This blog draws on my experience as a human rights activist in Colombia and following my exile. I present some areas that I think are important for future research and LGBT activism in Colombia.  These include some reflections specific to Lesbian women in Colombia. There is a section for comments at the end of the page which I look forward to reading!

The Colombian context for LGBT activism

In Colombia, a country with serious human rights problems, there is a clear gap between official rhetoric and the legal framework and reality.  As a consequence impunity levels are high. Other discontinuities exist too. For instance there are a number of widely recognised gay writers, who are able to participate in public debate and adopt critical positions on the armed conflict and the state responsibility. But Colombia ranks very high in the statistics for the number of transgender women killed because of transphobia.

Tracing the emergence of LGBT activism (how much progress has there actually been?)

Things have moved very fast in the last 10 years. For example 56 pro-LGBT regulations and laws have been published during the period, 3 major cities in Colombia now have LGBT policies, and all the major political parties have LGBT policies. However, the tendencies of the movement in Colombia, or how coherent it is, are still not clear.

The LGBT community only began to organise recently, in 2001, with the creation of Planeta Paz. The term LGBT was adopted  from the international movement because it was clear a name was needed  that would help identify them as populations working on identity and on sexual and gender diversity, but the learning curve has been steep as they have sought to catch up with other traditional and new social  movements such as the trade union movement,  civil and political human rights activists, indigenous groups, and even women’s rights groups that preceded them in playing a key role in terms of human rights, (armed) conflict resolution and justice.

The LGBT contribution to human rights in Colombia.

As in other places, the LGBT movement has a clear contribution to make in terms of identity: this is an interest that is common to each one of the four or more populations that integrate the LGBT movement.  In this they have built on and extended the contribution of other new social movements such as the indigenous and black movements.  Like the women’s movement they have helped demonstrate how gender and sexuality are key factors in institutions that are central to society (the family, the church, school) and therefore a key area for negotiation between the state and civil society.

Of particular importance to the Colombian context is the fact that gender and sexuality dynamics are linked to the roots of the armed conflict. Further research into these aspects will therefore eventually contribute to thinking on how to progress in the human rights agenda and peace building.

The ways in which gender and sexuality can be linked to the conflict in Colombia, are well illustrated in Sanchez Baute’s latest novel  Libranos del Bien (Sanchez-Baute 2008). Sanchez Baute is the most prominent openly gay author in Colombia.  He tries to explain the conflict from the perspective of a specific region (the Caribbean), and from his experience as a gay person in Colombia. I end this section by presenting  quoting explains the LGBT Agenda for the Peace Process, produced by the LGBT Sector of Planeta Paz (quoted by Jose Fernando Serrano-Amaya). The statement reflects discussion  about whether or not LGBT people have a special approach to peace building:

“‘Body, the first territory for peace’ is the name of a political agenda that is still in the process of being written by the Sector. This agenda briefly states what is considered to be particular about this approach. Instead of claiming that LGBT are citizens that experience the same conflict as other Colombians, the agenda highlights that there are several types of violence that affect LGBT people in particular but that are not recognised as being important in comparison with other kinds of violence stemming from the violent conflict. They argue that since discrimination, homophobia, and hate crimes mainly target the body it has to be the starting point for any peace proposal.”

Lesbian human rights activism, how far we can go with visibility?

Hate crime and intolerance, added to the fact that there are high levels of impunity, suggest that lesbians should seek to raise their profile in the regions is not the solution. We have seen that increasing visibility seems to have increased levels of attacks against other LGBT members.  Does the increasing visibility of the LGBT movement fit the narrative presented above about the evolution of general or LGBT human rights discourse? It is clear that in the LGBT movement, with a few exceptions, gay men tend to be more visible than lesbians.  This lack of lesbian leadership is more extreme in the regions.  Asked about this, one of the most prominent LGBT leaders in the Caribbean region of Colombia confirmed that leaders tend to be gay middle class men who are not native to the region.  He also said that lesbians seem not to be interested in taking on leadership roles, usually because they frequently remain in the closet but also because they have felt that their invisibility (“lesbians do not exist”) has allowed them to maintain their lesbianism relatively unaffected by violence. It is certainly my experience of violence against women that heterosexual women are permanently at risk; it seems lesbians do not wish to expose themselves to even more violence by coming out. How, then, might we promote a role for lesbians as human rights activists in regions where their security cannot be guaranteed?  On the other hand, there is a lack of research on violence against lesbians. Reports focus principally on violence against gay men, sex workers and transgender women, who tend to be more exposed to “external” violence. But very little is known about the levels of violence against lesbians committed by their relatives and members of their close communities. Research in other countries has shown that lesbians tend to be more vulnerable to attack than heterosexual women in these scenarios.

