HIV Treatment

UNAIDS welcomes the issuance of Resolution 881 of 2023 by the Ministry of Health of Colombia, which initiates the administrative procedure to evaluate the existence of reasons of public interest for issuing a compulsory license for dolutegravir (DTG)-based regimens. According to the ministerial resolution, the impact of this measure could mean a significant reduction of more than 80% of DTG’s price.

Dolutegravir (DTG) is an antiretroviral integrase inhibitor, recommended by the World Health Organization (WHO) as a first-line treatment option for people living with the human immunodeficiency virus (HIV). Regarding viral suppression and disease reduction, treatments incorporating DTG-based regimens have demonstrated greater adherence due to their lower incidence of adverse events while presenting enhanced effectiveness, safety, and reduced likelihood of resistance development.

Compulsory licensing is a provision in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (“TRIPS Agreement”), that enables governments to supply its citizens with generic versions of patented treatments either through domestic production or imports, ensuring drug prices are affordable. WTO Inter-ministerial 2001 Doha Declaration reaffirmed the rights of member states to make use of all flexibilities in the agreement to protect public health, including compulsory licenses, “and the freedom to determine the grounds upon which such licenses are granted.” More recently, in the 2021 Political Declaration of the United Nations General Assembly High-level Meeting on AIDS, countries have committed to make use of TRIPS flexibilities “specifically geared to promoting access to medicines.”

"This resolution is a step forward to provide equal and sustainable access to best HIV treatment options for all people living with HIV in Colombia, nationals and migrants. This action shows the government’s commitment to close the treatment gap with assured quality affordable essential medicines which are easy to take and very well tolerated.”, says Andrea Boccardi, UNAIDS Director for the Andean Countries (Peru, Ecuador, Bolivia, and Colombia. "The government issued national guidelines in 2021, in line with WHO recommendations, but until now high prices of DTG have remained an obstacle to make it widely accessible to people living with HIV in Colombia."

The Colombian League for the Fight against AIDS and the IFARMA Foundation also celebrated the decision from the Colombian government. Both institutions participated on behalf of civil society in the updating of the Clinical Practice Guidelines (CPG) based on scientific evidence for the care of HIV/AIDS infection in adults, pregnant women and adolescents.

"The decision validates past initiatives of civil society in Colombia to achieve greater coverage of simplified treatments with fewer adverse effects at the lowest possible price, while at the same time it will reinvigorate the efforts of community-based organizations in education and promotion of adherence to ARVs, recognizing that structural barriers are factors that facilitate or hinder adherence to antiretroviral treatments", says Jorge Pacheco, Director of the Colombian League for the Fight against AIDS.

“Through this measure Colombia is taking an important step to guarantee people’s access to the most appropriate medication for them in line with international recommendations and commitments”, says Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. "Timely access to effective HIV treatment can save lives, improve health outcomes, enhance the quality of life, and contribute to the overall well-being of individuals living with HIV. This measure shows commitment to the global effort to combat inequalities in access to health."

UNAIDS commends and supports the Ministry of Health for its proactive approach to pursuing public interest and urges all stakeholders to collaborate in implementing Resolution 881 of 2023. 

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.

Last year, Elina Kruglova made a bold decision. She disclosed her HIV status during the casting of a popular reality TV show in Uzbekistan.

“I disclosed my status right at the casting because the project lasted for several months, and I needed to take medicine daily,” she said. “I made the decision to be honest and mustered up the courage. I thought they wouldn't accept me, but I passed the casting," Ms Kruglova explained.

In her second-year student in the Faculty of Agricultural Economics at Tashkent State Agrarian University in Uzbekistan, she grew up in an orphanage. She was the first child living with HIV in her country to start antiretroviral (ARV) therapy seventeen years ago. Despite facing stigma, she has been taking life-saving medicine daily.

Uzbekistan struggles with HIV-related stigma and discrimination.

According to the recent Multiple Indicator Cluster Survey (MICS) in Uzbekistan, 76% of women aged 15-49 in the country would refuse to purchase vegetables from a vendor living with HIV and would not accept children living with HIV attend school with other children. Prejudice is fuelled by a lack of knowledge; only 14% of women in the same age group possess comprehensive information about HIV. Uzbekistan's HIV cases have steadily risen by 44 % in the last six years (31,088 in 2016 to an estimated 45,000 in 2022.)

