Breaking Down Barriers

Since 2017, the Global Fund’s Breaking Down Barriers initiative has provided financial and technical support to 20 countries – Benin, Botswana, Cameroon, Côte d’Ivoire, Democratic Republic of the Congo, Ghana, Honduras, Indonesia, Jamaica, Kenya, Kyrgyzstan, Mozambique, Nepal, the Philippines, Senegal, Sierra Leone, South Africa, Tunisia, Uganda and Ukraine – to tackle human rights-related and gender-related barriers to HIV, TB and malaria services. For the 2023-2025 grant cycle, the Global Fund expanded this initiative to four more countries: Bangladesh, Burkina Faso, Nigeria and Thailand. The goal is to increase the effectiveness of Global Fund grants and ensure that health services reach those most affected by the three diseases.

Programs to address stigma, discrimination and other human rights barriers have expanded in all 20 countries through a range of different activities – from social media campaigns, radio programs and community dialogues to implementing the HIV Stigma Index and antidiscrimination laws. The Breaking Down Barriers initiative puts in the hands of people affected by HIV, TB and malaria the knowledge and the skills to understand, demand and secure their health-related human rights. The initiative works to enable health care providers, police, prison officials, judges and parliamentarians to provide supportive and effective services to those who are most vulnerable to disease. It represents an unprecedented investment in health-related human rights.

Midterm assessments of each of the 20 countries where the initiative runs were conducted over the 2020-2022 period. The assessments scored programs on a scale of 0-5 to reflect an expansion of the program and its impact. The results show that the Global Fund partnership is making progress in removing human rights‐related barriers to HIV, TB and malaria services even in challenging contexts. For HIV, the average score across the Breaking Down Barriers cohort increased by 52%, and for TB by 120%. Progress assessments are underway, continuing to demonstrate progress and impact. But it is more than just increases in scores – we are seeing tangible change within communities.

In Ghana, the Global Fund supports TB community organizations, such as the TB Voices Network, to strengthen community-led monitoring of rights violations and implement legal empowerment activities for TB champions, including integrated “know-your-rights” training. In Mozambique, TB community outreach workers and peer educators receive training on defending basic human rights and work with paralegals to monitor and address human rights violations against people affected by TB.

In Botswana, when community dialogue work began, many traditional chiefs were hostile to key populations, with some openly declaring that they did not want them in their communities. When organizations led by and representing key populations facilitated dialogues with traditional leaders to discuss issues related to human rights, harmful gender norms and gender‐based violence, they observed how these conversations helped break down barriers. One participant described the immediate impact: “By the time the traditional chiefs walked out the door, they had completely changed. The power of bringing people directly affected to represent the issues caused...a real breakthrough.”

Breaking Down Barriers: Assessments and National Strategic Disease Plans