Centering LGBTI Health and HIV at the HLPF

Civil Society Must Remain Vigilant During Discussions of “Health for All” in Sustainable Development

by Stephen Leonelli, Senior Policy Advisor at MSMGF

MSMGF and several key partners attended the second annual United Nations High-Level Political Forum (HLPF) on Sustainable Development in New York from July 10 – 19. Designed as the central platform for review of Agenda 2030 and the Sustainable Development Goals (SDGs), the HLPF was greeted with unprecedented interest this year with over 2500 participants from civil society.

Download the full report

The 17 SDGs are comprised of 169 targets which ambitiously aim to achieve human rights across the economic, social, and environmental dimensions of sustainable development. We outlined ways to get involved in the HLPF here. Specifically the targets in SDG 3, “Ensure healthy lives and promote well-being for all at all ages” (especially Target 3.3 on “Ending HIV”), provide a vital entry point for addressing the HIV and health needs of LGBTI people, as illuminated by our recent publication, Agenda 2030 for LGBTI Health and Well-Being.

The guiding principle of the Sustainable Development Goals is to “leave no one behind.” This necessarily requires meaningful engagement of civil society that works with marginalized and vulnerable communities. Despite challenges to full participation outlined below, Community activists must continue to be vigilant to ensure that Member States, UN agencies, and civil society are aware of structural barriers that gay and bisexual men and other key populations, such as transgender people, sex workers, and people who use drugs, face in fully realizing their health and rights.

Sites of Engagement:  MSMGF at the HLPF

The main mechanism for assessing national implementation of the SDGs is the Voluntary National Review (VNR) process. UN Member States are encouraged to conduct “regular and inclusive” reviews of progress at the national and sub-national level, in consultation with civil society and other stakeholders. The voluntary reports are then used as the basis for review and interactive discussion at the HLPF each year. In consultation with national partners on the ground, MSMGF submitted inputs on VNR reports and participated in forming questions for six countries (Botswana, Brazil, Indonesia, Kenya, Nigeria, and Zimbabwe). We noted that most country VNR reports were dismally lacking with regard to data on LGBTI people, and HIV was often sidelined in the assessment of implementation of the health targets.

MSMGF also partnered with OutRight Action International, the United Nations Development Programme (UNDP), and RFSL – the Swedish Federation for LGBTQ Rights – to organize an official UN side event on July 11th to discuss the importance of data on LGBTI people for Agenda 2030. Amidst a packed room with representatives from Member States, UN agencies, development practitioners, and civil society, Micah Grzywnowicz from RFSL introduced the concept of inclusion for LGBTI people in the context of “leave no one behind.” Dr. Mandeep Dhaliwal from UNDP then discussed efforts to create indicators for the LGBTI Inclusion Index, which seeks to measure inclusion of LGBTI people across five dimensions of development. Dr. Felicity Daly from OutRight and I then presented an overview of available data on the health of LGBTI people and recommendations to Member States for reporting on LGBTI health in the SDGs, as detailed in-depth in Agenda 2030 for LGBTI Health and Well-Being. Finally, Niluka Perera, a young gay activist from Sri Lanka and member of the Platform to Fast Track the Human Rights and HIV Responses with Gay and Bisexual Men, discussed efforts in Asia and the Pacific to include youth LGBTI people in SDG implementation.

The discussion at the side event acknowledged challenges in generating and gathering national-level data on LGBTI people due to lack of political will, lack of capacity, and the inability of practitioners to safely and respectfully obtain data on sexual orientation, gender identity and expression, and sex characteristics (SOGIESC). This was the first ever side event at the HLPF to focus on data disaggregation by SOGIESC and inclusion of LGBTI people in the SDGs.

