AIDS Action Europe: Strategic framework 2011-2015
Together we work towards a more effective response to the HIV epidemic
Amsterdam, December 2010 Martine de Schutter, Executive Coordinator AIDS Action Europe
Together we work towards a more effective response to the HIV epidemic
Contents 1
Introduction
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2 2.1 2.2 2.3 2.4 2.5 2.6 2.7
AIDS Action Europe’s vision, guiding principles, core values and mission Who we are Our vision Our guiding principles Our core values Our mission Our strategic objectives: What we aim for Our strategic directions: What we do
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3 3.1 3.2 3.3 3.4
Context, challenges and opportunities Epidemiology Global and European commitments and policy frameworks Human rights, stigma and discrimination Funding the response to the epidemic
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4 4.1 4.2 4.3
Strategic directions 2011-2015 Strategic direction 1: Make an effective and meaningful contribution to regional and national policies related to HIV and AIDS Strategic direction 2: Facilitate continuous exchange among NGOs on good practices and lessons learned related to HIV and AIDS Strategic direction 3: Develop a stronger, more effective organisation and network
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Governance
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Strategic partnerships
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Financial coverage of the strategic plan
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Annex: list of abbreviations
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Introduction
AIDS: because the global fight against HIV and AIDS is what unites our members Action: because we want to move beyond networking into concrete actions Europe: because we need to collaborate on a shared agenda in Europe In March 2004, these were the words of Peter van Rooijen representing AIDS Action Europe’s interim Steering Committee at the Open Forum on AIDS Action in Europe. This event, which took place in Brussels, gathered some 100 NGOs who witnessed the beginning of a new structure for Pan-European collaboration in the response to HIV and AIDS: AIDS Action Europe. Six years later, the partnership has grown to 400 NGOs and community organisations in Europe and Central Asia. At recent AIDS Action Europe Steering Committee meetings an overall strategy for the coming years was defined, as well as the general mission, vision, guiding principles and core values of the network. With this strategy for the period 2011-2015 we aim to set out a clear agenda for strengthening the response to the epidemic, maintaining our commitments and providing a framework to prioritise our actions. In the coming period AIDS Action Europe will continue to work on strengthening NGOs to make an effective contribution to European HIV policies through advocacy and public policy dialogue and facilitating continuous exchange among NGOs on good practices related to HIV. Together we work towards a more effective response to the HIV epidemic.
Harry Witzthum Chair Steering Committee AIDS Action Europe
Martine de Schutter Executive Coordinator AIDS Action Europe
Amsterdam, December 2010 For more information, please contact the office at office@aidsactioneurope.org or visit www.aidsactioneurope.org
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2 2.1
AIDS Action Europe’s vision, guiding principles, core values and mission
Who we are
Founded in 2004, AIDS Action Europe is a partnership of almost 4001 AIDS-related non-governmental organisations from 45 European and Central Asian countries. We currently have 132 members in 26 countries of the European Union, as well as 262 from 19 Eastern European and Central Asian countries outside the EU. We are the regional network of ICASO, the International Council of AIDS Service Organizations.
2.2 Our vision
As regional office of ICASO, AIDS Action Europe is part of ICASO’s mission to mobilize and support diverse community organisations to build an effective global response to HIV and AIDS. This is done within a vision of a world where people living with and affected by HIV and AIDS can enjoy life free from stigma, discrimination, and persecution, and have universal access to prevention, treatment, care and support.
2.3 Our guiding principles
We are committed to ICASO’s guiding principles: • The central role of people, communities and their organisations in developing and implementing national and international policies and programs; • The right of each community-based organisation to determine its own priorities, methods of organisation, and programs, and to have those choices respected by governments and international agencies. • Ensuring the protection and fulfilment of the human rights of all people living with, affected by, and vulnerable to HIV/AIDS; • The GIPA principle that advocates and promotes the “greater involvement of people living with, and affected by HIV/AIDS” in all aspects of prevention, care and support and research; • Ensuring that the needs of women living with, affected by and vulnerable to HIV/AIDS are addressed, and that they are guaranteed an equal voice in policy and program development and implementation; • Ensuring that the needs of young people and children living with, affected by and vulnerable to HIV AIDS are addressed, and that they are guaranteed an equal voice in policy and program formulation and implementation; • Non-discrimination and non-stigmatisation on the grounds of HIV status, gender, religion, race, sexual 1
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Number of members as of October 2010
Together we work towards a more effective response to the HIV epidemic
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orientation, age, cultural or social class, citizenship status, drug use, or employment in the sex industry; Removing fear, coercion and deception from all HIV/AIDS policies, programs and services; Ensuring that relevant international programs are coordinated, and involve partnerships among those living with, and affected by HIV/AIDS, communities and their organisations.
2.4 Our Core Values
Our work is guided by a set of core values, which shape the ethical framework for our actions. • Be accountable and hold others accountable While political commitments, human and financial resources are all essential to support implementation efforts, they do not of themselves guarantee results. AIDS Action Europe will hold leaders accountable for the formal commitments they have made about the response to the HIV/AIDS epidemic, particularly related to the UNGASS (2001) and Dublin (2004) Declarations, Millennium Development Goals and the EU Communication on HIV/AIDS (2010-2014). We will also hold ourselves accountable for commitments made by civil society. We aim to live up to the principles in the code of good practice for NGOs responding to HIV/AIDS2. We will build capacity of the community sector to mobilise and directly inform and advocate for effective programming and policies, especially on expanding and aligning prevention alongside treatment in order to achieve universal access and a comprehensive response to HIV and AIDS. • Be transparent We are transparent, honest and ethical about our mission, activities, results, achievements, budget and funding sources and our members and partners. This information is easily accessible and open to the public3. Our partnerships should sufficiently guarantee the independent position and the integrity of AIDS Action Europe, as reflected in our ethical code that provides guidelines for partnerships and sponsoring, for working with the private sector4. We have transparent procedures for membership and partnership and the Steering Committee and office staff election processes.
