This blog is one of the main ways that the NGO Delegates and the CF Team share information about the work of the Delegation and forthcoming PCB meetings. We encourage you to comment and/or ask questions. The posts are listed in order of most recent. Navigate this page by using the search function or the checklist system on the left to narrow down your search by PCB meeting, theme, or any other tag or key word.

Walk in My Shoes — UNAIDS Board Devotes Key Session to HIV, Adolescents and Youth

Blog7 February 2014 by Suksma Ratri[PDF][print]

A major concern in the global response to HIV is how to ensure that young people take their rightful place as active participants with access to high quality HIV services and the right skills and knowledge to adopt strategies to stay safe, delivered in a supportive environment. Recognizing the critical need to urgently scale up effective HIV responses to adolescents and youth, the UNAIDS Programme Coordinating Board, meeting in Geneva this week, devoted a full-day thematic segment to HIV, adolescents and youth.

The situation is extremely serious. Although there has been a 32% reduction in the estimated number of new HIV infections among people aged 15-24, this key group is facing an emerging crisis. While the number of AIDS-related deaths overall fell by an estimated 30% between 2005 and 2012, estimates suggest that the number of deaths among young people increased by 50%. In addition, 15-24 year olds still accounted for 39% of all new adult infections in 2012.

“This is the time to re-imagine the HIV response among adolescents and youth. Young people are ‘the now and the future’, born in an era of HIV and antiretroviral treatment,” said Michel Sidibé, Executive Director of UNAIDS. “Without addressing their needs, there will be no AIDS-free generation and the gains made towards eliminating new HIV infections among children will be lost—their HIV risk merely deferred to the second decade of life.”

Lively and frank discussions

Under the theme of Walk in my shoes, the 19 December gathering brought together a host of young people from around the world who themselves led the main sessions on HIV prevention, testing and treatment. Young people explored ideas, experiences and solutions with the Board about the shape and scope of meaningful HIV programmes encompassing youths and adolescents at a time in their lives of great psychological, physical and social change. The discussions were lively, frank and open.

There was much emphasis on how to foster greater inclusion and ensure that young people are not simply passive recipients of programmes but play an integral role in their design, implementation and evaluation. It was found that currently their use of HIV prevention, treatment and care services is often lower than their older counterparts and that there remained a critical need for a scale-up of youth-friendly services and programmes which are fully resourced and tailored to their specific needs. Opportunities to link HIV with other sexual and reproductive health services as well as education, gender equality and social protection were also explored.

In a session on what successful HIV prevention looks like for young people, their unique prevention needs were highlighted, including those for key populations such as men who have sex with men, injecting drug users and sex workers. Young leaders shared good practices at country level. Renata Bayazitova from the Public Foundation “Ganesha” in Kyrgyzstan said that the critical elements of success for harm reduction services for young women who inject drugs, is to greater access to safe spaces, free of judgment, where young people can come at any time without the fear of being misunderstood, where they can get information and support on a range of issues.

Across all programmes a common element of success was the involvement of young people in the design of the services. The participants highlighted that only by working with young people will services be developed which are right for them, delivered in the right way, by the right providers and in the right places. Jerson See from the community organization Cebu Plus in the Philippines said, “You need to work with us, be case we know the market…we are the market.”

Creating an enabling social and legal environment in which young people feel motivated to go for HIV testing was also examined through a session which asked the question—‘Do all tests have to be hard? It was noted that current levels of HIV testing among adolescents and youth are still very low and that with treatment available it was now imperative to ensure young people living with HIV are diagnosed and linked to care and treatment.

One of the critical barriers raised repeatedly by participations was laws pertaining to the age of consent in accessing HIV testing services. “In Mexico, you are allowed to take an HIV testing when you are under 18, but according to the law a parent or guardian has to come with you to receive the test result,” said Corina Martinez Fundación Mexicana para la Planeación Familiar, A.C. “Fortunately in Mexico that rule is already under review, but it is important to take this example and monitor to ensure that in all our countries, these measures should be strengthened to ensure universal access to HIV testing.”

Participants also heard Zambia’s innovative mobile technology project, U-report, which has been able to scale up demand for HIV testing among young people, as well as Dr Nono Simelela, Special Adviser to The Deputy President, Chair of the South African National AIDS Commission, outlining the process in South Africa which led to the lowering of the age of consent in access to HIV testing to 12.

There was also an animated dialogue on challenges and solutions in relation to access to treatment and how this access can be integrated into youth-friendly services which also offer sexual and reproductive health interventions and support with adherence to drug regimens and disclosure.

After a full day of discussion and debate, youth delegates and Board members were galvanized into redoubling their efforts to ensure that young people have the tools and the space to put themselves front and centre of the AIDS response and play an active role in achieving in getting to the end of the AIDS epidemic.

“As a youth movement, we’ve never been more organized than now,” said Pablo Aguilera, Director of the HIV Young Leaders Fund. “We’re ready to work to ensure HIV remains a priory in the post-2015 development framework”.

Taken from: http://www.unaids.org/en/resources/presscentre/featurestories/2013/december/20131220youth/

 

33rd PCB Communique

Blog3 February 2014 by Suksma Ratri[PDF][print]

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NGO DELEGATION TO THE UNAIDS PCB: COMMUNIQUE OF THE 33rd PCB

Summary – 33rdPCB Meeting

The 33rd Programme Coordinating Board (PCB) meeting agenda covered items on the coordination of technical support, as well as the strategic use of antiretroviral medications for treatment and prevention of HIV. Discussions on the post-2015 agenda were also prominent throughout the Board meeting. Through collaborating with other Civil Society groups globally in a call for a High Level Meeting (HLM), the Delegation was able to lead on negotiations that successfully resulted in the PCB inviting the United Nations General Assembly to consider convening a High Level Meeting on HIV at an appropriate time after 2015, to help ensure accountability towards the achievement of universal access to HIV prevention, treatment, care and support in the post-2015 era. A one day thematic session focussed on HIV, Youth and Adolescents was also held.

The delegation faced vocal criticisms from a small number of Member States in relation to the right of the Delegation to bring Decision Points to the meeting and the quality and validity of the research in the NGO Report. Nevertheless, a majority of Member States voiced their strong support for the Delegation’s important contribution to discussions at the PCB, the success of its work and its watchdog role.

The NGO Delegation demonstrated and reinforced its constant commitment to the critical role of civil society in responses to HIV and AIDS, human rights, and universal access to HIV prevention, treatment, care and support. The Delegation was successful in introducing and securing language throughout decision points endorsed by the PCB that explicitly included women and girls, key populations and transgendered persons. The NGO Delegation’s interventions and annual NGO Report led to spirited discussion among the Board and expanded the decisions.

The Delegation would like to give particular and significant recognition to the Youth representatives and leaders who spoke effectively and powerfully on issues facing young people and adolescents but who also presented solutions and remedies to such challenges.

The Delegation welcomed four new delegates, attending the 33rd PCB as part of an orientation process. The Delegation will be joined by Kenly Sikwese representing Africa, Laurel Sprague representing North America, Yolanda Simon representing Latin America and the Caribbean and Khartini Slamah representing Asia and the Pacific.

At the same time the Delegation said farewell to 3 delegates at the end of their term – Mabel Bianco, Jane Bruning and Ebony Johnson. Mabel, Jane and Ebony’s commitment to the Delegation and the role and rights of civil society and communities in HIV responses will be sorely missed.

Over the next six months, the Delegation will focus on engaging in the mid-term review of the United Budget, Results and Accountability Framework, continuing discussions on HIV and AIDS in the Post-2015 Development Framework, implementation of a newly developed partnership agreement between the Global Fund and UNAIDS, planning and engagement in a thematic session on Social Drivers at the 34th PCB, and development of the next NGO Report (to be presented at the 34th PCB). The delegation will also be conducting recruitment for new members commencing mid-2014. Watch out for the call for applications.

