As world representatives meet this week to set next course on HIV, deletions of key populations raise questions on commitment to ambitious 90-90-90 goals
Sexual minorities, people who inject drugs and the barriers they face ignored on the ground, and now obscured in revised political declaration, advocates find
In June 2011, leaders and representatives of countries around the world, meeting at the United Nations issued a declaration committing to intensify their efforts to eliminate HIV and AIDS. While just a few days earlier the first news that treating HIV prevents not only illness, but transmission of the virus had broken at a scientific conference, the findings, and their ramifications were not then widely known.
Over the half decade that followed, science leaped forward, applying and furthering the findings of HPTN 052, the trial that proved that access to antiretroviral treatment could lower incidence of HIV, and also showing the preventive power of the medicine as pre-exposure prophylaxis. At the same time, surveillance capacities and data collection improved in the years that followed the 2011 declaration that suggested only “that each country should define the specific populations that are key to its epidemic and response, based on the epidemiological and national context.” That was the document’s one reference to “key populations” who experience high impacts from their country’s HIV epidemics, but low access to services. The same document made six fleeting references to laws that stand between people and medicine, which it gently suggested countries might “commit to review.”
The progress since then moved UNAIDS to set a goal of “ending AIDS” on a “fast-track,” by aiming to reach 90-90-90 targets of diagnosis, treatment, and sustained viral suppression. Donor-funded programs that include the Global Fund to Fight AIDS, Tuberculosis and Malaria and the President’s Emergency Plan for AIDS Relief have refocused efforts to reach and include the disenfranchised populations left out of national responses. And strengthening civil society groups have supplied some of the missing data the last declaration suggested countries consider.
That progress set an agenda for the successor to that 2011 United Nations meeting, that begins this week, ambitiously called the 2016 High Level Meeting on Ending AIDS . It would produce a new, high-reaching international declaration of commitment, advocates for effective HIV responses around the world have hoped, this one drawing on the knowledge accumulated since the last. A draft released in April, with language that named the populations to be reached — men who have sex with men, transgender women, sex workers, people who inject drugs, and wording that would require nations to “commit to remove punitive laws, policies and practices that block access to HIV services, including age of consent laws, policy provisions and guidelines that restrict access to services among adolescents, travel restrictions and mandatory testing, including of pregnant women, and those related to overly broad criminalization of HIV transmission, same-sex sexual relations, sex work and drug use and provide legal protections for people living with, at risk of and affected by HIV . . .” supported some of those hopes.
But on the eve of the meeting, the release of a new draft declaration, deleting those goals, and reflecting none of the knowledge, possibilities or determination gathered over the last five years, has left civil society representing the most affected groups wondering if they will remain invisible in the commitment to come. MSMGF — the Global Forum on MSM and HIV — and NSWP — the Global Network of Sex Work Projects — have summed up their concerns here, and are urging advocates to take action to ensure a declaration that reflects progress rather than regression.
Stay tuned . . . Science Speaks will cover events at the United Nations this week.