Funding community-led HIV responses: we’re not there yet

who_eb124_090119In 2016, UN member states committed to two goals as part of the big global push to end AIDS: Ensure that 30% of all HIV service delivery is community-led, and ensure that 6% of HIV resources are allocated to advocacy, community mobilization, and other “social enablers”. But a recent UNAIDS report to which I contributed found that instead, global investment in these two commitments has declined.

The report, Best practices on effective funding of community-led responses, was written for the 43rd meeting of the UNAIDS Programme Coordinating Board (the PCB) in December 2018. Other controversies grabbed the limelight that week, so some positive developments got overshadowed – for instance, new work by UNAIDS on affordable medicines, a moving discussion of mental health, and a significant expansion of UNAIDS’ work to address HIV among migrants.

But back to that promise to fund community-led responses. Looking at data from health financing institutions including the Global Fund, PEPFAR, European Union, Japan, and private philanthropies, among others, we found not much clear and consistent data – everyone was measuring different things — which makes it hard to hold anyone accountable. Does “community-led response” describe community health workers working in government clinics? Key-population led NGOs? What about international NGOs with local offices? Same with “social enablers” – what kinds of advocacy and mobilization do they include or leave out? There’s no clear agreement, so donor reports are measuring apples and oranges.

More work needs to be done to agree what these terms are precisely meant to capture. HIV funding to civil society organizations should be disaggregated further to track investment in organizations that are led by people living with HIV, women, young people and key populations.

In many countries, political and bureaucratic barriers, or closing civic space, make it hard for civil society groups doing the real frontline work, let alone rights-based advocacy, to access HIV funding. Human rights are interdependent: you can’t progress right to health without the right to freedom of association or expression.

UNAIDS has developed a good tool, the National AIDS Spending Assessment, to enable countries to monitor and report what they are funding, but as this site shows, few countries have reported lately. Robert Carr Fund for Civil Society Networks has some good practices in tracking investment in social enablers, which other donors could consider.

Can more money be raised for the global HIV response? While the Global Fund has launched its new investment case, AIDS activists say the new $14 billion ask isn’t enough. Luxembourg and Ireland have already pledged more than in the past — so maybe there’s hope that we can reach those 30% and 6% commitments after all.



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