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UN Women estimates that globally in the past 12 months 243 million women and girls aged 15–49 years were subjected to sexual and/or physical violence perpetrated by an intimate partner. As a result of the lockdowns imposed to stop the spread of COVID-19, emerging data show that such violence has intensified. In France, for example, reports of domestic violence have increased by 30% since the lockdown started on 17 March, and in Argentina emergency calls about domestic violence have increased by 25% since its lockdown started on 20 March. Many other countries have reported such increases.

Recently, the Odnoklassniki social network, known as OK, hosted a broadcast for experts and others to discuss how to survive lockdown and avoid family conflict and gender-based violence. The broadcast was seen by 1.7 million OK network users across eastern Europe and central Asia.

“I live in Kyrgyzstan,” Ulzisuren Jamstran, a representative of UN Women in Kyrgyzstan, said. “Here, according to the government, the level of domestic violence increased by 65%. We see an increase in aggression against women and children in Kyrgyzstan, we see an increase in suicides among children, even young children.”

Lyudmila Petranovskaya, a Russian psychologist, explained how isolation made good relationships become better and problematic relationships become more problematic. She emphasized that people need to be aware of the options if they are locked down with an abuser. “People have to look for contacts, a hotline, call friends, try to find another place to survive isolation. Staying with the abuser is dangerous. This threat is more serious than coronavirus,” she said.

Julia Godunova, Deputy Head of the Board of the Eurasian Women’s Network on AIDS, spoke about studies in eastern Europe and central Asia that show that more than 70% of women who survived violence do not seek help because of the perceived shame.

Dina Smailova, the founder of the #DontBeSilentKZ nongovernmental organization, addressed female survivors of violence. “When we are silent, we allow these crimes to multiply. I urge women not to be silent. Our movement is expanding, we are active not only in Kazakhstan, but also in other countries of central Asia and beyond.”

The broadcast highlighted successful experiences around the world in responding to gender-based violence. The example in Spain, where women in danger can visit pharmacies and use a code word to alert staff that they need help, was praised. The role of the private sector was also shown to be important—since many shelters are not open at present, hotels are stepping in and providing shelter, either for free or at a minimal cost.

The broadcast was part of a joint initiative of the UNAIDS regional office for eastern Europe and central Asia, the UNESCO Institute for Information Technologies in Education and OK, in partnership with the regional office of UN Women for eastern Europe and central Asia.

Signed by Ghada Fathi Waly, Executive Director, UNODC; Tedros Adhanom Ghebreyesus, Director-General, WHO; Winnie Byanyima, Executive Director, UNAIDS; Michelle Bachelet, United Nations High Commissioner for Human Rights. — * We thank UNDP for their contributions to this statement.

We, the leaders of global health, human rights and development institutions, come together to urgently draw the attention of political leaders to the heightened vulnerability of prisoners and other people deprived of liberty to the COVID-19 pandemic, and urge them to take all appropriate public health measures in respect of this vulnerable population that is part of our communities.

Acknowledging that the risk of introducing COVID-19 into prisons or other places of detention varies from country to country, we emphasize the need to minimize the occurrence of the disease in these settings and to guarantee that adequate preventive measures are in place to ensure a gender-responsive approach and preventing large outbreaks of COVID-19. We equally emphasize the need to establish an up-to-date coordination system that brings together health and justice sectors, keeps prison staff well-informed and guarantees that all human rights in these settings are respected.

Reduce overcrowding

In the light of overcrowding in many places of detention, which undermines hygiene, health, safety and human dignity, a health response to COVID-19 in closed settings alone is insufficient. Overcrowding constitutes an insurmountable obstacle for preventing, preparing for or responding to COVID-19.

We urge political leaders to consider limiting the deprivation of liberty, including pretrial detention, to a measure of last resort, particularly in the case of overcrowding, and to enhance efforts to resort to non-custodial measures. These efforts should encompass release mechanisms for people at particular risk of COVID-19, such as older people and people with pre-existing health conditions, as well as other people who could be released without compromising public safety, such as those sentenced for minor, non-violent offences, with specific consideration given to women and children.

A swift and firm response aimed at ensuring healthy and safe custody, and reducing overcrowding, is essential to mitigate the risk of COVID-19 entering and spreading in prisons and other places of deprivation of liberty. Increasing cleanliness and hygiene in places of deprivation of liberty is paramount in order to prevent the entry of, or to limit the spread of, the virus.

Compulsory detention and rehabilitation centres, where people suspected of using drugs or engaging in sex work are detained, without due process, in the name of treatment or rehabilitation should be closed. There is no evidence that such centres are effective in the treatment of drug dependence or rehabilitation of people and the detention of people in such facilities raises human rights issues and threatens the health of detainees, increasing the risks of COVID-19 outbreaks.