Throughout the TV show, Ms Kruglova shared her experiences of being an orphan and living with HIV. Over time she became an inspiration for young people and those living with HIV.

"When the TV episode aired, I started contemplating how people would perceive me, what they would say, and how they would react,” she recalled. “Psychologists were working with us during the project, which made it easier for me to handle the pressure."  

To her surprise, people positively reacted when they recognized her on the streets, and she received numerous supportive messages from people living with HIV via Instagram.

"I am grateful for the trust they placed in me " she said.

For her, the Tashkent day-care center for children and families affected by HIV supported by UNICEF and UNAIDS played a crucial role in her life. It provided a safe haven, gave guidance throughout her childhood and teenage years. The center's support group, the professional consultations, and master classes helped her develop practical life skills. She is optimistic about the future and believes that people can change their attitudes towards HIV with the right information and education.  In her mind, hiding only makes things worse.

Aida Muravyova knows all about the power of disclosing her HIV status.

She is a 16-year-old school student in Kazakhstan and learned about her HIV status when she was 6 years old. Although advised against disclosing her status at school and extracurricular activities, Aida chose a different path.  She shared her HIV status with her classmates in school and took on the role of breaking down the myths and misconceptions surrounding HIV in front of her peers and adults.

“When I was told about my HIV diagnosis, I thought to myself, 'Okay, I have red hair, I have HIV, I take pills... what else?!'"

Ms Muravyova found solace through the Teenergizer Movement, a youth-led initiative supported by the Kazakhstan Government, UNICEF, UNAIDS and other donors. Teenergizer aims to empower young people living with HIV. It created a safe space for young women like her to connect, have fun, and share experiences without shame or stigma. The movement has reached many young people in the country, creating a ripple effect of reliable information and support.

When Teenergizer came along, Ms Muravyova invited classmates to join. "They got valid information, learned with me, and even conducted training sessions,” she said. “The most gratifying part was when one of my classmates' mothers, initially frightened by my HIV status, learned about HIV through her child's participation in Teenergizer.”

Her friend told her that her family had an open conversation, hashed out concerns, and now everything is okay.

Gender assessments conducted in several countries of Central Asia, including Kazakhstan, confirmed that gender inequality, stereotypes, customs and practices increase women’s vulnerability to HIV as well as limit their choices and expose them to socioeconomic and health difficulties.

Ms Muravyova refuses to let her HIV status define her or limit her dreams.. "I have seen many people living with HIV, but never in my field of Electrical and Aerospace Engineering... I want to change that perception and demonstrate that living with HIV can be different, cool, and interesting."

The UNAIDS Regional Policy and Equality Officer in Central Asia, Elena Kiryushina, sees role models like Elina and Aida as well as community networks as key.

“Promoting leadership among adolescent girls and young women, fostering positive masculinities in boys and men, providing care and support to adolescents living with HIV, especially those who lost parents and access to comprehensive sexuality education in and out of schools, and supporting gender-transformative approaches are essential steps to address HIV and gender-related stigma and to build foundation for the gender equality in Central Asia and beyond,” she said.

UNAIDS and partners believe empowering women and girls and challenging cultural norms is crucial to address HIV stigma and ensure equal access to support and health services.

Ms Muravyova has one mantra. “Speak, and don't be afraid!,” she said. “We are together, and together we'll make it through.”

UNAIDS launching group to generate evidence on the inequalities driving pandemics and advocate for the adoption of multisectoral approaches to strengthen the response to AIDS and other pandemics  

BRASILIA/GENEVA, 6 June 2023—Brazil is hosting the announcement of the new Global Council on Inequality, AIDS and Pandemics chaired by The First Lady of Namibia, Monica Geingos, the Director of the University College London Institute for Health Equity, Sir Michael Marmot and the Nobel prize winning economist, Joseph E. Stiglitz. Brazil’s Minister of Health, Nísia Trindade, is a founding member.

“I am delighted to host the announcement of the Global Council on Inequality, AIDS and Pandemics. It is time to convert lessons learned into action by reducing the inequalities driving today’s health crises and strengthening pandemic preparedness for the future,” said Ms Trindade, “Brazil is determined to play its part by making the case for increased collaboration and evidence-based policymaking to build more resilient health systems around the world.”
 

