41^st

UNAIDS PCB Meeting

Thank you, chair.

I would like to reflect on the role that UNAIDS can take in the context of UN Reform. As we know, the UN reform is not politically neutral or merely a technocratic exercise. Bids for power and privilege lurk in every proposal, and while many experts advise for a stronger and more effective UN, some powerful Member-States are opposed to a robust institution, using their clout to block change and taking geopolitical moves against multilateralism and accountable democracy.

It was in this context that, this year, UNAIDS and the PCB NGO Delegation organized a side event at the High Level Political Forum, to share our unique governance experience and to put forward a clear proposal: to have the UNAIDS example considered and adopted by all other UN Agencies governance bodies.

And I would like to use this opportunity to thank Portugal, Botswana, Liberia, France, Jamaica and Brazil for highlighting some benefits of taking stakeholder voices at governance level, ranging from greater legitimacy and trust due to stronger accountability and shared ownership, to the promotion of social cohesion in grassroots outreach, and improving people’s experience in service delivery while fostering greater responsiveness to citizens’ needs.

But there is still a lot of work to do. And we look forward to having other Member States and Co-sponsors express support on this request at this PCB, so we can continue to discuss ways to develop this advocacy agenda further. So, this is my first point . We count on you to take this message forward to the other UN Boards you seat. At this stage, more than having new UN resolutions and guidelines, we need a UN system that delivers on the inclusive nature of the 2030 Agenda by giving such an example.

We face today an unprecedented war against human, social and economic rights. Fundamentalist forces are clearly gaining spaces in governments bodies, creating a serious damage in the context of the AIDS response. This is a reality we face in many countries, including in Brazil, my own country where actions to promote gender equality are now forbidden at schools, while GBV and attacks against LGBTI people increase all over the country.

Therefore, for the NGO delegation, it is very concerning that all reasons to take a different path in responding to AIDS are outlined in our reports, declarations, and international commitments. But power relations stop these from happening at national level. This is why AIDS is far from over. Enough of people still dying due to AIDS; enough of the lack of access to combined prevention and treatment; and enough of discrimination, violence, and human-rights violations that fuel this epidemic.

It is our role, as PCB NGO delegation to bring here the facts we deal with in our daily work. We recognize the advances but we need to highlight the challenges. So please listen to us: To continue the “business-as-usual” approach will have counterproductive consequences. These delays impede addressing the structural or root causes of the AIDS epidemic in all its contexts.

As such, my second point today is to strongly urge Member-States and the UNAIDS Joint Program to take actions toward a paradigm shift. It is important to see the energy and commitment expressed by Michel and many MS here. But it is imperative to do more and do better, including by reversing the alarming trend of shrinking space for civil society.

Indeed, strengthening civil society capacity to sustain and increase its contributions in the AIDS response should be addressed by this board as a matter of urgency. It should be aligned with an inclusive set of global, regional, and national priorities, with accountability mechanisms and indicators about effective civil society engagement, to ensure an enabling context for sustainable development and accountable governance. It is time to face reality: in order to advance we need to full engage and fully fund civil society. Otherwise, stop saying you will leave no one behind and will end AIDS.

Thank you Honorable Chair and congratulations to Ghana for your adoption of the treat all strategy to achieve 90-90-90. And thank you Michel, for your thoughtful and thorough update on the global program of UNAIDS and the overview of where we are today in the global AIDS response.  As you have stated in your remarks today, “But even with all this progress, AIDS is not yet over.”  16 million need treatment—67% of infections in 15-24 year olds are among adolescent girls and young women–1 in 5 people living with HIV report having faced discrimination in health care settings and so forth  which leads me to borrow from the theme for the 17^th ICASA—Ending AIDS—Doing differently.

Colleagues, doing business as usual is not enough. As Michel reminds us, we cannot, must not, be complacent. If we are going to identify, reach, address, serve and treat all those living with HIV and at risk of HIV infection, we need an approach that demonstrates that we are listening and prepared to ‘do differently’.  We must no longer just take note of the problem, discuss it, call for a new study, and go on to the next item on the agenda.  We cannot just report out the data from our new study, and talk about those not included in the response as though that is an intervention We need to stop. We join Michel in calling for a new strategic framework for assessing and responding to the statement – AIDS is not yet over, for those not yet reached. We cannot be complacent. The UNAIDS we need will closely examine the data concerning all those included in the phrase—AIDS is not yet over—and will work with the most affected communities, member states, cosponsors, and CSO/NGOs to chart a more affective and impactful course for addressing the gaps and needs.

We, in the NGO delegation, join you in calling for full implementation of the Fast Track strategy to end AIDS.  We believe that we need a road map for the last miles, for the communities left out on the side of the road, for those who might be on the bus, have no idea where we are going, and appear to be taken along for the ride.  We need a few new mile markers that will help all of us to not lose our way while simply focusing on the middle three 90-90-90, and on achieving all, none, or some, of the three 0’s.

To that end, we are asking consideration for a first and fifth 90.  We would like to suggest that it is time to include a first 90-90% of all those at risk for infection, and all those who are on the outside of the AIDS response—imagine capturing 90% of all those at risk for HIV — with information about HIV, guaranteed access to health care and comprehensive sexual health services, human rights protections including their sexual and reproductive rights and freedom of movement—how much closer to the end of HIV would we be, the world over.  What if the health sector could offer a robust program of comprehensive combination prevention designed to reach and serve all populations comprising the first 90? And that is why our NGO Report is focused on leaving no one behind.

And we would like to suggest a fifth 90. We must work together to ensure 90% of those living with HIV experience a satisfactory quality of life and social well-being.  We would like to suggest that the UNAIDS we need must be prepared to assist with the fifth 90% —  by addressing quality of life, social and mental health and well-being of those living with HIV.

We believe if we commit to doing things differently, we can successfully address the first and fifth 90.  We are asking ALL, ourselves included, to stop doing business as usual, and to start doing our collective business differently to end the AIDS epidemic by 2030.

Thank you.

Many thanks to UNAIDS and everyone involved for a great job. It is obvious that the new strategy for attracting resources and the country envelope mechanism is working.

But this is a global level, and we will all go to our homes and answer the question of our communities: what will change in our country?

And here it is important for us to tell UNAIDS that the joint program must be joint until the end. Primarily collaborative with communities and civil society.

