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Smiling Coast

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Zambia, Situated in Eastern and South Africa region, Lower Middle Income Countries is part of the Highest HIV Burden disease Countries with 11% of prevalence ( Almost 1,500,000 PLWHIV . Significate Progress have been made in reaching 90-90-90 Fast targets in 2020 and moving forward almost reaching 95-95-95 Targets by 2025 ,But New infections are still high as we have seen reduction of 16% since 2010 with 38,000 new Infections in 2021 , Also domestic Finanacing still a chalennge as per NASA 2021 indicated that 90% of HIV response is funded by External Partners.

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Philippines has the fastest growing HIV epidemic in Asia and Pacific region having more than 300% increase in the last decade. The pervasive stigma, sociopolitical conditions, and barriers to healthcare services are fueling the epidemic in marginalized populations.

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The UNAIDS Fiji MCO covers 14 Pacific Island Countries (PICs). Fiji's HIV epidemic is now the 2nd fastest growing in the AP region (129% increase in the last decade), while other PICs have a prevalence of 0.1%. Though a low epidemic the vulnerabilities in this region are high-low condom use, low HIV testing, low HIV knowledge, High STI rates, emerging IDU and high S&D.

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Cambodia was one of the first countries to achieve the 90-90-90 targets in 2017, and is now dealing with its last and hardest mile of the HIV response. With a treatment cascade (95-95-95 targets) of 86-99-98, the country is focusing on its gaps (prevention, communities, sustainability) and ensuring an inclusive and multi-sectoral response to better identify the areas of needs and inequalities.

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The national HIV response in South Sudan unfolds in one of the most challenging country contexts in the Africa region.  HIV continues to be a public health priority with an estimated prevalence of 1.95% among adults aged 15-49 years, after having shown a slow but study decline from 2.5% in 2019.  New HIV infections trends has reversed for the first time, with a decline for the first time in 10 years (from a high of 17,000 to 11,000 in 2022).

South Sudan is far from achieving the 2025 global targets. For example, in 2022, there were an estimated 165,000 PLHIV of which 39% knew their status, 32% were accessing treatment and 27% were virally suppressed. In addition, while deaths from HIV have fallen in the last five years the rate of decline is insufficient for epidemic control.

Sustained and significantly higher investment is required to scale up the HIV response to accelerate the HIV response in the country. There is low domestic investment in the public health sector overall, with critical health system weakness unaddressed, including those relating to infrastructure, facilities and equipment, and human resources for health (HRH) recruitment and retention. This has led to an almost complete reliance on the financial, technical, and operational capacity of international partners to deliver the national HIV response. The programme is therefore donor-driven, mostly parallel, with inadequate integration across the PHC, particularly family planning, ANC, reproductive maternal neonatal and child health, sexually transmitted infections and other SRH programmes, including tailored services for adolescents and young people where they are available.

The country requires investment in national data and information for decision-making and quality improvement at all levels, resulting in the ongoing inability of stakeholders to 'know the HIV epidemic' in such detail as to effectively prioritise investment for higher impact.

Gender inequality is a key driver of the HIV epidemic globally. Unequal power relations, unequal access to opportunities including education and employment, gender-based violence, and many other factors including culture and harmful traditional practices such as child marriages, leave groups of people, particularly, women, girls, and key populations, vulnerable to HIV infection and unable to access lifesaving services.

South Sudan has a very high incidence of sexual and gender-based violence (SGBV). While it is impossible to obtain national level estimates due to chronic under-reporting, it is accepted that rates of GBV are very high.

Gender inequality, discriminatory and harmful traditional and cultural practices, such as girls being a source of family wealth (bride price), unpaid female labour, and child/forced marriage, limit access to opportunities, resources and participation for women and girls. Both child marriage (45%) and teenage pregnancy (300 per 1,000 adolescent girls) contribute to the lack of educational attainment.  South Sudan has the lowest proportion of female students enrolled in primary school and the second lowest proportion enrolled in secondary school in Sub-Saharan Africa. HIV is not only driven by the socio-cultural norms of a people, but the legal environment plays a critical role in reducing vulnerability to HIV infection and improving the lives of PLHIV.

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Ghana

Ghana has a generalized HIV epidemic (prevalence 1.7%) with high prevalence rates in MSM, FSW and AGYW. Estimates indicate 350,000 persons are living with HIV in Ghana. Limitted information on the impact of HIV epidemic in transgender women, IDUs, persons deprived of liberty and other groups. Stigma and discrimination against key populations (specially members of LGBTIQ community) and PLHIV is a remaining barrier. MTCT remains in high rates.

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The most populous country on the planet! Since the detection of the first case of HIV in Chennai (Tamil Nadu) in April 1986, considerable progress has been made under NACP to halt and reverse the epidemic. As a result, the HIV epidemic in India continues to be low. The continued low prevalence may give an exaggerated sense of achievements leading to complacency. In fact, HIV prevalence and incidence among key population remains at much higher level than the general population. Hence the need for continuous action and the vigil.

