HIV and Human Rights: Here and Now?

The 18th International AIDS Conference kicks off this week here in Vienna. Twenty-five thousand people are expected to attend sessions focused on the latest in HIV science, policy and programs, and the city is decked out, with a red ribbon adorning Parliament, a planned fashion show and Cotillion, and a concert by Annie Lenox. The theme? "Rights Here, Right Now."

Those who bemoan that the meeting is not more narrowly devoted to the latest from virology labs are missing the point: there are other more scientifically focused conferences on HIV/AIDS, and raising global attention to the on-going AIDS crisis requires some spectacle. Far too many people mistakenly think that this epidemic is over. The celebrities and politicians who gather biennially for this event are here to reaffirm that far too many have died of AIDS, far too many are continuing to die from AIDS, and we have the knowledge and resources to end this epidemic if we can muster the political will.

At the last conference, in Mexico City in 2008, Bill Clinton said that these conferences are important "because they enable us to measure our progress since the last meeting, to acknowledge continuing problems, to evaluate the positive and negative new developments." So, what progress has been made and what problems are continuing? What positive and negative developments can be noted?

Certainly, there is some positive news. UNAIDS recently announced that the prevalence of HIV has fallen among young people in 15 of the most heavily affected countries. The biggest drop was in Kenya, where HIV prevalence in 15 to 24 year-olds fell 60 percent between 2000 and 2005. Decreases were also seen in Ethiopia, Malawi, Cote d'Ivoire, Burundi, Haiti, Namibia, Zimbabwe, Botswana, Rwanda and Lesotho.

But there are also many continuing problems.

In more than 160 countries the use of criminal law to target groups at high risk of HIV infection creates a barrier to effective HIV prevention and treatment. Criminal laws targeting sex workers, drug users, men who have sex with men, impede HIV outreach and treatment programs and drive people we most want to reach away from important, life-saving, services.

In Uganda, for example -- once a "success story" in the fight against AIDS, a law proposed in May criminalizes "attempted transmission" of HIV and requires mandatory testing and forced disclosure of HIV status. The result may be to discourage people from getting tested, getting treated, and preventing others from being infected. In Kenya, where homosexual conduct is punishable by up to 14 years in prison, violent attacks earlier this year against suspected homosexuals shut down HIV treatment programs.

In China, Cambodia and Vietnam, drug users are routinely swept up and detained -- for up to six years -- for "treatment" that consists of little more than arduous military-style exercises and forced labor. Understandably, in these countries, few drug users are keen on seeking out HIV services that might endanger their lives rather than protect them. In much of Eastern Europe and Central Asia, few drug users have access to needle exchange programs or opiate substitution therapy, such as methadone, which have been proven to cut HIV transmission effectively, and dramatically.

The conference in Mexico highlighted human rights as well, in particular discrimination against gay men and drug users, and barriers to accessing comprehensive HIV prevention information. President Felipe Calderon committed Mexico to eliminating restrictions on importing antiretroviral drugs, and pledged that his government would provide medicines to all people living with HIV.

In the two years since, though, attention to HIV in the local media has nearly disappeared. In the first six months of 2010, I could find only one article in a major Mexican newspaper, highlighting an increase in the number of people living with HIV and the number of people dying of AIDS. The article warned that the number of people unable to afford antiretroviral medicines was increasing.

The first conference on AIDS was held in 1985, and since 1989 the conferences have had slogans that reveal how we are addressing the epidemic. In 1989, the slogan was "The Scientific and Social Challenge of AIDS." Conferences in 1990 and 1991 also highlighted science and policy. Then came solidarity slogans: "A world United against AIDS" (1992); "The Global Challenge of AIDS: Together for the Future" (1994); "One World, One Hope" (1996); "Access for All" (2004). Recent themes have been more impatient ("Time to Deliver" (2006); "Universal Action Now" (2008); "Rights Here, Right Now" (2010).

Two years ago, Clinton talked about these meetings as a way of taking stock. Sadly, this is the one area where the global response to AIDS has failed the most. AIDS conferences are good opportunities to generate attention -- for a week. Holding governments to account for their promises is another thing altogether.

Success in the fight against AIDS requires protecting the human rights of those most vulnerable to HIV infection and making sure that those living with HIV are not discriminated against. It requires evidence-based and rights-based programs that reach those most in need. Governments everywhere are failing to meet their own commitments to spending on health or to providing aid for HIV programs in places that clearly don't have enough resources.

When we meet again in Washington DC for the 2012 conference we can have fashion shows and concerts, but let's make the theme "Accountability."