44^th

UNAIDS PCB Meeting

Thank you Chair,

As we meet at this pivotal time at UNAIDS, we would like to thank the Interim Executive Director for her report, but also equally important is to thank the entire UNAIDS staff for “holding the line,” and to all PCB members – including the co-sponsors and my fellow PCB NGO colleagues that, through different working groups and committees, carried on the most important message we can send to the world in this moment: a message that the mission of UNAIDS is still absolutely relevant, to respond to an epidemic that, let’s be frank, at the current speed, will be far from over.

We acknowledge that none of the “collective results” presented here were easy to accomplish, but we see that we are moving forward with complex change processes at the organizational level.

A stronger UNAIDS is a matter of urgency, and complacency has no role in the future of the response. Therefore, we can’t give – or accept – excuses. It is time to be sharp in reaffirming that ending AIDS is not only one part of the global sustainable development agenda equation, but it is a crucial piece for promoting human rights for all, in all countries. We are glad to hear the words of recognition, from the acting executive director today, but also yesterday during a series of bilateral meetings we had, with different member state constituencies, about the crucial importance of our communities in all results we have accomplished so far. After all, If there is something that we have already proven to the world in this response, it is that the meaningful participation of people living with HIV and those affected by HIV and AIDS,is, and will forever be fundamental to the solutions and responses implemented.

So this PCB requires many agreements from us, but there is one of them that we can not give up: UNAIDS and member states must continue investing in the human-rights based and community-led responses. It is still more relevant nowadays, when the programmatic focus – both from donors and national governments – demand to address structural and social barriers; resulted from growing nationalism, political instability, and a deliberate rejection of science in many countries; and when there is a growing lack of sustainable funding for community-led organizations – including in Latin America where most countries rely on domestic funding for the AIDS response – and when, in the globe, countries that were role model in the AIDS response are now backtracking.

Yes, community-led organizations ARE social enablers for ensuring the AIDS response meets the needs of the people most affected by HIV, including protections for health, sexual rights, reproductive rights and other human rights.

But, what cannot be quantified cannot be counted, and what cannot be counted cannot be considered in policies or in budget allocation.

So, we are happy to share that last week, UNAIDS convened a space for networks of people living with HIV – including women and young people, gay men and other men who have sex with men, people who use drugs, sex workers, transgender people, people affected by TB, women, and treatment access activists – to lead the way we define our community-led responses and key population-led responses based on our own perspectives and diversity. It was followed by a three-day multistakeholder technical consultation to, for the first time in our history, define targets for social enablers, as part of the series of consultations to estimate the impact and resource needs for the 2021-2030 global response.

So, in times of failures in many countries to provide comprehensive, evidence-based HIV prevention, and growing concerns about HIV incidence among key populations, including young women and girls, it is essential to strengthen the capacity of the organizations and communities that, when responding to AIDS, are also fighting inequalities in difficult political contexts that are undermining the entire Agenda 2030. Invisibility, silence, stigma and discrimination have killed enough people.

It is time to not only to recognize but to really invest in those who deliver on the commitments to implement human-rights, people-based and community-led responses to AIDS. And only a stronger UNAIDS, with a strong leader in place, can do that.

I wish us all a harmonious, supportive, and fruitful PCB. Thank you.

Firstly, I would like to start by thanking the Acting Executive Director Gunilla Carlsson for stepping up during this crucial time of transition for UNAIDS. At this vital juncture, UNAIDS must equally be inward looking and outward facing. It must model itself on the key values that are core to the success of the AIDS response- transparency, accountability, inclusion, equality and respect in all our diversity.

I would like to echo Gunilla’s reminder that this is not a time for complacency but for urgent action and leadership. It is a reminder of what is at stake here at the 44th PCB- not just the future of UNAIDS, but the future of the global HIV and AIDS response. It is a reminder that so much rests on how we move forward at this meeting. We must be united in our focus and goal of ending AIDS by 2030.

