Joint United Nations Programme on HIV/AIDS (UNAIDS)

In 2021, UNAIDS completed the development of highly consultative and inclusive  Global AIDS Strategy 2021-2026. The strategy is a bold new approach to use an inequalities lens to close the gaps that are preventing progress towards ending AIDS. The Global AIDS Strategy aims to reduce these inequalities that drive the AIDS epidemic and prioritize people not yet accessing life-saving HIV services. The Strategy sets out evidence-based priority actions and bold targets to get every country and community on track to end AIDS as a public health threat by 2030. 

The Strategy also calls for a thoroughly prepared and resilient HIV response that protects people living with, at risk of and affected by HIV in humanitarian settings and from the adverse impacts of current and future pandemics and other shocks (Result Area 10).  

The seventy-fifth session, of the UN General Assembly has an agenda item 10 -- Implementation of the Declaration of Commitment on HIV/AIDS and the political declarations on HIV/AIDS, to get the world on track to end AIDS as a public health threat by 2030 and accelerate progress towards achieving the Sustainable Development Goals, in particular, Goal 3 on good health and well-being. The UN High Level Meeting of Heads of State and Government, and representatives of States and Governments assembled at the United Nations in June 2021, adopted The Political Declaration entitled “Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030”. 

The 48th UNAIDS Programme Coordinating Board (PCB) included in this agenda a thematic segment on COVID-19 and HIV. This was at a time when the COVID-19 pandemic was pushing HIV responses off-track, but innovations and creative responses were also emerging and helping communities and countries recover momentum. The objective was to provide an overview of the progress in responding to the colliding pandemics of COVID-19 and HIV since December 2020, analyze lessons learned and based on those, and reflect on how to build better and fairer HIV responses. The session brought together political and global health leaders, community experts, program leaders, and implementing partners from around the globe to share and discuss how countries and communities were utilizing lessons learned from the HIV response and, in many cases, the HIV infrastructure itself, to respond to the COVID-19 pandemic, as well as how the COVID-19 pandemic could support building back better and fairer HIV responses. The thematic segment background note included recommendations that informed the PCB’s decisions. 

https://www.unaids.org/en/resources/documents/2021/PCB49_Follow-up_Thematic_Segment  

https://www.unaids.org/sites/default/files/media_asset/PCB48_Thematic_Segment_Background_Note_EN.rev2_.pdf 

https://www.unaids.org/sites/default/files/media_asset/PCB49_Decisions_EN_.pdf (item 6)  

World AIDS Day Report: Unequal, unprepared, under threat: why bold action against inequalities is needed to end AIDS, stop COVID-19, and prepare for future pandemics

World AIDS Day commemoration 2021: END INEQUALITIES. END AIDS. END PANDEMICS. 

On 29 November 2021, UNAIDS released the annual World AIDS Day report. The report issued a stark warning that if leaders fail to tackle inequalities, the world could face 7.7 million AIDS-related deaths over the next ten years. Tackling inequalities is a long-standing global promise, the urgency of which has only increased. In 2015, all countries pledged to reduce inequalities within and between countries as part of the Sustainable Development Goals. The Global AIDS Strategy 2021–2026: End Inequalities, End AIDS and the Political Declaration on AIDS adopted at the 2021 United Nations High-Level Meeting on AIDS have ending  inequalities at their core. UNAIDS further warned that if the transformative measures needed to end AIDS were not taken, the world also remain trapped in the COVID-19 crisis and remain dangerously unprepared for the pandemics to come. 

The World AIDS Day key messages highlighted the urgent need to end the inequalities that drive AIDS and other pandemics worldwide. Tackling inequalities will advance the human rights of key populations and people living with HIV, make societies better prepared to beat COVID-19 and other pandemics, and support economic recovery and stability. Fulfilling the promise to tackle inequalities will save millions of lives and will benefit society as a whole.

https://www.unaids.org/en/resources/documents/2021/2021-World-AIDS-Day-report  

in 2020, UNAIDS released a report calling for a human rights approach to COVID-19 that puts communities at the center. The report based on an assessment of 16 countries early responses to the COVID pandemic warns against blanket compulsory travel restrictions and criminal sanctions against people affected by pandemics such as COVID-19. The report points out that such measures tend to have a disproportionate effect on the most vulnerable and create barriers to health. It notes that restrictions that are imposed, must respect human rights and be necessary, appropriate, evidence-informed and limited in duration. Empowering people to protect themselves and others through voluntary measure can have greater effect. The report put out Seven key lessons from HIV for an effective community-led responses to current and future pandemics. 

