CONSENSUS STATEMENT OF THE EASTERN AND SOUTHERN AFRICAN CIVIL SOCIETY AND COMMUNITY REPRESENTATIVES TO THE EXPERT MEETING ON HIV COMBINATION PREVENTION IMPLEMENTATION IN 15 FAST-TRACK COUNTRIES

Posted by Editor on March 25, 2017

We, representatives of civil society and communities participating in the meeting to revitalize HIV combination prevention in Eastern and Southern Africa (ESA) at Victoria Falls, Zimbabwe on 23 and 24 March 2017:

Are encouraged by and welcome the commitment and leadership of ESA governments and in particular the leadership of the Zimbabwean government in convening this meeting around revitalising HIV combination prevention for ESA

Celebrate ongoing scientific advances, political commitments and community activism that have led to significant achievements in stabilising HIV incidence within general population and increasing accessibility of treatment, whilst recalling that much more is needed if we are to end AIDS by 2030.

We are optimistic that implementation science has proven what is effective and this will further be enhanced by new and exciting innovations. Our joint task is to demonstrate the political will and leadership to allow evidence to guide us and to take effective interventions to scale. This also implies that we need to stop doing what does not have impact.

Acknowledge the crucial role of civil society and communities to monitor progress of, and collect and analyse data for, HIV prevention, ensure accountability, prevent inefficiencies, reduce transactional costs and guarantee high return on investments at national, regional and continental levels, including through frameworks such as the African Governance Architecture and African Peer Review Mechanism;

Remain strongly concerned about the prevention crisis, particularly by:

  • the underinvestment, specifically from domestic resources, in HIV prevention; and
  • the lack of prioritisation and integration of proven behavioural and structural approaches that are critical to the realisation of epidemic control, particularly around tailored interventions for key populations (including people who sell sex; people who use drugs; men who have sex with men and transgender individuals) and priority populations including adolescents and young women who continue to be affected by legislative, policy and social frameworks that perpetuate violence, stigma, and discrimination and acts as barriers to effective HIV prevention.

Call on governments, donors, development partners and other stakeholders to implement the below measures to reinvigorate the AIDS response in ESA if we are to bring an end to AIDS by 2030 and meet the Fast-Track targets.

Seven measures to meet the Fast-Track targets in ESA

1. Existing prevention commodities and new technologies

  • Commit to a comprehensive prevention approach which is community-owned, affirms and invests in the leadership of communities and community organisations including those representing people living with HIV, women, young people, adolescents and key populations;
  • Commit to increasing research and development of HIV preventative and therapeutic vaccines, and curative interventions as well as access to new prevention technologies such as HIV self-testing and home testing, long acting pre-exposure prophylaxis (PrEP), microbicides, WHO-approved harm reduction treatments including methadone treatment as well as quality assured commodities such as clean needles and syringes, condoms and water-based lubricants and services such as elimination of vertical transmission and voluntary medical male circumcision;
  • Commit to offering treatment regardless of CD4 count to 95% of people living with HIV particularly women, children, adolescents, young people, key populations and other priority populations as per the 2015 WHO treatment guidelines  

2. Strengthening research and use of epidemiological and programmatic data to shape combination prevention programmes:

  • Recognise that epidemiological and programmatic data tell us to prioritise adolescents, young people, key populations and other priority populations;
  • Ensure that implementation science and operations research activities are well designed and funded so that new interventions can be taken to scale more quickly;
  • Strengthen efforts to capture data and strategic information, including size estimates, disaggregated by gender and age; with a focus on people living with HIV, adolescent girls and young people, key populations and other priority groups, to inform policies and programming;
  • Reaffirm the critical importance of involving communities in the efforts to collect and own their data and strategic information as well as the critical contribution of strategic information collected by civil society and key populations; and
  • Make better use of programmatic data to review and assess the impact of HIV prevention interventions, in order to guide priorities and inform efficient and judicious utilisation of resources

3. Financing and accountability

  • Governments in ESA should make a clear commitment to fully finance a comprehensive and sustainable combination prevention revolution that supports the role of communities and civil society, including through an increase of domestic spending in a scheduled and practicable way aimed at meeting the Abuja 2001 Declaration goal of 15% of national budgets for health; and
  • Global solidarity and partnership remain key to financing an increased focus on combination prevention and should be based on the global target of 0.7% of budgets to overseas development aid as per the Paris Declaration; and
  • Commit to an accountability mechanism with set targets and indicators aligned to the monitoring of the Outcomes Document of the 2016 High Level Meeting on Ending AIDS and the Sustainable Development Goals to monitor the progress of the implementation of the ESA prevention programmes