See the full code at http://www.hivcode.org/ See www.aidsactioneurope.org 4 See www.aidsactioneurope.org 2 3
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• Be inclusive Membership is free and open to all NGOs in Europe and Central Asia, including national networks, AIDS service organisations and community-based groups of people living with HIV/AIDS. Those that do not fit into this definition can apply as partners. AIDS Action Europe partners are European networks, governmental organisations, global networks and international organisations that are active in the field of HIV/AIDS in Europe and Central Asia. Organisations can become a member or partner as long as they endorse our mission and ethical code. We strive for diversity in terms of HIV status, gender and geographical representation in our Steering Committee, application is open to all member organisations. Our inclusive approach is also put into practice through our bilingual communications (website and other means) in English and Russian. • Put in practice the GIPA principle (greater involvement of people living with HIV) People living with HIV understand each other’s situation better than anyone and are often best placed to counsel one another and to represent their needs in decision- and policy-making forums. GIPA is critical to ethical and effective responses to the epidemic. In our selection process for new Steering Committee members we explicitly aim to maintain a good balance in terms of the representation of people living with HIV. Among our member organisations a considerable number are community groups of people living with HIV. We also strive explicitly to have people living with HIV play key roles at international and regional fora, in representation of AIDS Action Europe or as partners in the process. • Work from a human rights based approach To properly address vulnerability to HIV and access to prevention and services, the abuse of human rights needs to be addressed. Without this the result is continued discrimination and disempowerment of people living with HIV, men who have sex with men, injecting drug users, migrants, sex workers and other groups at risk. This places them at further risk of violence and exposure to HIV and reduces their access to necessary prevention, care and treatment services. We will maintain our commitment to challenging policies, programming and practices that undermine best practice in public health and/or that violate human rights and allow for stigma and discrimination.
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• Facilitate a networking and partnership culture We continue to improve our communication with members and partners, as well as other stakeholders, through different channels, such as the Clearinghouse and website, the HIV/AIDS Civil Society Forum, e-news, social media. We facilitate capacity development of our member organisations. We also continue close collaboration and where possible find synergy with other key European and international networks and organisations, such as EATG, ICASO, European Commission, WHO Europe, ECDC and UNAIDS. • Be cost-effective AIDS Action Europe intends to be focused and pragmatic about achieving our objectives. We are committed to build on existing experiences, expertise and infrastructure provided by our members and the organisations and institutions with whom we work and to prevent duplication of existing activities. We strive to use the best available evidence in our decision-making process and priority setting. Our decisions are based on the principle that we will provide a given level of service at least cost. We offer quality products, but will not spend resources on unneeded luxury. • Make a difference AAE intends to be pro-active and to remain goal-oriented, since we aim to make a difference, which means that we aspire as the result of our actions significant change, as reflected in a more effective response towards the epidemic in Europe and Central Asia. We do not want to do more of the same, but choose our priorities and actions on the basis of a sound judgement of the need in the region and the most effective approaches.
2.5 Our mission
To unite civil society to work towards a more effective response to the HIV epidemic in Europe and Central Asia. We strive for better protection of human rights and universal access to prevention, treatment, care and support. We work towards a reduction of health inequalities focussing on most at risk populations and the epidemic in Central and Eastern Europe and Central Asia.
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2.6 Our strategic objectives: What we aim for
Framed by our mission, vision, guiding principles and core values, AIDS Action Europe’s strategic objectives in Europe and Central Asia are to strengthen civil society’s contribution to a more effective response to the HIV epidemic by: • Making an effective and meaningful contribution to regional and national policies related to HIV and AIDS • Facilitating continuous exchange among NGOs on good practices and lessons learned related to HIV and AIDS • Developing a stronger, more effective organisation and network
2.7 Our strategic directions: What we do
AIDS Action Europe’s core strategic directions and activities centre on (1) advocacy and public policy dialogue and (2) linking and learning. These two strategies are interconnected. Through advocacy and agenda setting at global, European and national levels, we influence policy development. Our role as e.g. co-chair of the HIV/AIDS Civil Society Forum – an NGO advisory body to the European Commission – ensures that the voices of NGOs are heard by policy makers, regional institutions and key stakeholders. Through linking and learning on the basis of specific capacity development projects, our online Clearinghouse platform, website and regular communication channels, an exchange between our members in the wider European and Central Asian region5 is facilitated.
5 Our region includes the following sub regions and countries: Central Asia: Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Central Europe: Albania, Bosnia and Herzegovina, Bulgaria, Croatia, Cyprus, Czech Republic, Hungary, Poland, Romania, Serbia and Montenegro, Slovakia, Slovenia, Macedonia and Turkey. Eastern Europe: Baltic States (Estonia, Latvia and Lithuania), Belarus, Caucasus Republics (Armenia, Azerbaijan and Georgia), Moldova, Russian Federation and Ukraine. Western Europe: Andorra, Austria, Belgium, Denmark, Finland, France, Germany, Greece, Iceland, Ireland, Israel, Italy, Luxembourg, Malta, Monaco, Netherlands, Norway, Portugal, San Marino, Spain, Sweden, Switzerland and United Kingdom.
