Jamra primary scholl for children affected by HIV/AIDS, drugs or poverty, Senegal (c) Nell Freeman/Alliance Participants in the Photovioce project, Ecuador © Marcela Nievas for the Alliance
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An HIV-free generation: What’s holding us back?


Children in Cambodia © Michael Nott for the Alliance/Khana

As we mark World AIDS Day 2012 we do so with the knowledge that, if new opportunities are seized, for the first time in the global HIV response, achieving an HIV-free generation† is possible.

Game-changing research and scientific breakthroughs  are providing the opportunities. However, political commitment is required to tackle the epidemic in the most effective way to make an HIV-free generation a reality.

These possibilities would not been have imaginable on the first World AIDS Day, 24 years ago. The biggest risk to the response now is allowing this opportunity to be missed. The technology and evidence alone are not enough, what is also needed are the right programmes, at the right scale, in the right places††.

Most marginalised at risk of losing out

Nearly 60% of people living with HIV live in countries now classified as middle income. And key populations such as men who have sex with men (MSM), transgender people, sex workers and people who inject drugs are all at significantly higher risk of HIV infection.

While a continued focus of international assistance for the HIV response in low income countries is critical (particularly in basic infrastructure), the role of donor governments’ support to middle income countries – where international aid is being withdrawn or significantly reduced - must be addressed in a way that does not punish the poorest and most marginalised.

As Marcela Romero, regional coordinator of REDLACTRANS, a strategic partner of the Alliance in Latin America and the Caribbean, says: “We’ve got the skills to reach those that are most at risk. What’s holding us back is the environment we work in. International donors are pulling out and most national governments would sooner ignore the murders of transgender women than fund programmes for us.”

Although for the first time in 2011, domestic funding for HIV surpassed the contributions of international donors, many have not yet prioritised sufficient resources for effective health services. And national governments are less likely to be encouraged to fund programmes aimed at politically isolated groups whilst international donors are disengaging. As international aid reduces the fear is that the gap in services for key populations gets larger, and the goal of an HIV-free generation moves further away.

In order to scale up a smarter and more targeted response, funding for international and national civil society organisations will be vital. Civil society’s ability to engage marginalised groups is critical to achieve an HIV-free generation.

“Through peer-led approaches we address the needs of MSM and other key populations. If we didn’t we would lose the gains that have been made.” says Uyapo Ndadi, Director of BONELA, Alliance Linking Organisation in Botswana, a middle-income country with an HIV prevalence of 24.8%.

“Vulnerable groups don’t exist in isolation, by having targeted services for key populations we expect Botswana’s HIV prevalence rate to continue to decrease, not just among key populations, but the overall population.” The rate of new infections in Botswana has decreased by 71% since 2001.

Vietnam: How international aid helps to leverage a more effective HIV response

The impact of international aid can be seen in Vietnam, which has been classified as middle income since 2010. Since 2004, a large-scale harm reduction programme, supported by UK aid and World Bank, has been providing clean needles and syringes for people who use drugs and condoms to sex workers.

“This programme is a shining example of what international aid can help achieve and why it is so important for key populations in middle income countries” says Khuat Thi Hai Oanh, the Executive Director of SCDI, the Alliance’s Linking Organisation in Vietnam, “Without this funding the project simply wouldn’t exist and those who it has reached would be at much higher risk of HIV infection”.

Due to Vietnam’s middle income status this programme is likely to end in 2013. The possibility of a continuation plan is currently being explored. Read more about the success of programme here.

What we’re calling for

This success story in Vietnam, the future of which now hangs in the balance, highlights the importance of our World AIDS Day ask to international donors.

Do not let the goal of an HIV-free generation slip away. Turn the opportunities into a reality by:

1) Ensuring that the poorest and most marginalised are not the ones who pay the price when specific HIV programmes are ending

2) Making a human rights based approach central to HIV programming, and ensure the inclusion of key populations

3) Recognising the key role of international and national civil society organisations as being the key mechanism for scaling up services for the most marginalised

4) Fully funding the Global Fund to Fight AIDS, TB and Malaria to ensure smart cost-effective investments in the HIV response.


† An HIV-free generation is shorthand for the goal of achieving a world with significantly reduced new infections, no AIDS-related deaths and where HIV-positive people are healthy and can realise their rights. UNAIDS, Together we will end AIDS, 2012.

††The Investment Framework for HIV is a model for achieving an HIV-free generation. It shows that we have a window in which to act – and that the time is now.