42^ème

UNAIDS PCB Meeting

Thank you, Madame Chair. Good morning everyone.

Michel, thank you for your report. To our constituencies, it is crucial to see that UNAIDS is taking concrete actions to ensure zero tolerance and zero impunity for harassment and abuse of authority. The #UNAIDSWeNeed must respond to this epidemic also by ensuring it is a place free of any kind of violence, so you can lead by example. Therefore, we welcome the dedicated dialogue this afternoon on sexual harassment because it shows the importance of this issue for this board: an issue that we need to address and solve, while at the same time, we do not undermine the importance of keeping in mind that AIDS is not over yet. In fact, it is not only continuing the work, but to face the fact that the challenges upon us require redoubling efforts to respond to the magnitude of the AIDS epidemic. And the challenges here are not small, nor too little.

Therefore, although we believe that everyone in this room is committed to achieve health for all, to win this epidemic will require more: we need to see your political leadership translated in human and financial resources at all levels, so we can really advance toward a consistent and sustainable HIV response. We are sorry to say, although optimism is important, the reality we face constantly slaps our faces. And, in many places, despite all good words and commitments made here and in New York, we are still leaving too many people behind – including when they need us most: it is time to be more responsive and stop acting as if effective action is impossible in time of crises. It is hard, but impossibility is a myth we feed everyday. We need a focused action through disaster risk reduction in the heart of the HIV response. I am talking about the war in Syria and about the hunger in South Sudan.

I am talking about rising extremisms; attacks on multilateralism and democracy; and shrinking space for civil society to advance the policy agenda. I am talking about Police confiscation of condoms and the rising LGBTI intolerance in many countries; the bill proposing over-criminalisation of key population including towards PWID, extramarital and same-sex sexual activities in Indonesia; the imprisonment of MSM in Nigeria; ARV stock-outs in Papua New Guinea; and the continuous repression and killing of PWUD in the Philippines and Bangladesh. About the killing of transgender women in Brazil, punitive laws in Guyana; the law suits against sex workers in some rich, but unfair countries; and I am talking about the 70,000 people living with HIV in Venezuela that will need to change their therapeutic schemes because Nicolas Maduro’s dictatorship has killed its own health system.

So, the question, I guess, is that we have urgency and we can wait no longer. UNAIDS must do better to protect the rights of people – including the sexual and reproductive rights of women; by adequately funding the progressive civil society and community-led initiatives; and, finally, by reducing inequality within and among countries which is one of the most transformative SDGs, because it addresses both economic inequalities and discrimination that affect poor and marginalized populations.

We need true leadership to achieve that. Leaders that inspire by example. Leaders that can take care of and empower their people, constituencies and employees. And here, in this room, I see many leaders that can push and truly “leave no one behind” by enforcing laws and policies to protect all people without distinction of any kind such as race, class, gender, disability, age, migration status, HIV status, sexual orientation, gender identity or any other status. We know that already, or at least we should have learned it by now.

We have urgency. Failing to overcome AIDS, when we know what to do and how to do it, will be a major setback in the history of civilization. We can do better, much better. But we need to do it together – Member-States, communities and , UN Agencies. We are not there yet, but if we are united we may be able to overcome AIDS. Thanks.

Thank you very much Madame Chair,

And thanks also to Michel for your support for the expansion of community-led, people-centred approaches to reaching the 90-90-90 targets.

The NGO Delegation is alarmed at the fact that, while we have less than a thousand days remaining to the 2020 Fast-Track milestone, the financial resources available to UNAIDS fall short by about 27% with about half of people living with HIV accessing treatment.

Where is the missing quarter for prevention to reduce new infections?

What is the real picture of how many with access to treatment are truly retained in care?

Where’s the funding for the UNAIDS we need? Getting to Zero? Not with zero funding.

Zero equals ZERO.

Can we really continue to believe that we will meet our targets for 2020 (which is just around the corner) with the slow pace of resources and Member States’ lack of responses to calls for enhancing partnerships and creating enabling environments for people living with HIV, people on the move, women and key populations? Meanwhile, stigma still stands in the way of progress the world over.

Business as usual is not acceptable and the NGO Delegation welcomes the establishment of the Office of Innovation. However we wait early to hear more about it and invitation to engage with the same. Only through transparency will UNAIDS build respect and trust and be able to promote the “solidarity of inclusion.”

For UNAIDS to continue working efficiently with limited resources, it needs to be able to expand its solidarity with the community response and reach out to wider groups of constituencies, particularly those who are left behind, such as people on the move, Indigenous Peoples and trans communities. We need to be able to follow the natural and rapid evolution of managing strategic information towards the use of technology that can better communicate UNAIDS’ work with specific populations such as young people, people who are living remotely, people with language barriers, etc. Many young people and other populations over the world are no longer willing to read through a 150-page document (or even a 5-page document) in a language that they do not use in their daily lives.

