GENEVA, 13 December 2019—Winnie Byanyima, speaking at the first meeting of the UNAIDS Programme Coordinating Board (PCB) since her appointment as the UNAIDS Executive Director, has outlined her priorities for 2020. Noting that, “The global response to HIV and the Joint Programme provide one of the strongest examples of the value of multilateralism and global solidarity,” she added that, “The year 2020 provides us with an opportunity to reflect upon how the Joint Programme can work even better.”

The Executive Director of UNAIDS said that UNAIDS would step up its work in four areas: women and girls in Africa; defending the human rights of everyone; putting science, innovation and technology in the hands of people; and financing the global AIDS response.

Ms Byanyima noted the enormous progress that has been made in the AIDS response, but told the meeting that, despite major progress by some countries and some regions, the world will overall not reach the target of a 75% reduction in new HIV infections by the end of 2020. The 45th meeting of the PCB, which concluded yesterday, underlined the importance of countries increasing investment in HIV prevention, with no less than one quarter of HIV spending to be invested in prevention programmes.

During the meeting, the PCB also requested a review of the UNAIDS 2016–2021 Strategy, its implementation and the results obtained. The results of the review will be considered in a wide-ranging consultation and will be presented at the next meeting of the PCB, in June 2020, as part of the development of the next UNAIDS strategy.

“The process for the development of the next strategy will be deeply data-driven and consultative, involving UNAIDS staff, our Cosponsors, civil society, people living with and affected by HIV, young people, faith institutions, ministers of health, finance and gender and parliamentarians, scientists, donors and the private sector,” said Ms Byanyima.

In her opening address to the PCB, Ms Byanyima spoke about the challenges and opportunities that lie ahead in the less than 13 months until the end of 2020―when a set of HIV prevention, treatment and other targets should be reached―and the less than 11 years until 2030, the date by which the world has committed to end AIDS.

Ms Byanyima said that her priority would be UNAIDS’ greatest asset―its staff. “Much has been done, but there is still a long way to go. Work must continue to restore trust among staff and with external partners, and to change the culture so that UNAIDS never tolerates any kind of abuse of power, such as harassment, sexual misconduct or bullying, and UNAIDS encourages staff to feel safe and to speak up.”

The PCB, noting the recent Joint Inspection Unit review of the management and administration of UNAIDS, welcomed Ms Byanyima’s commitment to establish an annual PCB agenda item to cover internal and external audits, ethics and other topics on accountability.

In paying tribute to Gunilla Carlsson, the UNAIDS Deputy Executive Director, Management and Governance, who will be leaving UNAIDS in early 2020, Ms Byanyima thanked her for guiding UNAIDS through the recent reputational crisis and facilitating the leadership transition. Wishing Ms Carlsson well in her future endeavours, she praised Ms Carlsson for driving forward critical reforms in management and governance, ensuring protection and support for staff members who have suffered from harassment and abuse of authority and leading the implementation of the UNAIDS Gender Action Plan and the Management Action Plan.

The PCB’s nongovernmental organization delegation put forward a report on universal health coverage, highlighting the role of communities as critical partners and stakeholders in the design and implementation of universal health coverage, and a request was made by the PCB for UNAIDS to continue to support countries to ensure that comprehensive HIV services remain or become available and accessible under a universal health coverage programme.

The last day of the meeting was a full-day thematic session on reducing the impact of AIDS on children and youth, which raised alarm that progress in eliminating new HIV infections among infants and getting children from 0–14 years old living with HIV on effective HIV treatment and thriving has slowed worryingly. The PCB engaged with panels on the importance of youth leadership in shaping the HIV response towards holistic approaches.

Representatives of United Nations Member States, international organizations, civil society and nongovernmental organizations attended the three-day meeting, which was chaired by China, with the United States of America serving as Vice-Chair and Belarus as Rapporteur.

The PCB’s decisions can be found at https://www.unaids.org/en/whoweare/pcb/45.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

10 December 2019

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

I am humbled and excited to be with you in Orkney, in the North West Province of South Africa, to commemorate my first World AIDS Day as the UNAIDS Executive Director.

Thank you for the warm welcome from the heart of your community.

On World AIDS Day, and indeed every day, we remember the millions of lives lost to HIV over the past 40 years, more than three and a half million of them here in South Africa—lives lost to despair, stigma and exclusion.

