Redefining Key Populations as a Proud American

During the week of June 8-10, the fourth General Assembly High-Level Meeting (HLM) on Ending AIDS was held at the United Nations in New York. Aspirations for this meeting were high; participants hoped for a bold declaration to be set from both the global U.S. and European advocates. But disappointment reigned when the final declaration was approved on the first morning of the General Assembly—and activists from more than 20 countries walked out of the assembly hall in protest.

The declaration includes a set of specific, time-bound targets to be reached by 2020. It also mentions key populations, including transgender, for the first time, along with harm reduction. However, it falls far short of the original “zero” draft, which included evidence-based action points, and specific language addressing human rights and sexual and reproductive rights.

This was my fourth time attending the HLM on Ending AIDS since it first started in 2001. And the HLM truly is a fascinating process to watch. It encapsulates the United Nations at its very roots, from all the U.N. decorum (for example, the General Assembly chairperson must always preside over the session), to the security and 1960s décor, to the negotiation process. All this pomp and ceremony, leading up to a political declaration that member countries around the world must sign and agree upon in every detail. These declarations include agreements that we in the United States take for granted every day—declarations about human rights, women’s rights, key populations, comprehensive sexual education, harm reduction, sex workers… the list goes on.

Even as UNAIDS was releasing their press release announcing a “Bold new Political Declaration on Ending AIDS adopted in New York,” country representatives, mainly Ministers of Health, were rising to the podium. Each speaker—national representatives and delegates from member countries and organizations—had five minutes on the General Assembly floor to state their position. They acknowledged their acceptance of the declaration while also expressing their disagreement with specific language and concepts–often in dichotomous and opposing views. For example:

• Iceland objected to the term “sex worker,” saying that it is incomplete, and does not take into account that the majority of countries adopt different ways to regulate sex work.
• Sudan expressed reservation with the term “key populations,” because it focuses on only five specific groups, whereas the definition (and the groups at most risk) can differ from one place to another. The Africa Group also endorsed the sovereign right of each nation and said that the definition of key populations varies from country to country.
• Ambassador Sarah Mendelson, from the U.S. delegation, lauded the engagement of civil society in the development of the declaration, and pushed for more wording on human rights, women’s reproductive rights, and stigma and discrimination against people living with HIV.
• A representative from the Africa Group expressed gratitude to countries that have lifted travel restrictions for PLHIV and urgently called for testing, early testing during infant circumcision, and sexual health education related to HIV among youth.
• Argentina, reading a statement representing 32 countries, reaffirmed human rights for all key populations, and endorsed removing punitive laws and practices that block access to HIV services.
• The Vatican/Holy See representative advocated for more abstinence-based prevention language and expressed reservations about language addressing an array of concepts: sexual and reproductive health, harm reduction measures (including opioid substitute therapy and needle and syringe provision for people who inject drugs), gender norms and stereotypes, and comprehensive sexual education.  

As delegates from each nation face each other in a semi-circle, they show their allegiance to diplomacy and negotiation. Participants who watch this process are reminded of our vast differences in political ideology and belief systems. And yet within these aging walls, surrounded by antique paintings, everyone is equal; everyone is given one vote. And this forces the delegates to listen to one another. No matter how tiny or vast a nation may be, how many resources a nation may have spent, or how many lives may have been lost, the system is designed to force negotiation and to build consensus.

Unfortunately, it often forces one to aim towards the lowest common denominator. Many attendees felt this was the case with this Political Declaration. And yet the HLM process is also a lesson in humility, and in leading from behind.

As the U.S. demonstrated on day two of the General Assembly there are several ways to influence the Political Declaration outside of the halls of the U.N. When Ambassador Debbie Birx, PEPFAR, stood to announce that the U.S. would be forming a USD$100 million Key Populations Investment Fund to expand access to proven HIV prevention and treatment services for key populations, a hush fell over the Assembly Hall. As the Ambassador urged countries to guarantee accountability for their actions, she rallied the troops to stand behind key populations, and to counter the comments from the floor over the past few days that were trying to diminish their worth. Ambassador Birx threw down the gauntlet, saying, “PEPFAR stands firmly and unequivocally with and for key populations, defined by UNAIDS as gay men and other men who have sex with men, transgender people, sex workers, people who inject drugs, and prisoners; and we are deeply committed to protecting and promoting their health and human rights.”

It was at this moment that I was proud to be an American. I was proud to stand behind the fund; but mostly, I was proud to stand behind the words. Because while so many countries had denied key populations, and had wanted to “redefine” them over the past few days, the U.S. was pushing back: saying regardless of what you say, we stand proudly behind the definition, and the population. We know who are the most affected by this pandemic; and we will continue to fight until their voices can be heard. Here, and across every corner of every nation, every district health facility, every rural community health clinic, and every Orlando night club, we will amplify their voices and fight for what they truly need.

Written by Helen Cornman