U.N. commits to AIDS reduction

Its far-reaching declaration could funnel billions toward reducing the spread of the disease by 25 percent.

Published June 28, 2001 7:22PM (EDT)

The United Nations wrapped up its first-ever meeting focused on the global AIDS crisis in New York this week with a sweeping 16-page "Declaration of Commitment" on HIV/AIDS endorsed by all 189 member nations. Surely no one will leave completely happy with the result: an international treaty with bold propositions that is, ultimately, unenforceable.

But there were also enough firsts for AIDS activists, women's rights activists and gay and lesbian human rights groups that nearly everyone could walk away with some sense of a victory.

"I must say that, for once, controversial issues were not covered in a blanket of diplomatic language," said Pieter Piot, executive director of the United Nations AIDS program (UNAIDS). "The issues were discussed explicitly." Or, as Gudmund Hernes, director and coordinator of AIDS activities for the U.N. agency UNESCO, put it: "If anyone told me 30 years ago that the General Assembly would talk about condoms, I would have said that it was impossible."

The drafting of the declaration proved to be the most contentious challenge of the summit, and ended with major modifications of the text that proved unpopular with some countries, which had wanted language that was decisively pro-gay rights and franker in its description of intravenous-drug use and prostitution. Still, argued U.N. Secretary-General Kofi Annan, the declaration ultimately proved "progressive." For example, it calls for nondiscriminatory access to "condoms, microbicides, lubricants, sterile injecting equipment, drugs including anti-retroviral therapy" and more. Sterile injecting equipment, of course, could be read as an allusion to clean needles for intravenous-drug users.

Much ado had been made at the opening of the meeting about a fight between conservative religious blocs led by Islamic nations and the Vatican and socially liberal countries led by the European Union and Canada over whether the declaration should explicitly make reference to homosexuals, intravenous-drug users and sex workers -- language that reportedly was included in a draft version of the document created by UNAIDS. That battle, along with disagreement over human rights guidelines for dealing with the HIV/AIDS crisis, led to a rift that prolonged negotiations until 3 a.m., and held up approval of the declaration until the final day of the meeting.

The United States, according to foreign press accounts, joined the Vatican and the Islamic nations in arguing against inclusion of the language. The exclusion of such language would be consistent with previous positions taken by President Bush, from a comment made during the presidential debates that he doesn't believe in "special rights" for gays to a statement last month in which he said that he would not acknowledge June as Gay Pride Month because, as a spokesman said, Bush does not believe in "politicizing people's sexual orientation." Generally speaking, Bush seems to eschew any legal or official recognition of gays and lesbians.

When asked whether the United States played a role in modifying the declaration, John Sandage, a State Department lawyer who was a chief U.S. negotiator, told Salon: "We were comfortable with references to gay men in the document. We had difficulties with the way it was worded, and we wanted to find a text that could get the support of everybody because we thought it was important that the world speak with one voice. So we had flexibility on the choice of words. But we didn't have any difficulty acknowledging that gay men are a vulnerable group."

Sandage declined to specify what language created obstacles, but when asked whether it was the term "men to men sex" (a term others report caused major controversy in the draft negotiations) the U.S. had objected to, Sandage said: "It wasn't that we were uncomfortable with it, it was that other member countries were uncomfortable with it and we wanted to be sure we could find a text that everybody would support." The compromise language alludes to gays, drug users and sex workers ("sexual practices, drug using behavior, livelihood") in a section calling for programs that address the groups most vulnerable to HIV infection.

Though all member nations ultimately agreed on the declaration, the cultural differences that arose were apparent in speeches given before the General Assembly by some Islamic nations, including Saudi Arabia, Iran and Libya.

Iranian Deputy Minister of Health Ali-Akbar Sayyari admonished delegates not to forget the "moral aspect involved" in HIV infection and attributed "irresponsible sexual behavior" to the rapid spread of the disease. Saudi Arabian Deputy Minister of Health Youssouf Al-Masruwah, meanwhile, said his country would support the U.N.'s effort to eradicate AIDS, provided that the international strategies are "in conformity with the teachings of Islam." Libyan Ambassador to the U.N. Abuzed Omar Dorda took it one step further: "Homosexuality is one of the main causes of this disease. In fact, God sent the prophet Lot with a clear message preventing such practices and banning them."

