There are still alarming levels of violence against transgender people, and a lack of recognition of their rights. During a visit to UNAIDS headquarters in Geneva, Switzerland, on 18 September, Marcela Romero and Venus Tejada, representatives of the Latin American and Caribbean Network of Transgender People (REDLACTRANS), shared the startling fact that transgender women in the region have a life expectancy of only 35 years.

During the visit, Ms Romero and Ms Tejada met with the UNAIDS Executive Director, Michel Sidibé, and spoke about REDLACTRANS’ work in 13 countries. A grant to REDLACTRANS from the Global Fund to Fight AIDS, Tuberculosis and Malaria helped to establish a centre that collects testimonies and follows up cases of human rights violations committed against transgender women in Latin America and the Caribbean.

“Stigma, discrimination and violence against sexual and gender minorities prevent them from accessing health services,” said Mr Sidibé. “Everyone has the right to health, no matter their gender or sexual orientation. For that, we need zero discrimination for everyone, everywhere.”

Ms Romero and Ms Tejada also presented Mr Sidibé with a copy of REDLACTRANS’ report, Waiting to die, which compiles cases of human rights violations against transgender people and gives recommendations to decision-makers.

“Stigma and discrimination is a barrier to the services we need to stay healthy. Some transgender women are dying due to lack of access to treatment. Without comprehensive health care, there are no equal rights nor true democracy,” said Ms Romero

Since its creation in 2006, REDLACTRANS has promoted the development of gender identity laws. In Argentina, the Plurinational State of Bolivia, three federal districts of Mexico and Uruguay, where gender identity laws have been enacted, transgender rights are increasingly enforced and, consequently, transgender people can access health-care services. Such laws have brought about positive changes in the services provided to transgender people and resulted in less stigma and discrimination in health-care settings. “Without identification, one cannot travel, register for school or access many services that are essential to function in society,” said Ms Tejada.

Ms Romero and Ms Tejada called on UNAIDS to address how forced migration, persistent inequalities and poverty affect the quality of life of transgender women.

Of the 1.8 million children aged 0–14 years living with HIV globally, 1.7 million are in Africa. As part of efforts to eliminate mother-to-child transmission of HIV in Africa, the African Union and the Organisation of African First Ladies against HIV/AIDS (OAFLA), with support from UNAIDS, and partners launched a campaign called Free To Shine in early 2018.

Now the campaign is ready to be rolled out across 42 African countries but urgently needs funding. To enable the roll-out, the African Union and OAFLA held an event on the margins of the 73rd session of the United Nations General Assembly to help raise much-needed resources to support the campaign.

The roll-out of the campaign will allow OAFLA members to engage in community-level activities to help reduce stigma and discrimination at home and in the community, raise community awareness about the importance of adherence to treatment and retention in care for pregnant women and women who are breastfeeding and to promote male involvement.

As part of the campaign, the first ladies will also leverage their unique position to influence policy-makers and agenda-setters to better address the needs of women living with HIV—advocating for policies and laws that discourage stigma and discrimination based on HIV status and for the removal of user fees for pregnant women and women who are breastfeeding, as well as other barriers that limit access to HIV and health services.

The session was moderated by television and radio journalist Zeinab Badawi. 

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The World Health Organization recently released its Global tuberculosis report 2018. Although it shows encouraging pockets of progress in responding to tuberculosis (TB) and HIV in some areas, it paints a rather bleak picture on ending the dual epidemics by 2030.

HIV is a relatively recent epidemic, having first been identified in the early 1980s; however, TB has been around for thousands of years. Archaeologists believe that TB affected the ancient Egyptians, with King Tutankhamun himself having possibly been affected.

Many famous people have fallen ill or died of TB over the years, including John Keats, Frédéric Chopin, Charlotte and Emily Brontë, Nelson Mandela and Franz Kafka, to name but a few. In the early twentieth century, supposed cures for TB included day-long bracing outdoor siestas in Swiss mountain sanitoriums, freezing cold showers and diets of up to 12 meals a day washed down with litres of milk and wine, and even staying in cowsheds, where the warmth and ammonia gases given off by the animals’ urine was supposedly a balm for infected lungs.

