The NGO Delegation's Communique for the 48th UNAIDS PCB Meeting is already out. The Communique contains the following sections: Report of the Executive Director; Report by the Chair of the CCO; Organizational Oversight Reports; Unified Budget, Results and Accountability Framework (UBRAF) 2016-2021; Statement by the Representative of the UNAIDS Staff Association; Follow-up to the thematic segment of the 47th PCB meeting; Update on implementation of the HIV response for migrant and mobile populations; Thematic Segment: COVID-19 and HIV: sustaining HIV gains and building back better and fairer HIV responses

You may download the PDF version of the Communiqué (with photos from the virtual PCB meeting) here.

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Alexander Pastoors, Europe Delegate

The 48th UNAIDS Programme Coordinating Board (PCB) meeting, held between June 29 and July 2, was the fourth virtual PCB meeting (including the March 2021 2-day Special Session) due to the ongoing challenges of the COVID-19 crisis. The June PCB meeting focuses traditionally on internal housekeeping, with the bulk of the agenda filled with oversight reports on performance of the Joint Programme and management, as well as financial statements. This time, there were also other important topics, such as the zero draft of the next Unified Budget Results and Accountability Framework (UBRAF). This was timed right after the High Level Meeting on HIV and AIDS held last June 8-10 at the UN Headquarters in New York City.

The meeting was chaired by Namibia, using the Zoom platform with interpretation available in the six official UN languages. Given the experience with previous virtual meetings, the 48th PCB meeting was also reduced to three half-days followed by an additional day for the Thematic Segment. It was preceded by four themed pre-meetings between June 15 to 22, with an additional day to consult and discuss all decision points on the 25th of June, as well as virtual drafting rooms held on June 30 and July 1.

The virtual PCB meeting format continued to provide challenges and present inequities to participation, particularly for the NGO Delegation and CS observers. This proved to be ever so difficult in a changing political climate where, in the absence of face-to-face lobbying and consultations with delegations of Member states, finding consensus became almost impossible. The trend of trying to erase key and vulnerable populations and scientific evidence from being mentioned in official documents started last March during the negotiations for decision points accompanying the adoption of the new Global AIDS Strategy and was propelled to an unprecedented level of diplomatic sabotage by Member States with autocratic regimes. The unsuccessful adoption of the report from the March special session on the first day of the meeting proved to be a prelude for the rest of the PCB meeting, where these diplomatic acts of sabotage like those displayed during the HLM were continued. On the last day of the meeting, for the first time in the history of the Joint Programme, the members of the PCB had to vote to adopt the report of the previous meeting of the PCB.

We find it extremely troublesome to see a technical forum such as the PCB being subjected to political games that in the end hurt and marginalize the very people that UNAIDS needs to serve the most. As the communities most affected by the HIV epidemic, we will remain vigilant as ever.

Agenda 1.3: Report of the Executive Director

Dr. Karen Badalyan, Europe Delegate

In her report to the 48th PCB meeting, UNAIDS Executive Director Winnie Byanyima mentioned the profound impact of COVID-19 on each of the HIV/AIDS priority areas. Winnie’s report is an urgent call to action to tackle the acute and intersecting inequalities that are obstructing progress and to put communities at the forefront of the HIV response. She also emphasized the changes across laws, policies, social norms, and services that are required to get us back on track to reach the end of AIDS as a public health threat by 2030.

In previous PCB meetings, the PCB NGO Delegation raised the importance of granular and real-time data collection and analysis to improve the efficiency and impact of health system responses. In our intervention, we also mentioned that the effective and sustained political will is vital to the success of HIV/AIDS responses. In this report, Winnie mentioned efforts to ensure that no one is being left behind by strengthening the gathering of granular data, including subnational estimates in more countries.

Small but important steps are also being done towards inclusion of non-binary and more gender-sensitive approaches in UNAIDS work, e.g., in indicators development, intervention targeting, and reporting. The PCB NGO Delegation appreciates the ED report for mentioning such approaches and philosophy in UNAIDS overall vision.

