Time to turn the corner on AIDS
The G20 met this year at a critical moment for the world. We are living in an exceptional era when political unrest, financial instability and human insecurity place unprecedented pressures on society.
Today, more people are forcibly displaced than since the end of the Second World War. This year, 2015, represents the biggest leap of displacement ever seen in a single year. Almost half of the world’s 1.1 billion young people are under- or unemployed, becoming targets for exploitation and radicalisation. Within the next two years, the richest 1% of the global population will have more wealth than the remaining 99%.
The current situation is unsustainable and dangerous. We need collective action and global governance more than ever. The G20 has never been more relevant or essential as a forum and lever to address our global crises.
In September, the remarkable targets of the Sustainable Development Goals (SDGs) were adopted by the international community. With their explicit targets to reduce inequalities, the SDGs are a welcome shift from the Millennium Development Goals (MDGs), which measured progress against blunt averages that masked widening gaps both within and between countries and communities.
I am encouraged that, under Turkey’s presidency, the G20 determined that its work in 2015 would focus on ensuring inclusive and robust growth through collective action. The G20’s focus on inclusion resonated with what we have learned, over three decades of the global AIDS response, about what is truly possible through collective global action.
From the very beginning of the epidemic, action was driven by a movement of people living with HIV and other affected communities. Since then, the response has continually pushed forward the frontiers of development. It has institutionalised inclusive governance and established rigorous global accountability mechanisms. It has challenged global norms on access to affordable medicines. And it has revealed the inherent linkages among health, human rights, and social, economic and political empowerment.
To turn the corner and end AIDS as a public health threat by 2030 – the ambitious target set for the SDGs – no one can be left behind. Furthermore, the world will not be able to end extreme poverty, address the effects of climate change or close equity gaps unless the human rights issues critical to ending AIDS are simultaneously addressed.
Ending AIDS is not only feasible – it is within our grasp. Achieving this target under the SDGs would avert 28 million HIV infections and 21 million AIDS-related deaths over the next 15 years. This is an incredible opportunity to save lives and strengthen fragile economies all over the world.
I look to the G20 to take the lead and fuel a new surge of action. There are five areas where I believe that together we can make a historic impact on this epidemic and ease its associated blights of inequity, poverty, discrimination, sexual violence and skewed justice.
Making a historic impact
First, we must replace punitive approaches against marginalised communities with inclusive approaches. How will we reach gay men and transgender people, sex workers and people who inject drugs when they fear health services and hide from government authorities? Globally, more than 100 countries criminalise some form of sex work, and drug use remains criminalised in most countries.
Shockingly, 61 countries still have laws in place that permit criminalisation of people living with HIV – primarily involving HIV non-disclosure, exposure or transmission. In 76 countries, same-sex sexual practices are criminalised; in seven countries they are punishable by death. In addition to high rates of violence against them, transgender people are not recognised in most countries and are generally absent from public policy formulation and social protection programmes.
I urge the G20 to review laws and policies around what are in many countries considered difficult and sensitive issues, such as sex work, drug use, homosexuality and gender identity. The G20 is capable of leading the way towards abandoning criminalisation and harsh law enforcement practices.
Second, the G20 must act to put women and girls at the centre of all its efforts. The post-MDG world has fallen far short of eliminating gender inequality and gender-based violence and abuse. More than 100 countries still deny women the same inheritance rights and access to land and property as men. Early marriage and adolescent pregnancy remain common, particularly in low-income countries. Violence against women remains a global pandemic, perpetuated by social norms: more than a third of women worldwide believe that domestic violence is justified under certain conditions, and about the same percentage have been victims of gender-based violence in their lifetimes.
The G20’s commitment to inclusion requires concrete efforts to ensure gender equality across laws, policies and practices and to address gender-based violence. Real and threatened violence hampers women’s ability to protect themselves from HIV and unwanted pregnancies. AIDS remains the largest killer of women of reproductive age globally. This has to change, and the G20 should lead the way.
Third, the G20 should embrace a comprehensive approach to empowering youth. This must include ensuring their universal access to sexual and reproductive healthcare services, including for family planning, information and education. Today, there is the largest generation of adolescents and young people ever. To thrive in our societies, they need more than education and employment – they need life skills that include comprehensive sexuality education. It is unacceptable that 65% of young men and 72% of young women still lack accurate, comprehensive knowledge about HIV. We will never end the AIDS epidemic until our young people can seize, and fully enjoy, their sexual and reproductive rights.
As a fourth action, the G20 should support and strengthen civil society, whose representatives include vulnerable and marginalised communities. AIDS has taught us in no uncertain terms that empowering the people most affected by HIV delivers progress against the epidemic. Affected communities – uniquely positioned as they are on the ground and in the streets – know what works and what needs be done. Moreover, they can and will do it.
Civil society needs more than political space – it requires investment. But across the board, these organisations face a major funding crisis. We cannot afford to lose them – and the diverse movements they represent – as allies, partners and agents of change. Activism constitutes a global public good, and it comes from our youth, our women, our gay activists and our other brave campaigners for equality.
Scaling up resources to end the epidemic
Fifth, and finally, the G20 can and must play a key role in scaling up resources to end the AIDS epidemic. We know what combinations of biomedical and behavioural measures work to successfully reduce AIDS-related mortality, new HIV infections and mother-to-child transmission. We know how to reach those being left behind. We know how to make the money work. Importantly, this means allocating resources to places and people where they will make the greatest impact. It means targeting areas where the most marginalised and excluded populations reside.
We have succeeded in reaching the AIDS targets of MDG 6. We met the ‘15 x 15’ goal of reaching 15 million people with HIV treatment by 2015 – and we did it six months before the deadline at the end of this year. With this in mind, I have no doubt that we can defeat AIDS by 2030 if we scale up action in the next five years.
Current investments in the AIDS response are around $20 billion a year. Increasing that by $8–12 billion a year would produce long-range economic benefits of more than $3.2 trillion. That is a 17-to-1 return on our investment. Who wouldn’t take that deal?
The G20’s focus on ensuring inclusive and robust growth through collective action is critical to meet the many challenges we face as a global family. The AIDS epidemic represents just one challenge – but one that, to overcome, will deliver benefits across the SDGs.
Let us transform this challenge into an extraordinary opportunity. Let us be the generation that ends this cruel epidemic. Let us take action to ensure that no one is left behind. Let us turn the corner and walk into the sunlight of a world without AIDS.
