Since the United Nations High-Level Meeting on Ending AIDS in 2016, the young key populations’ movement and its visibility have grown considerably in Asia and the Pacific. Through their engagement with national and regional networks of key populations, more and more young people have taken up space in decision-making processes and in mobilizing resources to support local and national organizations. However, despite those important efforts, more needs to be done to meaningfully engage young key populations in the HIV response as leaders, beneficiaries and partners.

UNAIDS data from 2019 alarmingly shows that 27% of all new HIV infections in Asia and the Pacific were among young people. Young gay men and other men who have sex with men accounted for 52% of all new HIV infections among young people. Overall, 99% of new HIV infections among young people were among young key populations and their partners.

A side event held on the sidelines of the United Nations High-Level Meeting on AIDS, held in New York, United States of America, and online from 8 to 10 June, looked at the progress made and challenges in the HIV response and emphasized the critical role of young people in leading change and promoting successful and innovative approaches to the HIV response.

The speakers and panellists stressed that significant barriers exist for young key populations to access HIV testing, treatment and prevention services and routine sexual and reproductive health and rights services in the region. Those barriers include a limited availability of differentiated HIV services for young key populations, stigma and discrimination, punitive laws and other legal barriers that leave young key populations on the margins and out of reach of HIV services.  The COVID-19 pandemic continues to widen existing inequalities and service gaps, but thanks to the engagement of community-led organizations, populations at higher risk of HIV, including young key populations, were able to access essential HIV and health services.

The speakers and panellists noted that young people are showing us the way to revolutionize HIV prevention and increase the uptake of HIV services by implementing new strategies and innovations that cater to the specific needs of young people. During the COVID-19 pandemic, organizations led by and serving young people, such as the Lighthouse Social Enterprise in Viet Nam and the Human Touch Foundation in India, have been at the forefront of the HIV response, providing HIV services in partnership with the local government to the communities that need them the most.

The team at the Human Touch Foundation, a community-based organization in Goa, India, that provides care and support to adolescents living with HIV has, since the start of the COVID-19 pandemic, organized volunteers to deliver antiretroviral therapy to people’s doorsteps. Moreover, the organization played a critical role in getting the local government to waver public transport costs to ensure that people living with HIV had access to treatment. With the increased anxiety and depression brought on by the COVID-19 pandemic, the Human Touch Foundation offered psychosocial support services to adolescents living with HIV, both in the form of online counselling and in-person consultations.

Similarly, the Lighthouse Social Enterprise, a lesbian, gay, bisexual, transgender and intersex (LGBTI) organization led by young people based in Hanoi, Viet Nam, has been instrumental in providing differentiated service delivery to young key populations during the COVID-19 pandemic. Some of the services it provides at its clinic include HIV counselling and testing, post-exposure prophylaxis, pre-exposure prophylaxis and antiretroviral therapy. The Lighthouse Social Enterprise also established a referral service to ensure that young key populations are linked with other health services, such as sexually transmitted infection testing and treatment, mental health support and harm reduction services. What makes the Lighthouse Social Enterprise unique is that the clinic is entirely run by young people. Health-care workers are given training by the Lighthouse Social Enterprise team on LGBTI and key population needs and issues in order to ensure that services are youth-friendly and free from stigma and discrimination. Last year, the Lighthouse Social Enterprise provided services to more than 3000 members of young key populations in Viet Nam.

The side event was an opportunity for different organizations led by and serving young people working on HIV-related issues to share experiences and define common strategies to keep HIV on the political agenda at the national and municipal levels.

Quotes

Excellencies, distinguished delegates, colleagues, friends.

Thank you, General Assembly President Bozkir, Deputy Secretary-General Amina Mohammed, co-facilitators Ambassador Gertze of Namibia and Ambassador Fifield of Australia, and all Member States; together you’ve drafted, negotiated, and delivered this Political Declaration. It will be the basis of our work to end this pandemic that has ravaged communities for 40 years.

AIDS is not over. It is one of the deadliest pandemics of modern times. Since the start of the epidemic 77.5 million people have been infected with HIV. We have lost nearly 35 million people to AIDS. An AIDS death every minute is an emergency! HIV rates are not following the trajectory that we together promised. Indeed, amidst the fall-out from the Covid crisis, we could even see a resurgent pandemic.

But a never-ending HIV pandemic is not our fate. In spite of all the set-backs, we can end AIDS as a public health threat, as we promised, by 2030, if we come together.

Business as usual, however, would fail. The programmes that have secured substantial progress will not enable us to finish the journey because the road is blocked. The evidence and analysis is clear. Inequalities in power, status, rights and voice are driving the HIV pandemic. Inequalities kill. As the Global AIDS strategy sets out: to end AIDS, we have to end the inequalities which perpetuate it.

