Cosponsors

Since school doors closed last March due to COVID-19, the majority of Jamaican students are still receiving tuition exclusively online. Social media and messaging services are more relevant than ever as a channel to share knowledge and resources with young people, as well as to receive their feedback.

The United Nations Children’s Fund (UNICEF) U-Report is an innovative message-based tool designed to engage with young people, provide them with information and give them an opportunity to weigh in on issues of national importance. Jamaica became the first Caribbean country to launch U-Report, joining a global movement of more than 5 million U-Reporters. UNAIDS Jamaica recently collaborated with UNICEF to find out what young people know, or don’t, about HIV. The 10-question quiz also provided correct information to the participants.

Almost 2000 young people responded to the survey, with just 214 achieving a perfect score. The quiz pointed to some worrying gaps in knowledge relating to both HIV basics and access to information on HIV prevention. One in 10 respondents mistakenly thought HIV could be transmitted by mosquitoes, for example. Almost one in three were not aware of the local solution for delivering school-based sex education, the Health and Family Life curriculum.

The results of the survey corroborate Jamaica’s most recent Knowledge, Attitude and Behaviour (KAB) survey results and demonstrate that there are still glaring HIV knowledge gaps among young people. The survey revealed that only 33% of young people between the ages of 15 and 24 years correctly identified the ways in which HIV can be transmitted. This was a 6% decline in knowledge levels as compared to the 2012 KAB survey. The 2017 study also found that 40% of respondents with multiple partners did not use a condom during their last sexual encounter.

“The results of the HIV U-Report quiz have reinforced the need for efforts to be made to address the decline in knowledge on information on HIV among young people in Jamaica,” said the UNAIDS Country Director for Jamaica, Manoela Manova. “Particularly in the context of COVID-19, it is critical that we innovate to ensure that this messaging and engagement takes place on digital platforms and with a view to ensuring that no child or young person is left behind.”

The U-Report social messaging tool has proved to be a quick and useful way to gather information that can be used to inform programmes and plans focusing on young people in Jamaica. UNICEF Jamaica has supported innovations to ensure that children and young people have access to education and support during COVID-19, including tele-mental health services, virtual instruction training for teachers and strategies to close the digital divide.

During COVID-19, virtual dialogues and behaviour change communication have been scaled up. A UNICEF-supported initiative aims to address the gaps in HIV and sexual and reproductive health knowledge for young people in Jamaica. The National Family Planning Board’s Adolescent Sexual and Reproductive Health Campaign focuses on teen health, including targeting sexually active teenagers with messages on condom use and dispelling myths about HIV transmission. The campaign disseminates sexual and reproductive health/HIV information through social media and uses animated characters to reach adolescents. The campaign also speaks about the benefits of abstinence and birth control. 

8 March 2021

Winnie Byanyima

Executive Director of UNAIDS
Under-Secretary-General of the United Nations

Women leaders have provided a guiding light for the world in responding to the COVID-19 crisis, from heads of government to coordinators of grass-roots social movements. They have reminded the world how crucial it is to have critical numbers of women, in all their diversity, in positions of leadership.

But the COVID-19 crisis has seen progress towards equality pushed back. It has widened the gap between women and men in wealth, in income, in access to services, in the burden of unpaid care, in status and in power.

Up to 20 million more secondary school-aged girls could end up out of school following the crisis. Many may never go back to school or have access to skills and economic opportunities, and will be at greater risk of violence, poor health, poverty and more.

Two and a half million more girls are now at risk of child marriage in the next five years. There has been a dramatic increase in violence against women.

Pandemics such as COVID-19 and HIV magnify the fissures in society and exacerbate vulnerabilities. Gender-based and intersecting inequalities and violence hold back the lives of women and girls all over the world.

The pandemic has brought into sharp and painful focus that even before COVID-19 an estimated 34 million girls between the ages of 12 and 14 years were out of school, one in three women globally reported having experienced physical or sexual violence and women the world over worked longer hours for less or no pay.

Women who were already stigmatized are among those who are being hardest hit by the impacts of the pandemic. The sudden loss of the livelihoods of sex workers and their lack of access to health care and social protection have intensified their vulnerabilities, especially for those living with HIV. Many female migrants and precarious workers adversely affected by the pandemic are excluded from government relief and protection programmes, as well as health services. Stigma, discrimination and criminalization put transgender women, and women who use drugs, at heightened risk of HIV and other sexually transmitted infections, and hold them back from accessing HIV prevention, treatment and care services.

Recovery strategies cannot be gender-blind or gender-neutral: they must overturn the inequalities that hold women back.

Together, UNAIDS, UN Women, the United Nations Children’s Fund, the United Nations Educational, Scientific and Cultural Organization and the United Nations Population Fund have convened a broad movement, Education Plus, to work with governments to secure the transformative changes that will enable all of Africa’s adolescent girls to be in school, safe and strong. That includes all the girls who have been pushed out of school during the COVID-19 crisis and those who were excluded from school even before the crisis hit.

