11 Oct 2017
Laurel Sprague’s powerful statement at the inaugural meeting of the Global HIV Prevention Coalition
Remarks delivered by Laurel Sprague, Executive Director of the Global Network of People Living with HIV (GNP+) on October 10, 2017 at the inaugural meeting of the Global HIV Prevention Coalition in Geneva, Switzerland. The coalition is chaired by the Executive Directors of UNAIDS and UNFPA and brings together United Nations Member States, civil society, international organizations and other partners as part of efforts to reduce new HIV infections by 75% by 2020.
Excellencies and honourable ministers, UN family, NGO partners, and dear community partners and fellow people living with HIV, thank you for the opportunity to speak to you today about HIV prevention on behalf of GNP+ and people living with HIV.
Without diminishing too much the multiple complexities that people face in the world, I believe we all can acknowledge that life without HIV is less challenging for people, families, communities, and countries than life with HIV.
An important role that people living with HIV play in HIV prevention is that we can say two important messages very clearly. The first is that if you test positive for HIV, you will be okay. The second message is that HIV is for life and life is easier – much easier – without HIV.
For those who test positive, there is a further message. It is this: You will need to learn about and INSIST on good HIV treatment and a life with dignity, no matter how people treat you, how sick you feel, or how much social prejudices make you want to hide – but you can find a community and support. Everything that you need to survive exists in this world.
These two messages – you will be okay but it is better without HIV – are too often seen as contradictory, but they are not. Too often HIV prevention messages are designed to scare people about HIV and they do so by demonizing those who have HIV. This doesn’t work. The more that people fear the outcome of an HIV test, whether for medical reasons or because of social prejudice, the easier it is to push it from their minds. Let’s work together make it safe to talk about HIV, test for HIV, and have HIV, all of which makes it safer and easier to not have HIV.
People living with HIV have always been central to HIV prevention efforts. Our communities – lead by key populations – created HIV prevention. Prevention brought us together to organize around health for our communities – based on the love we have for each other.
People with HIV continue to lead the work to change the laws and abuses that leave us vulnerable and to promote the good things that both prevent new infections and keep people with HIV alive: housing, economic stability, jobs, education – and the collective social, economic, and political empowerment of girls and women and marginalized groups – which Michel and Natalia just spoke of eloquently.
Yet too often people living with HIV are excluded from prevention conversations as prevention failures. I would like to challenge anyone who has thought of people with HIV as failures of prevention to take a moment and re-imagine us — as your partners, as people with the most prevention knowledge.
The majority of new HIV infections come from people who do not know their HIV status, so we need to recognize the tremendous role already being played by people living with HIV. We know what prevention means in intimate spaces, vulnerable spaces, spaces where we need to hide, as well as in family spaces – spaces far beyond slogans and banners.
In fact, since 2011, GNP+ and PLHIV networks worldwide have promoted the Positive Health, Dignity, and Prevention Framework which provides a comprehensive rights-based approach to HIV prevention, treatment, care and support. Among other rights, this framework affirms that:
HIV prevention demands that we commit to the right to bodily integrity and respect for autonomy for all people – and especially for those you might see as different or other than you, or simply as young as in the case for girls.
From people living with HIV, what do we need to do to really commit to prevention?
1) Stop blaming individuals for having HIV. Too often we presume that people are bad rather than that the context in which they live is bad or that the laws are bad. HIV is a collective concern that needs to be addressed collectively and with attention to the social and economic forces that put some people at much greater risk for HIV, as well as other struggles for health and wellbeing.
2) Examine economic priorities that limit States’ ability to ensure the right to prevention, as a key component of the right to health.
3) Put funding for prevention in the hands of communities, who have a huge impact and who are best positioned to do the work but are never resourced properly.
When we talk about economic barriers, we need to address three key issues:
1) Affordability of medicines. States need to be supported to stand against the unjust intellectual property regimes that make treatment so costly that prevention funding is strangled.
2) Costs of incarceration. We must end criminalization of sex workers, people who use drugs, LGBT people, and PLHIV, and guarantee real access to justice to women in all of our diversity. Not only can the resources be diverted from jails to health care, this allows us to be partners with you, rather than being forced to do our work to save our communities in fear, in the shadows.
3) Effectiveness of economic stability for HIV prevention. Commit to maintain existing prevention activities that work: condoms, harm reduction for people who use drugs, psychosocial support, economic support. We know what works: housing, education, employment, non-judgmental health care, economic stability. They are all reflected in the commitments governments have made in the SDGs.
I invite you to imagine a world of meaningful gender equality, in which we’ve closed the gap between the richest and poorest, and ensured an adequate income and health care for all – this is a world where HIV can no longer thrive.
If we want to prevent HIV prevention in our communities and countries, than we need to say that what matters is that we create social norms that promote a culture of care and support for all. We don’t have to agree. But we do need to support people’s dignity and ability to survive this often hard world that we are all together in.
The Global HIV Prevention Coalition is in no way a statement that people without HIV have more value or deserve more attention and support than people with HIV. This Coalition is not intended to divert resources from treatment and care for people living with HIV. Instead, this Coalition is here to recognize that we all matter, we all are worth saving. That means doing the hard work to ensure that people living with HIV are able to stay healthy, alive, and free from soul-crushing prejudice and discrimination AND the hard work to make sure that everyone who is not HIV-positive has the support and resources they need to remain HIV negative, no matter their place or community…no matter how politically marginalized, none of us is dispensable.
Let me conclude by thanking UNAIDS and UNFPA and co-chairs for leading this work on HIV prevention and reaffirming that GNP+, representing people living with HIV, is committed to the global HIV prevention coalition being established.