Effective medicinal treatment for TB became available in the mid-1940s and has changed little since. Today’s medicine, although toxic and antiquated, is incredibly effective and relatively cheap. However, finding people with TB to treat and ensuring that they stay on treatment poses problems and is particularly urgent for people living with HIV.

The World Health Organization estimates that in 2017 there were around 10 million people with active TB disease, 9% of whom were people living with HIV. Of the 10 million, approximately 3.6 million, or 36%, are “missing”, meaning that they may not have been diagnosed or properly treated. Among people living with HIV, the gap is wider, at 49%.

People living with HIV with latent TB are around 20 times more likely to develop active TB. Untreated TB is rapidly fatal among people living with HIV.

Fewer than 60% of TB patients are screened for TB, precluding treatment and resulting in preventable deaths. TB is the leading infectious killer globally and the leading killer of people living with HIV, accounting for one in every three AIDS-related deaths. In 2017, around 1.6 million people died of TB, including 300 000 people living with HIV.

Many breakthroughs can be achieved by improving collaboration between HIV and TB programmes to find and treat TB and HIV, including investing in diagnostics, vaccines and medicines, including preventive medicine and medicine to treat TB, including multidrug-resistant TB.

However, more commitment, investment and action are needed.

It is estimated that US$ 10.4 billion is required in 2018 for an effective response to TB in the 118 low- and middle-income countries that account for 97% of reported cases globally. The actual amount available in 2018 was US$ 6.9 billion—a shortfall of US$ 3.5 billion.

To respond effectively to HIV, UNAIDS estimates that US$ 26.2 billion will be required for the AIDS response in 2020. In 2017, US$ 21.3 billion was available in low- and middle-income countries—a shortfall of around US$ 5 billion. Only by filling the funding gaps will ending the epidemics start to become a reality.

With around 1.7 billion people, or 23% of the world’s population, infected with latent TB, of whom 5–10% have a chance of developing active TB disease, the world needs to take urgent action.

On 26 September, world leaders will come together at the United Nations in New York, United States of America, for the very first United Nations High-Level Meeting on Tuberculosis. As TB takes centre stage for one important day, the world has the opportunity to set some bold actionable targets to end two of the world’s leading infectious killers: TB and HIV.

To seize this opportunity would not only stop more than 6000 people dying every day from TB and HIV, but it would prevent new infections and bring the world a giant leap closer to improving global health, reducing poverty and achieving the Sustainable Development Goals.

Noncommunicable diseases (NCDs) are by far the biggest killers of people worldwide, responsible for 71% of all deaths globally. Defined by the World Health Organization as diseases of long duration and generally slow progression, the four main types of NCDs, which account for 80% of all NDC premature deaths, are cardiovascular diseases, cancer, chronic respiratory diseases and diabetes.

People of all ages can be affected by NCDs, but they tend to affect older people. With increasing numbers of people living with HIV accessing treatment and hence living longer, people living with HIV are increasingly falling ill with NCDs. Being HIV-positive, however, also increases the risk of developing NCDs, either because of the infection itself or owing to side-effects of the medicines used to treat HIV. The care that people living with HIV receive therefore increasingly needs to include care for NCDs.

Since people in many low- and middle-income countries are smoking more, drinking alcohol more and becoming less active, and their diets are changing, rates of NCDs are increasing. Age-adjusted death rates from NCDs are nearly twice as high in low- and middle-income countries as in high-income countries.

However, the successes to date in the AIDS response show what can be done if countries take decisive action. It is becoming increasingly clear that if the world is to control NCDs, the lessons of the AIDS response need to be learned and applied to the response to NCDs.

Health-care systems in regions that are home to most people living with HIV were designed to primarily address acute, rather than chronic, illnesses. However, HIV programmes in those same countries can be good models for how to step up services for NCDs, showing how to provide continuity of care, support adherence to treatment and engage communities.

The AIDS response has had a huge impact on global health. The impact of early diagnosis and treatment, HIV services being in many countries the entry point for broader health services, the importance of tackling poverty and other social determinants of health, raising community awareness and creating demand for services, the importance of putting civil society and communities in the centre, with their engagement, activism, advocacy and mobilization—these are all key lessons from the AIDS response that can guide the response to NCDs.

