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Yes, Strengthen the Health System—But Strengthen It for All

Christine Stegling

Community activism has played a crucial role in achieving better access to HIV treatment. Although there is comparatively better access to treatment now than in the past, communities must remain at the center of the global HIV response.

The International Treatment Preparedness Coalition (ITPC) was established in 2003 as a loose but fierce coalition of AIDS activists from across the world, united in a common belief in the right to health for all. Over the years, this movement has grown into a global network of treatment activists, with regional structures in Africa, Asia, Latin America, the Caribbean, and Eastern Europe.

In mid-2013, I took over the leadership of ITPC and was one of the first recipients of the Open Society New Executives Fund. With this support, we focused on two strategic initiatives: 1) making the global coalition a more cohesive and strategic advocacy force, bringing local and regional community treatment–access voices to the global health discourse, and 2) establishing the network as its own legal entity in the Global South.

Both of these initiatives have been vital to ITPC’s mission, ensuring that local issues around access to medicine and health funding provide a counter-narrative to the often overly celebratory tone of the global health debate.

But there is still much to do. The current emphasis on health system strengthening runs the risk of neglecting to address the real issues faced by marginalized and stigmatized communities. There is a need for community activists to monitor service provision at a time when national governments increasingly take responsibility for the delivery of HIV services. We need to repoliticize the AIDS movement to counter the complacency and bureaucratization of community engagement.

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