Leaders from both the private and public sectors have called for fresh investment models for new technologies and the smarter roll-out of innovations to end AIDS and tuberculosis by 2030.

The plea was made by panellists taking part in a debate at the Health Innovation Exchange, a three-day event organized by UNAIDS and held between 21 and 23 May on the sidelines of the World Health Assembly in Geneva, Switzerland.

Speaking at the event, the Executive Director of the Stop TB Partnership, Lucica Ditiu, said new approaches are vital in order to make faster progress in the response to the epidemics.

“We will not achieve our targets of ending AIDS and tuberculosis by doing things as we have always done them in the past,” she said. “Products must be developed with the patient in mind and we must work with developers to help them gather evidence that their innovations work in order to shorten the timeline from validation to implementation.”

Roland Göhde, chair of the German Healthcare Partnership, a joint venture of the Government of Germany and the Federation of German Industries, said there was an urgent need for greater synergies right along the chain of development and innovation. “The private sector needs to be systemically involved by other sectors. We need to bundle and conflate the different expertise of the involved sectors to get rid of fragmentation.” 

Mr Göhde also underlined the importance of training in new technologies. He described how the German Healthcare Partnership had facilitated the training of laboratory workers in Burkina Faso in new haematology technologies as well as the training of biomedical engineers in Kenya and Senegal.

Jenifer Healy from USAID reminded the audience that the World Health Organization had estimated that the cost of achieving the Sustainable Development Goals health targets was an initial US$ 134 billion annually in 2017, rising to US$ 371 billion by 2030.

“While we have made great progress in global health, including in reducing the impact of AIDS, the funding gap for new investments will triple by 2030,” she said.

The Global Head of Public Health at Johnson & Johnson, Jaak Peeters, also underlined the importance of supporting the best science possible for global health, a more rapid implementation of best practice innovation and the fullest embrace of public–private collaboration.

In his comments, the Director-General of the Ghana Health Service, Anthony Nsiah-Asare, said that political commitment was required to ensure that innovation was deployed to deliver smarter, more efficient and high-quality services to the people most in need.

“If I want to see the change, I need to be the change,” said Aniz Mitha, the Executive Director of Community Health Rights Advocacy (CHeRA), an organization that works with male sex workers in Malawi. When Mr Mitha speaks of change, he does so with the quiet and unwavering authority of someone who knows what he is talking about.

From a conservative Muslim family in Malawi, Mr Mitha was thrown out of the house at a young age when his parents found out that he was gay. With nowhere to go and no means to support himself, he fled to Johannesburg, South Africa, where he spent many years as a sex worker. “For me, I was looking to survive; I wasn’t thinking about my health,” he said.

When he became ill, he took an HIV test, and he learned that he was living with HIV. Being an illegal immigrant, he couldn’t access health-care services in South Africa. He returned to Malawi, where he began HIV treatment and started CHeRA. “I thought: how can I help others not go through the same experience that I did?” he said.

CHeRA raises awareness and builds the capacity of male sex workers on HIV prevention and treatment, sexual and reproductive health and rights, economic empowerment, psychosocial support and access to justice. Through a UNAIDS funding arrangement, it recently reached more than 250 male sex workers in three priority districts in Malawi, distributed more than 30 000 condoms and lubricant and linked six male sex workers living with HIV to care and treatment. In another programme funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the organization has trained 50 peer educators and distributed more than 6000 condoms and condom-compatible lubricant.

Mr Mitha is keenly aware of the many challenges that face male sex workers, having faced them himself. “In Malawi, sex work is not recognized as work, so there are no laws to protect sex workers. Also, most of our male sex workers are gay men or men who have sex with men, so they live in fear of arrest because homosexuality is illegal in Malawi,” he said.

Stigma and discrimination is institutional, he said. “Male sex workers are not recognized as a key population in the HIV response in Malawi, so we are not prioritized in government plans. And negative attitudes from health-care workers push us away from care.”

“Say I am being abused or beaten and I go to a police station,” continues Mr Mitha, “I will get questions like “Why you are dressed like this or why do you speak like this?” The abuse is institutionalized. It pushes us away, so even in terms of health care, we go to private hospitals where we pay money even if we don’t have money.”

