Statement by Nadia Rafif, Senior Policy Advisor
The Global Forum on MSM and HIV (MSMGF)
As said just before, yes, HIV advocates have been asking for targets with similar specificity and ambition for non-ART prevention—including attention to stigma, discrimination and criminalization, since rights-based delivery of services is absolutely essential. We are afraid about the over medicalization of the HIV response.
UNAIDS has released both a prevention target draft and a draft of non-discrimination targets. Together, these two documents are the beginning of what a comprehensive response, complementing 90-90-90 could look like. But, as we describe below, there is still a pressing need to review and clearly articulate the overall document.
- As an overall comment, the targets around key populations seem unambitious and very programmatic focused. We know that new infections increase amongst key populations where punitive laws are in place and health care services are either closed to key populations or healthcare providers exercise stigma and discrimination against key populations, deterring access and ultimately causing a rise in new infections amongst sex workers, men who have sex with men and people who use drugs. Challenging this context of criminalization, stigma and discrimination is integral to working towards prevention amongst key populations yet this context seems missing in the document, both in the background/discussion section and in the resulting targets that do not reflect issues beyond basic service provision and access to PrEP
- In the actual targets, the only targets related to key populations are the provision of basic services including condoms and PrEP. This doesn’t translate from the discussion that talks about the need to be innovative and use a combination of old and new prevention interventions including tailored programs (community led and rights-based programs should be mentioned more explicitly given recent evidence of their efficacy in prevention amongst key populations). If PrEP and other early treatment as prevention strategies are being recommended then perhaps priority access to early treatment for key populations should also be considered given the current treatment gaps experienced and documented by key populations.
- The language used around PrEP should be the same for all key populations in that one group should not be “reached with PrEP” whilst another groups should “have access to PrEP” – this implies disparity between some key populations and others, with one being targeted and the other being offered new prevention technologies
- Final point is that the targets seem to be quite flexible for country level shifting in approaches used to meet these prevention targets – “Critically important, each country would determine and plan how to reach these targets, e.g. determine what a 75% reduction would imply for them”. To avoid the implementation of rights-violating prevention measures and programmes, clearer guidance that is evidence-based and ensures the human and health rights of key populations are protected
Global Discrimination Targets
We are not going far enough in the proposed targets and indicators to challenge stigma and discrimination against PLHIV and key populations. More analysis and concrete targets and related indicators should be included on the 3 interconnected levels of;
- State endorsed and perpetuated stigma/discrimination (punitive laws around transmission, sex work, drug use, homosexuality etc);
- Community and societal-level stigma and discrimination (moving beyond the language around ‘acceptance’ of key populations into communities towards key populations having full human rights respected and for stigma and discrimination and the laws, policies and practices that support and perpetuate it, removed.
- Stigma and discrimination in health programming – concrete targets needed to challenge discriminatory health practices and attitudes of healthcare providers, this is vital to increasing access to health for key populations and reducing discrimination
The bottom line is inescapable. Without ramped up delivery of lifesaving treatment and targeted prevention in the next five years, along with advances in non-discrimination and human rights that make these services possible, the AIDS epidemic will remain a serious global health threat as far as we can see.
Funding has slowed; stigma and discrimination continue to magnify vulnerability and have worsened in some places. The world needs ambitious targets that will drive new resources based on the evidence and human rights. Targets are about making change: pushing for new money, strategic investments, and advances in human rights. Stronger emphasis on Discrimination and prevention efforts, supporting communities led organization need to be made.