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3.1
3
Context, challenges and opportunities
Epidemiology
HIV is still a major concern for public health in our region. Almost 30 years into the epidemic. Over 100’000 new cases of HIV were reported in 2008, bringing the estimated number of adults and children living with HIV in Eastern Europe and Central Asia6 to 1.5 million in 2008 [1.4 million–1.7 million according to the latest data from UNAIDS] – a staggering 66% increase from 2001. This is the highest annual increase to date for Europe and Central Asia. To make things even worse: the epidemic does not look the same throughout the region, there are different challenges in different regions. The rate of newly diagnosed HIV cases reported per million varies widely among the three geographical areas in Europe and Central Asia (East, Centre and West). By far the highest rate has been reported in the East (179/million), which is more than twice that which has been reported in the West (72/million) and more than ten times that in the Centre (15/million)7. Aggravating the situation, there is a full-blown funding crisis in Eastern Europe and Central Asia, due primarily to the economic crisis on the one hand, and the withdrawal of the Global Fund for AIDS, Tuberculosis and Malaria (GFATM) from previous non-EU countries that are now (candidate) EU-members or countries recently showing increased economic development putting them out of reach of GFATM criteria. In both cases, affected governments do not seem eager to fill the funding gaps and many well-devised programmes are being threatened to close down and thereby reverse whatever progress has been made in recent years. The sharp increase in HIV infections over the past decades has strong correlations with processes of social exclusion. The populations experiencing greatest exclusion—across economic, social, cultural and political dimensions have been disproportionately vulnerable to HIV infection and have been facing considerable barriers in access to necessary prevention, treatment, care and support services8. A number of countries have expanded access to antiretroviral therapy, but treatment coverage remains low. By December 2008, 22% of adults in need of treatment were receiving it. This is considerably less than the global average for low- and middle income countries (42%). Evidence suggests that injecting drug users, the population most at risk of HIV infection in Eastern Europe and Central Asia, are often the least likely to receive antiretroviral therapy9. ECDC and WHO Europe state that interventions to control the epidemic should be evidence-based and adapted to the country and geographical area. From the surveillance perspective the following is recommended10: 8 9
Fact sheet HIV in WHO Regional office in Europe (EURO), 2010 ECDC/WHO Regional Office for Europe. HIV/AIDS Surveillance in Europe 2008 Fact sheet HIV in WHO Regional office in Europe (EURO), 2010 Fact sheet HIV in WHO Regional office in Europe (EURO), 2010 10 ECDC/WHO Regional Office for Europe. HIV/AIDS Surveillance in Europe 2008 6 7
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• • • •
For the countries in the East: interventions to control HIV among injecting drug users, including harm reduction programmes, should be the cornerstone of HIV prevention strategies. Measures should also be strengthened to prevent heterosexual transmission targeted at those with high-risk partners; For the countries in the Centre: prevention should be adapted to each country’s circumstances in order to limit the epidemic to its current low level. However, as the epidemic among men who have sex with men is increasing, interventions to control HIV in this group should be strengthened as a priority; For the countries in the West: interventions to control HIV among men who have sex with men should be the cornerstone of HIV prevention strategies, including innovative programmes for this group. Interventions for prevention, treatment and care must be adapted to reach migrant populations; Overall, HIV counselling and testing should be promoted to ensure early diagnosis and access to treatment and counselling to help prevent or reduce further transmission and improve the longer term treatment outcomes for the individuals concerned. Equity in access to HIV treatment and care for all population groups in need should be ensured in order for countries to reach the global goal of universal Access to prevention, treatment and care.
3.2
Global and European commitments and policy frameworks
HIV is a political priority for the region, which is reflected in several commitments and declarations during the past decade. The UNGASS commitment on reaching universal access by 2010, the Millennium Development Goals, the Dublin Declaration on Partnership to fight HIV/AIDS in Europe and Central Asia (2004) as well as the Vilnius (2004)11 and Bremen (2007)12 Declarations are frameworks for action for all key stakeholders from civil society to governments and other public and private partners. Across Member States, disparities in prevention, treatment and care continue to exist, and in our region ‘universal access’ is not a reality yet. This is acknowledged in the “Commission Communication on Combating HIV/AIDS in the European Union and neighbouring countries, 2009 -2013”. This region-wide policy has been developed by the 11
Vilnius Declaration on Measures to Strenghten Responses to HIV/AIDS in the European Union and in Neighbouring Countries (2004) Bremen Declaration on Responsibility and Partnership - Together Against HIV/AIDS (2007)
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European Commission for the member states of the European Union and neighbouring countries. There does not exist a similar comprehensive policy for Eastern Europe and Central Asia. The Communication is also a framework for action for the coming years for all stakeholders involved. The Commission Communication is a continuation of the first Communication, especially in terms of its focus on political leadership and human rights, though with greater focus on prevention, priority groups and key regions. Combating HIV/AIDS remains a public health concern and a political priority for the European Union and neighbouring countries. Intensifying prevention is recognised as key to combat HIV/AIDS. In the light of the current epidemiological trends and considering the most affected groups, the new policy prioritises men having sex with men, migrants and people using injecting drugs. The Communication particularly calls for action for the most affected sub region Eastern Europe. The priorities set in the Communication fit very well into the prime focus of AIDS Action Europe. In the Communication civil society is recognised as a key actor in combating HIV/AIDS at all levels and is considered instrumental in keeping HIV/AIDS on the political agenda. The European Commission wants to ensure that civil society stays involved in HIV/AIDS related policy development and implementation and remains a front line partner in a coordinated response, sharing responsibility for meeting commitments. Amongst others, AIDS Action Europe is involved through co-chairing of the HIV/AIDS Civil Society Forum. The 2010 progress report on implementation of the Dublin Declaration13, capturing reporting from 49 countries of the region, states that civil society is recognised as an important player in the response to HIV across the region and that it is heavily involved in that response. Almost all countries included in the survey (98%) reported involving civil society to some extent in developing their strategic framework. Governments and civil society acknowledged specific benefits of including civil society in the response to the epidemic. In 90% of the reporting countries civil society was fully or partially involved in the development of the strategic framework. 65% included most at risk populations in policy design and programme implementation. Although relations between governments and civil society have improved, there are common limitations among countries, due primarily to limited financial and technical support to civil society as well as limited involvement in national monitoring and evaluation activities. In conclusion, the ECDC identified the following needs for action: • to promote partnership between government and civil society based on mutual accountability • to involve key populations in all aspects of programmes that affect them • to evaluate civil society’s contributions and ability to contribute to the national response 13 European Centre for Disease Prevention and Control. Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 progress report: summary. Stockholm: ECDC; 2010.