Overcoming the COVID-19 crisis, and ending new HIV infections and AIDS-related deaths, both require that we close in on the inequalities that drive vulnerabilities. The new global AIDS strategy 2021–2026 puts the rights and multiple and diverse needs of women and girls across their life cycle at the centre of the response: from preventing vertical transmission to providing access to quality education in safe and supportive environments to ensuring comprehensive sexuality education and holistic sexual and reproductive health services.

Gender inequality is not only wrong. It is dangerous. It weakens us all. A more equal world will be better able to respond to pandemics and other shocks; it will leave us healthier and safer and more prosperous.

Progress on gender equality has never been automatic. It has never been given, it has always been won.

We are inspired by the women’s movements leading the struggle for equality. The United Nations stands alongside you to advance a world where women and girls in all their diversity will thrive and take their rightful places as equals.

This International Women’s Day let’s support and celebrate women taking the lead.

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.

The Global Fund to Fight AIDS, Tuberculosis and Malaria, the Government of Congo and health partners have announced two new grants worth more than US$ 64 million to strengthen prevention and treatment services to respond to HIV, tuberculosis and malaria and to build resilient and sustainable systems for health in Congo.

The two grants are a 97% increase from the previous allocation against the three diseases and will be spent from 2021 to 2023.

“UNAIDS looks forward to continuing to work closely with all partners to accelerate the elimination of vertical transmission of HIV and paediatric AIDS in Congo and to improve access to HIV/tuberculosis programmes, sexual and reproductive health, and legal services for young women and adolescent girls and all groups at higher risk of contracting HIV,” said Winnie Byanyima, Executive Director of UNAIDS.

The HIV grant will significantly increase the number of people living with HIV who know their HIV status and will expand access to life-saving antiretroviral therapy, particularly for pregnant women. In 2019 in Congo, only 51% of people living with HIV knew their HIV status and only 25% of people living with HIV were accessing antiretroviral therapy. Only 10% of pregnant women living with HIV in Congo were offered antiretroviral medicine to prevent the virus being passed to their babies.

The tuberculosis component of the grant aims to boost the national tuberculosis response, increase the notification of new tuberculosis cases and reach a 90% treatment success rate by 2023, in line with the World Health Organization’s End TB Strategy. The grant will also support the country’s efforts to improve treatment success for people with multidrug-resistant tuberculosis. The malaria grant will support the country’s goal to distribute 3.5 million mosquito nets by 2023 and expand access to quality malaria diagnostics and treatment tools.

“In the context of the country’s financial crisis, exacerbated by the COVID-19 pandemic, the grants allocated to Congo are a breath of fresh air. They provide renewed impetus to the government’s action in favour of populations affected by HIV, tuberculosis and malaria,” said the Prime Minister of Congo, Clément Mouamba.

The United Nations Development Programme will implement the HIV and tuberculosis grant, while Catholic Relief Services will implement the malaria grant.

GENEVA, 3 February 2021—UNAIDS warmly welcomes the announcement by the President of the United States of America, Joe Biden, that he has rescinded the Protecting Life in Global Health Assistance Policy (PLGHA, previously known as the Mexico City Policy). The policy required foreign nongovernmental organizations to certify that they would not perform or actively promote abortion using funds from any source (including non-United States funds) as a condition of receiving United States Government funding.

“Rescinding the PLGHA is a strong demonstration of the new United States Administration’s commitment to supporting women to claim their rights and to access sexual and reproductive health and rights information and services,” said Winnie Byanyima, UNAIDS Executive Director. “We look forward to working closely with the new United States Administration to ensure that all women and girls can exercise their human rights and get the sexual and reproductive health information and services they want and need.”

The former United States Administration took previous restrictions established by the Mexico City Policy to a new level by applying the policy to global health assistance provided by all executive departments and agencies. This severely limited access to critical sexual and reproductive health-care services and stifled local advocacy efforts, in turn undermining human rights in general and sexual and reproductive health and rights in particular worldwide.

UNAIDS welcomes the White House’s call to waive conditions related to the PLGHA in any current grants with immediate effect, to notify current grantees, as soon as possible, that these conditions have been waived and to cease imposing these conditions in any future assistance awards.

“Women and girls having full access to their sexual and reproductive health and rights is closely connected to their overall safety, health and well-being. We hope that this will inform the passage of the Global Health, Empowerment and Rights Act—legislation designed to permanently repeal the PLGHA,” added Ms Byanyima.

UNAIDS also warmly welcomes the announcement by the President that the United States will restore funding to the United Nations Population Fund (UNFPA), a key UNAIDS cosponsoring organization working around the world to provide reproductive health care for women and young people. UNAIDS appreciates the commitment by the United States Secretary of State, Anthony Blinken, to appropriate US$ 32.5 million in support for UNFPA this year.

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.

