Leaving the meeting of the REVS PLUS nongovernmental organization, the women bid each other farewell, saying, “A demain soir (See you tomorrow night).” They had gathered at a health drop-in centre that also acts as a network hub for various HIV networks in Bobo-Dioulasso, Burkina Faso, to discuss the following evening’s plan: HIV testing among their peers at selected sites.

“We share our experiences and act as confidantes,” said Camille Traoré (not her real name), a sex worker and peer educator. Her colleague, Julienne Diabré (not her real name), wearing a long flowing dress, chimed in, “In our line of work, it’s hard to confide in someone, so confidentiality is key.”

REVS PLUS/Coalition PLUS advocacy manager, Charles Somé, described the group of women as an essential link in the chain to reach out to sex workers.

“Because of stigma and discrimination, many sex workers hide and move around so they miss out on health services and are much more likely to be infected with HIV,” he said. HIV prevalence among sex workers is 5.4% in Burkina Faso, while it’s 0.8% among all adults in the country.

By recruiting peer educators who know the realities of the job and can relate to other women, Mr Somé said that HIV awareness has increased in the community.

“We also innovated and started HIV testing in the evenings in places where sex workers gather,” he said. Prostitution in Burkina Faso is not illegal, but the penal code forbids soliciting. 

The following evening, along a darkened street, REVS PLUS set up foldable tables with two stools at each table. A solar lamp allowed the peer educators to see in the pitch dark and jot down information. Donning plastic gloves, the trained peer educators sat with women, who had their finger pricked and within five minutes were given their HIV test result. No doctors, no nurses were needed. The testing was done by peers because sex workers are afraid to be identified as sex workers. 

Mr Somé explained that over the years REVS PLUS outreach has gained the trust of sex workers.

Peer educators, he said, regularly called him to complain about police violence. “It went from arbitrary arrests, to stealing their money, to rape,” Mr Somé said.

Ms Diabré described her dealings with the police. “During the day they point a finger at you and discriminate, while at night they become all nice to get favours and if we don’t deliver then it gets ugly,” she said.

After documenting police abuse for a year with the help of bar owners and feedback from sex workers, REVS PLUS met with government officials and then the police.

“Our approach got their attention and we started awareness training with police officers based on law basics and sex work,” Mr Somé said.

Slowly, REVS PLUS identified allies in each police station, facilitating dialogue whenever an issue occurred. In addition, all sex workers now need to carry a health card showing that they have had regular health check-ups.

A Nigerian woman wearing purple lipstick, Charlotte Francis (not her real name), said, “We still have issues and stay out of their way, but it’s gotten better.” She waved her blue health card, which she says bar owners regularly demand.

Showing off his bar and a series of individual rooms around an outdoor courtyard, Lamine Diallo said that the police no longer raid his establishment. “Before, police would haul away all the women and even my customers,” he said.

UNAIDS, with funds from Luxembourg, is currently partnering with REVS PLUS to scale up the police awareness training across the country. Trainings have taken place in the capital city, Ouagadougou, and in Bobo-Dioulasso.

UNAIDS Burkina Faso Community Mobilization Officer Aboubakar Barbari sees the programme as two-fold. “We supported the awareness sessions for police and security forces because it not only reduces stigma, it also puts a spotlight on basic human rights.” 

“I am lucky,” Charles Somé said. The hyperactive human rights advocacy worker from Burkina Faso recalls going to a training event and chiding some of the men there about their sexual orientation. “I had pre-conceived ideas and asked them “Don’t you want to get married?”, “Don’t you want to have kids?”” he said. One young man opened up to him and, after days of honest conversations, Mr Somé had a sea change in his views.

“It dawned on me that if I am not judged, why should I judge others,” Mr Somé said. From then on, when lobbying on behalf of gay men and other men who have sex with men, he has used the word “we”.

“I defend them and respect them,” Mr Somé, who works for the REVS PLUS/Coalition PLUS nongovernmental organization, said. 

Homosexuality is not illegal in Burkina Faso, but stigma and discrimination remains high. Many men marry and hide their double life. Support groups for lesbian, gay, bisexual and transgender people have popped up, but discretion is key.

