Memorandum submitted by the International
HIV/AIDS Alliance
EXECUTIVE SUMMARY
1. The International HIV/AIDS Alliance has
a special interest in HIV, marginalised populations and emerging
epidemics with over 12 years experience working with sex workers,
gay men and other men who have sex with men, injecting drug users
and people with HIV/AIDS in Asia, Africa, Latin America, the Caribbean
and Eastern Europe.
2. Global commitments to universal access
to HIV treatment, care, support and prevention mark a significant
development in global AIDS policy. However early responses to
these new commitments by national governments suggest little or
no attention to the needs of marginalised populations in national
planning for universal access.
3. Our experience in working with marginalised
populations demonstrates widespread HIV risk and vulnerability
amongst these groups, very low levels of access to basic HIV services,
along with widespread violations of human rights. Without a sea
change in our approaches to reducing the vulnerability of marginalised
populations and addressing human rights violations against these
groups, universal access will not be realised.
4. A global HIV services gap exists which
sees 95% of injecting drug users, 89% of men who have sex with
men, and 84% of sex workers without access to basic HIV services.
5. HIV/AIDS is fuelled by human rights violations
and human rights violations exacerbate the impact of AIDS. Very
few interventions to address human rights violations against marginalised
populations are funded, designed or implemented.
6. Support for AIDS programming from donors
must be flexible enough to respond to diversity in the nature
of different epidemics. In addition, AIDS programming must be
guided by principles of equity and effectiveness so that funding
mechanisms do not reinforce existing discriminatory approaches
to marginalised populations. Donors must guard against avoiding
funding work that is politically sensitive or ideologically bound.
7. HIV prevention approaches must be integrated
into broader development strategies to address the causes and
consequences of social and economic deprivation, which in turn
leads to HIV vulnerability.
8. The UK Government's leadership role in
international policy fora to speak about and champion the rights
of marginalised populations is applauded by the Alliance. This
support can be expanded, capitalising on the UK Government's substantial
resources and reputation, to make a much bigger difference to
the lives of sex workers, injecting drug users, men who have sex
with men and people living with HIV/AIDS. The focus for this expanded
support is contained in the recommendations.
SUMMARY OF
RECOMMENDATIONS
Improving multilateral understanding and action
on HIV and human rights
We urge the International Development Committee
to recommend that the UK sponsor a resolution for the creation
of the Special Rapporteur on HIV and Human Rights at the UN Human
Rights Council and convene an international meeting to begin the
process of developing an International HIV and Human Rights Action
Plan.
Bringing greater coherence to the UK's approach
to the global AIDS pandemic
We urge the International Development Committee
to call on both the Department for International Development and
the Foreign Office to work together to develop a UK strategy for
integrated action on HIV internationally.
Providing international leadership on the rights
of sexual minorities
The Alliance asks the International Development
Committee to recommend to the Secretary of State for International
Development and the Foreign Secretary that the UK Government appointment
a Special Representative for Sexual Minority Rights, who acting
within government and on behalf of the UK internationally could
be tasked with developing a shared understanding of the human
rights situation for sexual minorities, together with increasing
the political and community support for better promotion and protection
of their rights nationally and intern rights of sexual minorities.
Strategy development, implementation and monitoring
The Alliance invites the International Development
Committee to recommend that the Department for International Development
develop a strategy for implementing its commitment in Taking Action
to vulnerable populations, which would include funding parameters
and a monitoring system which can track spending and results against
the strategy.
HIV/AIDS, MARGINALISED
POPULATIONS AND
EMERGING EPIDEMICS
1. The International HIV/AIDS Alliance and
our special interest in HIV, marginalised populations and emerging
epidemics
The International HIV/AIDS Alliance ("the
Alliance") is a partnership of organisations working together
to strengthen community responses to AIDS. Established in 1993,
the Alliance has a secretariat in Brighton, UK, and partners in
32 developing countries in Africa, Asia, Latin America, the Caribbean
and Eastern Europe. The Alliance has a long and proud history
of working with communities and sub-populations key to the dynamics
of HIV transmission. These sub-populations—men who have
sex with men, sex workers, injecting drug users and people with
HIV/AIDS—commonly experience high levels of stigma and discrimination,
are routinely denied services, and are disproportionately infected
with and affected by HIV/AIDS. Despite this, our programming experience
consistently illustrates how the involvement of these populations
in programme design, delivery and decision making builds the skills
and social capital necessary to prevent HIV transmission, and
to care for, support and treat people with HIV/AIDS.
