Author: Rico Gustav

On 23rd September 2019, world leaders will be gathering in New York to participate in United Nations High Level Meeting on Universal Health Coverage. This meeting will produce a Political Declaration that will reflect commitments from state leaders on their effort to achieve Universal Health Coverage. The Political Declaration are currently being prepared and negotiated between co-chairs of the High Level Meeting and member stated.

The co-chairs have released a Zero Draft document that is currently being used to negotiate with member states. The Zero Draft can be found on this link

This paper was prepared by the Free Space Process together with the PITCH Programme to inform the negotiations of the Zero Draft of the Political Declaration of the High-Level Meeting on UHC.

GNP+ also have produced a position paper on UHC “Putting The Last Mile First” that can be found here

GNP+ encourage all national PLHIV networks to start engaging with their health ministries, permanent missions to the United Nations, and any other relevant government bodies in their country, to raise the issues faced by people living with HIV and those who are coming from key population groups. Universal Health Coverage will not be achieved unless everyone, including people living with HIV and key population groups enjoy the fulfillment of their human rights in full.

Download the printable version here

Goal 3.8 of the Sustainable Development Goals mandates Universal Health Coverage. This is defined by the World Health Organisation as health coverage that ensures that (1) all people and communities have access to the promotive, preventive, curative, rehabilitative and palliative health services that they need, (2) care is of sufficient quality to be effective, and (3) the use of these services does not expose the user to financial hardship[i].

In September 2019, the United Nations General Assembly will hold a High-Level Meeting on Universal Health Coverage, resulting in a Political Declaration that sets out Member States’ commitments and accountabilities. This Position Statement[ii] outlines the priorities that we, as people living with HIV, want to see addressed within the Declaration, alongside all other processes and plans related to Universal Health Coverage at national, regional and global levels.

GNP+ demands Universal Health Coverage that:

1. Puts the last mile first – placing the needs of the poorest and most marginalised members of society at the start and centre, and transforming ‘leave no one behind’ from rhetoric to reality.

As with all of the Sustainable Development Goals, Goal 3 (‘ensure healthy lives and promote well-being for all’) should ‘leave no one behind’.  However, these words – freely employed across stakeholder groups, from donors to civil society – will remain an empty slogan if Universal Health Coverage does not place the poorest and most marginalised members of our society first. This means that, rather than serving as a final check for if the strategy has worked, such community members are the starting point and remain centre stage throughout.

The logic, and moral obligation, is clear. If Universal Health Coverage works for the poorest and most marginalised – including people living with HIV and other key and vulnerable communities (who are directly and disproportionately affected by diseases and poor health) – it will work for everyone.

‘Putting the last mile first’ must apply to the mechanisms to finance Universal Health Coverage. For example, alongside fair measures to increase tax revenues, countries should develop national health insurance schemes that start from the point of premium waivers (for the poorest and most marginalised), and then address the level of subsidy to be provided by the wider population – rather than the other way around.

Improving the health of the poorest and most marginalised brings benefits at all levels – from individuals to national economies. For households and families, it can serve as an essential stepping stone towards improved wellbeing and prosperity – enabling them to break out of the poverty trap that imprisons generations, with each unable to improve its socio-economic status[iii]. Reducing out-of-pocket health costs – and protecting against financially catastrophic health events – frees up people’s resources. In turn, this enables them to improve their quality of life and health-seeking behaviour.

Currently, over half of the world’s population lack access to essential health services[iv]. Meanwhile, 45% of global expenditure on health is out-of-pocket. Without personal, private or state insurance, this pushes almost 100 million people into extreme poverty every year.

There is concrete evidence that investment in health yields results. For example, in lower and middle income countries, funding for diseases such as HIV has increased people’s life expectancy and regenerated human capital, with reduced mortality accounting for 11% of economic growth[v].

All involved in Universal Health Coverage should match their words with actions. Yet, some of the very stakeholders purporting to ‘leave no one behind’ continue to pursue policies that contradict that promise. In particular, many donors are transitioning their support out of middle-income countries – where key and vulnerable communities are disproportionately affected by diseases such as HIV and TB[vi] and where, within punitive legal environments, targeted health programmes have depended on external funding.  In too many countries, this has already led to devastating reductions in life-saving services for people living with HIV and other affected communities. Domestic investment has failed to keep pace and/or national governments have refused to fund programmes for communities that they criminalise and that they can’t, or won’t, reach.

2. Builds comprehensive, people-centered and community-led and based systems for health – a holistic approach that maximises and resources the unique role, reach and impact of community responses.

Universal Health Coverage requires wide-ranging and well-run systems for health. These go beyond government-run and facility-based health systems to incorporate community-led and based systems for the delivery, management and monitoring of health education, prevention, support and treatment services.

Community responses complement other sectors. They bring unique added value – notably their reach to, and acceptability among, those most marginalised and vulnerable who have specific needs that are unmet by others. Community responses are dynamic – able to respond to immediate challenges and actual needs, and to make the best use of available resources.

