[procaare] Common Position on the Participation of Southern African Civil Society in Universal Access

["Sara Page" <sara@safaids.org.zw>]

Common Position on the Involvement and Participation of 
Civil Society in Universal Access Processes in Southern Africa
Sara Page, SAfAIDS
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Often disjointed in their advocacy, civil society often fails to 
make an impact at international events and high level meetings 
because they have not reflected, reviewed and discussed their 
common advocacy points.

Therefore, in preparation for UNGASS 2008 discussion, a number of 
southern African civil society organisations met on May 26th to 
discuss a common advocacy position on the involvement and 
participation of civil society in Universal Access processes. The 
following statement highlights the discussions and key concerns 
expressed by some civil society organizations in southern Africa. 
This statement has fed into a broader African CSO policy statement 
which highlights the key policy concerns related to UNGASS.

Your comments and feedback are welcome.

Sara Page
SAfAIDS
Email: sara@safaids.org.zw

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Common Position on Involvement and Participation of Civil Society 
in Universal Access processes in Southern Africa

May 26th, 2008

A region in crisis

Southern Africa is the epicentre of the HIV epidemic. It is the 
region most affected by HIV and AIDS in the world, which has 
witnessed a significant deterioration of health and development of 
the region's population. Despite bearing the brunt of the epidemic, 
a common voice for southern African civil society has been lacking 
significantly in all international and regional fora.

It was recognised that there is a need for more meaningful 
contribution, adequate consultation and preparation among civil 
society organisations in southern Africa. Therefore, as 
organisations representing diverse sectors of the Civil Society in 
Southern Africa, we met to reflect, review and dialogue on a common 
position in preparation for the upcoming UNGASS meeting (June 
2008).

The primary specific objectives of the meeting were to:
* Share country experiences and CSO perspectives on the progress of 
HIV and AIDS responses
* Identify and capitalise on advocacy opportunities where southern
African civil society can help lend their voices to the debates
* Consolidate southern African perspectives ahead of UNGASS meeting
* Agree on an southern African Common Position Paper for UNGASS 
review based on our experiences from country reports
* Develop a comprehensive advocacy strategy for civil society 
organisations in southern Africa

>From the 10 southern African countries that have formally submitted 
UNGASS country reports, we have noted with appreciation that there 
has been substantial progress to scale up essential HIV prevention, 
treatment, care and support services for those who need them. 
Numerous governments in southern Africa have demonstrated greater 
commitment and leadership, as evidenced in newly established 
strategic frameworks and improved coordination of national 
responses to HIV. In addition, financial resources for national 
multi-sectoral HIV responses have continued to increase.

Despite this progress, civil society groups participating in the 
southern Africa pre-UNGASS meeting have identified the following 
challenges / gaps that hamper the achievement of universal access 
in the region.

1. Limited Involvement of Civil Society in UNGASS Monitoring 
Processes
Since the 2006 UNGASS High Level Review meeting, a number of 
southern African countries strengthened the involvement of civil 
society in the review, analysis and writing of the UNGASS country 
reports. In particular, Zambia and Zimbabwe took strategies to 
enhance open consultation between relevant government ministries 
and civil society. However, a number of countries felt that civil 
society continues to be sidelined in national processes for 
reporting on UNGASS indicators. It was recommended that:
* Civil society needs to build its own capacity to monitor, analyse 
and feed into national M&E mechanisms.
* All countries should have a civil society technical working group 
to support the country reporting process for UNGASS and a 
representative on the National AIDS Council to support the country 
reporting process for UNGASS.
* There should be a stronger voice of HIV positive people on 
National AIDS councils to ensure that civil society data is 
adequately fed into the national M&E process and UNGASS reports.
* There is a need to strengthen partnership forums to enhance 
coordination and engagement of CSOs.
* Stronger links between CSO and parliamentarians need to be formed 
to enhance information flow, awareness creation and 
oversight/monitoring of policies.
* Governments and civil society should link and co-ordinate 
associated international plans and treaties that have been signed 
and inform all stakeholders well in advance of reporting dates, 
processes,etc (i.e. UNGASS, CEDAW, MDGs, Maputo Plan of Action, 
VAW)

2. Prevention
The year 2006, was identified as the year of prevention in the 
southern African region. Government and civil society organisations 
committed themselves to enhancing a focus on prevention, while 
maintaining the emphasis on access to treatment.  Although some 
countries are showing a decline in HIV infection rates, the 
participants of the southern Africa pre-UNGASS meeting highlighted 
that existing prevention strategies are failing to have the desired 
impact. There is an urgent need to scale up and deliver prevention 
interventions that have impact. Beyond abstinence and condom 
provision, there is a need to provide a range of prevention 
strategies which increase faithfulness, reduce intergenerational 
sex and multiple concurrent partnerships. Many countries are 
exploring additional strategies such as male circumcision. From CSO 
in southern Africa, the following are key recommendations to 
strengthen the prevention aspect of the response in the region:

* Scale up HIV and TB prevention programmes at the same pace as 
treatment initiatives. Prevention programmes need to be 
comprehensive and include a range of strategies.
* There is a need to identify comprehensive HIV prevention 
programmes and services that address gender inequalities and focus 
on the needs of women, youth and older people.
* This includes conducting more research on male circumcision and 
its impact on women, identifying more prevention methods that are 
female-controlled, and working with health professionals to 
eliminate stigma associated with youth, women and older people who 
seek HIV prevention and sexual reproductive health services.
* Information about HIV and TB prevention needs to be widely 
accessible in relevant languages and formats (including Braille, 
sign language, and vernacular). An overall fatigue to HIV and TB 
messages has been noted therefore HIV information and messages need 
to be developed together with target audiences.
 * Violence, rape and sexual assault of women need to be addressed 
in the strongest terms to address HIV and AIDS. There is a need to 
put legislation and policies into real practice to protect women's 
rights and safety.
* All countries need to make a national commitment to developing 
targeted HIV prevention programmes for vulnerable and 'at risk' 
groups. In addition, governments should address the legislative 
barriers to effectively addressing the HIV prevention and sexual 
reproductive needs of these groups.
* As a prevention strategy, there is a need to place an emphasis on 
economic empowerment of women, children and the older people 
through social protection policies, micro-finance, property rights 
or cash transfers.
* Greater emphasis on mainstreaming HIV prevention and behaviour 
change strategies into other development areas (i.e private sector, 
education..etc).

3. Treatment and Care
In southern Africa, there has been an overall increase in access to 
treatment for adults living with HIV. However none of the countries 
have reached the target they set. There remains a significant 
portion of people without sufficient access to treatment and care, 
as evidenced by the ongoing high mortality rates in the region. Of 
particular concern, is the need for treatment and care for children 
and older people (adults above 50 years of age) who are 
HIV-positive. From CSO in southern Africa, the following are key 
recommendations:
* Scale up access to the continuum of care required by people 
living with HIV, regardless of their age or sex. The continuum of 
care is understood to include relevant tests, prophylaxis for OI 
and TB, anti-retroviral treatment, and psychosocial support.
* A key component of comprehensive care for people living with HIV 
is access to good quality food. However the region has high food 
insecurity which directly compromises effective treatment of people 
living with HIV and AIDS. There is a need for treatment approaches 
to include nutritional support
* Regional strategies need to be established as a matter of urgency 
to ensure sustainability of ARV and treatment supplies in the 
southern African region. Governments in the region should make 
better use of the flexibilities within TRIPS agreements.
* There is an urgent need for a harmonised protocol on ART for the 
entire southern African region, as mobile population, migrants and 
refugees have the right to greater access to treatment
* Scale up treatment literacy initiatives in the region through 
greater involvement of people living with HIV as peer educators and 
community health workers.
* All countries need strategies that support households headed by 
older persons and /or children.

4. Vulnerable and Marginalised Groups
Among southern African countries, there was no data on indicators 
related to vulnerable and 'at risk' groups, including MSM, 
prisoners, IDUs, and CSW. As a result, significant populations are 
not being reached with HIV prevention, care or treatment.

>From CSO in southern Africa, the following are key recommendations:
* All countries in southern Africa need to recognise sexual 
diversity among its populations address legislative barriers and 
develop programmes that reach LGBTI groups.
* All countries in southern Africa need to establish strategies for 
addressing intravenous drug use
* More specifically, young people, women and the elderly who use 
drugs or are sexual minorities need access to HIV-related services
* All countries need to establish programmes for older persons, and 
there is an urgent need to review key indicators in UNGASS (in 
particular indicators 7, 16, 17) to incorporate older populations.
* All countries should reject legislation and policies that 
criminalise HIV and AIDS.

5. Integration of Sexual and Reproductive Health and Rights
In many of southern African countries, HIV and AIDS have been 
addressed separately from other sexual and reproductive health 
services and programmes. This has created an artifical separation 
of health care services. A key recommendation is to enhance 
programmes focused on comprehensive sexual and reproductive health 
services for men and women.

This would include:
* Ensuring that all HIV positive women have access to SRH services 
which offer high quality counselling and support to enable them to 
make informed decisions about family planning.
* Strengthening adult women's treatment guidelines that include a 
focus on women particularly dealing with the continuum of care and 
respecting women's choices to parenthood in treatment regimes 
(specifically with regard to first line regimen drugs being 
contra-indicated in pregnancy)
* All women in southern Africa, irregardless of HIV status should 
have the right to decide to become pregnant or to terminate a 
pregnancy.
* VCT and STI services need to screen and refer for risks of 
Violence Against Women
* Screening and coverage for cervical cancer need to be increased
* Need for increased funding to develop sexual and reproductive 
health services, with specific attention to fertility aspirations 
of HIV positive couples.
* Regional programmes are needed to provide  HIV and AIDS / SRHR 
related services for commercial sex workers and mobile populations

6. Health Systems strengthening
To achieve the impact required to effectively address the HIV 
epidemic in southern Africa, there is an overall need to increase 
funding and strengthen health systems, including training of health 
professionals and community health workers. Resources and systems 
need to be developed to enhance the links between formal and 
community prevention, care and treatment services.

>From CSO in southern Africa, the following are key recommendations:
* Resources are needed to strengthen communities and the AIDS 
response to address issues of women, youth and elderly
* Address health care workers crisis by strengthening community 
resources to help fill the gap through task shifting.
* Southern African countries need to be more vocal in advocating 
for compensation for trained health care workers who immigrate to 
developed countries.  A regional strategy is needed mitigate the 
migration of health workers.
* Invest in the future- in order to have an impact, development 
partners need to consider long tern funding of HIV and TB 
programmes

As civil society organisations in southern Africa, we are committed 
to working in partnership with governments and other stakeholders 
to ensure the achievement of universal access.

Cross-posted from AF-AIDS (af-aids@eforums.healthdev.org)
http://www.healthdev.org/eforums/af-aids