West and Central Africa

The Government of Equatorial Guinea has launched a new community-based campaign against COVID-19 with the support of UNAIDS.

The UNAIDS Country Office for Equatorial Guinea has been supporting the government of the country since the beginning of the COVID-19 pandemic. It has supported testing and sensitization campaigns for people living with HIV and has now joined the new community-based campaign by providing the Ministry of Health with financial support to support volunteers and facilitate their travel. 

The first 10 days of the campaign will focus on Bioko Island and the campaign will continue on the mainland from the end of March. Since February, there has been an upsurge of new COVID-19 infections in Malabo, the capital of Equatorial Guinea. The new campaign will allow the health authorities to trace people with COVID-19 and quickly isolate high-risk patients in order to limit the risk of transmission. 

The Director-General for Hospital Coordination, Juan José Owono Okiri Nkogo, said, “After only two days of the campaign, we have already detected nearly 50 positive cases, which have been quickly managed and directed to the reference centres.”

Justino Obama, the President of the National Committee for the Fight against COVID-19, praised UNAIDS’ efforts. “Equatorial Guinea thanks the UNAIDS office for this support,” he said.

“As with HIV, our most effective weapons against COVID-19 are solidarity and responsibility. Thanks to them, we will win the battle against COVID-19,” said Jeanne Seck Ndeng, the UNAIDS Country Director for Equatorial Guinea.

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

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

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

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

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

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

UNAIDS and the African Union have signed a new memorandum of understanding (MoU) to reinforce their partnership and to recommit member states to end AIDS through the Catalytic Framework to End AIDS, TB and Eliminate Malaria in Africa by 2030.

The MoU commits partners to work towards addressing the socioeconomic and political impact of HIV in Africa and accelerate the goal of reaching universal health coverage to take AIDS out of isolation. It will pave the way for more resilient, agile and inclusive health systems in Africa.

“The renewed MoU between the African Union and UNAIDS opens new windows of cooperation and new opportunities for ending AIDS in Africa. We need to deliver on this promise—it is doable,” said Amira Elfadil Mohammed Elfadil, Commissioner for the Department of Health, Humanitarian Affairs and Social Development, at the signing ceremony.

The Department of Health, Humanitarian Affairs and Social Development, formerly known as the Department of Social Affairs, will coordinate African Union Commission departments and organs to ensure that HIV remains a continental priority and is integrated into the broader development, human rights, humanitarian and peace and security agenda of the African Union. 

“I am delighted to sign the renewed MoU with the African Union,” said UNAIDS Executive Director, Winnie Byanyima. “The African Union is one of UNAIDS’ most important partners. I look forward to reinforcing our relationship to put communities at the centre of the response to HIV, address other health challenges such as COVID-19 and reduce inequalities that increase people’s vulnerability.”

This year is a pivotal year as United Nations Member States are expected to recommit to the HIV response with the adoption of a new political declaration in June. The partnership agreement with the African Union is being signed as the continent grapples with overburdened and insufficiently financed health systems in the face of the COVID-19 pandemic.

UCOP+, the Congolese Union of Organizations of People Living with HIV, through funding and technical support from UNAIDS, set up the Observatory project, designed to collect and analyse data to guide action to improve the quality of HIV services.

“The Observatory, which looks at access to and the quality of HIV and HIV/tuberculosis services, is a community-based initiative. Its main objective is to help the government and civil society define and implement national policies in accordance with international norms and standards,” said Natalie Marini, Human Rights and Gender Adviser at the UNAIDS Country Office for the Democratic Republic of the Congo.

The Observatory was set up following repeated stock-outs of HIV and tuberculosis medicine, requests for payment for services that are supposed to be free, the persistence of stigma and discrimination and human rights violations and the long distances that people have to travel to access health care. Three areas are monitored monthly—the availability of services, the quality of care, including the availability of medicine, and accessibility of care.

