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.

UNAIDS Executive Director Michel Sidibé and the President of the Russian Olympic Committee and First Deputy Chairman of the Russian State Duma, Alexander Zhukov, signed an agreement on 23 March to join forces to accelerate the global goal of ending the AIDS epidemic. The memorandum of understanding was signed on the sidelines of the fifth Eastern Europe and Central Asia AIDS Conference, being held in Moscow, Russian Federation.

The memorandum of understanding commits UNAIDS and the Russian Olympic Committee to work together to raise HIV awareness among athletes and sports fans, promote access to HIV treatment and reduce the health, social and economic impact of the AIDS epidemic. The programme will also involve addressing stigma and discrimination affecting people living with HIV, including athletes.

UNAIDS and the Russian Olympic Committee will exchange and share know-how and will involve athletes, sports associations and nongovernmental organizations in HIV prevention and awareness efforts at the national and community levels. They will also cooperate in running media campaigns and other HIV-related programmes with athletes, coaches and other opinion leaders from the sports community in the Russian Federation and internationally, particularly in eastern Europe and central Asia.

UNAIDS has been working in partnership with the International Olympic Committee on AIDS awareness and HIV prevention since 2004.

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Governments, health experts and civil society activists have renewed their commitment to accelerate HIV testing and treatment programmes across the Middle East and North Africa as part of efforts to achieve the UNAIDS Fast-Track targets by 2020.

At a meeting hosted by the Government of Algeria and co-organized by UNAIDS and the World Health Organization (WHO), people living with HIV, national AIDS programme managers, representatives of civil society networks and the United Nations, technical partners and the media came together to assemble and reinforce the political leadership, technical capacities and resources to enable the rapid scale-up of HIV testing and treatment services.

The participants expressed their concern at the current low testing and treatment coverage in the Middle East and North Africa region. They stressed the need to mobilize additional resources and underlined that spending on the epidemic should be regarded as investment rather than expenditure. Discussions also highlighted the need to optimize rapid diagnostic technologies and to transition towards a test and treat model in line with the WHO’s new guidelines.  

The meeting in Algiers ended with a regional declaration led by Algeria’s Minister of Health to guarantee a sustained commitment to the Fast-Track strategy ahead of the United Nations High Level Meeting on AIDS taking place in June 2016.

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Israel is an indigenous community leader living in Veracruz, Panama City. He was diagnosed with HIV 7 years ago, when he was 24. At that time, Israel had no knowledge of HIV. “I thought I would die soon after and I wouldn't see my children grow up,” he said.

Israel looked for support and started to get involved with local civil society organizations advocating for improved sexual and reproductive health for young people and promoting the human rights of key populations. He became an active member of Genesis+ Panama, bringing to the organization the voice of indigenous people.

“Indigenous youth continue to encounter significant barriers in accessing comprehensive sexuality education and services in our language and according to our own practices and model of well-being,” Israel said. “This is a missed opportunity, since our communities can contribute to the HIV response and the development of our society.”

HIV among indigenous populations is an emerging public health concern, as data show that indigenous people are particularly vulnerable to HIV. The government reports that indigenous people have little knowledge of how HIV is transmitted, negative attitudes towards people living with HIV and low HIV testing rates. Reporting on indigenous people’s rights, the Economic Commission for Latin America and the Caribbean found that more indigenous girls initiate sexual activity before the age of 15 than their non-indigenous peers. The rate of teenage pregnancies is more than twice as high for indigenous girls. Another matter of concern is that violence against women, which has links to HIV infection, is prevalent among indigenous populations in Panama. 

Israel works hard to change the situation in his community. He organizes meetings with indigenous young people and teenagers, either at a home or the beach, to discuss health and other important topics. “I want to give my children and other young people access to information and tools to prevent HIV,” he said.

