Policy briefing - European Union: honouring commitments on HIV and human rights? by International HIV/AIDS Alliance

CAMPAIGN BRIEFING Supporting community action on AIDS in developing countries

European Union: honouring commitments on HIV and human rights?

ABOUT THE CAMPAIGN

Introduction OUTPACING THE RESPONSE

‘What’s Preventing Prevention?’ is a campaign of the International HIV/AIDS Alliance, supported by the Stop AIDS Alliance. Our mission is to support community action to prevent HIV infection, meet the challenges of AIDS, and build healthier communities.

Respecting and promoting a human rights-based approach in any response to HIV is widely recognised as essential to successfully achieving universal access to HIV prevention, treatment, care and support. Still, three decades into the epidemic, the human rights of people living with HIV and those who are particularly vulnerable to HIV (including sex workers, people who use drugs, transgender people, or men who have sex with men) are frequently breached. In addition to the burden faced by the disease, those key populations are affected by human rights violations, such as denial or loss of employment, privacy, freedom from discrimination or freedom of movement.

That’s why we’re calling on donors and governments to guarantee a more effective HIV prevention response that enables groups that are at higher risk of being infected or affected by HIV to access prevention services and realise their rights. The campaign has three strands:

This briefing analyses how the EU’s human rights commitments are translated in its HIV response at country level. It identifies gaps in the EU’s leadership and proposes measures to guarantee that the human rights of those who are most vulnerable to HIV are respected and promoted through EU engagement at national level.

BETTER FUNDING

The current EU Programme for Action to Confront HIV, Malaria and Tuberculosis ends in 2011. It is essential the EU urgently agrees on the renewed and updated strategy and operational plan on HIV and AIDS, in external action that underscores the importance of a human rights-based response to HIV, if the EU is to make a real impact on the epidemic.

Donors need to increase the proportion of their funding for HIV prevention interventions that reach communities at higher risk of HIV.

REMOVE BARRIERS National governments need to remove the political and social barriers that stop people from accessing prevention services.

The recently developed UNAIDS Investment Framework is an evidence-based model to calculate financial needs for the HIV epidemic and drive resource allocations1. It relies on HIV practitioners implementing a coordinated range of interventions proven to be most effective in addressing HIV among populations with the highest need. The Framework shows that placing greater emphasis on community mobilisation, using programmatic approaches grounded on the principles of universal human rights, are crucial for an effective HIV and AIDS response. The European Union (EU) response to HIV should be framed by this model if the EU is to deliver on its commitments to HIV and human rights.

OUR SAY Communities at higher risk of HIV must be able to participate in decision-making around HIV prevention programmes. This is the best way to ensure services meet their needs.

ABOUT Stop AIDS Alliance (SAA)

The Global Fund to Fight AIDS, Tuberculosis and Malaria has played a pivotal role in providing human rights-based approaches to the HIV response for over ten years. The cancellation of all new programming by the Fund until 2014, decided in December 2011, could have a devastating impact on the global HIV response. As the largest donor to the Global Fund, the EU should exert its leadership and call for an emergency Replenishment Meeting and for proposals, before the International AIDS Conference in July 2012, in order to fill the funding gap.

Stop AIDS Alliance (SAA) is a partnership between STOP AIDS NOW!, based in the Netherlands and the International HIV/AIDS Alliance, based in the United Kingdom, with policy and advocacy offices based in Brussels, Geneva and Washington D.C. Through engaging with EU and US policy makers, EU Institutions, United Nations agencies and other relevant stakeholders, we aim to ensure that the HIV response remains a high priority on the global policy agenda to achieve universal access to HIV prevention, treatment, care and support. Our presence in the three main global policy centres as well as in the Netherlands and the UK aims to contribute to harmonized HIV policy messages, building linkages between advocacy groups active in the different locations and voicing the concerns and needs of the International HIV/AIDS Alliance’s and STOP AIDS NOW! partners working in the field. www.whatspreventingprevention.org www.stopaidsalliance.org

Stop AIDS Alliance Rue Belliard 65/7 B-1040 Brussels Belgium Phone: +32 (0)2 235 0911 Fax: +32 (0)2 230 5464 Email:afetai@stopaidsalliance.org 1

This briefing proposes measures to guarantee that the human rights of those who are most vulnerable to HIV are respected and promoted through EU engagement at national level.

