Progress in Breaking Down Human Rights-Related Barriers to HIV and TB Services
A new report released by the Global Fund at the 24th International Aids Conference in Montreal, Canada July 29, unveils key findings of the activities supported by the Global Fund's Breaking Down Barriers initiative.
Breaking Down Barriers initiative is the groundbreaking program launched in 2017 to provide intensive financial and technical support to 20 countries* to address stigma and discrimination, criminalization and other human rights-related obstacles that continue to threaten progress against HIV, tuberculosis (TB), and malaria.
"One of the most powerful lessons from the history of the fight against HIV is that success in confronting such a formidable disease cannot be achieved through biomedical interventions alone," said Peter Sands, Executive Director of the Global Fund. "We must also confront the injustices that make some people especially vulnerable to the disease and unable to access the health services they need. The same is true for TB, malaria, and other diseases, including Covid-19."
In the context of HIV and TB, men who have sex with men, transgender people, sex workers, people who inject drugs, people living with HIV, and people in prisons and other closed settings are socially marginalized, often criminalized and face a range of human rights abuses that increase their vulnerability to the diseases and undermine their access to health services.
The key findings of the midterm assessments, which were conducted between 2019 and end 2021, reveal all countries involved in the Breaking Down Barriers initiative saw progress in removing human rights-related barriers to HIV services, with a mean increase of 0.9 points from baseline on the 0-5 scale. However, even the top five scoring countries (Ukraine 3.7, Jamaica 3.5, Botswana 3.3, Senegal 3.1 and Kenya 3.1) are falling short of the scores that would represent a comprehensive response at a national level (above 4.0). Sierra Leone (+1.7), Jamaica (+1.6), Cameroon (+1.3) and Mozambique (+1.3) showed the greatest increase in scores.
All countries surveyed also showed progress on TB programming. The TB scores at midterm ranged from Ghana (2.8) to Sierra Leone (0.2), with an average increase from baseline of 0.6. For many countries, addressing human rights barriers to TB services entailed the development of new interventions, and the progress reported in the midterm assessment reflects a rapid expansion. The greatest increase was seen in Ukraine (+1.1) and Côte d'Ivoire (+1.5).
However, the assessments also show that Covid-19 slowed the progress of the Breaking Down Barriers initiative in many countries. But they also chronicle the ways in which human rights-related work on HIV contributed to rights-based approaches to Covid-19. In a few countries, support was provided to community-based paralegals to address human rights violations that occurred during lockdowns. Many innovative measures were undertaken to ensure that key populations would continue to receive services despite lockdowns or quarantines. In several countries, community awareness-raising focused on the prevention of gender-based violence during lockdown periods.
Another round of evaluations, planned for late 2022 and the first six months of 2023, will capture up to five years of activity and provide further insights into the results and impact achieved in the countries involved in the Breaking Down Barriers initiative.
Global Fund human rights funding is unprecedented. In the 20 countries of the Breaking Down Barriers initiative, Global Fund investments in programs to reduce human rights-related barriers have increased more than 10-fold – from slightly over US$10 million to now over US$130 million. Never has there been this much funding to support the implementation of comprehensive programs to remove human rights-related barriers to health services.
"The Breaking Down Barriers experience demonstrates that, where there is sufficient funding and technical support, multiple stakeholders can be energized to combine and strengthen their efforts, and as a result, can make real progress in removing long-standing barriers," concluded Sands. "This is critical to defeating HIV, TB and malaria, building truly inclusive systems for health that leave no one behind, and enabling everyone, everywhere to realizing their right to health and well-being."
The Global Fund provides 30% of all international financing for HIV programs (12% of all available resources) and has invested US$22.7 billion in programs to prevent, diagnose and treat HIV and Aids and US$3.8 billion in TB/HIV programs as of June 2021. In countries where the Global Fund invests, total Aids-related deaths have dropped by 65% over the last 20 years.
The U.S. will host the Global Fund's Seventh Replenishment Pledging Conference in New York City on 19-21 September 2022. With a Replenishment of at least US$18 billion, the Global Fund, together with partners, could reduce (from 2020 to 2026) new HIV infections by 68%, from 1.1 million to 348,000; Aids-related deaths by 59%, from 579,000 to 239,000; incidence and mortality rates by 71% and 63% respectively; HIV incidence among adolescent girls and young women in most affected countries by 72%; and provide antiretroviral therapy to 28 million people in 2026 to reach 91% treatment coverage in 2026.
The 20 countries involved in the Breaking Down Barriers initiative are Benin, Botswana, Cameroon, Côte d'Ivoire, Democratic Republic of the Congo, Ghana, Honduras, Indonesia, Jamaica, Kenya, Kyrgyzstan, Mozambique, Nepal, the Philippines, Senegal, Sierra Leone, South Africa, Tunisia, Uganda and Ukraine.
The Global Fund is a worldwide partnership to defeat HIV, TB and malaria and ensure a healthier, safer, more equitable future for all. We raise and invest more than US$4 billion a year to fight the deadliest infectious diseases, challenge the injustice which fuels them and strengthens health systems in more than 100 of the hardest hit countries.
Since the beginning of the COVID-19 pandemic, we have invested an additional US$4.3 billion to fight the new pandemic and reinforce systems for health. We unite world leaders, communities, civil society, health workers and the private sector to find solutions that have the most impact, and we take them to scale worldwide.
Since 2002, the Global Fund partnership has saved 44 million lives.