30 Years Ago AIDS Was Deadly, Spreading Fast; Today ‘We Have a Chance to End This Epidemic Once and For All,’ Says Secretary General, as High-level Meeting Opens
30 Years Ago AIDS Was Deadly, Spreading Fast; Today ‘We Have a Chance to End This Epidemic Once and For All,’ Says Secretary General, as High-level Meeting Opens
|Department of Public Information • News and Media Division • New York|
Sixty-fifth General Assembly
90th & 91st Meetings (AM & PM)
30 Years Ago AIDS Was Deadly, Spreading Fast; Today ‘We Have a Chance to End This
Epidemic Once and For All,’ Says Secretary General, as High-level Meeting Opens
Assembly President Says Meeting ‘Unique Opportunity’ to Reiterate Commitments;
Head of UNAIDS: World Must Agree on ‘Transformational Agenda’ to End Epidemic
After three decades, the global fight against AIDS was at a moment of truth and, now more than ever, Governments, civil society and the private sector must come together to ensure that past commitments to achieve universal access to life-saving treatments were met and that the elusive pandemic was stopped in its tracks in the coming decade, United Nations Secretary-General Ban Ki-moon declared today as he opened the General Assembly High-level Meeting on AIDS, which aimed to shape the future global response.
“Thirty years ago AIDS was terrifying, deadly and spreading fast,” said Mr. Ban. “Today, we have a chance to end this epidemic once and for all”.
Addressing world leaders, representatives of civil society, the private sector and international agencies gathered in New York to review progress made since the 2001 Special Session on HIV/AIDS. Mr. Ban pointed out that, since that session, new infections had dropped by 20 per cent, and HIV was on a steep decline in some of the most-affected countries — Ethiopia, South Africa, Zambia and Zimbabwe among them — which had cut infection rates by one quarter in the last 30 years.
Indeed, the challenge had changed, and the goal now was to end AIDS within the decade: zero new infections, zero stigma and zero AIDS-related deaths. “We must be bold,” he said, which meant facing sensitive issues, including men who have sex with men, drug users and the sex trade. This week’s meeting was an historic call to action for partners to unite in order to lower costs, deliver better programmes, commit to accountability and trigger a “prevention revolution” that harnessed the energy of young people and potential of new modes of communication. “We can end the fear,” he said. “We can get to an AIDS-free world”.
To make that happen, people living with HIV must be stakeholders in every aspect of the process, said General Assembly President Joseph Deiss (Switzerland), calling the High-level Meeting a “unique opportunity” to reiterate the collective commitment and bolster the AIDS campaign. It was too soon to halt collective efforts or be put off by treatment costs and budget cuts. Ten million people still lacked access to treatment and far too many others were being infected. He urged industrialized countries, emerging powers and developing nations alike to ensure that negotiations in trade and intellectual property rights were harmonized with efforts to combat AIDS.
For Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), the issue was not over paying now or paying later. If investment in research and development were sustained, in five years time, simple and inexpensive diagnostics and medication would be available to everyone, everywhere, he said, as well as a vaccine that would eradicate the virus.
“It is time to agree on a transformational agenda to end this epidemic”, he observed. To achieve the three zeros, the Global Fund to fight AIDS, Tuberculosis and Malaria must continue to deliver. AIDS was a metaphor for inequality; 1.8 million people died from it each year in developing countries and millions of babies were still born with the HIV virus in countries of the global South. “Getting to zero is not an aspirational goal or a magic number,” he said. “It must be our collective plan”.
Throughout the day, world leaders and other senior officials took the floor with ideas to fine tune the global response, with many urging a swift end to the stigma against people living with AIDS. Information and services on HIV and AIDS must be readily available for marginalized groups. Solutions also must be found to intellectual property rights concerns that had hampered delivery of life-saving antiretroviral drugs to developing countries. Most speakers outlined national efforts to achieve universal HIV prevention, treatment, care and support — as enshrined in the 2006 Political Declaration — and encouraged developed countries to support programmes that would achieve those goals.
Giving a human face to the day’s plenary debate, Tetyana Afanasiadi, a woman from Ukraine openly living with HIV, said what was needed was an ambitious declaration and the political will to endorse it. Her life and health, and those of millions of other people, depended on the decisions of the High-level Meeting. “That is why no compromises, like 80 per cent of access, can be accepted,” she said.
The day also featured the first two of five scheduled panel discussions intended to generate new thinking about the future. Participants in the morning panel on “Shared responsibility — a new global compact for HIV” called for a new paradigm in AIDS response that focused not only on the disease, but championed broader social development, supported the establishment of robust national health systems and, most importantly, responded to those without a voice. (Please see Press Release GA/11087)
The afternoon panel, entitled “Prevention — what can be done to get to zero new infections”, heard frank and passionate discussion of the devastating impact that stigma, discrimination and harmful social attitudes had on efforts to stop the spread of HIV. Tackling those issues required leadership to bring HIV/AIDS “out of the shadows”. Policies and legislation could either “hold back, or support” prevention strategies. (Please see Press Release GA/11089)
Also delivering opening remarks at the High-level plenary meeting was
Mathilde Krim, Founding Chairman of the Foundation for AIDS Research (amFAR).
In the plenary debate, the Presidents of Honduras, Rwanda, Nigeria, Mali, Fiji, Gabon and Chad delivered statements.
Also speaking were the Prime Ministers of Lesotho, Djibouti, Central African Republic, Belgium, Swaziland, Sint Maarten (on behalf of the Netherlands), Saint Kitts and Nevis (on behalf of the Caribbean Community) and Mozambique.
The Vice Presidents of Ghana, Mauritius, Guatemala and the United Republic of Tanzania also spoke, as did the Deputy President of South Africa.
The Deputy Prime Ministers of Tajikistan, Equatorial Guinea and Viet Nam also delivered remarks. Joining them were the Foreign Minister of Algeria and the Minister of State of Kenya.
Ministers and senior Government officials from the following countries also spoke: Senegal (on behalf of the African States and African Group), Namibia (on behalf of the Southern African Development Community), Paraguay (on behalf of the Union of South American Nations), Denmark, United States, India, Qatar, Cambodia, Mexico, Guinea, Liberia, Bangladesh, Botswana, Saint Lucia, Jamaica, Zimbabwe, Congo and Thailand.
The High-level Meeting on AIDS will reconvene at 10 a.m. Thursday, 9 June.
The General Assembly today opened its High-level Meeting on HIV/AIDS, which runs from 8 to 10 June. Over the three days, more than 160 world leaders and other high-level officials are expected to comprehensively review progress achieved in realizing the 2001 Declaration of Commitment on HIV/AIDS and its time-bound, measurable goals, with a view to achieving universal access to HIV prevention, treatment, care and support, bearing in mind that those targets had expired at the end of 2010. They also were expected to adopt a consensus outcome document, which would set the course for the global response to HIV/AIDS over the next decade.
Delegates had before them the Secretary-General’s report entitled United for universal access: towards zero new HIV infections, zero discrimination and zero AIDS-related deaths (document A/65/797), which assesses the progress and gaps in the global response to the pandemic, based on data submitted by 182 countries and on national and regional reviews of universal access to HIV prevention, treatment, care and support.
Among its findings, the report notes that the number of people newly infected with HIV declined by 19 per cent in the decade before December 2009, with at least 33 countries experiencing a decline in HIV incidence of at least 25 per cent. As of December 2010, more than 6 million people were estimated to be receiving antiretroviral therapy in low- and middle-income countries. While such gains were promising, they were insufficient and in jeopardy, the report states, noting that stigma, discrimination and gender inequality continued to undermine efforts to achieve universal access to HIV prevention, treatment, care and support.
Bold decisions were needed to dramatically reshape the AIDS response, the report finds, including by championing a “prevention revolution” that harnessed the energy of young people and potential of new modes of communication. The upward trajectory of costs must be broken and better programmes delivered. All stakeholders must ensure that responses to HIV promoted the health, human rights and security of women and girls, and further, that robust mutual accountability mechanisms were forged.
JOSEPH DEISS, President of the General Assembly, said that a decade ago the Assembly had adopted an ambitious declaration to reverse the AIDS epidemic at a time when the situation seemed hopeless. “Today, the results are there to be seen,” he said. In the past five years worldwide the number of people with access to treatment had increased tenfold. Millions of lives had been saved. There had been real progress in prevention; the number of new infections was declining. “It is too soon to halt all our efforts and be put off by the cost of treatment and budget cuts,” he said. Ten million people still had no access to treatment and far too many people were still being infected. It was necessary to continue complementary and closely linked prevention, treatment, care and support measures.
“We have reached a critical moment in time,” he said, calling the high-level meeting a “unique opportunity” to reiterate collective commitment and bolster the campaign against AIDS. Global action must be based on broad partnership among Governments, the private sector and civil society to combat the virus. The civil society hearing held prior to the opening of negotiations was proof of the importance of civil society in holding Governments responsible for their actions and of its essential role in fostering respect for human rights in the context of the AIDS response.
Even 30 years after the beginning of the epidemic, the stigmatization of and discrimination against persons living with the virus and vulnerable groups far too often continued to present a major obstacle to any open debate on AIDS-related issues and hindered progress, he said. Universal access implied social justice and social inclusion. “Persons living with the virus must be stakeholders in every aspect of our effort,” he said. Their experiences and stories were essential in developing an effective strategy for combating the epidemic.
Countries with a long history of industrialization, emerging powers and developing countries must ensure that multilateral negotiations in trade and intellectual property rights were harmonized with efforts to combat AIDS, he said. At times, the response was depicted as competing with other development and health priorities. On the contrary, there were synergies that must be maximized between the AIDS response and universal enrolment, gender equality and better health systems. Reversing the spread of AIDS was a Millennium Development Goal and a benchmark for achieving all the other goals.
“We must take a holistic approach and integrate the response to AIDS into broader development programmes,” he said. The meeting’s outcome document must take that approach in order to allow the global community to make significant progress in many areas.
United Nations Secretary-General BAN KI-MOON recalled that 30 years ago, AIDS was terrifying, deadly and spreading fast. “Today, we have a chance to end this epidemic once and for all,” he declared, adding that the story of how that had come to be had been written by many in the Assembly Hall. In the 1980s, there was a terrible fear of a new plague. Fellow human beings had suffered not only from sickness, but discrimination or, worse, vilification. Looking back, there was much that could have been done differently.
