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AIDS Action Europe - Continuity and Innovation 2017 [AAE] [748531] - Operating Grant
Project abstract

Under its leading motto for the Framework Partnership Agreement, continuity and innovation, AIDS Action Europe (AAE) will maintain to work in 2017. As a comprehensive NGO network in the field of HIV/AIDS with over 400 network members and partners AAE is a unique player with substantial added value for European policy making and programme implementation. Based on the problem analysis and the activities implemented in 2015 and 2016, AAE will focus on tackling following core problem areas in 2017:
Advocacy for a new policy framework
Advocacy for European issues at the international level
Upscaling access to prevention for gay men and other MSM
Improved access to HIV services for all those whose access is limited due to their residency status
Affordability of medicines and access to treatment
Community based voluntary counselling and testing (CBVCT) outside medical settings
and tackling stigma and discrimination
Within Objective I, AAE will ensure that Civil Society’s voices are being heard and key populations’ needs are addressed by organising the EU HIV/AIDS CSF, contributing to the Think Tank, contributing to key European events and participating in the UNAIDS PCB. Furthermore AAE will continue its activities regarding undocumented migrants, affordability of medicines, promoting CBVCT and upscaling access to prevention for gay men and other MSM. Tackling stigma and discrimination is a core task for AAE and is reflected as a cross sectional theme in all our activities. AAE will advocate for the rights of key populations and contribute to fairer, inequality reducing societies. Under Objective II communication and collaboration, facilitate linking and learning between members and partners are at focus with a recently re-launched and re-designed AAE Clearinghouse and website as well as through our social media presence. Objective III will ensure overall governance, the functioning of the network and the implementation of the annual work programme.

Summary of context, overal objectives, strategic, relevance and contribution of the action

Under its leading motto for the Framework Partnership Agreement, continuity and innovation, AIDS Action Europe (AAE) maintained its work in 2017. As a comprehensive NGO network in the field of HIV/AIDS with over 400 network members and partners AAE is a unique player with substantial added value for European policy making and programme implementation. Based on the problem analysis and the activities implemented in 2015 and 2016, AAE focused on tackling the following core problem areas in 2017:
Advocacy for a new policy framework
Advocacy for European issues at the international level
Upscaling access to prevention for gay men and other MSM
Improved access to HIV services for all those whose access is limited due to their residency status
Affordability of medicines and access to treatment
Community based voluntary counselling and testing (CBVCT) outside medical settings
and tackling stigma and discrimination

Within Objective I, AAE ensured that Civil Society’s voices are being heard and key populations’ needs are addressed by organising the EU HIV/AIDS, Hepatitis and Tuberculosis CSF, contributing to the Think Tank, contributing to key European events and participating in the UNAIDS PCB. Furthermore, AAE continued its activities regarding undocumented migrants, affordability of medicines, promoting CBVCT and upscaling access to prevention for gay men and other MSM. Tackling stigma and discrimination was a core task for AAE and is reflected as a cross sectional theme in all our activities. AAE advocated for the rights of key populations and contributed to fairer, inequality reducing societies.
Under Objective II communication and collaboration, and facilitating linking and learning between members and partners were at focus with the AAE Clearinghouse and website as well as through our social media presence.
Objective III ensured overall governance, the functioning of the network and the implementation of the annual work programme.
a) Advocacy for a new policy framework
Advocacy activities for a new EU communication for combatting HIV/AIDS in the European Union and neighbouring countries were not successful. At the moment, the EU is without a renewed policy framework after the Action Plan deriving from the Communication 2009 – 2013 ended at the end of 2016. However, huge efforts were put into the extension of political and strategic directions with regards to the so called integrative approach, that adds the response to the infectious diseases of TB and viral hepatitis not only as co-infections but also as mono-infections to the agenda. With its renewal in 2017 the Civil Society Forum broadened its membership to TB and hepatitis organisations. The Civil Society Forum (CSF) as an advisory body, pooling expertise and good practices, assists Member States in their health system reforms, in particular where Civil Society’s participation is needed.
The Commission announced that there will be a staff working document that includes the response to all three diseases and that will be published in 2018 under review and feed in of the CSF. This is specifically necessary where CSO can reach key populations whose access to the health care system is limited. AAE will continue to monitor, collect information and advocate for support of CSO in the region and hence, contribute to strengthening health care systems and nobody is left behind. The staff working document will also support the role of civil society organisations in the response to HIV, TB and viral Hepatitis in times where it gets more and more difficult to deliver their services.
b) Advocacy for European issues at the international level
During the summer of 2015, AAE applied for and received a seat at the NGO delegation to the UNAIDS PCB for the period of 2016-2017. With AAE’s participation in the work of the NGO delegation it was ensured that European issues are heard and properly addressed in the global agenda by consulting our members and reporting back t

