Sierra Leone





WEDNEDSAY, 27th  JUNE 2001

Your Excellencies
Mr. President of the General Assembly
Mr. Secretary-General of the United Nations
Distinguished Colleagues Ladies and Gentlemen

It is indeed with great humility and honour that I wish to convey the most sincere and warmest greetings from H.E. Alhaji Dr. Ahmad Tejan Kabbah, President of the Republic of Sierra Leone, the Government and People of Sierra Leone to members of this august Assembly. May I also take this opportunity to extend the congratulations of my delegation to you Mr. President upon your election to preside over this Twenty-Sixth session specifically convened to address the quagmire of the HIVIAIDS pandemic. It is Sierra Leone's fervent hope that over the course of our meeting, this Assembly will produce concrete results, which shall herald a definitive global consensus aimed at resolving this alarming issue currently threatening international peace and security.

In the same vein, our President, His Excellency Alhaji Dr. Ahmad Tejan Kabbah conveys his tribute to the Secretary-General, His Excellency Kofi Annan for the excellent way he has made the fight against HIV/AIDS not only a personal cause, but a priority matter for the entire United Nations System. The Government and people of Sierra Leone commend his leadership.

Mr. President, the first cases of HIV/AIDS in Sierra Leone were reported in 1987, diagnosed in the Southern (Bo) and Eastern (Kenema) provinces. Although the results of numerous studies to determine the magnitude of the HIV/AIDS situation in Sierra Leone have sometimes been inconclusive, there has definitely been a gradual increase in the prevalence of the disease. Indeed, many of the predisposing factors for this already exist These include the breakdown in civil society as a result of the 10-year war, massive population displacements with attendant losses in livelihoods and shelter, increase in prostitution (also amongst males), homosexuality, infra-venous drug abuse, and the presence of troops from many countries where the problem is much more pronounced from the epidemiological as well as socio-economical points of view.

As in almost all other countries, HIV/AIDS was initially considered to be principally a health problem. Consequently, the solutions to this problem were concentrated in the health sector. With support from the World Health Organization and other UN agencies and organizations, the Ministry of Health established a National AIDS Control Program Secretariat in 1986, principally to assess the situation through sero - surveillance and to initiate country - wide Health Education Programs. The first sero - prevalence survey conducted in the country in 1987 showed a total of only 10 HIV antibody positives and 2 AIDS cases and 1 death from AIDS - related complications. As at December 2000, a cumulative total of 1716 HIV positive individuals have been identified, out of which 608 AIDS cases have been recorded, 386 of whom have died. As the problem is escalating, other adverse development-related consequences of the disease are becoming more apparent. The realization is dawning that if the scourge is to be contained, the determinants that lie outside the health sector, especially the socio-economic causes and effects must be addressed. These include economic and socio - cultural characteristics such as the extent and distribution of poverty, the concentration of wealth, the position of women and gender inequalities, cultural and traditional practices that involve both the use of skin piercing instruments and contact with blood (e.g., male and female circumcision, ear piercing, tribal marks, gum piercing and tattooing). The roles of all of these factors are being taken into consideration in our efforts to control this scourge.

Currently, the World Bank, in partnership with UNAIDS, other UN agencies and other major stakeholders, is supporting the development of a multi-sector response to the emerging HIV/AIDS epidemic in Sierra Leone through the formulation of the Sierra Leone HIVIAIDS MultiSector Project (SHARP). This is to be a country program within the context of the US$500 million Multi-Country HIV/AIDS Program for the Africa Region (MAP). This project will help to organize the response against the emerging HIV/AIDS epidemic, as well as against Sexually Transmitted Diseases and Tuberculosis, which are important risk co-factors in the early stages of the epidemic. This is to be achieved through a multi-sectoral approach by:

. Containing or reducing the level of the epidemic;
. Mitigating its effects; and
. Increasing access to prevention services as well as care and support for those infected and affected by HIV/AIDS.

The emphasis will be placed on the prevention among youth and women of child-bearing age groups, that are particularly vulnerable to HIV/AIDS and that represent a large segment of the Sierra Leonean population. The intention is also to address the military and ex-combatants.

The contribution from the World Bank and the other above-mentioned partners is not intended to replace, but to supplement existing, planned, or proposed activities of others. The proposed four components of SHARP are:

1. Capacity Building and Policy Development this will enhance the institutional capacity to develop and implement a coordinated, multi-sectoral prevention and care HIV/AIDS campaign, based on a national strategy and action plan. It will support the assessment, restructuring and strengthening of the National HIVIAIDS Council and Secretariat for coordination and administration; assist in the development of a National HIVIAIDS strategy and Action Plan; provide advocacy training and technical support activities; and support monitoring and evaluation.

2. Multi-sectoral Responses for HIV/AIDS Prevention and Care: will support key line ministries in developing their, plans and implementing HIV/AIDS related activities for their staff and for their client group, with respect to HIV/AIDS prevention and care, including support for people living with HIVIAIDS and their dependents.