The initiative shows the importance of collaboration between civil society, health services and donors in the HIV response and has led to an improvement in HIV/tuberculosis services in health facilities. “The Observatory is an indispensable tool that gives us the first clues about supply,” said Aimé Mboyo, director for the National AIDS Control Programme. “It helps us enormously.” The data from the Observatory complements the data of the National Health Information System (SNIS).

Since its launch in 2013, the Observatory has contributed to reducing the cost of access to health care in some health facilities and has anticipated stock-outs and helped to reduce their frequency. The Observatory has also reduced self-stigma by valuing the people who use the services and putting them at the heart of the system. “Before, I didn’t have anything to say about the care offered to me,” said Joséphine Ntumba (not her real name), who is living with HIV. “Now I can give my opinion and make a difference.”

The concept of a “community observatory” has been shown to be a success and is now integrated in the concept note for the Democratic Republic of the Congo of the Global Fund to Fight AIDS, Tuberculosis and Malaria. However, there is still a long way to go—only three out of 23 provincial health departments are covered. 

The Central African Republic has made significant progress in its response to HIV over the past four years. New HIV infections continue to decline and the number of people on antiretroviral therapy has increased from less than 25 000 in 2016 to more than 47 000 in 2019.

Despite this progress, the Central African Republic remains far from the 90–90–90 targets. Less than half of the 100 000 people living with HIV in the country have access to treatment and the government estimates that less than 20% of people on treatment have an undetectable viral load. For those who are on treatment, the quality of care is insufficient. Recent studies reveal a very high rate of immunological and therapeutic failure among people living with HIV on treatment.

Various factors contribute to this situation, including hospital-based management, the unavailability of biological monitoring in rural areas, the lack of human and material resources in health facilities and laboratories and the absence of community-based approaches that promote treatment adherence and information. In addition to these system-related factors, since December 2020 the country has faced a resurgence of a political and security crisis, which makes access to treatment difficult.

There is a need to simplify and adapt the cascade of HIV-related services to take into account the preferences and expectations of different groups of people living with HIV while reducing unnecessary burdens on the health system. People-centred care is now the goal of the Central African Republic.

The Central African Republic aims to diversify, accelerate and generalize differentiated services. The Catalytic Initiative promoted by UNAIDS with the financial support of Luxembourg is helping the country to achieve this ambition. A first decisive step has been taken with the organization of a round-table discussion, entitled Catalytic Initiative on Differentiated HIV and Tuberculosis Services. The meeting brought together the Ministry of Health, the Comité National de Lutte contre le SIDA, civil society, people living with HIV, tuberculosis stakeholders, key populations, youth organizations, the United Nations, Médecins Sans Frontières and the French Red Cross.

The participants reviewed the existing pilot programmes of differentiated services in the country and the obstacles related to their implementation. They stressed the urgent need to expand differentiated services, particularly in the current context of the increasing insecurity and humanitarian challenges that make it difficult for people to access HIV and tuberculosis services.

“It is in the current context of the security crisis that the differentiated services approach is most valuable in the Central African Republic,” said Patrick Eba, UNAIDS Country Director for the Central African Republic.

The participants agreed on the activities to be implemented and validated the project implementation schedule to improve the quality of care and biological monitoring of people living with HIV and tuberculosis patients by stimulating the implementation of differentiated services.

“I welcome this opportunity offered by UNAIDS to remove bottlenecks to improve the overall management of HIV,” said Marie-Charlotte Banthas Bata, the Director of Communicable Disease Control at the Ministry of Health and Population, Central African Republic, pictured above, centre.

“Community organizations must be at the centre of the implementation of differentiated approaches,” said Bienvenu Gazalima, the President of the National Network of Associations of People Living with HIV in the Central African Republic 

The next key steps will be the documentation of existing differentiated approaches in the country and the development of a national guidance document for scaling them up.