In a related fracas, Karyn Kaplan, head of the International Gay and Lesbian Human Rights Commission, the only gay and lesbian nongovernmental organization invited to speak at the meeting (as a participant in a round-table panel on AIDS and human rights), had her invitation temporarily rescinded after Islamic nations objected to her organization's presence. Kaplan's name was restored to the speaking roster after Argentina, Canada, Norway and the European Union introduced a resolution in the General Assembly calling for her inclusion that was approved by a 62-0 vote, with 30 countries abstaining and many more not participating in an effort to prevent a quorum.

The vote itself was significant, says Scott Long, project director for IGLHRC. "This was the first time a gay and lesbian issue has ever been debated on the floor of the General Assembly. It's a precedent that will have serious impact on the way vulnerable groups and marginalized groups and outsiders from all parts of society can get involved in the U.N."

But Long also criticized the final U.N. declaration, which excluded the human rights guidelines for dealing with the AIDS crisis that had been negotiated at a 1996 meeting of UNAIDS and the Office of the High Commissioner for Human Rights, and made specific references to gays, and particularly the need to decriminalize homosexuality and repeal sodomy laws. "Egypt, Pakistan, Malaysia and other Organization of the Islamic Conference member nations didn't want specific commitment on human rights they would be held accountable to," he said. "It's disgraceful. Everyone knows that HIV is enabled by human rights violations."

It's clear U.N. leaders were concerned that the clash with Islamic nations would obscure the positive developments and pledges of commitment at the conference. "At the end of the day, all the disputes over wording will seem trivial. This is truly a historic moment in the epidemic," UNAIDS senior policy advisor Julia Cleves told reporters Tuesday. And at a press briefing on Wednesday, Annan told reporters, "In the last three days, some painful differences have been brought into the open. But like AIDS itself, these differences need to be confronted head-on, not swept under the carpet. What is important is that after today we shall have a document setting up a clear battle plan for the war against HIV/AIDS with clear goals and a clear timeline." Annan also said that the declaration sets "standards against which people can measure their own performance, that the average citizen can use to challenge their governments."

War metaphors like Annan's were popular during the conference. During his remarks before the General Assembly on Monday, Secretary of State Colin Powell spoke of "no enemy in war more insidious or vicious than AIDS. An enemy that poses a clear and present danger to the world. The war against AIDS has no front lines. We must wage it on every front." By contrast, AIDS activists with organizations like ACT-UP and the Health GAP Coalition were hawking Holocaust metaphors, characterizing the reluctance of some member nations to support anti-retroviral drug treatments and prevention efforts as promoting "genocide."

Like many battle plans, the final declaration adopted by U.N. member states included the ambitious goals one might expect in a major theater of war. Its most ambitious agenda item calls for a 25 percent reduction in HIV prevalence among young men and women between 15 and 24 by 2005. It also calls for countries to take steps to empower women by "promotion and protection" of their "full enjoyment of all human rights" and to reduce their vulnerability to HIV/AIDS by eliminating risk factors such as discrimination, violence, trafficking of women, sexual abuse and "customary practices," an allusion to the female circumcision or "female genital mutilation" that is performed as a ritual in some African and Islamic nations.

Borrowing a line from the Spice Girls, who have charmed many an African leader, Annan said of the gender provisions: "It has been said that 'girl power' is Africa's own vaccine against HIV, and that should be true for the whole world." Ex-Ginger Spice and former U.N. goodwill ambassador Geri Halliwell couldn't have said it better.

The declaration also states that by 2005 member states should provide access to sterile supplies for drug users, female and male condoms and clean blood supplies to help prevent the spread of the disease. And the many groups demanding debt relief and poverty eradication as a key weapon in fighting AIDS should be pleased with the declaration's language urging developed countries to observe the pledge they made to the Organization of Economic and Development Cooperation nearly 30 years ago to spend 0.7 percent of their gross national product on development assistance to developing nations.

The declaration includes a provision calling for governments to "strengthen healthcare systems and address factors affecting the provision of HIV-related drugs, including anti-retroviral drugs" by 2003 -- a move that pleased the many nongovernmental organizations that demanded provisions for treatment of those already infected with HIV. (On Tuesday, activist groups ACT-UP and OxFam staged a brief protest in the basement of the U.N. headquarters calling for increased access to anti-retroviral and other anti-AIDS drugs.)

"The declaration puts treatment firmly on the map," said Anne-Valerie Kanina of Doctors Without Borders' "Access to Essential Medicines" campaign. "It confirms that there can be no choice between prevention and treatment; they are mutually reinforcing."

