Ambassador Sarah Mendelson
The United States would like to express its appreciation to the Governments of Switzerland and Zambia, and their respective Permanent Representative to the United Nations, Jürg Lauber and Dr. Patricia Mwaba Kasese-Bota, for their exemplary efforts as co-facilitators of the United Nations High-Level Meeting on Ending AIDS.
The U.S. is pleased to align ourselves with the general statement made by the Permanent Representative of Argentina.
The U.S. commitment to ending the epidemic of AIDS cannot be overstated. And in articulating this commitment, we must acknowledge the role that civil society and the NGO community has played in this decades-long effort. We believe that this declaration is a necessary step in the continuing effort to combat HIV and AIDS, and appreciate that the international community is able today to reiterate its political will to end the epidemic. The Political Declaration, however, is far from a perfect document. We would like to point out some of our issues with the Declaration
We continue to be committed to work with others to implement the 2030 Agenda. Together, we have made tremendous progress in the global HIV/AIDS response; however, the work is far from done, particularly for those at risk of being “left behind.” The language in the Political Declaration could have been stronger and more explicit on this point. The protection of human rights provides the foundation for ending the AIDS epidemic as a public health threat by 2030 – the target supported by 193 UN Member States in adopting the 2030 Agenda in September 2015. However, the language in the Political Declaration should have been stronger and more explicit on this point – the world’s population deserves no less.
Despite the significant medical advances in HIV/AIDS over the past 35 years, we have not made nearly as much progress in preserving human rights and creating the legal and policy environments needed to prevent stigma and discrimination. This has resulted in part due to the lack of acceptance of human rights of all persons, without distinction, and in part because we have not systemically measured stigma and discrimination, thus limiting efforts to chart progress.
The United States remains firmly committed to ending stigma, discrimination, and violence against persons living with HIV/AIDS and key populations and to help to create legal and policy environments which increase their access to HIV prevention and treatment services. When any person is stigmatized, discriminated against, disrespected in the health care setting, or is subjected to violence in accessing HIV/AIDS services, the health and human dignity of everyone in that community are threatened. We need to ensure that HIV services are comprehensive and reach the most vulnerable populations. In this regard, the needs and rights of individuals living with, at risk of and affected by HIV, especially members of key populations, including men who have sex with men, transgender persons, sex workers, persons who inject drugs, and prisoners must be addressed. To control the epidemic and, ultimately, achieve an AIDS-free generation, it is imperative that we identify, measure, and change the complex dynamics driving stigma and discrimination, and encourage innovative, tailored, community-led approaches to address them for each risk group. We need to measure and change the outcomes of key population clinical cascades, specific by population and location, where stigma and discrimination are key drivers limiting the ability to make progress. Without exception, all efforts to address these issues must include the populations directly affected from the outset and at every stage.
The United States also remains firmly committed to protecting the sexual and reproductive health and rights of all women. Every woman has the right to have control over and decide freely and responsibly on matters related to her sexuality, including sexual and reproductive health, free of coercion, discrimination and violence. A lack of protection of this right contributes to the alarming facts that 390,000 adolescent girls and young women are infected with HIV annually, and that girls account for three-quarters of all new HIV infections among adolescents in sub-Saharan Africa. The AIDS epidemic will not be ended by 2030 unless sexual and reproductive health and rights are protected.
The United States is committed to measures to promote access to safe, affordable, quality, and efficacious medicines, diagnostics and related health technologies for HIV and other diseases, while at the same time providing important incentives for innovation through a robust Intellectual Property regime. In doing so, the United States continues to strive to provide the most effective tools for all populations and to reach our shared goal of ending the AIDS epidemic. We have concerns that the work of the Secretary-General’s High-Level Panel on Access to Medicines, which is currently underway, and is noted in the Declaration, will not achieve meaningful results.
As we have made clear through our submission of views earlier this year, among our concerns is the Panel’s narrowly-defined mandate, the non-transparent manner in which it was constituted, and the presumption of a policy incoherence. We believe the Panel has the potential to divide rather than to bring together countries, patients, and stakeholders.
The United States hopes that any recommendations from the Panel or the Secretary-General will not divide us, but further the goals of both access and innovation and find common ground for future work on this critical issue.
We reiterate our understanding that this non-binding document does not create rights or obligations under international law. Additionally, we note that the term “equitable” is used in multiple contexts in the Declaration. While the United States fully endorses the importance of universal access to health care services, we must collectively avoid any unintended interpretation of the term “equitable” that implies a subjective assessment of fairness that, among other things, may lead to discriminatory practices.
The United States understands that this Declaration does not imply that states must join human rights instruments to which they are not a party, or that they must implement those instruments or any obligations under them. This Declaration does not change the current state of conventional or customary international law. Nor do we understand it to recognize any rights not previously recognized or expand the scope of, or modify in any way, previously recognized rights. We further understand this Declaration to be consistent with longstanding U.S. views regarding the International Covenant on Civil and Political Rights, including Article 17, and interpret it accordingly. The United States understands that any reaffirmation of prior documents in this Declaration applies only to those states that affirmed them initially.
In supporting this Declaration, we reaffirm our long-standing commitment to both international development and the promotion of human rights. However, we must reiterate the concerns of the United States regarding the topic of a “right to development,” which are long-standing and well known; it does not have an agreed international meaning, and any related discussion needs to focus on aspects of development related to human rights, which are universal rights held and enjoyed by all individuals and which every individual may demand from his or her own government.
The United States remains committed to not only turning the tide on HIV/AIDS but also on the unrelenting stigma and discrimination within the health system and community. The United States, through the President’s Emergency Plan for AIDS Relief, PEPFAR, has dramatically increased funding to support key populations, women, comprehensive approaches to the measurement and change of stigma and discrimination, and to ensure that anyone, anywhere, independent of race, gender, sexual orientation, or gender identity or other status can access information and services to change the course of the HIV/AIDS pandemic.
Thank you for this opportunity to make these important points of clarification. We ask that this statement be added to the official record of this High Level Meeting. With these clarifications, we are pleased to join consensus on the adoption of the Political Declaration to accelerate the fight against HIV and to End the AIDS Epidemic by 2030. Thank you.