There’s another huge benefit to this approach. The same laws, policies and strong people-centred health services needed to end AIDS, will also help the world overcome Covid-19, be ready to tackle future pandemics, and support inclusive economic growth and the human rights of all. We will all do better.

Here are three bold shifts we need to take together:

1. We need to end inequalities in access to health technologies, by spurring the best science and getting it to everyone.
   COVID-19 showed science moves at the speed of political will. We need to speed up AIDS science by investing in innovations in treatment, prevention, care, and vaccines, as global public goods.
   And we need to deploy science in ways that shrink instead of grow inequalities.
   For example, let’s get the new long-acting anti-retroviral medicines that will make it easier to treat and prevent HIV to women in all their diversity and key populations in the global South first, not years after people in rich countries have access.
   Let us ensure that all medicines which can prevent deaths of people living with HIV are manufactured by multiple producers affordably especially in the global South, where the disease is concentrated
   We need funding, but we also need to reform failing rules on intellectual property, and support globally distributed production, so access to life-saving science is no longer dependent on the passport you hold.
2. We need to end the inequalities in access to essential services, by delivering on guaranteed health and education for everyone. For many communities, new HIV infections have become rare; and living long, fulfilling lives with HIV is the norm. But within and between countries, a widening gap separates those who have prevention, treatment and care services and their rights respected and those who are excluded.
   Today we are setting bold, ambitious goals to reach 95% of those in need with HIV treatment and prevention: to get there we need to re-imagine HIV services, making them easy to access and designed around people’s lives.
   We need to ensure all girls complete secondary education and are empowered with the full set of services and rights.
   We need to end user fees for essential services and provide these services through public systems funded by taxation. We need to integrate community-provided services. We need to combat tax avoidance, which impedes domestic resourcing for health and education.
   Most developing countries are facing severe fiscal crisis, with a revenue loss above 20% in 2020 and health budgets under threat, with Africa under especial pressure.
   This is a time to increase revenues, and that requires an end to tax dodging and tax competition that empty public coffers.
   We also need debt restructuring to overcome the COVID19 shock and the establishment of a fair debt crisis resolution mechanism. We need to step up, not step back on the commitment to aid as 0.7% of gross national income by all developed countries and ensure that more of the IMF’s USD 650 billion Special Drawing Rights issuance flows to low and middle-income countries.
3. We need to end the inequalities in the realisation of rights, particularly for people living with HIV, and those vulnerable to or affected by HIV.
   I applaud Member States’ commitment to reform laws and protect rights. The evidence shows that when laws are strengthened to support gender equality and the rights of key populations and confront stigmatisation, countries have much greater success in treatment and prevention programmes, benefiting everyone. They’ve rolled back HIV.
   We need to keep moving forward in our common journey, away from harmful, punitive, outdated often colonial laws and from all forms of discrimination.

This moment calls for us to work together across sectors, across countries. Populism’s false promises are proving no match to biology: as Covid reminds us, we’re not just interconnected, we’re inseparable.

We cannot end AIDS in one country or one continent, we can only end AIDS everywhere.

I pay tribute to the civil society groups from across the world whose fight against inequalities has been the spur to action. You, communities, women’s groups and grassroots movements, have constantly pushed us; at times that pushing has been uncomfortable; but my message to you is: keep pushing us all. Keep the fight on! Pressure from the power of people is key to ending inequalities and ending AIDS.

Martin Luther King said the moral arc of the universe is long, but it bends towards justice. He didn’t mean this process is automatic. As he noted, “social progress never rolls in on wheels of inevitability; it comes through the tireless efforts of people”. The trajectory of new HIV infections and AIDS deaths will not, through business-as-usual, bend down, but we can pull it down.

We cannot be neutral on inequalities. To get back on track to ending AIDS, we must be deliberate in confronting them. The only alternative is a vicious cycle of injustice, illness, and emergency. The most unrealistic thing we could do now is to imagine we can overcome our crises through minor adjustments or tinkering.

Whether we are remembered as promise-breakers or promise-keepers, as failures or victors, as the people who ended AIDS, or only as the people who could have ended AIDS, is up to us.

Epidemics magnify our worst traits—inequalities, injustices, and fear; but also, our best traits—ingenuity, resilience, and courage.

I’m confident we will win, together. Thank you.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Costa Rica has joined the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. At a United Nations High-Level Meeting on AIDS side event on 7 June, the Vice President of Costa Rica, Epsy Campbell Barr, emphasized the country’s commitment to human rights by highlighting that a comprehensive and effective HIV response needs to include the human rights of people living with HIV.

