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Putting the last mile first

The Global Network of People Living with HIV (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.
  2. Builds comprehensive, people-centred and community-led and based systems for health – moving beyond narrow ‘health systems’ to a holistic approach that maximises and resources the unique role, reach and impact of community responses.
  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.
  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.

UNITAID Communities Delegation Handbook

UNITAID is an innovative global health initiative that uses its long-term sustainable funding to support projects that positively impact the market for medicines, diagnostics and other health products for HIV/AIDS, TB and Malaria.

This handbook describes the mission and vision of the delegation and the Terms of Reference of the different delegation members.

Appeal to Global Fund on Funding in the Caribbean!

The Board of the Global Fund is considering a policy that will cause the Global Fund to transition out from some countries in the CARICOM region and other Upper Middle Income Countries. Together with the Caribbean Regional Network we appeal to the Global Fund to preserve their financing. With high HIV prevalence and significant gaps in access to prevention, treatment, care and support, especially for key population living with HIV, cutting financing risks severely undermining the gains made in the HIV response.

The letter below was today delivered to the Global Fund Board.

Summary Demands High Level Meeting 2016

The United Nations will gather for the High Level Meeting on HIV on 8-10 June 2016. Many say this may be the last High Level Meeting on HIV ever. This also depends on whether member states dare to give the HIV response teeth with greater political commitments to fight stigma and discrimination, protect human rights and fundamental freedoms and ensure universal access to treatment, care and support for all people living with HIV.

This is our chance to move members states to come to an unequivocal agreement with clear, time bound targets that ensure the rights and protection of people living with HIV and key populations.

A ‘Zero Draft’ of the political declaration, developed by co-facilitators Switzerland and Zambia was just released. This key document lays the foundation of the negotiations towards the High Level Meeting this upcoming June.

This summary contains the key messages and principles we demand from our national delegates.

Sign-on letter: Civil Society Organisations Call on the Prime Minister of Mauritius to stop the deportation of a student living with HIV from Mauritius

The AIDS and Rights Alliance for Southern Africa (ARASA), Prévention Information Lutte contre le Sida (PILS) and the undersigned civil society organisations call on the Prime Minister of Mauritius to stop the deportation of a young woman from Cameroon solely on the basis of her HIV status. We urge policy makers in Mauritius to review and amend the Immigration Act which specifies that persons afflicted with any infectious disease are prohibited from entering the country.

As part of her study permit application, the female student was tested for HIV upon arrival in Mauritius. After testing positive for HIV, she received a notification letter from the Passport and Immigration Office informing her that the application for her study visa had been denied and that she would be deported from the country.
The determination that the student be deported on the basis that her HIV status is a contagious infection, as provided for in the Immigration Act, is discriminatory. Scientific and medical developments in the last three decades have proven that effective HIV treatment has significantly reduced AIDS-related deaths and has transformed HIV infection from a condition that inevitably resulted in early death to a chronic manageable condition.

It is well accepted that states may not discriminate against people living with HIV or members of groups perceived to be at higher risk of HIV infection on the basis of their actual or presumed HIV status. International human rights law guarantees the rights to equal protection before the law and freedom from discrimination on any ground. The rights to equality and non-discrimination in the context of HIV has in addition been interpreted as imposing an obligation on states to review and repeal any laws, policies and practices to exclude treatment based on arbitrary HIV-related measures. The provisions of the Immigration Act which permit deportation on the basis of HIV status are discriminatory and there is no evidence that laws of this nature protect public health.

The deportation of this student on the basis of her HIV status only is not only contrary to fundamental international human rights, but will undoubtedly fuel the already high rates of stigma and discrimination against people living with HIV in Mauritius. All persons have the right to education and this right extends to people living with HIV. States should ensure that people living with HIV are not discriminatorily denied access to education, including access to schools, universities, scholarships and international education or subject to restrictions solely based on their HIV status.

We appeal to the Mauritian government to make progressive efforts to increase awareness and education on HIV, law and human rights for the general public, government agencies, services providers within key sectors and law enforcement officials. Comprehensive anti-discrimination law that protects people against discrimination on the basis of real or perceived HIV status should be adopted.

