By Owen Ryan, IAS Executive Director
The United Nations was born in 1945 to help maintain peace and resolve global conflicts. The founding documents of the UN recognized that peace involves much more than the lack of warfare. A world living in peace is one in which people have the tools they need to live happy, healthy and productive lives. A peaceful world is one in which our natural environment is protected and our fundamental human rights respected and celebrated. It is a world that is just and equitable.
In the opening months of his tenure, United Nations Secretary-General António Guterres confronts a host of extraordinary and complicated challenges. The very founding principles of the UN are being disputed as never before. As democracy and a commitment to human rights recede, repression and inequality increase, unprecedented numbers of people flee their homes as a result of civil conflict, and the future of our planet faces unparalleled threats. In the midst of such profound shifts, the global AIDS epidemic presents the Secretary-General with yet another critical challenge but also a potentially transformative opportunity. During his tenure, the world will have to choose to take the budgetary, policy, and programmatic steps that determine whether or not we end AIDS as a public health threat once and for all.
Taking into account the lessons we have learned from our response to AIDS, here are five actions the Secretary-General can take to promote a healthier, more secure and equitable world:
Lead the fight against social and economic disparities: Although middle-income countries are home to fabulous private wealth, nearly three out of four of the world’s poor people live in these countries as well. Middle-income countries are also where new infections are rapidly increasing among the most socially marginalized populations. As HIV risk has long been correlated with high levels of social and economic inequality, it is hardly surprising that middle-income countries are also where new HIV infections are increasing the fastest. The withdrawal of international health and development assistance from these countries, combined with massive poor populations and still-limited fiscal space in national public sectors, means that many poor people in middle-income countries actually become more deprived of essential health and social services as their own countries develop economically. If we are indeed committed to leave no one behind and to address the needs of the most vulnerable – as the Sustainable Development Goals commit us to do – we must find ways to reduce these inequalities and to reach the poor in middle-income countries with the assistance they need.
Promote human rights and social justice as essential pillars of global progress: As the recognized leader of the global community, the Secretary-General must articulate an alternative to growing authoritarianism, the declining space for civil society in many countries, and increased acceptance of human rights abuses and social injustice. These trends are fundamentally incompatible with ending AIDS, as widespread discrimination and unjust conditions create a climate that increases vulnerability to HIV and deters the most vulnerable from seeking essential services. As the human rights climate worsens, the global community must push back and advance a positive, people-centred agenda that recognizes respect for human rights and a commitment to social justice as non-negotiable, regardless of setting.
Actively take on the uncomfortable: As more and more countries embrace scapegoating the most vulnerable, the UN must be bold in its opposition. On HIV, the UN must fearlessly and visibly oppose the criminalization of sex work, same-gender relations, and HIV transmission, exposure or non-disclosure. The UN must enthusiastically promote sexuality education, sexual and reproductive health and rights, and legal recognition and protections of gender identity. The UN must champion the causes of the most vulnerable, including poor households, adolescent girls and young women, migrants and prisoners. The UN must boldly lead efforts to rethink global drug policy, including decriminalization of drug possession. As more than three decades of the AIDS response has shown, courage is the only effective choice to end the epidemic.
Promote universal access to affordable medicines: Although historic gains have been made in lowering the prices of antiretroviral medicines, costs remain too high. And the advances seen to date in reducing costs of drugs for HIV are nowhere to be found in the case of cancer, hepatitis and other health problems. The Secretary-General should actively explore and promote a “new deal” for access to medicines. Instead of charging exorbitant prices for a tiny few, makers of medicines should aim for universal access with a reasonable profit margin. In the meantime, urgent steps are needed to preserve the viability of the generic pharmaceutical industry and to strengthen the ability of countries to maximize legal flexibilities to increase access to essential medicines. These reforms will require a rethinking of intellectual property regimes, a re-commitment to global solidarity and an embrace of more socially responsible roles for private enterprises. In addition to the benefits to the AIDS response, promoting access to affordable medicines will also aid in combatting hepatitis, tuberculosis and non-communicable diseases.
Accelerate UN reform: As forces of nationalism increase and hostility to international cooperation intensifies, the UN urgently needs to demonstrate its added value in addressing key global challenges. Marshalling UN system resources and working with partners to end AIDS – an issue on which UN leadership has been especially noteworthy – is an excellent place to demonstrate the UN’s global potential. On AIDS and other key priorities, reform efforts should be redoubled to make the UN leaner, less duplicative, more results-focused, more flexible and quicker to act in the face of both emerging challenges and new opportunities.
In the quest to end AIDS, the world confronts major headwinds. While we have the tools we need to end the epidemic, there are reasons to doubt whether the world has the will to see this fight through to the end. Only courageous global leadership will get us to the “end game” for AIDS. The Secretary-General should own and lead this renewed global commitment to make AIDS a thing of the past.