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At the United Nations, the U.S. Once Again Opposes the Role of Evidence in HIV Prevention

From May 31 through June 2, high-level government officials convened at the United Nations to review global progress in living up to promises made in the Declaration of Commitment on HIV/AIDS in 2001. People living with HIV/AIDS, advocates, and concerned experts expected these leaders to generate a new document that set forth a declaration that reflected the world's cumulative knowledge of the pandemic and a strategy to achieve universal access to prevention, treatment, and care. As a result of ongoing political tensions, however, the final Political Declaration falls short of these ambitious and necessary goals. In particular, language around HIV prevention, especially for young people, faced threats from the representatives of the U.S. government and their ideological allies.

Early drafts of the declaration called for massive scale-up of “evidence-based,” comprehensive prevention. In its annual report issued just prior to the meeting, Joint United Nations Programme on HIV/AIDS (UNAIDS) identifies key policy actions governments must take to ensure quality, effective prevention efforts, including to “review and reform legal frameworks to remove barriers to effective, evidence-based HIV prevention.”1 During negotiations on the Political Declaration, however, the U.S. took issue with the key phrase “evidence-based” and offered amendments to the document that would replace “evidence-based” with “evidence-informed.” Out of step with global best practices, this move seems to be designed to protect the U.S. enforced abstinence-only-until-marriage approach to prevention for young people that has long been criticized as lacking evidence of effectiveness and drew criticism from the UNAIDS report.

U.S. funded abstinence-only-until-marriage programs drew the ire of civil society representatives attending the high level review from countries receiving funding under the President's Emergency Plan for AIDS Relief. Instead, these advocates called for a much broader approach to HIV prevention, one that is not only beyond abstinence-only-until-marriage but also beyond “ABC” (abstain, be faithful, and use condoms). Rolake Odetoyinbo of the Pan African Treatment Access Movement (PATAM) from Nigeria explained, “ABC failed me because I got infected in my marital bed.”2

Speaking on the same panel, Rev. Jàpe Heath of the African Network of Religious Leaders Living with or Affected by HIV and AIDS (ANERELA) called for removing barriers and moralistic messages and focusing on creating safer practices and empowerment through education.

To ensure ongoing international support for broad education, the Youth Coalition, an international coalition of young advocates dedicated to advancing sexual and reproductive health and rights, put forward language to incorporate “comprehensive sexuality education” into the paragraph on youth. Norway subsequently proposed the language.

The final draft declaration did not go as far as the Youth Coalition proposal but did not capitulate to pressure from the U.S. In support of prevention programming and prevention for youth specifically, the participating governments agreed to:

Reaffirm that the prevention of HIV infection must be the mainstay of national, regional and international responses to the pandemic, and therefore commit ourselves to intensifying efforts to ensure that a wide range of prevention programmes that take account of local circumstances, ethics and cultural values is available in all countries, particularly the most affected countries, including information, education and communication, in languages most understood by communities and respectful of cultures, aimed at reducing risk-taking behaviours and encouraging responsible sexual behaviour, including abstinence and fidelity; expanded access to essential commodities, including male and female condoms and sterile injecting equipment; harm-reduction efforts related to drug use; expanded access to voluntary and confidential counseling and testing; safe blood supplies; and early and effective treatment of sexually transmitted infections. ( paragraph 22)

Commit ourselves to addressing the rising rates of HIV infection among young people to ensure an HIV-free future generation through the implementation of comprehensive, evidence-based prevention strategies, responsible sexual behaviour, including the use of condoms, evidence- and skills-based, youth-specific HIV education, mass media interventions and the provision of youth-friendly health services. ( paragraph 26)

To read the Political Declaration, please visit:
http://www.un.org/ga/aidsmeeting2006/declaration.htm

To view the original Declaration of Commitment on HIV/AIDS, please visit:
http://www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html

References

  1. Report on the Global AIDS Pandemic: A UNAIDS 10 th Anniversary Special Edition ( Geneva : Joint United Nations Programme on HIV/AIDS, 2006), 146, accessed 26 June 2006, <http://www.unaids.org/en/HIV_data/2006GlobalReport/default.asp>.
  2. UNGASS PANEL: ARE US RESTRICTIONS UNDERMINING HIV PREVENTION? THURSDAY, JUNE 1 Panel presentation sponsored by Action Aid Uganda ; Advocates for Youth, Center for Health and Gender Equity (CHANGE), Human Rights Watch, International Council of AIDS Service Organizations (ICASO), International Women's Health Coalition; UK Working Group on US Global AIDS Policy.

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