West and Central Africa

"We are here, we are not giving up". These are the encouraging words of Thérèse Omari, an activist who has been involved in the fight against AIDS for more than 20 years within the Femme Plus organisation, of which she is the co-founder and National Director in the Democratic Republic of Congo.

Femme Plus, true to its motto "Positive Life", works to improve the quality of life of people living with HIV. "The objective is for our beneficiaries to live in harmony with themselves, with their environment and with their beliefs," explains Ms Omari. 

To this end, the organisation provides psychosocial support to people living with or affected by HIV through counselling, care and support services. Femme Plus also carries out numerous activities in communities to free people living with HIV from the burden of stigma. "There is still a lot to be done to change behaviours towards people living with HIV," says Ms Omari. In the Democratic Republic of Congo, HIV-related stigma is still very present, especially in community settings. "Many people living with HIV say they no longer participate in family gatherings and other events fearing discrimination. It is therefore essential that people who come to Femme Plus feel that they are considered normal people with rights and obligations," she explains. In order to raise awareness, the organisation runs workshops to provide communities with the knowledge to better support people living with HIV, without isolating them or treating them differently.

Ms Omari also deplores the persistence of stigma and discrimination in health care settings despite the numerous HIV-related trainings for health care workers. In particular, she receives testimonies from pregnant women who have tested positive for HIV in one facility and wish to give birth in another, fearing of being stigmatised and treated differently. This is problematic as it can be detrimental to the provision of appropriate care for the mother and baby.

Ending discrimination and ensuring that the rights of people living with HIV are protected is therefore one of Femmes Plus' priorities to help them assert themselves and make the right choices about their health. "We encourage people living with HIV to empower themselves, to speak up about their condition, for their own well-being," says Ms Omari. 

Ms Omari also raises other obstacles to the AIDS response. The lack of access to prevention and treatment, and the low rate of people with an undetectable viral load, are among the shortcomings of the fight against HIV in the Democratic Republic of Congo. "Not everyone has access to testing. There are still people with HIV who live in anonymity," warns Ms Omari.

To overcome this gap, Femme Plus works with community leaders to teach them how to stay healthy with HIV. Among other activities, it also engages with pregnant and breastfeeding women, providing them with the knowledge to protect their babies and thereby stop vertical transmission.

"As long as there are people who do not know their HIV status, who do not have access to treatment and who have not reached an undetectable viral load, the fight of Femme Plus will remain meaningful," insists Ms Omari.

She concludes by pointing out that the fight against AIDS in the Democratic Republic of Congo is taking place in a context where resources are limited. "The local population must be involved in psychosocial care and prevention activities to make HIV an electoral issue," she explains. While waiting for more substantial funding from the State and better traceability of funds, community-led services have a crucial role to play with people living with HIV. They are at the heart of the fight against AIDS, advocating for access to prevention and life-saving care, calling for respect for human rights and addressing the specific needs of their beneficiaries. Their support is therefore pivotal in meeting the challenges of the HIV response and ending AIDS by 2030.

Ms Martine Somda Dakuyo was 34 years old when she was diagnosed with HIV. The news, which she describes as traumatic, suddenly shattered all the hopes and plans of this mother of four. "I suffered a lot from the fear of dying prematurely and in deplorable conditions," she says. Despite a deep sense of anger and injustice, she finally came to terms with her status and even went public in the media to encourage people living with HIV to accept themselves and get help.

Today, with her treatments controlling her viral load and keeping her healthy, Martine can look forward to a happy and productive life. She is one of the pioneers in the fight against AIDS in Burkina Faso, having fought for nearly 29 years with the NGO Responsabilité Espoir Vie Solidarité (REVS+). This association, of which she is the initiator and President of the Board of Directors, works for the prevention of HIV, the care of people exposed to the virus and the promotion of their human rights.

"The fight against AIDS in West and Central Africa remains a health emergency," says Ms Somda. Although the HIV prevalence rate is 0.7% in Burkina Faso, Ms Somda asks us about the situation of key populations, who are more exposed to the dangers of HIV, and the reasons that lead to this sad reality. In particular, she mentions the political and security context in the region, proposed laws that discriminate against key populations and the low involvement of people affected by HIV in the fight against AIDS as obstacles to effective care.

In order to protect key populations from the dangers of HIV, Martine’s ambition is to provide universal access to prevention methods, which are a crucial aspect of the fight against AIDS.

"Focusing on effective access to health and rights for people in situations of social rejection and criminalisation is the challenge for the fight against AIDS," she says.

