The United Nations Declaration on Ending AIDS should have been easier. It was not.

On Tuesday, the United Nations is expected to adopt new targets to end AIDS as a public health threat by 2030, a goal that appears most countries can easily agree to. But the consensus has been elusive.

In early negotiations on the agreement, called the Political Declaration, the United States and the European Union fought to ban policies and laws that stigmatize, or even stigmatize, high-risk groups. Criminalize too – and go back far enough to relax patent protections for HIV drugs.

The United Nations Declaration sets priorities for the global AIDS response and guides policies at the national level. It also gives global health groups and civil society organizations the advantage of pressuring governments to honor their commitments.

After several days of heavy editing by representatives of some countries and deft negotiations by others, member states are expected to accept the final version of the declaration on Tuesday morning. Included in the final draft is an important new goal of reforming discriminatory laws in most nations so that less than 10 percent of the world’s countries have measures that unfairly target people at risk of HIV or living with it.

“Those laws are turning people most affected by HIV away from HIV prevention and treatment,” said Matthew Kavanaugh, director of the Global Health Policy and Politics Initiative at Georgetown University. “It could be a valuable tool in getting the world back on the path to ending AIDS.”

Dr. Kavanagh and his companions on Monday new work published It shows that countries that criminalize homosexual relationships, drug use, and sex work have had little success in returning HIV.

But the announcement doesn’t move the needle on patent protection. The United States was among the nations whose representatives significantly watered down — or moved to curtail — patent easing to allow greater access to affordable HIV drugs in low- and middle-income countries. A stance on direct odds with the Biden administration’s backing patent exemptions for COVID vaccines.

“The administration’s mixed message given recent support for a COVID-19 vaccine patent exemption is misleading and disappointing,” said Annette Gaudino, director of policy strategy at the Treatment Action Group, an advocacy organization in New York. “This will be the first time America has placed the profits of pharmaceutical companies on people’s and public health.”

Every five years, the United Nations brings together heads of state, health ministers and NGOs to set priorities for tackling the HIV epidemic. At a similar meeting in 2016, member states agreed to a goal of fewer than 500,000 new HIV infections annually, fewer than 500,000 AIDS-related deaths, and an end to HIV-related discrimination by 2020.

The world didn’t meet those goals: About 1.5 million people were infected with HIV in 2020, and about 690,000 died.

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

“To end AIDS by 2030, governments must commit to adopting a people-centred, rights-based approach to HIV, working on policy and law reform, engaging and supporting communities, and ending inequalities should,” Winnie Byanyama, UNAIDS Executive Director, said in an emailed statement.

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

Representatives from some countries, including the Africa Group, China, Russia and Iran, attempted to remove signs for sexual or gender identity, or sex education for girls. They were only partially successful: the current text calls for prevention methods tailored to high-risk groups, including sex workers, men who have sex with men, drug users, and transgender people.

Representatives of African countries successfully inserted language emphasizing the “sovereign rights of member states” and asserted that the commitments in the declaration would be implemented “in line with national laws, national development priorities and international human rights”. almost half of the countries 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 clause that Saudi Arabia, Russia and the Holy See clarified from the text. tried to do.

Representatives from Belarus, China and Russia also removed a clause asking member states to recognize the autonomy of citizens on matters related to sexuality; His substituted text encouraged “responsible sexual behavior, including abstinence and fidelity”. The final document reverted to the original text.

Even if the declaration is accepted on Tuesday, these countries may distance themselves from specific sections that contradict their cultural or religious norms.

Some experts said the inclusion of language about high-risk groups is critical to success. Gay men and other men who have sex with men, people who inject drugs, and female sex workers have a nearly 30-fold higher risk of HIV than the general population.

If those groups can’t access preventive treatment, clean needles, condoms or education, “we’re going to really eliminate AIDS by 2030,” said Eric Sawyer, author of HIV and Long-Living An advocate for the people who live.

An early draft of the declaration also included a lengthy section on easing patent protections. Under current global regulations, only the 50 least developed countries are allowed to expire patents on pharmaceutical products to be distributed to citizens.

The draft called for an “indefinite moratorium on international intellectual property provisions for drugs, diagnostics and other health technologies”. Representatives from the United States and Switzerland removed that clause. “This is not the place to discuss these general issues,” an EU representative said.

The United States also added language to the scaled-back version to recognize “the importance of the intellectual property rights regime in contributing to a more effective AIDS response”.

Activists said the stance against patent exemptions was completely in line with the European Union, which also opposed exemptions for patents on COVID vaccines. Vaccine manufacturers have argued that patent protection is necessary to drive innovation.

But citing an urgent need for vaccines, Biden administration officials have said they would support a patent exemption that allows companies to make cheaper versions of vaccines for the rest of the world.

Given that development, “it would be really incongruous for America” ​​to oppose the easing of patent protections for HIV drugs, said Brooke Baker, a law professor at Northeastern University and of the Health Global Access Project, an advocacy organization. Senior policy analyst said.

“Why in the world is America talking with its mouth to two sides that seem to have almost the same issue?”

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