A methodology that might help to improve our understanding of the situation of the lesbian movement in Colombia

Millie Thayer’s article, “Identity, Revolution and Democracy in Lesbian Movements in Central America: the Costa Rican and Nicaraguan Cases” illustrates very well the particularities and differences marking two countries from the same region, reminding us that all the countries in the region are different. Thayer also uses some of the methodologies proposed by new social movement writers, concluding that social movements are built, and collective identities constructed, by particular people in particular locations at particular moments of history and that the reasons for this can be found by looking beyond global structural shift or formal political institutions.

Observing the case of Costa Rica and Nicaragua I would argue that Colombia might be seen as a hybrid of both:  a country with a strong history of human rights activism and conflict but also a country desperate to become, and be seen as, modern.

Lesbian groups and the HIV response

In the specific topic of LGBT and HIV I want also to add here what I think about the contribution to the HIV response made by lesbian groups and some women’s groups.

One important area relevant to the issue of lesbians as human rights activists is how to integrate with other movements and how this work might be recognised. Women’s human rights activists have supported LGBT rights and a large number of lesbian women in Latin America and the Caribbean have worked on HIV/AIDS. This is not because AIDS is an issue for lesbian women as such, but more as an expression of LGBT solidarity towards gay men and more recently towards Transgender women (the group most affected by HIV in the region).

There is still not enough recognition of what the lesbian and women’s movements and lesbian solidarity have contributed and might contribute  to the future of other members of the LGBT community and to those who are affected by a lack of sexual and diversity rights, including those working on HIV/AIDS.

I hope you have enjoyed reading this blog and I look forward to reading any comments you may have!

This blog was first presented as a paper at the International conference on LESBIAN LIVES ‘Masquerades’(17th- 18th February 2012), University College Dublin (UCD John Hume Institute for Global Irish Studies).  You can download the full paper as a PDF here, which contains a bibliography.

I would like to start this blog by sharing with you the paper I presented at the International conference on LESBIAN LIVES ‘Masquerades’(17th- 18th February 2012), University College Dublin (UCD John Hume Institute for Global Irish Studies).  (It is important to clarify that I was not representing the Alliance at the conference). You can download the full paper as a PDF here, which contains a bibliography.

I hope you have enjoyed reading this blog and I look forward to reading any comments you may have!

I have lived with the complexity of human rights activism in Colombia for the last 30 years. This paper is an attempt to understand and explain how the human rights movement has developed in Colombia (a country that has suffered more than 50 years of internal armed conflict). Rather than explaining the human rights situation in Colombia I want to focus on my experience as a human rights activist exiled in the UK, on the process of coming out as a lesbian, first in the UK and eventually in Colombia, and on the circles I have moved in as an activist. Finally, in the second part of this blog I explore a set of questions that will form a part of my PhD research.

The journey begins

My journey started in Colombia in the 1980s when I worked with poor children in a shanty town outside Bogota while attending a secondary school run by progressive nuns influenced by Liberation Theology. I wrote the dissertation for my law degree (on human rights in Colombia) while working with the country’s first firm dedicated to the defence of human rights– which produced the information that formed the basis of Amnesty International’s pioneering reports on the country.  Later, in 1988, I headed up the Human Rights and International Relations Office of the newly-formed left wing party the Union Patriotica (UP).  The UP was initially formed in 1985 as the political expression of the guerrilla movement the Revolutionary Armed Forces of Colombia (FARC) during peace negotiations with the government. It was  later joined by human rights activists – such as me – and by other left wing activists.

My initial involvement with human rights and left wing activism focused almost exclusively on Civil and Political Rights at a time when Economic, Social and Cultural Rights – including Women’s and Sexual and Reproductive rights – were barely on the human rights agenda. My dissertation had mentioned Economic, Social and Cultural Rights but lacked any women’s rights or gender analysis (my comrades and I used to say that we could work on women’s rights after the revolution).

