My name is Naadu Awuradwoa Addico and I work as a Project Officer at Planned Parenthood Association of Ghana (PPAG). On 24 May, I participated in a Ministerial meeting organized by the Global HIV Prevention Coalition titled High-Level Dialogue on accelerating HIV prevention and preparing for future pandemics.

In that meeting I shared the story of Abena, a young woman from Ghana who, at age 19, contracted HIV from a 40-year-old man who coerced her into transactional sex with the promise to fund her high school fees.

While I avoid the obvious details, I ask: What if Abena was empowered to negotiate for safer sex? What if she had access to Pre-Exposure Prophylaxis (PrEP)? What if she lived in a community with robust social support systems that catered for her needs?

You see, these are some of the reasons why HIV prevention cannot wait!

Many adolescent girls like Abena face poverty, disability, marginalization, discrimination and exploitation. These factors perpetuate HIV transmission and hinder an effective response to AIDS. Just last year, an adolescent girl or young woman acquired HIV every two minutes.

This is beyond alarming!

Policies and laws must allow girls to not only access HIV prevention services like PrEP, but also to complete their education regardless of their background and circumstances. Abena need not have paid such a heavy price to get the support she needed for her schooling.

In reference to the popular saying ‘teamwork makes the dream work’, young women and girls have a crucial part to play on this journey of ending AIDS. So, I appealed to Governments in the meeting as well as global leaders, donors and all stakeholders to provide resources and commit to ensuring girls like Abena can have equal access to knowledge, support and safe spaces to remain HIV free.

When you are developing and implementing HIV prevention programmes for young people and making critical decisions about our health and well-being, let our voices be heard and echoed. We want to work with you.

Right after taking his HIV treatment each morning, Antonio Hooker prepares a kit of fresh herbs and fruits he has bought at the local market to cross the Bilwa area, a village on the northern Caribbean coast of Nicaragua, as a health promoter for the Association of People Living with HIV (ASONVIHSIDA). He strengthens HIV prevention knowledge among vulnerable groups in his indigenous Miskitu community. He also teaches community leaders and people living with HIV or other health problems to use the power of natural medicine in conjunction with antiretroviral medicines to improve their immune systems.

Antonio is one of the dozens of volunteers and community promoters who have been certified by the Nicaraguan AIDS Commission, the Ministry of Health and the Institute of Natural Medicine and Complementary Therapies through training in "Self-Care in Sexual Reproductive Health and HIV from the Perspective of Natural Medicine".

Since his diagnosis 17 years ago, Antonio has learned the importance of self-care. He now shares his knowledge and training experiences with family members and others living with HIV in remote communities along the Nicaraguan coast.

"The course opened my mind to the importance of natural medicine and traditional practices, such as massage and meditative activities," says the health promoter. "We know these techniques work because we see improvement in our health while seeing progress in adherence to HIV treatment, as well as strengthening social, community networks and relationships within the families of people living with HIV."

The course "Self-care in Sexual Reproductive Health and HIV from the Perspective of Natural and Holistic Medicine" aims to provide guidelines on self-care for people living with HIV or similar conditions and their families. Through the appropriate use of medicinal plants, reflexology (a system of massage used to relieve tension and treat illness, based on the theory that there are reflex points in the feet, hands and head linked to each part of the body) and complementary therapies, such as the practice of the Chinese martial art and system of callisthenics well known as Tai Chi Chuan, which consists in sequences of slow controlled movements. 

"The objective is to build skills and abilities among people living with HIV, volunteers and active community members to develop a comprehensive approach to sexual and reproductive health, sexually transmitted infections (STIs) and HIV," explains Dr Enrique Beteta, Nicaragua's Deputy Minister of Health. "It also allows people to access information and linkage to health services at the local level to take care of their health and the well-being of those around them."

The services harnessing natural medicine are complementary, not alternative, to HIV medicines. Indeed, the programmes have helped increase uptake of and adherence to HIV medicines.

