Community mobilization

UNAIDS is deeply saddened at the death of Paul Farmer

GENEVA, 11 March 2022—UNAIDS is deeply saddened at the death of Paul Farmer, anthropologist, doctor and global health champion. He was Kolokotrones University Professor and Chair of the Department of Global Health and Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women’s Hospital in Boston and co-founder of Partners in Health.

“Paul Farmer fought for social justice and human rights and passionately believed in the right to health for all,” said Winnie Byanyima, the Executive Director of UNAIDS. “His work saved millions and showed us the way to reach health care with dignity.”

Partners in Health, a social justice organization founded more than three decades ago, establishes long-term relationships with sister organizations based in settings of poverty. Its main goal is to bring the benefits of modern medical science to those most in need.

In 2000, Mr Farmer and colleagues proved that community-based approaches to HIV treatment in poor settings worked. In 2000, an estimated 4.7 to 8.9 million African children aged 0–17 years had lost one or both parents due to AIDS and HIV had become the world’s leading infectious cause of death among adults with more than 90% of those deaths occurring in low- and middle-income countries. Many had argued that the high cost of antiretroviral medicines (more than US$ 10 000 annually) and the lack of health infrastructure would mean that progress against AIDS would be impossible, but Mr Farmer and his team proved them wrong. His pilot HIV treatment programme in a poor community in rural Haiti that relied on an existing tuberculosis-control infrastructure showed that positive results could be made among people with advanced HIV. 

Mr Farmer also advocated that HIV treatment could reinvigorate HIV prevention programmes and argued that, from his experience in Haiti and Rwanda, the rollout of effective antiretroviral therapy lessened HIV-related stigma and discrimination. 

In 2012, Mr Farmer and his team celebrated the fact that almost 10 million people living in low- and middle-income countries were on antiretroviral therapy. Later, he focused on people dying of hepatitis C, like HIV a treatable and preventable disease, and regretted that at the time of his death nearly 10 million people living with HIV still did not have access to treatment.  

In late November 2021, Mr Farmer joined a virtual UNAIDS panel ahead of World AIDS Day. He stressed that all human lives have the same value and that everyone has the inalienable right to be healthy and to fulfil their potential. Drawing parallels between COVID-19 and HIV, he said, “Inequality is a major driver of pandemics in general. As with AIDS as with structural racism, gender inequality and various forms of social marginalization, active processes continue to structure risk for COVID-19 and also for the fruits of science that have been marshalled to fight it.”

UNAIDS is saddened by the death of Prof Paul Farmer, a passionate advocate for HIV treatment, who showed the world that AIDS-related deaths can be reversed with access, rights & compassion. The global health community has lost a pioneering leader, but his work will continue on. pic.twitter.com/UVS7JP8xuj

— UNAIDS (@UNAIDS) February 21, 2022

He added, “We are now living in a time of vaccine apartheid ... were we to have had a vaccine for HIV, it would be a similar challenge. So, it is, in fact, not two different pandemics posing two discreet sets of challenges but two colliding pandemics.”

As Mr Farmer repeated over and over again during his life, it is our collective duty to take the steps needed to tackle inequalities. UNAIDS, in its 2021 World AIDS Day report, Unequal, unprepared, under threat: why bold action against inequalities is needed to end AIDS, stop COVID-19 and prepare for future pandemics, warned that if the transformative measures needed to end AIDS are not taken, the world will also stay trapped in the COVID-19 crisis and remain dangerously unprepared for the pandemics to come.

Partners in Health has organized an online memorial service at 10:00–12:00 Eastern Time (16:00–18:00 Central European Time) on 12 March 2022 to honour his work.

By David Chipanta, UNAIDS Senior Adviser, Social Protection

Joe Muriuki was a son of the African soil, born and raised in Kenya, a local, national and global advocate for the right of people living with HIV to access life-saving HIV treatment free from stigma and discrimination. In 1987, he became the first Kenyan and among the first of all people living with HIV in Africa to share publicly that he was living with HIV.

Mr Muriuki died from oesophagus cancer-related complications on 14 February 2022, having lived a healthy life with HIV for more than 36 years, thanks to his access to life-saving HIV treatment and through living his life with a sense of purpose.