UNAIDS and the World Health Organization have published updated guidance on ethical considerations in HIV prevention trials. The new guidance is the result of a year-long process that saw more than 80 experts and members of the public give inputs and is published 21 years after the first edition appeared.

“UNAIDS is committed to working with the people and populations affected by HIV, promoting and protecting their rights,” said Peter Godfrey-Faussett, UNAIDS Science Adviser. “This guidance sets out how to carry out ethical trials on HIV prevention while safeguarding the participants’ rights during scientific research and promoting the development of new HIV prevention tools.”

With 1.7 million people becoming newly infected with HIV in 2019, there is still an urgent need to develop new ways of preventing HIV and make them available so that people can protect themselves from the virus. While new methods of preventing HIV have been developed over the past few years, for example pre-exposure prophylaxis, taken orally, in the dapivirine ring or in long-acting cabotegravir injections, the demand for easy-to-use and effective HIV prevention tools remains strong.

However, the need to develop new HIV prevention methods needs to be balanced with the need to protect the people who participate in scientific studies of the safety and efficacy of the prevention tools.

Research on people is governed by a well-established framework of ethical standards. The new report sets out in 14 guidance points the ethical standards for research on HIV prevention and upholds and explains the universal principles of ethics for research involving people in ways that are relevant to the participants and to developments in research for HIV prevention.

“The World Health Organization must ensure that policymakers and health implementers keep ethics at the heart of their decision-making. This collaboration with UNAIDS in convening a wide range of stakeholders for the review is a model for the future development of ethics guidance,” said Soumya Swaminathan, Chief Scientist at the World Health Organization.

The ethical considerations surrounding HIV prevention research are complex. Research must be conducted with the populations for which the new methods might have the most impact—such as key populations and adolescent girls and young women in locations where there is a high incidence of HIV—but members of those populations often live in situations that make them vulnerable to discrimination, incarceration or other harm, which can limit their participation in research and makes ethical research more challenging. The updated guidance seeks to set out how to ethically incorporate the needs of the people who could most benefit from HIV prevention research.

The updated guidance includes a number of key revisions to the previous edition. The importance of community members being involved at all stages of research projects is highlighted—there must be an equal partnership among research teams, trial sponsors, key populations, potential participants and the communities that live in settings where trials are taking place.

The issue of fairness, with an inclusive selection of study populations without arbitrary exclusion on the basis of characteristics such as age, pregnancy, gender identity or drug use, is emphasized. The guidance also underlines contexts of vulnerability—people and groups should not be labelled as vulnerable, but rather the emphasis should be on the social or political contexts in which people live that may render them vulnerable.

That researchers and trial sponsors should, at a minimum, ensure access to the package of HIV prevention methods recommended by the World Health Organization for every participant throughout the trial and follow-up is set out in the updated guidance, along with the need for post-trial access by participants to products that are shown to be effective. 

“This revised guidance will support all stakeholders in designing and conducting ethically and scientifically sound HIV prevention trials that advance the AIDS response towards the goal of zero new HIV infections,” added Mr Godfrey-Faussett.

This guidance document is also available in Portuguese.

Imagine using a health-care system that has no concept of you as a person, or of your unique needs. Nurses might not ask important questions. Doctors might overlook the solutions you really require. You might feel unwelcome.

That has always been the reality for transgender people in Jamaica. A new strategy seeks to change this.

With support from UNAIDS and the United Nations Population Fund (UNFPA), TransWave Jamaica has launched the Trans and Gender Non-Conforming National Health Strategy, the first of its kind in the English-speaking Caribbean. The five-year plan is a rights-based road map for how the health and well-being of transgender people can be advanced. It moves beyond recommendations for the health-care system to the structural and societal changes necessary to achieve equitable access to services and opportunities for the transgender community.

“Too many transgender people stay home and suffer or change who they are to access public health-care spaces,” explained TransWave Associate Director of Policy and Advocacy, Renae Green. “We need improvement to basic services, including psychosocial support. And we need transgender people to be able to access public health services as their authentic selves.”

Through the Unified Budget, Results and Accountability Framework Country Envelope for Jamaica, UNAIDS collaborated with UNFPA to support a robust year-long process of research, community engagement and strategy development, including a monitoring and evaluation framework. The strategy development process was informed by a multisectorial steering committee composed of civil society organizations, international cooperation partners and government authorities.

HIV is a major priority for the Jamaica transgender community. Around 50% of transgender women participants in two recent studies were living with HIV. But there are other pressing concerns. Two surveys found that around half of transgender respondents were unemployed. One third skip meals. One in ten sells sex to survive. Research conducted in 2020 by TransWave found that half of respondents had been physically assaulted in the past year, with 20% reporting sexual assault. More than 80% had been verbally abused.

“The needs go beyond HIV and health care. Other factors affect people’s ability to be safe, to be adherent or to remain HIV-negative. We should take into account the whole person, not just a part,” said Denise Chevannes-Vogel, HIV and AIDS Officer for the UNFPA Sub-Regional Office for the Caribbean.

