48th PCB - Key Note Speech - Agenda item 10: Thematic Segment - COVID-19 and HIV: sustaining HIV gains and building back better and fairer HIV responses

Delivered by Naina Khanna, Co-Executive Director, Positive Women's Network-USA

Greetings. Thank you so much to the UNAIDS Programme Coordinating Board, Member States, civil society, the UNAIDS Secretariat and the UNAIDS Cosponsors. I am pleased to have the honor to address this distinguished body on the topic of COVID-19 and HIV.

My name is Naina Khanna, I use she/they pronouns, and I am the co-executive director of Positive Women’s Network-USA. PWN is a national membership body led by and for women and transgender people living with HIV; we have been a trans-inclusive organization since our founding in 2008. Our goal is to elevate a rights-based response to the HIV epidemic, with a specific focus on, racial, ethnic and gender justice. We understand this to mean that we must focus on intersecting systems of social, political and economic marginalization. In particular, communities that bear the brunt of state violence due to criminalization of sex work, homosexuality, gender identity, poverty, substance use, and more – otherwise known as “key populations”. We advocate for compassionate responses that center and uplift involvement from communities that are most vulnerable and which consistently name truthfully and precisely which communities are most vulnerable – both because it is the right thing to do and because it is the smart and effective thing to do.

In the United States, as in many countries, the COVID-19 crisis exposed extreme fault lines, inequities and failures of political leadership. The United States is the country with the highest number of confirmed COVID-19 cases and deaths in the world. A year ago today we had 56,000 new COVID cases diagnosed in a single day. We have lost more than 600,000 lives.

It didn’t have to be this way. The first year of the U.S. COVID-19 response was plagued by political leadership from the very top that didn’t trust science, didn’t believe in human rights, and certainly did not value the lives of people who are Black, brown, indigenous, migrant, poor or sick. Deliberate, egregious inattention. Not that different from the early days of the HIV response in the United States. Services for people living with HIV were disrupted as a result of COVID and for our members, women and transgender people living with HIV who are already extremely low-income and one emergency away from eviction, this meant potential crisis.

PWN, like many civil society groups around the world, sprang into action. We partnered with the HIV Medicine Association to create and disseminate a bilingual, online Frequently Asked Questions document on COVID and HIV to people living with HIV. We launched an online support group when in person services shut down. We ran an emergency cash assistance program to help women living with HIV who were impacted by household job loss with basic survival needs like medication, food, rent payments, and electric bills, and some of whom were at risk of dying due to climate crisis when a major storm hit the Gulf coast earlier this year. That cash assistance program has given out US $25,000 to date. Our members handed out masks, hand sanitizer and maintained community-based syringe exchange services, because clean needles save lives. We helped women with HIV navigate increased violence and create safety plans needed because some were mandated to stay home under lockdown orders when home wasn’t safe.

This parallels what happened everywhere in the world. Community based organizations - especially those led by key populations groups- stepped up to fill gaps governments couldn’t or wouldn’t. We are able to do that effectively because our communities – people living with HIV, sex workers, people who use drugs, transgender people, gay and bisexual men - trust us to keep them safe and we know where to find them and what they need. We know how to maintain confidentiality and how to address stigma and discrimination.

We are basically running an informal public health infrastructure, sometimes in collaboration with government and sometimes parallel to it. Where communities were engaged and involved in the COVID-19 response, the response was better.

This is why it is critically important to meaningfully engage community-led organizations in all aspects of national pandemic responses, including the continuing COVID-19 response. We must create mechanisms to mobilize and make available short term emergency funding to community-led organizations, in addition to a stable, long-term funding base. And HIV services should be funded, guaranteed and expanded through any such crisis so that they can be maintained. Otherwise we stand to lose precious ground in the HIV response, especially for key and vulnerable populations. These dual pandemics of HIV and COVID must not be placed in competition with each other. Both must be addressed at the same time and we need to increase donor funding for both HIV and COVID-19. Some critical gains were made during the COVID-19 crisis that we cannot lose. We must sustain and promote practical and innovative programs and services that became possible as a result of COVID-19, such as putting services online, differentiated care models, take-home opioid substitution therapy, and multi-month dispensing of ARVs. The COVID-19 response in the U.S and globally has benefited from HIV health systems, the HIV research enterprise, our public health infrastructure, and the HIV workforce.

