UNAIDS campaigns have dominated the global effort to end HIV/Aids as a public threat since 1999. Credit: UNAIDS

By Ed Holt
BRATISLAVA, Dec 1 2025 (IPS)

“It’s like adding fuel to an already burning fire,” says Aditia Taslim.

“We have not recovered from the impact of the US funding cuts earlier this year, and closing down UNAIDS prematurely will only make things worse, especially for key populations and other criminalized groups, including people who use drugs,” Taslim, who is Advocacy Lead at the International Network of People Who Use Drugs (INPUD), tells IPS.

Her view is shared widely by HIV activists around the world who were stunned by a proposal from UN Secretary-General Antonio Guterres in September, included in a report on progress on UN reforms, to shut down the UN’s main agency to fight HIV/AIDS next year.

UNAIDS, the civil society groups that sit on its board, experts, and national governments across the globe had already been working on a transformation plan for the agency, which would see it end in its present form around 2030 when current HIV targets expire.

And many still do not understand exactly why closure next year is now being planned.

“There is a lot of confusion around this right now. We’re not sure why 2026 was chosen. Perhaps it was because we were in fact already in a process of transformation,” Angeli Achrekar, Deputy Executive Director of the Programme Branch at UNAIDS, told IPS.

But the proposal has been met with vociferous pushback—a call from the UNAIDS Programme Coordinating Board (PCB) NGO Delegation to the Secretary General urging him to reconsider was endorsed by more than 1 000 NGOs.

World Aids Day has been commemorated since 1988 and is a significant platform for people to unite against the disease. Credit: UNAIDS

Many of those same groups have warned that if the early closure does go ahead, gains in fighting the disease will be at risk, and, some are certain, lives will be lost unnecessarily.

“If this happens, the world will be much less effective in preventing and treating HIV, which means more people dying from a disease that is completely preventable and treatable. There’s no doubt in my mind that closing UNAIDS will lead to more HIV infections and deaths,” Julia Lukomnik, Strategic Advisor at Dutch organization Aidsfonds, told IPS.

UNAIDS, which started operations in 1996, is unique among UN structures in that its governing board actually includes civil society groups. This, experts say, has meant that in all its work, those on the ground working directly with the communities affected by the disease – not just people living with HIV (PLHIV), but also key populations most at risk, including drug users, sex workers, members of the LGBT+ community, and others—have had a crucial say in developing its policy and implementing its work.

Indeed, while the agency’s activities include treatment projects, in many countries it is seen as a vital bridge, directly and through partnerships with local NGOs, between communities and local, regional, and national authorities.

“If UNAIDS were to close in 2026, the impact would be significant, particularly in countries like Vietnam where community-led organizations depend on UNAIDS for data, technical guidance, coordination, and engagement space. UNAIDS has played a critical bridging role, connecting governments, donors, and civil society in Vietnam,” Doan Thanh Tung, Executive Director at Lighthouse Vietnam, one of the largest LGBTQ+ organizations in Vietnam, told IPS.

This is of particular concern at a time when marginalization and criminalization of key populations and PLHIV in many countries is worsening.

UNAIDS has played a crucial role in advocating for the rights of key populations and PLHIV, including helping bring in landmark legislation enshrining some rights and access to services.

UNAIDS workers provide support to communities in need of their services. The organization and its workers have been badly affected by the impact of a sudden acceleration of cuts to international HIV financing. Credit: UNAIDS

Campaigners fear that without UNAIDS presence, some communities would very quickly face increased marginalization or criminalization, without anyone to speak up for them.

“We’re in a context of increasing criminalization of key populations for the HIV epidemic. We know—in part because of UNAIDS— that violating the rights of key populations leads to increased HIV cases. When you criminalize gay and trans people, you increase HIV cases. When you criminalize sex workers, you increase HIV cases. When you criminalize safe injection sites, you increase HIV cases,” said Lukomnik.

“Closing the UN body that most strongly advocates for the human rights of these groups at the very time when these rights are increasingly threatened will almost certainly increase both rights violations and HIV cases,” she added.

Within UNAIDS, officials are aware this could be a problem.

“The question is where can advocacy for key populations be maintained [without UNAIDS] in countries. UNAIDS can raise issues to do with key populations with governments. Will other organizations be able to do that?” Eammon Murphy, UNAIDS Director, Regional Support Teams for the Asia Pacific and Eastern Europe and Central Asia regions, told IPS.

“One of the critical functions we perform is being the voice of communities. The voice of the community must be safeguarded at the local, regional and global levels,” Achrekar said.

As well as allowing it to advocate for communities, the trust that communities have with the agency means it can have a better view of an epidemic in a given country than state authorities might have, say experts.

They highlight UNAIDS’ vital role in collecting and evaluating data on the disease in specific communities and using data to develop effective interventions and national policies and set HIV targets. If that monitoring and evaluation capacity is lost suddenly with no time to replace it properly, the impact on authorities’ efforts to fight an HIV epidemic could be devastating, they argue.

“UNAIDS set the targets for the global AIDS response that has given countries the ability to shape their strategic plans to respond to HIV and AIDS. Those targets and strategic plans ensured high-impact interventions that led to a reduction of new HIV infections, addressing inequalities, gender-based violence and stigma and discrimination against people with HIV or AIDS,” Tendayi Westerhof, National Director, Pan African Positive Women’s Coalition-Zimbabwe, told IPS.

“It was responsible for the Global AIDS  Programme report that monitored progress of the AIDS response by countries. If UNAIDS is closed, this will have a huge impact on the monitoring of progress by countries in fighting AIDS,” she added.

The proposed closure of the agency also comes at a time when HIV groups are still reeling from recent upheavals in global aid funding.

The withdrawal of US aid at the start of this year, which had previously accounted for 73 percent of international HIV/AIDS financing, has already had a devastating effect on the fight against the disease, forcing many organizations on the frontline of the HIV response to close.

UNAIDS modeling forecasts the funding cuts could lead to an additional 6.6 million new HIV infections and 4.2 million AIDS-related deaths by 2029.

Closing UNAIDS against this backdrop could further imperil the sustainability of the HIV response in some places, especially in those where services for key populations are already underfunded.

“We have seen the impact of the abrupt funding cuts from the US, which have crippled a lot of harm reduction services and forced many drug user-led networks and organizations to close their operations. Harm reduction has also been severely underfunded. Closing down UNAIDS will only create reasons for governments to close down services and programmes, as well as funding for people who use drugs,” said Taslim.

“In most low- and middle-income countries, services and programmes for people who use drugs… are still heavily dependent on international donors. Closing UNAIDS prematurely means that services and programmes for our community will be the first to be removed from national priorities. There is no sustainability strategy in place for services and programmes for people who use drugs and other key populations, as well as other criminalized and marginalized communities,” he added.

Tung warned that dismantling UNAIDS at a time when global funding for HIV is shrinking “would likely erode global-to-local solidarity, reduce community engagement in the HIV response, and weaken independent data systems, which could further exacerbate the epidemic and undo decades of progress in HIV prevention and control that would be extremely difficult to recover.”

But while activists warn of the potential for a 2026 closure of UNAIDS to profoundly impact the world’s HIV response, they also point out that so far it is only a proposal and that there is some hope it may not come to pass.

“The proposal to end UNAIDS in 2026 was made by the UN Secretary General, but it’s really up to the UNAIDS PCB to make this call,” said Lukomnik.

UNAIDS officials point out that the agency had already begun a process of transforming itself.

Earlier this year, the PCB set out its plan to restructure between 2025 – 2027, and then review its structure and mandate again in 2027. It had been expected that after that, a transition period would see key UNAIDS functions shifted to other parts of the UN system or other actors involved in the HIV response by 2030.

The first phase of this restructuring involved the agency this year beginning a huge reduction in the number of its staff and offices around the world—both are to be cut by more than 50 percent.

Achrekar said the transformation was in part a response to global funding changes but also to reflect moves towards greater sustainability in the global HIV response.

“Our transformation is partly because of the current funding volatility, but it was already underway before that. We are focused on ending AIDS as a public health threat by 2030 and even before the General Secretary’s proposal, we at UNAIDS knew that we had to transform for where the HIV response was shifting to in the future—that as countries start to approach 2030 HIV targets, the HIV response would need to be sustainable after 2030. Our transformation means we can be fit for when the HIV response needs to become sustainably supported by countries,” said Achrekar.

“We are not certain if this SG proposal can be turned back. But we believe there could be a way to bring some coherence to what the SG has proposed and the transition we had already planned. UNAIDS is not afraid of transforming,” she added.

However, if the proposal does come to pass and UNAIDS closes next year, the organization is hoping others involved in the global HIV response will be able to step up, to some extent, to help maintain the response.

“We are just one player in the HIV response and all the others have critical roles too. The global solidarity in the HIV response must be maintained in future and we have to be able to safeguard what is critical in the HIV response and the people affected by HIV,” Achrekar said.

Note: This article is brought to you by IPS Noram in collaboration with INPS Japan and Soka Gakkai International in consultative status with ECOSOC.

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About 9.2 million people across the world living with HIV were not receiving treatment in 2024, according to the UNAIDS report. At the launch of the report were Rev. Mbulelo Dyasi, Executive Director of SANARELA. Winnie Byanyima, UNAIDS Executive Director, Aaron Motsoaledi, Minister of Health of South Africa. Juwan Betty Wani, Programme Coordinator, Adolescents Girls and young women Network South Sudan. Helen Rees, Executive Director, Wits RHI. Credit: UNAIDS

By Jennifer Xin-Tsu Lin Levine
UNITED NATIONS, Jul 10 2025 (IPS)

UNAIDS called the funding crisis a ticking time bomb, saying the impact of the US cuts to the President’s Emergency Plan for AIDS Relief (PEPFAR) could result in 4 million unnecessary AIDS-related deaths by 2029.

A historic withdrawal of global HIV/AIDS funding threatens to derail decades of hard-won progress in the fight against AIDS, according to UNAIDS’ annual report, entitled Aids, Crisis and the Power to Transform. This funding shortage – caused by sudden and massive cuts from international donors – is already dismantling frontline services, disrupting lifesaving treatments for millions and endangering countless lives in the world’s most vulnerable communities.

“This is not just a funding gap—it’s a ticking time bomb,” said UNAIDS Executive Director Winnie Byanyima.

Despite major strides in 2024, including a decrease in new HIV infections by 40 percent and a decrease in AIDS-related deaths by 56% since 2010, the onset of restricted international assistance, which makes up 80 percent of prevention in low- and middle-income countries, could have disastrous effects. The report, mostly researched at the end of 2024, concluded that the end of AIDS as a public health threat by 2030 was in sight.

