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To:      

The  Global  Fund  Secretariat  and  the  Global  Fund's  Strategy  Investment  and  Impact   Committee  (SIIC)   Eurasian  Harm  Reduction  Network  (EHRN)  on  behalf  of: International  Network  of  People  who  Use  Drugs  (INPUD)   International  Drug  Policy  Consortium  (IDPC)   International  Council  of  AIDS  Service  Organizations  (ICASO)   KNCV  Tuberculosis  Foundation     The  Global  Forum  on  MSM  &  HIV  (MSMGF)   Recommendations  for  the  development  of  the  New  Funding  Model  (NFM)  of  the   Global  Fund   October  10,  2012

From:   • • • • • Re:  

Date:

Note:   This   set   of   recommendations   summarizes   the   views   on   the   NFM,   expressed   by   civil   society   and   community   representatives   who   participated   in   the   2nd   EECA   Regional   AIDS   Forum   –   a   post-­‐conference   hub   of   the   XIX   International   AIDS   Conference   (IAC),   which   took   place   in   Kyiv   on   September   28,   2012,   and   the   feedback,   collected   by   the   Civil   Society   Action   Team   (CSAT)   for   Eastern   Europe   and   Central   Asia   within   the   consultative   process   on   the   NFM,   from   a   range   of   experts   in   EECA,   including   current   implementers  of  the  Global  Fund  grants.       ___________________________________________________________________________________     Summary  of  key  recommendations:     • Within   the   NFM   the   Global   Fund   should   expand   the   use   of   MARPs   channel,   regional   and   non-­‐ CCM   modalities   of   funding   as   they   are   essential   for   most   of   the   globe   where   epidemics   are   concentrated  among  MARPs  due  to  the  marginalization  of  key  populations  as  a  result  of  severe   stigma   and   discrimination   in   government   policies   and   lack   of   political   will   to   invest   in   the   evidence-­‐based  programs  that  target  MARPs.   • The   formula   to   define   the   allocation   to   country   bands   must   be   nuanced   and,   in   addition   to   disease  burden  and  ability  to  pay,  take  into  account:   1. The  epidemic  growth  and  dynamics,  particularly  among  MARPs;   2. Coverage  of  MARPs  by  high  impact  interventions;   3. A  government’s  willingness  rather  than  just  ability  to  pay  for  these  services.    

To  ensure  that  the  Global  Fund  meets  the  needs  of  the  MARPs  effectively  and  globally,  the  NFM  needs   to  have  both  a)  a  MARPs  reserve  “band”,  and  b)  a  MARPs  reserve  built  into  every  country  “band.”    

 

 

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While   we   understand   that   allocation   by   diseases   based   on   historical   levels   is   meant   to   be   a   temporary   one-­‐year   or   less   measure,   we   would   like   to   voice   our   strong   concern   about   this   process   and   believe   that   a   better   measure   of   burden/need   must   be   developed   as   soon   as   possible.   In   addition,   it   is   critical   that   these   global   diseases   allocations   not   impede   on   country   ability  to  develop  ambitious  proposals.     Procedures  for  regional  and  non-­‐CCM  proposals  must  be  simplified  and  streamlined  to  eliminate   multiple  hurdles  and  barriers  to  such  vital  streams  of  funding  that  are  mostly  implemented  by   Civil   Society   Organizations   (CSOs)   and   Community   Based   Organizations   (CBOs)   and   target   the   most-­‐at-­‐risk  populations  underserved  within  national  programs.       Prior   to   relying   on   NSPs   in   the   Global   Fund   proposal   development   and   resource   allocation   decisions,  the  Global  Fund  and  technical  partners  must  evaluate  the  NSPs  to  see  how  they  score   on   respect   for   human   rights   and   the   levels   of   adequate   national   investments   in   MARPs,   particularly   in   concentrated   epidemics.    As   part   of   the   iterative   process   and   risk   prevention   strategy,  the  Global  Fund  needs  to  negotiate  prioritization  and  selection  of  human-­‐rights  based   programs   in   legal   environments   that   limit   access   to   services   and/or   are   detrimental   to   the   quality  and  effectiveness  of  MARPs  programs.     Strong   and   empowered   civil   society   should   be   acknowledged   by   the   Global   Fund   as   an   in-­‐ country  stakeholder  best  positioned  and  most  invested  in  sustaining  the  long  lasting  impact  of   MARPs   programs   funded   by   the   Global   Fund.   The   Global   Fund   must   invest   in   civil   society   capacity   building   and   strengthening   affected   communities.     Community   ownership   of   responses   to   the   epidemics   can   only   be   guaranteed   within   the   country-­‐owned  proposals  to  the  Global  Fund  if  the  proposed  program  is  in  full  alignment  with   international   guidance   on   human   rights.   Otherwise,   the   Global   Fund   must   resort   to   multi-­‐ country/regional   and/or   non-­‐CCM   proposals   and   invest   in   critical   enablers   to   reach   MARPs   with   prevention  and  treatment  and  to  build  the  capacity  of  CSOs  and  CBOs  to  advocate  for  national   policies,  practices  and  budget  allocations  that  are  inclusive  of  and  respect  the  human  rights  of   key  affected  communities.   In   order   to   ensure   the   continuity   and   sustainability   of   MARPs   programming   after   the   Global   Fund  funding  is  gradually  phased  out,  transition  plans  should  be  part  of  the  grant  negotiations   within  the  iterative  process  in  MICs.   When  preparing  and  submitting  the  Concept  Note  within  the  NFM  the  countries  should  have  the   opportunity   to   express   the   full   demand   and   include   all   activities   they   consider   critical   for   an   effective   response   to   their   epidemics.   Countries   should   not   be   limited   by   a   certain   funding   ceiling  at  this  initial  stage  of  the  iterative  process  and  should  have  an  opportunity  to  negotiate  

