Discussion
27 Jul - 2 Aug 2022

AIDS 2022 programme highlights and rapporteur reports

Andrea Nannipieri
Andrea Nannipieri • 25 July 2022

Dear colleagues,

A small group of UNDP colleagues from the HIV, Health and Development team are participating in AIDS 2022 as delegates from 27 July - 2 August 2022. 

During the conference week the team will cover a selection of activities related to key populations, human rights, digital health, stigma and discrimination, investments and efficiencies and gender. The team will post highlights, new research, evidence and key takeaways below. We hope these updates will help to inform your work.

We encourage you to share your views and comments.

The CoP on HIV and Health team 

 

Read up on UNDP at AIDS 2022 here

Back to the UNDP at AIDS 2022 landing page

Comments (17)

Jeffrey O'Malley
Jeffrey O'Malley Moderator

Connecting LGBTI+ and key population activists in Africa

Today’s session began with panelists sharing their thoughts on why it is important for LGBTI+ and HIV activists to work together in Africa and recounting success stories of such partnerships.  That said, each panelist described quite different approaches to fostering such collaboration, linked to their country context; their own roots as activists in HIV, or on trans or LBQ women’s issues; and to some degree, their relationship with different funders.  Some subtle but significant differences of perspective emerged in the first round of interventions, particularly regarding the focus of many HIV and health donors on narrow quantitative measures of success as opposed to broader measures of social and policy change. Most of the panelists underlined the importance of an intersectional (or a “whole person”) approach to health, rights and social change – including but going beyond HIV.   Contributors seemed to agree that both the LGBTI+ and HIV key population movements benefit from diversity – newer and more experienced groups; “insiders” working closely with governments as well as “outsiders” pushing the envelope; actors focusing broadly on social and gender justice as well as others focusing more specifically on the intersection of sexual and gender diversity issues and HIV.   That said, a number of interventions from the audience sharpened the conversation, in particular flagging issues of financial and organizational competition among different kinds of activists (and different generations of activists).  It was clear that there is a strong appetite for more discussion, reflection and debate at country level on why and how these movements can work together, as well as the limitations of such collaboration.   

Boyan Konstantinov
Boyan Konstantinov Moderator

Jeff, this was a strong session - many congratulations to you and team! Impressive how, minutes after you started, the huge room we had started filling with young activists from African countries, but also many people for Southeast Asia, who came to listen and compare notes. Speakers were joking about overusing the term "intersectionality" but the session was about intersectionality - and connecting the dots between HIV and key populations, LGBT+ rights and inclusion and catalytical factors for a positive social change. The panelists were impressive. Engaging and empathic, with excellent chemistry between them - all of them strategic thinkers, who know their field very well. A pleasure to listen.

Boyan Konstantinov
Boyan Konstantinov Moderator

UNDP and the ILO organized a pre-conference on access of people living with HIV and key populations to social protection on the margins of AIDS 2022. The pre-conference was attended by 92 people in person and in virtual space. The discussion was inspired by the global dialogue social protection that UNDP and the ILO organized last year for 52 countries worldwide. In 2021. Following this dialogue, we developed a checklist on social protection. It helps assess inclusiveness of national social protection systems vis-à-vis people living with HIV and key populations. During the pre-conference we learned how this checklist was piloted by UNAIDS in the Central African Republic and Cote-d’Ivoire. The stakeholders have appreciated the section on programme monitoring, which allows communities, donors, and partner to exercise control on the implementation of provisions in laws and policies, as well as the ideas for inclusion of new HIV-sensitive social protection measures in the design section. The checklist can also support ongoing social protection initiatives of UNAIDS, for instance in Mali.

Photo OneWe learned about the advocacy work of the Lakshya Trust from the state of Gujarat in India and the advocacy efforts and partnership with the government and support from UNDP to ensure access to COVID-19 testing and vaccination for trans people, as well as to expand the access of transgender people to other social services.

The Dominican Republic has developed the access to labor market system Superate and the unified beneficiary database Siuben, where now key populations and people living with HIV are registered in a save manner that protects their persona information. The Superate system also provides access to the labor market to people in the informal economy, including sex workers.

