TABLE OF CONTENTS
Welcome Panel – Leading United: Re-Embracing the Fast-Track Cities Commitment to Solidarity
High-Level Panel – Health for All: Realizing the Human Right to Health for Migrant Populations
Community Panel – Al Centro: Defining the Centrality of Affected Communities in Urban HIV Responses
Panel Session 1 – Towards 2030: Defining the Calculus of Success for Ending Urban HIV Epidemics
Panel Session 2 – Momentum Lost: Re-Energizing Urban and Peri-Urban Tuberculosis Responses
Panel Session 3 – Course Correction: Mapping a Path Towards Achieving Urban HCV Elimination
Panel Session 4 – Common Vision: IAPAC-Lancet HIV Commission on the Future of Urban HIV Responses
Promoting a Continuum of Care and Social Services for LGBTQ+ People
Improving Health Service Provision for Migrants and Internally Displaced Persons
Prioritizing Quality of Life within the Context of Holistic Urban Health
Democratizing HIV Testing and Linkage to Care through Community Checkpoints
Leveraging a Cohort of Champions to Tackle Urban HIV Response Challenges
Utilizing an Implementation Science Lens to Optimize Urban HIV Responses
Introduction
The Fast-Track Cities 2022 conference took place October 11-13, 2022, in Sevilla, Spain, and was the third in-person gathering of cities and municipalities accelerating their responses to HIV, tuberculosis (TB), and viral hepatitis – three conditions cited as urban health priorities in the New Urban Agenda as well as the Paris Declaration on Fast-Track Cities. The conference was organized by the International Association of Providers of AIDS Care (IAPAC), in collaboration with the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the Fast-Track Cities Institute (FTCI). The Fast-Track Cities 2022 conference’s aims were to highlight successes achieved across the Fast-Track Cities network; address cross-cutting challenges to accelerating HIV, TB, and viral hepatitis responses; and share best practices in urban HIV, TB, and viral hepatitis responses.
Building upon the successes of the past three global gatherings of the Fast-Track Cities network, this year’s conference provided space for interactive dialogue to support a network of “connected cities,” facilitating the collaborative development of innovative approaches to attaining the goals, objectives, and targets to which all Fast-Track Cities are committed. The conference featured plenary sessions, panel discussions, oral abstract and e-poster presentations, and city and municipal case studies. In partnership with the Stop TB Partnership and the World Hepatitis Alliance, the conference also featured topics related to ending the HIV and TB epidemics and eliminating HBV and HCV. The event also saw the launch of the Sevilla Declaration on the Centrality of Communities in Urban HIV Responses, a commitment by signatories of the Paris Declaration on Fast-Track Cities to center communities in their HIV, TB, and viral hepatitis responses.
While this conference summary report focuses on the plenary and panel sessions, we also invite you to review the oral abstract book and poster abstract book that were published following the conference’s conclusion. Additional content is available at https://www.iapac.org/conferences/fast-track-cities-2022/.
Panel Sessions
Conference Welcome
The conference welcome began with Secretary of State for Health Silvia Calzón (Spain), who celebrated the 180 Spanish municipalities that have joined or are in the process of joining the Fast-Track Cities network, including many recent additions. She noted that Sevilla was the first city in Spain to sign the Paris Declaration on Fast-Track Cities and welcomed delegates to the city. In discussing the strategies Spain is taking to achieve the global goals on ending HIV, Secretary Calzón stressed the importance of continuing to fight discrimination throughout society. Next was Dr. José M. Zuniga (IAPAC and Fast-Track Cities Institute, Tampa, FL, USA), who like the Secretary also highlighted the importance of addressing stigma, including intersectional stigma. Dr. Zuniga presented the Fast-Track Cities initiative’s calculus for success: political will and commitment, community engagement and leadership, data-driven and equity-based health planning, and high-quality care and social support. Finally, Mayor Antonio Muñoz Martínez (Sevilla, Spain) noted that Sevilla joined the Fast-Track Cities network in September 2015, and since then has taken a three-fold strategy: promoting health and preventing HIV among all individuals, improving quality of life and integrated healthcare for people living with HIV, and effective inclusion of people living with HIV and key populations in society. The coalition of multisectoral stakeholders that they have assembled to work on these goals has proven effective. Sevilla has made great progress on the 95-95-95 targets: today, 90% of people living with HIV know their status, 98% of those people are on treatment, and 93% of them are virally suppressed. However, he encouraged those who have met or surpassed some of these goals to not let their guard down and to continue to fight HIV, TB, and viral hepatitis.
