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OUR
IMPACT IN

HIV in a
changing
world

MESSAGE
FROM OUR
EXECUTIVE
DIRECTOR

In 2021, the world began to grapple with the changes COVID-19 had brought. Yet again, HIV organisations proved themselves to be the vanguard of pioneering, community-led healthcare. Rather than scaling back their services, our partners continued to find innovative ways to ensure marginalised people were not forgotten.

Despite this, the long-term future of the global HIV movement remains uncertain. Political and public interest in HIV continues to wane, while international funding for the HIV response in low-and middle-income countries has fallen by more than 10% since 2015.

Against this challenging backdrop, Frontline AIDS supported millions of marginalised people to claim their sexual and reproductive health and rights. Our impact in 2021 is down to the extraordinary effort of frontline partners in over 100 countries and our team in South Africa, Lebanon, the UK and elsewhere. Working in often unimaginably difficult circumstances, the Frontline AIDS partnership continues to show dogged determination to reach our shared goal of ending AIDS for everyone, everywhere.

our mission:
ending aids
for
everyone,
everywhere

Frontline AIDS has been on the frontline of the world's response to HIV and AIDS for 29 years, working with marginalised people who are denied HIV prevention and treatment simply because of who they are and where they live.

a global
partnership

The Frontline AIDS partnership
currently consists of

60
PARTNERS

spanning
more than

100
COUNTRIES

OUR GLOBAL
PARTNERSHIP
FOOTPRINT

The global footprint
demonstrates the scale and
impact of the Frontline AIDS
global partnership.

12.1  MILLION

marginalised people provided with sexual and reproductive health and rights interventions

1,592

community-based or community-led organisations supported to respond to HIV

63

civil society organisations in 29 countries held governments, donors and the private sector to account on their commitment to end AIDS

65

organisations in 25 countries strengthened community-led health responses

21

donors supported more sustainable and inclusive HIV responses

11

governments were supported to provide more sustainable, inclusive and evidence-based HIV responses

4

countries improved national laws and policies to protect the rights of marginalised people

10

countries were supported to expand access to stigma-free, inclusive HIV services

9

countries were supported to expand access to stigma-free, inclusive HIV services

21

countries reduced the levels of violence faced by marginalised people and increased safety and support for marginalised communities

The figures here are based on data reported by 49 Frontline AIDS partner organisations.

Doing
Development
Differently

The aspiration to "do development differently" - to share power and strengthen accountability between regions - is not new for Frontline AIDS.

In our 29-year existence we have consistently sought to elevate community-led action on HIV, understanding that utilising the knowledge and experience of those most affected is what makes an effective HIV response. Our goal has always been for communities most affected by HIV to lead the movement to end AIDS, and for power to be located where the greatest impact of AIDS is felt.

In 2019, we evolved our model to enable leadership to be further distributed across the partnership, and 2021 saw us take significant steps in this journey. We established the Partnership Council, a steering committee made up of nine of our partners, which will oversee the quality, effectiveness and further evolution of the Frontline AIDS partnership.

We also agreed
four key principles
that define us:

1 Equality

All partners are equal, wherever they are situated, whatever their capacity or budget size.

2 Diversity

Our collective power is fuelled by our diversity of voices and expertise.

3 Self-government
and shared
responsibility

Partners have an equal voice to co-define and co-produce how we work together to end AIDS.

4 Mutual
accountability

As a partnership we co-design and agree on accountability mechanisms, including leading on actions in our strategy and reporting back on results.

It is these principles, and a shared vision of a world without AIDS, that create the partnership.

Despite COVID-19 and the political turmoil of the past few years, our engagement with partners has never been stronger.

Our commitment to anti-racism

In 2021 we continued our journey to becoming an anti-racist organisation. We ran a consultative process to gain a sense of how racism impacts our lives - personally and professionally - and opened up spaces for people within the organisation to have conversations about race and racism, and to feel confident in doing so.

Collaborating for
change in 2021

Our Global Plan of Action 2020-2025 drives the work of the Frontline AIDS partnership. This plan is based on ten areas that are essential to creating a future free from AIDS for everyone, everywhere.

While we saw progress in all areas across the wider partnership in 2021, Frontline AIDS focused on HIV prevention, innovative programming and strengthening community-led health responses.

