AIDS 2006 International Conference, Toronto

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AIDS accountability initiative

AIDS Accountability International, a foundation based in Sweden, has been trying to gain political support at the conference for a new AIDS accountability index - along the lines of the human development index - that would promote transparency,  best practice and greater accountability in HIV responses through a national rating system. It is hoped the index would capture the attention of policy makers, multilateral bodies, governments, NGOs, business and the media.

Reactions to the index among governments at the conference have been mostly positive, although those outside government have questioned whether it is actually necessary to get political consensus on the initiative (given the extra time this will take), and whether it wouldn't be better to just develop the index as fast as possible and use the results to then gain the attention of national governments.

Another issue that has been raised is the degree to which the index will link in with the current work to set national targets for achieving universal access. Work on the index seems to pre-date the universal access targets, but it will be important to try and bring these two iniatives together.

Researchers in South Africa are currently working on developing the index, and at present expect to complete the project in 2008. Care Canada have been representing civil society.

Spreading the word

The Alliance has been distributing tools and resources to delegates at the conference throughout the week, from its exhibition stand in the main hall. Resources from organisations across the Alliance have been available from the stand.

Delegates have had the chance to meet and talk to staff from a variety of Alliance programmes, while Alliance staff have been able to get first hand feedback from people using Alliance tools and resources in their work every day.

Scaling up comprehensive approaches

Vyacheslav Kushakov from Alliance Ukraine examines civil society and national government collaboration on multidisciplinary approaches to treatment, care and support - the second of two poster presentations on scaling up comprehensive responses to the HIV/AIDS epidemic in Ukraine. 

Supporting civil society engagement in Global Fund implementation

Over 100 people attended a joint Alliance and Global Fund satellite on Sunday to share their experiences and perspectives on Global Fund implementation. Speakers from Ukraine, Senegal, Thailand, and Ecuador, among others, talked about civil society's role, and the lessons learned so far.

At the start of the session Alliance executive director Alvaro Bermejo summed up the reasons why the Global Fund is important for civil society - because it has redefined governance and national ownership. This has been through civil society participation, through greater transparency, by being country led and demand driven, and through large scale funding of civil society activity including that of marginalised groups.

Duncal Earle, Team Leader of Operational Partnerships and Country Support at the Global Fund also outlined ways in which civil society is involved in the Global Fund and raised the question of when is the right time to transfer the role of Principal Recipient to civil society and others, so that programmes and renewal are not jepordised.

Asia Russell from Health Gap told delegates that many Global Fund partners see the role of civil society as bringing up the difficult and political issues – such as funding the fund.  But while they look to civil society organisations to take an advocacy role for the Global Fund, there also needs to be a role for civil society as providers and implementers in the response, and the buisness model of the Global Fund needs to support the role of civil society as implementers.

Asia added that in order to use all the capacity available in country to scale up responses to HIV, the Global Fund needs to give national civil society organisations more power and influence.

The session concluded with recommendations for civil society leaders to engage more and for civil society networks to become the conduit for information and communication. We also need to be aware that it is currently the exception rather than the rule that there are national civil society consortia that can watchdog Global FUnd performance, and work to change this. There also needs to be more thought about who takes on the role of leading civil society innovation within the Global Fund - currently the only place for this to happen is at the Country Co-ordinated Mechanism (CCM) level. However, because the Global Fund is county driven and demand driven - and because it does not have a national presence and is not built into national structures - there is a gap for the role of civil society.

The session ended with an open discussion, and a call for governments to act upon the need for greater investment in capacity strengthening.

First national targets presented for universal access

On Tuesday, countries including Pakistan, Cameroon, Ghana, Swaziland, Brazil, Mexico and Moxambique presented their national targets to achieve universal access to prevention, care and treatment by 2010. Susie Mclean, senior policy adviser at the Alliance, was at the small meeting where national AIDS committees and ministers for health presented their targets. All spoke of the involvement of civil society in developing the targets but, cautioned Susie,  it remains to be seen the true extent of this involvement.

