ICASA 2019: Strong leadership and communities key to ending AIDS

Delegates at the opening conference of ICSA 2019 © Frontline AIDS

Thousands of people converged on Kigali for Africa’s largest conference on AIDS. But what difference will it make to bringing the continent closer to tackling one of it’s biggest health issues? From an audience with Winnie Byanyima to breaking out of the echo chamber, community advocates Gracias Atwiine, D’bora de Carvalho and Lloyd Dembure reflect on the challenges and opportunities.

1. How were marginalised communities represented during the conference?

Lloyd: Apart from sessions with partners community engagement was limited. We need to make it a safe space for communities to share their experience and create deliberate spaces away from the global village where people are speaking into a chamber and preaching to the converted. We need to look at the whole programme to see if it’s comprehensive and allocate programmes so that we address the gaps, covering all the groups that are mainly getting new HIV infections, so that we truly leave no one. If we focus on some areas that we are comfortable with and we leave other groups, then we marginalise those groups. Without the communities we won’t achieve much.

D’bora: There was limited participation of communities, especially sex workers, lesbian, gay, bisexual, transgender, queer and intersex, and people who use drugs attending the International Conference on AIDS and STIs in Africa (ICASA). This jeopardised somehow the Mozambican CSO expectation to engage and share experiences with other communities.

Gracias: At times, the ICASA space was a little inhibitive and there was a high level of security. It was even more so when the president opened the conference but also when the first lady spoke at a panel. As Uganda is the next ICASA host, the organisers must ensure that delegates feel safe without necessarily deploying security personnel in the conference space.

2. How can civil society hold governments accountable for promises made at ICASA?

D’bora: “Money is not everything. The money needs to be spent in programs which are effective and bring evidence” said Paul Kagame [President of Rwanda] in his call to action to African leaders, adding that political willingness at country level without practical action and bold measures to end HIV by 2030 is nothing .

It’s common for governments to transfer their responsibility to provide quality social services for its citizens to the donor community. The lack of budget to finance quality social services is the justification used. But Kagame demystified this discourse. Seeing Mozambique’s President Nyussi and the Ministry of Health listening to this was powerful . Now, the Ministry of Health can’t tell us that there is a lack of domestic funds to finance the HIV response in Mozambique.

Lloyd: Although there were government officials and a delegation from the National AIDS Council who also participated in our [PITCH] sessions, I feel the connection should happen more back home.

In the session on the HIV prevention shadow reports, the Ministry of Health officials said there are other elements where they need civil society to support them on issues like human rights for key population groups. Because they [government] are a part of the system, it might be difficult for them as some of the issues are politicised. Instead, they can partner with civil society by sharing evidence on where the concentrated epidemics are, and we can use that evidence to push for policy and law reform.

3. What impact will the new UNAIDS Director have beyond the conference?

Gracias: This was the first time the UNAIDS director didn’t speak at the opening conference of ICASA, so  people and the media kept running after her [Winnie Byanyima] to pick her mind on certain critical issues.  Her voice at the opening ceremony would have shaped the various discussions and guided many countries on new approaches to employ to end HIV/AIDS in Africa.

In sessions, she was bold and constantly reminded us of the importance of leadership and involving communities in the fight against HIV if countries want to reach epidemic control. I was inspired by Frontline AIDS’ session where she spoke about how Rwanda had quietly reviewed her laws and decriminalised KPs. She stated: “You don’t have to put the rights of the minority for the majority to decide on”.

She talks a lot about gender-based violence as one of the contributory factors to the heightened HIV prevalence among women in Africa and the world over. Certainly, issues of gender, community participation, women including transgender women will be one of her focus areas during her tenure in office.

UNAIDS’ Director visits Uganda 

Winnie has since visited Uganda to meet with the President, Uganda AIDS Commission leadership and members of civil society. During the meeting she emphasised the need to invest in targeted prevention if Uganda is to reach epidemic control by 2030. She is committed and passionate and stressed that we need to re-think HIV prevention messaging and ensure the right laws are in place to support prevention efforts.

She specifically called upon the leadership of Uganda to review laws that criminalise KPs since data has shown that new infections are high among KPs including HIV prevalence. Adding that there is an impact of non-progressive laws that further send KPs underground with limited health care access including HIV care.

As a result, the president committed to convening a dialogue with his legal team to discuss the out-dated and non-progressive laws in Uganda including laws that criminalise key populations. This kind of follow up to ensure the laws are reviewed is a powerful indicator that goes to ground her commitments into actions.

4. What was your key takeaway?

Lloyd: A number of speakers challenged civil society to politicise the health advocacy agenda as at the beginning of HIV where we had robust advocacy activities.  How else can we improve our targeting like engaging key stakeholders whom we don’t usually engage with such as the Ministry of Finance on domestic resource mobilisation? This will help in improving our results. How can we have a co-ordinated advocacy approach to reach those in the corridors of power? We need to reach out to more decision makers who can influence the desired change.

D’bora: The participation of President Filipe Nyussi was an encouraging moment for the Mozambican delegation at ICASA and he was the only other African president attending the conference. He recognised that the HIV response in Mozambique is far away from the expectation, but also promised to have HIV, malaria, tuberculosis, and non-transmissible disease such as cancer as the four top priority diseases in the next government (starting from January 15, 2020). In addition, he acknowledged the role of civil society and community based organisations in the HIV response and promised to improve the quality of health service provision as Mozambique implements Universal Health Coverage (UHC).

Even though there are development plans at country level, referring to a willingness to end poverty, fight HIV and increase the financing to Health and education, the political leadership’s willingness is not followed by practical actions. As such, from the presidents to the leaders at the bottom level the speech is beautiful, but no one is really keen to translate their speech into action. However, Rwanda has taken bold measures to achieve the 90-90-90 targets, becoming an example for other African countries.

Gracias Atwiine, Lloyd Dembure and D’bora de Carvalho are country focal points for Uganda, Zimbabwe and Mozambique in the Partnership to Inspire, Transform and Connect the HIV response (PITCH), a strategic partnership between Frontline AIDS, Aidsfonds and the Dutch Ministry of Foreign Affairs. 

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