Following a one-week visit to Tanzania and Zanzibar to launch the 2022 Global World AIDS Day report; to commemorate World AIDS Day; and to see first-hand the extraordinary work of joint efforts by the government, partners and communities to end AIDS in Tanzania and Zanzibar, UNAIDS Executive Director Winnie Byanyima issued the following statement:

“I observed strong commitment from the Government of Tanzania, our partners and activists at the frontlines fighting the HIV epidemic.

In particular, I thank Tanzania for hosting the launch event of this year’s World AIDS Day report “Dangerous Inequalities” on 29th November in Dar es Salaam, and for inviting me to join the World AIDS Day commemoration on 1st December in Lindi, Tanzania.

For the report launch, I thank our guest of honour, Hon. Minister George Simbachawene, Minister of State in the Prime Minister’s Office, for committing to end inequalities to end AIDS in Tanzania. The civil society representative, Chair of the National Council for People Living with HIV, Ms Leticia Mourice Kapela, added the commitment of communities to the theme “Equalize”, as did Deputy Minister of Health, Hon. Godwin Modell, on behalf of the Ministry of Health.

We are honoured by Her Excellency President Samia Suluhu Hassan leading the World AIDS Day commemoration, and grateful for her Government’s commitment to ending the AIDS pandemic. H.E. President Hassan spoke powerfully on the need to overcome inequalities in the AIDS response and called on TACAIDS to reduce inequalities, prevent new HIV infections and address stigma and discrimination. I commend H.E. President Hassan for her country joining the Education Plus Initiative in the lead up to World AIDS Day.

I also congratulate Tanzania for being the first country to join the Global Alliance to End AIDS in Children and I thank H.E. President Hassan for agreeing to host and participate in the launch of the Alliance early next year. No baby should be born with HIV, and no child living with HIV should be without treatment.

I welcomed the opportunity to visit the Mukikute Harm Reduction programme in Tanzania, which gives hope and dignity to people who inject drugs. I was uplifted by the passion of this community to mobilize and empower.

I was equally grateful for the opportunity to meet with allies, including ZAPHA+ and the Zanzibar Key and Vulnerable Population Forum (ZKVP-Forum).

Over the past 12 years, Tanzania has been able to reduce new HIV infections by almost 50% and to cut AIDS related deaths by 50%. 86% of Tanzanians who live with HIV are on treatment. I congratulate Tanzania on their leadership in the AIDS response. Together, with the required commitment and resources, and by bringing an end to societal and economic inequalities, we can end AIDS as a public health threat by 2030.

In closing let me reiterate the commitments that I made to Tanzania and Zanzibar in our joint efforts, namely to:

1. Strengthen UNAIDS presence in Dodoma, the national government capital of Tanzania, to support TACAIDS, Ministry of Health and other Ministries in the AIDS response.
2. Collaborate with the Ministry of Health in hosting the Ministerial launch of the Global Alliance and the development of the country action plan.
3. Move forward Education Plus in Tanzania by ensuring that more children get enrolled in and complete secondary school.
4. Support Tanzania and Zanzibar in the funding request application for the Global Fund HIV/TB grant.
5. Support and strengthen collaboration between the governments of Tanzania and Zanzibar and networks of people living with HIV and other community groups that are vulnerable and at high risk for HIV infection.

I thank the government, civil society and partners of Tanzania and Zanzibar for my visit.

U=U, which stands for Undetectable = Untransmittable, is a vital public health message for the HIV response. Undetectable = Untransmittable means that people living with HIV who achieve an undetectable viral load through consistent antiretroviral treatment and monitoring cannot transmit HIV. As Thailand has shown, the message of U=U also helps in combatting the stigma which people living with HIV can face in healthcare settings and wider society.

U=U is a priority activity in Thailand’s 2017 – 2030 National Strategy to End AIDS. The approach has already been tested in the capital city, Bangkok. A same-day treatment initiation programme there has resulted in more than 95% of people on treatment achieving viral suppression after just six months of antiretroviral therapy. The national initiative brings together Thailand’s Institute for HIV Research and Innovation (IHRI), the Department of Disease Control, the Ministries of Public Health, Education and Labor, the National Health Security Office, and the Subcommittee on the Promotion and Protection of AIDS Rights, supported by UNAIDS.

