not valid -- Senegal

The Centre de Prise en Charge Intégrée des Addictions de Dakar (CEPIAD), which opened in December 2014, is an addiction reference centre in Dakar for Senegal and the wider region. To date, it has cared for 1200 people, including approximately 250 people currently enrolled on its opioid substitution therapy programme.

In Senegal, HIV prevalence among people who inject drugs is 3.7%, well above the average of 0.4% among the general population. HIV prevalence is higher among female drug users (13%) than among men (3%), but women represent less than 10% of CEPIAD’s active caseload. In response, CEPIAD has reached out to women who inject drugs. With the support of UNAIDS, and in collaboration with the Conseil National De Lutte Contre le Sida, CEPIAD organized a week of activities around World AIDS Day to address the specific needs of women.

“Women were at the heart of the organization of this week. We want to remove the misrepresentations and misunderstandings that hinder their attendance at the centre,” said Ibrahima Ndiaye, Deputy Coordinator of CEPIAD.

Women were able to access HIV and hepatitis C screening services, gynaecology consultations, including cervical cancer screening, and addiction counselling. Talks with female drug users and a debate on harm reduction were organized on 1 December, World AIDS Day.

A three-day training on making soap, using honey, aloe vera, shea butter, palm oil and mbeurbeuf, and a batik workshop were also offered. More than 50 women participated and the products were sold on the closing day of the week of activities.

Ndeye Khady, the founder of the batik workshop, is a former crack smoker who is currently accessing opioid substitution therapy and antiretroviral therapy at CEPIAD, where she met her husband, also a former drug user. “My dream now is to have a child. I am so grateful that I have been able to take advantage of the services offered. I encourage more women to use them,” she said.

Face masks, sanitizers and soap. Food packages and money to pay the rent. Information about how to protect yourself and your loved ones from the virus—the list goes on.

The necessities of life during the COVID-19 pandemic can be hard to come by, but communities are organizing and delivering services and much needed commodities to the people that need them the most. And communities with experience of responding to other epidemics are turning their lessons learned to COVID-19. 

“Organizations led by and for people living with HIV and key populations are now spearheading urgently needed programmes to combat COVID-19 and secure the health and well-being of their communities,” said Demba Kone, the UNAIDS Country Director for Senegal.

Like in many other countries around the world, face masks and other personal protective equipment are in short supply in Senegal. However, the Enda Santé nongovernmental organization had a quick and efficient solution—the many local tailors and dressmakers, who are highly skilled and had a ready access to supplies of fabric. Responding to the call of “come work with us”, the tailors and dressmakers produced thousands of high-quality masks in a record time, and at a very low cost. And the local production meant that the money stayed in the local economy, which had been badly affected by the pandemic.

Enda Santé has also begun negotiating with donors that fund HIV programmes. Funds that had been allocated to HIV-related activities that could not be carried out in the current context have been re-allocated to support COVID-19-related activities in the most-affected communities.

Focusing the right resources at the right place is crucial when responding to outbreaks that are travelling fast through communities. Enda Santé therefore went to work to identify the communities that were the most vulnerable and in the greatest need.

Drawing on statistics generated by the government, as well as their own knowledge about the demography and availability and accessibility of health services, Enda Santé looked at poverty levels among communities, the neighbourhoods where overcrowding was the worst and where people had difficulty in accessing health care. It was clear that the people who were the most vulnerable to HIV were also now very vulnerable to COVID-19.

Enda Santé focused on those communities, distributing prevention materials and mobilizing young and female leaders from the community, training them to go door to door explaining how people could protect themselves, how to identify cases and how to get people into treatment centres.

It was obvious that many of the people affected by HIV that Enda Santé worked closely with—people living with HIV, sex workers, people who inject drugs and young women and adolescent girls—had lost their incomes because of the lockdown and were now struggling with the triple impact of HIV, COVID-19 and poverty. In response, Enda Santé organized the delivery of food and cash transfers.

