SECRETARY-GENERAL HIGHLIGHTS IMPORTANT PROGRESS MADE TOWARDS UNIVERSAL HIV/AIDS PREVENTION, TREATMENT, AS GENERAL ASSEMBLY OPENS TWO-DAY HIGH-LEVEL MEETING
SECRETARY-GENERAL HIGHLIGHTS IMPORTANT PROGRESS MADE TOWARDS UNIVERSAL HIV/AIDS PREVENTION, TREATMENT, AS GENERAL ASSEMBLY OPENS TWO-DAY HIGH-LEVEL MEETING
|Department of Public Information • News and Media Division • New York|
Sixty-second General Assembly
102nd, 103rd & 104th Meetings (AM, PM & Night)
SECRETARY-GENERAL HIGHLIGHTS IMPORTANT PROGRESS MADE TOWARDS UNIVERSAL HIV/AIDS
PREVENTION, TREATMENT, AS GENERAL ASSEMBLY OPENS TWO-DAY HIGH-LEVEL MEETING
Calls for End to Discrimination against People Living with HIV;
Panels: Speeding Access; Leadership in Countries with Concentrated Epidemics
United Nations Secretary-General Ban Ki-moon today applauded the “important achievements” Governments had made towards obtaining universal access to HIV prevention, treatment, care and support by 2010, and called for an end to discrimination against HIV-infected people, saying it was “an affront to our common humanity”.
“In the world as a whole, I call for a change in laws that uphold stigma and discrimination -- including restrictions on travel for people living with HIV,” Mr. Ban said, opening the General Assembly’s high-level meeting that is taking stock of progress in the implementation of the world body’s 2001 Declaration of Commitment on HIV/AIDS.
Presenting his latest report on the progress made towards the goal of universal access, he cited encouraging trends, including in the provision of health services for women and children. More mothers now had access to interventions that prevented transmission to their infants, and more HIV-infected children are benefiting from treatment and care programmes, he said.
At the same time, however, he added, six decades after the adoption of the Universal Declaration of Human Rights, it was shocking that there was still discrimination against those at high risk and such stigma attached to individuals living with HIV. “This not only drives the virus underground, where it can spread in the dark; as important, it is an affront to our common humanity,” he said.
Joining the Secretary General’s call on all countries to drop restrictions on entry to people simply because they were living with HIV, Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS) added: “It is time now to speak out and take concrete action to address gender inequality and special vulnerabilities of women, homophobia and other human rights violations that make AIDS so complex and challenging.”
He also agreed that, despite significant achievements, HIV still took the lives of some 6,000 people every day and was still the number one cause of death in Africa, even ahead of malaria. Also troubling was that the numbers of people newly infected with HIV were far and away outpacing those beginning antiretroviral drug treatments: for every two people who began antiretroviral drugs, five new people were infected. If that continued, it would be more and more difficult to build on past gains and make new headway towards universal access.
“This is why I have been insisting on a […] shift to a new phase in the AIDS response -- a forward-looking phase which treats AIDS as both an immediate crisis and as a long-wave event. This is our best opportunity to reach universal access,” he said. Moreover, pretending that AIDS “has been fixed” or that there was already enough money being devoted to the fight against it would simply condemn millions of people to perfectly avoidable deaths. He appealed for scaled-up resources for prevention, treatment and care, and making drugs available to everyone who needed them, “wherever they are, whoever they are, and whatever their lifestyle”.
General Assembly President Srgjan Kerim, who is presiding over the two-day event, said the failure to make sufficient progress in the response to HIV/AIDS profoundly impacted on all aspects of human development. Citing key Millennium Development Goal objectives, he said the international community could not make progress on reducing hunger when millions of people died of AIDS during the most productive years of their lives; nor could progress be made towards universal primary education, when, in some countries, more teachers died of AIDS than were being trained for the job.
Leadership from national Governments in prioritizing health and developing effective plans to combat disease was critical, he said, adding: “Leadership, at all levels -- international, national and local, is critical for an effective response to HIV/AIDS […] experience had demonstrated that courageous leadership at the forefront of prevention efforts contributes to a reduction in the rates of infection.” Such leadership could also ensure adequate resources were allocated and that those resources were spent prudently. Leadership also ensured that those made vulnerable by the disease were also protected, he added.
Ratari Suksma, of Coordination of Action Research on AIDS, agreed that all people must be provided with the tools they needed to combat HIV, or to treat it if they were already infected. She was from the South-East Asian region, where a women’s highest risk of HIV was through marriage. Governments in the region were well aware of that fact, and still thought the disease could be stopped by keeping people living with HIV out of their countries. Nothing could be further from the truth: the only thing such restrictions did was spread fear, increase stigma and breed discrimination.
Urging Governments to guard against legislation that criminalized the lifestyles of vulnerable groups, she called for specialized outreach, delivered with assistance from civil society organizations, which could help raise awareness about prevention and treatment methods. Among other things, she called on Governments to eliminate testing of migrant workers; pass enabling laws that made it easer to get prevention methods to people who needed them; stop treating HIV/AIDS as a separate issue and integrate it into the global reproductive health, gender and human rights agenda; make treatment affordable to ensure access to all; and let civil society “sit at the table” when decisions were made.
Following those opening presentations, in the high-level plenary, Government officials shared the strategies and results of their national programmes, as well as their international cooperation. Many speakers agreed that there was a need for a long-term track, as well as an emergency track, that gender-related efforts had to be increased and that Africa and other least developed regions remained a priority. There were also calls for increased efforts in prevention to match the advances in treatment.
In an informal civil society hearing, some 20 representatives of non-governmental organizations shared views on their individual foci with national representatives, after hearing opening statements from the Secretary-General and the Assembly President. Ending discrimination, achieving universal access to treatment and increasing support for women and children were top priority at the session.
Also today, a panel discussion was convened under the theme “How do we build on results achieved and speed up progress toward universal access by 2010 -- Moving on to reach the Millennium Development Goals (MDGs) by 2015?”, chaired by the Minister of Health and Nutrition of Sri Lanka, Nimal Siripala De Silva. A second panel, chaired by Caroline Chang, Ecuadorian Minister of Health, was themed “The challenges of providing leadership and political support in countries with concentrated epidemics”.
Speaking at the plenary today were the Heads of State of El Salvador, Togo, Mozambique, Burkina Faso, and the Central African Republic.
The Prime Ministers of Swaziland and Saint Kitts and Nevis (on behalf of the Caribbean Community (CARICOM)) also spoke, as did the Deputy Prime Minister of Viet Nam.
Ministers from Antigua and Barbuda (on behalf of the “Group of 77” developing countries and China), Mexico (on behalf of the Rio Group), Zambia (on behalf of the Southern African Development Community), Marshall Islands (on behalf of Pacific Small Island Developing States), Ecuador, Botswana, Algeria, Germany, Qatar, Austria, Bulgaria, Côte d’Ivoire, Cambodia, Sri Lanka, Honduras, Malawi, Kenya, Democratic Republic of the Congo, Guyana, Iceland, United Republic of Tanzania, Indonesia, South Africa, Portugal, United Arab Emirates, Senegal, Bahrain, Guinea, Eritrea, Liberia, Estonia, Mali, Namibia, Brazil, Monaco, Niger, Lesotho, Cyprus, Sierra Leone, Bahamas, Ukraine, Guatemala, Benin, Jamaica and Slovenia (on behalf of the European Union) also spoke.
The General Assembly’s high-level meeting to review progress achieved on HIV/AIDS will continue at 10 a.m. Wednesday, 11 June.
The General Assembly today convened a high-level meeting to review the progress achieved in realizing the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS. It had before it the Secretary-General’s report, Declaration of Commitment on HIV/AIDS and Political Declaration on HIV/AIDS: midway to the Millennium Development Goals (document A/62/780), which is based on the reports of 147 Member States on national progress in the response to HIV.
According to the report, as of December 2007, an estimated 33.2 million people worldwide were living with HIV. In 2007, an estimated 2.5 million people were newly infected with HIV and 2.1 million AIDS deaths occurred. In 2007, national surveys found that 40 per cent of young males (ages 15 to 24) and 36 per cent of young females had accurate knowledge regarding HIV -- still well below the goal of 95 per cent unanimously endorsed by Member States in the Declaration of Commitment on HIV/AIDS.
The report says that the percentage of HIV-infected pregnant women receiving antiretrovirals to prevent mother-to-child transmission increased from 14 per cent in 2005 to 34 per cent in 2007. Meanwhile, most injecting drug users and men who have sex with men lack meaningful access to HIV-prevention services. Sex workers are somewhat more likely to receive HIV-prevention services, although access is sharply limited in many countries.
More than 80 per cent of countries, including 85 per cent in sub-Saharan Africa, have policies in place to ensure equal access of women to HIV prevention, treatment, care and support, says the report. Women in sub-Saharan Africa have equal or greater access to antiretrovirals, but the reverse is true for women in countries with concentrated epidemics. Although most countries have strategic frameworks that address the epidemic’s burden on women, only 53 per cent provide budgeted support for women-focused programmes. Overall, antiretroviral coverage rose by 42 per cent in 2007, reaching 3 million people in low- and middle-income countries, approximately 30 per cent of those in need. Despite the existence of affordable treatments for tuberculosis, only 31 per cent of individuals living with both HIV and tuberculosis infection received both antiretroviral and anti-tuberculosis drugs in 2007.
The report further states that, according to recent household surveys conducted in 11 high-prevalence countries, an estimated 15 per cent of orphans live in households receiving some form of assistance, a modest increase over the estimated 10 per cent reported by high-prevalence countries in 2005. Although the number of countries with laws to protect people living with HIV from discrimination has increased since 2003, one third of countries still lack such legal protections. While 74 per cent of countries have policies in place to ensure equal access to HIV-related services for vulnerable groups, 57 per cent of these have laws or policies that impede access to HIV services. Funding for HIV-related activities in low- and middle-income countries reached $10 billion in 2007 -- a tenfold increase in less than a decade. In low- and lower middle-income countries, per capita domestic spending on HIV more than doubled between 2005 and 2007.
The report recommends that senior political leaders in countries, with the assistance of donors, technical agencies and civil society, should vigorously lead the process to ensure the implementation of policies on HIV. Although nearly all countries have national policies on HIV, most have not been fully implemented and key components of national strategies often lack any budgetary allocation. National leaders and Governments, donors, researchers, non-governmental organizations and all other stakeholders engaged in the response to HIV must begin planning for the long term, building into their efforts strategies to ensure the sustainability of the robust, adaptable and enduring collective effort that will be required over generations.
In countries where HIV prevalence exceeds 15 per cent, the report recommends national mobilization involving every sector of society. Even in countries with low levels of HIV infection, populations most at risk are experiencing an exceptionally heavy burden of disease, including substantial numbers of new HIV infections. Scaling up focused HIV-prevention strategies for populations most at risk represents an urgent public health imperative, requiring a degree of political courage and leadership that has often been lacking. Countries should urgently undertake initiatives to improve prevention, diagnosis and treatment of tuberculosis in HIV-positive individuals and to diagnose HIV infection in those with tuberculosis, even as they strengthen efforts to achieve universal access to HIV treatment, including antiretrovirals. Countries should ensure a massive political and social mobilization to address gender inequities, sexual norms and their roles in increasing HIV risk and vulnerability.
SRGJAN KERIM, President of the General Assembly, said that combating HIV/AIDS was fundamental to the United Nations quest for the “dignity and worth of the human person” and “better standards of life in larger freedom”, in the words of the Charter, which were still relevant some 60 years later. While there had been some progress towards achieving the 2010 target for universal access and attaining the 2015 Millennium Development Goal target to halt the spread of the deadly disease, that progress had not been nearly fast enough. “The failure to make sufficient progress in our response to HIV/AIDS profoundly impacts all aspects of human development,” he said, adding that the pandemic was not only a major health issue, it was at the heart of what was now being referred to as a development emergency.
By example, he said that the international community could make no progress on reducing hunger when millions of people died of AIDS during the most productive years of their lives; no progress could be made towards universal primary education when, in some countries, more teachers died of AIDS than were being trained to teach; and no progress could be made on gender equality goals and the empowerment of women when the majority of HIV-infected adults were women and infection levels among adolescent girls were still several times higher than for boys of the same age. Recalling the observations contained in the Secretary-General’s report, he said that mitigating the impact of the disease would advance the first Millennium Goal to eradicate extreme poverty and hunger, and promote Goals related to child and maternal health care, as well as to gender equality.
Further, given the devastation wrought by HIV/AIDS on the education sector, particularly in sub-Saharan Africa, combating the disease would also positively impact efforts to achieve universal primary heath care. “Improving our response to the HIV/AIDS pandemic must, therefore, become a central feature in all development efforts,” he said, calling for special attention to the pandemic in sub-Saharan Africa, which, last year, accounted for 68 per cent of adults living with the disease, 90 per cent of HIV-infected children and 76 per cent of AIDS deaths. It remained the leading cause of death among adults in the subregion, where the number of people in need of treatment continued to outstrip financial, human and logistical resources, and would fall short of the 2010 universal access target.
He went on to say that the 2001 Declaration of Commitment recognized prevention as the “mainstay of the response”, and while knowledge was critical to that end, the Secretary-General’s report made it clear that knowledge about the disease among young adults were far below targets set seven years ago. In 2007, the rate of new infections had been 2.5 times higher than the increase in the number of people on antiretroviral drug therapy, and it was, therefore, urgent to step up prevention efforts.
To that end, the situation of some vulnerable groups merited special focus during the Assembly’s two-day meeting, including children living with HIV, who were less likely to receive treatment than adults; and women and girls, who now made up some 61 per cent of HIV-infected adults in Africa. There was also a need to focus on the plight of children orphaned by the disease, he added, stressing that the world’s future was at risk if millions of children remained vulnerable to the disease or continued to live in dire poverty and hunger.