The EU’s global commitments to human rights and HIV

RECOMMENDATIONS to HONOUR EU COMMITMENTS

At the 2011 UN General Assembly High-Level Meeting on HIV and AIDS, UN member states signed a Political Declaration on HIV and AIDS that places human rights at the very heart of the global HIV response

To honour the bold commitments made in the Political Declaration, the EU must implement a series of practical and coordinated actions by the Commission and member states:

In the Declaration, UN member states agreed to:

The EU must develop a renewed and updated strategy and operational plan on HIV and AIDS in external action aimed at honouring the commitments on HIV and human rights it made when signing the Political Declaration on HIV and AIDS.

Commit to intensify national efforts to create enabling legal, social and policy frameworks in each national context in order to eliminate stigma, discrimination and violence related to HIV and promote access to HIV prevention, treatment, care and support and non-discriminatory access to education, health care, employment and social services, provide legal protections for people affected by HIV, including inheritance rights and respect for privacy and confidentiality, and promote and protect all human rights and fundamental freedoms with particular attention to all people vulnerable to and affected by HIV.2

The EU should call for an emergency Replenishment Meeting of the Global Fund and for proposals, before the International AIDS Conference in July 2012, in order to fill its funding gap. The EU should recognise the new UNAIDS Investment Framework for HIV as a blueprint for the future of its HIV response, and fully integrate the Framework’s recommendations into its future programming.

The European Commission (EC) and EU member states worked together at the High-Level Meeting to ensure the Political Declaration reaffirmed the “full realisation of all human rights and fundamental freedoms for all is an essential element in the global response to the HIV epidemic, including in the areas of prevention, treatment, care and support… and recognise also the need, as appropriate, to strengthen national policies and legislation to address such stigma and discrimination.” 3

EU funding instruments should place human rights at the centre of funding decisions in the HIV response. They should include outcome indicators addressing the major economic, legal, social and technical barriers that impede effective responses to HIV as a key measure to ensure meaningful country ownership.

By signing the Political Declaration, the EU and its member states also committed to “redouble efforts to achieve, by 2015, universal access to HIV prevention, treatment, care and support as a critical step towards ending the global HIV epidemic.”

The EU should prioritise support for human rights-based HIV programming. It should consolidate technical coordination between the different aid instruments, including through long-term investment to support the capacity development of non-governmental organisations working to serve the needs of vulnerable and marginalised populations. It should also demand accountability and sensitivity from the health sector.

Measurable targets for 2015 agreed in the Political Declaration on HIV and AIDS •

Reach 15 million people living with HIV with antiretroviral treatment

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Reduce sexual transmission of HIV by 50%

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Reduce transmission of HIV among people who inject drugs by 50%

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Eliminate mother-to-child transmission of HIV

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Gradually increase expenditure on HIV and AIDS to between US$22 (€16.1) and US$24 (€17.6) billion in low and middle-income countries

The European External Action Service should make full use of its potential to become a progressive force for advancing human rights within the EU’s HIV response at global and country levels. Notably, it should engage more EU delegations in a policy dialogue with national governments and in the Global Fund to Fight AIDS, Tuberculosis and Malaria Country Co-ordinating Mechanisms (CCMs). The EU should pursue greater policy coherence to meaningfully contribute to the realisation of the right to health. In particular, it should not impose any provisions in free trade agreements with third countries that limit access to essential medicines.

