Saving lives in times of trouble—Aid for AIDS interventions in Venezuela

Daniel Mora-Brito, Senior Manager and Focal Point to the Global Fund Board Private Sector Delegation (PSD)

Since its founding in 1996, the New York-based international NGO Aid for AIDS has become a beacon of hope for thousands of people around the globe. Jesús Aguais, its founder and Executive Director, is a force of nature whose dedication to save the lives of people living with HIV is appreciated worldwide. His crusade to increase access to treatment and prevention for HIV/AIDS started as a local effort in New York City, his home since he left Venezuela in 1989, but has since been scaled up into a large and influential network covering 59 countries.

Recently, Jesús and Aid for AIDS have had a key role in catalyzing multi-sector initiatives to support people living with HIV in Venezuela, particularly with the collapse of the country’s health system and disappearance of essential medicines from pharmacies and hospitals across the country. Jesús has led the design of cooperative mechanisms and logistical arrangements to ensure that key populations have access to antiretroviral (ARV) drugs and other treatments.

In this interview, we asked Jesús about the contributions his organization has made to address the severe health crisis of Venezuela, and the role of the private sector in supporting his efforts to increase the access to ARVs and other commodities for key populations. He also shares some of the challenges that civil society organizations are facing in one of the world’s most difficult development contexts.

Can you tell us a bit more about the health crisis in Venezuela and the contributions of Aid for AIDS to improve the situation of HIV patients?

The crisis in Venezuela is complex and needs to be explained in the context of two phases: (1) the gradual stockouts of essential medicines in 2016, and (2) the politization of humanitarian assistance in 2019.

One could say that the humanitarian crisis in Venezuela has been acute for the last four years. When drug shortages became common in 2016, several civil society organizations, particularly the Red Venezolana de Gente Positivas (RVG+)—translated as the Venezuelan Network of HIV Positive People—reached out to Aid for AIDS for help. At that point, they were already foreseeing a complete stockout of ARVs, endangering the health of thousands of patients. Our main priority is to facilitate access to ARVs for people living with HIV, so we decided to work with NGOs focused on universal access and prevention.

We immediately focused on advocacy, educating the public about the drug shortages and the overall collapse of the health system in Venezuela. A year later, a pharmaceutical company partnered with us to provide ARV donations worth approximately US$10 million. By utilizing the list of people registered in Venezuela’s National AIDS Program, we knew the exact type and quantity of treatments that were needed, and the company made its contribution based on this information. Then, two other pharmaceutical companies made important donations, which included antimalarials for 440,000 patients and ARVs for 18,200 additional patients.

Drugs were being distributed as expected within an organized and deliberate strategy until political circumstances, marked by new internal conflicts between the Maduro administration and opposition groups, changed in late January 2019. This marked the emergence of the second phase of the crisis, where international aid was politicized and, therefore, shipping and distributing live-saving medicines has become even more difficult.

Given the tenuous circumstances, what measures is Aid for AIDS introducing to guarantee service delivery?

What makes Aid for AIDS unique is the ability to provide a solid and safe mechanism for distribution of essential medicines to Venezuela. Donations are received and stored in the warehouses of the United Nations Humanitarian Response Depot (UNHRD) in Panama, which also handles further shipping of the donations. Aid for AIDS constantly monitors conditions on the ground to determine the best time to move and deliver commodities.

For us, it was essential to understand that we could not operate under a humanitarian aid framework, so we signed an agreement with UNAIDS whereby this organization incorporates our donations as programmatic goods. As such, these commodities enter Venezuela as part of international cooperation programs with the United Nations system. While these drugs are delivered into the country as part of UNAIDS support, Aid for AIDS covers the cost of shipping and handling, and manages the transportation of these drugs from ports to designated distribution centers across Venezuela. Within this model, we have been able to successfully reach 35,000 people with HIV in 2018. Thanks to this model, we became the first and most important provider of ARVs in the country at this time of crisis.

