Stepping into the Remera Health Centre in Kigali, the Desert AIDS Project (DAP) delegation visited one of the 552 integrated health centres in Rwanda. The clinic offers everything from primary care to clinical care for all ages, as well as HIV services.

The head of the centre, Emile Musabyimana, led the group around the facility, which includes a laboratory where HIV, viral load and tuberculosis testing are carried out. He is particularly proud that Remera has adopted the test and treat approach, which means that anyone who tests positive for HIV is immediately offered treatment.

The Remera Health Centre serves about 3000 people living with HIV, of which 2400 are virally suppressed. The clinic monitors patients on a monthly basis until their viral loads drop to undetectable levels.

Established by a group of volunteers in 1984, the DAP provides HIV prevention, treatment and care services to people living with and affected by HIV across the Palm Springs, California, area. It has expanded its primary care facility to include a dental clinic and affordable housing.

The delegation, in Kigali for the International Conference on AIDS and STIs in Africa (ICASA), discussed some of the challenges the Remera centre faces. Mr Musabyimana explained that too few young people come to the clinic.

“We need to address the issues of why they don’t come and get tested,” he said. “And when they do know their HIV-positive status, they don’t always stay on treatment.”

As a result, the centre organized an informal chat with young people living with HIV with the delegation.

“A lot of these kids were born with HIV and a lot of them are stigmatized and so they’re fighting it and fighting through it,” said Patrick Jordan, DAP Vice-Chair. He added, “To see them in their valiant efforts and how strong they are is inspiring.”

David Brinkman, DAP Chief Executive Officer, couldn’t agree more. He applauded the health centre’s work as well as Rwanda’s low HIV prevalence rate compared to neighbouring countries in the region.

“We really have to acknowledge what Rwanda is doing,” he said. “People on the ground have all the knowledge they need, it’s now about resources so that when we combine knowledge and resources, we will end the epidemic by 2030.”

Over the past year, a partnership between DAP and UNAIDS has been growing, with the idea of joining forces to support grass-roots and community-led HIV efforts worldwide.

The 20th International Conference on AIDS and STIs in Africa (ICASA) opened in Kigali, Rwanda, on 2 December, under the theme “AIDS-free Africa―innovation, community and political leadership”.

Researchers, governments, civil society and other stakeholders, such as UNAIDS and its Cosponsors, are gathering for a week to share scientific advances, best practices and lessons learned, and to galvanize political leadership and action.

The President of Rwanda, Paul Kagame, encouraged African leaders to prioritize domestic financing for health care. “Good politics and governance have everything to do with health,” said Mr Kagame. “There is no substitute for building an inclusive and caring society.”

Rwanda, a country of 12 million people, has an HIV prevalence of 2.5% and 220 000 people living with HIV. Some of its sub-Saharan African neighbours have an HIV prevalence as high as 20% and millions of people living with HIV, making HIV very much a reality for the continent.

At the opening ceremony, the President of Mozambique reiterated the importance of political leadership. “We need leadership to convey the right messages and our brothers and sisters to test for HIV and seek treatment,” said Mr Filipe Nyusi. He added that a community approach can improve service uptake.

This was a sentiment echoed by the World Health Organization (WHO). “Since the early days, communities have been the driving force of the AIDS response,” said the WHO Director-General, Tedros Adhanom Ghebreyesus. He added, “Our job as leaders is to listen to communities and what they need, not to tell them what they need.”

The conference opened a day after World AIDS Day 2019. This year’s theme recognized the essential role that communities have played and continue to play in the AIDS response at all levels. UNAIDS highlighted the essential role of communities at a time when reduced funding and a shrinking space for civil society have put the sustainability of services in jeopardy.

Winnie Byanyima, the UNAIDS Executive Director, stressed throughout the day’s sessions that resources must flow to communities and civil society. “To people living with HIV, the question of resource mobilization is a question of life and death,” Ms Byanyima said at an African leadership meeting on investing in health. “When the money from donors dries up, will there be enough money for people’s treatment?” she asked. “This is why the prevention agenda is critical.”