As Member States had concluded during the Assembly’s thematic debate on the Millennium Development Goals in April, success in addressing the health Goals depended on building stronger national health care systems, including better basic science and diagnostic tools. Leadership from national Governments in prioritizing health and developing effective plans to combat disease was critical, he said, adding: “Leadership, at all levels -- international, national and local -- is critical for an effective response to HIV/AIDS […] experience has demonstrated that courageous leadership at the forefront of prevention efforts contributes to a reduction in the rates of infection.”
He said leadership could also ensure that adequate resources were allocated to HIV prevention, treatment and care and that those resources were spent prudently. Leadership also ensured that those made vulnerable by the disease were also protected. As delegations conducted their deliberations, they must remember that the lives of millions depended on member States’ decisions to make universal access a reality. Finally, he said that Government leaders, members of civil society and United Nations officials must take the necessary actions to see a major turning point in the effort to combat the global HIV/AIDS pandemic.
BAN KI-MOON, United Nations Secretary-General, recalled that, two years ago, Member States had pledged to scale up towards universal access to HIV prevention, treatment, care and support by 2010. There had been some important achievements since then: by the end of last year, 3 million people had access to antiretroviral treatment in low- and middle-income countries, allowing them to live longer and have a better quality of life. More mothers had access to interventions that prevent transmission to their infants, while more HIV-infected children were benefiting from treatment and care programmes. Such progress showed that much could be achieved with enough political will and solid commitment and resources.
However, he said, there had been 2.5 million new HIV infections last year, and 2 million deaths. There were twice as many people in need of antiretroviral treatment and going without, as there were receiving it. “This situation is unacceptable,” he said. The levels of commitment and financing shown so far must be stepped up, so as to build on what had been started.
He noted that 2008 was a milestone year in several ways. In September, Member States were expected to meet again to review progress on the Millennium Development Goals, after passing the midpoint to the deadline of 2015. Halting and reversing the spread of AIDS was a Goal in itself, as well as a prerequisite for reaching almost all the others. How the world fared in fighting AIDS would impact on all efforts to cut poverty and improve nutrition, reduce child mortality and improve maternal health and curb the spread of malaria and tuberculosis. Progress towards the other Goals was critical to progress on AIDS -- from education to the empowerment of women and girls.
He said that this year also marked the sixtieth anniversary of the Universal Declaration of Human Rights. Six decades after the Declaration had been adopted, it was shocking that there should still be discrimination against those at high risk, such as stigma attached to individuals living with HIV. One of his most moving experiences as Secretary-General had been his meetings with the United Nations own group of HIV-positive staff, “UN Plus”. He expressed determination to make the United Nations a model workplace in embracing all staff living with HIV. Meanwhile, in the world as a whole, he called for a change in laws that upheld stigma and discrimination, including restrictions on travel for people living with HIV.
Finally, he paid tribute to Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), who would be leaving the United Nations. He said Dr. Piot had been a tireless leader in the response to AIDS since the earliest days of the epidemic, and had shaped UNAIDS into a living example of United Nations reform. The world needed more leaders like Dr. Piot in every sector of society, to carry on the fight against AIDS.
PETER PIOT, Executive Director of UNAIDS, said the world was finally starting to see real results in the fight against AIDS and in ensuring universal access to treatment in almost every region -- results that many said would never be seen because of, among others, denial of the disease, lack of finances and not enough medicines. “Imagine what would have happened to those 3 million people now taking antiretroviral drugs if we had waited to mount a defence against the disease,” he said, stressing that those persons would almost certainly had died.
At the same time, he said, there was still a long way to go. Especially since the virus continued to take the lives of some 6,000 people every day and it was still the greatest cause of death of adults in Africa, even ahead of malaria. Also troubling was the fact that, for every two people who began antiretroviral drug treatments, five new people were infected. If that continued, it would be more and more difficult to build on past gains and make new headway. It was, therefore, necessary for the international community to change its way of thinking and treat AIDS as both an immediate crisis –- which indeed it was -- and as a long-wave event. That was the best way to achieve universal access.
There was a real danger in keeping up a “business as usual” attitude about the breadth and depth of the pandemic, he continued. Pretending that AIDS “has been fixed”, that there was already enough money being devoted to the fight against it, or that it was not a heterosexual pandemic was a recipe for condemning millions of people to death. The international community could –- and must -- back up its commitments by first scaling up access to health and health care. It must also scale up resources available for research and development into new lifesaving drugs and treatment methods. It must also make drugs more affordable to all the people who needed them, “wherever they are, whoever they are and whatever their lifestyle”.
There must also be an urgent intensification of HIV prevention efforts, he said, emphasizing that there was no simple shortcut and that success against the pandemic required multiple-track interventions, while moving ahead with research. Prevention efforts needed to reach all people, including men having sex with men, drug users and sex workers. There also needed to be further study into the close links between HIV and tuberculosis, maternal and child health and sexual and reproductive health programmes. “Moreover, if we can provide every teenager around the world with access to HIV prevention –- ranging from sex education through programmes to promote mutual respect between boys and girls, to access to HIV prevention -- we’ll be well on the way to a generation of HIV-free adults,” he added.
“It is time now to speak out and take concrete action to address gender inequality and special vulnerabilities of women, homophobia and other human rights violations that make AIDS so complex and challenging,” he said, stressing that stigma and discrimination around AIDS remained as strong as ever. He joined the Secretary-General in calling on all countries to drop restrictions on entry to people simply because they were living with HIV.
He said that, while many people seemed to believe that enough money was being made available to fight the disease, that was not the case. The Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President’s Emergency Plan for AIDS Relief were making a real difference, but the sobering reality was that the overall international response to the pandemic remained seriously underfunded. In fact, in 2007, there had been a shortfall of some $8 billion. If the international community wanted to get anywhere near universal access to HIV prevention, treatment, care and support, the world would need to significantly increase investment.
In addition, he said, stakeholders must keep prioritizing the UNAIDS mantra of making the money work for people. There were still many areas where unit costs of delivery could be reduced, local ownership strengthened, coordination improved and accountability increased. Finally, he said, the 2001 special session had marked a historic turning point in the global response to AIDS and triggered political leadership, funding and action on the ground. AIDS might be one of the defining issues of the time –- but it was clearly now a problem with a solution. Equally clear, however, was the fact that achieving that solution would take time and it was going to be a long, tough job. “The challenge to us all now is to stay the course right through to the very end and never give up,” he said.
RATRI SUKSMA, Coordination of Action Research on AIDS, said she was from the South-East Asian region, where a women’s highest risk of HIV was through marriage. Governments in the region were well aware of that fact, and still thought the disease could be stopped by keeping people living with HIV out of their countries. Nothing could be further from the truth; the only thing such restrictions did was spread fear, increase stigma and breed discrimination.
She said that authorities in her country said there was a “concentrated epidemic” among populations –- drug users, sex workers and men having sex with men, many of whom were married -- that were often denied access to treatment, care and support. “Are we not all human and deserving of equal treatment and access?” she asked. Indeed, the truth was that, if HIV infection in one specific group was allowed to go unaddressed, the spread of the virus could never be stopped among the general population. Criminalizing certain behaviour only pushed people underground and made them afraid to come forward and report infections or receive treatment. She urged Governments to guard against legislation that criminalized the lifestyles of vulnerable groups.
She went on to say that all people must be provided with the tools they needed to combat HIV or to treat it if they were already infected. While Governments must reach out with specialized care, non-governmental organizations could also help in raising awareness about prevention and treatment methods, as well as care facilities. Among other things, Governments must eliminate testing of migrant workers; pass enabling laws that made it easer to get prevention methods to people who needed them; stop treating HIV/AIDS as a separate issue and integrate it into the global reproductive health, gender and human rights agenda; make treatment affordable to ensure access to all; and let civil society “sit at the table” when decisions were made.
Telling the Assembly she was HIV positive, Ms. Suksma said that revelation put at risk her entry into at least 70 countries around the world. She also risked being stripped of her property and everything she owned. When she had discovered her status, it was thought in her country that only sex workers and drug users got the disease; she was neither. As a woman and mother, she called for her human rights to be protected, as well her right to own property. She needed protection against violence, and to manage and control all matters related to her sexual and reproductive health.
ANTHONY S. FAUCI, Director, National Institute of Allergy and Infectious Diseases, National Institutes of Health, United States Department of Health and Human Services, recalled that the first cases of AIDS had been reported in five gay men in Los Angeles 27 years ago. “As we have sadly witnessed, AIDS has turned into one of the most devastating scourges in human history, and its full impact has yet to be realized.” Most cases occurred in poor countries, where HIV/AIDS was superimposed on other problems, such as poverty, food insecurity, lack of clean water and sanitation and endemic infections such as malaria, tuberculosis and parasitic diseases.
He said that the early days of AIDS “were the darkest of my professional career”. But, with the discovery of HIV as the cause of AIDS in 1983, “an extraordinary and breathtaking” scientific odyssey had been launched. Basic research had unlocked many mysteries relating to the disease and facilitated the development of nearly 30 life-saving drugs. As with most diseases, the developed world benefited first from those developments, and the implementation gap between discoveries and delivery to people in the developing world, who needed them most, was most dramatic in the provision of anti-HIV drugs. Heroic work had been done to make those drugs available. Yet, just 30 per cent of HIV-infected people in low- and middle-income countries were receiving treatment.
Some had argued that providing universal access to therapy was futile, he said, because they believed that the virus would develop resistance to those drugs. The answer to that dilemma was to develop new and better drugs, not to withhold therapy and care. It also meant performing research that would guide best practices appropriate for resource-poor settings to minimize the emergence of drug resistance. Significant resources were needed to train doctors and nurses in resource-poor areas, because the shortage of trained health-care workers was an important limiting factor in efforts to scale up services. Medication alone rarely solved problems. But, AIDS services needed not compete for scarce resources required for other diseases. Rather, it should serve as an opportunity for synergy in addressing the multitude of health problems besetting so many poor nations and communities.
He said that striving for universal access to AIDS therapy and related services was imperative, but it was impossible to achieve that Goal, since newly acquired infections outstripped the ability to treat everyone infected with HIV. In 2007, two more people had become newly infected for every person put on treatment. “The solution is prevention,” he said, hopefully with, but possibly without, a safe and effective vaccine. Since only one fifth of people at risk of HIV infection had access to preventive approaches such as condom distribution, prevention of mother-to-child transmission, provision of clean needles and others, those preventions must be applied more widely, especially if they were documented to be successful. For example, recent studies in Africa had shown that adult male circumcision could help prevent men from becoming infected through heterosexual intercourse. The spread of HIV infections was also linked to the lack of empowerment of women; ongoing research to develop microbicidal gels offered hope of empowering women to protect themselves.
Regarding an HIV vaccine, he said the top candidate had so far proven ineffective when clinically tested. Continuing the search for that vaccine demanded intense resolve, even as treatment and non-vaccine prevention efforts were being ramped up. “In summary, during the first 27 years of the AIDS pandemic, much has been accomplished, but we are sobered by the many challenges that remain.” Meanwhile, continuing to develop interventions and delivering them to the people who needed it -– regardless of where they lived –- would require political will, long-term financial commitment, scientific and public health vision and dedication from all sectors of society.
ELÍAS ANTONIO SACA GONZÁLEZ, President of El Salvador, said his country had taken various measures to ensure universal and free distribution of antiretroviral drugs to anyone needing them. Decentralized hospitals were equipped with highly qualified multidisciplinary medical and paramedical personnel, leading to a reduction of deaths among HIV/AIDS patients by 35 per cent. There had also been a reduction in the deaths of those suffering from both AIDS and tuberculosis by 30 per cent. Because of the 90 per cent increase per year in the number of pregnant women being tested, the number of children infected by HIV/AIDS, which had stood at 150 five years ago, had been reduced to 15.
He stressed the importance of promoting respect for the human rights of migrants. As such, he believed the discriminatory burden placed on people travelling with HIV/AIDS was unacceptable. Such restrictions were not new, but the number had increased, now being instituted in more than 70 countries. He called on leaders of the world to turn down restrictions that hampered the free transit of persons living with HIV, and hoped the General Assembly would make a firm recommendation in that regard. El Salvador had eliminated such restrictions four years ago.
“With HIV/AIDS, there is no truce, neither budget nor time,” he said. The Latin American and Caribbean region only received 8 per cent of world aid to combat the disease. Thus, it was important that donors approached middle-income countries such as those with the same vision and solidarity as that shown in other contexts.
FAURE ESSOZIMNA GNASSINGBÉ, President of Togo, said that, while his country had been battling a relatively high prevalence of HIV infection, recent trends had revealed that the numbers were stabilizing. Togo had been able to make headway with the help of programmes launched with its partners. At the same time, the Government had been able to devote on its own the necessary financing to ensure the distribution of necessary antiretroviral drugs. Togo had launched a national AIDS health plan, specifically targeting sex workers and other vulnerable groups.
The plan would also target the education sector and the workplace with information awareness campaigns, he said. In that effort, the Government would need the support of donor partners and the wider international community. To that end, he called for the easing of restrictions on accessing the resources of the Global Fund to Fight AIDS, Malaria and Tuberculosis. He thanked the donor community for its help and called on all nations to come together to fight the spread of the disease. Indeed, the AIDS pandemic was a development challenge as great as any other and needed to be tackled with the full commitment, dedication and application of resources of the entire international community.
ARMANDO EMÍLIO GUEBUZA, President of Mozambique, said a presidential initiative on HIV and AIDS had been launched in his country in February 2006. Meetings had been held with women, religious leaders, business people, community leaders and youth. That initiative had been replicated at provincial and district levels, and by various public and private institutions. People could now talk more freely and openly about AIDS; the rate of infection had gone down in some places; and more people volunteered for testing and counselling. Through the commitment of the Government and its partners, tangible strides had been made in scaling up access to, and delivery of, HIV care and treatment. Compared to 6,000 people reached in 2005, over 100,000 people were able to benefit from antiretroviral therapy in 2008. From an initial 21 health facilities at the end of 2004, there were presently 215 health units that offered antiretroviral therapy. Children had access to 170 of them.
