40^th

UNAIDS PCB Meeting

Thank you Chair.

Recognizing the urgent need to face the “challenge of change” together at this tempting moment, the NGO Delegation supports the EXD’s report and recognises his extra-ordinary leadership in the response.

Characterized by partnership, innovation and activism, as communities, we are the living face to the AIDS journey.

The global solidarity has served to register these gains, 18.2 million people on treatment, 60% reduction in new infections among children, increased recognition of the role of communities in the HIV response.

A new plan of action, a revised operating model and #TheUNAIDSweneed, is that which will not let down people. A strong, visionary, well–resourced Joint Program that won’t only exist to survive, but will serve to work with communities, including those left behind.

The new operating model should, then, be stronger in highlighting the role of civil society, communities and key populations in the HIV response. It should also ensure that there is a clear engagement strategy across the joint program for communities including people living with HIV, young women and girls, gay men and men who have sex with men, people who use drugs, sex workers and transgender people. This strategy must avail of the necessary tools and resources for communities to engage with relevant stakeholders especially at country level. Madam First Lady, we applaud you for your demonstrable contribution to the HIV response, and the strong message on zero discrimination. Zero discrimination is not negotiable. You are a leader who gets results for communities. We also appreciate interventions crystallizing the role of communities and the need to have communities at the center, that have been made by Portugal, Germany, Sweden, and United Kingdom and the delegations they represent.

As a game changer, we contend that the active maintenance of civil society as an independent and key actor in the AIDS response should be an explicit goal of any financing system in the proposed plan of action.

We are outraged that:

• 18 Million more people are waiting for treatment

• In the past hour 125 people died of AIDS related causes

• 240 people were newly infected with HIV

• We are failing young women and adolescent girls

• Men are not accessing testing and services

• Men are not accessing testing and services, key populations are still marginalized and driven to margins of society

• There is growing inequality/gap and vulnerability in South Sudan, Venezuela, West and Central Africa amongst migrants from the Mediterranean region as well as indigenous people and the underlying factors driving these inequalities.

#TheUNAIDSWeNeed leaves no one behind.

Thank you Chairperson for the opportunity.

Thank you, Michel, for your report. It is important to keep in mind the context we are facing, while, continuing to push for a Joint Program that is innovative and designed to lead the world in achieving universal access to HIV prevention, treatment, care and support.

Thank you Chairperson, for clear, direct, and sensitive report.

The NGO Delegation notes the UBRAF Performance Monitoring Report 2016. We particularly wish to commend the efforts of the Joint Programme to work towards the achievement of the set targets to end AIDS, despite the current challenges in the global AIDS response, key among these being the question of lack of funding to the response and its consequence on fully resourcing the UBRAF.

Thank you Chair.

Thank you, Chair.

During the last PCB in December, we had the privilege to dedicate a whole day to the theme of HIV and ageing. I am saying privilege, as although ageing is a normal part of a life cycle, for us, people living with HIV, ageing became a reality not that long ago with the era of combination antiretroviral therapy.

The NGO Delegation appreciates the development of the rich draft decision points and that our suggestions were mostly integrated into the final draft. We can only encourage the Board to approve these decision points.

However, in the era of SDGs, we must raise our concern, that our proposed decision point, aiming at exploring innovative ways of affordable and sustainable research and development structures, has been omitted. It is clear that we need to continue the multilateral discussion on the issues of pricing, affordability and sustainability of treatment and care programmes.

Most importantly, we must not stay silent about the tragedy that not every person living with HIV is granted the chance to age. In 2017, over 30 years into the epidemic and over 20 years after the introduction of combination therapy, globally half of the people living with HIV have no access to antiretroviral treatment. In some regions, such as Eastern Europe or Latin America and the Caribbean, these figures are even more tragic.

People living with HIV still die every hour all over the world, as universal access to treatment is blocked by criminalization, by restrictive policies and guidelines, by stigma and by intellectual property issues, or because their Governments cannot afford or decide not to allocate enough funds for all people in need of treatment. And because humanitarian disaster constantly emerge and we fail to respond, such as the ongoing tragedy of communities of PLHIV in Venezuela who do not have access to medication or food any more.

As the proposed Decision Point 7.2 b says – quote – an ageing population of people living with HIV is a measure of a successful response to HIV – end quote, we must also admit that every life lost to HIV is a failure of the response to HIV.