Evaluating UNAIDS engagement with Civil Society

This PCB meeting provided opportunity for the launch of a new process for evaluating the Joint Programme’s engagement with Civil Society. For several years now, the NGO Delegation has been pressing for a new evaluation process to be used by the Secretariat and the Co-Sponsors other than the very anemic Civil Society indicators in the UBRAF. At the October Technical Consultation, the Delegation supported the consultants’ recommendations that a new questionnaire be adapted from the UNAIDS Guidance for Partnerships with Civil Society including People Living with HIV and Key Populations and that a new Co-Sponsors’ thematic report/assessment be developed each year. This is to be supported by selected case studies conducted by a third party evaluator.

In response to this recommendation, the Secretariat and Co-Sponsors organized a Co-Sponsors’ Evaluation Working Group on Civil Society (CEWG) to initially be chaired by Fatiha Terki of the World Food Program. The CEWG will have two Delegation members acting as full participants, actually helping to shape the questionnaire and the annual report.  The CEWG, which held its first meeting during the week of the PCB, will also begin looking toward the development of new indicators to be introduced following this UBRAF cycle. The Delegation is delighted to be participating in this process, with a particular goal of enhancing the Joint Programme’s engagement of key populations.

NGO Observers who attend and intervene in the Board meeting are a vital part of reminding the board of all the persons who are implicated in its work. Their presence also strengthens the work and accountability of the NGO Delegates.

THANK YOU to the civil society Observers and organizations who supported the NGO Delegation. Thank you also to all civil society partners who contributed to preparatory briefing calls and supported the continuation of the thematic session.

Leadership in the AIDS Response

The Delegation had written to Michel Sidibe conveying the concern of the Delegation and our Civil Society partners about his choice of Sir Andrew Witty, the CEO of GlaxoSmithKline (GSK), for the Leadership session, whilst also recognizing that the choice was Michel’s prerogative. This was based on the feeling that a big pharma CEO was not the right symbol for leadership in the AIDS response. We requested a Delegation meeting with Sir Andrew, which was granted. The Delegation prepared both an intervention and notes for the meeting that expressed our concerns about the behavior of big pharma in opposing generics, their lobbying for TRIPS+ clauses in Free Trade Agreements, restrictive voluntary licenses especially for MICs, and their generally greedy pricing structures.

But Sir Andrew’s plane was not able to land in Geneva because of fog. So, on the one hand we got our wish, while on the other we missed a chance to have a frank discussion with him.

Strategic Use of ARVs

The Delegation generally welcomed this paper. But our intervention on the treatment aspect addressed two issues. One was diagnostics and the need for reliable and affordable diagnostics in all countries, especially viral load. We suggested that a better measure of success in treatment than numbers of people on treatment would be numbers of people with viral load suppression.

The second part of the intervention was about the need for affordable access to second and third line ARVs in all countries. It then explored some of the price barriers such as the cumbersome process for TRIPS flexibilities, TRIPS+ clauses in Free Trade Agreements, restrictive voluntary licenses (in other words many of the points we would have made had the Leadership session gone ahead). The unacceptable inequity in access between developed and developing country was a major point of this intervention. At the end it called for a moratorium on TRIPS until a better mechanism for delivering affordable essential medicines in all countries can be found.

Coordination of Technical Support

The Delegation welcomed the paper on the Coordination of Technical Support, especially the proposed new Roadmap and the recognition of the need to prioritize response to the Global Fund’s New Funding Model. We noted our concerns about UNAIDS’ capacity to deliver speedily enough and to the level needed, ensuring accountability for this new technical support Roadmap. It was disappointing that the Technical Support Decision Point, in its exclusive focus on countries served by the Global Fund, excluded any mention of ongoing technical support to meet the needs of other countries, as noted by those Member States led by Mexico. Similarly, the NGO Delegation was astounded that the Decision Point failed to recognize the critical role of civil society including key populations relative to providing technical support in the AIDS response. By excluding any such mention, the Decision Point contradicts frameworks such as UNAIDS Treatment 2015 which emphasizes the urgent scaling up of community based and civil society responses.

After the Decision Points had been adopted we made an intervention expressing our concerns about the failure to mention Civil Society so that it will be recorded in the minutes.

Executive Director’s Report

In response to Michel Sidibe’s mention of faith-based communities, the Delegation took the opportunity to affirm the vital role of faith-based healthcare professionals as partners in HIV prevention, treatment and care. We also noted, however, the growth of religious fundamentalism and its support of disenabling social and legal environments, impacting negatively on universal access to HIV services.  The Delegation called on UNAIDS to elaborate a strategy to specifically address this emerging threat.

The Delegation also appreciated Mr. Sidibe’s recognition of the importance of keeping civil society and key communities in the front of the AIDS response. However, we noted that on the other hand the funds for civil society engagement continue to decrease. We called on UNAIDS to implement the various Decision Points (DPs) relative to this matter approved during the 30th PCB, and to report to the PCB in 2014.

On the Post-2015 ongoing discussions, the NGO delegation highlighted that HIV should remain a high prioritywithin the Post-2015 framework. We welcomed Michel Sidibe’s request made at International Conference on AIDS and STIs in Africa (ICASA) to have a distinct goal in the Post-2015 framework and urged the present Member States and co-sponsors to embrace and support this proposal. The delegation also emphasized that while not forgetting that governments still have to accelerate efforts to achieve the current MDGs and 2011 High Level Meeting (HLM) Commitments, we would like to have clarity on the UNAIDS strategy to promote among Members States the idea of having HIV as a distinctive goal within the Post-2015 agenda, especially by building synergy with other sectors beyond Health, including the  sexual and reproductive rights sector, which is key to move forward the agenda of treatment and prevention.

Prior to the PCB, the NGO Delegation was widely involved with other Civil Society groups globally to call for a High Level Meeting (HLM) on HIV/AIDS. During the PCB, the Delegation submitted to Mr. Sidibe a hard copy of a letter signed by over 400 CS groups calling for such an HLM. After much difficult negotiation, the PCB adopted a Decision Point that invited the United Nations General Assembly to consider convening a High Level Meeting on HIV at an appropriate time after 2015 as part of a broader strategic effort to reaffirm and renew political commitments, and to ensure accountability towards the achievement of universal access to HIV prevention, treatment, care and support in the post-2015 era. This was a major success for the Delegation at this PCB as well as in terms of collaboration between the Delegation and wider civil society.

NGO Report

This year the NGO Report was “The Equity Deficit: Unequal Access to HIV Treatment, Care, and Support for Key Affected Communities”. Too many people with HIV lack access to ART. In this Report, we focused on treatment access for gay men and other men who have sex with men, transgender people, sex workers and people who inject drugs: communities that persistently struggle for visibility and access to health services in many contexts.

The Report was presented prioritizing examples of inequities that key communities suffer in different countries. The evidence based data demonstrates very clearly the “Equity Deficit”. We made recommendations to UNAIDS and Member States. After our presentation, most of the governments and co-sponsors expressed support for and welcomed the Report and its clarity as well as the in depth analysis. Three countries questioned the methodology as well as the right of the NGO Delegation to present DPs, according to article 10 of the ECOSOC resolution. UNAIDS Legal Counsel clarified for the PCB the right of the NGO Delegation to present recommendations to the Board. That right extends to NGO and other Observers assuming the required protocol is followed. As the only representatives at the PCB with voting rights, it is then at Member States’ prerogative as to whether they accept such recommendations. The NGO Delegation thanked those who provided positive comments and answered those questioning the methodology by noting that data included in theReport was drawn from over a 100 peer reviewed research sources, validated country and global HIV and AIDS reporting,  as well as interviews with 40 key informants from communities across the globe.

The Delegation also clarified that our role on the PCB is not to present ‘scientific studies’, but to bring the voice of our communities. However, in this case, the Report was intentionally designed as a meta-analysis of available and verifiable data and met high standards of methodological rigour.

Regarding our rights on the PCB, we specified that we are members of the PCB with voice so we can request that they discuss our recommendations and decide about them: we have the right to ask them to discuss because we express the voice and experiences of our constituencies. In the end, our approach was accepted and we had three negotiations in the drafting room about our recommended DPs.