ABUJA/GENEVA, 10 March 2021—The UNAIDS Executive Director, Winnie Byanyima, has met the President of Nigeria, Muhammadu Buhari, to discuss the country’s response to the colliding pandemics of HIV and COVID-19. The meeting was part of Ms Byanyima’s three-day visit to the country, which also included visits to communities on the frontline of the response and events to mark International Women’s Day on 8 March.

During their meeting, Ms Byanyima thanked Mr Buhari for being an early champion of the People’s Vaccine campaign, which is calling for a fair and equitable distribution of vaccines against the coronavirus to ensure that poorer countries are not left behind in the response. Nigeria began to vaccinate frontline health workers last weekend after taking delivery of 4 million doses of vaccine, facilitated through COVAX, the international mechanism set up to bulk buy vaccines and distribute them equitably worldwide. Of 300 million vaccine doses administered worldwide so far, most have been administered in just 10 countries.

Ms Byanyima also applauded the country’s progress against the HIV pandemic and said UNAIDS stood ready to strengthen its partnership with Nigeria to further reduce the impact of the HIV pandemic and end AIDS as a public health threat as part of the 2030 Agenda for Sustainable Development.

“Nigeria has made good progress on expanding the delivery of HIV testing, treatment and care services over recent years, contributing to a steep decline in AIDS-related deaths,” said Ms Byanyima. “I look forward to reinforcing UNAIDS’ partnership with government, communities and all other stakeholders to drive new HIV infections down and kick-start a decade of action to end AIDS as a public health threat for everyone.”

There were 1.8 million people living with HIV in Nigeria in 2019 and 1.3 million people know their HIV status. Around 1.1 million people are now on HIV treatment to keep them alive and well. AIDS-related deaths have fallen by more than a third over the past decade, although HIV infections have declined at a more modest rate.

During her visit, Ms Byanyima also met community activists, who have been instrumental in minimizing the disruption to HIV testing, treatment and care services despite the challenges caused by the COVID-19 pandemic and the measures taken to contain it.

On Monday, Ms Byanyima took part in events to commemorate International Women’s Day hosted by the Federal Minister of Women’s Affairs, Pauline Tallen. Ms Byanyima stressed the importance of women’s leadership and participation at all levels of decision-making to ensure that issues of importance to women, such as ending gender-based violence and expanding access to essential services, including health and education, were addressed.

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.

The Democratic Republic of the Congo has been plagued by political instability since the 1990s and has seen widespread attacks against civilians, violence between ethnic factions, rape and other forms of sexual violence, and murder. Sexual violence against adolescent girls and young women is common.

Violence against women and girls continues to be a global pandemic that affects one in three women in their life. Violence against women is a major factor for contracting HIV—in areas with a high HIV burden, such as sub-Saharan Africa, women subjected to intimate partner violence are 50% more likely to be living with HIV. And men who are perpetrators of violence against women tend to be at a higher risk of HIV themselves and to use condoms less frequently, thus increasing the risk of HIV transmission.

According to the latest Demographic and Health Survey of the Democratic Republic of the Congo, HIV prevalence is three times higher among women aged 15–49 years (1.1%) than among men of the same age (0.4%) and twice as high among young women aged 15–24 years (0.46%) than among young men of the same age (0.22%).

RENADEF (Réseau National des ONG pour le Développement de la Femme), a platform of approximately 350 non-state groups working for women, is tackling this issue front and centre. As a subrecipient of a grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria, RENADEF is running a project to strengthen awareness around sexual and reproductive health and rights, including HIV, to facilitate access to support services and to encourage behaviour change among adolescent girls and young women in 16 HIV high-burden provincial divisions.

In collaboration with health-care providers, almost 200 peer educators and mentors have been trained on sexual and reproductive health and more than 600 educational talks in different settings, including schools and communities, have been facilitated, reaching more than 6500 people, including 2500 girls.

