UNFPA The United Nations Population Fund

Imagine using a health-care system that has no concept of you as a person, or of your unique needs. Nurses might not ask important questions. Doctors might overlook the solutions you really require. You might feel unwelcome.

That has always been the reality for transgender people in Jamaica. A new strategy seeks to change this.

With support from UNAIDS and the United Nations Population Fund (UNFPA), TransWave Jamaica has launched the Trans and Gender Non-Conforming National Health Strategy, the first of its kind in the English-speaking Caribbean. The five-year plan is a rights-based road map for how the health and well-being of transgender people can be advanced. It moves beyond recommendations for the health-care system to the structural and societal changes necessary to achieve equitable access to services and opportunities for the transgender community.

“Too many transgender people stay home and suffer or change who they are to access public health-care spaces,” explained TransWave Associate Director of Policy and Advocacy, Renae Green. “We need improvement to basic services, including psychosocial support. And we need transgender people to be able to access public health services as their authentic selves.”

Through the Unified Budget, Results and Accountability Framework Country Envelope for Jamaica, UNAIDS collaborated with UNFPA to support a robust year-long process of research, community engagement and strategy development, including a monitoring and evaluation framework. The strategy development process was informed by a multisectorial steering committee composed of civil society organizations, international cooperation partners and government authorities.

HIV is a major priority for the Jamaica transgender community. Around 50% of transgender women participants in two recent studies were living with HIV. But there are other pressing concerns. Two surveys found that around half of transgender respondents were unemployed. One third skip meals. One in ten sells sex to survive. Research conducted in 2020 by TransWave found that half of respondents had been physically assaulted in the past year, with 20% reporting sexual assault. More than 80% had been verbally abused.

“The needs go beyond HIV and health care. Other factors affect people’s ability to be safe, to be adherent or to remain HIV-negative. We should take into account the whole person, not just a part,” said Denise Chevannes-Vogel, HIV and AIDS Officer for the UNFPA Sub-Regional Office for the Caribbean.

“We value the fact that we were able to bring together the community to have a discussion about their needs beyond HIV,” said Ms Green.

The TransWave team led the community needs assessment. Some community requests, such as hormone replacement therapy or gender assignment surgery, are unique. But others are common to all people. They want access to health care and housing, education and employment. And they want to see themselves represented in the civil society spaces where many access care and support.

“We will not reach any AIDS-related targets if we do not prioritize transgender health as a whole. People are dying because of violence, living on the streets, lack of jobs and lack of opportunities. Even the HIV prevention knowledge that most people would acquire through formal education settings is not available to transgender people when they are bullied and forced to drop out. So this process was about reflecting on the impact indicators. What would it take for them to live longer, better lives?” said Ruben Pages, UNAIDS Jamaica’s Community Mobilization Adviser.

But what chance does this comprehensive and forward-thinking strategy have of succeeding in a country famed for its social conservatism? The partners are optimistic. On one hand, the approach calls for longer-term goals, including law reform around issues such as gender identity recognition and decriminalizing sex between same-sex partners. But the strategy is also a practical guide for transgender inclusion in systems and frameworks that are already in place. With targeted action there can be quick wins.

Manoela Manova, the UNAIDS Country Director for Jamaica, said the strategy will help the country accelerate progress to end AIDS.

“Going forward, there will be renewed focus on ensuring that excellent prevention, testing and treatment outcomes are achieved across all communities, especially key and vulnerable populations,” Ms Manova said. “This is an opportunity to make good on our commitment to leave no one behind.”

Warm smiles greet Lily as she approaches her first stop of the day—one of the 11 brothels scattered across the country that Lily, the President of the Bangladesh Sex Worker Network, visits quarterly to check in with the women and see what assistance they need. Though her visits have been limited in recent months due to movement restrictions to curb the spread of COVID-19, Lily knows well enough that those smiles are a brave front for the troubling times that her peers have experienced.

“I see the sex workers as my sisters—I feel their happiness and pain and I try my best to solve any issue they face,” Lily said. During the COVID-19 pandemic, Lily and the 29 community-based organizations serving sex workers in the country have struggled to respond to the increased calls for support. In March, government countrywide movement restrictions meant that sex workers could no longer have clients, leaving most of them without a source of income and unable to provide for themselves or their families.

“Sex workers’ children faced challenges during the COVID situation because their mothers couldn’t arrange to provide them with food. When we [the Bangladesh Sex Worker Network] learned about this issue, we reached out to many organizations and the private sector for assistance,” explained Lily. Responding to the call to action, the network mobilized funds to support 2100 sex workers across the country. Community-led support in Bangladesh has also garnered global recognition. Most recently, a former sex worker, Rina Akter, was recognized by the BBC for her efforts, and those of her team of helpers, to serve 400 meals a week to sex workers in need.

