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Eliminations of mother to child transmission (MTCT) and pediatric HIV remains a priority for the WCA response. It is a tragedy that MTCT and HIV related deaths among children remains unacceptably high.

As we say in Sierra Leone it is criminal for any child to be born or die of HIV when we have the technology and strategies to prevent MTCT using the 4-prong approach, integration of services and providing lifesaving pediatric HIV treatment. Both Liberia and Sierra Leone have prioritized achieving the eliminating target of less than 5% by 2025.

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Thru UCD advocacy and support, Iran joined Prevention coalition early after development of the coalition. Combination prevention is an important strategy of NSP where it covers, PreP- and PEP, condom programming, KP programme w emphasis on harm reduction as well prevention of vertical transmission. Thru UN support led by UNAIDS, PMTCT gained significant coverage and the country is moving towards eMTCT. HIV testing/treat/ VL suppression are also well placed in the NAP. NAP lags on testing coverage and is trying various approaches such as self-test (different methods), community based initiatives, using social media, etc to increase access to testing services. Again thru UCD support and advocacy, Iran joint Global Partnership to end Stigma and discrimination. The country also fulfilled Stigma Index.2. The country took three areas of health care setting, community settings and humanitarian settings as its priorities to address S&D w development of protocols and training/ capacity building. It also expanded its its efforts to education, workplace and legal settings by training of medical students on S&D in order to have the next generation of medical practitioners free of S&D, development of HIV S&D protocol for forensic/legal medicine practitioners and its relevant training and planned for development of HIV S&D in workplaces. Integration of HIV in PHC began by introduction of PMTCT and linkage of HIV w ANC services and is expanding thru linkage of HIV and TB and Hepatitis services. The country has a specific strategy to enhance and strengthen use of data and generating evidence for better decision making and programming. Empowerment of women and communities need further support.

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Commit to eliminate vertical transmission of HIV and paediatric AIDS.  Lord Dartey

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Commit to eliminate vertical transmission of HIV and paediatric AIDS.  Lord Dartey

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It is imperative for South Sudan to commit and proactively work towards eliminating vertical transmission of HIV and paediatric AIDS.  Children 0-14 years have the lowest achievement across the three 95s of any population in South Sudan. Based on the UNAIDS 2022 estimates, children have only 15% known HIV status, 15% on ART, and per UNAIDS 2019, only 36% viral suppression. This, compared to an achievement of 31-24-82 percent among adults during the same periods.

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Tharcisse Barihuta /Zambia : End Inequalities and Engagement of Stakeholders to End Aids by 2030 

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Tharcisse Barihuta /Zambia : End Inequalities and Engagement of Stakeholders to End Aids by 2030 

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Zambia has made tremendous progress in reaching 90-90-90 Fast Track Targets end 2020 But: New HIV Infections remain very Hight (33000 in 2022) Particularly among adolescents Girls and Young women and Key populations. Working with Stakeholders to Close these Inequalities for access to SRH/HIV services particularly making Cultural norms and Laws conducive for these populations will reduce drastically new HIV infections. Looking at access to Test, Treatment and Viral Suppression, Despite the tremendous progress, Children and Men are Lugging Behind . Again, engaging the stakeholders particularly, the Boys and Men to seek HIV services and for them to support the Mothers and Children will close these Gaps and ensure 95-95-95 Targets are reached by 2025.

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In Morocco, all the commitments of the 2021 Political Declaration are relevant and essential to achieve the elimination of HIV by 2030 as a public health issue. The latest GAM report informs us that the first 95% target of People Living with HIV (PLHIV) knowing their status is currently achieved at 78%. This indicates that additional efforts are required to address this testing shortfall in order to achieve this goal. Therefore, I consider the commitment to achieve the targets for HIV testing, treatment, and viral suppression to be a priority.

There are issues of inequality in access to testing and care services between regions, between rural and urban areas, and especially among pregnant women. The coverage for HIV testing remains insufficient, and it is important to intensify and diversify testing efforts to reach the target percentage of 95% of PLHIV who know their status.

