Ambition and acceleration Annual Review 2012
a community-led “Through response we improved the lives of 4.7 million people in 2012
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About the International HIV/AIDS Alliance We are an innovative alliance of nationally based, independent, civil society organisations united by our vision of a world without AIDS. We are committed to joint action, working with communities through local, national and global action on HIV, health and human rights. Our actions are guided by our values: the lives of all human beings are of equal value, and everyone has the right to access the HIV information and services they need for a healthy life.
Our 2010-12 strategy AIM 1 AIM 2 AIM 3
Protect human rights Increase access to health services Support secure livelihoods
This report highlights successes under the following four responses in order to achieve our aims: RESPONSE 1 Scale up integrated programming RESPONSE 2 Support well functioning community-based organisations RESPONSE 3 Help form engaged, inclusive societies RESPONSE 4 Create a learning alliance
International HIV/AIDS Alliance (International secretariat) Telephone: +44 (0)1273 718900 Fax: +44 (0)1273 718901 Email: mail@aidsalliance.org Web: www.aidsalliance.org Registered charity number: 1038860
HIV and Healthy Communities 2012 was the final year of our HIV and Healthy Communities strategy (2010-12) which challenged us to scale up integrated programmes. Over the three-year period we expanded significantly and reached over 10 million people. We welcomed into the Alliance six Linking Organisations in sub-Saharan Africa and four organisations from Asia and Latin America1. Increasing the integration of human rights and sexual and reproductive health into our HIV programmes has been, and remains, a priority. We have made substantial progress over the period of this strategy. This integration is now embedded in what we do and will continue to get stronger. Our ambitious new Link Up programme will be a core part of this. It will improve the sexual and reproductive health and rights of more than one million young people in Bangladesh, Burundi, Ethiopia, Myanmar and Uganda. All our work is grounded in human rights and you can hear from an activist on page 13 why it is impossible to separate human rights and HIV. During this strategy we have also expanded our portfolio of work with marginalised and mostat-risk populations. This includes the Pehchan project – Alliance India’s HIV prevention work with sexual minorities – and work to strengthen the regional transgender network in Latin America and the Caribbean (REDLACTRANS). Our work with men who have sex with men in Africa is also set to increase in the year ahead. Our global policy work over the past three years has helped develop a human rights framework for HIV and we are continuing to help shape the discussions about a post-2015 development framework to keep HIV2, health and human rights on the agenda.
Published 2013 © International HIV/AIDS Alliance Design by Progression
REDLACTRANS on a march through the streets of Guatemala to demand an end to transphobia in Latin America © Aldo Fernandez /REDLACTRANS/Alliance
1. In Sub Saharan Africa between 2010 and 2012 we welcomed L’Alliance Burundaise Contre le SIDA (ABS) in Burundi, Zimbabwe AIDS Network, the AIDS Consortium in South Africa, the Botswana Network on Ethics, Law and HIV/AIDS (BONELA), the Organization for Support Services for AIDS (OSSA) in Ethiopia and Positive Vibes in Namibia. In Asia we welcomed the Humasafar Trust in India and the Centre for Supporting Community Development Initiatives (SDCI) in Vietnam. In Latin America and the Caribbean we welcomed Promoteurs Objectif Zerosida (POZ) in Haiti and Asociacion Atlacatl Vivo Positivo (Atlacatl) in El Salvador. Mozambique National AIDS Service Organisation (MONASO) joined in 2010 and left in 2012.
Unless otherwise stated, the appearance of individuals in this publication gives no indication of either sexuality or HIV status.
2. The Alliance worked with other civil society organisations to ensure that governments attending the 2011 United Nations High Level Meeting adopted a robust political declaration to make a real difference in the lives of people living with HIV and those at higher risk of HIV.
Children supported by a group for people affected by HIV, Uganda © Nell Freeman for the Alliance A youth group in the Malnicherra tea plantation in Sylhet, Bangladesh. The group raises awareness of sexual and reproductive health and rights © Alliance
Introduction The global Alliance exists for one reason – to end AIDS. This is an ambitious goal, but one we believe is realistic. When we look back over 2012 we can be proud of the progress we have made. The Alliance is made up of 40 independent, national organisations3. Our collective determination means that despite another challenging year for the HIV response4 we reached 69% more people in 2012 than the year before, improving the lives of 4.7 million people and reaching the ambitious targets in our 2010-12 strategy5. Right from our foundation 20 years ago, the Alliance chose to tackle HIV and AIDS by championing a community-led response, enriched and strengthened by learning from each other. Supporting community action on HIV, health and rights remains just as relevant to the AIDS response today as we embark on our new strategy.
Diverse approaches The stories we bring you here include a mapping exercise in Burkina Faso which is helping to prevent mother-to-child transmission of HIV; work to reach fishermen in Malaysia with harbourside needle and syringe exchanges; and a campaign to stop governments across Latin America ignoring the senseless murders of transgender women.
Through our community-driven approach we reached 984,000 people with sexual and reproductive health services last year, and more than doubled the amount of people accessing Alliance-provided voluntary counselling and testing services. Our work over the past year has highlighted again that to reach the people who are most affected by HIV and AIDS – and create lasting change – communities must be at the helm.
A responsibility to remain ambitious While our successes provide us with hope, what spurs us on to change more lives is the injustice and personal tragedy that we see every day. Lives are ruined because essential treatment is not available or because of a basic disregard for human rights, fuelled by stigma. All too often the two problems are intertwined.