This is the June PCB where the important housekeeping for UNAIDS occurs. We must ensure there are adequate funds and investment to keep our house running optimally through a fully funded UBRAF. We must ensure budgets are adopted to maintain momentum and ensure gains are not lost. We must protect the people within the house, and those that serve in it through progressing the Management Action Plan. We must adhere to agreed processes in our consideration of the search for the next Executive Director. Without all this in order, the house that so many of the most marginalised depend on for light and shelter cannot function.

Let us not forget why we are here. I urge you to maintain your sight on the broader vision that we all want to achieve. As key populations our lives depend on it.

I would like to commend the acting Executive Director, Gunilla Carlsson, in her statement on the importance of remembering where we are in the AIDS response – that it is far from over, and the end of AIDS is not near.

Over the past few years, we have spoken about scaling up prevention. A global coalition was formed to accelerate HIV prevention and strengthen the political commitment to ensure access to primary prevention. Despite the global efforts that have been put together, impact at the country level is lacking. We are not moving to where we want to be, and in some cases, we are moving backward quite quickly.

I have mentioned this in my interventions in previous PCB meetings, and I will not rest until there are changes. So please allow me to address a few issues as a reality check.

Countries in our region remain vulnerable to an increasing trend of new HIV infections. Over the past few years, we have seen an increase in the number of new infections in countries like Bangladesh, Malaysia, Pakistan, the Philippines, and Papua New Guinea.

People living with HIV do not have access to life-saving treatment. Despite the overall achievement on the adoption of the WHO guidelines of Test and Treat, 8 million people do not have access to ARV. This includes countries that are lagging behind in treatment coverage including Madagascar, Pakistan, South Sudan, and Indonesia with 7, 8, 13 and 15 percent respectively.

Structural barriers remain key to achieving the 90-90-90 targets, but they also remain forgotten and neglected. Let’s agree that young girls and adolescent women, as well as boys and young men, will remain vulnerable if they do not stay in school and are not well-informed of sexual reproductive health and rights. More and more countries have recently upheld punitive laws on same-sex relationships and HIV disclosure. People who use drugs remain criminalised, and difficult discussions on harm reduction and drug decriminalisation are often off the radar. As a result, we see funding for harm reduction services continuously shrinking and people who use drugs do not have access to clean needles and syringes, including life-saving naloxone, and prisons remain overly populated.

As we move towards increased domestic funding, let’s not forget that our communities are continuously left behind. Transgender persons continue to be excluded in the HIV response because countries fail to acknowledge and include them in their datasets. Stigmatization and discrimination against sex workers and their family members continues. Many of their children have no access to citizenship which also leads to effective exclusion from schooling, from healthcare, and in some cases from social support.

For the first time, 24 years since its inception, UNAIDS is looking at setting targets on social enablers. Moving beyond just intention towards actual measurable actions. Additionally, with the support from the Global Partnership to eliminate all forms of HIV-related stigma and discrimination, we are hoping that we can finally walk the talk.

It is not the time to be complacent.

As we continue our conversation around the quality of leadership, management of UNAIDS, and the performance of the Joint Programme, I ask you to remember two things: People still die of AIDS. And there remains a lot to do.

It is an exciting time as the world looks forward to meeting in my country Kenya, and in my home of Nairobi for ICPD+25. In 1994, I was the same age as my three-year old daughter when the governments signed the ICPD Programme of Action. This agreement placed human rights at the centre of sustainable development, and recognised reproductive rights as human rights and also addresses structural issues related to HIV responses.

We know that when people, especially young people, are empowered to make their own choices about their sexual and reproductive health– free of force, coercion, and fear – the whole world prospers. I say, when women and girls have the agency, information, and access to make their own choices, especially on reproduction, the whole world prospers.

We want you to know that youth-led and youth-serving organizations from around the world, are committed to supporting UNFPA to make sure that young people are meaningfully engaged before, in, and after the Nairobi summit. We look forward to more clarification on the financial and administrative support for youth to do so.

Speaking of the sexual rights and reproductive rights of women and girls in our diversity, we recently had the results of the ECHO trial, which bring to light the magnitude of HIV risk for women and girls in Africa. These results remind us we are still far from realizing the ambitions and vision of the first ICPD. Young women in the trial still acquired HIV at unacceptably high rates despite getting the best HIV prevention package on offer and being enrolled in the trial because they were seeking contraception, not because of their HIV risk profile.

