Speakers Call for ‘Prevention Revolution’, Mainstreaming of Anti-AIDS Programmes into National Health Systems as General Assembly’s High-level Meeting Continues
Speakers Call for ‘Prevention Revolution’, Mainstreaming of Anti-AIDS Programmes into National Health Systems as General Assembly’s High-level Meeting Continues
|Department of Public Information • News and Media Division • New York|
Sixty-fifth General Assembly
92nd & 93rd Meetings (AM & PM)
Speakers Call for ‘Prevention Revolution’, Mainstreaming of Anti-AIDS Programmes
into National Health Systems as General Assembly’s High-level Meeting Continues
High-Ranking Officials Acknowledge Fragility of Gains of Last 30 Years
Calling for a “prevention revolution” on the second day of the General Assembly’s High-Level Meeting on HIV/AIDS, ministers and other high-ranking Government officials stressed that programmes to combat the disease must be mainstreamed into national health systems during the next phase of the global response to the pandemic, while emphasizing that those directly affected must be included in the search for solutions.
Expected to conclude tomorrow with the adoption of a political declaration affirming actions to reshape the global response, the three-day Meeting is intended to provide a high-level review of progress made since the 2001 General Assembly Special Session on HIV/AIDS. To that end, more than 70 speakers took the floor today to celebrate a decade of progress in mobilizing political action and saving millions of lives, even as they underscored the fragility of those gains.
“Together, we can go further still; we can go faster towards a world with zero new infections, zero discrimination and zero deaths tied to AIDS,” said Dédé Ahoefa Ekoué, Togo’s Minister for Planning, Development and Territorial Administration. Like other countries in sub-Saharan Africa, where the epidemic’s impact had been especially devastating, Togo had experienced notable reductions in infection rates, she added.
She acknowledged that those achievements were due, in large part, to critical support from, and partnerships with, subregional, regional and international organizations — particularly the Global Fund to Fight AIDS, Tuberculosis and Malaria and the Joint United Nations Programme on HIV/AIDS (UNAIDS) — and noted that Togo was moving ahead to allocate long-term budget support for programmes to combat HIV and AIDS. As in other countries where the most alarming trends of the disease had begun to slow and even be reversed, however, enhancing and consolidating those successes would require mobilizing further financing and support at the international level, she said.
José Van-Dunem, Angola’s Minister for Health, said that while his country had rapidly expanded HIV-specific services in response to the epidemic, “we quickly realized that this is not the best way to create sustainable services”. Today, the Angolan Government was committed to integrating HIV services into existing health services, enhancing systemic responses and making HIV care an essential part of primary care, he said. Continued investment in knowledge, access to health services and education, gender equality and youth leadership, among other things, would allow Angola to ensure that no man, woman or child was infected with HIV.
Throughout the day-long debate, which lasted well into the evening, successive speakers agreed that efforts to realize “zero new HIV infections, zero discrimination and zero AIDS-related deaths” must be based on a new, international political commitment to more effective long-term actions. Views converged on the need to deploy specific programmes aimed at particularly vulnerable populations, including youth, women and girls. Prevention must also target other at-risk groups, such as men who have sex with men, sex workers, intravenous drug users and migrants, some speakers said.
Many speakers also highlighted the challenges of achieving needed behavioural changes. While difficult, behavioural change was nevertheless paramount in ensuring and improving efforts to reduce HIV transmission, they said. On a related note, a number of speakers underscored the need to address stigmatization of and discrimination against people living with HIV, and other vulnerable groups, suggesting that multifaceted education initiatives and shared responsibility were essential in sparking positive behavioural changes.
In a similar vein, Martin Dahinden, Switzerland’s Secretary of State, called for a greater human rights focus, saying that a rights-based approach must be at the heart of any and all action against AIDS. He emphasized in particular that individuals should have the right to decide the future of their sexual health, suggesting that, given the critical role of men and boys in the areas of sexual and reproductive health and combating HIV/AIDS, homophobia and other forms of discrimination must be banned through “vigorous” legislation.
Speakers from a number of countries currently enjoying low HIV prevalence rates expressed concerns that the virus could still spread quickly in the future. Teima Onorio, Vice-President of Kiribati, said the presence of several high-risk groups carrying other sexually transmitted diseases indicated the speed with which HIV might spread if it were more widely introduced. Like Nelson Eduardo Soares Martins, Minister for Health of Timor-Leste, who expressed similar worries, Ms. Onorio pointed to particular dangers facing her country’s predominantly young population, and outlined specific Government initiatives to provide services to that vulnerable group.
Several other speakers described particular efforts to curb mother-to-child transmissions, especially in tandem with work to realize the Millennium Development Goals. One speaker said that efforts to reduce mother-to-child transmissions by 2015 must be reinforced by a strong emphasis on general prevention.
Zeroing in on the need for widespread access to generic drugs, Douglas Slater, Minister for Foreign Affairs, Commerce and Trade of Saint Vincent and the Grenadines, said the willingness of States not only to allow, but also to champion the widest and most flexible distribution of all generic medications remained the standard by which the developing world would judge their commitment to eradicating HIV/AIDS. “Three decades into this struggle, no human being should be suffering and dying simply because the necessary medication is priced out of their Government’s reach,” he emphasized.
Providing a glimpse of the negotiations on the outcome document, Erik Solheim, Norway’s Minister for the Environment and International Development, said that while the text contained ambitious targets, his country would have wanted to see clearer messages on several issues, especially an acknowledgement of the importance of sexual and reproductive rights. Norway was also disappointed that, during the negotiations, representatives of religious faiths had not been helpful in fighting stigma on the part of faith communities or addressing the needs of marginalized groups.