OUR
ACHIEVEMENTS
IN 2021

This year our
Message on the hiv
Prevention crisis
Broke through

This year our
Message on the
HIV Prevention
crisis
Broke through

In 2021, we saw once again how progress on HIV prevention has stalled as news broke that 1.5 million people had acquired HIV in 2020 - one million more people than the global target. The impact of the COVID-19 pandemic on the HIV infection rate is undeniable, but this only tells part of the story. Even before coronavirus, progress on HIV prevention was drastically failing.

Frontline AIDS is the loudest civil society voice on the HIV prevention crisis. For a number of years we have been steadfast in ringing the alarm - showing that infection rates for adolescent girls and marginalised communities are not coming down fast enough - and providing donors and governments with evidence from the frontline on what they can do to change things. This was the year our message finally broke through.

When UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria released new strategies in 2021, both made HIV prevention a key priority. The central focus of UNAIDS' new strategy is the complex inequalities that drive HIV. We were undoubtedly a major player in influencing this change, and this tectonic shift will deliver a more effective response to HIV and AIDS.

Championing
comprehensive
sexuality education

We know that adolescent girls and young women are on the frontline of the HIV prevention crisis. And we know how vital comprehensive sexuality education is to making sustainable change.

That's why, in 2021 we used our collective voice to influence the Eastern and Southern Africa Ministerial Commitment to Comprehensive Sexuality Education and Adolescent Sexual and Reproductive Health and Rights. The first iteration of this commitment happened in 2013 and resulted in many East and Southern African countries improving sexual health education and increasing sexual and reproductive health and rights (SRHR) services for young people.

The 2021 commitment set out what countries need to do to keep moving forward. We supported civil society and youth advocates from across the region to develop a widely-endorsed declaration and call to action outlining what young people truly need. This was used to lobby governments across East and Southern Africa, presenting a strong and unified civil society voice. In December 2021, 10 East and Southern African countries endorsed the commitment, which supports the expansion of comprehensive sexuality education (CSE) for adolescents. This will enable more adolescents to protect themselves from HIV, sexually transmitted infections and unwanted pregnancies and claim their sexual and reproductive health and rights.

“In Uganda, the idea of CSE does not ring well in the ears of many religious and cultural leaders who equate it with promoting promiscuity. These leaders want young people to be safe. That's what we want too... We want a safe and supportive country ... where teenagers can choose books over babies, where we don't get HIV or die from AIDS-related illness. Let us celebrate this common ground and build upon it so we can move together into a world we all want.”

Martha Clara Nakato of the SRHR Alliance in Uganda, who participated in advocacy on the renewal of the Eastern and Southern African Ministerial Commitment on CSE and Adolescent SRHR.

Empowering young people to challenge harmful conservative rhetoric

In April 2021, we began Empowered for Change in Kenya and Uganda - countries with the joint third-largest HIV epidemics in the world, where adolescent girls and young women face high rates of infection.

The pilot programme provided intensive advocacy training and mentoring for 27 young women and men affected by HIV. These young people learnt how to counter harmful conservative rhetoric that is blocking progress on issues like CSE, and advocate for young people's access to HIV, SRHR and gender-based violence services and information.

The pilot surpassed our expectations. Amongst other things, it ended the practice of police charging for gender-based violence examinations in Uganda, something that was stopping many young survivors coming forward. It saw young women in Kenya conduct research with their peers on the PrEP dapivirine ring, which helped the Kenyan Government decide to roll out access.

We now have a tried-and-tested model to use in similar settings to build young people's access to, and influence over, those who make decisions on the sexual and reproductive health issues that affect their lives.

Reaching marginalised
people through
innovative partnerships

This year we continued to use the expertise and systems developed from decades of working on community-led HIV responses to reach marginalised people in programmes beyond our sector.

The Frontline AIDS partnership made significant contributions to the COVID-19 People's Vaccine global advocacy campaign, reached marginalised people in complex humanitarian environments in Lebanon, Mozambique, Nepal and Uganda, and was at the forefront of linking people living with HIV to COVID-19 vaccinations.

With Bridges to Development, we established FIG (the Female Genital Schistosomiasis Integration Group), a coalition of organisations from across a number of sectors: sexual and reproductive health and rights; HIV; HPV/cervical cancer; neglected tropical disease; water; sanitation, and hygiene.

In 2021, FIG partner LVCT Health in Kenya piloted a project in Homa Bay that integrated female genital schistosomiasis (FGS) prevention and treatment into HIV services. Adolescent girls and young women were trained to raise awareness on how to prevent FGS and spot FGS symptoms. They reached 1,700 of their peers in just six months. An FGS awareness campaign ran on a popular local radio station in Homa Bay to raise wider public awareness, while community health volunteers and primary healthcare clinicians were trained to identify FGS symptoms and provide treatment.

