World AIDS Day - 2020
2020 has been like no other year on so many levels: with over 1,4 million deaths thus far that have resulted from the COVID-19 pandemic, the great loss of employment and income for so many marginalised communities and greater society, the foreclosure of millions of businesses, health systems that have been overwhelmed and struggling to cope with the demand for hospital beds and ventilators, not forgetting all the frontline responders to this pandemic who have gone over and beyond the call of duty to safeguard human life at times at the expense of their own. One can only be grateful to be alive as we close this year, though with a heavy heart. This is a year that most are eager to see become a thing of the past and a yesteryear to afford new hope, more so as various vaccine trials gain success.
The Accountability International team or #TheATeam as we affectionately are known, has been resilient, smart and responsive through this challenging year where remaining businesses and organisations that survived this global catastrophe had to embrace virtual and remote working methods. With Zoom having gained popularity and utility as a mode of communication and operation for many entities, many have been left “Zoom’d out” from virtual meetings fatigue. Lessons from virtual and remote working methods, adding to the overall impact of COVID-19 on overall wellbeing, mental wellness and emotional wellbeing of various communities has taken centre stage as the emerging health and wellness concern for many. What we are learning from the current pandemic enveloping the world, is the urgent need to foreground communities in all of our response. Through Accountability International’s COVID-19 Scorecard for Africa, we have seen how sex work communities, LGBTI persons, women and girls, youth, persons using drugs, to name but a few were and continue to be excluded and not reached by efforts to provide for remedy and interventions meant to alleviate the impact of the pandemic on their livelihoods.
On the wake of this year’s World AIDS Day commemorations, the measure of the efficacy of all efforts to combat this long ensuing pandemic can only be tested from the lens and experiences of all marginalised communities. Criminalisation of HIV, the criminalisation of gender identity and expression, sexual orientation, the freedom to choose or end a pregnancy, are but some of the major impediments to ensuring that we indeed see an end to HIV by 2030 as various global and continental commitments endeavour such as the SDGs, the ICPD commitments, Agenda2063 at the higher level. It is for this we continue to prioritise our work on Challenging Criminalization Globally, because continuing to co-exist with and not challenge the exclusion, othering and penalisation of communities living on the periphery of society, will remain the undoing of all efforts at global, continental and national level to redress HIV as well as COVID-19. To drive this point home, we need to acknowledge that we continue seeing higher HIV prevalence and incidence amongst trans diverse communities, MSM and sex work communities, likewise, COVID-19 new infections are on the rise in socio-economically disenfranchised communities and areas more so in the Global South and Africa more specifically. This is a direct correlation to the disregard, invisibilisation and exclusion of these communities in legislation, policy and service roll-out across different regions. As our African HIV Financing Scorecard (a partnership with the Society for AIDS in Africa) demonstrates, funds for the HIV response in Africa have been decreasing over recent years but that a myriad of innovative and original ideas and possibilities exist about how African human rights activists can be mobilising to increase both funds and accountability in this area.
As the world enters into the 16 Days of Activism Against the Abuse of Women & Girls, one cannot help but ask the question that should the 365 days of the year not be dedicated to combating sexual and gender based violence and femicide across board? This is relevant to bring to the fore given the spike in domestic and gender based violence cases throughout the year where victims and survivors were stuck indoors with their abusers as the world adhered to lock-down restrictions instituted as a response to the COVID-19 pandemic. In this period of COVID-19 emergency responses by states, our COVID-19 Scorecard for Africa has brought evidence to the fore how such emergency protocols have been used unfairly and disproportionately to target LGBTIQA+ persons and those carrying sex work status, as but extensions of state sanctioned gender based violence towards sexual minorities. For this it cannot be said enough how the SGBVF discourse, movement, campaigns and messaging is in dire need of an intersectional approach to ensure that all its efforts do not exclude any forms of abuse, oppression and violence towards any subsects of society unfairly targeted on the basis of their sex, gender (including gender identity and expression), sex work status, sexual identity and orientation. A failure to categorise, include and mainstream the experiences of all persons abused, violated and oppressed by patriarchal violence and systems indiscriminately so as to make holistic impact in shifting the status quo. The Transgender Day of Remembrance was commemorated on the 20th of November recently, where the available statistics of reported and accurately recorded numbers of transgender persons who have been killed from transphobic violence and murders as well as deaths resulting from systemic and structural violence stands at 350. Of the 350 deaths of trans diverse persons, 98% of them were transwomen and transfeminine individuals, while 79% of the trans deaths in the US were black and brown trans persons. To continue running under the banner of ending violence against women and girls at the exclusion and peril of transwomen and trans feminine individuals, lesbian women and female sex workers is a disservice to a holistic redress and remedy of sexual & gender based violence and femicide.
