Unlocking the Power of Choice in HIV Prevention

In Harare, Zimbabwe, on the 3rd of December 2023, AfNHi convened the 6th Biomedical HIV Prevention Forum (BHPF) with the support of the BHPF and AfNHi steering committee partners who made the forum a success. The BHPF partners among others included the Advocacy for Prevention of HIV and AIDS (APHA), AIDS Health Foundation (AHF), AVAC,  Frontline AIDS,  Global Network of People Living with HIV (GNP+), HIV Vaccine Trials Network (HVTN), International AIDS Vaccine Initiative (IAVI), International Partnership for Microbicides (IPM), New HIV Vaccines & Microbicides Advocacy Society (NHVMAS), Rwanda NGOs Forum on HIV/AIDS and Health Promotion, Society for AIDS in Africa (SAA), CASPR Partners, WACI Health and partner the Global Fund, CIFF, and USAID.   

• In her impactful address at the BHPF, Tariro Pamela Mapeto, a young leader from Zimbabwe, shed light on the gaps and opportunities for involving the youth in HIV prevention research. Tariro emphasised the need for meaningful inclusion of young people as equal contributors in crafting solutions tailored to their needs. She highlighted the disproportionate impact on adolescent girls and young women in Sub-Saharan Africa, underscoring the urgent need for their active involvement. Despite the challenges, Tariro asserted that young people possess untapped potential for innovative solutions crucial in the global fight against HIV. Her call to action focused on scaling up interventions such as PrEP, U+U, and self-testing while urging the approval and expansion of newer options like long injectable PrEP and DAPIRing. Tariro emphasised the importance of intentionally creating and sustaining platforms for the voices of Adolescent Girls and Young Women in the HIV response, bridging knowledge gaps through youth-centric channels like social media. Finally, she urged the facilitation of effective support groups to provide safe spaces for young people affected by HIV by: fostering interaction, sharing experiences, and empowerment among peers. Tariro’s call to action resonates as a compelling roadmap for bridging the gap between policy and action in the multifaceted realm of HIV prevention. 

The HIV Prevention Choice Manifesto was envisioned and put together by African women, girls, feminists, and advocates for HIV prevention across Southern and Eastern Africa. United in their call for sustained political and financial commitments for HIV prevention choice.  The Choice Manifesto was visualised following extensive dialogues with funders, governments and communities. At the BHPF, a panel of experts delved into the implications of this manifesto, unravelling its significance and envisioning its impact on the future landscape of HIV prevention. 

Moreover, Grace Kumwenda urged the importance of choice in HIV prevention. She presented the HIV prevention pipeline, which includes long-acting injectables, dual protection pills and ongoing advocacy through the Choice Manifesto. Grace emphasised the importance of quickening the process from product approval to hands-on implementation and addressing structural barriers. Advocating for provider training and investing in healthcare professionals is essential for successful implementation. 

The Partner’s Panel on the future of biomedical HIV prevention, featured insights from key representatives. Mary Latka, from USAID, emphasised collaboration with local governments, donors, and academia, and creating an enabling environment for affordable choices. Anna Rammou, of CIFF, highlighted the importance of choice, emphasising CIFF’s commitment to multi-stakeholder agreements and empowering communities to make informed decisions. Financial diversification and accountability were key considerations for CIFF. Dr. Vuyiseka Dubula, of the Global Fund, emphasised the centrality of communities in their strategy for future prevention options. Community representative, Ruth Akulu, stressed the need for sustainability in HIV prevention, addressing challenges such as gender-based violence and empowering communities to make choices. She advocated for broader participation in research across all African countries to ensure demand and supply alignment for effective solutions. 

Key takeaways from the forum; 

Strengthen Youth Involvement: Actively involve young people in shaping HIV services by letting them express their preferences in terms of services, delivery methods, and locations. Their meaningful participation should be a cornerstone in the planning and execution of Biomedical HIV Prevention (BHP) initiatives. 

Let Communities Lead: Empower communities to take charge of programs designed for them. Decision-making processes within BHP should prioritise the voices and needs of the communities being served, ensuring programs are tailored to their unique circumstances. 

Unlock the Power of Choice: Expand the range of available HIV prevention options. It is crucial to ensure that key populations are not excluded, and affordability must be prioritised to guarantee widespread access to these prevention products. 

Enabling Policy Environment: Remove or amend punitive laws that hinder access for key populations. Create policies and legal frameworks that facilitate the distribution and accessibility of BHP products, particularly to those who need them the most. 

Sustainable Financing: Strengthen domestic resource mobilisation efforts to fund biomedical prevention research. Emphasise the importance of sustainable financing, exploring various funding options to ensure the continued development and accessibility of prevention methods. 

Partnership & Collaboration: Promote collaboration among stakeholders and partners. Strengthen domestic resource mobilisation not only for funding but also for fostering collaboration among diverse entities involved in biomedical prevention research and health funding options.