Ensuring health, safety and human dignity

All states are required to ensure not only the security, but also the health, safety and human dignity, of people deprived of their liberty and of people working in places of detention at all times. This obligation applies irrespective of any state of emergency.

Decent living and working conditions as well as access to necessary health services free of charge form intrinsic elements of this obligation. There must be no discrimination on the basis of the legal or any other status of people deprived of their liberty. Health care in prisons, including preventive, supportive and curative care, should be of the highest quality possible, at least equivalent to that provided in the community. Priority responses to COVID-19 currently implemented in the community, such as hand hygiene and physical distancing, are often severely restricted or not possible in closed settings.

Ensuring access to continued health services

Prison populations have an overrepresentation of people with substance use disorders, HIV, tuberculosis (TB) and hepatitis B and C compared to the general population. The rate of infection of diseases in such a confined population is also higher than among the general population. Beyond the normal infectivity of the COVID-19 pandemic, people with substance use disorders, HIV, hepatitis and TB may be at increased risk of complications from COVID-19.

To ensure that the benefits of treatments started before or during imprisonment are not lost, provisions must be made, in close collaboration with public health authorities, to allow people to continue their treatments without interruption at all stages of detention and upon release. Countries should embrace a health systems approach, where prisons are not separated from the continuity-of-care pathway but integrated with community health services.

Enhancing prevention and control measures in closed settings as well as increasing access to quality health services, including uninterrupted access to the prevention and treatment of HIV, TB, hepatitis and opioid dependence, are therefore required. Authorities must ensure uninterrupted access and flow of quality health commodities to prisons and other places of detention. Staff, health-care professionals and service providers working in closed settings should be recognized as a crucial workforce for responding to the COVID-19 pandemic and receive appropriate personal protective equipment and support as necessary.

Respect human rights

In their responses to COVID-19 in closed settings, states must respect the human rights of people deprived of their liberty. Restrictions that may be imposed must be necessary, evidence-informed, proportionate (i.e. the least restrictive option) and non-arbitrary. The disruptive impact of such measures should be actively mitigated, such as through enhanced access to telephones or digital communications if visits are limited. Certain fundamental rights of people deprived of their liberty and corresponding safeguards, including the right to legal representation, as well as the access of external inspection bodies to places of deprivation of liberty, must continue to be fully respected.

Adhere to United Nations rules and guidance

We urge political leaders to ensure that COVID-19 preparedness and responses in closed settings are identified and implemented in line with fundamental human rights, are guided by World Health Organization (WHO) guidance and recommendations and never amount to torture and other cruel, inhuman or degrading treatment or punishment. In prisons, any intervention should comply with the United Nations Standard Minimum Rules for the Treatment of Prisoners (the Nelson Mandela Rules).

People deprived of their liberty exhibiting symptoms of COVID-19 or who have tested positive should be monitored and treated in line with the most recent WHO guidelines and recommendations. Prisons and other places of detention must be part of national COVID-19 plans with dedicated participation of affected populations. All cases of COVID-19 in closed settings should be notified to responsible public health authorities, who will then report to national and international authorities.

In line with our mandates, we remain available to provide support in the rapid deployment of the recommendations outlined above.

This document is available in Arabic, Chinese, French, Portuguese, Russian and Spanish. 

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.

United Nations entities in South Africa, including UNAIDS, are working closely together to support government and community responses to the COVID-19 pandemic. The United Nations in South Africa has jointly engaged with civil society, the private sector and key affected communities, including people living with HIV and tuberculosis, to rapidly respond to the impact of a national lockdown that commenced on 26 March.

Using the World Health Organization eight-pillar approach, the United Nations in South Africa has developed a multisectoral plan centred on the immediate health and other needs of people, including access to medicines, HIV prevention and testing services, food security, education, social protection and community resilience.

On 30 April, the United Nations in South Africa launched an emergency flash appeal for US$ 136 million to support close to 10 million people in need. The appeal will help fund the civil society response and ensure that the needs of key populations and vulnerable communities are met in the response to COVID-19, including continued health support to people living with HIV, migrants and refugees, women and children affected by violence and communities facing shortages of food and other essentials.

UNAIDS has worked with partners to coordinate the United Nations in South Africa plan, providing support to strategic information, community engagement and communication. Funds already available to the United Nations Joint Team on HIV/AIDS are being reprogrammed to ensure that civil society, people living with HIV, key populations and vulnerable communities continue to be supported in the AIDS response while also addressing new challenges from COVID-19.

United Nations staff, including UNAIDS staff based in provinces with a high HIV burden, are working in the national and provincial COVID-19 command centres and supporting community health workers actively engaged in screening, contact tracing and voluntary testing. South Africa has massively scaled up screening for COVID-19.

