The HIV epidemic in the Middle East and North Africa is still growing—an estimated 20 000 new HIV infections in 2019 marked a 25% increase over the 16 000 new infections in 2010. The region is far from controlling its HIV epidemic and HIV treatment coverage is low, with only 38% of people living with HIV accessing HIV treatment in 2019, resulting in 8000 people dying from AIDS-related illnesses in the region.

Community-based organizations can play important roles in the region’s HIV response, but they are constrained in many countries by limited civic space and resources. In response, community leaders living with HIV have come together to launch the first regional network of people living with HIV, MENA Plus, to strengthen the community HIV response in the region.

“It is time people living with HIV have a network where they make their own decisions and get our rights without stigma and discrimination,” said Amina Ibrahim (not her real name), a member of MENA Plus from Egypt.

With a vision of a society where people living with HIV live with respect and dignity, enjoy their full rights and have equal opportunities, MENA Plus aims to enhance the leadership, representation and effective engagement of people living with HIV across the Middle East and North Africa.

“We need to discuss the suffering of people living with HIV, and especially of children living with HIV, and how to educate them about living their lives,” said Soumayya Abdelwafi (not her real name), a member of MENA Plus from Morocco.

The network will advocate for HIV treatment and prevention services in the region, the sustainability of HIV funding and ending vertical (from mother to child) transmission of HIV and new HIV infections among children.

MENA Plus will put a strong emphasis on human rights, campaigning on sexual and reproductive rights, sensitization on gender diversity and sexual orientation and the rights of minorities and key populations—vital for a region whose HIV epidemic is highly concentrated among key populations and their sexual partners.

“With diversity, we enrich networking and advocacy to help achieve rights,” said Souhaila Abdalla (not her real name), a member of MENA Plus from Tunisia.

Through enhancing the leadership, representation and effective participation of people living with HIV, especially in decision-making around health and social and financial programmes, MENA Plus aims to empower people living with HIV in the region.

“MENA plus is a welcome addition to our UNAIDS team of partners across the Middle East and North Africa. Our friends, family and colleagues living with HIV have shown remarkable resilience, determination and innovation in responding to the interconnected challenges posed by HIV and COVID-19 in recent years. Through MENA Plus, their work has the potential for even greater impact, as the new global AIDS strategy puts community-led responses at the heart of UNAIDS’ work,” said Shereen El Feki, Director of the UNAIDS Regional Support Team for the Middle East and North Africa.

Early diagnosis of infants who have acquired HIV vertically (from their mother) is vital. Swift testing of infants exposed to HIV and an immediate start of antiretroviral therapy upon diagnosis can ensure the survival of children who have acquired HIV. Without early diagnosis and treatment, about half of infants with HIV die by the age of two years, but many HIV-exposed infants in low- and middle-income countries are not accessing early infant diagnosis.

In the Caribbean, coverage of virological testing for early infant diagnosis varies from 21% in Jamaica to 99% in Cuba.

The 64th regular session of the Commission on Narcotic Drugs—the policymaking body of the United Nations with prime responsibility for drug-related matters—is being held from 12 to 16 April, at which the anniversaries of the 1961 Single Convention on Narcotic Drugs and the 1971 Convention on Psychotropic Substances are being marked.

In addition to the opening, operational and normative segments, more than 100 side events are taking place addressing various aspects of drug programmes and policies, including the impact of COVID-19. Five resolutions are being debated, including one on the impact of the COVID-19 pandemic on the implementation of Member States’ joint commitments to address and counter the world drug problem.

The normative session is looking at the implementation of the international drug control treaties, including the follow-up to the implementation at the national, regional and international levels of all commitments, as reflected in the ministerial declaration of 2019, as well as the inter-agency coordination of efforts in addressing and countering drugs.

In addition, the session will see deliberation on the contributions by the Commission on Narcotic Drugs to the work of the United Nations Economic and Social Council, including follow-up to and review and implementation of the 2030 Agenda for Sustainable Development.

The opening segment included a message from the United Nations Secretary-General, who noted that the COVID-19 crisis has shown the world how much the world needs solidarity, shared responsibility and international cooperation to improve health coverage.