“The response to HIV has shown that the impossible is possible,” said Michel Sidibé, the Executive Director of UNAIDS. “UNAIDS will work with our partners in the United Nations system to share best practices from the AIDS response to guide countries, communities and other partners.”

As part of the world’s effort to combat NCDs, on 27 September countries will come together in New York, United States of America, at the United Nations for the Third High-Level Meeting on the Prevention and Control of Noncommunicable Diseases. UNAIDS is a part of the United Nations Interagency Task Force on the Prevention and Control of Noncommunicable Diseases and will be sharing its knowledge at the high-level meeting.

The health of women, children and adolescents is the cornerstone of public health. Healthy women and children create healthy societies and if adolescents are helped to realize their rights to health, well-being and education they become equipped to attain their full potential as adults. However, each year approximately 5.9 million children die before the age of five years and 289 000 women die in pregnancy and childbirth.

As part of the United Nations response to this crisis, the former United Nations Secretary-General, Ban Ki-moon, launched an initiative during the 2010 United Nations Millennium Development Goals summit to save and improve the lives of millions of women, children and adolescents around the world.

The initiative, Every Woman Every Child, was an unprecedented global movement that mobilized action by governments, the private sector, academia and civil society to address the major health challenges facing women, children and adolescents. As part of its work, the movement put into action a Global Strategy for Women’s and Children’s Health, a road map to galvanize political leadership and resources and to create a powerful multistakeholder movement for health.

The technical work of the movement is done by the H6 partnership, currently chaired by UNAIDS, which puts to work the collective strengths of UNAIDS, the United Nations Population Fund, the United Nations Children’s Fund, UN Women, the World Health Organization and the World Bank Group to operationalize the Global Strategy for Women’s and Children’s Health.

Today, spearheaded by the current United Nations Secretary-General, António Guterres, Every Woman Every Child is a multistakeholder platform that is saving millions of lives by placing women, children and adolescents at the centre of universal health coverage and the Sustainable Development Goals.

To highlight the need for continued political momentum around the movement, Every Woman Every Child held a high-level reception during the 73rd Session of the United Nations General Assembly in New York, United States of America, to underscore the importance of commitment, action and accountability by high-profile global leaders and influencers.

At the 2010 launch, more than US$ 40 billion was pledged, with numerous partners making additional financial, policy and service delivery commitments. However, speakers at the event highlighted that more help is urgently needed.

They stressed that the international community must pledge additional commitments to take Every Woman Every Child past the tipping point, which, the organizers say, would save the lives of 16 million women and children, prevent 33 million unwanted pregnancies, end stunting in 88 million children and protect 120 million children from pneumonia.

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We must protect, promote and fulfil human rights if we are to achieve HIV and health targets on the African continent and ensure access to HIV prevention, treatment, care and support services for all. This was the main call to action during a recent regional consultation for national human rights institutions and parliamentarians held in Nairobi, Kenya.

“This conference is indeed very timely for Africa, as it offers an opportunity to deliberate on how best national human rights institutions can work with parliaments in fostering the right to health through building strong partnerships,” said Enid Muthoni, the International Development Law Organization’s Country Director in Kenya.

National human rights institutions play a key role in promoting and protecting HIV-related human rights, including the right to health, and in ensuring that these are effectively addressed at the local and national levels. They serve as an important bridge between government, civil society and other stakeholders, helping to empower duty-bearers to respond to issues related to the right to health and rights-holders to realize these rights.

“Human rights and health are inherent for everyone. National human rights institutions, parliament and civil society and everyone at an individual level has a role to play in promoting the right to health,” said Madeleine Nirere, Chair of the Network of African National Human Rights Institutions.

The right to health is especially important to promote among people being left behind by the AIDS response, including key populations—such as gay men and other men who have sex with men, sex workers, transgender people and people who inject drugs—to claim their rights to non-discrimination, HIV prevention and treatment services, information and education and freedom from sexual coercion and violence.

“If you have no health, you have nothing else. Everyone should therefore have a right to health,” said Miriam Were, former Chairperson of Kenya’s National AIDS Control Council and Champion for an AIDS-Free Generation.

The call to action from the consultation focused on a broad-reaching range of human rights issues, including promoting public–private partnerships and policies and actions to end stigma and discrimination in health-care settings and other institutional settings, such as schools and workplaces. The participants also called for the repeal of punitive laws, policies and practices that create barriers to access HIV and health services and appealed to countries to ratify and domesticate the many existing African human rights mechanisms.