We believe that country envelope planning will be more effective if communities are involved in the process. In turn, UNAIDS can involve civil society in the resource mobilization process, as, for example, the Global Fund does. But what we want is a more transparent and more inclusive process for us. We work in resource mobilization and can do more, and we want to be more involved in spending planning decisions.

The work of co-sponsors can also be more collaborative. And here we are also talking about communities. An example of the joint work of WFP and the Network of People Living with HIV in the Military Conflict Zone in Ukraine can be implemented in any crisis situation in any country. So why not support it?

And finally, we turn to countries. We urge all countries not to delude themselves that the epidemic has become controlled and concentrated in the EECA region and sub-Saharan Africa. AIDS is not ending and business as usual is not enough, we need collaboration, a transparent process and engaged work.

Dear Fellow Board Members,

As the NGO Delegation to the UNAIDS PCB, we bring unique, first-hand experiences and perspectives of individuals and communities most impacted by the AIDS Epidemic. Each year, we develop and present a report focusing on one or more issues of particular interest/ and or urgency for the communities we represent: people living with or affected by HIV/AIDS. One of the added values of having us, as civil society and communities on board, is to highlight the inequity and neglect faced by individuals and communities that are disproportionately impacted by the AIDS epidemic. Thus, this is the basis for the 2017 NGO Report –  The UNAIDS we need must leave no one behind: Getting to zero includes all of us (the 10/10/10).

One may ask, what do we need from UNAIDS and who are the 10/10/10?

As we are all aware, we are ushering in results around implementation of the UNAIDS treatment targets, or more popularly known as the 90-90-90, with some countries already celebrating successes of meeting these targets. However, when we look purposefully, we realise that some of us are being left behind and/ or are at the verge of being left out in the future because of specific barriers to our access to essential prevention, care and treatment.

In addition, earlier this year, the Joint Program embarked on the process of refining its operation model and as such, individuals and communities which have for long been at the margins of the response who wish to ride on the Global Review Panel’s recommendations, seize this moment and assume the driver’s seat moving forward.

To share with you some background, similar to previous NGO Reports, from July to August, we reached out and held consultations with almost 300 people, from all corners of the world, from all sorts of backgrounds and circumstances, all members of the communities we represent.

The vast majority of individuals who were interviewed or who participated in focus group discussions and interviews were from communities and key populations left behind. Most of our respondents were from small, local community-based organizations (CBOs), while others were from larger global, regional, or national networks and organizations. This report is not intended as a comprehensive review. However, it seeks to shed light on the realities of communities left behind, as well as to contribute to debates and strategies by presenting various viewpoints and experiences, needs and demands of key affected communities and populations that are currently left lacking.

Colleagues, not responding to the needs of those in most critical vulnerable conditions would represent a continued failure from the perspectives of equity, human rights, public health, and an adequate  response to the epidemic. We continue to document and report that, people left behind are not a homogenous group: our characteristics differ by context, but we are people living with HIV in our diversities, we are indigenous peoples, ethnic members of Key populations including transgender women, and migrant gay and other men who have sex with men, adolescent girls and young women, boys and men, sex workers from rural areas, and people who use drugs who may also be living with HIV, undocumented migrants and refugees, people in prisons and other areas of incarceration.

The extreme neglect and vulnerable conditions faced by the communities I have mentioned above, are exacerbated by the lack of data and other information about them; social, cultural, economic, legal and political barriers; and stigma and discrimination. As the NGO delegation therefore, we believe that an improved and sustained impact requires acknowledging and understanding the interlinked nature of these different vulnerabilities, which should inform our policy and programming towards improved engagement with communities and individuals left behind.

Disheartening as they are, such results do not tell the entire story. Another study of progress toward 90–90–90 targets has urged caution in interpreting results. It notes that although several countries have achieved the targets and others are on the verge of doing so, “in many countries a significant proportion of people living with HIV still remain undiagnosed and therefore unable to benefit from HIV therapy” and call for “more efforts to reach these undiagnosed individuals.”

Remarks of this sort underscore the fact that, although the 90–90–90 targets may be valuable advocacy and programmatic goalposts, achieving them should not be construed as solving or controlling HIV. The rest of the road to truly curbing AIDS—and reaching the millions of people who do not have access to treatment or prevention services or support—will be very difficult. That is because many of the major gaps will continue to exist among key and other populations in highly vulnerable conditions who have always been most severely affected by HIV, yet tend to be ignored in HIV responses due to reports that do not show the true severity of the situation.

During one of our focus group discussions in Uganda, one youth leader had this to say: “If we don’t disaggregate key populations by age, the adolescent and young members will always be left behind, as they are not able to access services due to cultural, legal and socio-economic barriers like age of consent or recognition. For example, adolescent sex workers and young girls at institutions of higher learning who are always targets for rich sugar daddies (cross-generational sex), yet these adolescent girls and young women are not recognized as mainstream sex workers.”

The upshot is clear: as countries scale up their HIV programmes to reach the Fast-Track targets, they are unlikely to achieve strong, sustainable results unless they recognize and address the barriers and challenges faced by individuals and populations that are being left behind. They have to respond in ways that improve the access to comprehensive and quality rights-based HIV prevention, treatment and care of these individuals and communities, currently left behind. This will require an HIV response that is interlinked with other sectors.

Colleagues, the key areas that we are highlighting in the report are intersectionality, inclusion and context, in relation to HIV vulnerability and being “left behind”.

Indigenous people. Indigenous People are generally looked at, as tribal minorities (e.g. in India) and groups who were native to a region or country before the arrival of a different group or groups who then became politically, socially, economically and culturally dominant. Indigenous peoples often are culturally and socially marginalized, and their specific worldviews and social systems are seldom recognized in health strategies and engagements. For instance a 2015 study noted the disproportionate HIV vulnerability experienced by indigenous peoples in Canada: “Indigenous peoples make up 4.3% of the Canadian population yet accounted for 12.2 % of new HIV infections and 18.8 % of reported AIDS cases in 2011.”

Migrants and other mobile populations both with regular and irregular status are in conditions that  create or increase their vulnerability due to the structural obstacles they face in accessing HIV services, and the stigma and discrimination they experience in many aspects of life, including in healthcare settings. This vulnerability is aggravated in the case of undocumented migrants who have to survive outside the “system” and who having limited or no access to formal services. Even in academic publications, the lack of data on sub-populations within migrant populations has been noted.