Welcome Panel – Leading United: Re-Embracing the Fast-Track Cities Commitment to Solidarity
This panel began with a brief welcome from Deputy Mayor María Encarnación Aguilar Silva (Sevilla, Spain) on behalf of the host city’s mayor. Jorge Garrido (ApoyoPositivo, Madrid, Spain) noted that the success of the biomedical response to HIV has been hindered by many shortcomings with respect to the sociopolitical angles. He pointed to civil society as being leaders in advancing ideas like Undetectable = Untransmittable (U=U) and to addressing issues of stigma and person-centered care. He pointed to social exclusion of LGBTQ+ people, racial and ethnic minorities, and other groups as being an ongoing challenge to ending stigma and thus HIV. Next, Raf Tuts (UN-Habitat, Nairobi, Kenya) noted that the New Urban Agenda’s objectives of a better and more sustainable urban future cannot be achieved without ending HIV. He applauded the progress made in many cities even during the COVID-19 pandemic. He noted that 60% of people will be living in cities by 2030, making cities critical in ending HIV and TB and eliminating viral hepatitis. Dr. José M. Zuniga (IAPAC and Fast-Track Cities Institute, Tampa, FL, USA) focused his remarks on the innovations being advanced by Fast-Track Cities, including with respect to topics like U=U, for which the science is irrefutable and yet stigma- and political-based barriers remain. He noted that “equality” is not enough for people living with or at risk for HIV, who face unique barriers and thus need equitable solutions to accessing prevention and care. Dr. Zuniga also highlighted recent research finding significant intra-city inequities with respect to HIV, underscoring the importance of equity-based and hyper-local responses. Dr. Zuniga noted that “Fast-Track Cities is a force for good, and relevant to all cities.” Next, Winnie Byanyima (UNAIDS, Geneva, Switzerland) called attention to a recent UNAIDS report showing that progress is faltering and inequalities are widening, despite HIV cases and deaths all being preventable. She called for bold political leadership at every level, global solidarity, the centering of communities, and a focus on human rights to continue fighting HIV. “We count on all of you to stand strong on rights and to be inclusive with your policies and programs. UNAIDS will be standing with you and supporting your bold leadership,” Ms. Byanyima noted. “Together, we can end AIDS as a public health threat by 2030.” Finally, Minister of Health Carolina Darias (Ministry of Health, Spain) reflected on the many lives that have been impacted by HIV over the past 40 years, including through stigma and discrimination. We must continue to advance scientific evidence like U=U that counteracts stigma; no one should feel isolated or alone in living with HIV. “Nowadays, PrEP is a reality all over Spain, and more than 14,000 people have started PrEP in our country,” the Minister of Health noted as a further sign of progress. She commended the 180 cities and other local government entities across Spain that have joined the Fast-Track Cities network, making it the largest participant in the initiative worldwide.
High-Level Panel – Health for All: Realizing the Human Right to Health for Migrant Populations
Antía André Hernández (Spanish National Radio) moderated the conference’s High-Level Panel on the right to health among migrants, which began with remarks from four city representatives. Deputy Mayor María Encarnación Aguilar Silva (Sevilla, Spain) spoke of the importance and challenges of aligning work across multiple levels of government and developing multisectoral alliances. To eliminate barriers to care for migrants, they enjoy “fully consolidated rights” with respect to health that are equal to others, with four nonprofit organizations assisting migrants in entering the local healthcare system. This includes both medical care and broad social services including support systems and employment, for which Sevilla has had a local plan since 2016. Next, Deputy Governor Tavida Kamolvej (Bangkok Metropolitan Administration, Thailand) said that her government has used the COVID-19 pandemic as an opportunity to build trust and establish institutional connections with undocumented migrants. All migrants are entitled to health services under the “Health for All” approach; significant budget increases have facilitated improvements. Better understanding clients and making services more client-centered remains a goal to maintain people in care. Mayor Delroy Williams (Kingston, Jamaica) noted the importance of global coordination to address the needs of migrants, who together have a population equal to one of the world’s most populous countries. Rounding out the city representatives was Mayor Austin Abraham (Gaborone, Botswana), who identified his country’s adaptation of a treat all strategy in 2016 as a turning point in HIV care access for migrants. Their research showed that it would only be a 1.2% increase in ART spending to bring migrants living with HIV under care, and that there could be an eight-fold increase on that investment by averting future cases under a treatment as prevention lens.
The panel also included additional experts, beginning with Dr. Eamonn Murphy (UNAIDS, Geneva, Switzerland), who raised the issue of involuntary migration and the particular challenges facing those who are compelled to move between countries. Migrants who are actively in transit between places also face challenges in accessing services. Dr. Murphy noted that UNAIDS does not distinguish in service recommendations for migrants versus others. Next, Andriy Klepikov (Alliance for Public Health, Kyiv, Ukraine) provided an update on the migrant crisis resulting from the war initiated by Russia. He talked about the importance of civil society in procuring necessary medicines when the government’s capabilities were limited. The investment that has been done in HIV and public health infrastructure, including through Ukraine’s Fast-Track Cities, has helped to serve the population during this time, as has city leadership: “Mayors play a key role being on the front lines with people.” The movement of Ukrainians is very fluid as the conflict continues, which creates a lingering challenge: “When your population is mobile, your services cannot be static.” Finally, Dr. Meg Doherty (World Health Organization, Geneva, Switzerland), who highlighted the WHO’s new report and plan on refugees and migrants, for which the number one recommendation was that actors identify the root causes of the health conditions of these populations, which often are socioeconomic. Reorienting health systems to be welcoming to migrants and raising public awareness are other key strategies.