HIV-affected communities have: mobilised millions of individuals; influenced policies and laws; improved access to services; and challenged stigma and discrimination. This has, in turn, led to better health outcomes. Community responses have also demonstrated their ability to deliver the type of wider, integrated programmes that are essential to the scale-up and cost efficiencies required by Universal Health Coverage. For example, interventions originally focused on HIV and TB have already evolved to add other critical concerns, such as gender-based violence and sexual and reproductive health and rights. Many community-run HIV testing programmes have expanded their scope to include testing for diabetes and high blood pressure.

To be effective, UHC strategies must be based on diverse and multi-sectoral systems for health – which integrate and resource  community responses as an essential component, rather than ‘optional extra’.

GNP+ wants Universal Health Coverage to build on the strengths and resources that already exist within countries’ systems for health.

These include the significant gains of over 30 years of community activism and advocacy on HIV, including by people living with HIV. This has provided a legacy of incomparable: expertise (such as on rights-based approaches for marginalised groups and gender transformative programmes for women and girls); and evidence (such as about the cost-efficiency of community-based drug procurement and the efficacy of multi-sectoral governance for health programmes). Critically, it has also provided extensive infrastructure, such as in terms of community-based networks, outreach mechanisms and referral systems.

Universal Health Coverage requires wider and integrated responses to health, such as that combine preventative and curative services, and that bring together different disease areas. However, there is no need to ‘start from scratch’, wasting both time and money. Instead, countries need to build on what’s already there – in particular, consolidating what communities already know about ‘what works’ and continuing to apply those assets to a wider and scaled-up health remit. This will provide firm and extensive foundations, to which specific, additional services and systems can be addded to fill any gaps.

3. Embodies rights and equity – with legal and policy frameworks that address the full range of, and barriers to, social determinants of health, especially for key and affected communities.

Universal Health Coverage should be founded in the understanding that health is a human right, not a ‘commodity’ or a ‘privilege’. It is the right of each and every person, regardless of their social or political status, or their ability to pay. This includes community members who, throughout the world, are systematically denied their rights, such as due to being criminalised or lacking legal recognition.

To be effective, the scope of Universal Health Coverage cannot be limited to medicines, clinics and health workers. UHC must also address social justice in order to improve health outcomes. To reach and support everyone, especially those most marginalised and vulnerable, the strategy must operate within an enabling environment that protects people’s rights and safety.

Universal Health Coverage provides an opportunity to review and, where necessary, repeal laws and policies that violate human rights and harm people’s health. Social insurance plans must include provisions against discriminatory practices and ensure equity and quality in health care delivery.

Criminalisation is an especially powerful enemy to Universal Health Coverage. If vulnerable communities – such as sex workers, men who have sex with men, trans people and people who use drugs – remain penalised, efforts to provide them with effective health services will continue to fail.  If such populations cannot live openly and safely, they will neither be able to engage in the mechanisms to fund Universal Health Coverage (such as insurance schemes), nor access the packages of support provided.

Many types of HIV interventions for key and vulnerable populations – such as harm reduction for people who use drugs or sexual health counselling for men who have sex with men – are unlikely to be included in Universal Health Care packages in contexts where such populations are criminalised. Meanwhile, the subsumption of such interventions within Universal Health Care strategies risks diluting the specific needs and expertise involved in such programmes, as well as diverting funding from proven community responses.

Universal Health Coverage policies and programmes should not be so ‘blanket’ or ‘standard’ that they neglect the specificities of individual diseases and health concerns – such as stigma and discrimination in the case of HIV.

Achieving Universal Health Coverage requires action beyond the field of health alone. It also requires attention to the wider social and structural determinants of health and the enablers of a fair and just society – such as education, employment and housing. For example, without access to clean water, a stigma-free community and adequate income to buy nutritious food, medicines are not enough to achieve good health.

UHC requires collaboration among all stakeholders. However, it is essential that the involvement of the private sector is closely regulated – to ensure ethical safeguards, prevent conflict of interest and mitigate excessive profits.

4. Puts key and affected communities in the driving seat – listening to their needs, respecting their experience, and providing concrete opportunities to shape plans, packages and fiscal mechanisms.

Universal Health Coverage requires a broader approach to health services delivery that emphasises the interconnection of health conditions.

However, it would be a backwards step – and cost lives – to discard the hard-fought gains of focused action on specific health concerns. For example, in developing effective plans for Universal Health Coverage, there is much to be learned from the three decades of the global response to HIV. An example is the area of governance and decision making – where people living with HIV and other key and vulnerable communities have worked alongside civil society, governments, the United Nations and donors in formal decision-making bodies, from National AIDS Committees to Country Coordinating Mechanisms (for the Global Fund to Fight AIDS, TB and Malaria). While some such bodies are under threat (in particular in contexts of donor transition), they provide concrete examples of mechanisms for meaningful engagement.

Finally, as Universal Health Coverage becomes a reality, communities such as people living with HIV must be allowed to continue their critical role as independent watchdogs. This involves monitoring impacts on the lives of real people, identifying gaps and barriers, and holding decision-makers to account.

GNP+ calls on United Nations Member States to adopt a Political Declaration on Universal Health Coverage that:  

* Puts the last mile first.

* Builds comprehensive, people-centered and community-led and based systems

   for health.

