Access, Accountability and Rights

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Your voices, your views Your the Global Fund on voices, your views

on the Global Fund

These articles have been written as part of a series to feed into the Global Fund Partnership Forum process in 2011. The views expressed in these articlesare those of the Key Correspondent and the persons interviewed by them. Whilst the material will contribute to information shared at the in-person consultation on the 2011 Global Fund Partnership Forum, it is not published as an official communication of the Global Fund to Fight AIDS, Tuberculosis and Malaria. June 2011 AIDS Portal and CNS News Initiative:This content is available under the Creative Commons LicenceAttribution 3.0 Unported (CC BY 3.0) license

The Key Correspondent Team (KC) is a vibrant network of more than 250 community-based writers from more than 50 countries, hosted by the International HIV/AIDS Alliance. KCs come from a variety of backgrounds related to HIV, health and development, uniting to ‘speak their world’ and give a voice to the voiceless. For more information about the KC team visit: http://www.aidsalliance.org/Pagedetails.aspx?id=466

TABLE of CONTENTS
Acknowledgements Is the Global Fund really working? Communities speak A focus on women and children
The Global Fund: enhancing possibilities for people living with HIV in Zimbabwe Women and children: scaling up services for HIV, TB and malaria in India

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Addressing human rights in country contexts

Public health and social justice: the time to stop criminalising Thai injecting drug users is now Walking the path of human rights HIV, sex-workers and injecting drug users: developing a rights-based approach in Central Asia and Eastern Europe Between resentment and dependency: The Global Fund in Indonesia Invest in the health of ALL populations at risk of HIV Infection in India Free Trade Agreements (FTAs) and health – more leverage required The Global Fund in the Dominican Republic: accomplishments & challenges Mixed perceptions of the Global Fund in Kenya Meeting the MDG targets for TB eradication in Zimbabwe: Global Fund money is vital Co-ordination is the key: CCM partnerships in India Global Fund in the Dominican Republic, and opportunity to grow. The Global Fund in Indonesia: Baby Rivona Positive Women’s Network To Protect public health and social justice: Stop Criminalising IDU: Thailand speaks out Simplify and build local competencies to manage Global Fund grants: a view from India

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Saving lives and value for money

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26 29 31 34 35 40 42 45 45 45 45

Strengthening risk management

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Strengthening country-level partnerships for greater impact

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Video articles

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About the KCs

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ACKNOWLEDGEMENTS
This report was written by nine Key Correspondents (KCs) from seven countries: Bharathi Ghanashyam (India) Bobby Ramakant (India) Evgenia Maron (Russia) Henry Neondo (Kenya) Ignatius Gutsa (Zimbabwe) Jittima Jantanamalaka (Thailand) Shobha Shukla (India) Suksma Ratri (Indonesia) and Vladimir EncarnaciónJáquez (Dominican Republic) The project was managed by Nadine Ferris France in her role as an Independent Consultant and implemented together with the AIDS Portal led by Robert Worthington www.aidsportal.org and CNS News led by Bobby Ramakant www.citizen-news.org on behalf of the Global Fund. Funding was provided by the Global Fund, as part its support for broad-based consultations on the 2011 Partnership Forum. We would like to thank all those who were interviewed as part of this project and who took the time to share their views. We are grateful to the International HIV/AIDS Alliance for their support with coordination and translation. We would also like to thank Ian Hodgson for his help with editing. Lastly, thanks to the wonderful Key Correspondents who produced high quality articles in a short period of time, for making sure the voices from the countries, those most affected by HIV, tuberculosis and malaria are heard. Photo credits (in order of appearance in this report) India: The Global Fund/Gary Hampton Russia: The Global Fund/Oliver O’Hanlon Indonesia: The Global Fund/Robert Pearce Kenya: The Global Fund/John Rae India: The Global Fund/John Rae

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IS THE GLOBAL FUND REALLY WORKING? COMMUNITIES SPEAK

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n 2002, the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) was created to provide substantial financing to support programmes tackling three of the world’s most devastating diseases. Eight years on, Global Fund financing has contributed to improving the lives of more than 6.5 million people. All activities of the Global Fund are rooted in ensuring collective action and involvement from all sectors of society. This principle is reflected in its governance framework, and a Global Fund ‘Partnership Forum’ is convened biannually to consult with stakeholders on the Fund’s policies and strategies. As part of the 2011 Partnership Forum consultations, a team of Key Correspondents (KCs) conducted interviews with Global Fund stakeholders in Asia, Africa, Eastern Europe and the Caribbean during April and May 2011, seeking their views on the Global Fund’s work in their region. From these interviews, the KCs wrote in-depth feature articles and produced video articles focusing on one or more of the following five thematic areas in relation to HIV, TB and malaria responses: 1. Thinking about what it funds and the way funding is currently provided, what should the Global Fund to fight AIDS, Tuberculosis and Malaria do more of – or less of – in oder to maximize value for money and increase the number of lives saved and infections prevented? 2. What changes can the Global Fund make to its model to address barriers in the delivery of evidence-based services to most at risk populations - in a way that protects human rights and prevents and manages violations? 3. What more can be accomplished for the three diseases by focusing on women and children? 4. How can the Global Fund do more to strengthen risk management and ensure that its funds are used transparently, yet still support the principle of operating with simplified, rapid and innovative processes? 5. What are the ways that country-level partnerships can be strengthened to improve outcomes and impact for the three diseases? This document is a compilation of some of their articles, selected to best illustrate the themes of the Partnership Forum.Even a cursory glance confirms that whilst the Global Fund is undoubtedly a force for good, there are multiple challenges that can diminish the Fund’s effectiveness.

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The articles identify many community concerns. These include delays in getting funds to communities and some key populations failing to benefit from money flowing into certain countries. For example, a lack of focus on women and children is noted in some Indian programmes, poor attention to the needs of injecting drug users (IDU) in Thailand, and unwillingness to support programmes working with the lesbian gay bi-sexual and transgender (LGBT) community in Indonesia. Those interviewed call on the Global Fund to use their significant leverage as a major donor to advocate for more inclusive programmes that really reach the people most in need - the Hijra in India for example, or sex workers in Eastern Europe and Central Asia.They also call on the Global Fund to be more assertive in ensuring that programmes contribute to respecting, protecting and fulfilling human rights. There are also many comments about the benefits of the Global Fund – the hugely positive impact that increased funding can have. This is noted in Zimbabwe, where there has been rapid and successful roll out of Directly Observed Treatment Short course (DOTS) for the treatment of TB. In the Dominican Republic, funding has significantly increased access to anti-retroviral treatment (ART), and increased involvement of civil society in national policy-making. What must never be forgotten in all discussions about funding mechanisms, politics and programming, are the true beneficiaries of Global Fund activities – communities and people. Assessments should look not just at quantitative elements, but also at the qualitative. Is there a substantive improvement in quality of life? This is a fundamental question, and perhaps the most poignant comment comes from Indonesia, where the KC notes “communities…refuse to be seen only as ‘numbers’, beautifying statistical reports.” As the Fund nears the end of its first decade, we can see that it has had a profound impact on the lives of millions of people who would have otherwise suffered greatly from HIV, TB and malaria. This is also a time for reflection – as the tectonic plates of the global economy shift, and as civil society continues to assert itself, this consultation demonstrates there are areas requiring serious attention. Progress can be made, though this requires meaningful dialogue and partnerships – the bedrock of effective global health interventions.

This document contains selected articles from the KCs, showing the different perspectives of Global Fund stakeholders in different countries organised according to the themes outlined above. The complete series of KC articles are available on: http://www.aidsportal.org/web/globalfundconsult/documents together with all documentation produced as part of the e-Forum and e-Survey consultations for the 2011 Partnership Forum.

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A FOCUS ON WOMEN AND CHILDREN

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The Global Fund: enhancing possibilities for people living with HIV in Zimbabwe
Ignatius Gutsa, Zimbabwe: May 2011

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imbabwe currently faces a huge HIV and AIDS crisis. Over the course of the past decade, the country has experienced a severe economic downturn, resulting in acute shortage of drugs and equipment to fight HIV. To aid Zimbabwe's response, the country received a major boost at the beginning of 2010, with a five-year US$84 million grant from the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund). This grant has gone a long way towards increasing access to HIV services and treatment. The grant came from Round Eight, and is the third since 2000. What is commendable about this funding is that it comes against the backdrop of yet another marked decline in adult HIV prevalence (ages 15-49). From a high of over 30 percent in the late eighties, prevalence fell to 15. 7 percent in 2007, and currently stands at 13.7 percent, according to 2009 estimates [1]. Interventions now need to focus on people already living with HIV. Funding from Round Eight has certainly come at the right time for the Zimbabwe National Network of People Living with HIV and AIDS (ZNPP+). ZNPP+ was founded in 1992 as a national umbrella body, representing and coordinating the interests and activities of support groups and organisations of people living with HIV (PLHIV) throughout Zimbabwe. ZNPP+ received funding as a 'sub-sub recipient' of the 'sub-recipient' Zimbabwe Aids Network [2]. The ZNPP+ also received under Round Five, as a sub-sub-recipient of the Southern Africa AIDS Dissemination Services (SAfAIDS). Judith Feremba, the Gender and Youth Officer at ZNPP+, acknowledges that funding received under Round Five helped their organization tremendously. Ms Feremba said: "Funding from Round Five of the Global Fund enabled PLHIV to have a voice in the constitution-making process, as this was an opportunity to air their views and have their issues mainstreamed into the new constitution. Based on our active participation in the current constitution-making process, we are anticipating that the rights of PLHIV will be enshrined in the new constitution. This will be a milestone achievement as the current Zimbabwean constitution lacked explicit reference to the right to healthcare for PLHIV.” Funds received under Round Eight have also enabled ZNPP+ to reach out to its constituency. ZNPP+ is currently scaling up its outreach activities, and its visibility in all of Zimbabwe’s ten provinces. Ms Feremba noted that: “This has resulted in more members coming in to join our support groups, as we are now more visible and more mobile because of the vehicles we obtained as a result of funding. We can now go out and meet the community. There is more awareness of and increased visibility of ZNPP+.” ZNPP+ has also started outreach programmes to youths and children. This is commendable, because as Ms Feremba acknowledged: "The initial thrust of ZNPP+ was to focus on grownups. Children were only indirectly benefiting as a result of their presence in their parents' support groups. There has however now been a change as we are now sensitising our members in all the provinces to pull out the youths so that the youths can actually form their own support groups.” As the Global Fund is doing a lot for PLHIV in Zimbabwe, Ms Feremba also notes that it needs to focus on protecting livelihoods. “You will find that people living with HIV have specific needs now that they are up and about because of antiretroviral therapy (ART). So they need more livelihood support.