Costa Rica is the third signatory to the global partnership in the Latin America and Caribbean region, joining Jamaica and Argentina.

The side event, Latin America and the Caribbean on the Road to Eliminating HIV-Related Stigma and Discrimination, was co-organized by the regional coordinator of the global partnership, RedTraSex (the Sex Workers Network for Latin America and the Caribbean), the Global Network of People Living with HIV and the Governments of Jamaica and Costa Rica, with the support of UNAIDS.

Five year ago, the 2016 United Nations Political Declaration on Ending AIDS recognized the HIV epidemic as a human rights challenge. Member States expressed concern about HIV-related stigma and discrimination around the world and about the regulatory and legal frameworks that discourage and prevent people from accessing HIV-related services.

The Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination was created in 2017. The initiative has the goal of catalysing and accelerating the implementation of commitments made to end HIV-related stigma and discrimination by United Nations Member States, United Nations agencies, bilateral and international donors, nongovernmental organizations and communities.

Countries have made commitments on ending discrimination in various international conventions, and have made further promises at the regional and national levels. The global partnership supports countries in transforming those promises into reality through policies, programmes and practices that strengthen health and HIV-related rights.

Through the regional coordination of RedTraSex, the global partnership supports an open and ongoing dialogue in the regional civil society networks with the goal of strengthening national coordination platforms and representation, with a focus on people living with, at risk of or affected by HIV.

Quotes

A side event at the United Nations High-Level Meeting on AIDS, being held in New York and online from 8 to 10 June, has highlighted the science relevant to the new UNAIDS global strategy and targets and the changing scientific environment that will take the world to 2030, the Sustainable Development Goal target date for ending AIDS.

At the event, Science, HIV and COVID-19—Where are we Headed?, Jon Cohen, a leading science journalist, moderated a panel discussion that included Anthony Fauci, the Chief Medical Adviser to the President of the United States of America, Loyce Maturu, an activist working for Zvandiri in Zimbabwe, Soumya Swaminathan, the Chief Scientist at the World Health Organization, and other leading HIV scientists.

In the complexity and multidimensional nature of the global AIDS response, science has been a constant force, moulding and adapting how the world reacted. A similar role for science has been seen in the other ongoing pandemic—COVID-19. The side event was an opportunity to discuss the role of science and to review major and emerging scientific themes that will influence the trajectory of the HIV pandemic in the approach to 2030.

Mr Fauci emphasized the importance of long-term engagement and investment in surveillance and basic sciences to increase preparedness for future pandemics, noting that we must focus on building trust in science and explaining how knowledge evolves through the accumulation of reliable data that can alter clinical and public health guidance. The COVID-19 pandemic has taught us lessons in efficiency and in accelerating the translation of basic science into effective interventions, he said. However, we must address the challenges of access, intervention pricing and social biases that limit our global impact. He concluded that both the HIV pandemic and the COVID-19 pandemic have the power to strengthen the global community, and he committed the United States to being a global leader and reliable partner in those efforts.

Greg Millett celebrated the amazing fall in new HIV infections in several places, such as London, Denmark and Australia, where pre-exposure prophylaxis (PrEP) and effective testing and treatment is really working for gay men and other men who have sex with men.  He highlighted the importance of recent scientific advances that have led to new technologies, such as HIV self-tests and new PrEP modalities.

A major theme was around equity. For both COVID-19 and HIV, the participants noted that we must ensure that all people in all countries reap the benefits of science. Commentators in the audience reiterated that this is even more important given the participation of so many people across so many countries as the altruistic participants in the research that has led to the exciting new tools for HIV prevention and vaccines for COVID-19. And Mr Millet pointed out that we are all interrelated and interconnected. HIV infections and other diseases are, of course, in no way limited to national boundaries.

Loyce Maturu reminded everyone that young people are central to the HIV response. Young people are often left behind and treated as end users of services that are not specifically designed to suit their lifestyles. She acknowledged that science was the reason that she was with us, healthy, beautiful and empowered after falling sick with HIV-related illnesses as a child and witnessing the death of both her mother and brother from HIV. Young people need to be central to science and brought to the tables that set the research priorities.

Quarraisha Abdool Karim, and others, exhorted political leaders not to “drop the ball” for HIV. We need to finish the job and not allow the huge challenges of dealing with it deflect us.

All the participants pushed for HIV programmes to be based firmly on scientific evidence, and Wafaa El Sadr noted that the evidence base comes not only from biomedical laboratories and large clinical trials, but also from implementation and the social sciences. The Co-Chairs of the upcoming International AIDS Society Science Conference, in July 2021, Adeeba Kamarulzaman and Hendrik Streeck, hoped that the high-level meeting would be a boost for stronger engagement with science—registrations for the conference are as high as ever, despite the COVID-19 restrictions. Mr Streeck called for a massive effort to bring thousands of HIV vaccine scientists together in one huge effort, similar to the collaboration around the Large Hadron Collider or even the Manhattan Project.