I discovered I was HIV-positive when I was pregnant with my first child. After my husband died I was inspired to start doing something for the community Shaleen, outreach worker, Malaysia
In this review, Shilla, Jamel and Marcela share their stories in the hope that the Alliance can help reduce the stigma and discrimination that continues to be the major barrier to their communities accessing the essential services they need. With 34 million people living with HIV globally the Alliance will continue to confront these challenges in the next phase of the response. We have a responsibility to ensure our targets remain ambitious.
Looking forward: our 2020 vision Our new strategy HIV, Health and Rights: Sustaining Community Action (2013-20) articulates the determination of the wide range of community leaders, activists, programme managers and civil society advocates who make up the Alliance. It responds to a number of critical external factors: the unfinished Millennium Development Goals; the rapid withdrawal of development financing from middle-income countries and a more fragmented base of support for civil society; a more inclusive model of country ownership; and scientific breakthroughs that present new opportunities to end AIDS.
Supporting community action on HIV, health and rights to end AIDS
HIV, HealtH & rIgHts sustaInIng communIty actIon Strategy 2013-2020
We are committed to end AIDS by working with communities to take national and global action on HIV, health and human rights. www.aidsalliance.org/strategy
3. At the time of going to print (June 2013) the Alliance included 40 Linking Organisations and Country Offices. We have welcomed TACOSODE in Tanzania and unfortunately seen the closure of Alliance Zambia. AIDS Care China has replaced the Country Office in China, and Alliance India, formerly part of the secretariat, has transitioned to an independent Linking Organisation. The Alliance also includes an international secretariat and seven Regional Technical Support Hubs. See the back cover for full details. 4. A significant decline in HIV funding that was predicted by many was, to a large extent, mitigated in 2012. See page 14 to read more about this. 5. See box out HIV and Healthy Communities.
Ambition and acceleration: Annual Review 2012
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Response
01
Scale up integrated HIV programming
We significantly increased our reach in 2012. More people benefited from our community-based services that are tackling HIV and other health related issues, including sexual and reproductive health.
74,000
We reached 4.7 million people
Over half, 2.7 million, were in Africa
(up from 2.8 million in 2011)
Over pregnant women living with HIV received services to prevent mother to child transmission
(up from 64,000 in 2011)
& 984,000
people received SRH services
(up from 504,000 in 2011)
4.1 million people prevention We reached
with services and 58 million condoms were distributed
&
The number of people accessing voluntary counselling and testing services more than doubled
x 10,000
97%
of Linking Organisations report data to national AIDS authorities, and 10 are making a significant6 contribution to national HIV targets. For example, Positive Vibes contributes 90% of Namibia’s prevention target with most at risk populations 6. Significant is defined here as contributing 10% or more to a national HIV target. 97% of the 32 LOs that answered the 2012 survey.
4
(596,000 people from 210,00 in 2011)
Ambition and acceleration: Annual Review 2012
Social mapping: transforming communities’ health in Burkina Faso Burkina Faso faces enormous challenges providing healthcare for its citizens. For example, there is just one midwife for every 13,000 inhabitants and a quarter of all births take place at home.
This means mothers – together with their unborn and newborn babies – are at particular risk of complications during pregnancy or childbirth. In the central-eastern region, home to just under a million people, a simple but innovative social mapping exercise has been capturing allimportant data that has far-reaching implications for planning, implementing and following-up health services in the community. Led by Alliance Linking Organisation, the Initiative Privée et Communautaire de Lutte Contre le VIH/SIDA au Burkina Faso (IPC), in conjunction with the Regional Health Centre, the project targets women of childbearing age in six districts. It is a prime example of how the work of community-based organisations can help meet a population’s health needs. Community health volunteers capture real-time data on the health of households as well as monitoring follow-up services, including treatment adherence. To date more than 500 villages have been mapped enabling over 100,000 women and girls in remote areas to be referred on to formal health services including family planning, antenatal care and safe delivery services.
Encouraging uptake of services is a crucial step in a region where contraceptive coverage stands at just 21% – seven percentage points below the already low national average of 28%. This is where the community health volunteers are key to success, acting as a gateway to link up families with their local health centre. The mapping tool is deliberately uncomplicated and does not depend on high literacy levels. This enables both the volunteers to use it when interviewing households, and helps individuals to take an active part in the decision-making processes affecting their own health. The community action led by IPC and its partners is bridging the gap between informal community systems and formal health services, improving health and saving lives. The simple mapping tool in action © Ollivier Girard for IPC
A community health volunteer explains how she can help people make decisions about their health © Ollivier Girard for IPC
Ambition and acceleration: Annual Review 2012
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Breaking taboos in Bangladesh In Bangladesh young people are the most vulnerable to HIV. The risks are even higher for young people from highly stigmatised groups, such as sex workers, people who inject drugs, and men who have sex with men.
Social and cultural taboos cause a pervasive silence around sexual and reproductive health and rights, but things are changing. HASAB, the Alliance Linking Organisation in Bangladesh, has trained 300 peer leaders on issues important to young people, including HIV prevention, sexual and reproductive rights, safe motherhood and addressing gender-based violence.
