37^th

UNAIDS PCB Meeting

Mr. Chair, we thank you for your leadership. Executive Director Sidibe, we thank you for your insistence on immediate action in the face of the suffering created by HIV.

As the NGO Delegation, we strongly support the current strategic direction of UNAIDS and the targets set. We cannot accept that people are left behind any longer.

As we scale up our hopes to end the epidemic, we need to be honest. The strategy is inspiring. But money is running out. We have fast track language but not fast track money. We need to fully fund the UNAIDS strategy for 2016 to 2021. We need to fully fund the Global Fund replenishment. We need to fully fund civil society work to address HIV.

In every country, including my own, we see people – many young – continue to die of AIDS because they fear mistreatment and violence, because medications are too costly, or because they lack basic sexual education.

It is time for AIDS to stop stealing our loved ones. We have evidence. We need action to end discrimination and violence against women, girls, and LGBTQI people; and ensure quality prevention, testing, treatment, and support.

We say that EVERYONE must have access to respectful, affordable, quality prevention, treatment, care and support, irrelevant of where they are or who they are.

We must learn from and support communities to conduct critical advocacy and support work.

In Zimbabwe, with little funding, Widows Fountain of Life, run by Angeline Chiwetani, provides psychosocial support for widows, especially those who recently buried their husbands and then received an HIV diagnosis. Communities need funding.

The Hungarian Blue Point Foundation is currently blocked from continuing their highly effective needle exchange program for people who use drugs by their local government. This takes place despite Constitutional protection of these services as part of the national civil right to health. Communities need protective legal environments and funding.

We have fast language on communities. We need fast funding for communities.

We ask the Member States, do not make this PCB one in which we leave with nothing more than fast language, its our collective responsibility. The time is now that we must fight again as we have done before. We must stand strongly against mistreatment of vulnerable people and we must end AIDS.

The NGO Delegation welcomes the vision portrayed in the update on the AIDS response in the post-2015 development agenda. We desperately yearn for a day when we can truly say we have ended the AIDS epidemic in every corner of the globe, and among every population. Even more, we yearn for the day when gender equality is real, when discrimination based on sexual orientation and gender identity is ended, when people of all ages, races and cultural backgrounds, including indigenous people, migrants, sex workers, and people who use drugs, are able to live their lives with dignity, free from fear, free from marginalization, free from poverty and hunger, free to live lives of opportunity and promise, with all of their rights fully protected.

The realization of this vision will only come, however, if all of us are prepared to change the way we carry out our responsibilities such that we see our work in the context of global transformation, not just our specific responsibilities in the AIDS response. While much of our focus has been on HIV-specific interventions, the reality is that these alone cannot achieve that vision. So we are pleased that the Social Development Goals require a cross-cutting perspective. We are also pleased that the Joint Programme has actively engaged in the SDG process and has leveraged these goals in the proposed Updated Strategy and in all of its activities.

Specifically, we are delighted, following on the Decision Points that stemmed from thematic on drugs, that the Joint Programme has actively engaged in preparations for the UNGASS on the World Drug Problem and has actively promoted a public health approach to addressing drugs. We would urge that human rights be included as well, as these are key lessons learned from the AIDS response. As we heard in the Thematic on People Who Inject Drugs, government actors, including but not exclusively law enforcement, routinely violate the rights of people who use drugs, deterring access to both prevention for people who are HIV- and treatment and care for people who are HIV+.

Last December, the PCB approved Decision Points that, if implemented, would put multi-sectoral responses to the cross-cutting social drivers of HIV poverty and inequality at the heart of the AIDS response. Certainly, this is the spirit of the Sustainable Development Goals. While these Decision Points are not reflected as clearly as we would like in the proposed updated Strategy, we urge the Joint Program to strongly advocate for inclusion of a commitment to address the social and structural drivers of AIDS epidemic in the political declaration resulting from the High Level Meeting on HIV/AIDS in 2016.

The truth is that, even if we had unlimited resources, all of the bio-medical interventions in the world will not end the AIDS epidemic unless we address the conditions that put marginalized people at risk and that keep people living with HIV out of care and unable to maintain viral suppression. We don’t have unlimited resources in the AIDS response, so this should compel us to seek out intersectoral partnerships that rely on mutual interest. Otherwise, our language regarding “leaving no one behind” will remain nothing more than words, and our communities will indeed be left behind.

