It is my great pleasure to join this conversation. The HIV movement is a vibrant, forward-thinking movement which can legitimately take considerable credit for the major turnaround we have seen over the past four decades as the prognosis for HIV changed from certain death to near-normal – if not normal – lifespan.
It is you who raised the game, taking leadership in calling for human rights in the health response, and demanding that people be treated with dignity regardless of their health status.
The amount of progress we have seen since HIV was first identified is nothing short of outstanding. We have treatments today we could only have dreamed about back then. Anti- retroviral therapies continue to improve, we now even have Pre- exposure Prophylaxis (PrEP), post-exposure prophylaxis (PEP), and drugs to stop the vertical transmission of HIV.
This is a good picture. But there are many, manychallenges.
Progress has slowed down considerably over the last few years, and we lost even more ground with the COVID-19 pandemic, which revealed and worsened the multiple inequalities that have fuelled the AIDS epidemic. Without a major boost to our momentum, we are in danger of not meetingour goal to end AIDS by 2030.
This is not, however, merely an issue about aggregate numbers.
Patterns of prevalence indicate the role which inequality, discrimination and stigma have played in determining who is at risk of infection with HIV and what health outcomes they can expect to have. For example, key populations remain at much higher risk than the general population: 34 times higher for transgender women, 26 times higher for sex workers and 25 times higher for gay men and other men who have sex with men.[1]
Access to anti-retroviral therapies tells another story about inequalities: Around 1.8 million children aged 0-14 were living with HIV at the end of 2019. Just under half of these children have access to life-saving HIV medication.[2]
AIDS is still the leading cause of death for women aged 15 to 49 years, with the Global Fund estimating that, every week, five thousand adolescent girls and young women are infected with HIV in East and southern Africa. (see Global Fund, Results Report 2021, p. 21)
Motivated by the urgent need to address this situation, Member States of the UN General Assembly committed, in December 2021, to meeting the following targets by 2025:
(a) less than 10 per cent of countries with restrictive legal and policy frameworks;
(b) less than 10 per cent of people living with and affected by HIV experiencing stigma and discrimination; and
(c) no more than 10 per cent of women, girls and persons living with, at risk of or affected by HIV experiencing gender-based inequalities and sexual or gender-based violence.
My Office has submitted a report to the current session of the Council which aims to contribute to discussions on these goals. I would like to thank UNAIDS for their active engagement and support as well as many of you who provided inputs.
The OHCHR report looks at two areas: the actions needed to meet these “societal enabler” targets specified in the Political Declarationon HIV and AIDS, and other gaps in the HIV response.
I will highlight 4 of the areas in which my Office made recommendations:
(1) Laws and policies determine, to a great extent, how much we enjoy our rights. Our recommendations here call, in essence, for the establishment or strengthening of law and policy environments that enable the enjoyment of human rights in the context of HIV. Freedom from stigma and discrimination and the removal of barriers to health services are particularly critical here.
(2) It is crucial that strategies and plans to address HIV-related stigma, discrimination and the marginalization of key and other vulnerable populations be developed and adequately funded.
Where special measures are necessary to promote equality, they should be adopted.
Plans, interventions and strategies should specifically address multiple and intersecting forms of discrimination.
(3) States should develop national strategies and plans to address discrimination against women and girls in all their diversity in their access to health services, including sexual and reproductive health services. These plans and strategies should be implementedtogether with action to protect women and girls from gender-basedviolence, taking into account its interlinkages with HIV/AIDS.
(4) A human rights-based approach should be adopted in order to ensure that all policies relevant to the HIV response respect, protect and fulfil human rights, ensuring that key and other marginalised populations are empowered to claim their rights.
We call here for the availability and accessibility of good quality health services, including sexual and reproductive health services, for everyone on an equal basis. Key and vulnerable populations, such as persons with disabilities, refugees and persons deprived of liberty, should be prioritised.
Since stigma, discrimination and other human rights violations against persons living with HIV are experienced in health settings as well as in broader society, health personnel should receive training and sensitisation in respecting and protecting the health and health-relatedrights of people living with HIV.
In this regard, my Office piloted, in December 2021, a training for health workers to apply a human rights-based approach in the provision of sexual and reproductive and HIV health services, for women living with HIV, in close collaboration with UNAIDs and the Ministry of Health in Uganda.
Excellencies, colleagues and friends,
The voices of people with lived experiences in shaping the HIV response should be a golden thread that runs through all our programming and planning. Similarly, the participation of all other stakeholders, particularly community-led organisations, is a vital element. Civic space should be opened up and stakeholders supported financially and in other ways to participate in the HIV response.
Finally, we need to allocate resources in such a way that the actions needed to both regain lost momentum and make progress are well-funded and, consequently, effective. Innovative financing, such as the Global Fund’s Debt2Health mechanism, are inspiring examples of what is possible when we are determined about meeting our political commitments.
I hope that the recommendations set out in the report will be helpful in catalysing more determined efforts towards meeting the targets for 2025 and protecting the rights of persons living with or affected by HIV.
Thank you.