It happens every five years. The United Nations General Assembly convenes high-level meetings on HIV/AIDS to review progress on the epidemic and draw attention to what should be done. The goals are often lofty and sometimes they are met or exceeded.
This year’s high-level meeting (HLM) in June resulted in an ambitious political declaration to fast-track progress on ending HIV/AIDS over the next five years and ending HIV/AIDS by 2030. The Fast-Track approach of the Joint UN Program on HIV/AIDS (UNAIDS) set among its short-term (2020) goals, decreasing new HIV infections to fewer than 500,000 globally, decreasing AIDS-related deaths to fewer than 500,000 globally, and delivering treatment to 30 million people worldwide.
The document also includes language committing to bold new commitments by all member states to accelerate HIV prevention, treatment, realize human rights and address gender-based violence. And the declaration allocates $13 billion to replenish the Global Fund to Fight AIDS, Tuberculosis and Malaria. It also addressed barriers to affordable, generic medications, diagnostics, and health technologies related to ending AIDS.
It was a very progressive document, according to activists present at the meeting. At least the initial draft was.
A funny thing happened on the way to the final draft. Five hours of intense negotiations resulted in a significantly weakened document, stripped of commitments to eliminate discrimination, remove punitive laws and barriers to HIV prevention and treatment for marginalized groups including men who have sex with men (MSMs), drug users, transgender people, prisoners, and sex workers.
These are groups that advocates say are in most need of prevention and treatment resources.
A political bargaining chip
George Ayala, executive director of MSMGF, a global forum on MSM and HIV, says the declaration had some good points, but insists for gay men in countries unfriendly to them, the document demands that they “stay in the closet.”
“Out of seventy-two paragraphs in the document, gay men were referenced in only one paragraph, and then offers no specificity about what should be done for us. The message is that gay men and other marginalized groups don’t matter. These countries can use [the document’s] silence on MSMs to justify laws or policies that criminalize gays.
The countries Ayala refers to include the usual suspects, including Russia, Iran, Indonesia, and a group of Gulf States. These are U.N. members who routinely deny access to quality HIV prevention and treatment services to these marginalized groups, Ayala says.
But he also places some fault with friendly western countries like the U.S. and European nations, who did not fight hard enough for these groups in the consensus document.
Advocates for these groups who were present at the meeting say marginalized groups were used as a political tool in bargaining.
Michael Ighodaro, a program and policy assistant for AVAC, watched some of this wrangling. He tells A&U that countries friendly to these marginalized groups traded away language including them for their own priorities.
“Denmark really wanted language in the document that included sex education and services for young people. Some countries didn’t want that. So the Danish bargained away language for gay men and transgender people in order to keep sex education services for youth.”
Denmark was far from the only country succumbing to pressure from the anti-LGBT coalition between the first draft and final draft. Ighodaro says that other countries including the U.S. bargained away wording on LGBTs and other groups, but he wasn’t at liberty to share details.
What was most maddening, Ighodaro says, is that the ambassadors from obstructing nations were generally smart, non-homophobic people who were doing the bidding of their governments.
“Several ambassadors told me that they had gay friends and homosexuality was not evil but they said they couldn’t take a stand for gays because the religion in their countries wouldn’t allow it,” Ighodaro says.
Ighodaro, who’s from Nigeria, spent most of his time in the public U.N. strategy sessions making sure that gay-friendly countries understood the need for inclusion of LGBTs and other groups. Though used to antigay rhetoric, he tells A&U that hearing it on the floor of the U.N. was shocking.
“It was a horror show. It was disgusting. In the room where the countries had to give a reason why they support or don’t support parts of the resolution, these countries from the Middle East and Africa stood up and said, ‘we don’t accept gays, it’s not part of our religion, it’s not part of our culture’ and some other things I don’t want to repeat. I’ve never been anywhere where there was so much hatred expressed.”
U.N. rules prohibit member states from rebutting those comments. But friendlier countries can express affirmations for gays and transgender people and sex workers. And they do. A colleague of Ighodaro from Mexico stood in front of a rainbow flag and pledged unqualified support for LGBTs and other groups which are, in some countries, considered criminals.
Beyond the resolution
Kenyon Farrow, the U.S. and global health policy director for the Treatment Action Group (TAC), tells A&U that he’s “a little cynical” about the U.N. and what can be accomplished in terms of HIV.
“The U.N. doesn’t have the power to compel countries to honor anything they’ve committed to [in the document]. So, even if we had the perfect U.N. document, then what? Activists still have to do the work and make sure the country does the work they signed on to.”
But if the U.N. lacks enforcement levers to ensure that marginalized groups are served—even if they were included in the document—why would ambassadors from some member states fight so hard to exclude these groups from the document’s language? The answer, according to activists, is politics.
“The U.N. is a political place through which countries are making statements about their own values,” Farrow says. “It [the declaration] is used to reflect what the constituents back home want to hear.”
Farrow adds that global and local activists can and should use the blatant exclusion of marginalized groups in the declaration to organize for real change at the ground level.
Some are doing just that.
Niluka Perera, projects officer at Youth Voices Count, an LGBT youth advocacy group in the Asia Pacific region, tells A&U that the U.N. declaration also lacks any references to young key populations at high risk of contracting HIV. His solution: interventions at the regional level.
“The epidemic is getting younger and in this situation member states choosing to ignore young key populations is unacceptable. We need to bring this awareness to our constituencies at the country level to inform their interventions and advocacy.”
Perera says his network plans to conduct a series or webinars especially for its members to orient them on the political deceleration. “The goal is to explore what as young people we should do both at the country level and the regional level to make sure that young key populations are not left behind,” he says.
From there, Perera says, members will be developing informational materials on the political deceleration to be used by members at the country level and organizing training sessions regionally in order to develop a regional plan for HIV/AIDS outreach, prevention and treatment for young people.
Perera suggests that, as bad as the U.N. declaration was for marginalized communities, advocates shouldn’t get angry. They should get organized. Farrow would agree with this approach.
“As far as the U.N. declaration relates to people impacted by HIV, it’s an opportunity for civil society to call out all of the contradictions in the countries and for groups to organize around that, even when their countries sign on to the document or when they don’t sign on. That’s where the potential win is.”
Larry Buhl writes A&U’s monthly Hep Talk column.