-          Hello I am Silvia, I am HIV positive.  I was told you need somebody to interview tomorrow.

-          Yes thank you for calling me back. I need some background information.

-          Sure…

-          How did you catch HIV?

( long pause)

-          If I told you I got HIV from my husband, or if I told you I got HIV from injecting drugs, or that it was a one night stand, or maybe that I became HIV positive because my mum was positive… what difference would it make? I mean…  after 30 years…. we all know how HIV is transmitted, right?

The journalist moves on to the next few questions. Before hanging up she tells me she needs to speak to a producer and she will let me know  within next 20 minutes if I will be interviewed the following day.

Nobody called me back.

Networks of women living with HIV and their supporters, including the Global Fund,  have developed a letter to the leaders of the G8 which has been translated, in less than 24 hours in 8 languages (including Chinese, Japanese and Hindi !). The letter can be read and signed by anybody who supports us, individually or as an organization here is the link:

http://www.womeneurope.net/index.php/page/Global_Fund_Petition_to_G8/en

Lack of funds was a feature not only on the international field, but also of our local reality.  Positively UK is  struggling and every penny counts. So this year we decided we would try and go in tube stations to rattle our cans and ask passer byes for spare coins and the occasional note, in exchange for a red ribbon.

I was totally dreading it.

We had to start at 730 am, and no matter how much coffee I drink I am at my most unsociable at that time. Luckily we were  aided by some bubbly volunteers from Grey Goose Vodka. Not even the sight of my very cute volunteer put me in a good mood when I arrived at Euston Station just after 7. When I went to talk to the station manager my worst fears  seemed to become a reality:

-  ‘Morning… I am here for a charity collection, here is the authorization

- A yes,  yes….Just keep out of the way,  this station is very busy

-  OK, will do…

-  What are you collecting for anyway?  People have no money those  days, everybody is strapped up for cash…

- It is World AIDS Day, I am collecting to support People with HIV in the UK

- Well, nobody has definitely any money to give to THAT!

I just looked at the floor in anger.

So I went to stay at a corner while the Grey Goose cutie was at the other corner.

- World AIDS Day, World AIDS Day!

We shouted, while people walked by,  trying to avoid us, not to waste time in the rush hour. When the first woman stopped and said ‘Oh my God I nearly forgot!’ and gave us a few pounds I felt a knot in my throat. For the first 15 minutes I found it really hard  not to cry every time somebody stopped and gave me money.  But after about after half an hour I toughened up and  I was OK.  Euston is the station close to my yoga school,  where I go to practice every morning, so many of my friends from yoga passed by. From them I got money AND a hug.

We collected from 5 stations for only a couple of hours and we reached our target of £2000, which all considered is pretty good. So we will do it again next year. I am ok having had the experience, but I don’t think I am looking forward to doing it again!

With a little bit of research, and a few mouse clicks, I discovered that this expression has its roots in the Disability Rights Movement (DRM). It was the title of a famous book by the disability activist James Charlton. The author first heard it from South African activists from the DRM, who claimed it came from activists in Eastern Europe. So it originates at the geographical margin of the usual locations of power. It is important to remember that the DRM set out to redefine disability as a social construct. Those activists pointed out that people with disability only had impairments, and it was society which was creating ‘disability’ by generating and maintaining barriers. For example disability is created when a bus doesn’t have a system that allows wheelchair access. However, ‘disability’ is constructed by more the physical barriers. The lives of people with disabilities have been limited not just by the architecture of buildings or lack of braille for those who do not see or sign language for the deaf.  The rights of those of us living with disabilities have been also violated by attitudes an preconceptions, by patronizing approaches and institutionalization.

It all sounds very familiar, doesn’t it? Obviously there are many affinities between the disability movement and the movement of people living with HIV. Most of the barriers we face are not imposed by the virus or physical limitations but by society. The enormous advances of medical care mean that many of us have, from a narrow medical point of view, healthy lives. However society’s attitudes and prejudices towards HIV still prevent many of us to live our lives fully, or at the same standard as anybody else. To give some examples, in the past few months I have been in support group were young beautiful women were isolated and terrified to disclose their status to anybody, and hadn’t had a relationship in years. I met a mother who had her children separate cutlery and plates because of the fear of HIV. A few weeks ago a colleague who is also openly living with HIV and has often spoken publicly about stigma, had eggs thrown at her. This is still happening in the UK in 2011. The virus may be undetectable in our blood, but stigma is around us: often reinforced by other social factors, such as poverty, gender inequality and racism. Reclaiming our voice, reclaiming our visibility, is part of our struggle.

‘Nothing about us without us’ has recently moved from being the slogan of those at the margin, fighting against oppression, to being integrated in the mainstream and absorbed in the language of those in power. The current UK government used   ‘Nothing about me, without me’ as the mantra of their plans to restructure the NHS. This time they stressed the individual, ‘Me’ instead then ‘Us’. After much debate the NHS reform bill was passed in parliament. The includes much more localized health boards in which patients, including people with HIV, and other stakeholders, such as healthcare providers, and elected decision makers, will have a place to influence how health services are delivered. So far so good, it is difficult to argue about’ shared decision making’, and there is a wealth of evidence that shows that when ‘patients’ are involved in all decisions and planning of their health the outcomes are better. However it implies that there is a level playing field for all people who access health care. Sadly the reality is that we live in a very unequal world, and I am doubtful that people with HIV, and especially those who are poor and isolated, will be able to seat on those decision making bodies.

At the IAS conference in Rome last July, Louise Binder, an HIV positive woman and advocate from Canada said:’ At school I learnt that if A equals B and B equals C then A equals C. We keep hearing Knowledge is Power. And I know that Power equals Money, so therefore Knowledge equals Money” Luisa’s point was: how can we know our rights and be empowered, without investment? This year Positively UK ran out of financial support for two incredibly successful project s which increased positive women’s knowledge and power to affect decisions. The project ‘From Baby to Pregnancy and Beyond’ , headed by Angelina Namiba, which trained positive women to be mentor mothers, and PozFem UK, the UK network of women with HIV, which skilled up positive women to become advocates were halted by a lack of funds. We are still continuing to run them on voluntary basis, but it is not enough and the work cannot grow. To be effective we need meetings with training, transport, childcare. Without future funding of such projects it is very unlikely that voices of women, will be heard, and therefore decision about us will not be made with us but by those who already have the biggest share of power.

To conclude I would like to propose a slight change of focus in the NHS mantra , I think that as community advocates we should continue using its original form : Nothing about US without US ‘ . We need to recognise the importance of our collective voice and collective action since historically, it is collective action that has propelled change. Hopefully This this conference, will play an important role in creating a collective voice and collective action.

The hard questions we need to ask ourselves as advocates are about who the ‘Us’ in ‘Nothing about Us without Us “ is. We need to question our relationships with each other. Who are we as a community of people living with HIV in the UK? Whose interests do we represent? We are a very divers e group and this is our richness as well as our weakness. Questions of how we can better represent our diverse communities and also how we can be accountable also belong to us at the grassroots as much as to those at the top.

This article was written for Positively Women Magazine as a comment on the UK conference for People living with HIV that took place in London in September 2011.

The UN High Level Meeting on AIDS (HLM) took place in New York in June, to coincide with the 30^th anniversary of the recognition of AIDS. It was the third meeting of this kind; previously held in 2001 and 2006. This meeting is important because it establishes the commitment of the UN Member States to addressing the HIV epidemic. The political declarations released in 2001 and 2006 were instrumental in the introduction and scale-up of treatment and prevention across the most affected parts of the world.

As you can imagine, I was extremely excited to represent the Global Network of People Living with HIV (GNP+) at the HLM, and to speak at the closing plenary on the importance of involving people living with HIV in the response to the HIV epidemic. I profoundly believe that our meaningful involvement can make this response much more effective. However, during the HLM I started having serious doubts that an institution with so little female representation could devise a political declaration meaningful to women – nearly 52% of the 34 million people who live with HIV worldwide.

