Ecumenical Advocacy Alliance

Lyn's Comment: A very prominent advocacy voice in faith communities is the Ecumenical Advocacy Alliance, based in Geneva, Switzerland.  CABSA has been working with the Alliance in various ways and are official members of the Alliance.

More Information on Advocacy from the Social Welfare Forum

"The aim of the Policy Engagement programme of the National Welfare Forum is to ensure public participation in the formulation of social service, welfare and development policies. The ultimate goal is to not represent civil society but to facilitate the process for members to coordinate and represent themselves."

Lyn's Comment: The material below is taken from various parts of the Participant Handout for the Policy Engagement programme, which can be downloaded from the Forum website The Participant Handout 2009 can also be downloaded

What Is Advocacy?

Advocacy means any action geared towards changing the policies, positions or programmes of any type of institution. Advocacy is about identifying a problem in a community, coming up with a solution to that problem, establishing strong support for that solution and providing an effective implementation plan.

Lobbying influential people for support is part of the advocacy process.

When the beneficiary is an individual the advocacy effort could be considered as Private Advocacy. When the advocacy aims to benefit the public at large, or a large group of individuals, it could be regarded as Public Advocacy. It is sometimes difficult to distinguish public advocacy from private advocacy.
Sometimes public advocacy efforts stem from private advocacy initiatives. Most advocacy conducted by Civil Society Organisations (CSOs) is public advocacy.
Examples of Private Advocacy:
When an individual campaigns for street lighting in their neighbourhood to prevent crime; When an individual campaigns for a bus stop in the neighbourhood.
Examples of Public Advocacy:
When organisations come together to launch a specific effort to combat crime in business, ego Business Against Crime; When several organisations come together to improve road safety or public transport. 

What is Social Justice Advocacy?
Social justice advocacy is public advocacy that draws attention to an injustice and promotes the public good. It focuses attention on improving the well-being of the poor and marginalised members of the community, for example, women, children, workers, the disabled, etc. 

What is Lobbying?
Lobbying comes from the verb "to lobby", which means an attempt by citizens to influence public officials at a high level. Lobbying is one of the most common methods used by citizens to influence public policy. It is used to put pressure on politicians and government officials to take up the interests of the people and to support their cause. In most democracies lobbying is recognised as a legitimate way for citizens to have their voices heard. However, critics of lobbying say that wealthy people and business are better able to spend time on and pay for various lobbying activities. 

Advocacy Goals
It is useful to remember that there are long term and short term goals in advocacy work. The long term goal relates to the change the campaign wants to make in people’s lives. It is known as the Impact goal. This goal reflects the problem the campaign wants to address.
Usually this change is only policy if a law changes or a new law/policy is developed. This change in the legislation or system is the short term goal on the journey toward solving the problem. It is known as the Effect goal and it usually describes the decision that the decision maker is called on to take.  These goals are met through an interactive process known as the cycle of advocacy. The stages in the advocacy cycle do not necessarily follow a specific order and often the campaign shifts from implementation mode back to redefining the problem as the campaign progresses and more information about the problem or stakeholders emerges.

The Advocacy Cycle 

‘Just as humans seek a dignity that says not by bread alone, so we as (social) advocates must work to effect change not by elections alone, not by mass mobilisation alone, not by lobbying alone, not by information alone, not by coalition alone, not by media alone and not by anything else alone.’   (Michael Pertschuk, Advocacy Institute, USA)

The advocacy process may involve any combination of the above approaches.
The effectiveness and success of any advocacy process depends, amongst other factors, on how well the following processes are implemented:

Analysis includes collective brainstorming of the problem which can be carried out in the form of a detailed problem tree analysis. The output of this exercise will form the basis for the advocacy approach to be developed later. During this stage research about the problem environment is critical to develop a comprehensive picture of the dimensions of the problem. This could merely entail the reference and synthesis of research already undertaken by other institutions, or the commissioning of tailor-made research.
Strategy Development entails making a realistic selection from the dream list of policy options already identified during policy analysis, and then prioritising based on what is realistic and expedient in terms of maximum outcome for minimum inputs. During this stage, the organization will also identify key stakeholders and possible strategic partners to engage.
Implementation refers to the operationalisation of the advocacy strategy to ensure that responsible individuals or teams are clearly mandated with specific tasks. Even though advocacy should be an organization-wide undertaking, the location of coordination and leadership around specific tasks is necessary to ensure that activities are carried out as planned and on time. Ideally, the advocacy plan should be integrated into the broader organizational and team work plans.
Evaluation and Review refers to the monitoring of advocacy and lobbying outcomes in relation to stated goals: How far have we come in relation to where we want to be and what further actions are needed to realize our goals? Was the strategy realistic, or does it require some strategic adjustment on our part? 

Advocacy Roles:
It is necessary to clarify the role that your organisation will play to achieve your policy goal. There are mainly four roles to consider:
1. Expert informant – Can you use your relationships with policy makers for providing technical advice on policy issues?
2. Capacity Builder – Can you support other organisations in their efforts to carry out advocacy?
3. Lobbyist – Do you want to take a visible approach and address your target audience personally?
4. Mediator – Can you broker competing interests of various groups and through mediation achieve policy change?"

Community Advocates Training Manual.

Subtitle: The HIV/AIDS Prevention Project for Vulnerable Youth in  Northern Nigeria

Published by the Population Council 2007

Abstract: The Community Advocates Training Manual is a joint effort between Population Council/Abujaand its partners  Adolescent Health Information Projects (AHIP), Federationo Muslim Women Associations in Nigeria (FOMWAN) and Islamic Education Trust( IET). The curriculum aims to improve knowledge and strengthen the skills of community representatives from the northern region of Nigeria to openly discussen sitive issues relating to HIV/AIDS, reproductive health and marriage.

Download this training manual here (PDF, 827.45 KB, 75 pg)

Participatory Advocacy: A Toolkit for VSO Staff, Volunteers and Partners. 11/09

Voluntary Service Overseas (VSO) have recently launched: ‘Participatory Advocacy: A Toolkit For VSO Staff, Volunteers And Partners’ . It provides a rich variety of approaches to advocacy. Although the toolkit has been written primarily for the use of VSO staff, volunteers and partner organizations, you can adapt and use all the materials for your own organization and cultural, social or political situation. Use this toolkit to plan and implement effective strategies that lead to enduring social change.

To download this resource, click here (PDF, 3.55 MB, 51pg)

Practical Action in Advocacy Part C

Part C of Understanding Advocacy.

Part C of Understanding Advocacy.  The advocacy cycle is suitable for all types of advocacy work and following it will improve your chances of success. The five sections in Part C explain the five steps in the advocacy cycle, from identifying the issue at the start, to evaluation at the end. These five stages lead into one another, but you may need to keep going back to previous stages if you want to gather more information or change your methods.

The actual time for planning and doing advocacy work will vary, depending on the urgency and complexity of a particular issue, the amount of information needed and the advocacy methods chosen. The basic process outlined in the introduction provides a framework and the main questions to address for an immediate response to an issue. You will need to work through each section in more detail for issues requiring a more longterm response.

Download this document here (PDF, 849.80 KB, 84 pg)

Advocacy & Communication - Handbook for CBOs. IDASA (2006).

Advocacy 2.0 Guide: Tools for Digital Advocacy

Quick and Easy Guide to Online advocacy. This guide presents advocates with a collection of popular online services that can be used for advocacy quickly with little to no technical support. There are services for publishing photographs and video, for setting up a campaign blog or for using mobiles to communicate in a group. An amazing amount of functionality and tools are available simply by connecting to the Internet and opening up a web-browser. You don't need to have a lot of technical expertise to try some of these. You also don't need much money, these services are offered at low- to no-cost. http://onlineadvocacy.tacticaltech.org/

Endorse the NGO Code of Good Practice

On December 1 2007, the Code of Good Practice for NGOs Responding to HIV/AIDS will re-open for new endorsements.

The NGO Code of Good Practice sets out the key principles, practice and evidence base required for successful responses to HIV, drawing on the knowledge and experience gained since the response to HIV began. Key issues addressed in the Code include:

- The meaningful involvement of people living with HIV and affected communities.
- Evidence-based programmes based on the needs of the most vulnerable.
-Transparent governance and accountability to beneficiary communities.

160 NGOs have already signed on to the Code. We invite you to make YOUR commitment to continuous improvement and accountability today by reading the Code and sending a signed endorsement letter to the Code Secretariat

HIV and AIDS Advocacy & Media Relations. Training Manual for Religious Leaders.

Religions for Peace has a commitment to strengthen advocacy among religious communities regarding the AIDS pandemic. Due to stigma and discrimination, children are often deprived of basic social services and the support of their extended families. Such an enviroment can open the door for abuse, sexual exploitation, and other issues.   Advocacy means championing a cause; creating awareness and understanding about AIDS; and working to ensure that relevant policies and programs are put in place. HIV/AIDS advocacy helps drive a more effective response globally, regionally and nationally.

This training manual, used together with the participants’ handbook, is meant to strengthen the advocacy and media relations skills of religious leaders at both national and community levels in order to expand their advocacy efforts on behalf of children orphaned and made vulnerable by HIV/AIDS, with the goal of bringing greater priority to their needs and expanding the response. Download here

How a Red Ribbon Conquered the World. 2/6/2011

History of the red ribbon as symbol for HIV and AIDS

By Tom Geoghegan BBC News, Washington DC

Thirty years after the HIV virus was first documented, the red ribbon is the ubiquitous symbol of support for those living with the illness. Who thought of it and how did it get so big?

In the sparse surroundings of a former classroom on a spring day in 1991 - a decade after the rise of Aids - a group of 12 artists gathered to discuss a new project.

They were photographers, painters, film makers and costume designers, and they sat around in the shared gallery space known as PS122 in New York's East Village.

Within an hour or so of brainstorming, they had come up with a simple idea that later became one of the most recognised symbols of the decade - the red ribbon, worn to signify support for people with HIV/Aids.

"We wanted to make something that was self-replicating," says Patrick O'Connell, who chaired the meeting. "It's extremely simple, like Bauhaus but half a century later. You cut the ribbon 6-7 inches, loop it around your finger and pin it on. You can do it yourself."

The ribbon was the latest project by Visual Aids, a New York arts organisation founded by O'Connell that raises awareness of HIV/Aids.

When they sat down in the shared gallery space of PS122 in May 1991, they wanted to get people talking about the illness that was decimating their professional and social network, in the face of public indifference and private shame.

People were dying without even telling their friends why they were sick, and the artists wanted a visual expression of compassion for people living with Aids and their carers.

"Even in New York, we were very aware of how many people couldn't talk about it, or were oblivious, or were going through it themselves but ashamed to talk about it," says photographer Allen Frame, who was also one of the 12. "We wanted to make people feeling isolated more supported and understood."

Their inspiration came from the yellow ribbons tied on trees to denote support for the US military fighting in the Gulf War, he says. Pink and the rainbow colours were rejected because they were too closely associated with the gay community, and this was an illness that went well beyond.

"Red was something bold and visible. It symbolised passion, a heart and love."

The shape had no significance but was easy to make.

It took two more meetings to refine the design and then they set to work on making the ribbons themselves, distributing them around the New York art scene and dropping them off at theatres.

Initially there was a text that went with it, to explain why they were being worn, although this was later dropped because it became superfluous.

A few weeks after that first meeting, the group sent a box of 3,000 ribbons to the Minskoff Theatre on Broadway, ahead of the Tony Awards for the theatre industry. Some of them were making ribbons and watching the televised event as actor Jeremy Irons, one of the presenters, came on to the stage wearing one.

"Within three days, the media finally figured it out and it snowballed. I started being contacted by people in Hollywood," says O'Connell.

Demand increased to such a degree that supply needed to be outsourced, and Visual Aids used a charity working with homeless women to make the ribbons. They sent out 10,000 ribbons for one Oscars ceremony, and over the coming years they made about 1.5m.