The second part of the two-hour panel began with Mayor Wild Ndipo (Blantyre, Malawi), who spoke on the importance of mapping out the city’s actors in HIV prevention and care to improve synergy. City-level political will and commitment is critical to see beyond barriers to improving service delivery. Many migrants pass through Blantyre en route to a final destination, some of whom are displaced, and “they should not be left behind.” Next, Deputy Mayor Issa Malam Salatou (Libreville, Gabon) noted that healthcare coverage in Gabon is inclusive of documented migrants, but undocumented migrants have trouble accessing services. They are working in Libreville to address the root causes of the HIV epidemic under their commitments with UNAIDS. Mayor Maria Josefina Belmonte (Quezon City, Philippines) spoke next on the 10 million Philippines citizens who are working as migrants abroad. Even though most are high school or college educated, limited skilled work opportunities abroad make it difficult for them to receive healthcare services and maintain participation in the Philippines healthcare system. Quezon City has created a database of migrant workers abroad and their families to better track and support this population. Next, Judge Andy Brown (Travis County, TX, USA) recalled working with other county officials to gain additional COVID-19 vaccine doses to create a mass vaccination site aimed at helping the most vulnerable, which included a disproportionate number of Latinx individuals; they estimate that 40,000 people who died in Texas as a result of COVID-19 would have lived had similar programming been implemented statewide. Migrants need support in addressing social determinants of health, such as eviction prevention and home repair assistance to stay stably housed. In general, county programs need to be neutral as to immigration status and be available in more languages. Robert Ndugwa (UN-Habitat, Nairobi, Kenya) noted that urban populations are increasing, in part due to migration; for example, refugees and internally displaced people tend to settle in cities. Informal settlements (or slums) develop partially as a result of policies and actions of local governments, so action plans should be carefully formulated to address this; migrants often settle in areas with high health risks. Accessibility, affordability, and quality of services are all key, and must be city-specific, while also aligning with national and international plans and actors.
The panel ended with speakers focused on the needs of migrants with respect to TB and viral hepatitis. Dr. Lucica Ditiu (Stop TB Partnership, Geneva, Switzerland) highlighted the intersection of TB with issues like nutrition and poverty. She stressed the importance of advocates on these issues working together to avoid competing for the attention of decision-makers. With respect to TB, the longer it takes migrants to receive care, the more likely that others will have contracted the airborne condition, underscoring the importance of responsive services; this has included combining COVID-19 and TB screening as appropriate. Finally, Cary James (World Hepatitis Alliance, London, UK) suggested that questions as to the “cost-effectiveness” of hepatitis programs miss the human element with respect to services that are life-or-death. He applauded international actors for working to integrate services, including through the WHO’s strategies and the Global Fund’s increased support for viral hepatitis services. He asked those working in Global Fund-supported countries to review the new support that is available for Hepatitis B and C. “Just because you’re not aware of hepatitis within migrant populations doesn’t mean it’s not there. I think the stigma around hepatitis is so crippling that they’re afraid to speak out. If they’re recently displaced, they’re afraid to be identified with living with viral hepatitis in camps, but we know it’s there.”