Thailand’s wider HIV response has achieved strong results, with an estimated 94% of people living with HIV aware of their status, 91% of diagnosed people on treatment and 97% of those on treatment virally suppressed. But despite these successes, barriers remain as a result of stigma. There are too many late diagnoses, and some people remain fearful about accessing HIV services. To increase use of HIV services, to achieve U=U for all people living with HIV, it is vital to ensure that every person is treated with respect and dignity by the healthcare system.

Dr. Nittaya Phanuphak, Executive Director of the IHRI, emphasized that knowing one’s HIV status is the critical first step to enrolling in antiretroviral treatment.

“People at risk of contracting HIV and people living with HIV from all groups in Thailand must have equal and convenient access to HIV testing and, if positive, to antiretroviral treatment as soon as possible, which will lead to U=U,” said Deputy Minister of the Public Health Ministry, Dr. Sopon Makthon.

Thailand’s U=U initiative embraces a community-led approach which enables people living with HIV to support others who are newly diagnosed to start and stay on antiretroviral treatment. “Community leadership is vital to communicate U=U effectively,” said Patchara Benjarattanaporn, UNAIDS Country Director for Thailand. “This will help tackle stigma and self-stigma, and help boost positive health-seeking behavior.”

Apiwath Kwangkaew, president of the Thailand HIV/AIDS Network, urged all health workers to amplify the message of U=U: “Today's medical personnel must confidently explain U=U to enable social understanding. Health services must be brave and speak up. New understanding will bring change,” Mr. Kwangkaew said.

“UNAIDS welcomes amplification of the message that U=U. It is key to reaching the goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths,” concluded Taoufik Bakkali, UNAIDS’ Regional Director.

“This isn’t your mother’s clinic!” said one amazed visitor.

From banners to brochures, all promotional materials are slick and cheerful. Smiling faces and toned torsos are everywhere. A purple colour scheme covers the whole building. Even files and staff face masks are colour coordinated. A pair of Facebook Live hosts have the good looks and energy of K-pop stars. And the organization’s slogan is decidedly upbeat: “where community fulfills your happiness”.

Over almost two decades, Thailand’s Mplus Foundation has refined a unique approach to providing comprehensive HV services to key population clients including men who have sex with men and transgender women.

Their method goes far beyond a cool brand identity. Mplus has leveraged domestic and international partnerships to create a key population-led health service with impressive results. They dispense more than half of the PrEP in Thailand’s Chiang Mai province.

This year they tested 95% of the almost 8000 people they reached with face-to-face services. Of those who tested positive, 91% were placed on treatment while the other 9% are in follow-up case management. And 100% of their clients who received viral load testing were found to be virally suppressed.   

“Community organizations can best reach key populations to receive services. We find that people who do not want to get tested at the hospital are comfortable with peers who they know understand their  life,” explained Pongpeera Patpeerapong, Director of the Mplus Foundation.   

Since its formation in 2003 Mplus has evolved to deliver a full range of services. They now have health centres in four provinces, while their mobile testing units serve clients in another five districts. They support a local hospital in each province, linking people to care and helping them with adherence. Mplus provides rapid testing, CD4 and viral load monitoring, and is also authorized to dispense medication. A small fleet of motorcycles even makes PrEP deliveries to clients in remote areas.

Both their online and offline engagements are anchored by a peer-led strategy. Their social media presence is commanding—everything from Twitter to Tik Tok. There are closed Facebook groups and special applications for clients to connect with community. Offline, they go beyond information booths to host parties and sport meet-ups. These aren’t just bonding exercises. Clients book appointments online and face-to-face interactions usually result in receiving an HIV test.

Mplus also provides technical assistance to other countries. It has supported an organization in Laos with online interventions and helped community groups in Cambodia develop campaigns to promote PrEP.

They played a key role in advocating nationally for the accreditation of community health workers. All Mplus staff are certified by the Department of Disease Control following a rigorous programme of study, evaluation and practice.

The programme continues to progress.  Mplus is strengthening their mental and emotional health support offering, and is working towards becoming certified to provide HIV and sexually transmitted infection (STI) treatment.

While in the past the programme was more heavily funded by the U.S. President's Emergency Plan for AIDS Relief through the United States Agency for International Development, today half of their investments come from branches of the National Health Security Office.

“Domestic funding is very important to develop our systems,” Mr. Patpeerapong said. “Community-based organizations have to be able to access domestic funding to cover more issues, including stigma and discrimination.”