A UNAIDS staff member has broken the record for Murphs completed over a 24-hour period. Peter Koopmans, who has been working for UNAIDS for 10 years, began the record attempt on World AIDS Day, 1 December, to raise money for a South African charity working to support sexually abused children and to increase awareness around HIV in the province of KwaZulu-Natal.

Mr Koopmans completed 15 Murphs just ahead of the 24-hour deadline after a gruelling ordeal that in total saw him run 30 miles (48 km) and do 1500 pull-ups, 3000 push-ups and 4500 squats. Each of the 15 Murphs consisted of running for one mile (1.6 km) and doing 100 pull-ups, 200 push-ups and 300 squats, followed by a further one-mile run—all while wearing a 10 kg vest.

“I have always wanted to try this challenge, and this allows me to have a direct impact on the lives of others,” said Mr Koopmans, who has been training for the record attempt for the past eight months.

The record attempt took place at UNAIDS headquarters in Geneva, with staff on hand throughout the night to encourage Mr Koopmans in his efforts.

Mr Koopmans has so far raised US$ 21 000 for the South African charity Bobbi Bear, which was supplemented by funds from UNAIDS World AIDS Day fundraising activities, bringing the total to well over US$ 25 000. Donations can continue to be made on the special funding page Murph for Bobbi Bear until 4 December.

Communities played a central role in the commemoration of World AIDS Day in South Africa, which was held in the rural community of Orkney, in the North West Province.

At the invitation of the Government of South Africa, the UNAIDS Executive Director, Winnie Byanyima, commemorated her first World AIDS Day as UNAIDS Executive Director in the local community. Ms Byanyima paid tribute to the role of communities in the AIDs response, including communities of people living with HIV and communities of women, girls and others at higher risk of, or affected by, HIV.

Ms Byanyima told the audience of several thousand people that it was an honour to mark World AIDS Day in South Africa—a country that was late to respond to HIV but that had made huge strides over the past decade and now had more than 5 million people on treatment. She noted, however, that there was still a long way to go, especially to protect women and girls.

“Enough is enough. All women and girls must have the right to choose if they have sex and with whom, and how they protect themselves. We need to bring power, equality and agency to all young women and girls,” she said.

Ms Byanyima said we must never accept that people living with HIV are still dying of AIDS. “It is not a question of science. It is a question of inequality, powerlessness and exclusion. The system is still failing for those who are marginalized,” she said.

South Africa’s Deputy President and Chair of the South Africa National AIDS Council, David Mabuza, told the World AIDS Day event audience that South Africa’s AIDS response had succeeded thanks to the work of communities and the contributions of activists and development partners.

“We could not achieve this without partnerships and support from our global partners,” he said. “That is why we must appreciate the contribution of the global campaign by UNAIDS that has galvanized political leadership, civil society and the private sector into coherent action. Community action remains an important pillar in making change happen, and in shaping the policy agenda and outcomes.”

He noted that there was still much work to be done, including intensifying HIV prevention and tackling contributing factors, including providing comprehensive sexuality education and ending gender-based violence.

Mr Mabuza also said he was pleased to be joined by Ms Byanyima. “She is an activist of note and a distinguished advocate for human rights and development,” he said.” We have no doubt that her vast experience in political leadership and human development will take us forward in the struggle to end the AIDS epidemic.”

In the days prior to the World AIDS Day commemoration, Ms Byanyima met with political and civil society leaders, women activists and others to hear their concerns and understand the challenges and opportunities facing South Africa.

She also visited a clinic in Soshanguve, outside Pretoria, to see in action the project Ritshidze (“saving our lives”), which aims to improve the quality of HIV and tuberculosis service delivery in South Africa by empowering people living with HIV to monitor the health services they receive and to advocate for changes needed. The project is funded by the United States of America with support from UNAIDS.

"We can spend billions building beautiful clinics to distribute millions of pills,” Ms Byanyima said. “But only if we empower communities at the grass roots to hold service providers accountable and call out injustices will we make a real difference for people."