We also celebrate the struggles and resilience of those alive today because of the huge progress the world has made against the epidemic.

I begin by paying tribute to your liberation movement, which started in townships across South Africa. Your struggle inspired and moved the whole world to action to end the evil system of apartheid. Amandla!

Eyes of the world on South Africa

The eyes of the world are again on South Africa.

After starting late, today you are making remarkable progress against AIDS! More than five million South Africans living with HIV are now on antiretroviral therapy—20% of all the people on treatment in the world.

There was a 53% reduction in the number of AIDS-related deaths from 2010 to 2018.

More than 95% of pregnant women living with HIV are on treatment.

HIV incidence declined by 44% between 2012 and 2017. Great progress!

But even here in South Africa, with all this progress, we cannot rest, and we are still on a journey. Almost 2.5 million people living with HIV are not yet on treatment. We have a job to do. There are more than 1400 new HIV infections among adolescent girls and young women every week. This is intolerable.

So today, on World AIDS Day, here in South Africa and around the world, let us commit to overcoming the challenges and barriers we still face.

Governments have committed to ending AIDS by 2030. We must keep this promise. But business as usual will not get us there.

I am going to talk about five things we need to do, faster and in a more focused way, to beat AIDS.

Women and girls paying the highest price

First, we won’t beat AIDS unless we make huge progress on the rights of women and girls and gender equality in Africa.

It is unacceptable that, worldwide, HIV remains the leading cause of death for women aged 15–49 years.

Millions of poor women and girls are denied the right to make decisions about their health and their bodies.

Fifteen million adolescent girls (aged 15 to 19 years) worldwide have experienced forced sex at some point in their life.

Three billion women and girls live in countries where rape within marriage is not a crime.

Enough is enough.  

All women and girls must have the right to choose if they have sex, and with whom, and how to protect themselves.

We need to bring power, equality and agency to all young women and girls.

When we know that keeping girls in school reduces their risk of acquiring HIV, we must empower all girls to stay in school.

We must bring the power of movements together, the power of the HIV movement, the youth movement and women’s movements, to fight for gender equality and end gender-based violence—then we will beat AIDS.  

Second, we must protect the human rights of all people, end marginalization and the terrible injustice of AIDS-related mortality.

While we should be proud that 24.5 million people around the world are now on life-saving HIV treatment, we cannot accept that 770 000 people died of AIDS-related illnesses in 2018.

We must never accept that in 2019 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. That, we can change.

The system is finally working for millions of people living with HIV, but it is still failing for those who are marginalized: gay men and other men who have sex with men, transgender people, sex workers, people who use drugs, prisoners, foreign workers, migrants, refugees and people with disabilities.

In 2018, more than half of all new HIV infections were among key populations and their partners.

Social injustices and human rights violations are drivers of HIV. They must be tackled, or we will lose the battle on HIV prevention.

It is everyone’s right to access health and information and to be treated with respect and dignity.

On World AIDS Day, I call upon all countries to repeal laws that discriminate and criminalize groups of people and drive them away from life-saving services.

Third, we need to put the science and technology to work to save lives. The world has spent billions of dollars developing the fastest tests, the best treatment and new prevention technologies, such as pre-exposure prophylaxis (PrEP) and other women-controlled methods.

Now let us put them to work, in every community, in every country.

Here in South Africa, your progress to 90–90–90 is impressive:

• Ninety per cent of South Africans living with HIV know their status.
• Sixty-eight per cent of people who know their status are on HIV treatment.
• Eighty-eight per cent of people on treatment have an undetectable viral load. And we know that undetectable = untransmissable (U = U).

I’d also like to commend progress in some districts here in South Africa that have reached 90–90–90 ahead of the target date.

But what would your first 90 be today if you were not using rapid tests?

What would your second 90 look like if you were still waiting months or years for someone to go on treatment?

How many people would have reached viral suppression if you were still using a treatment regimen of three, or six or 12 pills per day instead of a one-pill fixed dose combination?

In clinics and countries around the world, these outdated tools are what is keeping us from reaching 90–90–90. We cannot end the AIDS epidemic in the twenty-first century using twentieth century tools and approaches.

The true power of science and innovation is only when it is in the hands of the people.

We have only 13 months remaining to reach 90–90–90, and there is so much work to do, so many lives to save.

Today, I am calling on every ministry of health, every national AIDS programme, every community, to be bold and quick to get on the Fast-Track. Let us put science, innovation and technology to work for the people.