A strong policy framework on human rights and HIV

At the regional level, the Cotonou Agreement7 states EU development cooperation should support efforts by the Africa, Caribbean, and Pacific group of states to strengthen the response to HIV and AIDS, including through “developing supportive legal and policy frameworks and removing punitive laws, policies, practices, stigma and discrimination that undermine human rights, increase vulnerability to HIV/AIDS and inhibit access to affective HIV/ AIDS prevention, treatment, care and support.”8 It also recommends the EU support countries to scale up access to evidence-based comprehensive HIV/ AIDS prevention, which addresses the local drivers of the epidemic.9

The Lisbon Treaty 4 reasserts that the EU is founded on a respect for human rights, including the rights of people belonging to minorities. It also recognises that the EU contribution to sustainable development is grounded in the protection of human rights. The EU is the world’s largest source of official development assistance, recognising health as a right for all and an essential objective within the Millennium Development Goals.5 The European Parliament recently reaffirmed that “access to health care is part of the Universal Declaration of Human Rights and that governments have a duty to fulfil their obligation by providing a public health service to all.” 6 The European External Action Service was created in 2009 with a mandate to enhance human rights and gender equality by engaging 136 EU delegations around the world. These now have a formal representative and coordinating mandate in relation to the EU member states. The European External Action Service should make full use of its potential to become a progressive force for advancing human rights within the EU’s HIV response at global and country levels. This new institutional body gives the EU an opportunity to be more engaged in policy dialogue with national governments, including with National AIDS Commissions and Global Fund CCMs. The European External Action Service should prioritise actions that reinforce multi-sectorial coordination in promoting legal reform and engagement of law enforcement agencies to scale-up evidence-based responses to HIV. The EU Council adopted a ‘Toolkit to Promote and Protect the Enjoyment of all Human Rights by Lesbian, Gay, Bisexual and Transgender (LGBT) People’ in June 2010. The guidelines are meant to help EU institutions, member states, delegations, representations and embassies in countries outside the EU to respond proactively to violations of the human rights of LGBT people. They are also intended to help address structural causes behind these violations. On health, the guidelines aim to ensure the EU supports equal access to health facilities for LGBT people, that health services are adequate for them, and that they are targeted with adequate information on HIV prevention.

‘The right of everyone to enjoy the highest attainable standard of physical and mental health implies those who are affected by HIV must have access to information as well as effective prevention and treatment options. The recent adoption of an EU tool kit to help promote and protect the respect of human rights by lesbian, gay, bisexual and transgender people will further consolidate EU action in this area.’ Catherine Ashton, Vice-President of the Commission/High Representative of the Union for Foreign Affairs and Security Policy

The EU made clear its position on HIV and human rights during the High-Level Meeting on HIV and AIDS in July 2011. Its statement emphasised that:

TO ENJOY THE HIGHEST ATTAINABLE STANDARD OF PHYSICAL AND MENTAL HEALTH IMPLIES THOSE WHO ARE AFFECTED BY HIV MUST HAVE ACCESS TO INFORMATION AS WELL AS EFFECTIVE PREVENTION AND TREATMENT OPTIONS. Catherine Ashton, Vice-President of the Commission/High Representative of the Union for Foreign Affairs and Security Policy

The EU and its Member States are severely concerned that inadequate attention is being paid to the prevention needs of key populations at higher risk. The world will not be able to sharply lower the rate of HIV transmission without paying special attention to the prevention needs of these groups, in particular men who have sex with men, injecting drug-users and sex workers and their clients.

The EU statement further articulated that: We know that programmes to encourage safe behaviours, complemented with strong human rights protection, are far more effective in controlling HIV than the counterproductive use of criminal sanctions or other forms of coercion. We welcome the commitment of the General Assembly to end stigma and discrimination for people living with, affected by or vulnerable to HIV. We believe that social attitudes need to be transformed, and resources must be allocated to anti-stigma strategies and other initiatives to promote and protect human rights.10

A Lack of strategy To honour existing commitments The European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis, through External Action (PfA), which ends in 2011, aspired to outline principles for country strategies to confront the three diseases. This was in order to: Increase human security and the protection of human rights [and] help to overcome stigma and discrimination among those infected and affected, including groups at higher risk of HIV/AIDS infection e.g. commercial sex workers, men having sex with men, injecting drug users and prisoners, and protect the rights of such people while at the same time providing access to essential services based on equity.11