“The call to action will enable national human rights institutions and parliamentarians to firmly express their determination to help achieve the health and HIV targets and operationalize the resolutions and mechanisms at our disposal,” said Jantine Jacobi, UNAIDS Country Director in Kenya.

This year’s theme for World AIDS Day, which will be marking its 30th anniversary on 1 December, will be “Know your status”.

Significant progress has been made in the AIDS response since 1988, and today three in four people living with HIV know their status. But we still have miles to go, as the latest UNAIDS report shows, and that includes reaching people living with HIV who do not know their status and ensuring that they are linked to quality care and prevention services.

HIV testing is essential for expanding treatment and ensuring that all people living with HIV can lead healthy and productive lives. It is also crucial to achieving the 90–90–90 targets and empowering people to make choices about HIV prevention so they can protect themselves and their loved ones. 

Unfortunately, many barriers to HIV testing remain. Stigma and discrimination still deters people from taking an HIV test. Access to confidential HIV testing is still an issue of concern. Many people still only get tested after becoming ill and symptomatic. 

The good news is that there are many new ways of expanding access to HIV testing. Self-testing, community-based testing and multidisease testing are all helping people to know their HIV status. 

HIV testing programmes must be expanded. For this, we need political will and investment, as well as novel and innovative approaches to HIV testing that are fully leveraged and taken to scale.

Join us this World AIDS Day in raising awareness about the importance of knowing one’s status and calling for the removal of all barriers to accessing HIV testing. 

About World AIDS Day

World AIDS Day originated at the 1988 World Summit of Ministers of Health on Programmes for AIDS Prevention. Since then, every year United Nations agencies, governments and civil society join together to campaign around specific themes related to AIDS.

Unjust laws can prevent people from accessing the services they need to prevent or treat HIV, and people who use drugs need help and care, not punishment—these are two of the messages from the new Model Drug Law for West Africa. Launched on11 September in Dakar, Senegal, the model drug law aims to guide policy-makers in the region on how to better frame their drug laws.

It is increasingly recognized that the current drug laws are not effective and result in enormous costs. The model drug law shows how countries can modify their laws in order protect the health and welfare of people while at the same time allowing law enforcement to focus on the most serious drug offences.

“The risk of acquiring HIV is 23 times higher among people who inject drugs, yet they still face human rights abuses, punitive legal environments and are left out of health and HIV programming,” said Michel Sidibé, Executive Director of UNAIDS. “It is essential that countries take a human rights-based approach that is grounded in scientific evidence and includes critical harm reduction services to protect the health and welfare of people who inject drugs and their communities.”

Drawn up by the West Africa Commission on Drugs, a group convened by Kofi Annan comprising experts from western Africa, the model drug law notes that barriers to accessing health services for people who use drugs need to be removed. People who inject drugs are one of the groups at highest risk of exposure to HIV, but they remain marginalized and often out of reach of health and social services.

The model drug law suggests removing criminal penalties for people who use drugs and making harm reduction measures available. It has been shown that harm reduction works—when harm reduction services are made available, new HIV infections fall sharply. For drug use, and possession of drugs for personal use, the model drug law sets out alternatives to conviction and punishment.

“Our current drug laws stigmatize and penalize drug users. However, pushing them to the fringes of society or locking them up in ever increasing numbers will not solve the problem. On the contrary, it worsens health issues and puts enormous pressure on the already over-stretched criminal justice systems,” said Olusegun Obasanjo, former President of Nigeria and Chair of the West Africa Commission on Drugs.

The model drug law also seeks to enhance access to essential medicines such as morphine and other opioids to manage pain. Many people in western Africa are denied the pain-relieving medicines that they need because doctors and other health professionals are not prescribing opioids for fear of prosecution. The model drug law suggests special protection for medical staff to help remove barriers to accessing pain relief.

Experience around the world has shown that it is possible to change drug laws for the better. The new model drug law is a step towards making such changes in western Africa.

For the second year in a row, UNAIDS has been recognized for meeting or exceeding all of the performance indicators of the United Nations System-Wide Action Plan on Gender Equality and the Empowerment of Women (UN-SWAP). UNAIDS was the first United Nations entity to achieve this and remains the only one to date.