I welcome the research as the trial DID demonstrate that a diversity of contraceptive methods are possible however the same contraceptive methods my mother had could be the same choices (or lack of choices) her granddaughter has when she becomes of age. If that does not make you sad, it terrifies me to imagine she will not appreciate being a woman fully because of the constant sad experiences she will have to battle with as I have to. Why do we still have contraceptives methods that I can count on one hand so many years later? Why do I still have to be denied Dolutegravir, the best ARV in Africa now because of my reproductive potential when access to contraceptives is still a challenge and choice is only when you can afford it?

It’s time to deliver on the promise of ICPD as we have had a generation of girls growing up like me and we don’t see the changes that we need for ourselves or our daughters to fully embrace and enjoy our sexual and reproductive health and rights. And it’s time that we open the doors of this promise of sexual and reproductive health and rights to everyone. Signing on to an agreement is one thing, making it work is what carries the day and makes sure change happens.

Thank you.

Thank you Chair,

The NGO Delegation welcomes the MAP as a crucial tool in bringing about a necessary cultural change within the organisation in order to transform UNAIDS into a workplace with zero tolerance for bullying, abuse of power, or harassment (including sexual harassment).

We would like to thank the chair of the Working Group for the excellent report, that under her skillful leadership reached consensus on most of the discussed items within the TOR, and did so within a seemingly impossible timeline.

We note with appreciation that since the last PCB in December, much has been improved in the way leadership is addressing these issues. We commend the Secretariat for the transparent process, including the involvement of staff in every step of the way in shaping the MAP.

We remind those inside and outside UNAIDS who seem to think we should now put this issue behind us, that inequities in power, and their abuse, are not marginal to the work of UNAIDS, but stand at the very centre of the global epidemics. We must model inside UNAIDS the world we want outside.

Moving to three crucial issues on which there is yet no consensus:

Standard of proof in harassment cases

It is imperative to act on this as swiftly as possible, and to consider moving to a system that applies different evidentiary standards in a proportional manner so that the standard of proof required is proportionate to the gravity of the ensuing disciplinary action. To continue to apply “beyond reasonable doubt” to all cases is to continue to weigh the system against those reporting abuse and to discourage reporting. The speed at which the greater UN system moves cannot be a brake on UNAIDS creating a just and functional workplace.

Better Board Functioning

The Delegation agrees with the many PCB members who feel that the PCB needs to improve its governance in ways that fulfill its responsibilities to staff and brings it closer to accepted global, and UN best practices. This needs to happen not at some distant time in the future, but with urgency. It may not, however, need to happen here and now at this PCB session. We will, within a matter of weeks, have a new Executive Director. One of their key management priorities will be to take leadership and manage the changes already begun. Let us establish our relationship with the new ED and take urgent collective action on governance.

Support to the PCB

It is self-evident to the NGO Delegation that this body needs a dedicated capacity to support our responsibilities. We strongly call upon the PCB to request the Bureau to draft a TOR for such a capacity and to bring them back to us via intercession.

In conclusion, moving a culture to put staff and a healthy working environment at the centre of UNAIDS’ work is not like switching on a light. Cultural change here, as in all organisations, is a marathon and not a sprint. It will require stamina and endurance for the change to be effective, to be lasting, and to be sustained. But effective, lasting and sustained change is what we need for UNAIDS to become the UNAIDS we all need.

Thank you Mr. Chair:

As my NGO colleague from Latin America and the Caribbean highlighted, the secretariat has already embarked on the implementation of the Management Action Plan (MAP). The report on the “Update on Strategic Human Resources Management Issues” indicates that the secretariat views the MAP as an opportunity to implement new, creative and effective approaches in human resource management, to ensure a reinvigorated, strengthened and thriving workforce that a stronger UNAIDS requires. In addition, UNAIDS also has a comprehensive 5 year Human Resource Strategy with investments in staff development to strengthen performance; support collective leadership in an enabling environment that upholds staff dignity and accountability to support a collective vision that would lead to a strengthened UNAIDS.