Innovative approaches also need to be developed to reach populations with diverse testing methods, such as community-based testing and index testing, among others. These strategies could contribute to greater testing coverage, faster identification of HIV cases, and ultimately, a more effective response to control the virus spread.

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Ghana is currently facing a complicated country situation where conservative ideologies in some sectors of the society are promoting regressive movements attempting against the human rights of the persons (including some left behind populations). The parliament is currently discussing a private´s member bill againts LGBTIQ+ persons (Promotion of Proper Human Sexual Rights and Ghanaian Family Values Bill). If approved, this will will put in risk the achieved progress in the HIV response in Ghana, especially in key populations. Considering this context it is crucial for Ghana to work on the committment related to realize human rights and eliminate stigma and discrimination, especially when MSM is the highest prevalence group in th country and whe the situation of the HIV epidemic in transgender women is unknown. Also, stigma and discrimination against PLHIV continue as a barrierr since many years ago at healthcare, education, labor and community sectors.

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End inequalities and engage stakeholder to end AIDS by 2030

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End inequalities and engage stakeholder to end AIDS by 2030

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For Uzbekistan it is a priority to promote strong partnership and join the efforts of all partners and stakeholders. It also includes meaningful engagement with civil society and communities, young people and women. If this strong partnership will be based on common values and goals, mutual respect and trust, and the experience, sensibilities, and knowledge that each partner brings to the table, then other commitments will be fulfilled

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Although all of the ten commitments are critical for Brazil, realizing human rights and eliminating stigma and discrimination is the most important commitment of the 2021 Political Declaration for the country. Since 1st case of HIV/AIDS was reported in Brazil in 1982, the country was going through a transition from a military dictatorship to a democracy. This change opened government and political institutions to democratic procedures. This transition as well as other underlying sociopolitical and economic changes of the time, strengthened activism that would profoundly affect not only the spread and migratory pathways of HIV/AIDS but also the overall national response to the epidemic. While the disease was initially considered a severe threat to national health and remained subject to intense stigma and discrimination, Brazil today is seen as a reference of a successful response to the epidemic that implemented a National AIDS Program (NAP) with a rights-based approach to disease prevention and treatment. However, changes in government after 2011 led to increasingly conservative government that saw the removal of policies and dissolution of civil society committees that were integral to the national response. Brazil's leadership to make treatment available to all through their UHC and fight to develop generics was a huge win for delivering HIV services. Despite being seen as a model in the response in the early 2000s, and their rights-based approach, stigm and discrimination have been the biggest barrier to reaching epidemic contral and ending AIDS as an epidemic. The country has done well in progressing towards the first 90 and third 90 but has been unable to close the gap on the second. Prevention and treatment services are available but this does not mean that everyone has access to them. Key and most vulnerable populations (homeless, migrants, indigenous) continue to encounter different levels of stigma and discrimination, making it difficult for them to access services. The intersecting inequalities further compound these challenges.

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Effective implementation of combination HIV prevention (David - India)

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Effective implementation of combination HIV prevention (David - India)

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India is needs to fully leverage the potential of the HIV prevention toolbox! PrEp and Self-testing have been piloted and proven to work. UNAIDS and its partners/stakeholders are advocating for these innovations to be accepted and scaled by the national response.

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Accelerate universal health coverage and the integration of HIV services.

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Accelerate universal health coverage and the integration of HIV services.

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All ten commitments are important but in countries like Pakistan and Afghanistan that face numerous and complex challenges, accelerating UHC would have magnifying effects for the health and wellbeing of all people including PLHIV, KPs, their partners and families. HIV services, including prevention and treatment, were included in the package of basic services under UHC in Pakistan – an achievement. However, funding for UHC and localization of UHC at the provincial level (under devolution) are key steps that are still a work in progress. Given the concentrated nature of the HIV epidemic in the country where the numbers against the ‘95-95-95’ targets remain at ‘24-14-8’, integration of HIV services in UHC is critical.

