By Marsha Martin, North American Delegate
World AIDS Day 2017 marks completion of the first 50 days, the midway point of the first 100 days of implementation of the HIV Prevention 2020 Road Map. The Prevention Road Map, completed following extensive consultations with more than 40 countries, organizations and civil society partners, provides “the basis for a country-led movement to scale-up HIV prevention programmes as a part of a comprehensive response to meet the global and national targets, and commitments to end AIDS as a public health threat by 2030.” (UNAIDS, 2017) The time is now to stop and assess progress to date.
The Road Map embraces the 2016 UN Political Declaration on ending AIDS by 2020. Selecting key targets and commitments from the 2016 Declaration such as: fewer new infections; access to prevention services; access to biomedical prevention; removal of barriers to access services; increased condom availability; and, increased allocation of HIV budgets for prevention, the Road Map is intended to be a living document, for use as guidance by national HIV programme implementers. In addition to the targets, the Road Map also includes a call to action: a 10-point plan for accelerating HIV prevention at the country level. The 10-point plan lays out “the immediate concrete steps that each country can take to accelerate progress towards meeting the 2020 commitments” on prevention of HIV. (UNAIDS 2017)
To coordinate and facilitate acceleration of country-led HIV prevention programmes, and interventions, UNAIDS, in partnership with UNFPA, hosted (and partnered to establish) the Global HIV Prevention Coalition. The Coalition, co-chaired by Prof. Sheila Tlou and Dr. Alvaro Bermejo, convened its inaugural meeting over two days in Geneva, Switzerland October 10-11, 2017. Thirty-one country delegations, from Angola to Zimbabwe, along with civil society representatives and key stakeholders from the private sector, foundation community, and media, participated in the inaugural meeting.
The first day of the meeting was designed to introduce attendees to the global HIV prevention context. The meeting was opened by UNAIDS Executive Director Michel Sidibe, UNFPA Executive Director Natalia Kanem, and GNP+ Executive Director, Laurel Sprague, thus setting the stage for a robust dialogue on strengthening the global prevention agenda. The welcoming remarks were followed by an overview of the global prevention Road Map and review of country level commitments and milestones for implementation. Health Ministers and HIV/AIDS country-level officials reported on their progress to date. Ministers and officials from Brazil, Ghana, India, Namibia, Ukraine, Zimbabwe, among others, presented highlights from their local HIV prevention initiatives. Others leaders assured attendees that they were ready to move to implementation of the 10 point action plan. In addition to the countries selected from within the scope of the Roadmap, donor countries, global HIV funders, and key population organizations responded to the stated commitments and encouraged the leaders to take seriously the need to invest in sustainable responses.
A series of plenary panels with topics ranging from strengthening leadership and accountability to moving from commitment to action to GPC support for national level implementation provided details and best practice examples from MSMGF, Global Fund, NYP+ Tanzania, INPUD, INERLA+, PEPFAR, NSWP and Bill and Melinda Gates Foundation. Mokowa Blay Adu-Gyamfi, Ghana AIDS Commission; Marsha Martin, UNAIDS PCB NGO Delegation and Julitta Onabanjo, UNAFA East and Southern Africa gave Day One concluding remarks and endorsed the Global Coalition and Road Map.
The second day of the meeting was designed to engage each of the 25 country delegations in group work sessions to identify immediate priorities for their in-country work. Each small group was asked to consider action steps that would build upon the successful country consultations and chart a course for Road Map implementation. Specifically each group was asked to discuss and answer the following three questions: What are the immediate priorities for the global coalition? How do countries move from country consultations to road map implementation at the country level? What support will countries need?
Many suggestions emerged from the work group sessions, key among them were ideas centered on communication and harnessing the involvement of civil society. The first step agreed on was to send letters to heads of States and civil society announcing the coalition, as way to achieve universal buy-in and country ownership. Establishing mechanisms to support South-South exchange, technical assistance and capacity building was also encouraged. A communication mechanism, with clear channels and translation services, is necessary to ensure all countries and civil society partners are included and engaged in country level coalitions. It was also agreed that a special space must be established for countries to speak and learn from each other on management of difficult issues/tasks.