However, we noted in the update that UNAIDS has lost more than 25% of its workforce between 2011 to 2018. Meanwhile, we have continued to build a very ambitious HIV agenda that keeps expanding to ensure that we end AIDS by 2030. We also know that this ambitious plan has not been accompanied with increased funding, instead, we have seen significant reductions, jeopardizing UNAIDS ability to deliver an optimized response. We are concerned that changes in funding have major impacts on job losses, result in overburdened staff, leading to frustration and poor morale. A strong human resources management strategy calls for sufficient financial resources to ensure that UNAIDS is staffed adequately to meet its mandate.

As my colleague mentioned, from 2013 to 2018, there was only an increase of 2% in female staff at UNAIDS and a notable absence of Trans people. We have been calling for the integration of GIPA/MIPA in the HIV response for many years to ensure that those impacted by HIV, particularly those from key populations, are included in leadership positions in organizations and institutions working with them. As an example, in the organization where I work, we deliver primary health services to immigrant and refugee women from the global South and they populate all levels of the organization. This is GIPA/MIPA in practice. We are calling on UNAIDS to ensure , an intersectional approach based on gender, race/ethnicity, sexual orientation, geography, etc. as part of the human resource management strategy.

Finally, we also noted a number of issues around hiring of new staff including: the long duration of time it takes to fill vacancies, issues around job mobility, as well as competency and leadership gaps, which all require attention. A strong UNAIDS needs to ensure that the human resources management strategy is grounded on principles of justice, fairness and transparency to foster cultural competency and build leadership skills while supporting a work/life balance.

We call on donors to ensure that UNAIDS is adequately resourced to ensure a reinvigorated, strengthened and thriving workforce, so that the UNAIDS we need responds effectively to the response and leaves no one behind.

Thank you.

Thank you for the opportunity to speak, Chair.

The NGO Delegation supports the UNAIDS Secretariat Staff Association and are gratified at seeing the overall staff satisfaction with the changes at UNAIDS, including the adoption and start of the Management Action Plan. We see the well-being of the staff as integral to strengthening UNAIDS.

Culture changes are required to ensure that these goals are met. Culture change in terms of how people interact with each other, as well as the workload expected of them. We are heartened that UNAIDS is moving in this direction. Work cultures do not move with just policy adoption, they do when staff from all levels are engaged and encouraged to alter how they interact with each other and their workplace. We expect that the Management Team, with the addition of the Deputy Executive Director and the Director of Human Resources, will achieve these results.

As we have noted in our interventions, power must be attended to in the workplace, whether it’s hierarchical power because of differing positions or power inequalities due to identity. A minority in my own country – I am gay, a racial minority and living with HIV- I am all too familiar with how our identities can be weaponized in the workplace, how people will overlook the power dynamics in the ways they can abuse or ignore our needs. I am also painfully aware of the difficulty in proving this, and I empathize with those staff who have experienced this in the course of doing their jobs. In a human rights-based and just world, people should not be treated poorly for coming to work.

As the PCB, we have to support the culture change. For the past few years, we have expected UNAIDS to achieve the same level of work with a drastically reduced budget. We have to make accommodations in our expectations based on realistic assessments of jobs, positions, and assignments. We cannot ask UNAIDS to advocate for human rights on the one hand and then expect on the other that the staff work well above and beyond the normal work week and their assignments.

It is clear that mobility and transparency remain key concerns for the USSA. We need the right skills, the right standards and the right people doing the important work of UNAIDS. We look forward to seeing how these challenges are resolved with the appointment of the new Executive Director.

Finally, as someone living with HIV, I want to encourage UNAIDS to incorporate the GIPA principles more fully moving forward – not just with rhetoric but with action. We need to value the contribution of staff living with HIV and from key populations. The lived experiences of people living with HIV and other key populations are important in making the UNAIDS we need.

We welcome the report and decision points of the 43rd PCB Thematic Segment on mental health and HIV/AIDS––promoting human rights, an integrated and person-centered approach to improving ART adherence, well-being and quality of life.