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•
3.3
to provide adequate and sustainable financial support for civil society
Human rights, stigma and discrimination
“Protecting human rights, including the right to health, is an obligation of national governments under international law. The countries in the region must do a better job in ensuring those rights are respected and enforced. It is challenging…But it isn’t any harder than living with HIV.”14 The legislative framework and standards for social and health services for people affected by HIV/AIDS in Europe differ considerably between countries. Access to services and medical treatment, as well as to prevention or harm reduction measures, is often limited. Social exclusion, discrimination due to HIV status and the non-respect of basic human rights of people living with HIV still persist. In some countries sexual transmission of HIV can be considered a crime. Migrants, especially undocumented, face difficulties in access to services in several countries across Europe, as well as restrictions on entry, stay and residence based on HIV status. Conservative, sometimes religiously grounded, developments in the region do affect human, sexual and reproductive rights, access to prevention, treatment, care and support. The region has among the highest prices worldwide for treatment. There is increasing evidence of treatment interruptions and stock-outs of medication, both within the European Union as well as further Eastwards. We, as core regional network, need to act. Rights, stigma and discrimination should and will continue to be at the core of the work of AIDS Action Europe since stigma and discrimination severely affect the lives and health of people living with HIV as well as most at risk populations in general. Decriminalisation of personal behaviours (related to drug use, sex work, HIV exposure and transmission) is an immediate priority. We also need to produce, collect, disseminate and use evidence of what works and doesn’t work in combating HIV, in order to guarantee an evidence-based approach. The wide geographic and cultural diversity in our region is also reflected in the diversity in the epidemic. There are vast differences in the region, both in terms of HIV prevalence as well as the groups most at risk. The response should therefore be tailored well to the local priorities and most effective approaches. Throughout the region however, a common concern is the stigma and discrimination experienced by people living with HIV and the most at risk populations. Working from a human rights perspective is crucial to respond adequately to the epidemic. 14 Unprevented and prevented HIV cases in Europe and Central Asia. Presentation by A. Shakarishvilli at the regional session on Europe and Central Asia. International AIDS Conference, Vienna, July 22, 2010.
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The Dublin progress report 2010 presents strong evidence of residual stigmatisation and discriminatory attitudes. More than half of the countries reported having laws, regulations or policies that present obstacles to effective prevention, treatment, care and support for groups most at risk. These obstacles are particularly identified for people using drugs (64%), prisoners (56%) and migrants (48%). It is unclear to which extent available mechanisms, such as relevant law and policies, are used to combat stigma and discrimination15. The Dublin progress report also shows clearly the current lack of knowledge about the extent of stigma and discrimination in the region. Only 39% of countries were able to provide data about attitudes towards people living with HIV. Less than half of countries have policies prohibiting HIV screening for employment purposes and only 55% have programmes to reduce stigma and discrimination. The same patterns is seen with non-discrimination laws and regulations. There is definitely a gap between the protection of human rights on paper and actual practice.
3.4
Funding the response to the epidemic
Financing for national HIV responses in the region is increasingly coming from domestic sources. But external financial support for the low- and middle-income countries is still needed and the countries are concerned that the financial crisis limits their access to external funding sources, such as the GFATM16. Around 50% of the international donor funding for Eastern Europe and Central Asia is spent on prevention, while in the case of government funding this is only 20%17. The Dublin progress reports shows that per person expenditure on HIV prevention has ranged from €0,05 in Malta to €4,44 in Luxemburg. The extent to which countries’ prevention expenditure focused on specific populations at risk varied from 1% in Kazakhstan to 97% in Czech Republic18. There is evidence that some countries in the region are effectively using their funding for prevention to reach the most at risk populations. But if you look at HIV spending on prevention in Eastern Europe and Central Asia, the situation is 15 European Centre for Disease Prevention and Control. Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 progress report: summary. Stockholm: ECDC; 2010. 16 European Centre for Disease Prevention and Control. Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 progress report: summary. Stockholm: ECDC; 2010. 17 Is there enough political commitment for funding? Presentation by S. Schonning at the regional session on Europe and Central Asia. International AIDS Conference, Vienna, July 22, 2010. 18 European Centre for Disease Prevention and Control. Implementing the Dublin Declaration on Partnership to Fight HIV/AIDS in Europe and Central Asia: 2010 progress report: summary. Stockholm: ECDC; 2010. 19 Is there enough political commitment for funding? Presentation by S. Schonning at the regional session on Europe and Central Asia. International AIDS Conference, Vienna, July 22, 2010.