However, resources continue to be an issue in achieving targets. "Representatives from Ghana made an interesting point," said Susie. "Because they had involved civil society, and because they had made the targets aspirational rather than 'business as usual', there are now much higher expectations and not enough resources to deliver." 

"This is a reminder that there are still big resource gaps. The UK Department for International Development has said that no national AIDS plan will go unfunded. This is an opportunity to prove that. Donors must now provide the resources needed to implement the targets." It is still unclear how or when the national targets that have now been developed are to be published.

Representatives from Alliance organisations around the world also met on Tuesday morning with a high level UNAIDS representative to discuss Alliance input into development of targets in a further 20 countries over the next three months. A key issue raised was how to ensure meaningful involvement of civil society. There was also a recommendation that once targets have been set there needs to be a review mechanism to ensure their quality.

Pre-conference symposium builds skills on stigma and discrimination

A pre-conference symposium on reducing the stigma of AIDS took place on Saturday 12 August, looking at lessons from countries including Mexico, Tanzania and Vietnam. As part of the symposium, Alliance regional co-ordinator for stigma and discrimination Sue Clay and Alliance regional trainer Chipo Chiiya, took a skills building session on understanding and challenging HIV stigma in high prevalence countries, using a toolkit developed with the involvement of over 50 NGOs.

"We had a great mix of people," said Sue. "And we got everyone singing and dancing together before we started to break the ice. The session took the group of around 25 people through three activities from the stigma toolkit, including an exercise looking at and discussing pictures of stigma in action. We had new pictures of stigma in Senegal to use as well, and this was a great opportunity to test them out."

The group also spent some time discussing how HIV had affected their own lives. "We had quite a mix of people," said Sue. "While some had been very directly affected, and others less so, everyone agreed that even though we are all working on HIV, we don't take the chance often enough to talk about how we ourselves have been affected."

"Everyone acknowledged that stigma was still a problem where they lived and worked, and the symposium really brought out the personal experiences of the group. During the question and answer session at the end, people didn't want to stop! It is just sad that this couldn't have been part of the main conference programme so we could have reached more people."

Accountability: promises, performance and possibilities

Shaun Mellors (Alliance senior technical adviser for civil society development) and Anandi Yuvaraj (senior programme officer at Alliance India, pictured right) spoke alongside Philippa Lawson (Constella Futures), Bernard Gardiner (International Red Cross), and Jacqueline Rocha Cortes (advisor for International Cooperation at the Ministry of Health Brazil) at a symposium examining accountability in the HIV/AIDS response.

Shaun Mellors gave an insightful summary of developments in the global HIV movement starting from the years before treatment, which were characterised by fear but spawned the activism and networks that took the movement forward. Looking at the state of the movement today, he acknowledged the challenges facing it in developing  better leadership and making the voices of the movement more representative of those affected and less dominated by men and developed nations. Philippa Lawson looked at 'past memories' of the epidemic, while Anandi Yuvaraj examined the civil society response in India.

Bernard Gardiner warned of the dangers of NGOs being reduced to silent contractors, but pointed out that in reality NGOs are already able to influence donors and policies even without a seat at the table. He also pointed out that NGOs and civil society have now gained representation at the Global Fund board level. Introducing the Code of Good Practice for NGOS responding to HIV/AIDS, signed by over 160 NGOs before its launch last year, he said it was a way to address both what should be done by NGOs in the AIDS response and also how it should be done. The code is now being taken to a new phase, with donors being invited to support its implementation.

Finally, Jacqueline Rocha Cortes looked at the Brazilian example where the federal constitution of 1988 guarantees that "health is a citizen's right and a state's duty", a stipulation that she said had made a big difference to the success of the Brazilian response, and which had been followed up in 1996 by Sarney's law which provided universal access to treatment.

UK government announces new funding for positive networks

In a move warmly welcomed by all at the conference, the UK Department for International Development announced on Monday that it will fund three global networks run by, and providing support for, people living with HIV. The Global Networks of People living with HIV and AIDS (GNP+) and International Community of Women Living with HIV/AIDS (ICW) are both recieving £375,000, while the International Treatment Preparedness Coalition (ITCP) receives £1 million.