This focus of human rights activists during the 1980s on civil and political rights was a ‘classic’ response to repression that was primarily carried out by the state. But as the conflict developed and its economic and social aspects became clearer, Economic, Social and Cultural Rights had to be included.  Parallel to this, the indigenous and black movements were growing stronger, a fact recognised in the 1991 Constitution, which introduced the cultural and identity rights that eventually became a door to introduce LGBT or gender identity and sexual diversity rights in Colombia.  The 1991 Constitution is, therefore, a landmark in terms of the recognition, consolidation (and institutionalisation) of New Social Movements in Colombia – that have increasingly influenced the human rights agenda in the country over the last 20 years.

A political exile: coming to the UK

In 1989 I had to leave the country because of my work with the UP (more than 1,000 of whose leaders were killed between 1985 and 1989).  Before leaving the country I had experienced domestic violence at the hands of my then left wing activist partner, was raped, tortured, and spent a short period of time in prison.  Even after these experiences my approach to human rights activism continued to concentrate on civil and political rights.

In exile, while living in a Refugee Centre in London, I started to work with other refugee women.  This was the first time I had focused on working with women and realised such activities were recognised as a vital part of human rights activism (something unimaginable on the left or in human rights work in Colombia at that time).

A survivor, not a victim

Additionally, on arrival in the UK, and when granted refugee status, I received several labels:  I was a victim, a refugee woman, a second language refugee woman, a second language refugee woman from a developing country.  It is possible that the fact I saw myself as (or that ‘they’ made me feel like) a victim, finally allowed me to understand the effects of being a woman, and how – as a woman – my human rights were violated. I was able rapidly to retrieve the status of survivor rather than victim.  It is also possible that because I was feeling safe in the UK, I was able to allow myself to become the real me, something that later contributed to my process of coming out as a lesbian.

Soon afterwards, I joined London University and started my postgraduate courses at the Women’s Studies faculty (Human Rights and Education and MSc Politics of Rights). In this period the move to include women’s rights in the human rights agenda became stronger. Simultaneously I was working (particularly with the Latin American community) in women-only organizations and in a women’s refuge with victims of violence, consolidating my understanding of gender issues. Other human rights activism for different minority groups also came to my attention, particularly issues around LGBT groups. These experiences helped me to begin  to define my sexual identity: another aspect of my life that was probably denied or postponed because of the ‘revolutionary’ idealism I had in my teens and twenties, while living in Colombia and working as a human rights activist.

Homecoming: back to Colombia

Returning to Colombia in 1997, it was clear that I wanted to continue my activism. But this time I was able to do it in a safer way, protected by my new citizenship, a British passport and the support of an International NGO. I got involved in work with internally displaced people, and later focused all my attention on working on the Children and Conflict Programme with Save the Children and on my book about Girls in Armed Conflict in Colombia (Paez-Manjarres 2002).

This work and research allowed me to carry out a gender analysis of the armed conflict in Colombia and to focus on the situation of girls from minority groups.  At the same time I was also able to observe the first steps in the growth and consolidation of the LGBT movement.  Initiatives like Planeta Paz, which brought together key representatives from different social movements working on conflict resolution, included for the first time LGBT representatives. This was probably the first time that sexual diversity had been linked to the social and political conflicts that have dominated Colombian society during the last 50 years.

LGBT movement finally acknowledged

However, at this stage, at the beginning of the 21st Century, it could not be said that LGBT activists were coordinating or liaising with human rights movements, and vice versa.  For instance, the main international reports did not take violations against this group into account.  Two topics that did appear on the agenda at the end of the 1990s and beginning of the 2000s was that of women and armed conflict and gender- based violence. However, the focus was primarily on violence against heterosexual women, rather acts associated with sexuality or gender identity.  I have been examining the topic of gender- based violence and LGBT groups recently (looking in particular but not exclusively at how gender- based violence affects responses to HIV/AIDS); it will comprise a core part of my future doctoral research.

Later (2004), after returning to the UK, I joined WOMANKIND, where I was able to focus on women’s empowerment projects, and gender- based violence.  It was when I went to the Women’s Human Rights Activists International Conference in Sri Lanka in 2005 that I realised how the LGBT movement was finally being acknowledged as a key part of human rights activism.  LGBT representatives were also invited to participate in this event.  It was acknowledged that both heterosexual women and LGBT community members should be recognised as human rights activists, and that there were linkages between the women’s and the LGBT movements, particularly in the area of gender-based violence.