Young people––usually in generalized terms, though sometimes more specifically, such as “young people among key and affected populations. An online survey respondent from Rwanda, noted that; Young people below the age of 35 represent more than 65% of Africa’s population. This offers the continent with a unique opportunity to leverage its economic, social and political development. Which is why adolescent girls, young women and young people who account for the biggest percentage of new HIV infections in Sub Saharan Africa should be a key population regardless of their backgrounds, social lives, sexual orientation, gender identity, cultural background, economic status, religious affiliation or education.

Why are these groups or populations “left behind”?  Are they hard to reach for HIV programmes? or they are just easy to ignore??

Responses vary, but there are many common themes, including social, cultural, economic, political and legal aspects, stigma and discrimination; human rights violations; and poverty. Many respondents also referred to  “conservative ideology”, either across society as a whole or dominant within some governments, and fundamentalist religious movements etc.

Other reasons were also cited, included

• Lack of specific or targeted strategies or support to engage the population(s)
• Lack of support for population-driven responses that take a “nothing about us without us” approach, including the Greater Involvement of People living with AIDS (GIPA) principle;
• Lack of funding for CBOs that work with the most vulnerable populations; and
• Negative influence of some religious groups (a factor mentioned frequently by Latin American and Caribbean interviewees and respondents to the online survey).

Lack of data for and about many groups of people who are disproportionately vulnerable to HIV is one of the major hindrances to informed and inclusive policy and programming in the HIV responses. For instance too little is known about how many people are at risk, why they are at risk, and how those barriers can be overcome most effectively. Data that do exist are often not disaggregated (e.g. by age, sex or the type of specific vulnerability) and therefore are of limited use for designing targeted interventions and programmes. As one respondent from the Asia–Pacific region framed it: “If we don’t disaggregate key populations by age, the adolescent and young key populations will always be left behind, as they are not always able to access the available services for key populations due to legal and cultural impediments.”

There are a few critical areas where UNAIDS needs to immediately refocus its approach to ensure an improved, more inclusive and more efficient global response. One major role UNAIDS has always played, yet can improve on, is that of a mediator or convener between communities of PLHIV and other key populations and governments. This is particularly crucial in situations that require urgent attention: for instance, the “war on drugs” in the Philippines and the ongoing health emergency in Venezuela. Without a full understanding of the importance of putting communities and civil society at the centre of the local and national HIV response, UNAIDS and governments will not be able to address the needs of the missing populations and those left behind.

UNAIDS needs to clarify its role as an “honest broker” in bilateral and other donor relations in the country to ensure that no one is left behind, and it needs to “show they can add value”. By being active participants in Country Coordinating Mechanisms, PEPFAR COP processes and other donor mechanisms, UNAIDS can ensure more equitable distribution of resources particularly for key population organisations and networks and NGOs.

Moving forward;

In the spirit of not leaving anyone behind, we request UNAIDS to begin challenging itself in how it operationalizes the principle of “leaving no one behind”, in particular treating communities as people who experience intersecting and varying levels of vulnerabilities. In this sense, it will challenge the way we collect information, challenge the way we support Member States, and perhaps challenge the way UNAIDS positions itself especially in challenging political environments. There is also a need towards improved and harmonised approaches for continued support for the participation all communities in HIV responses.

Clear asks;

• “Help communities to advocate for smooth transition from donor to state funding, as well as the necessary legislative changes.” (Interviewee from eastern Europe and central Asia, community sector)
• “[Provide] more support for key population organizations and not just those under their definition, but at the national level as well, such as young women and girls and women in difficult circumstances.” (Interviewee from Latin America and the Caribbean, community sector)
• “UNAIDS is in a unique position to intervene on legal and regulatory barriers to access. They should take a lead on these. Helping governments better allocate their budgets according to their epidemics. (Interviewee from Europe, migrant community sector)
• “Provide technical assistance to capacitate the communities on how to understand and appreciate the data.” (Interviewee from Asia-Pacific, community sector)
• “Draw attention to the regional issues of from eastern Europe and central Asia, especially the issues around harm reduction. UNAIDS should do the political and diplomacy fight in the region for the region.” (Interviewee from international civil society organization working in the from eastern Europe and central Asia region)

There is a need to improve the governance of the Joint United Nations Team on AIDS at country level to provide flexibilities that can enable it to increase attention on populations that are left behind. The NGO Delegation is concerned that any reduced importance of UNAIDS can lead to reduced focus on HIV. To avoid such an outcome, civil society, communities and UNAIDS must work together in a constructive way. Supporting civil society to participate in Joint Annual Reviews, AIDS Development Partners’ Meetings, as well as Joint UN Support for National AIDS Programmes Coordination Committees, could be one way of involving important community and key population actors more closely to ensure that no one is left behind.

Thank you Honourable Chair and also thank you, dear Musah for presenting our report. It is not only a great honour, but also an immense responsibility to be speaking there.

It is an immense responsibility, as we have the opportunity to speak on behalf of communities and people whose needs are ignored due to their social status or cultural background, whose voices are suppressed by punitive laws and discriminating policies and practices, who are forced into hiding, who are locked up, humiliated or even tortured for engaging in sex work, drug use or same sex sexual behaviours or for being who we are: transgender people or people living with HIV.

We have the opportunity and thus it is our duty to be the voices and the faces of the communities who are left behind in the AIDS responses at all levels, communities and individuals whose fundamental human rights – the right to information and freedom of expression, the right to social security and the right to life, to mention a few relevant ones in the HIV context – are protected by the Universal Declaration of Human Rights, and whose rights are still violated based on distinctions that are against the foundations of all UN declarations.

These violations of human rights of individuals and whole communities, in combination with the shrinking space for civil society, especially for those NGOs who provide services for those left behind despite the hostile environments, further increase the already existing gaps and inequalities and are contributing factors to the current state of the HIV epidemic globally. If we want to end AIDS and mean that we are leaving no one behind, all social, cultural, economic, legal and political barriers must be removed; stigma and discrimination against PLHIV and key populations must be eliminated.

Our report shows that business as usual will continue to leave people behind. We need human rights- and evidence based, inclusive approaches to be implemented now, approaches that create safe spaces and enabling environments for all to access comprehensive quality prevention, treatment and care services.

