Month: July 2019

The Global Network of People Living with HIV (GNP+), Frontline AIDS, UNAIDS and the World Health Organization co-hosted a webinar on Defining and Measuring Quality of Life for People Living with HIV on 2 July 2019.

For those who were not able to join the webinar, the recording  and the presentation slides are available here.

One of the most critical lessons coming out of global HIV movement is that we are “people” first, and just like any other human being, the spectrum of needs of people living with HIV is wide and complex. Focusing solely on a single dimension of our lives, such as only using biomedical approach, does not work. Addressing these needs comprehensively, both health-related and non-health related, is critical as how we live with the virus is determined by how we live our life overall.

The webinar facilitated an exchange of ideas on how to measure community-led interventions that improve the quality of life of people living with HIV and outlined the various methods for measuring the outcomes and impacts of community-led interventions that address integrated, person-centred approaches to improving quality of life.

Webinar speakers were:

• Rico Gustav, Executive Director of GNP+
• Huidrom Rosenara, Associate Director: Care & Support, Alliance India
• Maximina Jokonya, Counsellor, Africaid-Zvandiri
• Andy Seale, World Health Organization Technical Advisor
• Laurel Sprague, UNAIDS, Special Advisor, Community Mobilisation
• Kevin Moody, Consultant for GNP+

Quality of life is an essential issue for people living with HIV. It affects their ability to enter and stay within the continuum of care and, ultimately, become and remain virally suppressed. However, quality of life is person-dependent and means different things to different people. Quality of life comprises three core components: prevention, care, support and treatment for HIV; prevention, care support and treatment for non-HIV-specific physical and mental health issues; and, well-being and wider social, cultural and economic rights.[i]

Positive Health Dignity and Prevention[ii]presents a comprehensive framework for addressing the needs of people living with HIV in communities, which pre-dates the sustainable development goals, illustrates that health and wellness sit within a larger political, socio-economic and cultural context, in a similar way.[iii]

Initiatives have begun to address the issue of quality of life for people living with HIV:

• At the global level, the UNAIDS Fast-Track Cities initiative is conducting an online survey of the quality of life of people living with HIV[iv].
• At the European level, HIV Outcomes has developed recommendations to the European Parliament that include finding innovative approaches to service delivery; increased measurement of quality of life; funding for studies to generate data to support interventions; reduced stigma and discrimination and, community involvement.[v]
• At the service delivery level, healthcare providers are finding innovative ways to integrate services and move away from siloes; implement person-centred solutions; promote early detection of co-morbidities; increase linkages to prevention, etc. Examples include the user-driven HIV clinic at Sørlandet Hospital, Kristiansand, Norway[vi], Vihaan from Alliance India[vii], 56 Dean Street London[viii], Ward 86 San Francisco[ix]and Happi App and Value-based healthcare Amsterdam[x].

However, what is missing is an investment case for community-led interventions that improve the quality of life of people living with HIV. While it is important for clinical work to continue to build evidence surrounding the screening, prevention and treatment of co-morbidities, it is essential that donors, governments and communities see that community-led interventions on pre-clinical and non-clinical domains that affect health and wellbeing is essential to improve the quality of life of people living with HIV.

As the conversations about Universal Health Coverage continue, we must start from the perspective that health is not a commodity and that it is much more than just condoms and pills. As people living with HIV, we have had to fight every step of the way to access treatment and stay alive. But this is not enough – those of us lucky to be alive expect much more. We want well-being, dignity and quality of life. We demand you put into practice the tenet that “health is not merely the absence of disease, it is the state of complete physical, mental, and social well-being”. Although promotive and preventive services are included in the definition of UHC, most efforts and resources to date do not prioritise this. To ensure social and health protection for communities that have been neglected and ignored for decades, if not centuries, we know that we need to go beyond health and make progress on education, gender equality, safety and other critical priorities.

