning a lot of new information. I would recommend that any sexually transmitted infection/HIV refresher training be conducted in this manner in the future, to minimize costs and provide this opportunity to health-care workers who otherwise do not have the possibility to attend,” said a nurse from the Leguava Clinic in West New Britain Province.

“The training provides relevant content which is well presented by the facilitators. I enjoyed the quizzes at the end of each presentation. The bonus being that it doesn’t take the worker away from their worksite, it doesn’t incur travel costs and it allows the participants to learn at their own pace. Also, the fact that the facilitators are still available on the platform is a great opportunity for ongoing mentorship,” said a student from the Innanaka Clinic in Hela Province.

The team behind this initiative comprises members of the National HIV Technical Working Group, including the UNAIDS country office, and lecturers, content providers, online class moderators and others. Google Classroom is free for use and all materials are stored in Google Drive using a Google account.

The virtual trainings will be followed by supervisory visits and onsite mentoring to be conducted by the sub-teams of the National HIV Technical Working Group. Due to this successful experience, this format is now being considered for other trainings in Papua New Guinea.

“The quick and strategic action to offer the antiretroviral therapy prescribers training virtually has saved lives here in Papua New Guinea. Without it, we could not have effectively rolled out the new HIV treatments that are combating HIV drug resistance,” said David Bridger, UNAIDS Country Director for Papua New Guinea. 

Kenyan AIDS activist Inviolata Mbwavi died on 29 July 2020 in Kakamega, Kenya, at the age of 48 years. 

Ms Mbwavi was the first Chief Executive Officer of the National Empowerment Network of People Living with HIV in Kenya. At the time of her death she was the National Coordinator of the International Community of Women Living with HIV, Kenya Chapter (ICW-Kenya). ICW-Kenya exists to support an enabling human rights environment, promote gender equality and address the HIV-related vulnerabilities and needs of women and girls. ICW-Kenya also works to respond to HIV among gay men and other men who have sex with men and transgender people, supports legal frameworks enabling trade and intellectual property legislation for improved access to affordable essential medicines and commodities and campaigns against violence and discrimination against key populations.

For Ms Mbwavi, the responses to HIV and to other underlying social, economic and legal factors were equally important. She was uncomfortable with an HIV response that does not question why more girls than boys and more women than men are living with HIV in Kenya and the wider African continent decades after the advent of the epidemic.

Ms Mbwavi was an active member of a civil society coordination group on HIV and tuberculosis and collaborated with UNAIDS in pushing for an HIV response that values and recognizes the contribution of civil society and affected communities.

“Inviolata Mbwavi was a fierce advocate for gender equity, safety and dignity. She was a passionate activist and leader who broke barriers for women and for civil society and was one of the first women living with HIV to serve in a Country Coordinating Mechanism. Her leadership qualities and desire to serve were further demonstrated when she twice ran to be a member of parliament,” said Medhin Tsehaiu, UNAIDS Country Director for Kenya. “We give our condolences to her family and all who loved her.”

The town of Corriverton in Guyana lies far east, on the Suriname border. Miriam Edwards, the Executive Director of the Guyana Sex Work Coalition, hired a taxi early last Thursday to take her team of peer counsellors there. They planned to conduct welfare checks, offer HIV testing and distribute care packages, masks and condoms as part of a project supported by the Office of the United Nations High Commissioner for Refugees (UNHCR). It’s a nearly 200-mile trip from the capital, Georgetown. Since the COVID-19 outbreak, the regular bus hasn’t been available. Other changes to the flow of life have been devastating for sex workers in Guyana.

“Because of the curfew they are not able to work. Plus the children are home full time. They (the sex workers) can’t make any moves. Some are able to look (work) for money, but in doing so they take more risk. Workshops are not their first priority,” Ms Edwards says plainly. “Their main need is food and sanitization.”

COVID-19 has meant fewer opportunities for work and more competition. A Dominican sex worker reported being attacked by a pair of local women. Her face was swollen and stitched when Ms Edwards got to Corriverton.