Looking ahead, however, there were proud accomplishments that the Assembly could build upon, he said, as the campaign against AIDS had always been much more than a battle against disease. It was a cry for human rights, a call for gender equality and a fight to end discrimination based on sexual orientation. Indeed, it was a demand for the equal treatment of all people.
Citing progress, he said that since 2001, new infections had dropped by 20 per cent, and since 2006, when leaders had gathered in the Assembly and pledged that every person would receive services, care and support to cope with the disease, AIDS-related deaths had fallen by 20 per cent. Today, HIV was on a steep decline in some of the most-affected countries — Ethiopia, South Africa, Zambia and Zimbabwe among them — which had cut infection rates by one-quarter in the last 30 years.
“Today, the challenge has changed,” he said. “Today, we gather to end AIDS.” The goal was to end AIDS within the decade: zero new infections, zero stigma and zero AIDS-related deaths. “We must be bold,” he said, which meant facing sensitive issues, including men who have sex with men, drug users and the sex trade.
Emphasizing that he had made the campaign against AIDS a personal priority, he recalled that former Secretary-General Kofi Annan had asked pharmaceutical companies for help in getting AIDS medicine to all who needed it. Their agreement had led to the establishment of the Global Fund to fight AIDS, Tuberculosis and Malaria, a revolution that had saved lives around the world. It had been a model, he said, he had applied to the current campaign to reduce child and maternal mortality, and one that would bring the Global Strategy on Women’s and Children’s Health to life.
“Today’s historic meeting is a call to action”, he declared, underlining that all partners must come together in solidarity as never before. Costs must be lowered and better programmes delivered. Leaders must commit to accountability and ensure that HIV responses promoted the health, human rights, security and dignity of women and girls. Finally, “we must trigger a prevention revolution”, he said, by harnessing the power of youth and communications technology. With those steps, AIDS could be stopped. “We can end the fear,” he said. We can get to an AIDS-free world”.
MICHEL SIDIBÉ, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), spoke about the collective, historic achievements of the world. Thirty years ago the disease was called the gay plague and slime disease. People were afraid of each other and there was no hope. “This image should not disappear. It is part of our history,” he said, adding that the AIDS movement was the story of a people breaking the conspiracy of silence, demanding equity and dignity, confronting societies’ wrongs, seizing their rights, and making a passionate call for social justice. Since then, a compact had been made between the global North and the South, which had produced lifesaving results.
In 2001, when negotiating the outcome document, it was said that the world could not afford to treat people living with HIV in the developing world, he said. But, today, more than 6.6 million people were being treated in low- and middle- income countries. It was said then that prevention strategies would never work and Senegal, Uganda and Thailand were the only success stories, then. But, today, 56 countries, including 36 in Africa, had been able to stabilize the epidemic and reduce the number of infections significantly. Infections had reduced by 35 per cent in South Africa and by more than half in India. In China, the HIV mortality rate had fallen by 64 per cent. Many other countries had reached universal access to treatment.
The Global Fund must be able to continue to deliver, he said. He lauded the efforts of the United States Emergency Fund to help produce good results. Under Gabon’s leadership, the Security Council yesterday adopted historic resolution 1983, which recognized the deadly link between HIV and violence against women in conflict and post-conflict situations. It showed that AIDS remained a critical challenge for the era. Now was not the time to be complacent. AIDS was a “metaphor for inequality,” he said, noting that 1.8 million people were dying from it every year in developing countries. Nine million people were still waiting for treatment. In the North, a new HIV-free generation was emerging. But, millions of babies were still born with HIV/AIDS in the South.
“We are at a defining moment. It is time to agree on a transformational agenda to end this epidemic,” he said. That agenda must achieve zero HIV infections, zero discrimination and zero AIDS-related deaths and it must become a reality. To do that, it was necessary to revolutionize HIV prevention and mobilize young people as agents of change; scale up universal access to treatment; break the tragedy of high cost treatments; promote innovation and technology transfer; and promote country ownership through new values and shared responsibility. It was necessary to stop violence against women and girls. Vulnerable populations like migrants, sex workers, and men who had sex with men must not face discrimination and must have access to life-saving services.
“We will realize our vision of zero if we take AIDS out of isolation,” he said. He called for strengthening health systems and investment. “It is not a question of paying now or paying later, either we pay now or we pay forever,” he said, adding that if investment in research and development could be sustained “we will have in five years time simple and inexpensive diagnostics and medication available to everyone everywhere,” as well as a vaccine that would eradicate the virus. “Getting to zero is not an aspirational goal or a magic number; it must be our collective plan.”
TETYANA AFANASIADI, a woman from Ukraine openly living with HIV, said that her country was experiencing the fastest-growing epidemic of HIV infection and that the seaport city in which she lived had the highest HIV prevalence rate. She had been living with HIV and using drugs for 13 years, had hepatitis C for almost 11 years, and had a family, husband and eight-year-old son who did not have HIV and gave her great support. Three years ago, she took part in an opioid substitution therapy programme that enabled her to live, work, be an active citizen and take care of her son. Describing how people who used drugs survived in her region, she noted that 70 per cent of drug users in Eastern Europe and Central Asia were HIV-positive and that 90 per cent had various types of viral hepatitis, but that only one person out of five had access to antiretroviral therapy. Harm reduction programmes were being oppressed and drug dependency was considered a crime, rather than a disease. “Drug dependency and HIV-infection require treatment, not prosecution,” she said.
In the case of women using drugs, the situation got more complicated, she added, noting that, if such women decided to give birth, they could not go to a drug treatment clinic, because they would be registered as a drug addict and be deprived of their child. HIV-infection was grounds for refusal of admission to crisis centres, so, as a result, such women often started to sell sex services and became exposed to violence. Necessary HIV and sexually transmitted infections (STI) prevention programmes oriented towards women needed to continue to be developed.
Opioid substitution therapy was also a powerful tool against the HIV epidemic, she said. The progressive decision to start substitution therapy programmes had helped more than 6,0000 people in Ukraine, but 50,000 people in the country were still waiting for such help. She also pointed out that, because most countries of Eastern Europe did not have opioid substitution programmes, she could not visit them because her treatment was illegal there, “just like street drugs.” Given that opioid substitution therapy in her home city had changed people’s lives, returned them to their families, helped them to find jobs and stopped them from committing crimes, it was time to stop refusing antiretroviral treatment to people who used drugs.
What was needed now were specific targets, an ambitious declaration and the political will of governments to endorse it, she said, noting that her life and health and those of millions of other people depended on the decisions of the high-level meeting. She, along with thousands of other people, was in need of hepatitis C treatment, which was not available in their region. Thousands of other people waiting for antiretroviral treatment had died without it. “That is why no compromises, like 80% of access, can be accepted.” The representatives of key populations demanded 100% access to HIV treatment, as well as treatment of tuberculosis, hepatitis, opportunistic infections, and drug dependency. She insisted on the active engagement of key communities in programme development and policy-making by Member States in response to the epidemic.
MATHILDE KRIM, Founding Chairman of the Foundation for AIDS Research (amFAR), recalling that in 1981, five cases of the disease had been discovered, said: “None of us in 1981 could have predicted the tragedy to follow,” with the virus that would come to be known as HIV destroying the body’s immune defence system. HIV infection had always had lethal consequences. In the 30 years since its discovery, 25 million people had died worldwide of AIDS-related illness and more than 33 million people now lived with HIV. In the United States alone, more than 56,000 people became HIV-infected each year, and a total of 1 million United States citizens now lived with HIV/AIDS.
In 1981, nothing was known about how the disease was transmitted, she said, nor about if and how it could be prevented and treated, or whether it was confined to one or more “at-risk” groups. While prevention activities and research programmes had been slow to start, they had resulted in “remarkable” success stories in the history of biomedical research. Naming a few, she said a raft of useful prevention interventions had been found, and could be applied “if we’re ready to use them”. Condoms were effective barriers to HIV infection. Other actions included tests to ensure blood safety, male circumcision, and an arsenal of more than 30 antiretroviral drugs to treat HIV-infected people, allowing them to live longer and relatively healthy lives.
Moreover, mother-to-child transmission had been virtually eliminated in some countries with the use antiretroviral treatment, she said, adding that microbicide gel also could reduce women’s risk of contracting HIV. Another study recently had shown that high-risk, but HIV-negative men who had sex with men who also took antiretroviral drugs could reduce their risk of contracting the virus by more than 90 per cent, while another clinical trial showed that healthy, HIV-positive persons were less likely than untreated persons to pass on the virus to their partners. In addition, it now was possible to shield many psychoactive drug users from HIV transmission through the sharing of contaminated needles.
All those advances were good news, she said, especially because the rate of new infections today was outpacing the ability to provide antiretroviral treatment. “We are still losing ground to HIV and we are still losing the battle against HIV and AIDS”, she emphasized. None of the preventive treatments could, by themselves, end the epidemic, but if used in various combinations — and on the scale required to reach all vulnerable populations — they could lead to a substantial and worldwide reduction in the incidence of HIV infection and AIDS. Smart investment in HIV prevention would pay off handsomely, both in life and in treatment costs averted. Ultimately, ending the global AIDS epidemic would require the equivalent of a vaccine for prevention and curative treatments, a goal which had proven difficult, not least because the virus had multiple strains and rapid mutation rates.
Nonetheless, there had been glimpses of hope, she said, notably in 2009, when, for the first time, mothers’ preventive effect had been observed. Certain antibodies also could stop more than 90 per cent of known HIV strains from infecting human cells. Indeed, research was generating more optimism that a cure was now within the realm of possibility, with the “Berlin patient” — an AIDS survivor — serving as living proof that a cure was technically feasible, though procedures that that person had undergone were not likely to be replicable on a meaningful scale. Such advances had led to the formation of collaborative research teams to find a cure. “We have a choice we never had before”, she emphasized, asking delegates whether they should be content with limiting efforts and resources, and dealing with only pieces of an enormous and still growing tragedy. Rather, she challenged them to summon the collective will to make larger, more strategic investments in future research, and to apply the findings earlier — not later — to solve the AIDS epidemic during our lifetime. “The lives we help save may be our own”, she said.