The Alliance uses the term key populations to
refer collectively to sex workers, gay and other men who have
sex with men and injecting drug users because these groups are
key for two reasons. They are key to patterns of HIV transmission
and are key to preventing and mitigating the impact of HIV/AIDS.
The Alliance's original mission centred on the
human rights and epidemiological benefits of working with key
populations in emerging epidemics Our experiences in working with
key populations to fight AIDS in many countries for more than
twelve years informs the evidence we provide here.
2. A brief overview of populations that are
key to the dynamics of the HIV epidemic
2.1 Gay and other men who have sex with men
In a few societies sex between men is widely
accepted; in some it is tolerated, and in many it is the subject
of strong disapproval, legal sanctions and social taboos. Official
indifference or hostility means that there are few prevention
and care programmes for men who have sex with men in developing
countries. It also means that little research has been undertaken
to discover HIV prevalence rates, how many men are at risk and
how best to provide them with the information they need to protect
themselves and their sexual partners.
Sex between men, particularly anal intercourse
without a condom, is one way in which HIV and other sexually transmitted
infections are transmitted. Although HIV prevalence rates among
men who have sex with men are high in some countries; due to the
relative invisibility of male to male sex, sex between men may
be an unrecognised factor in national and regional epidemics.
Where HIV prevalence is low, focusing prevention
efforts on people with high risk behaviours such as men who have
sex with men not only protects those individuals but can contain
the epidemic at a fraction of the cost associated with a generalised
epidemic. Doing this effectively requires support for both risk
and vulnerability reduction interventions.
Risk reduction activities might include distributing
condoms and lubricant among men who have sex with men or providing
them with specifically targeted education aimed at promoting safer
sex.
Supporting gay and other men who have sex with
men to come together and to organize themselves for social networking,
solidarity building and policy advocacy can play an important
part in reducing their vulnerability.
2.2 Sex workers
Sex workers are key to the dynamics of most
HIV epidemics; the potential for a large number of sexual partners
increases the likelihood of exposure to HIV for sex workers and/or
the possibility of exposing others to HIV.
HIV prevention in the context of sex work rests
on a range of factors including the legal and policy environments
in which sex work occurs; the legal, social and economic status
of sex workers; and the capacity of sex workers to organise themselves
and to identify and implement effective responses to the challenges
they face, including HIV.
Although many countries criminalise sex work
and thereby subject the act of buying or selling sex for money
to criminal sanction; sex workers have the same human rights as
everyone else, particularly rights to education, information,
the highest attainable standard of health, and freedom from discrimination
and violence, including sexual violence.
Since the beginning of the AIDS epidemic sex
workers have organised around health and human rights issues,
and as a result some sex worker organisations have played a crucial
part in reducing HIV risk and vulnerability.
2.3 Injecting drug users
Injecting drug use is estimated to account for
just less than one-third of new infections outside Sub-Saharan
Africa. [6]
In spite of the importance of preventing HIV
among injecting drug users, coverage of HIV prevention for this
population is at best 5% globally. [7]
There are approximately 13 million injecting
drug users worldwide, of whom 8.8 million live in eastern Europe
and Central, South and South-East Asia. There are around 1.4 million
injecting drug users in North America and 1 million in Latin America.
[8]
Use of contaminated injection equipment during
drug use is the major route of HIV transmission in eastern Europe
and Central Asia, where it accounts for more than 80% of all HIV
cases. It is also the entry point for HIV epidemics in a wide
range of countries in the Middle East, North Africa, South and
South-East Asia and Latin America.
Alarmingly, new epidemics of injecting drug
use are being witnessed in countries of sub-Saharan Africa. [9]
Beyond the physical risks associated with drug
injection, drug users are vulnerable to HIV because of their social
and legal status. Ironically, in many countries this means that
HIV interventions are not legally available to drug users, or
that drug users are unable or unwilling to access them for fear
of recrimination or arrest.
