The NGO Delegation’s Summary Bulletin for the 49th UNAIDS PCB Meeting is already out. The Communique contains the following sections: Report of the Executive Director; Report by the NGO Representative; Leadership in the AIDS Response; HIV in prisons and other closed settings; 2022-2026 UBRAF Output and Indicators and revised 2022-2023 Workplan; Evaluation; Follow-up to the thematic segement from the 48th PCB meeting; Report of the progress on actions to reduce stigma and discrimination in all its forms; Thematic Segment – “What do the regional and country-level data tell us, are we listening and how can we leverage those data and related technology to meet our 2025 and 2030 goals?”
Chapeau
The 49th PCB meeting was the sixth virtual PCB meeting (including the two Special Sessions in between) since the COVID-19 pandemic restricted international travel and face-to-face meetings in 2020. The NGO Delegation was a little more adjusted in dealing with this virtual meeting modality, despite the increased hours it required in terms of their engagement. The pre-meetings were somehow uneventful as minimal discussions took place. Even the official PCB meeting itself from Dec 7-10 consisted mainly of PCB members giving out the usual statements in response to the agenda items. The interactions were more intense in the drafting rooms where crucial decision points were debated on, especially on the NGO Report, UBRAF indicators, and the reports on HIV and prisons and progress on actions to reduce stigma and discrimination. Similar to previous PCB meetings, the same Member States were raising the same questions with the same arguments, i.e., questioning definitions such as key populations, societal enablers, etc., which tended to delay or derail the decision-making process. This will be an ongoing challenge for the PCB and specifically the NGO Delegation to strategize on and address in future meetings.
Agenda 1.3: Report of the Executive Director
Iwatutu Joyce Adewole, Africa Delegate
The report of the Executive Director, Winnie Byanyima, made mention of the milestones in 2021, foremost of which was the adoption of the Global AIDS Strategy 2021-2026 and the new Political Declaration on HIV/AIDS. Apart from these new HIV guideposts, the report also highlighted the Joint Programme’s continuing partnerships with governments, development agencies, and civil society, as well as achievements in improved HIV services delivery despite the disruption of COVID-19 in many countries, particularly in the Africa region.
The EXD is hopeful that countries will support and implement the targets in the Global AIDS Strategy, scale-up support for community-led responses, and adopt human rights approaches by removing legal, policy, programmatic, and societal barriers that hold the HIV response back.
The NGO Delegation’s intervention reiterated the priorities of the Global AIDS Strategy and Political Declaration, and the important role of UNAIDS in fighting not only HIV, but also vaccine inequity. The Delegation stressed that lack of funding may bring failure to the global response and how the realignment process has impacted on UNAIDS Staff. We further urged Member States and donor nations to fully fund UBRAF and step up bravely, the way communities affected by the epidemic would and have always done in these times.
Agenda 1.4: Report by the NGO Representative
Andrew Spieldenner, North America Delegate
Each year, the NGO Delegation puts together a report meant to focus on a particular issue that is key or emerging in the HIV response for civil society, key populations, and other marginalized groups. In 2021, the NGO Report covered societal enablers and their importance in the HIV response. The topic was selected due to the ongoing resistance to societal enablers in 2021’s Global AIDS Strategy and the United Nations Political Declaration on HIV.
In researching this report, the NGO Delegation discovered that diverse multi-sector partners believe in societal enablers, but few agreed on their definitions, appropriateness, or scalability. UNAIDS has specified three areas as societal enablers for the HIV response: removing gender-based violence; punitive laws and policies; and stigma and discrimination.
With these lenses, the report highlights the harms of: violence and the lack of social protections; criminalization against HIV-status, drug use, sex work, gender identity, and same-sex sex practices; and the contexts of stigma and discrimination in healthcare, education, employment and communities. The Decision Points (DPs) recall the most ambitious targets of the Global AIDS Strategy and the Political Declaration, and highlight the importance of targeting the 10-10-10 in the HIV response.
The NGO Delegation knew that focusing on societal enablers – especially on the issues of scalability and their role with key populations – could be potentially controversial. The Co-Sponsors were overwhelmingly in support of the NGO Report, as were a majority of Member States on the PCB. There were long negotiations on the wordings of the DPs and the definitions of key populations. Some of the Member States raised the question of resourcing these endeavors – a question which has consistently emerged as Member States are supposed to take more ownership of their HIV response. In the end, the NGO Delegation was successful in contributing to further demonstrating the need for scalable societal enablers in education, employment, healthcare, social protections and decriminalization for key populations and other marginalized groups (including adolescent girls and women in all their diversity).