Empowering key population-led health services has been crucial in improving Thailand’s HIV programme results. One of five people living with HIV in Thailand were identified and referred by a key population-led health service under the domestic health financing scheme. Four out of five people on PrEP in the country are served by community-led organizations. These services play a critical role in Thailand’s  strategy of Reach, Recruit, Test, Treat, Prevent, Retain.

“Thailand is well-positioned to be a leader in addressing the need for a sustainable community-led response as a critical part of the health infrastructure,” said UNAIDS Country Director for Thailand, Patchara Benjarattanaporn. “By creating an enabling system for health outreach we can address the challenge of late diagnosis and better reach key population communities with services.”

Thailand has integrated HIV services into its Universal Health Coverage scheme and increased investments in key population- and community-led health services. UNAIDS Programme Coordinating Board (PCB) members visited Mplus and other community-led health services ahead of the 51^st PCB meeting in Chiang Mai, Thailand.

Tanzania became the 13^th African country to join the Education Plus Initiative, committing to provide greater investments to ensure boys and girls complete secondary school. 

Education Plus is an initiative spearheaded by UNAIDS to accelerate action and investments in education to prevent HIV. Evidence shows that completing secondary education reduces the risk of HIV infection and early pregnancy and improves their livelihoods and prosperity for girls and young women. The education Plus initiative is centred on empowering adolescent girls and young women and achieving gender equality in sub-Saharan Africa.

On 30 November 2022, during the HIV week commemoration, the Office of the Prime Minister, led by the Minister of State for Policy, Coordination and Parliamentary Affairs, Mr George Simbachawene, alongside the Deputy Minister of Health Dr Godwin Mollel, launched the initiative in Lindi region, Tanzania. 

"Young people aged 15-24 years make up one of the largest groups of new infections, among all new infections every year, approximately 30% are among people aged 15–24. That means for every 10 new infections, three are from this age group,'" said Mr. Simbawachane 

The launch of Education Plus in Tanzania will accelerate the ongoing country's adolescent education, health and wellbeing agenda.  Tanzania has been particularly affected by HIV. In 2021 around 1.7 million people were living with HIV; 74% of new HIV infections among young people aged between 15 and 24 were among young women, showing the disproportionate impact HIV is having on young women and girls.

Minister Simbachawene said the country would increase primary education opportunities for adolescents and enable them to stay in school by removing all barriers to completion of primary and secondary school education. Through the initiative, Tanzania will strengthen efforts to bring HIV education, reproductive health, and life skills to adolescents inside and outside of school.

The initiative comes at a time when Tanzania has made good progress in adopting global treaties and agreements to address gaps in education and health rights and increase opportunities for girls and boys. Most commitments have been translated into national policies and strategies, as demonstrated by the government’s commitment to offering free basic and secondary education. Tanzania has also adopted policy decisions to implement a re-entry program for children who drop out and to include comprehensive sexuality education into the curriculum. The country has also amended the HIV and AIDS Act to lower the age of consent for HIV testing and allow HIV self-testing.

The minister also pledged to do more to eliminate gender-based and sexual violence by providing youth-friendly education, skills building, and enhancing referrals by connecting youth to health and community services.

However, key gaps remain, with national surveys showing increased rates of teenage pregnancy, school dropouts, and high levels of gender-based violence. Around 27% of young women aged between 15 and 19 years already have a child or are pregnant and 50% of ever-married women aged between 15 and 49 report experiencing physical, sexual, or emotional violence.

The total number of students enrolled in secondary education is still below 50%, and for those in school, there is a high dropout rate, and some do not complete their schooling. The country has a low completion rate in secondary schools at 11.3%, and dropout in secondary schools due to pregnancy was reported at 4% in 2020.

Despite increased political will and significant achievements, women's and girls' vulnerabilities remain very high. Adolescent girls and young women in Tanzania continue to shoulder the burdens of domestic work, gender inequality in education, and harmful norms. Many are entrenched in cycles of poverty and extreme vulnerabilities.

At the launch, the government committed to strengthening policies to facilitate the provision of education and essential skills to prepare and equip young people for employment and other economic opportunities.  

The launch was attended by key partners including Dr Leonard Maboko, the Executive Director for Tanzania Commission for AIDS (TACAIDS) youth representative Pudensiana Mbwiliza; Permanent secretary office of the Prime Minister, Dr John Jingu and Hon Judith Nguli from Lindi Regional Commissioner’s office and Tanzania PEPFAR coordinator Jessica Greene;  representatives from  UNAIDS, UNESCO, International Labour Organisation (ILO), UNICEF and the World Health Organisation (WHO). 

