GLOBAL HEALTH: ‘On World AIDS Day we remind people that the HIV pandemic is not over’
CIVICUS speaks with Gastón Devisich, Head of Community Engagement of Fundación Huésped’s Research Department, about the role of civil society in the fight against HIV/AIDS, both at the community level and in global governance bodies.
Fundación Huésped is an Argentinian civil society organisation (CSO) that has been working since 1989 on public health, including on the right to health and disease control. It is a member of the regional platform Coalición Plus and, represented by Gastón, one of the two Latin American and Caribbean organisations that are part of the NGO Delegation to the UNAIDS Programme Coordinating Board.
What have been the results of the latest round of pledges to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and what will be their implications?
The primary goal of the Global Fund to Fight AIDS, Tuberculosis and Malaria is to make catalytic investments and leverage innovations to drive faster progress in reducing new infections, address structural barriers to improving outcomes for these pandemics and build equity, sustainability and lasting impact. Its new strategy places people and communities front and centre in all its work, challenging power dynamics to ensure that affected communities have a voice in the fight and opportunities for a healthy future.
The Global Fund’s Seventh Replenishment has brought in a total of US$15.7 billion. It was the culmination of a successful campaign that began more than a year ago. It is a remarkable achievement, not only because several public and private donors increased their pledges, in many cases by more than 30 per cent, but also because a record number of implementing governments – at least 20 – have stepped up to become donors as well.
This support will be dedicated to saving 20 million lives, averting 450 million new infections and generating new hope for ending AIDS, TB and malaria. This investment will also strengthen health and community systems to increase resilience to future crises.
Given its central role in the fight against pandemics, the Global Fund also plans to continue contributing to the global pandemic preparedness agenda in coordination with the World Health Organization, the World Bank and other partners.
What role does civil society have in the governance of UNAIDS?
The Joint United Nations (UN) Programme on HIV/AIDS, known as UNAIDS, was the first UN programme to have formal civil society representation on its governing body. The participation of CSOs on the UNAIDS Programme Coordinating Board is critical to the effective inclusion of community voices in this key global policy forum in the area of HIV/AIDS.
The NGO Delegation is composed of five CSOs, three from developing countries and two from developed countries or countries with economies in transition, plus five more acting as alternate members. Our purpose is to bring the perspectives and experience of people living with HIV/AIDS and those populations particularly affected by the pandemic, as well as civil society, to ensure that UNAIDS is guided by an equitable, rights-based, gender-sensitive approach to ensuring access to comprehensive HIV prevention, diagnosis, treatment, care and support for all people.
The existence of a community delegation within the highest governance body of a programme such as UNAIDS is critical to ensure the meaningful involvement of populations most affected by HIV at all levels of policy and programme development, implementation, monitoring and evaluation. Strengthening meaningful community engagement fosters a relationship of greater trust and respect with those of us who are the direct beneficiaries of any programme or policy.
The involvement of all stakeholders, provided it is transparent and based on mutual understanding, can minimise misunderstandings and reduce the likelihood of unnecessary conflict or controversy. This helps improve our access to rights and the provision of quality services necessary to ensure it, as well as addressing power inequalities between decision-makers and the community to establish more equitable and horizontal relationships.
Why is it important to incorporate the voices of communities in decision-making spaces?
There is an urgent need to develop additional strategies to address the HIV epidemic. A wide range of factors create, intensify and perpetuate the impact of the virus and its underlying determinants may be rooted in the cultural, legal, institutional and economic fabric of society.
To achieve a comprehensive response to HIV, it is essential to recognise power imbalances and address them by developing practices that prevent their inadvertent replication or reinforcement throughout the implementation of programmes and policies.
Local organisations have unique expertise to contribute to the HIV response. We have critical knowledge and understanding of local cultures, perspectives and language, the local dynamics of the HIV epidemic, the concerns of the most vulnerable or marginalised populations and local priorities that other stakeholders may not necessarily have. The community can help ensure that the goals and procedures of HIV response are appropriate and acceptable for them, in order to avoid reinforcing existing inequalities.
What does Fundación Huésped’s work consist of, both at the national level and within this global space?
Our comprehensive approach includes the development of research, practical solutions and communication related to public health policies in Argentina and Latin America. We seek to develop scientific studies and preventive actions and advocate for rights to guarantee access to health and reduce the impact of diseases, with a focus on HIV/AIDS, viral hepatitis, vaccine-preventable diseases and other communicable diseases, as well as sexual and reproductive health.
As representatives of civil society in UNAIDS, we actively seek the views of our communities on key issues related to UNAIDS policies and programmes, and advocate with governments and cosponsoring organisations – 10 UN organisations that make up the UNAIDS Joint Programme – for significant improvements in the implementation and evaluation of HIV/AIDS policies and programmes.
What challenges do organisations working on HIV/AIDS face and what support do they need to continue doing their work?
The HIV agenda is still current, with new challenges and the persistence of stigma, discrimination and rights violations. Forty years after the first cases of HIV were reported in the world, and thanks to scientific advances, the implementation of policies, plans and programmes, civil society activism and human rights achievements, there are more and better strategies available to control the virus, which could end AIDS today. Yet this year there were 1.5 million new HIV cases and 680,000 new AIDS-related deaths worldwide – including 110,000 cases and 52,000 deaths in Latin America and the Caribbean.
World AIDS Day, 1 December, is our annual opportunity to remind people that the HIV pandemic is not over. Over the past 40 years science has generated much innovation, but these benefits do not reach all people equally. The best science in the world cannot compete with the debilitating effects of poor health systems. To end AIDS we need to correct the course of the HIV response, starting with ending inequities. A better response is needed today. We cannot afford to waste any more time.