Agenda 2: Leadership in the AIDS Response
Violeta Ross, Latin America and the Caribbean Delegate
In the session on Leadership in the AIDS Response, Dr. Salim S. Abdool Karim from the Centre for the AIDS Programme of Research in South Africa (CAPRISA) presented the path forward for HIV control, with emphasis on how coronavirus and its variants impacted this context. He referred to the unmet needs in HIV prevention, the most affected populations in different regions and the long path to the agreed goals of 90-90-90.
The resurgence of HIV-associated stigma combined with the stigma of coronavirus is an emerging battle we need to fight. In almost 40 years of the HIV response, we learned the impact of stigma in the realization of the right to health. As we continue to respond to coronavirus and its variants, we cannot allow the resurgence of HIV stigma.
The NGO Delegation raised concern over the presentation of the one person with HIV with compromised immunity who was detected with the Omicron variant. This unfortunately, was misinterpreted by the media, blaming people living with HIV for yet another virus. We asked Dr. Salim and other scientists to use this information with care, especially when dealing with mass media.
The Delegation also emphasized that the leadership of the HIV response during the coronavirus pandemic implies a fast and agile response to COVID-19, but also the ability to maintain and sustain the gains in the AIDS response.
Agenda 3: HIV in prisons and other closed settings
Jonathan Gunthorp, Africa Delegate
Prison services are subject to strange contexts. In the USA, prisons are a state function and so there is no national mandate allowing for USA commitments. Elsewhere, prisons mostly fall under justice or security clusters in governments and are in many places seen as instruments of punishment and not of rehabilitation. Often prison health is isolated and unaccountable to health ministries.
These, and many other oddities, lead, in most member states, to poorly funded prison health & HIV programmes, and often to poor health outcomes for incarcerated people living with HIV and other key populations. Increasing use of legal persecution of key populations, especially among people who use drugs and sex workers, along with minorities, political opposition, and a skew towards incarcerating people of colour, exacerbates the situation.
At the PCB, it became clear that a range of Member States worldwide will continue battling to define prisons as being outside of the global AIDS response, and to limit the health rights of prisoners. It’s worth thinking at this point how best CSOs in HIV find CSOs in prisons rights, and strategize how to ride a wave of new thinking – particularly in OECD countries – on prison & justice reform, and to expand the thinking into action across all regions.
Agenda item 4: 2022-2026 UBRAF Output and Indicators and revised 2022-2023 Workplan
Jonathan Gunthorp, Africa Delegate
The UBRAF indicators and workplan that were presented at the 49th PCB meeting was more improved than the previous versions had been. Scores of changes had been demanded – some of them contradictory – but many had been incorporated. And yet by the end of the meeting, one might have been forgiven for thinking that some donor member states had resorted to budget bullying to get their own way on how exactly they would see UNAIDS moving forward, and that their chosen instrument was the UBRAF.
The endgame appeared to say, “we won’t fund UNAIDS fully; you need to make significant cuts now; and we insist on oversight of what you cut and what you keep.” This is perhaps understandable and even justifiable oversight of tax-generated donor funds (the deliberate decision to underfund and thus partially disable the Joint Programme is, however, unforgivable). It has the unfortunate and seemingly deliberate consequence of skewing the Joint Programme alignment with the Global AIDS Strategy, into a budget cutting exercise.
Civil Society and communities need to keep advocating for a fully funded UBRAF and a strengthened UNAIDS that is enabled to support and facilitate implementation of the Global AIDS Strategy and on the Political Declaration. But our advocacy needs to support transparency and a range of better accountability at every level and with cosponsors, as well as on issues of community and community service delivery funding.
Agenda 5: Evaluation
Alexander Pastoors, Europe Delegate
This agenda item covered the annual report on evaluation and the evaluation plan for 2022-2023. The conference room paper in connection with this agenda item was a report on the evaluation of the work of the Joint Program on preventing and responding to violence against women and girls.
Generally speaking, the members of the PCB spoke very positively on the papers and reports submitted by the secretariat. It appears that since the establishment of an independent evaluation office that reports directly to the PCB, both the quality and relevance of the programs evaluated have improved. PCB members, including the NGO Delegation, also agreed that the topics selected to be evaluated in the evaluation plan were relevant and important in light of the strategic result areas of the new UBRAF.
In response to questions raised by the NGO Delegation and other PCB members on the follow-up of recommendations described in the conference room paper, Secretariat informed us that most of the recommendations were already integrated in the latest version of the UBRAF and working plan for the next biennium.