Daouda Diouf, the Executive Director of Enda Santé, reflected on the process. “We had already learned how to do all of this work in the context of HIV, so we were transferring the skills we learned in responding to HIV for 25 years, and we moved to apply them to COVID-19. The speed of action, engaging community members and putting them at the centre of the work, the door-to-door approach, pre-empting the risk of transmission, delivering prevention packages, and so on. We were able to act very quickly.”

Home to 5 million people living with HIV, western and central Africa is not on track to ending AIDS by 2030. Every day, more than 760 people become newly infected with HIV in the region and only 2.6 million of the 5 million people living with HIV are on treatment.

Insufficient political will, frail health systems and weak support for community organizations―as well as barriers such as HIV-related criminalization―are the most significant obstacles to progress. A regional acceleration plan aims to put the region on track to reaching the target of tripling the number of people on antiretroviral therapy by 2020 and achieving epidemic control. While progress has been made, that progress is not coming fast enough. Children are of particular concern―only 28% of under-15-year-olds living with HIV in the region have access to antiretroviral therapy.

“We need policies and programmes that focus on people not diseases, ensuring that communities are fully engaged from the outset in designing, shaping and delivering health strategies,” said Gunilla Carlsson, UNAIDS Executive Director, a.i., speaking at the Global Fund to Fight AIDS, Tuberculosis and Malaria Sixth Replenishment Conference, taking place in Lyon, France, on 9 and 10 October.

There are many examples of how investing in communities can make a difference. “The response is faster and more efficient if it is run by those who are most concerned,” said Jeanne Gapiya, who has been living with HIV for many years and runs the ANSS nongovernmental organization in Burundi.

Community-led HIV testing and prevention is effective, particularly for marginalized groups. “Most of the people tested by communities were never reached before and this shows how community organizations are unique and essential,” said Aliou Sylla, Director of Coalition Plus Afrique.

Reducing the number of new HIV infections among children and ensuring that women have access to the services they need remains one of the biggest challenges in the region. Networks of mothers living with HIV who support each other to stay healthy and help their child to be born HIV-free have been shown to be an effective way of improving the health of both mothers and children.

“Our community-based approach works. In the sites where we work we have reached the target of zero new HIV infections among children and all children who come to us are on treatment,” said Rejane Zio from Sidaction.

Financing remains a concern and although total resources for the AIDS response have increased, and HIV remains the single largest focus area for development assistance for health, domestic investments account for only 38% of total HIV resources available in western and central Africa, compared to 57% worldwide. Greater national investments reinforced by stronger support from international donors are needed to Fast-Track the regional response. Bintou Dembele, Executive Director of ARCAD-Sida, Mali, said, “We have community expertise, but we lack the funds to meet the need.”

Support is growing for community-based approaches in the region. Recognizing the importance of community-led work, Expertise France and the Civil Society Institute for Health and HIV in Western and Central Africa announced a new partnership on 9 October. “The institute brings together 81 organizations from 19 countries aiming to ensure better political influence at the global and country levels and to galvanize civil society expertise in programme delivery. This partnership is a recognition of our essential contribution,” said Daouda Diouf, Director of Enda Sante and head of the steering committee of the institute. “The situation in western and central Africa remains a priority. It is clear that community-based approaches are agile and appropriate for responding to pandemics,” said Jeremie Pellet from Expertise France.

Shifting to a people-centred approach has been at the core of reforms in the region. A growing regional resolve to accelerate the response and to strengthen community-led approaches that have been proved to work provides hope for the future of the HIV epidemic in western and central Africa.

Western and central Africa continues to lag behind the rest of Africa in preventing and treating HIV, leaving millions of people vulnerable to HIV infection and 2.4 million people living with HIV without treatment. Following calls to action made at the 2016 United Nations High-Level Meeting on Ending AIDS and the July 2016 African Union summit, UNAIDS and partners launched a plan to accelerate efforts to stop new HIV infections and ensure that everyone in the region has access to life-saving treatment.

Although resources available in western and central Africa to respond to HIV increased by 65% between 2006 and 2016, reaching an estimated US$ 2.1 billion, most countries remain highly dependent on donors. However, international funding is declining and current investment levels are far lower than what is actually needed to make a sustainable change.