The 2009 PfA progress report stressed the EU plays an important role in “bringing attention to crucial and sensitive priority areas such as sexual minorities, harm reduction, condom programming, and integration of HIV/AIDS and sexual and reproductive health and rights.”12 The related Council of the EU conclusions adopted by EU member states underscored the need for an enhanced focus on human rights and called for the renewal of the PfA after 2011. How these efforts will be continued in the long term is unclear. The Commission is yet to respond to repeated invitations and calls from the Council, the European Parliament, the Joint EU-ACP Parliamentary Assembly and civil society “to initiate a broad consultative process with Member States and other stakeholders for the preparation of a geographically comprehensive European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action for 2012 and beyond based on an assessment learnt from EU action.”13 In the absence of a policy framework on AIDS, the profile and impact of the EU collective response will weaken. It will become virtually impossible to achieve the commitments towards universal access made by the EU at the High-Level Meeting due to the lack of a coherent and coordinated response with clear objectives and measurable indicators of success.

In response to increasing numbers of new HIV infections in EU member states, and particularly in Eastern Europe, the Commission presented ‘Communication on combating HIV/AIDS in the European Union and neighbouring countries (2008–2013)’ in 2008, focusing on most-affected priority regions, key populations and evidence-based approaches. However, the EU member states have so far failed to adopt conclusions in the Council of the EU to guide the implementation of the communication. In line with its commitments at the High-Level Meeting, the EU should develop a renewed and updated strategy and an operational plan to respond to HIV and AIDS in its external action, recognising that this response goes beyond global health. One of the main obstacles to an effective response is the vulnerability of key affected populations to human rights violations, stigma and discrimination. Only a strong human rights-based approach to the epidemic can guarantee that key populations access HIV programmes and services. In that regard, the EU should recognise the UNAIDS Investment Framework as a blueprint for the future of its AIDS response.

An investment framework for the EU to meet its HIV commitments The UNAIDS Investment Framework for HIV and AIDS sets out a model for HIV investment and programming for the next decade.14 It projects an increase in spending on HIV and AIDS from €9.5 billion now to €16.3 billion in 2015, followed by a gradual decline to €8 billion in 2020. The model proposes combining effective HIV interventions with critical enablers that make these interventions work. It endorses working with key populations and the prominent role of community mobilisation in the HIV response. It also positions human rights-based programming such as advocacy, stigma reduction and supportive laws, as essential to the model. If embraced by major donors, including the EU, and implemented worldwide, it is estimated the Investment Framework would prevent 12.2 million new HIV infections and 7.4 million deaths by 2020. This is the first modelled prediction of a decline in HIV and AIDS by the end of this decade and achievement of the global goals for 2015 set in the Political Declaration on HIV and AIDS.

Placing human rights at the centre of EU funding and programming decisions Collectively, the Commission and the EU member states have contributed substantial financial resources to the global AIDS response in the last decade. The EU defined its role in the HIV response in a comprehensive framework, the ’European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action 2007–2011‘. With the adoption of the European Consensus on Development (2005), the AIDS response became an objective in its own right and one of five cross-cutting areas to be mainstreamed into all EU development policies.15 The EU is the largest donor to the Global Fund, having provided 52% of its resources from 2002 to 2010. The Commission alone contributed slightly over $1.2 billion (€882 million) from 2002 to 2010 and should meet $1.3 billion (€956 million) by 2013.16 EC health development assistance amounts to more than €600 million, annually. It is provided mainly through Sectorial Budget Support, and HIV and AIDS interventions can potentially be delivered and/or mainstreamed through these. However, the EU is starting to move away from disease-specific interventions, to focus on broader health systems strengthening, as illustrated by the adoption in 2010 of the EU Communication on the EU Role in Global Health. The European Development Fund, which is the aid instrument for African, Caribbean and Pacific countries, represents an EU investment of €22.7 billion for 2007 to 2013 for development. It provides aid mainly in the form of General Budget Support and Sectorial Budget Support, with Country Strategy Papers providing the basis for allocating support. However, it has been noted that support for health in general and, “the response to HIV and AIDS in particular is a very low priority in the CSPs (Country Strategy Papers).”17 The Development Co-operation Instrument provides funding to 47 developing countries in Asia, Latin America and the Gulf region through geographic and thematic programmes. The budget for geographic programmes for 2007 to 2013 is €10 billion, including a 20% benchmark to be spent on basic health and education. Importantly, the regulation that established the Development Co-operation Instrument identified addressing the AIDS pandemic as one of the key priorities of cooperation with these regions.18 The Development Co-operation Instrument’s thematic programme has several portfolios, including Investing in People. Besides health financing delivered through General Budget Support or Sectorial Budget Support for health, Investing in People represents the EC’s largest available health portfolio. There is a commitment that 55% of its €1 billion budget from 2007 to 2013 should be allocated to health.19