Photo TwoCivil society in Zambia, supported by UNAIDS, partnered with the government to carry out assessment on the impact of COVID-19 on people living with HIV and key populations and the opportunity to make the current social protection system more inclusive. The government is already following up with some of the recommendations of the community organizations.

The panel discussion and the session of questions, answers and comments demonstrated that:

  • We have excellent examples of community led responses, which cover not only HIV services, but social protection as well.
  • We need fast, scalable, sustainable solutions that not only provide temporary relief but also help alleviate poverty, reduce inequality and promote inclusion. Social protection is inextricably linked with efforts to decriminalize HIV and key populations and combat stigma and discrimination.
  • More inclusion means less cost over time – it reduces mortality and morbidity improves the labor force, alleviates poverty.
  • The co-sponsors of the Joint Programme have an important role in the efforts to promote social protection for people living with HIV and key populations. We must redouble our efforts to support such initiatives with the strong meaningful engagement of affected communities. We need also to support the capacity of government and civil society stakeholders in inclusive social protection.

Photo Three

 

Chiranjeev Bhattacharjya
Chiranjeev Bhattacharjya Moderator

Welcome Boyan !....The sessions of the Pre-conference were excellently planned and scheduled...It was well evident from the lessons & experiences shared by the speakers that Decriminalization and removal of legal barriers is a major step to facilitate and expedite Social Protection and welfare measures for the PLHIV and Key populations. It empowers communities, increases ownership of Government and helps in Institutionalization of Social Protection service delivery. In India, the examples of HIV and AIDS (Prevention and Control)  Act 2017, Transgender Persons (Protection of Rights) Act 2019 and recent advisory of National Human Rights Commission and Supreme court judgement on Sex workers are classical examples. 

Secondly, the example of Dominican Republic is interesting where we can have a unified database system for integrated service delivery and it may also help in individual tracking like in the case of prevention and treatment cascade. 

 

Boyan Konstantinov
Boyan Konstantinov Moderator

Indeed, India shared many interesting examples. Chiranjeev, can we get a copy of the Supreme court judgement? Thank you!

Jeffrey O'Malley
Jeffrey O'Malley Moderator

Trans Inclusion in HIV/AIDS National Strategic Plans

GATE and AmFAR are running a very useful session right now on trans inclusion in HIV national strategic plans (NSPs).  They looked at 60 NSPs from the highest prevalence countries around the world, to identify attention (or lack of attention) to trans issues in NSP narratives; epi data; M&E / targets; NSP activities; and NSP budgets. While 65% of NSPs mentioned trans issues in at least one of these sections, it was usually in the narrative - which isn't linked to activities and budgets and accountability.  Only 8% mentioned trans issues in all five sections.     There was also important input from TransBantu Zambia, noting that the Zambia NSP is strong on trans issues but trans community members often don't understand the importance of the NSP and how to leverage its commitments into action and programmes.

 

Jeffrey O'Malley
Jeffrey O'Malley Moderator

Leveraging PEPFAR in response to other epidemics 

Most of us are already familiar with the challenges posed by COVID-19 to the AIDS response:  supply chain disruptions; sick, burned-out and re-deployed health workers; lock-downs creating challenges for both prevention and care; and so on.   Many of us also know the resilience and creativity in HIV responses throughout the last two years.  But this session also underlined how some of the adaptations and mitigation measures actually IMPROVED some aspects of programme delivery.   Similar to data that I saw from South Africa a few months ago, it turns out that ART and PrEP uptake among certain populations (especially MSM) actually improved, largely due to multi-month dispensing of drugs and follow-up through on-line contact rather than in-person appointments.  And people took their meds too, as shown through viral load monitoring.    Some of these innovations that were seen as compromises in the face of COVID must be maintained into the future!

 

Kathryn Johnson
Kathryn Johnson Moderator

Hi colleagues, I had the opportunity to virtually join the Opening Session. An overarching theme of the speakers was addressing barriers to access, including discussing the situation of those unable to participate in person at AIDS2022. Reflecting on the message of the new UNAIDS strategy, speakers highlighted how important it is to end inequalities and systemic racism, in addition to criminalization, stigma and discrimination, that significantly impacts global health, which has always disproportionately affected the most marginalized. Other speakers noted the importance of including all stakeholders at every stage for an effective HIV response. As part of this, those most affected by HIV must be able to express their views and be part of the conversation. Equally, it was recognized that all conversations are grounded in science, but without financial investments, progress towards a vaccine and a cure will not happen. We saw what the global community is capable of with the COVID-19 response, and we need the same level of urgency, collaboration and financial investment in the HIV response. The recently released UNAIDS report is clear we must do all we can to get back on track to achieve the targets.

