Secretary-General Describes Promise in Fight against HIV/AIDS, Tells Member States ‘Now Is Not the Time to Falter’, as General Assembly Meets to Assess Progress
Secretary-General Describes Promise in Fight against HIV/AIDS, Tells Member States ‘Now Is Not the Time to Falter’, as General Assembly Meets to Assess Progress
|Department of Public Information • News and Media Division • New York|
Sixty-third General Assembly
88th & 89th Meetings (AM & PM)
SECRETARY-GENERAL DESCRIBES PROMISE IN FIGHT AGAINST HIV/AIDS, TELLS MEMBER STATES
‘NOW IS NOT THE TIME TO FALTER’, AS GENERAL ASSEMBLY MEETS TO ASSESS PROGRESS
General Assembly President Says Resources Needed to Meet HIV/AIDS
Goals ‘Miniscule’ Compared to Money Spent on Financial Stimulus, Arms
At a General Assembly meeting today on implementation of the 2001 Declaration of Commitment on HIV/AIDS and the follow-up Political Declaration of 2006, United Nations Secretary-General Ban Ki-moon spoke of progress in the world’s AIDS response ‑‑ citing heightened commitment, better prevention, improved treatment and more strategic use of funding ‑‑ but stressed that, with about five new infections occurring for every two people on treatment, “now is not the time to falter”.
In his address to the Assembly, the Secretary-General said the economic crisis should not be used as an excuse to abandon commitments, but as an impetus to make the right investments for the benefit of future generations. In addition, a vigorous and effective response to AIDS should be linked to global commitments to reduce poverty, prevent hunger, lower childhood mortality and protect the health and well-being of women.
Referring to his report on advancements in the world AIDS response, Mr. Ban recalled the commitment of world leaders three years ago to universalize access to HIV prevention services, treatment, care and support by 2010. So far, more than 110 countries had established clear national targets towards that goal. Many were making headway towards those targets, and in some cases had already reached them.
He reported that nine countries had achieved the 25 per cent reduction in HIV prevalence called for in the 2001 Declaration of Commitment on HIV/AIDS. In 14 African countries surveyed, there was a decrease in the percentage of young pregnant women living with HIV. There was a tenfold increase in the provision of antiretroviral drugs in the past five years, which contributed to the first decline in the number of AIDS deaths since the epidemic was recognized nearly 30 years ago.
As funding for HIV programmes in low- and middle-income countries rose to $13.7 billion in 2008, Mr. Ban said the United States President’s Emergency Plan for AIDS Relief initiative and the United Nations Global Fund to Fight AIDS, Tuberculosis and Malaria had begun leveraging AIDS funding to strengthen health systems in some of the neediest places.
Mr. Ban also called on States to exercise “wisdom” and “courage” in the fight against HIV/AIDS, which he said was not merely a medical or scientific challenge, but also a moral one.
Urging Governments to review their legal frameworks, he added that a sound AIDS response should comply with human rights principles. Noting that a growing number of Governments were taking steps to criminalize HIV transmission ‑‑ believing it would prevent the spread of infection ‑‑ he argued that such policies sent the message that people living with HIV were a danger to society.
“We must, instead, encourage tolerance, compassion and inclusion,” he said.
He pointed out that approximately one third of United Nations Member States had no laws in place to prohibit HIV-related discrimination. In many countries where such laws existed, they were inadequately enforced. In some cases, national legal frameworks created institutionalized discrimination against at-risk groups. He urged the world to resist prejudice, discrimination and stigma in the name of AIDS, calling them “diseases of the human spirit”.
Assembly President Miguel d’Escoto Brockmann (Nicaragua), in his opening statement, said he feared the global economic crisis had left people questioning the feasibility of global aims, and saying that the crisis would be a test of the international community’s will.
At the same time, he reminded Governments that the amount needed to achieve universal prevention, care, treatment and support was “miniscule” compared to what was spent on economic stimulus measures or arms. Where spending on weapons totalled almost $1.5 trillion, $25 billion would be required in 2010 to reach the world’s specified AIDS targets ‑‑ $11.3 billion more than what was available today.
The representatives of more than 30 countries spoke at the meeting, including the representative of Luxembourg. Speaking in her capacity as President of the Economic and Social Council (ECOSOC), she assured the Assembly that the problem of HIV/AIDS would receive ample attention at its annual ministerial review, scheduled to take place in Geneva from 6 to 9 July. As part of preparations for that session, a meeting of ECOSOC in Latin America in June had been devoted to HIV/AIDS and its impact in that region. Debates held in preparation of the ministerial review had participants discussing the merits of “integrated” policies to combat the disease, in which the ministers of health, education, labour, finance and foreign affairs all had a role.
The Minister of Health of South Africa, speaking on behalf of the Southern African Development Community, described the headway made in the region in combating HIV/AIDS, which had the highest rates of prevalence of HIV/AIDS in the world. But, even with a host of encouraging outcomes ‑‑ such as indications of increased condom use, and more efforts at addressing issues of marginalized groups ‑‑ more robust prevention methods were needed to turn the tide against AIDS, for which international cooperation would remain important. He appealed to partner States to be sensitive to cultural and social practices that communities already had, and to support approaches that were familiar to local people.
Also speaking were the representatives of the Czech Republic (speaking on behalf of the European Union), Swaziland (on behalf of the African Group), Mexico (on behalf of the Rio Group), Iceland, Chile, Qatar, France, Lichtenstein, China, Turkey, Australia, Bahamas, Brazil, Kenya, Argentina, United Republic of Tanzania, Viet Nam, Republic of Moldova, United States, Indonesia, Egypt, Japan, Cuba, Norway, Malawi, Zambia, Haiti, Morocco, Russian Federation, Canada, Pakistan, India, Malaysia and Thailand.
Prior to the meeting on HIV/AIDS, the Assembly paid tribute to the memory of the late President of Gabon, El Hadj Omar Bongo Ondimba, who passed away on Monday, 8 June 2009. Assembly President d’Escoto led delegates in a moment of silence to commemorate the former leader.
The Secretary-General extended his sincere condolences to the late President’s family, as well as the Government and people of Gabon at a time of sadness and loss.
Also paying tribute to the late President were the representatives of Swaziland (on behalf of the African States), United Arab Emirates (on behalf of the Asian States), the former Yugoslav Republic of Macedonia (on behalf of the Eastern European States), El Salvador (on behalf of the Latin American and Caribbean States), Norway (on behalf of the Western European and other States), United States (as the host country) and Bahrain (on behalf of the Arab States).
Michel Régis Onanga Ndiaye, Chargé d’affaires of Gabon, expressed gratitude to all those who had taken the floor to pay tribute to the late President.
The Assembly will meet again at 10 a.m. Wednesday, 17 June, to hear the remaining speakers on the world response to HIV/AIDS.
The General Assembly met this morning to consider the implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS. It had before it a draft decision (document A/63/L.37) by which it would take note of two reports on progress in achieving the Millennium Development Goal related to HIV/AIDS.
The first was a report of the Secretary-General on progress made in the implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS (document A/63/812), which gives an update on developments in the AIDS response, looks forward to agreed 2010 milestones, recommends key actions to accelerate progress and urges renewed commitment to the goal of universal access to HIV prevention, treatment, care and support.
The report contains several key recommendations, among them that all stakeholders reaffirm their commitment to move towards universal access to HIV prevention, treatment, care and support by 2010. National prevention strategies should address national and local needs, taking into account the dynamics of national epidemics and evidence of what works to prevent HIV transmission at the individual, community and societal levels.
Annual financing from all sources must increase to $25 billion by 2010 in order to achieve national universal access targets. Global leaders should explore and support innovative financing mechanisms for HIV and other development challenges.
The report also recommends that laws and law enforcement should be improved and programmes to support access to justice should be taken to scale to prevent discrimination against people living with HIV and populations vulnerable to infection. HIV-related travel restrictions should be eliminated; the criminalization of HIV transmission should be limited to intentional transmission; and laws that burden or impede service access among sex workers, men who have sex with men, and injecting drug users should be repealed.
Finally, the report urges all stakeholders to fully commit to maximum transparency and accountability in the global response, including regular reporting on their national and global commitments.
By way of background, the report notes that, in June 2008, the General Assembly, at its High-level Meeting on HIV/AIDS, assessed progress in the response to the global HIV epidemic. Reports from 147 countries showed that progress had been made, including in the areas of access to antiretroviral therapy and the prevention of mother-to-child transmission.
Despite such encouraging developments, considerable challenges remain, including significant access gaps for key HIV-related services. The pace of new infections continues to outstrip the expansion of treatment programmes, and commitment to HIV prevention remains inadequate. While funds available for HIV in low- and middle-income countries increased from $11.3 billion in 2007 to $13.7 billion in 2008, there has been a global economic downturn since the 2008 High-level Meeting.
Building on the commitments agreed to at the Assembly’s twenty-sixth special session on HIV/AIDS, held in 2001, Member States agreed in 2006 to move towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010. As of February 2009, 111 countries had established country-specific targets for universal access through broad, consultative national processes.
The second was a report of the Joint Inspection Unit (JIU) on the review of the progress made by the United Nations system organizations in achieving Millennium Development Goal 6, Target 7, to combat HIV/AIDS (transmitted in a report of the Secretary-General contained in document A/63/152).
The Unit says that the most important factor that limits the effective functioning of the Joint United Nations Programme on HIV/AIDS (UNAIDS) is its weak and outdated mandate. The Economic and Social Council (ECOSOC) established the mandate in 1994, when the pandemic was viewed as a health problem with limited impact. Thirteen years later, the situation has drastically changed. UNAIDS now has a broad and challenging responsibility, and yet its progress depends on actions taken by other entities/actors ‑‑ such as national Governments, international donors and civil society ‑‑ over whom it has no institutional authority. The mandate of UNAIDS needs to be enhanced and reinforced, and the authority of its secretariat needs to be enhanced for effective coordination.
With regard to the division of labour, the Unit says there is a lack of awareness and clarity among the various stakeholders at the country level, particularly among the various Government departments and civil society partners on the division of labour and its modalities. The lead agency concept among the United Nations country teams also lacks clarity, due to the overlapping mandate of the “Co-sponsors”, as the stakeholders are called. There are overlapping issues in the division of labour, such as the prevention of mother-to-child transmission, that have remained unresolved among the Co-sponsors.
It adds that the financial resources needed for HIV/AIDS are rising due to the increase in the numbers of people living with HIV and the expansion in HIV/AIDS programmes to serve more of those in need. The financial resources available for HIV/AIDS fall far short of what is needed to scale up towards universal access. UNAIDS estimates that the amount needed for an expanded response in low- and middle-income countries will be $18.1 billion in 2007, $22.1 billion in 2008 and $30.2 billion in 2009. To meet the goal of universal access by 2010, available financial resources for HIV must quadruple by 2010 compared to 2007 ‑‑ up to $42.2 billion and continue to rise to $54 billion by 2015.