During the General Assembly, I watched one male government minister or high-level official after the other making solemn declarations on their commitment to HIV; often they came from countries where I knew women and other affected populations get very little legal or political protection. One of the lowest moments was the panel session on ‘Women and Girls’, where four out of five panellists were men. I was wondering whether they would ever have a session on men who have sex with men, mostly run by women?

In spite of the under-representation of women in the limelight, women had prepared for the HLM by carrying out a virtual consultation; Positively UK, the organisation where I work, co-ordinated its European arm. More than 800 women replied to a questionnaire, translated into nine languages and distributed in 95 countries, in just two weeks. This global consultation made clear the wishes of women in regard to HIV:

• Ensure comprehensive and inclusive HIV services that address the visions, life-long needs and rights of women and girls in all our diversity.
• Eliminate stigma and discrimination, and ensure full protection of the human rights of all women and girls, including our sexual and reproductive rights.
• Strengthen, invest in, and champion our leadership and equality to ensure the full and meaningful participation of women and girls, in particular those of us living with and affected by HIV, in the HIV response.
• Empower us to be catalysts of social justice and positive change, and eliminate all forms of violence against us.
• Ensure full access to information and education, including comprehensive sexuality education for all women and girls.

As you can see, women’s demands were not surprising or unreasonable.

What seems really shocking is that, firstly, our claims are still not being addressed, and secondly, that in 30 years of AIDS, this was the first global consultation among women supported by UNAIDS and carried out by a partnership of NGOs.

In many ways, the Political Declaration to come out of this HLM is a progressive one. Its most important victories are:

• A commitment to getting 15 million people on treatment by 2015 (80% of the 18 million people who will need it). This is new and a major victory.
• A call on governments to optimise the use of TRIPS (trade agreements) flexibilities to increase and sustain access to low-cost, generic medicines.
• A target to reduce transmission among people who inject drugs by 2015, including the use of opioid substitution therapy and needle exchange programmes.

But the declaration has several weaknesses, including:

• Only four paragraphs dedicated to women, with the only numeric targets relating to mother-to-child transmission and maternal health: women are only important as ‘baby makers’. Our health and prevention needs at all stages of our lives are ignored.
• Transgender people have not been identified as an at-risk population; funds for prevention, treatment and care for this group will still be difficult to obtain.
• Men who have sex with men, people who inject drugs, and sex workers are only referenced in relation to their HIV risks; their human rights are not affirmed in the document. Homophobia, transphobia, and discrimination against sex workers – factors significantly heightening HIV risk – are not mentioned.

I came back from New York sad and angry: there is still much work to do. I am still convinced that unless those of us directly affected by HIV are meaningfully involved, the epidemic will not recede. It is up to us to hold our governments accountable and to continue to demand that our human rights are upheld in policy and in action.

It has been exciting, emotional  and exhausting to be here.  I was diagnosed in Rome over 14 years ago.  At that time I was not given any referral to any positive women’s group or psychological support. The isolation and the lack of support I experienced lead to the worst two years of my life, completely locked in deep depression, shame and stigma.  It is difficult to describe the overwhelming feelings of getting back here as an openly HIV positive woman and as part of a global movement of women living with HIV.

Every time I spoke publicly, during the conference,  I introduced myself as an Italian woman with HIV who had been diagnosed here in Rome.  I felt it was an important political statement to make. I believe that being visible and vocal as a woman with HIV is a crucial strategy in order to have our rights to be treated with dignity and respect upheld.

During this week I  discovered that Italy has the largest number of women living with HIV in Europe: 48,000, to be precise. During the Town Hall meeting we organized, Rosaria Iardino, one of the leaders of the movement of people living with HIV in Italy, denounced  how women’s sexual and reproductive health and rights are still violated in my country of birth. Rosaria told us how women with HIV in Italy  are still often ‘strongly advised’ to have abortions. Just a couple of weeks ago, a young positive woman, in Sicily received a lot of pressure from her gynaecologist to end her pregnancy, because she is HIV positive. Thanks to the intervention of Network Persone Sieropositive (NPS) this young woman was informed of her rights, and legal action has been taken against the doctor.  She has now chosen she will have the baby. I know that  many women, especially if they are depressed and isolated,  will not have the initiative of reaching out to networks of people with HIV. This is why our visibility and voice is important, so that those women,  who are most isolated,  can be reached. This is why I almost say in in one breath, when I introduce myself: I am Silvia Petretti, I am an Italian  woman living with HIV.

Within this context, I was horrified at the opening ceremony when the line up of official speakers, a total of six, didn’t include a woman. I just couldn’t keep my mouth shut and I started screaming: ‘Where are the women? Dove sono le donne? 52% of those living with HIV are women! Why are we not on stage?”. I think a few people thought I was raving mad, but also a lot of people thought that it was about times somebody spoke up.

Thankfully the closing ceremony had a different tone with Alessandra Cerioli, the President of LILA, and Lella on stage giving a very strong speech, calling for the continuing funding of HIV research. During the speech Alessandra mentioned the work that the Women Networking Zone has done to bring 20 young positive women activists to the conference, and the crucial importance of promoting gender equity in the response to the HIV epidemic. Alessandra also asked for the Pope to bless the prevention revolution that was announced at this conference:  people with HIV who are  successfully on  treatment will not transmit HIV 96% of the time. This is a rate of protection greater than condoms, which are reported to be 85% effective. It means that we can finally say:  treatment is prevention! Please Pope Benedict give your blessings to us so that we can have the money to put it into practice!!!

The closing session had also another major highlight for me. This was Dr. Adaora A. Adimora from the  United States, who was the rapportuer on the prevention track in the conference. Dr Adaora summarized all the incredible scientific evidence presented  regarding prevention. Most Importantly Dr Adaora also included gender equity as a key structural intervention, alongside biomedical interventions, to end the HIV epidemic. It is exhilarating to have the scientific community finally aligned with what us, women living with HIV have been saying for a long time. It is truly a prevention revolution!

This IAS conference has finally shown that we have the tools to reverse the HIV epidemic,  now we need the money. To know more about the scientific evidence presented at IAS I recommend the NAM website

I,  Jane Anderson, and two people from BMS arrived at the meeting in North London,  in the very constituency of Margaret Thatcher.  I was wearing my most conservative suit, it was actually dark blue. I almost looked like a banker.

MEP:  Good morning I am ‘so and so’ , Member  of the European Parliament.

Me: Good Morning, I am Silvia Petretti  co-ordinator of PozFem, the national network of women with HIV in the UK, and also coördinator of WECARE the European network of positive women. I am myself HIV positive. I have lived with HIV for 14 years.

MEP: (eyes widening) You mean you have got ‘it‘ ??!!

Me: Yes I have lived with HIV for almost 15 years`

MEP: How did you get it, was it needles or sex…?

In spite of this awkward start, by the end of the meeting she agreed to  set up a Public Hearing on Women and AIDS  at the European Parliament in 2012.

You can find the webcast  here. The intervention of civil society is at the end of the 3 hours.

” I stand before you today as a woman living with HIV to affirm why our involvement is important. Those of us who are directly affected by HIV and all the key populations who are also made vulnerable to H-I-V  need  to be at the centre of the response to the HIV epidemic.

When I was invited to this High Level Meeting with the task of speaking on our involvement, I was so excited. I profoundly believe that our meaningful involvement can radically change and make much more effective,  our response to the HIV epidemic. However, when the draft declaration was released, some doubts started rising in my mind. Are you are truly listening to us, women living with HIV?

