Challenges

The Joint United Nations Programme on HIV/AIDS (UNAIDS) is reporting the lowest levels of new HIV infections in this century at 2.1 million. In the last three years alone, new HIV infections have fallen by 13 per cent. AIDS-related deaths are at their lowest since the peak in 2005, having declined by 35 per cent. To get on track, new targets will focus on closing the gap in access to HIV treatment and prevention by setting new targets for 2020, including a bold target of providing access to antiretroviral treatment. The treatment target ? known as 90-90-90 ? would enable 90 per cent of people living with HIV to know their HIV status, 90 per cent of people who know their status to access HIV treatment and 90 per cent of people on HIV treatment to achieve viral suppression.

Toward a Solution

The Global Transfer Project aims to strengthen partnership and collaboration between governments and communities in an effort to fast-track the AIDS response in countries by 2020. It provides opportunities for countries to learn about successful systems, processes and strategies from one another, increasing their potential for positive results. Consultations have been carried out in participating countries to facilitate discussion on HIV prevention services and bring interventions to scale in mega cities and large urban centres, focusing on socially marginalized groups of men having sex with men, transgender people, sex workers and people who inject drugs. Sharing cities’ EpiData, vulnerabilities, socioeconomic conditions and the HIV burden of key affected populations through consultations has helped Cambodia, India, Indonesia and Thailand to revisit their programme plans and prioritize strategies that work for marginalized groups.

Inter country exchanges, visits to HIV-prevention learning sites and community-to- community interaction have: (a) encouraged the promotion of community-led models; (b) highlighted the need for a self-sustaining community response to AIDS; and (c) exposed country representatives to different epidemics, responses and contexts, including locally sustainable models. For example, the Humsafar Trust (Mumbai, India), a learning site, had taken steps to diversify its services and mobilize funds through its community research and advocacy division. Indonesian delegates visiting India were exposed to the use and implementation of telemedicine for the case management of patients in rural settings. Centres of excellence are rolling out this strategy to help in scaling up service focused on increased quality and provide mentoring among clinicians.

A multi-pronged strategy has been adopted by a South-to-South (S2S) platform for facilitating knowledge and skills transfer between countries. It includes: (a) country needs assessments; (b) mentoring community-based organizations; and (c) thematic workshops and guided exposure visits and missions to countries. Four community-based organizations (Ashodaya Samithi and the Humsafar Trust in India; the HIV Foundation in Thailand; and KHANA in Cambodia) were selected as learning sites. These organizations are being funded based on their core HIV competencies and the innovative approaches that they adopt to increase service coverage of key populations. Some of their innovative approaches include community-based HIV testing approaches (testing for triage) to reach out to unreached key populations, case management of HIV prevention, and treatment cascade through demand creation using peer health navigation for effective referrals and links with public health and other social protection schemes. The recipient countries were aided by twinning arrangements between cities, bi-directional learning missions, and agreed frameworks for knowledge transfer of best practices in identifying areas and ways to strengthen prevention and treatment approaches. Short-term fellowships and on-site technical support and virtual platforms have been mapped to promote South-South learning.

The project has helped India to learn from Cambodia?s experience in community-led HIV testing approaches. Cross-fertilization of ideas has provided further impetus for India to initiate a revision of its national guidelines. A similar promising learning example under the S2S collaboration platform was found in the Indonesian mission to India and Thailand. Indonesia adopted the test-for-triage approach to scale up testing services for men who have sex with men and other key populations, and it also discovered how to optimize coordination between public health systems and communities.

Through cross-learning and cross-fertilization of ideas, countries partnering in this initiative could appreciate the need to: (a) strengthen their response systems in the area of clinical excellence; (b) conduct training in the psychological aspects of care; (c) engage in operational research; and (d) pursue management excellence to reinforce the AIDS response. Community-to-community exchanges facilitated the creation of platforms for members to share implementation approaches, curriculums and pedagogical approaches for increased HIV testing, information on scaling up treatment, and ways to improve links to social protection schemes.

Many of these innovative community-owned and -led approaches help to develop resilience among key populations and respond to emerging needs in a meaningful way. The learning sites have built their internal systems to address policy issues and legal reforms. Similarly, national AIDS control councils that are keen to revise their programme guidelines and standard operating procedures relating to HIV prevention and treatment services based on exchange missions are direct, significant developments under S2S platforms.

Partners include governing-board members of national AIDS control councils, administrative heads of public health research institutes, programme managers at government and non-government levels, research agencies and communities and national AIDS control bodies and organizations at the national and subregional levels. The role of governments is to recommend centres of excellence, non-governmental and community- based models and public-private partnerships that promote partnerships between institutions and communities. The Head of the National AIDS Control Organization in India and the Secretary of the National AIDS Council in Indonesia chaired the missions at the national level, exchanged countries’ progress, and reviewed opportunities for future collaboration and focus areas to share best practices. Representatives of community-based organizations from key populations were part of country missions as equal partners and agreed on common agendas and priority areas for cross- learning. In addition, technical experts from centres of excellence extended their support by providing technical assistance to improve the quality of HIV services in the area of prevention and treatment for key affected populations and people living with HIV. This was facilitated by UNAIDS country offices in the respective countries involved in this project.