So how do we communicate the important achievements and the remaining challenges to the new generation of technology savvy activists and advocates in the modern world of fake news and alternative facts?

We need to restore the trust through transparency and communicate better through innovation to the complexities and unprecedented challenges that continue to overshadow our work. During this age of the #MeToo global movement focusing on performance and the improved quality of life for ALL people around the world, especially for those continually left behind the #UNAIDSWeNeed should stop doing business as usual and keep our commitments to the end of AIDS.

Thank you, Chair.

The NGO Delegation welcomes the report of the chair of the committee of co-sponsoring organizations.

We appreciate the spirit of collective action, the delivery of the Joint Program. Your commitment ensuring that no one is left behind cannot be over-emphasized. The bold step taken by UN Women, UNAIDS, UNDP and GNP+ to support a movement, which addresses HIV related legal and policy reforms through a global compact to end stigma and discrimination is well espoused.

We note however that, 35 years into the HIV response, the way we communicate our gains and results should be changed.

It’s not about numbers, but actually lives. Madam Chair, let’s not expect to accelerate results for people when community support systems have no budget, expect to have People living with HIV adhere on treatment while they are hungry, expect people who inject drugs to have needle exchange programs when they don’t have the space and power to negotiate in policy spaces, expect young people to have adequate knowledge on HIV when the primary school completion rate is just 32%. We need empowerment-based reporting, a people-centered approach and an impact-oriented policy and programming.

Madam Chair, it’s high time we change the narrative – I hear “West and Central Africa, Eastern Europe and Central Asia” are regions left behind, including countries like Venezuela, South Sudan, Somalia, Syria and many others. We need to walk the talk of the Catch-Up plans; we need plausible ways that demonstrate how communities are going to be at the center, how capacity of community organizations is being built towards receiving and managing Global Fund grants, addressing human rights violations, shaping country’s needs and plans.

When we read the CCO report we read a lot of process reporting and all of them are very important, but we fail to understand the impact or the outcome that is expected and the outcome achieved. Other than UNHCR’s overview in providing support to 50 emergencies in the year, it is very difficult to see the overall outcome of work done by the individual CCOs. One area which we want to highlight is that the UN Joint Programme should have, by now, developed the capacity and empowered civil society organisations to manage and implement the Global Fund projects in order to ensure that funding goes to those who are most affected in each country.

Ladies and gentlemen, a resilient and effective response is based on meaningful participation of the communities, who, especially when confronted with inequalities, have the capacity to address the risks and vulnerabilities, while everyone else, is on lip service.

…….”As others are plotting to reach the moon, we should strive to reach the villages”….Julius Nyerere

Thank you.

Thank you, Madam Chair.

Since the first news on sexual harassment at the UNAIDS Secretariat emerged, the NGO Delegation has been closely following developments on the issue in relation to the Secretariat and the broader UN system in general. Given our unique position on the Board and our mandate, we have continued conversations with our constituencies. From these conversations, we have had to realize that, even within our Delegation, our perception and understanding of the issue is as diverse as the communities we come from; it is shaped by our own lived experiences and the experiences of our communities. This by no means should be viewed as division within our communities.

There was one key particular issue that emerged from these discussions that I would like to address and clarify the Delegation´s standpoint on. We have heard rising concerns that the energy, time and money invested into addressing the issue, including the setting up of the Independent Panel is diverting attention, capacities and funds from our core business and duties of the Board, the Joint Programme and in broader sense, the HIV response.

On behalf of the NGO Delegation, I would like to deliver our united standpoint: this IS NOT diversion from our core business; this IS our core business of the HIV response at ALL levels as gender based violence, harassment, bullying, and abuse of power are deeply rooted at all levels of society and are the main drivers behind the HIV epidemic in all regions.

It is our duty, and I am addressing each and every one of us in the room, regardless of our affiliation, to grab the momentum that has been catalyzed and driven by the brave women of the #Metoo movement, and finally address the underlying issue of abuse of power that manifests in the form of stigma and discrimination, harassment and violence, if we are to take our commitment to ending AIDS seriously.

Unless these underlying, deeply rooted issues are addressed, all the great work, energy and funds invested into the AIDS response will not be able to reach our common goal, ending AIDS.

It is HIGH time to bring in the long due structural reforms and fundamental changes, so that after over 35 years into the epidemic, women, young persons, people who use drugs, gay men and other men who have sex with men, sex workers, people of trans experience, and people living with HIV in our own and unique diversities can finally enjoy equality and solidarity that is inherent to all human beings and live our lives free of harassment, abuse and violence.

The UNAIDS we want is at the forefront of this change by embracing it as its core business.

