Agenda 4: Follow-up on the Thematic Segment from the 38th PCB
By Musah Lumumba
The world is at a critical moment in the history of the AIDS epidemic and the HIV response. We have a four-year window of opportunity that represents a make-or-break moment to end the AIDS epidemic by 2020.
We were the first, as Communities to respond to the epidemic three decades ago and have since taken a myriad of actions to help people access HIV services as well as adding a human face to the response in our diversity.
Sex workers, transgender people, people living with HIV and other groups have become researchers, producing data for key global stakeholders such as the World Health Organisation (WHO). A new funding scheme in Ethiopia and Tanzania from international NGO Comunità Volontari per il Mondo has enabled people living with HIV to train nearly 4000 government officials and community leaders on the realities facing key populations.
We can continue therefore to document that community responses work, not only because they are cost efficient but also because they actually result in good health outcomes. In some cases they were the first to deliver HIV services to key population groups before state facilities. For instance In Mali, before the government launched its own programme, antiretrovirals were first brought into the country through community organization, In South Africa, AIDS treatment activists conducted ground-breaking work in advocacy, community mobilization and litigation to increase access to care and treatment across the continent, in Uganda, TASO (the AIDS Support Organization, was the first to organize PLHIV into support groups through which they are enrolled into HIV care and treatment.
With the increasing understanding of the decline in HIV global HIV financing landscape despite the increase in number of people who rely on community led HIV service delivery, plausible models for delivering funding to grassroot communities of women, PLHIV, young people and key populations should be the people who are on the driver seat of the fast track.
Mr. Chair; A huge difference between estimated needs and actual spending on community led responses, continues to undermine our efforts. In order to make significant progress therefore, the investments to enable the end of AIDS by 2030 need not only be definitively earmarked but be increased and front-loaded during the next four years. And we need strong indicators in the 2017 Global AIDS Monitoring Framework to be able to track these investments, particularly the 30% of all service delivery that must go to communities, and 6% of the overall AIDS funding that must go to social enablers such as advocacy and community mobilization.
However, unless we enable continuation of an impactful community led response, young people, women, girls, drug users, sex workers and other key populations’ access to comprehensive HIV services including their social protection will be undermined. For instance when the Global Fund withdrew from Romania in 2010 after the country had gained middle-income status, this created a financial gap for the community led response, which led to a drastic increase in HIV cases, specifically in key populations. Among people who inject drugs, new HIV infections rose from 3% in 2010 to 29% in 2013. Much of this increase is linked to the lack of funds to provide targeted prevention interventions for people who inject drugs.
Worse still, targeting key affected populations in challenging situations e.g escalating levels of stigma and discrimination, criminalization among others create barriers and disincentives for them to access services, and more broadly propagate distrust and drive key populations underground and to the margins of society. This underscores the need to completely rely upon grass root networks of young people, women, girls, sex workers, transgender and other key populations, to provide data on these groups, with large variations in data collection.
The story, which the Joint Program tells well of “How AIDS Changed Everything,” is a story of international solidarity anchored on a strong pillar, a community led response, where communities have invested their efforts to reach key populations with services that meet their needs and as such, continued scale-up of a fully funded community led response, is critical to ending the epidemic.