In from the margins – annual review 2006

Introduction by Alvaro Bermejo

2006 saw the epidemic continue to grow, with 4.3 million people newly infected around the world, and another 2.9 million people dying from AIDS, 380,000 of whom were children under 15.

The AIDS response also grew, with the bold political commitments by governments to achieve universal access to HIV prevention, care and treatment by 2010 (agreed by the G8 and UN in 2005). However, governments are now failing on implementation.

All countries should have set universal access targets by now, but at the time of going to press only around 60% had done so. Even more worryingly, it has also become clear that in many countries targets for reaching key populations such as sex workers, men who have sex with men, and injecting drug users are not being set. Without action, these same marginalised and vulnerable groups that many governments consistently ignore will be left out again, despite their central role in effective HIV responses.

A key theme running through this year’s annual review is marginalisation and vulnerability. We have featured highlights of the Alliance’s work to support vulnerable communities and marginalised groups to stand up for their right to equal access to services and break down the barriers that exist.

The Alliance continued to expand its work in 2006, with new programmes in Uganda, South Sudan, Malawi, Jamaica, Bolivia and Peru. Alongside our 28 country programmes, three strong regional programmes were also operating in North Africa, Central Africa, and Latin America and the Caribbean. These regional programmes support country-based activities and regional networks, and encourage South-to South learning and policy exchange.

Through these programmes and activities, the Alliance reached over 1.3 million people in 2006 (rising to over 47 million when you include information, education and communication campaigns).

This is clear evidence that the Alliance model works – something a joint donor evaluation carried out in 2006 for the American, British, Norwegian and Swedish governments backs up. It concluded, “In quantitative terms (numbers of partners and projects, value of grants provided, range of intervention types, and coverage of key populations), the Alliance has supported an impressive scaling up of ‘action on the ground’.

“The Alliance’s approach stands out from other more internationally-driven and managed approaches. The linking organisations model has been critical to this success, enabling the Alliance to develop sustainable national capacity.” The evaluation goes on to say that, through our work at the community, national and international levels, we have also “played a major part in giving communities a voice”.

All our work and impact has been made possible by the continued generous support of our donors. However, the evaluation also highlighted the importance of increasing the level of unrestricted funding for the Alliance if it is to make the biggest difference it can. This unrestricted funding is the only way we can pay for the investment and start-up costs needed to work in more countries, and to act strategically in the areas we think will have most impact.

Vulnerable and marginalised communities and groups are often pushed aside by governments and health services, yet reaching and involving them is the key to a successful HIV response. We need the resources to ensure that these groups have the skills, confidence and support to demand their rights and equal access to services.

Having access to adequate unrestricted strategic funding will be crucial for us to continue to increase the scale and coverage of our activities, to reach more communities, in more countries with broader HIV interventions. For many of the most vulnerable and marginalised people in the world, this could mean the difference between communities decimated by the epidemic or a life free of HIV and AIDS.

Alvaro Bermejo

Executive director,

International HIV/AIDS Alliance