UN AIDS Declaration sets some ambitious goals, fails to address others

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The United Nations headquarters in New York City.

The United Nations General Assembly adopted the Political Declaration on HIV/AIDS: Intensifying our Efforts to eliminate HIV/AIDS Friday at the conclusion of the three-day High-Level Meeting on AIDS in New York City. The ambitious goals set forth in the declaration include putting 15 million people on life-saving antiretroviral therapy in low and middle-income countries by 2015 (about twice the number currently on therapy) and halving the number of tuberculosis-related deaths among people with HIV. The plan includes a “push towards” ending HIV in children in the next five years, and Member States also agreed to increase AIDS-related spending to reach between $22 billion and $24 billion in low- and middle-income countries by 2015.

“These are concrete and real targets that will bring hope to the 34 million people living with HIV and their families,” said UNAIDS Executive Director Michel Sidibé in a press release. “Through shared responsibility, the world must invest sufficiently today, so we will not have to pay forever.”

“A new goal of reaching 15 million people is the bare minimum that is needed to begin to reverse the AIDS crisis by saving lives and preventing new infections. We are very glad to see the United States joining countries around the world to set this target,” said Health GAP’s Asia Russell in a press release. While goals are great, she said, a real plan is needed to set out to achieve these goals.

A report recently released by UNAIDS stated that approximately 6.6 million people in middle and low income countries are currently on treatment. The U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) program is supporting the treatment of 2.7 million and plans to increase that to 4 million by 2013. But with President Obama’s fiscal year 2012 budget request marking only a very slight increase in PEPFAR funding, to include the U.S. contribution to the Global Fund, advocates worry about the ability to scale up treatment further. 

“PEPFAR country directors in several African have been directed by Washington headquarters to plan for ‘painful cuts next year,” according to the Health GAP release. The declaration does address the need to push toward closing the gap between domestic and international funding for HIV, increasing country ownership.

As for human rights language, some found the outcome declaration stronger in certain areas, and weaker in others. For example, although the declaration language included increasing preventive measures in the most vulnerable populations, including explicit reference to men who have sex with men, one issue of contention is how injecting drug users (IDUs) are addressed in the document. 

“The declaration does call for Member States to reduce transmission of HIV among IDUs by 50 percent by 2015, but UNAIDS is already on record calling for a reduction to zero infections, so this seems to be a step back,” said Zoe Hudson, senior policy analyst at the Open Society Foundations.  “These provisions are further weakened by a paragraph that only requires Member States to ‘give consideration’ to harm reduction programs.  Every other prevention intervention is embraced outright.”

Hudson also expressed concern with declaration language that calls for member states to “combat the world drug problem” without much clarity on what that means.

“These efforts in the past have for the most part relied on criminal penalties and incarceration, which put drug users at increased risk of HIV,” Hudson said.  “The declaration fails to call on Member States to treat drug use as a public health issue or to provide universal access to HIV prevention services.”

In addition to committing countries to intensify national efforts to create legal, social and policy frameworks to eliminate stigma and discrimination of those with HIV, the document also pledges to eliminate gender inequalities, gender-based abuse and violence including a woman’s right to protect herself from HIV infection.

The declaration does address the recent HPTN 052 trial findings, which show that earlier ART initiation among HIV-infected persons reduces sexual transmission to an HIV-negative partner by more than 96 percent. “Calling for intensifying national HIV testing campaigns; it urges countries to deploy new bio-medical interventions as soon as they are validated including earlier access to treatment as prevention,” according to a press release from UNAIDS.  The HPTN 052 study results have emboldened many advocates to call for action to end AIDS.

An investment in accelerated basic research, to specifically include female-controlled prevention methods such as microbicides and other new prevention technologies, is also committed to in the declaration.

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