VCT@WORK Operational Guidelines

Respecting human rights in the implementation of the VCT@WORK initiative: Operational guidelines

Access to VCT is part of a comprehensive workplace response to HIV. The VCT@WORK initiative seeks to address the needs of large and small businesses, as well as workers in the informal economy. These operational guidelines provide guidance on respecting human rights in the implementation of the VCT@WORK initiative, with a particular focus on the following.

  • consent
  • confidentiality
  • counselling
  • connection to care
  • gender equality and women’s empowerment
  • meaningful engagement of people living with HIV
  • inclusion of key populations

In all workplace settings, staff HIV awareness is crucial to reducing HIV stigmatization and discrimination. Information should be made available to ensure that all workers know where they can go to seek voluntary and confidential HIV testing, and how to access HIV prevention, treatment, and care and support services.

A workplace policy with clearly defined principles to protect the rights of workers and to ensure non-discrimination and gender equality, as described in ILO Recommendation No. 200, is essential for the implementation and success of the VCT@WORK initiative. Of equal importance is the need for a truly representative HIV workplace committee, which should serve as a mechanism for the development and review of the workplace policy and programmes – including the VCT@WORK initiative.

The principle of Greater Involvement of People Living with HIV (GIPA) is central to the implementation of the VCT@WORK initiative. A growing body of evidence shows that programmes implementing GIPA achieve better, and more sustainable, results. Globally, organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria continue to invest in the involvement of people living with HIV at all levels. At the local level, GIPA facilitates the creation of an environment that enables people living with HIV to fulfil their potential as employees, leaders and active members of society; it reduces stigma and contributes to the elimination of judgmental attitudes and discrimination. The guidelines further reinforce the need to:

a. build strong partnerships between workplaces involved in the initiative and employers’ and workers’ organizations, PLHIV networks and national governments, and, in particular, national AIDS commissions and VCT service providers;

b. provide adequate infrastructure and facilities for VCT to be conducted with respect for confidentiality and privacy, and aligned principles; and

c. establish good referral links with other service providers, to ensure that the needs of all PLHIV (women, men and transgender people) working with an organization are met.

The operational guidelines were developed following data collection from three country-level consultations with networks of PLHIV in India, Nigeria and South Africa – the three countries in the world with the highest numbers of people living with HIV. The inclusion of policy makers and decision makers from the business community in country-level discussions allowed them to express their concerns with regard to the implementation of HIV testing in and through the workplace.

 

 

Community Guide to the WHO Guidelines

GNP+ is  proud to present Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

Community guide copy

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed this Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

The guide is designed to be updated regularly, and extra modules will be added as further guidelines are issued by WHO, such as those on key populations and adolescents.

 

You can download the modules here.

Download here:

“Whoever designed the guide deserves a round of applause because it is really great and we will be putting it to use right away. The question is how can we use this simplification as a model for getting information such as this to the commmunity.”

Dr Rose Wafula, PMTCT co-ordinator at NASCOP (National AIDS and STI Control Program) Kenya

Community Guide Module G: Policies

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Community Guide Module F: Programmes

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Community Guide Module E: ART for Children

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Community Guide Module D: ART for Pregnant Women

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Community Guide Module C: ART for adults

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Community Guide Module B: Using ARVs to prevent HIV

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Community Guide Module A: HIV diagnosis

This set of modules is designed to be used by communities to support the use of the new resource, Driving the HIV response: A community guide to the WHO 2013 Consolidated Guidelines on the Use of Antiretroviral Drugs for Treating and Preventing HIV Infection.

The downloadable modules cover different topics, and include:

The Global Network of People Living with HIV (GNP+), the International HIV/AIDS Alliance and STOP AIDS NOW! developed the Community Guide in response to the World Health Organization (WHO) 2013 Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV. It aims to assist community leaders and civil society organisations to:

  • better understand the new WHO recommendations and guide country-level discussions on priorities (within civil society and between civil society and government)
  • ensure the meaningful participation of communities most affected by HIV in national decision-making and planning
  • advocate for any changes or further research necessary to adapt recommendations to suit their country context
  • mobilise and prepare communities for the implementation of new recommendations.

Moving Beyond Lip Service: Meaningful Engagement of Women Living with HIV and Civil Society in Efforts to Prevent Vertical Transmission of HIV

The Global Plan towards the Elimination of New HIV Infections among Children by 2015 and Keeping their Mothers Alive (Global Plan) was launched in July 2011 at the United Nations General Assembly Special Session (UNGASS) High Level Meeting by a Global Task Team, led by UNAIDS and PEPFAR.