Stars like Bette Midler and Richard Gere were not only wearing them, but openly discussing why it was important. A ribbon-sporting culture developed within the acting profession.

"It became trendy and sometimes I think celebrities felt blackmailed and thought they had to show up wearing a ribbon, which wasn't the case," says O'Connell. "We weren't keeping count that way."

The ribbons first crossed the Atlantic in large numbers on Easter Monday in 1992, when more than 100,000 ribbons were distributed at an Aids benefit concert in London's Wembley Stadium for Freddie Mercury.

They also began to proliferate in mainstream American life. Schools and churches across the US touched by the illness started to contact Visual Aids for advice on how they could explain it to children and parishioners - the answer was to hold a ribbon-making event.

"This was a way to educate people in a non-combative way," says O'Connell, who has a ribbon on every item of clothing. Direct action was still important, he says - campaigners occupied the Stock Exchange and tried to re-enact a funeral on the White House lawn - but the ribbon was a way to broaden the conversation.

One unforeseen consequence has been the number of awareness ribbons that have been adopted since - pink for breast cancer being the most well known.

The artists purposefully never trademarked it - the point of the project was to invite more people in, says O'Connell - which meant it could appear anywhere without Visual Aids' permission or any payments. It even turned up on a US Post Office stamp.

But he and some of the other artists behind the concept believe the proliferation and merchandising of the ribbon - ornamental ribbons selling for $19.95 in department stores and red ribbon mugs - has commercialised and trivialised their idea.

In a spirit more in tune with the one envisaged by Visual Aids, the ribbon is replicated in many different forms for memorials on World Aids Day, and its symbolism no longer needs any explanation.

In the poorest parts of the world, ribbon production has been central to efforts to raise funds and change attitudes, says Sir Nick Partridge, chief executive of the Terrence Higgins Trust in the UK.

Women's collectives make ribbons and adorn them before selling them in their community.

"A number of people living with HIV really appreciate seeing other people wearing the red ribbon. They realise they're not alone and recognise that the majority of people wearing them probably don't have HIV themselves, and that sense of support and solidarity is very, very important.

"There has been some criticism, that it is only a symbol. But symbols are important, and the way in which the red ribbon was embraced by community activists, doctors and researchers is a unifying emblem in what is a very disparate epidemic.

"The brilliance of the artists was not copyrighting it. Making it freely available was a gift to the Aids community worldwide."

Those 12 artists never worked together again as a group, but with the battle against the illness ongoing, their activism continues.

Media Advocacy Manual.

Survival is the First Freedom: Applying Democracy & Governance Approaches to HIV/AIDS Work. PACT 1999

The Internet Advocacy Book

The online version of The Internet Advocacy Book is a free resource for non-profits and socially-progressive political organizations who use the internet to advocate for their cause.While "techies" may benefit from The Internet Advocacy Book, the intended audience is non-profit executives, cause marketing consultants, and political campaign professionals.Rather than a "how to" format, The Internet Advocacy Book is written as a "how better to" guide, with laser focus on the best uses of your internet-advocacy time. Here, you'll find candid advice and insightful recommendations, without the bias or self-interest of rah-rah sales reps. This approach is evident throughout the book. For each topic, you'll notice that the coverage of advantages and disadvantages includes at least as many cons as pros. Self-assessment scorecards will help you identify areas of current strength as well as weakness. And our recommendations are concise and specific; so you may find that you can accomplish many of your internet marketing goals with in-house staff and volunteers.

Why Advocate on HIV? (Tearfund) 2008.

“Advocacy is about influencing people, policies, structures and systems in order to bring about change. It is about influencing those in power to act more fairly.”

“This booklet is for organisations that are engaged in work with people who are living with or affected by HIV but have not yet considered carrying out advocacy on HIV. In this short guide, we look at what advocacy is, what global and local commitments have been made to address HIV, and why advocacy on HIV is necessary.

We look briefly at how to begin advocacy work on issues around HIV, and recommend further resources and contacts.

The aim of this booklet is to inspire organisations to integrate advocacy into their work in responding to HIV, in order to bring long-term positive change.

Download PDF (256.17 KB)

Join the Global Fund's Born HIV Free Campaign. 19/5/10

The 'Born HIV Free' campaign is being launched today at an event starring Carla Bruni-Sarkosy in Paris.

The 'Born HIV Free' campaign is being launched today at an event starring Carla Bruni-Sarkosy in Paris.

This social media campaign is part of the replenishment process for the Global Fund to Fight AIDS, Tuberculosis and Malaria, which will culminate in October 2010 with the announcement of international donors' financial contributions for 2011-2013. The Born HIV Free campaign adds to the calls for a fully funded Global Fund by emphasizing the Fund's crucial role in helping to prevent vertical or 'mother-to-child' transmission of HIV.

1. Most children could be protected from being infected with HIV when in the womb, during pregnancy or through breastfeeding if their mothers had access to the proper prevention, care and treatment services. In 2008, some 430,000 children under 15 became infected with HIV - the vast majority through vertical transmission
2. A fully funded Global Fund is a vital part of the international architecture that can help achieve Universal Access to HIV prevention, treatment, care and support, including for parents and their children

As people of faith, we are compelled to ensure that each child born is free from disease or disadvantage because we believe that each individual is precious and endowed with an inherent dignity that demands our care and attention. This is all the more so when protection from HIV infection in the womb, during delivery or through breast-feeding is achievable if we are alert, diligent and committed.

The EAA highlighted vertical transmission as part of its 2009 'Prescription for Life' campaign. The campaign saw hundreds of children asking pharmaceutical companies to do more to improve testing and treatment for infants and children living with HIV, including by improving access for all HIV-positive expectant mothers to antiretroviral medicines. During 2010, it continues to advocate for the prevention of vertical transmission, of which support for the Born HIV Free campaign is a part.

What can you do?

Live the Promise Action Alert. Urge G8 to make 2010 count for Universal Access. 4/5/10

In 2005, the G8 committed to providing Universal Access to HIV prevention, treatment, care and support by 2010. This target will not be met.

Despite some progress in expanding access to treatment, UNAIDS calculates that for every two people who first accessed treatment in 2007, five became newly infected with HIV in the same period. What's more, under the new World Health Organization treatment guidelines, an estimated 11 million people with advanced HIV infection today have no access to antiretroviral therapy.

In 2010, the G8 must recommit to achieving Universal Access and must ensure that, this time, its words are translated into action. This will require political and financial commitment to a time-bound action plan that must be agreed upon at the G8's upcoming Summit in Canada this June.

Join with a wide range of civil society actors in urging the G8 to act now to achieve Universal Access. The world, including the 33 million people currently living with HIV, cannot afford to wait any longer.

What can you do?

1. Read and sign on to the EAA letter urging the G8's Canadian hosts to make 2010 count for Universal Access. The deadline for signatures is 4 June 2010. Organizational signatures (organization name and the country in which you are based) are preferred. To indicate your support, send an e-mail to rfoley [at] e-alliance.ch or fax: + 41 22 710 2387.

EAA will then send the final letter with all the signatures to Prime Minister Harper in Canada. You will receive a copy of the letter to send to your own country's Canadian embassy.

G8 countries are: Canada, France, Germany, Italy, Japan, Russia, the United Kingdom and the United States of America.

2. Add your voice to wider civil society calls for G8 action on Universal Access by:

signing up to the World AIDS Campaign's online petition here writing a letter as part of the International AIDS Society's campaign here highlighting Universal Access as a key message within the Interfaith Partnership and the 'At the Table' campaign

Letter

Dear Prime Minister Harper,

We are writing to urge you, as host of June's G8 Summit in Canada, to ensure that 2010 is a pivotal year in the drive to provide Universal Access to HIV prevention, treatment, care and support.

As faith-based organizations from around the world, we deeply regret that the G8's 2005 pledge to provide Universal Access to all who need it by 2010 will be missed. Despite some progress in expanding access to antiretroviral treatment since 2005, the stark reality is that 1.7 million adults and 280,000 children died as a result of AIDS in 2008 and today an estimated 11 million people still wait for life-saving treatment, including hundreds of thousands of children.

The Universal Access goal is not about figures; it is about life and death. The G8 must seize the opportunity provided by its upcoming Summit to renew its political and financial commiment to achieving Universal Access and to reassure the 33 million people currrently living with HIV of its commitment to them.

Recent history has shown that a reconfirmation of the Universal Access pledge on its own, however, is simply not enough. Although the G8 has laudably recommitted to Universal Access every year since 2005, the goal remains unmet. In 2010, therefore, a G8 promise must be followed by G8 action. Crucially, a fully costed and time-bound plan of action for realizing Universal Access must be developed and agreed upon.

In particular, the promise of Universal Access will remain a distant dream without adequate funding. The G8's failure to deliver the funds it committed in 2005 comes at a time when a global scale-up of treatment and prevention access is increasingly urgent to meet the health and development Millennium Development Goals (MDGs) by 2015. For example, the Global Fund, which is essential to achieving Universal Access and the health MDGs, has just launched a replenishment process, yet even the highest scenario presented to donors in March, will not achieve these goals.

What's more, the effects of the global financial crisis coupled with severe shortages of HIV treatment, stalled progress on the expansion of HIV prevention and services, and the unacceptable violations of the human rights of people living with and affected by HIV, remind us that any hard won progress is fragile and reversible. In 2010, it is imperative that the G8 moves forward rather than back on the Universal Access goal.

Please be assured of our prayers and support as you discuss these issues with other world leaders and seriously consider how to turn your words into action. As people of faith, many of us are already active in HIV prevention, treatment, care and support programs, actively supported not only by international donors but funds from within religious communities. It is only when we all pull together to scale up both action and financial commitment that all people living with HIV will receive the treatment and support they need to live life to the full. It is only then that fewer people will become infected with the virus. And it is only then that Universal Access will be achieved.

Yours in faith,

[organizational signatures to be added here] 

TAC and Partners Announce Universal Access Campaign. 28/5/10

Treatment Action Campaign

28 May 2010

Contents:

1)      TAC and partners to march for universal access

On 17 June 2010, TAC and partners will be holding a peaceful demonstration in Johannesburg. We will be calling on governments and funders to scale up funding to meet the targets for universal access to HIV treatment, prevention and care. The demonstration will be held during the World Cup, targeting world leaders in attendance to meet their funding commitments for HIV and health.

Included in this newsletter is information on why we are marching ‘Africa wins every time you INVEST in HIV and TB’. Also included are copies of letters sent by TAC and partners to South Africa President Jacob Zuma, United States President Barack Obama and United States Vice President Joe Biden. In these letters we call on the Presidents and Vice President to take leadership to ensure that universal access targets are met across the region and funding is expanded to meet these targets.

2. Africa wins every time that you INVEST in HIV and TB!

Expanded and sustained funding is needed to meet universal access targets for HIV treatment, prevention and care. Commitments to meet universal access by 2010 were made in July 2005 by G8 nations. This created the momentum that led to a global commitment to universal access by 2010, as endorsed by country leaders at the 60th session of the United Nations General Assembly. The global commitment to universal access is also reflected in the Millennium Development Goals – particularly, MDG 6 – which in addition to universal access, also commits countries to the target of halting and reversing the spread of HIV by 2015.

Yet today we are far from meeting universal access targets and governments and funders have already begun to backtrack on their funding commitments - threatening to undermine the gains made and future access to treatment, care and prevention. Worldwide about 4 million people are receiving antiretroviral treatment (ART) – however, this represents only 42% of the people who need it. Further, less than a quarter of HIV positive pregnant women have access to prevention of mother to child transmission (PMTCT).[1]

Reaching universal access is necessary to reducing AIDS mortality, opportunistic diseases and new infections as well as upholding our fundamental right to health. 

RESOURCES FOR HEALTH

Developed and developing nations are not meeting their funding commitments for HIV and health. International financing mechanisms for health and HIV such as the Global Fund are struggling to secure the finances necessary to continue to expand programmes. A reduction in HIV funding will lead to millions of avoidable deaths across the region.