Reaching rural areas The project has been particularly ground breaking in Sylhet, in north-eastern Bangladesh, where our implementing partner Reliant Women Development Organisation has established youth groups in local tea gardens. It is the only sexual and reproductive health project in the district.
Malnicherra is the oldest of Bangladesh’s 165 tea gardens. Here youth groups meet twice a month after school or at the weekend. There are 25 members in each group. Sima, 18, who lives on the Malnicherra estate, is a peer leader for three girls’ groups: “I’m happy that I’m letting people know about these issues ... At first I was a bit shy in the sessions but now the young people are eager and come forward to talk to me about sensitive issues, so it feels good; they encourage me to talk.” At the start of the project, gatekeeper meetings with parents, religious leaders, community leaders and teachers proved essential in ensuring support for the youth groups. “People went to the gatekeeper meetings out of curiosity initially. People would say: all those girls in one room together, what are they doing?”, says Sima. “Now they know, they are enthusiastic.”
Previously I didn’t know about condoms. Now I talk with my clients... I say to them: you came for momentary satisfaction but you have no idea... I explain how HIV is spread Shilla, youth group member
Shilla7, a sex worker in Sylhet, joined one of the youth groups a year ago. “I heard about the group sessions from my friend. [I now understand] how a sex worker can go on with her life in safety.” “Previously I didn’t know about condoms. Now I talk with my clients... I say to them: you came for momentary satisfaction but you have no idea... I explain how HIV is spread.” The work in Bangladesh will continue under Link Up, an ambitious new three-year programme which will reach over one million young people across five countries.
Sima, one of 300 peer leaders © Alliance
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Ambition and acceleration: Annual Review 2012
7. Not her real name
Response
02
Support community-based organisations
We believe a strong community response is critical to ending AIDS. We are an alliance of national organisations providing communitybased organisations with financial and technical support. In 2012:
1,800
community-based organisations received grants and technical support from Linking Organisations, up by 21% from 1,488 in 2011
The Regional Technical Support Hubs8 provided 9,700 days of technical assistance, an increase of
103%
Our good practice programming standards continue to support quality programming. At the end of 2012 we had guides in the following areas: Greater involvement of people living with HIV (GIPA); HIV and drug use; integration of sexual and reproductive health and rights; and family centred HIV programming for children Some of the ways the standards have supported our work in 2012 include: • The Community Action on Harm Reduction (CAHR) programme used the standards to produce Reaching Drug Users: A Toolkit for Outreach Services • The sexual and reproductive health (SRH) standards have informed our advocacy work on HIV-SRH integration. In July 2012 we led the development of a family planning and HIV integration side event during the London Family Planning Summit • The standards have been incorporated into cycle two of the redesigned Alliance accreditation process. This will further guarantee the standard of Alliance programmes as well as help identify technical support requirements
A needle exchange aimed at fishermen takes place harbour side in Terengganu, Malaysia © Alliance
8. The Alliance has seven Regional Technical Support Hubs representing 1) Eastern Europe and Central Asia 2) South Asia 3) South East Asia and the Pacific 4) East, Central and Southern Africa 5) West and North Africa 6) Latin America and 7) the Caribbean.
Investing in communities: Annual Review 2012
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Providing the evidence: the benefits of harm reduction Kenya’s east coast is part of a major route for the drug trade, particularly for opiates such as heroin. So while heroin has been readily available, access to safer injecting equipment has not.
The most significant story of 2012 for the four-year, five country Community Action on Harm Reduction programme (CAHR) was the establishment of a needle exchange programme in four towns on the east cost of Kenya – to demonstrate the benefits of this approach. In December 2012 these programmes reached 140 people who inject drugs. These may seem modest figures, but they show harm reduction starting to make its mark in Kenya after years of resistance.
Exchange learning Over 100 days of technical support were provided to KANCO, the Alliance’s CAHR partner in Kenya, which covered the basics of harm reduction and running outreach programmes, and involved exchange visits to learn from projects in Malaysia, Mauritius, Tanzania, and Ukraine. For example, in Pahang, Malaysia, many fishermen cope with the harsh reality of a life spent at sea by injecting heroin. KANCO was able to learn from outreach teams there, who have also experienced resistance to harm reduction programmes. “People equate drug users as being HIV-positive. There’s stigma around this... so it makes it hard for people who use drugs to be accepted,” says Zulkefi Abdulleadin, manager of the local outreach programme DiC Pahang. “When we started a needle exchange in 2007 we experienced a police raid while doing outreach... Now we find them friendly, they’re ok and let us get on with our job.” “The reception of the local community is also changing through the CAHR programme,” says Abdulleadin. “This has come about through the work we are doing with village chiefs. We go from one village to another to explain what the programme does.” 8
Ambition and acceleration: Annual Review 2012
The figures speak for themselves. Back in 2002, 18 people a day tested positive for HIV – mostly people who inject drugs. Now the number of new infections has halved, thanks in large part to grassroots schemes such as DiC Pahang. KANCO is hoping to replicate similar success, inspired by seeing how deeply-held beliefs within tight-knit communities can change. Other organisations in Africa are also following KANCO’s journey with keen interest. The Alliance is one of the largest civil society organisations delivering harm reduction services. To date9, our CAHR programme has reached 136,000 people who inject drugs and their partners and families, across five countries.
