On 28th October 2021, WACI Health launched an African youth advocacy and leadership program for global health, which defines, creates, and implements change while equipping young African advocates with skills to make a global impact on health.

Under the Tree brings together all of WACI Health’s youth leadership programs, including AfNHi Youth Cohort, YL4H (Youth Leaders for Health), RUN4TB Youth and AGYW Voices. Through these programs, we have witnessed the power of youth advocacy and leadership in policy change.

Rosemary Mburu, executive director at WACI Health, says, “By fostering youth leadership, WACI Health acknowledges that young people should lead today, not wait for tomorrow. As an organisation that mentors youth to drive advocacy, we help develop knowledgeable, bold and accountable youth leaders for global health.”

We are inspired by Youth Leaders for Health, a joint program by WACI Health, RESULTS UK, Health Promotion Tanzania-HDT, Hope for Future Generations, and CISMATSL. In addition, YL4H was an 18-month journey of skill development, mentorship, and influence for policy change, which demonstrated the power of youth voices in advocacy.

The project ended in March 2021, and 25 Youth Leaders passionate about health and healthcare systems were trained to advocate for policy reform. Under the Tree will contribute to the YL4H goal of more decisive youth leadership for better and more equitable systems for health in Africa.

Under the Tree will apply three key strategies: (i) structured module-based training (ii) continuous group coaching (iii) facilitates and connects young people to advocate for policy change at crucial national, regional and global advocacy moments.

Currently, Under the Tree is training and mentoring a group of 12 young people drawn from the AfNHi Youth Cohort. These12 young people from Nigeria, Ghana, South Africa, Zimbabwe, Tanzania and Uganda attend weekly online classes covering a range of topics from advocacy, engagement with communities, policymakers and civil society, media engagement, data advocacy and understanding the global, regional and local financing mechanisms.

The module-based online classes are combined with group coaching on specific skills to expand their capability to advocate for policy change at key national, regional and global advocacy moments. Additionally, Under the Tree hosts a monthly virtual Youth Forum, which is open to all young people passionate about health advocacy. It is a space for peer-to-peer learning and mentoring.

Using youth voices to advocate for and create community change is an outcome we strive for. Youth, adults, and their communities can potentially benefit from these interactions in significant ways.

Close to 4,000 people die each day from tuberculosis, which is the fourth leading killer among infectious diseases. There have been 10 million tuberculosis infections in 2019 alone, and 1.4 million have died from the disease. There were approximately 140,000 cases of TB in Kenya in the same year.

Around 32,000 TB-related deaths occurred in Kenya in that year alone. This could have been prevented through more targeted programming.

Male tuberculosis survivors from Kenya, Nigeria, and South Africa participated in the Just Men forum to share their stories with celebrities and become Male champions for TB advocacy. A live Facebook session complemented the event with Ambassador for Youth and Adolescent Rep Health Programme (AYARHEP), which is an adolescent and youth reproductive, health rights organisation, focused on gender advocacy on TB.

It is estimated that TB is more prevalent in men with approx. 60% of cases are diagnosed in men. According to Kenya’s 2016 prevalence survey, the disease killed the most productive population (18-44 years), and men were two times more likely to be infected than women.

The 2018 High-Level Meeting of the United Nations (UNHLM) focused on eradicating TB by 2030. To contribute to national and global goals, the commitment recommends gender-sensitive programming and innovative TB response strategies.

Due to men being more susceptible to TB, addressing gender-related barriers that prevent access to and treatment adherence is crucial. As their first remarks, Dr Waqo, Head of the National Tuberculosis Program, and Dr Kinyanjui, Country Director of the African Health Forum, highlighted financial barriers and societal norms that force men to prioritise income-generating activities over their health.

Furthermore, low levels of awareness of TB suggest that TB messaging for men needs to be creative.

As we continue strengthening the conversation around TB in women, it is crucial to ensure that men who carry the most considerable disease burden are not excluded from the discussion.

