UK civil society welcomes the adoption of the United Nations General Assembly of the 2021 Political Declaration on HIV and AIDS. It is important to remember that the Declaration is not just a piece of paper. It will have real-world consequences for millions of people living with and affected by HIV. It gives us an opportunity to get the HIV response back on track. The Declaration couldn’t come at a more pressing time for the HIV response. Despite significant progress, all of the global targets for 2020 have been missed. COVID-19 is threatening to reverse progress in the HIV response. For example, in facilities surveyed by the Global Fund, HIV testing fell by over 40% in 2020.
We therefore needed this declaration to mobilise and unite all governments towards bold leadership. The Declaration should further focus the global HIV response on evidence-based policy making. The Declaration does mark progress from the 2016 High Level Meeting. It presents a roadmap that we can use to get the HIV response back on track. We welcome how the Declaration broadly aligns with the priorities of the new Global AIDS Strategy. This Strategy was passed by consensus at the UNAIDS Programme Committee a few months ago. The Declaration rightly highlights the need to address the structural barriers of discrimination, gender inequality, criminalisation, underfunding and exclusion of the groups most affected by HIV.
We welcome references to education and employment, gender equality, the empowerment of women and girls, food security, housing, social protection and mental health. This demonstrates some recognition of the need for a holistic approach to the HIV response.
We particularly welcome that key populations are named within the Declaration. And the inclusion of the 10-10-10 targets on societal enablers. These call for member states to end all inequalities faced by people living with HIV, key and other priority populations by 2025. We also welcome the inclusion of language around community leadership; advancing HIV prevention intervention; ending pediatric AIDS by 2025 and committing to the 95-95-95 targets on testing, treatment and viral suppression.
With huge funding gaps, we welcome the Declaration’s target to fully fund the AIDS response both from domestic and ODA resources. This notably includes enhancing global solidarity to meet the target of 0.7% of gross national income as development aid. It also calls for increasing annual HIV investments in low- and middle-income countries to US$29 billion by 2025.
We remain disappointed however to see that the final Declaration presented diluted language, or completely removed text, on critical areas that were in the Zero Draft. It is shameful that Governments weakened the language on these critical areas. These areas include:
- advancing progress of scientifically proven interventions around sexual and reproductive health and rights (SRHR).
- comprehensive sexuality education (CSE).
- harm reduction.
- sexual orientation and gender identity.
- community leadership.
- decriminalisation and repealing punitive laws.
- TRIPS waivers to make essential medical technologies and innovations more equitably available.
Moreover, some critical areas did not even get a mention in the initial Zero Draft. This includes the climate crisis. The climate crisis is one of the biggest challenges that the world faces. Despite having a clear interconnection to the HIV response, it was not even mentioned. This completely undermines the above commitments which are unachievable without addressing the climate crisis. A stark example of the connection between climate and HIV is the impact of cyclone Kenneth in Mozambique in March 2019. Every health clinic suffered severe damage and many people were displaced. This caused significant impacts on access to healthcare and essential medicines. Catastrophic events like this, which impact the HIV response, will only increase if the international community does not take the climate crisis seriously.
We acknowledge the Decalaration’s commitment to work with youth- and community-led organisations. However, the Political Declaration lacks action for how it will resource and support chronically underfunded youth-led CSOs rather than just engage them. This includes youth key population-led CSOs.
There is also no inclusion of language on sustainability and transitions. For example, there is no mention of donors needing to develop and implement transition frameworks with needs- based aid allocation methodologies. Language on this would’ve helped mitigate against the impact of donor transition. Donor transitions have led to reversal of development gains and resurgence of HIV in several countries.