He said the fact that more people were aware of the dangers posed by AIDS did not translate into a scaling down of the infection rates, however. For that reason, the country had established a task force, chaired by the Minister of Health, to study how prevention efforts could be made more effective. With the help of its partners, Mozambique would hopefully be able to strengthen its integration of HIV-tuberculosis activities, as well. He called on all Member States to rededicate themselves to defeating HIV/AIDS and other killer diseases.
BLAISE COMPAORE, President of Burkina Faso, said his country’s National Council on HIV/AIDS had been holding regular meetings and had been sharing with other countries of the subregion its experiences in combating the disease. That effort had ensured that countries of the region were “not in it alone” and had led to the establishment of a regional framework for action. He added that Burkina Faso had also stepped up national efforts to prevent the transmission of the disease from mother to child and had, to that end, dramatically increased the number of health centres around the country dealing with that matter.
At the same time, the country was still dependent on the international community for nearly 70 per cent of the resources it needed to combat the disease, he said. There was also a need to ensure more targeted funds to support regional and subregional initiatives, especially those focused on combating tuberculosis, which was the number one killer of people living with the virus. Finally, paying tribute to all those living with HIV/AIDS or caring for people with the disease, he said it was time for the international community to reaffirm its commitment to wiping out HIV/AIDS, and ending discrimination against and scaling up care for those living with the virus.
FRANÇOIS BOZIZÉ, President of the Central African Republic, said the HIV/AIDS problem existed amid a backdrop of simultaneous energy, food and environmental crises. The high prevalence of HIV among 15 to 49 year olds in his country had made it one of the most affected in central Africa. That was due to ignorance among the population regarding the disease, despite the Government’s efforts to educate them about transmission and prevention. The Government had also found it difficult to encourage people to seek voluntary testing. Efforts to stem mother-to-child transmission had largely been ignored, and people living with HIV faced discrimination.
He said the national response plan against HIV/AIDS was part of the country’s Poverty Reduction Strategy Paper, which had received much support from the United Nations. Meanwhile, the National Committee for Combating AIDS involved members of civil society, the private sector and the country’s development partners to reduce the transmission of HIV/AIDS from 2006 to 2010, as well as to improve the living conditions of people living with HIV/AIDS and create an enabling environment to tackle the disease. The National Committee’s operational plan and national monitoring and evaluation plan allowed the country and its partners to apply the “Three Ones” promulgated by UNAIDS [one agreed AIDS action framework, one national AIDS coordinating authority and one agreed country-level monitoring and evaluation system]. The National Assembly had adopted a law specifying the rights of people living with HIV/AIDS, and had a better understanding about the risky behaviour among young people with regard to multiple partners.
Refugees and displaced persons were also vulnerable to the disease, he said. Years of instability linked to political and military crises had made the spread of HIV/AIDS more likely, meaning that more attention must be paid to displaced populations in post-conflict zones. Support was sought from the international community not just to consolidate peace, but also to strengthen the social fabric and to stop AIDS. He asked the World Bank to implement the Africa Multi-Country HIV/AIDS Programme in his country.
ABSALOM THEMBA DLAMINI, Prime Minister of Swaziland, said his country was among those hardest hit by the virus, with some 26 per cent of the population between the ages of 15 and 49 infected with HIV. Nevertheless, Swaziland had made great strides in its national response to the pandemic through the coordinated efforts of the Government, bilateral and multilateral partners, private donors, non-governmental organizations and support groups of people living with HIV, among other community groups. The rate of infection among people under 25 had decreased markedly and prevalence rates among the 15 to 19 age range had gone from over 32 per cent in 2002 down to 26 per cent in 2006.
He went on to say that HIV testing and counselling continued to be an integral component of Swaziland’s national strategy. That was the entry point to prevention, treatment and care and support services. It was also a vital ingredient in reducing the stigma and discrimination associated with HIV/AIDS. Data showed that, as of 2007, some 25 per cent of the population had been tested and now knew their HIV status. Swaziland’s target for 2010 was for at least half the men and women in the 15 to 49 age bracket to know their status. Among other things, he stressed the Government’s commitment to strengthening antiretroviral treatment, patient follow-up and drug management systems, including the capacity for laboratory services and overall resources for health. The Government was also working to provide support for vulnerable children and orphans, as well as elderly persons.
DENZIL L. DOUGLAS, Prime Minister of Saint Kitts and Nevis, speaking on behalf of the Caribbean Community (CARICOM), said 21 countries of the Caribbean had submitted assessment reports on their progress in achieving the key indicators adopted at the 2006 special session on HIV/AIDS. Considerable political leadership had been mobilized in the region, resulting in new health financing to scale up the response within countries and in the region as a whole. In doing so, it had benefited from the support of various partners, including UNAIDS. In the Caribbean, AIDS knew no borders, and its component countries were always looking for ways to use their limited resources as efficiently as possible. Indeed, an essential prerequisite for universal access to AIDS care in the region was a stronger health system.
He expressed commitment to a country-led process in mounting an AIDS response, but voiced a need for support from technical agencies and development partners. He made a series of pledges to the Assembly, on behalf of CARICOM, to scale up HIV programmes and services; to keep AIDS a high political priority in the region; to secure funds to make headway towards universal access and to overcome the weak capacity of the health and social sectors; and to work with all members of society to achieve those aims. He pledged to continue looking on AIDS as a long-term priority, as well as an emergency requiring immediate attention. Joining forces to combat the disease was critical to the region and, indeed, the world.
TRUONG VINH TRONG, Deputy Prime Minister of Viet Nam, said that a serious and broad-based scaling up of efforts to halt the spread of HIV/AIDS was necessary if the international community was to meet the relevant Millennium targets in health and access to health care. To that end, due attention must be paid to, among others, vulnerable populations and those at high risk of exposure to HIV; combating all forms of discrimination; and strengthening the global long-term response to the pandemic.
For its part, the Vietnamese Government had called for a full-scale mobilization of ministries, agencies, political and social organizations and civil society to address the epidemic. It had also adopted legislation on prevention, as well as action plans as the foundation of a thorough legal framework for implementation at various levels. However, despite the success of those and other efforts, including boosting antiretroviral treatments, Viet Nam’s response still faced some challenges, including the need to further expand its coverage of harm-reduction programmes –- condom distribution, needle exchange and methadone treatment –- as well as access to HIV prevention, treatment care and support services.
He said there was also a need for a strong monitoring and evaluation system to conduct science-based analysis of the epidemic and make comprehensive assessments on the effectiveness of intervention programmes. That could lead to the development of appropriate polices and action plans in a timely manner. While there was also a need for more resources from international donors, Viet Nam was also making every effort to broaden its international cooperation and earnestly hoped to receive continued financial and technical assistance for implementation of its national strategy for HIV/AIDS prevention.
Civil Society Hearing
SRGJAN KERIM, President of the United Nations General Assembly, welcomed the representatives of civil society and reiterated that the epidemics under discussion were not only a major public health issue, but also a development emergency with a direct impact on the achievement of the Millennium Development Goals. Dealing with the issue demanded partnership among Member States, the United Nations system, the scientific community, the private sector and civil society.
He stressed that, while the partnership had achieved much, it must be further strengthened and commitments made must be translated into concrete action. Civil society participation was a vital link between policy and implementation. He thanked the Civil Society Task Force and UNAIDS for their rigorous work in guaranteeing that the speakers on the panel represented the priorities of diverse constituencies worldwide. Although such diversity might exist, there was agreement on the importance of achieving universal access by 2010, as emphasized in the 2006 political declaration. Hopefully, today’s meeting would reinforce efforts to reach that crucial goal.
MARK HEYWOOD, International Council of AIDS Service Organizations (ICASO), and Deputy Chairperson, National AIDS Council of South Africa, said the world was failing many people as human rights violations that increased the risk of HIV/AIDS got worse. Hundreds of thousands of children were still being born with HIV infection and people were dying in squalid prisons infested with tuberculosis. Women and girls continued to be raped, while in Zimbabwe, China and other countries, people fighting for human rights found themselves victims of their own Governments.
Calling for an end to the suppression of civil society leaders by oppressive Governments, he noted that, in the last 20 years, nearly one third of United Nations Member States had adopted constitutions that protected human rights. However, those legal commitments were meaningless unless they were implemented. Governments must live up to the standards they set on paper, and civil society could not just pay lip service and hold conferences. Civil society leaders must work with and assist Governments, but they should not trust Government promises.
Pointing to a direct link between civil society action and human rights protection, he said it had taken South Africa several years to end the exclusion of people with HIV and AIDS from public positions. Some officials still persecuted doctors who carried out recommendations of the World Health Organization (WHO) on mother-to-child transmission of HIV and maternal mortality. Civil society must recognize that human rights must be demanded, fought for and won through legal action, education and empowerment.
He called on Governments to recognized civil society organizations as equals, and on the United Nations to end its policies of “quiet diplomacy” when dealing with brutal Governments. “Human rights will not be realized when they’re delivered in email declarations from New York,” he said, urging Governments to demand an urgent increase in development aid, particularly from Organization for Economic Cooperation and Development (OECD) countries. Such an increase was a human rights duty. There should also be open denunciation of countries like Zimbabwe which violated their citizens’ right to health.
BAN KI-MOON, Secretary-General of the United Nations, describing civil society workers as the vanguard in the fight against HIV/AIDS, said the role of national Governments was to protect the rights of all citizens, yet many were failing in their responsibilities as discrimination blocked universal access to HIV treatment by 2010. “We must do more to eliminate all discrimination against people living with HIV and uphold their rights, including the right to health, the right to work and the right to travel.”
He said one of his most rewarding experiences as Secretary-General had been his meetings with United Nations-Plus, the Organization’s own group of HIV-positive staff. He expressed his determination to make the United Nations a model workplace, embracing them and all staff living with HIV, and also paid tribute to all those assembled who had led the struggle for the past decades, while applauding the emerging new leaders of the next phase, which required an approach combining here-and-now emergency tactics with strategic long-term thinking. “We must keep our foot on the accelerator and navigate the longer road map at the same time,” he said.
The following panellists participated in the civil society hearing: Gulnara Kurmanova, International Women’s Health Coalition (IWHC), Kyrgyzstan; Leonardo Sanchez, Amigos Siempre Amigos, Dominican Republic; Albert Zaripov, ICASO, Russian Federation; Winnie Sseruma, World Council of Churches, United Kingdom; Silvia de Rogama, Positive Women of the World, Mexico; Stephanie Raper, Global Network of People Living with HIV (GNP+), Australia; Loon Gangte Hemnilun, GNP+, India; Gracia Violeta Ross Quiroga, Bolivian Network of People Living with HIV/AIDS, Bolivia; Gary Cohen, Becton Dickinson, United States; Romano Ojiambo-Ochieng’, ICASO, Uganda; and Alessandra Nilo, GESTOS, Brazil.
Ms. KURMANOVA said women sex workers were subject to violence and human rights violations that made them more vulnerable to HIV/AIDS. In order to assist them, sex work should be decriminalized, their human rights protected and stigma and prejudice against them combated. Sex workers should be allowed to participate in making policies that concerned them. “Sex workers are not part of the AIDS problem; sex workers are part of the solution.”
Mr. SANCHEZ said the killing of homosexuals in Latin America and the Caribbean had become a critical problem, often based on religious grounds. Less than 1 per cent of resources for HIV were allocated to gay men and men who had sex with other men. That was a violation of human rights and showed how stigma and discrimination could feed a global health crisis. It was estimated that between 7 per cent and 46 per cent of HIV/AIDS carriers were sexual minorities. Transgender rights were limited and authorities and decision makers were not allowing those communities to become involved in planning sexual health and reproductive health services. Women who had sex with other women were also vulnerable. Member States should commit technical and financial resources in addition to holding inter-institutional dialogues to empower sexual minorities.
Mr. ZARIPOV said he and his close friends had begun using drugs in 1996, a time when there had been just one local drug-rehabilitation programme, and when police persecution of drug users was to be feared. After becoming HIV-positive he had learned about the only treatment programme and now worked for it to help others.
Despite getting his life together, he was stigmatized as a drug addict and all his friends continued to be drug addicts, some of them having died and all having contracted hepatitis, he said. Such stories were typical around the world. Despite evidence of the benefits of harm-reduction therapies, they remained unavailable to those in need, particularly those who were HIV-positive. Universal access to treatment was essential and drug policies must take health and human rights into account.
Ms. SSERUMA said the disproportionate impact of HIV/AIDS on women and girls was due to a range of discriminatory factors, in addition to lesser access to treatment and prevention assistance. More concrete steps were needed to ensure the participation of women and girls in planning and policymaking for care and assistance, as well as greater protection of women from violence and other human rights violations. Other measures should include greater support for care takers and migrants, and the lifting of restriction on the rights of people with HIV/AIDS.
Ms. ROGAMA, saying it was “unthinkable, unacceptable and a crime in progress” for infected women and infants in developing countries not to have universal access to care, urged the global community to provide holistic care and support to women and children.
Ms. RAPER said that, as a young person living with HIV and lucky to have grown up because many had not, said many others lived in foster homes or with parents who did not want them. Heavily stigmatized, they felt relieved to attend camp with other young people in similar situations and to be accepted among their peers. It was also necessary to eradicate prejudice among school officials against HIV-positive students, to ensure greater access to programmes against mother-to-child transmission, and to protect the rights of young people with HIV.