Luxembourg is one country that remains committed to investing in western and central Africa. Marc Angel, Chair of the Foreign Affairs and Development Committee in the Luxembourg Parliament and UNAIDS Champion for the 90–90–90 Targets, joined UNAIDS on a recent visit to Senegal to see how Luxembourg’s contribution to UNAIDS for the acceleration of the AIDS response in western and central Africa was helping to make a difference.

Supported by funding from Luxembourg, UNAIDS and partners have established the innovative Civil Society Institute for HIV and Health in West and Central Africa. The institute acts as a coordinating mechanism for around 80 nongovernmental organizations working in the interests of people affected by HIV in 20 countries across western and central Africa.

One such group is CEPIAD, the first centre for harm reduction for people who inject drugs in western Africa. The medical staff and social assistants are pioneers in the region, treating people who use drugs with a public health approach rather than judgement. In Mbour, at the treatment centre for key populations, Mr Angel heard from people who had injected drugs in the past, who shared their personal stories of how the centre had helped them to reintegrate with their families and society.

“Only by including key populations can the 90–90–90 targets be reached,” said Mr Angel. “Senegal’s public and civil society actors have to continue working hand in hand towards this objective. For Luxembourg’s development cooperation, the human rights dimension in the fight against AIDS and in global health is key. Together with UNAIDS we need to ensure that voices from communities are being heard, working all over the country, in particular with vulnerable populations, including children.”

Mr Angel also visited the paediatric treatment ward of the Albert Royer Hospital, where he met young people living with HIV. They shared their experiences of treatment for HIV, which is allowing them to live normal lives. He noted the progress made in stopping new HIV infections among children in Senegal and the important work done around sexual and reproductive health and HIV to prevent new HIV infections among adolescents.

During meetings with the Minister of Health and Social Action of Senegal, Abdoulaye Diouf Sarr, and the Secretary-General of Senegal’s National AIDS Committee, Safiatou Thiam, Mr Angel praised Senegal for decreasing the national HIV prevalence.

However, he also highlighted areas of concern, including the high HIV prevalence among key populations, emphasizing that access to treatment for key populations was instrumental to ending AIDS by 2030. He also advocated for an increase in national resources to respond effectively and sustainably to HIV in Senegal.

DAKAR/GENEVA, 16 January 2019—At a high-level meeting in Dakar, Senegal, UNAIDS, the United Nations Children’s Fund (UNICEF) and the World Health Organization (WHO) urged countries in western and central Africa to do more to stop new HIV infections among children and adolescents and increase HIV testing and treatment coverage.

In 2017, around 67 000 children (aged 0–9 years) and 69 000 adolescents (aged 10–19 years) became newly infected with HIV. Two thirds (46 000) of adolescents newly infected with the virus were girls. While progress has been seen in stopping new HIV infections among children in some countries—eleven countries registered a reduction of more than 35% between 2010 and 2017[1]—others, including Nigeria, which has the largest epidemic in the region, experienced no declines at all.

“Countries in western and central Africa have a real opportunity to create a positive change for children and young people,” said Michel Sidibé, Executive Director of UNAIDS. “Underlying issues including a lack of domestic investment, fragile health systems, user fees, gender inequality and widespread stigma and discrimination must urgently be addressed to remove barriers and save lives.”

In western and central Africa, close to 800 000 children and adolescents aged between 0 and 19 years were living with HIV in 2017—the second highest number in the world after eastern and southern Africa.

“The majority of children living with HIV in this region are not receiving care and treatment because they do not know they have HIV as they have not been tested,” said Marie-Pierre Poirier, UNICEF Regional Director for West and Central Africa. “We can reverse that trend by focusing on a family-centered approach to HIV testing and treatment and by rolling out innovative point-of-care technologies that bring testing closer to the primary health facilities and the communities where children live.”

Less than half of all pregnant women living with HIV in the region (47%) had access to antiretroviral medicines to prevent transmission of the virus to their child and only 21% of infants exposed to HIV were tested for the virus within the first two months of life.

We should not lose anymore of Africa’s future to AIDS,” said Matshidiso Moeti, WHO Regional Director for Africa. “Effectively tackling HIV in children and adolescents needs strong and quality health services. By committing to universal health coverage, countries can fast-track progress towards an AIDS-free generation in western and central Africa.”

