The opening session of the 2020 International AIDS Conference shared the findings of a rapid online survey demonstrating the increased socioeconomic vulnerability of lesbian, gay, bisexual, transgender and intersex (LGBTI) people due to COVID-19.

UNAIDS, the LGBT+ Foundation and researchers from the Johns Hopkins Bloomberg School of Public Health and other universities around the globe convened a COVID-19 disparities working group. It surveyed more than 20 000 LGBTI people in 138 countries in April and May and found that three quarters (74%) were fully or partially locked down, leading to economic consequences for many.

About 13% of the survey participants have already lost their jobs in the wake of the pandemic and a fifth (21%) are expecting to lose it in the near future. Nearly half the survey participants (47%) faced economic difficulty, with a quarter unable to meet their basic needs, skipping meals or reducing meal sizes.

Of concern, 21% of participants living with HIV reported that they had experienced “interrupted or restricted access” to refills of antiretroviral therapy and 42% of those said they had less than a month’s supply on hand. Worrisome disruptions were also reported for pre-exposure prophylaxis and access to HIV testing. The study also highlights that racial and ethnic minorities consistently have lower access to HIV services.

Erik Lamontagne, Senior Economist at UNAIDS and one of the members of the working group, reported at the conference that the crisis had pushed 1% of respondents to start engaging in sex work and that 2% had to continue to sell sex during the COVID-19 pandemic, risking exposure to the coronavirus. The pandemic has reduced the ability to negotiate safer sex for 13% of respondents, potentially increasing their risk of acquiring HIV. Respondents also reported reduced access to safe injecting equipment and opioid substitution therapy.

“What worries us is that socioeconomic factors, such as limited access to health care, lower income, unemployment and food insecurity, combined with higher anxiety and depression rates, may place some at higher risk of contracting HIV and affect treatment adherence among people living with HIV,” said Mr Lamontagne.

The study shows that COVID-19 increases the vulnerability of groups that are already disproportionately affected by HIV. Solutions and targeted programmes are required from the global community and governments to sustain prevention, testing and treatment services and to help the LGBTI community not only to survive but emerge from the crisis.

Shakhnoz Amirova (not her real name) lives in Tashkent, Uzbekistan. She has been taking antiretroviral therapy regularly since 2017, when she discovered that she was living with HIV. She continued the treatment while pregnant with her child, so she did not have to worry about her baby’s health, which was born HIV-free. But the COVID-19 pandemic has changed everything, and the lockdown restrictions severely limited access to medical services.

The immediate anxiety about the possible disruption to her HIV treatment and that of her husband, who is also living with HIV, was allayed by the health-care facility that she attends, the Republican AIDS Center, dispensing a two-month supply of antiretroviral therapy for everyone who needs it.

However, Ms Amirova was pregnant again and worried about the impact that COVID-19 may have on her and her unborn child, since information on how COVID-19 may affect people living with HIV was scarce. She was even unsure whether the coronavirus outbreak would stop her being able to have her baby at the maternity hospital.

“Women living with HIV feel especially vulnerable during pregnancy and childbirth, as fear of virus transmission, stigma and discrimination are added to the fears for the well-being of their baby. Of course, the situation with coronavirus is an additional stress factor. At such a difficult moment, women really need help and support, and we are trying to provide this help to them,” said Evgenia Korotkova, a representative of Ishonch va Khaet, an organization that helps people living with HIV.

The Positive Maternity programme run by Ishonch va Khaet helps women living with HIV who are pregnant or have recently given birth with social support, delivering antiretroviral therapy and baby food and providing medical care. During the COVID-19 outbreak, Ishonch va Khaet and similar organizations are working doubly hard so that people who need help get it as quickly as possible.

Yuldashev Kahramon Haldarovich, the Director of the Republican AIDS Center, noted the special role of nongovernmental organizations during a pandemic. “Community involvement in HIV prevention and support for people living with the virus are very important, especially at such tense moments, when the efforts of all health professionals and doctors are concentrated on fighting another pandemic. We cannot leave people who need HIV services behind; they also need help, and they need it today. The work of volunteers from social organizations is priceless.”

Since keeping patients and medical personnel in maternity hospitals safe from COVID-19 is such a priority, UNAIDS and the United Nations Population Fund have made a donation of a range of personal protective equipment, including masks and gloves, and disinfectant to 21 maternity hospitals in Uzbekistan.