https://www.unaids.org/sites/default/files/media_asset/human-rights-and-covid-19_en.pdf

The cost of inaction: COVID-19-related service disruptions could cause hundreds of thousands of extra deaths from HIV 

A modeling group convened by the World Health Organization and UNAIDS released a report called The cost of inaction: COVID-19-related service disruptions could cause hundreds of thousands of extra deaths from HI. The report estimated that if efforts are not made to mitigate and overcome interruptions in health services and supplies during the COVID-19 pandemic, a six-month disruption of antiretroviral therapy could lead to more than 500 000 extra deaths from AIDS-related illnesses, including from tuberculosis, in sub-Saharan Africa in 2020–2021. The report highlights the need for urgent efforts to ensure the continuity of HIV prevention and treatment services to avert excess HIV-related deaths and prevent increases in HIV incidence during the COVID-19 pandemic. It will be necessary for countries to prioritize shoring up supply chains and ensuring that people already on treatment can stay on treatment, including by adopting or reinforcing policies such as multi-month dispensing of antiretroviral therapy to reduce requirements to access health-care facilities for routine maintenance, reducing the burden on overwhelmed health-care systems. 

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/may/20200511_PR_HIV_modelling  

Preventing HIV infections at the time of a new pandemic: A synthesis report on program disruptions and adaptations during the COVID-19 pandemic in 2020 

The COVID-19 pandemic is threatening decades of hard-won development and public health gains. UNAIDS is committed to playing a pivotal role in ensuring that people living with and affected by HIV have the information and support they need during the COVID-19 pandemic and is promoting the development and support measures required to ensure access to HIV prevention and treatment services continues uninterrupted. The report provides a synthesis of the status of HIV prevention programming during the COVID-19 pandemic, identifies critical vulnerabilities, risks, and significant service disruptions, and documents responses in a range of settings. The report places a substantial focus on gathering information on program innovations at the community level. 

https://www.unaids.org/en/resources/presscentre/featurestories/2021/july/20210107_HIV_prevention_new_pandemic  

English, French, Spanish

Six Concrete Measures to Support Women and Girls In All Their Diversity In The Context Of The Covid-19 Pandemic 

In 2020, UNAIDS released a guide highlighting six critical actions to put gender equality at the center of the Covid responses COVID-19 is not only a health issue, just as HIV never was. It impacts a wide range of human rights, and although it affects all people, it does so unequally. COVID-19 has highlighted the stark inequalities across societies, with a lack of pandemic preparedness and fragile or non-functioning institutions posing graver impacts. Women and girls in all their diversity are experiencing the most significant impact of the crisis. This guide is designed to provide recommendations to governments to confront the gendered and discriminatory effects of COVID-19. It highlights good practices; shares lessons learned from HIV and other past public health crises; provides strategic information; calls for engagement with communities most impacted by COVID-19; and sets forth concrete immediate and forward-looking recommendations for crisis responses, policy development, and investment strategies. The guide presents six key areas of concern regarding the human rights of women and girls in all their diversity during the COVID-19 pandemic—differing needs of women and girls, particularly those most marginalized; access to essential health services; the neglected epidemic of gender-based violence against women and girls; misuse of criminal and punitive laws; adolescent girls and young women’s education, health and well-being; and valuing women’s work and making unpaid care work everybody’s work. 

https://www.unaids.org/en/resources/documents/2020/women-girls-covid19  

English, Arabic, Spanish

UNODC, WHO, UNAIDS, and OHCHR joint statement on COVID-19 in prisons and other closed settings0 

Signed by Ghada Fathi Waly, Executive Director, UNODC; Tedros Adhanom Ghebreyesus, Director-General, WHO; Winnie Byanyima, Executive Director, UNAIDS; Michelle Bachelet, United Nations High Commissioner for Human Rights, the joint statement urgently draw the attention of political leaders to the heightened vulnerability of prisoners and other people deprived of liberty to the COVID-19 pandemic, and urge them to take all appropriate public health measures in respect of this vulnerable population that is part of our communities. 

