|Department of Public Information • News and Media Division • New York|
Sixty-fourth General Assembly
91st & 92nd Meetings (AM & PM)
General Assembly Holds Review of International Efforts against HIV/AIDS;
Told Progress Made, but Epidemic Continues to Outpace Global Response
Hears from Some 42 Speakers in Day-Long Debate; Secretary-General’s Report
Calls for Strengthened Links between AIDS Response, Other Development Goals
Following a day-long debate on implementing the 2001 Declaration of Commitment on HIV/AIDS and the follow-up 2006 Political Declaration on HIV/AIDS, the General Assembly this afternoon adopted by consensus a draft decision to take note of the Secretary-General’s recommendations on the matter, use the report to inform a high-level plenary meeting on the Millennium Development Goals in September, and hold consultations by December to pave the way for a comprehensive HIV/AIDS review next year.
That April report — which charted progress in implementing the Declaration, and recommended several ways to achieve the desired goal of universal access to HIV prevention, treatment, care and support — showed mixed results. In it, the Secretary-General noted that the number of people in low-income and middle-income countries receiving antiretroviral treatment jumped tenfold in five years to 4 million, and HIV infections dropped 17 per cent from 2001 to 2008. But the epidemic continued to outpace the response, with five new infections reported for every two people receiving treatment. He stressed that slowing that rate was vital to achieving almost every development goal.
Deputy Secretary-General Asha-Rose Migiro, delivering a statement on his behalf, agreed with that assessment, saying the report presented a strong case for strengthening the links between the AIDS response and the other millennium targets. “I hope we will see, in the five years until 2015, strong support for national health, education and social service systems translate into benefits for HIV-specific programmes as well,” she said. “This will require more resources from national and global institutions. The cost may be great. But the cost of inaction will be even greater.”
Social and legal challenges, however, were preventing an effective response in many countries. Many of them, still reeling from the global economic crisis, scaled back programmes, notably for individuals at high risk for HIV infection, such as men who had sex with men, injecting drug users and sex workers, in favour of development efforts considered less controversial, she said. That funding shift was worrisome, and could negatively affect all patients, as HIV/AIDS treatment and prevention programmes were proven to improve the health of the population as a whole.
HIV was one of the leading causes of death among reproductive-age women worldwide, she said, stressing that efforts to improve maternal health and achieve the fifth millennium target needed a big push, rather than pitting one target against another. She added that she would chair this year’s replenishment process for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
Echoing those concerns, Acting Assembly President Jarmo Veli Tapio Viinanen ( Finland) said: “Time is not on our side.” Some 7,400 people were newly infected with HIV every day — nearly half of them young people and children. “Future generations will ask if we fulfilled our responsibilities. We must do our best to be able to answer that question, particularly at the high-level plenary meeting in September and Comprehensive AIDS Review next year,” he said.
Still, political ambitions had been encouraging, he said, noting that more than 100 countries had set ambitious national targets to reach universal access and were making progress in their responses, despite limited resources. They had recognized that investments today would reduce cost requirements in the future.
Several delegates took the floor to support that claim, and highlight their respective national and regional HIV/AIDS initiatives. For example, Congo’s representative, speaking on behalf of the African Group, said African countries had addressed HIV/AIDS as a cross-cutting issue within the New Partnership for Africa’s Development (NEPAD), AIDS Watch Africa, and the Commission on HIV/AIDS and Governance for Africa. The region had maintained progress; its mortality rates unchanged since the Secretary-General’s 2009 report, while access to antiretroviral therapy had increased in most countries and 45 per cent of pregnant women received treatment to prevent mother-to-child transmission.
But, the number of people suffering from HIV/AIDS remained high, he said, warning that a weakening of donor and partner support could reverse progress made and have serious economic and social consequences in Africa. Stronger strategic global partnerships were necessary to ensure success.
Spain’s representative, speaking on behalf of the European Union, said the discrimination, stigma and exclusion that prevented access to HIV prevention, treatment and support must be eliminated. As inequalities, gender-based violence and abuse were the main drivers of the epidemic, it was essential to increase self-protection of women and girls, ensure full access to education and information, and further integrate programmes for sexual and reproductive health and rights.
The European Union Commission was a founding member of the Global Fund and had a key role on its Board, providing more than 55 per cent of total contributions since 2001, he said. It had also adopted a new Communication on combating HIV/AIDS in the European Union and neighbouring countries for 2009-2013 that focused on cost-effective prevention programmes and targeted measures for at-risk groups.
Viet Nam’s representative, speaking on behalf of the Association of South-East Asian Nations (ASEAN), said ASEAN members, in a bid to implement the 2001 and 2006 Declarations, had strengthened regional cooperation and political commitments that affirmed the social responsibility of all members to act together. That was illustrated at several ASEAN Summits since 2001, including the fourteenth summit in Thailand in 2009 that adopted the ASEAN Socio-Cultural Community Blueprint which highlighted HIV/AIDS control.
Similarly, Guyana’s representative, speaking on behalf of the Caribbean Community (CARICOM), noted regional efforts, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), to mobilize technical support and resources, as well as joint efforts with the United Nations. In July 2009, a Partnership Framework Agreement was signed and, in November 2009, the Global Fund had approved a $34.5 million PANCAP proposal. CARICOM States were also seeking to create a Regional Technical Support Facility as a joint initiative between PANCAP and UNAIDS.
Also speaking today were the representatives of Chile (on behalf of the Rio Group), Australia (on behalf of the Pacific Islands Forum), United Kingdom, Venezuela, South Africa, Monaco, Egypt, Canada, Cuba, France, El Salvador, Kenya, Russian Federation, Mexico, Indonesia, Kazakhstan, India, San Marino, Japan, Argentina, Sudan, Bosnia and Herzegovina, Gabon, Norway, United Republic of Tanzania, Botswana, Qatar, Thailand, Nicaragua, United States, Liechtenstein, Bangladesh and Brazil.
The observer for the Holy See also addressed the Assembly, as did representatives of the observer delegations of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and of the International Organization for Migration.
The General Assembly will meet again at a date and time to be announced.
The General Assembly met this morning to consider 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/64/L.54/Rev.1) by which it would welcome the Secretary-General’s report on progress towards implementing the Declaration and its recommendations, decide to undertake the necessary consultations to determine by no later than December 2010 the modalities and organizational arrangements for the 2011 comprehensive HIV/AIDS review, and include on the agenda of its sixty-fifth session an item entitled “implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS”.
According to the Secretary-General’s report (document A/64/735), as of December 2008, an estimated 4 million people in low- and middle-income countries were receiving antiretroviral therapy — 10 times more than five years ago. New HIV infections dropped 17 per cent between 2001 and 2008, and the number of pregnant women who received antiretroviral drugs to prevent mother-to-child transmission increased from 10 per cent in 2004 to 45 per cent in 2008.
New data to be released this year would likely show an increase in the number of countries achieving their 2010 country targets for universal access to selected HIV-related services, the report stated. But, many countries were still not on track to achieve their global commitments. The epidemic continued to outpace the HIV response: for every two people starting antiretroviral therapy, five were newly infected. Country targets for universal access by 2010 would be reviewed in 2011.
The report stated that stigma and discrimination continue to beset people living with HIV individuals most at risk of infection and social and legal challenges create significant barriers to an effective national AIDS response in many countries. A sustainable response must reach further to address punitive laws and the social drivers of the disease. Slowing the rate of new infections and HIV-related morbidity and mortality was vital to advancing almost every global development goal. To help achieve universal access and the Millennium Development Goal targets, the Joint United Nations Programme on HIV/AIDS (UNAIDS) was implementing the “Joint Action for Results: UNAIDS Outcome Framework 2009-2011”, a strategic plan focusing on 10 priority areas.
In his report, the Secretary-General recommends several ways to expedite progress towards universal access to HIV prevention, treatment, care and support. He said stakeholders must significantly intensify efforts to prevent new infections by making better use of proven strategies, such as solid commitments to eliminate mother-to-child transmission and optimizing the health of HIV-positive mothers and their families. National partners should begin planning now for long-term, sustainable antiretroviral therapy; and the HIV response should work actively with partners outside the HIV field to strengthen and leverage the synergies between HIV programmes and other Millennium Development Goals.
Further, HIV programmes should be specifically tailored to help them better support the strengthening of health-care systems; national Governments and international donors should sustain and increase financial contributions to HIV programmes; and prior to the 2011 review, national partners, with support from UNAIDS, should hold open, inclusive consultations to review progress in achieving country targets for universal access.