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programmatic  and  funding  priorities  within  the  “indicative  funding  range”  and  which  would  go   into  a  competitive  “incentives  stream.”     While   CCMs   may   have   representation   of   key   affected   populations   (KAPs),   these   groups,   as   primary   beneficiaries,   must   be   fully   engaged   in   the   development,   implementation,   monitoring   and  evaluation  of  Global  Fund  programming  (particularly  in  quality  assurance).  Representatives   of  KAPs  must  be  included  into  and  supported  to  participate  meaningfully  in  the  iterative  process   as  well  as  in  the  process  of  the  grant  renewals  and  reprogramming.    

  Detailed  recommendations  for  the  New  Funding  Model  (NFM)  of  the  Global  Fund  and  the  Rational:       The   Global   Fund   should   guarantee   that   most   at   risk   populations   (MARPs)   for   HIV/AIDS   and   TB,   particularly   people   who   inject   (PWID),   men   who   have   sex   with   men   (MSM),   sex   workers,   and   their   respective  communities,  and  prisoners,  including  those  in  middle-­‐income  countries  (MICs),  can  benefit   from  Global  Fund  investments  and  programming  within  the  New  Funding  Model  (NFM)  in  order  for  the   Global  Fund  to  have  a  sustainable  impact  globally.   The   Global   Fund’s   MARPs   channel,  multi-­‐country/regional   and   non-­‐CCM   grants   are   essential   for   most   of   the  globe  where  HIV  epidemics  are  concentrated  among  MARPs  –  Europe  (Eastern  Europe  in  particular),   Asia,  Middle  East  and  North  Africa,  Central  America  and  the  Caribbean  and  South  America.  Such  modes   of   funding   are   vital   where   national   governments   have   not   fully   embraced   the   human   rights   based   response   to   the   epidemics   nor   have   the   political   will   to   invest   in   the   evidence-­‐based   programs   that   effectively   reach   MARPs.   Often   despite   the   countries’   ability   to   pay,   there   is   a   limited   or   absent   willingness   to   pay   on   the   part   of   governments.   Investments   in   high   impact   interventions   targeting   MARPs   and   related   critical   enablers   and   community   systems   strengthening   (e.g.   advocacy,   capacity   building   etc.)   are   vital   to   curbing   concentrated   epidemics   sustainably,   as   well   as   to   preventing   the   concentrated   epidemics   from   spilling   into   the   general   populations   through   bridge   populations   such   as   sexual   partners   of   PWID.   Within   the   NFM   the   Global   Fund   must   recognize   the   cost   effectiveness   of   prevention   of   a   generalized   epidemic   by   assisting   a   country   to   nip   the   epidemic   in   the   bud   in   an   evidence-­‐based,  human  rights  respecting  effective  way.     • Country  Bands     According   to   the   recent   Global   Fund   Board   decision   GF/B27/DP7,   the   principles   for   determining   the   composition  of  and  funding  allocation  to  each  Country  Band  are  expected,  at  a  minimum,  to  be  based   on  disease  burden  and  ability  to  pay  (e.g.  income  level).     However,  in  our  view  the  formula  to  define  the  allocation  to  country  bands  must  be  more  nuanced.  In   addition  to  disease  burden  and  ability  to  pay,  take  into  account:  