“We value the fact that we were able to bring together the community to have a discussion about their needs beyond HIV,” said Ms Green.

The TransWave team led the community needs assessment. Some community requests, such as hormone replacement therapy or gender assignment surgery, are unique. But others are common to all people. They want access to health care and housing, education and employment. And they want to see themselves represented in the civil society spaces where many access care and support.

“We will not reach any AIDS-related targets if we do not prioritize transgender health as a whole. People are dying because of violence, living on the streets, lack of jobs and lack of opportunities. Even the HIV prevention knowledge that most people would acquire through formal education settings is not available to transgender people when they are bullied and forced to drop out. So this process was about reflecting on the impact indicators. What would it take for them to live longer, better lives?” said Ruben Pages, UNAIDS Jamaica’s Community Mobilization Adviser.

But what chance does this comprehensive and forward-thinking strategy have of succeeding in a country famed for its social conservatism? The partners are optimistic. On one hand, the approach calls for longer-term goals, including law reform around issues such as gender identity recognition and decriminalizing sex between same-sex partners. But the strategy is also a practical guide for transgender inclusion in systems and frameworks that are already in place. With targeted action there can be quick wins.

Manoela Manova, the UNAIDS Country Director for Jamaica, said the strategy will help the country accelerate progress to end AIDS.

“Going forward, there will be renewed focus on ensuring that excellent prevention, testing and treatment outcomes are achieved across all communities, especially key and vulnerable populations,” Ms Manova said. “This is an opportunity to make good on our commitment to leave no one behind.”

Global partners that are committed to ending paediatric AIDS have come together to call on countries to rapidly scale up access to optimal, child-friendly HIV treatment for infants and children. The partners include the United Nations Children’s Fund, the World Health Organization (WHO), UNAIDS, the United States President’s Emergency Plan for AIDS Relief, the Global Fund to Fight AIDS, Tuberculosis and Malaria, Unitaid, the Elizabeth Glaser Pediatric AIDS Foundation, and the Clinton Health Access Initiative (CHAI).

Children living with HIV continue to be left behind by the global AIDS response. In 2019, only 53% (950 000) of the 1.8 million children living with HIV (aged 0–14 years) globally were diagnosed and on treatment, compared to 68% of adults. [1] The remaining 850 000 children living with HIV have not been diagnosed and are not receiving life-saving HIV treatment. Two thirds of the missing children are aged 5–14 years and do not routinely attend traditional health facilities. Engaging communities and the families of people living with HIV, tuberculosis and other related diseases and offering family services are needed in order to find and start on treatment those missing children.

An estimated 95 000 children died of AIDS-related illnesses in 2019, in part due to lack of early diagnosis of HIV among infants and children and immediate linkage to optimal HIV treatment regimens. Untreated, 50% of infants infected with HIV during or around the time of birth will die before the age of two years. [1]

The United States Food and Drug Administration recently gave tentative approval for the first generic formulation of dolutegravir (DTG) 10 mg dispersible tablets. [2] This approval was the result of an innovative partnership between Unitaid, CHAI and ViiV Healthcare, together with generic suppliers, which accelerated the timeline of development by several years. The approval was quickly followed by the announcement on World AIDS Day of a groundbreaking agreement negotiated by Unitaid and CHAI that reduces the cost of HIV treatment by 75% for children in low- and middle-income countries, where the DTG 10 mg dispersible tablets will be available at a cost of US$ 4.50 for a 90-count bottle. [3] 

This now means that WHO-recommended, preferred first-line DTG-based antiretroviral treatment is now available in more affordable and child-friendly generic formulations for young children and infants as young as four weeks of age and weighing more than 3 kg. [4]  Rapid transition to this treatment, in combination with improved HIV diagnosis for children and other supportive measures, will help to urgently reduce the 95 000 preventable AIDS-related deaths in children.

DTG-based HIV treatment leads to better outcomes for children. DTG is less likely to be affected by drug resistance and achieves viral load suppression sooner; child-friendly dispersible tablets improve adherence due to a lower pill burden and being easier to administer. These factors help children achieve and maintain viral load suppression, the gold standard for measuring the effectiveness of HIV treatment. DTG-based treatment is the standard of care for adults. Starting on this regimen from infancy reduces the need for changes in treatment as they mature through childhood, adolescence and adulthood. Fewer regimens and regimen changes simplifies management of health care, improves stock management and reduces wastage. 

WHO has recommended DTG-based HIV treatment for all infants and children since 2018 [4] and provided dosing recommendations for infants and children over four weeks of age and more than 3 kg in July 2020. [5]

Suppliers have indicated their ability to meet global scale-up ambitions. Accurate forecasts of demand are critical to inform production planning and delivery timelines. It is therefore critical that national programmes start including DTG 10 mg dispersible tablets in their new procurement plans, review stocks and orders for existing non-DTG treatment for children, share forecasts with HIV treatment procurement partners and suppliers and place orders as early as possible.