Berry Nibogora
Berry Nibogora Moderator

HIV in 2022 & beyond: A view from the National Institute of Allergy and Infectious Diseases (NIAID)

Today at 13h00 EST, I will be covering this session in which one of the leading infectious disease specialists - Antony Fauci - will be sharing from the institute he chairs. I was amazed by the comparison he made on Friday 29th between the HIV&AIDS and Covid-19, particularly on condoms and masks and how the structure-based vaccine development efforts made under HIV vaccine research paved the way for the Covid-19 vaccines that are saving lives.... Stay tuned for more insights later today

Berry Nibogora
Berry Nibogora Moderator

A brilliant presentation by Dr Antoni Fauci around HIV in 2022 and beyond, flagging how ending it is within our reach despite the impact of Covid-19 on the global HIV response…. but a lot of investment in terms of resources for researching the unanswered questions and new challenges. Using data and anecdotal evidence, he highlighted that the journey for HIV vaccine has been long and may have got people and communities tired but now is not the time to get off. Scientific progress and technological advances have not been utilized fully and countries must step up to use and follow science in addressing HIV and fighting the persisting stigma.

Dr Fauch insisted on the importance of the concept of treatment=prevention based on the fact that undetected virus equals untransmissible (U=U) that revolutionalised the field of HIV and if it added to a scaled-up use of PrEP would have a game-changer impact. He reminded the audience that PrEP is 99% efficient despite being under-utilized and the growing evidence of the dropping of PrEP adherence by its users 6 months later (41% of users stopping and 38% with sub-optimal adherence.

Responding to questions from the audience, Fauci reiterated the importance of community engagement/involvement as one of the key features of what he would have done differently. He also reminded the audience the importance of equity in ensuring access to any prevention and treatment tools that become available.

Quite an interesting session that ended up giving insights on comparing HIV/AIDS, Covid-19 & Monkey-Pox

Berry Nibogora
Berry Nibogora Moderator

The Health innovation was yet another important session held between 16:30 and 17:30 in room 220 d/e and virtually through Channel 1.

 

The moderator from Bill & Melinda Foundation reminded the audience different innovations that happened over the last 4 decades, including financial innovations, scientific innovations, etc. …but he reiterated that today’s focus of the conversation is harnessing the digital health and the role of community-led response.

The first presenter highlighted how the use of digital technology to improve health of human beings, from preventative messages (reaching communities using digital tools), to STIs testing (for awareness raising and uptake of testing services, especially for key populations), to PrEP uptake and adherence (identification of PrEP provider and increase uptake through social media platforms – use of big data); clinical interventions optimization; and to assisting in mental health services using platforms that are readily and safely available for users. He concluded his talk with thoughts on possible actions and challenges need to be considered for harnessing the digital technologies, including closing the demographic gaps in big data, anonymizing the data, addressing stigma and groups’ implications and involving ethics and regulatory bodies. The first speaker was interrupted by a picket from Latin America demanding the world to find a cure for HIV&AIDS

The second talk given by Solange Baptiste (from ITPC) was about community-led monitoring as an innovative strategy for health. Defining what it is, why it is important, urgent and innovative from how it is implemented in six steps () before focusing on how data are translated into advocacy. She insisted that CLM is a framework that could be applied to any disease, not only HIV, before sharing the findings of two CLM projects that illustrated the power of CLM data in influencing global health institutions, such as the Global Fund, UNAIDS and PEPFAR.

She closed with the counter-facts: what would have happened it was not implemented using the example of Malawi.

In terms of challenges, she highlighted the sustainability challenges given the low investment in CLM. She reminded the audience that the traditional methods will not get us to end HIV; we need to tell the whole story, which she illustrated by using the Zimbabwean case of 95-95-95 where the presentation of general populations’ progress did not capture the progress and lack thereof with regards to services for gay men and transgender communities.

