POSITIVE ACTION

Progress
report

Positive Action’s mission is to be a transformational partner that champions people and communities to end AIDS.

Our vision is healthy communities in a world free
of AIDS.

THE CONTEXT
FOR OUR WORK

Positive Action is working towards the UNAIDS goal of ending AIDS by 2030, achieving its 95-95-95 goals, with zero HIV or AIDS-related discrimination.

Progress is being made in relation to these targets, however, in certain areas this progress has stalled. Stigma and discrimination contribute towards more HIV infections and deaths (UNAIDS).

There’s still more to be done.

New HIV Infections Globally
In 2020

65
0%
Men who have sex with men, transgender people, sex workers, and those who inject drugs
100%

1.7 million children living with HIV
In 2020

46
0%
Don’t have access to HIV treatment
100%
UNAIDS. 2021 Factsheet. Available at: https://www.unaids.org/sites/default/files/media_asset/UNAIDS_FactSheet_en.pdf. Last accessed: September 2021.

£20m investment into programmes that aim to end paediatric AIDS, support harm reduction services for people who use drugs, and tackle HIV-related stigma in over 60 countries since 2020

KEY MILESTONES

Positive Action Strategy and Funding

The strategy was announced at the International Conference on AIDS and STIs in Africa (ICASA) 2019, Kigali, Rwanda, under the vision of ‘healthy communities in a world free of AIDS’, with the following key focus areas:

  • Ending paediatric AIDS
  • Supporting community-based harm reduction services
  • Addressing HIV-related stigma

For the first time, a logic model and results framework were developed to ensure that Positive Action could define and measure its contribution towards ensuring that no person living with HIV is left behind.

A CyberGrants management system was also launched, with the intent of automating an end-to-end grants management process, serving as a tool to efficiently collate and analyse grantee reports and improve the grantee experience from start to finish.

Four grants in three countries, £2.6M invested in 2020 and £2.4M invested in 2021

The Paediatric Breakthrough partnership builds on the Positive Action for Children Fund (PACF). This partnership contributed to the development of a service delivery framework to end paediatric AIDS via four key, global and local implementing partners in Mozambique, Uganda and Nigeria, with the possibility of extending to Cameroon and Zimbabwe.

A co-developed Implementation Science project was created to measure the effectiveness of this partnership, by understanding the impact and effectiveness of the Paediatric Breakthrough Partnership in Mozambique, Nigeria and Uganda. The research will be conducted jointly by the Uganda Vaccine Research Institute (UVRI) and International AIDS Vaccine Initiative (IAVI) in Uganda.

The two research areas are:

  • Breakthrough Partnership’s collective impact: To understand if working together yields greater results than if each partner had worked on their own
  • Breakthrough Partnership’s effectiveness as a partnership: To understand how well partners work together, to build and grow from this collaborative approach

73 grants in 13 countries

A partnership with the Global Fund and Global Network of Young People Living with HIV (Y+ Global), that supports adolescent girls and young women (AGYW) to have a meaningful voice in decisions that affect their health. This initiative is aligned to the Global Fund’s funding cycles and processes that prioritise and agree on country investments in HIV, TB and Malaria programmes.

The HER Voice Fund provides small grants to AGYW-led community-based groups to facilitate participation and engagement in policy and decision-making processes.

Key locations of
Positive Action Grants

A map of the Key locations of Positive Action Grants

Map To Show Key
locations of Grants

Innovator

Turkey, Egypt, Somalia, Tunisia, Morocco, Malawi, Nigeria, Serbia, Thailand, Uganda (2), Zimbabwe, Kenya, Tanzania, India, Rwanda, Tajikistan

Momentum

Zambia (2), Eswatini, Uganda (7), Nigeria, Malawi (3), Kenya (5), Cameroon (2), Zimbabwe (3)

Challenge

Russia, Zambia, Nepal, Uganda, Ukraine

BT Paeds

US, UK, Netherlands, South Africa for implementation in Mozambique, Uganda and Nigeria

SCDI

Vietnam

AMREF

Ethiopia

W4GF

Zimbabwe, Toronto

Harm Reduction Nigeria

Nigeria

Africa REACH

South Africa and US for implementation in priority countries in sub-Saharan Africa