Community Panel – Al Centro: Defining the Centrality of Affected Communities in Urban HIV Responses
This panel session was moderated by Sbongile Nkosi (GNP+, Johannesburg, South Africa) who began by positioning the Sevilla Declaration on the Centrality of Communities in Urban HIV Responses, which was launched at this conference, as a roadmap for how local governments and stakeholders can center communities. Dr. Dázon Dixon Diallo (SisterLove, Inc., Atlanta, GA, USA) began the panel by calling for the elevating of community organizations and greater recognition of the role that proximity plays, with people who are affected by issues like HIV best able to tell us what they know and need. Being too focused on numbers over people can remove the humanity and intersectionality of issues like HIV. Regarding racial and ethnic inequities in HIV epidemics, Dr. Diallo stated, “The darker the hue, the greater the need,” with Africa bearing the largest burden and communities of color in other contexts facing deep inequities in terms of HIV incidence and outcomes. Next was Jumoke Patrick (Network of Seropositives, Kingston, Jamaica), who spoke with respect to his network as the largest such organization in the Caribbean. “It is very important, in terms of community, that we are involved in the national HIV response and the urban HIV response,” he said. His presence at the conference helps demonstrate that the community does work in partnership in government in Jamaica, but noted that there remains a lot of work globally to see that goals for responses to be more community-led (and for that to be supported with quantitative data). He noted that stigma has driven many people living with HIV in Jamaica to move from rural to urban areas, while also describing the importance of countries like Jamaica that do not have laws preventing discrimination to advance such measures. Next, Midnight Poonkasetwattana (APCOM, Bangkok, Thailand) explained that key populations make up the bulk of those living with HIV in the Asia-Pacific region. He discussed the importance of community being at the table to addressing questions of financing and policy, including issues of importance to key populations, such as access to gender-affirming care among transgender people. People engaging in chemsex are another population who should be served by both organizations who work with people who use drugs and organizations serving members of the LGBTQ+ community who are affected by this issue. Diego García (Sevilla Checkpoint, Sevilla, Spain) presented next and discussed that while there is a stronger framework for HIV responses in Europe than in many other regions, the challenges remain largely similar. He spoke of the group of women who began the local organization Adhara in 2004 and advanced public awareness, political power, and the concept of peer support among people living with HIV. Much of the work they have done has been thanks to Sevilla joining the Fast-Track Cities network, which brought support and funding to their work, including opening a sexual health clinic and public awareness campaigns. Finally, Sibongile Tshabalala (TAC, Johannesburg, South Africa) spoke about a just-launched second report on HIV in the Eastern Cape of South Africa; they are monitoring hundreds of clinics, in part using Global Fund support for community-led monitoring. “As much as we talk about community-led responses, in most cases, we are leaving people behind. We are leaving key populations behind.” Their work talks about what is happening on the ground and invites people living with and at risk for HIV to tell their own stories. “People are standing up, telling government, telling implementing partners, that this is what they are going through every day.” She encouraged us to think more about the community at large because we often realize too late that a population, such as girls and young women, face rising and ignored needs.
Panel Session 1 – Towards 2030: Defining the Calculus of Success for Ending Urban HIV Epidemics
Charles King (Housing Works, New York, NY, USA) moderated this panel session, which began with a presentation from Dr. Nombulelo Magula (University of KwaZulu-Natal, eThekwini (Durban), South Africa). She shared stories of several clients living with HIV, which had common threads of stigma, poor living conditions, and food security, all of which are risk factors for stopping ART. One silver lining of COVID-19 was opening up systems of care to provide differentiated services; resources were made available to healthcare providers to find creative solutions that disrupted the normal hierarchy. Dr. Magula recommended including teenage pregnancies, poverty, and violence as variables in our model for success around ending HIV. Next, Tom van Benthem (GGD Amsterdam, Amsterdam, Netherlands) shared that the Netherlands has eliminated transmission among sex workers and people who inject drugs, and continue to pursue an ambitious Getting to Zero strategy; this will ensure that marginalized populations, such as migrants, will also be served despite barriers such as stigma and discrimination that they face. He pointed out that reasons for people not seeking care are almost always social and not medical, which must inform strategies. The final presenter was Solange Baptiste (ITPC, Johannesburg, South Africa), who pointed out that city-specific contexts (e.g., unique gaps in HIV cascades, differing groups being left behind) must be considered in formulating our calculus for success. “You measure what you treasure,” so prioritizing the perspective of the affected population is key, and community-led monitoring (CLM) can support this. This has led to program improvements, mapping and responding to COVID-19, and addressing structural issues (e.g., documenting gender-based violence, better inclusion of key populations). We cannot end HIV without addressing both supply and demand sides of care.
Panel Session 2 – Momentum Lost: Re-Energizing Urban and Peri-Urban Tuberculosis Responses
Dr. Suvanand Sahu (Stop TB Partnership, Geneva, Switzerland) moderated this session, which began with Dr. Ramya Ananthakrishnan (REACH, Chennai, India). Dr. Ananthakrishnan described the large burden of TB in India and how her organization works nationwide with local communities, providers, policymakers, and the private sector. They undertook three national assessments: one on data regarding key and vulnerable populations, one on legal environments, and one on TB and gender, all of which reinforced the need for local community engagement to end TB. They conducted trainings for women on TB and other key diseases, plus social enablers like financial literacy, to become community mentors; they were especially vital during the COVID-19 pandemic. “This is an example of how, when we invest in affected communities and we invest in women, the powerful return that we get,” Dr. Ananthakrishnan said. She also discussed TB survivor networks and a community accountability network that brings feedback to the healthcare system. Next, Austin Obiefuna (Afro Global Alliance, Accra, Ghana) began by recalling the words of Nelson Mandela that “we can’t fight AIDS unless we fight TB as well” and reminding participants that TB is the number one cause of death among people living with HIV. He pointed to the lack of political will, sufficient funding, accountability mechanisms, and community engagement as major barriers. Opportunities include using digital tools, developing a TB vaccine by 2025, advancing collaborative governance with TB advocates, and incorporating public health thinking into urban planning and design. TB and HIV advocates are not in competition, but rather must work together with crosscutting governance and a focusing on people rather than conditions. Finally, Michael Wilson (Advance Access & Delivery, eThekwini (Durban), South Africa) pointed to examples like New York City, NY, USA, in the late 1980s, where TB cases as tripled over a 15-year period. They began to conduct active case-finding among populations such as people experiencing homelessness and treated all cases, and rates dropped dramatically over the next few years. A similar situation unfolded in Russia in the 1990s, where TB in prisons was tackled with great success. In eThekwini, COVID-19 served as a catalyst to raise awareness and open a harm reduction center via a multisectoral partnership that serves those at risk such as people experiencing homelessness and those who use drugs. They also utilize a peer-led system to provide treatment to people where they are (e.g., shelters, public spaces).
