HLM 2016 AIDS: “Reaffirming” urgency while dodging realities, UN resolution on HIV shows what happens when a declaration is political

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Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030 sets new targets, notes gaps, but leaves much unsaid, most affected behind

NEW YORK — After weeks of amendments, deletions, rephrasing, and equivocations, the document agreed to by the member states represented there had been committed to paper already when the last speaker at the opening of the United Nations High-Level Meeting on Ending AIDS stood to address the General Assembly last week.


Ndaba Mandela addresses the UN General Assembly High Level Meeting on Ending AIDS

He remembered the day, he said, when his family gathered to tell reporters how his father had died. One relative, he said, wanted to say it was tuberculosis that had killed him. But his grandfather, Nelson Mandela, insisted they would tell the world that his last surviving son had died because of AIDS.

“My grandfather was not afraid of the truth,” Ndaba Mandela reminded the audience, before urging all nations to address the impact of HIV on those most affected, including people living with the virus, people who use drugs, sex workers, migrants, and sex workers.

“As the great Nelson Mandela said,” he concluded, spreading his fingers, “it is in our hands.”


Michel Sidibe addresses the opening of the UN General Assembly High Level Meeting on Ending AIDS Wednesday morning in New York

But the discussion of the cause that had brought them all there that followed carried a different theme, as one speaker after another first praised and then washed their hands of the declaration they had produced.

It is a declaration that embraces World Health Organization guidelines recommending everyone with the virus have access to treatment. It expresses commitment to the diagnosis and treatment goals that UNAIDS has set as essential to defeating the pandemic, as well as recognition of the consequences that falling short of those goals will bring. It acknowledges the need to confront the impact of tuberculosis and sets goals to end the impact of that disease among people with HIV. And yet it is a document that leaves unclear how any of that will be accomplished.

Some member states took exception to paragraphs in the document that called for gender equity and access to HIV prevention and contraception for women, that, as the representative of Sudan put it, “runs counter to the legal framework of several countries.” Some didn’t like a paragraph urging comprehensive sexual education, on which, Sudan and others claimed, no consensus on what exactly that includes, exists. A number complained about the document’s allusion to greatly higher rates  of HIV among people who inject drugs, sex workers, men who have sex with men, transgender people, and prisoners, with Sudan’s representative claiming, apparently straight-faced, that the document’s fleeting mention of those populations constituted a “focus on only five groups,” and risked “turning a blind eye” to others. Iran’s representative warned that attention to those “key populations” represented a discriminatory approach “that could risk the health of the general public.”

The Holy See, a non-voting member, joined Iran and other representatives in countering calls in the document for harm-reduction measures (that include opioid substitute therapy and needle and syringe provision for people who inject drugs) with complaints that “harm avoidance,” including “abstinence before marriage and mutual fidelity during marriage,” did not receive their due. (The Holy See representative, who also noted that his church “does not accept socially constructed gender,” and found allusions to birth control objectionable, alone took exception to at least 12 paragraphs in the declaration).

Iceland’s representative noted his country remains unsatisfied with the term “sex worker.”

All of these responses were interspersed by those of countries, that, their representatives insisted, had wanted more. It was, Ambassador Sarah Mendelson, speaking for the U.S., said “far from a perfect document.”

Wording on human rights, the most affected and marginalized populations, women’s reproductive rights, she said, “should have been stronger and more explicit.” Canada and Australia agreed, both expressing disappointment that the declaration did not include a call to end stigma and discrimination against gay, lesbian, bisexual and transgender people.

They voiced concerns echoed by those outside the hall, some of whom had walked out as the member states officially approved the document, who found the declaration’s ambiguity and omissions a commitment to “business as usual,” rather than to progress. Noting that the declaration had been composed without the representation of some of those most affected, they issued a “shadow declaration,” that included evidence-based action on points that had appeared in the original declaration’s zero draft, but disappeared long before  the iteration of the document that reached to General Assembly hall that morning.

It left the question still of what happened between the time member states decided to get together again and affirm a commitment to ending the global pandemic, and now. For a document rife with ambiguities, that “notes with grave concern,” the exponential impact of HIV on sex workers, prisoners, transgender people, people who inject drugs, men who have sex with men, but does not insist on changes in policy towards those populations, that “calls attention to” insufficient coverage of proven measures to stop the spread of the virus among people who use drugs, but does not call for action, it satisfied no one, leaving commitment to its goals in doubt.

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