In order to achieve universal access to prevention, care and follow-up services, Ms Somda advocates, among other things, greater involvement of people affected by HIV in the development of national AIDS strategies, better recognition of actions carried out on the ground and the elimination of social and economic inequalities that fuel the epidemic.

In addition, Martine expressed concern about conservatism and cultural, religious and traditional pressures that lead to stigma and discrimination against people living with HIV.  This discrimination manifests itself in various forms; through verbal or physical attacks, threats, harassment, arbitrary arrests, she observes. Such behaviour is dangerous and represents a major obstacle to the fight against AIDS, as it discourages people living with HIV from seeking appropriate services. There is an urgent need to stop such violence in order to create a climate where the rights of people living with HIV are respected and protected. Establishing a more inclusive discourse, free of discriminatory and erroneous prejudices, will allow for a more effective response guided by values of respect, integrity and equality.

With this in mind, in 2015 REVS+ set up workshops and training for decision-makers, religious and customary leaders, health professionals, police and the media. The aim of these activities is above all to denounce stereotypes about people living with HIV and to put an end to discrimination.

"The contribution of community services to the response to HIV is well known and proven, as they complement the services offered by the public health system," explains Ms Somda. Ensuring the continuity of their activities and allowing the greatest number of people to benefit from them, is a necessity for effectively combating AIDS in the region. The resilience of networks such as REVS+, which ensured that prevention activities and care services for people affected by HIV were maintained, was one of the reasons why the impact of the COVID-19 pandemic on people living with HIV was minimised.

Finally, to ensure the effectiveness of the fight against AIDS in the region, and more specifically in Burkina Faso, Ms Somda hopes to see more funding that is "more field-oriented, aligned with policies, strategies and in line with the needs of marginalised groups".

Through this exchange with Martine Somda, we see once again that there is still a long way to go to end AIDS in the region. However, this goal is within reach if all actors in the HIV response work together to develop multi-sectoral strategies. Implementing measures to achieve universal access to prevention services, eliminating HIV-related inequalities and stereotypes, and better managing investments are key priorities for ending AIDS by 2030.

On 24 February 2021, Ghana became the first recipient of a shipment of 600 000 COVID-19 vaccines under the COVAX initiative, a global effort to provide access to vaccination and curtail transmission of the virus in developing countries.

Joshua Appiah, who is living with HIV, was apprehensive about getting the Covid vaccine because he had been influenced by misinformation: “Some of what was circulating on social media frightened me. I was scared the jab would compromise my immune system and kill me!”. 

After coming to learn that it is a lack of vaccination which poses a threat to health, particularly for people living with HIV, Joshua is angry at those who have promoted “misleading stories about the vaccine, its effects, the motivations behind its creation”. That is why Joshua decided to play his part. In June this year, he became one of 40 Vaccine Champions to undergo COVID-19 vaccination advocacy training, aimed at reinforcing their capacity to spread positive messaging and debunk “fake news”, myths and lies in their discussions with local community members. In turn, the programme hopes to increase vaccine uptake in local communities and among people living with HIV at ART sites, as Ghana continues to battle vaccine hesitancy.

The two-day training for Vaccine Champions was organised by Hope for Future Generations (HFFG), in partnership with the National Association of Persons Living with HIV (NAP+) Ghana, Young Health Advocates Ghana (YHAG), and the Ghana Red Cross Society (GRCS), with technical support from the Ghana Health Service. This activity falls under the Partnership for Accelerated COVID-19 Testing (PACT) 2.0 project, supported by UNAIDS and funded by the Government of Germany.

For Joshua, the topics covered, such as public sensitization on COVID-19, debunking myths and misconceptions, developing effective communication strategies, investigating the role of Vaccine Champions and working with data collection tools, have been enlightening and have empowered him to spread the word on vaccine uptake. “I took particular interest in the sessions on COVID-19 vaccine myths and misconceptions. I am now convinced that vaccines do not contain microchips, nor render people infertile, and I also feel comfortable spreading scientifically sound facts among the communities I am in contact with.” 

In her opening remarks for the training in Accra, Executive Director of HFFG, Cecilia Senoo, described the current state of vaccine hesitancy as worrying, reinforcing the urgency of the project. She commended the Vaccine Champions for embarking on a “worthy cause” and encouraged the Vaccine Champions to remain devoted to their mandate. UNAIDS Ghana Youth Programs Officer, Eric Sinayobye, stated that, “vaccine hesitancy is a stumbling block to achieving mass immunity in Ghana, hence the need for Vaccine Champions to help educating members of the community”.

After the training, the 40 Vaccine Champions were deployed at ART sites and inside communities to provide education on the importance of getting vaccinated, as well as to help debunk myths surrounding the vaccines in the next three months. With funding from the Government of Germany, UNAIDS continues to work with the Africa Centers for Disease Control (Africa CDC) to strengthen community-led response against COVID-19 and HIV in Africa.