We call on Member States to remove all legal and structural barriers that block universal access of HIV treatment and care and request the Joint Programme to continue providing its assistance in reaching the treatment targets.

#TheUNAIDSWeNeed ensures that every person living with HIV is granted the opportunity of ageing with HIV.

Thank you.

Estimated to be over 5 million, adolescents and young people represent a growing share of people living with HIV worldwide, who are faced with low treatment rates, increasing AIDS related deaths and poorly disaggregated data.

Children born with HIV are also growing up into adolescents who have to deal with their HIV status as they grow and develop. If the current trends continue, hundred of thousands will become HIV positive in the coming years, widening not only the pool of YPLHIV, but also the number of PLHIV globally, impacting on existing health and other socio-economic interventions.

The medical, psychosocial and economic aspects of a growing and aging population of people living with HIV cannot be over emphasized. As adolescents have to deal with taking medicines in school environments, cognitive deficiencies, and management of HIV infection for the rest of their lives, the older people living with HIV are dealing with livelihood, employment and ageing associated co-morbidities.

What worries us however is that, science seems to be insufficiently understanding the cause for accelerated ageing, yet, as communities of PLHIV, we are the living examples of this dichotomy.

In a rights-based approach, we can clearly see that PLHIV are not just treatment models, as in a homogenous group, which only require Septrin and ARVs, but we are individuals with different health needs beyond our HIV status. If it is messy to allow young girls living with HIV to discuss their sexual health and reproductive rights, shall we as well forget about cervical cancer, children being born with HIV, and forced sterilization? Shall we not pay attention to ano-rectal cancers, as well as, diabetes, mental health, etc.?

Therefore, we need differentiated interventions for all PLHIV especially for those with cross vulnerabilities. Lastly, I pay tribute to my senior colleagues here, who have over time, shaped the way the world looks at us. The first people to bring attention to human rights abuses, the people who paved the way for future generations and set the standards of inclusion, equality and zero discrimination.- It takes courage. I also salute those who have lost the battle in the long run, when science had no tools to manage HIV complications. When everyone seems to be good at just talking, with no actions.

#THEUNAIDSWENEED ensures that interventions are delivered in a continuum for everyone in a life cycle approach – leaving no one behind.

Thank you, Chair.

Thank you Chair.

We heard yesterday about a very important campaign against discrimination in Panama presented by First Lady Lorena Castillo: Zero discrimination is not negotiable across the continuum of the global, national and local HIV response. Most of the time in this room this phrase is used in the context of the lives and experiences of people living with HIV, to those vulnerable to HIV acquisition, and to diverse communities living on the edge, generally left out and left behind. Today I want to apply this phrase to the human resource challenges in the HIV architecture.

The NGO Delegation welcomes this report on Strategic Human Resource Management. We encourage UNAIDS to continue strengthening the capacity of the staff to support and carry out the mission and vision of achieving universal access to HIV prevention, treatment, care and support and uniting the world against AIDS. To successfully implement the mission and vision, a strong, capable, committed and cared for workforce across the UNAIDS family is essential. As stated in the report, the future of the global HIV response will require an agile and dynamic workforce, careful deployment of staff resources according to evolving needs, priorities and realities. UNAIDS needs to sustain a high-performing and engaged workforce that is free from discrimination, that is invested in for its diversity; that is supported to continuously move toward greater gender equity. People working in the community-led response to HIV have been in the forefront and remain key for full implementation of the global response; however, sufficient attention has not been given to their maintenance, sustainability, re-tooling, trauma healing, and care.

We request UNAIDS to encourage national and regional governments to take note of community networks and civil society organizations that are doing the work, implementing the HIV agenda, and integrate their work, with adequate budgets, clearly and sustainably in their HIV response. We are pleased to see and read the recognition that “while change and challenges have confounded our human resources” we must be prepared to modify, modernize and maximize our human resources. We agree and call on everyone in the room to make accessible the tools to support human resource development in ALL of our workspaces in our global HIV architecture if we are to see the end of this epidemic.

