Posted by Editor on April 16, 2018

We, 27 representatives of civil society organisations and communities implementing HIV prevention activities in Southern Africa, participated in a civil society consultation on addressing structural barriers to HIV prevention in the region, hosted on 10 and 11 April 2018 ahead of the Southern Africa Development Community (SADC) “Regional HIV Prevention Consultation: Stocktaking on the Progress in Fast Tracking HIV Prevention by Member States” from 12 to 13 April 2018 in Johannesburg, South Africa.

We reviewed the progress of HIV prevention efforts in the region and the implementation of the 100- day plans developed by SADC Member States following the launch of the Global HIV Prevention Coalition Roadmap in October 2017. We also reflected on the involvement of civil society in HIV prevention policy development and programming at the national level.

We are encouraged by the political will and leadership demonstrated by SADC Members States, particularly the adoption of the SADC Framework for Target Setting for HIV Prevention in the SADC Region, the accompanying HIV Prevention 2020 Roadmap and score card as well as the Regional Strategy for HIV Prevention, Treatment, Care and Reproductive Health and Rights among Key Populations by Ministers of Health in November 2017.

We recognise the important role of the SADC Secretariat in convening Member States and facilitating peer-learning and sharing of lessons learned on HIV prevention policy and programming. We also welcome the involvement of the SADC Secretariat in the development and implementation of the 100-day plans, and welcome the steps taken to create a platform to review progress of the implementation of the 100-day plans.

We want to emphasise the need for continued political will and leadership at the national level to ensure that we continue to accelerate HIV prevention efforts by capitalising on the momentum created by the 100-day plans.

We encourage Member States to continue investing in strengthening multi-sectoral coordination and accountability platforms, which include civil society, with a focus on adolescent girls and young women and their partners and key populations such as sex workers, lesbian, gay, bisexual, transgender and intersex (LGBTI) people, prisoners and people who use drugs.

We are gravely concerned by the daily realities faced by people most in need of HIV prevention services which include organisations that provide services to key populations being harassed and their operations suspended, key populations confronted by state-sponsored violence perpetrated by law enforcement officials, sex workers being arrested and harassed for carrying condoms, people who use drugs being harassed and arrested for carrying syringes and adolescent girls being chastised and humiliated for seeking HIV prevention and family planning services. Further, failing health systems and user fees remain persistent barriers to access to HIV prevention services.

Despite the challenging realities we face, we take courage from the commitment made by Member
States “… to ensure that at least 6 per cent of all global AIDS resources are allocated for social enablers,
including advocacy, community and political mobilization, community monitoring, public communication and outreach programmes to increase access to rapid tests and diagnosis, as well as human rights programmes such as law and policy reform and stigma and discrimination reduction” in the 2016 Political Declaration on HIV and AIDS: On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030.

We are further encouraged by the discussion on structural barriers to HIV prevention during the SADC stocktaking meeting and the recognition by many Member States that structural interventions are the missing enabler to accelerating our HIV prevention efforts.

We also remain hopeful because we have documented evidence that the following interventions, implemented across the SADC region by communities, are amongst those that are effective in addressing structural barriers to HIV prevention services and commodities:

  • Peer education and peer out-reach for sex workers in South Africa;
  • Facebook appointments for young people in Botswana;
  • Training of law enforcement officials and health care service providers in Zimbabwe;
  • Registration of LGBTI organization in Botswana and Mozambique;
  • Decriminalisation of homosexuality in Seychelles;
  • Documentation of rights violations and access to justice in Botswana, Namibia, South Africa and Zimbabwe;
  • Harm reduction for people who use drugs in Mauritius, Tanzania and South Africa;
  • Transformational dialogues with community leaders, health care providers and law enforcement officials in Malawi, South Africa, Zambia and Zimbabwe;
  • Dialogues with religious leaders on sexual orientation and gender identity in Malawi and Namibia; and
  • Engaging and training Members of Parliament, National Human Rights Institutions, lawyers and judges at the regional level

We call on your support to take these efforts to scale and urge Members States to ensure appropriate
domestic resources are allocated to do this work and to contract civil society and those most affected,
including key populations, adolescent women and young girls, who know best what works to prevent
HIV infection, to address structural barriers to HIV prevention.

Review of progress of implementation of 100-day plans

We are concerned that the meaningful involvement of civil society during the target setting process for the 100-day plans as well as in the overall HIV prevention policy and programme development and implementation varies within and between countries. We urge Member States to address challenges facing the ability of civil society organisations to engage meaningfully in HIV prevention policymaking and programme design and implementation, including financial resource constraints threatening community systems strengthening.

We also note that high rates of migration in the region, social marginalisation, stigma and discrimination remain key barriers to HIV prevention and are exacerbated by the lack of an enabling legal and policy environments. We urge Member States to address these barriers in a person-centered manner that ensures that no one is left behind.

The recent flat-lining and decrease in funding for HIV is of great concern and the HIV response in the region is facing an uncertain future. We urge donors to honour their overseas development aid commitments and for Member States to continue increasing domestic allocations to HIV programming. Further, we call on Member States and the global community to ensure that a quarter of all global AIDS spending is allocated to HIV prevention interventions and that community-led service delivery covers at least 30 per cent of all service delivery by 2030 as promised in the 2016 Political Declaration on HIV and AIDS.

More than 3 decades into the HIV response, innovation is critical – particularly in policy and programming for key populations, adolescent women and young girls and their partners. We cannot continue “business as usual” and need to focus on the quality of services, not only the quantity of services provided.

We are particularly concerned by the limited reporting and progress in the following key areas in the 100-day plans:

  • policy changes to create an enabling environment for prevention programmes;
  • defining service packages (specifically for AWYG and key populations);
  • social contracting mechanism for civil society implementers; and
  • size estimation studies for key populations, in particular people who use drugs and transgender people

We urge Member States to use the platform provided by SADC for peer-learning and capacity strengthening between those Members States who have progressed in these areas outlined above and those who have not. This is also an opportunity for Member States to engage civil society organisations who focus on these areas to use and learn from their expertise and experiences.

We remain committed to addressing structural barriers to HIV prevention and appreciate that the template to assess the implementation of the Regional Strategy for HIV Prevention, Treatment, Care and Reproductive Health and Rights among Key Populations already includes strong indicators to track interventions to address structural barriers.

However, we recommend that the SADC Secretariat and Member States consider key indicators outlined in the attached annexure in their reporting on HIV prevention plans to continue accelerating HIV prevention efforts.

Johannesburg, South Africa
13 April 2018