“I am forced to hide because I am not accepted,” Rachid Hilaire (not his real name) said. He joined an informal conversation group in his home town, Bobo-Dioulasso, where young men talked about relationships, sex, HIV and other issues. “I had many doubts about myself, but once I had more confidence in myself, I felt I could help others,” he explained. Standing outside the REVS PLUS meeting room, he joked with Mr Somé about keeping an eye on him. Mr Hilaire is one of 50 REVS PLUS peer educators who facilitate informal talks like the one he had attended tailored to gay men and other men who have sex with men. After being trained, he and another peer educator led frank talks with men.

Mr Hilaire’s biggest challenge, he said, remains educating the general public, along with political and religious leaders. “I blame the older generation for their lack of awareness,” he said. “Everyone deserves to be free and I long to feel that freedom,” he said. 

Yacuba Kientega (not his real name) fled his home in Bobo-Dioulasso and moved to Ouagadougou when his family found out he had relationships with men. “I eventually came back to pursue my studies in Bobo-Dioulasso, but am living in a different neighborhood,” he said. For him, he felt things had become better for gay men, but he would not give up the fight.

As a lobbyist for an HIV umbrella network, Mr Somé’s battle for people’s rights never ends.

“I really try to have underrepresented communities heard by the government and parliamentarians,” he said. He believes support groups and peer education have helped to reach key populations, such as people who inject drugs, gay men and other men who have sex with men and sex workers. “We have seen an uptick in health-care services by focusing on certain communities and I hope it will stay that way,” Mr Somé said. “Ending AIDS will necessitate really tackling stigma and putting the onus on prevention,” he added.

The UNAIDS Country Director for Burkina Faso, Job Sagbohan, couldn’t agree more. “The HIV response must follow the evolution of the epidemic,” he said. At one time, we had to save lives and we succeeded by concentrating on treatment for all, he explained. “To end the HIV as a public health threat, we need to zero in on prevention and awareness,” he added. “It’s the only way to maintain our progress and end AIDS.”

“The HIV epidemic is a human rights epidemic. An epidemic of human rights loss, denial, derailment and in some instances abuse and violation.” With these words, Kate Gilmore, the United Nations Deputy High Commissioner for Human Rights, opened the Consultation on Promoting Human Rights in the HIV Response.

But while there are commitments, treaties and agreements, action is needed—this was the call from the consultation, held in Geneva, Switzerland, on 12 and 13 February, which sought to share regional and subregional strategies and best practices.

The consultation heard that stigma and discrimination, poor access to justice and punitive laws, policies and practices are barriers to the most vulnerable people accessing HIV prevention, testing, treatment and care.

Throughout the event, there was a central theme of removing harmful criminal laws, funding human rights and working closely with the community, through a call for national and regional institutions to listen, act, lead, reform and fund.

While the traditional human rights barriers—for example, stigma and discrimination and criminalization—persist, new problems are emerging. Questions of how to ensure that criminalized populations are included in universal health coverage, or that human rights and key populations programmes continue to be funded as a country transitions to middle-income status, was raised. A number of speakers, including Michaela Clayton, Director of the AIDS and Rights Alliance for Southern Africa, endorsed a top-down, bottom-up approach to promoting human rights, drawing on the actions of both political leaders and civil society together. 

“This isn’t easy. We can only do this by working in partnership: governments, civil societies, accountability mechanisms, human rights groups and health professionals,” said Tim Martineau, UNAIDS Deputy Executive Director, Programme, a.i.

Faith-based organizations have been delivering HIV services in the countries most affected by HIV since the start of the epidemic. How to strengthen collaboration on HIV services for migrants and refugees was the subject of a recent workshop organized by the World Council of Churches, UNAIDS and partners.

Wangari Tharao, the Director of Research and Programs at Women’s Health in Women’s Hands, migrated from Kenya to Canada at a time when the HIV epidemic was beginning to take hold across Africa. She knows only too well from personal experience the many challenges that migrants face, particularly in relation to health care. Language barriers, poor continuity of care, a lack of health insurance, no social protection and a lack of migrant-inclusive health policies all affect the health and safety of migrants as they seek to settle in new countries and communities.