 

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Not   just   disease   burden   but   also   the   pace   of  epidemic   growth   and   dynamics,   particularly   among   MARPs;   -­‐ Level  of  coverage  of  MARPs  by  high  impact  interventions;   -­‐ A  government’s  willingness  rather  than  just  ability  to  pay  for  these  services.     To  ensure  that  the  Global  Fund  meets  the  needs  of  the  MARPs,  the  NFM  needs  to  have  both  a)  a  MARPs   reserve  “band”,  and  b)  a  MARPs  reserve  built  into  every  country  “band.”       The  NFM  must  preserve  eligibility  and  access  of  countries  where  i)  the  Global  Fund  currently  provides   the  majority  of  resources  for  MARPs;  ii)  too  few  or  no  other  reasonable  alternative  sources  of  funding   are   identifiable   for   MARPs   and   CSOs/CBOs   rely   on   the   Global   Fund   support   to   sustain   and   scale   up   services   for   vulnerable   populations;   iii)   governments   are   unable   or   unwilling   to   support   MARPs   programs.       Within  the  NFM  the  MARPs  channel,  introduced  in  Round  10,  should  be  strengthened  to  generate  more   focused  investment  in  marginalized  and  highly  affected  populations.  For  new  and  renewed  grants,  the   Global   Fund   needs   to   i)   ensure   that   the   MARPs   channel   remains   dedicated   to   the   most-­‐at-­‐risk   populations  (rather  than  being  too  broadly  defined  as  would  have  been  the  case  for  Round  11  before  its   cancellation);   ii)   increase   funds   available   for   the   MARPs   channel;   iii)   adjust   maximum   amounts   for   individual   grants   to   reflect   different   country   size   and   needs;   iv)   strengthen   guidance   on   investment   in   critical  enablers  that  are  crucial  to  effective  programming.  
 

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  • MARPS  programming  and  sustainability     In   order   to ensure   the   continuity   and   sustainability   of   MARPs   programming   after   the   Global   Fund   funding   is   gradually   phased   out,   transition   plans   should   be   part   of   the   grant   negotiations   within   the   iterative  process  in  MICs.  The  counterpart  financing,  as  a  strategy  to  ensure  country’s  co-­‐investments,   works   best   for   interventions   that   are   politically   acceptable   in   applicant   countries,   whereas   programs   targeting   MARPs   still   require   considerable   advocacy   by   civil   society   and   by   affected   communities.   In   countries   where   the   governments   are   unwilling   to   support   MARPs   programs,   the   Civil   Society   Organizations   (CSOs)   and   Community   Based   Organizations   (CBOs)   predominantly   rely   on   the   Global   Fund  and  other  donors  to  sustain  and  scale  up  MARPs  programs  and  few  other  reasonable  resources  are   identifiable   in   the   short   term.   The   Global   Fund   therefore   needs   to   invest   in   the   civil   society   capacity   building   and   strengthening   affected   communities.   Strong   and   empowered   civil   society   should   be   acknowledged   by   the   Global   Fund   as   an   in-­‐country   stakeholder   best   positioned   and   most   invested   in   sustaining  the  long  lasting  impact  of  MARPs  programs  funded  by  the  Global  Fund.  In  the  contexts  where   this   applies,   The   Global   Fund,   for   reasons   of   clear   effectiveness   and   efficiency,   should   address   the   drivers   of   the   epidemic.   Enabling   (for   a   time-­‐limited   initial   stage)   a   lasting   catalytic   role   of   civil   society   is   the   evident   strategy   for   ensuring   that   authorities   in   the   short   and   long   run   will   reach   MARPS   with   an   evidence-­‐based,  human  rights  respecting  and  thus  effective  intervention  strategy.  

