Podcast Summary: "2024 UNAIDS World AIDS Day Report: The Rights Way to End the Epidemic?"

Podcast: A Shot in the Arm
Host: Ben Plumley
Guest: Christine Stegling, Deputy Executive Director, UNAIDS
Date: November 29, 2024

Episode Overview

This episode centers on the launch of UNAIDS’ new World AIDS Day report, “Take the Rights Path to End AIDS,” for 2024. Host Ben Plumley and guest Christine Stegling (Deputy Executive Director, UNAIDS) discuss the critical role of human rights in achieving the goal of ending AIDS as a public health threat by 2030. The conversation explores why rights-based approaches are essential, challenges in different countries regarding stigma, discrimination, and rollback of rights, and how UNAIDS and its partners are navigating changing political environments, domestic ownership, and funding sustainability.

Key Discussion Points & Insights

1. Why a Rights-Based Approach in 2024?

• Report Focus: UNAIDS’ 2024 report emphasizes a “rights path” to ending AIDS, continuing last year’s focus on community-led responses but pushing further to protect human rights at the core of the response.
  • “[We] have increasing evidence… you need to protect people's human rights to ensure that they can actually make use of the services and the biomedical interventions that we have…” (Christine, 01:31)
• Not Either/Or: Rights and biomedical interventions are interdependent. Without legal, social, and institutional environments supporting people’s rights, uptake of new biomedical prevention tools stalls.
  • “No matter what biomedical interventions we have, they don't matter if people don't access them… We need to create that enabling environment...” (Christine, 03:35)
• Progress & Plateaus: While Africa has seen substantial declines in new infections, progress has plateaued globally, with 1.3 million new infections annually—pointing to a prevention crisis, not lack of medical technology.

2. Clarifying the Goal: Ending AIDS vs. Ending HIV

• Target Nuance: The SDG-aligned target is to reduce new HIV infections and AIDS mortality by 90% compared to 2010 (not outright eradication). Ending AIDS means drastically reducing incidence and mortality, but not the elimination of HIV, which will persist for decades (06:29).
• Quality of Life: Ensuring that people living with HIV have good quality of life and protection from discrimination is as important as biomedical or epidemiological targets.
• The Role of Stigma: Success stories like Botswana show that reducing stigma in healthcare facilities and workplaces is central to progress.

3. Setting and Translating Targets

• Targets as Political Tools: UNAIDS sets global targets as both motivators and practical benchmarks. These are political expressions intended to inspire countries, not just project management metrics (10:12).
  • “They are political targets. They motivate people to… get to this higher target… They get translated at country level to country targets.” (Christine, 10:45)
• Balancing Ambition and Reality: The process now involves negotiating new 2026–31 targets, trying to ensure ambition without leaving behind marginalized populations.

4. Country Ownership and Sustainability

• Roadmap Development: UNAIDS is working with 30+ countries to create “sustainability roadmaps,” ensuring governments—not donors—take policy and financial leadership (13:03).
  • Key components:
    • Mapping current response and planning for integration into broader health and social systems.
    • Addressing human rights/gender barriers to access, not just finance.
    • Creating fiscal space through measures like better taxation, tackling indebtedness, and integrating health programs across government sectors.

5. Challenges: Rolling Back of Rights and Changing Political Climates

• Tensions in Country Ownership: Growing anti-rights legislation (particularly in parts of Africa) threatens inclusive HIV responses (18:08). UNAIDS must navigate situations where governments may deprioritize rights.
  • “...If you accept that countries drive the agenda, they can drive… in ways that are not rights based.” (Ben, 18:08)
• Role of the UN: The UN, despite its bureaucracy, remains a critical advocate for rights and inclusive public health, maintaining pressure and supporting civil society, especially when other actors step back (18:52).

6. Case Studies: Uganda and the Philippines

• Uganda’s Anti-LGBTQ Law: Christine confirmed a “definite chill” in LGBTQ access to services, with prep uptake among these communities declining. UNAIDS intervened as amicus curiae in court, demonstrating the public health impact of discriminatory laws:
  • “I think the easiest way where we can see it is… a real decline in the uptake of prep, of oral prep provision.” (Christine, 23:30)
• Philippines’ Rising Infections: Infections have soared (420% increase since 2010), now mainly among young gay men. Policy barriers, especially age-of-consent laws for testing and treatment, prevent youth from accessing care:
  • “It doesn't always have to be as dramatic as an anti-homosexuality act. Sometimes it's age of consent.” (Christine, 27:33)

7. Trans Rights and the Global North

• Transgender Rights Under Pressure: With anti-“woke” agendas gaining traction in donor countries, notably the US, the podcast discussed the implications for funding and political support for inclusive responses (29:04-31:20).