Statement by Acting President of General Assembly
JARMO VELI TAPIO VIINANEN ( Finland), Acting President of the General Assembly, said four years ago Member States had committed to pursue the goal of universal access to comprehensive HIV prevention, treatment, care and support. It was time to look at progress made, reflect on remaining challenges, and stake out the way forward. The meeting was particularly important in the lead up to the high-level plenary meeting on the Millennium Development Goals in September. The challenges posed by the HIV/AIDS epidemic were significant. HIV caused more deaths among reproductive-age women worldwide than any other health condition. The epidemic had impeded — and, if not addressed, it would continue to undermine — efforts to achieve several of the millennium targets.
Political ambitions had been encouraging, he said. More than 100 countries had set ambitious national targets to reach universal access. Countries had made progress in their response to AIDS, despite limited resources. They had recognized that investments today would reduce cost requirements in the future. “Today’s meeting should serve not only to reaffirm the importance of achieving universal access. In the face of challenges such as the financial crisis, it should also strengthen our resolve to intensify national and international efforts,” he said. Political commitment to achieve universal access was vital, as was recognized by the Economic and Social Commission for Asia and the Pacific (ESCAP) in its recent resolution.
“Time is not on our side,” he said. Some 7,400 new HIV infections happened every day. Nearly half of those infections were among young people and children. “Future generations will ask if we fulfilled our responsibilities. We must do our best to be able to answer that question, particularly at the high-level plenary meeting in September and Comprehensive AIDS Review next year,” he said.
Statement by Deputy Secretary-General
ASHA-ROSE MIGIRO, Deputy Secretary-General, delivering a statement on behalf of the Secretary-General, said today’s meeting was taking place as the response to HIV and AIDS reached a crossroads. Since 2001, global rates of new HIV infections had decreased by 17 per cent. More than 4 million people in low- and middle-income countries had gained access to antiretroviral therapy - a 10-fold increase in just five years. A few years ago, tools to eliminate mother-to-child HIV transmission were just ideas. Now they were being put into practice all over the world. The world was also confronting stigma and discrimination, seen in the lifting of decades-old travel restrictions against people living with HIV by several countries. But, more must be done.
The global financial crisis, the effects of conflict around the world, and the response to natural disasters were stretching limited resources, she said. Social and legal challenges were preventing an effective response in many countries. Individuals most at risk of HIV infection — men who had sex with men, injecting drug users and sex workers – were pushed to the margins, instead of being constructively engaged. “Universal access means more than ensuring that those who need treatment or prevention services receive them. It implies an extra effort to reach those who are marginalized, criminalized or disenfranchised,” she said.
Some Governments were cutting back on their response to AIDS, to give more to other development efforts considered less controversial, and lagging farther behind, she said. That was cause for serious concern. Such shifts in funding could very negatively affect all patients. Treatment and prevention programmes for HIV and AIDS were proven to affect the health of the population as a whole. Efforts to improve maternal health and achieve the fifth Millennium Development Goal needed a big push. But, less well-known was the fact that HIV was one of the leading causes of death among women of reproductive age worldwide. “The global response to AIDS is, therefore, an essential part of our efforts to meet women’s health needs. The Millennium Development Goals are indivisible and should never be pitted against each other,” she said.
The Secretary-General’s report presented a strong case for strengthening the links between the AIDS response and the other Millennium Development Goals, and it put forward a set of ambitious, but achievable recommendations, she said, expressing hope that the MDG summit in September would demonstrate greater resolve to strengthen those links. “I hope we will see, in the five years until 2015, strong support for national health, education and social service systems translate into benefits for HIV-specific programmes as well,” she said. “This will require more resources from national and global institutions. The cost may be great. But the cost of inaction will be even greater.”
She fully endorsed the strategic approach taken by UNAIDS to focus on 10 priority areas under its Outcome Framework, and said she would chair this year’s replenishment process for the Global Fund to Fight AIDS, Tuberculosis and Malaria. “We are here today on behalf of millions of men, women, girls and boys who have been given new hope by the recent advances in HIV and AIDS treatment and prevention,” she said. They now saw a future for themselves and had goals set by themselves, not by world leaders. They wanted to be teachers, doctors, parents and productive members of their communities. “If we do our part, they will have hope. We must realize their aspirations for the future — as well as our own,” she said.
RAYMOND SERGE BALÉ (Congo), speaking on behalf of the African Group, said that significant challenges remained with regard to universal access to prevention, treatment, care and support. The upcoming high-level meeting on the Millennium Development Goals in September would be a vital chance to address the issue of HIV/AIDS, which continued to represent a serious problem and handicap for development. African countries had addressed HIV/AIDS as a cross-cutting issue within the New Partnership for Africa’s Development (NEPAD), AIDS Watch Africa, and the Commission on HIV/AIDS and Governance for Africa, he said. Through these initiatives, a commitment to achieving universal access had been expressed, constituting a major stage in dealing with the pandemic at a global level.
Current statistics contained in the Secretary-General’s report showed progress made. New infections had decreased by 17 per cent from 2001 to 2008, while, in 2008, 10 times more people had access to antiretroviral therapy than in the previous five years. African countries had maintained progress achieved, as mortality rates had not increased since the Secretary-General’s 2009 report and access to antiretroviral therapy for HIV-positive people had increased in most countries. In addition, approximately 45 per cent of pregnant women received treatment to prevent infection of their children. However, the number of people suffering from HIV/AIDS remained high. The result of the improvement in treatment, he noted, had reduced the mortality rate, but increased the number of people living with the disease.
Despite progress made, more efforts were needed, he said, urging international donors and national Governments to meet their commitments. African countries supported recommendations on improving universal access in efforts to stop and reverse the number of cases by 2015. Any weakening in the efforts of partners could reverse progress made and have serious economic and social consequences in Africa. Therefore, strengthening strategic global partnerships was necessary to ensure success. He expressed hope that the international community would work in a coherent and transparent way to realize commitments made. Collective efforts, he said, were a vital precondition for addressing gaps in achieving universal access to treatment, care and support.
JUAN ANTONIO YÁÑEZ-BARNUEVO (Spain), speaking on behalf of the European Union, reaffirmed the Union’s commitment to the objectives set out in the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS. The barriers of discrimination, stigma and exclusion which prevent access to HIV prevention, adherence to treatment and antiretroviral medication, care and support, must be eliminated, he said, stressing that universal access could not be achieved without respect for human rights. Citing inequalities, gender-based violence and abuse as the main drivers of the epidemic, he noted the importance of work to increase the self-protection of women and girls and to ensure full access to education and information.
Emphasizing prevention as a mainstay of HIV/AIDS response, he welcomed progress in the development and use of new prevention tools. In this regard, he underscored the call on national Governments and international donors to intensify their efforts in HIV/AIDS prevention based on “Know your epidemic — know your response”, and called for further integration of programmes for sexual and reproductive health and rights, as well as the removal of legal and other barriers to effective HIV prevention. Efforts to tackle the epidemic should focus on youth infected with, or affected by HIV/AIDS, as well as other key populations at higher risk of infection — including men who have sex with men, injecting drug users, sex workers, prison populations, and others — as well as support their inclusion in the planning of strategies and programmes.
As a part of the international response, the European Union Commission had been a founding member and played a key role in the Board of the Global Fund, providing more than 55 per cent of the total contributions since 2001. It had also adopted a new Communication on combating HIV/AIDS in the European Union and neighbouring countries for 2009-2013 which focuses on the promotion of cost-effective prevention programmes and the implementation of measures targeting at-risk groups. In the way forward, the European Union will enhance its focus on policy coherence. Overall, the response to HIV/AIDS could only be successful through the use of a comprehensive approach and the establishment of a clear connection between all Millennium Development Goals, he said, noting that the upcoming high-level meeting was a unique opportunity to strengthen linkages, responses and efforts.
OCTAVIO ERRÁZURIZ ( Chile), speaking on behalf of the Rio Group, said approximately 2 million people in the region lived with HIV/AIDS. Although access to antiretroviral treatment had increased, the region still faced key challenges such as preventing new infections, providing necessary treatment, care and support, and reintegrating HIV-positive people into economic and social activities. To achieve universal access to treatment, it was necessary to make use of cooperation mechanisms, including South-South cooperation, and innovative instruments to reduce the cost of antiretroviral drugs, particularly since most resources in the region to address the epidemic were used to purchase medicine. Also in the region, it was necessary to increase access to second-line and third-line antiretroviral medicines, as well as to reduce their cost. Training of health-care personnel, technology transfer and the production of affordable, safe, effective and good quality medicine were essential.
He underscored the importance of defining specific solutions for middle-income countries, noting that initiatives to fight HIV/AIDS responded to such serious regional challenges as inequity and poverty. During last year’s debate on the subject, the Rio Group stressed the need to maintain and increase investments to respond to the epidemic. A significant part came from international cooperation. The Secretary-General’s report stated that total annual investments must reach $25.1 billion in order to achieve universal access to prevention, treatment, care and support. That meant a 40 per cent increase over 2008. Mobilization of international resources presumed that donor countries would fulfil their commitments to official development assistance (ODA), if possible, before the agreed deadline, in order the help reach the millennium targets by 2015.