Methods and means

I.1 The EU HIV/AIDS, Hepatitis and Tuberculosis Civil Society Forum
The EU HIV/AIDS, hepatitis and TB Civil Society Forum is an advisory body to the European Commission. Huge efforts were put into the extension of the CSF with regards to the so called integrative approach, that adds the response to the infectious diseases of TB and viral hepatitis not only as co-infections but also as mono-infections to the agenda. With its renewal in 2017 the Civil Society Forum broadened its membership to TB and hepatitis organisations. Moreover, the Coordination Team, before consisting of the European AIDS Treatment Group (EATG) and AIDS Action Europe was extended to three more organisations. For this term, 2017 to 2019 EATG, AAE, Global Health Advocates (GHA), Eurasian Harm Reduction Association (EHRA) and Correlation Network (CN) were elected into the Coordination Team. The Coordination Team then decided that the secretariat work to the CSF will be performed by AAE and EATG. Two annual meetings, constant exchange between the CSF coordination team members via mails and conference calls, the CSF Facebook page (HIV Europe Policy) and email exchange with the CSF members through the CSF mailing list are methods to ensure the functioning of the CSF. Advocacy initiatives are implemented by writing letters and statements, by outreach to national and European stakeholders as well as by information and briefs to external stakeholders. Results and reports of the CSF meetings and advocacy activities are published on the AAE website.
I.2 Contribution to implementation, monitoring and evaluation of European HIV policy
With the changes in the Civil Society Forum, also the EU Think Tank, the representation of Member States extended its agenda to viral hepatitis and TB. The EU HIV/AIDS, hepatitis and TB Think Tank provides the platform to share Civil Society’s perspectives and positions on EU policies. Six members of the CSF participate one day in the biannual meetings of the Think Tank, report from the CSF meetings and ensure that Civil Society’s voices are being heard. Furthermore, policies and guidelines from stakeholders are reviewed and given input to in the process of their preparation if required.

I.3 Advocate as AAE for Civil Society concerns regarding European policy initiatives by participating in key European events
Participation in key European events, to deliver key speeches and other contributions and provision of reports considering this events on AAE media are the instruments to give Civil Society a voice. Furthermore, AAE holds a seat on the NGO Delegation to the UNAIDS Programme Coordinating Board (UNAIDS PCB) as a staff member was elected for the period 2016-2018. In this way, the European Civil Society perspective is represented at the global level.

I.4 Promote findings of the European HIV Legal Forum (EHLF)
The EHLF is a network of policy and legal experts facilitated by AAE. The project implemented in 2017 in the framework of the EHLF focuses on access to HIV prevention, care and treatment for migrants in an irregular situation. The desk research and the legal survey now including 16 countries and the project findings were used in presentation and promoted in two national conferences, during a workshop addressing legal environments and during the AAE Member and Partner Meeting in 2017.

I.5 Support and facilitate national and regional advocacy efforts on “Affordability of medicines and access to treatment”
The affordability training manual was translated into Russian and was applied in 2017 in three regional trainings, two for the Southern EU Member States and one in the Russian language for the Eastern Europe and Central Asia region.

