The International AIDS Society (IAS) Conference on HIV Science opened on 18 July. The participants were welcomed by Adeeba Kamarulzaman, the Chair of the IAS, and Hendrik Streeck, the local Chair of the conference, who held up UNAIDS as an example of the multisectoral approach that was needed for the response to COVID-19. The opening address was delivered by Angela Merkel, the Chancellor of Germany, which was followed by a panel discussion.  

The panel’s speakers drew parallels between the need for global solidarity for COVID-19, especially with regard to access to vaccines, and for HIV, recognizing that both viruses spread regardless of borders and need a global response. They also spoke about the imperative to not let the HIV response be slowed because of the COVID-19 pandemic. Repeated emphasis was made on the bi-directionality of COVID-19 and HIV investments, reminding the audience of the importance of investment in HIV science for developments in COVID-19.

Jens Spahn, Germany’s Federal Minister of Health, accepted that the global response to COVID-19 has been slow but stressed that political decisions had been made to increase global vaccine access, and supply would increase briskly in the coming months. Yvette Raphael, a South African activist living with HIV, recounted her struggle to fight stigma and discrimination relating to HIV, gender and race/ethnicity. She reminded the audience that scientific data relate to real people with human relationships. 

Soumya Swaminathan, the Chief Scientist at the World Health Organization, reflected on the priorities of primary health care and universal health coverage. Perhaps the most frequent and strongly felt sentiments concerned the need to combat misinformation and disregard for science. “Follow the science” was a phrase that resonated over the course of the rich discussion.

Quotes

The increase was largely due to disbursement of prior-year multilateral funds. Bilateral funding from donor governments, other than the U.S., continues a downward trend.

A new report from KFF (Kaiser Family Foundation) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) finds that donor government disbursements to combat HIV in low-and middle-income countries increased by US$377 million in 2020, reaching US$8.2 billion in 2020 compared to US$7.8 billion in 2019. Donor government funding supports HIV care and treatment, prevention, and other services in low- and middle-income countries.

The rise in funding is almost entirely the result of an increase in United States contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was due largely to the disbursement of prior-year funding. U.S. disbursements to the Global Fund are not expected to remain at this level in 2021.

The United States continues to be the largest donor to HIV, accounting for 76% of all donor government funding, followed by the United Kingdom (US$612 million, 7%), Japan (US$258 million, 3%), Germany (US$246 million, 3%), and France (US$216 million, 3%). As other donor governments continue to pull back bilateral funding, the United States accounts for an increasing share of overall funding for HIV from donor governments.

The report reflects prior-year political and funding decisions and does not fully capture the impact of COVID-19 on donor funding decisions.

“While many donor governments are beginning to bounce back from the pandemic, its global impact and related recession make future funding for HIV response unpredictable,” said KFF Senior Vice President Jen Kates. “Not only are some low- and middle-income countries experiencing a ‘third-wave’ of COVID-19, vaccines remain largely out of reach, potentially leading to greater funding needs for HIV and other health services.”

"We are at a critical stage in the AIDS response as countries are confronting the huge challenges posed by the COVID-19 pandemic," said Winnie Byanyima, Executive Director of UNAIDS. "But we do still have an opportunity to end the epidemic by 2030 if donors and countries alike commit to mobilize resources and prioritize health, human rights and equality which are the key components, not only to lead us out of the pandemics of HIV and COVID-19, but they are the cornerstone to economic recovery and security."

These data are included in a broader UNAIDS global report, which examines all sources of funding for HIV relief, including local governments, non-governmental organizations, and the private sector, and compares it to the resources needed to achieve goals related to testing and treatment.

The new report, produced as a long-standing partnership between KFF and UNAIDS for more than 15 years, provides the latest data available on donor government funding based on data provided by governments. It includes their bilateral assistance to low- and middle-income countries and contributions to the Global Fund, UNAIDS, and UNITAID.  “Donor government funding” refers to disbursements, or payments, made by donors.

By Mbulawa Mugabe, UNAIDS Country Director for South Africa

It is with great sadness that I received the news that the Executive Mayor of Johannesburg, Geoffrey Makhubo, passed away on 9 July 2021.

Having served in various senior positions in the Johannesburg Council and as the Member of the Mayoral Committee for Finance, Mr Makhubo was appointed Johannesburg Executive Mayor in December 2019, a position that he served with commitment and dedication.

Mr Makhubo was a strong advocate in the response to HIV, and on World AIDS Day 2020 he urged communities to work together to end HIV-related stigma. UNAIDS is grateful for his leadership and commitment to public health and to the HIV response, and for his unwavering support for the Fast-Track cities initiative. Given his commitment to the urban health agenda, Mr Makhubo addressed the global Fast-Track cities conference in 2020 and was a panellist at the United Nations High-Level Meeting on AIDS Fast-Track cities side event in June 2021.