“While a few sex workers had savings, most could not provide for themselves,” said Rahat Ara Nur, Technical Officer for the United Nations Population Fund in Bangladesh. “Through the United Nations Population Fund, we provided sex workers with COVID-19 prevention commodities, such as masks and handwashing materials, and we also developed public service announcements which were aired on community radio to ensure we raised awareness about COVID-19 precautionary measures among the community."

With the closure of entertainment venues, a classification that includes brothels, some sex workers have resorted to street-based sex work, which increases the risk of violence, condom-less sex and no pay or low pay.

Sex workers are also experiencing increasing vulnerability to gender-based violence. Without a source of income, conflicts about finances arise, and sex worker networks report that their members have experienced abuse at the hands of their spouses, partners and brothel owners.

Some sex workers report that they have become homeless because the brothels have been closed, or in some cases the residents were evicted because rent could not be paid. Many sex workers cite stigma and discrimination as a barrier for other forms of employment. Health outreach services that once provided brothels with sexual and reproductive health services, including HIV testing and prevention, have been suspended due to travel restrictions.

Bangladesh, October 2019. Credit: UNFPA Bangladesh/Naymuzzaman Prince

These developments are not unique to Bangladesh, however. Throughout the Asia–Pacific region, national and regional networks of sex workers are reporting that the COVID-19 outbreak has exacerbated the inequalities faced by sex workers, and many are either not eligible or excluded from social protection services.

“There is no government support specifically targeting sex workers. There is support for the general public, particularly those that are low income, but sex workers are not eligible for these social protections because they work in the informal economy,” said Hnin Hnin Yu, the Chairperson of Sex Workers in Myanmar (SWiM), a nongovernmental advocacy group for sex workers’ rights.

Additionally, many sex workers are migrants (international or internal) and lack the necessary papers or registration with local authorities to access the government’s support. Eligibility criteria for social support, such as documentation of income, proof of residence, national identification, contribution to existing social protection schemes and filing taxes, are all reasons given for excluding sex workers from government support. An online consultation of female sex workers from across the country, organized by UNAIDS and SWiM, revealed that apart from limited funds from humanitarian actors, none of the sex workers had received social support.

“When Global Fund to Fight AIDS, Tuberculosis and Malaria assistance for COVID-19 was allocated, funds for people living with HIV included the most vulnerable sex workers to receive food provisions,” said Mr Myo, Community Support Adviser for UNAIDS in Myanmar. “However, we recognized that this was an ad hoc solution that reached a small portion of the vulnerable population and there is a need for more sustainable support, such as social protection, for sex workers.”

It has become clear that focused support for sex workers must be prioritized. Recognizing that more needs to be known about the gaps in social protection for sex workers, UNAIDS in collaboration with the United Nations Population Fund and the World Food Programme are exploring the possibility of conducting a needs assessment and vulnerability mapping initiative of female sex workers during the COVID-19 pandemic. Data from the community-led mapping initiative will be used to inform programming for livelihood support, food security, improved access to antiretroviral therapy, sexual and reproductive health services and gender-based violence prevention and response services.

Commenting on the prospects of the United Nations agencies joining forces to coordinate a vulnerability mapping exercise with sex worker networks, Ms Nur expressed excitement about how this advocacy tool will not only help to identify the challenges that sex workers face during the COVID-19 outbreak, but it would also catalyse further work to mobilize resources for programmes and address injustices that pre-date the COVID-19 pandemic.

Hnin Hnin Yu cites discrimination and harassment from police as a long-standing challenge facing sex workers’ rights. During the COVID-19 outbreak, communities have reported increased police surveillance, harassment, including physical violence, and demands to pay fees to conduct sex work. In response, SWiM provides community-led, peer-to-peer legal aid for sex workers who have been arrested, educating them about their rights.

For those working closely with community-led organizations it has been inspiring to see that although sex worker networks and the sex workers they represent have seen challenges all around them, they have done their best to support their peers. There is hope that the data gathered in a vulnerability mapping exercise would not only generate the evidence needed to advocate for expanding the reach of social protection and humanitarian response services to be inclusive of sex workers, but could also inform the scale-up of community-led programming. 

When Lineo Tsikoane gave birth to her daughter, she was inspired to intensify her advocacy for gender equality to give Nairasha a better life as a girl growing up in Lesotho.

“I think a big light went off in my head to say, “What if the world that I’m going to leave will not be as pure as I imagine?” I ask myself, “What kind of world do I want to leave my daughter in?”” she says.

As a result, Ms Tsikoane champions for women’s social, economic and legal empowerment at her firm, Nairasha Legal Support. It offers legal support for women in small and medium enterprises and women who are survivors of sexual and gender-based violence.

