ICAAP 2007

August 22nd

On the third and last day, the

Alliance

was hosting several events.

A skills building on Civil society engagement and the Global Fund to Fight TB, AIDS and Malaria was conducted in the morning. Based on the experience of

Cambodia

, with an additional contribution by the Global Fund, the session analysed the successes and challenges of civil society involvement in Global Fund processes at the national level. Taufiquar Rahman from the Global Fund highlighted some of the lessons learnt in regards to civil society involvement. Civil society organisations have proven to be strong implementers with a large majority of PRs and subrecipients’ performance rated A or B1. Involvement of civil society as implementers has also shown to increase the absorptive capacity of countries. Civil society brings increased capacity in-country to achieve results, allows for flexible implementation and can also provide additional technical support – as the example of KHANA from

Cambodia

showed. As a subrecipient of Global Fund grants, KHANA subgrants the funds to 60 implementing partners, and provide technical support to these partners to support them in implementation.

Dr Sin Somuny, Board Member of KHANA, Executive Director of Cambodia’s MEDICAM and civil society representative on the CCM, as well as Oum Sopheap, Executive Director of KHANA, and Ngin Lina, representing Cambodia’s National AID Authority were present at the session to provide insights and lessons learnt to share with the audience concrete examples of how civil society overcame certain challenges. Their contributions showed that civil society engagement in the national Global Fund processes in

Cambodia

has been meaningful and the contributions of civil society are recognised.

Heng Sok Rithy, representing the Cambodian Network of people living with HIV (CPN+), outlined how the Global Fund processes and resources have enabled the network to play an important role in decision making and planning at national level and has been able to expand its geographical reach and now comprises over 34,000 members. The network has also been able to expand its activities in technical support to PLHA organisations across

Cambodia

.

Bacha, as facilitator of the session, emphasised that unfortunately this level of engagement is not the case in most countries. He called on members of the audience to take back the key lessons from

Cambodia

’s experience to hold its CCMs and other national processes accountable to ensure civil society engagement.

Participant of the session shared examples from the region where civil society representation and involvement is not occurring meaningfully. Taufiquar from the Global Fund emphasised here the role of civil society in drawing this to the attention of the existing CCM itself and to Global Fund Secretariat, so that this can be taken into account. He gave a compelling example of a country that had submitted a proposal for Round 7, where a letter from civil society drew attention to the lack of transparency and civil society engagement in the development of the process. After further dialogue with the stakeholders in country, the proposal was subsequently screened out.

The

Alliance

day ended with a satellite which aimed to increase the involvement of civil society engagement in the monitoring and implementation of Universal Access processes. The session was co-hosted by the UNAIDS Regional Support Team for Asia and the Pacific, and provided some of the background to the Universal Access process and commitments made including those that are meant to ensure engagement of civil society in the processes. Both case studies that were presented showed success stories in the engagement of civil society in the processes to date. Dr Suresh Kumar from the National AIDS Control Organisation,

India

, outlined the ways in which civil society has been involved in the development of the national plan and in each phase of its implementation at both national and state levels. He also emphasised the important role that civil society can and has played in advocating against repressive laws in India, that have been an important barrier to an more effective response. He also highlighted the importance of civil society networks as an key mechanism in providing the processes to identify civil society representatives that are elected by and truly represent their constituencies.

Bob Nebrida, from PHANSUP in the

Philippines

, showed how the relationship between stakeholders has developed into a co-stewardship to achieve Universal Access. He drew attention to the fact that certain prerequisites made this possible, including the existence of a common cause and agenda, mutual respect and that resources and capacity enabled this true partnership to develop. In regards to some key recommendations for achieving Universal Access, he highlighted, among other things, the need to make civil society initiatives an integral part of the health system to increase its capacity.

With contributions from the audience, notably

Myanmar

, the discussion then focused on settings where civil society engagement has not been supported to the same extent. It was emphasized that donors have an important role to play in emphasizing the need for civil society engagement and have the potential to ser requirements on countries where this is currently not being implemented.

The satellite session also served as the forum for the launch of a tool produced by the 7Sisters Network, which outlines Minimum Standards for civil society engagement in Universal Access processes. The tool has been developed in order to support civil society and governments to assess the engagement of civil society and to support the establishment of partnerships and support the improvement of existing ones. It was noted during the session that these minimum standards could and should be adopted to assess engagement in other processes at national and international levels. The tool will be available online shortly.