The GFF We Want is a platform for Civil society in the GFF implementing countries which begun in 2018, which aims to leverage the knowledge and capacity of the civil society coalitions working on the GFF to capture lessons learned, identify best practices and strengthen cross- learning by leveraging key relationships and moments including the GFF Resource Mobilization Campaign to drive country level work and global commitments to mobilize resources and ensure the success of the GFF. The GFF We Want has been implementing key activities to support the GFF resource mobilization throughout 2021. The campaign has leveraged key moments such as Generation Equality Forum, United Nations General Assembly and looking forward to the Nutrition for Growth. The Global Civil Society coordinating Group Jointly with the GFF We Want launched the GFF Wall of Fame in September 2021. The GFF Wall of Fame is a virtual platform which aims to highlight and celebrate GFF successes, including: donor commitments, country government commitments, CSO and youth contributions to results in GFF countries, and other GFF progress. Here are a few stories of impact which can be found on the GFF We Want Wall of Fame;

● In April 2019, Côte d'Ivoire launched a nationwide dialogue about health financing.
FENOS-CI was one of the key actors and stakeholders from the health sector involved in
discussions that led to creating the National Platform for the Coordination of Health
Financing (PNCFS). The 1.658 trillion CFA Franc investment envelope supported three
Civil Society bodies: an investment committee, a technical secretariat, and technical
working groups. Funding will be directed to the communities' needs through the
platform, strengthening the Ivorian health system. As a result of the National Dialogue
meeting, the investment file was created, giving the donors a framework for funding the
healthcare priorities of their sectors.

● GFF processes assisted youth-led organizations and policymakers at the local and
national levels in Kenya to reduce duplication of resources and enhance effective
advocacy through SMART Health Policy leadership training. In addition to the FP 2030
commitments, the national Scaling Up Nutrition strategy (2021-2025) and the
reproductive health policy (2020-2030) were developed due to knowledge gained from
this project. The partners will collaborate closely to increase county FP budgets during
the next financial year.

● As part of the Youth and Adolescents Health Forum, UYAHF fosters youth advocacy and
research initiatives that improve access to, demand, and uptake youth-friendly services
and collects evidence about young people's experiences with youth-friendly services.
The youth advocacy plan and coordinated action plan were developed based on this
evidence. As a result of this study, young people contribute to, inform, and influence
decision-making processes. Youths are also using the evidence to highlight the lack of
youth-friendly services in lower health facilities, lack of short-term family planning
services. Based on the evidence, a cost-effective implementation plan for family
planning in Uganda is being evaluated. It is important to note that now young people
can hold policy makers for their promises and demands for improved health care for
adolescents at the district and national levels. In Eastern Mbale, Busia, Tororo, and
Butalejja districts, UYAHF, in partnership with the Eastern Regional Youth Network, has
held several district-level policy dialogues to improve access to youth-friendly sexual
and reproductive health services. As a result, in Butalejja, the district has agreed to
provide family planning services, condom distribution, HIV tests, and GBV screening at
trading centers with funds from the PHC non-wage budget and the RBF. At Butalejja,
policymakers from the chief's office participated in a dialogue with education, health,
production, cultural, and religious leaders and teachers, students, and media experts.

The GFAN Torch Caravan has gained momentum since leaving South Africa in July and now spans five regions and includes 15 African countries in Africa. Southern Africa – South Africa, Zimbabwe, and Malawi East Africa – Kenya, Uganda, Ethiopia, Tanzania, Burundi, Rwanda Central Africa – DRC, Cameroon, Niger, West Africa – Senegal, Burkina Faso (Current holder) —– Nigeria, Ghana (October)
The Torch will be in West Africa during October and be received in the MENA region – Morocco, Tunisia, Egypt, in November. The engagements among key stakeholders have been remarkable with interactions from:

● MoH (Permanent Secretary) – Kenya, Uganda, Ethiopia, Malawi
● Ministers’ of Health – Uganda (Health and Finance), Ethiopia, Malawi, Rwanda, DRC
● Country Coordinating Mechanism (CCM)

WACI Health, the GFAN Africa secretariat is encouraged to see that every participating country included their CCM in receiving and handing over the Torch. Despite language barriers, political unrest, and the effects of the COVID-19 pandemic, the Torch Caravan has traversed the continent. It is impossible to suppress the enthusiasm and appreciation shown during this journey of gratitude and hope. As a result, the campaign has enjoyed traditional and social media coverage, which has raised awareness. In addition, the Torch Caravan united communities from all walks of life in celebration and acknowledgement of the impact. Through parliamentary engagement, there is an increase in political will for the GF@20 campaign and strong collaboration as we work together towards the 7 th Replenishment. In addition, working with partners and stakeholders such as the British High Commission, TB HIV care, Malaria No More has built
stronger partnerships and collaborative efforts. The campaign strengthened partnerships between civil society, making it easier for them to collaborate in-country. A special highlight was when the Torch was received by Burkina Faso’s first-ever Olympic Champion, Hugues Fabrice Zango.

