No one at the high-level United Nations conference devoted to ending the AIDS epidemic by 2030 denies serious scientific and financial challenges remain, but cultural sensitivities may prove the toughest stumbling block on the way to achieving that goal.
A number of gay and transgender groups were excluded from attending the three-day-long conference that began Wednesday by countries who objected to their presence and nations squabbled over references in a final statement to topics involving gay sex and intravenous drug use.
General Assembly President Mogens Lykketoft conceded that cultural sensitivities complicated negotiations, which continued until the last minute, but hailed the final result, which calls for countries to reduce the number of new HIV infections to below 500,000 a year by 2020, down from 2.1 million in 2015 and bringing the number of annual AIDS-related deaths to under half a million in 2020 from 1.1 million last year.
"It's obvious that cultural sensitivities have played a very big role in all the difficulties we have met during this process and of course many of us hope that at the end, the evidence we have of what works, the evidence we have on the necessity to integrate all key populations in the efforts against this epidemic will prevail, but there are different opinions, there are limitations for how long we can come with a consensus in the whole UN family," Lykketoft said.
Matthew Kavanagh, senior policy analyst for the anti-AIDS group HealthGap, said he applauded the so-called 90-90-90 treatment target for 2020 whereby 90 percent of people infected with the disease know their HIV status, 90 percent of those who know they are infected are accessing treatment and 90 percent of those receiving treatment have suppressed viral loads.
But Kavanagh said he was disheartened over efforts by countries like Russia, Iran, Poland and several Gulf states who managed to strip language from an earlier draft of the conference's political declaration that would have called for the decriminalization of homosexuality and drug use and urging they be treated instead as human rights issues.
"So there's one reality that bold targets have been set," Kavanagh said. "Then there's this other reality that we will never reach those targets so long as critical populations like men who have sex with men are criminalized and stigmatized, because when they are they can't and won't access treatment."
Michel Sidibe, executive director of UNAIDS, recognized the complexity of the issue but added that he felt the declaration was something to be proud of.
"I think anything linked to sexuality is very complex. Is it about taboo? Is it about norms? Is it about the position of people in the society? It's about so many factors, cultural factors, economic factors. That's why AIDS is so complex. It's not easy to deal with a political declaration when you're talking about HIV/AIDS. You're confronting different societies, different opinions," Sidibe said.
But Sidibe said those opinions could also change over time.
He cited China, which long promoted zero tolerance for drug injectors until UNAIDS was able to demonstrate that the policy was not effective in containing the spread of AIDS. The Chinese government then embarked on the world's biggest harm reduction program and today the country is close to eliminating transmission among intravenous drug users, Sidibe said.
"I think we are seeing a lot of change, I remember we could not even talk about men having sex with men a few years ago," Sidibe said, noting that many countries were starting to think about reforming theirs laws to make them more inclusive.
Still, even after the 193-member General Assembly adopted the final political statement by consensus, several countries took to the floor to denounce terms they found objectionable.
Iceland complained the term sex worker jibed with their laws involving prostitution; Singapore objected to language stating that criminalization of drug users hinders efforts to reach those infected with HIV/AIDS.
Sudan flagged terms in the statement ranging from "sexuality" to "comprehensive education" — because it also included sexual education. Russia complained that some of the language in the statement interfered with the principle of national sovereignty. Indonesia and the Holy See lamented that the document did not recognize the importance of sexual abstinence in limiting the spread of the disease.
Meanwhile, Canada and the US complained that the language protecting human rights wasn't stronger and defended the inclusion of civil society groups in the discussion — a reference to the exclusion of a number of gay and transgender groups whose presence at the conference had been vetoed by some UN member states.
Nelson Mandela's grandson Ndaba Mandela also addressed the conference, recalling that when his father died of AIDS the family considered telling the media he had died of TB or pneumonia, but his grandfather insisted on telling the truth despite the stigma attached to the disease.
He called on countries to ensure the wellbeing and dignity of high risk groups like LGBT people, drug users and sex workers among others.
"I am here to ask leaders of the 35 countries that still don't allow foreigners living with HIV to enter or reside within their countries to end travel restrictions now. Because the truth is that building walls or denying visas is not how we protect ourselves from HIV or end a global epidemic. Bigotry and fear do nothing but spread the virus," Mandela said.
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