Thank you, Chair.

The NGO Delegation welcomes this update on the AIDS response on the post-2015 agenda.

Clearly, ending the AIDS epidemic by 2030 is one path in achieving the Sustainable Development Goals that the world has taken on since its adoption in September 2015. What is even more clear now is the importance of how the efforts to achieving the end of AIDS is relevant not just to one Goal, but to a number of Goals, and how a multisectoral approach is necessary to effectively respond not just to the global epidemic, but to ensuring that we are able to reach the ambitious targets that we set in the 17 Goals of the SDGs in the next 15 years.

In the last 15 years, we have seen how HIV and AIDS have changed everything: the varying but increasing political commitments towards ensuring that targets are met and the efforts to ensure that the AIDS movement is well-funded. This would not be possible without the tireless efforts of communities to participate in these processes, particularly of key populations including people living with HIV, women, and young people. Most importantly, in the last 15 years, we communities changed the global social movement.

In 2009, in one of the meetings of the Association of Southeast Asian Nations Task Force on AIDS on young key populations, we called for attention on the lack of spaces where young gay men and other men who have sex with men, young transgender people, young people who use drugs, young people who sell sex, young people living with HIV, including young key affected women and girls, can participate in decision-making processes; that we are not just speakers to give testimonials about our experiences growing up and for the decision-makers to decide our fate. We know what is best for our communities, and with the right support in building our capacities and leadership, in working together with governments, we can take the lead in the HIV response. Today, we see young key population-led organizations in countries like South Korea where young PLHIVs come together and help each other, despite the difficult stigmatizing environment. We see LGBTI youth movements in the Pacific talking directly to their Presidents demanding for the recognition of their rights. Communities have changed the landscape of HIV and AIDS.

As we move forward in our discussion on the implementation and monitoring of the SDGs, let us continue to raise the leadership of communities once more. At the 2016High Level Meeting on HIV and AIDS, we want to make sure that communities are part of this process. After all, there will be no HLM without us.

Thank you.

The NGO Delegation expresses our sincere gratitude to the Secretariat for their commitment to the participation of civil society and communities in the development of the UNAIDS Strategy 2016-2021. This Updated Strategy, after all, is about us – people from key populations, communities most affected by the HIV pandemic that has cost millions of lives around the world. We need to make sure that, as we continue our discussions on the Strategy in this room, that you do not forget us in the process, and that you value our stories and our lived experiences.

Central to the framework of this Updated Strategy is the recognition of the rights of key populations, women in all diversity, young people, and other vulnerable populations, including migrants, incarcerated people, and indigenous peoples. We are not just numbers in your Excel sheets and registries. We are people. We have needs and aspirations. We have families. We have rights.

The theme for this Updated Strategy is the Fast Track approach, which means fast-tracking treatment coverage and access and faster delivery of combination prevention services, AND IT MEANS ALSO FAST-TRACKING EFFORTS TO END DISCRIMINATION; efforts which are often undermined.

In recognizing our human rights, we must not forget that when we talk about my right to access treatment services, we are talking about my right to bodily integrity. When we speak of my right to protect myself from harm, I am exercising my right to free myself from violence and discrimination. Unfortunately, our rights as key populations are seen in segments and not interlinked with each other. My sexual and reproductive rights as a woman are as important as my other political, civil, social, and economic rights. My sexual and reproductive rights are my fundamental human rights.

Every minute, a young woman is infected with HIV. Every hour, a young gay man and a transgender woman are infected with HIV. Every hour, a young person who uses drugs and a young sex worker are denied access to harm reduction services. Every hour, a woman with HIV faces cruelty from health care workers because she is pregnant; a couple with HIV is denied family planning services. Every hour, a woman with HIV is forcibly sterilized. Everywhere, people living with disabilities are denied access to sexual and reproductive health services due to inaccessible healthcare centres and discrimination by healthcare workers.

The question is not how recognizing sexual and reproductive rights will end AIDS. The question is when are you going to recognize our sexual and reproductive rights so that we can end AIDS.

Like Tanzania, we in the NGO Delegation had considered asking to reopen the strategy beyond the discussion of sexual and reproductive health and rights. But in the spirit of collaboration and solidarity, we agree that the strategy should be closed tonight so that we can move forward with implementation to fully meet our communities’ needs.

