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GOVERNANCE - QUESTION 1

How can the UNAIDS Board help guide the wider global AIDS response?


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31 comments:

  1. More effective communication and coordination between PCB and Governing bodies of the Cosponsors regarding decisions affecting the global AIDS response to help ensure closer collaboration, policy coherence and integration

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  2. In the governance structure it would be highly appreciated to co-convene workstreams etc. like in the newly established International Partnership on Religion and Sustainable Development in which UNAIDS is a co-founder. we would also benefit a lot if committed FBOs can co-convene the programming and also allocate respective Budgets together with UNAIDS funders etc. for achieving the SDGs we do Need much more cooperation and not less. and very lean implementation structures, also in relation to GFATM,

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  3. The Board is doing fine. The areas of improvement would be;
    1. Strengthen the link between the board and the boards of the cosponsor agencies.
    2. Improve communication, communication, communication!

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  4. An even broader integration of CS and a better communication about the PCB meetings would be helpful. To secure broader CS involvement country delegations at PCB meetings should actively be encouraged to bring members from the CS as community delegates with them. UNAIDS could as well initiate a meeting between the community delegates to discuss how community representatives can address or lobby for relevant topics important for their local communities.

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  5. If HIV is to be eliminated, stigmatisation has to be eradicated.If UNAIDS were to get one message out to the world that HIV is simply a medical condition and that stigmatising this condition is a violation of the human right to dignity and respect, I believe that persons living with HIV would enjoy the freedom needed to socialise equally without fear, have access to care and treatment like any other person with a medical condition like diabetes or high blood pressure and take responsibility not to pass the virus to another. We need such a revolution and UNAIDS can do this.

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  6. In order to improve the impact and the visibility of the PCB decisions within the wider global AIDS response, the PCB chair and co-chair could attend the board meetings of the cosponsors to present the PCB decisions to the other commissions and governing boards/bodies to ensure closer collaboration, policy coherence and integration of efforts across the board.

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  7. Une mémorandum d'entente entre le CCP/ONUSIDA et les Conseil d'administration ou autres structure de gouvernance similaires des coparrainant pour présenter les réalisation du coparrainant à travers l'ONUSIDA et veiller à ce que au positionnement du SIDA. Les Coparrainnant doivent maintenir la riposte au VIH dans leur agenda sauf s'ils veule asphyxier leur secrétariat ONUSIDA. Présenter les succès est bien mais ne pas oublier d'attirer le partenaire sur le problèmes de VIH et SIDA à travers lequel il veut être utile au niveau d'un pays, continent ou le monde.

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  8. UNAIDS understands itself as very important- as a (or the) peak organisation. This is, of course, true. Yet real work happens when peak organisations understand themselves as servants of the people they are charged with caring for. UNAIDS is an extraordinarily bureaucratic and risk-averse organisation, which to outsiders sometimes appears to exist largely to perpetuate itself and the careers of its staff. Those staff would do well to remember daily who the most affected communities are-- the poorest, most marginalised people on the planet-- and realise that the goal of our work is to end HIV and to care for those affected, not to further the careers of bureaucrats. This would be an attitudinal shift which might well result in changes in the ways UNAIDS does its business.

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  9. UNAIDS Secretariat at Country Level should be revised and improve a lot in terms on communication. At Global and Regional level seems that there is clear the Secretariat role, while at the Country level the Secretariat fights with the co-sponsors to be seen as implementing agency. 1. There is the case of my specific country Mozambique that this happen often, which is a clear indication that the Secretariat staff at National Level are Not aware about the Global Division Labor among the agencies; 2. This cases is even more strong with UNDP due to some particular areas of expertise in particular Human Rights position; 3.We kindly request Mr.Sidibe and Helen Clark to revise and to better clarify the Human Rights and HIV position of UNAIDS which role should play and how better coordinate with UNDP that it is a implementing agency and co- sponsor member. The same applies to the recent global fund advisor position created where the Secretariat UNAIDS is now also open a conflict in a countries where UNDP has to implement and deliver on Global Fund; 4. UNAIDS Secretariat at country level not much committed with coordination, sharing information and resource mobilization. In most occasions UNAIDS Secretariat at National level proposed the closure of the UN Joint Team monthly meetings which surprises the co-sponsors members. If there is no monthly meetings how the coordination will be done among agencies?...; UNAIDS Secretariat discrimination on some agencies in favor of others when comes to resource mobilization. 5. UNAIDS International staff with lack of respect of country National staff. No respect of cultures and people that they suppose to support. Directors and International senior staff do not much engaged in resource mobilization in a critical countries where the levels of epidemic are very high.