Two years into the COVID-19 pandemic and there is still much misinformation around the disease. This is fuelling vaccine hesitancy and undermining efforts to respond effectively and protect the most vulnerable.

To respond to misinformation around COVID-19 and HIV, UNAIDS and the Africa Centers for Disease Control and Prevention (Africa CDC), with support from the German Ministry of Health, are organizing a series of training sessions to strengthen the capacities of African Ministries of Health and National Public Health Institutes. The sessions cover key areas of risk communication and community engagement on COVID-19 and HIV such as strategic communication planning, media engagement, familiariziation with continental and regional guidelines, social media and rumour management.

“These trainings aim at harmonizing and coordinating our risk communication and community engagement interventions on COVID-19 and HIV, and better engage our communities in the response to pandemics” said Benjamin Djoudalbaye, Head of Public Health Diplomacy at Africa Centers for Disease Control.

According to the World Health Organization, in the first three months of 2020, nearly 6 000 people around the globe were hospitalized because of coronavirus misinformation. Rumors on COVID-19, HIV, and most recently Monkeypox are reinforcing stigma and discrimination affecting populations which are already marginalized due to their race, economic status and/or gender identity.

To track and address rumors and fake information surrounding COVID-19 and HIV, UNAIDS and Africa CDC are running a rumor management system—a software that uses machine learning combined with human expertise to collect and analyze rumour data from open source traditional media (web-based, broadcast) as well as social media (Facebook, Twitter, Whatsapp). The system enables the identification of false and misleading narratives and sentiments related to COVID-19 and HIV. Weekly reports are then consolidated and used by Africa CDC as an alert system across the continent.

The first training session was held on 28 June in Dakar, Senegal for eleven countries of the West Africa Region. Two other training sessions will be held in the central and north African regions in July 2022.

As part of the Education Plus initiative, young women advocates in Senegal have met with key female figures in the region to discuss the education of girls in sub-Saharan Africa and the challenges they face.

A social work student in her second year of professional training said young women like her who are living with HIV still face stigma and economic marginalization in most spheres of life “Sometimes, the medicines are not in stock, and young women living with HIV often have to share their medication with each other while waiting for a new supply.” According to her, education guarantees a better future for young people, as it did for her in helping her to overcome the challenges she faces because of her HIV status and her difficult upbringing.

Another participant, Maah Koudia Keita (known as Lady Maah Keita), a Senegalese woman with albinism, and a musician, said that women with albinism are victims of harassment and the majority of them have experienced rape and sexual violence.

She is one of three professional female bass players in Africa and the only one in Senegal. She said, “People like me who were lucky to get an education now have to do the work of dispelling myths around women with albinism that drive the violence.” According to Ms Keita, the more educated and aware the community is, the better women and people with albinism can defend themselves.

Adama Pouye, a feminist activist and member of the Senegalese feminist collective that led the Buul Ma Risu (Don’t Mess with Me) movement, spoke at length during the meeting about raising awareness on sexual assault on public transport.

“Every day, you hear violent words and women come to believe that’s what they deserve,” she said. “You are told how far you can go by standards put in place by a patriarchal society, by men, and by religious standards, but our religious interpretations cannot be about oppressing women,” Ms Pouye said.

Young women are key advocates who the Education Plus initiative is working with to rally political leadership, development partners and communities in order to fulfil every adolescent girl’s right to education and health by enabling all girls to complete a quality secondary education in a violence-free environment.

As UNAIDS Executive Director Winnie Byanyima stressed at the meeting, “In this region of western and central Africa, the vulnerability of girls is high.”

She also said that four out of 10 young women are married before the age of 18 years, saying that children becoming brides is a gross violation and a failure to harness the full potential of girls.

“Keeping girls in a classroom, if she stays and completes secondary school, has a protective effect for girls from HIV. What we fought and won for primary school is what is needed for secondary education,” Ms Byanyima said.

Fatou Nar Mbaye Diouf, the Deputy Executive Secretary of the National AIDS Council, Senegal, could not agree more. “We know that allowing girls to complete secondary education protects them from HIV and improves many other health and development factors,” she said.

Sharing key data from Senegal, Ms Nar said the level of comprehensive knowledge about HIV increases with the level of education. “Among young women, it is 10% among those with no education and 41% among those with secondary education or higher, while among young men knowledge of HIV varies from 9% among those with no education to 51% with education,” she said. “Education is key.”

