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Windhoek, NAMIBIA - Sometimes it is best to go where everyone does not know your name, but where you feel welcome just the same. It is that way for many sex workers and men who have sex with men (MSM) in Namibia, who bear the brunt of criticism, repulsion and stigmatism in almost all aspects of their daily lives.

As a result, these men and women shy away from accessing essential health services, such as HIV testing/treatment, prophylaxis (PrEP), condoms, lubricants and contraceptives.

According to the first ever integrated bio-behavioral surveillance study (IBBSS) 2014, among MSM in Namibia, HIV prevalence among MSM was estimated to be 10.2 per cent in Keetmanshoop, 7.1 per cent in Oshakati, 10.1 per cent in Swakopmund/Walvis Bay, and 20.9 per cent in Windhoek the capital city.

The estimated HIV prevalence estimated among MSM in Oshakati and Swakopmund/Walvis Bay approximated that of the general population of adult males in the surrounding Oshana and Erongo regions, as measured by the Namibia Demographic and Health Survey, 2013.

HIV prevalence among MSM in Keetmanshoop was slightly lower than that of the general population of adult males in Karas Region, while HIV prevalence among MSM in Windhoek was nearly twice as high as HIV prevalence among adult males of the general population in Khomas Region.

Non-judgemental care

In 2018, the Namibia Planned Parenthood Association (NAPPA) with support from United Nations Population Fund (UNFPA) Namibia convened several advocacy meetings with key partners aimed at establishing a drop in centre at the Out Right Namibia offices.

Out Right Namibia is a Namibian organisation working with the lesbian, gay, bisexual, transgender and intersex (LGBTI) community aimed at advancing the rights, interests and expectations of the LGBTI community in Namibia. 

Both the drop in centre and NAPPA Okuryangava clinic had flexible working hours to allow key population to access sexual and reproductive health (SRH) and HIV services at their convenient times, it also involved opening the clinic on Saturdays to allow key population to access services without fear of stigma and discrimination. 

All service providers and staff at the drop in centre and clinic were trained and sensitised on the importance of quality, non-judgemental service provision to key population. The staff at Outright Namibia were also mobilised to build awareness and information about the services being provided at the drop in centre and clinic.

Pleasant experience

“I have had a very pleasant experience visiting NAPPA. As a sex worker, it is important that I feel comfortable and go to clinics where I’m free of judgement. NAPPA has opened their doors for me and I feel at home. There are no complications here as the services are free and I prefer this clinic over local hospitals,” said sex worker, Martha Keto (not her real name).

Keto, 30, has been a sex worker for almost 12 years and has been receiving PrEP treatment at the clinic since October 2017. ”I come regularly for my tests and for PrEP treatment which keeps me protected from contracting HIV. The testing I receive here not only keeps me updated on my HIV or STI status, but it keeps up with my overall health. I am informed about a lot of health information including my liver and the nurses are even able to tell if my alcohol consumption is too high,” she said.

“The staff at the clinic are very friendly. I am an old client so they all know me very well. I would recommend NAPPA services to my colleagues who are also workers. Their doors are always open for us, even during weekends we are able to come in if needed.  There is a large number of sex workers in Namibia and I hope the services provided by NAPPA could be exposed so that more sex workers will be informed of the free services that are offered here,” she said.

Keto’s sentiments are shared by Cinton Nati and Gideon Markus, (not their real names) who are both homosexual males receiving services at the NAPPA clinic.

“If it had not been for the friendly staff at the NAPPA clinic and their constant support and encouragement, I would have not visited the clinic as recommended by the nurse,” said Nati. He said this made it easy for him to develop a personal relationship with the clinic’s staff because they were very encouraging and as a result, he was able to see major improvements not only in his health but also his confidence.

Prior to visiting NAPPA, Nati experienced emotional and mental difficulties associated with being newly diagnosed with HIV. As a result, he would often miss his appointments as he found it difficult to accept the reality of being newly diagnosed with HIV.