https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2020/may/20200513_joint-statement-covid19-prisons  

Arabic, Chinese, French, Portuguese, Russian, Spanish

UNAIDS HIV support to the Global Fund to Fight AIDS, Tuberculosis and Malaria (GF) COVID-19 Response Mechanism Funding Application Requests 

The Global Fund’s response to COVID-19 

Since early 2020, many HIV, TB and malaria programs have faced significant disruption due to COVID-19 related public health measures, supply chain challenges, impediments to health service attendance, and impact on health care systems. In many countries, national COVID-19 responses have negatively impacted HIV prevention programs HIV prevention programs, especially for key and vulnerable populations (KVPs), and adolescent girls and young women and their partners. Services such as antenatal care, HIV testing and early infant diagnosis, and treatment initiation/adherence, have all been affected. The pandemic has also highlighted the central role of communities, community-led organizations, and community health workers in the response. Another key impact, which became apparent even in the very early stages of the pandemic in 2020, has been the significant rise in gender-based violence (GBV) and human rights abuses, including increased stigma and discrimination.  

In 2020, in response to the pandemic, the Global Fund introduced grant flexibilities and the C19RM to help countries fight COVID-19, mitigate its impacts on life-saving HIV, TB and malaria programs, ensuring the availability of critical health commodities to deal with priority diseases, and prevent fragile health systems from being overwhelmed. To date, the Global Fund disbursed more than $759 million. 

In 2021, the Global Fund raised an additional amount of almost $3.7 billion to fight COVID-19, thanks to an emergency fund of $3.5 billion provided by the United States Government and a contribution of €140 million from the German Government. As a result, the Global Fund was able to accelerate its response to the pandemic and continue its support through C19RM in 2021.  

Innovative technical support to GF C19RM Funding Requests 

In 2021, the Joint United Nations Programme for HIV/AIDS (UNAIDS) set up an innovative technical assistance (TA) model to support countries to prepare applications for the second phase of the COVID-19 Response Mechanism (C19RM). This model comprised in-country support to proposal development, an online Virtual Support Desk Mechanism and virtual peer reviews of draft applications, as well as a helpdesk to provide countries with tailored technical support on request. UNAIDS considered the experiences learnt in assisting countries to prepare their 2020-2022 Global Fund Funding Requests and first applications to C19RM in the previous year, 2020, when designing this technical assistance model. 

Launched in May 2021, the main purpose of the virtual technical support was: (i) to ensure better attention to communities, human rights, and gender (CRG) considerations; as well as (ii) mitigating the impact of COVID-19 on HIV programs and developing interventions to bring HIV programs back on track and even expand their reach, tailored to the pandemic context in each country. However, support was also available for other aspects of proposal development, including tuberculosis (TB) and malaria program mitigation as well as areas related to strengthening health systems. 

UNAIDS and its technical support partners (Oxford Policy Management and Genesis Analytics) established an online support mechanism for countries preparing their C19RM 2021 Full Funding Requests to the Global Fund. The support is virtual, not only given COVID-19 travel restrictions but also because these have led to new ways of working through online mechanisms, which also result in savings and increased efficiency. 

Through this virtual platform, countries could receive virtual support from specialists on HIV, COVID-19, CRG and community health systems. Specialists could conduct virtual desk reviews of draft C19 applications or clarify technical questions. Consultants and those drafting proposals could access and share the latest guidelines and examples of COVID-19 adaptations and cross-cutting considerations for human rights and gender equality. Those interested could also participate in the regular Virtual Clinics (webinars) on specific topics such as CRG, GBV, HIV mitigation, prevention, and service delivery through virtual innovations. UNAIDS through its technical leads provided the technical content to be used by the selected consultants and applications reviewers during the review and feedback process. 

Summary of C19RM Virtual technical support provided to date 

Remote desk peer reviews of draft C19RM applications in English or French were conducted by experts from the UNAIDS and a team of consultants. In total, 18 draft applications were submitted for peer review and several of them resubmitted for additional reviews before submission to the Global Fund. Applications came from Botswana, Central African Republic, Chad, Congo, Cote d’Ivoire, Gambia, Kenya, Liberia, Madagascar, Namibia, Nigeria, Pakistan, Senegal, Tanzania, Uganda, Zambia, Zanzibar, and Zimbabwe. The corresponding Base Allocation amounts to over $624 million. 