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The celebrations will continue with cake cutting, dancing and hope until the Cape to Cairo Torch caravan campaign will culminate on 8 December 2021 in Durban, South Africa, alongside ICASA 2021.

In September 2021, WACI Health led a team of young women on a dialogue on women-initiated HIV prevention options and Sexual Reproductive Health Rights (SRHR). Globally, these discussions are ongoing given the approval by WHO in July 2020, for the Dapivirine Vaginal Ring (DPV-VR) as an additional prevention choice for women at substantial risk of HIV infection as part of combination prevention approaches. Read more here. This news has since been considered a milestone in the quest to provide women with expanded choices for HIV prevention. Young women (aged 15-24), and adolescent girls (aged 10-19) in particular, account for a disproportionate number of new HIV infections. In sub-Saharan Africa, despite making up just 10% of the population, one out of every five new HIV infections happens among Adolescent Girls and Young Women (AGYW). In the worst-affected countries, 80% of new HIV infections
among adolescents are among girls, who are up to eight times more likely to be living with HIV than adolescent boys. It is estimated that around 50 adolescent girls die every day from AIDS- related illnesses. Dapivirine Vaginal Ring is intended for prevention of New HIV infection via vaginal sex in HIV Negative women 18 years and older. The Vaginal Dapivirine ring contains an antiretroviral drug
called Dapivirine which is released slowly over the course of one month directly to vaginal tissues to help protect against HIV at the site of potential infection. Little of the drug is absorbed elsewhere in the body resulting in low systemic uptake. There are studies underway
examining the safety of a combined Dapivirine-levonorgestrel ring that would protect against HIV infection and unwanted pregnancy, as well as different vaginal rings that combine antiretroviral and other medications to prevent STIs. “Unlike other HIV prevention methods like use of condoms, this female controlled innovation gives full control to women to look after their safety,” she says. Biological and social factors contribute to high rates of infections among women. “The high number of infections among women does not mean they have riskier sexual behaviors compared to men” Gloria Mululu, Program Officer WACI Health The Dapivirine Ring (DVR) in Kenya and many other countries in sub-Saharan Africa, initiative by advocates are ongoing thus calling for updating of ARV guidelines and Essential Medicines List to include Dapivirine Ring as other Regulatory national processes and approval are ongoing to
ensure access. The ring has currently been approved for use in Zimbabwe. This dialogue meeting resolved to have a campaign that looks at holistic needs of adolescent girls and Young Women’s HIV prevention and SRHR, Multipurpose HIV prevention, Protection of AGYW against Gender-based violence (GBV), and Inclusivity of women in all their diversities. “While a lot has been done to curb new HIV infections in the country, all stakeholders should move in and address the barriers to access HIV prevention options/tools by Adolescents, Girls and Young Women and be allowed to make a choice on which methods work for them. Dapivirine Ring is a game changer in women’s HIV prevention options. AGYW needs training as champions to lead on advocacy efforts towards country policy update and regulatory initiatives towards Dapivirine Ring access” Patricia Jeckoniah, Technical Advisor, Policy and Partnerships, LVCT. The vaginal ring is a complimentary prevention method in addition to other safe sex practices especially when women cannot access or use PrEP. It does not prevent infection from other sexually transmitted diseases or from pregnancy. “Four decades since the outbreak of HIV, the country has registered great strides in efforts to combat the virus. However, not much progress has been made around adolescents and young women, and time has come where scientists must include this demography as they develop HIV preventive methodologies. This subset is privy to Sexual Gender Based Violence (SGBV), and the young women movement must be well coordinated so that they are present in all spaces where their voices must be heard. They should be given opportunities to share their ideas about HIV mitigation, dealing with intimate partner violence amongst other issues related to SGBV. Further, the movement must ensure that girls are at the table every time their issues are being discussed, be ready to be mentored and ready to mentor other girls, especially in the rural communities. They must also be part of the research so that there is their representation in data gathering.” Faith FAO. Calling for safeguarding of the gains made in the fight against HIV new infections as we fight Covid 19, there is a need to invest around girls. There is a need to invest in capacity building, programs, exposure and money available to ensure that organizations can conduct their
activities. There is also a need to see how resources that are coming in are targeted to adolescent and young women programs towards building their capacity.