* Embodies rights and equity.

* Puts key and affected communities in the driving seat.

The Political Declaration should be accompanied by an accountability framework that establishes targets through which all stakeholders – including key and affected communities – can hold countries to account. These should include specific indicators to assess the extent to which Universal Health Coverage is ‘putting the last mile first’ and meeting the needs of the poorest and most marginalised.

[i] Universal Health Coverage and Health Financing, WHO; https://www.who.int/health_financing/universal_coverage_definition/en/

[ii] This Position Statement is based on the experiences and priorities of GNP+ and its constituents. It is also informed by resources produced with or by partner organisations, such as: HIV and the High-Level Meeting on Universal Health Coverage: What’s at Stake? (blog), Ruben Pages (UNAIDS), Rico Gustav (GNP+), Neil McCulloch (NSWP), George Ayala (MPact), Judy Chang (INPUD), Julian Kerboghossian (Y+), Lillian Mworeko (ICWEA), Mohammed Barry (PACT), Ruth Morgan Thomas (NSWP), Elani Nassif and Laurel Sprague (UNAIDS), 2019; Discussion Paper: Community Responses for Health: Issues and Ideas for Collaborative Action, Aidsfonds, Free Space Process, the Global Fund to Fight AIDS, Tuberculosis and Malaria, ICASO, International HIV/AIDS Alliance, UNAIDS, MPact, the Stop TB Partnership and WHO, December 2018; and The UHC That We Want: A Position Statement from the Asia-Pacific Community and Civil Society Universal Health Coverage Caucus, Global Fund Advocates Network Asia-Pacific and APCASO.

[iii] Key Facts: Poverty and Poor Health, Healthy Poverty Action, January 2018; https://www.healthpovertyaction.org/news-events/key-facts-poverty-and-poor-health/

[iv] Tracking Universal Health Care Report, WHO and World Bank, 2017.

[v] Global Health 2035: A World Converging Within A Generation, Professor Dean T Jamison, Professor Lawrence H Summers, Professor George Alleyne and Professor Kenneth J Arrove, The Lancet, 2013.

The world around us is constantly changing. Some of these changes happen so incrementally that we do not realise they are happening. I cannot remember how we spent our days before the era of the internet. It  slowly took over the world, and now we cannot imagine what we would do while we’re waiting for public transportation, or while sitting in a doctor’s waiting room. We often forget that it is not only the world that is changing, but that we are also, both as a society and as individuals. We no longer perceive the world as it used to be.

Similarly, the global development landscape is rapidly changing. Most of us remember the era of the Millenium Development Goals, and while it’s still fresh in our memory and in the way that we articulate in our proposals to donors how our work contributes to its goals, the world moves on. Now the world is obsessed with “moving beyond silos”, and the interlinkages between the economy, environment and equality as expressed in the Sustainable Development Goals.

And just as we, individually and as a society, change in the face of new developments, GNP+ as an organization must change along with the evolving global development and health landscape. In 2018, GNP+ launched a new Strategic Plan that aims to tackle three priority issues that influence the lives of people living with HIV: access to treatment and services, stigma and discrimination and the engagement of people living with HIV in efforts to increase the quality of our lives. While in some parts of the world, the daily situation for people living with HIV has improved, in most parts of the world, it has not, and in some places, the quality of life for people living with HIV has deteriorated.

Early in 2019, the GNP+ Board appointed me as the Executive Director to deliver on the new Strategic Plan and to serve our global communities. I took on the work knowing that the organization required significant transformation. GNP+ needs to change not in terms of of who we are, or what we do, because GNP+ will always be a global network of, by and for people living with HIV.  However, changes are necessary in how we deliver on our mission and serve our constituents as we grow. The organization has been evolving over the last four years to find the most effective governance, operational modalities, and strategy within the global architecture. We are deeply grateful for the time, investment and energy that so many talented people have given to GNP+ so far. We now need to make sure we have the right people in the right places doing the work on priority issues that can make an impact in communities where systematic change is most needed.

Over the next eight months, GNP+ will implement internal changes to help our organization’s ability to deliver on our strategic vision as we expand. We ask for your support during this time of transition; we are confident that with the support of GNP+’s key allies and skilled management, these changes will result in a stronger movement of people living with HIV around the world.

Rico Gustav

GNP+ Executive Director

The Global Network of People living with HIV (GNP+) and TBpeople recognises March 24th as World TB Day, the annual day to focus attention on tuberculosis (TB), by calling for a paradigm shift centering people living with HIV and people who have experienced TB, at the centre of our collective responses to fighting the two diseases.

As organizations governed explicitly by and for people who are living and affected by HIV and/or TB, GNP+ and TBpeople are now joining forces to establish a more collaborative and formalized relationship in promotion of stronger and more unified global and regional TB and HIV community-led advocacy responses.

TB and TB/HIV co-infection remain unprecedented global health crises. Every single day, nearly 4500 people lose their lives to TB and close to 30,000 people fall ill with this preventable and curable disease. Additionally, the risk of developing TB is estimated to be between 16-27 times greater in people living with HIV and TB/HIV co-infection is responsible for one in three HIV-related deaths.