“Since the very first time my partner and I went to the NAPPA clinics, both at Out Right Namibia and at Okuryangava, we have been treated very well and the staff have gone out of their way to make us feel safe. I have had counselling sessions to make sure that I am doing alright and also checkups to make sure the medication is not having any side effects on my body and that I remain healthy. The staff at the clinics have also regularly checked that we understand how to look after ourselves and that we practice sound sexual health guidelines,” said Markus.

“Each time we visited the clinic at Okuryangava, Sister Fungai Bhera (Senior Registered Nurse) would first make time to chat to us about how we have been.  This might sound like a small thing to others, but to me, it means the world as I know she cares about us and that I am taken care of and in safe hands,” said Van Den Berg.

He alluded: “LGBTI community in Namibia has never had proper support from our country’s leaders and as a result, there is still a lot of LGBTI people that get discriminated against and live in fear of their communities as we do not enjoy the same legal rights. Hence we live very secretive lives, sometimes even double lives. I think it is these secret lives that make it easy for LGBTI people in Namibia to land in situations where they are highly vulnerable to getting infected with HIV and other sexually transmitted infections.”

More KPs accessing services

In 2018, a total of 523 KPs were reached with sexual and reproductive health services at the two sites. This included 233 sex workers, 188 men who have sex with men 70 truck drivers and 32 women who have sex with women.  A total of ten outreach events were held targeting KPs at various hotspots in Windhoek.

The comprehensive service package provided at the two sites included: HIV testing and counselling, those who tested positive were immediately enrolled for treatment; PrEP services, those who tested negative were also counselled and informed about PrEP services and those who agreed were enrolled on PrEP; family planning services including condoms; sexually transmitted infections (STIs) screening and treatment; and information education related to SRH, HIV and gender-based violence.

GENEVA, 4 April 2019—UNAIDS and UNFPA, the United Nations sexual and reproductive health agency, are seriously concerned by new criminal law provisions that came into force yesterday, 3 April 2019, in Brunei Darussalam. The provisions, which impose the death penalty for same-sex sexual activity, adultery and for having a child outside of marriage, breach a number of international human rights norms, including the right to be free from torture and from cruel, inhumane or degrading treatment. The provisions will have a significant negative impact on overall health and well-being.  

“These extreme and unjustified punishments will drive people underground and out of reach of life-saving HIV treatment and prevention services,” said Michel Sidibé, Executive Director of UNAIDS. “I strongly urge Brunei Darussalam to suspend or repeal the amendments to the Syariah Penal Code and I offer UNAIDS’ support to ensure that laws are grounded in human rights, based on evidence and protect the most vulnerable.”

Laws that punish sexual orientation, same sex relations and reproductive health care are discriminatory, and have a disproportionate impact on women, creating barriers to accessing health information and services, which in turn increases vulnerability to HIV and other health concerns. Impeding access to sexual and reproductive health and rights, including HIV services, negatively affects public health.

“Every person, without any distinction on any grounds, has an equal right to live free from violence, persecution, discrimination and stigma of any kind. Human rights are universal. Cultural, religious and moral practices and beliefs, and social attitudes must not be invoked to justify human rights violations against any group regardless of gender or sexual orientation,” stated Natalia Kanem, Executive Director of UNFPA.

Criminalization of same-sex sexual conduct has been shown to increase stigma and give license to discrimination, violence and harassment. Evidence shows that where communities are criminalized, they are more vulnerable to violence, less likely to access necessary HIV and other health services, and less able to protect themselves against HIV infection. Criminalizing people also works against reaching the Sustainable Development Goals agreed by the United Nations General Assembly.     

UNAIDS and UNFPA are concerned by increasing conservative and discriminatory policies and rhetoric in a number of countries, which may potentially give rise to violence, stigma and discrimination against people on the basis of gender, gender identity and sexual orientation. Recent discussions with governments in the Asia–Pacific region and beyond have highlighted the need to put evidence-informed and human rights-based laws and policies in place. 

Last December, Brunei Darussalam called for more and better data on its key affected and higher-risk populations in order to ensure more effective outreach. The production of those data, which would help improve Brunei Darussalam’s health-care provisions for key affected and higher-risk populations, will be undermined by the Syariah Penal Code.

