What changes can the Global Fund make to its model to address barriers in the delivery of evidence-based services to most at risk and other underserved populations - in a way that protects human rights and prevents violations?
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The Global Fund has distinguished itself as a multilateral financing mechanism that has made significant contributions to protecting, promoting and fulfilling human rights through scaling up prevention, treatment, care, and support for HIV, tuberculosis and malaria. In this primary role as financing and not implementing programs, the Global Fund has played a vital role both in supporting interventions to overcome stigma, discrimination and other human rights-related barriers to prevention, treatment, care, and support, as well as in using its unique position to promote positive legal and policy change. Particularly in regard to HIV, the Global Fund has stimulated the creation of in-country processes that have opened doors to participation in HIV programming for people living with and vulnerable to HIV, and the inclusion of the voices of people living with and vulnerable to HIV is required to be demonstrated in all HIV funding applications.
However, on the question of human rights, inherent conflicts can arise in the Global Fund's principles when countries fail to implement rights based policies and programs in their approved funding request, or have policies that undermine human rights and dignity of people in need of services.
On the one hand - the Global Fund explicitly supports rights-centered approaches to the three diseases, with a particular focus on significant issues of stigma and prejudice that arises for people living with or affected by HIV in concentrated epidemics. Most at risk populations in this context include: adults and youth who inject drugs and their sexual partners; female, male and transgender sex workers and their sexual partners; and men who have sex with men, transgender people and their sexual partners. Whilst smaller in number, other at-risk groups include women who have sex with women who are abused through corrective rape practices, and youth who engage in transactional sex in high risk HIV settings.
On the other hand, the Global Fund also claims as a central principle that the programs it funds should result from "country-driven" processes. This dilemma was most recently discussed by Michel Kazatchkine, the Executive Director of the Global Fund, in Toronto in June 2010 when he said:
"Admittedly our dual commitment to human rights and to country ownership sometimes poses challenges, particularly when countries fail to implement rights- based policies and programs or have policies that undermine human rights." However, he also added that "one thing is clear: we do not support interventions that are not evidence-based or that infringe human rights."
Across 2011, the Global Fund is writing its new strategy for 2012 – 2016, and is seeking to target strategic interventions that address human rights and access (to prevention, treatment, and care and support) as a more centralized pillar of its work. In addition to the challenges faced by most at risk populations in concentrated HIV epidemics -across the three diseases, there are also persons who are particularly underserved. These are people who have significantly higher levels of risk, mortality and/or morbidity from HIV, tuberculosis or malaria than the rest of the population – but whose access to or uptake of relevant services is significantly lower others. The potential for human rights related barriers to accessing prevention, treatment and care and support services exist in such contexts also.
Partners collaborating with the Global Fund within its whole of partnership model have similarly developed new strategies or action plans that prominently address human rights, such as the UNAIDS "Getting to Zero" Strategy 2011 - 2015, the WHO HIV/AIDS Strategy 2011 - 2015, and Stop TB Partnership's Global Plan to Stop TB: 2011 – 2015. The Global Fund's new strategy is an opportunity to identify the strategic interventions that it will pursue to promote best practice human rights programming, and simultaneously, address human rights barriers and violations in a way that draws on the important work of other specialized agencies and funds.
Additional resource links
UNAIDS 'Getting to Zero' Strategy 2011 - 2015
WHO Global Health Sector Strategy for HIV 2011 - 2015
Stop TB Partnership's Global Plan to Stop TB: 2011 – 2015
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