Latin America

Mayor Aquiles Alvarez Henriques of Guayaquil, Ecuador's largest city and the nation's main port, signed the Paris and Sevilla Declarations on February 28, placing the city among the almost 500 municipalities around the world that are committed to fast-tracking action at local level to improve the quality of life of people living with and affected by HIV. Through this commitment, the city pledges to contribute to the country's goal of ending AIDS as a public health threat by 2030.

Guayaquil is the capital of the province of Guayas, Ecuador's most populated province and the most affected by HIV, with over a third of all new HIV infection notifications in the country, according to the Ministry of Public Health of Ecuador. It has a concentrated epidemic among key populations, with an HIV prevalence of 7.3% among gay men and other men who have sex with men (MSM), for example. 

"A significant number of cases reported with HIV in 2023 live in Guayaquil", said Andrés Díaz, Technical Director of the city's Infectious Disease Prevention Unit of the Health and Hygiene Directorate. "We know that the best way to improve HIV prevention is through education and sensitization of citizens so that they can get tested." 

Guayaquil has made significant efforts to intensify HIV screening and has increased the detection of HIV-positive cases by 1.6%. Diagnosed people are immediately linked to the public health system to start first-line antiretroviral treatment, which is universally available to nationals and migrants in Ecuador. 

Nonetheless, the Health Department of the Guayaquil Municipality has developed a plan with key actions to be implemented as a result of the city’s commitment to the Fast-Track initiative. Some of the most strategic priorities incorporate the scale up of HIV services, including HIV prevention, early diagnosis, and timely treatment of HIV and other sexually transmitted infections; the sensitization of civil servants on issues of stigma, discrimination, and gender-based violence linked to HIV; and facilitate the engagement of communities, specially from key and vulnerable population, in the definition and implementation of HIV programmes at community level.

Representatives of community and civil society organizations such as Corporación Kimirina, the Ecuadorian Coalition of People Living with HIV, and the Silueta X LGBT+ Trans Association attended the event. These organizations play a crucial role in the city's efforts to respond to HIV. "Citizen involvement under the local authority's leadership, with emphasis on the most vulnerable and at-risk community groups, is vital to achieving the goal of ending AIDS by 2030,” emphasized the delegates of Corporacion Kimirina Maria Elena Acosta and Lily Marquez. Similarly, Joan Morales from the Ecuadorian Coalition of People Living with HIV stressed that "By signing the Paris and Sevilla Declarations, Guayaquil joins many other cities that have committed to provide accelerated and sustained health services that allow us to eradicate not only AIDS but also TB, Malaria, and other tropical diseases, with actions that contribute to reducing discrimination towards people living with HIV and other affected communities."

Created in 2014, the Paris Declaration on Fast-Track Cities Ending the HIV Epidemic is a political declaration with commitments and targets that include ending urban AIDS and tuberculosis (TB) epidemics, as well as eliminating viral hepatitis (HBV and HCV). It also articulates a mandate to place people at the center of the response. To define and facilitate that mandate, the Sevilla Declaration on the Centrality of Communities in Urban HIV Responses was created in 2022, outlining the 10 commitments that cities and municipalities are asked to make to increase the engagement of and promote leadership by affected communities in attaining the Fast-Track Cities initiative's goals, objectives, and targets.

"We congratulate the Mayor's Office of Guayaquil for its commitment to contribute to Ecuador’s efforts to reach the 2025 Global AIDS Strategy targets, reducing the number of new HIV infections and AIDS-related deaths and eliminating stigma and discrimination in all its forms,” said Andrea Boccardi Vidarte, Director of the UNAIDS Office for the Andean Countries. "This commitment is also a recognition of the leadership of communities most affected by HIV and their support to the city's goals." 

In the heart of the bustling Guatemala City, Juan used to face the daily grind of life with an unwavering spirit. He had been diagnosed with HIV several years ago and had learned to manage his health effectively. As a dedicated employee at a marketing firm, he poured creativity into every project he touched.

Life seemed to be on an upswing for him until an unexpected turn of events unfolded at the workplace. A colleague stumbled upon Juan's medical records and, in a breach of privacy, discovered his HIV status. Soon, whispers spread through the office, and Juan began to feel the cold stares and hushed conversations whenever he walked by. Ultimately, he was dismissed from his company for "restructuring reasons."

As the discrimination became more blatant, Juan decided it was time to take action. He sought advice from Líderes Profesionales, a network of lawyers specializing in discrimination cases for people living with HIV. With UNAIDS's support, this network is committed to fighting for justice and equality for marginalized communities.

Upon hearing Juan's story, the lawyers at Líderes Profesionales were appalled by the flagrant violation of privacy and the subsequent discrimination. They quickly assembled a legal team dedicated to ensuring justice for Juan. The lawyers explained the legal protections in place for individuals with HIV, emphasizing that workplace discrimination based on health status is a clear violation of the law.