However, in early 2025 the United States government announced “shifting foreign assistance strategies,” causing them to withdraw aid from organizations like the President’s Emergency Plan for AIDS Relief (PEPFAR), which had earlier promised 4.3 billion USD in 2025. PEPFAR is one of the primary HIV testing and treatment services in countries most affected. Such a drastic decision could have ripple effects, including pushing other major donor countries to revoke their aid. The report projected that if international funding permanently disappears, they expect an additional 6 million HIV infections and 4 million AIDS-related deaths by 2029.

At a Press Briefing, Assistant Secretary-General for UNAIDS Angeli Achrekar noted the importance of PEPFAR since its inception in 2003, calling it one of the most successful public health endeavors. She expressed hope that as the US lessens its support, other organizations and countries are able to take up the global promise of ending AIDS without eroding the gains already made.

Achrekar noted “acute shifts” in a weakening of commitment from countries less directly affected by HIV/AIDS since the US has pulled funding.

UNAIDS also reports a rising number of countries criminalizing populations most at risk of HIV – raising stigma and worsening gender-based violence and non-consensual sex, two of the highest HIV risk-enhancing behaviors. The report showed the primary groups who lacked care were child HIV infections and young women, which is likely related to government campaigns  “attacking HIV-related human rights, including for public health, with girls, women and people from key populations.”

These punitive laws include criminalization or prosecution based on general criminal laws of HIV exposure, criminalization of sex work, transgender people and same-sex sexual activity and possession of small amounts of drugs. These laws have been on the rise for the past few years, and in conjunction with limited funding, the results for HIV/AIDS-positive patients could be fatal.

Recently, scientific breakthroughs have been made regarding long-acting medicine to prevent HIV infection. Health workers have seen tremendous success, both with new technologies like annual injections and the potential for more growth in the form of monthly preventative tablets and in old prevention techniques like condom procurement and distribution and access to clean, safe needles for drug users. However, due to various global conflicts and wars, supply chains have been disrupted, often harming countries not in the thick of the altercation but reliant on products like PrEP, an HIV prevention medication.

Although many countries most afflicted with the AIDS crisis have stepped up, promising more national funding for the issue, and many community networks have doubled down on their efforts, the disruption of supply chains and the lack of international frontline health workers cannot be solved overnight. To entirely restructure how healthcare is provided takes time – something those with HIV do not always have.

Areas like sub-Saharan Africa, which in 2024 housed half of the 9.2 million people not receiving HIV treatment, have been particularly affected by the recent changes. The majority of child infections still occur there, and combinations of “debt distress, slow economic growth and underperforming tax systems” provide countries in sub-Saharan Africa with limited fiscal room to increase domestic funding for HIV.

Despite the loss of funding, significant progress has been made to protect essential HIV treatment gains. South Africa currently funds 77% of its AIDS response, and its 2025 budget review includes a 3.3% annual increase for HIV and tuberculosis programs over the next three years. As of December 2024, seven countries in sub-Saharan Africa have achieved the 95-95-95 targets established by UNAIDS: 95% of people living with HIV know their status, 95% of those are on treatment, and 95% of those on treatment are virally suppressed. UNAIDS emphasized the importance of this being scaled up to a global level.

Achrekar observed, referring to countries whose domestic funds towards AIDS have increased, that “prevention is the last thing that is prioritized, but we will never be able to turn off the tap of the new infections without focusing on prevention as well.”

She reiterated the importance of countries most affected by the HIV/AIDS crisis establishing self-sustaining health practices to ensure longevity in both prevention and treatment.

Achrekar praised the global South for their work in taking ownership of treatment while still calling upon the rest of the world to join.

She said, “The HIV response was forged in crisis, and it was built to be resilient. We need, and are calling for, global solidarity once again, to rebuild a nationally owned and led, sustainable and inclusive multi-sectoral HIV response.”

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Ahead of World AIDS Day (1 December), a new report by UNAIDS released its report, 'Take the rights path to end AIDS.' Credit: UN AIDS

By Ed Holt
BRATISLAVA, Nov 26 2024 (IPS)

Gaps in realising human rights could stop AIDS being ended as a public health threat by 2030, UNAIDS has warned in a report to mark World AIDS Day.

In the report, entitled Take the Rights Path, the group says the global HIV response is at an inflection point and that decisions taken now by governments will determine whether the AIDS pandemic is no longer a public health threat by the end of the decade, a commitment in the UN Sustainable Development Goals (SDGs).

It highlights that a litany of widespread rights abuses, including girls being denied education, impunity for gender-based violence, arrests of people for who they are or who they love, and other barriers to accessing HIV services simply because of the community a person is from, are endangering efforts to end the pandemic.

The group has called on world leaders to ensure rights are upheld so that everyone that needs to can reach lifesaving programmes and AIDS can be ended, or risk “a future of needless illness, death, and unending costs.”

“It is entirely possible to end AIDS—the path is clear. Leaders must only choose to follow it,” Winnie Byanyima, UNAIDS Executive Director, told IPS.

HIV/AIDS activists and public health experts have in recent years increasingly pointed to the effects of repression of human rights on efforts to fight HIV/AIDS.

They have highlighted a growing marginalization and stigmatization of key populations, including LGBT+ people, and drug users, in a number of countries, including the introduction of legislation directly discriminating against those communities. Meanwhile, women’s rights continue to be repressed or not fully upheld in many parts of the world.

The UNAIDS report points out that currently, only three countries report no prosecutions over the past 10 years for HIV non-disclosure, exposure, or transmission and have no laws in place criminalizing sex work, same-sex relations, possession of small amounts of drugs, transgender people, or HIV nondisclosure, exposure, or transmission. It also shows that 44 percent of all new HIV infections worldwide are among women and girls.

Activists say it is essential that criminal and other laws that harm people’s rights must be removed, and at the same time laws and policies that uphold the rights of everyone impacted by HIV and AIDS are enacted.

“The science couldn’t be more clear—criminalization is prolonging the HIV epidemic and erodes the trust in the health system that is necessary not only for an effective HIV response but also for strong pandemic responses more broadly. But these gaps can be overcome—what’s missing is political will,” Asia Russell, Executive Director of campaign group Health GAP, told IPS.

There is concern, though, that against a backdrop of growing authoritarianism and a pushback against rights in many countries, this will be challenging.

“Scapegoating and criminalizing communities is a tool dictators and autocrats are turning to more frequently, driving people away from life-saving health services and making all communities less safe,” said Russell.

Ganna Dovbakh, Executive Director at the Eurasian Harm Reduction Network (EHRA), went even further, suggesting widespread criminalisation meant that achieving the end of AIDS as a public health threat increasingly appeared to be “wishful thinking.”

“It sounds unrealistic. Taking into account anti-gender and anti-human rights movements across the globe, it sounds too ambitious,” she told IPS.

However, while the report raises concerns about how the failure to ensure human rights is impacting efforts to fight HIV/AIDS and the potential for inaction on the matter to halt or even reverse progress in battling the disease, UNAIDS points out that there has been success in countries where people-centred approaches to fighting HIV have been adopted.

“Seven countries in Africa (Botswana, Eswatini, Kenya, Malawi, Rwanda, Zambia, and Zimbabwe) have already reached UNAIDS testing and treatment targets (95-95-95) for the general population.

“This is a testament to global solidarity, African political leadership, and the strong collaboration between governments, communities, civil society, science, and the private sector,” said Byanyima.

“While there are rising threats from anti-LGBTQ fundamentalists in the US, Russia, Uganda, Kenya, Tanzania, and elsewhere, not all countries are blindly embracing criminalization,” said Russell. “Some governments, however, have recently rejected this approach—such as Namibia, pointing to the racist and colonial origin of such laws and their destabilizing effect not on the HIV response but on society as a whole.”

However, the report lays bare the scale of the global challenge to end AIDS by the end of the decade.

In 2023, 9.3 million [7.4 million–10.8 million] people living with HIV were still not receiving antiretroviral therapy, and 1.3 million [1.0 million–1.7 million] people newly acquired HIV. In the regions where numbers of new HIV infections are growing the fastest, only very slow progress is being made in scaling up pre-exposure prophylaxis (PrEP). These regions also lag behind sub-Saharan Africa in progress towards meeting the 95–95–95 HIV testing and treatment targets, according to the report.

It also said that coverage of prevention services among the populations at greatest risk of HIV is very low—typically at less than 50 percent—and that HIV infections are rising in at least 28 countries around the world.

“These countries need to look at their policies and programmes and build a rights-based approach to turn their epidemics around,” said Byanyima.

Despite this, the group remains optimistic that the disease can be ended as a public health threat by the end of the decade—if governments take action now.

“It is still possible, but leaders must act now to dismantle barriers to health. I remain hopeful, but it will only happen if countries with expanding epidemics change course and protect everyone’s rights to protect everyone’s health,” said Byanyima.

Some others agree, but say it is likely governments will need to be pushed into taking the action necessary to end AIDS.

“We have the interventions that can deliver the defeat of the AIDS crisis—if deployed at scale, with the people most in need at the front of the line rather than pushed to the back. What’s missing is equitable access to the advances of science and human rights and the political will,” said Russell.

“The case for closing the HIV funding gap, reversing criminalizing laws, and accelerating deployment of superior prevention technologies could not be stronger. Unfortunately. Many governments are not, on their own, showing the leadership we need… pressure is needed now to compel government action—political will in response to the AIDS crisis rarely happens because of benevolence; it emerges in response to the pressure of accountability from communities,” she added.

Mark Harrington, Executive Director of the Treatment Action Group campaign organisation, said decades of advances in medical science meant “the toolkit we have to prevent and treat HIV, and to ensure that people can live healthy long lives regardless of HIV status, is better than it’s ever been,” but that governments must be pushed to ensure they are “responsive to the health needs of their people to fulfill the promise of all these results of decades of research and activism.”

“Political will has to be continually created and strengthened. As activists, that is our job. Over the past four decades, scientists and activists have made unbelievable progress against a once untreatable disease. We need to keep on reminding policymakers of their duties and communities of their rights to health,” he told IPS.

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Excerpt:

Lillian Mworeko of ICWL with UNAIDS Executive Director, Winnie Byanyima, at the launch of the Choice Manifesto. Credit: Wambi Michael/IPS

By Wambi Michael
MBALE, WAKISO, KAMPALA, Uganda, Nov 26 2024 (IPS)

In Uganda, women and girls are more affected by HIV. Out of 1.4 million people living with the disease, 860 000 are women and girls.

According to UNAIDS, every week, 4,000 adolescent girls and young women aged 15–24 years became infected with HIV globally in 2023, with 3,100 of these infections occurring in sub-Saharan Africa.

