Position Paper: Zero-Draft 2021 Political Declaration on HIV and AIDS

WITHSTAND WITH STANCE

(v.) to remain firm successfully (n.) with a clear view or opinion

APCOM’s STANCE:
As a regional organisation and key population network, we serve and represent a range of diverse and
dynamic constituents including gay men and other men who have sex with men, and communities of
diverse sexual orientation and gender identity and expression and sex characteristics (SOGIESC). At
every level, we are committed to: the individual human being, the community they belong to, the
country they live in, and the Asia-Pacific Region.

APCOM is committed, and hereby reaffirms our commitment, towards our community’s pursuit of
equity, dignity, and social justice. Our stance is ALWAYS on the well-being of the community that we
belong, serve and represent. Our stance is grounded on ensuring that we, gay men and other MSM
enjoy the rights and services to which we are entitled as citizens of our countries, as well as living a
life of dignity to which we are entitled to as human beings.

The persistence of HIV epidemic in Asia-Pacific is a consequence of interacting factors which require
a multi-pronged intervention with adequate resources and community leadership. It is our stance
that effective HIV response are embodied these key priorities.

A ACCESSIBLE, AVAILABLE, AFFORDABLE, EQUITABLE and INNOVATIVE

cascade of HIV services from prevention, testing, treatment, to case management.
This includes the delivery of combination HIV prevention using scientifically proven
innovative tools such as PrEP,, and Treatment as Prevention through
communicating ‘Undetectable=Untransmittable’;

P PROTECT and PROMOTE human rights of key populations, removal of

punitive laws, decriminalization of drug use and sex work, dismantling structural and
societal barriers, eliminating stigma and discrimination, achieve highest attainable
standard of well-being for key populations and PLHIV

C COMMUNITIES and COMMUNITY-LED INTERVENTIONS play critical

role in the HIV response in leading the HIV service delivery, demand generation, and
monitoring. Increasing key population and community leadership to effectively
implement differentiated service delivery.

O OPTIMAL RESOURCES and INVESTMENTS for rapid scale up of

community-led service delivery and human rights intervention, effective
implementation of accessible and equitable HIV programs, elimination of stigma
discrimination decriminalization of key populations and ensure removal of punitive
laws

M MEASUREABLE ACCOUNTABILITY
HIV IN ASIA-PACIFIC AND THE HLM

As reported by UNAIDS through the Global AIDS Strategy 2021-2026, the service scale-up in Asia-
Pacific Region has been insufficient to meet the needs of the 5.8 million people living with HIV in
Asia and the Pacific. Slow progress in the response underscores the failure to prioritize HIV
prevention, bring services to scale and tailor approaches to address the needs of key populations.

The Global AIDS Strategy also highlights the concern that earlier gains in the regional response in
Asia and the Pacific are under threat, as many countries in the region experience new waves of HIV
infection. In 2019, 98% of new HIV infections in the region were among key populations and their
partners or clients.

On 8-10 June 2021, the High Level Meeting (HLM) will facilitate the adoption of the 2021 Political
Declaration on HIV and AIDS. Once adopted, the 2021 Political Declaration will guide national HIV
responses and plans, human rights interventions and legal reforms, and financing commitments
from donors and domestic governments for the period 2021-2026.

Through the commitments of Member States to the HIV response, the 2021 Political Declaration is
expected to have a significant influence on national strategic plans and HIV programs.

As members of key populations and communities, the HLM is an important platform to develop
strong recommendations in ending AIDS at the same time advocate and call on the Member States
for commitments to national strategic plans going forward.

NOTABLE LANGUAGE IN THE ZERO DRAFT 2021 POLITICAL DECLARATION

o The Zero Draft reaffirmed continued commitment from UN and Member States to end AIDS;

o The Zero Draft used a progressive language especially when it referenced to “key
populations” and “populations at higher risk of HIV infection” and when it acknowledged
specific key populations as gay men and men who have sex with men (MSM), people who
inject drugs, sex workers, and transgender people;

o Commitment to enhancing global solidarity to close the HIV response gap, and increasing
annual HIV investments in low- and middle- income countries to USD 29 Billion by 2025;

o The Zero Draft’s commitment to the realization of human rights and elimination of stigma
and discrimination, and commitment to expand investment in societal enablers including
human rights protections, reduction of stigma and discrimination and law reform in low- and
middle-income countries to USD 3.1 Billion by 2025.
 o Commitment to accelerating integration of HIV services into universal health coverage and
strong systems for health and social protection, building back better and fairer from COVID-
19 and humanitarian crises

o Commitment to investing in community-led emergency response infrastructure, and

providing strengthened community outreach, information, and peer support during health
emergencies and pandemic situations;