In light of these realities, GNP+ and TBpeople are committed to working together to amplify action to increase resource sustainability and accountability for TB/HIV treatment and critical health services that influence the quality of lives of people living with HIV and people affected by TB.

“TBpeople has grown as an organization rapidly during the past year, and in the coming months there shall be some exciting and tangible outcomes from our efforts,” says Paul Thorn, the Head Of Secretariat for TBpeople. “We aspire to be the most influential network of TB activists in the world, and it’s only fitting that we have this deeper partnership with GNP+, who in their own right as an organization, have made such a tangible difference over the years in the fight against HIV.”

“We welcome this new collaboration with TBpeople. With global health financing reduced, the replenishment of the Global Fund to Fight AIDS, TB and Malaria still hanging in the balance, and discussions around universal health care rapidly advancing, the public health and humanitarian risks of letting the TB and TB/HIV epidemic go unchecked, must be taken into account,” says Rico Gustav, Executive Director of GNP+. “We therefore will be working hand in hand with TBpeople to strengthen community voices and responses in these arenas to ensure that the priorities and needs of the TB and TB/HIV community are met.”

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The Global Network of People Living with HIV (GNP+) is the only worldwide network representing all people living with HIV. Its mission is work for the improvement of the quality of life of all PLHIV through advocacy, knowledge management and community development.

TBpeople is the global network of people affected by TB. Started in 2016, the network is driven by its vision, World Free Of TB, and its mission, Unite People, Defeat TB.

20 March 2019, Tokyo, Japan

The AIDS epidemic came to a turning point with the innovation of HAART, which enabled people infected with HIV to recover and live a healthy and productive life. Even though that particular medical innovation was a game changer, its impact was very limited, as at that time the circumstances were not on our side in terms of affordable pricing and resources allocated to fight the epidemic. Thus, as written in history, we “HIV patients” had to fight to gain access to the treatment that could save our lives.

As our voice roared globally to draw attention and demand concrete support from the international community, the Global Fund to Fight AIDS, Tuberculosis and Malaria (the Global Fund) was created and began to transform our collective lives. HIV medicines become available and people started getting the treatment that they needed. We were able to run our own programs and serve the needs of our own communities, we gave community members clean needles, condoms and lubricants to keep them away from the virus. Our programs allowed us to talk to our friends and encourage them to get an HIV test when regular health workers couldn’t or wouldn’t reach them. In short, we developed the means to organize and strengthen ourselves and to have a seat at the table and be heard in policy making processes at the national, regional and global decision-making bodies that impact our lives.

I was diagnosed with HIV in Indonesia in 2005, when I undertook a mandatory medical check-up test for employment purposes. There was no counselling provided, they just took my blood and run some tests including HIV, and instead of receiving medical care, I instantly got fired when the results came back positive. I had nowhere to go for help or support. As I went back deep into the dark hole of helplessness, surprisingly, I found a glimpse of light at the end of the tunnel. The help came in the form of a community outreach program run by fellow drug users, like myself, with support from a university in my home town. It was a local initiative where they provided harm reduction services including clinical and psychosocial services. I was given a lot of information related to HIV infection and I was encouraged to join a people living with HIV (PLHIV) peer-support group where I got to meet others living with HIV. Fortunately, at around the same time, the Indonesian government had just started its national HIV treatment program with the Global Fund’s support, and because of that, my peers enable me to get timely access to life-saving HIV treatment.

There is a body of evidence that has demonstrated over the last two decades since the Global Fund was established about how, if the community of people living with HIV is properly embraced as partners, our unique skills and lived experiences can help navigate the direction of this movements towards the ultimate goal of ending AIDS, Tuberculosis and Malaria.

However, for us to get there, we need to do more and not less, and at the same time we have to address many challenging issues, some which most country governments prefer to close their eyes to and ignore. Our community remains highly stigmatized due to our backgrounds as ‘populations with risky behaviour’ and even worse, rather than getting the help we deserve as human beings, we are criminalized because of our sexual orientations, or our drug use, or because we chose to sell sex to earn our income. We have been systematically pushed into a corner where we are prevented from empowering ourselves or using our potency as the solution to one of the biggest threats to public health globally. Instead, we are being labelled as the roots of the problem, despite the mountain of evidence showing the other way around. These unjust attitudes towards our communities has limited the reach of our collective worldwide AIDS response, shackled our efforts to achieve maximum impact, and further jeopardized all of our investments to this cause.

The Global Fund continues to prioritize countries that are of low income but have high rates of HIV. While this is a good thing to maximize the impact of the resources that we have, we should not forget that there is an epidemic among key populations that is concentrated. Middle income countries still need the Global Fund’s support in their effort to end the epidemic, particularly in ensuring that the rights of key populations continue to be protected and respected in the response towards the epidemic. The HIV epidemic is not limited by borders, so we need to ensure that the Global Fund remains global so that it can do what needs to be done, where it needs to be done.

Now we are have arrived at another tipping point, where we can either move forward and finish the job or revert back to a different time where humanity is undermined and our voice is silenced.