In 2023, in sub-Saharan Africa, women and girls accounted for 62 percent of all new HIV infections.

As part of the efforts to prevent new infections and death among the adolescents and women, Uganda adopted oral PrEP in 2017, or pre-exposure prophylaxis. PrEP, or pre-exposure prophylaxis, is medicine people at risk for HIV take to prevent getting HIV from sex or injection drug use.

In January 2021, the World Health Organization (WHO) recommended that the dapivirine vaginal ring (DPV-VR) may be offered as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches.

Dr. Daniel Byamukama, the head of HIV prevention at the Uganda Aids Commission, revealed that HIV prevalence remains high among key populations. Credit: Wambi Michael/IPS

Because Uganda largely depends on donor support for HIV/AIDS treatment and prevention, PrEP tools like the dapivirine vaginal ring (DPV-VR) and a twice-yearly injection known as lenacapavira are rolled out in a phased-funded approach, and therefore more women and adolescent girls continue to be infected despite the efficacy of these medications and tools.

A bio-behavioral survey conducted in 12 of Uganda’s regional towns found that 54 percent (over half of the sex workers aged 35-49 years) were living with HIV. The results of the survey released in October indicated that one in three commercial sex workers missed taking their ARVS at least once.

Dr. Geoffrey Musinguzi, the principal investigator, said each female sex worker had had a sexual encounter with at least four men. He suggested HIV pre-exposure prophylaxis (PrEP) could stop the majority of HIV transmissions that still happen in Uganda and most of the sub-Saharan countries.

Lynette Nangoma (not her real name) is one of the lucky female Ugandan women who have had the chance to have access to oral pre-exposure prophylaxis as well as the vaginal dapivirine vaginal ring. She told IPS that there are times when she forgets to take her PrEP pills. Nyangoma usually engages in multiple sexual relationships. ”Thank God I’m still alive and HIV-free. I think those tablets helped a lot. As you may know, this job of ours can be risky,” she narrates.

Dr. Diana Atwine, the Permanent Secretary at Uganda’s Health Ministry, said the dapivirine vaginal ring is only available in seven districts funded by USAID under PEPFAR.

Dr. Daniel Byamukama, the head of HIV prevention at the Uganda Aids Commission, revealed that HIV prevalence remains high among key populations, at 33 percent among sex workers, 15 percent among prisoners, and 17 percent among people who inject and use drugs.

Nangoma told IPS that she has been using the dapivirine vaginal ring for the last four months.

“I feared it at first when a health worker was brought in to teach us about it. It looked too big. But I decided to try it. I can tell that for me, I find very convenient.”

The dapivirine vaginal ring is a female-initiated option to reduce the risk of HIV infection. It must be worn inside the vagina for 28 days, after which it should be replaced by a new ring. The ring works by releasing the antiretroviral drug dapivirine from the ring into the vagina slowly over 28 days.

Nangoma told IPS that some of her colleagues have been hesitant to use it, fearing discomfort.

Dr. Carolyne A. Akello, who has spent over 10 years in HIV/AIDS research with a focus on HIV prevention among women of reproductive age, including adolescent girls and young women, told IPS: “Yes, it looks big, but actually the vagina is a very accommodating organ. The ring is inserted into the vagina, and it is held up by the muscles. The ring was well researched. It is one size fits all. So whether small, big, or short, it fits every woman. It usually goes to the back of the vagina. There is where it sits for all the 28 days.”

“For a woman to use it consistently, we ask her to leave it there even during sex and menstrual periods. And many women, once they fix it, actually say, ‘Wow. The ring seems to have disappeared; I don’t feel it any more.’ And also, many men don’t feel it during sex. Seven out of ten men did not know that their partner was using the ring,” said Akello.

Unlike daily oral PrEP, dapivirine vaginal ring does not rely on remembering to take a pill each day and is also discreet as it stays inside the vagina throughout the month.

HIV/AIDS activist and access to medicine campaigner who leads the International Community of Women Living with HIV in Eastern Africa (ICWEA), Lillian Mworeko, told IPS that one of the advantages of the dapivirine vaginal ring is that it is discreet.

“It gives power to the woman in terms of control. They are able to fix it themselves. They are in charge. You are giving power to the woman to take care of their prevention. We strongly advocate for it,” Mworeko said. “So that women, especially adolescent girls and young women who are not able to negotiate for safer sex, have a tool that is in their control without seeking permission.”

Uganda was among the first countries in sub-Saharan Africa to approve dapivirine ring. Others included Namibia, South Africa, Kenya, Zimbabwe, Zambia, Malawi, Rwanda, Eswatini, Lesotho, and Botswana. The ring was designed for women to use in countries that still carry a high level of stigma around HIV. In 2023, South Africa announced a national rollout of the ring. Eswatini, Zambia, Rwanda, and Kenya have embarked on similar efforts.

Dr. Diana Atwine, the Permanent Secretary at Uganda’s Ministry of Health, said the dapivirine vaginal ring is only available in seven districts funded by USAID under PEPFAR. Less than three hundred women had accessed the vaginal ring through that initiative by the end of August 2024.

While Atwine says lenacapavir will be a game-changer in terms of reducing the burden of daily pills and minimizing stigma and stigmatization, her ministry’s budget cannot afford the high cost of such tools.

As Uganda joins the rest of the world to mark World AIDS Day, Mworeko used the occasion to express her frustration that so many women in Africa cannot access these tools because their governments say they cannot afford them. Gilead Sciences, the company behind lenacapavir, reportedly charges the one-month ring, which currently costs USD 12.8 per month.

“When we talk about life and the lives of people, we need to put it into the context that nothing can compare with a person who is going to live with HIV for the rest of their life. We cannot compare the price of prevention with treating a person for life,” argues Mworeko.

She suggests that other than waiting for donations that delay or never arrive, the leaders of Africa must set part of their national budgets to ensure that women and girls have access to the new prevention tools and methods.

“What is the cost of preventing a young girl from getting HIV, and they are going to live the rest of their life free of HIV? They are going to deliver babies free of HIV, and they are going to contribute to the economy of their country. Compared to not acting now in the name of the cost, we are going to have this young person infected with HIV, and we must treat them,” Mworeko asked.

When asked about the facts that Uganda and other countries in Africa lacked money to make their own purchases of the prevention measures, Mworeko said, “What are our priorities? Who prioritizes what? We must prioritize where our hearts are. We cannot continue talking about new HIV infections when tools are here.”

Part of Mworeko’s frustration was partly directed towards researchers and the manufacturers of these medicines and preventive measures.

“I think the most disturbing situation is that most of the research is done here in our country. We are slow at rolling them out. Yet other countries pick up and fund these interventions. So we contribute to research, but we don’t benefit as a country. Because there is no one who would want to see their children infected with HIV,” says Mworeko, one of the activists behind the HIV Prevention Choice Manifesto for Women and Girls in Africa.

Uganda was among the countries where clinical trials for Gilead’s PURPOSE 1 were conducted. The results showed the high prevention effectiveness of the six-monthly long-acting injectable drug lenacapavir for cisgender adolescent girls and women, cisgender men, and transgender women.

The Global HIV Prevention Coalition (GPC), UNAIDS, and other partners called on Gilead Sciences to accelerate their efforts in ensuring that it is made available, accessible, and cost-effective, especially to low- and middle-income countries. It said the company’s approach must reflect the urgency of their needs.

“We urge Gilead to act swiftly in ensuring equitable, sustainable, broad access, particularly in markets with the highest need,” said GPC.

Gilead promised in early October that it will prioritize providing lenacapavir to Rwanda, South Africa, Tanzania, Thailand, Uganda, Vietnam, Zambia, and Zimbabwe until generic versions are available.

Dr. Flavia Matovu Kiweewa, one of the researchers on Gilead Sciences’ PURPOSE program in trials in Uganda, said: “I know Gilead Sciences has committed to providing licenses to generic manufacturers to make this product. But countries need to advocate so that we can be the first beneficiaries of lencapvir because we have significantly contributed to the study. But not only that, we are seeing lots of infections in young women.”

Dr. Herbert Kadama, the PrEP coordinator at the Ministry of Health, said Uganda plans to adopt lenacapvir and dapivirine vaginal ring are part of the efforts to address the challenges women also face with HIV/AIDS. He noted that 63 percent of new infections in Uganda, like the rest of Africa, are in women and girls.

According to Dr. Flavia Matovu Kiweewa, lencapvir prevents HIV acquisition by HIV-negative women by 100% compared to other preventive measures, but it is not a vaccine.

”We are glad that for the first time ever in history, we have an intervention that can give 100% protection against acquiring HIV. For us who have been in the PrEP field for quite some time, we faced lots of disappointments, especially for women trials. Because women are not able to adhere to daily interventions and they are influenced by their partners and friends,” said Matovu Kiweewa.

“Lenacapvir is going to be a game changer in the HIV prevention landscape. We are very excited that if we can access lanacapvir in Uganda and other high-burden settings in Africa, we will reduce the incidence of HIV significantly,” she added.

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Excerpt:

A transgender person participates in health services provided by the Khmer HIV/AIDS NGO Alliance (KHANA) in Phnom Penh, Cambodia, December 2019. Credit: UNAIDS

By Ed Holt
BRATISLAVA, Jul 14 2023 (IPS)

A report released this week has highlighted how continuing criminalisation and marginalisation of key populations are stymying efforts to end the global HIV/AIDS epidemic.

The report from UNAIDS, entitled ‘The Path that Ends AIDS’, says that ending AIDS is a political and financial choice, and that in countries where HIV responses have been backed up by strong policies and leadership on the issue, “extraordinary results” have been achieved.

It points to African states that have already achieved key targets aimed at stopping the spread of HIV and getting treatment to people with the virus. It also points out that a further 16 other countries, eight of them in sub-Saharan Africa, which accounts for 65% of all people living with HIV, are close to doing so.

But the report also focuses on the devastating impact HIV/AIDS continues to have and how alarming rises in new infections in some places are being driven largely by a lack of HIV prevention services for marginalized and key populations and the barriers posed by punitive laws and social discrimination.

Estimated adults and children living with HIV. Credit: UNAIDS

“Countries that put people and communities first in their policies and programmes are already leading the world on the journey to end AIDS by 2030,” said Winnie Byanyima, Executive Director of UNAIDS.

Experts and groups working with key populations have long warned of the effect that the stigmatisation, persecution and criminalisation of certain groups has on the AIDS epidemic.

They point to how punitive laws can stop many people from accessing vital HIV services.

