Communities Deliver: the impact of community responses

This summer, UNAIDS and Stop AIDS Alliance (a joint partnership between the Alliance and STOP AIDS NOW!) launched a new report - Communities Deliver – which synthesises the compelling evidence from numerous studies of the many ways in which communities are advancing the response to HIV and the crucial role they will play in ending the AIDS epidemic by 2030.

UNAIDSThe report comes at a timely moment. The global AIDS response has set new targets for its post-2015 future, the Global Fund to Fight AIDS, Malaria and Tuberculosis has almost finished consulting on their 2016-2020 strategies, and many governments are looking to renew their national HIV plans.

“We have heard a lot of donors say that the evidence showing the effectiveness of community responses is just not there”, says Christoforos Mallouris, Community Mobilisation Adviser at UNAIDS, who co-authored the report. “Many just equate communities with a cheaper way of giving services. This report presents arguments that dispel this myth - the evidence is there.

“We know community responses work, not only because they are cost efficient but because they actually result in good health outcomes. In some cases they deliver better health outcomes than state facilities.”

Communities were the first to respond to HIV three decades ago and have since taken a myriad of actions to help people access HIV services and tackle HIV-related stigma and discrimination. Their work has been as diverse as the communities themselves, which has made the concept of ‘community responses’ hard to define and categorise.

Communities Deliver offers a simple categorisation of community responses in four core areas, namely advocacy and participation in accountability, service provision, community-based research and financing.

It provides compelling cases studies to show how community action translates into results.
For example, Maximizing ART (antiretroviral therapy) for Better Health Prevention and Zero New HIV Infections (MaxART) implemented a number of health and community system interventions in Swaziland to dramatically scale up HIV testing to 250,000 people per year, to improve access to treatment and reach 90% of people eligible for treatment, and to reduce loss to follow-up of people on treatment from 22% to 10% by 2014.

Or Vida Digna, a Participatory Community Assessment programme led by NGO Atlacatl in El Salvador, which drafted a new law on sexual and reproductive health rights to ensure the rights of transgender women were addressed. As a result of their efforts the draft law now refers to hormone regimes and rights to access specialist doctors – an important step in encouraging the state to address gender identity issues formally.

How sex workers, transgender people, people living with HIV and other groups have become researchers, producing data for key global stakeholders such as the World Health Organisation (WHO). And how a new funding scheme in Ethiopia and Tanzania from international NGO Comunità Volontari per il Mondo has enabled people living with HIV to train nearly 4000 government officials and community leaders on the realities facing key populations.

These and numerous other examples from across the world that are included in the report, show the varied yet effective role communities play in responding to HIV. In many instances, community responses support public health systems by filling critical gaps, which enables marginalised populations to access health services. Yet examples of community-based organisations supplying direct services on a large scale also appear. In Uganda, for example, The AIDS Support Organisation (TASO) has reached over 200,000 people with HIV treatment and other services.

“Although 2030 signals the endpoint, the goal to end the AIDS epidemic as a public health threat, we need to set goals for 2020 that look at what we need to do operationally to get to 2030. How many people need to be on treatment by this point? What prevention services must be accessed by whom? How many people need to be free from HIV related stigma?” says Mallouris.

“We must be asking what the role of communities will be in getting us to the 2020 targets. We need to transform the response overall so that community responses are better integrated, part of the overall system, and are adequately funded.”

To compliment the report, a series of good policy and practice guides are planned. Each of these will present innovative case studies and support scale-up and adaptation to different contexts, promoting learning and cooperation across regions.

UNAIDS and Stop AIDS Alliance plan separate launches of Communities Deliver in Africa, Asia Pacific, Europe, North, Central and South America and the Middle East this Autumn. The document is currently being translated into Spanish, French and Russian. If you would like to know more about the country and regional launches, please email druiz@aidsalliance.org