PORFIRIO LOBO SOSA, President of Honduras, stated his clear commitment to ensuring universal access to prevent and treat HIV/AIDS. Those affected by the disease were stigmatized. Combating HIV/AIDS was a high priority. He had done much to carry forward Government efforts to respond the scourge in a timely way in order to fulfil the sixth Millennium Development Goal, which called for reversing the spread of HIV/AIDS by 2015. The number of new HIV infections was declining in Honduras. The country had implemented standard health-care programme for HIV/AIDS patients and had instituted training and capacity-building to improve care.
Action had increased at all levels. In Honduras, there now existed a greater number of health-care centres providing counselling and HIV testing, he said. The number of people tested had reached nearly 200,000 in the last 12 months. The Government was implementing a national plan to promote prenatal screening so that expectant mothers could go to health-care centres to receive care for HIV/AIDS. The goal was to try to prevent mother-to-child transmissions. The Health Secretariat had revised its strategy and instituted a comprehensive approach to address sexually-transmitted diseases for the 2011-2015 period.
Honduras now had an approach that promoted a shared responsibility among families, which was intended to empower them, so that everyone could play an active part in health care, he said. Despite such successes, the socioeconomic impact of HIV/AIDS was significant. The disease hit young people of a reproductive, economically active age. It had an adverse impact on family income and on the labour force in the medium-term and the long-term. Significantly extending the response to HIV/AIDS must be a priority. It was necessary to act to prevent the disease, in particular its impact on women and young girls, and to protect vulnerable people through social cohesion. Honduras’ Government was doing much nationally and internationally to prevent and treat HIV/AIDS and other sexually transmitted disease.
PAUL KAGAME, President of Rwanda, said the HIV and AIDS epidemic had reversed health and development gains in many countries, especially in Africa, and efforts to find a cure had come up against competing global priorities and challenges. The High-level Meeting provided an opportunity to review modest progress. “It is time to galvanize Member States to commit to a transformative agenda that overcomes the barriers to an effective, equitable and sustainable response to HIV and AIDS”, he stressed. Even in the face of economic hardship, courageous leadership continued to inspire solidarity, notably five years ago, with the pledge to achieve universal access to prevention, treatment, care and support for HIV/AIDS sufferers. Developing countries had increased their response in several ways.
By way of example, he said prevention had worked and treatment had saved lives, noting that, in Africa, new infections had dropped from 2.2 million cases in 2001 to 1.8 million in 2009, while AIDS-related deaths had dropped by 25 per cent since 2005 in sub-Saharan Africa. Investing in prevention, treatment, care and support was not only the right thing, but the smart thing to do, and no single Government acting alone could overcome the pandemic. A comprehensive approach that responded to all aspects of the disease was needed, he said, noting that early diagnosis and treatment had reduced by 90 per cent the chances of infecting others.
Today, there was a better understanding of the disease, which should inform future efforts, he said, underscoring that work to be done included surmounting the resistance to some antiretroviral drugs. Stigma and gender-based disadvantages also must be eliminated and an integrated approach must be adopted. Further, conscious leadership was needed at all levels of society. Where stigma persisted, the HIV/AIDS response could not be effective. There could be no higher aspiration than to work towards a future free of AIDS. With predictable financing, shared responsibility and a comprehensive approach, he was confident that gains could be built upon for the well-being of all people.
GOODLUCK EBELE JONATHAN, president of Nigeria, said the international community stood on the “doorsteps of history”, with an opportunity to build on the gains of the past ten years. An AIDS diagnosis was no longer an automatic death-sentence, and HIV was now better understood. Africa continued to bear a disproportionate burden of HIV and AIDS, but that continent’s leaders were committed to increasing access to services for HIV and AIDS, Tuberculosis, and Malaria. In 2006, the African Union adopted the Continental Framework for Harmonisation of Approaches Among Member States and the Integration of Policies on Human Rights and People Infected by HIV and AIDS. This and other efforts were aimed towards a sustained, coordinated and resolute continental action to stop new infections, maximize efficiency in the delivery of treatment, and achieve sustainable financing for the HIV response.
In Nigeria, HIV/AIDS services were currently the most rapidly expanding health interventions, with a multisector approach that better mobilized resources and improved coordination among public, private and civil society stakeholders. Among Nigeria’s relevant successes were the Youth Leadership in AIDS programme, the promotion of behavioural change and awareness through media and film, an annual journalists’ award for excellence in HIV/AIDS programming, and a bill presently before Nigeria’s parliament seeking to address the specific issues of stigmatization and discrimination directed at those living with HIV.
He said his administration remained determined to provide new impetus to the HIV/AIDS response by integrating the health sector into the country’s human development agenda. For example, from now until 2015 the Government would lead and coordinate the multisectoral implementation of its National Strategic Framework and Plan for HIV/AIDS. As for universal access, it aimed to increase government funding from 7 per cent to 50 per cent by 2015. Also by 2015, his administration would strive to eliminate mother-to-child transmission, and would work with the Nigerian National Assembly to allocate at least 15 per cent of the federal budget for the health sector, as agreed in the Abuja Declaration. Such objectives would greatly contribute to achieving the joint objectives of the Millennium Development Goals and the elimination of new HIV infections, including AIDS-related deaths, by 2015. He said it was not the time for the international community to take its eyes off the target, but rather for it to retain the resolve and focus of the Declarations of 2001 and 2006, if the gains of the past 10 years were not to be eroded.
AMADOU TOUMANI TOURE, President of Mali, emphasized the need to fine tune the response to the epidemic, based on today’s improved knowledge of it. Mali hosted the World Youth Summit on AIDS. It had been an opportunity to take advantage of youth’s outlook on health care needs and a way of meeting their needs, as well as drawing on youth leadership, in that regard. He said that during the Summit, youth has asked him to speak for them during today’s meeting and to convey that youth had already taken the lead in responding to the HIV/AIDS epidemic. But, their efforts alone were not enough to end the epidemic. Those young people had invested hope in the Assembly’s work and declarations. They had asked that the Assembly implement resolution 58/133, which called for a role for young people in the fight against HIV/AIDS.
Young people, he said, have asked for greater decision-making power. Young people wanted to see resources funnelled to HIV/AIDS prevention, treatment, education and care. They wanted the stigma against people living with the disease to end. They wanted to have readily available information and services on HIV/AIDS, particularly for key population groups. Young people must accept their responsibility in dealing with the epidemic. At the Summit, they had agreed to do so.
RATU EPELI NAILATIKAU, President of Fiji, said that for a small island developing State such as his own, the threat of HIV/AIDS was “like a ticking time bomb”. Youth were under threat from the scourge, which would debilitate the island’s people and economy, if action were not taken. Fiji depended heavily on tourism and it was vital to maintain controlled health regimes to safeguard that lifeblood to the economy. Religion and tradition greatly influenced behaviour in Fiji and he thus, recognized the exemplary work of social institutions in the response to HIV/AIDS. Since 2006, the Regional Strategy on HIV and other sexually transmitted infections had guided national and regional responses to HIV and AIDS, an issue that had been featured in ministerial meetings since 2004.
Turning to legislation and reform, he said much had been done in the Pacific, but progress towards legislative amendments had been slow. That was a monumental challenge, given the punitive approach to HIV/AIDS and the high levels of stigma and discrimination. For its part, Fiji, in 2011, had implemented the HIV/AIDS Decree, which provided human rights-based measures in the care and support for sufferers of HIV and AIDS. Social marginalization was among the main barriers to the HIV/AIDS response. Another challenge lay in ensuring that HIV-related laws were fully implemented and enforced. Legislation should provide human rights-based measures in prevention and support work.
“That is the way to go,” he said, adding that Fiji’s work with a network of faith-based organizations, the private sector, youth leaders and civil society, among others, would produce the desired outcome. “We must change the way we view HIV/AIDS as being only a health issue,” and ensure that health resources and funding were available to guarantee universal access to prevention, treatment and support — whether in places of work, play or worship. The major funding sources in the Pacific — including through the Global Fund to fight HIV/AIDS, Tuberculosis, and Malaria — would come to an end in two years. Funds would be needed to eradicate the AIDS scourge.
Ali Bongo Ondimba, President of Gabon, said today’s meeting was an opportunity to make a new commitment to combat HIV/AIDS. He said he had presided over a meeting of the Council yesterday, which adopted a resolution on HIV/AIDS. Africa had insufficient resources to deal with the epidemic. It was necessary to mobilize more resources to strengthen strategies for action. Much had been achieved in the last 30 years since AIDS was first discovered. Today, there was more knowledge of the epidemic, better care and better access to treatment. Better cooperation among all stakeholders had led to a reduction in mortality due to HIV, less infections, and greater life expectancy for those living with HIV. Gabon, under his leadership, continued to invest significant resources in the fight against HIV/AIDS, despite its limited resources.
Gabon had increased resources, improved universal access to care, offered free health insurance, and decentralized medical care for those living with HIV across the board in all healthcare services, he said. The Government’s goal was to develop better prevention and treatment programmes in all health-care services. He called on the international community to create new innovative financing schemes in order to generate the resources needed to fight the disease.
Societies must try to protect those living with HIV and those at high risk of stigmatization, he said. They must also address youth’s particular vulnerability to the disease. Youth was sacred. He called for intensified action to prevent the disease among young people and for using social media in that regard to implement HIV prevention strategies. The international community had not fulfilled its commitments as set forth in the 2001 and 2006 declarations on HIV/AIDS. The current meeting’s outcome document must be more dynamic. It must respond to the call to achieve universal access to treatment.
IDRISS DEBY ITNO, President of Chad, said an HIV/AIDS vaccine had been sought for 30 years and the efforts to mobilize all players had shown there was reason for hope. While such determination had brought leaders together today, the global economic crisis had also forced States to address other priorities. HIV/AIDS had adversely impacted Chadians, with a 2005 study showing that the prevalence of infection was at 14 per cent of people aged 15 to 40 years old. Against that backdrop, the Government had devised a strategy to counter HIV/AIDS, which outlined free medical care for HIV/AIDS sufferers. In 2007, 747,000 people had benefited from that care, a number that doubled in 2008.
Combating the scourge was also outlined in Chad’s poverty reduction strategy, he continued. A national institute had been created under the Prime Minister’s Office, while civil society had started workshops and created a watch dog institute to ensure human rights in the care of those suffering from HIV/AIDS. Such efforts were in line with the international goals of achieving zero new infections, zero discrimination and zero AIDS-related deaths. Chad also supported the joint African Union position outlined in April 2011.
