Statement to the Global Fund Board
During the event of the 52nd Board meeting, Lilongwe, Malawi
18th to 22nd November 2024
1. About KP-TNC
The Key Population Transnational Collaboration (KP-TNC), established in 2020, is an initiative by a network of 8 Key Population consortia (KPC) in Africa stretching from e Southern Africa – the Zambia Key Population Consortium (ZKPC) and Malawi’s Diversity Forum (MDF); Eastern Africa – Tanzania Key and Vulnerable Population Forum (T-KVPF), Zanzibar Key and Vulnerable Population Forum (Z-KVPF), South Sudan Key Populations Consortium (KEANNET), and Kenya Key population consortium (KP Consortium); and West Africa, Nigeria KP consortium and Ghana KP consortium. Other consortia that have shown interest to join include those from Lesotho, Namibia, Zimbabwe and Mozambique.
As a regional organization, KP-TNC strengthens KP movement building, promotes a community of best practice, works to ensure inclusivity, respect and well being of Key Populations in its target regions with a focus on promoting human rights and access to KP friendly HIV and related health services. It does this by promoting advocacy on KP issues and concerns. Practical areas include policy advocacy, human rights response, capacity building, movement building, programming and funding.
2. KPs Interface with the Global Fund
The Global Fund has been a key ally of the Key Population Communities in all its recipient countries. The modular framework handbook of 2023-2025 considers KP communities in all three diseases. Moreover the modules recognize KPs with respect to the efforts to remove Human Rights-Related barriers to Prevention and treatment. These interventions by Global Fund have contributed in a big way to advancing HIV gains within these particular communities. Global Fund through its country coordinating mechanisms has ensured that KPs continue to be recognised in proposal writing and programming. However, while the modular framework of the Global Fund recognizes the KP community, structural issues within countries make it difficult for these communities to be involved fully so they can assist in advancing the HIV gains.
Some of the progress areas include:
- KP CCMs membership has increased over time
- KPs are participating in GF proposal writing as both core and back up teams
- KPs are participating in technical working groups on HIV response in their countries
- Some KP CSOs are receiving GF monies to implement programs as SRs or SSRs. These go to CLM or supporting DICs and/or wellness centers
- The GF has played a role in reducing the weight of the structural barriers faced by KPs by financing stigma index and supporting multi stakeholder engagements
In this statement we are highlighting gaps that we have identified over time within the KP-TNC countries and offer our recommendations for improvement. In doing this we are cognizant that GF may have certain constraints, but any efforts in addressing these highlighted gaps will be appreciated. We are also available to advance this conversation in a manner that we can create solutions together.
3. Identified Gaps in KP Programming
3.1. Deepening Criminalization, stigma and Human Rights Challenges
Issues of criminalization and the legal environment in the different countries has been a barrier for KPs to access HIV and health services. In the last three years, several countries have passed laws that have worsened criminalization. More stigma at institutional and individual level, violence, arrests and harassments are also being reported on a regular basis. In Nigeria the leader of the KP consortium and a popular transwoman were murdered in early August 2024 while 15 sex workers have been jailed for 8 months; in Tanzania and Zanzibar three MSM and a trans were murdered since January 2024, there are about six MSM who have been imprisoned for 30 years, and there are frequent arrests of members of KP community; in Ghana a new law criminalizing LGBTIQ+ population is awaiting presidential assent while in Malawi the constitutional court maintained the criminalization. In countries like Kenya, politicians are pushing for laws that would mainly criminalize key populations. The impact of a worsening legal environment for KPs in the KP-TNC countries, has an effect on health seeking behavior and on related access rendering a big blow on the HIV gains achieved in these communities to-date. Deepening criminalization raises the sensitivity of KP issues within countries bringing about a need to build capacities of countries on public health approaches to offering services to KPs.
The KP-TNC requests the GF to make investments in the safety and security and mental health of KP leaders and their communities. Lately there have been cases of escalating violence and arrests of members of the KP communities in different countries. Resources are needed to support legal representation, bailing and bonding of those in custody and also being incarcerated. On the other hand Issues of mental health are on the rise, both affecting leaders and community members themselves. Investments in these areas will go a long way to not only improve the well being of KPs but also HIV gains.
The KP-TNC recommends curriculum change in health colleges and universities, health workers should be trained at tertiary level on sensitivity to KP matters. Sensitivity training for health care workers has been a challenge because of transfers, deaths and moving on, it has proved to be unsustainable in the long run, so this training must be integrated as a core part of every health worker’s education. .
3.2. KP Oriented Community Led Monitoring and KP oriented Surveys
It is important that KP Community led monitoring (CLM) is KP community led. It is also important for GF to assist in the creation of tools for KP CLM so as to capture specific KP data. This will assist to carter specific KP issues and concerns which may easily be lost as a result of generalization.
KP Bio Behavioural Surveys (BBS) and Size Estimates (SE) need to be extended to all countries receiving GF financing. In some countries, some populations, mainly MSM and transgender populations, are being excluded. The Global Fund should work with countries to ensure that all populations are included in BBS.
3.3. Meaningful Participation of KPs in Policy and Programming
We request that GF assist KPs to participate fully in CCMs. Currently KPs are only accorded an observer position in some of the country’s CCMs. They also are not allowed to vote. In some countries KPs are represented through a proxy. In some countries KPs can only become alternates and not substantive members. Moreover, KPs face barriers to participating in CCMs such as XYZ. s. It is important that KP CCM representation be addressed so that KPs may be well represented and able to participate meaningfully.