One Venezuelan woman ventured out during the curfew. She alleges that police officers in the border town detained her and demanded sex. When she refused, one of them hit her with his gun.

Another Venezuelan sex worker had gone missing since the previous weekend. Her documents and clothes were left in her hotel room, but she still hasn’t turned up.

The complications around sex work in Guyana have deepened since COVID-19. At a time when many locals are out of work, migrants have been particularly affected by joblessness. More of them are exchanging sex for money to survive. 

According to a recent Response for Venezuelans (R4V) report by UNHCR and the International Organization for Migration, there have been more reports of sex workers facing eviction or being at risk due to job loss.

“This situation increased their vulnerability of becoming victims of human trafficking, exploitation and gender-based violence,” the report says.

Meanwhile, many Guyanese sex workers have found it difficult to access the social support provided for formal-sector workers by the government.

“The problem is that many in authority don’t see sex work as work,” Ms Edwards said.

But some do. According to Rhonda Moore, Programme Manager at the National AIDS Programme, during COVID-19 the HIV Food Bank has expanded its reach to HIV-negative members of key populations. This includes female, male and transgender sex workers.

Ms Edwards points to the need for even more targeted social support, including for single mothers, migrants and those working in the interior.

The Guyana Sex Work Coalition’s strategy has been to pair the distribution of nutrition support and hygiene supplies with offers of HIV testing and safety reminders on COVID-19, HIV and sexually transmitted infections. According to Ms Edwards, this is a time of high stress and uncertainty and her clients are not necessarily able to absorb mass media messages. Text reminders and phone calls have been key approaches to ensuring that individual sex workers are informed and to address their unique challenges. Sometimes they need medication or money for transport. Many of the migrants need a safe space.

UNAIDS is embarking on a project with the Caribbean Sex Work Coalition to help national networks address sex workers’ knowledge, HIV prevention and social support needs during COVID-19.  A major goal of the project is region-wide advocacy to encourage Caribbean governments to include sex workers in their planning and protection.

“Sex workers need to be included in national social protection schemes and many of them need emergency financial support,” said James Guwani, Director of the UNAIDS Caribbean Sub-Regional Office. “To win the battle against COVID-19 or HIV, we must give life to the principle of leaving no one behind.”

Inspiring stories of solidarity during the COVID-19 outbreak in eastern Europe and central Asia have been shared by community leaders, businesspeople, celebrities and others. Under the umbrella of #TogetherWeWin, a series of Instagram and Facebook Live talks have shown how people are supporting each other in this difficult time. 

“The COVID-19 pandemic has become not only a challenge to health care and economies, it has also become a test for social solidarity. We have seen some amazing examples of solidarity and unity in supporting people who are left behind,” said Alexander Goliusov, Director, a.i., of the UNAIDS Regional Support Team for Eastern Europe and Central Asia.

Arusik Mkrtchyan, from Armenia, a long-time friend of UNAIDS, spoke with Narine Manukyan, chair of the AI MAYER (Armenian Mother) charity, which helped more than 300 families who lost their livelihoods during the lockdown with food and medicine. “I have always believed that charity should support people in a sustainable and long-term way, create opportunities for people to solve their problems by themselves. But in this situation, families with children with disabilities whose parents lost their jobs faced the problem of not having food to eat,” said Ms Manukyan. Ms Mkrtchyan also spoke with Hamlet Khnkoyan, who started the Let’s Help Families in Need movement, which initially helped several families in his neighbourhood with food supplies but snowballed into supporting more than 600 families.

Olya Tira, the UNAIDS Goodwill Ambassador for the Republic of Moldova, spoke with the blogger Lilu Ogovan, a founder of Together for You, Anna Racu, and Ruslan Poverga, from the Positive Initiative.

Ms Racu spoke about Together for You, which supported medical personnel by providing personal protective equipment and disinfectant, as well as purchasing other medical equipment. Aid was initially provided to ambulance stations, but, over time, hospitals that were looking after patients with COVID-19 were also helped. Mr Poverga said that the Positive Initiative, together with partners, delivered antiretroviral therapy to more than 850 people living with HIV, including 65 Moldovans who were trapped abroad during the lockdown. “The crisis forces people to be creative. People stopped thinking in terms of “possible” and “impossible”, we just know that it is necessary to do this and that’s it, and the question is only how exactly we will achieve what we want. And I am very glad that, thanks to our partners as well, we have succeeded,” Mr Poverga said.

