West and Central Africa

UNAIDS fully backs calls made today by an eminent group of United Nations experts that Ghana should reject a proposed “family values bill” that targets the country’s lesbian, gay, bisexual, transgender and intersex community.

After analyzing the draft legislation, the independent experts appointed by the United Nations Human Rights Council concluded that adopting the legislation in its current or any partial form would be tantamount to a violation of a number of human rights standards, including the absolute prohibition of torture.

The experts said that the proposed law seeks to establish a system of State-sponsored discrimination and violence against the LGBTI community.

UNAIDS has already called for the law to be rejected as a gross violation of human rights. It has also warned that the legislation would be a grave setback for the HIV response in driving vulnerable people further away from essential HIV treatment, care and prevention services.

Ghana: Anti-LGBTI draft bill a “recipe for violence” – UN experts 

GENEVA, 12 August 2021 — UN human rights experts* urged Ghana’s Government to reject a proposed ‘family values’ bill, saying it seeks to establish a system of State-sponsored discrimination and violence against the LGBTI community. The first reading of the bill took place on 2 August 2021, and its consideration is expected to resume in October 2021.  

“The draft legislation argues that any person who deviates from an arbitrary standard of sexual orientation or gender identity is immediately to be considered dangerous, sick or anti-social,” said the experts. “Such laws are a textbook example of discrimination. 

“The proposed law promotes deeply harmful practices that amount to ill-treatment and are conducive to torture, such as so-called ‘conversion therapy’ and other heinous violations like unecessary medical procedures on intersex children, and so-called corrective rape for women,” they added. 

The independent experts, appointed by the Human Rights Council, presented an analysis of the draft bill to the Ghanaian Government, concluding that adopting the legislation in its current or any partial form would be tantamount to a violation of a number of human rights standards, including the absolute prohibition of torture.

For example, attempts to prevent human rights defenders from organising themselves to defend LGBTI people, and the absolute prohibition of public debate on sexual orientation and gender identity, raises grave concerns about rights to freedom of opinion and expression, and of association. Moreover, the bill in question would essentially legitimize the above instances of violence against LBTI women and reinforce existing gender stereotypes and discrimination against women, which are both cause and consequence of violence against women and girls.

“The consideration of this legislation is deeply perplexing in a country that has been regarded as a champion of democracy in Africa, with an impressive record of achieving certain Millennium Development Goals by 2015,” they said. They cited specific concerns about the MDG goals on health, education, employment, housing and gender justice. 

“The draft legislation appears to be the result of a deep loathing toward the LGBTI community. It will not only criminalise LGBTI people, but anyone who supports their human rights, shows sympathy to them or is even remotely associated with them.

“Given that LGBTI people are present in every family and every community it is not very difficult to imagine how, if it were to be adopted, this legislation could create a recipe for conflict and violence.” 

ENDS

*The experts: Victor Madrigal-Borloz, Independent Expert on protection against violence and discrimination based on sexual orientation and gender identity; Reem Alsalem, Special Rapporteur on violence against women, its causes and consequences; Koumbou Boly Barry, Special Rapporteur on the right to education; Irene Khan; Special Rapporteur on the promotion and protection of the right to freedom of expression; Mary Lawlor, Special Rapporteur on the situation of human rights defenders; Nils Melzer, Special Rapporteur on Torture and other Cruel, Inhuman or Degrading Treatment or Punishment; Tlaleng Mofokeng, Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health; Elina Steinerte (Chair-Rapporteur), Miriam Estrada-Castillo (Vice-chairperson), Leigh Toomey, Mumba Malila, Priya Gopalan, Working Group on arbitrary detention Clément Nyaletsossi Voule, Special Rapporteur on Rights to Freedom of Peaceful Assembly and Association

The Special Rapporteurs, Independent Experts and Working Groups are part of what is known as the Special Procedures of the Human Rights Council. Special Procedures, the largest body of independent experts in the UN Human Rights system, is the general name of the Council's independent fact-finding and monitoring mechanisms that address either specific country situations or thematic issues in all parts of the world. Special Procedures' experts work on a voluntary basis; they are not UN staff and do not receive a salary for their work. They are independent from any government or organization and serve in their individual capacity.

