Interventions on Agenda 1.3 Report of the Executive Director
Intervention by Marcus Oda (Eurasian Coalition on Male Health)
Thank you chair. On behalf of the Eurasian Coalition on Male Health, I would like to thank the executive director for his remarks and recognize the efforts made at the recent HLM. At the same time, I would like to highlight certain failures of the HLM to commit adequate attention, resources, and support to respond to the HIV epidemics among men who have sex with men, trans* people, and other key populations. HIV has a devastating and disparate impact on these populations. In the region of Eastern Europe and Central Asia in particular, stigma, discrimination, and other legal or social barriers serve to increase these populations’ risk of HIV infection and to reduce their access to HIV services. In 2014, in our region, 96% of all new HIV infections occurred among key populations and their sexual partners.
Despite these facts, the Political Declaration overlooks important data with respect to key populations and uses language that essentially renders these populations invisible in the context of the HIV response. In order to achieve the ambitious goals set by the Political Declaration, it is imperative that key populations receive the necessary attention, resources and support in the HIV response.
In addition, I would like to condemn the decision of certain UN member states to exclude a number of NGOs, including the Eurasian Coalition on Male Health, from participating in the High Level Meeting due to our work on the rights of MSM and trans* people. By voting for the exclusion of these organizations, conservative governments have sent the message that they do not care about the lives of MSM and trans* people and that they do not intend to address the HIV epidemic threatening these populations.
The involvement of communities in the development of HIV/AIDS programs and in the global HIV response, in general, is of the utmost importance. Communities are best situated to assess their own needs and to advocate for the services, resources, and support they require. If we are aiming to achieve the ambitious goals set by the Political Declaration, we must ensure the right of the communities most affected by HIV, including MSM and trans* people, to shape and influence global, regional, and national HIV responses.
Intervention by Nadia Rafif (Global Forum on MSM & HIV)
MSMGF (The Global Forum on MSM & HIV) together with the Global Platform to Fast-Track the HIV and Human Rights Responses Among Gay and Bisexual Men and Other Men Who Have Sex with Men (The Platform) and others KAP networks (NSWP) are deeply disappointed by the adoption of a flawed Political Declaration at the United Nations High-Level Meeting on Ending AIDS (HLM). We are deeply worried that you consider the New political declaration as the document which help us to close a door and open a new one and you named it as : “A bold, ambitious, forward-looking and balanced document which reflects the reality of the epidemic in 2016”
The Political Declaration inexcusably fails to meaningfully address the HIV epidemic among key populations, including gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, and transgender people.
While the political declaration claims to commit UN member states to “fast-track targets” to end the AIDS epidemic by 2030, the document’s repeated omissions, exclusions, and misrepresentations of gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, and transgender people as key populations affected by HIV worldwide, lack of commitments to key populations programming, and failure to address legal and policy frameworks that stigmatize and criminalize key populations worldwide all raise new barriers and obstacles to achieving targets to end AIDS. It also lacks an explicit commitment to support and finance key population-led and tailored prevention, care, and treatment services.
While the document opens with a sweeping “commitment to end the AIDS epidemic by 2030,” our networks and many of its global civil society allies contend that the Political Declaration is a significant set-back in our work to end AIDS, particularly among key populations.
In every country in the world, gay and bisexual men and other men who have sex with men, sex workers, people who use drugs, and transgender people shoulder disproportionate HIV incidence and prevalence, lack equitable access to HIV services, are criminalized, and face unrelenting stigma, discrimination and violence. No country can end its epidemic unless it effectively addresses HIV in all four of these key populations – whether in Africa or anywhere else in the world.
As MSMGF made clear in signing with over 100 civil society allies a Global Civil Society Organization (CSO) Declaration, we recognize the Political Declaration’s important commitments in several areas, including: strong references to the connection between gender-based violence and HIV, explicit positive reference to harm reduction as an important HIV strategy, consistent attention to stigma and discrimination as significant challenges to effective HIV responses, and explicit reference to the importance of meaningful stakeholder participation including people living with HIV, women, youth groups, feminists, human rights defenders, national human rights institutions, and other civil society organizations.
In contrast, the final Political Declaration strips and weakens much of the original Zero Draft language addressing key populations, depicting the global HIV epidemic in inaccurate and revisionist terms, and rendering gay and bisexual men and other men who have sex with men, sex workers, people who inject drugs, and transgender people almost invisible, along with other potentially vulnerable populations.
The final Political Declaration includes numerous references to UN member states being allowed to define their own epidemics and responses, setting a disturbing precedent for governments to ignore evidence indisputably and consistently showing gay men, sex workers, people who use drugs, and transgender people to be nearly everywhere most affected by HIV.
The Political Declaration also opens the door for governments to deviate from normative guidance for evidence-based HIV prevention and treatment approaches established by the World Health Organization (WHO) and other UN agencies.
In one item of good news, the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR) announced at the HLM that it would create a $100 million Key Populations Investment Fund “to expand access to proven HIV prevention and treatment services for key populations.”