2.4 Prisoners
Prisons are sites for drug use, unsafe injecting
practices, tattooing with contaminated equipment, violence, rape
and unprotected sex. Conditions in most prisons make them extremely
high-risk environments for HIV transmission, leading them to be
called "incubators" of HIV, hepatitis C and tuberculosis.
They are often overcrowded and offer poor nutrition with limited
access to health care.
Both male and female prisoners often come from
marginalised populations, such as injecting drug users or sex
workers, who are already at increased risk of HIV infection.
HIV prevention and treatment efforts in prisons
should be important components of national AIDS strategies not
only because of the undoubted benefits in public health terms
but also as a matter of fundamental human rights.
Furthermore, most prisoners at some point return
to the community. People retain the majority of their human rights
when they enter prison, losing only those that are necessarily
and explicitly limited because of incarceration. They retain such
rights as freedom from cruel and inhuman punishment, and the right
to the highest attainable standard of health care.
Over 20 years into the HIV response these populations
remain key to the dynamics of the epidemic and continue to be
disproportionately infected with HIV and affected by it. Unfortunately
the political and institutional commitment required to address
the economic, social, gender and other disparities which fuel
AIDS epidemics and exacerbates its impact on people with these
behaviors or in some settings remains unacceptably low.
3. Global commitments to universal access;
a world of opportunity
The July 2005 G8 commitment to universal access
to HIV treatment, care, support and prevention marked a significant
development in global AIDS policy. From that momentous commitment
followed the 2005 World Summit Outcome (resolution 60/1), whereby
all UN Member States committed to a massive scaling up of HIV
prevention, treatment and care with the aim of coming as close
as possible to the goal of universal access to treatment by 2010
for all who need it.
And on 2 June this year at the High Level Meting
on AIDS, the UN General Assembly committed to scale up towards
the goal of universal access to comprehensive HIV prevention,
treatment, care and support by 2010.
These ambitious commitments have brought the
AIDS response to another historic juncture. Scaling up towards
universal access is an extraordinary commitment by world leaders,
signalling the political will to devote the resources and energy
required to end AIDS.
4. What will constitute universal access?
Diverse definitions for the phrase "as
close as possible to universal access" emerged from these
events.
The concept of universal access clearly implies
that all people should have access to HIV related information
and services. In early 2006 UNAIDS facilitated a global consultation
process on universal access, identifying five key features of
universal access:
— Accessible: locally relevant
and meaningful information and services need to be available when
and where people need them, and they need to be able to use them
without fear of prejudice or discrimination;
— Affordable: cost should not
be a barrier to commodities (eg medicines and diagnostics, condoms)
and services (eg harm reduction) that exist now, and to what we
hope will be developed in the future (eg microbicides and vaccines,
and new medicines);
— Comprehensive: prevention, treatment,
care and impact mitigation must be linked and planned and delivered
with the full inclusion of people living with and affected by
HIV;
— Sustainable: HIV is a lifelong
challenge requiring sustained action for preventing new infections
and saving and improving the quality of the lives of those with
HIV; services must be available throughout people's lives rather
than as one-off interventions. New technologies and approaches
must continue to be developed to meet ever-changing needs; and
— Equitable: information and services
must be made available to rich and poor, women and men, young
and old, and to vulnerable groups, including men who have sex
with men, sex workers and injecting drug users.
The spread of HIV reflects different patterns
of risk and vulnerability which means that putting programmes
in place which evidence these qualities will mean different things
in different places.
Consequently, locally tailored prevention, treatment,
care and support interventions are crucial to respond to epidemics
that vary in their intensity, pace and impact in each country.
But despite local differences it is possible
to say that certain behaviours and vulnerabilities together with
the abject failure to provide basic HIV prevention and treatment
services continue to drive the epidemic among key populations.
As a result even within countries some groups
are disproportionately at risk of and affected by HIV/AIDS.If
universal access is to mean anything it must address the needs
of both those most vulnerable to and those most affected by HIV/AIDS.
5. Barriers to universal access: risk, vulnerability
and violations of the right to health
In Latin America, the Caribbean, many parts
of Asia and in Eastern Europe, the dynamics of HIV transmission
are markedly different from those in sub-Saharan Africa. Sub-populations
significant to the dynamics of HIV epidemics in these countries
include men who have sex with men, sex workers, injecting drug
users and prisoners.