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The European Instrument for Democracy and Human Rights is designed to support civil society initiatives on human rights.20 The 2011–2013 budget is €1,104 billion and these funds are relevant for organisations founded by or working with groups that are often key to the epidemic, such as men who have sex with men, injecting drug users and sex workers. Global calls for proposals are launched from the EC. Funds are also decentralised to the EU delegations that request to be part of the Country-Based Support Scheme and issue local calls for proposals. Nevertheless there is a lack of technical coordination between Investing in People and the European Instrument for Democracy and Human Rights in Brussels and at country level. This means there is no specific joint programming focused on the right to health of marginalised communities. Further technical coordination between EC aid mechanisms should seek to build specific capacities for key populations to advocate for their right to health. Managers of the European Instrument for Democracy and Human Rights portfolio should work with their Investing in People counterparts to identify priority countries, to issue calls for proposals for civil society and LGBT community groups, and other vulnerable populations. When it comes to country dialogue for development cooperation, an EC official noted the EU is firm in following guidelines on aid effectiveness21 and the International Health Partnership which focus on country ownership22 and tries as much as possible not to ”fragment into too many different and specific issues as it puts too many requirements to the country”.23

‘We try to identify, through country dialogue, which kind of indicators we’re going to look at. We avoid imposing or enforcing a certain approach for them to access the grants. But we can influence at the policy level. The Delegations call for proposals to grantspecific activities… several (calls) have been able to support high risk populations or vulnerable groups regarding HIV and AIDS and their rights. At another level in these kinds of programmes we have, it’s about better access for vulnerable groups, better access to health services.’ Development and Cooperation-EuropeAid Directorate-General official, EC

This approach contradicts European Parliament24 calls for the EC to address impediments to placing “human rights at the centre of decisions on the allocation of funding for responses to HIV/AIDS within and outside the EU, in ensuring that future monitoring of progress in the fight against HIV/AIDS incorporates indicators that directly address and assess human-rights issues in relation to HIV/AIDS.” In line with its 2011 Political Declaration commitments and the European Parliament’s recommendations, the EC should ensure that both geographic and thematic funds include outcome indicators addressing the major economic, legal, social and technical barriers. These should also address the punitive laws and practices that impede effective responses to HIV, in particular for key populations, without fragmenting aid negotiations or overriding country ownership as enshrined in the Paris Declaration and International Health Partnership principles.

WE TRY TO IDENTIFY, THROUGH COUNTRY DIALOGUE, WHICH KIND OF INDICATORS WE’RE GOING TO LOOK AT. WE AVOID IMPOSING OR ENFORCING A CERTAIN APPROACH FOR THEM TO ACCESS THE GRANTS. BUT WE CAN INFLUENCE AT THE POLICY LEVEL. THE DELEGATIONS CALL FOR PROPOSALS TO GRANT-SPECIFIC ACTIVITIES… Development and Cooperation-EuropeAid Directorate-General official, EC

Outreach workers give medical advice and condoms to a female sex worker © Gideon Mendel for the Alliance

