Mampolokeng Mosolo is the picture of a dignified, proud African gogo (granny). Dressed in her Sunday best—pressed white shirt, knee-length black pencil skirt, impeccable hair and sensible heels—Ms Mosolo commands a soft power during the Khoelenya Community Council meeting in Mohale’s Hoek, a remote area in the west of Lesotho.

The council members are discussing sexual and reproductive health and rights. Ms Mosolo addresses her peers on the council with the quiet assurance of someone who has been on a life-changing journey she could not have imagined for herself as a younger woman.

When Ms Mosolo first found out that her grandchild—who was assigned female at birth and she raised as a girl—identified as a boy, she thought Mpho had been sucked into a satanic cult.

“I didn’t take it very well to hear that my grandchild thought of herself as a transgender boy,” Ms Mosolo says, a term she heard for the first time when Mpho broke the news of his gender identity to her.

When Mpho was 16 years old he would wear trousers to school as the institution’s policy gave girls the option to wear dresses or slacks.

“When girl students were then told to wear dresses, he refused and stopped going to school,” Ms Mosolo says. 

Mpho eventually went back to school later that year to take exams but failed his assessments. He dropped out and then went to a local vocation school to learn sewing. That did not last long either, Ms Mosolo says, as her grandchild faced stigma and discrimination from students and teachers for being a member of the lesbian, gay, bisexual, transgender and intersex (LGBTI) community.

Tampose Mothopeng, a Mosotho activist and human rights defender, says LGBTI people in the small mountainous country often face a backlash from their families, peers and members of the broader community. 

“LGBTI people face a lot of challenges daily,” he says. “Rejection, limited access to health-care services, stigma and discrimination and psychological issues. For instance, the health-care system is designed by the very system that rejected you. We must challenge the system until it sees us as human beings,” he emphasizes.

Mr Mothopeng runs the People’s Matrix Association, a community-based organization that advocates for LGBTI and gender-nonconforming people in Lesotho. Mr Mothopeng says it is essential to have a community driving its own mandate, otherwise organizations cannot fully understand, “the true challenges that communities are going through.”

“Without passion there is no way we can sustain volunteerism,” he continues. “Communities can stand up for their rights better than others. We need communities running their own projects.”

Indeed, Ms Mosolo and Mpho’s relationship took a positive turn after Ms Mosolo was referred to the People’s Matrix Association after attending a local HIV and gender-based violence workshop in her community, where issues of sexual orientation and gender identity were raised, and she wanted to know more.

“I received training from the People’s Matrix Association. I then sat Mpho down and said, “My child, I have accepted this because this is something that exists. They say that you are born with it and that you feel it in your blood,”” she says.

The People’s Matrix Association works with a wide range of partners to conduct sensitization workshops on LGBTI issues and works closely with faith-based organizations in Lesotho to foster a culture of acceptance between the church and LGBTI people.

The Khoelenya Community Council works in partnership with Phelisanang Bophelong, a community-based organization that provides HIV prevention and treatment support to people living with HIV. PB, as it is known locally, with the support of UNAIDS, supports the council to run HIV, sexual and reproductive health and rights and gender-based violence sensitization dialogues with the local community.

Through this forum Ms Mosolo was further exposed to LBGTI people and, through this experience, came to understand her grandchild better.

Mpho is now 23 years old and works in Cape Town, South Africa. Ms Mosolo hopes he will return home to Lesotho one day. She says she would like to build him and his future wife a home on her land. “I would rest knowing Mpho has a place to call his own,” she says.

Ms Mosolo’s journey has brought her a great deal of acceptance, a quality she promotes to her peers on the council and to people in her community. She too has become a human rights defender.

“As people we need to accept and embrace that this is here. I have seen with my own eyes that some men fall in love with men. We need to embrace it for children to progress with their lives,” she says.

UNAIDS is partnering with the Africa Centres for Disease Control and Prevention (Africa CDC) to support the roll-out of the Partnership to Accelerate COVID-19 Testing (PACT) in Africa, including Madagascar.

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

With funding from PACT, Madagascar is implementing a project to strengthen the engagement of civil society in the national COVID-19 response in the country. The first phase of the project has been initiated in six districts of the former province of Mahajanga, part of the Boeny region in south-west Madagascar.

