Ending HIV: ideology vs evidence at the UN

This week’s negotiations over the UN’s Political Declaration Ending AIDS are rife with circular debates, and sex, gender and sexuality are flashpoints of polarization. 

Susana T. Fried
8 June 2016

"Ending AIDS requires evidence-informed, rights-based global leadership”. Photo: UNAIDS

When you hang around the United Nations long enough, you hear some of the strangest things.  In the past few months, I’ve been following the process leading up to the UN High Level Meeting on Ending AIDS (8-10 June) in New York.  In advance of the meeting, Member States of the UN have been negotiating a Political Declaration on Ending AIDS that’s supposed to represent the way forward. Though one might hope that such a global stocktaking would be dominated by conversations that move us toward a vision for “ending AIDS epidemic by 2020,” it has been quite the contrary. The space of diplomacy in 2016 is often rife with circular debates in which wealthy countries resist financial commitments for addressing key concerns, and evidence-informed information is contested by extremist politics and conservative ideas about gender, sex and sexuality.

In the current negotiations three disputes have reached new heights of absurdity: first, whether we can “name” the communities that are most affected by HIV globally - “key populations”- composed of men who have sex with men [MSM], transgender women, drug users and sex workers; second, whether evidence supports the claim that gender-based violence increases women’s and key populations’ vulnerability to HIV; and third, whether we can name “comprehensive sexuality education” as one important strategy to reduce vulnerability to HIV and increase access to services. The debates illustrate a toxic combination of cowardice, misogyny, homo-and trans-phobia, religious fundamentalism, and a closing of space for realistic discussion of how to solve pressing global challenges by governments and civil society together.

The term “key populations” itself, as well as the groups that it encompasses, has been contested regularly by a number of member states of the UN. The resistance to using the term stems from a view that simply naming key populations acknowledges their existence without judgement. This might seem bizarre in the context of HIV where there is an abundance of evidence about “key populations” carrying the greatest burden of HIV across epidemic contexts.  Perhaps this represents magical thinking that if “we don’t name them, they will go away.”  This fantasy hampers effective HIV responses that require the full meaningful participation of all the people who are most affected.  Not surprisingly civil society groups are contesting attempts to exclude and misrepresent:  in a strongly worded statement, the Global Forum on MSM and HIV and the Global Network of Sex Work Projects noted:

We emphatically reject revisionist characterizations of the global HIV epidemic.  We do not accept negative characterizations of men who have sex with men, sex workers, transgender people, and people who inject drugs, and we certainly disagree with the idea that key populations are only worthy of mention in the context of discussions about risk – especially since it reinforces old stereotypes about our communities as being irresponsible.  We are not surprised by these actions because using key populations as a political wedge is a routinely employed tactic by governments to subjugate, oppress, debase, and belittle its citizens. These are also tactics deliberately used to throw activists off their game and to distract global attention away from State-sanctioned abuses and corruption.

BCopyrightUNAIDSpeople-final-1 (1).jpg

Governments’ effort to mischaracterize and deny the association between gender-based violence and HIV is another example of the misinformation game being played at the UN. Fifteen years ago, at the time of the  2001 Declaration of Commitment (the outcome document from the UN General Assembly Special Session on HIV), evidence about the association between gender-based violence and HIV was extremely limited.  While we had many testimonies, observations and logical analyses of the connection, there was almost no well-documented epidemiological evidence demonstrating the relationship. Over the past fifteen years this has changed, and today we have solid empirical evidence of the connection. The fact that some member states seek to deny the connection shows how many governments still refuse to grapple with the extensive reality of gender-based violence, especially violence against women and girls and violence against “key populations” (those unmentionable men who have sex with men, transgender people, drug users and sex workers).

Finally, the current draft of the Political Declaration contains no reference to “comprehensive sexuality education.”  This despite the fact that the draft declaration itself notes that “that only 36 per cent of young men and 28 percent of young women (15-24) possess accurate knowledge of HIV, and that laws and policies in some instances exclude young people from accessing sexual and reproductive health-care and HIV-related services..."  Comprehensive sexuality education (CSE) means the provision of scientifically accurate, non-judgmental information about the body and puberty; including education about bodily development, sex, sexuality, and relationships, along with skills-building to help young people communicate about and make informed decisions about sexual health and sexuality. It attempts to empower people to deal positively with their sexuality, protect themselves from unwanted pregnancy, HIV and sexually transmitted infections, learn values of mutual respect and non-violence in relationships, and have the ability to plan their sexual and reproductive lives.  Almost 80 per cent of countries have policies or strategies in place that support CSE. That some governments seem to see this important health and education strategy as anathema rather than essential to national HIV responses is scientifically indefensible and substantively difficult to explain. It represents a potentially life-threatening triumph of ideology over common sense.

Such disagreements illustrate how the process leading up to this High Level Meeting on Ending AIDS has been fraught.  At the outset, a number of global and regional HIV networks focusing on LGBTI and drug users were excluded from participation. This isn’t unusual, especially as UN spaces today are marked by highly polarized ideological differences among governments and a persistent effort to close the space to active civil society engagement.  However, given the urgency of engaging, educating and ensuring the exercise of rights for those who are most affected by HIV – women and girls (especially adolescent girls and young women in Eastern and Southern Africa), “key populations” (men who have sex with men, transgender women, people who inject drugs and sex workers), and young people – the choice to proffer ideology over evidence means that this meeting on ending AIDS unfortunately won’t meaningfully move us in that direction.

The battle between ideology and evidence is set to continue at this week's UN High Level Meeting on Ending AIDS.

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