Social and economic inequalities within countries and between them are exacerbating and prolonging pandemics and amplifying their impact amongst the poorest and the most vulnerable. The same intersecting inequalities that drive HIV, COVID-19, MPox and other diseases are leaving countries and communities at risk of future outbreaks and pandemics. But experience shows that there are actions at the global, regional and national levels that can build pandemic responses that reduce rather than exacerbate inequality.

The work of the Global Council will harness essential evidence for policymakers and elevate political attention to the need for action to end inequalities that fuel AIDS and other pandemics. Crucially, it will encourage and support frontline communities to advocate for the policy shifts necessary to fight current pandemics and better prepare for tomorrow’s outbreaks.

“The AIDS response is one of the best examples of how communities experiencing intersecting inequalities can unite to overcome them and save millions of lives,” said UNAIDS Executive Director, Winnie Byanyima who is a member of the Global Council and is in Brazil for the announcement. “A broad movement of people living with and affected by HIV has brought down the price of medicines and diagnostics, strengthened national health responses, enabled the rise of a strong network of community-led organizations and secured the removal of punitive discriminatory laws in many countries. But evidence-based policies and approaches need to be applied everywhere and for everyone and sadly that’s not the case right now.” 

Gender-based inequities endanger the health of women around the world. For example, in countries including Ghana, Côte d’Ivoire, and Liberia HIV prevalence for young women is more than 5 times more than young men of the same age—reflecting, in part, economic and education inequality.

“Gender inequality provides fuel to pandemics like AIDS and COVID-19” said the First Lady of Namibia, Monica Geingos. “It increases the vulnerability of women and girls to deadly viruses by limiting access to knowledge, financial resources, and life-choices and undermines their ability to protect themselves and their families. We have to re-imagine pandemic responses that can reduce inequality rather than exacerbate it.”

“Inequalities in access to health and other essential services are largely the result of deliberate policy choices,” said Joseph Stiglitz. “To fight future pandemics, we must learn the lessons of the HIV response and adopt inequality-busting approaches to make the world a healthier, fairer and safer place for everyone.”

Successes and failures in the HIV response provide valuable lessons on how the world can deal with future pandemics. For example, gay men are more likely to be living with HIV. But laws and policies drive the size of the gap. In Malaysia where gay men are criminalized and arrested gay men are 72 times more likely to be infected than other adults; but in Thailand where same-sex relations are legal and community pandemic response is strong, gay men are only 12 times more likely. Viruses cross population groups. These contribute to why Thailand, with lower inequality, is approaching epidemic control while Malaysia is losing ground in the fight against AIDS.

Meanwhile, the issue of inequality extends beyond HIV to other pandemics. Countries with higher income inequality, for example, have experienced greater COVID-19 mortality. At the height of the COVID-19 pandemic, wealthy countries spent billions of dollars on responses but almost half of developing countries were forced to cut health spending, undermining the capacity to fight global pandemics.  Several countries in Africa continue reporting significant numbers of MPox deaths during the pandemic, yet the vaccines being used in high-income countries are not available.        

Even within countries that have made good progress against HIV, some communities have struggled to benefit from the staggering pace of medical advances. In Brazil, HIV infections are falling dramatically among the white population as access to treatment is widened and new prevention tools such as PrEP are rolled out but HIV infections among the black population are still on the rise.

“Evidence-based strategies to address the social determinants of health are crucial not only for improved health outcomes for the individual but also for building stronger economies and fairer societies,” said Sir Michael Marmot, from Brasilia. “Health is a good marker of how well a society is doing overall. Health equity tells us about societal inequalities.”

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.

Right after taking his HIV treatment each morning, Antonio Hooker prepares a kit of fresh herbs and fruits he has bought at the local market to cross the Bilwa area, a village on the northern Caribbean coast of Nicaragua, as a health promoter for the Association of People Living with HIV (ASONVIHSIDA). He strengthens HIV prevention knowledge among vulnerable groups in his indigenous Miskitu community. He also teaches community leaders and people living with HIV or other health problems to use the power of natural medicine in conjunction with antiretroviral medicines to improve their immune systems.

Antonio is one of the dozens of volunteers and community promoters who have been certified by the Nicaraguan AIDS Commission, the Ministry of Health and the Institute of Natural Medicine and Complementary Therapies through training in "Self-Care in Sexual Reproductive Health and HIV from the Perspective of Natural Medicine".