Nicaragua’s comprehensive approach and partnership with communities has helped it to advance progress on treatment and prevention. Since 2010, Nicaragua has experienced a 20% decrease in new HIV infections, while in Latin America, new infections have increased by 5% in the same period. About 11 000 people live with HIV in the country, and 90% have been tested and know their positive diagnosis, above regional (82%) and global (85%) rates.

The course offers 84 hours of theoretical and practical training, a quarter of which is focused on Sexual and Reproductive Health and HIV modules. The certification also focuses on putting people at the centre, not only as beneficiaries but also as key protagonists, participating, exercising and demanding access to their rights for equality and equity.

"The course also aims to identify in people the autonomy to make decisions, as transformative agents, in a framework of respect, solidarity and social justice," explains Marie Engel, Director of the UNAIDS Multi-country Office for Guatemala, Honduras and Nicaragua. "Working to eliminate stigma and discrimination is also an important outcome of this initiative."

Brazil has joined the 34 countries that are part of the Global Partnership to take action to eliminate all forms of HIV-related stigma and discrimination. The country's entry into this group of nations was announced at a celebratory event of the International Day Against Homophobia, Biphobia, and Transphobia, held in Brasilia, Brazil’s capital and organized in partnership by UNAIDS, ILO, and the Ministry of Human Rights and Citizenship.

The Global Partnership is an initiative launched through a call for action from the NGO Delegation to the UNAIDS Programme Coordinating Board (PCB) in 2018 to remove HIV related stigma in six settings: healthcare, justice, community, workplace, educationa and humanitarian.  It is co-convened by UNAIDS, UN Women, the United Nations Development Programme (UNDP), the Global Network of People Living with HIV, and the Global Fund to Fight AIDS, Tuberculosis, and Malaria. It is also supported by a technical working group composed of 10 United Nations agencies and 24 partners and civil society organizations.

With Brazil, now 35 countries have formally joined the Global Partnership, committing to act against HIV-related stigma and discrimination in the contexts of healthcare services, educational settings, workplaces, justice systems, domestic and community environments, emergency systems, and humanitarian crises.

According to Luisa Cabal, the Regional Director of UNAIDS in Latin America, Brazil's entry into the Global Partnership is a significant step in the collective response against HIV-related stigma and discrimination in Latin America and the world. "By joining this initiative, Brazil reaffirms its commitment to defending human rights, promoting social inclusion, and eliminating barriers to access prevention, diagnosis, treatment, and ongoing response to HIV," she explains.

By joining the Global Partnership, Brazil will have access to a platform that will allow the country to share experiences and best practices with the other participating countries, creating opportunities for collective learning, strengthening the joint response to HIV-related stigma and discrimination.

"It is important to highlight that by joining the Global Partnership, Brazil will also reinforce its leadership role in the region and global diplomacy for health and human rights, demonstrating its commitment to equity and social justice," emphasizes Luisa Cabal.

It is indeed a precedent for the GP that commitment to join the Global Partnership has been witnessed by two Ministers.

Minister of Human Rights and Citizenship Silvio Almeida reiterated his unrestricted support and commitment to public policies promoting and protecting the rights of LGBTQIA+ people. ”For those who suffer violence, and are killed simply for being who they are, these people will be protected in a public commitment, and I renew this commitment not only as Silvio Almeida, but as Minister of State for Human Rights of Brazil” emphasized H.E.

Representing the Ministry of Health Helvécio Miranda, Secretary of Specialized Health Care, similarly shared the Ministry's commitment to embrace the agenda of LGBTQIA+ rights and ensure comprehensive healthcare access for all people emphasizing on a gender approach, and with a special focus on those at risk, with specific needs, or experiencing different forms of violence.

Vinícius Pinheiro, Director for Brazil at ILO, embraced the significance of the Global Partnership in promoting social justice and decent work with inclusion and opportunities for all people so that no one is left behind.

