UN High-Level Meeting on Ending AIDS faces battle over key populations

Alliance of reactionary countries seeks to block recognition of key populations in a new global framework for HIV response

Activists say that a United Nations Political Declaration on Ending AIDS, due to be finalised this week at a UN High-Level Meeting on Ending AIDS in New York, could exclude language recognising the critical importance of key populations for the prevention and treatment of HIV, unless sympathetic governments intervene to ensure the inclusion of language reaffirming the needs of marginalised and criminalised populations.

In particular, activists say that interventions by Russia, Iran, Indonesia and a group of Gulf States have resulted in the removal of references to the need to repeal discriminatory and punitive laws affecting sex workers, people who use drugs and men who have sex with men.

References to ensuring access to tailored HIV combination prevention services for key populations have also been removed, and an explicit list of key populations is missing from the draft declaration.

Glossary

key populations

Groups of people who are disproportionately affected by HIV or who are particularly vulnerable to HIV infection. Depending on the context, may include men who have sex with men, people who inject drugs, sex workers, adolescent girls, prisoners and migrants.

harm reduction

Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use (including safer use, managed use and abstinence). It is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

transgender

An umbrella term for people whose gender identity and/or gender expression differs from the sex they were assigned at birth.

90-90-90 target

A target set by the Joint United Nations Programme on HIV/AIDS (UNAIDS) for 90% of people with HIV to be diagnosed, 90% of diagnosed people to be taking treatment, and 90% of people on treatment to have an undetectable viral load. 

stigma

Social attitudes that suggest that having a particular illness or being in a particular situation is something to be ashamed of. Stigma can be questioned and challenged.

References to the burden of HIV infection in key populations in different regions of the world have been diluted, and key populations are referred to only in the context of risk, rather than as groups of people in especially high need of effective HIV prevention services and treatment.

Key populations have disproportionately high rates of HIV infection and yet, have poorer access to essential HIV services. For example, people who inject drugs are 24 times more likely to acquire HIV, sex workers are ten times more likely to acquire HIV and transgender people are 18 times more likely to acquire HIV.

Key populations face criminalisation, discrimination and a lack of provision of essential evidence-based prevention and treatment services, and are increasingly left behind as the coverage of HIV treatment is scaled up. In Eastern Europe, for example, only 20% of people living with HIV are receiving antiretroviral treatment and half of all new infections are estimated to be occurring in people who inject drugs. Most governments in Eastern Europe express strong opposition to harm reduction measures that could limit HIV infection, continue to promote aggressive policing of drug users and publicly endorse discrimination against men who have sex with men and transgender people.

“After 35 years of the AIDS epidemic, it is reprehensible that some governments would still rather criminalise communities and obstruct access to evidence based HIV services than work together to end this epidemic,” said George Ayala of the Global Forum on MSM & HIV. “We are demanding leaders that oppose this deadly approach to take a stand today, by requesting the Co-Chairs of the High Level Meeting to open the draft Declaration today for further negotiation. We believe evidence and human rights will carry the day—but only if politicians are willing to work, and to speak out for what is right.”

Activists are calling on the government representatives of the United States, European Union countries, Australia, South Africa, Brazil, Argentina and Colombia to mount a last-ditch defence of the rights of key populations, by pushing for an inclusion of specific acknowledgement of the key populations affected by HIV and the burden of stigma, violence and discrimination faced by these groups. Activists are also calling for the needs of key populations to be addressed in all sections of the declaration that discuss strategies for ending the epidemic, and language concerning sexual and reproductive health and rights of women and key populations to be retained.

UN human rights experts have also called for a strong focus on key populations and harm reduction for people who inject drugs in the final declaration.

In a statement issued last week, the Office of the United Nations High Commissioner for Human Rights said “states must commit to removing the punitive frameworks that fuel mass incarceration, HIV epidemics, and negative health outcomes,” and recommendeds that the declaration “adopt a new target to prevent HIV among people who inject drugs, and commit to ensuring availability and access to evidence-based treatment, including harm reduction programmes.”

The draft declaration is designed to commit national governments to endorse the Fast-Track approach to achievement of the 90-90-90 targets, and to provide a framework for the global HIV response over the next five years. The UNAIDS 90-90-90 Fast-Track target calls on countries to reach the following goals:

  • 90% of people living with HIV diagnosed by 2020
  • 90% of diagnosed people on antiretroviral treatment by 2020
  • 90% of people in treatment with fully suppressed viral load by 2020.

The declaration also commits national governments to work towards reducing TB-related deaths by 75% by 2020, and to reduce new infections among young women to less than 100,000 per year by 2020.

“Without commitments on advancing the response among marginalised and criminalised groups, the very goal of the declaration—to guide the world in ending AIDS as a global epidemic by 2030—will not be achieved,” said Asia Russell of Health GAP (Global Access Project).

Activists are calling on organisations to lobby their national government representatives and use social media platforms to express the strength of feeling on the issue. In particular they encourage advocates to "urge your government and missions in NYC to avoid rushing into approving a seriously flawed document," and to demand that "your delegations emphatically speak against weakened or misleading language or language that renders key populations invisible."