This plan covers all low- and middle-income countries, but focuses on the 22 countries with the highest estimates of pregnant women living with HIV. The Global Plan sets out how by 2015 countries can work to ensure that mothers are supported to stay healthy and that children are born without HIV.

The civil society representatives on the GSG for the Plan aim to ensure that a wide range of civil society voices are heard as governments, UN agencies, donors and others work to make the Global Plan a reality. This report brings together the voices and messages heard from an online survey and two face-to-face consulta- tions about the Global Plan. This included:

  • >  An online survey in French and English which garnered approximately 140 responses from more than 40 countries during October 2011;
  • >  A community consultation in the Global Village at the International Conference on AIDS and STIs in Africa (ICASA), held in Addis Ababa, Ethiopia in December 2011 with more than 100 ICASA attend- ees, representing more than 20 countries; and
  • >  A closed, by invitation only, consultation with people living with HIV in the Global Village during ICASA. The consultation was facilitated by two women living with HIV and was attended by approximately 40 women and men living with HIV from at least nine countries.

Positive Health, Dignity and Prevention – Operational Guidelines

Positive Health, Dignity and Prevention represents a fundamental shift in the way in which people living with HIV are involved in the HIV response:
  • It calls for leadership by people living with HIV, including those from key populations.
  • It transforms the concept of access to services, from a simple biomedical model to a holistic approach to meeting the needs of people living with HIV and their families in their communities.
  • It puts the person living with HIV in the centre, and calls for a comprehensive set of actions – at policy and service delivery levels – that take into consideration the individual’s lived environment.
  • It recognises the importance of meeting not only the person’s clinical needs but also their health needs and to protect their human rights.

Positive Health, Dignity and Prevention was developed for and by people living with HIV based on numerous consultations. at the global, regional and national levels. It articulates the next stage in the HIV response, where people living with HIV are at the centre and services offered in an environment that is supportive to meet all the needs of people living with HIV and their families. Instead of being regarded by “positive prevention” programmes as mere recipients of care and vessels of a virus that needs to be contained, people living with HIV embrace a new paradigm where they are actively involved as part of the solution to the epidemic and not seen as part of the problem.

These guidelines articulate actions that can be taken at country level to reach the 2011 United Nations Political Declaration on HIV and AIDS: 15 million people on treatment, reduce sexual and drug-use related transmission of HIV by 50%, and stop new infections among children by 2015.

 Available in English, French and Spanish

Zambia: Positive Health, Dignity and Prevention

Zambia is one of the more urbanised countries of sub-Saharan Africa with a high rate of population growth. The country has ten provinces that are subdivided into ninety-five districts. Within the districts, the administrative units are Chiefdoms and Constituencies and the latter is made up of Wards.

  • Almost 40 percent live in urban areas .
  • Average household size is 5.2 .
  • Life expectancy is 51.2 years .
  • 45.4 percent of the population below the age of 15 years .
  • 60% live below the national poverty line (2006).

The epidemic

The HIV prevalence among adults 15-49 years was 14.3% in 2007. Prevalence varies across regions, ranging from 7% in North-Western province to 22% in Lusaka province. The prevalence was about twice as high in urban (20%) than in rural areas (10%). In Zambia, HIV disproportionately affects more women than men, with women constituting 57% of the 1.2 million adults est mated to be living with HIV (UNAIDS, 2008). Women aged 20-24 are 2.3 times more likely to be HIV-positive than men of the same age group (Central Statistical Office, CSO, 2008).

Progress Since 2005, with support of development partners, the Government has provided free anti retroviral therapy (ART) in all public health insƟ tuƟ ons. The proportion of people who are both eligible for and able to access ART has increased from 38.9% in 2007 to 68% in 2009 (NAC, 2010). Over the years, the number of public and private facilitates providing ART related services such as CD4 counts has increased, resulting in improved services in both rural and urban areas. According to the 2009 Zambia Sexual Behaviour Survey,2 levels of HIV-related stigma and discrimination have in general been declining since 2005. Modest positive changes have been observed in proxy indicators to measure the level of stigma and discrimination (CSO, 2010).

