Since the early 1990s, the AFAO International Program has worked to support stronger civil society responses to HIV, health and human rights in Asia and the Pacific. Grounded in principles of community ownership and a partnership approach, AFAO’s International Program works closely with communities most affected by HIV to engage in capacity development, organisational strengthening, policy, advocacy and strategic planning.
More recently, AFAO leads multi-country programs in Asia and the Pacific to ensure responses to HIV are sustainable. With an expanded scope, AFAO’s International Program is working with respective country governments and communities to scale up effective programs that can reduce HIV transmission in the region, sustain investments in community-led HIV prevention programs, and influence more efficient HIV financing policies.
Building on AFAO’s partnership approach, the International Program currently works with over 20 civil society and community-based organisations, the United Nations, World Health Organisation (WHO), the World Bank as well as Ministries of Health and other government stakeholders across ten countries in the Asia and the Pacific.
Sustainability of HIV Services for Key Populations in Asia Program (SKPA Program)
The SKPA Program is an eight-country initiative to scale up and promote HIV prevention services for communities most affected by HIV, with an aim to stop HIV transmission and AIDS-related deaths by 2030.
Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the SKPA Program is a three-year project that works with gay and bisexual men,, transgender people, people living with HIV, sex workers and people who inject drugs in Bhutan, Lao PDR, Malaysia, Mongolia, Papua New Guinea, the Philippines, Sri Lanka and Timor-Leste.
While different social and political contexts exist across these countries, rapid economic growth in recent years is shifting these countries towards middle-income status, reducing their eligibility for international development funding. Middle-income countries are expected to fully fund health and HIV programs domestically. However, funding key populations who bear the greatest burden of HIV is a contentious issue, as gay and bisexual men, transgender people, sex workers and people who inject drugs are still highly stigmatised in these countries. As a result of political sensitivities, domestic government spending on these communities are minimal, with international donors funding most of the programs for these populations. As HIV is becoming increasingly reliant on domestic investment, the question becomes: will investment in key populations and their programs, which have been shown to be most effective and value for money, be reversed?
The SKPA Program aims to sustain the investment gains in these countries, by working with governments and key population communities to increase the financial sustainability of community focused programs, to strengthen the use of up-to-date information to inform programmatic design, bridge HIV service delivery gaps, and work on strengthening systems that support community ownership and action.
Sustainable HIV Financing in Transition Program (SHIFT)
The SHIFT Program was a two-year advocacy program that worked towards sustainable, cost effective and strategically allocated funding for the HIV response in Indonesia, Malaysia, the Philippines and Thailand from January 2017 to December 2018. Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the program placed communities and civil society at the centre of the HIV response, by engaging communities affected by HIV, civil society organisations (CSO) and program country governments to ensure HIV programs and services can be sustainably resourced by these countries.
The SHIFT program succeeded in integrating the capacities of communities and civil society to play a central role in supporting sustainable HIV investments in these countries. In Indonesia, the program established civil society coalitions at both the district and national level to advocate for HIV programs and investment needs of communities. Partnering with Indonesia AIDS Coalition (IAC), more than 30 civil society organisations working with and for HIV and key populations were mobilised to work with governments. By positioning civil society as respectable and equal partners, these coalitions were successful in gaining local government support to fund community programs. Most notable, at the national level, IAC was invited to contribute to the National HIV Strategic Plan of 2020-2024, to prepare components on sustainability and integration of community-led HIV financing initiatives.
In Malaysia, similar advancements in building civil society’s capacity made possible through partnership with Malaysian AIDS Council (MAC) has seen the inclusion of key population representatives as formal members to the Ministry of Health’s HIV decision making board. Additionally, capacity building workshops saw CSOs gaining a better grasp of investment concepts, leading to inclusion of robust funding proposals for programs targeting underserved key populations. Spurred by Malaysia’s political change following the election of a new progressive government, there is a move towards abolishment of the death penalty, especially as it relates to drug possession. On the heels of this development, the SHIFT program’s initiative to cost the impact of criminalisation presented clear evidence to move away from criminalising drug use, towards a public health approach, generating significant interest in the Ministry of Health and the new Malaysian government to repeal drug laws.
In the Philippines, the impact has also been overwhelming. Led by country partner Action for Health Initiatives Inc. (ACHIEVE), the program mobilised both national and sub-national stakeholders, including senators, public figures, as well as community advocates and activists. Building on a multi-stakeholder approach of mobilising communities and CSO coalitions, as well as engagement with key decision makers, the strategy succeeded in getting the HIV and AIDS Policy Act ratified in both the senate and House of Representatives and was formally approved by the president in December 2018 after years of lobbying. On the sub-national level, civil society and representatives of key populations were also integrated into decision making boards of local councils across six cities.
In Thailand, integration of the need for sustainable investment in community-based programs also saw the strengthening of relationships between government and CSOs. With country partner Thai National AIDS Foundation (TNAF), a partnership was formalised with the national health insurance agency to ensure domestic financing of CSOs. Furthermore, the move towards establishment of a CSO accreditation system to provide robust guidelines in supporting CSOs to comply with the regulatory frameworks and improvement of services, have also contributed to building trust between CSOs and government agencies.
A resource page of assessments, findings from studies and evaluation of the SHIFT Program is available for general access. Please see below for specific documents:
- SHIFT Program Evaluation
- Studies on Cost of Criminalisation
- SHIFT Baseline Study
- Situational Assessments on HIV financing for each country
For further information contact the AFAO International Program Manager, David Fowler at David.Fowler@afao.org.au