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It would be a positive step if the Fund could support and enhance livelihoods of PLHIV. Livelihoods programs for women living with HIV would help particularly, as they often carry the added burden of looking after the family.” In order to guarantee gains made and enhance the quality of services for organizations such as ZNPP+, the Global Fund also needs to address bureaucratic bottlenecks. Some of the concerns raised by Ms Feremba relate to delays in getting funding and materials on time. “If the Global Fund could trust implementing organisations by funding them directly, this would speed up implementation of programs. The [current] system, of having principal sub recipient and sub-sub recipient, affects implementation funds are not reaching some sub-sub recipients on time. Targets are supposed to be met. Implementers just need to get their funds directly.” Delays in procurement of essential drugs and services are affecting ZNPP+ and its members. Ms Feremba noted that they have seen delays in the supply of Home Based Care (HBC) kits for their members since the previous year. She says: “There is a need to improve on the supply side. Sometimes when we attend Country Coordinating Mechanism (CCM) meetings, we are told we can only get a two-week supply for our members. Our the Home Based Care kits have been delayed since last year, and only arrived this year even though we started implementing that program last year under Round Eight.”

Sources: [1] www.nac.org.zw/index.php?option=com_content&task=view&id=83&Itemid=142 [2] www.kubatana.net/html/archive/hivaid/100519znnp.asp?orgcode=zim033&year=0&range_start=1

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Women and children: scaling up services for HIV, TB and malaria in India
Bharathi Ghanashyam, India: May 2011
he theme of this article is based on the question, ‘Is the Global Fund adequately supporting services for women and children in your country?’ Perhaps a more apposite query would be this: ‘Is your country doing enough to convince the Global Fund to adequately support services for women and children in your country?’ By its very mandate, the Global Fund’s model is based on concepts of country ownership and performancebased funding. People implement their own programmes in-country, based on their priorities. The Global Fund provides financing on the condition that verifiable results are achieved. This in effect means that it is not the Global Fund, but the countries themselves, who have to decide funding priorities. Having established this, it is important to say here that there is compelling evidence to suggest that women and children in India need special and focussed attention with regard to all three diseases – HIV, TB and malaria. The situation with malaria in particular, is shrouded in mystery; data is not easily available, and spokespersons not forthcoming. But there is a strong likelihood that it could be just as severe as HIV and TB. In its World Malaria Report 2008, the World Health Organisation (WHO) estimated that there were 10.6 million cases of malaria and 15,000 deaths from the disease in India during 2006 [1]. A good proportion of these are likely to be women and children.

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There is certainly evidence to confirm the vulnerability of this demographic with regard to HIV and TB. Dr Soumya Swaminathan (Coordinator, Research Special Programme for Research and Training in Tropical Diseases, World Health Organisation) reported recently in The Hindu [2], “in 2009, India had the highest number of TB cases in the world (approximately 2 million new patients), suggesting that the prevalence in children is also likely to be high. Tuberculosis is the third major killer of women aged 15-44 years, accounting for approximately 700,000 deaths a year globally and causing illness in millions more.”

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Swamithan also points out the additional challenges that women with TB face. TB is more common during and immediately after pregnancy, possibly due to changes in the immune system during this time. This not only poses a risk to the life of the woman, but also increases the chances of death in newborn babies. Babies born to women with TB are underweight, and at high risk of developing the disease themselves, due to close contact with their mother. TB can also cause infertility and chronic infections of the reproductive system. Linkages between HIV and TB challenge women and children more acutely than men. According to Dr Swaminathan, a study in Pune found that TB increased the probability of death for HIV-infected pregnant women and their infants. Further, HIV-positive women with TB during pregnancy have a higher risk of transmitting HIV to their babies, compared to women without TB. It is also accepted that women suffer more stigma and isolation when they are infected or affected by HIV or TB. For example, children are often pulled out of school to help care for their sick parents. In addition, among the beneficiaries of the CHAHA programme implemented by the India HIV/AIDS Alliance, it was found that women head 38% of CHAHA households, and 8% of children in the programme are orphans. Therefore the situation requires consideration at several levels, especially around prevention, accurate diagnosis (in the case of TB), treatment, care and support. Partial responses are inadequate, and this is a reality that has been accepted and documented across the world. More importantly, it has been demonstrated through successful interventions. James Robertson, Country Director, India HIVAIDS Alliance, says, “The additional resources provided by the Global Fund have helped ensure that priorities not adequately funded by the national budget get sufficient support to show impact. For example, the Prevention of Parent to Child Transmission (PPTCT) programme was initially scaled up in India with a Round 2 grant and expanded with subsequent funding. This funding was essential, as it has enabled the government to take ownership of this vital service. The Round 6 funding for children and families affected by AIDS has helped provide data and experience to support efforts to include expanded programming for these groups in India’s new national HIV strategy.” Andreas Tamberg, Fund Portfolio Manager, The Global Fund, says, “The overarching goal of the Global Fund’s partnership model is to create an enabling environment to support countries to develop and implement effective, evidence-based programmes to respond to AIDS, tuberculosis and malaria. This partnership is based on a core set of shared principles and a collective responsibility for delivering on international targets on health through achievement of the Global Fund’s vision – a world free of the burden of AIDS, tuberculosis and malaria.” In this light, it becomes important for concerned countries to take joint responsibility with the Global Fund to create and sustain the enabling environment that can achieve the desired impact.

“The additional resources provided by the Global Fund have helped ensure that priorities not adequately funded by the national budget get sufficient support to show impact.”- James Robertson -

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Several respondents thought that the priorities of the National AIDS Control Organisation (NACO) towards women and children left a lot to be desired. One person, wishing to remain anonymous, says, “There is considerable uncertainty about whether women’s and children’s needs must be addressed by NACO or the Ministry of Women and Child Development. But in the community we feel that HIV is a complex issue. Aanganwadi workers and Accredited Social Health Activists (ASHAs) cannot address the needs related to People Living with HIV (PLHIV) and Children Living with HIV (CLHIV), as they are not trained for this. They can inadvertently cause situations that can lead to stigma and exclusion. Therefore this task has to be held by NACO, which has to build in and seek support for these activities within its programmes.” Traditionally, the National AIDS Control Programme (NACP) has not given much importance to care and support, whereas evidence proves that this is the one area that can dramatically improve the lives of PLHIV. Diagnosing and treating TB in children is challenging. Risk of progression from infection to disease is increased among children (particularly up to four years old), HIV-infected and malnourished. These are also the groups that pose the greatest diagnostic challenges because of difficulties obtaining sputum samples, and the paucibacillary nature of disease (involving few bacilli). As stated in ‘Pathways to better diagnostics for Tuberculosis’, a blueprint for the development of TB diagnostics by the New Diagnostics Working Group of the Stop -TB Partnership, “Increasing the speed, effectiveness and accuracy of diagnostic tests is central to the goal of rolling back the global tuberculosis epidemic that afflicts nearly a third of the world’s population.” This situation certainly merits greater attention from the Global Fund. Partner countries, particularly India, should take these issues seriously when prioritising areas for funding. Country Coordinating Mechanisms (CCMs) are the nucleus of the Global Fund’s country-level programmes and performance. Several respondents felt commented on limited civil society representation on CCMs. For one, “A very small number of members of the CCM comprise civil society. Corporate members exist in name only as they often do not participate in meetings. In this scenario, whatever the government decides works, and while the government might mean well, the absence of voices from a wide range of stakeholders results in important priorities getting missed out.” The figures are out there. Women and children need support at several levels and they need it fast. Returning to the theme of this article, perhaps it should be, ‘Is your country doing enough to convince the Global Fund to adequately support services for women and children in your country?’ This is a question to ponder over, and seek answers.

SOURCES: [1] The Hindu 17th June 2010: www.hindu.com/2010/06/17/stories/2010061754161100.htm [2] The Hindu 14th April 2010: www.thehindu.com/health/medicine-and-research/article1694675.ece

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ADDRESSING HUMAn RIGHTS IN COUNTRY CONTEXTS

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Public health and social justice: the time to stop criminalising Thai injecting drug users is now
Jittima Jantanamalaka, Thailand: May 2011 Drug use and criminalisation

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hailand has been a leader in HIV prevention and treatment for 20 years. Success has come to Thailand in many HIV contexts, but not for HIV transmission driven by injecting drug use.

The combination of the criminalisation of injection drug use and a lack of a coherent legal and policy framework on drugs, means that not only injecting drug users (IDUs) are at risk when they access services, but service providers are also at risk of being penalised for offering them. In Thailand, service providers have been arrested, jailed or blacklisted – confirming the gravity of the situation. Criminalisation of drugs can increase HIV infection rates, particularly among IDUs. The number of new hepatitis C virus (HCV) infections has also escalated since the ‘war on drugs’ was launched. On one hand, when in some countries rates of heterosexually transmitted HIV infections are falling, HIV transmission through the injecting drug route continues to rise. While harm reduction approaches have proven effective at reducing the spread and impact of the epidemic among IDUs, progress in addressing IDU's needs and priorities moves at a snail’s pace.

The role of agencies
Stigma, discrimination and criminalisation of drug use make it more difficult for IDUs to access existing services. Harm reduction approaches for IDUs have long been neglected, though the situation has changed over the past 14 years, since the Asian Harm Reduction Network (AHRN) came into being. “AHRN has been addressing this issue since then,” said Dr Apinun Aramrattana, Co-chair, AHRN Foundation Board. In Thailand, key agencies and stakeholders are more receptive to harm reduction programmes, and IDUrelated issues are now better understood. More funding is available, and there has been a scale up of harm reduction services. “IDU networks have gained strength over the past years,” said Dr Apinun. However, because the IDU issue is so sensitive, users are still stigmatised and discriminated against. This is a huge barrier to accessing harm reduction services for those who need them the most. “ IDU-related stigma and discrimination delays the treatment,” said Dr Apinun.

The Global Fund
Raising awareness about harm reduction continues to be a challenge. The Global Fund has already brought in some changes towards formulating and scaling up harm reduction programmes in Thailand, with funding from Round 8. Despite obstacles, the agencies implementing IDU related programmes in Thailand are communicating with each other, which had never happened before, according to Dr Apinun. With Thailand getting the Global Fund round 8 grant, it is not only an opportunity to address human rights issues related to IDUs but also sex workers and migrants, said Dr Apinun.