Groups working with people living with HIV in Uganda, which earlier this year passed anti-LGBTQI legislation widely considered to be some of the harshest of its kind ever implemented (it includes the death penalty for some offences) say service uptake has fallen dramatically.

“The law has had a very negative effect in terms of health,” a worker at the Ugandan LGBTQI community health service and advocacy organisation Icebreakers told IPS.

“Community members are threatened by violence and abuse by the public, many are afraid to go out. HIV service access points are now seen by LGBTQI community members as places where they will be arrested or attacked,” he said.

Newly infected adults and children. Credit UNAIDS

Speaking on condition of anonymity, the worker added: “This is going to affect adherence to treatment and will be bad for the spread of HIV. Some people are being turned away at service centres, including places where people go for ARV refills because although the president has declared that treatment will continue for members of the community, there are individuals at some centres who say the law has been passed, and so they don’t need to give treatment to members of the community.”

Groups working with people with HIV in other countries where strict anti-LGBTQI laws have been introduced have also warned that criminalisation of the minority will only worsen problems with the disease.

In Russia, which has one of the world’s worst HIV/AIDS epidemics, anti-LGBTQI legislation brought in last year has effectively made outreach work illegal, potentially severely impacting HIV prevention and treatment. Widespread antipathy to the community also forces many LGBTQI people living with HIV to lie to doctors about how they acquired the disease, meaning the epidemic is not being properly treated.

A worker at one Moscow-based NGO helping people with HIV told IPS: “What this means is that the right groups in society are not being targeted [with measures to prevent the epidemic growing] and so the epidemic in Russia is what it is today.”

Harsh legislation, conservative policies and state-tolerated stigmatisation also impact another key population – drug users.

Countries in regions where drug use is the primary or a significant driver of the epidemic, such as Eastern Europe and Central Asia and Asia and the Pacific, drug users often struggle to access harm reduction and HIV prevention services. They fear arrest at needle exchange points, attacks from a general public which often views them negatively, and prejudice and stigmatisation from workers within the healthcare system.

At the same time, in states with harsh laws targeting the LGBTQI community, drug users, sex workers or other vulnerable groups, civil society organisations helping those populations are also affected by the legislation, meaning that vital HIV prevention and treatment services they provide are hampered or halted completely.

And these problems are not confined to a handful of states. The UNAIDS report states that laws that criminalize people from key populations or their behaviours remain on statute books across much of the world. The vast majority of countries (145) still criminalize the use or possession of small amounts of drugs; 168 countries criminalize some aspect of sex work; 67 countries criminalize consensual same-sex intercourse; 20 countries criminalize transgender people; and 143 countries criminalize or otherwise prosecute HIV exposure, non-disclosure or transmission.

Consequently, the HIV pandemic continues to impact key populations more than the general population. In 2022, compared with adults in the general population (aged 15-49 years), HIV prevalence was 11 times higher among gay men and other men who have sex with men, four times higher among sex workers, seven times higher among people who inject drugs, and 14 times higher among transgender people.

Ann Fordham, Executive Director at the International Drug Policy Consortium, told IPS there was an “urgent need to end the criminalisation of key populations”.

“Data shows HIV prevalence among people who use drugs is seven times higher than in the general population and this can be directly attributed to punitive drug laws which drive stigma and increase vulnerability to HIV. It is devastating that despite evidence that these policies are deeply harmful, the majority of countries still criminalise drug use or the possession of small quantities of drugs,” she said.

But it is not just minorities which are disproportionately affected by HIV.

Globally, 4,000 young women and girls became infected with HIV every week in 2022, according to the report.

The problem is particularly acute in sub-Saharan Africa region, where there is a lack of dedicated HIV prevention programmes for adolescent girls and young women and where across six high-burden countries, women exposed to physical or sexual intimate partner violence in the previous year were 3.2 times more likely to have acquired HIV recently than those who had not experienced such violence.

Research has suggested that biological, socio-economic, religious, and cultural factors are behind this disproportionately high risk of acquiring HIV. Many girls and young women in the region are economically marginalized and therefore struggle to negotiate condom use and monogamy. Meanwhile, a predominant patriarchal culture exacerbates sexual inequalities.

“For girls and women in Africa, it is general inequalities which are driving this pandemic. It is social norms which don’t equate men and women, girls and boys, it is norms which tolerate sexual violence, where a girl is forced to have unprotected sex and that is then dealt with quietly rather than tackling the abuser,” Byanyima said at the launch of the report.

UNAIDS officials say that promoting gender equality and confronting sexual and gender-based violence will make a difference in combatting the spread of the disease, but add that specific measures aimed at young women and girls, and not just in sub-Saharan Africa, are also important.

“[Sexual and reproductive health] services are not designed for young women in many parts of the world – for instance girls cannot access HIV testing or treatment without parental consent up to a certain age in some countries,” Keith Sabin, UNAIDS Senior Advisor on Epidemiology, told IPS.

“A lack of comprehensive sexual education is a tremendous barrier in many places. It would go a long way to improving the potential for good health among girls,” he added.

But while the report highlights the barriers faced by key populations, it also shows how removing them can significantly improve HIV responses.

It cites examples from countries from Africa to Asia to Latin America where evidence-based polices, scaled up responses and focused prevention programmes have reduced new HIV infections and AIDS-related deaths, while some governments have integrated addressing stigma and discrimination into national HIV responses.

It also noted that progress in the global HIV response has been strengthened by ensuring that legal and policy frameworks enable and protect human rights, highlighting several countries’ removal of harmful laws in 2022 and 2023, including some which decriminalized same-sex sexual relations.

“Studies strongly suggest a better uptake of services among men who have sex with men (MSM) in countries where homosexuality has been decriminalised or is less criminalised. A certain policy environment can improve uptake [of HIV services] and outcomes,” said Sabin.

The UNAIDS report calls on political leaders across the globe to seize the opportunity to end AIDS by investing in a sustainable response to HIV, including effectively tackling the barriers to prevention and services faced by key populations.

Experts agree this will be crucial to ending the global epidemic.

“We have long known that we will not end AIDS without removing these repressive laws and policies that impact key populations. Today, UNAIDS is once again sounding the alarm and calling on governments to strengthen political will, follow the evidence and commit to removing the structural and social barriers that hamper the HIV response,” said Fordham.

IPS UN Bureau Report

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Dorcus Auma weaving sisal fronds into a basket. Her Kenyan women's group has helped provide income to care for her grandchildren, orphaned by HIV/AIDS. Credit: Charles Karis/IPS

By Charles Karis
NAIROBI, Jun 27 2016 (IPS)

Seventy-three-year-old Dorcus Auma effortlessly weaves sisal fronds into a beautiful basket as she walks the tiny path that snakes up a hill. She wound up her farm work early because today, Thursday, she is required to attend her women’s group gathering at the secretary’s homestead.

Except for their eye-catching light blue dresses and silky head scarfs, they would pass for ordinary village women. They are part of the Kagwa Women’s Group in the remotest part of Homa Bay County in Kenya’s lake region.

A recent county profile of HIV/AIDS prevalence by the National AIDS Control Council (NACC) revealed that Homa Bay County leads Kenya in HIV prevalence, standing at 25.7 percent.

Auma joined the group in 2008 when the care of her three grandchildren was thrust upon her shoulders.

“HIV/AIDS robbed me of my three children, leaving me with the burden of having to take care of three children left in a vulnerable condition,” says Auma.

With no steady income to provide for their basic needs, she joined other women who shared the same predicament.

UNAIDS says that microfinance can play a big role in helping households affected by the HIV/AIDS pandemic, and the women’s group at Homa Bay has proved this to be true.

Composed of 28 members, it started as a merry-go-round, which is a self-help group that helps women to save money. The group is supported by World Vision through an initiative to enhance target households through cooperatives.

“Within economic strengthening we are trying to help the families to get economically empowered through the locally available resources. This is a group of old women, they are all grandmas, and they had already started doing their own merry go-rounds. We came in with training on village savings and loaning, which is a simplified model of the savings at the rural level – it’s like a rural bank,” says Jedidah Mwendwa, a technical specialist with APHIA II Plus (pdf), one of the implementing organizations.

Most of the members are grandmothers whose children died from HIV/AIDS, and hence were left to fend for their grandchildren.

“Since the grannies cannot engage in vigorous economic activities, they were introduced into saving and loaning at their own level. They agreed to raise monies for saving and loaning among themselves through locally available resources like making ropes, baskets and mats,” says Mwendwa.

“When they meet on Thursdays, they collect all their material contributions. One of their members is sent to the nearby market, which is Oyugis, a distance of 61km, to go sell their products and the following week, the money that came from the market is what is saved for each specific member,” says Mwendwa.

The savings are rotated to individual members on an annual basis, and since they do not have a secure place to keep the money, they usually loan out the entire collected amount to members who return it with one percent interest.

“Since I joined this group, my life has changed. I have been able to engage in sustainable farming. My grandchildren have a reason to smile as they have nutritious food on the table,” says Auma, as she gives instructions to her eldest grandchild, a 16-year-old girl, on how to separate the sisal strands.

Initially, local people were a bit reluctant to attend the HIV caretaker training sessions because of the real stigma associated with the illness, but most have come around, and their efforts are paying off.

“We offer to the group and school clubs sensitization on adherence and nutrition,” says Rose Anyango, a social worker in the county. “The women and the children are responding well and the stigma no longer exists. Through village savings and loaning they are able to feed their children as well as educate them.”

The group has seen immediate successes in behavior, attitudes and practices regarding cultural dictates and inclusion of people living with HIV/AIDS in development activities. Women are now actively taking the lead in economic empowerment, enabling them to support their families.

The group now plans to increase to increase its impact by involving more members from the surrounding community, which will go a long way in not only empowering of locals but also reduce the stigma of HIV/AIDS.

Significant numbers of women, such as members of the Mt Hagen Handicraft Group in the Highlands region of Papua New Guinea, have been impacted by HIV/AIDS with consequences including widowhood and hardship. Credit: Catherine Wilson/IPS

By Catherine Wilson
GOROKA, Papua New Guinea, Aug 11 2015 (IPS)

It has only been six months since Iveti, 37, lost her husband of 18 years, but already she is facing hardship and worry about the future.

Similar to many married women in the rural highlands region of Papua New Guinea, a southwest Pacific Island state of seven million people, she stayed at home to look after their two children, a daughter aged 11 and a son now in his early twenties, while her husband’s income paid for the family’s needs.