Furthermore, we request that GF assist KP community CSOs to be involved in programming. This means that they should not only be beneficiaries but be involved in the entire program cycle beginning from designing to project closure. At the moment, KPs are only involved in proposal writing and as beneficiaries and have nothing else to do with the current programs. Most KP are being used as mobilizers on GF projects by Sub Recipients and that is the best that is available for them.
3.4 Building capacities of KP led organizations so as they may do more
There is a need for a long term capacity building plan for KPs. Issues of competing for resources between the international offshoots and local organizations needs to be addressed. KP CSOs need to be capacitated to be in a position to receive funds meant for KP programming as SRs and SSRs. This will enhance program success, currently we have Implementing partners who are localizing from INGOs into the local NGOs to receive funding for KP programming. Alternatively we also have other local partners such as FBOs who traditionally have issues with KPs receiving these funds. This is not only disadvantageous to the KP community CSOs but also places the long term security of KPs in jeopardy should these partners opt to share the data they have on KPs with hostile quarters such as the government or the media. x
3.5 Investing in Strengthening Regional KP Organizing
Regional KP organizing is quite important in assisting the sharing of best practices and exchange of expertise among KP CSOs. It is also a powerful avenue of inter-consortia regional solidarity and voice amplification during needful and crisis times. Global Fund is requested to consider resourcing regional bodies that foster a community of best practice in KP advocacy and work, including KP-TNC. These types of initiatives will have the effect of strengthening local KP consortiums and sustaining best practices within the region through a particular community of practice..
3.6 Investing in skills and economic empowerment of KPs
We request that GF consider skill building and economic empowerment packages for KPs as part of its portfolio. Most members of the KP community are poor. This poverty exposes them to greater vulnerability to HIV and other poor health outcomes. Many have not had the opportunity to develop job skills, and even where they are skilled, employers tend to discriminate against them. Innovative ways of empowering KPs socio-economically, either through social enterprises and occupational endeavors, would be quite helpful. Alternatively, any means to empower KP Community members will in a big way assist reduce their vulnerability and hence HIV risk too.
3.7 Addressing specific issues, emerging and other diseases affecting KPs
Diseases such as STIs, Mpox, COVID, Marburg, etc. have a big toll on Key Population Groups. Currently with Mpox, it seems that governments from different countries are not ready to reveal that this disease is in their countries. Hence, the communication channels on this disease are quite weak with devastating effects on the members of Key Populations. We understand that the C19 has some resources to assist governments with diagnostics and vaccines, but if governments are in denial, they are likely not to apply for this support. The challenge is that the KP communities keep suffering as a result of this. We request GF to create a way in which there could be an alternative community grant that would be available to CSOs to spread education and prevention messages so as to reduce the harmful effects of Mpox and emerging pandemics to KPs. Of course if this is possible, the alternative community grants could be made available for other important concerns facing KPs and members of the general public.
In several countries harm reduction services would need to be introduced or scaled up. There is a big feeling that the PWUD community is being left out. There are a number of policies which have remained in their draft form including drug policies, harm reduction policies and stigma which have stalled.
3.8. Addressing the sustainability of KP Programming
Despite ongoing discussions on sustainability frameworks, integration, and social contracts within GF and PEPFAR, KP communities are often excluded from these processes. This exclusion exacerbates existing challenges, including weak community interventions, persistent structural barriers and stigma. The continued sidelining of KPs, coupled with insufficient political will and the marginalization of KP voices, hinders the development of truly sustainable and locally-driven KP programs. To address these challenges, it is crucial to prioritize the meaningful inclusion of KP entities in all stages of program development, implementation, and monitoring. This includes ensuring equitable resource allocation, strengthening KP-led organizations, and fostering genuine partnerships between KP communities, government agencies, and international funders.
3.9. Addressing operational challenges in KP Programming in countries
We observe that KP related programs take time to commence even when the programs are funded, this shows that KP programs are not prioritized. Most KP programs are faced with unspent funds resulting in compromising burning rates. This delay in implementing KP programs happens yet the needs within the KP Community are so great. On the other hand, some of the SRs implementing KP work don’t even understand KP needs and what matters most to them. In some cases the SRs chosen may be those that at one time or another may have perpetuated stigma against KPs. These same one time hostile SRs will have massive data on KPs with a likelihood of using it against them in the future.
Moreover, KPs are always engaged during the proposal writing phase but they do not get the opportunity to implement when money comes and are only considered as mobilizers. In this vein, we seek the GF intervention by considering funding that would support KP programming, this will help to arrest this dire situation Therefore, we urge the Global Fund to consider funding mechanisms that directly support Key Populations (KP) organizations to lead and implement their own programs, ensuring their meaningful involvement throughout the entire project cycle, from proposal development to monitoring and evaluation.
4.0 Conclusion
The Global Fund has made significant strides in combating HIV, TB, and Malaria, saving millions of lives worldwide. Its innovative funding mechanisms and partnerships have catalyzed impactful programs and strengthened health systems. Moving forward, it is crucial for the Global Fund to ensure the meaningful inclusion of Key Populations in all aspects of its work, recognizing their unique needs and vulnerabilities, and empowering KP-led organizations to play a central role in program design, implementation, and monitoring. KPTNC welcomes the opportunity to partner with GFATM to ensure increased KP inclusion.
