Holding Governments Accountable for their Commitments in Ending AIDS – A progress update of APCOMs engagement to date

Ahead to the 2021 UN General Assembly High-Level Meeting on HIV and AIDS, APCOM is pleased to launch the Joint Statement for Asia and the Pacific region: Recommendations for meaningful integration of priority needs and concerns of Key Populations in Asia and the Pacific into the 2021 Political Declaration on Ending AIDS

The Statement came from two webinars held on 28 and 29 April attended by 66 participants, and also an online survey completed by 59 people. Both of these events allowed further opportunity to engage and reach out to our community in the region to seek their input, guidance and further validate the concerns highlighted in the development of the civil society statement.

“Thank you to the key population groups in Asia and the Pacific region for coming together to make a big noise about the need for 32% of resources to be invested in key population-led interventions to address the dreadful fact that 98% of all new HIV cases in Asia and the Pacific occurs among key populations and their sexual partners,” Midnight Poonkasetwattana.

The two sessions were partnered with UNAIDS Asia Pacific and the Asian Network of People Who Use Drugs (ANPUD), with leadership from APCOM’s Ambassadors; JVR Prasada Rao (HIV/AIDS Ambassador), the Hon Michael Kirby (LGBTQI Human Rights Ambassador), and Ratu Epeli Nailatikau (Pacific Ambassador), and final remarks from Chair of the APCOM Regional Advisory Group, Dédé Oetomo. 

APCOM and our regional partners significant contributions to the consultative process have ensured that the voices and needs of the LGBTQI community from Asia Pacific are not forgotten.

“We implore that everyone invests and implement based on research because we know for a fact AIDS can be eliminated, HIV can be treated and engagement with communities is a must. We must end stigma and discrimination by ending criminalisation of Key Populations.”

Datuk Dr. Christopher Lee, President, Malaysian AIDS Council

The Statement highlights a total of 12 key recommendations and have been submitted to the following bodies as recommended from the consultations, with endorsement from 35 organisations, including the main key populations networks in Asia and the Pacific region; ANPUD, APCOM, APN+, APNSW, APTN, and Youth LEAD:

• President of the General Assembly,
• UN Secretary-General
• Co-facilitator of the High-Level Meeting
• UNAIDS Executive Director
• WHO Director-General
• Advisory Group to the Multistakeholder Taskforce
• Multistakeholder Taskforce 

“Ending AIDS is contingent to ending criminalization of people who use drugs, people engaged in sex work, men who have sex with men and transgender people”

Mr. Simon W Beddoe, Chairperson, ANPUD

The 12 Recommendations

1. The Declaration must specifically and expressly name key populations and vulnerable groups most affected by HIV. These are: people who inject drugs, gay men and other men who have sex with men, transgender persons, sex workers and prisoners. Each key population group must be named, recognised and respected. Specific targets should be developed and set explicitly for each key population group which will result in effective and tailored solutions. The Declaration must also specifically and expressly address and recommend effective measures against discrimination on the grounds of sexual orientation;
   
2. Governments, relevant UN agencies, funders and other stakeholders must identify, expose and take immediate action to remove legal, social, and structural barriers preventing key populations in accessing sustainable services and solutions, and must have effective measures in place to counter human rights violations, gender-based violence, stigma and discrimination;
   
3. Governments must decriminalise substance use, sex work, sexual orientation, gender identity and/or expression and guarantee an enabling environment in which key populations can live a life without fear, in freedom, free from discrimination and reach their full potential. In countries where key populations continue to be criminalised, data protection with safeguards must be guaranteed;
   
4. Governments must assume leadership and accountability, prioritise and make funds available in the continued fight against HIV and AIDS. In view of the approach and inaction of some governments in the region, HIV and AIDS continue to be a significant challenge leading to severe detrimental effects on key populations. Member States should reaffirm and guarantee the access to safe, effective and affordable medicines and commodities for all key populations, without discrimination, in the context of HIV epidemic. These are fundamental to the full realisation of the right to enjoy the highest attainable standard of physical and mental health; 
   
