A. Mainstreaming, Gender and MDGs: Advisory Services

1.  Planning and financing multi-sectoral action on HIV, health and MDGs: The most successful responses to HIV combine strong health services with strategic action in other sectors that address underlying socioeconomic determinants influencing the epidemic –such as income inequality, poverty, migration patterns, and gender relations. It is increasingly recognized that these same socio-economic factors also shape other health outcomes, including but not limited to maternal health, child health, diabetes, cancer and other chronic conditions. UNDP is well positioned, through its mandate on poverty reduction and promoting gender equality, to effectively address the social determinants of HIV as well as other health related outcomes. UNDP works with partners to identify key socioeconomic causes and consequences of HIV and other health priorities, support multi-sectorial action, and mainstream attention to these issues into development instruments. Along with other UN partners, UNDP coordinates support to national planning processes such as national HIV plans, national development plans, gender equality strategies, MDG Acceleration Frameworks, and sector-wide approaches. UNDP also provides support to countries to calculate the costs involved in effective multi-sectorial responses, to identify opportunities for cost savings, and to develop strategies for financial sustainability.

2.  Gender, poverty and HIV synergies: Gender inequality and income inequality are two of the most powerful and pervasive socio-economic factors that influence HIV epidemics. At the same time, there is strong evidence from countries that strategies to effectively address gender, women’s economic security, or HIV service access can lead to beneficial impacts in all three areas. Even more important is the evidence that in some circumstances, simultaneously addressing gender, poverty and HIV can be both less costly and more effective than addressing each issue in isolation. UNDP promotes attention to leadership and rights of women and girls as part of HIV responses, with particular attention to women who are living with HIV and/or marginalized. UNDP works with partners to address gender, poverty and HIV synergies in policies and plans related to gender based violence, public health, MDGs and human development.

3.  HIV-sensitive social protection: HIV can have a devastating impact on individuals and their families, often leading to poverty and social exclusion. In countries that are heavily affected by HIV, these impacts extend to the community level. Social protection strategies can be more effective if they are designed to be sensitive to the particular impacts and consequences of HIV. In countries where poverty contributes to driving the HIV epidemic, effective social protection strategies can also contribute to HIV prevention. UNDP participates in the inter-agency Social Protection Working Group, co-convened by UNICEF and the World Bank.

4. Promoting action outside the health sector on social determinants of health beyond the MDGs: Chronic or non-communicable diseases (such as cardiovascular diseases, cancers, chronic respiratory diseases and diabetes) represent a leading threat to human health and development. These four diseases are the world’s biggest killers, causing an estimated 35 million deaths each year and representing 60% of all deaths globally.  These diseases are preventable by eliminating the principle underlying causes: tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol. Multi-sectoral responses outside of the health sector can help to contribute to addressing these factors, and are important in complementing health-sector efforts. UNDP brings its expert knowledge and experience of supporting multi-sectorial initiatives to enhance responses to non-communicable diseases. UNDP provides support to mainstreaming of non-communicable disease issues into national development plans to address prevention and impact mitigation. Building on a mandated role in tobacco prevention and control, UNDP can also help to strength governance and support the financing of emerging non-communicable disease responses. 

B. Governance and Human Rights: Advisory Services

1.  HIV-related law, human rights, stigma and discrimination: Appropriate laws and supportive legal environments can play a crucial role in slowing the spread of HIV, increasing access to care and treatment, and reducing the impact of the epidemic. Conversely, punitive laws can undermine access to effective HIV services, especially for marginalized populations and people living with HIV. UNDP supports countries to create an enabling human rights environment, promote gender equality, and address HIV-related stigma and discrimination. To advocate for and advance human rights based approaches, UNDP supports initiatives that promote access to justice, legislative review and reform, and enforcement of protective laws and anti-stigma initiatives.