The groups are actively engaged in influencing, developing and creating policies that affect the lives of vulnerable groups such as women and children, sex workers, and injecting drug users.

Announcing the money, UK International Development Minister Gareth Thomas said the networks "have encouraged work on improving access to treatment, led the way on innovations such as home based care, and have played a vital role in holding governments to account on effective implementation of their policies".

The money is particularly welcome as it can be used to fund the core infrastructure of the organisations, providing greater stability and possibilities for future development.

Scaling up lessons learned from the field

Fareed Abdullah (pictured left), Director of Technical Support at the International HIV/AIDS Alliance Secretariat, chairs a poster discussion on scaling up lessons learned from the field.

The Ukrainian approach

Ludmyla Shulga from Alliance Ukraine gives a poster presentation on the 'Complex approach to tackling the HIV/AIDS epidemic among IDUs', focusing of the experience of the Alliance Ukraine's work with injecting drug users. 

Pre conference satellite agrees new Global Forum on MSM & HIV

Joseph O'Reilly, Senior Policy Adviser

The International AIDS Conference has seen an unprecedented focus on the HIV related needs of gay and other men who have sex with men and the creation of a new Global Forum to address the ongoing vulnerability of and effect of HIV on same sex attracted men throughout the world.

Globally, the fact that fewer than one in 10 men who have sex with men (MSM)  have access to basic HIV/AIDS prevention services and even fewer have access to HIV/AIDS care and support is a scandal.

Silence and invisibility combine to form a fatal cocktail for the world’s gay and other men who have sex with men who, who are disproportionately at risk of and affected by HIV/AIDS.

While a lack of funding and political will has limited the number of studies on MSM and HIV/AIDS in many regions of the world, a report launched at the International AIDS Conference in Toronto today by TREAT Asia indicates that HIV prevalence rates among MSM exceed 25% in some parts of Asia. Studies from Latin America and the Caribbean, meanwhile, suggest that prevalence rates in that region vary from approximately 10 – 20% .

In fact, seroprevalence estimates among MSM around the world remain among the highest of any group.

Combined with the fact that only one in ten homosexually active men have access to even the most basic HIV information the situation for gay and other MSM is itself a missaporpiation of resources and a human rights violation of the right to health.

The international community's commitment to universal access provides a real opportunity to reverse this situation and to close the funding and services gap for men who have sex with men in developing countries.

However, closing the funding and services gap will only solve part of the problem. Human rights violations against gay and other MSM  — including arbitrary arrests, serious physical violence and even murder — increase their vulnerability to HIV and fuel new infections among them. Human rights abuses also follow infection, exacerbating the impact of HIV/AIDS.

At “MSM & HIV: Advancing a Global Agenda for Gay Men and Other Men who have Sex with Men” a pre-conference satellite event attended by over 300 AIDS activists, researchers and community representatives, which I chaired, participants agreed to work to address these issues through a new Global Forum on MSM & HIV.

The Forum, the first ever attempt to bring together gay and other men who have sex with men from both the North and South to fight AIDS together, will coordinate a global response to the enormous gaps in funding and services that currently exist for MSM living with and at risk for HIV/AIDS.

Addressing the closing session of the event Dr Peter Piot, executive director of UNAIDS, pledge his personal and UNAIDS’ organisational support for the Forum and its work.

The Global Forum will marshal the efforts of individuals and organizations from all regions of the world to mobilize existing resources and to pressure governments and international bodies to scale up HIV/AIDS funding and human rights protections for MSM.

The Forum will work to bring activists and service providers working with MSM in the North and the South together.

Collaboration within and between developing and developed countries is a matter of both solidarity and need — MSM in Canada, the U.S., Australia, and Europe also continue to be disproportionately affected by HIV/AIDS and the Forum poses a real opportunity to take a unified, holistic approach to this global challenge of AIDS in gay communities and among homosexually active men in all its dimensions.

As its first advocacy initiative, the Forum is calling on candidates for the executive directorship of the Global Fund to Fight AIDS, TB and Malaria  publicly commit themselves to closing the HIV prevention and treatment services gap for MSM.