We cannot limit the UHC conversations to a conversation about the economy, about health systems, or health insurance. Health is a right. Because it is a right, we need to start talking not only about health systems, but systems for health. Systems that put the last mile first and that meet the needs of the most marginalised will be ready to meet the needs of others. We know from experience that it does not work the other way around. This is not only about mortality but also about quality of lives, as Rico Gustav, GNP+ Executive Director outlined in his keynote address for the 44th UNAIDS PCB Thematic Segment on UHC. We cannot limit the UHC conversations to a conversation about the economy, about health systems, or health insurance. Health is a right. Because it is a right, we need to start talking not only about health systems, but systems for health.

We need to build a comprehensive theory of change model that describes the relationships between and among health-related and non-health-related domains that affect quality of life. Currently, these are seen as separate areas and are being dealt with and funded as discreet entities. We need to bring it all together in order to measure the cause and effect of interventions and to validate (or not) underlying assumptions and evidence of those relationships.

The webinar included case study examples of the impact and power of community-led responses as seen in the Vihaan project led by Alliance India and the Community Adolescent Treatment Supporters (CATS), as operationalised through Africaid-Zvandiri. Huidrom Rosenara described how the Vihaan project coordinates with nearby ART Centres and provide access to person-centric care and support services through community-led and technology-based outreach approach.

The centres track and bring people back to the continuum of care with help from the tablet-based mPower tool. They provide referral to health and non-health services, including TB co-infection, peer support and community services. Maximina Jokonya spoke about how Community Adolescent Treatment Supporters (CATS) work closely with adolescents living with HIV and provide peer support for: information, counselling, monitoring, support, referral and follow up. This has resulted in improved: adherence, viral suppression, retention in care, mental health, sexual and reproductive health and rights, protection and prevention.

Andy Seale of WHO spoke about the link between quality of services and quality of life, showing that improvements in one can positively affect the other. He recognised that quality of life needs to be addressed holistically, beyond HIV and across health, including mental health, chronic diseases, etc. In fact, it needs to be seen through a lens beyond the health sector and consider the individual, community and an enabling environment. WHO is approaching Universal Health Coverage from a quality perspective, ensuring that quality if central to service provision, which need to be effective, safe and people-centred.

Laurel Sprague of UNAIDS spoke specifically on community-led responses. She indicated that it will not be possible to improve the quality of life of people living with HIV – or, indeed to achieve many of the SDG goals – without investing in and following the leadership of people living with HIV and those most affected by HIV. To track community-led responses, we need to be able to define and measure what this means. UNAIDS is working with global networks to do define and measure the community-led response. More on this will be shared in the coming months.

Moving forward, we call for the creation of a Technical Working Group to develop a systems-level theory of change model to address the health and non-health-related domains that affect the quality of life of people living with HIV. More information on the formation of the Technical Working Group will be shared in the coming weeks.

For those who were not able to join the webinar, the recording  and the presentation slides are available here.

[i]https://frontlineaids.org/wp-content/uploads/2019/02/quality_of_life_briefing_final_original.pdf

[ii]https://gnpplus.net/assets/wbb_file_updown/2090/GNP_PHDP_ENG_V4ia_2.pdf

[iii]http://www.unaids.org/en/AIDS_SDGs

[iv]http://www.fast-trackcities.org/survey/index.php/649523

[v]http://hivoutcomes.eu/recommendations/

[vi]https://www.sciencedirect.com/science/article/pii/S1055329015001466?via%3Dihub

[vii]http://www.allianceindia.org/our-work/vihaan/

[viii]56 Dean Street, London, UK, http://dean.st

[ix]Ward 86, Zuckerberg San Francisco General Hospital, USA, https://zuckerbergsanfranciscogeneral.org/find-care/hivaids/

[x]Happi App and Value-based healthcare, https://happiapp.nl/en

Why Algeria, Azerbaijan, Belarus, Brazil, Bulgaria, China, Colombia, Kazakhstan, Mexico, Romania, Russia, and Turkey must issue compulsory licences on dolutegravir now.

 At the 10^th IAS Conference on HIV Science, the World Health Organization (WHO) recommended, today (21 June 2019), that all countries immediately adopt dolutegravir-based regimens as the preferred first-line treatment for HIV.

