On Tuesday, the United Nations is expected to adopt new targets to end AIDS as a public health threat by 2030, a target that most countries seemingly could easily have agreed to. But consensus was elusive.
In early negotiations on what is known as the Political Declaration, the United States and the European Union fought to outlaw policies and laws that stigmatize or even criminalize high-risk groups – and adopted measures to relax patent protection for H.I.V. cut back drastically. Drugs.
The UN Declaration sets priorities for the global fight against AIDS and guides national policy. There are also opportunities for global health and civil society organizations to put pressure on governments to honor their commitments.
After several days of heavy processing by delegates from some countries and skilful negotiations by others, it is expected that the member countries will adopt a final version of the declaration on Tuesday morning. The final draft includes an important new goal of getting most nations to reform discriminatory laws so that less than 10 percent of the world's countries would take action that unfairly targets people affected by H.I.V. are threatened or live with them.
“These laws drive the most powerful of H.I.V. away from H.I.V. Prevention and Treatment, ”said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University. "This could be a crucial tool in getting the world back on track to end AIDS."
On Monday, Dr. Kavanagh and colleagues do a new paper showing that countries that criminalize same-sex relationships, drug use, and sex work have had much less success, H.I.V.
But the declaration does not move the needle to patent protection. The United States was one of the nations whose delegates watered down or shortened the language significantly to loosen patents to provide better access to affordable H.I.V. Medication in low- and middle-income countries, an attitude that is in direct contradiction to the Biden government's support for renouncing patents on Covid vaccines.
"The mixed messages from the administration in the face of recent support for the waiver of Covid-19 vaccine patents are confusing and disappointing," said Annette Gaudino, director of policy at Treatment Action Group, an advocacy group in New York. "This would by far not be the first time the US has put drug company profits above people and public health."
The United Nations brings together heads of state, health ministers and non-governmental organizations to identify priorities for combating H.I.V. Pandemic every five years. At a similar meeting in 2016, member countries agreed to accept fewer than 500,000 new H.I.V. Infections annually, fewer than 500,000 AIDS-related deaths and eradication of HIV-related discrimination by 2020.
The world did not achieve these goals: About 1.5 million people became infected with H.I.V. in 2020, and about 690,000 died.
Ending AIDS by 2030 was an ambitious goal adopted by the United Nations in 2015 as part of a broader sustainable development agenda. But without more advanced policies and laws, the goal is not achievable, said Dr. Kavanagh.
"To end AIDS by 2030, governments must commit to taking a people-centered, rights-based approach to HIV, working on policy and legal reform, engaging and supporting communities, and ending inequalities," said Winnie Byanyima, Executive Director from UNAIDS said in an email statement.
The original draft of the Declaration of 28th Status, Sexual Orientation and Gender Identity. "
Delegates from a few countries, including China, Russia and Iran, tried to erase allusions to sexual or gender identity or sex education for girls. This has only partially succeeded: the current text calls for prevention approaches that are tailored to risk groups, including sex workers, men who have sex with men, drug users and transgender people.
The statement in its current form also calls on countries to “empower women and girls to take care of their sexual and reproductive health and reproductive rights,” a section that Saudi Arabia, Russia and the Holy See attempted remove the text.
Representatives from Belarus, China and Russia also deleted a section calling on member countries to recognize citizens' autonomy in matters of sexuality; its replaced text encouraged "responsible sexual behavior, including abstinence and fidelity". The final document has been reverted to the original text.
Even if the declaration is adopted on Tuesday, these countries may distance themselves from certain sections that contradict their cultural or religious norms.
Including language through high-risk groups is critical to success, some experts said. Gays and other men who have sex with men, people who inject drugs, and female sex workers are almost 30 times more likely to have H.I.V. compared to the general population.
If these groups don't have access to the preventive therapies, clean needles, condoms, or education, "we will undermine the possibility of actually ending AIDS by 2030," said Eric Sawyer, an advocate and long-term survivor for H.I.V.
An early draft of the declaration also contained a longer section aimed at relaxing patent protection. Under current global rules, only the 50 least developed countries are allowed to remove patents on pharmaceutical products for distribution to citizens.
The draft called for “an indefinite moratorium on international intellectual property regulations for drugs, diagnostics and other health technologies”. Representatives from the United States and Switzerland deleted this section. A representative from the European Union said: "This is not the place to discuss these general issues."
The United States also added language to the reduced version to recognize the "importance of the intellectual property rights regime in contributing to a more effective AIDS response."
Activists said a stance against patent protection was completely consistent for the European Union, which also spoke out against waiving patents on Covid vaccines. Vaccine manufacturers have argued that patent protection is essential to fuel innovation.
Citing the urgent need for vaccines, however, Biden government officials have said they would support a patent waiver that would allow companies to manufacture cheaper versions of the vaccines for the rest of the world.
Given this development, "it would be really inconsistent for the US". against a relaxation of the patent protection for H.I.V. Drugs, said Brook Baker, a senior policy analyst with the Health Global Access Project, an advocacy group.
"Why in the world should the US be talking on a seemingly identical subject from two sides of the mouth?"