The NGO Delegation's Communique for the 45th UNAIDS PCB Meeting

The NGO Delegation's Communique for the 45th UNAIDS PCB Meeting is already out. The Communique contains the following sections: Report of the Executive Director; Report by the NGO representative; Annual progress report on HIV prevention 2020; Report on progress on actions to reduce stigma and discrimination in all its forms; Report of the Joint Inspection Unit on the management and administration review of UNAIDS; Lessons learned on the nomination process of UNAIDS Executive Director; Evaluation Plan; Election of officers; Thematic Segment - Reducing the impact of AIDS on children and youth

You may download a PDF version of the Communique (with photos from the PCB Meeting) here.

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CHAPEAU

Alexander Pastoors, Europe Delegate

The 45th meeting of the Programme Coordinating Board (PCB) took place in calmer waters than the previous meetings of the board. The venue was, as usual, the Executive Boardroom of the World Health Organization (WHO) in Geneva, Switzerland and the meeting was held from December 10 -12, 2019. It was the first meeting of the newly appointed third UNAIDS Executive Director in the history of the Joint Programme, and the first woman to hold that position, Ms. Winnie Byanyima from Uganda. The meeting was chaired by Ms. Li Cui from China.

Winnie’s report to the board was generally well-received, including by the NGO Delegation. Yet, as the current UNAIDS Strategy nears its expiration date in 2021, her report initiated a debate among members of the board about a possible next UNAIDS Strategy and the process involved. This discussion was closely linked with the agenda item that reflected on the report of the Joint Inspection Unit (JIU).

Just as in previous years, the first two days of the PCB discussed the report by the NGO Delegation and several other more policy and programme-driven items such as prevention, barriers to funding of community-led responses, and the Global Partnership for action to eliminate all forms of HIV-related stigma and discrimination. The third day of the meeting focused on the Thematic segment to inform the members of the PCB about possible actions to reduce the impact of AIDS on children and youth.

AGENDA 1.3: REPORT OF THE EXECUTIVE DIRECTOR

Jonathan Gunthorp, Africa Delegate

Winnie Byanyima, in her first report to the PCB as Executive Director, made a focused, strong, and rights-based Executive Director’s report with her vision for UNAIDS, and what needs to be done to achieve that vision.

The Delegation welcomed her appointment and responded with the following points:

What we must do to succeed:

• Recognize that the current strategies and tools for the response are currently insufficient and must be changed, quickly
• Reorient our health systems to cope with the coming decades of treatment
• Put people living with HIV, sex workers, LGBTI people, people who use drugs, women, and young people at the centre of our ‘people-centred’ approaches
• Stare our multiple failures in prevention in the face, invest for success, and turn these around with speed
• Use the 2030 Agenda as an opportunity to address the political, social, economic, and commercial determinants of health, and the structural barriers that continue to lead to inequalities, violence, stigma, and discrimination.

Who we must be and how we must organise:

• Take up the new ED’s feminist approach, implement it internally, as well as externally
• Recruit for a younger Secretariat to serve young people in the response
• Keep and promote UNAIDS staff who live out a vision of a rights-based response

AGENDA 1.4: REPORT BY THE NGO REPRESENTATIVE

Jules Kim, Asia and the Pacific Delegate

This year, the report from the NGO Delegation was titled, “If It Is To Be Truly Universal: Why Universal Health Coverage Will Not Succeed Without People Living with HIV and Other Key Populations, Women and Young People.” Despite there having been a thematic session on UHC in June and a High Level Meeting on UHC resulting in a Political Declaration, the NGO Delegation felt it was crucial to highlight what people living with HIV, key populations, women, and young people could bring to UHC. The successes of the community-led HIV response in reaching the most marginalised was an important lesson for UHC if it is to be truly effective for all.

The Report was presented by the Asia Pacific NGO Delegate and was grouped into six key contributions that people living with HIV, key populations, women and young people and their organisations and networks, could make to UHC. Examples of the vital contributions were taken from numerous interviews, case studies, literature reviews, and focus group discussions conducted by the Delegation to highlight within the report, providing conclusive evidence as to why UHC cannot succeed without us, communities at its centre.