It is important to implement evidence-based, people-centered, human rights and community-led policies and programs in relation to mental health and HIV. These cannot occur without addressing the social determinants of health – including the legal barriers to accessing HIV and mental health services, prevention, treatment, care and the negative impact of criminalisation of HIV, people living with HIV/AIDS and all our key populations – on mental health and on our Quality Of Life.

People living with HIV with mental health issues face multiple stigma and barriers to accessing HIV services, prevention, treatment, care and support. People who use drugs face overwhelming lack of appropriate services and support, unacceptable levels of stigma and discrimination, and daily fear of criminalisation.

Our Delegation wants to see these Decision Points effectively translated in the global and national HIV response. Mental health issues should be included in policies in order to promote the quality of life of people living with, at risk for and affected by HIV, key populations, including young people, women, girls and adolescents.

We ask for integrated and intersectional approaches on mental health and HIV in the upcoming new strategy of UNAIDS and in National Strategic Plans – and that they be developed and implemented with meaningful engagement and leadership of community-led organizations.

We also would like to see efforts and resources for sustaining and improving mental health, including preventing burnout of HIV and other service providers, among them health care, outreach and community workers.

We call on Global Fund, PEPFAR, development partners, and Member States, to commit funds in support of people-centered, rights-based and evidence-based integrated strategies and services for addressing mental health and HIV, stigma and discrimination and quality of life.

The most precious thing in the world is human life. We are now living longer lives due to the benefits of access to ART, prevention programs and services. Let us live this long life, with quality of life- without stigma and discrimination, without criminalisation, with respect regardless of our diversity or choices. You, who are in this room, can make this happen. Just strengthen your effort, your courage, political will, investment and collaboration. When you return to your countries, please remind your governments that all people have a basic right to live how they choose.

We cannot end the AIDS epidemic without tackling mental health issues, and addressing legal and policy barriers for all.

Thank you Chair,

We thank the Secretariat for the effort to give the PCB overview of the current state of the HIV epidemic. UBRAF contains a wealth of information about almost every aspect of the elimination of HIV and AIDS. It shows us where we’re on track – but also where we fail and where key populations are continuously left behind despite promises of many member states and UN Agencies that they would do everything in their power to prevent exactly that.

Let’s be frank: the reality is still shocking and inequality continues to feed this epidemic. As a gay man living with HIV and thus a member of a key population, I know how important good quality data is for community engagement and advocacy. It is imperative that harmful policies of member states, like criminalising HIV transmission, sex work or drug use, need to be amended or abolished. We have to show the detrimental effects of such policies on the lives of people living with HIV. In many countries, we can only fight for that with policymakers based on data. So it is concerning that, at this point in history, besides fighting for accurate data, many governments are not considering their epidemic’s key populations when defining their budget and allocating funds. UBRAF is quintessential in holding member states and UN organizations accountable for the targets they agreed on in the 2016 Political Declaration to End AIDS as a public health threat by or before 2030.

However, UBRAF also shows us only one side of the coin due to the way targets are formulated. Although many indicators appear to be in the green zone and exceed the 2019 milestone, the reality is often very different. 93% out of the 90 countries that supplied data for UBRAF have adopted the treat all policy which, in itself, is a fantastic achievement. But simply adopting the WHO treat all guidelines doesn’t deliver ART magically to people who need it. If I would live in Indonesia instead of the Netherlands, 85% of my friends would not be on treatment although both countries have similar treatment guidelines. We appreciate the work done in Venezuela, but I want to stress that it had to take massive pressure from civil society for the UN to act AND people are still dying in Venezuela.

Furthermore, we see that some indicators, specifically those about sexual and reproductive health and rights, are exceeding 2019 milestones, yet we know they are either stagnant or continuously on the decline since 2016.

Mister Chair, as many of my colleagues have already stated, this is no time for complacency. UBRAF is a wake-up call for those under the impression that we are on track to reach our 2020 targets. We are leaving too many key populations and women and girls, including adolescent girls, behind. It is high time that Member States, the Joint Programme, and the Cosponsors redouble efforts in putting the last mile first in reaching the most marginalized populations in the effort to eliminate AIDS by 2030. We won’t accept excuses for failing on that. You can do better.