Mr Muriuki fought against AIDS-related stigma and discrimination in his native Kenya at a time when an HIV diagnosis was thought to mean imminent death. He offered a testimony that a healthy life with HIV was possible. He formed the first support group of people living with HIV in Kenya, the Know AIDS Society, to encourage people living with HIV to overcome fear, stigma and discrimination and to advocate for changing policies and laws to remove AIDS-related stigma and discrimination.

After his HIV diagnosis, stigma and discrimination forced Mr Muriuki to leave his job, and he returned to his home city, Nyeri, to await his death. In Nyeri, the stigma and discrimination he experienced stopped him from opening a bank account. However, he overcame the obstacles in his path and decided to dedicate his life to a crusade against HIV. His courage and conviction to openly disclose his HIV status, and to fight AIDS-related stigma and discrimination, were heroic.

His campaigning also formed the foundation of Kenya’s national AIDS response, prompting the government to declare AIDS a national disaster before establishing the National AIDS Control Council in 1999. Mr Muriuki was also active globally, advocating for access to life-saving HIV treatment for people living with HIV in Africa and their greater involvement in the AIDS response. He served in the Network of African People Living with HIV, the Global Network of People Living with HIV, the International Treatment Preparedness Coalition and the Pan African Treatment Movement, among other organizations, advocating with candour for equitable access to HIV treatment for people living with HIV in Africa.

Although Mr Muriuki’s HIV was virally suppressed, from 2018 he struggled with cancer, eventually dying from its complications. He was worried that the AIDS response was ignoring noncommunicable diseases and in his work with Kenya’s HIV Tribunal he pushed for noncommunicable diseases to be brought to the forefront of the AIDS response.

Mr Muriuki will be sorely missed by his family, friends and colleagues in Kenya and around the world.

By Tabita Ntuli, UNAIDS Community Support Adviser, South Africa

If one word could define Leonora Nontokozo Mathe, AIDS activist and champion of key population rights, it is ubuntu—an African word with deep meaning that describes the character of people who recognize their shared humanity and humility. Born with HIV, Ms Mathe died this week after a long struggle with pneumonia.

Born and raised in Bulawayo, Zimbabwe, Ms Mathe was a phoenix who rose from the ashes after losing both of her parents at the tender age of 12 years. Ms Mathe was no ordinary person; she was an unforgettable icon who challenged HIV for the 31 years of her life. A quiet revolutionary, like still waters running deep, she was shy in her mannerisms, yet her advocacy spoke volumes. She knew how to listen attentively and was even better at speaking and expressing her mind in a way that advocated for the rights of people living with HIV.

Ms Mathe was a mother, sister and friend, a devoted advocate and champion of key population rights who was so softly spoken, loving and supportive. To know her personally meant you were exposed to her cheer and comical nature, for she was always cracking jokes and no one could hold back from laughing at some of the things she would say. She had the ability to make everything seem manageable, no matter how big or seemingly scary it was, and she spoke so candidly about her journey with HIV.

Ms Mathe travelled the world with her advocacy, visiting Namibia, Uganda, Rwanda, Morocco, Spain, the United Arab Emirates, Qatar, the Netherlands and Belgium, to name just a few of the countries she travelled to. A visionary and a leader who was starting her own organization, Hashtag InSolidarity, with the purpose of being more instrumental to key populations, she had partnered with a 14-year-old to help raise 100 000 crayons for needy kindergartens through a project called the Crayon Craze.

She wanted so much to empower women and girls through her organization and was in the implementation stages when her health became more challenging.

For the past three years, Ms Mathe was in and out of hospital, battling with pneumonia, yet she spoke which such lightness and understanding. She would say things like, “You know this body of mine has been through so many challenges due to being born with HIV, nothing shocks me any more about it, I just have to keep on fighting for my kids and my dreams to manifest before I die.”

Her dreams are as valid today as they were when she was alive. She experienced so many challenges with establishing her organization and trying to source funding and wanted to work with women living with HIV who are passionate about helping other women.

“Leonora Nontokozo Mathe was a tireless and passionate activist and leader who dedicated her life to championing the rights of people living with HIV and key populations and the empowerment of women and girls,” said Eva Kiwango, UNAIDS Country Director for South Africa. “We share in the sadness and offer condolences to her family and all who knew and loved her. She will be sadly missed.”

