Namibia has a fantastic opportunity. It can end the AIDS pandemic by 2030, by letting communities lead.
Communities of people living with HIV or at risk of and those affected by HIV are the drivers of progress in the HIV response. They connect people to public health services, build trust, innovate, monitor the implementation of policies and services, and hold service providers accountable.
For example, in Namibia, Tonata Network of People Living with HIV focuses on ensuring that individuals and families are enrolled in care, remain in care and, if they are on treatment, take their medications correctly. Tonata supports the establishment of HIV support groups and nurtures them, encouraging members to learn about positive living, adhering to their medication, and participating in community projects to generate income. In addition, support groups connect members to service providers, communities, and constituency leaders to whom they take their system-wide concerns. So far, there are more than 15 000 members in 500 support groups. In addition to the house visits and community sensitisation activities, Tonata integrated other issues such as the response to the Covid-19 pandemic by sharing bulk text messages with Covid-19 information in local languages to enhance prevention and social and behaviour change.
This clearly demonstrates how the contribution of the community-led organisations in the HIV response has helped tackle other pandemics and health crises, including Covid-19, Mpox and Ebola in countries that had it. Letting communities lead builds healthier and stronger societies.
However, so many communities face barriers to their leadership. Community-led responses are under-recognised, under-resourced and in some places even under attack. Globally, funding for communities has fallen by 11% in the last 10 years from 31% in 2012 to 20% in 2022.
These funding shortages, policy, and regulatory hurdles, capacity constraints, crackdowns on civil society and on the human rights of marginalised communities are obstructing the progress of HIV prevention, treatment, and care services.
It is in everyone’s interest to fully fund community-led organisations and remove the many obstacles they face. It is by enabling communities in their leadership that the promise to end AIDS can be realised.
This is why communities are at the centre of World AIDS Day commemoration this year, including in a major new UNAIDS report Let Communities Lead.
The report sets out the facts and figures that demonstrate communities’ impact and shares how progress is being driven by communities through case studies from across the world and through guest essays by nine pioneering community leaders. As the report notes, there is a need not only to recognise the contribution communities make, but also to address the barriers that stand in their way. This World AIDS Day is a call to action to support communities and unleash their full potential.
The leadership role of communities needs to be core in all HIV plans and programmes and their formulation, budgeting, implementation, monitoring, and evaluation.
Communities need to be fully and reliably funded to allow them to scale up their services and for workers to be properly remunerated for their contribution.
Barriers to community leadership need to be removed. There must be an enabling regulatory and legal environment that allows communities the space to operate and protect the human rights for all, including in Africa where adolescent girls and young women, people who use drugs, sex workers, migrants and refugees, and other vulnerable populations who are at high risk of acquiring HIV.
On 26 October 2023, the Ministry of Health and Social Services launched the Namibia Social Contracting for Health Policy. The policy aims to strengthen the delivery of essential health services and enable the government to contract civil society organisations (CSOs) to provide essential health services in line with government priorities. In addition, the policy promotes the inclusion of community-led organisations in the national frameworks and policies, as service providers.
It has been a long-standing principle of the HIV response to bring people living with and affected by HIV to the decision-making table, under the slogan, ‘Nothing About Us Without Us’! Where this is being followed, progress is being made. Supporting communities in their leadership is not only the right thing to do, but also essential for advancing public health.
AIDS is far from over. Last year, worldwide 630 000 people died of AIDS-related illnesses, 1.3 million people were newly HIV infected with HIV and 9.2 million people did not have access to lifesaving HIV treatment.
In Namibia, there were 3100 AIDS- related deaths and 5600 new HIV infections recorded in 2022.
We have the tools to prevent new HIV infections and ensure that all people living with HIV access treatment. The end of AIDS is within reach. We even know how to get there: Let Communities Lead!
*Dr David Chipanta is the UNAIDS country Director.