UN Human Rights, country page: Ghana

For more information and media requests please contact Catherine de Preux De Baets (+41 22 917 93 27/ cdepreuxdebaets@ohchr.org) or write to ie-sogi@ohchr.org

For media enquiries regarding other UN independent experts, please contact Renato de Souza (+41 22 928 9855 / rrosariodesouza@ohchr.org).

Follow news related to the UN's independent human rights experts on Twitter @UN_SPExperts.

By Brigitte Quenum, UNAIDS Country Director for Côte d’Ivoire

It is with great sadness that I learned on 15 July 2021 of the death of Cyriaque Yapo Ako, one of the pioneers in the response to HIV in Côte d’Ivoire and in Africa as a whole.

A founding member of Ruban Rouge CI in 1994, he never stopped promoting the role of communities in the response to HIV. The Executive Director of RIP+ in the 2000s, he then contributed his expertise to several organizations, including the International Treatment Preparedness Coalition, African Men for Sexual Health and Rights and I CHANGE CI, and collaborated with several partners, including UNAIDS, Population Services International, the United States President’s Emergency Plan for AIDS Relief and the United Nations Development Programme, as a resource person for technical assistance.

As a founding member of Arc-en-Ciel in 2003, the first nongovernmental organization for gay men and other men who have sex with men in the AIDS response in Côte d’Ivoire, he advocated for the need to create a safe space for sexual minorities in Africa, in particular in Côte d’Ivoire, where gay men and other men who have sex with men were commonly subject to stigma, discrimination and violence.

His dynamism and activist spirit enabled him to speak out on behalf of the most marginalized and neglected people in the AIDS response.

From 2004 to 2009, he was the representative of people living with HIV and sexual minorities on the Country Coordinating Mechanism Côte d’Ivoire, where he made a significant contribution to defending people-centred HIV responses in the development of HIV applications to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

His participation in several international conferences contributed to the advocacy of the rights of people living with HIV and more broadly the rights of key populations. He defended his positions, notably through his participation in events such as the International Conference on AIDS and STIs in Africa (ICASA) in 2008 in Dakar, Senegal, ICASA 2011 in Addis Ababa, Ethiopia, ICASA 2013 in Cape Town, South Africa, and the 2016 International AIDS Society Conference in Durban, South Africa, with his contribution in the form of oral presentations and statements.

His passing is a great loss to all those involved in the AIDS response, especially those committed to defending the most vulnerable.

He was a friend, brother and colleague to many of us.

May his soul rest in peace.

Like the rest of the world, COVID-19 has hit Côte d’Ivoire hard. As soon as the first cases of COVID-19 were confirmed in March 2020, a national response plan was developed by the government. Unfortunately, the restrictive measures to protect the population had an impact on the use of health services, including those related to HIV, threatening the fragile retention in care of people living with HIV. Pregnant and lactating women living with HIV and their children, one of the most vulnerable groups, have been particularly affected, and maintaining their access to services and care was essential to avoid undoing years of effort.

The United Nations Development Programme (UNDP) and UNAIDS joined forces to help retain 333 pregnant and lactating women living with HIV in antenatal, maternity and paediatric services in Abidjan. The project will provide, over nine months, 1000 food kits and 1000 hygiene kits to help beneficiaries with food assistance and help them protect themselves against COVID-19.  A food kit contains 20 kg of rice, six litres of oil, 10 pieces of soap and four boxes of children’s flour, and a hygiene kit contains two bottles of hydroalcoholic gel, two bottles of liquid soap and 50 surgical masks. The project also aimed to ensure that the women have access to the comprehensive package of services developed under Côte d’Ivoire’s prevention of mother-to-child transmission of HIV (vertical transmission) programme, to ensure that all exposed children of the project’s beneficiaries are screened early and have access to appropriate care and to document and share good practices.

One of the beneficiaries, Ouattara Maimouna, who has been living with HIV for five years and is a breastfeeding mother of three children, said, “Doctor, this gift was incredibly important to us. It has helped us a lot! This stock of food helps me feed my family. I cannot thank you enough, because I ran out of ways to sustain the small business that used to support my family.”

