Cities

Mayor Aquiles Alvarez Henriques of Guayaquil, Ecuador's largest city and the nation's main port, signed the Paris and Sevilla Declarations on February 28, placing the city among the almost 500 municipalities around the world that are committed to fast-tracking action at local level to improve the quality of life of people living with and affected by HIV. Through this commitment, the city pledges to contribute to the country's goal of ending AIDS as a public health threat by 2030.

Guayaquil is the capital of the province of Guayas, Ecuador's most populated province and the most affected by HIV, with over a third of all new HIV infection notifications in the country, according to the Ministry of Public Health of Ecuador. It has a concentrated epidemic among key populations, with an HIV prevalence of 7.3% among gay men and other men who have sex with men (MSM), for example. 

"A significant number of cases reported with HIV in 2023 live in Guayaquil", said Andrés Díaz, Technical Director of the city's Infectious Disease Prevention Unit of the Health and Hygiene Directorate. "We know that the best way to improve HIV prevention is through education and sensitization of citizens so that they can get tested." 

Guayaquil has made significant efforts to intensify HIV screening and has increased the detection of HIV-positive cases by 1.6%. Diagnosed people are immediately linked to the public health system to start first-line antiretroviral treatment, which is universally available to nationals and migrants in Ecuador. 

Nonetheless, the Health Department of the Guayaquil Municipality has developed a plan with key actions to be implemented as a result of the city’s commitment to the Fast-Track initiative. Some of the most strategic priorities incorporate the scale up of HIV services, including HIV prevention, early diagnosis, and timely treatment of HIV and other sexually transmitted infections; the sensitization of civil servants on issues of stigma, discrimination, and gender-based violence linked to HIV; and facilitate the engagement of communities, specially from key and vulnerable population, in the definition and implementation of HIV programmes at community level.

Representatives of community and civil society organizations such as Corporación Kimirina, the Ecuadorian Coalition of People Living with HIV, and the Silueta X LGBT+ Trans Association attended the event. These organizations play a crucial role in the city's efforts to respond to HIV. "Citizen involvement under the local authority's leadership, with emphasis on the most vulnerable and at-risk community groups, is vital to achieving the goal of ending AIDS by 2030,” emphasized the delegates of Corporacion Kimirina Maria Elena Acosta and Lily Marquez. Similarly, Joan Morales from the Ecuadorian Coalition of People Living with HIV stressed that "By signing the Paris and Sevilla Declarations, Guayaquil joins many other cities that have committed to provide accelerated and sustained health services that allow us to eradicate not only AIDS but also TB, Malaria, and other tropical diseases, with actions that contribute to reducing discrimination towards people living with HIV and other affected communities."

Created in 2014, the Paris Declaration on Fast-Track Cities Ending the HIV Epidemic is a political declaration with commitments and targets that include ending urban AIDS and tuberculosis (TB) epidemics, as well as eliminating viral hepatitis (HBV and HCV). It also articulates a mandate to place people at the center of the response. To define and facilitate that mandate, the Sevilla Declaration on the Centrality of Communities in Urban HIV Responses was created in 2022, outlining the 10 commitments that cities and municipalities are asked to make to increase the engagement of and promote leadership by affected communities in attaining the Fast-Track Cities initiative's goals, objectives, and targets.

"We congratulate the Mayor's Office of Guayaquil for its commitment to contribute to Ecuador’s efforts to reach the 2025 Global AIDS Strategy targets, reducing the number of new HIV infections and AIDS-related deaths and eliminating stigma and discrimination in all its forms,” said Andrea Boccardi Vidarte, Director of the UNAIDS Office for the Andean Countries. "This commitment is also a recognition of the leadership of communities most affected by HIV and their support to the city's goals." 

Gathered in Amsterdam for the annual Fast-Track Cities conference between 25 ─ 27 September 2023, cities shared their various initiatives toward achieving key HIV targets.

In Nairobi, Kenya a situation analysis conducted at a granular level helped the county to better understand the gaps in the HIV response and to identify priority actions. The data showed that there was a lack of health service points, especially for key populations and young people living in informal settlements. In addition, stigma and discrimination also keeps people away. Zipporah Achieng, a young person living with HIV navigating the dusty streets of Kibera, one of several informal settlements, can attest to this. “Before, life was not easy, the healthcare workers were not well trained, and when they saw youth coming to the hospital, they would start judging them, discriminating them.”