Mr. GANGTE HEMNINLUN said three million people living with HIV were on antiretroviral therapy today, a significant achievement, but seven million people still awaited treatment. Some countries reported 70 per cent coverage, but others had just 7 per cent. That was not good enough to reach universal coverage by 2010, as required by the Millennium Development Goals, and the world needed a better system to fight HIV. Anti-HIV programmes must be comprehensive, preventing mother-to-child transmission and simultaneously fighting HIV, tuberculosis and hepatitis. Comprehensive budgetary action plans were needed to achieve universal coverage by 2010.
Ms. ROSS QUIROGA said that, like her, many people living with HIV were subjected to coercive measures, such as mandatory testing, denial of visas to travel abroad and deportation. At least half the countries participating in the current meeting imposed travel restrictions on people living with HIV, which fuelled discrimination, portrayed people living with HIV as enemies and denying them participation in the response to HIV. Member States should end all travel restrictions, which could be interpreted as xenophobic measures rather than health measures. Even migratory birds had protections while travelling between countries and human beings living with HIV deserved the same.
Mr. COHEN said it was important for the business sector to be part of the global response to HIV/AIDS, through public-private partnerships. Many companies had policies for prevention, antiretroviral treatment and protecting people with HIV/AIDS from discrimination in the workplace. Some were active in diagnostic testing, including in 58 developing countries, and were funding prevention and treatment programmes for workers. The business sector could have a significant impact in treating HIV, but it should do more.
Mr. OJIAMBO-OCHIENG’ said that, even as he spoke, millions of workers with HIV were going to their jobs, many of whom were facing discrimination and many others dying. HIV/AIDS was definitely a workplace issue and a central development issue. The workplace was also a key entry point for health intervention and labour unions were well placed to protect workers and ensure they received the care they needed. More support was needed for workplace and union-based programmes to combat HIV/AIDS. “We can all work together to make our workplaces safe and healthy.”
Ms. NILO pointed out that, while civil society was obliged to provide services that should be provided by Governments, it was excluded from opportunities to monitor Government performance. Governments could not be counted upon to monitor their own services and today’s meeting must therefore forge a new accountability framework that would integrally include civil society and not be a mere rubber-stamp for reports at all levels.
Representatives of Member States and organizations then addressed the hearing.
A representative of Burkina Faso said the stigma of HIV often led to the extermination of human beings. Denying people access to treatment, as in Gambia and other sub-Saharan African countries, led to death or resistance to eventual treatment.
A representative of Norway said more than 70 countries imposed travel restrictions on people with HIV. Those who suffered most were the thousands of people who needed to travel to find work, including migrant and prospective migrant workers. Norway called for the immediate lifting of such restrictions.
A representative of South Africa, stressing that his country’s Constitution guaranteed its citizens the right to health care, encouraged civil society organizations to work with Governments to ensure the sustainability of the programmes they initiated.
A representative of Peru said that as a sex worker she had been subjected to violence for many years and today there was still no awareness of how sex workers were affected by violence. More empowerment and better sexual rights for sex workers were needed. Condoms for women were as important as condoms for men. A woman guaranteed sexual rights would find it easier to exercise all her other rights.
A representative of the United Kingdom said travel bans served no purpose and called on the United Nations to ensure that they were lifted by 2010. The rights of a European Union citizen were well documented and migrants deserved the same rights.
A representative of Cuba said it was her Government’s priority to care for those infected and to ensure they had full rights. Barriers must be overcome worldwide until all persons could live with full dignity.
A representative of the Netherlands said the fight against discrimination should be at the heart of all HIV/AIDS policies.
A representative of the International Council of AIDS Services Organizations (ICASO), recounting the disturbing experience of finding out he was HIV-positive in the Philippines, said comprehensive options were needed for young people in the areas of prevention, care services and living with HIV. Another ICASO representative stressed that financial resources lay at the heart of the struggle to provide universal access. Developed countries must provide adequate support for the Global Fund and developing countries must support their national programmes according to their best means.
A representative of Zimbabwe said the operational space given to non-governmental organizations had been shrinking, threatening to reverse all the progress made in recent years.
A representative of Argentina said that imprisoned HIV-positive people should enjoy their full human rights and be included in prevention and care programmes. They must not be allowed simply to die.
A representative of Germany seconded the need for programmes in prisons, including the distribution of clean needles and condoms, and treatment.
MOROLAKE ODETOYINBO, Global Network of People Living with HIV/AIDS (GNP+, Nigeria) and the Civil Society Task Force, said, in concluding remarks, that human rights abuses were a betrayal of the promise of Governments to govern. Sex workers were harmed and harassed, but sex work must be identified as legitimate. Sex between two consenting adults, regardless of sexual identify, deserved to be treated fairly. Drug rehabilitation programmes were necessary, but stigmatization was not.
The fastest-growing HIV infection rate was among newly married women, he said, adding that younger girls were also carrying the HIV burden. The part of the world in which one lived should not determine one’s access to treatment, but that was unfortunately now the case, with seven million people awaiting treatment. HIV was not just a disease of the poor. The world needed comprehensive care, prevention and treatment programmes. Without universal standards, universal access could not be achieved.
ASHA-ROSE MIGIRO, Deputy Secretary-General of the United Nations, concluded the discussion by assuring those assembled of her own commitment as well as that of the Secretary-General and the entire United Nations system to work with determination in addressing the concerns expressed today. No stone would be left unturned in meeting the challenges. “United we stand, divided we fall.”
Panel Discussion I
The panel on “How Do We Build on Results Achieved and Speed Up Progress towards Universal Access by 2010 -– Moving on to Reach the MDGs by 2015?” was chaired by Nimal Siripala de Silva, Minister of Health and Nutrition of Sri Lanka, and included the following panellists: Nilcea Freire, Minister of Women’s Affairs of Brazil; Lydia Mungherera, AIDS Service Organization (TASO) of Uganda and founding Member of the Uganda Business Coalition on HIV/AIDS; and Margaret Chan, Director-General of the World Health Organization (WHO).
Opening the panel, Mr. SIRIPALA lauded the fact that the “3 by 5 initiative”, which called for having 3 million people on antiretroviral therapies by 2005, had been reached. It showed that, with determination, results could be achieved. The 2008 Secretary-General’s report confirmed that most countries had made good, but varied progress in responding to the HIV epidemic, particularly in terms of antiretroviral therapy. At least another 6 million people needed treatment, raising serious concern as to whether universal access to treatment and the health-related millennium targets could be achieved.
The panel must address the issue of much-needed national policy and coordination, he said. Increased and sustainable financial resources were needed for AIDS-related programmes. Many countries had indicated that they faced such challenges as obtaining sustainable financing, strengthening health systems and affordable commodities, as well as countering stigma and discrimination and the lack of integration of HIV into key services. Panellists should discuss strategies to overcome those obstacles. Key at-risk populations must be recognized in national programmes. It was also essential to critically examine legal and legislative frameworks in order to provide people infected with HIV with necessary protections, as well as to create comprehensive regional and global mechanisms for price negotiations and cost-effective procurement of HIV-related commodities. Participants should also discuss how Governments could involve civil society more widely in scaling up towards universal access to treatment.
Ms. FREIRE pointed to the adoption of the Global Strategy on Public Health, Innovation and Intellectual Property, calling it a major breakthrough for public health that would benefit millions of people. In analyzing the Secretary-General’s report, she noted that many countries had made progress, but she asked if such results were sustainable. Brazil was one of nine developing countries that had reached 80 per cent treatment coverage. She lauded the fact that several countries’ reports pointed to inequalities between men and women as obstacles to stopping the pandemic. Specific segments of the population had specific needs, which deserved specific strategies. Her Ministry had launched an integrated plan in 2007 to create federal, provincial and municipal action to fight the HIV/AIDS epidemic and other sexually-transmitted diseases among women and girls, and among homosexuals and transgender people. Brazil had also benefited from an integrated and intersectoral approach to fighting the epidemic.
She said achieving greater results required broader access to quality health and reproductive services, as well as prenatal and gynaecologic treatment, fighting poverty, improving the population’s educational level and fighting regional inequalities, as well as inequities in gender, race and ethnicity. Technical and financial cooperation among nations was also critical to curbing the pandemic. In the last two years, the international community had taken important steps to overcome the barriers that impeded access to good quality antiretroviral drugs and laboratory supplies. However, much more remained to be done. She stressed that, according to WHO and UNAIDS, only 30 per cent of patients in need of treatment worldwide received it. Last year, Brazil’s Government bought generic antiretroviral drugs to ensure long-term sustainability of universal access to treatment.
Ms. MUNGHERERA said that, while countries were making progress in scaling up HIV services, almost 7 million people would die due to a lack of access to antiretroviral drugs. As the world celebrated the sixtieth anniversary of the Universal Declaration of Human Rights, HIV policies and programmes must be consistent with human rights standards and laws in order to achieve universal access to treatment by 2010. Stigma and discrimination still blocked people’s access to services, particularly vulnerable groups such as the disabled, sexual minorities, migrants, commercial sex workers and young women. Gender inequality also drove the pandemic. Substitution drugs and clean needles were not available, or were illegal in many countries. That must be addressed, since injection drug users comprised 10 per cent of HIV infections globally. Evidence-based public health initiatives must take priority over those driven by moral and political ideologies.
The engagement of communities was a key to scaling up access to treatment, she continued. People living with HIV and civil society played a critical role in reaching out to and representing the needs of marginalized populations. Social support policies that enabled communities to carry out that role effectively must be put in place urgently. Standards of care, treatment and support must be consistent among regions. Building health systems infrastructure, such as clinics and laboratories, ensuring adequate human resources and managing the drug supply were keys to strengthening health systems. There must be no drug stock-outs, including of drugs to prevent mother-to-child transmission. Better, less toxic drugs were available, but they were not affordable for resource-constrained countries, especially in Africa where the pandemic was raging. The recent explosion of drug-resistant tuberculosis was a global emergency that must be addressed through more integrated HIV and tuberculosis programmes and investment in research for new drugs and a tuberculosis vaccine. Several countries did not utilize scaling up capacities, because they feared they could not sustain programmes. That was unacceptable. Donors must support countries with sustainable and predictable financing.
Ms. CHAN said national targets were essential to building on results and speeding up progress towards universal access to treatment. They would also stimulate countries’ drive to aim high and to learn lessons and increase accountability. A total of 108 countries had set targets for universal access and that had helped them prioritize and set strategies. She stressed the importance and power of evidence on policy formulation and priority-setting. Resources helped support results-based accountability. Experience showed that progress could be very rapid. For example, Ethiopia had successfully tripled its coverage of HIV testing and counselling in just one year, thanks to declining costs of testing and treatment, as well as other factors. In addition to national plans, targets and price setting, it was important to take a hard look at the realities and to create mechanisms to address them. Funding must be predictable and sustainable.
Several reports showed that countries were reluctant to scale up programmes without the assurance of predictable, sustainable funding, she continued. The need for treatment was life-long. A stockpile of medicines was needed. Addressing stigma and discrimination, both huge obstacles, was also essential, as was broad investment in human resources and infrastructure, including in supply chains and laboratory services. The potential synergy created by integrated services must also be exploited. Programmes should be tailored to the needs of each community. What worked in one country may not be appropriate in another. The leadership role of national authorities must be safeguarded, she said, stressing the importance of staying ahead of the curve and making use of the lessons learned and food for thought provided by the HIV pandemic’s evolution over the last 27 years. Indeed, progress had been made, but the world was still falling far behind. “We must not slip on this extremely important pandemic, which has huge implications for gender and development in many countries,” she said.
During the ensuing question-and-answer period, several participants from regions worldwide pointed to the need to strengthen health systems, as well as to address barriers for people trying to gain access to health services. Drugs and commodities were necessary to address specific epidemics. A representative of the United Kingdom suggested that clear health-care delivery targets be set, such as calling for a certain number of midwives per rural populations. Many participants also underscored the need for universal access to treatment. Representatives from the Russian Federation and Venezuela, among others, shed light on their Government’s success in providing universal or near universal access to treatment free of charge, as a basic human right.
Afghanistan’s representative warned that countries like his with low infection rates should not be lax in their approach to the epidemics, as risk factors -- such as high infection rates from neighbouring countries as well as infection among injection drug users and sex workers -- could cause rates to rise, if not dealt with properly. A few speakers implored developed nations to provide more aid to their developing country counterparts in the health-care field. Indeed, they said, Governments should not be reluctant to invest in research, testing and prevention programmes and they must be held accountable by global leaders and civil society. Participants also agreed that education played a tremendous role in prevention and in keeping infection rates low.
Panel Discussion II
Opening the second panel discussion on “Challenges of Providing Leadership in Countries with Concentrated HIV Epidemics”, Chairperson Caroline Chang, Minister for Health of Ecuador, said the participants would focus on ways to build support for care, prevention and treatment -– including harm reduction programmes –- targeting specific groups at high risk of contracting HIV, including sex workers, intravenous drug users and men who had sex with men. Those vulnerable groups often faced discrimination and suffered from the stigma surrounding the disease.
The panellists included: Rigmor Aasrud, State Secretary of Health and Care Services, Norway; Sonal Mehta, India HIV/AIDS Alliance; and Antonio Maria Costa, Director-General of the United Nations Office at Vienna and Executive Director of the United Nations Office on Drugs and Crime (UNODC).
Ms. AASRUD said that, because her country had discovered high HIV prevalence rates in specific communities –- intravenous drug users, sex workers and men who had sex with men –- the Government had adopted an intervention policy of “following the virus”. Overall, there was a very limited HIV-infection rate among drug users and sex workers, and, in fact, injecting drug users were perhaps the group demonstrating the most sustained behaviour change. On the other hand, a recent increase in HIV-infection among men who had sex with men was a source of great concern.
That had led to increased funding and preventive efforts directed primarily towards HIV-positive homosexuals, young homosexuals and homosexuals with immigrant background, she said. Measures established for those groups included information, counselling and testing, and health services. A key element in HIV-prevention was working more closely with target groups in designing and implementing the relevant activities.