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Concentrated epidemic

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At the end of 2021, there was an estimated of 98000 people lived with HIV in Peru and 5500 new infections. In the last 10 years, new HIV infections increased 32% and deaths decreased 29%; due to 80% coverage of HIV treatment. The HIV epidemic is in concentrated in key populations with 0.4% prevalence rate in general population, 10% in gay men and MSM, 31.8% transgender women, 1.3% in sex workers; 0,7 % in venezuelan migrants and refugees and 1.8% in Amazonic indigenous Awajun. Most affected populations are male people between 20-34 years old, living in Lima and Callao provinces.
In this context, main priorities areas for UNAIDS' are to scale up combination prevention services at primary health level to reduce new HIV infections; streghten care and treatment continuum to reach viral supression target by 2025; and eliminate legal/policy barriers to HIV services and discrimination towards PLHIV and KPs, including indigenous groups and migrants populations.
The UNAIDS MCO is responsible for PERU, ECUADOR, BOLIVIA and COLOMBIA. More information attached for easy reference.

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Roza Babayan. The Republic of Armenia, a landlocked country located in the southern Caucasus, belongs to the high human development and Upper Middle-Income category. Armenia is a unitary, multi-party, democratic nation-state with an ancient cultural heritage. The first Armenian state of Urartu was established in 860 BC. Armenia was the first nation to adopt Christianity as a state religion, an event traditionally dated to AD 301.
The healthcare system in Armenia is skewed towards inpatient care, concentrated in the capital city, despite concerted efforts to reform primary care provision. Out-of-pocket payments remain high (over 80 percent of total health expenditure), reducing access to essential services for the poorest households, especially concerning inpatient care and pharmaceuticals. The fertility rate in Armenia has remained low (1.6 children per woman in 2018) and maternal mortality decreased to 18,3 per 100,000 live births in 2017.

In 2021, it has a total population of 2,96 million,  and a large diaspora estimated to be eight to ten million ethnic Armenians globally.

Armenia is a developing country and ranks 85th on the Human Development Index (2021). Armenia ranked 63rd out of 180 countries on Environmental Performance Index (EPI) in 2018.
HIV epidemic in Armenia is concentrated among KP. HIV overall prevalence of 0.3 and HIV incidence of 0.2/1000 population. The number of new HIV diagnoses was increased, in 2022 were detected 535 HIV cases. HIV epidemic in Armenia is concentrated among key populations (KPs) and labour migrants. According to 2021 IBBS, HIV prevalence among people who inject drugs (PWID) is 2.6% and men who have sex with men (MSM) is 5.0% and among female sex workers (FSW) – 0.2%.  Based on 2018 survey, HIV prevalence was 1.2% among 900 urban male labour migrants tested for HIV under. According to 2021 IBBS, a very high proportion of PWID have used sterile equipment during the last injection – 99%. The condom use among FSW was 93.2%, among MSM – 79.6% and PWID – 32.4%. HIV testing and status awareness were the highest among MSM – 100%, followed by PWID - 95.4%., but was low among FSWs – 77.2%․ However, according to the programmatic data, the HIV testing coverage in 2022 among MSM was 35․3%, FSW – 39․3% and PWID – 39.4%. The testing yield through lay providers was the highest among MSM - 2.8% and below 1% for other KPs (0% for Transgender (TG)). Out of the positive tests results provided by lay providers, only 37.9% were confirmed by the National Center for Infectious Diseases (NCID) for FSW , 64.8% for MSM and 76.2% for PWID. Other cases either were not linked to NCAP or were not confirmed.

According to 2022 Spectrum estimates, the number of people living with HIV (PLHIV) in the country is 4,850. Out of this number, 82,6% were diagnosed; 77,2% of the diagnosed were put on antiretroviral (ARV) treatment; and 70,5% of PLHIV who were on treatment had viral suppression.

Between 1988 and 2022, the main reported mode of transmission in Armenia was heterosexual contacts (81.3%), followed by sex between men (11.4%) and injecting drug use (5.8%). Mother-to-child transmission and unknown 0.6% and 0.9%, respectively.

The alarmingly attributed to the migration factor (migrants and their partners), with 41.3% of newly diagnosed HIV infections in the last five years.

Between 2020 and 2022, 60.5% of all HIV patients who had CD4 test result at the time of diagnoses were diagnosed at the late stage of HIV infection with a CD4 count <350 cells/mm3. In 2022, 230 AIDS cases and 74 deaths were reported.

Stigma and discrimination towards key populations (sex workers, people who inject drugs, men who have sex with men, transgender people, people living with the diseases) remain high, with 0.3% of MSM, 18.3% of FSWs and 17% of PWID having reported in the 2021 IBBS avoiding healthcare because of fear of stigma and discrimination. The Legal Environment Assessment underway, and a desk review of legal barriers completed in February 2018 in response to the TRP recommendation, have identified legal and policy barriers that may hinder access of KPs to HIV-related prevention and health care.

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Known as the land of a Thousand Hills, Rwanda is a landlocked country with a population of 13.2 million. The HIV prevalence among adults aged 15-49 has been stabilized at 3% since 2005 with a high prevalence peak of 7.4% among
women aged 50-54 and 6.5% among men aged 55-59 years, translating into the shift of the HIV epidemic to elders or people ageing with HIV as an impact of reduced mortality and high retention to treatment. From 2018 to 2022, new infections declined by 34% (from 4927 to 3229 annually). HIV prevalence among KPs is much higher than the national one for FSWs at 35.5% and MSM at 6.5%.