We celebrate the fact that Japan is one of the primary driving forces in the Universal Health Coverage (UHC) discussions. We need to keep fighting for health for all to ensure that people have equal access to the services that they need. There is a lot of lessons to learn that the HIV community can share to contribute to the strength of the ongoing UHC discussions. UHC must build on the successes and failures that the global HIV response has gained and together, we can ensure that the right to health is fulfilled and not just a privilege for some.

We choose the right path almost two decades ago; let’s ensure that we do so again.

Across communities and borders, stigma and discrimination continues to be the number one issue identified by people living with HIV as a problem. Stigma remains a major barrier to accessing treatment, prevention, care and support, to adhering to treatment and to living a high quality life. Discrimination places people living with HIV and key populations, including women,  in danger in their day-to-day lives by destroying families and communities, causing legal and economic hardship and violating basic human rights.

That’s why GNP+ and the NGO delegation to the UNAIDS PCB have teamed up together to serve as civil society co-convenors of the Global Partnership for Action to Eliminate All Forms of HIV-related Stigma and Discrimination. The Global Partnership is a mechanism that we are using to push for accelerated implementation of commitments established in the 2016 Political Declaration to end HIV-related stigma and discrimination. “It is time for Member States, UN agencies, bilateral and international donors, NGOs and communities to work together and strengthen their efforts and investments to ending AIDS as part of achieving the Sustainable Development Goals by 2030”, said Jules Kim, NGO delegate for the UNAIDS PCB.

Last week, the GNP+, and  the NGO delegation of the UNAIDS PCB met with the other Global Partnership  co-convenors, UNAIDS, UNDP and UN Women in New York City for a two-day strategy and work planning meeting.  Just prior to the meeting, six civil society organizations were chosen, through an open call process, to co-lead, with an UN entity, the work within each of the thematic settings. To this end, the healthcare setting working group will be co-led by Asia Catalyst with the WHO; the workplace settings working group will be co-led by the Asociación de Mujeres Meretrices de Argentina (AMMAR) along with the ILO; the educational settings working group will be co- led by ATHENA Network with  UNESCO . The justice settings working group will be co-led by UNDP with ANP+ , household settings will be co-led ICW-EA in collaboration with UN women  and finally the humanitarian and emergencies working group will be co-led by  ICASO with WFP .

The Thematic Working groups will lead on and coordinate technical support and strategic stigma and discrimination related guidance for countries to facilitate innovative interventions, collaborative work, and information sharing. The working groups will also be exploring accountability and responsibility mechanisms so that countries will be able to move the needle and effectively address HIV related stigma and discrimination, even incrementally.

“1 March 2019 – Zero Discrimination day reminds us all that the fighting against HIV-related stigma and discrimination is far from over,  says Rico Gustav, GNP+ Executive Director.  “GNP+ is pleased to be a co-convenor, together with the NGO Delegation to the PCB and UN co-convenors, of the Global Partnership as it seeks to transform our communities best strategies, tactics and mechanisms for addressing and measuring HIV-related stigma and discrimination into actionable and accountable global targets and goals for Member States.”

*Update: Read this important statement from the Venezuelan Network of Positive People, RVG+ (Red Venezolana de Gente Positiva)

La Red Global de Personas que Viven con VIH (GNP +) expresa nuestra grave preocupación por la salud, la seguridad y el bienestar de al menos tres destacados activistas del VIH que están siendo atacados por el gobierno de Venezuela, en medio del devastador desarrollo político, económico y una crisis humanitaria sin precedentes.

Como se ha informado ampliamente, el pueblo de Venezuela está sufriendo debido a una crisis humanitaria extrema. Como resultado, las personas con VIH en particular, están experimentando niveles alarmantemente altos de inseguridad tanto alimentaria, de vivienda y como de salud, incluyendo desabastecimientos de medicamentos antiretrovirales (ARV).

Recientemente, activistas contra el VIH relacionados con la Fundación Mavid y el movimiento de personas que viven con el VIH en Venezuela, Jonathan Mendoza, Wilmer Alvarez y Manuel Armas Jhas, fueron detenidos en una redada. Las últimas noticias sugieren que pueden haber sido liberadas, pero sus condiciones son actualmente desconocidas. El gobierno venezolano ha estado confiscando sistemáticamente los suministros de socorro y los medicamentos que se donan para quienes más los necesitan.

GNP + hace un llamado urgente a la comunidad internacional de derechos humanos, incluidos los Estados Miembros de las Naciones Unidas (ONU), al liderazgo del Secretariado de Naciones Unidas para el sida (ONUSIDA), al Programa de las Naciones Unidas para el Desarrollo  (PNUD), al Fondo de las Naciones unidas para la Infancia UNICEF, la Agencia de las Naciones unidas para los Refugiados (ACNUR), la Organización Mundial de la Salud y la Organización Panamericana de la Salud para presionar al gobierno de Venezuela para que garantice los derechos de los activistas contra el VIH proteja la salud y los derechos de todos los defensores de derechos humanos y ciudadanos de Venezuela que están sufriendo esta crisis en curso.