To be continued...

August 21st

On August 21^st, the Alliance co-hosted its first evening satellite session together with the Global Fund to Fight AIDS, TB and Malaria, entitled ‘Increasing the effective role of civil society throughout the architecture of the Global Fund in South and East Asia’. Through a contribution by Dr Bobby John, Alternate Board Member of the Delegation of Developing Country NGOs, the audience was presented with an overview of the structures and mechanisms in place for civil society engagement at global and national levels – in governance structures such as the Board and the Country Coordinating Mechanisms (CCMs); as implementers of Global Fund grants; and in the crucial role of ‘watchgdogs’ at the national level. Bobby John gave specific examples of how the action of civil society has resulted in changes in Global Fund policies, such as the explicit requirement for civil society representation on the CCMs.

The session also highlighted the high performance ratings of civil society organisations acting as principal recipients (PRs) and sub recipients of Global Fund grants, and representatives of civil society from Bangladesh and India spoke of their experiences as co-PRs and as management agencies, managing the NGO component of the grant of the governmental PR. Leng Kuoy from Alliance linking organisation KHANA highlighted their experience in building the capacity of local NGOs in Cambodia to become effective subrecipients. He outlined the strategies used by KHANA to develop the technical skills but also address the needs in organisational development in areas such as transparency and accountability. Leng Kuoy outlined some of the key challenges in this process which included the varying levels and gaps in capacity among sub recipients which required a range of approaches and types of technical support. He emphasised that an important lesson learnt from the experience in Cambodia was that promoting collaboration with other agencies, the government and even other donors can help partners aim for programme sustainability and an effective contribution to the national response.

Contributions from the audience drew particular attention to the difficulties and gaps in civil society involvement in CCMs at country level. In his summary, the co-chair of the session, Dr Abdelkader Bacha from the Alliance, drew attention to the fact that the Global Fund is still a relatively new organisation, and that its story of promoting and enabling civil society engagement has been a remarkable one that is unimaginable with other donors. He gave the example of Senegal, where the ‘Observatoire’ group of NGOs (including the Alliance linking organisation ANCS), monitored the progress of the Global Fund implementation and after initial withdrawal of the funds due to concerns of implementation through the governmental PR, was able to review the grant and became a co-PR. Bacha highlighted that this experience shows that involvement of civil society globally and at country level is crucial, and that we have a role in strengthening the potential of the Fund. He noted that while things are improving for civil society, there are many examples, some recounted by members of the audience of the session, where civil society engagement, in particular at national level remains a challenge. Not all governments are naturally open to engage with civil society, and we as civil society need to make it clear that we are not competitors to governments, but that we complement the response.

Other events of the day at ICAAP included the launch of the Colombo Declaration on Universal Access to treatment. The Declaration was launched by the Asian Network of People living with HIV (APN+) and restates the call for universal access to treatment. The Declaration was presented during a satellite session hosted by UNDP in the region, which presented three success stories in region of countries using TRIPS flexibilities to significantly reduce the prices of antiretrovirals in their countries. The speakers showed the process used in Malaysia and Thailand for issuing compulsory licenses which allowed the government to purchase antiretrovirals at low cost for public provision. The presentations however also highlighted the challenges faced in the interactions and reaction by pharmaceutical companies, such as the case of Thailand where Abbott withdrew Kaletra from the market. Examples were also provided that showed the open discouragement and opposition of some stakeholders at national and international levels for the use of compulsory licenses by countries in the region. Other cases from India were also presented where the national patent laws, at times questioned and appealed by pharmaceutical companies, have allowed for widespread production of generics.

A very compelling presentation by Shivananda Khan, from Naz Foundation International, highlighted the glaring gap in services and resources available for addressing the needs of gay men, other men who have sex with men (MSM), and transgenders in the region. Shiv presented figures that showed that MSM populations are several times higher infected than general population in many countries in the region, at times with infection rate upto 15 times higher. However, investments do not match the need. In Thailand MSM are estimated to contribute over 20 per cent of all new infections, while MSM-specific spending accounts for slightly over 1 per cent of the total national budget for AIDS. Shiv drew attention to the rights of gay men, other MSM, and transgenders as equal citizens in their countries, including the need for legal reform to ensure that they are no longer criminalised. He highlighted that if this neglect and denial of human rights continued, the epidemic would not be curbed.