Mahajanga has been chosen for the first phase because of its high HIV prevalence among key populations. According to a 2016 national survey, HIV prevalence is particularly high among sex workers, at 22.7% in 2016. As the former province is frequented by tourists, there are also concerns that another wave of COVID-19 may occur.

UNAIDS, the National AIDS Council, the Ministry of Health, at least 40 representatives of networks of people living with HIV and networks of lesbian gay, bisexual and transgender people (LGBT), a representative of the Mayor of Mahajanga and representatives of the health centre, local school and prisons attended a launch of the project. During the launch, 60 bottles of bleach were offered to the municipality to assist tuk-tuk drivers in Mahajanga with hygiene, as they and their passengers are at higher risk of COVID-19 infection.

Five community-led organizations have been identified to develop an implementation plan for the PACT project. The plan will be finalized after the results of a situational analysis of the impact of COVID-19 in the Boeny region are made available. The main recipients of the project are an estimated 136 000 people—people living with HIV, adolescents both in and out school, prisoners and key populations.

The project will engage local authorities and beneficiaries to contribute to effective implementation of the PACT project in Mahajanga and to the intensification of COVID-19 tests, with a particular emphasis on strengthening demand generation and contact tracing.

“We are proud to be among the seven African countries to receive funds to support the deployment of PACT,” said Jude Padayachy, the UNAIDS Country Director for Madagascar. “This project focuses on the COVID-19 response among people living with HIV, LGBT people, young people and adolescents, who have difficulty accessing care due to stigma and discrimination. No one should be left behind.”

Patson Manyati cuts an awkward and lonely figure in a room bustling with young people in their twenties. His elegant poise, greying beard and baby blue shirt place him at least 40 years too old for this scene.

Mr Manyati is on one of his first visits to the drop-in centre of Gays and Lesbians of Zimbabwe (GALZ) in Mutare, in eastern Zimbabwe. GALZ is a membership-based association that promotes, represents and protects the rights of lesbian, gay, bisexual, transgender and intersex (LGBTI) people in Zimbabwe.

While Mr Manyati may look out of place, being at GALZ is the most “comfortable” he has ever felt as a gay man living in Zimbabwe in his 60 years.  

“When I see people like me, I feel very happy,” says Mr Manyati in his musical, soft-spoken voice. His eyes don’t stop shimmering while he talks. Remarkable for someone who has grown up around pervasive homophobia. The kind of homophobia that, as recently as 2017, saw the former president describe gay people as, “worse than dogs and pigs.”

GALZ maintains that the hatred and fear caused by the late president’s particular brand of homophobia, “is still being felt in Zimbabwe today.”

While being at GALZ makes him happy, as soon as Mr Manyati ventures out beyond the gates of the premises, he must be guarded and vigilant. Beyond the insults, the threat of jail is real, as Zimbabwe punishes same-sex sexual relationships with up to 14 years imprisonment.

Beyond jail, there is the everyday lived experience of discrimination, violence and hate crimes with which LGBTI people must contend—not only in Zimbabwe, but also in the 69 countries worldwide that criminalize same-sex sexual relationships.

And even in countries that don’t, like neighbouring South Africa. While same-sex marriage is legal and LGBTI rights are constitutionally enshrined, being gay is dangerous. In the first half of 2021, there has been a spate of murders of young gay men and an outcry from the LGBTI community for the government, media and public to take hate crimes more seriously.

Under these conditions, it is an act of defiance just to exist and, even more so, to be deliberately happy.

Happiness is something Mr Manyati has tried to carve out for himself, despite the odds.

Born in Mutoko, a small town in Zimbabwe’s Mashonaland East Province, Mr Manyati says his parents expected him to get married in his twenties to a woman and to carry on the family name as one of the seven Manyati sons.

While his parents insisted on marriage for some time, Mr Manyati stood his ground. As the sole caregiver for his parents and siblings, they eventually gave in and he lived his life single, never coming out to his parents. 

“I couldn’t get married because I have the body of a male but, inside, I feel like a female. I know I am … I feel … like a female. So why should I marry a female?”, he says, visibly grappling with complex concepts about his gender identity without the vocabulary to do so.

Here at GALZ, everyone tells him “who they are,” says Mr Manyati. Perhaps with a few more visits and more interaction with the young people around him, who are so much more self-assured in their sexual orientation and gender identity, it may not be too late for Mr Manyati to give name to his feelings.