Equally important was adopting a human rights approach that respected the dignity and autonomy of individuals, she said, adding that reaching marginalized groups was crucial to meeting the goal of universal access. While promoting the right to health for all vulnerable groups and scaling up harm-reduction and other prevention treatment and care programmes, bold leadership was needed in order to ensure the necessary steps were taken.
Ms. MEHTA said her organization’s experience had shown that, generally, access to vulnerable populations was very limited, certainly because of stigma, but also because national AIDS strategies did not adequately address the specific needs of vulnerable groups. At the same time, the stigma was so strong in many countries with concentrated epidemics that those living with HIV were afraid to come forward lest they were ostracized further or, in many cases, beaten, harassed or otherwise abused, often by police and health authorities.
All that was made much worse because the human rights of such vulnerable groups were rarely taken seriously, leaving them to feel like victims of multiple discrimination, she said. That was especially true of transgender persons and migrants living with HIV. Leaders must be bold enough to show that all human beings deserved respect, protection and access to the same services provided to those not belonging to a stigmatized group. Leaders should also recognize that high-risk populations deserved to have their human rights protected and promoted. Research had shown that investing in human rights was investing in human development. “How can it be more important to win an election than to save a life?”
Mr. COSTA said that, in the coming weeks, his Office was set to release The World Drug Situation, its annual report, which would reveal that about one third of new HIV infections worldwide were occurring among intravenous drug users. The mechanisms for transmission were well known; they included contaminated needles or unsafe sex while under the influence of drugs. Studies had proven that interventions including prevention, alternatives such as methadone and even counselling had yielded positive results. Nevertheless, it was clear that HIV/AIDS was a “runaway train” and much more must be done to address it, starting with serious efforts to contact that vulnerable population segment and address real needs.
On prisons and detainees, he said some ministers had told him that HIV prevalence in detention centres was often as much as 20 per cent higher than in the general population. While the methods of transmission were well-known –- including rape, contaminated tattooing equipment and drug use -– the role played by overcrowding, corruption and bad prison management received less scrutiny. Indeed, most prisons around the world were overcrowded, which proved that inmates were pretty low on the list of national-development priorities.
Turning to the sex industry, he said his Office was very concerned because it touched on one of the key areas of its mandate -- tackling human trafficking. Studies had shown that a majority of the young people ensnared by traffickers ended up HIV-positive at the very least. It was clear that Governments must target both the demand and supply sides of the sex industry as well as the criminal networks involved in smuggling people.
On gay and bisexual men, he said that, in most cases, it was virtually impossible to get concrete figures, perhaps because they lived on the margins, feeling that they were not a part of any society. Nevertheless, more must be done to reach that population group and provide targeted assistance. Overall, it was clear that many individual members of the vulnerable groups shared a few similarities. Most were poor and nearly all were subject to social marginalization, discrimination and various other human rights abuses. “So it’s clear we need leadership to get to them.” Non-governmental organizations and Governments should work together to identify the groups and their specific needs while generating funds to combat AIDS.
Many of the civil society delegations taking the floor during the ensuing discussion highlighted the urgent need for Governments to take action against stigma and discrimination. A representative of the youth caucus called for targeted assistance for young people often left adrift upon revealing their health status.
Another speaker said the fact that HIV infection rates and AIDS deaths were skyrocketing in prisons was unconscionable, especially since Governments controlled nearly every aspect of the lives and behaviour of inmates. While State authorities could not be everywhere at once, it was shameful that prison officials cynically ignored sick inmates, failed to provide them with timely treatment, and rarely provided counselling and outreach.
The Minister for Health of Antigua and Barbuda said it was difficult to convince men who had sex with men, and sex workers living in small countries and communities, to disclose their sexual preferences and practices because many rightly feared discrimination. Stigma and the fear it engendered could be countered by the actions of strong leaders and sustained political will on the part of Governments. Leaders must overcome their own fears of identifying with such groups and becoming associated with programmes to address their specific needs. Above all, they must realize that men having sex with men, sex workers and pimps really did exist.
JOHN H. MAGINLEY, Minister of Health of Antigua and Barbuda, speaking on behalf of the Group of 77 developing countries and China, said that progress had been uneven since 2006 and significant scaling-up was required if the international community was to achieve the goal of universal access to HIV prevention, treatment, care and support by 2010 and the Millennium Development Goal target of halting and beginning to reverse national epidemics by 2015. “We know what needs to be done, and today we are facing challenges beyond what Dr. Peter Piot termed ‘the crisis management approach’ to look at truly sustainable long-term responses to fight this epidemic,” he said. In that way, the possibility would increase, particularly for low- and middle-income countries, to maintain and continue to build on the gains achieved to date.
Among the most important priorities, he listed prevention, education, strengthened health systems and building capacity. The dearth of trained medical workers in many developing countries was impeding the battle against HIV/AIDS. Developing countries were forced to find creative solutions to counter the effects of migration of health personnel to developed countries. Training and education initiatives were under way to shift tasks to nurses, medical officers and even community-based organizers, who could be instrumental in providing critical treatment, care and support to the most at-risk populations. It was also important to provide access to affordable drugs. The Group encouraged initiatives that had enabled developing countries to make use of the Trade-Related Aspects of Intellectual Property Rights Agreement’s flexibilities for public health purposes. It continued to call for support of its efforts to access affordable HIV medicines, including generic antiretrovirals and other essential drugs.
Among other goals, he mentioned the need to advance research and development. While disappointed with the outcome of recent trials of an HIV vaccine, it was important to remain encouraged by the work currently under way on developing a new generation of microbicides for prevention of the virus. Despite a tremendous increase in funding, however, there remained a significant gap between need and available resources. UNAIDS estimated that between $27 billion and $43 billion in 2010, and $35 billion and $49 billion in 2015 would be needed to close the resource gap to ensure universal access. Predictable funding from all sources would have to be secured. Developing countries knew that they must include financing from their own national budgets and had risen to meet that challenge. Domestic spending in low- and middle-income countries had grown to approximately one third of all money for the AIDS response. Yet, burdened as developing countries were by heavy external debt, unmet official development assistance (ODA) commitments and vulnerability, it was worrisome that middle-income developing countries were unable to benefit from much of the front-line funding.
JOSE ANGEL CORDOVA VILLALOBOS, Minister of Health of Mexico, speaking on behalf of the Rio Group, said that besides being one of the Millennium Development Goals, the fight against AIDS also contributed to the achievement of other development goals such as gender equality and the empowerment of women, reducing infant mortality and improving maternal health. Nearly 2 million people lived with HIV in Mexico. The rate of prevalence remained stable in Latin America, but continued to grow in the Caribbean. The challenge was to prevent new infections, as well as to provide treatment, care, support and reintegration. Innovative mechanisms must be used to reduce the price of antiretroviral medicines.
He said that the trade-related intellectual property rights of the World Trade Organization should not impede measures to protect the public health. HIV/AIDS should not only be addressed from the health sector but also from the education sector. Education and prevention remained the best strategies to reduce the incidence of HIV/AIDS. As stigma, discrimination and homophobia often had prevented open discussions, it was necessary to have clear, transparent and non-prejudged information, as well as legislation promoting equality. With an increase in resources, detection tests should be made more accessible and studies should be developed to identify and quantify the impact of the epidemic on different population groups. Prevention and fighting HIV/AIDS must adhere strictly to the human rights of the people living with HIV.
Speaking in his national capacity, he said that Mexico had exponentially multiplied its resources for the response to HIV over the past five years. The availability of antiretroviral medicines for those who lacked health insurance had increased by 390 per cent. More than $350 million was being allocated annually to finance the country’s response to HIV. The National AIDS Programme had bought some 3 million units of condoms for free distribution. The country had also approved a constitutional amendment against discrimination, and there were no laws or restrictions for people living with HIV to enter the country.
BRIAN CHITUWO, Minister of Health of Zambia, delivering a statement for Zambia’s President, Levy P. Mwanawasa, on behalf the Southern African Development Community (SADC), noted that, although the region contained 4 per cent of the global population, it accounted for 36 per cent of the world’s people living with HIV and AIDS. The SADC Maseru Declaration on HIV and AIDS articulated five priority interventions: prevention; improving care; mitigation; resource mobilization; and strengthening evaluation. Given the high number of orphans and vulnerable children, the region is also developing a comprehensive regional programme to complement ongoing mitigation efforts. SADC members contributed to a regional fund, and were benefiting from contributions by international partners. The region continued to face underdevelopment and poverty, with the rise in food and oil prices adding to the challenges. Medicines, especially antiretroviral drugs, remained unaffordable.
Speaking in his national capacity, also on behalf of President Mwanawasa, Mr. CHITUWO said that Zambia was at the forefront of preventive services to protect unborn babies. Nearly 40 per cent of pregnant mothers were accessing services devoted to preventing mother-to-child transmission. Despite the huge cost, antiretrovirals were introduced in the public sector, using local resources, in 2002, and more than half of Zambians requiring treatment were accessing antiretrovirals for free by 2005. The Government also acknowledged the critical role played by civil society, and had successfully mainstreamed HIV issues into its national development plan.
AMENTA MATTHEW, Minister of Health of the Marshall Islands, speaking on behalf of the Pacific Small Islands Developing States, said that, although HIV prevalence remained low in most of those countries and progress had been made in addressing it, that remained a major concern because of the high proportion of youth, the rate of social change and the high mobility of the population. It was difficult to sustain comprehensive national responses in the region due to the lack of resources, resistance to addressing the stigma attached to sexually transmitted diseases, lack of capacity for treatment, and inconsistent coordination between national and regional Governments, among other factors.
She urged the international community to better address cross-cutting issues, such as the effect of climate change on the spread of HIV, and to incorporate preventive health measures into global development and climate strategies. She also urged donors to fulfil existing commitments and to provide funding for research and development. She looked forward to strengthening partnerships between national and regional organizations and the international community.
CAROLINE CHANG, Minister of Public Health of Ecuador, said that the spread of the disease could not be controlled without sustained prevention and response policies. Such policies must no longer be focused on emergency measures, but on long-term care with sufficiently funded programmes. To achieve long-term sustainability, other issues must be dealt with, such as poverty eradication, reduction in child mortality rates and gender equality -- Millennium Development Goals directly linked to the global fight against AIDS. The political commitment and leadership, with the participation of all sectors of society, including people living with HIV and civil society, remained fundamental pillars for advancing universal access to prevention, treatment, care and support services. Due to high rates of young people living with AIDS, sexual education programmes must be fortified at all levels.
Turning to her country’s national efforts, she said that Ecuador had made significant advances towards checking the spread of HIV/AIDS, providing treatment for 80 per cent of infected people. Ecuador counted on a World Bank fund in order to satisfy the current demand for antiretroviral treatment. The country had built new treatment centres and added 22 new clinics over the past year to provide specialized treatment. The percentage of pregnant women with HIV receiving antiretroviral treatment had risen from 48.9 per cent in 2006 to 74.1 per cent in 2007. The Government had adopted a policy of “no more children with HIV in 2015”. The Constitution prohibited discrimination against persons living with AIDS, persons with different sexual orientation or for health conditions. A Ministerial decree prohibited mandatory HIV exams for persons applying for a job. Care was being extended to children living with HIV and AIDS. There had been a significant increase in social investment to control HIV/AIDS over the past two years, and in 2006, the preventive budget had topped almost $3 million.
DANIEL K. KWELAGOBE, Minister for Presidential Affairs and Public Administration of Botswana, said the rate of expansion in universal access to required services did not keep pace with the growth of the epidemic. The rate of provision of services to combat HIV/AIDS, therefore, must be accelerated. Sub-Saharan Africa hosted more than two thirds of all people infecting with HIV. There had been a decline in prevalence in some countries, however, and that achievement could be consolidated for the region with the support of the international community.
He said that, for more than two decades, his country had mobilized an aggressive national response. Of every hundred newborns, 96 were HIV-free. A national treatment programme offered free treatment to citizens who met certain criteria. It had enrolled more than 88 per cent of those in need of treatment. Accessible, affordable and effective treatment created a more favourable environment for HIV prevention; however, treatment success could also give a false sense of security. In 2004, Botswana had introduced routine HIV testing in all its facilities, which had had a telling impact. Since 2006, there had been a declining trend in prevalence among those who had been tested for the first time. Botswana had now embarked on a more aggressive prevention effort, which was the mainstay of the national response.
AMAR TOU, Minister of Health, Population and Hospital Reform of Algeria, said that, although the HIV/AIDS prevalence rate in Algeria was 0.14 per cent, the country’s commitment to fighting the pandemic remained unwavering, as confirmed by relevant United Nations agencies. The country was implementing a comprehensive national policy that relied on a broad network focused on prevention, treatment and care, as well as psychological support and reversing stigmatization and discrimination. There were 60 voluntary screening centres in the country, as well as 12 treatment and care centres and a national testing laboratory, which would soon be decentralized with the establishment of 20 annexes.
He added that Algeria had been the first Arab and Islamic country to see the creation of an association of people living with HIV. Important financial and human resources had been mobilized to put in place all necessary structures and ensure diagnosis, availability and free access to treatment and antiretroviral drugs. He thanked UNAIDS and the Global Fund for their valuable support on concretizing the Algerian national plan. Durable support would undoubtedly ensure greater effectiveness of the country’s action.
ULLA SCHMIDT, Federal Minister for Health of Germany said that for Germany and the European Union, non-achievement of the Millennium Development Goal on HIV/AIDS was unacceptable. Germany had brought that up at the “G-8” meeting last year and had pledged €4 billion by 2015, doubling its financial support to the Global Fund. Affordable drugs were essential in the fight against HIV/AIDS, but that was only one element. Without massive improvements in health care delivery, the debate was fruitless. Political leadership was vital in overcoming stigmatization and discrimination, including HIV travel restriction.