Many Member States, Cosponsors, and civil society observers spoke strongly in recognition of the critical role of these communities and the need for these to be incorporated into UHC. The Decision Points (DPs) from the NGO Report did go to a drafting room, as consensus could not be reached on the floor. However, agreement was reached fairly swiftly and importantly, the vital aspects of the DPs were agreed upon. These included DPs recalled from previous PCB meetings and recognition of the need to address structural, economic, and social drivers of the AIDS epidemic in advancing broader global health goals. Of special note were new DPs that requested the Joint Programme to continue supporting Member States in creating an enabling environment for people living with HIV and other key populations, women and young people by addressing and overcoming relevant economic, social, structural, and regulatory barriers – including stigma, discrimination and criminalization and a DP that called on the UNAIDS Joint Programme to continue supporting Member States in ensuring all the elements of comprehensive HIV programming, as set out in the UNAIDS Strategy (2016-2021), remain or become available and accessible to people living with HIV and other key populations, women and young people under UHC frameworks and policies.

AGENDA 3: ANNUAL PROGRESS REPORT ON HIV PREVENTION 2020

Aditia Taslim Lim, Asia and the Pacific Delegate

The NGO Delegation was extremely concerned with this agenda item, as it seemed to be a repeat of the discussions at the 40th PCB Thematic Segment on HIV Prevention 2020 in June 2017, and its follow-up discussion at the 41st PCB meeting in December 2017. The data from the report shows significant reduction in HIV prevention since 2010, but if examined closely, the annual trend is still very similar, and in some countries, new infections have increased. Some examples that we can pull out from the data is South Africa which had 39% decrease since 2010, but with only 10-11% decrease every year since 2015. Indonesia was reported to have 29% decrease since 2010, but with only less than 10% decrease every year since 2015. Uganda had a 36% decrease since 2010, but only had a 4% decrease in 2017 and an increase of 6% in 2018.

The Global HIV Prevention Coalition was formed in 2017 to accelerate prevention efforts and to galvanize political commitment among its member countries. Despite all the progress made towards its roadmap implementation, countries are still not doing enough to reduce infections. In some instances, they have even regressed. Member States argue that it requires time for the Coalition to make an impact. However, the NGO Delegation reminded the PCB that communities of key and most affected populations do not have the luxury of time. We need to ensure that the promised 25% investment for prevention is fulfilled, condoms for both male and female must be made available and accessible, harm reduction services must be funded, PrEP must be scaled up, and vertical transmission must be eliminated, now!

This is business as usual wrapped in a different ambition. UNAIDS and Member States need to stop pretending that they are doing something different, when they are caught doing exactly the same thing.

AGENDA 6: REPORT ON PROGRESS ON ACTIONS TO REDUCE STIGMA AND DISCRIMINATION IN ALL ITS FORMS

Alessandra Nilo, Latin America and the Caribbean Delegate

We welcomed the results of the report, “Update on actions to reduce stigma and discrimination in all its forms.” This agenda item was a special moment for us, since the Global Partnership resulted from an idea proposed by the PCB NGO Delegation at the 41st PCB meeting in December 2017.

We thanked the support from all co-conveners -- UNWomen, UNAIDS, GNP+, and UNDP -- but we expressed deep concerns about the challenges before us. Fighting stigma and discrimination is clearly an urgent necessity in all countries, including those with structured AIDS responses in place. As example, we mentioned the recent results of the Stigma Index in Brazil, of which 64% of respondents suffered HIV-related stigma and/or discrimination.

This Partnership is a timely opportunity, but global political declarations or commitments will continue to be inefficient if followed by almost zero budgets, including for responses or approaches that address human-rights issues in the AIDS responses.

It is regretable that our communities are losing faith in public policies, but we expressed hope that this Partnership won't be one of many initiatives that UNAIDS begins without concluding. We demand that it should be given all the human and financial support required in order to support Member States to address structural barriers that keep stigma and discrimination among the most perverse symptoms of AIDS.

AGENDA 7: REPORT OF THE JOINT INSPECTION UNIT ON THE MANAGEMENT AND ADMINISTRATION REVIEW OF UNAIDS

Alexander Pastoors, Europe Delegate

The Joint Inspection Unit (JIU) is the only independent external oversight body of the United Nations system mandated to conduct evaluations, inspections and investigations system-wide. In its reportthe JIU reviewed the management and administration of the Joint Programme, specifically the UNAIDS secretariat and its relation with the Cosponsors, as well as the role of the PCB regarding oversight and accountability. The inspection and evaluation started in 2018 and were temporarily halted during the time that the Independent Expert Panel (IEP) did its investigation regarding prevention of and response to harassment, including sexual harassment, bullying and abuse of power at UNAIDS Secretariat.