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worrisome. 89% of government funding goes to general population prevention programmes, although most countries’ epidemics are dominated by injecting drug use. This means that only 11% of governmental funding for prevention is spent on the groups most at risk: people using drugs (8%), sex workers (2%) and Men having sex with men (1%)19. Within the region the following funding characteristics by sub region can be identified: Eastern Europe and Central Asia • Big increase in funding since UNGASS • GFATM funds stimulate national funds • Underinvestment in prevention (especially from national funds) • Gross underinvestment in programs targeting most-at-risk populations • Money wasted on high pharmaceutical prices • Most-at-risk populations and people living with HIV may be penalized by GFATM eligibility criteria Central and South East Europe • Not eligible for GFATM • Low donor interest • EC funds not accessible • Declining support for programs • Perceived “low prevalence” makes HIV a low priority • High pharmaceutical prices20 Western Europe • Low donor interest • EC funds are limited • Declining national support for programs
20 Is there enough political commitment for funding? Presentation by S. Schonning at the regional session on Europe and Central Asia. International AIDS Conference, Vienna, July 22, 2010.
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A major concern is how funding opportunities will develop in the context of the current global economic crisis. In the last couple of years it has been difficult for many NGOs, especially those in new EU member states and Eastern Europe and Central Asia, to access international and domestic funding. A considerable number of donors have phased out of the bigger part of Europe, which is also the case with the GFATM, which until now has been a key funder in Eastern Europe and Central Asia. In several countries, governments or other donors have not stepped into the funding gap due to withdrawal of GFATM resources. This situation, worsened by the economic crisis, will affect human and financial resources to tackle the epidemic, and NGOs, including AIDS Action Europe, will face severe challenges in securing sustainable funding and maintaining core programmes and projects that have proven to be effective.
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Strategic directions 2011-2015
Framed by our mission, vision, guiding principles and core values, AIDS Action Europe’s strategic objectives in Europe and Central Asia are to strengthen civil society’s contribution to a more effective response to the HIV epidemic by: • Making an effective and meaningful contribution to regional and national policies related to HIV and AIDS; • Facilitating continuous exchange among NGOs on good practices and lessons learned related to HIV and AIDS; • Developing a stronger, more effective organization and network.
4.1
Strategic direction 1: Make an effective and meaningful contribution to regional and national policies related to HIV and AIDS
4.1.1 What is the current situation? For the European Union member states and neighbouring countries in Eastern Europe, the new EU Communication on HIV/AIDS is a framework for action for the period 2009-2013. For the remaining countries of our region in Eastern Europe and Central Asia, no such umbrella policy, supported by national government, does exist. WHO and UNAIDS are currently developing strategic frameworks for the period 2011-2015, globally as well as regionally. While some progress is being made throughout the region in terms of better legislative environments, better access to treatment and prevention programs, we also observe some worrisome trends: a harsher political environment towards migrants, criminalisation and other restrictive legislation affecting people living with HIV and other most at risk groups such as migrants, men having sex with men and people using drugs, rise of (religious) conservatism, less tolerant societies, homophobia, xenophobia. Even though there is by now sufficient scientific evidence that harm reduction programs work, some countries are refusing to implement such programs and thereby fuelling the epidemic. In parts of Eastern Europe and Central Asia drug control policies do severely limit access to harm reduction services and foster repressive policies towards injecting drug users that hinder the access to effective prevention programmes. Access to treatment is not universal across the region. As already indicated earlier, access to treatment in Eastern Europe and Central Asia is a serious issue of concern, including the growing number of reporting on stock-outs both within the European Union as well as Eastern Europe and Central Asia and the indications of treatment interruptions. In several countries, the health care system works along vertical lines and lacks a good referral system, for example
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for co-infections (Hepatitis B and C, tuberculosis), other STIS and broader sexual and reproductive health. On top of that, the economic crisis has led to serious budget cutbacks that negatively affect the health response and capacity to roll out effective programs. Experts speak of a funding crisis with respect to the region. 4.1.2 What do we envision? We envision a Europe and Central Asia where public policies and programmes related to HIV are developed from a human rights and public health perspective, evidence-based, non-discriminatory and aiming to reach universal access to prevention, treatment, care and support for all. The region, including ourselves as regional network, needs to make more effort to live up to global & regional commitments, primarily the UNGASS and Dublin Declarations Rights, stigma and discrimination need to continue to be at the core of the work of AIDS Action Europe since stigma and discrimination continue to affect the lives and health of people living with HIV as well as most at risk populations in general. 4.1.3 How do we want to do this? In 2004, AIDS Action Europe was invited by the European Commission to co-chair, together with the European AIDS Treatment Group (EATG), the HIV/AIDS Civil Society Forum (CSF). After 2 meetings in 2004, the CSF was formally established in 2005. The CSF is an advisory body to the Commission to facilitate the participation of non-governmental organisations, including those representing people living with HIV/AIDS, in policy development and implementation and in information exchange activities. The Forum includes about 40 organisations from all over Europe. Since 2004, AIDS Action Europe has co-chaired two meetings yearly. The CSF has been pro-actively involved in several Commission policies on HIV/AIDS. The CSF acts also as an informal advisory body to the European Think Tank on HIV/AIDS, in which AIDS Action Europe has 3 seats. The Think Tank is a forum to exchange information between the Commission and the member states. The CSF enables AIDS Action Europe to raise awareness about arising issues, be involved in policy development, pro-actively advocate for policy and legal changes, and exchange information and good practices with a diverse group of national and regional stakeholders. Next to national NGOs and regional networks, the CSF includes representatives from WHO Europe, ECDC, UNAIDS, EMCDDA, GFATM, among others. Co-chairing of the CSF made a difference for AIDS Action Europe: it created opportunities to become a key partner
