Reflections on the Declaration of Commitment on HIV/AIDS Adopted by the UN's General Assembly Special Session on HIV/AIDS, June 27, 2001

By Françoise Girard, Senior Program Officer, International Women's Health Coalition

>>Download the full declaration here.

Heads of state and numerous government officials from around the world met June 25-27, 2001 at the UN's General Assembly in New York to agree on a global action agenda to respond to the HIV/AIDS pandemic.  This Special Session of the General Assembly was convened to deal with the devastating scale and impact of the disease, especially in the developing world. While the end result had its shortcomings, most participants described the Special Session as a watershed event in the fight against HIV/AIDS.

The Special Session adopted, by consensus, a Declaration of Commitment entitled "Global Crisis – Global Action." The Declaration provides a comprehensive agenda for combating HIV/AIDS worldwide, and includes actions to be taken by governments, UN agencies, and other actors. Among other important principles, the Declaration recognizes that respect for human rights is central to reducing vulnerability and preventing stigmatization. It also stresses the need to ensure gender equality in turning back the pandemic, and explicitly recognizes that young people and women are most at risk for HIV/AIDS.

The Declaration promotes an integrated approach to HIV that combines prevention, treatment, care, and support, with prevention as the mainstay of action. In this respect, the Declaration of Commitment stands in sharp contrast to the first draft issued at the beginning of the negotiations, in which assisting orphans and alleviating the impact of the pandemic were the main themes. In spite of initial resistance by several donor countries to strong statements on treatment, the final Declaration recognizes that treatment is essential to prevention efforts and provides a powerful incentive to be tested for HIV.

The Declaration was adopted without reservations by the world's governments, with the exception of the Holy See—which objected to a number of the final paragraphs, including the call for promoting condoms to prevent infection. Throughout negotiations, many countries articulated progressive positions on the sexual and reproductive health of women and young people, including all of Latin America, several African countries, the European Union, and all other industrialized countries except the United States. Prime Minister Pascoal Mocumbi of Mozambique made a particularly compelling statement in the General Assembly on the need to talk frankly with youth about sexuality and to address gender inequality in the context of sexual relations. The Bush Administration, in its first UN negotiation on sexual and reproductive health issues, dramatically changed the traditional US stance by allying itself with Islamic countries and the Holy See in advocating conservative positions.

In spite of this opposition, the negotiations reached several agreements favorable to women's and girls' health. Particularly heartening is the Declaration's focus on women and youth and the need to address power imbalances between young and old, especially young girls and older men. Thus, the Declaration recognizes that young people must have access to the information, education, and youth-friendly health services necessary to reduce their vulnerability to infection. It states that programs should not only address HIV/AIDS, but also be part of a broader approach that addresses the needs of youth for economic opportunities, education, and literacy.  It also calls on governments to take action to ensure that women have control over their sexuality.

In addition, women's health advocates successfully insisted that the document call for women's access to full therapy for HIV/AIDS, rather than just partial therapy for the prevention of HIV transmission to the child during delivery. In regard to research and development, microbicides were identified as a very promising field of research requiring substantially more funding.

Furthermore, the meeting drew significant media attention around the world. It brought the African dimensions of HIV/AIDS into sharp focus, and increased overall awareness of the potential for the pandemic to explode in South Asia, China, and parts of Southeast Asia. The Special Session also made it clear that there is still time to act in many parts of the world, and that much can be done to reduce infection rates and provide effective treatment and care.

Vigorous debates on the priorities and geographic scope of the Global Fund for HIV/AIDS led to an agreement that it should receive applications for funding from all developing countries, but with a priority for the lowest-income countries and those where the pandemic is most acute; and that programs for prevention, treatment, care, and mitigation of impact should all receive consideration.

Yet the meeting had its share of disappointments. Though the Declaration calls for annual expenditures of 7 to ten billion US dollars to combat the disease, the Special Session itself did not generate pledges of more than 2 billion US dollars—a significant shortfall. There was also great controversy over identifying certain stigmatized groups known to be particularly at risk for HIV infection, namely men who have sex with men, sex workers, and IV drug users. These groups were mentioned explicitly in the original draft, but after much wrangling and opposition from Islamic countries, specific references were removed from the Declaration. All references to the International Guidelines on HIV/AIDS and Human Rights were also expunged from the Declaration, apparently because the Guidelines themselves explicitly name the same groups. Advocates were also disappointed by the inclusion of phrases like “risky and unsafe sexual behavior” in the document, which could be used to condemn same-sex sexual relations. Because of lingering disagreement on how women's and young people's rights should be understood in different national contexts, a few paragraphs of the Declaration call for programs that respect cultural values, thus allowing for the argument that culture can trump universal human rights.

Finally, some issues remained largely unresolved at the Session, such as the governance and oversight of the Global Fund for HIV and Health, and specific action on affordability and accessibility of anti-retroviral drugs.

Particularly useful paragraphs in the document include paragraph 59, which calls for national strategies to empower women to have control over matters related to their sexuality. Paragraph 60 recognizes that governments should provide health care and health services, including sexual and reproductive health, to women and adolescent girls. Paragraph 61 calls for the development and implementation of national strategies for women's empowerment, and for the protection and promotion of women's full enjoyment of all human rights. Paragraph 63 reaffirms the need to include HIV/AIDS education in school curricula and provide young people with youth-friendly information, education, and counseling services. Paragraph 70 calls for research and development of microbicides and other female-controlled methods of protection against infection. Throughout the document, there are several mentions of the need for gender-sensitive approaches and combating gender discrimination (paragraphs 15, 37, 47, 59, 60, 61, 62).

Advocacy by many nongovernmental organizations contributed substantially to the document's progressive stance on gender and youth, and the relatively strong place accorded to human rights and to prevention and treatment. However, civil society access to the negotiations was severely restricted throughout the process, in line with a recent and disturbing trend to limit NGO participation in UN activities.

>>Download the full declaration here.