I applaud the declaration for the ambitious goal of putting 15 million people on ART by 2015. But I am concerned, after hearing every single woman with HIV in this meeting calling for our recognition as women in every stage of  our lives, that the only target set for women in the declaration has to do with ‘ Mother to Child Transmission’.  We don’t have value just as ‘baby makers’ we need to be acknowledged  and our rights to health must be promoted and upheld, in every stage of our lives. Whether we have children or not.

Moreover every single woman in this meeting talked of how Gender Based Violence is both the cause and the effect of HIV.  Therefore, in addition to the strong declaration to end violence against women, we also need concrete and specific numeric targets and investment in this area.  I am also deeply concerned by the absence of a target for key populations who are made most vulnerable to HIV, such as transgender people, as well as the disappearance of providing housing as a priority intervention. How can we be successfully being involved and work together to reverse  this epidemic when  essential rights, are not met?

I rest hopeful that by telling you today why is important to involve us and invest in us,  you will listen,  and together we will be able to instigate more actions,  which will make a real difference in women’s lives, my life, and in the lives of the whole community.

There are six clear reasons why our involvement makes sound and common sense.

Firstly our involvement makes sense for historical reasons. We follow the steps of the most powerful liberation struggles of the past 200 hundred years: the anti-slavery movement, the suffragettes, the civil-rights movement, the international labour movement,  the anti-colonization struggles in the Americas, Africa and Asia,  and, most recently, the anti-apartheid movement have all had at their core the most affected people. And they were all successful in creating a change that initially was viewed as unreasonable and unattainable. Our ancestors, fought to make the vision of dignity and freedom a reality.  And so do we.

My second reason is legal: as Member States of the United Nations you are bound by the declaration of human rights to uphold all our rights to participation, dignity, equality,  freedom from degrading treatment, freedom to have a family, freedom of access to information.  Sadly many of these rights are denied to us who live with H-I-V,  and others who are made most vulnerable to H-I-V, not only in less economically developed countries, but even in the so called developed Europe, where I was born. We need more then medications to live with dignity and safety, we need  your acknowledgment and solidarity and the support of everybody around us.

Thirdly our involvement makes political sense:  creating a solid alliance with civil society will make the response more powerful. It is better to work together, and have us on your side rather than against you.  We cannot afford to waste our energies struggling against each other. We are the ones who are living with HIV every day in our bodies, families and communities. We are the ones who can best advise on what knowledge or skills or powers or choices we should- have- had, which could have enabled us not to acquire HIV in the first place. Engage with us and Use our personal experience.

Fourth, it makes economic sense to work together: in the present times,  when  resources are limited,  we can provide a committed work force. I have been employed as an openly HIV positive support worker within a team of other positive employees for over 10 years and I know, because of my direct experience, that we will work harder than anybody else to lessen the impact of H-I-V on our communities. Of course we need to be valued and remunerated for our efforts. But it is not just a salary that motivates us: it is the future of our children, our families and those close to us. Moreover we all know that a vibrant community translates in economic growth.

Reason number five is awareness and   Education:  We need to continue  to increase the voice and visibility of us who live with H-I-V. This is the most powerful tool for ensuring that communities see real faces in this pandemic,  and it goes a long way in ending stigma.  When people realize that someone with HIV is just like you and me, they also realize that H-I-V can affect anybody and this plays an extraordinarily important role in our prevention efforts.

My last reason is around  health: and not just our own individual health but the health of the societies we live in. H-I-V has not just damaged our bodies it  has deepened existing wounds in our communities. Stigma and discrimination hurt and damage both who receive it and who  perpetuates it. This is why we all need to heal together. Of course when we are involved our own individual health improves:  we have better mental health and emotional  resilience; when we can be open about our status, adherence to medication improves, which means we can stay longer on cheaper treatments and we can keep the virus in our bodies undetectable. Being successfully on ART, according to recent scientific trials, means that we are up to 96% less likely to transmit HIV. The ultimate result of our improved health is that communities are healthier, with strong  committed citizens, working for broader health and policy, beyond HIV.  And as prejudices and lack of inclusion disappear, also as a result of our involvement, and acceptance, communication and social cohesion grow, we heal together. Together we create a world that is healthier,  for all.

Because of these six clearly inter-connected reasons: historical, legal, political, economic, educational, and  health, it is clear that it make so much sense to invest in civil society. Like two hands working together to turn a wheel, so together, hand in hand, we can achieve real solidarity, or, as it is called by my bothers and sisters in South Africa, UBUNTU. United we can achieve the social, economic and cultural transformation necessary to revers the HIV epidemic and succeed in our vision for global health.”

I have written this speech in collaboration with Alice Webourn  and with the support of Sophie Dilmitis at UNAIDS.

On the positive side the document commits to getting 15 million people on ARVs treatment by 2015. This represents 80% of the 18 million people who will need ARVS by 2015.  This time bound, numerical target is a major victory.  The 2006 declaration lacked numerical treatment targets. However we still lack gender specific targets for women and girls on treatment.

Also The document includes a target of reducing transmission among people who inject drugs by 2015. (para 63) It also recognizes the WHO/UNODC/UNAIDS Comprehensive Package of Interventions for HIV prevention, treatment and care for people who inject drugs that includes both opioid substitution therapy and needle and syringe programmes as part of comprehensive package.

This are just a couple of notes to highlight the positive side of the document. Civil society groups are preparing more extensive documents which will help us with our advocacy in the next few days.

Below is the compete declaration

Political Declaration on HIV and AIDS Intensifying Our Efforts to Eliminate HIV and AIDS

1. We, Heads of State and Government and representatives of States and Governments assembled at the United Nations from 8 to 10 June 2011 to review progress achieved in realizing the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS, with a view to guiding and intensifying the global response to HIV and AIDS by promoting continued political commitment and engagement of leaders in a comprehensive response at community, local, national, regional and international levels to halt and reverse the HIV epidemic and mitigate its impact;

2. Reaffirm the sovereign rights of Member States, as enshrined in the United Nations Charter, and the need for all countries to implement the commitments and pledges in this declaration consistent with national laws, national development priorities and international human rights;

3. Reaffirm the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS and the urgent need to scale up significantly our efforts towards the goal of universal access to comprehensive prevention programmes, treatment, care and support;

4. Recognize that, although HIV and AIDS are affecting every region of the world, each country’s epidemic is distinctive in terms of drivers, vulnerabilities, aggravating factors, and populations affected, and therefore the responses from both the international community and the countries themselves must be uniquely tailored to each particular situation taking into account the epidemiological and social context of each country concerned;

5. Acknowledge the significance of this meeting which marks three decades since the first report of AIDS; ten years since the adoption of the Declaration of Commitment on HIV/AIDS and its time-bound measurable goals and targets; and five years since the adoption of the Political Declaration on HIV/AIDS and its commitment to urgently scale up towards achieving the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010;

6. Reaffirm our commitment to the achievement of all the Millennium Development Goals, in particular MDG 6, and recognizing the importance of rapidly scaling up efforts to integrate HIV and AIDS prevention, treatment, care and support with efforts to achieve these goals, and in this regard welcome the outcome of the 2010 United Nations Summit on the Millennium Development Goals entitled “Keeping the promise: united to achieve the Millennium Development Goals”;

7. Recognize that HIV and AIDS constitute a global emergency and pose one of the most formidable challenges to the development, progress and stability of our respective societies and the world at large, and require an exceptional and comprehensive global response that takes into account that the spread of HIV is often a consequence and cause of poverty;

8. Note with deep concern that despite substantial progress over three decades since AIDS was first reported, the HIV epidemic remains an unprecedented human catastrophe inflicting immense suffering on countries, communities and families throughout the world; that more than 30 million people have died from AIDS, with another estimated 33 million people living with HIV; that more than 16 million children have been orphaned because of AIDS; that over

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7000 new HIV infections occur every day, mostly among people in low- and middle-income countries; and that less than half of people living with HIV are believed to be aware of their infection;