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A Global Fund Principal Recipient (PR) in Thailand is Population Services International (PSI). Their Global Fund round 8 project, ‘Comprehensive HIV prevention among MARPs by Promoting Integrated Outreach and Networking (CHAMPION-3)’, aims to reduce new HIV infections by providing universal access to HIV prevention services for IDUs in selected provinces. The program is facilitating an urgently needed rollout of needle and syringe programs for IDUs. Program strategies include reducing the risk of infection from HIV and other sexually transmitted infections (STIs) through strengthening and scaling up of prevention activities; increasing access to care, treatment and support; creating an enabling environment; advocating for improved policy and practice; and strengthening strategic information systems, surveillance, research and data use for better programming and policy improvement for IDUs.

“One of the major obstacles is when some of our outreach volunteers who use drugs get arrested or blacklisted. It impacts our work adversely.” - VeeraphanNgammee
The drug use situation in Thailand is not reducing but changing, said Khun Veeraphan Ngammee coordinator of ‘12 D Thailand’. The IDU who previously injected heroin are now using amphetamine or other substances, so continue to be at risk of HIV, HCV or other health conditions. When the Global Fund project in Thailand began, IDUs could access information about harm reduction services in two ways – the first method was through outreach volunteers, and the second is through drop in centres they were accessing for their needs, said Veeraphan. Veeraphan continues: “One of the major obstacles is when some of our outreach volunteers who use drugs get arrested or blacklisted. It impacts our work adversely. The law enforcement officers don’t understand the harm reduction and rights based approaches and put them in jail. Jailing the often aggravates the situation by bringing them in close contact with drug dealers or their networks and push them into drugs-related crime.”

The need for effective harm reduction
Outreach volunteers discuss health issues with their IDU friends and study barriers that prevent them from accessing services. They also provide clean needles and syringes, cotton, water and other supplies. This is vital, for more than 36% IDUs are reported to share syringes in Thailand. So the clean needle and syringe programme protects users from HIV. But more than that, the programme gives respect, care and understanding, acknowledging their value as human beings. They are not judgemental, or prescriptive. This is why harm reduction makes a difference when we provide options to reduce the risk of HIV, hepatitis C and other health conditions while using drugs. If they are ready to stop then they will ask for assistance. High quality and community driven harm reduction interventions have been shown to encourage IDUs to come forward seeking advice, rather than simply going underground. Criminalising drug use leads to IDUs not only trying to avoid law enforcers, but also denies support from health service providers. For Veeraphan, this impacts on HIV, public health and social justice adversely.

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He suggests, “I think that the Global Fund has done a good job on harm reduction programmes but it would be better if there are resources invested to work on legal reforms and mechanism to work with law enforcement agencies for optimising programme impact, and create the good environment for those who working in the field. “One of the major modes of HIV transmission is sexual intercourse which has been recognized and Thailand has invested significantly in preventing HIV transmission through sexual route. But a lot more needs to be done to prevent HIV transmission among IDUs.”

Harmonisation is vital
Without harmonising ‘war on drug’ policies and public health policies for IDUs, and investing in the protection of human rights and right to health for IDUs, nothing much can be achieved – in terms of HIV, drug use, hepatitis C or human rights. Thailand needs to regain its reputation for a global leader in HIV prevention for IDUs and also for HIV transmitted through other routes.

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Walking the path of human rights
Shobha Shukla, India: May 2011

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report from the UN Special Rapporteur calls upon nation states to decriminalise consensual same-sex conduct, repeal discriminatory laws relating to sexual orientation and gender identity, repeal laws criminalising sex work, and provide human rights education for health professionals. Criminalisation is not only a breach of a State’s duty to prevent discrimination, it also creates an atmosphere where affected people are disempowered, unable to achieve full realisation of their human rights. According to a recent UNDP report, India has 30.5 million men who have sex with men (MSM), and over a million Hijra and transgender people. The national HIV prevalence in MSM is estimated at 7.41%, with 24% testing positive in the state of Goa and 18.8% in Mumbai. While MSM in India are at high risk of acquiring and transmitting HIV, only about 4% are able to access appropriate services. The situation is more serious for transgender populations. Here, HIV prevalence can be as high as 42% in Mumbai, and 49% in Delhi. This has been attributed to low levels of awareness, unsafe sexual practices, inadequate services and social marginalisation. The same report confirms that MSM and transgender people are highly stigmatised in India, with many reporting discrimination when accessing health care services, education, employment and justice. There is also violence perpetrated by police and health care workers. This is a gross violation of human rights. The new Pehchān programme, implemented by the India HIV/AIDS Alliance and six state partners with Round 9 grant support from the Global Fund For AIDS, TB and Malaria (the Global Fund), is designed to strengthen community-based organisations for MSM, transgender and Hijra populations to address barriers in the delivery of HIV prevention services in a way that protects human rights and prevents violations. Heterosexuals living with HIV in India also face stigma and discrimination, but for MSMs and transgender populations there is double jeopardy. They are at increased risk of contracting HIV, and face poor access to services. In order to prevent and control HIV, we must protect and promote the human rights of the most vulnerable and marginalised people. Community organisations and civil society consider overwhelmingly that the Global Fund should urge recipient countries, including India, to introduce appropriate legislation, which decriminalises same sex relationships. Once appropriate laws are in place, steps can be taken at the country level for their proper implementation. Another suggestion was to withhold funding from countries with a record of human rights violations. The Naz Foundation International (NFI) is headed by Shivananda Khan, and is the recipient of another Global Fund Round 9 grant that supports a regional community-strengthening programme to reduce the spread of HIV among MSM and transgender people. Shivananda Khan considers the main stumbling block to be legislation. He wonders, “How do we talk of human rights for MSM when, in many countries there are no human rights in general for anybody? The Global Fund needs to engage more strongly at the government level, with its partners [including the World Bank, and World Health Organisation] to ensure that the government recognises the problem, and makes changes in the political and legal environment of the country. The Global Fund will have to engage policymakers and urge them to repeal punitive laws, and lift the ban on homosexuality by decriminalising the whole process.”

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In India, one positive development was the landmark judgement by the Delhi High Court, ruling same sex behaviour in consenting adults as legal. But even after two years, a Supreme Court decision (which will be binding in all states) is still awaited. However, Shivananda feels that for the common person on the street there is little change. Socio-cultural conditioning creates rigid mindsets, which are difficult to change overnight. It is not only that we need effective legislation. We also need to address issues around policing in public places, where most transgender people and MSM meet and interact. Here, the police often harass lesbians, gays, bisexuals and transgender people, and blackmail them. So a lot of work has to be done nationally, once laws change, for all sections of society, to enable them to understand that human rights are there for all, (including MSM and transgender populations), irrespective of who they are and what they do. The Global Fund, ably supported by other agencies - the government, media, and community-based organizations, can together bring about a positive change. It has to be a combined effort, and not an individual one.

“We have learnt by now that in health, if it is not a rights-based intervention then it leads us nowhere.” - Loon Gangte Arif Jafar, Country Director, Maan AIDS Foundation, one of the six Pehchān implementing partners, feels that unless legal reforms are done for all high risk populations - be it MSM, injecting drug users (IDUs) or sex workers - we cannot talk about human rights. He cites the example of ‘a guy from Bangalore’ living at a time when homosexuality was not decriminalised. He was taken to a psychiatrist to ‘cure’ his homosexuality. When he approached the Human Rights Commission about this inappropriate approach they expressed inability to intervene and call it a human rights issue – the practice was then criminal in the eyes of the law. So there must be proper laws in place. Loon Gangte of the Delhi Network of people living with HIV (DNP+) says, “We have learnt by now that in health, if it is not a rights-based intervention then it leads us nowhere. The Global Fund should be investing in human rights. Mere distribution of commodities will not help if we don’t look into the human rights perspective of the community. Because the Global Fund has money, it has the power to lobby against the criminalisation of certain groups, and insist on legal reforms.” Shaleen Rakesh and Abhina Aher of India HIV/AIDS Alliance, which implements Pehchān, strongly feel that community-oriented programmes of the Global Fund should have a strong human rights component. According to AbhinaAher, “for MSM and transgender people the issue of health is less of a priority as compared to issues of harassment, violence, stigma and discrimination.” She wants the Global Fund to make country coordinating mechanisms (CCMs) stronger by giving them an agenda that works beyond reduction of vulnerability and addresses human rights as well. Shaleen Rakesh wants “the Global Fund to be more specific in its approach and make budgeted interventions in the area of human rights. It should support specific programming to address human rights barriers and violations. In fact, all proposals should [include] human rights and stigma reduction elements as an integral part of Global Fund grant applications.” Anand Grover, UN Special Rapporteur on Right to Health, and a senior Supreme Court lawyer heading the HIV/AIDS Unit of Lawyers’ Collective, would like the Global Fund itself to ‘think of walking the human rights talk’. He is forthright in saying, “There is no clarity on human rights within the Global Fund,and there are [many] different lobbies. I think human rights have to be applicable to the Global Fund itself.”

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“We need responses which are built on the solid foundations of equality and dignity for all, and which protect and promote the rights of those who are living with HIV and those who are typically marginalised.” - Anand Grover He continues, “We should start thinking of a Global Fund which requires contributions from developing countries, low- and middle- income countries and developed countries. Governments should be told that if they want money from the Fund, they must follow a human rights framework. In this way the Global Fund can be made as leverage to promote human rights.” An enabling legal and policy environment is absolutely essential in order to achieve universal access to HIV/TB prevention, treatment, care and support. In the words of Helen Clark, Administrator, UNDP, “Every day, stigma and discrimination in all their forms bear down on women and men living with HIV, including sex workers, people who use drugs, MSM, and transgender people. Many individuals most at risk of HIV infection have been left in the shadows and marginalised, rather than being openly and usefully engaged. To halt and reverse the spread [of HIV], we need rational responses, which shrug off the yoke of prejudice and stigma. We need responses which are built on the solid foundations of equality and dignity for all, and which protect and promote the rights of those who are living with HIV and those who are typically marginalised.”