Ms Mathe was exceptional, phenomenal, wonderful, gifted and talented. A fiery soul whose light burned so brightly, particularly on key population matters, on which she unapologetically spoke about issues that needed urgent attention and addressing.

A light that burned so beautifully shall never be forgotten—her legacy lives on.

Health systems and communities have been pushed to the breaking point by the COVID-19 pandemic, a pandemic that the world was woefully unprepared for. Two years on, networks of key populations and people living with HIV are still at the forefront of the COVID-19 response, working to ensure that communities have access to timely and undisrupted HIV services. Among them is Youth LEAD, the network of young key populations in Asia and the Pacific, which in 2020 established the YKP COVID-19 Emergency Relief Fund to support initiatives led by young people in Asia and the Pacific.

One of the beneficiaries is Ya_All, an organization for young lesbian, gay, bisexual, transgender and intersex (LGBTI) people based in Manipur, India. “The second COVID-19 wave hit north-east India really hard, as it did across the country. We saw health-care systems collapse in front of our eyes. This greatly affected our work as we saw more and more young key populations experience delays in accessing HIV prevention services and saw an increase in mental health issues,” said Sadam Hanjabam, the founder and Chief Functionary of Ya_All. Thanks to the YKP COVID-19 Emergency Relief Fund, Ya_All supported 300 young LGBTI people and members of other key populations to access telecounselling services in five districts to help them with depression and other mental health issues.

Since the outset of the COVID-19 pandemic, the YKP COVID-19 Emergency Relief Fund has helped organizations led by and serving young people implement programmes that ensured young key populations and people living with HIV were not left behind in the HIV and COVID-19 responses. This included providing essential food and supplies of personal protective equipment, information on HIV and COVID-19 prevention and continued access to HIV prevention and treatment services, including mental health services. It also included establishing harm reduction programmes, distributing seed funding for businesses led by transgender people, providing housing and supporting digital and peer-led initiatives.

Funded through the Robert Carr Fund, the AIDS Health Care Foundation and the UNAIDS Regional Support Team for Asia and the Pacific, the YKP COVID-19 Emergency Relief Fund has supported more than 20 projects from 15 organizations led by young people across the region, and has made a considerable difference to the lives of young key populations.

The Viet Nam Young Key Populations Network is one of the beneficiaries of the fund in Viet Nam. Even though the country was in complete lockdown for a substantial period, with a seed grant the network managed to produce HIV and sexual and reproductive health and rights digital educational content for young people at risk of HIV, distributing harm reduction materials to 15 provinces across the country.

Similarly, YPEER Pilipinas, another beneficiary of the fund, trained 1000 young people on HIV combination prevention strategies and screened more than 900 young people for HIV. With a small grant, they were able to scale up the #GetCondomPH Programme, which resulted in successfully distributing more than 11 000 condoms across the Philippines.

In Cambodia, KHANA has given mental health support training to more than 70 LGBTI leaders. The training accelerated ongoing mental health peer support to key affected populations who were experiencing mental health issues. “Online counselling sessions on how to cope with mental health issues were incredibly helpful. The YKP COVID-19 Emergency Relief Fund was an effective mechanism that allowed us to provide timely support to young people in need of HIV prevention and other health services,” said Phorng Chanthorn, Senior Coordinator at KHANA.

These few examples out of the many show that young people, communities and civil society play a crucial role in pandemic responses, helping HIV programmes rebound and adapt to COVID-19 rapidly. Still, these efforts have not been easy. “Youth networks are trying to find ways to recover, adapt and effectively lead in this new funding landscape that has resulted in greater competition for donor funding. Many programmes, including this one, showcase the impact and necessity of supporting youth-led HIV programmes and initiatives. However, it’s not enough,” said Vanessa Monley, Programme Officer at Youth LEAD.

In 2020, young people accounted for 26% of new HIV infections in Asia and the Pacific. In some countries, close to half of new HIV infections were among young people, and one in three members of young key populations do not know their HIV status.

“It is critical to find innovative ways to continue to scale up access to HIV services for young key populations in the context of COVID-19, ensuring that we do not give up achieved gains, and to respond to the additional issues that have come with the pandemic, such as mental health and social support issues. UNAIDS is fully committed to supporting responses led by young people and ensuring their sustainability as we work collectively to end AIDS by 2030,” said Taoufik Bakkali, Director, a.i., of the UNAIDS Regional Support Team for Asia and the Pacific. 