The Nairobi City County, with the support of the USAID-funded joint UNAIDS-IAPAC Fast-Track Cities project, developed activities to create awareness, address vulnerabilities, and reduce discrimination with a focus on young people. Informal settlements house up to 60% of Nairobi’s population despite covering less than 10% of the city. Over a period of five years, community members worked hand in hand with healthcare providers in the establishment of 30 friendly health centres for young people and men who have sex with men and sex workers. As a result, stigma against people living with HIV has been reduced while the uptake of HIV and other health services increased significantly during this time.  

Ms Achieng is now a peer educator. She goes out in the community sharing her experience and getting people to come to the clinic. “Now I know what is right and what is wrong, I’m happy because life has changed, life is sweet, there is medicine, there is support, and I’m just happy,” said Ms Achieng.

Nairobi's commitment to fast-tracking HIV services for young people and key populations not only contributed to the city's own public health goals but also set an inspiring example for other urban centres in the country.

Discussions about sex and HIV in Indonesia remain taboo and information limited. As a result, HIV-related knowledge is low, especially among young people. In 2018, UNAIDS created an online chatbot named Tanya Marlo and integrated it in the popular messaging application LINE. “Before Marlo, finding reliable information about HIV and sexual health was really hard. It was difficult to get the right information”, says Arisdo Gonzalez, a user of the online application.

Support provided by the Fast-Track Cities project allowed this pilot to grow into a key tool to reach young people and increase HIV prevention and testing.

Last year alone, 200 000 engagements were recorded on social media and on average 100 users are directed to counselling every month. “Tanya Marlo has been an absolute hit among young people in Indonesia,” said Tina Boonto, UNAIDS Country Director in Indonesia. “Young people feel that they can chat with Marlo anytime, anywhere, and in secret, nobody has to know about it.” To ensure its sustainability and further development, a community group, YKS, has taken over the management of the application.

Kyiv joined the Fast-Track Cities initiative in 2016 and had made remarkable progress towards key HIV targets until Russia declared war in Ukraine. Many feared that treatment, HIV services and outreach would disintegrate.  Thanks to emergency funds and the support of the Fast-Track Cities project, a number of interventions were put in place to help those in need, in particular members of key and vulnerable populations like people who inject drugs and LGBTIQ+ members. “Since the invasion, we have managed to maintain our test numbers, didn’t lose a single patient, and ensured continued access to antiretroviral therapy” said Dr. Vitali Kazeka, Director of the Kyiv AIDS center.

One of Kyiv's notable achievements is the establishment of shelters designed to cater to the unique needs of key populations affected by HIV. These shelters provide a safe and supportive environment while also ensuring access to essential healthcare services, counseling, harm reduction programmes, and education about HIV prevention. “The Fast-Track Cities project makes people living with HIV, and those from key population groups, feel like equal citizens of the city… They see that there are special initiatives that care about them and their future,” said Nataliia Salabai, UNAIDS Fast-Track Cities focal person in Kyiv.

Launched in December 2014, the Fast-Track Cities partnership has grown to more than 500 cities and municipalities that have committed to accelerate their local HIV, tuberculosis (TB), and viral hepatitis responses to achieve Sustainable Development Goal (SDG) 3.3 by 2030.

More than half of the world’s population currently live in cities and cities account for a large and growing proportion of people living with HIV, tuberculosis (TB) and other diseases. The risk of contracting, and vulnerability to, HIV and TB infection is often higher in urban areas compared to rural areas, because of urban dynamics such as social networking, migration, unemployment and social and economic inequalities.

In 1988, a group of activists came together in Fortaleza, the fifth largest city in Brazil and capital of Northeastern state of Ceará, to create the local chapter of the National Network of People Living with HIV and AIDS (RNP+CE). The aim was to ensure that people living with HIV could be guaranteed the right to care, treatment adherence, and legal assistance.

Currently, the NGO (Non-Government Organizations) also offers educational workshops, support for the combination prevention of sexually transmitted infections (STIs), and other activities for more than 1,000 registered people. Among them is Carlos Salmão, an HIV activist living in Fortaleza, who felt individually and collectively welcomed by the organization. "This support was very important to me and is fundamental for people living with HIV here in Ceará because it is a reference of the response to the AIDS epidemic. That is why I feel pleasure in contributing", he explains.

