Gabon

Gabon is one of the partnering countries involved in the Partnerships to Accelerate COVID-19 Testing (PACT) initiative in Africa. The project, developed under a partnership between UNAIDS and the Africa Centres for Disease Control and Prevention, aims at fostering collective action to respond to the colliding HIV and COVID-19 pandemics through strengthened community engagement, including the deployment of community health workers.

The UNAIDS Country Office for Gabon, in collaboration with other stakeholders, has chosen, as a starting point, to involve community actors to support the most vulnerable populations, in particular people living with HIV and the lesbian, gay, bisexual, transgender and intersex (LGBTI) community, in the context of COVID-19.

To increase coordination, ensure successful implementation and minimize the risks, all the stakeholders were involved from the design phase of the project. From the government, the Ministry of Health and the national steering committee of the pandemic response plan were involved at the highest level and appointed representatives to follow the development process and launch the project. In addition to a cabinet minister, representatives of Ministry of Health specialized national programmes joined the project, along with representatives of civil society and development partners.

The project will support the deployment of more than 70 people to accelerate the response to COVID-19 among vulnerable populations and to mitigate the impact of COVID-19 on the HIV response and services for other diseases, sexual and reproductive health and gender-based violence. In particular, it will contribute to supporting the continuity of services through increased community engagement. The project will cover four regions of Gabon, Libreville, Lambaréné, Port-Gentil and Franceville, that are severely impacted by COVID-19 and that have the highest HIV prevalence in the country.

Before the official launch of the project, UNAIDS signed an agreement with the Gabonese Red Cross, which in turn signed agreements with the selected community health workers, members of six associations and networks involved in the response to HIV and gender-based violence and that work with the LGBTI community and on sexual and reproductive health.

“The partnership with the Africa Centres for Disease Control and Prevention and support through UNAIDS has given a glimmer of hope to communities in Gabon that are often left to fend for themselves. It has shown that with even a little support, communities can innovate and make a difference. The involvement of communities should always be at the heart of the response to pandemics. We hope that this support can be sustained over time as the needs are still tremendous,” said the UNAIDS Country Director for Gabon, Françoise Ndayishimiye.

The project also has an innovative component in the monitoring of community actors. A mobile digital app was developed to support the community health workers with real-time data collection for monitoring and reporting on their activities. The app will ease reporting by allowing them to provide regular weekly reports on awareness and to support activities for people living with HIV and people living with tuberculosis, including on sexual and reproductive health, prevention of early pregnancies, HIV, gender-based violence, COVID-19 and discrimination.

GENEVA, 7 July 2020—UNAIDS welcomes the decision by Gabon to decriminalize same-sex sexual relations. Following a vote by the Gabon Senate on 29 June 2020, the signing off of the decision by the President means that Gabon has joined a growing list of countries in Africa and beyond that have removed criminal laws that target and discriminate against lesbian, gay, bisexual, transgender and intersex (LGBTI) people.

“I applaud the collective decision by Gabon’s parliament, government and President to decriminalize same-sex sexual relations,” said Winnie Byanyima, UNAIDS Executive Director. “By doing so, Gabon is righting a grave injustice inflicted on the LGBTI community in the country.”

Paragraph 5 of Article 402, which criminalized same-sex sexual relations—with a maximum penalty of six months in prison and a 5 million central African CFA franc fine—was inserted into the new Gabonese Penal Code in July 2019. That paragraph has now been withdrawn. UNAIDS is encouraged that such a step back in terms of human rights can be overturned quickly when communities, civil society, politicians and other allies come together to campaign to right wrongs.

Through legitimizing stigma and discrimination and violence against LGBTI people, the criminalization of same-sex sexual relations stops people from accessing and using HIV prevention, testing and treatment services and increases their risk of acquiring HIV. It is also a profound violation of a basic human right.

Gay men and other men who have sex with men had a 26 times higher risk worldwide in 2019 of HIV acquisition than all adult men. Prohibitive legal and policy environments created by stigma and discrimination are key barriers to dramatically reducing new HIV infections. While UNAIDS calls for the removal of such discriminatory laws, a critical immediate step would be to stop enforcing them.