“I was not informed about sexually transmitted infections and their consequences on my life, but I had the chance to participate in an awareness session organized by the peer educators and mentors in my neighbourhood; at the end of the session, I approached one of the sensitizers to explain my problem to her. She gave me advice and referred me to a health training, where I was taken care of for free and I feel good now,” said Nathalie Nyembwe (not her real name), who attended one of the educational talks.

The project also supports clinics giving psychosocial, legal and judicial support to survivors of sexual violence. Since 2018, clinics have been held that have provided psychological support to almost 5500 people and legal/judicial support to more than 3500 survivors of sexual violence.

The community sensitization, capacity-building of legal clinics and support for survivors of sexual violence have contributed to an increase in the reporting of rape.

“It’s particularly important, particularly as we reflect on our experience with COVID-19, that we acknowledge the important role that women have played to protect others from violence, to ensure continued support to vulnerable families and to ensure access to food and medicine. Women have provided invaluable support to keep people connected to neighbours, services and information, all the while ensuring that homes remain a safe space for children and families to continue to learn and grow socially,” said Susan Kasedde, the UNAIDS Country Director for the Democratic Republic of the Congo.

As a champion country of the Global Partnership for Action to Eliminate all Forms of HIV-Related Discrimination, the Democratic Republic of the Congo has a unique opportunity to strengthen its implementation of coordinated, comprehensive and scaled-up action involving a range of stakeholders and to build synergies on action on gender equality across sectors. 

Nigeria has demonstrated that putting people at the centre of the AIDS response works in advancing HIV service delivery. The 2018 Nigeria HIV/AIDS Indicator and Impact Survey identified 10 states with HIV prevalence above 2%, nine of which had a significant unmet need for HIV treatment and were at risk of being left behind if no action was taken. These states were prioritized by the national AIDS response for concerted action with the help of the United States President’s Emergency Plan for AIDS Relief (PEPFAR) and the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

In 2020, while many countries experienced HIV service disruptions, the PEPFAR-supported HIV programme in Nigeria experienced significant growth and exceeded some targets.  

“The achievements of Nigeria with PEPFAR and the Global Fund in 2020 have significantly moved the needle towards treatment saturation and advanced the hope of epidemic control and the end of AIDS in these states and the entire country,” said Osagie Ehanire, the Minister of Health of Nigeria.

PEPFAR’s leadership and implementing partners took quick action and fast-tracked their community engagement plans, utilizing existing community network machinery to ensure there were no disruptions in the delivery of HIV services.

“Thanks to PEPFAR and its implementing partners, Nigeria was able to ensure not just continuity of HIV services, but was able to expand the reach, despite the country being locked down due to COVID-19,” said Gambo Aliyu, Director-General of the National AIDS Coordination Agency. “A record 279 000 people living with HIV additionally were put on treatment during this period.”

PEPFAR, together with its implementing partners, developed a people-centred package of services that was informed by data, best practices and community intelligence. The package recognized that one size does not fit all and catered for the unique needs of the various populations served.

Existing community networks, including key population networks and social groups, were consulted to determine the best way to make sure that the services that people need were available to them in their homes, at social gatherings or through support groups—thus minimizing contact with facilities.

Community antiretroviral therapy teams (CART teams) went to hard-to-reach areas around the country as well as to areas effected by COVID-19 lockdowns. Programmes such as a minimum three-month provision of antiretroviral therapy and viral load services were provided at treatment pick-up areas, which not only helped community-led providers to ensure that people stayed on treatment but saw a record number of people living with HIV start on treatment. By the end of 2020, the majority of people on treatment were included in the multimonth dispensing programme, which had a large impact on HIV treatment retention and adherence.

Viral load samples were collected in the communities, sent to laboratories for analysis and the results were then sent to health-care facilities, from where people were notified—this had a positive impact on viral load coverage. Index testing was expanded through community networks, ensuring continuity and safety as well as improvements in testing and case finding.