Panel Session 3 – Course Correction: Mapping a Path Towards Achieving Urban HCV Elimination
Jessica Hicks (World Hepatitis Alliance, London, UK) opened this panel by celebrating the signing of the Sevilla Declaration the night prior, reaffirming their cities’ commitments to working with communities to end not just HIV and TB, but also to eliminating viral hepatitis. First, Dr. Olufunmilayo Lesi (WHO, Geneva, Switzerland) spoke on the importance of engaging communities and civil society, including key and other priority populations, in advancing solutions to viral hepatitis. Equity, efficiency in delivery, and affordability were among the enablers of successful testing and treatment. Dr. Lesi also described new WHO recommendations on HCV self-testing released last year and on service delivery made earlier this year; these include decentralization at peripheral health or community-based facilities, integration with existing care services, and task-sharing among non-specialist providers to expand services. Next, Rachel Halford (Hepatitis C Trust, London, UK) spoke on the roughly 14,000 people being treated for HCV in London; as more people have entered care, it has become harder to engage those who remain. An emergency department testing program has combined HIV, HBV, and HCV testing where it is possible to do so. They also have a whole-prison testing program operating on an opt-out basis. They have worked to advance peer-led services that take them out of formal clinical settings, which has been an effective way to test and refer for treatment. Ms. Halford said that the Fast-Track Cities network in London has assisted in aligning HIV and viral hepatitis efforts. Finally, Caroline Thomas (Peduli Hati Bangsa, Jakarta, Indonesia) spoke about community-led initiatives, including training peer educators in 12 cities representing eight key and priority populations. They also created community-led hepatitis screening in four high-burden cities, about 5% of whom screened positive for HCV. They successfully advocated for a significant price decrease for treatment and created a digital referral directory. “Sometimes in the community, we feel discouraged with our effort, and it seems the effort is very little in contributing nationally. [But] no matter how small the steps are, it does not dimmish the impact.”
Panel Session 4 – Common Vision: IAPAC-Lancet HIV Commission on the Future of Urban HIV Responses
Dr. José M. Zuniga (IAPAC and Fast-Track Cities Institute, Tampa, FL, USA) moderated this session examining the ongoing work of the IAPAC-Lancet HIV Commission on the Future of Urban HIV Responses, for which he serves as Chair and for which panelists are participants. First to present was Dr. Nombulelo Magula (University of KwaZulu-Natal, eThekwini (Durban), South Africa), who serves as Chair of the Social Determinants of Health Subcommittee. Local context is key and interventions must be culturally responsive based on the conditions on the ground. We need to look at root causes of things like gender-based violence, stigma, and racism that drive HIV epidemics. To address wide-ranging social determinants of health, interventions need to be integrated across sectors, starting in the household and driven by communities. Next was Corey Prachniak-Rincón (IAPAC, Boston, MA, USA), who serves as Coordinator of the Commission, speaking in place of Dr. Nicoletta Policek, Chair of the Right to Health Subcommittee, who could not be present. Mx. Prachniak-Rincón noted that the concept of a right to health, while established in international law, is missing or “toothless” in many national constitutions. Nonetheless, the Commission has found that a rights-based approach has been useful in explaining how to end HIV epidemics in urban settings. This is especially true of key populations and other groups, such as migrants, who face intersecting forms of discrimination. While relevant rights are generally established at the national level, urban actors can play a role in realizing human rights and in filling in gaps to those rights. Next, Midnight Poonkasetwattana (APCOM, Bangkok, Thailand), who serves as Chair of the Redesigning HIV Responses to be Equity-based, spoke on the importance of modernizing HIV service delivery and working to serve those who are still being left behind. COVID-19 has revealed many ways of reaching communities through innovative models, include web-based and at-home delivery. Cities need roadmaps on which communities face inequities and plan for how to better serve them. “There has to be a renewed political will to ending AIDS, and that has to be reinvigorated,” Mr. Poonkasetwattana said. “When it comes to the agenda and resourcing for equitable responses for urban responses, this needs to be talked about a lot more at the urban level.” He also noted the importance of advancing universal health coverage. The next speaker was Dr. Dázon Dixon Diallo (SisterLove, Inc., Atlanta, GA, USA), who is Chair of the Implementing Data-driven Accountability Frameworks Subcommittee. Dr. Diallo said that the issue begins with what data is being collected and who owns that data; a lot of the data that the subcommittee thinks we need is already being collected, but needs to be better leveraged at the local level. Partnerships in collecting and utilizing data is another key issue. The Sustainable Development Goals, including SDG 11 on cities, provide many of the goals on which we need data in order to holistically advance our goals with respect to HIV. Data can help drive the goals and needs coming out of all the subcommittees, which will be reflected in the Commission’s final report. The final speaker was, Cary James (World Hepatitis Alliance, London, England, UK), who chairs the Syndemic and Co-morbid Conditions Subcommittee, and who spoke about the importance of person-centered care in developing comprehensive rather than siloed services. Peer-led and community-driven services are particularly important for people living with stigmatized conditions. HIV-serving entities can learn a lot from those working on conditions such as viral hepatitis, and the reverse is also true. There are many opportunities to work on screening and treating HIV in conjunction with other conditions, including through the Global Fund. Dr. Zuniga closed out the session by saying, “I would like to thank all 60 Commissioners who have very busy lives and who have been on this journey with us since late-2020. We’re looking forward to the publishing the report, so stay tuned.”