Thank you.

Thank you Mr. Chair, I’m gonna speak in Spanish, I’m going to speak in Spanish.

We have reached a unique moment in our history: the end of a global pandemic that has wreaked havoc on millions of lives around the world.

The dream of a world where we never lose a sister, a spouse, a friend, or a child to AIDS again is within our reach. For the first time we have the capacity, technology and solidarity necessary to make it possible.

This update in the UNAIDS strategy marks the critical steps towards that dream that we share as humanity, and today, more than ever, we must seek agreements that make it possible for no human right to be denied, to anyone, anywhere.

Today as we celebrate the 70th anniversary of the United Nations; We must be aware that no strategy that seeks to curb HIV and end AIDS as the cause of further losses can ignore human rights for everyone, everywhere.

10 years ago, I was part of a group of 15 young gay men, living in Paraguay, who were determined to stop the destruction of our lives; without experience, without resources and without support, we formed what is now SOMOSGAY. Today, I am just one of the 8 survivors of that group. Not a single year has gone by in which we have not lost one of our colleagues to homophobia that denied them access to services, support and accompaniment.

Rafael, Marcelo, Pablo, Miguelo, Richard, Eduardo, William, they were beautiful people. Erasing them from the world is not an option. Erasing gays, lesbians, bisexuals or transgender people from the documents shouldn’t be either.

Unconditional respect for the human dignity of all, including lesbians, gays, bisexuals and transgender people, is the only way forward.

Beyond the walls that separate us, building bridges between our differences is paying attention to our humanity, our empathy and our mutual respect; These are the values that have saved us so many times from the dark abyss into which hatred drags us.

Finally, the NGO Delegation would like to congratulate the UNAIDS Secretariat for ensuring that our needs and those of our communities, as people of this planet and not just as key populations, were heard and included in the Strategy update. The thirty years of struggle confront us with a reality in which we must rethink the political strategies that can provide a response that includes everyone in the world. Paraguay is a country of 7 million inhabitants and 30,000 of its citizens live with HIV/AIDS. It is urgent that we carry out accelerated response actions. Our size should not be a reason to leave us behind. Don’t leave us behind. Don’t leave our rights behind. That is the commitment we have made and each one of us must recognize her responsibility in fulfilling it.

Aguyje peeme guarã (Thank you very much to all of you)

On behalf of the NGO Delegation, we express our appreciation to Joel Rehnstrom and his team for incorporating the majority of our recommendations into this document. Thank you.

We now have the UNAIDS strategy that is needed to call a halt to the illness, death, and family grief that HIV can cause. We can stop the suffering now. But to realize this hope, we need ambitious indicators and we need an ambitious budget. We fear the budget numbers provided here – a zero growth budget – will not accelerate the HIV response in the way that is absolutely needed to save lives.

The Fast Track response is an approach that is intended to end the AIDS epidemic as a public health concern by 2030. As such, the Fast Track approach is necessary in every region, subregion, country, city and community. We cannot fast track the response to HIV only in countries with big populations and with big epidemics. We also need to fast track the response in countries where the epidemic mostly affects key populations and in medium-size and smaller cities. The fast track approach in countries with concentrated epidemics will have an extremely beneficial impact on key populations, reducing new infections, reducing HIV-related deaths and reducing stigma and discrimination on key populations. We need fast track EVERYWHERE.

Considering this, we ask the PCB to commit to the level of funding required to realize the hope of the Fast Track, with the understanding that the budget numbers may need to be increased as the Results and Accountability Framework is revised. We need more than Fast language, we need Fast Track money.

In the consultation process, communities asked for clear and transparent reporting from the Joint Programme that allows us to understand what activities are taking place, who is doing those activities, and what investments are being made. As the expert group refines the results and accountability framework, the NGO Delegation looks forward to seeing clear lines of accountability that are transparent to communities.

The NGO Delegation seeks a well-defined and central focus in the UBRAF on advocacy, communities strengthening, and resource mobilization.