The virtual helpdesk has been used on multiple occasions by CCMs, writing teams, consultants, communities and UNAIDS Country Offices to answer technical questions or provide advice on all aspects of the narrative application form, detailed budget, quantification of health products and other key annexes.  

The Virtual Community of Practice Resource Hub/Website has been established and enriched with a repository of background information where any interested party can access and/or share the latest guidelines, technical notes, examples of COVID-19 adaptations for HIV services, country experiences, cross-cutting tools and thematic reports on human rights and gender, among other issues. These contents were pulled together by UNAIDS working closely with key immediate partners and experts on the topic as well as country teams for good country examples. 

Virtual clinics/webinars (Table 1) have been coordinated by UNAIDS and conducted regularly since May 2021, covering key HIV and COVID-19 topics of interest to countries, technical assistance providers, the Global Fund colleagues and partners working on C19RM applications, which are also available as recordings on the virtual community of practice resource hub. A total of five webinars covering key technical areas on COVID-19 impact mitigation approaches and country examples, spanning the various C19RM funding windows have been conducted to date. 

Table 1. Virtual Clinic Topics 

The huge interest in and growing audiences for the C19RM Applications virtual clinics, and the improved C19RM applications because of peer review and online/virtual technical support, indicate that the UNAIDS Virtual Support Mechanism has had promising results. The support to countries with their C19RM applications has resulted in several key experiences and lessons learnt to inform future applications The virtual support mechanism may even go beyond 2021 if the Global Fund access additional funding and opens new C19RM application windows.   

With support from the German grant, UNAIDS has been extending support to fight COVID-19 and HIV on a project on risks communication and community engagement on COVID-19 and HIV. As part of this project to fight misinformation and build vaccine acceptance, a rumor tracking software is being used to collect and monitor data on COVID-19 (mainly perceptions and sentiments) and is being expanded to HIV.  

The project aims at understanding the public perceptions/sentiments on COVID-19. Ultimately contribute to raise awareness and build acceptance for the COVID-19 vaccines including for people most at risks, PLHIV, KPs and reduce associated stigma and discrimination through impactful and informed outreach campaigns.  

The AU and Africa CDC have been partnering with Novetta, an advanced analytics company with technology that relies on open-source analytics. Building on their experience with the Ebola crisis, they have developed a rumor tracking software to help address COVID-19 misinformation and support decision-making in Africa through the collection, use and monitoring of relevant data (incl. public narratives, sentiments, media) and identification of knowledge gaps (public health campaigns etc.). The data is shared through weekly reports with the African Taskforce on COVID-19, AU Member States, development partners, WHO and other UN agencies to inform the response and help strategize on outreach and targeted communication campaigns at continental/regional/national levels.  

Drawing from the lessons learnt from HIV, UNAIDS leverages on the HIV response experience to strengthen collaboration with Africa CDC, AU, and partners to ensure PLHIV and KPs are included in the risks communication efforts to fight COVID-19, more specifically targeted and outreach sensitization/communication campaigns, including aspects on stigma and discrimination. 

The UNAIDS COVID-19 Portal collects quantitative and qualitative data from around the world on the COVID-19 epidemic and response, the impact, and implications of the response for vulnerable populations and HIV-related services, how communities are responding, and the roles of UNAIDS in the response. 

The Portal serves a number of specific functions: (1) allowing all of us to get a better picture of how the COVID-19 response – and the UNAIDS role in it – is progressing, so we can learn from (and copy!) each other and spot opportunities to collaborate; (2) facilitating reporting on COVID-19-related matters to donors, member states, our Board, UN agencies and UNAIDS headquarters, and other key stakeholders; and (3) providing up-to-date material on COVID-19-related activities for internal and external communications. A report with synthesized portal data is issued and shared with UNAIDS immediate partners. Including the Global Fund, PEPFAR, etc. The portal uses an innovative business intelligence software called Sisense. 

The Portal is intended to operate as a platform where users from across the UNAIDS Secretariat can contribute, see, organize, and analyze key current information about their own – and others’ – offices, teams, and departments, including country and issue specific data. Internally, the development of the Portal is viewed as an opportunity to launch a new approach to data and knowledge management among different teams in UNAIDS.