What does that look like: It is a collective civil society sector that has a secure line of financing. It is a workplace that moves from greater involvement of people living with HIV to meaningful involvement of people living with HIV at all levels of responsibility. It means a workplace that supports growth and development of staff and encourages full participation in the mission and vision of responding to and ending AIDS. It means a workplace that clearly demonstrates that people living with HIV and those from communities most affected including our gay, lesbian, bisexual, and transgender brothers and sisters, communities of color, formerly incarcerated persons, migrant and immigrant communities, our family and friends who are sex workers or who use drugs are valued and shows this through honest engagement, employment, leadership, respect, and support. However, that is not what we experience currently in the field.

Success in achieving the 20-20 targets and the 20-30 goals hinges on sustaining a strong HIV architecture with infrastructure built on expertise, solid financing, capacity, relationships and networks available all along the continuum.

The UNAIDS WE NEED recognizes the true value of a well cared for workplace at all levels of the response, inside the UNAIDS family, its relatives around the globe and their off spring.

We are a big family. Our shared goals and vision require that our family is well fed, clothed, safe, secure, is stably housed and learns to nurture and take verty good care of its members.

All these days we talk a lot about the obligations of the countries. And, first of all, about the obligations to ensure the right to health for all its citizens. When we talk about health for all citizens of our countries, we first start talking about medicines. The main points of Fast Track are focused on drugs – the second and third 90. We want to draw attention to the fact that health is not only treatment and drugs. We understand that health is prevention. Moreover, if we talk about 90-90-90 – then prevention gives us the opportunity to realize the first 90 – testing.

For the countries of my region that are in the transitional period, it is fundamental importance not to lose the prevention component when switching to domestic funding.

In Ukraine, we manage to make big steps towards that, right now in the new round of the Global Fund. We, civil society and the community, decided to completely revise the country application. Together with civil society, communities, and government we were working hard to plan the process of transition of prevention to domestic financing. Every player has a responsibility to work together on this transition.

But the experience of colleagues from neighboring countries of our region tells us that in reality nothing is as smooth as at the planning stage. The devil is in the detail. All countries of our region inherited the budgetary process of the Soviet period. It means that states allocate funding for activities, that were to be done during the year – at the end of the year. It means that NGOs cannot make this work because they do not have their own resources. And state institutions can not make this work – because they can not work effectively with key groups.

Specifications for social orders that are done by state structures are often created without consulting with NGOs, and we get such examples:

Kazakhstan – state money can not be used for people with chronic diseases, we understand what this means for our groups.

Belarus – technical barriers, but thanks to the efforts of civil society and the constructive and dedicative position of the state, work to overcome them is under way right now.

In conclusion, all this work can and should be accelerated. We the NGO delegation believe that UNAIDS can and should coordinate this work and not only in the Fast Track countries.

UNAIDS can help focus government attention on the fact that:

First: Without prevention – the right to health will not be realized and the level of diagnosis for HIV – the first 90 – will not be reached.

Second: Without NGOs, there will be no prevention in key populations and it is necessary to quickly remove the barriers blocking the work and funding of NGOs and communities.

This is how we see #TheUNAIDSWeNeed, especially in this transition period.

Thank you!

The United Nations Permanent Forum on Indigenous Issues recently recommended that the Joint United Nations Programme on HIV/AIDS, in collaboration with the United Nations Population Fund (UNFPA) and the Inter-Agency Support Group on Indigenous Peoples’ Issues, sponsor an expert group meeting on HIV/AIDS by 2019, which would include the full and effective participation of indigenous peoples living with and affected by HIV/AIDS, to analyse the sociocultural and economic determinants of health for HIV/AIDS prevention, care and treatment in indigenous communities, with the Forum’s collaboration, in order to ensure the realization of target 3.3 of the Sustainable Development Goals.

The Permanent Forum also recommended that States collaborate with indigenous peoples to ensure adequate resources to design and fully implement HIV/AIDS and hepatitis B and C programs that address the social, economic and cultural determinants of health for HIV prevention, care and treatment in indigenous populations, in particular indigenous women and youth.

My question is: how legitimate is UNAIDS for Indigenous Peoples? How can UNAIDS work with member states and Indigenous Peoples to scale up primary prevention?

The PCB NGO Delegation appreciates that often there is more flexibility in implementing programmes supported by Foundations. And therefore Foundations grants are probably the best support for work around structural barriers in HIV prevention – the intervention that can lead to most sustainable outcomes.

