This 2011 Political Declaration commits to reaching 15 million people living with HIV with antiretroviral treatment; to reduce sexual transmission of HIV by 50 per cent by 2015; to reduce transmission of HIV among people who inject drugs by 50 per cent by 2015; and to eliminate mother-to-child transmission of HIV.
If it is honoured, it will add to the impact achieved by the previous High Level Meeting (HLM) in 2006, where the international community committed to the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010. Although that target has not yet been reached, the 2006 Political Declaration triggered an unprecedented response to HIV, with over 6 million people receiving antiretroviral treatment worldwide and a reduction in AIDS-related deaths by more than 20 per cent.
The International HIV/AIDS Alliance secretariat and Linking Organisations worked with other civil society organisations to ensure that governments attending the 2011 HLM adopt a robust Political Declaration to make a real difference in the lives of people living with HIV and those at higher risk of HIV. The negotiations leading to the HLM and the language included in the Political Declaration reflect deep contradictions in the approach that some States take to the HIV. The text reflects a clear tension between evidence-based approaches to HIV that emphasise the crucial role of human rights and the participation of key affected populations (such as men who have sex with men (MSM), transgender people, sex workers (SW), or people who use drugs) in the HIV response on one hand; and positions of some governments who privilege some social, religious or political ‘values’ over effective responses to HIV on the other.
However, the adopted text:
- sets measurable targets to treat 15 million people by 2015;
- affirms commitment to invest in effective prevention;
- commits to increase funding;
- commits to a human rights approach to HIV;
- proposes better mechanisms for an evidence-based and accountable response to HIV;
- acknowledges that the response has to reach men who have sex with men, people who use drugs and sex workers among other populations that are at higher risk.
The Political Declaration will bring hope for millions of people affected by HIV and AIDS worldwide. But it will only be worth what governments make of their pledge.
The time for governments to honour their commitments has already started.
The Political Declaration in detail
Recommitting to Universal Access and setting measurable targets in reach and funding
The declaration commits to “redouble efforts to achieve, by 2015, universal access to HIV prevention, treatment, care and support as a critical step towards ending the global HIV epidemic.”
Although many governments were reluctant to including measurable targets in the political declaration it does set concrete and measurable targets for 2015: to reach 15 million people living with HIV with antiretroviral treatment; to reduce sexual transmission of HIV by 50 per cent by 2015; to reduce transmission of HIV among people who inject drugs by 50 per cent by 2015; and to eliminate mother-to-child transmission of HIV. If these targets are met, the impact of the global HIV response in the next five years would be extremely significant.
The declarations commits to gradually increasing expenditure on HIV and AIDS by 2015 to between USD$22 and USD$24 billion in low- and middle- income countries. It also urges developed countries to reach the target of 0.7% of their GNP to official development assistance; and African countries to devote 15% of their national budget to health by 2015. The declaration also pledges to work towards closing the global resource gap for the HIV response through strategic investments that include innovative financing but does not mention the Financial Transaction Tax which the Alliance and, many others are campaigning for.
The Global Fund to Fight AIDS, Tuberculosis and Malaria is recognized as a “pivotal mechanism for achieving universal access to prevention, treatment, care and support by 2015”. However, the document does not make explicit the need to fully fund the Global Fund
Committing to an evidence-based response and a stronger accountability framework
The Alliance and other civil society organisations called on governments to scale up their HIV responses based on a ‘know your epidemic‘ basis and to strengthen the existing accountability mechanism by which countries report their progress on an annual basis.
The Political Declaration acknowledges that programmes must become more cost-effective, evidence-based and deliver better value-for money and calls on “donors and UN system to support Member States in ensuring that nationally driven, credible, costed, evidence-based, inclusive and comprehensive national HIV and AIDS strategic plans are, by 2013, funded and implemented with transparency, accountability, and effectiveness.”
The Declaration also aims to reinforce the existing country reporting mechanism (known as UNGASS indicators), committing to revise the UNGASS core indicators proposed this year by the end of 2012 and “where necessary, to strengthen national, regional and global coordination and monitoring mechanisms of HIV and AIDS responses”.
Reaffirming human rights values in the HIV response
The experience of the Alliance Linking Organisations and partners on the ground is that one of the most important obstacles in the response to HIV is the vulnerability of key affected populations. This includes violations of their human rights and the high level of stigma and discrimination individuals and communities affected by HIV face on a daily basis.
Only a human rights approach to the epidemic can guarantee that those at higher risk and most vulnerable access HIV programmes and services.
During negotiations, the adoption of a human rights framework for the global HIV response was constantly under threat. The final Declaration was weakened by text that reaffirms the sovereign rights of UN Member states and the prominence given to national laws, and to cultural, ethical and religious values which could undermine commitment to a scaled up response that is based on evidence of what works. Concessions to ‘cultural values’ often undermine evidence based programming and policies.
However, the declaration does reaffirm “that the full realization of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic”. It gives particular attention to all people vulnerable to and affected by HIV and commits to “monitoring the impact of the legal environment on HIV prevention, treatment, care and support” and to intensifying “national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV.”
Recognising men who have sex with men, people who use drugs and sex workers as key affected populations
Negotiations prior to the meeting were marked by a growing number of conservative positions in relation to the acknowledgment of the importance of some populations who are at higher risk of HIV. In previous political declarations, no specific mention of men who have sex with men, people who use drugs or sex workers was made. This represents an important acknowledgement of how disproportionately affected certain population groups are.
The 2011 political declaration notes that “many national HIV prevention strategies inadequately focus on populations that epidemiological evidence shows are at higher risk, specifically men who have sex with men, people who inject drugs and sex workers.” Unfortunately, it does not include these groups explicitly when outlining HIV interventions for vulnerable groups and when making human rights considerations to the HIV response.
The Alliance is deeply disappointed that transgender people, one of the populations at higher risk and with highest HIV prevalence rates worldwide, are not mentioned at all in the document.
Another highly contested area during negotiations were references to harm reduction. The Political Declaration does commit to a reduction of 50% of HIV transmission among people who inject drugs, but it also states that consideration should be given “as appropriate” to implementing and expanding risk and harm reduction programmes, but only “in accordance with national legislation”. This remark could accommodate countries that criminalize drug use depriving people who use drugs of accessing the services they need. The declaration also calls for Member States to “combat the world drug problem”, an ambiguous wording that fails to represent drug use first and foremost as a public health issue.
Emphasising the role of community-based responses to HIV
The Alliance’s model relies heavily on community responses to HIV, which have proven to provide an essential part of the national responses to HIV. They allow HIV programmes and services to reach key affected populations, reduce social stigma and discrimination and link up community based service providers with primary health care and national health care systems.
It is extremely positive that the Political Declaration endorses the community response to HIV recognising “the role that community organizations play, including those run by people living with HIV, in sustaining national and local HIV and AIDS responses …and strengthening health systems, in particular the primary healthcare approach.”
With care and support services forming a significant part of the community response to HIV, it is a disappointment that only two paragraphs refer to them in the document. In the last few days of negotiations references to “the effects of long-term living with HIV” and to “disorders associated with aging” were dropped. However, it is encouraging that the core components of comprehensive care and support are included in the text.
Putting these commitments into practice could make a real difference to the HIV epidemic. The Alliance will monitor the implementation of the Political Declaration and will continue to advocate for a strong, transparent and accountable framework to review progress in delivering this important declaration.
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