Sexual transmission of HIV

GENEVA, 29 October 2022—Responding to the statement by the Russian government that it intends to extend the so-called “LGBTQ propaganda” law, UNAIDS Executive Director Winnie Byanyima has joined with UN High Commissioner for Human Rights in expressing deep concern.

“Extension of this law,” said Ms Byanyima, “is a further violation of the rights of people to autonomy, dignity and equality. Not only will it harm the security and general wellbeing of LGBTQ individuals, it will have a serious negative impact on people’s health outcomes. The evidence is clear that punitive and restrictive laws, including those restricting free speech, increase the risk of acquiring HIV and decrease access to services. Such laws reduce the ability of service providers, including peer networks, to provide critical sexual and reproductive health information and services, and increase stigma related to sexual orientation, making it harder for people to protect their health and that of their communities. This will undermine Russia’s efforts to end AIDS by 2030. Our call to the Parliament and Government of Russia is to withdraw these harmful proposals and indeed to repeal the existing law. Stigmatising approaches damage public health, perpetuate pandemics and hurt everyone. Social solidarity, inclusion and protecting every person’s human rights are key to ending AIDS and ensuring health for all.”

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.

Like any other regular day in Bangkok, Thailand, Pete went to work and was living a pretty normal life. He had a business that imported and exported fresh vegetables from neighbouring countries in South-East Asia, a family business that he shared with his sister. He was happy and in a serious long-term relationship with his boyfriend, and everything seemed perfect. That day, he and his partner went to get tested for HIV, and that’s when his life suddenly began to change.

“I found out about my HIV status in 2016 and soon after left my business because I didn’t know if I was going to live much longer. Without guidance and mental health support, I had many misconceptions about HIV, and I started to suffer from depression,” he said.

“I blamed myself for contracting HIV, and I couldn’t cope with this thought. I became a drug user, was engaging in chem sex, broke up with my partner and survived suicide attempts,” he continued. “But after receiving support from local organizations of people living with HIV, I decided to retake control of my life. I started to talk openly about HIV to help other young people live with a positive diagnosis. Even though this was never my plan, I knew I had to do it. That’s why I became an HIV activist,” he added.

Nowadays, Pete (famously known online as Pete Living with HIV) is a well-known HIV activist in Thailand and has come far since his diagnosis. He has spent the past few years building an online community for people living with HIV. In this safe space, people can connect and be comfortable enough to share their stories and experiences in an open environment free from stigma and discrimination. His Facebook group, which has strict membership requirements (for obvious reasons), has more than 1300 members.

“I created this space because I didn’t have a place to share my story. I wanted to create a platform where people living with HIV can be proud of themselves and be reminded they are not alone. No one deserves to be stigmatized, bullied, dehumanized or disrespected. Everyone deserves to be loved, respected and accepted,” he said.

In 2019, the country announced the Thailand Partnership for Zero Discrimination, which calls for intensified collaboration between the government and civil society to work on stigma and discrimination beyond health-care settings, including workplaces, the education system and the legal and justice system. UNAIDS has been involved since the outset of the initiative by providing technical assistance to formulate the zero discrimination strategy and the five-year action plan, develop a monitoring and evaluation plan and operationalize the strategy as a joint effort between the government and civil society.

Pete thinks this initiative is a cornerstone to ending the AIDS epidemic, as stigma and discrimination continues to be the main barrier to HIV services. “Although it has improved a lot over the years, I still experience stigma and discrimination when I go for regular sexually transmitted infection check-ups. I still receive judgement from nurses and doctors,” he said.

Pete has also become a passionate activist for, and speaks about the importance of, U = U (undetectable = untransmittable) at international forums and conferences. “U = U changed my life. I continue to fight for and promote U = U because its messages have the power to change the lives of people living with and affected by HIV. Still, more importantly, it can change social attitudes and tackle stigma and discrimination,” he said.

With U = U, HIV treatment has transformed the HIV prevention landscape. The message is clear and life-changing: by being on HIV treatment and having an undetectable viral load, people living with HIV cannot transmit HIV to their partners. The awareness that they can no longer transmit HIV sexually can provide people living with HIV with confidence and a strong sense of agency in their approach to new or existing relationships.

Pete launched a campaign in 2020 focusing on U = U and mental health advocacy. “Through my social media channels, I raise awareness about the importance of listening to people and their experiences and respecting them. U = U is key to helping people living with HIV overcome self-stigma and negative feelings like shame, which discourage them from accessing and/or remaining on treatment. U = U is encouraging; it can help remind people living with HIV to be proud of themselves,” he said.