3. Health Sector Responses: will improve Ministry of Health and Sanitation (MOHS) health services related to HIV/AIDS/STIS, including management protocols, training, testing, counseling, HIVIAIDS patient care, and related improvements in delivering services. Other specific interventions will include capacity building of staff, procurement of condoms, refinement of National Health Action Plan in relationship to HIV/AIDS and STIs, and support to the development of guidelines and the strengthening of health infra-structure to make the use of Anti-Retro-Viral therapy safe, effective and sustainable.
4. Community and Civil society Initiatives: will support community - based initiatives proposed by civil society organizations and other groups for HIV/AIDS prevention, as well as care and support of people living~with HIV/AIDS and their dependents. Emphasis will be on Information, Education and Communication and Behavior Change Communications (IECBCC) campaigns, support to high risk groups and vulnerable groups subject to sexual abuse, youth related activities, and income-generating activities for People Living with HIV/AIDS and their dependents. It is expected that over 50% of SHARP resources will be allocated for these activities, highlighting the importance of this component

To date, implementation arrangements for the proposed National AIDS Control Program include the establishment of the following structures:

i. National HIV/AIDS Council (NAC) with H.E. the President as Chairman. Council members will be representatives of civil 'society and the Government in equal numbers. The composition includes ministers, NGOs, Civil Society, the private sector, representatives of religious, women, and youth groups, as well as people living with HIVIAIDS. Duties of the NAC will include overall responsibility for SHARP, as well as national performance in responding to the HIV/AIDS epidemic, including that the health sector.

ii. National HIV/AIDS Secretariat will have dual responsibilities in that it will both serve as the NAC Secretariat, but also be responsible for SHARP multi-sector activities including planning, coordination, monitoring and evaluation, and research. It will be headed by a Director who will report to the National HIVIAIDS Council. It will be administratively supported by the overall coordinating ministry, i.e., the Ministry of Development and Economic Planning, and would not be an implementing agency.

iii. the National HIV/AIDS Control Program will continue to work under the Ministry of Health and Sanitation; principally, it will carry out testing, HIV/AIDS/STIS management, and patient care.

iv. District HIVIAIDS Committees will be established in each district as the country situation warrants. Members of these committees will include representatives of Non - governmental Organizations'/ community based Organizations, representatives of principal line ministries, religious groups, women and youth, and people living with HIV/AIDS. The chairpersons will be selected from amongst the members for a one - year period, on a rotational basis.

In addition to the afore-mentioned, our Cabinet has recently established a sub-committee on HIV/AIDS to support national policy formulation.

The World Bank recently fielded an Identification Mission (3rd - 18th May 2001) headed by a lead specialist with experience in the formulation of HIV/AIDS Control Programs in the Gambia and other sub-Saharan African countries. The purpose of this Mission was to explain the MAP process and structure, to work with Sierra Leonean counterparts in gathering baseline information, developing the project design objectives, prioritizing proposed activities; formulating the financial and procurement architecture, the monitoring and evaluation systems, and to identify what further work needs to be done to adequately prepare the project. Workshops were head with line ministries to reinforce the partnership nature of the process, as well as to provide guidelines for the preparation of lime ministry project plans.

It is now accepted that if unchecked, the continued spread of HIVIAIDS will dramatically alter the country's prospects for post-conflict recovery and development It will slow the economic growth, act as a further disincentive for foreign investment, further weaken the already fragile human resource base, intensify poverty and inequality, place an enormous additional burden on the governments health budget, reduce Life Expectancy even further, and leave the next generation of Sierra Leoneans more vulnerable to the epidemic and with less hope for the future. We now know that HIVIAIDS is not just a health problem, but one that cuts across almost all sectors, and is a major link in the poverty cycle. This link, in conjunction with numerous others, must be broken if Sierra Leone is to survive and develop. This can only be achieved through the formulation of a multi-sectoral policy, with relevant strategies and activities, effectively coordinated and implemented. It is in the light of this that the Ministry of Development and Economic Planning has been designated a coordinating role in the formulation of a National HIVIAIDS Prevention and Control Plan.

Mr. President, a major breakthrough is needed in the way people who have HIVIAIDS are treated. Even if the drug cocktails were free and had no side effects, the cost of delivering these drugs and enforcing daily compliance in rural Africa would be over whelming. What is needed is an easily administered treatment vaccine that significantly reduces viral load, improves white blood cell count and enables patients to feel dramatically better, allowing them to return to a productive life and take care of their families. It is therefore, important and indeed imperative that all of us promote clinical trials using treatment vaccines.

In conclusion, Mr. President, Sierra Leone participated in the Summit on HIVIAIDS, Tuberculosis, Malaria and related Diseases held in Abuja, Nigeria 24 - 27th April 2001. One of the conclusions of this Summit is the creation of a 7 -10 Billion Dollars Global fund for HIV/AIDS, Tuberculosis, Malaria, and other related Diseases. Although Sierra Leone is just emerging from a 10 - year war that has devastated its economy, the Government hereby pledges to make a contribution even of a symbolic nature to this Fund, as an indication of our determination to control these diseases, which contribute so much to deterring the health and development of the people of the sub - region.

I thank you very much for your attention.