Togo

Holy Disrupters: Interviews with Religious Leaders and advocates on HIV and Compassion

Reverend Godson Dogbéda Téyi LAWSON KPAVUVU, Presiding Bishop of the Methodist Church of Togo

UNAIDS speaks to Reverend Godson about his work on HIV and about some of the challenges he is facing

What was your experience working on HIV in the early days?

I had been studying abroad and when I came back in 1992I found that members of my community were dying. But people weren’t talking about what was causing it, they were giving it nick names. It was of course AIDS. During a pastoral meeting I spoke with the Bishop who told me, ‘young man, this thing is a sin, you can’t talk about it openly here, the community won’t accept it’.  

This was until two or three years later when some of our colleagues from the church became sick and were dying of AIDS. I went back to the bishop and said now we have to talk about HIV. So, I created a small group and I joined up with the association of people living with HIV in Lomé – it was a safe space where people living with HIV could speak openly.

“Young man this thing is a sin, you can’t talk about it openly here, the community won’t accept it.”

We began to advocate with the government, working with the association and with churches and religious leaders in the country. But theologically, HIV was still spoken about as a sin, so if theologically the narrative isn’t correct, it will damage the whole process. So we corrected the narrative to make it clear that HIV is a virus, not a sin. This was the starting point.

“HIV is a virus, not a sin - this was the starting point.”

From then we created small teams within the communities to support people living with HIV and especially to support the families. To break down the stigma we had to start with the families and then the communities. We published books for academics so they could use them to teach, and we trained the young pastors.

Your work with key populations is well known – how did this come about?

I realized the importance of working with key populations when my uncle died in 2000. He was a gay man who contracted and died of AIDS.  I drew on my personal experience with my own family to start working with key populations.

“My uncle died in 2000. He was a gay man who contracted and died of AIDS.”

Today the government has put in place a framework to ensure that everyone living with HIV has access to treatment, but there is still a lot of stigma and discrimination. The loudest voices who have been speaking out are women, the mothers who are saying these are our children, how can we discriminate against our own children. So, we have engaged them in our efforts to break down the stigma around HIV and around key populations.

How has your work changed today?

Treatment is there, Togo has a plan for treatment and treatment is free of charge. But a real issue is adherence and how people can maintain their treatment within the communities amidst the ongoing stigma. We are training mentors and supporting volunteers to encourage people to stay on treatment.  It’s how best to support people in their families and within their communities.

“Togo has a plan for treatment and treatment is free of charge. But a real issue is adherence”

The human and social dynamics around HIV in Africa are complex. We have three generations now of children who are living with HIV, many who have been orphaned because of epidemic and having to explain to them that their parents loved them and didn’t want to pass on the virus, this can be hard. I have had experience with young people who have attempted to take their own lives because it’s too much for them, and we are there, the church is there to support them.

“I have had experience with young people who have attempted to take their own lives because it’s too much for them”

We are due to end AIDS among children in Africa by 2025 but to do this we are facing many challenges, not just access to testing and treatment, it’s about poverty, local contexts, social conflicts, military coups and migration. But if you put paediatric HIV at the top and give faith leaders the opportunity to organize women’s desks and children’s activities around that we can start educating children and young people about HIV, how to prevent it and they can have their own language to communicate among themselves.

I’m asking my colleagues from the religious communities to come to the forefront of the fight against AIDS and to integrate HIV into their messages especially around ending AIDS among children in Africa. 

After years, their wait is over. The Association des Femmes Amazones Zen (AFAZ) has opened a drop-in centre in Lomé, the capital of Togo, where female sex workers can find refuge and help.

Funded by the United States President’s Emergency Plan for AIDS Relief through the Ending AIDS in West Africa project implemented by FHI 360, the centre opened last October, providing HIV prevention and testing services, the treatment of sexually transmitted infections, care for people living with HIV and assistance to survivors of gender-based violence.

Honorine Têlé Mensah, the coordinator of AFAZ, said that such drop-in centres bring many benefits for the community. The centre provides people with a place where they can listen, receive information and training and meet and share with others. It is a place where they can feel safe and free from discrimination and stigma. “By helping women to speak out and feel confident, we help them set an example for the community. In this way, the centre has an impact on the entire community,” she said.

But she has encountered difficulties. “Some people don’t want to get tested, and we sometimes lack nutritional kits to assist people living with HIV to stay on treatment and items such as reagents for HIV testing. Restrictions due to the COVID-19 pandemic have not helped either.” According to her, funding should be reviewed and the provision of items such as nutritional kits should be taken into account.

“I would like all AFAZ members in Togo to be able to benefit from drop-in centres and care centres like in Lomé,” she said. In the future, she would like the centre to grow. “It would be great if members could benefit from training in entrepreneurship or income-generating activities,” she said.