When she left Kenya, stigma and discrimination around HIV was rife. Today, Ms Tharao says that stigma around HIV is the same. “As migrants we deal with HIV in silence, we are very fearful about stigma and discrimination and are reluctant to enter health-care settings. It is important to think about how to deliver services and how to overcome the challenges faced by populations on the move,” she said.

“We need to understand the life and journey of a migrant from a global perspective and from an individual level in order to understand the challenges they face. Legal status, documentation, proof of identity must never be reasons for denial of health and well-being,” said Tim Martineau, UNAIDS Deputy Executive Director, Programme, a.i.

Although the faith sector has played an important role in the response to HIV, religious beliefs and practices have sometimes been used to justify judgemental attitudes, resulting in stigma and discrimination.

“As faith communities, we can and must do more to support migrants and refugees: to protect them from HIV and tuberculosis; to promote access to health care and prevention; and to reduce stigma, discrimination and violence,” said Olav Fykse Tveit, General-Secretary of the World Council of Churches.

The workshop showcased many examples of faith-based organizations providing services to welcome, protect, integrate and promote the rights of migrants, refugees and other people on the move. Networks provided by mosques, churches and faith communities can form the first entry point of a refugee, migrant or displaced person into a new society.

“People trust faith groups and we can build on that to deliver community outreach, disseminate HIV prevention messages and provide HIV treatment and care services,” said Michael P. Grillo, Director for the Military International HIV Training Program for the United States Department of Defense HIV Prevention Program.

During the workshop, which was held in Geneva, Switzerland, on 20 and 21 February, the participants identified the key elements of a road map to strengthen the engagement of faith-based organizations and expand their role in the response to HIV and in providing services for migrants and refugees. It will build on commitments in the 2016 United Nations Political Declaration on Ending AIDS and the 2018 United Nations Political Declaration on Tuberculosis, while supporting the Global Compact for Migration’s commitments related to the right to health.

The PK5 neighbourhood of Bangui, Central African Republic, is home to much of the city’s Muslim community. Once a bustling commercial area and the centre of Bangui’s nightlife, PK5 has become a no-go zone for many.

Like much of the country, the PK5 area and its population were greatly affected by the violence that engulfed the country in 2012 and 2013. The non-Muslim inhabitants of PK5 left; rival armed groups continue to exert control. Across the country, the consequences of the violence have led to a huge displacement of people and a humanitarian crisis. At the end of 2018, it was estimated that 2.9 million people—more than half of the country’s population—were in need of humanitarian assistance and protection.

However, the people of PK5 remain resilient. Recognizing the need for a greater awareness of HIV in the community, Muslim youth leaders and the Catholic University Center, with the support of UNAIDS, organized an HIV testing and awareness-raising campaign from 23 January to 13 February at the Henri Dunant Health Centre in PK5.

The campaign was the first of its kind to take place in PK5 since the 2012–2013 violence. In the two weeks of the campaign, 1500 people accessed voluntary HIV testing and counselling services. People who tested positive for HIV were referred for treatment.

The campaign was opened by Pierre Somse, the Minister of Health, during an event attended by religious leaders, women and young people. Mr Somse took an HIV test and stressed the importance of all people knowing their HIV status. Knowledge of HIV status in the country remains low, with only 53% of people living with HIV knowing their HIV status.

“The government is committed to intensifying its efforts to deliver health and social services to all Central Africans. PK5 is not forgotten and its population will not be left behind in our efforts to increase access to HIV testing, treatment, care and support,” said Mr Somse.

Pamela Ganabrodji, Head of Information and Counselling at the Henri Dunant Health Centre, added, “We are very proud of what we have achieved through this HIV campaign, but challenges remain. We call on the government and international partners to continue supporting the HIV and sexual and reproductive health activities of the Henri Dunant Health Centre, which are critical in a community where cultural and social taboos represent a key barrier.”

On the last day of the campaign, a community dialogue was held to discuss the HIV and sexual and reproductive health challenges faced by the people of PK5. The needs are urgent and range from basic health and social services to a lack of economic opportunities. Low access to modern contraceptives, incomplete knowledge about HIV and poverty contribute to making young people and women vulnerable to HIV.