The reception of the local community is also changing through the CAHR programme Zulkefi Abdulleadin, manager of the local outreach programme DiC Pahang
A peer outreach worker talks about safer injecting with clients in Kenya © Nell Freeman for the Alliance
9. As at 1 April 2013
Stories from the frontline
You can read Spices and Silk at
In 2012, a ‘writeshop’10 brought colour to the complex process of providing technical support to Global Fund11 grant implementers.
It was the culmination of an eight-month initiative for regionally-based consultants who provide support through the Alliance’s South Asia and South East Asia and Pacific Technical Support Hubs. The result is a collection of case studies that reflect the experiences of technical support providers and bring to life the contexts they operate in.
www.aidsallianceimpact.org /spicesandsilk
Putting it into practice Technical support has been vital to build the skills of recipients to manage, implement and report on Global Fund grants. Over the past decade the Global Fund portfolio has increased dramatically, now spanning 151 countries. The significant amount of funding, coupled with the need to demonstrate impact and value for money, has made more detailed reporting requirements essential.
Rich stories Reading Spices and Silk you can find stories rich in cultural context that document how consultants have responded in challenging situations. For example, what happens when you turn up to advise on programme management to find a needle exchange without any needles, or when a community-based organisation refuses to see why keeping records is of any importance?
I’m not interested in technical textbook definitions... I only care about what you think Extract from Spices and Silk
Through these stories we see how consultants are often asked to make the impossible possible, demonstrating why a pool of skilled local and regional experts is critical.
A hand sewn sari, made by Rashida, a transgender woman in Bangladesh. She only feels safe to express her identity in private at youth group meetings © Alliance
Capacity building Hubs Through the Technical Support Hubs we are able to support civil society within and beyond the Alliance. On average Linking Organisations receive 57% of the Hubs’ support, the remaining support responds to requests from other civil society organisations and governments, as well as the Alliance secretariat. South-to-south technical support is provided on a needs-driven basis, and includes the following key areas: Organisational development • Strategic and operational planning • Governance and management • Documentation and knowledge management • Monitoring and evaluation Thematic areas • H IV and sexual and reproductive health integration • Harm reduction for programmes supporting people who use drugs • Prevention of mother-to-child transmission • Treatment, care and support
www.aidsalliance.org/hubs
10. A writeshop is an intensive process which brings together people with different perspectives on a subject. Written materials can be produced in a very short time by people who do not have the time to write extensively. 11. The Global Fund to Fight AIDS, Tuberculosis and Malaria.
Ambition and acceleration: Annual Review 2012
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Where we work
Visit our interactive map
The Alliance includes 40 Linking Organisations, seven Technical Support Hubs, and an international secretariat.
View our impact country by country at
maps.aidsalliance.org
Key
Type of Work Linking Organisation or Country Office** Alliance project*** International secretariat
H
UK
Regional Technical Support Hubs (see page 9)
BELGIUM
UKRAINE
H
MONGOLIA KYRGYZSTAN
USA TUNISIA
MOROCCO MEXICO
CHINA
LEBANON
ALGERIA
MYANMAR
BANGLADESH HAITI
H
EL SALVADOR
SENEGAL
CARIBBEAN COTE D'IVOIRE
H
BURKINA FASO
INDIA*
ETHIOPIA
CAMBODIA
UGANDA BURUNDI PERU
Latin America and the Caribbean
REDTRASEX the regional network of sex workers carries out advocacy activities in 15 countries, and REDLACTRANS works in 17 countries in Latin America:
Argentina Bolivia Brasil Chile Colombia Costa Rica
Dominican Republic Ecuador El Salvador Guatemala Honduras
Mexico Nicaragua Panamá Paraguay Perú Uruguay
The Vida Digna project has helped reduce HIV-related stigma in Costa Rica, El Salvador, Guatemala, Honduras, Nicaragua and Panama.
10
Ambition and acceleration: Annual Review 2012
H VIET NAM
SOUTH SUDAN
NIGERIA
ECUADOR
H
DEMOCRATIC REPUBLIC OF CONGO
H
KENYA
THE PHILIPPINES MALAYSIA INDONESIA
TANZANIA
H BOLIVIA
ZIMBABWE
NAMIBIA BOTSWANA SWAZILAND
MOZAMBIQUE
SOUTH AFRICA
* There are six Linking Organisations in India. ** See back page for a full list of Alliance Linking Organisations and Country Offices. *** Where there is no Alliance Linking Organisation or Country Office
Ambition and acceleration: Annual Review 2012
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Response
03
Help form engaged, inclusive societies
Stigma and discrimination and human rights violations fuel the HIV epidemic. For the HIV response to be effective, we must advance human rights and strengthen civil society’s capacity to influence global and national policies, and ensure programmes and finances reach the most at risk.
During our 2010-2012 strategy we significantly increased our programming with the LGBTI communities12
“It is impossible to be an HIV activist without being a human rights activist... for me it’s the same thing” Transgender activist, Honduras
395,000 12,000 9,300 x 10,000
people were reached with stigma and reduction initiatives (up from 90,000 in 2011)
81%
decision makers were reached through policy activities at local, national and international level
law enforcers, health professionals and local officials were reached in 17 countries. As the implementers of laws and policies, frontline staff are important to engage so they can help advance, not abuse, human rights
In 2012 for the first time, Commonwealth member states collectively committed to tackling legislation hindering the HIV response and pledged to repeal discriminatory laws
of Linking Organisations participated in national level advocacy13
1,500
66% of countries have most at risk populations represented in decisionmaking on HIV funding allocation14 12
Ambition and acceleration: Annual Review 2012
Over petitions were sent via the What’s Preventing Prevention? campaign, calling for Latin American governments to protect and promote the human rights of transgender people
12. Lesbian, gay, bisexual, transgender and intergender communities (LGBTI). Examples include Pehchan, Alliance India’s work with sexual minorities; strengthening the regional transgender network in Latin America and the Caribbean (REDLACTRANS); and initiatives with men who have sex with men (MSM) in Africa. 13. 81% of the 32 LOs that answered the 2012 survey. 14. 66% of the 32 LOs that answered the 2012 survey.