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in shaping European policies, setting priorities and advocate on key regional issues. The CSF is a core instrument to make our community voices heard. The co-chairing of the CSF enables AIDS Action Europe to be pro-actively involved in both the implementation of the Commission Communication, as well as to monitor and evaluate the process. We will define at the CSF meetings an action plan for civil society, and have twice yearly a monitoring moment. The CSF also works as a channel for AIDS Action Europe’s advocacy around key issues. Both positive and negative developments at the regional and national level can be addressed by the CSF, put on the agenda or otherwise taken action on. AIDS Action Europe would like to support its member organisations in their advocacy and lobby to improve policies and programmes in their countries, as well as to speak out on human rights violations. At present, there are insufficient human and financial resources to carry out this task in a sustainable way all over the region. The ROST project (Responding to HIV through Organisational Support and Technical Cooperation in EECA), led by AIDS Foundation East -West for AIDS Action Europe, will work specifically on developing the advocacy and resource mobilisation capacities of member organisations in Eastern Europe and Central Asia. As CSF co-chairs as well as directly as AIDS Action Europe, we will speak out on violations and advocate for protection of human rights, working towards a reduction of stigma and discrimination. 4.1.4 • • • • •
What do we want to achieve by 2015? The Commission Communication is implemented adequately, and both process and outcomes are monitored; Increased platforms for dialogue between civil society and decision makers at national levels are facilitated by AIDS Action Europe, through the ROST project and other channels; We have built bridges and alliances with civil society and key stakeholders such as policy-makers, lawyer collectives etc. HIV is mainstreamed in strategic documents and meetings; We have advocated with European and international governments to maintain their bilateral support for countries in Eastern Europe and Central Asia as well as their support to the GFATM, UNAIDS and other multilateral channels; AIDS Action Europe has advocated for the development of a strategy for the budget cutbacks that
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• • • • •
Central and Eastern Europe and Central Asia are facing; AIDS Action Europe has broadened its policy and advocacy work outside EU including Eastern Europe and Central Asia, prioritising an increase of political will of national decision makers to support HIV prevention among most at risk populations. Since Central Asia falls out of scope of the Civil Society Forum, we need to look into other mechanisms that can be used; In addition to the European Commission, WHO Europe and UNAIDS, we have strengthened relations with UNODC, taking into consideration that injecting drug use fuels the epidemic in many countries of our region; We have developed an advocacy agenda that prioritises the key issues that affect and connect civil society in our region and have reached out to the sub regions where we have fewer members, like Southern Europe; We have strengthened work with other networks, like EATG, to call for action on several treatmentrelated concerns, such as increasing number of stock-outs in the region (including the EU), treatment interruptions, as well as to advocate for better antiretroviral procurement procedures in Eastern Europe and Central Asia, with the aim of price reduction; As regional network of ICASO we have linked and where needed adapted our activities to global developments and have shared our lessons learned with other regions.
4.2
Strategic direction 2: Facilitate continuous exchange among NGOs on good practices and lessons learned related to HIV and AIDS
4.2.1 What is the current situation? Worldwide and in our region there are numerous programmes, projects, policy initiatives and other actions that are successful and have made a difference. Unfortunately these good practices are not always available for those in need, and the wheel is still being reinvented. With over 400 NGOs united in our network it is indisputable that we possess a valuable sum of expertise, resources and materials together. AIDS Action Europe has committed itself to prevent duplication of existing activities by stimulating linking and learning and encouraging our members and partners to share their work. To date21, more than 1,000 good practice materials and key documents have been shared 21
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1184 publications available in the clearinghouse in October 2010.
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and made centrally available through our HIV/AIDS Clearinghouse. Our other linking and learning activities are grounded in hosting the CSF as well as in specific capacity development projects and communication activities. Clearinghouse online database In March 2007 AIDS Action Europe launched the Clearinghouse www.hivaidsclearinghouse.eu to facilitate the exchange of good practices and key documents on HIV and AIDS across Europe and Central Asia. The HIV/AIDS Clearinghouse allows quick and easy cross-border information sharing on HIV related topics. Visitors can find all sorts of materials, including leaflets; videos; policy papers; and toolkits. The online database has now become one of the most well-known tools for NGOs, policy makers, European networks and projects and other stakeholders to share their information. It is closely linked to the members’ section on the AIDS Action Europe website, where all member organisations present themselves with their so-called member profiles. In addition, we recently created a section for Commission-funded projects to upload their profile and key products. This enables members and EU projects to know more about the work of their colleagues and to engage in further collaboration. Further linking and learning is facilitated through maintaining pro-active communication with the network, by continuously updating the website and through regular dissemination of a e-newsletters and clearinghouse updates. Through different projects, AIDS Action Europe has built and continues building capacity among its member organisations in the region on a variety of topics and approaches. Project ROST: Responding to HIV through Organisational Support and Technical Cooperation in EECA 2010-2012 This 3-year project is implemented by the Moscow Office of AIDS Action Europe’s partner organisation AIDS Foundation East-West. The goal of the project is to strengthen advocacy, resource mobilisation and networking initiatives carried out by AIDS-related non-governmental and community-based organizations at the national and regional level by supporting capacity development in these areas. At the same time this Project will increase AIDS Action Europe activities in Eastern Europe and Central Asia and will be a start for more active advocacy in and for this region. The project will build on the lessons learned with the PTAP and EPAA projects, carried out in the last years.