8. Preparing for Shifting Donor Politics

• Anticipating Policy Shifts: UNAIDS emphasizes its neutral, principled role, engaging whoever is in power, while highlighting the global impact and evidence of success of US, UK, and other countries’ investments (30:55-33:36).
  • “What we are seeing now… we’re almost there. We can see the end… You can either go this way and get to the end or… you will not win it.” (Christine, 32:59)
• Advocacy for Sustainable Funding: UNAIDS encourages both donor and recipient countries to value continued investment, particularly as global solidarity wanes.

9. Development Aid, Security, and Migration

• Missed Narrative Opportunity: The development sector has failed to communicate how aid addresses root causes of migration and global security. This link, prominent in early 2000s arguments for HIV funding, should be revived (38:46).
• UN as Convenor: UNAIDS continues to play a unique convening role—bringing together governments, civil society, and donors to coordinate responses and broader development impact (36:14-38:46).

10. Botswana’s Election: Local Leadership Rooted in Human Rights

• Christine reflects on Botswana’s opposition victory and the elevation of a human rights advocate who once chaired her former organization (Bonella). It’s an example of how leadership rooted in rights can influence national responses positively (40:02-42:57).

11. Personal and Organizational Challenges

• UN Leadership in Crisis: The episode concludes on a personal note about UNAIDS Executive Director Winnie Byanyima’s ongoing ordeal to secure her husband's safety in Uganda, highlighting the risks faced by rights advocates (43:21-45:26).

Notable Quotes & Memorable Moments

• Christine Stegling on the centrality of rights:
  “We need to create that enabling environment that allows people to come forward, to use prep, to demand condoms, to do all the things that we know, avert new infections…” (03:35)
• On targets as motivation:
  “They are political targets. They motivate people… They have very much to do with how they look at country level, because the UNAIDS targets get translated at country level to country targets.” (10:45)
• On setbacks in Uganda:
  “No, it's a definite chill. And it has an impact. And we have seen it. I think the easiest way where we can see it is that we have seen a real decline in the uptake of prep, of oral prep provision.” (23:30)
• On adapting to global donor changes:
  “We are the United Nations of all countries. And we work with a lot of different governments… I think the important bit is to really make… a narrative for all the governments that we're working with that is based on the principles that we stand for as the UN.” (31:20-31:59)
• On development aid and security:
  “We need to change that narrative…which is a very inward looking issue around how do we deal with migration and go back to where is, where is the root cause of migration? …development aid has always had a role to play to say let's ensure that living spaces are, are the right ones for people so that nobody wants to leave their country if they don't need to.” (38:46)

Timestamps for Important Segments

• [01:31] – Introduction to the 2024 UNAIDS World AIDS Day report and focus on rights
• [03:35] – Why rights (not just biomedical tools) matter for epidemic control
• [06:29] – Defining “ending AIDS as a public health threat”
• [10:12] – The political function of international targets
• [13:03] – Country ownership and sustainability roadmaps
• [18:08] – Tension between country ownership and rollback of rights
• [23:30] – The real-world impact of anti-LGBTQ laws in Uganda
• [26:12] – Philippines case study: ramping up infections among young gay men
• [29:04] – Trans rights and US political shifts
• [30:55] – UNAIDS preparations for potential changes in US administration/funding
• [36:14] – Broader advocacy, development, and migration
• [40:02] – Botswana election: a rights-based leader comes to power
• [43:21] – Executive Director Winnie Byanyima’s family crisis in Uganda

Conclusion

This episode provides a detailed, nuanced view on why protecting rights is essential to ending AIDS as a public health threat, the complex political environments in which UNAIDS operates, and the urgent challenges facing both donors and recipient countries. It’s both sobering and hopeful, reminding listeners of the persistent need for global solidarity, courage, and principle-driven action—even as biomedical advances offer new hope for epidemic control.

For more details, check the “Take the Rights Path” executive summary linked in the show notes.