Thank you Danny and all the members of the Bureau for your diligence in following though on the Independent Expert Panel.

Thank you Gunilla for you work and commitment to addressing these important issues.

Thank you to you Lina and staff association for you stewardship of staff concerns.

Thank you to all of you for committing to improve communication within and outside of UNAIDS on the work of the panel and implementation of this very important behavior and cultural change inside UNAIDS.

It is clear from the reports today that the combined intentions are not and will not be “business as usual at UNAIDS” and we welcome that

I would like to share just a few brief highlights from our experiences on the NGO Delegation.

Earlier this year, the NGO Delegation, as representatives of civil society, began a series of consultations with our constituencies to listen to their concerns and solicit input about best practices in response to handling the issue of sexual harassment at UNAIDS. Key among the concerns were: the need to provide support to individuals who report and have reported unethical workplace behavior and incidents; the need for ongoing education and training on ethical and appropriate workplace standards at UNAIDS;and the lack of a clear communication strategy within and outside of UNAIDS. Oh and let me not forget that there is unanimous support for radically reducing the time it takes to process incidents and adjudicating cases.

The NGO Delegation has recently developed and administered a survey to solicit best practices from within civil society on how to best respond to sexual harassment issues, on what a good workplace program looks like and what is known about how UNAIDS addresses these and related issues. Once we examine the responses, we will share the results with you.

Most recently on behalf of the NGO Delegation, I participated in the consultation with the ATHENA network and many UNAIDS staff from the field and headquarters. The meeting was another important opportunity for all of us together to learn and for others of us to be reminded about how sexual harassment, sexual assault, abuse of power and unethical workplace conduct are important issues for women living with HIV and the trauma of such behavior is long lasting. We cannot let these issues go unaddressed. We, in the NGO Delegation are interested in examining these issues in the context of how we improve the HIV service delivery models to be more inclusive of the needs of all persons who have experienced violence, assault and other forms of sexual abuse.

Taken together, these outreach and consultation meetings have provided us with clear instructions for how we can come together and create safe spaces to explore tough and very important issues. If we are to come to the end of AIDS, we cannot stop taking on tough issues, taking the time to listen to and learn from each other in a way that demonstrates respect for honest processes, that are based on mutual trust and respect for diversity of experiences. We have to live the change we want to see. It’s time.

The #UNAIDSWeNeed must have a leadership that is not afraid of taking tough steps to make UNAIDS a safe and enabling workplace free of any abuse and harassment.

Thank you Madam Chair.

The NGO delegation acknowledges the hard work that has gone into putting the staff association and HR report together. We commend the staff association for its annual surveys for the past 7 years to inform internal advocacy. We are encouraged to note that 89% of respondents to the staff survey are still committed to the values of UNAIDS despite challenges experienced and the questionable future of the joint programme.

We take note of the priority issues raised by the secretariat including harassment, ill treatment and abuse of authority; staff health insurance and protection of UN salaries and conditions of service.

However, we are concerned about staff reports of workplace related stress, anxiety and uncertainty about their future and that of the Joint Programme, frustrations about poor communication from management and failure to address negative media reports about the sexual harassment allegation at UNAIDS. While we commend women at UNAIDS for challenging their portrayal in the media as window dressing and passive victims of sexual violence, we caution that this assertion be not taken to undermine women who came out and reported experiencing sexual harassment at the workplace.

We would like to underscore that harassment is unacceptable but still happens at the secretariat as evidenced by the staff survey that reported violence of an egregious nature including physical conduct of a sexual nature, unwelcome and unwanted sexual advances, xenophobic violence, being offended based on real or perceived HIV status, being humiliated based on one’s gender and disability and being threatened about continuation of one’s job.

We welcome the 5 point action plan and efforts at establishing an independent expert panel on harassment, including sexual harassment, bullying and abuse of power.

We are motivated to support UNAIDS to develop stronger mechanisms to hold perpetrators of violence accountable, to prevent and protect its staff from ALL forms of harassment and create an ambience of a working environment of the #UNAIDSWeNeed.

Thank you Madam Chair.

At the onset, let me request the august gathering to pardon me if I get too direct or emotional. I have some strong comments and some sad remarks to make. But first and foremost, we appreciate the hard work gone in preparing four parts of performance and finance reporting for UBRAF. They are intense and deep and reflect the hard work done by the team. We are also thankful to 13 countries who have already provided funds for 2018, and really, really hope the others will do the same quickly. We will never tire of saying that the argument of shrinking resources for HIV programmes and for civil society is not a fund issue, it is an issue of political will, of accountability and of saving lives in the forefront of the governments’ duties responsibilities, before politics.