Speaking for UNAIDS at the opening plenary, Ninan Varughese, a UNAIDS Senior Adviser, noted that the new global AIDS strategy calls for the intensification and redoubling of efforts to scale up comprehensive harm reduction for people who inject drugs in all settings and commits to promote and support community-led responses. He added that the engagement of key populations, including people who inject drugs, is critical to a successful HIV response everywhere and reminded the plenary of UNAIDS’ call on all leaders to come together to support the High-Level Meeting on AIDS from 8 to 10 June 2021.

More than 170 former heads of state and government and Nobel laureates, including former Prime Minister of the United Kingdom Gordon Brown, former President of Colombia Juan Manuel Santos, former President of Liberia Ellen Johnson Sirleaf, former President of France François Hollande and Nobel Laureates Professor Joseph Stiglitz and Professor Francoise Barre-Sinoussi, today called on President Biden to support a waiver of intellectual property rules for COVID-19 vaccines and pursue a people’s vaccine to end the pandemic in an open letter today.

The letter was sent to the White House as U.S. health authorities advised a pause in the use of the Johnson & Johnson Covid-19 vaccine. A waiver of intellectual property rules would allow for a scale up in manufacturing in the U.S. and around the world, overcoming artificial supply constraints.

The former world leaders and Nobel Laureates encourage President Biden to take the urgent action only he can and “let this moment be remembered in history as the time we chose to put the collective right to safety for all ahead of the commercial monopolies of the few.”

The letter specifically asks President Biden to support a proposal from the South African and Indian governments at the World Trade Organization (WTO) to temporarily waive intellectual property rules related to COVID-19 vaccines and treatments. At the current pace of vaccine production, most poor nations will be left waiting until at least 2024 to achieve mass COVID-19 immunization.

Gordon Brown, former Prime Minister of the United Kingdom said:

"President Biden has said that no one is safe until everyone is safe, and now with the G7 ahead there is an unparalleled opportunity to provide the leadership that only the U.S. can provide and that hastens an end to the pandemic for the world.”

“An urgent temporary waiver of intellectual property rules at the World Trade Organization would help us ramp up global supply of vaccines together with a global multi-year burden sharing plan to finance vaccines for the poorest countries”.

“This would be in the strategic interests of the U.S., and of every country on the planet".

Joseph Stiglitz, Nobel Economics Prize Laureate, said:

“While the U.S. has made enormous progress in vaccinating its own population, thanks to the efforts of the Biden administration, that alone is unfortunately not enough”.

“New mutations of the virus will continue to cost lives and upend our interconnected global economy until everyone, everywhere has access to a safe and effective vaccine. Intellectual property is the utmost artificial barrier to global vaccine supply. We as a nation must lead with our allies to back the South Africa and India waiver at the WTO, insist on technology transfer, and strategically invest in production”.

François Hollande, former President of France, said:

“The extreme inequality in access to vaccines around the world creates an unbearable political and moral situation. It is above all sanitary and economic nonsense as we are all concerned. That the Biden administration is considering waiving barriers related to intellectual property rules offers hope for the international community. If the United States supports the lifting of patents, Europe will have to take its responsibilities. In the face of this devastating pandemic, world leaders must prioritize the public interest and international solidarity”.

Other signatories include Mary Robinson, the former President of Ireland, Fernando Henrique Cardoso, the former President of Brazil, and Helen Clark, the former Prime Minister of New Zealand, together with over 60 other former heads of state and heads of government that span every continent.

The leaders also called for the intellectual property waiver to be accompanied by the open sharing of vaccine know-how and technology, and by coordinated and strategic global investment in research, development, and manufacturing capacity, especially in developing countries, underscoring that threats to public health are global and require global solidarity-based solutions.            
 

These actions would expand global manufacturing capacity, unhindered by industry monopolies that are driving the dire supply shortages blocking vaccine access. The resulting vaccine inequality, the leaders warned, means that the U.S. economy already risks losing $1.3 trillion in GDP this year, and if the virus is left to roam the world, the increased risk of new viral variants means even vaccinated people in the U.S. could be unprotected once more.