The extensive evaluation and inspection by the JIU culminated in a number of formal and informal recommendations to the UNAIDS secretariat, the PCB and to the Cosponsors. The progress on the eight formal recommendations will be monitored by the JIU, but the twenty-five informal recommendations will not be monitored. It came as no surprise that the discussions among the Member States with regards to the JIU report were largely focused on the recommendation to strengthen oversight and accountability by the PCB of the Secretariat and specifically, human resource management, much like the discussions at the 43rd and 44th PCB meetings. As this is the fourth JIU report in a row pointing out the structural lack of oversight by the PCB, this necessitated being addressed by the PCB and could no longer be brushed aside. The issue at stake here is to find a balance between keeping the structure of the Joint Programme agile and flexible while strengthening oversight by the PCB, in order to ensure that donor countries keep faith in the organisation.

That was also the position the NGO Delegation brought forward in the negotiations that took place in the drafting room. The PCB resolved to create a time-limited working group that will develop recommendations (options) to the PCB on how to establish better oversight. The NGO Delegation will be represented in this working group, which will report back at the 47th PCB meeting in December 2020. Meanwhile, a stand-alone agenda item for Secretariat to inform the PCB on internal and external audits, ethics, and other topics on accountability, will be included in future meetings.

AGENDA 8: LESSONS LEARNED ON THE NOMINATION PROCESS OF UNAIDS EXECUTIVE DIRECTOR

Alessandra Nilo, Latin America and the Caribbean Delegate

In 2019, the NGO Delegation engaged in the process of finding a new Executive Director for UNAIDS through its membership in the Search Committee. The report that was presented in this Agenda item was a synthesis of the work done and lessons learned by the Search Committee, which included two of our NGO delegates, Alessandra Nilo (LAC) and Jonathan Gunthorp (Africa), whom we thank for their dedication.

One of the existing rules of the ED selection is that the PCB does not have a say in the final recommendation or decision. The candidates who are shortlisted by the Search Committee are considered at some extent by the PCB, but it is the Cosponsors who will give the final recommendation to the UN Secretary General, who then appoints the Executive Director. At the 45th PCB meeting, the possibility of changing this rule was raised. However, the idea had little support from other Member States and after some consideration, the process remained the same. The NGO Delegation is thankful to the entire Search Committee and its chair, the Republic of Belarus, for seeing this selection process through.

AGENDA 9: EVALUATION PLAN

Andrew Spieldenner, North America Delegate

The Evaluation Unit at UNAIDS emerged out of the need to assess how well the Joint Programme is working where, and to assess what other kinds of data are needed. UNAIDS has had inconsistent evaluation activities over its lifetime, and this was the first reportsince the Evaluation Unit was approved at the 44th PCB meeting in June 2019. Evaluation is a staple of many public health and HIV programs, but large international or intergovernmental organizations are often not under the same pressure to produce data to funders as our NGOs.

Some Member States questioned the Evaluation Unit in terms of their budget and how they do their work. While oversight is expected and required, it seems short-sighted to constantly question the processes until findings are presented. The NGO Delegation interventions on this item looked at the importance of effective evaluation for key populations, as well as support for evaluating the impact of the Joint Programme on Gender-Based Violence.

Preliminary findings showed some strengths and some gaps in the Joint Programme. The strengths include UNAIDS impact regionally in terms of policies and guiding HIV responses, as well as the importance of direct funding. Some gaps include coordination across Cosponsors and the impact of policies in-country. This kind of data can help UNAIDS reflect on how it does its work, correct where the work can be improved, and enhance and sustain the work that is going well.

AGENDA 11: ELECTION OF OFFICERS

Aditia Taslim Lim, Asia and the Pacific Delegate

At this PCB meeting, several changes to the composition of the Board were announced. This include the composition of the 22 Member States, the chair of the Committee of Cosponsoring Organizations (CCO), the NGO Delegation, and the PCB Bureau.

Member States Composition Changes:

Full composition of Member States

The 2020 Chair of CCO: United Nations Development Programmes (UNDP)

NGO Delegation: Latin America and the Carribean: Bolivian Network of People Living with HIV/AIDS, represented by Gracia Violeta Ross Quiroga and the Jamaican Network of Seropositives represented by Jumoke Patrick; Europe: Eurasian Key Populations Health Network represented by Caren Badalyan.

PCB Bureau (2020): United States of America (Chair), Namibia (Vice Chair), India (Rapporteur), UNDP (CCO Chair) and NGO Delegation (Andrew Spieldenner, main representative; Jonathan Gunthorp, alternate representative).

