This month’s UN summit for the adoption of the post-2015 global development agenda will provide an opportunity for States to endorse 17 new global Sustainable Development Goals (SDGs).1 The goals, built on the momentum from implementing the Millennium Development Goals (MDGs) 2000-2015, will guide economic, environmental and social initiatives for the next 15 years.2
SDG 3, the overarching goal on health issues, seeks to ensure healthy lives and promote wellbeing for all at all ages. Target 3.3 is, “By 2030, end the epidemics of AIDS, tuberculosis, malaria and neglected tropical diseases and combat hepatitis, water-borne diseases and other communicable diseases”.3 There are several other goals and targets in the proposed SDGs that are relevant to ending AIDS by 2030; these include goals 1-5, 8, 10, 11, 16 and 17. It is therefore useful to look at the SDGs as whole to assess how they might impact issues of HIV.
By ending poverty and hunger, ensuring quality healthcare and education, achieving gender equality and reducing inequality, the world would be addressing some of the underlying factors that leave people vulnerable to HIV infection. Other SDG targets that will contribute to target 3.3 are the promotion of economic growth and decent work, making cities safe and resilient and promoting peaceful and inclusive societies. Strengthening HIV programs to secure affordable HIV treatments can also contribute to other health and equity agendas, including TB, hepatitis C and non-communicable diseases.
To appreciate the significance of SDG 3.3, we must reflect on the achievements and the lessons learned from MDG 6, which aimed at combating HIV & AIDS, malaria and other diseases. MDG 6 had two key HIV targets: halting and beginning to reverse the spread of HIV by 2015; and to achieve, by 2010, universal access to treatment for HIV & AIDS. According to UNAIDS, the world has succeeded in meeting these targets and even in some instances exceeded them.4 UNAIDS estimates that by end of 2015, over 15 million people living with HIV will be receiving antiretroviral therapy (ART); only one million people were receiving ART in 2001. The number of pills taken daily has reduced from eight to one, and between 2000 and 2015, the number of new HIV infections per year has reduced from 3 million to 2 million. UNAIDS attributes this achievement to increased funding, empowering communities, and adopting evidence-informed human rights-based approaches (HRBAs) to programs and policies.5 Despite these achievements, we must be alive to the fact that in general MDGs had a blind spot on human rights, inequality, and the use of HRBAs. The proposed SDGs, partly informed by HIV successes using HRBAs, are paying greater heed to human rights.
To achieve the ambitious target set by SDG 3.3, we would have to ensure that by 2030, there are zero HIV infections, zero HIV related deaths, zero HIV related discrimination, and all people who are living with HIV would have access to ART. “Ending AIDS by 2030” was a catchphrase during the 20th International AIDS conference in Melbourne in 2014: it has shaped the proposed vision and goals of the UNAIDS Strategy 2016-2020. There is overwhelming evidence on what needs to be done to end AIDS by 2030 and we therefore have no excuse in failing to achieve these targets. But we have learned from the past that the indicators we select must reflect human rights.6
UNAIDS and the Lancet Commission recently published a paper on defeating AIDS and advancing global health.7 The paper has seven key recommendations to achieve SDG 3.3. One is to uphold human rights and address criminalization, stigma, and discrimination, using practical approaches to change laws, policies, and public attitudes that violate human rights. Indeed many HIV rights activists have argued that unless the global HIV response removes the legal and human rights barriers that affect the lives of people living with HIV, we cannot end AIDS by 2030. Nevertheless, very few countries have human rights programs embedded in the national AIDS plans.8
The Global Commission on HIV and the Law in its July 2012 report, Risks, Rights and Health emphasizes that scientific tools alone are not sufficient to halt and reverse AIDS. It notes that enabling legal environments is essential.9 Changes in law and public policy could almost halve new HIV infections globally, lowering the HIV incidence from 2.1 million to 1.2 million new infections a year, according to AIDS 2031 project.10 And yet, less than 1% of the $18.9 billion spent on HIV/AIDS in 2012 went towards essential human rights responses.11
Organizations working at the intersection of AIDS and human rights are facing overall funding challenges with donors retreating on their funding commitments.12 As well as that, countries and regional blocs are negotiating trade agreements that contain problematic clauses that exceed the minimum standards required by the Trade Related aspects of Intellectual Property Rights (TRIPS) and could consequently affect the prices and availability of generic medicines.13 There are over 35 countries that have HIV travel restrictions. All these actions pose a threat to gains made so far and will limit the global capacity to end AIDS by 2030.