Coming back to UBRAF, it is concerning that the resources available are not fully utilized.. We see less and less money spent on addressing the needs of civil society and community mobilisation, and more and more on guidelines, health systems and budget support. At this stage, there is a concern that funding civil society is not supported appropriately, and that it represents a lack of vision of those who are committed to Ending AIDS. And we will not reach the people that are left behind, we will not be able to negotiate or do the advocacy work with governments for the latest prevention or treatment measures and we might not be able to enhance work on the structural barriers. By now we have all learned that for better business of HIV prevention and treatment it is important to invest in the communities.

I would like to thank UNAIDS and the co-sponsors for making the reading of UBRAF report so difficult and so complicated, because if it were simple and easy to read it would be so heart breaking to see that out of total of 21 indicators of the eight strategic result areas of 2016-2021 strategy, there has been poor to very poor progress in last one year. One area of particular concern is the so-called fast track countries. It is very critical and important for the governments, who have signed-up to fast track promise, to realise that the results create a sad picture. The report reflects very poor to no progress on the 15 indicators between 2016 and 2017; three indicators show reverse trend and only three show relatively more number of countries reporting some progress in that areas. Do I sound as roundabout as the report itself? Let me attempt to make this simple. For the first indicator of ensuring community based testing and quality assured testing, in 2016 19/33 fast track countries reported having these services and in 2017 it is still the same number, not a single more country have started to provide these services. Another indicator is on the number of countries that implement latest eMTCT guideline, again there were 23/33 countries following the guidelines in 2016 and in 2017 only one more country was added to the list. In fact, there are countries with very low coverage that is way below the average performance within the region.

Is the performance report a mirror of political will? Is it the naked truth about reduced funding or does it reflect lack of performance accountability by people who should be performing? I would say it is a combination of all the three. I felt very responsible and guilty suddenly on flight. While I am spending energy in reading the 630 pages of four-part UBRAF report – while I combat with the cosponsor report to figure out the overall impact; juggle with numbers to justify the impact of joint programme; read case studies to see how the joint programme worked with civil society to increase .1% of domestic budgets – Asha the leader of a network in my hometown passed away at 27 due to cervical cancer, since pap smear test is not part of routine check up for six monthly monitoring; Romi died due to multiple infections because he was failing on his treatment regime and the CD4 machine was not working in Delhi hospital; Chinmay developed TB as coinfection and found it difficult to continue his MSW studies; and Simon is standing in line in government hospital to get his Hep C medicine started.

Now is the time when we really need the Civil Society Advocacy funds, that was talked about last year by the newly formed resource mobilisation team. The team did excellent job at scoping exercise but I am not sure how much was done on real resource mobilisation – since there was no target and therefore it seems there is no report.

While we are at money matters, may I please request UNAIDS to make the financial reporting simple. It is almost impossible for us non-charted accountants to understand that the overall expenditure against budget is 85% and that while the reporting of all the UNAIDS and Cosponsors are on overall UBRAF, the finances don’t clearly reflect budget versus expenditure. I could not find out for Secretariat for example, where I can see budget versus expenditure.

We are very curious to learn what happened to the joint resource mobilisation plan for 43 million with cosponsors. Have any efforts been successful or has it not moved.?

Finally, despite so much paper I couldn’t see the intense and essential work done by the UNAIDS and cosponsors at country levels in the CCMs, convening the various players at country level to negotiate change of regime or initiate test and treat, or being honest negotiators or amplifiers for our voices with government. All that work is not reflected in simple and straight way. Most impactful support I remember of UNAIDS in India was when then UNAIDS UCC helped us negotiate the largest single country MSM and TG programme for India within CCM and outside, when the national programme was very skeptical of the capacity of MSM and TG organisations, the success of the Pehchan project led to change in national figures for at risk MSM and TG. Can we please simply and directly show what is outcome of all the efforts and how much work is done countries not mere global meetings and compacts?

The #UNAIDSWeNeed must be more accountable, help member states to be more accountable, because now we have been waiting for too long. It is now or we collectively be ready for never.

Thank you, Madam Chair,

Speaking about the effectiveness of the implementation of the Joint United Nations Program on HIV / AIDS, we must always remember that the objectives of the program are 90-90-90. Of these, the third 90 is not only an indicator of the effectiveness of treatment, but also an indicator of the effectiveness of the entire work – of how the programme is changing quality of people’s lives. If the indicators of treatment effectiveness are low, this means that part of the resources spent for the purchase of medicines, programs aimed at increasing adherence to treatment, are wasted. And it means that the money spent on the first 90 and second 90 were also partly lost.

In the example of the Eastern Europe and Central Asia region, we can see that the rapid growth of the epidemic is directly related to the lack of access to treatment and its effectiveness. At the end of 2016, only 28% of PLHIV were on treatment, and only a shocking figure of 25% had a suppressed viral load. And for us, it’s not just statistics, but people and figures say that out of every 100 PLWH in the region, 72 will die or fall ill with tuberculosis due to lack of access to treatment. Between 2010 and 2016, the number of new HIV cases increased by 60%, deaths increased by 27%. In India, we gather the government has just started promising that the last 90 will be measured in phased order, the action is yet to come.