“Our main focus is gender-based violence, because this happens to be a country that has one of the highest incidences of rape and intimate partner crime in the world,” she says.

Even before the COVID-19 outbreak, violence against women and girls had reached epidemic proportions globally.

According to UN Women, 243 million women and girls worldwide were abused by an intimate partner in the past year. In Lesotho, it is one in three women and girls.

Less than 40% of women who experience violence report it or seek help.

As countries implemented lockdown measures to stop the spread of the coronavirus, violence against women, especially domestic violence, intensified—in some countries, calls to helplines increased fivefold.

In others, formal reports of domestic violence have decreased as survivors find it harder to seek help and access support through the regular channels. School closures and economic strains left women and girls poorer, out of school and out of jobs, and more vulnerable to exploitation, abuse, forced marriage and harassment.

The United Nations Population Fund (UNFPA) works together with UNAIDS, the United Nations Children’s Fund and the World Health Organization on 2gether4SRHR, a joint programme funded by the Swedish International Development Cooperation Agency, to address HIV and sexual and reproductive health in Lesotho.

During Lesotho’s lockdowns, UNFPA worked with Gender Links, the Lesotho Mobile Police Service and others to support efforts to prevent and respond to incidences of gender-based violence.

“We are ensuring that a helpline, where people experiencing gender-based violence can call, is in place and is working and we are also providing relevant information through various platforms for people to access all the information they need on gender-based violence,” says Manthabeleng Mabetha, the UNFPA Country Director for Lesotho.

Mantau Kolisang, a local policeman from Quthing, Lesotho’s southernmost district, characterized by rolling hills and vast landscapes, says one reason why gender-based violence is prevalent in Lesotho is because the law is not heeded in the rural areas.

“It’s difficult to implement the law since these are remote areas,” he says, adding that while he has made arrests, he has no transport to access far-flung areas in the small mountainous region. 

Lesotho’s law states that a girl can marry at the age of 16 years. However, Mr Kolisang says cultural practices, coupled with contraventions of the law, has made some men believe a 13-year-old girl “can be a wife”, exposing Basotho girls to violence.

“Men don’t regard it as a crime,” he says, adding that girls have been abducted from the mountains for forced marriages.

Between 2013 and 2019, 35% of adolescent girls and young women in sub-Saharan Africa were married before the age of 18 years. Girls married before 18 years of age are more likely to experience intimate partner violence than those married after the age of 18.

Because of poverty, gender inequality, harmful practices (such as child, early or forced marriage), poor infrastructure and gender-based violence, girls are denied access to education, one of the strongest predictors of good health and well-being in women and their children.

In Lesotho’s legal system, women are regarded as perpetual minors. This categorization infantilizes women, Ms Tsikoane says. A man who abuses a woman can often walk away unscathed from the justice system if he says the woman in question is his “wife”, she adds.

“This makes women vulnerable to commodification because a child can be passed around,” she says.

Ms Tsikoane says there is a direct link between the minority status of women and HIV infection in Lesotho. In 2019, there were 190 000 women 15 years and older living with HIV in Lesotho, compared to 130 000 men. 

Adolescent girls and young women between the ages of 15 and 24 years are particularly vulnerable. They accounted for a quarter of the 11 000 new HIV infections in Lesotho in 2019.

“My hypothesis is women cannot negotiate safe sex,” says Ms Tsikoane.

The dangerous reality that Basotho women live in worries Mr Kolisang. But due to a lack of institutional support and resources, he feels his actions have limited effect.

“I feel for these children. I feel for these women. I do feel for them. I can help, but the problem is how?” he laments.

Ms Tsikoane says she finds “trinkets of opportunities” for her and her colleagues to help their clients and navigate a legal system that is not favourable towards women.

“So, if you are not being well assisted at a police station, if you feel like someone is dragging your case and you are struggling to get an audience, we are there. We will support you and we will fight with you,” she says. 

GENEVA, 23 November 2020—The latest progress report of the Global HIV Prevention Coalition shows that despite observed declines in new HIV infections among adults in several countries, overall progress in HIV prevention efforts remains variable and is too slow to reach the 2020 targets committed to at the 2016 United Nations High-Level Meeting on Ending AIDS.

“We can’t end AIDS if year after year people continue to become newly infected with HIV,” said Winnie Byanyima, Executive Director of UNAIDS. “This year is a milestone for taking stock of a decade of progress towards ending AIDS by 2030. Sadly, the world has come up short against the commitments made to drastically reduce new HIV infections.”

In 2016, United Nations Member States committed to reach a worldwide HIV prevention target of fewer than 500 000 new HIV infections among adults by 2020, a 75% reduction from 2010. By the end of 2019, the reduction was just 23%, with 1.7 million people becoming infected with HIV last year.