Since his diagnosis 17 years ago, Antonio has learned the importance of self-care. He now shares his knowledge and training experiences with family members and others living with HIV in remote communities along the Nicaraguan coast.

"The course opened my mind to the importance of natural medicine and traditional practices, such as massage and meditative activities," says the health promoter. "We know these techniques work because we see improvement in our health while seeing progress in adherence to HIV treatment, as well as strengthening social, community networks and relationships within the families of people living with HIV."

The course "Self-care in Sexual Reproductive Health and HIV from the Perspective of Natural and Holistic Medicine" aims to provide guidelines on self-care for people living with HIV or similar conditions and their families. Through the appropriate use of medicinal plants, reflexology (a system of massage used to relieve tension and treat illness, based on the theory that there are reflex points in the feet, hands and head linked to each part of the body) and complementary therapies, such as the practice of the Chinese martial art and system of callisthenics well known as Tai Chi Chuan, which consists in sequences of slow controlled movements. 

"The objective is to build skills and abilities among people living with HIV, volunteers and active community members to develop a comprehensive approach to sexual and reproductive health, sexually transmitted infections (STIs) and HIV," explains Dr Enrique Beteta, Nicaragua's Deputy Minister of Health. "It also allows people to access information and linkage to health services at the local level to take care of their health and the well-being of those around them."

The services harnessing natural medicine are complementary, not alternative, to HIV medicines. Indeed, the programmes have helped increase uptake of and adherence to HIV medicines.

Nicaragua’s comprehensive approach and partnership with communities has helped it to advance progress on treatment and prevention. Since 2010, Nicaragua has experienced a 20% decrease in new HIV infections, while in Latin America, new infections have increased by 5% in the same period. About 11 000 people live with HIV in the country, and 90% have been tested and know their positive diagnosis, above regional (82%) and global (85%) rates.

The course offers 84 hours of theoretical and practical training, a quarter of which is focused on Sexual and Reproductive Health and HIV modules. The certification also focuses on putting people at the centre, not only as beneficiaries but also as key protagonists, participating, exercising and demanding access to their rights for equality and equity.

"The course also aims to identify in people the autonomy to make decisions, as transformative agents, in a framework of respect, solidarity and social justice," explains Marie Engel, Director of the UNAIDS Multi-country Office for Guatemala, Honduras and Nicaragua. "Working to eliminate stigma and discrimination is also an important outcome of this initiative."

The University of San Carlos de Guatemala (USAC) Faculty of Medical Sciences, in collaboration with UNAIDS, the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), launched an online course titled "Conceptos clave sobre VIH, Género y Derechos Humanos" (Key Concepts on HIV, Gender, and Human Rights). The four-module course is designed to provide teaching staff with detailed knowledge about key concepts related to HIV, its treatment and prevention, and the national and international legal framework guiding the response to HIV, as well as the gender and human rights dimensions of the epidemic.

With an estimated three new HIV infections each day in Guatemala and only 73% of the estimated 31,000 people living with HIV receiving antiretroviral treatment and persisting high level of stigma and discrimination towards people living with HIV, the course is a significant step towards addressing the country's HIV challenges. The course aims to provide teaching staff and students with the necessary resources to promote, protect, and fulfill the human rights of adults, adolescents, and children living with or at risk of acquiring HIV, in all their diversity.

The course consists of 140 hours of study, including 70 hours of theory and 70 hours of practice, and will be undertaken between May and August 2023. Course participants will join virtual classes and synchronous group workshops and will have to submit the required tasks according to a work schedule.

The course covers four modules: Module 1 - Update on HIV and AIDS; Module 2 - National and international legal framework for the response to HIV; Module 3 - Health sector Policy framework for HIV response; Module 4- Key concepts on gender and human Rights.

During the inauguration, Marie Engel, UNAIDS Country Director, expressed her hope that participants would enjoy taking the course as much as she and other partners had in developing it. She also emphasized that "the course will be enriched with participants' individual knowledge and experiences, their doubts and concerns. There is obviously a lot of knowledge and wisdom among course participants that the facilitators will strive to capture."

