Category: News

The Global Criminalisation Scan website has been revamped and taken over by our expert and trusted partners at the HIV Justice Network. The new Global Criminalisation Database provides the latest data on HIV criminalisation laws globally”

Read Press Release below:

Today, we are delighted to announce a new version of the HIV Justice Network (HJN) website, www.hivjustice.net.

The centrepiece of the new website is the Global HIV Criminalisation Database, which comprises three separate but interrelated databases:

• Laws and Analyses – a new portal providing updated information and analysis of HIV criminalisation laws previously collated by GNP+ as part of the Global Criminalisation Scan;
• Cases – a regularly updated searchable global database of reported HIV criminalisation cases; and
• Organisations – a new directory of organisations around the world actively working against HIV criminalisation.

Each section of the Database also features an interactive search tool and global map providing a visual account of where different kinds of laws are used, where various types of cases have been reported, and where organisations operate.

“We hope this new, improved version of our website will continue to be an essential source of up-to-date information for individuals and organisations advocating against HIV criminalisation around the world. We would especially like to acknowledge GNP+’s tremendous work developing and promoting their Global Criminalisation Scan, and take seriously our responsibility as custodians of global HIV criminalisation data moving forward” – Edwin J Bernard, HJN’s Executive Director.

Read the full press release at: https://www.hivjustice.net/news/global-hiv-criminalisation-database-launched-today/

Commentary By Rico Gustav, Executive Director of Global Network of People Living with HIV

“I don’t mind taking the ARVs. But you know that I’ll probably die from hunger or beaten up by silop (slang word for police) anyway, right?” These words by a fellow drug user that I was trying to convince to start ARVs years ago when I was a peer educator in Indonesia echoed for years in me, because of the broken spirit that I saw that day. But these days those words are synthesized in me for a very different reason: because he was entirely right.

You can give someone ARV treatment their entire life, but what will it do if they die from being criminalized? Of domestic violence? Of starvation? Of not being able to protect themselves from those who are supposed to protect and serve our own society?

COVID-19 is just the latest reminder of the fact that health is not only about health. It is also about social justice for those who cannot even wash their hands with clean water because it is not available to them. It is about economic justice for the sex workers that cannot afford to isolate themselves as their work security is not protected, but rather persecuted. It is about political choices for the political parties that wish to privatize the health system, rather than investing in affordable health systems that are available for the public.

When the world moved from the Millennium Development Goals to the Sustainable Development Goals, one primary passion behind it was this understanding that development sectors are interconnected. You cannot address one dimension of society, without developing others.

We can be sure that over the next two to five years, pandemic preparedness and health security will be high on the global development agenda. Society cannot afford to get hit like this again, not with our current economic, social, political systems. We are ‘lucky’ that COVID-19’s highest estimated mortality rate is about 2%. With the 7.7 billion people occupying the earth and the natural progression of globalization, we can almost be 100% sure something else will be coming, something that may be far more fatal than COVID-19.

COVID-19 will not be the last one, it also was not the first one. We have had many warnings. Not only MERS, SARS or Ebola. More than 32  million people have died of AIDS-related illnesses[1], it was ignored for years and some people continue to ignore it and pretend it’s not their problem. For many years, tuberculosis has been the leading cause of death, yet the current global financing for TB response is US$15 billion[2] from being effective to combat it.

Unlike HIV and TB, COVID-19 made everyone feel vulnerable, instead of ignoring it as a disease that attacks certain groups that are marginalized. But COVID-19 should be a reminder that we may be your security guards, your office cleaners, your drivers, construction workers, sex workers, shop keepers, the gay guys you mocked on the street and the women you catcalled shamelessly – but our health is your health. The seconds we spend not being able to access services we need, are the seconds you spend putting your own well-being at risk.

People living with HIV have been advocating for strengthened and modernized health systems for many years. But more accurately, we have been advocating not only for strong and resilient health systems, we have been advocating for something far more important: systems for health. Systems for health is a system that recognizes the centrality of community-led response and person-centered care. Systems for health is an approach that recognizes that health does not exist in isolation and recognizes that the success of health goals fully rely on the success of our society to address overall inequality.  Systems for health put the last mile first, by prioritizing the most marginalised and most vulnerable.

On this World Health Day, let us remember that social and economic classes may divide us, but the absolute fact is that humans live as a vulnerable herd, and we can die as one if we do not start recognizing the interconnectedness of both dimensions of our lives, and interconnections between us as individuals.

With solidarity in this difficult time,

Rico Gustav

[1] https://www.who.int/gho/hiv/en/

[2] http://www.stoptb.org/assets/documents/about/cb/meetings/32/32-04%20Global%20TB%20Financing/32-4.4%20Global%20TB%20Financing%20-%20Bridging%20the%20financial%20gaps%20in%20the%20TB%20response_Presentation.pdf

The Global Network of People Living with HIV (GNP+), the International Community of Women Living with HIV (ICW) and the Global Network of Young People Living with HIV (Y+) congratulate Rico Gustav, GNP+ Executive Director and member of the Communities Delegation to the Global Fund Board, on his appointment as Chair of the Strategy Committee of the Board of the Global Fund for 2020 to 2022.