In a new UNAIDS report, Holding the line: communities as first responders to COVID-19 and emerging health threats, organizations led by and for people living with HIV and key populations detail their efforts to respond to the colliding pandemics of COVID-19 and HIV. Drawing on qualitative survey data spanning 225 community-led organizations across 72 countries, the report provides a snapshot of the organizations’ work during early 2020 to sustain the HIV response while supporting their communities through the COVID-19 pandemic. The report also illuminates the high-priority actions that are still urgently needed to ensure the continuity of HIV-related services, as well as the sustainability of the community-led organizations providing them.

In community members’ own words, the report tells a story of the phenomenal resourcefulness of community-led organizations to mobilize when and where governments could not. Their stories show that organizations led by and for people living with HIV and key populations, including women and young people, have leveraged in-depth HIV knowledge into broader pandemic expertise. In the face of service interruptions, health commodity shortages, curfews and severe funding gaps, the organizations adapted rapidly to continue providing HIV-related services.

Community-led organizations reported becoming more involved in distributing antiretroviral medicines and self-testing kits, negotiating with government officials to ensure that medicines would be accessible and personally delivering them to beneficiaries. Many organizations also reported shifting their services online, as well as relying on telephone and email contact for personal counselling and monitoring of health status, with some even making home visits in urgent circumstances. Material support, including food packages and income supplements, was mobilized and distributed to those in greatest need.

Organizations also undertook COVID-19-related service provision. They began outreach to community members and the broader public to raise awareness about COVID-19 and share information about how people could protect themselves. They detected and responded to rising levels of gender-based violence, providing assistance and support to survivors. They also distributed masks, soap and hand sanitizer, and constructed handwashing facilities. When the cost and availability of masks and soap became an issue, many community-led organizations reported finding innovative ways to produce these items themselves.

However, the majority of these organizations were distressed that their absence—especially from planning and decision-making processes—was resulting in the failure of national COVID-19 responses to address the needs of their communities. They repeatedly expressed deep concern about the economic impact of lockdowns and travel restrictions on their beneficiaries. They also highlighted continuing difficulties in obtaining personal protective equipment and travel approval, public transport or private vehicles for their staff. 

Organizations reported shouldering extremely heavy burdens with little external support. Intense funding gaps left staff in these organizations exhausted and working nights and weekends to fundraise, usually unsuccessfully, with some even turning to their own personal salaries and savings to help their communities.

Community-led organizations are at the heart of a people-centered, human rights-based public health response. UNAIDS has repeatedly called for support and funding for community-led infrastructure, emphasizing that communities urgently need the space and the resources to lead. 

“Community-led organizations have guided us through two pandemics, first the AIDS pandemic and now COVID-19,” said Winnie Byanyima, Executive Director of UNAIDS. “Their central and critical role in providing services at the heart of communities, reaching the most vulnerable, must be recognized and valued. Collectively, we must do more to support them financially, engage them meaningfully in decision-making processes and ensure they have all the resources they need to continue their work in responding to HIV and COVID-19 and for future pandemics.”

Where public health systems have engaged community-led networks and organizations and empowered those most affected by pandemics, they have been more successful at countering disinformation, ensuring the continuity of health services and protecting the rights and livelihoods of the most vulnerable. This is what it means to put people at the centre of pandemic responses.

In order to ensure the sustainability of a community-led HIV response, the report calls for five measures to be adopted as a matter of urgency:

• Community-led organizations must be fully included and integrated into national pandemic responses, including the continuing COVID-19 responses. This cannot be limited to consultation and should take place at the level of policy development, planning, design and evaluation of interventions.
• Short-term emergency funding must be mobilized and made readily available to community-led organizations.
• A stable, long-term funding base must be established to enable community-led organizations to function effectively.
• The information base on the work of community-led organizations must be expanded and deepened through systematic documentation, identification of good practices and information-sharing.
• Continuity of HIV-related services must be guaranteed, including through expanding funding to community-led organizations and establishing collaborative arrangements between community-led organizations and medical facilities to ensure sustainability of the HIV response through COVID-19 and future pandemics.