“About 700 hygiene kits and 700 food kits have been distributed since the project started in December 2020. The United States President’s Emergency Plan for AIDS Relief’s (PEPFAR) implementing partners unanimously indicate that the kits have contributed to the loyalty of pregnant and breastfeeding women to prevention of vertical transmission of HIV and paediatric care services, as well as to self-support groups,” said Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire.

At this stage of implementation, some lessons learned are already emerging. The project has been very well received by the beneficiaries because of their vulnerability, which has been aggravated by the COVID-19 crisis. The support has helped to increase their compliance with appointments at the various prenatal consultations, to improve the continuity of treatment and viral load testing for pregnant and breastfeeding women and to strengthen the link between women living with HIV and the staff providing both clinical and community care. The project also emphasizes the importance of taking into account the social component in the care of women in prevention of vertical transmission of HIV services.

The distribution of food and hygiene kits will continue until the end of 2021. Pregnant and breastfeeding women living with HIV have become more vulnerable in the midst of the response to COVID-19 and assistance strategies that respond to their specific sensitivities must be designed. “The mobilization of UNDP, UNAIDS, PEPFAR implementing partners and their nongovernmental organization partners has ensured a coalition of support for advocacy and the scaling up of outreach efforts to vulnerable populations,” added Ms Quenum. “While this one-time initiative is useful, efforts should be made to integrate other activities, such as nutrition promotion and the integration of a social component in the care of women living with HIV in vertical transmission services and other care sites.”

An HIV-sensitive and inclusive social protection assessment will start in the coming months in collaboration with the key ministries involved. Mobilization of funds for social aspects related to women living with HIV and advocacy for sustainable support measures will be required.

In 1999, when he started working for UNAIDS, Samuel Larkai committed himself to using his driving experience to contribute to ending AIDS by 2030. He started his career in driving as a shipping assistant in a timber firm, after which he moved to the United Nations Development Programme to serve as a driver. He was then recruited by the UNAIDS Country Office for Ghana as a chauffeur. He has driven not only the length and breadth of Ghana but also neighbouring countries, Togo, Benin and Burkina Faso, on official assignments.

Mr Sam, as he is affectionately called, recalls how Ghanaians received the news about HIV in Ghana in the early 1990s. “At the onset, most people heard about HIV via television and radio education. Also, education in schools was intense,” he said.

Looking back, he attributes the rise in new HIV infections to the non-adherence of people to the education they received on HIV prevention. “I also recollect the opposition of religious institutions to condom usage among young people. They felt young people were being encouraged into promiscuity, but of course this was not the case. What they failed to realize was that the spread of HIV needed to stop urgently!” He added that, “Condom negotiation should be encouraged, as having protected sex remains one of the ways to prevent the transmission of HIV.”

Over the years, one issue has continued to cause him sleepless nights—HIV stigma. He recollects an experience at the Korle Bu Teaching Hospital, where he was refused entry into the HIV clinic, while the UNAIDS country director was allowed in. An official at the clinic explained that his status as an indigen, a native of the town, might allow him to identify some of the people living with HIV locally, with a risk of stigma for anyone he could identify. Reflecting on the negative effects of HIV stigma, Mr Sam believes in the value of education on sexual and reproductive health, which can be an effective weapon in fighting HIV stigma.  

Having worked with UNAIDS in Ghana for such a long time, Mr Sam has seen the progress that has been made. “I am filled with joy when I see people living with HIV exude confidence and power after all they have been through. Many now serve as examples and mentors to the younger generations. This is the way to go!” he said with a smile.

Mr Sam applauds the strides made towards ending AIDS as a public health threat and is confident that it can be achieved by 2030, if everyone keeps trying their very best.

Since key populations and their sexual partners account for 69% of new HIV infections in western and central Africa, reaching 95–95–95 among key populations will result in a significant impact on the overall HIV epidemic in the region. However, programmes focusing on key populations are insufficient. In western and central Africa, funding for programmes for key populations represented only 2.4% of the region’s overall HIV funding between 2016 and 2018, according to Frontline AIDS.

Having strategic information—quality data and analysis—is vital for an HIV response, for ensuring accountability and since it allows ambitious and measurable time-bound targets for monitoring progress to be set. 