4. Human Rights and structural barriers

  • Governments and partners commit resources and work with civil society to develop SMART targets for a structural cascade, based on modelling that includes targets for 2020 and 2030, in regards to addressing structural barriers such as problematic laws, policies and practices within law enforcement and health care service provision and access to justice;
  • Undertake legal audits and promote dialogue to enact and enforce protective laws and reform harmful laws and policies such as mandatory testing, age of consent laws, property inheritance laws, laws that legalize child marriage and marital rape as well as the criminalization of HIV transmission, exposure and/or non-disclosure;
  • Particular attention and resources must be focused on groups facing legal discrimination such as men who have sex with men, sex workers and people who use drugs.
  • Increase human rights literacy, protect human rights defenders and strengthen redress mechanisms and monitoring institutions such as Human Rights Commissions, Prosecutor General, Ombudspersons, independent police investigating organizations and regional African human rights organizations;
  • Strengthen the capacity of members of Parliament, decision makers and other duty bearers including judges, police and healthcare providers on HIV, gender equality issues and human rights more broadly; and
  • Facilitate dialogue with stakeholders such as people living with HIV, key populations, other groups at risk of HIV, traditional and religious leaders and law enforcement officials to increase interventions to eliminate stigma, discrimination, address prohibitive cultural, religious and social barriers such as child marriages and female genital mutilation

5. Gender

  • Commit to a community, women, and youth-centred combination prevention agenda that simultaneously takes into account the role and needs of men and boys;
  • Commit to working with community and faith leaders to change harmful norms and practices, modify aspects of culture that fuel patriarchy, gender-based and intimate partner violence;
  • Ensure a systematic integration of policies; greater and more effective linkages and increased support for work that connects SRHR and HIV programming as well as GBV;
  • Commit to dedicated funding, strategic use of gender data and gender transformative approaches that enhance the agency and empowerment of women and girls and works towards genuine gender equity; and
  • Implement and strengthen interventions to keep young girls in school and strengthen access to economic opportunities for women

6. Adolescents and Young People

  • Young people in all their diversity including those living in rural area and young people living with disability need to not only be ‘at the table’ but meaningfully involved in setting the HIV prevention agenda and in all processes from planning, implementation, monitoring and evaluation of all prevention projects and particularly those aiming to meet their needs;
  • Develop policies and programs to ensure accurate information, education and services on sexual and reproductive health particularly on contraception, HIV, gender identity and sexual orientation are provided in health centres, in schools and at home; 
  • Embrace information communication technology (ICT) and emerging trends such as social media and virtual social hangouts as a way of HIV prevention among young people by investing, encouraging and setting up Technology and media applications that engage, educate and empower young people on HIV; and
  • Invest on youth-led organizations and initiatives by providing a continuous technical support through a mentorship grant schemes and direct financial support to effectively advocate and deliver high quality interventions and HIV prevention services

6. Community Systems Strengthening

  • Acknowledge the resilience of communities and protect the political space for civil society, including communities of key populations and networks of people living with HIV, to operate, form associations and fulfil their duties to support combination prevention efforts;
  • Commit investments to resource and strengthen civil society to ensure local ownership and enable communities to effectively play their full role to support community engagement, mobilization and appropriate community-led service delivery that prevent inefficiencies, reduce transactional costs and maximises return on investments; and
  • Commit to predictable resourcing of the continued involvement of people living with HIV, key populations and communities affected by HIV in the development, implementation and monitoring of regional, national and subnational policies and Fast Track targets and to support the creation of demand, delivery of services, monitoring of programmes, promotion of accountability and addressing wider social and structural barriers

In turn, we re-commit to:

  • Openly collaborate and partner with governments and other stakeholders in order to inform, educate, mobilise and organise our communities to respond to the prevention crisis by supporting the implementation of the Fast Track Strategy and embracing its principles of ambition, focus, change, speed, saturation and human rights;
  • Offer to lead when political barriers continue to prevent or stall implementation of critical interventions, such as generating size estimates of all key populations; and
  • Pledge to hold ourselves, governments and other stakeholders to account to ensure that all plans, programmes, and interventions are person-centred, based on human rights and ensure evidence based responses, equity, effectiveness as well efficiency.

 

Victoria Falls, Zimbabwe

23 – 24 March 2017