After limited pre-sessional negotiations, government delegates struggled to reach consensus on the Declaration of Commitment on HIV/AIDS (the Declaration),4 and to mobilize the political will and economic resources needed to combat the epidemic. In addition to the plenary debate, the UNGASS also featured four round table discussions (the Round Tables), composed of national delegates and civil society representatives, to examine specific aspects of the epidemic, namely: 1) Prevention and Care; 2) HIV/AIDS and Human Rights; 3) Social and Economic Impact and the Strengthening of National Capacities; and 4) International Funding and Cooperation.5 These Round Tables were a unique attempt within a UN conference to facilitate dialogue between Member States, UN agencies and civil society actors with expertise in the focus area.6
Previous Commitments Affirmed
D. Preventing and Reducing the Prevalence of HIV/AIDS
E. Care, Support and Treatment
- Sexuality Education and Information
- Availability of and Access to Commodities, Diagnostics and Treatment
- Mother-to-Child Transmission
F. Adolescent Reproductive Rights
Several areas proved controversial during the negotiations on the Declaration, in particular the debt burden of low-income nations most affected by HIV/AIDS,18 the creation of a Global AIDS Fund, and the constraints placed on NGO and youth participation during the UNGASS. However, it was the unwillingness of many conservative governments to identify specifically vulnerable groups within the Declaration - such as men having sex with men, sex workers and their clients, and injecting drug users - that proved most contentious during the negotiations.19 Overall, however, even with weakened language regarding at-risk groups, the resultant Declaration calls for bold actions to address HIV/AIDS at the community, national, and international level.
In the two decades that have passed since its initial identification,7 HIV/AIDS has grown into a pandemic that has devastated families and communities worldwide. Over the past 20 years, AIDS-related illnesses have taken the lives of more than 19 million people8 and have left more than 13 million children orphaned.9 Currently, an estimated 40 million adults and children carry the virus.10 Its effect has been greatest in sub-Saharan Africa, where several nations report prevalence rates exceeding one out of every five adults.11 In other regions, although prevalence rates have remained lower by comparison, the sheer number of infected persons threatens to overwhelm public health care infrastructure. In South and Southeast Asia, the number of HIV-positive people now stands at 6.1 million.12
Although different modes of transmission have fueled the spread of the virus,13 women and young people, particularly adolescent girls, are most at risk for HIV infection. Biological susceptibility, combined with lower economic, social and political status contribute to women and adolescents' increased vulnerability to infection.14 Women now represent over half the total number of all cases in the worst affected African countries,15 and face increasing vulnerability to HIV infection in every region of the world. Adolescents currently account for half of all new infections.16 In the United States, adolescent girls constitute 64% of HIV-positive 13-19 year olds.17
Many aspects of the Declaration stand out as important gains, in particular its focus on concrete, time-bound actions, unusually specific provisions for funding and resource allocation, and the protection of the rights of people infected and affected by HIV/AIDS. Also unusual in international instruments, the Declaration charges governments with contributing significant financial resources - between U.S.$7 and $10 billion annually - to HIV/AIDS prevention, care, and treatment programs in the most affected countries.20 In addition, the Declaration calls for strengthened partnerships between governments, political leaders, and civil society, particularly PLWHAs, women, youth, and other vulnerable groups.21
One critical achievement of the UNGASS was the inclusion of some language within the Declaration promoting the health and rights of women and girls in the context of HIV/AIDS. Although the Declaration fails to explicitly address the broader concept of reproductive rights or the need for governments to provide comprehensive reproductive health care services, the Declaration makes clear the inextricable link between gender equality, equity and empowerment and the ability of women and girls to protect themselves from HIV infection.22 It likewise acknowledges that gender discrimination and barriers to young people's access to sexuality information, education, and communication (IEC) have been formidable factors in fueling the spread of HIV/AIDS.23 Though taking a more limited approach, the Declaration reaffirms the commitments made at the landmark 1994 International Conference on Population and Development (ICPD),24 the 1995 Fourth World Conference on Women (Beijing),25 and their five-year reviews26 to promote women's empowerment in matters related to sexual and reproductive health, particularly HIV/AIDS.
This paper will analyze issues that affected civil society participation and inter-governmental negotiations during this historic Special Session. It will then examine the strategies outlined in the Declaration of Commitment to protect and promote the reproductive health and human rights of women and girls infected and affected by HIV/AIDS.
