World AIDS Day 2019: Communities make the difference!
World AIDS Day takes place on 1 December each year. The theme of World AIDS Day 2019 is “Communities make the difference”.
Communities contribute to the AIDS response in many different ways. Their leadership and advocacy ensure that the response remains relevant and grounded, keeping people at the centre and leaving no one behind. Communities include peer educators, networks of people living with or affected by HIV, such as gay men and other men who have sex with men, people who inject drugs and sex workers, women and young people, counsellors, community health workers, door-to-door service providers, civil society organizations and grass-roots activists.
World AIDS Day offers an important platform to highlight the role of communities at a time when reduced funding and a shrinking space for civil society are putting the sustainability of services and advocacy efforts in jeopardy. Greater mobilization of communities is urgently required to address the barriers that stop communities delivering services, including restrictions on registration and an absence of social contracting modalities. The strong advocacy role played by communities is needed more than ever to ensure that AIDS remains on the political agenda, that human rights are respected and that decision-makers and implementers are held accountable. (UNAIDS)
- 37,900,000 estimated number of people living with HIV at the end of 2018
- 1,700,000 people were newly infected with HIV in 2018
- 770,000 people died of HIV-related causes in 2018
- 500,000 target number of new cases and deaths per year by 2020
1. Today 4 in 5 people with HIV get tested and 2 in 3 get treatment: communities played a major role in achieving this success.
- Of the estimated 37.9 million people living with HIV at the end of 2018, 79% were diagnosed, 62% received treatment, and 53% had achieved suppression of the HIV virus with low risk of infecting others.
- One of the key contributors to this success in all countries has been the thousands of members of HIV and “key population” community networks and community health workers, many of whom are living with or affected by HIV.
2. WHO recommends countries to adopt community-based HIV testing, prevention, treatment and care as a core strategy.
- WHO recommends a strategic mix of approaches for testing, including community-based testing, self-testing and provider-assisted referral to reach people at highest risk of HIV.
- Countries like South Africa and Rwanda have shown how trained peers or community health workers have delivered rapid diagnostic tests with same-day results, enabling more people to know their HIV status.
- WHO recommends increased rapid testing in community settings for key populations in Europe, Asia and the Americas to replace laborious approaches causing weeks of delays in test results and treatment initiation.
- WHO is also adding new recommendations to mobilize community-based social networks for increasing demand for HIV testing, including self-testing and to promote dual HIV/syphilis rapid tests and new digital tools.
3. Community-based HIV treatment and monitoring saves money and reduces workloads for doctors, nurses and other health care professionals.
- WHO recommends countries train and mobilize community health workers, including people living with HIV, to provide decentralized and differentiated HIV treatment and care.
- Evidence shows more people continue with HIV treatment when peer educators counsel and support each other.
- WHO also recommends that community health workers support monitoring and data collection.
4. Expanding the role of communities and community-based health care will help countries meet global HIV and UHC targets.
- Health services are struggling to provide all people with HIV services they need. Global fast-track targets for HIV for 2020 are unlikely to be met unless more support becomes available.
- The most glaring gap is seen in prevention. In 2018, 1.7 million people were newly infected with HIV – this number must reduce by three-fold to meet the 2020 target of 500 000.
- Testing and treatment coverage is off track too – especially for key populations and children. For example, more than half of all new infections are among key populations and their partners; only half of the children in need are receiving ART, of which only half achieved viral suppression due to the use of suboptimal medicines.
5. Community and civil society engagement must remain a key strategy to boost primary health care.
- Activism and civil society action have been key resources in the HIV response from the early days, inspiring the global health community to galvanize efforts for increased equity, respect for health and human rights, and scientific innovation.
- In September 2019, global leaders signed the first-ever UN declaration on UHC with a central focus on primary health care, tailored for and built through empowered and engaged communities.
- Today, people-centred care, community and civil society engagement are included in three Sustainable Development Goal targets.
- World AIDS Day 2019 provides an opportunity to translate our commitments into action, to ensure the role of communities for HIV and health progress are both celebrated and accelerated.