9. Reiterate with profound concern that Africa, in particular sub-Saharan Africa, remains the worst-affected region, and that urgent and exceptional action is required at all levels to curb the devastating effects of this epidemic, and recognize the renewed commitment by African governments and regional institutions to scale up their own HIV and AIDS responses;

10. Express deep concern that HIV and AIDS affect every region of the world, that the Caribbean continues to have the highest prevalence outside of sub-Saharan Africa while the number of new HIV infections is increasing in Eastern Europe and Central Asia, North Africa and the Middle East, and parts of Asia and the Pacific;

11. Welcome the leadership and commitment shown in every aspect of the HIV and AIDS response by governments, people living with HIV, political and community leaders, parliaments, regional and subregional organizations, communities, families, faith-based organizations, scientists and health professionals, donors, the philanthropic community, the workforce, the business sector, civil society and the media;

12. Welcome the exceptional efforts at national, regional and international levels to implement the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS and the important progress being achieved, including a more than 25 per cent reduction in the rate of new HIV infections in over 30 countries; the significant reduction in mother-to-child transmission of HIV; and the unprecedented expansion of access to HIV antiretroviral treatment to over 6 million people, resulting in the reduction of AIDS-related deaths by more than 20 per cent in the past five years;

13. Recognize that the worldwide commitment to the global HIV epidemic has been unprecedented since the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS, represented by an over eight-fold increase in funding from $1.8 billion in 2001 to $16 billion in 2010, the largest amount dedicated to combating a single disease in history;

14. Express deep concern that funding devoted to HIV and AIDS responses is still not commensurate with the magnitude of the epidemic either nationally or internationally, and that the global financial and economic crises continue to have a negative impact on the HIV and AIDS response at all levels, including the fact that for the first time, international assistance did not increase from 2008 – 2009 levels; and in this regard welcome the increased resources that are being made available as a result of the establishment of timetables by many developed countries to achieve the targets of 0.7 per cent of gross national product for official development assistance by 2015, stressing also the importance of complementary innovative sources of financing, in addition to traditional funding, including official development assistance to support national strategies, financing plans and multilateral efforts aimed at combating HIV and AIDS;

15. Stress the importance of international cooperation including the role of North-South, South- South and triangular cooperation in the global response to HIV and AIDS, bearing in mind that South-South cooperation is not a substitute for, but rather a complement to, North-South cooperation, and recognize the shared but differentiated responsibilities and respective

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capacities of governments, donor countries, as well as civil society, including the private sector, while noting that national ownership and leadership are absolutely indispensable in this regard;

16. Commend the Secretariat and the Co-sponsors of the Joint United Nations Programme on HIV/AIDS for their leadership role on HIV and AIDS policy and coordination, and for the support they provide to countries through the Joint Programme;

17. Commend the Global Fund to Fight AIDS, Tuberculosis and Malaria for the vital role it is playing in mobilizing and providing funding for national and regional HIV and AIDS responses, and improving the predictability of financing over the long-term, and welcome the commitment of over US$30 billion in funding from donors to date including the significant pledges made by donors at the 2010 Global Fund replenishment meeting; note with concern that while these pledges represented an increase in financing, they fell short of the amounts targeted by the Global Fund to further accelerate progress towards universal access; and recognize that to reach that goal it is imperative that the Global Fund’s work be supported and also that it be adequately funded;

18. Commend as well the work of UNITAID based on innovative financing and focusing on accessibility, quality and price-reduction of antiretroviral drugs;

19. Welcome the Secretary-General’s Global Strategy for Women’s and Children’s Health, undertaken by a broad coalition of partners, in support of national plans and strategies, in order to significantly reduce the number of maternal, newborn and under-five child deaths as a matter of immediate concern, including by scaling up a priority package of high-impact interventions and integrating efforts in sectors such as health, education, gender equality, water and sanitation, poverty reduction and nutrition;

20. Recognize that agrarian economies are heavily affected by HIV and AIDS which debilitate their communities and families with negative consequences for poverty eradication, and that people die prematurely from AIDS because, inter alia, poor nutrition exacerbates the impact of HIV on the immune system and compromises its ability to respond to opportunistic infections and diseases, and that HIV treatment, including antiretroviral treatment, should be complemented with adequate food and nutrition;

21. Remain deeply concerned that globally women and girls are still the most affected by the epidemic and that they bear a disproportionate share of the care-giving burden and that the ability of women and girls to protect themselves from HIV continues to be compromised by physiological factors, gender inequalities including unequal legal, economic and social status, insufficient access to healthcare and services, including for sexual and reproductive health and all forms of discrimination and violence, including sexual violence and exploitation against them;

22. Welcome the establishment of UN Women as a new stakeholder that can play an important role in global efforts to combat HIV by promoting gender equality and the empowerment of women, which are fundamental for reducing their vulnerability to HIV; and the appointment of its first Executive Director;

23. Welcome the adoption of the UN Convention on the Rights of Persons with Disabilities, and recognize the need to take into account the rights of persons with disabilities as set forth in

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that Convention, in particular with regard to health, education, accessibility and information, in the formulation of our global response to HIV and AIDS;

24. Note with appreciation the efforts of the Inter-Parliamentary Union in supporting national parliaments to ensure an enabling legal environment supportive of effective national responses to HIV and AIDS;

25. Express grave concern that young people aged 15 to 24 account for more than one third of all new HIV infections, with some 3000 young people becoming infected with HIV each day; note that most young people still have limited access to good quality education, decent employment, and recreational facilities, as well as limited access to sexual and reproductive health programmes that provide the information, skills, services and commodities they need to protect themselves; that only 34% of young people possess accurate knowledge of HIV; and that laws and policies in some instances exclude young people from accessing sexual healthcare and HIV-related services such as voluntary and confidential HIV-testing, counselling and age-appropriate sex and HIV prevention education; while also recognizing the importance of reducing risk taking behaviour and encouraging responsible sexual behaviour, including abstinence, fidelity and correct and consistent use of condoms;

26. Note with alarm the rise in the incidence of HIV among people who inject drugs and that despite continuing increased efforts by all relevant stakeholders, the drug problem continues to constitute a serious threat to, among others, public health and safety and the well-being of humanity, in particular children and young people and their families; and recognize that much more needs to be done to effectively combat the world drug problem;

27. Recall our commitment that prevention must be the cornerstone of the global HIV and AIDS response, but note that many national HIV prevention programmes and spending priorities do not adequately reflect this commitment; that HIV prevention spending is insufficient to mount a vigorous, effective, comprehensive global HIV prevention response; that national prevention programmes are often not sufficiently coordinated and evidence-based; and that prevention strategies do not adequately reflect infection patterns or sufficiently focus on populations at higher risk of HIV; and that only 33 per cent of countries have prevalence targets for young people and only 34 per cent have specific goals in place for condom programming;

28. Note with concern that national prevention strategies and programmes are often too generic in nature and do not adequately respond to infection patterns and the disease burden; for example, where heterosexual sex is the dominant mode of transmission, married or cohabitating individuals, including those in sero-discordant relationships, account for the majority of new infections but they are not sufficiently targeted with testing and prevention interventions;

29. Note that many national HIV prevention strategies inadequately focus on populations that epidemiological evidence shows are at higher risk, specifically men who have sex with men, people who inject drugs and sex workers, and further note however that each country should define the specific populations that are key to its epidemic and response, based on the epidemiological and national context;

30. Note with grave concern that despite the near elimination of mother-to-child transmission of HIV in high-income countries and the availability of low-cost interventions to prevent transmission, approximately 370 000 infants were estimated to have been infected with HIV in 2009;

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31. Note with concern that prevention, treatment, care and support programmes have been inadequately targeted or made accessible to persons with disabilities;