In 2017, a Jamaican actress starred in an educational video about HIV treatment adherence. It was an upbeat, innocuous reminder to people living with the virus to eat healthily, exercise and take their medicine every day.

After she made the film, the young woman faced some strong reactions—bookings dried up, strangers in the street pointed at her and her daughter faced teasing at school. Although she herself is HIV-negative, it was a sharp reminder concerning the stigma and discrimination faced by people living with HIV.

Earlier in 2019, Jamaica’s Minister of Health, Christopher Tufton, appeared in a public service announcement with the young actress to tell people that a person’s HIV status was no reason to discriminate against them. “There is still a lot of work to be done and while I was disappointed by the reactions to the video, I have seen and heard enough to understand that HIV-related stigma and discrimination is still a big challenge in the community and something we have to work on,” he said.

Jamaica’s 2017 HIV/AIDS Knowledge, Attitudes, Behavior and Practice survey found that just 12% of respondents were accepting of people living with HIV. Over the years, Mr Tufton has had his own journey from fear to acceptance.

He was a teenager in Manchester, United Kingdom, when the first HIV cases were diagnosed in Jamaica during the early 1980s. During the decade that followed, as a post-graduate student in the United States of America and the United Kingdom, he heard how advances in the scientific and social response to HIV were creating new pathways toward prevention and stigma reduction. He describes his current spell as Minister of Health as “peak awareness.”

“Over time, I have evolved from fear to actively advocating for greater levels of tolerance. I’ve been more interactive with people affected by HIV and with vulnerable groups. I have become an advocate both for anti-discrimination and for prevention. HIV does not have to be a death sentence. It can be treated. It can be controlled. If you take your medicines you can live a long and fruitful life,” says Mr Tufton.

Thousands of Jamaicans living with HIV are still not accessing treatment. As it updates its National Strategic Plan, the Ministry of Health and its partners are focused on addressing the challenges around connecting people to care and keeping them on treatment. For example, they are working to increase testing and outreach to men. Men are far more likely than women to be diagnosed late and to die from AIDS-related illnesses.

Having drawn the connection between relatively low levels of treatment coverage and discriminatory public attitudes, the government has boosted efforts to change hearts, minds and behaviours. Health-care discrimination is monitored through the Client Complaint Mechanism, as well as the Jamaica Anti-Discrimination System managed by the Jamaica Network of Seropostives. The Ministry of Health is also deploying strategies to reduce stigma and discrimination by training health-care workers, engaging with the faith community and running additional campaigns aimed at the general public.

These efforts come as the country prepares to transition away from a substantial degree of international funding for the AIDS response to greater national ownership. Along with its

commitment to provide free HIV treatment for all who need it in 40 facilities across the country, the government will also ensure that vulnerable communities currently served by donor programmes are included in domestic budgetary planning.

Partnering with civil society is a critical strategy for ensuring that the most stigmatized groups—people living with HIV, transgender people, gay men and other men who have sex with men and sex workers—are able to successfully access treatment.

“Civil society organizations are key partners. As part of the process we will identify which groups are best suited to deliver services. There are government systems in place for engaging with service providers,” says Mr Tufton.

The UNAIDS Country Director, Manoela Manova, welcomes this commitment to working with civil society to address prejudice and increase access to services.

“Jamaica has done a good job at HIV testing,” says Ms Manova. “Now new strategies are needed to reach those who are not aware of their status and to connect people diagnosed with HIV with treatment. The more we do to ensure that people feel safe and respected, the closer the country will come to ending AIDS.”

UNAIDS employee Peter Koopmans will attempt to break the world record for the number of Murphs on World AIDS Day, 1 December, while fundraising for an HIV charity.

Named after a United States Navy officer killed in Afghanistan in 2005, the workout was one of Michael Murphy’s favorites. Originally called a Body Armor, a Murph consists of wearing a 10-kilo vest while:

• Running for one mile (1.6 km).
• Doing 100 pull-ups.
• Doing 200 push-ups.
• Doing 300 squats.
• Running for another mile.