“The old adage “What gets measured gets done” may be a cliché, but it is still very true for the HIV response. Over the years, data collection, analysis and dissemination have led to a better understanding of the HIV epidemic and helped programmes to reach the right people in the right place at the right time,” said Marie Engel, Adviser at the UNAIDS Regional Support Team for Western and Central Africa.

In order to strengthen their skills in building and analysing data on the location and size estimates of key populations, approximately 30 people from four countries—Senegal, Côte d’Ivoire, Guinea and Guinea Bissau—and who were mainly from organizations for key population recently attended a training session in Saly, Senegal. During the training, which was part of a subregional project called RECCAP, funded by Expertise France, the Enda Santé nongovernmental organization, in collaboration with Johns Hopkins University, trained the participants on basic statistical analysis methods, population size estimation, health mapping tools and the analysis and presentation of collected data. UNAIDS and the World Health Organization sponsored the participation of several participants.

“The development of local capacities will allow for programmes that are best adapted to contextual changes by locating the dynamics of HIV vulnerability and analysing how sociospatial combinations influence epidemiological data. The diversity of the selected participants’ profiles and the plurality of the training team’s experiences guarantee a transfer of know-how and true sharing,” said Daouda Diouf, Enda Santé’s General Manager.

It is hoped that the training will empower key populations to exercise leadership—an essential mainstay of HIV responses to ensure that they are inclusive, equitable, effective, efficient and sustainable.

Despite the great progress made since the early days of the HIV epidemic, the HIV response for children is still lagging behind the response for adults.

Children living with HIV are particularly susceptible to tuberculosis (TB), one of the leading causes of AIDS-related deaths. In 2020, according to government statistics, 9400 people died of AIDS-related illnesses in Côte d’Ivoire, including 800 children under the age of 14 years. There were 21 000 people under the age of 15 years living with HIV in the country—only 49% had access to antiretroviral therapy. How to correct such an inequality was the question at the heart of a national consultation on paediatric HIV and TB that was held from 8 to 10 June in Abidjan, Côte d'Ivoire.

The consultation, Acting Together for a Generation without AIDS and Tuberculosis, was aimed at improving the prevention and management of HIV and TB among children and adolescents in Côte d’Ivoire.

In her opening speech, Dominique Ouattara, the First Lady of Côte d’Ivoire, called for “The development of an ambitious road map that will enable Côte d'Ivoire to achieve its commitments.” She invited all the participants to engage in a dialogue on the challenges and priority actions needed, and to discuss the roles, responsibilities and contributions of each partner.

The consultation is part of the Confessional Initiative, a UNAIDS and United States President’s Emergency Plan for AIDS Relief initiative that is organizing national consultations and training in Cameroon, Côte d’Ivoire, Kenya, Nigeria and the United Republic of Tanzania.

“The consultation presented the national situation regarding diagnosis, treatment and prevention of HIV and tuberculosis among children, identified the key challenges, outlined the solutions, priority actions and resources needed to improve the national roll-out of optimal paediatric HIV and tuberculosis treatment and diagnosis and identified good practices for replication through civil society and faith-based organizations,” said Patrick Brenny, the Director for the UNAIDS Regional Support Team for Western and Central Africa.

The targets in the 2016 United Nations Political Declaration on Ending AIDS and in Start Free, Stay Free, AIDS Free for paediatric AIDS have not been met. Globally, during 2020 an estimated 160 000 children acquired HIV, far from the global 2020 target of 20 000. Modelling has also shown that the COVID-19 pandemic could have a major impact on new HIV infections among children in sub-Saharan Africa.

Ms Ouattara appealed to the 350 participants to work towards reducing inequalities and asked all stakeholders to join forces to achieve certification of the elimination of mother-to-child transmission of HIV. “Today, in 2021, no child should die of AIDS or tuberculosis in our country," she added.

The UNAIDS Country Office for Ghana is supporting the Millennium Promise Alliance, the Network of People Living with HIV and the Young Health Advocates Ghana in a partnership to strengthen community engagement in the COVID-19 response.