Empowered communities accountability

Fourth, communities are the focus of the UNAIDS World AIDS Day report.

On Friday, I visited the Block X clinic in Tshwane and met amazing people living with HIV. I saw how the Ritshizde project, with five leading organizations for people living with HIV, under the leadership of the Treatment Action Campaign, is unleashing the power of community accountability—empowering people living with HIV to monitor the services they access, advocate for changes in how services are delivered and hold officials and service providers accountable.

We can spend billions of dollars or rand, building beautiful clinics to distribute millions of pills. 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.

Here in South Africa, I have learned about Operation Sukhuma Sakhe—this is a model of community development in KwaZulu-Natal that put communities at the centre of development. It is an integrated approach for empowering communities, addressing social drivers and fighting poverty and inequality. I commend the Minister of Health, Zweli Mkhize, for introducing this when he was the Premier of KwaZulu-Natal.  

Financing to get to the end of AIDS

Finally, we will not get to the end of AIDS without the resources to sustain the race.

We celebrate the commitment of the Government of South African for committing nearly US$ 2 billion per year from domestic public resources for HIV. South Africa is a trailblazer for investing in the fight against AIDS. I urge all governments to follow its lead.

Yet, Africa, the region with the highest burden, is facing serious financing challenges that undermine its ability to invest in health care for all its people.

There are four particular issues to pay attention to.

The first is international tax avoidance. Billions of dollars of profits are channelled from Africa to tax havens offshore, shrinking the capacity of African governments to invest in health and other vital development priorities.

No one country can solve the problem of corporate tax dodging alone. African countries, which are the biggest losers, must call for urgent, concerted international action. The BEPS 2.0 process promoted by the Group of 20 with the technical assistance of the Organisation for Economic Co-operation and Development is a step in the right direction.

The second issue is the frustrating stagnation and even decline in domestic revenue mobilization across Africa. Despite a decade of economic expansion, progressive tax reforms that could allow for bigger budget allocations for social investments have not happened. African countries lack the systems to capture tax from private investments, especially from international companies. Countries are failing to raise the resources they need.

The third issue is debt. From 2008 to 2017, tax collection to gross domestic product reduced (down from 20% to 18%), while debt stocks grew at a 10% annual rate. While borrowing has allowed African economies to expand, it has now turned into a serious problem.

Half of African low-income countries are already in debt distress or at high risk of being so. Debt repayments are now eating up public budgets, and what we most care for is now under threat: investments in public health, including the AIDS response.  

Two examples. In the last three years (between 2015 and 2018), health spending in Kenya dropped by 9% and debt servicing increased by 176%. In Zambia, the figures are even more staggering: there was a nearly 30% drop in health spending and an increase in debt servicing of 790%. 

Africa has entered a new debt crisis.

Vulnerable people, including people living with HIV, must not be made to pay the price of the crisis. UNAIDS will work with African countries to chart pathways out of the crisis that protect and increase investments in universal health care, including their AIDS responses.

Fifth and finally, ending AIDS is a shared responsibility. And to the partners and donors here today, I ask you not to roll back at this time of need. The share of aid for public health has stagnated in recent years. This needs to be reversed.

More positively, last month, governments and foundations responded to the call of the President of France, Emmanuel Macron, making unprecedented donations to the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). This is proof that global solidarity is not exhausted. It is stronger than ever.

We cannot allow the poorest and the most vulnerable to pay with their lives.

I call on all donors, development partners, foundations and the private sector to go the extra mile. Even with the Global Fund replenishment and the amazing support of the United States President’s Emergency Plan for AIDS Relief, we still need to close the growing funding gap to end AIDS once and for all.

Conclusion

Comrades, we can beat AIDS if we focus and work harder and faster towards our 2030 goal.

We must roll back patriarchy and empower women and girls and root out violence against them.

We have to fight stigma, discrimination and criminalization and guarantee the human rights of all marginalized groups.

We must invest in more scientific innovations for prevention, testing, treatment and care and empower communities to lead the response on the ground. We must find national pathways towards sustainable long-term financing of AIDS responses. All these are achievable—they are an exciting and wining agenda!

And when we win, we will not just end AIDS. We will have fairer, more equal and healthier societies.

We will build societies based on gender equality and justice for all. 

We will live lives where everyone is valued and can fully exercise their rights and where nobody is left behind.