Israel also coordinates a football team of young indigenous women. Each weekend the team participates in local leagues. Before the games start, Israel and the other coaches provide the players with training related to HIV prevention. He said, “There are many young people at risk in my community and I feel that by leveraging the power of football we are creating opportunities to improve their well-being and strengthen social capital.”

Israel also dedicates his time to raising awareness about respect and solidarity towards key populations and people living with HIV. “In indigenous communities, myths still persist around HIV,” he said. “The fear of being excluded or rejected prevents people from taking an HIV test or going to health facilities.”

Reflecting on what he has learned since his diagnosis, Israel said, “HIV has not limited me. It opened my eyes to social justice and motivated me to become the person I am today.”

If the Fast-Track approach to end the AIDS epidemic is to be successful, the rights, roles and responsibilities of men in the AIDS response need to be placed firmly on the global agenda.

It has long been noted that the Fast-Track Strategy cannot be achieved without action on gender equality and human rights. The vulnerability of young women and girls has been an important focus of many programmes and has been debated many times, but more recognition is needed that harmful norms also drive the epidemic among men. Health systems are falling short of addressing the needs of men, which is having a negative impact on the health of both men and women.

“Men play a critical role. When we engage men for their own health and to change harmful gender norms, we improve both men’s and women’s health. This is an essential element of the UNAIDS Fast-Track approach to ending the AIDS epidemic,” said Michel Sidibé, UNAIDS Executive Director.

Reaching men with HIV-related prevention, treatment, care and support services is vital. Men and adolescent boys make up nearly 49% of the global population of 34.3 million adults living with HIV and account for 52% of all new adult HIV infections. Around 60% of the 1.2 million people who died of AIDS-related illness in 2014 were male.

According to UNAIDS, there is a lack of services for men who are at higher risk of HIV infection. Diversity among men, including age, risk behaviour and sexual orientation, needs to be taken into account when planning programmes.

Women under the age of 25 are often vulnerable to HIV, and gender inequality and the structures of society often prevent them from accessing the HIV information and services that can protect them. Men, on the other hand, are affected later in life and are more empowered to access services, but, for many reasons, they don’t.

Men’s access to HIV services is important for their own health but it is also an important way to reduce vulnerability among women. Engaging men in health services for their own health can also provide an entry point for programmes that can also transform harmful gender norms.

UNAIDS calls for more work to be done to explore exactly how harmful gender norms and notions of masculinity may increase men’s vulnerability. For example, stereotypes of male “strength” and invincibility can lead to men not using condoms and avoiding health services, such as HIV testing. It has been shown by research in 12 low- and middle-income countries that men with less equitable attitudes to women are less likely to be tested for HIV.

In addition, studies have reported that men are more likely not to seek out—and stick to—antiretroviral therapy.

UNAIDS contends that health professionals themselves often assume that men do not need, or are not willing to use, HIV-related services. There is a need for such preconceptions to change, with the development of comprehensive policies and programmes that promote men’s access to programmes and address their specific needs. This means changing the perceptions of men in the response to HIV, as they are often referred to as “transmitters” or “vectors”, stereotypes that blame them for infection, stigmatize them and isolate them further from accessing services.

There is a call for a global shift in the discussion on HIV and gender—that it should become more inclusive of men and encourage their greater positive engagement in all aspects of the AIDS response and in advancing gender equality. Sexual and reproductive health is not the responsibility of women alone. Focused, integrated sexual and reproductive health services must be made available to men and adolescent boys. Although much more research needs to be done, there is already a body of data that lays the groundwork for developing and implementing more comprehensive policies and programmes.

To reflect the seriousness of this issue and the need to chart the way forward, a global high-level meeting on men, adolescent boys and AIDS is being held in Geneva on 10 and 11 December. It is co-convened by UNAIDS, Sonke Gender Justice and the International Planned Parenthood Federation. The main objectives are, broadly, to build consensus on what the evidence is saying about men and adolescent boys in the HIV response and what role they have to play in ending the AIDS epidemic.