AIDS was also a development issue, he said, and the Government’s efforts had been incorporated into its development strategy and policies. Also, oil revenues had been invested in education and health, as seen in the building of universities and health centres. As a “cross-roads” country, Chad shared borders with six countries, with which it had shored up forces to combat HIV/AIDS. Amid such efforts, international solidarity in resource mobilization was essential. In the 2009-2016 period, Chad aimed to achieve universal prevention, treatment, care and support for those suffering from HIV/AIDS and he encouraged rich countries to support programmes to achieve such goals.
KGALEMA MOTLANTHE, Deputy President of South Africa, said that the HIV and AIDS epidemic was a leading cause of death in a number of developing countries, particularly in sub-Saharan Africa, because of the lack of scientific breakthrough in medications and lack of financial resources to access antiretroviral and other drugs. Women bore the biggest brunt of the disease, but reproductive health and HIV prevention programmes did not adequately address that group. The recent results of tenofovir-based gel had raised hopes that a female-initiated prevention alternative could become available soon. Although the recent financial crisis had impacted developing countries in particular, the fight against HIV and AIDS should not be compromised, and costs needed to be reduced to facilitate universal coverage. In Africa, a number of strategies were adopted to address challenges posed by HIV and AIDS, including the adoption of the Kampala Declaration at the African Union Summit of Heads of State meeting in Uganda in July.
South Africa had embarked on programmes coordinated through the South African National AIDS Council that were rooted in partnerships with various stakeholders and addressed the social determinants of the HIV, AIDS and tuberculosis epidemics, he said. The Government plan of actions improved citizens’ lives through the provision of houses, poverty eradication strategies, economic policies and interventions focusing on youth development. The National Strategic Plan from 2007-2011 aimed to reduce new infections by 50 per cent and to achieve 80 per cent coverage with respect to access to antiretroviral therapy. Great progress was made in areas such as the reduction of new infections among young people and reducing mother-to-child transmission of HIV, using dual therapy, from 8.3 per cent to 3.5 per cent. Through the HIV Counselling and Testing Initiative, started in April 2010, 12 million to date were tested. 1.4 million people were put on antiretroviral therapy through public health facilities alone. Public expenditure on HIV and AIDS increased by 40 per cent per annum and, in the current financial year, $1 billion was allocated to HIV and AIDS programmes. Additionally, South Africa was hosting its 5th AIDS Conference, which would contribute towards the development of a new Strategic Framework for 2012-2016.
PAKALITHA MOSISILI, Prime Minister of Lesotho, said that, in a world rife with challenges, the international community remained biased in addressing those challenges. Priority was given to political issues, while social and health challenges ranked last. For that reason, an old, bedridden and frail grandmother found herself having to fend for grandchildren whose parents had been decimated by a lack of medication for HIV/AIDS, and many children were deprived of their childhoods when forced to act as breadwinners for their siblings. His country remained one of those worst hit by the HIV and AIDS pandemic in sub-Saharan Africa. Against the backdrop of Lesotho’s commitment to the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS, he said this week’s high-level meeting provided an opportunity to take stock of current measures and share ideas on how best to win the war on the disease.
In Lesotho, notable progress had been made regarding prenatal care for HIV-positive women, helping to reduce mother-to-child transmission. Progress had also been made to improve attitudes towards HIV testing, with tremendous increases in testing among both men and women. Condom use for “high risk sex” had improved somewhat among women, but had fallen slightly among men.
In further measures, in 2008, Lesotho had adopted the improved cut-off point for eligibility for antiretroviral treatment, resulting in a significant increase in coverage. Actions were also being taken to determine HIV-related morbidities, such as cancer and mental illness, and to develop appropriate responses. The National HIV and AIDS Strategic Plan was being revised and updated in line with the World Health Organization (WHO) and UNAIDS guidelines, and an initiative to “energize all prevention” activities had commenced. The HIV/TB co-infection, post-exposure prophylaxis, management of other opportunistic infections, condom programming and supplies chain management were also being addressed. A “vulnerability study” was also being conducted to define and support orphans and vulnerable children. Still, Lesotho faced challenges stemming from a lack of human resources, food insecurity, and inadequate resources. Those were not insurmountable, however, as the people of Lesotho had always, through their determination and selflessness, overcome the most daunting of challenges.
DILEITA MOHAMED DILEITA, Prime Minister of Djibouti, said his Government was committed to combating the disease in order to achieve sustainable development. But, constant efforts were needed to improve the lives of, and the stigma faced by, people living with HIV, as well as to end ignorance about the disease and cultural barriers that denied its victims their human rights. He underscored the role of Djibouti’s First Lady in that regard, as well as that of certain religious authorities. To effectively counter the disease over the long-term, financing was required. He noted the difficulty in preventing the disease among migrants transiting the Red Sea and Gulf of Aden. In acknowledging the existence of HIV/AIDS in 2003, his Government had made an important political commitment that allowed it to create the necessary institutional and regulatory framework to tackle the disease. Today, there existed a new committee under the Prime Minster’s leadership to coordinate a national response to AIDS, as well as a new secretariat to guarantee a national response to AIDS, as well as to malaria and tuberculosis.
In the past 10 years, Djibouti had joined all international initiatives against HIV, he said. It was a leader in the Horn of Africa thanks to the leadership of the Intergovernmental Authority on Development initiative. A harmonization of policies against the disease would bolster prevention, access to treatment and care of migrants that were at high risk for contracting HIV. In September, an international conference in Djibouti on ports, mobility, migration and vulnerability to HIV brought together 15 African Foreign Ministers. During that event, Djibouti’s President strongly advocated a strategy for the region’s countries to share health care costs for combating the epidemic. Djibouti’s high-level commitment to combat HIV/AIDS was part of its poverty reduction strategy. The nation’s 2008-2012 plan aimed to reduce HIV infections, improve integral care for HIV-positive people and follow up with a national response. A 2007 law was adopted to protect people living with HIV. Despite limited financial resources, much had been achieved in that regard. Today, 95 per cent of the population was aware of the disease and 97 per cent of pregnant women had agreed to HIV testing.
FAUSTIN ARCHANGE TOUADERA, Prime Minister of the Central African Republic, called for a world alliance to eradicate HIV/AIDS, which would carry out an untiring fight around the world. While past investments had borne fruit, the results were fragile. His country had subscribed to the political declarations on HIV/AIDS in 2001 and 2006, documents that had guided its combat of the disease. The Central African Republic’s vision was also outlined in its Poverty Reduction Strategy Paper, which aimed to arrive at zero infections, zero discrimination and zero AIDS-related deaths.
But given that 67 per cent of the country’s antiretroviral needs had not been met, there was much to do to scale up the main activities, he said, noting that, despite economic difficulties, his Government had mobilized domestic resources over the last five years to make more of those drugs available to patients . International funding came from the Global Fund to fight HIV/AIDS, Tuberculosis and Malaria, the World Bank, African Bank, bilateral partners — such as France — and United Nations agencies, like the Joint United Nations Programme on HIV/AIDS and the United Nations Development Programme (UNDP). He encouraged UNAIDS to ensure that the Central African Republic continued to benefit from such funding, as international solidarity was needed.
YVES LETERME, Prime Minister of Belgium, said that Belgium fully endorsed the recommendations and targets outlined in the new Joint United Nations Programme on HIV/AIDS Strategy and in the Secretary-General’s report. There was a long way to go in terms of achieving those goals, but the disease could be better controlled through a combination of political will, scientific research and generosity in international cooperation. To stop the further spread of AIDS was to a large extent a matter of respect for human rights and political will, and to help those affected through a variety of treatments. Given that 7,000 people became newly infected with HIV every day and 3,000 young people and 1,000 children were among them, the most vulnerable members of society were at risk and it was the duty of every Government, “every political authority worthy of their name” to protect them. Universal, non-discriminatory access to therapy would have a preventative effect, as antiretroviral therapy could help prevent transmission by more than 95 per cent.
An integrated approach included investment in the research, development and delivery of new prevention tools and of accessible and affordable HIV-medicines, particularly for children, he said. In Belgium, the private sector, research institutions and universities had played a pivotal role in that research, and a Belgian pharmaceutical company had granted a royalty-free licence for its antiretroviral component to develop, manufacture and distribute the compound as a microbicide in resource-poor countries. Only two weeks ago, the United States Food and Drug Administration had approved a promising one-a-day pill for HIV treatment developed by a Belgian company. Additionally, fighting AIDS was a global responsibility and Belgium was committed to doing its part on the international level. From 2008 to 2010, official development funds targeted for combating AIDS increased from 34.6 to 46.5 million euro. Development aid with an AIDS component amounted to 404 million euro in 2010. Belgium also ranked tenth worldwide for its contribution to UNAIDS and thirteenth for its contribution to the Global Fund.
SIBUSISO BARNABAS DLAMINI, Prime Minister of Swaziland, said the devastation of HIV/AIDS had been as destructive as any holocaust encountered in any war. It had destroyed families and communities, and inflicted severe damage on economies. At the same time, the world had had steered a counter-attack as perhaps never envisaged in the early days of the disease. His region, the most severely challenged by HIV prevalence, presented daunting statistics, but in the last decade, new infections had dropped from around 4 per cent of the population in 2000 to 2.6 per cent in 2010. The high proportion of new infections were among young people, especially women, and studies were being conducted on women’s sexual behaviour and the impacts of prevention programmes, which would inform national prevention efforts.
In addition, the national strategic framework recognized the importance of all stakeholders “buying in” to a fully consultative and participatory approach, “right down to the community level”, he said. A new AIDS framework had been created and a council that drew from all sectors had been put in place to oversee HIV/AIDS policies. Among other efforts, the country had piloted an early introduction of antiretroviral treatments, reduced mother-to-child transmission, strengthened safe delivery initiatives and increased treatment for HIV-positive mothers. It aimed to reduce mother-to-child transmission to zero by 2015 and also had scaled up its circumcision programme. To support children who had been orphaned by HIV/AIDS, 1,500 neighbourhood care points and other social centres had been built and a free education programme started to keep them in school. “AIDS has substantially reduced our human capital,” he said.