This is the call of World AIDS Day. This is the call of the 2030 Agenda for Sustainable Development.

The world has only one year and one month left to reach the 2020 targets.

The world has only 11 years to meet its commitment to end the AIDS epidemic and reach the Sustainable Development Goals.

There is no time to lose. We can do it.

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."

Cabinet Secretary, Acting Governor James Nyoro, colleagues from the United Nations system. Jambo!

Community health volunteers, you are my heroes. I am so happy to be here with you today in Kiambu County, Kenya.

And I thank you for the warm welcome from the heart of your community at the launch of the UNAIDS report, Power to the people.

Thank you, young people. Especially the young person with a disability who just spoke to us, who reminded us that not all people living with HIV are the same—they are all different, and we must be inclusive. We will remember it. We will act on it.

I want to express my sincere condolences and solidarity with the people of West Pokot on the tragic loss of life and property following the torrential rains and landslides. I hurt with you.

Launch of Power to the people

I am here because Africa is the continent still most affected by the HIV epidemic.

More than 25 million people are living with HIV in sub-Saharan Africa—more than two-thirds of the global total of 37.9 million people living with HIV.

I am also here because many countries in Africa are leading the way to end AIDS. We are heroes, fighting the epidemic.

In Kenya, AIDS-related deaths have fallen by more than 50% since 2010, and new HIV infections are down by 30%. This is a great achievement. Great progress in a short time.

Today, I can announce that 24.5 million people living with HIV around the world now have access to life-saving treatment. Great news and great progress.

Joining the marathon to end AIDS

This is a special day for me.

I am launching my first UNAIDS report.

With this new report, I am paying tribute to the families and communities devasted by AIDS, the women’s grass-roots groups and the communities that have mobilized and transformed the AIDS response. I congratulate you. We owe you a lot.

In my country, women got together in villages, bought saucepans and blankets, looked after each other, buried the dead, didn’t let anyone suffer alone. It was the women in our communities who did that.

Today, I am committing UNAIDS to take some big steps in a new direction.

Fight inequality and poverty

The first step is to address inequality and the injustices that fuel the HIV epidemic.

AIDS hurts people who live in poverty. This is a problem for everyone, but a big problem for the poor.

We have to address inequality. It cannot be right that some people get treatment and live long lives, while others cannot access health care and die.

We must fight inequality, lift all people up out of poverty.

We need to provide more services—education, health, social protection. That is how we will end AIDS.

Gender equality and women’s rights are key

We must advance women’s rights if we are to end AIDS, so our second big step in the race to end AIDS must be to tackle gender inequality.

Despite progress in prevention and treatment, HIV remains the leading cause of death for women aged 15–49 years worldwide.

Every week, 6000 young women aged 15–24 years are newly infected with HIV.

Across sub-Saharan Africa, young women and girls face rates of HIV far higher than men and boys.

Young women in sub-Saharan Africa aged 15–24 years are twice as likely to be living with HIV than men of the same age.

These are numbers that shame us all.

This is a gender injustice with tragic repercussions. Why are young women more vulnerable?

If we are going to keep our promises, we must end the gender power imbalances that are driving HIV risk and vulnerability.

We need to champion gender equality and empower young women and girls to transform our societies.

Worldwide, one in three women will experience physical or sexual abuse in her lifetime.

In too many of our communities, a women’s first experience with sex is violent, is forceful. That is the reality.

Yesterday, we launched 16 days of activism against gender-based violence. Every day we should commit to achieve equality for women and girls, so their vulnerability to violence can end.

Here in Kenya, I am concerned about the rate of femicide.

Every week, we read a media report of a woman, often a young woman, killed by her partner.

We need to speak up for these women, call for justice and an end to impunity. The world must be a safe space for all of us.

UNAIDS will pay more attention to fighting those laws, traditions, cultures and practices that enable and perpetuate gender-based violence. A woman’s body is her body.

It is our urgent duty to ensure that all women and girls, of all ages, have unrestricted access to sexual and reproductive health services.

We cannot accept that millions of women still cannot get access to contraceptives, because we know that their right to contraception is core to their empowerment across every aspect of life.

We are doing an injustice to millions of young people who still cannot access the simple health services they need: free condoms, an HIV test without parental consent and pre-exposure prophylaxis.

Keeping girls in school reduces their risk of HIV. We need to ensure that all young people can stay in school, and that every school provides quality comprehensive sexuality education—to know about their bodies, their health.