The Unit says that in countries like Brazil, India, South Africa, Russian Federation, Poland and Botswana, which have plenty of financial resources of their own devoted to the fight against the HIV/AIDS pandemic, authorities are eager for innovative ideas from the United Nations family that could assist them in making the fight against HIV/AIDS much more effective, efficient and sustainable in the long run. On the other hand, a number of poorer developing countries continue to depend heavily on foreign bilateral donors as a reliable means of funding in support of the national response to HIV/AIDS. If unchecked, this will be an extremely dangerous trend in the long-term sustainability of the implementation of HIV/AIDS mandated programmes and activities.
The international community and the United Nations system seem to be optimistic about the future prospects for the fight against HIV/AIDS. However, the Unit says that, after more than 100 meetings with representatives of Governments, non-governmental organizations, and civil society there is every reason to believe that the world is currently losing the battle against the HIV/AIDS pandemic.
The Unit recommends that the Economic and Social Council review and strengthen the mandate of UNAIDS, including enhancing the authority of the secretariat, in order to effectively lead, coordinate and monitor the fight against HIV/AIDS and to ensure proper accountability of the Co-sponsors to the joint programme. As part of the review, the number of Co-sponsors should be restricted to the six original organizations/Co-sponsors, namely, the United Nations Development Programme, World Health Organization (WHO), the United Nations Population Fund, the United Nations Children’s Fund, the United Nations Educational, Scientific and Cultural Organization and the World Bank. Other organizations could participate through the Co-sponsors on the basis of a memorandum of understanding.
The Economic and Social Council should review and revise the authority, role and responsibility of the UNAIDS Programme Coordinating Board, to enable it to have supervisory responsibility over the UNAIDS secretariat and the Co-sponsors in relation to the joint programme on HIV/AIDS.
An addendum to the report (document A/63/152/Add.1) contains the views of the organizations of the United Nations system on the recommendations provided in the report of the Joint Inspection Unit.
Also today, the Assembly had before it a draft resolution on the Peacebuilding Fund (draft A/63/L.72), by which it would take note of arrangements for the revision of the terms of reference for the Peacebuilding Fund, as contained in the report of the Secretary-General (document A/63/818).
Tribute to President of Gabon
President of the General Assembly MIGUEL D’ESCOTO BROCKMANN ( Nicaragua) began today’s meeting by paying tribute to the memory of the late President of Gabon, El Hadj Omar Bongo Ondimba, who passed away on Monday, 8 June 2009. Expressing the Assembly’s condolences to the Government and people of Gabon, and to the bereaved family of the late President, he then invited representatives to stand and observe a minute of silence.
United Nations Secretary-General BAN KI-MOON joined the Government and people of Gabon in paying tribute to the late Gabonese President. He recalled the important role played by the late President in attempting to resolve several crises in Africa, including in Burundi, Chad and the Democratic Republic of the Congo. He also recalled with great appreciation his contributions to the Economic and Monetary Community of Central Africa, a force for stability in the subregion. He also thanked the late President for his commitment to the United Nations, and work to strengthen cooperation between the Organization and Africa. His understanding of the delicate challenges had proved consistently useful to those in conflict prevention, peacemaking and peacebuilding in Africa. He extended his sincere condolences to the family, Government and people of Gabon at a time of sadness and loss.
Also paying tribute to the late President were the representatives of Swaziland (on behalf of the African States), United Arab Emirates (on behalf of the Asian States), former Yugoslav Republic of Macedonia (on behalf of the Eastern European States), El Salvador (on behalf of the Latin American and Caribbean States), Norway (on behalf of the Western European and other States), United States (as host country) and Bahrain (on behalf of the Arab States).
MICHEL RÉGIS ONANGA NDIAYE, Chargé d’affaires of Gabon, expressed gratitude, at this time of deep mourning for his country and all of Africa, to all those who had taken the floor to pay tribute to the late President, El Hadj Omar Bongo Ondimba. The late President had devoted his political life to Gabon’s development and issues of peace and security in Africa. His role in seeking solutions to various crises on the continent had been acknowledged. His vision of dialogue and peace would continue to guide his country’s diplomacy. At this time of transition, Gabon would scrupulously maintain respect for the rule of law, and protection of human rights and fundamental freedoms.
Statement by the General Assembly President
Mr. D’ESCOTO ( Nicaragua), President of the General Assembly, expressed encouragement at the progress made in the global response to AIDS, as described by the Secretary-General in his report. But, he asked whether the world was on track to achieve the 2010 deadline to achieve universal access to comprehensive HIV prevention, treatment, care and support, which was only 18 months away. The latest information and analysis told a story of the global community’s shortcomings, where 29 million people needing HIV treatment worldwide still lacked medication. Roughly two out of three HIV-positive pregnant women did not receive services to prevent mother-to-child transmission. The pace of new HIV infections was occurring at a faster rate than that at which access to treatment was being expanded.
He drew attention to particular aspects of the global AIDS response that were cause for special concern: in Africa, where 22 million people lived with HIV, and the scene of three out of four of the world’s AIDS deaths in 2007.
“We have begun to build the systems needed to sustain HIV treatment and prevention over the next generation. But I must emphasize that we have only just begun,” he said. In the absence of a cure, treatment and prevention campaigns must be enhanced. To be effective, the world community must also promote just and caring societies with policies and programmes that empowered the most vulnerable. Sadly, the history of AIDS illustrated the failure to serve and protect the most vulnerable.
He pointed out that women made up 60 per cent of people living with HIV in Africa. Women’s right to own or inherit property was unrecognized in many parts of the world, condemning many affected by AIDS to destitution, or worse. Many women and girls continued to be subjected to gender-based violence, increasing the risk and vulnerability for HIV. More must also be done for children, with 370,000 children under 15 years of age becoming infected by HIV in 2007. They were less likely than adults to receive life-preserving HIV therapies. Approximately 15 million children had lost one or both parents to AIDS, but fewer than one in six households in which those orphans lived received any form of assistance in 2007.
He remarked that many countries had laws hindering access to critical life-saving services for the groups most at risk –- men who had sex with men, drug users and sex workers. Such laws contributed to the stigma and discrimination that violated the dignity and human rights of those most in need of understanding and solidarity. The global community’s pledge to move towards universal access by the end of next year was an encouraging expression of global solidarity with individuals, households and communities suffering the most from AIDS. The question was whether the world would keep its promises.
He said the global financial and economic crisis crippling economies around the world placed people with HIV/AIDS at greater risk. He said he feared that many Governments were resigned to reducing programmes and diminished expectations. People were questioning the feasibility of visionary global aims during a time of economic crisis. The H1N1 pandemic added a new level of complexity and tested the collective will. “But it is precisely when times are difficult that our true values and the sincerity of our commitment are most clearly evident,” he stressed.
Even as many countries witnessed signs of cutbacks in AIDS funding, he said Governments should be reminded that the world did have the resources to mount the kind of AIDS response to which it had committed itself. Cuts would produce the greatest costs and greater human suffering in the future. The amount needed to achieve universal access was a miniscule fraction of the sum that had been spent on economic stimulus measures. The world continued to tolerate the “obscenity” of growing arms expenditures, which totalled almost one and a half trillion dollars globally, an increase of 45 per cent since 1999. By contrast, for countries to reach the specific AIDS targets, they required $25 billion in 2010, which was only $11.3 billion more than what was available today.
He said that, as decisions were made in the coming months on budgetary and policy priorities at global and national levels, it was his hope that the enormous human and development dimensions of AIDS be kept in mind. Investments made today would yield dividends for generations, and would improve maternal and child health, promote empowerment of women, and reduce poverty. As the world moved closer towards the 2010 goal for universal access, able to glimpse the deadline for the Millennium Development Goals, he urged all to renew their resolve to “put people first”. The goal of universal access could be achieved, and must be achieved.
Statement by Secretary-General
Secretary-General BAN KI MOON said the meeting came at an intense period for global health, which was a top priority. Yesterday, he had convened a forum on “Advancing global health in the face of crisis”. Last month, he had met with members of the United Nations staff living with HIV, called UNplus. They were mothers, fathers, brothers and sisters, as well as colleagues and friends. They lived and worked with dignity and faced adversity with courage. He had heard stories of hope and resolve.
“I said something I tell people everywhere,” he said. “HIV is not about ‘us versus them’. It is about everyone. There is no ‘them’ –- only us, together.”
He added, “That meeting was a reminder of what brings us here today –- the stories, the struggles, the real lives, difficulties and triumphs of women and men the world over.”
He said his report, before the Assembly, provided an update on developments in the AIDS response. Three years ago, leaders had gathered to forge a “landmark commitment” to achieve the goal of universal access to comprehensive HIV prevention services, treatment, care and support by 2010. Progress on that could now be seen, and four areas, in particular, showed promise. In terms of commitment, more than 110 countries had established clear national targets for universal access. Many were making headway towards those targets, and in some cases had already reached them. On prevention, of 14 African countries surveyed, there was a decrease in the percentage of young pregnant women living with HIV. Nine countries had achieved the 25 per cent reduction in HIV prevalence called for in the 2001 Declaration of Commitment.
Continuing, he pointed to a third area of progress, treatment. Over a period of five years, there was a ten-fold increase in the provision of antiretroviral drugs, which contributed to the first decline in the number of AIDS deaths since the epidemic was recognized nearly 30 years ago. On resources, he said financing for HIV programmes in low- and middle-income countries had continued to increase, reaching $13.7 billion in 2008. Building on the momentum, the United States Government’s President’s Emergency Plan for AIDS Relief (PEPFAR) initiative and the Global Fund to Fight AIDS, Tuberculosis and Malaria had started leveraging AIDS funding to strengthen health systems in some of the neediest places.
He said that those advances showed what global solidarity, cooperation and commitment could achieve, but there were still nearly five new infections for every two people put on treatment. “Now is not the time to falter,” he said.
He added that the economic crisis should not be used as an excuse to abandon commitment, and should be an impetus to make the right investment that would yield benefits for generations to come. A vigorous and effective response to the AIDS epidemic was linked to meeting global commitments to reduce poverty, prevent hunger, lower childhood mortality and protect the health and well-being of women.
But, to achieve the goal of universal access, he said barriers to progress needed to be overcome, not just in battling the disease, but also in confronting obstacles that society put in the way. The fight against AIDS required an attack on “diseases of the human spirit” –- prejudice, discrimination and stigma. The latest estimates showed that about one third of the United Nations Member States still had no laws in place to prohibit HIV-related discrimination. In many countries where such laws existed, they were inadequately enforced. Legal frameworks institutionalized discrimination against groups most at risk and against vulnerable populations.
He observed that, in recent years, a growing number of countries had taken steps to criminalize HIV transmission. In theory, that had been done to prevent the spread of infection. In practice, it had done the opposite –- reducing the effectiveness of HIV prevention efforts by reinforcing stigma. Such measures sent the message that people living with HIV were a danger to society. “We must, instead, encourage tolerance, compassion and inclusion,” he stressed.
He called on Governments to review their legal frameworks to ensure compliance with human rights principles, on which a sound AIDS response was based. It was not a medical or scientific challenge only, but also a moral challenge. “Let us find the wisdom and courage for bold action on all those fronts,” he said.
