The HIV/AIDS pandemic has destroyed or damaged the lives of many tens if not hundreds of millions of people across the world. The World Health Organisation reports that in 2014 39.9m people worldwide were living with HIV or AIDS, and that 1.2m died from AIDS-related illnesses – and the disesase continues to disproportionately affect the most vulnerable people and societies.
Now a new attempt has been made to rally the world behind a strategy. The 2016 High-Level Meeting on Ending AIDS, held at the UN General Assembly, focused on the importance of accelerating the response to HIV with a view to ending the pandemic by 2030, and reached a political declaration that sets targets to “[end the epidemic as a public health threat by 2030](](http://www.un.org/apps/news/story.asp?NewsID=54172)”.
But ambitious as it is, the declaration fails to address one of the most crucial factors driving the pandemic: discrimination along the lines of racism, sexism, homophobia, and transphobia, as well as religious fanaticism and denials of societal problems such as gender-based violence.
The meeting and the declaration made it clear that many states still prioritise their own political objectives over the need for education, awareness-raising, and the ending of discrimination. A great many countries simply refuse to acknowledge that the discrimination and intolerance they still incubate are major factors in the disease’s spread.
They refuse to champion education and awareness-raising about the disease, particularly within marginalised and vulnerable groups. Instead, they persist with policies, practices and beliefs that create precisely the social conditions in which the virus can spread faster.
This is a major obstacle in the fight to limit and stop the advance of the disease. As the international advocacy organisation AIDS-Free World has long argued, “when discrimination ends, so will AIDS”.
As the academic Susana T Fried explained, there are three main reasons this persists: a refusal to name the communities most affected globally by HIV and AIDS, namely men who have sex with men, transgender women, drug users and sex workers; efforts to dismiss or downplay the clear evidence that gender-based violence plays a significant role in the spread of HIV; and efforts to block the declaration from stressing the need for comprehensive sex education.
Standing in the way
Anyone who follows events at the UN will not be surprised to learn that the countries at the forefront of undermining this latest effort are countries where homophobia, transphobia, gender-based violence, gender-discrimination, religious fanaticism, and intolerance of minority religions and beliefs are encouraged or tacitly approved by state laws and practices.
More than 70 UN member states criminalise the acts or identities of sexual and gender minorities. If the declaration from the 2016 meeting named the communities that these states marginalise and abuse, it would effectively force them to acknowledge that those groups exist and are vulnerable rather than criminal. And that in turn could actually require states to provide these people with health and other services.
But as so often happens when it comes to human rights at the global level, there’s a dangerous paradox here. Even if language acknowledging vulnerable people could be forced into the declaration, it wouldn’t necessarily protect these people from their own governments.
People trying to access HIV/AIDS services grudgingly provided by inhospitable states (if they did indeed provide them) would effectively be “outed” to the authorities. And identifying such groups as “vulnerable” could well be used to further stigmatise, belittle or oppress their members.
More dispiriting still, these matters have received too little attention at the General Assembly, and the motivations of the states trying to block them have gone largely unchallenged.
Many countries where gender discrimination remains entrenched within law and culture haven’t even accepted that gender-based violence is a problem, let alone moved to address it. Those states have blocked any effort to acknowledge the clear evidence of the link between gender-based violence and the spread of HIV. They have no incentive to acknowledge that this abuse leads to the disproportionate spread of HIV amongst victims (almost always women and girls).
Equally, countries marked by religious fanaticism and intolerance of minorities are generally unlikely to support comprehensive sex education. In many such countries, sexual, reproductive and bodily autonomy directly contradict laws, practices and norms once again, particularly when it comes to women and girls.
One way forward
If these obstacles cannot be cleared, the world stands little chance of finally halting the spread of HIV, preventing AIDS-related deaths, and ending the abusive practices that have allowed and enabled the global pandemic to continue.
Still, simply criticising those countries for bringing their national political agendas to the table makes little sense. After all, as the legendary diplomat Sergio Vieira de Mello pointed out, UN members criticising other countries for being political is akin to fish criticising each other for being wet. But it’s equally senseless to expect multilateral negotiations between states who have vested and politicised interests in watering down the text of a declaration until it’s no longer fit for purpose.
This global health crisis requires the sort of response seen during any other time of grave public emergency: expert-led norms, policies and practices imposed upon all states across the world irrespective of whether they contradict national attitudes and agendas on gender, sex, religion or the restriction of the rights of minorities.
That is not statement of colonial intent. It is an already established norm. We already aim to enforce global laws on many other global threats to human life; we should do the same to combat this disease.