Although there has been some progress in antiretroviral therapy coverage for children in western and central Africa, which rose from 18% in 2014 to 26% in 2017, the region still has the lowest coverage in the world. Around 52 000 children and adolescents aged between 0 and 19 years died of AIDS-related illnesses in 2017—34 000 of whom died before they reached their fifth birthday.

In the 2016 United Nations General Assembly Political Declaration on Ending AIDS, countries from western and central Africa committed to work towards reducing the number of new HIV infections among children and young adolescents (under 15 years) to 6000 by 2020 and to ensuring access to treatment for 340 000 children and young adolescents (under 15 years) by 2020.

However, pledges to accelerate the HIV response have not been accompanied by a surge in resource mobilization. The total resources needed for an effective response in western and central Africa were 81% greater than the funds available in 2017.

Translating commitments into action requires engagement from political and community leaders, drastically scaling up investments, scaling up innovative technologies such as point-of-care for early infant diagnosis, differentiated service delivery strategies—including family testing and longer prescriptions for antiretroviral medicines—and task-shifting approaches applied to HIV care and treatment services for children across the region.

As part of concerted efforts to step up progress in the region, UNAIDS, UNICEF and WHO called a High-Level Meeting on the Elimination of Mother-to-Child Transmission of HIV and Universal Health Coverage of Paediatric HIV Testing and Treatment in West and Central Africa to unpack the challenges, share best practices and innovative approaches to address the persisting bottlenecks, agree on corrective actions and ensure commitment to action from countries and partners.

Hosted by the Government of Senegal, the meeting is being held in Dakar from 16 to 18 January 2019, bringing together ministers of health, experts, representatives of civil society and partners from across the region as well as high-level representatives of United Nations organizations, the African Union, the Economic Community of West African States and the Economic Community of Central African States.

During the meeting, countries and partners are expected to renew their commitment to the 2015 Dakar Call to Action for Accelerating the Elimination of New HIV Infections in Children and Access to Treatment for Children and Adolescents Living with HIV by 2020.

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.

Unjust laws can prevent people from accessing the services they need to prevent or treat HIV, and people who use drugs need help and care, not punishment—these are two of the messages from the new Model Drug Law for West Africa. Launched on11 September in Dakar, Senegal, the model drug law aims to guide policy-makers in the region on how to better frame their drug laws.

It is increasingly recognized that the current drug laws are not effective and result in enormous costs. The model drug law shows how countries can modify their laws in order protect the health and welfare of people while at the same time allowing law enforcement to focus on the most serious drug offences.

“The risk of acquiring HIV is 23 times higher among people who inject drugs, yet they still face human rights abuses, punitive legal environments and are left out of health and HIV programming,” said Michel Sidibé, Executive Director of UNAIDS. “It is essential that countries take a human rights-based approach that is grounded in scientific evidence and includes critical harm reduction services to protect the health and welfare of people who inject drugs and their communities.”

Drawn up by the West Africa Commission on Drugs, a group convened by Kofi Annan comprising experts from western Africa, the model drug law notes that barriers to accessing health services for people who use drugs need to be removed. People who inject drugs are one of the groups at highest risk of exposure to HIV, but they remain marginalized and often out of reach of health and social services.

The model drug law suggests removing criminal penalties for people who use drugs and making harm reduction measures available. It has been shown that harm reduction works—when harm reduction services are made available, new HIV infections fall sharply. For drug use, and possession of drugs for personal use, the model drug law sets out alternatives to conviction and punishment.

“Our current drug laws stigmatize and penalize drug users. However, pushing them to the fringes of society or locking them up in ever increasing numbers will not solve the problem. On the contrary, it worsens health issues and puts enormous pressure on the already over-stretched criminal justice systems,” said Olusegun Obasanjo, former President of Nigeria and Chair of the West Africa Commission on Drugs.

The model drug law also seeks to enhance access to essential medicines such as morphine and other opioids to manage pain. Many people in western Africa are denied the pain-relieving medicines that they need because doctors and other health professionals are not prescribing opioids for fear of prosecution. The model drug law suggests special protection for medical staff to help remove barriers to accessing pain relief.

