Tracking Progress Since AIDS 2000 in Durban
Two years ago, we collected every press release and flyer issued at the Durban Conference. Now we are opening those files again to ask: "How far were the words, commitments and plans implemented? Did they make it into concrete actions?
In the final lead-up to this years International AIDS Conference in Barcelona, a selection of those announcements are being systematically reproduced and revisited on INTAIDS - to find out what has been achieved in the 22 months since they were issued. We start the debate today by looking back at the plenary given at AIDS2000 by Kenneth Roth, Executive Director of Human Rights Watch titled: Human Rights and the AIDS Crisis: The Debate Over Resources. HDN asked Mr Roth how his views on where the money for the AIDS response should come from, and on national commitments and transparency, had changed since he made that speech two years ago- and what differences he thought the UNGASS and Global Fund developments had made.
In the coming weeks, we shall be looking closely at other statements and commitments that were made during the Durban Conference in 2000 - by governments; by drug companies; by international organizations and by prominent NGOs. What has happened to those fine words and statements? Which of the projects and promises turned into real progress? How much of the hype and publicity turned into thin air?
They Said... You Said #1
Human Rights Watch Plenary Revisited
The International Covenant on Economic, Social and Cultural Rights (see end of this posting) was the foundation of a plenary speech given by Kenneth Roth, Executive Director of Human Rights Watch, at the International AIDS Conference in Durban in 2000.
Reiterating the inextricable connections between health and human rights, Roth identified the need to approach the HIV/AIDS epidemic as an issue not only of civil and political rights, but more crucially, one of economic and social rights. With this in mind, he called for the mobilization of a different approach to HIV/AIDS one in which ALL governments, of both developed, and developing, nations, are responsible and accountable for addressing the epidemic with the appropriate urgency and transparency, both independently and cooperatively. Only in this way, he claimed, would the world be able to move toward securing the tremendous resources needed to address HIV/AIDS.
Since 2000, we have seen two turning points in this aspect of the HIV/AIDS field. The first was the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) in mid-2001 and the resulting Declaration of Commitment; the second, was the establishment of the Global Fund to Fight AIDS, Tuberculosis & Malaria.
We asked Mr Roth for his reaction to these two events, with respect to some of the statements that he made at Durban two years ago. What follows is a series of excerpts from both his original speech and his recent response.
On resources to pay for the response to HIV/AIDS...
Kenneth Roth 2000:
Today  a new public-health challenge has come to the fore in the fight against AIDS. The issue is less what should be done to prevent or treat HIV infection than where we will find the enormous resources we need. Who should pay the cost of combating AIDS? In particular, does the industrialized world have an obligation to help the people of the developing world, and if so, what precisely is owed? Should obligations arising out of the AIDS pandemic differ from obligations arising out of other public-health crises or from the general need for basic health care?
For today,s purposes, let us assume that we can identify what it means to violate the right to the "highest attainable standard of mental and physical health. That is an ambitious but worthy goal. In the context of AIDS, it must mean access to the best available information, drugs and treatment for avoiding infection and treating the disease. Needless to say, fulfilling this right is extraordinarily expensive. UNAIDS estimates that the funds needed annually to deliver adequate prevention programs to sub-Saharan Africa alone would be approximately US$2 billion, while another $2 billion would be needed for basic drugs and treatment.
So, it is easy enough to conclude that the right to the highest attainable standard of health is unfulfilled. But the answers to the two other questions needed for effective public shaming are more difficult to provide; who is responsible for this violation of human rights, and what is the remedy? Does it make sense to blame impoverished governments when they have so few available resources? If not can we blame other governments the more prosperous West for not contributing more to the global fight against AIDS? If so, which governments are to blame, and how much money should they contribute?
Kenneth Roth 2002:
In my remarks at Durban, I noted that the mobilization of a vastly more important level of resources to address the treatment and prevention challenges of HIV/AIDS is a central challenge to combating the epidemic. This remains true today. The creation of the Global Fund was an important response to the need for greater mobilization of international assistance to combat HIV/AIDS, but it is of concern that pledges to the Fund remain so much lower than the order of magnitude hoped for and needed.
On national commitments and transparency...
The duty to provide international assistance for securing economic and social rights requires governments of the industrialized world to devise and publicly adopt a global plan and timetable for meeting the extraordinary economic challenges of combating AIDS. Governments of the developing world must proceed with similar transparency and resolve within their countries. Such commitments permit the public scrutiny of economic priorities that is the best way we have of enforcing these human rights. If these steps are taken, we will have gone a long way toward containing this deadly disease.
