The Programme Coordinating Board (PCB) is the governing body of UNAIDS and it is made up of Member States, UN agencies and NGO Delegates. Our mission as the PCB NGO Delegation is to ensure that the priorities and interests of affected people, constituencies and communities are considered in UNAIDS decisions and policies.

Meet the NGO Delegation in Melbourne at AIDS 2014

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The NGO Delegation to the UNAIDS Programme Coordinating Board (PCB) will be holding an interesting and engaging session at the upcoming World AIDS Conference. Titled ‘Meet the Experts,’ this interactive session will allow the audience to gain a better understanding of what the NGO Delegation does, how it works within the UNAIDS PCB, and how they ensure civil society concerns from around the world are channeled to and addressed by the UNAIDS Secretariat.

The session will take place on Monday July 21, 14:30-16:00 at Claredon Room D&E. In attendance will be delegation members from Africa, Asia and the Pacific, Europe, Latin America and the Caribbean, and North America.

Looking very much forward to seeing you there.

Final decisions, recommendations, and conclusions of the 34th PCB

Blog17 July 2014   [PDF] [print]

34th Meeting of the UNAIDS Programme Coordinating Board
Geneva, Switzerland; 1-3 July 2014
Decisions

Below is a summary of outcomes or decisions of the meeting. Agenda items not mentioned, were adopted by the board or unchanged. The entire document can be downloaded here. For the agenda of the meeting, click here.

Agenda item 3: Update on the AIDS response in the post-2015 development agenda
5.1 Welcomes the update on the AIDS response in the post-2015 development agenda and;
5.2 Takes note of the decision of the UNAIDS Programme Coordinating Board at its 32nd meeting on the post-2015 development agenda, in particular: a. Stresses the importance of ensuring that HIV and AIDS are central to the post-2015 UN development agenda and of advocating for the inclusion of targets under relevant goals towards achieving zero new HIV infections, zero AIDS-related deaths and zero discrimination; and b. Builds on the lessons learned from the HIV and AIDS response in addressing other complex health and development challenges in the post-2015 era;
5.3 Takes note of the ECOSOC Resolution E/RES/2013/11, in particular: a. Recognizes the value of the lessons learned from the global HIV and AIDS response for the post-2015 development agenda, including the lessons learned from the unique approach of the Joint Programme and that the Joint Programme offers the United Nations a useful example to be considered, as appropriate, as a way to enhance strategic coherence, coordination, results-based focus and country-level impact, based on national contexts and priorities;
5.4 Takes note of the ongoing work of the Open Working Group on Sustainable Development Goals and its explicit inclusion of language on “ending the epidemics of AIDS, tuberculosis and malaria”;
5.5 Calls on member states and the UN Joint Programme to pursue, in line with our common vision of the three zeros, a clear commitment in the post-2015 development agenda to ending the AIDS epidemic as a public health threat and an obstacle for overall sustainable development by 2030, provisionally defined as the rapid reduction of new HIV infections, stigma and discrimination experienced by people living with HIV and vulnerable populations and key populations, and AIDS-related deaths by 90% of 2010 levels, through evidence based interventions to include universal access to HIV prevention, treatment, care, and support, such that AIDS no longer represents a major threat to any population or country; As defined in the UNAIDS 2011-2015 Strategy ‘Getting to Zero’, footnote n. 41: ‘Key populations, or key populations at higher risk, are groups of people who are more likely to be exposed to HIV or to transmit it and whose engagement is critical to a successful HIV response. In all countries, key populations include people living with HIV. In most settings, men who have sex with men, transgender people, people who inject drugs and sex workers and their clients are at higher risk of exposure to HIV than other groups. However, each country should define the specific populations that are key to their epidemic and response based on the epidemiological and social context’.
5.6 Encourages the UN Joint Programme and member states to pursue HIV-sensitive indicators under several goal areas, including, but not limited to, health, gender, education, partnership, and youth, to ensure policy coherence and joined-up action to address the social, political, economic and environmental determinants of HIV, poor health, poverty and inequality (at community, national and global levels); and strengthened inclusive accountability mechanisms to enable broad participation and ownership in implementing and monitoring the post-2015 agenda;

