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All UN member states have endorsed a commitment to protect human rights in the global fight against HIV and to ensure universal access to HIV prevention, treatment, care, and support. To assess progress towards fulfilling this commitment, countries submit reports to UNAIDS biennially, known as UNGASS reports. Our quantitative analyses show that core indicators relating to most-at-risk populations, particularly men who have sex with men (MSM) and people who inject drugs (PWID) are limited or absent from many UNGASS reports, particularly those submitted by countries in developing regions. We conducted a qualitative thematic analysis of the narrative part of the 2010 UNGASS country progress reports, an important yet under-explored part of the reporting process, to consider how signatory countries in developing regions address the issue of MSM and PWID in a written form. Our analysis identified a repertoire of narrative approaches to MSM and PWID which revealed fault lines between countries’ endorsement of the Declaration of Commitment on HIV/AIDS and programmatic responses to MSM and PWID. Our findings raise questions about the relationship between “universal” human rights and “local” cultures, and about the UNGASS reporting process itself. Through critical engagement with these questions, our article aims to contribute to international dialogues on how to better recognise and respond to shortcomings in the global commitment to human rights and universal access for people vulnerable to HIV.