He urged donors to actively participate and consider pledging generously at the replenishment conference in October. A key part of combating HIV/AIDS was in developing medium-term and long-term plans, in addition to short-term ones, which had adequate financing schemes and strengthened public health systems. Noting that people under 25 years of age accounted for more than 40 per cent of new infections, and the commitment to reduce HIV prevalence among young people by 25 per cent by 2010, he reiterated the region’s contribution to strengthening HIV/AIDS prevention efforts as stated in the Ministerial Declaration entitled “Preventing with Education” adopted at the first meeting of Ministers of Health and Education for Stopping HIV/AIDS and sexually transmitted diseases in Latin America and the Caribbean in August 2008. He reiterated deep concern over the overall expansion and feminization of the pandemic and acknowledged that women and girls bore a disproportionate burden in caring those affected by HIV/AIDS.
GEORGE TALBOT ( Guyana), speaking on behalf of the Caribbean Community (CARICOM), said that HIV/AIDS remained a pressing challenge within the region. Despite progress made — including a clear decline in HIV/AIDS prevalence since 2004 and a significant rise in access to treatment — a renewed focus on prevention efforts was needed to reach the most at-risk population groups. Efforts by CARICOM States, through the Pan Caribbean Partnership against HIV and AIDS (PANCAP), towards mobilizing technical support and resources had become a challenge to undertake in light of global crises. However, much had still been achieved, he said, noting the signing of the Partnership Framework Agreement in July 2009 and the approval of a PANCAP proposal for $34.5 million by the Global Fund in November 2009. CARICOM States were, in addition, pursuing the establishment of a Regional Technical Support Facility as a joint initiative between PANCAP and UNAIDS.
Addressing the global response to the issue, he called for Member States to fulfil their commitments of ODA and urged active involvement in the Replenishment Conference of the Global Fund in October. In light of linkages between the Millennium Development Goals, factors such as education, the role of women and children, and a healthy workforce in sustainable development were vital in combating HIV/AIDS. He noted that CARICOM States were seeking to ensure universal access to HIV/AIDS related prevention, treatment, care and support services for all persons in need through collaboration with regional and national entities, the promotion of policies and legislation addressing stigma and discrimination, intensified negotiations for reduced-cost antiretroviral drugs, and strengthened international links with development partners.
As success within the region was in large part due to the political support received, he called for increased political support within the international community. He highlighted the need for the international community to adjust to the changing dynamic of the disease, saying that it was “the only way that we will finally be able to claim victory in our battle”.
LE LUONG MINH (Viet Nam), speaking on behalf of the Association of South-East Asian Nations (ASEAN), said he was encouraged by the global response to HIV/AIDS, which had led to significant progress since adoption of the 2001 Declaration and the 2006 Political Declaration, notably the 17 per cent decrease in new infections between 2001 and 2008, as well as a decline in HIV incidence in many countries, including an ASEAN member. But, he noted with grave concern that HIV/AIDS remained the most deadly infectious disease in the world and the leading cause of death among women of reproductive age, and that the need for treatment still outpaced the availability of antiretroviral therapies. He lamented that HIV/AIDS-related knowledge among young people had not yet improved, and that stigma, discrimination and punitive laws continued to undermine efforts to prevent new infections. That meant many countries would not be able to fulfil targets for universal access to HIV prevention, treatment, care and support by the end of 2010.
ASEAN was deeply concerned that HIV/AIDS continued to threaten the lives and future of its people, especially vulnerable populations, with socio-economic consequences that posed a formidable challenge, he said. ASEAN was committed to implementing the Declaration of Commitment and the Political Declaration, and it had strengthened regional cooperation to effectively respond to the epidemic, as well as made its own regional political commitments through concrete strategies and programmes. That was illustrated at several ASEAN Summits since 2001, including the one in Viet Nam last April. HIV/AIDS control was highlighted in the ASEAN Socio-Cultural Community Blueprint adopted at the fourteenth ASEAN Summit in Thailand in 2009.
Recognizing the transboundary nature of HIV/AIDS, ASEAN members were guided by the ASEAN Vision 2020 on Southeast Asian Nations that were outward looking, living in peace, stability and prosperity, he said. As such, they affirmed the social responsibility of all members to act together in resolving HIV/AIDS. National leadership, ownership, political foresight and commitment to sustainable financing, multisectoral coordination and partnerships were a necessary part of an effective response to HIV/AIDS. The gender dimensions of the epidemic must also be addressed. Responses must be scaled up for children who were infected, affected by or vulnerable to HIV/AIDS.
GARY QUINLAN (Australia), speaking on behalf of the Pacific Islands Forum, said the report of the Commission on AIDS in the Pacific entitled “Turning the Tide” launched in New York last year was an important milestone for the region. The Commission drew global attention to the state of the epidemic there. It found sexually transmitted infections were endemic. High labour mobility, gender inequality, young populations with limited knowledge of how HIV was transmitted, cultural influences that restricted people’s willingness to talk about sex, and low condom use were other key risk factors. The Secretary-General had called for vigilance about the modes of transmission within each country and flexibility in national approaches. That was certainly needed in the Pacific, where diversity within and between countries required a variety of approaches. HIV transmission occurred in the region mainly through unprotected sex and women comprised the majority of reported cases.
Different epidemics required different solutions, he said. For Papua New Guinea, a comprehensive and scaled-up approach to prevention, care and treatment was required. The Government of that country had achieved notable success in providing antiretroviral treatment. At present, about 61 per cent of people in need and eligible for treatment were receiving it — up from 31 per cent in 2007. Mitigating the impact was a challenge, but preventing it was an even greater one. A good example of success, in that regard, was the 2007 agreement by the leaders of the thirty-eighth Pacific Islands Forum to amend the then-Pacific Regional Strategy on HIV and AIDS. That amendment stressed the emerging epidemic in other sexually transmitted diseases, resulting in a new strategy that addressed both HIV and sexually-transmitted diseases. The shift to focus on the latter was informed by the understanding that responses to HIV, particularly in low-prevalence countries, must be strongly linked to responses to sexual and reproductive health, and to maternal and child health.
Research was also important, he said. The Commission on AIDS in the Pacific suggested that patterns of the epidemic in the Pacific differed considerably among countries. When Governments understood those patterns, they could target interventions more closely and get better results. Pacific island leaders were committed to an effective and sustainable response to HIV/AIDS and sexually transmitted diseases. The support given by the Commission on AIDS in the Pacific attested to that. Business and faith-based leaders, like the Papua New Guineas Business Coalition against HIV and the Pacific Conference of Churches, were also helping to increase service provisions and reduce stigma and discrimination.
PHILIP PARHAM ( United Kingdom), aligning with the statement made on behalf of the European Union, said that HIV/AIDS continued to outstrip the global response. While approximately 4 million people infected with the disease had received antiretroviral therapy, more than 6 million people could not access it. Overall progress was “fragile”, he said, welcoming efforts by the Secretary-General to prioritize universal access on the agenda. In light of significant challenges, progress made showed that success was possible, as an estimated 400,000 new cases had been averted in Africa and more than 5 million AIDS orphans and vulnerable children and households now received some form of social and financial support.
Looking ahead, he highlighted the need to promote gender equality, transform harmful gender norms, and stop violence against women and girls in the worst affected countries of sub-Saharan Africa. Gender inequality and gender-based violence served as significant factors fuelling the epidemic, he noted, underscoring the need for women’s empowerment to be at the heart of the international development agenda. Given limited financial resources, he stressed the need to show that “money spent on AIDS buys real results” and urged Group of Eight (G-8) countries to meet their financial pledges.
MOIRA MÉNDEZ ROMERO ( Venezuela) said HIV/AIDS continued to be one of the most tragic epidemics of our time. Every day, there were more than 6,800 new infections and more than 5,700 deaths, due largely to inadequate access to services for prevention and treatment. The epidemic was not just a problem of severe dimensions in the health sector. Its reach extended to the economic, social and political sphere. That was why Venezuela continued to make Government policies that effectively addressed the HIV/AIDS problem. The Chavez administration recognized its duty and it provided universal access for all Venezuelans to free and efficient prevention, care and support. That was also recognized by social movements and community organizations. The Venezuelan Government had shown leadership. The Ministry of Peoples Power for Health, and national programme for HIV/AIDS and sexually transmitted infections channelled the actions of different bodies, which had led to important progress in recent years. There was greater visibility and public awareness of the problem of HIV/AIDS at the national level.