32. Recognize that access to safe, effective, affordable, good-quality medicines and commodities in the context of epidemics such as HIV are fundamental to the full realization of the right of everyone to enjoy the highest attainable standard of physical and mental health;

33. Express grave concern that the majority of low- and middle-income countries did not meet their universal access to HIV treatment targets despite the major achievement of expansion in providing access to antiretroviral treatment to over 6 million people living with HIV in low- and middle-income countries; that there are at least 10 million people living with HIV who are medically-eligible to start antiretroviral treatment now; that discontinued treatment is a threat to treatment efficacy; and that the sustainability of providing life-long HIV treatment is threatened by factors such as poverty, lack of access to treatment and insufficient and unpredictable funding; and by the number of new HIV infections outpacing the number of people starting HIV treatment by a factor of two to one;

34. Recognize the pivotal role of research in underpinning progress in HIV prevention, treatment, care and support and welcome the extraordinary advances in scientific knowledge about HIV and its prevention and treatment; but note with concern that most new treatments are not available or accessible in low- and middle-income countries and even in developed countries there are often significant delays in accessing new HIV treatments for people not responding to currently available treatment; and affirm the importance of social and operational research in improving our understanding of factors which influence the epidemic and actions which address it;

35. Recognize the critical importance of affordable medicines, including generics in scaling up access to affordable HIV treatment; and further recognize that intellectual property rights protection and enforcement measures should be TRIPS compliant and should be interpreted and implemented in a manner supportive of Member States’ right to protect public health and, in particular, to promote access to medicines for all;

36. Note with concern that regulations, policies and practices, including those that limit legitimate trade of generic medicines, may seriously limit access to affordable HIV treatment and other pharmaceutical products in low- and middle-income countries and recognize that improvements can be made, inter alia, through national legislation, regulatory policy and supply chain management; noting that reductions in barriers to affordable products could be explored in order to expand access to affordable and good quality HIV prevention products, diagnostics, medicine and treatment commodities for HIV including for opportunistic infections and co-infections;

37. Recognize that there are additional means to reverse the global epidemic and avert millions of HIV infections and AIDS-related deaths, and in this context we recognize that there is new and potential scientific evidence available that could contribute to the effectiveness and scaling up of prevention, treatment, care and support programmes;

38. Reaffirm the commitment to fulfil obligations to promote universal respect for and the observance and protection of all human rights and fundamental freedoms for all in accordance with the Charter, the Universal Declaration of Human Rights and other instruments relating to

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human rights and international law; emphasize the importance of cultural, ethical and religious values, the vital role of the family and the community and in particular people living with and affected by HIV, including their families, and the need to take into account the particularities of each country, in sustaining national HIV and AIDS responses, reaching all people living with HIV, delivering HIV prevention, treatment, care and support, and strengthening health systems in particular primary healthcare;

39. Reaffirm that the full realization 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 recognize that addressing stigma and discrimination against people living with, presumed to be living with or affected by HIV, including their families, is also a critical element in combating the global HIV epidemic; and recognize the need, as appropriate, to strengthen national policies and legislation to address such stigma and discrimination;

40. Recognize that close co-operation with people living with HIV and populations at higher risk of HIV infection will facilitate the achievement of a more effective HIV and AIDS response, and emphasize that people living with and affected by HIV, including their families, should enjoy equal participation in social, economic and cultural activities, without prejudice and discrimination, and that they have equal access to healthcare and community support as all members of the community;

41. Recognize that the access to sexual and reproductive health has been and continues to be essential to HIV and AIDS responses, and that governments have the responsibility to provide for public health, with special attention to families, women and children;

42. Recognize the importance of strengthening health systems, in particular primary healthcare and the need to integrate the HIV and AIDS response into it, and note that weak health systems, which already face many challenges including lack of trained and retention of skilled health workers, are among the biggest barriers to access HIV and AIDS-related services;

43. Reaffirm the central role of the family, bearing in mind that in different cultural, social and political systems various forms of the family exist, in reducing vulnerability to HIV, inter alia, in educating and guiding children and take account of cultural, religious and ethical factors, to reduce the vulnerability of children and young people by ensuring access of both girls and boys to primary and secondary education, including HIV and AIDS in curricula for adolescents; ensuring safe and secure environments especially for young girls; expanding good-quality youth-friendly information and sexual health education and counselling services; strengthening reproductive and sexual health programmes; and involving families and young people in planning, implementing and evaluating HIV and AIDS prevention and care programmes, to the extent possible;

44. Recognize the role that community organizations play, including those run by people living with HIV, in sustaining national and local HIV and AIDS responses, reaching all people living with HIV, delivering prevention, treatment, care and support related-services and strengthening health systems, in particular the primary healthcare approach;

45. Acknowledge that the current trajectory of costs of HIV programmes is not sustainable and that programmes must become more cost-effective, evidence-based and deliver better value-for-

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money and that poorly coordinated and transaction-heavy responses and lack of proper governance and financial accountability impede progress;

46. Note with concern that evidence-based responses, which must be informed by incidence and prevalence disaggregated data, including by age, sex, and mode of transmission, continue to require stronger measuring tools, data management systems, and improved monitoring and evaluation capacity at the national and regional levels;

47. Note the relevant UNAIDS and WHO strategies on HIV and AIDS;

48. Recognize that the deadlines for achieving key targets and goals set out in the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS have now expired, while noting with deep concern that many countries have been unable to fulfil their pledges to achieve them, and stress the urgent need to recommit to those targets and goals, and commit to new, ambitious and achievable targets and goals building on the impressive advances of the past ten years and addressing barriers to progress and new challenges through a revitalized and enduring HIV and AIDS response;

49. Therefore, we solemnly declare our commitment to end the epidemic with renewed political will and strong, accountable leadership and to work in meaningful partnership with all stakeholders at all levels to implement bold and decisive actions as follows, taking into account the diverse situations and circumstances in different countries and regions throughout the world:

Leadership – Uniting to End the HIV Epidemic

50. Commit to seize this turning point in the HIV epidemic and through decisive, inclusive and accountable leadership to revitalize and intensify the comprehensive global HIV and AIDS response by recommitting to the commitments made in the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS and by fully implementing the commitments, goals and targets contained in this Declaration;

51. Commit 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, with a view to achieving Millennium Development Goal 6, in particular to halt and begin to reverse by 2015 the spread of HIV;

52. Reaffirm our determination to achieve all the Millennium Development Goals, in particular MDG 6, and recognize the importance of rapidly scaling up efforts to integrate HIV prevention, treatment, care and support with efforts to achieve these goals;

53. Pledge to eliminate gender inequalities, gender-based abuse and violence; increase the capacity of women and adolescent girls to protect themselves from the risk of HIV infection, principally through the provision of health care and services, including, inter alia, sexual and reproductive health, and the provision of full access to comprehensive information and education; ensure that women can exercise their right to have control over, and decide freely and responsibly on, matters related to their sexuality in order to increase their ability to protect themselves from HIV infection, including their sexual and reproductive health, free of coercion, discrimination and violence; and take all necessary measures to create an enabling environment for the empowerment of women and strengthen their economic independence;

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and in this context, reiterate the importance of the role of men and boys in achieving gender equality;

54. Commit by 2012 to update and implement, through inclusive, country-led and transparent processes, multi-sectoral national HIV and AIDS strategies and plans, including financing plans, which include time bound goals to be reached in a targeted, equitable and sustained manner to accelerate efforts to achieve universal access to HIV prevention, treatment, care and support by 2015; and address unacceptably low prevention and treatment coverage;

55. Commit to increase national ownership of HIV and AIDS responses while calling on the United Nations system, donor countries, the Global Fund to Fight AIDS, TB and Malaria, the business sector and other international and regional organizations, to support Member States in ensuring that nationally driven, credible, costed, evidence-based, inclusive and comprehensive national HIV and AIDS strategic plans are, by 2013, funded and implemented with transparency, accountability, and effectiveness in line with national priorities;

