The Seventh Replenishment Brings Us New Hope

A transgender rights activist and Director Programmes of Khawaja Sira Society (KSS) from Lahore, Pakistan, Moon Ali has been pushed to stand up for her own rights and for the rights of her community from a very young age.

As a transgender woman, struggling with stigma, discrimination and violence is still very much a part of her daily life and being a part of KSS has given her an opportunity to not only empower herself, but it has also enabled her to stand up for and fight for the rights of her brothers and sisters of the transgender community in Pakistan.

Moon as a panel speaker at a seminar organised by KSS at the BeaconHouse National University in 2018. (Source: Daily Pakistan)

“It is not an exaggeration to say that the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund) has played in developing KSS to what it is today. The Global Fund has also played an important role in supporting, developing and strengthening many other community-led organisations in Pakistan. The resources channelled by the Global Fund to community-based organisations such as KSS provided us the foundation to build upon our movements, mobilise, and organise ourselves. More importantly, the emphasis that the Global Fund has on promoting and protecting human rights and gender equality and ensuring the meaningful engagement of communities and key populations has been a game changer. The Global Fund has brought historically marginalised communities such as the transgender community to the table on equal footing,” enthused Moon.

The partnership between the Global Fund and Pakistan began in 2004, and to date, the Global Fund and Pakistan have signed more than US$ 1.035 billion worth of grants for HIV, TB, malaria and Resilient and Sustainable Systems for Health (RSSH). Through the support of the Global Fund, Antiretroviral Therapy (ART) was also provided free for People Living with HIV (PLHIV) since 2018, and in 2019, Global Fund investments have put 22,900 PLHIV on ART; treated 330,000 people affected by TB; and have distributed 3.92 million mosquito nets.

Significantly, Global Fund investments in the country have paved the way for the development of community systems – including amongst Key Populations. While there is ample room for improvements, this community system has facilitated the delivery of services for not only HIV, it has also ensured that communities are provided the necessary support to protect and promote their human rights. The community-based model that is being implemented in Pakistan has increased the engagement of community- and Key Population-led organisations from six to 17, enabling increased delivery of HIV services to more communities in need across the country, while also strengthening the human rights movement of key populations.

Despite the inroads made in battling HIV with the support of the Global Fund and with the commitment of the national government, Pakistan continues to face multiple challenges in its fight against HIV, which were further amplified by the COVID-19 pandemic since the onset of 2020.

According to the World Health Organisation (WHO), Pakistan is the second most affected COVID-19 affected country in South Asia (preceded by India) with over 1.5 million confirmed cases of COVID-19 and 30,359 deaths. As of 4th May 2022, a total of 252,931, 485 vaccine doses have been administered in Pakistan with only almost 7 million persons receiving a booster or additional dose out of a population of over 220 million.

“The impact of COVID-19 on poor and vulnerable communities in Pakistan, and especially on marginalised populations such as the transgender and Hijra community will continue to haunt us long after the pandemic is controlled. Even as we learn to live with COVID-19, pre-existing structural barriers, inequalities and inequities and distributive justices have exacerbated the effects that COVID-19 have on us,” said Moon. “COVID-19 only augmented further the harsh realities that key populations such as transgenders living with and/or affected by HIV faced.”

Since the onset of COVID-19 in Pakistan in early 2020, KSS through the leadership of Moon took measures to ensure that the staff of the organisation were kept safe and that communities served by the organisation continued to receive required services. 

Through mobilising resources from local NGOs, donors and well-wishers, KSS has provided food and nutrition packages to more than 1,000 transgender people in Lahore. 

During the lockdown period in 2020, HIV prevention and testing services were provided to over 1,100 and 500 transgender people respectively, and treatment services were provided to 40 clients, including referral support. Through the peer educators of KSS supported by Global Fund grants, KSS has disseminated information on COVID-19 good hygiene, preventive measures and on social distancing measures which targeted the transgender community on KSS social media platforms. Throughout the lockdown, KSS peer educators kept in touch with transgender PLHIV, monitoring their ARV status and facilitating ARV delivery in collaboration with local clinics.