CHeRA is now registered as a nongovernmental organization. Although started in 2016, it was only registered in 2017 after UNAIDS played a pivotal role in amending provisions in the Malawi HIV and AIDS Management Control Act of 2018 that criminalized or discriminated against certain groups, such as sex workers. This paved the way for organizations of lesbian, gay, bisexual, transgender and intersex people and sex workers to be registered.

Like many people who serve others, his work has spilled over into his private life. Knowing what it feels like to be disowned by one’s family, Mr Mitha gives shelter to people who have nowhere else to go, who stay as long as it takes until they can look after themselves.

He has built an unshakeable sense of self, family and community through his work and his life. “I am living openly with HIV and as a gay person; I am a role model to so many. They see that it is possible. I see a lot more people like me opening up and living openly as gay and with HIV,” he said.

Mr Mitha wants to grow CHeRA into an organization that is a strong advocate for equitable access to health care for male sex workers.

“We need more financial support to expand the work we do,” he said. “We provide access to HIV prevention information and services to a population that is being left behind. It is making a difference. When you are working as a community organization, it means what affects my community affects me too,” he said.

The First Lady of Kenya, Margaret Kenyatta, visited UNAIDS headquarters in Geneva, Switzerland, on 21 May to talk about her Beyond Zero initiative to improve maternal and child health and to reduce the impact of HIV in the country. During her visit, Ms Kenyatta met UNAIDS Executive Director, a.i., Gunilla Carlsson and addressed staff at a town hall meeting. 

Since its launch in January 2014, the Beyond Zero initiative has transformed the lives of thousands of women and children across Kenya, mobilizing resources and forging new partnerships to improve health outcomes, with a special emphasis on reducing maternal and child deaths and preventing new HIV infections.

Beyond Zero has delivered more than 50 mobile clinics to every county in Kenya. The clinics have resulted in increased access to and uptake of health-care services. The initiative has also made a significant contribution to the progress made in the country’s AIDS response, with new HIV infections among children down from about 13 000 in 2013 to 8000 in 2017.

With the launch of the Beyond Zero Medical Safari in 2018, the focus is on providing free health care and surgical services, including fistula surgeries, to Kenyans in remoter parts of the country. There is also a strong commitment to increase the social inclusion of children living with disabilities and to engage with adolescents to reduce the risk of HIV infection.

Ms Kenyatta told UNAIDS staff that the response to HIV had to be continued with renewed vigour.

“We cannot leave the battlefield just yet,” she said. “We must recommit ourselves to ending AIDS by 2030 so that in the years to come, when AIDS will be spoken of as a thing of the past, we shall remember the roles we played, however big or small.”

Ms Carlsson thanked Ms Kenyatta for her continued support for the response to HIV.

“The First Lady is an incredible advocate for maternal and child health. She is a champion for issues that are close to our hearts. The Beyond Zero initiative is transforming the lives of women and children across Kenya.”

Accompanying Ms Kenyatta on her visit to UNAIDS were Kenya’s Cabinet Secretary for Health, Sicily Kariuki, the Chair of the National AIDS Control Council, Nduku Kilonzo, and Kenya’s Ambassador to the United Nations in Geneva, Cleopa Mailu.

As part of celebrations for the International Day against Homophobia, Transphobia and Biphobia on 17 May, UNAIDS signed a memorandum of understanding with Pride House Tokyo.

Pride House is an international initiative that provides a safe space for lesbian, gay, bisexual, transgender and intersex (LGBTI) athletes, their families and friends during major sporting events such as the Olympic Games and Paralympic Games and the FIFA World Cup. Japan is hosting the 2020 Olympic Games in Tokyo.

Gon Matsunaka, the Executive Director of Good Aging Yells, an LGBTI advocacy organization, leads a consortium of 28 civil society groups that launched Pride House Tokyo. He signed the memorandum of understanding with Gunilla Carlsson, UNAIDS Executive Director, a.i.

“This is a win–win partnership for UNAIDS and Pride House Tokyo,” said Ms Carlsson. “I sincerely hope that not only our relationship with Japan, in particular with Japanese civil society, will be further strengthened, but also that we will be able to contribute to the success of the Olympic and Paralympic Games in Tokyo next year.”