In an optimistic conclusion, Ms Swaminathan hoped that the proven success of the scientific collaboration that has produced multiple COVID-19 vaccines so quickly should be a stimulus for greater enthusiasm and investment in collaborations to end not just AIDS but also other major public health challenges, such as tuberculosis, malaria and noncommunicable diseases.

Quotes

World leaders agree to reduce the annual number of new HIV infections to under 370 000 and AIDS-related deaths to 250 000, eliminate new HIV infections among children, end paediatric AIDS and eliminate all forms of HIV-related discrimination by 2025. They also committed to providing life-saving HIV treatment to 34 million people by 2025.

NEW YORK, 8 June 2021—United Nations Member States adopted a set of new and ambitious targets in a political declaration at the United Nations General Assembly High-Level Meeting on AIDS, taking place in New York, United States of America. If the international community reaches the targets, 3.6 million new HIV-infections and 1.7 million AIDS-related deaths will be prevented by 2030.

The political declaration calls on countries to provide 95% of all people at risk of acquiring HIV within all epidemiologically relevant groups, age groups and geographic settings with access to people-centred and effective HIV combination prevention options. It also calls on countries to ensure that 95% of people living with HIV know their HIV status, 95% of people who know their status to be on HIV treatment and 95% of people on HIV treatment to be virally suppressed.

“In this Decade of Action, if we are to deliver the 2030 Agenda for Sustainable Development all Member States must recommit to ending the AIDS epidemic by 2030,” said Volkan Bozkir, the President of the United Nations General Assembly.

“To end AIDS, we need to end the intersecting injustices that drive new HIV infections and prevent people from accessing services,” said Amina J. Mohammed, Deputy Secretary-General of the United Nations.

The political declaration notes with concern that key populations—gay men and other men who have sex with men, sex workers, people who inject drugs, transgender people and people in prisons and closed settings—are more likely to be exposed to HIV and face violence, stigma, discrimination and laws that restrict their movement or access to services. Member States agreed to a target of ensuring that less than 10% of countries have restrictive legal and policy frameworks that lead to the denial or limitation of access to services by 2025. They also committed to ensure that less than 10% of people living with, at risk of or affected by HIV face stigma and discrimination by 2025, including by leveraging the concept of undetectable = untransmittable (people living with HIV who have achieved viral suppression do not transmit HIV).

“I would like to thank Member States. They have adopted an ambitious political declaration to get the world back on track to ending the AIDS pandemic that has ravaged communities for 40 years,” said Winnie Byanyima, the UNAIDS Executive Director.

Expressing concern at the number of new HIV infections among adolescents, especially in sub-Saharan Africa, a commitment was made to reduce the number of new HIV infections among adolescent girls and young women to below 50 000 by 2025. Member States committed to eliminate all forms of sexual and gender-based violence, including intimate partner violence, by adopting and enforcing laws that address the multiple and intersecting forms of discrimination and violence faced by women living with, at risk of and affected by HIV. They pledged to reduce to no more than 10% the number of women, girls and people affected by HIV who experience gender-based inequalities and sexual and gender-based violence by 2025. In addition, commitments were made to ensure that all women can exercise their right to sexuality, including their sexual and reproductive health, free of coercion, discrimination and violence.

Countries were also urged to use national epidemiological data to identify other priority populations who are at higher risk of exposure to HIV, which may include people with disabilities, ethnic and racial minorities, indigenous peoples, local communities, people living in poverty, migrants, refugees, internally displaced people, men and women in uniform and people in humanitarian emergencies and in conflict and post-conflict situations. Countries also committed to ensure that 95% of people living with, at risk of and affected by HIV are protected against pandemics, including COVID-19.

“The stark inequalities exposed by the colliding pandemics of HIV and COVID-19 are a wake-up call for the world to prioritize and invest fully in realizing the human right to health for all without discrimination,” said Ms Byanyima.

Member States also committed to increase and fully fund the AIDS response. They agreed to invest US$ 29 billion annually by 2025 in low- and middle-income countries. This includes investing at least US$ 3.1 billion towards societal enablers, including the protection of human rights, reduction of stigma and discrimination and law reform. They also committed to include peer-led HIV service delivery, including through social contracting and other public funding mechanisms.