 

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MARPS  programming  and  risks  framework     The   NFM   will   introduce   a   system   where   each   country   and   project   will   have   a   specific   risk   assessment   based   on   past   performance   and   local   risk   factors.     The   risk   profiling   of   programming   focusing   on   MARPs   needs   to   take   into   account   the   complexity   of   working   in   these   communities.   Adjustments   may   be   needed   to   ensure   the   risk   framework   is   appropriate   for   MARPs.   Limited   national   resources   and/or   absent  political  will  often  result  in  the  National  Strategic  Plans  (NSPs)  being  developed  and  implemented   in   disregard   of   the   health   and   human   rights   needs   of   MARPs,   whose   behaviors   are   likely   to   be   criminalized  and  the  evidence  of  effectiveness  of  essential  prevention  and  treatment  interventions  that   target   MARPs   is   ignored.   Therefore,   prior   to   relying   on   NSPs   in   the   Global   Fund   resource   allocations   decisions,   the   Global   Fund   and   technical   partners   must   evaluate   the   NSPs   to   see   how   they   score   on   respect   for   human   rights   and   the   levels   of   adequate   national   investments   in   MARPs,   and   they   should   assess   the   quality   of   the   epidemiological   data   on   which   the   NSPs   are   based,  particularly   in   concentrated   epidemics.   Affected   communities,   including   MARPs   groups,   should   be   included   in   this   appraisal   process.    As   part   of   the   iterative   process   and   risk   prevention   strategy,   the   Global   Fund   needs   to   negotiate  selection  of  human-­‐rights  based  programs  in  legal  environments  that  limit  access  to  services   and/or   are   detrimental   to   the   quality   and   effectiveness   of   MARPs   programs,   and   encourage   human   rights   advocacy   and   programming   supplementing   it   with   legal   aide   to   the   MARPs.   Achieving   this   will   require  the  Global  Fund  be  more  open  to  funding  proposals  outside  of  CCM  channels,  where  it  is  clear   that  CCMs  are  acting  as  a  barrier  to  effective  programming.       • Proposal  development  process     When   preparing   and   submitting   the   Concept   note   the   countries   should   have   the   opportunity   to   express   the   full   demand   and   include   all   activities   they   consider   critical   for   effective   response   to   an   epidemic.   Countries  should  not  be  limited  by  a  certain  funding  ceiling  at  this  initial  stage  of  the  iterative  process   and   should   have   an   opportunity   to   negotiate   programmatic   and   funding   priorities   within   the   “indicative   funding  range”  and  which  would  go  into  a  competitive  “incentives  stream.”       • Nothing  about  us  –  without  us:  Engagement  in  access  to  funding  process     The  Global  Fund  has  a  commitment  to  multi  stakeholder  engagement  in  all  its  processes.    While  CCMs   may  have  representation  of  key   affected   populations   (KAPs),   these   groups   may   need   additional   support   to   ensure   that,   as   beneficiaries,   they   can   be   fully   engaged   in   the   development,   implementation,   monitoring  and  evaluation  of  programming  (particularly  quality  assurance).    In  particular,  they  should  be   included   into   and   supported   to   participate   meaningfully   in   the   iterative   process  for   funding   applications   under   the   NFM,   as   well   as   in   the   process   of   the   grant   renewals   and   reprogramming.   Community   ownership   of   responses   to   the   epidemics   can   only   be   guaranteed   within   the   country-­‐owned   proposal   to   the   Global   Fund   if   the   proposed   program   is   in   full   alignment   with   international   guidance   on   human   •   5  

 