“With this campaign, we, the young people of PK5, are showing that we are not helpless and that we are part of the solution for HIV and other social issues,” said Aroufay Abdel Aziz, President of the Muslim Youth of the Central African Republic.

A second phase of the HIV testing and sensitization campaign will continue until the end of March and will include focused HIV prevention messages with sensitization by peer educators and focus group discussions on HIV and sexual and reproductive health issues.

“UNAIDS will continue to engage the government and other United Nations agencies and partners to reinforce the involvement of young people in the HIV response,” said Patrick Eba, UNAIDS Country Director for the Central African Republic.

Healthy populations are critical for Africa’s long-term economic growth, increasing economic gains through raised productivity, job creation and the promotion of equality. However, Africa’s health-care systems require significant investments to meet the needs of their populations and to address changing patterns of ill health across the continent.

The provision of health care in Africa, however, is constrained by a lack of public funds and limited and unpredictable donor funding. As part of innovative efforts to find a sustainable way to strengthen national health systems across the continent, African public and private sector leaders came together at the Africa Business Health Forum on 12 February to promote dialogue and identify opportunities for collaboration.

“Prioritizing health is a political choice and spending on health must be considered as an investment and not a cost. Investments in health are investments in human capital,” said Michel Sidibé, Executive Director of UNAIDS. The Prime Minister of Ethiopia, Abiy Ahmed, added, “We need affordable and quality health care for all, spearheaded by governments and the private sector working collaboratively to enable equitable access.”

During the event, which was held in Addis Ababa, Ethiopia, on the sidelines of the 32nd Ordinary Session of the Assembly of the African Union, the Healthcare and Economic Growth in Africa report was launched. The report will help to guide investments and shape narratives around health in Africa. It highlights opportunities where governments and the private sector can work together to improve health outcomes and ensure quality health care that is accessible for all.  

“By 2030, an estimated 14% of all business opportunities in the health and well-being sector globally will be in Africa, second only to North America. This is a huge opportunity for the private sector,” said Vera Songwe, Executive Secretary, United Nations Economic Commission for Africa.

Also at the event, the African Business Coalition for Health—a platform designed to mobilize a core group of private sector champions to unlock synergies and advance health outcomes to build healthy economies throughout Africa—was launched.

“It is clear that African governments alone cannot solve the continent's health challenges. We have no alternative but to turn to the private sector to complement government funding,” said Aigboje Aig-Imoukhuede, Chairman of the Africa Initiative for Governance and Co-Chair, GBC Health.

“If I am meant to be a leader, I needed to be truthful,” said Lloyd Russell-Moyle, British Member of Parliament, reflecting on his bold move to reveal his HIV-positive status in the House of Commons in late November 2018, days before World AIDS Day.

He explained that for years he would honour people for their outstanding work in the HIV field and yet he never opened up and was honest with people about living with HIV.

“The more people don’t talk about it, the harder it is for everyone. As a Member of Parliament my job involves speaking out, being an advocate and helping people in their journey,” Mr Russell-Moyle said.

In his speech to the House of Commons, he described the sense of fear he had when he learned that he was living with HIV nearly 10 years ago. In his view, there is internal stigma, which kept him from speaking about his status for fear of “spreading” what used to be a deadly disease and the fear that people may reject him if they knew he was living with HIV.

“All that stigma makes a treatable disease life-threatening due to the impact on an individual’s mental health and access to medication,” he said in his emotional 28 November speech. In a telephone interview with UNAIDS, he specified that, “In no way should we glorify HIV, but it is liveable and manageable.” And living with HIV should not hold anyone back in any way, shape or form, he stated.

He desperately wants people to understand HIV better. “I want to get to the stage where I don’t have to explain that if you take one pill a day, you [have a viral load that is] undetectable and if you become undetectable you cannot pass the virus on to anyone,” he said. 

That’s why, with the leading British association representing professionals in HIV care, BHIVA, Mr Russell-Moyle wants to reform certain laws. One European Union law forbids people living with HIV from obtaining a full pilot licence.