“For most adolescent girls and young
women, the availability of the ring
widens the pool of preventative options
to choose from. Young women are
diverse and have varied preferences.
The ring will improve the uptake and
access of HIV prevention products,”
Joyce Ouma, AVAC Fellow.

With- Me, in- me is an AGYW led campaign demanding expanded choice for HIV prevention for
AGYW and Sexual Reproductive health and Right (SRHR), Multipurpose HIV prevention tools,
protection against Gender-based violence (GBV), and Inclusivity of women in all their
diversities. The campaigns highlight challenges as faced by AGYW living with and impacted by
HIV and enhance the awareness among Health providers, policymakers, and youth-serving
organizations about the existing disparities.
“The greatest aspect about the Ring is its bodily autonomy. Nobody needs to know you are
using it hence giving you the power to be in charge of your own protection. This is a plus for
every woman and especially if you have started to develop trust issues with your sex partner”
Joyce Ng’ang’a, Policy advisor WACI Health.
For more information check this Reading Material

In addition to the many resources mobilized in response to COVID19, it is essential not to overlook other pandemics that still have a great and lasting effect and on which equally important and lifesaving work has been concentrated. A recent seminar series called Life Sciences Across the Globe focused on global experts discussing how to advance life sciences. World-renowned HIV researchers were among those presenting.

The Institute of Infectious Disease and Molecular Medicine (IDM) at the University of Cape Town (UCT) held its monthly seminar on 4 August. The series is a collaboration between the Howard Hughes Medical Institute and Janelia Research Campus.

The IDM’s Education Committee chair, Associate Professor JoAnn Passmore, emphasized the institute’s focus on diseases relevant to Africa and its commitment to training the next generation of African scientists.

“The world currently has more than 40 million [people] living with HIV, many of whom live in sub-Saharan Africa. HIV researchers have been focusing on the endgame: a cure for HIV. 

Strategies towards a cure

Sharon Lewin is a physician and basic scientist who specializes in infectious diseases. Lewin is the inaugural director of The Peter Doherty Institute for Infection and Immunity, a joint venture between the University of Melbourne and Royal Melbourne Hospital in Australia. In addition to developing clinical trials to develop a cure for HIV, she conducts research to understand why HIV persists despite treatment.

The goal of reaching 95% of people living with HIV on treatment by 2025 is a challenging one, given that 1.8 million new infections occur annually in the world.

Due to antiretroviral therapy, the face of HIV has changed dramatically. With a daily dose of one tablet, antiretroviral therapy is now more straightforward. Additionally, treatment is relatively cheap, mostly accessible, nontoxic, and available to at least 70% of the world’s population.

“People will have to inject themselves every other month just to keep their virus under control with new advances in antiretroviral therapy. Since antiretroviral therapy isn’t perfect, we need a cure,” she said.

HIV testing is a core strategy in HIV prevention. A person who tests positive and begins treatment gradually becomes less infectious. We are treating it as we prevent it.

Destigmatizing testing is key – HIV testing and COVID19 testing are two very different things. We need to normalize testing since people don’t like to get tested for many reasons. In contrast, testing people frequently, with their consent, and starting treatment [early] is very effective. Those actions have led to reductions in HIV over time.”

Bringing it home

Thumbi Ndung’u is a professor of infectious diseases and the Max Planck group leader at Africa Health Research Institute. The Females Rising through Education, Support, and Health (FRESH) cohort is under his care. FRESH aims to empower young women through the programme and to encourage participation and feedback in a bidirectional manner.

Ndung’u noted that the highest HIV prevalence is in KwaZuluNatal. According to Dr. Emily Wong’s research published in Lancet Global Health this year, 36% of males and 60% of females aged 25 to 44 are HIV positive.

“As someone living in a resource-limited environment, the most exciting approaches revolve around early diagnosis and early immune therapy and these approaches are probably more likely to be implemented in these settings,” said Ndung’u. “There’s also evidence that this is achievable. So combination approaches will likely form the first line of HIV cure strategies.

“We have a history where we have seen that developing interventions by themselves is not enough. Instead, we need to make sure that interventions are tailored to the communities that will benefit from them.”

Hope and healing

Over the past 30 years, of the 78 million people who have been infected with HIV, 39 million have died of it.