In most countries, key populations tend to have
a higher prevalence of HIV infection than that of the general
population because they engage in behaviours that put them at
higher risk of HIV transmission. Male to male sex, commercial
sex and injecting drug use all bring high risks of HIV transmission.
In addition to increase HIV risk, these groups
are almost always marginalized from society and services, experience
systematic discrimination, violence and abuse.
At the same time, the resources devoted to HIV
prevention, treatment and care for these populations are not proportional
to the number of people living with HIV from these groups or of
the impact of the virus on them. This is a serious mismanagement
of resources and above all a violation of the right to health
and to health care and services for individuals from these groups.
6. HIV/AIDS is fuelled by human rights violations
and human rights violations exacerbate the impact of AIDS
Despite the fact that we have understood the
relationship between HIV and human rights almost since the beginning
of the epidemic, [10]human
rights abuses continue to fuel AIDS and human rights violations
continue to exacerbate the impact of the disease.
The destruction wrought by HIV/AIDS is fuelled
by a wide range of human rights violations, including sexual violence
and coercion faced by women and girls, stigmatisation of men who
have sex with men, abuses against sex workers and injecting drug
users, and violations of the right of young people to information
on HIV transmission.
HIV prevention programmes continue to be stalled
and undermined by these abuses, and assessments of the effectiveness
of particular interventions continually fail to address the problem
of the abjectly hostile policy environment for HIV prevention,
treatment and care in the countries in which we work.
In prisons, HIV spreads with frightening efficiency
due to sexual violence, lack of financial and human resources,
lack of basic amenities, lack of access to condoms, lack of harm
reduction measures for drug users, and lack of information.
Human rights violations only add to the stigmatisation
of people at highest risk of infection and thus marginalise and
drive underground those who need information, prevention services
and treatment most desperately.
Abuses also follow infection. People living
with HIV/AIDS are subject to stigmatisation and discrimination
in society, including in their communities, in the workplace and
in accessing services.
One of the most prominent and enduring insights
arising out of the Alliance's HIV programming in the last twelve
years is that effective prevention of the epidemic will be impossible
as long as the human rights abuses that fuel infection, and follow
it, go unaddressed.
7. No commitments to vulnerability reduction
Global HIV prevention efforts continue to prioritise
risk reduction and impact reduction interventions over vulnerability
reduction interventions. Programmes that provide information to
drug users about safe injecting, but then jail drug users for
the possession of clean injecting equipment, only to rapidly intensify
their vulnerability to HIV in prison. Programmes that provide
sexual health services to sex workers but then provide no protection
from violence and coercion to engage in unsafe sex. Programmes
that educate girls about HIV transmission undermined by inadequate
police and judicial responses to rape and by social and cultural
norms that condone rape. Programmes that seek to educate men who
have sex with men about HIV transmission undermined by violence,
imprisonment and social exclusion.
Just as human rights are essential to reducing
vulnerability and mitigating the impact of the disease, effective
HIV programming depends on good governance, supportive laws and
policies and the transparent and comprehensive application of
the rule of law.
In many of the countries in which we are working
there is a profound and widening gap between what is said about
the importance of human rights in relation to fighting the epidemic,
and what is actually being done.
8. The global HIV services gap
While funding for HIV programmes has increased
in recent years, many countries fail to direct financial resources
towards activities that address the HIV prevention needs of the
populations at highest risk, opting instead to prioritise more
general prevention efforts that are less cost effective and less
likely to have impact on the epidemic.
UNAIDS, 2006 Report on the Global AIDS Epidemic.
The latest available data for coverage of services
for HIV/AIDS prevention, care and support in low and middle income
countries provides a compelling demonstration of the HIV services
gap for sex workers, men who have sex with men and injecting drug
users.
Data from a UNAIDS/USAID/WHO/Policy Project
study[11]
estimates coverage of basic HIV services for injecting drug users
at an appalling 5%. The same study estimates coverage of basic
HIV services for men who have sex with men at 11% and for sex
workers, 16% coverage. In the UNAIDS report for 2006[12]
they cite coverage data from 2005 that shows only 9% of men who
have sex with men received any type of HIV prevention service
in that year, and that less than 20% of injecting drug users received
any HIV prevention services.