While MSMGF commends PEPFAR, we commit to hold the U.S. government accountable for ensuring the new fund quickly supports community-based and key population-led organizations directly, rather than locking up resources in large international implementing agencies, which are far too often not sufficiently well-connected to grassroots community organizations. This may require creative new partnerships and funding networks. MSMGF together with its partner networks will continue to advise as needed and as appropriate.
We will continue to diligently hold governments worldwide accountable for effectively addressing HIV in meaningful partnership with key populations, and we hope to get the support from UNAIDS to do it so.
MSMGF and the Global Platform to Fast-Track the HIV and Human Rights Responses Among Gay and Bisexual Men and Other Men Who Have Sex with Men (The Platform), United Nations member states adopted a very weak political declaration at the UN High-Level Meeting to End AIDS (HLM) in New York City.
Intervention by Christian Hui (GNP+)
My name is Christian Hui, a gay man living with HIV since 2003 from Canada and a former person who used and injected substances, and I am representing the Global Network of People Living with HIV (GNP+) today to express our grave concerns about the Political Declaration that was adopted at the meeting by UN member states on June 10, 2016.
On behalf of all people living with HIV and key populations most impacted by the epidemic, we will hereby bring forth the problematic practice of exclusion—an act that was practiced by member states leading up to the HLM, and are presumed to be condoned unless otherwise stated, to intentionally exclude 23 civil society representatives from the most affected key populations including Gay, Bi, and Men who Have Sex with Men: People Who Use or Inject Drugs; Sex Workers; People who have been or Are Incarcerated, and Transgender people; and groups representing People Living with HIV—to prevent them from taking part in the process where member states and key stakeholders across the globe gather to fast-track the global HIV response for the next 5 years.
Through the supports of many civil society organizations, many members of the excluded groups were able to speak out on the human rights violations they face as key populations at “The Impact of Civil Society Exclusion on Ending the AIDS Epidemic by 2030” unofficial side event held at the Ford Foundation the day prior to the start of the HLM.
What was important to note was that the UN General Assembly President Mogens Lykketoft went on the podium and spoke for all to bear witness that the UN was founded on the values and principles to protect human rights worldwide, and that he was personally disappointed that member states have allowed one another to exclude civil society from their right to participate and become meaningfully engaged at meetings such as the HLM.
The most important message he gave was to urge member states to hold one another accountable on any attempts to suppress human rights, and with civil society and key population groups acting as community watchdogs, to ensure that such outright violation of rights and expressions will not happen again.
I would like to remind member states that since the very beginning of the epidemic, it was people living with HIV and key populations that have led the global AIDS response. We demand the human rights that all citizens of the world deserve, that we not be punished or criminalized for our HIV status or belonging to specific identity groups such as Gay, Bi, MSM; People Who Use or Inject Drugs; Sex Workers; Prisoners, Transgender people, or Indigenous status.
We deserve to be proactively engaged by member states and UNAIDS and to be included in all key discussions and planning of the global AIDS response. Lastly, we will not be silenced, and we refuse to be treated as if we do not exist.
Thank you. Merci. Chi Miigwetch.
Intervention by Tamar Gabelnick (Elizabeth Glaser Pediatric AIDS Foundation)
While fully supporting the points made by my NGO colleagues who just spoke, the Elizabeth Glaser Pediatric AIDS Foundation would like to highlight some of the positive elements of the High Level Meeting, specifically the pivotal outcomes achieved for children and adolescents. First, we celebrated the certification of the elimination of mother-to-child HIV transmission by Armenia and Belarus, along with other notable achievements of the Global Plan to Eliminate Mother-to-Child Transmission. We would also like to congratulate Thailand for its certification last week.
Second, UNAIDS and PEPFAR announced that the Global Plan will be followed by a new global framework to end the AIDS epidemic among children, adolescents and young women by 2020. The framework includes 3 interwoven components each with highly ambitious Fast Track targets. They are: Start free to end vertical HIV transmission, Stay free to cut new infections among adolescents and young women, and AIDS Free to increase treatment for children and adolescents.
The new framework reflects an understanding that achieving an AIDS-free generation requires a more comprehensive and cyclical approach that starts and ends with PMTCT, including primary prevention among girls and young women, but also promotes starting and keeping children on treatment, virally suppressed, and healthy as they move into adolescence and adulthood.
And third, we were thrilled to see that elements from all three parts of this framework were included as commitments in the HLM Political Declaration, including eliminating vertical HIV transmission, providing 1.6 million children with treatment by 2018, and reducing new infections among adolescents and young women to under 100,000 by 2020.
We applaud such bold targets and the commitment to urgent action that they signify. We were also pleased that the targets were backed by other commitments to address the protracted challenges that may prevent us from meeting those targets. For example, mother-to-child transmission is stubbornly persistent in the breastfeeding period, where 60% of infections are now occurring. Only half of HIV-exposed infants are being tested, and test results are taking months to get back to caregivers. Children living with HIV are not being found and linked to treatment. The average age children are starting treatment is close to five years old, when 80% of HIV positive children will have already died by that age. Treatment adherence and viral suppression is far too low among children and adolescents. Optimal pediatric formulations are still not available. And stigma plus harmful gender norms and practices continue to prevent effective prevention and treatment among girls and women.