“There was always food to serve to my children, but now the man who provided the food has gone. On the days we don’t have food I make ice-blocks and sell them at the market for 20 or 30 kina [seven to 10 dollars]." -- Iveti, a 37-year-old widow
“I worry about food; I worry about bills and the children. I worry about the relatives who come and visit to mourn with us, because we have to kill a pig [for a feast] or give them something. Who is going to come and say they have the money for all this?” Iveti frets as she sits in her modest home on the outskirts of Goroka, a town in Eastern Highlands Province.

She is surrounded by her children, and her husband’s mother and sister who also live with her.

“There was always food there to serve my children, but now the man who provided the food has gone. On the days we don’t have food I make ice-blocks and sell them at the market. We get 20 kina (seven dollars) or 30 kina (10 dollars). Every two days we pay about 20 kina for the power and with the 10 kina (about 3.60 dollars) which is left, we buy a tin of fish.

“My daughter goes to school and we budget 4 kina (just over a dollar) for her lunch,” she continued.

There is a diversity of widows’ experiences in Papua New Guinea. Those who have completed secondary or tertiary education and have an independent source of income are in a strong socio-economic position to look after themselves and their children.

However, more than 80 percent of the population resides in rural areas where many women have limited access to education and employment.

Female literacy in the Eastern Highlands, for example, is about 36.5 percent. Gender inequality in the country is exacerbated by social practices, such as early and forced marriage, bride price and widespread domestic and sexual violence experienced by two-thirds of women in the country.

While there are no accurate statistics available about widows in Papua New Guinea, the national Widows Association claims that most have been in widowhood for between five and 30 years.

For women in the highlands, the risk of losing a husband is increased due to the prevalence of tribal warfare. Outbreaks of fighting between different clan groups can be triggered by disputes over landownership or pigs, the most prized livestock, or ‘payback’ for a wrong committed against a community.

And, in most cases, the death of a male warrior plunges the wife and children into a precarious existence.

Families are also being impacted by the HIV/AIDS epidemic. By 2010, 31,609 cases of the virus had been reported with the highest prevalence of 0.91 percent recorded in the Highlands, slightly higher than the national rate of 0.8 percent, which is estimated to have decreased to about 0.7 percent last year.

When a husband dies, the widow and children usually have the right to remain on the husband’s land and property. But this is often not the case if AIDS, which is accompanied by social stigma, has been the cause of death.

Agatha Omanefa, Women’s Project Officer at Eastern Highlands Family Voice, a non-governmental organisation dedicated to counselling and supporting families, told IPS that while extended families were traditionally very protective of vulnerable members, she had witnessed rising cases of brothers of the deceased husband making moves to claim the land.

When “the husband’s relatives come in to share the properties the widow becomes a loser with her children […]. Sometimes they come up with stories, history, such as: ‘you are from there, your husband is from here’ and then she [the widow] needs someone to support her to secure the land,” she explained.

“It is having a big impact on widows’ lives, especially when they have small children. So they often keep little food gardens to try and maintain the children’s welfare as well as themselves.”

Families in Papua New Guinea are traditionally large with up to eight or 10 offspring, and the struggle includes paying for children to complete education, especially to secondary level. Female headed households are several times more likely to be below the absolute poverty line, according to government reports.

But one of the greatest threats to a widow’s welfare is the risk of being accused of sorcery. In nearby Simbu Province, women aged 40-65 years are six times more likely than men to be blamed for using witchcraft to cause a death or misfortune in the community, reports Oxfam, and the consequences, including torture and murder, can be tragic.

“There is growing concern that sorcery accusations that lead to killings, injuries or exile are often economically or personally motivated and used to deprive women of their land or property,” the United Nations Special Rapporteur on Violence against Women, Rashida Manjoo, reported in 2013.

Widows with sons, however, have a source of protection.

“In our culture in the Highlands, when you have a son, no-one will chase you out, because you will gain strength from your son, but if a woman does not bear any child then she is more vulnerable,” Irish Kokara, treasurer of the Eastern Highlands Provincial Council of Women, explained.

President Jenny Gunure added that there was also a lack of awareness about women’s rights and the law at the village level, a situation the women’s council is working to rectify through a bottom-up education programme aimed at rural women, which was begun last year.

However, Kokara believes that the risk of violence will not diminish until the behaviour of young men, who often perpetrate such crimes as part of vigilante gangs, is addressed.

“It is the youths who take drugs, like marijuana, who are the ones burning the women and hanging them on trees. So we need to change the youths first, then we can change the community,” she declared.

In recent weeks widows across the country have called through the local media for the government to introduce legislation to better support recognition of their rights.

Edited by Kanya D’Almeida

Providing pregnant mothers with antiretroviral medicines can reduce the risk of HIV transmission from 45 percent to just one percent, according to the World Health Organisation (WHO). Credit: Jeffrey Moyo/IPS

By Kanya D'Almeida
UNITED NATIONS, Jun 30 2015 (IPS)

In 2013, an estimated 240,000 children were born with HIV. This was an improvement from 2009, when 400,000 babies tested positive for the infection, but still a far cry from the global target of reducing total child infections to 40,000 by 2015.

Bucking the global trend, one small island nation has made gigantic strides towards the 2015 goal. That country is Cuba, and in 2013 it recorded just two babies born with HIV.

Today, Cuba has become the first country in the world to receive validation from the World Health Organisation (WHO) that it has eliminated mother-to-child transmission of HIV and syphilis.

Executive Director of UNAIDS Michel Sidibé said in a press release today, “This is a celebration for Cuba and a celebration for children and families everywhere. It shows that ending the AIDS epidemic is possible and we expect Cuba to be the first of many countries coming forward to seek validation that they have ended their epidemics among children.”

Every single year, over 1.4 million women living with HIV become pregnant. Without proper treatment, they run a 15-45 percent chance of transmitting the virus to their kids – during pregnancy, labour, delivery or breastfeeding.

But if both mother and child receive proper antiretroviral treatment, the risk of transmission falls to just one percent.

Since 2010, the Pan American Health Organisation (PAHO), which serves as the Regional Office for the Americas of the WHO, has been working with its partners in Cuba and other states in the region to roll out a comprehensive programme to eliminate mother-to-child transmission of both HIV and syphilis.

This process has involved improving early access to prenatal care, testing for pregnant women and their partners, caesarean deliveries and substitution of breastfeeding.

Such services were undertaken and provided within the larger framework of equitable access and universal healthcare, in which maternal and child health is integrated with programmes to combat sexually transmitted diseases.

“Cuba’s success demonstrates that universal access and universal health coverage are feasible and indeed are the key to success, even against challenges as daunting as HIV,” PAHO Director Carissa F. Etienne said in a statement on Jun. 30.

“Cuba’s achievement today provides inspiration for other countries to advance towards elimination of mother-to-child transmission of HIV and syphilis,” she added.

WHO and its partners first published comprehensive guidelines on the processes and criteria for validation of eliminating mother-to-child transmissions in 2014.

Because treatment and prevention can never be 100 percent effective, ‘elimination’ is defined as “a reduction of transmission to such a low level that it no longer constitutes a public health problem”, according to PAHO.

In March of 2015, a group of international experts visited Cuba to assess its progress towards the elimination target, and spent five days visiting health clinics, labs and government institutions interviewing a range of experts and other stakeholders.

Comprised of experts from 10 countries including Argentina, Japan and Zambia, the mission considered a number of indicators – all of which must be met for at least one year – including confirming that new child infections as a result of mother-to-child transmissions are less than 50 cases per 100,000 live births.

Other indicators, which must be met for at least two years in order to receive validation, include ascertaining that more than 95 percent of HIV-positive women know their status, receive at least one ante-natal visit, and receive antiretroviral drugs.

“Eliminating transmission of a virus is one of the greatest public health achievements possible,” WHO Director-General Margaret Chan announced on Jun. 30.

“This is a major victory in our long fight against HIV and sexually transmitted infections, and an important step towards having an AIDS-free generation,” she added.

According to the World AIDS Day 2014 Report, there were 35 million people living with HIV/AIDS in 2013. Since the start of the epidemic in the 1980s, 39 million people have died of AIDS-related illnesses and close to 78 million have become infected with HIV.

Thanks to sustained local and global efforts to fight the epidemic, the death toll has fallen significantly in the past decade, from 2.4 million deaths in 2005 to 1.5 million in 2013, representing a 35-percent decline.

New infections have also declined by an estimated 38 percent since 2001, from 3.4 million to 2.1 million in 2013.

Among children, new infections have fallen from an estimated 580,000 in 2001 to 240,000 in 2013. If more countries emulate Cuba’s example, the international community will be closer to its 2015 goals, and the ultimate goal of eliminating AIDS altogether.

Edited by Kitty Stapp

At a time when HIV rates have stabilised or declined elsewhere, the epidemic is still advancing in the Arab world, exacerbated by factors such as political unrest, conflict, poverty and lack of awareness due to social taboos.

According to UNAIDS (the Joint United Nations Programme on HIV/AIDS), an estimated 270,000 people were living with human immunodeficiency virus (HIV) in the countries of the Middle East and North Africa (MENA) region in 2012.

“It is true that the Arab region has a low prevalence of infection, however it has the fastest growing epidemic in the world,“ warns Dr Khadija Moalla, an independent consultant on human rights/gender/civil society/HIV-AIDS.With the exception of Somalia and Djibouti, the [HIV] epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users

The United Nations estimates that there were 31,000 new cases and 16,500 new deaths in 2012 alone. “Infections grew by 74 percent between 2001 and 2012 while AIDS-related deaths almost tripled,” says Dr Matta Matta, an infection specialist based at the Bellevue Hospital in Lebanon.

However, both Moalla and Matta explain that figures can be often misleading in the region, due to under-reporting and the absence of consistent and accurate surveys.

With the exception of Somalia and Djibouti, the epidemic is generally concentrated in vulnerable populations at higher risk, such as men-who-have-sex-with-men, female and male sex workers, and injecting drugs users.

In Libya, for example, 90 percent of those in the latter category also live with HIV, notes Matta. Furthermore, adds Moalla, most Arab countries do not have programmes allowing for exchange of syringes.

The legal framework criminalising such activities in most Arab countries means that it is difficult to reach out to specific groups.  With the exception of Tunisia, which recognises legalised sex work, female sex workers who work clandestinely in other countries are not safeguarded by law and thus cannot force their clients to use protection, which allows for the spread of disease.

Lack of awareness, the absence of voluntary testing and of sexual education, social taboos, as well as poverty, are among the factors driving HIV in the region. “Arab governments and societies deny the epidemic and the absence of voluntary testing means that for every infected person we have ten others that we do not know about,” stresses Moalla.

People living with HIV or those at risk face discrimination and stigma.  “More than half of the people living with HIV in Egypt have been denied treatment in healthcare facilities,” explains Matta.