Through the memorandum of understanding, UNAIDS will provide technical assistance to and jointly programme activities related to human rights and sexual health run by Pride House Tokyo.  

“I hope that UNAIDS’ support and experience on lesbian, gay, bisexual, transgender and intersex human rights and sexual health will carry over beyond the Olympic Games and change society in Japan and across Asia,” Mr Matsunaka said.

Among the Group of Seven countries, Japan is the only country yet to legalize same-sex partnerships. Mr Matsunaka explained that Tokyo has no big LGBTI centre, so he hopes Pride House Tokyo will become permanent beyond 2020.

The concept of Pride House started during the 2010 Vancouver Olympic Games, during which a local organization set up a hospitality and information centre on LGBTI issues. The concept spread around the world, with local nongovernmental organizations hosting similar houses during major sporting events.

Isaac Ahemesah has been involved in the AIDS response for almost 25 years, the last 16 of which were spent working for UNAIDS in various positions across Africa. His most recent assignment has been as a Fast-Track Adviser in the UNAIDS Country Office in Malawi.

Mr Ahemesah’s interest in the AIDS response started in 1995, when he was studying social work at university in Ghana. As part of his studies, he was required to carry out field work at the local hospital, where there was a hospice for the many people dying from AIDS-related illnesses.

“At that time, there was no treatment for HIV. There was nothing for people living with HIV at all,” he says. “I didn’t know what I was getting myself into,” he continues. I just knew I needed to help.”

This was the beginning of his long involvement in the AIDS response. He started his professional career at the Catholic Relief Service as an HIV and AIDS Programme Officer and went on to join UNAIDS in 2003 in the UNAIDS Country Office in Ghana. Since then, he has held various positions, including Institutional Development Adviser, Human Rights, Gender and Community Mobilization Adviser in Liberia and currently Fast-Track Adviser in Malawi.

Having survived the terrorist attack on the United Nations complex in Abuja, Nigeria, in 2011 and the outbreak of Ebola in Liberia in 2013, Mr Ahemesah remains undeterred in his passion for a people-centred AIDS response.

“People living with HIV need their voices to be amplified in a way that affords them dignity and respect. Everyone needs access to HIV prevention, treatment, care and support services that are free from stigma and discrimination. We need to ensure that no one is left behind,” he continues. “UNAIDS provides me with an opportunity to turn these important principles into reality.”

Among the achievements he is most proud of during his time in Malawi is the advocacy work that he and his colleagues have been able to carry out with partners such as the United Nations Development Programme and civil society organizations. Together, they worked on the country’s HIV and AIDS Management and Control Act in 2018 to strike out or amend all provisions that criminalized people or discriminated against certain groups. This partnership ensured that the final legislation was consistent with international human rights standards and in line with model laws developed by the South African Development Community and Law Commission.

The new law has helped to create an enabling environment in which HIV services can be provided to everyone in Malawi, including lesbian, gay, bisexual, transgender and intersex people and female sex workers, who are at higher risk of acquiring HIV than the general population.

“The changes to the legal environment have allowed UNAIDS and its partners to work more openly and effectively with key populations such as sex workers and lesbian, gay, bisexual, transgender and intersex (LGBTI) people,” says Mr Ahemesah. “Six LGBTI community-led organizations are now officially registered, which means they can apply for funding, follow training opportunities and be run as fully functional organizations.”

Mr Ahemesah is happy that Malawi is making good progress towards reaching the AIDS targets, including the 90–90–90 targets. There are around 1 million people living with HIV in Malawi, of whom 90% know their HIV status. It is estimated that 71% of people living with HIV are now on treatment and that 61% of people living with HIV have suppressed viral loads.

Advances against HIV have contributed to an increase in the country’s life expectancy, from 46 years in 2000 to 64 years in 2018. Malawi was also the first country in Africa to adopt the Option B+ strategy, which ensures that pregnant women living with HIV have immediate and lifelong access to treatment to ensure that they stay healthy and that their children remain HIV-free.

During the 15 years he has spent working at UNAIDS, Mr Ahemesah has occupied many different roles. His experience will stand him in good stead as he prepares to leave Malawi later this year to take up his next assignment, as the UNAIDS Country Director in Sierra Leone, but it is his passion and commitment to improve the lives of people living with and affected by HIV that continue to be his most valuable attribute.