Launched in 2017, the Global HIV Prevention Coalition aims to bring fresh momentum and clarity to HIV prevention programmes in 28 focus countries—the 28 countries worldwide with the greatest burden of new HIV infections. The 28 coalition countries have identified and promoted priority programme approaches and interventions, rekindled political commitment for HIV prevention and guided and supported programme implementation.

Progress in reducing new HIV infections in coalition countries is varied. In Eswatini, for example, new HIV infections declined by 64% between 2010 and 2019. In Pakistan, on the other hand, there was a 74% increase. But in 26 coalition countries new HIV infections declined.

The report notes that there has been significant progress in implementing 10 strategic actions set out in the Global HIV Prevention 2020 Road Map, but a number of countries still have difficulties in changing underlying factors that hold back effective HIV prevention programmes, including shortfalls in financing, insufficient action on addressing the obstructive legal, policy and structural barriers that hinder programmes for key and vulnerable populations and the slow adoption of guidance on social contracting.

“To drastically reduce new HIV infections, we have to bridge the gaps and dismantle barriers that deny adolescent girls, young women and key populations access to quality, respectful sexual and reproductive health services. It’s time to end, once and for all, all forms of stigma, discrimination and marginalization that stand in their way,” said Natalia Kanem, Executive Director of the United Nations Population Fund.

The COVID-19 pandemic is an additional challenge to maintaining progress in HIV prevention this year. Of particular concern are disruptions in HIV prevention services such as voluntary medical male circumcision, interrupted access to prevention commodities, including safe injection supplies, the effects of lockdowns on educational and social support services and the interplay between economic downturns and heightened HIV risk behaviours and vulnerability. This year’s report therefore begins to document adaptations that countries are taking to mitigate the potential effects of the COVID-19 pandemic.

The progress report was launched at a virtual meeting of ministers of health from Global HIV Prevention Coalition focus countries at which members took stock of the progress to date, with the aim of charting a way forward for the next five years on the road to ending AIDS by 2030.

“HIV prevention will be at the core to the new global AIDS strategy for the next five years,” added Ms Byanyima. “Together with the United Nations Population Fund and the rest of the UNAIDS Joint Programme, we will support the Global HIV Prevention Coalition to reach our ultimate goal of zero new HIV infections.”

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.

Within the UNAIDS Joint Programme, the United Nations Population Fund (UNFPA) is a co-convenor, together with other United Nations funds and programmes, on HIV prevention among adolescents, young people and key populations, as well as on decentralizing and integrating sexual and reproductive health and rights and HIV services. UNFPA also plays a technical role in prevention and condom programming within the Global HIV Prevention Coalition.

The UNFPA Evaluation Office undertook an evaluation to assess the performance of UNFPA in integrating its approach to supporting the response to HIV within the broader context of sexual and reproductive health and rights, population dynamics, gender equality and human rights for the period 2016–2019, the results of which have recently been published.

“The lessons and recommendations from this evaluation will strengthen the organization’s HIV response, to deliver stronger results during the United Nations Secretary-General’s Decade of Action to achieve the Sustainable Development Goals. The evaluation results are also particularly relevant as UNFPA channels its efforts to align its programming to respond to and recover from the COVID-19 pandemic,” said Marco Segone, Director of the UNFPA Evaluation Office.

Statement of the Joint UN Programme on HIV/AIDS (UNAIDS) Interagency Working Group on Key Populations on the need to ensure access to quality, safe, and non-discriminatory services for HIV key populations and migrants in the context of the COVID-19 pandemic

The rapid spread of COVID-19 continues to impact billions of lives around the world. Unprecedented human and financial resources are needed to address this pandemic. UN entities, NGOs, communities of people living with HIV, sex workers, gay men and other men who have sex with men, people who use drugs, transgender people, and people in prisons and their sexual partners, as well as civil society all have a role to play in fighting COVID-19, saving lives, and tackling far-reaching social and economic consequences. Critical moments like this remind us more than ever that inequality can be a matter of life and death and that everyone is born free and equal in dignity and rights, including to the highest attainable standards of health.

Lessons learned from the global HIV response should inform COVID-19 responses: HIV has taught us that it is a shared responsibility and we need to empower communities and involve them in the response; we should never compromise on human rights; we need to remove all forms of stigma and discrimination; and we need to support vulnerable and marginalized groups.

UNAIDS estimates that 62 % of the new HIV infections are among key populations and their sexual partners. Key populations experience particular forms of exclusion, criminalisation, inequality and discrimination that render them particularly vulnerable to HIV and again now to COVID-19. People in prisons and closed settings, where physical distancing is not always an option, are extremely vulnerable to COVID-19. People in prisons also have a higher prevalence of HIV and TB which poses a higher risk of complication if infected with SARS-COV 2, as do migrants, who also face greater HIV vulnerability. LGBT people are reporting an elevated risk of domestic and family violence, increased social isolation and difficulties in accessing crucial HIV treatment and gender-affirming health services. Leaving key populations behind at this critical moment could have a grave impact on health and human lives. It could reverse the gains in the global HIV response as well. 

