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That enabling environment remains elusive and transitory
GFO issue 438

That enabling environment remains elusive and transitory



Article Type:
Editor's Note

Article Number: 1

One country decriminalizes same sex relations while another objects to the word ‘sexual’ because it “does not support LGBTQ”

The usual round up of what to expect from this issue of the Global Fund Observer, plus some musings on the Global Fund’s lack of transparency and the unwillingness of some countries to recognize the rights of LGBTQ+ people.


Dear readers


This issue of GFO is the calm before the storm that is the three Global Fund Committee meetings which started in Geneva this week and will finish on Thursday. To this end, we bring you an overview of the agendas for the three Committees (Audit & Finance, Ethics & Governance and Strategy). We would love to bring you a summary of all the background documents as well but, as you know, for some reason the Global Fund is going backwards in terms of transparency and does not want to share these, even after the meetings have taken place. Nonetheless, we will attempt to summarize the main issues and stakeholder reaction in our special post-Committee issue after this one.


But before we go into the next five articles, there are a few items of interest since our last Editorial.


UN General Assembly formally adopts resolution on Political Declaration on Tuberculosis 


In a press release dated 9 October, the Stop TB Partnership announced that the United Nations General Assembly has formally adopted by consensus the Political Declaration of the High-Level Meeting on the Fight against Tuberculosis. Member States discussed and adopted the Declaration through UN Resolution A/78/L.4, which is now available in all UN languages. This follows the Declaration’s adoption at the High-Level Meeting on TB on 22 September, reported on by GFO in our last issue (you can read the articles here and here). This important step gives the Declaration the full endorsement and support of all UN Member States.


The increasing polarization of countries that refuse to accept LGBTQ+ rights


Just when you think there is nothing left to surprise you, on 21 September the Permanent Secretary (PS) in Zambia’s ministry of health issued a letter to all provincial health departments and cooperating partners entitled “Use of the term ‘sexual and reproductive health and rights’”.


In this missive he said that the 2nd Joint African Union (AU)-European Union Ministerial meeting held in Kigali in October 2021 rejected the use of the term ‘sexual and reproductive rights”. This is because the inclusion of the words “sexual” and “rights” in the same phrase is inclusion of Lesbian, Gay, Bisexual, Transgender and Queer (LGBTQ) rights. Zambia, says the PS, was party to the decision by the AU and does not support LGBTQ rights. The addressees of the letter are therefore “advised to avoid using the term in public announcements and speeches and only refer to ‘Reproductive Health and Rights’”.


Having presumably spent the past two years contemplating whether or not, or how, to operationalize the AU decision, Zambia has now issued this somewhat confusing message. Heterosexuals, not just LGBTQ+, also enjoy ‘sexual’ relationships,  so dropping the word ‘sexual’ makes little sense. And the word ‘rights’ is still in there. So does this mean that reproductive health rights are allowed since they result in childbearing but sexual rights for both straight and LGBTQ+ people are not? Yet Zambia’s Global Fund funding request submitted under Window 2, and endorsed by the country, does include Modules for men who have sex with men and transgender people. So, the country waited judiciously until after submission before issuing this announcement! Does this mean that these planned activities in the funding request will not be implemented? since a country which does not recognize the rights of certain populations can hardly then implement services aimed at them.


On the other side of the coin, UNAIDS announced that on 4 October Mauritius’ Supreme Court ruled that a discriminatory law criminalizing consensual same sex relations is unconstitutional and will be immediately struck from the legal code. Previously, under Section 250 of the Mauritian Criminal Code (which dated back to 1898) anyone convicted could have faced up to five years in prison. “The Supreme Court today overturned an obsolete colonial law and demonstrated its commitment to non-discrimination and leaving no-one behind,” said Lisa Singh, United Nations Resident Coordinator in Mauritius. “The UN in Mauritius and internationally welcomes the decision of Mauritius to join the growing list of African countries protecting the human rights of everyone, including LGBTQI+ people.”


And now for the rest of this issue…


This week we bring you the Global Fund’s 2023 Results Report which informs us that 2022 was a year of rapid acceleration in the Global Fund partnership’s fight against HIV, TB and malaria. The Report is pleased to note that programs to tackle the three diseases showed a strong recovery after COVID-19’s impact.


We then move on to the Office of the Inspector General’s audit report on the Country Coordinating Mechanisms which makes for interesting reading. It acknowledges the impact of COVID-19 and insufficient resources to implement the CCM Evolution Strategy Initiative, but is nonetheless critical of performance.


Article 5, Promoting accountability and collaboration in global health: insights from an Aidspan roundtable, is an account of a successful training in Rwanda organized by the German Federal Ministry for Economic Cooperation and Development Health and UK’s Foreign, Commonwealth & Development Office. It is a flagship Aidspan project that focuses on strengthening the capacity of Supreme Audit Institutions in sub-Saharan Africa to ensure accountability of Global Health Initiative-supported programs, especially those of Gavi and the Global Fund.


We then move on to MOPAN’s assessment of the UNAIDS Secretariat which is a depressing read. Even before the organization’s realignment a year ago, UNAIDS was going through some difficult times. One can only hope that the leadership picks up the slack and starts to power forward because, if not, the current situation is likely to continue to have an adverse impact on programs for HIV and sustainable health systems.


Finally, we conclude with a report from the United States on its COVID-19vaccination program (United States reports on it COVID-19 vaccination efforts). While some targets were not met for a variety of understandable reasons given the unprecedented situation, the United States and partners nonetheless made herculean efforts that had real impact.


If you enjoy the GFO and find it relevant to your work, please encourage your colleagues to colleagues to subscribe!


Don’t forget: if you are aware of an interesting development relevant to disease programmes or health systems and that you feel is worthy of global discussion, do let us know together with the name of a person prepared to write about this (or we might even do it ourselves if you ask us nicely!). Suggestions and comments can be sent to us, Ida Hakizinka or Arlette Campbell White in English, French, Portuguese or Spanish at and/or


The Aidspan Editorial Team


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