The recent arrest of Zambian HIV treatment and human rights advocate Paul Kasonkomona for only talking about legal barriers to HIV and other health services for Zambians who are prisoners, sex workers or members of sexual minorities, raises the question of how those barriers can be addressed by the country’s board charged with distributing money from the Global Fund to Fight AIDS, Tuberculosis and Malaria. After all, in Zambia, the board, known as a Country Coordinating Mechanism — CCM — is housed in a government building. And if just talking about improving health access to gay and other marginalized Zambians can get you thrown in jail for several days — with the prospect of at least 30 days more looming if one is found guilty — that could make it hard to get anything done. At the same time who sits on those boards is supposed to help to ensure that Global Fund money is spent effectively, fairly and where it is needed.
Recently, two reports released by AIDS Accountability International, a Sweden and South Africa-based nonprofit that examines AIDS responses, said those boards could hold both the challenges to sound health responses, and the solutions. Right now, the reports said, lack of representation by youth as well as gay, lesbian and transgender people on CCMs is a challenge. This gap diminishes opportunities for groups representing some of the most marginalized and affected populations to get funding, bring attention to their needs and how to address them, and, instead, leads to generalized HIV prevention and treatment approaches.
Who is really affecting the Global Fund decision making processes? A Community Consultation Report looks at challenges in five southern African countries, including Zambia. “The CCM in Zambia”, it notes, “is operating in a very tough climate.” Following misappropriations of Global Fund money by the organization charged with distributing the funds to civil society groups, the two principal recipients are the country’s Ministry of Finance and the Churches Health Association of Zambia. And in a country that has retained colonial criminalization of homosexuality, members of the CCM told researchers, the topic of how to ensure members of sexual minorities have access to health services seldom comes up. Swaziland appears, according to the report to make an more active effort, having “openly invited MARPS (most at-risk populations) to make a formal request to be a member of the CCM.” The report notes, however, that gay people are “legally and culturally marginalized” in Swaziland. That possibly is the reason that its CCM has no gay, lesbian or transgender representation now.
AAI’s Quantitative Analysis of CCMs, in turn, breaks down the numbers. A pie chart of CCM composition across Southern Afica shows that members of “Key Affected Populations” make up just 3 percent of the boards, with the government making up 37 percent. In a country where a man just spent several days in jail for discussing the rights of gay people, and where a recent headline in a government-owned newspaper reiterated “Gov’t Will Not Be Pressured to Accept Homosexuality” this may sound like an overwhelming challenge to fairness. But this report also notes that the members of CCM’s actually evaluate the lack of representation by gay, bisexual, lesbian and transgender men and women as more “unacceptable” than did people who did not sit on the boards.
A summary of the reports’ findings also points to the successes the Global Fund already has enjoyed, and says “the Global Fund’s inclusive and participatory structures do have the potential to expand opportunities for broad participation in decision-making.”
Stay tuned, as Science Speaks continues to examine the challenges and opportunities faced by Global Fund as its new funding model begins.