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  10. In terms of the UN response for people who use drugs, the essential change that UNAIDS needs to make is to move from the current position of recognising the problem to one of genuine leadership in solving it.

    In its 2011 Strategic Investment Framework (Schwartlander et al.), UNAIDS made clear that programming for key populations including people who inject drugs is not an optional extra, but is essential to ending AIDS. Since then, UNAIDS has held a PCB meeting on people who inject drugs, has released reports on HIV and drug use and has set ambitious targets relating to this key population, for example in the context of the fast track strategy and the 90-90-90 targets.
    Yet as we describe elsewhere in this consultation, five years after the Strategic Investment Framework we are in a worse position than ever before. New HIV infections among people who inject drugs increased by a staggering one third between 2011 and 2015 – a period in which UN member states at the 2011 High Level Meeting on HIV had committed to halve transmission among this key population. At present, we quite simply have no hope of achieving the 2020 targets for people who inject drugs.

    UNAIDS’ current approach of issuing and re-issuing guiding messages on the health and rights of people who use drugs, without an active and applied strategy to ensure that these are taken up, is not working. This is unsurprising given that we are talking about a highly stigmatised and criminalised community, catering for which offers governments little political capital. Recognising this, UNAIDS urgently needs to creatively explore how it can better persuade, enable, pressure and incentivise countries to scale up harm reduction provision, learning from those governments that have already done so, consulting with civil society and campaigning organisations and working with co-sponsors to pin down what will get harm reduction services to those who need them fast.

    Concerted UNAIDS leadership is also needed to mobilise resources to alleviate the funding crisis currently facing harm reduction – whether from national governments, donors or multilaterals such as the Global Fund. Rather than making unrealistic assumptions that countries, if left unsupported by the donor community, will eventually step up and fund harm reduction, UNAIDS needs to work actively to help countries make the transition to domestic funding, while also ensuring that gaps are filled and calling out countries that are failing to address HIV among people who inject drugs.

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  11. The UNAIDS Programme Coordinating Board (PCB) is unusual in including a diverse range of state, non-state and intergovernmental organizations in a relatively well-functioning Board. Intercessional coordination is provided by the CCO, which acts as a standing committee of the PCB, and executes its decisions. Day-to-day coordination is provided by the Global Coordinators, who act for their heads of agency on the CCO. This structure is set out in the ECOSOC resolutions that created UNAIDS, and has served the joint programme well for more than two decades. The governance mechanism is very well constructed and is not in need of major revision (which would, in any case, require a decision of ECOSOC).
    Nevertheless, the actual implementation of the Board meetings could be improved by focusing more on high level strategic issues, and less on providing overly detailed (and sometimes inconsistent) instruction to the joint programme. More focused, higher-level strategic discussions would be useful to provide guidance on the wider global AIDS response. Fewer, higher level, and more consistent decisions by the board would improve oversight and strategic management. Above all, the board should be action-oriented and focused on getting agreement on strategic decisions that relevant to the broader AIDS response.
    Currently the PCB meets twice yearly. This places a large financial and human resources burden on the secretariat, cosponsors, CS representatives and member states. It may be worth revisiting the need for semi-annual meetings. Annual meetings may be sufficient to provide high level strategic guidance to the joint programme, while allowing more flexibility in the day-to-day implementation of the joint programme.
    Thematic discussions have become a routine part of the PCB meetings. While these discussions are interesting and useful for advocacy purposes, they are resource-intensive and seldom result in decisions. One may question their value to the management of the joint programme or for providing strategic guidance to the broader AIDS response. It may be worth considering to separate these altogether from the PCB meetings in order to allow more scope for decision-making.

