Universal access

Civil society urges United Nations Member States to include financing, services and rights commitments as priorities in the 2016 Political Declaration on Ending AIDS

NEW YORK, 6 April 2016—At the Informal Interactive Civil Society Hearing on HIV, civil society organizations have called on United Nations Member States and partners to ensure that the response to HIV is fully funded and that financing for community-led action is increased significantly over the next few years. They also called for 30 million people to have access to life-saving HIV treatment by 2020 and for ambitious HIV prevention targets to be met.

The hearing, convened at the United Nations Headquarters in New York, United States of America, by the President of the United Nations General Assembly, is part of the groundwork for the United Nations General Assembly High-Level Meeting on Ending AIDS, which will take place from 8 to 10 June 2016 in New York. The hearing provides an opportunity for civil society organizations to fully contribute to the preparations, to ensure that their voices are heard and that their interests are reflected, and that their recommendations are taken forward in the drafting of the new Political Declaration on Ending AIDS.

“We are aligned in our objectives of ending the AIDS epidemic by 2030,” said Mogens Lykketoft, President of the United Nations General Assembly. “Now we must work together to ensure a strong Political Declaration on Ending AIDS with clear targets that will lead the world to ending the AIDS epidemic as part of the Sustainable Development Goals.”

Representatives of civil society emphasised the need to reach the people most affected by HIV, who continue to be left behind in the AIDS response including sex workers, men who have sex with men, transgender people and people who inject drugs. The representatives also discussed the importance of ensuring a rights-based approach that is inclusive, based on evidence and people-centred during the interactive panel discussions with Member States.

“To end the AIDS epidemic, no one can be left behind,” said Michel Sidibé, Executive Director of UNAIDS. “Civil society advocacy, engagement and service delivery will play a critical role in translating the targets of the Political Declaration on Ending AIDS into real action on the ground to reach even the most marginalized people with life-saving HIV services.”

Community efforts have proven to be essential in overcoming many of the major challenges in the AIDS response, including reaching people most affected by HIV with life-changing HIV services, providing support to help people adhere to their treatment and bolstering other essential health services. Civil society engagement has also been critical in advocating for new resources, improving HIV programming and making progress on human rights issues.

“The cost of inaction is extremely high,” said Marama Pala, of the International Indigenous Working Group on HIV/AIDS and Co-Chair of the Stakeholder Task Force. “Individual communities are where the work gets done. There is no ending AIDS without us.”

UNAIDS estimates that US$ 26.2 billion will be needed for the AIDS response in low- and middle-income countries in 2020—up from the US$ 19.2 billion available in 2014. UNAIDS also underlines that greater investment in civil society advocacy and community-based service delivery will be critical.

By 2020, UNAIDS estimates that investment in community mobilization needs to increase threefold, to 3% of total HIV resources in low- and middle-income countries. Outreach to key populations in low- and middle-income countries is estimated to need to grow to about 7.2% of total HIV investments by 2020, and the estimated resource needs for community-based delivery of antiretroviral therapy need to increase to about 3.8% of total investment for HIV.

The Informal Interactive Civil Society Hearing on HIV included representatives of nongovernmental organizations, the private sector, organizations and networks representing people living with HIV, women, adolescents and young people, and other stakeholders.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Since the start of the AIDS epidemic civil society has been at the forefront of the response to HIV—demanding access to treatment and HIV services, calling for the respect of human rights and supporting community-led HIV services.

Today the role of civil society remains more relevant than ever as the success of community efforts in providing HIV services, particularly to key populations, is becoming more widely recognized as essential to ending the AIDS epidemic.

Community efforts have proven critical in overcoming many of the major challenges in the AIDS response, including reaching people most affected by HIV with life-changing HIV services, providing support for adherence to treatment and other essential health services. Civil society engagement has also been critical in advocating for new resources, improving HIV programming, and moving progress forwards on human rights issues.

Despite the wide recognition of the important role communities play in responding effectively to HIV, community organizations are facing severe financial challenges and many are closing their doors.