Results were seen across the entire 90–90–90 cascade as follows:

• An increase in people on HIV treatment of more than 279 000 people living with HIV in 2020, with more than 131 000 people being initiated and retained in care during the fourth quarter alone. PEPFAR Nigeria showed excellent success, accelerating efforts to identify people living with HIV and link them to care, with quarter-on-quarter growth. The growth in people on HIV treatment saw an additional seven states moving towards treatment saturation since the initiation of the “surge” programme approach, where intervention efforts are dramatically scaled up. Key populations represented approximately 25% of this overall growth, as the number of people on treatment among most key populations tripled. Key populations also had a testing yield of more than 10%.
• Improvements in pre-exposure prophylaxis (PrEP) uptake, especially among key populations. The number of people newly initiated on PrEP rose from nearly 2000 in the third quarter of 2020 to nearly 23 000 in the fourth quarter.
• Scale-up of multimonth dispensing from 55% in the first quarter to 94% in the fourth quarter 2020 was a key factor in improved continuity of treatment.
• Improvement in viral load coverage (88%) and suppression (93%) by the third quarter, building on previous successes and maintaining those gains to approach the third 90 target in a little over six quarters.
• PEPFAR’s orphans and vulnerable children programme achieved and exceeded all targets set for the year, including more than a million orphans and vulnerable children served by PEPFAR Nigeria by the end of 2020. Additionally, 98% of those under the age of 18 years in the orphans and vulnerable children programme have a documented HIV status, and approximately 100% of those who tested HIV-positive started treatment.

These results could not have been achieved without the support of community-led organizations. “The Network of People Living with HIV/AIDS in Nigeria (NEPWHAN) wishes to thank PEPFAR for the continuous engagement of our members across the country in the provision of HIV services to people living with HIV,” said Ibrahim Abdulkadir, NEPWHAN National Coordinator. “This has increased retention in care and improved quality of life for people living with HIV, as well as viral suppression among people living with HIV on antiretroviral therapy.”

PEPFAR Nigeria has designed its approach so that it can be owned by the Nigerian people. The National Data Repository and the National Alignment Strategy are key building blocks of a long-term and sustainable public health and health services approach to ending the AIDS epidemic in the country.  

“I am profoundly impressed by the progress that PEPFAR Nigeria has made, in collaboration with the Government of Nigeria, partners and allies, to identify, enrol and sustain so many Nigerian people living with HIV on life-saving treatment,” said Bill Paul, the Deputy Coordinator for Program Quality, Office of the United States Global AIDS Coordinator. “Their success in sustaining the effort despite the impact of COVID-19 would not have been possible without a supportive policy environment both in the government and in the United States embassy.”  

Based on these accomplishments, Nigeria is well-positioned to accomplish the 95–95–95 targets well in advance of 2030.

At the end of 2020, progress on the 90–90–90 treatment targets was 73–89–78—that is, 73% of people living with HIV had been diagnosed, 89% of those diagnosed were accessing treatment and 78% of those accessing treatment were virally supressed.

The proposed new global AIDS strategy calls for putting people at the centre of the HIV response, empowering communities and closing the gap on inequalities. “Nigeria is poised to be the next HIV turnaround country, after South Africa. We have all the ingredients to make this happen and I commend PEPFAR for working with the government, communities and partners to show the world that this is the only way to end this pandemic, by working with the affected communities,” said Erasmus Morah, the UNAIDS Country Director for Nigeria.

The Network of People Living with HIV in Senegal (RNP+) marked Zero Discrimination Day 2021 by hosting a dialogue on the extent and impacts of the stigma and discrimination faced by women and girls living with HIV in Senegal—a country in which the 2017 People Living with HIV Stigma Index showed one in two people living with HIV experienced stigma and/or discrimination from others.

“Discrimination continues to affect women and girls and this is the reason why they are often excluded from the labour market, are isolated in their communities or experience stigma in health centres. Key populations are also historically the target of discrimination in Senegal,” said Soukèye Ndiaye, the President of RNP+.