Agenda 1.4: Report by the Chair of the CCO

Jonathan Gunthorp, Africa Delegate

Discussion around the CCO report acknowledged the 25-year contribution of Cosponsors to the Joint Programme, but perhaps did not engage critically enough in the weaknesses or failures of this period. The collective UN inability to win fundamentally needed services and rights for key communities in many regions of the globe needs as much reflection and attention as the substantial victories that have been won. It particularly needs that reflection now as a sizable minority of Member States channel significant resources into pushing back rights won, and denying in multilateral forums that key populations need rights, or services, or that they even exist. The confluence of a new Global AIDS Strategy, the 2021 Political Declaration of the HLM, and the concerted effort of a furious few Member States to bring a new cold war into the UN system, almost certainly means a new era in the global response that will require new tactics by all players, but in particular, careful strategizing of Cosponsors. Civil society will look to see smarter funding, bolder tactics, and braver advocacy for rights by Cosponsors at country levels.

On a different note, given the rising diversity and role of people on the move in the global HIV response, the NGO Delegation introduced the need to consider lobbying the International Organization for Migration (IOM) to apply as UNAIDS Cosponsor.

Agenda 3: Organizational Oversight Reports

Alexander Pastoors, Europe DelegateUnder agenda item 3, there were three organizational oversight reports presented and discussed. The reports from the internal and external auditors are standing items which are brought to the attention at every June PCB meeting. In addition to these reports, the first report from the ethics office was discussed, as requested by the PCB on its 45th meeting.

Although the reports from the external and internal auditors focus primarily on financial parameters of UNAIDS, both reports highlighted concerns with regards to low levels of trust between staff and senior management. This was reiterated in the first report from the ethics office.

The NGO Delegation acknowledged the fact that despite low levels of trust within the Secretariat, there were also substantial steps taken in transforming the organization into a workplace free of harassment and abuse of power. But cultural changes take time.

The NGO Delegation urged senior management to take the outcomes of the global staff survey as well as the survey of the UNAIDS Secretariat Staff Association seriously and to redouble the efforts to make UNAIDS a safe workplace for all of its staff in all their diversity.

Agenda item 4: Unified Budget, Results and Accountability Framework (UBRAF) 2016-2021

Charanjit Sharma, Asia and the Pacific Delegate

The June PCB meetings discuss the Unified Budget Results and Accountability Framework (UBRAF) reports, which include the performance and financial reports. UBRAF is the mechanism to monitor the progress of implementing the Joint Programme’s work. The performance reports include regional and country reports on fast track commitments; the accomplishments related to the eight Strategy Result Areas and Indicators Report (covering the previous Strategy 2016-2021); and, the organizational report involving the 11 Cosponsors of the Joint Programme. The reports reflected the critical impact of COVID-19 on the global HIV response in 2020 and the ways in which regional and country teams responded within the context of the pandemic.

With a new UBRAF being developed in consonance with the new Global AIDS Strategy, the NGO Delegation remains steadfast in its advocacy for the Joint Programme to not lose sight of the central role that people living with HIV and key populations face, especially in the context of competing global health priorities and resources. With many countries moving towards domestic financing, we note that much of this funding comes with restrictions, including for social enabling activities, human rights advocacy, and gender-sensitive/non-binary approaches activities. These circumstances clearly indicate shrinking spaces of civil society and more importantly, the shrinking of funding for community-led responses. We acknowledge the efforts of UNAIDS Secretariat, Cosponsors, and national health structures in the COVID-19 emergency response. We urge UNAIDS to address the dual pandemics with equal importance and resources allocation by not forgetting to put communities at the center of the response.

Agenda 7: Statement by the Representative of the UNAIDS Staff Association (USSA)

Andrew Spieldenner, North America Delegate

The Statement of the UNAIDS Secretariat Staff Association (USSA) has become a more central part of the PCB meetings. In prior years, the USSA statements have raised the flag on internal problems the staff face, as well as alert the PCB to grievous sexual harassment and bullying occurring in the organization. With the new leadership in 2020, the NGO Delegation had looked forward to a better workplace for our colleagues at UNAIDS. While the report at the 48th PCB Meeting showed that some elements have improved, there remains a lack of trust and a fear of reprisal between executive management and the staff. Staff felt unsure of their jobs and reported being stressed. We acknowledge that this situation is common during the COVID pandemic, that all of us are experiencing imbalance between life and work, that most of our organizations are on unsure ground.