Tuberculosis (TB) is the world’s number one cause of death from an infectious disease and remains the leading cause of death among people living with HIV, despite being preventable and curable. Reacting to the unacceptable burden of disease and death caused by TB, a new network of TB survivors and affected communities, called TB People, compiled the Declaration of the Rights of People Affected by Tuberculosis, with the support of leading human rights lawyers and the Stop TB Partnership.

The declaration, launched on 14 May at the Global Health Campus in Geneva, Switzerland, will guide countries to implement the commitments made at the 2018 United Nations High-Level Meeting on Tuberculosis and will inform the last board meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) before its replenishment meeting in Lyon, France, in October.

“Too many people have been buried whose lives could have been saved if their rights had been protected,” said Maurine Murenga, communities representative on the board of the Global Fund. “Too many children have survived and been cured of tuberculosis only to be forced to sit isolated on one side of their classroom with their classmates on the other side,” she added.

The lack of human rights protections makes people more vulnerable to developing TB disease, negatively affects their ability to access effective treatment and exposes them to stigma and discrimination by the very fact of having TB. TB-related human rights violations include failures to diagnose or treat people properly, restricted access to health information by people living with TB and shackling prisoners accessing TB treatment in hospital.

For the first time, the rights of people affected by TB that are enshrined in existing global and regional human rights laws are listed in one declaration alongside an explanation of their relevance for people affected by TB. This innovative declaration aims to inform and empower people and communities affected by TB to be able to claim and protect their right to a life free from TB and when necessary to ensure equitable access to quality TB prevention, diagnosis and treatment, free from stigma and discrimination.

“Communities must be put at the centre of the response to tuberculosis ”, said Shannon Hader, UNAIDS Deputy Executive Director, Programme, adding that, “People have the right to science and to be empowered to demand access to the most effective tuberculosis medicines, diagnostics and vaccines—those available now and those we’re striving to create for the future.”

The declaration also seeks to ensure that governments and other service providers are aware of their commitments and obligations to protect and promote the rights of people affected by TB.

During the launch of the declaration, many TB survivors, activists and partners shared stories about how TB and the denial of their rights had directly affected them or their families, including Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization, whose brother almost died from TB for fear of the stigma that surrounds the disease.

Rhea Lobo from TB People described her harrowing experience of having bone TB. The report on her initial bone samples was lost for several months. She was denied a copy of the results so that she could not seek a second opinion and had to resort to smuggling the results out to photocopy and return them. A new doctor discovered that she had been given the wrong treatment dose for six months, putting her at risk of developing drug-resistant TB.

The declaration was dedicated to the memory of Dean Lewis, a tireless activist for the rights of people living with TB and people who use drugs, who had suffered several episodes of TB. Dean was among the core group who conceived and compiled the declaration but died before its completion, owing to the lack of the health services he needed.

One of the 11 UNAIDS Cosponsors, UN Women is working closely with UNAIDS to improve the lives of women and girls worldwide. In Malawi, for example, UNAIDS and UN Women have partnered to reduce the impact of gender-based violence and mitigate the risk of HIV infection among women and girls.

“UN Women is the youngest of the UNAIDS Cosponsors, and we are delighted to work closely with UNAIDS and other partners under the UNAIDS Unified Budget, Results and Accountability Framework 2016–2021,” says Clara M.W. Anyangwe, the representative of UN Women in Malawi. The Unified Budget, Results and Accountability Framework (UBRAF) is a UNAIDS instrument that maximizes the coherence, coordination and impact of the United Nations response to HIV by combining the efforts of the UNAIDS Cosponsors and UNAIDS Secretariat. Its principal aim is to allocate financial resources to catalyse country-level action in the AIDS response.

With UBRAF funding, UN Women in Malawi has teamed up with an impressive number of partners, including UNAIDS, the Ministry of Gender, Children, Disability and Social Welfare, the National AIDS Commission, the National Law Commission, the United Nations Development Programme, the Malawi Network of AIDS Service Organizations and civil society to implement a project that aims to enhance the national response to sexual and gender-based violence, harmful practices, sexual and reproductive health and rights and HIV.

