The HIV movement and the humanitarian sector – Why do we need to work together?

1. The humanitarian sector

In 2016, humanitarian organisations signed the Grand Bargain, a commitment to increase the effectiveness and efficiency of humanitarian action, which includes putting more money in the hands of local actors. This ‘localisation’ agenda means responding to a crisis by channeling more funds to local organisations instead of UN agencies and large international non-governmental organisations (INGOs). The sector agreed, in any future crisis, to transfer a minimum of 25% of funds to local or national organisations. However, while these figures vary significantly across responses, the sector is far from achieving its localisation targets. For example, a report commissioned by the Disasters Emergency Committee (DEC) in November 2022 found that less than 1% of humanitarian funding in Ukraine had been allocated to local/national actors. 

Why is this important? When UN agencies and large INGOs land in a new crisis, they need time to develop an understanding of the context, and they tend to focus on reaching the largest number of people in need within the shortest possible timeframe. This means that although aid is intended for the most vulnerable, beneficiary selection is often conducted through existing community gatekeepers, such as political, religious or tribal leaders, who typically represent the ‘mainstream’ community. Those who were already marginalised in ‘normal times’, such as people living with HIV, members of the LGBTQ+ community, sex workers, or people who use drugs (depending on the context), might be left behind. We have seen this in humanitarian crises, and we also observed it during the COVID-19 pandemic. You can find recommendations for organisations working across the humanitarian-development nexus in this advocacy brief, which is based on the experiences of marginalised communities during COVID-19. 

2. The HIV movement

Meanwhile, the HIV movement has spent the last 40 years building the capacity of civil society actors worldwide. This includes organising people living with HIV to know their rights, fighting stigma and discrimination, establishing community health systems, and creating services for young people, sex workers, the LGBTQ+ community, and people who use drugs, delivered by trusted peers. These services are not just created for them, but with them, following the motto “nothing for us, without us”. We know that when resources are placed in the hands of affected people, they understand their needs best, and how to address them. Using the networks of trust established by the HIV movement to distribute humanitarian aid allows marginalised populations to access the same resources as other groups in times of crisis, making humanitarian responses more inclusive and effective. By leveraging existing networks and groups, rather than trying to create new representations of marginalised groups, humanitarian actors can increase the efficiency of their response.  

At the same time, the HIV movement has mostly operated in times of peace. There are specificities to emergency response during conflicts or natural disasters that require adaptations to our programming and approach. How should we adapt our messaging and services when the people we work with may be facing new threats such as explosive remnants of war, or have been displaced to another region of their country? If the existing health service is no longer able to provide the same level of care as before, in what way should we ensure access to healthcare?

Even under stable conditions, we are still far from achieving the 2030 target of ending AIDS. When you factor in conflict, and the effects of climate change, the outlook becomes even more concerning. Data from the Frontline AIDS Climate-HIV Framework suggests that carbon emissions continue at the current rate, we can expect between 11.6 and 16 million additional cases of HIV by 2050. This framework links the effects of climate change — such as rising temperatures, weather-related disasters, sea level rise, and air pollution — to the pathways that increase rates of HIV: increased human migration, prevalence of other diseases, food insecurity, economic stress, conflicts, terrorism, and the erosion of health infrastructure. All these pathways will either create or exacerbate existing humanitarian crises. It is vital that we learn from the humanitarian system on how to plan and prepare for emergencies, coordinate with the humanitarian cluster system, and operate quickly and at scale.  

3. Working together to tackle connected crises

To sum it up, the humanitarian sector is struggling to meet its own targets of ‘localisation’, but has extensive knowledge of how to operate in disrupted settings. Meanwhile, the HIV movement needs help adapting to these disrupted settings, but knows a thing or two about reaching the most marginalised, and empowering communities so they can lead their own responses. This is the opportunity: by working together and learning from each other’s systems and approaches, we can ensure that services reach everyone, everywhere, and be more prepared and resilient for the challenges ahead.

At Frontline AIDS, we have planted the seeds for this collaboration by joining the Inter-Agency Task Team (IATT) on HIV in Emergencies, a group of UN agencies, donors and NGOs working at global, regional and country levels to accelerate the response on HIV in humanitarian settings and emergencies. Currently, the group is reviewing the 2010 inter-agency guidelines for addressing HIV in humanitarian settings. Moreover, the Frontline AIDS team is engaged in reviewing a priority matrix for global HIV interventions in humanitarian emergencies.  

Another example of collaboration with the humanitarian sector has been in Ukraine. Frontline AIDS’ long-term national partner, Alliance for Public Health (APH), has been implementing humanitarian projects with Christian Aid, via DEC funding. We discussed this collaboration in detail at a recent event ‘Continuity in Crisis: A Positive Story of Localisation, Innovation and Inclusion in Ukraine’ (see the recording), which showcased the experience of joining forces to reach the most marginalised during the ongoing conflict in Ukraine. The event took place in London on 2 July 2024 and was a collaborative effort involving Frontline AIDS, APH, Christian Aid, DEC and ALNAP.