This bleak scenario is compounded by the security challenges prevailing in the region which not only make it difficult to deliver prevention and other programmes, but also restrict access to services by those on treatment and cause displacement and loss of follow-up according to the UNAIDS report.

The war in Iraq that began in 2003, for example, led to the destruction of most of the country’s programmes and facilities under the National AIDS Programme and, according to Moalla, the national aids centre in Libya was recently burnt down.

In addition, in some countries, conflict has significantly increased the vulnerability of women. By 2012, for example, only eight percent of the estimated number of pregnant women living with HIV in the MENA region received appropriate treatment to prevent mother-to-child transmission according to the UNAIDS report.

Meanwhile, only a few governments have worked on effective programmes to fight the epidemic, although there are signs of the emergence of NGOs tackling the problem with people living with HIV and providing them with support.

“North African countries and Lebanon have generally done better than others, while Gulf countries are doing the least,” says Moalla, adding that less than one in five people living with HIV are receiving the medicines they need in the Arab region.

While some efforts have been made with the UNDP HIV Regional Programme pioneering legal reform in several countries, as well as drafting an Arab convention on protection of the rights of people living with HIV in partnership with the League of Arab States, these are not enough.

“The Arab world attitude taking the high moral ground on the issue of HIV is no barrier for the epidemic,” says Matta. “The region’s governments need to address a growing problem that is only worsened by the general upheaval.”

(Edited by Phil Harris)

Chifundo ART Clinic in Lusaka. Credit: AHF

By Chisha Mutale
Lusaka, Jul 28 2014 (IPS)

Chisha Mutale reports from Lusaka that substantial progress has been made against the transmission of HIV from mother to child by the the Zambian government and its cooperating partners.

[podcast]http://traffic.libsyn.com/ipslatamradio07/zambia_PMTCT.mp3[/podcast]

Nadezdha Tolokonnikova and Maria Alyokhina (fourth and fifth from the right) with activists from the Andrei Rylkov Foundation for Health and Social Justice in Moscow marking the United Nations International Day Against Drug Abuse and Illicit Trafficking with calls for reform of Russia's hard-line drug policies. Credit: Andrei Rylkov Foundation

By Pavol Stracansky
MOSCOW, Jun 26 2014 (IPS)

A protest in Moscow Thursday marking the U.N. International Day Against Drug Abuse and Illicit Trafficking has highlighted the ‘torture’ drug users are put through in the Russian criminal justice system.

Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot Group who were controversially jailed for performing in a Moscow cathedral in 2012, spoke in the Russian capital to highlight the plight of drug users in Russia.

Joining protestors in more than 80 cities around the world demanding drug policy reforms, they attacked what they said was their country’s “cruel and inhuman” treatment of drug users.

Describing a litany of rights abuses against drug users, including torture and beatings by police and prison warders, they said Russian authorities viewed imprisonment as a “cure for drug dependency”.“Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities .... Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country” – Nadezhda Tolokonnikova and Maria Alyokhina, members of the Pussy Riot punk rock group

“People who use drugs are outcasts – they are despised, hated, accused of all problems, and criminalised. Similar to xenophobia and homophobia, narcophobia has become a protective cloak for the authorities…. Creating an image of the enemy, the subhuman, the zombie, and reinforcing that image in the public consciousness justifies the inhuman treatment of drug dependent people in our country,” they said.

“Russia’s drug policy is built on torture. Humiliation and violation of human dignity – thisis what drug dependent people face everywhere, from hospitals to prisons and other state facilities,” they added.

Russia takes a hard-line approach to drug use, implementing repressive drugs legislation, including lengthy jail terms for possession of even tiny amounts of hard drugs.

Drug users say they are also targeted by police: official figures show that one in six of the Russian prison population is a drug user and, according to other surveys, just under 30 percent of drug users have been arrested at some point since they started using drugs.

They say they also regularly have confessions extracted from them or are coerced into helping officers as they go into withdrawal in detention – a charge police deny.

There is a complete lack of relevant medical services for drug users in temporary holding facilities and pre-trial detention centres and even painkillers are rarely given to addicts going into withdrawal.

Drug users in prison face particular hardship. Conditions for all prisoners are poor with hygiene often bad, cells massively overcrowded and brutality and disease rife. But drug users are especially vulnerable.

Anya Sarang, head of the Moscow-based Andrei Rylkov Foundation for Health and Social Justice, which works to raise awareness of drug problems, told IPS: “Russian prison is torture in itself with prisoners not given basic medical infection control, nutrition etc., and general human rights violations. But drug users are more vulnerable than other prisoners.

“For instance many are HIV positive, but not only are there problems getting their medicine or starting them on treatment because they are not given necessary immune system checks in some cases, but their diet is poor and there is always the risk of infections, such as tuberculosis.”

Tuberculosis (TB) is a major problem in Russian prisons, according to the World Health Organisation (WHO) and other bodies. Studies have shown that a person with HIV is 25 times more likely to contract TB in a Russian prison than outside one.

But the risk of potentially deadly infections is only one problem facing drug users in prisons. As in many jails across the world, drugs are smuggled in and traded between inmates, giving users, some of whom may never have tried hard drugs, access to substances like heroin and experience of dangerous drug-taking methods.

Campaigners say that this is further evidence of how the criminalisation of drug use only perpetuates and worsens drug problems.

Michel Kazatchkine, UN Special Envoy for HIV/AIDS in Eastern Europe and Central Asia, told IPS: “We know from studies that contact with the criminal justice system is associated with increased injection drug use and other similar behaviour, among other problems. Putting drug users in prisons …. is making things worse not just in prisons but also for communities when they are released from prison.”

Activists point to how opioid substituition therapy (OST) for people in custody or prison has been successfully implemented in some Western states.

But the practice is completely banned in Russia, despite being widely implemented in many countries around the world, recommended by the World Health Organisation (WHO), and having been proved to be successful in helping halt the spread of HIV/AIDS.

Russia has one of the world’s fastest growing HIV/AIDS epidemics – there were 78,000 new HIV cases registered last year, up from 69,000 in 2012 and 62,000 in 2011 – which the Joint United Nations Programme on HIV and AIDS (UNAIDS) and other bodies say has been historically driven by injection drug use.

Drug use in the country is growing equally rapidly. According to figures from the country’s Federal Drug Control Service (FSKN) there were an estimated 8.5 million drug addicts in 2013 – up from 2.5 million since 2010. The service says up to 100,000 people die each year in Russia from drug abuse. It is also the world’s largest heroin consumer.

Tolokonnikova and Alyokhina said only a reform of drug policy including decriminalisation would improve the situation in prisons.

But Russian authorities show no sign of lifting the OST ban nor improving the very limited harm reduction services which exist in the country and FSKN officials have made a number of public statements in recent months reaffirming their commitment to hard-line drugs policies.

Kazatchine told IPS: “I don’t see any sign of Russia’s approach to drugs softening. What I am seeing is a toughening of the way Russian society looks at marginalised groups, such as drug users, men who have sex with men, LGBT people, etc. The climate has toughened and Russia is de facto criminalising drug use and recession.”

This, critics say, has left Russian drug users in a terrible position in society. Sergey Votyagov Executive Director of the Eurasian HRM Reduction Network (EHRN), told IPS that they were “one of the most stigmatised and under-served populations” in the country.

Meanwhile, the devastation wrought by Russia’s drugs policies has been seen clearly in its newest territory. Just days before Thursday’s protest in Moscow, campaigners in Ukraine had raised the alarm over the fate of drug users in Crimea following its recent annexation.

OST is available in Ukraine and had been provided to 800 people in Crimea. But as part of Russia, Moscow ordered OST programmes there shut down at the start of May.

A mission by the Council of Europe to Crimea which ended last month reported that at least 20 people had died following the cessation of the programmes and at least 50 more had migrated to the Ukrainian mainland, while a few had gone to Russia for detoxification and rehabilitation treatment.

Those who remained spoke of having to deal with intimidation by new authorities and, in some cases, losing their jobs because of either worsening health or their status as former OST patients being made public.

Some who have fled the peninsula described the fear and desperation among drug users still there.

Speaking at an event organised by the International HIV/AIDS Alliance in Ukraine in Kiev earlier this month, one woman, Oksana, who left the day after her OST treatment had stopped, said:  “I might have died if I had stayed in Crimea.

“I am disabled, I have had a stroke and I know very well how it feels to be left without therapy and help. Those who could not leave Crimea are in terrible conditions. Some of them are already dead, others have chosen suicide.”

There is little hope that things in Crimea will change any time in the foreseeable future. Earlier this month, Sergei Donich, deputy prime minister in the Crimean government, told local media that OST was ineffective and was being pushed by pharmaceutical firms who stood to gain from it.

Kazatchine described the situation on the peninsula as a “tragedy”, adding that it was unlikely there would not be more deaths among drug users.

He told IPS: “Evidence shows that OST reduces mortality, it prevents overdoses among drug users. I think it is inevitable that [with no more OST] more drug users will die.”

Credit: Imani N. Manyara

By Mary Itumbi
Nairobi, Jun 23 2014 (IPS)

New HIV infections remain high among sex workers in Kenya. In this report from Nairobi, Mary Itumbi says attitudes towards sex workers and policies that criminalize sex work are largely to blame.

[podcast]http://traffic.libsyn.com/ipslatamradio07/sex_workers_final.mp3[/podcast]

With Option B+, pregnant women are started on lifelong antiretroviral therapy regardless of their CD4 count. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, May 26 2014 (IPS)

Kenya’s health sector has been facing significant challenges, ranging from a shortage of health care providers to a series of labour strikes. The problems have not only disrupted health services, but have HIV experts divided on whether to roll out Option B+ nationwide or just to pilot it in high volume facilities such as major referral hospitals. 

Option B+ is the latest treatment option recommended by the World Health Organisation for HIV positive mothers.

In the earlier Options A and B, mother and baby were given antiretrovirals (ARVs) during pregnancy and breastfeeding; only women with CD4 counts under 350 were prescribed ARVs for life. CD4s, or helper cells, fight infections in the body.

Option B+ consists of lifelong provision of ARV therapy to pregnant women, regardless of their CD4 count.

Dr John Ong’ech, assistant director at Kenyatta National Hospital, told IPS that when discussion begun in 2013 on whether to start option B+ in Kenya, “at the national policy level, people were divided on whether to roll out Option B+ fully.”

Currently, Option B+ is only available in the two major referral hospitals, Kenyatta National Hospital (KNH) in Nairobi province, the Moi Referral Hospital in the Rift Valley province, and in a few mission and district hospitals.

“There are those who felt that we need to first fix systems in the health sector,” said Ong’ech.