The partners are committed to support national governments as they develop rapid transition plans from existing suboptimal HIV treatment to DTG-based treatment for infants and children, including advocacy for political commitment, mobilizing international and domestic resources, new policies and guidelines, managing medicine supply, distribution and stock, training health-care workers and sensitizing and engaging affected communities to ensure demand and treatment literacy for children living with HIV and their caregivers in order to ensure rapid uptake of these new formulations.

Further guidance for national programmes and partners is available from WHO. [5] The CHAI HIV New Product Introduction Toolkit has dedicated resources to help countries transition to paediatric DTG. [6]

Quotes from partners

“National governments, partners on the ground and affected communities need to work together to find and treat the children and infants whose lives can be saved by these new medicines,” said Shannon Hader, UNAIDS Deputy Executive Director for Programme. “The new medicines are cheaper, more effective and more child-friendly than current treatments for infants and young children. We need to get them into clinics to save lives now.”

“The United States President’s Emergency Plan for AIDS Relief works tirelessly to ensure clients can access the best available HIV treatment, including advanced, paediatric regimens for children living with HIV,” said Deborah L. Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy. “The accelerated introduction and expansion of paediatric DTG has the potential to save and improve the lives of thousands of children around the world. The United States President’s Emergency Plan for AIDS Relief will continue to collaborate with global and local partners to ensure the young children we serve can promptly access paediatric DTG.”

“Providing antiretroviral drugs to people living with HIV is at the core of our support to national HIV programmes,” said Peter Sands, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria. “This new and affordable child-friendly HIV treatment is a tremendous step forward that will improve and save the lives of some of the most vulnerable in society—young children infected with HIV. We are committed to support countries to make a fast transition to these new drugs.”

“Children in low- and middle-income countries often wait years to access the same medications as adults, hindering their quality of life, or even resulting in preventable deaths. We are proud to have worked with partners on this groundbreaking agreement that will bring quality assured dispersible DTG to children at a record pace,” said Philippe Duneton, Unitaid Executive Director. “Ensuring access to this treatment will transform the lives of children living with HIV, helping them to remain on treatment and saving thousands of lives.”

“For the first time, children living with HIV in low- and middle-income countries will have access to the same first-line antiretroviral medication at the same time as those in high-income countries,” said Iain Barton, Chief Executive Officer of the Clinton Health Access Initiative. “The partnership should serve as a model to remove barriers that hinder development of paediatric formulations to deliver top-line medications quickly and affordably.”

“The persistent treatment gap between adults and children prevents us from achieving an AIDS-free generation,” said Chip Lyons, President and Chief Executive Officer of the Elizabeth Glaser Pediatric AIDS Foundation. “Children living with HIV around the world urgently require age-appropriate, effective and accessible formulations. Approval of dispersible DTG is a momentous step forward, but meaningless if this new formulation doesn’t quickly reach the babies and small children who desperately need it most. The Elizabeth Glaser Pediatric AIDS Foundation is committed to supporting accelerated roll-out, uptake and delivery of new, optimal paediatric antiretroviral medicines in partnership with global, regional and local leaders.”

“The persisting treatment gap between mothers and children is unacceptable with the new scientific breakthroughs that are within our reach to change the trajectory”, said Chewe Luo, Associate Director and Chief of HIV, United Nations Children’s Fund. “The United Nations Children’s Fund welcomes global commitments and progress made in developing better diagnostic approaches and optimal regimens for children to improve their outcomes.”

“This has the potential to be a true game-changer for children with HIV", said Meg Doherty, Director of Global HIV, Hepatitis and STI Programmes at WHO. “We must do all in our power to help countries get this new paediatric DTG 10 mg to all the children who need it."

[1] UNAIDS. Start Free Stay Free AIDS Free - 2020 report. 07 July 2020. https://www.unaids.org/en/resources/documents/2020/start-free-stay-free-aids-free-2020-progress-report

[2] https://www.accessdata.fda.gov/drugsatfda_docs/pepfar/214521PI.pdf

[3] UNITAID press release. Groundbreaking Agreement Reduces by 75% the Cost of HIV Treatment for Children in Low-and Middle-Income Countries. https://unitaid.org/news-blog/groundbreaking-agreement-reduces-by-75-the-cost-of-hiv-treatment-for-children-in-low-and-middle-income-countries/#en 

[4] World Health Organization. Updated recommendations on first-line and second-line antiretroviral regimens and post-exposure prophylaxis and recommendations on early infant diagnosis of HIV. Interim guidance. 1 December 2018, https://www.who.int/publications/i/item/WHO-CDS-HIV-18.51.

[5] World Health Organization. Considerations for introducing new antiretroviral drug formulations for children. Policy brief. 1 July 2020, https://www.who.int/publications/i/item/9789240007888.

[6] Clinton Health Access Initiative. HIV new product introduction toolkit. Pediatric 10 mg dispersible, scored resources, https://www.newhivdrugs.org/.

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.