Experience around the world has shown that it is possible to change drug laws for the better. The new model drug law is a step towards making such changes in western Africa.

Civil society leaders from western and central Africa have laid out a road map to take a more active role in scaling up HIV prevention and treatment services in the region. The eight leaders reiterated that without their involvement and help, it would be difficult to reach people and the treatment goals.

“We want to be more involved, because we are on the ground and we are the people concerned,” said Daouda Diouf, Director of ENDA Dakar and rapporteur of a three-day meeting of civil society, UNAIDS and partners held from 19 to 21 February in Geneva, Switzerland.

In 2016, the western and central Africa region faced disproportionately high AIDS-related deaths compared to its share of the world’s population. Although HIV prevalence in the region remains low, few people living with HIV there have access to treatment.

The leaders pointed out the many challenges they face. In many francophone countries, medical care remains too centralized, carried out mostly in clinics, limiting outreach from peer educators and community workers. They also said that stigma and discrimination keeps people away. National health policies often do not allow civil society to deliver key services, such as HIV testing.

Hidden fees for health services paid by the patient also dissuade people from seeking help. And funding and political will have waned in recent years, reducing their capacities.

Aliou Sylla, Director of Coalition Internationale Sida-Plus, stressed that civil society has many solutions and experience from pilot programmes that have been proven to work.

“Because we have clinics that do not look like clinics, because we do peer-to-peer HIV testing and because we offer counselling, we are much more capable of reaching vulnerable people,” he said. “Just have confidence in us.”

His colleague wholeheartedly agreed. Ibrahima Ba, coordinator at Bokk Yakaar, a nongovernmental organization and leader of the regional network for people living with HIV, added that not only can civil society reach people, it can also monitor the progress of national and regional HIV plans. “Count on us to be implementers, but also watchdogs, so that governments are held accountable.”

The road map includes an upcoming regional meeting bringing together civil society from 12 western and central African countries in order to incorporate their views in national HIV plans. UNAIDS will be advocating for them to have more influence in countries.

In closing the meeting, Deputy Executive Director Luiz Loures said, “The data and the evidence show that we are not optimizing our efforts in the AIDS response in this region.” Looking at the civil society leaders, he concluded, “We need to use civil society as an engine.”

During the Global Partnership for Education meeting on 2 February, hosted by Senegal and France, UNAIDS Executive Director Michel Sidibé discussed the importance of education and health. “Integrating education and health is key for our success in controlling the epidemic among young people. Without effective, quality and sustainable health and education systems we are failing young people”, Mr Sidibé said. Credit: UNAIDS/B. Deméocq.

The First Lady of Senegal, Marieme Faye Sall, and the First Lady of France, Brigitte Macron, inaugurate a cardio-paediatric centre that provides surgical treatment for children affected by cardiologic diseases. The centre, funded by the Cuomo Foundation in Monaco, supports women and children in Senegal. Credit: UNAIDS.

Preventing mother-to-child transmission of HIV is crucial, as is community involvement, stressed Mr Sidibé during his meeting with Ms Sall. The western and central Africa region lags behind in access to treatment and prevention, which is why UNAIDS and partners launched a western and central Africa catch-up plan. Credit: UNAIDS/B. Deméocq.

Mr Sidibé also met with the Minister of Health and Social Action of Senegal, Abdoulaye Diouf Sarr, stressing that no matter who you are or where you are from, everyone has the right to health, the right to an education, the right to equal opportunities and the right to thrive. Credit: UNAIDS/B. Deméocq.

The Secretary General of the Organisation Internationale de la Francophonie, Michaëlle Jean, will raise the issue of counterfeit medicines at the upcoming World Health Assembly in May. Credit: UNAIDS/B. Deméocq.

Minister of International Development of Norway, Nikolai Astrup, and Mr Sidibé met on the sidelines of the meeting. Credit: UNAIDS/B. Deméocq.