AARON MOTSOALEDI, Minister of Health of South Africa, spoke on behalf of the Southern African Development Community (SADC) and aligned himself with the statement to be made by the African Group. He voiced support for the Secretary-General’s recommendation for accelerating progress towards universal access, and reaffirmed the commitment of SADC to move towards that end by 2010. Sub-Saharan Africa carried the heaviest burden of HIV/AIDS, and had the potential to undermine regional efforts to attain many international development goals. The SADC States use three declarations as their reference point on HIV/AIDS: the 2001 Declaration of Commitment on HIV/AIDS; 2003 SADC Declaration on HIV and AIDS; and the 2006 Political Declaration on HIV/AIDS. Those programmes and strategies were informed by, and respond to, epidemiological information on the magnitude, nature and dynamics of the epidemic in the region. Individual countries, district and local responses were tailored to respond appropriately. Technical support from United Nations agencies was welcome.
He said that in some SADC States, policies and legal frameworks had been amended to address issues relating to stigma and discrimination. In some instances, laws supported compulsory testing of sexual offenders, and discussions were under way to address issues of marginalized groups. SADC members also have a database, which is used for sharing information and managing research in the individual countries. The community has a common research agenda, covering research on basic science, vaccine development, microbicide development and operational research. Even though there had been many encouraging outcomes, more robust prevention methods were needed to turn the tide against AIDS. International cooperation, particularly in terms of technical assistance and access to research funding, was still important.
He said encouraging progress had been made in preventing HIV infection among youth in some SADC States. In most countries, there was convincing evidence to suggest stabilization of the epidemic. Behavioural studies indicated increased condom use, although the provision of condoms was below what was required. Similarly, the availability of HIV voluntary counselling, testing and anti-retroviral treatment was being scaled up throughout the region, but still remained below what was needed. With assistance of the Regional Office for Africa (AFRO) of the WHO, the region was working on the best way to translate into policy research findings on male circumcision as an HIV prevention tool. SADC countries were at different stages of that process. SADC was supportive of the Secretary-General’s call for increased annual funding to $25 billion by 2010.
He voiced concern over the feminization of AIDS, and added that the empowerment of women and girls, and the elimination of violence against women, must be part of the response mechanism. Programmes aimed towards that goal should include: childhood development; keeping girls in school; changing cultural and religious practices that put girls and women at risk; provision of health care services including sexual and reproductive health, voluntary counselling and testing; prevention of mother-to-child transmission; and equal access to education for both men and women. In that regard, SADC welcomed the agreed conclusions of the fifty-third session of the Commission on the Status of Women on the equal sharing of responsibilities between men and women, including in the context of HIV/AIDS. He underscored the need to involve men and boys in addressing gender inequality and the empowerment of women.
He expressed concern over the large number of vulnerable children, estimated at 15 million, of whom 80 per cent lived in sub-Saharan Africa. He appealed to partner States to be sensitive to cultural and social practices that communities already had, and to assist with technical and organizational skills for approaches that were familiar to local people. A child orphaned by HIV/AIDS and those orphaned for other reasons were both vulnerable, and a number of SADC members had developed national plans, which had been costed. But, it was a challenge to find the resources required to implement them.
He said SADC States respected the rights of all persons to equal access to prevention, treatment, care and support for HIV and AIDS without discrimination. In that light, he said SADC States would encourage the Secretary-General to include, in his future reports, equal focus on the HIV and AIDS response for other groups, such as persons with disabilities and older persons. People with disabilities were particularly at risk, due to the social and economic inequalities they faced. The same would go for older persons. It was important that statistics regroup the age brackets, possibly at five year intervals. The vulnerability of older persons was not only the caring of orphaned children and the sick, but also in the risk of being infected.
He said, despite education and awareness raising campaigns, many people in the region did not have even knowledge of the disease. SADC States had learned that informational material that responded to cultural diversity and local conditions in local languages ensured the relevance, appropriateness and effectiveness of interventions. As the world moved towards the deadline of 2010, it was imperative to have adequate data and information to review progress in implementation of commitments. While supporting the Secretary-General’s call for accountability, he urged the United Nations system to consider that as one of the weakest links in the regional response, and to prioritize technical support in that area, especially to civil society.
He ended by reiterating the call for the international community to complement and support national efforts through increased funding and debt forgiveness.
MARTIN PALOUŠ ( Czech Republic), speaking on behalf of the European Union, candidate countries and associated countries, said his delegation was fully committed to universal access to HIV/AIDS prevention, treatment, care and support, and to achieving the Millennium Development Goals (MDGs). Such commitments were reiterated in the European Union “Agenda for Action on MDGs”, adopted in June 2008, among other documents.
As outlined in the Secretary-General’s report, many countries had made progress in scaling up towards universal access, he said. As the target year of 2010 approached, however, it was clear that HIV/AIDS was a challenge that needed leadership and a long-term response. He shared the concern that the commitment to prevention remained inadequate. Combination and prevention strategies must be scaled up, as should the implementation of preventive approaches, including access to male and female condoms. Indeed, there was not just one type of the HIV/AIDS epidemic, and “knowing your epidemic” was a key feature of basic prevention. The world must acknowledge that, with current efforts, the target of universal access might not be achieved in the original time frame.
He said the Union was greatly concerned at the lack of effective prevention programmes, as seen in the number of new infections among young people. He encouraged a stronger commitment to protect the 15 million children orphaned by HIV/AIDS. To reverse the trend of feminization of the disease, the European Union had led efforts to increase global action against gender inequality and gender-based abuse, as drivers of the epidemic. His delegation was committed to supporting partner countries in bolstering women’s rights and empowerment, and ensuring approaches that were effective for women and girls. It was fully committed to the International Conference on Population and Development Programme of Action. Gender equality and the full realization of human rights were essential principles in the global response to the HIV/AIDS pandemic.
Further, he urged combating the stigma and discrimination of those living with HIV. HIV-specific restrictions on country entry were discriminatory and he urged their elimination. He also urged overcoming legal, regulatory and other barriers that limited access to treatment and support, and called for intensified action to promote safer sexual behaviour, including through the use of male and female condoms. Programmes to change risky behaviours, complemented by strong human rights protections, were effective for combating HIV. As the world’s largest donor, the European Union had contributed to increased resources for the global HIV/AIDS response, including by quadrupling its contribution to the Global Fund to Fight AIDS, Tuberculosis and Malaria. Indeed, it was a common duty to act on commitments to support an effective response to the HIV epidemic.
JOEL MUSA NHLEKO ( Swaziland), speaking on behalf of the African Group, said the HIV/AIDS pandemic was the world’s greatest threat. While Africa was home to just over 10 per cent of the world’s population, it was also home to nearly two thirds of all people living with the disease. Indeed, over the devastating 25‑year arc of the virus’ spread, Africa had borne and still bore the heaviest burden. Although there had been great progress towards mobilizing the resources to combat the disease and to provide access to prevention, treatment, care and support, it was not nearly enough. The challenge was immense and would remain so for years.
With that in mind, he cautioned that complacency might reverse the gains achieved thus far, and called for scaling up efforts to combat the epidemic, which was a major obstacle to development that threatened the social and economic fabric of nations in Africa, and elsewhere. The combat against the disease required a comprehensive and coordinated approach, especially since turning back its spread would have an impact on efforts to achieve so many other agreed development goals, including poverty eradication, universal primary education, gender equality and child mortality. Turning to the numbers, he noted that in Africa, “the global epicentre of the AIDS pandemic”, there were about five new infections every minute, of which three were among children and young people. Each day, 5,500 people died of AIDS-related illnesses, leaving behind an ever-increasing number of orphans. Africa was home to more than 12 million orphans, he said.
In the face of such sobering statistics, the African Group supported the Secretary-General’s recommendation that all stakeholders must reaffirm their commitment to make progress towards universal access to HIV prevention, treatment, care and support by 2010. The Group was also determined to realize the Millennium Development Goal of halting and reversing the spread of HIV/AIDS by 2015. He said achieving those goals required a sustained response, and Africa had attempted, with its limited resources, to organize a strategy to tackle the pandemic focused on prevention and access to universal treatment. In 2005, the African Union had decided to establish an African Centre focused primarily on promoting cooperation in the fight against AIDS, and to coordinate the work of specialized facilities continent-wide.
In 2006, he said the African Union had held a special meeting in Nigeria to reaffirm its commitment to combating the disease and outline a common approach, the Abuja Declaration. That programme contained several priorities, including improvement of health systems and education. At the same time, Africa was aware that implementation of the Declaration’s objectives also required implementation of various relevant regional and global agreements, sustained advocacy to prevent future infections and well-coordinated partnerships. He went on to call for increased and more predictable resources dedicated to tackling HIV/AIDS “without politicization or imposition of certain social or cultural concepts that do not take into account the particularities of each society.”
CLAUDE HELLER (Mexico), speaking on behalf of the Rio Group, said that, as indicated in the report of the Secretary-General, his region had increased its annual financing for HIV/AIDS programmes over the past two years. That trend had been jeopardized by the current global economic crisis, however, and it was therefore necessary to maintain and increase the region’s response to the epidemic, including through enhancing international cooperation. Failing to take such steps to boost investment would have grave repercussions, especially since the spread of HIV/AIDS, and success in combating the disease, had a clear impact on development.
Citing the HIV targets included among the Millennium Development Goals, he went on to stress that fighting the spread of the epidemic contributed to the achievement of other agreed development objectives, such as gender equality and women’s empowerment, reducing infant mortality and improving maternal health. “In addition, we need to ensure the sustainability of the HIV/AIDS response,” he said, stressing that plans and programmes should target not just immediate needs, but medium- and long-term goals. They should be bolstered by adequate financing structures, including strengthened health care systems.
Focusing on the situation in his region, where nearly 2 million were living with HIV, he said that in Latin America the prevalence rate remained relatively stable, but the numbers continued to grow in the Caribbean. Moreover, while countries in the Latin American and Caribbean region had better access to antiretroviral drugs than countries in any other part of the developing world, they nevertheless faced challenges, including finding the ways and means to prevent new infections, and to reintegrate HIV-positive people into social and economic life. Since the Assembly’s 2001 special session, the Rio Group had stressed the need to achieve universal access to treatment, a goal that had at the time seemed impossible by 2010.
He said that there had been some significant progress since that meeting and the international community must not lose momentum, especially regarding the political leadership required to finance an effective fight against HIV/AIDS. For its part, the Rio Group recognized universal access as an integral part of guaranteeing the effective realization of human rights, particularly to the highest standards of physical and mental health for all. Countries inside and outside the region needed to take advantage of cooperation schemes and innovative mechanisms such as South-South cooperation, especially to lower the prices of antiretroviral medicines. He also stressed the importance of defining specific strategies for middle-income countries, which faced serious challenges, such as widespread income disparities and poverty.
BERGLIND ASGEIRSDOTIR, Permanent Secretary, Ministry of Health of Iceland, said the Secretary-General’s report provided a valuable update on the HIV/AIDS epidemic. Many countries had reported considerable progress in halting the spread of the disease, including through access to antiretroviral therapy. Unfortunately, such positive trends were not uniform. The pace of new HIV infections continued to outstrip the expansion of treatment programmes and the commitment to HIV prevention remained inadequate. The active promotion of gender equality and women’s empowerment, and protection of the girl child, were critical to combating HIV/AIDS. Women and adolescent girls were among the most exposed to the disease but often lacked access to preventive care. She was deeply concerned at the expansion of epidemic among women, children and vulnerable groups. Ensuring their protection must be central to combating the disease.