GALZ is a lifeline for its members. It offers regular clinic days at its Harare drop-in centre and referrals at its other drop-in centres, in Mutare and Masvingo, for a range of health-care services, including HIV prevention and treatment. It also provides critical counselling services and safe spaces for LGBTI people to socialize and relax, away from the “harsh” streets.

The leadership at GALZ says that things are slowly getting better for LGBTI people in Zimbabwe.

In 2017, GALZ was included as an official participant in the funding proposal developed for the Global Fund to Fight AIDS, Tuberculosis and Malaria. This helped to secure US$ 2 million for programmes that serve gay men and other men who have sex with men, the largest investment ever in an HIV and sexual and reproductive health response for the community. The funding resulted in the three GALZ drop-in centres.

The National AIDS Council (NAC) of Zimbabwe has a key populations forum, supported by UNAIDS, and of which GALZ is a member. The NAC is visibly working to improve the health and well-being of key populations even while their activities remain criminalized.

Despite progress, the lingering stigma and discrimination that the LGBTI community faces in Zimbabwe has resulted in Mr Manyati and people of his generation leading an isolated life. 

“It makes me feel safer to rather stay by myself,” says Mr Manyati, adding that all his peers and friends from the LGBTI community have since died. “Sometimes I cry,” he sighs.

When Mr Manyati’s friends were alive, they would live their lives to the fullest, even though the law was a constant threat and they remained unlucky in love with the men they encountered. 

“[You would know] he doesn't really like you because he has another love somewhere and you are just one on the side. In the end, he gets married and leaves you,” says Mr Manyati of these encounters.

Mr Manyati is adamant that he is “too old” to look for love now, and that he would rather focus on looking after his health as one of the estimated 1.4 million Zimbabweans living with HIV.

Mr Manyati discovered he was living with HIV when he developed a cough five years ago. He went to a local nongovernmental organization, New Start, for an HIV test and after a course of tuberculosis treatment he was initiated immediately onto HIV treatment. His health is his main priority.

“I continue with HIV treatment. That’s how I’m looking healthy now,” Mr Manyati concludes, eyes still shimmering.

* Not Yet Uhuru is a quote by the Kenyan freedom fighter Oginga Odinga. Uhuru is a Swahili word meaning “freedom”; thus, it loosely means “not yet free”. It is a hashtag routinely used by GALZ in its social media posts.

Monica Geingos, the First Lady of Namibia, showcased two flagship programmes of the Office of the First Lady to the UNAIDS Executive Director, Winnie Byanyima, during Ms Byanyima’s recent country visit to Namibia.

Launched in February 2018, the #BreakFree anti-violence campaign aims to contribute towards preventing violence through awareness-raising around various forms of violence in Namibia and finding pragmatic solutions for prevention.  

As part of the campaign, Ms Geingos hosted a women leaders’ dialogue to engage Ms Byanyima and women leaders in Namibia on critical discussions about gender inequality and gender-based violence as critical structural drivers of the HIV epidemic. 

Women leaders called for collective support and leadership towards achieving gender equality and ending gender-based violence in Namibia through national gender policies and strategies. “We need to use the law as a tool for social justice,” said Yvonne Dausab, the Minister of Justice, during the dialogue.

The Government of Namibia has recently launched a mass media campaign, Nationhood and National Pride, against gender-based violence. This comes at an opportune time, as Namibia recorded an increase in sexual and gender-based violence, femicide and human rights violation cases in 2020, which prompted a series of youth-led countrywide protests against sexual and gender-based violence.

Last year, more than 2300 cases of domestic violence were recorded at various magistrate courts across the country, a considerable increase from 2044 similar cases registered in 2019.

“Even though progress has been made in policy development, women’s representation and other areas, girls are still born in an unequal world and violence against women still remains a challenge,” said Ms Byanyima.

Another separate yet interrelated programme of the Office of the First Lady is the #BeFree movement. It was launched by Ms Geingos in 2016 with the technical and financial support of UNAIDS and the United Nations Population Fund.

The purpose of #BeFree is to create a non-judgemental, inclusive platform that encourages honest and robust dialogue and information-sharing so that young people are free of the issues that stand in the way of their development. This includes HIV, alcohol and drug use, unintended pregnancy, mental health issues and relationships with parents or caregivers.