The time for selective politics, exclusionary approaches and interventions lacking an intersectional lens is long up. Foregrounding marginalised communities in all our work and seeking out the minorities within the minority and the most marginalised of the marginalised is the key to ending all pandemics of COVID-19, HIV and SGBVF. As many go into the end of year resting period, it would be great to bring this holistic attitude into the new year as we all continue battling these various pandemics.
Accountability International wishes all its programmatic and funding partners, communities, movements and stakeholders a wonderful and hopefully restful end of year, as we take care of our bodies, minds and spirits to continue persevering to advance justice, inclusion and dignity for all marginalised communities.
Ricki Tshepo Kgositau-Kanza
It is now twenty years since the iconic conference AIDS 2000 was held in Durban, South Africa. What people remember from that conference, which was the first time an International AIDS Conference was held in Africa, was that it played a vital role in raising awareness that the HIV epidemic was a global epidemic. Africa was put on the map in the response and has stayed there since then, and has even become a leader in the response.
Many probably also remember the resistance to evidence-based treatment from the South African Government of the time, under the leadership of the then President, Thabo Mbeki, supported by the infamous health Mantombazana 'Manto' Edmie Tshabalala-Msimang, who proposed natural food remedies rather than rolling out clinically proven anti-retroviral programmes. The policy directly led to the death of 300 000 people in South Africa.
For Accountability International, the conference was a starting point. It was in Durban that the young Nkosi Johnson gave his now famous speech – in today’s terms we would have described the media attention it garnered as “viral”. The young child spoke of the need for stigma and discrimination against HIV positive people to be addressed.
Our Board chair and founder Rodrigo Garay met Nkosi (and his mother) in Durban privately and had a discussion. At the time Rodrigo was working for International AIDS Society, but felt after he left IAS in 2004 that he needed to do more for the epidemic, still having the encounter with and speech by Nkosi in mind. So, with a few other people he set up AIDS Accountability International in 2005. The organization then began by scorecarding countries performance on HIV and AIDS as a means to improve accountability. The method was developed over two years by over 100 experts from around the globe, and was later adopted by UNAIDS and many others.
Accountability International to day still provides trainings on how to do scorecards for advocacy as well on Accountability Literacy, and thousands of people have been reached by these trainings and our reports in the past years. In 2018, when our work had explained beyond HIV and AIDS, the name changed to Accountability International, but we continue to hold in our hearts the cause and people who live with and work on HIV and AIDS.
To learn more about our scorecarding work and our Accountability Literacy, have a look at our website here.
 Lewandowsky, Mann, Bauld, Hastings, Loftus. "The Subterranean War on Science". Observer. Association for psychological science. Retrieved 4 November2013.
The low hanging fruits that can be used for both pandemics are the within the accountability framework of transparency, dialogue and action. HIV has adversely affected many people in Sub Saharan Africa, many being women and young girls because of their vulnerabilities. 61% of new infections occur in Africa among women and younger women of ages of 16 – 24 being the hardest hit.
At the beginning of the HIV pandemic in the early 1990s in Africa, health systems were rarely ready to capture what was one of the worst atrocities of modern-day pandemics on human life. The stigma and discrimination that surrounded those living HIV /AIDS by then, was a ‘curse’ and led to committed messaging by activists against stigma and discrimination. Coming out as a person living with HIV to this day remains one of the most difficult things to do. Sub Saharan Africa has been adversely affected and HIV like COVID-19 had put an incredible strain on health systems. East and Southern Africa are the hardest hit countries in the world where a larger proportion of people are living with HIV/AIDS globally. With HIV Sub Saharan Africa relies mainly on donor funded relief to respond to HIV /AIDS.
In commemoration of World AIDS Day, the theme is perfectly be apt. The 2020 AIDS Day theme is “GLOBAL SOLIDARITY, SHARED RESPONSIBILITY”. Pertinent issues arise in how HIV will be ended and the resilience and impact that nations have endured and the responses that they have engaged in over the last three decades.
The issues are as follows;
- Whether access to HIV services has been included in the programming during COVID-19?
- How have been the uptake for testing, use of condoms, and access to ARVs during COVID 19?