In Belarus, there was a live broadcast by Yuri Tkachuk, a singer, television presenter and member of the country’s UNAIDS Red Ribbon Team. UNAIDS Goodwill Ambassador Svetlana Borovskaya, along with television journalist and producer Irina Rombalskaya, as well as representatives of the People Plus community organization, Tatyana Zhuravskaya and Anatoly Leshenok, and Julia Stoke from the Positive Movement, discussed the theory of small actions.

“I believe in this theory. Even when it looks like you do not have a lot of time and financial resources, you can still help substantially. For myself, I chose the path of one good deed a day,” said Ms Rombalskaya, who is buying food and medicine for older people during the lockdown. Ms Zhuravskaya and Mr Leshenok organized the delivery of antiretroviral therapy and helped Belarusians who were outside the country when the border was closed to obtain antiretroviral therapy.

In Kazakhstan, a Facebook Live stream was hosted by Adele Smith, a television presenter and head of the Charity Warehouse project. She talked to Aruzhan Sain, the Commissioner for Children’s Rights in Kazakhstan and founder of the Volunteer Charity Foundation, which helped children with serious illnesses during the COVID-19 outbreak when, due to the closure of the border, there was a significant shortage of medicines and medical supplies. Volunteers found and purchased medical equipment and medicines and delivered them to children’s hospitals, with the foundation later expanding its work to other medical institutions.

Konstantin Avershin, a businessman and leader of the I’m Alma-Ata movement in Kazakhstan, initiated the Who If Not Me challenge, aimed at helping people in need. Assistance was provided in various areas, from the supply of personal protective equipment to doctors to legal support for victims of domestic violence. The challenge brought together 14 cities in Kazakhstan, many volunteer networks operating in the country and the government.

Elena Bilokon, the founder of the Community of Women Living with HIV in Kazakhstan, also joined the broadcast and spoke about her story of supporting people from key populations and about living with HIV in a crisis.

Erkin Ryskulbekov, a UNAIDS Goodwill Ambassador for Kyrgyzstan and television presenter, invited a human rights activist, Gulgaaki Mamasalieva, and Kyrgyzstan’s triathlon champion, Aivaz Omorkanov, to his Instagram Live feed.

Ms Mamasalieva shared her experience in creating an online forum that brings together most of the country’s volunteer organizations and makes it possible to make a direct request for assistance and receive an immediate response. The forum is based on the Telegram platform and facilitates volunteers communicating with each other during an emergency. “We have 10 years of experience in civil monitoring. We know all the standards and requirements for providing such assistance, including how these processes should be organized during emergencies,” said Ms Mamasalieva.

Mr Omorkanov spoke about how he managed to complete his triathlon training programme while staying at home under lockdown as well as starting an online fundraising initiative, inviting world sports starts to join him and raise funds to provide personal protective equipment for doctors at the infectious diseases hospital. In total, US$ 6500 was raised. “My message was that we can help our country even while staying at home,” said Mr Omorkanov. In addition to raising funds, the action had another goal—to encourage people to do sports and maintain a healthy lifestyle, even while under lockdown.

Mr Ryskulbekov ended the discussion by saying, “When I do charity work and help people, I understand that although my actions are needed by others, I’m actually the one who needs it the most; it’s me who becomes happier by doing good things.”

On an early Fijian morning, Marlene Dutta, coffee cup in hand, is sitting on her back deck surrounded by greenery. Not even the sound of birds in the background can peel her away from her computer screen. She is busy sorting through messages and reviewing the activity on the Facebook page that she created, Barter for Better Fiji, an online community that has revitalized Fiji’s traditional bartering practices and helped communities sustain themselves during the COVID-19 outbreak.

