Last week, at the United Nations General Assembly (UNGA) High-Level Meeting (HLM) on Ending AIDS, 193 member states adopted the Political Declaration (Declaration) on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030. Ideally, the Declaration should serve as a cornerstone that demonstrates the global political commitment to ending one of the most significant epidemics of our time. Unfortunately, many issues remained largely unaddressed in the final version of the Declaration. The anticipated ‘contentious’ issues that created the most amount of turmoil included:
- the naming of the key populations in more strategic places in the text
- the inclusion of sexual and reproductive health and rights (SRHR) as an area of focus
- explicit mentioning of comprehensive sexuality education (CSE)
- adequate investment in community strengthening systems
On reflection, the meeting was characterized by a number of highs and lows that succinctly spotlighted areas of both successes and gaps in the global AIDS response.
A focus on quality anti-retroviral treatment (ART): Countries committed to nearly doubling the number of people who receive life-saving HIV treatment over the next five years. For the first time, the UN member states committed to monitoring the quality of treatment, with a goal of getting 90% of those receiving ART to reduce their viral load to the point where it is undetectable. This measure improves quality of life and reduces the risk of transmission.
Political commitment in action: Political commitment to HIV at the global, regional and national level is integral to a sustained response. Indicators of this commitment have evolved over the past 35 years, with a number of countries moving beyond the rhetoric. Following the adoption of the Declaration, UN delegations were offered the opportunity to make country position statements reflecting upon the Declaration. Multiple delegations delivered statements affirming support for programming related to key populations and inclusion in their national HIV plans.
Of particular note and timing, the United States President’s Emergency Plan for AIDS Relief (PEPFAR) announced last Friday the creation of a USD $100 million Key Populations Investment Fund, “to expand access to proven HIV prevention and treatment services for key populations.” This kind of tangible political commitment is what counts, and PEPFAR should be commended for its action to address some of the wrongs in relation to the unwillingness of governments to truly defend human rights approaches for key populations.
Collective solidarity of civil society: Believing until the end that the Declaration could be made stronger, civil society eventually developed a Civil Society and Communities Declaration to End HIV: Human Rights Must Come First. This document has now been signed by over 150 organizations and brought forward collective solidarity on the need for human rights as an integral part of any future HIV response. This message will undoubtedly echo loudly at the upcoming 21st International AIDS Conference (AIDS 2016) in Durban.
Lack of recognition of the HIV epidemics among key populations across various HIV scenarios: Through exclusion, the final Declaration fails to meaningfully address the HIV epidemic among key populations, including gay and bisexual men and other men who have sex with men, sex workers, people who inject drugs, and transgender people. It also lacks an explicit commitment to support and finance community strengthening by key population-led agencies on tailored prevention, care, and treatment services.
Inadequate centrality of ‘rights’ as a precursor to ending HIV: The notion of ‘rights’ is largely absent from the Declaration, specifically around addressing SRHR, including explicit reference to CSE or highlighting legal and policy frameworks that stigmatize and criminalize key populations and people living with HIV. Despite the evidence, which shows that rights-based programming is central to ensuring access to HIV prevention, care and treatment services, the Declaration remained largely silent on some of the nuances.
Exclusion and lack of engagement of civil society actors: The proactive and meaningful engagement of civil society actors is, in many ways, one of the key lessons that the HIV sector has given to the broader health and development community. Paradoxically, prior to the HLM, conservative member states rejected accreditation of a number of civil society organizations from LGBTI and harm reduction agencies to attend the meeting. This exclusion was a direct affront to the values and beliefs that the AIDS response was built on.
While the Declaration is not ideal, it provides a platform for strengthened issue-based advocacy and ensuring that the global targets are on track. Several paragraphs do provide the necessary entry points that, collectively, we should use. Advocates should push for stronger programming and inclusion. Researchers and scientists should ensure that rights-based and evidence-informed responses remain a key part of driving scientific advancement. And increasingly policymakers should be bolder in terms of where and how HIV funding is utilized most efficiently.
A new era in the HIV response will only become a reality when sound science informs good policy based on the lived realities of those communities at the forefront of the epidemic. As General Assembly President, Mogens Lykketoft said, "We must pay greater attention to equality and inclusion, uphold human rights and speak out against stigma and discrimination."
Get the full overview of IAS’s representation at the HLM along with key take aways here.