Neither of these data sets survey HIV treatment
access, but we can assume that access to treatment services for
these populations is even lower, given the generally very poor
access to health services that marginalised populations experience,
together with the continued inadequacy of treatment provision
in general.
These figures undermine the optimism that accompanies
announcements of increased resources for AIDS and growing political
commitment to tackle the disease. These figures also highlight
the systematic failure to protect the fundamental right to health
of individuals from these groups.
9. Universal access and marginalised populations—insufficient
progress
There is little evidence to suggest that the
international commitments to universal access will do much to
close the HIV services gap for marginalised groups.
Debate at the UN High Level Meeting on AIDS
in June this year failed to generate a shared agreement about
the additional risk or impact of HIV on sex workers, men who have
sex with men or injecting drug users. Whilst it is possible for
the UK Government to acknowledge and speak of the uneven burden
of AIDS on marginalised groups, and the behaviours that create
HIV risk and fuel marginalisation—risky sex, injecting—many
other governments remain, after over 20 years, unable to speak
about male to male sex, sex work and drug use in ways that support
good public health.
From this, it also appears that the UNAIDS-led
process of national target setting towards universal access will
do little to address the special needs of these groups at the
country level.
Early indications[13]
are that very few countries have evidenced even a minimum level
of commitment to these groups in their national targets for delivering
universal access.
One of the chief tests of the commitment to
universal access both at the national and international level
must be to close the HIV services gap for those most at risk of
HIV.
10. Key priorities: Coherence, integration
and tailoring
Ensuring adequate funds to mount an effective
global response to HIV/AIDS has been difficult. However, due in
no small part to the leadership of the UK Government, over the
last few years there has been an unprecedented increase in global
financial resources devoted to responding to HIV/AIDS. However,
this amount remains less than half of what is required by 2005,
and only a quarter of what will be required by 2007 to ensure
a comprehensive response to AIDS in low and middle-income countries.
[14]
Unfortunately, the continued resource gap is
only one of a number of funding challenges. The additional challenges
include:
— inconsistent approaches from
the international donor community that undermine effective country-led
prevention responses in general and particularly with populations
key to the epidemic in many countries;
— lack of incorporation of HIV
prevention efforts into broader development strategies;
— recognising different epidemic
dynamics and developing multifaceted approaches.
INCONSISTENT APPROACHES
FROM THE
INTERNATIONAL DONOR
COMMUNITY
The US Government's announcement in 2003 of
some $15 billion to fight AIDS set a new global benchmark for
AIDS and challenged the current levels of funding provided through
the bi-lateral programmes of other large donor countries. The
contribution also shifted understandings of the level of resourcing
required and gave non-government and community based organisations
a sense that closing the global AIDS funding gap was in fact possible.
The concept of an "emergency response"
which lies at the heart of the US Government's PEPFAR programme
has proved useful in bringing a sense of urgency to the global
and national responses to AIDS. However, some of these new sources
of funding also come with new conditions.
Whilst clear funding criteria and comprehensive
monitoring and evaluation are important features of effective
resource allocation, some restrictions inhibit rather than promote
the design and delivery of comprehensive programmes. Such bi-lateral
programmes that determine allocation of resources to donor-driven
prevention priorities risk undermining interventions that have
been developed based on country needs and experiences.
It is vitally important that in mobilising international
resources to close the HIV/AIDS funding gap, new gaps do not develop
in prevention services and programmes, especially for at risk
groups. Restrictions on the nature and type of HIV prevention
work that national governments and other organisations can adopt,
such as responding to the HIV prevention needs of sex workers
and injecting drug users, is a case in point. It is vitally important
that HIV prevention interventions do not unintentionally reinforce
existing discriminatory approaches to key populations.
It is also vitally important that our prevention
efforts are guided by evidence demonstrating effectiveness, by
principles of equity and by a focus on impact. Funding mechanisms
must be fluid and responsive to different dynamics in the epidemic,
and to the evidence emerging from all levels of programming. Ideological
opposition to, for example, building the capacity of sex workers
or young women to protect themselves from HIV, must be challenged
in a global HIV prevention strategy.
