By Sharanya Sekaram
On the 16th of October a meeting with members of key populations related HIV was held with the Regional Director of the UNAIDS Regional Support Team, Mr. Eamonn Murphy to consider the option of re-opening a country office in Sri Lanka after their withdrawal in 2016.
Following the meeting, ostensibly on request from Mr. Murphy, a letter entitled ‘Request by Communities to re-establish UNAIDS office in Sri Lanka’ was sent to various networks for their comments and signature. The letter in question was addressed directly to Mr. Murphy and described the undersigned as “leaders and representatives of organizations led by, working with and serving key populations in Sri Lanka”. It offered multiple reasons and arguments as to why those who would sign this letter believed there was need for UNAIDS to re-establish a country office in Sri Lanka.
One of the primary reasons given in the letter was that “UNAIDS office in Sri Lanka has convened spaces for the communities to directly engage with the decision making bodies including the National STD/AIDS Control Program (NACAP) and Ministry of Health” emphasizing that “the ‘middle man’ role played by the UNAIDS country office in Sri Lanka has provided the communities the space, opportunity, strategic direction, capacity and strength to bring our concerns, issues, challenges and solutions to the tables where decision were being made”.
This idea is reiterated several times through the letter. When asked if the communities are currently unable to engage directly with the mentioned bodies, especially as it is within their mandate, Niluka Perera of Youth Voices Count said that there has been a lack of meaningful engagement and it has often been limited to a “tick the box activity” especially with other UN bodies in Sri Lanka. This was also echoed by Bhoomi Harendran – President, National Transgender Network, who said when she began her activism and engagement, “they [UNAIDS] were the only organization that opened door for us through the UN system”. Currently she says, apart from a cursory meetings and invitations to participate in specific events; organizations such as UNDP and UNFPA don’t effectively engage with the Community and there has been no progress in this regard.
We asked what specifically UNAIDS can do as a middle man to facilitate this access, given that they have not been present in the country for 2 years, and why national organizations such as Family Planning Association of Sri Lanka (FPASL), currently spearheading the HIV intervention along with the National STD/AIDS Control programme (NSACP) are not a sufficient conduit for key populations in Sri Lanka.
Niluka responded that in his opinion, it would not be complicated for UNAIDS to get back in the role they played before, especially as they are not a part of the Global Fund, and don’t participate in the power dynamic that exists. FPASL and NCACP are perceived as de facto donors within this system, i.e. determine which key population groups are selected for Global Fund HIV funding.
“UNAIDS can raise the voice of the community in situations where the Community cannot due to these dynamics, such as when they have made funding requests to these organizations”. When asked if they have attempted to engage with Global Fund directly, Niluka said that they had and the request for UNAIDS to return was to explore “all channels possible” that would benefit the community.
Dr. Dayanath the former UNIADS Country Representative echoed this sentiment saying that back in 2015 the UAIDS office was able to provide a space for Key Populations to engage within the UN system. Should they be reestablished they will be able to recreate that safe space as they did before, such as with the Forum for people living with HIV.
Not everyone agrees – in an email responding to the call for signatures, Palitha Vijay Bandara – Coordinator, Positive Hopes Alliance, said their organization along with several others will not be supporting such a request. He stated that UNAIDS have done their job by setting up key population networks. Palitha suggests that now the focus should be to engage with NSACP, as they have the mandate to “Test and Treat” to reach the National 2025 goal of ZERO New HIV Infections, and ZERO AIDS Related Deaths.
Thenuranketh Perera – Chief Executive Officer, Venassa Transgender Network, similarly feels that there is no role for UNAIDS to play at this time, and that his organization would not be supporting this request either. He described how in 2016 when the decision was made to close the office, an appeal was made by them and other organizations (including Positive Hopes Alliance, Lanka Plus and Heart to Heart) to reverse the decision based on the very reasons given in the letter penned last month. He said that those currently spearheading the return of UNAIDS to Sri Lanka didn’t feel this need in 2016. And that since “the community organizations have upheld their work and work for the community without UNAIDS. There is no real need for UNAIDS to come back”.
Dr. Lilani Rajapaksha, the current Director of NSACP said that whatever organizations there are should in her frank opinion “support the community and community organizations directly”. It is vital that the country needs are first identified, and in her view, she feels that what is most urgently needed is office space for community organizations, including office equipment etc, so that they can be empowered to continue their work. She admitted that there are shortcomings that must be addressed, yet often there are “external elements” that seek to create unnecessary conflict between the caregivers and those needing care. It is vital she emphasized to assess what the specific needs and issues of communities are and focus on solving those.
Another concern raised in the letter was that “The legal challenges faced by the key populations are increasing with consecutive governments becoming worryingly conservative”. This rings especially true in light of the Presidents recent homophobic comments, and the consistent reporting around increased HIV transmission among men who have sex with men in Sri Lanka, which doesn’t necessarily reflect the success of the government’s targeted test and treat initiative which is responsible for the increased number among certain key populations. In a story we carried last year that focused on HIV and testing, Dr. Sisira Liayanage who at the time was the Director of the NSACP clearly said that this increase can be attributed to the increase in the number of people being tested, and the national goal is to reach zero new HIV infections by 2025. Interestingly in this regard, the letter to UNAIDS states “new HIV infections among the MSM and transgender communities rapidly with a rise in the overall new HIV infections every year”. Would this not be similar to the sensationalist reporting in the mainstream media? Niluka’s response was that “we need a more complex conversation and data with regard to this.”
Given that UN agencies tend to shy away from culturally sensitive issues such abortion reform, and rights of people of diverse sexual orientation and gender identity – no UN agency statement came out in response to the President’s homophobic derogatory butterfly comments – would the return of UNAIDS make a difference? In 2011 when the then Global Fund Round 9 project came under fire in the media for promoting homosexuality through the distribution of condoms and lubricants, UNAIDS maintained a stoic silence. This is neither surprising nor disheartening, it appears to be a consistent strategy of non-engagement in terms of political expediency and needs to be understood as such.
Given that the research from IAS 2017 shows that those on effective treatment do not pass on the virus. And that in 2017, The Terrence Higgins Trust (UK) also began their can’t pass it on campaign that states: “Scientific evidence shows that people on effective treatment for HIV are not infectious. This is because the treatment will reduce the amount of the virus in their blood to such a low level that it is no longer able to infect someone via the usual routes. That’s a really important and remarkable thing for a number of reasons. First of all, it means there should be no new HIV infections. We can stop HIV being passed on by encouraging people to get tested and treated” – Sri Lanka would be well served on focusing on their Test Treat goal to achieve their 2025 vision of ZERO New HIV Infections and ZERO AIDS Related Deaths. The only people who remain infectious are those who don’t know their status and those who aren’t on treatment. Do we really need UNAIDS to return to achieve this?
Dr. Dayanath stated that a great deal of the effectiveness of the UNAIDS office would lie in the hands of the person who leads the organization. He emphasizes that while he had not seen the letter in question, it was vital that UNAIDS did not come back simply for “name sake” but to play a specific role as they did in the past. We would concur and go further, i.e. if progress is dependent on leadership of individuals, then wouldn’t Sri Lanka be best served through the leadership of members of key populations such as Niluka, Palitha, Thenu and Bhoomi? Are they not our future? Will they, together with the communities they represent, not help the Ministry of Health achieve their goal and vision by 2025?