HER Voice Fund

Netherlands for implementation in 13 countries in sub-Saharan Africa

COVID-19 ERF

South Africa, Zimbabwe, Malawi, Uganda, Kenya, Tanzania, Botswana, Nigeria, Cameroon, Indonesia, India, Thailand, Nepal, UK

New funding streams and rounds under Community Strategic Initiatives (CSI) and a Covid-19 Emergency Response Fund

  • Focused on community and peer-led initiatives to provide comprehensive, innovative and accessible harm reduction services at the community level for people who inject drugs.
  • Six grants in six countries with an investment of £197K

The 2020 Innovator grants supported new projects to address HIV self-stigma globally and HIV-related stigma in the Middle East and North Africa:

  • Five HIV-related stigma grants in five countries with an investment of £478K
  • 18 self-stigma grants in 11 countries, with an investment of £1.3M
  • The second funding round focused on supporting community-based harm reduction services and provided eight grants with an investment of £730K

Momentum grants focus on scaling up or replicating interventions that are proven to work. In 2020, grants were given to organisations focused on adolescent mothers living with HIV, to provide tailored care and address the myriad of issues affecting adolescent mothers and their children:

  • First funding round: Supported adolescent mothers living with HIV and their children to enjoy health and well-being, which resulted in 11 grants with an investment of £3.2M
  • Second funding round: Improved retention in HIV care among children living with HIV and their caregivers, which resulted in 10 grants with an investment of £2.6M
  • Third funding round: Increased HIV case finding and treatment and provided support to children and early adolescents living with HIV aged 0-14 years

  • This fund was launched to help address specific challenges for the HIV community created by the global pandemic. The fund emphasises Positive Action’s ability to be agile and flexible, responding quickly to support those in need.
  • 36 grants in 16 countries, with an investment of £690K

227 grants in 64 countries, with an investment of £5.7M

This includes grants awarded previously under the Positive Action Adolescents (PAA) programme, Positive Action Children’s Fund (PACF), Positive Action Europe (PAE), Positive Action Girls and Women Fund (PAGW), and the Positive Action MSM & Transgender Fund (MSM&T).

CASE STUDIES

STAR-STAR

The Association for Support of Marginalised Sex Workers (STAR-STAR) is a community-based organisation led by sex workers committed to the improvement and promotion of sex workers’ rights in the Republic of North Macedonia. STAR-STAR and the World Health Organization’s (WHO) North Macedonia office conducted research on how HIV prevention services could be improved. Four focus groups in Skopje, Gostivar and Strumitsa explored the experiences and perceptions of sex-workers’ access to and use of HIV prevention tools.

In 2020, STAR-STAR worked with the Health Education and Research Association to reach 547 sex workers with critical HIV services.

STAR-STAR mobile health clinic:
  • Delivered 1,120 HIV and sexual reproductive health services
  • Referred 280 sex workers to gynaecological services
STAR-STAR permanent health facility:
  • Reached 267 sex workers
  • Delivered 1,068 HIV and sexual reproductive health services
  • In total, 3,593 condoms and 1,734 lubricants were distributed to sex workers

The organisation also partnered with the Health Education and Research Association and the University Clinic for Infectious Disease to train health service counsellors on how to support sex workers and other marginalised populations. The training resulted in:

  • 70% increase in knowledge of HIV transmission modes
  • 74% increase in use of antiretroviral therapy (ARV)
  • 64% decrease in mother-to-child transmission rates

Zvandiri (‘As I am’)

Zvandiri is a community-based, clinical and psychosocial service delivery programme originally aimed at adolescents living with HIV in Zimbabwe, who were in need of tailored HIV support services.

Zvandiri combines support groups, community outreach, Community Adolescent Treatment Supporters (CATS), mobile health and youth-friendly clinics to improve the treatment outcome, mental health and social protection of children and adolescents.

The research found that differentiated service delivery can substantially improve HIV virological suppression in adolescents with HIV. The CATS intervention has now been adopted or adapted in eight countries in sub-Saharan Africa.