Supporting community innovation

The United Nations has actively engaged with civil society organizations through sector networks, some of which have been established to coordinate responses to the pandemic, such as the C19 People’s Coalition and the COVID-19 Front, and long-standing networks, including the South African National AIDS Council (SANAC) Civil Society Forum and the National Economic Development Council Community Constituency. Their plans include a strong emphasis on advocacy, communication and social mobilization around issues such as medical care, shortages of food and fresh water, crowded housing conditions, homelessness and loss of income. The United Nations Country Team is providing technical support to civil society and resource mobilization through its emergency flash appeal.

UNAIDS has also supported organizations representing people living with HIV to survey and document the needs and challenges of people living with HIV in accessing essential health and social services, antiretroviral therapy and safety and hygiene services committed by the government. The survey results will inform a dialogue led by people living with HIV to find joint solutions.

Working with the government and other partners

Under the leadership of the United Nations Resident Coordinator in South Africa, Nardos Bekele-Thomas, the United Nations in South Africa is fully supporting the all-government, all-society COVID-19 response led by the National Command Council, chaired by the President, with a cutting-edge Ministerial Advisory Council that provides the science and evidence for decision-making.

The United Nations has jointly consulted the government, including the Department of Health and the Department of Social Development, to explore response needs, including support to the National Solidary Fund set up by the President for resource mobilization. The United Nations also briefed the diplomatic corps, the business sector, private foundations and philanthropies on how the United Nations is responding to support the government, civil society and communities. Consultations were also held with the World Bank, which is currently developing a post COVID-19 strategy and possible support to the national response.

The UNAIDS Country Director for South Africa, Mbulawa Mugabe, emphasized the importance of using lessons from the AIDS epidemic to put people at the centre of the COVID-19 response and encourage communities to identify issues and develop solutions. “We need to make sure that we act with purpose and speed,” he said. “Communities have mobilized themselves and are determined that people who need services have access to them. We remain concerned that COVID-19 may impact differently on the 5 million people in South Africa who are living with HIV and on treatment and the 2.5 million people who are not currently receiving antiretroviral therapy. It is important to protect the progress in the AIDS response to date and continue achieving the HIV prevention and treatment targets for 2020.”

The Joint Team on HIV/AIDS in South Africa is working with the Department of Health, primary recipients of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief in an effort to safeguard access to HIV services and promote multimonth dispensing of antiretroviral therapy.

UNAIDS is working with the United Nations Office on Drugs and Crime, the Department of Social Development, SANAC and other partners to address disruptions for homeless people, including those who use drugs, so they can access essential services, including antiretroviral therapy, replacement needles and syringes and methadone, even after they were relocated to emergency shelters. The Office of the United Nations High Commissioner for Human Right is monitoring the impact of the lockdown regulations and enforcement procedures on marginalized people and key populations and is advocating to end stigma and prevent punitive measures. The social protection cluster in the United Nations team is working with government and civil society to address humanitarian challenges.

The World Health Organization and UNAIDS are working with the Department of Health and SANAC to develop communication materials directed at communities, including podcasts to be made available through WhatsApp and community radio stations. 

Gains made in preventing mother-to-child transmission of HIV could be reversed, with new HIV infections among children up by as much as 162%

GENEVA, 11 May 2020—A modelling group convened by the World Health Organization and UNAIDS has estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021. In 2018, an estimated 470 000 people died of AIDS-related deaths in the region.

There are many different reasons that could cause services to be interrupted—this modelling exercise makes it clear that communities and partners need to take action now as the impact of a six-month disruption of antiretroviral therapy could effectively set the clock on AIDS-related deaths back to 2008, when more than 950 000 AIDS-related deaths were observed in the region. And people would continue to die from the disruption in large numbers for at least another five years, with an annual average excess in deaths of 40% over the next half a decade. In addition, HIV service disruptions could also have some impact on HIV incidence in the next year.

“The terrible prospect of half a million more people in Africa dying of AIDS-related illnesses is like stepping back into history,” said Dr Tedros Adhanom Ghebreyesus, Director-General of the World Health Organization.

“We must read this as a wake-up call to countries to identify ways to sustain all vital health services. For HIV, some countries are already taking important steps, for example ensuring that people can collect bulk packs of treatment, and other essential commodities, including self-testing kits, from drop-off points, which relieves pressure on health services and the health workforce. We must also ensure that global supplies of tests and treatments continue to flow to the countries that need them,” added Dr Tedros.

In sub-Saharan Africa, an estimated 25.7 million people were living with HIV and 16.4 million (64%) were taking antiretroviral therapy in 2018. Those people now risk having their treatment interrupted because HIV services are closed or are unable to supply antiretroviral therapy because of disruptions to the supply chain or because services simply become overwhelmed due to competing needs to support the COVID-19 response.

“The COVID-19 pandemic must not be an excuse to divert investment from HIV,” said Winnie Byanyima, Executive Director of UNAIDS. “There is a risk that the hard-earned gains of the AIDS response will be sacrificed to the fight against COVID-19, but the right to health means that no one disease should be fought at the expense of the other.”

