United Nations AIDS Meeting.

The 189 member states of the United Nations General Assembly met June 25-27, 2001, and unanimously approved a document that can be an important tool around the world for urging governments and others to take responsibility for helping to control the global epidemic. Almost everyone agrees that the meeting was largely a success, though only time will show its results. Here are some of the key issues:

* The central question is whether governments around the world will find the political will to be serious about AIDS, and take measures to end the epidemic and meanwhile reduce its destruction and suffering. For many reasons governments have avoided acknowledging or dealing with the disease. Yet everyone knows that the epidemic will not go away by itself but will become incomparably worse, with many parts of the world affected as severely as southern Africa, where as much as a third of the entire adult population is HIV-infected, and half of teenage boys and girls are likely to die of AIDS.

About a dozen heads of state came to the meeting, all from developing countries, almost all from Africa. No heads of state came from any rich country -- nor from any of the Eastern European or Asian countries where the epidemic is rapidly spreading. Most countries sent their health minister instead. (The U.S. sent both its health minister, Secretary of Health and Human Services Tommy Thompson, and Secretary of State Colin Powell, a leader on global AIDS.)

One African head of state who did not attend was Thabo Mbeki of South Africa -- even though he was in Washington at the time, and traveled to West Point, Pennsylvania to visit a Merck AIDS research lab on the last day of the meeting. His absence illustrates one factor keeping governments away from AIDS -- embarrassment. Almost everyone sees Mbeki's handling of the epidemic in South Africa as disastrous.

But the meeting produced good news as well on government political will. All the countries accepted a strongly worded Declaration of Commitment (see below). The United Nations session brought AIDS to the attention of government officials who otherwise have not dealt with it. It clearly changed the tone of some of the discussions in the U.S. Congress (and probably as many other governments as well), at least for now.

* Many new donations, commitments, and programs were announced at this special session on HIV/AIDS. Many of these were donations to the Global AIDS and Health Trust Fund now being developed (which will also fund programs for tuberculosis and malaria, where relatively little money can have great importance in saving lives and improving human health). Also important were other donations, such as offers to help train thousands of doctors and set up medical clinics. Many people believe that what is important is the total level of funding (including appropriate in-kind contributions), not only cash for the Fund.

* The General Assembly unanimously adopted a strong Declaration of Commitment, including detailed timetables and goals for achieving results, such as reducing mother-to-child and other new infections. The Declaration emphasizes women's rights (women are often infected because they do not have the power to refuse sex or negotiate safe practices). It notes that "stigma, silence, discrimination, and denial, as well as lack of confidentiality" undermine prevention, treatment, and care, and must be addressed. It names prevention as the mainstay of response, and also notes that "prevention, care, support and treatment for those infected and affected by HIV/AIDS are mutually reinforcing elements of an effective response and must be integrated...." It recognizes the importance of access to medication, notes the need to reduce the cost of drugs and related technologies, and outlines ways of doing so.

In discussing resources, it sets a goal of $7 to $10 billion per year by 2005, and urges developed countries to try to meet the target of 0.7% of their GNP for development assistance, as they have previously committed to do (only a handful have so far). (In April of this year, African countries agreed to a target of 15% of their national budgets on health-sector improvements to help address the epidemic.) The Declaration of Commitment includes a fairly weak section on debt relief.

It has a major section on research and development, "including biomedical, operations, social, cultural, and behavioral research and in traditional medicine...." Research infrastructure, research cooperation, ethics of human research, drug side effects, the, female condom, and of course vaccines and microbicides, are all explicitly addressed.

What is most remarkable about this document is that all countries in the United Nations accepted it -- after fairly minor compromises which weakened it only slightly.

The Declaration of Commitment is available at http://www.un.org/ga/aids/

Controversies at United Nations AIDS Session

* Removal of naming vulnerable groups

Some mostly-Islamic countries, and also the U.S., did not want to name vulnerable groups, especially men who have sex with men, or sex workers and their clients. So the following language (from the May 11 draft Declaration of Commitment was replaced:

"By 2003, develop national strategies, policies and programmes, through a participatory approach, to promote and protect the health of those most vulnerable to, and at greatest risk of HIV infection, such as: children in especially difficult circumstances, men who have sex with men, sex workers and their clients, injecting drug users and their sexual partners, persons confined in institutions and prison populations, refugees and internally displaced persons and people separated from their families due to work or conflict;"

The entire section on vulnerable groups was rewritten, and in many respects strengthened; the following paragraph (number 62 in the final document) includes the replacement for the language listing groups some countries did not want named:

"By 2003, in order to complement prevention programmes that address activities which place individuals at risk of HIV infection, such as risky and unsafe sexual behaviour and injecting drug use, have in place in all countries strategies, policies and programmes that identify and begin to address those actors that make individuals particularly vulnerable to HIV infection, including underdevelopment, economic insecurity, poverty, lack of empowerment of women, lack of education, social exclusion, illiteracy, discrimination, lack of information and/or commodities for self-protection, all types of sexual exploitation of women, girls and boys, including for commercial reasons; such strategies, policies and programmes should address the gender dimension of the epidemic, specify the action that will be taken to address vulnerability and set targets for achievement;"