Working at the Alliance

In 2006, I started to work at the International HIV/AIDS Alliance, with the Latin America team.  The Alliance employs a stigma and discrimination approach and more recently has adopted a more human rights –HIV focus.  The approach is explained by the fact the countries where I work face concentrated epidemics.  It has been recognised that one way to avoid generalised epidemics in these countries is through working with and empowering the most affected population, among them gay men, other men who have sex with men, and transgender women.

This is where most of my work has been focused over the last few years. It has also coincided with me coming out as a lesbian at work. Over the last five years I have observed the growing visibility of the LGBT movement and its different manifestations within Latin American countries. Issues such as civil partnership, gay marriage, non-gender identity, sexual orientation and discriminatory access to services have been discussed and in some cases recognised by legislatures in different countries of the region.  Additionally, and more recently, LGBT people have become more pro-active as human rights activists.

LGBT: growing visibility, growing violence

It appears that this increased recognition of LGBT rights and the growing visibility of LGBT people as human rights activists and members of a movement have led to increased levels of violence against the LGBT populations in Colombia.  In recent years, well know activists have had to leave the country because of their gay activism;  they are listed among the targeted groups that right wing paramilitaries have identified as a threat to society, alongside trade unionists and other human rights activists.  Since 2005 the organisation Colombia Diversa has published biannual a reports (pioneering in Latin America) on human rights violations against LGBT people in Colombia.  The reports compile data on the systematic violations perpetrated against LGBT people in the country.

The murder of Wanda Fox, 2009

It is in this context that Wanda Fox, a transgender woman human rights activist with whom I worked as part of the programme I was coordinating in Colombia, was killed in 2009. She was killed while doing her work as a human rights activist.  She was working on promoting gender identity rights for transgender women with other transgender women and local authorities, as well as promoting the image of transgender women in the marginalized community where she lived.  She believed that her community (predominantly very low income families, sex workers and the homeless) saw transgender women not only as sex workers but as playing a role to benefit the community. Not only did she believe they would tackle discrimination but that they had the potential for change.  It is possible that this politicisation and desire to change the status quo could not be tolerated in a society that seems still to have a long way to go in assimilating changes in equal opportunities or anti discriminatory laws in Colombia.

You can read Part 2 of this blog here. In it I explore a set of questions on LGBT rights and human rights in Colombia that will form a part of my PhD research.

We find her busy making chapattis with the help of her daughter and nephew. She does not look anything like the woman we met when we visited her six months ago (see One foot in the grave, July 2011). The only thing that has not changed about her is her bright and welcoming smile. She is Elizabeth Wambui Nthumbi, a 32-year-old from Kenya’s Kawangware slum who barely a year ago had one foot in the grave and was wondering why death was not knocking in her door despite the fact that she was ready for it.

Elizabeth, 32, is a living testimony that tuberculosis (TB) can be cured if you properly adhere to treatment. She had been suffering from extra-pulmonary tuberculosis and had twice defaulted on her treatment, which led to the re-occurrence of the disease. She was also an acute alcoholic who drank cheap local brews in the many Kangemi dens. She was jobless at that time and she was at times forced to steal from her boyfriend to sustain her habit. She continued her drinking sprees at the expense of her family and children.

The second time her TB reoccurred, community health workers and TB supporters from Kangemi put their feet down and made sure that she adhered to her treatment religiously.

Elizabeth was delusional and could not walk the second time TB attacked her and was completely bedridden. So the community workers, led by Joyce Wambui, began delivering TB medication to her and even engaged a nurse who would give her the daily injections that are mandatory for a re-treatment case. Her cousin, Grace Waithira, never left her side and, whenever she could, would bring her food and take care of her personal hygiene. Besides this health workers made sure she was enrolled for food supplements that are normally prescribed for people whose immunity is compromised.

At the time, Elizabeth could have been mistaken for someone in the fourth and final stage of HIV as her body was displaying the HIV wasting syndrome but she was and is not living with HIV. Rather she had extra pulmonary TB of the bones, an infection caused when TB bacteria spreads beyond the lungs. Just like pulmonary TB, extra pulmonary TB is usually treated with a combination of four medicines for six months but in the case of a re-treatment the period of taking drugs extends a further two months thus making it to eight months in total. Extra pulmonary TB occurs less commonly than pulmonary TB. According to a 2010 Kenyan ministry of health report, Kenya of all recorded TB cases in the country, just 16% were cases of extra pulmonary TB.