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HIV, sex-workers and injecting drug users: developing a rights-based approach in Central Asia and Eastern Europe
Evgenia Maron, Russia & Bobby Ramakant, May 2011

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ccording to the joint United Nations programme on HIV/AIDS (UNAIDS), Eastern Europe and Central Asia is the only region where HIV prevalence remains on the rise. The number of people living with HIV (PLHIV) has almost tripled since 2000, and reached an estimated total of 1.4 million in 2009. A rapid rise in HIV infections among injecting drug users (IDU) at the turn of the century caused the epidemic in this region to surge, and the epidemic is concentrated mainly among people who inject drugs, sex workers, their sexual partners and, to a lesser extent, men who have sex with men (MSM). About one quarter of the 3.7 million people who inject drugs in this region are living with HIV.

Sex work and HIV
“It is crucial that the Global Fund increase funding for rights-based services that promote sex workers’ health and rights and meaningfully involve sex workers in the development and implementation of programmes that directly affect the health and safety of sex workers, their family and clients” said Aliya Rakhmetova, the coordinator of Sex Workers’ Advocacy Network (SWAN). SWAN members concur: “There has been a lot of pressure from certain anti-prostitution groups and foreign governments to criminalise clients. We strongly oppose this as it pushes sex workers and their clients underground and away from HIV services. “The Global Fund should support and promote non-discriminatory laws and practices towards sex workers and oppose criminalization and penalization of sex work in the states in Eastern and Central Europe and Central Asia.”

Criminalization and penalization of sex workers
For SWAN, “In most countries across the region, the penalisation of individual sex work results in fines, detention at a police station or prolonged incarceration. The threat of these pushes sex workers into more dangerous and isolated working conditions leading to increased risk of violence and decreased access to health and harm reduction services…and to rush negotiations [when] the client is aggressive or refuses to use a condom. They are less likely to carry condoms with them for fear of them being used as evidence of prostitution.”

Institutional discrimination, raids and repression
SWAN highlighted, “In some countries, even though sex work is decriminalised, police rely on local by-laws against street prostitution, identity (ID) offenses, offenses against public order, migration offenses or ministerial orders to specifically target sex workers for repression and detention. “The economic weight of repeated and routine fines, extortion and robbery by state actors or losses of income due to detention exert pressure on sex workers to sacrifice condom use for increased income from unprotected sex or increase their number of clients. This increases sex workers risk’ of HIV infection.”

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Violence and impunity
According to SWAN, “In most countries in the region, sex workers face extremely high levels of physical, sexual, psychological and economic violence by police which in some instances rises to the level of torture.” Not only sex workers are threatened. According to SWAN, “In two countries in the region, police have threatened outreach workers. In one they threatened the closure of an organisation that provides HIV and harm-reduction services, in another they seized the names of participants. Both of these cases occurred in retaliation for organisations providing support to sex workers denouncing police violence.”

Discriminatory laws
SWAN adds, “The criminalisation and penalisation of sex work are inherently discriminatory laws. However, even in countries where sex work is decriminalised, a number of other discriminatory laws and regulations persist. In Hungary and Latvia, where sex work is legal failure to comply with regulations (i.e. soliciting for sex work in certain (often unpublicised) zones such as near churches, working out of an apartment where one lives with children or not undergoing mandatory medical examinations can result in an administrative offense punishable by imprisonment or a fine and a criminal record. “Mandatory HIV and STI-testing and forced STI-treatment discourage sex workers from voluntarily testing. In Latvia, a discriminatory regulation makes sex work illegal for HIV-positive people who face an administrative fine or criminal charge.”

Improving response for IDUs
According to Alik Zaripov, treatment activist from the city of Kazan, Tatarstan, Russia, “It is necessary to establish low-threshold centres with programs to improve access and adherence to antiretroviral (ARV) treatment for people who use drugs. With the support from the Global Fund and with the participation of both NGOs and regional authorities it’s necessary to establish such centres. [to] provide opportunities to involve IDUs in HIV preventive programmes, advocate for their interests and engage with the community.” He continues, “The indicators which the Global Fund has now - on the purchase of syringes and their distribution – are not enough to measure the quality of programs this way. [The Fund] should include [indicators for] case-management at special low-threshold centres aimed at increasing adherence to treatment and ensuring access to treatment for IDUs.”

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Zaripov considers that Global Fund supported programmes on syringe exchange need periodic review. “It seems to me that there should be no rigid framework - for example, in terms of harm reduction – we offer syringe exchange for all the five years of the Global Fund grant implementation. And people die because syringes are not a basic need anymore.”

Hepatitis C
According to Gulnara Kurmanova of Kyrgyzstan, “The Global Fund should consolidate HIV/TB programs under HIV leadership and hepatitis C should be included into list of priorities for funding.” She continues, “Monitoring systems need to be harmonised for national, the Global Fund and other donor supported programmes. I suggest developing a guideline on monitoring systems’ harmonization“ We are waiting for the recommendations of the Global Commission on HIV and the Law. Decriminalization of sex work, same sex behaviour and injecting drug use is a priority.” For Kurmanova, there is a vital need for qualitative research to explore key issues, such as ”young IDUs who just started using drugs are invisible, and programs try to find money for any kind of rehabilitation, which youngsters do not want. Look at curves of new cases of HIV especially in Kyrgyzstan. Youngsters are moreat-risk, but they do not want to go to programs addressing needs of those who have used drugs for years. “The first step is understanding of priorities and felt needs, not perceived needs. Empowerment of people is a bridge between ‘services’ and human rights.”

Human rights approaches
Sex worker and IDU communities must be at the centre of responses to HIV in Eastern Europe and Central Asia. Stakeholders should adapt a human rights framework on which to base their approaches. The Global Fund has strong influence as a financing mechanism for HIV, TB and malaria, which must be exercised to save more lives and prevent infections in these regions.

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SAVING LIVES AND VALUE FOR MONEY

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Between resentment and dependency: The Global Fund in Indonesia
Suksma Ratri, Indonesia: May 2011 The Global Fund in Indonesia

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t is nine years since the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) was first established. Since its inception, the Global Fund has become the main financier of programs to fight these diseases, with a total approved funding of US$ 21.7 billion for more than 600 programs in 150 countries throughout the world. Though the mechanism may seem flawless and ideal, it is important not to rely just on national reports to assess the Fund’s effectiveness. We also need the views of stakeholder constituents – the direct beneficiaries of the funding. Anecdotally, we hear that experiences on the ground do not match the glowing reports released by governments. An example is Indonesia, a large country consisting of over 17 thousand islands. In October 2010, reported cases of AIDS were 24,131, with 4,158 cumulative deaths. With its complex geographical structure, does the Global Fund program run smoothly and ideally in all 33 provinces of Indonesia? Does the program have great impact to the Key Affected Populations, such as injecting drug users (IDU)?

Stakeholders
Aries is a peer educator from Central Java, nurturing a local support group. For him, the Global Fund program in his area is limited to providing of ART, CD4 checks and operational costs for health care service providers. Even though the AIDS mortality rate has dropped to zero in his area, Aries considers the program to still have problems, especially around inequality in implementation. In Central Java, only selected cities and districts enjoy financial support from the Fund, whilst others are still struggling. Not only that, but in his area, Aries found that target groups are limited to sex workers, people living with HIV (PLHIV) and IDUs. Women are included in the PLHIV group, but children and youth are not addressed, or men who have sex with men (MSM) and transgendered people. He also expresses concerns regarding the program monitoring systems. So far, documentation only includes quantitative data. Oldri, a Program Manager in the Indonesia Positive Women's Network has a similar opinion. For her, implementation of Global Fund programmes in Indonesia is effective in the context of interventions for specific target groups, but less successful for Key Affected Populations. In short, the program has been successful quantitatively, but not necessarily qualitatively. Success in Indonesia is limited, due to role shifting of civil society and communities into the supporting of health system strengthening – a role which should be government’s, fulfilling the citizens right to health. For Oldri, the objectivity of programmes is also low and sporadic, targeting only high -risk groups, in spite of data from the Indonesia Ministry of Health (2010) suggesting that 25% of PLHIV are from general population. Women working at home for example, are not considered a high-risk population. Dr Bagus, a medical practitioner, feels that judging from the proposal based on the National Strategic Plan (NSP), the multi-sectoral approach that was adopted, guided by three principal recipients (PRs) is an innovative way to execute the action plan. It was hoped this would contain the epidemic in Indonesia, but several challenges and potential obstacles became evident, such as the program quality, uneven program expansion, understanding the philosophy of the program, sustainability and coordination.

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Quality of programming has always been a key issue, due to large numbers of quantitative reports tracking outreach, syringe distribution and condom distribution. These reports are not accompanied by evaluations of service quality. Dr Ramona (Association of Family Planning Indonesia - PKBI) and Dr Wan Nedra (The Central Board of NahdlatulUlama - PBNU) both confirm this problem. The PKBI and PBNU are both PRs, and they claim that most programs focus only on quantitative aspects, with little consideration for quality. This creates a dilemma for the program implementers. Wan Nedra did praise the Global Fund for its organized structure and guidelines, but feels strongly that capacity building and advocacy must also be included as core elements addressed by the fund. Given the geographical location of Indonesia, Wan Nedra also addressed her concerns that activities can only be implemented in certain areas. PBNU conclude it is impossible to conduct programs in Maluku, Southern Borneo and Lampung, due to the local characteristics, communication problems and recurring internal conflicts. Dr Ramona mentioned that PKBI runs Global Fund programs in only 12 provinces and 68 sub-provinces mainly Java, most of Sumatra and Bali. Another issue is sustainability. Global Fund activities are used by the government as an excuse not to allocate funding for HIV prevention, treatment, care and support in the national or local government budget. The fact that funding is only temporary seems is not to be considered, and the government seems in denial that sooner or later international funding will be discontinued, with countries expected to be financially independent. The dependency of the government on foreign aid is a matter of great concern.

Community Resentment
Many people are unaware of the shocking circumstances regarding Indonesian PRs. One incident stands out, when PKBI was accused of serious human rights violations during the Global Fund Round 8. The allegation came from SSR field officers of the TegakTegar Foundation, claiming they had to undergo mandatory urine test, leading to four people being terminated due to urine testing positive for drugs use. They subsequently filed a complaintto the National Commission on Human Rights, and as yet there has been no follow up or clarification from the Global Fund Country Coordinating Mechanism (CCM), or the Technical Working Group (TWG). This incident caused resentment amongst grassroots communities, especially when PKBI was once again was selected as the PR for Round 11.

