Community mobilization

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Delivering an AIDS-free generation is the goal of a new (RED) campaign unveiled this summer. In partnership with America Móvil, a leading wireless provider in Latin America, the (RED) RUSH TO ZERO campaign aims to raise awareness and mobilize resources to end new HIV infections among children by 2015.

Through the campaign, launched in June 2012, funds generated by the sale of wireless products with (Telcel)^RED and (Claro)^RED branding—two America Móvil networks—will benefit programs supported by the Global Fund to Fight AIDS, Tuberculosis and Malaria that prevent new HIV infections among children in Latin America and Africa. America Móvil has committed an annual contribution of up to US $2 million to the AIDS response from 2012 to 2015 through the support of all America Móvil subsidiaries and other Grupo Carso companies, as well as the Carlos Slim Foundation.

According to the latest data from UNAIDS, an estimated 40,000 children were living with HIV in Latin America in 2011. That same year, some 2,000 children in the region were newly infected with HIV.

“UNAIDS salutes the (RED) campaign and its partners for this important initiative,” said Dr César Núñez, UNAIDS Regional Director for Latin America. “(RED) RUSH TO ZERO has helped bring us one step closer to our common goal of zero new HIV infections among children.”

(RED) campaign

Since 2006, (RED) has engaged businesses and consumers in the global HIV response raising, to date, more than US $190 million in partnership with globally-recognized brands. For each product sold, (RED) partners contribute up to 50% of profits toward the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Through the new campaign in Latin America, (Telcel)^RED and (Claro)^RED products will be displayed in Claro and Telcel stores throughout Latin America. Customers will be informed about how the campaign works and how they can help bring an end to AIDS.

At the Red Ribbon Award special session, the winners were congratulated by many eminent personalities including Mr. Sidibé, UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit of Norway, U.S. Congressman Jim McDermott, Minister of Health and Social Affairs of France, Marisol Touraine and International Coordinator and CEO GNP+, Kevin Moody. Credit: UNAIDS/Chris Kleponis.

WASHINGTON, DC, 25 July 2012— Ten community-based organizations, which have shown exceptional and inspiring action on AIDS were honoured with the 2012 Red Ribbon Award in a special session of the XIX International AIDS Conference (AIDS 2012) on Wednesday. The Red Ribbon Award is the world's leading award for innovative and outstanding community work in the response to the AIDS epidemic.

The 2012 winning organizations are from Egypt, Haiti, India, Iran, Kenya, Mexico, Myanmar, Sri Lanka, the Russian Federation and Uganda. Over 1400 nominations from more than 120 countries were received by the Red Ribbon Award secretariat, which is hosted by the Joint United Nations Programme on HIV/AIDS (UNAIDS) in partnership with other UN organizations, AIDS 2012, the Global Network of People Living with HIV/AIDS, STOP AIDS NOW!, the Global Network of Women Living with HIV/AIDS and the International Council of AIDS Service Organizations.  A technical review committee of civil society representatives selected the winners. Each of the winning organizations will receive a US$10,000 grant and international recognition for their innovation and leadership and have been invited to participate in AIDS 2012 in Washington D.C.

“The winners of the Red Ribbon Award 2012 have accomplished so much with so little. They work at the grassroots level in very challenging situations to ensure that vulnerable groups and people living with HIV get the information, services and opportunities they need,” said UNAIDS Executive Director Michel Sidibé. “Communities are where the response to AIDS started and it is their energy, innovation and leadership that have set us on the course to end of AIDS.”

At the Red Ribbon Award special session the winners were congratulated by many eminent personalities including Mr. Sidibé, UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit of Norway, U.S. Congressman Jim McDermott, Minister of Health and Social Affairs of France, Marisol Touraine and International Coordinator and CEO GNP+, Kevin Moody.

Crown Princess Mette-Marit presented the award to the winners and said, “I am proud to give the awards to these outstanding organizations, whose actions in the communities they serve truly make a difference to people affected by HIV. The community response to HIV is at the heart of the AIDS response.”

Nobel laureate and General Secretary of Myanmar’s National League for Democracy, Aung San Suu Kyi delivered her remarks through a video. She stressed the importance of community-based organizations and said, “By strengthening the community we strengthen our chances of achieving democracy and of building up strong democratic institutions."