Health workers supervising Elizabeth’s medication ensured that alcohol was not sneaked in to her by siblings and friends. Like all other medication TB drugs and alcohol do not mix. Alcohol abuse not only place individuals at increased risk of acquiring a number of diseases it also places those with these diseases at higher risk of poor outcome and death as it suppresses the immune system. Alcohol can also complicate treatment, since people with drinking problems are less likely to be able to adhere to medication regimes.

According to Evelyn Kibuchi, the KANCO TB Advocacy Manager, people who are addicted to drugs should be well counseled before being initiated to TB treatment in order to understand the affect the drugs they are using will have on the efficacy of their treatment.

“Alcohol should be discouraged when one is on TB treatment because it increases the frequency of urination thus making drugs pass out in the urine before they are absorbed,” she adds.

Echoing this sentiment, Dr Joseph Sitienei, the head of TB Division, said: “Alcohol and TB do not go together and a person should not compromise because the two are can potentially be toxic to the liver.”

The doctor also emphasized how important it is for anyone with TB to adhere to treatment, adding that this is paramount to avoiding further complications and the emergence of multi drug resistance TB.

In TB management, as with the management of other long term illnesses, adherence to treatment is a problem. However, TB treatment presents particular challenges for adherence because the treatment is long and involves taking a number of medications. Side effects are also common and the patient feels better long before treatment has been completed.

TB patients are expected to adhere to 90% of treatment for it to be a success and cure them of TB. Failure not only increases the risk of development of drug resistant strains it also increases the change that TB will spread in the community, which in turn increases the burden of TB in the country.

Kenya currently ranks 13th among the high burden countries. Any further increases in the burden of TB would overstretch the health system, which his already laden with TB patients. The problem will be worse with the multi-drug (MDR) and extensively drug resistance (X-DR) TB cases, which are likely to develop with non-adherence, and are difficult and expensive to treat.

Elizabeth, who finished her treatment on the 10 January 2012, has not touched alcohol since starting her re-treatment and vows never to even go near it again. She thanks God that she is alive and hopes that God will give her the strength to do something better and meaningful in her life. She plans on becoming a TB advocate who will sensitize people about TB and issues related to it.

See Sidi’s KC profile for more stories on Kenya.

For successes, it was the year that, for the second time round, the Kenyan Government allocated over Kshs 900 million towards procurement of ARVs. It was the year that TB control received a new diagnostic technology, the geneXpert, after relying on the microscopy for decades.

Challenges

The year 2011 saw Global Fund Round 11 cancelled due to donor’s laxity to live up to their promises towards the kitty.

It was the year that the Kenyan government was faced with many civil strikes including the doctors’ strike. Among other demands, doctors asked for the meeting of the 15% allocation to health in accordance with the Abuja declaration, an increase in the number of medical staff and improvement in the health infrastructure. 2011 is gone and 2012 opens many windows of opportunities for advocacy to cover the gaping holes left in the past year.
2012 is an election year. Elections provide opportunities to vote in new leaders who will shape the future and direction of the country, it is a make or break moment.

Health advocates should lead in educating the public on the best choice of leaders. We need leaders who are sensitive to health and who will prioritize health in all spheres including budget allocation, policy formulation and advocacy.

Advocacy call

Among other issues, advocates must join the doctors in pushing for the 15% allocation to health. The health of Kenyans must not be compromised. Innocent lives must not continue being lost due to inadequate allocation and other curable and preventable causes like TB.

Kenya continues to grapple with the rising cases of multi-drug resistant TB (MDR-TB). As at the close of the year, there are over 500 cases of MDR-TB. The most unfortunate thing is that the country has been relying on funding from the Global Fund for treatment and management of the drug resistant strain.

With dwindling funds from the Global Fund, the government must take full responsibility of those infected with the strain. It should not only provide free treatment for all those infected, but should also provide sustained social support to all those under treatment.

We are closing the year still calling for the completion of the MDR-TB isolation facility at Kenyatta National Hospital. Started in 2008, the ward still remains incomplete even with an investment of over Ksh 44 million from Global Fund Round 5.

In the coming years, there is need to push for the completion of the ward to admit those infected to reduce chances of infecting others and to demonstrate value for the money received from the Global Fund.

There is need too to continue agitating the government to invest in the roll out of the newest TB diagnostic technology, the genexpert. The technology has been proven to increase case detection by 30%.

The technology is also able to detect resistance to the two key anti-TB drugs. Advocates should agitate for increased funding for TB in the next year to be able to roll out the genexpert to the entire country. South Africa has taken the lead and rolled it out.