Agenda 6: Follow-up to the thematic segment from the 48th PCB meeting
Violeta Ross, Latin America and the Caribbean Delegate
In the follow up of the Thematic Segment of the 48th PCB “COVID-19 and HIV––sustaining HIV gains and building back better and fairer HIV responses”, the NGO Delegation emphasized the diverse roles that communities living with and affected by HIV did during the COVID-19 pandemic and until the present day. People living with HIV and affected communities continue to experience the direct and indirect impacts of the COVID-19 pandemic, not only in the regions that are epicenters of the pandemic, but in all regions of the world. The PCB called on Member States to sustain community-led and community-based initiatives to respond to the HIV and COVID-19 pandemics. Delegates acknowledged how the COVID-19 pandemic challenged most health systems. Despite progress in vaccination and the measures to mitigate coronavirus outbreaks, there were disruptions in the provision of antiretroviral medications and HIV prevention supplies, as well as resurgence and increase of stigma, discrimination, and gender based violence. As we enter the 4thwave with new variants of coronavirus, it is important for people with HIV and affected communities to raise awareness about the indirect impact of the pandemic, which is leaving HIV behind in the development agenda.
The NGO Delegation hopes the pandemic can be transformed into an opportunity for re-opening the global health debate, especially the sustainable financing of HIV and COVID-19 responses.
Agenda 7: Report of the progress on actions to reduce stigma and discrimination in all its forms
Jumoke Patrick, Latin America and the Caribbean Delegate
The report on the progress of the actions to reduce Stigma and Discrimination in all forms discussed how stigma and discrimination were addressed in the Global AIDS Strategy and UBRAF. The report also mentioned Joint Programme-supported country efforts to end HIV-related stigma and discrimination in numerous ways, through joint and agency-specific efforts, and through the Global Partnership for Action to Eliminate all forms of HIV-related Stigma and Discrimination (the Global Partnership).
The report pushed for continued efforts to reduce all forms of stigma and discrimination and called for renewed political commitments, especially on the part of Member States for the achievement of the 2025 targets. The report concluded that HIV-related stigma and discrimination continues to hinder access to and use of HIV prevention, testing and treatment services, and constitute major barriers to ending AIDS as a public threat by 2030.
This agenda item followed mere formalities during the PCB and did not have an extensive floor discussion or any disagreement. Interestingly, while there were some debates about the proposed DP that encouraged Member States to join the Global Partnership, most of the PCB members were largely in agreement with the DPs. The NGO Delegation supported the DPs and delivered floor interventionsto reaffirm our position and reminded the PCB that ‘it’s time we do more, be more, invest more and care more’ for People living with HIV, key populations, and communities impacted, to ensure equality and equity for all and the ending of HIV related discrimination in all its forms.
Agenda 10: Thematic Segment – “What do the regional and country-level data tell us, are we listening and how can we leverage those data and related technology to meet our 2025 and 2030 goals?”
Jonathan Gunthorp, Africa Delegate
When do we have enough data to help communities access better services and lead a better quality of life, and when too little? Who monitors the data collectors, and do we trust them all? Are data neutral, can they be harmful, and can we mitigate the harm? The data thematic at the 49th PCB meeting grappled with these questions and with possible solutions and examples of good practice.
By the end of the session, some things were very clear. Data are essential to health. Not only to achieve a more focused and better-quality health for all, but also to more effective design and delivery of HIV programming and health for all. A health practitioner who can dial up a wider range of my health data can better understand me, treat me, and refer me for social and other needed services. Conversely, the more data stored on me, the greater the dangers of abuse. Commercial interests are predatory, and Member States are not always benign. Both have used data to discriminate against, attack, and persecute key populations and others. Big agencies working in health have difficulty admitting this in public or even to themselves.
What is urgently needed is more community participation in data collection and use; increased rights of individuals to control their own data; and a global mechanism for recognizing data privacy as a human right.
This conversation is just beginning and will continue on to the 50th PCB meeting in June 2022.
The NGO Delegation would like to thank our outgoing Delegates who served their three-year term with steadfast commitment, vigor, and substantial contributions to the debates and deliberations at the PCB:
Jonathan Gunthorp, SRHR Africa Trust, Africa
Jules Kim, Scarlet Alliance, Australian Sex Workers Association, Asia-Pacific
Alexander Pastoors, Hiv Vereniging, Europe
Andrew Spieldenner, United States People Living with HIV Caucus, North America
We would also like to wholeheartedly welcome our incoming Delegates who will serve their term from January 2022-December 2023
Mubanga Chimumbwa, Zambian Network of Young People Living with HIV, Africa
Midnight Poonkasetwattana, APCOM, Asia-Pacific
Aleksey Lahov, Eurasian Harm Reduction Association, Europe
Dinah Bons, Trans United Europe – BPOC Trans Network, Europe
Christian Hui, Prevention Access Campaign, North America
Cecilia Chung, Transgender Law Center, North America