UNAIDS, together with our Cosponsors—the United Nations Population Fund, the United Nations Entity for Gender Equality and the Empowerment of Women, the United Nations Educational, Scientific and Cultural Organization and the United Nations Children’s Fund—will step up for women and girls, especially in Africa.

Human rights

The third step I ask us to take today is on human rights.

The human rights and citizen rights of women and girls, gay men and other men who have sex with men, transgender people, sex workers, people who use drugs and prisoners are being denied.

Without judgement, we must ensure that they can access HIV services, so this disease can end. We must treat them as equal citizens, so they can enjoy their right to health and get services to protect themselves and their partners from HIV.

One third of key populations do not know their HIV status.

In many countries, we still have laws that criminalize key populations or discriminate against people living with HIV, so they go underground and hide, and when they hide they can’t enjoy their right to health.

The crackdowns and restrictions on gay, bisexual, transgender and intersex groups and campaigns are unacceptable.

Young people are being judged and punished for who they are and who they love.

We will not end AIDS unless we guarantee the human rights of all people, especially key populations.

Funding and resources

Despite progress in recent years, there are still not enough resources available to end the AIDS epidemic. Poor countries are struggling to pay for everything they need—health, education, roads, water, sanitation.

Health should be a top priority. Without healthy people, we will not make progress.

Two-thirds of countries in Africa still charge fees for health care, and millions of people are just one sickness away from falling into extreme poverty.

Despite the world’s commitment to implement universal health coverage, the percentage of people paying catastrophic health costs out of their pocket has only increased in the past five years. Health cannot be a privilege for the rich—it should be a right for everyone.

Public debt has climbed above 50% of gross domestic product in half the countries in sub-Saharan Africa. In a constrained fiscal space, governments must find pathways to a sustainable long-term financing of their HIV responses. We want to work with governments to see how to create fiscal space and manage their priorities within budgets reduced by debt repayments.

During the recent replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, countries and foundations made a historic down payment to advance the end of AIDS. But more work is also needed to ensure that every dollar, euro and shilling is being used effectively.

In many middle-income countries, governments are still paying thousands of dollars more for the same quality medicines that are available to low-income countries for just pennies a day. This is unacceptable. We will try hard to see that prices come down.

Universal access to quality health care is not a commodity—it is a human right.

Conclusion

I do not underestimate the challenges ahead, but I feel a lot of excitement about what can be achieved for people. We are standing on the shoulders of people who fought—how can we fail to finish?

What I have called for today requires some urgent changes.

Changes in how we think what is possible.

Health care for each and every person—this is not impossible.

Changes in how quickly we act.

Changes in how we work as UNAIDS—we need to look at ourselves in the mirror.

But let us be in no doubt, we can end AIDS.

I’ve lost loved ones.

We can go into a future of health for all.

Cabinet Secretary and all the activists here today, I wish you all the best in your endeavours. UNAIDS is right behind you.

Game-changing approaches, such as medicine to prevent HIV (PrEP), integration of contraceptive services with HIV testing, viral load suppression (U = U), harm reduction, and comprehensive sexuality education, give people the power to protect themselves from HIV and, for people living with HIV, the power to thrive

NAIROBI/GENEVA, 26 November 2019—A new report by UNAIDS, Power to the people, released ahead of World AIDS Day, shows that where people and communities living with and affected by HIV are engaged in decision-making and HIV service delivery, new infections decline and more people living with HIV gain access to treatment. When people have the power to choose, to know, to thrive, to demand and to work together, lives are saved, injustices are prevented and dignity is restored.

“When people and communities have power and agency, change happens,” said Winnie Byanyima, Executive Director of UNAIDS. “The solidarity of women, young people, gay men and other men who have sex with men, sex workers, people who use drugs and transgender people has transformed the AIDS epidemic—empowering them will end the epidemic.”

The report was launched in Kenya on 26 November by the Executive Director of UNAIDS, the Cabinet Secretary of Health of Kenya and community representatives. It shows that significant progress has been made, particularly in expanding access to treatment. As of mid-2019, an estimated 24.5 million of the 37.9 million people living with HIV were accessing treatment. As treatment roll-out continues, fewer people are dying of AIDS-related illnesses.