“This is a pivotal moment for all people living with HIV, as we will demonstrate direct leadership in the oversight and development of the Global Fund strategy,” said Olena Stryzhak, Interim Chair of ICW.

The Strategy Committee is one of the Global Fund’s three committees that has delegated authority from the Board to perform decision-making, advisory and oversight in their specific areas. The Strategy Committee provides oversight of the strategic direction of the Global Fund and to ensure the optimal impact and performance of its investments in health. This appointment as the Strategy Committee Chair is especially important at this time, given that the new Global Fund Strategy for 2023 – 2028 will be developed under the stewardship of the Strategy Committee.

“We talk about people centred responses, about community leadership, about strengthening health systems- and here is a leader who understands these issues and can help direct discussions and decisions with partners,” said Igor Kuchin, Chair of the Y+ Board.

“Representing the needs and concerns of people living with HIV, and people affected by TB and malaria, and our broader community, will be central to the work of the Strategy Committee. I am looking forward to ensure that we put the last mile first and improve the quality of life for all,” said Rico Gustav.

Gustav’s term will officially begin in May this year.

This International Women’s day, sister organisations the Global Network of People living HIV (GNP+), the International Community of Women living with HIV and the Global Network of Young People living with HIV (Y+), call for justice for women living with HIV whose lives have been devastated by this horrific violation of their human rights and an end to all violations of women’s autonomy and bodily integrity.

The forced and coerced sterilization of women living with HIV has been documented in over 31 countries around the world, including 9 countries in Eastern and Southern Africa. Women and girls who face discrimination, including on grounds of HIV status, have been disproportionally targeted by the practice. “Women of reproductive age around the world, particularly those of us living with HIV, continue to experience and targeted by outdated and harmful attitudes that manifest in violations of our rights. We look to the women who came before us as inspiration to claim our sexual and reproductive health and rights!” said Annah Sango, Y+ leader.

Forced or coerced sterilisation of women living with HIV, not only violates human rights but it also makes no sense as a public health rationale, and ignores well established elimination of vertical transmission of HIV practices that have existed for two decades. The practice violates established international human rights law, including the rights to bodily integrity, full, free and informed consent and the right of women living with HIV to marry, to have a family and to decide freely on the number and spacing of their children as enshrined in the Convention on the Elimination of all forms of Discrimination against Women (CEDAW).[1] The sterilisation of women living with HIV violates governmental obligations to respect, protect and fulfil the right to the highest attainable standard of physical and mental health and represents a form of violence against women and has been recognised as torture— violating women’s rights to be free from cruel, inhumane, or degrading treatment or punishment.Forced and coerced sterilisation is under no circumstances a legitimate method of prevention of vertical transmission and sterilisation is never an emergency procedure that justifies suspension of an individual’s rights to informed consent.

The South African Commission for Gender Equality (CGE) recently confirmed findings  that  women living with HIV in two provinces were sterilized without their informed consent in public hospitals on the basis of discrimination related to their gender and HIV status, as they have long claimed was the case. ICW, in partnership with Her Rights Initiative, lodged the complaint in 2015 on behalf of 48 women living with HIV who suffered forced or coerced sterilization in state hospitals.The CGE’s investigation focused on 15 hospitals and included meetings with the South African National Department of Health and onsite inspections.

“Women living with HIV who brought this complaint have shown tremendous bravery in standing up to the pervasive stigma and discrimination they experience in healthcare settings and claiming their rights to bodily autonomy and to choose whether and when to have a family”, said Sharon Mashamba, Regional Director, ICW Southern Africa.

ICW’s documentation detailed the harrowing experiences of women, who endured humiliating and degrading treatment from healthcare workers. Women were asked to sign consent forms while in labour and some while they were being prepared for Cesarean section surgery. In most cases signing the consent forms was a pre-condition to receiving medical treatment. The women reported that they were misled by doctors who told them they should not have children because they were HIV positive. The women described being powerless due to being in labour and the unequal power dynamics characteristic of healthcare settings.

“Women living with HIV continue to be subjected to egregious forms of reproductive oppression in healthcare settings. Until these practices are ended everywhere and until women who have experienced these violations have justice, we must keep fighting” said Sophie Brion, Human Rights Lawyer.

ICW, GNP+ and Y+ call on all governments to explicitly prohibit sterilization without free, full, and informed consent and in cases of violation to ensure justice and remedies including reparations to survivors and their families and swift action to hold accountable medical providers who forcibly sterilise women living with HIV.

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This statement is based on the Press Statement by the International Community of Women Living with HIV which can be found at:  https://tinyurl.com/qt3wgqa

[1]UN Convention on the Elimination of all forms of Discrimination against Women (CEDAW), General Recommendation 24, para.22, ; CEDAW, General Recommendation 19: Violence against Women, UN GAOR, 1992, UN Doc. A/47/38, at para. 22.