Ms Byanyima, at the invitation of Ms Geingos, attended a #BeFree dialogue with young people on strengthening HIV prevention and gender equality and addressing stigma and discrimination.

During the event, Ms Byanyima reflected on her activism journey and encouraged young people to build resilience and self-confidence and to empower themselves in order to overcome the challenges they face, especially in tertiary institutions.

Ms Geingos noted the growth and transformation of the #BeFree movement in the past five years. Under the movement, her office has hosted and facilitated  more than 35 dialogues and reached more than 100 000 young people and partners from all sectors of society. Ms Geingos asked young people to continue to speak out against violence, abuse and discrimination while also ensuring that they achieve academic excellence and their goals and aspirations. 

To conclude her visit to Namibia, Ms Byanyima met with Hage Geingob, the President of Namibia, above, to acknowledge Namibia’s commitment to the AIDS response and the country’s success in attaining the 90‒90‒90 treatment targets ahead of the 2020 deadline and its domestic investment in the HIV and health responses.

“AIDS came to my door as a surprise. It all started in 1988, when my partner, Rafael, started to get sick. We were both 28 years old at the time,” said Georgina Gutiérrez, who has been a human rights activist for people living with HIV in Mexico for more than 30 years.

Today, she is a representative of the Mexican Movement for Positive Citizenship, which aims to promote the empowerment of people living with HIV in prison. She is also part of the Latin American and Caribbean Movement of Positive Women.

“In those years, stigma and discrimination were widespread. I knew about HIV only through television and many women who had HIV-positive partners assumed they were living with HIV without ever having been tested,” she said.

Her partner was imprisoned in Santa Martha Acatitla Penitentiary in Mexico City, where he spent eight years. This was when she got to know the reality inside prison, and it was this experience that would set the course of her life towards working with jailed people living with HIV.

“People living with HIV in prison are invisible to society. I remember many years ago, as a protest they would burn their mattresses, just to demand dignity in their access to HIV treatment,” Ms Gutiérrez recalled.

Ms Gutiérrez knew that there was a need for action to protect the physical and mental health of people living with HIV in prison. This is how she and others started a project against HIV and COVID-19 in the Santa Martha Acatitla Penitentiary.

The project is one of 30 initiatives selected from more than 190 applicants for the UNAIDS 2020 call for proposals for community-based organizations working on HIV in Latin America and the Caribbean that received funding. The project received an award of US$ 5000 to help its work.

The Santa Martha Acatitla Penitentiary houses around 2000 inmates, including 180 people living with HIV, some in the advanced stages of AIDS-related illnesses. People living with HIV are concentrated in Dormitory 10 in the prison.

“Dormitory 10 is overcrowded and physical distancing is difficult. Hygiene standards were low. In addition, most of them had not received COVID-19 personal protective equipment—the very few who were able to access such equipment did so through their families,” said Ms Gutiérrez.

In addition to the 180 people living with HIV in the prison, each of whom received personalized face coverings and other personal protective equipment and who attended a series of trainings, approximately another 1000 staff and inmates benefited from the project.

“I have been able to see them change. They have told me many times that they feel safer with the tools and knowledge they have gained,” said Ms Gutiérrez. “They feel good to know there are people concerned about them during this health crisis.”

“With our trainings and donations, the prisoners can now keep their rooms clean and can frequently wash their hands, clothes and personal belongings.” 

Working for HIV prevention is, “A commitment I have in every drop of my blood,” she said. “With these actions, we are giving life to forgotten people. I thank UNAIDS for financing this project—with it we are supporting a population that is being left behind.”

On any given day, approximately 11 million people worldwide are incarcerated. The risk of sexual violence among prisoners—and their inadequate access to condoms, lubricants, pre-exposure prophylaxis and harm reduction services—increases their chances of contracting HIV, hepatitis C and other sexually transmitted infections.

The HIV response in the Philippines has been hit by the COVID-19 pandemic, especially access to HIV prevention and treatment services. According to the Global Fund to Fight AIDS, Tuberculosis and Malaria, in Metro Manila coverage of HIV prevention services for gay men and other men who have sex with men has decreased by 74% since 2019. Government figures show that compared to 2019, in 2020 HIV testing decreased by 61% and enrolment in HIV care reduced by 28%. The COVID-19 pandemic has drawn attention to socioeconomic divides, highlighting failures within the health system to adequately deal with not one pandemic but two. 

