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|Naam||International HIV/AIDS Alliance (Joannah Davis)|
|Datum||22 maart 2018|
In order to prevent instability in the regions around Europe it will be important not only to prevent conflict, but health epidemics and pandemics such as HIV, Tuberculosis and Hepatitis C, which contribute to cross national health security threats. Diseases exacerbate poverty, decrease social cohesion and contribute to instability. These diseases affect migrating communities, particularly members of LGBTI communities who flee their countries to find safer spaces. HIV/AIDS is not over, every year more than 1.6 million people acquire HIV. Eastern Europe and Central Asia is the only region in the world where the HIV epidemic continues to rise rapidly, with a 60% increase in annual new HIV infections between 2010 and 2015. In 2016, there were roughly 190,000 new HIV infections in Eastern Europe and Central Asia. An epidemic of drug-resistant tuberculosis (TB) is mounting in Eastern Europe, and without intervention on multiple fronts there is little hope the spread will slow. It is in the Netherland’s and Europe’s interests to contain the epidemic on their doorstep.
New HIV infections all over the world are concentrated among key populations; LGBTI people, sex workers, people who use drugs, and migrants. This is particularly true in Eastern Europe, the Middle East and North Africa. These populations experience high levels of stigma and discrimination, and are often criminalised, which prevents them from accessing HIV prevention and treatment services. The Netherlands has shown great political leadership in advocating for the rights and health of these groups, and should continue to do so, for example by remaining active in the Global Prevention Coalition. The Netherlands is one of the main funders of harm reduction programmes. These programmes are effectively slowing down the spread of HIV/AIDS, hepatitis C and TB. We hope that the Netherlands will continue championing and funding these life-saving programmes. In an era of closing space for civil society and growing conservatism, we will lose ground in areas such as drug policy without the leadership of the Netherlands and a coalition of the progressive governments. This was evident at the Commission on Narcotic Drugs in March 2018 in Vienna when the Outcome Document agreed at UNGASS 2016 was under attack by the Philippines, Egypt, China and Pakistan. Drug policy reform is a development issue: we cannot achieve the SDGs unless we end the ‘war on drugs’.
Global data highlights the alarming impact of HIV on adolescents and young people. HIV is the second largest cause of death of adolescents globally, and the first in Africa. East and Southern Africa is home to two-thirds of all A&YPLHIV (aged 15-24), with an estimated 430,000 young people acquiring HIV every year.
Many young people face elevated risks during adolescence as this is period of experimentation and physical and emotional change. It is a time of emerging sexuality, and changes in their brains and bodies influence the choices they make. They can become more vulnerable to HIV and SRHR problems through lack of accurate information, use of alcohol and drugs, sexual debut, multiple partners, unsafe sexual practices, and poor access to relevant and responsive services. Negative cultural attitudes to young people’s sexuality, gender norms and practices, violence, poverty, and the lack of participation of young people in decisions that affect their lives, all impact on their long term health.
We recommend that the Netherlands support government and civil society programmes that integrate HIV, sexual and reproductive health and rights (family planning), education, and employment interventions in order to ensure that young people are resilient and empowered to make informed decisions about their health and lives. Just creating employment opportunities will not be sufficient if there is not a healthy and productive workforce. Likewise, just delivering HIV or family planning interventions through the health system will not be effective if young people have no motivation in life because of a lack of educational and employment opportunities. Civil society can support the Netherlands and its government partners in low and middle income countries to design integrated programmes and create referral pathways that deliver a healthy, productive workforce.
In the Netherlands’ previous strategy ‘A World to Gain’, countries were categorised as Trade, Transition, or Aid based on income status. In the development of the new strategy, we suggest that the government considers the growing inequality within Middle Income Countries (MICS) and tailors its aid interventions accordingly. 70%, or 1.6 billion of the world’s poorest people now live in MICS, according to the Global Multidimensional Poverty Index published by the University of Oxford. By 2020, 70% of people living with HIV will also live in MICS.
While there has been a marked increase in domestic funding for health, especially in MICS, domestic funding is not tailored to meet the needs of the most marginalised, for example young women and girls, LGBTI communities, people who use drugs, sex workers, or even the very poor. Transitions can be a particularly risky time for these key populations. In countries where key populations are politically unpopular, discriminated against or even criminalised, the national government may be reluctant or unwilling to take over provision of services when a donor exits.
So what can the government of the Netherlands do? It can work with the multilateral mechanisms in which it invests, such as the Global Fund to Fight AIDS Tuberculosis and Malaria (GFATM), to carry out more responsible transitions in Middle Income Countries. This includes funding civil society before, during and after the transition process. The Netherlands can also challenge governments who leave key populations behind when they take over service provision. Finally, the Netherlands, can provide new bilateral funding mechanisms for CSOs working with key populations in countries where Global Fund has withdrawn.
We congratulate the Netherlands on creating the innovative and transformative Dialogue and Dissent strategic partnership. Significant advocacy capacity strengthening and advocacy results have been achieved by the communities and partners we work with as part of this programme. For example, our partner in Kenya has recently won an historic court case appealing the use of forced anal examinations, a major breach of human rights. In Uganda we are building political and public support for the start-up of life-saving harm reduction programmes. We encourage the Netherlands to continue supporting civil society strengthening and engagement in decision-making processes, in order to hold governments to account.