The UNAIDS Executive Director presents the Red Ribbon Award in the category 'Prevention among/by people who use drugs' to representatives of the Afraye Sabz Association, based in Iran's Kermanshah Province, which has increasing numbers of people living with HIV, specifically among young people who inject drugs. Credit: UNAIDS/C. Kleponis

The Red Ribbon Award was first presented in 2006 and since then has been handed out every two years at the International AIDS Conference.  This year there were five award categories and the ten winners are listed below by category:

1)     Prevention of sexual transmission

The Help, Myanmar focuses on prevention, care, support and advocacy for men who have sex with men (MSM) and works to ensure that the voices of MSM are heard and their issues taken up at the national level. All members of the HELP are MSM and almost half are living with HIV. More

SEROvie, Haiti, focuses on the health and rights of Haiti’s sexual minorities and became a vital source of aid, support and advocacy for sexual minorities following the January 2010 earthquake. SEROvie conducts HIV prevention, health referrals, and psychological and social support, as well as home-based care visits, vocational training and a micro-credit programme. More

2)     Prevention among/by people who use drugs

Afraye Sabz Association, Iran is in Kermanshah Province, which has increasing numbers of people living with HIV, specifically among young people who inject drugs. The association promotes HIV awareness, especially among youth, by providing educational and other complementary services, as well as support to PLHIV and their families.

Espolea, Mexico offers a space where young people feel free to think, create and perform and focuses on three central issues for young people: HIV, gender, and drug policy. The group works for a consolidated, comprehensive national agenda for young people, that encourages their participation locally, nationally and internationally.

3)     Treatment, care and support

The Kenya Hospices & Palliative Care Association (KEHPCA), Kenya represents all of the country’s palliative care service providers. Its mission is to scale up palliative care services and ensure those in need receive the services. Approximately 27% of Kenyan hospice patients receive palliative care for HIV and AIDS and KEHPCA has advocated extensively for the integration of palliative care into health services in Kenya. More

Positive Women’s Network (PWN+), Sri Lanka works to empower its PLHIV members and reduce the discrimination and stigma that women living with HIV face when accessing health services. The group also advocates for global and national policies and runs two drop in centres operated by PLHIV for PLHIV to provide safe, secure, confidential and stigma-free environments for counselling services, financial and emotional support. More

4)     Advocacy and human rights

Initiative Group ‘Patients in Control’, Russian Federation is a grassroots initiative started in 2010 that now involves about 50 leading activists from across Russia. It organizes street actions, press conferences and roundtable discussions focused on issues such as drug stock-outs and the absence of HIV treatment guidelines. The group has achieved significant results in terms of government action on these issues. 

Delhi Network of Positive People (DNP+), India seeks to improve the treatment and facilities for PLHIV and provides a platform to help empower patients to make informed treatment decisions. Over the years the group’s work has expanded from a support group to service delivery and human rights advocacy. More

5)     Stopping new HIV infections in children and keeping mothers alive, women's health

Giramatsiko Post Test Club, Uganda, is an organization for and run by rural women living with HIV. The organization provides skills and knowledge for HIV prevention, care, support and treatment. It advocates for the rights of women living with HIV and their families and empowers women by increasing their livelihood skills. The organization has established 19 Post Test Clubs. More

Global Youth Coalition against AIDS (GYCA) Egypt is a group of young activists working to raise community awareness around health issues, specifically taboo topics such as sexual and reproductive health and rights, and advocating for a human rights-based approach to HIV/AIDS interventions that includes accurate information, condoms and needle exchange for young people. They have an initiative which works with women from low-income communities.

UNAIDS Executive Director Michel Sidibé and US Secretary of Health and Human Services Kathleen Sebelius participated in the YouthScore 2012 event in Washington, on 21 July, 2012. Credit: UNAIDS/Y.Gripas

On the eve of the first International AIDS Conference in the United States in two decades, Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), joined US Secretary of Health and Human Services Kathleen Sebelius and others to launch Youth Score—a series of events to mobilize young people to lead the way to an AIDS-free generation.

The events will use sports, music and art to connect young people to the information they need to protect themselves and others from HIV. According to a UNAIDS report released on 18 July, youth remain particularly vulnerable to HIV infection. Nearly 5 million people aged 15-24 were living with AIDS in 2011 and, that same year, almost 900,000 young people became newly infected with HIV. The report shows that young people overall lack key information on HIV prevention and transmission. It calls for broad social mobilization of young people to reach the vision of “three zeros.”