Despite this, what has been clear from the onset of the COVID-19 outbreak is that civil society and communities have stepped up to the challenge to provide HIV services while navigating through restrictions on movement and lockdowns. One example is the Family Planning Organization of the Philippines (FPOP), a civil society health service provider and advocate of sexual and reproductive health and rights with a network of more than 1000 community-based services across the country. One of those service providers is the Rajah Community Center, a primary HIV clinic located in Iloilo City in the Western Visayas region of the Philippines, which provides HIV services for key populations, including young key populations, in a friendly and stigma-free environment. 

“When I tested positive for HIV, I knew nothing about it. I did not know how to protect myself from it and talking about sex was taboo in my house. My friends and I were clueless about condoms,” said Jhenard Jude, a young person from Iloilo City. After receiving his positive diagnosis, Mr Jude learned about the Rajah Community Center. “I heard from my friends that Rajah provides youth-friendly services. I was worried about how others would look at me because of my status, but the staff at the clinic were non-judgemental and very friendly. I was given a care worker who supported me every step of the way to access antiretroviral therapy,” he said.

“This is home to me. I got my HIV self-test kit here in June 2020. Rajah is safe and convenient,” said Lloyd Legario, a young person who regularly visits the clinic for HIV testing and prevention services. 

Winnie Byanyima, the UNAIDS Executive Director, has been learning about the Rajah Community Center during a two-day virtual mission to the Philippines to engage with communities, civil society and the government about the country’s response to HIV and COVID-19. During her virtual visit, Ms Byanyima was given a pre-recorded tour of the community clinic and had an open dialogue with Mona Liza S. Diones, the Chapter Program Manager of FPOP Iloilo, Robert Figuracion, the Rajah Community Center Clinic Officer, and three clinic clients from key populations.

“I had the pleasure to speak with some very courageous people who were very open about their experiences at the Rajah Community Center. I extend my deepest gratitude and solidarity to community-based organizations and frontline workers for stepping up and providing essential services during COVID-19,” said Ms Byanyima.

To ensure the continuity of HIV services during COVID-19, FPOP Iloilo worked closely with the Philippines Department of Health, local government units and other treatment hubs and support groups to serve key populations and people living with HIV. Blended services that included online counselling and onsite services covered prevention commodities, testing services, treatment and medical care. This also included providing psychosocial services, which have seen a sharp rise in demand since the first COVID-19 outbreak. Telemedicine and mobile clinics became new channels for differentiated care. Innovative programmes to deliver antiretroviral therapy to clients were established and pre-exposure prophylaxis (PrEP) and condoms were frontloaded to community champions for distribution.

During the virtual visit, Ms Byanyama also learned about the HIV & AIDS Support House (HASH), another renowned community-led service provider, which in coordination with the Department of Health has worked to prevent disruption to HIV services during COVID-19. HASH offers community-based screening, PrEP, HIV referral services, medical assistance to children living with HIV and psychosocial support to key populations. “Civil society organizations were quick to respond to the situation by coming out with innovative courses of action, such as online counselling, alternative modes of antiretroviral therapy delivery and mobilization of volunteers and partners to assist those who were affected by the COVID-19 pandemic,” said Desi Drew Ching, the President of HASH. 

“To sustain community-led services, government and development partners have to optimize collaborative partnerships with civil society. This will strengthen their leadership capacities and enhance civic space funding through social contracting programmes,” said Louie Ocampo, the UNAIDS Country Director for the Philippines.

By Nandini Kapoor, Community Support Adviser, UNAIDS Country Office for India

The death of Smarajit Jana has left us shaken. True to his nature, he fought COVID-19 valiantly, but sadly the champion for the response to HIV succumbed to the coronavirus.

How do you begin to describe Mr Jana? A medical doctor, a public health specialist, an epidemiologist, a researcher and academician, an ardent advocate for the response to HIV and the architect of India’s national HIV response for key populations, a champion of human rights and the dignity of sex workers, the founder of the Durbar Mahila Samanwaya Committee (DMSC) collective of sex workers, a winner of national and international honours and accolades, a distinguished voice in domestic and global forums, and much more.

A great leader, an incomparable professional and, above all, a human being par excellence, he gave voice to the most vulnerable and the most marginalized to ensure they were heard and their dignity respected. He touched innumerable lives. Words are not enough to capture the range of his work and the difference he made to so many lives. What he did is etched in the hearts of the lives he touched—with warmth, with love, with affection.