“Protecting medical personnel in maternity hospitals from infection is as important as protecting pregnant women. The country is currently on the way to eliminating mother-to-child transmission of HIV. Preventive measures against COVID-19 are important for supporting the progress made,” said Charos Maksudova, the representative of UNAIDS in Uzbekistan.

Ms Amirova safely gave birth in the maternity hospital, happy that both her and her baby avoided becoming infected by the new coronavirus and that her baby was born HIV-free. “But fear for my children, especially for a newborn, does not leave me for a minute,” said Ms Amirova.

Now back at home, she is receiving help from peer counsellors from the Positive Maternity programme.

Since the 2020 HIV targets are soon to elapse, UNAIDS is leading a three-year process to develop new targets for 2025 and to estimate the epidemiological impact and the resources needed for the HIV response from 2021 to 2030.

At the 2020 International AIDS Conference, a session chaired by Anton Pozniak, the President of the International AIDS Society, presented the process and main results from the consultations that have informed it, as well as the next steps. It is expected that the targets will inspire countries to develop ambitious national strategic plans and inform discussions in preparation for the United Nations high-level meeting on AIDS in 2021. 

“This 2025 target-setting exercise sets itself apart from previous rounds of this work in that it includes a stronger focus on the need for social enablers to achieve targets for the AIDS response, as well as consideration for the integration of HIV services,” said Shannon Hader, UNAIDS Deputy Executive Director, Programme.

Paul De Lay, the Co-Chair of the Steering Committee of the 2025 target-setting process, highlighted that the objective is to focus on what will be needed in 2025 in order to achieve the 2030 goal of ending AIDS as a global public health threat. He stressed the broad participation and transparency of the process, which has included representation from governments, civil society, key populations, academia and others.

A representative of Avenir Health presented the model to be used in the estimation of the impact of the targets. The model includes data on population sizes, the estimated impact of each service included and the effectiveness and sustainability of the interventions.

The session heard presentations from the three co-chairs of the technical consultations on testing and treatment, primary prevention and addressing social enablers.

Wafa El-Sadr, from ICAP at Columbia University, said that according to the results of the technical consultation on testing and treatment, in order to leave no one behind the targets should be the same for all subpopulations, including key populations. There should also be specific targets for men and women adjusted by age group and specifically for children younger than 13 years of age. Pregnant women should have testing and treatment targets higher than 95%.

On primary prevention, Quarraisha Abdool Karim, from the Centre for the AIDS Programme of Research in South Africa, indicated that, globally, new HIV infections have declined, but the rate of the decline was far too slow to reach the 2020 target. HIV prevention requires a context-specific combination approach that includes behaviour, biomedicine and an enabling environment for service access and uptake, and the set of targets for 2025 should call for countries to address structural barriers to services. According to her, most parts of the world are not living up to their commitments to scale up primary prevention services, and so the 2025 targets must include a strong statement on HIV prevention.

On social enablers, the session heard that the response to HIV must be people-centred and be based on the principle of inclusion and participation, highlighting the need for community-led responses.

The target-setting process will feed into the new UNAIDS global AIDS strategy currently being developed.

Thousands of households have been helped in Abidjan, Côte d’Ivoire, through a joint initiative to reach vulnerable households with money for nutrition and food security and basic health kits during the COVID-19 pandemic. 

Restrictions on movement imposed to stop the spread of the new coronavirus in Côte d’Ivoire have had a significant impact on the ability of people to earn a living, resulting in an increasing danger of hunger. For people living with HIV, malnutrition and food insecurity reduce HIV treatment adherence, impacting their health and increasing HIV transmission, since stopping treatment can increase a person’s viral load, which increases the chance of passing the virus on. Food insecurity can also increase HIV risk behaviours, potentially putting people at increased risk of acquiring HIV.

The partnership between the World Food Programme, UNAIDS and the Magic System Foundation—a nongovernmental organization that works in the fields of education, health, the environment and culture—allows for a cash transfer of 51 000 central African CFA francs (around US$ 89) per household to cover food needs for two months, distributes hygiene kits and protective equipment to limit the transmission of COVID-19 and gives advice on nutrition.

“The cash transfer allowed me to buy my medicine for three months and to stock up on rice for my family. It gave me the strength to live and smile again,” said one of the recipients.

The priority focus of the campaign are female-headed households and households with pregnant and breastfeeding women, young children, the elderly, people with disabilities and people living with HIV.

