HIV, Rights and Law in the Era of the 2030 Agenda for Sustainable Development
Rt Hon Helen Clark
Keynote Speech at the opening of Global Dialogue on “HIV, Rights, and Law in the Era of the 2030 Agenda for Sustainable Development”. Amsterdam, 22 July 2018.
It is a great pleasure to be speaking today at this Global Dialogue on HIV, Rights and the Law in the Era of the 2030 Agenda for Sustainable Development. In my comments today, I will reflect on:
The importance of the landmark report of the Global Commission on HIV and the Law, and the action it spurred; and
The need to stay the course on advocacy for the abolition of the bad laws which are such a significant barrier to effective responses to the HIV epidemic.
Let me note at the outset, however, that the era of the 2030 Agenda is not the only era in which we are living. That Agenda and the SDGs agreed in 2015 offer hope for a better world for all. For key populations vulnerable to HIV and for all people living with HIV, there is the prospect of inclusion, voice, agency, and good access to prevention and treatment services. The future painted by Agenda 2030 is a transformational one – and one that is badly needed.
But, jostling alongside it, there are other visions of the future – those of the authoritarians and populists who have very different ideas. Their grasp on power is based on appealing to the worst in human nature – not to the best as Agenda 2030 does. Where they hold sway, the chances of getting the political leadership required to tackle the entrenched inequalities, discrimination, and stigmatization which contribute to the HIV epidemic are slim. This is a barrier to achieving not only the SDG target of ending AIDS, but also to achieving many other SDGs too.
The Global Commission on HIV and the Law was formed by UNDP in 2010 to improve understanding of how good law could improve HIV responses and to make recommendations accordingly. Naturally in HIV responses there is and always will be a strong focus on access to prevention and treatment services. But these are never provided in a vacuum. The law of the land may be a significant barrier to key populations receiving the services they need. In such an environment, the services can’t do their job.
My support as UNDP Administrator for the Commission’s work was based on witnessing the importance of changes to the legal environment in the early days of the HIV epidemic in New Zealand – including as a young Health Minister. In my country, the need to respond effectively was a catalyst for the repeal of legislation which criminalised men having sex with men, and for interaction between authorities and marginalised populations which in the past were vulnerable to arrest and detention rather than to engagement on policy and services.
LGBTI, sex workers and people using drugs were all the beneficiaries of these changes which contributed hugely to driving down the rate of HIV infection. In time, sex work too was decriminalised, and the leader of the sex workers was recently awarded a high national honour which recognised her contribution to health and wellbeing in the sector.
The Global Commission Report in 2012 advocated the removal of laws which were discriminatory against any group, including on the basis of actual or perceived HIV status. It advocated the repeal of laws which criminalized HIV transmission, exposure, and non-disclosure. It called for major law and policy changes to uphold the human rights of and reduce stigma against key populations – LGBTI, sex workers, people who use drugs, prisoners, and migrants. It called for better law on sexual and gender-based violence and action to enforce it, and for the removal of all barriers to accessing sexual and reproductive health services. It made recommendations to improve legal and other protections for children impacted by the epidemic, and called for a review and overhaul of the intellectual property regime to ensure access to treatment.
Follow up to the Report
It’s not unknown for reports of commissions to be launched with a fanfare and never be heard of again. But UNDP was determined that that would not happen with this vital report. It demanded follow up, and it got it. UNDP took the Report on the road and has worked in 88 countries to support its recommendations:
22 countries have done detailed legal environment assessments, and these typically lead to recommendations followed by action for reform. Another twenty are planned.
Others have done more focused legal reviews- in the Asia-Pacific region there have been 28 such reviews of their HIV responses.
Another 21 countries across the world’s regions have had some form of national dialogue and action planning on HIV and the Law.
A number of judicial dialogues have been held to inform judicial decision-making on HIV, and among other things spurred the development of the African Regional Judges’ Forum on HIV, Human Rights, and the Law. There have now been a number of landmark human rights-based decisions related to HIV in African courts.