The event brought together civil society organisations, young people’s networks, and representatives of people living with HIV and partners. Co-lead by five United Nations agencies working with governments, women’s and youth movements; the initiative is of even greater urgency as the COVID-19 pandemic has pushed millions of African girls out of school.

The Sanpatong Hospital in North Thailand has reinvented and refined its HIV programme for more than three decades. It began attending to people living with HIV in 1989, and in 1996 started offering antiretroviral treatment.

“We have patients who have been with us for 30 years,” says Dr Tawit Kaewprasert, Deputy Director of Provincial Public Health Office and Director of Sanpatong Hospital.

In the last five years the hospital has not had a single case of mother-to-child HIV transmission. An impressive 96% of people on treatment who received viral load tests there this year were virally suppressed, with 98% of those patients being undetectable. Management speaks about the 92% retention rate for clients who were on treatment in 2022 in terms of how those results can be improved.

“We have not achieved that target just yet,” Dr Manusin Kongka says, referring to the proportion of people who stayed on antiretroviral therapy. “But we can reach the target and even achieve beyond 95%.”

The team even aims to achieve 100% viral suppression among people who have been on treatment for at least five years. The current 96% result isn’t considered to be good enough.

This ambitious goal-setting flows from the National HIV Policy and Thailand’s commitment to end AIDS by 2030 through a well-articulated strategy to reach, recruit, test, treat and retain people in care, while also working to prevent new infections.

 Of course the strategy relies heavily on Sanpatong and institutions like it. This 130-bed facility boasts a central lab that serves surrounding hospitals in Chiang Mai, Lamphun and Mae Hong Son with HIV diagnosis, CD4, viral load monitoring and some opportunistic infections testing.

Their approach includes the adoption of HIV response best practices including PrEP, index testing and same-day treatment initiation.

“Patients can start treatment before they even get their CD4 result,” Dr Kongka explained.

All staff have received anti-stigma training as well as orientation around the U=U, undetectable = untransmittable, initiative. The facility uses a differentiated approach for antiretroviral treatment delivery. Depending on their health status, some clients can collect multiple month dispensing at district health promoting hospitals while others can receive their medicine by mail.  

But a major key to Sanpatong’s success is the linkages it has made with groups of community-led organizations to drive case detection, linkage to care, psychosocial support and the monitoring of services. The Hospital works with Mplus, CAREMAT and FHI360 on prevention, testing and retention in care. Organizations of people living with HIV run support groups. The Community Led Monitoring team even helps primary care nurses to contact patients who have been lost to follow up and conduct home visits. The people living with HIV network collaborated with key community-based organizations in Chiang Mai to conduct community-led monitoring to improve the quality of HIV services at the Sanpatong hospital.

“Our collaboration with community organizations increases awareness about HIV, improves quality of care and access to care, decreases the waiting in community clinics and increases continuity of care for HIV patients,” said Ms Sineenuch Suwansre, HIV Coordinator.

This close collaboration with communities is enhanced by the Thailand Government’s move to integrate HIV services into the Universal Health Coverage scheme. Now certified organizations and lay HIV service providers can access domestic financial support within the national health infrastructure.

“Universal Health Coverage is a mechanism for the sustainable financing of HIV prevention as well as sustainable financial support to key population- and community-led health services. The Thai government’s move to fund Community-led Health Services as an element of the mainstream public health system is a win for people living with HIV, for HIV prevention and for sustainability,” said UNAIDS Thailand Country Director, Patchara Benjarattanaporn. 

Member States of the Association of Southeast Asian Nations (ASEAN) have reaffirmed their commitment to accelerate progress toward ending AIDS as a public health threat by 2030.

At the 40th and 41st ASEAN Summits under the Chairmanship of the Kingdom of Cambodia, Member States pledged to strengthen community-led responses and increase financing for the HIV response. Echoing the World AIDS Day call to “equalize” the AIDS response, country leaders also agreed to a comprehensive agenda to end the inequalities stalling progress.

The ASEAN Leaders’ Declaration on Ending Inequalities and Getting on Track to End AIDS by 2030 is aligned with the 2021 UN Political Declaration on HIV and AIDS and the 2021–2026 Global AIDS Strategy and targets.

"We are now in an era where treatment and various options on HIV prevention can be made available and accessible, and it is important to shine a light on where inequalities and gaps continue to persist if ASEAN is to sustainably accomplish these targets,” said H.E. Ieng Mouly, Senior Minister and Chair of Cambodia’s National AIDS Authority.