Closing Panel – Urban Health: Recommitting to a More Equitable, Healthy, and Socially Inclusive Future
The closing panel was moderated by Dr. José M. Zuniga (IAPAC and Fast-Track Cities Institute, Tampa, FL, USA) and began with Mayor Femke Halsema (Amsterdam, Netherlands), announcing that her city will be home to Fast-Track Cities 2023. Dr. Elske Hoorenborg (GGD Amsterdam, Amsterdam, Netherlands) stated that the political commitment of Amsterdam’s city leadership, as well as the multisectoral approach to their HIV response, are two of the keys to their success. Dr. Hoorenborg reflected on new learnings from the conference, including the content on the expanding field of HIV self-testing, which is something that many cities have only begun exploring; she pointed to an example from Australia of tests being available from vending machines as an innovative approach worthy of further study. Next to speak was Dr. Julia del Amo (Ministry of Health, Madrid, Spain), who was present throughout the conference and who remarked on the strong engagement of communities from across Spain, using the leadership of Sevilla as a strong example. With 180 cities in Spain now part of the Fast-Track Cities network, the Ministry of Health is looking forward to doing even more to engage with municipalities on the issue of ending HIV. Dr. del Amo ended by thanking the city of Sevilla for the example they have set of the importance of urban leadership in the field of HIV. Regarding the host for next year’s conference, Amsterdam, Dr. del Amo remarked, “They really are an inspiration and a model for us all… I look forward to being there.”
Plenary Sessions
Promoting a Continuum of Care and Social Services for LGBTQ+ People
Dr. Jorge Saavedra (AHF, Miami, FL, USA) moderated this session, in which Simon Cazal (SOMOSGAY, Asunción, Uruguay) discussed the opening of a clinic in 2010 to fill the gap created by anti-LGBTQ+ stigma in formal institutions; today, they are the main civil society provider of HIV services, with just over half of the country’s HIV cases being first identified through their center, which has a relaxed and non-clinical feel. The organization is working with local and national government actors to improve services more broadly. The city of Asunción’s membership as a Fast-Track City has proven important in advancing this goal. Erika Castellanos (GATE, Amsterdam, Netherlands) focused on services provided to the trans community, beginning with the example of mobile clinics in Latin America that provide trans women who engage in sex work are able to access diverse services. This type of response addresses the community’s needs to have services outside of a traditional clinic with regular business hours. Ms. Castellanos pointed to the Tangerine Clinic in Bangkok, cliniQ in London, and Trans United in Amsterdam as examples of entities providing holistic services to trans people.
Improving Health Service Provision for Migrants and Internally Displaced Persons
Gary Jones (UNAIDS, Geneva, Switzerland) moderated this session featuring Dr. Naing Myint (International Organization for Migration (IOM), Geneva, Switzerland), who began by noting that there are approximately a billion migrants in the world, of whom more than half live in cities. IOM has three core areas of health: connecting health security and human mobility, increasing communities’ health resilience, and strengthening migration health governance. During the COVID-19 pandemic, 90% of countries provided vaccines to migrants in regular situations, while that was true for only 57% for migrants in irregular situations, 46% for internally displaced persons, and 75% for refugees and asylum seekers. Dr. Myint concluded by advocating for the mainstreaming of health into migration policy and migration into health policy to advance global goals with respect to both areas.