UNAIDS and UNFPA support the calls of the United Nations High Commissioner for Human Rights and the open letter of the five United Nations human rights mandate holders to suspend the implementation of the revised penal code and urge all governments to protect the human rights of all people. This includes repealing criminal laws against adult consensual sexual conduct and decisions on reproduction, implementing laws to protect all people from violence and discrimination and ensuring that adequate health services, including sexual and reproductive health services, are accessible, affordable and acceptable to address their needs.

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.

UNFPA

UNFPA is the United Nations sexual and reproductive health agency. Our mission is to deliver a world where every pregnancy is wanted, every childbirth is safe and every young person's potential is fulfilled. Learn more at www.unfpa.org.

BERLIN, GERMANY, 16 October 2018—Eleven heads of the world’s leading health and development organizations today signed a landmark commitment to find new ways of working together to accelerate progress towards achieving the United Nations’ Sustainable Development Goals.

Coordinated by the World Health Organization, the initiative unites the work of 11 organizations, with others set to join in the next phase.

The commitment follows a request from Chancellor Angela Merkel of Germany, President Nana Addo Dankwa Akufo-Addo of Ghana, and Prime Minister Erna Solberg of Norway, with support from United Nations Secretary-General Antonio Guterres, to develop a global plan of action to define how global actors can better collaborate to accelerate progress towards the health-related targets of the 2030 Sustainable Development Agenda.

“Healthy people are essential for sustainable development – to ending poverty, promoting peaceful and inclusive societies and protecting the environment. However, despite great strides made against many of the leading causes of death and disease, we must redouble our efforts or we will not reach several of the health-related targets,” the organizations announced today at the World Health Summit in Berlin. “The Global Action Plan for Healthy Lives and Well-being for All represents an historic commitment to new ways of working together to accelerate progress towards meeting the 2030 goals. We are committed to redefine how our organizations work together to deliver more effective and efficient support to countries and to achieve better health and well-being for all people.”

The group has agreed to develop new ways of working together to maximize resources and measure progress in a more transparent and engaging way. The first phase of the plan’s development is organized under three strategic approaches: align, accelerate and account.

• Align: The organizations have committed to coordinate programmatic, financing and operational processes to increase collective efficiency and impact on a number of shared priorities such as gender equality and reproductive, maternal, newborn, child and adolescent health.
• Accelerate: They have agreed to develop common approaches and coordinate action in areas of work that have the potential to increase the pace of progress in global health. The initial set of seven “accelerators” include community and civil society engagement, research and development, data and sustainable financing.
• Account: To improve transparency and accountability to countries and development partners, the health organizations are breaking new ground by setting common milestones for nearly 50 health-related targets across 14 Sustainable Development Goals. These milestones will provide a critical checkpoint and common reference to determine where the world stands in 2023 and whether it is on track to reach the 2030 goals.

The Global Action Plan will also enhance collective action and leverage funds to address gender inequalities that act as barriers to accessing health, and to improve comprehensive quality health care for women and girls, including sexual and reproductive health services. 

The organizations that have already signed up to the Global Action Plan for Healthy Lives and Well-being for All are: Gavi the Vaccine Alliance, the Global Fund to Fight AIDS, Tuberculosis and Malaria, the Global Financing Facility, UNAIDS, UNDP, UNFPA, UNICEF, Unitaid, UN Women, the World Bank and WHO. The World Food Programme has committed to join the plan in the coming months.

The final plan will be delivered in September 2019 at the United Nations General Assembly.

For more information, www.who.int/sdg/global-action-plan

Media enquiries

• Gavi, the Vaccine Alliance: Frédérique Tissandier; +41 79 300 8253; ftissandier@gavi.org
• Global Financing Facility: Melanie Mayhew; +1 202-459-7115; mmayhew1@worldbankgroup.org
• Global Fund: Ibon Villelabeitia; +41 79 292 5426; ibon.Villelabeitia@theglobalfund.org
• UNAIDS: Sophie Barton-Knott; +41 79 514 6896; bartonknotts@unaids.org
• UNDP: Adam Cathro; +19179159725; adam.cathro@undp.org
• UNFPA: Omar Gharzeddine; +1 212 297 5028; gharzeddine@unfpa.org
• UNICEF: Sabrina Sidhu; +1 917 476 1537; ssidhu@unicef.org
• Unitaid: Andrew Hurst, +41795616807; hursta@unitaid.who.int
• UN Women: Maria Sanchez Aponte; +16467814507; maria.sanchez@unwomen.org
• World Bank Group: Maya Brahmam; +1 202 361 2594; mbrahmam@worldbankgroup.org
• WHO: Christian Lindmeier; +4179 500 6552; lindmeierch@who.int