Thank you, Chair.

The NGO Delegation acknowledges the new format for UBRAF. Even though the information is spread out across several reports, it is easier to find the kind of information you need.

What does financial reporting have to do with Civil Society? Quite simply, it gives us a way of seeing how resources are accrued and spent in the UNAIDS context. We see some of the politics of resourcing at UNAIDS and where there are shortfalls. And civil society suffers in these shortfalls.

As our delegation has said over and over again, we need to restore full funding to the UNAIDS UBRAF as crucial for leveraging the full potential of the Joint Programme and accelerating progress towards the goal of ending the AIDS epidemic by 2030. Without full funding, this goal will remain a mirage in the distance. But, besides doing the housekeeping and restoring the UNAIDS credibility among donors, we need to lead UNAIDS to a sustainable and secured financial situation. At the heart of it, we assume we all share the vision that the HIV response remains a critical issue for our time.

We do note that there remains a lack of clarity in monitoring mechanisms for tracking resources involving community-led responses. When we see such little funding going to gender and gender-based violence, as well as stigma and anti-discrimination efforts, we wonder at how we reach a discrimination and stigma-free world.

The NGO Delegation urges the Joint Programme and Member States to increase the investment in civil society and community-led initiatives and their involvement in decision making. After the meetings last week on target setting, UNAIDS is well on its way to developing a classification for community-led work, and we look forward to seeing the results of these meetings, as well as how UNAIDS can support Member States to resource community-led efforts regionally and locally.

We also are cautious about the challenges faced by middle-income countries and the country transition plans. Country transition plans must take into account the political landscape on the ground. In places where conservatism is on the rise, key populations and women and girls rely more and more on civil society networks and organizations to find support and access to key services. And in these contexts, civil society is actively being defunded and restricted. We have an intimate understanding of where the shortfalls are in the field: we have to survive in them. Advocacy and human-rights efforts must be upheld in order for key populations and women and girls to thrive. In the 68 countries that criminalize homosexuality, for instance, where do you imagine I would go to get my HIV care that would be safe and free of stigma and discrimination?

Mr. Chair, today marks the international day against drug abuse and illicit trafficking. Allow me to take this opportunity to recall the number of people who have died in the war on drugs, because countries have failed to provide services and protect the rights of people who use drugs. 450,000 drug-related deaths were recorded at the end of 2015, a dramatic increase of 150% compared to 2009. A reported 27,000 people have been killed in the Philippines as a result of a crackdown and extrajudicial killings. A record high of 71,500 overdose related death in the US, 4,000 in Canada and 9,000 in Europe in 2017. Our communities have been pushed to the margins of society, harassed, imprisoned, tortured, denied services, and in some countries, executed.

An estimated $100 Billion are spent annually to reduce the supply and demand for drugs which have not resulted in a reduction in the number of people who use drugs. When evidenced-based programs such as harm reduction, remain underfunded in many countries, people who inject drugs are made more vulnerable. As we speak today, many people in different parts of the world are being executed. As a person who uses drugs and as someone whose life has been saved by harm reduction services, I ask you to end the war on drugs.

At the 43rd PCB, the NGO Delegation expressed its concern over the lack of participation of key populations and the community in decision making of the country envelope process. This year, unfortunately, very little progress has been made. Reflecting on last year’s country envelope allocation, it is disheartening to see that only 8% was made towards human rights program, 3% on gender and gender-based violence, and 2% on the humanitarian program. On the other hand, 32% allocation was spent on test and treatment, even as many of these 71 countries also receive funding from Global Fund and PEPFAR for test and treatment.

With many countries moving into increased domestic funding and social contracting mechanism, we note that much of this funding comes with restrictions, including social enabling activities, advocacy, human rights- and gender-related activities.

These situations clearly show the shrinking space of civil society and most importantly, the shrinking of funding for community-led responses. UNAIDS must continue to champion greater and meaningful involvement of people living with HIV and key populations in decision-making process, to ensure funding for key populations and communities.