“The partnership between government and civil society, together with the meaningful involvement of communities, has allowed us to significantly reduce new HIV infections and AIDS-related deaths,” said Sicily Kariuki, Cabinet Secretary for Health in Kenya. “Communities are the very centre of the AIDS response and are critical to ending AIDS.”

Progress in reducing HIV infections, however, is mixed and 1.7 million people were newly infected with the virus in 2018. New HIV infections declined by 28% from 2010 to 2018 in eastern and southern Africa, the region most affected by HIV. In a promising sign, the incidence rate of HIV among adolescent girls and young women aged between 15 and 24 years in the region declined from 0.8% in 2010 to 0.5% in 2018, a 42% decline. However, young women and girls still bear the brunt of new HIV infections—four out of five new HIV infections among adolescents in sub-Saharan Africa are among girls.

Outside of eastern and southern Africa, new HIV infections have declined by only 4% since 2010. Of increasing concern is the rise of new HIV infections in some regions. The annual number of new HIV infections rose by 29% in eastern Europe and central Asia, by 10% in the Middle East and North Africa and by 7% in Latin America.

“In many parts of the world, significant progress has been made in reducing new HIV infections, reducing AIDS-related deaths and reducing discrimination, especially in eastern and southern Africa, but gender inequality and denial of human rights are leaving many people behind,” said Ms Byanyima. “Social injustices, inequality, denial of citizenship rights and stigma and discrimination are holding back progress against HIV and the Sustainable Development Goals.”

Power together

The report shows that when people and communities have power and agency, change happens. Communities have put rights-based, people-centred principles at the heart of HIV programmes, ensuring that AIDS responses tackle the inequalities and injustices that fuel the epidemic.

Women and girls are the backbone of care support in their families and communities, providing unpaid and often undervalued work in caring for children, the sick, the elderly and the disabled and underpinning fragile social support systems. This must change. The involvement and leadership of communities of women is vital in the response to HIV.

“As a community leader, I am able to relate to people and understand their background better than someone from the outside. I have been living openly with HIV for 25 years, so people come to me with their issues, such as HIV-related stigma, disclosure and adherence. I have never stepped back from this role as I am part of this community,” said Josephine Wanjiru, an HIV community activist Kiandutu, Thika, Kenya.

The power to choose

Women and girls are demanding integrated contraception and HIV and sexually transmitted infection testing, prevention and care options. Almost 40% of adult women and 60% of adolescent girls (aged 15–19 years) in sub-Saharan Africa have unmet needs for modern contraception.

In several countries in sub-Saharan Africa, young women’s uptake of medicine to prevent HIV—pre-exposure prophylaxis (PrEP)—has been shown to be high in projects that integrate PrEP into youth-friendly health services and family planning clinics and when provision of PrEP is separated from treatment services.

Eleven million voluntary medical male circumcisions to prevent HIV have been performed since 2016, 4 million in 2018 alone in the 15 priority countries.

The power to know

The power to know allows people to keep themselves free from HIV or, if living with the virus, keep healthy. However, people are finding out their HIV status too late, sometimes years after they became infected, leading to a delay in starting treatment and facilitating HIV transmission. In Mozambique, for example, the average time for diagnosis after infection for men was four years.

Adherence to effective treatment suppresses the virus to undetectable levels, keeping people healthy and preventing transmission of the virus. Knowing this allows people living with HIV the opportunity to lead normal lives, confident that they are protecting their loved ones, and confronting stigma and discrimination.

HIV self-testing is now helping more people to find out their HIV status in privacy, breaking the barriers of stigma and discrimination and facilitating linkage to treatment.

Knowledge of HIV among young people is alarmingly low in many regions. In countries with recently available survey data, just 23% of young women (aged 15–24 years) and 29% of young men (aged 15–24 years) have comprehensive and correct knowledge of HIV. Studies show that comprehensive sexuality education does not lead to increased sexual activity, sexual risk-taking or higher infection rates for HIV or other sexually transmitted infections.

The power to thrive

The power to thrive is ensuring that people have the right to health, education, work and a standard of living adequate for health and well-being.

New HIV infections among children have declined by 41% since 2010 and nearly 82% of pregnant women living with HIV are on antiretroviral therapy. However, thousands of children are falling between the cracks. Half of all children born with HIV who are not diagnosed early will die before their second birthday, but, globally, only 59% of HIV-exposed children were tested before two months of age.