The University of San Carlos de Guatemala (USAC) Faculty of Medical Sciences, in collaboration with UNAIDS, the World Health Organization (WHO), and the United Nations Population Fund (UNFPA), launched an online course titled "Conceptos clave sobre VIH, Género y Derechos Humanos" (Key Concepts on HIV, Gender, and Human Rights). The four-module course is designed to provide teaching staff with detailed knowledge about key concepts related to HIV, its treatment and prevention, and the national and international legal framework guiding the response to HIV, as well as the gender and human rights dimensions of the epidemic.

With an estimated three new HIV infections each day in Guatemala and only 73% of the estimated 31,000 people living with HIV receiving antiretroviral treatment and persisting high level of stigma and discrimination towards people living with HIV, the course is a significant step towards addressing the country's HIV challenges. The course aims to provide teaching staff and students with the necessary resources to promote, protect, and fulfill the human rights of adults, adolescents, and children living with or at risk of acquiring HIV, in all their diversity.

The course consists of 140 hours of study, including 70 hours of theory and 70 hours of practice, and will be undertaken between May and August 2023. Course participants will join virtual classes and synchronous group workshops and will have to submit the required tasks according to a work schedule.

The course covers four modules: Module 1 - Update on HIV and AIDS; Module 2 - National and international legal framework for the response to HIV; Module 3 - Health sector Policy framework for HIV response; Module 4- Key concepts on gender and human Rights.

During the inauguration, Marie Engel, UNAIDS Country Director, expressed her hope that participants would enjoy taking the course as much as she and other partners had in developing it. She also emphasized that "the course will be enriched with participants' individual knowledge and experiences, their doubts and concerns. There is obviously a lot of knowledge and wisdom among course participants that the facilitators will strive to capture."

Dr. José María Gramajo, General Coordinator of the USAC Faculty of Medical Sciences' Area of Teachers and Postgraduate training, highlighted that "this refresher course will contribute to the professional development of faculty teachers, sharing with them the latest knowledge about innovations related to HIV prevention, detection, and care, and ensuring an in-depth understanding of cross-cutting issues relevant to HIV and other public health problems."

Teaching staff and students are catalysts with the power to change the national response to HIV. As stated by Dr. Mirna Herrarte, Coordinator of the national HIV, STI, and AIDS program, "I am glad to know that there are so many professionals who want to know more about HIV. In the country, HIV treatment schemes are constantly reviewed. As an anecdote, Guatemala had more than 200 antiretroviral schemes a year ago. Under my leadership, we have reduced those schemes by 75%."

Inequalities persist in the most basic health and HIV services, such as access to screening, treatment, and condoms. USAC's collaborative initiative is an important step towards ensuring that all sectors, including academia, are engaged in ending social, economic, and legal inequities. The University of San Carlos de Guatemala is the largest and oldest university in Guatemala, and the only national and public university in the Central American country. 

For many years Mami taught at a state school in Kanazawa, Japan. When she started transitioning and dressing in a less masculine way, her colleagues and supervisors frowned upon it. Finally, she was fired.

As a transgender woman in a small, conservative city, Mami struggled to find another job and felt very isolated. “When a friend invited me to work at the Kanazawa Rainbow Pride community centre, I was happy to have a place where I was accepted,” she said.

Founded in 2022, the Kanazawa LGBTQI+ centre is in a 150-year-old tea house in what was the city’s former Samurai marketplace. The sliding panels allow for a variety of configurations depending on gatherings. Mami and her friend, Kennosuke Okumara, Head of the Kanazawa centre’s secretariat, were serving tea and coffee in the open bar kitchen to visitors.

“Before I worked in Tokyo but I returned to my native city,” Mr Okumara explained. “The problem was that there were and are no options for gay people here,” he said.  Mr Okumara lives with HIV and laments the fact that HIV and LGBTQI+ issues are still taboo. “There is so little information, it is a shame and I am here to share my experience and share more awareness,” he said.

Mixing a green tea in a small cup with a bamboo whisk, Mr Okumara in his apron paused and looked at Mami. “This is a safe space for all here,” he said.