Under the leadership of RFSL and OutRight, MSMGF joined the first ever LGBTI coalition for the HLPF, which engaged in joint advocacy and information sharing throughout the HLPF (view more information from OutRight’s UN Newsletter). The coalition made statements and gave inputs at the Ministerial Declaration negotiations, the Thematic Review on Implementation (see Micah Grzywnowicz’s statement here), questions during the thematic discussions of SDG 3 (written about here) and SDG 5, questions for several VNR sessions, and the VNR breakfast meeting between States and civil society.

At the conclusion of the HLPF, a Ministerial Declaration was adopted by Member States to affirm the importance of Agenda 2030. HIV is mentioned twice in the document, but key populations, LGBTI people, and SOGIESC references are missing. The lack of consensus on some paragraphs within the Ministerial Declaration exhibits the tensions and challenges for securing financial commitment and partnership to achieve the SDGs by 2030.

Nonetheless, in the ECOSOC President’s Summary of the 2017 HLPF, the necessity to prioritize ending discrimination against lesbian, gay, trans, and intersex communities is mentioned. This acknowledgement is an important signifier that increased visibility of our communities is critical at events like the HLPF and underscores the value of community engagement in these global processes.

How can we make the HLPF more meaningful next year?

This year’s HLPF theme was “Eradicating poverty and promoting prosperity in a changing world,” which included an in-depth review of implementation of seven SDGs, including SDG 3 on Health. The theme of next year’s HLPF is “Transformation towards sustainable and resilient societies,” and over 30 countries[1] have already opted to participate in the VNR process.

Based on reflections from this year, MSMGF offers three aspirations for how the HLPF can be added to the toolkit of advocacy entry points for activists concerned about the HIV and human rights of key populations and LGBTI people:

  1. Increase Consultation with and Meaningful Engagement of LGBTI and Key Population Communities

At the HLPF, the “leave no one behind” mantra manifested itself most often when discussing which civil society organizations and groups were consulted and involved in VNR processes. Several countries explored innovative forms of civil society engagement, but there is a strong desire to improve the process for years going forward. Together 2030 crafted a powerful open letter articulating a way forward at the HLPF and for VNR processes next year to increase effectiveness and buy-in from civil society, and some of those asks are echoed below.

Some key examples of successful civil society engagement should be highlighted, tweaked, and replicated for years going forward. For example, a coalition of Brazilian CSOs  in the Civil Society Working Group for the 2030 Agenda prepared a full “Spotlight Synthesis Report” to accompany the official State VNR report. The SDGs Kenya Forum brought together groups from a variety of sectors (including disability rights and gender equality groups) for a year-long consultative process that convened prior to the VNR release, participated in verifying the draft VNR, and sent participants to the HLPF itself. In the Netherlands, youth activists were invited to draft a section of the official VNR Report.

MSMGF applauds these efforts and innovations, but unfortunately outreach to LGBTI groups and HIV community organizations was still insufficient. MSMGF is currently working on an in-depth analysis of the 43 VNR reports submitted this year. Our preliminary analysis shows that no reports included data for the agreed upon indicator 3.3.1 on HIV Incidence by Key Population. Furthermore, in some contexts our partners and LGBTI groups/activists were consulted, but their inputs were not ultimately included in the official VNR report.

As our partners at the Stop AIDS Alliance note, community action is vital to achieve the SDGs. But our experience at the HLPF illuminated two challenges: LGBTI community groups may not be plugged in to national and mainstream development initiatives; and even if they do participate in consultations related to the VNRs, LGBTI and key population representatives or organizations may not see their inputs included. For too long, LGBTI and HIV issues have been siloed and detached from mainstream development programming due to homophobia, transphobia, and a variety of other forces. Going forward, development practitioners must endeavor to actively seek out the inputs of marginalized and vulnerable communities, especially the LGBTI and HIV-affected communities.

