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Financement de la lutte contre le sida | Patrick Levy | Peter Piot

UNAIDS: Red Ribbons or Human Rights?

1 November 1996 (MAHA)

GENEVA, 1 November 1996 (MAHA)

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Cross-border or international work is often held under suspicion by community activists, AIDS workers, and people living with HIV/AIDS. Often, questions are raised about the usefulness of this work and whether anyone benefits from it except for the select few who metamorphose into self-appointed international VIPs in the stratospheres of international conferences.

Yet international networking and solidarity is increasingly the terrain for AIDS struggles in the late 1990s. It is a necessity to build a strong, coherent effort to take grassroot demands and needs to the international level, and to hold those responsible for what gets done.

In this issue, we publish our detailed report which takes stock of what has already been said and done in one international forum, the United Nations Human Rights Commission, by UNAIDS in collaboration with the European section of the International Consortium of AIDS Service Organizations (ICASO) and the European project AIDS & Mobility.

Many factors contributed to EuroCASO’s collaborative work with UNAIDS on human rights. First, EuroCASO, plagued by funding problems and an apparent lack of interest from member organizations, had the courage to question its existence and objectives. EuroCASO Working committee member Patrick Levy (Israel) wrote in 1995 of the urgency of international human rights work, as he attended a conference in Spain on new HIV restrictions for refugees.

UNAIDS human rights officer Marcus Stahlhofer organized a well-attended intensive workshop on the UN human rights machinery at last year’s AIDS & Mobility Meeting.

Conference attendees agreed that AIDS & Mobility needs to "play a role in advocacy and lobbying" around human rights and discrimination. Participants were "encouraged" to network with ICASO or EuroCASO. A group composed of Stahlhofer, Kim Mulji (NAZ Project, London), and Helen Peters (Norway) was mandated to continue work. Patrick Levy, who did not attend, was to be invited to participate.

According to Levy, AIDS & Mobility sent a letter in Spring 1996 to selected members of its network, asking for information on human rights violations and explaining the "purpose of the work." Information submitted was then selectively used in preparing an ICASO statement on HIV/AIDS and human rights at the April 1996 session of the UN Commission for Prevention of Discrimination and Protection of Minorities.

EuroCASO and ICASO have since published this statement in their respective newsletters, assuring us that this work will "strengthen the ethical and legal response in order to face the virus effectively" but giving no hint on how this may come to happen. UNAIDS makes the various documents available by request. Nevertheless, we find it regrettable that these organizations do not widely and regularly publish the results of their work.

The reality is that many small organizations which contributed have still not heard about these results (or lack thereof). Worse, the original Spanish government violations which jump-started the human rights work have slipped from sight. No sustained grassroots effort anchored the UN-level work to this reality, using it along with all other means available to build pressure on the Spanish government.

Come what may, we are here to stay

Many of the organizations active in the amorphous European Ethnic Minority and AIDS Network coordinated by AIDS & Mobility come from settled Third World communities - Algerians in France, Afro-Caribbean and Asian in the UK - which have struggled to establish that "come what may, we are here to stay" or "J’y suis, j’y reste." The massive emigration of ex-colonial populations to the industrial metropolises of Europe to fill the need for cheap labor has created new kinds of multiethnic and multiracial social formations similar to those in the United States. Decades have passed since this process began on a large-scale. "Mobility" is history. The refusal by European governments to recognize this constitutes one crucial basis for denying these communities our human rights.

Foregrounding the needs of ethnic/racial minorities must be at the top of the HIV and human rights agenda, given the disastrous impact of AIDS on these communities. An emphasis on "mobility" dilutes those struggles. In fact, substituting "migration" as UN jargon supports a different kind of "conspiracy of silence" in refusing to recognize that these political communities are constantly changing but permanent features of European societies.

The ICASO/EuroCASO statement did not address this reality. Instead, it spoke of the "acute problem of HIV/AIDS" among "mobile populations all over the world," not specifically among settled Third world communities in Europe, much less to "people of color" ("ethnic minorities") in Europe or elsewhere. (An August 1995 ICASO statement justified the "specific focus" on migrants because of a supposed "psychosocial instability"!)