“Young people are among the most vulnerable to new HIV infections, but their calls for support are too often not heard," said Michel Sidibé. “This must change as this is the generation that will help bring us to our vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths.”

The Youth Score launch event brought together young people from Washington DC and across the world to share their experiences in stopping AIDS. It attracted more than 200 young people who came out to participate in workshops and clinics with Lorrie Fair of the U.S. Women’s National Soccer Team, Steve Zakuani of the Major League Soccer team Seattle Sounders and former National Basketball Association player Michael Adams. Entertainment was provided by graffiti artists and musicians, including DJ Money and Niqé.

Much of the focus of the event was on equality and human rights, and the broader initiative will push these themes in an effort to reverse AIDS-related stigma. According to the new UNAIDS report, minority youth and gay men are particularly at risk of infection:

• There are nearly 5 million young people living with HIV in the  world. About 2400 young people become infected with HIV each day.
• Awareness about HIV is low among young people—only 24% of young women and 36% of young men have adequeate basic information about HIV.
• Young women 15-24 old are most vulnerable to HIV infection, with infection rates twice as high as among men of the same age.

“The International AIDS Conference is a big deal because HIV in DC is a big deal,” said Leonard, 16 years, a participant in the event from Northwest DC. “Hopefully since people from all over the world will be involved, people will recognize how bad it is in DC and the rest of the world and pay attention to our epidemic.”

NBA legend Magic Johnson, who has lived with the disease since the early 1990s, echoed the sentiment. “In the fight against AIDS in America, young people from minority communities need to be on the front lines, “he said. “YouthScore and other programs that are raising awareness in economically challenged areas are vital.”

In addition to highlighting equality, Youth Score focuses on expanding access to HIV education, male and female condoms and resources for youth organizations that focus on the disease. As evidenced by the participation of Secretary Sebelius, the initiative will also seek out partnerships and collaboration with diverse sectors to ensure that young people’s voices are heard in discussions over policy and programs.

“The Obama Administration’s goal of an AIDS-free generation will only be reached if young people play a central role,” said Kathleen Sebelius. “That’s why UNAIDS’ efforts to give them a voice and the tools they need to be effective leaders in their communities is so important.”

Youth Score will eventually visit a range of countries around the world before culminating in Salvador de Bahia at the opening of World Cup 2014 in Brazil.

"No sport is more popular with global youth than soccer," said world-famous Brazilian soccer star Ronaldinho. "Whether in Washington, Rio, or Johannesburg, soccer has the ability to act as an attractive platform to bring together young people and educate them about AIDS.”

Partners in the Washington DC event included the DC Department of Health, The Grassroot Project, Metro TeenAIDS, Soccer for Good, The Magic Johnson Foundation, Advocates for Youth, The World Bank, Ragball International, Youth Force, Monumental Sports and Youth Core.

UNAIDS Deputy Executive Director, Programme, Paul De Lay speaking at the opening session of the interfaith event Taking Action for Health, Dignity and Justice.Credit: UNAIDS/Y.Gripas

What is the added value of faith communities taking action on health, dignity and justice in the context of HIV? This was the fundamental question addressed by participants at the interfaith event held in Washington DC on 20 July 2012. Taking Action for Health, Dignity and Justice explored ways in which faith communities can use both advocacy and on-the-ground responses to address the root causes of vulnerability to HIV and promote a more just, equitable and inclusive societies.

“This battle will not be won by pharmaceuticals, but by communities themselves, communities that are marginalized and discriminated against,” said EAA Executive Director Peter Prove. “This is our special role—our presence in those communities, at a grassroots level, and in a leadership role, in forming opinions,” he added.

Through plenary sessions and numerous workshops, hundreds of religious and community leaders, faith-based representatives, young people and people living with HIV provided an overview of the faith community’s work on health, dignity and justice in the context of HIV and discussed the challenges and opportunities ahead. “We gather here to ensure that our legacy is to fulfill God’s most sacred commandment, which is to preserve life,” said Rabbi David Saperstein, Director and Counsel of the Religious Action Center of Reform Judaism, USA.

Speaking at the opening session, UNAIDS Deputy Executive Director, Programme, Paul De Lay stressed the importance of the faith communities’ response to HIV. He cited examples such as the YWCA that has been a leader mobilizing young people around HIV prevention, treatment, care and support, using a broad range of strategies from participating in CrowdOutAIDS to promoting synergies between health and primary and secondary education for girls.