“It’s outdated considering that HIV treatment now involves a pill a day with no side-effects,” he said.

He also has been vocal about the British Government’s public health spending cuts. “We are at a crossroads right now, having made so much progress,” Mr Russell-Moyle said. “We are in danger of lifting our foot off the pedal so close to the finish line.”

Not funding vaccine research and reducing sexual health screening and prevention will cost the government in the long run and ruin lives, he predicted. “It’s a race against the disease, and if we slow down at this stage we will likely see a rebound,” he said.

According to Public Health England, 12% of people living with HIV in England are unaware of their diagnosis. A Brighton-based foundation launched a Making HIV History campaign to improve knowledge and encourage people to come forward for testing—Mr Russell-Moyle noted that the Stigmasaurus video animations were a great tool to correct stereotypes.

“We have got the drugs, the tools to allow everyone to live happily, so for those who don’t know their status: get tested, get treatment, it will be okay.” He concluded, “It is okay.”

A Tanzanian delegation touring South Africa has stressed the role of political leadership in the AIDS response and noted the importance of matching policies and legislation to the responses to HIV and tuberculosis (TB).

Led by Oscar Rwegasira Mukasa, the Chair of the HIV and Narcotics Parliamentary Committee of the United Republic of Tanzania, the delegation included Tanzanian Members of Parliament and representatives of the Tanzania Commission for AIDS (TACAIDS). Mr Mukasa said political leaders have an important role to play in uniting efforts in the AIDS response and harnessing domestic resources “so that we can stand on our own feet,” during the 13 to 15 February visit.

The United Republic of Tanzania will take over the Chair of the Southern African Development Community (SADC) in August and the parliamentarians indicated they would use that opportunity to engage SADC ministers of health in developing policies on HIV and TB in the region. We need to align policies and legislation with technical programming for HIV and tuberculosis to ensure that we are in synch with the 90‒90‒90 strategy,” Mr Mukasa said.

This was echoed in a meeting with Aaron Motsoaledi, Minister of Health of South Africa, who emphasized the regional nature of the epidemics of AIDS, TB and malaria and called on the United Republic of Tanzania to use its forthcoming leadership role in SADC to advance coordinated policies and actions. Mr Motsoaledi, who is Chair of the Stop TB Partnership board, reminded the delegates of the inextricable linkage between HIV and TB and noted that TB is the biggest cause of death in South Africa and of people living with HIV.

The delegates explored a range of issues, including the multisectoral response in South Africa, legislation, sustainability and service delivery arrangements, including public, private and community service delivery. The study tour included field visits to a community health centre and a medicine-dispensing ATM.

In a meeting hosted by the South African National AIDS Council (SANAC), its Chief Executive Officer, Sandile Buthelezi, told the delegation that HIV is still very much a health emergency. Noting the high burden of drug-resistant TB, he said that South Africa was adopting new treatment options. “South Africa has strong political leadership, yet still more needs to be done to reach our targets,” he said. Mr Buthelezi stressed the importance of engaging civil society and working with government institutions and the private sector to coordinate efforts and ensure that the needs of people at higher risk of HIV infection and people living with HIV are reflected in HIV programmes.

Mbulawa Mugabe, the UNAIDS Country Director in South Africa, noted the considerable success in the region, but said there was a risk of complacency. “People are on HIV treatment for the rest of their lives and we need political commitment to invest domestic resources to sustain prevention and treatment efforts in the long term,” he said.

Leonard Maboko, the Executive Director of TACAIDS, noted that the parliamentarians would use the results of their study trip to strengthen their national response, explore innovative service delivery models and advance a multisectoral approach. “Too often we talk among ourselves: we need to consult others on these issues,” he said.

The Community, Health Education and Knowledge Building (CHECK) project in Ethiopia is a joint collaborative project between the Italian Agency for Cooperation and Development (IACS) and UNAIDS. The project aims to support awareness-raising on HIV prevention and increase demand for the uptake of HIV and other health services, including for noncommunicable diseases.