Calling for expanding access to the latest technologies for tuberculosis (TB) prevention, screening, diagnosis, treatment and vaccination, Member States agreed to ensure that 90% of people living with HIV receive preventive treatment for TB and reduce AIDS-related TB deaths by 80% by 2025. Countries also committed to ensure the global accessibility, availability and affordability of safe, effective and quality-assured medicines, including generics, vaccines, diagnostics and other health technologies to prevent, diagnose and treat HIV infection, its coinfections and other comorbidities through the use of existing flexibilities under the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and ensure that intellectual property rights provisions in trade agreements do not undermine the existing flexibilities as outlined in the Doha Declaration on the TRIPS Agreement and Public Health.

“The AIDS response is still leaving millions behind—LGBTI people, sex workers, people who use drugs, migrants and prisoners, teenagers, young people, women and children—who also deserve an ordinary life, with the same rights and dignity enjoyed by most people in this room,” said Yana Panfilova, a woman living with HIV and member of the Global Network of People Living with HIV.

The high-level meeting is being attended in-person and virtually by heads of state and government, ministers and delegates in New York, people living with HIV, civil society organizations, key populations and communities affected by HIV, international organizations, scientists and researchers and the private sector. UNAIDS supported regional consultations and the participation of civil society in the high-level meeting. Civil society organizations called on Member States to adopt a stronger resolution.

“While we have made some significant progress as a global community, we are still missing the mark and people are paying the price with their lives. There’s one single reason we are missing our goal: it’s inequality,” said Charlize Theron, Founder of the Charlize Theron Africa Outreach Project and a United Nations Messenger of Peace.

Member States also committed to support and leverage the 25 years of experience and expertise of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and committed to fully fund the programme so that it can continue to lead global efforts against AIDS and support efforts for pandemic preparedness and global health.

In accordance with the Global AIDS Strategy 2021–2026: End Inequalities, End AIDS, adopted by consensus on 25 March 2021 by the UNAIDS Programme Coordinating Board, as well as the report of the United Nations Secretary-General, Addressing Inequalities and Getting Back on Track to End AIDS by 2030, issued on 31 March 2021, UNAIDS would have welcomed even stronger commitments on comprehensive sexuality education, sexual and reproductive health and rights, and sexual orientation and gender identity, unqualified acceptance of evidence-based HIV prevention options, such as harm reduction, a call for the decriminalization of the transmission of HIV, sex work, drug use and laws that criminalize same-sex sexual relationships and further flexibilization of intellectual property rules for access to life-saving medicines, vaccines and technologies.

In 2020, 27.4 million of the 37.6 million people living with HIV were on treatment, up from just 7.8 million in 2010. The roll-out of affordable, quality treatment is estimated to have averted 16.2 million deaths since 2001. AIDS-related deaths have fallen by 43% since 2010, to 690 000 in 2020. Progress in reducing new HIV infections has also been made, but has been markedly slower—a 30% reduction since 2010, with 1.5 million people newly infected with the virus in 2020, compared to 2.1 million in 2010.

UNAIDS

The Joint United Nations Programme on HIV/AIDS (UNAIDS) leads and inspires the world to achieve its shared vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths. UNAIDS unites the efforts of 11 UN organizations—UNHCR, UNICEF, WFP, UNDP, UNFPA, UNODC, UN Women, ILO, UNESCO, WHO and the World Bank—and works closely with global and national partners towards ending the AIDS epidemic by 2030 as part of the Sustainable Development Goals. Learn more at unaids.org and connect with us on Facebook, Twitter, Instagram and YouTube.

Around 300 faith leaders and representatives of faith-based organizations met on 7 June in an online event, Faith2EndAIDS, Faith2EndInequality, on the sidelines of the United Nations High-Level Meeting on Ending AIDS.

Sharing lessons learned by faith-based organizations and faith communities in addressing stigma and discrimination, promoting human rights and increasing access to HIV services, the participants also explored the main areas of action in the political declaration on AIDS and the particular role of faith responses in implementing the commitments.

Practical examples were shared of faith-motivated programmes that increase access for people affected by inequalities, such as programmes for migrants and children. The participants emphasized the critical role that faith responses can play in mitigating stigma.

A key focus going forward is the 12 Million Campaign, where faith leaders, individuals and communities of faith commit to key actions that could promote access to HIV services by the 12 million people who are living with HIV who still do not have quality and consistent HIV treatment, care and support.

The active discussions in the chat box reflected the enthusiasm and commitment of faith communities and people of faith to play a meaningful role in ending AIDS and ending the inequalities that drive the pandemic.

Quotes

Many factors in society, including poverty, stigma, discrimination and persistent gender and socioeconomic inequalities, influence the health of individuals and communities, the participants heard at a side event at the United Nations High-Level Meeting on AIDS, being held in New York and online from 8 to 10 June.

