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“If you are uncomfortable in the room then you are in the right place” – Reflections on anti-racism and decolonizing global health from the International AIDS Conference in Montreal

By guest contributors Ayoade Alakija, Winnie Byanyima, Vuyiseka Dubula-Majola, Madhukar Pai; Christine Stegling, Steve Letsike, Lazenya Weekes-Richemond, Lola Abayomi, Leigh-Anne-Agnew, Divya Bajpai, Kreena Govender, Yumnah Hattas, Mumtaz Mia, Tabita Ntuli, and Orosmani Gonzales-Romero

For the first time in its history, the International AIDS Conference (#AIDS2022) – the largest gathering of HIV and AIDS experts and activists – hosted a satellite session, focusing on institutional racism and decolonizing global health.

Poster of the International AIDS Conference session, courtesy of the authors.

The Canadian government and the International AIDS Society (IAS), organizers of these bi-annual conferences including AIDS2022, held in Montreal, Canada, received heavy and apt criticism for the often complex, traumatic and humiliating visa application processes, visa denials as well as the exorbitant travel and conference registration costs which blocked hundreds of delegates, mainly from the Global South, from participating in the conference in person. All African panelists for the satellite session on stigma related to HIV in clinical settings were forced to participate virtually, due to visa denials and/or high participation costs inciting Dr Ayoade Alakija, co-Chair of the African Union’s Vaccine Alliance, to tweet a picture of the empty chairs stating “A picture is worth a thousand interviews. Here’s the @AIDS_conference news segment right here. No more words needed.”

The Global North dominance over hosting health conferences and the under-representation of Global South participants, who often have to overcome financial and visa barriers, which in our opinion is underpinned by racism and discrimination, is chronic. Researchers who reviewed more than 20 years of global health conferences found that 96% of such events happened in high- or middle-income countries with only 39% of attendees from low-and middle-income countries.

Activists vehemently protested against the visa denials and the conference being held in a Global North high-income country.  Adeeba Kamarulzaman, former president of the IAS and co-chair of AIDS2022 said that she was “deeply upset” about the visa denials that were a result of “global inequality and systemic racism”.

Did the IAS and other conference decision makers heed the calls and take action to validate and redress the harsh experiences of those from the Global South who were excluded?  The answer is a resounding no. The 12th IAS Conference on HIV Science will take place in Brisbane, Australia in 2023. A clear indication that the concerns of thousands of Black, Brown and Indigenous people living in countries most impacted by HIV/AIDS are being ignored.

Back to the historic AIDS2022 satellite; “Anti-racism and decolonizing the AIDS response: From rhetoric to reformation”, which brought together a powerful panel of public health experts and activists. Their bold and courageous statements and calls to action, challenging institutional racism and racism as a pathology struck a chord. For many Black, Brown and Indigenous people, these issues are rooted in historical and generational trauma that is still very personal and visceral. Reverberations from the satellite session, amplified through social media, continue to gather momentum, demanding collective and organized action. “Conference inequity” is a chronic and neglected problem which is symptomatic of the insidious and deeper issue of systemic institutional racism that exists in global health and development.

As the panelists of the #AIDS2022, anti-racism and decolonization session, we share the following key messages and calls to action.   

Authors at IAS 2022. Photo courtesy of the authors.

Winnie Byanyima: Intersectional disparities are putting sub-Saharan African women, Black and Brown people in higher income countries, men who have sex with men and transgender persons across the world at higher risk of HIV infection and other ill-health outcomes. Where we have been able to disaggregate data based on racial and ethnic identities, there is clear evidence of the disparity with very often Black Women at the bottom of the ladder.  Our focus on ending inequalities in the Global AIDS Strategy recognizes that inequalities are brought about by racial and other intersecting identities. Racism stymies people’s life chances, multiplying their risks. We need to dismantle systems which uphold systemic discrimination. We need to do this in a way which addresses intersectional inequalities of race, gender, income-level, health status, and nationality.   

Ayoade Alakija: From the very early days there were barely veiled racist attacks on the Director General of the WHO, from global leaders, from presidents and the way that dynamic impacted the global views of what people thought or not of this microbe called SARS- COVID 2. People underestimated the gravity of the moment because the man at the head of the WHO was a Black man from Northern Ethiopia named Tedros. But we wonder what would have happened if he was a white man from Calgary, Alberta, called Theodore.  Perhaps the world would have taken it more seriously and we would not be where we are today. Perhaps the WHO would not have had their funding cut in a pandemic. From North America to the UK to Africa communities of color have fared the worst through this pandemic. And institutional racism is defining history and the way we respond to crises, be they man-made conflict or naturally occurring viruses. It’s time that our leadership says “we are not having the AIDS conference for in Canada; we’ll have these conferences in the Global South so that we can make decisions together. 