The letter, which was coordinated by the People’s Vaccine Alliance, a coalition of more than 50 organizations including Club de Madrid, Health GAP and UNAIDS, warned that at the current global immunization rate, it was likely that only 10 percent of people in the majority of poor countries will be vaccinated in the next year.

Françoise Barré-Sinoussi, Nobel Prize in Physiology or Medicine Laureate said:

“We will not end today’s global pandemic until rich countries – most especially the United States – stop blocking the ability of countries around the world to mass produce safe and effective vaccines”.

“Global health is on the line. History is watching. I, with my fellow laureates and scientists across the globe, urge President Biden to do the right thing and to support the TRIPS waiver, insist on pharmaceutical corporations to share vaccine technologies with the world, and strategically invest in distributed production”.

Muhammad Yunus, Nobel Peace Prize Laureate said:

“Big pharmaceutical companies are setting the terms of the end of today's pandemic – and the cost of allowing senseless monopolies is only more death and more people being pushed into poverty”.

“We need strong government action to lead - not only philanthropy and the private sector – to solve today’s unprecedented crisis. We together urge President Biden to stand on the right side of history – and ensure a vaccine is a global common good, free of intellectual property protections".

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Notes to editors:

The full letter and list of signatories can be found at here

The letter was coordinated by the People’s Vaccine Alliance, a coalition of more than 50 organizations including Club de Madrid, the Yunus Centre, Oxfam, Health GAP, UNAIDS, Physicians for Human Rights, the Nizami Ganjavi International Center, Global Justice Now and Avaaz.

Staying in school longer has a protective benefit in reducing the risk of HIV infection. Higher levels of educational attainment among women are also associated with increased control over sexual and reproductive health and rights.

In eastern and southern Africa, a positive association between condom use at last higher-risk sex and completion rates of lower secondary school among adolescent girls and young women has been seen. Additionally, greater gains have been made in reducing new HIV infections among adolescent girls and young women in countries that have higher completion rates for lower secondary school (>50%).

Education Plus, a new advocacy initiative for adolescent girls’ education and empowerment in sub-Saharan Africa, is being launched to step up action to ensure that every girl in sub-Saharan Africa gets a quality secondary education.

Following a public call for nominations, UNAIDS and the Programme Coordinating Board nongovernmental organization delegation has selected 16 representatives of civil society and the private sector from all regions to join the multistakeholder task force for the high-level meeting on HIV.

More than 560 nominations were received and the task force has been established with a broad and diverse expertise. There are at least two members per region. More than 50% of the members are women and 25% are under the age of 30 years. Six are openly living with HIV and all key populations are represented.

The United Nations General Assembly will hold its first high-level meeting on HIV since 2016 on 8–10 June 2021. In the run-up to the meeting, before the end of April 2021, an interactive multistakeholder hearing will be held with the participation of communities and other stakeholders, who will also participate in other activities before and during the high-level meeting itself. The task force will advise UNAIDS on the format, theme and programme of the multistakeholder hearing and will help to identify speakers for the hearing and high-level meeting plenary and panel discussions.

Multistakeholder task force members

Andrew Spieldenner, US PLHIV Caucus and MPact Global Action, United States of America

Souhaila Bensaid, MENA-ROSA, Tunisia 

Aaron Sunday, African Network of Adolescents and Young Persons Development and Association of Positive Youth Living with HIV in Nigeria, Nigeria 

Adilet Alimkulov, Kyrgyz Indigo, Kyrgyzstan

Jacqueline Rocha Cortes, MNCP National Movement of WLWA, Brazil

Phelister Abdalla, Key Affected Populations Health and Legal Rights Alliance, Kenya

Aleksey Lakhov, Humanitarian Action and Coalition Outreach, Russian Federation  

Judy Chang, International Network of People who Use Drugs, Italy

Sonal Mehta, International Planned Parenthood Federation, India

Yasmina Chan Lopez, Red Juvenil de AMUGEN, Guatemala

Alia Amimi, International Treatment Preparedness Coalition–MENA, Morocco 

Jacques Lloyd, Afrique Rehabilitation and Research Consultants NPC, South Africa 

Severin Sindizera, Indigenous Peoples Global Forum for Sustainable Development, Burundi

Angela Lee Loy, Aegis Business Solutions, Trinidad and Tobago

Jules Kim, Programme Coordinating Board nongovernmental organization delegation and Scarlet Alliance, Australia

Gideon B. Byamugisha, International Network of Religious Leaders Living with and/or Personally Affected by HIV, Uganda

Effective HIV responses require legal, policy and social environments that empower people living with HIV, those at higher risk of HIV infection and others affected by the epidemic to claim their rights and receive redress when those rights are violated.

