AIDS Today: 2014 edition


AIDS Today: Tell no lies, claim no easy victories (2014 edition) is the first edition of our new biennial publication that presents the global state of the civil society response to AIDS.

The report aims to spark a timely debate about the global AIDS response: what it has achieved, what it can teach others fighting for health and justice, and what remains to be done to bring about a sustainable end to AIDS.

This debate kicked off at the London School of Economics and Politcial Science (LSE) on 14 October 2014, where two of the report authors, Sisonke Msimang and Mark Heywood, joined social scientists to debate just that. The event was recorded, click here to watch or listen in full.

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Executive Summary

Taken together, these essays represent a wail against complacency, a battle cry in defence of human rights in an era of jargon and statistics.

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ESSAY: Unravelling the human rights response

Mark Heywood provides a short history of the rise and fall of the human rights approach in the HIV response.

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INSIGHT: Beauty and the beast

Monica Leonardo on how transgender activists won the right to gender identity in Argentina.

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INSIGHT: Women, power, sex and politics

Lead author, Sisonke Msimang, recalls how "in conversation after conversation, women told us that AIDS felt like it was simply one assault too many."

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ESSAY: Funding the fight to end AIDS

Asia Russell on how funding for HIV has stagnated at the very time when we have the potential to reverse the epidemic.

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INSIGHT: Supply and demand

Pauline Londeix outlines why drug prices and trade barriers are blocking drug access and what activists can do about it.

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ESSAY: Overcoming the epidemic of fear

Martin Choo explains Why the social context in which people living with HIV live, and love, matters most of all.

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INSIGHT: Against the grain

Anya Sarang provides the story of the Andrey Rylkov Foundation in Russia, which started as an initiative to protect the health and rights of people who use drugs.

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ESSAY: The architecture of AIDS

Robin Gorna on building a movement,sustaining a response.

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INSIGHT: Smoking out the gays

Dr. Frank Mugisha on how hatred has distracted Ugandans and reversed hard-won gains in the fight against AIDS.


  • ANONYMOUS - 24th October 2014

    Mark’s essay is very well written – as usual for him – and provides what I see as a fair summary of the evolving intersection of HIV and human rights. Nevertheless, I have several major disagreements. Most importantly, he doesn’t pay enough attention to the impact of both widespread treatment access and emerging PrEP and TASP (for prevention) on the entire paradigm of the HIV response. Both were made possible by the intersection of science and (rights) activism and both need rights activism to be sustained – but Mark ignores the major impact they have had on reducing community mobilization. Second, Mark is too uniformly positive about Peter Piot’s days at UNAIDS. Peter partnered with Mark, TAC and Section 27 – but he was quite poor on some other key rights issues, especially for the marginalized populations that drive the epidemic outside Africa. Finally, I think Mark is overly critical of the current UNAIDS. I’m no fan. But Michel Sidibe has been a brave and outspoken advocate on the rights of marginalized populations – far more than Peter was – and he is struggling to find a winning strategy for advocacy in the face of a very different development cooperation landscape than that faced by Peter.

  • Alvaro Bermejo - 24th October 2014

    Thanks for this comment. The whole aim of the publication is to try to get debates like this one going, so hope you manage to also read some of the other great articles in the book.

    Agree with your first point. On the second one I agree the landscape is a very different one and who knows what Peter would have done. But the reason I hear Mark’s comments on UNAIDS today resonate with so many (it was certainly the mood of the LSE room where Mark spoke for the launch) is not that Michel isn’t being outspoken but that many of the avenues that existed for strategic dialogue (beyond a specific guideline or event) between organised activists and UNAIDS have disappeared. I’m not sure who he is (or his team are) talking to in that struggle to find a winning strategy but from what I hear it’s not the activists. And this has now been happening for so long now that many activists are putting UNAIDS in the ‘not worth trying / irrelevant’ pile.

  • Anonymous 2 - 24th October 2014

    Firstly, hats off to you Alvaro and the Alliance team on the publication of “AIDS Today”. It is so important that we stand back from time to time to reflect on where we came from, where we are now, and where we want to go in the future. A few thoughts to add to the mix…

    My own take on where we are now in the AIDS response is… that it is not straightforward. Access to treatment has expanded exponentially in the past decade – the AIDS movement has demonstrated clearly that it is possible, even in poor countries with weak systems, to provide lifelong daily medicines to now close to 13 million people, in fact most of those who know their HIV status. This is an extraordinary achievement and, coupled with the solid evidence we have of the overwhelming preventive benefit of ART, should certainly drive our continued efforts to expand HIV testing approaches to reach the 19 million people living with HIV who do not know their status.