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Stigma and discrimination, along with other inequalities and social exclusions, are showing fundamental barriers. Marginalized populations who fear trial, violence, or imprisonment struggle to access sexual and reproductive health services, especially those related to contraception and HIV prevention.

Women and girls continue to be the most affected and accounted for more than half of all new HIV infections in the country.

However, where HIV services are provided comprehensively, HIV transmission levels are significantly reduced.

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Prioritizing effective HIV combination prevention especially among AGYW is particularly key in Rwanda given that new HIV infections are not reducing at the desired rate. The country has high rate of teen pregnancy, HIV prevalence among AGYW is 3 times more than in their peers. HIV prevalence among FSW is 35%. Robust and sustainable and evidence based prevention program that is differentiated geographically based on risk is critical. Engaging the relevant government sectors meaningfully is also important as well as having CSOs leading at community level to mobilize the communities and also monitor and provide feedback on program implementation

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Commitment to eliminate vertical transmission of HIV and pediatric AIDS - Marc SABA

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Commitment to eliminate vertical transmission of HIV and pediatric AIDS - Marc SABA

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Mali is lagging behind with regard to the EMTCT and pediatric AIDS. Meeting this important commitment is among the country key priority reflected in the National Strategic Plan (NSP) for HIV/AIDS. Reaching this goal will obviously help to end AIDS by 2030. In this regard, the Ministry of public health, the UN Joint Team on AIDS and the platforms of religious leaders have launched an ambitious program to end vertical transmission of HIV and to booster pediatric testing and treatment. The Global Fund and the PEPFAR are fully involved and supportive to the this initiative. The cultural barriers is one of the bottleneck which undermines pregnant women to access to testing. The role of the religious leaders is to sensitize husbands and pregnant women to adhere the testing offered during the pre-natal consultations.

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Realizing human rights and eliminating stigma and discrimination.  The government in Armenia commits to eliminating HIV-related stigma and discrimination and to respecting, protecting, and fulfilling the human rights of people living with, at risk of, and affected by HIV. The National Programme on HIV/AIDS Prevention for 2022-2026 is fixed to strengthen the sustainability of the national response to HIV/AIDS; reduce stigma and discrimination; and promote human rights and gender equality.
The MoH together with NGOs and international partners continuously works to decriminalize HIV transmission.
In 2022,  the new Criminal law was approved. According to this document, the "exposing another person to the obvious risk of infecting another person with the human immunodeficiency virus" disposition has been removed. It’s a really small step toward the actions for the decriminalization of HIV transmission in our country and this is an good example of moving forward to meet UNAIDS' “10-10-10” targets in Armenia.
Now, together with the Ministry of Health and NGOs, we continue our work with the Ministry of Justice to fully decriminalize HIV transmission.

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Eva Kiwango. Realise human rights and eliminate stigma and discrimination in South Africa 

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Eva Kiwango. Realise human rights and eliminate stigma and discrimination in South Africa 

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In December 2022, the Ministry of Justice set into motion a public participation process on the laws that govern sex work in South Africa. Cabinet approved the publishing of a draft Bill – The Criminal Law (Sexual Offences and Related Matters) Amendment Bill, 2022 – for public comment. The Bill will do something quite extraordinary if it does become law – it will fully decriminalise sex work and make South Africa only the third country in the world to do so, after New Zealand (in 2003) and Belgium (in 2022). It removes provisions in both the Sexual Offences Act and the Criminal Law (Sexual Offences and Related Matters) Amendment Act that make it illegal to buy or sell sexual services. It also expunges the criminal records of people who have been prosecuted in terms of these laws. These legal developments are important because the public health evidence for the decriminalisation of sex work is overwhelming. Research has shown over and over again that the criminalisation of any aspect of sex work places sex workers and clients at risk of HIV and other illnesses, strengthens prejudice, and makes vulnerable groups reticent to access healthcare and educational support, while increasing violence, rape, corruption, and torture against sex workers. Removing all criminal penalties would be the first step in addressing these challenges. A study has suggested that decriminalisation of sex work could avert 33-46% of HIV infections in 10 years among female sex workers. In the context of South Africa, where female sex workers have extraordinarily high HIV incidence and an HIV prevalence of more than 40% across different areas, decriminalisation will have a tremendous impact.

