08 November 2016
Successful Replenishment and the Risk of Zero Allocations for a resurgent epidemic
At the 5th Global Fund Replenishment Conference in September, US$12.9 billion was raised for the 2017 – 2019 Allocation Period — the largest replenishment amount ever in the Global Fund’s history. At the end of October, the Global Fund published its 2017 Eligibility List identifying which country components are eligible for funding during the during the 2017-2019 funding cycle, noting that eligibility does not guarantee an allocation. According to this list, Romania’s HIV/AIDS program is only eligible for funding for HIV/AIDS under the NGO rule, the criteria for which is detailed in the Global Fund Eligibility Policy.
In advance to the upcoming 36th Meeting of the Global Fund Board on the 16th and 17th of November, we – representatives of Romanian civil society organizations, including people living with HIV and TB and key populations – would like to express our deep concern about the potential disconnect between a successful replenishment and the small or non-existent allocations that will be made available for countries like Romania and upper middle income countries with HIV epidemics that are still not controlled. We believe that there is a high risk that the allocation for the HIV component for Romania for the next three years could be zero – the same as it was the previous allocation period. In this circumstance, even if we, as civil society, work hard to show that we meet the criteria of the NGO rule, there will be no funding available for us to apply for.
Some unfortunate history
The last Global Fund HIV grant for Romania came to an end on 30 June 2010. In 2011 the Romanian CCM developed an HIV proposal for submission to the Global Fund for Round 11, which we all know, was cancelled. At the same time, the 23rd meeting of the Global Fund Board adopted new country eligibility criteria that resulted in Romania becoming ineligible to apply for another grant owing to its classification as an ‘Upper Middle Income’ (UMI) country with a ‘moderate’ HIV disease burden.
However, in 2013, Romania’s HIV disease burden was increased to ‘high’, making it again eligible for an HIV grant under the New Funding Model (NFM) through the ‘NGO rule’. A targeted concept note was developed and submitted, but was not supported by the Global Fund. The Fund’s ‘Eligibility and Counterpart Financing Policy’ states that one of the conditions necessary to receive an allocation for HIV under the NGO rule is that the applicants must provide confirmation that the “allocation will be used to fund interventions that are not being provided due to political barriers and are supported by the country’s epidemiology”.
At that time, Romanian NGOs working on HIV, harm reduction and human rights, tried to prove that indeed, there were serious and insurmountable political barriers to the delivery of HIV prevention services for key populations that take the form of:
- the lack of a strategic HIV framework since 2007;
- the lack of national human rights strategy focused on vulnerable groups;
- the lack of targeting by the National HIV Program on prevention measures for people who inject drugs (PWID) and men who have sex with men (MSM) even though official data indicates that these are the most affected key populations;
- the ongoing lack of government funding for harm reduction interventions even after the government made a commitment to provide such public funds;
- the lack of political will to publicly address the steady increase of HIV among MSM;
- the lack of sexual and reproductive health education strategy and legal attempts to criminalise sex education in the public school system; and
- the lack of capacity of Romanian Government to address and implement the recommendations issued by the UPR in 2013 and the recommendations issued by the Committee on Economic, Social and Cultural Rights.
However, such issues were viewed by the Global Fund Secretariat as a ‘lack of funding or political will rather than political barriers’, per se. Unfortunately the same barriers still remain, and this sad history is resulting in catastrophe for people living with HIV in our country:
- HIV prevalence among PWID in Romania rose from 1.1 to 4.2 percent between 2008 (when we still had a Global Fund grant) and 2010;
- The prevalence among PWIDs then shot up to an estimated 49.2% in 2013 before falling back somewhat to 27.5% in 2014 due to the efforts of NGOs including mobilization of some support from the EU (structural funds), Norway and a few private foundations;
- It was noted in a January 2016 article in the International Journal of Drug Policy that “a specific HIV outbreak among drug users (around 2011) has been directly linked to the significant decline in harm reduction services following the Global Fund transition out of the country“;
- While estimated 18% MSM in the capital city had HIV in 2014, even country’s UNGASS report acknowledges lack of any HIV prevention among MSM with exception of volunteer sporadic actions;
- Although the Romanian government is supporting HIV treatment and partially funds someopioid substitution therapy, almost zero governmental funding has been allocated on HIV prevention activities among key affected populations in recent years;
- People from key populations remain highly stigmatized and marginalized, for example, criminal law punishes possession of ‘high risk’ drugs with up to 3 years of imprisonment. While the legislative and policy environment in Romania does provide for harm reduction and other services targeted to key populations to maintain some services, the Government has shown little commitment to fund such interventions, especially needle and syringe programs;
- At the same time HIV prevention services are still being partly funded in Romania by the Global Fund through its current TB grant, which while extremely helpful, only funds a small part of our population affected by both TB and HIV.