When treatment is adhered to, a person’s HIV viral load drops to an undetectable level, keeping that person healthy and preventing onward transmission of the virus. When a person is unable to take antiretroviral therapy regularly, the viral load increases, impacting the person’s health, which can ultimately lead to death. Even relatively short-term interruptions to treatment can have a significant negative impact on a person’s health and potential to transmit HIV.

This research brought together five teams of modellers using different mathematical models to analyse the effects of various possible disruptions to HIV testing, prevention and treatment services caused by COVID-19.

Each model looked at the potential impact of treatment disruptions of three months or six months on AIDS mortality and HIV incidence in sub-Saharan Africa. In the six-month disruption scenario, estimates of excess AIDS-related deaths in one year ranged from 471 000 to 673 000, making it inevitable that the world will miss the global 2020 target of fewer than 500 000 AIDS-related deaths worldwide.

Shorter disruptions of three months would see a reduced but still significant impact on HIV deaths. More sporadic interruptions of antiretroviral therapy supply would lead to sporadic adherence to treatment, leading to the spread of HIV drug resistance, with long-term consequences for future treatment success in the region.

Disrupted services could also reverse gains made in preventing mother-to-child transmission of HIV. Since 2010, new HIV infections among children in sub-Saharan Africa have declined by 43%, from 250 000 in 2010 to 140 000 in 2018, owing to the high coverage of HIV services for mothers and their children in the region. Curtailment of these services by COVID-19 for six months could see new child HIV infections rise drastically, by as much as 83% in Mozambique, 106% in Zimbabwe, 139% in Uganda and 162% in Malawi.

Other significant effects of the COVID-19 pandemic on the AIDS response in sub-Saharan Africa that could lead to additional mortality include reduced quality clinical care owing to health facilities becoming overstretched and a suspension of viral load testing, reduced adherence counselling and drug regimen switches. Each model also considered the extent to which a disruption to prevention services, including suspension of voluntary medical male circumcision, interruption of condom availability and suspension of HIV testing, would impact HIV incidence in the region.

The research highlights the need for urgent efforts to ensure the continuity of HIV prevention and treatment services in order to avert excess HIV-related deaths and to prevent increases in HIV incidence during the COVID-19 pandemic. It will be important for countries to prioritize shoring up supply chains and ensuring that people already on treatment are able to stay on treatment, including by adopting or reinforcing policies such as multimonth dispensing of antiretroviral therapy in order to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems.

“Every death is a tragedy,” added Ms Byanyima. “We cannot sit by and allow hundreds of thousands of people, many of them young, to die needless deaths. I urge governments to ensure that every man, women and child living with HIV gets regular supplies of antiretroviral therapy—something that’s literally a life-saver.”

Sources:

Jewell B, Mudimu E, Stover J, et al for the HIV Modelling consortium, Potential effects of disruption to HIV programmes in sub-Saharan Africa caused by COVID-19: results from multiple models. Pre-print, https://doi.org/10.6084/m9.figshare.12279914.v1, https://doi.org/10.6084/m9.figshare.12279932.v1.

Hogan B, Jewell B, Sherrard-Smith E, et al. The potential impact of the COVID-19 epidemic on HIV, TB and malaria in low- and middle-income countries. Imperial College London (01-05-2020). doi: https://doi.org/10.25561/78670.

Stover J, Chagoma N, Taramusi I,  et al. Estimation of the Potential Impact of COVID-19 Responses on the HIV Epidemic: Analysis using the Goals Model. Pre-print. medRxiv 2020.05.04.20090399; doi: https://doi.org/10.1101/2020.05.04.20090399

WHO

The World Health Organization provides global leadership in public health within the United Nations system. Founded in 1948, WHO works with 194 Member States, across six regions and from more than 150 offices, to promote health, keep the world safe and serve the vulnerable. Our goal for 2019-2023 is to ensure that a billion more people have universal health coverage, to protect a billion more people from health emergencies, and provide a further billion people with better health and wellbeing.

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.

With more than 11 million people in custody worldwide, and 30 million people entering and leaving detention every year, the threat of COVID-19 for people in prisons is very real. In the vast majority of the world’s overcrowded and underfunded prisons and detention centres, physical distancing is simply not an option. In situations where close confinement, shared facilities and spaces and poor hygiene are commonplace, inmates and prison staff are living in constant fear of the ticking COVID-19 time bomb.

“A health response to COVID-19 in prisons is not enough. This unprecedented global emergency demands a response based on human rights,” said Winnie Byanyima, Executive Director of UNAIDS. “Countries must ensure not only the security but also the health, safety and human dignity of people deprived of their liberty at all times, irrespective of any state of emergency.”