In 2021 there were an estimated 1.9 million people living with HIV in ASEAN countries and an estimated 78,000 new HIV infections. In most ASEAN countries there are now rising epidemics among young gay men and other men who have sex with men and transgender people.

“Wherever communities are being left behind, ASEAN remains vulnerable to the social and economic fallout of HIV,” said UNAIDS Asia Pacific Regional Director, Taoufik Bakkali. “This Declaration is important and timely. It paves the way for countries to comprehensively address the large gaps in service coverage that remain in several countries, particularly for key populations.”

The ASEAN Declaration calls for focus on key and marginalized populations and explicitly addresses the needs of people living with HIV, men who have sex with men, transgender people, people who inject drugs, sex workers and their partners. It contains wide-ranging commitments, including concrete strategies to achieve the 95-95-95 testing and treatment targets. (By 2025, 95% of people living with HIV in all countries and communities to be aware of their status, 95% of all diagnosed people on treatment and 95% of those on treatment achieving viral suppression.)

End inequalities

ASEAN states have committed to better facilitate the participation of people living with HIV. They pledged to remove barriers to HIV services by improving policy and legal environments. This includes taking steps to reform discriminatory and punitive laws such as those that criminalize key populations and block adolescents from accessing HIV prevention, testing and treatment, and restrict the entry, stay, and residence of people living with HIV. Countries further agreed to take steps to eliminate stigma and discrimination against people living with HIV and key populations in healthcare, education, and workplace settings, as well as in communities.

Strengthen, support and sustain community-led responses

Governments said they would ensure the inclusion of people living with HIV, and communities most affected by HIV, in AIDS response planning, implementation and evaluation. Community organizations, and particularly community- and peer-led interventions, should be strengthened and scaled-up. States agreed to continue investing in community-led service delivery, including by adopting and implementing social contracting policies. They also promised to support community-led monitoring and research.

Finance and sustain the AIDS response

The alliance agreed to address HIV response financing shortfalls by raising sufficient domestic and international financial resources to fill gaps. At the same time, they committed to developing and implementing plans to transition from external to domestic funding.  They promised to work to improve efficiency in the use of existing financial resources, including through integration with health and humanitarian responses and universal health coverage mechanisms. They also agreed to regional cooperation for research, sharing good practices, joint interventions and to strategize for improved access to health commodities.

Grace Amodu was 7 years old when she found out she was living with HIV. Until then she had been told to take pills daily for malaria or for headaches but she grew tired of it. Screaming and kicking she told her brother that she was going to stop taking her medicine and that she wanted answers. Her mother took her aside and explained that she was born with HIV and that the treatment would keep her healthy like other kids.

She remembers crying a lot and refusing to leave the house.

To keep her from spiraling out of control her mom encouraged her to join a support group, which she says turned her life around.

As she proudly says she has two children who are both free of HIV. Taking her medication at the same time every day throughout her pregnancy and afterwards meant she was not going to transmit HIV to her babies. "When you take medicine it suppresses the virus and even though I feared my children may have HIV they both tested negative.”

She credits International Community of Women Living with HIV (ICW) Nigeria chapter for giving her hope and confidence.

“ICW was like a backbone, they were there for me like the colleagues, everyone around was standing for me, even the boss, Assumpta Reginald, was like a mother figure to me,” Ms Amodu said. “She held me by the hand telling me that, ‘You can do this and you can become a better person.’

As a result, Ms Amodu has become an HIV advocate and a community pharmacist.

"We go to the hospital and get medicine for people and give them to patients who are maybe not able to access their drugs because they have no transport fare or they are far away or due to the stigma in the hospital they don’t want to come to have nurses and doctors shout at them so we take these drugs down to their doorstep and give it to them,” she explained.

More than 90% of people living with HIV in Nigeria are on antiretroviral medicine but stigma and discrimination are still rampant.

For Ms Amodu the solution is simple. Give people the right information about HIV to break the cycle.

“We need to make people understand that you being HIV positive is not making you less of a human, you are also a human being and you deserve equal rights,” the 28-year-old said.

Stella Ebeh knows all about stigma. She started volunteering in 2004 helping people living with HIV like herself. Then she started working in a health center and became a public health officer. Over the years Ms Ebeh said she has cared for more than 7000 patients and also became a mentor-mother (giving HIV advice to pregnant women and counselling), and an anti-stigma ambassador.