Together with Juan, the legal team initiated a lawsuit against the firm. They filed a complaint citing violations of privacy, discrimination, and failure to provide a safe and inclusive work environment and asked for payment of benefits and compensation for unjustified dismissal.

Líderes Profesionales worked tirelessly to expose Juan's unjust treatment, seeking justice for him and advocating for broader change in workplace policies. They organized workshops to sensitize companies, urging them to implement comprehensive diversity and inclusion training and policy.

As of December 2023, the case is still ongoing. The legal team's goal is to seek compensation for Juan and foster an environment where such discrimination would not be tolerated in the future.

"Juan's experience and five other discrimination-related workplace cases this year inspire us to continue our advocacy work," says Julio Rodríguez, Director of Líderes Profesionales. "We redouble our efforts to support individuals facing discrimination, using each case as an opportunity to raise awareness and push for systemic change."

In Guatemala, 31,000 people are estimated to be living with HIV. HIV-related stigma and discrimination are still pervasive. According to the latest National Stigma Index (2017), 14% of people living with HIV reported losing their job or source of income due to their positive status for HIV, and 13% of people living with HIV reported being denied employment or opportunity to work because of HIV.

 "Having access to legal support really represented a turning point for Juan. Empowered by it, he is a more vocal advocate for HIV awareness and anti-discrimination efforts," says Marie Engel, UNAIDS Country Director for Guatemala, Honduras and Nicaragua. "Through his journey, Juan contributes to a more just and inclusive society for all." 

In the quiet corner of a community center in Guatemala City, 29-year-old Emma - fictitious name - sits among other women she does not know. In the faces and gestures of each of them, you can see that they all carry the weight of violence and injustice on their shoulders.

The first subtle rays of sunlight gradually fill the room; calm and comfort invite Emma and the others to feel more relaxed in their hearts and souls. With tired eyes, small hands, and a heart scarred by violence, she looks around, absorbs the energy of the place, and takes a deep breath as she awaits the start of a therapy session and an informative talk about HIV.

As the therapy session began, Emma shyly and cautiously shared her experiences with Wendi Polanco, who, since 2019, has become a helping hand for many women battered by gender-based violence. Through Latiendo Juntas, the organization she leads in Guatemala, Wendi clearly proves that sisterhood works and is transformative.  

With support from UNAIDS, Latiendo Juntas coordinates a project to improve access to comprehensive health services, including sexually transmitted infections (STI) and HIV testing and care for women survivors of violence. They also contribute to their resilience and empowerment by raising awareness of human rights, including their sexual and reproductive rights, through group therapy and HIV information talks, which provide facts and a platform for open dialogue, fostering a non-judgmental environment.

"The room becomes a sanctuary where the pain of women like Emma and so many others is recognized," says Wendi. "The community center is a refuge for them, and a network of support among the women is woven with the sun's warmth. I feel relieved when I see how the weight on their shoulders begins to lessen."

Throughout these therapy sessions, Emma and other women discover comfort and empowerment. The therapeutic journeys offered at Latiendo Juntas become a catalyst for their resilience, liberation, and self-care.

The link between HIV and violence against women is a widespread problem, as gender-based violence increases women's vulnerability to HIV infection. Women who experience violence may have difficulty negotiating safe sexual practices, including the use of condoms, which increases their risk of contracting HIV. In addition, fear of violence may deter women from seeking HIV testing, treatment, and support, perpetuating the cycle of violence and silence and limiting their access to critical and essential healthcare resources.

Violence against women in Guatemala is endemic and can be described as a shadow pandemic. The country has one of the world's highest rates of femicide: the intentional murder of women because they are women.

"Addressing the intersection of HIV and violence against women requires comprehensive efforts that include education, empowerment, and dismantling gender-based power imbalances," says Irene Izquieta, UNAIDS Advisor on Rights and Gender for Guatemala, Honduras, and Nicaragua. 

Colombia makes landmark decision to declare the HIV medicine dolutegravir of public interest, allowing the country to purchase or manufacture more affordable, generic versions of the live-saving HIV medicine

BOGOTÁ/GENEVA, 4 October 2023—UNAIDS applauds the government of Colombia for declaring the HIV medicine dolutegravir of public interest. This important breakthrough in public health measures will allow the government to issue a compulsory license, breaking the monopoly, and making it much more affordable for the Colombian government to purchase or manufacture. The new decision could mean that the price of the life-saving medicine is reduced by as much as 80%.