Pete is now strengthening partnerships with national stakeholders and allies of the HIV response to ensure that messages related to U = U, HIV prevention and zero discrimination are amplified and reach different audiences. He is also a representative on a multisectoral task force to design and implement the People Living with HIV Stigma Index in Thailand, which will be conducted this year. He has supported the United Nations in Thailand on various campaigns, including the Everybody Deserves Love Valentine's Day campaign and the zero discrimination campaign, in which he is engaging young people from across Thailand. 

The Bangkok Metropolitan Administration (BMA) in Thailand has been awarded the inaugural Circle of Excellence Award at the Fast-Track cities 2021 conference, held recently in Lisbon, Portugal. The Circle of Excellence Award showcases outstanding work in fast-tracking the HIV response and advancing innovative programming to end the AIDS epidemic in cities by 2030.

“To receive the Circle of Excellence Award for Bangkok is a great honour. It demonstrates not only the past achievements but, moreover, the future commitment to accelerate the HIV response and towards ending AIDS in Bangkok. We are proud that innovations have produced remarkable results, particularly same-day antiretroviral therapy and key population-led health services, such as specialized and holistic services for transgender people and the scale-up of pre-exposure prophylaxis (PrEP) programmes. These innovations are not only applied in Bangkok but have become models for the region,” said Parnrudee Manomaipiboon, the Director-General of the Department of Health, BMA, during the award ceremony.

Organized by the International Association of Providers of AIDS Care, in collaboration with UNAIDS, the Fast-Track Cities Institute and other partners, the Fast-Track cities conference highlighted successes achieved across the Fast-Track cities network, addressed cross-cutting challenges faced by local stakeholders and shared best practices in accelerating urban HIV, tuberculosis and hepatitis B and C responses.

“Bangkok has put in place a 14-year strategic plan for ending AIDS from 2017 to 2030, which is under the leadership of the Bangkok Fast-Track Committee,” said Pavinee Rungthonkij, the Deputy Director-General, Health Department, BMA. “During COVID-19, BMA and partners have introduced innovations such as multimonth antiretroviral therapy, an express delivery of antiretroviral therapy service, sexually transmitted infection self-sampling and PrEP,” she added. Among other achievements, Bangkok has expanded its PrEP services to 16 municipal public health centres and eight city hospitals and implemented citywide awareness campaigns. PrEP in the City was the first citywide PrEP campaign focusing on transgender people in Asia.

“Significant progress has been made in the HIV response since Bangkok joined the Paris Declaration to end the AIDS epidemic in cities in 2014. It shows that mutual commitments and a strengthened partnership between stakeholders at all levels are key to an effective HIV response. Bangkok will continue to leverage support, scale up innovations and Fast-Track solutions to achieve the 2025 targets and end AIDS by 2030,” said Patchara Benjarattanaporn, the UNAIDS Country Director for Thailand.

In 2019, key populations (including gay men and other men who have sex with men, people who inject drugs, sex workers, transgender people and prisoners) and their partners accounted for 62% of all new HIV infections worldwide, including the largest share of new infections in every region other than eastern and southern Africa.

Globally, new HIV infections declined by 23% from 2010 to 2019. The 1.7 million new infections that occurred in 2019 are more than three times higher than the global target of less than 500 000 new infections in 2020.

However, barely a dent has been made in the number of HIV infections among female sex workers, people who inject drugs and transgender women, and HIV infections among gay men and other men who have sex with men increased by an estimated 25% between 2010 and 2019.

This story was first published by UN Women

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As COVID-19 pushes the AIDS response even further off track and the 2020 targets are missed, UNAIDS is urging countries to learn from the lessons of underinvesting in health and to step up global action to end AIDS and other pandemics

GENEVA, 26 November 2020—In a new report, Prevailing against pandemics by putting people at the centre, UNAIDS is calling on countries to make far greater investments in global pandemic responses and adopt a new set of bold, ambitious but achievable HIV targets. If those targets are met, the world will be back on track to ending AIDS as a public health threat by 2030.

The global AIDS response was off track before the COVID-19 pandemic hit, but the rapid spread of the coronavirus has created additional setbacks. Modelling of the pandemic’s long-term impact on the HIV response shows that there could be an estimated 123 000 to 293 000 additional new HIV infections and 69 000 to 148 000 additional AIDS-related deaths between 2020 and 2022.

“The collective failure to invest sufficiently in comprehensive, rights-based, people-centred HIV responses has come at a terrible price,” said Winnie Byanyima, Executive Director of UNAIDS. “Implementing just the most politically palatable programmes will not turn the tide against COVID-19 or end AIDS. To get the global response back on track will require putting people first and tackling the inequalities on which epidemics thrive.”