At the event, Strengthening national social protection systems to adequately include people living with, at risk of, or affected by HIV to fast-track ending AIDS, speakers pointed out that it is at the intersections of multiple inequalities that the most vulnerable people lie. Compounding vulnerabilities hit the most marginalized and left behind people, and COVID-19 has brought those inequalities to the forefront.

The event highlighted promising country experiences. It showcased innovative approaches in enhancing access to social protection by people living with, at risk of and affected by HIV and brought together high-level representatives of governments, civil society, donors and academia to accelerate joint programming of HIV and social protection programmes to respond to COVID-19 and end AIDS by 2030.

The new global AIDS strategy aims to reduce the inequalities that drive the AIDS epidemic and acknowledges social protection’s central role in that. Social protection has the power to address the social and economic drivers of the HIV epidemic and to break down the barriers that people face in accessing HIV services. Social protection comprises public and private action to reduce risk, poverty and inequality, such as social safety nets, social security and labour market policies. It includes education, nutrition, housing, health and other social services.

Quotes

Caribbean partners from governments, civil society and the development community met on 7 June to discuss regional priorities for the 2021 United Nations High-Level Meeting on AIDS and its resulting political declaration. The virtual Caribbean Caucus was hosted by the Pan Caribbean Partnership against HIV/AIDS (PANCAP) and moderated by the Caribbean Community (CARICOM) Assistant Secretary-General, Douglas Slater.

The PANCAP Director, Rosmond Adams, noted that the Caribbean has made significant progress in key aspects of the HIV response. Eight countries and territories have been validated by the World Health Organization for eliminating vertical HIV and syphilis transmission. And between 2010 and 2020, AIDS-related deaths in the region fell by half (51%).

But to get on track to end AIDS by 2030, he said Caribbean countries must step up the pace around prevention, testing, treatment, care and ending stigma and discrimination. By 2020, 82% of people living with HIV in the region were diagnosed. Two thirds (67%) of all people living with HIV were on treatment and 59% were virally suppressed.

While new HIV infections have fallen by 28% since 2010, the rate of decline is too slow. Overall, members of key population communities and their partners accounted for 60% of new HIV infections in 2020. Around one third of new HIV infections were among young people aged 15–24 years.

Speaking on behalf of the Caribbean Regional Network of People Living with HIV (CRN+), Diana Weekes noted that key structural barriers continue to block access to HIV prevention, treatment and care services. These include “stigma and discrimination … lack of privacy, breach of confidentiality and limited redress” when people’s rights have been violated. She noted that no country in the region has adopted the CARICOM model antidiscrimination legislation, which was developed almost a decade ago. CRN+ called for greater emphasis on policy and legislative changes as well as community-led responses to address these structural barriers.

Ivan Cruickshank, the Executive Director of the Caribbean Vulnerable Communities Coalition, pointed to regional data that show that HIV disproportionately affects key populations, including gay men and other men who have sex with men, transgender people, sex workers and people who use drugs.

“According to the latest UNAIDS report, nations with progressive laws and policies, as well as robust and inclusive health systems, have had the best HIV outcomes. We must therefore create inclusive societies in which people are confident in their ability to seek medical treatment and exercise their social and economic rights. We must go beyond declarations, to remove laws that continue to criminalize communities and limit young people’s access to sexual and reproductive health and rights,” Mr Cruickshank said.

The Guyana Health Minister and Caribbean representative on the UNAIDS Programme Coordinating Board, Frank Anthony, reaffirmed the region’s commitment to the HIV response, saying that “governments in the region stand ready to do their part in ending AIDS by 2030.”

He pointed to longstanding challenges in the region, such as “removing the legal obstacles that foster discriminatory practices” and “prevention sustainability.” But he also emphasized the new threat posed by COVID-19, noting that “finite financial resources had to be reprogrammed to meet these urgent demands.” He called for increased vaccine equity and a review of plans to transition countries in the region away from international HIV funding.  

“We must use the platform available to us at this United Nations high-level meeting to ensure that we highlight our vulnerabilities to the HIV epidemic and the COVID-19 pandemic,” he said.

During discussions, civil society participants also emphasized the profound negative impact of COVID-19 containment measures on lives and livelihoods. They said there was an additional need for solutions to provide nutrition, mental health and financial support to people living with HIV and members of key population communities.

The Director of the UNAIDS New York Liaison Office, César Núñez, noted that in the response to both HIV and COVID-19, the role of communities is clear.

“The response must include a key role for civil society at the table when frameworks are being put together and implemented,” he said.

Mr Núñez ended by calling for CARICOM’s support in securing an ambitious, action-oriented and laser-focused political declaration.