5. Governments must enable and accelerate full, equal and meaningful participation of affected communities at all levels and in all steps in preventing HIV. At least 40 per cent of resources committed for AIDS programmes should flow into high impact prevention among key populations who are bearing the maximum brunt of new infections and deaths. The intention of a people-centred political declaration must translate into the direct engagement of the community at all levels, including policy development, practice, planning, implementation and monitoring of progress. Communities must be empowered and be connected with various stakeholders, including relevant government ministries and agencies, UN agencies, donors and other relevant stakeholders. Broadening the space for communities to become partners in HIV, health and social-protection-related decision-making processes and execution of practices also requires openness, commitment and adequate resources from governments and other stakeholders;
   
6. Member States must ensure that services comply with human rights standards and that all forms of violence, discrimination and coercive practices towards key populations in health-care settings are prohibited and further eliminated. There is a need to modernise service delivery. Virtual interventions must be promoted and further developed, not just in the context of COVID-19. In addition, the implementation of differentiated service delivery (DSD) must be expanded to increase community-led distribution and delivery of HIV services including prevention, testing and treatment;
   
7. National governments must ensure wider access by key populations to scientifically-proven innovative HIV prevention tools such as Pre-Exposure Prophylaxis (PrEP), and HIV Self-Testing (HIVST), including immediate and increased access to Antiretroviral treatment (ART), and adherence among People Living with HIV (PLHIV) as Treatment as Prevention (TasP), using the principles of ‘Undetectable = Untransmittable’ (U=U);
   
8. Adequate financial support from governments and donors must be guaranteed and set in motion to key population communities and organisations to respond to HIV and AIDS. In the past year, in particular, but even before the onset of the COVID-19 pandemic, networks and organisations working to prevent HIV and AIDS, experienced struggles and other negative impact due to the national government’s de-prioritisation of HIV and AIDS response, coupled with a lack and/or redirection of funding by international donors. The large demands on national health budgets occasioned by consequences of the COVID-19 pandemic must not impede achieving an end to HIV by 2030. Similarly, in order to achieve the 2030 SDG Goal 3, it will be essential that donor countries maintain the established high levels of financial support;
   
9. There must be enhanced international cooperation to support the efforts of Member States to achieve health goals, with a particular focus on those who remain at high risk, namely key populations, towards ending the AIDS epidemic by 2030, implement universal access to health-care services and comprehensively address health, development and human rights challenges;
   
10. At national level, governments must implement a multisectoral approach that goes beyond health for a more effective HIV response. Cross-sectoral coordination among relevant ministries and/or state agencies in response to HIV must be built and strengthened to tackle related health and development issues. Essential components of such an approach requires re-establishing strong political commitment, with adequate resources and improving governance structures. There should be strong and effective coordinating bodies, such as the National AIDS Commissions, to lead the multisectoral response, and the Commissions should be empowered to allocate resources to priority programmes and be accountable for tangible outcomes. There is also a need for more stakeholders, including the private sector, to actively participate in prevention and control of HIV;
    
11. There is a need to urgently review the eligibility criteria for receiving grants from the Global Fund. There are many organisations who serve and address the needs of key populations in Asia and the Pacific who are struggling to survive because the country they are in, is no longer eligible for grants from the Global Fund, but whose government has de-prioritised the fight against HIV and AIDS. Countries which are middle income but carry a high disease burden, should be eligible to receive Global Fund grants until 2030;
    
12. Key populations need to be meaningfully included in addressing challenges and offering solutions caused by the COVID-19 pandemic. More than a year into the pandemic, there are still very few signs that key populations are being included. In addition to being marginalised in the political sphere, thousands of members of our communities, including key populations, continue to experience the ever- changing impact of COVID-19. We are also witnessing LGBTQI community organisations having to close operations due to lack of sustainable funding and many organisations have not received emergency funding.  For those who manage to survive, the burden of community leaders is negatively affecting their mental health and abilities to perform.

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