Dr De Lay also highlighted the progress being made by UNAIDS to engage more fully, and in a more knowledgeable way, with faith leaders around to world, to support their positive impact on communities affected by HIV. The UNAIDS Framework for partnership with Faith Based Organizations is an important tool in this work.

“Now more than ever is it important for us to work in partnership to achieve our common goals,” said Dr De Lay. “We must work together to challenge the ideologies that deprive people of their dignity and their right to development,” he added. 

Participants recognized the power of faith to inspire hope and give comfort to the vulnerable, and to mobilize people—toward compassion, care and service, and away from stigma and discrimination, punitive laws and policies. However, it was also noted the need to be honest about some of the serious stigma and discrimination issues among the faith community.

“My prayer is that faith communities will have the courage to open up these crucial conversations with young women and to accompany them to get correct and accurate information, access to HIV services and be there for them at the point of vulnerability,” said Maria Ziwenge of the Young Women’s Christian Association of Zimbabwe.

Faith perspectives are sometimes hard for scientists to deal with, and are too often left out. In an UNAIDS conducted global review of HIV communication programmes in 1998 it was found that the missing piece in HIV messaging and programming—cited by people in all world regions—was spirituality.

The interfaith pre-conference identified opportunities for the faith community to engage in the HIV response through advocacy by calling for sustainable funding to achieve universal access to HIV treatment for all and holding governments accountable to their commitments; through community mobilization by demanding creation for uptake of voluntary testing and treatment services, especially in the light of the important treatment as prevention findings; and by scaling up service delivery provided by the faith community to support national efforts.

Men gather to discuss cultural and social issues related to gender justice and equality.

Sitting on a traditional stool at a Dare—a special meeting platform, Chief Chiveso of Mashonaland Central Province in Zimbabwe speaks to men about the possibility of having babies born HIV free and keeping their mothers alive. For that to happen, stresses the Chief, there is a need to challenge harmful cultural and religious practices that can affect community responses to HIV.  "As a Chief, I am going to continue supporting and leading health issues in my village so that families can live better.”

Chief Chiveso has the support of Padare/Men’s Forum on Gender—a Zimbabwean organisation that works with traditional leaders in Mashonaland to influence public opinion on various community issues. These include the promotion of HIV services and mobilising men to actively participate in preventing new HIV infections among children.

Men play a significant role in defining community practices. Traditionally, Zimbabwean men would gather around a fire or under a tree to discuss community issues and make decisions about the community while excluding women and children. This practice fuelled gender inequalities since most decisions did not take into account women’s views.

Padare’s goal is to subvert this exclusive male practice and bring together traditional and local leaders, pastors, grandfathers, fathers, uncles and brothers to discuss cultural and social issues related to gender justice and equality, including the support for programmes to stop new HIV infections among children.

"In these communities men have positions, power and privileges that come from patriarchal values. We are harnessing their power so that they can be agents of social change in their communities," said Kevin Hazangwi, Director of Padare.

Zimbabwe’s National AIDS Strategic Plan aims to reduce transmission of HIV from mothers to children from 14% in 2010 to 7% in 2013 and to less than 5% by 2015. Currently, Government figures indicate 70% coverage of prevention of mother-to-child HIV transmission services in the country.

Rising community voices in HIV action

Through the Padare initiative, Chief Chiveso engages men in open dialogues where community members are encouraged to challenge low health seeking behaviours in the village and to understand HIV prevention, treatment and care services. These interactive dialogues—known as Community Conversations—enable community decision-making and actions concerning the elimination of HIV.

“This programme gave me a lot of knowledge about existing antiretroviral drugs and HIV prevention services,” said Tatenda, a proud father living with HIV. “I was supporting my wife when she was in labour. I now have twins who were born HIV negative.”

Padare also conducts consultative meetings that tap into the local rich traditions. These meetings enable communities to identify gaps in knowledge and attitudes, behaviours and cultural practices that are harmful to the AIDS response. In these open discussions, community members are able to raise key issues and provide solutions without personalising the issues. Spousal inheritance and girl pledging for spirit appeasement—offering of a young girl to remedy criminal offences or to appease the spirit of a murdered person—are among the negative cultural practices that are discussed.

A higher-level platform known as Indaba is also used by Padare to engage the Chiefs themselves to advocate for greater action in their respective communities. Such dialogue enables the Chiefs to agree on sound HIV policies ensuring the involvement of men in preventing new HIV infections at community and national level.