In 2018, 160 000 children (aged 0–14 years) became newly infected with HIV, and 100 000 children died from an AIDS-related illness. They died either because they weren’t diagnosed, or because of a lack of treatment—a shocking indictment of how children are being left behind.

Gender inequalities, patriarchal norms and practices, violence, discrimination, other rights violations and limited access to sexual and reproductive health services exacerbate the risk of HIV infection among adolescent girls and young women, particularly in sub-Saharan Africa. Each week, an estimated 6000 young women (aged 15–24 years) are infected with HIV.  

In Eswatini, a recent study showed that adolescent girls and young women who experienced gender-based violence were 1.6 times more likely to acquire HIV than those who did not. The same study also showed that the economic empowerment of women and girls helped in reducing new HIV infections among women by more than 25% and increased the probability of young women and girls going back to school and finishing their education.

Key populations are being left behind

Key populations and their partners account for at least 75% of new HIV infections outside of sub-Saharan Africa and are less likely to be on treatment than others. More than one third of key populations do not know their HIV status. Community-led support among gay men and other men who have sex with men is effective in increasing the uptake of PrEP, promoting safer sex, increasing HIV testing rates and supporting treatment adherence.

Transgender people are subjected to discrimination in every sphere of life, including education and employment—only 10% work in the formal economy. But community activism has led to long overdue attention to the rights and realities of transgender people.

Community empowerment activities among sex workers have been shown to increase the odds of condom use with clients by three times and reduce the odds of HIV infection by more than 30%.

The power to demand

The power to demand gives communities and individuals the power to participate in the decisions that affect them. There have been reports of crackdowns, restrictions and even attacks on groups and campaigns supporting key populations. Some governments refuse to recognize, support or engage community organizations in their national responses to HIV and are subsequently missing out on their enormous potential to reach the people most affected by HIV.

People and communities will end AIDS

The work of community-led organizations is unique and powerful and can have a substantial impact on how the world fairs towards ending AIDS. UNAIDS urges all countries to fully support and enable their community-led organizations, ensure they have a seat at all decision-making tables concerning the health and well-being of their community members and remove any barriers to their active engagement in the response to HIV. Only by fully funding and fully supporting the work of community organizations will the end of AIDS become a reality.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

1 December 2019

I believe in communities.

Communities make change happen.

Communities are the best hope for ending AIDS because communities have fought against HIV right from the beginning!

As the epidemic raged through our countries, cities, villages, women held communities together and bore the higher burden of care for their families.

For far too long we have taken their volunteerism for granted.

In the face of adversity, communities of gay men, sex workers and people who use drugs have organized themselves to claim their right to health as equal citizens. 

So, we know that communities have proved their worth. There is no debate there.

Without communities, 24 million people would not be on treatment today. Without communities led by women living with and affected by HIV, we would not be close to ending new HIV infections among children, raising orphans and caring for the sick. 

Twenty-five years ago, a Burundi woman called Jeanne was the first person to disclose that she was living with HIV. Today, Jeanne is holding leaders accountable and fighting for the right to health care.

Pioneers like Jeanne have been joined by younger leaders, like 20-year-old Yana, who was born with HIV in Ukraine. Yana founded Teenergizer, a group bringing together young people across eastern Europe. In a world where power resides with old men, she wants her peers to have a voice and a choice.

Consider Fiacre. He lives in Central African Republic, displaced by conflict along with thousands of others. Fiacre cycles to a clinic, crossing barriers and checkpoints to collect antiretroviral medicines for him and members of a group he belongs to. Without this support, each person would have to make the dangerous journey on their own. Simply amazing.

As you can see, communities make the difference all over the world.

However, the way communities are being taken for granted has to change.

On World AIDS Day, UNAIDS salutes the achievements of activists and communities in the struggle against HIV. We remember and we honour all those whom we have lost along the way. Activists challenged the silence and brought life-saving services to their communities. But the countless contributions by women and many others can never replace the responsibility of governments.

Let me remind you, governments committed to at least 30% of HIV services being community-led. 

They also agreed that 6% of all HIV funding go to community mobilization, promoting human rights and changing harmful laws that act as barriers to ending AIDS.

Let’s be clear, defending human rights and challenging discrimination, criminalization and stigma is risky work today.

So, we call on governments to open a space so that activists can do the work they do best.

With communities in the lead and governments living up to their promises, we will end AIDS.

Winnie Byanyima

Executive Director of UNAIDS

Under-Secretary-General of the United Nations

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.