Screening: the cornerstone of the fight against HIV
From 17 to 21 November 2025, the International Testing Week (ITW) took place— a global screening initiative launched and coordinated by Coalition PLUS, now in its sixth year, aimed at identifying people living with HIV, sexually transmitted infections (STIs), and screening for related or at-risk cancers such as cervical or anal cancer. The week forms part of the activities of the Accès Santé 2 project, which we support, and which works to improve access to sexual health services for key populations and for women. Let’s take a closer look at Bujumbura, Burundi’s economic capital, to follow the associations involved in the event and members of the Coalition PLUS platform, a long-standing partner of L’Initiative.
Providing access to care and testing for populations deprived of it
The visit began at the Turiho Center (“we are alive” in Kirundi), the first facility in Bujumbura to provide care and testing for people living with HIV (PLHIV), and which today follows more than 3,000 patients. This represents 50% of the entire active caseload of the National Association for the Support of Seropositive Persons and people living with AIDS (ANSS santé PLUS) — also supported by L’Initiative through the Success project, which focuses on cervical cancer prevention — whose activities we observed. On average, 120 people visit this welcoming and respectful space each day, with numbers rising to over 300 during the International Testing Week.
Some populations are particularly exposed to risk and are further marginalized or even criminalized for their practices or sexual orientation. For them, accessing healthcare without fear of denunciation is exceptional. This is notably the case for men who have sex with men (MSM), sex workers (SW), and people who inject drugs (PWID), who are 30 times more affected by HIV than the general population.
The community-based association BAPUD (Burundi Association of People Who Used Drugs), a partner of ITW, is dedicated to the latter group, offering services including opioid substitution therapy (OST). While 150 PWID currently benefit from this support, human needs collide with financial constraints: the waiting list already includes more than 300 additional people. The NGO Society for Women and AIDS in Africa (SWAA) — affiliated with a pan-African movement of women fighting HIV/AIDS — operates six antiretroviral therapy (ART) clinics and eight community sites, with a national active caseload of 4,200 PLHIV.
In recent years, associations have had no choice but to drastically scale back their health services in Burundi, particularly due to budget cuts following the closure of the U.S. PEPFAR program and the end of USAID funding. Yet their work remains essential in this country of 12 million people which, despite significant progress, still has one person living with HIV out of every hundred, and a 12% rate of mother-to-child transmission (though none has been recorded at the Turiho Center in nearly seven years).
Beyond screening, ITW mobilizes efforts around prevention and holistic support, not only for PLHIV but also for vulnerable patients. In 2024, 76 associations from 46 countries participated in the event, collectively testing nearly 85,000 people. Among them: 29% were sex workers, 23% men who have sex with men, 7.5% migrants, 5.5% PWID, and 3.8% incarcerated individuals. Of those who tested HIV-positive, 73% were referred to appropriate care structures.
Highlighting the effectiveness of community-based care
Within partner associations that make ITW a success, peer educators — trusted actors within hard-to-reach communities and part of those very communities themselves — maintain fragile links that sometimes hang by a thread due to insufficient resources.
As key contributors to community-based health services, they provide confidential and secure testing in a welcoming, non-judgmental environment. By multiplying access points — health centers, outreach activities, and self-testing — community-based action promotes early detection of STIs including HIV, hepatitis, and precancerous lesions. This represents a critical preventive measure, as women living with HIV are six times more likely to develop cervical cancer. Thanks to peer educators, beneficiaries receive appropriate care, helping to reduce transmission.
Mental health is also integrated into the care offer, with psychosocial support aimed at tackling isolation and discrimination. Stigma — which manifests as psychological and physical violence — has genuine health consequences. Billy, a young PLHIV activist from the Grandir Ensemble network, is a witness to this reality. His HIV status was only disclosed to him as a teenager, and he kept it secret until beginning university. He then committed himself to preventing others from facing the same stigma, becoming a peer educator to encourage testing and support young people learning about their HIV status.
La Maison de la joie, meanwhile, shelters children orphaned by AIDS who are themselves living with HIV — such as Prince, born to a mother who was a sex worker. The association provides structure, access to medication, and a community built on solidarity and sharing for children who might otherwise face marginalization and life-threatening conditions. It gives them a future.
This approach, centered on community health as an essential complement to traditional health systems, lies at the heart of Coalition PLUS’s work. It is also the guiding objective of Access Health 2, which aims to strengthen community health system capacities and to influence public health policy by fully recognizing the role of peer education.
For this reason, the network strongly invests in advocacy for better access to care (availability of supplies, testing, and treatment). To this end, evidence from their activities is analyzed and shared to mobilize opinion leaders, decision-makers, health professionals, and institutional partners in the fight against HIV.
Shifting the perspective: screening as a cost-effective choice
Reduced development aid contributions are being felt across many low- and middle-income countries. A recent blow came from the latest replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which raised less funding than expected and now must scale back its support for the coming three-year cycle.
Testing centers are closing, vital services are interrupted, and health workers — including peer educators — are losing their jobs. Behind these statistics lie human lives. People already among the most vulnerable are stripped of essential care and protection. Such discrimination and service cuts pave the way for pandemics that know no borders.
Yet efforts such as those of ITW — much like the Access Health 2 project — in testing, treatment adherence, recovery where possible, and promoting positive health behaviors, consistently deliver compelling measurable results. Reduced infections, morbidity, and mortality, along with improved quality of life, all demonstrate the effectiveness of investments in global health.
Financing a comprehensive, accessible, and equitable care offer for all — including community-based services to reach the most exposed populations — is not an expense but a cost-effective choice. It is an investment that enables earlier diagnosis, reduces transmission, and alleviates pressure on health systems. In both the Global South and the Global North, investing in health means saving by prioritizing prevention rather than emergency response.
Read the 2024 ITW Impact Report
Discover the data behind the International Testing Week (ITW), coordinated by Coalition PLUS. Each year in November, this week intensifies the health initiatives carried out throughout the year.
Photos of the report : © Benjamin Girette for Coalition PLUS