“As Chiefs we should play a major role in sensitising our communities. Over and above the right of children to a dignified life, the babies we are losing are potential nurses, doctors and teachers for our society’s tomorrow,” added Chief Chiveso.

Traditional leaders as custodians of culture

Faith-based leaders in Mashonaland Central are also taking action to change negative religious and cultural practices and boost service uptake in their communities.

“Religion and the church have been accused for being the source of male chauvinism and patriarchy. We pledge to keep it as a fountain of hope, a source of information and health,” said Pastor Sifelani, of the Anglican Church in Bindura. “Gone are the days when we would encourage people to flush away antiretroviral drugs because they have been healed and we blamed witchcraft for sickness and death instead of HIV.”

Traditional leaders are considered the custodians of culture and are therefore critical to shift society’s attitudes. Bringing together communities to discuss issues in their own terms has a positive effect in increasing HIV service uptake. There is greater scope for replicating this programming model in sub-Saharan Africa where the idea of men’s forums is culturally appropriate and can be traced to past and current practices.

(L to R): UNDP Administrator Helen Clark, Prime Minister John Key and UNAIDS Executive Director Michel Sidibé.

UNAIDS Executive Director Michel Sidibé and UNDP Administrator Helen Clark praised New Zealand as a model for the AIDS response in a joint meeting on 6 March with the country’s Prime Minister, John Key.

New Zealand implemented early evidence-based programmes to ensure that vulnerable populations receive priority attention and support that was essential to control the spread of HIV. In 1987, New Zealand was among the first countries to introduce needle—syringe programmes for people who use drugs. It was also a regional pioneer in decriminalizing sex work (2003) and sex between men (1986). These programmes and reforms are widely credited with having prevented the spread of HIV among populations at high risk of infection in New Zealand. Nationally, HIV prevalence remains low, with about 0.1% of the population living with HIV.

During the meeting, Mr Sidibé urged Prime Minister Key to champion the UNAIDS vision of vision of Zero new HIV infections, Zero discrimination and Zero AIDS-related deaths in the Pacific region. "You have already made so much progress. Drawing on this experience, New Zealand can be the first country in the Pacific region to show that getting to Zero is possible,” said the UNAIDS Executive Director.

The UNDP Administrator warned of the need for continued vigilance in the HIV response, even in low prevalence countries like New Zealand. “We can never relax—this is a deadly disease, and there is no cure,” said Ms Clark. “If you are complacent, HIV prevalence rates can take off.”

Throughout the three-day mission to New Zealand, Mr Sidibé and Ms Clark encouraged senior government officials to lift travel restrictions for seasonal workers visiting New Zealand. “HIV-related travel restrictions have no public health rationale and are at odds with New Zealand’s outstanding record on HIV and human rights,” said Mr Sidibé.

Official opening of centre for women living with HIV

On the eve of International Women’s Day, and as part of their official visit to New Zealand, Mr Sidibé and Ms Clark opened Positive Women Inc’s new premises and community house in Auckland for women living with HIV. The organization aims to raise awareness of HIV in the community through educational programmes, with a particular focus on HIV prevention and de-stigmatisation.

Co-founders of Positive Women Inc. Judith Ackroyd (far left) and Suzy Morrison (far right) with UNDP Administrator Helen Clark, National Coordinator for Positive Women and Asia Pacific UNAIDS PCB NGO Delegate, Jane Bruning (centre) and UNAIDS Executive Director Michel Sidibé.

"It is an honour for me to join you in the opening of this impressive community house. Your efforts to support and empower women living with HIV are a true testament of your commitment to the AIDS response," said Mr Sidibé.  "Women are critical agents of change and that by harnessing our collective strengths, we can end this epidemic."

The community house has been designed as a safe and welcoming space for women living with HIV and their families. It offers weekly member lunches, a relaxation lounge, a computer corner and printing facilities. Members are encouraged to organize knitting circles and conversation groups with their peers.  An on-site social worker attends to the social and psychosocial needs of women and their families.

“Women represent the invisible face of the AIDS epidemic,” said Jane Bruning, National Coordinator of Positive Women Inc. “These are women who run households, cook dinner, have jobs and raise families. They are the ones keeping everything together. So to be able to offer them a place to come for advice or just a chat and a cup of tea is extremely important.”

