Upon the occasion of the International Francophone Conference on HIV/AIDS and Hepatitis, (Bordeaux,4 to 7th of April 2018), we—people affected by and living with HIV, community workers, doctors, nurses and activists collectively representing Coalition PLUS—launch a call for the immediate removal of barriers to the demedicalization of testing and care. We consider this step necessary to fast-track the HIV response. Furthermore, we note that strong backing from certain stakeholders—notably those in the medical profession, the scientific community, and key institutional players—is crucial to the full integration of community actors in response.
Now is not the time for complacency: every year, nearly two million people are newly infected with HIV and one million die from AIDS-related causes (UNAIDS, 2017). The epidemic continues to expand, particularly among men who have sex with men, sex workers and people who inject drugs. For these key populations, the relentless dedication of community actors has proven necessary to effectively address the specific needs of these at-risk groups. In collaboration with doctors and the existing medical care system, community agents bring a complementary and indispensable contribution.
This call for demedicalization requires collective awareness, regulatory reform, political actions, and concrete resources to reach the 90-90-90 goals. The community-based strategy has proven successful in targeting and reaching key populations, reducing fear of discrimination and stigma, and improving rates of retention in care.
Yes, demedicalization constitutes a set of tried-and-tested tools in our fight. These include, but are not limited to, the following: the delegation of rapid-testing to community health agents in the public sector and community-based associations; the initiation of ARV treatment by nurses and distribution of ARVs by community agents; the provision of HIV self-tests kits and PrEP for people most at-risk of HIV infection; and the facilitation of community access to viral load testing and post-exposure treatment. Demedicalization enabless improved proximity to key populations. Despite strong recommendations from WHO and UNAIDS in favor of greater engagement of community agents in all aspects of the response, task-shifting remains very unequally implemented around the globe.
Mere recognition of the importance of the relevance and competence of community actors is no longer sufficient.
We call on:
- Policy makers, doctors, health workers from all countries to promote task-shifting and take concrete action to support the rapid implementation of demedicalized strategies;
- Countries to demonstrate political will to implement demedicalization in all aspects of the AIDS response, to remove corresponding barriers , to support the national scale-up of this strategy, and to provide domestic funding for community activities;
- UNAIDS to accelerate the process of “catch-up plans” for Western and Central Africa through the support of all countries involved in implementing task-shifting strategies, to propose a costed action plan for the recruitment of two million community health agents in Africa as announced in July 2017, and to promote to policy-makers the necessity of a community-led approach ;
- WHO to closely monitor regional and national uptake of WHO guidelines, with a particular focus on the country-level adoption and effective implementation of its recommendations;
- International donors, such as the Global Fund and PEPFAR, to increase funding for community interventions in the global South.
We want effective community expertise immediately recognized everywhere!
Sign the Call to demedicalization!Read the petition
Find the full list of signatories here !