2. Mahvu W et al. 2020. Effect of a differentiated service delivery model on virological failure in adolescents with HIV in Zimbabwe (Zvandiri): a cluster randomised controlled trial. The Lancet Global Health. Vol. 8, e264–75.

HER Voice Fund

Implemented by Y+ Global, the HER Fund supports AGYW to have a meaningful voice in decisions that affect their health.

Launched in recognition of the vital role of AGYW in driving and shaping the HIV response, the fund provides small grants to these groups across 13 countries (Botswana, Cameroon, Eswatini, Lesotho, Kenya, Malawi, Mozambique, Namibia, South Africa, Tanzania, Uganda, Zimbabwe and Zambia) to facilitate participation in policy and decision-making processes.

Positive Action provided a second year of funding to support organisations working to improve AGYW and young people’s health including training, mentoring and engagement across policy and advocacy.

Each priority country has a HER Voice Country-Lead organisation responsible for coordinating Voice Fund activities and a HER Voice Fund Ambassador, who works closely with country-leads and represents the fund in meetings and media opportunities.

Paediatric – Adolescent Treatment Africa (PATA) C3 Model

The C3 model promoted partnership between health facilities and community-based organisations (CBOs) to deliver services for improved vertical transmission case findings and HIV treatment, as well as support for adolescents across the HIV care cascade. The C3 partnership, initiated in 2014, had two three-year phases.

Phase 1: Developed and disseminated models for effective clinic-CBO collaboration, with 36 partnerships

Data gathered from clinic rapid assessment forms, programmes, forums, site visits and summits, and good practise, lessons and innovations identified

  • The C3 toolkit guide was developed to assist health providers, CBOs and coordinators
  • C3 summit hosted 32 C3 teams to share evidence-based best practice
Phase 2: Strengthened clinic-CBO partnerships
  • The toolkit was adapted for adolescent programming and a best practice guide for peer-support was developed
  • An additional 19 clinic-CBO partnerships were developed
  • The C3 model was integrated into programmes such as Find Test Treat 4,000 in partnership with SAfAIDS, Aidsfonds and the READY programmes in partnership with Frontline AIDS

WHAT’S NEXT?Learnings and Future Outlook

A concerted effort is required by all stakeholders to ensure that the world can meet the global UNAIDS prevention targets by 2025. Positive Action has prioritised prevention in 2021 whilst ensuring strong alignment to treatment, care and support.

Our approach to HIV prevention builds on our history and is firmly rooted in our strategy, meaning that we invest in community-led and community-driven responses because we believe that communities know best.

We believe strongly in the principle of “nothing for us without us” and through this we want to ensure that people can exercise choice when making decisions about HIV prevention options that are suitable for them in their context and their reality.

We support a combination approach to HIV prevention and look at investing in applications that address biomedical, structural and behavioural interventions collectively;

Biomedical

Biomedical - interventions that use medical and clinical methods whilst remaining product agnostic e.g. condoms and lubricants, ARV-based prevention options, voluntary medical male circumcision and harm reduction programmes including needle syringe programmes

Behavioural

Behavioural - interventions that encourage and support safer behaviour including counselling for risk reduction, comprehensive sexuality education (CSE), peer-led education programmes and social marketing/digital campaigns

Structural

Structural - interventions that promote and contribute to an enabling environment such as addressing structural barriers, addressing gender inequality and violence; laws to protect the rights of people living with HIV and key populations, and interventions to reduce stigma

Positive Action as a flexible and agile donor

Everything we do as Positive Action is to bring positive change towards the end of AIDS. This requires us to be flexible and agile in how we respond, and support communities living with and affected by HIV. Not only did ViiV Healthcare launch the COVID-19 Emergency Response Fund in 2020, but Positive Action also offered a COVID-19 Top-Up Fund to grantees who were experiencing challenges during the respective second and third wave of COVID-19 in their contexts. We were also able to support a Positive Action grantee in Haiti who was affected by the earthquake in August 2021.

Flexibility also relates to being able to respond to changes or priorities in the HIV epidemic, and the Positive Action Flexible Fund was launched in September 2021 to respond to the growing HIV prevention needs of people who use drugs in Eastern Europe and Central Asia.