Prioritizing Quality of Life within the Context of Holistic Urban Health
Dr. Helen Corkin (UK Health Security Agency, London, UK) moderated this session with Nikos Dedes (Positive Voice, Athens, Greece), who began by speaking of the ongoing need for a paradigm shift towards health-related quality of life as people living with HIV are living longer but not necessarily well. Discrimination, stigma, and comorbidities are three major factors detracting from quality of life for people living with HIV. The HIV Outcomes group is working to build political support and policies to deliver person-centered, integrated care. We have seen health-related quality of life issues embedded in the UNAIDS Global Strategy, in regional strategies (e.g., EU level), at the national level, and in cities. COVID-19 served as a wakeup call for many on the importance of health-related quality of life. Dr. Corkin facilitated the discussion and noted that factors such as criminalization and mental health, as well as the stigma associated with both, can complicate gains towards quality of life among people living with HIV.
Democratizing HIV Testing and Linkage to Care through Community Checkpoints
Christoph Weber (Checkpoint BLN, Berlin, Germany) moderated this session featuring Miguel Rocha (GAT, Lisbon, Portugal), who spoke about HIV checkpoints: convenient, nonclinical urban sites that conduct rapid HIV testing and referrals. Studies have found that the checkpoint model increases uptake of HIV testing among sexual minority men, is cost-effective, and leads to HIV being diagnosed earlier. Checkpoints help democratize HIV services by being community-based and peer-led, and can take place at a fixed center, using outreach units, or on-premises at relevant venues. They generate demand through campaigns, word-of-mouth, and partner notification, and provide referral as needed to specialized consultations, including escorting to the site.
Leveraging a Cohort of Champions to Tackle Urban HIV Response Challenges
Gonçalo Lobo (Fast-Track Cities Institute, Lisbon, Portugal) moderated this session with Prof. Jane Anderson (Homerton University Hospital, London, UK), who spoke on creating a European Cohort of Champions designed to share strategies across the continent’s Fast-Track Cities. Even within Europe, local issues affecting HIV responses differ – for example, prevalence of HIV among people who inject drugs varies. Therefore, finding cities that have similar populations or conditions is critical in helping cities to learn from one another and adapt best practices. The Cohort of Champions assists with this and is especially valuable for countries that do not have a critical mass of Fast-Track Cities and in which their city may be the only one participating in the program, thus providing fewer natural partnerships. The initiative’s objective is to build partnerships between those who have met and are still working towards 95-95-95 goals, focusing on areas of success and learning how to do more. The initial five topics will be strengthening networks, stigma and discrimination, testing and diagnosis, PrEP and prevention, and inclusive and integrated health.
Utilizing an Implementation Science Lens to Optimize Urban HIV Responses
Sindhu Ravishankar (Fast-Track Cities Institute, Washington, DC, USA) moderated this session with Dr. Frederick Altice (Yale University, New Haven, CT, USA), who began by defining implementation science as the “study of methods to promote the systemic uptake of research findings… into routine practice to improve the quality and effectiveness of health services and care.” Four key ingredients for implementation research are appropriate implementation questions, the research team, community partners, and theories, models and frameworks. Collaborative learning should happen between the research team and community partners, who may identify practical limitations or barriers to the research. Dr. Altice provided examples included Bishkek, Kyrgyzstan, in a region which has seen an increase in new HIV cases and related deaths, with an epidemic mostly driven by people who inject drugs. Methadone treatment is associated with better outcomes across the HIV cascade among people who inject drugs, but patients on methadone has declined over the past several years. Clinicians identified as barriers misinformation, stigma, logistical challenges, and lack of motivation on the part of patients; on the other hand, patient-identified barriers included the bad reputation of programs, logistical issues, unclear expectations, rigid policies, and poor treatment. This conversation resulted in the development of change projects to improve services.
City Case Studies
Africa
Case studies from Africa were presented over a two-day period and included reports from:
- Blantyre, Malawi (Madalitso Juwayeyi, FACT Malawi): How Intergenerational Relationships
- Are Hampering HIV Prevention Efforts in Adolescent Girls and Young Women in Blantyre City
- eThekwini, South Africa (Nthabiseng Malakoane, eThekwini Department of Health): eThekwini PLHIV lead the way to HIVrelated awareness, education, and response at the community level
- Kinshasa, DRC (Lembe Baza Virginie): Contribution of peer educators in the HIV status disclosure, adherence and retention in treatment to Adolescents and Young PLHIV