Community organizations participated in prevention projects, he said. He underscored the continued increase of all actors in prevention and care. Political support in Venezuela was constant and the Government had made ongoing budget allocations for national HIV/AIDS programmes, enabling it to broaden comprehensive coverage for people living with HIV. The Government ensured an adequate budget in the health-care sector, to allow for the achievement of health-care goals, including on HIV/AIDS. Programmes to prevent the spread of the epidemic among the general population were sufficiently financed. There were also education, prevention and other awareness-raising activities on such topics as abstinence, the promotion of condom use for safe sex, combating sexual violence against women and the fight against mother-to-child transmission. Venezuela was on track to meet the Millennium Development Goals related to HIV/AIDS by 2015.
Highlighting progress made in combating HIV/AIDS, NOMONDE XUNDU ( South Africa) said that the most effective solutions to the issue would come from the most affected communities. There were currently 5.7 million people living with HIV in her country, a figure which represented 17 per cent of the global burden of HIV and 25 per cent of the disease burden in Sub-Saharan Africa. In light of the need for a multisectoral response, South Africa’ National Strategic Plan on AIDS and STIs (2007-2011) was developed with cooperation with key stakeholders in Government, civil society and the private sector. Progress made included the initiation of antiretroviral therapy of approximately 1 million people to date, the stabilization of HIV prevalence among pregnant women attending antenatal clinics, and the decline of HIV incidence among youth, she said. However, sexual transmission of the disease remained high and HIV testing remained low.
In efforts to scale up interventions to address HIV/AIDS and accelerate national response on an unprecedented level, President J.G. Zuma announced interventions to expand access to treatment for those infected with HIV and launched the national HIV Counselling and Testing campaign, which seeks to test 15 million South Africans by June 2011. The campaign — which offers free HIV testing and counselling at all public health facilities and targets people over the age of 12 who are sexually active — has been hailed as the biggest campaign ever undertaken in the world to date, she noted.
The Government had committed to fund more than two thirds of its own AIDS response and committed $1 billion to the AIDS response in 2010. A recent re-costing of the national antiretroviral therapy programme indicated that the country would need substantial external financing to support the scale-up of prevention and treatment services. Therefore, resources from the Global Fund and other partners would continue to be needed. Noting South Africa’s national response theme of “I am responsible, we are responsible, and South Africa is taking responsibility”, she said that the support of several partners could hopefully assist the country in dealing decisively with the pandemic.
ISABELLE PICCO ( Monaco) said HIV/AIDS continued to be a major challenge for health, development and stability. She was encouraged by the fact that the number of new infections had dropped 17 per cent from 2001 to 2008. But, the objectives of the 2001 Declaration had not been achieved. Solidarity and action taken by all could slow down the rate of new infections, which was why Monaco focused on combating HIV/AIDS in its various cooperation programmes in Africa. Specific measures were needed in health care and development to address HIV/AIDS. Monaco contributed to the World Health Organization (WHO) to help reduce new infections, to the United Nations Children’s Fund (UNICEF) to help reduce mother-to-child transmission, and to microfinancing programmes to reduce poverty.
Monaco had a 2011-2014 programme aimed at reducing stigma against women and the feminization of HIV/AIDS, as well as stigmas faced by children, she said. Princess Stephanie was spearheading that and other initiatives to help people living with HIV/AIDS. Monaco’s La Maison de Vie project was a unique project in Europe. It provided a safe place and support for people living with HIV/AIDS. Monaco had renewed its framework agreement with the Joint United Nations Programme on HIV/AIDS (UNAIDS). As of January 2011, Monaco would become a member of UNAIDS Coordinating Committee. Monaco had a centre that offered free information on prevention to the population. It also held workshops and discussions on HIV/AIDS prevention and support in schools and local media. Media programmes also fielded questions on the subject from listeners.
WAEL M. ATTIYA (Egypt), aligning with the statement made on behalf of the African Group, said that the realization of the goal of universal access to prevention, treatment, care and support required more effective strengthening of national capacities in developing and low-income countries. Efforts in this regard, he said, required large investments to build governmental and societal capacities, expand research and make antiretroviral therapies more affordable. As such, continued international support was vital, in light of global crises and cutbacks on spending to improve health systems in developing countries. The international community should also commit to the effective use of resources, in cooperation with efforts implemented by non-governmental organizations and civil society.
Addressing international commitments to combat the epidemic, he called for more efforts in the fight against illegal trafficking of narcotic drugs and increased United Nations efforts to achieve the peaceful settlement of economically draining armed conflicts in African countries. Further, he underscored the need for regional cooperation in efforts to curb infection and mortality rates, noting that Egypt worked to share its expertise with other Africa countries through dispatching medical expertise, technical assistance and training. Other efforts by the country included the expansion of its pharmaceutical industry to produce antiretroviral medications. Such efforts — undertaken in cooperation with the private sector — were planned to contribute to the lowering of import costs.
JOHN MCNEE ( Canada) said Canada was committed to continuing its domestic and international efforts to address HIV/AIDS. Grounded in respect for human rights, Canada promoted and protected the dignity and rights of those living with, and at risk for, HIV/AIDS as key pillars to an effective response. It also strove to overcome stigma and discrimination and to sustain efforts in gender equality to address the feminization of the disease. That was one pillar in its approach to control the further spread of the disease, ensure that the most vulnerable populations had access to prevention, diagnosis, treatment, care and support, and to improve their quality of life. It was critical to understand the drivers of the infection, assess more systematically the effectiveness of interventions, augment surveillance practices, and guide research to where it was most needed. Building the evidence-base informed policies and programmes that aimed to meet the specific needs of populations disproportionately affected by HIV. Canada hosted the Second North American Housing and HIV Research Summit this month, and it was developing new research programmes to address the complex issues of co-morbidities and ageing experienced by people living with HIV.
Canada was also contributing to the global dialogue on HIV, tuberculosis, malaria and hepatitis C, and it was encouraged by progress on those, he said. He acknowledged the political role of civil society and people living with HIV/AIDS in the heart of the response. Canada was committed to scaling up efforts to achieve the goal of universal access to comprehensive HIV prevention, treatment, care and support. Between 2006 and 2009, Canada provided more than $650 million in funding assistance to strengthen health systems and to increase the availability and uptake of HIV/AIDS prevention and treatment in the developing world. It supported several large bilateral and regional programmes in Africa, Asia and the Caribbean, as well as multilateral initiatives that facilitated access to medicines for developing countries. It also provided aid to multilateral organizations and Canadian civil society in the response to HIV/AIDS internationally. To help reduce HIV transmission, Canada would continue to contribute to global efforts in research, laboratory sciences and programmes to develop vaccines and other prevention technologies.
Quoting the opening text of the Declaration of Commitment on HIV/AIDS of 2001, PEDRO NÚÑEZ MOSQUERA ( Cuba) expressed concern that agreed goals had not yet been achieved, despite the efforts made. As the number of people with HIV/AIDS in 2009 was 20 per cent higher than the number published for 2000, he urged the international community to redouble its efforts. The global economic and financial crises — a direct consequence of the “irresponsible behaviour” of transnationals and Governments of developed countries — further aggravated the situation, as commitments to development assistance remained unfulfilled or undermined, despite record military spending. Annual investments required to achieve universal access must reach $25.1 billion, he noted, a figure which represented 40 per cent more than total investments in 2008.
Although Cuba viewed the fullest enjoyment of physical and mental health as an inalienable human right, it was faced with a fierce economic, commercial and financial blockade imposed by the United States, which hindered access to new medications and technologies. Despite limited resources, the Cuban Health Care System, as well as the Multi-Sectoral HIV/AIDS Prevention and Control Program, were free and accessible to all. Because of that and the country’s scientific developments, Cuba had one of the lowest levels of prevalence on the planet. He stressed that people living with the disease did not need promises, but rather concrete actions from the international community, with its capacity to guarantee their right to health care. Speaking on behalf of the more than 30 million people living with the disease, he called for cooperation to save lives.
NICOLAS DE RIVIÈRE (France) said the Secretary-General’s report showed that important progress had been achieved, with 4 million people having antiretroviral treatment and a 17 per cent drop in new HIV infections from 2001 and 2008. But, it must be said that the efforts made had not met the challenges posed. It was unacceptable that for every two people receiving antiretroviral treatment, there were five new cases of HIV in need of treatment. Efforts must be increased. France had invested considerably in combating the epidemic by contributing $2.5 billion to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria since its inception. France was the Global Fund’s second-largest global donor. France was a founder of the Joint United Nations Programme on HIV/AIDS (UNAIDS), which played a crucial role in improving access to treatment. France’s financial contribution to UNAIDS since 2006, paid for by its levy on airplane tickets, was $655 million. Such investments had a positive impact on achieving the other Millennium Development Goals, particularly the goals on maternal and child health. By 2015, it was necessary to work to build synergies.