Both deaths and new infections could be avoided. Transition from branded drugs to generic ones, optimization of treatment schemes, patent opposition, – those measures could significantly reduce the cost of purchasing ART, and thereby save the funds that are so always critically lacking in programs for the prevention, care and support of PLHIV and key populations. Also, poverty is one of the main drivers of the epidemic. In Ukraine, according to a survey conducted in 2016, 61% of PLHIV live in poverty, 21% of them lack money for food. Often, because of critical poverty, people refuse treatment or stop it. As a result of the project, which was implemented in Ukraine in 2017-2018 by the All-Ukrainian Network of PLWH in partnership with World Food Programme, the effectiveness of treatment among PLWH who received monthly food assistance from WFP was 93% with an average treatment effectiveness of 38% in Ukraine. Please take a moment and accept that it is possible, but still not happening. Please take a moment and look at the 2 figures: 38% vs 93%. Imagine what the indicators would look like if similar, effective programmes have been invested with the full and meaningful involvement of communities and civil society. In contrast, in India, the PLHIV network runs the country’s care and support programme and raise local funds to support communities needs and make treatment effective.

And this means that the recipe for success for reaching 90-90-90 already exists: buy ART at affordable prices, provide access to PLHIV and key populations for services and food security, ensure the inclusion of key groups in the processes of determining country needs in response to the epidemic and a year later, we will report on significant progress in achieving the goals of 90-90-90. Well, besides this, with effective implementation of the Joint Programme, if a young person does not fall ill with tuberculosis, a woman gives birth to a healthy child, and no one has to die due to the current conditions of access to treatment in the EECA region, it is already a great success.

Greater and meaningful involvement of people living with HIV at all levels is critical and is the key to ending AIDS as a public health threat by 2030.

We have seen the achievement on getting to more than half of people living with HIV on treatment; and we have the target of a quarter for prevention because it is key to ending AIDS – though it remains underfunded. These, however, will not further advance without adequate investment that focuses on community-led initiatives.

We acknowledge the performance in this report, showcasing the achievement, challenges and way forward of the Joint Programme. Also, we welcome the implementation of the new model of country envelopes. We know it requires more improvement but, in the long run, we believe that this process will provide a lot of opportunities for the Joint Programme to address country-specific challenges and barriers.

Therefore we have two specific concerns. One is the need to have increased financial resources for the country envelopes; the second is that there has been very little engagement of key populations and civil society in the planning process. Perhaps there was a rush and overgeneralization to respond to the mandate of the Joint Programme, rather than the needs of the most-affected populations. We strongly request clear guidelines for engagement of civil society in planning the country envelopes in order to guarantee the meaningful involvement of the key populations, including women, youth, people on the move and others in the process. For example, we are aware that in India the entire UBRAF is spent on one state intervention rather than using it for catalysing reponses at the central level. In Brazil, the CSOs did not participate in the definition of how the country envelope funds will be allocated.

We cannot pretend that we are responding to the needs of key populations, including women, when we don’t even have enough data on specific populations and when we do not involve them in the processes. People who inject drugs, Indigenous Peoples, and transgender persons, for instance, have been left out in the prevention roadmap reported by many countries. This lack of data is what continuously leaves us behind.

How many more people who use drugs do we want to kill or throw into prison?

How much more money do we want to spend on arresting people who use drugs and eradicating drug use?

While evidence clearly shows cost-efficiency compared to public health approach.

Can we be honest? The war on drugs is a war on people! How many more transgender persons should be killed because of their gender identity?

How many more transgender persons do we want to persecute and humiliate in public? How many more times do we need to remind you that our community is dying due to the lack of political will to do what works?

We need to STOP PRETENDING that we are on our way to ending AIDS if we cannot protect basic rights and if we continue to fail in putting faces to the numbers.

42% of the 96 countries that have shown progress in addressing ONLY one law or policy that presents a barrier to delivering HIV services. This is NOT enough. The #UNAIDSWeNeed must invest more than only 6.5% to address structural barriers on human rights, stigma and discrimination. We are calling all leaders of the Member States, to stop pretending that we are achieving the end of AIDS.

I want to begin my remarks by reminding us of some of the key commitments from the 2016 Political Declaration on Ending AIDS:

We committed to increase and fully fund the HIV response from all sources, with overall financial investments in developing countries reaching at least US$ 26 billion/year;

We committed to ensure that financial resources for prevention are adequate and constitute no less than a quarter of global HIV spending on average;

We agreed to ensure at least 6% of HIV resources are allocated for social enabling activities, including advocacy, community and political mobilization, community monitoring, public communication, and outreach programmes for rapid HIV tests and diagnosis, as well as for human rights programmes, such as law and policy reform, and stigma and discrimination reduction and expanding community-led service delivery to cover at least 30% of all service delivery by 2030.