 Point-of-care diagnostic machines are a critical breakthrough in HIV early infant diagnosis. In the countries where they are being used, they are already saving the lives of infants living with HIV. The technology has been shown to work, we know it is cost-effective, now is the time to scale up – all HIV-exposed infants should have access to point-of-care diagnosis. 

The Global Fund (GF) proposal development process and the USA President’s Emergency Plan for AIDS Relief (PEPFAR) country operational plan (COP) processes are taking place right now – they are important opportunities to – all HIV-exposed infants should have access to point-of-care diagnosis (POC EID). 

 Why is early diagnosis so important? 

When infants living with HIV are untreated, the disease progresses quickly. Without treatment, up to 50% of children living with HIV die before their second birthday. 1 Untreated infants living with HIV are particularly vulnerable in the first three months of their life. 2 To have the best chance of survival they need to be tested and started on treatment. So, the World Health Organisation (WHO) recommends EID, which means testing infants born to mothers living with HIV within the first 6 weeks of life.

GNP+ and partners developed a brief on the importance of point-of-care early infant diagnosis for advocates participating in the PEPFAR COP and Global Fund country proposal processes. You can find it here.

Measuring HIV quality of life (sometimes referred to as the “4^th 90”) is becoming a critical aspect of the continuum of care. Due to the increasing importance of HIV quality of life, GNP+ proudly announces the formation of the HIV Quality of Live Partnership made up of GNP+, Frontline AIDS, the International Planned Parenthood Federation (IPPF), NCD Alliance, STOPAIDS, UNAIDS, the World Health Organization (WHO) and the Global Network of Young People Living with HIV (Y+).

This partnership aims to develop a framework for a comprehensive model of measuring quality of life of people living with HIV, including measuring the impact of community-led interventions in order to make a strong investment case for these services. We are proud to announce this on Universal Health Coverage (UHC) Day as we need to move beyond only measuring biomedical interventions and mortality indicators.

Quality of life is an essential issue for people living with HIV. It affects our ability to enter and stay within the continuum of care and, ultimately, become and remain virally suppressed. However, quality of life is person-dependent and means different things to different people. Quality of life comprises three core components: prevention, care, support and treatment for HIV; prevention, care support and treatment for non-HIV-specific physical and mental health issues that lead to people living with multiple chronic conditions including disability; and, well-being and wider social, cultural and economic rights. Not dying does not mean that people living with HIV are living  to their fullest potential. As people living with HIV, access to antiretrovirals, important as it is to our lives and well-being, is not the only thing we need in order to live better lives with the virus. We often do not have access to education, to jobs, to nutritious food, or to platforms where we can exercise our democratic rights. These, and all other dimensions of our life, influence the quality of life we live with HIV.

While happiness is a state of mind, quality of life is measurable and should be framing the way that we do our work on health. We cannot limit the UHC conversations to those about the economy, about health systems, or about health insurance. Health is a right. Because it is a right, we need to start talking not only about health systems, but systems for health. Systems that put the last mile firstand that meet the needs of the most marginalised must be ready, both technically and politically, to meet the needs of people living with HIV.

We are committed to ensuring that the ‘universal’ in UHC means every human being. We are convinced that the only way to do this is to make sure we reach those who are furthest behind, those who are most ignored and criminalized for their basic human identities by putting the last mile first.

As UHC marks the beginning of the evolution of health systems, on this UHC day, we would like to bring to the UHC deliberations the hard-learnt lessons from the global HIV movement, including the importance of community-led interventions and responses to improve quality of life. One of the most critical lessons coming out of the global HIV movement is that we are “people” first, and just like other human beings, the spectrum of needs of people living with HIV is wide and complex. Focusing solely on a single dimension of our lives, such as only using biomedical markers (or indicators), does not work. Addressing these needs – both health and non-health related – in a comprehensive, person-centred way, is critical to supporting how we live with HIV and, just as importantly, the quality  of our lives.

Visit our webinar for more information on measuring quality of life for people living with HIV.

The Communities Delegation (CD) to the Unitaid Board, representing people living with the diseases, actively participated in the Executive Board of Unitaid at its semi-annual meeting held in Geneva, on 20 and 21 November 2019.  The Communities Delegation 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.

Executive Director steps down

Mr Lelio Marmora has announced to the Unitaid Executive Board that after five years of service, he has decided to step down as Executive Director of Unitaid within the next few months. The Board has thanked Mr Marmora for his leadership and recognized his pivotal role in transforming Unitaid into a leading global health organization. Deputy Executive Director Dr. Philippe Duneton will assume the role of acting Executive Director as of March 2020 until a successor is appointed. Dr. Duneton is a seasoned member of the Unitaid executive team, and the Board has expressed complete confidence in his ability to lead the Unitaid secretariat at this time.