Those who are responsible for enabling such legal, policy and social environments need to be properly trained. However, country reporting to UNAIDS in 2020 shows that training programmes on human rights and non-discrimination legal frameworks applicable to HIV are operating at scale at the national level for police and other law enforcement personnel in only 40 out 102 reporting countries, for members of the judiciary in 36 out of 100 reporting countries and for lawmakers and parliamentarians in 30 out of 97 reporting countries.

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

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

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

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

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

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

On International Transgender Day of Visibility (March 31), the United Caribbean Trans Network (UCTRANS) launched the results of its survey Over-policed, Under-protected: The Experiences of Trans and Gender Diverse Communities in the Caribbean.

The study was conducted in 2020 with the support of OutRight Action International. It features feedback from transgender and other gender diverse respondents from 11 countries, garnered from surveys, individual interviews and focus group sessions.

Respondents identified the inability to change their gender marker, employment discrimination and discrimination in health services as the top challenges facing the community.

Except for Cuba, no Caribbean country allows transgender people to modify their gender on official identification.

“Gender identity recognition is important,” said Alexus D’Marco, UCTRANS’ Executive Director. “Every aspect of a trans person’s life—access to education, employment, housing, and healthcare—depends on their ability to show a valid identity card or documentation that aligns with their gender identity and expression.”

“It is beyond hormones,” said Yaisah Val of Community Action for the Integration of Vulnerable Women in Haiti (Action Communautaire pour l’integration des Femmes Vulnerable en Haiti, or ACIFVH). “We need legal recognition and documents.”

Forty-two percent of the study’s respondents indicated that they were currently unemployed. According to the report, discrimination and the lack of workplace and social protections compound this issue.

“We had someone who was working with the government and told they had to go home. They said they didn’t employ ‘she’, they employed ‘he’,” said Brandy Rodriguez of the Trinidad and Tobago Transgender Coalition, pictured above.

Around four of five respondents (78%) reported having experienced depression or anxiety. But just one-third (32%) of those who were receiving accessed health services said that it was trans-affirming or at least trans-competent.

HIV prevalence is disproportionately high among Caribbean transgender people—51% in Jamaica, 28% in the Dominican Republic, 8% in Guyana and 3% in Cuba. In 2019, 5% of new HIV infections in the Caribbean were among transgender people.

“The cycle of displacement contributes significantly to this HIV risk,” Ms. D’Marco said.  “If you are thrown out of the at an early age, experience gender-based violence and find yourself sleeping on beaches or the streets, you are more likely to have sex for a meal or a place to stay. Someone with education, access to housing and healthcare would be less likely to contract HIV.”

Responding to HIV in the trans community calls for increased investments in psychosocial support. Ms. Rodriguez who is a peer navigator for transgender people accessing HIV treatment in Trinidad and Tobago says COVID-19 has increased the proportion of her clients who do not have money for transportation, food and housing. A Guyanese respondent said many of her friends committed suicide due to being unable to cope with their HIV status.

Trans advocacy in the region has burgeoned over the last decade with important strides made toward increasing public awareness and political will. Ms. D’Marco credits RedLacTrans, the regional transgender network for Latin America and the Caribbean, with helping to build advocacy capacity in the Caribbean. In many countries activists and community organizations have scaled up public awareness and political engagement efforts.