He was a man of science, with his heart firmly anchored in the community he served. He brought science to the community level simply and brilliantly. And the reverse was true—he could easily translate policy and science in simple words for the community to understand.

I first met Mr Jana when I joined UNAIDS 18 years ago. We had organized a meeting for key populations and invited representatives of DMSC, since it had been key to the sex worker movement in India. We were told that they would attend, but not without Mr Jana, their guide, mentor and father figure. That was the level of trust and confidence they had in him. He spoke for their rights and ensured that the reality in the field was brought to the meeting table.

His skill at listening to the community and overlaying what he heard with policy discourse helped to move community-friendly strategies as part of the national HIV response. His presence at every meeting was full of energy and passion.

I have had several conversations with Mr Jana on a range of programmatic issues—the changing nature of sex work, preexposure prophylaxis, collectivization, decriminalization and much more, and each conversation was a learning experience for me.

I will miss him, above all his sage counsel and mentoring. But he will live on—in the work that he did and in the hearts of the vast numbers he impacted.

Our prayers are with his family and the thousands of people whose lives he touched and made better. Om Shanti.

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

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

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

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

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

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

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

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

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

The drop-in centre of the Uganda Harm Reduction Network (UHRN) looks lonely from the deserted suburban pavement. It is a non-descript house, hidden behind an imposing solid pink steel gate, in an equally non-descript neighbourhood.

It looks like so many other drop-in centres in eastern Africa that serve key populations—anonymous and low-key. Necessary characteristics, perhaps, in a region that mostly criminalizes people who use drugs, gay men and other men who have sex with men, sex workers and transgender people.

Once through the gate, visitors are greeted with a hive of activity that belies the quiet exterior. Clients and staff are buzzing around, setting up chairs under the makeshift gazebo in the verdant garden. In a few minutes, a group of people who use drugs will take part in a harm reduction workshop run by one of the centre’s staff. There is also a consulting room at the front of the drop-in centre; and at the back, is the office of Wamala Twaibu.

Mr Twaibu is the founder and chairperson of the Eastern Africa Harm Reduction Network and UHRN. A self-styled “former drug user with roots in Uganda and the pioneer of the harm reduction movement in eastern Africa,” Mr Twaibu has a kind face and a penetrating gaze that tells a story of adversity, resilience and triumph.

In the consulting room, 25-year-old Kemigisa Sandriano, a heroin user and sex worker, is taking an HIV test conducted by the centre’s resident doctor, Mukiibi Grace Nickolas. The night before, Ms Sandriano was assaulted by a client after he took off the condom during sex. She protested, telling him to leave. Her swollen, bloodshot right eye attests to what happened after that. She is smiley and talkative, seemingly unbothered by yet another instance of violence at the hands of a client. She is happy that in his battle to get his money back, she won.

Ms Sandriano was introduced to heroin by her ex-husband, who she says “ruined” her life. Nevertheless, she is upbeat about her recovery.

“I have the hope that I can stop. I even went to rehab for three months. When I saw my days of rehab coming to an end, I saw no plan and I started again,” she says.

“I am ready to go to rehab again,” she continues. “But when I come out, I don’t want to be idle. When they take us out of rehab, we need a job. They can say to us, “Work in a supermarket, work in this shop, so you can stabilize.””

Employment aside, Mr Twaibu says medically assisted treatment for people with opioid dependence is critical for rehabilitation. And, since, December 2020, with advocacy from UHRN and financial support from the United States President’s Emergency Plan for AIDS Relief and the Centers for Disease Control and Prevention, the first medically assisted treatment services in Uganda have been available at the Butabika National Mental Referral Hospital in Kampala.

UHRN screens and provides initial preparation for eligible clients and refers and links them to the hospital and provides them with ongoing psychosocial support services. In December 2020, there were 81 people who use drugs enrolled in medically assisted treatment.

Besides medically assisted treatment, through its drop-in centre UHRN offers a comprehensive package of health services, including behaviour change communication, a needle–syringe programme, psychosocial support, overdose management, HIV testing and counselling and sexually transmitted infection screening.

The COVID-19 pandemic posed a major challenge to UHRN’s clients, who even under normal circumstances face high levels of stigma and discrimination, police abuse and harassment, alienation and limited access to health and social services.