The project is run through four implementing partners in Hawassa, which lies in the Southern Nations, Nationalities and Peoples’ Region of Ethiopia. It focuses on women, young people and people living with HIV, including elderly people, female sex workers, prison inmates and the employees of private sector megaprojects.

On 7 February, Michel Sidibé, the Executive Director of UNAIDS, Tibero Chiari, the Director of IACS, and Seharla Abdulahi, the Ethiopian State Minister of Health, visited three CHECK project implementation sites in order to assess progress and meet people benefiting from the projects.

“HIV is a disruption of the social fabric that binds us together. But in Ethiopia, the community linkages hold the social antibodies to counteract HIV. When the community has the correct knowledge it can break the chain of HIV and create stronger linkages between people,” said Mr Chiari.

The Tilla Association of Positive Women runs an embroidery centre that supports women living with HIV in Hawassa through income-generating activities. At the centre, women living with HIV produce a range of knitted and embroidered items, such as school jerseys and uniforms for the security industry. Not only does the centre provide financial support for the women, it also provides a safe space and emotional support for the women who work there.

“Tilla is like your mother’s house,” said Aster Kebede, a woman living with HIV who works at the centre. “It is my home, my school, my work … my everything.”

The Medhin Elderly People Living with HIV Association is a short walk down the road from Tilla and has had the same impact on its members. Many of its members spoke of the impact that stigma and discrimination has had on their lives, especially as elderly people living with HIV, and the loss of husbands, wives, homes and incomes because of stigma. The association has also provided small grants to many of its members, who have used the catalytic funding to generate income, build small businesses and change their lives for the better.  

“Medhin has restored my self-confidence,” said Bizunesh Kensa, a 64-year-old woman living with HIV. “I don’t feel I am vulnerable anymore; nor do I worry.”

The Hawassa Industrial Park is a megaproject employing 28 000 people, 92% of which are young women and many of whom are from the rural areas of the region. Through the CHECK project, the Regional Health Bureau in Hawassa has produced and disseminated materials on HIV prevention and sexual and reproductive health for workers at the megaproject.

“These projects demonstrate that what matters most is the lives of people. They show the power of community-based projects to restore the dignity of people living with HIV and give them hope for the future,” said Mr Sidibé.

The Organisation of African First Ladies against HIV/AIDS (OAFLA) has announced that it is to expand its scope of work to incorporate a broader range of development issues affecting the continent. OAFLA has also changed its name, to the Organization of African First Ladies for Development (OAFLAD), and adopted a vision of “A developed Africa with healthy and empowered children, youth and women”.

During its General Assembly, held in Addis Ababa, Ethiopia, on 11 February, the newly established OAFLAD endorsed its 2019–2023 strategic plan, which outlines the key thematic areas that the first ladies will be working on. These include a continued focus on reduction of new HIV infections and AIDS-related mortality, noncommunicable diseases, gender equality, women’s and youth empowerment, reproductive, maternal, newborn and child health, social security and social protection.

In a tribute to Michel Sidibé, the Executive Director of UNAIDS, the First Lady of Burkina Faso and Chair of OAFLAD, Sika Kaboré, said, “What we will remember from Michel Sidibé’s career is that we can reach ambitious targets if we believe in them, if we unite our forces strategically and if we keep our faith in our populations and in the African values of solidarity and sharing.” A number of first ladies added words of support and appreciation for Mr Sidibé’s leadership and engagement over many years, and he was awarded a certificate of appreciation.

“UNAIDS has worked hand in hand with the Organisation of African First Ladies against HIV/AIDS since that very first meeting in 2002. I had the privileged to be there then and I have the privilege to be with you still today. I urge you all to remain committed to ending AIDS, because together we can ensure a better future for our children and young people, and a generation free from AIDS,” said Mr Sidibé.

The first ladies committed to continue to work on one of their flagship campaigns, Free to Shine, a campaign to end AIDS among children, adolescents and young people and keep mothers healthy. To date, the campaign has been launched in 15 countries across Africa, many having integrated the campaign into their national HIV plans. UNAIDS is providing further funding to launch Free to Shine in Zimbabwe and Sierra Leone, with roll-out starting in 2019.