An effective response to HIV was among the soundest forms of global investment in healthcare, she said. The commitment must be maintained and strengthened, particularly in the midst of economic challenges. Iceland would do its utmost to support international efforts. Respect for human rights was at the core of the country’s work to achieve universal access to prevention, treatment, care and support. At the same time, the Government was concerned that some countries had laws that hindered such support for vulnerable subpopulations. Several countries restricted the stay and residence of those living with HIV. Any measures that made people less likely to undergo testing undermined universal access to health care.
HELIA MOLINA ( Chile) reported on progress achieved by her country on commitments made in the Declaration of Commitment on HIV/AIDS. Its laws now guaranteed antiretroviral treatment for all who needed it, which had resulted in a decrease in mortality from HIV and an increase in the survival of affected persons. The Government guaranteed access for all pregnant women to HIV testing and to a protocol for prevention of vertical transmission, resulting in a 1 per cent decrease in the HIV vertical transmission rate. There was increased condom use, especially among young people. In addition, Chile had a legal framework prohibiting discrimination, which specified that hiring and retention in employment and in the education system could not be based on people’s “serological status”. HIV testing was voluntary, confidential and accompanied by pre- and post-test counselling.
Eight years had elapsed since the first appeal, she noted, observing that extremely important progress had been made in the area of care and access to antiretroviral treatment. But, major challenges and gaps still existed in regard to access to preventive services. The epidemic continued to spread, showing that efforts made had not been sufficient to contain it. Many of the inequities and inequalities existing in the world made people even more vulnerable, significantly affecting the poorest people, youth, women, men who had sex with men, refugees, migrants and persons deprived of liberty, among others. Hence, there was a need to focus more closely on social factors. Individual, social, cultural and regional realities must be taken into consideration to provide a more effective response. Diversity must be recognized as a cultural asset. There is a demand for information reflecting the various realities and a need for an ongoing evaluation of action.
She stressed the importance of strategic alliances, with much more decision-making involving relevant players. HIV/AIDS must become a more cross-cutting issue in society, with greater shared responsibility involving more social players, different Government sectors, the private sector and grass-roots organizations. For Chile, respect for the human rights of people living with HIV/AIDS was both a duty of the State and a requirement for making progress in controlling the epidemic, as well as meeting the ethical responsibility of an increasingly democratic society. She welcomed the creation of joint forums and initiatives to make prevention strategies, drugs and programmes to combat stigma and discrimination more accessible. She highlighted the initiative on universal access to HIV prevention, treatment and care proposed by the lead agencies, World Health Organization/Pan American Health Organization (WHO/PAHO) and UNAIDS.
SYLVIE LUCAS (Luxembourg), also speaking in her capacity as President of the Economic and Social Council (ECOSOC), said the question was of importance to her country, which devoted 13 per cent of its budget to multilateral aid for HIV/AIDS programmes. International efforts to combat AIDS were also at the core of the work of ECOSOC, and every year, the Council considered the report of the Executive Director of UNAIDS, which ECOSOC had established in 1994. This year, the Council was doubly interested in the issue, given that the annual ministerial review, scheduled for next month, would centre on public health. Combating HIV/AIDS, malaria and other illnesses was certainly part of that discussion. It also figured in discussions of the broader framework of strengthening health systems. She assured the Assembly that the problem of HIV/AIDS would receive ample attention at that session, from 6 to 9 July. Indeed, as part of preparations for the July session, a meeting of ECOSOC in Latin America in June had been devoted to HIV/AIDS and its impact in that region.
She said the Secretary-General’s report on progress in prevention and combating HIV/AIDS was encouraging, but it had also shown the magnitude of the illness. Debates held in preparation for the ministerial review had discussed possible guidelines on the theme of AIDS in the context of development. Participants said Governments must act at the interministerial level to draw up “horizontal” and “integrated” policies that could have an impact on the illness. In that respect, the ministers of health, education, labour, finance and foreign affairs all had a role. Education and communication were thought to be decisive in informing the populace and helping combat the stigma faced by individuals suffering from HIV/AIDS, and preventing their marginalization. Various sectors of the public sector must draw up policies to inform public action on health and combating HIV, such as the food, potable water, hygiene and urbanization sectors.
She pointed out that the issues of hunger and malnutrition were particularly relevant for at-risk persons and those living with AIDS. There was a need to adapt and change the perception and behaviour of society towards people who were infected or ill. The human and social aspect of HIV/AIDS deserved attention, in addition to questions of medicine and care. Inequitable results were often seen where AIDS sufferers were marginalized. Access to care must be democratized and adapted to the poor. Most people living with the virus were in sub-Saharan Africa, and a high number of those were women. Advances in maternal and infant health, where little progress had been made so far, would greatly contribute to the objective of fighting AIDS. It was important to see health systems being maintained, even amid the economic crisis. Aid, which had underpinned progress in AIDS, tuberculosis and malaria, must not be allowed to dry up.
She said those preliminary conclusions would be further developed and refined in Geneva at the ECOSOC meeting, where civil society, the private sector, as well as experts had been invited to lend their voice to the issue.
NASSIR ABDULAZIZ AL-NASSER ( Qatar) emphasized the importance of implementing the Declaration on HIV/AIDS, adopted by the General Assembly in 2001, and the Political Declaration on HIV/AIDS, adopted by the Assembly in 2006. Today’s meeting came in the approach to 2010, and he looked forward to reaching the goal of universal access to prevention, treatment, care and support. A renewed commitment was needed to speed collective and individual efforts to combat the disease, notably in guaranteeing support to low- and middle-income economies during the global financial crisis.
The spread of AIDS was both a health problem and a “social evil”, as it had an economic and social impact, he said. Despite its low rate of HIV infection, Qatar had implemented the Declaration and attached importance to establishing cooperation with relevant international organizations. The national committee for the prevention of AIDS, along with the United Nations Development Programme (UNDP), had developed a national strategy to combat the disease. The national committee also worked with legal State entities in supporting those affected by the disease.
He said Qatar had noted the Secretary-General’s report and hoped to cooperate in the “no-one-size-fits-all” framework of implementing the Political Declaration. Indeed, cultural and religious differences made it necessary to have different plans and strategies for combating the disease. For its part, Qatar had undertaken preventive activities in cooperation with the World Health Organization and UNDP, including in creating a training course for those working with youth. “We face huge challenges”, which required redoubling efforts, he said. He urged all actors –- including the mass media, religious leaders, donors and pharmaceutical companies -- to bridge the gap between what had been achieved and what was left to be done.
JEAN-PIERRE LACROIX (France), aligning himself with the European Union, said today’s meeting was pivotal to keeping a focus on the HIV/AIDS question, as following the development of the epidemic was essential. The Secretary-General’s report had noted considerable progress since 2001, with 3 million people with access to antiretroviral therapy. France welcomed progress in access to such therapy, and women’s access to services for the prevention of mother-to-child transmission. Such progress was encouraging and he underscored the vital role of UNITAID and the Global Fund in that regard.
Despite progress, the way ahead was still long in achieving universal access to prevention, treatment, care and support, he said, noting France’s reaffirmed commitment to that goal. The HIV/AIDS pandemic was among the greatest impediments to human development in Africa, where only 33 per cent of HIV-positive women benefited from services designed to prevent mother-to-child transmission. That was unacceptable. The global community must not let up on efforts, in that regard. For its part, France would work to respect its financial commitments to combat HIV/AIDS. Access to treatment must not overshadow prevention activities geared towards all vulnerable groups, including young women and drug users.
Indeed, the world needed a long-term policy, and he underscored that such a policy depended on strengthening health systems. The training of personnel and strengthening of State capacity in the health sphere were essential to making global actions more effective. Such a long-term policy hinged on actions intended to change mindsets -– notably to fight against the stigma and discrimination faced by those living with HIV/AIDS. He welcomed UNAIDS’ work in that regard, also reaffirming the need to combat against denying freedom of movement to those living with HIV. States had a duty to take all necessary measures to avoid spreading the pandemic. In December 2008, France launched an appeal for the universal decriminalization of homosexuality. He reiterated that appeal today, saying that the fight against HIV/AIDS was one shared by all. He particularly hailed the essential role of civil society and non-governmental organizations in that context.
GÜNTER FROMMELT ( Liechtenstein) said the fight against the HIV/AIDS epidemic remained one of the international community’s highest priorities. The 2001 Declaration of Commitment on HIV/AIDS remained the foremost tool for combating the scourge, both nationally and at international levels. Indeed, the fight against the disease was one of the areas where action on the part of United Nations had proven most effective and indispensable. The Organization’s success would have strong impact on global efforts to achieve the Millennium Development Goals, especially the HIV/AIDS-related targets.
He noted that, nine years after its adoption, the Declaration and the comprehensive approach it promoted remained more relevant than ever. The progress achieved, in the meantime, had been in areas such as the development of policies and improved funding for universal access to HIV prevention, treatment, care and support. That progress, however, or the lack thereof in specific areas, had led to the realization that the fight against the disease was as much a human rights imperative, as a development issue. Direct and indirect discrimination against people living with HIV and populations most vulnerable to infection posed serious challenges to implementation of the Declaration and the achievement of the relevant Millennium Goal targets.
He went on to say that his Government shared the Secretary-General’s concern about HIV-related travel restrictions, overly broad criminalization of HIV transmission and discriminatory laws impeding access by high-risk groups to health services. The response to HIV/AIDS would not be effective without an understanding of the social and structural determinants of HIV risk and vulnerability, he said, stressing that the human rights dimensions of the epidemic, including gender inequalities, social marginalization, stigma and discrimination, must be fully addressed. He also called for stronger emphasis on measures to prevent transmission of the disease. Indeed, “prevention is the cornerstone to our long-term success”, he said. Improved knowledge about HIV/AIDS and the risk of infection was needed, and prevention efforts could be greatly improved by adopting an integrated approach that drew on existing programmes focused on tuberculosis, maternal and child health, as well as sexual reproductive health.
LIU ZHENMIN (China), aligning himself with the “Group of 77” developing countries and China, said his country had placed HIV/AIDS on its agenda as a strategic issue that had a bearing on economic development, social stability, State security and the fate of the nation. China had set up the initial “form” of a mechanism for combating the disease that suited its specific situation. The Government had implemented a policy of “Four Frees and One Care”. That policy included a free voluntary blood test; free antiretroviral treatment for urban and rural AIDS patients who have economic difficulties; free medical advice and treatment for pregnant women with HIV and their babies; free education for AIDS orphans; and Government care for AIDS patients living in poverty.
Among other things, China had expanded its combat of AIDS to reduce new infections and strengthened international cooperation in that respect, he said. The Government would continue to fulfil its obligations to combat HIV/AIDS, notably by providing assistance and technological support to other developing countries. Like many developing countries, China faced uneven economic, social and cultural development among its regions, and had limited per capita resources for combating HIV/AIDS. As such, he hoped the United Nations would support developing countries in their efforts to combat the disease. In its future work, relevant United Nations institutions should continue to increase financial and technical support, which would particularly help China address practical difficulties, such as the high cost of antiretroviral treatment and a medicine shortage.