We also agreed that, in order to know whether we are moving forward–these financing and programmatic targets would be monitored. UNAIDS agreed to help coordinate the development and identification of tools and vehicles to assist with the monitoring task. Now what we need to agree on now is for UNAIDS to consider integrating and harmonizing all financial and programmatic targeting and monitoring processes to capture and tell the true story of how the collective WE is doing in achieving the agreed targets.

In 2016, an estimated US$ 19.1 billion was available for HIV in low- and middle-income countries, 57% of which came from domestic resources (public and private). International assistance for HIV amounted to US$ 8.2 billion in 2016. This translates to a funding gap of US$ 7 billion (the difference between the resources available in 2016 and the estimated US$ 26.2 billion needed by 2020). Another missing quarter. IF we do not fill that gap, what will that mean? Monitoring, NOT making it, is not the goal we agreed to. The tools are to assist us in moving forward, not for us to stand still and continually repeating the limited success we have achieved.

The historical trend shows that resources almost doubled from US$ 10 billion in 2006 to US$ 19.1 billion in 2016. WE do not have ten years to double the funds, we have only two short years.

While additional funds will be needed, resources should be prioritized to achieve efficiency gains in HIV programmes and innovative funding mechanisms should be urgently put in place. Prioritization of HIV programmes depends on the epidemiology and cost-effectiveness of service delivery in each setting, as well as resource availability. But it is also a political decision.

Transitioning from donor support to a sustainable domestic response is important for many countries faced with the prospect of losing eligibility for development assistance funds. But it won’t be possible for all countries, thus increasing the development assistance funds and having all countries reaching the 0.7% ODA target is also imperative.

Member States, UNAIDS Secretariats and Cosponsors, we have to change our tune and change the dance, if we are to reach our agreed goals and targets. And I am not sure we are prepared to do so. The challenges we are confronting about achieving the targets is not about feasible ways to monitor the achievement of financial related targets in the declaration. As my colleague from the African Delegation, Musah, reminded us yesterday, what we need to be monitoring is how people are getting diagnosed, getting care, and what is needed to make us to move to the end of AIDS as a public health crisis by 2030. Ambassador Birx shared yesterday we need to use our heads and our hearts in our work. Today, she encouraged us and many delegations reinforced it: we need to do it better.

I thought I heard some old songs playing these last few days. I want to suggest that it is time to change the music. Some of us can no longer dance to what we’ve heard here.

To transform the HIV trends, WE ALL need to learn the new beat and melody so we can change our dance routine. Some of us require new dance partners, some of us, because it is new music and a new routine, may actually need to take dance classes.

There are plenty of NGOs and CSOs prepared to teach those classes. Join us, learning to dance is a good way of moving our hears, our bodies and our minds. You are all invited invited to join us at the new PCB Impact ball.

Thank you.

Thank you Madam Chair;

I am Musah, born and raised in Busia, a border town shared between Uganda and Kenya. I count myself amongst the lucky few, as majority of my peers have succumbed to AIDS-related deaths. In 2003 at the age of 15 years, I was subjected to an HIV test simply because one of my loved ones had died of an AIDS defining illness. At high school, everyone knew what had transpired, Musah tested positive for HIV and here I am, I belong to the community.

Being involuntarily put in the spotlight, I had no choice but to reclaim my status. I founded a peer education club and became its president. This started my journey in HIV policy discourse and advocacy. I came to terms with reality and embraced my ‘unwanted stardom’.

In 2015, I joined medical school and I am now in my clinical years, where I find that the Hippocratic Oath requires me to look at one who seeks my support and intervention, as a patient. One of the questions I grapple with everyday is: if people are missing their monthly ARV refills, might they be sick? Another important aspect of adherence that is not shown by the figures: Do I condemn someone who presents with frequent sexually transmitted infections? On the other hand however, the same Oath compels me to remain a member of society, with special obligations to fellow human beings, those of sound mind and body, as well as the infirm.

I have been therefore challenged to be the change I want to see. Working with the International Federation of Medical Students Association, UNAIDS and the global network of young people living with HIV, we are responding to the community’s call, to eliminate HIV-related stigma and discrimination in the health care setting. We are motivating future doctors to look at HIV beyond a biomedical condition that requires a confirmed HIV positive result, ARVs and Septrin, to a condition that affects the general health and well-being of all those found to be living with it. Their sexual health including their inherent desire to have children, reproductive needs including contraception by choice, the psychological needs, food, safe water and livelihood.