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  12. UNAIDS desperately needs to demonstrate greater commitment and leadership in terms of the UN response for people who use drugs. Harm reduction services were - rightly - an essential component of the 2011 Strategic Investment Framework. Yet the situation, globally and within UNAIDS, is worsening. At present, we quite simply have no hope of achieving the 2020 targets for people who inject drugs.

    The Joint programme's approach of issuing guidance without an active and applied strategy to ensure that it is taken up, is not working - especially for a highly stigmatised and criminalised community such as people who use drugs. UNAIDS urgently needs to creatively explore how it can better persuade, enable, pressure and incentivise countries to scale up harm reduction provision, in collaboration with civil society and co-sponsors.

    UNAIDS leadership is also needed to mobilise resources to alleviate the funding crisis currently facing harm reduction – whether from national governments, donors or multilaterals such as the Global Fund. Rather than making unrealistic assumptions that countries, if left unsupported by the donor community, will eventually step up and fund harm reduction, UNAIDS needs to work actively to help countries make the transition to domestic funding, while also ensuring that gaps are filled and calling out countries that are failing to address HIV among people who inject drugs.

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  13. The UNAIDS Joint Programme should work closely with civil society and networks of people who use drugs to generate stronger evidence on the benefits of PUD- led responses to HIV, analyse how to incorporate PUD- led HIV responses in AIDS plans and to work on developing and advocating for strengthening the input of communities in designing and evaluating national and donor HIV policies, and programming frameworks.

    The Joint Programme should use its role as a broker to guide member states in recognising that people who use drugs play an essential role in AIDS response, from service delivery, to advocacy, to participation in accountability and to mobilising demand for services. The Joint Programme in a unique position to engage member states in identifying and removing legal and regulatory barriers that ensure the meaningful inclusion and quality participation of people who use drugs at all level of planning, as well as national and donor policy and programming frameworks. During advocacy on transition to domestic financing, the need to allocate investments towards community-based and community-led responses should also be pressed for, as per 39th PCB Agenda Item 4: 5.2 a) and b). This would move UNAIDS from a statement of recognition, towards addressing and taking action on this item.

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  14. Lastly, UNAIDS needs to make sure that drug user voices are included in their forums and consultations that engage wider civil society. People who use drugs need to be involved, and be represented in these spaces, if UNAIDS is true to its commitment of leaving no one behind, and is to effectively implement of the fast track strategy and reach 90-90-90 targets.

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  15. Teniendo más autonomia en sus acciones de país, en muchos paises onusida no puede hacer nada, o aplaudir las acciones de estado

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  16. Le système de remontée des réalités et vécu sur le terrain doit être affiné et structuré de telles sortes que les représentants de la société civile au PCB aient de la matière pour nourrir le plaidoyer et communiquent davantage avec la base.
    Il est plus important que la relation entre les acteurs communautaires et leurs représentants au PCB soient renforcés. Il existe encore plusieurs réseaux de personnes vivant avec le VIH ; de populations clés où de personnes affectées au niveau local qui ignorent totalement qu’ils ont des représentants au PCB qui peuvent porter leurs voies, témoigner de leur réalité en termes de stigma et de discrimination et surtout revendiquer leurs droits à la dignité, au respect et à l’accès au service. Nous avons des cas concrets de violations basées sur le genre, d’utilisation anti homosexuelles, anti travail de sexe, anti utilisateurs de drogues qui nous parviennent tous les jours sur le terrain mais nous savons pas par quel canal capitaliser et remonter ces données qui limitent aux services des populations clés vers nos représentants.
    Dès que ce système de remontée des données de la base sera renforcé, le conseil de l’ONUSIDA disposera des cas et de faits probants pour définir ses orientations stratégiques, mais surtout pour positionner davantage la problématique des droits humains au cœur de la riposte du VIH.

