Category: News

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.

As the global network of people living with a disease that still infects 1.8 million people every year and kills another 1 million annually, GNP+ can say loud and clear: Yes, we absolutely need UNAIDS as a distinct body that leads and co-ordinates the HIV response.

And not only do we still need UNAIDS, this is the time we need it to be stronger than ever to send a clear message globally that the AIDS epidemic is not over.

Yes, we have had tremendous success in scaling up treatment. However, only 21.6 million of the 36.9 million people living with HIV globally are accessing treatment. That is less than two-thirds of people who need treatment for their own health and to prevent further transmission of HIV.  Reaching the remaining 15.8 million will not be achieved by doing more of the same. The 41% of people living with HIV who do not have access to life-saving treatment now are the ones harder to reach – key populations living with HIV, the most disadvantaged rural and urban populations, the most disempowered financially and the most vulnerable because of gender inequalities. In some parts of the world and for some communities we are going backwards. We also have a crisis in HIV prevention, with 5 000 people being infected every day, especially among adolescent girls and young women as well as key populations. It is extremely dangerous to assume that a bend in the curve means mission accomplished.

More than ever we need a strong UNAIDS to transform the response to the epidemic – a transformation that is not about scaling up by doing the usual.

Responding to HIV is not about a stand-alone disease – the HIV response empowers communities, promotes gender equality and human rights, addresses social and structural barriers, and builds stronger and more accountable systems of health. This is also why UNAIDS is the first and only joint and cosponsored UN programme to combine the special expertise, resources and networks of various agencies. Our work on HIV has often catalyzed changes in the health systems and opened doors that have never been opened before. While mobilizing domestic political agendas on HIV, UNAIDS have often mobilized agendas on other areas, particularly on human rights, health systems strengthening, and most importantly on democratic rights. And it has been doing so in the most effective way: by ensuring that all these political agenda mobilizations can be measured by concrete and tangible sets of indicators – such as decrease in incidence and death related to AIDS. Ending AIDS remains a priority within the Sustainable Development Goals (SDGs) and an effective HIV response will help the world make progress not only on SDG3 on health, but beyond on gender equality, poverty, education, partnerships, strong communities and many others.

We must remember how critical UNAIDS is at national and regional levels as well. At the country level, UNAIDS has relatively successfully mobilized political support on the disease. We need UNAIDS at country level to convene and coordinate a robust HIV response, speak up for and support the meaningful engagement of communities living with and affected by HIV (including those from key populations), support the development of inclusive and integrated national health strategies, advocate for bold national AIDS plans that mobilizes all sectors and addresses structural barriers and ensure adequate investment in priority areas based on what works.

Also, as regional political structures become more important, we need UNAIDS to be influential at these levels. While guidelines and targets may be set at global level, the regional groupings (be it the African Union or BRICS) are critical to ensure greater political momentum in countries.

While it is still unclear how the global health architecture will continue to evolve and where it will end (or whether it will ever), one clear thing that we can learn from the past is that it is important to have a clear distinction between global institutions that develop science-based normative guidance, those who finance the implementation of those normative guidance, and the one that can mobilize global political commitments based on data and building a unified multi-stakeholder movement to ensure that the HIV agenda is rooted in the reality of our community. The World Health Oganization, UNAIDS and Global Fund are essential combinations that will ensure that not only the global HIV response goes well, but create necessary changes at the level where it is desperately needed: on the ground.

Perhaps one day we will not need UNAIDS. In fact, that would be the success of the AIDS response. But we are far from being at that point. HIV is still a global emergency. And we need a strong UNAIDS to lead all of us in a global, regional and national response to end AIDS.

It is with great sadness that GNP+ pays respects to Skip Rosenthal, a  former Board Member, who passed away peacefully on Friday , 7 June 2019. Skip was a valuable supporter of GNP+, having served on the board, being a representative of GNP+ North America and working as a consultant. Skip was an ardent human rights defender for people living with HIV and the LGBTI community, and was a community leader for over forty years – locally, regionally, nationally and internationally.

Skip founded, developed, sustained and expanded a fully operational peer-based AIDS Service Organisation, International AIDS Empowerment, which provides HIV care, prevention and social services on both sides of the US/Mexico border in El Paso, Texas. The organisation later added an LGBTI center with a pharmacy and doctor’s space to, a fitness room, an LGBTI library and social activities geared toward gay youth.Skip served as a consultant for the Pan American Health Organization (PAHO), the World Health Organization (WHO), UNAIDS, and others. More recently, he worked with the Texas Department of State Health Services to assist the state to adapt to the new healthcare environment. Skip has been recognized as a leader in the implementation of new HIV prevention technologies including Treatment as Prevention, Microbicides, Pre-Exposure Prophylaxis (PrEP) and Post-Exposure Prophylaxis (PEP).

GNP+ is truly grateful for Skip’s selfless and tireless work for the rights of people living with HIV and key populations over four decades. We send our condolences to his family and friends.

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