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There was also evidence of ‘money politics’ - cases where clients are compensated by certain amount of so-called ‘transport money’ to attend for VCT. This practice diluted the initial definition of VCT itself, as people were clearly not voluntarily attending for testing, but for financial reasons. The trigger for this practice is presumably the targets for testing field officers need to achieve, with little regard for capacity building. Field officers were frantically trying to meet a target without due consideration of work ethics. It was somehow a mutual symbiosis; the client needs extra money, while the field officer needs to reach the target. Nothing else matters, but to reach the target. On the other hand, PBNU as a Muslim faith-based organization also faces resentment and doubts from the community. Hartoyo, from Our Voice, suggests that PBNU as a PR is perceived by the LGBT community as reluctant to support programs addressing their needs and those of sex workers, despite the fact a performance indicator for the current round is to focus more on gay and transgender groups. Even though Wan Nedra of the PBNU denies this bias, criticisms are still being made, through mailing lists and discussion forums. These state that PBNU, despite its responsibility as the PR for the Global Fund Round 9, is still not engaging the LGBTQ community. This sort of friction raises serious questions about PR selection in Indonesia. Eventually the community will demand better evaluations of organizations wishing to be a PR. As for the National AIDS Commission, Nafsiah Mboistated that the implementation of funded programs is improving. After several unfortunate incidents with the Global Fund, Indonesia may have finally reached its peak, based on the 'A' ratings of the PRs in Indonesia. For Round 11, Indonesia has 4 PRs, consisting of 2 government institutions (the National AIDS Commission, and the Ministry of Health) and 2 Civil Society Organizations (PKBI and PBNU). Nafsiah emphasized that the cooperation and coordination between the government and Civil Society Organizations does need to be improved and strengthened, particularly because all parties need to realize that no one can work alone; good partnerships are required to achieve the national goals for HIV prevention. Nafsiah realizes the dynamic and frictions between the NGOs, government and the PRs, and claims that resentments will always occur no matter what. The most important thing at this moment is to continue the work and ensure the fund is utilized effectively.

Not just a number
Overall, on paper at least, the achievement of Global Fund targets in Indonesia suggests rapid progress. But if we talk with people at the grassroots, who are supposed to be the main beneficiaries, there is still much resentment towards lack of transparency within the CCM. Even though civil society is represented on the CCM, there seems to be a breakdown of communication – information about the Global Fund is not widely disseminated. This lack of transparency, together with limited gender-sensitive approaches, poor capacity building, and overemphasis on target oriented reporting, all comprise the greatest obstacles to effective programming. Even with the Global Fund’s noble mandate, representatives need to appreciate the difficult situation in the field. A much more comprehensive and qualitative mechanism is required, not just a focus on achieving targets. People are yearning for sustainable, friendly, gender-sensitive and non-discriminating services. Communities in Indonesia refuse to be seen only as ‘numbers’, beautifying statistical reports.

Communities in Indonesia refuse to be seen only as ‘numbers’, beautifying statistical reports.

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Invest in the health of ALL populations at risk of HIV Infection in India
Shobha Shukla, India: May 2011

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ccording to a recent UNDP report India has 30.5 million men-who-sex-with-men (MSM), and over a million Hijras, or transgenders. The national HIV prevalence amongst MSM is estimated at 7.41%, with 24% MSM testing positive for HIV in the state of Goa, and 18.8% in Mumbai. While MSM are at a high risk of acquiring and transmitting HIV, only about 4% of those at risk are currently able to access appropriate HIV services in India. In this dismal scenario, the Global Fund For AIDS, TB and Malaria (the Global Fund), Round 9 has done well to fund community-strengthening projects to reduce vulnerability and minimise risk of the further spread of HIV amongst MSM, and transgender populations in South Asia. Now it has to be ensured that through proper execution of these projects, more lives are saved and more infections are prevented in the members of this community. Voices from the affected community, as well as community organisations are of the opinion that the Global Fund bosses need to be less bureaucratic in their work with the grassroots organisations. They need to review their process for document verification and make it simpler and more sensitive to the needs of the communities. Naz Foundation International (NFI), headed by Shivananda (Shiv) Khan, focuses on male-to-male sexualities and sexual health concerns in South Asia. It is the recipient of the Global Fund Round 9 grant for community-strengthening programme aimed at reducing the rapid and alarming spread of HIV among MSM and transgender people in South Asia Association for Regional Cooperation (SAARC) countries. Shiv, who has been working relentlessly for the betterment of marginalised communities of MSM and transgender populations, says that, “the Global Fund is rightly bothered about getting value for money. It has done a lot for addressing and reducing corruption. They are working with region’s communitybased organisations (CBOs) to implement the framework for MSM. But at times it becomes too difficult to micromanage their goal of value for money and validating their documentation verification. Sometimes it becomes difficult for regional players to work with such a big organisation like the Global Fund. I am learning a lot many new things. They need to review their process for document verification and make it simpler.” Citing the example of Maan AIDS Foundation, which is also a recipient of the Global Fund Round 9 project, Arif Jafar, its Country Director, suggests that, “the programme was supposed to start in October but it has not yet started, because a lot of paper work still needs to be done. All this paper work, which the Global Fund has mandated organisations to follow, may be easy for governments, but for CBOs it is quite difficult to adhere to. The Global Fund that is supposed to save lives, make differences and have an impact on HIV, TB and malaria is already running 7 months late. This is surely going to adversely affect saving of lives and prevention of infections.” Loon Gangte of the Delhi Network of people living with HIV (DNP+) wants the Global Fund to “reduce paper work, minimise middle men, and enhance programme efficacy by optimising the funding and letting the money reach where it is meant to. As of now the fund trickles down through the Principal Recipient (PR), Sub-Recipient (SR), Sub-sub-recipient (SSR), and by the time the fund reaches at the community level it is much less. The Global Fund has a lot of system and structure to protect against corruption and to prevent misuse. However it is evident that the present system is unable to do so. So this is one area which the Global Fund can look into and simplify its processes, so that people who mean to get the funds receive it.”

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Another area, which Mr Gangte wants the Global Fund to examine is ensuring antiretroviral (ARV) drugs continue to be made available at affordable prices. He fears that once generic production of drugs is stopped in India due to Free Trade Agreements (FTAs), drug prices will increase many times. Ranjit Sinha is Secretary, Association of Transgender and Hijra in Bengal (ATHB), which is a recipient (under Solidarity and Action Against The HIV Infection in India - SAATHII) of the Global Fund grant awarded to ‘Pehchān’ consortium. This programme aims to strengthen and build the capacity of CBOs to provide HIV prevention programming for 453,000 MSM, transgender and Hijrapopulations in 17 Indian states. But Ranjit feels that “not enough has been done to address the needs of transgender and Hijra communities and most of the resources that have been allocated to sexual minorities have been invested in scaling up MSM programmes. We need to scale up investment on programmes that address the needs and challenges of transgender and Hijra populations as well.”

“Reduce paper work, minimise middle men, and enhance programme efficacy by optimising the funding and letting the money reach where it is meant to.” - Loon Gangte Bobby Jayanta, from Indian Harm Reduction Network, which is also a recipient of the Global Fund Round 9 grant for HIV-IDU component, wants legal reforms as far as MSM are concerned, so that their activities are not criminalised. Anand Grover, UN Special Rapporteur on Right to Health, and senior Supreme Court lawyer, heads the HIV/ AIDS Unit of Lawyers' Collective. He wants the structure of the Global Fund to be expanded, to ensure that civil society, as well as the communities – especially the marginalised, like MSM and transgender populations – are represented. Developing strategic partnerships and alliances between the Global Fund, affected communities, lawyers, policy makers and the media is critical to providing quality health and other services to MSM, so that instead of dying prematurely they are able to lead a humane life with dignity.

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Free Trade Agreements (FTAs) and health – more leverage required
Bobby Ramakant, India: May 2011

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urrently, a number of developing nations are negotiating many economic agreements with other countries or blocks of countries. Another alarming fact is that there is marked reluctance to divulge details about these negotiations, and harsh measures are taken against public health activists who demand their say. More than eighty per cent of antiretroviral (ARV) drugs purchased by the Global Fund are coming from such nations such as India where threat from such economic agreements looms large. According to Loon Gangte of the Delhi Network of People living with HIV (DNP+) and International Treatment Preparedness Coalition (ITPC – South Asia), “The Global Fund to fight AIDS, Tuberculosis and Malaria (The Global Fund) should look into it that more than 80% of antiretroviral (ARV) drugs purchased by it are coming from India and today we are at a very serious juncture with Free Trade Agreement (FTA) with the European Union. Although there are communities fighting against the FTAs from around the world but there is no serious position from the Global Fund against FTAs.” He continues, “Many people are getting worried with reducing money of the Global Fund but even if the Global Fund grants double up then also they are not enough to meet the required money to buy branded drugs which are 10 times or in some instance 100 times or more expensive than generic drugs. What are we going to do?”

Rich nations fund ‘The Fund’
Gangte added: “The Global Fund programmes will definitely be affected by FTAs and they have to look into these bilateral trade agreements which are being imposed by USA, European nations and other rich nations upon developing countries. Rich nations have influencing powers and at the end of the day, the Global Fund cannot fight them because that is where they get their money. The Global Fund must step in and speak out strongly and defend the campaign against FTAs.” For members of the European Free Trade Association (EFTA), particularly Switzerland where pharmaceutical companies like Sandoz, Roche, and Novartis have a great deal of influence, there is a strong interest in maintaining far-reaching Intellectual Property Rights (IPR) protection regulations. This includes data exclusivity and extended patent terms. Both of these go beyond India’s commitments under the Trade-Related aspects of Intellectual Property Rights (TRIPS) Agreement, and would delay the introduction of generic drugs. The result would be to undermine India’s public health policy. In addition, since India is a major exporter of generic drugs, this would have a negative effect for people in need of these medicines, in India andacross the globe. Swiss biotech giants like Syngenta also have a vested interest in stronger IPR protection over seeds and agrichemicals.

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“We have to be more strategic on the overall question of funding for health. There is a need to rethink about how the Global Fund [can be] advanced more effectively.” - Anand Grover The Global Fund for Health
UN Special Rapporteur on Right To Health, Anand Grover said, “There is no clarity on human rights within the Global Fund though they have indicated interest. Human rights [do] have to be applicable to the Global Fund itself and the government’s ‘Right to Health’ framework should take on issues regarding human rights, for example [around] vulnerable communities, testing, confidentiality, discrimination.” Grover, who is one of the senior-most Supreme Court lawyers in India, said: “We have to be more strategic on the overall question of funding for health. There is a need to rethink about how the Global Fund [can be] advanced more effectively. We have to think about a Global Fund for health [generally], and not only restricted to these three diseases [HIV, TB, Malaria]. I think we should start thinking of a Fund that actually requires contribution from developing countries, low- and middle- income countries as well as the developed countries. We have to think about having a new system of human rights for health; it could be in a framework convention or it can start by making a fund as a lever to promote human rights.”