She is very proud of overcoming stigma and as she called it, “walking on it,” but despairs that she is still not a full-time staff member. People living with HIV are very capable and yet we are often overlooked she said, adding, “I work like an elephant but eat like a rat.”

Patients pour in and out of the Marabara health centre on the outskirts of Abuja all day. Ms Ebeh goes from one person to another. She lingers a while with a pregnant woman who also prepares lunch on the premises, Ngozi Blessing.

Ms Ebeh insists on pregnant women taking all the precautions they can to give birth to healthy babies. Her husband and their five children are all HIV negative. Sadly, in Nigeria this is an exception.

Vertical transmission is 25% in the country - that is when a mother passes on the virus to her child during pregnancy or breastfeeding- a record high in the region.

UNAIDS Country Director Leopold Zekeng says this is unacceptable. For him it is a demonstration of the inequalities in terms of access to services.

“Two thirds of the 8 million women who get pregnant every year in Nigeria do not have access to PMTCT (prevention between mother to child transmission of HIV) services during ante-natal care,” he said.  

This is why Nigeria and UN organizations along with other partners are spearheading an effort to end AIDS in children.

Dr Akudo Ikpeazu, Director and National Coordinator, National AIDS and STDs Control Programme (NASCP) said that in the last 2 years they have done an enormous amount of work first trying to get a mapping to understand where all the women are having babies and where they receive ante-natal care if at all.

“A lot of them are in birth homes, they go to traditional birth attendants and many deliver at home and receive services at home and so we have a got new strategy which aims to find them where they are, ensure that they are treated, ensure that we can find them first, ensure that we can  test them, link them into treatment and count every single one that has gained access to care,” she said.

In other words, find all, test all, treat all and report all which happens to be Nigeria’s slogan encapsulating their strategy.

Once that vertical transmission tap, as she called it, is closed, then there will be a smaller pool of children to look after regarding treatment. Dr Ikpeazu said Nigeria intends to put in place an acceleration plan to have more children and adolescents on treatment and push for them to stay on treatment.

For Toyin Chukwuduzie, Director of Education as a Vaccine (EVA), HIV is one part of a larger equation.

“We see the number of unintended pregnancies, we see the burden of HIV especially among  adolescent girls, we also see the sexual and gender based violence happening in our society so these things are in existence, these things are happening, yet adolescents and young people don’t have the information they need to make decisions whether we are talking about schools, whether we are talking about health facilities or even in the homes where there are other adults so there are huge gaps,” she said.

The 35-year-old works with young people to fill those education gaps and build support. She is convinced that a main driver of these gaping holes are inequalities, one in particular.  

"I believe gender inequality is the root cause of many other inequalities so if had a magic wand gender inequality would be the one I would address the first because it’s key,” she said. “Addressing gender inequality is key to unlocking potential, potential of women and girls everywhere in this country.”

Hammering in her point, she added that despite everyone stressing the fact that young people are the force of the future Ms Chukwudize said, "If you are not providing that safe environment, if they are not healthy, if their dreams and aspirations are thrown off the path, how do they become the future that we want to see.”

On this Day of Action, as we celebrate a two-year anniversary of the launch by the World Health Organization (WHO) of the Global Strategy to accelerate the elimination of cervical cancer as a public health problem, we are reminded that despite the availability of the knowledge, tools and technologies, cervical cancer still kills more than 342 000 women a year (in 2020) globally. Every two minutes one woman loses her life to cervical cancer - a disease that is preventable and curable.

The high burden of cervical cancer is driven by gender, social and economic inequalities and health disparities in access to HPV vaccines, screening, care and modern prevention and treatment technologies. Because of those inequalities, women and girls in low- and middle-income countries (LMICs) remain most affected. Nine out of 10 women who die of cervical cancer reside in LMICs.  Cervical cancer is the number one cause of cancer-related death among women living in sub-Saharan Africa.

The WHO Global Strategy to eliminate cervical cancer launched by the WHO on 17 November, 2020 was supported among many by the UN partner organizations including IAEA, UNAIDS, UNFPA , UNICEF, and Unitaid. The UN Joint Action Group comprised of these six UN entities each bringing in its unique mandates and resources, is committed to supporting countries efforts in meeting by 2030 the global cervical cancer elimination targets – whereby 90% of girls are fully vaccinated against HPV by age 15, 70% of women are screened with a high-performance test between the ages of 35 to 45, and 90% of women identified as having cervical disease receive treatment. If these targets are met, 300 000 deaths from cervical cancer could be averted by 2030, 14 million by 2070, and over 62 million by 2120.