Levy is "not convinced that speaking about migrants and AIDS is easier than speaking about ethnic or racial minorities and AIDS." For Levy, the issue of "migrants and AIDS" (addressed explicitly by the ICASO statement) is a "completely different one" from that of "ethnic or racial minorities and AIDS." This is simply not true, at least for Europe’s Third world communities.

Levy cites the recent case of protests by Israel’s Falashas (see Migrants against HIV/AIDS, May 1996) as a "very strong and clear" example of the way in which "more and more countries are forced to face their responsibility regarding ethnic minorities and AIDS." For Levy, it is the "duty of NGOs and of bodies like UNAIDS to force governments to recognize their responsibility" toward ethnic minorities within their borders. Levy gives no indication of how this might happen, given that the resolution adopted by the human rights commission, although legally binding, has no enforcement mechanism.

ICASO gets cold feet

Levy acknowledges that the information compiled by AIDS & Mobility for the meeting did not include all countries (or communities) in the network, and that the information needs to be "updated and faithful." In a 20 June 1996 letter to Migrants against HIV/AIDS, he stated that "if we were in contact with you before, we could have [other] information, next time." We have not heard from Levy since.

According to the statement, the "worst" of "migrants’ already marginalized existence" is that they are "victims of hate by extreme right wing groups." "Migrants" are not simply "victims." While fascist violence must be opposed, so must police killings and "freelance" racist violence. An inordinate focus on far-right violence ignores the anti-Arab, anti-African racist roots of today’s far-right violence, and provides a very partial picture of the lethal cocktail of state racism and institutionalized neglect which now poses the greatest threat to life and dignity.

ICASO’s statement to the commission cites very few specific examples. One is the "cases...reported in France where persons died before they obtained their certificates permitting the treatment." This is at best factually inaccurate (it is not "certificates" which permit treatment, as treatment is guaranteed by French law, even for the undocumented).

The only other violations mentioned are US border controls, and the deportation of Filipinos or Koreans.

The ICASO statement gives "bureaucracy" and "discrimination" as two reasons why HIV+ migrants "often do not receive authorization necessary to obtain treatment." This is, at best, an ambiguous statement which conflates several issues - most obviously the distinction between the right to stay and the right to health - and neglects others.

ICASO also naively declares that "theoretically, in most developed countries, migrants who are HIV+ are entitled to facilities accessible to citizens and residents." It is unclear why this would only be the case in "developed countries", but in any case this is true neither in theory nor in practice.

Asked why there is no explicit mention of undocumented immigrants living with HIV and AIDS in the ICASO statement, Levy explained "we used information we received from our contacts."

Priorities were set by AIDS & Mobility. "We focused our work on the information migrants have on AIDS when entering the country, on the situation concerning HIV+ people who want to migrate, and on those discovering their status abroad," Levy stated. According to Levy, then, there is no explicit mention of ’illegals’ because "we did not want to enter in a subject we did not have enough information on."

Migrants against HIV/AIDS published one report originally drafted in response to AIDS & Mobility’s request for contributions to Levy’s presentation (see our May 1996 issue). A section dealt with "non-registered" migrants, stating that "in the Netherlands, health care is becoming a problem for illegal migrants" and mentioned "fear of being deported."

While ICASO was making its presentation, a broad alliance of organizations, including African health advocacy groups, were demonstrating in the United Kingdom to kill a racist Asylum Bill whose main clauses sought to restrict the health and social security rights of refugees.

Also, URMED (see front-page article) sent a complete report on its work to AIDS & Mobility several months before ICASO’s April 1996 presentation. Delegates from France to the Third Meeting spoke out loudly and often about the "Double Penalty" and its death sentence for undocumented, gravely ill people. Why was all this deemed "insufficient", by whom, and on what basis?

Levy cites "very strict UN regulations" concerning statement length and the necessity of having the resolution adopted by consensus as reasons for limiting the number of examples.