There have been parliamentary dialogues, and also partnerships with the Inter-Parliamentary Union and Parliamentarians Global Action to produce information and guidelines for legislators on effective and rights-based laws.
There has also been work to strengthen the capacity of civil society actors to provide and access legal services and advocate for better law, and there has been some dialogue facilitated between civil society and law enforcement authorities.
As well, former UN Secretary-General Ban Ki-moon agreed that there should be a High-Level Panel on Access to Medicines which could recommend improvements to the intellectual property regime. That panel reported in 2016 and reinvigorated the global debate on access to medicines. UNDP played an important role in supporting the panel.
All this activity has produced results:
Some countries have removed their HIV criminalisation
Some have decriminalised adult consensual same-sex relations.
There is quite a lot of reform going on in the drug law space as more countries come to the realisation that the “war on drugs” approach mandated by the UN conventions has failed. Law reforms to legalise or decriminalize drug use and to regulate are happening. There appears to be a new momentum for innovation in harm reduction measures with more jurisdictions introducing safe consumption spaces and drug testing. These build on the success of the needle exchange schemes introduced in my country and others up to thirty years ago which played such an important role in combating HIV.
So, where now for HIV responses based on human rights and better law?
Later today, a supplement to the Global Commission’s report will be published. It reinforces the 2012 recommendations and makes a number of extra and very specific ones – all of which if implemented would improve the HIV response. I hope that UNDP will now be supported by its funding partners to take this next generation of recommendations around the world as it did with the original report in order to drive further legal and policy reform.
Among the reforms advocated is for law which enables civil society organisations to operate effectively. The Supplement notes that “between 2012 and 2015, sixty countries passed 120 laws restricting the activities of NGOs with more than one-third of such laws related to foreign funding of NGOs”. In situations where key populations face criminalisation and/or harassment, restrictions on those who advocate for their rights add to the significant restraints on effective HIV responses.
We are at a moment of truth in the global HIV response:
The evidence points to deaths being down, but also to there being little progress in reducing new infections in the past decade.
The provision of Official Development Assistance for fighting HIV has stalled – it actually declined by twenty per cent between 2013 and 2016.
The challenges to effective responses have increased with the shrinking democratic space in many countries.
The world’s growing migrant population, now estimated at over a quarter of a billion people, often lacks effective access to services.
The world’s largest ever adolescent and youth demographic needs access to knowledge about HIV and access to prevention services.
These challenges – and how to confront them – are well scoped in the forthcoming International AIDS Society-Lancet Commission Report.
In reinvigorating the HIV response, the 2030 Agenda must be front and centre. It is a complex agenda, however, and for HIV it lacks the visibility and clarity which being one of only three specified conditions in the focused MDG6 gave. The SDGs are a much more crowded space.
Nonetheless, the Agenda encourages joined up ways of thinking and acting – which has to be positive for the HIV response. The vertical approach has worked to an extent, but if we are now in effect treading water and running the risk of regression, then the time has come to support HIV being part of more integrated approaches within and beyond the health sector.
As well, investment in primary prevention needs to be stepped up – otherwise we will not be able to make the decisive breakthrough in halting new infections which ending AIDS requires.
I do believe that the HIV/AIDS epidemic can be beaten:
if bad and discriminatory laws are repealed,
if human-rights based approaches are followed,
if HIV responses are better integrated with other health responses,
if international donors continue to invest in the response – the cost of treatment in low-income countries in particular will require international solidarity for decades to come,
if there is continuing investment in research and development, including in the search for vaccines and cures, and if – a very big if –
political and other leaders step up to support all the changes and investments required.
The challenge before all gathered in Amsterdam this week is to demand the stepped-up commitment and action which will enable the end of the epidemic as the SDG target exhorts. Better law and human rights upheld is an indispensable part of what is needed to get the results we want.