“Working together as UNAIDS Cosponsors is just a better approach,” says Ms Anyangwe. “There is no single agency that can help the country to achieve the UNAIDS 90–90–90 targets. Instead, each agency has a comparative advantage that they bring to the table. In this case, UN Women brings in the gender dimension and UNAIDS its expertise in the HIV response.”

Malawi has made great progress in reducing new HIV infections. In 2017, there were 39 000 new HIV infections, a 40% reduction since 2010, but 9500 of those were among adolescent girls and young women between the ages of 15 and 24 years. That is more than double the number among men of the same age group.

The project has produced a perception study on the prevailing gender norms that increase violence against women and girls and their risk of HIV infection in Malawi, such as rite of passage practices, sexual cleansing, child marriage, marriage by proxy and transactional sex. An indicator framework has been developed from the findings that will be used to track progress of Malawi’s National Strategic Plan for HIV and AIDS.

An important part of the project is to engage with traditional leaders, including those who facilitate rite of passage practices, and mother and father groups. As a result of the engagements, a framework has been developed that links partners in the local HIV, sexual and reproductive health and rights and sexual and gender-based violence response to monitor and address harmful cultural practices that occur during local rites of passage ceremonies.

A series of intergenerational dialogues that brought together young people, people living with HIV and traditional and faith-based leaders revealed that issues such as lack of access to youth-friendly HIV and sexual and reproductive health and rights services, peer pressure, stigma and discrimination and gender-based violence need to be addressed in order to increase young people’s resilience and empower them to protect themselves against HIV infection.

“We also leveraged UN Women’s global He for She campaign to engage men and boys as partners of women and girls. We were looking particularly to foster a positive masculinity. How can we use masculinity to protect women and girls against harmful practices?” said Ms Anyangwe.

During the dialogues, more than 100 men and boys took the pledge to be He for She champions to promote gender equality and reduce HIV and sexual and gender-based violence. The human rights approach embedded in the project has seen laws and policies that relate to HIV and gender translated into local languages and widely disseminated in affected communities.  

Ms Anyangwe insists that leveraging the specific expertise of partners under the UBRAF umbrella is reaping rewards in Malawi.

“It has also been great to have UNAIDS as a member of the Country Coordinating Mechanism of the Global Fund to Fight AIDS, Tuberculosis and Malaria. UNAIDS’ involvement in these mechanisms benefits us all,” she says.

“We really value UN Women’s continued support and partnership in ending HIV and gender-based violence in Malawi,” says Thérèse Poirier, UNAIDS Country Director for Malawi. “It has been beneficial to work as One UN so we don’t confuse our national counterparts by coming in and working separately on different areas of these interconnected and multilayered epidemics,” she said.

The Thai Red Cross AIDS Research Centre (TRC-ARC) has been at the forefront of the response to HIV since the early days of the epidemic, when its director, Praphan Phanuphak, diagnosed Thailand’s first case of HIV, in 1985. Since then, it has continued to develop and promote innovative prevention and treatment approaches, including pre-exposure prophylaxis (PrEP), same-day antiretroviral therapy and key population-led health services.

Located in Bangkok, Thailand, the TRC-ARC is an organization that sits under the umbrella of the Thai Red Cross Society. The Thai Red Cross has been a leading organization in the country’s response to HIV through projects implemented with partners and funded through the United States President’s Emergency Plan for AIDS Relief (PEPFAR).

Since the end of 2014, the TRC-ARC has been offering PrEP to people at higher risk of becoming infected with HIV through projects including the Princess PrEP programme, which is strongly supported by Her Royal Highness Princess Soamsawali. The Princess PrEP programme provides free PrEP services through community-led organizations such as the Service Workers in Group (SWING) Foundation, the Rainbow Sky Association of Thailand, Mplus, CAREMAT and SISTERS. The TRC-ARC also offers members of those community groups comprehensive training on health-care provision, sustainable financing, evaluation and quality control.

Since 2017, the TRC-ARC has also been offering same-day antiretroviral therapy to improve retention in care and adherence to treatment. People who test positive for HIV are initially prescribed a two-week supply of medicine and are then referred to other health facilities to continue their treatment.