Warm smiles greet Lily as she approaches her first stop of the day—one of the 11 brothels scattered across the country that Lily, the President of the Bangladesh Sex Worker Network, visits quarterly to check in with the women and see what assistance they need. Though her visits have been limited in recent months due to movement restrictions to curb the spread of COVID-19, Lily knows well enough that those smiles are a brave front for the troubling times that her peers have experienced.

“I see the sex workers as my sisters—I feel their happiness and pain and I try my best to solve any issue they face,” Lily said. During the COVID-19 pandemic, Lily and the 29 community-based organizations serving sex workers in the country have struggled to respond to the increased calls for support. In March, government countrywide movement restrictions meant that sex workers could no longer have clients, leaving most of them without a source of income and unable to provide for themselves or their families.

“Sex workers’ children faced challenges during the COVID situation because their mothers couldn’t arrange to provide them with food. When we [the Bangladesh Sex Worker Network] learned about this issue, we reached out to many organizations and the private sector for assistance,” explained Lily. Responding to the call to action, the network mobilized funds to support 2100 sex workers across the country. Community-led support in Bangladesh has also garnered global recognition. Most recently, a former sex worker, Rina Akter, was recognized by the BBC for her efforts, and those of her team of helpers, to serve 400 meals a week to sex workers in need.

“While a few sex workers had savings, most could not provide for themselves,” said Rahat Ara Nur, Technical Officer for the United Nations Population Fund in Bangladesh. “Through the United Nations Population Fund, we provided sex workers with COVID-19 prevention commodities, such as masks and handwashing materials, and we also developed public service announcements which were aired on community radio to ensure we raised awareness about COVID-19 precautionary measures among the community."

With the closure of entertainment venues, a classification that includes brothels, some sex workers have resorted to street-based sex work, which increases the risk of violence, condom-less sex and no pay or low pay.

Sex workers are also experiencing increasing vulnerability to gender-based violence. Without a source of income, conflicts about finances arise, and sex worker networks report that their members have experienced abuse at the hands of their spouses, partners and brothel owners.

Some sex workers report that they have become homeless because the brothels have been closed, or in some cases the residents were evicted because rent could not be paid. Many sex workers cite stigma and discrimination as a barrier for other forms of employment. Health outreach services that once provided brothels with sexual and reproductive health services, including HIV testing and prevention, have been suspended due to travel restrictions.

Bangladesh, October 2019. Credit: UNFPA Bangladesh/Naymuzzaman Prince

These developments are not unique to Bangladesh, however. Throughout the Asia–Pacific region, national and regional networks of sex workers are reporting that the COVID-19 outbreak has exacerbated the inequalities faced by sex workers, and many are either not eligible or excluded from social protection services.

“There is no government support specifically targeting sex workers. There is support for the general public, particularly those that are low income, but sex workers are not eligible for these social protections because they work in the informal economy,” said Hnin Hnin Yu, the Chairperson of Sex Workers in Myanmar (SWiM), a nongovernmental advocacy group for sex workers’ rights.

Additionally, many sex workers are migrants (international or internal) and lack the necessary papers or registration with local authorities to access the government’s support. Eligibility criteria for social support, such as documentation of income, proof of residence, national identification, contribution to existing social protection schemes and filing taxes, are all reasons given for excluding sex workers from government support. An online consultation of female sex workers from across the country, organized by UNAIDS and SWiM, revealed that apart from limited funds from humanitarian actors, none of the sex workers had received social support.

“When Global Fund to Fight AIDS, Tuberculosis and Malaria assistance for COVID-19 was allocated, funds for people living with HIV included the most vulnerable sex workers to receive food provisions,” said Mr Myo, Community Support Adviser for UNAIDS in Myanmar. “However, we recognized that this was an ad hoc solution that reached a small portion of the vulnerable population and there is a need for more sustainable support, such as social protection, for sex workers.”

It has become clear that focused support for sex workers must be prioritized. Recognizing that more needs to be known about the gaps in social protection for sex workers, UNAIDS in collaboration with the United Nations Population Fund and the World Food Programme are exploring the possibility of conducting a needs assessment and vulnerability mapping initiative of female sex workers during the COVID-19 pandemic. Data from the community-led mapping initiative will be used to inform programming for livelihood support, food security, improved access to antiretroviral therapy, sexual and reproductive health services and gender-based violence prevention and response services.

Commenting on the prospects of the United Nations agencies joining forces to coordinate a vulnerability mapping exercise with sex worker networks, Ms Nur expressed excitement about how this advocacy tool will not only help to identify the challenges that sex workers face during the COVID-19 outbreak, but it would also catalyse further work to mobilize resources for programmes and address injustices that pre-date the COVID-19 pandemic.

Hnin Hnin Yu cites discrimination and harassment from police as a long-standing challenge facing sex workers’ rights. During the COVID-19 outbreak, communities have reported increased police surveillance, harassment, including physical violence, and demands to pay fees to conduct sex work. In response, SWiM provides community-led, peer-to-peer legal aid for sex workers who have been arrested, educating them about their rights.