Refusing to be ignored Transgender women take their message to global leaders, in their fight to stop human rights abuses.
In 2012 the Latin American and Caribbean Network of Transgender People (REDLACTRANS) and the Alliance published The Night is Another Country. This report revealed how a shocking trend of systematic targeting of transgender women is going uninvestigated in Latin American countries15. Activists who are outspoken on human rights are a particular target and the risk they face increases exponentially if they also engage in sex work. Ninety per cent of the examples of violence relate to sex work. The case of the Colectivo Unidad Color Rosa de Honduras speaks volumes – of the seven members who set up the rights-based group in 2001, six have been murdered. All too often perpetrators are the very authorities who should be protecting citizens. The report concludes that the police take advantage of ambiguous legislation to criminalise and take reprisals against transgender activists.
Human rights and HIV cannot be separated “If we didn’t have to go out on the street at night, if we had education and job opportunities, it would be another story,” transgender activist, Honduras. Marginalising transgender women dissuades them from seeking health services and derails HIV prevention efforts. Transgender women in Latin America face an extremely high HIV prevalence rate of 35%, compared with a rate of less than 1% in the general population. As one transgender activist in Honduras puts it: “It’s impossible to be an HIV activist without being a human rights activist… for me it’s the same thing”.
Urgent recommendations The report calls for the arrests and trials of those responsible for murders and other human rights violations; legal recognition of gender identity; comprehensive health services for the transgender community; and for prisons and healthcare to accommodate transgender women in facilities intended for women (instead of with men) and protect them from abuse.
Groundbreaking success Over the last few years the member organisations of REDLACTRANS have contributed to historical achievements, including Argentina’s Gender Identity Law, which was passed in May 2012. This law, the first of its kind in Latin America, allows a person to reassign their name and gender without having to seek approval from doctors or judges or undergo surgery first.
Johanna Ramirez, a REDLACTRANS activist, taking her messages to the White House © Monica Leonardo for REDLACTRANS
How many more transgender people will have to die before someone sits up, takes notice and does something about it? Marcela Romero, Regional Coordinator of REDLACTRANS
In 2013 the Alliance supported REDLACTRANS to launch The Night is Another Country at a series of events in Brussels, Geneva, London and Washington DC. “The international community has an important role to play,” says Marcela Romero. “They need to place human rights at the centre of their political dialogues and negotiations… and challenge criminal legislation that is being used to prosecute people on the basis of their gender identity”. 15. In March 2012, the Trans Murder Monitoring Project reported more than 800 murders of transgender people worldwide, the majority in Latin America, and the majority met with impunity. Due to the lack of identity recognition and reporting this is likely to be a pale reflection of the true figures.
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Don’t stop now: continuing the fight in 2012 This time last year we voiced our fears of an impending funding crisis for the HIV response. With many donor governments introducing austerity measures, funding commitments were revoked and the Global Fund to Fight AIDS, Tuberculosis and Malaria was forced to cancel its Round 11 funding.
These decisions could have had a huge impact on Alliance programmes and undermined the progress being made in the HIV response. In response we published a hard-hitting report, Don’t Stop Now! How underfunding the Global Fund impacts on the HIV response, clearly highlighting the effects these cuts would have on individuals and communities. It included impact studies from Bangladesh, Bolivia, South Sudan, Zambia and Zimbabwe. This first report was followed up by HIV, Drug Use and the Global Fund: Don’t Stop Now! which showed how harm reduction programmes and the HIV epidemic would be affected by the very low levels of funding at that time. The report focused on China, Ukraine and Vietnam, all middle-income countries that would have been affected by the proposed ‘55% rule’16. We also launched our ‘What’s Preventing Prevention?’ campaign which resulted in 500 petitions being sent to Global Fund Board members in just one day.
Back in business In May the Global Fund announced it was back in the business of funding new programmes and that it would `freeze’ its 55% rule. The pressure to continue financing HIV, from us and others in the development sector, has prevented the significant decline that many predicted, but some pledges still needed to be honoured at that time. We continued the fight at AIDS 2012, the 19th International AIDS Conference. Representatives from Linking Organisations and the secretariat were speakers in key events and ‘Don’t Stop Now’ took to the street joining a 2,000 strong public march during the conference.
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Ambition and acceleration: Annual Review 2012
In December 2012, to coincide with World AIDS Day, we launched a report Calling for a UK Blueprint to achieve an HIV-free generation. Simply maintaining its HIV spending at around 7.1% of its official development assistance (ODA) and honouring the commitment to spend 0.7% of gross domestic product for ODA17, would make this possible.
