Suggests integrating, elevating and engaging communities at all stages of HIV-related decision-making
Photo: iStock Acquired Immunodeficiency Syndrome (AIDS) can be ended as a public health threat by 2030 if communities on the frontlines get the full support they need from governments and donors, according to a new report by the Joint United Nations Programme on human immunodeficiency virus (HIV) / AIDS (UNAIDS).
The report was released ahead of World AIDS Day on December 1. It included nine guest essays written by community leaders about how they were able to drive change, how they overcame obstacles, and what actions they want governments and international partners to take to enable communities to lead us to the end of AIDS by 2030.
According to UNAIDS, one person dies from AIDS every minute. Every week, 4,000 young women are infected with HIV and 9.2 million of the 39 million people living with HIV do not have access to life-saving treatment.
Treatment progress has been slow in some areas, particularly in Eastern Europe, Central Asia, the Middle East, and North Africa. Only about half of the over two million people living with HIV in these countries received antiretroviral therapy (ART) in 2022. ART delays the progression of HIV into AIDS and result in fatal consequences.
According to the UN report Let Communities Lead, there is a path to end AIDS, and it can be done by 2030 if communities take the lead. Investing in community-led HIV programmes delivers transformational benefits, it added.
According to the report, communities have successfully advocated for HIV and health funding, accelerated the scale-up of priority interventions, fought against discriminatory and criminalising laws and policies, and worked to make HIV services more focused and people-centered.
Programmes delivered by community-based organisations are associated with a 64 per cent increase in access to HIV treatment in Nigeria’s rural areas, a doubling of the likelihood of HIV prevention service use and a four-fold increase in consistent condom use among people at risk of HIV, according to a World Bank review.
Over the course of 18 months, a demand-creation and community-led initiative in West Africa that received support from the International Treatment Preparedness Coalition nearly doubled the number of people beginning HIV treatment in 16 health facilities, the UN said.
Advocacy by communities led Ivory Coast to remove user fees from HIV testing and treatment services; drove Malawi to facilitate additional antiretroviral therapy provision in underserved areas and remove identification requirements that impeded service access among sex workers and persuaded Togo to scale up the multi-month dispensing of medicines, the report said.
Community-led advocacy also contributed to the decision by Kazakhstan to change laws to allow people living with HIV to adopt children.
In the Middle East and North Africa, comparatively low HIV prevalence and persistent stigma often position the illness low on the regional political agenda. MENA Rosa, a regional network for women affected by HIV, uses personal stories, multiple media platforms and consistent advocacy to raise awareness of HIV and galvanise action to address the HIV-related needs of women and girls in the region.
The Transgender Welfare Equity and Empowerment Trust in India supports the socioeconomic inclusion of the transgender community by raising business sector awareness of transgender issues and connecting community members to well-paying jobs.
Health facilities run by community health-care workers have been established by Bulunga Incubator in the Nqileni village and three other rural villages in Eastern Cape, South Africa to ensure access to health services.
The report highlighted how communities are at the forefront of innovation. In Windhoek, Namibia, a self-funded project by the Youth Empowerment Group uses e-bikes to deliver antiretroviral medicines, food and adherence support to young people who often cannot attend clinics because their hours conflict with school.
Community-led organisations in China have developed smart phone applications that link people to self-testing, contributing to a more than four-fold increase in HIV tests across the country from 2009 to 2020.
But the UN report noted community-led responses are unacknowledged, undersupported, underresourced and, in some places, even under attack.
According to the report, in many countries, community-led responses are sidelined when important decisions are made.
Of the 194 countries, 63 had no provisions in place to enable the registration, operation and government funding of nongovernmental organisations or community service organisations.
Globally, funding channelled through communities has fallen in the past 10 years, from 31 per cent in 2012 to 20 per cent in 2021. These funding shortages, policy and regulatory hurdles and crackdowns on civil society and the human rights of women and marginalised communities are obstructing progress on HIV prevention, treatment and care services, the UN said.
Winnie Byanyima, UNAIDS executive director and UN under-secretary-general said:
“Above all, we need funding. The AIDS response in low- and middle-income countries needs over $8 billion more per year to be fully funded. This must include scaled-up funding for local programmes led by people living with HIV and prevention initiatives led by communities.”
Byanyima also added, “AIDS is beatable. Let’s finish the job by supporting communities to end this scourge in their neighbourhoods, their countries and around the world.”
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