However, unless urgent action is taken, the WHO’s recommendation is likely to be undermined by patent barriers in upper middle income countries (UMICs). Forty-nine UMICS excluded from voluntary licenses (VLs) issued by ViiV Healthcare must act now in order to access DTG: at least twelve of these countries must issue a compulsory license (CL).

The International Treatment Preparedness Coalition (ITPC) and the Global Network of People Living with HIV (GNP+) urges the 12 countries^[1] to exercise their right to use a compulsory license, which is a legal procedure authorized by international agreements and national laws. A CL will allow these countries to access more affordable generic versions of DTG existing today, and to comply with WHO recommendations.

Benefits of dolutegravir (DTG)

The WHO has confirmed that DTG results in faster viral suppression, fewer side effects and a high genetic barrier to resistance. DTG improves the quality of life among people living with HIV.

Countries benefit from DTG too: DTG can overcome the increasing prevalence of HIV drug resistance and simplify procurement processes. DTG-containing regimens have been the standard of care for HIV treatment in high income countries and utilized successfully in the US and Europe for more than 300,000 patients since 2015.

The importance of ensuring universal access to affordable DTG-based regimens has also been underscored by the recently released 2019 Global Epidemic Update by UNAIDS^[2] which highlights the increase in HIV infections in precisely the regions from which UMICs have been excluded from the VL. According to UNAIDS, “the annual number of HIV infections has increased in three regions: Eastern Europe and Central Asia (29% increase), Middle East and North Africa (10% increase) and Latin America (7% increase)”.^[3]

Exclusions for adults and children up until 2031

Access to DTG-based regimens in low and middle income countries is being dictated by patent barriers. ViiV has filed for, and been granted, multiple evergreening patentson DTG, claiming and extending their exclusive rights on DTG and DTG-based regimens in several countries until at least 2026, in some cases until 2031.

In 2014, ViiV Healthcare signed a bilateral voluntary licence (VL) with a generic company covering 92 countries.^[4] That same year ViiV also signed separate VLs with the Medicines Patent Pool (MPP) allowing generic producers to manufacture adult and pediatric generic versions of DTG: the adult ViiV-MPP VL covered all low income, all least developed and all sub-saharan African countries. Exclusions from the pediatric license were more limited but still left out key upper middle income countries. In 2016, the adult licence territory in the MPP VL was extended to 92 countries. In 2018, two more countries were added to the MPP VL territory.^[5] At present, 49 UMICs are excluded from the adult license and 9^[6] from the pediatric license.

“Hide and seek approach to licensing”

“ViiV has been playing hide and seek with dolutegravir through their piecemeal approach to licenses. With WHO’s recommendation today, countries excluded from the VLs have to end this waiting game and take action now. As civil society organizations, we have confirmed that all low and middle income countries will be able to access a USD75 price for a DTG-based regimen if they remove the patent barriers,”says Othoman Mellouk, ITPC’s Intellectual Property and Access to Medicines Lead.

Mellouk is referring to the pricing agreement^[7] brokered by the Clinton Health Access Initiative (CHAI) and others in 2017 for generic companies to offer a price of USD75 per person per year for public sector purchasers for a combination of dolutegravir, lamivudine and tenofovir (TLD). However, the offer appeared limited to only those countries included in the MPP voluntary license despite the fact that the VL includes provisions that allow supply to countries outside the territory if no patents are infringed or to countries where compulsory licenses have been issued. In January 2019, CHAI finally confirmed to ITPC that the price would be available to all low and middle income countries filling these two conditions.

140x price hike

“This confirmation is critical for upper middle income countries who have been struggling with protracted negotiations with ViiV on the pricing of DTG,” said Andrew Hill from the University of Liverpool.