UKRAINE: a forgotten neighbour Ukraine has a concentrated HIV and AIDS epidemic, particularly affecting injecting drug users, sex workers and their partners. It has one of Europe’s fastest growing numbers of new HIV infections and a high burden of tuberculosis (TB) co-infection. The Ministry of Health, in an attempt to better coordinate AIDS and TB interventions, has created a joint service to address the two diseases. HIV services are financed by the Global Fund and are well aligned with national indicators, with a specific focus on prevention in most-at-risk populations. TB services, on the contrary, are not well aligned with national plans. Civil society is calling for a revised national strategy that integrates TB, HIV and drug treatment. A revised HIV law focuses on anti-discrimination, and protecting the rights of people who use drugs and the human rights of people living with HIV. However, there are numerous cases of the human rights of people who use drugs being violated. In January 2011, the International HIV/AIDS Alliance’s ‘What’s Preventing Prevention?’ campaign called on the Ukrainian government to stop state authorities from harassing and abusing hundreds of patients receiving drug substitution therapy and the non-governmental organisations that support programmes providing substitution therapy. The call came after the Ministry of Interior’s drug enforcement department ordered comprehensive inspections of harm reduction and HIV programmes.25 The EC is significantly constrained by a limited mandate and capacity on public health in relation to Ukraine. The EC delegation in Kiev has not had a health officer for over five years. As a result, the EC has not been involved in the Global Fund CCM or in the policy dialogue on health. In the EU National Indicative Programme 2011–2013 for Ukraine, there has been no priority given to health care reform in Ukraine. Although HIV prevention was part of the EU–Ukraine association agenda, little has been done to action the agreed interventions.

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A better coordination of EU support at country level There is no comprehensive overview on what is happening at country level for programmes managed by the EU delegations. This is despite the geographic scope of EC support being practically global, given relations with 79 ACP countries as well as the relations with 47 countries in three other regions under the Development Co-operation Instrument (DCI). The only review of the EC’s portfolio of country-level support targeted to most at risk populations for HIV transmission is related to Investing in People. Table 1 below provides the full overview of those projects from 1998 to 2011, showing a lack of prioritisation of support to most-at-risk populations within EC programming. Over 15 years, only eight such projects have been approved.

TABLE 1: Investing in People projects targeted to most-at-risk populations (1998-2011) India: Supporting the scale-up of HIV services for males-who-have-sex-with-males

€ 958,584

Madhya Pradesh, India: Health for All: Ensuring highly vulnerable groups benefit from actions addressing HIV/AIDS, TB and HIV/TB co-infection

€ 675,000

Tamil Nadu, India: Improving HIV prevention and care among young women, FSW and MSM.

€ 605,995

West Java, Indonesia: (Theme II) Prevention, Control and treatment of HIV/AIDS among intravenous drug users.

€ 2,978,260

Iran: Empowerment of Selected Tehran Vulnerable Women (Sex Workers).

€ 300,000

Kazakhstan: A model programme against the spread of HIV/AIDS and TB in women prisons.

€ 228,052

Kenya: (Theme II) A comprehensive approach to reaching those most at risk and affected by HIV/AIDS

€ 4,408,289

Mauritius: Improvement of treatment, care and support of most at risk populations through prevention, empowerment and advocacy activities

€ 169,850

INDIA: a mixed performance

The 2009 Progress Report on implementing the PfA 2007–2011 stated that EC delegations “engaged actively in policy dialogue on the situation and country responses to HIV/AIDS, malaria and tuberculosis with the vast majority of ACP (African, Caribbean and Pacific) partner countries, especially in the medium and high prevalence countries in sub-Saharan Africa and the Caribbean islands.” 27

India’s National AIDS Control Programme Strategy and Implementation Plan, NACP (Phase III, 2006–2011) focuses on prevention of new infections through “saturation of coverage of high risk groups with targeted interventions… as well as scaled up interventions in the general population.” The Plan notes that stigma and discrimination “faced by people living with HIV/AIDS and marginalised populations such as sex workers, MSM (men who have sex with men) and IDUs (injecting drug users) is one of the most seriousobstacles to an effective response to HIV/AIDS.” (NACP III, 2006-2011)

But looking more closely it has been observed: When it comes to human rights and HIV, in particular for vulnerable populations like LGBT or sex workers, the EU in Southern Africa tends not to be very active. It seems the topic is not considered as the most important when it comes to advocacy and high level policy dialogue. It is very, very hard to get them to buy in from high level officials in Delegations… to do something or to bring the issues to the table and to be set indicators around these groups. It doesn’t happen or it doesn’t happen very often. 28

‘EIDHR [European Instrument for Democracy and Human Rights] has a very small budget in comparison with health programmes, for example, but what we are doing is filling in all those gaps of things that other programmes cannot support. Our focus is on discrimination. We work very well to be fully complementary… and if our colleagues of other EU programmes, like Investing in People or others, see gaps and specifically on discriminatory attitudes then we can do something, then we react.’ Development and Cooperation-EuropeAid Directorate-General official, EC Reviewing the implementation of the European Instrument for Democracy and Human Rights 2007–2010 Activity Report, there is limited evidence of the benefits to organisations working with men who have sex with men, injecting drug users and sex workers, and no assessment of any positive health outcomes or improvements in quality of non-discriminatory health services. Generally, while the policy frameworks are rhetorically committed to addressing the underlying issues preventing prevention, the scope and negotiation of aid falls short of targeting these issues.