France was aware of the importance of mother-to-child transmissions, he said. It was unacceptable that 400,000 children were still born HIV-positive, when the world had the means to prevent that. Greater action was needed. Current financial pledges were not enough. The response, in the face of the growth of the epidemic, must be global in nature. It must guarantee equitable and universal access to care. Further, programmes to treat HIV/AIDS must not be isolated. They could and should be used to help fight other diseases. It was also necessary to address social factors related to the disease, as social and legal obstacles hindered efforts to combat the epidemic. It was necessary to deal with the stigma and discrimination faced by HIV-positive people, and he welcomed the efforts of UNAIDS in that regard. He recalled the importance of decriminalizing homosexuality, in that regard. He called for increased resources to achieve a real drop in HIV/AIDS, and for all to respond to the Secretary-General’s appeal to replenish the Global Fund.
CARLOS ENRIQUE GARCÍA GONZÁLEZ (El Salvador), aligning with the statement made on behalf of the Rio Group, reaffirmed the country’s political will to continue strengthening measures towards combating the disease, noting that the country had joined strategies to eliminate discrimination as a primary barrier to success against HIV/AIDS. He highlighted the Government’s passage of a ministerial decree which ensured access to health services and the respect of the human rights of gay men, transsexuals, transvestites, and lesbians. The decree included actions aimed at addressing sexual-orientation-based discrimination and encouraged health-care institutions to report on actions that could be taken to reduce homophobia and discrimination. Efforts had also been taken to identify and correct discrimination practices within the public sector.
On both the regional and subregional level, preventative measures were needed. As the pandemic had expanded through Central American, Latin American and the Caribbean States, he said that cooperation between countries in the region should be a “cornerstone” in the fight to combat HIV/AIDS, and the exchange of information was central. While unprotected sex remained the primary means of transmission, the most alarming factor was transmission among vulnerable groups — including indigenous groups, which did not have the capacity needed to acquire contraceptives. Annual financing for programmes had increased in 2007 and 2008, but the upward trend was in jeopardy. Therefore, it was vital that investments be maintained or increased in efforts to achieve the Millennium Development Goals, within the framework of international cooperation. He said that there should be short-, middle- and long-term plans to combat the epidemic, which should include solid financing systems.
JOSHUA MWANGI MUGODO ( Kenya) said HIV/AIDS was still devastating large sections of African communities and was reversing modest gains made thus far. Sub-Saharan African countries were in different stages of addressing the pandemic, with mixed results. While some had some success, the situation remained grave, despite efforts in the last 20 years. During the past decade, several sub-Saharan African countries, including Kenya, had demonstrated that the epidemic could be tamed by adopting and coordinating an aggressive multisectoral strategy, deeply entrenched within the community and with high-level leadership. Despite Kenya’s gains in reducing HIV prevalence to 7 per cent, the threat was still very real. The lack of resources to sustain progress was threatening to wipe out gains made so far. The close link between HIV/AIDS and maternal health and child mortality had to be addressed. Kenya’s Government was determined to continue with aggressive awareness campaigns and expand voluntary counselling, testing initiatives and centres. But scaling up was seriously hampered by unpredictable, wavering funding.
Women comprised a huge percentage of those living with HIV/AIDS, he said. Kenya was addressing the feminization of HIV/AIDS by educating women and increasing their participation in all sectors and levels of decision-making. The Government had initiated policies and programmes to deepen women’s and youth’s participation in all aspects of development, among them the Women Development Fund, Youth Enterprise Fund, Local Authority Transfer Fund and Constituency Development Fund. Kenya’s 2009-2013 National AIDS Strategic Plan included cost-effective services for universal access to prevention, treatment and support; targeted community-based programmes for universal access; long-term programmes addressing the root causes and impact of HIV in key sectors; and operations that were nationally owned, harmonized and aligned at all levels.
ALEXANDER A. PANKIN ( Russian Federation) called for ongoing treatment, sustained financing, and the improvement of health-care services in the fight to combat the epidemic, noting that progress made would contribute to meeting other Millennium Development Goals. Just five years from deadline to achieve the millennium targets, the time had now come to mobilize efforts, he said. The Russian Federation fully supported efforts made by the World Health Organization and the Global Fund to address existing health problems, and prioritized the issue on its own agenda. He noted that the country had thus far contributed $225 million to the Global Fund and planned to increase its contribution in the future.
In light of the spread of the disease on both the regional and subregional levels, the country had increased its assistance to countries in the region, contributing $50 million to research and creating a coordination method in Eastern Europe and Central Asia. He noted that enhanced regional cooperation was called for at the Conference on HIV/AIDS in Eastern Europe and Central Asia, in Moscow last October, a meeting which focused on forecasting the spread of the disease and analysing effective prevention methods. Further progress in combating HIV/AIDS, he stressed, must be done on the basis of political will and practical methods.
SOCORRO ROVIROSA ( Mexico) said Mexico’s response had been enshrined in the March 2010 national report that reflected progress in implementing the 2001 and 2006 Declarations. Mexico’s main goal was to maintain HIV prevalence below 0.6 per cent for people aged 15 to 49. To obtain that, the National Centre for the Prevention and Control of AIDS launched a national prevention strategy, in which it defined the actions and functions of all public and private actors to combat the pandemic. Another important step forward in prevention was the increase in the use of services, including condoms, lubricants, and HIV/AIDS detection kits, particularly among pregnant women and other key sectors of the population. The Government had launched programmes and campaigns for indigenous people and those in detention, as well as programmes for youth. Educating young people on the matter was underscored in the “Prevention with Education” Ministerial Declaration approved during the First Meeting of Ministers of Health and Education for Combating HIV/AIDS in Latin American and the Caribbean, which took place in Mexico.
Mexico had also bolstered support through campaigns to reduce stigma, discrimination and homophobia associated with HIV/AIDS, she said. Its 2007-2012 national health programme proposed keeping access to antiretroviral therapies as a priority. Mexico had made a positive contribution to those statistics in the Secretary-General’s report, which showed that, as of December 2008, 4 million people in middle-income counties had received antiretroviral treatment. The fight against homophobia must be a priority. Mexico reaffirmed its commitment to respect for human rights and it set 17 May as a national day for tolerance and respect for preferences. She reiterated the need for UNAIDS to optimize its work in technical cooperation, in order to prevent United Nations agencies from carrying our redundant work in the countries it served. UNAIDS must maintain its commitment to allocate and increase resources for the fight against HIV/AIDS, especially in middle-income countries. A recently created fund for high-risk populations only had $200 million for five years. Therefore, support by UNAIDS and its co-sponsors to middle-income countries was vital.
ADE PETRANTO ( Indonesia) highlighted HIV/AIDS as a major threat to development, noting that it was a critical factor in the resurgence of other infectious diseases. Prevention efforts should be stepped up, he said, as prevention was “28 times more cost-effective than treatment”. In that regard, Indonesia set a national target in 2007 to achieve universal access by 2010 — which included making effective prevention, care, support, treatment and impact mitigation available to 80 per cent of its most at-risk population. In recent years, the Government had significantly increased its allocation of resources for HIV/AIDS and allocated $73 million to the issue in 2009, while provincial and district budgets in the same year rose to Rp 74 million.
Despite encouraging progress made, more resources were needed to fully reach the goal of universal access and other targets, he said. Indonesia, in efforts to stop the spread of the disease, planned to focus on extending service coverage, improving the quality and effectiveness of its HIV programmes and ensuring resource sustainability. He noted that the Government sought to mobilize more domestic and international funding, and to undertake partnerships with religious leaders, organizations and the private sector to fulfil its leadership responsibility in providing policy direction. Overall, Indonesia planned to select, prioritize, and scale up effective interventions, while promoting and strengthening local, national and international anti-HIV networks to reach its targets.
BYRGANYM AITIMOVA ( Kazakhstan) stressed the need for more resources to respond to the needs of many low- and middle-income countries to address the HIV/AIDS pandemic. She reasonably supposed that part of the financial resources were spent on obtaining antiretroviral medications to provide adequate treatment for HIV-positive people. She was counting on the 2011 meeting to hold a multilateral dialogue on how to provide more acceptable, reliable and affordable medications to meet the increasing demand for first-line and second-line therapies. It was crucial to make the elimination of mother-to-child transmission a priority, as well as promote social protection programmes for orphans and vulnerable children, whose parents were affected by HIV/AIDS. She supported the recommendations in the Secretary-General’s report on adopting strategically aligned programmes that combined health care, the social sphere and human rights protection. Kazakhstan had made progress in addressing HIV/AIDS related issues. It had adopted and nearly completed a 2006-2010 results-oriented comprehensive national programme to combat the pandemic. That programme had proven effective in reducing vulnerability and maintaining human rights.
