Conclusion

This book has sketched, in broad strokes, the complicated history of the global response to HIV/AIDS, and the role of CSOs within it. Broad strokes were necessary because global processes respond to and interact with uncountable local and national processes. This is a history of conflicting processes, cooperation and compromises that occurred over three decades, in varying spaces, among an ever-shifting combination of actors. This is a narrative about change. It illustrates the challenge an unknown

and lethal epidemic posed to traditional biomedical health responses, and the opportunity this created for a new type of response. It describes how a unique sense of global solidarity formed, for a moment at least, around the concept of AIDS exceptionalism, setting a precedent for addressing a global health issue. It outlines how human rights frames became increasingly interlinked with biomedical neoliberalism, and shifted into discussions around key populations with both new opportunities and limitations for transformation. It presents the uneven progress of these frames – such as around harm reduction – from local to global forums, and back to national and local contexts. It explains how the failure of biomedical state-based systems, and the use of AIDS exceptionalism, allowed new, more inclusive if not transformative, institutional forms to be created, and unprecedented levels of resources to be applied. This narrative also illustrates what has not changed – the dominance of

biomedical neoliberal approaches to GHG. This has limited rights-based outcomes: PWID still receive inadequate support and are stigmatized; the rhetoric of commitment to gender equality by HIV/AIDS institutions and leaders is not translated into policy action or resources; community and rights-based groups still struggle to access resources. As the HIV/AIDS response moves from being an exception within GHG to being normalized, opportunities for change constrict, as demonstrated by the lack of explicit human rights language within the SDG health goal and reduction of funding for key populations within middle-income countries. The overarching narrative is one of resistance within a dominant neoliberal

context, and the struggles that ensued. Within these processes, CSOs have been positioned as central agents. This is just one take on a much broader story

about GHG, the role of CSOs in global processes, and struggles for human rights. It is an important one because it demonstrates that community groups, activists and INGOs are actors to be reckoned with in global forums; and that they have promoted change, even within the confines of a political economy of biomedical neoliberalism and dominant donor state power. Throughout this history of CSO participation, contradictions (such as

between the rhetoric of supporting CCS in the Global Fund’s NFM and continued restrictions created by performance-based management) and opportunities (such as the creation of the Community Rights and Gender Technical Assistance Program) have been made explicit, contributing to a more nuanced understanding of the role and influence of CSOs within GHG.