We urge the expert panel to consider indicators that measure percent change, rather than raw amounts. We need to be able to identify percent changes in the investments in, and funding for, civil society. We need this information differentiated by support to grassroots organizations, women’s organizations, networks of PLHIV and key populations.  Tracking the percent change over time is also needed to see changes in levels of foreign and domestic investment in low and middle income; and investment in research, development, and roll out of new prevention and diagnostic technologies and interventions to end HIV and related stigma and discrimination

Finally, and above all else, we ask that every output measure be considered though the lens of human rights. For example, testing and treatment must always remain voluntary and informed; and the scale up community delivery must be funded and not added on as women’s or community’s unpaid labor.

We offer our support to the Secretariat in the further refinement of the Results and Accountability Framework.

Thank you.

Thank you Mr. Chair,

The NGO Delegation appreciates the focus on HIV in prisons and closed settings in the UNAIDS Strategy 2016-2021.

We agree with the assertion that HIV prevalence among prisoners may be up to 50 times higher than in the general population. We understand that many of the activities, which put people at risk of contracting HIV, are highly stigmatized in society and in many cases are considered ‘illegal’.

Experience throughout the history of humankind, has taught us the vital lesson that the distance between freedom and prison is so minute that prison walls, in reality, are not as impregnable as they seem. The late Nelson Mandela captured it succinctly when he said: “In my country we go to prison first and then become President.” This phenomenon is not peculiar to South Africa as Nigeria’s former President, Olusegun Obasanjo, also graduated from prison to the Presidential Villa. Examples of others who passed through prison before leading their countries include Benazir Bhutto of Pakistan; and Mahatma Gandhi who was imprisoned numerous times by the British, both in South Africa and India. You never can tell: my sister Simran may be the President of Nepal tomorrow.

This is why we recall Nelson Mandela’s words that: “It is said that no one truly knows a nation until one has been inside its jails. A nation should not be judged by how it treats its highest citizens, but its lowest ones.”

We unequivocally agree that a public health approach and alternatives to incarceration could reduce the number of prisoners acquiring HIV, TB, HCV co-infections by relieving overcrowding and ensuring access to harm reduction, prevention, counselling, adequate nutrition and other health services.

We know that racism and other forms of marginalization lead to discrimination and disproportionate incarceration and detention. For example, in Canada, Indigenous people comprise 3.8% of the Canadian population, but now account for 23.2% of the total inmate population.

Scarce resources are better devoted to health interventions such as harm reduction, addictions counselling, treatment and support – including programmes for children and people in pre-trial or temporary detention -rather than punitive responses that drive vulnerable populations into hiding, thereby pushing them further into harm’s way.

We recognize Portugal for decriminalization of drug use. We applaud South Africa for providing condoms in prisons, Iran for Opioid Substitution Therapy (OST) in prisons and Moldova for OST and Needle and Syringe Programs (NSP) in prisons. However, we need to do more. We need to vastly improve availability, accessibility, acceptability and quality of HIV prevention, treatment and care services in prisons and closed settings. African countries need to go beyond advocating for more funding. We need to recognize the need to focus on funding for OST, MMT, NSP, condoms provision and other related services. The UNODC needs to work with communities in Africa to establish policies and implement programs targeting people in prisons and closed settings. Most importantly, we should call for decriminalization of key populations. This is not just an issue of moral justice; this is an issue of human dignity. The Speaker from Moldova referred to prisons as places where lives are preserved. The reality is that lives are being destroyed and worsened in many prisons worldwide.

As a parting word, I wish to quote Nelson Mandela again. “For to be free is not merely to cast off one’s chains, but to live in a way that respects and enhances the freedom of others.”

We will continue to be behind our targets so long as we continue to leave a substantial number of our people behind….. our people in the prisons and closed settings. Therefore, if we who are outside the prison walls want to continue to be truly free, then we must treat our people in prison with compassion, dignity and care.

Thank you.

We would like to thank Dr. Mayaki for his strong words in support of civil society and community-based approaches for addressing HIV. The NGO delegation shares the emphasis on the need to increase multisectorality. HIV teaches us how much we all need one another, across differences in economies, geographies, and ideologies.

We thank Alessandra Nilo for her brilliant and direct words that draw our attention to the political inequalities — between countries and within countries — that fuel the epidemic.