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STRENGTHENING RISK MANAGEMENT

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The Global Fund in the Dominican Republic: accomplishments & challenges
Vladimir Encarnación Jáquez, DominicanRepublic: May 2011

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n the Dominican Republic, initiatives financed by the Global Fund to Fight AIDS, Tuberculosisand Malaria (the Global Fund) fall under the framework of the National Response to HIV, TB and malaria. After years of direct interventions focused on the prevention, control and treatment of these diseases, stakeholders consider the contribution of the Global Fund as a significant benefit to thousands of Dominicans. For Nicomedes Castro, Secretary of the Dominican Country Coordinating Mechanism (CCM): “The resources provided by the Global Fund have allowed for the acquisition and supply of medications, saving thousands of lives, and have also contributed with the implementation of successful practices regarding HIV, TB and malaria.” In addition the“Support of the Global Fund contributed to the drafting of the National Strategic Plan and the strengthening of civil society,” says Castro. In the Dominican Republic, HIV and TB are considered two of the main public health issues. This country has one of the highest TB rates in the region. Fortunately, and thanks to the financial support of the Global Fund, there are diverse programs addressing the rapid advance of TB, such as the TB National Program. The same applies to malaria, where conditions of poverty and overcrowding contribute enormously to its spread. In the case of HIV, the care of people living with the HIV (PLHIV) has been a priority projects financed by the Global Fund. For BethaniaBetances, National Programme Officer of UNAIDS, increasing access to antiretroviral treatment (ART), and a reduction in mother to child transmission are achievements made possible due to the Global Fund support. In terms of response, the Global Fund has played a key part in containing HIV, TB and malaria, and this is due in great measure to the rationalisation of resources, which allows them to be greater utilised. Jose Beltre, representative of Dominican youth networks in the CCM, sees the management of the Global Fund as positive. He says, “These funds have allowed us to control, improve and strengthen the actions of attention, prevention and investigation of the three issues, as well as the revision and improvement of the National Law on AIDS." Beltre sees the Global Fund support as being a key determinant in improving HIV, TB and malaria monitoring systems, and the main factor in increasing programs, projects and initiatives of prevention, control, and treatment. Other achievements highlighted by Beltre are the increase in the coverage of health services, the incorporation of new actors in the national response to HIV, TB and malaria, improvement in the quality of life of PLHIV, and the thousands of lives saved. Sergia Galvan, Director of the Collective on Women and Health and sub-recipient of the Global Fund, also recognises the generally positive intervention, highlighting as its main achievements the articulation of diverse actors involved through the CCM, the supply of ART to PLHIV, and the maintenance of basic funding for the work in HIV, TB and malaria. However, Galvan suggests that the Global Fund management has been marked by improvisation, conflicts and some inefficiency. She states that, to improve the management system, the Global Fund should reduce conflicts of interest between CCM members, the majority of whom are sub recipients.

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One view is that, to make the Global Fund management more efficient and ensure initiatives respond to the real needs of vulnerable population groups, it is necessary to restate and reinforce the role of the CCM, converting it into a more democratic and participatory space, acting as an agent of public and social control of funding. When asked about this, Dr Nelson Rodriguez, Vice Minister of Public Health and President of the CCM, states that the main challenge is to improve articulation and effectiveness of the CCM: “Good coordination is expressed in [effective] implementation.” Nicomedes Castro thinks a key requirement is to improve the contribution of vulnerable populations to CCM management. “If they improve management capacity and training, they improve their level of participation and optimise their advocacy,” he affirmed. Castro highlighted that, on occasion he has heard some representatives of vulnerable populations state they "don’t understand anything” when discussing a project. According to Castro, this is because members of the agencies are professionals of the first level, such as the representatives of other NGOs and the government. He concludes, “This improvement would have result in a CCM that, besides being representative, is really participatory and therefore supports projects according to the real needs of beneficiaries.” Another important challenge is sustainability of the national response without the support of external funding: specifically, without the support of the Global Fund. For this, it is necessary to focus on the empowerment of organisations to ensure activities do not disappear when the funding ends. The Global Fund and the CCM therefore have a responsibility to ensure proposals have a major sustainability component, and that the Dominican government acquires responsibility as the main entity accountable for the health of the Dominican people. There is no doubt in the Dominican Republic, there is a 'before' and 'after' the Global Fund in the national response to HIV, TB and malaria. Also, it is worth stressing the importance of the CCM, which facilitates dialogue between stakeholders, and allows a vision promoting integration and teamwork. It is worth noting we have made advances, but we must advance more.

“These funds have allowed us to control, improve and strengthen the actions of attention, prevention and investigation of the three issues, as well as the revision and improvement of the National Law on AIDS.” - Jose Beltre -

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Mixed perceptions of the Global Fund in Kenya
Henry Neondo, Kenya: May 2011

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unding for health should begin targeting prevention programmes that address issues that affect women and children, and the Global Fund to fight HIV/AIDS, TB and Malaria (The Global Fund) has a key role to play.

In the context of HIV, Professor Alloys Orago, Director of the National AIDS Control Council (NACC), says “for every one person put on treatment, two more get newly infected - women and the youth still bearing the brunt of the three most burdened some diseases: HIV, tuberculosis and malaria.” He continues, “Kenyan statistics shows that HIV prevalence is slightly over 8 percent in women, as compared to 4 percent in men. This is an indication that programmes have not been well focused. For a long time, people did not understand why this is so. In HIV, we are just coming to relate the impact our culture has on the spread of HIV.” Pregnant mothers and children under the age of five years are still most at risk of dying from malaria. The NACC is planning to engage more women - who experience 70% of the disease burden - in programme designs, implementation, monitoring and reviews at the community level. Kilonzo, Executive Director of Liverpool VCT, a local NGO, stated that the needs of women have been neglected – they are often unable to negotiate for safe sex, and face gender-based violence at all levels. Pauline Irungu, East African Coordinator of the Global Campaign for Microbicides, says there are cultural factors within society that predispose women to HIV. In African society, wife beating is condoned in the name of discipline. When this happens to a woman it is ‘ok’; when there is violence against a man, society will rise up against it. She adds that sexual violence against women is increasing. In conflict situations, women often suffer the most. Rape is used as weapon of war to revenge against enemy tribes: “the poor economic conditions have also led many women into prostitution so as to make ends meet and feed their family. Then there is the issue of loss of property when women lose their husbands.”

Global Fund
Benjamin OfosuKoranteng, Senior Advisor on HIV and Development Planning at the Regional Service Center of UNDP, Eastern and Southern Africa office, agrees. “The epidemic and its dynamics show that women and children are bearing the brunt. It is time to begin addressing gender issues. Global Fund money should begin to address these, to give us leverage on issues around the child and maternal mortality targets of the Millennium Development Goals,” he said. He adds that the Global Fund has done wonderful work, creating a strong base for many national HIV responses. But he notes that whilst funding has increased, this could be jeopardised because of current global economic crises. Koranteng says it is important to ensure that money received from the Global Fund is spent where it is most needed – “this requires national systems to be improved, so that this money can reach the bottom of the ladder.”

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He continues, “what is needed especially at the country level is to increase monitoring of the monies sent out from the CCMs, and ensuring that the percentage of recurrent expenditure by Fund implementing agencies is decreased, so that the money is invested in the lives of the people that need it most.” He adds that there is a need to strengthen monitoring systems already in existence. The effective disbursement and tracking mechanism employed by the Global Fund has prevented much abuse, and strengthening these will help identify any breaches early, before they spread. “We need to focus in the efficiency of systems in terms of monitoring NGOs and state agencies receiving this money.”

Target programmes
Evelyne Kibuchi, Tuberculosis Programme Officer at the Kenya Alliance of NGOs Coordinating Organisation (KANCO), says that there is no other significant funding for HIV, TB and malaria programmes, other than the Global Fund. But the funding is not adequate, and the TB sector reports an annual funding gap of Ksh20 billion. This also includes money budgeted and expected to come from the government, which has yet to see the need to locally fund responses to these diseases. A tougher challenge is the bureaucracy involved in actually getting money. For example, Kenya submitted a proposal for Round 9 in 2009, but even as we approach mid-2011, the country is still waiting for the money. It usually takes a full year following an application for money to be received, by which time many things would have changed. Lives will have been lost, and perhaps even the currency devalued. Kibuchi says, “I wish there was a system where one asks for money, and in two to three months it is received. The long wait usually leads to lots of revised work plans, and implementers having to close programmes. Many projects are being implemented that do not look at the intended outcomes, but meeting the activities of the funder,” she said. For example, this had significant impact on the malaria sector in Round 4. The original value of an awarded grant was valued at approximately USD80 million for a 5-year program, with approximately USD26 million for year 3 implementation.

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It was disbursed in October 2009, but in light of the failure of Kenya’s Global Fund Round 9 application, the country’s division of malaria control decided to reprogram years 4 and 5 of its Round 4 grant, in order to meet essential prevention and treatment gaps before the grant ended in January 2011. The majority of the remaining funds were used to support rolling out mass insecticide-treated net (ITN) distribution in targeted districts. It was estimated that funding would be enough to purchase approximately 4.5 million nets. James Kamau, Coordinator of the Kenya Treatment Action Network agrees with Kibuchi, adding that while Global Fund has been supporting women and children over the years, it is vital to get more involved in a campaign to eliminate paediatric HIV. He says, “Elimination should be the target - as this will lead to removing HIV from the mother. The focus should be on the value of what the money they send brings, than the very fact of just giving out the money.”