A global coalition of more than 80 youth organizations working on HIV (the PACT), and Youth Voices Count (YVC) launched a poll to get a sense of what young people know about sexual reproductive health.

More than half of the 270,000 young people aged 10-24 from 21 countries who responded to the U-Report poll (54% of boys and young men, and 58% of girls and young women) sought HIV and other services at a health centre or clinic in the previous three months.  About 36% of young people aged 10-24 who did not seek services reported feeling uncomfortable visiting a health centre or clinic, and more than 28% of young people (both sexes) said they felt scared to seek services.

The poll with support from UNAIDS, UNICEF and UNFPA was complemented by an in-depth survey and interviews led by YVC, which showed that approximately 15% of those who accessed any sexual health services in the past 6 months experienced refusal or mistreatment because of their age, sexual orientation, gender identity or HIV status. And of those who felt mistreated because of their age, 55% identified as gay, bisexual, and 25% identified themselves as living with HIV. Further, 32% of young gay, bisexual men and other young men who have sex with men, and 50% of young transgender people, felt that they had been discriminated against because of their gender identity or sexual orientation. Finally,16% of young people who identified themselves as living with HIV said they had been mistreated because of their HIV status.

Although healthcare settings should be safe spaces for those receiving care, this is not the case. Policies and attitudes remain barriers to youth-friendly HIV and sexual and reproductive health services. Indeed, 37% of respondents who reported having visited a clinic were not willing to recommend doing so to their peers.

This year’s theme for International Youth Day is Safe Spaces for Youth, highlighting the need of young people for safe spaces to come together, hang out, and participate in decision making processes as well as freely express themselves. This includes in healthcare settings, which should be places of safety and refuge, free from stigma, maltreatment, and violence.

Every day, approximately 1600 young people are infected with HIV, while one young person dies of AIDS-related illnesses every 10 minutes. Young women aged 15-24 are particularly affected. In sub-Saharan Africa, young women are twice as likely to be infected with HIV as their male counterparts. And young key populations (including gay men and other men who have sex with men, bisexual people, transgender people, young sex workers and young people who inject drugs) are at a high risk of HIV around the world due to rights violations, discrimination, exclusion, criminalization and violence. Of the young people living with HIV globally, most do not know their status.

Download more slides like this from 2018 Global AIDS Update Miles to Go 

Some 18 months after the launch of the catch-up plan, the National AIDS Council (CNLS), the Ministry of Health and UNAIDS co-organized a workshop in Bangui, to take stock of the progress and the challenges to accelerate access to treatment for people living with HIV in the Central African Republic. The workshop also served as an opportunity to renew political commitment to the HIV response and to call for urgent action on prevention.

The Prime Minister of the Central African Republic, Simplice Mathieu Sarandji, opened the meeting with 80 stakeholders present, including members of government, civil society organisations, people living with HIV, members of key populations, as well as local governments, traditional and religious leaders.

Key areas of progress since the launch of the catch-up plan in January 2017 included the development of new policies to implement test and treat, and the increase in the number of people on HIV treatment from 25,000 in 2016 to 34,000 in June 2018. Community treatment groups have been delivering HIV treatment to people in remote and insecure regions such as the eastern town of Zemio. In addition, a community treatment observatory is helping monitor access to and quality of HIV care in Bangui.

However, there are miles to go. Less than 35% of people living with HIV in Central African Republic access treatment — this is among the lowest in sub-Saharan Africa. Challenges include an inadequate monitoring and evaluation system, a lack of effective supervision of facilities providing HIV services, limited community engagement to implement HIV testing and treatment, as well as limited financial commitments to reach treatment targets. Most agreed on the need to improve coordination.