Además, las personas con VIH en Venezuela están experimentando interrupciones continuas de tratamiento y falta de medicamentos esenciales y medicamentos ARV, indispensables para su salud y supervivencia. Con un número limitado de profesionales de la salud que permanecen en el país e interrupciones frecuentes del tratamiento, cada vez más personas con VIH sufren y mueren de infecciones oportunistas fácilmente prevenibles.

Las organizaciones de la sociedad civil han estado trabajando incansablemente para apoyar a la comunidad en circunstancias extraordinariamente difíciles.

GNP + hace un llamado a la comunidad mundial de personas que viven con el VIH, a las redes de población clave y las organizaciones de la sociedad civil para que nos apoyen de inmediato publicando sus propias declaraciones de condena al difundir el presente mensaje y destacando a nivel mundial lo que les sucedió a Jonathan Mendoza, Wilmer Alvarez y Manuel Armas Jhas y todas las personas que viven con VIH en Venezuela.

Para obtener más información sobre el apoyo al esfuerzo en curso para obtener medicamentos y ayuda de emergencia para las personas que viven con el VIH en Venezuela, comuníquese directamente con GNP + en infognp@gnpplus.net o ICASO en icaso@icaso.org

To read the statement in English click here

*Critical Update: Read this important statement from the Venezuelan Network of Positive People, RVG+ (Red Venezolana de Gente Positiva)

The Global Network of People Living with HIV (GNP+) expresses our grave concern over the health, safety and wellbeing of prominent HIV activists that are being targeted by the government of Venezuela in the midst of their devastating ongoing political, economic and humanitarian crisis.

As has been extensively reported, the people of Venezuela are suffering due to an extreme humanitarian crisis. As a result, people living with HIV, in particular, are experiencing distressingly high levels of food, housing and healthcare insecurity – including stockouts of ARV medications.

Most recently, GNP+ has received alarming news that the Venezuelan government has targeted and raided the Mavid Foundation, an organization that has been supporting access to medicines for HIV positive people during this crisis. The Venezuelan government has been systematically confiscating relief supplies and medicines being donated for those who need it most. Recently, HIV activists connected to the Mavid Foundation and the PLHIV movement in Venezuela, Jonathan Mendoza, Wilmer Alvarez and Manuel Armas Jhas, were detained in a raid. Late-breaking news suggests that they may have been released, but their conditions are currently unknown.

GNP+ is urging the international human rights community including UN Member States, the leadership of UNAIDS, UNDP, UNICEF, UNHCR, the WHO and the Pan American Health Organization to put pressure on the Venezuelan government to  protect the health and rights of all human rights defenders and citizens of Venezuela who are suffering through this ongoing crisis.

Further, people living with HIV in Venezuela are experiencing continual treatment interruptions and stock-outs of essential medicines and life saving antiretroviral medicines (ARVs) needed for their health and survival.  With a limited number of health professionals remaining in the country and frequent treatment interruptions, more and more people living with HIV are suffering and dying from easily preventable opportunistic infections.

GNP+ is calling on the global community of PLHIV and key population networks and civil society organizations to immediately support people living with HIV in Venezuela by getting the word out, putting a global spotlight on what is happening to people living with HIV and their networks in Venezuela.

For more information on supporting the ongoing effort to get medicines and emergency relief to people living with HIV in Venezuela, contact GNP+ directly at infognp@gnpplus.net or ICASO at icaso@icaso.org

12 February 2019, Geneva, Switzerland.

According to article 12 of the International Covenant on Economic, Social and Cultural Rights (ICESCR), States must progressively realise the right to health, including the prevention, treatment and control of diseases. ICESCR General Comment No. 14 on the Right to Health points out that because of widespread inequality, ALL states should work together, through international cooperation and assistance, to make this commitment a reality. Once a State makes this commitment, any retrogressive measure or backsliding violates the right to health.

Today, as global aid for health declines many health donors are transiting their funding towards lower-income countries, and as such, they are terminating health funding for programs in middle-income countries. This can cause harm or loss of life when programs close abruptly and it jeopardizes the tremendous progress made in the global HIV response. It particularly puts key populations: men who have sex with men, sex workers, transgender people, and people who inject drugs, at risk. Too many States still criminalise key populations and refuse to fund services that could save their lives. These risks are no longer theoretical, as we have seen with the closure of HIV and harm reduction programs in Eastern Europe and Central Asia, in Asia and the Pacific and in Latin America and the Caribbean.

We strongly recommend that the Human Rights Council, the Office of The High Commissioner, and UNAIDS, in consultation with communities, key populations and global health financing agencies, develop a set of guiding principles for health donors. These guidelines must promote good practices and planning for health financing, including setting standards for responsible exit strategies when donors transition out or terminate funding. These guidelines must build upon existing human rights mechanisms to ensure both donors and recipients are held accountable.

Many global stakeholders are expecting that the Sustainable Development Goal 3, or the worldwide campaign for Universal Health Care (UHC), or stronger investment on broader health systems, will be the magic bullet answer for donors’ transition out of middle-income countries and the expected transition from vertical disease financing.

While the idea of integrating HIV into broader health system at the national level seems quite compelling; an important question remains, how do we expect a country that criminalises certain key populations, or a country where there is widespread discrimination against key populations, to provide continuous and quality health services to those who are criminalised, without putting them at risk for prosecution? Where will the political willingness be for providing us access to services that will improve our lives, when so many governments consider our very existence as a social disease?