- Whether because of restricted access to public hospitals are there chances of non-adherence by PLWHIV?
- What are the consequences of the shift in the investment that has been redirected to COVID-19 away from HIV?
- Whether the progress that has been made in HIV research in terms of vaccine and essential lifesaving medicines is satisfactory, compared to what we see is possible for COVID-19?
- Are there any renewed strategies that can be used to be investigate an HIV response using the COVID-19 response lens?
The International AIDS Conference that was held in July 2020 focused on four objectives that were:
- accelerating response to HIV response by using scientific research and policy;
- shining the spot light on populations that are left behind;
- renewing political commitment and resolve in responding to HIV and
- promoting the call for the next generation.
The four objectives add on to what has existed before though highlighted. It also presents the synergies and opportunities that accelerated HIV response can be achieved using the various urgent responses that are being used for COVID-19.
There has been limited access to hospitals over the last 10 months as a result of strict COVID-19 health protocols. As a result of COVID-19 there has been fear of ARV stock outs and lack of access to hospitals by PLWHIV. This has threatened the progress that has been made in providing treatment. World Health Organization (WHO) estimates that there has been deaths during 2020 due to ARV stock outs and compromised immunity of PLWHIV. In order to lessen such risk, the WHO has made recommendations that countries must adopt the ‘multi month dispensing’ which has been adopted by 129 countries to date.It is clear that because of limited access to hospitals there is an existing challenges of access to ARVs. It is also significant that vulnerable communities for example MSM, transgender persons, people living with disabilities are not specifically targeted and ARV’s are not reaching them. Countries have heavily shifted investment from public health issues to respond to COVID-19, leaving HIV response lagging behind. Despite that HIV vaccine trials and medicines that have been developed over the years have saved lives and will continue to do so. There must however be progress in making ARVs accessible to everyone who needs them, which is not yet a reality despite many campaigns including the UNAIDS 90-90-90 strategy.
The existing synergies of the responses for HIV and COVID-19 can be used to restrategize accelerated response to HIV. Due to political will and commitment COVID-19 protocols and limitations were immediately acknowledged and accepted by leaders across the world in an endeavor to limit the pandemic spreading, which lead to the world almost shutting down. This dedicated strategy can be tapped into in a less stringent way by having the world collaborate in ending HIV by engaging in concerted effective partnerships. There have been rapid focused researched on COVID-19 and clinical trials on finding a vaccine. The urgency to find a vaccine and cure for COVID-19 can be used to accelerate HIV testing, treatment and prevention.The visible deliberate efforts must be adopted to HIV as well. The messaging and awareness on COVID-19 cannot be missed anywhere, which was the case when HIV started, yet the messaging is now not a priority in many countries. Targeted and consistent messaging for HIV is needed so that all people can access HIV services. This also applies to community involvement in reacting and responding to COVID-19, a factor that can be used strategically as an inclusive and collaborative effort to lessen the infection rates of HIV in Sub Saharan Africa.
It is without a doubt that the world continues to deal and address pandemics through history with rigor each single time there is a world outbreak. The existing similar background of HIV and COVID-19 as noted will give nations a global view of what needs to be done to strengthen existing national health systems, the urgency that is needed to be taken as a way of responding effectively to health disasters. It has been over 30 years that HIV has existed, and good steps has been made in making treatment available to many across the world.
The key differentiation is that there has been minimal progress in finding an HIV vaccine that can shift the tremendous cost and health burden it has on countries particularly lower- and middle-income countries. The rigorous and focused research on COVID-19 must have a direct impression and benefit to finding vaccines and better approaches and medicines for HIV /AIDS. This is achievable to the extent that there must be redirected efforts into HIV funding and particularly heavy investment into clinical trials and more access by all populations to medicines without stigma. There are positives that COVID-19 can be used for a better response to HIV. COVID-19 has brought more scientific research and collaborations across the world, the same can be adapted for HIV in research. It is also time for more donor funding beyond Global Fund and PEPFAR as the two most leading donor relief for HIV.