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Together we work towards a more effective response to the HIV epidemic
Project Community-based Advocacy and Networking to Scale upHIV prevention in an Era of Expanded Treatment (PTAP) 2005-2009 This project, coordinated by ICASO, involved 10 countries across five different continents. In Europe, the two participating countries were Russia and Ukraine. The regional coordination was done by AIDS Action Europe’s office in Vilnius. The national partners have built capacity and strong partnerships and coalitions of civil society organizations for advocacy around aligning and expanding prevention and treatment programs and services. The ending of PTAP end 2009 also meant the closure of the AIDS Action Europe office in Vilnius. Project European Partners in Action on AIDS (EPAA) 2006-2008 The EPAA project, funded by the European Commission and other sources, aimed to strengthen knowledge, capacity, discussion and exchange among AIDS related non-governmental organisations and community based organisations in Western and Eastern Europe. Among its main achievements were the development and maintenance of www.aidsactioneurope.org and the clearinghouse information database www.hivaidsclearinghouse.eu as well as the organisation of 7 European good practice seminars: Working with the media, Monitoring & evaluation, Legislative & judicial systems, Gay men’s health, Voluntary counselling & testing, Resource mobilisation and Public policy dialogue. Focus on Eastern Europe and Central Asia AIDS Action Europe aims to support our members in Eastern Europe and Central Asia to a larger extent. A needs assessment among our Eastern European and Central Asian members in 2007 defined the following priorities for AIDS Action Europe: • Increasing the capacity of national NGOs in advocacy by provision of direct technical assistance (seminars and trainings on advocacy related issues and lobbying skills, development of standard support letters, and organization of translations, dissemination of information about funding possibilities); • Networking to strengthen regional and sub-regional initiatives, regional communication and cooperation; • AIDS Action Europe’s role to link between different initiatives; • Participation in regional (European Union) actions related to HIV/AIDS and drug policy and global (Universal Access) initiatives ensuring that countries come as close as possible to goals set, promoting
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the involvement of civil society and acting together with other international organisations working on the European Union or global levels. Our current project ROST was developed taking into consideration the identified needs. But there are financial and capacity restraints that prevent us from responding to all identified needs of our member organisations and limit the scope of our actions. 4.2.2 What do we envision? We envision an accelerated response to the HIV epidemic in Europe and Central Asia thanks to joint efforts of and collaboration between NGOs, community based organisations and other stakeholders in which they share their expertise and strengthen each other’s capacities in achieving their joint goal to reach universal access to HIV prevention, treatment, care and support. 4.2.3 How do we want to do this? Through further development of the Clearinghouse, other communication activities and specific capacity development projects. The Clearinghouse, primarily developed for our member organisations, will be further developed towards a core information and exchange tool, also tailored to the needs of new users such as policy-makers, researchers, projects funded by the European Commission. In addition to ready to hand good practice materials, we are also looking into inclusion of quality assurance and quality improvement models that can be used when designing good practice materials. Our quality assurance initiative with WHO Europe and BZgA will help develop these areas further. We will implement a social media strategy to increase networking with and between our target groups. We will explore ways to involve our members more actively in ongoing discussions. The ROST project, implemented by AFEW, will develop training and small grants programmes for our member organisations to strengthen their advocacy and resource mobilisation skills. It will also develop e-learning courses in order also enable capacity development for those organisations who cannot attend the trainings. We will continue to reach out to civil society in the region to sign-up as member of AIDS Action Europe. We will explore additional capacity strengthening project opportunities.
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4.2.4 • • • •
What do we want to achieve by 2015? AIDS Action Europe members have strengthened their capacity on new communication technologies and advocacy and resource mobilisation skills; The Clearinghouse is among the main European places where up-to-date materials and key documents are shared pro-actively to contribute to the development of good practices in the region. It is used by a variety of stakeholders; The members and European projects profile pages on our websites are used by our members and other stakeholders to look for partners in joint activities and learn from each others approaches; We have used and disseminated in a structured way available evidence and examples of success.
4.3
Strategic direction 3: Develop a stronger, more effective organisation and network
4.3.1 What is the current situation? AIDS Action Europe has a considerable number of member organisations, almost 400, but a very small office to manage the network and run its projects. At present the office in Amsterdam consists of an Executive Coordinator, Fundraising Coordinator, Communications Coordinator and Programme Assistant. The language barrier does limit at times the pro-active involvement of the office in advocacy actions in Eastern Europe and Central Asia. In the Russian Federation, AIDS Foundation East-West staff manage the ROST project as well as the Russian communication of the network, including the Clearinghouse and website. The AIDS Action Europe Steering Committee is a committed group with acknowledged expertise. They can however only volunteer a limited part of their time to the governance of the network. AIDS Action Europe is recognised as one of the key players in Europe. We are therefore increasingly asked for advice, support, to join initiatives and projects and to even take over information databases and project activities from other organisations. At present the human and financial resources are inadequate to respond to the increasing demand and challenges.
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Together we work towards a more effective response to the HIV epidemic
4.3.2 What do we envision? A network and office that offers its members access to quality and updated information, pro-active in advocacy and policy-development, working in-depth on capacity development of our member organisations through specific projects. In the end, making a difference and contributing positively to a more effective response to the epidemic. 4.3.3 How do we want to do this? Maintain and expand our current way of working and communicating in both English and Russian: an inclusive approach that takes into consideration the variety in our region. Expand the office capacity and increasing both the number, diversity and total amount of sponsors. 4.3.4 • • • •
What do we want to achieve by 2015? Increased visibility of AIDS Action Europe by clear communication messages about our added value; Increased human and financial resources at the office of AIDS Action Europe; More sustainable solutions to address the administrative burden of fundraising and management by the office; The network has grown yearly with 10% new members.