“I have not been taking my meds for seven months,” said Carla Joseph (not her real name), a transgender woman living with HIV in Haiti. “I need a reliable, direct place that will not ask me for a referral letter … to get back into care.”

She is speaking to one of Haiti’s community-led monitoring (CLM) field officers from the Civil Society Forum Observatory, who over the past year have been working to learn more about how to connect diagnosed people to treatment and ensure that those already in care are better served.

“During the monitoring we met many clients waiting for their turn to be consulted and get their drug refilled,” said Elisabeth Jacques, a Community-Led Monitoring Field Coordinator. “Shouldn’t the services be at the best day and time for the patient?”

UNAIDS is supporting the community-led monitoring work being conducted by Haiti’s Civil Society Forum Observatory. Community-led monitoring is an accountability mechanism to improve people’s access to HIV services and the quality of care they experience. The process is led and implemented by communities of people living with HIV, key populations and other vulnerable groups.

This initiative is part of a coordinated effort by partners, including the Ministry of Public Health and Population and the United States Government through the United States President’s Emergency Plan for AIDS Relief (PEPFAR). It aims to maintain and expand access to HIV services for Haiti’s estimated 150 000 people living with HIV, including 30 000 who are not yet aware of their status.

In its first report, the Civil Society Forum Observatory called attention to the need to improve client-centred services by extending service hours and reducing waiting times. It has also recommended an increase to six months for the supply of antiretroviral medicines dispensed to stable people living with HIV. Additionally, the community-led monitoring exercise unearthed a need to improve treatment literacy related to the concept of U = U (undetectable = untransmittable).

“We should build the capacity of civil society to do this sensitization work. They are more familiar with the clients. When someone is lost to follow-up, community members know how to speak to them and encourage them to come back. If we empower the community through community-led monitoring we can have a better handle of what’s going on,” said Soeurette Policar, the Coordinator of the Civil Society Forum Observatory.

The Head of HIV Prevention at the Ministry of Public Health and Population, Steve Mc Allan Smith, welcomed the recommendations. “Community-led monitoring will tell us how services are being rendered in the community and how people are experiencing those services from a client perspective. This approach will tell us how to tailor interventions to the specific needs of the patients. It will also help us address testing issues. But mostly it will help us retain people in care. Reaching the targets is really good,” he said. “But maintaining them long-term is what we are going for.”

Over the past year, the country has contended with intersecting crises. One month after the assassination of its president, Haiti endured a devastating earthquake, followed by a tropical storm. Worsening organized crime and an epidemic of kidnappings have had dire implications for the daily life of Haitians. In recent months a fuel shortage has made it even more difficult for people and organizations to conduct their affairs. And all this under the spectre of COVID-19.

Poverty, gender-based violence and the discrimination faced by people living with HIV and key population communities undermine people’s ability to stay on treatment. The challenging socioeconomic and security context only makes things worse. According to PEPFAR data, almost 8000 Haitians came off HIV treatment last year.

However, as the UNAIDS Country Director for Haiti, Christian Mouala, noted, Haiti was able to successfully implement multimonth dispensing of antiretroviral medicines to 88% of people on HIV treatment during COVID-19. This was thanks to coordinated efforts under the leadership of the Ministry of Public Health and Population and the collaboration of many stakeholders, including Haitian civil society.

“The people and health system here are resilient and adaptable,” Mr Mouala said. “At this time community leadership must become even more central to developing and implementing strategies to ensure people enjoy the best possible HIV, health and social support services.”

In 2001, Micheline Léon felt unwell. The then 33-year-old mother of three journeyed from her home in the small town of Corporand in central Haiti to a clinic in Cange. There she was diagnosed with HIV and tuberculosis.

Fortunately, three years earlier an organization called Zanmi Lasante—Haitian Creole for Partners in Health—had launched the HIV Equity Initiative. (Zanmi Lasante is the sister organization of the United States-based nonprofit health-care group Partners in Health.) This was one of the first projects in the world to effectively deliver antiretroviral therapy in poor, rural settings.

Twenty years later, Ms Léon is one of 2000 community health workers called accompagnateurs in the Zanmi Lasante network. Multiskilled teams of accompagnateurs are the link between patients and health facilities. They are also part of all HIV Equity Initiative discussions regarding patient care, treatment and social support.

