By Steven L. B. Jensen
Steven LB Jensen is a senior researcher at The Danish Institute for Human Rights. He is the author of the prize-winning book The Making of International Human Rights. The 1960s, Decolonization and the Reconstruction of Global Values and the co-editor of Histories of Global Inequality: New Perspectives
Editor’s Note: This is an updated version of an article that was originally carried in the Daily Maverick on January 26,2021. It is reprinted with permission of the author.
Last week, a new global AIDS strategy (End Inequalities. End AIDS. Global AIDS Strategy 2021-2026) was adopted in Geneva by UN member states after months of negotiations. This is a noteworthy achievement and really should be breaking news and the subject of major attention around the world. Unfortunately, it is not.
“Epidemics are like large sign-posts,” the German doctor and founder of social medicine Rudolf Virchow wrote back in 1848, “[and] form an inseparable part of the cultural history of mankind.” However, the international community appears to have lost an understanding of the enduring significance of the global response to the HIV/AIDS epidemic. The signposts for this are nevertheless all around if we care to look, with one topical example being the question: How come Covid-19 vaccines were developed relatively quickly?
As Professor Glenda Gray, the president of the South African Medical Research Council, explained to Daily Maverick on 30 November 2020, it has everything to do with the response to HIV:
“Covid-19, Ebola and Zika [virus] have benefited enormously from all the work that has gone into developing platforms for HIV vaccines, so if we had not invested all this money into HIV, we would not have solutions for Ebola, Zika and SARS-CoV-2. It’s because of those platforms that we’ve been able to nimbly move to the next pathogen.”
Anthony Fauci, the director of the US National Institute of Allergies and Infectious Diseases, supported this view in the Wall Street Journal on 24 December 2020: “Everything we do with every other pathogen spins off of things we’ve learned with HIV.”
In a world where recovery from the Covid-19 pandemic is top of the political agenda and vital for everyone’s future, we would do well to re-learn some vital lessons about the nature and transformative potential that the HIV/AIDS response has exemplified. This is not only because the AIDS crisis will remain serious for the foreseeable future – it is also because the global response to HIV/AIDS is one of the only successes the international community has had in the last two decades (even if some may describe this success as relative, given the scale of challenges still before us). We need to learn from and build on success. It is rare these days that we have such an opportunity.
We need examples of how international organisations and their processes bring benefits and improvements to people’s lives all around the world. It can be done, and the good news is that we have such an example right before our eyes. We need to start writing the story of the 21st century from this perspective. Setting the historical record straight could look something like this:
This century has been a period of protracted crisis and complex emergencies for the international community to deal with. Peace, security, human rights and development have been under constant threat and international diplomacy has been struggling to cope with the challenges before it. There are, however, other narratives that can nuance this overall assessment.
It has become clear that the greatest shapers of international public policy in this century have been representatives of people living with HIV, LGBTQ+ persons, sex workers and drug users, and their allies. Against the odds, these groups have delivered remarkable achievements not just for their own communities but for wider populations, societies and the international community as a whole. They have fought for human dignity and expanded freedoms for many – often without any recognition and at great personal cost. It is a reality too few people are aware of and understand the implications of.
The reason that members of these often stigmatised, marginalised and even criminalised communities deserve the above distinguished label is because of the pivotal role they have played – together with other public health experts and champions – in shaping the global response to HIV/AIDS over the last decades. They have activated international human rights law in both path-breaking and highly practical ways. They have expanded democratic culture and practices in countries around the world. Their activism has also brought more political attention and funding to other diseases, such as malaria and tuberculosis, and gradually to issues such as the strengthening of health systems. In the process, they transformed what global health – and to some extent also wider social development – means today.
Their long-standing campaigning for access to HIV prevention, treatment, care and support – making it a claim for universal coverage in the process – as well as for increasing social investments, helped to change the trajectory of the global AIDS pandemic. This has helped bring countries back from the brink of societal collapse and has done much to save the lives of communities around the world.