We must tackle all of these challenges head on, in clinics, in community settings, in schools, in law- and policy-making bodies, in laboratories, and elsewhere, and the Political Declaration lays out specific steps we must take to do so.
In closing, we would like to thank those actors in this room who have set the ball firmly in motion for a day when children are no longer being infected by HIV, and no longer dying of AIDS-related illnesses.
Intervention by David Ruiz (Stop Aids Alliance, Interagency Coalition on Aids and Development (ICAD)
We want to highlight two main issues in relation to the HLM, and ask UNAIDS and Member States for their leadership:
Whereas the Political Declaration includes strong commitment to the 90-90-90 strategy, access to treatment and financing issues among others, this must be accompanied with a strong commitment to KP, human rights and combination prevention programs in all countries, including MICs, as the only way to ending Aids by 2030. Many donors are withdrawing their financial support to MICs, often without appropriate plans for responsible and sustainable transition, and ignore the many reasons why MICs are not in a position to quickly take on the responsibility for their health systems and to meet the needs of their populations through continued service delivery. Key populations and human rights programs, which are often funded by external donors, now are needed to discontinue their service provision as donors withdraw from MICs. In order to prevent increases in new cases of HIV and to sustain progress made on HIV, there is an urgent need for sustainable transition plans and principles to help avoid gaps in the HIV response and ensure HIV service delivery for the poorest and most marginalized wherever they are. Technical agencies and donors, together with recipient countries, must develop guidelines on the content and process for ensuring sustainable transitions that can be implemented throughout the life of a grant. Predictable funding, long-terms plans, and ensuring formal systems support community system strengthening and human rights are essential for responsible transitions.
Our second key point is related to the UHC debate; as this is an opportunity to ensure integration and sustainability of HIV responses. But UHC programs should not just deal with financial measures, they must address all of the barriers to effective service coverage and build on the lessons learned of the HIV response. Whereas many countries are moving towards UHC, certain groups of the population might still be excluded, particularly key affected populations and other marginalized groups. Investment in and support of the community response to reach certain groups and the promotion of human rights should be a critical component of UHC policies and programs if UHC is to be truly realized. The UHC and HIV movements could provide an inclusive and equitable model for coordinated action in the next era of global health. The HIV movement has a significant body of evidence demonstrating the critical role of and the need to invest in community systems alongside public health systems. But also the engagement of UNAIDS and the HIV sector in this debate is a way to ensure that UHC packages include the entire range of HIV services, including HIV prevention, treatment, care, harm reduction and human rights programming.
Finally, we thank M Sidibé for his Report and acknowledge all efforts made by the co- facilitators and those member states that wanted to see a strong political declaration that is committed with and that include fully funded targets of the UNAIDS Strategy.
Intervention by Irina Maslova (Silver Rose)
On behalf of the Silver Rose, the movement of sex workers and their supporters , I would like to commend the NGO report to the UNAIDS PCB on sexual and reproductive health and rights.
Sexual transmission is increasing every year, and almost on par with the mode of HIV transmission through injecting drug use. Sex workers are attributed the threat of dissemination HIV and other socially significant diseases. In recent years, punitive laws and public health rhetoric further incited hatred against us via supporting moralism and gender stereotypes, and increasing violence against us. We face severe consequences that affect our health, our dignity, and sexual and reproductive rights.
Worldwide, sex workers are recognized as a group vulnerable to HIV, but not in Eastern Europe. Because of this, HIV prevention efforts and sexual and reproductive health services for sex workers are excluded from the government programs.If a sex workers is also a migrant, especially from the countries of Central Asia, then the sex worker does not have any help in matters of health and protection. Migrant sex workers are completely denied access to HIV services, and to sexual and reproductive health.
We are subjected to stigma and discrimination in its worst forms.Police raids are regularly held and very often featured on television in the criminal news almost every day, on all television channels across the country. Police raid is a legalized crime against sex workers: illegal entry into a dwelling, theft, threats, coercion to testify against himself, blackmail disclosure, sexual and gender-based violence,We face assaults and raids by ultra-nationalists who throw us to the windows and make march naked in the street. We see police calling local residents to do raids themselves and to photograph sex workers to clean up the streets.
We support WHO programming with sex workers, we do implement service programs, focusing on HIV and STIs, and on our sexual health. The most powerful thing that we do is protecting rights and teaching people to protect their rights within existing legal frameworks. We expect further shortage of funding from both international and national donors, and UNAIDS is a key player to support this work in the future. As all of us know, this work requires investments, effort, time and guarantees to sustain and to expand what has been done not only inthe name of HIV prevention, butforsexual and reproductive health, too.
We urge UNAIDS to help establish and sustain productive dialogues between sex workers and governmentsso that we could be partners in these dialogues. We urge UNAIDS and other partners to allocate funds and provide technical assistance to strengthen the capacity of sex workers, so that we can advocate for our sexual and reproductive health and rights, and access them.