Let Communities Lead in the Fight to End AIDS

World AIDS Day 2023 recognises the vital role played by the communities of people at risk for or affected by HIV.

The powerful message of World AIDS Day on 1 December this year will be “Let Communities Lead”, a theme that recognises the vital role played by the communities of people at risk for or affected by HIV. Their work inspires trust, fosters innovation and improves the equitable implementation of health policies and services.

Despite the progress made to date, in 2022 there were still 39 million people living with HIV worldwide, with an overwhelming 82% of cases concentrated in sub-Saharan Africa, 7.3% of whom were children and 24% of whom are untreated. In Spain, 3500 new cases are diagnosed every year, half of which are late diagnoses.

UNAIDS has set ambitious targets for the diagnosis, treatment and suppression of the virus, with the goal of ending HIV as a public health threat by 2030 and combatting the stigma and discrimination associated with the infection.

The vital role played by the communities at risk for or affected by HIV

The theme “Let communities lead” is a call to empower communities affected by the epidemic to assume leadership roles in the fight against HIV and to support them in those roles. UNAIDS has highlighted four essential components of community responses to HIV:

1. Participation in accountability
2. Community-based service delivery
3. Participatory community-based research
4. Community financing

Achievements of some communities in the fight against HIV

Community engagement, in the form of awareness raising and community-based campaigns, has changed the landscape of the AIDS response worldwide and continues to have a vital impact that is improving the well-being of individuals and communities.

Of particular note are the awareness-raising activities supported by the Global Network of People Living with HIV World AIDS Campaign International, which has established national networks of people living with HIV in many countries, including Cameroon, Ethiopia, Kenya, Malawi, Nigeria and the Republic of Moldova. These networks work closely with governments to plan, implement, monitor and evaluate programs that help expand access to HIV prevention, treatment, care and support in a discrimination-free environment.

Another example is the diffusion of the message U=U (undetectable = untransmittable), a campaign that empowers people living with HIV to have a sex life without fear, promoting adherence to treatment and safe sexual practices while freeing them from the stigma associated with the disease.

Communities humanise HIV prevention and treatment

The role played by communities in the provision of HIV services is particularly important because they humanise the delivery of prevention, treatment, care and support.

A notable example of this is the Step Up Project in South Africa, which focuses on helping drug users, who have limited access to HIV services because of the country’s punitive approach to drug use and the stigma and discrimination experienced by this group. The project provides HIV testing and prevention services, screening for other sexually transmitted infections and tuberculosis, and referral to health care services; they also offer harm reduction counselling and needle and syringe distribution services.

Another excellent example is the Red Argentina de Jóvenes y Adolescentes Positivos (RAJAP) (Argentine Network of HIV Positive Adolescents and Young People), an organisation that supports young people living with HIV and people aged between 14 and 30 years who belong to key population groups. Using an innovative approach, RAJAP works with and for young people, using their own language to help them identify rights violations, denounce injustice and claim their right to access services.

Let the communities participate in research

Community participation in research is also essential to ensure more in-depth and reliable results; communities can help researchers to obtain a more representative sample, to formulate the right questions and to achieve a more nuanced interpretation of their results. One example is the People Living with HIV Stigma Index, a unique tool designed to gather evidence on the stigma and discrimination experienced by people living with HIV and the impact this has on their lives, workplaces and health. People living with HIV are not only researchers who empower others but can also become agents of change when they share their own stories.

Community funding initiatives

Finally, community funding initiatives also play a key role in the fight against HIV. Many organisations have developed dynamic fundraising capabilities and gained valuable experience in channelling these funds into community-based organisations, in particular those working most closely with people living with HIV and marginalised populations.ç

For example, the international NGO Comunità Volontari per il Mondo (Community Volunteers for the World) funds the community response to HIV in key populations in Ethiopia and the United Republic of Tanzania. In Ukraine, Light of Hope acts as an intermediary, channelling government and local authority funding to NGOs. One of its major achievements has been the construction of nine buildings with favourable lease terms to house NGOs that provide HIV-related services at a lower cost per unit.

Giving communities a prominent role

UNAIDS Executive Director Winnie Byanyima has stressed the critical importance of "giving communities a prominent role and active leadership in the fight to eliminate HIV”. Community projects led by people living with HIV strengthen health services and empower vulnerable communities. To end the HIV epidemic, the world needs to let communities lead the way.