Aimed at reducing the community spread of COVID-19 and minimizing its effects on reaching the national HIV targets, the Partnership for Accelerated COVID-19 Testing (PACT) in Ghana will encourage the adoption of COVID-19 preventive behaviours, such as physical distancing, wearing face coverings and hand hygiene, reduce COVID-19-related stigma, promote vaccine uptake and strengthen the capacities of communities.

The PACT initiative in Ghana targets the two regions with the heaviest COVID-19 burden: the Ashanti and Greater Accra regions. Launching the project, the Director-General of the Ghana Health Service, Patrick Aboagye, commended the initiative and highlighted the urgent need for an all-hands-on-deck approach to end the COVID-19 pandemic.

The UNAIDS Country Director for Ghana, Angela Trenton-Mbonde, emphasized the importance of galvanizing HIV civil society to strengthen community engagement in the fight against COVID-19. “PACT will generate evidence for advocacy from communities, including people living with HIV, women’s groups and other vulnerable populations, to identify and inform health authorities of any disruption of essential health services, particularly HIV-related services at the community level, and will mobilize for greater uptake of those services,” she said.

The PACT initiative, launched by the Africa Centres for Disease Control and Prevention in April 2020, aims to conduct 10 million COVID-19 tests on the African continent. PACT has three pillars: test, trace and treat, which cover the procurement and distribution of COVID-19 test kits, the deployment and training of one million community health-care workers to support contact tracing and monitoring, and COVID-19 sensitization measures.

The UNITY Platform, a network of 34 organizations for lesbian, gay, bisexual and transgender (LGBT) people, has just published its 2020 annual report on violence against sexual and gender minorities in Cameroon. The report, produced annually by all the associations that the platform covers, shows more than 2000 cases of violence and violations of the rights of sexual and gender minorities affecting 930 people in 2020, compared to just less than 1400 in 2019. More than half of the reported cases involved psychological violence, with the rest consisting of cases of physical, sexual, economic or legal violence and hate speech. Gay men were the most affected victims of violence (552), followed by lesbians (214) and transgender people (64).

The report, Transphobie: le visage d’une nouvelle crise, places particular emphasis on violence against transgender people, which is being increasingly documented. According to a survey conducted by Réseau Indépendant des Trans d’Afrique, the results of which are published in the report, 53% of transgender people surveyed had experienced gender-based violence in health facilities. The perpetrators of violence could be strangers on the street (45%), family (41%), close or distant relatives (33%), intimate partners (26%) or ex-partners (10%).

The response to the violence by the UNITY Platform, which is hosted by the Cameroonian Foundation for AIDS (Camfaids), is presented in the annual report and includes services available within member organizations and external services offered in partnership with other organizations as needed.

The response mechanism starts with documentation and investigation and continues through medical care (consultations, examinations, care, treatment, provision of medication), psychological care (counselling, assessment of mental state, psychological consultations and follow-ups), social care (provision of means of subsistence, support in finding employment, admission to temporary housing as appropriate) and legal care (legal advice, assistance in drafting and filing a complaint) provided by one or more of the platform’s organizations.

“We have a system of focal points on gender-based violence issues within each UNITY member organization who are the first point of contact for victims. This is reassuring for the victims, who feel safe and understood simply because they are in a space that is well known to them,” said Nickel Liwandi, the Executive Director of Camfaids.

External mechanisms can include legal assistance through the intervention of a lawyer or police officer, medical assistance through specialized medical consultations, examinations, minor or major surgery and forensic certification or social assistance through referral to a partner organization’s shelter.

UNAIDS recently supported the efforts of the UNITY Platform and other civil society organizations in creating a space for exchange between LGBT organizations and other civil society organizations implementing HIV programmes with key populations, such as CAMNAFAW (Cameroon National Association for Family Welfare) and CARE Cameroon, to review the assistance provided to people prosecuted because of their real or perceived gender identity or sexual orientation.

Action continues to be taken to mobilize United Nations agencies and “champions” identified within governments, nongovernmental organizations and partner institutions to support civil society advocacy, as well as to institutionalize a platform for regular coordination and review of progress in implementing Cameroon’s recently adopted Five-Year Plan 2020–2024 to reduce human rights-related barriers to accessing HIV services.