I.6 Facilitate activities on “Community based voluntarily counselling and testing outside medical settings” at European level
Provision of VCT in community based settings still faces barriers in many countries. Based on the results of a kick-off meeting under participation of EUROHI

Work performed during the reporting period

Objective I: Civil Society’s contributions to regional and national HIV/AIDS policies and programmes are effective and meaningful
The renewed EU HIV/AIDS, Hepatitis and TB Civil Society Forum (CSF) meets biannually and is organised by the CSF Coordination Team. In its constituent meeting with new organisations also from the field of TB and Hepatitis (see above), it was decided that five organisations should be elected into the Coordination Team that formerly was composed by the two CSF co-Chair organisations of EATG and AAE. As mentioned above, apart from AAE and EATG, Correlation Network, Eurasian Harm Reduction Association and Global Health Advocates were elected into the Coordination Team. With the following discussions it became obvious that the work of a secretariat to the CSF is needed. The Coordination Team decided that EATG and AAE will continue this work for this term; the secretariat is the Policy Officer of EATG and the Executive Coordinator of AAE. During the second meeting the current chair-organisations EATG and AAE were proposed as Chairs for this CSF term by the Coordination Team and confirmed by the CSF Members. The Coordination Team worked during the second half of the year on a governance paper that describes the procedures and tasks of the Chairs, the Coordination Team and the Secretariat. Moreover, a strategy paper and a working plan were developed with support of the CSF Members. The preparation work as well as all advocacy activities are prepared by regular teleconferences and face-to-face meetings. Moreover, conference calls with the Commission supported the preparation of the meetings as well as the re-organisation of the CSF.
The first Civil Society Forum (CSF) in 2017 was conducted on June 20 and 21 and still prepared by the preceding Coordination Team. Apart from the regular topics on the agenda like the Update from the Commission and from the agencies and the reports from the CSF co-Chairs on recent activities and the report from the representatives from current and future EU Presidency Countries, the renewed CSF discussed how to organise itself in its new constituency.
Moreover the following topics were discussed: developments in Testing: CBVCT – Situation of counselling and testing in non-medical settings in Lithuania and legal and regulatory barriers to testing and linkage to care; addressing stigma and discrimination – access to insurances for PLHIV and health system changes in Latvia; the EU funded projects in the field of HIV, Hepatitis and Tuberculosis ESTICOM - European Surveys and Trainings to Improve MSM Community Health (Ulrich Marcus via video conference) and INTEGRATE - Integrating prevention, testing and link to care strategies across HIV, viral Hepatitis, TB and STIs in Europe were presented; HIV epidemics among men who have sex with men in newer EU member states and EU candidate countries; importance of Civil Society Involvement in Hepatitis C policy - the Community Declaration and the civil society conference on drug policy 2018 in Brussels; the World AIDS Conference in Amsterdam 2018 – State of preparation in the Netherlands: Civil Society and Commission perspective; the situation of sex workers in Europe and countries in transition – Reports from Macedonia and Bosnia-Herzegovina were discussed.
The second CSF Meeting was conducted on December 18 and 19. On the agenda were, apart from the regular topics a presentation on EU competence, instruments and tools in the field of HIV/AIDS, viral hepatitis, tuberculosis and STIs – Legal and political context for EU action; CSF governance; CSF strategic priorities and a follow-up from last CSF with updates and joint work. Upcoming policy meetings; Monitoring; Labour Migration in the WHO European Region and access to HIV, TB, hepatitis services; Improving HIV prevention and diagnosis with news from the ECDC expert meeting on HIV/STIs prevention of sexual transmission among migrants and MSM and ECDC guidelines review panel,

The main output achieved so far and their potential impact and use by target group (including benefits)

