State Department cable to embassies: Meet with, document, and respond to civil society when building country PEPFAR plans

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“We do need to figure out a meaningful way to have community from country input,” U.S. Global AIDS Coordinator Ambassador Eric Goosby said in response to a question at a Feb. 28 Kaiser Family Foundation Town Hall on global health diplomacy. “I do need to make it clear, and it would be in the form of something like a cable or directive.”

As President’s Emergency Plan For AIDS Relief in-country teams build HIV-fighting strategies in the future, they will seek, report on, and provide written responses to input from groups representing those most affected by HIV, following a State Department cable sent to embassies around the world earlier this month and released Monday.

The cable, to all diplomatic and consular posts, directing them to increase civil society engagement with PEPFAR’s work, follows long-voiced concerns that PEPFAR’s increasing shift toward “country ownership” would further marginalize the input of those most involved, knowledgeable and affected by conditions fueling the spread and toll of HIV in their countries.

The cable comes at a time when governments that are becoming increasingly involved in PEPFAR responses also have posed continued, and in some cases, increasing barriers to HIV prevention, treatment and other health services for men who have sex with men, people involved in sex work, people who inject drugs and disabled people. These barriers have included the enforcement and enactment of additional anti-gay laws in countries where efforts are already hobbled by homophobic laws, as well as institutionalized discriminatory neglect of marginalized populations. A report from several organizations, including amfAR, the Foundation for AIDS Research covered here June 19 drew attention to both the contributions of civil society groups, and ways that that engagement is undermined.

Citing examples “where civil society really has been effectively shut out of the discussions around the country operational plan,” amfAR director Chris Collins in February called for U.S. Global AIDS Coordinator Ambassador Eric Goosby to “be very explicit about your expectations around civil society engagement . . .”

The cable released this week acknowledges that while PEPFAR’s “vision of country ownership” would be one that includes the participation of people living with HIV and those in circumstances that leave them most vulnerable to acquiring HIV, the U.S.-based program can’t force governments to adopt that vision. But, the cable continues, “it can work to expand its own engagement with civil society . . .”

The cable instructs PEPFAR country teams to take three steps when preparing future “COPs” or Country Operational Plans:

  • Solicit input during “a pre-COP submission meeting, early in the planning process, with civil society, including both PEPFAR implementing organizations and organizations representing communities living with and affected by HIV,” ;
  • Submit details of civil society involvement in the resulting plan;
  • Write a response to civil society groups detailing how their input was used, and if not, the reasons that it wasn’t.

“This is a great step forward,” Collins of amfAR said Tuesday. “Civil society engagement is crucial to get services to those most in need and to make sure that the country ownership process doesn’t just mean government ownership, but ownership by the whole society. I’m very thankful to Ambassador Goosby for issuing this cable, and now it’s all about the follow through.”

His appreciation was echoed by other global HIV response advocates, as was attention to the next steps.

“PEPFAR is finally realizing that its programs will be more effective if it involves civil society in the planning. In many countries where it works, PEPFAR is the majority of HIV funding–and as a matter of human rights affected communities must have a say in how these funds are prioritized,” Matt Kavanagh of Health GAP (Global Access Project), said. “The question now becomes whether PEPFAR will make the COPS targets fully available so this involvement is meaningful.”

More detailed directions on civil society engagement are expected in PEPFAR’s 2014 Country Operational Plan Guidance.

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