Thematic Segment: HIV, Youth and Adolescents

The youth thematic presented an opportunity to take a critical look at the impact of HIV on young people and adolescents. While HIV infection amongst young people has decreased by 32% globally, AIDS related deaths amongst youth continue to rise. At the same time appropriate transition from adolescent to adult care and access to HIV antiretroviral treatment remain wholly inadequate.

The thematic day offered a combination of spoken word, candid discussion and well-constructed interventions from global youth leaders living with and affected by HIV, representing key populations and those leading the charge as HIV and Human Rights innovators. The youth leaders provided vivid illustrations of gross discrimination, legal barriers and harmful cultural norms that impede young people’s access to HIV, reproductive health and social protection services. These powerful testimonials included accounts of rape without recourse, culturally sanctioned child-marriage resulting in HIV infection, exclusion of youth using drugs from HIV care, isolation of LGBT youth and absence of youth health services.

Luiz Loures, Deputy Executive Director of UNAIDS, provided slides detailing the HIV epi-data on youth globally. A number of gaps were exposed in access to and availability of HIV and reproductive services for youth. Loures emphasized the major role of stigma, discrimination and the law creating barriers and excluding youth from care, particularly youth from key affected populations. He gave examples of harm reduction programming and programs addressing the needs of young MSM as effective solutions. Following, several youth presenters gave detailed examples of effective and inclusive programming led by youth that bring virtual support to young people living with HIV, expands HIV and reproductive health services to youth in rural communities, links youth that use drugs into HIV prevention and treatment and builds youth skillsets and advocacy activities. These examples all emphasized the role of youth leadership, human rights, social inclusion and greater financial investment on youth health structures and service delivery.

During the Youth Thematic session there were two interventions from the PCB NGO Delegation. The first intervention called for the PCB to reform punitive laws that deny services to key populations, greater investment in harm reduction services and access to HIV testing at the community settings. The second intervention called on the PCB to fund, implement, monitor and evaluate the UNAIDS Action Agenda for Women and Girls; support an increase in the age of consent for marriage; include young women and girls in national strategic planning; and leverage resources from the Global Fund and other mechanisms to resource transformative responses for the health and well-being of young women and girls.

Side meetings

One NGO Delegate participated in the Lancet Commission working group meeting on Sexual Reproductive Health Rights (SRHR) and HIV. The working group reviewed and discussed the draft paper developed by UNFPA looking at mechanisms to integrate HIV and SRHR in the Post-2015 Agenda. The draft paper examined barriers to access, health infrastructure and model integration programs.

Reminder: What is the PCB again?

The Programme Coordinating Board (PCB) is the governing body of UNAIDS. It is made up of 22 voting Member States, the 11 UN Cosponsors that make up the UNAIDS program, and an NGO Delegation (consisting of one delegate and one alternate from each of 5 regions). Please visit our website at: www.unaidspcbngo.org to see all presentations, decision points and talking points. If you are not already a subscriber, please join our mailing list.

Decisions from 33rd PCB Meeting – December 2013

BlogDecisions17 January 2014 by Suksma Ratri[PDF][print]

33rd  Meeting of the UNAIDS Programme Coordinating Board
Geneva, Switzerland 17-19 December 2013

Decisions, Recommendations and Conclusions  

The UNAIDS Programme Coordinating Board,
Recalling that all aspects of UNAIDS work are directed by the following guiding principles:

  • Aligned to national stakeholders’ priorities;
  • Based on the meaningful and measurable involvement of civil society, especially people living with HIV and populations most at risk of HIV infection;
  • Based on human rights and gender equality;
  • Based on the best available scientific evidence and technical knowledge;
  • Promoting comprehensive responses to AIDS that integrate prevention, treatment,care and support; and
  • Based on the principle of non-discrimination;

Agenda item 1.1: Opening of the meeting and adoption of the agenda
1. Adopts the agenda;

Agenda item 1.2: Consideration of the report of the thirty second meeting
2. Adopts the report of the 32nd  meeting of the UNAIDS Programme Coordinating Board;

Agenda item 1.3: Report of the Executive Director
3. Takes note of the report of the Executive Director;

Agenda item 1.4: Report by the NGO representative  
4. Requests UNAIDS in collaboration with Member States and partners to:

a. ensure that any implementation/guidance on new biomedical preventative technologies proceeds with the full and meaningful engagement of key populations,  promoting informed and voluntary adherence to ART;

As defined in the UNAIDS 2011-2015 Strategy Getting to Zero: “Key populations, or key populations at higher risk, are groups of people who are more likely to be exposed to HIV or to transmit it and whose engagement is critical to a successful HIV response. In all countries, key populations include people living with HIV. In most settings, men who have sex with men, transgender people, people who inject drugs and sex workers and their
 
b. further ensure the potential impacts of treatment as prevention – as indicated by an increasing body of evidence and support of the earliest initiation of ART for people living with HIV – will be aligned to the principle of treatment being first and foremost to benefit those living with HIV;

c. intensify coordinated technical support to governments, civil society, and key populations,  and UNAIDS to periodically report to the Programme Coordinating Board on progress in the effectiveness of technical support interventions at the country level;

d. report to the 35th PCB on concrete actions taken to reduce stigma and discrimination in all its forms consistent with the UN High Level Political Declarations of 2006 and 2011, the UNAIDS Strategy 2011-2015 and all the Programme Coordinating Board decisions related to the reduction of stigma and discrimination;

Agenda item 3: Update on the AIDS response in the post-2015 development agenda
5.1. Welcomes the update report on the AIDS response in the post-2015 development agenda and looks forward to discussing the findings and recommendations of the UNAIDS and Lancet Commission at its next meeting in June 2014;

5.2. Recalls the decisions from the 32nd PCB on the AIDS response on the post-2015 development agenda and invites the United Nations General Assembly to consider convening a High Level Meeting on HIV at an appropriate time after 2015 as part of
a broader strategic effort to reaffirm and renew political commitments, and to ensure accountability towards the achievement of universal access to HIV prevention, treatment, care and support in the post-2015 era;

Agenda item 4: Strategic use of antiretroviral medicines for treatment and prevention of HIV
6.1. Welcomes the paper;

6.2. Calls upon Member States to:

a. ensure that acceleration of access to HIV treatment, particularly for key populations  as well as women, children and adolescents living with HIV, including addressing the barriers to treatment access, are factored into all stages of HIV and health planning, implementation, monitoring and evaluation, and resource mobilization, particularly with regards to development of investment thinking approach, and support for the roll-out of the New Funding Model of the Global Fund to Fight AIDS, TB and Malaria (Global Fund) and other funding sources; clients are at higher risk of exposure to HIV than other groups. However, each country should define the specific populations that are key to their epidemic and response based on the epidemiological and social context.”

b. implement the 2013 WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection with the active engagement of People Living with HIV and key populations;

c. monitor HIV drug resistance according to the WHO Global Strategy for the Surveillance and Monitoring of HIV Drug Resistance 2012;

d. continue work towards further scale-up of access to HIV services including by strengthening communities and their role in the health system for promoting and supporting informed and voluntary uptake of HIV testing and counseling, treatment, care and support, and promoting treatment adherence;

e. work to ensure the sustainability of national AIDS responses recognizing the principles of country leadership and ownership through strengthening of shared responsibility, innovative sustainable financing to meet increased demand, building of strategic partnerships, strengthening health systems, including through the integration of HIV services, and multi-sectoral approaches;

f. ensure that programmes to expand access to HIV treatment are fully integrated in national health strategies and offer quality HIV services, improve treatment literacy, are voluntary, non-coercive and respect the human rights of people living with HIV;

g. ensure that national programmes effectively address the barriers to HIV testing and treatment faced by children and adolescents;