UNAIDS, the Office of the United Nations High Commissioner for Human Rights, the World Health Organization and United Nations Office on Drugs and Crime are calling on leaders to make detention a last resort, to close drug rehabilitation detention centres and to decriminalize sex work, same-sex sexual relations and drug use. They are urging countries to release the people who can be released and to consider people at risk of COVID-19, such as older people and people with pre-existing health conditions. Other people, including people sentenced for minor, non-violent offences, pregnant women, women who are breastfeeding and children, should also be considered for release.

As reports of terrified inmates sewing makeshift masks continue to emerge, countries are starting to take action. The Government of Ethiopia, for example, has released more than 30 000 prisoners and has heightened sanitation measures. Indonesia is releasing more than 50 000 people, including 15 000 people incarcerated for drug-related offences. The Islamic Republic of Iran is releasing 40% of its total prison population,100 000 people, while Chile is set to release around 50 000 people.

The Pacific region has among the world’s highest rates of gender-based violence. National research show that 72% of Fijian women experience gender-based violence, compared to the global average of 35%. Women in the region also have a low representation in leadership positions—out of the 560 Pacific members of parliament, 48 are women, of whom 10 are Fijian women.

Adding to these sociocultural impacts is the climate emergency. In response, Pacific women are demanding more involvement in climate-related decision-making and to be fully engaged in climate responses.

Komal Narayan, a Fijian climate justice activist, became fascinated during her postgraduate programme in development studies about how climate change overlapped with ethics and politics. “The effects of climate change are felt most acutely by the people who are least responsible for causing the problem,” she said. This motivated her to be more active and vocal about the issue, leading to her participation, together with other young delegates from Fiji, in the twenty-third United Nations Climate Change Conference, held in Bonn, Germany, in 2017.

“My goal in life is to be part of a society that is focused on addressing the issues of climate justice and encouraging and motivating more young people to be more involved in this space, as I believe that this issue is not just yours or mine but an issue that is at heart for the entire Pacific,” Ms Narayan said.

Ms Narayan was also one of the Green Ticket Recipients for the United Nations Youth Climate Action Summit in September 2019, where she was involved in a youth-led dialogue with the United Nations Secretary-General.

“As givers of life, as dedicated mothers, thoughtful sisters, domestic influencers and active contributors to socioeconomic development, we women have the power to give impetus to the global climate movement,” Ms Narayan said. “It’s about time that women and girls are given equal opportunities and equal access to resources and technology to be able to address climate justice. Countries, specifically government and civil society, should be playing a key role in this.” 

AnnMary Raduva, a year 11 student at Saint Joseph’s Secondary School in Suva, Fiji, believes that climate justice must recognize the connection between humans and the environment and how vulnerable we are if we don’t do something today.

“In the Pacific region, our indigenous communities depend intimately on the ecological richness for subsistence, as well as economically, and this dependence makes our people sensitive to the effects of extreme weather events, and we cannot ignore them. We have a close relationship with our surroundings and are deeply spiritual and culturally connected to the environment, and ocean, and this relationship has positioned us to anticipate, prepare for and respond to the impacts of climate change,” Ms Raduva said.

In 2018 she wrote to the Fijian Prime Minister asking him to relook at the Fiji Litter Act 2008 to classify balloon releasing as littering in Fiji. Ms Raduva soon realized that talking about balloon releasing was not enough, however, and that she had to find eco-friendly alternatives to amplify her message. The idea of planting mangroves along the Suva foreshore soon came to her.

Since 2018, she has initiated six planting activities and has planted more than 18 000 mangrove seedlings. She was invited to New York, United States of America, in September 2019 to march for climate justice at a United for Climate Justice event organized by the Foundation for European Progressive Studies. She stood in solidarity with the indigenous communities that are on the forefront of climate change as it advances in the Pacific region.

Ms Raduva has faced discrimination as a young female activist and has been mocked as a “young, naive girl”. She was told that she must not talk about climate change because activism is reserved for boys and adults. However, she believes that ensuring the participation of women, children and lesbian, gay, bisexual, transgender and intersex people and other minority groups in climate change talks is a priority for any institution or organization that aims to champion climate change issues.

Varanisese Maisamoa is a survivor of Cyclone Winston, which in 2016 was one of Fiji’s most powerful natural disasters. In 2017, she formed the Rakiraki Market Vendors Association, working with UN Women’s Markets for Change project—“We want to empower our market vendors to be climate-resilient,” she said. Through UN Women’s leadership training, she learned to be confident when speaking out about the issues affecting market vendors and to negotiate with the market council management.

Ms Maisamoa represented her association on the design of the reconstruction of Rakiraki’s market, which now features infrastructure resilient to a category 5 cyclone, a rainwater harvesting system, flood-resistant drainage and a gender-responsive design.

Ms Narayan, Ms Raduva and Ms Maisamoa are among the Pacific women who are pushing for more of a voice in and inclusiveness for women and girls in climate action. Their activism is working to reduce discrimination against women and girls, which results in inequalities that make them more likely to be exposed to disaster-induced risks and losses to their livelihood, and to build resilience for women to adapt to changes in the climate.