His death is a deep loss for the HIV community and the citizens of Johannesburg.

Mr Makhubo died from COVID-19 complications, following a positive test result in late June.

We extend our sincere condolences to Mr Makhubo’s colleagues, family and friends, and to the city of Johannesburg.

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

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

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

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

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

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

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

In a briefing co-hosted by the Organisation of African First Ladies for Development (OAFLAD) and UNAIDS, technical advisers to the first ladies renewed their commitment to the HIV response in Africa. Capitalizing on the convening, leadership and advocacy role of African first ladies, they highlighted the need to align national and regional efforts to the new Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the targets in the 2021 United Nations Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030.  

The briefing focused on presenting the outcomes of the United Nations High-Level Meeting on AIDS, including the Political Declaration on AIDS, the Global AIDS Strategy 2021–2026 and its new targets, the Education Plus initiative and the Common Africa Position on the High-Level Meeting on AIDS. It highlighted the unfinished business of the HIV response and the continued efforts to meet prevention and treatment targets and adopt a rights-based approach that leaves no one behind.

In her welcoming remarks, Berthilde Gahongayire, the UNAIDS Country Director for Ethiopia and the Director, a.i., of the UNAIDS Liaison Office to the African Union and the United Nations Economic Commission for Africa, reiterated the instrumental role played by African first ladies in putting previous United Nations political commitments into action. She also extended appreciation to the first ladies, who continued to invest in the HIV response during the COVID-19 pandemic in Africa. “We appreciate the support by first lady offices during the COVID-19 emergency in providing socioeconomic support to those vulnerable and marginalized, including protecting services for people living with HIV,” she said.  

The technical advisers expressed interest in participating in the Education Plus initiative and integrating the new political declaration targets in their national plans and in the OAFLAD 2019– 2023 strategic plan. Namibia, which was a co-facilitator of the High-Level Meeting on AIDS, shared information on the political declaration and called on the technical advisers to be champions for ending AIDS as a public health threat by 2030.

“I call on all technical advisers to support the popularization, dissemination and alignment of the political declaration and the global AIDS strategy in national programmes,” said Steven Bernardus Harageib, the Technical Director of the Office of the First Lady of Namibia. He added that Namibia is committed to demonstrating leadership in accelerating the AIDS response in Africa.

Moustapha Zakari, from the African Union Commission, on behalf of Margaret Agama-Anyetei, the acting Director of Health, Humanitarian Affairs and Social Development for the African Union Commission, commended the OAFLAD leadership on building momentum after the High-Level Meeting on AIDS. He saluted the commitment of member states in advancing the HIV response through the adoption of a Common Africa Position on the High-Level Meeting on AIDS, which was instrumental in the negotiation of the continent’s priorities in the new political declaration.  

The meeting, which was chaired by Michel Mongo from Congo, was attended by more than 30 technical advisers. Mr Mongo closed the meeting by requesting support from UNAIDS to update strategic plans and to articulate the new targets at the country level.

The COVID-19 pandemic is threatening decades of hard-won development and public health gains. UNAIDS is committed to playing a pivotal role in ensuring that people living with and affected by HIV have the information and support they need during the COVID-19 pandemic and is promoting the development and support measures needed to ensure that access to HIV prevention and treatment services continues uninterrupted.

Launched in 2017, the Global HIV Prevention Coalition aims to bring fresh momentum and clarity to HIV prevention programmes, focusing on 28 countries carrying the highest burden of the HIV epidemic. The Global HIV Prevention Coalition has published a new report, Preventing HIV infections at the time of a new pandemic: a synthesis report on programme disruptions and adaptations during the COVID-19 pandemic in 2020, which provides a synthesis of the status of HIV prevention programming during the COVID-19 pandemic, identifies critical vulnerabilities, risks and major service disruptions and documents responses in a range of settings. The report places a significant focus on gathering information on programme innovations at the community level.

“The COVID-19 pandemic risks reversing the hard-won gains made in HIV prevention, including the 23% reduction in new infections since 2010. And this is at a time when much more still needs to be done to drastically reduce new HIV infections. Gaps and threats to progress show great inequalities, and HIV prevention services and societal barriers for the people most left behind, such as key populations and adolescent girls and young women, have been disproportionately impacted by COVID-19,” said Shannon Hader, the UNAIDS Deputy Executive Director for Programmes.