Diana Hoon, the centre’s co-President called the centre a beacon of hope. “We are like a lighthouse in a very conservative, patriarchal society,” she said. Showing off the many pamphlets and flyers varying from knowing one’s HIV status to the Pride parade in the city to books about coming out in the makeshift library, Ms Hoon said that the centre not only was attracting more people, they also had 10 volunteers helping out... many of whom are mothers.

"Our parent seminars about LGBTQI+ have had a lot of impact,” she said. “People share stories about their children and a connection is made.”

As a Singaporean living with another woman who is originally from Kanazawa, Ms Hoon feels like she is doing her part to provide a lifeline for people and push for more acceptance.

“Among our many priorities we do HIV awareness as well as advocate for gender neutral toilets, gender neutral school uniforms and most importantly marriage for all, which does not yet exist in Japan,” she said. She also hopes that within five years they can add a shelter to house LGBTQI+ people.

In her mind there have been incremental steps. “Transgender people have been more outspoken of late and we have LGBTQI+ champions among the community,” she said.

Such a role model is Gon Matsunaka, Founder and former President of the Pride House Tokyo consortium and the Director of the Marriage for All movement in Japan. A former advertising executive for one of Japan’s top firms, Dentsu, Mr Matsunaka hid his sexuality for decades. “For me there was no future in my rural hometown, so I left for Tokyo,” he said. He then studied in Australia, worked in Tokyo as well as New York City and ultimately left his firm.

He came out as gay in 2010 and fixated on providing a community centre in Tokyo. The Olympic Games seemed like a golden opportunity.

The COVID pandemic struck, putting a lot of projects on hold but Mr Matsunaka and his team did not give up.

“In May 2020, survey after survey revealed that LGBTQI+ youth felt unsafe at home or they had lost touch with people, this really motivated me,” he said. He had secured 15 sponsors for a temporary LGBTQI+ safe space during the Olympic and Paralympic Games, called Tokyo Pride House. With the postponing of the Games however, the centre was cancelled.

The team persuaded the sponsors to shift their funding and create a permanent space. Years after the Olympics, Tokyo Pride House still stands proud within walking distance of the popular queer-friendly Shinjuku area in Tokyo.

In Kanazawa, Mr Matsunaka had linked up with Ms Hoon to start a Pride parade in 2021. Out of that success came the idea of a community centre.

Mr Matsunaka is particularly proud that the prefecture (city district) contributed half the funds to the Kanazawa Nijinoma centre. The rest was a result of crowdfunding.

Beaming in the Tokyo Pride House surrounded by rainbow flags, he said, “I never dreamed of this and never imagined it could be possible especially in a small city like Kanazawa.”

In his mind, women have been key. “Women have 2^nd rank to men especially in rural areas like Kanazawa, so they have been our greatest allies to change the patriarchal mentalities,” he said. “Mind you we have a lot more work ahead, but I only want to go forward not backwards."    

On International Day Against Homophobia, Biphopia and Transphobia (IDAHOT), UNAIDS stands in solidarity with the LGBTQI+ community. We must unite and celebrate diversity; a society where everyone, no matter where they live or whom they love, is able to live in peace and security; a society where everyone can contribute to the health and well-being of their community.

Alexander Godin moves through a number of locked doors escorted by a guard to prison 16’s pharmacy. This is part of his daily routine. He comes to get his medicine – a syrup-like dose of methadone. Methadone is an opioid agonist therapy (OAT) to help people overcome withdrawal symptoms, decrease heroin dependence and prevent HIV infection from infected needles.

Since 2000, a few prisons in Moldova offered such harm reduction services.

Now all do.

“I have been on methadone substitution treatment for 10 years,” said Mr Godin. His family urged him to take advantage of such services so he could get healthy again.

“For years I used drugs and opioids and for this, money was needed so problems began among my family,” he said.  Since he has been on the programme, he feels much better.

Any new prisoner to the country’s 17 penitentiaries sees a psychiatrist, a doctor and if needed is offered to join a treatment programme. Comprehensive harm reduction services not only include drug dependence treatment but also needle syringe exchange and HIV testing and treatment. HIV prevalence is 11% among people who inject drugs in Moldova vs 0.36% among the general population.