JOHN DRAMANI MAHAMA, Vice-President of Ghana, said that HIV/AIDS was a key component of the Ghana Shared Growth and Development Agenda from 2010 to 2016 and was accorded a high level of political commitment, with the Ghana AIDS Commission placed directly under the Office of the President. Ghana was among the 29 African countries reported by the World Health Organization to have been able to reduce prevalence of HIV/AIDS over the past decade, with a reduction from a national high of 3.6 per cent in 2003 to 1.5 per cent in 2010. Those modest achievements were attributable to a massive scale up under the programme dubbed “Towards Universal Access — Ghana’s Comprehensive Antiretroviral Therapy Plan,” which resulted in an increase in the number of persons on antiretroviral treatment from under 6,000 in 2006 to over 58,000 by March 2011. Additionally, Ghana had developed a new five-year Preventing Mother-to-child Transmission plan, aimed at reaching 95 per cent of all pregnant women by 2013. Civil society organizations, such as People Living with HIV/AIDS Associations, were also active members in the national response.
Ghana recognized that the main challenge in the fight against HIV/AIDS globally was how to ensure universal access to prevention and treatment, as well as zero transmission of new HIV infections in children by 2015, he said. There was a need, especially in sub-Saharan Africa, to invest in improving the weak health systems and guaranteeing access to the poor living in remote and peri-urban slums. In Ghana, the community-based health planning and services initiative was being expanded to provide much-needed basic services to all. To implement universal access, second- and third-generation antiretroviral medicines would need to be developed and the costs of these drugs needed to be affordable. Ghana called on all developing countries to increase their domestic sources of funding for implementation, as a basis for calling on development partners to assist with needed resources. Ghana also called for increased funding for the overall response, including support to civil society organizations, expanding the health care delivery systems and making antiretroviral drugs available.
MONIQUE AGNES OHSAN BELLEPEAU, Vice President of Mauritius, said, in the face of unprecedented human catastrophe caused by HIV/AIDS, it was vital to review past efforts and progress, and to chart a new path forward. There was no time for complacency. She called for strict prevention strategies and universal access to treatment to reach zero infections, discrimination and AIDS-related deaths. Political commitment was vital in that regard. In 2007, the Prime Minister of Mauritius had launched a multi-sectoral response to the disease. In Mauritius, the disease was mainly prevalent among intravenous drug users and men who have sex with men men. A behavioural survey in 2009 and 2010 aimed to better guide the country’s response to the disease. It revealed that up to 75 per cent of newly detected cases were among intravenous drug users. In 2005, the Government took bold action to implement a harm-reduction strategy. An HIV/AIDS act was passed to provide a legal framework for a needle-exchange programme and to eliminate all forms of discrimination against people living with the disease.
That spurred creation of a methadone maintenance therapy and needle exchange programme, which caused the rate of transmission among intravenous drug users to fall from 93 per cent in 2005 to 74 per cent in 2010, she said. The Government offered free antiretroviral therapy. A 2010 treatment protocol gave everyone access to care. The perception of risk of HIV was still low among the wider population. Decentralized programmes across the island had improved access to treatment and programmes to prevent mother-to-child transmission were set up in 1999. All pregnant women were offered an HIV test and all HIV-positive pregnant women received free medical care, in line with WHO recommendations. An HIV test was also given to all new prison inmates. All HIV-positive inmates received the same level of treatment as those in the non-prison population. Mauritius had set up a 2012-2016 drug control master plan. Her Government aspired to achieve zero new infections through prevention strategies. In 2008, it amended national laws to remove the marriage ban against HIV-positive people.
RAFAEL ESPADA, Vice President of Guatemala, said thirty years ago, the world had been shaken by the news of a deadly virus, perhaps wrongly associated exclusively to sexual promiscuity and drug use. Medical services had alerted the world to the medical horror and rightly had examined the problem from a medical, ethical and global governance viewpoint. The United Nations had understood early on that a global threat required a global response and, during the 2001 General Assembly Special Session on HIV/AIDS, 189 States had adopted a Declaration of Commitment. UNAIDS also was created, unleashing a frontal attack on the plague, with a view to controlling the situation by 2015.
In Guatemala, those goals had been taken on board, he said, especially in the Ministry of Health, which had focused on prevention work. The Government also had improved the supply chain for antiretroviral drugs, increased epidemiological research to better interpret data, and improved information programmes to end discrimination against HIV/AIDS sufferers. In its fight, Guatemala had received help from the Global Fund. At the same time, its policies were part of regional policies and linked to realistic economic plans for countries. Under the Council of Central American Ministers of Health, prevention efforts involved a human, political, and social approach. The Government also had launched a “Get Tested” campaign to raise awareness and promote the use of health services.
RUKIYA KURBONOVA, Deputy Prime Minister of Tajikistan, said that in 2006, her Government launched strategies to achieve universal access to treatment by 2010 and conduct a midterm review of the Millennium Development Goals as part of its national programme to counter HIV/AIDS. Such efforts were in line with Tajikistan’s 2010-2012 poverty-reduction strategies and its 2010-2020 health-care sector strategy, which focused on gender equality, human rights and universal access to treatment. The Government had scrutinized national laws to address HIV/AIDS to ensure they complied with international standards. Taking into account epidemiological data, the Government had analyzed the need for medicine and other resources to combat sexually transmitted diseases and tuberculosis, as well as the need for improved neonatal clinics.
A Government order in 2011 mandated monthly State benefits to young people under the age 16 that were living with HIV, she said. The Prime Minister was coordinating sectoral responses to HIV/AIDS, tuberculosis and malaria. The role of civil society in advocating AIDS-related issues had increased. To increase access to services, the Government had started a replacement therapy programme for intravenous drug users and a clean needle programme for prison inmates. Voluntary HIV testing had been scaled up. HIV-positive pregnant women were getting antiretroviral therapy. Such therapy had increased two-fold to prevent mother-to-child transmission. Still, there was a significant lack of budget resources to treat the disease. No country could tackle it alone. The United Nations must bring countries together to tackle the disease.
SALOMON NGUEMA OWONO, Deputy Prime Minister, Minister of Health and Social Welfare of Equatorial Guinea, said that, according to a 2004 study, 3 per cent of the sexually active population had been affected by HIV/AIDS, placing his country at a “generalized level” of dealing with the disease. The Government’s intervention had begun with the onset of the crisis in the 1980s, and with the creation of a national programme for combating HIV/AIDS, which aimed to reduce the infection of HIV/AIDS, tuberculosis and other diseases. Laws and decrees had also been designed, as had an institutional framework to carry out related work, especially in the area of prevention.
He went on to say that at the end of 2009, an estimated 20,000 people in Equatorial Guinea were living with HIV/AIDS, 5,700 of whom were eligible to start antiretroviral treatment. Today, 2,700 of those patients were on that treatment, which provided a 47 per cent coverage rate — a success that had been achieved, in part, because of the provision of free antiretroviral treatment, implementation of a universal access strategy and an increase in the number of treatment centres. Also, a mother-to-child prevention programme, launched in 2005, focused on, among other things, awareness raising, assistance to children orphaned by HIV and AIDS, and efforts to ensure secure births for HIV-positive women. “We hope to change the lives of current and future generations,” he said.
SARAH WESCOT-WILLIAMS, Prime Minister of Sint Maarten, speaking on behalf of the Netherlands, said the HIV prevalence rate was much higher in the Dutch Caribbean islands than the mainland. It was most prevalent among key populations, notably men who had sex with other men. Sint Maarten’s response to the disease was rights-based and fully embedded in the general health-care system. Sint Maarten had tailored programmes to the needs of key population. Programmes for people living with HIV and those in high-risk groups were closely in line with Assembly principles. But, the population of people living with HIV was ageing. Stigma and discrimination still occurred. Making treatment available over the long-term was a problem in the Dutch Caribbean. Harm reduction programmes had limited the number of infections among people using intravenous drugs. Thanks to testing and quality care, the transmission rate in Sint Maarten was now zero. Comprehensive sex education worked well. Armed with knowledge and access to youth friendly services, young people were having safer sex in Saint Maarten.
But sex education in other parts of the Kingdom had not been systematically introduced and young people were having sex at a younger age, she said. Improved policies were needed to counter that and too much remained to be done to combat the epidemic worldwide. Existing financing targets should be met in order to achieve universal access to treatment. Stronger measures were needed to address the epidemic among key populations. Legal barriers must be eliminated. That required bold political leadership. “We must accept the reality that most HIV infections are sexually transmitted. We must accept that young people are sexually active and equip them well to make safe choices,” she said. The outcome document should address the gender-based violence and human rights abuses of people living with HIV.
MODOU DIAGNE FADA, Minister for Health and Prevention of Senegal, speaking on behalf of the African States and the African Group, said “alarming” indicators in the Secretary-General’s report had noted that more and urgent efforts were required to eradicate HIV/AIDS. Against that backdrop, he called for an appropriate carrying out of the objectives in Assembly resolution 60/262 (2006) by strengthening national capacities to combat HIV/AIDS, especially in low-income countries. Efforts must be supported in order to apply various programmes and scale-up campaigns to end prejudice.
While steps to achieve equitable access to prevention, treatment and care were a major step forward in preventing mother-to-child transmission, he said the international community had a duty to provide adequate financial resources, as well as “wise” solutions for intellectual property rights issues. Microbicides and vaccines must be available to all at affordable prices. Such work must go hand-in-hand with the optimal use of national resources. A framework for cooperation must be created to guarantee coordination between national Governments and civil society, a model that also must be applied to the peaceful settlement of armed conflict, which increased the incidence of sexual violence and, thus, HIV and AIDS. In sum, the African Group would spare no effort in implementing the Declaration to be adopted at the end of the current high-level meeting.
DENZIL L. DOUGLAS, Prime Minister and Minister of Finance for St. Kitts and Nevis, speaking on behalf of the Caribbean Community (CARICOM), said the conference held ten years ago catalysed bold steps, including the Global Fund for HIV and AIDS, Tuberculosis and Malaria. HIV/AIDS, a disease that once seemed to strike a death knell for those infected, was now being addressed through the dedicated work of natural and behavioural scientists, philanthropists and non-governmental organizations, and leadership at national and global levels. The application of behaviour change through social marketing interventions had contributed in no small measure to arresting the spread of HIV.
