As the world marked International Human Rights Day on 10 December under the Covid-19 related theme “Recover Better - Stand Up for Human Rights”, a study by the AIDS and Rights Alliance for Southern Africa (ARASA) showed a steady decline in funding for social enablers.
Social enablers include activities that address barriers such as stigma and discrimination, violence, gender inequality and problematic laws and policies, which increase the vulnerability of people to HIV and also impede their access to and retention in services. At the United Nations General Assembly in 2016, world leaders committed to invest at least 6% of all global AIDS resources for social enablers and to ensure that 30% of all service delivery by 2030 is community-led.
The study by ARASA was conducted in two phases between the end of 2019 and June 2020 through a desk review of relevant literature, an online survey and key informant interviews. It found that nearly half of civil society and community organisations working on HIV social enablers in East and Southern Africa have experienced a decrease in funding in the past three-five years.
This finding is echoed by the Joint United Nations Programme on HIV and AIDS (UNAIDS), which reported in its 2020 Global AIDS update, that key enablers of effective HIV responses remain neglected in dozens of countries across multiple regions.
UNAIDS stated that from 2015 to 2020, there were 3.5 million more HIV infections and 820 000 more AIDS-related deaths than if the world was on track to meet its 2020 targets. That makes it unlikely that the Fast-Track target of six per cent of resources for social enablers will be met. Felicita Hikuam, director of ARASA, expressed concern. “It is globally recognised that socio-cultural, political and economic inequities and the general lack of attention to underlying determinants of health undermine the HIV response and increase vulnerability to infection,” she said.
She added: “Civil society, NGOs and community-based organisations play a critical role in breaking down these barriers and increasing access to crucial services for their communities through social enabling activities, which include advocacy, community and political mobilisation and community monitoring, as well as for human rights programmes such as law and policy reform, and stigma and discrimination reduction.”
Maria Stacey, the lead researcher in the study by ARASA, underscored the importance of community-led organisations and initiatives in responding to HIV. “Community-based and led organisations provide a crucial service in protecting and promoting human rights and addressing factors that perpetuate inequity in access to healthcare, leaving many communities behind. They are the bridge between communities and the rest of the HIV response. If the bridge is weak and unstable, the response cannot reach the people most in need. If we don’t strengthen and reinforce the bridge, we will not end AIDS by 2030,” Stacey said. The ARASA study found that the decline of funding is not experienced uniformly across countries, sectors of Southern, and East Africa. It presents a number of key findings on the emerging funding patterns regarding these focal areas. To begin with, the study established that civil organisations whose work revolve around the issues mentioned above have been particularly impacted by donors’ shift from focusing on HIV. It also observes that “an upswing in conservatism and nationalism globally” has resulted in some restrictions on “freedom of association and expression for civil society, particularly for organisations which hold their governments to account and/or represent the interests of marginalised communities”.
Under the United States of America’s Donald Trump administration, the reinstatement of the Mexico City Policy, which restricts funding to organisations, which provide or advocate for abortion - also known as the Global Gag Rule - has had a profound effect on HIV programmes.
In addition, the Anti-Prostitution Loyalty Oath is still being applied to foreign-based potential recipients of PEPFAR funds affecting HIV programming. In this regard, the research provides a range of examples from such countries as Botswana, Mozambique and Tanzania.
Additionally, the study shows that the lack of funding from domestic sources and the short-term approach to funding significantly undermines the effectiveness of these interventions. This is because human rights programming and social enablers require longer-term approaches as they involve changing norms, beliefs and long-standing cultural practices.