Unleashing community potential to end HIV/Aids
All countries have committed to achieve the Sustainable Development Goals by 2030. This includes the commitment to end the Aids epidemic as a public health threat. Yet with just eleven years to go, it is a mixed picture. In many countries, great progress continues to expand access to HIV treatment and prevention options that are, in turn, reducing Aids-related deaths and new HIV infections. But there are still far too many countries where Aids-related deaths and new infections are not decreasing fast enough, even rising in some cases, even though we know how to stop the virus.
So why are some nations doing so much better than others? The clue is in the title of UNAIDS new report, "Communities at the Centre".
Success is being achieved where policies and programmes focus on people, not diseases, and where communities are fully engaged from the outset in designing, shaping and implementing health approaches that respond to the way people actually live their lives. This is how real and lasting change is achieved, reducing the devastating impact of Aids, and reaching better health outcomes for all.
Adopting the latest scientific research and medical knowledge, strong political leadership and proactively reducing stigma and discrimination are all crucial. But without sustained investment in community responses led by people living with HIV and those most affected, countries will not gain the traction necessary to reach the most vulnerable, which is the only way to end the Aids epidemic.
Community services play varying roles depending on the context. They often support fragile public health systems, filling critical gaps; they come from and connect effectively with key populations such as gay men and other men who have sex with men, sex workers, people who use drugs, or transgender people; they provide services that bolster clinic-based care and they extend the reach of health services into the community at large. They also hold decision makers to account.
By signing the 2016 United Nations Political Declaration on Ending Aids, countries affirmed the critical role that communities play in advocacy, participation in the coordination of Aids responses and service delivery. Moreover, they recognised that community responses to HIV must be scaled up and committed to at least 30% of services being community-led by 2030.
Most countries are nowhere near reaching that commitment and where investment in communities is most lacking, there is often weaker progress being made against HIV and other health threats. All over the world, including in Asia and the Pacific, communities are demonstrating time and again that they can, and do, deliver results.
In Thailand, the community-led response to HIV is a gamechanger in increasing the uptake of HIV prevention and treatment services. For example, the Princess PrEP programme is a ground-breaking model of post-exposure prophylaxis (PrEP) delivered by the communities to people at substantial risk of HIV. This initiative, supported by HRH Princess Soamsawali Krom Muen Suddhanarinatha of Thailand, UNAIDS' Goodwill Ambassador for HIV Prevention in Asia and Pacific, has expanded the role of key populations in dispensing PrEP, with the additional outcome of improved retention of clients.
The Tangerine Clinic is also a remarkable community-led service. It was the first clinic in Thailand to offer a full range of healthcare and counselling services specifically for transgender people. Trained transgender personnel and gender-sensitive medical professionals manage and provide these services. The model of the Tangerine Clinic, which is one of the projects of Thai Red Cross Aids Research Centre, has been adapted by Vietnam and the Philippines.
Our communities are a source of strength and they present so much untapped potential. Unleashing it is the key to gaining the momentum we need to make faster progress towards reaching the UNAIDS Fast-Track targets and getting every country firmly on the right path to end Aids. The more we invest in communities, the closer we get to ending the Aids epidemic.
Gunilla Carlsson is Executive Director a.i. of UNAIDS.