He said the members of CARICOM and the Pan-Caribbean Partnership against HIV and AIDS had always played a very active role in the global process to combat HIV, as the region had the highest prevalence of infections after sub-Saharan Africa. As was enunciated through the Nassau Declaration, “the health of the region was the wealth of the region”, and the Caribbean region held out the hope of being among the first groups of countries to achieve universal access to treatment. The UNAIDS score card on universal access 2010 demonstrated that much progress had been made in the region, with a stabilization of the prevalence rate and a decline in new infections. Still, an estimated 17,000 persons in the Caribbean region became infected with HIV in 2009. Transmission rates among key populations were increasing, and women and girls outnumbered men and boys among people living with HIV. Universal access must be provided for HIV prevention, treatment care, and support. Emphasis must be placed on securing long-term and sustainable financing, without which reversal of the marginal gains made over the past decade was inevitable. The international community must work collectively to achieve the targets in the interest of humanity, those living with the disease and those yet to be born.
AIRES BONIFACIO BAPTISTA ALI, Prime Minister of Mozambique, said Mozambique’s 2010-2014 national strategic plan on HIV was guided by the Assembly’s Declaration. The Mozambique Presidential Initiative, launched in February 2006, bolstered national efforts carried out by multiple stakeholders throughout the country to combat the epidemic. Thanks to a consistent national strategy and strong support from bilateral and multilateral partners, Mozambique had reached historic levels of service delivery and outreach, particularly in increasing access to antiretroviral therapy, including for children under age 15, and in increasing services to prevent mother-to-child transmission. Mozambique’s first-ever national survey, conducted in 2009, revealed that women and young girls were most vulnerable to HIV infection. In recent years, national efforts had focused increasingly on dealing with stigma, gender inequality and gender-based violence.
Mozambique was strongly committed to eliminate mother-to-child transmission by 2015 through a robust national action plan, he said. Integrating HIV/AIDS and other health services had proven beneficial to both in terms of highly improved access to HIV-related treatment and care, tuberculosis and other health services. He stressed the important role of social services, education, youth and the agriculture sector in preventing HIV and mitigating the negative impact of AIDS. Prevention must be at the forefront of national strategies to fight the epidemic. Low levels of condom use and HIV testing were obstacles that must be addressed urgently. The feasibility of promoting male circumcision must be assessed further.
MOHAMMED GHARIB BILAL, the Vice President of the United Republic of Tanzania, said that the impact of the HIV and AIDS epidemic in a poor country like the United Republic of Tanzania was enormous and the Government had continued to implement the Declaration of Commitment on HIV/AIDS. Thirteen million people had been tested by December 2010 in a voluntary counselling and testing campaign, and there was a decline in HIV prevalence rates from 7 per cent for the Tanzanian mainland to 5.7 per cent, while the prevalence rate in Zanzibar was below 1 per cent. The Government had helped expand coverage and sustain services through numerous strategic plans and frameworks, as well as expanded treatment to more primary and community-based facilities. Through those interventions, the number of people on antiretroviral treatments had increased to 388,000 by December 2010, and, in 2010, 70 per cent of HIV-infected pregnant mothers and 57 per cent of HIV exposed babies were being provided with antiretroviral treatments. On the prevention side, the Government had put in place HIV prevention, including male circumcision and early detection and treatment of other high-risk diseases for the transmission of HIV/AIDS, including tuberculosis and sexually transmitted infections.
Noting that combating HIV and AIDS was the responsibility of everyone, he underscored the importance of involving the private sector and civil society and acknowledged the support from both bilateral and multilateral development partners. His Country faced a number of challenges that raise the possibility that some of the national and Millennium Development Goals and targets would not be reached, including the financing gap for HIV and AIDS intervention, which was above 90 per cent. To that end, his Government was establishing an AIDS trust fund and trying to scale up its national health insurance fund and community health fund towards universal coverage. Given that people died prematurely from AIDS because, among others, poor nutrition that exacerbated the impact of HIV on the immune system, the Government also urged for immediate action on the national and global levels to integrate agriculture, food and nutritional support into programmes for people affected by HIV. His country urged the international community to complement its national efforts and continue to invest in HIV/AIDS prevention and treatment.
RICHARD NCHABI KAMWI, Minister of Health and Social Services of Namibia, spoke on behalf of the Southern African Development Community (SADC), as well as for 11 million people living with HIV in the region, saying that they would continue to forge the regional response to the HIV and AIDS epidemic, guided by the “Maseru Declaration”. Progress had been made in fighting the AIDS epidemic in their region, with the percentage of adults living with HIV decreasing by up to 25 per cent in the nine most affected countries. Most of their countries now had Prevention of Mother to Child Transmission coverage rates of greater than 70 per cent and three had managed to reach 90 per cent. However, the number of newly infected people still outstripped the number of people starting treatment, and 2 million plus people who required treatment did not have access.
The sustainability of funds, particularly from outside the region, was threatened by the global financial crisis and changing donor priorities, meaning that SADC countries were obligated to find tangible solutions to their priorities, he said. They had re-pledged to increase national health budgets towards the 15 per cent Abuja Target of African Union Member States and would explore various innovative strategies aimed at mobilizing domestic resources, such as Zimbabwe’s AIDS Levy, which was collected from all workers’ salaries every month. SADC countries were encouraged to create a core strategic financial plan for the health sector, but without international solidarity and external support, their AIDS responses would be significantly undermined. They requested continued and increased financial assistance through international mechanisms, such as the Global Fund and through the President’s Emergency Plan for AIDS Relief. They also asked for technical support for local capacities and for the invigoration of research to find a cure to HIV and AIDS.
EDGAR GIMENEZ, Vice Minister of Public Health of Paraguay, speaking on behalf of the Union of South American Nations (UNASUR), said that the very groups that were stigmatized with regards to HIV/AIDS had a key role to play in stemming the tides of the epidemic. Those groups included men who had sex with men, male and female prostitutes, and drug users who used needles, among others. The right to health was a human right, and promoting access was a firm commitment of the UNASUR governments. He reconfirmed its commitments to eliminating barriers to treatment.
Another key issue in the battle against the AIDS pandemic was the cost of drugs. While UNASUR members were considered medium- and high-income countries, those classifications did not take into account persisting inequalities. That made it difficult to negotiate fair prices for drugs, specifically antiretroviral treatments. In response, UNASUR should make full use of the Trade-Related Aspects of Intellectual Property Rights, or “TRIPS agreement”, and other strategies to gain access. That would make it possible for the countries to fulfil their commitments and tackle the epidemic from a perspective that guaranteed human rights. He called for greater support from the agencies of the United Nations system, and stressed that access must be provided to all those living with HIV/AIDS, without discrimination.
SOREN PIND, Minister for Development Cooperation and Minister for Refugee, Immigration and Integration Affairs of Denmark, said that the international community needed to ensure that legal and political environments did not hamper the response to HIV/AIDS. They could provide more condoms, more communication and increased access, but they would not be able to tackle the epidemic if they did not address the stigma, discrimination and violation of human rights. Some countries found it difficult to talk about those issues in the health context, but if they were serious about fighting HIV/AIDS, then they needed to face the reality of human sexuality. HIV was mainly spread through sexual contact. Men who had sex with men, sex workers and drug users were the hardest hit by the epidemic. If they met those groups with discrimination and violated their human rights, that would help no one. If they deprived them of counselling and access to condoms and treatment, that would only fuel the epidemic further. That is why Denmark had chosen to fight against stigma and discrimination and why the human rights approach was key.
Denmark had conducted a review of its HIV/AIDS strategy and had doubled its budget with regard to that strategy from 500 million to 1 billion Danish kroner. The review looked at places where Denmark could increase its international impact and the effect of the 1 billion kroner, taking into account recent epidemic trends. More emphasis would be put on distributing male and female condoms in Africa. Denmark would also increase support to prevent transmission from mother to child by increasing treatment and services, and focusing on the link between combating HIV/AIDS and ensuring sexual and reproductive rights. Vaccine development, although high-risk, also offered a high return investment. Denmark would identify promising organizations to develop vaccines. Additionally, Denmark would assist at-risk populations, offering care directly to those groups to make a difference on the ground.
TRUONG VINH TRONG, Deputy Prime Minister of Viet Nam, said his country had achieved many of the Millennium Development Goals ahead of schedule, including those on poverty reduction, universal education, gender equality, and improving maternal and child health. Those living with HIV/AIDS accounted for about 0.26 per cent of Viet Nam’s population. The prevalence of infection from injected drug users had declined, as had the number of HIV/AIDS-related deaths. Frequent awareness campaigns and legal measures undertaken over the past twenty years had increased the participation of the population and social organizations. The National Committee for HIV/AIDS, Drugs and Prostitution Prevention and Control, founded over ten years ago, had effectively strengthened efforts to prevent and combat the disease.
However, Viet Nam remained a poor county facing numerous difficulties, and these initial gains remained fragile. Resources would be prioritized to implement national targets on HIV/AIDS prevention, care, treatment, and support, and the new United Nations initiative on zero new infections, zero discrimination, and zero AIDS-related death. That major threat to global sustainable development could only be averted by joint efforts and shared responsibility by each and every member of the international community. Necessary resources must be secured to develop national and international AIDS responses, emphasis must be placed on prevention measures, and those living with HIV/AIDS must be given better access to health-care services, particularly antiretroviral treatments and methadone.
SUSAN RICE, member of the Cabinet of the President of the United States, said ten years ago, the global HIV/AIDS situation was grave. From 1991 to 2001, more than 25 million people died from the AIDS pandemic. People in the United States were moved by that sweeping tragedy, and had then urged the international community to come together in a spirit of compassion and concern, as there was a shared responsibility to respond. She said the United States was proud to have been a leader in the global fight against HIV/AIDS, and it had played a central role in establishing the Global Fund to Fight AIDS, Tuberculosis and Malaria. The United States made the founding pledge to the Fund, and remained by far its largest single donor. In 2003, the President's Emergency Plan for AIDS Relief was created as the largest international response to a single disease that any country had ever mounted. Among its many efforts was the 2010 program providing HIV counselling and testing to more than 8.6 million pregnant women. More than 600,000 tested positive and received antiretroviral treatments, saving the lives of more than 114,000 babies from HIV infection.