HIV outcomes rely on far more than the availability of services or treatment.

According to the 2020 Jamaica People Living with HIV Stigma Index, more than one third (38%) of respondents delayed HIV testing due to fears about how others would respond if they received a positive diagnosis. And 30% were slow to start treatment because of concerns that people might learn about their status.

Many of those fears are founded.

Almost half of the study’s respondents (48%) had experienced stigma or discrimination related to their HIV status. Members of key population communities reported even higher rates of prejudice and worse mental health than other people living with HIV.

“More needs to be done to get those living with HIV, and communities impacted by HIV, to live in a country and society where they are accepted and appreciated. That will also make their health outcomes better,” said Jumoke Patrick, the Executive Director of the Jamaica Network of Seropositives.

To accelerate progress towards that goal, in 2020 Jamaica became one of the first countries to join the Global Partnership for Action to Eliminate all Forms of HIV-Related Stigma and Discrimination. The initiative combines the power of governments, civil society, donors, academia and the United Nations. It reaches beyond the health sector to address ignorance and bias in education, the workplace, the justice system, families and communities.

On 4 June, the Jamaica Partnership to Eliminate HIV-Related Stigma and Discrimination launched its first annual report, Enabling environment and human rights.

The State Minister in the Health and Wellness Ministry and Chair of the Partnership, Juliet Cuthbert Flynn, reiterated the government’s commitment to addressing the social and legal issues that are barriers to an effective HIV response. She called for political leadership across party lines to recognize their role in helping to create an enabling environment.

“This is an imperative as we strive to allow every individual—regardless of their occupation, socioeconomic status, sexual orientation, gender identity, age, health status, disability and other status—to enjoy their human rights,” Ms Cuthbert Flynn said.

“We strongly believe that AIDS in Jamaica is not over, but it can be,” said the UNAIDS Country Director for Jamaica, Manoela Manova,

She noted that the new UNAIDS report, Global commitments, local action, showed that while dozens of countries had achieved the 2020 targets, many, including Jamaica, are entirely off track.

“HIV remains driven by inequality. The countries with progressive laws and policies as well as strong and inclusive community and health systems have the best outcomes. New HIV infections and AIDS-related deaths reduce faster. That is what we would like to achieve for Jamaica,” Ms Manova said.

Jaevion Nelson, a UNAIDS consultant, detailed the achievements of stakeholders in the national HIV response in Jamaica. A national human rights public education campaign was led by the National Family Planning Board. Sensitization exercises were conducted with police and correctional officers, health-care workers and faith leaders and congregants. People living with HIV received legal support, with several securing resolutions such as being reinstated in their jobs and receiving settlement costs. A National Transgender Health Strategy was launched, and nongovernmental organizations collaborated to develop model antidiscrimination legislation. 

The next steps for the initiative include strengthening monitoring, evaluation and learning for its human rights agenda, increasing the engagement of legislators and creating a more sustainable framework for sensitizing health-care workers, law enforcement officers and other duty-bearers.

The UNAIDS Deputy Executive Director, Programme, Shannon Hader, delivered the feature address at the virtual event. “Societal enablers and HIV outcomes are linked,” she said. “We will only end AIDS if we strive to respect, protect and promote the rights of everyone, everywhere. It is the evidence-based thing to do.” 

At the United Nations High-Level Meeting on AIDS, which will take place from 8 to 10 June, Member States will adopt a new political declaration to bring the HIV response back on track. After the uneven progress made in the HIV response since the 2016 United Nations High-Level Meeting on Ending AIDS, this year’s high-level meeting will be the springboard for a decade of action to reduce inequalities and root out the social determinants that fuel the HIV epidemic.

In order to find out more about civil society’s aspirations and hopes for the high-level meeting and political declaration, UNAIDS talked to two civil society representatives, both of whom are living with HIV. Jacqueline Rocha Côrtes (JRC) is from the National Movement of Women Living with HIV/AIDS (MNCP/Brazil), the Latin American and the Caribbean Movement of Positive Women (MLCM+) and the National Institute of Reassigned Women (INAMUR/Brazil). Andrew Spieldenner (AS) is the Executive Director of Mpact. Both are members of the Multistakeholder Task Force to the HLM and were involved in drafting the 2021 high-level meeting civil society declaration, in which civil society organizations urge Member States to focus efforts and resources where they are most needed and to adopt a political declaration that explicitly recognizes who is most at risk of HIV and acknowledges why this is so, to commit to fully fund and support effective HIV responses and to hold Member States accountable for their actions.

What is the purpose of the civil society declaration you released ahead of the high-level meeting?