The delegation of United States Congressional staff members visited the ASAZA project, one of the main programmes in the country responding to gender violence and child sexual abuse.

A delegation of nine United States Congressional staff members travelled to Zambia from 18 – 24 February. The aim of the visit was to have a first-hand understanding of the progress made and challenges remaining in scaling up HIV treatment, care and prevention programs in one of the most heavily impacted countries Sub-Saharan Africa.

The trip, organized by UNAIDS in collaboration with the Office of the United States Global AIDS Coordinator and the American Embassy in Lusaka, provided Congressional staff with an overview about how the United States government and the United Nations system are working with the Government of Zambia to support the country’s AIDS response.

“What I have seen this week only reinforces my belief that the United States has a critical role to play in helping local communities address the many profound challenges posed by AIDS,” said Diana Ohlbaum, Democratic Congressional staffer co-leading the visit. “It’s inspiring to see how much of an impact what we do in Washington has here on the ground in Zambia,” she added.

Zambia has an estimated HIV prevalence of 13.5% with more than a million people living with HIV. Each year there are an estimated 82 000 new HIV infections in the country. While there has been important progress in scaling up access to antiretroviral treatment and in reducing new infections among children, the delegation saw a need for greater efforts to address the structural causes of vulnerability to HIV such as gender disparities.

The delegation visited a variety of programs in Lusaka, Monze and Livingstone—including programs focused towards the elimination of new infections among children, male circumcision and access to HIV treatment. The group also learned about the opportunities to integrate HIV programs and other primary health services, including the recently launched Pink Ribbon-Red Ribbon Initiative which seeks to better integrate HIV and cervical cancer programs.

Gender violence and child abuse

The delegation visited one of the main programmes in the country responding to gender violence and child sexual abuse. The programme, hosted at the Mazabuka District Hospital outside Lusaka, has been supported by both United States and United Nations funding and is designed to mitigate the impacts of sexual and gender-based violence.

ASAZA also supports a men’s network which works through traditional leaders in both urban and rural settings to change behavior and set new social norms among men.

Known as the ASAZA program, short for “A Safer Zambia”, the project supports survivors of sexual and gender-based violence through integrated care and long-term assistance and by working with surrounding communities to make it less common. Some of the support provided includes the collection and preservation of forensic evidence, prosecution of perpetrators, provision of medical treatment and facilitation of links to safer houses and survivor support groups.

ASAZA also supports a men’s network which works through traditional leaders in both urban and rural settings to change behavior and set new social norms among men. 

“We know that gender-based violence and abuse are contributors to the AIDS epidemic in many countries,” said Lisa Carty, Director of the UNAIDS office in Washington, DC. “To see the model developed at ASAZA, particularly the involvement of the men’s network, and to hear the courageous stories of gender-based violence survivors is proof that communities can take action to combat gender violence.  We all need to support this type of innovative approach,” she added.

Representatives from the community of people living with HIV and key populations most at risk urge governments in Asia and the Pacific to work with them to reach global AIDS targets and commitments.
Credit: UN ESCAP

Dressed in a striking blue and red shalwar kameez (traditional dress from South and Central Asia), Akkai, a transgender woman from Bangladesh, steps onto the stage. Turning to her audience of government officials from Ministries of health, justice, public security, drug control, social protection; United Nations officials; and fellow members of key populations most affected by HIV, she started to sing:

“I born as me/ My feelings changed… / I started behaving like a girl / I started walking like a girl / I started dressing as a girl / When my parents forced me to stop myself /  I was beaten up / I was locked up / I was tortured…./ …There was nobody to ask these things / … / This kind of torture, violence, harassment /  Is not faced only by me / Where to live?/ Where to share?/ Where to survive our life?”

Joining the scene, the coordinator of the Women’s arm of the Asia-Pacific Network of people living with HIV explained: “I have been living with HIV for 17 years. Fortunately I have had access to treatment. But now free-trade agreements are compromising access to essential medicines,” she said. “Eighty percent of generic medicines are made in this region. Without access to affordable medicines we cannot get to zero,” she added.

These personal experiences were two of many shared by people living with HIV and key affected populations at the United Nations Economic and Social Commission for Asia and the Pacific (UN ESCAP) high-level intergovernmental meeting held in Bangkok, Thailand from 6-8 February 2012. The meeting was an opportunity to review the region’s progress towards international targets on AIDS.