He said coordination among international organizations should be strengthened. He hoped United Nations bodies would use their influence to play a better coordinating role and facilitate the integration of projects. UNAIDS should also reinforce coordination with international organizations, notably those working to eradicate poverty. China was willing to work with the global community in exploring strategies for combating HIV/AIDS.
FAZLI ÇORMAN ( Turkey) said HIV/AIDS was more than a health issue; it was a matter of human security. As such, the fight against its spread was very much a part of the broader effort to achieve the Millennium Development Goals, and thus defeat poverty, ensure gender equality, prevent discrimination and secure universal enjoyment of human rights. On the situation in his country, he said although Turkey had relatively few HIV-positive citizens -– some 3,370 cases, according to the latest health ministry figures –- the overall number was rising and the Government was concerned.
He said some factors contributing to that increase could be Turkey’s relatively young population, the general lack of awareness about sexually transmitted diseases, the rise in intravenous drug use, a recent influx of commercial sex workers, or the number of Turkish men working abroad. He vowed the Government would be more vigilant, and noted that Turkey had in place a comprehensive reporting system and an important range of preventive measures. Further, HIV testing and antiretroviral treatment was free and serological testing for blood/tissue/organ donors, registered sex workers and patients undergoing major surgery were mandatory. He added that an AIDS Commission had been established in 1996 to carry out and coordinate country-wide activities and review progress with representatives from State institutions, civil society and the United Nations system.
Turkey, despite such progress, faced challenges, such as insufficient preventive services for vulnerable groups. Nevertheless, universal access to prevention and treatment services was an attainable goal. To that end, the current Strategic Plan on HIV/AIDS laid out national priorities and plans through 2011 to enhance the Government’s activities in the areas of prevention and support, voluntary counselling and testing, treatment and social support, among others. Finally, he stressed that, aside from meeting its national objectives, Turkey was committed to contributing to international efforts to combat HIV/AIDS. To that end, it had, among other things, allocated $3 million towards the relevant activities of the United Nations from 2008-2010.
GARY QUINLAN ( Australia) said that, in the Asia-Pacific region, which accrued some 1,300 new HIV infections every day, most countries were well behind schedule to achieve universal access by 2010, and many more were unlikely to achieve the Millennium Development Goal to halt the spread of the disease by 2015. With 2010 fast-approaching, the international community needed to accelerate progress, if it wanted to make good on its pledges. He stressed that, in a time of global recession, when many Governments were under pressure to cut services and when reduced family incomes might force people to take more risks, “we need to be smart about identifying key actions that will maximize our resources and make our efforts worthwhile.”
For its part, Australia planned to launch this year its new strategy for development assistance in HIV. He said the goal was to make a significant and sustained effort to help its partner countries achieve both the universal access and Millennium Goal targets. Drawing on its own experience and international research, Australia had concluded that one of the key actions it could support was to intensify HIV prevention, especially among at-risk populations. Comprehensive services were vitally important to that end, but impediments to universal access, including intangible obstacles to care, prevention and treatment created by stigmatizing laws, needed to be removed.
He said Australia’s new HIV strategy prioritized the review and improvement of legal and policy frameworks, including providing support for education and training of law enforcement personnel and social service providers. Ending discrimination against people living with HIV and those at higher risk of infection was a vital element of overall treatment and care objectives. He noted that, by 2020, male-to-male transmission would be one of the mains sources of new HIV infections in the region. Protecting people from discrimination on the basis of their sexual orientation removed fear of reprisal and their need for secrecy. It also increased the likelihood that persons belonging to higher risk, often stigmatized groups, such as intravenous drug users and sex workers, would have access to health services.
PAULETTE BETHEL (Bahamas), aligning herself with the Group of 77 developing countries and China, noted that, a year ago, delegates had gathered at the high-level meeting to assess progress in responding to the global HIV epidemic. The global AIDS response had produced positive results and played a major role in ensuring better health care for millions of people. However, the epidemic’s status remained daunting, with an estimated 33 million people living with HIV, half of whom were women. The Bahamas continued to see an increase in new infections among young women between 15 and 24 years old, and more must be done to combat gender inequality, which had increased their vulnerability to HIV.
Efforts to meet commitments were being severely hampered by the global economic crisis, and she commended United Nations work to raise awareness of the effects of the crisis across the global health spectrum. The Bahamas faced challenges, including budget shortfalls and decreased revenues. Despite that, the Government was making every effort to meet its commitment to fight HIV/AIDS. It had expanded outreach activities to the “men who have sex with men” community, historically difficult to reach, and had revised its policy to address other specific national situations. Its actions were guided by a national AIDS strategic plan for the 2007-2015 period, which adhered closely to the UNAIDS principles of the “Three Ones”. In that context, she thanked various stakeholders, including the Pan-American Health Organization, for their support. The Bahamas spent some $2.5 million each year on provisions for HIV/AIDS care.
While strides had been made, persistent gaps remained in terms of human resources, funding and infrastructure development, she said. Monitoring and evaluation must continue to receive priority attention. In addition, she urged finding an innovative mechanism to sustain the expansion of HIV/AIDS programmes and address other development challenges, like poverty, food security and climate change. “Sustainable funding is a key challenge”, she stressed. Achieving the goals of the Bahamas’ HIV/AIDS strategic plan would require additional funds, a call that could not go unheeded. In closing, she said that no country alone could win the fight against HIV and AIDS. Broad and sustained participation of all stakeholders was needed.
REGINA DUNLOP (Brazil), aligning herself with the Rio Group, recalled the Assembly’s decision in 2001, which she said was groundbreaking for realizing that an effective strategy to combat HIV/AIDS must be based on prevention, care and treatment. Brazil was committed to fighting the HIV/AIDS epidemic in various ways, including by ensuring access to prevention, treatment, care and support for all. That commitment was aimed at responding to a public health demand, and also to promoting and protecting the human rights of HIV/AIDS sufferers. The fact that many countries had adopted HIV-related restrictions on entry, stay and residence, as described by the Secretary-General’s report, was of concern. Brazil considered such steps discriminatory. Also of concern was the persistence of homophobia, gender stereotypes and other forms of discrimination against vulnerable groups, which could undermine risk reduction and access to treatment.
She said the HIV/AIDS epidemic had been stabilized in Brazil after it launched an integrated and comprehensive response. It included health promotion, prevention of new infections, and provision of integral and universal care for people living with AIDS. That response was a joint effort involving various sectors of Government, civil society, universities, the private sector, United Nations agencies and bilateral partners. But, a serious crisis was threatening the gains made; and, in order to protect the investment made in the fight against HIV/AIDS, there was a need to increase material and financial resources.
A substantive part of AIDS expenditure went to medicine, and a dollar saved in the purchase of medicine was crucial to saving lives, she said. Universal access presupposed access to affordable medicine of good quality. To provide access to medicine, the world must reconcile public health needs with intellectual property rights. Brazil underlined the important role of the Doha Declaration on Trade-Related Aspects of Intellectual Property Rights (TRIPS) Agreement and Public Health, and reaffirmed the right of countries to use to the fullest extent the flexibilities related to the TRIPS Agreement. It was also important to ensure unimpeded transit for medicines to their final destinations, free of artificial trade-related barriers.
She said access to affordable drugs was a challenge for many developing nations, and pursuing new innovative financing mechanisms was important in that regard. Brazil commended the activities of UNITAID, which supported countries in purchasing drugs for second-line treatment for HIV infection, tuberculosis and malaria. Because HIV/AIDS was still the leading infectious disease challenge in public health, it must be addressed in conjunction with efforts to strengthen health systems in the long run. She also touched on the promotion of condom use combined with other strategies, and the increased use of female condoms. Prevention strategies based on moral values should remain individual choices; although they were not to be disregarded, they did not by themselves provide a basis for public health policies.
ZACHARY D. MUBURI-MUITA (Kenya), associating himself with the African Group, said that HIV/AIDS prevalence in Kenya during the 1990s was about 20 per cent. By 2001, it had dropped to 14 per cent, and further, to 5.9 per cent at the end of 2006. Data gathered in a household survey last year was being analysed and would provide even more information on the disease. Even with those modest gains, the Government was pushing for new initiatives aimed at improving the situation. Last March, the Government launched the third strategic plan for HIV and AIDS, which was to be operational in July. The plan aimed to achieve Kenya’s universal access targets for quality, integrated services at all levels to prevent new infections. The plan included provision of cost-effective services, which would be informed by a rights-based approach to universal access to prevention, treatment, care and support services. Targeted community-based programmes would support universal access for an AIDS-informed society, and all stakeholders would operate within a nationally owned and harmonized framework.
Despite such hard-won successes, HIV/AIDS was a major concern for Kenya, where more than 1 million people lived with the disease, he explained. During the 2006-2007 and 2005-2006 financial years, the country spent $496.2 million on its HIV and AIDS response. The bulk of such financing came from donors. Within the country, the budget for HIV/AIDS had to compete equally with other diseases like malaria, and alternative financing arrangements were needed. Provision of quality health services was a labour-intensive business that required $50 million annually for five years to put in place a reasonable health workforce. Drugs, medical supplies and equipment were major factors that increased the cost of health care. To combat stigma and discrimination, Kenya had carried out aggressive campaigns and workshops in schools and other institutions.
Provision of universal access to prevention, care, treatment and support services required more than access to antiretroviral drugs, he said. It required trained health-care professionals, suitable facilities and increased funding ‑‑ all integrated within a fully functional health-care system. Areas that require urgent follow-up included ensuring the sustainability of HIV and AIDS funding, notably for antiretroviral treatment. Financial support for fighting HIV and AIDS should be provided in the form of grants, not loans. Kenya and other low- and middle-income countries should be considered for debt relief without conditionalities, with funds channelled to other priority areas, including the war against AIDS.
MARÍA LUZ MELON (Argentina) said the right to health must prevail over commercial interests and intellectual property rights should not impede measures taken for the protection of public health. Argentina called for the effective implementation of safeguards and flexibilities included in the World Trade Organization TRIPs Agreement. In that country, access to HIV/AIDS medicines had improved, and the supply was sustained, by the introduction of quality generic drugs, and by Argentina’s involvement in joint negotiations with other countries of the region and with pharmaceutical companies to reduce costs. Access to diagnostics and treatment needed improving, while taking into account concepts of social integration and the right to development.
She said Argentina was the first country in the region to introduce a law on AIDS, which made the State responsible for guaranteeing comprehensive attention, respect for dignity and non-discrimination, and for guaranteeing confidentiality for those living with HIV/AIDS. The legal framework was complemented by application of the American Convention on Human Rights and the National Anti-discrimination Act, and other laws concerning, among others, social security and prepaid medicine, the HIV diagnosis in pregnant women, the creation of a National Programme for Sexual Health and responsible procreation. The Millennium Development Goals served as a guide, and indicators were in place to demonstrate progress in stopping and reversing the epidemic in vulnerable populations.