We say today that all health concerns are global health concerns. Viruses do not respect borders and passport control. Whether we like it or not, we are in this together. Those of us from high income regions need to say to our leaders: when higher income countries provide funds, this should be seen not as charity but as obligations as members of a global community. At home, when governments provide full funding for health, this is not charity. This is a human rights obligation. Similarly, it should be an obligation for high income countries to actively work against trade barriers to affordable medications and commodities, such as the barriers in the Trans-Pacific Partnership. As Ale stressed, countries have common but differentiated responsibilities.

Funding has been the elephant in the room. Communities hang on by a thread and this is not because of poverty – or poverty alone – but because governments have not prioritized support to communities. Sustainable change requires sustained support.

Poverty is not only across nations but within nations. Marginalized people are invisible in the macro data but absolutely visible in rights violations. The US is part of the Fast Track strategy. Even in our rich nation, there are pockets of vulnerability – even ’emergencies’ – that need urgent attention. Full funding is also for these.

One group pushed regularly to the margins in North America is Indigenous Peoples. Remarkable organizations like the Indigenous All Nations Hope Network in Sasketchawan, Canada, have the community knowledge and trust to address HIV – in a province with HIV prevalence that is three times the national average and where 74% of new diagnoses are among those who are Aboriginal. Led by Indigenous women, they build on indigenous ways and cultures, and design programmes to provide a sense of belonging, to restore cultural identity, and to teach how Indigenous ways are complementary to and reinforce mainstream/Western knowledge and approaches. Without empowered and supported civil society organizations, these kinds of work will not happen.

We have many examples of civil society driven change. We have good information on the funding needs. Now we need to have a reality check and immediately find the funding needed for communities to do what we are dying – and living – to do.

We look forward to participating in the conversations about committed funding structures for civil society that was mentioned so many times today and yesterday.

What is the role of civil society in a Fast-Track AIDS response?

I will speak form the perspective of EECA, but I believe that a lot I’ll share will relate other MIC from MENA, LAC and AP.

Today we see economies in EECA graduating from low-income to middle-income and high-income. Poverty rates decrease, and in general there is more domestic investment in health.

This means that EECA states should rely more on their domestic funding for HIV, rather than expect international donors continue to provide their support.

As a result, MIC will face transition to domestic funding happening concurrently with their attempts to implement the fast track strategy.

While the improvement of economic situation and growth of GDP is an important precondition of country’s transition to domestic funding for HIV programs, it is not sufficient for the success of such transition.

Besides the availability of national funding for health itself, the following conditions must be in place before the transition happens:

High-level political will to support prevention among key populations, especially in countries where there is overall stigma and anti-LBGT legislation or drug use criminalization.

Legal environment supporting the provision of essential HIV services like harm reduction programs or services for MSM.

Well-developed systems of HIV treatment procurement, and capacity to negotiate procurement prices and relevant legislation supporting such pricing reduction strategies.

Civil society engagement is critical at this stage, as it helps keep governments accountable, advocate for legal changes and stimulate ARV price negotiation process.

But what’s most important, CS watchdogs the process of transition and can provide immediate feedback to the state and international partners if there are issues and challenges.

Example 1: Kazakhstan, funding for OST and NSP

Example 2: Ukraine – ARV procurement interruptions and how civil society helped save the situation

Thank you, Mr. Chair.

And thank you Dasha for, again, calling our attention to the issues and the situation of Europe, especially the Eastern European and Central Asian region.

We cannot emphasize enough the importance of sustainability of prevention, treatment and care programs, especially for those countries that are (1) transiting from international funding such as Global Fund to domestic funding. A key issue is that as the Global Fund and bilaterals ramp down, MIC’s are not rising to the occasion for one of two reasons. In some states, like Zambia, their entire health budget would not fill the treatment gap.  There are other states that simply don’t care because their epidemic only impacts marginalized populations.  In either case, “shared responsibility” cannot leave the world free to walk away from its responsibility to the people who will otherwise be abandoned.

Funds are one aspect of the issue, (2) existing and functioning structures are another. We have seen examples of European countries in transition not being able to ensure reliable and sustainable access to medication and diagnostics due to the lack of proper structures or procurement and budget setting.

Another worrying trend is that our governments, trying to meet international financial demands in the times of (3) austerity, tend to cut back on health and welfare budgets. As noted by Dr Mrisho from Tazania, this often results in attempting to get milk from a dead cow! This has devastating effects on those living in poverty, in need of health care and prevention services, and also on programs provided by civil society. These financial cuts might help in meeting economic indicators, but for sure they aggravate already existing gaps in societies, increasing vulnerability and marginalization, leaving hundreds of thousands of people behind and leaving us health structures that do not meet the requirements that can ensure the highest attainable health for all, jeopardizing the future of generations.