Agenda item 4: Follow-up to the thematic segment from the 33rd Programme Coordinating Board meeting: HIV, adolescents and youth
6.1 Takes note with appreciation of the summary report of the Thematic Session on HIV, adolescents and youth;
6.2 Recognizes with great concern that globally young women aged 15-24 have HIV infection rates twice as high as young men, and that there is a persistent and significant gap between antiretroviral treatment coverage rates for adult vs. adolescents and children;
6.3 Encourages member states to urgently scale up evidence informed, gender-responsive, youth-friendly HIV prevention, increase access to paediatric HIV treatment, scale up care and support programmes and to empower youth-led associations in order to ensure their participation throughout the HIV programming cycle including design, implementation and monitoring and evaluation;
6.4 Urges member states to strengthen initiatives that would increase the capacities of young women and adolescent girls to protect themselves from HIV infection;
6.5 Requests the Joint Programme to support countries, upon request, in reviewing their HIV testing, counselling and treatment policies and address age- and gender related legal, regulatory and social barriers to HIV testing, prevention treatment, care and support faced by adolescents;
6.6 Encourages member states and the Joint Programme to follow up on decision points 8.5 and 8.9 from the 24th Programme Coordinating Board with respect to comprehensive programing for adolescents and youth who inject drugs;
6.7 Further requests the Joint Programme to support countries to improve systematic and coordinated collection, dissemination and analysis of sex- by age disaggregated data at the national and sub-national level;
6.8 Recognizing the contribution of young people through the full programme cycle and within decision-making processes, requests UNAIDS to develop indicators to monitor youth participation within the AIDS response;

Agenda item 5: UNAIDS 2012-2015 Unified Budget, Results and Accountability Framework; 5.1: Mid-term review
7.1 Takes note of the report; expresses appreciation for the role that the Joint Programme has played in the response to AIDS; and urges acceleration of UNAIDS efforts to support countries achieve the global AIDS targets adopted by the UN General Assembly in 2011;
7.2 Decides to extend the duration of the existing strategy for two years through 2017, requesting UNAIDS to update the goals in the current strategy and to present on that basis an updated UBRAF for 2016-2017 at the 36th meeting of the Programme Coordinating Board, taking into account the lessons learned from the Mid-term review of the UBRAF and the ongoing consultative process of improving the UBRAF, including the need for a clear results-chain linking outputs to outcomes and impact intended for the Joint Programme;
7.3 Requests UNAIDS to develop the next phase strategy (starting 2018), results framework and budget for consideration of the Programme Coordinating Board at its 40th meeting, building on the current strategy and our common three zero vision, aligned with the resolution on the Quadrennial Comprehensive Policy Review (QCPR) of operational activities for development and taking into account lessons learned from the implementation of the QCPR and the UBRAF;

Agenda item 5: UNAIDS 2012-2015 Unified Budget, Results and Accountability Framework; 5.2: Performance reporting
7.4 Takes note of the report (Performance Monitoring Report) and requests UNAIDS to provide a consolidated Performance Monitoring Report to the 36th Programme Coordinating Board that captures progress against core indicators as well as expenditures; shows the link to outcomes, goals and targets; distinguishes cosponsor, Secretariat and joint results; and, using the UBRAF structure, showcase country performance;
7.5 Requests the Secretariat to prepare a conference room paper for the 35th Programme Coordinating Board meeting on concrete actions taken to address and implement the previous decision points approved by the Programme Coordinating Board that relate to civil society;

Agenda item 5: UNAIDS 2012-2015 Unified Budget, Results and Accountability Framework; 5.3: Financial reporting
7.6 Accepts the financial report and audited financial statements for the year ended 31 December 2013;
7.7 Takes note of the interim financial management update for the 2014–2015 biennium for the period 1 January 2014 to 31 March 2014, including the partial funding of staff-related liabilities and the replenishment of the Building Renovation Fund;
7.8 Encourages donor governments to release their contributions towards the 2012–2015 Unified Budget, Results and Accountability Framework as soon as possible;
7.9 Requests UNAIDS to do an analysis to determine the appropriate lower-limit threshold for the net fund reserve and report back at the 36th Programme Coordinating Board meeting;
7.10 Requests UNAIDS to hold a Financing Dialogue aimed at ensuring predictable and sustained funding, the efficient management of funds and transparency for effective implementation of the UBRAF within the overall AIDS response. The Financing Dialogue should take place before the end of 2014 to discuss programmatic and financial accountability and reporting, to review the distribution of core and non-core funds and to provide monitoring information on trends in funding and expenditures in relation to strategic directions and functions;

Observer Intervention on Post-2015 Development Agenda

Blog17 July 2014   [PDF] [print]

Update on the AIDS Response in the Post-2015 Development Agenda

Joint statement delivered by Caritas Internationalis on behalf of Association Community Pope John XXIII, Caritas Australia, Ecumenical Advocacy Alliance, Edmund Rice International, International Association of Charities, International Catholic Child Bureau, Medical Mission Institute, and Trócaire.