“Drop-in centers are often the only places where sex workers can access health care, legal advice and other services. They also provide a safe space for sex workers to gather, document abuses and mobilize for their rights,” said Eric Verschueren, UNAIDS Country Director for Togo. “UNAIDS supports the opening of more across the country.”

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.

The Parliamentary Network to Fight AIDS, Tuberculosis and Malaria reaffirmed its commitment to increase funding to end the three diseases at its annual meeting in Lomé, Togo, held on 4 and 5 October. The network committed to urge the heads of state and government of the Francophonie to advocate for increased funding during the sixth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will be held in Lyon, France, in October 2019.

“UNAIDS recognizes the important initiatives of French-speaking parliamentarians at both the national and international levels, as well as the advocacy and efforts of the Parliamentary Network to Fight AIDS, Tuberculosis and Malaria,” said Christian Mouala, UNAIDS Country Director for Togo.

The network, which is affiliated to the Parliamentary Assembly of the Organisation internationale de la Francophonie, also agreed that it will focus on the reform of punitive laws that perpetuate HIV- and tuberculosis-related stigma and discrimination.

“The responses to AIDS, tuberculosis and malaria require the commitment of all: national ministries of health, researchers, funders and, of course, parliamentarians. Only by pooling our efforts and with the strength of our parliaments and our members can we hope to, one day, overcome these epidemics,” said Didier Berberat, President of the Network to Fight AIDS, Tuberculosis and Malaria and Councillor for States, Switzerland.

UNAIDS has a cooperation agreement with the Parliamentary Assembly of the Organisation internationale de la Francophonie, which is due to be renegotiated this year.

UNAIDS and the International Organisation of la Francophonie (IOF) have joined together to support HIV testing among young people in Togo as part of the ProTest HIV campaign. For 15 days in Togo’s capital Lomé, UNAIDS and partners promoted voluntary HIV testing, care and support for people living with HIV and broader HIV prevention programmes among youth and adolescents, including access to reproductive health, family planning and sexual health services.

More than 2300 adolescents and young people attended the various events. Up to 600 people took an HIV test and more than 5000 male and female condoms were distributed during the 15 days.

The campaign in Lomé was held in partnership with the Ministry of Development Planning, the Ministry of Health, the University of Lomé, Maison TV5 Monde and the IOF Regional Office for West Africa.

UNAIDS is working with countries to ensure that, by 2020, 90% of young people have the skills, knowledge and capacity to protect themselves from HIV.

A high-level panel organized by UNAIDS and the Government of Togo and held on 14 October in Lomé, Togo, discussed HIV, security and humanitarian emergencies in Africa. The panel discussion took place in the margins of the African Union Extraordinary Summit on Maritime Security and Safety and Development in Africa.

There were more than 314 million people affected by humanitarian emergencies in the world in 2014, of which 67 million were forcibly displaced. An estimated 1.7 million people are living with HIV within these emergency contexts.

The meeting focused on the importance of implementing United Nations Security Council resolution 1983, on addressing the HIV response in conflict and emergency settings, increasing the focus, action and results on sexual violence and mainstreaming HIV in peacekeeping missions.

Special attention was directed towards the western and central African region, which is affected by many crisis and post-crisis situations and where only one out of three people living with HIV is accessing antiretroviral therapy. 

Key messages

• The evaluation report of resolution 1983 should be discussed at the next United Nations Security Council meeting, in November.
• The HIV response should be strengthened in conflict and emergency settings and there should be more focus and actions to address sexual violence.
• HIV should be further incorporated in peacekeeping missions.
• People should be at the front and centre of the response, and no one should be left behind in the response to HIV in emergencies and conflicts.
• Humanitarian and development funding for HIV and gender-based violence prevention and response should be included in national HIV and humanitarian strategies.
• Human rights and dignity should be fully respected in all humanitarian emergencies.

How to realize Africa’s potential for the future of all its peoples and build international support for the continent’s development were key questions explored in the first session of the Africa Rising Forum held this week in New York.

Taking place at the Africa Center and organized by the Mo Ibrahim Foundation, the 22 September event brought together a number of African heads of state, United Nations partners, and leaders from African civil society and the business community.

They examined how to move beyond simply talking about the need for broad-based economic transformation and sustainable development to taking concrete steps to make them a reality, especially with regard to the post-2015 development agenda. 

A session on ensuring shared prosperity looked at ways to improve investment and resource mobilization, champion entrepreneurship and ensure social protection. Another stressed that development cannot be achieved without the existence of good governance, peace, security and respect for human rights.