What mechanisms are you using to monitor the delivery of essential medicines to their intended users?

Aid for AIDS has been working with the RVG+ on a strong framework for social monitoring and accountability. This system was originally designed and implemented by people living with HIV to ensure that ARVs were reaching their intended recipients and to make the needs of key populations more visible. The unwavering efforts of the RVG+ and Acción Ciudadana Contra el SIDA (ACCSI)—translated as Citizen Action Against AIDS—have been instrumental in tracking the donations provided by Aid for AIDS.

This monitoring system has been so effective that it was adopted as the gold standard under the Pan American Health Organization (PAHO)’s Master Plan, a roadmap defined in 2018 by this organization, UNAIDS and other actors, to prevent and treat HIV, tuberculosis and malaria in Venezuela. Our distribution model was also included in the Master Plan as an example of a successful mechanism to improve ARV access.

When Aid for AIDS ramped up its support to Venezuela in 2016, the RGV+ and ACCSI reached out to the Global Fund to Fight AIDS, Tuberculosis and Malaria to ask for urgent support, despite Venezuela’s ineligibility to receive traditional funding from the Global Fund. After two years of intense lobbying and negotiation by many civil society entities, activists and Board constituencies, the Global Fund approved an assistance package of US$5 million for Venezuela, which contributes to the US$140 million in funding needs identified in PAHO’s Master Plan. Within the Global Fund contribution, US$4.9 million was allocated for purchasing ARVs while the remaining US$100,000 were utilized for social monitoring efforts.

With our operating model integrated into the Master Plan, resources from the Global Fund provided greater support to distribution and monitoring activities already underway. This was a great success for Aid for AIDS, as we had not only started an ARV distribution initiative with the support of the National AIDS Program, but co-created a social monitoring system that was formalized in a multilateral health strategy.

Since January 2019, we have faced additional bottlenecks resulting from a leadership change at Venezuela’s National AIDS Program, along with other management changes associated with donated ARV stocks through Aids for AIDS. To address this, we turned our approach on its head; we reach out to recipients to keep track of the treatments they have received rather than relying on the National AIDS Program for distribution data. We then compare the figures collected by civil society with those provided by the government to PAHO and UNAIDS.

Aid for AIDS has started a campaign to fund infant formula for malnourished children in Venezuela. What is the scope of this intervention and why is Aid for AIDS covering an area that seems to be outside its mandate?

We realized that many HIV positive women were breastfeeding without sufficient information on their viral loads, so we started an international campaign, Healing Venezuela, to mobilize resources for purchasing infant formula. Child mortality and malnutrition in Venezuela extend well beyond the scope of HIV, so when we made donations to hospitals we could not discriminate between the children of HIV positive women and those who could not breastfeed because of other health conditions. Another challenge is that we could only provide access to state-compliant formulas, or risk exposing the organization to governmental persecution and jeopardized program scalability.

We decided to expand the coverage beyond children of HIV positive women in selected health centers and to work with a national infant formula vendor. This was a positive step for us as we were increasing access to expensive products for underserved families, and it allowed us to work with a provider that was conversant with the nutritional needs of Venezuelan children. By May 2019, we will be covering a population of 1,500 children and we expect this number to steadily increase.

What is your message to future donors, especially in the private sector?

No single player can address the health challenges we are facing alone; partnerships are critical. We broke paradigms by demonstrating that corporate donations—not one, but three and counting—were possible in such a difficult context. We have developed an effective mechanism to channel contributions from the private sector through a multi-stakeholder partnership. We are working to disseminate success stories to encourage additional donations, and we are adapting to a unique situation by learning as we progress while ensuring adherence to proper accountability frameworks. Along with other established and experienced civil society organizations on the ground, we welcome all the support we can get from the private sector in this fight. This initiative shows that when we work together, no challenge is big enough to break our resolve, and we must continue working together to save as many lives as we can.

Matt RomneySaving lives in times of trouble—Aid for AIDS interventions in Venezuela