Community health workers live in the areas where they work. They help to ensure that patients recover and stay healthy. Their main roles include medicine distribution and home visits, as well as linking people to care. They accompany patients to clinics and track those who have missed appointments. During the COVID-19 pandemic, the accompagnateurs were key to Zanmi Lasante’s care and treatment work. The home-based care and contact tracing skills refined in response to HIV are now being used for COVID-19.

Zanmi Lasante has a holistic approach to care that includes social services such as providing accommodation, food and transport. Community health workers help to coordinate all the support needed. They also serve the wider community by running educational campaigns on topics such as mental health and sexually transmitted infections.

Critically, the accompagnateurs empower and inspire people to take charge of their own health. Ms Léon is a role model within reach. Since starting treatment she has stayed adherent to it and her HIV viral load has remained undetectable since she began receiving viral load tests in 2017. She owns a small fruit and poultry business and sometimes spends time in Port au Prince, where she has a new grandson. She takes part in various group activities at the Zanmi Lasante site in Cange, including support groups, viral load classes and mothers’ clubs.

“The psychosocial support I received from Zanmi Lasante made me realize that my diagnosis was not a death sentence and I could go on and live a healthy and fulfilled life,” Ms Léon said.

Another stalwart Haitian HIV programme employs a community health approach. GHESKIO, the Haitian Study Group on Kaposi’s Sarcoma and Opportunistic Infections, was founded in 1982, the year before HIV was formally discovered. It is the world’s oldest HIV organization and has conducted research and provided clinical care over the past four decades.

GHESKIO has leveraged a community-based model to help Haiti respond to HIV and other public health crises. When the COVID-19 pandemic reached the country in March 2020, GHESKIO reinforced an existing programme—Distribution of ART in the Community—to ensure that clients living with HIV were provided with a three-month supply of medication. From a small room at the National Solidarity Association (ASON), a team packages medicines into plastic bags and pours over their client list. If a person is unable to come for their medicines, they’ll receive a home delivery.

GHESKIO also strengthened training activities for their multiskilled community health workers. In this way they provided social support for patients as well as home care for cases that did not require hospitalization.

“Our Community Unit played an essential role in the acceptance of new COVID-19 treatment centres in the impoverished, crowded slums,” said GHESKIO’s Program Coordinator, Patrice Joseph. “In collaboration with the Ministry of Health, we have strengthened contact tracing, case investigation and outbreak management for COVID-19.”

One of the newest community health workers is CV, a 35-year-old mother of three from Village de Dieu, a slum south of Port au Prince. She herself survived COVID-19. When she began feeling ill a community health worker accompanied her to get tested. Following five days at GHESKIO’s COVID-19 hospital, a community team conducted home visits to ensure her full recovery.

Now she works as a greeter at GHESKIO. She is also a GHESKIO community health agent, encouraging patients to come to scheduled visits. CV supports community sensitization around COVID-19 prevention by promoting sanitation and educating people about the importance of COVID-19 vaccination.

“I don’t take one day for granted,” she said.

In a suburb of Nouakchott, Mauritania, a tent has gone up for an evening of counselling and HIV testing. Staff of the nongovernmental organization SOS Pairs Educateurs field questions, and people wanting to know their HIV status queue for a rapid test.

Mohammed Bilal, above, is supervising the evening event, along with peer educators, a nurse and a social worker. Pointing behind him to a small concrete house with a corrugated roof, he said that to keep all tests anonymous, people are given a number and they enter the makeshift office one by one. “We do counselling before the HIV test and after the person gets the results,” Mr Bilal said.

More than 70 men and women have opted to get a rapid test today.

In the El Mina neighbourhood, where the outreach event is taking place, Mr Bilal says that most people scrape by making a living, many women live alone raising children and most children don’t attend school. He grew up here and knows the community well. He and his team also know the needs of the people. For Mohammed Mouloid, above right, the Programme Coordinator at REMAP+, a network of people living with HIV, community outreach fills a big gap. During the COVID-19 restrictions, for example, they teamed up with SOS Pairs Educateurs, UNAIDS and others to distribute food kits.

Adjusting his glasses, Mr Mouloid said, “Before a person takes their medicine, they have two other priorities. The person has to eat first and find transportation to pick up their treatment. If both are not combined, then the third priority falls by the wayside and the person will never take their treatment.”

