United Nations: OutRight Action International's Oral Testimony

February 26, 2001, OutRight Action International presented a version of the following oral testimony at a plenary session of the first Informal Consultative Session for the UN General Assembly Special Session on HIV/AIDS. The testimony responded to UN Secretary-General Kofi Annan's recent report on HIV/AIDS. (Full text of the Secretary-General's report can be found at http://www.unaids.org/whatsnew/others/un_special/index.html.) Following OutRight Action International's presentation, the US delegate present interrupted the debate to rebuke OutRight Action International for its direct criticism of the US, and to ask the president of the Assembly to restrain NGOs from such direct criticism in future. OutRight Action International offers the text of its testimony, including its criticisms of the United States, so that civil society can arrive at its own judgments. 


The report of the Secretary-General raises many important issues which States must consider in the UNGASS process. Yet the final Declaration of Commitment must go further. Generalities must give way to specifics; convenient ambiguities must become clear calls to action. This paper was prepared by OutRight Action International. OutRight Action International's mission is to document and advocate against human rights abuses based on HIV status, sexual orientation, or gender identity. OutRight Action International cooperates with and supports the efforts of thousands of activists and organizations worldwide. This paper addresses two groups of issues on which the Secretary-General's report leaves gaps - gaps which the Declaration of Commitment must fill. These issues are: stigma and discrimination as they affect the HIV/AIDS pandemic; and access to treatment and care and their economic contexts.

I. Stigma and Discrimination

  1. Gender inequality both structures the spread of the epidemic worldwide, and distorts medical, social, and legal responses. The Secretary-General's report addresses gender only in marginal and insufficient ways, confining it to segregated sections. Conspicuously, the report fails completely to identify gender violence as a contributing factor to the pandemic. The final Declaration must view gender as a crucial factor throughout the HIV/AIDS pandemic:
    • The Declaration must call for integrating a gender perspective into all responses to the pandemic.
    • All recommended measures, whether aimed at prevention, treatment, or care, should be examined in terms of their differential impact according to gender.
    • Gender-disaggregated data should be produced in any evaluation of impacts.
  2. In this year of the World Conference against Racism, we must recognize the interconnection of forms of prejudice and discrimination. Existing hatreds in society contribute to the spread of AIDS, and complicate a response. The Declaration of Commitment must therefore identify groups and populations whom stigma renders particularly vulnerable to HIV/AIDS, including (but not restricted to) gay men, lesbians, bisexuals, transgender people, sex workers, prisoners, and IV drug users; it must call for measures to counteract discrimination, and must urge that vulnerable populations be integrated into all discussions of responses to the pandemic.
  3. The Declaration of Commitment must identify discrimination against people living with HIV/AIDS as a major concern. It is appalling, for instance, that the Secretary-General's report fails to condemn employment discrimination based on HIV/AIDS. The International Guidelines on HIV/AIDS and Human Rights should be integrated throughout the recommendations of the Declaration of Commitment. In particular, there should be renewed attention to Guideline 5, which calls on States to "enact or strengthen anti-discrimination and other protective laws that protect vulnerable groups, people living with HIV/AIDS and people with disabilities from discrimination in both the public and private sectors, that will ensure privacy and confidentiality and ethics in research involving human subjects, emphasize education and conciliation and provide for speedy and effective administrative and civil remedies." The UN should also show its own commitment to non-discrimination, by refusing in future to hold major meetings on HIV in countries which impose travel or immigration restrictions on people with AIDS.

II. Access to Treatment and Care and Their Economic Contexts

We commend the Secretary-General's report for stating (para. 101) that "We need to find ways of more effectively using trade policy provisions, such as compulsory licensing or parallel importation, to increase access to care." But the Declaration must go further, in acknowledging that current trade instruments are incommensurate with human rights standards. The report praises Brazil's "rights-based approach to care," which has used generic production to give affordable treatment to thousands. It recognizes Brazil's commitment to helping other countries in the global South do likewise. It is incomprehensible, then, that the report fails to condemn the US's attempts to impede Brazil's internationally applauded programs by a challenge before the World Trade Organization. The Declaration must call on the WTO to end its investigation into Brazil's intellectual property laws. Meantime, the report implies new promises by the pharmaceutical industry to deliver drugs to developing countries. This misstates the facts. Pharmaceutical companies' responses have been cosmetic, inadequate, and painfully slow. Drug donations and limited price reductions are stopgap solutions, which only reach a limited percentage of the population. The Declaration of Commitment must support generic competition in developing nations to reduce drug prices and thus increase the number of people who can be treated. People with AIDS need guarantees that treatment will be available for many years. Generics offer a sustainable supply of drugs which will continue after publicity has shifted away from AIDS in Africa. The Declaration must also support international assistance to developing countries in manufacturing, distributing, and procuring generic medications, and in building effective health care infrastructures. The Declaration of Commitment must clearly state that - in the words of the August 2000 resolution on "Intellectual Property and Human Rights" by the UN Sub-Commission on the Protection and Promotion of Human Rights - "human rights obligations" take primacy over "economic policies and agreements." As Dr. Peter Piot of UNAIDS has recently declared:

In the North, in return for innovation, intellectual property is protected and profits are made. This has benefited both Northern shareholders and society. But it doesn't work for the South, where 95 percent of the world's population of 36.1 million with HIV/AIDS lives.

The final Declaration must put preserving life before protecting patents. It must:

  • SUPPORT DEVELOPING COUNTRIES in using existing, legitimate means such as generic production, compulsory licensing, and parallel importing to provide affordable, quality care for their populations.
  • CONDEMN DEVELOPED COUNTRIES when they attempt to forestall those efforts.
  • CONDEMN PHARMACEUTICAL COMPANIES when they use litigation or other pressures to prevent countries from implementing the right to health.
  • MANDATE THE UN to explore ways of making transnational corporations accountable for human rights violations attributable to or abetted by their policies.
  • MANDATE THE UN and other intergovernmental agencies to assist developing countries in using existing legal mechanisms to protect the right to health. In particular:
    • The WHO should develop a database of affordable medications and their prices to assist countries in making market choices.
    • UNAIDS should explore and facilitate possibilities such as bulk purchasing of AIDS medication - already successfully practiced by UNICEF in the provision of childhood vaccines.
    • UNAIDS and other agencies should enter partnerships with the business sector only where they further the broader public interest, NOT narrow commercial interests.

Finally, the report praises the effects of debt-relief efforts in freeing funds for HIV prevention and care in developing countries. To recognize the effects is not enough, however; the Declaration of Commitment must address the causes. Debt payments and structural adjustment programs have devastated the ability of developing countries to care for their people's health. The Declaration of Commitment must call for debt cancellation and for an end to World Bank and IMF-sponsored "reforms" directed at privatizing and gutting health-care capabilities. Only by empowering the developing world to make its right to self-determination fully meaningful can an equitable global response to AIDS - and an equitable global order - be achieved.