In 2018, Andrew Hill and Joel Sim published results of an analysis of DTG pricing across 52 countries. They found that the median price of DTG^[8] in countries excluded from VL agreements was more than 140 times higher ($8718) compared to countries which are included ($60). They also found that DTG prices compared to efavirenz in several upper middle income countries, varied from 0% higher (in Brazil) to 6889% (in Colombia).^[9]

“ViiV has excluded several countries in Latin America from its VLs and as a result we are seeing exorbitant prices across the region. For Mexico, the host of this year’s IAS conference, dolutegravir is priced at USD2629 per person per year compared to USD143 for efavirenz; a price difference of 1738%. Already, over 80% of the Mexican government’s spending on ARVs goes to patented medicine,” said Alma de Leon, Treatment Activist and Regional Director of ITPC LATCA. “Procuring affordable generic versions will be critical to sustain Mexico’s commendable progress in achieving 90-90-90 and we call on Mexico to take the lead in our region and immediately issue compulsory licenses on DTG and DTG-based regimens.”

Routes to access

Twelve upper middle income countries^[10] have patent barriers that may block generic versions of DTG and/or tenofovir/lamivudine/dolutegravir (TLD).

For these countries, there are several options for immediate generic supply. Under the Viiv-MPP VL, generic companies who have taken the license are authorized to supply to these excluded countries if they issue a compulsory license. So far there are 17 generic companies and product developers who have taken the license^[11], 3 have WHO pre-qualification (PQ) for the DTG 50mg tablet and 2 have WHO PQ for the TLD combination.^[12]  At the same time, several of these upper middle income countries also have significant local production capacities that can be harnessed for the purposes of the CLs.

ITPC and GNP+ therefore call on the governments of: Algeria, Azerbaijan, Belarus, Brazil, Bulgaria, China, Colombia, Kazakhstan, Mexico, Romania, Russia, and Turkey; to issue compulsory licences on all patents covering DTG. ITPC and GNP+ also call on other UMICs excluded from the VL that have no patent barriers to immediately start procurement for generic DTG and DTG-based combinations.

“We are witnessing a situation similar to 20 years ago where people were either receiving treatment or not depending where they come from. This is unacceptable and countries must act now and issue compulsory licenses,” said Rico Gustav, Executive Director of GNP+. “The use of integrase inhibitors like DTG is now the standard of treatment for people living wit HIV. With the WHO recommendation; ready generic supply options; and a universally affordable generic price, the stars have been aligned for compulsory licensing by these countries.

Notes:

What did the WHO recommend?

First-line ARV drug regimens for HIV treatment:

Dolutegravir (DTG) in combination with an NRTI backbone may be recommended as the preferred first-line regimen for people living with HIV initiating ART.

• Adults and adolescents (strong recommendation, moderate-certainty evidence).
• Infants and children with approved DTG dosing (conditional recommendation, low-certainty evidence).

Second-line ARV drug regimens for HIV treatment: 

DTG in combination with an optimized nucleoside reverse-transcriptase inhibitor backbone may be recommended as a preferred second-line regimen for people living with HIV for whom non-DTG- based regimens are failing.

• Adults and adolescents (conditional recommendation, moderate certainty evidence).
• Children with approved DTG dosing (conditional recommendation, low-certainty evidence).

What is the USD 75 a year price?

A pricing agreement was announced on 21 September 2017 at UNGA by the governments of South Africa and Kenya with UNAIDS, the Clinton Health Access Initiative (CHAI), the Bill & Melinda Gates Foundation, Unitaid, DFID, PEPFAR, USAID, and the Global Fund, in collaboration with Mylan Laboratories Limited and Aurobindo Pharma. The agreement, which set ceiling prices for TLD in low- and middle-income countries (LMICs) at an annual cost per person of around US $75 and apply to public sector purchasers and will offer substantial reductions compared with the price of efavirenz-based FDCs.

What is a compulsory license (CL)?

A compulsory license (CL) is an authorization issued by governments allowing the manufacture or import of generic versions of a patented medicine.

CLs are legal provisions in international trade rules and part of most national laws. The rights of World Trade Organization (WTO) member countries to issue CLs is recognized in Article 31 of the WTO’s Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and has been reaffirmed by the Doha Declaration on TRIPS and Public Health. CLs have been issued in several countries to ensure access to affordable versions of patented medicines. In September 2017, the Malaysian government approved a compulsory license under its Patent Act 1983, on sofosbuvir to procure access to affordable generic treatment for people with hepatitis C.