New targets for getting back on track

Although some countries in sub-Saharan Africa, such as Botswana and Eswatini, have done remarkably well and have achieved or even exceeded the targets set for 2020, many more countries are falling way behind. The high-performing countries have created a path for others to follow. UNAIDS has worked with its partners to distil those lessons into a set of proposed targets for 2025 that take a people-centred approach.

The targets focus on a high coverage of HIV and reproductive and sexual health services together with the removal of punitive laws and policies and on reducing stigma and discrimination. They put people at the centre, especially the people most at risk and the marginalized—young women and girls, adolescents, sex workers, transgender people, people who inject drugs and gay men and other men who have sex with men.

New HIV service delivery targets aim at achieving a 95% coverage for each sub-population of people living with and at increased risk of HIV. By taking a person-centred approach and focusing on the hotspots, countries will be better placed to control their epidemics.

The 2025 targets also require ensuring a conducive environment for an effective HIV response and include ambitious antidiscrimination targets so that less than 10% of countries have punitive laws and policies, less than 10% of people living with and affected by HIV experience stigma and discrimination and less than 10% experience gender inequality and violence.

Prevailing against pandemics

Insufficient investment and action on HIV and other pandemics left the world exposed to COVID-19. Had health systems and social safety nets been even stronger, the world would have been better positioned to slow the spread of COVID-19 and withstand its impact. COVID-19 has shown that investments in health save lives but also provide a foundation for strong economies. Health and HIV programmes must be fully funded, both in times of plenty and in times of economic crisis.

“No country can defeat these pandemics on its own,” said Ms Byanyima. “A challenge of this magnitude can only be defeated by forging global solidarity, accepting a shared responsibility and mobilizing a response that leaves no one behind. We can do this by sharing the load and working together.”

There are bright spots: the leadership, infrastructure and lessons of the HIV response are being leveraged to fight COVID-19. The HIV response has helped to ensure the continuity of services in the face of extraordinary challenges. The response by communities against COVID-19 has shown what can be achieved by working together.

In addition, the world must learn from the mistakes of the HIV response, when millions in developing countries died waiting for treatment. Even today, more than 12 million people still do not have access to HIV treatment and 1.7 million people became infected with HIV in 2019 because they did not have access to essential HIV services.

Everyone has a right to health, which is why UNAIDS has been a leading advocate for a People’s Vaccine against COVID-19. Promising COVID-19 vaccines are emerging, but we must ensure that they are not the privilege of the rich. Therefore, UNAIDS and partners are calling on pharmaceutical companies to openly share their technology and know-how and to wave their intellectual property rights so that the world can produce successful vaccines at the huge scale and speed required to protect everyone.

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 Yerevan, the capital of Armenia, all polyclinics are now providing free, anonymous, and fast testing for HIV, Syphilis, Hepatitis B and C as part of the “Do not guess, get tested” campaign launched by the Ministry of Health and the Yerevan Municipality on World Hepatitis Day.

“It is an important signal to the population that we keep providing all necessary HIV services to people and that the COVID-19 pandemic has not stopped our prevention and testing work,” said Alexander Bazarchyan, Director of the National Institute of Health.

In preparation for this initiative, the Ministry of Health together with the National Institute of Health and the Municipality of Yerevan, conducted training sessions for medical staff in 20 polyclinics in Yerevan. More than 300 health workers—family doctors, infectious disease specialists, general practitioners, laboratory specialists, etc—received theoretical and practical information on “Management skills of Tuberculosis, Hepatitis B and C” and “HIV testing and counselling services in primary healthcare facilities”. 

The activities continued during the COVID-19 epidemic through an educational website developed with support from UNAIDS. The site is a platform where specialists can post accredited online courses so that health professionals can continue their education for free.

In addition, rapid tests for HIV, Syphilis, Hepatitis B and C were purchased within the framework of the UNAIDS Regional Cooperation Programme (RCP) for Technical Assistance on HIV and other Infectious Diseases funded by the Government of the Russian Federation. The RCP aims to strengthen health systems, ensure better epidemiological surveillance of HIV, and promote the scale up of HIV prevention programmes among key populations at higher risk in Armenia, Belarus, Kyrgyzstan, Tajikistan, and Uzbekistan.

“We welcome such timely support as this initiative can facilitate access to testing for people through primary healthcare services and make another step towards achieving Armenia’s commitments to increase access to early diagnosis and treatment,” said Roza Babayan, UNAIDS Representative in Armenia.