Agility mechanism and Chagas disease

While Unitaid has managed to support significant innovations in HIV, TB and malaria, the midterm review of the 2017-2021 strategy also showed that the operating model may not be nimble enough to catch smaller innovations with potential at an early stage in their gestation. Such investments also tend to be riskier by nature and may not have the same maturity in terms of path to scale-up. In that context, the Secretariat has developed a framework for an “Agility mechanism” that is intended to complement the operating model, and that can empower Unitaid to support innovation to the full while protecting the integrity of its mandate.

Following the September Board Seminar and the recent PSC meeting in October, the Board approved the framework to pilot an ‘agility mechanism’ which will allow Unitaid to invest in new opportunities of up to $20 million in 2020, approximately 10% of its annual funding pipeline. This agility mechanism will stay within the current mandate to support innovations in HIV/co-infections, TB, malaria, RMNCAH (reproductive, maternal, newborn, child and adolescent health) and Antimicrobial Resistance (AMR) and will be piloted during one year, with a view to informing the next strategy (2021-2016).

Scalability of Unitaid’s investments is key in areas that are especially dependent on domestic financing, such as RMNCAH. A timely example, relevant for maternal and child health, has been identified: new diagnostics and treatments for Chagas disease to contribute to the elimination of congenital disease, with technical breakthroughs to stimulate a country-led response. A call for proposals for Chagas disease was launched this week.

The agility mechanism will differ from the current operating model in two ways. First, the Executive Board delegates the administration of the agility mechanism to the Unitaid Executive Director, with the Secretariat determining which projects to source and select and taking responsibility for supporting projects and assessing progress. Second, the Executive Board does not seek to use the Board endorsements that are required in the current operating model, but instead requests that the Secretariat report annually on any projects supported by the agility mechanism. The Secretariat will, however, seek endorsement by the Board for projects over $5 million.

The Communities Delegation broadly agreed with the new mechanism and governance model in order to quickly respond to new opportunities and emphasised the need to include communities as key players in order to turn Unitaid’s investments into long-lasting in-country adoption and policy changes.

Expanded Area for Intervention (AfI): malaria chemoprevention, focus on intermittent preventive treatment in infants (ITPi)

The Board confirmed the expansion of the current AfI on malaria which already includes Seasonal Malaria Chemoprevention and chemotherapy in pregnant women to the renamed AfI “Malaria chemoprevention” by including the opportunities presented by Intermittent Preventive Treatment in infants (IPTi), for children under 12 months.

IPTi is considered a high-impact and cost-effective intervention for preventing malaria-related mortality in infants. Unitaid will look at tackling key barriers to scale up, such as determining the right dosing and formulations for infants, as well as identifying complementary opportunities for delivery by including IPTi in existing immunization programmes and weighing visits.

The Communities Delegation supported the expanded AfI and underlined the importance of community health promotion for the uptake and sustainability of these preventive interventions. “We strongly encourage that any IPTi project has a framework and clear budget for inclusive community engagement and that Ministries of Health will be involved so that the outcomes of these interventions will be integrated into the National Health Systems,” said Communities Board member, Kenly Sikwese. “Specifically, we want to ensure that communities can play a critical role in the advocacy for the long-term sustainability of the project.”

The delegation also advocated for a more comprehensive approach to reduce infant mortality from malaria. Severe anaemia continues to be a significant challenge in mortality for children under five years, hence a holistic approach of the social determinants, including nutrition, should be part of the Call for Proposals to be launched in the coming months.

Governance updates

The Executive Board appointed a new Chair and Vice-Chair for the Policy and Strategy Committee (PSC) and welcomed Sarah Boulton on behalf of the UK and Precious Matsoso on behalf of African Countries respectively. The Communities Delegation received Observer status on the PSC and became a full member of the Finance and Accountability Committee (FAC). The Board appointed Jamie Morris (Gates Foundation) on behalf of the Foundations and Leonard Abrantes on behalf of Brazil, as Chair and Vice-Chair of the FAC. Communities Board member, Kenly Sikwese, will continue serving as a member on the increasingly important Governance Working Group to overlook the development of a Code of Conduct for the organization.

The next Board meeting will take place in Geneva on 17-18 June 2020.

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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

Statement in French click here

Statement in Spanish click here

Statement in Spanish click here

Statement in Russian click here

This World AIDS Day, themed Communities make the difference, the Global Network of People Living with HIV (GNP+) highlights the central role that individuals and networks of people living with HIV play in the HIV response.

People living with HIV, as well as key population networks, have been at the center of holding decision-makers to account, providing services and making programmatic, policy and funding decisions that affect our lives. This World AIDS Day we highlight the Greater Involvement of People Living HIV (GIPA) principle in leading in the HIV response.

A key example of GIPA and people living with HIV at the center is the PLHIV Stigma Index, where people living with HIV are both the interviewers and the respondents. People living with HIV lead on all the data collection, analysis, dissemination of data and using the data for lobbying, policy reforms, health services delivery improvements, knowledge generation and creation of comprehensive knowledge about the human rights of people living with HIV.