What about data exclusivity?

Several of the upper middle income countries that are excluded from the Viiv-MPP VL may also have monopolies created by data exclusivity that would prevent the registration of generic DTG in those countries. Where there are no patent barriers in these countries, their governments should waive data exclusivity on DTG to enable registration and import of generic medicines. Where there are patent barriers and data exclusivity, the governments, along with compulsory licenses, should also waive data exclusivity restrictions. In several UMICs, data exclusivity laws or decrees themselves allow waiver in cases of public interest or where a compulsory license is issued.

What provision in the ViiV-MPP VL allows supply under a CL or where there are no patent barriers?

Article 2.4 of the ViiV-MPP licence agreement^[13] states: “For avoidance of doubt, it shall not be a breach of the Sublicense for Sublicenses to manufacture, use, sell or supply Products or Raw Materials outside the Territory where such activities would not infringe Non-Territory Patents, including without limitation, where a country outside the Territory has issued a compulsory licence on Non-Territory Patent(s) provided that Sublicensee is authorized to supply such country under the compulsory licence and such use is within the scope of the compulsory licence”.

^[1]Algeria, Azerbaijan, Belarus, Brazil, Bulgaria, China, Colombia, Kazakhstan, Mexico, Romania, Russia, and Turkey

^[2]https://www.unaids.org/en/resources/documents/2019/gau2019_stateepidemic

^[3]https://www.unaids.org/sites/default/files/media_asset/2019-global-AIDS-update_en.pdf

^[4]http://www.i-mak.org/wp-content/uploads/2017/06/I-MAKRoadmapSEReportDTG20170619F.pdf

^[5]https://medicinespatentpool.org/licence-post/dolutegravir-adult-dtg/

^[6]Belarus, Brazil, Bulgaria, China, Kazakhstan, Mexico, Romania, Russia and Turkey.

^[7]https://www.unaids.org/en/resources/presscentre/pressreleaseandstatementarchive/2017/september/20170921_TLD

^[8]Price for DTG alone, doesn’t include other ARVs to be used with in combination therapy.

^[9]https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6248837/

^[10]Algeria, Azerbaijan, Belarus, Brazil, Bulgaria, China, Colombia, Kazakhstan, Mexico, Romania, Russia, Turkey.

^[11]https://medicinespatentpool.org/licence-post/dolutegravir-adult-dtg/

^[12]https://extranet.who.int/prequal/content/prequalified-lists/medicines?label=dolutegravir&field_medicine_applicant=&field_medicine_fpp_site_value=&search_api_aggregation_1=&field_medicine_pq_date%5Bdate%5D=&field_medicine_pq_date_1%5Bdate%5D=&field_therapeutic_area=All&field_medicine_status=&field_basis_of_listing=All

^[13]https://medicinespatentpool.org/uploads/2018/08/Second-Amended-and-Restated-Head-Licence-for-DTG-Adults-07.2018.pdf

The Global Network of People Living with HIV (GNP+) is pleased to announce the Technical Working Group for the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination (the Global Partnership).

The Global Partnership was launched in December 2018 to catalyze and accelerate the implementation of commitments made to end HIV-related stigma and discrimination by Member States, UN agencies, bilateral and international donors, NGOs and communities as part of achieving the Sustainable Development Goals by 2030. The co-convening  group of the Global Partnership is comprised by UNDP, UN Women, GNP+ and UNAIDS.

The Technical Working Group for the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination members are:

• Eglė Janušonytė, International Federation of Medical Students Associations (IFMSA)
• Charles Siwela, Youth Engage
• Elidah Shelmith Mwangi, Positive Women Voices
• Alice Chitomfwa, Anti-AIDS Teachers Association Zambia
• Grace Kamau, Africa Sex Workers Alliance (ASWA)
• Alex Smith, International Development Law Organization (IDLO)
• Harry Prabowo, APN+
• Svitlana Moroz, Charitable Fund Club Svitanok
• Nalugo Sharifah, Uganda Network of Young People Living with HIV/AIDS (UNYPA)
• Levi Singh, SAT Regional Office
• Valeria Rachinskaya, All-Ukrainian Network of People Living with HIV
• Anthony Hron, CARE International
• Marija Pantelic, Frontline AIDS
• Matías Muñoz, Asociación Ciclo Positivo
• Elena Eva Reynaga, RedTraSex

We wish the Technical Working Group all the best as they take on  this important work.

