Regional feature: The United Nations hosts Asia Pacific Governments and Civil Society: a regional HIV and AIDS response and the post-2015 development agenda

The President of Fiji, Hon. Ratu Epeli Nailatikau¹

Between 28-30 January 2015, the Asia-Pacific Intergovernmental Meeting (IGM) on HIV and AIDS took place in Bangkok, Thailand. The President of Fiji, Hon. Ratu Epeli Nailatikau, chaired the gathering of over 30 countries that included China, India, Iran, Russia, Japan and Australia.

The IGM is a periodic, inclusive review of national efforts and progress in commitments made by governments to HIV prevention, treatment, care and support under the 2011 Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS.

The United Nations Economic and Social Commission for Asia and the Pacific (UNESCAP) coordinated the IGM in Bangkok, providing an opportunity for governments and civil society from across Asia and the Pacific to evaluate progress to date and agree on a shared roadmap to guide the region’s future response to HIV and AIDS.

‘Don’t leave communities behind’: civil society’s message to the IGM

While it is widely accepted that the effectiveness of the response in Australia has been a product of community and government working in partnership, civil society presence on the official delegations was a rarity, with most countries apart from Australia failing to afford this standing to civil society representatives.

The Australian Federation of AIDS Organisations (AFAO) was actively involved in meeting preparations, including articulating the civil society advocacy agenda, and in the meeting proper.

AFAO Executive Director Rob Lake was a member of the Official Australian Delegation and AFAO International Program staff attended holding civil society observer status at formal proceedings.

The sentiments of The President of Fiji, Hon. Ratu Epeli Nailatikau (shared above) were reaffirmed by Civil Society in a statement read by Naro Ao from APN+, when she called for a community and people-centred response to HIV:

‘We call on decision makers to scale-up rights-based, community-led and gender-responsive HIV treatment, care and support interventions.’

Civil society representatives, including AFAO, expressed grave concerns that, despite major advances in HIV treatment, over 1000 people are infected with HIV every day in the Asia-Pacific region, with the majority of these among men who have sex with men, transgender people, sex workers and people who inject drugs.

Across all these affected communities, young people are disproportionately affected.

At the meeting, the new 90-90-90 global treatment targets were also discussed, with civil society calling for more community-based HIV services.

Although the epidemic in the region is concentrated among key populations, less than 8% of overall AIDS spending is dedicated to HIV prevention among these populations.

While community representatives understand that community based prevention, testing and treatment works, many governments in the Asia-Pacific region continue to ignore this evidence.

In a statement presented by Mr. Liu Yan, a Core Working Group Member of Youth Voices Count, governments were urged not to ‘leave communities behind’:

‘Ending AIDS is impossible if governments continue to commit to Universal Access, without committing to decriminalise sex work, homosexuality, transmission of HIV, drug use; or creating laws to recognise the rights of young people and transgender people.

‘We are here today to remind governments that ending AIDS is only possible with a holistic approach that truly leaves no one behind.’

And, in responding to comments from Iran and Pakistan, Mr Liu also reminded delegates that:

‘Cultural and religious values should never supersede community rights. Community rights are human rights. The experiences of people living with and affected by HIV are valid experiences, they are not unethical.’

But above all, the urgency of the required HIV response was particularly powerfully articulated by Joleen Matele from the Pacific Sexual Diversity Network, who said:

‘Ending HIV is no longer a dream. It is now an achievable reality. By the end of this three-day meeting, 2,877 people from our region will have been newly infected.

‘Let’s make this IGM count. Let’s do our job. Let’s bring the number to zero. Don’t leave communities behind.’

Rob Lake furthered calls for evidence-based community centred responses that address legal and policy barriers to effective HIV prevention, testing, treatment, care, and support.

He noted that Australian Government funded programs, including those implemented by community organisations AFAO, APCOM (Asia-Pacific Coalition for Male Sexual Health), and APCASO (Asia Pacific Council of AIDS Service Organisations), are based on 30 years of evidence from Australia and across the region:

‘DFAT funded programs, including AFAO’s work in the region, are effective because they work with the most vulnerable populations. They have provided value and impact for Australia’s aid investment.’ Rob Lake said during the meeting.

What did the IGM achieve?

There were two key IGM achievements: a review of the regional HIV response; regional agreement on a future direction; and, the launch of several key civil society initiatives, including the report The Right(s) Evidence: Sex Work, Violence and HIV in Asia – A Multi-Country Qualitative Study⁵.

The IGM also provided a forum for discussion on key challenges, innovations and opportunities in the regional HIV response. Financial sustainability of national and regional responses and the need for regional cooperation were featured discussions as part of the regional review.