Mr Koopmans will attempt to do 15 Murphs over a 24-hour period at UNAIDS headquarters in Geneva, Switzerland. Fifteen Murphs will see him run 30 miles and do 1500 pull-ups, 3000 push-ups and 4500 squats. He has been training for the record attempt for the past eight months, logging countless hours in the gym.

“I have always wanted to try this challenge, and this allows me to have a direct impact on the lives of others,” Mr Koopmans said. Staff and friends will cheer him on throughout, and some will even attempt to do Murphs with him.

All funds raised will go to Operation Bobbi Bear, a human rights organization committed to helping sexually abused children, and raising awareness about HIV, in KwaZulu-Natal, South Africa.

You can donate and/or follow Mr Koopmans as he accomplishes this amazing feat on this website, while this video gives a brief overview of the challenge. 

When Greg Owen started hearing about a medicine taken daily that could keep people from contracting HIV, he didn’t believe it. The British man, from London, asked around and his friends told him that pre-exposure prophylaxis (PrEP) was only available in the United States of America or through a clinical trial, the PROUD study, in England.

“I finally managed to get a hold of some via a friend in early August 2015,” he recounted. “The next day, I went for an HIV test and it came back positive.” In shock, he felt like the system had failed him.

“It was too late for me, so out of necessity and anger we decided we had to do something,” Mr Owen said. His friend Alex Craddock was on PrEP. He needed to keep taking the medicine, which he obtained from the United States, so they both set out to help themselves and their friends.

They gathered as much information on PrEP as they could and on 19 October 2015 the website iwantPrEPnow went live.

With a small budget and limited time, but with a lot of publicity, iwantPrEPnow attracted more and more people. Traffic exploded.

“We had no master plan, but clearly there was a need for advice and access to the medicine within the community,” Mr Owen said.

Through a PrEP trial in England, more than 10 000 people have access to PrEP. In Wales, Scotland and Northern Ireland, PrEP is available through National Health Service (NHS) sexual health clinics. Countless others have obtained PrEP by buying it online.

Mr Owen, a club promoter turned full-time activism coordinator, credits 30 years of AIDS activism for improving HIV awareness and bringing new medicines to the forefront.

“PrEP has been a game-changer because it’s like the final piece of the jigsaw puzzle that has been missing,” he said. “We had already stepped up testing regularly, encouraged increased condom use and started people on treatment as soon as possible. All of these are part of our combination prevention response needed to fight the fire.”

Will Nutland, co-founder of  Prepster, a group advocating for PrEP to be integrated within NHS England, considers the medicine as one of the most effective and cost-effective HIV prevention tools ever.

“No other HIV prevention technology has had the impact on HIV diagnosis in a place like London,” Mr Nutland said.

Half of new HIV infections in the United Kingdom have been shouldered by gay men and other men who have sex with men. In the past two years, new HIV infections among gay men and other men who have sex with men have decreased more than 30% across the country, according to HIV data by Public Health England. And in London, there has been a 44% drop.

Prepster and iwantPrEPnow launched within a week of each other. The founders didn’t know each other, so when they realized the crossover between them, they met and now collaborate on most projects.

For Mr Owen, PrEP has also changed the narrative. “We now have whole generations talking about sex in a guilt-free way,” he explained. He believes that people feel more liberated after decades of shame, death and disease linked to sex without condoms.

Among HIV advocates, the sector feels reinvigorated. Mr Owen feels proud being part of this supportive, loving and vibrant community. He says their common goal has brought lots of different players together.

“PrEP needs to be made available to all and not just at sexual health clinics,” he said, echoing Mr Nutland.

Their ongoing objective involves further increasing awareness of and access to PrEP for everyone who could benefit, particularly women, transgender people and communities of colour.

“A community means no one is left behind,” Mr Owen said. “No one gets turned out, that’s a real community.”

Erva-Jean Stephens works as a Strategic Information Adviser in the UNAIDS Country Office in Jamaica. She describes her role as using evidence-informed data to shape programmes and policies that contribute to the country’s development.