The second Uganda PLHIV Stigma Index was launched this week by the National Forum of People living with HIV/AIDS Networks in Uganda (NAFOPHANU) with support from the Embassy of Ireland through the Prevention of HIV & AIDS in Communities of Karamoja (PACK) Project. The survey included 1398 people living with HIV in 9 regions of Uganda covering 21 districts.

The 2019 Uganda PLHIV Stigma Index highlighted issues of disclosure, experiences of external forms HIV stigma, such as exclusion from social gatherings, physical and verbal harassment or being gossiped about, and experiences of self-stigma.

The PLHIV Stigma Index tool was developed by GNP+, UNAIDS, the International Community of Women Living with HIV and  International Planned Parenthood Federation (IPPF) in 2008  and updated in 2017. In Uganda, the first national PLHIV Stigma Index survey was conducted in 2013, during the early days of the national antiretroviral treatment program. The updated PLHIV Stigma Index – the PLHIV Stigma Index 2.0 – was tested in Cameroon, Senegal and Uganda in 2017 and has been available from GNP+ since the end of 2017.

“The Stigma Index puts us in the centre and allow us to point out what has been working and what must be improve. With the fast-changing global health landscape, it is imperative to have a way to voice out our needs and priority beyond bio-medical interventions,” says Omar Syarif, the GNP+ Programmes Manager leading on this work.

“People Living with HIV are the experts in combatting stigma and discrimination, facing it every day in their lives.  The Stigma Index is a living advocacy tool that is used as a foundation for further advocacy and human rights  defense work towards an equal  and just world for all PLHIV,” says Alexandra Volgina, GNP+ Programmes Manager.

This is one of thousands of examples of people living with HIV at the center of the HIV response. GNP+ calls for investment in networks of people living with HIV and in the critical work networks do in mobilising their constituents to speak up about the issues that affect them and to develop and implement solutions together. GNP+ calls for the inclusion of people living with HIV in decision-making spaces as we work collectively to end AIDS and to ensure good quality of life for people living with HIV and the communities around us.

On 19 November 2019, Human Rights Watch released the statement ‘UAE: Groups Press to Aid Prisoners With HIV’. On November 4, Human Rights Watch released research that revealed that Emirati prison authorities are denying non-national prisoners living with HIV in some United Arab Emirates (UAE) prisons regular and uninterrupted access to lifesaving antiretroviral treatment. It was also found that prison authorities in al-Awir central prison in Dubai and al-Wathba central prison in Abu Dhabi have segregated detainees living with HIV from other prisoners and systematically discriminated against them.

The Global Network of People Living with HIV (GNP+) strongly supports the emphasis on the right of access to treatment for detainees, outlined in a letter from human rights and public health organizations and networks working on HIV and TB,  to Sheikh Mohammad bin Zayed Al Nahyan, the Abu Dhabi crown prince.

In addition, GNP+ calls for the protection of the rights of all people living with HIV in the UAE. People living with HIV (PLHIV) are not allowed to enter or stay in the UAE. Those found to be living HIV are immediately deported. The UAE does not allow the importation of antiretrovirals for personal use and do not provide HIV treatment and care.  Health exams, including HIV tests, are required in mandatory health testing when applying for visas and permits. These are clear violations of human rights, not only for those living with HIV, but also those not living HIV.

The Global Network of People Living with HIV call on the UAE authorities to work with the communities of PLHIV to review these draconian policies, to ensure that all people are able to access appropriate treatment and care for HIV.

By Nicholas Niwagaba, Uganda Network of Young People Living with HIV & AIDS (UNYPA) Executive Director

In Uganda, young people in all their diversity are actively involved and leading in policy  decision-making. The Ugandan Network of Young People Living with HIV (UNYPA), where I am Executive Director, has been journeying with GNP+ through the Bridging the Gaps (BtG) programme and invested in equipping young people with advocacy skills to effectively participate in key policy meetings and processes in Uganda, aimed at ensuring the specific needs of young people living with HIV are recognised and addressed.

Young people and adolescents (10 to 24  year olds), especially young women and young people among key populations (sex workers, people who use drugs, transgender people and men who have sex with men), continue to be disproportionately affected by HIV. Currently, over 30% of all new HIV infections globally are estimated to occur among young people aged 15 to 25 years. This is twice as  high among adolescent girls and young women (AGYW) and among young people from key populations. This points to the need to increase the meaningful engagement and involvement of young people in defining and designing programs aimed at improving their health.