Standard HIV prevention interventions—HIV/AIDS
awareness campaigns, voluntary counseling and testing, and accessible
STD treatment—apply to all epidemics, but our experience
of working with many different communities highlights how very
diverse the HIV epidemic is. Tailoring multi-faceted prevention
strategies to specifically address national and local needs is
critically important to national prevention planning.
Multi-lateral funding mechanisms such as the
World Bank MAP programme and the Global Fund allow for country-driven
prevention responses and must be supported in any global HIV prevention
strategy. The success of prevention programmes will ultimately
depend on coordinated, scaled up country action.
National governments, in partnership with civil
society and affected communities, must drive the process of expanding
prevention services and their specific needs and capacities will
shape their own strategies and their scaled up activities.
INCORPORATING HIV
INTO BROADER
DEVELOPMENT STRATEGIES
HIV/AIDS plays a central role in the development
agenda and development efforts must be designed to reduce inequalities
that increase vulnerability to HIV.
Although some progress has been made in adapting
development policies and programmes to respond more appropriately
to HIV, much more needs to be done. In particular, development
efforts must be designed to reduce gender inequities and enhance
economic and political opportunities for women and girls.
The inextricable links between poverty, HIV
vulnerability and the ever-increasing impact of the epidemic are
well established, but these links remain largely unaddressed in
HIV programming.
In many developing countries HIV prevention
continues to inadequately address the causes and consequences
of social and economic deprivation, which in turn lead to HIV
vulnerability.
HIV/AIDS programming must therefore:
— be integrated into poverty alleviation
strategies;
— feed into the assessments and
analysis of human vulnerability and livelihood strategies;
— be more effectively integrated
into, and strengthen, existing sexual and reproductive health
services; and
— revitalise some of the fundamental
approaches to public and primary health care developed over previous
decades.
Development policies need to be sensitive to
the exclusion and inequality experienced by people with HIV/AIDS
and populations particularly vulnerable to HIV, including sex
workers, men who have sex with men and injecting drug users.
HIV prevention strategies need to be included
much more extensively within Poverty Reduction Strategy Papers
and all other country led development strategies.
RECOGNISING DIFFERENT
EPIDEMIC DYNAMICS
AND DEVELOPING
A MULTIFACETED
APPROACH
We must acknowledge that distinct epidemics
require distinct approaches. One size does not fit all. This is
the case for both countries with generalised and concentrated
epidemics. Greater attention has to be given to understanding
transmission patterns in each different context. Greater attention
and time to social ethnography and community mapping is critically
important to planning effective interventions as they provide
both evidence about transmission dynamics and HIV prevention need—the
"blueprint" for HIV prevention planning.
This is particularly the case in mapping out
and designing effective responses for countries currently experiencing
concentrated epidemics. It is essential that we do not shy away
from recognising that transmission is occurring amongst priority
groups and set out measures to protect them.
The Alliance Frontiers Prevention Programme
(FPP) aims to make a significant contribution to reducing HIV
infection in three relatively low prevalence countries—India,
Cambodia and Ecuador—by working alongside key populations
(sex workers, injecting drug users and men who have sex with men),
delivering a comprehensive package of interventions within specific
geographical sites that are seen as potential high HIV transmission
areas. Addressing the HIV prevention needs of populations key
to HIV epidemics has the potential to reduce the overall impact
on the general population.
11. The UK Government's response; opportunities
to make a world of difference
The UK Government's response to the HIV needs
of key populations is undeniably moving in the right direction
but with relatively small modifications the UK could make a much
greater contribution, including through:
— improved international political
and policy leadership;
— improving multilateral understanding
and action on HIV and human rights;
— bringing greater coherence to
the UK's approach to the global AIDS pandemic;
— providing international leadership
on the rights of sexual minorities;
— strategy development, implementation
and monitoring.
IMPROVED INTERNATIONAL
POLITICAL AND
POLICY LEADERSHIP
In its leadership role in international policy
fora, the UK Government, specifically Secretary of State Hilary
Benn, Minister for International Development Gareth Thomas, and
senior DFID officials remain strong and outspoken supporters of
the rights of marginalised populations to access services, and
to protection from human rights violations. This work is rare
and precious in environments where it is much easier for leaders
to speak about mothers and children than it is to speak about
male to male sex and injecting drug use, as the Secretary of State
did at UN High Level Meeting in June this year. Similarly the
EU's statement on HIV prevention launched on World AIDS Day last
year during the UK's Presidency, the UK's own statement on injecting
drug use and harm minimisation and the commitment to fighting
for evidence based prevention in the UNAIDS HIV prevention strategy
process—are all enormously important examples of progressive
policy leadership which the Alliance applauds.