As the European Union Commissioner for Health said in a recent meeting at the European Parliament: “Hard to reach populations are not hard to reach but easy to ignore.” we are calling on you to stop ignoring us.

We call for your attention to the situation of the communities currently left behind and we call on your commitments and joint action to ensure that no one is left behind.

Thank you.

Thank you, President Dreifuss, for your remarks and your continuous leadership towards decriminalization of drug use and being a beacon of hope to the world in this era where more and more countries are waging wars against people who use drugs. Our Delegation would also like to recognize UNAIDS in its stronger statement towards the necessary reforms on drug policies globally.

I was with Luis Loures on his visit in my country, the Philippines – thank you, Luis, for the visit to listen to what’s happening on the ground. And true enough, we have seen that inspite of an effective HIV programme to reach out to people who inject drugs, the extreme punitive environment that my government is implementing, which is killing drug users, including those suspected of using, make it difficult for these programmes to take place. From people who use and inject drugs, we also heard that while there is an interest among these communities to provide peer-led needle and syringe programs, but they have to stop due to fear of being killed. There is enough evidence at this stage that harm reduction works and war against drugs uses resources that give no results. And governments committed  to provide harm reduction services and program to guarantee these services will reach the population who need them, but these are not enough. If you live in a country where you have a President, such as ours, who proclaims people who use drugs as NOT human beings, discourses around service delivery alone is not enough. We have to strongly condemn drug-related killings in the Philippines and end punitive laws in other countries where this is happening. As part of an international community, we need to be frank and say, “enough is enough”! We need a stronger political commitment to end criminalization against people who inject drugs.

In this regard, the NGO Delegation would like to congratulate the drug policy reforms that Switzerland and the leadership of former President Dreifuss has done, as well as Netherlands, Portugal or  Iran’s efforts towards the decriminalization of drug use  We need more countries to follow these examples, that are based on evidence, rather than ideology. And we need the leadership of UNAIDS and the leadership of UNODC to sustain and expand these policy changes.

I would like to end by sharing that two weeks ago, 11 gay men who were about to engage in sexual activity under the influence of drugs in the Philippines were arrested, and one of those living with HIV’s status was publicly announced on TV without his consent. We need to understand that criminalization does not only impact one population, but collectively cripples the progress that we are making in the HIV response.  The human rights abuses of key populations, and most importantly people who use drugs, must end if we want to end this epidemic. We must move the world towards decriminalizing people who use drugs. Enough is enough!

In continuation of intervention of my colleague from Asia Pacific, I will give just two examples from my region.

Russian Federation

According to the Administrative Code, the drug use is an administrative offense. Note to the article of this law allows to avoid administrative punishment if a person voluntarily applies to a medical organization for treatment. And this is good. But … The Criminal Code provides the punishment for the acquisition, storage and transportation of drugs for personal use. It turns out that the fact of drug use is an administrative offense, people who use drugs are still criminalized. According to statistics for 2016, 28,337 people were convicted. Because it is impossible to use substances without buying them, not storing them, and not transporting them (to a house, for example). And this number is growing every year…

According to various estimates, the number of people who use drugs in Russia is between 1.6 and 7.3 million. All this people are criminals.

The lack of drugdependance treatment  in TB clinics entails the exclusion of drug addicts from hospitals and treatment programs, which leads to an increase in cases of multidrug-resistant tuberculosis.

The war on drugs, and in fact with people who use drugs, makes it difficult to identify socially significant diseases and hinder the achievement of goals 90-90-90.

 Kyrgyzstan

Despite a decline in the proportion of people who use drugs, among newly registered HIV cases, from 66% in 2010 to 24.5% in 2015, people who use drugs still determine the nature of the epidemic in the country – 51.1% of the total number of HIV- infection.

At the same time, starting in 2019, the new Code on Violations and the Criminal Code will be used. New Codes will significantly complicate life and access to medical care for people who use drugs:

The penalty for a dose of heroin will be 2 400 euros. If the person does not pay during 2 months, another month is given, but the penalty is doubled to 4 800 euros. If a penalty is not paid within a month, the prison term is from 2 to 5 years.

Until a person has paid the penalty, he can not obtain / restore the passport, it means a complete denial of access to social and medical care.

Today, the penalty are equal to 300 euros, and now only one of six people is able to pay it, the rest of the people, who cant afford to pay penalty are totally outside the system of state medical and social care.

In conclusion, I want to say that there is not enough leadership of UNAIDS or UNODC on this issue, even if it is very strong, if the countries do not take leadership and responsibility for the health of people who use drugs on themselves. We need the leadership of countries to end the war with people and begin to provide treatment and care. Business as usual is not enough.

Thank you, Madam Chair,

And thank you also to Michel Sidibé for your official visit to Canada where, in Ottawa, you launched the release of the UNAIDS World AIDS Day Report: BLIND SPOT – Addressing a blind spot in the response to HIV: Reaching out to men and boys. In this era of shrinking space for civil society, I can also tell you that the 2-hour Civil Society Dialogue you also hosted at the Wabano Centre for Aboriginal Health was very well received.

This event, open to the general public, provided a safe space for civil society to voice their concerns about the HIV response domestically and internationally. This opportunity provided members of the communities of African, black and the Caribbean decent, Indigenous peoples, people living with HIV, key populations and many others to relay their views on progress and challenges of the Canadian response to HIV and AIDS.

Recently, Canada has shown a good example in reforming drug policy. For example, the Supreme Court of Canada struck down some mandatory minimum prison sentences for drug related offences and repealed a law against safe drug consumption sites. Now people who use drugs can access consumption sites without fear of arrest and prosecution. These legal frameworks are now much more supportive and less punitive of our citizens who use drugs.

However, we also still have punitive laws in Canada such as the prohibition of prison-based needle and syringe programs. These laws have disparate impacts on women, Indigenous peoples and ethnic communities. And despite the best advice based on scientific evidence from UN bodies and the Canadian Department of Justice, Canada continues to prosecute people living with HIV for not disclosing their HIV status before engaging in sexual behaviours. Let us be clear that people living with HIV who maintain an undetectable viral load are unable to transmit HIV through sexual activity. Additionally, Canada’s current laws on sex work purport to be about criminalizing sex customers and pimps but continue to criminalize the sex workers themselves.

