April 25, 2023UNAIDS

TB/HIV policy monitoring & advocacy - an HIV institutional perspective

Alasdair Reid

April 25, 2023UNAIDS

Outline• Historical perspective • International policy

frameworks and commitments to addressing TB in people living with HIV

• Translating global commitments into local action

• Engaging civil society in M&E of national TB/HIV activities

Advocacy• A set of targeted actions in support of a specific

cause

• A strategic process to influence positive political, social, economic and cultural change – UNAIDS

• Getting influential people to do what you want them too….

April 25, 2023UNAIDS

• Greater involvement of people living with HIV/AIDS• People living with HIV

- understand their situation better than anyone- best placed to support/educate one another- best placed to represent their needs in decision- and policy-making forums

• First voiced in 1983 at a national AIDS conference in Denver, USA• Formally adopted as a principle at the Paris AIDS Summit in 1994

- 42 countries declared GIPA critical to national AIDS response• GIPA now backbone of many AIDS interventions worldwide• People living with/affected by HIV involved in wide variety of activities

- appearing on posters, in videos, in plays- bearing personal testimony, and - supporting and counseling others with HIV- participating in major decision- and policy-making activities

GIPA principle

April 25, 2023UNAIDS

• Strong civil society movement against TB pre-antibiotic era- KNCV 1903 and UNION 1867/1920

• DOTS strategy 1993- Community involvement not explicitly

mentioned• WHO Community TB care project 1999

- Community-based care/role of community in delivering care rather than engagement of community in advocacy/activism, planning, M&E

• Amsterdam Declaration to Stop TB 2000- Recognised importance of building

partnerships with community

Civil society involvement in TB control

April 25, 2023UNAIDS

• Advocacy, Communication and Social Mobilization Working Group- Established 2005

• Global Plan to Stop TB (2006 – 2015)- Meaningful involvement of patients and

affected communities

• Stop TB strategy 2006- Empower people with TB and

communities

• WHO Global TB Control Report 2006

Civil society involvement in TB control

HIV• HIV epidemic began 25 years ago

• History of strong political advocacy/activism

• Rapid test on finger prick or saliva in minutes, simple and accurate

• Dozens of new drugs to treat HIV

• US research budget for HIV $3000 million (global at least $8bn)

TB• TB thousands of years old

• Recent adoption of advocacy/activism

• Diagnostic test more than 120 years old, tedious & inaccurate

• No new TB drugs for >40 years

• Global research budget for TB $430 million

Power of advocacy

Civil society role in global policy & advocacy

• Global Plan to Stop TB (2006-2015)- TAG and other civil society groups refused to endorse

the TB/HIV WG component of the GP as it was too slow and not in line with Universal Access

- Now (some of) TB/HIV WG targets being met in Africa

• UNGASS 2006- Shadow civil society reports- TAG and OSI lobbied country missions to include TB

language in UNGASS political declaration- ‘Emphasize the need for accelerated scale-up of

TB/HIV activities, in line with GP 2006-2015, and for investment in new drugs, diagnostics and vaccines that are appropriate for people with TB-HIV co-infection’

Civil society role in global policy & advocacy

• UNAIDS Programme Coordinating Board, Chiang Mai 2008- Important role that the NGO delegation played in promoting

TB as an important issue for people living with HIV at the PCB in 2007

- Active participation of HIV and TB civil society groups in PCB – presentations, panel debates and market place

Recognizes the 2006 UNGASS commitment to Universal Access to address threat of TB, esp MDR/XDR TB, poses to people living with HIV

Calls on member states to mobilize affected communities, CBOs & FBOs in addressing TB in people living with HIV

including issues of stigma, human rights, migrants and other marginalized populations and adherence support

Recognizes the need for a person-centered approach (one life – two diseases)

Requests UNAIDS and WHO to build capacity of affected communities to respond to the dual epidemics of TB and HIV

Civil society role in global policy and advocacy

• First HIV/TB Global Leaders Forum on HIV/TB- Major input from civil society - redrafted- Call to action reflects the decisions of the PCB

• UN High Level Meeting on HIV/AIDS 2008- Panel 4

• At country level- OSI Public Health Watch projects

supported 53 individuals and organizations in 38 countries to conduct monitoring and advocacy of policies on TB and HIV

- Stop TB Partnership Challenge Facility Supports civil society engagement in advocacy and

social mobilization activities to raise awareness and shape TB policy at local and national levels

Awaiting evaluation of first year of funding

Thank you!