Delivered by Wangari Tharao, North America NGO Delegate
There are both challenges and opportunities to integrate the HIV response into UHC. We have fought to ground the HIV response on rights-based approaches, equity, determinants of health, and sexual rights and reproductive health rights and justice. We will not compromise on any of these hard-won gains in the move to UHC.
Yet the systems we are being asked to trust and into which we are being asked to integrate are the very systems that, rather than being accessible to all, do not engage migrants, people who use drugs, sex workers, gay and bisexual men, people of trans experience, people in prison and other closed settings, and young girls. Can we really trust these systems to serve us in UHC?
As a migrant woman living in Canada, I am not a stranger to Universal Health Coverage. It is the system that serves me and other Canadians. But I was not always a Canadian citizen. I was once a woman without status and was not covered. More than 45% of women who access primary healthcare services at my organization in Toronto have no health coverage, yet they are living in the global North, in a country with one of the most comprehensive UHC plans. Having no health coverage and no income to pay for healthcare services is tantamount to a death sentence for a person living with HIV.
There are so many questions for the HIV response. I will mention only a few: • Does the universality of UHC cover undocumented migrants and in what ways will it do that?• How will UHC be universal in countries where both people and their health needs are criminalized?• How will UHC be universal in places where stigma, discriminaition, and even persecution of key populations is the norm?• What role will key populations play in planning, delivering, and monitoring of UHC?
Putting the last mile first includes answering these questions. As members of the NGO Delegation, we call on member states, Co-Sponsors and UNAIDS to ensure that the progress we have made in the HIV epidemic is not lost in the rush to UHC. UHC must be comprehensive, people-centred, and community-led. If it is not, it will never be universal.
Photo from UNAIDS Communications and Global Advocacy
Tags: 44th PCB Meeting
Delivered by Valeriia Rachynska, Europe NGO Delegate
The 30 years of the epidemic showed that meaningful involvement of PLHIV including women, girls and adolescents and key populations - such as sex workers, people who use drugs, men who have sex with men, people in closed settings, people of trans experience - at all stages of planning, implementation and evaluating programs increases the effectiveness of the national and global responses to HIV and other health challenges.
But let us remember that key populations in many countries are still criminalized and the lack of human rights-based and structural barriers continue to keep people away from health services. 68 countries still criminalize men who have sex with men. In many countries, abortion is considered a crime. Sex workers are subject to criminalisation and legal oppression in almost every country in the world. In these cases, the slogan “leave no one behind” will remain a rhetoric.
We can develop adequate service packages for all key populations, but we need to ensure that key populations are not left behind due the threats of imprisonment, stigma, and discrimination. Decriminalization of key groups, removal of punitive laws, access to sexual reproductive health and rights, including safe abortion, addressing structural barriers to health access, harmonization of national legislation according to the recommendations of WHO and respect for human rights must be the basis of UHC.
The other point is financing. Countries are facing barriers to transition to national funding and “middle-income” definitions hide inequalities within the countries. The UHC system assumes it can reach everyone. Think about people who use drugs and indigenous people. Countries do not keep good data on these groups, and healthcare systems often exclude them.
We urge governments to put the most vulnerable and marginalized communities in the first place. And social protection for all must be also considered in this conversation. It is with equal access for these groups that the new system must differ from the existing one. This requires changes in the policy and financing system, when socially vulnerable communities will not be faced with a choice: to pay for medical services or for food and shelter. But the question remains: how will advocacy, community mobilization, capacity development, human-rights related projects be funded?
Ensuring universal health coverage as a global goal is a good goal. But to achieve it requires the development of sustainable international exchange and cooperation, international and national initiatives that, together, will help to foster joint investments and improve collaboration. And in all of that, community-led organizations and community-led responses must be at the center of any new approach. Thank you.
Photo from UNAIDS Communications and Global Advocacy
Delivered by Devanand Millie Milton, Latin America and the Caribbean NGO Delegate
Good afternoon, all.
My name is Devanand Millie Milton.
I was torn apart last Friday as I left my country to attend the PCB meeting. I have left behind one of my Trans sister who lies in the morgue, waiting for her family to claim her body for burial. She died of HIV related illnesses. In my country, HIV medicines are available, but after many years of hard work. Stigma and discrimination continue to be a barrier for us to access HIV care and treatment. As an HIV positive Trans woman, this can also be my reality and it scares me.
The barrier to healthcare for the transgender population manifests in various forms: systemic discrimination, health service provider biases, and lack of knowledge. Shockingly, members of the transgender community lack access to information on sexually transmitted infections and resort to self-injecting hormones instead of seeking proper medical services. The lack of access to knowledge and appropriate services amongst the transgender population, despite being highly vulnerable to STIs, inevitably puts our health at risk.
At the micro-level, many healthcare providers do not exercise empathy and understanding in dealing with transgender patients. Discussions around UHC in the policy and the data landscape must give special focus to marginalised communities like transgender people and give us the preventative and curative health services we need to live a healthy life.
The World Bank’s Global Monitoring Report on UHC published in 2017 does not include the term ‘transgender’. This speaks to the fact that marginalized groups are excluded in UHC discussions.