rights. Otherwise,  the  Global  Fund  must  resort  to  multi-­‐country/regional  and/or  non-­‐CCM  proposals  and   invest   in   critical   enablers   to   reach   MARPs   with   prevention   and   treatment   and   build   the   capacity   of   CSOs   and   CBOs   to   advocate   for   national   policies,   practices   and   budget   allocations   that   are   inclusive   of   and   respect  the  human  rights  of  key  affected  communities.       In  order  to  ensure  such  an  involvement,  the  Global  Fund  Secretariat  should  include  into  its  Guidelines   and   Requirements   for   CCMs   an   additional   requirement   –   to   include   CCM   members   representing   non-­‐ government   sector   into   the   CCM   relevant   working   groups   or   committees   responsible   for   the   development   of   the   grant   proposals   and   to   engage   representatives   of   MARPs   communities   in   the   capacity  of  experts  to  participate  in  the  work  of  such  structures  (the  same  concerns  the  CCM  Oversight   Committee).       Country   Fund   Portfolio   Managers   (FPMs)   and   Local   Fund   Agents   (LFAs)   should   ensure   compliance.   In   order   to   do   this,   FPMs   should   be   fully   aware   of  the   in-­‐country   situations   with   regard   to   the   involvement   of   communities’   representatives   in   the   relevant   CCM   processes,   structures   and   establish   closer   contacts   with  CSOs  and  CBOs  implementing  Global  Fund  grants  as  sub  and  sub-­‐sub-­‐recipients,  and  those  acting  as   independent  watchdogs  and  advocates.       CCMs  should  continue  to  implement  the  practice  of  collecting   inputs/feedbacks   from  CSOs/CBOs  and  all   other  interested  parties  on  the  scope  (priorities,  interventions,  allocations)  of  the  country  proposals  to   the   Global   Fund   within   the   NFM   in   advance   to   the   development   of   the   proposal   concept   note.   To   achieve  this  CSOs/CBOs  must  be  better  informed  about  opportunities  to  provide  their  feedback  and  to   take   part   in   all   the   consultative   processes   related   to   grant   development,   implementation,   monitoring   and   evaluation.   Simple,   transparent,   clear   and   user-­‐friendly   channels   of   bilateral   feedback   and   communication   between   CCMs   and   civil   society/communities   should   be   developed   and   introduced   in   countries.             Also  the  Global  Fund  Secretariat  and  TRP  must  have  the  capacity  to  undertake  country  level  dialogues   on   CSS,   human   rights,   the   Sexual   Orientations   and   Gender   Identities   (SOGI)   policy,   gender   issues,   etc.   and  develop  plans  to  address  their  respective  gaps  and  weaknesses  in  expertise/knowledge/awareness   etc.  Significant  investment  in  building  this  capacity  is  required.     The  Dual-­‐Track  Financing  model  should  take  priority,  where  appropriate,  as  civil  society  and  the  private   sector  can,  and  should,  play  a  similar  role  as  government  structures  in  the  implementation  and  oversight   of   grants   at   the   country   level.   In   many   countries,   the   only   way   of   achieving   effective   MARPs   programming  is  to  work  through  non-­‐governmental  implementers.       The   Global   Fund   Secretariat   should   enact   the   recommendations   of   the   2011   evaluation   of   the   SOGI   Strategy  and  work  with  partners  to  develop  a  specific  action  plan  for  people  who  inject  drugs,  ensuring   that   the   Secretariat   continues   to   support   and   protect   the   large   portfolio   of   investments   in   harm   reduction  within  the  NFM.  

 

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Multi-­‐country  and  regional  proposals  

  Within   the   NFM   the   Global   Fund   resources   must   be   accessible   through   the   multi-­‐country   funding   channel  in  the  form  of  proposals  from  a  Regional  Coordinating  Mechanisms  or  Regional  Organizations,   as  a  means  to  providing  a  less  politicized  and  safer  platform  than  at  a  country  level  on  which  to  advocate   for  the  needs  of  key  affected  populations  (KAPs)  severely  underserved  through  national  programs.  
 