Ms Maisamoa’s story has been republished with permission from UN Women’s Markets for Change project, which is a multicountry initiative towards safe, inclusive and non-discriminatory marketplaces in rural and urban areas of Fiji, Solomon Islands and Vanuatu that promotes gender equality and women’s economic empowerment. Implemented by UN Women, Markets for Change is principally funded by the Government of Australia, and since 2018 the project partnership has expanded to include funding support from the Government of Canada. The United Nations Development Programme is a project partner.

How innovations in rapid testing and child-friendly medicines are saving lives in Uganda.

By Karin Schermbrucker and Adrian Brune — Originally published by UNICEF

Last year, nearly 450 infants acquired HIV every day – most of them during childbirth. These children are at extremely high risk of dying in the first two years of life. But so many of them are never diagnosed or treated.

Inadequate HIV testing and treatment for children is a widespread challenge. Although the 2019 global treatment rate for HIV-positive mothers stands at 82 per cent, the diagnosis and treatment of children with HIV is just 54 per cent in most regions.

This gap in coverage is often because diagnostic processes tend to be more complicated and cumbersome for children. Infants require a special type of testing for HIV (virological), which is not readily available in most low- and middle-income countries.

And although there are age-appropriate antiretroviral medicines for children, they can be hard to find in many areas largely due to a lack of investment in testing them. 

This delayed diagnosis and treatment doesn’t have to happen. UNICEF and Uganda’s Ministry of Health recently enacted HIV treatment reforms for children to great success. With the help of partners and innovative diagnostic tools, 553 facilities across the country were able to provide antiretroviral therapy for children – up from 501 in 2017.

Dr. Denis Nansera, a paediatrician, examines Kansiime Ruth, 25, and her daughters aged 1 and 4 years, at the Mbarara Regional Referral Hospital in Mbarara District, Western Region, Uganda on 20 August 2019. "A good number of mothers used to fall out of antenatal care. But with (medical advancements), we see a huge reduction in the time taken to diagnose a child, and time taken to get child on medication,” Dr. Nansera says. Photo: UNICEF/UNI211885/Schermbrucker

Kansiime's one-year-old daughter is weighed and measured at the Mbarara Regional Referral Hospital on 20 August 2019. UNICEF, in partnership with the Ministry of Health of Uganda and the Clinton Health Access Initiative has implemented Point of Care Early Infant Diagnostic (POC EID) testing. This rapid testing process uses devices that are easy to transport, operate and maintain, allowing more health centres to diagnose infants. With early diagnosis, infants can immediately start anti-retroviral therapy. Photo: UNICEF/UNI211886/Schermbrucker

Enoch Turyatemba, a laboratory technician at Mbarara Regional Referral Hospital, takes a blood sample from a baby for early infant diagnosis testing, which screens for HIV and determines results on the same day. "Before the Point of Care [POC] machines, we collected dry blood samples and had to send them away. The turn-around time was sometimes months,” Enoch says. “With a POC machine, HIV-positive children can start treatment the next day. “We are saving lives,” Enoch adds. Photo: UNICEF/UNI211916/Schermbrucker

Enoch Turyatemba tests a sample of blood with the POC machine. In addition to the rapid testing, the Ministry of Health has approved the use of oral pellets of pediatric HIV medicine, which can be mixed with food and/or breast milk to disguise the bitter taste of the medication. The pellets also do not require refrigeration – a huge advancement. Photo: UNICEF/UNI211884/Schermbrucker

Kenyonyozi Joseline holds her baby inside the POC clinic at the Mbarara Hospital. Adolescent girls are more vulnerable to HIV infection because their reproductive systems are not fully developed. Gender inequality and patriarchal norms in Uganda also make it difficult for girls and young women to negotiate safe sex, predisposing them to early pregnancies and HIV. Photo: UNICEF/UNI211905/Schermbrucker

Kenyonyozi carries her baby on her back outside the the POC clinic. Paediatric HIV services lag considerably behind those for adults and pregnant women. While 82 per cent of mothers living with HIV receive treatment, only 54 per cent of children living with HIV are accessing life-saving drugs. Just 59 per cent of babies born to mothers living with HIV are tested for HIV within the first two months of life. Photo: UNICEF/UNI211891/Schermbrucker

Kansiime and her daughters arrive at the Mbarara Hospital. The three family members all live with HIV and go to the clinic regularly to collect their medication. "When I go to hospital, I am surrounded by other women who have come for treatment. We are there for the same reason,” Kansiime says. “This has helped me overcome stigma and given me strength." Photo: UNICEF/UNI211907/Schermbrucker