In a recent turn of events that shook the core of the ICASA 2023 in Harare, the unexpected cancellation of the People’s March, a vital platform for advocacy and awareness, has sparked a wave of disappointment and condemnation among the conference’s participants, Civil Society, activists, and community members. The statement: “Upholding Civil Society Voices in Health International Conferences: A Response to the Suppression and Cancellation of Communities At ICASA 2023” serves as a collective response to this suppression of civil society voices and reflects on the broader context of community treatment since the beginning of ICASA 2023.

Introduction 

Empowering youth is not just a noble goal; it’s a responsibility we all share in creating a better, more inclusive society. One powerful way to achieve this is by integrating comprehensive sexual and reproductive health (SRH) education into the lives of young people, while also promoting gender-based violence (GBV) prevention. In this article, I’ll share my inspiring journey of taking proactive steps to make this vision a reality by engaging community and religious leaders, as well as law enforcement agencies. These efforts have led to a commitment that can change lives.

Advocacy Journey: September 4th to 7th

The journey towards empowering youth and promoting SRH education as a means of GBV prevention started with an advocacy visit.  During this period, our advocate connected with vital stakeholders within the community, including Community Leaders, Religious Leaders, and the Lagos State Police Force. Their commitment was instrumental in driving this initiative forward.

Community Leaders: Community leaders are the bedrock of our neighborhoods. Their endorsement and commitment to promoting SRH education and GBV prevention within their communities can significantly impact the acceptance and implementation of these vital programs. They understand the unique needs of their communities and can help tailor the messaging accordingly.

Religious Leaders: The influence of religious leaders on the beliefs and practices of their congregations is profound. Engaging with them was a strategic move, as it allowed for the dissemination of these crucial topics within the moral and ethical teachings of the community. Their commitment was instrumental in reaching a wider audience.

Lagos State Police Force: Law enforcement agencies play a pivotal role in addressing and preventing GBV. Collaborating with the police force is crucial in ensuring the safety of young people and providing effective support to GBV survivors.

Outcome of the Advocacy Visit: Community leaders expressed their commitment to support the initiative by allowing access to community spaces for educational workshops, providing resources, and encouraging community members to participate actively.

 Religious leaders expressed their commitment to incorporating SRH education and GBV prevention into their teachings, creating a bridge between faith and knowledge. The Lagos State Police Force committed to providing training for officers on how to handle GBV cases sensitively and efficiently, as well as supporting the initiative by raising awareness about SRH education and GBV prevention among the youth.

Preparation: September 20th and 21st

After securing the support and commitment of these key stakeholders, our advocate shifted focus to gather and organize informational materials, pamphlets, and brochures. These materials were designed to provide straightforward and actionable information about SRH and GBV prevention, along with highlighting the support services offered by the NGO or CSO involved in the initiative.

Informational Materials: Sorting materials that are easy to understand and act upon is critical. These materials cover a wide range of topics, including safe sex practices, consent, reproductive health, and the consequences of GBV. They are designed to resonate with the needs and understanding of young people.

Pamphlets and Brochures: These concise materials are like roadmaps to knowledge and action. They can be distributed in schools, community centers, and religious institutions, making sure the information reaches a diverse audience. These materials serve as both education tools and sources of reference for those seeking help or information.

Support Services: Equally important is making sure young people know where to turn for guidance, counseling, and assistance if they experience or witness GBV. By providing this information, the initiative ensures that young people have access to the help they need when they need it.

Conclusion

Empowering youth through comprehensive SRH education and GBV prevention is a journey filled with hope and positive change. The commitment gained from community and religious leaders, as well as the support of the police force, is a testament to the collective effort to create a safer and more equitable future.

By integrating SRH education and GBV prevention into the lives of young people, we are equipping them with the knowledge and tools to make informed decisions, foster healthy relationships, and contribute to a safer and more equitable society. This advocacy journey isn’t just inspiring; it’s actionable. It shows how individuals and organizations can drive change in their communities, one commitment at a time, ultimately making a lasting impact on the lives of young people. Together, we can empower youth and build a better tomorrow.

Omolayo Ogunyemi Cecilia

AfNHi Youth Mentee 2023

The Kenya National Pre-UN High-Level Meeting Civil Society Consultation, held on September 12, 2023 in Nairobi, Kenya, was a significant gathering that focused on the global priority of Universal Health Coverage (UHC). With Kenya facing persistent health challenges, including TB ,Malaria ,and HIV/AIDS, the consultation aimed to refine health priorities, strategize for post-UN HLM 2023 engagement, and enhance awareness of human rights and gender concerns. The primary objective was to establish a clear position on inclusivity and the ongoing implementation of UHC, while also creating a framework for holding leaders accountable for the meeting’s decisions and directives.