To make real progress in the AIDS response, what Key Populations need is less rhetoric and more evidence-based initiatives from governments. The world will only achieve the goal of getting to zero by dispensing with business as usual.

In Asia and the Pacific, 1 in every 10 people living with HIV are people who inject drugs, and 9 in every 10 people who inject drugs living with HIV have hepatitis C. In Indonesia, the HIV prevalence among women who inject drugs in Indonesia is 42.1%. Despite the large number of evidence and data that show harm reduction saves lives and can prevent HIV and viral hepatitis infections; in many countries, it remains small-scale, if not, lacks political support or even made illegal/banned.

The state of the war on drugs enforced by many countries have continuously put people who inject drugs at greater risk of new HIV infection. This is reflected in many countries in South East Asia, where criminalisation of drug use, compulsory detention of people who inject drugs, and other legal barriers have prevented the effective delivery of basic HIV prevention package.

 Further to this crisis is the threat of disappearing harm reduction services in countries experiencing transition to Middle-Income status, where many will no longer be eligible for Global Fund support and many of international funding will phase-out. This transition preparation is not well supported with bold leadership from governments to address the crisis.

In Indonesia, where I come from, increased repression, violence and war against drug-related crimes (including people who use and/or inject drugs) are often used by political leaders to gain political momentum and image credibility. It is particularly important for us, civil society, to push this agenda as we are heading towards 2019 Presidential Election.

On behalf of Rumah Cemara, we welcome the initiative that the UNAIDS is making towards developing policy recommendation as part of its Global Commitment to protect the health and human rights of people who inject drugs (on Do No Harm – Health, Human Rights and People Who Use Drugs and Harm Reduction Saves Lives) and to further lead Member States in making it happen.

I have been living with HIV for sixteen years and have witnessed the benefit of evidence-based initiatives such as Harm Reduction that has saved my life including many of my compatriots.

I am calling Member States to recognize and fully commit to Harm Reduction and call for bold political leadership of the Program Coordinating Board that is based on evidence and human rights, rather than punishment and repression. The business as usual approach towards ending the AIDS epidemic among people who inject drugs is not enough – and never will be. Harm reduction works – harm reduction saved my life!

 Thank you.

Thank you Mr. Chair. And Thank you UNFPA and UNAIDS for convening the inaugural meeting of the Global Prevention Coalition. We in the NGO delegation agree that a new effort is urgently needed to reinvigorate primary HIV prevention. We agree that this new effort needs to build on lessons learned from previous prevention initiatives, to fully embrace the five pillars of HIV prevention; especially when it comes to addressing the needs and protecting the rights of those most vulnerable; and to ensuring access to comprehensive combination prevention education and the latest in biomedical services. We also agree there is global consensus that the 90-90-90 target to reduce new HIV infections can be achieved if primary prevention programs are rapidly scaled up alongside treatment, remembering that successful HIV treatment is durable prevention. And we also applaud the member states and colleagues from the highest impact countries for their commitments to adopt the strategies contained in the roadmap and to implement the 10 point actions plans with its dashboards and report cards. We believe the establishment of the Global Prevention Coalition will eventually emerge as the global strategy that truly made a lasting difference.

However, in order to be fully realized, we also know new efforts are needed to make the necessary investments, systematically scale up and implement effective programs, including addressing structural and policy barriers that prevent people from accessing and using HIV prevention services.

As I stated earlier, we are very encouraged by the level of commitment and engagement shown by various delegations participating in the inaugural GPC however what is discouraging to us is that we see in some locations we are no longer moving forward to scale up of HIV prevention services. Quite the contrary, once again, in some places, condoms are re-emerging as evidence of sex work to arrest various people from of all populations at risk for HIV; young adolescent girls and boys are turning to transactional sex to meet life and materials needs; people who use drugs are being disappear and killed; and finally HIV positive men who have sex with men attending clinics to support retention in and adherence to antiretroviral care are arrested. This cannot be our collective action on the HIV prevention front. It will not work. We in the NGO community want to encourage UNAIDS, UNFPA and all of the countries to do things differently.

After nearly four decades, we know how to prevent and treat HIV. We have all of the tools and the latest technologies that are evidence and human rights based. Let’s take the approach of the Global Prevention Coalition, let’s follow the roadmap and take the necessary ten steps and arrive together as one united global community at the end of AIDS.

Thank you.

In line with Agenda 2030, healthy lives and well-being for all at all ages should be realized for women and girls, boys and men, as well as all members of key populations. However, we note that the world is at a critical moment in the history of the AIDS epidemic and the HIV response. We have only a two-year window of opportunity that represents a make-or-break moment to stop new HIV infections and end the AIDS epidemic by 2020.

Mr. Chair, Michel has just shared with us in his EXD’s report, that in Sub Saharan Africa, adolescent girls and young women account for over 70% of new HIV infections. In Eastern Europe and central Asia, as well as West and Central Africa, the situation is horrifying, as the epidemic is moving from being concentrated to more generalised.

For the past three decades we have engaged in a myriad of actions to help people who are easily ignored so that they can access HIV prevention services that meet their specific needs.

We have the models to reach our peers in schools and in different settings, through community mobilization, peer-support, referrals and linkage to care.

Unless we enable continuation of impactful community-led HIV prevention efforts in the HIV response, young people, women, girls, people who use drugs, sex workers, gay men and men who have sex with men, transgender people and other key populations’ access to comprehensive HIV services including their social protection will be undermined, especially in light of the dwindling global HIV finances.

Mr. Chair: A huge difference between estimated needs and actual spending on community led responses, continues to limit our efforts. In order to make significant progress therefore, the investments to enable the end of AIDS by 2030 need not only to be definitively earmarked, but also increased and front-loaded during the next two years towards PREVENTION 2020.

As it has been for the treatment agenda, with a popularised the 90/90/90 targets, we need leadership for success with and among key populations including;

1. Leadership for measurable results for people left behind
2. Creating a legal and policy environment conducive for utilisation of available services
3. Mobilising adequate financial resources for a reinvigorating prevention activism and sensitisation of decision makers at all levels
4. Strengthening the meaningful engagement and leadership of young people, women and men, people living with HIV and all members of Key populations including migrants and indigenous people

We reiterate that all the above, should be anchored on a strong and sustainable element of community empowerment, strengthening community systems as well as social protection, addressing gender inequality as well as stigma and discrimination.