AGENDA 12: THEMATIC SEGMENT – REDUCING THE IMPACT OF AIDS ON CHILDREN AND YOUTH

Lucy Wanjiku Njenga, Africa Delegate

The 45th PCB Thematic Segment on Reducing the Impact of AIDS on Children and Youth was deemed successful, as it brought together different voices from various fields that needed to be heard. The most notable and applauded sessions were the Keynote speech and the presentations and speeches of all the young people in the three panel sessions. They brought out the lived experiences and realities that needed to be heard by Member States, the Cosponsors and UNAIDS, as the review of prevention, treatment, and care given to children and youth takes shape in the 2020 and 2030 targets. We know the world is failing on the ambitious HIV targets for them.

From the discussions that happened in the room, the next steps that needed to take place were clear. To list a few:

• Ensuring and sustaining the meaningful involvement of adolescent and youth in HIV Programming from design, implementation to monitoring and evaluation
• The need to scale up children-friendly antiretroviral medication and Point of Care – Early Infant Diagnosis.
• Sustaining what has worked, like the DREAMS programme for prevention of new infections for girls and young women and engaging the whole circle of social influencers in their lives, as well as EGPAF, with mentor mothers.

REFLECTIONS FROM INCOMING DELEGATES

This was my first PCB meeting as the incoming Europe NGO Delegate, representing the Eurasian Key Populations Health Network. I am happy to be a part of a team of delegates from five regions, with outcomes-focused and equity-guided principles committed to improve pathways and policies that support UNAIDS and countries in the HIV/AIDS response.

It was very important and helpful for me to participate in the pre-PCB orientation meeting focused on addressing and understanding diversity between current, outgoing and incoming delegates and improving processes critical to delegates’ success, including retention and transition to a new role in the PCB NGO Delegation. I found my involvement process very effective since it began with a strong collaboration between Delegates and a supportive UNAIDS Secretariat. My fellow Delegates openly reflected on what they have learned and shared insights with new Delegates, passing on to us the knowledge they have acquired being PCB delegates. We should keep the tradition of organizing orientation meetings for future newcomers.

It was also very important to recognize our diversity within the group and map-out key roles and missions for each individual Delegate and for the full Delegation. My commitment is to bring the gender approach to the HIV/AIDS context and gender mainstreaming of UNAIDS work, as well as to use evidence-based data, research, and evaluation methods to improve policies, programs, and practices to enhance community participation and involvement in UNAIDS work at the national, regional and international levels.

- Caren Badalyan, Eurasian Key Populations Health Network, incoming Europe Delegate

Being present in the UNAIDS PCB after many years, I think the UNAIDS PCB looks much more organized and fit for its purpose. The NGO Delegation deserves my acknowledgement. When I was in the Delegation before (2007-2009), the Communication and Consultation Facility (CCF), the technical support provider for the NGO Delegation, did not yet exist. My colleagues and I presented and advocated for the CCF and I am very glad it got approval. I see the results of investing in communities and civil society.

For me, the best part of the 45th PCB Meeting was the Thematic Segment about the impact of AIDS in children and youth. The decrease of vertical transmission of HIV affected the functionality of the HIV pediatric market. For good reasons, we have less children born with HIV, but a small market looks less attractive for the pharmaceutical industry. The NGO Delegation in the PCB made sure this reality gets the recognition it deserves. Wake up, our children are dying! This is what we said.

I was impressed with the new Executive Director of UNAIDS, Winnie Byanyima, after the rocky period that UNAIDS just went through. I am confident that Winnie will take us through the next phase.

- Gracia Violeta Ross Quiroga, Bolivian Network of People Living with HIV/AIDS, incoming Latin America and the Caribbean Delegate

A Caribbean boy representing one of two Latin America and Caribbean Delegates at the UNAIDS PCB means a lot to him and those he has been representing, including communities affected by HIV in his work with civil society.

Attending my first PCB was an experience that allowed me to understand the UN system as it relates to governance and strategic decision-making regarding HIV/AIDs globally, and how systems of government and procedures are used to ensure that political will is in alignment with what is needed, e.g., human rights and protection of communities around the world.

I particularly took a keen interest in the thematic segment of the PCB meeting which focused on adolescents and young people, as this allowed for direct conversation and interaction with technocrats and community representatives who are on the ground working and advocating globally. This represented for me the core of what the response should look like and how it should continue as we push towards the fast track targets.

- Jumoke Patrick, The Jamaican Network of Seropositives, incoming Latin America and the Caribbean Delegate

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