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Charos Maksudova. Uzbekistan, is a landlocked country in Central Asia, with an ancient history and   mosques, mausoleums and other sites linked to the Silk Road. Tashkent is the capital of Uzbekistan. As of 2022, Uzbekistan has the largest population out of all the countries in Central Asia. Its 36 million citizens comprise nearly half the region's total population.
The HIV epidemic in Uzbekistan is the 3rd biggest and the 3rd fastest growing in the Eastern Europe and Central Asia region. By the end of 2021, the estimated number of people living with HIV was 59,000, with 45,296 people registered with the national AIDS service. While AIDS-related deaths have decreased by 28% since 2013, HIV incidence has increased by 32% since 2010. Sexual transmission of
HIV prevails: its rates have increased from 45.9% in 2011 to 73.2% in 2019, while parenteral transmission has decreased from 44.6% to 18.3% and vertical transmission from 3,7% to 0.3% accordingly.
Over the past ten years, HIV prevalence has increased among MSM (from 0.7% in 2011 to 4.5% in 2021). The rate has been steadily decreasing among people who inject drugs (from 8.4% in 2011 to 2.9% in 2021). Regarding sex workers, the rate has increased between 2011 (2.2%) and 2017 (3.2%) and decreased ever since, with a 1.27% prevalence as of 2021. There is currently no available data about the HIV situation of people in prisons, apart from a 0.5% HIV prevalence rate from 2018.

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Each corner of Uzbekistan attracts with its features. In Tashkent, you can take a walk in the most beautiful metro in the world or see the most ancient manuscript - the Koran of Usman. In the historical cities included in the UNESCO Cultural Heritage List - Samarkand, Bukhara, Shakhrisabz and Khiva, you can visit the most ancient architectural monuments that have preserved echoes of past eras.

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·       Estimated number of people living with HIV: 110000

·       HIV prevalence among 15 – 49: 1.1%

·       HIV prevalence among key populations:

o   SW:13,7%

o   MSM: 4,8%

o   Prisons: 5,2%

·       With 856 deaths for every 100,000 live births, Chad has one of the highest maternal mortality rates in central Africa, a phenomenon aggravated by the high number of early pregnancies (164.5 births per 1,000 adolescents between the ages of 15 and 19).

·       Estimated number of new infections among adults (15+ years old): 2400

·       Estimated number of new infections among children (0-14 years old): 950

·       Number of people on ARV treatment:82 755

·       Only 30% of children living with HIV are on life-saving treatment,
far behind adults of whom 70% are receiving antiretrovirals.

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Eric Verschueren MCO Togo Benin. 110.000 PLHIV for T and 69.000 for B. Good progress on treatment, somewhat less on prevention. IDH 158 for B and 167 for Togo with high prevalence of poverty (38 for B and 53 for T) and huge inequalities.

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Malawi, The Warm Heart of Africa

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Marie - Guatemala is a concentrated epidemic, with about 30,000 PLHIV.  Regarding the cascade of the continuum of HIV care: 88% of PLHIV knew their status, 73% of PLHIV have access to antiretrovirals, and 67% of PLHIV are virologically suppressed. The epidemic in Guatemala is not under control, the incidence indicator shows a decline from 10 years ago.

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Eva Kiwango - SA is the epicenter of HIV epidemic with an estimated 8 million people living with HIV (5.1 million adult females, 2.7 million adult males and 0.2 million children). TB is also a major cause of morbidity and mortality. Despite significant progress made towards HIV control, incidence remains high. Almost two-thirds of all new infections (64%) occur among women, of these AGYW constitute more than a third (37%) of all new infections. 94.2% of all PLHIV know their status, 75% of the people diagnosed were on treatment, and 92% of those treatment were virologically suppressed.  When disaggregated by sex and age, the cascade for adult females is at 95-81-90 and adult males at 92-72-90, while children under 15 years are at 80-69-60. HIV prevention efforts are not effective to reach global and national elimination goals. Key and other priority populations are particularly affected by social and structural barriers including stigma, discrimination, poverty, violence which impact on access to services. On 24 March 2023, the country launched the fifth National Strategic Plan for HIV, TB and STIs for 2023-2028. This new Plan entitled “The People’s NSP”, is by far the most critical since it will be the last one ahead of Agenda 2030, where the global community committed to end AIDS by the year 2030. The focus of this NSP is the bold strategic objectives and vision to reduce inequalities.

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Tunisia, a North African land of culture and history.

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Jamaica is the gateway to the Caribbean. It is the land of the swift and the country is endowed with pure natural beauty and tourists love to come here. Your next holiday should be in Jamaica. Amidst its beauty lies our passion as UNAIDS to end the AIDS epidemic.

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Multycountry Office for the Southern COne (Argentina, Chile Paraguay and Uruguay)

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brazil is beautiful

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namibia is beautiful