“When the power to produce health technologies is held by a few companies, the result all too often is that countries can’t afford the high prices and people who need newer products cannot access them,” said Luisa Cabal, UNAIDS Regional Director for Latin America and the Caribbean. “We are confident that this decision will have an impact across the whole region and beyond, as many middle-income countries are struggling to access generic markets of key health products to prevent and treat HIV infection.” 

The World Health Organization recommends dolutegravir as the preferred first-line and second-line HIV treatment for all populations. As well as being effective, treatments incorporating dolutegravir-based regimens have demonstrated greater adherence, due to fewer side effects, while presenting enhanced, safety, and reduced likelihood of drug resistance.

“This decision represents a milestone for public health in Colombia. Since the Ministry of Health initiated the administrative procedures earlier this year, over 120 civil society organizations, other government agencies, academia and international organizations including UNAIDS supported this process,” said Andrea Boccardi Vidarte, UNAIDS Director for the Andean Countries. "Through our local, regional and global offices, UNAIDS will continue supporting the government on the implementation of this landmark decision.” 

With this decision, the Colombian government estimates that it will be able to put 28 people on dolutegravir for the same price that it is allocated today to treat just one person. The implementation of the measure will allow the country to access less expensive, but just as effective, generic versions. A huge increase in reach with quality medicines which will save lives.

Colombia had already issued national guidelines in 2021 to prioritize dolutegravir as the recommended first-line antiretroviral treatment, in line with WHO recommendations. However, the high price of dolutegravir has remained an obstacle to expanding access and making it widely available to people living with HIV in the country.

This ruling will save lives in Colombia and across the region. The country hosts the largest number of Venezuelan migrants in the world (2.9 million as of October 2022). Recent studies have shown a 0.9% HIV prevalence among this migrant population, almost double the 0.5% HIV prevalence among the country’s adult population. 

“This decision provides the government with the legal conditions to manufacture or purchase more affordable versions of this essential first-line antiretroviral treatment for all people living with HIV in Colombia, including Venezuelan migrants”, said Ms Cabal.

Compulsory licensing is a provision in the World Trade Organization (WTO) Agreement on Trade Related Aspects of Intellectual Property Rights (TRIPS Agreement). It enables governments to supply its citizens with generic versions of patented treatments either through domestic production or imports, ensuring health products’ prices are affordable.

The 2001 WTO Declaration on the TRIPS agreement and public health reaffirmed the rights of member states to make use of all flexibilities in the TRIPS agreement to protect public health, including compulsory licenses. More recently, in the 2021 Political Declaration on HIV/AIDS, countries committed to make use of TRIPS flexibilities, specifically geared to promoting access to medicines.

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.

As millions of people around the world march in the streets of several big cities this month of June to celebrate and honor Pride Month, in Guatemala, over 200 LGBTIQ+ people in human mobility - applicants for refugee or asylum status or nationals and foreigners in transit – and in need of protection find every year in Asociación Lambda their reason to celebrate pride and life through psychosocial care, legal support, medical follow-up and the provision of a shelter or a safe space to be who they are.

Roberto Gonzales*, a Colombian migrant, is one of them. Like hundreds of thousands of other migrants, he overcame the exhausting experience of crossing the Darien Gap,  a journey in which the dangers include natural hazards and criminal gangs known for inflicting violence, including sexual abuse and robbery. According to statistics from the Government of Panama, from January to April 2023, a record number of 127,000 people crossed the Darien.

Unlike many people who go after the American dream, Gonzales wants to stay in Guatemala because the country has a lot to offer. "LAMBDA, for me, is a unique platform of empowerment. They listen to you; they invite you for training twice a month", he says. "Through Lambda, I have formed a network of friends and support. One should not forget the importance of mental health if we want to move forward."

Asociación Lambda works to improve the livelihoods of this marginalized group by providing technical assistance to community groups in management, governance, leadership, and entrepreneurship skills. Lambda's activities strengthen community organizations through education and training and build action and peer-to-peer learning networks.

Andres Martinez*, from Nicaragua, is thankful to Lambda for their support in successfully processing his refugee claim. In his country, he was persecuted for being a journalist and suffered violence in his community because of his sexual orientation. "It is difficult to reinvent oneself in another country, but my favorite color is green, the color of hope, because I hope one day to return to my country," says Martinez. "Here, at Lambda, I felt supported by a brother. One feels very safe with the staff. The shelter is my second home."

As in many parts of the world, LGBTQI+ people in Central America face a complex reality that exposes them to different forms of violence and discrimination and puts their physical integrity at risk, limits their life options, often forces them to flee their homes, and, in some cases, to escape their own countries. The National LGBTIQ+ Human Rights Observatory, which Lambda coordinates, documented at least 29 violent deaths of LGBTIQ+ people in 2022 in the region, killed for reasons allegedly related to their sexual orientation, gender identity, and gender expression.