We call on all Governments and partners to join us in,

Making quality, non-discriminatory HIV prevention, treatment, care and support services, and health services in general, available for key populations and migrants in the context of the COVID-19 pandemic.

These services must be based on respect, protection and fulfilment of human rights, regardless of existing punitive laws, policies and practices. They must be free from stigma and discrimination, based on evidence and science, and compliant with the most recent international guidance. Services must be equitable, based on informed consent, confidential and safe - for communities, as well as healthcare workers.

Rapidly adapting service provision to take into account the new realities of the COVID-19 pandemic.

Examples of adapted services are safe access to home HIV testing and remote counselling. Where possible, 3 to 6 months’ supply of ARVs, TB and viral hepatitis treatment should be supplied to ensure continuity of treatment, reduce transmission of HIV and co-infections, as well as the risk of COVID-19. People who use drugs should have access to harm reduction, including, where applicable and as advised by medical professionals, access to multiple opioid substitution doses to reduce OST site visits and COVID-19 exposure risk. Alternatives to imprisonment, where allowed, for non-violent offences could save lives, particularly for crimes not recognised under international law. Measures of early release should be taken for specific categories of people who are at particular risk of being affected by COVID-19, such as the elderly and individuals affected by chronic diseases or other health conditions, as well as pregnant women, women with dependent children, prisoners approaching the end of their sentence and those who have been sentenced for minor crimes in prisons, in-line with national policies and without compromising public health and safety. Emergency social protection measures for key populations are needed since they are often excluded from social services, including, but not limited to, housing and health insurance, and are often in precarious work situations. Service provision must continue to take into consideration intersectionality, gender and age diversity. It must be properly resourced with people, funding and materials. In order to be effective and efficient, these services must include key populations, their communities and organizations in their design and implementation.

Ensuring COVID-19 responses do not lead to the proliferation of punitive laws and measures to enforce restrictions or to criminalise transmission and exposure.

The gravely detrimental effect of such punitive measures on already marginalized or criminalized people has been well-documented in the HIV response, including by the Global Commission on HIV and the Law.

We won't stop COVID-19 if some people can’t afford or access testing or treatment. We must ensure that responses to COVID-19, or any other pandemic or health emergency, do not leave key populations, migrants and other vulnerable groups behind. As the Interagency Working Group on Key Populations we stand ready to work with all partners to ensure safe and rights-based access of key populations to quality HIV and COVID-19 services.

The Interagency Working Group on Key Populations is established under the UNAIDS Division of Labour and is co-convened by the United Nations Development Programme (UNDP), the UN Population Fund (UNFPA), and the United Nations Office on Drugs and Crime (UNODC) in partnership with the Global Network for and by People Living with HIV (GNP+), the International Network of people who Use Drugs (INPUD), MPact Global Action for Gay Men’s Health and Rights (MPact), Global Network of Sex Work Projects(NSWP), IRGT, and the UNAIDS Secretariat.

The United Nations system in Nigeria joined the fight against COVID-19 shortly after the first case was detected in the country in late February 2020.

UNAIDS’ lessons learned and expertise in facilitating, linking and bringing stakeholders together have been instrumental in guiding the United Nations multi-agency response, led by the Resident Coordinator, Edward Kallon. And by proactively mobilizing its political capital and goodwill in the country, UNAIDS has helped to bring resources and better lines of communication, coordination and accountability to the national COVID-19 response.

In mid-March, the Presidential Task Force was established to develop a COVID-19 response plan for how organizations should work together. Appointed as the only development member of the task force, the Representative, a.i., of the World Health Organization (WHO), Fiona Braka, provides the overall United Nations technical leadership to the government. Lessons learned from the HIV response fed into the development of the “four ones” guiding principles for the national response to the COVID-19 pandemic—one national COVID-19 multisectoral pandemic response plan, one COVID-19 national coordinating authority, one COVID-19 monitoring and evaluation system and one COVID-19 financing and investment platform.

“The “four ones” principles will simplify and clarify roles, responsibilities and relationships, including within the government,” said the Minister of Health of Nigeria, Osagie Ehanire.

Another lesson learned from the HIV response was the importance of ensuring that marginalized and vulnerable people are given consideration at every step of the development of a response to a pandemic. The potential impact of COVID-19 on people living with HIV, key populations and the poor also had to be at the centre of decision-making.