Source: UNAIDS & WHO, AIDS epidemic update (2001)
II. The UN General Assembly Special Session
A. Background to the Process
In July 2000, the first major international AIDS conference to be held in the South took place in Durban, South Africa. It spotlighted the realities that sub-Saharan African and other low-income nations face in combating HIV/AIDS. From its opening, this conference emphasized the link between poverty and a lack of public-health infrastructure, and the rampant spread of HIV/AIDS.27 Within the same month, the UN Security Council passed a resolution recognizing the considerable threat that HIV/AIDS poses to international and regional stability and security. The resolution called for additional actions "among relevant United Nations bodies, Member States, industry, and other relevant organizations" to discuss issues on HIV/AIDS prevention and care.28 This call to action was reiterated during the September 2000 Millennium Summit when the General Assembly voted to hold an emergency special session to address the problem of HIV/AIDS.29
Following the September General Assembly resolution, the secretariat of the Joint United Nations Programme on HIV/AIDS (UNAIDS) embarked upon the unprecedented challenge of organizing an international conference - to be attended by heads of state and high-level officials - with only nine months preparation time. Unlike other UN conferences or special sessions - which generally result from at least two years of planning and negotiations - the UNGASS on HIV/AIDS was organized with only two series of informal consultations among Member States, held in New York City from February 26 - March 2 and from May 21 - May 25, 2001.30
B. Role and Dynamics of Government Blocs
Throughout the pre-session and main plenary negotiations on the Declaration, four groups emerged as unified negotiating blocs on most issues: the European Union (EU), represented by Sweden; the Rio Group, led by Chile; a group of Islamic states, led by Egypt; and the Southern African Development Community (SADC), led by Zambia. The EU maintained the progressive stance it has taken in other recent UN inter-governmental negotiations in advocating for strong language on sexual and reproductive health rights and the rights of individuals to a full range of sexual and reproductive health information and services.31 The Rio Group, comprised of several Latin American countries that had taken a similarly progressive position at the five-year review of the Beijing Conference (Beijing+5),32 stood firmly in support of the rights of women and girls in matters relating to sexual and reproductive health and HIV/AIDS prevention. These delegations also provided a strong voice in discussions on AIDS treatment medications and the need for affordable drugs and the development of domestic pharmaceutical industries in low- and middle-income countries.33
The Zambia-led SADC bloc likewise stood its ground amidst pressure from conservative governments and pushed for language supporting women's and girls' human rights in matters related to reproductive health, sexuality, and HIV/AIDS prevention, treatment, and care. In many instances, countries such as Australia, Canada, Lichenstein, New Zealand, and Senegal joined forces with SADC, the EU, and the Rio group in support of women's and girls' full enjoyment of human rights, adolescent- and youth-specific concerns, and the rights of vulnerable and at-risk populations.34 A group of Islamic states35 objected vociferously in debates surrounding these issues and maintained strong opposition throughout the negotiations to any language referring explicitly to gay/bisexual men's vulnerability to HIV infection.36
Notably, during the UNGASS, the Vatican and the United States altered their recent positions and negotiating strategies vis-à-vis reproductive and sexual health issues. The Vatican, which usually speaks out strongly against the inclusion of language on reproductive rights, adolescent sexuality, and individuals' access to contraceptive information and services, remained remarkably quiet in this forum. While the Vatican entered its usual reservations to UN consensus documents to the Declaration,37 its participation throughout the UNGASS indicated a willingness to ensure progress on negotiations.38 In disappointing contrast, the U.S. delegation stood for the first time in recent years as a fairly conservative voice in UN negotiations. Although many if its interventions related to drug pricing and manufacturing and to manufacturers' compliance with intellectual property rights,39 the U.S. delegation also lobbied extensively for language on HIV/AIDS prevention that emphasized abstinence, at times at the expense of references to broader HIV/AIDS prevention and sexuality education components and to reproductive rights explicitly.40
C. Civil Society Participation
Like in many UN fora, the pre-session and plenary negotiations of the UNGASS demonstrated the tensions that exist between calls for civil society participation at the United Nations and the actual mechanisms for NGOs to openly and fruitfully participate in UN conferences. Statements made by UNAIDS, acting as the secretariat throughout the preparatory process, acknowledged the central role that civil society actors have played in the fight against HIV/AIDS,41 particularly in communities where government commitment to address HIV/AIDS and sexuality issues remains disturbingly weak. Furthermore, the General Assembly resolution establishing the process for this UNGASS encouraged Member States and Observers to include in their national delegations "civil society actors, people living with HIV/AIDS or representatives of their associations, ... young people's organizations," and representatives from the private sector.42 Participation of NGOs and PLWHAs was similarly encouraged for the Round Tables, in which government delegates and selected civil society actors with expertise in matters related to HIV/AIDS and medical, social, and economic issues were ideally to speak on equal footing.43
In reality, however, civil society representatives faced many obstacles to their effective participation in the UNGASS process. Despite recommendations to include them in national delegations, relatively few countries did so, and even fewer specifically incorporated youth, gender, and PLWHA perspectives.44 Overall, 41 Member States out of 189 included civil society actors on their national delegations.45 Many NGOs, particularly youth and PLWHA organizations, interpreted this marginalization as a lack of commitment by their governments to directly address HIV/AIDS and its intersection with poverty, gender, sexuality, and life style issues.46|
Likewise, because the informal consultations took place in New York City, many overseas groups were effectively excluded from providing input, due to prohibitive travel costs.47 The groups that did attend the informal consultations in May found that only one civil society intervention was allocated, for which four civil society representatives were elected to present brief statements and respond to delegates' questions.48 However, because the official intervention was scheduled for the evening of the first day, following an intense and lengthy series of meetings, only about 20 delegates remained in the hall for the statements.49 A second dialogue opportunity was eventually added, but was scheduled for lunchtime of the third day and was conducted without any translation services. The inconvenience of the time slot again led to extremely limited attendance by delegates, while the absence of translation forced the diverse participants to struggle with English.50
Another serious threat to NGO participation and to the inclusion of diverse perspectives in the negotiations was the unsuccessful attempt by a group of Islamic states to void the appointment of a gay-and-lesbian-human-rights activist to the Round Table on HIV/AIDS and Human Rights. This attempt to silence the participation of gay, bisexual, and transgendered persons in this forum seriously undermined the call for substantive cooperation between governments and NGOs.51 In the end, many NGOs voiced their frustration over the conflicting signals from the UN and from Member States, who called for civil society participation in the Special Session process but made their actual input very difficult.