Questions from the audience were around the scalability of the CLM model, the issue of data quality given that scientific community and the funders are still hesitant to us CLM data that are not peer-reviewed and how governments (South Africa) could fund CLM

Presenters reflected on these questions and highlighted a number of points:

  • discipline and scientific rigor need to give credit to the CLM model and investors and researchers need to trust the CLM model to check the level of triangulation and verification that was used;
  • scalability speaks to sustainability and investment that is put to CLM and funders are key to that;
  • the digital divide is yet another equity and inclusion problem that needs to be progressively addressed given that currently digital health and innovation are not democratically accessible.

The session was closed by awards to research in children and HIV research.

John Macauley
John Macauley Moderator

Prime session - HIV and Human Rights – 30 July 2022

Key discussion points

Presenter Mr. Caleb Orozco highlighted work around decriminalization of consensual same-sex relationships in Belize. He emphasized that many countries are still experiencing systems of oppression and it is important to unpack this phenomenon. Fairness and solidarity are needed to achieve any change. Inequalities are built into geopolitics and ordinary people are indispensable in this discussion. While discussing criminalization of the HIV, we need to understand these values are deeply rooted in structures of society and injustice. It is our responsibility to change these systems but also to recognize opportunities to become change makers. Decriminalization is one of many tools to dismantle a system of oppression towards KPs and PLHIV and hence creating a system of hope. We need to ensure 1. Reforms of punitive and discriminatory laws and 2. Access to redress mechanisms.

The second presentation was from S. El Feki (UNAIDS Director, MENA Region). Her presentation looked at the important work of the Global Commission on HIV and the Law from 2012, which focused on analyzing how laws, policies and practices around HIV responses. It is clear that the law can be a key tool in the response to HIV. Now 10 years down the road, we have a clearer picture of the situation and examples of both positive developments (e.g., Botswana, Uruguay etc.,) but also negative changes. The UNAIDS 10-10-10 commitments provide a clear framework for countries to uphold the commitments they signed up to. It is important to understand that all laws are interrelated.

Key takeaways relevant for UNDP (in challenging environments but also across all contexts)

  1. Start with areas that are so-to-say easier to tackle (e.g., elimination of mother to child transmission, HIV and travel restrictions) and then move on to other points, which may be considered more sensitive.
  2. Take a more pragmatic approach – “Political opportunism” e.g., engage leaders who want to look good among their counterparts, who want to impress donors etc.
  3. Focus on lessening the blow of bad laws – shifting implementation of laws is equally important as changing the laws. We need to continue working on further sensitizing judges, lawyers, prosecutors, parliamentarians, law enforcement and other towards the needs of KPs and PLHIV.

The overarching message is that “laws that threat PLHIV and KPs with respect are those that we should strive for, and we should start with ourselves”.

Finally, the session was closed with awards presentation - Elizabeth Taylor Human Rights Award presented to Tetiana Deshko and Andrey Klepikov and Elizabeth Taylor Legacy Award to presented to Rosemary Mworeko.

Chiranjeev Bhattacharjya
Chiranjeev Bhattacharjya Moderator

HIV and Co-infections: Prime Session on 2nd August 2022

This session was led by a presentation by Dr. Marina Klein from the McGill University Health Center who spoke on the TRIPLE ELIMINATION of HIV, HBV and HCV. She begin by highlighting the targets for triple elimination followed by talk on the key ingredients for it. She highlighted that elimination is possible if there are simple POC tests, effective treatment is available, vaccines are available along with other preventive measures. She stressed upon the fact that the evidences of U=U for HIV may be utilized for similar strategies for Viral Hepatitis. Regarding HBV, Vaccination was identified a very important tool, however, coverage in resource poor settings continues to be a challenge. With reference to HCV, treatment was identified as the key to elimination since vaccine is not available. However high cost of drugs need regulation and examples of Egypt and India was given as best practices.  She finally also commented that the current elimination goals may not be realistic and may be made more realistic by adding feasible sub-goals. 