She said Argentina recognized the following populations as being of increased vulnerability: sex workers; the transvestite and transsexual community; homosexuals; men who had sex with men; the migrant population; members of aboriginal peoples; persons in situations of poverty; women, children and adolescents; drug users; and persons in situations of confinement. Older persons should not be neglected. Argentine policy also took a gender perspective into account, and there had been a particular focus on pregnant women living with HIV and preventing mother-to-child transmission. Their partners had also been included in prevention activities. In sum, the Ministry of Health was focused on improving accessibility of diagnosis and treatment, promoting access to condoms and preventive tools, promoting and providing access to counselling, and eliminating stigma and discrimination.
JOYCE KAFANABO (United Republic of Tanzania), aligning herself with the African Group and SADC, said her country had a national policy on HIV/AIDS and a national multisectoral strategic framework to guide HIV and AIDS activities. The multisectoral framework emphasized the need for concerted and multidisciplinary efforts from all sectors ‑‑ the Government, the private sector and civil society. HIV and AIDS were part of the national strategy for growth and poverty reduction, as well as Tanzania’s Development Vision 2025. Interventions such as behaviour change communications, promotion of condom use, safe blood transfusion, management of sexually transmitted infections, voluntary counselling and testing, and the prevention of mother-to-child transmissions were starting to bear fruit. HIV prevalence had declined slightly in recent years, with a prevalence rate of 6.6 per cent for women and 4.6 per cent for men in a 2007-2008 survey, compared to 7.7 per cent for women and 6.4 per cent for men in 2003-2004. It showed a significant decrease for men, but not so for women. Tanzania, like other parts of the world, continued to observe the increase in the feminization of HIV and AIDS.
She said new infections continued to occur. Those continued new infections highlighted the urgency with which the world must develop new preventive approaches and tools, in particular those that addressed the biological and sociocultural vulnerabilities of women. The special needs of persons with disabilities and older persons must also be taken into consideration. Male circumcision must be properly researched. She urged an increase in funds for research and clinical trials, as a country that was hosting clinical trials. Technical assistance was also required to enable the Government to work with developers to ensure the safety and availability of products.
She said she was encouraged by the increase in resources that had made it possible to make antiretrovirals available to many AIDS patients. So far, 234,974 people were enrolled for access, and the target was to reach 440,000 people by 2010. Gains would be set back if extra measures were not taken for prevention, diagnosis and treatment of opportunistic infections, such as tuberculosis. The availability of adequate food and good nutrition was crucial, as well, for those on antiretrovirals. A shortage of trained human resources in the health sector was a problem, as was building the capacity of the health system and infrastructure. Tanzania welcomed the financial support of its partners.
BUI THE GIANG (Viet Nam) said his country was encouraged that more HIV/AIDS-infected people had gained better access to antiretroviral therapy compared to three years ago, when the Political Declaration on HIV/AIDS was adopted. Stronger determination and a positive political environment at global, regional, national and local levels had been reinforced by increased resources for HIV programmes in low- and middle-income countries, which, in turn, had led to a drop in AIDS deaths. Equally important, new sources of technical support delivery coordination had been developed while country-level evaluation systems had been improved. All that had been possible thanks to the “all out” efforts of the entire United Nations system.
However, he was deeply concerned that the number of people living with HIV continued to increase, with more than 7,000 people on average becoming infected daily. AIDS was taking 5,000 lives a day, mostly because of a lack of prevention services and antiretroviral therapy. Viet Nam was alarmed that a huge number of children had lost one or both parents to AIDS. There was lopsided knowledge of the disease among various populations, including young people. Viet Nam supported the Secretary-General’s recommendation to revise policy responses to HIV/AIDS in changing situations and to ensure service provision to those most at risk.
For its part, Viet Nam had done its utmost to care for almost 170,000 Vietnamese living with HIV/AIDS, while trying to reverse the spread of the epidemic, he said. To that end, the Government had improved its HIV/AIDS legal and executive systems, including through its enactment of a law on HIV/AIDS control and the national HIV/AIDS control strategy, as well as the development of HIV/AIDS control centres in 61 of 63 provinces. Information, education and communication had been promoted, as seen in the launch of the “National Month of Action against HIV/AIDS”, and Government funds had been mobilized. Despite such efforts, however, the risk of HIV spreading still remained. Most HIV/AIDS control centres were weak in terms of personnel and equipment and finances were limited, which had led to an insufficient supply of antiretroviral treatments. To deal with those challenges, he said international cooperation was “much-needed”. His Government would be grateful for the United Nations’ continued cooperation, as well as that from Member States, and international and non-Governmental organizations.
ALEXANDRU CUJBA (Republic of Moldova), aligning himself with the European Union, said the Secretary-General’s report and today’s debate provided a good opportunity to evaluate actions to respond to the global HIV epidemic. He had taken note of the report’s recommendations and reiterated his country’s commitment to meet universal access targets by 2010. Combating socially conditioned diseases like HIV/AIDS and tuberculosis was an imperative task for Moldova and the Government regarded HIV/AIDS infection as a high priority. In 2007, the Parliament approved a law on the prevention and control of HIV/AIDS, which had been developed in line with United Nations standards. It aimed to reach State obligations under international commitments.
At the national level, he said State policy for HIV/AIDS was implemented through the National Programme of Prevention and Control of HIV/AIDS. That programme represented an integral multisectoral plan developed through a multi-stakeholder process that included Government, international organizations, non-governmental organizations and people living with HIV. The third National Programme for the 2006-2010 period contained nine strategic priorities, agreed upon by joint Government/non-governmental technical working groups. Significant progress had been made in achieving the “Three Ones”. Implementation was under the supervision of a national coordination council, which included Government ministries, non-governmental organizations, donors and working groups.
Under the National Programme, HIV patients were given free access to antiretroviral therapy, he explained. Moldova was among those countries that had achieved universal access to such therapy. The palliative care strategy for people living with HIV was approved, while a new service of voluntary counselling and treatment had been established throughout the country. Such progress represented a “symbiosis” of efforts by State institutions and non-governmental organizations. The civil society contribution was also significant in the country’s response to HIV. The third National Forum of Non-Governmental Organizations active in the area of HIV/AIDS and Tuberculosis, held from 11‑12 June, had gathered more than 120 representatives of civil society, State bodies and international organizations. While the Government had undertaken actions to allocate sufficient resources from the budget to fight HIV/AIDS, socio-economic problems, exacerbated by the 2007 drought, had led to many demands on its limited budget. As such, there was a need for programme-based budgeting. Moldova was supported by international organizations and received grants from the Global HIV/AIDS Fund. It was committed to increasing its efforts to develop a comprehensive HIV/AIDS approach.
JOHN SAMMIS (United States) said his country stood behind its commitments made in 2001 and renewed in 2006, and was proud to be a partner in the global effort to halt HIV/AIDS. The Government’s major contribution to the global fight was through the President’s Emergency Plan for AIDS Relief, the largest international health initiative in history dedicated to a specific disease. In the first five years of the programme, the American people supported antiretroviral treatment for more than 2.1 million people; care of over 10.1 million people; and prevention of mother-to-child HIV transmission during nearly 16 million pregnancies. The programme had worked to build links with other donors and multilateral organizations, including the Joint United Nations Programme on HIV/AIDS, and President Barack Obama had pledged to continue the programme’s critical work. The United States’ increased commitments to maternal and child health, family planning and health system strengthening would provide much-needed support to countries.
To maximize the impact of its HIV/AIDS programmes, the United States was engaging host country Governments and others through Partnership Frameworks, he said, which were designed to build country ownership. The United States shared the goal of extending lifesaving prevention, treatment and care services to marginalized groups ‑‑ men who have sex with men, commercial sex workers and injecting drug users. Through the programme, the United States proactively confronted the changing demographics of the HIV/AIDS epidemic, working to reduce gender inequalities and gender-based abuse. The Government strongly supported work being done by UNDP and UNAIDS to develop a gender action framework to guide United Nations efforts in addressing the needs of women and girls.
He said that, in the overall response to the epidemic, resources would continue to be a challenge, in part because the large numbers of people needing treatment, the success of counselling and testing programmes and growing capacity for AIDS treatment all created an increased demand for treatment that incurred significant long-term costs. The United States was responding to that challenge by continuing to seek efficiencies “wherever we can” with current programmes, and ensuring that the Emergency Plan’s resources achieved specific goals. The Emergency’s Plan’s support had strengthened health systems in many areas, like human resources, infrastructure, informatics, commodities logistics and laboratory services. Looking to the future, the United States would work with host countries to develop a framework for strategic assessments and identification of priorities for health system strengthening. The objectives of the 2006 Political Declaration and the health-related Millennium Development Goals were ambitious even without an uncertain global financial climate. He applauded the leadership of UNAIDS in “prodding all of us forward”.
HASAN KLEIB (Indonesia) said it was heartening that much had been achieved since the inception of the 2001 Declaration. For Indonesia, today’s meeting would be more than an assessment of progress thus far and discussion of the many challenges; it would provide a “springboard” for discussing ways to navigate the current global economic crisis that would impact on all efforts. Indeed, the economic crisis should be prevented from taking a toll on today’s objective, and rather be used to forge closer cooperation and partnership. New HIV/AIDS infections continued globally, particularly in low- and middle-income countries, and many countries’ lack of capacity posed serious obstacles to determining HIV/AIDS prevalence. That undermined efforts to provide universal access and he urged delegates to come up with a comprehensive strategy to help, in that regard.
Moreover, he said greater international action to strengthen the global health system was needed, which, in turn, would help scale up HIV services. As no health system could be sustained without a professional workforce, education and training were critical and should be part of international action. Integrating HIV services into reproductive health services could also help optimize limited resources and maximize impact. Nationally, he highlighted Indonesia’s National Commission on HIV/AIDS, which was guided by four components: prevention; treatment; care; and support interventions. The Commission had instituted several key policies, including a National AIDS Response Strategy and Action Plan for the 2007-2010 period, which was being aggressively implemented in areas where HIV was spreading. The Commission, along with regional Governments, was providing guidelines for establishing regional HIV/AIDS commissions. Finally, it was working with the national anti-drug agency to combat illegal trafficking of psychotropic substances and other drugs.
MAGED ABDELAZIZ (Egypt) said that, despite the relative drop off in estimated number of new HIV infections in 2007, and the decline in recorded cases worldwide, the total number of people living with the disease was still over 33 million, two thirds of which were in Africa. Undoubtedly, realizing the United Nations’ goal of universal access to prevention, treatment, care and support for all by 2010 required strengthening national capacities, especially in low-income countries. That would help reinforce the implementation of national programmes and awareness campaigns aimed at correcting widespread misconceptions. Such efforts required large investments to build Government and societal capacities, train relevant service workers, and make first and second line antiretroviral treatments available at reasonable prices.
He said the global financial crisis made it necessary to boost international support and assistance to meet global commitments on HIV/AIDS, especially in light of spending cutbacks that might affect health-care systems in developing countries. He noted that the Secretary-General’s report had stressed that an additional $11.3 billion was needed annually to help countries reach the universal access target by 2010. It would also be important to effectively tackle the trade-related obstacles to achieving that goal, including restrictions on transit trade in medicines, and intellectual property rights. Further, preventing and combating HIV/AIDS was linked to efforts to ensure broad-based development, including providing support to strengthen health-care systems and infrastructure, and transfer of medical and technical know-how.