Kazakhstan had strong political leadership, multisectoral cooperation, preventive measures and treatment, in line with United Nations recommendations in the field of prevention, treatment, care and support, she said. Its programmes were aimed at safe sexual behaviour and safe injection of drugs. To strengthen prevention measures, monitoring and assessment were further strengthened. It was important to promote regional partnerships to address the pandemic. In May, a regional conference had been conducted to analyse the epidemic and its development among risk groups. Kazakhstan intended to improve the monitoring and evaluation system and strengthen diagnostic capacity and prevention programmes. It had also held a conference on combating stigma and discrimination of HIV-positive people.
MANJEEV SINGH PURI (India), noting that the adult HIV rate in India was as low as 0.36 per cent, said the primary objective of its national programme to combat HIV/AIDS — the National AIDS Control Programme — was in line with millennium target number 6. The programme, he said, sought to scale up India’s efforts through targeted interventions for high-risk groups, strategize comprehensive information, education and communications packages for certain segments, and scale up service delivery. The country recognized that the fight against HIV/AIDS also had socio-economic and developmental dimensions and, therefore, mainstreamed prevention, care and treatment into all Government activities, while undertaking partnerships with corporations, non-governmental organizations and other stakeholders.
He emphasized the need for a holistic approach in effectively combating the issue, noting that the approach should include effective prevention strategies and access to low-cost treatment for all. Additionally, he called for greater cooperation and coordination at the international level, citing India’s research work in collaboration with the International AIDS Vaccine Initiative. In light of the major obstacle to universal access that the high cost of antiretroviral drugs represents, the Indian pharmaceutical industry had worked to reduce costs by producing high-quality drugs for those affected in India and other developing countries. He asked that the international community recognize and support such efforts.
DANIELE BODINI ( San Marino) said HIV/AIDS not only brought immense pain and death. It also destroyed, in so many communities and countries, the fundamental right of young generations to live a long, enjoyable life. The number of HIV-infected people now totalled 33 million; but, that number was in the hundreds of millions when the families and communities affected as well were factored in. Even as the number of people cured with antiretroviral therapy was 10 times greater than five years ago, for every two people starting such therapy, five were newly infected. It appeared that the world was losing the battle against the epidemic. Therefore, it was necessary to increase global medical efforts, as well as enhance education and prevention of the disease, especially among young people.
San Marino was responding to its domestic challenge through a prevention and education strategy, he said. It was actively involved with information concerning sexually transmitted diseases. Its national health-care system took care of its citizens, monitoring HIV/AIDS cases, while guaranteeing free treatment and anonymity for all patients. Internationally, San Marino participated directly and through private foundations in UNICEF-sponsored programmes in various developing countries.
SHIGEKI SUMI ( Japan) said that HIV/AIDS and global health was a key element of Japan’s foreign policy. Under the Health and Development Initiative announced in 2005, the country had been tackling the disease and other health issues through the Japan International Cooperation Agency (JICA) and its partners, he said. During the G-8 Kyushu Okinawa Summit in 2000, it took up infectious diseases as one of the key agenda items, which led to the establishment of the Global Fund. As a founder of the Fund, Japan appreciated the results achieved, including the successful resource mobilization in the amount of $20 billion for three major infectious diseases, expansion of the antiretroviral therapy for 2.8 million people, and the Preventing Mother-to-Child Transmission (PMTCT) service for 930,000 HIV-positive pregnant women as of 2009.
Recognizing HIV/AIDS as a threat to human security, the country renewed its commitment to achieving universal access and the millennium targets and continued to support such efforts through the Global Fund. He noted that the Third Replenishment Conference of the Global Fund in October was the best opportunity to strive for achieving the millennium targets by 2015, calling for contributions from new donors. He emphasized the need for a comprehensive approach in making disease control work effectively and addressing maternal, child and newborn health, urging that HIV/AIDS response be integrated into primary health-care methods. Lastly, he underscored prevention as key to achieving sustainable impacts, noting that programmes should be developed to address epidemiological and social trends.
MARÍA LUZ MELON ( Argentina) stressed the importance of mutual support in the response to the HIV/AIDS pandemic and greater development programmes to achieve the Millennium Development Goals. Efforts must also be made outside the health-care sector, taking into account that HIV transmission was greatest in situations where people were vulnerable and socially marginalized. Vulnerable populations such as sex workers, transsexuals, homosexuals and transvestites, men who had sex with men, migrants, indigenous people, the poor and drug users were at great risk. Since 1990, Argentina had a law aimed at controlling the pandemic and guaranteeing care, respect for dignity and non-discrimination, and confidentiality for persons living with HIV/AIDS. A gender perspective had been integrated into national policies on HIV/AIDS, particularly as they concerned care for pregnant women, 87 per cent of whom received treatment to prevent mother-to-child transmission.
Argentina’s Ministry of Health was working in line with the objectives of the 2001 Declaration, including those to reduce HIV prevalence among young people by 25 per cent by 2010, guarantee access to information regarding the disease, and treatment and care for 95 per cent of young people. The country’s Federal Health Plan aimed to improve diagnostic testing for the population, improve access to quality care, generate preventive measures with all social actors to stem the disease, create a base to guarantee access to resources for prevention, and identify relevant actors to promote access to condoms and other prevention tools. Argentina had set several immediate goals, among them reducing HIV prevention among pregnant women aged 15 to 24 by 10 per cent; reducing the HIV mortality rate by 12.5 per cent; reducing AIDS incidence by 20 per cent; and increasing condom use among young people by 25 per cent.
NAJLA A.H. ABDELRAHMAN ( Sudan), aligning with the statement made on behalf of the African Group, said increasing infections among pregnant women represented a threat to women globally. Given factors that increased the danger of HIV/AIDS within the Sudan, the President had reaffirmed the country’s full commitment to combating the disease through the initiation of a comprehensive national strategy. A North-South agreement assisted in facing the consequences of internal migration and economic difficulties. With regard to youth and women, two alliances had been launched under the leadership of the First Lady in order to involve all sectors of society, she said. Further, the Government had laid down the foundation to assist those affected with the disease and develop the necessary strategies to provide access to treatment.
In other efforts, it developed and enacted laws to protect those infected, focused on improving their living conditions, and established support groups. Considering the education sector, she highlighted improvements made in providing youth with the knowledge and know-how to protect themselves. Looking ahead, she said that Millennium Development Goal 6 might not be achieved within the time frame allocated unless the international community redoubled its efforts to meet commitments. In spite of the links between the millennium targets, insufficient focus had been given to combating the spread of HIV/AIDS. In addition to joint efforts to improve capacities, she called for comprehensive consultations with partners in UNAIDS and an increase of international development assistance to developing countries.
IVAN BARBALIĆ ( Bosnia and Herzegovina) said the HIV/AIDS pandemic represented a major ill on a global scale. It was of the utmost important to address the issue. The HIV/AIDS pandemic did not respect regional borders and it was necessary to generate an extraordinary response. He fully supported all efforts by international organizations to provide treatment, care, support and prevention. Bosnia and Herzegovina had a low HIV prevalence rate. Ninety per cent of the people who suffered from the disease in Bosnia and Herzegovina were intravenous drug users, and there were no reported cases of mother-to-child transmission. She pointed to technical cooperation between UNAIDS and Bosnia and Herzegovina’s Council of Ministers, which had set up a national advisory board on HIV/AIDS.
Bosnia and Herzegovina was in the process of preparing a national HIV/AIDS strategy for the 2010-2014 period, he said. The 2004-2009 strategy was still in place. It had aimed to prevent transmission, provide care, create a legal framework for ethical principles, ensure cooperation and develop capacity to combat the disease. He lauded the work of several international organizations that enhanced HIV prevention, including the work of UNICEF, United Nations Population Fund (UNFPA), and Partners in Health. A global and comprehensive response was needed.
Aligning with the statement made on behalf of the African Group, MARIANNE ODETTE BIBALOU (Gabon) noted information in the Secretary-General’s report which showed that universal access had expanded to more people, thus providing millions of patients who live in low- and middle-income countries with antiretroviral therapy. Despite encouraging developments, she said, a lack of resources remained a major challenge that many countries needed to meet, particularly those in sub-Saharan Africa.
Efforts in the fight against the disease were ongoing and productive in Gabon, as the Government — in cooperation with several partners — was working to raise awareness. Several campaigns had been organized, including the “Caravan against HIV and AIDS” launched by the former First Lady. Promoting the slogan “Every family is fighting HIV and AIDS”, the national strategic plan sought to set up mobile treatment centres and provide free screenings for youth, pregnant women and the unemployed. In light of the deadline to achieving the Millennium Development Goals, she called for all stakeholders to renew and strengthen their commitments and to work towards partnerships. By working together, she stressed, the challenges posed by HIV/AIDS could be overcome.