The inclusion of some text was deeply problematic for an effective national HIV response. We are alarmed by reference to the autonomy of Member States to define the specific populations that are central to their response dependent on context. There is also a reaffirmation of the sovereign rights of Member States. This not only undermines the global nature of the HIV response. It also facilitates the perpetuation of discriminatory laws and human rights abuses towards marginalised groups. These groups should be protected under an agreed definition of key populations. Comprehensive education is also considered “relevant to cultural contexts”. This gives Member States the ability to avoid education on HIV prevention and sexuality and gender based violence. Having this is integral to reaching the target of ending AIDS by 2030. Stronger language is needed regarding the barriers affecting young people’s ability to access HIV testing and services. This includes overcoming spousal and parental consent to access HIV testing and services.
We do however acknowledge it was a very difficult negotiation. Compromises had to be reached. Given this, we are alarmed by Russia’s refusal to accept the negotiated consensus. By forcing a vote, Russia deliberately undermined internationalism and ability to reach global consensus. This is critical to drive forward progress in the global HIV response.
Throughout the negotiations on the Declaration we have welcomed opportunities for consultation. We welcome how the UK Government was pushing for a more ambitious text until the very last moment. We welcome how the UK Government advocated for the inclusion of stronger and evidence based text related to CSE, SRHR and advancing the rights of key populations. The UK’s commitment to advancing action in these areas was highlighted by the UK representative’s strong speech in yesterday’s plenary. However, it is still very disappointing that the UK was opposed to stronger language on TRIPS Flexibilities.
It is important to highlight that if the UK Government is genuinely committed and concerned around a ‘resurgence in the pandemic’, these words are not yet being met with all the necessary actions. Whilst other Governments are using the High Level Meeting to ramp up their financial and political commitments for the HIV response, we fear the UK is stepping away.
It is alarming that the UK Government has abandoned the 0.7% aid spending commitment. The UK Government is implementing drastic cuts to crucial organisations in the HIV response. This includes slashing their funding to UNAIDS, Unitaid and UNFPA by over 80% respectively. The UK Government has cut global health Research & Development spending in half. The UK Government has also decimated its funding for HIV bilateral programmes. This has forced the closure of a number of vital HIV services. Whilst we welcome the UK Government’s support for the Declaration, we urge them to realise that these cuts will actively undermine the global community’s ability to reach the important targets in the Declaration.
With implementing cuts of over 80% to UNAIDS, the very agency organising the High Level Meeting, we are concerned that the power of the UK’s voice and influence in the Declaration negotiations was diminished. The UK is pushing other Member States to agree to an ambitious Declaration (which includes language on the 0.7% aid spending commitment) but meanwhile is giving the dangerous practical message that it no longer matches its words with action.
We urge the UK Government to use outcomes from the High Level Meeting to reignite their historic leadership in the global HIV response. It must adhere to the Declaration’s commitments. The UK Government should review its domestic legislation that hinders our HIV response and fuels inequalities. It should work towards the decriminalisation of the transmission of HIV, sex work and drug use. The UK Government must also urgently address the health inequalities experienced by people of colour living with HIV in the UK. Extensive data from the UK CHIC analysis of HIV outcomes by ethnicity has demonstrated significantly worse outcomes for people of colour.
In line with ambition of the Declaration, the UK Government should advance its leadership in the global HIV response by:
- Urgently announce supplementary allocations to HIV organisations that have been cut.
- Continue as a leading donor to UNAIDS, UNFPA, Global Fund and Unitaid.
- Urgently return to the 0.7% aid spending commitment.
- Actively support the full use of all TRIPS Flexibilities and advance discussions on TRIPS waivers to make essential medical technologies and innovations more equitably available.
- Advance the UK’s voice and funding to community-led organisations to end all inequalities faced by communities and people affected by HIV.
UK civil society organisations look forward to furthering our partnership with the UK Government in its continued leadership for the HIV response.
Civil Society Representative in the UK Government’s Delegation to the UN High Level Meeting on HIV & AIDS; STOPAIDS Senior Advocacy Advisor
Youth Representative in the UK Government’s Delegation to the UN High Level Meeting on HIV & AIDS; CHIVA Youth Advocacy Coordinator; Youth Stop AIDS Steering Committee Inclusivity and Diversity Officer