Innovations on
mental health

There is growing evidence of the toll the COVID-19 pandemic has taken on mental health. In 2021 we saw communities innovate to address this emerging issue.

In Uganda, partners working on the SRHR Umbrella programme began offering mental health screening and referrals to mental health support services for people living with HIV and their families. The initiative reduced depression among adolescents with HIV by around 50% and among parents and caregivers by 40%. Young people who were offered mental health support were better able to adhere to their HIV treatment, and parent-child communication significantly improved.

Sounding
the alarm on
pandemic
preparedness

Sounding
the alarm on
pandemic
preparedness

In 2021, the question of how the world can be better prepared for future pandemics came to dominate the global health agenda. New institutions began to form that will shape global health financing for many years to come. The HIV, tuberculosis and hepatitis C movements have 40 years' experience of responding to pandemics, yet we were not invited to contribute to this new agenda. We knew this would make plans to respond to future pandemics less effective, so we mobilised.

With UNAIDS, the Elton John AIDS Foundation, the African Alliance, the International Treatment Preparedness Coalition and other partners, we hosted a series of events and webinars throughout 2021 to ensure that civil society and communities from the HIV movement are engaged in these vital global and national discussions.

By the end of 2021, an active group was regularly meeting to share intelligence and respond to an ever-changing landscape. As always, our emphasis was on shared learning; enabling partners that are leading the way on developing inclusive and effective pandemic response plans to exchange knowledge and advocacy strategies with partners in other countries.

Vaccinating
marginalised
communities
against COVID

In 2021, we supported partners in India to run a COVID-19 vaccination service for marginalised communities.

As in other parts of the world, misinformation and scaremongering about COVID-19 vaccines were circulating in India at the time and vaccine hesitancy was common. For many marginalised people, such as female sex workers, men who have sex with men and transgender people, these fears were magnified by experiences of discriminatory healthcare. Some people from marginalised communities who had tried to access existing COVID-19 vaccination camps had been verbally abused and told to leave.

Not only is it everyone's right to get a COVID-19 vaccination, for people living with HIV it is essential. There is evidence that people living with HIV have an increased risk of serious illness or death if they contract COVID-19.

Community expertise

The weekly vaccination service, which was exclusively for people living with and affected by HIV, was run by Alliance India. By offering the COVID-19 vaccine in a safe, non-judgemental space, around 1,830 people from marginalised communities in Surat, Gujarat were vaccinated in 2021.

The Gujarat Network of People Living with HIV/AIDS (GSNP+) mobilised its existing networks to combat vaccine hesitancy and spread the word about the service, while Surat Municipal Corporation provided the healthcare workers and COVID-19 vaccines.

Daxaben Patel, the founder of GSNP+, experienced discrimination when she got her COVID-19 vaccine. This motivated her to act. She says: “I'm part of a community-based organisation, but I'm also a community member, so I've faced struggles in my life, and we understand the challenges for any community members, whether women or key populations.

“The community-based organisation[s] play a big role…because everyone has their expertise, and everyone has their own way of reaching community members and their own infrastructure.”

Alliance India then replicated the model in Delhi. Between October and December 2021, three vaccination drop-ins were organised, and around 350 female sex workers, men who have sex with men, transgender people and people living with HIV were vaccinated.

Long-term localisation:
embedding REACT in Eastern
Europe and Central Asia

Long-term
localisation:
embedding REACT
in Eastern
Europe and Central Asia

REAct (Rights - Evidence - Actions) is a system for monitoring and responding to the human rights violations that marginalised communities experience, which Frontline AIDS developed in 2014.

Since 2019, Frontline AIDS' strategic partner in Ukraine, Alliance for Public Health (APH), has been operating REAct in Georgia, Kyrgyzstan, Moldova, Russia, Tajikistan, Ukraine and Uzbekistan, with technical support from Frontline AIDS and financial support from the Global Fund.

In 2021, APH began using REAct entirely independently of Frontline AIDS. This demonstrates the effectiveness of our technical assistance and is a key example of how programming can become locally-led and sustainable.

Developing
a data-driven
picture

With APH's support more than 120 civil society organisations in Eastern Europe and Central Asia had used REAct to document more than 7,000 cases of rights violations by November 2021.