“From the minute myself and the other volunteer administrators of the page wake up, our eyes are on the page”, said Ms Dutta, a business skills development consultant. They are busy monitoring or sharing information from the government about restrictions on items to barter.

In Fiji, where approximately 30% of the country’s gross domestic product comes from tourism, travel restrictions to prevent the spread of COVID-19 have brought about tough times for many.

Reflecting on how she came up with the idea for the Facebook page, Ms Dutta said, “Bartering has always been something that Fijians rely on in their daily lives, amongst their friends, families, amongst communities. We all have a skill, a talent, something that we can grow, a whole host of things stuffed away in our houses. If people could trade items or services to get what they needed, then they may be able to sustain themselves through this time.” From these thoughts, Barter for Better Fiji was born. Ms Dutta is astounded by how popular the page has become. Initially envisioned to only be used by her friends, the page now has a following of more than 180 000 members—a huge amount considering that the country has a population of only around 900 000 people—and thousands of requests for new memberships arrive daily.

Aside from helping members to barter for necessary food or services, or sustaining small businesses by linking them to new suppliers for their trade, the page is also creating a greater sense of community. Members have been able to reconnect with long-lost neighbours, family members and childhood friends. Ms Dutta recounts stories of complete strangers meeting on the page to barter only to find that they are neighbours on the same street or have traditional ties.

“Through the page we hope to foster an economy of kindness. That is behind everything that happens on the page,” explained Ms Dutta. “That in itself has brought this sense of community where people are being purposefully and intentionally kind, compassionate and merciful to each other.”

While the Barter for Better Fiji Facebook page doesn’t specifically target the needs of vulnerable groups or people living with HIV, groups such as the Fiji Network for People Living with HIV, the Rainbow Pride Foundation and the Survival Advocacy Network Fiji have reported that their community members have benefited from the online bartering platform. The page has made bartering the “new normal” for vulnerable groups.

“Whether LGBTQI+ or not, we are all humans at the end of the day, and we need to support each other one way or the other. That’s why I think having such a page is a wonderful initiative,” said one member of the Rainbow Pride Foundation.

Community members have been able to barter items or provide cleaning services in exchange for groceries, while others point to how money saved through bartering has allowed them to venture into other income-generating activities, like backyard vegetable gardens and food stalls. At a time when tourism has seen a decline, some groups, such as sex workers, have found their sources of income vanish.

Lesbian, gay, bisexual, transgender and intersex community members have also faced stigma due to false understandings about how the new coronavirus is spread. Yet members of those groups have proclaimed how the uplifting stories and connections developed among members of the Facebook page have helped them to cope and have positively affected their mental health. It is because of these positive stories, stories of communities coming together to cope with the COVID-19 pandemic, that Barter for Better Fiji is interested in expanding the Facebook page to a website and app.

As Fiji grapples with moving beyond the COVID-19 outbreak, Barter for Better Fiji recognizes its important role in what lies ahead, how that it is more than a platform for bartering but also a space to share heart-warming stories of connection that promote an economy of kindness.

Phenomenal Positive Youths are young people living positively with HIV, working towards the elimination of stigma and discrimination, adherence to HIV treatment, access to sexual and reproductive health and rights services and mental health support in Zambia.

UNAIDS has facilitated sexual and reproductive health and rights training for the Lusaka team of Phenomenal Positive Youths and plans to extend it to other districts in Zambia. The training will now include the impact of the COVID-19 outbreak on young people living with HIV, which is currently being evaluated through an impact assessment survey.

Currently, its members are part of the multisectoral risk communication community engagement pillar, as recommended by the World Health Organization’s COVID-19 Strategic Preparedness and Response Plan. Under this pillar, they are involved in creating and disseminating messages on COVID-19, busting myths, social listening and raising awareness, under the guidance of the Ministry of Health in Zambia.

UNAIDS has advocated for the implementation of multimonth dispensing of HIV treatment in Zambia. As a result, the Ministry of Health has issued a national circular to accelerate the implementation of the multimonth dispensing policy, instructing health facilities to provide three to six months of antiretroviral medicines to people living with HIV. Phenomenal Positive Youths is encouraging its members and health-care workers to follow the new guidelines.