“UNAIDS and the Ivorian Network of People Living with HIV are working with various partners—mayors, nongovernmental organizations, the Red Cross, mosques, churches, community leaders, neighbourhood leaders and traditional chiefs—to facilitate access to especially vulnerable people living with HIV,” said Brigitte Quenum, the UNAIDS Country Director for Côte d’Ivoire.

“The health crisis has forced some households to adopt irreversible food strategies, such as selling assets or borrowing money to meet their food needs. Cash-based food aid helps build the resilience of vulnerable households and preserve their livelihoods. The cash transfer provides the opportunity to have a diversified and balanced diet for good health, while leaving recipients with a choice,” said Adeyinka Badejo, the World Food Programme Representative in Côte d’Ivoire.

A further round of assistance for vulnerable households, especially households containing members of key populations or people living with HIV, will take place soon. The second round will draw on a rapid assessment of the needs of people living with HIV during the COVID-19 pandemic, which was carried out by the network of people living with HIV with the support of UNAIDS, and on the lessons learned from the first round of assistance.

Mihai Ceban (not his real name) has been locked down at home since 17 March, when a state of emergency was declared in the Republic of Moldova in response to COVID-19. He is an information technology specialist, so working from home has not disrupted his daily routine too much. His was worried, however, by his inability to go out to get his supply of HIV pre-exposure prophylaxis (PrEP). He has been taking PrEP to prevent becoming infected with HIV since September 2019. Although he has a partner, he says taking PrEP makes him feel safer. “You can’t fully trust your partner,” he said.

During the state of emergency, restrictions imposed by the authorities and the fear of becoming infected with COVID-19 limited his social contacts to a maximum of two or three people. However, his partner continued to lead an active social life, which increased his risk of HIV infection. 

"The fear of COVID-19 was enhanced by the fear of getting infected with HIV. That's why, when I saw I was running out of my pills, I started worrying. I wondered what I would do if no one was working? How do I protect myself? The response came from the GENDERDOC-M Information Center, which delivered my PrEP at home. And the fact that it was delivered to me during the pandemic means that my right to health was respected. It’s my right to have an active protected sex life during the pandemic. And the delivery of PrEP services at home has brought psychological relief and reduced the anxiety of becoming infected with HIV,” Mr Ceban said.

Mr Ceban is not the only beneficiary of the PrEP deliveries. Alexandru Goja, a health programme consultant at the GENDERDOC-M Information Center, said that during the pandemic more than 90 people received PrEP deliveries at home. 

“At the beginning of the pandemic, everyone went into a kind of panic. Some people on PrEP discontinued taking it, but most wanted to continue. For them, we went out, into the parks, in front of their apartments blocks, where we tested them for HIV and delivered their medicine. During quarantine, people from key populations avoided going to medical institutions to pick up their medicines, trying to prevent the risk of becoming infected with COVID-19. The support provided by nongovernmental organizations helps them to exercise their right to health,” said Mr Goja. 

Angela Nagît, an infectious disease specialist at the Hospital of Dermatology and Communicable Diseases, agrees with him. During the pandemic, she carried out consultations and prescribed PrEP remotely. It is very important that once enrolled on PrEP, the person should stick to it, she said. 

“In the Republic of Moldova, HIV infection continues to be a major public health problem with a great medical, social and economic impact. Around half of the people who are estimated to be living with HIV don’t know their status. Unprotected sexual contact is one of the risk factors for HIV transmission. PrEP is a way to prevent infection, thus ensuring the right to health, especially for those from the key affected groups,” she said.

It’s 10 in the morning in Abidjan, Côte d’Ivoire.

Like every morning, Arouna Bakari (not his real name), mask on his face, washes his hands before entering a “smoking room”, as people who use drugs call the open drug-taking places in Abidjan. He checks that the hand washing sink installed in front of the smoking room is working properly. He can now start his work and distribute prevention equipment against COVID-19 to the people who gather there.

Mr Bakari works for Parole Autour de la Sante (PAS), a community-led organization made up of people who use drugs and former people who use drugs, their relatives and social scientists. It operates the first “therapeutic community”, a mixed residential programme for people who use drugs, in western Africa.

Created in Côte d’Ivoire in 2016, PAS promotes the health of people who use drugs through harm reduction and services for HIV, tuberculosis, sexually transmitted infections and hepatitis. Since October 2019, thanks to funding from OSIWA (the Open Society for West Africa), PAS has strengthened its activities, with a focus on the respect of the human rights of people who use drugs—still a highly stigmatized and discriminated against community—and their access to health services. This is why Mr Bakari, in addition to his work in the smoking rooms, also trains health workers, journalists and the security forces.