The RNP+CE was one of five Brazilian NGOs that received resources from the Fast-track Cities grants initiative, launched by UNAIDS in 2022. With the award, the organization developed actions around two objectives: increasing linkage and adherence of vulnerable key-populations to HIV prevention, diagnosis, and treatment by disseminating and sharing information with health professionals as well as the general public; and improving the knowledge of the Undetectable Equals Untransmittable (U = U) strategy in the city of Fortaleza by carrying out communication campaigns.

Project actions and participation of municipal government

The project involved 10 local HIV-positive activists in the development and implementation of the communication campaigns. They also were involved in preparing a seminar that brought together 120 people from civil society to dialogue about and to present to municipal government representatives proposals to improve the care for people living with HIV, based on the perspectives and actual needs of the users of public health services in Fortaleza. An additional theme of discussion was the challenges and the importance of guaranteeing a satisfactory level of adherence to HIV treatment to avoid abandonment.

Still as part of the project, a booklet on HIV, self-esteem and health was produced and distributed, providing practical information for people who receive a positive diagnosis for HIV. Additionally, in coordination with the municipal government, RNP + CE printed and distributed more than 3,000 copies of posters on HIV treatment adherence and on U = U. This material was displayed in places with high concentrations of people, such as bus terminals, reaching about 1.1 million people daily.

Participation of local government officials was a strategic element to the project’s success, as they are in direct contact with reality and the existing challenges. "We are still far from reaching an ideal level where there is less need to reinforce these [HIV] actions, but we are advancing in this direction through constant and well-structured work", says Carlos Paiva, coordinator of IST/AIDS at the Municipal Health Secretariat of Fortaleza.

Ariadne Ribeiro, UNAIDS Officer for Equality and Rights for All People, agrees and adds: "It is rewarding to see how the dialogue between communities, civil society, and the municipal government is moving towards a common goal, which is the improvement of public policies in the city of Fortaleza for people living with HIV and to end AIDS as a threat to public health."

At a Fast-Track Cities 2022 conference reception held today in Seville, Spain, several Mayors and a Deputy Governor in attendance were joined virtually by peers from across the Fast-Track Cities network to sign their names to a declaration aimed at defining and facilitating the placement of affected communities at the center or urban HIV responses.

• The Mayors of Blantyre (Wild Ndipo), Kingston (Delroy Williams), Libreville (Issa Malam Salatou), Quezon City (Ma. Josefina Belmonte), and Sevilla (Antonio Muñoz Martínez) signed the Sevilla Declaration on the Centrality of Affected Communities in Urban HIV Responses (Sevilla Declaration) along with Johannesburg Mayor (Dada Morero), New York City Mayor Eric Adams, and other Mayors who participated via video or virtually.
• The Deputy Governor of the Bangkok Metropolitan Administration (Dr. Tavida Kamolvej) also affixed her signature to the declaration during the Sevilla ceremony, and a representative from GGD Amsterdam signed on behalf of that city’s Mayor (Femke Halsema). Multiple county and provincial officials from Fast-Track Cities in other countries also signed the declaration via video or virtually.
• Moreover, Mayors and representatives from an additional 22 Fast-Track Cities in Spain signed the declaration. Of note, the reception’s signing ceremony was witnessed by Carolina Darias, Minister of Health of Spain, in whose country more than 150 cities have joined the Fast-Track Cities network, with Sevilla having been the first Spanish city to sign the Paris Declaration on Fast-Track Cities Ending the HIV Epidemic in 2015.

According to Dr. José M. Zuniga, President/CEO of the International Association of Providers of AIDS Care and the Fast-Track Cities Institute, the Sevilla Declaration will supplement the Paris Declaration on Fast-Track Cities, which more than 400 cities and municipalities worldwide have signed since the network’s launch in 2014, thus joining the Fast-Track Cities network. The new declaration includes 10 commitments Fast-Track Cities are asked to make that range from safeguarding the dignity and rights of communities affected by HIV to meeting the United Nations goals for community-led HIV responses.

“An amorphous and overly malleable term such as ‘placing people at the center’ of the HIV response has little effect if it can be interpreted in a million different ways or worse actioned as mere tokenism that disenfranchises those whose voice at the table and leadership are critically needed,” said Dr. Zuniga. “The 10 commitments that Fast-Track Cities are making in signing the Sevilla Declaration reflect an important step forward in clearly defining, operationalizing, and facilitating what we mean by ‘placing people at the center’ of urban HIV responses at a time when it is most critical to do so.”