We need quality education including comprehensive sexual and reproductive health, life skills including negotiation of safer sex, inclusiveness and human rights, to reduce inequalities in HIV prevention among young people, adolescent girls and women, boys and men as well as all members of key populations

Chair, we need to monitor progress against prevention targets including those related to HIV vulnerability and barriers to access as well as establishing accountability for achieving these, as a powerful monitoring tool in prevention 2020.

Thank you Mr. Chair and thank you to Michel and his team for extensive work that has happened since last year: the budget cuts, quick decision making in the process of distributing resources, negotiations with stakeholders and cosponsors, development of country envelopes, Global Review Panel, and innovative resource mobilization.

The NGO delegation acknowledges and appreciates the entire UNAIDS Joint Programme with all the co-sponsors and secretariat to work together and rebuild the resilience and credibility of the Programme. It is important to produce actions and results quickly and timely, but that is not enough. We would have liked to see more systematic and formal engagement and involvement of civil society and communities groups in planning of the country envelopes. We feel that while many activities will be implemented with communities and civil society, the real partnership comes when we plan together.

The NGO Delegation appreciates the joint resource mobilisation plan, to which we are happy to be associated with as a working group member during the development process. But we would now like concrete targets for the short, medium and long term for the resource mobilisation team that they aspire to.

We appeal to the Member States to fully fund the Joint Programme by either keeping their level of funding steady, or increasing if you can. We also appeal to newer countries including my own Indi who have just started contributions to mechanisms such as Global Fund to also keep a small percentage for UNAIDS, every penny counts. Along with investing in service delivery, it is obvious to invest in target setting and response monitoring. In order to protect your investment in mechanisms such as the Global Fund, it is important to fully fund the Joint Programme. Advocacy of the Joint Programme, in partnership with civil society, not only will lead to scale up but also ensure sustainability of activities and services initiated.

To the Secretariat, we would say that if we are serious about resource mobilisation, appropriately resourcing the resource mobilisation team is extremely necessary, we don’t think it is well resourced as of now, if you think it is well resourced, we think you are not ambitious enough. We are also keen to ear the messaging around resource mobilization. And we want to make sure new money is raised.

Civil society is an extremely useful resource not only for advocacy and service delivery to the unreached, but also as effective fund raising – the Global Fund is a good demonstration for that. We would be happy to partner with the UNAIDS to raise funds, or continue our engagement on the advisory group capacity.

Finally, we ask the innovative resource mobilisation team to clarify the advocacy funding and how would it link to civil society. It is not enough to raise funds for Secretariat, if it is not going to link to advocacy. We strongly suggest to establish an advocacy fund as a part of innovative fund raising mechanisms which can be used by civil society to effectively negotiate domestic funding with governments and stakeholders. In times when there are shrinking spaces for civil society, this fund will ensure vibrancy in the HIV response. Without this fund and this partnership, it will be business as usual, which is not enough. The UNAIDS we need must be bold and courageous to take risks in finding new money and not just engage in redistributing already committed funds.

Thank you.

It has been proven throughout history that humans can do more when it is a matter of survival. When it is needed, we invent new ways of doing things, new tools and methodologies. It is clear that in the past year, the UNAIDS Joint Program understood that its situation was really a matter of survival, and so it improved its coordination and moved quickly, including putting in place a new Joint Programme Action Plan and a new Fundraising Operating Model that not only aims to improve its traditional way of mobilizing resources, but is also open to innovative processes for raising funds.

In this regard, I commend our Board for pushing and supporting UNAIDS and would like to recognize the role of the PCB NGO delegation for insisting on the need for a new fundraising plan, supported by a new communication strategy, at the Global Review Panel.

The agility and timely work we saw here is rather uncommon within systems like UN. Yes, it gives us hope. However, only a fully funded Joint Programme can continue investing in innovative processes and establish the consistency that usually drives success. So, it is imperative that the sense of urgency continues and that, instead of doing business as usual, we move from a highly concentrated funding model towards the long-term financing of solutions.[1]Let’s remember that although playing a strategic role in responding to AIDS, traditional donors have not responded sufficiently to UNAIDS yet there are many ways of doing so.

For years, we have pushed UNAIDS to use innovative financing mechanisms. The amount of financial resources in the markets is enormous, compared to concrete economics of products and services: there is now $100 trillion in the global savings pool, just to give you one example. This condition of excessive financial liquidity is an out-of-proportion revenue source that is not tapped into, mainly because of lack of polical will. And we don’t need to be afraid: contrary to orthodox liberal economics mantra, financial transaction taxes, for instance, have not distorted the capital markets where they exist: In 2016, the UK raised 2.8 billion Pounds on Stamp Duties on Shares and Securities; Brazil raised an average of 10 billion Reals on a broad FTT legal framework. So we will be happy to work with the Joint Program to discuss about FTTs and many other mechanisms of consistent revenue collection that could bring on board a critical mass of new donors, while showing to the world the relevance of UNAIDS in the global AIDS architecture, properly communicating its values, results, and its comparative advantage for contributions – a narrative still to be developed.

Finally, the new fundraising model also needs to contribute towards a fully funded civil society, in alignment with the financial targets agreed in the 2016 Political Declaration and with proper disbursement of funds for strategic areas – including human rights, gender equality and funds for advocacy work. It is still concerning that the current proposal does not go far enough in detailing how civil society and communities will be involved or benefited. So, we need to improve the transparency and accountability of the fundraising and budget allocation processes because to be successful, participation should be meaningful.

In this regard, clear standards and principles must also be set for the institutionalized engagement of civil society and other partners in the new fundraising model. At this stage, it has been proven throughout AIDS history that improved and sustained HIV responses require acknowledgement of the intersectionality of the different areas and expertise, as well as enhanced and consistent engagement of communities.

Our delegation’s messaging has been repetitive. But we are not tired. Business as usual will take us nowhere and certainly not to Ending AIDS.

[1] Ten donors are responsible for 86% of funds, with the US as the major donor.

Thank you, Chair. The NGO Delegation welcomes the report on the updates on actions to reduce stigma and discrimination in all its forms. Actions have taken place since this Decision Point was approved at the 35^th PCB, my first PCB meeting and these have resulted in important changes.