It was agreed that ensuring health for all was a critical facet of Africa’s rise, and that ending the AIDS epidemic as a public health threat by 2030 now a realistic goal. There was also a consensus that the continent’s rise should not only be measured in terms of overall wealth generated but by the inclusiveness of socioeconomic progress that leaves no one behind.

Mr Sidibé addressed a group of eight West African Heads of State and other high-level participants at the opening session of the UEMOA conference today in LoMÉ, Togo.

Delivering a speech at today’s opening session of the 16th Conference of the West African Economic and Monetary Union (UEMOA), UNAIDS Executive Director Michel Sidibé congratulated leaders across the region for their personal commitment to the HIV response, specifically with regard to upholding human rights and protecting human capital. Addressing eight Heads of State and other high-level participants in LoMÉ, Togo, he called on African leaders to reduce their “triple dependency” on external sources for HIV drugs, commodities, and technologies.

Mr Sidibé noted that an estimated 630 000 people living with HIV in West Africa currently receive antiretroviral medicines, representing about 30% coverage. A vast majority of HIV drugs dispensed in Africa are imported, he added.

To ensure the health and security of their populations, African leaders should focus greater attention and resources on the local production of medicines, said the UNAIDS Executive Director. “In the future, regional and global power and national stability will be determined not by who controls arms, but by who controls access to medicines,” he said.

The development and production of medicines is expected to be a major growth industry in the 21st century.  According to IMS Institute for Healthcare Informatics, the global pharmaceutical market is set to reach more than US $1 trillion in sales by 2015.  African countries represent 25% of the global health burden but control just $10 billion—or 1%—of the global medicines market.

“This is a sector poised for growth, and can serve to generate African innovation, strengthen systems, save lives and advance security,” said Mr Sidibé.

UNAIDS Executive Director Michel Sidibé with President of Senegal Macky Sall

During his address, the UNAIDS Executive Director outlined four proposals to boost West Africa’s market share of HIV drugs and other medicines: establish and enable local pharmaceutical production to reduce dependency on imported medicines; remove trade barriers to allow for the emergence of pharmaceutical production hubs that can serve the regional market; strengthen national drug regulatory authority and increasingly harmonize regulatory policies across the region; and advance research and development to build Africa’s knowledge-based economy.

Noting that no single country, ministry or leader could advance these proposals alone, Mr Sidibé called for increased national and regional partnership across a variety of sectors, including trade, industrial development and health.

Later in the day, the UNAIDS Executive Director participated in a separate meeting with African Heads of State attending the conference. Echoing Mr Sidibé’s earlier comments, the Heads of State reemphasized the need for innovative financing mechanisms to address Africa’s HIV response.

UNAIDS Executive Director Michel Sidibé (left),
photographed here with Prime Minister Gilbert Houngbo of Togo on 21 February.
Credit: UNAIDS/J-C Abalo

Sustainable financing for the AIDS response was a key topic of discussion in a meeting on 21 February between UNAIDS Executive Director Michel Sidibé and Prime Minister Gilbert Houngbo of Togo.

Noting with concern that Togo relies on external sources to finance more than 80% of its HIV response, the UNAIDS Executive Director urged the leadership of Togo to take on a greater share of national AIDS investments.

“We cannot put a person on antiretroviral treatment for 30 years and depend on external aid to cover the bill,” said Mr Sidibé, while meeting with Prime Minister Houngbo in LoMÉ, Togo’s capital city. “We need an African solution,” he added.

Mr Sidibé emphasized that HIV resources in Togo should be prioritized for populations at higher risk of HIV infection, such as sex workers and men who have sex with men. To that end, a comprehensive understanding of the national epidemic, including good data, was vitally important, he added.

During the meeting, Mr Sidibé congratulated the leadership of Togo for progress in the national HIV response. According to government figures, knowledge on HIV prevention and transmission among the population is relatively high, at 80%. Access to antiretroviral treatment in Togo has more than doubled since 2008, from approximately 11 000 people to more than 25 000. Mr Sidibé urged the leadership of Togo to build on these gains and ensure treatment access for all people living with HIV.

The UNAIDS Executive Director expressed concern that a majority (56%) of pregnant women in Togo lack access to services that prevent HIV transmission from mother to child. He commended Togo’s leaders for their efforts to develop a national plan to eliminate new HIV infections among children.

Acknowledging the gaps in access to services for HIV-positive pregnant women, Prime Minister Houngbo said that the leadership of Togo was fully committed to the UNAIDS target of Zero new HIV infections among children. The Prime Minister expressed his commitment to achieving the targets in the 2011 Political Declaration on AIDS and echoed Mr Sidibé’s call for increased domestic spending on AIDS.

Mr Sidibé’s official visit in LoMÉ was part of a four-country mission to Togo, Bénin, Ghana and Cote d’Ivoire.