The development of programs for MSM, who exist in every country, should be a condition of all future Global Fund agreements. The Global Fund's new executive director can help make that happen and candidates for the position should pledge to do so. An open letter to canidadates will be send later this week.

The HIV & MSM pre-conference satellite appeared on the front page of The Daily Voice, the official newspaper of the International AIDS Conference.

Making Contact

The latest edition of 'Contact', a publication of the World Council of Churches which is distributed to Christian faith communities worldwide has been launched at the World AIDS Conference in Toronto.

'HIV Prevention: current issues and new technologies' includes an interesting article on the new SAVE model of HIV prevention which has been developed by church leaders in Africa in response to the limits of ABC. Other articles are on Positive Prevention, PMTCT, vaccines, microbicides and post exposure prophylaxis.

The magazine also carries two articles by Alliance Senior Policy Adviser for Prevention, Joseph O'Reilly, one of which underscores the importance of putting key populations at the heart of the response to the epidemic and another on HIV stigma and discrimination.

'Contact' can be viewed and downloaded at http://www.wcc-coe.org/wcc/news/con-182.pdf

Putting early childhood development on the agenda

"It takes more than ARVs to raise a child: the importance of community support for children affected by AIDS" aimed to draw attention to the importance of early childhood development, and the role communities can play in providing support to younger children affected by HIV and AIDS. In this session, held in the Global Village and organized by the Bernard van Leer Foundation and the Coalition for Children affected by AIDS, three programmes from East and West Africa reflected on their work.

All three showed how it is possible to work with community members to provide integrated, holistic support for younger children, using local resources and the knowledge and wisdom of older people. The whole spectrum of care for children must be considered – nutrition, shelter, psychosocial wellbeing, health and economic strengthening as well as challenging the stigma and discrimination attached to HIV.

Are we losing the momentum for national targets for universal access?

This was the question being asked after the first day of the conference, where there was scant evidence of any leadership from UNAIDS to take forward the debate on agreeing national targets to achieve the universal access commitments agreed at the UN High Level Meeting earlier this year.

The first day was conspicuous by the lack of discussion in sessions on the issue, with no lead from UNAIDS. The process to agree these national targets for universal access to prevention, care and treatment by 2010 is already looking behind schedule, and needs visible leadership from UNAIDS if it is to be achieved. One possibility being suggested to move things forward could be through reviving the Global Steering Committee.

Abbott issues statement announcing price reductions for ARVs in low and middle income countries

Pharmaceutical company Abbott has announced price reductions for some of its HIV medicines in 45 low and low-middle income developing countries. The news, which it says is designed to ensure long-term, sustainable access to high-quality HIV medicines, is helpful to the International HIV/AIDS Alliance, especially its work in Ukraine where Abbott drug Kaletra is used in its treatment programmes. The Alliance has been in discussions with Abbott about the challenges of drug pricing for its work in Ukraine, in particular.

The yearly cost of Kaletra will now be just under two-thirds of what it has been so far for Ukraine and other middle-income countries - about half of its price in rich countries. However, this Kaletra price is still over four times higher than the low-income price of $500.

The World needs Round 6 now

Developing Country NGOs, Communities of People Living with the Diseases and Developed Country NGOs are continuing their ‘Fund the Gap’ campaign for increased funding for the Global Fund, with a petition for conference delegates to sign up to. The message to the international donor community is simple:
“We urge the International Donor Community to make additional financial pledges to the Global Fund to Fight AIDS, TB and Malaria to ensure that Round 6 proposals are fully funded, and that sufficient funds are available for annual rounds of proposals. Over the next few years the Fund needs to grow to US$11 billion a year to do its part in the global effort to reach Universal Access by 2010 and to achieve the Millennium Development Goals by 2015.”

Alliance India launches handbook on PLHA involvement with skills building workshop

Monday afternoon also saw the successful launch of a new Alliance India toolkit and CD-ROM on ‘Enhancing the greater involvement of People Living with HIV (GIPA) in NGOs/CBOs in India’. The handbook and CD were launched by Anandi Yuvaraj, senior programme officer at Alliance India in Delhi, with introductory speeches from Purnima Mane Director of Policy, Evidence and Partnerships at UNAIDS, Jahnabi Goswami, President of the Assam Network for PLHA and vice president of INP+, Alliance Executive Director Alvaro Bermejo, and Alka Narang from UNDP in India.