Global Fund misuse in Kenya
According to Kamau, there is widespread misuse of Global Funds in Kenya. “We know that there are people who should be taken to court, but are not.” The country has local fund agents but they are not effective. They either not doing their work, or they are helping the intelligent pilfering or misuse of the Global Fund in a way that means no theft is detected. In addition, Kenya’s absorption capacity is poor, because of bureaucracy. Round 7 funds are still not being utilised fully. Round 2 funds, to tackle TB, were never used. But Professor Orago refutes this, contending that the recent announcement by the Global Fund that Kenya would receive USD34million from the Round 10 application is testimony of confidence in Kenya, not only from the Global Fund, but donors as well. “At least we have not heard of any complaint from a single donor of the misuse of funds brought into the country,” he said. According to Professor Orago, Round 10 is going to maintain HIV treatment, and address the nutritional needs of those on treatment. Orago also disclosed that Kenya is the only country in the region receiving the full amount of USD510 million, up to 2014, from the US President’s Emergency Plan for AIDS Relief (PEPFAR). In addition, USD135 million from the World Bank funds the ‘Total War against AIDS’ programme. He acknowledges this is not enough. So far, only 432, 000 receive anti-retroviral treatment (ART). According to WHO’s current treatment guidelines, 650,000 Kenyans require access, as of end 2010. Accordingly, Kenya’s ‘total war’ on HIV requires the equivalent of KSh9 billion a year. Yet, dismayingly, Orago revealed that resourcing for programmes in Kenya is still heavily dependent on development partners: “The government’s contribution to programme activities is only 15%, with 85% from international donors.” As a way forward, Orago asserts the need to revolutionise prevention: for every person who starts ART, two others are newly infected.

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STRENGTHENING COUNTRY-LEVEL PARTNERSHIPS FOR GREATER IMPACT

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Meeting the MDG targets for TB eradication in Zimbabwe: Global Fund money is vital
Ignatius Gutsa, Zimbabwe: May 2011

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uberculosis (TB) is a major public health problem in Zimbabwe. As of 2011, the country ranks 20th out of 22 on the list of high-burden TB countries. In 2008, Zimbabwe had an estimated 73,714 new TB cases, and an incidence of 557 per 100,000 people [1]. To aid the national TB response in Zimbabwe, the Global Fund to Fight AIDS, Tuberculosis and Malaria (The Global Fund) supports a number of programmes. For example, funding received from Round 8 is used for strengthening and expanding the activities of the National Tuberculosis Program. This builds on activities funded under Round 5, to ensure gaps are weaknesses in TB programmes are addressed. The national TB response in Zimbabwe targets patients, and people living with HIV (PLHIV), the population at risk. Activities include improving diagnostic services through the strengthening and expansion of the Directly Observed Treatment Short course (DOTS) service. By adopting DOTS, Zimbabwe’s approach is consistent with the global strategy for TB control, first released by the World Health Organisation (WHO) in 1991. This strategy has been shown to reverse the TB epidemic in many countries as a result of giving supervised medication, and increasing the efficacy and safety of domiciliary treatment. Regular and complete treatment is essential to treat TB and prevent relapse. It also protects against the development of multi-drug resistant tuberculosis (MDR-TB). Direct observation ensures patients receive the right drugs, at the correct dosage, at the right times. In Zimbabwe, DOTS is the basic package underpinning the country’s Stop TB Strategy [2]. Zimbabwe received a Round 8 grant for 86.8 million USD for HIV, which will include support for TB-HIV integration services, and improvements in TB case finding amongst PLHIV. It will also provide TB medication (including cotrimoxazole as preventative therapy) and antiretroviral therapy (ART) for eligible, dually infected patients. Under the Global Fund Round 8 grant, Zimbabwe will receive 55 million USD following an application entitled ‘Towards Universal Access: Improving accessibility to high quality DOTS in Zimbabwe’, which commenced in January 2010 [3]. As money from the Global Fund continues to flow into Zimbabwe, it is becoming apparent that sustainable healthcare requires long-term commitment. There is hope that eradicating TB in Zimbabwe is now a real possibility, and funding is proving decisive in meeting the Millennium Development Goals (MDGs). MDG Goal 6 focuses on combating HIV/AIDS, malaria and other diseases, with target 6c the “halting and beginning to reverse the incidence of malaria and other major diseases” [4]. In additional, target 6.10 is to increase TB case detection and cure through the introduction of DOTS. The Global Fund is contributing towards Zimbabwe meeting these targets. In addition, financial support from the Global Fund to the Ministry of Health and Child Welfare for The National TB Control Program (NTCP) is proving critical for a coordinated response to TB, HIV, and sexually transmitted infections (STI). This is demonstrated by the NTCP’s policy of testing TB patients for HIV, and providing ART and counselling to HIV-positive patients. The Global Fund is therefore helping the NTCP achieve its TB mandate, through its support for scaling up operations throughout the country. Speaking to Ngoni, a TB patient under the DOTS treatment programme in Harare, he notes that DOTS has made his life much more comfortable. Ngoni was referred to the treatment centre earlier this year by a relative who had been already been treated successfully. Ngoni, who lives in Budiriro, a high-density

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I was then placed on DOTS.” Ngoni has been on DOTS treatment for the past five months. Agnes, another TB patient residing in Mufakose, shared his sentiments. She notes that DOTs has given her a sense of well being in her life. Agnes was diagnosed with TB in late December 2010. Since then she has also been part of a DOTS programme. The experiences of these two TB patients reflect a current trend in Zimbabwe. More and more TB patients are being treated successfully, thanks to the Global Fund. It is now possible to improve TB diagnostic services through the expansion of DOTS, salary support and incentives for the recruitment and retention of critical staff, and equipping peripheral microcopy centres in Zimbabwe.

“More and more TB patients are being treated successfully, thanks to the Global Fund.” - Ngoni, a TB patient One NTCP official, who requested anonymity, notes that funding provides a critical missing link in the fight against TB. It enables much-needed resources in the fight against TB in Zimbabwe. The country is now well on course to meeting its MDG targets by “increasing the proportion of TB cases detected and cured under DOTS.” Financial support from the Global Fund in Zimbabwe is proving critical in meeting our MDG targets, by supporting the expansion and effectiveness of TB control and the integration of TB and HIV services.

SOURCES: [1] Grant Performance Report External Print Version, ZIM-809-G12-T, Last accessedon: 19 May 2011 [2] Grant Performance Report External Print Version, ZIM-809-G12-T, Last accessedon: 19 May 2011 [3] Grant Performance Report External Print Version, ZIM-809-G12-T, Last accessedon: 19 May 2011 [4]The Millennium Development Goals (UNDP): http://www.undp.org/mdg/goal6.shtml

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Co-ordination is the key: CCM partnerships in India
Bobby Ramakant, India: May 2011

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he Global Fund to fight AIDS, Tuberculosisand Malaria (The Global Fund) should strengthen national partnerships on specific issues and their coordination with Country Coordinating Mechanisms (CCMs). This is not only to optimise programme performance, but also ensure that community voices are central to health responses. India boasts of a CCM and also national partnerships on specific issues like HIV or TB. However a coordinated response between these national partnerships is lacking. According to Dr Nevin Wilson, Director of the International Union against Tuberculosis and Lung Disease (The Union) – South East Asia Office in New Delhi, “The level playing field is missing. We have the civil society and we have the government’s national TB programme (formally called the Revised National TB Control Programme - RNTCP), [but] they cannot be equal partners. What stops the Global Fund from giving money directly to civil society?” He continues, “Why do they need government’s permission to do that? [Civil society] has every right to access the money, provided they obey the statute on how foreign resource comes into the country. They can use it, it is up to them to advocate for it, and the Global Fund needs to find these partners and invest in them. Why do we need permission from the government to invest in civil society of that country? If civil society is agreeing that they want to do an intervention for TB, and the technical review panel (TRP) thinks that the intervention is worth investing in, the Global Fund must provide that level playing field. It must open their doors and give them the money.” The Union is a Principal Recipient (PR) of the Global Fund round 9 grant in India, and implements one of the largest advocacy, communication and social mobilization (ACSM) programmes in the world. It is not only the national partnerships that need strengthening, but also their interaction with the CCMs needs attention. “There is no good mechanism for coordination between the national TB partnership, RNTCP, other principal recipients and the CCM. There is no defined way to work with these partners and this needs to be established,” said Dr KS Sachdeva, Chief Medical Officer (CMO) of RNTCP, Ministry of Health and Family Welfare, Government of India. RNTCP is also a PR of the Global Fund grant. Subrat Mohanty, from the secretariat of National Partnership for TB Care and Control, agrees. “The Global Fund organizes regional and other meetings of PR and Sub-Recipients (SR). So if they invite the national partnerships to these meetings, it will add so much more value in bringing forth issues from the frontlines related to TB care and control,” he says. He continues, “In India’s CCM there are members who represent different most-at-risk populations (MARPs) and these members are elected by their communities to represent their respective constituencies, but there is no representation of the national partnerships. If the Global Fund can ensure that national partnerships are invited as standing invitee or as a member of CCMs that would be really helpful.” Blessina Kumar, TB-HIV activist, community representative and Vice Chair of the Stop TB Partnership, confirms there is poor networking. “Without linkages of CCMs with these country level partnerships, CCMs will remain a mechanism with no touch with reality. We run the risk of proposals that do not affect people on the ground. That is why it is so important to have a good partnership. A partnership that can bring together voices of affected communities and feed into the CCM is what will make it really more effective.”

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The Global Fund should not just be a financial mechanism, but also take ownership of how the money is used. Kumar continues, “With funding there is also certain responsibility. I know that Global Fund has said that they don’t want to interfere with CCM. But as funders there is also a responsibility to ensure that what is intended reaches the people that need it most.” Maan AIDS Foundation is a recipient of the Global Fund grant in India. Arif Jafar, Executive Director said, “Yes, the men who have sex with men (MSM) community is involved in CCMs. Even the National AIDS control Programme (NACP) Phase IV’s technical resource groups have representatives from MSM and other high-risk group communities. That certainly helps, because we have community voice in these processes.” However, representatives of transgender and Hijra populations are less involved. “We are not engaged in such partnerships, and more needs to be done to address the needs of transgender and Hijra populations. When we speak about human rights of different genders, we need to begin by at least recognising specific gender identities,” said RanjitSinha, Secretary, Association of Transgender and Hijra in Bengal (ATHB). ATHB is in process to be a sub-recipient (SR) of the Global Fund-supported ‘Pehchaan’ project, managed by the Solidarity and Action against the HIV Infection in India (SAATHII). There is a clear desire for a well-coordinated health response, but this is a long way from fruition. “Community Systems Strengthening (CSS) is a key [and] national policy development, to strengthen that response,” said Shivananda Khan, Chief Executive of Naz Foundation International (NFI). NFI is the PR of the Global Fund Round 9 grant for community-strengthening programme, aimed at reducing the rapid and alarming spread of HIV among MSM and transgender people, in South Asia Association for Regional Cooperation (SAARC) countries. More coordination is required between national partnerships on specific issues, such as TB and HIV. “In the National Partnership for TB care and control there are members that include networks of people living with HIV (PLHIV). In terms of collaboration between national partnerships on TB and HIV in India, it is really not happening. The Global Fund round 9 Project provides an opportunity to include and train district level networks of PLHIV and we will continue advancing our efforts to engage more communities in national partnership for TB care and control in India,” said Subrat Mohanty. “The Global Fund should invest in building in-country capabilities and capacities, this is very important,” said Blessina Kumar. “At a larger level policies need to be in place to ensure that the national collaborative efforts happen. They have to be part of the policy and a prerequisite to get funding. If that happens and if programmes are monitored against those indicators we can achieve a lot.”