* Removal of reference to the United Nations HIV/AIDS and Human Rights International Guidelines

Many of the same countries wanted no mention of this document, the result of the Second International Consultation of HIV/AIDS and Human Rights, a meeting organized jointly by the Office of the United Nations High Commissioner for Human Rights and UNAIDS. The guidelines were described as follows by ICASO, the International Council of AIDS Service Organizations, in email on World AIDS Day (December 1, 2000), before the current controversy had emerged:

"There are 12 guidelines in all, each containing action-oriented measures. For example, they call upon states to: provide political and financial support to ensure that community organizations are able to carry Out their activities effectively; review and reform public health laws to ensure that they are consistent with international human rights obligations; enact or strengthen anti-discrimination and other protective laws to protect vulnerable groups, people living with HIV/AIDS, and to provide for speedy and effective remedies when the laws are broken; enact laws and regulations to ensure safe, effective and affordable medications, and adequate prevention and care information."

The 58-page document is available at: http://www.unaids.org/publications/documents/human/

Apparently these conservative governments wanted to remove any reference to this document because it could support the human rights of gays and lesbians (although gays and lesbians are not mentioned in the 12 guidelines). Although far from a majority, these countries had leverage because of the great desire of most countries to have unanimous agreement of all UN member countries on the Declaration of Commitment. After long negotiating sessions lasting until 2:30 or 3:00 a.m. each night, agreement was reached to drop this reference, as well as the listing of vulnerable groups, from the document. In return the conservatives agreed to approve the document, even though they did not get other changes they wanted.

* Allowing International Gay and Lesbian Human Rights Commission at Human Rights Roundtable

The entire General Assembly spent almost three hours on the morning of the first day on whether a representative of the International Gay and Lesbian Human Rights Commission (IGLHRC, based in San Francisco and New York) could sit on a round table on human rights -- after about nine governments, apparently led by Egypt, objected because she represented a gay organization. Some of these governments did not want to be identified, and were not publicly known when we last checked. Perhaps coincidentally or perhaps not, Karyn Kaplan, the speaker they tried to ban, is also a leader in the movement to make medications more affordable in poor countries.

As we understand the procedure, any country could veto a non-government representative from the round table; even one country would have been enough, and their veto could not be appealed. But a representative could be added to the round table by a two-thirds vote. So Ms. Kaplan was added back by a vote of 62 in favor, none opposed, and 30 abstaining -- with the countries most opposed not voting at all, in a failed attempt to deny a quorum and prevent the vote from counting.

The U.S. delegation voted in favor of her speaking, and also was helpful in the negotiations.

"While it may seem unreasonable that the General Assembly spent almost three hours to allow a short speech on human rights, there was a bigger issue involved. A decision the other way could have been a message and precedent that gay organizations (and perhaps gay individuals) were not accepted as equal partners in the United Nations fight against global AIDS.

Not all of the governments that tried to block the quorum, or were less than supportive by abstaining, were necessarily against a gay representative, as there were also procedural issues involved. In addition, the General Assembly is divided into blocks of nations that usually vote together, so it is likely that some votes were cast in block solidarity, or traded for votes on other issues, or represented reluctance to offend Egypt or other countries that were upset that Ms. Kaplan was being voted back on the roundtable after they thought they had her removed.

So far no one has been able to fully explain to us what really happened here, or why. It is not clear what Egypt or the other countries that objected expected to gain, even if they had won. It seems that the attack on equal gay participation was largely used to pursue other ongoing issues at the UN -- issues sometimes difficult for an outsider at that institution to understand.

* Visa denials

Many AIDS organizers who should have been at the United Nations AIDS session were not allowed to participate. Most, apparently, were vetoed by their own governments, some of which do not like AIDS organizations. No reasons were given for these denials, so it is not known how many were barred this way.

Some were stopped by U.S. officials at U.S. embassies in several countries, who would not give them the waiver required for an HIV-positive non-citizen to enter the United States. Apparently some were also stopped by U.S. officials because they did not have enough money --as if they were tourists instead of AIDS experts attending a major United Nations meeting. It is our understanding that U.S. policy was to give the HIV waivers, but that by law the final decision to give visas is up to each embassy. There are many countries and therefore many U.S. embassies, and it seems that not all of them took the AIDS meeting seriously.

While it is too late for a remedy for this meeting, something can be done about the larger issue of irrational travel restrictions and gross discourtesy or worse to international visitors. These problems happen because the travelers are not citizens of the countries they are entering, so they have no political power there, and the usual checks and balances which would otherwise offer some protection do not exist. So irrational restrictions and harassment of even routine visitors can grow with little restraint.

What is needed is an international movement on behalf of travelers, and probably immigrants as well, which could function like the ACLU does in protecting political liberty in the U.S., by fighting test cases within each country. It could and should improve on the ACLU model by picking cases for their public-relations appeal as well as their legal or procedural value. It would attract citizens of any country by helping to protect them in their own travels -- and also appeal to national pride, organizing those who want to make their own society more hospitable to business travelers, workers, tourists, customers, relatives, refugees, and any other visitors who are not excluded for legitimate reasons.