JRC: The civil society declaration has several purposes. First of all, to bring together the main inputs given by civil society globally on the desired content of the 2021 political declaration on AIDS. Secondly, the civil society declaration serves as a tool to mobilize community efforts locally and regionally and to harmonize and sharpen our positions in order to build a stronger community position on our demands worldwide.

AS: The civil society declaration released ahead of the high-level meeting is a clear statement of the values, concerns and needs of our communities. Where Member States might be more concerned with politics, civil society continues to elevate and centre those most impacted by HIV—the same populations most often marginalized by governments through punitive laws and policies. As civil society, we want to ensure that Member States understand where we stand, in the hope that they support our work and communities in the development of the political declaration.

What are the major asks from civil society to Member States?

JRC: The major asks from the civil society declaration, from my personal perspective, are to show and remind Member States how strong we are and of our ability to mobilize and guide what is needed to end AIDS. It is an opportunity to show that we, the communities, are alive and attentive, even more so during times like this, where the COVID-19 pandemic has had such a negative impact on the response to AIDS. It is also a call to international and multilateral organizations.

AS: We want Member States to recognize the disproportionate impact of HIV on sex workers, people who use drugs, transgender people and gay and bisexual men and to centre the needs of key populations in the HIV response. We want Member States to support the delivery of necessary HIV interventions, such as comprehensive sexuality education, harm reduction in all its forms and HIV prevention and treatment. We want Member States to protect sexual and reproductive health and rights. We want Member States to be flexible with the Trade-Related Aspects of Intellectual Property Rights (TRIPS) with HIV technologies and to fully fund the HIV response.

What are the expectations of communities and civil society organizations for the upcoming high-level meeting and new political declaration?

JRC: In the political declaration, we expect to see a minimum standard of progressive broad language that includes everyone in order to make it clear that, when we refer to the response to AIDS, we are referring to human rights, the flexibility of trade agreements, the financing of the AIDS response, the community-led responses, the reduction and elimination of gender-based violence. We expect the political declaration to include firm commitments to fulfil the many goals established in the 2016 political declaration and in other political declaration that have not yet been met, as well as the most recent priorities established by the UNAIDS Global AIDS Strategy 2021–2026, agreed by many countries, which calls for the elimination of inequalities to end AIDS by 2030.

We also hope that conveniently politically correct technical language won’t serve as a veil to cover particular interests, leaving aside issues such as sexual and human diversity, sexual health and reproductive rights and the reduction and gradual elimination of punitive laws that further stigmatize people and punish citizens, who are often imprisoned or killed simply because they exist as they are.

AS: As civil society and communities, we expect Member States to support the Global AIDS Strategy 2021–2026. We understand that some Member States will be against the language describing key populations, as well as against key HIV interventions, including harm reduction, comprehensive sexuality education and TRIPS flexibilities. We hope that Member States can seek compromise to embrace and support what’s necessary to move forward in the HIV response.

Some Member States are still reticent to advance the agenda when it comes to key populations, drug use and the criminalization of sex work. What would be your message to them?

JRC: My message to them is that whether they accept it or not, humanity will not be linear like some of their political and economic projects and even social projects that try to dictate the course of human lives, over which the authorities have no governability or rights. In the same way that United Nations Member States refer to national sovereignty on whether to adopt or not certain measures, people have an inalienable autonomy to decide what is best for their lives and how they want to live.

It is imperative that Member States recognize the existence and rights of key populations.

As a reassigned transsexual woman living with HIV for 27 years, I cannot help but state that if we want to end inequalities we will necessarily have to approach and embrace human diversity.

AS: After 40 years of HIV, the disproportionate burden of HIV remains on key populations, including people who use drugs, sex workers, gay and bisexual men and transgender people. We cannot end the HIV epidemic if we do not centre the needs of key populations, including the greater involvement of people living with HIV. If Member States continue to ignore our needs, marginalize our communities and legislate against us, then the HIV epidemic will continue unabated, no matter the advances in HIV technologies.

Once the political declaration has been adopted, what will be the role of civil society in making it a reality on the ground?

JRC: We will do what we have always done—we will advocate and influence politics. We will monitor and mobilize, fight, carry out community-led work and provide community responses, build and act with solidarity, respect the internal dynamics of the various sectors, including the governments, but act on our rights and demand that our governmental authorities to do their work and comply with their commitments and duties.

And we count on UNAIDS, one of our most valuable partners, and on other United Nations agencies.

AS: The global key population networks have been advocates for community-led responses and accountability mechanisms. With the support of multilateral and philanthropic funding, we will continue to support grass-roots local and regional efforts. Unfortunately, with shrinking civil society space and funding, this will be a challenge. We need multilateral and philanthropic support in order to continue this role.