Sex workers, transgender men and women, people who use drugs and gay men lost livelihoods and faced even more violence and detention under the guise of lockdown measures. Movement was severely limited as motor vehicles required a special permit to operate.

UHRN rose to the challenge. A team of 25 peer educators used bicycles, funded by Frontline AIDS, and motorcycles to reach their clients where they were, providing antiretroviral medicine refills and condoms to clients who could not reach health facilities.

The organization rolled out virtual counselling services on risk reduction and addiction management through phone calls and WhatsApp. As part of personal protective equipment procurement, UNAIDS, through the National Forum of People Living with HIV/AIDS Networks in Uganda, provided soap and bleach to prevent COVID-19 infection among the drop-in centre’s dedicated staff, who worked right through the pandemic.

Despite the constraints of the pandemic, UHRN’s needle–syringe programme reached 287 clients in 2020, providing more than 15 000 clean needles and syringes, tourniquets, cotton balls, swabs, water ampoules, condoms, lubricant and safe-injecting information notes.

“I’m proud that harm reduction issues are taking a centre stage in Uganda,” says Mr Twaibu. “Community-led means ownership. Usually when the community is at the centre, accountability and community needs are prioritized,” he says.

The Union for HIV Prevention and Harm Reduction is a nongovernmental organization located in Balti, in the Republic of Moldova. It provides integrated services to people who use drugs and other affected populations throughout the north of the country.

Each year, more than 3000 people benefit from its services, which including mobile testing for HIV, sexually transmitted infections and hepatitis, harm reduction services, including a needle–syringe programme, the distribution of condoms and psychological and social support. The organization’s outreach and medical workers work closely with state clinics and hospital departments that offer opioid substitution therapy to people who use drugs.

However, the organization has faced a long-time logistical problem with regard to the collection of used needles and syringes generated by the harm reduction programme. Medical waste disposal in the Republic of Moldova, especially in the north of the country, is problematic. Ala Iatco, the nongovernmental organization’s head, explained that destruction of used equipment was only possible by contracting medical institutions to do the work and that the union had to send boxes with contaminated waste to Chisinau, the capital of the country.

“For the approximately 20 years of the harm reduction programme in the country, this problem was always present and solved through burning needles and syringes or other non-environmentally-friendly ways. We had to find a solution to increase the effectiveness of the comprehensive package of services and enhance the safety and security of personnel and volunteers while operating the needle–syringe programme,” said Svetlana Plamadela, UNAIDS Country Manager for the Republic of Moldova.

The UNAIDS Country Office for the Republic of Moldova, together with the United Nations Office on Drugs and Crime and the union, came together and suggested a solution. In July 2017, specialized modern medical waste management equipment was procured from the Russian Federation and installed within a Union for HIV Prevention and Harm Reduction facility. The total cost of US$ 23 000 was funded with resources from the One UN Joint Action to Strengthen Human Rights in the Transnistrian Region of the Republic of Moldova project, financed with the support of the Swedish Embassy and co-funded by the Center for Health Policies and Studies (PAS Center), which is a Principal Recipient of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

“The availability of the one-stop disposal system provided by the needle smelters and syringe cutters significantly reduces the risk of accidental exposure and contamination with bloodborne diseases by the volunteers and medical personnel,” added Ms Plamadela.

So far, three organizations—the Union for HIV Prevention and Harm Reduction, Young Women Cernoleuca and Adolescent!—have benefited from the needle–syringe destruction equipment. Partner organizations usually make monthly shipments of needles and syringes for destruction, which are collected by field workers in eco-boxes.

According to Ms Iatco, the equipment is easy to use and maintain. “The machine transforms the contaminated syringes and needles into biologically safe waste. We save almost 50% of the cost of destruction. And, most importantly, we face much fewer risks as we avoid transportation, storage and transfer of hazardous material. For our organization, located in a remote area where no such equipment is available in medical institutions, it’s a cost-effective and less risky solution,” she said.

The needle–syringe programme in the Republic of Moldova started in 1999. Its main goal is to prevent the transmission of HIV and other infections among people who inject drugs by avoiding the sharing of injecting equipment and ensuring enhanced access to health-care services and psychosocial support. The programme also aims to curb the sexual transmission of HIV among people who inject drugs and their sexual partners by promoting the use of condoms and raising awareness about the link between drug use and risky sexual behaviours.