She said her country, during its European Union presidency, had launched an initiative contained in the “Bremen Declaration”, which might offer a model in the fight against HIV/AIDS. A national HIV strategy should include components such as education and awareness-building, prevention -- including promotion of safer sex, drug substitution and needle exchange -- and free and anonymous access to testing, as well as universal access to treatment and care. Such a strategy could only succeed if State and civil society joined efforts in a spirit of cooperation.
GHALIA BINT MOHAMMAD BIN HAMAD AL-THANI, Chairperson of the Board of the National Health Authority of Qatar, commended the recommendations of the Secretary-General, including on improving the knowledge of children, youth and women about HIV/AIDS. Awareness was the best way to deal with the disease. Although the number of cases of HIV/AIDS infection was still relatively low in Qatar, it was a duty to support international efforts to help the most affected countries. In Qatar, voluntary screening was being expanded to cover the groups most at risk.
She said that, despite the relatively small number of reported cases, Qatar had developed a short- and long-term action plan. Training courses had been carried out for media personnel, as well as for religious leaders. Preparations were under way to train teachers, and a website on AIDS prevention had been launched in November. Work was also under way to integrate into national law an approach to support the rights of people living with HIV. Such a legal document would be the first of its kind in the Arab region.
ANDREA KDOLSKY, Federal Minister of Health, Family and Youth of Austria, fully aligning her country with the statement of Slovenia on behalf of the European Union, described the extensive programmes her country had instituted to lessen the impact of HIV/AIDS. The provision of nationwide, free access to treatment and care for all had led to a dramatic decrease in the number of deaths and new infections. Nevertheless, prevention, seen as the cornerstone of all other activities aimed at fighting the pandemic, remained the main focus.
She said that, internationally, Austria was fully committed to meeting assistance obligations and to achieving Millennium Development Goal number 6 to fight HIV/AIDS. It was supporting an array of relevant international programmes, but sustainable results could only be achieved if considerable investments were made in health infrastructure, including comprehensive training of health-care workers. Otherwise, the multiplicity of donor aid channels and the vertical focus on specific communicable diseases would continue to distort the health systems of recipient countries.
EVGENIY ZHELEV, Minister of Health of Bulgaria, said the experience in his country had proven that when a strong political will and leadership were coupled with actions and significant financial resources, an effective national HIV response could become a reality. From 1996, there had been one unified coordinating body: the National Committee for AIDS Prevention. During the last eight years, the annual allocation to fight AIDS had increased almost six times. For 10 years, the country had been providing free-of-charge antiretroviral treatment to all who needed it. Services for HIV prevention among populations at higher risk had been scaled up, as well as care and support for people living with HIV.
He said that, presently, his country was implementing an integrated approach that incorporated prevention, treatment and care, which had resulted in strengthening the human and institutional capacity in those areas, and in boosting national standards and best practices for the provision of specific services for the higher-risk populations. People living with HIV received quality medical care and psycho-social support. Challenges included the need to ensure sustainability and increase the financial resources allocated to the national HIV response, as well as to ensure access for all young people to health and sexual education based on life skills.
CHRISTINE NEBOUT-ADJOBI, Minister for HIV/AIDS Control, Côte d’Ivoire, thanked the international community for helping her country to deal with the HIV/AIDS crisis. Côte d’Ivoire was among the most affected countries of West Africa, which was also seeing feminization of the epidemic. The Government had committed itself to the efforts to halt and reverse the spread of the epidemic by 2015. So far, the expenses of Côte d’Ivoire and its financial partners for fighting AIDS had amounted to $80 million, 15 per cent of which had been contributed by the State. That contribution was steadily growing.
She said her country had seen a progression of knowledge on HIV, due to the introduction of educational and awareness programmes. There was also a large change in young people’s behaviour. The challenges included the military crisis, gender inequality, insufficient coordination and difficult financial procedures. Among the remaining problems was the low level of screening and low rate of the systematic use of condoms. Actions had been taken to address those issues, but the Government’s efforts required continued help from the international community. While counting on itself, Côte d’Ivoire would also like to be able to count on international solidarity.
Princess NORODOM MARIE RANARIDDH, Senior Minister and Chairperson of the National AIDS Authority of Cambodia, said that the AIDS epidemic in her country had been halted and reversed. The country had effectively achieved its Millennium Development Goal for AIDS. The HIV prevalence among adults aged 15 to 49 had decreased to 0.9 per cent from a revised estimated of 1.2 per cent in 2003. That reversal was attributable to a pragmatic approach to HIV prevention, coupled with extensive voluntary counselling and testing, as well as rapidly expanded access to antiretroviral treatment. The essential elements for the coming years included the need to ensure committed political leadership at each level; institutional leadership; strong partnerships; good governance; and the efforts to confront silence and denial surrounding HIV.
She said that consistent condom use in high-risk behaviour settings remained high, at between 88 and 95 per cent. Some 26 million condoms had been socially marketed in 2007. Voluntary testing and counselling were widely available in Cambodia. The country had exceeded the 2010 Universal Access Target of 25,000 people receiving treatment and care. Some 28,000 Cambodian adults and children -- 85 and 89 per cent, respectively, of all those in need -- were leading full lives, because they had access to antiretroviral treatment. Costed action plans, finalized this year as part of the country’s Universal Access road map, were guiding the efforts to provide a minimum package of HIV prevention services to injecting drug users, men who had sex with men and for the prevention of mother-to-child transmission. Among the challenges were the changing trends in the sex industry, emerging epidemics in communities of injecting drug users and men who had sex with men. Gender inequities, gender-based violence and poverty were also among the problems. Fifty-six per cent of new infections now occurred among monogamous, married women, and a third were transmitted from mothers to infants.
As Cambodia moved from an emergency scenario to one in which HIV was an endemic disease, much needed to be done to ensure the sustainability of its success, she said. A key lesson had been a strategic investment of AIDS resources in the strengthening of the health sector. Similar investments would also be required in the social sector. Assistance from the Global Fund, multilateral and bilateral partners had provided the financial foundations of Cambodia’s response. It was essential to ensure continuity of that support.
NIMAL SIRIPALA DE SILVA, Minister of Healthcare and Nutrition of Sri Lankaand Chairman of the Executive Board of the World Health Organization, said that there were now about 5,000 persons infected with HIV among his country’s population of 20 million people. Sri Lanka had a strong political commitment and political will to fight the epidemic. It provided free health care and education for all of its citizens and had built an extensive infrastructure, focusing on primary health care. An HIV prevention programme was part of the country’s strong health-care system. Sri Lanka’s traditional and conservative society held a deep and abiding respect for the sanctity of the family. Its well-established HIV/AIDS Control Programme had been established with the strong support of the World Bank, the World Health Organization, UNAIDS, the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA) and the Global Fund. In particular, Sri Lanka provided free antiretrovirals for those who needed it, with the World Bank’s assistance. Currently, 102 patients received such treatment.
He said his country’s commitment to free health care had not been compromised, in spite of the burden of substantial defence expenditures to meet threats and sabotage by an armed group described by several Member States as “the most ruthless and organized terrorist outfit in the world”. The National Plan for 2007-2011 had been designed to target segments of the population that had been identified as high-risk. Several other groups, including migrants, internally displaced persons, plantation workers and uniformed services personnel had been targeted for preventive interventions. Programmes were also in place to educate youth. A recent project had also been launched to address the country’s prison population of 30,000. In the future, more emphasis would be placed on voluntary counselling, testing and screening for sexually transmitted diseases. A broad-based culturally sensitive media campaign would reach out to the population to emphasize the need to develop and reinforce appropriate behaviours, modify risky behaviours and change attitudes, which would dispel stigma and discrimination.
ELSA PALOU, Minister of Health of Honduras, said the HIV epidemic had offered a window through which all kinds of discrimination could be seen. People with the virus had been victims of discrimination in all cultures, and women had been most affected. The virus had reached the families, and women who had never left home were now affected, as their partners had died and they were now heads of households with no income. The feminization of the epidemic was being confronted by the country’s First Lady, who had been leading a coalition of first ladies. The epidemic was no longer a public health problem, but a political and social one, which needed to be addressed comprehensively.
She said that since 2006, Honduras had made significant advances in levels of treatment. There was still a gap in antiretroviral treatment, however, and there were areas of difficult access, particularly for marginalized people. There were now 22 centres for people with HIV/AIDS, and programmes to prevent mother-to-child transmission had been integrated to a great extent in prenatal care. Greater effort was needed, however, to promote safe sexual behaviour and sexual education. Because the link between the disease and human rights had been recognized in the 26 years of the epidemic, there were now observers in the two main hospitals and elsewhere who ensured ethical care.
KHUMBO KACHALI, Minister of Health of Malawi, said that AIDS was one of six priority areas in the country’s Growth and Development Strategy. The prevalence of HIV in Malawi had declined from 14.4 per cent in 2005 to 12 per cent in 2007, surpassing the universal access target of 12.8 per cent in 2006. HIV and AIDS knowledge in Malawi was almost universal and was translating into positive behavioural changes. For example, condom use had increased from 47 per cent to 57 per cent among sexually active males and from 30 to 37.5 per cent among sexually active females. There had also been a remarkable improvement in the number of people accessing HIV services. The national HIV and AIDS policy provided a clear legal and administrative framework, addressing the needs of vulnerable groups and issues of stigma and discrimination.
He said that some of the challenges facing the country included human resource capacity, inadequate infrastructure, donor fund disbursement procedures and procurement conditionalities resulting in poor absorption of funds. For its part, the Government of Malawi would continue to strengthen the systems for effective HIV and AIDS service delivery. However, it would also like to request all the development partners to review and relax their disbursement conditionalities. Also of critical importance was international cooperation.
NOAMI SHABAN, Minister for Special Programmes, Office of the President of Kenya, said that in her country, the infection rate had declined from 14 per cent in 2001 to 5.1 per cent in 2006. Kenya had also made commendable progress towards universal access to HIV and AIDS prevention, treatment and care services. HIV/AIDS, however, remained a major concern. Currently, 1.1 million adults and 100,000 children were living with HIV/AIDS, and an additional 250,000 patients required antiretroviral treatment. There were also problems of funding, health infrastructure, stigma and high levels of poverty.
She said that, overall, the country had spent 0.8 per cent of gross domestic product (GDP), or $162.4 million and 1.3 per cent of combined donor and Government sources ($334 million), on HIV and AIDS response. The bulk of HIV and AIDS financing had come from the donor community. Alternative financing arrangements had to be explored. An investment of $50 million per year was required to put in place the necessary number of health workers to deliver quality health care. Drugs, medical supplies and equipment were major factors in the high cost of health care. Legislative reforms to facilitate the use of generic drugs could reduce costs. Investing in community organizations led by women was a feasible strategy to fight stigma and ensure gender equity. The sustainability of HIV and AIDS funding was critical.
VICTOR MAKWENGE KAPUT, Minister of Health of the Democratic Republic of the Congo, said that since the election of a democratic Government in 2003, the President had guided the fight against HIV/AIDS. He had created a multisectoral programme to combat AIDS and had launched a universal campaign for the prevention of HIV. He had made the fight against AIDS one of five pillars of a growth strategy. Currently, the country was experiencing a generalized AIDS pandemic, with more women and young people affected. HIV prevalence stood at 4.04 per cent at the end of 2007. People living with AIDS were concentrated in areas with internally displaced persons and in border zones. They also lived in densely populated areas, such as the mining regions, ports and rivers. Barely one quarter of young people were using condoms, and there was increased sexual violence against women as a consequence of the war.
He said there were some 168,500 new infections, and 347,500 people living with AIDS needed treatment. Of those, less than 10 per cent had access to it. His country needed resources to respond to the pandemic. The road infrastructure was completely dilapidated. The social and health infrastructure was very weak and in some areas completely destroyed. Although the Government was sparing no effort to mobilize resources to hold back the HIV/AIDS scourge, expenditures amounted only to $1 per capita per year. Because his country neighboured nine others, it had a role to play in the global fight against the pandemic and was participating in several regional and subregional initiatives.
LESLIE RAMSAMMY, Minister of Health of Guyana, said that his country was on track to meet its targets for universal access; the epidemic had been stabilized, with definite signs of reversal. Dismayed over the problem of outward migration of skilled health-care personnel, Guyana was concerned that, after many meetings and conferences, an equitable solution was not anticipated soon. Recipient countries should assist developing countries to enhance their training capacity. Guyana had integrated the challenge of co-infection with tuberculosis in its fight against HIV. It had also adopted guidelines for earlier treatment of persons living with HIV. That treatment must revert to the discretion of the doctors and must not be restricted by imposed “CD4” cut-offs or financial considerations. While progress had been made in making medicines and commodities for the fight against HIV more affordable, many of those items were still too expensive. Prevention, treatment and care for HIV must become fully integrated into the provision of health care for all. Guyana believed there was a need for a far more aggressive prevention strategy, in which all tools were optimally utilized.
He said that United Nations leadership was vital in tackling the aspects that still drove the epidemic in many countries. Commercial sex workers, their clients and managers must be targeted aggressively so that they became part of the solution, without legal, cultural and religious restrictions. Legislation should address stigma and discrimination linked to HIV. Guyana lauded international efforts, particularly from developed countries, to mobilize resources to enable all countries to mount a comprehensive response against HIV. However, donor countries, the Global Fund and other funding agencies, in their re-examination of eligibility criteria, should ensure that no country was excluded on the basis of gross domestic product. Disease-specific responses had served Guyana and the world, but it was time to also focus on strengthening the health systems, as those underpinned effective prevention, treatment and care. One could not build capacity for human resources, supply chain, information, health financing for HIV, unless health system gaps were addressed comprehensively.
