The 49th PCB meeting was the sixth virtual PCB meeting (including the two Special Sessions in between) since the COVID-19 pandemic restricted international travel and face-to-face meetings in 2020. The NGO Delegation was a little more adjusted in dealing with this virtual meeting modality, despite the increased hours it required in terms of their engagement. The pre-meetings were somehow uneventful as minimal discussions took place. Even the official PCB meeting itself from Dec 7-10 consisted mainly of PCB members giving out the usual statements in response to the agenda items. The interactions were more intense in the drafting rooms where crucial decision points were debated on, especially on the NGO Report, UBRAF indicators, and the reports on HIV and prisons and progress on actions to reduce stigma and discrimination. Similar to previous PCB meetings, the same Member States were raising the same questions with the same arguments, i.e., questioning definitions such as key populations, societal enablers, etc., which tended to delay or derail the decision-making process. This will be an ongoing challenge for the PCB and specifically the NGO Delegation to strategize on and address in future meetings.
NGO Report
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NGO Report of the 49th PCB Meeting | 23 November 2021
Left Out: The HIV Community and Societal Enablers in the HIV response
The 2021 NGO Report focuses on the importance of strengthening societal enablers for the HIV response. The Global AIDS Strategy recognizes that HIV services on their own will not be sufficient to reach the 2030 target without concerted efforts to address the social and structural factors that increase HIV vulnerability and diminish the ability of marginalized populations to access essential services.
PCB Summary Bulletin
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49th PCB Meeting | 1 January 2022
NGO Delegation’s Summary Bulletin
The NGO Delegation’s Summary Bulletin for the 49th UNAIDS PCB Meeting reflects the engagement of the NGO Delegation on all agenda items amongst which: Report by the NGO Representative, HIV in prisons and other closed settings, and Thematic Segment – “What do the regional and country-level data tell us, are we listening and how can we leverage those data and related technology to meet our 2025 and 2030 goals?”
Agenda items
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Agenda Item 1.3 | 49th PCB Meeting
Report of the Executive Director
NGO Delegate representing Africa
Intervention delivered by Iwatutu Joyce Adewole
Thank you Chair, I speak on behalf of the whole NGO Delegation.
Firstly on behalf of the NGO Delegation, I would like to express our appreciation and thanks to Dr Shannon Hader for her contribution to UNAIDS and the HIV response. We thank you for your ongoing commitment, innovation and partnership in progressing the actions necessary to meet the targets to end AIDS as a public health threat and to address the inequalities that continue to drive the HIV epidemic.
2021 has been both the best and the worst of times, and the Executive Director’s Report reflects both the heights as well as the depths. For our Delegation, both the Global AIDS Strategy and the Political Declaration with their increased emphases on inequalities, community delivery, key populations, human rights, and young people are obvious highlights, as is the ECOSOC re-emphasis on the importance of our role as the community here on this PCB. As an African Delegate, I must add the role UNAIDS has played in my Continent coping with COVID-19 and fighting vaccine inequity, as well as the Education Plus Initiative – with its emphasis on co-financing to fight AIDS, and most recently, the innovative Dakar Call to Action.
With regard to the worst of times, this year has seen donor nation after donor nation fail to put their money where their mouths are, and a growing horror on our part that some might be prepared to see the global response fail, as they play cliff-edge games of perfection-seeking. This ongoing uncertainty has altered the nature of the realignment project and is partly responsible for this being a truly terrible year for many UNAIDS staff, with consequent disruptions of their lives and of their mental health.
There is much that is needed to succeed in 2022. A fully funded UBRAF is a prerequisite for almost all of it. We desperately hope that member states – having learned some lessons at least from COVID’s continuing disruptions – will see starkly the disruptions likely from a resurgent HIV epidemic, and will step up now – fiscally – late but brave, just as their citizens most affected by AIDS step out every day of their lives, tired but brave.
I thank you.
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Agenda Item 1.4 | 49th PCB Meeting
Report by the NGO Representative
NGO Delegate representing North America
Presentation delivered by Andrew Spieldenner
Thank you, Chair.
The NGO Report is an opportunity for the NGO Delegation to raise or focus attention on key issues for civil society and the communities most affected by HIV.
