By Simon Rushton, Special to CNN
Editor’s note: Simon Rushton is an associate Fellow at Chatham House’s Centre on Global Health Security. The views expressed are the writer’s own.
In his comments in the lead up to World AIDS Day this Sunday, UNAIDS Executive Director Michel Sidibé reiterated the organization’s view that every person counts. “If we are going to keep our pledge of leaving no-one behind we have to make sure HIV services reach everyone in need.” Yet although the updated statistics on HIV and AIDS released this week show remarkable progress in many areas, they also make clear that some are indeed being left behind.
The headline figures are encouraging: a 33 percent decrease in new HIV infections since 2001; a 29 percent decrease in AIDS-related deaths since 2005; a 40-fold increase in access to antiretroviral therapy between 2002 and 2012. But as UNAIDS also admits, global progress in the fight against AIDS is highly uneven. The situation varies widely between countries and regions. In some of the most populous parts of the world – such as the Middle East and East Asia – both new HIV infections and AIDS-related deaths have actually increased over the past decade.
And although the promise of leaving no-one behind sounds uncontroversial, in practice it is highly political. Those “left behind” are not always the victims of a lack of resources (although that remains a problem), and they are not simply forgotten. Instead, in many cases they are deliberately and systematically excluded from accessing prevention, treatment and care services by their governments. Sex workers, men who have sex with men, transgender people and intravenous drug users are in many countries targeted by legislation that restricts their ability to make use of the services they need. In many countries, persistent gender inequalities also make women much more vulnerable to infection, and much less able to access treatment once infected.
Human rights language has long featured prominently in the rhetoric of all the major global AIDS institutions and it is essential that rights remain at the heart of AIDS work, and continue to be respected in AIDS programs at the global, national and local levels.
There have been cases where global AIDS organizations have been successful in persuading countries to change their policies by “shaming” them and publicising the fact that their policies do not accord with their human rights obligations. The International Task Team on HIV-Related Travel Restrictions was one example. Leaders in the AIDS policy community, including Sidibé, have sometimes been highly outspoken about the need for social change and have been clear in calling for an end to discriminatory practices. But are those countries that deliberately practice discrimination really “shame-able” in this way? Are we beginning to reach the limits of what global AIDS institutions can achieve through lecturing governments on respecting the rights of their citizens?
The message, it seems, needs to be amplified – from above and below. We need national governments (including the major donors in the global AIDS effort) to offer more vocal support for the rights of marginalized communities across the world, and to be politically braver in criticising those governments who deny the rights of their citizens to access healthcare.
Equally important, however, is revitalising the grassroots of the AIDS movement. It was civil society that founded the global effort against AIDS in the 1980s and 1990s and that persuaded those governments who were receptive to their message to take it seriously. Ever since, activists and affected communities have continued to play a vital role in defending the rights of those affected by the disease. But in recent years, AIDS activism has become notably less high-profile on the global stage.
Social media gives us a new opportunity to engage with the disenfranchised and a chance to offer them a voice – anonymously where necessary. Pressure from below has been a crucial factor in precipitating social change throughout history, not least around AIDS. We need to hear more from those who are themselves left behind – especially on World AIDS Day – and their voices need to be supported and amplified. It is time for those who claim to have their interests at heart to listen and act.