6.3. Requests the Joint Programme to:

a. support on-going national and international processes led by countries and regional institutions to convene national and regional consultations for the definition of revised national targets for universal access to HIV treatment keeping in mind the need for defining new milestones and targets for the AIDS response beyond 2015, and to provide a report at a future meeting of the
Programme Coordinating Board;

b. further support implementation of the 2013 WHO Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection ensuring the active engagement of People Living with HIV and key populations;

c. further support countries to monitor HIV drug resistance according to the WHO Global Strategy for the Surveillance and Monitoring of HIV Drug Resistance 2012;

d. support capacity development of communities in their role in the health system for promoting and supporting informed and voluntary uptake of  HIV testing and counselling, treatment, care and support, and promoting treatment adherence;

e. continue to support the availability of affordable, quality, safe and effective antiretroviral medicines and harmonizing medicines regulatory systems, as well as the provision of technical support for countries to maximize utilization of the
flexibilities under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and the Doha Declaration;

f. support countries to effectively address and remove the barriers to HIV testing and treatment faced by children and adolescents;

g. further support countries to effectively address and remove barriers to HIV testing and treatment for key populations, women and girls;

6.4. Recognizing that two out of three children do not have access to treatment:

a. requests UNAIDS to prepare a discussion paper and a gap analysis on paediatric HIV treatment, care and support with specific, time-bound targets for getting all children living with HIV on treatment and a strategy on how this would be achieved to be presented at the 35th  meeting of the Programme Coordinating Board.

Agenda item 5: Coordination of HIV technical support in a rapidly changing environment
7.1. Welcomes the paper on coordination of Technical Support in a rapidly changing environment;

7.2. Recalls the UNAIDS technical support coordination role for all countries and regions;

7.3. Requests UNAIDS, in light of the importance of the roll-out of the Global Fund New Funding Model, to take necessary steps to strengthen the coherence and coordination among bilateral and multilateral technical support agents based on country contexts and requirements, in particular for the implementation of this Model. In doing so, UNAIDS should continue to address other technical support as needed, retaining its focus on the 30+ priority countries and cooperate closely, within its mandate, with technical support agents for TB and Malaria as well as for health system strengthening retaining the principle of national ownership and leadership;

7.4. Requests UNAIDS to report on the UNAIDS-Global Fund Partnership Agreement and its financial implications, including for UNAIDS’ Technical Support Facilities, at the 34th meeting of the Programme Coordinating Board;

Agenda item 6: Next Programme Coordinating Board meetings  
8.1. Agrees that the themes for the 34th  and 35th  Programme Coordinating Board meetings be respectively: “Addressing social and economic drivers of HIV through social protection” and “Halving HIV transmission among People Who Inject Drugs”;

8.2. Further agrees to request the Programme Coordinating Board Bureau to take appropriate and timely steps to ensure that due process is followed in the call for themes for the 37th  Programme Coordinating Board meeting, as necessary;

8.3. Agrees the change in the date of the 34th  PCB meeting to 24-26 June 2014 and of the 36th  PCB meeting to 30 June-2 July 2015;

8.4. Further agrees the dates for the 38th  (28-30 June 2016) and the 39th  (6-8 December 2016) meetings of the Programme Coordinating Board;

Agenda item 7: Election of Officers
9. Elects Australia as Chair and Zimbabwe as Vice-Chair for the period 1 January 2014 to 31 December 2014 and approves the composition of the PCB NGOs.

UNAIDS and the World Bank Group Endorse Action Points to Address Extreme Poverty and AIDS

Blog17 January 2014 by Suksma Ratri[PDF][print]

PRESS RELEASE

GENEVA/WASHINGTON, 15 January 2014—During a high-level meeting and discussions in Washington last week, UNAIDS and the World Bank Group endorsed four areas of action to accelerate efforts that address the interrelated challenges of AIDS, inequality and extreme poverty.

UNAIDS and the World Bank Group have committed to work closely with UNDP and other international partners, to address the social and structural drivers of the HIV epidemic that put people at greater risk of HIV and deny them access to services. These social and structural drivers include gender inequality, stigma and discrimination, lack of access to education and unstable livelihoods. UNAIDS and the World Bank Group will advocate for:

1. Aligning health and development efforts around country-led time-bound goals towards ending extreme poverty and AIDS, with special attention to the inclusion of the poorest and most marginalized populations. Areas of focus will include: supporting countries to adopt progressive legal systems that remove discriminatory laws, especially among populations most vulnerable to HIV infection; increasing access to income, adequate housing and safe working conditions; and accelerating reforms towards
universal health coverage and universal access to HIV services and commodities.

2. Urging the Post-2015 development agenda to include targets towards ending AIDS alongside the goal of universal health coverage, so that no one falls into poverty or is kept in poverty due to payment for AIDS treatment or health care.

3. Promoting national and global monitoring and implementation research. Actions will include: working closely with global partners and countries to innovate and monitor service delivery, including for HIV, especially to the poorest and the most marginalized; and intensify implementation research to capture and codify innovative approaches to address the linkages between efforts towards ending extreme poverty and ending AIDS.  As part of this effort, the World Bank Group will launch a major new trial to better understand how social protection systems reduce HIV infection, particularly among young women in the highest burden hyper-endemic countries.

4. Convening two high-level meetings in 2014 with national policy leaders and experts on ending AIDS and extreme poverty. The first meeting will be convened in Southern Africa to share current research and discuss how it can be translated into practice. The second meeting will be held during the International AIDS Conference in July 2014 in Melbourne.

Despite unprecedented progress over the past decade in the global response to HIV, economic inequality, social marginalization and other structural factors have continued to fuel the HIV epidemic. The epidemic continues to undermine efforts to reduce poverty and marginalization.

HIV deepens poverty, exacerbates social and economic inequalities, diminishes opportunities for economic and social advancement and causes profound human hardship. “Ending the AIDS epidemic and extreme poverty is within our power,” said Michel Sidibé, Executive Director, UNAIDS. “Our combined efforts will contribute to a global movement working to ensure that every person can realize their right to quality healthcare and live free from poverty and discrimination.”

“Just as money alone is insufficient to end poverty, science is powerless to defeat AIDS unless we tackle the underlying social and structural factors,” said Jim Yong Kim, President of the World Bank Group. “To end both AIDS and poverty, we need sustained political will, social activism, and an unwavering commitment to equity and social justice.”

“Stigma, discrimination and marginalization stand in the way of fully realizing the promise of HIV prevention and treatment technologies,” said Helen Clark, UNDP Administrator. “We know that where laws and policies enable people affected by HIV to participate with dignity in daily life without fearing discrimination, they are more likely to seek prevention, care and support
services.”

Improving health services and outcomes is critical to ending extreme poverty and boosting shared prosperity. The recent Lancet Commission on Investing in Health estimated that up to 24% of economic growth in low- and middle-income countries was due to better health outcomes. The payoffs are immense: the Commission concluded that investing in health yields a 9 to 20-fold return on investment. Investing in health also means investing in equity. Essential elements of a human rights-based response to HIV include: enabling laws, policies and initiatives that protect and promote access to effective health and social services, including access to secure housing, adequate nutrition and other essential services. Such measures can help protect people affected by HIV from stigma, discrimination, violence and economic vulnerability. HIV-sensitive social protection is already a key component of the UNAIDS vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.

“Pills on a shelf do not save lives,” said Sveta Moroz of the Union of Women of Ukraine Affected by HIV. “To end the AIDS epidemic for everyone will require a people-centered approach driven by the community and based on social justice. It demands an approach that ensures basic human rights to safe housing, access to healthcare, food security and economic opportunity. These are rights that actively remove barriers to real people’s engagement in effective HIV prevention and care.”

UNAIDS and the World Bank Group will work to ensure that these efforts feature prominently in the Post-2015 global development agenda, and are integral elements in ending AIDS, achieving universal health coverage, ending extreme poverty and inequality and building shared prosperity.

Contact:
UNAIDS Geneva | Sophie Barton-Knott | tel. +41 22 791 1697 | bartonknotts@unaids.org
World Bank Group | Melanie Mayhew | tel. +1 202 459 7115 | mmayhew1@worldbank.org

UNAIDS  
The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank Group—and works
closely with global and national partners to maximize results for the AIDS response. Learn more at unaids.org and connect with us on Facebook and Twitter.

