African Civil Society position paper on HIV and AIDS in Africa: Moving to Action

We, African civil society organizations comprising organizations and
networks of people living with HIV, young people, women, religious leaders
and community workers at the frontline of the fight against AIDS, met in
Abuja, Nigeria on April 10 to 12 2006 to develop a consolidated position
for use during the review processes of the Abuja Declaration and Framework
Plan for action, and the United Nations General Assembly Special Session
on AIDS (UNGASS) Declaration of Commitment (DoC), and to chart a way
forward regarding access for all people requiring information and services
related to HIV prevention, care, support and treatment. This statement
reflects the outcomes of these deliberations, as well as the sentiments of
the undersigned African Civil Society Organisations.

African Civil Society Organisations are:

Unified in our commitment to working in partnership with all stakeholders
who recognise the role of Civil Society as a force for change, and as a
critical ally of communities affected by poverty, inequality and disease;

Concerned that although there are now more resources available to fight
AIDS in Africa than there were five years ago, urgent action is needed to
reach the millions of African people who are still excluded from access to
life-saving prevention, care and support and treatment services;

Horrified by the fact that in some instances, corruption and mismanagement
of funds have jeopardised the rights of people living with HIV and
affected by HIV and AIDS to access prevention, care and support and
treatment, and that in the absence of structures and systems to monitor
the use of funds in a transparent manner, the continent will be unable to
sustainably respond to the challenges of scaling up towards Universal
Access;

Outraged that two decades into the AIDS epidemic, Africans are faced with
the reality that many of our health systems are buckling under the
pressure of new AIDS treatment programmes; large portions of our budgets
are externally-funded and subject to unacceptable conditionalities; many
of our best, brightest and most educated are systematically poached by
institutions based in the Global North; the rights of women and girls
continue to be violated with impunity, further deepening their
vulnerability to infection and stigma; young people remain on the margins
of policy and programme design even as their vulnerability to infection
has not yet been addressed; and people living with HIV in many communities
remain unable to access basic services due to the stigma and
discrimination that they face on a daily basis;

Alarmed that onerous debt repayment obligations and conditionalities by
international finance institutions (IFIs) continue to undermine the
capacity of most African governments to devote sufficient resources for
HIV and AIDS including meeting the 15% Abuja commitment, we note that only
two African countries reached the target of 15% of health spending within
their national budgets and if debt repayments are factored in, not a
single African country would have reached the target set in 2001;

Deeply disturbed by the fact that without a massive and sustained effort
to meaningfully involve civil society organizations, the global
difficulties that impeded the attainment of the "3 by 5" campaign will
also be encountered in the push towards Universal Access in the next four
years;

Dismayed that that despite the pledges made by states in the UNGASS DoC,
not one single African country has met the target of "reducing HIV
infection amongst young people by 25% by 2005" nor have any African
countries managed to "ensure 90% access to information, education,
services and life-skills," or reduce "by 20% the number of babies
infected by HIV;"

Strongly convinced that Universal Access to prevention, treatment, care
and support can only be achieved where goals and targets are set: without
goals there can be no progress towards access;

Unshakeable in our belief that comprehensive prevention, care and support
and treatment are indivisible: action in one area without equivalent
actions in the other areas is unacceptable;

Recommitted to moving beyond words to address the poverty, inequity and
violence that drive and exacerbate the impact of HIV and AIDS on the
communities that we represent and work with;

Within the Abuja Declaration and Framework Plan for Action, we therefore
call for:

1. Leadership, Partnership and Accountability
* Enact domestic legislation to ensure that the Abuja Declaration is given
effect in a manner that is commensurate with the State of Emergency
declared by many countries;
* Establish as a matter of urgent priority an inclusive and participatory
process for the development of national targets and indicators which
includes clear timeframes that will be reviewed on an annual basis;
* Include within the 15% health spending target, a specific set of
separate targets for each of the three diseases: AIDS, Tuberculosis and
Malaria;
* Establish independent national oversight committees with active
participation of civil society, to monitor the Abuja Declaration;
* Ensure that there is adequate resourcing and planning to enable civil
society participation in the processes outlined above;
* Put in place explicit accountability mechanisms that address the
allocation of responsibilities, timeframes, funding and access to
information by civil society organizations involved in monitoring and
reviewing progress;
* Recognise the importance of building and maintaining partnerships with
all stakeholders within civil society including people living with HIV,
young people, the media, parliamentarians, the private sector, faith-based
organizations, trade unions and community-based groups.

2. Sustainable Financing and Health Systems Strengthening
* Work in partnership with civil society organizations to accelerate
action on the removal of unfavourable conditionalities for accessing
resources, particularly the removal of budgetary ceilings imposed by IFIs
on social sector spending and the removal of odious debt repayments which
are demanded at the expense of the health and human rights of African
people;
* Explore and support innovative means of mobilising additional domestic
resources to secure sustainable and predictable financing for HIV and AIDS
(such as the International Finance Facility and the Airline Solidarity
Contribution), including reducing military spending in order to increase
social spending, and ensuring that National Economic Planning Processes
reflect the commitments made in the Declaration;

3. Human Resources
* Ensure that health systems and infrastructure strengthening is supported
by a commensurate investment into the human resources of Africa by putting
in place long-term, comprehensive and fully costed Human Resource Plans at
national and regional levels to address Africa's primary challenge.
* Specifically that all WHO guidelines for effective delivery of health
care should be met by 2010, in particular the ratios recommended regarding
the number of doctors and nurses per patient, the number of hospitals and
clinics per population.