The Regional Director for West and Central Africa for UN Women, Oulimata Sarr, concluded the intergenerational dialogue by saying that girls’ education is not a threat, nor should it be seen as that. “We want to move the needle and move it together with young women,” she said.

Ms Sarr wants the next generation to be supported as they seek more space in decision-making. “We need to pass the baton to young people, who organize differently from us, create an intergenerational legacy with young people holding us to account.”

Growing up in Jamestown, one of the oldest districts of Accra, Ghana, Susana Dartey saw the daily abuse and exploitation faced by female sex workers, which inspired her to set up the Women of Dignity Alliance (WODA) to empower female sex workers and fight the inequalities they face.

“Since sex work is illegal in Ghana, our members have been faced with a lot of abuse and cannot report this due to the fear of being arrested,” says Mrs Dartey, who serves as the Executive Director of WODA. WODA has grown from one member in 2016 to a team of 16 staff members, comprised of current and former female sex workers. “Belonging to the same neighbourhood, I found my voice through theatre and realized that I could use the same methodology or technique to give a voice to these women,” she added.

In Ghana, there are two categories of female sex workers—so-called roamers and seaters. Roamers are mobile and travel to clients, whereas seaters are stationary and work out of their homes or brothels. In 2020, HIV prevalence among female sex workers in Ghana was estimated to be 6.9%.

The COVID-19 pandemic has been challenging for sex workers in Ghana, with lockdown restrictions hampered their ability to work. Sex workers in the country have also reported feeling left out of the official support being given to society as a whole during the pandemic.

In the face of these obstacles, Mrs Dartey is determined to empower female sex workers to become role models for women in their community through the Women Empowered Through Social Entrepreneurship project, which is supported by the UNAIDS Solidarity Fund.

To address the socioeconomic problems brought about by the COVID-19 pandemic, WODA is nurturing promising social enterprises that are established, led, sustained and scaled up by the sex workers themselves, with the aim of empowering up to 400 sex workers, either directly or indirectly.

The three areas addressed by the programme are training on sustainable income generation, facilitation of COVID-19 prevention among sex workers and creating an opportunity for sex workers to be agents of change within their communities.

Mrs Dartey explained how the sex workers are undergoing training in skills as diverse as beauty treatment, soap-making, confectionery production, breadmaking and floral decoration. The beneficiaries of the project are educated in the operating practices of social enterprises and are given opportunities to learn entrepreneurial skills from experts.

“As a roamer for eight years, I have never experienced the kind of hardship COVID-19 has brought to my work. Before COVID-19 set in, I could make up to 230 Ghana cedis daily, but these days it’s very difficult to even make 50 Ghana cedis. When Susana informed me about the UNAIDS Solidarity Fund supported initiative, I was so glad. I love to make ladies look good, so I am eagerly looking forward to acquiring skills in pedicure, manicure and make-up artistry to earn a livelihood,” said one of the beneficiaries.

A part of enabling key populations and vulnerable communities to survive the hardships brought about by the COVID-19 pandemic is to support sustainable income-generating solutions that emerge from those communities. The UNAIDS Solidarity Fund was established to highlight the ingenuity of key populations by enabling access to finance for establishing sustainable social enterprises.

“My hope is to bring these women together to set up a goal for themselves. This project is looking at their future and at the end of the project the sex workers will have set up social enterprises that belong to them,” said Mrs Dartey when asked about her hopes for the project.

A beneficiary of the project who aspires to establish a make-up studio said, “I met Susana in the early part of 2021 and that was the beginning of a new me. Through WODA, I can now boast of some skills in make-up artistry and wig cap-making.” She also calls for sex work to be legalized. “I want sex work to be made legal so that the police will stop arresting and abusing us,” she added.

Humanity is behind in eradicating AIDS by 2030. This delay is not due to a lack of knowledge, capacity or means, but to structural inequalities such as stigma and discrimination which are obstacles to access health services.

Viruses such as HIV or COVID-19 do not differentiate between people, but societies do. They stigmatize and discriminate against people living with HIV, mostly out of ignorance, because they are afraid of the disease.

Discrimination remains one of the biggest battlefields in the Central African Republic and this is why the country was the first in the world to join the Global Partnership to fight against all forms of HIV-related discrimination and stigma.

To make this Global Partnership a reality, a Zero Discrimination Platform was established. It is composed of about thirty partners representing ministries, the National AIDS Council, UN agencies, technical and financial partners, civil society, human rights organizations and other organizations. With UNAIDS support, the Platform called on Ozaguin, the "king of Central African rumba" to use music and art to convey its messages of tolerance and compassion.