However we believe that the UK Government could
make a vital contribution to progress in this area by taking the
initiative in the following areas.
IMPROVING MULTILATERAL
UNDERSTANDING AND
ACTION ON
HIV AND HUMAN
RIGHTSAs already stated while
there is widespread, though not universal, recognition that stigma
and other rights violations fuel the epidemic and that many people's
rights are seriously harmed by HIV, these basic understandings
are not adequately reflected in law and policy, or in HIV programming.The
move towards universal access to prevention, care and treatment
demonstrates the potential of concerted international attention
and action. We need to see the same focus given to protecting
and advancing the human rights of those most affected by HIV and
AIDS.
The UN Secretary General's Note, Scaling
up HIV prevention, treatment, care and support, [15]describes
in detail some of the necessary human rights interventions to
bring about universal access, but these interventions do not appear
in the Political Statement arising out the High Level Meeting
or in any international action plans.
We are calling for the development and implementation
of a global action plan on HIV and human rights which would help
mobilise national, regional and international action to protect
and to promote human rights—thereby helping to prevent HIV
and mitigate its most negative effects.
The plan would identify those actions necessary
to advance human rights, focusing on reducing HIV vulnerability
and protecting the rights of affected communities. Following its
development, international expertise and funding could be identified
to help the UN, Member States and civil society implement the
plan.
We also believe that the international community
in general and the UN system in particular needs to enhance its
understanding of the human rights violations which fuel the epidemic
and which also follow infection. Above all they must understand
how to protect and promote people whose rights are all too routinely
violated.
Whilst the Alliance welcomes the integration
of HIV/AIDS into the work of some of the UN's human rights mechanisms,
the relationship between HIV/AIDS and human rights violations
continues to go unaddressed in a variety of UN fora.
In order to help overcome this problem and to
create a focal point for analysis and policy development at the
UN we are proposing the appointment of a Special Rapporteur on
HIV and Human Rights by the new UN Human Rights Council. The Special
Rapporteur would act as the focal point for UNAIDS' work in leading
the development and implementation of the Human Rights Action
Plan recommended above, and would make an important contribution
to generating the interest and political will necessary with the
UN family and among member states for the UN to tackle HIV-related
human rights violations.
It is very clear that a step change in our commitment
to human rights is necessary if we are going to make them a reality
for people living with and affected by HIV. The changes needed
to achieve this at the international level will only come about
if there is a clear focus backed up by an ambitious and funded
plan.
We urge the International Development Committee
to recommend that the UK sponsor a resolution for the creation
of the Special Rapporteur on HIV and Human Rights at the UN Human
Rights Council and convene an international meeting to begin the
process of developing an International HIV and Human Rights Action
Plan.
BRINGING GREATER
COHERENCE TO
THE UK'S
APPROACH TO
THE GLOBAL
AIDS PANDEMIC
Whilst the role of the Foreign Office in advocating
for a progressive approach to AIDS through its international policy
and diplomatic efforts is referred to briefly in Taking Action
there is little evidence to suggest that the Government has a
coherent strategy for implementing that approach.
Significant gains in HIV prevention and impact
mitigation could be made through UK efforts outside the remit
of the Department for International Development. The Foreign Office's
efforts aimed at promoting good governance, respect for human
rights, democratic principles and sound management of natural
resources through programs such as the Global Opportunities Fund
do not currently adequately consider opportunities to advance
the UK's commitment to universal access to HIV treatment, prevention
and care.
We believe that opportunities also exist to
promote the UK's HIV related foreign and development policy through
better use of the FCO's public diplomacy, drugs and crime and
global conflict prevention programs.
We urge the International Development Committee
to call on both DFID and the Foreign Office to work together to
develop a UK strategy for integrated action on HIV internationally.
