World leaders adopted a new Political Declaration on HIV/AIDS “Intensifying our Efforts to Eliminate HIV/AIDS” at the recent UN High Level Meeting. The Declaration sets out the direction and commitments for the global response to HIV for the period up to 2015.
The text of the Declaration was heavily negotiated by Government representatives, and compromises had to be made on all sides to ensure the resolution was adopted. As such, the end result is not as strong on certain issues as IPPF and many other organisations ( and governments!) may have liked to see, but there are some good things about it as well that will help shape the future response to the epidemic.
In the lead up to, and during, the High Level Meeting, IPPF actively advocated for a number of key advocacy messages to be included in the Declaration. Please find below a brief summary of how and to what extent the Declaration addresses these.
Key message 1: Maximise existing policy and programme synergies between HIV and associated responses to improve the lives of young women and girls
- The linkages between HIV and sexual and reproductive health are recognised in numerous key places in the Declaration (e.g. paragraph 41, 59, 96, 98 and 99). There is also a commitment to “direct resources to and strengthen the advocacy, policy and programmatic links between HIV and […] sexual and reproductive health” (para. 98)
- The Declaration includes a specific commitment to “eliminate mother-to-child transmission of HIV by 2015 and substantially reduce AIDS-related maternal death” (para 64)
At a side event during the HLM the newly developed Global Plan – which IPPF and some MAs helped develop - was officially launched. This GLOBAL PLAN TOWARDS THE ELIMINATION OF NEW HIV INFECTIONS AMONG CHILDREN BY 2015 AND KEEPING THEIR MOTHERS ALIVE is ambitious – and it highlights the imperative role of a comprehensive response to PMTCT ( and its links to relevant MNCH issues)
· Women and girls are recognised throughout the document as particularly vulnerable to HIV and the document pledges to “eliminate gender inequalities… and take all necessary measures to create an enabling environment for the empowerment of women” (para 53)
Key message 2: Mention the ‘unmentionables’
- The Declaration specifically mentions men who have sex with men, people who inject drugs and sex workers as populations at higher risk (para 29). This is the first time a General Assembly Session document has ever made explicit reference to these specific groups.
- The section “Advancing Human Rights to Reduce Stigma, Discrimination and Violence related to HIV” (para 77-85) includes, among other things:
o Commitment on intensifying national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV… (para 77)
o Commitment to review, as appropriate, laws and policies that adversely impact on the successful, effective and equitable delivery of HIV prevention, treatment, care and support programmes… (para 78)
- Related to this key message in particular, IPPF would have liked to see stronger language, including:
o specific mention of transgender people
o a commitment to repeal, or at the very least review, punitive discriminatory laws and policies
Key message 3: Uphold the rights of people living with HIV
- The Declaration includes general language on the rights of people living with HIV, in particular in the section “Advancing Human Rights…” (para 77-85). Paragaph 80, for example, includes a commitment to promote and protect human rights of people living with HIV (para. 80).
- However, there is no mention of or commitment to address a growing phenomenon:
o ending the criminalization of HIV transmission;
- The need for evidence-based responses in mentioned in several places, including in commitments on evidence-based prevention measures and approaches (para. 59 and 60). However, paragraph 59 also includes the text “…taking into account local circumstances, ethics and cultural values”, which has the potential to undermine an evidence-based approach.
Key message 4: Renew the political commitment to HIV
- Overall, the Declaration reaffirms and recommits to commitments made in the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS (para. 3 and 50). But it is not as strong as it should have been on a robust accountability framework and mechanism.
- The Declaration recognises that HIV requires an exceptional and comprehensive global response (para. 7), and includes clear commitments on:
Treatment: 15 million people living with HIV on antiretroviral treatment by 2015 (para. 66) (already labelled as the ‘15 by 15’ commitment); and
Funding: closing the global HIV and AIDS resource gap by 2015 (para. 86)
- Though the Declaration refers to the need for “expanding access to essential commodities, in particular male and female condoms…” (para. 59), it does not commit to specifically closing the condom gap.
Of particular importance is the recent ‘game-changing’ evidence about ‘treatment as prevention’ that is clearly reflected in the Declaration: ‘Deploying new biomedical interventions as soon as they are validated, including …….earlier treatment as prevention.’ This will have a significant impact on the nature of prevention programming – and its inherent links to STI management; adherance counselling and support; and the importance of increased access to VCT to support earlier treatment initiation.
The Declaration provides a solid basis and support for our continued and expanded work on HIV – and highlights the important niche that IPPF has pioneered ( with partners) in linking SRH and HIV responses at the policy, programme and structural levels. The Declaration also provides an opportunity to reflect on those specific areas where increased advocacy is required.
