On March 27, members of the NGO Delegation joined the UNAIDS Secretariat, cosponsors, and Member States in Geneva as part of a multi-stakeholder consultation to review progress in meeting the goals of the UNAIDS 2011-2015 Strategy. Since 2011, the mechanism used to detail, track, and report on progress toward meeting UNAIDS’ goals is the Unified Budget, Results, and Accountability Framework, known as UBRAF. This consultation was designed to gather input on the midterm review of the UBRAF, which will be presented in full at the 34th PCB in July.
The consultation opened with an overview of the context of the global HIV epidemic, with particular focus by Michel Sidibé on emerging political challenges to protecting basic human rights. Sidibé spoke of the need to reach those who have been left behind in access to prevention, treatment, and care as a major challenge for 2015 and beyond. Echoing the NGO Report presented to the PCB last December, he called for better data that is disaggregated so we know what works for different populations. He spoke against rising conservatism and fundamentalism that threatens the sexual and reproductive health rights of women and young and the safety and health of lesbian, gay, bisexual, and transgender people, specifically pointing to laws in Uganda, Nigeria, Russia, and India. Noting the twenty African countries without homophobic laws and the approximately forty non-African countries with homophobic laws, Sidibe warned that we need to support the African countries that don’t have homophobic laws rather than label and attack the entire continent as homophobic. He argued that fundamentalism and lack of human rights for LGBT people is not an African problem but rather a global problem and needs to be understood and discussed as such. Further, Sidibe argued that making the link between violence against women, economic security, and HIV should be made central to the HIV response.
Further challenges described by Sidibé included the need for a stronger debate about intellectual property and public goods (the topic of the upcoming NGO Report in December 2014) and the movement of countries with large populations of people living with HIV into middle-income status. He noted that 87% of people living with HIV will be in middle-income countries in the next 5-10 years and that approaches to development assistance must be adjusted to account for this context. Sidibe expressed the conviction that countries must be supported to scale up their own funding for health programs and be less dependent on international assistance. He highlighted the new partnership between UNAIDS and the World Bank to focus jointly on addressing social drivers and inequality in order to end new infections and HIV-related illnesses and deaths.
Sidibe’s opening remarks that the Joint Programme has reduced expenditure by 48 million US dollars through, among other cuts, reducing consulting and contractual services by 35% and travel costs by 30% and cutting headquarters staff positions in Geneva. As a result, 70% of UNAIDS staff are in the field.
Sidibe’s remarks were followed by a lively Q&A session in which member states asked for more detailed information, including baselines, measurable indicators, outcomes, and analyses of gaps, as well as reporting on how technical assistance work is conducted and shared between UNAIDS and cosponsors, such as WHO, and how UNAIDS can be a catalyst for communication between governments and civil society. The NGO Delegation is about the effects of diverting so many staff members to the field. Sidibe responded by indicating his feeling that too many people remain in the central office and that, although he finds the change successful, they need to find further ways to become leaner and rely more on the leadership of the cosponsors.
Following the opening remarks, examples of achievement, lessons learned, and cooperation between the Secretariat, cosponsors, countries, and civil society were shared by various partners and cosponsors. Speakers focused again on the growing dangers for key populations and the need to address violence against women, expressing the need, in the words of Luis Loures, UNAIDS Deputy Executive Director, to “focus our resources on this growing crisis.” They noted the successes of the Three Zeroes campaign and reduction in vertical transmission and also the work still ahead in even such basic areas as condom access, given that some countries have only eight male condoms per man available per year and only one female condom for every eight women. Further critical gaps include real treatment access that sensitively and competently meets the needs of HIV-positive women who are pregnant, for whom loss to follow can be as high as 89%, and for children when overall, only 34% of children (and 67% of adults) in 21 priority countries who need ART have access to it. Finally, the situation of HIV in humanitarian emergencies was highlighted as a critical gap, with the needs of people living with HIV seemingly invisible in the emergency responses.
In Sidibe’s opening remarks and in comments from member states, the post-2015 agenda was raised as an area in which the PCB members need to strategize and work together closely. Saraswathi Menon, UN Women’s director of policy, noted that the post-2015 agenda provides opportunities to address issues using the language of rights that were not addressed before, including unpaid care work, violence against women, and sexual and reproductive health rights, which was a weak target in the MDGs.
In the comments period, the NGO Delegates emphasized the importance of joint collaboration among the various co-sponsors and the secretariat’s role of accountability and specifically requested that UNICEF work jointly with UN Women in UNICEF’s programs for pregnant mothers to address violence against women. The NGO Delegates further stressed that it is critical to explain to local communities why key populations, such as gay men and other men who have sex with men and women and men who use drugs, are important. We must ensure that medical, parliamentarians, and other opinion-makers are informed so they don’t just react from an emotional perspective. We called for support to strengthen advocates from key populations so that they can advocate for themselves and not just have us talking about them.