We represent
communities directly affected by the global HIV pandemic - communities of
people living with HIV, documented and undocumented migrants and mobile
populations, men who have sex with men, people incarcerated, people using
drugs, sex workers, transgender people, women, and young key populations from Asia and the Pacific.
We have participated
and engaged in the 11th ICAAP Community Forum to discuss the HIV
epidemic, the HIV response, and how the issues around it impact on our lives
and our communities. These include the continuing inadequacy of funding; the continued
presence of legal barriers and the lack of comprehensive legal reforms such as the
decriminalization of key populations; lack of sincere commitment to serve
communities; and an uneven political will to bring about an end to the HIV
epidemic.
There is a global
commitment to “Get to Zero”, yet in the Community Forum, we found ourselves
tackling the same issues that communities have raised again and again, in
various platforms at the national level, regionally, and globally.
We are deeply
frustrated that the same issues surface and remain unaddressed especially at
the time when we have the evidence and the knowledge we need to stop the HIV
epidemic. Communities have the unique expertise to effectively craft the shape
of the response, and their leadership is crucial, and yet they remain
marginalized. This demonstrates that we are not getting to Zero Discrimination,
Zero New Infections, Zero AIDS-related deaths. We are instead getting to Zero
Change!
We have made gains in
changing risky behaviors to decrease vulnerabilities to HIV infection, but we
have not made adequate gains in changing the behavior of policy makers,
political leaders, and state actors. Evidence should be the foundation of the
response, and yet 30 years later, HIV is still viewed from the lens of dogmatic
morality.
For communities, we
see the “Three Zeroes” very differently.
Zero
access to funding.
There is funding for the response, but it is often not based on evidence and insufficient
for effective scale up. The emphasis is on quantity and not quality. Donors largely
still define the funding agenda, without community involvement and leadership.
The way funding models are structured harms the community and hampers community
building efforts – they encourage competition rather than solidarity and
collaboration. Furthermore, current funding priorities manifest the
medicalization of the HIV response: prevention is deprioritized to focus on
profit-driven treatment. Funding decisions on treatment should improve the
lives of PLHIVs and people living with other life-threatening conditions like Hepatitis
C. Corporate profits must not stand in the way of sustainable and effective
responses.
Funding for the HIV
response must put key population and communities at the center of decision-making.
Resources must be scaled up and targeted directly to communities, and that
should include support for core operations and sustainability of community
organizations, not just specific program outcomes.
Funding for human
rights, gender equality, community mobilization, and advocacy must not be
excluded in the HIV response. While we urge governments to fund all of its aspects,
until this is achieved, we call on international donors to fund these areas adequately.
Zero
legal reforms.
Repressive laws and practices that undermine the HIV response must be reformed
to meet human rights standards and public health goals. Sex workers, sex industry workplaces, sex work
clients and others involved in the industry are highly criminalized. People who
use drugs are subjected to mandatory detention, involuntary rehabilitation and
capital punishment. Same-sex sexual behavior and relationships are still
considered as legal offenses in many countries. Age-of-consent laws impede
access to health, including HIV testing, and community mobilization.
Migrants face
exclusion, stigma, and discrimination in accessing health services and are
subjected to mandatory HIV testing and deportation. People in custody, detention,
and prisons lack access to basic healthcare, treatment, legal aid, and harm
reduction prophylactics. HIV services and testing for young key populations
remain unavailable due to laws that require parental consent. Safe abortion
remains illegal in many countries, and gender-based violence hampers the full
participation of women. Common laws, civil laws, and religious laws perpetuate
human rights abuse and violence against communities affected by the HIV
epidemic.
If we are to get to Zero
Discrimination, human rights should be the overarching guiding principle of the
HIV response. A concrete plan must be established for legal reforms, especially
the complete decriminalization of key populations. Transparent mechanisms
should be established to improve accountability of governments based on human
rights standards.
Zero
political will.
There is zero change because of the absence of the political will to get to the
Three Zeros. Sex work must be recognized as work. Drug use must be recognized as
a human rights and public health concern, not as a law enforcement issue. Human
rights related to sexual orientation and gender identity must be protected, and
same-sex behavior between consenting individuals must not be treated as a
crime. Transgender people should be given full gender recognition and citizenship
rights. Gender disparity needs to be addressed comprehensively, as does
paternalistic tokenism of young key populations.
Political inertia keeps
the response from fulfilling what the evidence shows. Communities remain
invisible, ignored, and are often not recognized by duty-bearers; where they
are visible, they are treated as criminals and second-class citizens.
To stop this inertia, human
rights must be embedded in the HIV response, and communities must be embraced
as equal partners. Enabling advocacy and
ensuring accountability should be prioritized to give the response the
political momentum that it needs.
STAND WITH US! SHOW US
THE SUPPORT! IT’S TIME TO END AIDS, THIS IS OUR LIVES, AND THE TIME TO ACT IS
NOW!