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5
Governance
The AIDS Action Europe Steering Committee, composed of 12 member seats, acts as governing body of AIDS Action Europe on all programmatic issues concerning policy, strategy, finance, monitoring and evaluation. The Steering Committee is composed by individuals from members or partners of AIDS Action Europe. Its composition is balanced in terms of HIV status, gender and geographic representation. Steering Committee members attend on a personal title and in recognition of their personal expertise. AIDS Action Europe’s geographical scope (WHO region of Europe) is reflected in the composition of the Steering Committee. In 2010, members came from Belarus, Croatia, Germany, Georgia, Hungary, Kyrgyzstan, Switzerland, the Netherlands, Ukraine, United Kingdom and regional networks AIDS Foundation East-West and European AIDS Treatment Group22. Steering Committee members have a term of three years, with the possibility for re-election of one additional period. For institutional memory and ease of working, there is a staggered turnover of 3-4 Steering Committee members yearly. There are permanent seats for the HIV/AIDS Civil Society Co-chair, the AIDS Action Europe host organisation and the European AIDS Treatment Group. The Steering Committee elects its Chair for a two-year term. In principle each Steering Committee member that is part of the Steering Committee for at least six months can apply for the position of Chair. AIDS Action Europe’s office consists of an Executive Coordinator, Fundraising Coordinator, Communications Coordinator and Programme Assistant. AIDS Action Europe’s core programme and staff are hosted by STI AIDS Netherlands at its office in Amsterdam. Formally and legally, AIDS Action Europe is a programme of the Department of Policy and Programmes of STI AIDS Netherlands. AIDS Action Europe also works through a host organisation in the Russian Federation, AIDS Foundation East-West, who coordinates the project ROST and manages the Russian communications, including the Clearinghouse and website. The AIDS Action Europe strategy 2011-2015 will be translated into the key components of the annual work plan and budget for the coming years.
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See www.aidsactioneurope.org for the actual composition of the Steering Committee
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Strategic partnerships
Our role as HIV/AIDS Civil Society Forum co-chair and member of the HIV/AIDS Think Tank facilitates coordination with other European networks and projects, national NGOs and key-stakeholders such as WHO Europe, UNAIDS, ECDC. Co-chairing of the Civil Society Forum has led to close and good working relations with co-chair European AIDS Treatment Group. Co-chairing of the HIV in Europe Initiative has led to closer collaboration between civil society, scientists and policy makers. We have good working relations with many regional projects and networks. Since 2006 we have a Memorandum of Understanding with WHO Europe. We work together on a variety of issues such as testing and counselling guidelines. There is close coordination with UNAIDS, especially in relation to the UNGASS. ECDC coordination on monitoring of the Dublin Declaration and other issues takes place primarily through the Civil Society Forum. We offer a platform for HIV-related projects funded by the European Commission. This platform, located on our website, contributes to exchange, closer coordination and collaboration between the different projects, AIDS Action Europe and other stakeholders. We are also a member of the EU Health Policy Forum and actively contribute to larger global health issues. AIDS Action Europe is the 3rd partner in the Working group on Quality Assurance and Improvement in HIV prevention, next to BZgA and WHO Europe. The process will foster close collaboration between academic institutions, NGOs and other stakeholders. As European network of the International Council of AIDS Service Organizations (ICASO) we work together on a variety of global policy and advocacy actions. The director of STI AIDS Netherlands is part of the ICASO board, the Executive coordinator part of the Executive Director Group and the Communications Coordinator of the Communications Working Group. AIDS Action Europe Steering Committee members are part of board and advisory groups of ECDC, HIV in Europe (as co-chair) and EATG.
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7
Financial coverage of the strategic plan
To maintain the current advocacy, linking and learning and network management core programme and the ROST project, an overall budget for the network between €700.000- €1.000.000 yearly, is forecasted for the coming years. To respond to the needs of our member organisations we need to speed-up and expand our current activities. Additional project funding would need to be secured in order to expand the current work programme. In 2010, AIDS Action Europe received financial contributions from the European Commission Second EU Public Health Programme (2008–2013) through the Executive Agency for Health and Consumers; Aids Fonds; ViiV Healthcare Positive Action Programme; Levi Strauss Foundation; M•A•C Aids Fund; Open Society Foundations and T101 Limited. A core challenge is to diversify and enlarge our funding sources, in the context of a global economic crisis. AIDS Action Europe aims to secure resources both for core programme functions related to advocacy, policy advice, communication and information dissemination, and network management, as well as specific project funding for capacity development and linking and learning. Taking into consideration as well that new projects and activities cannot be carried out unless there is financial coverage of a core office managing the overall functions of the network.
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AFEW: BZgA: CSF: EATG: EC: ECDC: EMCDDA: EU: GFATM: GIPA: ICASO: NGO: ROST: UNGASS: UNODC: WHO:
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Annex: list of abbreviations
AIDS Foundation East-West Bundeszentrale f체r gesundheitliche Aufkl채rung Civil Society Forum European AIDS Treatment Group European Commission European Centre for Disease Prevention and Control European Monitoring Centre for Drugs and Drug Addiction European Union Global Fund for AIDS, Tuberculosis and Malaria Greater involvement of people living with HIV International Council of AIDS Service Organizations Non governmental organisation Responding to HIV through Organisational Support and Technical Cooperation United Nations General Assembly Special Session on AIDS United Nations Office on Drugs and Crime World Health Organisation
Together we work towards a more effective response to the HIV epidemic
Photography: page 7 and 33: Soa Aids Nederland page 12 and 22: Svitlana Valko page 18 and 28: Belarusian PLWH Community Layout based on design by: echt-johan-manschot.nl
AIDS Action Europe: strategic framework 2011-2015