Continuing challenges We can be proud of the contribution our advocacy efforts have made in 2012 but we know we need to be prepared to adapt. This includes exploring more innovative financing solutions, particularly as development funding is rapidly withdrawn from middle-income countries, where the majority of the 34 million people living with HIV reside.
Taking ‘Don’t stop now!’ to the streets at the International AIDS conference © Alliance
Read how we plan to address these challenges in our new strategy HIV, Health and Rights www.aidsalliance.org/strategy
16. The Global Fund’s proposed rule that 55% of its funding commitment in any given year should be allocated to lowincome countries. 17. This commitment was confirmed in the UK’s 2013 budget.
Response
04
Create a learning Alliance
One value of being part of the Alliance is the wealth of south-to-south knowledge available. Opportunities created for sharing experiences and expertise strengthens individual organisations, and the Alliance as a whole.
4/5
The average value given by Linking Organisations when asked to rate the Alliance as a learning organisation
A sex worker in Marrakech greets her son and his friend. She attends peer education sessions on sexual health, which are supported by the Alliance © Nell Freeman for the Alliance
14 organisations took part in Horizontal Learning Exchanges, including: • POZ (Haiti) visited ANCS (Senegal) to learn about monitoring and evaluation • KANCO (Kenya), NAF (Mongolia), Rumah Cemara (Indonesia) and Alliance Myanmar visited Alliance India to learn from its experience in policy and advocacy and programming for men who have sex with men
At the end of 2012
82%
of Linking Organisations were accredited. Accreditation is designed to guarantee quality across the Alliance
18
Linking Organisations rate the overall value of being part of the Alliance as 3/5 or above19. ‘Credibility and prestige’ and ‘knowledge management and technical support’ were most valued
Inspire was launched. The Alliance’s new global intranet provides a virtual meeting place for Linking Organisations to source and share knowledge. It has been designed with accessibility in mind, i.e. for places where internet access is slow, and it can be viewed in any language
91% 18. This included 17 Linking Organisations completing the full accreditation and 15 completing a new Linking Organisation assessment. For new Linking Organisations this lighter accreditation process is undertaken in order to provide time to build their capacity in order to meet full Alliance accreditation standards. 19. 91% of the 32 Linking Organisations that answered the 2012 survey.
Investing in communities: Annual Review 2012
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Local knowledge, global gains Our 20 years of community-based work has provided us with a rich resource of local knowledge. We work hard to make sure that it doesn’t just stay local but is shared, adapted and put to use across the Alliance.
The integration of HIV and sexual and reproductive health is a key priority for the Alliance. Here are some of the significant ways that expertise and learning in this area has been shared in 2012.
Setting priorities Family planning, maternal, newborn and child health, and gender and sexuality were the focus of a regional workshop for francophone Africa. Participants were surveyed ahead of the weeklong event to determine their priorities and the workshop was tailored accordingly. Hosted by the West and North Africa Technical Support Hub20, the 17 participants included programming staff from French speaking Linking Organisations and potential Hub consultants. “By bringing the Linking Organisations together with the Hub we create a technical support ‘web’ that helps us expand and support HIV-SRH integration across the region,” says Abdoulaye Ki, Hub manager. “It will have ongoing benefits as the participants plan to continue to exchange ideas and best practice.”
E-learning The training for francophone Africa was informed by the Good Practice Guide on the Integration of HIV and SRH and Rights, which has also been made into an interactive e-learning course. The course is aimed at programme staff who have some experience delivering HIV programmes but want to know more about integrating sexual and reproductive health. It is also for Hub consultants who need to have a common understanding of the Alliance’s standards so we can provide consistent, high quality technical support.
Working in partnership Our partnership with Marie Stopes International (MSI)21 is also indicative of the increasing emphasis on integration. We have developed a bespoke tool to help MSI integrate HIV services into its sexual and reproductive health clinics. The clinics use the tool to self-assess their readiness for integrating HIV. “The assessments to date have found that MSI programmes are enthusiastic and willing to offer HIV services with family planning and sexual and reproductive health services. The findings also enable us to identify where funding and training is required to make HIV and sexual and reproductive health integration possible,” says Heidi Quinn, senior technical advisor for MSI’s Supporting International Family Planning Organisations project.
Mothers and child at a health and HIV centre in Ecuador © Marcela Nievas for the Alliance
We presented the tool at the Impact for Integration Conference in Kenya in September 2012. The conference brought together key stakeholders to share best practice and progress made in sub-Saharan Africa. Many countries in the region have a high burden of HIV, high maternal mortality rates, and a lack of family planning services.
Hub-to-hub exchange Also in 2012, the East and Southern Africa Hub in Kenya visited the South Asia Hub in India to learn from its sexual and reproductive health project with most affected populations. Alliance India has extensive experience improving transgender and hijra communities’ access to services22. At the core of the Alliance, the secretariat has a key role to play in identifying synergies and opportunities for knowledge sharing. In the year ahead we will continue to find opportunities to share both challenges and successes across the Alliance to improve our effectiveness.
20. The Alliance has seven Regional Technical Support Hubs representing 1) Eastern Europe and Central Asia 2) South Asia 3) South East Asia and the Pacific 4) East, Central and Southern Africa 5) West and North Africa 6) Latin America and 7) the Caribbean. 21. The Alliance/Marie Stopes International (MSI) partnership works to enhance HIV and sexual and reproductive health integration across the policies, programmes and services of both organisations. 22. The Pehchan project builds the capacity of community-based organisations to provide HIV prevention programming for men who have sex with men, transgender people and hijras in 17 Indian states.