2. HIV and sexual diversity: Around the world, people involved in commercial sex, men who have sex with men, and transgender people are at particularly high risk for HIV, and make up a significant part of most countries’ HIV epidemics. The goals of universal access to HIV programmes, and reversal of the HIV pandemic, will not be achieved without increased involvement of these populations and recognition of their rights and needs. This includes promoting rights to health education and health services, and personal autonomy in seeking health care regardless of gender, gender identity, or sexuality. UNDP addresses the nexus of HIV and sexual diversity in particular through attention to the broader legal and policy environment, as well as by partnering with municipal governments to strengthen their understanding and response to these populations.

3. Intellectual property, innovation and treatment access: By the end of 2010, about 6.65 million people in low- and middle-income countries were receiving HIV treatment, representing less than half of the 15 million estimated to require treatment. To sustain people on life-saving treatment and to scale up access, prices of diagnostics and treatments must fall further and new technologies must be geared towards and made available to the poor. UNDP provides advisory support to reform national intellectual property legislation so as to protect public health while remaining compliant with international agreements (in particular, the Trade-Related Aspects of Intellectual Property Rights Agreement -TRIPS-, of the World Trade Organization). UNDP also advocates in support of public health-sensitive reforms of intellectual property legislation and adoption of measures that adequately address the need for affordable, accessible, safe and efficient medicines.

4.  Leadership, governance and local HIV responses: Effective HIV responses require strong leadership from inside and outside government, at national and local levels. Governance and oversight structures must be designed to promote accountability, achievement of results, and synergies between HIV and broader health efforts. Inclusion of most affected populations and effective partnerships between government and civil society are crucial. As most HIV infections happen within large urban areas where the burden of care is also greatest, municipal governments have a particularly important role in local responses. UNDP leverages its core mandates in Democratic Governance, Capacity Development and Local Development to strengthen leadership and governance of HIV responses at national and local levels. Priorities include facilitating partnerships between governments and NGOs; support to assist countries in aligning structures and frameworks and promoting harmonization; and support to municipal leadership.

C. UNDP's Partnership with the Global Fund

1. Global Fund implementation support: The Global Fund to Fight AIDS, Tuberculosis and Malaria has become the primary multilateral financing mechanism used by low- and middle-income countries to support their AIDS, TB and malaria programming. In certain countries, World Bank financing also remains important. Considerable progress on MDG 6 around the world is linked to access to these resources. The UNDP/Global Fund partnership facilitates access to resources for action on MDG 6 by countries that face constraints in directly receiving and managing such funding. This includes countries in crisis/post-crisis situations, those with weak institutional capacity or governance challenges, and countries under sanctions. When requested, UNDP acts as temporary Principal Recipient in these countries, working with national partners and the Global Fund to improve management, implementation and oversight of Global Fund grants. These approaches and services are agreed as part of an overall partnership between the Global Fund and UNDP.

2. Global Fund capacity development: Countries implementing Global Fund financed projects often require support in capacity development, in relation both to the procedures of the Global Fund and to ensure that such financing strengthens rather than undermines broader health systems. When serving as interim Principal Recipient, one of UNDP’s key roles is to develop the capacity of one or more national entities to enable them to assume the management of grants. UNDP often provides more limited, ongoing capacity development support to national Principal Recipients, after transition from UNDP to national partners. Even in circumstances where UNDP has not itself served in the Principal Recipient role, some countries seek its support in specific areas of Global Fund-related capacity development and performance improvement.

 3. Global Fund and public policy: In addition to immediately delivering public health services and supplies, Global Fund projects often provide important opportunities to influence the broader country policy environment in a way that both accelerates achievements and sustains results. UNDP focuses particularly on circumstances where countries with Global Fund grants would also benefit from UNDP’s broader HIV, health and development strategies, in areas such as multi-sectorial planning and financial sustainability; human rights and law; gender/poverty/HIV synergies; and sexual diversity. UNDP works with the Global Fund directly to influence and improve its own policies in these areas, as well as with country partners as appropriate.