Various assessments undertaken in the country have revealed that women living with HIV face obstacles in accessing reproductive health services, that sex workers face high levels of stigma in health-care settings and that the economic and social vulnerability of women living with HIV is not sufficiently taken into account in HIV programmes.

This dialogue served as the spearhead for the advocacy strategy that RNP+ will develop this year on human rights and gender issues in order to better respond to the expectations of its members and communities affected by HIV. This strategy will be accompanied by communication tools such as videos in several local languages and dialogue and sensitization sessions with key actors in the regions most affected by HIV.

During the dialogue, the participants were invited to support the RNP+ in this process. In particular, they were asked to become “champions” committed to making a better use of journalists, community radio and social networks to sensitize the general public to the challenges of discrimination.

Abdoulaye Ka, in charge of human rights issues at the National AIDS Control Council (CNLS), recalled the importance of continued collaboration between the state and non-state sectors. “Community organizations and networks have long been essential in the fight against AIDS because of their central role in raising awareness, informing, dispelling myths and misinformation and providing services to marginalized, vulnerable and discriminated against populations.”

The dialogue, which was supported by UNAIDS, brought together about 30 participants, including people living with HIV, representatives of women’s movements and key populations, human rights advocates, policymakers and health service providers in a meeting held both virtually and physically.

“In Senegal, we know that discrimination against people living with HIV is still a major stumbling block in all aspects of the HIV response. The United Nations Joint Team on AIDS has always placed human rights and gender considerations at the centre of its work and support,” said Demba Kone, the UNAIDS Country Director for Senegal.

On 1 March, people around the world join together to celebrate Zero Discrimination Day, which this year highlighted the urgent need to take action to end inequalities.

In recent years, the Central African Republic has made the reduction of health inequalities a national priority. In mid-2019, 10 priority areas towards universal health coverage were established. These include the objective of ensuring that every citizen in the country has access to a health centre within 5 km of his or her home.

The country was the first to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination, which through harnessing the combined power of, and using the unique skills of, governments, civil society and the United Nations aims to consign HIV-related stigma and discrimination to history.

To mark Zero Discrimination Day this year, the country organized several activities ahead of and during the day. A declaration recalling the government’s commitment to non-discrimination and equality was issued by the Minister of Health and Population on television and radio. “It is only by addressing inequalities that we can achieve the Sustainable Development Goals, including those related to well-being and health for all,” said Pierre Somse, the Minister of Health and Population.

Recent studies show that inequality and stigma are major obstacles to access to health services. For example, more than 80% of people living with HIV in the country report having experienced discrimination or stigma. “These challenges are further compounded by conflicts and attacks on populations and health personnel that deprive hundreds of thousands of our citizens of their rights, including the right to life, dignity and health,” Mr Somse added.

A civil society consultation was organized to flesh out the priorities for the elimination of stigma and discrimination in the country. A round-table meeting was also held on a national network of human rights journalists radio programme to raise awareness on the negative impact of stigma and discrimination as a major barrier to people taking up HIV prevention, treatment, care and support services. Speaking on the programme, Aminata Adoum, of the National Association of Women Lawyers, highlighted the work of her organization in supporting women living with HIV against discrimination and violence.

On Zero Discrimination Day 2020, health professionals, including professional organizations of doctors, nurses and midwives, as well as patients’ associations, signed a National Charter for Quality of Care and Patients’ Rights that sets the principles of humanism, ethics and respect for dignity to guide relations between patients and health-care providers. This year, the patients’ charter was posted in health facilities in the capital city, Bangui, and dedicated sensitization sessions on the charter took place for medical staff in two major health-care centres in the capital.

“This Zero Discrimination Day campaign is part of a comprehensive set of priority activities to address human rights barriers to HIV services that the country will be implementing over the next three years, including community-led monitoring of human rights violations, know your rights education, legal services, the development of anti-discrimination law and engagement with community leaders, legislators and opinion-makers,” said Patrick Eba, the UNAIDS Country Director for the Central African Republic.