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She continues, “Partnerships need to be inclusive. We need to open it out, we need to let people come in, and if it needs resources, then let’s put resources into it. Unfortunately people who are left out are often the people with the diseases. PLHIV community has a voice but TB community doesn’t.” Kumar suggests that diverse countries like India should strengthen local partnerships at the district level, to feed into state and national partnerships. “A person sitting in a village needs to feel that her or his needs, challenges or successes are being reflected in the national plan. This is what these partnerships should be doing.” A coordinated health response at the national level is warranted not just to enhance programme performances, but also get the most value out of financial resources by saving lives, preventing infections and protecting human rights. It also helps foster country ownerships of programmes by meaningful community engagement, and ensures that responses reflect needs and challenges faced by most at risk populations (MARP). The Global Fund, by virtue of being a significant donor, can have a significant impact here. By influencing stakeholders, the Fund could make the coordinated response to HIV, TB and malaria a reality for India.

“Partnerships need to be inclusive. We need to open it out, we need to let people come in, and if it needs resources, then let’s put resources into it.” - Blessina Kumar -

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VIDEO ARTICLES
Global Fund in the Dominican Republic, and opportunity to grow. Vladimir, Dominican Republic: May 2011
The Global Fund to fight AIDS, Tuberculosisand Malaria has contributed significantly to improving HIV, TB and malaria responses and strengthening health systems. This video documents what more it can do more to save lives and prevent infections – by genuinely engaging affected communities at all levels of programmes receiving Global Fund support. The video presents interviews with Global Fund grant recipients, CCM representatives/ office bearers, and other stakeholders in-country and shines a spotlight on a number of pertinent issues affecting the Dominican Republic. 7 minutes [Spanish with English sub-titles]

The Global Fund in Indonesia: Suksma Ratri, Indonesia: May 2011

The Global Fund to fight AIDS, Tuberculosisand Malaria has had a positive impact in Indonesia helping the country leverage local and national funding for its programmes. The video presents interviews with a diverse range of stakeholders and touches on issues around financial accountability, the need for programme implementers to have more training to manage TB, HIV or malaria programs, raises fears of people living with HIV about starting on anti-retroviral therapy and adhering to treatment and presents views on the scaling up treatment to meet MDGs targets. 5 minutes [English and English sub-titles]

To Protect public health and social justice: Stop Criminalising IDU: Thailand speaks out Jittima Jantanamalaka, Thailand: May 2011

This video documents Thailand as a leader in HIV prevention and treatment for 20 years and highlights that this leadership has not extended to HIV transmission driven by injecting drug use. It presents interviews with Global Fund grant recipients in Thailand for programmes addressing injecting drug users (IDUs). The combination of the criminalisation of injection drug use and a lack of a coherent legal and policy framework on drugs, means that not only IDUs are at risk when they access services, but service providers are also at risk of being penalised for offering them. 8 minutes [Thai with English sub-titles]

Simplify and build local competencies to manage Global Fund grants: a view from India Bobby Ramakant, India: May 2011

This video documents what the Global Fund can do more - or less of in India to save more lives and prevent infections. The Global Fund has contributed significantly over the last decade in accelerating India’s response to tuberculosis, HIV and malaria, saving lives and preventing infections. However a lot more needs to be done. If the Global Fund and India do business as usual, currently unreached populations are unlikely to benefit. This video presents interviews with the beneficiaries of the Global Fund grants (government, civil society) and those from affected communities who are suggesting ways to simplify the process and to build local competencies for managing the grants. 8 minutes [English with sub-titles]

All videos are available at: www.aidsportal.org/web/globalfundconsult/documents

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ABOUT THE KCS
Suksma Ratri, Indonesia
Suksma Ratri is the Operations Manager in a foundation focusing on educationsupport for underprivileged children in Indonesia. She advocates for earlyeducation in HIV prevention. During 2008-2010, she served as a ProgramOfficer for Malaysia-based Coordination of Action Research on AIDS and Mobility Asia (CARAM Asia). She is the Program Officer of the TaskForce for Empowerment of Migrants living with HIV and their spouses (TFEM)which functions in seventeen countries across Asia. A Key Correspondent for some years, Ratri was also a former Core Group member of WAPN+ [Women of APN+] and is a well-known activist promoting the rights of women living with HIV and AIDS.

Bharathi Ghanashyam, India
Bharathi serves as the Head of Communications for the Akshaypatra Foundation inIndia. She also founded and leads Journalists Against Tuberculosis (JATB) and is an active Key Correspondent.She has written regularly for prominent English dailies such as DeccanHerald and The Hindu Business Line. She wrote acommentary for The Lancet on primary healthcare and issues related tochildren and HIV. She is the recipient of the Reporting HIV/ AIDS Bursary,2006 given by The European Union (EU)-India media initiative on HIV/AIDS;and the 'Reporting HIV/AIDS- EU-India Media Awards 2006' given by theThomson Foundation, UK.

Ignatius Gutsa, Zimbabwe
Igantius is a faculty member in the Sociology Department, University ofZimbabwe. He has carried out research and also presented papers focusingmainly on the issues of sexuality of the elderly, HIV and AIDS, and climatechange at international conferences held in Africa, Europe andLatin America. He has consulted for key agencies such as theInternational HIV/AIDS Alliance, UNFPA, CTA and Boost Fellowship Zimbabwe amongothers. He was selected as one of fourteen New Faces for African Development by the European Report on Development for the year 2010. He is a KeyCorrespondent and also a National Board Member for 'Restless Development'.

Henry Neondo, Kenya
Henry is a health journalist based in Nairobi, Kenya. He has been writinghealth stories on issues such as HIV and AIDS, tuberculosis and malaria forthe last ten years. He has focussed on issues such as community voices ongay rights, stigma, and discrimination as a Key Correspondent since2003. He also contributed to a publication 'Fighting TB on the frontlines'(2006). He writes regularly for a number of media outlets including AfricaScience News Service (ASNS), News from Africa and Scidev.net among others.

Bobby Ramakant, India
Bobby Ramakant is the Director of CNS Stop-TB Initiative and manages Citizen News Service (CNS) since January 2010. He is a World Health Organization (WHO) Director-General’s WNTD Awardee for the year 2008. He co-authored the commentary for The Lancet TB series (May 2010), is on the board of Microbicides Society of India (MSI) and was elected as Vice President of Indian Network of NGOs on HIV/AIDS (INN) in 2009. He is also part of the SEA-AIDS and Stop-TB eForum Resource teams, a member of sub-working groups of Stop TB Partnership, and has earlier worked with the Health and Development Networks (HDN) in varying capacities (2000-2009). Bobby has been a Key Correspondent himself and also providing training and support for KCs in many projects since 2001.

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Vladimir Encarnación Jáquez, Dominican Republic
Vladimir is a social and professional communicator, activist and youth facilitator, engaged inhuman rights, sexual health, reproductive health, youth policy, and HIV/AIDS. He has 15 years experience working with and for young people in the local community at thenational level and atinternational regional and global levels. A member of Corresponsale Clave (www.corresponsalesclave.org), the Latin American Key Correspondent Team, he is currently the Coordinator of the Zeta Jota (www.zetajota.com.do), a Web portal developed by and for young people who bet on the social use of Information and Communication Technologies (ICTs).

Jittima Jantanamalaka, Thailand
Jittima writes and broadcasts radio programmes and produces short films and graphics on a range of health, development and environment issues. She is the Managing Director of the JICL Media and Communication Services Company, which also hosts the Citizen News Service. She has worked with lead institutions including the Stop TB Partnership, the International Diabetes Federation, World Diabetes Foundation, Health and Development Networks, Healis Sekhsaria Institute of Public Health, Salaam Bombay Foundation, and ACT India. Jay's creativity and multimedia skills bring real flair to her projects on a range of health issues from HIV, tuberculosis to cancer and diabetes.

Shobha Shukla, India
Shobha has been writing extensively, in English and Hindi, on issues around health and development, focusing on tuberculosis HIV, diabetes, gender, cancer, cardiovascular diseases, COPD, lung health, tobacco control among others, over past years. She serves as the Editor of Citizen News Service (CNS), which syndicates contents in 4 languages to a diverse range of media globally and produces radio programmes broadcasted through FM 102.5 in Thailand. Her people-centric writings on health and development have been widely published in the media including The Hindustan Times (India), Asian Tribune, The Colombo Times (Sri Lanka), The Seoul Times (South Korea), Modern Ghana, Central Chronicle (India), The Nigerian Voice, Zimbabwe Telegraph, Pakistan Christian Post to name a few. She has provided on-site issue-based coverage from a range of International, regional, national and local events on health, with support from the Stop TB Partnership, UNDP, International Diabetes Federation (IDF), World Diabetes Foundation, WHO, TB Alliance, Bill & Melinda Gates Foundation, among others. She is a J2J Lung Health Fellow 2010.

Zhenya Maron
Zhenya Maron is a leader of Astra Foundationlocated in St. Petersburg, Russia, and an advocate for health and interests of people living with HIV. Astra’s goals are promoting interests and health care for vulnerable groups and protection of maternity and childhood. Zhenya started as a local NGO social worker at the state detoxification clinic in 2002. Prior to her current position, she worked with the Population Services International/Russia and with the Humanitarian Action, one of the first harm reduction organizations in Russia. She has a M.A. in Social Work from St. Petersburg State University. Since 2006, she has been involved as an activist and as a translator in different International Treatment Preparedness Coalition initiatives in Russia, including preparation of Civil Society Alternative Report for UNGASS’2008. In 2007, Zhenya joined the team of community-based project “Simona+” initiated by FrontAIDS movement and ITPC and currently coordinates it. “Simona+” is focused on patients’ monitoring and advocacy to eliminate barriers to treatment of HIV/AIDS and co-infections for IDUs.

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