“In countries with high rates of HIV, over 50% of cervical cancer cases are reported among women living with HIV.  Women living with HIV are six times more likely to develop cervical cancer and to develop it at younger age than those without HIV. It is unacceptable to claim that we have saved a woman’s life by enabling access to antiretroviral therapy for HIV alone, if we then leave her to die from cervical cancer. Our joint focus is on breaking down silos, building bridges between HIV and cervical cancer programmes, and bringing the two communities together because we know that linkages save lives.” – Winnie Byanyima, UNAIDS Executive Director 

“No woman should die of cervical cancer when we have a highly effective HPV vaccine and quality diagnostics. We need prevention and early detection - this is how we ensure that this disease is eliminated globally.  Governments and partners need to invest in accelerated access to resilient primary health care that delivers integrated care like routine immunization and sexual and reproductive health. And we must commit robust long-term human resources for adequate and accessible health care workers in communities and at facility level. Funding for health and health equity are prerequisites for cervical cancer elimination around the world.” - Dr Aboubacar Kampo, Director of Health Programme, UNICEF New York HQ

“We have the tools and technologies to end cervical cancer. Now it is a question of access. Unitaid stepped up the moment WHO issued its call to action, and within just a few years we have introduced effective technologies and developed screen-and-treat models that work in resource-limited settings. The last piece of the puzzle is scale up – we need to see a concerted global effort so every last woman can benefit from life-saving preventive care and we can end cervical cancer for generations to come.” – Dr Philippe Duneton, Executive Director, Unitaid

“Despite being one of the leading causes of death from cancer for women in low- and medium-income countries (LMICs), cervical cancer is also one of the most preventable and treatable cancer types. Nuclear applications such as diagnostic imaging can help detect the cancer at an early stage and increase survival rates. Radiotherapy can successfully treat women with cervical cancer, even in advanced cases. With our Rays of Hope initiative, we aim to increase access to these technologies worldwide and close the unacceptable gap of inequality.”- Najat Mokhtar, IAEA Deputy Director General and Head of the Department of Nuclear Sciences and Applications

“On this second anniversary of the Global Strategy for Cervical Cancer Elimination, the UN Joint Action Group (UNJAG)* celebrates the successes achieved. As the world population continues to grow, more girls and women will require life-saving vaccination, screening and treatment. We acknowledge the need for effective mobilization of resources and partners to achieve the 90-70-90 global elimination targets. Going forward we will continue to focus our attention and joint efforts on ensuring full prevention, high quality life-saving services and equity in access to modern technologies for women and girls across the world.” – Petra ten Hoope-Bender, UNJAG Chair, Technical Adviser Sexual and Reproductive Health and Rights, UNFPA.

* IAEA, UNAIDS, UNFPA, UNICEF, UNITAID and WHO 

GENEVA – Reflecting on 100 days since the 24th International AIDS Conference in Montreal, at which the World Health Organisation issued landmark guidance on how long-acting injectable anti-retroviral medicines can help prevent new HIV infections, and ViiV Healthcare committed to enabling access, AIDS campaigners are urging ViiV Healthcare to take vital next steps to enable timely rollout of game-changing,  life-saving, long-acting injectable HIV medicine to millions of people. 

At AIDS2022, the International AIDS Conference in Montreal, 29th July - 2nd August, ViiV Healthcare the manufacturer of cabotegravir (CAB-LA) committed to share technology, and ensure an affordable price, for the long-acting, injectable HIV medicine. The announcement generated international excitement as CAB-LA has been shown to be a safe and effective prevention tool. Reflecting on 100 days since then, global health leaders say there is an urgent need to for ViiV to take crucial next steps. 

ViiV committed at the Conference in Montreal to lower the price for CAB-LA in a subset of low- and middle-income countries. But ViiV has not yet published this price. Advocates say the annual per person price needs to be equivalent to the price of oral PrEP,  tens of dollars not hundreds of dollars. Multiple governments and financing agencies have indicated their interest in purchasing CAB-LA for PrEP if the medicine is offered at an affordable price point. Advocates are calling on ViiV to transparently and rapidly share details of their planned pricing strategy. 