The Abuja Declaration

In 2001 African nations committed (in the Abuja declaration) to placing the fight against HIV/AIDS ‘at the forefront and as the highest priority issue in our respective national development plans… for the first quarter of the 21st century’. Related to this was the pledge to expand funding for health to 15% of their annual budgets. Yet today African nations continue to spend far too little on health and only 6 of 52 African nations have met or surpassed the 15% target. African nations remain particularly reliant on external funding to support their ART programmes. It is estimated that Global Fund support is responsible for at least 40% of people on treatment in Southern and West/Central Africa, and 80% of people on treatment in East Africa.

The President’s Emergency Plan for AIDS Relief (PEPFAR)            

In the past, the United States (US) has been a global leader in its response to HIV/AIDS and expanding access to ART through PEPFAR. Yet today, under the Obama administration, the US is turning away from PEPFAR in favour of the new Global Health Initiative (GHI). The GHI broadens the mandate of health interventions without expanding funding, resulting in less funding for HIV. The financial year 2010 and 2011 budget requests have included a flat-lining of AIDS funding, and decreased funding for treatment.

Expanding funding for other health interventions and priorities should be done but not at the expense of patients on and in need of ART.

It is also extremely distressing that the US has stated that PEPFAR will move away from providing ‘direct care’ in favour of ‘technical assistance.’ PEPFAR funded programmes could be forced to close their doors as the US moves away from funding direct care. Across the region PEPFAR programmes have already begun to slow or in some cases even cap enrolment onto ART.

The Global Fund to Fight AIDS, Tuberculosis and Malaria (GLOBAL FUND)

The move away from funding ART by the US is part of a larger global trend away from funding HIV in favour of other millennium development goals (MDGs) and health interventions (below we will address a number of these arguments). This trend is threatening the future of the Global Fund, the single largest multilateral funding mechanism for the health sector and HIV. The Global Fund has saved nearly 5 million lives since 2005, or 3,600 people a day. The Global Fund finances ART treatment for almost two thirds of people in the developing world. The Global Fund must raise $20 billion for its upcoming round to increase the scale-up of ART and build on efforts to meet universal access.

ART – IMPROVING HEALTH OUTCOMES AND MEETING MDGs

Expanded access to HIV treatment, prevention and care is necessary to meeting universal access but it is also necessary to meeting a number of other MDGs and improving health outcomes.

ART and prevention

Governments and funders have argued that funding for prevention should be prioritized over ART. However, it is becoming increasingly clear that ART is necessary as part of a package of prevention services to reduce HIV incidence. Studies have shown that ART reduces the risk of sexual transmission of HIV in sero-discordant partnerships when the HIV positive partner is adhering to treatment. (ART is effective as part of a package of prevention services and sero-discordant partners should continue to use condoms). ART is already used as a prophylaxis treatment to prevent HIV transmission to infants and rape survivors, yet access to these services remains limited.

ART and maternal health

HIV continues to be the leading cause of maternal and infant mortality in the African region. In at least 4 Southern African countries (South Africa, Lesotho, Botswana and Namibia), more than 50% of deaths in children under 5 are attributed to HIV. Expanded access to HIV treatment, prevention and care is necessary to reducing maternal and infant mortality and meeting MDGs 4 and 5.

Initiating mothers onto ART treatment earlier will reduce maternal mortality. 84% of maternal deaths occur in women whose CD4 counts fall below 350 cell/mm3 before initiating treatment. Expanded access to ART is also necessary to reducing infant mortality. ART (HAART or PMTCT) during pregnancy and breastfeeding have been shown to reduce HIV transmission from mother to child to below 2%. Further, for HIV positive infants, immediate access to ART can reduce mortality by 75%.

ART and opportunistic infections and mortality

Evidence has shown that initiating ART at a CD4 count of 350 cells/mm3, rather than below 200 cells/mm3, reduces opportunistic diseases and death. (The START trial, which is currently enrolling patients, will provide more evidence on the optimum time to initiate treatment.) Further ART is necessary to the successful treatment of a number of diseases. In line with this, South Africa has updated its HIV treatment guidelines to provide earlier ART to all patients co-infected with HIV/TB.

ART and health system strengthening

Health system strengthening is necessary to effectively responding to an HIV epidemic and to improving health outcomes. Further, any reduction in funding for ART will increase opportunistic infections and AIDS related diseases - thereby increasing the burden on health systems. Experiences in a number of countries have shown that AIDS programmes have begun to strengthen health systems. In 2009, Médecins Sans Frontières reported that HIV/AIDS programmes have had a positive impact in terms of human resources for health, improved laboratory monitoring and pharmacy capacity and management, and more effective health management information and procurement systems.

NOW IS THE TIME FOR UNIVERSAL ACCESS – BUILDING ON SUCCESSES

South Africa, the epicenter of the epidemic, is turning the tide in its AIDS response. For the first time there is real political will to reduce new infections and to ensure that all people in need are able to access treatment. This is evident through expanding funding for HIV as well as the implementation of updated evidence based policies and treatment guidelines. It would be a tragedy if these gains were undermined by the international backlash away from funding HIV. 

With expanded funding, HIV programmes across the region are positioned to expand treatment and care, reduce new infections, build country health systems, support universal access targets and lay the path to meeting a number of other MDGs. Now is the time for governments and funders to leverage the successes of HIV programmes and partnerships built to strengthen their global health responses and expand access to ART to all people in need. 

African nations - meet your Abuja funding commitments for health.
President Obama - protect access to ART by expanding PEPFAR funding.
Make universal access happen – replenish the Global Fund.
Governments and funders - close the gap for universal access

3. Letter to President Barack Obama from TAC and partners

18 May 2010

Dear President Barack Obama,

RE: Expanded and sustainable funding is needed to meet universal access targets for HIV treatment, prevention and care.

Over the past decade the United States has expanded access to treatment for over 2.4 million people living with HIV/AIDS. The Presidents Emergency Plan for AIDS Relief (PEPFAR), established in 2003 under former President George W. Bush, built treatment and care programmes and strengthened health systems across the developing world. When country governments refused to acknowledge HIV/AIDS, PEPFAR secured the right to life for millions.

In 2005, the United States, as a G8 nation, committed to supporting universal access to HIV treatment, prevention and care. This commitment was later endorsed by country leaders at the 60th session of the United Nations General Assembly. The global commitment to universal access is also reflected in the Millennium Development Goal 6 – which in addition to universal access, also commits countries to halting and reversing the spread of HIV by 2015.

In its seventh year, PEPFAR is strategically positioned to expand treatment and care, reduce new infections, build country health systems, support universal access targets and lay the path to meeting a number of other millennium development goals (MDGs).

Today over 4 million people are receiving antiretroviral treatment, but this only represents 42% of people that need it. Expanded and sustainable funding is needed to meet universal access targets. Despite PEPFAR’s unique positioning to strengthen the impact of global AIDS programmes and global health outcomes, the US is backing away from its commitments on HIV/AIDS.

In 2008 PEPFAR was set to expand with the passing of the Lantos-Hyde legislation. This landmark legislation approved $48 billion for PEPFAR over the next five years, with $39 billion earmarked for HIV. However, over the past year, it has emerged that HIV/AIDS programmes may never see this level of funding as across the region PEPFAR programmes are capping patient enrolment.

The approved $48 billion did not make it into the 2010 Congressional budget, and Congress increased PEPFAR funding by just 2.2% for 2011, the smallest in the programme’s history. Further, President Obama, during your electoral campaign you committed to expanding funding by $1 billion per year, yet you only asked for a $366 million increase for 2010. These unmet PEPFAR funding commitments will undermine efforts to meet universal access.

In the past year the number of HIV positive people that PEPFAR started onto treatment was the smallest it has been for four years. Programmes across the region are feeling the effects of contracting PEPFAR funding. In some countries where programmes are heavily PEPFAR funded, most-visibly Uganda, the flat-lined budget has resulted in patients who are eligible for treatment being turned away from facilities without receiving care.Further, the future of PEPFAR funded treatment programmes are threatened as the US aims to move away from providing ‘direct care’ to ‘technical assistance’. The move away from providing direct care has been promoted to develop country ownership and funding of ART programmes as developing countries often spend far too little on health and HIV.

The lack of funding by developing countries is a valid concern, echoed by civil society across the region. The Treatment Action Campaign (TAC), the AIDS Rights Alliance of Southern Africa (ARASA) and partners launched a regional campaign in 2009, to pressure developing country governments to expand funding for HIV and health and to promote effective use of funds through civil society budget monitoring. We have already begun to see real gains in South Africa, the epicentre of the epidemic, in expanding funding to reach universal access targets.

In addition, while there is a great need for technical assistance to build health care systems in the developing world, this investment should not be made at the expense of the care that millions are receiving through PEPFAR funded programmes. The reality is that a premature move by PEPFAR away from providing direct care will have devastating health consequences in the region. Transferring patients from PEPFAR funded programmes, to government facilities without the drugs, capacity or resources to absorb the patients will result in treatment resistance, increased mortality and preventable new infections.

Why the move away from funding HIV/AIDS is based on flawed arguments with potentially profound and devastating consequences.

President Obama, in 2006 you visited Africa as an advocate of people living with HIV. In Kenya you took an HIV test to encourage others to get tested and lessen the stigma and discrimination faced by people living with HIV. In South Africa you visited the Treatment Action Campaign’s Khayelitsha offices and spoke to HIV educators working in township schools. After visiting Africa you campaigned around the need to strengthen and expand PEPFAR stating: ‘We are all sick because of AIDS - and we are all tested by this crisis.

Today, under your administration, the United States’ policy priorities are shifting away from HIV/AIDS programmes. This shift in priorities has been promoted by arguments that funding for HIV has crowded out funding for other diseases and has expanded at the expense of other MDGs and health systems strengthening. These arguments are flawed as a move away from funding HIV/AIDS will worsen health outcomes, set us back in meeting a number of other MDGs and destabilize health systems.

Opponents of HIV funding argue that money should instead go to other MDGs and particularly infant and maternal health. Yet, HIV continues to be the leading cause of maternal and infant mortality in the African region – in at least 4 Southern African countries (South Africa, Lesotho, Botswana and Namibia), more than 50% of deaths in children under 5 are attributed to HIV. It is estimated that every minute a child is born with HIV.

It is clear that expanded access to HIV treatment, prevention and care is necessary to reducing maternal and infant mortality and meeting MDGs 4 and 5. Initiating mothers onto ART treatment earlier will reduce maternal mortality - 84% of maternal deaths occur in women whose CD4 counts fall below 350 cell/mm3 before initiating treatment. Expanded access to ART is also necessary to reducing infant mortality. ART (HAART or PMTCT) during pregnancy and breastfeeding have been shown to reduce HIV transmission from mother to child to below 1%. Also, for HIV positive infants, immediate access to ART can reduce mortality by 75%.

Another argument against HIV funding is that the HIV programme is isolationist, neglects other diseases and is carried out at the expense of health system strengthening. Experiences on the ground have shown this claim to be unfounded. In many cases HIV programmes have supported strengthening services for a wide range of diseases. HIV care has often included: early screening for cervical cancer, enhancing utilisation of sexual and reproductive health services, testing for and treating TB and malaria (which along with AIDS are responsible for most of the world's infectious disease deaths) and promoting access to safe water supplies and better nutrition.

In 2009 Medicins Sans Frontieres reported that HIV/AIDS programmes have had a positive impact in terms of human resources for health, improved laboratory monitoring and pharmacy capacity and management, and more effective health management information and procurement systems.

Antiretroviral therapy is also essential to the successful treatment and prevention of many other diseases rife in sub-Saharan Africa. These medicines are a major contributor to reducing opportunistic infections and AIDS related diseases. Far too few patients are accessing treatment too late. The consequences of late treatment are more new infections, more opportunistic diseases, more AIDS-related disease and high rates of mortality.