There have been harm reduction programmes in Côte d’Ivoire for some years now. Community organizations have been set up and work with the national AIDS programme, the national institutions in charge of drug policy and the international nongovernmental organization Médecins du Monde.

The COVID-19 pandemic and the restrictions on movement imposed to stop it had the initial effect of freezing PAS’ work. But very quickly the commitment to continue services regained momentum at PAS.

“People who use drugs noticed that there were no associations or nongovernmental organizations out there in the field despite the fact that people who use drugs were still grouped together in places where drugs are consumed and they still shared equipment (crack pipes, joints, cigarettes, syringes, needles), with the risk of infection with HIV, hepatitis and tuberculosis. With the addition of COVID-19, people who use drugs were now also without access to reliable information and prevention equipment to fight this new health challenge,” said Jerome Evanno, a founding member of PAS.

Therefore, PAS decided to collect and distribute COVID-19 prevention materials and to continue its harm reduction work. PAS’ workers were trained in the prevention of COVID-19 and PAS produced a video clip in nouchi, the Ivorian slang that is the language of communication in the smoking rooms, on the importance of correct hand washing.

Community research was conducted on the perceptions of people who use drugs in the context of COVID-19 in order to understand the unique fears and needs in the face of the new coronavirus. The results and recommendations of the survey have been disseminated to partners in order that they can advocate and adapt their programmes in accordance with the expectations and needs of people who use drugs.

In order to reduce the risk of outbreaks of COVID-19 in prisons, PAS also has been advocating for the release of prisoners and distributing coronavirus prevention materials to inmates at the infirmary of the Abidjan prison.

Hundreds of thousands of people around the world have been stranded abroad due to the bans on flights and border closures imposed to stop COVID-19. As elsewhere, thousands of non-nationals have been stranded in Egypt indefinitely.

Travel restrictions have had many repercussions on the daily lives of non-nationals, putting significant economic pressure on them and potentially putting their well-being at risk.  

The UNAIDS Country Office for Egypt has been working on COVID-19 from the start of the pandemic in the country, establishing a direct line of communication with the National AIDS Program and working with it to ensure the continuation of HIV treatment by everyone on it and to help non-nationals in Egypt to get supplies of antiretroviral therapy.

Sophia Bianchi (not her real name) is an Italian tourist stranded in Sharm El Sheikh. “I ordered my antiretroviral treatment in late April from Italy via a courier service. Unfortunately, the shipment was stuck at the airport customs in Cairo for weeks. I contacted UNAIDS and they have been very helpful, following up daily with the Egyptian Ministry of Health and Population to get approval for releasing the shipment and checking on me and my health. They kept pushing through the Eid holidays and it all got resolved in two weeks. It was a stressful time but now I am relieved,” she said.

Antiretroviral therapy is available in Egypt free of charge to all nationals and registered refugees. However, as there is no community-based dispensing, nor private market purchase of antiretroviral medicines, gaps remain in ensuring that non-nationals can access treatment. For this reason, UNAIDS’ work during the COVID-19 pandemic has been essential in bridging the gaps.

There are strict rules on the dispensing of antiretroviral therapy in Egypt—only close family members are able to collect it from the dispensing centre. For Fatima Ahmed (not her real name), a refugee from Yemen who because of chronic illnesses that put her at higher risk from COVID-19 cannot leave her house, this was a significant barrier to accessing her HIV treatment. UNAIDS got in contact with the Egyptian Ministry of Health and Population to get an exceptional approval to dispense her medicine through a nongovernmental organization.

“I have not left the house for more than three months. My family has not been able to support me financially, so I was left without revenue. Thanks to the support of the National AIDS Program and MENA Rosa, a nongovernmental organization, peer supporters have delivered three months of antiretroviral treatment to my doorstep,” said Ms Ahmed.

However, much still remains to be done in reaching out to the most in need in Egypt. UNAIDS in Egypt has been advocating for the right to health and universal health coverage for everyone and is working in partnership with the Egyptian Ministry of Health and Population to ensure treatment for all nationals and non-nationals in the country.

“We believe in the absolute right of everyone to have access to their basic right to health. Ensuring access to antiretroviral therapy during these exceptional times is therefore our upmost priority. We are working relentlessly with our governmental and nongovernmental partners to build long-term policies to ensure treatment and care services for people living with HIV during times of emergency,” said Walid Kamal, the UNAIDS Country Director for Egypt. 