Another significant achievement has been the creation of the Tangerine Clinic, the first in the country to offer health care and counselling tailored towards transgender people. The clinic is managed by transgender people and staffed by gender-sensitive medical professionals. It provides sexual and reproductive health-care services, psychosocial counselling, hormone counselling and therapy, HIV testing services and referrals for treatment.

During his recent visit to Thailand, the Executive Director of UNAIDS, Michel Sidibé, paid tribute to the work of Mr Praphan and the TRC-ARC at an event organized by UNAIDS and attended by representatives of the Thai Ministry of Public Health, the Thai Ministry of Foreign Affairs, PEPFAR, USAID, United Nations development partners and civil society organizations.

“The Thai Red Cross AIDS Research Centre has played a key role in developing and promoting innovative and effective prevention and treatment approaches to HIV for more than 30 years,” said Mr Sidibé, “Its contribution expands beyond Thailand, being a catalyst for change across the Asia–Pacific region,” he said.

Mr Praphan thanked UNAIDS for recognizing the achievements of the TRC-ARC and said its work would continue until the end of the AIDS epidemic. “I accept this recognition on behalf of all the people working with me at the Thai Red Cross and in the community to ensure that no one is left behind. We have demonstrated how science, integrated into the community level, can bring health care to the most marginalized groups of people.”

Condoms, if easily available and used consistently and correctly, are one of the most effective and inexpensive methods available to reduce the sexual transmission of HIV and other sexually transmitted infections and to prevent unintended pregnancy. Despite this, condoms are still not sufficiently available to those who need them in many countries with a high burden of HIV.

The estimated condom need in 47 countries in sub-Saharan Africa in 2015 was 6 billion male condoms; however, only an estimated 2.7 billion condoms were distributed.

During a visit to South Africa, UNAIDS Executive Director, Michel Sidibé, has warned that the global AIDS response is at an inflection point, at which gains to date could easily be reversed unless urgent efforts are made to reach targets for 2020 and achieve ambitious goals for the decade beyond.

In a meeting with South Africa’s Minister of Health, Aaron Motsoaledi, Mr Sidibé congratulated the country on its progress made to date and encouraged the government to accelerate action to reach ambitious targets that will put the HIV response on a sustainable path to ending the AIDS epidemic by 2030. Mr Sidibé said it was time to fully leverage the power of communities to close the remaining gaps to the UNAIDS 90–90–90 treatment targets. 

In a meeting with the First Lady of South Africa, Tshepo Motsepe, Mr Sidibé encouraged her to use her voice and outreach capacity to empower people who lacked visibility and access to services, particularly emphasizing the importance of adolescent girls to have access top the human papillomavirus vaccine to prevent cervical cancer. 

Ms Motsepe indicated her willingness to engage on national and international issues for the sake of social development. “Health is not simply the absence of disease,” she said. “Some call me the First Lady, some call me the President’s spouse, but whatever you call me I am a social worker for South Africa.”

Mr Sidibé also met with former South Africa President Kgalema Motlanthe and urged him to keep people alert to the serious risks of losing momentum in the AIDS response and especially the need to engage more men in HIV testing and sustained treatment. 

Mr Motlanthe, who is a member of the Champions for an AIDS-free Generation in Africa, expressed his appreciation for the efforts of Mr Sidibé over the course of his career, including as UNAIDS Executive Director. He noted that Mr Sidibé has repeatedly identified and advocated for crucial steps to advance the AIDS response.

“Your timing has always been spot-on,” he said.  

While in Johannesburg, Mr Sidibé addressed the directors of UNAIDS country offices across eastern and southern Africa. He reminded them of the primary purpose of UNAIDS—to serve the needs of people living with HIV and those at risk of infection. As a health organization, he stressed that UNAIDS plays a unique role in advocating for the rights of vulnerable people, engaging strongly with civil society and insisting that nobody should face discrimination for how they live or who they love. 

“UNAIDS is not an organization driven by logistics or materials,” he said. “It is an organization that puts people at the centre.”

“The AIDS response, especially in eastern and southern Africa, offers lessons and approaches to ensure sustainability through political leadership, resource mobilization and community engagement,” he continued.

“With people behind you, you can really make the world better.”