A symposium hosted by APN+ provided an opportunity for participants to address some of their concerns and questions relating to the increasing support and guidance on provider-initiated testing and counselling (PITC). The WHO Guidance makes the important distinction of promoting PITC only in settings with generalised epidemics, but with increasing support for PITC, many participants from the region expressed concern regarding the implementation of PITC in this region. There was also explicit recognition of the fact that PITC has the important potential to facilitate access to prevention, treatment, care and support services. Anand Grover from the Lawyers’ Collective in India made the important observation that despite clear guidance from WHO on PITC, which clearly outlines the need for consent in the test (through either the opt-in or opt-out approach) “PITC is actually being implemented as routine testing in the real world”. He highlighted his concerns that consent will not be fully informed and that women in particular may not be in the situation where they can actually consent or object to a test offered by a health care provider.

Following the post from August 19^th, please find here the draft of the Community Statement for ICAAP as it was presented at the Opening Ceremony on August 19^th:

Download community_forum_statement.doc

August 20th - the first day of successful Alliance events at ICAAP

At the first day of the official conference, the Alliance held two successful skills-building sessions.

Colleagues from MAMTA, one of Alliance India's lead partners, facilitated a session titled 'Communicating with Young People (10-24yrs) on Sexuality & Rights for addressing HIV/AIDS'. The objective of the session was to help participants to understand the need to address sexuality, gender and rights in context of HIV. The session showed how to develop simple and contextually sensitive and appropriate messages especially for young people. The session was originally planned for 25 participants, but was attended by three times that number, with a long queue at the door. MAMTA has been asked to conduct another session on the same topic, due to high demand.

The Alliance's Susie McLean, along with Anan Pun from Recovering Nepal, facilitated a session titled ‘Nothing about us, without us – meaningful involvement of people who use drugs’. The session focused on practical strategies to involve people who use drugs in planning and decision-making. The session was well-attended by both representatives of the community of people who use drugs and programme planners. It enabled the Alliance to place itself as a source of support for drug users and for initial discussions on possibilities for support for the newly established Asian section of the International Network of People Who Use Drugs (INPUD-Asia).

At the end of the day, The Alliance's Abdelkader Bacha co-facilitated a UNAIDS-hosted session on 'Monitoring Progress in Commitments to Universal Access: Role of Inter-governmental Bodies', which featured representatives of SAARC, ASEAN and PIF – the three inter-governmental bodies of the Asia-Pacific region. The representatives identified that there was a gap in defining their concrete role and contribution to monitoring universal access targets up until now. However, the session highlighted that despite the fact that these bodies’ mandate is limited to a coordinating role, there is a potential for playing an important role in monitoring universal access targets.

Bacha summarised the main aspects of this role in his final statement at the session, by identifying that inter-governmental bodies can play a facilitating and stimulating role in increasing political commitment for universal access; that this commitment can help generate a regional strategic framework with concrete targets; that the inter-governmental bodies can negotiate to create spaces for discussion and engagement with a wide range of sectors including civil society; that they can provide and mobilize technical support for countries in the region; and that they themselves can monitor the progress of countries in achieving universal access, in partnership with civil society and other stakeholders in the region.

In addition to these events, Alliance colleagues attended a meeting hosted by IPPF titled ‘Moving closer to integration of HIV and SRH: Challenges of moving from corridors of power to people’s backyards’, which brought together members of the sexual and reproductive health (SRH) community and various Ministers of Health from the region. It aimed to identify successful strategies for successful integration. Within the context of the Alliance’s efforts to increase its own work to strengthen the link between SRH and HIV, Alliance participants noted that the discussion on integration focused very much of integration of HIV into SRH services, but not vice versa, and that no AIDS organisations were involved in the debate and statements during this meeting. We also identified that the need to involve communities was not addressed at all, and that it would have been interesting to hear more on concrete approaches in which integration can contribute to the reduction of vulnerability to HIV infection and sexual and reproductive ill-health. The statements of the Ministers present reflected varying understanding and levels of implementation of integration at the national level across the region. However, IPPF very successfully brought the issue and importance of integration to the attention of these high-level representatives, and at the same time highlighted the need for more concrete and practical guidance for these policymakers on approaches to increase linkages between SRH and HIV.

