HIV: Who Cares?

25 years on, 25 million dead, 40 million living with HIV – who cares?

A landmark high-level United Nations meeting has failed to make any firm commitment to increased access to HIV treatment, despite energetic lobbying by AIDS activists to head off a weakened international response to HIV/AIDS.

The meeting, held in New York in early June, was timed to coincide with the 25th anniversary of the first reports of AIDS, and was attended by representatives of more than 140 countries, including nearly a dozen heads of state. It was also attended by more than 1400 representatives of non-governmental and PLWHA organisations, including Australia’s National Association of People Living with HIV/AIDS (NAPWA) and the Australian Federation of AIDS Organisations (AFAO [1]Australian Federation of AIDS Organisations. AFAO is the peak non-government organisation representing Australia's community-based response to HIV/AIDS. AFAO's work includes education, policy, advocacy and international projects. ), the first time that broad-scale participation by civil society groups had been seen at such a high-level international meeting.

But hopes that the meeting would build on the historic commitments made at 2001’s UN General Assembly Special Session, and last year’s G8 summit, quickly faded, with activists loudly condemning a proposed declaration, sponsored by conservative countries, which they said would weaken the response to the global epidemic at a time when more urgent action was needed.

“Some countries wanted to remove all references to human rights, vulnerable groups, generic drugs, or access to condoms, sterile injection equipment and harm reduction efforts related to drug use,” wrote Theo Smart in a report for Aidsmap.com. “In addition, several counties want to strip the document of any reference supporting the empowerment of women – even though it is now well-recognised that the social, political and economic disadvantages faced by women are one of the major drivers of the pandemic.”

After many rounds of frantic negotiation, activists were successful in reworking the declaration to incorporate these missing and crucial elements. Attempts to expand on the commitments made in 2001 were blocked by conservative countries, preventing the meeting from making much-needed commitments on harm reduction for injecting drug users, or for protecting the rights of at-risk minority groups such as gay men.

At the conclusion of the meeting many attendees remained concerned that the final declaration doesn’t go far enough, and that it signals a fading international commitment to do whatever is necessary to save the lives of the 40 million people living with HIV/AIDS worldwide, the vast majority of them in developing countries, and to prevent a worsening epidemic in south-east Asia and the Pacific.

“I know that none of you got all that you wanted in this declaration,” Jan Elliasson, President of the UN General Assembly, told activists at the conclusion of the meeting. “That is the nature of negotiations. But I know that thanks in part to the influence brought to bear by civil society, the draft got stronger not weaker in the final hours.”

While the declaration commits the global community to increasing access to treatment for people living with HIV/AIDS, the meeting failed to agree on any firm targets or to include these in the final document. UNAIDS [2]Joint United Nations Programme on HIV/AIDS. UNAIDS is the main advocate for accelerated, comprehensive and coordinated global action on the epidemic. head Peter Piot described the lack of concrete targets as “disappointing,” and suggested that it would now be up to individual countries to set their own goals for improving access to treatment, rather than having a co-ordinated global plan.

There was also little evidence that the money needed to fight AIDS in the developing world would be made available. While the 2001 meeting set a target of 7–10 billion US dollars by 2005, this year’s meeting set no targets, but merely “recognised” that 20–23 billion US dollars a year would be needed by the end of this decade. Where that money will come from is not addressed.

Wealthy countries, including the United States, were said to have engaged in intense backroom negotiations to prevent the inclusion of firm commitments to provide the funds necessary to save lives.

“At this stage in the pandemic, we expected government commitment to close the global funding gap,” said Kieran Daly of the International Council of AIDS Service Organisations. “Instead they have tried to let themselves off the hook.”

Bill Whittaker, who represented NAPWA at the meeting, acknowledged that the outcome was far from ideal, but it could have been much worse if not for the efforts of activists and NGOs.

“While it does not meet the ideal goal of a very bold declaration, UN declarations are necessarily a product of compromise,” he said. “NAPWA notes that there are some very important commitments, timelines and actions which can make a marked difference to HIV prevention and treatment delivery, and we call on all UN member states, particularly those in Asia-Pacific, to implement them immediately.”

Whittaker also singled out Australia’s new Ambassador for HIV/AIDS, Annmaree O’Keeffe, for praise, saying that the Australian government delegation had been one of the groups pressing for a more workable and meaningful outcome. O’Keeffe’s statement to the General Assembly committed Australia to taking a leadership role in the response to HIV/AIDS in our region, and highlighted the contribution of people living with HIV.

“The foundation of Australia’s success has been the close collaboration with, and partnership between, affected communities, people living with HIV/AIDS, all levels of government, and the heath and research sector as well as the adoption of innovative education and prevention initiatives,” she said.

Importantly, O’Keeffe’s official speech on behalf of the Australian government also contained a strong endorsement of harm reduction for injecting drug users, calling this “one of the most dramatic factors contributing to Australia’s success in HIV prevention.”

While there were many criticisms of the outcome of the meeting, most advocates lauded the decision to place greater emphasis on the impact of HIV/AIDS on women and girls, and to highlight the ‘feminisation of the AIDS epidemic’. A spokesperson for Kofi Annan said the UN secretary-general was “particularly heartened” by this.