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  17. In order not to make change configuration Program Coordinating Board through ECOSOC, as it is difficult and complicated process, we suggest - for example, to add the possibility of including associate members - non-members of the board. But those, who can propose topics, take part in preparation of PCB meetings and discussions - for example to be connected to the working groups conducted for preparation of PCB Meetings.
    We also suggest the opportunity to submit reports not only NGO delegation, but to include other stakeholders – Member States, scientist, private foundations, etc

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  18. Strengthen communication between the UNAIDS Board and the boards of the Co-Sponsors.

    Focus the discussions at the Board on key strategic and oversight issues for the Joint Programme, its vision, overall direction etc. The thematic sessions are interesting but do not seem to lead to substantial changes in practice. Discussions on specific topics during the board (such as the recent sessions on paediatrics and IP) should only be on the agenda if there are key issues in relation to these topics which are clearly impeding progress towards the delivery of the strategy. If this is not the case it is not clear why such sessions take up valuable time at the Board.

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    Replies
    1. I agree. But the PCB would also operate a lot more effectively if its members were more aware of the full range of Cosponsors work (which has a budget considerably larger than the core budget). That includes communication between boards but it also means all organizations being a bit more joined-up: so that people in UN departments, aid reviews and other cross-organizational processes treat the Joint Programme in a more holistic way.

      Reports from Cosponsors on their work should come from their documents and websites, which should principally be background and not be overly repeated in reports to the PCB. The Board should focus principally on joint work and the bigger, strategic picture.

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  19. It is very unclear from the perspective of this seasoned follower what value the thematic sessions add.

    Has there been follow up to ascertain its impact?

    Surely it is everyone's interest to focus scarce time on measuring progresss and providing strategic direction to the Joint Programme.

    There are already a lot of places where these issues take place. Having them (again) at the PCB adds little value but detracts significant time and impact.

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  20. In order to improve the impact and the visibility of the PCB decisions within the wider global AIDS response, the PCB chair and co-chair can attend the board meetings of the cosponsors to present the PCB decisions to the other commissions and governing boards/bodies to ensure closer collaboration, policy coherence and integration of efforts across the board.

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  21. The value of the thematic session and the decision behind the choice of themes is unclear. At the moment the PCB and the thematic session do not provide a good indication on where we are compared to targets set out in the Global HIV Strategy. Any technical sessions in either the PCB or the thematic session should be developed to help address and raise awareness of the MAIN blocks to progress against delivery. These sessions should be based on need with consideration of the impacts and outcomes desired from the sessions.

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  22. There is a need to strengthen the links between UNAIDS Board and the Boards of cosponsoring agencies. Besides, the country representatives on those boards should be encouraged to share information and agree to echo/disseminate relevant positions of their countries across several boards, which is currently not the case. That way, the important statements on HIV and AIDS presented at UNAIDS Board could be heard in cosponsors boards, and integrated into other relevant thematic areas, highlighting the need for and the opportunity of the cross-sectoral nature of the AIDS response.

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  23. Es importante enfatizar el rol de las comunidades, por ejemplo, se menciona el marco normativo ecuatoriano vigente, el cual se enfoca en propiciar, fomentar y garantizar el ejercicio de los derechos de participación de las ciudadanas y los ciudadanos, colectivos, comunas, comunidades, pueblos y nacionalidades, a través de la intervención comunitaria en la planificación, organización, ejecución, normatización, generación de mecanismos, instrumentos y procedimientos para el seguimiento de las políticas públicas y la prestación de servicios públicos en salud; centrándose actualmente el Ministerio de Salud Pública en la promoción y prevención de salud, con especial énfasis en la atención primaria, esto lograría orientar la respuesta mundial al sida.

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  24. Ensure all member states have at least 1 CS/PHLIV/KP representative as part of the official country member delegation, and increase the numbers of delegates for the NGO delegation to the PCB. Also ensure that the UNAIDS board and countries act consistently between various multilateral bodies (Global Fund, UNITAID) to ensure the AIDS ecosystem is well-coordinated.

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  25. The PCB seems to work pretty well. CCO is important body and needs to be viewed as important partner with substantial weight in need of consultation prior to conversations with Member states so as to avoid contradictions between secretariat and cosponsors.