And we need to (4) fast track EVERYWHERE. We need to think of communities everywhere: smaller countries may not bring huge numbers to our statistics but without them, we will not reach the global ending of AIDS as a public health epidemic by 2030.

Finally we need to ensure funding mechanisms to (5) strengthen communities of key populations: drug users, sex workers or men who have sex with men, in countries where governments completely ignore any investment due to stigma and discrimination or existing punitive laws. In this regard, we would like to recall Dasha’s striking comparison been richer Russia and poorer Tajikistan and her call to the Joint Programme to help us open closed doors.

Thank you for your attention.

Power of partnership for Implementation, innovation and equity: collective solutions for a sustainability AIDS response.

Thank you, Chair. It is true that this panel is important to make sure that we are implementing solutions collectively in the spirit of partnership.

As we adopt and now plan for the implementation of the Fast Track, there are more questions than answers. And one question that needs to be answered: DO WE COUNT??? Do lives of men who have sex with men, transgenders, sex workers, people living with HIV, people who use drugs, women in all diversity, adolescents, and young people really count??

The answer must be a resounding and unequivocal YES! Key populations’ lives count! Every life of those most vulnerable to HIV has an equal value!

Though we are frequently reminded that we are in the era of evidence-based public health, data-driven decision-making and performance-based metrics, the evidence on HIV among key populations is routinely ignored. At the same time, funding for HIV services responsive to our needs remains wanting. And we heard that clearly from my fellow community representative from the Asia Pacific.

In July 2014, the World Health Organization released a long awaited,rapidly developed publication: the Consolidated Guidelines on HIV prevention, diagnosis and care for key populations with a revolutionary section on critical enablers. Yet there are questions on the willingness of institutions: governments, donors, development agencies and civil society — to embrace their fundamental responsibility to respond to the health needs of key populations and invest in evidence in a sustainable manner.

New technical guidelines and progressive policies are important, but to make a difference, they must be applied. Investments must be targeted to fill these gaps and expanded to match the scale of our needs. Health and budget ministries of countries must also have the political commitment and must work in partnership, together with communities, to ensure focus and funding is invested for key populations. Now is the time to prove WE, and yes, that includes Asia Pacific, COUNT!

AIDS Funding

Thank you, Chair.

We have all invested our time and resources that have translated into the UNAIDS 2016-2021 Strategy, which the board passed on Monday. This Strategy is strongly immersed on the fast-track approach, for us as women, men, transgender, children and youth, and we all trust it can lead us to the promised land, “a land with no AIDS BY 2030”.

For this Strategy to deliver us to that promised land, it needs to be fully owned, funded, implemented and evaluated from time to time; less of this, we may be building castles in the air.

Over the years, the global community has joined hands to respond to this epidemic with the leadership of the Joint Program. I must also recognize the north-south and south-south collaboration that we have seen exhibited over the years. Chair, I must appreciate the US, UK, Sweden, Norway, Netherlands, Switzerland and every one who has immensely supported civil society especially, youth programs.

Important to note however, is that resource envelope in the HIV response hasn’t met the existing needs in quality and quantity. This has continued to compromise our ability not only to mobilize our peers for existing services that might meet their needs but also to contribute our efforts maximally. The most needed social support such as nutrition, safe water, shelter and economic support for OVCs and widows within communities most impacted by the epidemic isn’t always funded.

It is our humble request therefore that we do a costing of how much it shall be needed to end AIDS by 2030 with communities’ support especially networks of PLHIV and other key populations. We urge our respective governments to increase local mobilization and funding not only for health but for HIV too. Many of our colleagues, are finding difficulties in copying up with mental health problems, sexual and reproductive health conditions like cervical and anal cancers, chronic illnesses and co-morbidities like diabetes, hypertension and kidney disease among others.

We must commit to fully funding the Global Fund and also come up with flexible mechanisms that ensure that substantial amount of monies and other resources reach grassroots organizations especially for PLHIV, women, key populations and young people. For we are not only fast and furious, but mobile and innovative too!

Thank you.