The co-signatories believe that the AIDS response in the Post-2015 Development Agenda needs to aim toward completion of the positive results already attained through such public health interventions as development of more effective testing and treatment and universal access for all in need. Complete change in focus and priorities should be avoided or we risk additional outbreaks of generalized epidemics of life-threatening infectious diseases such as HIV. The international community also should promote an integral system of care that prioritizes community-based primary care, and includes prevention of vertical transmission as well as treatment, in particular for HIV-positive children, children living with HIV/TB co-infection, and their mothers. Such care also should be holistic in focus, attending to the needs of the whole person, including physical, emotional, and spiritual needs. Of particular concern in this regard is the situation of HIV-positive children, and children living with HIV/TB co-infection. Despite evidence that treatment is very successful in such children, even in resource-limited settings, there remain significant obstacles to expansion of ART access for children living with HIV. For children living with both HIV and tuberculosis (TB), the situation is even worse: despite the fact that TB remains the main cause of death among children with AIDS, paediatric drug formulations are not available to treat HIV/TB co-infection in children. The Post-2015 Agenda should take into account and aim toward positive policies and practical actions to eliminate the negative social, economic, and political determinants of poor health, including poverty, poor quality education, insufficient or improper nutrition, conflict and violence, in order to assure quality of life and living conditions that promote and assure health for all. Furthermore, Caritas Internationalis and the other co-signatories point out the need for the Post-2015 Development Agenda to acknowledge and support the key role of civil society and, in particular, of faith-based organizations, in addressing the health needs of isolated populations, of those living in “Failed States”, of those affected by generalized violence and long-term emergencies, and aim to ensure adequate resources to non-State actors engaged in health care in places that are not reached by the public health system.

34th PCB Thematic – Panel Discussion Speech

Blog15 July 2014   [PDF] [print]

34th PCB Thematic – second moderated panel discussion
By NGO Delegate Charles King, North America

“Low-Threshold Harm Reduction Housing for Active Substance Users Living with HIV who are Experiencing Homelessness or Housing Insecurity”

I used to walk the streets of New York City and see people sitting on the sidewalk holding signs that read “Homeless with AIDS – Please help me!” and I used to think to myself, how could this possibly be happening in the wealthiest city, in the wealthiest country in the world. That question led me to join a small group of people who formed the Housing Committee of ACT-UP New York to agitate about homelessness.

As it turns out, homeless people with HIV and AIDS in NYC tend to come from certain specific groups – many use injection drugs or smoke crack; many are mentally ill; many are gay, bisexual, transgender or lesbian, and had their first taste of homelessness as abused or cast-away adolescents or teenagers; many are former prisoners, usually convicted of crimes associated with addiction or poverty. And of course, all of these cohorts overlap enormously.

In other words, the reason NYC had an estimated 12,000 homeless people with AIDS living on its streets in 1989 was because these were people we would just as soon throw away. But of course, the excuses always give for not doing anything was that “drug addicts can’t be housed.” So we founded Housing Works to prove that this wasn’t true.

(After all, most people who are addicted to drugs or alcohol are not only stably housed, they go to work every day … and if you don’t believe that, you don’t know your neighbors very well!)

Our approach is pretty simple. We provide people – single adults, couples, and families with children with safe decent housing and wrap support services around it. What does safe and decent mean? Well, I have lived in one of our community housing facilities now for over 15 years – so it has to be good enough to where I would want to live there.  What kind of services? It depends. For some it is a home visit by a care manager at least once a week, every day when there is a crisis. For others, in congregate units, we have trained staff on site 24 hours a day. What you do in the privacy of your apartment is your business, but we are always ready to listen and help out if you have a problem.

So what is the result? Well, the overwhelming magnitude of our folk do quite well, with many moving to our more independent housing settings after a year or two in a supportive environment. All in all, about 95% of the people we house come in with long histories of addiction. And generally, we see the same pattern in our facilities. Over time, about 1/3 of people stop using drugs all together, 1/3 reduce or change their use so that they can successfully manage all of their other activities of daily living, including employment. And 1/3 continue to live reasonably chaotic lives but are having their health needs met.

Even before we started “the Undetectables,” over 70% of people living in our housing were completely virally suppressed. And that isn’t unusual. Studies show that housing stability is a much bigger predictor of viral suppression than factors such as mental illness or drug use. And just to show you why housing is so important, people who are housed after being homeless are four times less likely to engage in high risk behavior such as sharing syringes or transactional sex. When you look at data like that, you quickly see that housing is an effective healthcare intervention for people living HIV, both for its prevention benefits and for the direct health outcomes.

But housing is just the first step. If you offer other services on top of housing, like voluntary harm reduction therapy, mental health services and education, job vocational training and work opportunities, such as we have at Housing Works, you achieve even bigger success.   What kind of success?  Well, over 25% of Housing Works’ 600 fulltime employees, including a number of managers and program directors, came through our doors as homeless people living with AIDS.