- Maputo, Mozambique (Belia Nyambir, Maputo City Council): Male Engagement in Primary Health Care – Maputo’s Experience
- Nairobi, Kenya (Anthony Kiplagat, Nairobi Metropolitan Services): Nairobi City Journey towards HIV program sustainability
- Windhoek, Namibia (Louw Jane Melissa, City of Windhoek): Strengthening campaigns to increase Adolescent Girls and Young Persons (AGYP) HIV prevention in the context of COVID-19
- Lagos, Nigeria (Monsurat Adeleke, Lagos State AIDS Control Agency): The Impact of TBAs and Mentor Mother Program on Lagos City PMTCT Coverage
- Lusaka, Zambia (Mayor Chilando Chitangala, Greater City of Lusaka): The Contribution of Empowered Communities in Supporting Ending AIDS in Childre: The Case of Lusaka City
- Yaoundé, Cameroon (Landom Shey, ReCAP+): Improving quality and equitable access to
- care through the rollout of HIV User Fee CLM Program in Cameroon: Case of Yaoundé City
- Johannesburg, South Africa (Mphephu Charles, Sakha Isizwe Drop-in Center)
- Kampala, Uganda (Christopher Oundo, Kampala Capital City Authority)
- Kigali, Rwanda (Mukangarambe Patricie, City of Kigali)
Asia-Pacific
Case studies for the Asia-Pacific region were presented on the second day of the conference and included:
- Adelaide, Australia (Colin Batrouney, Thorne Harbour Health): CONNECT: Rapid HIV Testing in the Community
- Almaty, Kazakhstan (Anna Deryabina, ICAP at Columbia University): Almaty Model for HIV Epidemic Control
- Jakarta, Indonesia (Dwi Oktavia Tatri Lestari, Jakarta Provincial Health Office): Roadmap Fast-Track in Jakarta
- Bangkok, Thailand (Nittaya Phanuphak, Institute of HIV Research and Innovation)
- Melbourne, Australia (Edwina Wright, Monash University)
- Mumbai, India (Vijaykumar Karanjkar, Mumbai District AIDS Control Society)
- Tokyo, Japan (Junko Tanuma, National Center for Global Health and Medicine)
Europe
Case studies from Europe were presented on the second day of the conference, including:
- Cardiff, UK (Darren Cousins, Fast-Track Cardiff and Vale): Getting to a National Action Plan
- Amsterdam, Netherlands (Elske Hoornenborg, Center for Sexual Health): Amsterdam Fast-Track Cities Case Study
- Nantes, France (Christophe Jouin, Nantes City Councilor, and Jérôme Gournay, Nantes Objectif Zéro): Nantes Zero New Viral Infections
- Kyiv, Ukraine (Hanna Starostenko, Deputy-Mayor of Kyiv)
- Prague, Czech Republic (Jakub Tomšej, Czech Society of AIDS Help)
- Sevilla, Spain (Fernando Martínez-Cañavate García-Mina, Municipality of Sevilla)
Latin America & Caribbean
Case studies for Latin America and the Caribbean were presented on day three of the conference:
- São Paulo, Brazil (Claudia Velasquez, UNAIDS): UNAIDS and Fast-Track Cities in Brazil
- Callao, Peru (Takaaki Robles, Amigas por Siempre): Fortalecimiento del liderazgo de la mujeres trans y su participación en espacios de toma de decision local
- Buenos Aires, Argentina (Fabian Portnoy, City of Buenos Aires)
- Kingston, Jamaica (Alisha Robb-Allen, Kingston and St. Andrew Health Department)
North America
North America case studies were presented on day three of the conference:
- Charleston, SC, USA (Shanna Hastie, South Carolina Department of Health & Environmental Control): The Future is U
- Denver, CO, USA (Carleigh Sailon, Department of Safety City and County of Denver): Support Team Assisted Response (STAR) – Sending the Right Response to 9-1-1 Calls in Denver
- México City, México (Andrea González-Rodríguez, Clinica Especializada Condesa): Mexico City Case Study
- Montréal, QC, Canada (Alexandra de Pokomandy, McGill University): Montréal City Case Study
- Pittsburgh, PA, USA (Kelly Prokop, Prevention Point Pittsburgh): Prevention Point Pittsburgh
Conclusion
In closing the Fast-Track Cities 2022 conference on October 12, 2022, Dr. José M. Zuniga (IAPAC and Fast-Track Cities Institute, Tampa, FL, USA) concluded, “I would encourage us all to reflect on how we will take what we have learned from each other to optimize the work we do on behalf of the people we serve, to whom we deliver services, and for whom we advocate.” Based on the content shared at this year’s conference, he called for delegates to return to Fast-Track Cities 2023 in Amsterdam with updates on critical topics such as:
- What new innovations they adapted within an implementation science framework to address HIV, TB, and viral hepatitis.
- How they have leveraged city multilateralism in public health, even in the face of national and international uncertainties, such as unprovoked wars.
- How they have advanced the goals of the Sevilla Declaration to place people/communities at the center of HIV, TB, and viral hepatitis, in a meaningful way.
- How have they tackled intersectional stigma and prevented it from affecting the dignity of people leaving with and affected by HIV, TB, and viral hepatitis.
- In a social transformation context, how have they prioritized ending the status quo of inequities that mark these epidemics.
IAPAC and FTCI are thankful for the partnerships in Sevilla and Spain that made this year’s conference possible, and look forward to continuing these important conversations at the Fast-Track Cities 2023 conference in Amsterdam. We also acknowledge support from Spain’s Ministry of Health as well as our corporate sponsors AbbVie, Gilead Sciences; Merck Sharpe & Dohme, and ViiV Healthcare.