“Global Fund grants supported us with masks, sanitisers, and other personal protective equipment for the safety of our staff members when facing COVID-19, through the years, the strengthening of the organisation accumulated over the years through Global Fund investments contributed immensely towards efforts of community-based and -led organisations in reacting to COVID-19 swiftly and successfully,” explained Moon. She further highlighted that community mobilisation efforts supported by the Global Fund was instrumental not only in channeling support to community members, it also served well in seeking feedback and information to improve their COVID-19 emergency response plans.  

The Global Fund has allocated US$ 10.6 million to Pakistan to fight COVID-19 and mitigate its impact on HIV, TB and malaria responses through its COVID-19 Response Mechanism (C19RM). In addition, under the 5% Grant Flexibilities, an initiative to support countries through reprogramming grants to enable rapid responses to challenges posed by COVID-19, Pakistan was able to reprogram US$ 5.5 million of its existing grants. 

“While we truly appreciate the Global Fund for its immediate and strategic responses and interventions to support countries in mitigating the impacts of COVID-19 on HIV, TB and malaria, as communities and civil society, we had experienced a lack of meaningful community engagement in COVID-19 related processes at the country level – including the development of funding requests and in implementation – during the onset of the pandemic,” explained Moon. “Meaningful community engagement is the cornerstone of successful country implementation and programmes, and is the mantra of the Global Fund model as we know it. COVID-19 has demonstrated that community systems have a hugely important role to play during pandemics to ensure uninterrupted service delivery and treatment access.”

Moon also shared her concerns on the sustainability of the national HIV response of Pakistan. The economic impacts of COVID-19 and the ongoing war in Ukraine in addition to the recent political instability in Pakistan will challenge efforts of community advocacy on domestic resource mobilisation for health and for increased allocations for national programmes through government budgets for the country to reach its national and global targets for HIV, TB and malaria. She highlighted the integration challenges between the provincial and national governments continue to affect HIV responses at provincial and district levels, and that human rights and gender-related barriers faced by key and marginalised communities remain key obstacles for Universal Health Coverage. 

“The challenges faced by our communities from HIV exacerbated by COVID-19 is just the tip of the iceberg amidst the multitude of challenges faced around health responses – including equitable access and quality services. The solutions that we want need to be comprehensive, holistic, sustainable and fully financed, and above all, focus on key populations that are often left behind,” Moon observed. 

Moon as a speaker at a recent food distribution drive for Ramadan 2022. (Source: Facebook)

“I am a good example that demonstrates how Global Fund investments in countries such as Pakistan, has trickled down to strengthen the capacities of community members at an individual level. The opportunities created by the Global Fund through the provision of resources have not only enabled continuous capacity building, it has also enabled and empowered individuals from marginalised communities. The ripple effects from Global Fund funded programmes over the decades have developed and enabled a generation of transgender community activists who know their rights and are ready to defend them. My metamorphosis into a leading trans rights advocate in a conservative country like Pakistan where we have been historically marginalised and stigmatised would not have been possible without the Global Fund,” shared Moon.

Moon further expounded upon the mechanisms facilitated by the Global Fund such as the policies of community engagement and representation in decision-making processes which are unparalleled – including the Country Coordinating Mechanism (CCM), which has provided unique opportunities for her and her community members to receive the acknowledgement and respect, and contribute towards decision-making processes and programme implementation with dignity.

Moon further stressed, “Within this context, the Seventh Replenishment of the Global Fund brings us hope. Its proven track record in saving lives, and investments in communities systems strengthening as part of health systems prepares us for future pandemics. We thank the leadership of the United States in hosting the Seventh Replenishment Pledging Conference of the Global Fund and we are placing our confidence and aspirations in all donors to achieve at least the US$ 18 billion needed to continue saving lives and strengthening our health and community systems.”