However, Migrants against HIV/AIDS has learned that the initial statement drafted by Levy in collaboration with AIDS & Mobility did in fact include many other examples, and was generally much stronger in condemning human rights abuses against "mobile populations."

As a UNAIDS source commented, "NGOs like ICASO can blast governments. UNAIDS can’t." Why, then, did Levy get "cold feet" and tone down the ICASO statement?

Red card, not ribbons, for UNAIDS

UNAIDS boss Peter Piot’s statement to the Commission argues that the degree to which governments limit "key rights to information, education, health and non-discrimination" increases vulnerability to HIV infection and puts the "right to life" in jeopardy. "This is true for all people," declared Piot, "but especially for vulnerable and marginalized groups who are bearing the brunt of this epidemic. Such groups include women, children, minorities, indigenous peoples, refugees, homosexuals, sex workers, drug-users, and prisoners. The discrimination they already face in access to education, health care and social support renders them particularly vulnerable to HIV/AIDS."

This is typical and unavoidable UN jargon and laundry list of constituencies. So what did UNAIDS have to say about refugees? Piot spoke of a refugee family which "desperately needs asylum but is denied it because of the HIV status of one family member" and is "left in limbo in a refugee camp where they are likely to face insecurity, lack of adequate health care..." According to the statement, this family "faces the heart-rending choice of leaving behind the family member living with HIV." It is unclear whether this means leaving behind the family member in the refugee camp (in "limbo") or whether this implies abandoning family members in the country of origin.

Piot describes forced deportation of an HIV+ migrant worker with a euphemism: "being sent home" (paragraph 16 of declaration). This leaves open the question of whether or not deportation is a human rights violation. UNAIDS must take a clear position on this human rights issue. As Levy himself told us, "what is unsaid is often more important than what is said."

Questioned about this, Levy assured Migrants against HIV/AIDS that, "knowing Peter Piot, I don’t think this is what he wanted to say" and suggested that we ask him to clarify UNAIDS’ position. In the same way, Levy, an Israeli, considers that, given his "personal background," he needs not "explain what can be" his position on "deportation."

Such answers miss the point and further confound the real issue: Why has the human rights work done at the UN level ignored or erased the struggles of immigrant communities, and how have UN-level workers been accountable to the constituencies they claim to be representing?

It is not personal background that is in question, it is what actually gets said and done in public when individuals are not simply representing themselves but carry a collective mandate. Such a mandate does not end once the presentation is read in the halls of the United Nations.

Rather, the committed individuals who have been almost singlehandedly pushing this work forward need to stop to take stock of what has been done, and must remain honest in evaluating both the potential and the real impact of their work. They must make themselves accountable to the communities and the organizations on whose behalf they have been acting.

The other conspiracy of silence

ICASO and UNAIDS explain that much work remains to be done for governments which sit on the Commission to take seriously the link between HIV/AIDS and human rights. Levy explained, for example, that "the USA were ready to discuss informally on [sic] discriminations related to AIDS for migrants, but were not ready to include this item officially in the UN resolution." Even human rights NGOs have only reluctantly taken the issue onboard.

It is equally clear that the UNAIDS and ICASO must first understand the realities of HIV/AIDS struggles for Europe’s Third world communities. They must develop a stronger, more coherent position about immigrant and "ethnic minority" rights in general before it can be expected that such a position could be adopted by governments.

Those involved must recognize that something has gone wrong. It will not do to acknowledge the existence of "issues" but then to go on as planned in making the next presentation. Nor will it be sufficient to tweak the expert vocabulary, or even to add a paragraph about deportations.

We must ask ourselves why we make presentations to the United Nations. International human rights work in a vacuum is meaningless. Indeed, as Levy wrote in a EuroCASO article, "participation in the sub commission... won’t solve all the problems on this burning issue."

"The Commission is a circus," noted an insider. "It has its own intricate rules, but public pressure is the real motor which can push forward the HIV/AIDS and human rights agenda."