What is the causal link between homelessness and HIV?

There have been a number of studies that show that homeless people are up to seven times more likely to become HIV positive than other people, even controlling for other risk factors such as injection drug use and sex work. For homeless people, it’s not about risk behaviors – it’s more about a high-risk context that involves chaos, violence, particularly for homeless women and gay men, lack of privacy, and pressure to engage in high-risk sex for survival.

In fact, we are seeing a case study of these unfold before our eyes in Greece, where the economic crisis has forced more people who use drugs into homelessness, resulting in huge upsurge of new HIV infections.

Why is housing so important?

Safe, stable housing is the threshold to everything else, including reducing risk, increasing access to care and maintenance of treatment, and the ability to make positive and healthy choices and changes in behavior. Study after study shows that:

  • Housing reduces behaviors that can transmit HIV
  • Increases rates of engagement in primary care
  • Increases use of ARVs
  • Increases adherence to treatment
  • Increases viral suppressing
  • Reduces avoidable emergency room and in-patient care
  • And uses less public resources even taking into account housing supports… unless of course, you count on people dying earlier for lack of a place to live.

What are appropriate up-steam interventions?

The first thing we need to do is just start tracking the housing status of the people we serve – it costs almost nothing but that isn’t done in most places and if we tracked it – the implications would jump out at us.

The second thing is to start seriously experimenting with housing interventions, from rent subsidies to supportive congregate housing, in low and middle income countries to prove the viability and cost-effectiveness of the intervention in those settings – it’s pretty shocking that the only body of research on housing and HIV is in North America.

The third is to scale up using both HIV specific and cross-sectorial HIV-sensitive approaches. For example, housing program targeting key homeless populations with HIV aren’t that expensive. Meanwhile, if a LIC or MIC is using World Bank money to develop housing, why not prioritize housing homeless people with HIV an those most at risk of infection?

Sitting here in front of representative of nation states, large and small, rich and poor, I ask you to imagine what it would be like if you were a homeless person with HIV or AIDS. Where would you sleep? What would you eat?  How would you bath or take your ARVs? And how would you feel when people look the other way as they pass you by on the streets as if you were nothing more than unsightly rubbish?

Then imagine if that person you just conjured up were your brother or your sisters, your son or your daughter. And when you go home to the country from which you have come, or to the next meet with the leadership of a country to which you give aid, consider a program that treats every homeless person with HIV as if he or she is that person. If you do that, we will know the real meaning of solidarity in a world living with AIDS.

Observer Intervention at 34th PCB Thematic

Blog15 July 2014   [PDF] [print]

By Eliane Drakopoulos, Public Policy and Advocacy Officer, Elizabeth Glaser Pediatric AIDS Foundation

The Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) strongly welcomes the report submitted by the UNAIDS Secretariat regarding the importance of social protection in the HIV response, and today’s wide-ranging discussion on these issues, particularly the moving personal stories we have heard.

Within that context, EGPAF believes that increased attention must be paid to the role that gender inequality plays in limiting progress in preventing pediatric HIV, and in increasing testing, care and treatment for all women, including especially adolescent girls.

Traditional perceptions of masculinity often enable and encourage men to dominate sexual decision-making, engage in risky sexual behaviour, perpetrate violence against women, and refrain from seeking healthcare services—all of which place men, their female partners and children–especially adolescent girls–at risk of HIV.

In fact, data from several countries suggest that the risk of acquiring HIV is up to seven times higher for women with violent or controlling intimate partners. Pregnancy, in particular, is a period during which women often experience increased physical and sexual violence from their intimate partners.

Women’s perception of their partners’ approval of HIV testing has been identified as one of the strongest predictors of women’s willingness to test. Likewise, opposition from male partners is associated with low HIV testing uptake and failure to return for test results. Up to 75% of women in some countries say that their partners alone make health decisions for their families.

On the other hand, research shows that programmes that target transformation of gender roles, screen for intimate partner violence, promote gender equitable relationships, and constructively engage men as supportive partners for women’s health can improve health outcomes for women, men and children, including in the area of HIV.

International commitment to end paediatric AIDS is now greater than ever. Promoting gender equality, in conjunction with facility-based medical interventions, has the potential to produce so many gains. It can enable programmes to expand beyond just delivering ARVs to pregnant and other women and work towards enabling women to protect themselves from HIV, decide their own fertility, and access and continue to use HIV prevention, care and treatment services. By integrating these approaches into national HIV plans there is promise that governments and donors can achieve better results. On the other hand, without more widespread implementation of gender transformative HIV programmes, increasing treatment, care and support for women will be impossible, and the elimination of pediatric HIV will remain elusive.

Representing Civil Society on the UNAIDS Programme Coordinating Board