The 2012 Zambia Country Report,3 listed several indications of the HIV epidemic being reversed including: a slight reduction in the percentage of the adult population living with HIV from 15.6 in 2001-2002 to 14.3 percent in 2007; a significant reduction in the percentage of young women 20-24 years living with HIV from 16.3 in 2001-2002 to 11.8 percent in 2007; in the antenatal sentinel surveillance the percentage of pregnant HIV-positive women in this age group dropped from 34.3 percent in 1994 to 28.1 percent in 2008-2009.

Among children born to mothers living with HIV, the percentage of infants contracting HIV reduced from about a peak of 7.72 per cent in 1997 to about 1.99 per cent in 2011 because of the reduction of HIV infection among pregnant women and the prophylaxes administered to women living with HIV in the prevention of vertical transmission. National coverage for this programme in 2011 at about 80 per cent was approaching near universal levels.

Challenges

The report also summarised challenges remaining: There are still sub-optimal numbers of children accessing ART, due to challenges in relation to the availability of infant diagnostic tests. Although the percentage living with HIV reduced among all the groups by sex and area of residence, it increased among men 15-49 years in rural areas from 8.9 per cent in 2001-2001 to 11.0 per cent in 2007. In fact, the gains in rural areas where the level of the epidemic can be said to be about half of that in urban areas were modest. Although the level of the epidemic in rural areas is much lower than in urban areas, the population affected is quite high since about 65 percent of the population lives there.

South Africa: Positive Health, Dignity and Prevention

South African society continues to be seriously affected by HIV, together with its related diseases, especially tuberculosis. South Africa currently ranks the third highest in the world in terms of the TB burden, and the incidence has increased at alarming rates in the past decade. There have been signs of a steady decline in the HIV infection rate but South Africa continues to have the highest number of people who are living with HIV in the world, with an estimated 5.7 million people living with HIV.

The Positive Health, Dignity and Prevention report review the results of the different GNP+ evidence gathering tools that were applied in South Africa in recent years to assess whether the HIV response works within a human rights framework respectful of people living with HIV.

Moldova: Positive Health, Dignity and Prevention

The Republic of Moldova is the poorest country in Europe (in terms of per capita income). The country is divided into 32 districts, five municipalies, the autonomous territorial region of Gagauzia and the administrative-territorial region located on the left  bank of the Dniester River known as Transnistria.

While Moldova registered a growth in GDP in recent years, unemployment remains high, wage arrears increased dramatically and external migrantion continues. There is a widening gap between rural and urban areas and also high levels of gender inequality. Moldovan women are mostly employed in low- paying jobs and occupy lower positions in the job hierarchy where they are employed.

People of Moldova:

  • The average birth rate is 1.5 children per woman
  •  Life expectancy is 69 years
  • 29 % live below the poverty line.

The epidemic
The HIV epidemic in the Republic of Moldova is a concentrated one, mainly affecting people who use drugs. The results of the last HIV sero-prevalence survey among people who use drugs carried out in 2009 showed an HIV prevalence of 16.4% in the capital of the country. However in the last three years, the number of newly registered HIV cases among the tested people who use drugs is decreasing, according to the 2012 Country Progress Report.

Ethiopia: Positive Health, Dignity and Prevention

Ethiopia is the second most populous country in Africa. The country has nine Regional States and two City Administrations. These are subdivided into over 800 administrative woredas (districts), which are further divided into kebeles, the smallest administrative unit. Ethiopia is one of the countries with the lowest per capita income, estimated at 390 USD per annum and over a third of the population live below the absolute poverty line. Nevertheless, it has one of fastest growing economies among non- oil producing countries in sub-Saharan Africa. In recent years, the country has seen rapid progress in economic growth, expansion of social infrastructure, and in improving healthcare.

People of Ethiopia:

  •  The majority (83.9%) reside in rural areas
  • The average household size is 4.7
  • The average life expectancy is 51 years for males and 53 years for females
  • Women in the reproductive age group constitute 24% of the population

The epidemic
With an estimated adult prevalence of 1.5%, Ethiopia has a large number of people living with HIV (approximately 800,000) and about 1 million children orphaned by AIDS  There is wide variation in HIV prevalence among administrative regions, and between urban and rural settings as confirmed by Demographic Health Survey (DHS) 2011: urban adult HIV prevalence was 4.2% (women 5.2%, men 2.9%) while rural adult HIV prevalence was 0.6% (women 0.8%, men 0.5%).

The 2012 Country Progress Report published by the Government of Ethiopia summarises the progress made and challenges remaining in its current response.