“Angola has a long history of epidemic outbreaks,” said Michel Kouakou, UNAIDS Country Director for Angola. “From cholera, malaria, polio and yellow fever, the country is well prepared and has competent people to deal with outbreaks, including health-care workers,” he said.

As a result, the President of Angola, João Lourenço, took immediate steps early in the COVID-19 outbreak, including a nationwide lockdown, closure of the border and cessation of international flights.

While this had the effect of keeping new COVID-19 cases low, it caused many people to lose their livelihoods, especially people who work in the informal sector.

To respond to the food insecurity that this caused, especially among people living with HIV, the UNAIDS Country Office for Angola leveraged its partnerships to reach thousands of people in Luanda, the capital city of Angola, with food baskets.

Under the auspices of her Free to Shine campaign, which focuses on the elimination of mother-to-child transmission of HIV in Angola, the First Lady of Angola, Ana Afonso Dias Lourenço, in partnership with the Saham Angola Insurance Company, the Association of HIV-Positive People and UNAIDS, distributed 1000 food baskets to people living with HIV, 500 of which were given to pregnant women living with HIV.

As the lockdown proceeded, Yola Semedo, a popular Angolan singer and songwriter and a UNAIDS National Goodwill Ambassador, arranged a virtual concert, which was televised on national television. She raised funds for an additional 14 000 food baskets, which she distributed in Luanda and Benguela provinces, including 500 food baskets for people living with HIV in Luanda.

“Our people are vulnerable due to COVID-19 and at this time I feel very happy to be a daughter of this land. It is at this time that we realize that ours are here with us,” said Ms Semedo.

A long-standing civil society partner of UNAIDS, the Angola Network of AIDS Service Organizations, which supports people and families living with HIV, has distributed 1500 food baskets, and the numbers are growing as more are distributed every day.

The Association of Policewomen in Angola also joined the movement and donated 120 food  baskets to the faith-based organization Associação de Solidariedade Cristã e Ajuda Mútua in order for them to distribute the packs to female sex workers, who have experienced a loss of income owing to the COVID-19 pandemic.

“While many countries in the region have used lockdown as an excuse to further criminalize key populations, including sex workers, this action has shown that solidarity is key during this time,” said Mr Kouakou.

Officially, she calls herself Juliana, but she also goes by the name Anna Morena and has an organization of the same name—the Anna Foundation Uganda.

The small, youth-led organization promotes sexual and reproductive health and rights, HIV prevention, advocacy, research, entrepreneurship and fundraising for the transgender community in central Uganda.

As a response to the malnutrition experienced by transgender people because of the COVID-19 outbreak, the foundation has raised US$ 1600 from a private donor to support transgender people and their dependents with food relief, which has reached more than 200 people.

Members of the foundation volunteer their time to conduct referrals for mental health and supply medical services, including deliveries of treatment and hormone therapy to transgender people who cannot currently access facilities due to the COVID-19 pandemic.

Ms Morena named herself and the foundation in memory of a friend who moved to Kampala, the capital of Uganda, at the age of 16 years. She was working as a sex worker to survive, met a man in a nightclub one night and was found dead the next day.

“I thought that maybe I could be “Anna” too, because she had a dream—to live as a normal person,” said Ms Morena wistfully.

Ms Morena doesn’t like labels, but she refers to herself as a “trans girl” because she wants people to know that she’s “not just a sex worker.”

She is open about being a sex worker so she can encourage others to come out and speak about it. She also volunteers to educate people about being transgender, which she does “out of love.” The sex work is to put food on the table.

“Most of the trans women I know are doing sex work. They are usually between the ages of 16 and 25 years, a time when hormones are high and one’s understanding of sexuality and gender identity is still developing,” she said.

Globally, transgender people are 12 times more likely to become infected with HIV than the general population. Nineteen countries worldwide, including Uganda, prosecute and/or criminalize transgender people.

In their daily lives, transgender people experience exclusion from family and society, barriers to employment and extreme forms of sexual, physical, emotional and psychological violence. According to Ms Morena, the COVID-19 pandemic is making things worse.

“COVID-19 has led to an increase in gender-based violence and a scarcity in commodities such as condoms and lubricants. Most sex workers are still doing sex work so that they can survive and we are seeing a rise in infections,” said Ms Morena.

She said prices for essentials such as mobile phone data have risen, making it harder for community-based transgender organizations to stay connected to their members.

In the absence of funding for vocational training, the only choice for transgender people who want to make a difference is to volunteer, said Ms Morena, because there is limited donor funding for transgender organizations. “Donors are very specific about what they will support, meaning there is a lot of competition for funding,” she said.

