Efforts to increase LGBTI people’s and sex workers’ involvement in planning Ugandan health services are not going smoothly, reports Ugandan correspondent Kikonyogo Kivumbi.
( 76crimes article)
An election to choose representatives of those key population groups was ruled invalid on Wednesday, Jan. 21. As a result, those groups still have no official representatives on the Ugandan health policy panel known as the Country Coordinating Mechanism (CCM).
A new election is scheduled for Feb. 5.
Representation for LGBTI people and sex workers is important because those groups suffer from a higher rate of HIV infections than the overall population. Among Ugandan men who have sex with men (MSM), the HIV infection rate is an estimated 12 to 33 percent, compared to 7.3 percent for all Ugandans.
Uganda’s CCM oversees grants from the Global Fund (the Global Fund to Fight AIDS, Tuberculosis and Malaria), which finances many of Uganda’s anti-AIDS efforts.
CCM’s exist in every country that applies to the Global Fund for grants for the prevention and treatment of AIDS, tuberculosis and malaria. These are country-level multi-stakeholder partnerships that develop and submit grant proposals to the Global Fund based on priority needs at the national level. After grant approval, they oversee progress during implementation.
The Global Fund now requires every CCM to include representatives of Key Affected Populations (KAP), because their health needs have often been neglected in many countries, particularly in those, like Uganda, where same-sex intimacy is a criminal offense.
Professor Vinand Nantulya (Photo courtesy of news.ugo.co.ug)
Professor Vinand Nantulya (Photo courtesy of news.ugo.co.ug)
LGBTI groups and individuals had contested the original results of the election of KAP representatives. In response, Uganda’s CCM chairperson, Professor Vinand Nantulya, declared the election invalid.
While chairing a meeting of activists from various KAP constituencies earlier this week, Nantulya cited “obvious flaws” in the selection of Geoffrey Mugisha and Shalince Naturinda as KAP representative. Notably, they are brother and sister; they are from the same organization, the MARPS Network; and there was no transparent, verifiable and agreed upon mechanism for the election.
He said the “flawed election” was marred by undeclared conflicts of interest, the MARPS Network process of convening a meeting and electing its own staff, and lack of communication, consultation and feedback from KAP representatives and other interested groups.
Uganda Country Coordinating Mechanism Uganda meeting, January 2014.
Meeting of Uganda’s Country Coordinating Mechanism in January 2014.
The Global Fund has clear procedures for selecting country representatives, which include an open and transparent selection process. The Global Fund “requires all CCMs to show evidence of membership of people that are both living with and representing people living with HIV… as well as people from and representing Key Affected Populations, based on epidemiological as well as human rights and gender considerations.”
Kivumbi, executive director of the Uganda Health and Science Press Association, said that “for smooth operations of the CCM, new elections will be held on February 5th with a clear, time-bound road map.”
A separate meeting on Jan. 21 of the Uganda AIDS Commission (UAC) secretariat “also agreed that LGBTI/MSM and sex workers representation was wanting,” he said.
A total of eight KAP sub-constituencies have been identified, with MSM, LGBTI and sex workers included. The Secretariat decided that these groups, working directly with Nantulya, will nominate five representatives each and forward names to the CCM by Jan. 31, Kivumbi said. The 40 nominees will gather on Feb. 5 and elect the two representatives to the CCM.
Activists from many LGBTI groups in Uganda will be working to develop their own process to choose their delegates who will, in turn, vote in Kampala on Feb. 5.
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Additional notes to activists
As far as The Global Fund is concerned, every country that wants to get grants funded by the Global Fund must conform to the eligibility requirements for CCM's (see links in article above ) These were revised in 2013 to ensure participation of Key populations at the CCM level, to ensure key populations have a voice in the design and implementation of HIV programs. That revision took many years work by groups such as GNP+ and MSMGF and many others. The implementation will mean that, at last, "no one is left behind," and its about time!
The determination of what are the Key populations in any specific nation is usually determined through the National plan, through epidemiological or other evidence and studies (in those cases of nations that do not keep such statistics). I cannot think of any African nation where MSM (and that includes trans persons) would not be an identified key population. The Global Fund, in negotiations with the nations, ensures that they should not exclude specific populations for any "cultural" reasons if there is some evidence the group may represent a cluster of cases from which the virus may spread.
The UNAIDS, many years ago developed a definition of Key populations and what groups could and should be targeted if we are ever going to defeat the pandemic (thanks in large part to the participation of the NGO Delegation to the UNAIDS PCB (Board) where excellent delegates have pushed this issue forward).
The Global Fund bought into the UNAIDS proposals on targeting key populations about 3 years ago, when it became very clear the Millennium goal for HIV was not going to be met. It then hired specialized human rights staff and developed policies and implemented its new funding model starting in January this year.
Unfortunately, there is not yet an independent mechanism (outside the Global Fund) to ensure implementation outside of Southern Africa, where gay and MSM groups set up a mechanism last year to monitor and ensure implementation. Despite this, there is some optimism that most nations in Sub-Saharan Africa will likely implement these new programs and invest in new and significant ways. There will no doubt be some hick-ups, but most sub-Saharan nations have fairly well organised LGBTI communities to keep an eye on things and to complain if there were no programs.