Madhukar Pai: All aspects of global health, including conferences, are designed to benefit the Global North. From antiretrovirals for HIV/AIDS to COVID-19 vaccines to monkeypox vaccines, we see the African continent and low-income nations left behind. This is not a mistake or unconscious bias. This is deliberate, intentional and working as it is designed to work. When we see the same, recurrent pattern decade after decade and disease after disease, the only explanation is white supremacy and systematic racism. We cannot decolonize global health without confronting this reality. If decolonization is to happen, then the Global South must assert itself and be the driver. The self-determination and self-sustenance of Black, Indigenous and people of color (BIPOC), and Global South countries is fundamental. They need to make their own drugs, vaccines and tools to meet their needs. They cannot rely on trickle down charity from the Global North. Where does that leave others, those who are in the Global North, white people, and people with privilege? Their path to collective liberation lies in the practice of real allyship. People in HICs must be allies to people in LMICs. White people in global health must be allies to BIPOC people. Men in global health must be allies to women. Able-bodied and cis-hetero people must be allies to people with disabilities and LGBTQ+. The list goes on because it is intersectional.

Madhukar Pai, speaking at IAS. Photo courtesy of the authors.

Vuyiseka Dubula Majola: The reality for many Black and Brown people in the world continue to face structural racism and thus this uncomfortable conversation. AIDS activism has been a ground-breaking movement that shifted the balance of power between the North and South with access to affordable medicines. We were never shy to name and shame. So let’s be brave again and vulnerable to openly engage in this anti racism and decolonization of global health movement. It is clear that we will never reach our equity and development goals for as long as we do not confront the biggest white elephant in this room. The recent AIDS conference is a typical example of racism, exclusion and putting people in vulnerable conditions… and we say no more!. We need to take a position. No more sitting on precarious fences. Be counted, be an ally and join us.

Lazenya Weekes-Richemond: The global health sector and the global AIDS response has been white- washed with Black and Brown people largely excluded from key decision making. This white-washing is intentional, it is racist and it is rooted in the belief that Western knowledge, Western medicine, Western ideals are superior. If global health programs fail to consult and include Black and Brown people with lived experiences from LMICs, we’ll continue wasting money, we’ll continue to see widening health inequalities and ultimately, we will fail to reach the Sustainable Development Goals in 8 years’ time.

Christine Stegling: We need everyone working in global health – funders, implementers and researchers – to have honest internal reflections about the prevalence and impact of racism in the aid sector and within their own organizations. As a white woman in a leadership position, I’ve asked myself some deeply uncomfortable questions about my own privilege. This wasn’t easy. We all have very personal journeys and experiences. I had not really consciously asked myself what white privilege means for me when I show up in spaces. I am still on that journey, and it is deeply personal but I want to state that whatever you do as an organization, do not shy away from the difficult personal work we all have to do, and white people in particular need to do. In my position as a female leader, I will continue to be an ally and use my voice to raise concerns about racism and post-colonial approaches to doing development wherever and wherever possible.

Steve Letsike: We ought to be frank and honest in our discussion on this subject. We need to reflect on the importance of truth when discussing structural racism in the AIDS response. The marginalized majority, who carry a disproportionate burden of the AIDS epidemic continue to be disadvantaged and disempowered by deep seated economic, ethnic and racial inequalities. Power imbalances are by design and are by no means unique to the field of global health. Yet health is often the locus where many of these inequalities intersect.

Ensuring that #AIDS2024 will be held in the Global South provides strategic opportunity for our joint mobilization and collective action.  As a first step, in the spirit of moving from rhetoric to action, we commit to drafting an anti-racism and Decolonization Charter, for our collective action. Redressing the issue of ‘conference inequity” will be a key component of the Charter.  We encourage – and stand in solidarity with – all Black, Brown, Indigenous, Global South and racially marginalized people, as well as our white Global North allies around our common agenda.

About the authors:

Ayoade Alakija is WHO Special Envoy for the ACT-Accelerator, and Co-Chair of the African Union’s African Vaccine Delivery Alliance (@yodifiji)

Winnie Byanyima is the Executive Director, UNAIDS (@Winnie_Byanyima)

Vuyiseka Dubula-Majola is Director, Africa Centre for HIV and AIDS Management, Stellenbosch University, South Africa (@VuyisekaDubula)

Madhukar Pai is a professor of epidemiology and global health at McGill University in Montreal, Canada (@paimadhu)

Christine Stegling is the Executive Director of Frontline AIDS (@SteglingC)

Lazenya Weekes-Richemond is a Strategy Manager at the NHS England (@LazenyaR)

Steve Letsike is the Deputy-Chair of The South African National AIDS Council (SANAC) (@msletsike)

Lola Abayomi, is an Adviser of Programmes and Communications at Frontline AIDS (@lola_abayomi)

Leigh-Anne-Agnew is a Senior Adviser of Risk Management at Frontline AIDS

Divya Bajpai is the Director of Programmes at Frontline AIDS

Yumnah Hattas is the Senior Adviser for Gender and SRHR at Frontline AIDS

Mumtaz Mia is the Senior Adviser for Diversity, Equity and Inclusion at UNAIDS

Tabita Ntuli is the Community Support Adviser at UNAIDS South Africa (@tabitamah)

Orosmani Gonzales-Romero is a Procurement and Operations Officer at UNAIDS (@OGCfgos)

Kreena Govender is the Regional Adviser for Gender, SRHR and Human Rights at UNAIDS MENA (@KreenaGovender)

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