A total of 40% of organizations responding to a recent UNAIDS survey reported that their funding had decreased since 2013. Two thirds expected flat or reduced funding in the future. The decline in funding is resulting in a decline in community services—89% of those who reported a decrease in funding also reported they had to scale down their services as a result.

Greater investment in civil society and community-based service delivery is critical to the Fast-Track approach. Outreach to key populations in low- and middle-income countries should grow to about 7.2% of total investments by 2020, and the estimated resource needs for community-based delivery of antiretroviral therapy should grow to about 3.8% of total investment.

By 2020, investment in community mobilization should increase three-fold to 3% of total resources in low- and middle-income countries to help civil society represent the interests of communities affected by HIV, and to drive ambition, financing and equity in the AIDS response. Social enablers—including advocacy, political mobilization, law and policy reform, human rights, public communications and stigma reduction—should reach 6% of total expenditure by 2020.

UNAIDS has issued two new reports highlighting the importance of investing in community action. Invest in Advocacy details important contributions by community based advocates and points to the need to increase investment to drive an accelerated and more equitable response to HIV. It also notes that a report from the UNAIDS-Lancet Commission on Ending the AIDS Epidemic described advocacy as a “global public good” deserving of support commensurate with its importance.

Stronger Together provides details of the evidence base for community-provided services achieving scale, delivering quality services, and producing results. The report notes guidance from the World Health Organization and others calling for increased engagement of communities to provide a range of HIV and other health-related services.*

In order for community-led services to continue it is essential that international organizations, development partners, governments, private funders and other partners increase investment in community advocacy and services in order to continue and scale up HIV services.

The crucial role of community responses will be among the issues highlighted at the Civil Society Hearing taking place on 6 April in New York. The Hearing is part of the lead up to the United Nations High Level Meeting on Ending AIDS which will take place from 8 to 10 June at the UN headquarters in New York. At the hearing, civil society representatives from around the world will speak to UN Member States about major issues in the AIDS response, including the need for increased financing, leaving no one behind, integration, innovation, and partnering between governments, the private sector and communities.

* The new reports build on other recent publications, Communities deliver and Community-based ART delivery which include more details on the success of community responses.

Meeting in Libreville, Gabon, on 12 February, the ministers of health of the Economic Community of Central African States launched an ambitious programme to strengthen regional cooperation by establishing a community health fund to reinforce the region’s AIDS response.

The ministers also decided to improve coordination by setting up a specialized unit to enhance cross-border HIV prevention strategies and by developing a regional mechanism to source antiretroviral medicines on a larger scale. They also adopted a plan to increase the proportion of pregnant women and children receiving antiretroviral medicines.

The measures are designed to encourage countries to better share their experiences, allowing for a more efficient implementation of recommendations made during a meeting of HIV experts in Dakar, Senegal, in December 2015. 

The World Health Organization (WHO) hosted a briefing in Geneva, Switzerland, on 1 February on the United Nations Secretary-General’s High-Level Panel on Access to Medicines. Representatives of United Nations missions, international organizations, civil society and the private sector were provided with information on the context for the panel and on opportunities to interact with and submit contributions to its work.

The panel was appointed by Secretary-General Ban Ki-moon in November 2015 to support the attainment of Sustainable Development Goal 3: ensuring healthy lives and promoting the well-being of all. The key outcome of the panel’s work will be an evidence-informed, rights-based analysis of proposals and recommendations to promote the development and production of health technologies in a way that balances trade, human rights and public health.

Through a call for contributions and a series of hearings and global dialogues, the 16 members of the panel and its expert advisory group will consider a number of proposals and recommendations across all diseases, technologies and populations in low-, middle- and high-income countries in order to ensure that no one is left behind.

The United Nations Development Programme, in collaboration with UNAIDS, will serve as the secretariat for the panel, which will present its final report to the Secretary-General in June 2016.

Public health leaders and key stakeholders from around the world have come together at the Prince Mahidol Award Conference  to discuss how limited health resources can be used in the most cost-effective way to provide high-quality health care.