Our report, “Left Out: The HIV Community and Societal Enablers in the HIV Response”, emerges from the last two years – of COVID-19 and its ongoing and massive social, economic, cultural and health impacts and disparities; of the development of the Global AIDS Strategy (which most of us spent so many hours and days on) and the UN High Level Meeting on HIV and its Political Declaration; of the rush towards “ending the AIDS epidemic by 2030” without the adequate resourcing and political prioritization globally. All of us recognize the importance of societal enablers, yet few are brought to sustainable scale, especially for key populations.
UNAIDS focuses on three societal enablers: stigma and discrimination, gender-based violence, and discriminatory laws and policies.
Throughout this presentation, we will be incorporating quotes from people who were interviewed or completed the online survey.
| “Societal enablers are essential for key populations and other vulnerable groups to be able to live full and productive lives.” – Tim Sladden, Technical Advisor, United Nations Population Fund |
I am a gay man living with HIV. In my own country, I am a racial minority. I have lived in urban settings all my life – largely due to my needs for culturally responsive healthcare and a supportive community. I have purposefully gone to HIV clinics that are sexuality and gender-responsive; and my healthcare has been covered through insurance or public benefits. After I realized I wasn’t going to die, I was fortunate enough to go to graduate school.
I have also been a person who uses drugs. I have been physically assaulted a few times, once in an intimate partner relationship. I have experienced stigma and discrimination in healthcare, education, employment, and socially – even in my own family – sometimes by my HIV status, other times for my sexuality or race. Intersectional stigma manifests in multiple ways, and we have to make clear that these compounding methods of marginalization affect my capacity to seek out healthcare and adhere to treatment.
| “Provision of free antiretroviral therapy and proper counseling has helped people living with HIV a lot in maintaining adherence and also reduced stigma to a great extent. Still, people living with HIV from various communities like LGBTQ people, drug users, and sex workers face double stigma. This needs to be reduced.” – Pritha, Community activist, India |
HIV-related stigma does not exist in a vacuum. HIV-related stigma is related to the social attitudes around sex, sex work, drug use, sexuality and gender identity, and race and ethnicity. When law enforcement arrests a sex worker and discovers they are HIV-positive – and therefore vulnerable to HIV criminalization laws – the laws against sex work are what brought that person into focus for HIV-related stigma. If we refuse to see the intricacies of intersectional stigma, then we are turning our back on all key populations.
| “The majority of the key population live below the poverty line. This is because most of them cannot get quality work or meaningful employment as a result of poor academic opportunities, their sexual/social behaviour, or sexual orientation.” – Anonymous, Community activist, Africa |
Stigma and discrimination get enacted in various contexts. Education and employment are two places where stigma and discrimination exclude key populations and other marginalized groups. LGBTQ persons are not protected from discrimination in these settings globally. There are few pathways to education and employment for people who use drugs and people who have been in prison. Migrants are often reliant on grey economies in order to survive. We focus on education and employment interventions in this report to show how vital these tools can be for the HIV response.
| “Societal enablers help key populations and other vulnerable groups gain autonomy and make better decisions. It allows these marginalized groups to get more protection from violence and stigma.” – Cecilia Chung, Director of Evaluation and Strategic Initiatives, Transgender Law Center, U.S.A. |
Yes, I have experienced violence and walked the streets afraid: I am not alone. In my own country, my transgender and gender non-conforming sisters AND brothers are more likely to experience violence than any other group; 2021 has been the deadliest year on record with at least 49 transgender or gender non-conforming people being murdered in my country (375 in the world that we know of).
Violence occurs even in places where constitutional protections are in place. In a country where LGBTQ rights are constitutionally guaranteed, the lack of social protections and intersectional stigma can still result in violence. In June of this year, a young queer person revealed his HIV-status at a party and was kidnapped, tortured and murdered over the course of a night. The police were reluctant to investigate until LGBTQ advocates protested, the Spanish and English media became involved, and the federal government intervened. The lack of social protections and the HIV-related stigma and homophobia all played a role in this murder.