We also need more commitment from the government to cover the over USD 5.2 million funding gap for TB control in the next year.

Health advocates from the African region therefore have a huge responsibility in the coming year to ensure more commitment from their National governments.

The era of relying on donor funds should be buried with 2011. African governments should realize the health of their citizens entirely lies with them.

You cannot give birth and leave your neighbour to fend for the baby! This is my parting shot!

Evelyne Kibuchi is the Senior Advocacy Manager for the TB Advocacy Project at KANCO, the Alliance’s Linking Organisation in Kenya.

His visit has highlighted a number of important issues for the HIV response in Ukraine and resulted in a number of significant steps forward.

Dr. Kazatchkine met with Mykola Azarov, the Prime Minister of Ukraine, and they had a discussion which he described as “frank and productive”. Dr. Kazatchkine called on the Ukrainian authorities to increase government funding of HIV programmes, expand opioid substitution therapy, and ensure HIV prevention takes place in prisons. He also acknowledged the success of substitution therapy in Ukraine, calling it the leader in this area in Eastern Europe.

Dr. Kazatchkine meets with Mykola Azarov, the Prime Minister of Ukraine

The Prime Minister has now expressed his personal commitment to scaling-up substitution therapy for people who inject drugs, and confirmed an ambitious new target to enrol 20,000 patients. This commitment to scaling-up should mean a 100% increase in patients over 2012-13. The Prime Minister has now assigned the Minister of Health to take control over increasing the number of patients.

Dr. Kazatchkine has also been key to the Cabinet of Ministers’ approval of a draft law exempting Global Fund support from tax, which will have a significant impact on funding over the next few years.

During the visit Dr. Kazatchkine saw the work of a number of projects supported by Alliance-Ukraine, including a substitution therapy site, the prevention work done by the organisations ‘Eney’ and ‘Vertical’ and the Convictus community centre.  During the meeting with civil society activists Dr. Kazatchkine appreciated cooperation of civil society organizations with Ukrainian state institutions to prevent epidemics in the country and the impact achieved.

Dr. Kazatchkine visits an Alliance Ukraine project

Dr. Kazatchkine acknowledged the work done by Alliance Ukraine, stating that: “The Global Fund partnership with the International HIV/AIDS Alliance in Ukraine greatly contributed to paving the way for a breakthrough in the control of the HIV/AIDS epidemic in the Eastern Europe region. The number of new HIV infections among injecting drug users in Ukraine has stabilized and HIV prevalence among them has been reduced. Harm reduction programs among most-at-risk populations were key in achieving this progress. And while much remains to be done, best practices of prevention programs among most vulnerable populations in Ukraine have become best practices where are shared globally”.

The visit was widely reported by international media outlets including New York Times, Washington Post, Associated Press, the Ukrainian government official web-site and local media, such as  ICTV and others.

We hope that the outcomes of this trip will make a significant impact HIV prevention and on the lives of the 350,000 people estimated to be living with HIV in Ukraine.

A lot of recent attention has focused on the failings of the reconstruction efforts in Haiti since the devastating earthquake which hit in January 2010. There is little doubt that many of the criticisms are well founded.  A large portion of the funds promised for the reconstruction efforts has simply never materialised. The largest proportion of the money went to multilateral agencies, and big well connected NGOs. A much smaller proportion went to the Haitian government – around 13%[1] – and even less directly to Haitian NGOs – with some estimates as low as 0.4%.

The full article is published on AlertNet. You can continue reading it here

You can read about the next steps for global health cooperation in this co-authored blog on The Broker.

“How would it feel to be discriminated against for something about myself that I cannot change?” Clinton said. “This challenge applies to all of us as we reflect upon deeply held beliefs, as we work to embrace tolerance and respect for the dignity of all persons.” You can read or watch Clinton’s full speech here.

Her speech echoes (almost word for word) remarks that a Sudanese Islamic Scholar made just last week in Riyadh, Saudi Arabia. He was taking part in a workshop organized by the  Alliance and UNAIDS for heads of National Aids Commissions and civil society representatives from across the Middle East And North Africa which you can read more about here.

The Alliance-UNAIDS project on rights based national approaches to the HIV response has allowed us to hold rich discussions this year with the people responsible for the national AIDS strategies of over 25 countries. We have heard them talk openly and extensively about the HIV response among people living with HIV, men who have sex with men, transgender people, people who use drugs, sex workers or migrants, populations who are often at higher risk of HIV and subject to human rights violations.