What is the commitment from the Gates Foundation to not merely invest in coalition but also on the ground in interventions, especially to middle-income countries that need such interventions since that is where highest number of concentrated epidemic countries belong and that is from where most bureaucratic donors are transitioning from. And especially to interventions that change policies, norms, and laws, not just service delivery.

And to UNAIDS: how can we ensure this investment in the refined model of resource mobilization that in allocating these resources will include communities?

Let me start by appreciating the Panelists for their very insightful interventions.

According to the Prevention Gap Report 2016, new infections in adults 15+ has stayed static since 2010 at an average 1.9m annually. There is no gainsaying the fact that we have dropped the ball. These figures are an indictment on us all and this is totally unacceptable.

What happened to the robust prevention agenda that buoyed us in the early days of the epidemic when all that drove the robust response was the passion of the communities impacted greatly by the loss of friends and family to AIDS? We achieved so much on the consciousness of our shared humanity, with no financial agenda to speak of. Prevention worked, and still works, and we need to fund it.

The NGO Delegation welcomes the Background Note – HIV Prevention 2020 and particularly the beginnings of the resurgence of a prevention agenda premised on the right to prevention – combination prevention – as a composite of the right to health. The International Covenant on Economic, Social and Cultural Rights provides for the right to the highest attainable standard of health in Article 12. The Committee on Economic, Social and Cultural Rights explaining the obligation of Member States in this regard in General Comment 12 of 2000 said that the right to prevention [Art. 14(2)(2)] ‘…requires the establishment of prevention and education programmes for behavior-related health concerns such as sexually transmitted diseases, in particular HIV/AIDS, and those adversely affecting sexual and reproductive health, and the promotion of social determinants of good health, such as environmental safety, education, economic development and gender equity’

We can no longer afford to treat prevention as the proverbial Cinderella, the step-sister left behind because there is no wealthy benefactor/stepmother to dress her for the royal ball. We must all become the fairy god-parents that fight the cause of the Cinderellas of our communities – young women and adolescent girls, MSM, sex workers, transgender persons, people who used drugs, prisoners and detainees – who are being left behind by a growing apathy towards combination prevention in our global response. I have used a popular children’s story figuratively to remind us that our shared humanity and the universal right to the highest attainable standard of health should be the primary consideration driving the HIV agenda, not economic gains. 1.9 million new infections per year is unacceptable and this figure requires far less resources to impact, if we re-prioritise the right to prevention in the global response.

My question to the panelist is – In your opinion, what would it take to reinvigorate an HIV Prevention agenda that is premised strongly on the Right to Prevention and resourced?

Thank you, Chair.

Today, as we engage in important discussions on the topic of “Global Partnerships,” I raise my voice to ask the question, “where is our partnership with the Venezuelan people?” The political and economic crisis in Venezuela should not be treated as a topic alien to us. The images of starvation, violence, oppression and death remind us that the situation in Venezuela is also a serious human rights and humanitarian crisis.

After 30 years of significant gains in the fight against HIV, Venezuela finds itself in a public health crisis as it runs low on HIV essentials. Antiretrovirals, vaccines, surgical and basic medical supplies including reagents for diagnostics are at critical levels throughout the entire country. These shortages are directly affecting the 77,000 persons living with HIV who suffer from frequent interruptions of antiretroviral treatment and face the permanent shortage of diagnostics for CD4 and viral load. Local NGOs and community groups are informing us that thousands are currently living without their medications already. The 90-90-90’s are quickly slipping out of the hands of a people that are struggling to address the 0-0-0’s of their basic needs such as food, water, shelter and security.

As Venezuela is currently ineligible for Global Fund support, a call is made to all global partners to become engaged and respond to the crisis by telling the story of Venezuela from a humanitarian perspective and not a political one. This call is for all global partners to find bold ways of reaching those in need by rising above the political barriers and forging effective partnership. We call for a strengthened UNAIDS office in Venezuela to work with civil society and communities.

As great investments are being made to accelerate efforts to end the HIV epidemic, we cannot and should not ignore the plight of those countries that are regressing due to political and economic challenges. We must reflect on the following “How will we claim global success in 2030, if countries such as Venezuela will be struggling with the effects of a resurging epidemic?” Have we done enough and what will be the cost of our inaction today.

#TheUNAIDSWeNeed and deserve is a UNAIDS that does not lose sight of the human factor of HIV, it is a UNAIDS that exemplifies the core values of global partnership and responsibility.

Thank you!