Thursday 16 October 2014

Blog Action Day: Inequality and HIV

Indraveer Chatterjee
The global HIV epidemic is characterised by inequality. To name just two dimensions of this: gender inequality fuels the spread of HIV; and unequal access to treatment results in unnecessarily high rates of illness and death in many countries. 

To mark the Blog Action Day theme of inequality this year, we invited Indraveer Chatterjee, Principal Solicitor at the HIV/AIDS Legal Centre (HALC) to write about how inequality within the epidemic is entrenched by a lack of support for human rights.

This article is based on a presentation Indraveer gave at an AIDS 2014 feedback session at ACON in September.

I've been asked to present one take-home message from among the hundreds discussed at the recent international AIDS Conference, and my choice is easy: the lack of funds for human rights initiatives.

Human rights, and HIV (and hepatitis C) stigma were front and centre at the conference. They are also ever present in all the big picture UNAIDS messaging. Zero discrimination is one of the three 'zeros' in the UNAIDS 2011 - 2015 strategy, and the one that UNAIDS Executive Director Michel Sidibé acknowledges is the hardest to achieve. The fact that a lack of human rights is the principal obstacle is also implicit in the recognition that we now have the science to end this epidemic.

The need for human rights is echoed across the board, and not just by community advocates - the prestigious medical journal Lancet launched a special issue on HIV and sex workers at the conference. Its front cover stated 'to address HIV in sex workers will need sustained community engagement and empowerment', and that this would require a 'human-rights based approach to health'.

Sex workers are one of the 12 key vulnerable populations identified by the UNAIDS Gap Report released earlier this year. It is no coincidence that these populations are also among the most disenfranchised. Their susceptibility to HIV can be seen in some simple statistics. Compared to the general population -

  • sex workers are 12 times more likely to get HIV
  • men who have sex with men are 19 times more likely
  • prisoners are 50 times more likely
  • 13% of people who inject drugs are living with HIV; and
  • One third of all new infections outside Sub-Saharan Africa are among injecting drug users. 

In Australia, sustained and effective advocacy in the early years of the epidemic by the populations most affected resulted in negligible rates of HIV infection among sex workers and people who inject drugs; and while rates of HIV are higher among gay men, we continue to have a very low overall prevalence. There can be little doubt that the decriminalisation of homosexuality played a significant role in that.

Human rights slogans in the 'G'day: Welcome to Australia'
 Networking Zone hosted by AFAO at AIDS 2014.
The Lancet special issue corroborates - through rigorous, peer reviewed work - strongly held beliefs that protecting the human rights of vulnerable populations such as sex workers is crucial to reducing the impact of HIV. Punitive laws that reinforce stigma and discrimination, and drive people underground, afraid to access HIV treatment and prevention services, are key impediments to halting the spread of HIV in these populations in many countries.

This was a key message at AIDS 2014, but the money spent simply does not reflect the importance that human rights based interventions are accorded in public speech. Funding priorities are the clearest indicator of what is actually important to governments, and it's clear that vulnerable populations are not high on their list.

One of the most striking presentations I attended at the conference was by Ralph Jürgens, Director of programs for the Open Society Public Health Program: If 'critical enablers' are critical, why are they not being adequately funded? A mapping of donor priorities and trends on HIV and human rights.

The first slide of that presentation simply stated We will not end AIDS by 2030, a thought that is neither controversial nor surprising, but somewhat overlooked during the entirety of the conference.

Jürgens and his colleagues' premise is that human rights initiatives are critical, but are receiving next to no funding. Their data certainly supports it, and people across the board in Australia could attest to this, even in the context of a developed, functioning democracy.

Their analysis of funding to human rights initiatives in Africa showed that only 17% of programs experienced an increase in funding, while almost 60% experienced a funding decrease. More worryingly, 70% of the organisations surveyed had never received money from their domestic government - currently the largest source of funds, and likely to grow what with the general downturn in foreign aid spending.

Staff and volunteers at HALC, which has had to downsize
due to inadequate funding.
In 2012, less than 1% of global HIV funding went to the human rights response. Jürgens noted that 'many of the rights organizations that have made progress possible in the fight against HIV are closing down or downsizing because they find it increasingly difficult to access funds for their work'; sentiments that I (with many colleagues not just in HIV, but in the community legal, and the community space generally) unfortunately empathise all too closely with. We had to downsize last year, basic payments are an ongoing struggle, and we may well have to downsize again next year.

As Jürgens says, these 'are the organizations that hold their governments accountable, take pharmaceutical companies to court, or create social movements that demand real change. Without these changes the 2030 goal will only be empty talk. And we will continue to leave millions of people behind.'

While at AIDS 2014, I saw people doing remarkable things in environments that were hostile beyond belief, with non-existent or unsustainable funding. The struggles of Ugandan activists following the public backlash there against the alleged actions of a nurse intentionally infecting a child, and the successful actions of Ukrainian activists in not only obtaining state funding for the purchase of hepatitis C treatments, but also obtaining 60% price reduction from pharmaceutical companies, are but two of the many unbelievably inspiring stories of grassroots - and fundamentally human rights based -- advocacy that I saw at the conference.

So in this context of the need for a human rights based approach and shrinking funding, what can be done?

Australia is seen as a global leader in relation to HIV. People I met at the conference made it very clear to me that our actions influence other governments. I believe this means that we need to translate what we do around HIV and human rights for that broader international audience; we must articulate the value of the human rights based approach and the necessity of funding human rights advocacy organisations. If we do this in Australia, so will governments around the world.

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