In countries where opioid substitution therapy (OST) is available, such as Kyrgyzstan, Moldova and Ukraine, REAct gathered solid evidence to show that the police are using OST distribution points as 'hunting spots'. In a clear breach of human rights, police are arresting people who use drugs before they can collect their medication, then exploiting the pain of withdrawal to obtain confessions or force people to inform on others. This is the evidence advocates need to change things.

Andriy Klepikov, executive director of the APH, said: “The evidence collected reveals the legal barriers, harassment and criminalisation of HIV-vulnerable populations. This makes it difficult, sometimes impossible, for them to access health services, prevention and treatment of HIV, tuberculosis and other diseases.”

Before Russia invaded Ukraine, APH was working to introduce REAct in Belarus, Armenia, Azerbaijan and Albania as part of a new US$13 million programme. APH remains committed to this expansion, despite the ongoing conflict.

“This makes it difficult, sometimes impossible, for them to access health services, prevention and treatment of HIV, tuberculosis and other diseases.”

Looking ahead
to 2022

War raging in the heart of Europe is shaping the world in 2022. Not only is Russia's invasion of Ukraine creating a devastating humanitarian crisis, it is having a far-reaching impact on supply chains and energy supplies across Europe, and causing significant rises to the cost of living in much of the world. All of this will have a direct impact on the resources available for communities everywhere to attain better health and wellbeing. Like COVID-19, this unprecedented challenge requires new ways of organising to find collective, creative solutions.

Not that COVID-19 is over. On the contrary, it continues to put pressure on the capacity of our staff, partners and the communities we work with. Global health priorities have changed and there is a real threat of HIV becoming a 'neglected disease', with dire consequences for our goal of ending AIDS. But the HIV epidemic hasn't gone away and sexual and reproductive health and rights are still being denied for millions of people. From communities on the frontline we are hearing about declining access to HIV and SRHR services, record levels of teenage pregnancy and a growing number of people presenting with late-stage HIV.

The global HIV response has a huge task ahead of us. But again and again we see communities rise to meet these challenges, adapting and innovating to protect hard won gains and deliver for marginalised people. There is an urgent need for renewed support from donors and governments to ensure these efforts reach a large enough scale to have the impact that is so desperately needed.

In 2022, Frontline AIDS will continue to lead in bringing the latest learning to the HIV response and other sectors by tracking and incubating new ideas and ways of working. Our new innovation hub will continue to buzz with this work and become the go-to place for all partners and donors looking for cutting edge, integrated, community-led HIV responses and wider solutions to reach and support marginalised people.

Aligning
with other
movements

The COVID-19 pandemic has brought into sharp focus how interconnected the issues of marginalisation are.

The links between poor health, human rights violations, poverty and environmental degradation are clearer than ever before. This calls on all of us to work in more connected, collective ways. It is only through collective working that we will find solutions to these urgent problems of our times.

Climate change and HIV represent two of the greatest threats to human health, now and in future. We are now building connections with the climate justice movement, fully aware that the people who are bearing the brunt of climate change are the very same people who are most affected by HIV, and that gender and social inequalities will only deepen as the climate crisis grows. This is a key priority for 2022 and beyond.

Health,
human rights
and social justice

Health,
human rights
and social
justice

Frontline AIDS is expert at providing tools for practical human rights and HIV work, including developing monitoring tools for human rights violations and supporting and implementing human rights and HIV programmes at scale.

In 2022, we will proactively grow expertise on translating the data collected through REAct and the Rapid Response Fund into effective advocacy that achieves change for marginalised people, nationally and globally.

Thank you
to our
donors and
supporters

Your support and flexibility during a challenging year has been integral to the delivery of the second year of our Global Plan of Action. Despite all of the challenges, we're still committed to delivering the results we set out before the pandemic. Your help made all of this possible.

THANK YOU TO:

We are immensely grateful to the donors that supported Frontline AIDS in 2021. This includes:

  • Elton John AIDS Foundation
  • Expertise France
  • Ford Foundation
  • the German Government (GIZ)
  • the Government of the Netherlands (BuZa)
  • Gilead Sciences Inc.
  • The Global Fund to Fight AIDS, Tuberculosis and Malaria
  • Irish Aid
  • Open Society Foundations
  • New Venture Fund
  • Rockefeller Brothers Foundation
  • Soho House
  • the Swedish Government (SIDA)
  • the UK Government (FCDO)
  • UNESCO
  • ViiV Positive Action