Framed by our mission, vision, guiding principles and core values, AAE’s general objective in Europe and Central Asia is to strengthen civil society’s contribution to a more effective response to the HIV epidemic. AAE is striving for reduction of health inequalities, focusing on most at risk populations and the epidemic in Eastern Europe and Central Asia.
Due to AAE’s activities in the EU HIV/AIDS, Hepatitis and TB Civil Society Forum, the contributions to the EU HIV/AIDS, Hepatitis and TB Think Tank, and the participation in key European events like the Malta conference, AAE contributed in 2017to making Civil Society needs, concerns and perspectives heard. Advocacy for a new communication “Combating HIV/AIDS in the European Union and Neighbouring Countries” were unsuccessful. However, the Commission started to prepare a staff working document. The integrative approach, as described above, was implemented in the CSF in order to assure sustainability of policies where people living with/affected by HIV, viral Hepatitis and Tuberculosis are involved and to overcome thinking in silos which is predominantly the case in health systems. This was an active undertaking as it also meant to extend the number of organisations in the Coordination Team as well as redefining structures, governance, duties and tasks of the co-Chairs, the Coordination Team and the secretariat. The EU commitment is expressed in the communication on the Sustainable Development Goals. In its advocacy efforts, AAE addressed members and partners of AAE as well as policy makers and decision makers.
AAE through its EHLF built the ground to facilitate activities for improved access to HIV services for all those who have limited access due to their residency status. In order to diminish negative consequences for individuals and to impact the public health burden at national and EU level in the long term, AAE continued to promote the findings of the legal survey with additional data from the 6 countries that joined the EHLF network. The EHLF was presented at the European HIV Academy for Enabling Legal Environments and the AAE Member and Partner Meeting.
AAE’s activities regarding affordability of medicines with providing 3 trainings in 3 regions of Europe helped to broaden the coverage of treatment rates throughout the region and reduce the incidence of AIDS cases. They also diminished HIV incidence due to the preventive effect of antiretroviral medication. Advocacy in terms of affordability of hepatitis C treatment supports accessibility to very potent drugs with high curing rates. This is specifically important to those people who do not benefit from interferon based treatment. The manual, developed in 2015 was translated into Russian and was used in the first Russian language training for the EECA region in Kyiv. Altogether 38 advocates and activist were trained in the 3 trainings in 2017. The training manual is a free resource and available in both languages on the AAE Clearinghouse. The trainings provided a good understanding of the legislative structure that prices of medications are developed in. This knowledge is essential for the activists based in the European Union when they interact with their respective governments in their advocacy work on accessibility of medications and health care services and also for those activists who are based in candidate countries of the EU to have a better understanding of the legislative framework their countries are planning to enter and to help them prepare for the changes that can influence accessibility in their respective countries. The trainings also focused on examples of god practices improving access to medicines for the prevention of HIV (pre-exposure prophylaxis) and the cure of viral hepatitis C. Examples of successful price reduction and alternative access mechanisms (buyers´ club) were part of all trainings and the trainees were tasked to develop a joint advocacy plan to improve access to medica