GUDLAUGUR THOR THORDARSON, Minister of Health of Iceland, said that coverage for essential HIV prevention, treatment, care and support remained far too low in many parts of the world to have a major impact on the course of the epidemic. In the countries most heavily affected by HIV, the epidemic’s impact, sadly, continued to grow. He was deeply concerned about the overall expansion of the epidemic among women, children and vulnerable groups, which must always be involved in actions to combat the epidemic. Well-educated children were the hope for an AIDS-free world. A particularly evident shortcoming in HIV prevention was the fact that the rate of progress in expanding access to essential services was failing to keep pace with the expansion of the epidemic itself. Unless the international community took immediate action to follow through on the pledges made, the epidemic’s humanitarian and economic toll would continue to increase.
He said that current trends suggested that the global community would fall short of achieving universal access by 2010 without a significant increase in the level of resources available for HIV programmes in low- and middle-income countries. Among other things, further price reductions for antiretrovirals would be needed, especially with respect to newer drugs. Accordingly, Iceland had adopted legislation on compulsory licensing to make it possible to assist those in need with affordable medicines. An Icelandic pharmaceutical company was currently in the process of obtaining a prequalification licence from the World Health Organization to produce affordable antiretroviral drugs. His Government had also decided to contribute $1 million to the Global Fund in the next three years.
DAVID HOMELI MWAKYUSA, Minister for Health and Social Welfare of the United Republic of Tanzania, said that his country was among those with a high HIV prevalence, at a rate of 7 per cent in 2004. The prevalence was declining recently, as were HIV transmission rates, as a result of effective prevention programmes and the commitment of the Government, development partners and other stakeholders. Prevention was at the core of the country’s strategies. The socio-economic impact of the epidemic was enormous, with increased AIDs-related morbidity and a growing number of orphans. Effective mobilization of all sectors, as well as other partners and stakeholders, was essential to success. The country’s strategic framework emphasized a multisectoral approach, impact mitigation and delivery of antiretroviral drugs. The United Republic of Tanzania had enacted a legislation, which aimed to protect vulnerable populations and reinforce observance of the human rights and legal protection of people living with HIV/AIDS, orphans and vulnerable children.
He said that there were many organizations working with the Government in the area of prevention, including civil society and faith-based groups. There were also workplace programmes, as well as programmes for armed forces and refugee camps. Voluntary counselling and testing (VCT) services had been available since 1995, but the use of those services had remained rather low. To promote their use, a national HIV testing campaign had been launched in 2007. The provision of antiretrovals had also brought new hope to thousands of people living with HIV/AIDS. Currently, more than 143,000 people were receiving treatment, and 276,760 patients were being monitored. However, financing HIV/AIDS control programmes was a big challenge to the already overburdened national budget. In order to ensure sustained response, HIV/AIDS had been mainstreamed in the national strategy for poverty reduction. With the prevailing shortage of human resources, however, his country wished to add its voice to those calling for support and commitment of additional resources for the fight against AIDS.
SITI FADILAH SUPARI, Minister of Health of Indonesia, speaking on behalf of the Indonesian President and aligning her statement with that of the Group of 77 developing countries and China, said that the prevalence of HIV was low in her country. In 2006, it was estimated that around 193,000 people were living with the virus. However, since the first case of AIDS was identified in 1987, the number of infected individuals had increased annually. Growth of HIV prevalence had accelerated in the past four to five years, with data indicating that more than half of intravenous drug users were HIV-positive. Indonesia had mounted a comprehensive attack on the epidemic, moving towards universal access targets for prevention, care, support and treatment for people living with HIV/AIDS. Antiretroviral drugs were now available for more than 10,000 eligible people living with HIV/AIDS, and voluntary counselling and testing was being scaled up. Emphasis had also been placed on further educating youth about the disease.
She said that Indonesia had an AIDS commission comprising 21 Government ministries and agencies, five non-governmental organizations and representatives of people living with HIV/AIDS. It defined targets for progressive achievement of universal access to prevention and care, as required by the 2001 Declaration of Commitment. In the coming years, Indonesia would develop a national strategic plan for HIV; a ministerial decree ensuring free antiretroviral drugs for all people with HIV/AIDS; and a policy on “co-infection issues” involving tuberculosis and HIV. To achieve those goals, the country looked forward to continued support from international partners, including the United Nations. However, the United Nations system in the field would improve significantly if it ensured greater coherence and coordination among its agencies.
MANTO TSHABALALA-MSIMANG, Minister of Health of South Africa, said the Secretary-General’s report evidenced the sobering reality that effective prevention strategies were needed to address issues related to HIV and AIDS. The discussions on harmonization were encouraging. Donors and recipient countries should commit to working together to develop the necessary capacities to achieve alignment of development assistance with national priorities, policies and plans.
Since the 2006 high-level meeting, he said, his country had intensified its response to HIV and AIDS, in line with a newly revised national strategic plan. The national AIDS budget had been increased by 25 per cent each year since then. The result had been a decrease in the prevalence of the disease among those under 20 years of age and a decline in the average prevalence of HIV nationally. Still, the rate of new infections continued to rise, as pointed out in the Secretary-General’s report. An enhanced and sustainable response by all was needed, especially by strengthening prevention programmes. The discussion in regional and global meetings should focus on implementation of programmes, affordability of medicines, human resources challenges and appropriate diagnostic techniques. Those debates should not be limited to the health sector, but should also consider other development challenges.
Moving on to recommendations, he said the Assembly should consider the implications of knowledge gaps in basic sciences and its consequences for HIV vaccine and microbicide development. More resources should be dedicated to basic science research and to affordable alternatives, such as complementary and traditional medicines. Development partners should help African countries improve their surveillance and pharmaco-vigilance capacity. Concrete recommendations and monitoring mechanisms should be put in place to ensure “visible action” on women’s empowerment, and children affected by the disease should not be discussed only in the context of being orphans. Rather, a far more coherent dialogue should be developed to build families and communities, and give hope to youth.
ANA JORGE, Minister of Health of Portugal, aligning herself with the European Union, said her country reaffirmed the need to focus on prevention, with particular attention on stemming mother-to-child transmission; increasing young people’s knowledge of HIV infection; working with the at-risk population; and promoting early diagnosis and positive prevention. Those measures should be accompanied by efforts to achieve a better quality of life; improve access to care for people currently living with HIV/AIDS; and guarantee universal access to combined antiretroviral therapy. Reliable public health data was essential and, for that reason, there must be full commitment to standard procedures for data-gathering and information-sharing.
She said ensuring universal access to HIV-related services was an important element of Portugal’s national health plan. Other target areas were sexual health education in schools, discrimination in the workplace, and the health rights of migrants and undocumented peoples. Needle and syringe exchanges were also a focus and had been extended to prisons, which resulted in a decrease of HIV infection among drug users. During its Presidency of the European Union, Portugal organized the first meeting of national AIDS coordinators, which focused on translating principles into action. Over the next two years, Portugal would take on the Presidency of the Community of Portuguese Speaking Countries -- a group of eight countries with 230 million people. During that time, it would try its best to move faster towards universal access to HIV prevention and care.
HUMAID MOHAMMED AL-QUTAMI, Minister of Health of the United Arab Emirates, said his country was deeply concerned about the speed with which the disease was spreading around the world, especially in developing countries. International and regional efforts should be doubled, in order to provide the resources necessary for those countries to obtain drugs, implement their national strategies, and support preventive measures, including those that focused on awareness and behavioural change.
He said that HIV and AIDS did not represent a national health problem in the United Arab Emirates. In 1985, his country had adopted a strategy to combat AIDS, which included the provision of moral, social, medical and financial support for those infected and their families. Medical treatment comprised complex drug treatment and the means of prevention of complications of the disease. That method had resulted in maintaining low levels of infection. No cases of transmission through blood had been recorded because of screening. The country also had mandatory AIDS testing for couples planning to marry.
SAFIETOU THIAM, Minister of Health and Prevention of Senegal, paid tribute to all those who had contributed to international HIV/AIDS funding and initiatives. However, she said they were still insufficient given the scope of the epidemic and its effect on the health and economies of developing countries. In particular, Africa needed further international solidarity to reach the goal of universal access by 2010.
She said that, in Senegal, despite recognition as a pioneer in AIDS programmes, the quality and quantity of interventions must be increased. HIV response had been more and more ambitious, but even more work must be done in prevention and improving the quality of life of those with HIV infection. She called for urgent, consistent and concrete measures to ensure that universal access to prevention, care and treatment was achieved.
FAISAL BIN YAQOOB AL-HAMR, Minister of Health of Bahrain, stressing the continuing scope of the epidemic, especially among children in the developing world, said that his Government and civil society took the issue very seriously. It made sure that young men were aware of all methods of prevention and was cooperating with other Gulf countries, among other efforts.
The most important element in confronting the dangers of HIV/AIDS, he said, was a unified national commitment. National efforts must not be limited to traditional methods of awareness-raising, but innovative programmes to reach high-risk groups and school-age children must be implemented in ways consistent with local values. His country had also surveyed attitudes in the country and had used the results to correct misperceptions and fight discrimination. Other efforts had been conducted in coordination with the United Nations Development Programme (UNDP) and other agencies. The number of AIDS cases in the country had been estimated at around 1,000; a confidential testing programme had been instituted, along with programmes to change the behaviour of high-risk groups, such as drug users.
SANGARE MAIMOUNA BAH, Minister of Public Health of Guinea, aligned herself with the statement given by the Group of 77 and China and the one to be delivered by the Group of Arab States and the least developed countries. She said the scourge of AIDS had been tackled in her country through a coordinated framework involving a wide variety of stakeholders. Various national surveys had shown that the prevalence of HIV/AIDS had fallen between 2001 and 2005. However, the rate of infection among women had risen compared to that of men, and the prevalence of HIV/AIDS in urban areas was higher than in rural areas.
She said that, as of 2002, the Government’s multisectoral approach had resulted in the first national strategic framework 2003-2007, laying out several lines of action in HIV prevention, the provision of psychosocial care, reducing the disease’s socio-economic impact and developing a system of governance for the national response. The Government also provided support to people living with HIV/AIDS, and was focused on managing the issue of co-infection with tuberculosis. A new strategic framework covering 2008 to 2012 was already strengthening the nation’s efforts to coordinate its work, resulting in increased involvement from local communities and civil society, with the assistance of international partners. It was important to reinforce the country’s health system and resource mobilization, since the deadline to achieve the Millennium Development Goals was fast approaching. She appealed to all partners to lend their full support in the struggle against AIDS, and, in return, her Government would do everything it could to honour its commitments.
SALEH MEKI, Minister of Health of Eritrea, said a significant number of those affected by HIV/AIDS in the world were able to lead a productive life. However, the next phase of planning should attempt to ensure the involvement of civil society in implementing HIV/AIDS programmes and encouraging international partners to continue playing the positive role they had played in the past. For its part, the situation of HIV/AIDS in Eritrea was still at a level where it could be controlled. Most HIV infection was transmitted through heterosexual sex. Other cases of HIV infection resulted from mother-to-child transmission or through cuts. Since the first cases of AIDS were reported 20 years ago, the number of AIDS cases had reached over 26,000 by 2007 and between 60,000 to 70,000 people were currently HIV-positive.
He said Eritrea’s guiding principles in the fight against HIV/AIDS was to adopt a multisectoral approach that was: evidence-driven and results-based; targeted vulnerable groups; and linked with international guidelines. As such, attention was being directed at commercial sex workers; truckers; tuberculosis patients; single, unemployed and urban-based women; orphans and vulnerable children; refugees and cross-border travellers; and victims of cultural practices. Moreover, there was a need to pay more attention to the military and other uniformed services, such as police and prison staff, as well as prisoners and their family members. The Ministry of Health had recently joined hands with civil society to implement programmes targeted at HIV/AIDS, malaria and tuberculosis. Over all, Eritrea’s efforts were characterized by good governance, wide partnerships, community involvement, appropriate planning based on evidence and the creation of supportive environments. It had also conducted regular monitoring and evaluation, and its services were decentralized, but integrated.
WALTER GWENIGALE, Minister of Health and Social Welfare and Vice-Chair of the National AIDS Commission of Liberia, speaking on behalf of his country’s President, Ellen Johnson-Sirleaf, noted that his country was just recovering from 14 years of civil conflict and had elected the first woman Head of State on the continent. Her leadership had enabled substantial progress to be made with legislative, judicial and economic reforms. Progress had also been made in the restoration of basic services, such as health care. Based on those advances, the international community and donors had shown renewed confidence in Liberia’s future.
Still, many challenges had to be met in a country where health services had been completely disrupted and where 90 per cent of doctors and health-care professionals had left, he said. The first case of AIDS was diagnosed in 1986 and the National AIDS Commission established in response fell apart in the prolonged civil crisis. The Commission was reconstituted in 2007 and a new national strategy was being developed on the basis of the “three ones” principle, one national AIDS Authority, one strategic framework and one monitoring and evaluating system. Data collection had been intensified and antenatal surveys had been conducted. And AIDS action had been integrated into the broader development agenda.
He said a Poverty Reduction Strategy had been approved in April, aimed at moving the country beyond interim policy strategy towards sustainable development. In that regard, the challenges facing Liberia in regard to HIV and AIDS included the scaling up of prevention programmes, the expansion of access to treatment, the reduction of impact on children and addressing the challenge of rape. By working with the support of the Global Fund, the Government had been able to strengthen its national response, so as to place 2,000 persons in treatment.
MARET MARIPUU, Minister of Social Affairs, Estonia, noted that the deadline for achieving universal access to HIV prevention and care was only two years away. Estonia had a relatively high rate of HIV prevalence, with its main risk group being injecting drug users. For four years, Estonia had the support of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which helped the country to expand its evidence-based prevention interventions, and covered expenses relating to antiretroviral drugs. The Estonian Government was now fully responsible for financing those programmes, and results showed that the country had been able to slow down the spread of the disease among the main risk groups.
