Communities have always played a huge part in the response to HIV. People coming together, organising themselves and demanding their right to health. For people most vulnerable to HIV, it is no exaggeration to say that communities often make the difference between life and death.
For young women and girls and for marginalised and vulnerable groups of people such as gay men, straight men who have sex with men, transgender people, sex workers, people who use drugs, prisoners and migrants, the pathway to health is not always as clear-cut as it should be. Stigma and discrimination, repressive laws, ignorance and even hate, can all prevent vulnerable people from accessing life-saving prevention, treatment and care.
This is where communities often step in. Communities of people living with HIV, of marginalised and vulnerable groups, of women and of young people lead and sustain the delivery of peer-to-peer HIV services, defend human rights and advocate for access to essential services. They fight every day to keep people at the centre of decision-making and implementation and help to make sure that no one is left behind.
Women and girls are the backbone of care support in their families and communities, providing unpaid and often undervalued work in caring for children, the sick, the elderly and the disabled and underpinning fragile social support systems. The involvement and leadership of communities of women is vital in the response to HIV and we must support them and utilise their potential.
Community-based services often support fragile public health systems by filling critical gaps; they are led by or connect strongly with women and other marginalised populations; they provide services that complement clinic-based care and they extend the reach of health care to groups that would otherwise fall through the gaps.
For example, Rainbow Sky Association of Thailand (RSAT) is one of the five community-based organisations in Thailand that provide free PrEP services through lay providers under the successful Princess PrEP Project. With four clinics and 10 drop-in centres across the country, RSAT is a one-stop service with flexible service hours. In addition to PrEP, RSAT provides needs-based and client-centred services such as hormone level check-ups for transgender people, STI screening, legal consultation and harm reduction. The Thai Red Cross Aids Research Centre with PEPFAR support through the USAID LINKAGES Thailand project implements continuous capacity building to ensure that community-health workers can provide HIV services in accordance with national standards.
Sisters is another community-based organisation whose reputation is spreading across borders as a model for programmes that provide HIV services where they are most needed. The organisation that carries out outreach work among Pattaya's transgender community. Sisters runs a drop-in centre in Pattaya where they provide medical services, counselling and skills development for transgenders. Working in partnership with transgenders to identify their needs, Sisters also advocate for policies and programmes that improve their health, safety and engagement in the Aids response.
At a time, when reduced funding is putting the sustainability of HIV services in jeopardy, community activism remains critical. Indeed, a greater mobilisation of communities is urgently required and barriers that prevent them delivering services and seeking funds must be dismantled. Communities must have the space and power to voice their demands and write their own solutions. In 2016 world leaders signed the United Nations Political Declaration on Ending Aids, which recognised the essential 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 against HIV and other health challenges.
Communities stand ready to play their part in building healthier and more resilient societies, but they need our support. On World Aids Day tomorrow, let's celebrate communities, recognise the essential role they play in the response to HIV and commit to meeting the promises made to them.
Winnie Byanyima is UNAIDS Executive Director.