International update Don’t leave communities behind: developing a new Global Fund strategy

On 24–25 June 2015, consultations were held in Bangkok, Thailand, among partners in global health, including civil society, non-government organisations and public health experts, seeking input into a new strategy for the Global Fund to Fight AIDS, Tuberculosis (TB) and Malaria (The Global Fund).

The Partnership Forum brought together more than 120 people to focus on developing the Global Fund’s strategy for 2017–2021.

The Global Fund is a partnership between governments, civil society, the private sector and affected communities, and is the largest multilateral funder of health programs in developing countries.

In developing the new strategy, the Global Fund is asking how the partnership can achieve more impact, contribute to the Sustainable Development Goals, and accelerate progress for people affected by HIV, tuberculosis and malaria.

Civil society representatives, Zakaria Bahtout from the International Treatment Preparedness Coalition in the Middle East and North Africa (ITPC-MENA), and Maura Elaripe Mea from Igat Hope, Papua New Guinea delivered the opening plenary at the forum, calling for a new a Global Fund strategy that invests in people and human rights.

The complete plenary speech is reproduced below.

Zack: Good morning ladies and gentlemen. My Name is Zakaria Bahtout. I am 32 years old. I am from Morocco.

I work for the International Treatment Preparedness Coalition-MENA. And I am an activist working for injecting drug users and on intellectual property issues.

Maura: Greetings, members of the Partnership Forum. My name is Maura Mea. I am from Papua New Guinea. I am 38 years old. I am a living with HIV and I have also had malaria and TB. I have an HIV-negative child and she is three years old.

Today we are here as equal partners, not beneficiaries. We are the implementers of the current Global Fund strategy. We hope you will learn from our expertise and experience as we work to create the new strategy.

Zack: We would like to share some of the priorities for the next Global Fund strategy that community and civil society participants share in the Asia-Pacific and MENA regions.

We want a Global Fund that is truly global – one that does not leave key populations and vulnerable communities behind, regardless of the income classification of their country.

In the Arab and Muslim countries of the MENA region, men who have sex with men and people who use drugs are criminalised and persecuted.

The Global Fund is the only institution that permits us to get services for these populations and has allowed us to begin critical work to protect their rights.

The Global Fund effectively obliged states in our region to begin to provide HIV services for key populations. But if the Global Fund leaves, governments will not support services and advocacy for key populations. Not ever.

My colleagues in Asia tell me that illegal migrants and ethnic minorities are ‘key populations,’ highly vulnerable to Malaria. But governments do not recognise them, and they cannot access the identity papers they need to access health services.

It is only community organisations like ours that reach these key populations. And they rely on donor support, like the Global Fund. If the Global Fund leaves these countries, how will these key populations affected by Malaria get the services they need?

Maura: We want a Global Fund that increases investments in human rights and gender equality programming If you are woman living with HIV in Papua New Guinea, my country, you are bound to experience violence from your husband’s family.

If you are a sex worker and you speak out about your work, your HIV status, or your rights, you may be risking your life. I am on the CCM (Country Coordinating Mechanism¹).

When I invited the sex worker group, Friends Frangipani, to join the meeting to develop our concept note, they refused, fearing that they would experience disrespect. And they are right.

Even though I always raise the issues of women and girls and the barriers to sexual and reproductive health, I am not heard, and these programs do not find their way into concept notes.

And let us not forget about the human rights of children and adolescents, especially from key populations.

They do not get tested because the age of consent policies force them to disclose their status to their families, risking discrimination.

Zack: We want a Global Fund that places health and lives ahead of profits.

From the early days of the HIV response around the world, activists encouraged governments to use TRIPS flexibilities to make quality, generic HIV treatment affordable. The Global Fund was a strong partner in those efforts.

In the MENA region we are continuing that tradition of fighting for hepatitis C treatment.

We realised that the drug user community did not know about coinfections between HIV and hepatitis C. So we used the Global Fund and other donor money to educate them about their right to hepatitis C treatment.

We taught them to understand how treatment works and the importance of adherence. We call this treatment literacy.

We learned that the pharmaceutical company, Gilead, was applying for a patent for a hepatitis C in Egypt. The patent would make it impossible for people to afford this drug.

So we supported our community to directly approach Egypt’s ministry of health to encourage them to resist the patent. This made Gilead nervous and the Egyptian government was able to negotiate a 99% reduction in price for the drug.

We cannot have resilient and sustainable systems for health if the costs of essential medicines are too high. And we cannot have resilient and sustainable systems for health if communities are not funded to do critical advocacy work to make treatment affordable.

Maura: That is why we want a Global Fund that supports the contributions of civil society and communities in the fight against the three diseases. We will never accelerate progress to end the three diseases without communities at the centre.

Because of lack of funding for communities in Papua New Guinea, we are still trying to convince our communities to get screened for TB and tested for HIV.

We are still far away from scaling up casefinding for TB or achieving suppressed viral load. Support for scale up of the community-response will make all of the other strategic goals sustainable. That needs to be front and centre in the strategy.

Zack: Asia-Pacific has the highest number of new TB cases in the world. It has second largest population of people living with HIV after sub-Saharan Africa. It carries the second largest burden of Malaria in the world.

In the Middle East and North Africa between 2001 and 2012 the number of new HIV infections grew by 52 percent – the most rapid increase in HIV among world regions.

The crisis of the three diseases continues in both of our regions.

We must all work together, communities, donors, Board members, Secretariat to deliver the kind of Global Fund that will give the world a chance to finally end AIDS, TB and Malaria in our lifetimes.

Thank you.

Reference

1 Country Coordinating Mechanisms are central to the Global Fund’s commitment to local ownership and participatory decision-making.

These country-level multi-stakeholder partnerships develop and submit grant proposals to the Global Fund based on priority needs at the national level.

Maura Elaripe Mea is from Igat Hope, the national network of HIV-positive people in Papua New Guinea. She is the first HIVpositive woman to come forward publicly about living with HIV in PNG.

Zakaria Bahtout is Communications Officer at ITPC-MENA.