The Executive Board of Unitaid held its semi-annual meeting in Seoul, South Korea, on 19 and 20 June 2019. The Communities Delegation (CD) to the Board, representing people living with the diseases, actively participated in the discussions and was represented by the Board Member, Liaison Officer and four delegation members. This brief report summarises the key issues discussed at the Board meeting, the Communities Delegation’s positions, and the resulting outcomes and decisions.

Midterm strategy review

Adopting the midterm review (MTR) of Unitaid’s 2017-2021 strategy, the Board acknowledged that Unitaid is on track towards its mission to maximise the effectiveness of the global health response by catalysing equitable access to better health products. The review confirmed that Unitaid’s investments support highly innovative health products such as medicines and diagnostic tools, which can save lives of millions of people and create greater impact for the global health response.

As Unitaid’s portfolio and work areas continues to expand, the Delegation emphasised the need and the opportunity to update the current Civil Society Engagement (CSE) Plan that provides the framework for involvement of Communities and NGOs within Unitaid grants and scale-up of the interventions. “We must innovate the way Unitaid works with Civil Society, specifically for demand creation and grant implementation,” said Communities Board member, Kenly Sikwese. “We also want to drastically increase the awareness among local stakeholders, from government officials, health care workers to patients, about the important interventions that Unitaid funds in their country.”

During a side meeting with the Communities Delegation, Executive Director Lelio Marmora agreed that the involvement of Communities within Unitaid grants must be significantly improved and welcomed the Delegation’s suggestion to establish a new model for Civil Society Engagement. The Delegation and the Secretariat will meet later in the year to agree on a new approach for a community-led demand generation framework within Unitaid projects. The new model will provide more opportunities for community-based organisations to work closer with grantees and to develop scalability and sustainability plans across the Unitaid portfolio.

The MTR report findings were approved by the Board and the Secretariat will present the next steps at the Policy and Strategy Committee meeting in October.

The report from the Chair of the Proposals Review Committee (PRC) highlighted some areas for improvement of the PRC, the independent expert body which provides advice to the Secretariat and the Board on the grants proposed for funding. The report suggests including Community Engagement experts in the PRC membership to provide advice in areas such as demand generation. The inclusion of community representatives in this important technical review panel has been a long-standing demand from the Communities delegation.

The Secretariat presented a portfolio performance update which included a high-level overview of Unitaid grant portfolio, the assessment of the performance of each grant, and a review against 2018 Key Performance Indicators. The Delegation congratulated the Secretariat on the cost savings generated by grants like the Seasonal Malaria Chemoprevention (SMC) grant and highlighted the good example of CSE best practices implemented in the ART Optimisation Dolutegravir project. “The investments Unitaid has made in Dolutegravir is changing the way HIV is treated globally. The data generated by the Unitaid-funded studies are today informing WHO policies and guidelines, with a direct impact of our investments. Sometimes we take this crucial work for granted,” said Sikwese.

The Board furthermore agreed that Unitaid could consider an expansion with more Board members if they commit and demonstrate sustained support for Unitaid’s mission. The Board discussed potential new members and the resource mobilisation opportunities in this context.

Chagas disease

Unitaid is constantly seeking new ways to stimulate innovation and bring new life-saving products more affordably and sustainably to communities in need. With the adoption of the Sustainable Development Goals (SDGs), the global health landscape is changing, requiring Unitaid to strategically reposition itself in a global landscape that emphasises integration and achievement of results across disease areas.

Following initial discussions during the Policy and Strategy Committee workshop last May, the Secretariat presented a formal case for consideration to the Board to expand Unitaid’s mandate and work on Chagas disease.

