 Ladies and gentlemen, dear colleagues, good morning. My name is Michel Kazachkin, and I'm very pleased to co-chair this session this morning with Karen Kaplan. Karen and I both join in welcoming you. Thank you for being here early morning. We have a very exciting session, and it's about leadership communities. It's about the very core of the work around harm reduction, and I'm sure we'll hear very interesting and stimulating and inspiring communications. We've asked each speaker to stick to something around 12, 13 minutes so that after each speaker, we could take a few questions and comments from the audience. And without any further comment, Karen, would you introduce our first speaker? I'd be happy to. Narrow? Rajiv. Rajiv Kaplan, to particular honor, he's one of my oldest friends in this movement. Rajiv, with almost 15 years of experience in the field of HIV and drug use from the grassroots level, where it is about saving one life at a time, to the global boardrooms where public health policies and programs are made to stand against corporate greed and broken promises, I have gained a wealth of invaluable insights that can be useful to mitigate the challenges and finding innovative solutions. Alongside a proven track record as a community mobilizer, a committed activist, and a good program manager, Rajiv has successfully established himself at the national, regional, and global levels as an acknowledged leader in the people living with HIV and people who use drugs movements. Rajiv has demonstrated his commitment to improving the quality of lives of people living with HIV and their meaningful involvement at all levels with his pioneering work in HIV treatment and care in Nepal and by leading the civil society involvement in policy development, program implementation, and decision making, presently working on decriminalizing drug use and legalizing cannabis in Nepal by 2020. Welcome. Thank you, Karen. And thank you, Michelle, and the rest of the panel. I'd like to thank the organizers for giving me this opportunity to speak in this session. There's been a sought change as expecting Elliot Albus to be one of the co-chairs, so I had designed my presentation or written my presentation based on the fact that Elliot would be around. So when I'm referring to Elliot, please take it in that way. But I'm happy that Karen is here. And as she said, we have been in this fight for a long time, and we have had a very good relationship all over. So I'll begin my presentation, which I have written in the piece of paper, because sometimes I tend to speak too much and get all over the place. So that has been my lesson learned in the 15 years. So I said, I'd write it, and that would send the messes clear. So I'll begin with that. Thank you for inviting me to speak in this important event and with you, all important people in the lovely city of Kuala Lumpur. Last time I ever spoke in a major session such as this was in KL, was in 1999. Then I was speaking at the closing plenary of the fifth ICAP, the International Congress on AIDS in Asia and Pacific. It was my first AIDS conference ever after being diagnosed with HIV in 1997. Today I will share with you my experience of more than 15 years of living with HIV using drugs, leading a grassroots PLHIV and drug user movement in Nepal, and representing our community in different global forums, being part of the solution by ensuring greater involvement in policy development at national level, running a hospice and a shelter for orphans. Today I will speak of the community perspective, so you might as well have guessed it right. I do not have a PowerPoint presentation nor any significant data to make my point. Yet I hope that I will make my point. This confidence is hugely derived from the inspiring words of the biggest leader of our times, Steve Jobs, in his book by Walter Isaacson, where he said, I quote, people who know what they are talking about don't need PowerPoints, unquote. Successful advocacy is intended to bring positive changes in the lives of many, and that is what we have been aiming for in the past decades. A major victory for people living with HIV community has resulted from successful advocacy that has led to significant increase in access to life-saving treatment around the world. Many other examples of change in policies are also considered as some of the best examples of successful advocacy at national and local levels. However, a stark reality that we often confront while discussing in depth about advocacy is the fact that we have invested way too much and achieved very little. For instance, if we sit down and calculate how much we have spent in the past 20 years globally on advocacy-related activities and what we have achieved so far, I'm sure the cost of results that we have achieved could be as high as hundreds of millions of dollars. If we look at it retrospectively, I think we would have never invested on such costly results. So why did we not realize earlier that we are not achieving desired results from our advocacy and redesigned our interventions or made them cost-effective? My answer is that we still haven't realized. Let me now jump into something else because I was trying to put the two concepts that I was to present together, but I just could not put it together. So the next part of my presentation is more closer to home and it refers to Elliot as I said earlier. So I begin, what an incredibly fractured people using drugs movement you have in your country. Read an email to me from my friend and one of our co-chairs today, Elliot Albers, sometime back. To an outside world, it looked like communities were fighting with each other, blaming each other for all different reasons, calling names publicly in international and regional forums were some of the reasons for my friend to conclude. I tried to explore why our movement is fragmented, why we cannot collaborate and work together. I tried finding answers to why we are so close with so many commonalities than the rest of the world yet so far. Here's what I think what's going on. Firstly, the pie is too small these days. As we all have noticed and are affected by continuous shrinking of funding in the past years, it is not very hard to understand that there is more and more competition whereas the resources are getting lesser every day. As the saying goes that an empty pot makes a louder noise, I think that's exactly what's happening around us too. As we geared up to rapidly scale up interventions that we knew worked the global financial crisis hit and the funding started to shrink. Before the financial crisis, I remember the global fund board meeting starting with the executive director's report that urged countries not to be sighed in asking for resources. It changed so rapidly that in less than a year, the same global fund executive director's report would start talking about efficiency gains or cutting the fat. Now the countries are asked to cut everything that are not related to putting pills in the patient's mouth. I was leading the Nepal CCM and the first things that were seen as fat was support to community networks. The argument was that it's not community's job to put the pills on the patient's mouth. Fair in a sense, but for those who have been in AIDS movement for a long time, it was a retreat from the global commitment announced by Kofi Annan, a back glass and the