She said much more needed to be done, however. The national response would focus on teaching young people how to protect themselves from the virus and to live a healthy sexual life. The challenge lay in providing harm reduction services, treatment and care. In addition, there was a need to guarantee access to medical services and antiretroviral therapy for those who were being infected today, and to ensure the quality of those services. The country’s experiences with providing treatment, care and counselling had proven effective in reducing mother-to-child transmission of HIV, and it would continue those activities.
OUMAR IBRAHIMA TOURE, Minister of Health of Mali, speaking in the name of his President, thanked all those dedicated to fighting AIDS. He described the severity of the problem in Africa, in particular. He said Mali had signed on to many regional commitments on HIV/AIDS and launched a vast, multisectoral programme. That programme was coordinated by a single Government entity, allowing great progress in prevention, care and treatment. It aimed to achieve universal access by 2010, in coordination with its partners. Momentum must be maintained and linked with Millennium Development Goals; therefore, further partnerships must be mobilized and strengthened.
RICHARD NCHABI KAMWI, Minister of Health and Social Services, Namibia, aligning himself with the Group of 77 and China, said his country’s socio-economic development plan, “Namibia Vision 2030”, highlighted the need to mainstream HIV/AIDS programmes as one way to tackle its development challenges. A national policy on HIV/AIDS was approved by Parliament in 2007. At present, the country was able to provide treatment to 77 per cent of those in need, and would continue to endeavour towards universal access for its population. Namibia was currently estimated to have over 200,000 people living with HIV/AIDS, of which around 65,000 needed antiretroviral therapy.
He said that recent surveys showed that the epidemic had stabilized, with over 93 per cent of babies born to HIV-positive mothers receiving antiretroviral prophylaxis countrywide. With those advances, the focus for Namibia was now on prevention, with particular attention on creating awareness among the youth. At the same time, the country faced challenges and setbacks in the form of tuberculosis and HIV/AIDS co-infection. Indeed, drug resistant tuberculosis was currently increasing. To address those challenges, Namibia had intensified its interactions with all stakeholders in HIV programming, and the Government had continued increasing the financial resources devoted to health sector programmes. Namibia also received support from the United States and from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
NILCEA FREIRE, Minister of the Special Secretariat of Policies for Women of Brazil, said that the Brazilian response to AIDS was integrated and comprehensive, harmonizing health promotion, prevention and care, based on the principles of the National Health System. In order to ensure universal access, it had made compulsory the licensing of an antiretroviral drug in 2007, allowing the Government to buy a generic version, in line with international agreements on trade. The affordability of drugs and other supplies remained a major challenge for most developing countries and her country was cooperating in several initiatives in that regard.
She also stressed the importance of promoting condom use, which was a priority of her country. She said that, in Brazil’s experience, other prevention strategies based on moral values, such as abstinence and fidelity, should remain individual choices, not the basis of public health policies. AIDS must continue to be addressed in conjunction with efforts to strengthen health systems in the long run, and also involved a wide variety of national and international sectors. In that connection, she spoke of programmes that targeted women and other vulnerable or high-risk groups, such as gay men and transgender persons.
JEAN-JACQUES CAMPANA, Minister of Social Affairs and Health of Monaco, said that extensive efforts in the struggle against HIV/AIDS in his country were led by Princess Stéphanie, a Special Representative of UNAIDS and also the Chairperson of Fight AIDS Monaco. A strong, sustainable and ongoing effort was still needed worldwide. Prevention was the most crucial phase in the fight. The global challenge could only be met through additional financing and, therefore, Monaco had scaled up its own funding commitment. In addition, progress in the fight against any form of discrimination had to be sustained, to ensure that each community shared a more fraternal approach to persons living with HIV, and a recent conference in the Principality represented an important milestone, in that regard.
ISSA LAMINE, Minister of Health of the Niger, who spoke on behalf of the President of the Niger, said his country had adopted a decentralized and multisectoral approach in its work on HIV/AIDS. A special coordination body within the President’s office helped strengthen links between institutions. The country was currently drafting a plan to scale up universal access to treatment, care and support among key communities that the Government was in the process of identifying. According to the 2006 demographic and health survey, the prevalence rate seemed to have stabilized at 0.7 per cent. Although that overall rate was low, the rate of infection among sex workers and the defence forces was as high as 30 per cent. Sex workers now used condoms more regularly, as did the general population, reflecting increased knowledge and awareness of the risks posed by HIV/AIDS.
He said the number of people undergoing voluntary screening had risen, and several thousand people were receiving antiretroviral treatment. Campaigns to prevent mother-to-child transmission seemed to show encouraging results. A programme to combat discrimination against people living with HIV/AIDS had also been successful, and seen the participation of both Christians and Muslim leaders. That led to the rise of associations and networks to be formed by people living with HIV/AIDS, while a Parliamentary network had succeeded in pushing through a law on the prevention and care of HIV-positive patients. Regrettably, civil society groups in the Niger had been unable to keep up with the Government’s efforts. Medical supplies were often out of stock, affecting the quality of care being provided. The country would soon draw up a strategy on ways to improve distribution of those drugs, and it would soon hold a round table on financing. International partners were asked to continue providing their valuable assistance, in the meantime.
MPHU RAMATLAPENG, Minister of Health and Social Welfare of Lesotho, aligning her country with the statements made on behalf of the Group of 77, the African Group, Southern African Development Community and the least developed countries, said that, despite the severe stress put on its resources, Lesotho had made tremendous progress in a wide range of areas since 2005, mainly because of strong and consistent leadership at the highest political levels. In addition to the areas of prevention and treatment, progress was being pursued in improved management and coordination of response at all levels and a more favourable legal environment, including legislation to remove barriers to access for women and girls and to address stigma and discrimination in the workplace.
She said that her Government was also committed to finding sustainable solutions to the challenges of: limited human resources in the health sector; slow progress in behavioural change; the lack of data on high-risk populations; inadequate coordination of services for tuberculosis and HIV co-infection; difficulties in supply-chain management; food security crises involving many patients; an increasing number of orphans and other vulnerable children; inadequate monitoring systems; and the challenges of coordination among stakeholders. She looked forward to continued progress in those areas and expressed gratitude for the partners who had helped her country achieve the progress it had made thus far.
CHRISTOS PATSALIDES, Minister of Health of Cyprus, fully supported the statement of Slovenia made on behalf of the European Union and said that the world would not achieve universal access by 2010 unless the global response was accelerated and maintained in a sustained, long-term and all-inclusive manner that engaged all stakeholders, under the leadership of the United Nations. In Cyprus, HIV infection had been maintained at a very low prevalence rate, the Government having made it one of its highest priorities, with a policy formulated in line with European Union positions.
He said he expected his country to be affected by many of the same factors as other European countries in the years ahead, including the movement of populations, drug use and a false sense of security among the population. In the face of those challenges, he endorsed the call for reinforcing the efforts of Governments around the world to remove barriers to care and prevention and reverse the course of the pandemic at national and international levels. Within its capacity, his country would provide all the necessary support and cooperation in those efforts, especially in those countries and vulnerable groups that had been worst affected.
SOCCOH KABIA, Minister of Health and Sanitation of Sierra Leone, said prevention was not enough in addressing HIV and AIDS. Free antiretroviral therapy was being provided to all citizens in his country. In addition, with the help of public-private partnerships, access to free treatment was also provided. However, shame, stigma and fear still deterred people from accessing services. A 2006 HIV/AIDS Prevention and Control Act sought to address that stigma and discrimination.
Also, he said, following the 2006 High-Level meeting commitment, a comprehensive National Strategic Plan had been developed that took into account the changing nature and epidemiology of the disease. It addressed the needs of all sectors of the population with respect to diagnosis, counselling, treatment and disease surveillance. It also called for adoption of measures to mitigate the impact of cross-cutting issues, such as tuberculosis and malaria. The programme was managed by the National AIDS Secretariat and was under the chairmanship of the President. Resources were being mobilized in a transparent and accountable manner, including from the World Bank, the Global Fund, the United States President’s Emergency Plan for AIDS Relief and all development partners, including the United Nations agencies.
HUBERT MINNIS, Minister of Health and Social Development of Bahamas, said 25 years after first detection of AIDS in the Bahamas, universal access to antiretroviral therapy had decreased mortality from 18.4 per cent to 8.8 per cent. The Bahamas had been one of the few countries to have been recognized as “having turned the tide” against HIV. Notably, the mother-to-child transmission rate had declined and, since 2003, no mother-to-child transmission had occurred in women receiving treatment according to protocol.
Continuing, he said the epidemiology of HIV and AIDS was changing in her country just as in the Caribbean overall. There were a significant number of new infections among women in the 15-to-24 age group, as well as in HIV and tuberculosis co-infections. Drug resistant strains of tuberculosis had been identified. Therefore, monitoring and evaluation must be given priority attention, along with more support for laboratory testing. The numbers of trained health-care professionals must be increased, together with managed migration of the health workforce. Another challenge was the growing migrant population that accounted for 25 per cent of HIV and AIDS cases in the Bahamas, which compromised the ability of the Government to provide services due to language barriers and cultural differences.
Creative ways to procure adequate and sustainable financing for HIV and AIDS programmes was imperative, he concluded. Safety networks must be strengthened and children provided for. More technical cooperation must be forged between developed and developing nations, as well as among developed nations. Emphasis must be placed on sharing technical expertise, technological support, training and the transfer of knowledge.
VASYL KNYAZEVIC, Minister of Health of Ukraine, speaking on behalf of the Ukrainian President, said his country had been among those that initiated the historic General Assembly special session on HIV/AIDS in 2001. Its national report on the implementation of the Declaration of Commitment of HIV/AIDS for 2006-2007 was highly detailed and demonstrated significant progress on the issue over the past two years. Prevention services were being widely implemented among at-risk populations, including substitution therapy among injection drug users.
He said nearly 9,000 people with HIV/AIDS had access to antiretroviral drugs, thanks to support from the Global Fund, and 6,000 were being transferred to a programme being supported by Ukraine’s medical system. The Government was aware of the danger that continued to be posed by HIV/AIDS, and it recognized the complexity and enormity of the tasks that lay ahead. Already, nearly 2 per cent of the adult population in Ukraine was infected. A coordination council on HIV/AIDS, tuberculosis and drug use had recently been established under the supervision of the Ukrainian President.
EUSEBIO DEL CID PERALTA, Minister of Public Health and Social Assistance of Guatemala, aligning himself with the statements made on behalf of the Group of 77 and the Rio Group, said his country intended to take all measures needed to combat HIV/AIDS. All sectors had united to implement integral strategies for that purpose, and partnerships had been created with the private sector. There had been enhancements made to health-care facilities, awareness-raising programmes, training in prevention, human rights and gender issues for health-care workers, and drug procurement programmes, among other initiatives. Finally, the country believed in a rights-based approach to fighting the pandemic and, for that reason, had instituted anti-discrimination programmes.
KESSILE TCHALA SARE, Minister of Health of Benin, said the prevalence of HIV/AIDS in his country had fallen from 2001 levels, which made it an exception in West Africa. That success had been made possible with political support at the highest level, which enabled the Government to establish focal units within all ministries and national institutions. The budget for combating AIDS had increased, and a law had been enacted to combat discrimination against people living with the disease. AIDS prevention programmes helped pave the way for promoting health issues in general, and galvanized groups of people of different faiths, as well as proponents of both modern and voodoo medicine.
He stressed that, while Benin had succeeded in extending its level of care coverage and in reducing the socio-economic impact of HIV/AIDS, it would require another $300 million to maintain that success. Benin had so far benefited from the sustained support of UNAIDS and other development partners, but continued assistance would be necessary to scale up prevention and support services. Efforts must also be spent on strengthening leadership and political resolve; multisectoral coordination, evaluation and monitoring; and building better links among Government, the private sector and civil society.
RUDYARD SPENCER, Minister of Health and the Environment of Jamaica, aligned himself with the statement made on behalf of the Group of 77 and that made by the Prime Minister of Saint Kitts and Nevis. He said his Government had coordinated a comprehensive HIV/AIDS response during the past two decades, despite numerous obstacles. The prevalence rate had slowed; stigma against marginalized groups had decreased and AIDS mortality had started to decline.
He said the challenges that remained included dangerous behaviours that were difficult to change. The risk of sexual transmission had been compounded, in addition, by a dramatic increase of access to explicit sexual messages. There were still too few messages about appropriate sexual behaviour. To confront that challenge, Jamaica had witnessed strengthened commitment from leaders as role models. In addition, there were plans to achieve universal access over the next four years and legislation was being reviewed to ensure the human rights protection of all Jamaicans, regardless of health status. In light of the current budgetary challenges, including high food and energy prices, Jamaica welcomed continued external support for its HIV/AIDS programmes, while seeking to integrate the response into overall socio-economic programmes, including poverty reduction.
DARKO ZIBERNA, State Secretary of the Ministry of Health of Slovenia, on behalf of the European Union, said the Union remained fully committed to the achievement of Millennium Development Goal 6, by providing a wide range of policies and instruments to fight HIV/AIDS throughout the world. He reaffirmed that the fight against the pandemic could only be successful if a comprehensive approach was taken that included scaling up efforts significantly towards the goal of universal access to prevention, treatment, care and support by 2010. He also reaffirmed the European Union focus on prevention measures and at-risk populations.
The Union remained deeply concerned, he said, that women now represented half of the adults living with HIV, particularly in Africa. For that reason, the Union was leading global efforts to address gender inequality, gender-based violence and gender-based rights abuses. The vulnerability of children and young people must be targeted more intensively and victims supported more systematically. The European Union and its member States were active contributors to the Global Fund and urged that all partners accelerate efforts to ensure access to affordable medicines.
More investment should also be made in strengthening health systems, development and full human rights for people living with HIV/AIDS and members of other vulnerable groups, he said. In that context, he reiterated the European Union’s commitment to freedom of movement of patients.
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