This report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Stop AIDS Alliance draws on multiple sources to document the many ways in which communities are advancing the response to AIDS and to explore evidence for the effectiveness of these responses. Four core areas of community-based responses to HIV include: (i) advocacy, campaigning, and participation in accountability; (ii) community-based service delivery; (iii) participatory community-based research; and (iv) financing through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other funders. Each of these areas is illustrated in the report by examples of community-based actions from various countries and contexts around the world.
“Communities were the first responders to HIV three decades ago, and they remain essential in advocating for a robust response to the epidemic, delivering services that can reach everyone in need and tackling HIV-related stigma and discrimination.”
This report from the Joint United Nations Programme on HIV/AIDS (UNAIDS) and Stop AIDS Alliance draws on multiple sources to document the many ways in which communities are advancing the response to AIDS and to explore evidence for the effectiveness of these responses. Four core areas of community-based responses to HIV include: (i) advocacy, campaigning, and participation in accountability; (ii) community-based service delivery; (iii) participatory community-based research; and (iv) financing through the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) and other funders. Each of these areas is illustrated in the report by examples of community-based actions from various countries and contexts around the world.
Despite what the report characterises as “substantial achievement” over 30 years of response to HIV – with communities at the forefront of action – challenges remain. For example, gender inequalities faced by young women in sub-Saharan Africa – and stigma and discrimination faced by people living with HIV in other key populations globally – can lead to denial of access to, or deterrence of people from seeking, vital services. In addition, legal and sociopolitical environments such as punitive laws or abusive law enforcement can obstruct effective access to and delivery of services. Because “communities give a voice to those who need services, provide feedback as to whether policies and programmes are working and suggest how they can be improved”, they are key participants in responses that: generate positive health and development outcomes and strengthen health systems; safeguard the rights of those they reach and serve; mobilise communities, including marginalised, socially excluded, and criminalised population groups; improve the quality, equity, and scale of national responses through their participation in accountability and coordination mechanisms; mobilise communities and service providers, building on a sense of shared responsibility and solidarity around issues of health and social justice; bring programmes to scale when there are sufficient investments both in the programmes themselves and the capacity to build and sustain them; and pioneer innovative approaches that build ownership and leadership in communities.
The report concludes with recommendations for future directions in community-based HIV responses. For instance:
- scaling up community-based services requires support from governments, in supplying resources, providing an enabling policy environment, and ensuring systemic linkages
- communities need to balance advocacy with service delivery more effectively
- funding must be made available not only for service delivery but also increasingly for advocacy and research
- look deeper at the structural and systemic inequalities by developing approaches that combat stigma and discrimination, understanding which approaches are most successful and can be scaled up, advocating for the best possible responses, and holding people to account
- conduct more research to understand the impact of responses that are peer-led or community-based.
- invest in and support non-medical community interventions that address deep-rooted structural barriers through a multisectoral approach that includes health, social care, justice, education, labour, and all other sectors of society
- shift community responses from emergency to long-term responses and integrate them in health systems requires supporting community-based service providers to make the transition
- recognise that community systems strengthening (CSS) is an approach that requires domestic and external partners to engage in systematic strengthening of community systems to ensure a comprehensive response: they must keep in mind an effective balance between state facilities and community systems
- include the principle of Greater Involvement of People living with HIV and AIDS (GIPA) as a starting point for strengthening the participation of people living with HIV and key populations in measuring progress towards achieving Universal Health Care