A Farewell to Abstinence and Fidelity: Comments on the 2016 Political Declaration on Ending AIDS

Opening ceremonies at the U.N. 2016 United Nations General Assembly High Level Meeting on AIDS 6.8.16
By Guest Contributor |

by Mikaela Hildebrand

In June, I took part in the 2016 United Nations General Assembly High Level Meeting on AIDS as part of the official Swedish government delegation.

At the Swedish Association for Sexuality Education (RFSU), we had, together with many other committed organizations, followed the negotiations for a good few months. Sex has regularly proven to be a polarizing issue for the U.N. member states, and we knew the opposition would be tough.

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We needed a political declaration that delivered a policy commitment to evidence-informed programs to advance comprehensive sexual and reproductive health and rights, comprehensive sexuality education included, to re-shape HIV prevention efforts.

Much was at stake. Comprehensive knowledge about correct and consistent HIV prevention remains appallingly low, and has stalled over the past 15 years. New HIV infections have only dropped about 8% from 2010 to 2014 among young people and adults, and there are still about 5,700 new HIV infections every day.

While the assessment of the outcome document has been rather polarized, with some seeing it as a failure while others hail it as a great success, when it comes to comprehensive sexuality education, the outcome document all but mentions the concept. Paragraph 62 (c) reads:

Commit to accelerate efforts to scale up scientifically accurate age- appropriate comprehensive education, relevant to cultural contexts, that provides adolescent girls and boys and young women and men, in and out of school, consistent with their evolving capacities, with information on sexual and reproductive health and HIV prevention, gender equality and women’s empowerment, human rights, physical, psychological and pubertal development and power in relationships between women and men, to enable them to build self- esteem, informed decision-making, communication and risk reduction skills and develop respectful relationships, in full partnership with young persons, parents, legal guardians, caregivers, educators and health-care providers, in order to enable them to protect themselves from HIV infection.

While the word sexuality is missing, all the core elements of comprehensive sexuality education are there. However, the most important thing is the two missing words: abstinence and fidelity.

This small omission is, in fact, a hard won major gain from the negotiations and signals a much needed shift in HIV prevention from dogma to evidence.

On the last day of the meeting, when the negotiations had been sealed and the Political Declaration adopted, I had a conversation with Kent Buse, chief of Strategy and Policy Directions at UNAIDS, on the importance of these missing words. We decided it needed highlighting.

So together with Sarah Hawkes, a professor at University College London, we wrote a commentary that was published recently in the Lancet Global Health, to make sure that the removal of these two concepts from the toolbox of HIV prevention, at least at a global policy level, does not go unnoticed.

The commentary outlines the following four-point policy action agenda:

  • Update country policy frameworks and abandon abstinence-based and fidelity-based HIV prevention programs, in consultation with technical agencies.
  • Develop comprehensive sexuality education curricula that include addressing gender-power dynamics to deliver on the sexual health and gender equality targets of the 2030 Agenda for Sustainable Development, and strengthen capacity of teachers to deliver it.
  • Work with teachers’ unions, parent associations, and traditional and community leaders to shift community perspectives on comprehensive sexuality education and the delivery of comprehensive sexual and reproductive health programs in and out of schools.
  • Support advocates, including youth groups, to hold their governments accountable for international commitments made, including in the Political Declaration on HIV and AIDS.

The Political Declaration has now been adopted, but outdated national frameworks will not change themselves.  We now need groups and individuals to get involved at the country level to translate this policy commitment to action. And we need to continue to push for evidence-informed strategies to prevent new HIV infections and end the AIDS epidemic by 2030.

Mikaela Hildebrand is a senior policy adviser for sexual and reproductive health and rights at RFSU, the Swedish Association for Sexuality Education. This post was originally published at the website of the International Planned Parenthood Federation (IPPF) and is reposted here with permission.

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