Ms Stephen’s professional career is entwined with an activist’s desire to see better health outcomes for ordinary Jamaicans.

“I try to serve people first,” says Ms Stephens. “People reach out to me because I make myself accessible and I easily relate to their needs. I naturally build networks outside of the work environment that I think might be beneficial to the work we do.” 

She supports the nongovernmental organization Eve for Life because she believes that young women and girls living with or affected by HIV are being left behind with regard to international funding and programmatic focus. Beyond providing technical support to help Eve for Life increase its funding, Ms Stevens has mobilized private sector organizations and UN Cares, the United Nations system-wide workplace programme on HIV, to raise funds and create care packages for young women and their children.

Under her leadership, UN Cares Jamaica has trained United Nations staff members in the country on issues such as unconscious bias and the human rights of lesbian, gay, bisexual, transgender and intersex people and of people who use drugs. In 2016, the United Nations team in Jamaica received an award from the United Nations Secretary-General for its work on raising awareness about HIV and noncommunicable diseases.

In 2018, UN Cares Jamaica launched UN Moves. This is an offshoot of a project led by the Ministry of Health that aims to harness the power of the private and public sectors to help create a healthier, happier population through nutrition, exercise and education. But for Ms Stevens, the most critical area of UN Cares’ work remains addressing HIV-related stigma and discrimination.

“There needs to be ongoing training on cultivating and maintaining a model work environment where stigma and discrimination have no place. Sometimes we may not realize to what extent people are looking at us in the United Nations and how important it is for us to walk the talk,” said Ms Stevens. She thinks about her own journey and how through the UN Cares programme she has learned to identify and uproot her own biases.

Ms Stevens has a degree in environmental health and food safety and a master’s degree in public health with a specialization in medical epidemiology. She began her career with the Ministry of Health, using monitoring and evaluation techniques to ensure outbreaks of malaria and food-borne illnesses were quickly brought under control.

She hopes to be part of the team that sees the end of the AIDS epidemic.

“When you look at the history of the Caribbean in terms of eradicating diseases, political commitment and community involvement have always intersected,” she explains. “To meet our commitments on controlling the transmission of HIV, we need to see more meaningful community engagement and leadership, supported by political will. I am here to provide the strategic information necessary to help realize that goal.”

The United Republic of Tanzania has approved a change to the law that lowers the age of consent for HIV testing from 18 years to 15 years. The amendment to legislation also makes self-testing for HIV legal, also from the age of 15 years.

“These amendments will significantly accelerate our intention to meet the 90–90–90 goals, which aim at ending the AIDS epidemic by 2030,” said Ummy Mwalimu, Minister of Health, Community Development, Gender, Elderly and Children. The ministry was instrumental in tabling the amendments to the legislation.

The 90–90–90 targets are ambitious treatment targets to help end the AIDS epidemic. They aim to ensure that, by 2020, 90% of all people living with HIV will know their HIV status, 90% of all people who know their HIV status will be on antiretroviral therapy and 90% of all people on antiretroviral therapy will be virally suppressed.

The changes to the law will contribute to improved access to HIV testing for adults aged 15 years and over.

At the end of 2018, the progress on the 90–90–90 targets in the United Republic of Tanzania was 78–92–87. In 2018, there were 72 000 new HIV infections in the country. While this is a 13% reduction from 2010, it is below the 28% reduction across eastern and southern Africa. 

“I congratulate the Government of the United Republic of Tanzania on its leadership and high-level political commitment to the AIDS response. UNAIDS will continue to work hand-in-hand with all our partners to ensure that access to HIV testing and treatment continues to expand,” said Leo Zekeng, UNAIDS Country Director in the United Republic of Tanzania.

This story, by Duniya Aslam Khan in Imvepi refugee settlement, Uganda, is reproduced from UNHCR, a UNAIDS Cosponsor 

On a bright sunny day in northern Uganda’s Imvepi refugee settlement, Inga Viola and Rufas Taban sit comfortably under the shade of a jacaranda tree, leafing through an old register.