The NGO Delegation recognizes the USSA as the representative voice of the staff. In our intervention, we asked for more transparency and respectful engagement between leadership and staff. In addition, we wanted to know more about the kinds of harassment still being experienced as the data was aggregated, as well as results of previous investigations.

Agenda 8: Follow-up to the thematic segment from the 47th PCB meeting

Violeta Ross, Latin America and the Caribbean Delegate

The Delegation’s work started with our participation in the Thematic Segment (Cervical Cancer and HIV – addressing linkages and common inequalities to save women’s lives) at the last 47th PCB meeting, in which we strongly advocated for the needs of women living with HIV in all our diversity. We also flagged the needs of transgender men who could be affected by cervical cancer and HIV.

Our intervention at this PCB meeting welcomed the report and focused on the inequalities that surround women and the intersections between HIV and cervical cancer. We urged for policies to become real, relevant, and accessible for women through programs that are led by communities and especially by women. This agenda item is a reminder of areas that remain unattended in HIV policy programming.

The decision points arising from the meeting that we deemed important were: empowerment and investments for Human Papillomavirus vaccination programs, screening, treatment, and prevention of cervical cancer with services provided by different types of implementers including those led by communities; scale up of technical guidance for countries; and, integration with primary health services.

Agenda 9: Update on implementation of the HIV response for migrant and mobile populations

Violeta Ross, Latin America and the Caribbean Delegate

The update was an outcome of the 43rd PCB NGO Report, “People on the Move, Key to Ending AIDS.” It was comprehensive and detailed on several programs across cosponsors, but it showed the lack of an integrated approach for HIV, mobility and migration. Years of experience on HIV policy-making at global levels have taught us that issues that are not addressed with specific solutions by responsible entities often fall off the agenda. Yet, our intervention urging the PCB to explore the creation of an international platform to elevate the importance of HIV, mobility, and migration was not accepted.

During the PCB pre-meeting, we asked an open question on the reasons why the International Organization for Migration (IOM) is not a Cosponsor of UNAIDS, given that this 69-year old institution became a related UN agency in 2016. We understand the bureaucratic processes and protocols about UN agencies becoming Cosponsors, but it remains a concern for us why a UN agency with a significant mandate addressing migration and mobility issues is not.

The NGO Delegation will continue to raise issues related to migrants and mobile populations’ increased vulnerabilities and its intersections, the limits of national sovereignty, and the multiple violations of human rights in the context of migration, mobility, and HIV.

Agenda 10: Thematic Segment

Iwatutu Joyce Adewole, Africa Delegate

The 48th PCB Thematic segment, “COVID-19 AND HIV: Sustaining the HIV Gains and Building Back Better and Fairer HIV Responses” was timely in light of the continuing COVID-19 crisis. It opened with a powerful keynote speech from Naina Khanna, co-executive director of the Positive Women’s Network USA, who made the case for communities taking lead in the response, given the failures of political leadership and social and economic inequities. The session highlighted the impact of COVID-19 on the HIV response, not just on funding cuts, but in reversing the progress already made. Many communities of key populations experienced significant disruption of their lives, including unwarranted deaths. The key issues highlighted in many countries were in the context of HIV criminalization and the intersection of public health and policing, with the pandemic exacerbating the policing of communities and key populations. People living with HIV are at higher risk of severe COVID-19 illness and death, yet the vast majority are denied access to COVID-19 vaccines.

In the intervention done by the NGO Delegation, we emphasized the need to sustain funding and address inequalities as intersecting elements of the COVID-19 and HIV response. We also urged for responses that emphasize public health, rights-based, and community-led approaches. The Delegation will be engaged in the upcoming 49th PCB to ensure that decision points arising from the thematic reflect the perspectives of and respond to the needs of people living with HIV, key populations, and other marginalized communities.

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Delivered by Naina Khanna, Co-Executive Director, Positive Women's Network-USA

Greetings. Thank you so much to the UNAIDS Programme Coordinating Board, Member States, civil society, the UNAIDS Secretariat and the UNAIDS Cosponsors. I am pleased to have the honor to address this distinguished body on the topic of COVID-19 and HIV.