“Our biggest problem in Mauritania is stigma associated with HIV,” Mr Mouloid said, explaining that people living with HIV often drop out of treatment programmes. Only 40% of the 8500 people living with HIV in the country are on life-saving treatment. Mr Mouloid has lived with HIV for nearly 20 years and was one of the first people in Mauritania to take antiretroviral medicines, in 2004. “I have been married twice and have two children who are both HIV-negative, so I am a testament to living a healthy life, but things are tough in our society,” he said.

The HIV epidemic in Mauritania is concentrated in cities and among key populations. HIV prevalence among adults is around 0.3%, but is 9% among sex workers and 23% among gay men and other men who have sex with men. Mauritania criminalizes sex work and same-sex sexual relations, so people tend to hide. 

To reach out to key populations, SOS Pairs Educateurs, with the support of the United Nations and partners, recently opened a drop-in centre, above, in front of the bus station in the capital city (they have eight other drop-in centres around town). A television blasts in the corner as peer educators mill about chatting with a truck driver. A pilot project distributing HIV self-test kits that people can use in the privacy of their own home has also been undertaken. 

Sharif (he did not want to give his last name) explains that he stops by regularly to pick up condoms and get information from the counsellor. “I came here to know more about COVID-19 and other health risks,” he said. He said he had never taken an HIV test, which are provided for free, but was thinking about it.

According to the UNAIDS Country Director for Mauritania, El Mustapha Attighie, community outreach like this is a way to support vulnerable groups.

“Stigma hinders our response to HIV and if human rights are not respected and people are left behind, this increases the risks of HIV,” he said. He added that UNAIDS’ mandate clearly states advocating for rights and treatment for all and as a trained doctor he focuses the debate on people accessing health care.

He believes that Mauritania could end AIDS by 2030. “We have the opportunity to make this objective a reality,” he said. “Channel more money and means where the epidemic is, to quash it and also stop it from reaching a broader population.”

SOS Pairs Educateurs has expanded its activities to reach different populations. It founded a school for street children and children who have dropped out of school and organized trainings for girls in sewing as well as a teen dance group. “Here for many the reality is that you have little hope so by having kids succeed in school or on the dance floor, it boosts them and impacts the entire family,” said the SOS Pairs Educateurs Director, Djibril Sy, above. He grew up in El Mina and still lives there, saying that countless people have benefitted from its work in the past 20 years. “Aside from hope, we really try to instil a sense of self-worth,” he added, explaining now that he wants to give young people trainings in entrepreneurship.

Despite progress, western and central Africa represents 8% of the world population but is home to 12% of all people living with HIV globally and experiences 22% of all AIDS-related deaths in the world.

UNAIDS is deeply saddened by the sudden death of Ly Penh Sun, Director of the National Center for HIV/AIDS, Dermatology and STD (NCHADS) Cambodia, who passed away on 9 November 2021. UNAIDS expresses its sincere condolences to his family, his friends and the country.

Ly Penh Sun was instrumental to the success of the commendable HIV response in Cambodia. He spearheaded and strived towards the last mile of ending AIDS through listening to science and embracing innovations. Under his leadership and in close partnership with civil society, Cambodia set the historical milestones of being one of the first countries globally to achieve 90-90-90 targets in 2017. Together, they set the ‘zero to roll-out PrEP’ model in the region, introduced HIV self-testing and scaled-up multi-month dispensing of ARV treatment to mitigate service disruptions during the COVID-19 pandemic.

“His leadership championed the welfare of people living with HIV and supported communities to be meaningfully involved in the HIV response,” says Khin Cho Win Htin, UNAIDS Country Director a.i. for Cambodia. Ly Penh Sun worked tirelessly to confront HIV-related stigma and discrimination and was a trendsetter for community engagement and people centred approaches. As part of his work, he supported community-led service delivery for HIV prevention tailored to the needs of key populations.

“Ly Penh Sun was a tireless champion for HIV prevention in Cambodia and Asia and the Pacific. He was very influential in the region. He has always promoted and fostered partnership, South-to-South collaboration and sharing of best practices and knowledge. He will forever be remembered as the friend of the community, an innovator and a legend of the AIDS response in Cambodia,” said Taoufik Bakkali, UNAIDS Regional Director for Asia and the Pacific. “He will stay in the memory of the UNAIDS family forever.”