“UNAIDS regularly coordinated with the networks since the beginning of the COVID-19 outbreak, providing technical guidance and ensuring synergy with the efforts of the government,” said Abdulkadir Ibrahim, the National Coordinator of the Network of People Living with HIV/AIDS in Nigeria.

Working with the United Nations Development Programme, UNAIDS liaised with the wider United Nations system and the government and facilitated the handover of US$ 2 million worth of emergency medical commodities to the government, ensuring that the supplies and equipment were prioritized for use in public health facilities and by health-care workers.

The One UN COVID-19 Basket Fund was launched on 6 April. Part of one of the “four ones”, the one COVID-19 financing and investment platform, the Basket Fund channels the contributions of donors to the COVID-19 response. UNAIDS played a critical role in its establishment, working with the United Nations Resident Coordinator and the United Nations Development Programme to ensure that the financing platform put people and communities at the centre. UNAIDS, UN Women, WHO and the United Nations Population Fund helped to mobilize US$ 6.5 million for civil society and community engagement, social protection for vulnerable households, community-led surveillance and monitoring of COVID-19 and HIV and the documentation of community best practices.

In announcing a €50 million contribution to the Basket Fund, the Head of the European Union delegation to Nigeria, Ketil Karlsen, said, “The COVID-19 Basket Fund gives us the opportunity to cooperate and act rapidly in the deployment of assistance that can help to enhance health-care services and cushion the most vulnerable.” 

Perhaps the most important contribution by UNAIDS to the COVID-19 response in the country, however, has been advocating to harness the vast HIV infrastructure in the country for the fight against COVID-19.

“We must leverage HIV assets on the ground, including not just laboratory facilities but community health workers and volunteers. To fight COVID-19 effectively we will have no choice but to engage communities to own the response,” said Erasmus Morah, the UNAIDS Country Director for Nigeria.

In a joint effort, the United States Government, the National Agency for the Control of AIDS, the United Nations Children’s Fund, WHO, UNAIDS and the Presidential Task Force mapped and initiated the engagement of approximately 100 000 community health-care workers and volunteers to undertake risk communication, social mobilization, contact tracing and home care.

COVID-19 is far from over in the country, with cases steadily rising, and United Nations staff have not been spared. However, as Mr Kallon, said, “The United Nations must stay open for business and deliver for the people while ensuring that staff members and their dependents are provided with the necessary environment for their protection against COVID-19.” Following this, a COVID-19 isolation and treatment centre as an extension of the United Nations clinic was established for staff as frontline workers, together with their dependent family members. 

Moving forwards with the COVID-19 response, in addition to the continued support for the Presidential Task Force, the United Nations Country Team, including UNAIDS, is gearing up to support Nigeria to address the major gaps in subnational preparedness. Key issues such as the loss of livelihoods, heightened vulnerabilities and food insecurity, the increased risk of gender-based violence and limited access to essential health services will also be addressed in the coming months.

Shakhnoz Amirova (not her real name) lives in Tashkent, Uzbekistan. She has been taking antiretroviral therapy regularly since 2017, when she discovered that she was living with HIV. She continued the treatment while pregnant with her child, so she did not have to worry about her baby’s health, which was born HIV-free. But the COVID-19 pandemic has changed everything, and the lockdown restrictions severely limited access to medical services.

The immediate anxiety about the possible disruption to her HIV treatment and that of her husband, who is also living with HIV, was allayed by the health-care facility that she attends, the Republican AIDS Center, dispensing a two-month supply of antiretroviral therapy for everyone who needs it.

However, Ms Amirova was pregnant again and worried about the impact that COVID-19 may have on her and her unborn child, since information on how COVID-19 may affect people living with HIV was scarce. She was even unsure whether the coronavirus outbreak would stop her being able to have her baby at the maternity hospital.

“Women living with HIV feel especially vulnerable during pregnancy and childbirth, as fear of virus transmission, stigma and discrimination are added to the fears for the well-being of their baby. Of course, the situation with coronavirus is an additional stress factor. At such a difficult moment, women really need help and support, and we are trying to provide this help to them,” said Evgenia Korotkova, a representative of Ishonch va Khaet, an organization that helps people living with HIV.

The Positive Maternity programme run by Ishonch va Khaet helps women living with HIV who are pregnant or have recently given birth with social support, delivering antiretroviral therapy and baby food and providing medical care. During the COVID-19 outbreak, Ishonch va Khaet and similar organizations are working doubly hard so that people who need help get it as quickly as possible.

Yuldashev Kahramon Haldarovich, the Director of the Republican AIDS Center, noted the special role of nongovernmental organizations during a pandemic. “Community involvement in HIV prevention and support for people living with the virus are very important, especially at such tense moments, when the efforts of all health professionals and doctors are concentrated on fighting another pandemic. We cannot leave people who need HIV services behind; they also need help, and they need it today. The work of volunteers from social organizations is priceless.”