Opening Remarks

Kenya AIDS NGOs Consortium (KANCO) Executive Director,Allan Ragi, opened the engagement with an acknowledgment of the progress made in the battle against TB and other health-related issues. He shared some insights about the changing landscape of HIV/AIDS in line with Tuberculosis infections while also citing a previous lack of addressing TB-related issues in the early years due to negligible funding. Nonetheless, he acknowledged the progress that has taken place over the years, including increasing donor funding and programmatic support from Kenyan authorities, including the Ministry of Health (MOH), Kenyatta Hospital, and the Health Committee at the Council of Governors (COG). These initiatives have seen the growth of the TB champions movement, with a focus on issues such as drug-resistant TB. At the same time, he emphasized that everyone should aim to make a difference, reminding everyone that ‘you never get it unless you ask for it or identify the issue.’ The emphasis was placed on collective responsibility and collaboration towards making a substantial impact in the health sector.

Overview of High-Level Meeting Processes and Updates

Evaline Kibuchi  The Chief National Coordinator at Stop TB Kenya delivered a comprehensive presentation that detailed the extensive preparations for the upcoming UN High-Level Meeting (HLM) scheduled for September 2023. The presentation emphasized the significant progress and developments that have taken place since the initial TB HLM in 2018. 

During the presentation, there was a thorough exploration of the organization and themes of the HLM, highlighting a shared global commitment to two key priorities: expanding Universal Health Coverage (UHC) and strengthening efforts related to Pandemic Prevention, Preparedness, and Response (PPPR). This indicates a global consensus on the importance of these critical health objectives as part of the UN HLM’s agenda.

Achievements and Commitments

The consultation celebrated Kenya’s noteworthy achievements in reducing new infections and TB-related mortalities from 33,000 in 2019 to 21,000 by 2021, along with its significant progression out of the high MDR-TB countries category. The outlined provisions of the Political Declaration reiterated a commitment to ensuring an all-encompassing, equitable, and people-centered approach in TB responses nationwide.

Inputs from Consultative Meeting with Key Populations

The Consultative Meeting with Key Populations resulted in the presentation of valuable insights, emphasizing the need for more comprehensive and diversified strategies to ensure the continued effective implementation of Universal Health Coverage (UHC). Key populations stressed the importance of addressing specific concerns related to the Lesbians,Bisexuals, Transgender, Queer, Intersex & Gender Non Conforming (LBTQIGNC) communities, along with other vulnerable groups, to ensure their equitable access to health resources and protection. These contributions highlighted the significance of promoting transparency and accountability in national health initiatives, ultimately enhancing the resilience and responsiveness of healthcare systems.

After a thorough review of existing National Health and Human Rights Policies, an assessment of Community-Led Responses, an examination of societal enablers, and an evaluation of external support and investments, the following key action points were identified;

• Acknowledging diverse perspectives within Civil Society Organizations (CSOs).
• Advocating for legal reforms to support Key Populations and the LBTQIGNC communities.
• Documenting achievements to shape evidence-based policies.
• Promoting community-driven initiatives for healthcare ownership.
• CSOs monitoring and allocating funds effectively.

These key action points serve as the foundation for a more inclusive and equitable approach to healthcare delivery and policy formulation, ultimately enhancing the well-being and healthcare access of Key Populations and the LBTQIGNC community.

Conclusion

In conclusion, our journey toward fostering true inclusivity and equitable representation for Key Populations and LBTIGNC communities is one that demands our unwavering commitment and persistence. The reflections from our consultative meeting have illuminated essential next steps on this path.

First and foremost, we must recognize that inclusion is intricately linked to the presence of supportive laws and policies, as well as accessible data. These foundational elements are pivotal in our quest for comprehensive reform. Moreover, as we navigate this journey, we must understand that all reforms involve processes. It becomes imperative to ensure that these processes are underpinned by protective laws that safeguard all communities, especially our Key Populations and LBTIGNC communities. 

To operate programs safely and without victimization, we must harness existing safety mechanisms, allocate resources effectively, and uplift those who carry our message. This underscores the urgency of enhancing our safety nets. In our pursuit of inclusivity, we must avoid using language that inadvertently discriminates against sexual and gender minorities. Our conversations and documents should reflect a commitment to eradicating such biases.

The prevailing tendency to exclude communities in planning, policy development, and implementation must change. Communities are urged to push for representation in financial processes and decision-making spaces from grassroots to the national level. To achieve this, we must foster intentional inclusion and meaningful engagement with political representatives and authorities through the proper channels and procedures. Capacity building, particularly through CSOs, is instrumental in this endeavor. Finally, comprehensive guidelines for Community-Led Monitoring (CLM) and monitoring of other diseases and chronic illnesses must be developed, extending beyond HIV care to address the diverse healthcare needs of our communities.

Our journey towards inclusivity and equitable representation is undoubtedly challenging, but with collective dedication and adherence to these vital reflections and next steps, we are poised to effect transformative change and ensure that no one is left behind in the pursuit of better health and well-being.

Fahe Kerubo

AfNHi Mentee 2023