While the policy is being implemented, Oswald Chisenga, the team leader of Phenomenal Positive Youths, said the organization has noticed that young people have experienced challenges in accessing their monthly supply of HIV treatment. “The limitation of travel during the COVID-19 outbreak, the fear of exposure to the coronavirus and the associated stigma is restricting people from visiting health-care facilities, even with the revised national guidelines,” he said. “Even messages on COVID-19 have been misinterpreted by people as meaning they should not go to a health facility, even when the need arises.”

Thus, the organization has developed an unconventional and innovative approach to ensure that its members have an ongoing supply of antiretroviral therapy, called chilimba (a commonly used local word meaning to loan or advance a colleague something). Members of the organization loan their antiretroviral medicines to one another until the person in need can obtain their supply, at which time the medication is returned.

“We help each other so that no one skips a day or does not have enough antiretroviral therapy due to different circumstances. It may be because of illness, or the person is very far from the health facility or they have no documentation to access the health facility,” said Mr Chisenga. “We communicate with one another using our social media groups. This helps us to maintain adherence, encourages openness and virtual interactions or physical ones while observing social distancing guidelines,” he added. 

This is only one of the innovations that Phenomenal Positive Youth has brought into the youth-led movement in Zambia. The group was also among the first associations to speak openly about mental health among young people, especially among young key populations and young vulnerable people.

Arpi Hakobyan (not her real name), a former sex worker, lost her income after the COVID-19 pandemic hit Armenia. And then her parents threw her out of their home and took her passport. She had no place to go and no one to ask for help, until a friend advised her to contact the New Generation nongovernmental organization.

Opened by the New Generation in June 2020 in the centre of Yerevan, the capital of Armenia, the Safe Space occupies a three-storey building that gives people living with HIV, members of key populations and women who have suffered from domestic violence a safe refuge.

“When the COVID-19 pandemic began, we started receiving calls from people who, because of their belonging to key populations or because they were HIV-positive, were discriminated against, found themselves without work, without support, sometimes without a home,” said Sergey Gabrielian, the head of the organization. “It is widely believed in our society that it is these groups that spread not only HIV but also COVID-19, which is why they are expelled from work or from society. These people have nowhere to get help from—they are not on any lists of recipients of government social assistance programmes.”

The Safe Space gave Ms Hakobyan a place in the shelter. The New Generation’s lawyer and psychologist reached out to her, helped to replace her documents and found her a job.

Referrals are made to the shelter by HIV service and human rights organizations across the country. Administrators, lawyers, psychologists and volunteers are on duty 24 hours a day. For the first three days, psychologists and lawyers work with the clients to find out their circumstances, help with documentation and understand how to proceed further. The average stay in the shelter is 15 days, with the maximum being a month.

“Of course, we are not a hotel, this small programme is not designed to support people for several months—there only 37 people who can be simultaneously in the shelter. And the demand for it is enormous,” said Mr Gabrielian.

A key feature of the shelter is a special HIV services room in which people can take an HIV test and get counselling and a referral to an HIV clinic. People who use drugs and need harm reduction services are referred to a nearby organization where such services can be obtained.

Mr Gabrielian said that when it became obvious that the fight against COVID-19 could hit the HIV epidemic hard, the New Generation’s employees decided to switch to a new way of providing HIV services—online consultations, the provision of tests and prevention materials by mail and the use of outreach workers.

“We insisted that programmes for key populations should not be stopped because of the coronavirus, otherwise, with the end of one pandemic, we will see an outbreak of the AIDS pandemic,” he said.

Today, the Safe Space project is supported by the Elton John Foundation, with support also from the Swedish Government. Negotiations are under way with the Global Fund to Fight AIDS, Tuberculosis and Malaria and UNAIDS on the future of the service.

“The coronavirus made us understand what new ideas could be included in the HIV service programme. It was these special circumstances that made us move on and look for new ways to support people in times of crisis,” said Mr Gabrielian.