The evolution of the virus and the eras of despair, hope, and most recently, the hope that a cure might be in sight.

“The cure for HIV will come. We’ve got to be optimistic. We’ve got to believe.”

There are a variety of barriers that can make it difficult to continue treatment, continue at scale, and continue well. Politics, discrimination, stigma, accessibility, and specific regulations are some of these barriers. This epidemic is far from over.

Working with community advisory boards and including those served in terms of education is crucial to ensuring that the community has a voice.

“The best science is relevant science. Relevance asks, ‘What is the priority?’ Science then asks the right question. If asked and listened to, the community frames the context. And together, the community and science can find the right answer.”

The Torch Caravan, an initiative of the Global Fund@20, spreads light and hope throughout Africa.  In addition to passing the torch, eight countries reflected on the Global Fund’s impact on reducing disease burdens and building sustainable systems for health care. 

The highest level of participation has been achieved by civil society organizations, parliamentarians, and people dealing with the disease themselves. The Global Fund changed the narrative because before it came if someone had HIV, they would waste away and die. But since then, people have a new perspective.”   Maurine Murenga, Lean on Me Foundation, Kenya

There is much excitement and gratitude expressed by various countries. The Central African Region will receive the torch in September from the East African Region.

Peter Sands, Executive Director, the Global Fund: “We celebrate the people, the partners, the advocates and the communities who have led to this remarkable success.”

While providing supply support for the COVID-19 response to support overstretched healthcare systems and community health networks, Global Fund works tirelessly to protect lifesaving AIDS, tuberculosis and malaria programs. We are stronger when we work together. 

Several health services have been negatively affected by COVID-19 outbreaks, partly due to overburdened systems. In low- and middle-income countries with high rates of HIV, tuberculosis, and malaria, disrupted services could result in premature deaths over the next five years.

During the largest epidemic in history, the WHO has warned against diverting funds from programs fighting HIV, TB, and malaria. Despite this, USD 1.7 billion is being diverted from health into security because of the Covid outbreak. This is equivalent to the amount needed to treat all three diseases over two years.

In light of rising COVID-19 mortality rates worldwide, it has become increasingly evident that vulnerable populations are disproportionately affected. Vulnerable people include those who live in densely populated areas, those with low socioeconomic status, migrants, and minorities. There are higher rates of comorbid chronic conditions in these groups, placing them at higher risk for infections and severe disease consequences.  

Services to prevent disease (voluntary medical male circumcision, pre-exposure prophylaxis, long-lasting insecticide-treated nets [LLINs], and seasonal malaria prevention) have been suspended or reduced; ongoing treatment (for HIV and tuberculosis) and new acute treatment (for malaria) have been cut by 25 to 50 per cent during peak demand periods, as well as treatment for those newly seeking care (HIV or tuberculosis testing and treatment). 

The Xpert MTB/Rif molecular diagnostic tool, intended to diagnose tuberculosis accurately, was potentially repurposed for COVID-19 diagnosis, further driving down diagnosis and treatment rates for tuberculosis. 

HIV experts and communities have often stepped up and provided support during the worst of the crisis. The worldwide response has drawn on decades of experience in combating AIDS. Globally, many countries responded quickly, addressing vulnerabilities, maintaining health services, and creating synergies between AIDS control and COVID-19. By doing so, HIV and COVID-19 threats are dealt with simultaneously.

Despite a decline of 23% in HIV-new infections since 2010, the COVID-19 pandemic may reverse this trend, and populations already behind may fall further behind. Recovery programs are therefore essential for areas with high HIV rates, as are programs for tuberculosis and malaria to reduce the health impact of the COVID-19 pandemic.

Priorities for reducing the effects of COVID-19 include maintaining services such as HIV and tuberculosis treatment (for new and existing patients), malaria prophylactic treatment, and LLIN distribution.

As a result of social distancing measures instituted by COVID-19, it is estimated that HIV transmission and tuberculosis transmission would be reduced by 10%.

Insufficient national and global investments in pandemic readiness are exposed by the recent HIV and COVID-19 pandemics and their responses. Health systems will need to be more resilient in the long run in order to handle shock events such as pandemics.

Together with HIV, TB and Malaria, COVID-19 should build synergies to make sure that they increase access to services, decrease the risk of infection and disease, and impact programme outcomes.