| “Human rights and access to health are intertwined, and the causal relationship between human rights violations and vulnerability to HIV are well evidenced. Social determinants of health such as stigma, poverty, criminalisation, legal oppression and gender inequality, negatively impact on sex workers’ health, including increased vulnerability to HIV. Criminalisation of sex work, including the criminalisation of clients and third parties, fuels and fosters human rights violations and discrimination, reducing sex workers’ access to HIV prevention, treatment and care.” – Ruth Morgan Thomas, Global Coordinator, NSWP |
I have heard the “where’s the HIV” when we talk about societal enablers. This narrowing of the HIV response is difficult for me to hear as a member of a key population group. It’s hard to talk about treatment adherence and healthcare access when we have so many barriers and so few resources to manage.
| [SLIDE 9] “Fifteen countries in the Asia-Pacific region criminalize same-sex relations and this is a massive obstacle for men who have sex with men to access healthcare and other services. The HIV epidemic in Asia is already concentrated among MSM and transgender people and these criminalization laws make it harder to stop the epidemic.” – Midnight Poonkasetwattana, Executive Director, APCOM Foundation, Thailand |
Discriminatory laws and policies seem difficult to remove – sometimes even impossible. In our report, we showcased the work of people living with HIV and their allies removing HIV criminalization laws at the country level, with the support of government actors. Yes, we can change laws and policies – people have done it around the world. In limited areas, there has been movement decriminalizing HIV-status, LGBTQ identity and practices, sex work, drug use (like marijuana), and harm reduction activities (like safe injection sites). We need this change to happen in more places. We invite Member States to work with community-led efforts to repeal punitive laws and policies.
Where do we go from here? Our NGO Report has several Decision Points, incorporating some of the priorities in the recent Global AIDS Strategy and the UN Political Declaration on HIV.
Here are some starting points:
- Invest in key population-led and community-led solutions. Stigma and discrimination, punitive laws and policies, and violence affect us in unique ways. We need partners to resource our organizing for solutions.
- Key populations and other marginalized groups ARE the public in public health. We are not “risk behaviors” or “disease vectors” to be controlled: we are vital parts of all countries.
- Recognize HIV treatment is one part of the picture for key populations and other marginalized people. What makes us vulnerable to HIV acquisition is the larger context of our lives including what opportunities are available, and what opportunities are not.
I am a gay man living with HIV and a racial minority in my country. I am lucky enough to have access to housing, education, employment, HIV medication, mental health services, and a community. These should not be the result of where I live or was born: these should be fundamental rights for all.
NGO Delegate representing Europe
Intervention delivered by Alexander Pastoors
Thank you chair,
I speak on behalf of the NGO Delegation.
Today, nineteen years ago, I received my first positive HIV-test results. These results had a profound impact on my life as a gay man. I was fortunate enough to be living in the Netherlands which meant that, medically speaking, I had not a lot to worry about. Yet the impact on other parts of my life was of a different magnitude. A multitude of barriers appeared on my future path of life: I wouldn’t be able to get a mortgage or life insurance, cutting me off from the housing I desired. I had to conceal my condition from my future employers in order to not risk losing a job and, should I accidentally transmit the virus to a lover, I could face criminal charges and be sentenced to jail.
Today, most of those barriers have been removed in the Netherlands. Due to many years of tireless work of civil society, a set of societal enablers has been put into place that measurably improved the lives of people living with HIV and the communities most affected by HIV.
HIV non-disclosure is no longer grounds for criminal charges. The negative impact on prevention was deemed to be too high a toll by the highest court in the Netherlands. Since that ruling, the number of new infections per year is decreasing steadily and is on course to fall to close to zero by 2030.
Although the drop in new infections can’t be attributed solely to societal enablers, such as the reform of criminal law, we wouldn’t be where we are now without them. Unfortunately, many key populations around the globe do not benefit from societal enablers. Even today, in some countries of the European Union, a lover scorned can still get people living with HIV in serious judicial trouble even if no transmission of HIV has occurred.
Societal enablers are key to reaching our global HIV targets and, subsequently, they need to be properly financed and brought up to scale in every corner of our world. One way to do that is for meaningful collaborations between community-led and key population-led groups with government partners. We, therefore, urge UNAIDS, the cosponsors, and the Member States to take all necessary steps.
Thank you.
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Agenda Item 2 | 49th PCB Meeting
Leadership in the AIDS Response
NGO Delegate representing Latin America and The Caribbean
Intervention delivered by Violeta Ross
Thanks, Dr. Salim, for the old and new data presented to us. We have always used the science for our response, however the information given about one person living with HIV who developed a resistant variant of COVID-19 has already been misinterpreted by the media, blaming us, people living with HIV, again for another virus. What we ask is for this information to be given with care, especially for those who are not HIV experts. We have been living with HIV for a long time and fighting stigma and discrimination and here we go again.