SIGRUN MOGEDAL ( Norway) said people who received treatment today would need it tomorrow. A large number of people that needed treatment still did not have access to it. There had not been a breakthrough to stop HIV transmission, meaning the rate of infection continued to outpace the global response. That meant they need to do even better in safeguarding achievements and results, and to ensure long-term sustainability. The fact that the world was far from universal access meant that it needed to work differently. Stopping HIV transmission was one key element. Stopping stigma, discrimination and disempowerment was another. Dealing with structural causes that disempowered women and girls, caused vulnerability and denied dignity and rights were at the centre of challenges faced. “We cannot any longer deal with HIV and AIDS in isolation; what counts are synergies,” she said. Obvious synergies were in the health sector. The Secretary-General’s report made a special case for maximizing the potential in synergies between goals 4 and 5. The approach outlined in the draft Joint Action Plan being formulated for the Millennium Development Goals summit was essential for keeping mothers alive and preventing HIV mother-to-child transmission. It should be embraced and acted upon by the HIV/AIDS movement.
The message to bring forward was that vertical transmission and maternal mortality and morbidity due to HIV/AIDS could be stopped, she said. Safe deliveries, care for the newborn and coping with HIV/AIDS before, during and after birth had the same system requirements. “If we cannot cope with AIDS in pregnancies, we cannot make deliveries safe,” she said. Moving forward, she said it was important to build on what had already been learned and actively use the HIV/AIDS response as an amplifier to track and expedite the Millennium Development Goals response, in terms of access to health services, improved interaction between delivery and demand, access to medicine at affordable prices, and sexual and reproductive rights, among others.
JOYCE KAFANABO (United Republic of Tanzania) said under the strong political leadership of President Jakaya Mrisho Kikwete, her country was achieving notable progress in combating HIV/AIDS. The rate of prevalence of HIV for both men and women had declined. The number of people receiving antiretroviral therapy, including for pregnant women to prevent mother-to-child transmission, had increased. The challenge was to sustain those achievements and to increase the momentum towards achieving the 2015 Goals. New infections continued to occur, highlighting the urgent need to revisit the country’s prevention strategies. Each country needed to understand the drivers of the epidemic and to make better use of proven strategies, while continuing to develop new preventive approaches, especially those that addressed women’s biological and sociocultural vulnerabilities. The feminization of HIV/AIDS was of great concern to the Government of Tanzania, which had made women’s empowerment and women’s education a priority.
She said Tanzania was mindful of the need to continue investing in HIV prevention, treatment, care and support. It needed to draw up plans to sustain antiretroviral treatment for those currently undergoing that type of therapy. The Global Fund for HIV/AIDS, Malaria and Tuberculosis had helped countries such as her own to fund such programmes, and she called on development partners to provide the Fund with more resources at the next replenishment exercise. Moreover, in view of links between the global AIDS response and the achievement of the Millennium Development Goals, she urged Governments to strengthen data collection, so that there was adequate data and information to review progress at the upcoming review of the Goals. For its part, Tanzania reaffirmed its unequivocal commitment to implementing the 2001 Declaration on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.
NTESANG MOLEMELE (Botswana) said that, while the Secretary-General’s report confirmed that the global community had indeed mounted a strong and comprehensive response that had yielded significant gains against the HIV/AIDS pandemic in many areas, the disease had nevertheless continued to outpace the response. That reality was particularly highlighted by the fact that for every two people enrolled in antiretroviral therapy, there were five new infections that would eventually require some form of HIV-related services. “Clearly, this calls for drastic scaling up of access to HIV-related services for all, especially girls, youth, women and other vulnerable groups,” she said, adding that without such expanded and accelerated actions, the collective effort to meet commitments on HIV/AIDS would “remain a distant possibility”.
She went on to say that sub-Saharan Africa continued to lag far behind other regions in reversing the spread of HIV/AIDS, and unless drastic steps were taken to step up implementation in that and other areas, Africa would not attain its Millennium Development Goals. Botswana remained one of the most widely affected countries and the Government had put in place a number of interventions to combat the scourge. Implementation of those programmes had resulted in some modest achievements in raising and sustaining awareness on HIV/AIDS, preventing and reducing new infections, reducing HIV/AIDS related morbidity and mortality, and reducing the number of orphaned children. “Prevention remains the mainstay of the national response,” she said, stressing that testing and knowledge about one’s status were the keys to that effort. Routine testing for all patients visiting health facilities in Botswana had been introduced in 2004, and today, more people than ever had access to that service, including at voluntary testing and counselling centres.
ALYA AHMED S. AL-THANI (Qatar) said, despite a low HIV-prevalence rate in Qatar, her Government had taken several steps, such as setting up in 2006 a national committee to combat HIV/AIDS, a programme for capacity-building, and a prevention programme supported by the UNAIDS and the United Nations Development Programme (UNDP). It had also set up a national committee and a national strategy to combat HIV/AIDS in areas where it was spreading. Qatar’s Government had also adopted principles based on Muslim sharia law, providing care to everyone without discrimination. She commended the Secretary-General’s report, which pointed to a 17 per cent decrease in the number of HIV infections between 2001 and 2008. She stressed the importance of remaining vigilant. HIV was the main cause of death among women and the main cause of infant mortality worldwide.
Stigma and discrimination remained a burden for those living with HIV, she said. It was necessary to step up investments, because the current amount was insufficient. Several countries had not set up the necessary measures to honour their commitments, in that regard. She called for efforts to strengthen current financial mechanisms. She reaffirmed the importance of having a degree of flexibility in terms of national implementation strategies. No one single model could be applied to all countries. Different plans and strategies tailored to countries’ specific needs were necessary. Qatar had good experience with using religious and cultural values and incorporating them into awareness-raising campaigns.
SANSANEE SAHUSSARUNGSI ( Thailand) voiced her country’s firm commitment to fighting HIV/AIDS, saying it would continue to focus on meeting the goal of universal access to prevention, treatment, care and support by 2010, along with other commitments beyond 2010. The Administration of the current Prime Minister had given particularly strong policy support to the national AIDS strategy, which was currently being redrafted as an accelerated plan. That Administration had been credited with placing a renewed focus on HIV prevention. It had revived the free condom campaign of the early 1990s, which had in the past achieved “astonishing” success and had been copied as a model in many countries.
She said Thailand recognized that the epidemic was constantly evolving, and that there was a need to redouble efforts to reach emerging groups of youth and women that were becoming increasingly vulnerable to HIV infection. In that regard, the Government had strengthened its focus on reaching youth groups and women who were victims of violence, since they were often found in environments that were more prone to HIV/AIDS than normal. Internationally, Thailand would continue to place importance on working with the countries of ASEAN, and with UNAIDS, which was doing excellent work in raising awareness, and in exchanging best practices, technical know-how and experience in prevention and care. Thailand was proud to have contributed to the Global Fund to Fight AIDS, Tuberculosis and Malaria.
MARIA RUBIALES ( Nicaragua) said that it was necessary to achieve universal access and incorporate HIV-positive individuals into economic and social activities. In this regard, the country was utilizing a multidisciplinary, multicultural and cross-cutting approach in implementing a model on health care that strengthened the fight against HIV/AIDS at a grass-roots level. Such efforts led to a significant reduction of the infection risk of specific groups, while a policy of free health care had achieved much in the way of treating the disease. There were approximately 4,000 HIV cases in Nicaragua, and of those, around 1,000 were receiving treatment, she noted.
The country had achieved a considerable increase in the number of treatment and testing centres, as there were currently 27 available, as compared to the three centres available in 2007. In these centres, people could receive care and regular testing, and a Government cooperation agreement allowed for access to antiretroviral therapy for women and children. She said that coverage had been extended for rapid HIV testing, and the increase in testing benefited an additional 30 per cent of women in some municipalities. Overall, the country would continue work towards its commitments. She restated the need to mobilize resources and for donor countries to meet their commitments in achieving the millennium targets.
LAURIE SHESTACK PHIPPS ( United States) said the United States was a leader in the global fight against HIV/AIDS and it worked to relieve suffering among the world’s poorest people. The Obama Administration had invested $63 billion in six years to help partner countries improve the health care of their citizens through integrated approaches. As part of it, the United States was increasing funding to the President’s Emergency Plan for AIDS Relief (PEPFAR). President Obama had mandated an increase in that funding in fiscal 2010 and fiscal 2011 — the largest to date in a United States President’s budget. A metric for success was not money spent, but lives saved. The number of people receiving antiretroviral treatment had risen from 1.6 million in 2009 to 2.5 million today. The number of people treated in coming years would continue to grow to nearly 4 million. A comprehensive approach was needed to save the lives of not only those living with HIV. Maternal and child health care and strong health systems overall played a large part, as well.