In addition, we are seeing increasing evidence that ART is an effective method of prevention and that expanded access to ART, is necessary as part of a comprehensive package of prevention services. ART is already used in the region to prevent mother to child transmission (PMTCT) and for post exposure prophylaxis (PEP) for rape survivors. However it is now recognized that ART is an important prevention method to reduce to risk of sexual transmission of HIV in sero-discordant partnerships – to the extent that experts based at the World Health Organization have suggested immediate treatment of all people living with HIV as a potential strategy for eliminating the epidemic.

Another fatal miscalculation in the arguments to reduce HIV funding is that they do not contextualize the devastating human, social, political and economic impacts of reducing access to treatment. HIV has disproportionately affected young adults in the developing world – the backbone of any economy. A reduction in treatment for HIV would be reflected through the economy, thereby impairing development. Further, vulnerable segments of the society, especially women, have the highest rates of HIV prevalence. Reducing access to health services would further marginalize these groups.

Now is the time to build on gains made in recent years and reach universal access across the region!

We call on the US to build on the strong partnerships it has nurtured across the developing world and leverage the lessons and successes of PEPFAR to strengthen its global health response in a rational, responsible and humane manner.

Today we are seeing the implementation and strengthening of evidence based policies for prevention and treatment in the region. We are positioned to eradicate mother to child transmission of HIV by 2015 – with sufficient funding and political will. Further there is increasing evidence that antiretroviral treatment and prevention cannot be separated and that treatment must be scaled up, as part of a comprehensive package of prevention services, to reduce new infections.

South Africa, the epicentre of the epidemic, has 17% of the global burden of HIV and 28% of the global population with dual HIV/TB. After years of dragging its feet and undermining HIV/AIDS efforts, the new South African government, under the leadership of President Jacob Zuma and Health Minister Aaron Motsoaledi, have put in place evidence based treatment policies as well as expanded funding for HIV. The government is also taking steps to strengthen the health system, overcome barriers and integrate the delivery of health services. In this new era of real political will to address the HIV epidemic, now would be the worst possible time for the US to back away from its HIV commitments.

Be a champion for the region! Be a champion for universal access!

During the 2010 World Cup in South Africa, TAC, ARASA and partners will march for the right to access treatment for all people and the need to ensure that sufficient and sustainable resources are made available. We will march for you, President Obama, not to turn your back on the President’s Emergency Plan for AIDS Relief and the lives supported by it. Further we will call on you to take advantage of the opportunities to end mother to child transmission, reach universal access and improve health outcomes across the region.

On 17 June 2010 we will be engaging in a peaceful demonstration in Johannesburg to demand expanded and sustainable resources for health. We ask that you come out and meet us, once again, to accept our march memorandum. We ask that you recommit to expanding funding for HIV/AIDS. Further, we call on the United States of America to take leadership by example to ensure that all developed nations uphold their commitments to universal access for HIV treatment, prevention and care.

27 May 2010

Dear President Jacob Gedleyihlekisa  Zuma,

RE: South Africa must take leadership to push for universal access for HIV treatment, prevention and care at the 2010 G20 Summits

President Jacob Zuma, over the past few months, under your leadership, we have finally begun to see the political will needed to address the HIV epidemic in South Africa. We commend you for your leadership and for putting in place evidence based policies to effectively respond to the epidemic. We urge you now to show leadership to meet universal access targets for HIV prevention, treatment and care across the region.

Over the past few months, the policies that have been put in place by you and the Minister of Health, Aaron Motsoaledi, have put South Africa on the path to achieve universal access targets. South Africa must spearhead universal access through proper funding and implementation of the updated policies.

This year South Africa will participate in the 2010 G20 Summits to be held in Canada during June and South Korea during November. South Africa is the only African country on the G20 and therefore represents the needs of the entire region and other developing countries. We urge you, President Zuma, to use this global platform to advocate for universal access targets to be met across the region. Meeting universal access targets will require expanded and sustainable funding from developed and developing nations.

In July 2005, the G8 made a commitment to support universal access to by 2010. This created the momentum that led to a global commitment to universal access by 2010, as endorsed by country leaders at the 60th session of the United Nations General Assembly. A key target was that 80% of people who need HIV prevention, treatment and care must have access to these services. The global commitment to universal access is also reflected in the Millennium Development Goals (MDGs) – particularly, MDGs 4,5 and 6 – which in addition to universal access, also commits countries to the targets of halting and reversing the spread of HIV, reducing child mortality and improving maternal health.

Today universal access remains a distant target. About 4 million people globally are receiving antiretroviral treatment – however, this represents only 42% of the people who need it.

It is particularly concerning that, despite how far we are from meeting our targets for universal access, funders have already begun to backtrack on their commitments. Without expanded funding, programmes across Africa will be unable to continue to initiate new patients onto treatment. Further, the emphasis of funders away from supporting ‘direct care’ to providing ‘technical assistance’ will jeopardise future access to treatment for many patients receiving treatment from programmes supported by international funding.

We call on you to take leadership at the G20 Summits to protect millions of lives across the region. To ensure the sustainability of current treatment programmes and to ensure future access to treatment for new patients the following steps need to be taken:

1.       Developed nations must recommit to supporting universal access targets. Further, developed nations must ensure that sufficient and sustainable resources are made available to meet these targets. Cuts in international funding for HIV must be reversed.

2.       African governments need to continue to scale-up funding to improve health outcomes, strengthen healthcare systems and meet universal access targets.

1.       Cuts in international funding for HIV must be reversed. Developed nations must recommit to supporting universal access targets. Further, developed nations must ensure that sufficient and sustainable resources are made available to meet these targets.

a) Global Fund to Fight AIDS, TB and Malaria (Global Fund)

The Global Fund to fight AIDS, TB and Malaria acts as the single largest multilateral funding mechanism for the health sector. The Global Fund has saved nearly 5 million lives since 2005, or 3,600 people a day. It accounts for two-thirds of international funding for TB treatment, 70% of international funding for malaria treatment and prevention, and pays for two-thirds of those receiving ART.

Despite commitments from developed nations to support universal access, the Global Fund has been chronically underfunded. While the Global Fund originally aimed to generate $10 billion from the G8 annually by 2008 only $3 billion was yearly given by these countries. Over the past year there have been a number of worrying signals and statements indicating that the Global Fund will be unable to secure sufficient funding for upcoming rounds.

President Zuma, we call on you to champion the replenishment of the Global Fund at the G20 Summits. Sustainable and expanding funding for the Global Fund is necessary to meeting universal access targets.

b) President’s Emergency Plan for AIDS Relief (PEPFAR)

It is estimated that, from 2003-2009, PEPFAR treatment support saved over 3 million adult lives. PEPFAR programmes were set to expand in 2008 when the United States Congress reauthorized the programme for five more years at a cost of $48 billion. However it has now become clear that developing countries may never see this level of funding.

$48 billion did not make it into the 2010 Congressional budget, and Congress increased PEPFAR funding by just 2.2% for 2011, the smallest in the programme’s history. Further, while President Barack Obama’s electoral campaign platform pledged to give $1 billion a year, he asked for only a $366 million increase for 2010.In the last year, the number of HIV-positive people that PEPFAR started on treatment was the smallest it has been for four years, even while demand increases as patients live longer and the disease continues to spread unabated.

In countries where ART programmes are heavily PEPFAR funded, most visibly Uganda, the flat-lined budget has resulted in patients being turned away from facilities without receiving care. Civil society and doctors in Uganda have reported that they have already been instructed to stop enrolling new patients onto PEPFAR funded ART programmes.

In the past, the United States has championed expanding access to treatment and today millions of patients across the region rely on PEPFAR funded programmes for ART. A move away from funding lifelong treatment programmes by PEPFAR would be unconscionable. Further, the need for treatment has not been met, and PEPFAR’s unmet funding commitments are undermining efforts to meet universal access.

South Africa must reinforce the continued need for the United States to be a leader in expanding access to prevention, treatment and care. Especially as the US’s move away from funding HIV is based on flawed arguments (see below: Why the arguments of the opponents of HIV funding are flawed).

c) Financial Transactions Tax

The Financial Transaction Tax (FTT) is a proposed financing mechanism to raise money for health and other social needs. South Africa should champion the mechanism at G20 Summits to close the gap between service provision and need.

The FTT would be a modest levy placed on all financial transactions to raise revenue to help finance the fight against AIDS, maternal mortality, extreme poverty, climate change and other development challenges. South Africa and the region continue to face a wide range of developmental needs as well as mounting anger and dissatisfaction about poor service delivery and therefore we must support this initiative for health financing. The FTT would be an important source of funding to address a number of these needs.

2.       African governments need to continue to scale-up funding to improve health outcomes, strengthen health care systems and meet universal access targets.

Developed countries have argued that they are backing away from HIV funding to promote country ownership of ART programmes. Concern about under spending on health by developing countries is valid. Developing countries are not meeting their financing commitments for health. Most notably, African heads of state committed, in the Abuja declaration of 2001, to:

“placing the fight against HIV/AIDS at the forefront and as the highest priority issue in our respective national development plans for the first quarter of the 21st century.”

\Related to this commitment was a pledge to “set a target of allocating at least 15% of our annual budget to the improvement of the health sector”. However, no clear roadmap towards achieving this target was set at either the regional or national levels.

Almost ten years later, progress towards the Abuja target remains extremely slow. East Africa has recorded the greatest increase in regional average spending on health, going from 7.9% in 2001 to 9.4% in 2010. Southern Africa has increased only marginally from 10 – 10.3%, while West/Central Africa has recorded almost no increase in regional average spending on health. Throughout sub-Saharan Africa, only six countries have achieved or surpassed the Abuja target.

African government can no longer rely solely on international funders to support their treatment programmes. Governments must take steps to expand funding for health and HIV as well as set out clear plans to meet the Abuja targets.

President Zuma, we call on you to champion meeting the Abuja targets across the region by expanding funding for health. We call on you take a firm stand against recent rhetoric by African Finance Ministers dismissing their development declarations.

Why the arguments of opponents of HIV funding are flawed

Developed countries, and particularly the United States, have been increasingly shifting away from funding HIV in favour of other health interventions and millennium development goals. A number of the arguments against funding HIV are flawed and below we will respond to some of the key arguments raised by developed countries as justification for reducing HIV funding

Opponents of HIV funding have argued that HIV funding is isolationist and has crowded out funding for other health interventions and millennium development goals (MDGs). A global health priority that is being championed as a critical area for focus, over HIV (MDG 6), is that of maternal and child mortality (MDGs 4 and 5). However, a wealth of scientific evidence has shown this thinking to be deeply flawed. HIV continues to be a leading cause of maternal and child mortality in the African region – in at least 4 Southern African countries (South Africa, Lesotho, Botswana and Namibia), more than 50% of deaths in children under 5 are attributed to HIV.

It is clear that expanded access to HIV treatment, prevention and care is necessary to reducing maternal and infant mortality and meeting MDGs 4 and 5. Initiating mothers onto ART treatment earlier will reduce maternal mortality. 84% of maternal deaths occur in women whose CD4 counts fall below 350 cell/mm3 before initiating treatment. Expanded access to ART is also necessary to reducing infant mortality. ART (HAART or PMTCT) during pregnancy and breastfeeding have been shown to reduce HIV transmission from mother to child to below 1%. Further, for HIV positive infants, immediate access to ART can reduce mortality by 75%.

Opponents of HIV funding argue further that HIV programmes are isolationist, neglect other diseases and are carried out at the expense of health system strengthening. Experiences on the ground have shown this claim to be unfounded. In many cases HIV programmes have supported strengthening services for a wide range of diseases. HIV care has often included: early screening for cervical cancer, enhancing utilisation of sexual and reproductive health services, testing for and treating TB and malaria (which along with AIDS are responsible for most of the world's infectious disease deaths) and promoting access to safe water supplies and better nutrition.