4. Comprehensive Prevention, Care, Treatment and Support
* Urgently scale up prevention efforts in order to meet the DoC targets
agreed upon in 2001, with particular emphasis on sexuality education and
life-skills and specific efforts aimed at decreasing the vulnerability of
women and youth, and promoting their ability to fully enjoy their sexual
and reproductive health and rights;
* Accelerate action on lifting tariffs on cost and price of medicines and
trade rules and mechanisms that impede access to affordable medicines;
creating an enabling environment for local production of medicines;

5. Research and Development
* African states must urgently commit build and strengthen national and
regional research capacity and infrastructure so as to lead HIV research
efforts that Africans will directly benefit from - including treatment,
prevention, indigenous African traditional medicines, and behavioural and
social science;
* African states must urgently commit to financial and human resources for
the research, development and planning for future access of vaccines,
microbicides and other female-controlled methods of preventing new HIV
infections - nationally and regionally;

6. Women's Rights and Gender Equality
* Through policy, institutional and legal frameworks, develop a policy,
legislative and administrative environment in which the rights of African
women and girls, especially those living with HIV are actively promoted,
fully enjoyed and protected within and through the ratification and
domestication of international instruments such as CEDAW, the Protocol to
the African Charter on Human and People's Rights on the rights of Women in
Africa; Solemn Declaration on Gender Equality in Africa (2004);

7. Human Rights
* Create enabling environments through policy, institutional and legal
frameworks at national level that promote and protect the human rights of
those living with and affected by HIV and AIDS, and that further reduces
their vulnerability to stigma and discrimination through the enactment of
Human Rights legislation;
* Ensure that the rights of orphans and vulnerable children are promoted
and protected through the massive scaling up of efforts aimed at providing
children with the protections outlined in the Convention on the Rights of
the Child, to which all African states are signatories;

Within the UNGASS DoC and the Declaration Statement on Universal Access,
we further call for Heads of States and government to adopt the following:

1. Explicit Targets
At the Abuja Summit, and again at the UNGASS Review, ensure that the
following targets are inserted into any document that is adopted in
regards to Universal Access:

"By 2010, ensure that at least 10 million people have access to HIV
treatment - including 7 million Africans - through an acceleration of HIV
treatment scale-up efforts by all stakeholders, including civil society,
people living with HIV, member-states, donor countries and multilateral
institutions. In order to ensure that this target is reached equitably,
Member States should develop, in an inclusive manner, specific targets for
the inclusion of vulnerable populations in national treatment plans,
including, for example, active injecting drug users, children, men who
have sex with men, women, and migrant populations."

"By 2010, ensure that all pregnant women living with HIV have access to
information and ARV therapy to prevent mother to child transmission."

"By 2010, ensure that the information and means to avoid HIV infection is
available to all citizens through an accelerated effort by civil society,
people living with HIV/AIDS, member states, donor countries and
multilateral institutions."

2. Commitment to Tracking Progress on Universal Access

At the Abuja Summit and again at the UNGASS Review, ensure that African
states commit to the review of progress towards the prevention, care and
support and treatment targets contained in the DoC and outlined above.
This should be done in a High-level Joint Publication developed by key
stakeholders within civil society in partnership with the African Union.
The Summit is requested to adopt the following recommendation:

"By June 2008, ensure that the African Union Commission, in close
collaboration with civil society organisations and other key stakeholders,
produces a High-level Review of Progress towards the goals of ensuring
that a minimum of 7 million Africans have access to treatment services
related to HIV and AIDS; ensuring that all pregnant women living with HIV
have access to information and ARV therapy; and ensuring that all Africans
have access to the information and means to avoid HIV infection."

ENDS.

For steering committee of the African Civil Society Coalition on HIV and AIDS:

ActionAid International - Africa
African Council of AIDS Service Organisations (AfriCASO)
African Microbicides Advocacy Group (AMAG)
Central African Network of AIDS Service Organisations (CANASO)
Eastern African Network of AIDS Service Organisations (EANASO)
Global Youth Coalition on AIDS (GYCA)
Journalists Against AIDS (JAAIDS) Nigeria
Network of African People Living with HIV/AIDS (NAP+)
Treatment Action Campaign (TAC)
Open Society Institute for Southern Africa (OSISA)
Oxfam International
Panos Institute GAP
Southern Africa AIDS Information Dissemination Service (SAfAIDS)
Society for Women and AIDS in Africa (SWAA)
World AIDS Campaign

Abuja, Nigeria, 12 April 2006