Effective implementation of combination HIV prevention

Paragraph 46 (a-g),

Position
o The Zero Draft did not reaffirm nor recognize the critical importance of community-led
interventions in the HIV response. The mention of community leadership in Par.46 is only in
relation to the ‘important role in the response to the COVID-19 pandemic’.
o Recognition to community-led interventions as critical enabler is also absent
o The Zero Draft lacks clear and specific description of ‘community-led services’ and fails to
underscore the importance of community-led response in ending AIDS
o On the other note, Paragraphs 30 and 31 jointly emphasize the inclusion of Treatment as
Prevention and Pre-Exposure Prophylaxis into services included in the Combination of HIV
Prevention on the ground of scientifically proven efficacy. However, the commitments of
Paragraph 46 failed to include them as priorities intervention,

Recommendation:
o The paragraph to commit to increasing key population and community leadership, resource
allocation to community-led service delivery to effectively implement differentiated service
delivery of combination HIV prevention including scientifically proven innovative tools such as
PrEP,, and Treatment as Prevention through communicating ‘Undetectable=Untransmittable’

Critical Review: Paragraph 47 (a-d), Zero Draft

HIV testing, treatment and viral suppression

Position:
o Noting the commitment to include HIV self-testing, and rapid ART inititation as differentiated
strategies. As reported by UNAIDS in 2021 Global AIDS Strategy, service scale-up has been
insufficient in Asia-Pacific. The services did not meet the needs of 5.8 million people living with
HIV in the Region.
o It is worthy to underscore the inclusion of community-led and community-based services as
ways to overcome challenges to service delivery of HIV testing, treatment and viral suppression;

Recommendation:
• The paragraph to establish the role of community-based facilities as point of care for testing
and treatment, as well as its role in assisting the administration of HIV Self-testing, without
limiting the role to only delivery HIV services
o The Member States to commit to support the decriminalization of people who use drugs and
effectively address the removal of structural barriers to access by MSM who use drugs
(‘chemsex’) and, and strengthen linkages from program outreach to their free access to testing
services and/or HIV Self-Testing;
o Strengthen the integration and delivery of services that prevent and treat HIV, address mental
health issues of key populations, HIV/TB and HIV/Viral Hepatitis services for people who inject
drugs, and testing for COVID-19;

Critical Review: Paragraph 50 (a-e), Zero Draft

Community Leadership

Position:
o The Zero Draft lacks clear and specific description of ‘community-led services’ and fails to
underscore the importance of community-led response in ending AIDS and undertake stronger
advocacy with governments to amplify community-led services.
o As in Paragraph 46, recognition to community-led interventions as critical enabler is also absent
o It is important to underscore the commitment articulated in Article 51.c backing the realization
of human rights and elimination of stigma and discrimination. It is also important to recall that
similar commitments were made in the 2016 Political Declaration, Paragraphs 63.b and 63.c. It
is also equally important, if not more, to highlight the persistent disparities in access to HIV
services by the key populations. Although several actions were taken in few countries, the sore
lack of implementation in most countries to address the societal and structural barriers
prevented a successful and effective response;

Recommendation
o Reaffirm the critical role of community-led responses in the HIV response and commitment to
undertake stronger advocacy with governments to amplify community-led services
o Highlight that the key populations and their communities shall lead the implementation of
community-based monitoring and will receive support in effectively assessing the quality of
services and enabling environment, and contribute to the improvement of national HIV
programs;
o Consider setting qualitative indicators to assess the quality of services, level of security and
safety of the environment, and quality of lives of key populations.

Critical Review: Paragraph 51 (a-e), Zero Draft

Realizing human rights and eliminating stigma and discrimination

Position:
o It is important to underscore the commitment articulated in Article 51.c backing the realization
of human rights and elimination of stigma and discrimination. It is also important to recall that
similar commitments were made in the 2016 Political Declaration, Paragraphs 63.b and 63.c. It
is also equally important, if not more, to highlight the persistent disparities in access to HIV
 services by the key populations. Although several actions were taken in few countries, the sore
lack of implementation in most countries to address the societal and structural barriers
prevented a successful and effective response;
o Both the 2016 Political Declaration and Zero Draft 2021 Political Declaration use similar
language in the commitment to remove punitive and discriminatory laws that block effective
response to HIV. Apparently, the language is not strong enough to be binding to Member
States. The adoption of the 2016 Political Declaration, notwithstanding, Indonesia abridged the
rights of gay men and other MSM during its 2017 crackdown.