Yet the COVID-19 crisis has also exacerbated human rights vulnerabilities for key populations through new forms of surveillance, policing, and criminalization. In some countries including the U.S. we have seen massive suspension of privacy rights, lists and data of people who are COVID positive shared with law enforcement, increase in violence, police using lockdowns to profile certain groups including key populations. Restrictions on movement and free speech have been particularly harmful to vulnerable groups, including migrants and people who are mobile. In some countries COVID is being used in some places as a justification for more HIV criminalization, or as a way to target key populations.

Laws and practices that criminalize and/or target gay and bisexual men, people living with HIV or COVID-19, transgender and gender non-conforming people, sex workers, and people who use drugs undermine the public health response and must be repealed so that full human rights are protected for vulnerable communities.

Now, the U.S. is making significant progress in vaccine access under the Biden-Harris administration. But within our own country, we still face severe disparities in who actually is getting the vaccine, with key populations left behind. And globally, we know that powerful high-income countries pre purchased sufficient doses for their entire populations, sometimes twice the number they actually needed, while many low and middle income countries do not have access. The fact that vaccines are available but not accessible and being hoarded by rich countries is an actual crime against humanity, and especially a crime against Black and brown bodies.

Recently, the G7 countries pledged to share 1 billion vaccine doses, half of which would come from the US. But this represents merely a fraction of the approximately 11 billion doses needed to vaccinate the world. Support for low and middle income countries to enable them to produce vaccines for their populations and significantly more donations are necessary to vastly increase supplies and ensure equity. High income countries such as the US must take steps to overcome barriers to vaccinating the world.

Important steps on this include an intellectual property waiver such as the TRIPS waiver mentioned by my colleagues; surge funding for pandemics, and increasing funding for the Global Fund and PEPFAR. We should also explore more permanent agreements to share technology and allow countries to waive IP in global public health emergencies as the norm rather than an exception.

The HIV and COVID-19 pandemics have represented a crisis fundamentally due to who is considered disposable and whose rights to health, safety, and life are deemed to be negotiable. A real commitment to ending these dual public health crises requires that we consistently emphasize a rights-based approach, grounded in sound science, not stigma, bias, prejudice, or discrimination. Such a response must be guided by community, led by those populations that are most impacted and harmed. With a vision towards the future. New diseases will come and go. I urge this body to consider what steps you can take so that we never have to face such a human rights abomination again.

Thank you so much for your time and for your consideration.

48th PCB - Intervention by Iwatutu Joyce Adewole - Agenda item 10: Thematic Segment - COVID-19 and HIV: sustaining HIV gains and building back better and fairer HIV responses

Delivered by Iwatutu Joyce Adewole, Africa, on behalf of the NGO Delegation

Thank you, Chair.

I speak on behalf of the NGO Delegation.

Over the last 40 years, the world has battled the HIV epidemic as a public health threat. We have rocked the ribbon together, contributing necessary aid and funding to help mitigate the effects on our communities.

But what if an emergency pandemic breaks out, killing millions of people and causing more havoc on millions more? We are not going to let it reverse the progress already made.

Two major effects the COVID-19 has had on the HIV response: Funding and Inequalities.

To combat the COVID-19 pandemic, a lot of resources were and is still needed. With HIV being deprioritized and donor funding dwindling in the last several years, programs that had previously demonstrated to be necessary and beneficial, such as HIV treatment and prevention, SRHR programmes, human rights advocacy, and providing protection for those at risk among others, have suffered.

Member states can have and take time to debate and agree on language and decision points for days, while 4500 girls and women in Sub Saharan Africa get infected every week. It is safe to say that the pandemic has sent us a step back in the HIV response. As members of the NGO Delegation, we urge the Joint Programme and other donor agencies to adequately support and fund both the COVID-19 and HIV response that emphasise public health, rights-based approaches, and community-led.

I thank you.

48th PCB - Intervention by Jonathan Gunthorp - Agenda item 2: Leadership in the AIDS Response

Delivered by Jonathan Gunthorp, Africa, on behalf of the NGO Delegation

*The invited speaker was Dr. John Nkengasong, MSc, PhD, Director of the Africa Centres for Disease Control and Prevention.

Thank you, Chair.

Doctor, I want to thank you for your presentation. We are very grateful for your leadership at this time. And grateful too for the timeous establishment of the Africa CDC, just before this crisis which none of us could have foreseen. We could not have imagined when we created a CDC for the Continent, how essential it would be at this time.

I speak on behalf of the entire NGO Delegation, but I speak as an African, and I speak from South Africa, currently under the onslaught of the third wave, which has broken over us in terrible ways. More sadly, I speak today as a neighbour of Namibia, devastated by the tragedy of this COVID wave.