Dr. José María Gramajo, General Coordinator of the USAC Faculty of Medical Sciences' Area of Teachers and Postgraduate training, highlighted that "this refresher course will contribute to the professional development of faculty teachers, sharing with them the latest knowledge about innovations related to HIV prevention, detection, and care, and ensuring an in-depth understanding of cross-cutting issues relevant to HIV and other public health problems."

Teaching staff and students are catalysts with the power to change the national response to HIV. As stated by Dr. Mirna Herrarte, Coordinator of the national HIV, STI, and AIDS program, "I am glad to know that there are so many professionals who want to know more about HIV. In the country, HIV treatment schemes are constantly reviewed. As an anecdote, Guatemala had more than 200 antiretroviral schemes a year ago. Under my leadership, we have reduced those schemes by 75%."

Inequalities persist in the most basic health and HIV services, such as access to screening, treatment, and condoms. USAC's collaborative initiative is an important step towards ensuring that all sectors, including academia, are engaged in ending social, economic, and legal inequities. The University of San Carlos de Guatemala is the largest and oldest university in Guatemala, and the only national and public university in the Central American country. 

Harm reduction policies and practices help people who are using drugs to stay alive and protect them from HIV and Hepatitis C

Released ahead of International Harm Reduction Day - 7 May 2023

GENEVA, 5 May 2023—Many prison systems are struggling to cope, with overcrowding, inadequate resources, limited access to healthcare and other support services, violence and drug use. In 2021, the estimated numbers of people in prisons increased by 24% since the previous year to an estimated 10.8 million people, increasing the strain on already overstretched prison systems.   

Drug use is prevalent in prisons. UNAIDS Cosponsor, the United Nations Office on Drugs and Crime (UNODC), estimates that in some countries up to 50% of people in prisons use or inject drugs. Unsafe drug injecting practices are a major risk factor for the transmission of HIV and hepatitis C due to limited access to harm reduction services, including condoms, clean needles and syringes, and a lack of comprehensive drug treatment programs, particularly opioid agonist therapy.

People in prison are 7.2 times more likely to be living with HIV than adults in the general population. UNAIDS reports that HIV prevalence among people in prisons increased by 13% since 2017, reaching 4.3% in 2021. Although data are limited, it is thought that around one in four of the total prison population has hepatitis C.

“Access to healthcare, including harm reduction services, is a fundamental human right, and no one should be denied that right because they are incarcerated,” said Eamonn Murphy, UNAIDS Regional Director for Asia Pacific and Eastern Europe and Central Asia. “Prisons are too often ignored in countries' efforts to respond to HIV. A multisectoral, multifaceted approach is urgently needed to save lives, which includes access to clean needles and syringes, effective treatment for dependence on opioid drugs and reducing stigma and discrimination.”

Both drug use and HIV infection are more prevalent among women in prison than among imprisoned men. In particular, women who use drugs and sex workers are overrepresented in prisons. Highlighting the urgent need to scale up the implementation of community-led harm reduction services for women who use drugs and women in prison. 

Ms Ghada Waly, Executive Director of UNODC, said, “It is time to put compassion at the heart of our responses. To take a more serious look at de-penalization and alternatives to incarceration for minor drug offenses, focusing instead on treating and rehabilitating. To use a gender-sensitive lens when looking at women and girls who use drugs, and to ensure that they have equal access to treatment. To reach out to young people, who are using drugs more than ever before, understand their vulnerabilities to substance abuse, and help them be part of the solution. To stand with marginalized and vulnerable people, including people in prisons who are underserved by treatment programmes, and people who inject drugs, who are far more likely to be living with HIV, yet far less likely to access life-saving services”.

Among the countries reporting on prisons to UNAIDS in 2019, just 6 of 104 countries had needle and syringe programmes in at least one prison; only 20 of 102 countries had opioid substitution therapy programmes in at least one prison, 37 of 99 countries had condoms and lubricants in some prisons.

UNAIDS, UNODC, and WHO have long supported expanding harm reduction services to all prisons. However, according to Harm Reduction International, only 59 countries globally provide opioid agonist therapy in prisons.

Some countries have made huge progress in recent years. Despite the challenges faced by the influx of refugees and the repercussions of the war in Ukraine, Moldova, (which has an HIV prevalence of 3.2% in its prisons, compared to 0.4% among the general population) has committed significantly more resources into its prison systems.