“ViiV Healthcare needs to publicly announce an interim pricing strategy, which prioritises affordability so countries and procurement bodies can plan and purchase at scale,” said Dr Yogan Pillay, South Africa country director at The Clinton Health Access Initiative. “Governments and other procurers will only purchase long-acting injectable HIV medicines at scale if the drugs are affordable and if there’s a clear timeline as to when the drugs will be available.” 

While ViiV’s commitment to facilitate the generic production of CAB-LA via an agreement with the Medicines Patent Pool for use in 90 countries is helpful, HIV experts are calling on ViiV to allow an expansion of the number of countries eligible in order to accelerate progress in supplying the product to those in need. Although the current set of 90 countries includes both low- and middle-income countries, it excludes dozens of other middle-income countries, amongst which are countries with high rates of HIV infection. Expanding the list of countries would help incentivise generic production by expanding the potential market size. 

“ViiV Healthcare should allow generic production and supply in all low- and middle-income countries,” said Lilian Mworeko, Executive Director, International Community of Women Living with HIV East Africa. “Anything short of this would mean that millions of people who need these products would not be able to access them for years to come. Every day of delay would represent failure to prevent the spread of HIV and takes us further away from ending AIDS by 2030.” 

“At the AIDS Conference in Montreal, ViiV took important first steps to enable this powerful new prevention tool to reach many in need.  It is now time for ViiV to take additional courageous steps. These include ensuring registration with medicines agencies in all the countries with the highest rates of HIV, announcing the low price and expanding the set of countries allowed in the generic market. Bold actions by ViiV in this moment could help save millions of lives,” said Matthew Kavanagh, Deputy Executive Director, a.i. at UNAIDS. 

Following a five-day visit to Jamaica to see first-hand the extraordinary work of joint efforts by the government, partners and communities to end AIDS, UNAIDS Executive Director Winnie Byanyima issued the following statement:

“I have observed strong political commitment and country ownership in Jamaica’s response to HIV. I also witnessed the active contribution and engagement of civil society and communities living with or affected by HIV. Your dedication and commitment give me hope that Jamaica and the wider Caribbean region can end AIDS.

However, there are barriers to overcome, these include addressing inequalities, eliminating stigma and discrimination, ending punitive laws which harm the AIDS response, and eliminating gender inequalities, including gender-based violence. In all my engagements with senior government officials, civil society and international development partners, I have shared four vital recommendations to overcome inequalities and ensure a sustainable response to HIV:

• Getting the data right—and using the evidence to ensure access to HIV services for everyone who needs those services, free of stigma and discrimination
• Improving governance and coordination for a truly multisectoral and multidisciplinary HIV response
• Ending gender-based violence – and especially sexual violence
• Increasing fiscal space and efficiently investing in what works

More investment is needed to end persistent structural barriers and develop anti-discrimination legislation. Social contracting schemes need to be implemented with civil society, which will be transformational in delivering community-level services. Health systems must be strengthened to deliver people-centred services more efficiently and more cost-effectively, which is also crucial for pandemic preparedness.

As the Executive Director of UNAIDS my commitment is to intensify and expand support from our 11 Cosponsors to end AIDS in Jamaica and across the Caribbean. In supporting efforts to increase access to HIV prevention and treatment services and in ensuring an enabling environment where people feel safe in accessing those services.

UNAIDS will support efforts to integrate HIV into other health services, especially at the primary health care level, without compromising the quality of HIV services being delivered. UNAIDS further commits to strengthening partnerships with our stakeholders in the region and ensuring effective coordination of our efforts.

We will also work with the President’s Emergency Programme for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, TB and Malaria, and the Pan-American Health Organization (PAHO) to strengthen data systems and ensure a response which is evidence based and which reaches the people most in need. UNAIDS will also continue to work with partners to mobilize resources to support Jamaica’s efforts to fight HIV.

Jamaica is making progress. But I know Jamaica can move faster and reach the 15 000 people living with HIV, including over 300 children, who are currently not accessing HIV treatment.

We only be able to end the HIV pandemic, or indeed any other pandemic, when human rights are respected and when everyone is supported in accessing the health and social services they need.

I thank the Government of Jamaica, civil society and everyone who made my stay in the country an exciting one. I salute all of you for your tireless efforts and your ongoing work. We are making progress. Let's get everyone who is not on treatment on treatment. Let's eliminate vertical transmission. I am confident that Jamaica can end this fight. UNAIDS is here to support you. We can – we will – end AIDS in Jamaica and the Caribbean.”