PROVIDING INTERNATIONAL
LEADERSHIP ON
THE RIGHTS
OF SEXUAL
MINORITIES
The rights of sexual minorities are amongst
the least recognised and protected in international law and national
practice.
The failure to recognise sexual minority rights
and to provide protection for them fuels an AIDS pandemic and
inhibits effective responses to it.
The UK has an excellent record domestically
on advancing the rights and status of sexual minorities including
gay and other men who have sex with men, transgender and intersex
persons and is therefore well placed to leverage its commitment
at home for improvements in the situation for individuals from
these groups internationally.
To begin that process the Alliance is asking
the International Development Committee to recommend that the
UK Government appointment a Special Representative for Sexual
Minority Rights.
The appointment of a Special Representative
on Climate Change within the Foreign and Commonwealth Office[16]
provides a model for these recommendations.
The UK has a very extensive diplomatic network
and powerful diplomatic assets which it can deploy in pursuit
of this exercise and in support of its stated commitment to universal
access for marginalised groups. A Special Representative acting
within government and on behalf of the UK internationally could
be tasked with developing a shared understanding of the human
rights situation for sexual minorities together with increasing
the political and community support for better promotion and protection
of their rights nationally and intern rights of sexual minorities.
STRATEGY DEVELOPMENT,
IMPLEMENTATION AND
MONITORING
DFID's AIDS Strategy, Taking Action,
refers to vulnerable populations consistently, but without setting
out any specific actions to guide DFID programming. Despite this,
we know that DFID support work with men who have sex with men
in Latin America and the Caribbean, with drug users in China,
and with sex workers in Cambodia. What this work lacks however,
is a unified and demonstrable strategy that sets out work with
vulnerable populations as a high priority in terms of its in-country
programmes, and that allocates specific resources towards meeting
the HIV related needs of these groups, supporting efforts that
protect and promote their rights and closing the HIV services
gap for them.
The absence of a more developed policy and an
action plan, with a system for allocating and monitoring resource
use means that it is currently impossible to properly assess DFID's
commitment to and action in this area.
Without such a plan the UK will not be able
to assess whether it is doing enough at sufficient speed to improve
the situation for members of key populations affected by HIV in
the developing world.
DFID's higher corporate goals to address the
world's poorest people can lead to some conflict of purpose here.
Addressing highly vulnerable populations in emerging HIV epidemics
requires a shift in broader DFID policy that currently prioritises
its support to highly impoverished countries, namely many African
countries. Given that the highest burden of AIDS remains in Africa,
it is entirely appropriate that Africa remains the central focus
for DFID's AIDS spend, but it must not be at the exclusion of
work with marginalised populations in concentrated or emerging
epidemics.
The Alliance invites the International Development
Committee to recommend that the Secretary for State instruct the
Department for International Development to develop a strategy
for implementing its commitments in Taking Action for vulnerable
populations, which would include funding parameters and a monitoring
system which can track spending and results against the strategy.
October 2006
6 UNAIDS (2006). Report on the global AIDS epidemic.
http://www.unaids.org.en/HIV data/2006GlobalReport/default.asp Back
7
UNAIDS (2006). Report on the global AIDS epidemic. Back
8
UNODC (2004). 2004 World drug report. Vienna. Back
9
Joint UNAIDS statement on HIV prevention and care strategies for
drug users. Geneva. Available at http://www.unaids.org/html/pub/una-docs/cco_idupolicy_en_pdf.pdf Back
10
UNAIDS, HIV/AIDS and Human Rights: International Guidelines,
September 1996. Back
11
SAID, UNAIDS, WHO, CDC and the POLICY Project, Coverage of
selected services for HIV/AIDS prevention, care and support in
low and middle income countries in 2003 , Washington, June
2004. Back
12
NAIDS (2006) Report on the Global AIDS Epidemic. Back
13
ersonal communication, UNAIDS staff, October 2006. Back
14
inancial resources for HIV/AIDS programmes in low- and middle-income
countries over the next five years. UNAIDS, November 2002. Back
15
www.unaids.org Back
16
Margaret Beckett appoints New Climate Change Representative,
08/06/06, viewed at http://www.fco.gov.uk/servlet/Front?pagename=OpenMarket/Xcelerate/ShowPage&c=Page&cid=1007029391638&a=K
Article&aid=1148476529299 Back
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