As World AIDS Day (1 December) approaches, UNAIDS is urging governments to fully leverage the power of grassroots communities to help end AIDS as a public health threat. A new report launched today by UNAIDS, Let Communities Lead, shows that the proportion of HIV funding channeled through community-led organizations has declined by at least 35% over the last decade. To accelerate progress, the work of communities on the frontline must be better integrated into all aspects of the HIV response and properly resourced.
When an emergency strikes, communities are the first responders. Community advocacy from the streets to the courtrooms to parliaments has secured groundbreaking changes in policy. Strategic advocacy by communities has expanded recognition and protection of human rights in India, where the Supreme Court recognised same-sex relations and also ruled that sex workers have the same rights and access to social protection schemes as all other people.
“Community have led the HIV response here in India in partnership. Their intimate understanding of local nuances, coupled with resilience, fosters inclusivity and innovation in achieving sustainable progress. This World AIDS Day, let us recognize and amplify the pivotal role communities play in charting a path towards ending AIDS as a public health threat in India”, said David Bridger, Country Director of the UNAIDS India Office.
Communities include organizations of people living with HIV, the key populations (men who have sex with men, people who use drugs, prisoners and other people in detention, sex workers and transgender people) and other civil society organizations. Since the inception of the AIDS pandemic, they have driven progress. This includes activism for global access to lifesaving antiretroviral therapy, legal and policy changes to create a more enabling environment for an effective HIV response and delivery of HIV prevention, testing, treatment and care services.
Through the 2021 Political Declaration on ending AIDS, United Nations member states committed to support community leadership. This includes having communities deliver 30% of testing and treatment services and 80% of HIV prevention services for people from populations at high risk of infection. However, the report reveals that while in 2012 around one-third (over 31%) of HIV funding globally was channeled through community-led organizations, by 2021, this declined to just 20%.
UNAIDS is calling for communities’ leadership roles to be made core in all HIV plans and programmes and for community-led organizations to be fully and reliably funded.
The situation in India
In India, the HIV epidemic primarily impacts key populations and their sex partners. There are an estimated 2.47 million people living with HIV, however the rate of new infections has declined by a little over 42% since 2010 which is above the global average of 38%. A great deal of India’s success in reducing new infections has occurred due to the partnership with community.
“Through constant engagement with authorities, we have improved the design of services provided by the health system, so they meet the needs of sex workers. We have successfully advocated with officials for us to be involved in decisions that affect our lives. We have also created important services for ourselves, after consulting our fellow sex workers to make sure they meet the needs of our community.” said Lakshmi, Secretary, Ashodaya Samithi – a community-led organization that is by, for and of sex workers.
Progress toward reaching the Global AIDS Strategy’s 95% testing and treatment targets is uneven. In 2022, 79% of people living with HIV know their status. Of these people, 86% are on antiretroviral treatment. Of those on treatment and tested for viral load, 93% are virally suppressed. A key priority for the country is reaching the people living with HIV who are unaware of their HIV status and need to be linked to treatment.
The report highlights how new approaches from communities are at the forefront of bringing change. A community-led initiative here in India by the TWEET Foundation supports the socioeconomic inclusion of the transgender community by increasing awareness of the business sector regarding transgender issues and by helping connect community members to well-paid jobs. In addition to promoting dialogue between government, civil society and businesses, the community-led initiative links community members to skills training, career counselling, entrepreneurship support and mentorship. TWEET complements its work on socioeconomic welfare with advocacy for solutions to challenges faced by marginalized transgender people of all identities.
The report also features nine guest essays from community leaders across the globe including one from India. Bhagya Lakshmi’s essay shares her experience as a sex worker in India, the achievements they have secured as a part of Ashodaya – a sex workers collective, the barriers they face, and what India needs to do to end AIDS as a public health threat.