Kansiime gives her one-year-old daughter her paediatric HIV medicine at home in western Uganda. Her daughter now takes the oral pellets instead of the bitter syrup she used to use, which has helped her viral load. "It is much easier to give her the pellets mixed into food so she doesn’t struggle with the taste,” Kansiime says. “My advice to other mothers: Give your children the medication they need so they can live longer and educate others." Photo: UNICEF/UNI211882/Schermbrucker

Kansiime's four-year-old daughter peeks her head outside the door to her house. She was born with HIV and needs to take medication on a daily basis. But she has survived past the critical period for young children and infants, making her survival into adolescence and beyond more likely. “I love singing – my favorite song is a song called Sconto,” she says. Photo: UNICEF/UNI211903/Schermbrucker

Kabiite Ajara, 32, helps her baby take her paediatric HIV medication in their home in Isongo, Uganda. They are both living with HIV. "I give my baby medication once a day,” she says. “Initially medicine used to make her weak and vomit. But currently she is ok with the drug – I crush the tablet and put it into water, which she takes easily." Photo: UNICEF/UNI211928/Schermbrucker

Kabiite plays with her daughter outside their home. Kabiite is HIV-positive, but regular medication keeps her strength – and spirits – high. "I love playing with my children – taking them to play in the banana plantation, cooking together,” Kabiite says. “[My daughter] loves playing football a lot! And she is good!” Photo: UNICEF/UNI211933/Schermbrucker

This World AIDS Day, UNICEF is calling on all governments and partners to urgently close the testing and treatment gap for children and adolescents living with HIV-AIDS; to establish supportive, stigma-free communities that provide opportunities for testing and care; and to enact improved policies and rights for people living with this survivable epidemic.

This story, by Duniya Aslam Khan in Imvepi refugee settlement, Uganda, is reproduced from UNHCR, a UNAIDS Cosponsor 

On a bright sunny day in northern Uganda’s Imvepi refugee settlement, Inga Viola and Rufas Taban sit comfortably under the shade of a jacaranda tree, leafing through an old register.

The pair are unrelated but share a unique bond – they were both diagnosed with HIV back in South Sudan, before civil war forced them to flee to Uganda in 2017.

“I was devastated when I found out,” says Inga, 32, who was diagnosed in 2014. “I felt like ending my life but I thought about my children and decided to live.”

Rufas, 49, nods solemnly, himself diagnosed in 2011.

Introduced to each other at Imvepi refugee settlement by their Ugandan nurse, Jedah Twebaze, they soon forged a friendship around their shared experiences – deep distress on finding out their status, leaving their homes behind and raising their families in exile.

They formed a support group, which they called the Friendship Serving Group, with Rufas, a former tax collector, as the secretary and Inga as the vice president. The group also doubles up as a savings cooperative and currently has 22 South Sudanese members, all HIV positive.

They contribute to the group’s kitty each month, sharing the accumulated savings at the end of the year. The group also helps spread HIV awareness in the community, while fighting the stigma associated with it.

“We use our meetings as an opportunity to talk about our wellbeing, check on members who are struggling with their status and provide counselling,” explains Inga.

She adds that they also educate each other on the importance of taking Antiretroviral therapy (ART) treatment – a life-saving course of medication that the conflict and the ensuing journey to safety disrupted, causing hers and Rufas’ health to deteriorate by the time they reached Uganda.

“I spent many days without taking medicine. Each new day without treatment meant getting closer to death,” she says.

Thanks to Uganda’s progressive refugee policy that has integrated refugees into the national HIV programme, refugees like Inga and Rufas are able to resume their treatment as soon as they arrive. They receive ART medication on a quarterly basis, free of charge.

The medications help suppress levels of HIV in the blood and slow damage resulting from the infection. It helps prevent progression from HIV to AIDS, thereby significantly extending life expectancy and reducing the risk of transmitting the virus to zero.

“I thought to be HIV positive meant dying soon but our kind nurse told us that with regular medication, we can live a very normal life,” says Inga, looking at nurse Jedah, who’s been nicknamed, ‘Dr. HIV’ by refugees for his advocacy and commitment to educate both refugees and Ugandans on HIV/AIDS.

Jedah works at UNHCR’s partner agency, Medical Teams International (MTI) and observes that the level of stigmatization among South Sudanese refugees has improved significantly.

“Educational sessions with the communities here have yielded positive results in fighting stigma,” he says.

According to UNAIDS statistics, by the end of 2018, an estimated 1.4 million Ugandans were living with HIV – 1.2 million were aware of their positive status and 72 per cent of them were on ART.  

Currently, over 17,000 refugees receive ART treatment across all the health facilities in Uganda’s refugee settlements where both refugees and nationals can access healthcare.

Earlier this year, Uganda launched a multi-year, Health Sector Integrated Refugee Response Plan, aimed at strengthening refugee healthcare through an integrated approach. Health services to refugees are currently aligned to the country’s national health policy and Health Sector Development Plan.

