Successful HIV programs need a rights-based approach to complement biomedical interventions
Article Number: 5
Global Fund reports significant progress in breaking down human rights-related barriers to HIV and TB services
ABSTRACT It is no news to those working in HIV that medical treatment alone will not succeed in addressing and halting the spread of HIV and that the right enabling environment must be in place so that biomedical activities are supported by corresponding actions in policy, legal, and social arenas. At Montreal’s International HIV Conference, the Global Fund Executive Director Peter Sands reported on the success of a Global Fund Initiative, Breaking Down Barriers, which does just that.
At the 24th International AIDS Conference, the Global Fund announced the release of a new report unveiling key findings of its Breaking Down Barriers program, a ground-breaking initiative launched in 2017 to provide intensive financial and technical support to 20 countries to address stigma and discrimination, criminalization and other human rights-related obstacles that continue to threaten progress against HIV, tuberculosis (TB), and malaria. This article is based on the press release about the new report.
“One of the most powerful lessons from the history of the fight against HIV is that success in confronting such a formidable disease cannot be achieved through biomedical interventions alone,” said Peter Sands, Executive Director of the Global Fund. “We must also confront the injustices that make some people especially vulnerable to the disease and unable to access the health services they need. The same is true for TB, malaria, and other diseases, including COVID-19.”
In the context of HIV and TB, men who have sex with men, transgender people, sex workers, people who inject drugs, people living with HIV, and people in prisons and other closed settings are socially marginalized, often criminalized and face a range of human rights abuses that increase their vulnerability to the diseases and undermine their access to health services.
The key findings of the midterm assessments, which were conducted between 2019 and end 2021, reveal all countries involved in the Breaking Down Barriers program saw progress in removing human rights‐related barriers to HIV services, with a mean increase of 0.9 points from baseline on the 0-5 scale. However, even the top five scoring countries (Ukraine 3.7, Jamaica 3.5, Botswana 3.3, Senegal 3.1 and Kenya 3.1) are falling short of the scores that would represent a comprehensive response at a national level (above 4.0). Sierra Leone (+1.7), Jamaica (+1.6), Cameroon (+1.3) and Mozambique (+1.3) showed the greatest increase in scores.
All countries surveyed also showed progress on TB programming. The TB scores at midterm ranged from Ghana (2.8) to Sierra Leone (0.2), with an average increase from baseline of 0.6. For many countries, addressing human rights barriers to TB services entailed the development of new interventions, and the progress reported in the midterm assessment reflects a rapid expansion. The greatest increase was seen in Ukraine (+1.1) and Côte d’Ivoire (+1.5).
However, the assessments also show that COVID-19 slowed the progress of the Breaking Down Barriers initiative in many countries. But they also chronicle the ways in which human rights-related work on HIV contributed to rights-based approaches to COVID-19. In a few countries, support was provided to community-based paralegals to address human rights violations that occurred during lockdowns. Many innovative measures were undertaken to ensure that key populations would continue to receive services despite lockdowns or quarantines. In several countries, community awareness-raising focused on prevention of gender-based violence during lockdown periods.
Another round of evaluations, planned for late 2022 and the first six months of 2023, will capture up to five years of activity and provide further insights into the results and impact achieved in the countries involved in the Breaking Down Barriers initiative.
Global Fund human rights funding is unprecedented. In the 20 countries of the Breaking Down Barriers initiative, Global Fund investments in programs to reduce human rights-related barriers have increased more than 10-fold – from slightly over $10 million to now over $130 million. Never has there been this much funding to support the implementation of comprehensive programs to remove human rights-related barriers to health services.
“The Breaking Down Barriers experience demonstrates that, where there is sufficient funding and technical support, multiple stakeholders can be energized to combine and strengthen their efforts, and as a result, can make real progress in removing long-standing barriers,” concluded Sands. “This is critical to defeating HIV, TB and malaria, building truly inclusive systems for health that leave no one behind, and enabling everyone, everywhere to realizing their right to health and well-being.”