    Similarly, efforts to make HIV testing a routine part of antenatal care, with immediate linkage to treatment and care for HIV positive pregnant women, are paying off. New vertical infections annually among children have dropped to below 250,000 globally for the first time, from a peak of 600,000 just a few years ago. More women and girls are accessing treatment that men, even if, sadly, becoming pregnant is now the easiest route to HIV testing and care. Furthermore, the efforts to eliminate vertical transmission have shown clearly that integration of HIV services with MCH services for women and children is the way forward.

    The prevention landscape is mixed. The biomedical tools we have - VMMC, needle and syringe exchange and OST, PrEP, PEP and of course ART – work. We just have not managed to take them to scale fast enough, for lots of reasons, some political, some not.

    And when we think about the protection and promotion of human rights, again, I think the results are mixed. We have failed to stop the relentless and disproportionate number of infections among girls in sub-Saharan Africa, and the violence, abuse, lack of education and poverty that drive them, and yet there is greater and greater commitment among donors, multilaterals, civil society to put an end to gender inequality. It will surely be a defining element of the post-2015 development agenda. How much has the AIDS response contributed to that?

    Abuses of rights against lesbians, gays, bisexuals and transgender people are on the increase in some parts of the world, while at the same time in other parts of the world same sex love and diverse gender identities are recognized as normal human variants. As more and more people come out as lesbian or gay, even if at great risk in some countries to their personal safety, fewer and fewer people can claim that they don’t know someone, or have someone in their family, that is gay. Eventually this will surely result in positive change. Funding and other support to LGBT groups through the AIDS response has been critical to advance the “visibility” and rights of LGBT people..
    While access to services for people who use drugs remains poor, there are chinks in the armor of the past 50 years’ global drug policy, chinks that will come to the forefront at the 2016 UNGASS on “The World’s Drug Problem”. These advances can also be attributable to work that originated in the AIDS response.

    On the flip side, the world increasingly faces a clash of cultures, secularism versus religious fundamentalism, and greater inequity, which also play into the successes and failures of the AIDS response, particularly in the area of human rights. And the current Ebola epidemic shows how quickly, out of fear, people can revert to calls for quarantines, travel bans, blaming of “victims”, etc. etc.

    Today’s rallying cry, led by UNAIDS, for “ending AIDS”, is a gamble. Certainly that is what all of us who have dedicated our lives to the fight against AIDS would like to see – an end to AIDS. However, could it play into those who would like to see “and end to the AIDS response”? I don’t know, but I do think we need to keep accelerating the scale up of what we know works, pushing back on those who would have us slip into the background.

    As for UNAIDS and its engagement of activists – under Peter or under Michel – this has always been dynamic and continues to evolve. One issue that Mark does not address in his article is that the activist movement has itself changed over time. Some could characterize it as weaker today than it was ten years ago. I would say that it has evolved. Many activists, over time, have moved into positions of influence, in governments, civil society organizations, multilaterals, donors. Has this strengthened or weakened the activist movement?

    The proposed strategy I most identified with, at the end of Mark’s article, was to “link HIV and AIDS to other struggles and a broader vision based on social justice”. This is a huge challenge for those of us who felt we got nowhere until “AIDS exceptionalism” took hold. But I think it is a challenge we must face, with open eyes, open ears and open hearts.

  • Andy Guise - 16th February 2015

    Whilst it is a little time ago now, I remember being at the launch event for AIDS today and a member of the audience welcoming the report with a comment on the increasing role of evidence in the response to HIV: “Evidence can be an act of power, an act of violence, and a way to avoid listening to the voices of people living with HIV”. I fully support the role of evidence in policy, and how evidence based policy can save lives, and reduce harms. I also see how the growing focus on evidence in the response to HIV can act to silence people or groups who may not sit in seminars and use the ‘right’ language, or who pose questions not so easily answered with reference to ‘evidence’ (why are the poor poor?). The AIDS today report seems to me to do a great piece of work in reminding us of how civil society has challenged science and the production of evidence, with activists leading and enabling scientific breakthrough through challenging science to be better and to respond to different questions.

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