Mr Sidibé, along with the Ambassador of Luxembourg, Nicole Bintner. Luxembourg has been an active participant and donor in the western and central Africa catch-up plan. Credit: UNAIDS/B. Deméocq.

Good health enables a girl to thrive, to grow, to think, to explore and to contribute to her community. Knowledge of how to stay healthy and access to quality health services enable her to prevent illness, to eat well, to manage her sexual health, to have healthy babies when and if she chooses to and to nurture her own well-being. Education and health are two of the most transformative elements of a girl’s life. Credit: UNAIDS/B. Deméocq.

A baby abandoned at a health clinic, an abusive boyfriend, dating woes and fake medicines are all plot twists in C’est la Vie (That’s Life), a television series based in, and produced in, Africa. Shot in Senegal, the sitcom takes place in the fictitious Ratanga health clinic, where midwives interact with patients and work on various cases. Their life stories and office politics come into play, adding intrigue, but the overall aim is to raise health awareness through entertainment.

The series, a first in western Africa, was inspired by Mexican pioneer Miguel Sabido—who used telenovelas to promote literacy and family planning—as well as by the educational television series Shuga. Shuga, the MTV English-language series, is now in its six season and has been so successful that it has moved its filming location from Kenya to capture new stories from Nigeria and South Africa.

Réseau Africain d’Education en Santé (RAES), a nongovernmental organization backed by several United Nations agencies and the French Government, founded Keewu, a production company, to launch the show.

RAES founding member and now Keewu producer Alexandre Rideau’s motivation for launching C’est la Vie was to reach millions via television. “The statistics speak for themselves in western Africa,” Mr Rideau said. “Young people are clueless about sexuality, HIV prevention and simple things like menstruation.” He also added that it was obvious from the many questions received that people had real difficulty in accessing information.

The show highlights many of the realities of the region, from high levels of maternal deaths to HIV infection. Four in five children living with HIV in western and central Africa are still not receiving life-saving antiretroviral therapy and AIDS-related deaths among adolescents aged 15–19 years are on the rise in the region, according to a UNAIDS/United Nations Children’s Fund report, Step up the pace. 

In its second season, C’est la Vie has gained in popularity, so much so that actors are being recognized in the street. Mr Rideau recounted that a toll collector in a toll booth in Dakar would not let an actress who plays an unpleasant character in the series go through in her car.

Broadcast in western and central African countries on A+ and TV5 Monde Afrique, as well as local channels, the show reaches about 100 million viewers. Mr Rideau explained that the series may not necessarily change people’s behaviour, but it gets crucial conversations started about health issues. In Senegal and Togo, open debates about the show’s themes take place in town squares following an airing.

Mr Rideau said that he wants to roll the show out in six other countries in 2018. A radio spinoff in the Hausa language is now being distributed in Niger.

PROMO REEL - C'est la vie! - Saison 1 from Keewu Production on Vimeo.

The President of Senegal and Chairperson of the New Partnership for Africa's Development (NEPAD), Macky Sall, reaffirmed his commitment to support efforts to ensure that 90% of the 4.5 million people living with HIV in western and central Africa have access to HIV treatment by 2020. The commitment was made during a meeting with Djibril Diallo, Director of the UNAIDS Regional Support Team for West and Central Africa.

With a treatment coverage of only 28%, the region is not on track to achieve the 90–90–90 targets whereby, by 2020, 90% of people living with HIV know their HIV status, 90% of people who know their HIV-positive status are accessing treatment and 90% of people on treatment have suppressed viral loads. However, during the High-Level Meeting on Ending AIDS, which took place in New York, United States of America, in June 2016, heads of state agreed to develop a plan for countries in the region to achieve the 90–90–90 targets on time. President Sall was designated as the champion of the initiative.

In this capacity, President Sall will seek support from his African peers for greater involvement and urgent action in the region. He also committed to discuss with the Presidents of Canada and France a call to raise additional funding for the AIDS response in the region.

Finally, he gave an assurance that he will elevate the profile of the local AIDS response in Senegal in order to make it a model for the other countries in the region. For that, he will mobilize additional annual funding to achieve universal coverage of prevention of mother-to-child transmission by 2018 and the 90–90–90 targets by 2020.