These discussions particularly focused on the need to continue addressing legal and policy barriers to accessing services for key populations at a higher risk of HIV and persons living with HIV. The legal and policy barriers include discrimination in health care, education, insurance, travel and employment, as well the affordability and accessibility of life-saving medicine and diagnostics.

A vital component of the meeting was reaching agreement on a shared agenda and direction for Asia and the Pacific’s future HIV response. Governments were able to come to an agreement (The Road Map), featuring a commitment to ending the AIDS epidemic in the region by 2030.

The Road Map calls for increased collaboration between government ministries, including health, justice, public security, police and drug control, in genuine partnership with civil society and key affected populations.

The Road Map also articulates the ongoing commitments and priorities of governments in the region for the HIV response as we move toward the conclusion of the Millennium Development Goals (MDGs) timeframe.

The new iteration of these goals, the 2015 Sustainable Development Goals (SDGs)², will be formalised in September 2015, and are a key mechanism in shaping development priorities for the coming years.

The original MDGs were quite targeted and specific. The MDGs number 8 in total, including goal number 6, which focuses on HIV. In contrast the SDGs represent a comprehensive and integrated set of global priorities for inclusive, equitable and sustainable development. Proposed goal 3.3 aims to end the AIDS epidemic, along with other communicable diseases, by 2030³.

In addition to proposed goal 3.3, proposed goals 3.7-3.8 aim to ensure universal access to sexual and reproductive health care services and ‘safe, effective, quality and affordable essential medicines and vaccines for all’; proposed goal 5 focuses on achieving gender equality for women and girls; and proposed goals 10.2-10.3 aim to eliminate discriminatory laws, policies and practices.⁴

For an effective response to HIV, it is vital that HIV remains prominent on the international development agenda. The SDGs reduce the international focus on HIV. It no longer features in a stand-alone development goal and this shift in focus is compounded by the expanding number of key development priorities in the SDGs.

The ongoing challenge for governments and civil society will be to ensure we do not lose focus on achieving the goal of ending the HIV epidemic by 2030.

Side Events: Civil Society Activities

Complementing the formal IGM sessions, there were a number of civil society led side events, which highlighted response priorities, strengthened shared advocacy agendas, and presented successes.

The first of these events was a one-day civil society pre-meeting facilitated by UNESCAP, at which civil society delegates discussed advocacy priorities for the IGM. In addition, there were side events, particularly focusing on issues impacting the lives of key populations.

The Right(s) Evidence: Sex Work, Violence and HIV in Asia – A Multi-Country Qualitative Study was launched through an interactive panel discussion on the final day of the conference.

The launch brought together panelists from Cambodia, Indonesia, Nepal and Sri Lanka to discuss leading efforts to reduce violence against sex workers from a government and community perspective, including the need for increased collaboration, programming for workplace health and safety, and the potential for regional cooperation.

The study received the inaugural Robert Carr Research Award at the International AIDS Conference in Melbourne last year for its community-driven research process, including the training of peer interviewers to conduct all interviews with sex worker participants.

It is the result of a research partnership between UN agencies and the Asia-Pacific Network of Sex Workers, and examines the impact of violence against male, female and transgender sex workers on their human rights and HIV risk. The full report can be accessed at www.aidsdatahub.org.

The need to focus on the important place of young people in the HIV response resonated strongly throughout the IGM. Following on from a pre-meeting youth caucus which focused on youth friendly services, comprehensive sexuality education, meaningful participation and supportive legal environments the youth delegates prepared a statement articulating regional priorities from a youth perspective.

Youth delegates, including from AFAO partner Youth Voices Count, also featured in the ‘How Old Are You?’ side event, which brought together speakers of all different ages, including Justice Michael Kirby.

In her introduction, Justine Sass from UNESCO noted the key idea behind the event:

‘Old enough to marry, but too young to have consensual sex. Criminally responsible for one’s actions, but not legally entitled to HIV testing without parental consent. When it comes to legal and policy barriers keeping young people from accessing sexual and reproductive health (SRH) and HIV services in Asia-Pacific, the incongruities abound.

The event was guided by panellist John Godwin’s 2013 report Young People and the Law, which can be accessed at unesdoc.unesco.org (PDF)

AFAO Involvement

AFAO was well represented at the IGM. Executive Director Rob Lake was a member of the official Australian Delegation along with staff from the Department of Foreign Affairs and Trade.

While it is widely accepted that the effectiveness of the response in Australia has been a product of community and Government working in partnership, civil society presence on the official delegations was a rarity, with most countries apart from Australia failing to afford this standing to civil society representatives.