This year has been an active one for UNYPA youth advocates. With the support of all our partners, including BtG, we have:

• engaged in the review of the new National Guidelines for Psychosocial Care and Support. These guidelines prioritise young people to ensure that they are supported in disclosure, adherence to treatment, proper mental health management, viral load suppression, and access to Dolutegravir (DTG) regimen for women and girls  living with HIV of reproductive age.
• pushed for the roll-out of Differentiated Service Delivery (DSD) with a new approach to improve youth friendliness of the services through the Youth & Adolescent Peer (YAPS) model, which is currently implemented under a pilot in 10 districts to be scaled up to 45 districts in Uganda by the Ministry of Health, in partnership with health facilities and our young peers.
• participated in the PEPFAR COP19 regional planning meeting to discuss the country strategy, priorities and budget for the following year as well as set targets on implementing country operation plans (COPs) to improve the response to HIV. At the meeting, the youth representatives pushed for specific interventions and budget lines for AGYW. This included an increase in allocation for national HIV prevention programming and including the Youth Advisory Panel (YAP) model that secured funding for scaling up the pilot to an additional 30 districts in Uganda to improve ART enrolment, retention and viral load suppression among young people.
• participated at the AIDS 2018 conference in Amsterdam where we shared our experience of the The Y+ Beauty Pageant for the Fast forward Award and won the Golden Egg Award with a seed grant of €  2,000  for scaling up the work. This has increased visibility of the campaign, organisation and reach of our programming.

UNYPA have mobilised support from partners domestically and internationally along with  GNP+ and other partners to strengthen our network and programming to service young people living with HIV, and in particular to push for quality services. The Bridging the Gaps support from GNP+ has contributed to equipping young people with the effective advocacy skills so we can speak up and speak out on issues that matter to us.

Young people are actively involved and leading the advocacy in Uganda and creating  impact for young people.

LYON, FRANCE  – The Global Network of People Living with HIV (GNP+) congratulates the Global Fund for raising $13.92  billion at the 6th Replenishment today, with a commitment for a further $100 million to be raised before  the end of the year. This is the largest amount of funding raised for the Global Fund in its history. 

But is it time to celebrate? We do not think so.

The 6th Replenishment target calculation of US$14 billion was based on the assumption that there will be 48% increase in domestic resources available in  Global Fund-eligible countries during the grant cycle. Beyond the seemingly hard-to-achieve amount of a $15 billion increase in domestic resource mobilisation, there are also questions on whether countries will invest their resources on the right health interventions that are supported by evidence?

The Global Fund is instrumental in funding services and programmes that are led by communities and key populations, including key populations who are living with HIV. However, many implementing country governments are still unwilling to fund programmes related to key populations. The Global Fund’s investments itself are not enough to sustain these critical life saving programmes and unfortunately, there is no silver bullet for sustainable resources available, except for both donors and implementing governments to step up and face their own political fear in investing for key population programmes and services. Stepping up the fight is not only about increasing resources available, but putting those resources into interventions that create sustainable impact: community-led interventions that promote and protect the rights to health and improve quality of life. 

We also encourage the Global Fund to be more ambitious in investing in evidence-based interventions that can accelerate its progress to achieve its mission. Political trends such as Universal Health Coverage and ambition towards health for all should be considered as opportunities to improve the quality of response to the three diseases and to further scale up existing interventions.

“The $14 billion target was the minimum needed for the Global Fund to reach its  own strategy goals, but not to reach the Global Plans for HIV, TB  and Malaria. We know that we need closer to $18 billion for the HIV, TB and Malaria responses. Although what we have may not be enough, we need to use the funds committed today to put the Last Mile First and prioritise the most marginalised groups, including people living with HIV and key populations such as sex workers, people who use drugs, transgender people and men who have sex with men,” said Rico Gustav, Executive Director of GNP+. 

This 6th Replenishment takes place during challenging times where geopolitical power struggle seems to be moving away from the spirit of multilateralism and as conservatism is dominating the political world stage, and polarising domestic politics both within donor and implementing countries. At the same time, the gap of living conditions in some parts of the world is widening due to slow progress towards achieving the Sustainable Development Goals. We believe that fully funding the Global Fund, a financing mechanism focusing on the three diseases that helps to redistribute resources among and within nations, will catalyse the progress needed to achieve health for all. By making sure that heavy disease burdens are properly addressed through adequate investment of resources, systems for health will have space and opportunities to truly improve quality of life for people living with HIV and key populations.  

We  will only  celebrate once we have gone the distance needed for all people living with HIV and key populations to have good quality of life, starting with the last mile first.

The Global Network of People Living with HIV (GNP+) congratulates member states of the United Nations for the commitment made yesterday through the adoption of the Political Declaration on Universal Health Coverage (UHC) made in New York during the High Level Meeting, but calls for an accountability mechanism to hold all actors to account in achieving UHC, to be established.

GNP+ believes that a strong accountability mechanism is the missing piece from the current Political Declaration. Without an accountability mechanism, real progress towards Health For All will remain limited and undescribable. We urge member states and United Nations agencies to expand the use of World Health Organization annual reporting system to capture progress beyond the two SDG indicators currently monitored for UHC. Commitments without clear global, regional and national targets will result in minimum progress and maximum self-congratulatory celebrations.

“Global commitments enshrined in a Political Declaration will only have meaning if translated into policies, actions, and financing at the country level. Clear, coherent, and communities-and civil society- inclusive accountability mechanisms that build upon national, regional, and global processes are needed to move the Political Declaration on UHC from mere rhetoric to reality.” said Rico Gustav, Executive Director of GNP+.  “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.”

