Governments, health experts and civil society activists have renewed their commitment to accelerate HIV testing and treatment programmes across the Middle East and North Africa as part of efforts to achieve the UNAIDS Fast-Track targets by 2020.

At a meeting hosted by the Government of Algeria and co-organized by UNAIDS and the World Health Organization (WHO), people living with HIV, national AIDS programme managers, representatives of civil society networks and the United Nations, technical partners and the media came together to assemble and reinforce the political leadership, technical capacities and resources to enable the rapid scale-up of HIV testing and treatment services.

The participants expressed their concern at the current low testing and treatment coverage in the Middle East and North Africa region. They stressed the need to mobilize additional resources and underlined that spending on the epidemic should be regarded as investment rather than expenditure. Discussions also highlighted the need to optimize rapid diagnostic technologies and to transition towards a test and treat model in line with the WHO’s new guidelines.  

The meeting in Algiers ended with a regional declaration led by Algeria’s Minister of Health to guarantee a sustained commitment to the Fast-Track strategy ahead of the United Nations High Level Meeting on AIDS taking place in June 2016.

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The Second African Conference on Key Populations in the HIV Epidemic, devoted to key insights, key advances and key partnerships, took place in Dar es Salaam, Tanzania, from 16 to 18 December. 

The conference brought together more than 200 researchers, policymakers, community actors, health service providers and government representatives from across Africa to discuss experiences, lessons learned and research findings regarding HIV and key populations. They include sex workers, transgender people, gay men and other men who have sex with men, people who inject drugs and others.

Key populations are vulnerable to HIV infection and have been left behind by the AIDS response. Punitive laws, stigma and discrimination are serious barriers throughout the continent for all key populations, with gender inequality contributing to the challenges faced by female sex workers. Migration of key populations within and between countries is another factor linked to their vulnerability to HIV.

Conference participants agreed that peer–led and community-based approaches work best and need scaling up. Effective interventions should be developed with close collaboration of key populations, as well. They also noted that data is important in policy dialogue and in facilitating community engagement.

The conference concluded with a call to action to ensure services for key populations are aligned to their needs and experiences and that key populations meaningfully participate in all areas that pertain to their health and well-being. Participants also called on governments to take down punitive legal barriers, to facilitate access to the justice system and to allocate more resources to serving key populations in the AIDS response.

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UNAIDS has welcomed a decision by the authorities in Malawi not to pursue sodomy charges against two men arrested on allegations that they had sexual relations. UNAIDS has also applauded the government’s decision to maintain a moratorium on arrests and prosecutions for consensual homosexual acts.

Police charged the two men at the beginning of December after they were arrested in the capital, Lilongwe. They were released on bail while waiting to hear if they would face trial. The news that there would be no further action was also commended by civil society activists, human rights defenders and development partners.     

Criminalization, violence, stigma and discrimination increase the risk of HIV exposure for men who have sex with men and other key populations in Africa and beyond.  They also act as a barrier to key populations accessing HIV prevention, testing and treatment services. Ending the AIDS epidemic by 2030 will require all countries to create an enabling and protective environment for everyone, including for people most affected by HIV.

The confirmation of the moratorium on arrests and prosecutions for same-sex relations in Malawi comes several months after a new Penal Code came into force in Mozambique which officially decriminalized same-sex relations in that country.

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Edith Tristán is a Panamanian woman who has been living with HIV for more than two decades. When she was diagnosed HIV-positive, antiretroviral therapy wasn't available in Panama and both her husband and son died of AIDS.

“It was a very difficult time, especially because of the lack of information about HIV,” Ms Tristán said. “My neighbours avoided me. At that time I ran a small food store and people would not buy from me. I struggled to support my mom and daughter with my job.”

Ms Tristán was one of the first people with HIV in the late 1990s to talk openly in Panamanian media about HIV and advocate for improved living conditions. “I started going to health institutions, looking for other people who were in my situation, to provide and receive support,” she said.

She then approached  PROBIDSIDA, one of the first organizations in the country to promote and defend the human rights of people living with and affected by HIV. Later on she was named the focal point in Panama for the International Community of Women Living with HIV/AIDS.

Ms Tristán is now a well-known human rights defender. Since 2011, she works as an HIV Counsellor in the Specialized Unit of the Ombudsman’s Office. One of her main duties is to handle complaints of women living with HIV. “Women are still stigmatized and discriminated at work, at home by their partners and at health care centres,” Ms Tristán said. “In 2015 I have followed up on six cases of women living with HIV whose human rights were violated and haven’t resolved any of them.”      

Panama has a concentrated HIV epidemic, with a low HIV prevalence rate in the general population but a markedly higher prevalence rate in key populations such as transgender women and men who have sex with men. Nevertheless, the number of new HIV infections among women over 15 years old has been increasing.