Within the framework of the international commitment to combat HIV/AIDS, more efforts needed to be devoted to, among others, the fight against illegal trafficking in drugs, and the peaceful settlement of disputes, especially in Africa, where such conflicts drained countries’ finances and sapped their ability to combat the spread of epidemics and address other health-related development objectives. He said that Egypt, for its part and in line with the African common response to HIV/AIDS, had sought to share its expertise with other African nations. Egypt had particularly focused on sisterly countries where the pandemic was most prevalent and had, among other things, dispatched medical expertise, technical assistance and training.
SHIKEGI SUMI (Japan) said the international community faced many challenges caused by the HIV/AIDS epidemic and, for that reason, his country was lending its support to achieving universal access to prevention, treatment, care and support. Japan took active part in the various bilateral and multilateral efforts announced in 2005. It valued the role of the Global Fund in supporting various AIDS initiatives and, as one of the major donors to the Fund, had contributed $1 billion since 2002.
He said the international community must not shirk its obligations towards vulnerable people in securing expanded access to prevention, treatment, care and support programmes. Even with the economic crisis, it must not let up its efforts to build stronger health systems. In that regard, Japan welcomed the Global Fund’s efforts to promote support for vulnerable groups. To secure steady implementation of AIDS programmes, there was a need to increase the variety of collaboration between private and public sectors. It was important, as well, to improve the effectiveness of support and cost-effectiveness of those activities.
He noted that an approach focused on certain diseases was not sustainable. Efforts must focus on a comprehensive approach that encompasses health system strengthening and maternal and child health. He was pleased to see various agencies in the United Nations and beyond working horizontally together on such a comprehensive approach. Japan supported those efforts by taking the lead in the world’s integrating efforts.
ABELARDO MORENO (Cuba) said the economic and financial crisis had not been caused by the countries most affected by the crisis, but by the power centres of the North. Efforts of countries in the South to achieve the Millennium Development Goals, including health-related goals, would be virtually voided. The goal of ensuring universal access to comprehensive prevention, treatment, care and support by 2010 would be hard to meet by the poorest nations. More than two thirds of those suffering from HIV/AIDS lived in Africa, with the sub-Saharan region being the most affected. Only one fourth of the people needing antiretroviral treatment had access to it.
He said that Cuba considered it important to reinforce the HIV/AIDS prevention strategy, which involved sex education in schools, and the mass media as an essential part. Education and prevention programmes for youth promoted a healthy and responsible sexuality, including the use of condoms. It had been scientifically proven in Cuba’s region of the world that the strategy to promote sexual abstinence was not effective in preventing HIV/AIDS. Cuba also believed in the fullest enjoyment of good physical and mental health as a fundamental human right, and gave great importance to the fight against HIV/AIDS and the fight against discrimination. The Cuban health system had universal coverage and was free of charge. The multisectoral HIV/AIDS prevention and control programme guaranteed access to medical services and antiretroviral treatment to 100 per cent of the population. It was responsible for the development of “surveillance interventions”, which paid heed to aspects of the right to work, full salary, differentiated food, and to social and political rights.
He said Cuba had managed to contain the pandemic, despite a United States blockade. It had produced six antiretroviral medicines and conducted research on a vaccine. The United Nations and other organizations had contributed to strengthening the country’s efforts to stem the pandemic. In turn, Cuba had offered its support to other developing countries. Over 38,000 Cuban health professionals and technicians had collaborated with 73 countries. If the millions of dollars allocated to the arms industry and used to bail out big companies were made available, it would be possible to eliminate hunger and pandemics. The world needed international solidarity, instead of competition, and social justice instead of wars.
MORTEN WETLAND (Norway) said his country’s efforts were aimed at addressing sensitive issues that “not everybody wanted to talk about”. Part of that country’s strategy was to focus on youth and sexual rights, and on sexual minorities and other vulnerable and at-risk groups. The gender focus was essential, since progress on preventing mother-to-child transmission was lagging behind other areas. The world’s long-term response to AIDS depended on addressing the type of stigma and discrimination that made young people vulnerable to HIV. This month, UNAIDS Goodwill Ambassador HRH Crown Princess Mette-Marit, would hold a Young Leaders Summit in Oslo.
He said the report before the Assembly did not cover up difficult questions; it was clear and “sets out direction”. That was the kind of leadership Norway expected from the United Nations. The AIDS scourge was not over, and would not be for many years to come. Even with the best prevention, millions would require treatment year after year, at a cost that would translate into tremendous burdens on national health budgets and international financing.
He noted that health was not expensive, but nor was it free of charge. For that reason, the AIDS response could not achieve universal access on its own. Many countries would not achieve the health goals if they did not manage their AIDS response. The social and structural factors that increased vulnerability to HIV were also factors that represented barriers to achieving the Millennium Goals, such as gender-based discrimination. It was not possible to deal with AIDS and the Millennium Goals separately ‑‑ it was time for a “handshake”. The debate on global health yesterday had made clear the importance of addressing maternal mortality, natal care and reproductive health, in ways that simultaneously strengthened access to service and made the most of resources.
He noted the report’s strong message on the need for political, legal and programmatic steps to deal with stigma and discrimination, and the need to review laws that presented obstacles to effective HIV prevention, treatment, care and support for vulnerable people. Norway underlined the importance of the work done by the International Task Team on travel restrictions faced by people living with HIV, based on their HIV-positive status. Such restrictions existed in some 60 countries. They have proven to fuel stigmatism and had a negative impact on national AIDS programmes and the achievement of universal access.
STEVE D. MATENJE (Malawi), aligning himself with the African Group and the Southern Africa Development Community, supported the Secretary-General’s forward looking recommendations and was committed to translating them into action aimed at the full implementation of the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration. His Government was fully committed to fighting HIV and AIDS. The Growth and Development Strategy, an overarching national development policy for achieving sustainable growth, placed HIV/AIDS among the six priority areas requiring urgent and continuous attention. The implementation process focused on various activities, including to prevent the spread of HIV infection, provide treatment for those living with HIV and AIDS and mitigate the health, socio-economic and psychosocial impact of HIV and AIDS on the general population.
Most importantly, he said the Government had placed the management of nutritional disorders as part of the country’s comprehensive response to HIV and AIDS prevention, treatment and care. Special attention had been given to the empowerment of women and the girl child. Progress had been made, he said, noting that condom use among sexually active males had increased from 47 per cent in 2005 to 57 per cent in 2007. In addition, 661,400 people were tested in 2007 versus 283,461 people in 2004; 280,446 pregnant women were tested in 2007, versus 52,904 in 2005, and 39 per cent of HIV-positive tuberculosis patients were placed on antiretroviral therapy in 2007, versus 29 per cent in 2005. About 53 per cent of the 1 million orphans and other vulnerable children received various types of assistance, including direct cash transfers. The National AIDS Commission was collecting data for 2008.
Challenges remained, he said, including stigma and discrimination in all settings, inadequate human resource capacity and a brain drain of skilled health-care professionals. Given that situation, Malawi looked forward to continued cooperation with its development partners and the global community in the collective fight against HIV and AIDS.
PATRICIA CHISANGA KONDOLO (Zambia) said her country was one of the sub-Saharan countries most affected by the HIV/AIDS pandemic. With a prevalence of 14.3 per cent of the adult population, and an estimated 1.2 million orphaned and vulnerable children (of which 75 per cent were orphaned by HIV), the pandemic was Zambia’s most critical health, development and humanitarian challenge. The Zambian Government realized that, unless the world enhanced its efforts to help scale up the country’s response, its efforts to achieve its development goals would be undermined. For its part, Zambia had initiated a multisectoral response, and had established a high-level Cabinet Committee of Ministers on HIV/AIDS and a National AIDS Council and Secretariat, with cross-sectoral representation. The Government had also mainstreamed HIV and AIDS into its fifth national development plan. It had finalized its 2006-2010 National HIV/AIDS monitoring and evaluation operational plan, to enable the country to track its progress.
She reported progress on certain key indicators: the programme to prevent mother-to-child transmission covered 40 per cent of HIV positive women. By the end of 2008, more than 1,500 health facilities provided HIV counselling and testing. Approximately 4,000 professional providers and 3,000 community providers were trained to offer that service. Approximately 500,000 people aged 15 years and older were tested during 2008 and knew their status. With regard to treatment, Zambia provided free antiretroviral therapy to an estimated 50 per cent of all adults and children with advanced HIV infection. The number receiving therapy had risen from 40,000 in 2005 to 150,000 in 2007.
She said Zambia recognized that the responsibility for AIDS went beyond the scope of the health sector and even beyond the responsibility of Government. The Government has acknowledged the role played by civil society and the private sector in scaling up the antiretroviral programme. Communities and households were being empowered through microfinancing with small capital investments focusing on women. Social safety nets had been introduced for families facing severe crisis. Much remained to be done, particularly in the areas of: youth empowerment; enhanced investment in human resources; revising laws to address issues of stigma and discrimination; and addressing gender inequality. She thanked UNAIDS, the Global Fund, the World Bank, the United States PEPFAR, bilateral partners and the community of non-governmental organizations for their support so far.
ASTRIDE NAZAIRE (Haiti), aligning herself with the Rio Group, said that nowhere but in her country had the need for total mobilization against the HIV/AIDS epidemic been so great. The national strategic programme guided Government efforts to reduce the HIV/AIDS pandemic. In 2009, the number of screening centres had increased 11 per cent. In 2007, those tested for HIV numbered 317,324 people. That number had increased to 521,070 between April 2008 and March 2009. Moreover, there were 79 sites that provided palliative care, thanks in part to assistance from the President’s Emergency Plan for AIDS Relief and the Global Fund.
The role of civil society had been very important, she said, and its links with the public sector had provided invaluable assistance, particularly in awareness raising among vulnerable groups, including among men who have sex with men. To improve information management, the national programme to fight AIDS launched a national database. Such work would not have been possible without international solidarity. The clock was ticking. Many indicators, including the feminization of the HIV/AIDS pandemic, were a major concern. Moreover, only 170,000 people living with AIDS were being treated with antiretroviral drugs. The need to reach the more than 56 per cent of children born to mothers with HIV/AIDS was even more urgent. Greater efforts had to be undertaken to ensure their protection. While the milestones achieved thus far were important, she appealed for a humanitarian mobilization to reach the Millennium Development Goals.
MOHAMMED LOULICHKI (Morocco), aligning himself with the African Group, was pleased to note the progress made since the 2001 Commitment and the 2006 Political Declaration was signed. But, he was aware of the limits of progress in terms of protecting and caring for vulnerable people. However, the consequences of the economic crisis on the fight against AIDS made it difficult to develop new international commitments to combat that plague. Yet, there was indeed a need for joint, sustained, political will to combat the disease. There was also a need for a substantial increase in financial aid to guarantee universal access to prevention, treatment, care and support.
He said Morocco was concerned by the impact of gender inequality on the fight on AIDS, which reduced the ability of girls and women to control the risks of being infected. He subscribed to comments in the UNAIDS report to the Economic and Social Council, which said that universal access depended on certain sociocultural factors. That issue needed addressing. More effort was required to increase awareness and to develop a more ethical approach to address the needs of populations most at risk.