True universal health coverage, that leaves no one behind, has to start with placing the needs of the poorest and most marginalised members of society at the start and center. While acknowledging that there will always be a debate on how to define which groups are most marginalized, we insist that this debate does not only highlight those who are challenged by geographical or economic barriers, but also the key populations that are highly stigmatized and marginalized. These key populations are often criminalized, even when doing so means member states are violating their human rights, and endangering their access to health services and programs they need to protect themselves and improve their health. Continuing to criminalize HIV transmissions, men who have sex with men, sex workers, drug users and transgender communities will mean leaving these communities behind, as past decades have proven. 

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. 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 an ‘optional extra’. 

Read more about GNP+ position on “Putting The Last Mile First” here.

The Global Network of People Living with HIV (GNP+) and the International Community of Women Living with HIV (ICW) proudly announce our joint decision to stand behind communities and join the co-organizers of HIV 2020 in Mexico City.

HIV 2020 provides a safe alternative for individuals who cannot or will not enter the United States of America (USA) or who cannot afford to attend AIDS 2020.

Legal travel restrictions act as a barrier for sex workers, people who use drugs and people who have been formerly arrested to enter the country. More than half of GNP+ staff may not be able to obtain a USA visa due to travel restrictions, including the Executive Director. ICW has been made aware of similar concerns from membership. While waivers may be issued, it is unclear what the effect is of disclosing to the USA government that we are part of key populations, as required in the USA visa application. Rejection of USA visa applications may also permanently influence an individual’s ability to apply for a visa to other countries.

Olena Stryzhak, Acting Global Chair of ICW, declares, “We stand beside GNP+ in supporting HIV 2020 as an alternative for those who cannot attend the AIDS conference. For many people living with HIV and representatives of key populations, these gatherings are either an opportunity of a lifetime or a serious impetus for changes for the benefit of ourselves and society. Only a strong community can improve the world around us.”

United, we have been engaging in discussions with a broad range of partners globally, including key population and some people living with HIV networks and groups, and have been monitoring the socio-political situation in the USA. Human rights conditions have significantly worsened in the last few years.

Current USA travel restrictions pose a significant barrier to GNP+ and ICW being able to freely consult with our constituency in all our diversity, and especially those most vulnerable and at risk of HIV.

As global advocacy organisations, we always encourage communities living with HIV and key populations to join marches, protests and demonstrations that are aligned with their issues and agendas. However, doing so with levels of police brutality in the USA, particularly towards people of colour, raises concerns for us about the safety of participants.

It is important to note that GNP+ and ICW support the individual decisions of those who wish, are able and can afford to attend the AIDS 2020 conference in San Francisco and Oakland. We also acknowledge and support communities and groups living with HIV in the USA who are working towards ensuring that AIDS 2020 pushes their domestic advocacy agenda.

Rico Gustav, Executive Director of GNP+, states: “Join us at HIV2020 where communities are reclaiming the global HIV response. We need to reclaim the response by acting in solidarity with people living with HIV, advocates, community-based organizations, healthcare and services providers, researchers, public health officials, and funders in order to ensure that the global HIV response becomes more than just numbers or simply rhetoric.”

The HIV 2020 conference is an opportunity to redefine and reinvigorate a lethargic HIV response by ensuring that there is strong political and civil society leadership and adequate resources to address the social economic and structural barriers that continue to deny key populations access to much needed prevention, treatment, care and support services. Only together, with our different expertise, guided by lived experience and committed to doing things differently can we meaningfully respond and ensure that we leave no-one behind”.

Registration for HIV2020 in Mexico City will start on 23  September 2019. Please visit www.hiv2020.org for more information.

The Global Network of People Living with HIV (GNP+) congratulates Winnie Byayima on her appointment as the new UNAIDS Executive Director. We wish her all the best in this critical role as sheleads UNAIDS in global, regional and national HIV responses. We are particularly pleased that a feminist woman has been appointed to this role for the first time.

As described in a joint letter in the The Lancet  on July 10, 2019, we call on Ms Byanyima to focus on four key areas in order to get the global AIDS response back on track:

• Closing the gap in political will and funding and ensuring that the world again steps up commitment from governments and donors.
• Partner with people living with and affected by HIV, key populations, and young people to deliver tailor-made technical, social, and political strategies for these communities.
• Lead transformations in legal and policy environments despite opposition—removing harmful laws, including those that criminalise some of the most affected populations, and accelerating uptake of evidence-based policy.
• Lead the cultural and institutional changes needed at UNAIDS to address abuse of power and establish accountable leadership.

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.

“Winnie Byanyima faces an incredibly difficult task in leading UNAIDS at a time when the HIV response is in a crisis. She must place the needs of the poorest and most marginalised members of society at the start and centre, and put the last mile first. Today’s epidemic is driven by marginalisation, stigma, and discrimination, resulting in poor health care, insufficient access to treatment, and substantial power imbalances. Full decriminalisation of key populations is non-negotiableto ensure that we have the means to protect ourselves and improve the quality of our lives as more than half of new HIV infections are among key populations. We are ready to work with her to take bold action and find solutions,” said Rico Gustav, Executive Director of the GNP+.