The United States also remained committed to responding to the serious epidemic faced at home. More than 1.7 million Americans had become infected by HIV, more than 600,000 had died of AIDS, and more than 50,000 became infected with HIV each year. In July 2010, the United States released the first comprehensive HIV/AIDS road map to reduce new infection, increase access to care, and reduce HIV-related health disparities. While the United States had long been a leader in restoring hope and saving lives, and would not let up that fight now, the struggle could not be met by any one country alone. A truly global response was required, and she urged fellow donors and the private sector to give and invest more. In order to sustain the fight over the long term, affected countries themselves needed to provide resources based on their capacities, to protect their citizens from HIV/AIDS. She saluted the champions of the fight in the worst affected countries, Governments rising to protect citizens, communities rallying to those in need, and civil society groups and individuals who had offered hope and comfort in hours of grief and fear. The international community needed to do more than maintain the gains made so far, and must expand those gains. Too many lives could and needed to be saved.
ABDELKADER MESSAHEL, Minister for Maghrebin and African Affairs of Algeria, spoke about the growth of the HIV/AIDS epidemic and the socio-economic impact that it had on Africa, because of the great toll on human capital and the cost of programmes. Despite progress, the challenge remained formidable. In Africa, access to treatment had grown, but it was still insufficient, as two thirds of HIV/AIDS patients still lacked health care. There were 16 million orphans. There was also a high level of mother-to-child transmission of HIV. While resources from both domestic and international sources had increased, the dip in 2009 and the current trend toward stagnation was a cause of concern. Mobilizing resources had to be key. Fighting HIV/AIDS required maintaining the spiralling costs of prevention and health care to ensure access by all.
Cooperation with pharmaceutical companies was also crucial to developing vaccines and less toxic drugs, he added. It was necessary to improve and simplify prevention and screening technologies. Integrated treatment was needed to better combat HIV/AIDS, including strengthening health systems relating to tuberculosis and other diseases. All of those issues were covered by the Abuja Declaration, but international cooperation and development partnerships needed to be strengthened. Algeria had sought to implement a multisector approach, including access to blood banks, screenings and AIDS treatment centres to curb AIDS and reduce the number of deaths. The low prevalence of HIV/AIDS in Algeria showed that it was a good approach.
GHULAM NABI AZAD, Minister of Health and Family Welfare of India, called for effectively scaling up actions and resources to implement the international declarations on combating HIV/AIDS. “Our actions must match our words,” he said. Thanks to India’s strong prevention, care, support and treatment programme, the prevalence of the epidemic had been contained to just 0.3 per cent. New infections had been reduced by half. In the last decade, there was evidence that the epidemic had stabilized and even reversed in some parts of the country. The Government’s focus had been on helping high-risk groups, expanding services and improving access to antiretroviral therapy. Universal access to second-line anti-retroviral therapy and early infant diagnosis were being rolled out.
The “Red Ribbon Express” train traversed the country to disseminate awareness about HIV/AIDS and provide services to some 8 million people annually, he said. The Government was posed to begin the next phase of the National AIDS Control Programme. Mother-to-child transmission of infection continued to be a challenge. The Government hoped to achieve zero transmission in newborns and to prevent mother-to-child transmission of HIV through better testing of the some 27 million pregnant women who gave birth every year. It intended to provide, free of charge, diagnostic tests, drugs, food and transport for all pregnant women and newborns with HIV, to help eliminate mother-to-child transmission. The Government was launching an initiative to deliver door-to-door male and female contraceptives in 17 provinces, covering 200 million people. The initiative would be expanded thereafter to the rest of the country. Pharmaceutical companies in India provided high quality, affordable drugs for use in India and about 200 other countries. He urged the international community to work together to remove trade barriers to disseminating quality, low-cost drugs to those in need.
ABDULLAH BIN KHALID AL-KAHTANI, Minister of Public Health of Qatar, said the goal of halting the spread of HIV/AIDS and beginning to reverse it would remain elusive unless the international community intensified its efforts. The new and ambitious strategy of UNAIDS for the next phase, from 2011 to 2015, constituted a real opportunity for the world to get rid of the epidemic. The new strategy came concurrently with the early announcement of the impressive results of Study No. 52, which proved conclusively that the use of antiretroviral drugs limited the spread of the disease by as much as 96 per cent.
One could not deny the positive impact of international efforts aimed at reducing the spread of HIV and alleviating the suffering of those affected, as well as those most vulnerable to infection. The leaders of the G-8 (Group of Eight) had reaffirmed their commitment to increase development aid, and he reiterated the call to the international community to intensify its efforts to help affected countries deal effectively with the epidemic, as well. However, major countries needed to fulfil their financial pledges, or developing countries’ efforts would not be effective.
DR. NUTH SOKHOM, Senior Minister and Chairperson of the National AIDS Authority of Cambodia, said his country had achieved Millennium Development Goal 6 on combating HIV/AIDS, malaria and other diseases, largely due to support and funding from friendly countries, development partners, civil society and the United Nations. Key elements in that achievement included the creation of a National AIDS authority in 1999, a 2002 Law on HIV and AIDS Prevention and Control, reductions in stigmas against persons living with HIV and other vulnerable communities, and the establishment of clear policies and strategies to address most at-risk populations. Further, support from the Global Fund had allowed Cambodia to scale up its prevention, care, treatment and support programmes toward the country’s universal access target. Consequently, HIV prevalence among the adult population had decreased from 2 per cent in 1998 to 0.7 per cent in 2010. More than 80 per cent of the most at-risk population consistently used condoms and 90 per cent of persons living with HIV were receiving antiretroviral therapy, among other successes.
Despite its success in controlling the first waves of HIV and AIDS, Cambodia was concerned about underlying determinants of the emerging second waves, he said. Among other things, the Cambodian Government faced challenges from a number of fast-evolving conditions to which the most at-risk populations were exposed. Those included difficulties in implementing the 100 per cent Condom Use Programme among entertainment workers, increases in the number of men having sex with men and transgendered persons, rising numbers of drugs users, and higher numbers of migrants. However, Cambodia had developed seven strategic areas for its Third National Strategic Plan for Comprehensive and Multi-sectoral Response 2011-2015 and seven national working groups had been set up. It was also using the “three ones” principle of UNAIDS — one national AIDS authority, one national strategic framework and one national monitoring and evaluation system — to achieve the “three zeros” strategy — namely, zero new infections, zero AIDS-related deaths and zero discrimination. In that context, he requested bilateral and multilateral support, including from the Global Fund, to combat the second waves of HIV and AIDS in his country.
JOSE ANGEL CORDOVA VILLALOBOS, Minister for Health of Mexico, said that 33.3 million people were living with HIV in the world today and new infections had declined by 20 per cent in the last decade. Latin America had the highest coverage rate for antiretroviral treatment, with 51 per cent. It was necessary to establish global and regional alliances, including people living with HIV, academics, scientists, and the United Nations, to respond in a coordinated fashion and comply with international goals and political declarations. Today was the time to reaffirm the obligation to adopt a multisector response which was vigorous and sustainable for the coming decades. To promote a more effective response, all countries must have timely and sustainable mechanisms for treatment. The costs of antiretroviral drugs needed to be reduced. Efforts had to be stepped up to increase prevention strategies focused on groups that were most at risk, without overlooking actions concerning the general population.
Following the idea of UNAIDS to “know your epidemic, know your response,” Mexico generated national data to understand the social and health factors surrounding the HIV/AIDS epidemic. The Government gave greater attention to men who had sex with men, sex workers, drug users, and transgendered, as well as paid attention to migrant populations, vulnerable women and prison inmates. Another priority was to eliminate vertical transmission, as it was unacceptable that boys and girls were born today with HIV or syphilis. It was necessary to promote user-friendly health services and sex education to prevent new infections in present and future generations. Mexico called upon all countries to ensure that their actions were based on respect for human rights and a gender-equity perspective, free of discrimination, homophobia and violence. It was not a time for complacency or censorship, but rather a time to work together and move forward united.
ESTHER MURUGI MATHENGE, Minister of State for Special Programmes of Kenya, said her country had taken stock of progress made in its national response to HIV/AIDS since the Declaration of 2001, and was employing a multisector response. Kenya’s National Strategic Plan for 2009 to 2013 was based on the premise of “know our epidemic, know your response”, and the Government hoped to scale up treatment to 80 per cent of all eligible people by 2015. Prevention of mother to child transmission was also high, at more than 83 per cent prevention, and the goal was to achieve 100 per cent prevention by 2013.
On the issue of orphans and vulnerable children, she said that by 2009, close to 1.2 million children had lost one or both parents. A cash transfer program now reached over 100,000 of those girls and boys. Another challenge was the feminization of the epidemic, driven largely by biological factors, inadequate empowerment, and gender-based violence. The number of annual infections was still very high, and she expressed the hope to decrease all infections, and to have zero infections in children, by 2015. She called on the international community to invest in new strategies to combat HIV/AIDS, and applauded the United Nations vision of zero new infections, zero discrimination, and zero AIDS-related deaths.
NAMAN KEÏTA, Minister of Health of Guinea, said that the HIV/AIDS epidemic was at a low level in his country, but still impacted development, as populations such as men in uniform, fishermen and miners were affected. Since the outbreak of the epidemic, Guinea had committed to defeating it and had obtained results with the help of technical and financial partners. However, the results had not met the country’s needs. There was a dearth of local financing. The dependence on outside financing threatened the maintenance of the country’s achievements in terms of tackling AIDS. Priorities for the new Government included creating a line of credit in the national budget and local resource mobilization mechanisms, while calling for technical and financial partners for Guinea and other African countries. The Government was also launching an appeal to its peers to find local financing solutions for the nation and continent.
VABAH GAYFLOR, Minister of Gender and Development of Liberia, said her country’s aspiration was to create an HIV- and AIDS-free society, thereby contributing to a global community of societies free of the pandemic. Recognizing the magnitude of that battle, Liberia launched a new phase in its HIV prevention programme targeting young people between 15 and 24 years old. At the same time, it retained a focus on the needs of women, who continued to bear a disproportionate burden from the disease domestically and globally. HIV and AIDS were also mainstreamed into each of the four pillars of the country’s first post-war agenda, commonly known as “Lift Liberia.” Its reconstituted AIDS Authority had also developed a new national strategy guided by the “three ones” principle of UNAIDS: one national AIDS authority; one national strategic framework; and one national monitoring and evaluation system.
