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Targets and Accountability

Both states and civil society advocates at the High Level Meeting called for quantitative targets to be included in the Political Declaration.  Proposals by civil society included a “10 by 10” goal of treating 10 million persons by 2010.⁶⁰  The African Common Position paper endorsed by the fifty-three member states of the African Union suggested a goal of treatment and prevention for 80% of those that need it.⁶¹  Some African countries, notably South Africa and Gabon, abandoned these numerical goals despite having agreed to such goals in a preparatory meeting in Abuja.⁶² The U.S. as well lobbied aggressively against quantitative goals for treatment or funding.⁶³  Ultimately, no new, specific, numerical goals made it into the Political Declaration. 

Nonetheless, the Political Declaration does reference some existing and proposed targets.  For example, Paragraph 18 relates the “goal of achieving universal access to reproductive health by 2015, as set out at the International Conference on Population and Development” to other development goals, such as the Millennium Development Goals. Importantly, paragraph 49 requires the setting up of “ambitious national targets” in 2006, “including interim targets for 2008 in accordance with the core indicators recommended by the Joint United Nations Programme on HIV/AIDS.”⁶⁴ Paragraph 20 calls for work “towards achieving the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010.” 

The goal of universal access reflects the principle of non-discrimination enshrined in U.N. human rights documents as well as pragmatically recognizing what is ultimately required to stopping the spread of HIV.  While recent efforts to expand treatment access may have saved 250,000 to 350,000 lives in 2005⁶⁵, more can be done.  More than five million people who need life-saving antiretroviral treatment did not receive them in 2005. Comprehensive prevention programs are not addressing the people who need them most, including youth, men who have sex with men, injecting drug users, and sex workers.⁶⁶  For example, only 9 percent of men who have sex with men “received any type of HIV prevention service in 2005.”⁶⁷

However, setting specific targets, rather then referencing broad aspirations to work “towards” universal access provide an important benchmark that advocates and governments can use as a mechanism for accountability in monitoring progressively realized rights. While the current set of core indicators recommended by UNAIDS for national AIDS programs are specific and measurable, they do not address the fundamental rights abuses that fuel the epidemic, nor track progress towards improving human rights protections.  For example, national reporting on key indicators has not been sufficiently sex disaggregated and contains nothing about gender-based violence.⁶⁸

The task for civil society, then, is to build upon the Political Declaration’s general targets and to focus attention on those necessary goals that current indicators do not address.  This paper raises many of the fundamental human rights that must be protected if the fight against HIV is to succeed.  By focusing on a set of strategies, civil society can look ahead and use the Political Declaration as a springboard for a comprehensive human rights approach.