To end the AIDS pandemic, let communities lead

The Philippines 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 HIV are the drivers of progress in the AIDS response. They connect people to public health services, build trust, innovate, monitor the implementation of policies and services and hold service providers accountable.

The contribution of the community-led organizations in the AIDS response has helped tackle other pandemics and health crises too, including COVID-19, Mpox and Ebola. Letting communities lead builds healthier and stronger societies.

During the COVID-19 pandemic, the role of community-led services was instrumental in continuing delivery of HIV services while government facilities were focused on COVID-19 response. Community-led organizations such as the Rajah Community Center in Iloilo City and the HIV and AIDS Support House (HASH) were able to continue providing HIV services to key populations. The use of telemedicine by these community-led facilities ensured that medical consultation for people living with HIV remained available even during the height of pandemic-related lockdowns.

But so many communities face barriers to their leadership. Community-led responses are under-recognized, under-resourced and, in some places, even under attack. Globally, funding channeled through communities has fallen in the past 10 years from 31 percent in 2012 to 20 percent in 2021.

These funding shortages, policy and regulatory hurdles, capacity constraints, crackdowns on civil society and on the human rights of marginalized communities are obstructing the progress of HIV prevention, treatment and care services.

It is in everyone’s interest to fully fund community-led organizations and remove the many obstacles they face. It is by enabling communities in their leadership that the promise to end AIDS can be realized.

This is why communities are at the center of World AIDS Day commemorations this year, including in the 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 recognize the contribution communities make but also to pull down the barriers that stand in their way. This World AIDS Day is a call to action to support communities and unleash their full potential.

That means:

• The leadership role of communities needs to be core in all HIV plans and programs and in 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 human rights for all, including young people, gay men and other men who have sex with men, transgender people, people who use drugs and sex workers.

A new HIV Law was enacted in 2018 (RA 11166) to fill the gaps and update the previous AIDS Prevention Act of 1998 (RA 8504) to be more responsive to the current state of the country’s HIV epidemic.

One of the significant updates in the new law is the greater role given to community-led organizations in the provisions of HIV services – prevention, testing, treatment and support. The law encourages government agencies and local government units to coordinate with and fund community organizations to continue and expand provision of services. However, current guidelines from regulatory agencies on channeling funding support to non-government partners are not accommodating the realities of community organizations and thus preventing them from accessing much needed support to continue and scale up their work.

It has been a long-standing principle of the AIDS response to bring people living with and affected by HIV to the decision-making table. 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 infected with HIV and 9.2 million people did not have access to lifesaving HIV treatment.

There are now an estimated 164,400 people living with HIV in the country and 24,400 new infections were estimated to be added in 2022 alone. The Philippines has fallen short of the 95-95-95 targets. It has only diagnosed 63 percent of its diagnosis target, only 62 percent of its enrollment to treatment target and only 25 percent of the viral load suppression target. Of the estimated number of people infected with HIV, there are still 115,873 who remain to be diagnosed and enrolled to life saving treatment.

We have the tools to prevent new HIV infections and ensure that all people living with HIV access treatment. It is estimated that the country can prevent 162,000 new infections and more than 8,000 AIDS-related deaths if the country ramps up interventions provided by community-led organizations. The goal of making communities participate to 30 percent of testing services, 80 percent of prevention services and 60 percent of societal enablers will make this goal achievable.

The end of AIDS is within reach. We even know how to get there: Let communities lead!

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Dr. Louie Ocampo is country director of UNAIDS Philippines.