In this Aug. 29 lecture, Director of the United Nations Development Programme’s HIV, Health and Development Group Mandeep Dhaliwal presented on the UN Sustainable Development Goals, HIV and human rights with commentary provided by strategy and governance consultant Jeffrey O’Malley.
Director, United Nations Development Programme HIV, Health and Development Group
With more than 25 years of experience working on HIV, health, human rights and evidence-based policy and programming in low- and middle-income countries, Mandeep Dhaliwal, a lawyer and medical doctor, joined the UN Development Programme in 2008 and was one of the architects of the Global Commission on HIV and the Law, an independent commission to catalyze progress around laws and policies that impact people affected by HIV.
Jeffrey O’Malley—former director of UNICEF’s Division of Data, Research, and Policy, as well as UNDP HIV, Health & Development—commented on the SDGs and their links to LGBT issues.
Lecture from Mandeep Dhaliwal
After a brief introduction from Professor Sofia Gruskin, director of the Institute for Global Health at USC, Dhaliwal overviewed the history leading up to the 2030 agenda for sustainable development, addressing the shift from the Millennium Development Goals (MDGs) to the UN’s 2030 Agenda and the Sustainable Development Goals (SDGs). The 17 interconnected goals and 169 targets were developed with the mantra “no one left behind,” setting a standard for both high- and low-income countries and avoiding placing an undue burden on countries within the “global south.”
The process of setting the 2030 Agenda was primarily meeting with constituencies from across the globe to ensure that the priorities reflected in the document were reflected in the lived experiences of people worldwide. Dhaliwal emphasized the importance of the “no one left behind” mentality, explaining that the focus on the marginalization of certain populations creates an impetus to identify who exactly is being left behind by the current structure of society. These marginalized groups—or “key populations”—were at the center of the discussion moving forward. Dhaliwal then provided an explanation of the relationship between human rights and the SDGS. Dhaliwal pointed out that of the 169 targets, the majority can be specifically linked to human rights standards and the powerful message this sends to the international community: that the institutionalization of human rights should be a priority for the global south and north alike.
The lecture continued on the topic of language, addressing the fact that of the many marginalized groups mentioned in the SDGs, LGBT people are not. Dhaliwal noted that this result was of course political, but that the language is broad enough to include populations that are not explicitly referred to within the document. The 2030 Agenda for Sustainable Development does, however, identify many key groups as a vulnerable population:
“People who are vulnerable must be empowered. Those whose needs are reflected in The Agenda include all children, youth, persons with disabilities (of whom more than 80 percent live in poverty), people living with HIV/AIDS, older persons, indigenous peoples, refugees and internally displaced persons and migrants. We resolve to take further effective measures and actions, in conformity with international law, to remove obstacles and constraints, strengthen support and meet the special needs of people living in areas affected by complex humanitarian emergencies and in areas affected by terrorism.”
The 2030 Agenda for Sustainable Development, Declaration, section 23
The remainder of Dhaliwal’s lecture was spent on the Agenda’s implications for those living with HIV/AIDS. She brought the audience’s attention to target 3.3, focusing on ending the epidemic of HIV, TB, Malaria. Since the beginning of the AIDS epidemic, more than 74 million people have been affected and 35.5 million have died. Dhaliwal made a point to mention that this number is more than 10 times the population of the City of Los Angeles and roughly 4-5 times the population of LA County. Dhaliwal remarked that the global response to HIV/AIDS has been remarkable on a number of fronts beginning with the unprecedented mobilization of people, especially people living with HIV/AIDS, within and across countries and that this is what is needed to mobilize sustained global action.
Dhaliwal also pointed out that the response to HIV/AIDS has demonstrated the potential for multi-sectoral responses to affect positive change, the power of human rights and rights-based approaches in addressing vulnerabilities, and the importance of setting bold standards and goals. She then spoke about how, in 2003, the WHO set a goal to put 3 million people on an HIV/AIDS medication known as antiretroviral therapy (ART) by 2005. Dhaliwal explained that this was thought to be too ambitious as the medication was not widely available in low- and middle-income countries. Voices in opposition claimed that the health systems in these countries were too fragile and that it would not be possible to achieve. Dhaliwal explained that while the WHO was ultimately not able to reach their goal, the fact of articulating it in this way proved that it was possible to treat a significant number of people in low- and middle-income countries. Dhaliwal explained that it is hoped the goals of the SDGs will have a similar affect.