“The mobilization of Cameroonian LGBT organizations within the Unity Platform is valuable because it provides us with the evidence needed for advocacy and action. The Unity Platform’s new report will serve to assess progress in reaching the targets of the Five-Year Plan 2020–2024. UNAIDS is committed to supporting the country’s efforts in line with our vision to achieve zero new HIV infections, zero discrimination and zero AIDS-related deaths,” said Steave Nemande, UNAIDS Strategic Intervention Officer for Cameroon.

The Gboklè/Nawa/San Pedro region is the second largest economic hub in Côte d’Ivoire and one of the regions most affected by the HIV epidemic. The region attracts many workers because of its important economic and industrial activities, mainly related to the port and agriculture, as well as sex workers and other members of key populations.

A joint United Nations Development Programme (UNDP)/UNAIDS mission to the region from 16 to 20 April learned about the realities of the HIV response in the region in the context of COVID-19 and assessed how the response takes into account the needs of the most vulnerable.

The mission first paid a courtesy call on the region’s administrative and health authorities, and then quickly focused on the sites where services are offered to people living with HIV and key populations. In the health-care facilities visited, whether at the Regional Hospital of San Pedro, above, or at the health centre of APROSAM (Association pour la Promotion de la Santé de la Femme, de la Mère et de l’Enfant) nongovernmental organization, the mission team saw the commitment and determination of the health-care teams and the administrations of the facilities. “We have set up a quality assurance team within the hospital to guarantee services centred on the needs of each patient,” said Alexandre Kissiedou, the Director of the Regional Hospital of San Pedro.

The visit to APROSAM was one of the most captivating moments of the mission. During the visit, the mission team had in-depth discussions with representatives of a dozen associations, who had come to APROSAM’s headquarters to meet the mission delegation. Useful discussions took place with representatives of associations of people living with HIV and associations representing key populations, as well as with representatives of nongovernmental organizations working with young people.

“It is the first time that civil society is honoured with the visit of the country representatives of two United Nations agencies,” said Odette Koffi, the Executive Director of APROSAM, an association involved in the response to HIV, tuberculosis and malaria in the region. She also noted that civil society is truly committed to the HIV response but lacks the means to meet the needs of all.

“Income-generating activities are no longer working as they used to. Today we can’t even feed ourselves properly and we can’t take antiretroviral medicines on an empty stomach,” said Maya Rose Nean, the head of the local CERBAS association for women living with HIV, when describing how COVID-19 had impacted women living with HIV in the country.

Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire, speaking on behalf of the delegation, underlined the vital work of nongovernmental organizations in the HIV response and praised the commitment of civil society organizations, people living with HIV and key populations. She said that a dialogue between UNDP and UNAIDS will address some of the pressing needs discussed with civil society. A donation of 400 food and hygiene kits was made by UNDP and UNAIDS to vulnerable people living with HIV and key populations.

The last day of the mission focused on human rights, with a visit to the Elan d’Amour reception centre, above, which offers temporary accommodation to people living with HIV and people who are victims of stigma, discrimination and gender-based violence, including people who come from remote areas for care and/or to collect their antiretroviral therapy. The delegation then visited a legal clinic supported by UNDP. These visits allowed the delegation to get a good understanding of the realities of human rights in the region, but also to understand their implications for specific HIV-related vulnerabilities. As a result of these two visits, the two agencies agreed to consider a joint project to better address HIV and human rights issues in the region.

For both teams, this mission was a success. The various needs identified will be the subject of concerted action either between UNDP and UNAIDS or by working with other Cosponsors that can provide relevant solutions.

Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire, above left, met with the Prefect of the San Pedro department. 

There have been successes in the commitment to end vertical transmission of HIV (from mother to child). For example, in eastern and southern Africa, 95% of pregnant women living with HIV received antiretroviral therapy to prevent vertical transmission of HIV in 2019.

Such successes have not been universally seen, however. In western and central Africa, the picture is not so positive—coverage of services for the prevention of vertical transmission in the region is among the lowest in the world. In 2019, only 58% of pregnant women living with HIV in the region received antiretroviral therapy to prevent vertical transmission.