Since keeping patients and medical personnel in maternity hospitals safe from COVID-19 is such a priority, UNAIDS and the United Nations Population Fund have made a donation of a range of personal protective equipment, including masks and gloves, and disinfectant to 21 maternity hospitals in Uzbekistan.

“Protecting medical personnel in maternity hospitals from infection is as important as protecting pregnant women. The country is currently on the way to eliminating mother-to-child transmission of HIV. Preventive measures against COVID-19 are important for supporting the progress made,” said Charos Maksudova, the representative of UNAIDS in Uzbekistan.

Ms Amirova safely gave birth in the maternity hospital, happy that both her and her baby avoided becoming infected by the new coronavirus and that her baby was born HIV-free. “But fear for my children, especially for a newborn, does not leave me for a minute,” said Ms Amirova.

Now back at home, she is receiving help from peer counsellors from the Positive Maternity programme.

Ahead of the opening of the Nairobi Summit on ICPD25, the Executive Director of UNAIDS, Winnie Byanyima, and Peter Eriksson, the Minister for International Development Cooperation of Sweden, co-hosted a ministerial breakfast meeting with key donors and partners to highlight the need for a strong UNAIDS to lead the global response to HIV.

It was Ms Byanyima’s first face-to-face meeting with some of UNAIDS’ key donors and partners in her capacity as the Executive Director of UNAIDS, during which she pledged to take a feminist approach in taking the organization forward.

“UNAIDS is at a critical juncture as it emerges from the challenges of the past two to three years, and the staff will be my first priority; we need healing, trust-building and closure. I want to bring back the joy in the great work of UNAIDS,” said Ms Byanyima.

Katherine Zappone, the Minister for Children and Youth Affairs of Ireland, Christopher MacLennan, Canada’s Assistant Deputy Minister of Global Issues and Development, and other heads of delegations applauded UNAIDS’ intention to make meaningful culture change happen at UNAIDS.

“UNAIDS has been at the frontline of the AIDS response for years. Canada has been a strong supporter and we are so pleased that Winnie has joined,” said Mr MacLennan.

Ministers and representatives of Australia, Belgium, Canada, Finland, Germany, Ireland, Luxemburg, the Netherlands, Norway, Sweden and Switzerland encouraged UNAIDS to continue its leading role in promoting community-led solutions and responses. They also highlighted the need to leverage the unique capacity of UNAIDS and build on its human rights expertise to address the social and political barriers that are hindering progress on HIV.

“We must integrate sexual and reproductive health and rights better into the HIV response in order to reach our targets,” said Mr Eriksson. “The Joint Programme has a very important role in driving sexual and reproductive health.”

The meeting was also attended by representatives of several UNAIDS Cosponsors―the United Nations Population Fund and the United Nations Development Programme (UNDP). “UNDP is committed to working with UNAIDS in supporting governments to establish enabling legal, policy and regulatory environs for effective and rights-based HIV responses,” said Achim Steiner, the Administrator of UNDP.

UNAIDS, donors and partners agreed on the need to forge partnerships with the Global Fund to Fight AIDS, Tuberculosis and Malaria to ensure a sustainable response to HIV.

The meeting was the first in a series of events planned as part of UNAIDS’ enhanced collective engagement and strengthened collaboration as it embarks on the process of developing a new strategic plan on HIV.

When Cyclone Idai hit Mozambique and the eastern part of Zimbabwe in mid-March, it couldn’t have come at a worse time. A month earlier, Zimbabwe had issued an emergency appeal for some 5.3 million people affected by an ongoing economic crisis, and limited rainfall had ruined crops. The sudden pounding rain and wind threw everything into chaos. Three hundred people died, hundreds disappeared and 40 000 lost their homes. Food insecurity plus a lack of basic services, including health care, skyrocketed in the hardest hit province of Manicaland.

For Mumtaz Mia, the UNAIDS Acting Country Director in Zimbabwe at the time, the most pressing issue was to ensure that people living with HIV, including pregnant women enrolled in prevention of mother-to-child transmission of HIV programmes, could access HIV treatment.

“In Zimbabwe, where emergencies are not a new phenomenon, people living with HIV were left stranded when their medicine got washed away,” she said.

For her, preparedness is key. “For the AIDS response, we must anticipate any disruptions to services that emergencies bring.”

Born in Malawi, Ms Mia has dealt with droughts and floods throughout eastern and southern Africa. She also spent some time in Kenya dealing with post-election conflict and worked five years in South Sudan for UNAIDS before her stint in Zimbabwe.