In addition, ART is essential to the successful treatment and prevention of many other diseases rife in sub-Saharan Africa. These medicines are a major contributor to reducing opportunistic infections and AIDS related diseases.

President Zuma, our South African government has recognized that improving a number of health outcomes can only be done through integrated health services and health systems strengthening. South Africa is now taking steps to integrate ART delivery with other needs including sexual health, antenatal care and treatment for tuberculosis as well as strengthening health systems.

In high prevalence countries, responding effectively to HIV and other health needs cannot be done without health systems strengthening and integration of health services. In many countries HIV programmes have laid the groundwork to do just this. Undermining HIV programmes will worsen health outcomes and weaken health systems. Instead, strengthening health systems and responding to a range of health needs should be done in partnership with, not at the expense of, HIV programmes. HIV is not over funded – health is underfunded.

Opponents of HIV treatment have further argued that HIV treatment receives too much attention, which undercuts investment in prevention. There is increasing evidence that ART is necessary as part of a comprehensive package of prevention services including: expanded access to male and female condoms; reproductive health and family planning services; medical male circumcision; PEP; PMTCT and safe infant feeding methods.

ART is already widely used for prevention of mother to child transmission (PMTCT) and post-exposure prophylaxis (PEP) for rape victims. Evidence is now showing that HIV positive patients adhering to ART have a reduced risk of transmitting HIV to their sexual partners – to the extent that experts based at the World Health Organisation have suggested immediate treatment of all people living with HIV as a potential strategy for eliminating the epidemic.

A more recent study, the Partners in Prevention HSV/HIV Transmission Study, which followed 3,408 couples in 7 African countries, confirmed that ART reduces the probability of transmission of HIV. The study found that: ‘ART use is associated with substantially lower risk for HIV transmission among heterosexual, African, HIV serodiscordant couples, where the HIV-infected partner did not meet national criteria for ART initiation at enrollment.

Lack of access to treatment is indirectly responsible for many new infections and for hindering other goals of the HIV response. As such, investing in ART now could lead to tremendous cost savings down the line – not only for HIV transmissions, but also for other morbidities such as tuberculosis that are associated with untreated HIV. While prevention undoubtedly needs more attention and resources, this must go hand in hand with treatment – not instead of treatment.

Moving forward – recommitting to universal access

We have demonstrated that the trend away from funding HIV is based on flawed arguments. The fatal miscalculation in the arguments to reduce HIV funding is that they do not contextualize the devastating human, social, political and economic impacts of reducing access to treatment. HIV has disproportionately affected young adults in the developing world – the backbone of any economy. A reduction in treatment for HIV would be reflected through the economy impairing development. Further, vulnerable segments of the society, especially women, have the highest rates of HIV prevalence. Reducing access to health services would further marginalize these groups.

President Zuma, during the G20 Summits this year you will represent the health and social needs of the region. It is clear that HIV remains an emergency in our societies across the region. However a strong framework has been built to scale-up and expand access to prevention, treatment and care and, with expanded and sustainable funding, universal access can become a reality.

There is a need for strong leadership to rally support for expanded and sustainable funding to achieve universal access targets. We call on you, President Zuma, to take leadership to rally this support. At the 2010 G20 Summits, G20 governments must recommit to ensuring that these targets are met.

28 May 2010

Dear Vice President Biden,

RE: Request for meeting to discuss the future of the President’s Emergency Plan for AIDS Relief and achieving universal access targets for HIV treatment, prevention and care.

The Treatment Action Campaign (TAC) and partners would like to request to meet with you to discuss the future of HIV/AIDS funding and the President’s Emergency Plan for AIDS Relief (PEPFAR) during your visit to South Africa in June 2010.

PEPFAR, established in 2003 under former President George W. Bush, has expanded access to antiretroviral treatment across the developing world. Over the past decade the United States has expanded access to treatment for over 2.4 million people living with HIV/AIDS. During a time when many governments refused to acknowledge the crisis of HIV/AIDS, PEPFAR secured the right to life for millions by funding access to treatment.

In its seventh year, PEPFAR is strategically positioned to expand treatment and care, reduce new HIV infections, build country health systems, support universal access targets and lay the path to meeting a number of other Millennium Development Goals (MDGs). In Africa, expanding access to antiretroviral treatment is necessary to achieving MDGs 4,5 and 6 – to reduce child mortality, to improve maternal health and to halt and reverse the spread of HIV.

Yet, despite PEPFAR’s unique positioning to strengthen the impact of global AIDS programmes and global health outcomes, the US is backing away from its commitments on HIV/AIDS. The US is turning away from PEPFAR in favour of the new Global Health Initiative (GHI). The GHI broadens the mandate of health interventions without expanding funding, which will result in less funding for HIV. The financial year 2010 and 2011 budget requests have included a flat-lining of HIV/AIDS funding, and decreased funding for anti-retroviral treatment.

We are deeply concerned that: the US has flat-lined funding for HIV and that funding for antiretroviral treatment is decreasing, and,

PEPFAR is moving away from providing ‘direct care’ in favour of ‘technical assistance’.

The flat-lined budgets have already resulted in the capping of patient enrolment onto ART and, in some cases, patients are already being turned away from facilities without receiving care. Targets to meet universal access to HIV treatment, prevention and care, endorsed by the USA, cannot be met without expanded funding for HIV.

Also, while there is a great need for technical assistance to build health care systems in the developing world, this investment should not be made at the expense of the care that millions are receiving through PEFAR funded programmes.

In his previous visit to South Africa, President Barack Obama, visited TAC’s Khayletisha office and spoke to HIV educators working in the township’s schools. At this point he expressed support for expanding access to HIV treatment, prevention and care. The need to expand access to these services remains an emergency in Africa - less than half of people in need are able to access treatment.

On May 19th we wrote to President Obama outlining these concerns. We hope to address these issues with you directly during your visit to South Africa. We will also be organising a mass march to your Consulate in Johannesburg on June 17th in order to demonstrate to you and the world the growing concerns and fears around this issue.

We look forward to your response and to introducing you to TAC and our partners.

A Perscription for Life

Equal Treatment

Equal Treatment or just ET, is TAC's high-quality magazine dedicated to covering health and HIV matters. It is produced five times a year and currently translated into isiXhosa, isiZulu and Setsonga. To receive a hard copy of ET, Click Here and we can send you a copy at no charge. We do request though that if you are from a medical institution, professional organization or from overseas, that you please make a donation to the TAC in exchange for recieving the magazine. Donations can be made here. If you are interested in ordering large quantities of the magazine for your workplace or union etc, Click Here.

16 Days of Activism Against Gender Violence

The 16 Days of Activism Against Gender Violence is an international campaign originating from the first Women's Global Leadership Institute sponsored by the Center for Women's Global Leadership in 1991.  Participants chose the dates, November 25, International Day Against Violence Against Women and December 10, International Human Rights Day, in order to symbolically link violence against women and human rights and to emphasize that such violence is a violation of human rights.

This 16-day period also highlights other significant dates including November 29, International Women Human Rights Defenders Day, December 1, World AIDS Day, and December 6, which marks the Anniversary of the Montreal Massacre.

The 16 Days Campaign has been used as an organizing strategy by individuals and groups around the world to call for the elimination of all forms of violence against women by:

GBV Communication Skills Manual

The training is designed so that all the materials used can be shared with participants at the end of the workshop

Family Heatlh International

The curriculum in this gender-based violence (GBV) manual on communication skills represents collaboration between Family Health International (FHI), the Reproductive Health Response in Conflict (RHRC) Consortium, and the International Rescue Committee (IRC). The manual includes a training outline, a list of materials needed, an in-depth training curriculum, and all transparencies, handouts, and activity sheets necessary to conduct a training. The training is designed so that all the materials used can be shared with participants at the end of the workshop, which will allow for subsequent trainings on topics relevant to their context. The training is designed to be completed in 5 days, beginning with an overview of GBV and then covering areas focusing on engagement strategies for work with GBV survivors, methods to support the service provider, and service provider responsibilities and community referrals facilitation skills overview, training review, and evaluation.

Download this manual here (PDF, 2.35MB, 194pg)

Get Moving! The GBV Prevention Network's Movement Building Initiative.

Get Moving! utilizes reflection sessions, exercises and readings, designed to stimulate personal and / or organizational reflection about GBV prevention work.

There are six phases in the Get Moving process. To correspond with each phase, the GBV Prevention Network published the Get Moving! series of booklets which are designed to stimulate personal and/or organisational reflection about movement building. The publications include ideas for reflection sessions, exercises, and readings that ideally would be conducted within member organisations, as well as readings and suggestions for journal writing that participants can do independently. According to the publication, the Get Moving! process is for any group or organisation interested in thinking more about the ideas and values that underpin GBV prevention work and what it would take to truly prevent GBV in the region.

Download the resources by phase:

I Endorse The Safe World for Women Campaign.

This is a campaign that seeks people to endorse this campaign which seeks to demand of the government to take action against gender-based violence. This campaign demands the government to:

Sign up for this campaign here

Promoting Gender Equality to Prevent Violence against Women

Focuses on violence against women by intimate partners

This briefing document focuses on violence against women by intimate partners. It examines the relationship of gender inequalities to gender-based violence and finds evidence that school, community, and media interventions can promote gender equality and prevent violence against women by challenging stereotypes that give men power over women. The document describes some of the promising methods of promoting gender equality and their effectiveness, including school-based interventions to work with schoolchildren before gender attitudes and behaviours are deeply ingrained and community interventions.

Download this document here(PDF, 591.08KB, 18pg)

Reporting Gender Based Violence: A Handbook for Journalists

To encourage and support sustained media coverage of gender-based violence (GBV)

Download this document here(PDF, 2.75 MB, 76pg)

Speak Out. Youth Report Sexual Abuse. A Handbook for Learners on How to Prevent Sexual Abuse in Public Schools

Published by the Department of Basic Education in South Africa July 2010

Authors: Dr Patricia Watson, Rolaball Eduscript and Julia Grey

This handbook is designed to contribute towards creating a safe, caring, and enabling environment for learning and teaching in public schools in South Africa. The purpose of the handbook is to equip learners with knowledge and understanding of sexual harassment and sexual violence, its implications, ways to protect themselves from perpetrators, and where to report incidences of sexual violence or harassment

Download this resource here (PDF, 6.4 MB, 32pg)

The Role of Religious Communities in Addressing Gender-Based Violence and HIV

The training began with opening speeches from a range of senior religious leaders and experts on GBV and HIV

This report summarises the United States Agency for International Development (USAID) Health Policy Initiative, Task Order 1, project titled The Role of Religious Communities in Addressing Gender-based Violence and HIV, which was designed and implemented in Africa by Futures Group International and Religions for Peace. Recognising the importance of collaborating to prevent and reduce gender-based violence (GBV) and HIV among women and girls, the initiative partners worked to improve the capacity of religious leaders and faith-based organisations (FBOs) to respond to GBV and its links to HIV.

To that end, the first component of this project brought together African religious leaders - with a particular focus on women of faith - for a regional training workshop on GBV as related to HIV. From July 30-August 2 2007, 23 delegates from 8 countries - Democratic Republic of Congo (DRC), Ghana, Kenya, Liberia, South Africa, Tanzania, Uganda, and Zambia - came together to participate in a 4-day regional training in Nairobi, Kenya. An emphasis on the participation of women infused this project, as reflected from the very beginning; participants in this regional training were drawn, in part, from the African Women of Faith Network (AWFN) and the National Inter-Religious Councils, established by Religions for Peace.

As detailed in the report, the training began with opening speeches from a range of senior religious leaders and experts on GBV and HIV. As a beginning exercise, participants were asked to agree or disagree with a few statements; this was designed to spark initial conversation about the topics at hand. For instance, most participants disagreed with this statement: "It is not appropriate for religious leaders to discuss matters relating to women and sexuality."

