Jhabindra Bhandari

The world has made remarkable progress since the late 1990s, but HIV remains a major public health and development issue. And like many other major health issues, it faces additional challenges during the COVID-19 pandemic. In this context, UNAIDS report on the global AIDS epidemic shows that 2020 targets will not be met because of deeply unequal success and increasing COVID-19 risks. As a matter of fact, HIV prevention, testing, treatment and care services are all being disrupted particularly in countries with fragile heath systems.

Advocacy
In the recent years, civil society has been playing an important role in the HIV response since the earliest days of the epidemic. More importantly, their contribution is visibly significant from advocacy to service delivery in the families and communities. Considering the critical role of civil society in the HIV response, networks of civil society organisations (CSOs) recently convened the first ever civil society conference on HIV, health and development in coordination with the key populations, representatives from development partners and governments.
This conference was instrumental in raising the voices of civil society in community response. While civil society represents diverse communities, their needs and priorities for community-based HIV prevention services are differently experienced. The broader discussions around HIV, health and development are needed to ensure that key populations have equitable access to comprehensive HIV services for their good health and well-being. Evidence shows that community responses to HIV result in positive health outcomes, foster community resilience and are cost effective. The governments and development partners are committed to the meaningful and inclusive participation of civil society at all levels of the AIDS response. However, there are critical needs to advocate for community-based responses so that marginalised communities will have easy access to prevention, treatment and care services in families and health care settings.
On the other hand, HIV related stigma and discrimination is recognised as a barrier to HIV prevention, testing, care and adherence to treatment. People living with HIV, key populations and other vulnerable groups continue to face stigma, discrimination, criminalisation, and ill treatment based on their actual or perceived health status, socio-economic status, age, sexual orientation or gender identity, expression, behaviour and other grounds. Therefore, the global response aims to catalyse and accelerate action in countries to end HIV-related stigma and discrimination in six settings: healthcare, education, workplace, justice, household, emergencies and humanitarian, based in the latest evidence on what works to eliminate HIV-related stigma and discrimination
Most of the development partners are largely working with CSOs at national and sub-national level to reach out to key and vulnerable populations. The community-based interventions and HIV services have been instrumental in ensuring robust local responses to HIV. In many ways, such partnerships have helped support people living with HIV to demand and receive protection of their rights to treatment, non-discrimination and participation. Community ownership and community-led approaches are the cornerstone of the civil society response. Therefore, capacity building of CSOs is crucial to advance their knowledge, skills and experiences to make sure that vulnerable people have an easy access to prevention, treatment and care services. The alliance or network of civil society organisations is crucial to raise their voices, insights and experiences for wider sharing and learning for enhanced solidarity and shared responsibility to address a range of issues faced by key and vulnerable populations
In Nepal, the role and contributions of CSOs have been appreciated by the government, development partners, political leaders and private sector to address a range of issues around HIV, health and development. Community response is largely driven by CSOs with the support from the government and development partners. There is critical need to further enhance the capacity of CSOs by providing platforms for sharing information and experiences, networking and providing opportunities to better engage with governments, partners and communities for effective and sustained community-led HIV response.
Additionally, the CSOs have a unique ability to interact with affected communities, react quickly to community needs and issues, and engage with affected and vulnerable groups. They provide direct services to communities and advocate for improved programming and policy environments. This enables them to build a community’s contribution to health, and to influence the development, reach, implementation and oversight of public systems and policies.
Community systems strengthening (CSS) is an approach that promotes the development of informed, capable and coordinated communities, and community-based organisations, groups and structures. This involves a broad range of community actors, enabling them to contribute as equal partners alongside other actors to the long-term sustainability of health and other interventions at the community level, including an enabling and responsive environment in which these contributions can be effective.

Improved health outcomes
The CSS aims to achieve improved health outcomes by developing the role of key affected populations and communities and of community-based organisations in the design, delivery, monitoring and evaluation of services and activities related to prevention, treatment, care and support of people affected by HIV, tuberculosis, malaria and other major health challenges. In the federal context, the issues and challenges of civil society need to be further discussed for common voices and solidarity. The perspectives of governments and partners on new role of CSOs need to be further clarified for consistency and accountability. There is an emerging need of increased social accountability to address the critical issues around community system strengthening, community-led advocacy and multi-sector engagement for robust HIV response to achieve the national targets of HIV, health and development.

(Bhandari is senior doctoral research fellow in global health systems)