Through global health initiatives, the United States would work to ensure that global investments were comprehensive, she said. Prevention and a woman-centred approach must be central to all efforts. PEPFAR programmes tailored to local epidemiology must be the highest priority. It was necessary to ensure that all programmes met the needs of women and girls. As a leading cause of maternal mortality, HIV had a devastating impact on women and children. Effective programmes had saved women’s and children’s lives directly, as had health-care systems and community-based programmes. Every country must take a leadership role in providing resources. The United States was supporting partner Governments in identifying and prioritizing unmet needs. Humanitarian support from donors should not reduce, but complement health-care efforts. The United States was the biggest contributor to the Global Fund at the country level. But, it should not be the sole resource in any particular country. It was necessary to leverage commitments from other sources.
GEORG SPARBER (Liechtenstein), while recognizing the tremendous progress made to date in the fight against the HIV/AIDS epidemic, noted nevertheless that the international community was not on track to meet the goal of reversing its spread by 2015, and despite notable successes by individual countries, risked to fail in achieving the undertaking to universalize access to HIV/AIDS treatment by 2010. In order to deliver on that commitment, he urged the international community to recognize the gender dimension of the issue, noting that women were disproportionately vulnerable to HIV/AIDS, and their specific situation needed to be addressed.
He said the provision of universal access to sexual and reproductive health services, for instance, had been proven to contribute to HIV prevention, and in particular to the elimination of mother-to-child transmission. Addressing the broader issue of gender inequality in societies ensured that HIV/AIDS programmes were targeted at the specific needs of women, such as preventing unintended pregnancies, strengthening antenatal care and expanding services for female sex workers. Further, he shared the Secretary-General’s concern expressed in his report about the overly broad criminalization of HIV transmission, the withholding of HIV prevention and treatment for the most-at-risk population, and other discriminatory methods. He was of the belief that a full and effective response to HIV/AIDS required that the human rights dimension of the epidemic was addressed, including gender inequalities, social marginalization, stigma and discrimination, such as through the meaningful involvement of people living with HIV in prevention programmes.
IQBAL AHMED ( Bangladesh) said efforts must be redoubled in the areas of prevention and treatment, stressing the importance of raising mass awareness at the grass-roots level and the role of the media and non-governmental organizations in achieving such awareness. With regard to treatment, antiretroviral drug prices needed to be lowered and the issue of higher priced second- and third-line drugs needed to be addressed, he said. Given limited financial resources, he urged the international community to fulfil their ODA commitments and to begin research into innovative sources of financing.
While Bangladesh was considered a low-prevalence country, significant levels of risky behaviour made the country vulnerable to HIV/AIDS. In efforts to combat the disease, a national AIDS/STD programme — which featured strong partnerships among Government, non-governmental organizations, civil society and donors — had been started in 1998 to facilitate comprehensive interventions targeted at the most vulnerable and bridge groups. Intervention packages, he noted, included condom promotion, detoxification, health education and counselling, community awareness and local-level advocacy, among other things. Addressing prevention, he emphasized the role of faith-based organizations and their leaders in raising awareness and empathizing with those affected by the disease.
GUILHERME DE AGUIAR PATRIOTA ( Brazil) said his country had worked relentlessly to make universal access a reality and to provide free, affordable medicines and treatment to all. Brazil’s results spoke for themselves, proving that “cost and coverage” were crucial to winning the fight against HIV/AIDS, especially for developing countries. On the broader combat against the disease, he said that, while new HIV infections had decreased worldwide by 17 per cent and some 14 million people in the developing world were now receiving treatment, those relative successes should not be seen as an excuse to relax. Indeed, much more remained to be done — new infections must be prevented and the lives of people living with the disease must be improved. “We have to fight discrimination and stigma. Financing has to be increased. Access to prevention, treatment and support must be universal,” he said.
There was no easy path to reducing vulnerability, he continued, stressing that sexual and reproductive health services, commodities and supplies needed to be widespread and free, or affordable. Sexual and reproductive rights had to be protected as a matter of fact and the United Nations and national Governments should implement public policies for the provision of HIV- and gender-sensitive education for young men and women. Turning to Brazil’s efforts, he said that, with the support of civil society movements, his country’s Government had enacted innovative HIV-prevention and -treatment policies that now reached some 600,000 people living with the virus. Those efforts had also made antiretroviral therapy available free of charge for all those who needed it.
As a result, the incidence of HIV in Brazil had stabilized and was now declining. For example, he noted that the number of affected children under the age of 5 had been nearly cut in half because of a major effort to prevent vertical transmissions. Despite such success, he said, Brazil faced the feminization of the virus. It had, therefore, responded with a relevant national plan created in partnership with civil society and health workers, which took into account social, economic and cultural factors that contributed to increasing women’s vulnerability. Among the main hurdles was the limited access to female condoms, and insufficient levels of investment in their technical improvement.
PHILIP J. BENÉ, Permanent Observer for the Holy See, noted that the global community continued to face challenges in its efforts to combat HIV/AIDS. Underscoring the need the combat the disease through realistically addressing its deeper causes and providing care to those infected, he strongly recommended that more attention and resources be allocated in support of a value-based approach on the basis of a spiritual and human renewal, which could lead to a new way of behaving towards others. In order to effectively stop the spread of the epidemic, a respect for the dignity of human nature and its inherent moral law must be included as an essential element in prevention efforts.
Considering available financial resources, he expressed the Holy See’s deep concern regarding the gap of funding for antiretroviral treatment among poor and marginalized populations. Several Catholic Church-related providers in Uganda, South Africa, Haiti and Papua New Guinea reported that international donors had instructed them not to enrol new patients in their programmes and voiced concerns about further cutbacks for those already receiving treatment, he said. If the global community failed to address its responsibility to offer access to medications, there could be grave public health, social and economic consequences.
Highlighting children living with HIV or HIV-Tuberculosis co-infection as particularly vulnerable, he noted that access to early diagnosis and treatment was far less accessible to children than adults. Without such access, several children died before their second birthday. In the face of the ongoing threat of HIV/AIDS, he urged the international community to acknowledge the demands of the human family for worldwide solidarity, an honest evaluation of past approaches and determined action that respected human dignity and promoted the integral development of civil society.
CHRISTOPH BENN, of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said that, a decade ago, when the world’s response to the AIDS epidemic, as well as malaria and tuberculosis, had been floundering, the international community had come together to stem the tide of ill health, discrimination and poverty the people suffering those pandemics had been condemned to. Among other initiatives, the Global Fund had been created as a dynamic partnership brining together Governments, multilateral agencies, civil society and the private sector. The impact of the global effort had been remarkable and today, more than 5 million people in the developing world had access to antiretroviral therapy. Since 2002, the Global Fund had approved grants totalling some $19.2 billion, out of which HIV proposals had accounted for some $10.8 billion covering 140 countries.
By the middle of this year, programmes financed by the Global Fund were providing antiretroviral therapy for to 2.8 million people. In addition, such programmes had distributed some 2.3 million male and female condoms and had provided 930,000 HIV-infected pregnant women with treatment to prevent mother-to-child transmission. He said that the efforts of countries and partners against HIV, as well as to combat malaria and tuberculosis, had saved more than 5 million lives in the past 6 years. Specifically on malaria and tuberculosis, he noted that Global Fund-backed projects were also having a wider impact beyond individuals, improving the situation of families and communities by bolstering infrastructure, expanding human resources, augmenting health-care worker skills and developing and supporting monitoring mechanisms. Finally, he noted that this year, the Global Fund would be seeking replenishment for its 2011-2013 cycles. Ensuring such funding was vital, especially with the deadline for the Millennium Development Goals rapidly approaching.
AMY MUEDIN, Programme Specialist of the International Organization for Migration (IOM), said that some progress had been made in lifting HIV-related travel restrictions, but many challenges remained in the area of HIV and migration. It was important to make it clear that migration in and of itself did not increase HIV risk, since migration was complex and there were many types of mobile populations. Policymakers must, therefore, “unpack” the linkage between migration and the spread of HIV, in order to target interventions to those migrants who did face increased risk of infection.
For that purpose, she said, multisectoral cooperation was required, within and among countries, bringing together sound health principles, labour policy and societal values such as solidarity, integration and human rights. IOM looked forward to continue working with Member States on those issues. Addressing the HIV prevention and care needs of migrants improved their health, avoided long-term social costs, protected the global public, facilitated integration and ultimately contributed to stability and economic development.
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