In the early 2000’s few of its prisons provided harm reduction services. Today all of the country’s 17 penitentiaries provide harm reduction services including, methadone (an opioid agonist therapy), access to psychiatrists, doctors and treatment programmes, needle and syringe exchange and HIV prevention, testing, treatment and care.

Svetlana Plamadeala, UNAIDS Country Director in Moldova said, “It’s about putting people front and center, treating them as equals and taking on a solid, public health approach, grounded in human rights and evidence.”

UNAIDS, UNODC, UNFPA, WHO, ILO and UNDP recommend 15 comprehensive and essential interventions to save lives and ensure effective HIV programming in prisons. These include HIV prevention, testing and treatment, condoms, lubricant, opioid agonist therapy and post-exposure prophylaxis. However, this is only part of the solution. UNAIDS also recommends that countries amend their laws to decriminalize the possession of drugs for personal use.

UNAIDS has set ambitious targets for 2025 which include: 95% of people in prisons and other closed settings who know their HIV status, 95% who know their status are on treatment; and 95% on treatment are virally suppressed; 90% of prisoners used condoms at last sexual activity with a non-regular partner; 90% of prisoners who inject drugs used sterile needles and syringes at last injection; and that 100% of prisoners have regular access to appropriate health system or community-led services.

UNAIDS advocates that communities take an active role in planning, providing and monitoring HIV services. However, this is not always facilitated in prison settings. Without community engagement it will be impossible to reach the global AIDS targets.

For more information on Moldova’s work on HIV in prisons please read Moldova expands harm reduction services to all prisons and watch https://youtu.be/JQYtnsiJKs0

Fact sheet: UNAIDS Human rights fact sheet on HIV in prisons

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.

In 1988, a group of activists came together in Fortaleza, the fifth largest city in Brazil and capital of Northeastern state of Ceará, to create the local chapter of the National Network of People Living with HIV and AIDS (RNP+CE). The aim was to ensure that people living with HIV could be guaranteed the right to care, treatment adherence, and legal assistance.

Currently, the NGO (Non-Government Organizations) also offers educational workshops, support for the combination prevention of sexually transmitted infections (STIs), and other activities for more than 1,000 registered people. Among them is Carlos Salmão, an HIV activist living in Fortaleza, who felt individually and collectively welcomed by the organization. "This support was very important to me and is fundamental for people living with HIV here in Ceará because it is a reference of the response to the AIDS epidemic. That is why I feel pleasure in contributing", he explains.

The RNP+CE was one of five Brazilian NGOs that received resources from the Fast-track Cities grants initiative, launched by UNAIDS in 2022. With the award, the organization developed actions around two objectives: increasing linkage and adherence of vulnerable key-populations to HIV prevention, diagnosis, and treatment by disseminating and sharing information with health professionals as well as the general public; and improving the knowledge of the Undetectable Equals Untransmittable (U = U) strategy in the city of Fortaleza by carrying out communication campaigns.

Project actions and participation of municipal government

The project involved 10 local HIV-positive activists in the development and implementation of the communication campaigns. They also were involved in preparing a seminar that brought together 120 people from civil society to dialogue about and to present to municipal government representatives proposals to improve the care for people living with HIV, based on the perspectives and actual needs of the users of public health services in Fortaleza. An additional theme of discussion was the challenges and the importance of guaranteeing a satisfactory level of adherence to HIV treatment to avoid abandonment.

Still as part of the project, a booklet on HIV, self-esteem and health was produced and distributed, providing practical information for people who receive a positive diagnosis for HIV. Additionally, in coordination with the municipal government, RNP + CE printed and distributed more than 3,000 copies of posters on HIV treatment adherence and on U = U. This material was displayed in places with high concentrations of people, such as bus terminals, reaching about 1.1 million people daily.

Participation of local government officials was a strategic element to the project’s success, as they are in direct contact with reality and the existing challenges. "We are still far from reaching an ideal level where there is less need to reinforce these [HIV] actions, but we are advancing in this direction through constant and well-structured work", says Carlos Paiva, coordinator of IST/AIDS at the Municipal Health Secretariat of Fortaleza.

Ariadne Ribeiro, UNAIDS Officer for Equality and Rights for All People, agrees and adds: "It is rewarding to see how the dialogue between communities, civil society, and the municipal government is moving towards a common goal, which is the improvement of public policies in the city of Fortaleza for people living with HIV and to end AIDS as a threat to public health."