2.       Gender. Many African societies still have gender norms where women are generally subordinate in public and in private life. As well Benin and in particular Togo (with a woman prime minister, a woman as president of the parliament and a notable increase of female parliamentarians) progress has been made over the last years. Togo is one of the best-ranked African countries in terms of gender environment, but both countries still need a lot of work. We did a gender assessment in Benin, in Togo that still needs to be done. 

3.       Social inclusion. As well Togo as Benin have written this in their development plans. Both countries are engaging in Universal Health Coverage. In both countries, we did an assessment ‘Social protection and HIV’ in the last two years. Results show that there are major problems. Benin as a HDI of 0,545 and ranks 158 and Togo 0,515 and ranks 167 (out of 189). So, poverty is ramping with an estimated poverty rate of 38,5% in Benin and 53,5% in Togo. So, there are huge economic inequalities that leave a lot of people behind. 

- Removing social and cultural barriers and reducing stigma and discrimination: social and cultural barriers prevent people to access health resources particularly women and children. Key populations face stigma and discrimination that prevent them accessing prevention, treatment and care services.

Empowerment and meaningful engagement of KPs and CBOs, who should be part of evidence-informed decision-making.   

Fostering and facilitating multisectoral alliances and collaboration to address intersecting inequalities, root causes of HIV-related vulnerabilities, and basic needs of PLHIV and KPs.    

 The wind of intolerance and negative propaganda gander against key population and increased access to sexual and reproductive health is gaining momentum in many countries in the subregion at a time when we thought that we have gone passed those days of blame and conspiracy theories. 

Unfortunately, this is not the case as increased intolerance is being manifested by communities that we hold in high esteem and who are expected to demonstrate more tolerance and support. This poses an entrenched challenge to ending AIDS as a public  health.

The other key issue that requires transformation is building resilient and sustainable systems for health to withstand the challenges posed by climate related humanitarian crisis such as floods and cyclones and health emergencies and disease outbreaks.

 Paying attention and addressing the human rights and ensuring continuity
of HIV services delivery in emergency situations will significantly contribute
to Malawi reaching the 2030 targets.

Transformation in design and delivery of health and HIV services: HIV services are largely delivered in vertical programmes that are not integrated in the primary health care system. These stem from the fact that the health delivery systems are donor-driven and characterised by different donors working in different service delivery facilities with different service packages and delivery models. Where different donors work in the same facilities, there is little integration of their services. A more transformative and sustainable way of dealing with service delivery will be a combination of pooled funding and other funding mechanisms that deliver a comprehensive package of service that are integrated in the PHC system in the country. 

Transformational change is also required in addressing deep social norms that drive gender inequalities such as early marriage and other gender-based violence against women and girls.  There is also the need for transformational change in the financing of HIV by leveraging humanitarian funding to strengthen the health sector and increasing domestic funding of the social services sector (including health and HIV).