For those working closely with community-led organizations it has been inspiring to see that although sex worker networks and the sex workers they represent have seen challenges all around them, they have done their best to support their peers. There is hope that the data gathered in a vulnerability mapping exercise would not only generate the evidence needed to advocate for expanding the reach of social protection and humanitarian response services to be inclusive of sex workers, but could also inform the scale-up of community-led programming. 

When Lineo Tsikoane gave birth to her daughter, she was inspired to intensify her advocacy for gender equality to give Nairasha a better life as a girl growing up in Lesotho.

“I think a big light went off in my head to say, “What if the world that I’m going to leave will not be as pure as I imagine?” I ask myself, “What kind of world do I want to leave my daughter in?”” she says.

As a result, Ms Tsikoane champions for women’s social, economic and legal empowerment at her firm, Nairasha Legal Support. It offers legal support for women in small and medium enterprises and women who are survivors of sexual and gender-based violence.

“Our main focus is gender-based violence, because this happens to be a country that has one of the highest incidences of rape and intimate partner crime in the world,” she says.

Even before the COVID-19 outbreak, violence against women and girls had reached epidemic proportions globally.

According to UN Women, 243 million women and girls worldwide were abused by an intimate partner in the past year. In Lesotho, it is one in three women and girls.

Less than 40% of women who experience violence report it or seek help.

As countries implemented lockdown measures to stop the spread of the coronavirus, violence against women, especially domestic violence, intensified—in some countries, calls to helplines increased fivefold.

In others, formal reports of domestic violence have decreased as survivors find it harder to seek help and access support through the regular channels. School closures and economic strains left women and girls poorer, out of school and out of jobs, and more vulnerable to exploitation, abuse, forced marriage and harassment.

The United Nations Population Fund (UNFPA) works together with UNAIDS, the United Nations Children’s Fund and the World Health Organization on 2gether4SRHR, a joint programme funded by the Swedish International Development Cooperation Agency, to address HIV and sexual and reproductive health in Lesotho.

During Lesotho’s lockdowns, UNFPA worked with Gender Links, the Lesotho Mobile Police Service and others to support efforts to prevent and respond to incidences of gender-based violence.

“We are ensuring that a helpline, where people experiencing gender-based violence can call, is in place and is working and we are also providing relevant information through various platforms for people to access all the information they need on gender-based violence,” says Manthabeleng Mabetha, the UNFPA Country Director for Lesotho.

Mantau Kolisang, a local policeman from Quthing, Lesotho’s southernmost district, characterized by rolling hills and vast landscapes, says one reason why gender-based violence is prevalent in Lesotho is because the law is not heeded in the rural areas.

“It’s difficult to implement the law since these are remote areas,” he says, adding that while he has made arrests, he has no transport to access far-flung areas in the small mountainous region. 

Lesotho’s law states that a girl can marry at the age of 16 years. However, Mr Kolisang says cultural practices, coupled with contraventions of the law, has made some men believe a 13-year-old girl “can be a wife”, exposing Basotho girls to violence.

“Men don’t regard it as a crime,” he says, adding that girls have been abducted from the mountains for forced marriages.

Between 2013 and 2019, 35% of adolescent girls and young women in sub-Saharan Africa were married before the age of 18 years. Girls married before 18 years of age are more likely to experience intimate partner violence than those married after the age of 18.

Because of poverty, gender inequality, harmful practices (such as child, early or forced marriage), poor infrastructure and gender-based violence, girls are denied access to education, one of the strongest predictors of good health and well-being in women and their children.

In Lesotho’s legal system, women are regarded as perpetual minors. This categorization infantilizes women, Ms Tsikoane says. A man who abuses a woman can often walk away unscathed from the justice system if he says the woman in question is his “wife”, she adds.

“This makes women vulnerable to commodification because a child can be passed around,” she says.

Ms Tsikoane says there is a direct link between the minority status of women and HIV infection in Lesotho. In 2019, there were 190 000 women 15 years and older living with HIV in Lesotho, compared to 130 000 men. 

Adolescent girls and young women between the ages of 15 and 24 years are particularly vulnerable. They accounted for a quarter of the 11 000 new HIV infections in Lesotho in 2019.

“My hypothesis is women cannot negotiate safe sex,” says Ms Tsikoane.

The dangerous reality that Basotho women live in worries Mr Kolisang. But due to a lack of institutional support and resources, he feels his actions have limited effect.

“I feel for these children. I feel for these women. I do feel for them. I can help, but the problem is how?” he laments.

Ms Tsikoane says she finds “trinkets of opportunities” for her and her colleagues to help their clients and navigate a legal system that is not favourable towards women.

“So, if you are not being well assisted at a police station, if you feel like someone is dragging your case and you are struggling to get an audience, we are there. We will support you and we will fight with you,” she says. 