16
Ambition and acceleration: Annual Review 2012
Strength through standards Our accreditation system is the backbone of a strong Alliance. It’s how we can guarantee standards and ensure a shared vision and values across the Alliance. Using assessment teams from peer organisations, we rigorously assess national organisations against high standards.
At the end of 2012 82% of Alliance Linking Organisations had been accredited. They were also strengthened through the process which helps identify areas where technical support is required.
Jamel, 21, is a gay peer outreach worker. He initially came in contact with OPALS, one of the community-based organisations supported by AMSED, as a client. Prior to that he had struggled to accept his sexuality.
A stronger position: Morocco
“In the past I was so concerned I couldn’t sleep. I suffered a lot from stigma,” he explains. “Now I am supported by the NGO. I feel that I have dignity and I have the right to live as I wish. After the training I wanted to put everything into practice and share the information... I have a great responsibility and commitment to my peers.”
Association Marocaine de Solidarité et de Développement (AMSED) in Morocco works to prevent HIV and to increase services that meet the needs of most-at-risk populations. Through the accreditation process AMSED strengthened several areas, including its financial capacity. This has helped it scale up HIV prevention work under its Global Fund activities, and expand its onward granting mechanisms. AMSED now provides grants to 102 community-based organisations, compared to 75 in 2012 when it was first accredited. AMSED’s activities reach key populations including men who have sex with men, sex workers, mobile and migrant populations, manual workers, single mothers, and young people. AMSED’s partners train and work with peer educators from within key populations. AMSED shares its expertise through the technical support it provides to 200 grassroots organisations. It builds their skills to report to donors and strengthens their community programmes.
AMSED’s work, along with other organisations, has increased the visibility of issues related to men who have sex with men and this has led to the recent success of the Moroccan Ministry of Health including a reference to this group in its 2012-16 national AIDS plan.
During a social and discussion session for men who have sex with men © Nell Freeman for the Alliance
Through the Alliance’s Middle East and North Africa programme AMSED’s partners build the capacity of groups of men who have sex with men to carry out peer education and provide HIV prevention services. Same sex activity is criminalized in Morocco and convictions can result in up to three years imprisonment. Community participation, using ideas like the peer leader approach, is key to engaging marginalised groups. When people’s identities are criminalised it takes a huge amount of trust for them to access services.
Ambition and acceleration: Annual Review 2012
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Financial summary Total expenditure:
Global Alliance accounts
Total expenditure of the Alliance was $131 million in 2012, a 42% increase since 2009. The target we set at the start of the HIV and Healthy Communities (2010-12) strategy was a 20% increase.
Alliance Linking Organisations are supported to become strong, effective, financially independent organisations. Nearly three quarters of all Alliance funding is now raised by Linking Organisations directly from donors, rather than through the secretariat. Eight Linking Organisations are now Principal Recipients of Global Fund to Fight AIDS, Tuberculosis and Malaria grants, up from four at the start of the 2010-12 strategy, and five Linking Organisations are usaid/pepfar prime recipients. Two Linking Organisations (Ukraine and India) successfully completed Global Fund audits.
From the secretariat including strategic funding $37 million (28% of total expenditure) was channelled through the secretariat and Alliance Country Offices23 in 2012. This included $10 million in strategic funding for the secretariat. Uses of strategic funding include supporting the continuity of Linking Organisations, institutional learning systems, south-to-south capacity building initiatives, and accreditation.
Expenditure $US millions
Strengthening our Linking Organisations
94.3
56.7
60.2
41.4
39.8
37.0
INCLUDES
INCLUDES
INCLUDES
SECRETARIAT STRATEGIC INCOME
SECRETARIAT STRATEGIC INCOME
SECRETARIAT STRATEGIC INCOME
Total = 98.1
Total = 100.0
Total = 131.3
2010
2011
2012
11.5
11.2
10.3
Funded directly in country Funded via Secretariat and Country Offices
23. Country Offices are financially part of the secretariat in the UK. Where possible, these offices later transition to become independent, national NGOs, and Linking Organisations of the Alliance.
