Upon identifying the need for a regional mechanism to monitor community-led monitoring in countries across the Asia-Pacific region, the Seven Alliance organized Line Up for Change: Collaboratively shaping the Asia Regional Observatory (ARO) Indicators. Held in Bangkok, Thailand on 11-12 September, with support from UNAIDS RSTAP, the regional consultation aims to identify a clear roadmap for framing regional indicators for the Asia Regional Observatory and included up to 30 community representatives and CLM practitioners in the region.
The Asia Regional Observatory (ARO) has the opportunity to spotlight issues and give voice to country and community-level partners to advocate for CLM buy-in and sustainability with governments and donors. The ARO serves a dual purpose: it assesses CLM implementation progress and consolidates data into a user-friendly dashboard. It is a crucial initiative led by the Seven Alliance and highlights the importance of CLM as part of community-led response, says Eamonn Murphy, UNAIDS RSTAP Regional Director. Hopeful that the leadership of Seven Alliance and community-led organizations on CLM leads to stronger healthcare systems, Eamonn believes CLM across the Asia-Pacific region delivers tangible benefits to improve HIV outcomes for people living with HIV and key populations.
The consultation started with a session on the CLM initiatives and achievements of the Seven Alliance at the regional level, as well as the challenges in practicing CLM. Joe Wong, Executive Director of the Asia Pacific Transgender Network (APTN), highlights some of these challenges including the lack of political will from governments and donors that makes funding for CLM difficult to access. Some countries are also still piloting CLM and need guidance on what CLM really is and that the tools currently available may be inadequate to capture the data that needs to be captured. The Seven Alliance conducted an online consultative process to identify priorities for regional indicators and insights on various aspects of CLM with a focus on the integrated approach to health services and advocacy. The process included a survey of 78 respondents (M:52; F:15; TG:11) from all key population groups, a majority of which identified as people living with HIV. When asked to prioritize services and interventions at the community level, respondents believed that services addressing stigma and discrimination (46.1 per cent), and HIV and SRH services (41 per cent).
Mental health services was also recognized as an important part of a broader health intervention related to HIV. The collected data will serve as a foundation for targeted advocacy strategies to enhance healthcare access and services for these groups. While specific indicator details were not provided during this presentation, the process of data tracking, verification, and reporting was highlighted as vital to community-based data and its role in advocacy efforts.
To have more in-depth discussions on CLM indicators, participants were divided into six breakout groups to discuss indicators for each key population group: MSM, YKP, PLHIV, PWUD/PWID, Transgender people, and Sex workers. Guided by the UNAIDS Global AIDS Strategy 2021-2026 and the WHO Consolidated Guidelines on HIV, Viral Hepatitis and STI for Key Populations, participants shared insights and concerns on monitoring specific aspects of HIV and related health services. Some of the points raised by participants included the need to consider CLM indicators beyond HIV services. For instance, on the intersection of Tuberculosis Preventive Therapy (TBT) and ART, participants noted that some clients without proper counselling lead to non-compliance with their ART. This shows that there is a need to consider TBT-related CLM indicators at the regional or national levels. Another participant raised the need for data disaggregation, particularly on the inclusion of transgender data on gender affirming surgeries as part of the SRH component of CLM indicators. Spotlighting the multi-layered nature of ending HIV stigma and discrimination, participants also noted the need to develop indicators that capture vulnerabilities beyond health, including education, livelihood and social inclusion, as well as the presence of equality and anti-discrimination laws and policies in addition to the absence of punitive laws. Moreover, qualitative indicators relating to the dignity and respect for key populations were raised as equally important.
On the second day of the regional consultation, participants continued to learn more about the ongoing initiatives of each Seven Alliance member in advocating for CLM across the Asia-Pacific region. Partners working at the country level in Bhutan, Cambodia, India, Indonesia, Nepal, and the Philippines also shared their progress and challenges in CLM advocacy and building the capacity of community organizations to engage in CLM work. Although the approaches of country partners varied, reflecting the different contexts in each country, common challenges surfaced. Government resistance or reluctance to support CLM initiatives remain an important barrier for country partners as government stakeholders often have misconceptions and misunderstandings about the purpose and value of CLM. Funding and sustainability of CLM is also a looming challenge across all countries, since although there is funding at present, which is itself limited, there is uncertainty among country partners on how CLM initiatives from the national down to the community level will remain adequately funded. Lastly, there remains a need to strengthen community systems and increase the capacity of other national level partners and community organizations to fully understand and engage with CLM initiatives.
The consultation concluded with breakout group discussions to develop recommendations for the second regional CLM workshop which will happen on December 2023. The workshop aims to provide a regional cross-learning platform where country and community partners across the region can share their progress and insights in advocating and practicing CLM in their countries as well as provide updates on CLM work done at the regional level.