The next speaker in the session was Ms. Jacqueline Huh for the Stop TB Partnership who spoke on integrating services to reduce burden of HIV, TB and COVID 19. She began by highlighting the Opportunities and Challenges in integration of services. She cited the innovations done as a response to the COVID 19 Pandemic which gave many solutions in integrating services. Further she spoke on various domains of integrating services on what need to be done like services should be accessible, affordable and people centric, Country driven and Country led, etc. She concluded her talk by talking about the new Pilot on Reimaging TB initiative in Uganda and Vietnam where different models of service integration will be tested. 

Key comments during Q&A were management of Hepatitis D should be also considered under triple elimination and importance of Government ownership for integration of services. 

The session end with the presentation of IAS/ANRS awards for the Best Abstracts in different tracks. 

Kathryn Johnson
Kathryn Johnson Moderator

I had the opportunity to join the Oral Abstract session - Not just law: Legal obstacles to an effective HIV response. This session featured four papers from Edwin Bernard, Greg Rosen, Monica Tabengwa and Paul Ayamah, which looked at different barriers to the HIV response and potential efforts to address these.

Edwin Bernard presented on the HIV Justice Network’s audit on blood-donation laws. He highlighted how the audit showed that 20 countries have HIV-specific criminal laws that apply to blood donors and that the criminalization of blood donors with HIV has primarily come about and persists due to “both HIV-related stigma and homophobia and is not supported by science.” He noted that this type of criminalization is a “disproportionate measure”, which attempts to “give the illusion of taking action to protect public health.”

Greg Rosen presented data from a study on the impact of laws requiring parental consent for HIV testing for adolescents and young people and testing rates. The study looked at 51 low- and middle-income countries and found a strong correlation with lower testing rates in over a third of the countries where there was an age of consent requirement present for adolescent HIV testing. He spoke of how the analysis provided some policy insights to consider, such as expanding HIV testing modalities outside of entities that would be required to enforce HIV testing requirements, expanding HIV self-testing, protecting implementing partners, and ultimately eliminating the age of consent policies.

Monica Tabengwa presented on the excellent work of the African Regional Judges Forum supported by UNDP, which has brought together judges from multiple jurisdictions to learn about issues related to HIV, TB and key populations. She spoke about how the African Regional Judges Forum recently launched its judicial training manual and highlight how there will be a dissemination among judicial training institutes. She discussed how it is hoped that the manual will be  and integrated into curricula in the region with further sensitization efforts  across Sub-Saharan Africa, in addition to the promotion of progressive jurisprudence through the use of and learning from the manual. 

Paul Avamah presented on the proposed anti-LGBTQ bill in Ghana. He spoke about the controversy surrounding the bill when it was announced and how they worked to quickly formulate a study to look into the potential areas that would be impacted by the bill if it is passed into law. He spoke about how men who have sex with men were already overrepresented in HIV statistics in Ghana, and how the study showed that law if passed would undermine any gains that had been made and create additional barriers for reaching key populations, such as men who have sex with men.

Elfatih Abdelraheem
Elfatih Abdelraheem

Prime Session: Long-acting treatment: Game changer or white elephant?

The session aims to highlight the clinical trials of some of promising long acting Anti-retroviral (ARVs) that are currently in various phases of experimentation. Dr. Catherine Orell presented the Carisel study and the SOLAR study which compare injection or oral administration and included participants from 13 countries. Prof Iskandar Azwa from University of Malaya – Malaysia, discussed the opportunities and challenges of Long Acting ARVs and Key population perception. He concluded with opportunities that less frequent dosing and avoidance of pill fatigue, increase choice for patients and providers, protection of health privacy and avoidance of stigma/daily reminder and addresses sub-optimal adherence. However, challenges include high cost in low income countries, injectable can not be self-administered coupled with high volume dosage. Dr. Lloyed Mulenga, the director of infectious diseases- Ministry of Health-Zambia presented three studies about HIV drug resistance in Zambia and Malawi. He concluded a number of lessons learnt related to how to address HIV drug resistance and simplification of second line ARVs. Finally, Prof Roy Gluick presented the proposed new treatment regimens of ARVs including various combinations and status of trials. The session concluded that there are many promising results for long acting ARVs that would improve treatment outcomes for PLHIV and KPs, however, the affordability of the cost in LMICs remain a challenge.

 

 

 


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