In Latin America, the vulnerability of women to HIV infection is associated with barriers they face. These include accessing information about HIV transmission, making decisions about their sexual and reproductive health, accessing testing and treatment services and obtaining the economic and social autonomy to protect themselves from violence. The risk of being infected with HIV is even higher for women who are victims of domestic violence.

Ms Tristán stressed, “The main problem is the lack of women’s empowerment. Fear limits their decision-making power. Women need to build up their self-esteem. With self-esteem a woman can defend her rights and seek information and help.”

To increase women’s empowerment, Ms Tristán coordinates a self-help group in Panama City and maintains regular contact with women living with HIV from around the country. Part of her job at the Ombudsman’s Office is to monitor clinics and pharmacies to check the quality of health care and services, visit antiretroviral therapy clinics and carry out home visits to talk with women and inform them about human rights, health and staying on treatment.

“When I look back, my fight has not been in vain,” Ms Tristán said. “I have taken advantage of every opportunity, not only for me but also to help others.”   

The 3rd Annual United Nations Camp Sweden took place at the Bosön sports facility from 6-17 September, 2015 in Stockholm, Sweden. The UNOSDP camp in collaboration with Cruyff Institute Sweden and The Power of Sport Foundation brought together 23 youth (aged 18-25) from around the world (Primarily Sub-Sahara Africa, Palestine and the Indian Sub-Continent) who work or volunteer on projects using sport for development and peace initiatives. The students learnt the best practices on how to harness the power of sport from leading practitioners such as Youth Sport Trust, Liverpool Football Club Foundation, UN Women, Women Win, International Paralympics Committee, UNAIDS and many more.

In 2014 in Rwanda, more than 95% of pregnant women living with HIV had access to antiretroviral medicines to prevent the transmission of HIV from mother to child. As a result, the country had fewer than 500 new infections among children last year, paving the way to achieving an AIDS-free generation. The incidence rate for HIV is estimated to be a stable and low 0.11%.

During a visit to Rwanda on 9 and 10 December, UNAIDS Executive Director Michel Sidibé celebrated the country’s achievements and praised President Paul Kagame on his government’s leadership in the continental AIDS response.

Mr Sidibé called on Rwanda to sustain the gains made in health and development and urged the country to keep moving towards sustainable financing for health and HIV.

He also met with the Minister of Health, the Minister of Foreign Affairs and Cooperation, the First Lady and civil society organizations. Mr Sidibé stressed the major role that civil society has to play in advocating for those being left behind in the AIDS response and in pushing for social justice and transformation. Civil society representatives highlighted that access to services for all, including key populations, has been ensured in Rwanda, although stigma and discrimination remain a challenge.

The importance of meaningful community engagement for health and development was further demonstrated during a visit to the Millennium Village Project in Mayange, 40 kilometres south of the capital. It is one of 14 clusters of Millennium Villages that operate across sub-Saharan Africa, serving the poorest and most remote communities in the region. Mayange has three health facilities: a health centre and two health posts.

Mr Sidibé visited the Mayange health centre, which uses an integrated approach to prevent new HIV infections and promote sexual and reproductive health services and family planning. No babies have been born with HIV in the Mayange health centre since 2013, showing that the elimination of mother-to-child transmission of HIV is within reach in Rwanda. Mr Sidibé congratulated the health centre and the local leaders, adding that change is possible with leadership, commitment and passion.

Mr Sidibé also participated in the signing ceremony of the Paris Declaration to Fast-Track the HIV response in cities, which took place at Kigali City Hall on 10 December. The Mayor of Kigali, Fidele Ndayisaba, committed to accelerate the response in the capital and to lead, guide and support other urban areas in doing so. The cities initiative will help translate commitments to Fast-Track the HIV response into targeted actions and rapid results through a focus on location and population.

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The Parliament of Djibouti has adopted a new plan to Fast-Track the end of the AIDS epidemic and increase protection for people living with HIV and key populations.  

The new strategy was formulated during a workshop attended by deputies as part of Djibouti’s national week of action against HIV. Opened by the Minister of Health and the Speaker of the National Assembly, the event brought parliamentarians together with people living with HIV and representatives of civil society organizations, the national AIDS, tuberculosis and malaria council and the United Nations. The workshop was an opportunity for parliamentarians to hear directly from people living with HIV about the social and legal challenges they face, including stigma and discrimination.  

The participants welcomed recent progress in the response to HIV in Djibouti, especially the decrease in HIV prevalence from 3% in 2000 to 1.6% at the end of 2014 and legislation introduced to strengthen the protection of people living with HIV and other vulnerable groups. The workshop also reviewed critical challenges to the HIV response, including the limited uptake of services to prevent mother-to-child transmission of HIV and pervasive stigma, discrimination and other human rights violations towards people living with HIV and key populations.

In drawing up the new plan, parliamentarians said better coordination across government was required to implement the non-discrimination provisions of existing legislation. They also called for a public meeting at parliament with the National Network of People Living with HIV to raise awareness about stigma and discrimination. 

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