We urge Winnie Byantima, in her role as incoming Executive Director, to engage with global key population networks at every opportunity to further discuss full decriminalisation of all key populations, across regions and in-country. At the country level, we call on the new Executive Director 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 mobilises all sectors and addresses structural barriers and ensure adequate investment in priority areas based on what works.

We are looking forward to working with her in this role as we work collectively to ensure the rights of all people living with HIV and key populations.

The Board and Secretariat of the Global Network of People Living with HIV (GNP+) are pleased to announce that Georgina Caswell has been appointed as the new Head of Programmes.

Georgina’s work has always been grounded in a belief that people living with HIV have a relevant and important role in defining and shaping the HIV response; and she brings with her extensive programming and implementation experience which has seen her manage diverse community-led HIV programmes, providing oversight and technical leadership to large-scale multi-country programmes focused on HIV prevention, treatment, sexual and reproductive health and rights, and stigma and discrimination.

Georgina was the programme manager at GNP+ from 2008 – 2013, where she supported networks of people living with HIV to build their research and advocacy skills to access prevention and treatment information and services. Returning to GNP+ is like coming home for Georgina.

“I am excited about the opportunity to work with GNP+ again to support work on treatment access, to address stigma and promote quality of life. I would like to help build and strengthen strong partnerships and solidarity with national networks of people living with HIV. I am particularly excited to work with young leaders living with HIV as we generate and push forward new ideas,” says Georgina.

Georgina was most recently a Programme Manager at Frontline AIDS where she was leading a range of programmes aimed at building resilient and empowered adolescents and young people. Georgina is a proud supporter of Y+ and the READY movement and has mentored several young people living with HIV in the movement.

Georgina also serves in a number of HIV leadership roles, including as Chair of the Access Advisory Committee for the International Partnership for Microbicides, Chair of the Biomedical HIV Prevention Forum for ICASA and Chair of the ViiV Positive Action for Women and Girls Fund.

“Georgina joins GNP+ at a transformational time in the global HIV, health and development sectors, with political and financial challenges affecting the strength and sustainability of networks of people living with HIV and key populations around the world,” says Rico Gustav, Executive Director of GNP+.

“We are committed as GNP+ to ensuring that people living with HIV are meaningful engaged in relevant national, regional and global policy discussions. We need to be innovative and strategic in how and where we engage, and having Georgina join the global team will help us achieve that more effectively.”

Georgina will take up her position in October 2019, and will be based at the GNP+ offices in Cape Town, South Africa.

The Global Network of People Living with HIV (GNP+) is pleased to announce the outcome of the selection of three new members of the GNP+ Board: Friedel Dausab, Valeriia Rachynska and Jeffry Acaba. We welcome them to the Board and thank them for their willingness to serve on this important body. The Board’s role is to ensure that GNP+ establishes and holds the trust of the community by being clear in its mission, prudent and ethical in its activities, and accountable for its actions. GNP+ welcomes the new board members in performing their governance duties including in continue evolving GNP+ governance and operations to ensure that it continue raising the voice of people living with HIV globally.

Valeriia Rachynska, from Ukraine, is head of the regional policy team of the All-Ukrainian Network of People Living with HIV/AIDS and also a member of the coordination council.  Valeriia’s is highly skilled in advocacy, representation, human rights, governance, management, and fundraising. She also has specific expertise in negotiations, at both high level, government and international forums, as well as at the ground level, and also in conflict areas.

Friedel Dausab from Namibia is the Director of Out-Right Namibia, an LGBTI advocacy organisation. Friedel is highly experienced in the spheres of governance, management and operationalizing ground level programmes. He has also had prior experience with fundraising, and fund management, having managed large Global Fund Grants. He also has experience at high level negotiations, grant writing, and formulation of strategies and policies.

Jeffry Acaba, from Philippines, has 13 years of experience in health policy advocacy, community mobilization and organizing, mixed-method research, programme design and management, and training design and facilitation. His areas of expertise is in HIV, TB, SRHE and LGBT issues. He is currently a member of the World Health Organisation Civil Society Task Force on TB as well as working as a Programme Officer at APCASO. He has previously been on the Panel for Communities and CS advisory to the 2018 HLM on TB, he has been part of the NGO Delegation to the UNAIDS Programme Coordinating Board.

We wish Valeriia, Friedel and Jeffry all the best for their two-year term and look forward to working with them.

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

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

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

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

Webinar speakers were:

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Benefits of dolutegravir (DTG)

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

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

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

Exclusions for adults and children up until 2031

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

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

“Hide and seek approach to licensing”

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

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

140x price hike

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

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

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

Routes to access

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

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

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

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

Notes:

What did the WHO recommend?

First-line ARV drug regimens for HIV treatment:

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

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

Second-line ARV drug regimens for HIV treatment: 

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

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

What is the USD 75 a year price?

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

What is a compulsory license (CL)?

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

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

What about data exclusivity?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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