56. Commit to encouraging and supporting the active involvement and leadership of young people, including those living with HIV, in the fight against the epidemic at local, national and global levels; and agree to work with these new leaders to help develop specific measures to engage young people about HIV, including in communities, families, schools, tertiary institutions, recreation centres and workplaces;

57. Commit to continue engaging people living with and affected by HIV in decision making, planning, implementing and evaluating the response and to partner with local leaders and civil society, including community-based organizations, to develop and scale up community-led HIV services and to address stigma and discrimination;

Prevention – Expand Coverage, Diversify Approaches and Intensify Efforts to End New HIV Infections

58. Reaffirm that prevention of HIV must be the cornerstone of national, regional and international responses to the HIV epidemic;

59. Commit to redouble HIV prevention efforts by taking all measures to implement comprehensive, evidence-based prevention approaches, taking into account local circumstances, ethics and cultural values, including through but not limited to:

a) conducting public awareness campaigns as well as targeted HIV education to raise public awareness about HIV;

b) harnessing the energy of young people in helping to lead global HIV awareness;

c) reducing risk taking behaviour and encouraging responsible sexual behaviour including abstinence, fidelity and consistent and correct use of condoms;

d) expanding access to essential commodities, particularly male and female condoms and sterile injecting equipment;

e) ensuring that all people, particularly young people, have the means to exploit the potential of new modes of connection and communication;

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f) significantly expanding and promoting voluntary and confidential HIV testing and counselling and provider-initiated HIV testing and counselling;

g) intensifying national testing promotion campaigns for HIV and other sexually transmitted infections;

h) give consideration, as appropriate, to implementing and expanding risk and harm reduction programmes, taking into account the “WHO/UNODC/UNAIDS Technical Guide for Countries to set targets for universal access to HIV prevention, treatment, care for injecting drug users” in accordance with national legislation;

i) promoting medical male circumcision where HIV prevalence is high and male circumcision rates low;

j) sensitizing and encouraging the active engagement of men and boys in promoting gender equality;

k) facilitating access to sexual and reproductive healthcare services;

l) ensuring that women of child-bearing age have access to HIV prevention-related services and that pregnant women have access to antenatal care, information, counselling and other HIV services and to increasing the availability of and access to effective treatment to women living with HIV and infants;

m) strengthening evidence-based health sector prevention interventions including in rural and hard to reach places; and

n) deploying new biomedical interventions as soon as they are validated, including female-initiated prevention methods such as microbicides; HIV treatment prophylaxis; earlier treatment as prevention; and an HIV vaccine;

60. Commit to ensure that financial resources for prevention are targeted to evidence-based prevention measures that reflect the specific nature of each country’s epidemic by focusing on geographic locations, social networks and populations vulnerable to HIV infection, according to the extent to which they account for new infections in each setting, in order to ensure that resources for HIV prevention are spent as cost-effectively as possible; and ensuring particular attention is paid to women and girls, young people, orphans and vulnerable children, migrants and people affected by humanitarian emergencies, prisoners, indigenous people and people with disabilities, depending on local circumstances;

61. Commit to ensure that national prevention strategies comprehensively target populations at higher risk; ensure that systems of data collection and analysis about these populations are strengthened; and take measures to ensure that HIV services, including voluntary and confidential HIV testing and counselling, are accessible to these populations so that they are encouraged to access HIV prevention, treatment, care and support;

62. Commit to working towards reducing sexual transmission of HIV by 50 per cent by 2015;

63. Commit to working towards reducing transmission of HIV among people who inject drugs by 50 per cent by 2015;

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64. Commit to working towards the elimination of mother-to-child transmission of HIV by 2015 and substantially reducing AIDS-related maternal deaths;

Treatment, Care and Support – Eliminating AIDS-related Illness and Death 65. Pledge to intensify efforts that will help increase the life expectancy and quality of life of all

people living with HIV;

66. Commit to accelerate efforts to achieve the goal of universal access to antiretroviral treatment for those eligible based on WHO HIV treatment guidelines that indicate timely initiation of quality assured treatment for its maximum benefit, with the target of working towards 15 million people living with HIV on antiretroviral treatment by 2015;

67. Commit to support the reduction of unit costs and improve HIV treatment delivery including through, inter alia, provision of good quality, affordable, effective, less toxic and simplified treatment regimens that avert drug resistance; simple, affordable diagnostics at point-of-care; cost reductions for all major elements of treatment delivery; mobilization and capacity building of communities to support treatment scale-up and patient retention; programmes which support improved treatment adherence; directing particular efforts towards hard-to- reach populations far from physical healthcare facilities and programmes and those in informal settlement settings and other locations where healthcare facilities are inadequate; and recognizing the supplementary prevention benefits from treatment alongside other prevention efforts;

68. Commit to develop and implement strategies to improve infant HIV diagnosis, including through access to diagnostics at point-of-care; significantly increase and improve access to treatment for children and adolescents living with HIV, including access to prophylaxis and treatments for opportunistic infections, as well as increased support to children and adolescents through increased financial, social and moral support for their parents, families and legal guardians and promote a smooth transition from paediatric to young adult treatment and related support and services;

69. Commit to promote services that integrate prevention, treatment and care of co-occurring conditions including tuberculosis and hepatitis; improve access to quality, affordable primary healthcare, comprehensive care and support services including those which address physical, spiritual, psychosocial, socio-economic, and legal aspects of living with HIV; and palliative care services;

70. Commit to take immediate action on the national and global levels to integrate food and nutritional support into programmes directed to people affected by HIV, in order to ensure access to sufficient, safe and nutritious food to enable people to meet their dietary needs and food preferences, for an active and healthy life as part of a comprehensive response to HIV and AIDS;

71. Commit to remove before 2015, where feasible, obstacles which limit the capacity of low- and middle-income countries to provide affordable and effective HIV prevention and treatment products, diagnostics, medicines and commodities and other pharmaceutical products as well as treatment for opportunistic infections and co-infections, and to reduce costs associated with

life-long chronic care, including by amending national laws and regulations, as deemed 10

appropriate by respective governments, to optimize:

(a) The use, to the full, of existing flexibilities under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement specifically geared to promoting access to and trade of medicines; and, while recognizing the importance of the intellectual property rights regime in contributing towards a more effective AIDS response, ensure that intellectual property rights provisions in trade agreements do not undermine these existing flexibilities, as confirmed by the Doha Declaration on TRIPS Agreement and Public Health, and call for early acceptance of the amendment to Article 31 of the TRIPS Agreement, as adopted by the General Council of the World Trade Organization in its decision of 6 December 2005;

(b) addressing barriers, regulations, policies and practices that prevent access to affordable HIV treatment by promoting generic competition in order to help reduce costs associated with life-long chronic care; and by encouraging all states to apply measures and procedures for enforcing Intellectual Property Rights in such a manner as to avoid creating barriers to the legitimate trade of medicines, and to provide for safeguards against the abuse of such measures and procedures; and

(c) encouraging the voluntary use, where appropriate, of new mechanisms such as partnerships, tiered pricing, open-source sharing of patents and patent pools benefitting all developing countries, including through entities such as the Medicines Patent Pool, to help reduce treatment costs and encourage development of new HIV treatment formulations, including HIV medicines and point-of-care diagnostics, in particular for children;

72. Urge relevant international organizations, upon request and in accordance with the organizations’ respective mandates, such as where appropriate, the World Intellectual Property Organization, the United Nations Industrial Development Organization, the United Nations Development Programme, the United Nations Conference on Trade and Development, the World Trade Organization and the World Health Organization, to provide national governments of developing countries with technical and capacity-building assistance for those governments’ efforts to increase access to HIV medicines and treatment, in accordance with national strategies of each government, consistent with, and including through the use of, existing flexibilities under the Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement, as confirmed by the Doha Declaration on TRIPS Agreement and Public Health;

73. Commit by 2015 to address factors that limit treatment uptake and contribute to treatment stock-outs, drug production and delivery delays; inadequate storage of medicines, patient drop- out, including inadequate and inaccessible transportation to clinical sites; lack of accessibility of information, resources and sites, especially to persons with disabilities; sub-optimal management of treatment-related side effects; poor adherence to treatment; out-of-pocket expenses for non-drug components of treatment; loss of income associated with clinic attendance; and inadequate human resources for healthcare;

74. Call on pharmaceutical companies to take measures to ensure timely production and delivery of affordable, good quality and effective antiretroviral medicines in order to contribute to maintaining an efficient national system of distribution of these medicines;

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75.

