HIV and AIDS is a Public Health and Human Rights Crisis

Today marks the first World AIDS Day under the Trump Administration. As Policy Advisor for Sexual Health and Rights at AJWS, I recall sitting down by my desk at this moment last year to reflect on what eight years of the global AIDS response under President Obama achieved. I was also thinking about my fears of what the global AIDS response could look like under then-President-elect Trump. A piece published by AJWS’s President and CEO Robert Bank described fears of a return to “abstinence-until-marriage” programming that defined the global AIDS approach during the Bush years, a potential reversal of a mandatory non-discrimination clause against LGBTI people in USAID contracts, and likely cuts to programs that finance life-saving treatment and prevention programming for the world’s most marginalized populations—including women, girls, LGBTI people, people who use drugs, and sex workers.

Today, many advocates are breathing a sigh of relief as funding for PEPFAR (the President’s Emergency Plan for AIDS Response) and the Global Fund to Fight AIDS, TB and Malaria, appears on track for funding on par with Obama-era levels—a rarity among international assistance programs targeted by President Trump’s FY18 budget proposal. Treatment access and preventative health programming have delivered real results over the past several years that all Americans should feel proud of. Just last year, the U.S. State Department released new data showing that as of 2016, 11.5 million men, women and children are on life-saving treatment, and that 1 million adolescent girls and young women have been helped because of U.S. programming and investments. Indeed, in 2017 the U.S. remained the largest bilateral contributor to defeating the AIDS crisis—investing nearly $6 billion towards testing, treatment and prevention funding—and provided nearly a third of the funding to the Global Fund to Fight AIDS, TB and Malaria.

Treating the Root Causes of the HIV/AIDS Crisis

However, no amount of investment in treatment, prevention and testing can address the underlying problem fueling HIV and AIDS: the denial of human rights. So long as the human rights of all people to live with freedom and dignity are not front-and-center to our AIDS response, we will not be able to meet our international commitments to end AIDS by 2030. In this regard, the Trump Administration—by privileging treatment at the expense of human rights—has fallen tragically short of what’s needed to put an end to AIDS in a way that truly leaves no one behind. So long as the Trump administration continues to deny women the right to make decisions about their own bodies and health and ignores human rights violations against LGBTI people, treatment alone will not solve the HIV/AIDS crisis.

Huge Obstacles to Human Rights in Kenya

I would like to share a story which illuminates exactly how disregarding human rights undermines the global fight against HIV/AIDS. This summer I visited Upper Rift Minorities (URM), an organization in Northern Kenya supported by AJWS that documents rights violations and advocates for the human rights of non-heterosexual and transgender refugees. Many members of URM fled Uganda in 2011 or 2014 after successive attempts by the Ugandan parliament to criminalize homosexuality. The ongoing criminalization of homosexuality has long been recognized as a barrier to controlling the spread of HIV/AIDS. According to the Global Commission on HIV and the Law, LGBTI people, sex workers and people who use drugs accounted for nearly 36% of all new HIV infections in 2015, with further acknowledgement that “homophobia drives [these populations] away from HIV testing and HIV prevention activities, and is associated with low adherence to treatment.” However, the added realities of migration, discrimination in the delivery of health services, homelessness and food insecurity made some of these LGBTQ refugees—many of whom were HIV positive—among the most vulnerable I have seen in my decade of advocating for global human rights and social justice.

One community member reflected on his tumultuous experience leaving Uganda, migrating to Kenya, and then navigating the UN’s and later the U.S. government’s refugee program. He described his experience as abandonment and neglect. Uganda made him a criminal, Kenya, his host country, left him languishing in refugee camps and the international system managed by the United Nations designed to help him build a better future for himself ultimately let him down.

Kakuma Refugee Camp has an HIV clinic, and within the clinic, a specialized practice for most at risk persons, such as gay men, transgender women, sex workers and drug users. That clinic, though underfunded, has been able to reach LGBTQ people and sex workers with services needed to keep HIV under control and prevent infection. Though I was pleased to see resources going to meeting the health needs of key populations, I left Kakuma wondering if an HIV response that only funds treatment is sufficient to ensure that those living with AIDS can live with dignity and with their full human rights recognized.

The answer is no, and sadly many of their vulnerabilities have been exacerbated by the political changes which dominated Washington, D.C. this past year. Those in the Kakuma refugee camp are over 7,000 miles away from D.C., but political changes there are preventing them from realizing their human rights.  For example, many people in Kakuma who are HIV positive were in the midst of navigating the complicated refugee resettlement process. Their progress ground to a halt when the Trump Administration nearly shut down the U.S. refugee program after taking office last January. Many women and girls who remain able to access treatment for HIV are no longer able to access safe abortions or abortion-related services because of the Trump Administration’s reinstatement of the Mexico City Policy, known as the global gag rule. This is especially devastating in places with high rates of sexual violence, which—aside from being a human rights violation in and of itself—makes women and girls vulnerable to unintended pregnancy and HIV infection.

The U.S. government continues to officially conflate consensual adult sex work with trafficking, criminalizing the livelihoods of sex workers who are already so vulnerable. And globally, the issue of violence against gay men in places like Chechnya, Azerbiajan, and Egypt has been paid mere lip service by Secretary Tillerson and the State Department, calling this Administration’s commitment to global human rights into question. Addressing these barriers is key to conducting a response to ending AIDS that keeps the human rights of all people at its center.

Fully Funded, Half-Baked

We cannot treat our way out of HIV and AIDS if we do not address human rights. And even if we could, as long as the most vulnerable among us still experience human rights violations—in the form of immigration bans, restrictions on sexual health, criminalization and violence—it will not be enough to ensure that all people can live with safety, respect and dignity. Health and human rights are two sides of the same coin, and the Trump Administration’s global AIDS response will fail if a commitment to justice and equality are not at its core. I fear that in the absence of a robust commitment to human rights from the American government, the AIDS response under the Trump administration will remain funded, but ultimately, half-baked.