  1. Promote Collection of Data on Sexual Orientation, Gender Identity and Expression, and Sex Characteristics (SOGIESC)

A common theme throughout the official sessions, side events, and informal networking was that data and evidence bases are crucial for informing policy. Despite this, activists from all sectors are struggling with the urgent need for more data and disaggregated data on LGBTI people. MSMGF and OutRight’s recent publication explores this issue in depth, and offers suggestions for the ways that indicators in SDG 3 should be disaggregated by sexual orientation, gender identity and expression, and sex characteristics (SOGIESC).

Most sessions on the topic of data disaggregation at the HLPF focused on disaggregation by sex and age, without thorough (or any) consideration of SOGIESC. Member States are reluctant to endorse and present non-nationally representative data, and civil society often lacks the skills to collect comprehensive data. The World Bank just released a report that discusses strategies to study development outcomes for LGBTI people via surveys and experiments, indicating that more development agencies are interested in this issue. UN agencies can and must play a more active role in linking government and civil society, and ensuring that data ends up in VNR reports.

In the short-term, Member States may be unable to unwilling to respectfully collect SOGIESC disaggregated data, so we must ensure that civil society and community groups are active agents in gathering key information. Partnerships between civil society, health clinics, and academic institutions can lay the groundwork for systematized government plans to collect and disaggregate data.

  1. Focus Advocacy on Criminalization, Violence, Stigma, and Discrimination 

Many stakeholders, including LGBTI and sexual and reproductive health and rights civil society, some Major Group representatives, and some Member States, made the link between stigma and discrimination against vulnerable populations and challenges to “leave no one behind.”

Discussion of exclusion based on gender, socioeconomic status, and ethnicity (indigenous status) often overlooked intersections with HIV-related discrimination, sexual orientation, gender identity and expression—though the Women’s Major Group, Children and Youth Major Group, and Indigenous People’s Major Group all mentioned SOGIESC in some statements. However, analyses of the factors that cause exclusion were lacking in terms of comprehensive review of laws, policies, and practices. Barriers to implementation of the SDGs must include naming homophobia and transphobia as social drivers that condone violence and discrimination. Specifically, criminalization of same-sex behaviors and punitive laws that inhibit expression of gender identity will always hinder full realization of the SDGs.

A convening of former members and partners of the Global Commission on HIV and the Law discussed the ways that 88 countries have worked toward revising legislation to be rights- and evidence-based in the HIV response. In June of this year, 12 UN agencies released a short statement on ending discrimination in health care settings that specifically names punitive laws that criminalize same-sex behavior, gender expression, sex work, and drug use. Future reporting from civil society and UN agencies must continue to facilitate greater understanding about the link between discriminatory laws and negative development outcomes.

Keeping Ourselves Accountable    

Achieving the Sustainable Development Goals requires multi-stakeholder engagement and political commitment to “leave no one behind.” This year we learned that the multiple interests at the HLPF may cause States to lose focus on HIV and health needs of the LGBTI community, and that civil society must be engaged much more in advance to ensure data is disaggregated and analysis is structural.

Member States, UN agencies, and civil society must collaborate in the HLPF and VNR processes. MSMGF will continue to monitor the HLPF and support partners in participating in Voluntary National Reviews, so that we can be sure that key populations including LGBTI people are not left behind, and that fighting HIV remains a priority for years ahead.

[1] As of August 11, the following countries have opted-in to the 2018 VNR:  Albania, Andorra, Armenia, Australia, Bahamas, Bahrain, Bhutan, Cabo Verde, Dominican Republic, Ecuador, Greece, Guinea, Hungary, Iceland, Ireland, Jamaica, Laos, Latvia, Malta, Niger, Paraguay, Poland, Republic of Congo, Romania, Saudi Arabia, Senegal, Singapore, Slovakia, Spain, Switzerland, Palestine, Uruguay, and Vietnam.

About MSMGF:
MSMGF is an expanding network of advocates and other experts in sexual health, LGBT/human rights, research, and policy, working to ensure an effective response to HIV among gay men and other men who have sex with men. We are directly linked with more than 120 community-based organizations, across 62 countries.