Inevitably, significant disruptions on HIV prevention services have been observed, and supply chains for crucial HIV prevention commodities, including condoms, lubricants and antiretroviral and other medicines, have been stretched. The report reflects on the early dips observed in the monthly numbers of people served by critical HIV prevention programmes, including huge drops in the number of voluntary medical male circumcisions performed compared to previous corresponding months.

At the same time, while it has vividly exposed and widened inequalities and health inequities, COVID-19 has also shown how to make health systems and other public institutions fairer, more inclusive and better able to meet the challenges of ending the AIDS epidemic. Health-service providers and community organizations have responded to the crisis by changing how they provide HIV prevention services and minimizing disruptions of essential services.

The report highlights COVID-19 impact mitigation innovations and adaptations of HIV services, including multimonth dispensing of condoms, lubricants, needles, syringes and pre-exposure prophylaxis (PrEP), differentiated service delivery and self-testing approaches, alternative access points for prevention commodities such as condoms and PrEP, take-home dosages of opioid substitution therapy for people who inject drugs, the safe continuation of outreach services for key populations and adolescent girls and young women and virtual platforms for prevention interventions—and calls for their scale-up even beyond the COVID-19 pandemic. The report further highlights how the COVID-19 pandemic response has drawn from HIV experts and communities and has taken early decisive action to address critical vulnerabilities, maintain health services and build synergies between the colliding pandemics.

“In over 30 years of developing effective prevention approaches, we have gained substantial knowledge and experience that decision-makers and health programme implementers can use in low- and middle-income countries to make the best possible choices in preventing SARS-CoV-2,” said Dr Hader. “The most pressing needs we hear from communities are the protection of livelihoods: how do people eat, live, care for themselves and survive COVID-19. UNAIDS can help broker services for people,” she added.

The report will support all stakeholders in their preparation of Global Fund to Fight AIDS, Tuberculosis and Malaria COVID-19 Response Mechanism applications, ensuring that proposal writing teams identify key HIV prevention innovations and adaptations that could be supported and scaled-up to regain global HIV prevention momentum and mitigate the impact of the COVID-19 pandemic on HIV services.

By Jacek Tyszko, Senior Adviser for Faith Engagement, UNAIDS

It is with deep sadness that I received the news that the Reverend Phumzile Mabizela, the Executive Director of the International Network of Religious Leaders Living With and/or Personally Affected by HIV (INERELA+), passed away on 5 July. 

Her dynamic leadership championed the welfare of people living with HIV globally and equipped faith communities to face HIV, strive for justice and guide faith engagement in the HIV response. She played an important role in shaping and implementing the UNAIDS/United States President’s Emergency Plan for AIDS Relief Faith Initiative.

Her death is a deep and inconsolable loss for faith communities, as well as for human rights defenders. She was a dear friend, sister and teacher to many of us.

She died from COVID-19 while serving on the front line of the HIV response, leading and calling for an end to AIDS and inequality.

We send our condolences to her family.

Migrants, refugees, internally displaced as well as crisis-affected and mobile populations who are living with HIV must have equitable access to COVID-19 vaccines, said the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the International Organization for Migration (IOM).

People on the move are often more vulnerable to diseases, including COVID-19 and HIV. In addition, people living with and/or affected by HIV and migrants often experience significant inequalities. They frequently face health hazards due to sometimes perilous migration processes, substandard living situations, dangerous working conditions, as well as general lack of information, stigma, discrimination and isolation.  Migrants and displaced people also face a great number of administrative, financial, geographic, social and cultural obstacles in accessing health care with regularity or continuity of care across borders – including access to HIV treatment.

During the pandemic, against a backdrop of rising xenophobia and discrimination, some migrants living with HIV found themselves facing a triple stigma related to (1) testing positive for COVID-19, (2) having a positive HIV status, and (3) being a migrant, all of which also often had serious negative consequences on their mental health. For many migrants and displaced persons living with HIV and other autoimmune diseases, or at risk of contracting HIV, risk exposure went up while availability of HIV services went down.

“To end inequalities and get the global response to HIV on-track to reach the 2030 target of ending AIDS as a public health threat, we must act immediately to reduce the inequalities experienced by migrants and mobile populations. This includes full access to HIV prevention and treatment services and to COVID-19 vaccines,” said Winnie Byanyima, Executive Director of UNAIDS ahead of the 48th UNAIDS Programme Coordinating Board Meeting taking place next week in Geneva, Switzerland. A progress report on HIV services for migrant and mobile populations as well as refugees and crisis-affected populations will be presented at the meeting.  

“Both the global AIDS response and the COVID-19 response are leaving millions of people behind, including many migrants and forcibly displaced persons,” stated IOM Director General António Vitorino. “We’ve seen that neglecting the health needs of marginalized groups can be devastating for communities. Together, all countries should pledge not to let it happen again.”