Download the resource here (PDF, 42pg, 625.43KB)

You & Rape

This booklet is our contribution to sharing the information we’ve gathered

Published by Rape Crisis Cape Town Trust

In 1992, the Natal Midlands Black Sash, Rape Crisis, and a number of other women’s organisations in Pietermaritzburg began a public rape education programme. This programme was the result of the rising number of rapes, and the need for society to support men and women who have been raped in a way that restores their dignity. It was designed to support rape survivors in bringing their attackers to trial - if that is what the survivor chooses to do. Although rape is a difficult subject for many people to discuss, men and women need to share their experiences as rape survivors in order to help and strengthen each other. This booklet is our contribution to sharing the information we’ve gathered from our experience over the years. The book has been updated several times. With this latest update, Rape Crisis has included the new sexual offences act and recent information regarding medical and social aspects of rape.

Contents:

Download this 33-page PDF here in:

International Day For The Elimination Of Violence Against Women. 25/11/09

Afroaidsinfo.org

• Up to one-third of adolescent girls report forced sexual initiation.
  
  • For example, a recent study suggests that in the United Kingdom:
    
    • one in three teenage girls has suffered sexual abuse from a boyfriend,
    • one in four has experienced violence in a relationship,
    • one in six has been pressured into sexual intercourse,
    • one in sixteen said they had been raped.
• Mass rape of women and girls continues to be seen as somehow a legitimate military weapon.
  
  • Reports suggest that, in Bosnia and Herzegovina, in a war that lasted a mere three years, somewhere between 10,000 and 60,000 women and girls were raped.
• Sexual violence against men and boys continues undaunted, unreported, understudied, and too often a source of ridicule and derision.
  
  • According to a number of studies, somewhere between 5 and 10% of adult males report having been sexually abused in their childhood.
• Women suffer violence in health care settings, “including sexual harassment, genital mutilation, forced gynecological procedures, threatened or forced abortions, and inspections of virginity.”
• Sexual violence in schools abounds almost in every country in the world
• In Canada, 23% of girls experience sexual harassment.
• There was a 25% rise in rape and sexual assaults between 2005 and 2007: Among all violent crimes, domestic violence, rape, and sexual assault showed the largest increase.

Abusive behaviour can also result from mental health issues or disorders. For example, someone with anger management issues, a diagnosis of intermittent explosive disorder, or a drinking or drug problem may easily get out of control during arguments (e.g., because there is something wrong with their ability to inhibit themselves at the brain level) and verbally or physically strike out at their partners and dependents.

1. UN: The Dag Hammerskjold Library, International Day for the Elimination of Violence Against Women. Available at http://www.un.org/Depts/dhl/violence/ and accessed on 28 October 2009.
2. Moshenberg, Daniel: Sexual and gender based violence: every day, everywhere and yet … 16 September 2009. Available at http://concernedafricascholars.org/sexual
   -and-gender-based-violence/ and accessed on 28 October 2009.
3. Subscribe to the newsletter of the South African Sexual Violence Research Initiative at http://www.svri.org/ for more information.
4. Moshenberg, Daniel: Sexual and gender based violence: every day, everywhere and yet … 16 September 2009. Available at http://concernedafricascholars.org/sexual
   -and-gender-based-violence/ and accessed on 28 October 2009.
5. Crehan, K &  Gordon, P: Shades of sadness: gender, sexual violence and the HIV epidemic. Available at http://www.alliancesforafrica.org/content_files/files/
   GenderSexualViolenceandHIV.doc and accessed on 31 October 2009.
6. Ibid
7. Ibid

Thursdays in Black. 17/02/09

Thursdays in Black is an international event. It began as a grassroots response to rape and violence against women in Argentina in early 1970’s. During that time in Argentina, women were being raped, murdered, and disappearing in alarming numbers. In, response local feminist organizers begin organizing “Thursdays in Black” to raise awareness about the violence that women faced, and to put pressure on governmental officials to do more to stop the violence.

Since those beginnings, Thursdays in Black has been taken up by communities in Bosnia, Israel, the Sudan, New Zealand and throughout Europe. It has more recently begun happening in the United States, mostly on college campuses. Indiana University students initiated the campaign on this campus for the first time in April 2004. Thursdays in Black is always locally organized. There is no international, national, or even state-wide effort to create or build on Thursdays in Black.

World Council Of Churches Campaign Against Violence Against Women. 25/11/09

Join the WCC in their campaign to stop violence against women:

• Adding your signature to the Letter to the UN Secretary-General to strengthen partnerships with faith-based organizations and increase commitments to end violence against women
• Sign the Interfaith Pledge on Restoring Dignity
• Join in Interfaith Prayer on Ending Violence Against Women
• Submit a Poster for the Interfaith Youth Poster Competition.  

2009 International Women's Day - 08/03/09

IWD is a global day celebrating the economic, political and social achievements of women past, present and future.

From the official International Women’s Day Website

2000 and beyond
IWD is now an official holiday in China, Armenia, Russia, Azerbaijan, Belarus, Bulgaria, Kazakhstan, Kyrgyzstan, Macedonia, Moldova, Mongolia, Tajikistan, Ukraine, Uzbekistan and Vietnam. The tradition sees men honouring their mothers, wives, girlfriends, colleagues, etc with flowers and small gifts. In some countries IWD has the equivalent status of Mother's Day where children give small presents to their mothers and grandmothers.

The new millennium has witnessed a significant change and attitudinal shift in both women's and society's thoughts about women's equality and emancipation. Many from a younger generation feel that 'all the battles have been won for women' while many feminists from the 1970's know only too well the longevity and ingrained complexity of patriarchy. With more women in the boardroom, greater equality in legislative rights, and an increased critical mass of women's visibility as impressive role models in every aspect of life, one could think that women have gained true equality. The unfortunate fact is that women are still not paid equally to that of their male counterparts, women still are not present in equal numbers in business or politics, and globally women's education, health and the violence against them is worse than that of men.

However, great improvements have been made. We do have female astronauts and prime ministers, school girls are welcomed into university, women can work and have a family, women have real choices. And so the tone and nature of IWD has, for the past few years, moved from being a reminder about the negatives to a celebration of the positives.

Annually on 8 March, thousands of events are held throughout the world to inspire women and celebrate achievements. A global web of rich and diverse local activity connects women from all around the world ranging from political rallies, business conferences, government activities and networking events through to local women's craft markets, theatric performances, fashion parades and more.

Many global corporations have also started to more actively support IWD by running their own internal events and through supporting external ones. For example, on 8 March search engine and media giant Google some years even changes its logo on its global search pages. Year on year IWD is certainly increasing in status. The United States even designates the whole month of March as 'Women's History Month'.

So make a difference, think globally and act locally !! Make everyday International Women's Day. Do your bit to ensure that the future for girls is bright, equal, safe and rewarding.

Decrease Violence To Decrease Risk of HIV Among Woman and Girls.

(Global Health Council) Addressing violence against woman and HIV/AIDS simultaneously can reduce the incident of both and have a positive impact on the lives of woman and their families. This policy brief examines the way in which violence fuels increased HIV vulnerability for woman and girls. It highlights successfully and innovative efforts needed to prevent it and recommends policy action. Download PDF (257.91KB 4p)

Ring The Bell. 25 Nov to 10 Dec 2008

Ring The Bell - 16 Days of Activism Campaign on Violence Against Women and Children

The Diakonia Council of Churches, The Centre for HIV/AIDS Networking (HIVAN/HIV-911) and the World Conference on Religion and Peace (WCRP) have partnered together for the 16 Days of Activism Campaign 2008.

The Campaign commences on 25 November and ends on 10 December and is designed to generate awareness of the plight of women, children and men who experience violence at the hands of others.

This year we have chosen the theme “Ring the Bell – Say NO to Violence”.  We trust that the campaign will encourage everyone to take a stand by “Ringing the Bell” on offenders – having courage to intervene.

A specific theme and colour has been chosen to mark each of the days of the campaign.  There are many ways to get involved, show your support, and simply take time to reflect during the 16 Days of Activism Campaign.

Say NO – UNiTE to End Violence against Women

Say NO – UNiTE to End Violence against Women is a global call for action, launched in November 2009, on ending violence against women and girls. It is presented by UNIFEM as a contribution to advance the objectives of UN Secretary-General Ban Ki-moon’s campaign UNiTE to End Violence against Women through social mobilization. UNIFEM Goodwill Ambassador Nicole Kidman is the Spokesperson of Say NO.

Based on country data available, up to 70 per cent of women experience physical or sexual violence from men in their lifetime. It happens everywhere – at home and at work, on the streets and in schools, during peacetime and in conflict. Violence against women and girls has far- reaching consequences, harming families and communities, stunting human development, and undermining economic growth. Everyone has a role to play in combating this global pandemic; the time to act together is NOW.

Say NO aims to trigger and highlight actions by individuals, governments and civil society partners. Actions can range from reaching out to students at schools, to volunteering at local shelters, advocating for legislation or donating funds towards programmes that protect women and girls from violence. Every action will be counted to showcase the global groundswell of engagement that exists on the issue. The initial target is to reach 100,000 actions by March 2010 and 1 million actions in one year.

Say NO builds upon the momentum generated during its first phase when 5,066,549 people signed on to a global call to make ending violence against women a top priority worldwide. Heads of States and Ministers from 69 Governments and more than 600 Parliamentarians have added their names to Say NO since then.

Working through traditional as well as online networks and social media, Say NO will engage participants from all walks of life. A range of web-based and other tools available on saynotoviolence.org will support partners in their advocacy efforts, highlight their work to a global audience and inspire others.

In line with the Secretary-General’s campaign framework that calls for an increase in funding for the multi-lateral UN Trust Fund in Support of Actions to Eliminate Violence against Women, Say NO encourages donations for the UN Trust Fund, which supports local and national programmes catalyzing change on the ground.

Say NO - UNiTE to End Violence against Women is an expanding global coalition of individuals, organizations, governments and the private sector to realize a vision that is ambitious, but must never be impossible – a future that is free from violence against women and girls. Let us count you in – take action to end violence against women now.

More information and toolkit available on website.

World YWCA International Women's Day Statement 25/03/09

Africa: 18th International AIDS Conference Stresses Right to Health

Universal access is a global commitment to scale up access to HIV treatment, prevention, care and support.

AllAfrica

With the HIV/AIDS epidemic still raging and the global economic crisis threatening desperately needed funding, an estimated 20,000 participants from 185 countries are assembling in Vienna July 18-23 for the 18th International AIDS Conference (AIDS 2010).

Since the first cases were reported in 1981, HIV -- the virus that causes acquired immunodeficiency syndrome (AIDS) -- has become one of the world's most serious health and development challenges. More than 25 million people have died of AIDS, and another 33.4 million now live with HIV/AIDS.

Over the past 15 years, scientific advances and global efforts to address the epidemic have made it possible to prevent and treat HIV even in the poorest nations. According to the World Health Organization, the number of people with HIV receiving treatment in poor countries has increased 10-fold since 2002.

AIDS 2010 speakers will describe the state of the epidemic and outline critical choices facing world leaders in the years ahead.

"This year's conference theme, 'Rights Here, Right Now,' reminds us that health care should be a right for everyone, but isn't," former U.S. President Bill Clinton said at the opening conference session July 18. "Notwithstanding the current economic difficulties, the evidence of the progress that has been made in the last few years is not an excuse to walk away from that right. It's an excuse to run toward it for all of us."

According to conference organizers, Vienna was chosen as the host city for AIDS 2010 in part because of its location near Eastern Europe, a region with a growing epidemic driven mainly by injected drug use. Southern Africa, home to 67 percent of all people with HIV, is the world's most heavily affected region.

MULTIDISCIPLINARY FORUM

Since the first international AIDS conference was held in Atlanta in 1985, the meetings have offered a multidisciplinary forum for networking and sharing information about new research and evidence-based programs and policies. A range of stakeholders has been able to evaluate the latest scientific developments and lessons learned and chart a course forward.