Going beyond ‘unhelpful rhetoric’

In our discussions, heads of National AIDS Commissions have repeatedly expressed a common concern: how can we practically advance the response to HIV among these populations?  They have shown a profound desire to go beyond debates about human rights concepts, described by some as “unhelpful rhetoric”, and focus on effective action on the ground.

At the Alliance, we believe that Clinton’s speech is inspiring: it approaches the inherent human rights of the LGBT community head-on, and it appeals to universal notions of humanity and dignity while lending a hand to engage “with those with whom we disagree in the hope of creating greater understanding”.

But we also want to believe that her speech underpins a genuine determination by the US administration to go beyond that “unhelpful rhetoric” and into effectively advancing the rights of sexual minorities and other key populations in the HIV response.

Just two days ago, President Obama issued a Memorandum titled “International Initiatives to Advance the Human Rights of Lesbian, Gay, Bisexual, and Transgender Persons”, which includes very concrete instructions for all US agencies working abroad to promote and protect the human rights of LGBT persons.

And in August, the United States’ President’s Emergency Plan for AIDS Relief presented its guidance on HIV Prevention among key populations, with a focus on human rights to ensure an effective HIV response and participation of affected populations in the development of programs.

Commitments and declarations

This should have been a fantastic year for advancing the human rights of those at higher risk of HIV or affected by it. In June, UN member states agreed a Political Declaration on HIV and AIDS which will guide the HIV response until 2015. The text committed to  promoting and protecting “all human rights and fundamental freedoms with particular attention to all people vulnerable to and affected by HIV” and for the first time, it mentioned explicitly men who have sex with men, drug users, and sex workers as key populations that most national HIV prevention strategies fail to focus on adequately.

Later on, the UN Human Rights Council passed it’s first ever resolution on sexual orientation and gender identity, and the Organization of American States adopted a similar text. The European Parliament resolution had passed a resolution on a rights-based approach to the EU’s response to HIV/AIDS last year.

An end to AIDS within a generation?

All these commitments and declarations coincide in time with a historic scientific breakthrough. This year, for the first time science has told us that it is possible to end AIDS within a generation. But science also warns that ending AIDS will be impossible without focusing efforts on key populations and without placing human rights at the centre of the HIV response.You can find out more in our discussion paper ‘What is the Investment Framework for HIV/AIDS?‘.

And then, just a few days ago, a reminder that all this could have just been simple rhetoric. The Global Fund, a formidable force in advancing the human rights of those most affected by HIV worldwide, providing programmes and a platform for key populations to engage in decisions that affect their lives, cancelled Round 11 of funding for lack of financial support from donors.

A right to life

We hear arguments around the “legitimacy” of this or that human right on a daily basis. But there is a principle at the very heart of the Universal Declaration on Human Rights that every single one of us embraces wholeheartedly: “Everyone has the right to life”.

But the cancellation of Round 11 means that, although anyone already receiving antiretroviral drugs thanks to the Global Fund will hopefully still have access to them, there is at present no funding to support the provision of such life-saving treatment for other people who need it. Until 2014 at least.

For TB and malaria it is starker – there will be no funding for programmes to expand TB treatments and treated bed nets.

It is simple, and it is tragic. For the Alliance and many partners around the world it is time to campaign hard to make sure that the Global Fund has the resources to scale up their programmes in the coming years, to preserve the right to life for thousands of people, to continue advancing human rights. Beyond rhetoric.

The 16th International Conference on AIDS and sexually transmitted infections in Africa (ICASA) has really given me food for thought. The conference held in the cradle of mankind Ethiopia drew participants from all over the world.

I was very excited because notable among the dignitaries was the former United States President, George Bush whose speech I found so inspiring.

Listening to the various presentations and this year’s theme, Time for Africa to own, scale-up and sustain HIV funding, is indeed a wake-up call for Africa.

At the Meet the United Nations Leaders: Getting to zero session, Michel Sidibe, the UNAIDS Executive Director, emphasized that getting to zero was a way of making sure that distribution of resources and access to services was equal. He said we need to change the way we do business in Africa; we should not think about money only as we would net get to zero. Mr Sidibe urged the response in Africa to decentralize as the real solutions are at community level. He also said the solution lies in innovation and health systems.

Elhadj As-Sy of UNICEF said it is in the very communities where discrimination and stigma against people living with HIV exists that the poorest of the poor share their last penny to care for their loved ones. From UNICEF’s perspective, getting to zero new HIV infections can only be done with the support of the communities.