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Ambition and acceleration: Annual Review 2012
Thank you The Alliance receives support from many contributors and would like particularly to thank the following:
The governments of:
As well as:
Australia (AusAID)
Bill & Melinda Gates Foundation
Canada (CIDA)
European Commission
Denmark (Danida)
The Global Fund to Fight AIDS, Tuberculosis and Malaria
Germany (Gesellschaft f端r Internationale Zusammenarbeit GIZ)
Levi Strauss Foundation
Ireland (Irish Aid)
United Nations Joint Programme on HIV/AIDS (UNAIDS)
Netherlands (BUZA)
United Nations Development Programme (UNDP)
Norway (Norad)
United Nations Population Fund (UNFPA)
Sweden (Sida)
ViiV Healthcare Positive Action Programme
Switzerland (SDC)
ViiV Healthcare Positive Action for Children Fund
United Kingdom (UKaid from the Department for International Development)
World Health Organisation (WHO)
Open Society Foundation (OSF)
United States (USAID)
Trustees Carmen Barroso, Brasil
Carole Presern, UK
Jan Cedergren, Sweden
Prasada Rao, India
Martin Dinham, UK
Nafis Sadik, Pakistan - Vice Chair
Zhen Li, China
Steven Sinding, USA - Chair
Callisto Madavo, Zimbabwe
Fatimata Sy, Senegal*
Kevin Moody, Canada/Netherlands
Jens Van Roey, Belgium
Kanini Mutooni, UK
* stepped down April 2013
Ambition and acceleration: Annual Review 2012
19
FSC
International HIV/AIDS Alliance Together to end AIDS
Mixed credit certified paper
The Alliance includes 40 Linking Organisations and Country Offices, seven Technical Support Hubs and an international secretariat. Bangladesh HIV/AIDS & STD Alliance Bangladesh (HASAB) hasab@bdmail.net www.hasab.org
El Salvador Asociacion Atlacatl Vivo Positivo (Atlacatl) info@atlacatl.org.sv www.atlacatl.org.sv
Belgium Stop AIDS Alliance (Brussels) afetai@stopaidsalliance.org www.stopaidsalliance.org
Ethiopia Organization for Social Services for AIDS (OSSA) beksendadi@yahoo.com
Bolivia Instituto para el Desarrollo Humano (IDH) info@idhbolivia.org www.idhbolivia.org
Haiti Promoteurs de l’Objectif Zerosida (POZ) cesac@pozsida.ht www.pozsida.org
Botswana Botswana Network on Ethics, Law and HIV/AIDS (BONELA) bonela@bonela.org www.bonela.org
India* India HIV/AIDS Alliance info@allianceindia.org www.allianceindia.org
Burkina Faso* Initiative Privée et Communautaire de Lutte Contre le VIH/SIDA au Burkina Faso (IPC) ipcbf@ipc.bf Burundi Alliance Burundaise Contre le SIDA (ABS) allianceburundi@yahoo.fr Cambodia* KHANA khana@khana.org.kh www.khana.org.kh Caribbean* Caribbean HIV/AIDS Alliance (CHAA) info@alliancecarib.org.tt caribbeanhivaidsalliance.org.tt China AIDS Care China aidscarecn@gmail.com www.aidscarechina.org Côte d’Ivoire Alliance Nationale Contre le SIDA en Côte d’Ivoire (ANS-CI) sdougrou@alliancecotedivoire.org www.alliancecotedivoire.org Ecuador Corporación Kimirina kimirina@kimirina.org www.kimirina.org
The HUMSAFAR Trust humsafar@vsnl.com www.humsafar.org LEPRA Society info@leprahealthinaction.in www.leprasociety.org MAMTA Health Institute for Mother and Child mamta@ndf.vsnl.net.in www.mamta-himc.org Palmyrah Workers Development Society (PWDS) palmyrah@dataone.in www.pwds.org Vasavya Mahila Mandali (VMM) vasavyamm@sify.com www.vasavya.org Indonesia Rumah Cemara (RC) rumahcemara@yahoo.com www.rumahcemara.org Kenya* Kenya AIDS NGO Consortium (KANCO) aragi@kanco.org www.kanco.org Kyrgyzstan Anti-AIDS Association (AAA) chbakirova@gmail.com www.antiaids.org.kg Malaysia Malaysian AIDS Council (MAC) contactus@mac.org.my www.mac.org.my/v2
Mexico Colectivo Sol carloscruz@colectivosol.org www.colectivosol.org Mongolia National AIDS Foundation (NAF) info@naf.org.mn www.naf.org.mn Morocco Association Marocaine de Solidarité et Développement (AMSED) kadermoumane@yahoo.fr http://amsed.mtds.com Myanmar International HIV/AIDS Alliance in Myanmar aidsalliance@myanmar.com.mm Namibia Positive Vibes (PV) casper@positivevibes.org www.positivevibes.org Nigeria New Initiative for the Enhancement of Life and Health (NELAH) femisoyinka@yahoo.com www.nelah.org Peru* Via Libre vialibre@vialibre.org.pe www.vialibre.org.pe Philippines Philippines HIV/AIDS NGO Support Program (PHANSuP) info@phansup.org www.phansup.org
Tanzania Council for Social Development (TACOSODE) tacosode@yahoo.com www.tacosode.or.tz Uganda Community Health Alliance Uganda (CHAU) emukisa@allianceuganda.org Ukraine* International HIV/AIDS Alliance in Ukraine office@aidsalliance.org.ua www.aidsalliance.org.ua United Kingdom International HIV/AIDS Alliance (International secretariat) mail@aidsalliance.org www.aidsalliance.org USA International HIV/AIDS Alliance (Washington DC) jwright@aidsalliance.org Viet Nam Supporting Community Development Initiatives (SCDI) scdi@scdi.org.vn www.scdi.org.vn Zimbabwe The Zimbabwe AIDS Network (ZAN) info@zan.co.zw www.zan.co.zw
Senegal Alliance Nationale Contre le SIDA (ANCS) ancs@ancs.sn www.ancs.sn South Africa The AIDS Consortium info@aidsconsortium.org.za www.aidsconsortium.org.za South Sudan International HIV/AIDS Alliance in South Sudan fbayoa@aidsalliance.org Switzerland Stop AIDS Alliance (Geneva) mhart@stopaidsalliance.org www.stopaidsalliance.org
* We have seven Regional Technical Support Hubs, each hosted by a Linking Organisation. For more information please contact tshubs@aidsalliance.org List accurate as at June 2013