This leads me to another point, we have not seen key populations in the data you presented and wanted to ask that question if key populations have been included in these studies.
Another point we want to raise is related to non-biomedical interventions. Of course we need the medications and we want more PrEp. We want people to have choices but not everything in HIV can be solved with a pill as we have seen all these years. We need more justice, less violence, less punitive laws and more human rights.
The last point is access. In HIV, we have seen how the joint alliances against the pharmaceutical industry really changed the trend of the epidemic. Unfortunately that did not happen with COVID — we see how the industry needs to be challenged and we have to oppose patents.
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Agenda Item 3 | 49th PCB Meeting
Update on HIV in prisons and other closed settings
NGO Delegate representing Asia and The Pacific
Intervention delivered by Jules Kim
I make this intervention on behalf of the NGO Delegation.
People in prisons and other closed settings are continuing to be left behind in HIV responses. The number of countries providing evidence-based HIV treatment, support and care to people in prisons and closed settings remains far too low, with minimal progress seen since this issue and urgent call to action was raised at the 41st PCB. Getting to zero means not ignoring the most vulnerable, and not ignoring those deemed easiest to leave behind.
The prisons are overcrowded with many of our key populations, which is no surprise given the criminalisation of our work, our lives, and our identities in so many countries around the world. There is a growing population of women living with HIV in prisons, and a disproportionate representation of key populations, indigenous people, and ethnic minorities.Available 2020 GAM data shows HIV prevalence to be at 55% among transgender people in prisons. There continues to be increases in the number of people being incarcerated and substantial overcrowding in prisons around the world with a corresponding increased risk of transmission of HIV, TB and other infections not only in prisons, but also in the wider community. And despite this elevated risk, there is a critical lack of HIV, TB, viral hepatitis services, and access to treatment within prisons and closed settings and stigma and discrimination remains rife.
We know what works but we must invest in addressing HIV for all populations in all settings.
Capitalise on the effectiveness of civil society partnerships and community led responses. End criminalisation and incarceration of key populations. We urgently need these legal and policy reforms. Increase political commitment to address HIV and other communicable diseases, through preventing the use of custodial sentences for minor offences and implementing measures for non custodial alternatives for key populations for nonviolent offences and thus reducing prison overcrowding. We must urgently act to ensure access to comprehensive prevention, treatment and care services for HIV, viral hepatitis and tuberculosis for prisoners and people in other closed settings. We must continue to monitor and track progress towards the achievement of the 95–95–95 targets for all key populations including in prisons and closed settings by 2025.
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Agenda Item 4 | 49th PCB Meeting
2022-2026 UBRAF Output and Indicators and revised 2022-2023 Workplan
NGO Delegate representing Asia and The Pacific
Intervention delivered by Charanjit Sharma
Thank you,Chair.
I speak on behalf of the NGO Delegation.
As a person who uses drugs living in India, I can underscore the added value and significant role that the Joint Programme has played in supporting the drug using community in policy dialogue and program implementation.
To reach the ambitious targets set in the Global AIDS Strategy, the Joint Programme needs a clear and comprehensive, yet concise UBRAF. The NGO Delegation acknowledges that UBRAF 2022- 2026 has improved significantly compared to the previous UBRAF.
With all our efforts to make the added value of the Joint Programme visible and measurable, what really counts at the end of the day is: have the combined efforts, programs, and actions of UNAIDS and Cosponsors in the regions and in countries helped the communities of people living with and affected by HIV? And have UBRAF indicators captured the real stories from the ground?
The previous UBRAF measured the percentage of countries implementing combination prevention, including 83% of 41 countries that have needle and syringe programmes and 66% of them have opioid substitution therapy at the end of 2020. While UBRAF ensures the availability, it does not report on the accessibility of these services. That’s the lens we need to apply when we look at the set of UBRAF indicators and specific outputs presented to the PCB today. We understand that measuring the impact on human rights has always been difficult and that is the central challenge in the UBRAF.