“For the first time in history we have the possibility to end AIDS and Asia-Pacific nations have shown we can lead the world in making an impact. But we cannot ignore the challenges our region faces and how these can jeopardize our ability to progress,” H.E. Ratu Epeli Nailatikau, President of Fiji, who underlined his long-term commitment and leadership on HIV as Chair of the high-level talks.

Representatives from the most-affected communities urged government delegations from Asia-Pacific nations to recognize the existing challenges in accessing HIV services posed by punitive laws and practices, threats to continued availability of HIV treatment and widespread stigma and discrimination. They also called upon governments to work increasingly with communities to ramp-up action to reach HIV goals.

The call to action was heard. By the end of the three-day talks, co-convened by UNAIDS and other UN partners, the nations present endorsed a framework to fast-track regional action on AIDS towards the achievement of global targets and commitments by 2015. Countries agreed to create ‘spaces’ for key affected communities—including people who use drugs, men who have sex with men, people who buy and sell sex, and transgender people—to be involved in the development of practical solutions to legal impediments and HIV service scale-up at the policy and programmatic level.

“It was recognized here that we have to find new ways to reach the maximum amount of people in the short time we have before 2015,” said UNAIDS Director of the Asia-Pacific Regional Support Team, Steven Kraus. “And there is no question; this must be done hand-in-hand with the community.”

Akkai, a transgender woman from Bangladesh, sings about the stigma and discrimination she faces.
Credit: UN ESCAP

In recent years, Asia and the Pacific has experienced significant progress in reduction of new HIV infections, increase on numbers of people receiving antiretroviral treatment and expansion of programmes to reach key populations most at risk.

Examples given by a number of countries at the Bangkok talks illustrated that scaled up HIV services coupled with intensive engagement of key affected populations, have led to declining epidemics. In Thailand for example, the transgender people-led initiative “Sisters”, which provides social services and support to transgender people in the Pattaya area reports that HIV incidence fell from 12 to 8% among people using its services in the last 5 years.

With such examples of progress, the importance of developing the next generation of community leaders is a central regional priority. The new Asia-Pacific framework for accelerated action underlines that young people from key affected populations must be heard, heeded, and have space at the policy and programme tables.

Emphasizing the readiness of young people most affected by HIV to take on a leadership role in the region’s future HIV response, Coordinator of Youth LEAD, the regional network for young HIV key affected populations, Thaw Zin Aye said: “Young people are taking ownership of the AIDS response and we are committed to carrying on the legacy. We urge governments to continue taking action with us.”

The endorsed regional framework emphasizes the need to share good practices and lessons learned in implementing the measures and commitments related to HIV. Asia-Pacific countries also requested UN ESCAP, UNAIDS and other cosponsors to support implementation of the road map.

From left to right: UNICEF Regional Director for Africa As Sy, UNAIDS Executive Director Michel Sidibé, together with Gottfried Hirnschall, the Director of the HIV Department at WHO at the community dialogue space.
Credit: UNAIDS/J. Ose

Under the banner “Getting to zero,” UN leaders and community representatives engaged in a passionate exchange on sustainable funding for the AIDS response in Africa. The discussion was overshadowed by mounting concern over the recent cancellation of Round 11 by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund).

UNAIDS Executive Director Michel Sidibé, UNICEF Regional Director for Africa, As Sy together with Director of the HIV Department at WHO Gottfried Hirnschall, answered questions posed by the audience gathered at the community dialogue space at the 16^th International Conference on AIDS and STIs in Africa conference.

Mr Sidibé was asked to briefly introduce UNAIDS’ vision of zero new HIV infections, zero discriminations and zero AIDS-related deaths. “For me, this vision is a way to respond to social injustice. All people can have access to the HIV services they need, if we make it a political priority,” said Mr Sidibé.

From the health sector perspective, Dr Hirnschall said, “There is a need put systems in place for people to access treatment, provision of quality and comprehensive services and above all the need for equality to get to zero."

Given the current funding constraints faced by the AIDS response, Mr Sidibé stressed that new ways of doing business are needed: “Getting to zero requires new partnerships, a democratization of problem-solving and innovative solutions to lower the price of drugs. Ultimately, the ‘zero-vision’ is about responding to the AIDS epidemic in a faster, smarter, and better way.”