So how do we place the intersectionality of identities and intersectionality of needs in this uncharted era of UHC? Our network is called the Global Network of People Living with HIV. But truth be told, the virus is just a single dimension of our lives. Most of the time, we are also people who use drugs, sex workers, transgender people, gay men or men who sleep with men. We are also living in poverty, unemployed people, incarcerated people, homeless, people, or people who are politically oppressed. All of these dimensions influence the quality of our lives and how we are living with the virus. How can we make sure that the discussion on SDG 3 and UHC does not just focus on health systems but also tackles more comprehensive conversation on overall systems for health?

We encourage the Office of the High Commissioner to further engage with the World Health Organization and co-chairs of the High-Level Meeting on Universal Health Coverage to ensure that the intersectional issues of universal access to health and human rights are clearly recognised in the forthcoming UHC political resolution.

Let’s also talk about stigma towards people living with HIV and those who are members of key populations communities and identities. While in some parts of the world, our work in reducing stigma and discrimination has demonstrated results, such as with the removal of legal barriers and laws that impede the rights of people living with HIV in India and in other countries.

Far too often we are seeing countries standing still, or even regressing in their work to alleviate stigma and discrimination against people living with HIV. We see this often with restrictions on our freedom of association and freedom of expression, with key populations and people living with HIV denied the right to register independent organisations and advocate for our rights. We would like to put forward as an example of best practice, the recently announced Global Partnership for Action to Eliminate all Forms of HIV-related Stigma and Discrimination, where communities and UN agencies have agreed to co-convene a global partnership that sets ambitious goals and commitments by member States to take actionable steps to end stigma and discrimination. We recommend not only other UN agencies, but also all member States join in on this effort to concretely end stigma and discrimination towards people living with HIV and key populations.

Finally, in this era where spaces for civil society, communities and key population are shrinking, and the incredible and valuable contribution of communities is being dismissed or denied, we would like to put forward UNAIDS as an example of where civil society, key populations and community contribution is still encouraged, supported and facilitated both at the governance and operational level. This model sets the standard that other UN agencies and States must live up to, so that they too will recognise the critical role that civil society, key population and communities have in addressing human rights related barriers and issues for all.

Download a copy of this speech here

GNP+ warmly congratulates Raoul Fransen on his appointment as executive director of International Civil Society Support (ICSS). As a well-respected advocate in the global HIV community, and a person living with HIV himself, Raoul is uniquely qualified to lead ICSS’s critical work into its next phase.

Over the years, Raoul has demonstrated an unwavering commitment to advocating for inclusive, human rights-based responses coupled with ambitious target setting and resources mobilization to meet the needs of those hardest to reach. ICSS will continue to benefit greatly from the experience, passion, stability and commitment that Raoul’s leadership brings.

ICSS is a critical ally in the AIDS movement and trusted GNP+ partner, said GNP+’s Executive Director, Rico Gustav, “our staff has worked closely with Raoul for years and have always been greatly impressed with his vision and interpersonal style, as well as his practical and innovative ideas on strengthening our engagement between networks of PLHIV and key populations.”

GNP+ also wishes to recognize and celebrate ICSS’s former executive director, the incomparable, Peter van Rooijen, whose pioneering leadership and tenacious activism on behalf of people of living with HIV and key populations has paved the way for securing community spaces and equitable access to decision-making processes that will benefit millions of people for years to come.

Moving forward, the GNP+ family looks forward to continuing our ongoing collaboration with Raoul and ICSS as we work towards addressing the unmet needs and challenges facing PLHIV and key population communities worldwide.

Earlier this week GNP+ hosted an informational teleconference with civil society representatives from the UNAIDS PCB, Global Fund and UNITAID community board delegations who are on the front line of shaping global HIV policy during a time marked by diminishing financial resources and radically shifting ideological and political agendas.

The call, which was attended by community activists and advocates from around the world, featured Alexander Pastoors, HIV Vereniging (Netherlands) and alternate member of the UNPCB NGO Delegation for Europe, Maurine Murenga, Lean on Me Foundation (Kenya), Board Member, Communities Delegation of the Global Fund, Sasha Volgina, GNP+ Program manager and Unitaid NGO Delegation Member and Dr. Matthew Kavanagh, HealthGap and O’Neill Institute for National and Global Health Law, Georgetown University.

The speakers discussed key events, deliberations and decisions made during the most recent UNAIDS PCB, Global Fund and UNITAID board meetings as well as the ongoing PEPFAR COP processes. They also spoke about how their efforts will advance the critical bilateral and multilateral funding, policy and strategic direction discussions that will impact the future health, safety and well-being of all people living with HIV globally in 2019.

Click here to listen & view the recording of the webinar.