World Bank Group
The World Bank Group is a vital source of financial and technical assistance to developing countries around the world, with the goals of ending extreme poverty and boosting shared prosperity. Improving health is integral to achieving these goals. The World Bank Group provides financing, state-of-the-art analysis, and policy advice to help countries expand access to quality, affordable healthcare; protect people from falling into poverty or worsening poverty due to illness; and promote investments in all sectors that form the foundation of healthy societies. Learn more at www.worldbank.org/health and connect with us: @worldbankhealth.

ICARH, TIER & AMSHeR CONDEMN THE SIGNING OF THE SAME SEX MARRIAGE [PROHIBITION] ACT 2014 BY PRESIDENT GOODLUCK JONATHAN

Blog17 January 2014 by Suksma Ratri[PDF][print]

PRESS RELEASE

[ABUJA] – The International Centre for Advocacy on the Right to Health [ICARH], the Initiative for Equal Rights [TIER] and the African Men for Sexual Health and Rights [AMSHeR] condemn the signing into law of the Same Sex [Prohibition] Act 2014 by the Nigerian President, Dr. Goodluck Jonathan.

The Act bans marriages or civil unions between persons of the same sex within Nigeria and void any such marriages and civil unions entered legally in other countries in Nigeria. The law goes further to criminalise the registration of ‘gay clubs, societies and organisations, their subsistence, possessions and meetings’ and bans the ‘public show of same sex amorous relationship either directly or indirectly’. The law provides a sentence of 10 years imprisonment to any person or group of persons that ‘witness, abets and aids the solemnisation of a same sex union or supports the registration of gay clubs, societies and organisations, processions or meetings’.

‘This law does not only criminalise same sex marriage which was already illegal in Nigeria, but it also is a violation of Chapter Four of the Constitution of the Federal Republic of Nigeria which guarantees the rights to freedom of association, expression, private life and freedom from discrimination’, says Olumide Makanjuola, Executive Director, TIERS.

The Act will also have adverse effects on healthcare practitioners who provide services to key populations including men who have sex with other men [MSM] as well as deny access to HIV services to persons in high-risk environments such as prisons. According to Mr. Ifeanyi Orazulike, of ICARH, Nigeria, ‘this law will undermine the efforts of the Federal Government of Nigeria and the President’s Comprehensive Response Plan for HIV/AIDS [PCRP] to address the high burden of HIV among key populations and will reverse the progress made so far in the fight against HIV/AIDS in Nigeria.’

AMSHeR urges the Government of the Federal Republic of Nigeria to consider the implications of this law on the fundamental rights of Nigerian citizens who will become targets of abuse, violence and other human rights violations on the basis of their real or perceived sexual orientation or gender identity. According to Kene Esom, Director of Programmes at AMSHeR, ‘Increasingly some African governments use homosexuality to whip up public sentiments and to divert attention from key national challenges such as rising unemployment, poverty, collapse of healthcare systems, corruption and police brutality. Unfortunately Nigeria’s Same-Sex [Prohibition] Act 2014 adds to the arsenals of redundant legislations used by the police and law enforcement agents to harass, blackmail and extort money from innocent citizens.’

AMSHeR calls on the Government of Nigeria to honour its domestic and international obligations and commitments to respect, protect and ensure the fulfilment of rights of all people within its territory; and to particularly protect minority groups from violence and discrimination by taking proactive steps to put in place measure that prevent the violation of their human rights.

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ICARH is an independent research initiative established in 1999 for the main purpose of contributing to policy issues/matter affecting the rights of sexual minorities and people living with HIV [PLHIV] in Nigeria through research, analysis, training, awareness campaigns development and advocacy.

TIER envisions a society that is free from discrimination on the grounds of age, gender, tribe and especially sexual orientation and gender identity amongst others. It works to achieve this through education, empowerment and advocacy. TIER’s activities include but not limited to Sexual health programming, skill acquisition programs, capacity building development and legal aid program.

AMSHeR is a regional coalition human rights organisations in 15 African countries working to address the vulnerability of MSM to HIV and to advocate for the respect and protection of the human rights of sexual minorities in Africa including the abolition of laws, policies and practices that promote violence, stigma and discrimination particularly on the basis of sexual orientation and gender identity.
For further inquiries please contact:

Ifeanyi Kelly Orazulike [+234 807 494 9006, alliance.ifeanyi@gmail.com, iorazulike@icarh.org]
Olumide Makanjuola [+234 807 551 0102, omakanjuola@initiative4equality.org]
Kene Esom [+2711 242 6801, kene@amsher.net]

Observer’s Intervention on Youth Thematic – Global Forum on MSM & HIV

Blog19 December 2013 by Suksma Ratri[PDF][print]

by Nadia Raffif

In every world region, men who have sex with men (MSM) face significantly higher rates of HIV than the general population. Young people are also at increased risk for HIV, comprising over 40% of new HIV infections worldwide. Young MSM (YMSM) face the heightened risks of both populations, as well as a number of vulnerabilities that are unique to YMSM. While data on HIV among YMSM are extremely limited, existing studies show high HIV prevalence among YMSM around the world: Russia (9%), Malawi (22%), Namibia (17%), Botswana (21%), United States (19%), Peru (13%), China (6%).

Despite the clear need for intervention, YMSM are often left out of research, policy, and programs designed for general MSM, general youth, and the general population. This has led to funding gaps, inappropriate programming, lack of surveillance data, access problems, and an absence of youth-specific services targeting the unique needs of young gay men.

In order to elevate and address the needs of YMSM in the response to HIV at the local-, national-, and global-level, the Global Forum on MSM & HIV (MSMGF) established the MSMGF Youth Reference Group (MSMGF YRG). First convened in 2010, the MSMGF YRG is composed of 18 YMSM advocates working for the health and human rights of YMSM in their respective regions around the world. The YRG advises and coordinates the work of the MSMGF on YMSM issues, advocating for the empowerment of YMSM within the global HIV response through skills building, cross networking, and meaningful participation in the decision-making processes that affect YMSM.

Since its inception in 2010, the MSMGF YRG has primarily focused on: A) elevating YMSM issues at major international forums; and B) generating data on YMSM health and human rights through research initiatives.

MSMGF YRG members have convened panel discussions at the most recent International AIDS Conference (“Putting the Pieces Together: Responding to the Needs of Young Men Who Have Sex with Men and the HIV Epidemic”) and the AIDS 2012 MSM Pre-Conference (“Targeting YMSM: An International Look at Programs and Funding for Young MSM”). The MSMGF YRG’s efforts thus far have been effective in raising awareness of the unique issues faced by YMSM globally and the urgent need to address them. Both panel discussions at the 2012 International AIDS Conference were delivered to full houses and received very positive reviews.

MSMGF YRG members also collaborated with the MSMGF Secretariat to produce a policy brief using data on YMSM from the MSMGF’s 2012 Global Men’s Health and Rights (GMHR) survey. Entitled “Young Men Who Have Sex with Men: Health, Access, & HIV,” the publication featured a secondary analysis of GMHR data from more than 2400 YMSM, indicating that YMSM around the world experience higher levels of homophobia, unstable housing, violence, and other factors that hinder access to HIV services, compared to older MSM.

YMSM reported significantly less access to medical care, less access to HIV prevention services, lower HIV treatment outcomes, higher prevalence of homophobia and violence, less community engagement, and less comfort with providers, when compared with MSM older than 30. Many of these factors act syndemically,fueling each other and leading to poor health outcomes for YMSM.

The publication concluded with a set of recommendations for supporting YMSM health and human rights that were developed collaboratively by members of the MSMGF YRG.

The YMSM policy brief was particularly successful in this regard, generating news stories in multiple outlets across three continents. The data and analysis presented in the policy brief was showcased at the first-ever LGBT panel at the World Bank’s 2013 Spring Civil Society, used to inform debate in Scottish Parliament, and helped guide the development of a national youth strategy to address HIV in Lebanon.