All country level coalitions were encouraged to engage and invest in civil society organizations from the beginning of the coalition development process. It was suggested that key stakeholders and allies be identified to support the Coalition’s key population interventions. Trade unions, private sector employers and funders, and inter-ministerial collaborations need to be established to work intersectionally and conduct an analysis of new and existing resources for acceleration of plans.
Each country was asked to calendar their 100 day plan, October 2017 to February 2018 with meaningful and achievable milestones. Suggested action steps includes:
October-Immediate plans for first 100 days;
November-Global agencies disseminate guidance and tools for target setting;
December-Countries assess current standing in context of targets, and take action to strengthen prevention programme oversight; and,
February– Countries have set and updated national prevention programmes and impact targets, identified key policy changes to create an enabling environment.
Following successful implementation of the first 100 days, the next 100 days, leading up to AIDS 2018, countries are to plan for capacity building, examination of financing for HIV prevention, determination of key population estimates, delivery of the first progress report at World Health Assembly May 2018, and convene national HIV/AIDS programme coordinators in Amsterdam July 2018.
Civil Society Organizations are encouraged to participate in the coalition processes within country and are asked to monitor implementation of the 10-point plans.
Thank you to UNAIDS, UNFPA and to all of the health ministers, country leaders and HIV prevention colleagues who are here today, who have been doing the work, sometimes in isolation, and some times in the dark. We are asking the world to join us on an interesting journey. Today we are moving HIV prevention out of the dark, out of isolation into the daylight and everyone is watching.
As Kenya reminds us, “We are all global citizens, more today than we have ever been.” The question is: Are we prepared to create a new global compact? To maintain, reframe, commit to sustain HIV prevention as a key component of the global HIV response and Global Health Architecture?
We have a Road Map – It has been agreed at this meeting, that it is a very good guidance for our journey to 2020 and 2030. It is not commodity driven, it is community driven. Communities are a critical component in the HIV prevention agenda, and I might say, HIV prevention equation. However, the math has to work out and all the numbers have to add up, variables included. And there are at least four variables in the equation.
Variable 1. We want to ask you, encourage you to consider all of the populations, all communities, all people, all parts of the globe, including: Migrant, mobile, undocumented, unseen, differently-abled communities, invisible and indigenous people, ethnic and racialized communities everywhere. That includes Europe, North America, MENA and the Caribbean. We cannot leave the US out either.
Variable 2. We have to talk about women and girls. We must make sure women are consulted globally, within country and locally; and we need to go way beyond ‘women of child bearing age” and to include all women, women’s rights organizations, and programs that reach adolescent girls and young women to add to the power of the equation.
Variable 3. We need to fully resource the community driven response. We need to create the enabling environment so they can do their jobs. This includes gay men and women’s organizations. CSOs and NGOs are the necessary value added to do the job, to achieve our goals of 75% reduction in new infections by 2020.
Variable 4. And we cannot forget probability. Will we do it? Do we have the courage to take the time to do what we need to do? Are we ready to be bold? We have to answer these questions.
We need to create a new compact and move from maintaining to sustaining HIV prevention as a key component of the global response. As Michel said, “we need courage and we need to be bold.”
We must quicken the pace. The issues are not easy ones to address. To address the structural issues/causes we must transform the way we think. What we are learning today, HIV is an entry point.
Communities are a critical component to make the difference. We are the value added. However, support to communities is happening too slowly. Our choices are likely, probably, possibly, or not at all.
We need a rapid response to support and strengthen communities in order to see a realistic and rapid reduction in HIV infection. We want to work together to achieve measurable results. We have our Road Map and we have Google maps. We know where we need to go. We know the 25 places that will help to bend the curve of the pandemic if we dramatically scale up HIV prevention.
Prevention is better than cure. We have a 10 point plan, which is totally doable. The analysis of what is holding us back, gaps in leadership, policy, financing, scalable implementation is right on target. How to move beyond where we are, we have to accept the central role of communities, not just as speakers, and consultants, but with real authority and leadership. It is about leadership and financial well-being. The five pillars of prevention are applicable everywhere and for everyone. We must build synergies by integration with the SDGs-six in particular, all of the quality of life-SDGs.
If we do what we say we believe should be done, we will be the global leaders we have been waiting for. We have all been watching. And now we have invited the world to watch along side of us. Everyone is now watching. We must be accountable for what we say we want to do. The NGO Delegation stands with you. And we are committed to working with all of you to achieve measurable success. Thank you.