Additional Community Resources From the Speakers 

PEPFAR Watch

The NGO Delegation communique for the 43rd UNAIDS PCB Meeting 

Statement on behalf of HIV and key population-led networks on supporting an ambitious Global Fund Replenishment 

The Global Fund is an essential mechanism that helps to ensure the life-saving treatment, care and prevention response for people living with HIV and key populations in countries that need it most. Over the last couple of years, people living with HIV and key population-led networks have been actively campaigning for stronger Global Fund replenishment targets to scale up the important work with key populations. That is why, in the lead up to the Global Fund’s 6th annual replenishment pledging conference later this year, advocates are questioning the rationale for a financing goal of only $14 billion to meet the needs of the tens of millions of people who are directly affected by AIDS, tuberculosis and malaria.

Global Action for Gay Men’s Health and Rights (MPact), Global Action for Trans* Equality (GATE), Global Network of People Living with HIV (GNP+), Global Network of Sex Work Projects (NSWP), and the International Network of People Who Use Drugs (INPUD), are extremely concerned that the Global Fund’s unambitious investment case will provide for, at best, only the maintenance of existing treatment, care and prevention targets over the next three years. More worrisome, is that this recent announcement sets the stage for a rollback, or even a reversal, of political commitments made by UN member states towards achieving the 2030 Fast Track targets, the 25% target set for prevention, the Sustainable Development Goals, as well as the Global Funds own 2017-2022 strategy.

The shrinking funding pool coupled with donors’ continued insistence for reduced investments in middle-income countries makes it difficult to address the health issues of 70% of people living with HIV, all of whom reside in middle-income countries. Flatlining Global Fund investments and an over-reliance on illusory promises of in-county co-financing, paints an incomplete picture of social, economic, and political stability that obscures 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.

Further, this announcement by the Global Fund all but ensures an exclusively biomedical response to HIV, TB, and malaria at a time when more balanced approaches, including community-led, rights-based programming, are so urgently needed. Lower investment in the global health response will almost guarantee that marginalized people that are vulnerable to the three diseases will be left behind.

We must recognize that donor divestment and declining funding is primarily a matter of weakening political commitment; the mis-prioritization of resources and the failure of leaders to build and maintain global solidarities. Setting an ambitious Global Fund investment case is essential for protecting and preserving the health, well-being, stability and security of the approximately 37 million people living with HIV around the world.

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 to boldly step up and exceed the 2019 replenishment investment target to enable the Global Fund to get back on track in ending the three diseases.

Click Here to Download the Statement

Dear Partners and Allies,

The Board and Secretariat of the Global Network of People Living with HIV (GNP+) warmly welcomes Rico Gustav as our incoming Executive Director. Mr. Gustav is a well-respected human rights and health activist that has been working at the intersection of HIV, drug use and key populations since his own diagnosis at 17 years old in Indonesia. As a long term organizational ally, Mr. Gustav previously held the roles of Interim Director and Community Development Manager at GNP+. More recently, he served as the Senior Policy Adviser for Sustainability at International Civil Society Support (ICSS) and as a Board Member for the Communities Delegation to the Global Fund.

Mr. Gustav will be taking the helm of GNP+ through a turbulent yet transformational time in the global AIDS, health and development sectors with multifaceted political and financial challenges affecting the strength and sustainability of networks of people living with HIV and key populations around the world. Support for civil society, particularly for advocacy and for networks led by and for people living with HIV, is waning. Donor transition from middle-income countries, continuing human rights barriers for the most marginalised, and the lack of political willingness to scale up national responses has left far too many people living with HIV exposed to multiple risks and has jeopardized the hard fought gains made over the last decade.  

To meet the ever-growing needs and challenges of the HIV response, GNP+ is fully committed to supporting the meaningful engagement of people living with HIV in all their diversity. This includes, advocating for sensitive and inclusive models of universal health coverage, ensuring the achievement of the sustainable development goals, and effective, innovative and comprehensive approaches towards addressing the unique issues that disproportionately impact the health, safety and wellbeing of key populations and people living with HIV.

It is important to note that our collective work on addressing HIV is not done. HIV continues to influence the lives of many people globally, and it is imperative that the broader health response prioritize those who have been left behind. It is essential for the sustainability of positive movements to embrace comprehensive approaches, including by intensifying our work around human rights, stigma reduction and access to HIV services in tandem with strengthening engagement in broader movements for health, social and economic justice.

“The long term sustainability and continuity of the critical work of our movement and community members depends, now more than ever, on our ability to support empowered, resilient, and active networks of people living with HIV and other key populations on the ground, where critical change needs to happen,” says Board Chair, Javier Hourcade Bellocq. “Moving forward, GNP+ is well positioned to work hand-in-hand within the family of global, regional, and national movements led by and for the people most affected by the HIV epidemic: including people living with HIV in all their diversity (women, men, young people, gay and other men who have sex with men, transgender people, sex workers, and people who use drugs) to build the necessary bridges between civil society and key bilateral and multilateral stakeholders to ensure that the voices of people living with HIV are heard, our needs and priorities are met, and our contributions in shaping better overall health and social support systems are recognized.”

Mr. Gustav will begin his term in early February and will be based at the GNP+ Secretariat headquarters in Amsterdam. He can be reached at rgustav@gnpplus.net.  We thank you for your ongoing support and look forward to collaborating with you in the near future.

In Solidarity,

Javier Hourcade Bellocq, Board Chair, GNP+