Targeted efforts are needed to reduce disparities in HIV risk and service access among YMSM. It is incumbent upon national governments, multilateral agencies like UNAIDS, and major global funders like PEPFAR and the Global Fund to recognize that the needs of YMSM must be addressed explicitly and directly. As the world reevaluates goals for the post-2015 development agenda, there are several concrete steps that can be taken to provide crucial support for YMSM health and human rights.

Statement of Intervention by North America NGO Delegation on Youth Thematic Segment

Blog19 December 2013 by Suksma Ratri[PDF][print]

by Ebony Johnson

Women represent fifty-two percent of all people living with HIV in low and middle income countries worldwide. However, the numbers are even more staggering in Sub-Saharan Africa, the region shouldering the largest HIV burden, wherein young women represent 68% of people living with HIV between the ages of 15-24. Why you ask? Worldwide women and girls are extremely vulnerable to HIV. Gender inequity and power imbalance are reinforced through political, social, cultural, economic and legal structures.

Without commitments and investments to provide free education to all young women; we grow up without a positive trajectory to gain to be safe, stay healthy, secure fair and decent employment, have full rights and live a quality life.

Without sufficient education, skills or an enabling environment that values the role of young women or women overall, we are propelled into early marriage, survival sex, homelessness and unemployment; all factors that limit our agency to refuse sex, negotiate condoms or have autonomy over our bodies. Punitive laws, policies and harmful cultural norms compound our risk for HIV with the absence of protections against gender-based violence, rape or incest. As we just heard from our panelist from Algeria and the colleague from UNFPA, childhood marriage still remains a tremendous problem across the globe. Globally, this problem translates into 37,000 girls being married each day. Girls who are without the power to refuse. Today, in many parts of the world girls and young women are forced or coerced into arrange marriages to honor religious obligations, provide financial support for families or as part of obsolete and detrimental traditional practices such as Ukutwala. In the words of UNFA Executive Director, “Childhood marriage means and end to education for girls and damages a woman’s [life] potential. These issues are compounded for us young women as we are without the social and legal protections to leave or refuse these marriages, even wherein there is infidelity which increases our risk of HIV and STI’s, martial rape or violence. Additionally, we also face challenges in leaving when laws and policies leave us without the ability to own property, consent to reproductive health services (including HIV prevention, testing or care) or have economic stability.

  • We, the UNAIDS NGO Delegation call on the UNAIDS Cosponsors, Secretariat and member states to continue to fund, implement, monitor and evaluate all of the recommendation of the UNAIDS Agenda for women and girls.
  • We call on you to leverage the opportunities created by the Global Fund and other funding partners, to resource gender transformative HIV responses, for the health, wellbeing and empowerment of girls and young women.
  • We request government to enact and enforce laws to increase the age of marriage
  • We ask for strong focus on young women and girls; including those of us living with HIV and within key populations in all national planning; that is funding, implemented and monitored

Our lives matter, If they are important to you, please find and implement programs and policies that we me and all women and girls live healthy, safe and quality lives. Thank you

Statement of Intervention by Europe NGO Delegation on YouthThematic Segment

Blog19 December 2013 by Suksma Ratri[PDF][print]

by Dasha Ocheret

I would like to draw your attention to the low coverage of HIV prevention programs of young people from key populations. NGOs working with key population often miss the opportunity to reach young people who use drugs, sex workers and men who have sex with men. In Eastern Europe, for instance, the mean age of harm reduction programs clients is over 30 years, and we fail to provide syringes, condoms and OST to young injectors or to prevent initiation of injections among who young people who use drugs but haven’t yet started injecting.

There are serious legal barriers that prevent us from engaging young people who use drugs in harm reduction services. Formally, our clients can’t be younger than 18 to be able to come and get clean syringes, access HIV testing in community settings and get any other forms of support. Young people cannot access opioid substitution treatment, and in practice they have to weight to get HIV, hepatitis C or tuberculosis to become eligible for drug treatment.

Another issue that prevents us from reaching young representative of key population is that we fail to involve them into planning, provision and evaluation of HIV prevention services. We hope that this thematic session will become a turning point in the meaningful participation young leaders from key populations in HIV advocacy.

Observer’s Intervention on Youth Thematic Segment – Harm Reduction International

Blog19 December 2013 by Suksma Ratri[PDF][print]

by Damon Barrett

Injecting drug use among adolescents has been largely overlooked in responses to HIV.

At Harm Reduction International we have undertaken the first global snapshot of available data on this issue – copies are available outside (And online at http://www.ihra.net/contents/1431 )

National population size estimates are exceptionally rare for this age group.

Under 18s are often not included behavioural surveillance. Specific research is quite rare. A lot of what is available is isolated, one off or old. In other words most countries don’t know their epidemic

This should not prevent action:

  • Early onset of injecting, and having recently begun injecting, have been associated with increased risks of HIV and hepatitis C transmission.
  • Low ages of initiation are clear across regions. In Nepal, for example,it is estimated that 20% of people who inject may be under 18.

A third of young people who inject reported starting under the age of 15 in Albania – a quarter in Romania.

In Indonesia adolescents are almost twice as likely to share needles than older counterparts. They are less likely to test for HIV

In Ukraine it has been estimated that there are just over 50,000 adolescents injecting drugs. According to data from harm reduction services, about 800 were reached last year.

 

And that raises the key question of knowing our responses. Adolescents who inject drugs are less likely to use or accessbasic harm reduction services. Rarely are services that do exist geared up for work with adolescents who have needs and vulnerabilities that render delivery of those services more difficult, additional to their legal status as a minor.

The existing comprehensive package on HIV and injecting drug use was not developed with adolescents in mind. So it is inadequate. And each of the nine interventions is more difficult to deliver for this age group. I don’t want to understate the complexities or sensitivities this involves. Of course it would be better if adolescents were not using drugs. But let’s remember that many are living in exceptionally difficult circumstances. Imagine a girl of 15 who is injecting drugs. She lives on the streets. She cannot go home due to abuse.  Her drug use is a response to that. This is why harm reduction is so important.  Even if we can guarantee that tomorrow we can help her overcome that trauma.

Even if tomorrow we can reunite her with her mother and even if tomorrow we can help her stop using drugs, today she is going to inject multiple times, and each occasion could expose her to serious harm including HIV.

So what are we going to do?And how many like her are there?  I leave you with that challenge and look forward to more attention to this issue.

Offline Observer’s Statement of Intervention on Strategic Use of ARVs – Caritas Internationalis

Blog18 December 2013 by Suksma Ratri[PDF][print]

Due to time constraints and the discretion of the Chair, unfortunately several Civil Society Observers were unable to deliver their intervention during the meeting. The NGO Delegation’s Communication & Consultations Facility hereby facilitate and assist the Civil Society in getting other platform of advocacy via this website.

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by Caritas Internationalis

Oral Statement under item 4 – Strategic Use of Antiretroviral Medicines for Treatment and Prevention of HIV, submitted by Caritas Internationalis (International Confederation of Catholic Charities), Association Community Pope John XXIII, Caritas Australia, Ecumenical Advocacy Alliance, Edmund Rice International, International Catholic Child Bureau, Medical Mission Institute Würzburg – Catholic Advisory Organization for International Health, and Trócaire.

Caritas Internationalis  delivers this statement in collaboration with the following co-signing organizations: Association Community Pope John XXIII, Caritas Australia, Ecumenical Advocacy Alliance, Edmund Rice International, International Catholic Child Bureau, Medical Mission Institute Würzburg – Catholic Advisory Organization for International Health, and Trócaire.

With regard to the report “Strategic Use of Antiretroviral Medicines for Treatment and Prevention of HIV” presented before the Programme Coordinating Board of UNAIDS, we would like to affirm, in particular, that “antiretroviral therapy is first and foremost about safeguarding the fundamental Human Rights to life and to health of people living with HIV”, and “[…] is
about transformation of communities and societies by restoring health, dignity and respect of people affected by AIDS.”