Bangkok-based AFAO International Program staff were also involved in the IGM as part of the civil society delegation holding observer status. Chris Connelly and James Malar were involved in the advocacy working group which drafted the civil society statements delivered at the IGM on behalf of civil society more generally.

AFAO international program staff were also active on the media working group, designing merchandise featuring the ‘don’t leave communities behind’ message, and a programme of social media releases shared across all the Asia and Pacific community networks.

Involvement in the respective advocacy and media working groups with our friends from Seven Sisters, APCOM, APCASO, Youth Voices Count, YouthLead, APN+, APNSW, IDPC and ANPUD strengthened working relationships across the organisations and ensured a shared and united messaged was delivered to Governments on behalf of civil society.

Civil society advocacy tools

The AFAO International team, in partnership with APCASO, produced advocacy materials for the IGM and undertook a capacity building-mentoring program for the 50 Asia and Pacific community participants who are part of the Australia Awards Fellowships (AAF) Mentoring Program.

The first civil society advocacy tool produced for the IGM was a briefing paper, HIV Investment Matters, examining the HIV commitments that have been made by Governments in Asia and the Pacific.

This briefing highlights that while the gap between targets and investments remains vast, it is not insurmountable provided there is sufficient political will and action to breach the gap.

The brief looks at the specific commitments that have been made by governments under the 2011 Political Declaration on HIV/AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS, and Economic and Social Committee for Asia and the Pacific (ESCAP) Resolutions 66/10 and 67/9.

The briefing serves as an important reminder to governments in Asia and the Pacific of their explicit commitments to sustained and strategic HIV investments.  The briefing paper is available at: APCASO – HIV Investment Matters

The second advocacy product captured the Vietnam experience in reforming health insurance laws and processes to ensure access to antiretrovirals for people with HIV.

In the context of declining international donor contributions to HIV in the region, especially to countries like Vietnam where economic development is occurring at a rapid rate, the need to secure domestic solutions to domestic HIV challenges is paramount.

The successful Vietnam experience required strong advocacy from civil society, including AFAO and APCASO partner Centre for Supporting Community Development Initiatives (SCDI), and partnerships between Vietnamese communities affected by HIV and the Vietnamese Government.

SCDI played an important role in this process, highlighting the importance of the capacity building and technical assistance they received through the Australian Government funded APCASO/AFAO Community Advocacy Initiative. The case study is available at: APCASO – Bridging the Gap

The third key activity by civil society in association with the IGM was the delivery of a mentoring module by AFAO Executive Director Rob Lake and APCASO Executive Director RD Marte to AAF fellows who attended the AIDS 2014 conference in Melbourne.

This module introduced the participants to the IGM. It provided background to the meeting, as well as explaining the meetings processes and the importance of the IGM in the global development agenda.

Effort was made to also share with participants some methods by which they could ensure their involvement in future regional meetings on behalf of their communities.

Where to from here?

Ending HIV by 2030 is a key commitment of governments from across the region. In the context of the emerging post 2015 development agenda, meetings such as the IGM carry additional weight, and provide an opportunity to highlight key advocacy messages.

The need to ensure implementation of the right interventions, for the right communities in the right locations, and to address the legal and policy barriers that impede these interventions, were key messages from the meeting. Equally, the need for governments to allocate domestic financing to their HIV responses was delivered with resounding clarity from civil society and the majority of the governments in attendance.

Attendance at the meeting proper, and production of advocacy materials reminding governments of their existing commitments and the success stories they can look to replicate, were key features of AFAO’s involvement and influence in the IGM.

The Road Map guiding the future response, the advocacy tools that were released by civil society over the course of the meeting, and the clear messaging the was delivered to governments regarding their existing commitments and the challenges ahead, underscored the significance of the IGM for Australia and for the region.

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James Malar is the Engagement and Communications Advisor at AFAO International Program in Bangkok.

 

References:

1 H.E President Speech at Key Address at the Intergovernmental Meeting on HIV and AIDS. Retrieved from: www.fiji.gov.fj

2 See: https://sustainabledevelopment.un.org/focussdgs.html

3 ibid.

4 ibid.

5 Bhattacharjya, M., Fulu, E., Murthy, L., Seshu, M., Cabassi. J., Vallejo-Mestres, M. (2015). The Right(s) Evidence: Sex Work, Violence and HIV in Asia – A Multi-Country Qualitative Study.United Nations Population Fund (UNFPA), United Nations Development Programme (UNPD), Bangkok. Retrieved from: www.aidsdatahub.org