It is sad that an effort which began around a specific violation in Spain has been rendered impotent at least as much by the workings of the UN machinery as by the inability to keep UN-level demands grounded in the needs of local organizations, by the failure to turn statements and resolutions into increased political pressure on recalcitrant governments.

Today the African Forum in Norway’s campaign is calling for a public inquiry into why Norway’s government decided, early July, to warn its white population that Africans are potential HIV carriers.

Only a strong, coordinated response in support of such local campaigns, in response to each and every instance of documented human rights violation can succeed in making credible the work being done at the United Nations and, above all, politically useful.

Background to this story

We sent a detailed list of questions concerning the ICASO statement at the April 1996 Session of the Commission on Human Rights to ICASO representatives Patrick Levy (EuroCASO), Dorothy Odhiambo (AfriCASO) , and Rinske van Duifhuizen (AIDS & Mobility). Of the three, only Levy replied. Therefore, our analysis is based largely on the statements, Levy’s replies and UN human rights and AIDS sources. This report does not discus other UNAIDS and ICASO presentations on HIV/AIDS in prison, women, etc.

AIDS is not the only killer

The widening chasm between those who have (or can afford) the new tritherapies and those who do not has yet again put the inequality between rich and poor countries at the heart of AIDS activism, much of which is today focused on "treatment issues."

Phase Two and Three vaccine trials are being negotiated between giant multinational pharmaceuticals, with international organizations renting out their "ethical" services as mediators in carrying out the trials on the peoples of Africa and, more recently, of Asia and Latin America.

Structural adjustment programs imposed by the World Bank and IMF force governments to service their debt rather than spend funds on social services, skewing national economies and provoking or worsening social dislocation which has been linked to increases in STDs. The AIDS pandemic is an unnatural disaster, sustained by the unequal global economic order in which 14 million children die from hunger and disease each year, where two billion people are illiterate, and where 1.5 billion people have little or no access to health care.

Uganda, which spends US$3 a person a year on health care, spends US$17 a person on debt payments. Yet community initiatives and public health efforts have resulted in a major decline in new HIV infections. Think what could be accomplished with a workable public health budget.

In the United States, by 1993, AIDS had become the leading cause of death among African Americans between the ages of 25 and 44, as one consequence of what US prison AIDS activist David Gilbert calls "theattack by the government-medical-media establishment on the health and lives of African Americans." By the early 1990s, the rate of new AIDS cases among Latinos was 2.5 times higher than among whites, and the latest US immigration bill sought to prohibit all foreigners - "legal" or not - from obtaining any form of AIDS-related care.

In Europe, immigration policy is increasingly planned and coordinated in Brussels, setting the boundaries to the health policy of withering welfare states. It has resulted in the exclusion of immigrants and refugees from health systems across Europe, as governments have "harmonized" their laws and practices by borrowing the worst from each other’s arsenal of repression. AIDS is not the only killer.

Europe’s Black and Third World communities - and first and foremost the African refugees from east and south-east Africa - have been pushed to the frontlines of struggles for health, Different emergencies have come to the forefront: housing in the UK, deportations in France, forced HIV testing of refugees, and so on. These on-going struggles are part and parcel of the struggles against the AIDS holocaust in Africa and the rest of the Third World. M

Business as usual

On 25 September 1996, UNAIDS and the Center for Human Rights recommended the appointment of a special rapporteur for the UN Human Rights Commission to defend the rights of people living with HIV or AIDS.

Australian Supreme Court Judge Michael Kirby, the meeting’s chairperson, underlined that in most coutnries, the penal code targets three "at-risk" populations: homosexuals, prostitutes, and drug users. No mention of the death sentence of the Double Penalty practiced by most European countries against their settled communities, no mention of repressive immigration laws and practices in Fortress Europe or elsewhere.

Once again, the human rights of immigrants and "ethnic" or "racial" minorities were written out of the picture, at least in media presentations. Yet immigration issues were addressed at the conference: Eric Sawyer cited the case of 260 Haitians interned by the United States. Until the Haitian community organized and protested, they were denied political refugee status because of their HIV+ status.