My name is Naina Khanna, I use she/they pronouns, and I am the co-executive director of Positive Women’s Network-USA. PWN is a national membership body led by and for women and transgender people living with HIV; we have been a trans-inclusive organization since our founding in 2008. Our goal is to elevate a rights-based response to the HIV epidemic, with a specific focus on, racial, ethnic and gender justice. We understand this to mean that we must focus on intersecting systems of social, political and economic marginalization. In particular, communities that bear the brunt of state violence due to criminalization of sex work, homosexuality, gender identity, poverty, substance use, and more – otherwise known as “key populations”. We advocate for compassionate responses that center and uplift involvement from communities that are most vulnerable and which consistently name truthfully and precisely which communities are most vulnerable – both because it is the right thing to do and because it is the smart and effective thing to do.

In the United States, as in many countries, the COVID-19 crisis exposed extreme fault lines, inequities and failures of political leadership. The United States is the country with the highest number of confirmed COVID-19 cases and deaths in the world. A year ago today we had 56,000 new COVID cases diagnosed in a single day. We have lost more than 600,000 lives.

It didn’t have to be this way. The first year of the U.S. COVID-19 response was plagued by political leadership from the very top that didn’t trust science, didn’t believe in human rights, and certainly did not value the lives of people who are Black, brown, indigenous, migrant, poor or sick. Deliberate, egregious inattention. Not that different from the early days of the HIV response in the United States. Services for people living with HIV were disrupted as a result of COVID and for our members, women and transgender people living with HIV who are already extremely low-income and one emergency away from eviction, this meant potential crisis.

PWN, like many civil society groups around the world, sprang into action. We partnered with the HIV Medicine Association to create and disseminate a bilingual, online Frequently Asked Questions document on COVID and HIV to people living with HIV. We launched an online support group when in person services shut down. We ran an emergency cash assistance program to help women living with HIV who were impacted by household job loss with basic survival needs like medication, food, rent payments, and electric bills, and some of whom were at risk of dying due to climate crisis when a major storm hit the Gulf coast earlier this year. That cash assistance program has given out US $25,000 to date. Our members handed out masks, hand sanitizer and maintained community-based syringe exchange services, because clean needles save lives. We helped women with HIV navigate increased violence and create safety plans needed because some were mandated to stay home under lockdown orders when home wasn’t safe.

This parallels what happened everywhere in the world. Community based organizations - especially those led by key populations groups- stepped up to fill gaps governments couldn’t or wouldn’t. We are able to do that effectively because our communities – people living with HIV, sex workers, people who use drugs, transgender people, gay and bisexual men - trust us to keep them safe and we know where to find them and what they need. We know how to maintain confidentiality and how to address stigma and discrimination.

We are basically running an informal public health infrastructure, sometimes in collaboration with government and sometimes parallel to it. Where communities were engaged and involved in the COVID-19 response, the response was better.

This is why it is critically important to meaningfully engage community-led organizations in all aspects of national pandemic responses, including the continuing COVID-19 response. We must create mechanisms to mobilize and make available short term emergency funding to community-led organizations, in addition to a stable, long-term funding base. And HIV services should be funded, guaranteed and expanded through any such crisis so that they can be maintained. Otherwise we stand to lose precious ground in the HIV response, especially for key and vulnerable populations. These dual pandemics of HIV and COVID must not be placed in competition with each other. Both must be addressed at the same time and we need to increase donor funding for both HIV and COVID-19. Some critical gains were made during the COVID-19 crisis that we cannot lose. We must sustain and promote practical and innovative programs and services that became possible as a result of COVID-19, such as putting services online, differentiated care models, take-home opioid substitution therapy, and multi-month dispensing of ARVs. The COVID-19 response in the U.S and globally has benefited from HIV health systems, the HIV research enterprise, our public health infrastructure, and the HIV workforce.

Yet the COVID-19 crisis has also exacerbated human rights vulnerabilities for key populations through new forms of surveillance, policing, and criminalization. In some countries including the U.S. we have seen massive suspension of privacy rights, lists and data of people who are COVID positive shared with law enforcement, increase in violence, police using lockdowns to profile certain groups including key populations. Restrictions on movement and free speech have been particularly harmful to vulnerable groups, including migrants and people who are mobile. In some countries COVID is being used in some places as a justification for more HIV criminalization, or as a way to target key populations.

Laws and practices that criminalize and/or target gay and bisexual men, people living with HIV or COVID-19, transgender and gender non-conforming people, sex workers, and people who use drugs undermine the public health response and must be repealed so that full human rights are protected for vulnerable communities.