We would also like to see UNAIDS along with UN Cosponsors engage more in difficult conversations such as harm reduction, drug decriminalisation and sexual reproductive health and rights, particularly in countries where conservatism is rising and repressive policies and practices are the norms.

As I mentioned yesterday, we cannot be complacent. We cannot do business as usual. It is time for dedicated and fearless actions as repressive politics undermine key populations globally.

I would like from the outset to make it clear that my intervention is not on behalf of the whole delegation, but as an individual delegate and a sex worker. Sex workers globally are looking forward to working together with the ED we need, to lead the UNAIDS we need.

The UNAIDS Executive Director we need, should bring an in-depth understanding of, and track record in, working with and supporting key populations as an unwavering and consistent ally -regardless of external pressures. We need an ED who recognises the central role of key population-led and other community-led organisations and networks as crucial for an effective response to HIV. They will be unafraid to speak up for the difficult and unpopular issues, and to stand up for the most marginalised- without exclusion, without exception, and without ever letting up.

If we have an ED that leaves a community behind where can we turn? Are we willing to accept that some communities less important than others are justified in being left behind?

The UNAIDS Executive Director that we need is also someone who recognises and fully endorses human rights as an integral aspect of the global HIV response. To us, this must mean unflinching support, including with funds allocated, for the decriminalisation of HIV transmission, exposure, and non-disclosure; decriminalization of same-sex sexuality and behavior; gender identity and expression; decriminalization of drug use and possession; and, the decriminalization of sex work, including a rejection of abolitionist views on sex work that, incorrectly and without evidence, conflate sex work, trafficking, and sexual exploitation; addressing gender inequity in all its forms and across the gender spectrum. The UNAIDS ED we need will be unafraid to advocate for de-criminalisations, as well as fight other forms of legal oppression of any aspect of sex work or our lives, and stigma and discrimination in driving the epidemic.

The UNAIDS ED should have a demonstrated track record of sound management and funds mobilization, as well as in effective and timely management of challenging human resources crises. They will have the ability to reinvigorate and strengthen UNAIDS at this crucial time to carry forward its coordinating and leadership functions in the AIDS response over the next decade and provide leadership and strategic vision to ensure we meet our goals to end AIDS by 2030. This all being said, my constituency has its own track record of working well with UNAIDS, its Secretariat, and its Executive Director. We fully expect to work well with any future ED, and to build constructive and collaborative relationships to ensure that all key populations are not left behind.

I thank you.

I speak this time not on behalf of the entire Delegation, but in my individual capacity as a Delegate and as a representative of positive young women from Africa.

Thank you Chair,

I speak on behalf of the NGO Delegation.

Across civil society globally, there is a wide spectrum of views on the candidates. That is healthy, and perhaps to be expected. You will hear from two of my colleagues in the Delegation who will each articulate views from constituencies they represent.

The Delegation agrees that the search process was fair, sound, well-executed, and should be applauded. Our task now is to take the product from that search and to make wise and skillful choices.

We also agreed that our next Executive Director should come from the global south. That is a non-negotiable from our standpoint. Across our various constituencies and representations, three of the five candidates stand out as the most preferred for the job. They are, in no particular order, Winnie Byanyima, Bernard Haufiku and Salim Abdool Karin.

Obviously, we need the new ED to strongly support community-led responses at all levels and take the UNAIDS community partnership to another level, so together we will continue to lead the success of the HIV response. She, or he, should be bold enough to challenge populist governments in this era where political leaders misconstrue facts or simply deny scientific evidence, and continue to criminalize key populations who are highly impacted by HIV.

In addition, the AIDS response in the past as well as in the future, has and will rely heavily on understanding the science. That is key. On a personal note, as a gay man living with HIV, I owe the fact that I’m still alive today, 17 years after I got infected, to the rigorous and steadfast application of the latest scientific evidence in my country’s public health response curbing the HIV-epidemic. If it wasn’t for scientists like Françoise Barré-Sinoussi and the late Joep Lange for instance, the world would be a darker place and many more people would have died. If it were not for communities fighting for human rights and people-centered approaches, we also won’t be here. It is therefore of the utmost importance that the next executive director of UNAIDS is steeped in both the science of the epidemic, as well as the political and structural dimensions of the epidemic.

