46th UNAIDS Programme Coordinating Board
Many people in our communities are alive today because of the leadership of UNAIDS of the global AIDS response. The response has been heroic, and, until COVID-19, unprecedented in global health cooperation.
And yet AIDS is not ended. Not as a public health threat, not as the leading killer of adolescents in southern Africa, not as a silent stalker of key populations worldwide, not a factor in growing stigma and discrimination of many in our communities. Nor will HIV be over in our lifetimes. Thanks to ARVs, many millions live thriving lives and will continue to do so after you and I in this meeting are no longer here. In my country, South Africa, alone, 7.7. million people - of whom over 700,000 are young people – live with HIV.
We are not on track to end AIDS. Twenty-four months ago, the Lancet Commission report, made up of some of the best minds in the response globally, reminded us of this; warned of possible rebounds, advised to make common cause with broader global health, and found that existing tools and strategies are insufficient. I repeat, found that existing .. strategies are insufficient.
We are now faced with a strategic turning point within the Joint Programme, at a time of another two global crises, on top of the AIDS crisis. The two new crises are, firstly because as yet less seen, the coming recession that will push scores of millions back into poverty and eat away at their ability to pay for health. It will increase poverty and unemployment, reduce food security and proper nutrition, increase child labour and decrease school retentions, and it will reduce the ability of countries to fund their HIV responses at the same time as grappling with COVID.
Secondly, is the crisis of COVID-19, which has already changed global health forever, though in ways we cannot yet fully know. It has flayed the wealthy along with the poor, but it has also exposed global inequities, between countries & within countries. It has reminded us, not that we need reminding in communities, of who can and who cannot afford health, and which member states have the resources to cope with disasters in health and which do not. While countries in the north have been heavily hit by the pandemic, it is in Latin America that bodies lie in the streets, that children with AIDS once again haunt TV screens as supplies and supply chains collapse, and in Asia that people break COVID-19 isolation and wait in vain for disrupted supplies of medicines.
And these scenes of pain are only those we all see. It is, above all, the uncounted, as Professor Sarah Davis of the Global Health Center, calls them, those whose data does not make it to our TV screens or our reports that are our people. It is people who use drugs in countries where they face psychiatric wards if counted, gay men in countries where torture or beheading face them, and Trans men and women who end up murdered and mutilated in gutters if they are counted. It is sex workers who face weekends of rape in police stations if they are counted. It is adolescent girls who face expulsions from school and home and sometimes community if they are counted, and backstreet abortions because they cannot be counted. It is migrants who are considered aliens in countries where they seek safety, and if counted may be detained or deported. And it is people living with HIV all over the world who face dismissals from employment, rejection by family, stigma, & discrimination if they are counted.
Our bold strategy going forward must find ways, if we are not able to count them, that they still count. Our strategy must, if it is not working for them now in ending AIDS, begin to work for them. Our strategy must take account of women and girls and it must take account of gender and the multiple gender identities held all over the world. It must do better for communities.
It will take many things to produce this bold strategy, but it will certainly take the participation of communities and civil society - as it has for the entirety of the HIV response – to make it successful. Because it will take communities then, it must take communities now to craft it. Community voices, constituency voices, qualitative data, and relevant quantitative data must all play their role in both the review of how we have done, in the post-review analysis and multi-stakeholder dialogue, and in the content for the strategy going forward.
So in conclusion, our plea from civil society to our fellow PCB members, and to member states and to civil society, is that we not find ourselves in December having treated the strategy exercise as a ‘tick box’ due to our COVID-19 distractions. The Secretariat Strategy Team and its coordinator, Tina Boonto, have been amazing in their outreach, and in their flexibility in this difficult time, and our thanks go to the Executive Director, the Secretariat and the PCB for lengthening the process in order to reach for a better product. Don’t waste this time. Don’t just fill in the forms with one eye elsewhere. Don’t send your B Team to online meetings. Don’t only focus on your most pressing issue in the HIV response. This is the time to collect the finest minds in the world together and to ask, “what kind of global strategy do we need to meet the challenges of this new world? Do we have it and if we don’t what must change?” And, of course, what kind of UNAIDS do we need to lead the global response in this COVID dominated or post-COVID world?” If we fail in this, we will not be forgiven and UNAIDS will in all likelihood not survive. When we succeed, the health SDGs will be a great deal closer to realisation, and the health and rights of all our constituencies will be a great deal better than they are now.
Tags: 46th PCB Meeting