Don’t Brexit the AIDS response: The world we come home to from Durban


The banners are rolled up, the Durban Convention Center floors are swept and the 18,000 delegates to the International AIDS Conference have all gone home. For many, the euphoric week of hugs, protests and panels blew by too fast. As global funding shrinks, there won’t be many more of these massive meetings. That makes it all the more critical to step up investment in and support for civil society now, as the engine that has driven funding, research, science and innovation in the AIDS response. Two recent reports I wrote explore both innovations and the challenges in actually getting the funds to communities.

The first was a report for African Men for Sexual Health and Rights (AMSHeR) on key populations’ engagement with global health financing. I worked at the Global Fund in 2013-15, during roll-out of the “new funding model”, and pushed for space for communities to advocate at the country level as an integral part of that model. So the job of assessing key populations’ satisfication with that experience felt a little like my old Human Rights Watch colleague Marc Garlasco, who did high-value targeting in Iraq for the Pentagon before he went to the war zones for HRW to document civilian casualties caused by the bombs. (Though I hoped that the Global Fund’s “new funding model” had been less damaging than the Iraq invasion.)

The  report for AMSHeR and a coalition of African LGBT and sex worker groups looks at how the Global Fund and the U.S. President’s Emergency Plan for AIDS Relief (“PEPFAR”) have done in their recently stepped-up efforts to consult with key populations in the region. The results of this research project were both as good as I hoped and as bad as I feared.

Many African countries have seen an unprecedented level of activity by key populations-led groups, advocating and advising ands generally using every bit of space we fought for them to get, and more. But despite this intensive, time-consuming engagement, key populations told us that their work remains underfunded. After an initial meeting or two with donors at a four-star hotel, many never hear back about what actually went into the grants. Levels of knowledge of Global Fund and PEPFAR processes and policies, including even the basic info about health budgets and programs in their own countries, were abysmally low.

Or as one key populations representative put it, “We are engaged in the process. When the money comes out, we are out.” Others said that their recommendations were the first to be cut after the consultations: Kenyan advocate Peter Njane noted wryly, “When Peter goes out of the room, MSM go out the window.” In a few countries such as Kenya, groups like Peter’s worked in coalition and successfully pushed for funding for their work.

However, while donors like the Global Fund are calling for more key populations engagement, some governments are balking. At the recent UN High-level Meeting on HIV and AIDS, a bunch of them, reportedly led by Russia and Iran, banded together to block 22 key populations groups from participating in the meeting, and to cut reference to those groups from the UN Political Declaration that frames the global HIV strategy. (Here’s more on the debacle, en Français).

A few governments have seen the light and have funded communities directly. Another report I wrote for UNAIDS, with co-conspirator Michael O’Connor, compiled 6 country case studies in which governments found innovative, democratic ways to do just that. Some advocates may scratch their heads over the list of countries: Malaysia, India, Malawi, Brazil and Moldova.

Let’s just say that Michael and I had a very hard time finding even six cases, and some of them have mixed records. For instance, Malaysia’s nifty mechanism for funding key populations has done good things for harm reduction, but largely failed to fund struggling LGBT groups. In India, a formerly massive model of funding NGOs through state AIDS societies has been curtailed by the current government. Instead, India’s leaders are trying to shut down access to foreign funding to thousands of NGOs, including the heroic Lawyers Collective, which has fought valiantly for rights of key populations and for affrodable treatment.

Activists in Durban staged a protest and press conference for Lawyers Collective. Here’s Mark Heywood speaking eloquently  about the efforts of China, India, Russia and others to crush civil society, disappear human rights lawyers, and as he says, “choke democracy.”

The fight for HIV over the next 5 years looks set to be a brutal fight over who gets the dwindling money, and a fight to keep beleagured civil society institutions open. Community-based organizations will be told condescendingly, in many countries, that they “lack capacity” to handle big grants. But some of the larger business-as-usual organizations should expect a growing clamor for them to do better at cash absorption in high-burden countries where donor funds have sometimes sat unspent for months, due to regulatory barriers, slow procurement pipelines, — and, one suspects, reluctance to set up programs that serve politically sensitive key populations.

Unless we fund and create space for key populations and human rights advocates to do their jobs, we’re not going to make progress towards ending any epidemics anytime soon. Or as Kenyan rights advocate Allan Maleche and a crowd shouted at the Lawyers Collective solidarity protest: “Hands off the lawyers, hands off the drugs.”






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