Even U.S. officials -- who had been critical of anti-retroviral drugs because, they argued, Africans do not have the infrastructure or requisite sense of time to properly administer the right dosages (possibly leading to variant strains of the HIV virus) -- seem to have done a turnaround on the subject. And that was despite the presence of U.N. delegation member Henry McKinnell, CEO of pharmaceutical giant Pfizer and chairman of the Pharmaceutical Research and Manufacturers of America.

Less than a month ago, U.S. Agency for International Development administrator Andrew Natsios roused AIDS activists when he told the Boston Globe that U.S. contributions to the U.N.'s global AIDS fund should not be used to treat those who are currently HIV positive because Africans "don't know what Western time is" and because of the "lack of infrastructure, lack of doctors, lack of clinics, lack of electricity." It was a terrible entrance for Natsios, and he backed away from those comments in an interview with the Associated Press this week. "I visited with the [Congressional] Black Caucus and I apologized," he told the wire service. "I used extemporaneous language. It came out the wrong way and it certainly upset people and I recognize that." And this week, U.S. officials confirmed that the U.N. AIDS fund would support the distribution of anti-retroviral drugs in areas where it is feasible.

Although neither the text nor any of the pledges in it is legally binding, UNAIDS executive director Piot described the "Declaration of Commitment" as an "instrument of accountability." The structure of the AIDS fund has not yet been determined, and many NGOs and other observers viewed the creation of a new U.N. bureaucracy with skepticism, which Annan and other officials tried to tackle head-on. Annan said that to build momentum behind the superfund, which aims to raise $7 billion to $10 billion for a global anti-AIDS war chest, the participation of nongovernmental organizations and the private sector (including pharmaceutical companies) is essential.

Annan also addressed long-standing criticisms of the all too often slow-moving U.N. bureaucracy when he laid out the early parameters of the fund for reporters. He stated that there would be a small and nimble board composed of representatives from governments, NGOs and the private sector and a scientific panel to determine the most effective and sound methods of dealing with the AIDS crisis. Countries would apply directly to the fund with proposals, and the money would likely be managed using the infrastructure of the World Bank. Donors to the fund -- both public and private -- would be permitted to place conditions on the expenditure of their funds, a provision that many believe will help spur donations from groups that might otherwise decline to participate. Annan said the secretariat responsible for the day-to-day administration of the fund would be small, and that monitoring systems would be put in place to ensure that donor money was spent appropriately. Annan said he planned to appoint a transition team to begin working out the technical details within two weeks.

The model for the superfund, he said, would be the Global Alliance for Vaccines and Immunization, a successful and nimble U.N. program that distributes vaccines.

Some question the need for a new U.N. bureaucracy to deal with the AIDS crisis. In her speech before the General Assembly, Britain's international development secretary, Clare Short, told member nations, "It is my strongly held view that we waste too much time and energy in U.N. conferences and special sessions. We use up enormous energy in arguing at great length over texts that provide few, if any, follow-up mechanisms or assurances that governments and U.N. agencies will carry forward the declarations that are agreed to. Poor countries have to commit ministers, officials and resources to participating in a U.N. talking shop, when such people are needed to tackle the desperate problem HIV/AIDS poses at home."

Short's criticisms were shared by Carole Collins, the HIV/AIDS director of Britain's Christian AID. "There were lots of raised expectations; people were hopeful about the fund," she said. "But we now know that there's only been a small amount of money pledged and that trying to administer it [will be difficult] ... When you ask them how they will create these boards, they say they've referred them to working groups that haven't been established yet. It's going to be very problematic. The lack of reference to community strengths was a serious omission." Collins also said that despite Annan's support for community-based programs, they had only been paid lip service in the declaration.

Collins has a point on the financing of the fund. Annan has said that $7 billion to $10 billion is required to seriously address the HIV/AIDS crisis, but by the end of the day Wednesday, the U.N. had managed to get only $500 million worth of pledges from countries -- and some of them would not specify whether the money would go to general AIDS expenditures or to programs funded by the U.N. AIDS superfund. So far, the financing of the fund has been an unmitigated disaster.

But that could change. Democrats and Republicans in the House of Representatives reached an agreement Wednesday to spend as much as $1.36 billion during the next fiscal year to fight AIDS globally. As much as $750 million of that could be used for multilateral aid, including the U.N. AIDS superfund. The amount agreed on was significantly higher than the annual AIDS expenditure of $480 million pledged by the Bush administration, via Colin Powell, on Monday.

By Daryl Lindsey

Daryl Lindsey is associate editor of Salon News and an Arthur Burns fellow. He currently lives in Berlin and writes for Salon and Die Welt.

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