UNAIDS is supporting this movement in different ways. UNAIDS Jamaica helped TransWave develop the Trans and Gender Non-Conforming National Health Strategy, a five-year rights-based road map for advancing the community’s health and well-being. UNAIDS Caribbean has collaborated with the Caribbean Vulnerable Communities Coalition, the Caribbean Broadcasting Union, the Caribbean Media Workers Association and the University of the West Indies Rights Action Project to conduct hands-on regional and national journalist trainings on how to cover transgender people and their issues responsibly. UNAIDS Caribbean has also supported community engagement and strategic communications around two successful strategic litigation cases challenging discriminatory laws that affect LGBT people, including a colonial-era crossdressing law in Guyana.

“As we increase our focus on achieving excellent HIV prevention, treatment and human rights outcomes for all key population groups, it is critical that we address the unique challenges facing the Caribbean transgender community,” said Dr. James Guwani, UNAIDS Caribbean Director. “We need more strategic information, more investments in community-based services and comprehensive strategies to increase transgender people’s access to education, employment, justice and healthcare.”

The President of Afghanistan, Mohammad Ashraf Ghani has joined world leaders and experts in an appeal for equitable and fair distribution of COVID-19 vaccines.

In a letter to the People’s Vaccine Alliance, President Ghani outlined that despite the numerous challenges Afghanistan continues to face as a country caught in conflict, Afghanistan has witnessed fewer human losses caused by the COVID-19 pandemic compared to other countries. However, the President underscored that this did not mean that the resulting implications were underestimated or ignored.

“We must put in place all possible efforts to maximize the supply of vaccine so that everyone, everywhere can benefit as quickly as possible,” said President Ghani. “I assure you of my unwavering support to the People’s Vaccine Alliance.”

In the letter he urges fellow leaders to urgently develop a common plan to massively scale up manufacturing of the vaccine. Which would not only save millions of lives, but also build capacity and infrastructure in countries around the world to manufacture medicines and vaccines to help achieve universal health coverage and prepare for future health emergencies.

He also urged fellow leaders—especially leaders in high-income countries—to insist that the vaccine technology and know-how is shared through the World Health Organization's Covid-Technology Access Pool, and that leaders unite to strongly support the proposal made by India and South Africa to the World Trade Organization to waive patents during the pandemic.

The President of Afghanistan joins more than 150 leaders and advocates globally who have signed up to be part of the People’s Vaccine Alliance including the President of South Africa and the Chairperson of the African Union Commission, the Presidents of Ghana and Senegal, the Prime Minister of Pakistan, the Director of the Africa Centres for Disease Control and Prevention and the Special Rapporteur on the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.

“EMERGENCY and all the members of People Vaccine Alliance advocate for equal access to the vaccines: while millions of people who have already been vaccinated in the United States, the United Kingdom or European countries feel safer, most of the low-income countries will barely be able to vaccinate one out of 10 people in 2021 due to the inaccessibility of vaccines,” said Rossella Miccio, President of EMERGENCY.

The People’s Vaccine Alliance calls on pharmaceutical corporations and governments to:

• Prevent monopoly on vaccine production by making public funding for research and development conditional on research institutions and pharmaceutical companies sharing all information, data, biological material, know-how and intellectual property. The WHO COVID-19 Technology Access Pool provides the mechanism for such sharing.
• Prevent monopoly on vaccine supply by enabling as many manufacturers as possible, including in developing countries, to produce the vaccines.
• Implement fair allocation of the vaccine that prioritizes health workers and other at-risk groups in all countries. Vaccination programmes should include marginalized groups, including refugees, prisoners and people living in slums and other crowded housing conditions. Allocation between and within countries should be based on need and not ability to pay.
• Provide the vaccine free of charge at the point of use.
• Ensure the full participation of the governments of developing countries as well as global civil society in decision-making forums about the vaccines (and other COVID-19 technologies) and ensure transparency and accountability of all decisions.

The People’s Vaccine Alliance

The People’s Vaccine Alliance is a coalition of organisations and activists united under a common aim of campaigning for a People’s Vaccine’ for COVID-19 that is based on shared knowledge and is freely available for all. A global common good. It is coordinated by Oxfam and UNAIDS and its other members include: EMERGENCY, Free the Vaccine, Frontline AIDS, Global Justice Now, International Treatment Preparedness Coalition, Just Treatment, Nizami Ganjavi International Center, Open Society Foundations, STOPAIDS, SumOfUs, Wemos and Yunus Centre.