They are one of the most affected groups in the country. 

For Maria Potrîmba Head of Infectious Diseases at prison 16 (Pruncul) helping prisoners stave off drugs has positive knock-on effects.

“If a patient is on this substitution treatment the person is more aware of consequences and will more likely adhere to their other treatment,” she said.

The prisons also make sure to provide clean syringes with a regular pick-up every two days carried out by volunteer prisoners.

The head of medical unit at prison 13 (Chisinau) believes harm reduction services are important for both inmates and prison employees.

“The volunteers are all prisoners and the vast majority of them are also people who have been treated for communicable diseases like HIV or hepatitis or tuberculosis,” Oleg Costru said.

Moldova has committed more resources to the prison programme over the years. “In the beginning, when these services were developed, they were actually financed from external sources,” said Irina Barbîroș, head of the medical department at the national prison administration. “Over the years, the state assumed its commitment and took over the financing of these services from the state budget.”

UNAIDS, UNODC and WHO have been long-time supporters of expanding these services to all prisons. Currently, according to Harm Reduction International, only 59 countries globally provide OAT in prisons.

This, even though harm reduction has been proven to not increase the number of people with drug dependency but rather provide personal and public health benefits.

Svetlana Plamadeala, UNAIDS Moldova country director, has seen the pilot projects gain traction in the country and is quite proud of the success of the nationwide coverage.

“It is really about putting people in front and people at center as well as taking on a solid public health approach,” she said. For her, to end AIDS, protecting the health and human rights of people who use drugs is key. “It is about equalizing.”

Daouda Diouf comes daily to the Fann Hospital compound daily. He is one of 250 people enrolled in CEPIAD*’s opioid substitution therapy programme (OST). OST is a globally recognized intervention to reduce injecting behaviours that put people who inject drugs at risk of contracting HIV and other blood-borne diseases, such as viral hepatitis.

“I am here to take my treatment and I am also a tailor, so I teach a few other users of drugs how to sew,” Mr Diouf said, cutting fabric in his makeshift outdoor workshop. Keeping occupied and selling his wares has helped him stay healthy for the last seven years.

Another enrollee agrees. He has found a passion for gardening and now oversees other patients at the centre’s green area.

For El Hadj Diallo, planting seeds, pruning trees is like a type of therapy. “When we are here, we forget our problems, I am happy doing it and it’s therapeutic for me,” he said.

Their other therapy consists of a daily dose of methadone. Mangane Boutha, the centre’s pharmacist carefully measures and distributes each dose in his office.

“Methadone is a medicine that acts as a heroin substitute, in our case it’s a syrup that is dosed in 10mg/ml portions with doses varying from patient to patient,” he explained.

Founded in 2014, CEPIAD has cared for more than one thousand people and is one of the first harm reduction centres in West Africa. Aside from opioid substitution, clean needle exchange and psychosocial support, they also offer health care.

“CEPIAD has become a testing and diagnostics center for HIV, and also tuberculosis as well as hepatitis and we distribute condoms,” said Dr Idrissa Ba, who coordinates the centre.

In Senegal, HIV prevalence among people who inject drugs is 9%, well above the 0.5% among the general population. Globally, due to stigma and criminalization, people who inject drugs face a 35 times higher risk of acquiring HIV than people who do not inject drugs.

Three-quarters of patients here are men but CEPIAD has been working hard to reach more women. Among people who use drugs, women are more likely to live with HIV, according to Dr Ba.  

Mariama Ba Thiam, who formerly used drugs, lived for years on the streets. She is now a peer educator in Dakar.  “I go out into the community and visit colleagues to raise awareness about getting off drugs and also how to reduce health risks so I refer them to CEPIAD and they can do like me, stop drugs,” she said.

Her plea: Get more funds to get more women and young people to come to the centre.

In Senegal, whilst drug use is a criminal offense, CEPIAD’s work has the support of the government, the United Nations as well as other partners.

