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Meet
Harry Prabowo
I am alive because of community. When I was diagnosed in Jakarta in 2010, I had a CD4 count of 20. Staff at my NGO took me to the doctor. They took turns looking after me. They were with me as I took my first steps after starting treatment. They held my hand. They made me laugh.
Today I not only have an undetectable viral load, but also the confidence to embrace life fully and proudly as a gay man living with HIV. Treatment on its own could not get me here.
For too many people, showing up for HIV services remains a lonely act of courage. Treatment services are still missing over 9 million people worldwide. We know that people living with HIV who anticipate high levels of stigma are more than twice as likely to delay enrolment in care until they are very ill.
Communities help drive demand for services. They mobilize political leadership. They ensure that people not reached by formal health systems can get support. They monitor the quality of HIV services and help shape solutions. They help create an enabling environment that promotes equitable access.
Thankfully, treatment is now recognized as an essential investment. But it is disgraceful and dangerous that all too often, peer navigation and community-led service delivery are regarded as optional extras. Investments in community leadership are essential to the success of prevention, testing, linkages to care, retention and adherence results. This is not just a nice thing to do—it ensures the programmes work and makes financial sense.
The countries in our region that are closest to achieving the 95–95–95 targets have embraced the power of communities to supercharge results. In Cambodia, inclusion of communities in the design and implementation of HIV services has been critical to increasing the number of people who access pre-exposure prophylaxis (PrEP). In Thailand, HIV services, including prevention, testing and treatment, are covered by the universal health coverage system, and certified community-led organizations are reimbursed for providing services.
Governments across the world made a commitment through the 2021 Political Declaration on HIV and AIDS to prioritize community leadership. They pledged to strengthen and scale up community- and peer-led interventions. They pledged to invest in community-led service delivery, including through social contracting. And they agreed to support community-led monitoring and research.
Countries need to create a more enabling environment for the equitable financing of community-led HIV responses. They can build on positive examples from across the continent:
The Seven Alliance, a consortium of seven networks of people from key populations and people living with HIV in the Asia and Pacific region, supported by the Joint United Nations Programme on HIV/AIDS (UNAIDS), is working with governments, donors and other partners to strengthen implementation of community-led monitoring. Part of the challenge is to raise the level of resources to be commensurate with the level of need and the plans we have agreed together.
Community leadership is how the required results are achieved. This proven, smart investment needs to be assured of scaled-up, multiyear, predictable financing. It is essential work. And it should be compensated and financed as such. The lesson for governments and decision-makers across the world should be clear. No one should think of our contribution as volunteerism.
Creator, ReproHealth Unfiltered