The lecture then moved on to so focus on the underutilization of the Law as a tool in the global response to HIV/AIDS, shedding light on its dual potential. She noted the Global Commission on HIV and the Law’s 2012 finding that law and policy that is informed by quality data and grounded in human rights can be a cost effective tool. The Commission also called for a global ban on HIV-related criminalization using evidence of its harmful effects to make this reccomendation. Dhaliwal pointed out the success of this tactic, sharing that since 2012, more than 89 countries have taken action to implement the recommendations of the Commission in one way or the other. Criminalization laws have been repealed, the right to comprehensive sexuality and the importance of sex education has been recognized, and some countries have introduced laws to prevent violence against key populations.
In her own words, Dhaliwal ended the lecture with “a story of caution” regarding the decline of funding for HIV/AIDS prevention and research. She warned that the 2030 Agenda has come at a time when the amount of resources available for this work have made it very difficult to identify or reach those who are most vulnerable. After expressing her belief that those who work in global health are inherently optimistic and that that optimism will propel the work forward, Mandeep Dhaliwal yielded the floor.
Commentary from Jeffrey O’Malley
At this point, Jeff O’Malley offered a perspective on what the SDG framework may mean for LGBT populations around the world even as they are not explicitly mentioned, and in relation to HIV specifically. Focusing on identity—both broadly and his own—he began his lecture with a brief description of his work. As he told it, in 30 years of work, he never included “LGBT” on his resume, but he nonetheless managed to bring “queer stuff” into the field of health and development. Moving on to the 2030 agenda, O’Malley spoke about the potential for progress made on the issues of LGBT populations and the complexity that the SDGs will need to account for if they are to be useful. O’Malley pointed out that queer people have multiple identities and one will need to identify whether ‘no one left behind’ is affective when translated into reality.
O’Malley then emphasized the importance of narrative and recognizing that the roots of the field of global health are not based in altruism. He asked the audience to think back to the middle of the 19th Century, when the cholera epidemic in London was linked to a water pump in a slum in Soho. The poor of London were blamed for the spread of the disease, with concern that the conditions in which poor people live cannot be contained and may affect for affluent member of society. Only once public health became a threat to the upper echelons of society was it seen as relevant or important to address and the field of study was born. O’Malley noted that even today the public health of the marginalized is most likely to be prioritized in light of security concerns. In 2000, when the UN Security Council first called a meeting to address a health concern, it was the threat of HIV/AIDS, particularly the safety of soldiers, that brought them to the table. Building on Dhaliwal’s anecdote about the WHO’s treatment goal and importance of setting high goals and standards, O’Malley noted that the goal was ultimately reached. Now, millions of people who need it are on ART treatment, much of which was financed by US taxpayers because it was a military priority of the Bush Administration.
At this point, the lecture shifted to the SDGs as they apply to those living with HIV. Pointing out that a third of people living with HIV are still not getting their required medication, O’Malley focused on the nuances of recognition. Noting that in Africa, there has been tremendous progress politically, but that because of misinformation there is a pervasive belief that all LGBT people are living with HIV. At this point, O’Malley reminded the audience that although it’s important to recognize the increased numbers of people living with HIV in queer communities, that they are people who are vulnerable to other issues such as poverty, gender-based violence, access to education or housing. Recognizing the lack to LGBT-specific language within the 2030 agenda, O’Malley explained that the focus on putting the furthest behind first in line should inherently prioritize queer and gender non-conforming members of society.
The lecture portion of the event came to a close with a call for better and increased data. O’Malley ended by stating that identity and vulnerability are complex and it is essential that all the lenses of sexuality and gender identity are recognized, studied and that data are collected. Only then will we be able to progress into the future.
The discussion was opened. Questions from the audience touched on the role of academic institutions in HIV responses for LGBTQI populations, intentionally flexible language within the SDGs, the benefits of local collaboration in development work, advancements in HIV prevention, gender equality and stigma. Focusing on the vitality of evidence, Mandeep Dhaliwal emphasized role of academic research in changing the behaviors of governments and policies. Jeffrey O’Malley spoke candidly about current failures to address the complex interplay between identity, stigma, and access. The meeting closed with a call from both speakers to engaged with human rights and the law to ensure they health and rights of vulnerable populations whoever and wherever they are.
The USC Law & Global Health Collaboration would like to thank both Mandeep Dhaliwal and Jeffrey O’Malley for their valuable time and expertise.