On international Harm Reduction day, UNAIDS firmly believes that if we are to end AIDS by 2030, we can’t leave anyone behind. And that includes people who use drugs.

*The Centre de Prise en Charge Intégrée des Addictions de Dakar (CEPIAD)

On April 14^th members of the Cook Islands rainbow community assembled at parliament with colourful flags and cautious optimism. It turned out to be the day they’d been working toward for the last twelve years. Parliament removed laws prohibiting consensual sex between men, striking out sections of the Crimes Act that had been on the books since the turn of the 20^th century.

“This decision by Cook Islands is part of a wave of global progress around abolishing harmful laws,” noted UNAIDS Asia Pacific Regional Director, Eamonn Murphy.

“This was a huge historical moment,” said Valery Wichman, President of the Te Tiare Association, the nation’s oldest lesbian, gay, bisexual and transgender (LGBT) organisation. “It’s not just a win for the community, but also a shift in terms of our nation maturing and upholding the constitutional rights of all people.”

Ms Wichman, an attorney and public servant, is also an akava'ine—a Māori word meaning transgender woman. She attests that the anti-LGBT laws which made so-called “sodomy” and “indecent acts” punishable by imprisonment reinforced prejudices. This contributed to the LGBT community’s exclusion, harassment and bullying. She has herself experienced being mocked and assaulted.

“A lot of people chose not to live here. It was too hard for them to endure their family’s and society’s judgment. The idea that you are not worthy has carried down from parents to children and has affected how we have been treated by our peers. A lot of trans women have not gone to the doctor because they have been misgendered and have felt disrespected. There have been cases where they ended up dying,” she said.

The journey toward law reform started in 2011. The spark was the discriminatory response to the nation’s first HIV diagnosis. Te Tiare led the advocacy charge with support from organisations including the Cook Islands Family Welfare Association.

A Crimes Bill drafted around 2013 removed the discriminatory clauses. In 2017 parliament set up a Standing Committee to review its raft of proposed revisions. Support for civil society to prepare submissions outlining public health grounds for reforms was provided by the United Nations Development Programme (UNDP), the lead agency amongst the United Nations Joint Programme on HIV and AIDS working on effective democratic governance and issues affecting sexual and gender minorities.

But following a political change the next year, the committee’s Chair recommended retaining the ban on gay sex. What’s more, he proposed a new section criminalising sex between women. The bill remained in limbo for years. Reform efforts seemed to hit a wall.

A strategy of public dialogue and political engagement rooted in Cook Islands culture enabled a breakthrough. Pride Cook Islands (PCI) was formed as a sister organisation to Te Tiare, focusing on this public advocacy branch of work.

“Obviously we are in a unique situation as a small, conservative, religious population,” PCI President, Karla Eggelton began. “The work of advocacy becomes more delicate when you are living beside people making these decisions for you. We welcomed support from international allies, but we knew we had to do this our own way and have our own approach that is mindful of the situation and culture we live in.”

First TCI tackled messaging. There were deep deliberations around word choice. The mandate was to keep the conversation simple. Ultimately the cause was framed as an equality issue. The rallying cry became, ‘don’t make us criminals in our own country’.

The organisation stayed in communication with policymakers on both sides of aisle. They not only explained their position, but sought to understand politicians’ concerns.

The group met with traditional leaders who are grassroots decision-makers. Village communities were invited to have conversations during public meetings.

“It offered an opportunity for us to understand the misperceptions. We were able to explain that all we are asking for is to not be made criminals. People said, ‘we don’t want to send you to jail, we love our neighbours and our family’,” Ms Eggelton remembered.

The organisation’s patron is Lady Tuaine Marsters whose husband, Sir Tom Marsters, is the British King’s Representative. Lady Marsters frequently attended consultations. Other spokespersons included parents and people with standing in the church. At times supporters were invited to simply stand in solidarity. But anyone who would speak was carefully prepared.

“We spent hours articulating what we would say. We reaffirmed our pledge to not become emotional. We had to keep each other in check to make sure we did not say anything we could regret,” Ms Eggelton outlined.

