1. Statement of the Johannesburg Civil Society Consultation

2. Background 30 civil society representatives from Kenya, Tanzania, Uganda, Botswana, Mauritius, South Africa and Namibia Discuss the model and its practical application to HIV programming

3. Potential to Advance Universal Access Agenda BUT……. Fundamental concerns about: Assumptions Shortcomings from human rights perspective Inattention to vulnerable and marginalised groups

4. Assumptions Sexual behaviour of Africans and the extent of transmission during the acute phase Availability of second line regimens Likelihood of universal uptake of testing on a voluntary basis Individual benefit of imposed initiation of ART Likelihood of lifelong adherence to treatment amongst asymptomatic individuals Capacity of health systems to deliver testing and treatment beyond to those who need it.

5. Fails to acknowledge…. The extent of modes of transmission in Africa other than through heterosexual sex; Legal, social and economic barriers to uptake of testing and treatment, particularly among women and other vulnerable groups; and Ideological opposition to evidence based prevention measures such as barrier methods, sex education, needle exchange and substitution therapy that need to be scaled up for the model to work.

6. Inattention to vulnerable and marginalised groups Ignores the socio-economic and cultural reality faced by sex workers, prisoners, refugees, LGBTI, MSM, WSW, IDU, PWD, children, and other vulnerable and marginalised populations. Exclusive focus on heterosexual sexual transmission ignores those populations for whom heterosexual sex is not their major HIV risk factor. Even for populations such as sex workers and refugees for whom heterosexual sex is a major risk factor, the model ignores the way in which these groups are chronically left out of national HIV programmes.

7. Human Rights Shortcomings…. Real fear that implementation will violate rights. Does not address human rights violations that fuel vulnerability and impede access.

8. Recommendations High level discussion of why progress towards universal access is so slow and how we can better hold governments accountable to universal access commitments The implementation of an ambitious strategy for scaling up human rights interventions that address vulnerabilities and barriers to accessing testing and treatment

9. Recommendations cont. Additional research into the validity of assumptions on which the model is based, both those acknowledged by the authors and those that are not An analysis of what the model would look like if many of its key assumptions did not materialize, and how these projections would be balanced against the obvious human rights concerns raised

10. Recommendations cont. An inclusive and transparent process of civil society consultation, particularly in countries where the model may be piloted or introduced.

11. AIDS and Rights Alliance for Southern Africa (Regional) AIDS Law Project (South Africa) AIDS Legal Network (South Africa) AFS (Solidarity with PLHIV in Madagascar) Bomme Isago Association (Botswana) Botswana Treatment Literacy Coalition (Botswana) Children Education Society (Tanzania) Faith and Hope Association (Seychelles) Global Coalition on Microbicides Grassroots Empowerment Trust (Kenya) HIV Collaborative Fund (Regional) Indian Ocean Network of PLHIV (RAVANE+) (Regional) Kenya Legal & Ethical Issues Network on HIV & AIDS (KELIN) (Kenya) Kenya Treatment Action Movement (Kenya) LEGABIBO (Botswana) Liverpool VCT (Kenya) NAP+

12. NAP+SAR National Empowerment Network of People Living with HIV/AIDS in Kenya (Kenya) Open Society Initiative (New York) Open Society Initiative for East Africa (Regional) Open Society Initiative for Southern Africa (Regional) Pan African Treatment Action Movement (Regional) PILS (Mauritius) RIVE Ocean Indien (La Réunion) Sahiba Sisters Foundation (Zanzibar) SCARJOV (Angola) SWEAT (South Africa) Tanzania Network of People Living with HIV/AIDS (Tanzania) Treatment Action Campaign (South Africa) Umunthu Foundation (Malawi) Women’s Organisation Network for Human Rights Advocacy (Uganda) Zambia AIDS Law Research & Advocacy Network (ZARAN) (Zambia) Zimbabwe Lawyers for Human Rights (Zimbabwe)