The new ED should be a person that, definitely will leave no people with trans experience, no sex workers, no gay men and other men who have sex with men, no people who use drugs, and especially not women, adolescents and girls behind. We need a dynamic person who will lead a stronger UNAIDS as a dedicated joint programme in the achievement of the next milestone of the HIV response, to end AIDS by 2030.

The 30 years of the epidemic showed that meaningful involvement of PLHIV including women, girls and adolescents and key populations – such as sex workers, people who use drugs, men who have sex with men, people in closed settings, people of trans experience – at all stages of planning, implementation and evaluating programs increases the effectiveness of the national and global responses to HIV and other health challenges.

But let us remember that key populations in many countries are still criminalized and the lack of human rights-based and structural barriers continue to keep people away from health services. 68 countries still criminalize men who have sex with men. In many countries, abortion is considered a crime. Sex workers are subject to criminalisation and legal oppression in almost every country in the world. In these cases, the slogan “leave no one behind” will remain a rhetoric.

We can develop adequate service packages for all key populations, but we need to ensure that key populations are not left behind due the threats of imprisonment, stigma, and discrimination. Decriminalization of key groups, removal of punitive laws, access to sexual reproductive health and rights, including safe abortion, addressing structural barriers to health access, harmonization of national legislation according to the recommendations of WHO and respect for human rights must be the basis of UHC.

The other point is financing. Countries are facing barriers to transition to national funding and “middle-income” definitions hide inequalities within the countries. The UHC system assumes it can reach everyone. Think about people who use drugs and indigenous people. Countries do not keep good data on these groups, and healthcare systems often exclude them.

We urge governments to put the most vulnerable and marginalized communities in the first place. And social protection for all must be also considered in this conversation. It is with equal access for these groups that the new system must differ from the existing one. This requires changes in the policy and financing system, when socially vulnerable communities will not be faced with a choice: to pay for medical services or for food and shelter. But the question remains: how will advocacy, community mobilization, capacity development, human-rights related projects be funded?

Ensuring universal health coverage as a global goal is a good goal. But to achieve it requires the development of sustainable international exchange and cooperation, international and national initiatives that, together, will help to foster joint investments and improve collaboration. And in all of that, community-led organizations and community-led responses must be at the center of any new approach. Thank you.

There are both challenges and opportunities to integrate the HIV response into UHC. We have fought to ground the HIV response on rights-based approaches, equity, determinants of health, and sexual rights and reproductive health rights and justice. We will not compromise on any of these hard-won gains in the move to UHC.

Yet the systems we are being asked to trust and into which we are being asked to integrate are the very systems that, rather than being accessible to all, do not engage migrants, people who use drugs, sex workers, gay and bisexual men, people of trans experience, people in prison and other closed settings, and young girls. Can we really trust these systems to serve us in UHC?

As a migrant woman living in Canada, I am not a stranger to Universal Health Coverage. It is the system that serves me and other Canadians. But I was not always a Canadian citizen. I was once a woman without status and was not covered. More than 45% of women who access primary healthcare services at my organization in Toronto have no health coverage, yet they are living in the global North, in a country with one of the most comprehensive UHC plans. Having no health coverage and no income to pay for healthcare services is tantamount to a death sentence for a person living with HIV.

There are so many questions for the HIV response. I will mention only a few:
• Does the universality of UHC cover undocumented migrants and in what ways will it do that?
• How will UHC be universal in countries where both people and their health needs are criminalized?
• How will UHC be universal in places where stigma, discriminaition, and even persecution of key populations is the norm?
• What role will key populations play in planning, delivering, and monitoring of UHC?

Putting the last mile first includes answering these questions. As members of the NGO Delegation, we call on member states, Co-Sponsors and UNAIDS to ensure that the progress we have made in the HIV epidemic is not lost in the rush to UHC. UHC must be comprehensive, people-centred, and community-led. If it is not, it will never be universal.

Good afternoon, all.

My name is Devanand Millie Milton.