Jeanne Gappya, a civil society representative from Burundi challenged the UN leaders in the panel: “When I go back to my country, I will be asked if the three zeros will arrive,” she said. “In my view there is another zero and that is zero financing. How are we supposed to get to zero with no funding?” she asked.

Mr As Sy acknowledged that the cancellation of the Global Fund Round 11 was a potential setback, and recognized the anxiety this has created among people living with HIV who are currently accessing treatment as well as organizations and governments pushing for scale up of prevention, treatment, care and support services.

However, Mr As Sy asserted that countries receiving global fund resources should start a discussion on diversifying their funding sources: “Our hopes should not be placed on the Global Fund alone. We need to find alternative sources of financing,” Mr As Sy said.

Echoing these concerns, Mr Sidibé noted that a large percentage of people living with HIV on the African continent are receiving HIV treatment thanks to the Global Fund. He cautioned against stopping this funding, particularly at this make or break moment when Africa is leading the world in reducing HIV infections and AIDS-related deaths.

Reflecting on the discussion, Auxiria Mwanza from Zambia said the news of the Global Fund Round 11 cancellations was teaching grass-roots organizations a lesson: “We can no longer rely on external funding. It is up to us to work hard in our own capacity to reach the three zeros. The dependence syndrome can be broken down and communities should have the capacity to respond for themselves,” Ms Mwanza said.

Mr Sidibé agreed that there is a need for African countries to reduce their dependence on external funding sources and for countries to explore innovative sources of funding. This could for example include the establishment of a tax on financial transactions and the creation of an African treatment agency that could make HIV treatment available at a lower cost on the continent.

Donor representatives interacting with civil society members at the community dialogue space.
Credit: UNAIDS/J.Ose

On Monday 5 December, discussions in the community dialogue space at the 16th International Conference on AIDS and STIs in Africa (ICASA) focused on financing the AIDS response. On this theme, UNAIDS and UNDP co-hosted the event ‘Donor dialogue session: Funding the grassroots and sustainable financing of the HIV response in Africa.’ The major part of the discussion revolved around the current economic situation and the fact that donors are decreasing their funding for AIDS.  The session allowed for direct interaction between donors and civil society representatives, and participants seized this opportunity to call for sustained funding for community organizations.

Set up as a panel of donor representatives, the audience asked panellists questions from the floor. Civil society participants were concerned about the cancellation of the Round 11 by the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund). As one member of the audience highlighted “we fear the consequences of discontinuing HIV treatment as a result of this cancellation.” The Global Fund representative Mark Edington, Director of Country Programmes, assured participants that the Global Fund is fully operational and committed to continue working with civil society organizations. Mr Edington also affirmed that “people already on ARVs are our top priority, and there is no question that we will maintain funding available for those already on treatment.”

Civil society representatives also asked how grassroots organizations could access funding given the current financial situation. Sheri Nouane Duncan Jones, HIV/AIDS Team Leader with USAID Ethiopia explained the ongoing change to their funding mechanisms. The organization is moving away from traditional umbrella funding—where international donor funds are transferred to grassroots organizations through bigger non-governmental organizations—to a direct funding through grant application to small local organizations. This approach is expected to cut intermediary fees as well as to increase effectiveness of the programmes funded.

Other issues addressed during the dialogue were related to strengthening accountability and transparency of civil society, its capacity to implement programmes and transform itself in a rapidly changing funding environment. Community members emphasized their need for capacity building on proposal writing to access funding. The lack of technical support available could jeopardize their future access to funding, participants said.

The session was moderated by Cheikh Tidian Tall, Executive Director of the African Council of AIDS Service Organizations. Representatives from the donor community that participated in the dialogue included Sheri Nouane Duncan Jones, HIV/AIDS Team Leader, USAID Ethiopia, Mary ODUKA, Senior HIV/AIDS Advisor, Irish AID, Kristina Kloss, German Back-Up Initiative, GIZ, Miriam Vuckovich, Technical Adviser on HIV/AIDS, GIZ and Mark Edington, Director of Country Programmes, the Global Fund to Fight AIDS TB and Malaria.

The community dialogue space at ICASA 2011 is dedicated to highlighting the successes and challenges faced by grassroots organizations and civil society in Africa. All the sessions open and dialogue based allowing for much more interaction with the panel members and the audience. The overall goal of the space is to provide a venue for civil society and people living with HIV to meet and interact with prominent leaders from governments, international organizations, UN agencies, the private sector and other groups from within the region and around the world.