August 19th - Opening and Launch of Regional Network of People who use Drugs

On Saturday, the conference's Community Forum took place, as did the official Opening Ceremony.

Prior to the conference, a regional survey of community-based organisations, local leaders and networks of people living with HIV had been conducted to help improve government accountability and enhance local capacity for monitoring national responses to AIDS. The survey results argue that civil society should take part as equal partners in all levels of national AIDS-related policy-making and programme implementation. Participants highlighted four main areas for civil society organisations in particular:

1. making sure that people get information that helps them keep their governments and officials accountable for their commitments on AIDS;
2. providing direct services to the most vulnerable individuals and populations;
3. promoting accountability by monitoring AIDS programmes and service coverage; and
4. participating in AIDS programme and policy-making, and evaluating those decisions.

This region-wide survey is providing input to the independent Commission on AIDS in Asia who will later this year be making recommendations on a set of measures designed to mobilise leaders in the region to respond to the epidemic more adequately.

These recommendations are also largely reflected in the Community Statement of this year’s ICAAP – a copy of which will be posted here as soon as it is available in electronic format.

The Conference’s Opening Session was attended by many high-level guests, including the Sri Lankan President. The Conference is the biggest international level event in Sri Lanka in the recent past, and has brought together 2000 delegates from 60 countries. The Sri Lankan president emphasised in his speech that "low prevalence does not mean no threat", and that Sri Lanka, like other low prevalence countries, must remain vigilant to the threat of HIV. He emphasised that wherever possible, the state should join up with the private sector, particularly manufacturers and marketers of drugs, to make them affordable. The President of the International AIDS Society in Asia drew attention to the need to adopt a multi-sectoral approach to HIV and to the importance of working with communities and NGOs.

In addition to these festivities, the Asian section of the International Network of People Who Use Drugs (INPUD-Asia) was established. In an attempt to bring the needs and views of drug users front and centre of the AIDS agenda, drug users launched this first regional coalition on August 19^th. “We hope that this network will lead to greater inclusion of drug user communities in the universal access framework and to improvements in addressing their needs” said Anan Pun, from Recovering Nepal and the leader of INPUD-Asia. In its official statement, the network highlights that funding support for drug-related activities is lacking, despite what is known about drug use as a major driver of the epidemic – and that “it is time to raise our voices as citizens, establish our rights and reclaim the right to be our own spokespersons striving for self-representation and self-empowerment”. The Alliance is already exploring ways in which it can support the network from now on.

August 18th - the Alliance Family Meeting

The Alliance family started off its time at ICAAP with an introductory meeting for all Alliance colleagues. Over lunch at the Galle Face Hotel, we met and shared some initial thoughts and plans for ICAAP.

Unfortunately, not all participants from the Alliance family were able to join us because of travel schedules, however, 25 of us were able to attend.

The Alliance family meeting not only provided an opportunity for all to meet and get to know each other better, but also to share some valuable information about the conference and to develop the key messages that we, as the Alliance want to promote during the Conference.

During an initial introductory exercise, we all brainstormed about some of the characteristics of the Alliance that made it a unique organisation to work for. Some of the outstanding characteristics included the Alliance’s unique approach of putting communities at the centre of the response with their true ownership. In many countries, the Alliance has pioneered work with key populations and ‘has provided hope to those who had previously lost it’. The Alliance was seen as a true network of organisations that allowed for sharing and involvement of all partners in all countries, and is generally respected and taking seriously at national level. Colleagues however identified the need for more horizontal learning and opportunities to benefit from the experience of other linking organisations and country offices directly. The session was great reminder for all of us – that the Alliance approach is in fact unique and that for many people we are really making change happen.

The next session addressed some of the key messages that we should be promoting as an Alliance during this conference. These messages included the importance of the Alliance approach to the response with its focus on communities and the success of our model. We also discussed some of the issues surrounding financing for AIDS, advocating to close the service gap in particular for key populations, as well as the importance of addressing stigma and discrimination by ensuring that interventions really address the issue comprehensively. We finished the meeting with some logistical information that will help us stay in touch during the week and make the week more easily manageable.

We are now looking forward to the Community Forum tomorrow and the Opening Ceremony of the Conference tomorrow night. Watch this space for daily updates on the Alliance family at ICAAP and reports on the sessions of the conference.