Moreover, we note with much concern that “children and adolescents represent the only population among whom AIDS-related deaths are increasing” , in particular due to lack of antiretroviral child-friendly fixed-dose combinations specifically adapted for resources-limited settings.

Perhaps, an even more fundamental problem is the persistent lack of adequate financing for both prevention and treatment programmes. In fact, flat-lining budgets and funding cuts lead to backtracking of progress made, and translate into millions of unnecessary deaths.

Global statistics on HIV incidence and prevalence continue to demonstrate the need for an intensive treatment response for people living with HIV worldwide. Of the 35.3 million people living with HIV, 25.8 million are sufficiently immuno-compromised enough to require antiretroviral treatment. The fact that 9.7 million people now have access to treatment represents a remarkable achievement. However, a 62 percent treatment gap still exists, showing the need for further scale-up of treatment. Moreover, above and beyond antiretroviral treatment, there is a need for a more comprehensive and sustained response to HIV and AIDS.

Catholic Church-related organizations have been engaged in such a comprehensive response since the early 1980s. For example, member organizations of Caritas Internationalis currently sponsor or support HIV programming in at least 114 countries. Moreover, eleven of the largest organizations within the Catholic HIV and AIDS Network (CHAN) collectively spent 135 million

Caritas Internationalis is a Confederation of 164 national member organisations present in 200 States and territories of the world. They are engaged in humanitarian assistance, social and health services, integral human development, and advocacy, with particular attention to the most rural and marginalized populations.

US dollars on HIV and AIDS in 2013 worldwide. While these represent just a fraction of the overall Catholic response, during 2010, CHAN members alone served 90,000 clients on ART, 25,500 pregnant women through PMTCT, 120,000 HIV-positive clients in home-based and palliative care, 314,000 clients in voluntary counseling and testing, 52,000 orphans and vulnerable children, and 5.5 million people through prevention initiatives.

Surveys conducted by both the Catholic HIV and AIDS Network  and the Ecumenical Advocacy Alliance showed that most faith-based organizations have been experiencing funding shifts since the end of 2009. The impact ranges from patients being forced off treatment, to agencies being unable to enroll new patients in treatment programmes, to staff layoffs and reduced programme outreach.

For example, since 2007, the Nsambya Home Care Programme in Kampala, Uganda, a Catholic community-based organization providing home-based and palliative care to 11,000 clients, ART to 5,000, voluntary testing, HIV prevention, and care and support to orphans and vulnerable children, has experienced a cut in nearly 75% of its total funding. Trained staff has been laid off, and medication and supply inventory is now held to a bare minimum. As a result, in the past few years Nsambya has been unable to enroll new clients on ART unless people already on treatment pass away, nor are they able scale up services to meet the demands of people in need of treatment but not already enrolled in ART programmes.

The need for uninterrupted and dependable sources of funding is critical for an effective and strategic HIV and AIDS response. Many organizations have no guarantee of funding beyond the current fiscal year, and equally worrying, many have experienced significant delays in promised funding. This uncertainty makes the implementation of services extremely difficult while, simultaneously, donors demand greater efficiency.

Moreover, wider care and support remains equally as critical as ART, but regrettably has not received the attention that was promised by its inclusion in the universal access. Although it is considered the third pillar of Universal Access, care and support is scarcely accounted for in formal, funded national AIDS responses or policy-making. At the global level, HIV care and support is not listed as a priority for many international institutions and donors. Therefore the work of community and family caregivers and home-based care organizations has remained largely invisible and inadequately supported.

In order to facilitate an effective and strategic use of antiretroviral medicines for treatment and prevention of HIV, we ask governments, UNAIDS, and other relevant stakeholders to fully respect and fulfill their commitments to HIV and AIDS treatment, care and support. We call on them to maintain long-term funding commitments; to provide comprehensive and integrated programming for adults and children living with or vulnerable to HIV infection; to build, strengthen and sustain human resource capacity; and, in particular, to improve support for infected and affected children.

Offline Observer’s Statement of Intervention on AIDS Response in The Post 2015 Agenda – Caritas Internationalis

Blog18 December 2013 by Suksma Ratri[PDF][print]

Due to time constraints and the discretion of the Chair, unfortunately several Civil Society Observers were unable to deliver their intervention during the meeting. The NGO Delegation’s Communication & Consultations Facility hereby facilitate and assist the Civil Society in getting other platform of advocacy via this website.

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by Caritas Internationalis

Oral Statement under item 3 – Update on the AIDS Response in the Post-2015 Development Agenda) submitted by Caritas Internationalis (International Confederation of Catholic Charities), Association Community Pope John XXIII, Caritas Australia, Ecumenical Advocacy Alliance, Edmund Rice International, International Association of Charities, International Catholic Child Bureau, Medical Mission Institute Würzburg – Catholic Advisory Organization for International Health, and Trócaire.

Caritas Internationalis delivers this statement in collaboration with the following co-signing organizations: Association Community Pope John XXIII, Caritas Australia, Ecumenical Advocacy Alliance, Edmund Rice International, International Association of Charities, International Catholic Child Bureau, Medical Mission Institute Würzburg – Catholic Advisory Organization for International Health, and Trócaire.

The co-signatories believe that the AIDS response in the Post-2015 Development Agenda needs to aim toward completion of the positive results already attained through such public health interventions as development of more effective testing and treatment and universal access for all in need. Complete change in focus and priorities should be avoided or we risk additional outbreaks of generalized epidemics of life-threatening infectious diseases such as HIV.

The international community also should promote an integral system of care that prioritizes community-based primary care, and includes prevention of vertical transmission as well as treatment, in particular for HIV-positive children, children living with HIV/TB co-infection, and their mothers. Such care also should be holistic in focus, attending to the needs of the whole person, including physical, emotional, and spiritual needs.

Of particular concern in this regard is the situation of HIV-positive children, and children living with HIV/TB co-infection. Despite evidence that treatment is very successful in such children, even in resource-limited settings, there remain significant obstacles to expansion of ART access for children living with HIV. In fact, the 2013 UNAIDS Global Report estimates that globally “HIV treatment coverage for children (34%) remained half of coverage for adults (65%)”. As a result, 30 HIV-positive children under 15 years of age die every hour.

For children living with both HIV and tuberculosis (TB), the situation is even worse: despite the fact that TB remains the main cause of death among children with AIDS, paediatric drug formulations are not available to treat HIV/TB co-infection in children.

The Post-2015 Agenda should take into account and aim toward positive policies and practical actions to eliminate the negative social, economic, and political determinants of poor health, including poverty, poor quality education, insufficient or improper nutrition, conflict and violence, in order to assure quality of life and living conditions that promote and assure health for all.

Furthermore, Caritas Internationalis and the other co-signatories point out the need for the Post2015 Development Agenda to acknowledge and support the key role of civil society and, in particular, of faith-based organizations, in addressing the health needs of isolated populations,

Caritas Internationalis is a Confederation of 164 national member organisations present in 200 States and territories of the world. They are engaged in humanitarian assistance, social and health services, integral human development, and advocacy, with particular attention to the most rural and marginalized populations.

Dr. Karusa Kiragu, The Global Plan for the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive, presentation given in conjunction with the Catholic HIV/AIDS Network meeting, 13 October 2011  of those living in “Failed States”, of those affected by generalized violence and long-term emergencies, and aim to ensure adequate resources to non-State actors engaged in health care in places that are not reached by the public health system.

Offline Observer’s Statement of Intervention on AIDS Response in Post 2015 Agenda – Stop AIDS Alliance, Ecumenical Advocacy Alliance & Interagency Coalition on AIDS and Development

Blog18 December 2013 by Suksma Ratri[PDF][print]

Due to time constraints and the discretion of the Chair, unfortunately several Civil Society Observers were unable to deliver their intervention during the meeting. The NGO Delegation’s Communication & Consultations Facility hereby facilitate and assist the Civil Society in getting other platform of advocacy via this website.