The key barrier to a sustainable HIV prevention program and HIV/AIDS sector in Romania is the lack of political will to fund the program by the Government.
We hope that members of the Global Fund Board understand the decision before you at your November meeting to apply your new allocation methodology may result in allocations of zero in communities facing a re-emerging HIV crisis. This stands in contradiction to commitments to keep the Global Fund global by introducing a differentiated investment approach in which funding decisions are guided by considerations of need and impact. As we fight against government inaction on HIV, the Global Fund must also live up to this commitment. Our live and the lives of the people we work with depend upon it.
ACCEPT Association (LGBT, SW), Romanita Iordache – Vice President
ALIAT Association (IDUs), Bogdan Glodeanu – Executive Director
ARAS – Romanian Anti AIDS Association (PLHIV, IDUs, SW, MSM, other), Monica Dan – Project Coordinator
CARUSEL Association (IDUs, Roma, homeless people, SW, PLHIV), Marian Ursan – Executive Director
COPAC – Coalition of Organizations of Patients with Chronic Diseases (18 NGOs), Radu Ganescu – President
CRJ – Centre for Legal Resources (Human Rights), Georgiana Iorgulescu – Executive Director
ECPI – Euro-regional Center for Public Initiative, Florin Buhuceanu – Executive President
FONPC – Federation of Non-governmental Organizations for Children (82 NGOs), Bogdan Simion – President
PARADA Foundation (Homeless and other vulnerable groups), Ionut Jugureanu – Executive Director
Romanian Angel Appeal Foundation (PLHIV), Silvia Asandi – General Director
RHRN – Romanian Harm Reduction Network (IDUs) Dragos Rosca – Executive Director
Save the Children Romania (Homeless people, other vulnerable groups), Liliana Bibac – Project Coordinator
SECS – Romanian Society for Sexual and Contraceptive Education, Iustina Ionescu – President
Sens Pozitiv Association (PLHIV, IDU, SW, MSM), Alina Dumitriu – Executive Director
UNOPA – National Union of Organizations of People Living with HIV (22 NGOs) Iulian Petre – Executive Director
Youth for Youth Foundation (young people), Adina Manea – Executive Director
PSI Romania (MSM/LGBT), Patricia Mihaescu – Operations Manager
 „Concluding observations on the combined third to fifth periodic reports of Romania”, 9 December 2014, pct. 22, Sexual and reproductive rights,available at http://tbinternet.ohchr.org/_layouts/treatybodyexternal/Download.aspx?symbolno=E/C.12/ROU/CO/3-5&Lang=En
 The Impact of Transition from Global Fund support to Governmental Funding on the Sustainability of Harm Reduction Programs. A Case Study from Romania. Eurasian Harm Reduction Network. 2016.
 EMCDDA (2016). Statistical Bulletin. Table on HIV Prevalence accessed at: www.emcdda.europa.eu/data/stats2016#displayTable:INF-108
 EU-funded project Sialon II. Report on a Bio-Behavioural Survey among MSM in 13 European Cities. Accessed at:http://www.sialon.eu/data2/file/133_Sialon%20II_Report%20on%20a%20Bio-behavioural%20Survey%20among%20MSM%20in%2013%20European%20cities.pdf
 Romania: Country Progress Report on AIDS Reporting period January 2015 – December 2015. Bucharest, April 2016. Available at:http://www.unaids.org/sites/default/files/country/documents/ROU_narrative_report_2016.pdf