In a letter sent by Phumzile Mlambo-Ngcuka, Executive Director of UN Women, to Michel Sidibé, Executive Director of UNAIDS, she congratulates UNAIDS for achieving gender parity at the professional and higher levels, as well as for having mainstreamed gender equality work objectives and learning objectives into its performance management tools.

Since the inception of UN-SWAP in 2012, UNAIDS has demonstrated continued progress and remains committed to continuing to improve its UN-SWAP scoring. In the UNAIDS Secretariat Gender Action Plan 2018–2023, launched in June of this year, the organization set a series of targets that will help to ensure that UNAIDS sustains and advances its commitment to gender equality and the empowerment of women in the workplace.

The targets include:

• Target 1: 50:50 gender parity across all staff levels and categories.
• Target 2: 100% of staff at all levels set a work and learning objective on gender.
• Target 3: 100% of eligible UNAIDS female staff to participate in the UNAIDS Women’s Leadership Programme and 100% of eligible UNAIDS staff to participate in the Mentoring Programme for Women.
• Target 4: 100% compliance with the UN-SWAP 2.0 framework.

UN-SWAP is a United Nations system-wide accountability framework designed to measure, monitor and drive progress towards a common set of standards for the achievement of gender equality and the empowerment of women.

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Leaders from African countries and China met in Beijing, China, during the 2018 Beijing Summit of the Forum on China–Africa Cooperation (FOCAC) on 3 and 4 September to accelerate the social and economic development of Africa. Under the theme of “China and Africa: toward an even stronger community with a shared future through win–win cooperation”, the two-day summit served to further enhance Africa–China collaboration in eight key areas: industrial promotion, infrastructure connectivity, trade facilitation, green development, capacity-building, health care, people-to-people exchanges and peace and security. China’s President, Xi Jinping, also announced a US$ 60 billion package of aid, investments and loans to Africa.

During the official opening, the President of China emphasized that Africa has a lot of potential and is a continent full of hope. He said that China would launch a health-care initiative and that information cooperation and exchange on public health would be intensified. Cooperation programmes will be launched on the prevention and control of emerging and re-emerging communicable diseases, schistosomiasis, HIV and malaria.  

The current Co-Chair of FOCAC, Cyril Ramaphosa, the President of South Africa, welcomed the new FOCAC initiatives, which will have a significant and lasting impact on peace, stability and sustainable development on the African continent. The current Chairperson of the African Union, Paul Kagame, the President of Rwanda, said that African countries will intensify work on industry, infrastructure and trade. Antonio Guterres, the United Nations Secretary-General, described FOCAC as an embodiment of two major priorities of the United Nations: to pursue fair globalization and to promote development that leaves no one behind. The Chairperson of the African Union Commission, Moussa Faki Mahamat, highlighted the need to further create synergy between the African Union’s Agenda 2063 and China’s Belt and Road Initiative.

Leaders agreed the Beijing Declaration and the Beijing Action Plan, which will serve as a blueprint for further cooperation between China and Africa in the next three years. The outcome documents, which list ending AIDS and halting and reversing HIV (together with tuberculosis and malaria) as part of the China–Africa health cooperation, also focus on sustainability in health and included the local production of medicines in Africa, strengthening systems and developing public health worker capacity as essential to achieving universal health care.

In bilateral meetings with the Presidents of Côte d’Ivoire, Equatorial Guinea, Mali and Sierra Leone, Michel Sidibé, the Executive Director of UNAIDS, highlighted the important contribution that China–Africa health cooperation can make to improving access to medicines and local pharmaceutical production in Africa.

The African Union endorsed the 2 million community health workers for Africa initiative, which was raised in the bilateral meeting with the President of Sierra Leone. Explaining to Mr Sidibé that he had recently visited a maternity hospital and learned that there are just two gynaecologists in the entire country, the President sees the community health worker approach as a key way to ensure that people are reached with essential health services.

Mr Sidibé met with the China–Africa Business Council, which also chairs the China–Africa Health Industry Alliance. China–Africa cooperation can generate transformational changes in health and provide a platform to find people-centred solutions for ending AIDS and expanding universal health coverage.