We note the important step forward taken by the secretariat and the work done by the Working Group to come up with the outputs and indicators in such a short time. We also note that this very ambitious timeframe requested by the PCB has led to a suboptimal outcome with regards to the formulation of some indicators and we look forward to its further refinementMany indicators tend to be very process orientated where the focus should be on the results, e.g. the number of countries where punitive and discriminatory laws and policies have been removed or amended.
We need UBRAF to be fully funded, but at the same time we also need the Joint Programme to be accountable not only to the donors but also to people living with HIV and key populations they serve.
Thank you.
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Agenda Item 5 | 49th PCB Meeting
Evaluation
NGO Delegate representing Europe
Intervention delivered by Alexander Pastoors
Thank you Chair,
I speak on behalf of the NGO Delegation.
In my first year as an NGO Delegate, I participated in the PCB working group that laid the foundation for a revised evaluation policy that formalized the establishment of an independent evaluation function reporting directly to this board. This was an important milestone in our combined efforts as board members to strengthen evidence-based decision-making, learning, and accountability of the Joint Programme.
Today, we see the first results of that decision in the shape of the first completed evaluation report on preventing and responding to violence against women and girls. The NGO Delegation welcomes this report with appreciation. Because only through solid evaluation of programs, actions and policies can we determine if what we do actually works.
We look forward to hearing from the Secretariat how the findings and recommendations of the report on preventing and responding to violence against women and girls have been or will be integrated into the strategic result area 6 of the UBRAF and working plan.
We also welcome the 2022-2023 evaluation plan that stipulates the focus for future evaluations of important topics such as the empowerment and resourcing of communities for stronger community-led responses and efficient and sustainable financing that are of strategic value for the NGO Delegation.
Lastly, given the importance of conducting comprehensive evaluations, we request the Executive Director to ensure that the evaluation function remains adequately resourced and staffed in accordance with the Evaluation Policy.
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Agenda Item 6 | 49th PCB Meeting
Follow-up to the thematic segment from the 48th PCB meeting: COVID-19 and HIV: sustaining HIV gains and building back better and fairer HIV responses
NGO Delegate representing Africa
Intervention delivered by Jonathan Gunthorp
Chair I speak as an Africa Delegate and not on behalf of the full Delegation.
I align myself with the Africa Group and my esteemed colleagues from Cameroon and Namibia; but unlike my esteemed colleagues, I am not a diplomat. I am an angry – a very angry- African.
Chair, we sit here and we talk of global solidarity in the COVId-19 response, and of all moving forward together. But we speak as if there is no bad behaviour in the response.
And yet Chair, as we speak, members of this PCB are hoarding vaccines in unjustifiable numbers while less than 4% of the developing world is vaccinated. As we speak, we are paying in Africa sometimes up to three times the price of what’s being paid in the global north for vaccines, while members of this PCB watch or, worse, protect the intellectual property rights which they know very well from the HIV response will kill people unless adapted or amended. Chair we speak while travel bans that are unscientific and nonsensical are imposed on Africa, as if Africa were the problem. And we speak while some members of this PCB refuse to recognize PCR tests from my country, which has one the best gene sequencing systems in the world.
Chair, global solidarity has been ruptured. Trust has been ruptured. Solidarity cannot be maintained; it must be rebuilt.
We have endangered the HIV response; we have endangered global health security; and we have endangered the future of the SDGs, all by our behaviour in this moment. We need to rebuild.
None of you are safe until we are all safe.
I thank you Chair.
NGO Delegate representing Latin America and The Caribbean
Intervention delivered by Violeta Ross
Regarding the intersections of HIV and COVID-19 pandemics, we would like to emphasize the role of communities and civil society, which has been fundamental in sustaining the HIV response at grass roots levels while the health systems responded to the challenges imposed by coronavirus.
Communities did everything but with very little support, we even took on our hands what was the role of the government., We helped in the distribution of antiretroviral medications, provided food support and psychosocial counseling for those affected by gender based violence, stress and trauma, and demanded the continuation of HIV prevention services when governments were focused on the emergency response to the pandemic.
At this point, it is clear that pandemics are going to be a continuous challenge for health systems. As we respond to whatever comes in the future, we must maintain and guarantee access to HIV medications and prevention services.
Before the pandemic, HIV was already deprioritized in the global political and health agendas. With the pandemic, it continues to face the risk of being “left behind” including us, those living with HIV and most affected communities.
