United Nations fails key populations

The fourth United Nations High-Level Meeting on Ending AIDS has set back the global fight against the AIDS epidemic and left the world’s most at-risk groups facing a future of further stigma and discrimination.

High hopes for the UN High-Level Meeting (HLM) on Ending AIDS ended in disappointment with a Political Declaration which failed to meet the needs of men who have sex with men, people who use drugs, sex workers and transgender people. With reference to these key populations removed from significant parts of the document, the Declaration effectively reversed years of struggle for recognition by groups representing people living with HIV. Given the exceptionally high levels of new HIV infections in key populations, their exclusion also mitigates against the UN achieving its stated target of ending the AIDS epidemic by 2030.

According to latest figures, key populations make up 90% of new HIV infections in Central Asia, Europe, North America, the Middle East and North Africa. In Asia and the Pacific region and in the Caribbean and Latin America, key populations and their partners account for two thirds of new infections. In sub‐Saharan Africa, key populations account for 20% of new infections.

A faltering response to HIV/AIDS

Shaun Mellors, Associate Director Africa at the Alliance, said: “This political declaration is very worrying and signals a faltering response to HIV/AIDS that, in our view, is a critical mistake and a missed opportunity to put us on the right path to bring an end to AIDS.

“It is not simply that references to key populations have been removed from significant parts of the document, what’s worrying is the context in which they are mentioned. Key populations are mainly mentioned as people affected by a disease, with the implicit stigma and discrimination that comes loaded with that, as opposed to being people with human rights and agency.”

The HLM on Ending AIDS was held in New York from 8-10 June. Getting due recognition for the rights and demands of civil society groups, and in particular those representing key populations, was always going to be a struggle.

Javier Hourcade Bellocq, Latin America and Caribbean regional representative for the Alliance, was a member of the Stakeholder Task Force, a group of civil society representatives advising the Office of the President of the General Assembly on how better to engage civil society in the HLM process. In the run-up to the meeting, he said how Russia and some countries in Africa were expected to push back on the language of key populations.

However, he also said: “At the end of the day ... [the Political Declaration is] a piece of paper with amazing or lousy language – it doesn’t matter. After the 10th June everything depends on what people do with the document back home in their countries or communities when they do policy and advocacy work.”

Advocacy demands

The Alliance will continue to press the UN hard for:

  • A people‐centred approach to funding the HIV response, targeted according to where people are living with HIV or are most at risk of HIV.
  • Transparent and quantifiable commitments by member states to end discriminatory laws that punish people living with or affected by HIV, including an end to laws that restrict the work and freedom of civil society organisations.
  • Increased member-state funding to remove human rights‐related barriers that prevent affected people from accessing services.
  • Ambitious, but concrete targets for member states to achieve in preventing HIV/AIDS, including ensuring that 25% of HIV investment goes on HIV prevention.
  • An end to the denial of effective and affordable treatment for the millions of people living with HIV and related diseases such as hepatitis C.
  • Support the community-led HIV response in the Universal Health Coverage (UHC) agenda, to invest in community systems alongside public health systems, and to ensure UHC packages include the entire range of HIV services, including HIV prevention, treatment, care, harm reduction and human rights programming.

Globally the decline in HIV incidence has been modest, going from 2.2 million estimated new infections in 2010 to 2.1 million in 2015.

Shaun Mellors said: “If we are to meet the global targets on HIV we need a fully‐funded HIV response, including increased investment in Civil Society, and substantial resources allocated for combination HIV prevention.

“Only by scaling‐up the community response will we be able to build resilient and sustainable systems for health. These are the things we need in order to deliver on the 2030 target.”

Related

Read a blog on how the last two weeks have delivered some difficult blows to the HIV response, by Wanjiku Kamau, the Alliance's lead on the PITCH programme, a Partnership to Inspire, Transform and Connect the HIV response.