He said that, despite the low level of infection in Morocco, combating HIV/AIDS was still a priority. It had established a system to monitor the problem and created institutions to coordinate actions in that field. With the support of its international partners, the country was able to provide care and combination therapy without discrimination. Under its strategic plan for 2011, the Government, with the help of civil society, aimed to provide 1 million people with screening and good quality care, including psychological care and access to antiretrovirals. It would also work to prevent mother-to-child transmission, with the partnership of the private sector. The Government wanted to involve young people in the fight against AIDS, and did so through youth clubs.
He said Morocco’s efforts were supported by UNAIDS, which provided technical assistance through the Global Fund. If international efforts had brought positive results at the international level in Africa, that progress should encourage the international community to lift the threshold of international ambitions and to talk of elimination, not just reduction of AIDS. The remedies were there; but the funds were modest compared to money set aside for the financial crisis. The international community must exercise resolve to protect future generations from that scourge ‑‑ that resolve was called political will.
MIKHAIL Y. SAVOSTIANOV (Russian Federation) said that, in recent years, significant progress had been made in combating disease, but combating HIV/AIDS remained among the most serious challenges of modern times. Cooperation between the World Health Organization, United Nations AIDS programmes and the Global Fund were among the most successful partnerships in combating HIV/AIDS. At the country level, key conditions for combating the disease were in providing management and guidance “across the spectrum” at national and local levels. Indeed, local efforts allowed for the creation of targeted measures, particularly in the area of medical services.
He said the Russian Federation had not been spared new HIV infections. As such, the Government had created a coordinating council within the Ministry of Health and Social Development. Civil society and those living with HIV/AIDS had actively participated in Government efforts. As a result, progress had been made in providing care for those living with the disease. In 2007 and 2008, the Government had provided $480 million in such areas as HIV/AIDS diagnosis and treatment, and prevention programmes ‑‑ 10 times the federal financing for such programmes in recent years. Combating HIV/AIDS was a priority. Moreover, the Government had contributed $40 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Also, he said countries in the Commonwealth of Independent States played an important role in combating infectious diseases and the Russian Federation would continue to provide technical and financial support. Some $50 million would be allocated to fighting HIV/AIDS infection programmes in Central Asia and Eastern Europe. The Government also was developing a programme to assist Central Asian countries in their fight against hepatitis.
HENRI-PAUL NORMANDIN (Canada) said domestic and international efforts were grounded in respect for human rights and recognition of the role of the determinants of health in affecting vulnerability and resilience to HIV and AIDS. His Government would work to overcome stigma and discrimination faced by those living with ‑‑ and at risk of ‑‑ HIV and AIDS. Partnership with civil society was at the heart of the Canadian response; policies were developed with advice from communities, including from people living with HIV and AIDS. At the international level, Canada had supported civil society engagement at ECOSOC and at the UNAIDS Programme Coordination Board.
Turning to the importance of reducing vulnerability, he said Canada recognized that social and economic factors like poverty and homelessness led to health inequities. In Canada, drivers of the epidemic were reflected in the increased vulnerability to HIV of indigenous peoples, drug users, and gay men and women. To respond, the Government had made progress in implementing a population-specific approach in research and surveillance, policy and programming, which focused on key factors affecting vulnerability and resilience. Another key area to which Canada was committed was in universal access to comprehensive HIV prevention. The Government was advancing effective evidence-based HIV prevention, testing and counselling approaches, including in linking HIV and AIDS with education and new prevention technologies. Canada supported the goal of universal access to essential care, treatment and support, and worked in developing countries to enhance health systems.
He said most people living with HIV and AIDS in Canada had access to high-quality care, treatment and support. Canada was a main contributor to the Asia-Pacific Economic Cooperation Health Task Force and the Health Working Group on HIV/AIDS, leading the development of guidelines to create an enabling environment in the workplace for those living with HIV and AIDS. With the entry into force of the United Nations Convention on the Rights of Persons with Disabilities, there was growing recognition of the interplay between HIV/AIDS and disability. As such, Canada hosted an international policy dialogue in March to discuss that unique interaction. In closing, he said Canada was committed to working with its global partners towards the common vision of ending the HIV and AIDS pandemic.
FARUKH AMIL (Pakistan) said that AIDS struck at the heart of most regions, rolling back accomplishments in health and education, and leaving society weakened at every level. It was encouraging that investment in fighting AIDS had increased from $300 million in 1996 to nearly $14 billion in 2008. But, a large gap in funding remained where HIV was on the rise. HIV/AIDS was not just a biomedical or demographic problem. It was a development issue, deeply rooted in poverty and underdevelopment. Some of its consequences included the loss of skilled labour, weaker agricultural sectors, declines in life expectancy and sickness and death of family breadwinners. The high costs of drugs, limited access to health facilities and lack of money for antiretroviral treatment made matters worse. Victims also faced isolation and discrimination. The multifaceted demands of the problem called for a comprehensive and well-coordinated response, based on addressing the root causes that fuel the pandemic.
He said Pakistan was aware of its responsibilities. An estimated 85,000 people lived with HIV in Pakistan. Although estimates for persons living with HIV in the general population had remained fairly constant over the years, the shift from low prevalence to a concentrated epidemic had taken place due to an increase in cases among injecting drug users. The Government had launched a coordinated effort with the United Nations system, civil society and bilateral donors. $30 million had been allocated for the 2003-2008 period, used to create awareness, strengthen safe blood transfusions and avoiding stigmatization of vulnerable populations. A comprehensive legislative framework on HIV/AIDS had been under consideration since 2006. He said the international community must commit itself to greater domestic and international funding for national HIV/AIDS plans and strategies, in a way that was predictable and aligned with national aims.
HARDEEP SINGH PURI (India) said it was critical to ensure that the gains made so far were not reversed by the severe economic and financial crisis. UNAIDS had played a major role in enabling Member States to establish mechanisms at the country level. But, because developing countries were marginal players within the UNAIDS governance structure, it had led to a situation where developing countries had not been able to get at resources being channelled to them. At times, Member States had not been able to use grants from the Global Fund. He said UNAIDS needed to ensure a “progressive strengthening” of developing countries’ roles in strategic resource planning.
He noted that a holistic approach would involve effective prevention strategies and access to low-cost, affordable treatment. It required not just the mobilization of additional resources, but also their efficient use. Despite national and international efforts, only 30 per cent of those needing antiretrovirals received the medication they needed. India was uniquely positioned as a source of low-priced and effective generic antiretrovirals, which could fill that gap. Unfortunately, “certain developments” of the recent past had been counterproductive to global efforts to provide affordable treatment. Several consignments of generic drugs of Indian companies had been seized by Dutch customs authorities, including a shipment of Indian-made antiretroviral drugs for HIV/AIDS treatment bound for Nigeria, on grounds of alleged violations of domestic patents and trademarks. Those generic drugs were perfectly legitimate in both India and the destination countries. Several developing countries had expressed concern at those developments.
He said the Government attached the highest importance to protection and enforcement of intellectual property rights, in accordance with the TRIPS Agreement. It did not support efforts to enshrine new, maximalist TRIPS-plus provisions in other forums. The action of the Netherlands customs authorities to seize generic drugs traded between developing countries, in full conformity with international disciplines, ran counter to the spirit of the TRIPS Agreement. Further, the TRIPS Agreement, as amended at Doha in 2001, allowed compulsory licensing powers to national Governments in case of drugs meant to fight endemic diseases.
In India, he said, the national AIDS council was chaired by the Prime Minister, and the state councils by the chief ministers. Such high-level political commitment was critical in containing the epidemic. The AIDS response was multisectoral. India had a low adult HIV prevalence of 0.36 per cent, but in absolute terms, they represented the third largest HIV-positive population in the world. The National AIDS Control Programme was based on the premise that prevention was better than the cure. The Government was committed to ensuring universal access, and 75 per cent of the programme’s budget was allocated to prevention programmes among high-risk people, such as sex workers, injecting drug users, truckers and migrant labourers. Counselling, testing and reducing stigmatization and discrimination were among other activities being conducted in India. Civil society played an active part in the war against HIV/AIDS. Around 200,000 Indians were currently receiving antiretrovirals and treatment for opportunistic infections. Blood monitoring was free.
HAMIDON ALI (Malaysia) said the global combat against HIV/AIDS faced considerable hurdles. Even before the current financial crisis, international efforts to stop the spread of the disease had yielded uneven results, and new infections were outstripping the pace at which new interventions and services could be put into effect. At the same time, there was still a danger that the financial crisis could lead to cutbacks in all national health services and a contraction of available donor funding. That point was of particular concern, because, while the burden of the epidemic fell disproportionately on developing countries, the burden of addressing its tragic effects was a responsibility for all.
He went on to warn against barriers that prevented most HIV-positive individuals from obtaining equitable and affordable life-prolonging drugs. With that in mind, he called for an end to trade restrictions and patent-related controls. As for the situation in Malaysia, he cited, among others, screening programmes that annually screened more than 1 million people. The increase in the number of screened individuals had revealed a decrease in the number of reported transmission cases since 2003, and there was now a high probability that Malaysia could achieve the target of reducing the number of new cases to a rate of 15 per 100,000 by 2015. At the same time, Malaysia was aware of the challenges it faced, including the feminization of the virus, he added.
With the majority of HIV/AIDS infections in Malaysia attributable to intravenous drug use, 60 per cent of the country’s overall budget to tackle the epidemic was devoted to the harm-reduction approach to reduce their vulnerability. He said Malaysia’s efforts in that regard included, among others, drug substitution therapies and needle and syringe exchange programmes. Despite success in that particular area, Malaysia had had a more difficult time reaching out to other marginalized and at-risk groups, chiefly sex workers, men who had sex with men, and transgender individuals. Reducing vulnerability to the virus among those groups was pivotal to halting the spread of HIV countrywide, and the Government had therefore been working closely with community-based organizations and non-governmental organizations to ensure they had access to HIV and AIDS related information, condoms and voluntary counselling.
DON PRAMUDWINAI (Thailand) said the political declaration adopted three years ago reaffirmed that prevention must be a mainstay of the global response to HIV/AIDS. States had committed to addressing HIV/AIDS concerns as related to youth and women, eliminating discrimination against those living with HIV, and scaling up activities related to tuberculosis and HIV. Despite the current financial and economic crisis, Thailand was committed to the issue of HIV/AIDS. Combating the disease was crucial to the well-being of people. To that end, the Government had taken several steps.
He said Thailand had set an ambitious and challenging target to reduce the number of new HIV infections by 50 per cent by 2011. To achieve that, prevention would be an important element. Prevention had the effect of reducing the loss of human resources, among the most valuable components of a country’s development. As the disease changed, methods to combat it needed to evolve. An important means of promoting prevention among youth was education and raising awareness on HIV/AIDS. To raise awareness, some municipalities had initiated projects to expose young people to HIV/AIDS patients. Easy-to-understand brochures had been distributed to young people and others, with a view to changing behaviour.
He also emphasized the importance of raising awareness in reducing stigma and eliminating discrimination, saying that some people were reluctant to venture to local administration to receive treatment, fearing the unknown consequences. Thailand’s efforts to raise awareness and exchange best practices and technical know-how extended throughout the region and the world. In closing, he reaffirmed Thailand’s commitment to achieving universal access to HIV prevention, treatment, care and support by 2010.
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