Communities and civil society play a central role in reducing stigma and discrimination. The work done by the Global Network of People Living with HIV and the International Community of Women Living with HIV/AIDS on the Stigma Index have resulted to measurable indicators on stigma and discrimination,as seen in the Global AIDS Monitoring report; and we encourage Member States to support PLHIV networks in implementating the Stigma Index, as part of improving their national HIV programs, especially in regions where it has not been implemented.

Also, the work done by lesbian, gay, bisexual, transgender, and intersex people, together with UNDP and UNESCO, such as in Asia Pacific, has resulted in a number of school policies and programs that not only protect LGBTI from discrimination, but provide a space for them to come together and demand for HIV services in their schools. People who use drugs and civil society who work on drug policy in my region, Asia Pacific, have formed a regional response team, in partnership with UNAIDS RST, to address the ongoing war on drugs in the Philippines and to resist any similar undertaking in the region. The Joint Programme needs to accelerate support for these efforts, as well as for Member States towards non-discriminatory access to employment, justice, education, and health services of people living with HIV and key populations.

Despite the progress, these are NOT enough. We have yet to see a global movement to fight stigma and discrimination. We have the 90-90-90 treatment targets that put treatment efforts on course; and the recently-launched Global Prevention Coalition will will galvanize focus on prevention. Why isn’t there any similar collective push to eliminate stigma and discrimination? We can’t keep beating around the bush. Enough is enough. We heard from yesterday’s interventions that many countries need to step up in addressing stigma and discrimination, if we are to end the AIDS epidemic. Hence, we request UNAIDS to facilitate the creation of a global compact to eliminate stigma and discrimination. This multisectoral global compact, which includes communities and civil society, can leverage funding, develop targets, ensure data availability, and push for a stronger political commitment towards ending stigma and discrimination, especially of people living with HIV, key populations, and those most affected by HIV.

This is my final intervention as an Asia Pacific delegate, and I would like to take this opportunity to thank everyone for their commitment. We come from diverse backgrounds that make our work at the PCB challenging, but also exciting. As someone living with HIV, seeing this room full of Member States, UN agencies, partners, and most especially communities and civil society, gives me a sense of joy and of hope. The PCB is a governance model that should be replicated in other UN boards, and I thank you all for your commitment to end this pandemic and to work towards making this world a better place to live in for people like me.

Our work does not and will not end here. For every pat on the back, we need to always ask ourselves: is this enough? Until we get to the end of the AIDS epidemic, it will never be enough. Let’s continue to act and keep the passion alive. We will get there. We will get there.

Thank you.

The NGO Delegation welcomes the Update on Actions to Reduce Stigma and Discrimination that seeks to highlight initiatives undertaken toward the elimination of HIV related discrimination globally.

Recognizing that important goals and strategies have been launched to eliminate stigma and discrimination by 2020 through the removal of punitive laws, policies and practices, addressing human rights violations and creating enabling environments for the most vulnerable to HIV, we also acknowledge that these goals remain far from our reach and the strategies are “not enough” or insufficient. People living with HIV, women, young girls, sex workers, lesbian, gay, bisexual and transgender persons; men who have sex with men, people who inject drugs; and people in prisons, among others, continue to be targets of unfair, inhumane and crippling discriminatory practices in all sectors of society, including in healthcare, legal and socio-economic arenas. Institutionalized rejection, discriminatory attitudes and neglect compromise the ability of these groups to enjoy their right to the highest attainable standards of mental and physical health.

Mr. Chair, it is timely and essential that we acknowledge the urgency to scale up efforts in addressing stigma and discrimination, if we are to achieve the global goals we have set for ourselves. In particular, it is important to recognize the important role of civil society in addressing the needs of key and most vulnerable populations and the need for increased funding to sustain and increase our efforts in raising awareness on the effects of stigma and discrimination, sensitization and attitudinal change and the promotion of human rights. The Delegation calls for “fully-funded civil society and communities” to achieve the goal of eliminating HIV-related stigma and discrimination. Stigma must be taken seriously and considered as the biggest infection that keeps people from accessing services.

In ending, we take this opportunity to recognize countries such as Canada, Australia and Switzerland that stand out as true examples of fostering an enabling environment for populations that for too long have been denied their rights, increasing their risk to HIV. In my own country of Belize, through a court ruling, the Sodomy Law has been found to be discriminatory and in contravention of the constitution. Even though these are stellar examples in alignment with the core principles of the global response to HIV, they remain exceptions begging to be emulated. But this is not enough. Substantial change and effective actions continue to be INSUFFICIENT and ripe for GREATER INNOVATION.

People in Asia and Pacific are facing increasing risk of HIV and other viral infections, with 38 countries applying laws that create barriers to HIV response; 15 with compulsory drug detention and rehabilitation for people who inject drugs, including 13 countries without explicit reference to harm reduction for people who inject drugs in the national programme. Additionally, 37 countries criminalise some aspects of sex work and 17 criminalise same-sex relations. Yesterday, I spoke about failing leadership that put people who inject drugs at high risk of new HIV infections. The failure to see evidence and rights-based approaches, and the increasing force from intolerant groups will continue to leave us behind.

Just two months ago in our region, Asia and the Pacific, we were shocked by the recent raid by law enforcement authorities on a Gay Spa. Not that we were surprised with the continuous criminalisation, but the fact that condoms distributed by the Spa were used as evidence to detain at least 51 gay men. We have also seen countless forced-closure of brothels that create transactional sex on the streets and Social Media platforms. The state of war on drugs, as I mentioned yesterday, will only create new HIV infections. Indonesia, right now, contributes 18% of new HIV infections in Asia and the Pacific, after China and India.

With the advancement of medical technology, people living with HIV now have higher life expectancy compared to 20 years ago. However, if we are to die, we are not dying because of AIDS; we are dying because of stigma, discrimination, criminalisation and the continuously shrinking civil society space that silences our critical role in the response.

Business as usual is not enough. It is time that we make a collective and stronger political commitment, with funding and clearer targets, to end stigma and discrimination.

Thank you.

Thank you, Chair and thank you, Secretariat for presenting a comprehensive background paper appealing to Member States to change the punitive laws that not only cause overcrowded prisons around the world, but often compound the problems related to the health of people most affected with HIV.