The 26 million people worldwide now accessing HIV treatment has been a desperately needed achievement, but it is also an astounding one, when one remembers what the outlook for treatment scale-up was back in 2000. This result and many more was only achieved through continued struggle, determination, endurance, innovation, skill, solidarity and conquering stigma and grief, and was also done with a sense of love.
Yes, you read correctly. Love is a resource in global politics. Take that in for a second before we move on.
In this context, it is relevant to remind ourselves of the political and historical backdrop against which these achievements were obtained. By this is meant the major global political events that since the year 2000 have run in parallel – while the struggles for a more comprehensive HIV/AIDS response unfolded – and which have left the international community facing desperate and entrenched problems or systemic crises.
This list of events includes global terrorism (11 September 2001 and its aftermath), wars (Iraq, Syria, Libya and Yemen), massive displacements and refugee crises (numerous), the global financial crisis (2008-), climate change and increasing global inequalities, to mention some. In a fractured world, the United Nations is struggling for relevance because of the political impacts of these multiple forms of crisis.
Despite its own problems and challenges, including that every improvement had to be fought for, the global response to HIV/AIDS has been the one major area where international policy-making and diplomacy have served as antidotes to the above-mentioned failures and disasters of the last two decades and the ensuing disillusionment with international organisations.
A recent NGO report to the UNAIDS Programme Coordinating Board (PCB) – the UN governance structure where the new global AIDS strategy is being negotiated – can provide us with more detail about what the communities have contributed through their formal engagement with global health governance over a quarter of a century. It represents a microcosmos of the much larger story about what communities and civil society have brought to both the HIV/ AIDS response and to international politics more widely.
The report Engagement, Evidence and Impact: 25 years of the NGO Delegation to the UNAIDS PCB documents that they have:
1) brought the lived realities of HIV to the UNAIDS PCB and have persistently advocated for the priority issues of communities and civil society;
2) brought evidence and passion to neglected and contentious issues before the PCB;
3) brought geographical diversity when highlighting the issues facing communities and civil society;
4) supported this inter-governmental forum in connecting the response to HIV to wider issues and processes;
5) contributed to the effectiveness, efficiency and accountability of UNAIDS governance; and
6) influenced the governance of and partnerships with other global health institutions.
To be even more specific, the NGO delegation has also been instrumental in altering misguided global policy approaches at the UN related to both HIV and sex work and to drug use. The NGO delegation has directed interventions in these areas to more human rights-based, transparent and accountable paths.
Reports from UN board meetings rarely qualify as epicentres of excitement. However, in a time of shrinking civic space and the persecution of human rights defenders, this example of NGO impact in UNAIDS governance processes deserves attention for the way it lays out achievements by civil society during a critical time in global history.
The HIV epidemic remains in a critical condition where gains can still be rolled back. Too many have lost their lives in the process and continue to lose their lives. However, we have come far from the scenarios of its manifold and devastating impacts presented to us at the turn of the century. Many people owe their survival to the activism and professionalism shown by HIV advocates from the above-mentioned communities and their allies. There can be no doubt that they have been the real leaders of the 21st century.
It is important to draw the right lessons from this and label correctly what this decades-long practice and experience means for present-day international politics: It offers us grand strategy for dealing with our unequal, struggling and suffering world.
The historical evidence that the global response to HIV/AIDS presents to us is remarkably clear. Human rights, social justice, well-being and empathy are core elements of what our grand strategy must look like in this century.
It is necessary to adapt our political and intellectual frameworks to this way of thinking and to do this quickly, because we need this view of a grand strategy to repair the social fabric of our societies and to help the world step back from the brink of multiple crises and disasters.
We need to return to the global HIV/AIDS response and make its diverse lessons a building block in securing a better trajectory through this century, including in Covid-19 recovery.
We could start by giving processes such as adopting and implementing the new global AIDS strategy and related processes the political significance they deserve. AIDS is not over, but neither is its transformative potential to still bring much-needed as well as surprising improvements literally for everyone – if we choose to care and to commit.
