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Шанс исправить подход к борьбе со СПИДом

3 августа, 2008 - В данной статье от редактора, опубликованной в начале августа, влиятельная ежедневная газета Guardian утверждает, что чтобы улучшить профилактику ВИЧ/СПИДа организации должны отказаться от демонизирования секс работников и потребителей наркотиков, как на этом настаивает Джордж Буш.  Далее

3 августа, 2008 - В данной статье от редактора, опубликованной в начале августа, влиятельная ежедневная газета Guardian утверждает, что чтобы улучшить профилактику ВИЧ/СПИДа организации должны отказаться от демонизирования секс работников и потребителей наркотиков, как на этом настаивает Джордж Буш. 


With President Bush's term coming to a close and a search underway for a new chief for the UNAids secretariat, the 15,000 experts and activists gathered in Mexico City for the 17th International Aids Conference can begin to repair the deadly damage inflicted by the Bush administration's reactionary take on HIV prevention and the UN's culpable failure to challenge it.

Since 2001, the Bush administration has poured billions of US government dollars into preaching abstinence to young people, maligning the efficacy of condoms, denying key HIV prevention services to drug users and eradicating sex work - the last, bizarrely, elevated to an explicit goal of US foreign policy. The net result today is that HIV prevention is in tatters in many countries, including in the US itself.

In 2007, 2.5m people contracted HIV, bringing the global total of people living with HIV to over 33m. HIV prevention services reach less than one in 10 injection drug users and men who have sex with men, globally, and less than one in five sex workers - even though these disenfranchised populations have some of the highest HIV infection rates and are crucial to stemming the epidemic's spread. The demonising of sex workers and drug users has intensified, with raids, imprisonment and punitive laws on the upsurge in country after country, rich and poor alike. US-funded abstinence-only programmes have derailed comprehensive approaches to HIV prevention in several sub-Saharan African countries, as well as fuelled persecution of gay men, sex workers and even people living with HIV.

Just as perniciously, through financial blandishments and outright bullying, the Bush administration has sabotaged the UNAids secretariat's commitment to providing rigorous guidance on any issue contested by it. (UNAids is a joint-agency effort that has coordinated the UN's response to Aids since 1996. Its 10 co-sponsors include the World Health Organisation and the World Bank.) The UNAids secretariat's now-outgoing executive director, Belgian virologist Peter Piot, blundered hugely in not combating the reactionary Bush agenda on HIV prevention when it first emerged. Consequently, global policy-making on HIV prevention has regressed at precisely the time when rigorous guidance could have made the billions now available for anti-Aids programmes work effectively.

To its great credit, in its early years of operation, UNAids successfully integrated human rights and public health imperatives, as well as on-the-ground evidence of what works best, in framing policies and guidance on HIV prevention. It developed a remarkable body of guidelines for legislators and other policy-makers about protecting the rights of the disenfranchised populations that are very vulnerable to HIV. It put together a wealth of evidence showing the value of Aids programmes and policies that put the last first – that engaged with and respected some of society's most marginalised persons as agents of change and HIV prevention. It pronounced as "best practice" those path-breaking programmes that recognised the power of sex workers to educate their clients and the public, and the effectiveness of drug users as counsellors and outreach workers in HIV prevention efforts.

Tragically, in the face of the Bush administration's assault, UNAids has disavowed much of this admirable legacy. The disavowal is particularly marked on sex work and injection drug use, the two areas singled out by the Bush administration. Thus, UNAids' longstanding policy guidance that sex work should be decriminalised, sex workers mobilised and health and workplace conditions regulated, as a central HIV prevention strategy, contrasts starkly with a UNAids guidance note on sex work released last year (pdf), seeming to have been dictated by the White House. The guidance note focused on "rescue" and "rehabilitation" of sex workers – an approach that UNAids had criticised in the past as being harmful to HIV prevention – rather than on supporting sex workers. The guidance note did not even refer to UNAids' earlier recommendations on sex work, let alone explain the reversal of policy.

It may bode well for a new era of more courageous UN leadership against Aids that the Commission on Aids in Asia, a group of distinguished experts convened by but independent of UNAids, released a report in March that breaks with both the Bush and the current UNAids lines. The HIV epidemic in Asia, the commission noted, affects mostly sex workers and their clients, drug users and men who have sex with men. The epidemic is stopped in its tracks, then, by ensuring that those persons have access to all the HIV prevention and treatment services that 25 years of experience have shown to be effective. But providing those services is nearly impossible to people whose most pressing worries are escaping police repression and overcoming social exclusion.

So with clarity and boldness that has been completely lacking from UNAids for many years now, the commission recommends decriminalisation of sex work as being essential to HIV prevention. It calls for reshaping policy on illicit drugs so that public health services for people with addictions are more important than criminal prosecution. And it enjoins Asian nations to repeal sodomy laws, to respect the rights of men who have sex with men, and to empower them to be part of HIV programmes and policy-making. The case for such legal and policy reform is so strong that UN secretary-general Ban Ki-moon himself explicitly endorsed the commission's call for decriminalising sex work, same-sex relations and "harm reduction" for injection drug users.

A strong and human-rights-based UNAids response is vital to ensuring that millions more people do not die as a result of preventable HIV infections. If the delegates to the Mexico Aids conference want to see HIV prevention efforts get back on track, they must insist that the next leader of the UNAids secretariat be someone who has the nerve to resolutely stand up to political pressures - and to always put the needs and legitimate demands of the last firs

Source: Guardian, UK