From 28th-31st August I attended the Latin American HIV/AIDS Forum in Sao Paulo, Brazil.
With the theme of ‘Health Systems and Community Networks’, the event consisted of workshops, round tables and conferences to spark debate on a variety of different issues which affect the HIV response in Latin America and the Caribbean.
“We need to define a new agenda”
This seems to have been the mantra of the Forum, beginning yesterday with the Community Forum and continuing today with the Latin American HIV/AIDS Forum. Over the last few days the mega-metropolis of Sao Paolo, one of the driving forces behind Brazil’s emerging economy, has been witnessing deep reflection among Latin America’s vibrant civil society. The sector is facing questions as to whether it still has the necessary weight to face up to these times of profound change for the HIV response.
And it’s not just the drastic reduction in international cooperation and the anticipated decline in Global Fund grants for the region, but also a runaway global agenda, marked by technological progress in prevention and treatment. Are we ready to take these new technologies on board when we haven’t yet evaluated whether we’ve been successful in the key areas we have been working on over the past decades? Despite the millions invested, infection rates have not declined dramatically in the region and thousands of people continue to die from AIDS in Latin America every year.
It’s at such times of change that the most basic questions must be asked. What should our position be regarding treatment as prevention when there are still thousands of people unable to obtain the antiretrovirals they need to survive?
“What’s the point of being the region with the highest treatment coverage in the world when, in practice, we have chronic shortages of antiretrovirals in an increasing number of countries in the region?” asks Pablo Anamaria, leader and founder of Peru’s People living with HIV movement.
This inconsistency between statistics and legislation and the daily lives of people living with HIV, transgender people, gay men and sex workers can also be seen in the high levels of violence and human rights violations that occur in the region, despite the fact that across LAC, these populations are only criminalised in the English speaking countries of the Caribbean.
And this inconsistency continues when it comes to financing. A recent UNAIDS study showed that 11 Latin American governments are funding at least 70% of their national HIV response. But the national HIV/AIDS budgets are generally less than 20% spent in the first six months of each financial year. Perhaps what we need is not more money, but more management capacity on the part of governments and a civil society that can monitor state investment and advise on promoting community mobilisation and the provision of quality health services, capable of providing quality care.
With the Millennium Development Goals expiring in 2015, the HIV response and development in general may look very different post-2015. What will we be celebrating or regretting in 2015? And how can we influence the post-2015 agenda? Will we one day be able to announce the end of the AIDS epidemic in the region? There are many questions but few answers.
“We are good at assessing the situation, but less so at taking action,” continues Pablo.
Over the last two days, I have heard repeatedly that we have to define two or three priorities, that we have to abandon the agendas of specific groups in order to establish a common agenda for civil society and that we have to strengthen national advocacy at a regional level in order to encourage governments not only to invest more but also to sustain civil society’s response financially.
“We’ve been talking to the wrong people,” says Alessandra Nilo, Executive Director of LACASSO. “The heads of the national AIDS programmes have not proved to be the right entry point to reach decision makers in the public sector. We need to establish new alliances with other sectors and involve ourselves more fully in our countries’ wider development and public investment agendas.”
Reaching a concrete and immediate agreement with civil society would require the involvement of leaders and networks whose absence was felt strongly at this Forum. I witnessed honest self-criticism and renewed energy to move forward, strengthened by the presence of young leaders who were born with the virus and whose presence is refreshing, creating hope that old leaderships will be renewed.
The fact that, as soon as the conference ends, so many are committed to start building this new political agenda for civil society, reflecting the new era of the epidemic that we are experiencing in Latin America and the Caribbean, makes me think that this time there will be progress.