During the pre-meetings, the delegation also organised a webinar on Chagas disease to learn more about this potentially new disease area, the current funding gaps, and what catalytic interventions in particular could be a good fit for Unitaid’s mandate.

CD member, Ms. Violeta Ross, made a passionate intervention about the devasting effects of this disease among disadvantaged and indigenous communities in remote, rural areas in Latin-America. She made the link between Chagas and Unitaid’s current involvement in Universal Health Coverage, Primary Health Care, Anti-Microbial Resistance and SDGs, and confirmed the delegation’s support to explore opportunities in Chagas, preferably as part of a package of Neglected Tropical Diseases (NTDs). The delegation however stressed the requirement for Unitaid to find additional resources in order to fund interventions in new disease areas, whilst maintaining the primary focus on the three core diseases of its mandate: HIV, TB and malaria.

Following discussion of these and other concerns, the Board did not reach a decision and agreed to hold further consultations over the next few weeks with Board members.

New leadership

The Unitaid Executive Board elected new leadership, reflected on its midterm strategy review and discussed ways to increase impact until the end of its strategy in 2021 and beyond.

The new Chair Ms. Marisol Touraine, former French Minister of Social Affairs, Health and Women’s Rights will lead Unitaid’s Board over the coming years. The Board also welcomed Ambassador Maria Louisa Escorel De Moraes from Brazil as its new Vice-Chair.

“Marisol Touraine brings a wealth of experience in public service and governance to our Executive Board,” said Communities Board member, Kenly Sikwese. “We greatly look forward to working with her, knowing that she recognises the meaningful involvement of Communities as a crucial component for the success of Unitaid’s mission.”

The Board thanked the outgoing Board Chair Ambassador Marta Maurás Pérez and Vice-Chair Ms. Sarah Boulton for their strategic guidance over the past years and elected its new leadership.

The next Board meeting will take place in Geneva on 20-21 November 2019.

This statement is available here in French, Spanish and Russian.

—-

The Communities Delegation to the Unitaid Board represents people living with and affected by HIV, TB and Malaria and those co-infected with HIV and HCV. The Communities Delegation has the goal of representing the views, voices, needs and interests of Communities living with the Diseases at Unitaid Board and Committee level. It aims to be transparent, accountable and to prepare communities to engage in Unitaid’s work areas that directly affect those living with the diseases at grassroots and country level, especially in the global south. The Communities Delegation to the Unitaid Board is hosted by the Cape Town office of the Global Network for and by People Living with HIV (GNP+). For more information, please contact Wim Vandevelde, Liaison Officer, Communities Delegation, wvandevelde@gnpplus.net

The Global Network of People Living with HIV (GNP+) and the HIV Justice Network (HJN) condemn the dismissal of the appeal by a Singaporean man living with HIV who was convicted to two years’ imprisonment for not disclosing his status to his sexual partner and for not communicating the risk of HIV transmission to his sexual partner. We are particularly concerned that the judgement has emphasised the lack of explaining the risk of HIV transmission as the main reason for dismissing the appeal.

“HIV prevention is a shared responsibility and therefore not the sole responsibility of people living with HIV. If more people are sensitised to the rights of people living with HIV, including their sexual rights, and were aware of the mechanisms of HIV transmission there would be far less stigma and discrimination towards people living with HIV. Furthermore, HIV criminalisation creates a bad public health environment where people living with HIV have fears in disclosing their status, which lead to delay in engaging in care and treatment,” said Rico Gustav, Executive Director of GNP+.

According to the Infectious Diseases Act in 2016 of Singapore, Section 23 (1) a person who knows that he has HIV Infection shall not engage in any sexual activity with another person unless, before the sexual activity takes place —(a) he has informed that other person of the risk of contracting HIV Infection from him; and (b) that other person has voluntarily agreed to accept that risk.

“HIV is the only disease singled out as a transmittable disease in the Infectious Diseases Act,” said Edwin Bernard, Global Co-ordinator of the HIV Justice Network. “Not only does thisperpetuate stigma, it also creates a false sense of security, suggesting that only people with diagnosed HIV can transmit HIV, when many new infections come from those who are undiagnosed. Ironically, a law such as this one that places such an onerous burden on people with diagnosed HIV, is only likely to make HIV testing, and open and honest discussions around HIV, less likely.”

