Shifting the paradigm in the fight against HIV/Aids

When we think about the global fight against HIV, the images that most frequently come to mind are the clinical response i.e. the distribution of life-saving Antiretroviral Therapies (ARVs), medical consultations, and frontline health workers in community clinics. These practical interventions are undeniably vital and they have kept millions alive since the advent of the drugs and subsequent rollout of these therapies.

To an extent, however, the availability of treatment becomes almost theoretical if the very people who most urgently need these clinics are too terrified to walk through the doors. In many parts of Africa, the populations most affected by HIV, including sex workers, people who use drugs, and LGBTQ+ communities face criminalisation, societal hostility, isolation and violence to which the state too often turns a blind-eye or even perpetrates. In these environments, medical supply chains are not enough. If a person faces imprisonment or assault simply for existing, the medication remains out of reach.

The Love Alliance partnership took the decision to tackle this challenge “upstream” by working with these communities to build strong and empowered advocacy networks. Love Alliance was a five-year programme funded by the Dutch Ministry of Foreign Affairs as well as an alliance of partners based in four regions of Africa and the Netherlands. Our team at Southern Hemisphere recently conducted the mid-term and end-term evaluations of this important initiative. 

Systems that are built to last

There is no doubt that clinic-based service delivery saves lives in the short term. However, to secure long-lasting, generational change, it is human rights advocacy and local movement-building that will make changes that last and it is that path, the unique and rather more difficult one, that Love Alliance deliberately chose.

Right from the start, the programme chose to hone in on the communities that were most impacted by HIV Aids. This in itself is a departure from the traditional approach to funding where focus was on health services for the general population.

Netherlands-based Aidsfonds was the lead contract partner of the Love Alliance. Moira Beery, Aidsfonds project lead explained that by working with thought leaders and locally-based grantmakers who are representatives from key populations; (the LGBTQ+ community, sexworkers and people who use drugs) the initiative targeted the root social structures that drive the epidemic, rather than just treating its symptoms. The core strategy was that the best way for these marginalised communities to be heard was to invest in them directly. By making sure they were organised, mobilised, that they had the capacity and skills but most importantly the standing in the community so that they could push for their own needs in their own local environments. 

Having a localised approach worked well. As opposed to a blanket solution, it addressed the precise issues impacting these different communities within the 10 countries within which Love Alliance worked. Examples included advocating for clinics where they could get non-discriminatory care, or pushing for extended operating hours in the evenings or on weekends enabling them to better serve those that needed the service. These empowered communities were able to ask for better clinics where safe drug-use equipment was available alongside HIV treatment prevention.

More than was bargained for

Whilst the primary focus of the programme was building capacity in the HIV advocacy space, there were some fortunate secondary side effects that benefited the building of a stronger civil society. 

The theory of change in the programme was that having strong, capacitated and intact movements that could advocate for themselves was the most effective way of having an impact. In fact, Moira credited Southern Hemisphere’s evaluation outcomes with the insight that had shaped her understanding that the very purpose of a movement is to create and sustain advocacy for change.

As the focus of the programme was on HIV/Aids, advocacy was predominantly targeted at national AIDS councils, national departments and ministries of health. However, given the highly restrictive nature of the environment for people within the LGBTQ+ and sex worker communities in eight of the 10 countries in which the programme ran, it was equally as important to engage and work with non-HIV institutions and others such religious and community leaders.

Resilience in the face of backsliding

By investing directly in capacity-building of local groups and equipping them with the fundamental tools from robust governance systems to advanced fundraising strategies, these grassroots networks grew in strength and expanded building a powerful safety net for vulnerable communities.

The true measure of a programme’s sustainability is how it withstands adversity. Throughout the five-year cycle in which the programme was running, the legal and social environments in the majority of the ten partner countries contracted with tightening restrictions and rising criminalisation of Love Alliance Communities. In the face of this, the movements didn’t fracture, instead they consolidated.

Even when hit by severe US government funding reductions in 2025, an interesting dynamic emerged. While traditional aid models might have retreated into safer, clinical service delivery, the Love Alliance partners did the opposite: they doubled down on advocacy. They engaged proactively with local governments for the inclusion of key populations, demonstrating a deep commitment to structural change over temporary band-aids.

A programme designed to shift power. 

Historically, International aid has suffered from a top-down approach with the centre of power sitting firmly in the Global North. The Love Alliance disrupted this model by shifting strategic decision-making power from the Netherlands directly to African alliance partners.

By establishing a decentralised strategic board composed of regional representatives, the programme unlocked an extraordinary level of agility. This local-led governance proved to be a lifesaver when political crises struck. For instance, when Uganda passed the draconian Anti-Homosexuality Act in 2023, the alliance did not get bogged down in European bureaucratic red tape but looked to the local grantmaker, UHAI to ask what was needed on the ground.

An emergency board meeting was convened and the board was able to redirect a sizable sum, to fund strategic litigation and emergency advocacy. This swift pivot resulted in tangible legal victories, successfully challenging unjust and unconstitutional prosecutions and securing the release of imprisoned individuals.

The way that the Love Alliance had been structured allowed for this flexibility and the ability to pivot in order to meet the needs of the moment.

Capacity building IS movement building

Moira speaks of an “aha” moment where everything fell into place for them.  She explained it as follows: the purpose of creating movements is to amplify people’s voices, in other words, the higher purpose of a movement is advocacy. But a movement consists of people and in order to create a robust movement, there has to be a continuous build-up of skills and capacity amongst individuals. 

Capacity building might mean learning about fundraising, teaching organisations to get their financial systems in order or setting up a board for the first time. As movements grow, so the capacity strengthening needs change but the need for capacity building  never ends. The reason for this is if you are doing it right, you have new people joining the movement and as these movements grow, so does the loudness of their collective voice along with the likelihood of systemic change.

This change is not always visible in the moment but becomes undeniable when you look back on it. Year one was simply about identifying the players on the ground but by year five you have grassroot advocates working directly with the Department of Health in some contexts.

This is the kind of lasting legacy that probably would not have been conceived of at the start, the ability to reach way beyond the clinic walls and into the corridors of government power and to edge just a small bit closer to a safe, just, and free world for all.