Local community groups working with populations vulnerable to HIV in Sub-Saharan Africa are making inroads into obtaining official recognition by their governments, which is expanding opportunities for increased funding and ensuring a more substantial, and needed, role in national HIV responses in the region.
Globally, new HIV infections are on the decline, with a 30 percent drop between 2010 and 2017 in eastern and southern Africa, according to the latest UNAIDS data. This has largely come as a result of decades of work to scale-up access to HIV treatment and increase testing – three out of four people living with HIV globally now know their status.
However, prevention services are not reaching those who need them most. Epidemics are becoming increasingly concentrated among populations that are at higher risk of HIV, namely men who have sex with men, transgender people, people who use drugs, sex workers and their partners.
“Key populations are the groups most affected by HIV, yet in many countries their behaviours are criminalized, resulting in heightened risks and hindering their ability to access health services,” said Deena Patel, Programme Manager at the United Nations Development Programme (UNDP). “In order for countries to have an HIV response that can succeed in the long term, it’s necessary for interventions to reach these vulnerable groups, and, moreover, that these groups be closely involved in the planning, implementation and monitoring of HIV policy, programmes and services.”
Becoming officially registered opens the door for key populations-led organizations to be fully included in national HIV responses, and deliver services tailored to specific vulnerable groups.
“It’s not enough for key populations to simply receive empathy from society – rather, we need to take ownership of the HIV response, we need to be part of the decision-making process,” said Germain Muhire from SFS in Rwanda. “Becoming registered helps to empower the community and build our capacities to deal with our problems. We’re now able to establish alliances and partnerships based on respect and fully shared responsibilities.”
Registration of the organizations is being assisted, in part, through the work of the Africa Key Populations Expert Group – a network of experts representing men who have sex with men, transgender people, people who use drugs and sex workers. The group, which is jointly supported by UNDP through the Africa Regional Grant on HIV and the Linking Policy to Programming Project, meets annually to share best practices and develop interventions to advance the engagement of key populations in the HIV response.
Currently, there are nine organizations affiliated with the Africa Key Populations Expert Group that are officially registered in five countries: Lesbians, Gays & Bisexuals of Botswana, SFS (Rwanda), Sisonke (South Africa), Alliance of Women Advocating for Change (Uganda), WONETHA (Uganda), Uganda Harm Reduction Network, East Africa Harm Reduction Network, Gays and Lesbians of Zimbabwe, and TREAT (Zimbabwe).
They provide services such as stigma and discrimination-free health services, legal aid services, health promotion activities, advocacy for legal and policy changes, implementing HIV and sexual and reproductive health programmes, informing national policy and programme design and monitoring and evaluation, conducting research, as well as engaging in resource mobilization efforts.
Through the Africa Key Populations Expert Group, the community groups are continuously analyzing their individual situations at the regional and national levels, developing tools to better address HIV, and learning from each other’s experiences around registration.
The efforts to empower key populations and increase their engagement in the response are taking place within challenging legal, political and social environments. A recent report by the Southern Africa Litigation Centre highlights the trend towards shrinking spaces for civil society groups working on promoting and protecting human rights to operate in the Southern Africa region. Even in locations where the behavior of key populations is not criminalized, they can encounter barriers that hinder their ability to deliver sexual and reproductive health services, conduct advocacy and raise funds.
“Some donors don’t fund non-registered organizations. So, registration has been very helpful in that it allows us to access more funding from different donors,” said Kyomya Macklean, Executive Director at Alliance of Women Advocating for Change in Uganda. “It’s also helped to strengthen our networking and collaboration at the district level to formalize our working relationships with the district local authorities through the signing of memorandums of understanding (MOUs).”
“It won’t be easy to accomplish our goals, we need to prepare ourselves to brave new forms of oppression. Having allies such as UNDP is more important than ever now.”
The registration process also sometimes involves compromises on the part of the organization in order to get past the regulatory requirements.
“Among the strategies we’ve had to employ while registering the Alliance of Women Advocating for Change with the NGO Bureau is avoiding the use or mentioning of certain terms when referring to our beneficiaries,” explained Kyomya Macklean. “We use general wording such as “marginalized communities including sex workers” or “women”. This helps to pass and approve all our documents. The other key strategy is using HIV and sexual reproductive services as a broader platform or umbrella.”