As part of the LGBTIQ+ Pride Month activities, Lambda opened the doors of its shelter to a United Nations delegation in Guatemala led by the Resident Coordinator Miguel Barreto for an exchange with migrants hosted and receiving care in their safe space. "I came away from the dialogue more human and supportive, and convinced of the centrality of the United Nations commitment to end discrimination and exclusion, reduce vulnerabilities, and promote the human rights of every human being," said Barreto after the visit and the dialogues.

Along with UNAIDS, several UN agencies, funds, and programmes, like the United Nations High Commissioner for Refugees (UNHCR), the International Organization for Migration (IOM), and the Office of the High Commissioner for Human Rights (OHCHR), have joined forces to support Lambda in different fronts hosting, sheltering and supporting LGBTIQ+ migrants and those in transit or in need of protection.

"Before coming to Lambda, very few of our clients had had sufficient access to information about HIV risks and prevention, many of them are victims of sexual crimes, and it is only when they arrive at Lambda that they are offered information and testing free of charge," explains Carlos Valdés, Director of Lambda. "Some people were already aware of their HIV diagnosis but did not know how to access care services."

Globally in 2021 gay men and other men who have sex with men have a 28 times higher risk of acquiring HIV than the rest of the adult (15-49) male population, and among transgender women, the risk is 14 times higher than adult women (15-49) in the general population

Among over 200 people who came to Lambda in 2022, 19% of the men and 17% of the women lived with HIV.

"The vast majority of these people were trans women and gay men, mainly from Guatemala, Honduras, Venezuela, and Nicaragua," explains Marie Engel, UNAIDS Representative for Guatemala, Nicaragua, and Honduras. "We know that these situations of stigma, discrimination, and violence create barriers to accessing health services, including HIV. We must recognize the greater vulnerability of the LGBTQI+ community to HIV and support their right to health and dignity."

*All names of Lambda beneficiaries in this report have been changed for people’s safety.

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.

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."

Brazil has joined the 34 countries that are part of the Global Partnership to take action to eliminate all forms of HIV-related stigma and discrimination. The country's entry into this group of nations was announced at a celebratory event of the International Day Against Homophobia, Biphobia, and Transphobia, held in Brasilia, Brazil’s capital and organized in partnership by UNAIDS, ILO, and the Ministry of Human Rights and Citizenship.

The Global Partnership is an initiative launched through a call for action from the NGO Delegation to the UNAIDS Programme Coordinating Board (PCB) in 2018 to remove HIV related stigma in six settings: healthcare, justice, community, workplace, educationa and humanitarian.  It is co-convened by UNAIDS, UN Women, the United Nations Development Programme (UNDP), the Global Network of People Living with HIV, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. It is also supported by a technical working group composed of 10 United Nations agencies and 24 partners and civil society organizations.

With Brazil, now 35 countries have formally joined the Global Partnership, committing to act against HIV-related stigma and discrimination in the contexts of healthcare services, educational settings, workplaces, justice systems, domestic and community environments, emergency systems, and humanitarian crises.

According to Luisa Cabal, the Regional Director of UNAIDS in Latin America, Brazil's entry into the Global Partnership is a significant step in the collective response against HIV-related stigma and discrimination in Latin America and the world. "By joining this initiative, Brazil reaffirms its commitment to defending human rights, promoting social inclusion, and eliminating barriers to access prevention, diagnosis, treatment, and ongoing response to HIV," she explains.

By joining the Global Partnership, Brazil will have access to a platform that will allow the country to share experiences and best practices with the other participating countries, creating opportunities for collective learning, strengthening the joint response to HIV-related stigma and discrimination.

"It is important to highlight that by joining the Global Partnership, Brazil will also reinforce its leadership role in the region and global diplomacy for health and human rights, demonstrating its commitment to equity and social justice," emphasizes Luisa Cabal.

It is indeed a precedent for the GP that commitment to join the Global Partnership has been witnessed by two Ministers.

Minister of Human Rights and Citizenship Silvio Almeida reiterated his unrestricted support and commitment to public policies promoting and protecting the rights of LGBTQIA+ people. ”For those who suffer violence, and are killed simply for being who they are, these people will be protected in a public commitment, and I renew this commitment not only as Silvio Almeida, but as Minister of State for Human Rights of Brazil” emphasized H.E.

Representing the Ministry of Health Helvécio Miranda, Secretary of Specialized Health Care, similarly shared the Ministry's commitment to embrace the agenda of LGBTQIA+ rights and ensure comprehensive healthcare access for all people emphasizing on a gender approach, and with a special focus on those at risk, with specific needs, or experiencing different forms of violence.

Vinícius Pinheiro, Director for Brazil at ILO, embraced the significance of the Global Partnership in promoting social justice and decent work with inclusion and opportunities for all people so that no one is left behind.