By Victoria Grandsoult 1, Jenny Vaughan 2, Kat Smithson 3, Cristina Bernardo 1, Ricardo Baptista Leite 1
The launching of the 2014 Paris Declaration on Fast-Track Cities (FTC) initiative  established a global network of more than 300 cities and municipalities that are committed to attain the UNAIDS 90-90-90 targets by 2020. The initiative seeks to build upon, strengthen, and leverage existing HIV-specific programs to achieve the following targets:
By 2020, 90% of all people living with HIV will know their HIV status.
By 2020, 90% of all people with diagnosed HIV infection will receive sustained antiretroviral therapy.
By 2020, 90% of all people receiving antiretroviral therapy will have viral suppression.
Cities are home to diverse communities and a wide range of stakeholders, making them uniquely positioned to develop innovative and disruptive solutions to drive progress. Successful, locally led, initiatives can influence decision makers and help to mobilise civil society locally, nationally, and globally.
London has a rich history of civil society and political engagement on HIV and AIDS. A range of strategies have been used to develop partnerships that are positioned to overcome barriers in healthcare access and increase HIV testing and treatment. London has already achieved the 2020 goals, with a current performance of 95-98-97 . While there is a lot to learn from London, there is equally still a lot to do address HIV because of health inequality and to ensure that all people living with HIV do so with the necessary quality of life expected for any chronic health condition. There are significant challenges to governance, brought about by a complex health and social care system; and to succeed, there is a continued need to fight against HIV related stigma in London.
Considering that Members of Parliament (MPs) and local legislators have powerful tools to contribute to the elimination of HIV and AIDS within cities, UNITE – Global Parliamentarians Network to end infectious diseases, STOPAIDS, and NAT (National AIDS Trust) organized a diverse panel of policy makers and community leaders for a pre-conference session to the IAPAC Fast Track Cities 2019 Conference, held in London in September.
The session was titled, Securing Political Leadership for Fast Track Cities and the panel was comprised of the following speakers:
(Opening statement) José Zuniga – President/CEO, IAPAC
(Opening statement) Shannon Hader - Deputy Executive Director of UNAIDS
(Chair) Jenny Vaughan – Senior Advocacy Advisor, STOPAIDS
Ricardo Baptista Leite MD MP – Founding President, UNITE; Member of Parliament, Portugal
Kat Smithson – Director Policy & Communications, NAT (National AIDS Trust)
Edward Davie – Councillor, Lambeth, London
Jonathan McShane – Terrence Higgins Trust Chair & former Hackney Cabinet Member for Health
Lloyd Russell-Moyle MP – Member of Parliament, Brighton, United Kingdom
Becky Kroger – UK Youth Delegate to the 2018 International AIDS Conference; HIV Advocate
Panellists discussed not only what can and should be learned from London’s approach to the HIV response over the years but also how increased political leadership is urgently needed to advance progress in London and in the global HIV response to stay on course to achieve the Sustainable Development Goal target of ending AIDS as a global health threat by 2030.
Dr José M. Zuniga, President/CEO of IAPAC (International Association of Providers of AIDS Care), and Dr. Shannon Hader, Deputy Executive Director of UNAIDS, opened the panel session with welcome remarks.
‘A coordinated multisectoral political and programmatic response to HIV remains a challenge facing policy-makers today. Thus, bridging municipal and national HIV responses is critical to strengthening the ability of local governments to attain and surpass the Fast-Track Cities’ 90-90-90 and zero stigma targets. The partnership between UNITE, IAPAC, and Fast-Track Cities will help to foster collaboration with parliamentarians worldwide whose policy decisions can contribute towards the Sustainable Development Goal of ending urban HIV, tuberculosis, and viral hepatitis epidemics.’ – Dr Zuniga
‘When we look to the cities, we can end the HIV epidemic rapidly. But how far and fast the city can go, depends on what happens at the national level.’ – Dr Hader
Recommendations from the panel on how to secure political leadership to accelerate the attainment of FTC targets include:
Political leadership at the national level must be linked with local government.
National commitments to ending AIDS are often executed at the local level; therefore, MPs must demonstrate political will and engage with local legislators. This is definitely the case in London and the rest of England, where local governments lead the decision making and funding for sexual health services in their communities. Engagement from national politicians can help accelerate progress for the 2020 and 2030 Goals by promoting local accountability.
Political leadership does not operate in a vacuum.
Parliamentarians should always be connected to those who are in the frontline of assessing the needs and challenges of those living with HIV. The ambition of the FTC initiative will not be achieved without a strong relationship between politicians and the third sector. It is increasingly critical to have this cross-sectoral cooperation in London. Significant budget cuts to local sexual health services, the NHS and civil society, alongside a difficult political environment marked by hostility towards migration and challenges to individual rights, are creating barriers to HIV treatment and care for key populations . Political leadership can be vital to amplifying the voices of those otherwise not heard.
Effective communication and information sharing are crucial.
Politicians and scientific leaders have a responsibility to educate the public on the current treatments and services that are available for HIV. Often, community-based organizations are leaders in extracting the necessary information from scientific reporting and translating it into the personal care delivered on the ground. Communities who have access to information are better equipped to advocate for their health.
Progress in HIV elimination must not stifle political will…
Reaching zero new HIV infections is achievable in England. Yet, having this end in sight must not reduce the political will to accelerate towards and beyond the FTC targets. Progress must be fought for and losing focus would jeopardize the gains that have been reached. In London, the FTC Initiative has come at a later stage and is igniting initiative to push beyond the targets.
… particularly in times of austerity.
Wavering in governmental leadership for ending HIV transmissions and AIDS is already being demonstrated in England with the slow rollout of PrEP , severe hits to public health spending, and increased marginalization of key populations . Stakeholders must find ways to make the system work more efficiently even within these limited parameters. There should be no left and right divide on HIV elimination and the human right to health means that everyone has the right to the highest attainable standard of physical and mental health.
The importance of the personal story. Politicians need to hear from affected communities.
Each stakeholder invested in eliminating HIV transmissions and the end of AIDS as a priority holds an important responsibility to win the hearts and minds of people on the ground and in political leadership. Telling personal stories brings to the heart of governments and communities the successes in the HIV response and the need to act more urgently and effectively.
 UNAIDS (2014). Paris Declaration Fast-track cities: Ending the AIDS epidemic: https://www.unaids.org/sites/default/files/media_asset/20141201_Paris_Declaration_en.pdf
 IAPAC (2019). London:
 National AIDS Trust (2017). UK investment in HIV prevention 2015/16 and 2016/17: https://www.nat.org.uk/sites/default/files/publications/NAT_PREVENTION%20REPORT_V2.pdf
 The Guardian (2019). ‘Scotland's introduction of HIV drug PrEP 'puts England to shame'
 AVERT (2019). HIV and AIDS in the United Kingdom (UK)
UNITE, the Global Parliamentarians Network to End HIV/AIDS, viral hepatitis and other infectious diseases
National AIDS Trust (NAT)