Global Citizens Summit 2009

Universal HIV Testing Endorsed

AIDS and Human Rights activists from 32 countries world wide as well as National AIDS Council commissioners from several African governments have questioned efficacy of the current HIV and AIDS response strategies and endorsed a radical plan of action to end HIV and AIDS especially in Sub-Saharan Africa.

Meeting in Nairobi from 27-29^th May under the banner of Global Citizens’ Summit on Social Mobilisation to end AIDS, the participants who preferred to be called citizens resolved to support the WHO/UNAIDS policy on Provider Initiated Testing and Counselling (PITC) as one of the ways to bridge the gap between those who have HIV and those who actually know they are HIV positive. They noted that many HIV positive people in Africa for instance only get to know their status when it is too late and are very ill for ARVs to work effectively because health personnel are not empowered to give their patients options to test for HIV at the earliest opportunity of visiting a health facility. This they said must change otherwise treatment efforts will surely never catch up with the virus since for every 2 people put on ARVs, 5 people are newly infected.

It was unacceptable, the summit of citizens observed, to have 33 million people living with HIV globally but a whooping 80% of them not knowing they actually do. Noting that over half of HIV infections actually occur during the early stages of infection, the summit supported universal HIV testing that would ensure those with HIV are identified early enough and put on ART.

‘Lame excuses that people give when universal access to testing is floated must be seen for what they are……we can not wait for everything to be perfect in the primary health care to initiate PITC. Africa cannot afford to continue arguing about tactics of tackling HIV and AIDS when what is needed is a broad strategy to stop new HIV infections. This would be akin to chasing a rat when your house is on fire’, said Wasai Nanjakululu, the Director, Oxfam Global Centre of Learning on HIV and AIDS. He wondered, ‘Of what value is it to mobilise people to mob the floor when the tap is running? Just shut the tap!’

ABC obsolete

The summit came to a conclusion that while abstinence, being faithful and condom use was a great strategy it has failed to stem the increasing numbers of new infections. They called on a change of strategy to embrace SAVE (safer sexual practices, access to medication, VCT and Empowerment) arguing that those who had been born HIV positive and have attained sexual maturity are at a loss with ABC messages.

Speaking during the summit high level meeting, the Archbishop of the Anglican Church in Kenya, Benjamin Nzimbi said ‘…the church must think differently and if  safer sex is the way to go, so be it…’

Competing Demand for resources

Noting that thwe globe was entering a critical phase for the AIDS response where there are competing demands for resources amidst other crises like climate change, food crises and the economic crises, the citizens called on a change in government policies to integrate HIV and AIDS responses into a better resourced primary health care system and stop AIDS isolationism.  It was stated that projectisation of HIV and AIDS response has led to all sorts of actors getting involved in the response without coordination, a practice that must end with governments taking control of the AIDS response and funding it as well.

The summit was appalled that while donors talked of transparency, accountability and coordination with respect to aid, they did actually the opposite. Giving the example of the Global Fund for HIV&AIDS TB and Malaria, The summit noted that many donors still did not channel their funds for AIDS though the fund, preferring to set up parallel bilateral mechanisms that rival country mechanisms on the country leading to wastage of resources. It was sad, the summit observed that donors were not willing to give their money through a body like GF which is professional, is apolitical, non-ideological and has representation from CSOs, Southern and Northern governments and opt for bilateral structures whose decision making process are shrouded in secrecy as there is no CSO representatives nor Southern Government representation on those decision making structures of bilateral aid agencies.

African governments were called out on thie failure to honour the Abuja 15% commitment to allocate at least 15% of their national budgets to health ministries to help fight HIV&AIDS, TB and Malaria. Out of 53 countries in Africa only two (Botswana and The Gambia) had lived to this promise. The summit argued that by failing to invest in health and in the aids response, African governments had ceded the control of the HIV and AIDS response to external actors with the consequence of a slow progress in ending the HIV&AIDS pandemic on the continent.

Sustainable Financing

Arguing for more sustainable financing strategies from both governments in the South and donors, the summit called on donor countries to open up their markets for agricultural and other goods from vulnerable citizens of the south so that they can become self reliant instead of perpetuating dependence on donor handouts.

Noting that treatment needed to go hand in hand with adequate and appropriate nutrition, the summit called on a change of policies by donor countries in the they finance development by removing protectionisms that keep vulnerable citizens goods from their markets or where they access those markets give value for the goods in stead of the pittances offered now that has kept the vulnerable citizens into poverty and exposed them to HIV and AIDS.

‘It must be business unusual from this time hence forth’, echoed Leonard Okello, the convener of the summit, adding.. ‘the new and critical phase in which the HIV&AIDS response is entering must be one in which citizens take charge and press their governments to be accountable to them but above all be accountable to themselves too by embracing HIV testing’

CSOs account to the citizens

In what seems a break from the past, the citizens demanded that all CSOs international as well as national ones should publish their annual accounts in the media in the countries they work in to enhance transparency and accountability. The summit noted that this should form part of the new code of NGOL practice that enhances accountability not just to donors and Northern country publics but to the citizens these NGOs claim to work with and for.

Others

Other critical steps that the summit resolved to press governments to enact policies to implement them were:

• Instituting a compulsory Aids levy like in Zimbabwe
• Establish national Aids endowment/ trust funds (profits from National Social Security Funds – should be ploughed into the Aids fund)
• Work with local decentralised government authorities to include HIV in their domestic budgets.
• Countries should establish strategic basket fund for HIV where all monies and procurement for HIV is handled and coordinated from like the case of Rwanda.
• They should explore innovative mobile banking for quick cash transfers to affected households directly as most money for HIV is wasted through bureaucracies at national levels
• CSOs should jointly plan for procurement with governments to reduce over-supply and wastage/expriy of drugs. Treatment must be governments’ primary responsibility and not that of NGOs
• Governments should have policies that give tax breaks and other incentives to individuals who care for the sick, educate orphans and generally provide services that otherwise should be provided by governments
• Innovative ways of increasing access to testing by the youth must be explored including incentives for scholarship ruffles for those who test regards of the test results
• UNAIDS, NGOS, governments must partner with the private sector to use their efficient networks and infrastructure to deliver HIV and AIDS responses like condoms being delivered by coca-cola vans and distributors to remote places across countries
• HIV and AIDS actors must innovatively engage traditional structures and knowledge in the HIV&AIDS response instead of rubbishing them as backward, this will assure citizens that actors want genuine partnerships with less power dynamics and recognises different cultures and opinions on matters of the day.
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UNAIDS

Speaking at the closing ceremony, Deputy Director of UNAIDS from Geneva Dr. El Hadj As Sy, described the deliberations and outcomes from the summit as innovative, bold and audacious. He challenged both the governments and donors to prioritise and invest in areas where they can make the biggest impact. He noted that 80 – 90% of people living with HIV not knowing their status was a serious matter. ‘Governments and donors must provide incentives for universal testing to occur’, he said

Kenya Government

Permanent Secretary in the ministry of Health Mr. Mark Borr said… ‘While progress has been recorded in many areas in the fight against AIDS, HIV is a scourge we are far from winning and require resources and efforts from all partners.’

Confirming the dismal figures of those living with HIV who actually know they do, Mr, Borr said, ‘…only 16% of the PLWHIV in Kenya know their status’, adding… ‘Sometimes the circumstances of knowing one’s status are de-motivating that one just hides their status.’  He said the Kenya government had embarked on a plan to make HIV and AIDS response embedded in primary healthcare.