To achieve SDG 3.3 countries that have punitive laws against People Living with HIV must repeal them and enact laws that facilitate and enable effective responses to HIV prevention, care and treatment services for all who need them. These laws, human rights commitments and constitutional guarantees must be enforced. Effective HIV responses require respect for the human rights of key populations including women, young people, people who use drugs, sex workers, transgender persons, prisoners, persons with disabilities, and men who have sex with men.
Human rights-based approaches to HIV must be tailored to the needs and realities of those affected by HIV. It is well known that protecting and fulfilling the human rights of people vulnerable to infection and those already infected is necessary if we are to end AIDS by 2030. Will evidence continue to be ignored post 2015, or will countries and donors adopt these key human rights actions to meet the SDG targets?
Ending AIDS by 2030 is ambitious but achievable. Cuba, with its elimination of mother to child transmission of HIV and syphilis, has shown the world that ambitious targets are achievable.14 UNAIDS and the Lancet Commission suggest that the next five years offers a critical window of opportunity to scale up the response to end AIDS as a public health problem by 2030. Such a response, to ensure “no one will be left behind” will require $180 billion in those five years.15 It also requires that human rights and rights-based approaches using the principles of participation, accountability, non-discrimination, empowerment, sustainability and respect of the rule of law take center stage.
Allan Maleche is the Executive Director of KELIN, the Alternate Board Member of the Developing Country NGO Delegation to the Global Fund Board, a Board member of the African Sexworkers Alliance and is currently a visiting scholar in the FXB Center for Health and Human rights at the Harvard T.H Chan School of Public Health.
1 UN. 2015. Transforming Our World: The 2030 Agenda for Global Action. New York, NY: UN. Available: https://sustainabledevelopment.un.org/content/documents/7891Transforming%20Our%20World.pdf;
2 The eight agreed upon goals, by all UN member states and UN agencies, that were to be achieve by 2015 http://www.un.org/millenniumgoals/
3 see note 1, p.14
4 UNAIDS. 2015. How AIDS changed everything. MDG 6: 15 years. 15 lessons of hope from the AIDS response. Geneva, CH: UNAIDS. Available: http://www.unaids.org/en/resources/documents/2015/MDG6_15years-15lessonsfromtheAIDSresponse
5 ibid, Footnote 4, p.21
6 UNAIDS Human rights Indicators what counts? https://megontheinternet.wordpress.com/2015/06/25/unaids-human-rights-indicators-what-counts/
7 The UNAIDS and Lancet Commission. 2015. Defeating AIDS, Advancing Global Health. London, UK: The Lancet. Available: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736%2815%2960658-4/abstract
8 Key programmes to reduce stigma and discrimination and increase access to justice in national HIV responses http://www.unaids.org/en/resources/documents/2012/Key_Human_Rights_Programmes
9 Report available at http://www.hivlawcommission.org/index.php/report
10 Cost and Choices: Financing the long term fight Against AIDS Available at http://r4d.org/knowledge-center/costs-choices-financing-long-term-fight-against-aids
11 HIV & Human Rights a Mapping of Donor Priorities and Trends in Southern Africa Available at: https://www.google.co.ke/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0CBwQFjAAahUKEwjNm7vSifLHAhUKzIAKHVloClY&url=http%3A%2F%2Fpag.aids2014.org%2FPAGMaterial%2FPPT%2F1198_1070%2Ffinal.pptx&usg=AFQjCNH8xEv9jFDVxgUsAali_rCgB8wnSA&bvm=bv.102537793,d.eXY
12 Open Society Foundation, “HIV and Human Rights: A Mapping of Donor Priorities and Trends in Southern Africa”, 2014, available at https://www.opensocietyfoundations.org/briefing-papers/hiv-and-human-rights-mapping-donor-priorities-and-trends-southern-africa
13 The Potential impact of free trade agreements on Public health (UNAIDS& UNDP issue brief) Available here; see also F. Quigley, “The Trans-Pacific Partnership and Access to Medicines”, Perspective in Health and Human Rights Journal website, June 2015, available at: http://www.hhrjournal.org/2015/06/18/the-trans-pacific-partnership-and-access-to-medicines/
14 WHO validates elimination of mother to child transmission of HIV & Syphilis in Cuba http://www.who.int/mediacentre/news/releases/2015/mtct-hiv-cuba/en/
15 UNAIDS. 2014. The Gap Report. Geneva, CH: UNAIDS. Available at: http://www.unaids.org/en/resources/campaigns/2014/2014gapreport/gapreport
Previous publications by Allan Maleche in the Health and Human Rights Journal
Right to Health Encompasses Right to Access Essential Generic Medicines: Challenging the 2008 Anti-Counterfeit Act in Kenya