“To begin patients on Option B+, you need clinicians because there are things to be considered, such as drug toxicity, at the treatment entry point, after which nurses can manage,” he added.

In 2013, nearly 20,000 HIV positive pregnant women were given Option B+ lifelong ARV therapy.  Another 55,860 should be enrolled to achieve 100 percent coverage, according to the Joint United Nations Programme on HIV/AIDS (UNAIDS).

Human resource crisis

Maurice Okoth, a clinician at a prevention of mother-to-child transmission (PMTCT) centre in Nyanza province, told IPS that Option B+ is not just a matter of ensuring drug availability.

“Clinic records must be organised, they must show if patients are defaulting and how these defaulters can be tracked. This is nearly impossible at the moment due to understaffing. We are facing a human resource crisis in the health sector,” he said

Kenya has some 36,000 nurses in the public and private sector but needs at least 80,000 more, according to government statistics.

Ong’ech agrees: “If you have adherence problems among the HIV patients that you are already treating, there is no need to roll out Option B+ because it will only get worse.”

The Director of Medical Services, Dr Simon Mueke, acknowledges that the disruption of health services due to labour unrest has affected PMTCT services.

In December 2011, doctors went on strike demanding more money for the health sector. In March 2012, nurses staged a two-week long strike, and five months later doctors stopped working for nearly three weeks. More strikes took place in 2013. A strike by doctors and nurses is looming in 2014 if government does not hire more staff.

Not surprisingly, PMTCT coverage fell by 20 percent in 2011 and 2012, according to UNAIDS.

Price and logistics

The price tag and the logistics of rolling out Option B+ nationwide are additional challenges.

Onge’ch says that, while ARVs are generally available across Kenya, “the country needs to come up with a cost effective way of procuring the additional drugs for Option B+.”

In ARV treatment, the actual cost of drugs represents less than 30 percent of the total. The new single-pill, fixed-dose regime costs about 180 dollars per patient per year, according to the Ministry of Health, and is expected to cost even less in the future.

“It is health care systems and the actual delivery of the services that take the remaining 70 to 80 percent,” said Okoth. “You need more laboratory services and viral load testing to ensure that they [women] are adhering to the treatment.”

Distance from home to the clinic is a problem. In Kisumu, Nyanza province, the average distance to the health facility is about 5.8 km while in Mandera, North Eastern Province, it is 20 kms, explained Okoth.

But Maya Harper, country director for UNAIDS Kenya, told IPS that Option B+ is a cost effective measure: “In the long run, it reduces the burden on the health system and on poor women. Placing women on and off treatment when they are pregnant is much more expensive.”
Beyond health infrastructure problems, Dr. Dave Muthama, from the Elizabeth Glaser Paediatric AIDS Foundation, says that stigma ”remains one of the major obstacles.“

At KNH, Ong’ech daily sees how stigma affects patients: some get the ARVs but do not take them while others refuse to collect the drugs for fear of being found out.

Poverty is another barrier, said Muthama: “Mothers do not adhere to the PMTCT visits because (…) while at the clinic, they are missing out on economically gainful activities.”

For Muthama, full elimination of HIV transmission to babies requires social structures to support HIV positive mothers.

“The society needs to go through the same four stages that most people who test positive for HIV go through: denial, anger, acceptance and coping,” he said.

Excerpt:

Demonstration Against Sexual Violence in Harare. Credit: Katswe Sistahood/IPS

By Rutendo Mawere
HARARE, May 9 2014 (IPS)

Rutendo Mawere reports from Harare on the link between gender-based violence and HIV and efforts to stop the practice.

*with additional reporting by Ish Mafundikwa

[podcast]http://traffic.libsyn.com/ipslatamradio07/final2.mp3[/podcast]

Keeping HIV-positive children on medication remains a difficult task. Credit: Miriam Gathigah/IPS

By Miriam Gathigah
NAIROBI, Jan 10 2014 (IPS)

Thanks to antiretroviral drugs, HIV-positive children can now live to adulthood. Yet a significant number of children living with HIV in Kenya will die due to delay in receiving anti-retroviral drugs (ARVs), inconsistent use of ARVs or, simply, no ARVs.

Seven-year-old Melvis* lives in Kisumu Ndog, in Nairobi’s sprawling Kibera slum, with his 75-year-old grandmother, Sabina. His mother died of AIDS three years ago. He has been taking ARVs most of his short life.“We have many more sites diagnosing children than sites where they can access ART services." -- Dr. Lucy Matu

“Keeping him on medication is difficult,” says Sabina.

Sometimes the clinic runs out of drugs, sometimes granny forgets to give him the pills, which must be taken every day at the same time to keep the virus at bay. “My memory is not as good as it used to be,” she says.

And Melvis’ drug regime requires a good memory: daily, but at different times, he must swallow three ARV pills, two of the antibiotic to prevent opportunistic infections, and sometimes anti-malarial pills.

Drug containers are colour-coded to help his illiterate granny. “Even with the colours, I still get confused,” she laments.

In its sixth Children and AIDS Stocktaking Report launched on Nov. 29, the United Nations Children’s Fund (UNICEF) says that, although there are more children on treatment, children are not benefitting as much as adults from progress made in low and middle-income countries in ARV coverage.

In these countries, ARV coverage for children under 15 years has consistently been half that of adults – 34 percent of children compared with 64 percent of adults in 2012.

“There is no technical justification why infants and young children cannot benefit equally from HIV prevention and treatment advances in Kenya,” says Ulrike Gilbert, UNICEF HIV coordinator in Nairobi.

Avoidable deaths

Dr. Lucy Matu, director of technical services at the Elizabeth Glaser Pediatric AIDS Foundation, explains that Kenya has some 4,700 sites offering prevention of mother-to-child transmission, but only 1,800 providing antiretroviral therapy (ART) services for kids.

“We have many more sites diagnosing children than sites where they can access ART services,” she says.

HIV diagnosis for children under two requires specialised laboratories, of which there are six in the country. “Correct and timely HIV diagnosis for young children has been slow,” Matu told IPS.

This shortage of paediatric treatment sites partly explains why, among 150,000 children eligible for ART in 2012, almost six out of 10 were not receiving it, according to the Progress Report 2013 of the Joint United Nations Programme on HIV/AIDS (UNAIDS).

At six percent, HIV prevalence in Kenya is in moderate decline, says UNAIDS, with 13,000 newly infected children in 2012, down from 23,000 in 2009.

In the absence of ART, one-third of HIV-positive babies will die before their first birthday and more than half before their second birthday.

Matu notes that many health care workers don’t know how to deal with HIV in children: “They go around in circles without informing the parent or guardian that the child is HIV-infected until it is too late to save the child’s life.”

Some parents and health workers believe that the survival of HIV-positive children is so poor that their early death must be accepted, Matu adds.

Many barriers

The UNICEF report lists several barriers to paediatric ART. Among them are limited availability of fixed-dose ARV combinations, poor palatability of recommended drug formulations for infants, lack of technology to test HIV infection among children under 18 months and fewer ART options for children than for adults.

Of the 22 ARVs approved by the United States Food and Drug Administration, five are not approved for use in children and another six are not available in paediatric formulations, according to UNAIDS.

Mary Naliaka, a health worker in paediatric AIDS with the Ministry of Health, explains that effective ART for kids requires a complex treatment formula.

“Changing dosage as a child grows is a major challenge,” she says. “One needs complex calculations to guide the adjustment.”

In a country where 35 percent of children suffer from malnutrition, “measuring the right dosage against the weight of the child can be daunting,” Naliaka told IPS.

For children in boarding schools, the lack of disclosure hurts treatment effectiveness. “If the school nurse is unaware of the child’s HIV status, they are unable to support them,” says Naliaka.

Matu says that parents, especially mothers struggling to accept their own HIV-positive diagnosis, find it difficult to take their children for HIV testing and feel guilty of passing on the virus.

The government estimates that 1.1 million children have lost one or both parents to AIDS; Many live with their elderly, illiterate and poor grandparents.

Although the Ministry of Health plans to reach 40 percent of caregivers of orphans through local community health workers who will teach them HIV care and provide food parcels, this help is yet to reach Sabina and Melvis.

Despite his hard life, Melvis has a sunny disposition and is energetic. He hawks pan-fried nuts in Kibera after school while Sabina sells deep fried potatoes near her shanty: “This is how we survive.”

*Not his real name. Family name omitted to protect privacy.

Seventy percent of France’s 20,000 sex workers are migrant women. Credit: A.D. McKenzie/IPS

By Lucy Westcott
UNITED NATIONS, Sep 26 2013 (IPS)

The age-old debate over how to regulate sex work has led to a rift between the United Nations and anti-trafficking organisations, which are pressuring the world body to rethink its position following two reports that advocate decriminalising all aspects of prostitution.

“When we saw the reports we became very concerned,” said Lauren Hersh, New York director of Equality Now, which is leading the public campaign that launched this week. “To have U.N. agencies call for brothel-keeping is egregious,” she told IPS.“People in prostitution need to be recognised as trafficking victims… We don’t believe anyone chooses.” -- Stella Marr of Sex Trafficking Survivors United

The coalition of 98 groups is asking the U.N. to update and reissue the reports, which were published last year, to reflect the experiences of survivors of prostitution, and include a wider range of views on the impact of legalising of the sex industry.

The two reports, Sex Work and the Law in Asia and the Pacific, backed by the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA) and the Joint United Nations Programme of HIV/AIDS (UNAIDS), and HIV and the Law, published by UNDP’s Global Commission on HIV and the Law, are focused on reducing HIV/AIDS while simultaneously protecting the rights of those involved in prostitution.

Survivors say that addressing the demand that keeps the cycle of prostitution in motion is imperative and is not adequately addressed in the reports.

Asked for comment, a spokesperson for UNDP said in a statement that the reports examined the issues of sex work through a specific lens of the HIV epidemic and strongly condemned sex trafficking.

“UNDP advocates and promotes the respect of human rights for all, especially the most excluded and marginalised. The report on Sex Work and the Law in Asia and the Pacific… clearly distinguishes between adult consensual sex work and human trafficking for sexual exploitation,” the spokesperson said.

Spokespersons from UNFPA and UNAIDS told IPS that the UNDP statement accurately reflects their agencies’ position.

The reports also see decriminalisation of the sex industry as a way to promote the ability of prostitutes to negotiate condom use, but Equality Now says that for many women in prostitution, there is an economic dependency, thus pressure, to have sex without a condom as clients will often offer more money for sex without one.

If women are trafficked or controlled by a pimp, they have less ability to insist on the use of condoms.