Regional   projects   and   activities   provide   valuable   opportunities   for   sharing   experiences,   developing   networks   of   civil   society  and  community  based  organizations,   building   the   capacity   of   civil   society  and   strengthening   the   community   systems   in   countries   that   have   common   cultural,   linguistic   and   historic   values.   Regional   projects   establish   platforms   for   exchange   of   best   practices   and   engage   a   broader   range   of   stakeholders   in   activities   that   face   barriers   at   country   level.   Regional   proposals   give   a   boost   to   advocacy   for   reform   of   national   policies   with   account   to   international   mechanisms   and   regional   practices,  which  is  crucial  for  most  regions  with  prevalence  of  LICs  or  MICs.       The   principle   of   funds   allocation   for   regional   proposals   should   be   clearly   determined   within   NFM.   When   developing  such  principles  SIIC  should  take  into  account  that:     -­‐ Multi-­‐county  proposals  targeted  at  MARPs  should  have  different  and  broader  funding  options  from   MARPs  single-­‐country  proposals  because  these  activities  have  different  goals  and  operate  at  a  much   different  scale,  dealing  with  regional  policy  and  advocacy,  community  mobilization  as  well  as  service   development  on  the  regional  level  including  coordination  and  migration  issues.   -­‐ The   determined   funding   amount   for   each   multi-­‐country/regional   proposal   should   be   within   the   same   funding   range   for   which   at   least   51%   of   countries   included   into   the   proposal   are   eligible   for   within  their  bands  if  they  submit  their  own  request  for  funding  for  that  same  component  through  a   single-­‐country  application.       • Non-­‐CCM  proposals     The   Global   Fund   should   maintain   possibility   for   NGOs   to   submit   non-­‐CCM   proposals.   The   non-­‐CCM   window   remains   an   opportunity   for   groups   marginalized   as   a   result   of   stigma   and   discrimination   in   government   policies.   The   Secretariat   could   better   define   ‘key   and   vulnerable   populations’   and   determine  eligibility  of  non-­‐CCM  proposals  on  the  basis  of  the  target  population.     Having  an  opportunity  to  submit  non-­‐CCM  proposals  is  important  for  CSOs  and  CBOs  in  situations  when:   -­‐  governments  fail  to  cooperate  with  NGOs  or  criminalize  vulnerable  groups  such  as  MSMs,  PWIDs  or   sex  workers;  

 

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-­‐

-­‐ -­‐    

 CCMs  refuse  to  include  into  the  Global  Fund  proposals  the  activities,  which  are  effective  and  of  high   impact   and   are     in   direct   response   to   the   country   epidemic   context,   and   proposed   by   community   groups  and  NGOs;     Government   programs   and   policies   for   working   with   MARPs   are   associated   with   non-­‐respect   for   human  rights   a   country   is   currently   in   conflict,   facing   natural   disaster   or/and   complex   humanitarian   emergency   and  there  is  no  legitimate  government  in  the  country.  

OECD’s  DAC  list  eligibility  filter  

  According   to   the   Global   Fund   Policy   on   Eligibility   Criteria,   Counterpart   Financing   Requirements,   and   Prioritization  of  Proposals  for  Funding  from  the  Global  Fund  “UMICs  not  listed  on  the  list  of  recipients  of   Official  Development  Assistance  (ODA)  of  the  Organization  for  Economic  Co-­‐operation  and  Development   (OECD)   recipients   are   ineligible   to   apply   for   funding   for   HIV   and   AIDS   proposals   except   if   the   application   is  submitted  by  a  non-­‐governmental  organization  (NGO)  within  the  country  in  which  activities  would  be   implemented  and  for  which  the  government  of  such  country  shall  not  receive  any  funding”.    Being  not   listed   in   the   OECD   DAC   list   should   not   be   a   barrier   for   any   country   to   apply   for   the   Global   Fund   HIV   grants.   There   is   no   such   requirement   for   TB   or   Malaria   grants   and  it  is  not   clear   at   all   why   it   should   exist   for  HIV  grants.         • NGO  rule     If  the  OECD’s  DAC  filter  remains  within  the  NFM,  the  “NGO  rule”  should  be  retained  too.  NGOs  should   have   an   opportunity   to   submit   CCM/non-­‐CCM   proposals   targeted   at   MARPS   if   their   countries   are   not   listed   on   the   OECD’s   DAC   list   of   official   development   assistance   recipients   and   therefore   are   not   eligible   to  apply  for  Global  Fund  funding  for  HIV,  and  if  these  countries  do  not  support  MARPs  programs  within   their   national   health   budgets   at   an   appropriate   level.     This   will   allow   such   countries   as   Russia,   Lithuania,   Bulgaria  and  starting  from  2012  –  Latvia  to  effectively  address  the  HIV  concentrated  epidemics  among   MARPs   in   these   countries.   The   principle   that   “NGO   rule”   overrides   the   G-­‐20   rule,   which   states   that   G-­‐20   upper  MICs  with  less  than  an  extreme  disease  burden,  are  not  eligible  to  apply  should  also  remain.        

 

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