By Robin Montgomery, Interagency Coalition on AIDS and Development (ICAD)
In October 2015, the renewed UNAIDS Strategy was approved amidst cheers from the global community at the 37th meeting of the UNAIDS Programme Coordinating Board (PCB). The renewed strategy is an ambitious but viable, comprehensive road map charting the end of AIDS as a public health threat by 2030 and is couched within the Global Goals for Sustainable Development (SDGs).
Just twelve months later, the conversation at this week's 39th PCB has taken a much more somber tone as delegates grapple with the funding crisis that has rocked UNAIDS and that continues to stunt the broader community-led HIV response around the world. Ironically, this is where we find ourselves following a year that has been packed with high-level events, conferences, and meetings that have rallied the commitment of governments, donors and the global HIV community around a new 2016 Political Declaration on HIV and AIDS, to which Canada is a signatory.
Among other requirements, these commitments call for significant increases in investment from donors as well as domestic and innovative financing mechanisms to reach the hardest to reach people and fast-track the end of the AIDS epidemic.
Delegates during the 39th UNAIDS Programme Coordinating Board (PCB) meeting, 6-8 December 2016.
While there has been debate as to what the precise figures may be, we now know that to get on the Fast-Track we must increase investments from $19 billion to at least $26.2 billion (and ideally $30 billion) by the year 2020. Yet, with competing global crises, the politics of scarcity, and the 13 per cent decline in HIV donor funding in 2015 compared to 2014 -- well, the math simply isn't adding up.
We are indeed seeing and hearing at global and country levels that a greater emphasis on community responses is a critical driver if we are to meet our global goals and targets. Widely touted as a "global public good" in the AIDS response, civil society is a critical partner in reaching key affected communities and in creating demand for and boosting uptake of health services and health-seeking behavior.
Strong civil society systems and community engagement are also seen by UNAIDS and the Global Fund as vital to the successful implementation of their renewed strategies and to achieving gender and human rights agendas, particularly for the most marginalized populations.
Nonetheless, while funding targets suggest that investments in community mobilization should increase threefold to three per cent by 2020, and spending on social enablers rise to eight per cent of total global HIV expenditure, a recent UNAIDS survey found that 40 per cent of organizations working on the ground reported that their funding had decreased consistently since 2013. Two-thirds expected flat or declining funding in the future. Indeed, the success of the Fast-Track strategy and reaching the 90-90-90 targets depends on community and civil society, a community and civil society that may be invited to the table, but increasingly can no longer afford to be there.
And the barometer continues to rise.
While in some areas of the world we have been able to bend the trajectory downwards in new HIV infections -- this is neither uniform across regions nor consistent within country borders. Those at greatest risk of HIV, those who are the most marginalized in society, continue to face the greatest hurdles barring access to timely, quality and affordable prevention, treatment, care and support services. This is as true in Canada as it is in other areas of the world. Key affected populations include but are not limited to: gay men and men who have sex with men, sex workers, people who use drugs, transgender people, Indigenous Peoples, people in prison and other closed settings, women and adolescent girls, young people, and people with disabilities.
We are just three years away from being called to account for our progress towards the 2020 Fast-Track targets -- a critical milestone in ending the AIDS epidemic. We still have a great distance to travel before we're able to call it a success. Measures to close this gap are readily available -- we've got lots of tools in our toolbox -- but what we need is an all hands-on deck approach.
In lead-up to the June 2016 UN High-Level Meeting on HIV and AIDS, Canadian civil society and community groups issued a list of Canadian priorities to get us to the end of AIDS by 2030. These priorities remain unchanged today. Strengthened political commitment to the HIV response is fundamental -- but it is not stand alone, it must be met alongside:
- Increased financial commitment in our domestic and international response that is balanced between expenditures on HIV treatments, the scaling of prevention services, and efforts that get at the root social and structural drivers of HIV vulnerability.
- Barrier-free access to quality rights-based treatment, combination prevention, care and support services by addressing disparities within and across countries, including by: using fully the flexibilities regarding intellectual property that exist in current international trade agreements (including, but not limited to, compulsory licensing) to scale up access to affordable medicines.
- The recognized role of People Living with HIV in leading successful, community driven and community-led responses, including increased funding support to reach the most affected and the most marginalized.
- Meaningful investment in and engagement of key populations as leaders and game-changers to the HIV response.
- Sexual and reproductive health and rights that are firmly embedded in a comprehensive HIV response and that address gender-based inequalities and violence, poverty, harmful cultural practices, and policies and laws which unjustly criminalize same-sex practices.
- Harm reduction and drug policy redirecting 10 percent of global expenditure on enforcing drug prohibition to harm reduction interventions.
- Accelerated efforts to ensure that enabling environments flourish which enable personal and individual identities, eliminate stigma and discrimination and remove pressures in the social determinants of health (such as criminalization and punitive legal frameworks, gender and racial discrimination, affordable housing and homelessness, unemployment, barriers to education, etc.)
- Global strategies to support inclusive research for innovative health technologies including preventative HIV vaccines, new/ multi-purpose prevention technologies and microbicides, and HIV cure research as cornerstones to a sustainable HIV response.
- Robust accountability mechanisms to monitor and ensure commitments are upheld and that all stakeholders are meaningfully engaged to play an integrated role in the HIV response.
The stakes are high. Inaction is not an option. Let's do our part and not backtrack on the fast-track to ending AIDS as a public health threat by 2030. The barometer is rising.
Robin Montgomery is the Executive Director of the Interagency Coalition on AIDS and Development (ICAD), a coalition of over 100 AIDS Service organizations (ASOs), international development non-governmental organizations (INGOS), faith-based organizations, educational institutions, labour unions and individuals committed to improving the response to HIV and related co-infections in Canada and in countries globally.
This blog is part of the blog series: Barometer Rising: No time to backtrack the fast track to ending HIV as a global health threat by 2030 by the Interagency Coalition on AIDS and Development (ICAD) in recognition of World AIDS Day (1 December). The series features a selection of blogs written by our member and partner organizations. Contributors share their broad range of perspectives and insight on what they think needs to be done to strengthen our HIV prevention efforts at home and abroad in order for the world to meet the ambitious target of ending AIDS as an epidemic by 2030.
Disclaimer: The views and opinions expressed in this blog series are those of the authors and do not necessarily reflect those of ICAD.
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