We knew at the beginning of COVID that vaccine supplies were going to be bad for the developing world and for Africa and that the North would be selfish. We had no idea how just bad, and just how selfish the North would prove to be.

Doctor, we appreciate speaking and talking about the role of communities now in COVID, and your solidarity with them and with us. We agree with the US intervention recognizing the comparison you made with the beginnings of the HIV epidemic, and the current issues in the COVID pandemic – and particularly your recognition of the role and centrality of communities in the respective responses.

We in communities, feel COVID the most closely of anyone in this room. We care for those who are sick and unable to get to hospitals. We bury the dead, and we care for those left behind when they are gone. We do this sometimes alongside our governments, and sometimes despite them. We collect & report data on COVID as we do on HIV, sometimes in agreement with our governments, but often in disagreement of their data and reporting.

We look forward, as communities, to working closely with yourself and the Africa CDC, not just on COVID and on HIV, but on all of the disease and illness burdens you spoke to and that our continent needs to overcome.

Again our appreciation for your work, Doctor. Good Luck for the long-haul ahead, and stay safe.

Thank You Chair.

48th PCB - Intervention by Violeta Ross - Agenda item 9: Update on the implementation of the HIV response for migrant and mobile populations

Delivered by Violeta Ross, Latin America and the Caribbean, on behalf of the NGO Delegation

The NGO Delegation reaffirms the importance of this topic. As explained in the report, responding to migration and HIV requires coordinated and systematic actions across co-sponsors, borders and countries. That is why our delegation calls for the need to explore the establishment of a new international coalition to elevate the attention to migration and HIV.

We know the issue is politically complex because it brings topics like punitive laws and travel restrictions. In mobility and HIV, we can see a clear example of how laws can go against the human rights of some people and groups, while pretending to protect our national borders. It also implies the topic of national sovereignty and its limits.

Despite those complexities, we need to be practical and acknowledge that in this century, we live in a globalized community. Nowadays, borders are diffused but what does not change across countries and borders is the dignity of human beings.

Therefore, because we are talking about people with human rights, we cannot simply disassociate from these debates or decisions. What we need are decisions that practically, ethically and politically respond to the issue of people on the move and HIV.

Those practical solutions are signaled in the report. As our delegation stated in the pre- meetings, we urge the PCB members to adopt and implement the recommendations of the report.

48th PCB - Intervention by Violeta Ross - Agenda item 8: Follow up to the Thematic Segment from the 47th PCB meeting Cervical cancer and HIV – addressing linkages and common inequalities to save women’s lives

Delivered by Violeta Ross, Latin America and the Caribbean, on behalf of the NGO Delegation

Cervical cancer is an issue of inequality and we WOMEN, LIVING WITH HIV IN ALL OUR DIVERSITY, we know about inequalities. The NGO Delegation welcomes the report of the 47th PCB Thematic Segment which we find comprehensive. As we move on the discussion for the decision points, we want to reflect in four ideas.

  1. MAKE IT ACCESSIBLE: make the HPV vaccination programs accessible for us. We mean accessible in terms of integrated programs that respond to our sexual and reproductive health and rights in a timely manner. Accessible also means affordable as HPV prices are still prohibitive for many countries including the middle income countries. This is a call for UNITAID, the Medicines Patent Pool and the Global Fund, entities that are doing something but need to do more.
  2. MAKE IT REAL: the discussion of cervical cancer and HIV in women cannot only be a PCB thematic segment. It has to be translated in political will and budgets from international donors and from member states. Demonstrate that you really care for our lives. This is a call for member states and donor agencies.
  3. MAKE IT RELEVANT: an overly medicalized response will not solve the intersection of cervical cancer and HIV. We have to work in the reduction of gender, socio-economic and structural inequalities and address health disparities that underlie the vulnerability of girls and women, including from key populations and in high risk settings, to both HIV and cervical cancer. This is a call for the Joint Program and all stakeholders.
  4. MAKE IT OURS: support us for being part of the response. Put women at the center of programs. Strengthen our capacities and acknowledge our role as partners to address the inter linkages between HIV and cervical cancer and you will see an outcome in demand creation and community mobilization. This will not happen out of goodwill, we need investments for community led and WOMEN LED INITIATIVES to respond to the intersections of cervical cancer and HIV.

Let´s not allow other women or girls to have HIV medications just to die with cervical cancer! This is a call for all of us.

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