Do you know that, as we talk now, someone has been denied a health service because of who they are? HIV related stigma and discrimination in hospitals has penetrated our gowns and uniforms; it doesn’t just affect our so-called patients, but also health workers who are assumed to be HIV positive as well. This has continued not only to impede access and quality of services, but has also undermined the morale and efforts of health care providers.

We should prohibit HIV mandatory testing and disclosure; respect the privacy and right to dignity of our people; link them to support networks; educate and support health workers to provide quality other than quantity, in a safe and non-judgmental way; and establish and/ or improve measures to track progress on ending discrimination in all its forms.

Thank you.

Good Day All.

My humble appeal to you today: Let all of us work diligently to accelerate efforts to develop synergies and links between national, regional and global efforts in reducing stigma and discrimination in all forms, including in health care settings and to leave no one behind in the efforts to ending AIDS as a public health threat by 2030.

These cannot be done if stigma and discrimination towards key populations remain in health care settings. Stigma and discrimination against transgender people living with HIV creates challenges that result in many who are unable to access health care not only in the Caribbean, but the world over.

Presently, there is little or no data on Trans persons, which leaves us invisible and worse yet, nonexistent. In Guyana where I come from, the incidence rate for Trans persons is 8.4% and new HIV infections remain high among Trans people aged 15-24 years old.

My transsisters and myself have experienced first hand discrimination in clinics. On many occasions, doctors avoid touching us during examination and if they have to, they put double gloves in front of us and not for others. In 13 months, we had three deaths, since people did not want to go for treatment.

The attitude, skills and experience of health care staff matter in the success and/or failure of the AIDS response. Health-care settings, in particular, should be safe spaces, an “oasis from stigma and discrimination.” Health care providers need to model desired behaviour. Unfortunately, stigma and discrimination are still realities that manifest themselves in a variety of ways, such as refusing to admit patients, delaying or withholding treatment or other forms of care, not attending to patients in beds, breaching confidentiality, and making inappropriate comments.

One type of stigma is bad enough. But “layered stigma”— in which one stigma (such as stigma because of HIV infection) is “layered” on pre-existing stigma such as gender, poverty, and sexuality or sexual orientation—is even worse. Layered stigma promotes concentrated HIV epidemics.

UNAIDS has made zero discrimination one of the pillars of its strategy: AND I QUOTE
“The future of the HIV epidemic will depend on how well the Caribbean will address identified challenges. Leadership is needed to remove punitive laws that diminish stigma and discrimination. Laws that perpetuate stigma and discrimination and limit access to health care and fuel the spread of HIV are not in the national interest” (UNAIDS).

Greater political and policy commitment are needed to make health-related services “stigma free.”

What would stigma-free health services look like? That all personnel (“from the receptionist to the guard to the surgeon”) are trained, have existing guidance for stigma- and discrimination-free services, ensure that client satisfaction is monitored, and key populations are included among staff and in evaluating services.

I am requesting all Members States and key donors to increase their investments to adequately address discrimination in health-care settings as part of a fully-funded global HIV response.

Thank you, Vinnay.

When I look around the room, I see representatives from at least 19 countries where Indigenous Peoples are recognized to reside.

According to the Stop TB Partnership, the world’s 370 million Indigenous Peoples face a plethora of issues caused by displacement, dispossession, loss of livelihood, systematic racism, abuse, and lack of recognition.

Further hindering an adequate response to these challenges, there is a pervasive lack of data about Indigenous Peoples concerning health and other key development indicators. Data that are available show a prevalence of extreme poverty and severe health disparities that include TB.

Data further indicate that Indigenous Peoples universally experience higher TB burdens than their non-indigenous counterparts and struggle with access to services due to remote location, severe discrimination, and lack of health programming that can accommodate their non-Western views of health and well-being.

Allow me to provide an example of over representation of TB among Inuit People, an Indigenous Group in Canada’s arctic, a high-income country in the 21st century.

Canada, considered a high-income country with very low TB prevalence, recently announced $22 million dollars over 5 years to eradicate TB in every Inuit region. Aligning with a global theme for Indigenous Peoples, incidence of TB is closely tied to living conditions and social determinants such as crowded housing, food insecurity and lack of access to culturally-appropriate health care services.

We’re playing catch-up with Indigenous Peoples in Canada with record numbers of active TB cases and latent TB.

The average annual rate of tuberculosis (TB) among Inuit in Canada is now more than 290 times higher than Canadian born non-Indigenous people. How did this happen?

A public health approach that includes and alternatives and or innovative measures to reduce the number of TB cases within an Indigenous Group in a developed country is ESSENTIAL TO ADDRESSING THIS SEVERE HEALTH DISPARITY. BY relieving overcrowding and ensuring access to harm reduction, prevention, counselling, adequate nutrition and other health services, WE CAN BEGIN TO ADDRESS SOME OF THE GAPS.