The challenge is how best to implement this strategy. Partnerships begin in the bedroom and therefore women should be protected. The next generation will depend on our partnerships if we are to have an HIV free generation.

The big question is, are our African government ready to face the challenge of providing treatment for the masses? African leaders signed the Abuja Declaration in April 2001, committing 15% of resources to their health budgets, but so far very few countries have managed to honor that promise. Globally the number of people seeking treatment each day is increasing in sub-Saharan Africa.

Aid effectiveness is about ensuring maximum impact of development aid to improve the lives of people by halving poverty. Over the years there has been a decline in donor funding. The 2005 Paris Declaration on Aid Effectiveness included the themes of ownership, alignment, harmonization, managing for results and mutual accountability.

Looking at Zambia, the budget for 2012 has already been approved and I hope to see efforts being put into ensuring people remain on treatment, especially those already on ART. The tricky part is the issue of new infections, will these wait till 2014? Definitely, not. We do not want to see the 1990s scenario come back otherwise the fight would be lost and the slogan Getting to zero will become an illusion.

When it comes to ‘owning’ the HIV response there is much Africans have done but challenges remain. One of my expectations of ICASA was to learn how involved African scientists have been in research around an AIDS vaccine. It is clear in this field there is much to do.

When it come s to owning the response, people living with HIV must play a significant role. I was disappointed that the plenary sessions did not give a platform to spokespeople from people living with HIV networks. That this voice was missing from crucial debates was a pity. I would have especially liked to have seen people living with HIV given the floor at leadership sessions discussing the Global Fund and funding crisis.

That said I have learnt a lot from ICASA. As the delegates, activists, media and participants begin to go back to their countries, the battle against zero discrimination, zero new infections and zero deaths, and reaching the Millennium Development Goals (MDGs) seems to have only just begun. Getting to zero and the MDGs will only be achieved by involving everyone in society – the grassroots up to the policy makers. Personally, as a Key Correspondent and an outreach worker, I will do my bit to make sure communities are well informed.

Although there have been previous studies indicating there is some connection between the use of hormonal contraceptives and HIV susceptibility, none have been able to mobilise the international community like the Heffron study has. As a follow-up, the World Health Organization is holding a meeting with family planning organisations and hopefully HIV organisations, as well, to determine what action is needed.

Integrating HIV services and sexual and reproductive health

Thirty years into the epidemic, Heffron’s article once again reminded us that HIV cannot be addressed in isolation. Since the beginning, we have known that adequately addressing HIV also means appropriately addressing individuals’ sexual and reproductive health needs and rights (SRHR). The SRHR and HIV sectors are still not effectively making strides together to maximise resources and experiences to jointly achieve improved SRH and HIV outcomes.

Why it has been so difficult to provide integrated services?

Of course, there are many levels of complexity as to why it has been so difficult for health professionals and civil society groups working in SRHR and HIV to provide holistic services and support to individuals and communities. From ever changing donor priorities to vying for an ever-shrinking funding pie, an ‘us vs. them’ mentality has developed between SRHR and HIV. Many of us are now struggling to overcome this fragmentation in the SRHR and HIV response.

Throughout 2011, the optimism and momentum has grown that we have the key ingredients to ‘getting to zero’.  We have political commitment, effective funding approaches and new technology to bring an end to AIDS and new HIV infections.

- Governments reaffirmed high level commitment to fight HIV and AIDS at the UN General Assembly High Level Meeting on AIDS;

- New investment framework for HIV which shows that if we invest in the right approaches, at the right level, we would actually see a significant drop in new HIV infections and be able to end HIV within the next generation;

- HPTN 052 study showed that antiretroviral therapy (ART) can decrease HIV transmission among sero-dicordant couples by 96%.

HPTN 052 demonstrates that the treatment vs. prevention dichotomy has never made sense and that scaling up treatment is scaling up prevention.  Clearly, treatment as prevention in combination with other proven prevention approaches both gives us the tools to treat people already living with HIV, as well as prevent millions of additional infections. This approach is good for individuals, makes financial sense and gives us hope for ending the HIV epidemic.

We must act now to save more lives

We now have to convince donors, policy makers and ourselves that working smarter together across health and development, and funding what works will ultimately result in saving millions of lives and improving quality of life for communities most vulnerable to HIV and other sexual and reproductive ill health, especially marginalised communities and people living with HIV.