A legal response to this challenge has been outlined in a draft HIV and AIDS bill which, if passed, could improve legal protection for the rights of people living with HIV and AIDS. In 2009 the Delhi High Court overturned the criminalisation of consensual sex between men – a decision partly grounded in arguments around allowing greater access to HIV services among men who have sex with men.

EIDHR HAS A SMALL BUDGET. OUR FOCUS IS ON DISCRIMINATION. WE WORK VERY WELL TO BE FULLY COMPLEMENTARY. IF OTHER EU PROGRAMMES SEE GAPS, SPECIFICALLY ON DISCRIMINATORY ATTITUDES. WE CAN DO SOMETHING TO REACT.

The EC Delegation has been praised by civil society for ensuring constructive collaboration with civil society in policy dialogue on the Global Fund CCM. As a donor, the EC is funding advocacy and technical support for developing national sexual and reproductive health and rights strategies. But the incoherence among the mechanisms undermines the response. EC grants to the India HIV/AIDS Alliance (Alliance India) have allowed them to develop programmes providing onward funding to smaller grassroots Indian civil society organisations focused on improving sexual and reproductive health and rights, including focus on the HIV prevention needs of most-at-risk groups and young people. However, progress risks being jeopardised as the bilateral EU Free Trade Agreement with India is currently being negotiated and if uncontested, it would cause the Indian generic pharmaceutical medicines manufacturing sector to severely curtail production and export of essential medicines.26 If enacted, this would negatively impact pricing and availability of generic antiretroviral drugs for HIV treatment in India and many other developing countries reliant on India as the main source of affordable generic antiretroviral drugs.

Development and Cooperation-EuropeAid Directorate-General official, EC

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Conclusion Despite a very strong policy framework on human rights and HIV, the EU is lacking a coordinated strategy to honour its commitments, especially now the EU Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action, has come to an end. This reality risks further undermining the profile and impact of the EU AIDS response which will continue suffering from a lack of coordination, coherence and visibility. •

ENDNOTES

* 1

Schwartländer, B. et al. (2011), ‘Towards an improved investment approach for an effective response to HIV/AIDS’, Lancet 377: 2031–41.

‘Political Declaration on HIV and AIDS: Intensifying Our Efforts to Eliminate HIV and AIDS’ (United Nations General Assembly Resolution A/RES/65/277, 8 July 2011).

ibid.

Treaty of Lisbon amending the Treaty on European Union and the Treaty establishing the European Community, signed at Lisbon, 13 December 2007.

EU Role in Global Health 2010. European Parliament resolution on a rights-based approach to the EU’s response to HIV/AIDS, 2010.

To sustain the gains of the last decade in the global response to AIDS and meet the 2015 universal access targets, there is an urgent need for the European Union to commit to working with other like-minded donor and developing countries to bring an end to HIV-AIDS, by fully recognising the importance of the human rights aspect of the AIDS response and putting in place instruments which go beyond the mere strengthening of health systems.

•

The EU should develop an updated policy framework for its global HIV/ AIDS response that is fully aligned with the 2011 Political Declaration on AIDS and integrates the Investment Framework to guide the EU’s joint programming at country, regional and global level. In that regard, there is a need for the EC to increase funding for support for human rights-based HIV programming, including long-term investment to support the capacity development of non-governmental organisations to serve the needs of vulnerable and marginalised populations lacking access to health care. The needs of such organisations should be prioritised in funding allocations, especially in the ACP countries where challenges are the greatest.

