Memorandum by the Terrence Higgins Trust
Terrence Higgins Trust (THT) is the largest
and oldest HIV service organisation in the UK, currently providing
advice, social care health promotion, testing and policy services
across England, Scotland and Wales. Although this service remit
is UK specific, THT has always collaborated with intergovernmental
organisations in sharing expertise and supporting global initiatives
to reduce the spread of HIV, to increase understanding of it and
support for the human rights of people with HIV and communities
at greatest risk.
Apart from the European Union, the two intergovernmental
organisations with which THT has most contact are the World Health
Organisation and UNAIDS. For the former, we have most recently
undertaken a review of the impact of the Dublin Declaration on
Partnerships for an Effective Response to HIV for the most vulnerable
and at risk populations across Europe. For the latter, we have
conducted a survey of criminal laws relating to HIV transmission
(with the Global Network of People with HIV) and we are to serve
on a new Task Team on global travel restrictions for people with
HIV. We are also responsible for co-ordinating the UK Civil Society
report on progress to the UN General Assembly Special session
(UNGASS).
It is THT's belief that these bodies, both in
the work we have been closely associated with and elsewhere (such
as the Global Fund for HIV, TB and Malaria) have provided vital
support and co-ordination in the global fight against HIV. Clearly,
like all bureaucracies (particularly multinational ones) there
are times when talk appears to overwhelm action but in general
we have been much better off with them than we would have been
without them.
In particular, the emphasis of these bodies
on not only clinical and epidemiological issues, but also on humanitarian
and legal concerns and social constraints have made a significant
impact on what is, in every country, a stigmatised and discriminated
against condition. Because of the nature of HIV transmission,
it thrives on denial, secrecy and silence and, in particular,
has in recent decades grown fastest in countries whose governments
have denied its existence or extent: South Africa; Russia; China
and, until recently, India.
The work of both the WHO and UNAIDS has challenged
governmental silence, given levers that can empower communities
to act for themselves and ensured that people's rights—to
health, to basic necessities and to legal protection and family
life—have been supported and the subject of international
scrutiny however great the national stigma of HIV.
Controversy has dogged HIV throughout the 25
years in which it has been known, and continues to do so. Global
surveillance figures have been challenged; treatment availability
and cost has caused strong debate and even civil action; the causes
of the virus distorted or denied. Yet throughout this, intergovernmental
organisations have played a vital, often under-acknowledged role
in ensuring that HIV is not forgotten or relegated and that recalcitrant
governments are coaxed into facing their responsibilities to those
within their boundaries with HIV and at heightened risk of it.
It is the view of THT that while there are many
causes for the ongoing spread of HIV—poverty, ignorance
and stigma—the greatest block to action against them is
a deficit in political leadership on the issue and in governmental
willingness to consider something which combines a number of social
taboos. Intergovernmental organisations such as UNAIDS and WHO
are therefore vital in creating pressure for improved political
leadership, because few governments care to be found lacking or
ineffective by their peers.
Despite the positive role which these organisations
have played, HIV (sometimes in tandem with TB or Hepatitis C)
continues to be a major global problem. But without their, and
other NGO, work in drawing attention to growing in country epidemics
and in ensuring attention was paid to resourcing education and
prevention, this could well have been—and could well still
be—considerably worse.
In addition to coordinating and contributing
to direct action on HIV, intergovernmental organisations also
play a role in shaping international legislation and regulation.
This impacts in areas such as human rights, access to HIV treatment,
the continuing development of new drugs and ongoing HIV research.
For example, the cost of HIV drugs has historically been the biggest
barrier to access to treatment in developing countries and has
been overcome through the WTO TRIPS Agreement and the granting
of generic licenses for drug manufacture. This has meant that
countries such as Thailand and India have been able to supply
drugs to those who need it at a vastly reduced cost. The continued
work of organisations such as the WTO will be vital to ensure
continued access to medication, as in-country intellectual property
legislation develops and new political and commercial pressures
are brought to bear on developing countries with HIV epidemics.
HIV will continue to be a major international
concern for decades to come, with 2.5 million people newly infected
in 2007 alone. With continuing improvements in the spread and
accessibility of effective treatments, this means increasing numbers
of people living with HIV each year. It will be vital for governments
to continue to make and improve provision for people with HIV
within their health and social care, and to fight for the eradication
of social stigma which helps to spread the virus and hinders outreach
to prevent its transmission.
The future role of intergovernmental bodies
in addressing this stigma and other human rights abuses which
fuel the spread of HIV, as well as their support in rolling out
treatment availability and best healthcare practices, will continue
to be an important one. It is THT's view that the United Kingdom
should continue to play a strong guiding and supporting role in
these organisations in order to fulfil our international duties,
in particular through the excellent work of DFID and in supporting
the Global Fund to fight AIDS, TB and Malaria.
February 2008
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