Does this mean that Key Populations especially transgender communities will be left behind?
I am hopeful that Universal Health Coverage will roll out to meet our Health Care needs and do not exclude us and any actions on UHC need to utilize a rights-based approached and be grounded in equity, determinants of health and sexual and reproductive health and rights, particularly for key populations.
In the spirit of inclusivity, UHC should start with considering the needs of the transgender community. The fact that UHC implementers do not consider centering the needs of the trans community as feasible is part of the problem. UHC should strive to make healthcare a safe space where anyone can get access to dignified health services, which is a basic human right. I know from personal experience that just putting up a clinic will not result in stigma and discrimination-free healthcare.
I am calling on Member States not to leave us to the fringes of society.Thank you.
Delivered by Lucy Wanjiku Njenga, Africa NGO Delegate
I speak this time not on behalf of the entire Delegation, but in my individual capacity as a Delegate and as a representative of positive young women from Africa.
I appreciate the women who have gone before to make most things possible for me and most girls. In 1862, Mary Peterson was the first black woman to graduate from college, Shirley Chishlom was the first woman to run for presidency in 1972, Wangari Maathai was the first woman and Kenyan to win a Nobel Peace Prize.
Now as we look forward to UNAIDS having a new Executive Director, we are ecstatic about the qualities and expertise the candidates bring to the position, recognizing that four out of five are Africans.
Then, like a dream come true, there is a powerful woman on the list from East Africa, my community and it warms my heart. My community supports her as the next Executive Director. She has a proven track record of democratic governance and peace building having served in the African Union Commission, at UNDP and as a member of the Ugandan Parliament. Serving in these roles, she never walked alone bringing the voices, views and platforms of diverse communities as well as being vocal on human rights and gender equality.
She has shown bold leadership and commitment to handle the difficult issues that have brought so many great leaders and organisations down. This resilience, dedication, openness and skill is key for me and the communities I represent. I commend her for taking the challenges facing Oxfam head on, digging deep and extensively to the bottom of the issues. I know she will be brilliant in implementing the monumental task of supporting staff during through transitions, reasserting its values and win back the respect and credibility the UNAIDS need. We have had the scientific side of the response for the last 30 years and we still see huge gaps especially with adolescent girls and young women high rise in new infections.
She is the candidate of choice for so many girls and young women in Africa. She has the piece we’ve not yet had - bold leadership for, and the skill set to transform the landscape for AIDS -a passionate and lifelong commitment to gender equality and human-rights based approaches necessary to beat AIDS. Moreso, her lived experience and professional skills can change the game, not only in Africa, but globally, with a fully funded UNAIDS. I would also like to reinforce she is not an outsider and has been personally affected by AIDS. She is Winnie Byanyima and having her there, many communities around the world will have a new dream, to one day be the leader she is. I look forward to supporting Winnie’s success as the First Black African Woman as the UNAIDS Executive Director to take us through this last mile and leave no one behind.
Delivered by Jules Kim, Asia-Pacific NGO Delegate
I would like from the outset to make it clear that my intervention is not on behalf of the whole delegation, but as an individual delegate and a sex worker. Sex workers globally are looking forward to working together with the ED we need, to lead the UNAIDS we need.
The UNAIDS Executive Director we need, should bring an in-depth understanding of, and track record in, working with and supporting key populations as an unwavering and consistent ally -regardless of external pressures. We need an ED who recognises the central role of key population-led and other community-led organisations and networks as crucial for an effective response to HIV. They will be unafraid to speak up for the difficult and unpopular issues, and to stand up for the most marginalised- without exclusion, without exception, and without ever letting up.
If we have an ED that leaves a community behind where can we turn? Are we willing to accept that some communities less important than others are justified in being left behind?
The UNAIDS Executive Director that we need is also someone who recognises and fully endorses human rights as an integral aspect of the global HIV response. To us, this must mean unflinching support, including with funds allocated, for the decriminalisation of HIV transmission, exposure, and non-disclosure; decriminalization of same-sex sexuality and behavior; gender identity and expression; decriminalization of drug use and possession; and, the decriminalization of sex work, including a rejection of abolitionist views on sex work that, incorrectly and without evidence, conflate sex work, trafficking, and sexual exploitation; addressing gender inequity in all its forms and across the gender spectrum. The UNAIDS ED we need will be unafraid to advocate for de-criminalisations, as well as fight other forms of legal oppression of any aspect of sex work or our lives, and stigma and discrimination in driving the epidemic.
The UNAIDS ED should have a demonstrated track record of sound management and funds mobilization, as well as in effective and timely management of challenging human resources crises. They will have the ability to reinvigorate and strengthen UNAIDS at this crucial time to carry forward its coordinating and leadership functions in the AIDS response over the next decade and provide leadership and strategic vision to ensure we meet our goals to end AIDS by 2030. This all being said, my constituency has its own track record of working well with UNAIDS, its Secretariat, and its Executive Director. We fully expect to work well with any future ED, and to build constructive and collaborative relationships to ensure that all key populations are not left behind.
I thank you.
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