Achieved outcomes compared to the expected outcomes

Objective I: The activities were implemented as planned with two CSF meetings conducted and the participation in and contributions to the two Think Tank Meetings. Furthermore, above described advocacy activities were undertaken in collaboration with AAE partners. In particular, attempts to impede CBVCT provision by our member organisation Demetra in Lithuania were tackled. The Lithuanian MoH assured in a letter to AAE that they will prepare changes in the legislation in order to allow performance of rapid HIV tests in non-medical settings. A common understanding of an integrative approach to respond to all three communicable diseases not only as co-infections but also as mono-infections, an approach that Civil Society has been advocating for in recent years, is in place and was implemented practically in the Civil Society Forum by extending the Coordination Team to five organisations and revising governance and strategic directions.
As shown above, AAE was invited and participated in 18 conferences and meetings and contributed by speeches, facilitations, podium discussions and/or statements.
AAE’s activities regarding the EHLF have met the expected outcomes. A presentation was prepared and was adopted several times during the year according to the meetings where it was presented. AAE presented the EHLF findings as integrated part of 2 meetings. The first meeting in September 2017 was looking at legal barriers to access where EHFL presented on the issue of access for migrants. AAE also decided to focus on migration during its second Member and Partner Meeting where the EHLF was presented and also several EHLF members participated and presented or shared their national situation to the participants.
AAE´s activities regarding affordability and pricing of medicines also met the expected outcomes. The affordability working group met twice during 2017 and conducted several teleconferences during the year. 3 regional trainings were conducted, as planned. The training manual developed in 2015 was translated into Russian and was used as basis of the Kyiv training for the EECA region in October 2017.
The PrEP in Europe website was launched, which besides providing a resource for information on PrEP availability in Europe, it is also the serves as the website for the PrEP in Europe Summit. In 2017 access to PrEP has been added on the national health agendas (Belgium, Ireland and Luxembourg) in several other EU countries while in other countries access is provided via alternative methods such as demonstration studies (United Kingdom) or initiatives of other providers (Germany and Czech Republic via German pharmacy chain).
Objective II: The data above shows the achieved indicators of AAE’s bilingual good practice and information exchange. The set process indicators for 2017 were met. Due to sharpened strategies for social media channels, AAE has become more visible and responsible. The HIV/AIDS Clearinghouse performed better than expected, with more up- and downloads as in 2016.
The AIDS Action Europe Member Meeting was conducted as planned. 39 people attended the meeting. A longer report was produced that reflect the discussions and conclusions of the meeting. The directions of the IAS conference in Amsterdam 2018 were laid out by the members; expectations to AAE regarding the conference were expressed. The good practice examples from Tajikistan, Georgia, Ukraine, Norway and the UK on migration and displaced persons was perceived by the participants as very valuable and pragmatically solution oriented. The results of the EHLF were presented and promoted during the meeting.
Objective III: With all the activities implemented regarding Objective III, the implementation of the work plan, governed and overseen by the AAE Steering Committee was implemented. The Steering Committee Meetings in Athens and Berlin were very important in order to re-settle the governance basis for AAE and prepare the strategic directions for 2018 to 2021.

Dissemination and evaluation activities carried out so far and their major results

The reports of meetings and working groups, such as the CSF meeting reports, the SC meeting reports, etc. were published on the AAE website. Their topics included reports about advocacy efforts, conference news and their contributions. The CSF Facebook site “HIV Policy in Europe” an exchanging information tool for CSF members, partners and other stakeholders was used as an interactive discussion forum.
“AIDS Action Europe: Strategic Framework 2015-2017” that was printed in July 2015 was disseminated at conferences, meetings and trainings.
The findings of European HIV Legal Forum were presented at the Enabling Legal Environments Training Academy, AIDS Action Europe Member Meeting as well as used in presentations at the 9th Italian Conference on AIDS and Antiretroviral Research and at the National HIV Conference in Dublin.
All materials produced by AAE target its members and partners and other stakeholders who are working in the fields of HIV/AIDS, TB and viral Hepatitis prevention in the WHO Europe countries.
The websites hivaidsclearinghouse.eu and aidsactioneurope.org that was redesigned and updated in January 2016 were used as dissemination platforms that provide news on activities and events to AAE’s stakeholders and regular users.
AAE´s evaluation is conducted internally with the help of an evaluation matrix that facilitated reporting to the activity, output and outcome related indicators. AAE’s activities regarding all 3 Objectives met the expected outcomes.
AAE conducted two evaluation surveys regarding its activities and performance in 2017 addressing its members and partners and the Steering Committee. More than 80% of the responding members felt being a part of the network AIDS Action Europe in 2017. 81% of members rated AAE’s operational work for the previous three years as successful. 90% find the information provided on the website and on the Clearinghouse useful. 86% find the information provided by AAE website and Clearinghouse is useful for regular information exchange, knowledge sharing and networking.
Steering Committee members were satisfied with the work of the AAE office regarding the implementation of projects, management of the operating grant and overall performance of the AAE executive Office.
AAE also conducted evaluations of the meetings organized by the network. After both CSF meetings and the three affordability trainings AAE conducted an evaluation survey among the CSF members and the training participants. Based on the feedback the future CSF meetings and the affordability trainings planned in the future will be improved.