76.

Expand efforts to combat tuberculosis, which is a leading cause of death among people living with HIV, by improving TB screening, TB prevention, access to diagnosis and treatment of TB and drug-resistant TB and access to antiretroviral therapy, through more integrated delivery of HIV and TB services in line with the Global Plan to Stop TB: 2011-2015; and commit by 2015 to work towards reducing TB deaths in people living with HIV by 50 per cent;

Commit to reduce the high rates of HIV and hepatitis B and C co-infection by developing as soon as practicable an estimate of the global treatment need, increasing efforts towards the development of a vaccination for hepatitis C and rapidly expanding access to appropriate vaccination for hepatitis B and diagnostics and treatment of HIV and hepatitis co-infections;

Advancing Human Rights to Reduce Stigma, Discrimination and Violence related to HIV

77.

78.

79. 80.

81.

82.

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, healthcare, 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;

Commit to review, as appropriate, laws and policies which adversely impact on the successful, effective and equitable delivery of HIV prevention, treatment, care and support programmes to people living with and affected by HIV and consider their review in accordance with relevant national review frameworks and timeframes;

Encourage Member States to consider identifying and reviewing, in order to eliminate, any remaining HIV-related restrictions on entry, stay and residence;

Commit to national HIV and AIDS strategies that promote and protect human rights, including programmes aimed at eliminating stigma and discrimination against people living with and affected by HIV, including their families, including through sensitizing police and judges, training health care workers in non-discrimination, confidentiality and informed consent, supporting national human rights learning campaigns, legal literacy, and legal services, as well as monitoring the impact of the legal environment on HIV prevention, treatment, care and support;

Commit to ensuring that national responses to HIV and AIDS meet the specific needs of women and girls, including those living with and affected by HIV, across their lifespan through strengthening legal, policy, administrative and other measures for the promotion and protection of women’s full enjoyment of all human rights and the reduction of their vulnerability to HIV through the elimination of all forms of discrimination, as well as all types of sexual exploitation of women, girls and boys, including for commercial reasons, and all forms of violence against women and girls, including harmful traditional and customary practices, abuse, rape and other forms of sexual violence, battering and trafficking in women and girls;

Commit to strengthen national social and child protection systems, and care and support programmes for children, in particular for the girl child, and adolescents affected by and vulnerable to HIV, as well as their families and caregivers, including through the provision of

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equal opportunities to support the development to full potential of orphans and other children affected by and living with HIV, especially through equal education access, the creation of safe and non-discriminatory learning environments, supportive legal systems and protections including civil registration systems, and provision of comprehensive information and support to children and their families and caregivers, especially age-appropriate HIV information to assist children living with HIV as they transition through adolescence, consistent with their evolving capacities;

83. Commit to promoting laws and policies that ensure the full realization of all human rights and fundamental freedoms for young people, particularly those living with HIV and those at higher risk of HIV infection in order to eliminate the stigma and discrimination they face;

84. Commit to address, according to national legislation, the vulnerabilities to HIV experienced by migrant and mobile populations and support their access to HIV prevention, treatment, care and support;

85. Commit to mitigate the impact of the epidemic on workers, their families, their dependants, workplaces and economies, including by taking into account all relevant ILO conventions, as well as the guidance provided by the relevant ILO recommendations, including ILO Recommendation No 200, and call on employers, trade and labour unions, employees and volunteers to eliminate stigma and discrimination, protect human rights and facilitate access to HIV prevention, treatment, care and support;

Resources for the AIDS response

86. Commit to working towards closing the global HIV and AIDS resource gap by 2015, currently estimated by UNAIDS to be US$6 billion annually, through greater strategic investments, continued domestic and international funding to enable countries to access predictable and sustainable financial resources, sources of innovative financing and by ensuring that funding flows through country finance systems, where appropriate and available, and is aligned with accountable and sustainable national HIV and AIDS and development strategies that maximize synergies and deliver sustainable programmes that are evidence-based and implemented with transparency, accountability and effectiveness;

87. Commit to breaking the upward trajectory of costs through the efficient utilisation of resources, addressing barriers to the legal trade of generics and other low-cost medicines, improving the efficiency of prevention by targeting interventions to deliver more efficient, innovative and sustainable programmes for the HIV and AIDS response in accordance with national development plans and priorities, and ensuring that synergies are exploited between the HIV and AIDS response and efforts to achieve the internationally agreed development goals, including the Millennium Development Goals;

88. Commit by 2015, through a series of incremental steps and through our shared responsibility, to reach a significant level of annual global expenditure on HIV and AIDS, while recognizing that the overall target estimated by UNAIDS is between US$22 and US$24 billion in low- and middle- income countries, by increasing national ownership of HIV and AIDS responses through greater allocations from national resources and traditional sources of funding including official development assistance;

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89. Strongly urge those developed countries which have pledged to achieve the target of 0.7 per cent of gross national product for official development assistance by 2015, and urge those developed countries that have not yet done so, to take additional concrete efforts in this regard to fulfil their commitments;

90. Strongly urge African countries which adopted the Abuja Declaration to take concrete measures to meet the target of allocating at least 15% of their annual budget to the improvement of the health sector, in accordance with the Abuja Declaration and Framework for Action;

91. Commit to enhance the quality of aid by strengthening national ownership, alignment, harmonization, predictability, mutual accountability and transparency, and results-orientation.

92. Commit to supporting and strengthening existing financial mechanisms, including the Global Fund as well as relevant United Nations organizations, through the provision of funds in a sustained and predictable manner, in particular to those countries with low- and middle- income with high disease burden and/or a large number of people living with and affected by HIV;

93. Recommit to fully implementing the enhanced Heavily Indebted Poor Country (HIPC) Initiative and agree to cancel all eligible bilateral official debts of qualified HIPC countries, who reach the completion point under the initiative, in particular countries most affected by HIV and AIDS, and urge the use of debt service savings, inter alia, to finance poverty eradication programmes, particularly for prevention, treatment, care and support for HIV and AIDS and other infections;

94. Commit to scaling up new, voluntary and additional innovative financing mechanisms to help address the shortfall of resources available for the global HIV and AIDS response and to improve the financing of the HIV and AIDS response over the long term; and commit to accelerating efforts to identify innovative financing mechanisms that will generate additional financial resources for HIV and AIDS, to complement national budgetary allocations and official development assistance;

95. Appreciate that the Global Fund to Fight AIDS, Tuberculosis and Malaria is a pivotal mechanism for achieving universal access to prevention, treatment, care and support by 2015; recognize the Global Fund’s reform programme; and encourage Member States, the business community, including foundations, and philanthropists to provide the highest level of support for the Global Fund, taking into account the funding targets to be identified at the 2012 mid- term review of the Global Fund replenishment process;

Health Systems Strengthening and Integrating HIV and AIDS with Broader Health and Development