“This is a very welcome step towards equality for LGBTI people in Gabon,” added Ms Byanyima. “I call on the at least 69 other countries and territories around the world that still criminalize same-sex sexual relations to do the decent thing: stop criminalizing people because of who they love.”

UNAIDS

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

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

Only 1.8 million people of the 6.5 million people living with HIV in western and central Africa were on antiretroviral therapy at the end of 2015. This 28% treatment coverage of people living with HIV in the region contrasts with the 54% coverage in eastern and southern Africa in the same year.

In response to this HIV treatment shortfall in western and central Africa, UNAIDS, the World Health Organization (WHO) and other partners in the region have developed country emergency catch-up plans to accelerate the AIDS response. These plans call for tripling HIV treatment coverage within the next three years.

At a meeting on the sidelines of the 70th World Health Assembly to support the catch-up plan, health ministers and other representatives of countries in the region vowed to strengthen government leadership, make structural changes in their health systems and strengthen accountability.

The meeting, which was organized by the WHO Regional Office for Africa and UNAIDS, was attended by the health ministers of Benin, Burkina Faso, the Central Africa Republic, Chad, Côte d’Ivoire, Gabon, Liberia and Nigeria and representatives of Cameroon, Guinea and Sierra Leone. They all collectively agreed to put in place strong measures to accelerate HIV treatment in their countries.

All the participants agreed that health-service delivery models had to be transformed, notably by community health workers taking a bigger role in health-care delivery. WHO and UNAIDS will continue to work with the countries as they implement their plans for increasing access to HIV treatment.

UNAIDS is working with countries to achieve the commitment in the 2016 United Nations Political Declaration on Ending AIDS of ensuring that 30 million people living with HIV have access to treatment through meeting the 90–90–90 targets by 2020.

HIV awareness events have been held at high schools in Ndende and Fougamou, Gabon. Sponsored by the Gabon Ministry of Health, the French embassy, the Pan African Organisation against AIDS and UNAIDS, the events attracted more than 3000 students, 500 of whom found out their HIV status.

A quiz on HIV, entitled “Stoppons le wela, Gabonese slang for “Put an end to this thing”, was given out to the students. Questions such as “Can you tell if someone has HIV?” and “How do you get infected?” tested the students’ knowledge on HIV.

Michael Anicet, dancer and UNAIDS Gabon Youth Advocate, got everyone dancing before he and other youth leaders led an interactive discussion about HIV. “Know your status! And if you are HIV-positive then get yourself on treatment and protect others from getting infected,” Mr Anicet told the students.

During the events, the young people asked about where to get treatment and spoke about sexual harassment, saying that it had to stop. Others told of how they had little access to HIV testing.

Other visitors to the events included the mayors of both cities, who stressed that their cities would do everything possible to make HIV testing and treatment available.

“Each committed city should develop plans to accelerate the AIDS response and allocate a budget to be complemented by public and private partners,” the Mayor of Fougamou, Serge Mandi Mboula, said during his city’s event.

The Mayor of Ndende, Maité Mapangou, concluded her city’s event by saying loud and clear, “We stand in solidarity and are truly committed.” 

Travelling to Gabon to attend the Africa Cup of Nations (CAN 2017), Gervais Yao Kouassi (Gervinho), UNAIDS Special Ambassador for Youth and China–Africa Collaboration, visited the UNAIDS office in Libreville, Gabon, to meet some 50 children and young people living with or affected by HIV.

Accompanied by young Gabonese ambassadors for HIV and by artist Charly Tchatch, the animator of the opening of CAN 2017 and an AIDS activist, the international football star talked to the children and young people and listened to their stories and concerns. The children and young people talked about problems with accepting their status and stigma and depression, but also about happiness, love and how they deal with their daily problems.

“I am very touched. It is the first time I hear such poignant testimonies”, said Gervinho. “As you know, I wanted to play with my team here, but I am injured. Your mental strength and joy of life encourages me to face life’s challenges.” Gervinho signed the Protect the Goal campaign ball to support UNAIDS’ vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths at CAN 2017.