Following the launch Anandi took a skills building workshop using some of the activities from the handbook, showing how to use the information, and carrying out practical sessions in groups. Anandi was very pleased with the turnout of around 60-70 people. “I was really pleased with that many people, and we had some heated discussions and there was good level of participation,” said Anandi. “When we suggested stopping to have a break, over half the participants were so interested that they didn’t take a break and carried on their group work and discussions.”

Early OVC satellite still draws audience

Despite an early start of 7am on a Monday morning, around 40 people turned up for an Alliance skills building workshop on the Orphans and Vulnerable Children toolkit (www.ovcsupport.net), led by Kate Harrrison, senior technical adviser for children at the Alliance secretariat.

Kate said she was pleased with the turnout – an audience mostly made up of NGO representatives. Getting to know the categorisation system better was one of the key interests of the audience. Many delegates were particularly impressed with the way the toolkit guides you from the very beginning of OVC work, with information on things to think of when setting up an OVC programme. For example, it is important to think through the focus of your work when starting, and be clear that it will not always involve HIV/AIDS. Undertaking a good situation analysis all came through as a key issue that the toolkit can help with.

The meeting also highlighted the importance of the toolkit being a living resource. “The session has been a great opportunity for me to find out new areas of information that people want, so we can continue to develop the toolkit,” said Kate Harrison. “One area of interest that came up on Monday was documentation showing the impact of nutrition programmes on OVC work, and I’ll be following this up.” 

Envisioning the future, or the present, for children affected by AIDS?

Kate Harrison, Senior Technical Advisor: Children

The conference started early for me, as I attended the “Envisioning the Future” symposium on children affected by AIDS, which took place in Toronto 2 days before the International AIDS Conference began. This was a chance for over 400 people working with children affected by AIDS all over the world to come together, share ideas, debate, and plan for the future.

The conference was opened by Stephen Lewis, the UN special envoy on HIV and AIDS. He asked some tough and pertinent questions – for example:

• Why was it the non-governmental organizations MSF and the Clinton Foundation, rather than bi-laterals and multi-laterals, who had negotiate so hard with pharmaceutical industry for accessibly priced fixed-dose combination treatment for Africa?
• How is it possible that only 9% of HIV positive pregnant women have access to PMTCT? And why in Africa do we use single dose nevirapine, when in the North we use full HAART, which cuts transmission by 99%? He called this slow progress on PMTCT a “terrible delinquency”.
  He then paid tribute to the “astonishing resilience, feistiness and pugnacity” of African women, many of them grandmothers, in responding to the situation of the millions of children affected by HIV and AIDS across the continent.

Querying the use of the word "future" in the symposium title, he pointed out that children need action today. This echoes my own frustration with the commonly used rhetoric about children being “the future” – children have rights here and now.

Interestingly, much of what was discussed in the rest of the symposium echoed a book written decades ago by David Morley, called “My name is Today”. This book outlines the need for a comprehensive approach to child health, advocating for primary health care.

From what I heard at this symposium, it seems we’re coming full circle back to primary health care, moving away from “AIDS exceptionalism” and towards integrated models of support, taking account of the need to improve the nutritional, material and developmental needs of all children in order to improve the situation of the most vulnerable. This, of course, brings us back to the macro-economic factors which cause poverty and instability which interact with HIV and AIDS, outlined with passion by Stephen Lewis, as he ended his speech with a challenge to the G8 leaders to meet the commitments to Africa they made in Gleneagles.

The Alliance at AIDS 2006 - 13-18 August

Welcome to the Alliance's AIDS 2006 blog which will be bringing you daily updates from the international conference in Toronto. This blog will include interviews with, and reports from Alliance delegates from around the world who are participating in and running a variety of sessions throughout the week. We'll also be bringing you their reactions to events and developments at the conference. A full list of events that the Alliance is involved in is available here.