She recounted that the UNAIDS country office met with the government, civil society, donors and other key stakeholders to discuss immediate action. Quickly, they made sure that HIV-specific needs were integrated in the emergency response. That meant coordinating, with UNAIDS Cosponsors, the Ministry of Health and Child Care and the National AIDS Council, to ensure the distribution of antiretroviral therapy and condoms, food support for people living with HIV and safe deliveries for pregnant women. They also set up assessments to address additional health and HIV needs following the disaster.

Almost 150 000 people living with HIV were in the cyclone-affected districts, and about 83% of them were accessing antiretroviral therapy. Most of them experienced a disruption of treatment during the crisis.

“Without a clear plan and instructions on action that needs to be taken in an emergency, precious days and weeks can be wasted trying to figure out what to do,” Ms Mia said.

She also believes that interagency contingency plans with specific tasks assigned to each agency to be taken in the event of an emergency would help action to be taken more quickly. “Using simple and clear guidance on the actions required by UNAIDS in emergency situations and the impact they can have on HIV are critical to guide country offices and managers,” she said, adding that “It’s important to earmark financial resources so that you can access and use the money right away.”

She practises yoga to help cope in times of stress and praises her supportive husband. “We try to have a semblance of a normal life at home during chaotic times,” she said, although she admits that often it is not easy. Throughout, she focuses on the people that needed her help. “I leave my door open, I listen to their stories and that gives me perspective to forge ahead.” That’s why she reiterated that in time of need, you cannot let people down. “Speed is of the essence.”

The UNAIDS Country Director for the Bolivarian Republic of Venezuela, Regina Lopez de Khalek, agrees. “In a humanitarian emergency, you have to act really quick in order to save lives, which means reinventing your everyday tasks to focus solely on the crisis,” she said.

In her case, she is dealing with the impact on people living or affected with HIV, of a political and economic crisis that affects more than 80% of the population. Inflation in the Bolivarian Republic of Venezuela has exploded, making basic food items beyond reach. Shortages have plagued the country, and medicine is no exception. Since May 2019, the country has recognized that there are some “humanitarian needs”, facilitating the delivery of medicine and rapid HIV and syphilis tests. With the help of international nongovernmental organizations, almost 60 tonnes of life-saving medicine have been delivered to the country. UNAIDS also worked for the country to receive emergency funds from partner organisations.

More recently, UNAIDS, the United Nations Population Fund and the Office of the United Nations High Commissioner for Refugees have jointly focused efforts to help people affected by stigma, discrimination and sexual violence. This included distributing post-exposure preventive kits, an emergency medical response for people exposed to HIV, to health services and introducing HIV tests to maternity units, as well as supporting civil society.

For Ms Lopez de Khalek, working jointly with other United Nations agencies and partners on the ground makes all the difference. “Not only does working hand in hand make sense, but it allows the AIDS response to stay relevant in a humanitarian situation,” she explained.

She recommends following the Inter-Agency Standing Committee HIV Task Force in Humanitarian Settings guidelines, but not to overlook the local and national context. “Know and understand the situation of the country you are in,” she said, “because although emergencies may seem equal, each crisis takes on the particularities of the country in which they occur.” And be proactive. “Act accordingly in advance, so that you are not just reacting,” she said. In her mind, it’s key to set up relationships, collaborate and engage with others and build a comprehensive response so that in the event of an emergency you and the people you are there to help are not left behind.

Simone Salem echoes that sentiment. “The key asset that helped me to respond to emergencies has always been the number of contacts I had across the countries as well as good relations with key people who were able to help,” the UNAIDS Community Mobilization Adviser in the Middle East and North Africa region said.

She added that when you start acting and giving concrete help, people will trust you and seek your support.

Ms Salem describes her work in Iraq, Libya and the Syrian Arab Republic as life-changing. “With each person I help, I realize the importance of my job and how crucial it is to always be alert to people’s needs,” the Egyptian said.

Recently, she helped people migrating or fleeing their homes to access HIV treatment and counselling. With the help of activists and regional networks, she supported the evacuation of lesbian, gay, bisexual and transgender (LGBT) people who had been targets of violence.

In times of crisis, she admires the solidarity that sprouts up at all levels. For example, Tunisians recently offered to give surplus HIV treatment to Libyans. The same occurred at the height of the Syrian conflict, with Lebanese people donating medicine.

Over time, she has become a much better decision-maker. Her secret? “Listen to what is said and also what is not being said, when analysing complex situations,” Ms Salem explained.

In her mind, it’s not a question of gender but of personality, although she said that women and vulnerable people she worked with came to her because they felt that she may be more supportive. The only regret she has is when she cannot help someone. “That’s very hard.”

Using her heart is how she explained she listened to people. When young LGBT people came to her saying that her comforting words had given them hope, she was touched.

“That was so precious to me and really keeps me going," Ms Salem said. “I push and push so that people are treated fairly and with compassion.”