Inge Tack, the UNAIDS Country Director, mentioned to Gervinho that despite AIDS budget cuts of 60% in Gabon since 2012, treatment rates have doubled and new HIV infections have been reduced by 30%, while paediatric treatment rates have tripled and coverage of prevention of mother-to-child transmission is at 78%. However, she also noted the need to improve the management of HIV treatment provision to achieve the 90–90–90 targets. “A radical shift in the organization and management of treatment delivery services is required to achieve the 90–90–90 targets in Gabon. Medicines need to be in the centre at all times and services reoriented to better serve patients’ needs,” said Ms Tack.

Gabon experiences persistent treatment stock-outs and poor care services result in no treatment adherence follow-up, no monitoring of drug resistance and no viral load measurement. Ms Tack stressed the need for a decentralized approach for the provision of antiretroviral therapy and an increase in community-led services.

Meeting in Libreville, Gabon, on 12 February, the ministers of health of the Economic Community of Central African States launched an ambitious programme to strengthen regional cooperation by establishing a community health fund to reinforce the region’s AIDS response.

The ministers also decided to improve coordination by setting up a specialized unit to enhance cross-border HIV prevention strategies and by developing a regional mechanism to source antiretroviral medicines on a larger scale. They also adopted a plan to increase the proportion of pregnant women and children receiving antiretroviral medicines.

The measures are designed to encourage countries to better share their experiences, allowing for a more efficient implementation of recommendations made during a meeting of HIV experts in Dakar, Senegal, in December 2015. 

UNAIDS Executive Director Michel Sidibé has praised President Ali Bongo Ondimba for his leadership on HIV and shared his conviction that Gabon is on the right path to ending the AIDS epidemic by 2030. During a meeting with President Bongo Ondimba on 28 November, Mr Sidibé urged the country to accelerate the implementation of the UNAIDS Fast-Track approach. President Bongo Ondimba reaffirmed Gabon’s commitment to eliminating mother-to-child transmission of HIV and to reaching the UNAIDS treatment target by 2020.

Gabon has made progress in its HIV response that needs to be consolidated. Between 2004 and 2014, new HIV infections fell by more than 64% and AIDS-related deaths fell by 50%, although there has been a worrying rise in adolescent AIDS-related deaths. Access to antiretroviral therapy has dramatically increased, but 53% of adults and 72% of children living with HIV are still in need of treatment.

A number of global initiatives, such as HIV and cities and All In, to end adolescent AIDS, have recently been launched by the Gabonese authorities with the support of UNAIDS and partners. Such initiatives will help translate commitments to Fast-Track the HIV response into targeted actions and rapid results. Accelerating the AIDS response in Gabon will also contribute to improving the performance of health and social services in the country.

During his two-day visit to Gabon, Mr Sidibé also met with the Minister of Foreign Affairs, the Vice-Premier, the Minister of Health, Social Affairs and National Solidarity, the First Lady and young people living with HIV engaged in a promising entrepreneurship programme. He also launched the global UNAIDS ProTestHIV initiative, which encourages young people to know their HIV status.

ProTest HIV, a global initiative that encourages young people to get tested for HIV, was launched by UNAIDS Executive Director Michel Sidibé in Libreville, Gabon, on 28 November. At the event, Mr Sidibé called on young people worldwide to join the movement and get involved in ending the AIDS epidemic.

Young ProTest HIV ambassadors selected by their peers participated in the launch, which was held at an HIV testing site set up at the Gabon marathon. UNAIDS is working with young people on the initiative to spread the word on the importance of HIV testing.

UNAIDS estimates that 17.1 million of the 36.9 million people living with HIV worldwide do not know they have the virus. Getting tested is a crucial first step for people living with HIV to access life-saving antiretroviral therapy.

Mr Sidibé urged young ambassadors to take the lead in Gabon on the first 90 of the UNAIDS 90–90–90 treatment target and to invite their peers to get tested, too. The UNAIDS 90–90–90 treatment target is that, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing antiretroviral treatment and 90% of people on treatment to have suppressed viral loads.

In Gabon, new HIV infections among children, adolescents and young people have largely declined since 2001, but AIDS-related deaths of adolescents have increased. This is partly due to the lack of integrated youth-friendly services and HIV-related stigma and discrimination. Adolescent girls in Gabon are particularly vulnerable—in 2014, 80% of adolescents newly infected with HIV were girls.