In addition, there is limited data on transgender people in the eastern and southern African region and Ms Morena believes that donors are not primarily interested in funding community-led research. But, she said, research is critical. “It is a way to help our governments understand the specific needs we have; it helps influence change and policies.”

Influencing change is something that Ms Morena does every day. During workshops run by the foundation, in partnership with other transgender and female-led community organizations, she tries to educate people about what it feels like to live in a transgender body by getting them to draw a picture of their bodies on a piece of paper they place on top of their heads.

Drawing one’s body out of sight always guarantees that it comes out a mess. This is Ms Morena’s advocacy punchline.

She holds up the drawing and tells them, “This is the pain I have to go through daily. This is how the world sees a transgender person.”

“This is not the body I want. I want to transition, but I don’t have the support of my family. I honestly love them. At times I try to do what I can to make them comfortable, but I also need to be happy,” she said.

This is the reason why the transgender community is so important, said Ms Morena. Solidarity helps.

“Trans women need safe spaces, places to stay and access to mental health services,” said Ms Morena. “The Government of Uganda is not willing to facilitate such spaces, so community-based organizations must bring these services until the fight for decriminalization has been won.”

Once the COVID-19 lockdown in her country was put in place, Marisela Mariño (not her real name), a transgender woman living with HIV, immediately contacted her treatment provider, convincing them to supply her with antiretroviral therapy to last at least two months.

“I was saved by having the phone number of one of the health promoters at the clinic I attend,” said Ms Mariño. But now she, like seven out of 10 people who responded to a Latin American regional survey on the needs of people living with HIV during the COVID-19 pandemic, does not have enough antiretroviral medicines for a lockdown of more than 60 days.

From the online survey, which was answered by 2300 people from 28 countries in the region, it was seen that despite the communication efforts by national health authorities and the international organizations that are leading the response to COVID-19, 31% of people stated that they had not received sufficient information on preventing the transmission of the new coronavirus. More than half, 56%, expressed that they do not have sufficient personal protective equipment, while only 22% of people think that masks are a useful protection against COVID-19.

Claudia Cardenal (not her real name), another transgender woman in the region, says that the offer of services adapted to the COVID-19 pandemic is not reflected in the options for people living with HIV. Ms Cardenal only has antiretroviral treatment for one more month, despite the World Health Organization recommendation that people living with HIV have at least a three-month supply.

The survey also shows that five out of 10 people are having difficulties in obtaining their antiretroviral treatment during the pandemic and less than two out of 10 people had antiretroviral medicines delivered to their homes.

Only three out of 10 people have been offered the option of telemedicine, and four out of 10 people living with HIV in Latin America state that they need psychological support to address anxiety related to COVID-19.

Stigma and discrimination continues to be an important barrier for people living with HIV to fully access their rights. More than half of the people surveyed, 56%, believe that they could suffer physical, psychological or verbal violence due to living with HIV in the midst of the COVID-19 pandemic. Forty per cent answered that they do not know where to go or call in the event that they encounter violence or discrimination due to living with HIV and the fear of discrimination caused three out of 10 people to refrain from accessing services in the midst of lockdowns.

Confinement can increase and incentivize stigma and discrimination. For example, in countries that have rules on leaving one’s home under the lockdown based on gender, violence to people with a different gender identity or expression than that appearing on their official identification may increase.

Job loss or lack of income was a top concern in the findings of the survey. Mobility restrictions and compulsory quarantines have deprived four out of 10 people who needed to leave their homes for work of their income, which means that four out of 10 people require nutritional support and/or cash transfers.

From the results of the survey, it is clear that the response to COVID-19 should consider the realities of people’s lives and focus on removing the barriers that people face to protect themselves and their communities.

Countries, ministries of health and national AIDS programmes should ensure access to three months or more of antiretroviral therapy by all people living with HIV, including refugees and migrants. In addition, the provision of food and other social protection services, including temporary shelters for key populations, people living with HIV and other vulnerable people, must be ensured.

The provision of services and support to the populations most affected by violence, especially women and girls, also needs to be a key priority for governments.

“This evidence has been shared with Cosponsors, national AIDS programmes and civil society organizations. I urge them to push for multimonth dispensing of antiretroviral therapy, social protection measures focusing on key populations and people living with HIV and support for mental health initiatives,” said César Núñez, Director of the UNAIDS Regional Support Team for Latin America and the Caribbean.