Then came an effort to increase visibility. The call for equality was largely coming from the LGBT community. They needed other people to demand the same. So PCI embarked on a campaign for people to show their support either by lending their voice to the public dialogue or flying the rainbow flag.  The group distributed free flags, urging people to fly one for their daughter, son or grandchild. From restaurants to bars, t-shirts to earrings, the display of support resonated.  

A first-of-its-kind pride ad on TV, newspapers and radio challenged Cook Islanders: “We are good enough to be your teachers, nurses, choreographers, dressmakers and orators… but not good enough in the eyes of the law. We are already part of your community, we are just asking you to recognise us as equals.”

This visibility and advocacy work was supported by UNDP through the Being LGBTI in Asia and the Pacific program. PCI developed a project to strengthen the digital capacities of community organisations. A critical outcome was the Pride Pledge Cook Islands initiative with the business community which provides visible safe spaces for LGBT people.

“The UNDP support was instrumental in promoting acceptance and awareness and utilising digital tools to share our message,” Ms Eggelton said.

TCI conducted frequent polls to gauge public sentiment. At the start of the process they lagged behind reform opponents. But by the time would-be Prime Minister, Mark Brown, made an election promise to change the law last year, public sentiment had tilted.

“Once we were able to establish that it was really about equality, then we saw a changing of the tide,” Ms Eggelton reflected.

Ultimately the entire government bench voted in favour of an Amendment Bill while opposition leader, Tina Brown, and two of her Members of Parliament also supported.

Renata Ram, UNAIDS Country Director for Fiji and the Pacific, noted that seven other countries in the Pacific region retain laws criminalising same-sex relations.

“The Cook Islands example proves that along with law reform we can have national dialogues about inclusion, justice and equity,” Ms Ram said.

At a national ceremony marking the end of the South Pacific cyclone season the rainbow community gathered once more, this time to give thanks.

“We want to make sure people understand our gratitude for everything that has transpired and for everyone who worked hard to achieve this,” Ms. Eggelton said. “Our community is now recognised through the eyes of the law as being equal. Now people can feel safe, not like second class citizens.”

In 1988, a group of activists came together in Fortaleza, the fifth largest city in Brazil and capital of Northeastern state of Ceará, to create the local chapter of the National Network of People Living with HIV and AIDS (RNP+CE). The aim was to ensure that people living with HIV could be guaranteed the right to care, treatment adherence, and legal assistance.

Currently, the NGO (Non-Government Organizations) also offers educational workshops, support for the combination prevention of sexually transmitted infections (STIs), and other activities for more than 1,000 registered people. Among them is Carlos Salmão, an HIV activist living in Fortaleza, who felt individually and collectively welcomed by the organization. "This support was very important to me and is fundamental for people living with HIV here in Ceará because it is a reference of the response to the AIDS epidemic. That is why I feel pleasure in contributing", he explains.

The RNP+CE was one of five Brazilian NGOs that received resources from the Fast-track Cities grants initiative, launched by UNAIDS in 2022. With the award, the organization developed actions around two objectives: increasing linkage and adherence of vulnerable key-populations to HIV prevention, diagnosis, and treatment by disseminating and sharing information with health professionals as well as the general public; and improving the knowledge of the Undetectable Equals Untransmittable (U = U) strategy in the city of Fortaleza by carrying out communication campaigns.

Project actions and participation of municipal government

The project involved 10 local HIV-positive activists in the development and implementation of the communication campaigns. They also were involved in preparing a seminar that brought together 120 people from civil society to dialogue about and to present to municipal government representatives proposals to improve the care for people living with HIV, based on the perspectives and actual needs of the users of public health services in Fortaleza. An additional theme of discussion was the challenges and the importance of guaranteeing a satisfactory level of adherence to HIV treatment to avoid abandonment.