96. Commit to redouble efforts to strengthen health systems, including primary health care, particularly in developing countries, through measures such as allocating national and international resources; appropriate decentralization of HIV and AIDS programmes to improve access for communities, including rural and hard-to-reach populations; integration of HIV and AIDS programmes into primary health care, sexual and reproductive healthcare services and specialized infectious disease services; improving planning for institutional, infrastructure and human resource needs; improving supply chain management within health systems; increasing

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human resource capacity for the response including by scaling up the training and retention of human resources for health policy and planning, health care personnel, consistent with the WHO voluntary “Global Code of Practice on the International Recruitment of Health Personnel”, community health workers and peer educators; and with support from and in partnership with international, regional organizations, the business sector and civil society, as appropriate;

97. Support and encourage, through domestic and international funding and the provision of technical assistance, the substantial development of human capital, development of national and international research infrastructures, laboratory capacity, improved surveillance systems, data collection, processing and dissemination; training basic and clinical researchers, social scientists and technicians, with a focus on those countries most affected by HIV and/or experiencing or at risk of a rapid expansion of the epidemic;

98. Commit by 2015 to working with partners to direct resources to and strengthen the advocacy, policy and programmatic links between HIV and TB responses, primary health care services, sexual and reproductive health, maternal and child health, hepatitis B and C, drug dependence, non-communicable diseases and overall health systems; leverage healthcare services to prevent mother-to-child transmission of HIV; strengthen interface between HIV services, related sexual and reproductive healthcare and services, and other health services, including maternal and child health; eliminate parallel systems for HIV-related services and information where feasible; and strengthen linkages among national and global efforts concerned with human and national development, including poverty eradication, preventative health, enhanced nutrition, access to safe and clean drinking water, sanitation, education and the improvement of livelihoods;

99. Commit to supporting all national, regional and global efforts to achieve the Millennium Development Goals, including those undertaken through North-South, South-South and triangular cooperation, to improve comprehensive and integrated HIV prevention, treatment, care and support programmes, as well as TB, sexual and reproductive health, malaria, maternal and child health care;

Research and development – the key to preventing, treating and curing HIV

100. Committoinvestinginacceleratedbasicresearchonthedevelopmentofsustainableand affordable HIV and TB diagnostics and treatments for HIV and its associated co-infections, microbicides and other new prevention technologies, including female-controlled prevention methods, rapid diagnostic and monitoring technologies, as well as biomedical, operations, social, cultural and behavioural and traditional medicine research, and continue to build national research capacity, especially in developing countries, through increased funding and public-private partnerships, and create a conducive environment for research and ensure that it is based on the highest ethical and scientific standards, and strengthening national regulatory authorities;

101. Committoaccelerateresearchanddevelopmentforasafe,affordable,effectiveandaccessible vaccine and for a cure for HIV, while ensuring that sustainable systems for vaccine procurement and equitable distribution are also developed;

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Coordination, Monitoring and Accountability – Maximising the Response

102. Committohavingeffectiveevidence-basedoperational,monitoringandevaluation,andmutual accountability mechanisms between all stakeholders to support multi-sectoral national strategic plans for HIV and AIDS to fulfil the commitments in this Declaration, with the active involvement of people living with, affected by and vulnerable to HIV, and other relevant civil society and private sector stakeholders;

103. Committorevisebytheendof2012therecommendedframeworkofcoreindicatorsthat reflect the commitments made in the present Declaration and to develop additional measures, where necessary, to strengthen national, regional and global coordination and monitoring mechanisms of HIV and AIDS responses through inclusive and transparent processes with the full involvement of member states and other relevant stakeholders, with the support of the Joint United Nations Programme on HIV/AIDS;

Follow up – Sustaining progress

104. Encourageandsupporttheexchangeamongcountriesandregionsofinformation,research, evidence and experiences related to implementing the measures and commitments related to the global HIV and AIDS response and in particular those contained in this Declaration; facilitate intensified North-South, South-South and triangular cooperation as well as regional, subregional and interregional cooperation and coordination; and in this regard, continue to encourage the United Nations Economic and Social Council to request the regional commissions, within their respective mandates and resources to support periodic, inclusive reviews of national efforts and progress made in their respective regions to combat HIV;

105. RequesttheSecretary-GeneraloftheUnitedNationstoprovideanannualreporttotheGeneral Assembly on progress achieved in realizing the commitments made in this Declaration; and, with support from Joint United Nations Programme on HIV/AIDS, report progress to the General Assembly in accordance with global reporting on Millennium Development Goals at the 2013 Millennium Development Goals special event and subsequent Millennium Development Goals reviews.

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The negotiations are  done by blocks of countries. For example the African countries form a block, and US an Europe another, Latin America another etc.

At the moment the major problems seem to happen in three areas:

Setting targets: for example number of women on treatment, amount of money invested etc. US and EU are trying to keep those as vague as possible so that they do not need to make any financial commitments. For example Civil Society is asking for an 80% reduction of AIDS related maternal death, while the US/EU block is pushing for a ‘Substantial Reduction’. But if there are not numbers involved what does ‘Substantial Reduction’  really mean?

Language:  This is also really important. Language is made of our values and can really influence  our actions. Civil Society is really fighting to have a Human Rights based language. On rights based language US/EU are really good,  while the African block is really pushing for using ‘Traditional values/family values’ and other conservative and potentially oppressive to women approaches. And there are many African women here who are very unhappy about this here. Especially women living with HIV.

Trade: The low price of ART are influenced by trading agreements.  Big economic interests are at stake. We need elastic trading agreements so that generic drugs can continue being produced at affordable prices. However there are strong attempts to restrict trading agreements regarding production and distribution of ARTs.

Going back to language an area that is really important to women is obviously maternal and children health. As women living with HIV we are pushing for the  right language in this area. We want the declaration to use  ’preventing vertical transmission’ instead that ‘preventing mother to child transmission’.So you may ask : but why? Everybody understands what preventing mother to child transmission is, vertical transmission is obscure. The reasons why Vertical transmission is preferable have been articulated by the civil society as follows:

- Vertical transmission has been chosen by people living with HIV globally as the preferred term because it is the neutral technical medical term and it takes the potential emotional blame which is still widely attached to women out of the title.

- PMTCT is often cited as under ‘gender’ or ‘women-centred’ programmes. However, if limited to preventing transmission to the foetus/baby it is not necessarily a gender or women-sensitive approach at all, and may actually put positive women’s long-term health at risk. Using the language of vertical transmission separates out the transmission piece from the longer term care, treatment and support for HIV positive mothers – which often isn’t in practice included in ‘PMTCT programmes’.

- Mother to child vilifies the mother, placing the burden of blame on her. It places blame even in situations wherein treatment and care were observed by the mother, however were unsuccessful in preventing a positive birth.

- It is absolutely essential that all possible is done not to make women feel to blame, since there is clear evidence from South Africa and elsewhere that pregnant women are avoiding ante-natal care, for fear of the HIV test (which is administered as a mandatory test in many places) being negative and for fear of the negative treatment they will receive as a consequence. This means that MDGs 4 and 5 are being undermined, as well as 6 (and 3).

- Prevention of mother to child makes the assertion of choice on the part of the mother (even in settings where treatment or prevention programs are not widely available)

- Full positive engagement of women in their babies’ care is crucial to the child’s survival and healthy start in life (Gerhardt S 2004). Therefore everything must be done at all costs to bring the baby’s mother on board in a positive and supportive way, to fulfil her rights to motherhood as safely for herself and her baby as possible.

- Vertical transmission was the term used at the 2011 High Level Consultation on the Sexual and Reproductive Health of Women Living with HIV, held in the context of the Commission on the Status of Women.

- UNAIDS Strategy uses the language of “vertical transmission”, including the following goal: “Vertical transmission of HIV eliminated and AIDS-related maternal mortality reduced by half.”

- The UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance also uses the language of “vertical transmission”

Well I hope this update is useful, and that I didn’t make any gross mistakes in the reporting.