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The Global Fund plays an essential role in providing human rights-based approaches to the HIV response. As the largest donor to the Global Fund, the EU should call for an emergency Replenishment Meeting and call for proposals in order to fill the Fund’s funding gap.

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Finally, the updated EU AIDS policy framework should propose concrete measures to increase policy coherence across the EU’s trade, external action, and development and human rights policies. The EU has an obligation to support the realisation of the right to health and to ensure that its trade engagement doesn’t undermine progress towards this right for people living with HIV and others in need of essential medicines across the developing world.

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With focused and aligned political, financial and technical engagement, the EU can play a vital role to bring an end to AIDS and ensure the achievement of the MDG 6 goal to halt and reverse the spread of HIV and provide universal access to HIV treatment for all those who need it, and the targets set in the Political Declaration of the High Level Meeting on HIV and AIDS.

The framework for the EU’s relations with 79 countries from Africa, the Caribbean and the Pacific.

Second Revision of the Cotonou Agreement 2010.

The African, Caribbean and Pacific countries, in particular.

ibid

‘A European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007-2011)’.

ibid

‘Council conclusions on Progress on the European Programme for Action to confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007–2011)’; ‘Combating HIV/AIDS in the European Union and neighbouring countries, 2009–2013’; ‘EU statement for World AIDS Day 2010’.

Schwartländer, B. et al. (2011), ‘Towards an improved investment approach for an effective response to HIV/AIDS’, Lancet 377: 2031–41.

Further policy commitments include the ‘Progress report on the implementation of the European Programme for Action to Confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007- 2011)’; ‘Council conclusions on Progress on the European Programme for Action to confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007-2011)’; ‘Combating HIV/AIDS in the European Union and neighbouring countries, 2009 -2013’; ‘EU statement for World AIDS Day 2010’ and; the revised Cotonou Agreement (signed in June 2010), which now includes an article on AIDS in the policy dialogue (31bis).

‘The EU Contribution to the Global Fund to fight AIDS, Tuberculosis and Malaria’, MEMO/10/470 Brussels, 4 October 2010. Available at: http://bit.ly/aCxmEk

Countdown 2015 Europe, ‘Funding for Reproductive Health Supplies: An Analysis of Official Development Assistance from European Donors’, September 2008.

Regulation 1905/2006 of the European Parliament and of the Council ’Establishing a financing instrument for development co-operation‘, 2006.

European Commission, ‘Investing in People: Strategy Paper for the Thematic Programme 2007–2013’.

90% of the beneficiaries are civil society organisations; 10% international organisations.

‘The Paris Declaration on Aid Effectiveness and the Accra Agenda for Action’. Available at: http://bit.ly/WsYG

The International Health Partnership and related initiatives (IHP+) seeks to achieve better health results by mobilizing donor countries and other development partners around a single country-led national health strategy, guided by the principles of the Paris Declaration on Aid Effectiveness and the Accra Agenda for Action.

Interview with official from the Development and Cooperation-EuropeAid Directorate General, EC, 28 October 2011.

Resolution on a rights-based approach to the EU’s response to HIV/AIDS

International HIV/AIDS Alliance in www.whatspreventingprevention.org

An analysis of the generic medicines and public health issues at stake in the EU India free trade area can be found at: http://bit.ly/eeEplc

‘Council conclusions on Progress on the European Programme for Action to confront HIV/AIDS, Malaria and Tuberculosis through External Action (2007-2011)’.

Interview with EC HIV Consultant, 31 October 2011.

Acknowledgements: This campaign brief was written and produced by Arben Fetai, Felicity Daly, Marielle Hart, Enrique Restoy and Felicia Wong. Photo credits: Front cover Audiovisual Library of the European Commission © European Union, 2011 Page 10 Outreach workers give medical advice and condoms to a female sex worker © Gideon Mendel for the Alliance For more information, contact: mail@aidsalliance.org

Produced for Stop AIDS Alliance by the International HIV/AIDS Alliance. Information contained in this publication may be freely reproduced, published or otherwise used for non-profit purposes without permission from the International HIV/AIDS Alliance. However, the International HIV/AIDS Alliance requests that it be cited as the source of the information. © International HIV/AIDS Alliance, 2011