Such progressive policies and programmes that support both refugees and their host communities will be among the topics under discussion at the Global Refugee Forum, a high-level meeting 17-18 December in Geneva. States, the private sector and others are expected to announce high-impact contributions that will give refugees a chance to thrive alongside their hosts.

For Inga and Rufas, unrestricted access to treatment and a positive attitude towards HIV patients has not only made their life in the refugee settlement easier but it has also alleviated stigma.

“People here treat HIV patients just like anyone who has any other illness,” says Inga. 

Another key milestone is the decline in mother-to-child transmission rates. Eighty-nine per cent of pregnant women who visited health centres were tested for HIV to prevent transmission to the unborn child.

“It is through these interventions that Inga and Rufas’ children are all HIV negative,” explains nurse Jedah.

The strong advocacy role played by communities in fighting stigma and spreading awareness is recognized in the theme of this year's World AIDS Day on1 December,  which is ‘Communities make the difference.’

While Inga and Rufas do their part to make a difference, more needs to be done to ensure that the AIDS response at national and international level remains an essential one.

“Let us control HIV because no one should contract this disease,” Rufas says. “As we know, prevention is better than cure.”

GENEVA, 25 November 2019—UNAIDS warmly welcomes the appointment of Ghada Fathi Waly as the Executive Director of the United Nations Office on Drugs and Crime and Director-General of the United Nations Office at Vienna.

“I look forward to working closely with Ms Waly to help build safer societies for all where everyone has unimpeded access to the right to health, education and justice,” said Winnie Byanyima, UNAIDS Executive Director. “UNAIDS will also continue to partner the United Nations Office on Drugs and Crime in advancing innovative harm reduction programmes and policies for people who use drugs that aim to reduce the damaging effects of drug use on individuals and societies, while respecting the rights of people who use drugs and prisoners.”

HIV infections among people who inject drugs are rising. Outside of sub-Saharan Africa in 2018, people who inject drugs and their sexual partners accounted for around one fifth of all people newly infected with HIV. In two regions of the world—eastern Europe and central Asia and the Middle East and North Africa—people who inject drugs accounted for more than one third of new infections in 2018. Viral hepatitis and tuberculosis rates among people who use drugs are also high in many parts of the world. These preventable and treatable diseases, combined with overdose deaths, which are also preventable, are claiming hundreds of thousands of lives each year.

Comprehensive harm reduction services—including needle–syringe programmes, opioid substitution therapy, drug dependence treatment, overdose prevention and testing and treatment for HIV, tuberculosis and hepatitis B and C—reduce the incidence of blood-borne infections, overdose deaths and other harms.

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.

Ahead of the opening of the Nairobi Summit on ICPD25, the Executive Director of UNAIDS, Winnie Byanyima, and Peter Eriksson, the Minister for International Development Cooperation of Sweden, co-hosted a ministerial breakfast meeting with key donors and partners to highlight the need for a strong UNAIDS to lead the global response to HIV.

It was Ms Byanyima’s first face-to-face meeting with some of UNAIDS’ key donors and partners in her capacity as the Executive Director of UNAIDS, during which she pledged to take a feminist approach in taking the organization forward.

“UNAIDS is at a critical juncture as it emerges from the challenges of the past two to three years, and the staff will be my first priority; we need healing, trust-building and closure. I want to bring back the joy in the great work of UNAIDS,” said Ms Byanyima.

Katherine Zappone, the Minister for Children and Youth Affairs of Ireland, Christopher MacLennan, Canada’s Assistant Deputy Minister of Global Issues and Development, and other heads of delegations applauded UNAIDS’ intention to make meaningful culture change happen at UNAIDS.

“UNAIDS has been at the frontline of the AIDS response for years. Canada has been a strong supporter and we are so pleased that Winnie has joined,” said Mr MacLennan.

Ministers and representatives of Australia, Belgium, Canada, Finland, Germany, Ireland, Luxemburg, the Netherlands, Norway, Sweden and Switzerland encouraged UNAIDS to continue its leading role in promoting community-led solutions and responses. They also highlighted the need to leverage the unique capacity of UNAIDS and build on its human rights expertise to address the social and political barriers that are hindering progress on HIV.

“We must integrate sexual and reproductive health and rights better into the HIV response in order to reach our targets,” said Mr Eriksson. “The Joint Programme has a very important role in driving sexual and reproductive health.”

The meeting was also attended by representatives of several UNAIDS Cosponsors―the United Nations Population Fund and the United Nations Development Programme (UNDP). “UNDP is committed to working with UNAIDS in supporting governments to establish enabling legal, policy and regulatory environs for effective and rights-based HIV responses,” said Achim Steiner, the Administrator of UNDP.

UNAIDS, donors and partners agreed on the need to forge partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure a sustainable response to HIV.

The meeting was the first in a series of events planned as part of UNAIDS’ enhanced collective engagement and strengthened collaboration as it embarks on the process of developing a new strategic plan on HIV.