In a statement, UNDP said that the criminalisation of sex work increases vulnerability to HIV and limits access to condoms and sexual health services.

But Hersh says that, “Often it’s the pimps and buyers that dictate condom use as women can get more money from not using one.”

Hersh emphasises that the coalition is not trying to undermine the efforts of the campaign against HIV/AIDS. Equality Now has spent nearly a year reaching out to the U.N. through internal channels, including sending a letter co-signed with over 80 organisations, to Michel Sidibe, executive director of UNAIDS.

Prostitution is legal in many countries, including Switzerland, where “sex boxes” were recently introduced in Zurich to promote the safety of prostitutes in what the city considers a more pleasant environment. But the situation for men and women in countries where prostitution is legalised and decriminalised remains dire, according to Equality Now.

“One of the major issues is that the reports did not consult with our partners on the ground, particularly survivor-led organisations,” Hersh told IPS.

Stella Marr, executive director and one of the co-founders of Sex Trafficking Survivors United, an international organisation of over 100 survivors of prostitution, is herself a survivor, first trafficked at age 20 and involved in prostitution for 10 years.

“If we don’t address demand, there will always be trafficking,” Marr told IPS, adding that she is “saddened” at the reports.

Marr believes the best solution is the Nordic model, which criminalises the purchase of sex, but decriminalises being a prostitute.

Marr left prostitution after a buyer offered to help her, giving her a safe place to live for two years. She is the only person she knows who this has happened to.

“The fact that I got out doesn’t mean I was strong. I was lucky,” Marr said.

Survivors of the sex industry do not have their voices heard as loudly as those who are currently involved due to the amount of shame around it, said Rachel Moran, a founding member of Survivors of Prostitution-Abuse Calling for Enlightenment (SPACE) International, who was prostituted from age 15 until she was 22.

Another facet of the reports Equality Now wants to address is the definition of “trafficking” by the U.N. In 2000, in the U.N. Protocol to Prevent, Suppress and Punish Trafficking in Persons, Especially Women and Children, commonly known as the U.N. Trafficking Protocol, members states agreed on a broad definition of trafficking that reflects a variety of experiences from sex trafficking survivors.

The 2012 U.N. reports recommend narrowing down and redefining the definition, which could mean many trafficked persons would no longer be considered victims and their traffickers would not be held accountable.

“I understand that it’s difficult… you have to have a way to help people out of that life,” Marr said. “People in prostitution need to be recognised as trafficking victims… We don’t believe anyone chooses.”

Equality Now is optimistic about future reports, including a recent study from Asia and the Pacific, launched by UNDP, UNFPA and U.N. Women, that reports the purchase of commercial sex in the region is strongly associated with widespread rape and sexual violence against women.

Michel Sidibé. Credit: Courtesy of UNAIDS.

By Mathieu Vaas
UNITED NATIONS, May 22 2013 (IPS)

The global fight against HIV/AIDS has seen recent hard-won breakthroughs, including the discovery of the genetic hiding place of the virus by doctors in Australia, a 50-percent drop in new infections across 25 low- and middle-income countries, and an increase of 63 percent in the number of people with access to HIV medication.

But ending stigma and discrimination against people living with HIV has proved more resistant, particularly so for those who are part of the Lesbian, Gay, Bisexual, Transgender or Queer (LGBTQ) community."Right now we are on the brink of reaching the response’s full potential to save lives." -- Michel Sidibé

Since its inception in 1995, UNAIDS has been a leader in strengthening the response to HIV/AIDS, as well as providing access to health care and assistance to those living with the virus and in working with grassroots communities to help them reduce their vulnerabilities.

With May 17 marking the International Day Against Homophobia and Transphobia, IPS spoke with Michel Sidibé, executive director of UNAIDS, about how discrimination affects efforts to stem the spread of HIV/AIDS, how that fight is moving forward, and the post-2015 development agenda.

Excerpts from the interview follow.

Q: What is the impact of criminalisation of homosexuality on the policies UNAIDS is implementing?

A: UNAIDS is seeking to advance the vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths. To get there, we need to have universal access HIV prevention, treatment, care and support.

Some of the populations most highly affected by HIV are gay men and other men who have sex with men, as well as transgender people. If criminalised, there is virtually no way they can access the HIV information, commodities and services they need to avoid HIV infection and to stay alive and healthy if HIV positive. Nor can they mobilise their communities and support each other to avoid risky behaviour.

Furthermore, criminalisation of homosexuality is both driven by discrimination and leads to discrimination. Many gay men living with HIV face double discrimination – for being gay and for living with HIV. We will never reach the goal of zero discrimination as long as homosexuality is criminalised.

Q: With 76 countries still criminalising homosexuality, how do you plan to reach out to LGBT communities in those countries? And worldwide?

A: It is very difficult to reach LGBT communities in these countries. However, at the same time, in such places, HIV has often been an important entry point, sometimes the only entry point, for the health and human rights of LGBT people.

While laws criminalise, the public health sector has often understood how important it is to reach these populations. They have estimated their population’s size, done epidemiological studies, included them in national AIDS responses and have implemented tailored programmes. We support them to do so, regularly convening leaders of the LGBT community with government to work together on strategies to respond to HIV.

We also ask our staff to work with the ministry of justice and with police to enable these public health responses even where homosexuality is criminalised. We need a great expansion of programmes, greater protection of rights and attention to the new and younger generation of LGBT people who need access to HIV services.

Q: Do you have a specific campaign focused on the LGBT community?

A: We do not have a specific campaign, but we are working on the HIV-related rights and needs of the LGBT community from many angles. In terms of financing the AIDS response, we are asking countries to be much smarter in their HIV investments, in particular, to put resources and programmes towards populations highly affected by HIV.

In terms of access to health services, we are seeking to expand HIV prevention and treatment to all people in need and know that many LGBT people are not getting access to these services. We hope to improve their access through promoting more user-friendly health services as well as greater outreach programmes to their communities.

In terms of human rights, we promote the fact that they, like all people, have human rights. Like the U.N. secretary-general and the high commissioner for human rights, we call for the decriminalisation of homosexuality, as well as for their rights to non-discrimination, freedom from violence, health and participation and inclusion.

Q: What is the UNAIDS agenda for the post-2015 new development goals?

A: UNAIDS remains firmly committed to supporting countries to achieve universal access to HIV prevention, treatment care and support. This means ensuring that everyone in need has access to HIV services without stigma and without discrimination.

Although there has been much progress in ensuring that even the most marginalised in society have access there is still a lot of work to do. To end stigma and discrimination around HIV we work with a broad range of partners including, community based organisations, faith-based organisations, political leaders, scientific committees, law enforcement bodies and many other groups.

Our response focuses on expanding the evidence base and increasing political engagement; engaging stakeholders to invest in programmes to reduce stigma and discrimination and increase access to justice; strengthening technical support for addressing punitive laws, practices, stigma and discrimination and strengthening support to civil society.

Q: There have been some breakthroughs in medical research on HIV and AIDS in recent months. Can we hope for a world free of AIDS in a few generations?

A: HIV has been one of the defining issues of our time and I strongly believe that we can end the AIDS epidemic. Right now we are on the brink of reaching the response’s full potential to save lives – so now more than ever countries need to commit to action and look to a future without AIDS.

Excerpt:

Among adult women in low and middle-income countries, the rate of new HIV infections fell by more than 50 percent over the past decade. Credit: Stella Paul/IPS

By Michelle Bachelet, Michel Sidibe, and Jennifer Gatsi Mallet
UNITED NATIONS, Dec 11 2012 (IPS)

Global efforts to reach the “three zeros” for women and girls – zero new HIV infections, zero discrimination and zero AIDS-related deaths – are gaining momentum. Much of the progress we have seen is underpinned by the work of women living with HIV.

Among adult women in low and middle-income countries, the rate of new HIV infections fell by more than 50 percent over the past decade. AIDS-related deaths among women fell by 27 percent between 2005 and 2011 versus a 23 percent decline in men.

More women living with HIV are accessing treatment: By the end of 2011, coverage of antiretroviral therapy stood at 68 percent among women compared to 47 percent coverage among their male counterparts.

The pace of progress is accelerating. In 21 priority countries of sub-Saharan Africa – the region most affected by the epidemic – nearly half of HIV-positive pregnant women received antiretroviral therapy for their own health in 2011, up from just 16 percent two years earlier.

As access to antiretroviral prophylaxis expands, there has been a dramatic decline in the number of new HIV infections among children. In sub-Saharan Africa, new HIV infections among children fell by nearly 25 percent between 2009 and 2011.

Despite these gains, our efforts for women and girls remain inadequate – a message amplified by women living with HIV from around the world in the new report “Women out loud”.

According to the report, launched Tuesday by UNAIDS and UN Women, nearly two-thirds of pregnant women do not know their HIV status. In many settings, fear of violence and discrimination continue to play a major role in women’s reluctance to be tested for HIV or, if HIV-positive, to seek treatment.

The report finds that HIV continues to exact a heavy toll on young women: HIV infection rates among women aged 15-24 are twice as high as among their male peers. This disparity is most pronounced in sub-Saharan Africa, where 3.1 percent of young women are living with HIV compared to 1.3 percent of young men.

Female sex workers are particularly vulnerable to HIV. According to a recent review of data from 50 countries, female sex workers are 13.5 times more likely to be HIV-positive as women who do not engage in sex work.

Clearly, our journey is far from over. Getting to zero will require accelerated action for women and girls in a number of key areas.

First, women and girls, in all their diversity, must be equipped with the knowledge and power to protect themselves from HIV and violence. To that end, gender equality, economic empowerment and women’s rights – in particular, their sexual and reproductive rights – are non-negotiable elements of effective HIV responses.

Second, comprehensive sexuality education is critical for all young people, especially young women living with HIV who may face special challenges in intimate relationships.

Third, it is our collective responsibility to advocate for changes in laws, policies and practices – grounded in reality – that protect women and girls from stigma and discrimination, safeguard their human rights, and shield them from violations such as rape and gender-based violence.

Finally, men and boys must be fully engaged in this movement to engender a supportive environment at family, community and national levels.

As our report testifies, the activism of women living with HIV is crucial. The world needs women’s leadership, resilience and good practices to transform our societies and communities. And we need stronger support for their full participation in AIDS responses.

“Despite decades of advocacy and evidence, the voices of women and girls remain on the margins,” noted AIDS activists from three corners of the globe in a joint editorial for Women out loud.

When women living with HIV speak out, we must listen carefully and act in solidarity to transform their words into action.

*Michelle Bachelet is Executive Director of the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women). Michel Sidibé is Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Jennifer Gatsi Mallet is Executive Director of the Namibia Women’s Health Network.