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  26. The right people have to sit in the board. Maybe people leading the AIDS responses in the countries should be the first supported by the missions who current do a great job. Similarly CSO should be country chosen from existing networks. In this way the professional and lived experience of people will be reflected in the board meeting deliberations

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  27. •The Board should continue guiding UNAIDS Secretariat work and ensuring that commitments made at Agenda 2030, 2016 Political Declaration and UNAIDS Fast Track Strategy 2016-2021 are being implemented; and
    •Assist community based organizations with resource mobilization to fund country-level programming around HIV prevention, treatment and support

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  28. PCB actualmente reprezintă o entitate destul de puternică la nivel mondial și regional. Parteneriatele cu alte agentii ONU, cum ar fi UNODC oferă posibilitate de amplificare a eforturilor și transfer de bune practici. Detinutii și echivalenta serviciilor de sănătate, fiind un grup de risc pentru mai multe maladii necesita mai multa atenție din partea PCB.

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  29. • While the 2030 strategic directions and 2020 goals set by UNAIDS are ambitious and appropriate to the tools we now have in hand, the UNAIDS’ 2016‐2021 Action Areas and Targets miss the mark. We now know the important health and prevention benefits of antiretroviral medications when used prophylactically and early for treatment. We know that access to comprehensive, targeted, rights‐based, and community supported sexual health programs for key populations, including HIV services are consistently undermined by stigma, discrimination, criminalization, and violence. We know that diagnostic capacity to monitor treatment outcomes at both the individual and community levels lags miserably behind current technologies. And, we know that a balanced response, one that honors, respects, and resources community ingenuity, leadership and knowledge will get us further than top down approaches that singularly privilege the bio medical.
    • Specifically, we recommend: 1. Aligning the action areas and targets with the 4 transformative shifts necessary to meet the 2020 goals; 2. Elevating men who have sex with men, sex workers, transgender women, and injecting drug users more explicitly and more evenly across the stated goals and proposed strategies; 3. Calling for initiation of HIV treatment upon diagnosis and upon demand for all people; 4. Urging governments to modernize diagnostics, including point‐of‐care technologies for all people; 5. Giving specific examples of how governments can front‐load investments and facilitate unfettered access to the latest treatment and diagnostic technologies, including through reforms of patent laws and trade agreements that exclusively advantage multi‐national pharmaceutical and bio‐tech companies; 6. Investing in community‐led efforts and promoting more global alignment across the UN family, in close partnership with the Global Fund and major bilateral agencies; 7. Leading efforts to decriminalize homosexuality, sex work, and injection drug use; 8. Nuancing gender‐based strategies to include transgender and gender variant people, whose rights are egregiously violated worldwide; 9. Promoting increased technical capacity of HIV service implementers, including greater sensitivity of healthcare professionals who are engaging people living with or who are at highest risk for HIV infection; and 10. Encouraging uptake of current normative guidance in the design and implementation of national AIDS responses, including but not limited to: Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations (WHO, 2014); Implementing Comprehensive HIV and STI Programmes with Men Who Have Sex with Men: Practical Guidance for Collaborative Interventions – “MSMIT” (UNFPA, WHO, UNAIDS, UNDP, World Bank, MSMGF, 2015); Implementing Comprehensive HIV/STI Programmes with Sex Workers: Practical Approaches from Collaborative Interventions – “SWIT” (UNFPA, WHO, UNAIDS, NSWP, World Bank, UNDP, 2013); Brief Sexuality‐Related Communication: Recommendations for a Public Health Approach (WHO, 2015); A Code of Conduct for HIV and Health Professionals (IAS, 2014); TRANSIT implementation tools in collaboration with the UN cosponsoring agencies and the International Reference Group on Transgender Women and HIV and IDUIT, in collaboration with the International Network of People Who Use Drugs.

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  30. It can be achieved through better communication with all parties involved. Coordination with other donors, and better and clearer messaging with country offices. Probably it is time to move from blueprints and allow country offices and country stakeholders to act based on country specificity and needs. This will make UNAIDS contribution much more efficient.

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