My speech suggested that even countries with serious resource constraints can take important steps to solidify their fight against HIV/AIDS, including establishing realistic national plans with clear timetables for action and demonstrating progress against those timetables. More such national plans exist and appear to be guiding action than was the case at the time of the Durban meeting, but the best efforts of many governments will be undermined if there is not soon an enormous increase in investment in fighting AIDS on the part of both governments in affected countries and international donors.
On social and cultural norms that affect the spread of HIV...
We should also insist that governments attack cultural norms and practices that fuel the spread of AIDS. We all know of the macho culture that celebrates the number of women that a man can sexually conquer, the horrifying myth that AIDS can be cured by sleeping with a virgin or young girl, or the deadly expectation that a wife have unprotected sex with her husband even if he is HIV-positive. These dangerous, destructive practices are too costly to tolerate. We must not allow discomfort with the topic of sexual mores to stand in the way of loud and frank denunciations by governments.
At Human Rights Watch, we remain concerned that human rights violations are fueling the HIV/AIDS epidemic in many countries, and that the human rights abuses suffered by people infected and affected by HIV/AIDS are widespread. These facts appear to be widely accepted, and large AIDS projects, such as those funded through World Bank lending, frequently pay lip service to the importance of respecting human rights as good HIV/AIDS policy. Nonetheless, donors and affected governments alike are not paying adequate attention to the human rights underpinnings of the epidemic or devoting enough effort to monitoring and addressing abuses. Our research has shown that sexual violence, the subordinate status of women and girls, a wide range of abuses suffered by children orphaned or otherwise affected by AIDS, discrimination and stigma faced by injecting drug users, gay men, sex workers and other high risk groups, and failure of the state to ensure freedom of expression for AIDS educators and outreach workers all continue to be important factors in driving the epidemic. These important human rights abuses barely register in the global discourse on HIV/AIDS even though they compromise national responses to AIDS in many countries. I hope that the Global Fund under its new leadership will use its significant influence to press governments to address human rights violations associated with the epidemic.
On enduring discrimination...
Similarly, we must insist on government leadership in denouncing and ending discrimination that impedes the fight against AIDS. For example, how can we reduce mother-to-child transmission if HIV-positive women are afraid not to breastfeed their babies for fear of stigmatization? How can we reduce transmission among gay men, lesbians, bisexual and transgendered people if the discrimination they face precludes education regarding same-sex sexual practices? Again, the issue here is not resources, but political will.
The inclusion of many human rights ideas in the declaration from the U.N. Special Session on HIV/AIDS was  a very positive development. The explicit recognition of the realization of the rights of women and girls as an essential element in the fight against HIV/AIDS was particularly welcome. Nonetheless, I was disappointed that the delegations to the Session could not find consensus around a strong statement highlighting the need for protection of the human rights of men who have sex with men, drug users, and sex workers. Although the world is rightly focused on the catastrophic situation in Africa where HIV prevalence rates in the general population are so high, there are many countries"probably more than 100"where the epidemic is thought to be largely confined to high-risk groups such as drug users and men who have sex with men. Persistent human rights violations against these traditional high-risk groups are contributing to a very destructive course of the epidemic in many countries. The failure of the Special Session to make this clear in its declaration was a case in which, unfortunately, extraneous moral agendas and political cowardice, including on the part of the United States, won the day over human rights principles.
Note to readers:
Since the Durban meeting, Human Rights Watch has established a program on HIV/AIDS through which [they] hope to contribute solid documentation of AIDS-related human rights abuses, analysis under international human rights law, and relevant advocacy to reduce abusive policies and practices. For more information, contact Joanne Csete (email@example.com), who heads the HIV/AIDS program.
For the full text of Kenneth Roth,s speech at AIDS2000:
"Human Rights and the AIDS Crisis: The Debate Over Resources Kenneth Roth, Executive Director of Human Rights Watch Plenary presentation of 11 July 2000 at the XIII International AIDS Conference, Durban
go to the HDN website: http://www.hdnet.org
International Covenant on Economic, Social and Cultural Rights - Adopted by the UN General Assembly in 1966, and ratified by 142 governments
1. The States Parties to the present Covenant recognize the right of everyone to the enjoyment of the highest attainable standard of physical and mental health.
2. The steps to be taken by the States Parties to the present Covenant to achieve the full realization of this right shall include those necessary for:
(a) The provision for the reduction of the stillbirth-rate and of infant mortality and for the healthy development of the child;
(b) The improvement of all aspects of environmental and industrial hygiene;
(c) The prevention, treatment and control of epidemic, endemic, occupational and other diseases;
(d) The creation of conditions which would assure to all medical service and medical attention in the event of sickness.
"They said You said is part of a joint initiative between Health & Development Networks and the 2002 International AIDS Conference. For further information, see the HDN website.
The opinions expressed in the related postings do not necessarily reflect the views of HDN or the AIDS2002 Conference.
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