In a July 7 preview of AIDS 2010 in Washington, Dr. Anthony Fauci, director of the National Institute for Allergy and Infectious Diseases, part of the U.S. National Institutes of Health, said pressing topics at the meeting would include universal access to treatment, the importance of prevention, and new modes of prevention that include vaccine progress and treatment with antiretroviral drugs as a way to prevent HIV transmission.

Results of a study of a new microbicide gel that contains an antiretroviral drug will also be shared at the conference. A microbicide is a gel or cream that women could use before or after sex to protect themselves from infection.

"If the microbicide does work," he said, "it will be the first time that a microbicide has been shown to have a positive effect."

Universal access to AIDS treatment is one of the eight targets of the United Nations Millennium Development Goals. Target 6 calls for halting and beginning to reverse the spread of HIV/AIDS by 2015, and achieving universal access to HIV/AIDS treatment by 2010. With only five months left in the year, prospects are slim for meeting the 2010 goal.

According to the Joint U.N. Programme on HIV/AIDS (UNAIDS), universal access is a global commitment to scale up access to HIV treatment, prevention, care and support. Ninety-nine countries have set targets for treatment, and 98 have set targets for one or more prevention interventions. An interactive map of global progress is available on the UNAIDS website.

Treatment with anti-retroviral drugs also can be a form of prevention, Fauci said in a recent interview with America.gov.

"If you get the virus level down in people who are infected," he said, "they are much less likely to infect other people."

"There's going to be a lot of talk about how do we pay for this," Jon Cohen, a reporter for Science magazine who is providing coverage of the meeting for the Kaiser Family Foundation, said in an interview July 17.

"The dreams, what people want to see happen, are great," he said. "The rich countries of the world are all feeling like they have empty pockets and the aspirations are higher than ever. There will be a lot of conflict and a lot of discussion about how do we pay for what we want to do and what we've promised people we're going to do."

U.S. NATIONAL POLICY

A week before AIDS 2010, on July 13, the United States -- where 1 million people live with HIV/AIDS and one person becomes infected with HIV every 9.5 minutes -- released its own national HIV/AIDS strategy (PDF, 1.37 MB).

In the report, the vision is that "the United States will become a place where new HIV infections are rare and when they do occur, every person, regardless of age, gender, race/ethnicity, sexual orientation, gender identity or socioeconomic circumstance, will have unfettered access to high quality, life-extending care, free from stigma and discrimination."

"Reducing new HIV infections, improving care for people living with HIV/AIDS, narrowing health disparities â-- these are the central goals of our national strategy," President Obama said July 13.

"They must be pursued hand in hand with our global public health strategy to roll back the pandemic beyond our borders," he said. "And they must be pursued by a government that is acting as one. So we need to make sure all our efforts are coordinated within the federal government and across federal, state and local governments, because that's how we'll achieve results that let Americans live longer and healthier lives."

Thousands March in Vienna for Rights of AIDS Patients. 21/7/10

Several thousand activists and anti-AIDS campaigners marched through Vienna's city centre

VIENNA — Several thousand activists and anti-AIDS campaigners marched through Vienna's city centre on Tuesday evening, demanding more respect for human rights in the fight against HIV.

Men and women of all ages, nationalities and sexual orientation paraded down the famous Ring boulevard in the early evening, carrying banners and accompanied by vuvuzelas and loud whistles.

Julio Montaner, director of the International AIDS Society (IAS), which organised the world AIDS conference in Vienna, led the march, alongside the head of UNAIDS Michel Sidibe, and Michel Kazatchkine, head of the Global Fund to Fight Aids, Tuberculosis and Malaria.

"Even if we had the resources and the technology, we could not achieve universal access to treatment for patients without respect for human rights," Kazatchkine told AFP amidst the noisy crowd.

Auma Obama, the half-sister of US President Barack Obama, who helps US charity CARE's anti-AIDS efforts in her native Kenya, also attended and did a little dance with her fellow demonstrators.

The march ended at Vienna's historic Heldenplatz (Heroes' Square), where Sidibe and Kazatchkine joined voices with other activists to call for more funds for the fight against AIDS as well as "Rights Here, Right Now" -- the slogan of the Vienna conference.

Singer and AIDS activist Annie Lennox performed a few songs but also swung scorching criticism at governments in eastern Europe, where the AIDS epidemic is spreading the fastest, shouting: "Where are you? A catastrophe is taking place in your backyard and you're ignoring it."

As for conference host Austria, "your one-million-euro donation to the Global Fund in 2002 is embarrassing," she stormed.

"This event alone will have generated over 45 million euros for the city of Vienna: set the example, put your money where your mouth is and donate generously to the Global Fund," she urged.

Lennox later asked for a minute of silence to remember the victims of AIDS.

Physicians for Human Rights Advocacy Toolkit. 2007.

Micah Network Prayer Week 23/02/09 - 01/03/09

Prayer Week

Micah Network member agency Tearfund UK is holding a Global Poverty Prayer Week from 23 February to 1 March 2009. They ask that we join with them, and the tens of thousands who were involved in the first prayer week in 2007, to be part of a growing network of local churches that are making poverty personal. Tearfund have put together resources that make it easy to pray about big issues like HIV and clean water.

Call to Action for Childhood TB

We, participants gathered at the ‘International Childhood Tuberculosis Meeting’ held March 17-18, 2011 in Stockholm, Sweden recognize that:

To ensure that all children exposed to TB or suffering from TB are correctly managed and receive the appropriate treatment, the individuals and institutions signing on to this call to action, pledge to advocate for universal access to prevention, diagnosis and treatment of TB for people of all ages.

We furthermore call on the international community to endorse this call for action to ensure that there is capacity to address the needs of children with TB.

To sign on to this call-to-action please reply with your name, country, and organization/affiliation (if appropriate) to childhoodTB@treatmentactiongroup.org

Children are Unknown Victims in Global TB Response

It is estimated that at least one million tuberculosis (TB) cases occur each year among children, and most of them in developing countries. These are conservative estimates because many children with TB are not notified, and many others live without access to proper diagnosis or treatment. This makes it difficult to calculate the true number of children affected by the disease. 

Childhood TB has not received the attention it deserves in the global TB response. The real tragedy is that children have been largely neglected in research, epidemiology and surveillance. “Children who are exposed to TB include those from poorer families, those in close contact with TB patients--especially infected relatives, malnourished children, and children living in overcrowded conditions. We lack the proper mechanisms to really help these infants and children.” says Zari Gill, World Vision’s director of infectious disease.

World Vision has specifically been working to draw attention to the impact of TB on children and to raise awareness in communities of the signs and potential effects of TB in children. Staff also work to strengthen local health systems to increase access to diagnosis and treatment, and to help communities monitor their TB patients to assure they complete their full course of TB treatment.

In its community-based response, World Vision trains local volunteers to conduct directly observed treatment short-course (DOTS) for TB treatment to help increase community knowledge about TB transmission, prevention and treatment. Training community volunteers contributes to the capacity of the local health system, freeing health staff time to focus on diagnosis and contact tracing, which is instrumental in the fight against TB. Contact tracing enables the community to identify where a person infected with TB contracted the disease, seeking to treat the disease at the source to prevent re-infection as well as further spread of the disease.

Globally, World Vision joins other organisations in its fight against TB. World Vision partners with the Stop TB Partnership and TB REACH. The TB REACH initiative of the Stop TB Partnership has a fast-track competitive selection of innovative projects, rapid disbursement of funds and a robust monitoring and evaluation system. TB REACH offers a lifeline by finding and treating people in the poorest, most vulnerable communities in the world. In areas with limited or nonexistent TB care, TB REACH supports innovative and effective techniques to find people with TB quickly, avert deaths, stop TB from spreading, and halt the development of drug-resistant strains. 

One of the newest projects funded by TB REACH is in Rwanda, where the World Vision team has launched the TB project on a national scale. In the first four months of the project in Rwanda, World Vision has helped to identify 154 new TB cases in adults and children, educated more than 1500 youth, obtained extensive media coverage, trained and equipped community health workers in three districts, and provided eight microscopes to local health facilities—necessary equipment for TB case detection.

Esperance Akayezu is a 24-year-old mother of two who was helped through this TB response project. Just six months ago Esperance believed dying was better than living. Since then, with the help of WV Rwanda’s tuberculosis (TB) response project, she has received diagnosis and treatment for her TB, as well as other assistance. She no longer despairs of life.

Esperance lives in a mud house with her pregnant sister and her two children, Uwase Divine and Ishimwe Prince, who are being treated for malnutrition. The entire family lives on sparse wages earned by local farm work. She has struggled to raise her two children in these circumstances, and her TB disease has put her children at risk of infection.

Esperance retells her first encounter with World Vision’s TB programme: “A few months ago, a community health worker who works with World Vision invited me to a TB screening. The next day, I went with her for screening. My results showed I was positive for TB, but, fortunately, HIV-negative. I was shocked and really needed some extra support.”

Since receiving help, Esperance is healthier and her children are protected from becoming infected with TB by their mother. Through community health workers trained by World Vision, Esperance receives regular home visits and medication. World Vision also assists with porridge, vegetable seeds and rabbits for her kitchen garden. She has gained 13 kilograms thanks to better nutrition.

“I thank World Vision and local health centre staff because they have advised me on several issues and provide counselling whenever I need it,” she said.

Thanks to generous sponsors, all TB patients have been supported through community-based DOTS, as well as small income generating activities such as small livestock (pigs, goats, rabbits). They also receive vegetable seeds and training about HIV and nutrition -- conducted especially for prevention and management of TB.

Read World Vision’s Call to Action to Prevent Childhood TB.

Global Health and Nutrition

A Call to Prioritise Children in the Global TB Response:

In the global response to tuberculosis (TB), children are the “silent sufferers.” Since they pose a low threat for transmission, children with TB have been relatively neglected. This is a stark violation of their right to health as per Article 24 of the Convention on the Rights of the Child. Attention is focused primarily on adults with TB because they are symptomatic, readily diagnosed and considered potential transmitters of infection.

Children are particularly vulnerable to severe disease and death due to TB. It is estimated that at least one million children develop TB each year..1 This unacceptably high toll of disease and death among children is made worse by the HIV epidemic. TB manifestations are more severe and progression to death is faster among HIV-positivchildren, yet they are at risk of diagnostic error and inappropriate treatment. Increased international travel and immigration have led to an increase in childhood TB rates in traditionally low burden, industrialised countries, and threaten to promote the emergence and spread of multidrug-resistant strains. Children with latent TB infection become a reservoir for future transmission when the disease reactivates in adulthood, fuelling future epidemics.2 We need to simultaneously address many risk factors for TB, especially HIV and AIDS and undernutrition3 as well as addressing the social determinants of tuberculosis4

A child usually gets TB infection from being exposed to a sputum-positive adult--usually a parent. Because of their immature immune systems, young children under age ten are especially at risk of not only becoming infected but of developing active tuberculosis.

Children also suffer when their mothers have TB, often requiring them to leave school to care for their family or leaving them as orphans when their mother dies. Tuberculosis is the third highest cause of death among women of reproductive age 5and therefore has a massive impact on the lives and health of children. Annually 700,000 women die of TB.6 Without rapid scale-up of TB programmes, as many as four million women will die between 2011 and 2015, leaving millions of children orphaned.

World Vision’s Experience:

World Vision works with children, families, communities and donors all over the world to improve the well-being of children. World Vision’s global Child Health Now campaign calls on governments to meet their commitments and increase their efforts to improve child health in order to meet MDG 4 by 2015. Throughout its experience with TB over the past decade, World Vision has identified critical needs and gaps in the response to TB among children, including:

World Vision’s Call on behalf of the “Silent Sufferers” of TB:

Understanding and Challenging TB stigma: Toolkit for Action

‘Understanding and challenging TB stigma’ has been developed in response to the need to address TB stigma especially where TB and HIV co-infection rates are high. The publication contains a range of participatory games, exercises and picture tools to help address TB stigma, suitable for a range of contexts and settings.