Furthermore, the facts of the case reported in the judgement suggest that there was no effective HIV risk during any sexual activity, regardless of whether or not disclosure – and acceptance of risk – was established beyond reasonable doubt. Condoms were used early in the relationship, and subsequently when condoms were not used, the unjustly convicted man had a very low viral load.

As expressed in the Expert Consensus Statement on the Science of HIV in the context of criminal law, HIV criminalisation laws and prosecutions have not always been guided by the best available scientific and medical evidence,have not evolved to reflect advancements in knowledge of HIV and its treatment, and can be influenced by persistent societal stigma and fear associated with HIV. HIV continues to be singled out, with prosecutions occurring in cases where no harm was intended; where HIV transmission did not occur, was not possible or was extremely unlikely; and where transmission was neither alleged nor proven.

GNP+ and HJN not only strongly condemn this legislation and the dismissal of appeal of this case, but all kinds of HIV criminalisation, which often entails legislation that is applied in a manner inconsistent with contemporary medical and scientific evidence and includes overstating both the risk of HIV transmission and also the potential for harm to a person’s health and wellbeing. Such limited understanding of current HIV science reinforces stigma and may lead to human rights violation and undermines efforts to address the HIV epidemic.

GNP+ commends the leadership shown by the United Kingdom (UK) with their pledge to the Global Fund that will save 2 million lives and an increase of 16% from the previous pledge in 2016. The increased pledge by the UK follows the example set by other early pledgers, such as the US$840 million from Japan (a 5% increase), Ireland (a 50% increase), Portugal (which more than tripled its commitment) and Luxemburg (a 11% increase).

“GNP+ applauds these early pledges and commitment to the HIV, TB and malaria response and to achieving Sustainable Development Goal 3: health and well-being for all. A fully-funded Global Fund is essential for protecting and preserving the health, well-being, stability and improving quality of life of the approximately 37 million people living with HIV around the world,” said Rico Gustav, Executive Director of the Global Network of People Living with HIV.

The Global Fund aims to raise at least US$14 billion at its 6th replenishment to be held in October in Lyon, France, which will be invested from 2020-22, but recognises that even with this amount there will still be a way to go to fully close the financing gap and meet the Global Goals. Up to $18 billion is estimated to be needed to address the health needs of people living with HIV, and to address the widening inequalities key populations still face.

The fact that 43% of new HIV infections are among gay, bisexual and other men who have sex with men, people who use drugs, sex workers and transgender people, demonstrates significant ongoing challenges in access to quality HIV prevention, treatment, care and support services for key populations that are already under constant threat. Community-led programmes also remain severely under-resourced, all three epidemics are experiencing growing drug-resistance and many low- and middle-income countries are not ready to fully scale up programs against the epidemics because of weak health systems; lack of appropriately targeted programs, including community-based programming; and domestic political and economic challenges in mobilizing resources for health.

As outlined in the Global Fund’s Sixth Replenishment Investment Case the global response is off track to meet the Sustainable Development Goal (SDG) 3: health and well-being for all. The Global Fund has been asking donors to increase their pledges by 15% in this replenishment and with the example set by the UK we will be in a better position to ensure that marginalised people that are vulnerable to the three disease are not left behind in the lead up to 2030. US$18 billion will ensure that the global response gets back on track and continues to play an essential role by building stronger health systems for HIV, TB and malaria and accelerate progress toward universal health coverage in the next three-year cycle. A fully funded Global Fund could halve the mortality rate from HIV, TB and malaria, save 16 million lives and avert 254 million new cases of HIV.

The health, lives and well-being of people living and affected by HIV, TB and Malaria depend on the outcome of this next replenishment cycle. We call on donor nations and implementing countries to boldly step up and exceed the 2019 replenishment investment and domestic resource targets to enable the Global Fund to get back on track in ending the three diseases.