UN 5th High Level Meeting on HIV/AIDS: Civil society says “Yes -- AND” to the 2021 political declaration

On Tuesday (June 8), the UN General Assembly voted overwhelmingly to approve the 2021 Political Declaration on HIV and AIDS introduced as part of the now fifth High Level Meeting on HIV/AIDS. Previous Declarations were accepted by unanimous consent, following months of negotiations. This year’s Political Declaration includes much to applaud, including new ambitious targets for prevention, investment goals to ensure everyone who needs treatment has access to it, and a financial and moral commitment to end gender inequality, stigma and discrimination. While all true, the overwhelming vote in favor, 165-5 (it was unexpectedly forced to a vote by the Russian Federation) obscures divisions that still exist around human rights and support for key populations and will undermine the targets and goals set forth in the declaration for the next five years, unless we pay heed.

The Russian Federation and a handful of other countries worked in the weeks ahead of the HLM to eliminate mention of harm reduction and rights-based programming, and weaken provisions related to key populations and youth. As Permanent Representative of Australia and meeting co-facilitator Mitchell Fifield noted, the Russian Federation made 73 changes to the document and then voted against the declaration it had weakened. Then after the vote, many countries that voted in favor of the declaration quickly disassociated themselves from the areas in it that addressed the rights of key populations or young people. Courtney Nemroff, the U.S. representative, highlighted the problem in her remarks: the declaration, although an important step forward, still “lacks the ambition needed to meet the stated goals of this high-level meeting — ending inequalities and ending AIDS.”

Early in the epidemic, which quietly spread for years, and 40 years ago this month began to receive attention from healthcare workers, scientists and activists, financing appeared to be the main obstacle to protecting the health and welfare of all those affected by HIV. There were some who thought the global “mortgage” of a commitment to treat all could never be fully funded. This was never true, and COVID-19 has shown that money flows when the political will exists. The additional US$10 billion in investment that UNAIDS calls for to end the HIV epidemic by 2030 seems modest in comparison to COVID-19 investments.

What the COVID-19 response and last week’s declaration demonstrate is that the biggest obstacle to overcoming HIV and other health threats is not money but laws and policies that affect access to prevention, treatment and care for all populations. The declaration commits to reducing annual HIV infections to under 370,000 people and to ensure by 2025 that 95% of people at risk of HIV infection are able to obtain appropriate, person-centered and effective combination prevention. But how can this be achieved when countries continue to criminalize or restrict the autonomy and rights of those people they need to reach?

A number of organizations and activists have spoken out after the adoption of the declaration. Together these responses represent a community amendment to the declaration. Together they say ‘yes’ to the declaration and….

• Protect human rights and eliminate structural barriers that result in discrimination, gender inequality, underfunding and excluding people living with HIV and people most at risk of HIV, such as key populations, priority populations and children who may be at elevated risk of HIV.
• Protect the sexual and reproductive health and rights of women and girls, eliminate gender-based inequalities, gender-based violence, stigma and discrimination, as well as punitive legal and policy environments.
• Commit to global accessibility, availability and affordability of safe, effective and quality-assured medicines, including generics, vaccines, diagnostics and other health technologies to prevent, diagnose and treat HIV infection.

Even though the vote on June 8 was overwhelmingly in favor of the Political Declaration on HIV and AIDS, the problem with a split vote is that it no longer sets the standards for policy in the way that a consensus adoption does. A new study from Georgetown University found little evidence in support of the argument that criminalizing behavior of marginalized people in a pandemic results in positive outcomes for them or their national response. The Political Declaration could have defined the minimum standards for developing policies that support those most at risk of HIV. Instead, it becomes the ceiling that may never be reached by many countries, unless civil society again makes the case and governments actually adopt policies that acknowledge that there is no end to the HIV epidemic without involving, supporting and accepting everyone.