As a result, participants identified priorities for the next six months to reach treatment targets for 2019. All stressed that communities, people living with HIV and key populations must be involved every step of the way. In addition, participants stressed the urgent need for increased domestic and donor funding.

A steering committee and technical working groups prepared the two-day workshop based on available data and on-the ground site visits. The groups included representatives from the Ministry of Health, CNLS, community organisations, people living with HIV, international NGOs such as Medécins Sans Frontières and the French Red Cross as well as UNICEF, UNFPA, WHO and UNAIDS.

Gender-based violence is one of the most persistent violations of human rights across the globe. According to the World Health Organization, about one third of women worldwide have experienced violence. Intimate partner violence increases the risk of HIV, in some regions by up to 1.5 times. Among marginalized populations, a high prevalence of violence is linked with higher rates of HIV infection, in particular among transgender women.

In Kenya, a recent study found that 32% of young women aged 18–24 years and 18% of their male counterparts reported experiencing sexual violence before the age of 18. Gender-based violence reduces the bargaining power to negotiate safer sex, stay on treatment or remain in school.

To shine a light and galvanize action to end gender-based violence in Kenya, the United Nations Population Fund (UNFPA), together with the Kenya Medical Women’s Association and the Kenya Women Judges Association, and partners, launched the Tuongee (Let’s Talk) Campaign on 25 May at an event hosted by Nicolas Nihon, the Ambassador of Belgium to Kenya and UNFPA.

Speaking at the launch, Michel Sidibé, the Executive Director of UNAIDS, said, “Gender-based violence and HIV are intertwined epidemics. If we are to transform either, we must address the structural barriers that drive both.” He spoke about the need to equip young women with the skills and capacities to make informed decisions about their health and underscored the critical importance of engaging boys and men early to change behaviours and challenge norms that allow gender-based violence to persist.

A young survivor of gender-based violence from Kisumu, a port city on Lake Victoria, made a moving and powerful testimony, reminding participants of the critical importance of the campaign and the need to speak up to help survivors to accept and heal. She also urged parents to talk to their children about violence and to support them in speaking out.

Mr Nihon underlined the commitment of the Government of Belgium to combat all forms of gender-based violence and commended the work of the Kenya partners in supporting the survivors.

“Gender-based violence is, unfortunately, not an uncommon phenomenon against women and girls,” said Ademola Olajide, UNFPA Representative to Kenya. “Care and support for the survivors is critical to eliminate gender-based violence and requires a multisectorial approach.”

The participants affirmed that community-level action combined with global advocacy and structural change can lead to change and that there is much potential to build on the good work already done to accelerate results.

Achieving gender equality, advancing women’s empowerment and fulfilling the sexual and reproductive health and rights of women and girls are central to UNAIDS’ work and crucial to reaching the Sustainable Development Goals and achieving the targets set in the 2016 United Nations Political Declaration on Ending AIDS.

UNAIDS, together with a wide range of partners, including women living with HIV and women’s organizations, are working to ensure that women and girls everywhere have their rights fulfilled and are empowered to protect themselves against HIV and that all women and girls living with HIV have immediate access to HIV treatment and care.

Around the world, many women, children and adolescents still have little or no access to quality health services and education, clean air and water, adequate sanitation and good nutrition. And far too many face violence and discrimination, unequal access to power and opportunity, and numerous barriers that harm their physical, mental and emotional health and well-being.

To accelerate change, the executive heads of the H6 partnership met on the sidelines of the United Nations System Chief Executives Board in London, United Kingdom, on 2 May and agreed a new results framework, H6 Results 2020. H6 Results 2020 aims to shape the H6 partnership into a trusted, valued source for technical support, strategic policy advice and best practices for the health and well-being of women, children and adolescents.

Developed under the chairpersonship of UNAIDS Executive Director Michel Sidibé, H6 Results 2020 is closely aligned with the Every Woman Every Child Every Adolescent Global Strategy and the 2020 Every Woman Every Child Partners’ Framework. H6 Results 2020 sets ambitious goals while committing to deliver on a number of concrete results for 2020.