beginning of the end of the global fund. So I'm saying here that it's not only the communities to be blamed for the chaos, it's also partly the donors to be blamed. Donors to be blamed for having a very sought-sightedness in terms of sustainability of the funding commitment itself. When we had lesser money, not only the fat was removed, in fact some vital organs got removed too. A case in point is the middle income countries. That's why I called it the beginning of the end of the global fund as I remember a group of activists from Eastern Europe gathered outside the meeting venue during the global fund's retreat in Sofia and handed a memo to the board chair that said, global fund is no more global, don't leave us behind. My second point, donor dependence and lack of ownership. Though we talked a lot about behavior change, interventions for our communities, though we designed excellent interventions to reach out to very hard to reach populations such as drug users, we failed to realize it's a challenge to reach out to the government and almost an impossible task to change their behavior. No matter how hard we tried to please them, it's not worked in most cases. This brings me to my second point as to how the lack of government ownership resulting from failure or lack of interventions designed to change government behaviors has affected the whole community movement. Had governments realized the importance of the communities, they would have supported community networks because we are the ones standing on the front line, we are the ones, we are the boots on the ground. My third point is compartmentalized funding processes. The communities understood very well the intended outcomes of the Paris declaration on aid effectiveness of 2005 and work towards achieving it. I've talked about ownership which is one of the pillars of the Paris declaration earlier. Now I'll talk of the second and the third pillars that are alignment and harmonization. Through alignment of resources and harmonization of interventions and avoiding duplication, we are aiming to achieve a more cohesive response. However, it is not easy as said as it is done in the grounds. Everyone has different interests, not to say that standing firm on our group interest is wrong, but sometimes we have to think rationally too. In one hand, we created mechanisms such as the country coordination mechanism that were inclusive of voices from different communities. They also became a source of all evil, not only the CCMs at the national context, but similar mechanisms at the global level had their own share too in giving out a wrong message. A message that said that my interest first, others' interests later, or nothing about us without us, only us, no one else. Having led the CCM and being part of the Global Fund Board, representing the communities, the developing countries in the South and East Asia delegations for nearly a decade, I saw very strange things happening that reflected anything but harmonization and alignment. Hence, I believe that, hence I believe that had we been able to harmonize our effort in true sense, as it was envisioned in the Paris Declaration and Accra as in the for action, we would never have to pit one group against the other, one disease against the other. The result, we all gain nothing from this silly fight. So, I would like to bring my presentation to a different tone by asking you all, what if we were to live this all over again? What will you do differently if you are the head of the Global Fund once again, Michelle? I would like to ask what communities would do differently, what donors would do differently and what governments would do differently, because if we honestly admit our mistakes and start to change them from now onwards, it isn't still too late. AIDS is going to remain with us no matter how hard we try to tell the world that it's ending in a few years from now, it's not. Coming back to my dear friend, Elliot, who calls me you bloody Nepali, because of all the trouble he has gone through trying to help set up a grassroots level national network of people using drugs, I'd like to conclude by saying that we are not bad, we are just a bit mad. My friend, and this madness has allowed us to survive resolutely in a very adverse and hostile environment. We as drug users are not considered human even till date. We are kidnapped and tortured not only by police, but our own people in the name of treatment. We are thrown out of jobs as if our drug using was highly contagious disease as Ebola, even if we are allowed to be treated at hospitals, doctors tend to wear the Ebola suits before treating our minor abscesses. We are sunned and isolated by our own friends and families because their social identity comes first, the health and well-being of their own supposedly beloved children. So why we not be mad and crazy? My friend, why? So that's the end of my presentation and I would just like to end with a different footnote as well on a different thing. Nepal has been going through a very hard time in the past six months, firstly with the earthquake that has devastated a lot of areas including Kathmandu, the city I come from as well as the neighboring cities. And after the earthquake and immediately after the earthquake and very recently with the blockade of the Indian blockade and I really would like to take this forum because we have all been in this fight together or everyone has a world and I'd like you all to know that there has not been a supply of fuel from Indian side, Nepal is a landlocked country, we don't have access to seaports and we have been deprived of food and fuel for the past two months because of some political differences within our governments and normal people like us are being hostages of that and we have been forced to go and look out for firewood to cook food. I run a shelter for orphans as I said earlier and for the past three weeks or more we have been cooking on firewood and that is not acceptable. Keeping people hostages on some political issues is not fair so I would hope that this mess could be put through you people and something would change and soon we would have some fuel because we have lost a lot of lives because of the lack of fuel ambulances could not bring patients to the hospitals in the center as well so thank you very much. Thanks for keeping it real Rajiv as always. So I'd like to invite the audience to ask questions to Rajiv at this point if you would like to ask a question just raise your hand or back in the people in orange. Yes, did you have a question? There's a microphone. Sorry just to raise the point that he ended with which is what would you do differently if you were given the opportunity to start all over again just on reflection any ideas? I know it's a bit loaded first thing in the morning but. Okay we'll go back to the old model of the Global Fund which is as Rajiv mentioned a model where we were asking countries not to be shy and come with the expression of their needs. I'm not sure the model where the allocation to various countries is decided top down is the right model to go. That's the World Bank's model. The Global Fund is not a World Bank. The Global Fund is not a development bank. The Global Fund is a fund to fund the fight against AIDS TB in malaria. So I think that's the thing I would do but I doubt that I will become the Global Fund's head the gate.