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YOW - Vertical transmission of HIV and paediatric 

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YOW - Vertical transmission of HIV and paediatric 

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Commit to eliminate vertical transmission of HIV and paediatric AIDS: The country is lagging with the elimination of MTCT (more than 10% transmission rate) and only 30% of children living with HIV are on ART. This commitment is linked to the one related to HIV testing, treatment, and viral suppression. Although the adult on treatment is 96, the viral suppression is low. 95-95-95 targets for adult and children are the country top priority.

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Malawi has registered progress in the HIV and currently attained 98-99 and 95 among women, 93-93-94 among men but children are lagging behind at 69-100-79. It is estimated that 1900 new infections will be through vertical transmission in 2023. New maternal infections while breastfeeding represent 21% and this remains a concern. Malawi will therefore continue to focus on addressing the structural barriers that expose children and their mothers to HIV.

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Eric Verschueren Benin TogoCommit to the elimination of vertical transmission of HIV and pediatric AIDS

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Eric Verschueren Benin TogoCommit to the elimination of vertical transmission of HIV and pediatric AIDS

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Togo and Benin are lagging in PMTCT (68% and 98% for Benin which is excellent) and pediatric AIDS (57% and 37% on treatment). Progress towards 95-95-95 on testing-treatment-VL suppression needs also to pass through this commitment.

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Eliminate MTCT and Paediatric -AIDS - Martin Odiit

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Eliminate MTCT and Paediatric -AIDS - Martin Odiit

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In Tanzania, there was an estimated 10.9% vertical transmission rate including breastfeeding period in 2021 compared to a target of less than 5% by 2025. Among adult (15+), 87% were on ART in 2021 while among children living with HIV, only 60% were on ART showing a glaring disparity when compared to adults.

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COmbine Prevention in the Southern Cone COuntries - Alberto A Stella

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COmbine Prevention in the Southern Cone COuntries - Alberto A Stella

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In the countries of the South Cone, Prioritize the effective implementation of combination HIV prevention is a priority since its expansion and decentralization would make it possible to better address key populations by linking them to specialized services for adequate prevention. These services also allow, as demonstrated by the evidence, early diagnosis of HIV, closing gaps in late diagnosis, diagnosis and treatment of other STIs including viral hepatitis, vaccination against hepatitis B and HPV, and expanding access to health for the most vulnerable populations. These services at the first level of care also allow strategic alliances with Civil Society to mobilize communities. This can be done in the context of the Fast Track Cities programs, with the involvement of provincial and municipal authorities and the signing of the Paris Declaration, expanded with the Seville Declaration, to promote greater policy coherence, both between different levels. government (national, provincial and municipal) and horizontal (between government sectors at different levels). In this way, social environments free of stigma and discrimination can also be promoted.

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To eliminate vertical transmission of HIV and paediatric AIDS is a moral imperative in a middle income country where it is unacceptable to witness almost 100 babies born with HIV every year.
It receives all the necessary funding and commodities to test pregnant women and provide ART to HIV+ pregnant /lactant women. It needs to develop a community approach to link pregnant women to health care centers.

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Strengthening and enhancing the use of data, science and innovation is particularly important for me because generating and using data smartly strengthens our ability to advocate and influence transformative change. It helps to garner political will and commitment to end AIDS by creating champions for eliminating barriers, protecting and respecting human rights, addressing gender inequalities, removal of discriminatory laws and above all help to increase domestic and international resources for the HIV response.

Implementation Sciences approach helps to identify innovative strategies as we build the ship and sail at the same time and also putting in corrective measure on strategies that work or do not work.