Noting that data collection to determine HIV prevalence in Liberia had been intensified, she said it stood at 1.5 per cent among the general population. Strikingly, HIV prevalence among women aged 15 to 24 was three times higher than among men in that age group. While the pandemic’s impact on national efforts to achieve social and economic recovery could not be ignored, gains had been made. They included: the development of a monitoring and evaluation plan with specific gender indicators; the placement of 42 per cent of 10,000 people on antiretroviral therapy; and increasing testing and counselling services for expectant mothers, among others. Nonetheless, prevention programmes must be scaled up, she said, to reach the goal of zero infections among women and girls, to expand access to treatment, to enrol more people in care and to reduce the impact on orphans and other children made vulnerable by AIDS. Finally, she thanked Member States for their investment, through the United Nations Mission in her country, in promoting an environment of peace and stability which was required to advance those efforts.
RUHAL HAQUE, Minister of Health and Family Welfare of Bangladesh, said that he believed the High-level Meeting would result in a strong declaration regarding the care and treatment of HIV/AIDS. The international community had achieved success in fighting the epidemic in the past, but it was a matter of great concern that more than 7,000 new cases of infection occurred every day, with women and adolescent girls facing the highest risk. Worldwide estimates also showed that 5 million young people were living with HIV. That was the result of factors like social inequality, neglect and social exclusion. It was time to protect adolescent girls and young women, so that their journey to adulthood was not affected by HIV. Bangladesh advocated for a full range of services, so that the HIV/AIDS epidemic did not inflict a disproportionate burden on women. Mr. Haque asked Member States to support the development of national health systems, so that women living with HIV were provided with sufficient assistance.
Bangladesh was considered a low-HIV-prevalent country, but there were cases of full-blown AIDS patients and it was possible that cases of HIV/AIDS went unreported because of the stigma, he said. Underlying causes of the cases included poverty, gender inequality and the high level of mobility of the population, including immigration to other countries for employment. Bangladesh had made progress in fighting the epidemic, but factors such as low condom use and men having sex with men all contributed to the spread of HIV in the country. The Government had to continue to provide support to the most at-risk populations. Global and regional efforts also had to continue. Bangladesh called upon developed countries to enhance their financial support, as well as to eliminate intellectual property and lower the costs of drugs. There was no room for complacency; the international community had to aim for zero infections, zero discrimination and zero related deaths.
JOHN SEAKGOSING, Minister for Public Health for Botswana, said over the past decade, his country has embarked on a number of intensive preventative measures, but people still continued to get newly infected. The percentage of the population living with HIV/AIDS was significantly high, at more than 17 per cent. Prevalence among Botswana women was at 19 per cent. However, positive achievements had been made with regard to universal access.
The percentage of HIV-positive pregnant women receiving completed courses of antiretroviral treatment stood at 94 per cent, and the global elimination target of less than 5 per cent mother-to-child transmission had been met. In Botswana, more than 93 per cent of those given the appropriate therapies survived beyond the first twelve months, and 100 percent coverage was supplied for orphans and vulnerable children. The significant domestic resources required for such programmes continued to be challenges to the national response, but sacrifices had been made to ensure access and quality care. Botswana supported the full realization of the right of everyone to the highest attainable standard of physical and mental health, and would continue to seek new and innovative ways to meet the challenges of universal access in the context of the rapidly changing epidemic. The country would focus on prevention, systemic strengthening, and scaling up treatment, care and support.
KEITH MONDESIR, Minister for Health, Wellness, Family Affairs, Social Transformation, National Mobilisation, Human Services and Gender Relations of Saint Lucia, said the Caribbean had been identified as the region with the second highest prevalence of HIV infection among males. In Saint Lucia, prevalence was estimated to be less than 1 per cent in the general population, with the number of new infections appearing to be stable over the past five years. The country’s national response had recorded many gains in the past ten years, including: free voluntary counselling and testing; a reduction of mother to child transmission; and a decline in the number of new reported cases of HIV/AIDS over the last five years. However, Saint Lucia continued to face many challenges in a comprehensive response to the epidemic and, in consultation with UNAIDS, recognized the need to develop an evidence-based response and a concentrated approach that addressed those most at risk. Because the Government’s external grants were coming to an end, it was imperative to deploy resources and efforts in the most effective manner possible.
He said Saint Lucia’s national strategic plan, drafted with the technical support of UNAIDS and the World Health Organization (WHO), had identified three major sectors of the populations most at risk, in order of priority: men who had sex with men; sex workers; and mother to child transmission. Young people and girls were also identified as high risk, given current behaviours and knowledge about the spread of HIV/AIDS. Education would include an emphasis on the risks associated with early sexual debut and would emphasize that girls were 50 per cent more vulnerable to sexually-transmitted infections. Saint Lucia would also focus on treating the epidemic in a concentrated fashion, focusing on linking testing to care. Humane programmes that were person-centred and provided the social support for those who were marginalized were essential. Prevention programmes would also be developed, promoting healthy sexual behaviour and building from existing health and family life education programmes in the schools. Finally, Saint Lucia reaffirmed its commitment to combating this disease by ensuring that resources were used most effectively.
RUDYARD SPENCER, Minister of Health of Jamaica, said that the progress made in Jamaica was noteworthy, as there was an 18 per cent decline in the number of persons reported with advanced HIV and AIDS in 2009 compared to the previous year. AIDS deaths had declined significantly, decreasing from 665 in 2004 to 378 in 2009. Paediatric AIDS declined by 19 per cent, decreasing from 32 cases in 2008 to 26 cases in 2009. The expansion of HIV testing in the public sector had resulted in coverage for about 84 per cent of pregnant women and 98 per cent of babies delivered in the public sector. Early testing had resulted in timely provision of antiretroviral treatment leading to reduced mother to child transmission, which now stood at less than five per cent.
Despite these advances, Jamaica faced challenges relating to inadequate human resources to scale up testing, treatment and support services, he said. The tight fiscal space undermined the Government’s commitment to advance in any significant way effective HIV and AIDS strategies. The country would need the continued consistent support of the donor community not just to maintain the gains, but to make leaps forward regarding international HIV/AIDS targets. Eliminating stigma and discrimination against those infected also constituted an unfinished agenda, so Jamaica was moving to make amendments to the Public Health Act and relevant Public Health Regulations, removing provisions regarded as discriminatory. The Declaration of Commitment signed by Prime Minister Bruce Golding and Leader of the Opposition Portia Simpson Miller in April 2011 demonstrated a commitment at the highest level of political leadership. Jamaica gave its commitment that the symbolic gesture would be supported by practical interventions to reduce discrimination and increase access for all persons, especially those who were marginalized, such as men who had sex with men, sex workers and drug users.
HENRY MADZORERA, Minister of Health and Child Welfare of Zimbabwe, said thanks to Zimbabwe’s commitment to universal access to treatment, the HIV prevalence rate in the country fell from more than 29 per cent in 1999 to 13.7 per cent at present. The decline was a result of expanded HIV prevention services, testing, counselling, and awareness campaigns. The Government had begun to incorporate male circumcision in its HIV prevention programmes, based on evidence that it could help prevent transmission. In 2006, Zimbabwe was among the first countries worldwide to develop and implement an evidence-based behavioural change strategy, which had since bolstered demand for and use of HIV prevention services. Despite funding challenges, Zimbabwe had achieved significant progress in treatment and care. By the end of 2010, it had achieved 77 per cent coverage towards its universal access target. Moreover, 350,000 of the estimated 593,000 people in the country in need of anti-retroviral therapy had access to it now.
Zimbabwe had adopted WHO’s newly revised HIV treatment guidelines, raising the threshold for initiating treatment for a CD4 cell count from 200 to 350, he said. That move had bolstered the demand for treatment services from 340,000 people seeking treatment to 593,000. The number of children receiving treatment — 10 per cent of the population — had doubled in the last two years and efforts were under way to further expand services to children in need. Coverage of programmes to prevent mother-to-child transmission had been expanded. The Government had set up a National AIDS Council and a National AIDS Trust Fund to promote universal access to care. Since the adoption of a multicurrency regime, the Government’s AIDS Levy had played a significant role in financing the national response to HIV/AIDS. The 2011-2015 national HIV and AIDS strategic plan aimed to scale up availability of, and access, to prevention, care and treatment.
GEORGE MOYEN, Minister for Health and Population of Congo, said his country had set up an institutional framework as a guiding tool for coordination with regard to battling HIV/AIDS. That enabled the country to structure its national response and take into consideration national and international concerns. To achieve universal access and prevention, and to achieve the Millennium Development Goals, Congo provided free HIV screening, free biological tests, free antiretroviral drugs, and increased funding for other activities. The number of patients under antiretroviral treatments had increased fourfold in five years.
He said the international community must welcome all international initiatives adopted for Africa in general, and the Congo in particular. He expressed gratitude to those organizations helping those living with HIV, as their commitment needed as much encouragement as possible. Still, Congo was nonetheless still concerned by the feminization of the illness, as well as the particular vulnerability of indigenous peoples to HIV.
PAIJIT WARACHIT, Permanent Secretary of the Ministry of Public Health of Thailand, said that his country had made substantial progress in the prevention of HIV infection among the general population and Prevention of mother-to-child transmission. Current coverage included nearly 97 per cent of women in need. Access to HIV treatment, care and support was now a reality for nearly 80 per cent of all in need. In addition, some services had been expanded to non-nationals and people in remote areas, including migrant workers and ethnic minorities. The Government projected that, for the next five years, certain key affected populations would account for 90 per cent of new infections, including men having sex with men, sex workers, injecting drug users and partners in a relationship with someone HIV positive. Thailand was working to emphasize innovation, focus on prevention and address the legal, social and environmental factors that hindered access to services and that fuelled discrimination. A rights-based and gender-sensitive approach was also integral to providing prevention services.
In order to scale up its prevention response, Thailand had decided to pilot innovative financing models, including a “country prevention fund,” he said. Thailand also recognized that HIV was more than a health challenge and that it was necessary to maximize synergies from government and non-government services in an integrated manner. Thailand was currently providing HIV prevention and care for migrant workers from neighbouring countries, with a substantial contribution from the Global Fund. Additionally, Thailand had scaled up treatment programmes that relied on domestic funding and little on international sources. In that respect, trade-related intellectual property rights (TRIPs) were essential in efforts to achieve universal access. The international community needed to work together to reach global targets, and Thailand reaffirmed its commitment to working with all nations to end the scourge of HIV/AIDS.
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