Commentary Sexual Health

Why are Human Rights so Central to the AIDS Response in Eastern Europe, Central Asia, and Everywhere Else?

Michel Kazatchkine

We will only be able to get people into treatment early, and retain them in treatment, if we finally move from rhetoric to real action on HIV and human rights.

Cross-posted in partnership from the HIV Human Rights blog and part of Rewire’s coverage of the International AIDS Conference, 2012.

I am thrilled to have been appointed this month as the United Nations Secretary-General’s Special Envoy for HIV/AIDS in Eastern Europe and Central Asia.

Eastern Europe is the region of the world that has witnessed the largest increase in HIV prevalence in the last ten years and where the epidemic continues to expand. While the overall HIV incidence has decreased globally, seven countries of the world have seen the number of new infections increase by more than 25 percent in the last ten years. Five of these countries are in the region.

The number of people in the region living with HIV now reaches 1.5 million. In 2011 alone, 170 000 people were newly infected with HIV, and there is no sign that the epidemic is slowing down. HIV prevalence is estimated to be one percent or higher in the Russian Federation and in Ukraine which, together, account for almost 90 percent of the newly reported cases in the region. The epidemic is concentrated mainly among people who inject drugs and their sexual partners, as well as among sex workers and, to a lesser extent, men having sex with men.

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It has been estimated that one-fourth of the 3.7 million people who inject drugs in the region are living with HIV. High HIV prevalence has also been found in prison populations, particularly among prisoners who inject drugs. Aggressive drug law enforcement and lack of adequate access to harm reduction programs in most countries of the region drive people who use drugs away from public health services and into environments where there is a much higher risk of contracting HIV, as well as tuberculosis and viral hepatitis.

Access to HIV treatment in the region remains very low, with only 23 percent of those estimated to be in urgent need of anti-retroviral treatment accessing it, compared to 55 percent in the African region. This is even more troubling now that it has been shown that HIV treatment is also a powerful public health tool to suppress transmission of HIV.

The above factors, plus a number of specific political, societal, cultural, and policy-related challenges, pose formidable obstacles to the fight against the epidemic in the region. I sincerely hope I will be able to make a difference and am committed to encouraging countries in the region to turn the tide of the epidemic and save millions of lives. An urgent mobilization is needed to respond to the epidemic in Eastern Europe and Central Asia, including much greater attention to, and involvement of marginalized and criminalized populations, particularly people who use drugs, sex workers, and gay men, and other men who have sex with men.

I vividly remember the fantastic march and rally for human rights at the last International AIDS Conference in Vienna two years ago. At the press conference that preceded the event, I said that we all needed to use the conference, and the march and rally, to re-invigorate the AIDS movement as a human rights movement. This is as true today as it was two years ago.

Why are human rights so central to the AIDS response, in Eastern Europe and Central Asia, as everywhere else? For all the 10 reasons that are so well articulated in the “Human Rights and HIV/AIDS: Now More Than Ever” declaration, that remains as important today as it was when it was first released six years ago. But also because new approaches, such as treatment as prevention, simply will not work without much greater attention to human rights. We will only be able to get people into treatment early, and retain them in treatment, if we finally move from rhetoric to real action on HIV and human rights.

Many good news stories are emerging at AIDS 2012 in Washington this week, about the scale up of access to anti-retroviral treatment, the decreasing AIDS-related mortality and the decrease in the overall incidence of new HIV infections. I am happy about the progress that has been achieved, demonstrating the feasibility and effectiveness of large-scale prevention and treatment programs in poor settings, something that, even five years ago, many experts did not believe could happen. But I remain troubled about the lack of attention to human rights issues and the large inequities we are seeing in access to prevention and treatment. Discrimination against, and marginalization of, people vulnerable to HIV remain formidable obstacles to the control of the epidemic. Inappropriate laws and policies continue to fuel the epidemic. People who use drugs, sex workers, gay men, and other men who have sex with men, and other stigmatized populations have a right to the same support, including social and medical support, as everybody else, but too often suffer exclusion, police harassment, arrest, violence and prison. I strongly believe that efforts to fight the epidemic among vulnerable populations will continue to fail unless human rights are truly brought to the forefront of everything we do.

We must pursue efforts to reduce HIV incidence among these populations with the same energy and determination from which efforts directed at reducing mother-to-child transmission of HIV are currently benefiting. Everyone has a right to prevention, and to support and treatment, if needed. In this context, I deplore the fact that so many sex workers and people who use drugs were not able to attend the conference. We all can and must listen and learn from them – not prevent them from participating in our debates!

As Special Envoy, I will continue to speak out loudly and clearly about the need to devote much greater attention to human rights. And I pledge to listen to the voices of those who too often are excluded.

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