The Sevilla Declaration was shaped by organizations representing people living with HIV, including the Global Network of People Living with HIV (GNP+), as well as through regional listening sessions involving local communities of people living with HIV across the Fast-Track Cities network. Also providing input were the four core partners of the Fast-Track Cities initiative: IAPAC, the Joint United Nations Programme on HIV/AIDS (UNAIDS), United Nations Human Settlements Programme (UN-Habitat), and the City of Paris.

“The Sevilla Declaration provides structure for communities of people living with HIV to more formally play a leadership role in HIV responses at city and municipal levels,” said Sbongile Nkosi, Co-Executive Director of GNP+, which formally endorsed the declaration at the Fast-Track Cities 2022 conference. “We talk a lot about ‘placing people at the center of the HIV response,’ but the Sevilla Declaration does more by articulating commitments local governments and institutions must make to create the space for and empower people living with HIV and their community-based organizations to lead urban HIV responses.”

In its Global AIDS Strategy, 2021-2026, UNAIDS emphasizes the critical nature of community engagement and leadership to regain momentum against HIV that was lost during the COVID-19 pandemic. Through its advocacy on community engagement, UNAIDS has consistently stressed that the call for “nothing for us without us” must be made more than just a slogan.

“In line with the Global AIDS Strategy and the Sevilla Declaration, empowering and integrating community engagement is the cornerstone to ending AIDS and having people at the center of the response, said UNAIDS Deputy Executive Director for Programme, Eamonn Murphy.

Click here to access the Sevilla Declaration.

At a Fast-Track Cities 2022 conference reception held today in Seville, Spain, six Fast-Track Cities and 100% Life, a Ukrainian community-based organization, received 2022 “Circle of Excellence Awards” and the “Community Leadership Award,” respectively, in recognition of their political, public health, and community leadership.

Earlier this year, the International Association of Providers of AIDS Care (IAPAC) and Fast-Track Cities Institute (FTCI), in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS), launched a nomination process to identify cities from six geographic regions whose work exemplifies the Fast-Track Cities mission. Both IAPAC and UNAIDS are core partners of the Fast-Track Cities initiative, which was launched in 2014 and today comprises more than 400 cities engaged in ending their urban HIV epidemics by 2030. The six cities selected to receive the 2022 “Circle of Excellence Awards” include:

• Asia-Pacific: Quezon City, Philippines
• Europe: Amsterdam, Netherlands
• Latin America/Caribbean: Kingston, Jamaica
• North America: New York City, NY, USA
• Southern/Eastern Africa: Johannesburg, South Africa
• Western/Central Africa: Lagos State, Nigeria

The Mayors of Quezon City (Ms. Ma. Josefina Belmonte), Kingston (Mr. Delroy Williams), and New York City (Mr. Eric Adams) accepted their cities’ 2022 “Circle of Excellence” awards in-person (Mayors Belmonte and William) and via video (Mayor Adams). Public health department officials accepted awards on behalf of Amsterdam, Johannesburg, and Lagos State.

100% Life was recognized both for its efforts during the ongoing war in Ukraine, as well as that of other community-led organizations in that country who have advanced humanitarian and public health efforts on behalf of Ukrainians living with and affected by HIV. Ms. Valeria Rachynska, who is Human Rights, Gender, and Community Development Director at 100% Life, accepted the 2022 “Community Leadership Award” on behalf of her organization and partner organizations across Ukraine.

“Political, public health, and community leadership are at the heart of the Fast-Track Cities movement and are integral to averting AIDS-related deaths, stemming new HIV infections, and eliminating HIV-related stigma,” said Dr. José M. Zuniga, President/CEO of IAPAC and FTCI, which launched the two awards at the Fast-Track Cities 2021 conference. “Congratulations to 100% Life and the six cities honored for their exemplary leadership. May they serve as an inspiration for other community-led organizations and cities as they respond to their urban HIV epidemics with bold leadership.”

“Among the lessons that we have learned in tackling HIV is the need for bold political leadership, global solidarity, ensuring communities are at the center of the response, and a commitment to human rights. This has been true for COVID-19 and will be true for other pandemics to come,” said Winnie Byanyima, Executive Director of UNAIDS. “Ending inequalities is the most effective way to ensure that we are more prepared for the next pandemic.  We look to city leadership to do this.”