Now, the U.S. is making significant progress in vaccine access under the Biden-Harris administration. But within our own country, we still face severe disparities in who actually is getting the vaccine, with key populations left behind. And globally, we know that powerful high-income countries pre purchased sufficient doses for their entire populations, sometimes twice the number they actually needed, while many low and middle income countries do not have access. The fact that vaccines are available but not accessible and being hoarded by rich countries is an actual crime against humanity, and especially a crime against Black and brown bodies.

Recently, the G7 countries pledged to share 1 billion vaccine doses, half of which would come from the US. But this represents merely a fraction of the approximately 11 billion doses needed to vaccinate the world. Support for low and middle income countries to enable them to produce vaccines for their populations and significantly more donations are necessary to vastly increase supplies and ensure equity. High income countries such as the US must take steps to overcome barriers to vaccinating the world.

Important steps on this include an intellectual property waiver such as the TRIPS waiver mentioned by my colleagues; surge funding for pandemics, and increasing funding for the Global Fund and PEPFAR. We should also explore more permanent agreements to share technology and allow countries to waive IP in global public health emergencies as the norm rather than an exception.

The HIV and COVID-19 pandemics have represented a crisis fundamentally due to who is considered disposable and whose rights to health, safety, and life are deemed to be negotiable. A real commitment to ending these dual public health crises requires that we consistently emphasize a rights-based approach, grounded in sound science, not stigma, bias, prejudice, or discrimination. Such a response must be guided by community, led by those populations that are most impacted and harmed. With a vision towards the future. New diseases will come and go. I urge this body to consider what steps you can take so that we never have to face such a human rights abomination again.

Thank you so much for your time and for your consideration.

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Delivered by Iwatutu Joyce Adewole, Africa, on behalf of the NGO Delegation

Thank you, Chair.

I speak on behalf of the NGO Delegation.

Over the last 40 years, the world has battled the HIV epidemic as a public health threat. We have rocked the ribbon together, contributing necessary aid and funding to help mitigate the effects on our communities.

But what if an emergency pandemic breaks out, killing millions of people and causing more havoc on millions more? We are not going to let it reverse the progress already made.

Two major effects the COVID-19 has had on the HIV response: Funding and Inequalities.

To combat the COVID-19 pandemic, a lot of resources were and is still needed. With HIV being deprioritized and donor funding dwindling in the last several years, programs that had previously demonstrated to be necessary and beneficial, such as HIV treatment and prevention, SRHR programmes, human rights advocacy, and providing protection for those at risk among others, have suffered.

Member states can have and take time to debate and agree on language and decision points for days, while 4500 girls and women in Sub Saharan Africa get infected every week. It is safe to say that the pandemic has sent us a step back in the HIV response. As members of the NGO Delegation, we urge the Joint Programme and other donor agencies to adequately support and fund both the COVID-19 and HIV response that emphasise public health, rights-based approaches, and community-led.

I thank you.

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Delivered by Jonathan Gunthorp, Africa, on behalf of the NGO Delegation

*The invited speaker was Dr. John Nkengasong, MSc, PhD, Director of the Africa Centres for Disease Control and Prevention.

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Delivered by Violeta Ross, Latin America and the Caribbean, on behalf of the NGO Delegation

The NGO Delegation reaffirms the importance of this topic. As explained in the report, responding to migration and HIV requires coordinated and systematic actions across co-sponsors, borders and countries. That is why our delegation calls for the need to explore the establishment of a new international coalition to elevate the attention to migration and HIV.

We know the issue is politically complex because it brings topics like punitive laws and travel restrictions. In mobility and HIV, we can see a clear example of how laws can go against the human rights of some people and groups, while pretending to protect our national borders. It also implies the topic of national sovereignty and its limits.

Despite those complexities, we need to be practical and acknowledge that in this century, we live in a globalized community. Nowadays, borders are diffused but what does not change across countries and borders is the dignity of human beings.

Therefore, because we are talking about people with human rights, we cannot simply disassociate from these debates or decisions. What we need are decisions that practically, ethically and politically respond to the issue of people on the move and HIV.

Those practical solutions are signaled in the report. As our delegation stated in the pre- meetings, we urge the PCB members to adopt and implement the recommendations of the report.

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