A specific issue that I see missing from the current recommendations and decision points is rape and violence against prisoners who are members of key populations. In 2001, Arif Jafar was arrested in the Indian city of Lucknow at the AIDS prevention agency where he worked. Charged with the offense of running a sex club, he was put in lock-up for 47 days, and named in the newspapers. This case helped spark a legal challenge to India’s sodomy law, known as Section 377. Jafar’s case has dragged on for 11 years without coming to trial.

Other examples show how existing services are denied due to stigma and discrimination against key populations in closed settings. A transwoman was raped in a prison in Brazil. After seeking medical care and requesting post-exposure prophylaxis that is offered in prisons, she was denied the prophylaxis and later was diagnosed with HIV.

And we shouldn`t forget about other closed settings: for example refugee camps in Syria and Turkey and Islands in Greece where people are living for years without access to medical care and support. Yes, they have access to testing, but if a person is diagnosed with HIV but there no treatment, it renders the testing almost useless. It’s also about detention rooms, where people are punished for being MSM or injecting drugs have no access to ART treatment and opioid substitution therapy.

But today, I am excited to intervene on this agenda, because I just came from a consultation in Delhi on the New Model Prison Manual, wherein rights and duties of inmates are defined and accessibility to health services of inmates also addressed. A monitoring software for closed settings was also launched to ensure that the provisions thus stated are implemented. A huge onus goes to the HIV/AIDS (Prevention and Control) Act 2017, which talks about access to prevention and treatment and penalizes HIV-related stigma and discrimination. Some states have initiated setting up de-addiction centers, providing condoms and OST facilities in prisons. But as an Indian, I can tell you, our problem has never been so much about policy, but about implementation.

It is not enough to have well-meaning policies and plans if they are not going to be turned into actions and measurable indicators. Enough is enough, we think it is high time that policies are made with much more inclusive processes and are implemented on ground for rights of people not advantage of system. We firmly believe business as usual is not enough.

Thank you, Mr. Chair.

On behalf of the NGO Delegation, I would like to welcome this comprehensive report on HIV in prisons and other closed settings.

As we’ve known all along, and is confirmed by this report, there is a high representation of key populations in prisons and, in most countries, HIV prevalence within prison populations is higher than in the general population. We also know that there are a lot of people who come in, and haven’t done drugs before who become addicted inside prison and come out with HIV or hepatitis C infection.

This report has shown that due to stigma and discrimination, criminal laws disproportionately affect certain population groups such as racial and ethnic minorities, migrants, and impoverished communities.

In Canada, while the rate of adults being supervised by the correctional system continues to decline, a history of cultural oppression, the damaging legacy of abuse in residential schools, and ongoing racism and colonialism have contributed to high rates of imprisonment for Indigenous people. Indigenous people represent over 25% of people in federal prison, despite comprising just 4.3% of Canada’s population. And Indigenous women are the fastest growing population among prisoners in federal custody.

In Australia, Aboriginal and Torres Strait Islander people account for 2.3% of the population. However, Australian Bureau of Statistics data show the Indigenous incarceration rate in 1991 was 14.4%. In 2015, it was 27.4%. In the March 2016 quarter, it was 28%. The proportion of adult prisoners who identified as Aboriginal and Torres Strait Islander ranged from 8% in Victoria to 84% in the Northern Territory.

In New Zealand, In February 2017, the prison population hit an all-time high, an increase of 364% in the last 30 years. A month later, the New Zealand Herald reported that 56.3% of that total are Indigenous Maori – also an all-time high – even though Maori make up only 15% of the population. Unfortunately, Maori are seven times more likely to be given a custodial sentence than non-Indigenous and eleven times as many Maori are remanded in custody awaiting trial.

In the United States, Native Americans are incarcerated at a rate 38% higher than the national average, according to the Bureau of Justice Statistics meaning that Native men are incarcerated at four times the rate of non-Indigenous men.

We wish to remind the PCB that the UN Standard Minimum Rules for the Treatment of Prisoners (the “Nelson Mandela Rules”), call for health care services to be organized “in a way that ensures continuity of treatment and care, including for HIV, tuberculosis and other infectious diseases, as well as for drug dependence.

Like everyone else in society, the people held in these facilities have the right to health. Enough is enough. If we continue with business as usual, the disproportionate rates of incarceration for racial and ethnic minorities, migrants, Indigenous Peoples and impoverished communities will only increase. Surely, prisoners are members of the 10-10-10.

Mr. Chair,

The NGO Delegation welcomes the report on HIV in prisons and other closed settings. The report highlights the severe inequalities, stigma and discrimination and human rights violations such as the right to health, the right to privacy or the right to dignity that people in prison face all over the world.

The report also calls our attention that as a result of discriminatory laws, policies and practices, people living with HIV and other key populations are disproportionately represented in prisons.

The overcrowding of prisons and the lack of services increase their vulnerabilities to HIV, viral hepatitis and tuberculosis infections.

Health in prisons is not only complicated by elevated risk for transmission of infectious diseases including HIV, but by limited access to health services as well.

Chair, from 14^th -16^th of November 2017, the PCB paid a field visit to the kingdom of Swaziland and we had a chance to visit the prisons, which are called correctional centers. We found these correctional centers to be a good model of health care delivery to prison populations. With support from PEPFAR and UNODC, they have a fully furnished and spacious health centre that provides HIV diagnosis and treatment services, including Tuberculosis and Multi-Drug Resistant tuberculosis. Lacking however, is distribution of condoms, as health staff and authorities don’t recognize that same-sex encounters do occur, which is worsened by the lack of policy that favors provision of condoms and other harm reduction interventions in prison settings.

Chair, the Report notes that HIV exists in prisons around the world and that there is scant data and information, especially on those who are infected post-arrival.

Paying attention to HIV prevention and treatment, as well other vulnerabilities like Tuberculosis due to overcrowding and Hepatitis C due to the lack of needle exchange programs, requires a fast track.

Like anyone else, people in prisons in their diversities and vulnerabilities have their fundamental human rights, including the right to health. The PCB has an obligation to ensure that the emerging and evolving needs of people in prisons and in all places of incarceration are met.

Lastly, in 2015, the United Nations General Assembly adopted the resolution on sustainable development goals, which among things, envisages a world of universal respect for human rights and human dignity, the rule of law, justice, equality and non-discrimination.

Mr. Chair, with the adoption of the SDGs, all countries and stakeholders pledged that no one should be left behind; unfortunately, people in prisons are among the 10/10/10.