Her Royal Highness Princess Maha Chakri Sirindhorn opened the conference by saying it came at a key moment since it followed the adoption of the Sustainable Development Goals by countries late last year. The UNAIDS Executive Director Michel Sidibé delivered a keynote address speaking about the need for a paradigm shift, moving from a disease response to a people-centred approach.

The conference, which is taking place in Bangkok, Thailand from 26 to 31 January, is being held under the theme Priority Setting for Universal Health Coverage. It is welcoming more than 900 government officials, representatives of intergovernmental organizations, international development partners and researchers from around 50 countries.

Thailand is one of the countries that have succeeded in putting people at the centre of their universal health coverage plan. Thailand champions the scale-up of community-led services. The Bangkok Metropolitan Administration, for example, works closely with civil society and communities.

During his visit to Thailand, Mr Sidibé visited two community-led programmes with Ms. Pusadee Tamthai, the Deputy Governor of Bangkok. One was the Service Workers in Group Foundation, better known as SWING, which supports sex workers by providing screening for sexually-transmitted infections, HIV counselling, testing, treatment, care and support services.

Mr Sidibé also visited the Tangerine clinic, housed at the Thai Red Cross AIDS Research Center, which is the first clinic to offer comprehensive sexual health services to transgender people in Thailand. Mr Praphan Phanuphak, Director of the Research Center, is a pioneer in the AIDS movement and demonstrates how science, integrated into community work, brings health care to even the most marginalized people.

The recently appointed United Nations High-Level Panel on Access to Medicines is meeting for the first time on 11 and 12 December in New York, United Sates of America, to explore innovative approaches of ensuring access to medicines for people most in need. The panel was set up as part of efforts to achieve Sustainable Development Goal 3: ensuring healthy lives and promoting the well-being of people of all ages.

The UN Secretary-General established the panel based on the findings and recommendations of the Global Commission on HIV and the Law convened by UNDP on behalf of UNAIDS. Its aim is to ensure that everyone can access quality, affordable treatment while incentivizing innovations and new health technologies. The newly established High-Level Panel will review and assess proposals and recommend solutions to policy incoherencies between the rights of inventors, international human rights law, trade rules and public health in the context of access to health technologies.

“Despite the progress that has been made in tackling a number of major global health challenges over the past three decades, so many people have been left behind,” said UNDP Administrator Helen Clark. “Disease and poor health are still big barriers to social and economic development in many countries, and our world has yet to witness truly inclusive and equitable development,” she added.

“Governments and the private sector have a responsibility to ensure that medicines are accessible to everybody,” said UNAIDS Executive Director Michel Sidibé. “The AIDS response is proof that access to affordable and effective medicines can halt and reverse an epidemic, contributing to an increase in life-expectancy and healthier communities.” 

Generic competition in the pharmaceutical industry, fostered by the use of flexibilities in the application of intellectual property has helped make life-saving HIV medicines much more affordable and allowed the massive scale-up of HIV treatment programmes. For example, in 2000, the price of antiretroviral medicines was around US$ 10 000 per person per year. The price of first-line treatment has now been reduced to as low as US$ 100 per person per year in some countries, ensuring access to life-saving medicines for around 15.8 million people in 2015.

However, despite the price reductions, 21.1 million of the 36.9 million people living with HIV still don’t have access to treatment and the price of second- and third-line HIV medicines are out of reach of many people. Since HIV treatment is for life, there is a continuous need for innovation on treatment regimens and sustained price reduction in HIV-related products, including diagnostics and treatment of opportunistic diseases, co-infections (like hepatitis B and C, and TB), and co-morbidities, and more funding for research and development into a vaccine and cure for HIV.

Some 16 members make up the high-level panel, bringing with them expert knowledge of the broad range of trade, public health, human rights and legal issues associated with innovation of health technologies and access to treatment. The panel, co-chaired by Festus Mogae, former President of Botswana, and Ruth Dreifuss, former President of Switzerland, will look at the urgent need for alternative models to foster research and development for global public health threats, including diseases for which financial returns are not guaranteed. They will cover not only infectious diseases, such as HIV and hepatitis C, but also the rising burden of non-communicable diseases and the affordability of health technologies. The panel will present its report to the UN Secretary-General in June 2016.