This story was first published by UN Women

On World AIDS Day, UN Women spoke to survivors and community changemakers in South Africa who as part of UN Women’s HeForShe community-based initiative and a joint UNAIDS programme are engaging men and women to reject violence against women and seek HIV testing and treatment. 

Until two years ago, Karabo Chabalala (28) and Sarah Baloyi (26), young women from Mamelodi — a township northeast of Pretoria in Gauteng, South Africa — were living very different lives.

“I was in a very dark place. I had multiple sexual partners and was part of a lifestyle that was not good or healthy for me,” says Baloyi. Her friend, Chabalala says, “I had many personal problems. I engaged in a transactional relationship with an abusive older man to fund my education and provide for my family.”

Their lives turned around following their involvement in UN Women’s HeforShe community-based initiative that aimed at improving attitudes and behaviours around gender-based violence (GBV) and HIV.

“Karabo introduced me to HeForShe, a community that cares for one another,” says Baloyi. “The dialogues showed me that I am not alone in my mistakes and could change my life. I have been inspired to promote safe and healthy living for young girls and to provide them with the same loving acceptance that was extended to me.”

Chabalala adds, “Many young women don’t open up at home about problems they are facing. These dialogues give us a space to express our thoughts and feelings and to ask any questions that we have about life.”

Led by UN Women’s partner, Southern Africa Catholic Bishops Conference (SACBC), and funded through the Joint United Nations Programme on HIV/AIDS (UNAIDS), the HeforShe dialogues have since 2018 engaged 115,000 men and women across seven districts (Mamelodi, Klerksdorp, Bojanela, Sedibeng, city of Johannesburg, Ehlanzeni and CapeTown) in South Africa’s five provinces.

“The dialogues are coordinated by 151 trained women and men ‘changemakers’, including young women like Baloyi and Chabalala, equipped with knowledge on HIV and violence prevention, unequal gender norms, the importance of HIV testing and adhering to treatment, responsible sexual behavior, and how socio-economic factors can drive HIV infections among men and women,” explains UN Women's South Africa Multi-Country Office Representative, Anne Githuku-Shongwe.

“Many women in Mamelodi have been victims of abuse or witnessed femicide in their homes, often at the hands of men who [are alcoholic].” says Baloyi.

“All I feel is anger,” says Chabalala. “These men don’t respect us. Women in our community are being raped and killed. Some men who perpetrate these crimes are out on bail the following day.”

“There has been a rise in GBV since the COVID-19 lockdown,” says Baloyi. “Abusive partners have been stuck at home and they are frustrated. They are no longer able to spend their time working or drinking with friends, and take it out on their partners and children. This is especially the case in informal settlements, where families live in one- or two-room shacks.”

South Africa is home to almost one-fifth of people living with HIV worldwide and has an HIV prevalence rate of 20.4 per cent among adults (15-19 years). In line with trends across Sub-Saharan Africa, in 2019, women accounted for the majority of new infections in the country. Structural gender inequalities, discrimination, violence against women and girls, and unequal gender norms continue to undermine efforts by women and girls to prevent HIV and use HIV/AIDS services.

“The stigma around HIV prevents people from seeking treatment. I have met some older patients who still fear going to the clinics because they feel judged or embarrassed,” says Chabalala.

To increase the uptake of HIV testing, the changemakers partnered with 20 local HIV counselling and testing clinics across participating districts. They also facilitated outreach for HIV testing at community and church events and developed a referral system. In two years, the HeforShe initiatives have resulted in 62 per cent of those engaged testing for HIV, and 36 per cent returning and adhering to their antiretroviral treatment. However, because of the COVID-19 pandemic, people living with HIV and people at higher risk of HIV infection are facing life-threatening disruptions to health services.

Inspired by the positive impact of UN Women initiatives in communities and empowered by the change makers, Mamelodi community members founded the national ‘Young Women for Life Movement (YWfLM)’, which has grown to 2,035 members. With support from the SACBC, the group is currently monitoring the proceeding of 30 cases of sexual and gender-based violence and 17 cases of femicide in the justice system, as well as supporting the families of survivors. They also played a crucial role in organizing food supply drives to the most vulnerable households in their communities during the COVID-19 lockdown.

“I started the Mamelodi chapter of the Young Women for Life Movement,” says Chabalala. “Being part of this community of 200 powerful young women has taught me so many things and helped me grow. It has changed my life”.

“As a YWfLM member, I work with our local clinic and visit people living with HIV in our community to confirm that they are taking their medication and to ask if they need any assistance or additional supplements,” says Baloyi. “We also have an HIV-positive support group that now mainly connects online due to the pandemic.”

Both Baloyi and Chabalala believe that men need to be more involved in initiatives to improve attitudes and behaviours to prevent GBV and HIV. “Young men need to not only be part of this conversation, they must have their own dialogues where they focus on how to change their mindset,” says Chabalala.

Baloyi adds, “Many more men need to join women in our fight. Men must join us in court and in the streets. They must fight with us.”