We know that racism (yes, it happens in Canada, as it happens in every single country too) and other forms of marginalization lead to discrimination and disproportionate provision, accessibility and quality of health care services. Just a few months ago, in the mainly Inuit community of Nain, my close friend’s 14-year-old nephew, Gussie Bennett died needlessly from TB. Many Inuit people have unanswered questions and fears about his diagnosis and death. From the perspective of the Inuit, healthcare service providers consider TB as an after-thought.

Article 23 of the UN Declaration on the Rights of Indigenous Peoples states that, “Indigenous Peoples have the right to determine and develop priorities and strategies for exercising their right to development. In particular, Indigenous Peoples have the right to be actively involved in developing and determining health, housing and other economic and social programmes affecting them and, as far as possible, to administer such programmes through their own institutions.

Article 24.2 reaffirms that, “Indigenous individuals have an equal right to the enjoyment of the highest attainable standard of physical and mental health. States shall take the necessary steps with a view to achieving progressively the full realization of this right.

The NGO Delegation must insist that the highest attainable standard of health be afforded to Indigenous Peoples globally, including the Inuit regions in Canada, and we call for the equal treatment for all people. It is long past time for a global catch-up plan for HIV and TB for Indigenous Peoples.

Thank you, Chair.

My name is Humphrey, Ndondo. I am a black gay man from Zimbabwe. I am also a public health practitioner.

I wish to share what I have seen, what I have heard and what I know so that you also know!

I feel particularly moved to contribute to this conversation because I am from a community that is in bed with TB and HIV; not by choice but by circumstances that are our daily lived realities.

Our communities of gay and bisexual men and other men who have sex with men, trans diverse persons, sex workers, and people who use drugs are seen as bad people, filthy, immoral, delinquents in society. We continue to be criminalized, stigmatized, marginalized and left behind.

I am deeply concerned about the response to TB and HIV among key populations particularly persons in closed settings, prisons, detention centers and refugee camps. In most of our countries the treatment of persons in holding facilities, detention and those incarcerated is deplorable to say the least, characterized by austere, inhumane and degrading treatment. The infrastructure in these facilities is often poor, under ventilated, over- crowded and conducive to breed, fester, and spread infections. In these facilities, we are perpetually under nourished and starved. We are isolated, lonely, depressed and suicidal. We have NO access to psychosocial support save for gardening projects that are part of our sentence and hard labour- our voices are often silenced

Even in death, our dignity is violated, our bodies are not respected and we die emaciated, malnourished, with a concoction of viruses and bacteria coursing our bodies. Our bodies are left to rot for days while waiting for our relatives to collect and bury us.

Our lives matter.

In conclusion, this narrative of how we are disproportionately affected by TB and HIV is not new. You all know, because we have told you so over the past decade!

Just in the 41st PCB Meeting, we presented a report on addressing HIV in prisons and closed settings and made bold recommendations for review of legislation to decriminalize and de- stigmatize key affected populations and create an enabling legal and policy environment for ALL.

We are NOT bad people – we are subject to bad laws and these bad laws are killing us!

Our lives matter.

In the Eastern Europe and Central Asia region, one of the keys to achieving the TB targets of the 2016 Political Declaration is to achieve the 90-90-90 treatment target of UNAIDS. However, there are still many gaps and challenges in achieving these goals.

Yesterday, I addressed the challenges and problems of the 90-90-90 targets in the EECA region. Under the first 90, people are diagnosed late for HIV, even at their 3rd – 4th clinical stage. On the second and third 90, lack of access to ART and its low effectiveness lead to the fact that 40% of all TB cases in the region are HIV-TB coinfections. In which, 30% of all TB cases become MDR-TB due to poor treatment retention and effectiveness.

Stigma and discrimination remains extremely high in the society, particularly against HIV and TB. People become isolated, and your neighbors will stop talking to you but continue to talk about you.. Your friends will stop visiting you. You are put in a hospital for 6 to 20 months, often in an isolation room with very poor facilities and environment. Your diagnosis is reported to other institutions such as school or work without your consent. This puts you at at risk of losing your job, or being put in a special school for children with TB, further increasing your vulnerabilities and reduce your treatment and health outcomes . And again, , all these happen without your consent.

Confidentiality is a key concern in TB, as it is a notified disease if data is not managed properly increase in discrimination and breach of confidentiality and that also keeps people away from taking treatment in affordable government settings.

All of these conditions are excellent for TB to continue killing people but devastating for communities with TB.

We need to ensure that there is access to affordable medicines for TB, including first-line and medicines for MDR-TB; eliminate stigma and discrimination related to HIV and TB; increase the Member States’ political will to achieve the 90-90-90 target. Without these, we will continue to fail in ending TB.