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A United Nations declaration on ending AIDS should have been easy.  This was not the case.

The United Nations on Tuesday adopted new goals to end AIDS as a public health threat by 2030, a goal that apparently most countries could easily have accepted. But the consensus had been elusive.

At the start of negotiations on the deal, known as the Political Declaration, the United States and the European Union fought to ban policies and laws that stigmatize, if not criminalize, high-risk groups – and drastically cut back on measures. aimed at relaxing patent protection for anti-HIV drugs.

The United Nations declaration sets priorities for the global AIDS response and guides policy at the national level. It also gives global health groups and civil society organizations a way to lobby governments to honor their commitments.

After days of heavy editing by delegates from some countries and skillful negotiations by others, member countries agreed to a final version of the declaration on Tuesday morning. The final draft includes an important new goal of ensuring that most countries reform discriminatory laws so that less than 10 percent of the world’s countries have measures that unfairly target people at risk for or living with HIV. .

“These laws keep those most affected by HIV away from HIV prevention and treatment,” said Matthew Kavanagh, director of the Global Health Policy and Politics Initiative at Georgetown University. “It could be an essential tool in getting the world back on track to end AIDS. “

On Monday, Dr Kavanagh and his colleagues published new work showing that countries that criminalize same-sex relationships, drug use and sex work have had much less success in rolling back HIV.

But the statement doesn’t move the needle on patent protections. The United States was among those countries whose delegates have significantly watered down – or decided to cut – the language to relax patents to allow better access to affordable HIV drugs in low- and middle-income countries, a position in direct contradiction to the support of the Biden administration. patent waivers for Covid vaccines.

“The administration’s mixed message, given recent support for patent waivers for the Covid-19 vaccine, is puzzling and disappointing,” said Annette Gaudino, director of political strategy at Treatment Action Group, an advocacy organization. rights in New York. “This would be far from the first time the United States has put the profits of pharmaceutical companies before people and public health.”

The United Nations brings together heads of state, ministers of health and non-governmental organizations every five years to set priorities to fight the HIV pandemic. At a similar meeting in 2016, member countries agreed to target fewer than 500,000 new HIV infections per year, fewer than 500,000 AIDS-related deaths and the elimination of HIV-related discrimination by 2020.

The world has failed to meet these targets: around 1.5 million people were infected with HIV in 2020 and around 690,000 died.

Ending AIDS by 2030 was an ambitious goal adopted by the UN in 2015, as part of a broader agenda on sustainable development. But without more progressive policies and laws, the goal is not achievable, said Dr Kavanagh.

“To end AIDS by 2030, governments must commit to a people-centered, rights-based approach to HIV, to work on policy and law reform, to involve and support communities and end inequalities, ”Winnie Byanyima, Executive Director of UNAIDS, said in an emailed statement.

The initial draft of the declaration, dated April 28, included a pledge to end “punitive laws, policies and practices, stigma and discrimination based on HIV status, sexual orientation and gender identity. “.

Delegates from some countries, including the Africa group, China, Russia and Iran, attempted to remove allusions to gender or gender identity, or sex education for girls. They have only partially succeeded: the current text calls for prevention approaches adapted to high-risk groups, including sex workers, men who have sex with men, drug addicts and people. transgender.

Delegates from African countries successfully inserted language affirming “the sovereign rights of member states” and stressing that the commitments contained in the declaration would be implemented “in accordance with national laws, national development priorities and international human rights” . About half of the countries where homosexuality is illegal are in Africa.

The declaration, in its current form, also urges countries to “empower women and girls to take charge of their sexual and reproductive health and reproductive rights,” a section that Saudi Arabia, Russia and the Holy – Headquarters have attempted to delete text.

Representatives of Belarus, China and Russia also deleted a section that called on member countries to recognize the autonomy of citizens on issues related to sexuality; their alternate text encouraged “responsible sexual behavior, including abstinence and fidelity.” The final document reverted to the original text.

Including language about high-risk groups is critical to success, some experts have said. Gay men and other men who have sex with men, people who inject drugs and sex workers are almost 30 times more likely to contract HIV than the general population.

If these groups cannot access the preventive therapy, clean needles, condoms or education they need, “we will erode the possibility of actually ending AIDS by 2030,” said Eric Sawyer, an advocate for people living with HIV who are long-term survivors.

A first version of the statement also contained a long section on relaxing patent protections. Under current global rules, only the 50 least developed countries are allowed to eliminate patents on pharmaceuticals in order to distribute them to citizens.

The draft called for “an indefinite moratorium on international intellectual property arrangements for drugs, diagnostics and other health technologies.” The representatives of the United States and Switzerland deleted this section. A representative of the European Union said: “This is not the place to discuss these general issues. “

The US also added wording to the reduced version to recognize “the importance of the intellectual property rights regime in contributing to a more effective AIDS response”.

Campaigners said taking a stand against patent waivers made full sense for the European Union, which also opposed a patent waiver on Covid vaccines. Vaccine makers have argued that patent protections are essential to spur innovation.

But citing the urgent need for vaccines, officials in the Biden administration said they would support a patent waiver that would allow companies to make cheaper versions of the vaccines for the rest of the world.

Given this development, “it would be really inconsistent for the United States” to oppose the relaxation of patent protections for anti-HIV drugs, said Brook Baker, professor of law at Northeastern University and Senior Policy Analyst at the Health Global Access Project, an advocacy organization.

“Why on earth would the United States be speaking two sides of its mouth about what appears to be an almost identical problem?” “

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