At the launch ceremony for Ozaguin's new song against discrimination, which took place on 9 December 2021 at the 20,000-seat stadium in Bangui, he was also nominated as a spokesperson for the Platform.

On behalf of the First Lady of the Central African Republic, the Minister of Health and Population invited every one, and in particular all institutions and influential personalities, not only not to discriminate, but also to fight against discrimination and stigmatization. "We must collectively report discrimination and stigma as soon as we see it and set an example. Discrimination kills. It exacerbates emergencies and fuels pandemics," said Minister Pierre Somsé.

The leadership shown by communities that are victims of discrimination and stigmatization remains a source of inspiration. Their determination, courage and vision are a star in the firmament, as demonstrated by the moving testimony of Ms. Christine Wilikon, a member of the national network of people living with HIV (RECAPEV) during the ceremony. "The first reactions to knowing my positive HIV status were dismay, and a desire to end my life. Rejection by my family members amplified my mental and social disorientation. But the support and advice provided by my parish priest gradually led to my social reintegration through income-generating activities such as petty trade, agriculture and market gardening.”, Christine shared. Her brave words were received with a standing ovation. She urged all Central Africans to put an end to feelings of guilt and shame, and to get tested to know their HIV status and if necessary, take the treatment which is free. 

Despite the remarkable progress made in the AIDS response in Africa, considerable gaps and challenges remain for achieving the 95–95–95 testing and treatment targets by 2025 and putting the continent on track to ending the AIDS epidemic by 2030. UNAIDS, the World Health Organization (WHO) and partners came together at a satellite session at the 2021 International Conference on AIDS and STIs in Africa to discuss how differentiated service delivery can bring the world closer to the targets.

People-centred differentiated service delivery is critical to accelerating access to and uptake of HIV testing and treatment services. While the COVID-19 pandemic has made many countries adapt HIV services to include delivery outside health facilities and by communities, and by scaling up multimonth dispensing of HIV and other medicines, it has also revealed a lack of resilience in key areas of systems for health, including the ability to ensure uninterrupted supplies of medicines and commodities, adequate funding for community-led organizations to provide services and support and the provision of integrated services for multiple health conditions. These adaptations and gaps have underlined the feasibility and importance of delivering differentiated, decentralized, integrated and community-based models of testing and treatment services across different settings.

During the session, representatives of ministries of health and communities, programme implementers, researchers and development partners highlighted ways in which differentiated service delivery has enhanced national efforts to reach their testing and treatment targets for all relevant population groups. They also presented new partnerships, tools, policies and best practices, and called attention to important policy shifts and innovations for scaling up differentiated service delivery, such as targeted community testing and self-testing for HIV, wider spacing of antiretroviral therapy dispensing and clinic visits, community antiretroviral therapy distribution and peer support for linkage to and retention in care for key and vulnerable populations.

“We see huge differences in testing and treatment uptake in different populations across different settings in Africa. For example, children are lagging behind adults, men are lagging behind women, and key populations living with HIV are lagging behind the general population of people living with HIV. Ensuring people- and community-centred differentiated service delivery approaches that respond to barriers to access and the diverse needs across all relevant populations together with conventional facility-based service delivery is critical to leaving no one behind,” said Ani Shakarishvili, UNAIDS Special Adviser, Access to Treatment, Care and Integration.

In April 2021, WHO released new guidelines on HIV prevention, testing, treatment, service delivery and monitoring. Updated service delivery recommendations include the initiation of antiretroviral therapy outside of the health facility, clinic visit spacing and dispensing of antiretroviral therapy every three to six months. The criteria for when a person is eligible to benefit from differentiated service delivery for HIV treatment have also been updated.

“The changes that have been made allow more people to access differentiated services for HIV treatment earlier in order to support their retention in care, meeting their needs and preferences and moving away from one-size-fits-all to more person-centred approaches,” said Clarice Pinto, a consultant on differentiated service delivery for HIV treatment at WHO.

On implementing and scaling differentiated models in countries, Anthony Ashinyo, the Deputy Programme Manager for the National AIDS/STI Control Programme in Ghana, underlined the need for multisectoral collaboration and partnerships between the government, implementers and communities to increase the uptake of differentiated service delivery.

“I see us being in the driving seat. I see us strengthening the influence of people living with HIV, recipients of care and affected communities in the design and implementation of national strategies and plans, so that they adequately reflect and respond to our lived realities and needs,” said Elsie Ayeh, the President of the Network of Persons Living with HIV/AIDS, Ghana.

The session concluded with the launch of a call to action to leave no one behind by scaling up differentiated HIV testing and treatment service delivery in Africa.

Read more about the session and watch pre-recorded presentations on differentiated service delivery from the speakers here.