World TB Day - March 24th

24 March marks the day in 1882 when Dr Robert Koch detected the cause of tuberculosis, the TB bacillus. This was a first step towards diagnosing and curing tuberculosis.  World TB Day raises awareness about the global epidemic of tuberculosis (TB) and efforts to eliminate the disease. One-third of the world's population is currently infected with TB.  The Stop TB Partnership, a network of organizations and countries fighting TB, organizes the Day to highlight the scope of the disease and how to prevent and cure it.

Call to Action: Make your voice heard by Obama: March to the US consulate on June 17th to save lives!

Dear Colleagues

If you would like to know more about the march, please contact  Catherine Tomlinson at the Treatment Action Campaign email  or call (0) 21 422 1700 .

  to reverse the funding cuts for HIV and to ensure that PEPFAR continues to expand funding to meet universal access targets.

We are calling on the United States and Europe:

  to replenish the Global Fund on AIDS TB and Malaria (GFATM) to meet universal access. The Global Fund has indicated that it must raise between $17 and $20 billion for its upcoming round to continue to expand its programmes. nbsp; The United States and Europe must publicly guarantee that this funding is made available to meet the expectations that they themselves have created by their commitments to universal access.

We are calling on President Zuma and Health Minister Motsoaledi:

;  to represent the needs of Africa during this year’s global forums on the MDGs. < To lead developing countries in echoing our calls for expanded and sustainable funding for HIV.

Mobilization:

TAC has mobilised branches and members to attend the march on 17 June. The expected figures include 1500 people from Gauteng, 800 people from Mpumalanga , 600 people from Limpopo and 65 people from the Free State.

By the end of today Phillip will email all partners pick up points in each province.

Media:

TAC has sent out the letters to Obama, Biden and Zuma to all media. TAC has also sent out a press statement announcing the march and with background of the march.

MSF has also published information on the M&G thought leader blog and is preparing an editorial to be published next week. Have other partners sent out statements?

TAC Ekurhuleni has secured a spot on KhaziFM to mobilize communities in Ekurhuleni to join the march. Are other districts raising awareness about the march?

The street posters advertising the march will go up on Monday.

On Monday morning, TAC and partners will send out a press statement on the march as well as march and press conference details. All partners should send this off on their media lists.

On Tuesday the press conference will be held at the COSATU offices in Johannesburg. There will be a TAC, MSF and COSATU speaker.

What else can we do? Will work on a facebook page over the weekend. Any ideas from partners?

Material:

The posters, pamphlets, t-shirts and banner will be delivered to the TAC office on Monday. MSF will be bringing 20 000 kites and XX paper shoes.

March permission and memorandum:

We have received permission to hold the march and will be gathering in George Lea Park at 10:00 am.

The US ambassador has responded to our letters. (will forward response to partners). TAC is trying to organize to meet with representatives of the US Embassy over the weekend to organize who will accept the memorandum.

Please see attached posters for the resources for health march on the 17^th June, please all offices print and put them up in the office. Also attached are details of pick up points in Gauteng.

Rally:

More details to be sent.

We call on you to join the march. AIDS is not over. Be seen. Be heard by the world while they are watching the World Cup played in our country.

Thank you

Denise

Civil Society Consensus Statement. 10/10

A ten point agenda for saving and bettering lives

CABSA decided to endorse the Consensus Statement sent to government and SANAC.  The finalised document as it was sent is attached. The statement was also endorsed at the COSATU-civil society conference. By mid November 2010 65 organisations indicated their support.

The Deputy President, Minister of Health and CEO of SANAC are all aware of this statement.  Minister Motsoaledi has read the statement, and SANAC Deputy President Mark Heywood handed it directly to Deputy President Motlanthe.

See the document attached below

The document articulates the concerns of civil society about the challenges around HIV and TB prevention, and the malfunctioning of the SANAC Secretariat. The document makes recommendations as well as outlines demands for SANAC to play its role in co-ordinating and supporting   sectors.



The demands are:

1.    We Demand Sustained Political Leadership and Engagement from the Highest Level of Government on an effective and efficient HIV response!

2.     We Demand a Unified Communications Strategy on HIV and TB Prevention!

3.    We Support the HIV Counselling and Testing (HCT) campaign – but implementation must be drastically improved!

4.    We Demand the integration of Community Health Care Workers (CCWs) into the health system!

5.    We Demand a Human Resources for Health plan by March 2011!

6.    We demand expanded access to improved ART regimens, better HIV and TB drug regimens & TB Integration!

7.    We Demand a Plan for Sustainable National and International Financing of the HIV and TB Response!

8.    We demand Social Assistance for people who are chronically ill!

9.    We demand that SANAC be revived as an effective and accountable institution driven by civil society priorities!

10.    Build independent, effective, accountable Civil Society organisations!



Please circulate and discuss the document in your organizations and networks, and forward your input and endorsements to Kate Paterson [paterson@section27.org.za]



 

OSLO Declaration on HIV Criminalisation. 2/12

Prepared by international civil society in Oslo, Norway on 13th February 2012

1. A growing body of evidence suggests that the criminalisation of HIV non-disclosure, potential exposure and non-intentional transmission is doing more harm than good in terms of its impact on public health and human rights.[1]

2. A better alternative to the use of the criminal law are measures that create an environment that enables people to seek testing, support and timely treatment, and to safely disclose their HIV status.[2]

3. Although there may be a limited role for criminal law in rare cases in which people transmit HIV with malicious intent, we prefer to see people living with HIV supported and empowered from the moment of diagnosis, so that even these rare cases may be prevented. This requires a non-punitive, non-criminal HIV prevention approach centred within communities, where expertise about, and understanding of, HIV issues is best found.[3]

4. Existing HIV-specific criminal laws should be repealed, in accordance with UNAIDS recommendations.[4] If, following a thorough evidence-informed national review, HIV-related prosecutions are still deemed to be necessary they should be based on principles of proportionality, foreseeability, intent, causality and non-discrimination; informed by the most-up-to-date HIV-related science and medical information; harm-based, rather than risk-of-harm based; and be consistent with both public health goals and international human rights obligations.[5]

5. Where the general law can be, or is being, used for HIV-related prosecutions, the exact nature of the rights and responsibilities of people living with HIV under the law should be clarified, ideally through prosecutorial and police guidelines, produced in consultation with all key stakeholders, to ensure that police investigations are appropriate and to ensure that people with HIV have adequate access to justice.

We respectfully ask Ministries of Health and Justice and other relevant policymakers and criminal justice system actors to also take into account the following in any consideration about whether or not to use criminal law in HIV-related cases:

6. HIV epidemics are driven by undiagnosed HIV infections, not by people who know their HIV-positive status.[6] Unprotected sex includes risking many possible eventualities – positive and negative – including the risk of acquiring sexually transmitted infections such as HIV. Due to the high number of undiagnosed infections, relying on disclosure to protect oneself – and prosecuting people for non-disclosure – can and does lead to a false sense of security.

7. HIV is just one of many sexually transmitted or communicable diseases that can cause long-term harm.[7] Singling out HIV with specific laws or prosecutions further stigmatises people living with and affected by HIV. HIV-related stigma is the greatest barrier to testing, treatment uptake, disclosure and a country’s success in “getting to zero new infections, AIDS-related deaths and zero discrimination”.[8]

8. Criminal laws do not change behaviour rooted in complex social issues, especially behaviour that is based on desire and impacted by HIV-related stigma.[9] Such behaviour is changed by counselling and support for people living with HIV that aims to achieve health, dignity and empowerment.[10]

9. Neither the criminal justice system nor the media are currently well-equipped to deal with HIV-related criminal cases.[11] Relevant authorities should ensure adequate HIV-related training for police, prosecutors, defence lawyers, judges, juries and the media.

10. Once a person’s HIV status has been involuntarily disclosed in the media, it will always be available through an internet search. People accused of HIV-related ‘crimes’ for which they are not (or should not be found) guilty have a right to privacy. There is no public health benefit in identifying such individuals in the media; if previous partners need to be informed for public health purposes, ethical and confidential partner notification protocols should be followed.[12]

This document is also available in French, German, Italian, and Spanish here

References

[1] UNAIDS. Report of the Expert Meeting on the Scientific, Medical, Legal and Human Rights Aspects of Criminalisation of HIV Non-disclosure, Exposure and Transmission, 31 August-  2 September 2011. Geneva, February 2012.

[2] UNAIDS/UNDP. Policy Brief: Criminalization of HIV Transmission. Geneva, July 2008; Open Society Institute. Ten Reasons to Oppose the Criminalization of HIV Exposure or Transmission. 2008; IPPF,GNP+ and ICW. Verdict on a Virus. 2008. See also: IPPF. Verdict on a Virus (documentary) 2011.

[3] GNP+/UNAIDS. Positive Health Dignity and Prevention: A Policy Framework. Amsterdam/Geneva, January 2011.

[4] UNAIDS/UNDP. Policy Brief: Criminalization of HIV Transmission. Geneva, July 2008.

[5] UNAIDS. (2012) Op. cit.

[6] Marks G et al. Estimating sexual transmission of HIV from persons aware and unaware that they are infected with the virus in the USA. AIDS 20(10):1447-50, 2006; Hall HI et al. HIV transmissions from persons with HIV who are aware and unaware of their infection, United States. AIDS 26, online edition. DOI: 10.1097/QAD013e328351f73f, 2012.

[7] Bernard EJ, Hanssens C et al. Criminalisation of HIV Non-disclosure, Exposure and Transmission: Scientific, Medical, Legal and Human Rights Issues. UNAIDS, Geneva, February 2012; Carter M. Hepatitis C surpasses HIV as a cause of death in the US. Aidsmap.com, 21 February 2012.

[8] UNAIDS. Getting to Zero: 2011-2015 Strategy. Geneva, December 2010.

[9] Bernard EJ and Bennett-Carlson R. Criminalisation of HIV Non-disclosure, Exposure and Transmission: Background and Current Landscape. UNAIDS, Geneva, February 2012.

[10] GNP+/UNAIDS (2011) Op. cit.

[11] Bernard EJ and Bennett-Carlson R (2012) Op. cit.

[12] UNAIDS. Opening up the HIV/AIDS epidemic: Guidance on encouraging beneficial disclosure, ethical partner counselling & appropriate use of HIV case-reporting. Geneva, 2000.

Global Fund Call to Action. 04/12/2011

PLEASE SIGN ON TO THE CALL TO ACTION BELOW, you can send your reply to jw@icssupport.org, and please also put up the Call to Action on your websites.

The cancellation by the Global Fund to Fight AIDS, TB and Malaria of all new programming until 2014 is unacceptable. This decision will cost lives and cripple international efforts to deliver on health-related goals, breaking promises made to some of the world’s most vulnerable people, and punishing the Global Fund's success of the last ten years. 

People living with HIV and their supporters, as well as communities affected by TB or malaria, are extremely concerned about the damage under-funding of the Global Fund is causing. We therefore demand that:

· The Global Fund Board and Secretariat mobilise the resources necessary to scale-up the response to the three diseases through a new funding opportunity for 2012, estimated at US$2 billion.[1]

·       Donors to the Global Fund – particularly governments – urgently deliver on the commitments they made to meet health goals[2] and to fund the Global Fund at its Replenishment Meeting in 2010.[3]

·       The Global Fund hold an emergency donor conference and issue a new call for proposals before the International AIDS Conference in July 2012 to fully fund the scale-up of programmes that will fundamentally changing the course of these three epidemics, and put the world on the path towards ending AIDS.

This is 200 days from 1 January. 200 days to save the Global Fund.

We cannot wait until 2014 for the Global Fund to support further scale-up of programmes and life-saving treatment. We urgently call on the Global Fund to meet the timeline above and for donors and affected countries to ensure that interventions with the highest impact on the three epidemics are supported.

The clock is ticking. Millions of lives are at stake.