The pair are unrelated but share a unique bond – they were both diagnosed with HIV back in South Sudan, before civil war forced them to flee to Uganda in 2017.

“I was devastated when I found out,” says Inga, 32, who was diagnosed in 2014. “I felt like ending my life but I thought about my children and decided to live.”

Rufas, 49, nods solemnly, himself diagnosed in 2011.

Introduced to each other at Imvepi refugee settlement by their Ugandan nurse, Jedah Twebaze, they soon forged a friendship around their shared experiences – deep distress on finding out their status, leaving their homes behind and raising their families in exile.

They formed a support group, which they called the Friendship Serving Group, with Rufas, a former tax collector, as the secretary and Inga as the vice president. The group also doubles up as a savings cooperative and currently has 22 South Sudanese members, all HIV positive.

They contribute to the group’s kitty each month, sharing the accumulated savings at the end of the year. The group also helps spread HIV awareness in the community, while fighting the stigma associated with it.

“We use our meetings as an opportunity to talk about our wellbeing, check on members who are struggling with their status and provide counselling,” explains Inga.

She adds that they also educate each other on the importance of taking Antiretroviral therapy (ART) treatment – a life-saving course of medication that the conflict and the ensuing journey to safety disrupted, causing hers and Rufas’ health to deteriorate by the time they reached Uganda.

“I spent many days without taking medicine. Each new day without treatment meant getting closer to death,” she says.

Thanks to Uganda’s progressive refugee policy that has integrated refugees into the national HIV programme, refugees like Inga and Rufas are able to resume their treatment as soon as they arrive. They receive ART medication on a quarterly basis, free of charge.

The medications help suppress levels of HIV in the blood and slow damage resulting from the infection. It helps prevent progression from HIV to AIDS, thereby significantly extending life expectancy and reducing the risk of transmitting the virus to zero.

“I thought to be HIV positive meant dying soon but our kind nurse told us that with regular medication, we can live a very normal life,” says Inga, looking at nurse Jedah, who’s been nicknamed, ‘Dr. HIV’ by refugees for his advocacy and commitment to educate both refugees and Ugandans on HIV/AIDS.

Jedah works at UNHCR’s partner agency, Medical Teams International (MTI) and observes that the level of stigmatization among South Sudanese refugees has improved significantly.

“Educational sessions with the communities here have yielded positive results in fighting stigma,” he says.

According to UNAIDS statistics, by the end of 2018, an estimated 1.4 million Ugandans were living with HIV – 1.2 million were aware of their positive status and 72 per cent of them were on ART.  

Currently, over 17,000 refugees receive ART treatment across all the health facilities in Uganda’s refugee settlements where both refugees and nationals can access healthcare.

Earlier this year, Uganda launched a multi-year, Health Sector Integrated Refugee Response Plan, aimed at strengthening refugee healthcare through an integrated approach. Health services to refugees are currently aligned to the country’s national health policy and Health Sector Development Plan.

Such progressive policies and programmes that support both refugees and their host communities will be among the topics under discussion at the Global Refugee Forum, a high-level meeting 17-18 December in Geneva. States, the private sector and others are expected to announce high-impact contributions that will give refugees a chance to thrive alongside their hosts.

For Inga and Rufas, unrestricted access to treatment and a positive attitude towards HIV patients has not only made their life in the refugee settlement easier but it has also alleviated stigma.

“People here treat HIV patients just like anyone who has any other illness,” says Inga. 

Another key milestone is the decline in mother-to-child transmission rates. Eighty-nine per cent of pregnant women who visited health centres were tested for HIV to prevent transmission to the unborn child.

“It is through these interventions that Inga and Rufas’ children are all HIV negative,” explains nurse Jedah.

The strong advocacy role played by communities in fighting stigma and spreading awareness is recognized in the theme of this year's World AIDS Day on1 December,  which is ‘Communities make the difference.’

While Inga and Rufas do their part to make a difference, more needs to be done to ensure that the AIDS response at national and international level remains an essential one.

“Let us control HIV because no one should contract this disease,” Rufas says. “As we know, prevention is better than cure.”