Communities Stepping It Up: the making of community led advocacy for sustainable financing of HIV prevention and treatment in Asia

by Min Fuh Teh | Capacity Development Advisor, Australian Federation of AIDS Organisations

Funding decisions for South East Asia’s HIV response has traditionally been the purview of policy makers, government ministries and development aid donors. Often regarded as a technocratic field, this perception of HIV financing has limited the input from communities and individuals most affected by HIV, despite these decisions directly affecting them.

Recent changes to the eligibility of developing countries for international funding threaten to entrench this problem and make it worse. As countries experience rapid economic growth they progress towards middle-income status and reduced eligibility for international development funding. Compounding this problem, communities most affected by HIV – gay men, transgender people, people who use drugs and sex workers, are primarily funded by international donors. These stigmatised communities struggle to attract investment from local governments.

This poses an urgent question: will local governments pick up where international donors left off, and invest in tried and true HIV responses for communities most impacted by HIV?

In response to this, AFAO in 2017 led the SHIFT Program, a multi-country initiative that worked towards strengthening the capacity of communities to advocate for sustainable, cost-effective and strategically allocated funding for the HIV response in Indonesia, Malaysia, the Philippines and Thailand. Funded by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the two-year program partnered with communities most affected by HIV, civil society organisations and country governments to ensure HIV programs and services can be sustainably resourced.

SHIFT put the role of communities as equal partners in HIV financing decisions centre-stage. It succeeded in integrating communities and civil society in domestic decision-making processes. In Indonesia, the program established civil society coalitions at both the district and national level to work with government stakeholders in budgetary planning for HIV. Through the program partner Indonesia AIDS Coalition (IAC), more than 30 civil society organisations working with communities on HIV were mobilised to engage in high level budgetary advocacy and decision making. As a result of these engagements, a significant sea-change in the government’s attitude to civil society saw IAC invited to contribute to the National HIV Strategic Plan of 2020-2024.

In Thailand, relationships between government and civil society have also been fostered by program partner Thai National AIDS Foundation (TNAF). Under TNAF’s leadership, an agreement was formalised with the government health insurance agency to ensure funds can be provided to community organisations for HIV prevention work. To further build trust between government agencies and civil society, TNAF and partner organisations have been progressing with an accreditation system for community organisations with robust guidelines to support organisations in complying with government regulatory frameworks.

In Malaysia, a partnership with Malaysian AIDS Council (MAC) saw the inclusion of key population representatives as formal members to the Ministry of Health’s HIV decision making board. To further build the capacity of community’s HIV financing knowledge and use in advocating for their communities, a series of workshops were organised in the lead up to the national grant proposal rounds for HIV funding. This resulted in an increase in robust funding proposals for programs targeting underserved communities such as gay men and transgender people.

Furthermore, on the heels of an election win for a progressive government in Malaysia, the SHIFT program pushed forward an initiative to cost the impact of criminalising drug use. A collaboration between communities and academics, the research presented clear evidence of the funds saved through harm reduction, as opposed to a punitive approach to drug use. With the government considering repealing criminal drug laws and abolishing the death penalty, these findings provide traction for legal reform and a policy guide for better allocation of tax payers’ money in health.

In the Philippines, a remarkable feat of legal reform was made possible through sustained community mobilisation. Led by program partner Action for Health Initiatives Inc. (ACHIEVE), national and sub-national civil society actors, senators and public figures were mobilised to repeal a 21-year-old AIDS bill. The sustained mobilisation succeeded in passing the bill, known as the HIV and AIDS Policy Act, aligning it with current rights-based responses. Some advancements include a lowered age of consent for HIV tests from 18 to 15, free and accessible HIV treatment, and anti-discrimination and workplace confidentiality provisions.

The SHIFT program has shown that despite the technical nature of HIV financing, communities have every bit the capacity to engage purposefully in advocating for the rights and needs of their communities. Beyond an ethical imperative – the call for approaches that respect the adage of “Nothing for us without us” needs to be put centre-stage. This is not just in the design of heath and HIV interventions, but also in the upstream decision-making processes, especially when it concerns the resourcing of programs that will most impact these very communities. The SHIFT program and the many lessons learned will hopefully continue to galvanise interest and initiatives in ensuring communities are positioned as equal players in the HIV financing field.