Still as part of the project, a booklet on HIV, self-esteem and health was produced and distributed, providing practical information for people who receive a positive diagnosis for HIV. Additionally, in coordination with the municipal government, RNP + CE printed and distributed more than 3,000 copies of posters on HIV treatment adherence and on U = U. This material was displayed in places with high concentrations of people, such as bus terminals, reaching about 1.1 million people daily.

Participation of local government officials was a strategic element to the project’s success, as they are in direct contact with reality and the existing challenges. "We are still far from reaching an ideal level where there is less need to reinforce these [HIV] actions, but we are advancing in this direction through constant and well-structured work", says Carlos Paiva, coordinator of IST/AIDS at the Municipal Health Secretariat of Fortaleza.

Ariadne Ribeiro, UNAIDS Officer for Equality and Rights for All People, agrees and adds: "It is rewarding to see how the dialogue between communities, civil society, and the municipal government is moving towards a common goal, which is the improvement of public policies in the city of Fortaleza for people living with HIV and to end AIDS as a threat to public health."

Although great strides have been made in tackling HIV in recent years, Africa remains the continent most affected by HIV and progress towards ending AIDS is stalling. The COVID-19 pandemic, global inflation, growing debt levels, and a retreat from overseas development assistance by some donors are hampering Africa’s efforts to ramp up national HIV responses and are jeopardizing broader outcomes for health, social development and economic growth.

UNAIDS estimates that globally, low and middle-income countries will need investments of US$ 29 billion annually to meet targets of ending AIDS as a public health threat by 2030. In 2021, only US$ 21.4 billion was spent on HIV responses low and middle-income countries. 

In order to advance urgent and collaborative action to keep HIV high on political agendas and re-prioritize funding for health and HIV, African ministers of finance joined international partners on the sidelines of the World Bank / International Monetary Fund Spring meetings in Washington DC to explore ways to ensure financial sustainability of domestic HIV responses.

During the event, Ministers of Finance and senior representatives from Angola, Burundi, Democratic Republic of the Congo, Eswatini, Kenya, Lesotho, Nigeria, Mozambique, Rwanda, South Sudan, Tanzania and Uganda, and the Minister of Health of Côte d’Ivoire came together with global partners, including PEPFAR, the US Department of the Treasury, UNAIDS and the Global Fund to Fight AIDS, TB and Malaria.

Participants explored co-creating country-led paths towards the sustainability of the HIV response within broader health financing challenges. In the dialogue with Ministers of Finance, several issues were explored, among those, the need to overcome financing bottlenecks for HIV, expand local production of medicines and health technologies, or strengthen health systems and pandemics preparedness, while considering the relevance of developing joint HIV financial sustainability road-maps. 

The event, ‘Investing in Sustainable HIV Responses for Broader Health Security and Economic Resilience in Africa’, was moderated by Donald Kaberuka, Chair of the Board of the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the African Union’s High Representative for Financing, the Peace Fund and COVID-19 response. The event included remarks by;

• Alexia Latortue, Assistant Secretary for International Trade and Development, US Department of the Treasury,
• Dr. John N. Nkengasong, US Global AIDS Coordinator and Special Representative for Global Health Diplomacy, PEPFAR, US Department of State,
• Winnie Byanyima, Executive Director, UNAIDS, and  
• Symerre Grey Johnson, Head of Regional Integration Infrastructure and Trade, New Partnership for Africa's Development (AU/NEPAD)

Participants also reflected on the finding of the recently released report by the Economist Impact, supported by UNAIDS, titled A Triple Dividend: The health, social and economic gains from financing the HIV response in Africa. The report provided evidence showing that fully financing the HIV response to get back on track to achieve the 2030 goals will produce substantial health, social and economic gains in 13 countries in sub-Saharan Africa. 

This meeting was the first in-person discussion among ministers of finance and international partners around the sustainability of the HIV response held since COVID-19 travel restrictions were lifted. The meeting will be followed by a series of regional and in-country engagements to advance the financial, political and programmatic sustainability of the HIV response in preparation for the African Union’s Assembly of Heads of State Extraordinary Session on Ending AIDS by 2030.