On 8 June, the United Nations General Assembly adopted the 2021 Political Declaration on HIV and AIDS, which specifically mentions migrants, refugees and internally displaced persons, and commits governments to ensuring that “95 per cent of people living with, at risk of and affected by HIV are protected against pandemics, including COVID-19.” To mitigate and treat COVID-19 and HIV, maintaining high standards of health care and protection, along with sharing disseminated and accessible information are crucial.

IOM and UNAIDS urgently call on governments to take concrete action to ensure that national COVID-19 vaccination campaigns include all migrants with co-morbidities such as HIV, in line with WHO’s prioritization recommendations, and that every effort is made to remove the barriers many of them still face in accessing health services, including stigma and discrimination. 

The two organizations, who have been formal partners since 2011, are expanding their longstanding partnership to address multiple forms of exclusion faced by migrants, refugees, crisis-affected and other mobile populations living with HIV, and stand ready to support countries in their efforts to recover from COVID-19 and the global commitment to end AIDS by 2030, through equitable and inclusive health programmes in line with principles of universal health coverage.

ACON, one of Australia’s largest HIV organizations, working to promote HIV prevention strategies among gay men and other men who have sex with men in New South Wales, Australia, has recently launched a new campaign video that enlists some of Asia’s most popular social media influencers.

The campaign aims to raise awareness and promote the uptake of pre-exposure prophylaxis (PrEP), particularly among Mandarin-speaking gay men and other men who have sex with men. The campaign addresses frequently asked questions about PrEP and features Fufu and Josh, also known on social media as FJ234, YouTube personalities with a following of 350 000 subscribers. The pair appear alongside a leading doctor and PrEP advocate, Stephane Wen-Wei Ku, who in the campaign breaks down information on PrEP through relatable and humorous conversations.

“PrEP is a good tool to protect yourself, even if you are not ready to talk about sex with your partner. So, we could all have a great sex life without worrying about HIV,” Josh and Fufu explained.

In Asia and the Pacific, civil society organizations in countries such as Thailand and the Philippines have turned to social media platforms and other innovative solutions to offer new ways to link communities to PrEP and other prevention options. For example, in Thailand, the PrEP in the City campaign, launched by the Institute of HIV Research and Innovation and supported by the UNAIDS Regional Support Team for Asia and the Pacific and other key partners, aimed to increase PrEP uptake among transgender women by challenging negative perceptions. Likewise, in the Philippines, civil society organizations used innovative programmes to deliver antiretroviral therapy to clients, and PrEP and condoms were frontloaded to community champions for distribution.

“Raising awareness of PrEP, which is an extremely effective strategy for preventing HIV transmission, is fundamental to our efforts in eliminating the virus,” said Nicolas Parkhill, the Chief Executive Officer of ACON, reflecting on the critical role of the campaign in scaling up PrEP among Mandarin-speaking gay communities in New South Wales.

PrEP has had an enormous impact on HIV transmission rates in New South Wales and Australia as a whole since it was first made available in 2016 through various state-based trials, and later in 2018 when it was subsidized under the national Pharmaceutical Benefits Scheme. Currently, there are three main ways to access PrEP in Australia. The most common is through the Australian health-care system at a subsidized cost. Other options include purchasing PrEP from a pharmacy using a private prescription from a doctor or purchasing it from a reputable pharmacy and importing it into Australia under the Personal Importation Scheme. These last two options are particularly important for people who are not covered under the Australian health-care system, such as international students.

“PrEP is now the most commonly used HIV prevention strategy for gay men, but if we are to realize its full potential on reducing HIV transmission in New South Wales, we need to break down barriers and ensure that PrEP is easily accessible to all men in every community. By working with Fufu, Josh, Stephane Wen-Wei Ku and Hotline, we hope the video will be able to help raise awareness and show how effective it is, how easy it is to get and its benefits,” Mr Parkhill added.

The campaign video was developed in partnership between ACON and the Taiwan Tongzhi Hotline Association, a sexual health organization. A vital feature of the campaign was that the content was developed with the Mandarin-speaking community, so that the messaging is authentic to Mandarin-speaking men. The video is available in Traditional and Simplified Mandarin, with English subtitles.

“To close the gaps and ensure that no one is left behind, we must foster innovation and scale up access to HIV prevention and treatment services. Strong national commitment to scale up PrEP, adopting national PrEP policies and guidelines, setting ambitious PrEP targets and allocating sufficient resources for PrEP will help countries across the region to get the HIV response back on track. We have the tools to end AIDS. Now we must use them,” said Eamonn Murphy, Director, UNAIDS Regional Support Team for Asia and the Pacific.

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

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

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

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

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

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