In 2021, the “Circle of Excellence Awards” recognized five Fast-Track Cities: Bangkok, Thailand; London, England, UK; Nairobi City County, Kenya; San Francisco, CA, USA; and São Paulo, Brazil. The 2021 “Community Leadership Award” recognized GAT, a community-led organization providing health and social services to people living with and affected by HIV in Portugal.

At the recent four-day World Urban Forum 11^th Session (WUF11) in Katowice, Poland, more than 20,000 people gathered to discuss the impact of rapid urbanization on cities, economies, communities and policies.  In an attempt to keep the HIV response and other health services in cities high on their agenda, UNAIDS, IAPAC and UN-Habitat co-organised a special session on Fast-Track Cities, focusing on innovation and the power of partnerships in accelerating the HIV response towards ending AIDS by 2030.

Eleanor Gouws, Senior Advisor at UNAIDS and Gonçalo Lobo, Vice-President at IAPAC, opened the session emphasizing the leading role cities have in addressing rights issues, reducing inequalities, protecting against risks and vulnerabilities, and keeping people healthier.

Five cities shared innovative examples to address HIV service gaps, more specifically how to reach key and vulnerable populations.

For example, in the municipality of eThekwini -Durban, South Africa, reaching and retaining in care young people infected with HIV remains a key challenge. A community-based project implemented in the high HIV burden district of Inanda, focuses on capacity building, peer education and support, as well as working with community leaders to reduce HIV-related stigma. Their goal has been to improve the uptake of HIV prevention, testing and treatment services among 10- to 35-year-olds. Close to 3,000 young people were reached and tested for HIV in the first six months of the project.

“A lot of effort has been put into building capacity of healthcare workers to ensure our project’s sustainability,” said Sibongile Mzulwini, Regional Manager at the National Association of Child [and Youth] Care Workers.

Similar efforts have been undertaken in Kenya. Since the city of Nairobi joined the Fast-Track Cities initiative, there has been a sharp increase in the number of clinics providing integrated care and drop-in centers where key populations and young people can access friendly and stigma free services. Testing uptake among young people increased by more than 5-fold between 2018 and 2021 in four informal settlements. Dr. Carol Ngunu, Deputy Director of Health at the Nairobi Metropolitan Services, highlighted the importance of, “understanding our local epidemics and gaps, knowing where the quick wins are and building ownership of communities in our local HIV responses.”

In Jakarta, Indonesia, artificial intelligence is leading the way to reach young people, notably men who have sex with men. With a reach of over 4 million people on social media in a seven-month period, Tanya Marlo, is an interactive mobile application in the form of a chatbot that gives HIV information and can also link users to a trained counsellor. “Tanya Marlo creates a bridge between the healthcare system and key populations at high risk of HIV infection,” said Tono Permana Muhamad, Program Director at the Kasih Suwitno Foundation. “These are people who usually do not access health services for fear of stigma and discrimination,” he said. The foundation currently manages the application to ensure its sustainability.

Stigma and discrimination also affect the HIV response in Kingston, Jamaica. As a result, the Jamaica Network of people living with HIV (JN+), with support from UNAIDS, is implementing a stigma-free spaces project to ensure that places of business, health, education, justice, entertainment and worship are respectful, inclusive and transformative. “We are building a stronger city HIV response in Kingston, thanks to the inclusion of communities through community-led responses and monitoring,” said Jumoke Patrick, the Executive Director of JN+.

Reporting from the host country’s perspective, Magdalena Ankiersztejn-Bartczak, President/CEO of the Foundation for Social Education in the capital city of Warsaw, which recently joined the Fast-Track Cities Initiative said that, “the influx of Ukrainian refugees in Poland had posed many challenges, including the continuity of life-saving treatment and support to people living with HIV.”

Despite the obvious challenges, Ms Ankiersztein-Bartczak said it has encouraged them to do more for people living with HIV and at high risk of HIV infection in Poland. “We count on the support of other Fast-Track Cities,” she said.

Concluding the session, the moderator, Robert Ndugwa from UN-Habitat, reminded participants that, “Cities face a myriad of challenges but also hold the key to solutions. They can act locally but influence globally.”