J.V.R. Prasada Rao
Former UN Special Envoy on AIDS, Asia Pacific
APCOM HIV/AIDS Ambassador
“This is a make or break situation for the global AIDS response. Any slippage in achieving the 2025 targets will further set the programme off track and the 2030 goal of ending AIDS will remain a distant dream.”
The historic adoption of the political declaration on HIV/AIDS by the UN General Assembly (GA) on 9 June 2021 is one more landmark in the chequered history of global AIDS response. The trigger for global attention to the AIDS pandemic was the 2001 declaration in a Special Session of the UN General Assembly in 2001, a first of many sorts. It was the first time that the GA had dedicated a special session for a disease response and the Security Council to adopt a resolution declaring HIV/AIDS as a security issue and not just a health-related problem. The establishment of the Global Fund and PEPFAR provided a strong resource base for the response.
During the 10 years that followed the declaration, the world has seen an unprecedented flurry of activity at country and regional level to rein in the raging AIDS epidemic. The march of the epidemic was halted and reversed in many countries and mortality has come down substantially with the anti-retroviral treatment becoming affordable to developing countries for inclusion in their national plans and programmes.
But no one had thought the success would lead to complacency, while it should have motivated the countries to perform better. By 2015 clear signs of the response slowing down were visible, but hopes were revived by the combined political will of countries who unanimously adopted the historic SDG agenda with 17 clear cut goals to be achieved by 2030. Ending AIDS by 2030 as a public health concern was one of them. It was followed by a high-level meeting on AIDS in 2016 where ambitious targets for 2020 were set on prevention, treatment, improving legal environment and elimination of mother to child transmission.
The following 5 years have seen further slowing down of the response with reduced investment both domestic and foreign and withdrawing of bilateral funding for AIDS by most of the traditional donors. The Global Fund and PEPFAR remained the only external funding sources for AIDS programmes. The joint UN programme on AIDS (UNAIDS) lost its effectiveness in re- energizing the global response because of its own internal management challenges.
The 2021 High-Level Meeting on HIV/AIDS, held in this backdrop, faced many challenges because of the entire global programme going off track. The new UNAIDS global strategy and the UN Secretary General’s report issued a few days before the HLM both expressed serious concern at the lagged response to AIDS in most of the member countries that failed to achieve any of the goals set for 2020. Civil society and key populations were equally concerned about the marginalization of the UN involvement in AIDS response in member countries across all regions, more so in Eastern Europe and Central Asia and the Middle East. In Asia Pacific 98% of the new infections were occurring among the key populations. Essentially, AIDS had become a key populations’ concern more than anyone else’s.
The negotiations on the zero draft of the political declaration had seen countries taking traditional positions on contentious issues like sexual and reproductive health and rights, comprehensive sexuality education, harm reduction and OST programmes for drug users and condom promotion programmes for sex workers. The hard work put in by the co-facilitators from Australia and Namibia and the leadership role taken by the US, European Union, India and Thailand ultimately paid dividends and a declaration acceptable to the majority of the countries was finalized for adoption. The GA took the unprecedented step of going for a vote and the declaration was finally adopted by all member countries, except for Russia and three others who voted against.
We do not know much about the behind-the-scenes negotiations but the intervention from the US delegate reveals that some important language had to be dropped for the sake of consensus, especially on issues like comprehensive sexuality education. On the positive side, the main concerns of key populations have all been prominently addressed in the document. Integration with Universal Health Coverage and the general health care system has been given prominence and alternative service deliveries were provided for the countries to work out the best possible combination. Resources of $ 29 billion per year were committed by 2025. New technologies like PreP and HIV self-testing were advocated. The 95-95-95 target was adopted for treatment of HIV positive persons. Elimination target for EMTCT has been shifted to 2025, five years beyond the original target of 2020.
Response to the Political Declaration (PD) has been muted and guarded this time because of the experience of the last five years when the lofty commitments made in the 2016 PD were given a go-by and a business as usual approach continued in many countries. The PD was received with skepticism on whether the commitment at the global forum will be translated into effective action. Moreover, the raging Covid-19 epidemic is bound to push any other agenda to a low priority for the next two years.
This is a make or break situation for the global AIDS response. Any slippage in achieving the 2025 targets will further set the programme off track and the 2030 goal of ending AIDS will remain a distant dream. It is now up to the country leadership and UNAIDS to spur into action by mobilizing political support and resources to fund priority intervention programmes to put the response back on rails. Civil society, especially the key populations, has to be vigilant to any further slippage occurring in the country responses. The activism of the late nineties which resulted in an exceptional response needs to be revived to hold the leadership at all levels accountable for performance and results. The goal of ending AIDS is achievable but looks daunting at the current stage of response.
Watch the HLM Here
8 June 2021
9 June 2021
10 June 2021
More information on the HLM:
- Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030
- United Nations High-Level Meeting on AIDS draws to a close with a strong political declaration and bold new targets to be met by 2025