Should the synergies be effectively adopted then HIV will become a shared responsibility at a global level and the quest to end it, will become a reality.
 https://www.unaids.org/en/resources/presscentre/featurestories/2020/june/20200608_new-hiv-infections-differ-by-sex-and-by-region (Accessed 22 November 2020).
 https://www.avert.org/professionals/hiv-around-world/sub-saharan-africa/overview (Accessed 22 November 2020).
 www.undaids.org/en/World_AIDS_Day (Accessed 22 November 2020).
https://www.who.int/news/item/06-07-2020-who-access-to-hiv-medicines-severely-impacted-by-covid-19-as-aids-response-stalls (Accessed 22 November 2020).
 https://www.who.int/publications/i/item/WHO-2019-nCoV-essential-health-services-2020.1 (Accessed 22 November 2020).
https://www.unaids.org/en/resources/presscentre/featurestories/2020/september/20200921_90-90-90(Accessed 22 November 2020.
McHahon et al Leveraging the advances in HIV for COVID—19 https://www.thelancet.com/action/showPdf?pii=S0140-6736%2820%2932012-2 (Accessed 22 November 2020).
World AIDS Day, which occurs annually on 1 December, importantly intersects with 16 Days of Activism against Gender-Based Violence. In Africa, over half of new infections occur among women, while women with HIV continue to be at the receiving end of some of the worst violations that take place in healthcare settings, such as involuntarily sterilisation. In countries like South Africa, this occurs despite the existence of strong constitutional and legal and protective frameworks, as revealed by a report by the South African Commission for Gender Equality (CGE) early this year. Involuntary sterilisation is not a myth, but an ongoing practice that amounts to inhumane and degrading treatment. While the furore over this year’s CGE report may make it seem that it is an issue that is coming to light for the first time, the South African National AIDS Council’s 2015 stigma index revealed that around 500 women interviewed said they had been subjected to forced sterilisation.
The practice of involuntary, forced or coerced sterilisation reflects many harmful realities;
- The infantilisation of women and removal of their bodily autonomy and integrity, as medical health practitioners take on the role of decision-makers who ‘know better’;
- The way in which our disease-centric conceptualisations of health and health systems socialise us to dehumanise those HIV/AIDS because of their illness, deeming certain bodies worthy, valuable, respectable, and others worthless, and unworthy of basic human rights;
- The enduring and dangerous power disparities between medical health professionals and those accessing healthcare, which are compounded by class differences (with impoverished women particularly at risk);
- The lack of critical, meaningful oversight and accountability mechanisms;
The responses from the Department of Health have been disappointing to say the least, and can be summed up to be composed of deflection, shifting of responsibility, excusing of violations and denial. The prevalence of the practice despite the use of consent forms, and an enabling legal environment, point towards the need to reflect and respond to gender-based violations in medical settings from a socio-cultural, psychological and human rights lens.
While the CGE report makes important recommendations, such as legislative reform, reviewing consent-giving procedures, and investigation of perpetrators, the South African story is an ongoing example of the importance of continuing to place emphasis on perception and behavioral change, with the same way it is an evident need in tackling Gender Based Violence. The fight against HIV/AIDS has logically been driven by bio-medical interventions in medical settings, and engendering trust in the medical sector.
Winning will need a deep understanding and acknowledgment that that is not enough. We need to unearth the underlying systems of oppression, and craft interventions that place the awareness of them at the centre of our struggle. Without an integrated accountability approach to this issue, this human rights abuse will continue far into the future, and many more women and their loved ones will be stripped of their basic human rights.
 https://www.unaids.org/en/resources/presscentre/featurestories/2020/june/20200608_new-hiv-infections-differ-by-sex-and-by-region(Accessed 22 November 2020).
Complaint Ref No: 414/03/2015/KZN ‘Investigation Report On The Forced Sterilisation Of Women Living With Hiv/Aids In South Africa’ http://srjc.org.za/wp-content/uploads/2020/03/Forced-Sterilisation-Report.pdf (accessed 24 November 2020).
S Ebrahim ‘Forced sterilisation amounts to ‘inhuman and degrading treatment’’ (4th March 2020) https://health-e.org.za/2020/03/04/forced-sterilisation-amounts-to-inhuman-and-degrading-treatment/ (accessed 24 November 2020).
 I Letsoalo ‘South African Hospitals 'Forcibly Sterilised' Pregnant Women With HIV: Report’ (27 February 2020) https://www.globalcitizen.org/en/content/south-africa-force-sterilised-pregnant-women-HIV/ (accessed 23 November 2020).
U Nkanjeni ‘IN QUOTES | Mkhize slams forced sterilisation of women with HIV/Aids’(26 November 2020) https://www.dispatchlive.co.za/news/2020-11-26-in-quotes-mkhize-slams-forced-sterilisation-of-women-with-hivaids/ (accessed 26 November 2020).