Science has demonstrated the huge benefits of early diagnosis and treatment and even with the information we heard yesterday, now it is more imperative than before to work hard with communities for early promotion of HIV testing and immediate access to HIV treatment. Being in antiretroviral medications is a way to prevent a severe COVID-19 infection.
Other important areas that communities have addressed in this pandemic are human rights, gender based violence, and the resurgence of stigma and discrimination, which most governments had no time to respond to. But we did, especially regarding the stigma attached to people who live with a virus.
We call upon member states and all actors in the HIV response to secure, maintain and guarantee HIV prevention and care services and to provide communities with the necessary support to continue our work at grassroots levels, in light of this continuing COVID-19 pandemic
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Agenda Item 7 | 49th PCB Meeting
Report on the progress on actions to reduce stigma and discrimination in all its forms
NGO Delegate representing Latin America and The Caribbean
Intervention delivered by Jumoke Patrick
Thank you, Chair.
I speak on behalf of the NGO Delegation.
Stigma and Discrimination has directly affected me as a gay man trying to navigate spaces and opportunities just to feel accepted and valued. I live in a developing Caribbean country that believes my sexual identity is not worthy of a conversation, much less being recognized with human rights in a safe and stigma-free space.
I am no different from a gay man living in Russia nor am I different from a transgender woman living with HIV in Iran. Discrimination and injustice hurt, kill, and harm the very fabric that brings us together as a programmatic response to HIV. It hurts us all and it harms us all when we fail to invest in and recognize and respect the rights of the very people who are significantly reduced to nothing by Stigma and Discrimination. It further increases vulnerability to HIV infection and undermines access to HIV-related prevention, testing, treatment and care services.
The progress report highlights the successes and the gains made so far as we continue to chart a progressive and dignified way forward to support our brothers and sisters living with and affected by HIV globally. We have seen the data, we have heard the stories and evidence of the harms done to the communities impacted by HIV. Colleagues, we cannot casually and selfishly continue to tiptoe around the issues when stigma and discrimination against people living with HIV and key populations remain embedded in the laws, policies, and practices across many countries.
It’s time we do more, be more, invest more and care more. People living with HIV, key populations, and communities impacted require us to go beyond our privileges and sovereignty to ensure equality and equity for all. We urge this Board to sustain and strengthen its support for the Global Partnership for Action and for Member States to commit funding and join in this collaborative effort to meaningfully address and eliminate discrimination in all its forms, across all settings, and across borders.
Thank you and One love!
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Agenda Item 10 | 49th PCB Meeting
Thematic Segment: What do the regional and country- level data tell us, are we listening and how can we leverage those data and related technology to meet our 2025 and 2030 goals?
NGO Delegate representing Africa
Intervention delivered by Jonathan Gunthorp
Thank you Chair
I thank all the speakers, and I particularly want to reference Winnie Byanyima & Meg Davis’ inputs, and their references to communities. I want to throw at delegates a number of data points researched by civil society and in the last six to eight weeks put before five Parliaments, twelve member states, and one regional economic community, and that have influenced tow regional SRHR and HIV agreements in my region.
The numbers are: there are 112 million adolescents and young people in southern Africa of whom 55.8 million are adolescent girls and young women, of whom some 11 million are on contraceptives, while some 20 million are not even seeking access to contraception.
There are 1.7 million positive living adolescents and young people of whom some 400,000 are not yet on ARVs, while a full 45 million still lack sufficient knowledge of HIV today, 10 December 2021.
And in a recent survey on GBV reporting at a national level in a member state, two out of three rape victims were 13-18yr old girls; two out of three of rapes were perpetrated by family, neighbours, or lovers; and two out of three rapes took place in the victim’s own home in daylight.
And moving beyond these figures, communities ask and answer questions that numbers don’t tell, like do girls get pregnant and drop out of school, or do they drop out of school and then get pregnant, or do they get pulled out of school for poverty reasons and then get married or or or….we need skillful community asking to answer questions about perpetrators, stigma, attitudes and other less numerical but no less real issues.
Chair, what is the point of all these figures? It’s about community, and two lessons about data. firstly, big data can be curated and projected by small people. And secondly, small data, when taken up by big-mouthed communities, cantalk big.
I thank you.