UN Commits to More HIV Treatment, but Key Populations Are Excluded


United Nations member states last week agreed to new targets for getting more people with HIV on treatment by 2020 and ending the AIDS epidemic as a public health threat by 2030 at the UN General Assembly High-Level Meeting on Ending AIDS. But a coalition of conservative countries was able to exclude civil society groups representing gay and transgender people and people who use drugs -- key affected populates that advocates say must be part of the conversation.

The UN's 193 member states adopted a "new and actionable" Political Declaration on Ending AIDS.The declaration includes a set of specific, time-bound targets that must be reached by 2020 in order to end the AIDS epidemic by 2030 within the framework of the UN's Sustainable Development Goals, according to a UNAIDS press release.

"The world has an opportunity to end an epidemic that has defined public health for a generation," said UNAIDS executive director Michel Sidibé. "The decisions made here, including the commitment to zero new HIV infections, zero AIDS-related deaths, and zero discrimination, will provide the springboard for the implementation of an innovative, evidence-informed and socially just agenda that will end the AIDS epidemic by 2030."

Since the last United Nations General Assembly Meeting on AIDS was held in 2011 there has been remarkable progress in responding to the global epidemic.

In advance of the this year's meeting, held June 8-10 in New York City, UNAIDS released its Global AIDS Update 2016, showing that 17 million people are now receiving antiretroviral therapy. Yet about half of people living with HIV are not yet on treatment, and the number of new infections has remained roughly stable since 2010.

The World Health Organization now recommends antiretroviral treatment for everyone diagnosed with HIV, regardless of CD4 T-cell count. The UNAIDS Fast-Track approach to ending the epidemic includes reducing the number of people newly infected with HIV from 2.1 million in 2015 to fewer than 500,000 in 2020, reducing the number of people dying from AIDS-related illnesses from 1.1 million to fewer than 500,000, and eliminating HIV-related discrimination -- a harder target to measure.

The meeting declaration focused on the effectiveness of therapy as well as the number of people on treatment, reaffirming the UNAIDS 90-90-90 targets of 90% of people living with HIV diagnosed, 90% of diagnosed people on ART, and 90% of people on treatment with undetectable viral load by 2020.

Key Populations Left Behind

The High-Level Meeting brought together heads of state, government officials, researchers, international organizations, and people representing the private sector and civil society, but some of the groups most heavily impacted by HIV and AIDS were not allowed to fully participate.

In the weeks leading up to the meeting, Russia, Egypt, Iran, and several African and Arab Gulf States were able to exclude 22 non-governmentalorganizations representing gay and transgender people, sex workers, and people who use drugs by rejecting their accreditation.

These and other conservative countries spearheaded efforts to remove references to HIV prevention, treatment, and harm reduction services for these groups, as well as the need to repeal discriminatory and punitive laws against them, Aidsmap reported. Some countries also objected to mentions of gender equality, contraception, and comprehensive sex education.

In response, activists from more than 20 countries walked out of the meeting and demonstrated outside UN headquarters to protest the exclusion of the key affected groups and to demand more funding to reach the 2030 targets. 

"The declaration negotiation process has been marked with polarization of member states defending extreme positions based on political, religious and cultural values rather than science and evidence based interventions," according to the International Treatment Preparedness Coalition.

"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," a coalition of advocates including the Global Forum on MSM, the Global Network of Sex Work Projects, and the Global Action for Trans Equality said in a statement. "The Final Declaration damagingly excludes and misrepresents key populations.  It also lacks an explicit commitment to support and finance key population-led and tailored prevention, care, and treatment services. Likewise, it is woefully misses the mark in highlighting legal and policy frameworks that stigmatize and criminalize our communities worldwide."

"The bigotry on display during these negotiations has been astonishing," Jamila Headley of Health GAP concurred. "After 35 years of the AIDS crisis, governments must know they can't end AIDS until they end deadly exclusion and human rights violations."

Recent data from UNAIDS suggests that in 2014 more than 90% of new HIV infections in North America, Europe, the Middle East, North Africa, and Central Asia -- and more than 60% in Latin America, the Caribbean, and the Asia and Pacific region -- occurred among people in key populations and their sex partners. Men who have sex with men and people who inject drugs are 24 times more likely, and sex workers are 10 times more likely, to acquire HIV than adults in the general population, according to UNAIDS.

During the high-level meeting the U.S. announced that the President’s Emergency Plan for AIDS Relief (PEPFAR) would allocate US$100 million to a multi-year Key Populations Investment Fund to expand access to HIV services for heavily impacted groups, in an effort to help close the gap between those who have access to HIV prevention and treatment services and those who are being left behind.

"It is unacceptable that key populations still face stigma, discrimination, and violence, which impede their ability to access quality HIV services," said Ambassador Deborah Birx, the U.S. Global AIDS Coordinator and Special Representative for Global Health Diplomacy. "PEPFAR stands firmly and unequivocally with and for key populations, defined by UNAIDS as gay men and other men who have sex with men, transgender people, sex workers, people who inject drugs, and prisoners, and we are deeply committed to protecting and promoting their health and human rights."

"In order for key populations not to be left behind in the global HIV/AIDS response we must ensure that specific barriers are addressed," according to a PEPFAR press release. "These include the lack of acceptance of human rights of all persons, without distinction; systematic and rigorous measurement and monitoring of stigma and discrimination and clear actions to mitigate; access to quality services for key populations; availability of disaggregated data by key populations; and focus on improving the capacity of key populations-led, community-based organizations not only to advocate for changes in policies but also directly implement services."



UN General Assembly. Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and to End the AIDS Epidemic by 2030. June 7, 2016.

UNAIDS. Bold New Political Declaration on Ending AIDS Adopted in New York. Press release. June 8, 2016.

HealthGAP. Global AIDS Activists Sound Alarm at UN: World Leaders Have Blood on Their Hands. Press release. June 8, 2016.

Global Forum on MSM and HIV et al. A High-Level Failure for the United Nations on Key Populations. Press release. June 8, 2016.

PEPFAR. PEPFAR Announces New $100 Million Investment Fund to Expand Access to Proven HIV Prevention and Treatment Services for Key Populations. Press release. June 9, 2016.