“I am excited about our revitalized H6 partnership. As the technical arm of the Every Woman Every Child movement, we plan to further streamline and simplify the health architecture, coordinating with key partners to leverage political capital, technical expertise and advocacy for results for women, children and adolescents everywhere,” said Mr Sidibé.

Taking forward the vision endorsed by the executive heads in March 2018, H6 Results 2020 builds on the achievements of the H6 to date and reinforces existing mechanisms while strengthening United Nations mechanisms to support countries. It outlines how the H6 will harmonize efforts of the six H6 organizations and with key partners at the country, regional and global levels and will focus on the countries with the highest burdens of maternal, child and adolescent mortality and morbidity for intensified action.

“The H6 partnership plays a critical role in ensuring that countries focus on the health needs of women in an intersectional way, with laser-like focus on gender equality, human rights and other enablers, such as education,” said Phumzile Mlambo-Ngcuka, the Executive Director of UN Women.

By amplifying its added value, the H6 partnership seeks to serve as a living laboratory for United Nations reform—heeding the call of the United Nations Secretary-General for a more country-focused, coordinated, efficient and accountable development system better able to assist countries in implementing the 2030 Agenda for Sustainable Development.

“It is important that the United Nation comes together to focus its technical support on key priorities in a few high-burden countries, and what must drive our focus is results for people,” said Tedros Adhanom Ghebreyesus, the Director-General of the World Health Organization.

While committed to driving progress across a range of priorities for women, children and adolescent health, H6 Results 2020 puts clear emphasis on reaching adolescents. Adolescent girls and boys (aged 10–19 years) remain a particularly underserved population by the health and social programmes of many countries. Ensuring the health and well-being of adolescents is critical to delivering on the mandate of each of the H6 partners.

“The H6 partnership has proven that working in close collaboration and bringing different expertise and experience to the table is not only effective in enabling countries to deliver rights-based quality care for the women and girls left furthest behind, but also ensures strong country ownership,” said Natalia Kanem, the Executive Director of the United Nations Population Fund.

The H6 combines the strengths of six international organizations to help countries to realize the United Nations Secretary-General’s Every Woman Every Child strategy. The partnership mobilizes political commitment and resources to transform societies so that women, children and adolescents can realize their rights to the highest attainable standards of health and well-being.

High-level representatives of the six organizations met in New York, United States of America, to shape a shared vision for the H6. During the meeting, which took place on 21 March, health leaders committed to jointly deliver more and faster results in countries.

The Chair of the H6, Michel Sidibé, shared his vision for the partnership, including how it can evolve to meet the demands of the Sustainable Development Goals, including in humanitarian settings, and be a leading platform to advance United Nations reform.

“As a transformative platform, I see the H6 as an outstanding opportunity to rapidly bring United Nations reform to life and deliver results for every woman, child and adolescent on the ground,” said Michel Sidibé, Executive Director of UNAIDS.

The participants were united in their ambition to make the H6 a one-stop shop for countries for strategic policy advice, technical assistance and strategic information. Adolescent health, particularly for 10–18-year-olds, was discussed as a key focus area.

“I see an effective H6 partnership as an important way to drive health impact at the country level for all children, including by better addressing gaps in services for the age group from 10 to18 years old, and by planting the seeds of development in humanitarian contexts,” said Henrietta Fore, the Executive Director of the United Nations Children’s Fund.

The participants also committed to ensure policy-making in which communities have a voice and decided to build innovative partnerships with stakeholders beyond the United Nations.

Enhanced transparency and accountability of the H6 and reducing fragmentation and duplication in the United Nations system, as well as between the United Nations and the World Bank, will be key to success, as will a strong focus on joint reporting of results. The H6 will also work in close collaboration with the Global Financing Facility and the Partnership for Maternal, Newborn & Child Health.

“The United Nations Population Fund is strongly committed to the H6 partnership, which has proven that working in close collaboration and bringing different expertise and experience to the table is not only effective in enabling countries to deliver quality care for the women and girls left furthest behind, but also ensures strong country ownership,” said Natalia Kanem, the Executive Director of the United Nations Population Fund.

The H6 principals will now develop a results framework and reconvene in May to review and endorse it. They are aiming to adopt a road map to roll out new ways of working by mid-year.