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This statement is made on behalf of Stop AIDS Alliance, the Ecumenical Advocacy Alliance and the Interagency Coalition on AIDS and Development (ICAD).

We acknowledge UNAIDS’ role thus far in positioning HIV within the Post-2015 framework negotiations.

As the new Post-2015 agenda becomes increasingly defined over the course of 2014, we call upon UNAIDS and member states to ensure strong political support to keep HIV at the forefront of the agenda, with concrete targets and indicators to protect and propel the gains we have made thus far.

Through this statement, we highlight three key areas where we call upon UNAIDS for its strong voice and leadership:

  • To actively engage with the WHO and World Bank coordinated process on a Universal Health Coverage monitoring framework to ensure transparency and the meaningful engagement of civil society in identifying and developing the principles and indicators to be included in this this monitoring framework.
  • To promote strongcommunity systems as critical in fulfilling the right to health and to sustainable responses to HIV, TB and malaria. Community systemsneed to be supported as a fundamental part of health systems and as a core element of the post-2015 agenda.
  • To strengthen coordination with other UN agencies, to increase direct engagement with UN Member States, and to support civil society mobilization at the country level to enable increased civil society participation in the Post-2015 process, including community engagement and networks of key populations. And to ensure that UN processes include KP and CS perspectives.

Civil society has played a key role in the Post-2015 process through regional and global consultations and through our involvement in the UNGA in September 2013. The  outcomes and key messages of which are presented in the PCB document supporting this session. Wewill continue to play a critical role in advocating for concrete targets and indicatorson HIV in the new Post-2015 Frameworkand look forward to working alongside member states, the UN, particularly the UNAIDS secretariat and its co-sponsors, and the Lancet Commission to ensure strong political and financial commitment to achieve an AIDS free generation.

Observer’s Intervention on Strategic Use of ARVs and Technical Support Coordination – Global Network for Sex Work Project

Blog18 December 2013 by Suksma Ratri[PDF][print]

by Ruth Morgan Thomas – NSWP

We welcome the explicit acknowledgement of the need for governments to ensure equitable access to HIV treatment for members of key populations who have, in reality, been excluded from HIV treatment programmes. To date, estimates to achieve equitable access for sex workers would require a 12 to 13 fold increase in access to treatment.

In order to realise equitable access, we need to address the structural barriers created by hostile legal and policy environments, including those created by criminal laws but also sometimes by public health legislation that requires mandatory registration, testing and treatment of sex workers and that prevent drug users from accessing both hepatitis and HIV treatment while the continue to use illicit drugs.

In addition, there is an urgent need for investment in community-led organizations and programming as the most effective way of addressing inequitable access and scaling up rights-based HIV testing and treatment for female, male and transgender sex workers and other key populations, namely gay men and other men who have sex with men, people who use drugs and transgender people.

On the Technical Support aspect, we also urge the role of global and regional key population networks and community-led organizations to be recognized as experts and providers of technical assistance in ensuring that the needs of our communities are appropriately included in concept notes for the roll out of the Global Fund New Funding Model and that we are seen as critical partners in the provision of technical assistance.

Observer’s Intervention on Strategic Use of ARVs – Pangaea Global AIDS

Blog18 December 2013 by Suksma Ratri[PDF][print]

by Ben Plumley – CEO, Pangaea Global AIDS

(an international technical cooperation agency based in USA and Zimbabwe)

 

Firstly, thank you to the PCB NGO delegation for sponsoring me to make a short intervention.

I would like to commend the UNAIDS cosponsor lead agency on treatment, WHO, for its 2013 comprehensive HIV treatment guidelines, which are possibly the most important milestone in the AIDS response in 2013, and which call for gold standard treatment for all people with HIV in need, regardless of where they live, and regardless of what age they are. International technical cooperation agencies, networks of people with HIV and their supporters, will work closely with all partners to help implement and sustain these standards of care.

However, the global AIDS epidemic is far from over. Many of us consider that it remains one of the greatest health, social and economic challenges of our generation. The response must be integrated into other health and social priorities, but  the sustained and strategic use of ARVs will be a central component of a long term response: Such a response needs to provide life saving medicines for all those in need throughout their lives, and will help us prevent a second wave of epidemics. It is a response that must be sustained throughout the life times of all of us in this room, if not also those of our children.

We urge UNAIDS PCB to ensure that the Joint Program prioritizes access to ARVs in treatment and where, appropriate, in prevention in its advocacy, policy and technical assistance.  This should be

a)      Evidence informed,

b)      Rooted in the human rights of people living with and at risk of HIV, and

c)       Designed to strengthen the national ownership of citizens and the authorities which they elect to represent them, particularly as it relates to health service delivery at facility and community levels.

Specific strategies have to be developed for girls and women, and key populations such as Men who have sex with Men, Injection Drug Users and Sex Workers. Very simply without strategies designed for and with these communities, there will be no long-term successful AIDS response.

There is cause of optimism, for example the Zimbabwe AIDS response which is well on its way to provide universal access to all its citizens in need of ARVs by 2016. For the global solidarity needed to support country leadership, the continued support of the US people for PEPFAR is an example.

One comment about the pricing of ARVs. There is some emerging experience that the pricing of the fixed dose combination of tenofovir, lamivudine and efavirenz produced by generic manufacturers may be higher than the price of the individual components.  This would go against public commitments made by originator and generics companies, and will hinder national and global funding efforts to scale up treatment. We hope that UNAIDS, through its UCCs, its partners, including the Global Fund, UNITAID and PEPFAR, monitor this closely.

Observer’s Intervention on Strategic Use of ARVs – International Network of People Who Use Drugs

Blog18 December 2013 by Suksma Ratri[PDF][print]

by Eliot Albers

Whilst we very much welcome the acknowledgement that “communities are vital partners in ensuring the success of the strategic use” of ARVs, and the need for equitable access to therapy for key populations – people who inject drugs,  gay men and other men who have sex with men, transgender people and sex workers. We remain concerned at the lack of a realistic assessment of the extent and severity of the barriers that keep members of key populations away from health services or that actively deny them access to those services.

As members of criminalised, stigmatised and discriminated against communities these barriers are considerable, and in some countries seemingly insurmountable. The legislation that makes us so vulnerable is actively stymying the ability of members of our communities from accessing those services, both treatment and prevention when they are available. These barriers are not occasional but systemic and include the refusal in many countries to provide ART and HCV treatment to currently active injecting drug users.
Whilst we have long known what is needed to prevent HIV transmission amongst people who inject drugs, all too often those services  - needle and syringe programmes, and opiate substitution programmes primarily, are in many countries either illegal or provided at a level that is nowhere near to appropriate scale. Where they are provided, the lack of  integration between these services and normative human rights guidance means that often accessing such services is to lay oneself open to police abuse, arbitrary arrest, and violence. People who inject drugs are often picked up by police officers on exiting needle and syringe programmes and harassed for having the essential prevention tools that they provide  in their possession. The same applies to sex workers, arrested and harassed for carrying condoms.
According to the most recent data only 4% of PLHIV who are injecting drug users are on ART (an estimation, I should note, that was made prior to the release of the 2013 consolidated guidelines and so is in fact likely to be considerably lower). That the figures are so low is clear evidence of the severity of the structural barriers preventing members of my community from accessing treatment.
If we are so seriously address these barriers we need to ensure in the short term that legal services are widely available to people who use drugs (and other key populations), that community based organisations are properly, sustainably resourced, and that global and regional key population networks are recognised and resourced to provide technical assistance  to our communities in country dialogues and other Global Fund processes, we call for prevention services to be monitored to ensure that they are compliant with, and do not breach, human rights norms. In the longer term, the global legal system that sustains the war on drugs approach needs to be comprehensively debated, and ultimately ended, as it is now beyond question that it is this approach that is driving the twin epidemics of HIV and HCV amongst the injecting community.
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Representing Civil Society on the UNAIDS Programme Coordinating Board