To the Special Session of the
United Nations General Assembly

By Anna K. Tibaijuka

Executive Director
United Nations Centre for Human Settlements

New York, 27 June 2001


Mr. President,
Distinguished Delegates,
Excellencies, Ladies and Gentlemen:

Earlier this month, Member states of the United Nations met in New York on the occasion of the 25`" Special Session of the General Assembly for an overall review and appraisal of the implementation of the outcome of the United Nations Conference on Human Settlements (Habitat II) held in Istanbul in 1996.

The Special Session adopted a Declaration on Cities and Other Human Settlements in the New Millennium, which, among other things, "resolves to intensify efforts at the international and national levels against HIV/AIDS and in particular to formulate and implement appropriate policies and actions to address the impact of HIV/AIDS on human settlements". It also recognizes the problem of accessing financial resources for housing by HIV/AIDS victims and the need for shelter solutions for accommodating HIV/AIDS victims, especially the orphans and the terminally ill.

The Declaration, therefore, recognizes the relevance and role of housing and shelter, or the living environments, in the prevention, care and treatment of HIV/AIDS.

As regards prevention, the link between poverty and HIV/AIDS prevalence is now well established. One characteristic of poor people who are most vulnerable to HIV/AIDS infection is inadequate shelter. Poor living conditions, including overcrowding and in extreme cases, homelessness, undermine safety, privacy and efforts to promote self-respect, human dignity and the attendant responsible sexual behaviour. Young girls living in overcrowded conditions are most at risk, and quite a number have been subjected to incest, rape and associated HIV infection.

In this connection, let me quote a passage from President Holkeri's statement at the African Summit on HIV/AIDS, tuberculosis and other infectious diseases: "In the Millennium Declaration, the world's leaders resolved to achieve significant improvement in the lives of at least 100 million slum dwellers. By doing so, we will also decrease the risk of the spread of infectious diseases, including tuberculosis and HIV/AIDS. The Millennium Declaration is an expression of political will of the world's nations ? it is the duty of the world's nations now to implement this will".

Equally critical, and often overlooked, is the pace and nature of population concentration processes in cities, particularly in sub-Saharan Africa, as a factor in the spread of HIV/AIDS. The condition of uprooted migrants who are often income-seeking members of once closely-knit family units and communities, the day-to-day precariousness of first income earners in cities, the sense of solitude and helplessness that the first impact in the big city invariably brings, the lack of social and psychological support in easing the transition from rural to urban ways of life, all combine to create the perfect conditions for the spread of HIV/AIDS.

Yet, cities are not only HIV/ADIS incubators ? they can provide an opportunity for better education, information, and prevention of its risks. Public information is an essential component of the good urban governance campaigns Habitat is spearheading in many cities in all continents. As the UN focal point for cities and local authorities, Habitat will also encourage mayors and world associations of cities to strengthen their efforts in combating HIV/AIDS.

In short, the implementation of the Habitat Agenda's goals of adequate shelter for all and sustainable human settlements development can therefore play an important part in winning the war declared by this meeting against HIV/AIDS.

Beyond prevention, housing and adequate living conditions have been established as critical in the success of care and treatment regimes for HIV/AIDS. A pioneering study recently released by the Joseph L. Mailman School of Public Health of Columbia University has reached the conclusion that marginalized persons once deemed unlikely to comply with difficult therapies can thrive on them when they have secure housing with supportive services responsive to their complex needs. More broadly, the study concluded that housing may address not only the need for shelter but have real and significant continuing effects on an individual's health.

This study was conducted in the very city where this crucially important summit is being held. It was based on the experience of a non-profit organization, Bailey House, founded in 1983 to provide people with AIDS in New York City with a permanent and safe place to live, proper nutrition and other support to enable them to maximize their health, independence and quality of life. A major premise of the Bailey House model is the reciprocal nature of housing and supportive services. Homelessness and conditions associated with homelessness are barriers to accessing services and adhering to service plans and treatment regimens; provision of housing facilitates access, utilization and adherence.

Mr. President, Distinguished Delegates:

This ground-breaking study has lessons relevant to both developed and developing countries on the importance of shelter in treatment and care for People Living With HIV/AIDS (PLWH/A). Developed countries yet to do so could emulate this Bailey House example, which is a clear Habitat "Best Practice". For the developing countries, especially in Sub-Saharan Africa where HIV/AIDS prevalence rates are highest, the findings of this study point at the double challenge of not only accessing Highly Active Anti-Retroviral Therapy drugs (HAART) for People Living With HIV/AIDS but also the need to improve housing and supporting care, especially for slum dwellers who make up over 50% of the urban population in developing countries.

Moreover, homelessness or unstable housing is established as one of the biggest risks for continuous care. Individuals who are struggling with housing issues are often in and out of care as other more pressing needs compete for time and attention. Most worrisome is the fact that to be successful with Highly Active Anti-Retroviral Therapy, adherence must be observed strictly to avoid development of treatment-resistant strains of HIV.

This clearly suggests that supporting developing countries to access Highly Active Anti-Retroviral drugs as well as requisite supportive housing and services are now a global public good. Clearly, investments made to develop these drug cocktails would be eroded if the resistant strains were to develop from inadequate administration and therapy. Institutional housing for AIDS patients under therapy and AIDS orphans as called for in the Declaration on Cities and Other Human Settlements in the New Millennium is a clear component of our effective response and commitment to fight the pandemic.

Mr. President,

Let me end by emphasizing the importance of giving priority to prevention in a comprehensive and integrated strategy to fight the pandemic. In situations where 25% of the population is infected, as in some Sub-Saharan African countries, we are faced with disaster. As such, prevention information and education campaigns, followed by prevention services (condoms and other tool kits) are a matter of life or death for the society. Economic, social and cultural realities in Seriously Affected Countries (SACs) dictate, among other things, the following principles for a preventive package:

(1) Household-to-household and institution-to-institution campaigns on responsible sexual behaviour, including safer sex;
(2) Comprehensive HIV Testing and Counselling. The availability of Anti-Retroviral drugs is critical to promote prevention because it has provided an incentive for people to wish to know their HIV status. If infected, they can take steps to live positively with HIV/AIDS. If free of the virus, they have greater reason to safeguard themselves against infection.

Mr. President:

In my intervention I have outlined the shelter dimension and the importance of a human settlements-based approach to HIV/AIDS prevention, care and treatment. Habitat, as part of the United Nations Secretariat and under the guidance and leadership of Secretary General Kofi Annan, is ready to play its part in the follow-up to this special session.

I thank you for your attention.