Also today, the Assembly held two panel discussions to foster debate on future initiatives. Participants in the morning panel, on “Innovation and technology”, stressed the urgent need to develop innovative drugs, diagnostics, vaccines and microbicides to treat HIV infection. They should also be made readily available on a global basis, particularly to sex workers, men who have sex with men, intravenous drug users and others most in need. (See Press Release GA/11091)
The afternoon panel, on “Women, girls and HIV”, explored the epidemic’s disproportionate burden on that vulnerable group, with participants suggesting that if Government were serious about halting the disease in the next decade, they must throw their political weight squarely behind the issue by urgently expanding sexual and reproductive health services and legislating gender equality. No gains would be made without ending violence against women, the said. (See Press Release GA/11092)
During the plenary debate, the Second Vice-President of Burundi also addressed the Meeting.
Ministers and other senior Government officials from the following countries also spoke: Democratic Republic of the Congo, Estonia, Barbados, Luxembourg, Mauritania, Suriname, Greece, Belize, Samoa, Tunisia, Kyrgyzstan, United Arab Emirates, El Salvador, Burkina Faso, Lao People’s Democratic Republic, Benin, China, Chile, United Kingdom, Indonesia, Brazil, Panama, Morocco, Niger, Sierra Leone, Guinea-Bissau, Cameroon, Antigua and Barbuda, Japan, Poland, Sweden, Saudi Arabia, Philippines, Cuba, Iran, Russian Federation, Peru, Paraguay, Mongolia, Armenia, Argentina, Nicaragua, Georgia, Canada, Malaysia, Venezuela, Ukraine and Haiti.
Malawi’s First Lady also delivered a statement, as did representatives of Egypt, European Union, Dominican Republic, Andorra, Iceland, Monaco, Belarus, New Zealand, Romania and Sudan.
A Consultant Venereologist of Sri Lanka’s National STD/AIDS Control Programme addressed the Meeting, as did France’s AIDS Ambassador, the Director of Lebanon’s National AIDS Programme and a representative of Portugal’s National AIDS Coordination.
Speaking in exercise of the right of reply was the representative of the Russian Federation.
The High-Level Meeting will reconvene at 10 a.m. on Friday 10 June.
The General Assembly met this morning to continue its High-Level Meeting on HIV/AIDS, which runs until 10 June. More than 160 world leaders and high-ranking officials are expected to review comprehensively the progress achieved in realizing the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS, including their time-bound, measurable goals, with a view to achieving universal access to HIV prevention, treatment, care and support, bearing in mind that those targets expired at the end of 2010. They are also expected to adopt a consensus outcome document, which would set the course for the global response to HIV/AIDS over the next decade. See Press Release GA/11086 for further details.
GERVAIS RUFYIKIRI, Second Vice-President of Burundi, said that in following the preparations for the High-level Meeting, his country had noticed a shared will to put an end to HIV/AIDS. Burundi welcomed the goal of zero new deaths, and called for incorporating activities against sexual violence into national HIV/AIDS programmes, as recommended by the Secretary-General and the Joint United Nations Programme on HIV/AIDS (UNAIDS). Since 2001, the country had made progress, despite political crisis, in responding to the epidemic through a multisector framework supported by authorities at the highest level, as well as a follow-up treatment and support mechanism.
He said that between 2001 and 2010, Burundi had increased from 20 to 400 the number of centres for diagnosing HIV and AIDS; the number of people diagnosed from 10,000 to 430,000; the number of centres for preventing mother-to-child transmission from 2 to 110; the number of women following the prevention protocol from 100 to 2,600; the number of centres for people living with HIV from 1 to 90; the number of people receiving antiretroviral treatment from 600 to 22,000; and the number of orphans assisted from 2,500 to 70,000.
The Government now had the opportunity to look to the future and set realistic goals, he continued, saying it intended to identify 1.9 million people for testing, 14,000 pregnant women who were HIV-positive, and to achieve 80 per cent coverage for antiretroviral treatment. However, Burundi faced enormous challenges, including a lack of qualified personnel, health-care equipment and infrastructure, and appealed to potential partners to continue supporting its fight against HIV/AIDS. The Government was pursuing efforts to combat AIDS by providing an annual subsidy, and hoped to see international efforts crowned with success and a world free of HIV and AIDS.
TEIMA ONORIO, Vice-President of Kiribati, said that although her country did not currently have a high HIV prevalence, it did have several high-risk groups carrying other sexually transmitted diseases, which suggested that AIDS could easily spread, should it be more widely introduced. Kiribati’s predominantly young population would be especially vulnerable, she stressed. In response, the Government had increased the number of voluntary confidential counselling and testing sites, with hours to accommodate specific groups like transactional sex workers, seafarers, policemen and antenatal mothers. A new clinic funded by the United Nations Children’s Fund (UNICEF) had opened in 2010, and focused on fathers and their role in preventing the transfer of HIV to children.
While the number of those infected with the virus remained small — just 54 confirmed cases — stigma and discrimination remained the major obstacles to proper care and the prevention of further infection, she said, emphasizing that the Government was working steadily to transform community perceptions. It was also supporting trainees for the human rights and workplace policy to work with the Pacific Islands AIDS Foundation, local lawyers and the Regional Rights Resource Team focal person to review and enforce current legislation for those living with HIV and other vulnerable and marginalized groups. The creation of a bill would be used to consult with community members and should help improve perceptions of affected individuals.
VICTOR MAKWENGE KAPUT, Minister for Health of the Democratic Republic of the Congo, said that from the emergence of the terrible pandemic in 1981, his country had remained open to assisting in the world’s response. Although the Government had made progress in supporting individuals living with HIV and protecting the uninfected, it continued to face many challenges. Indeed, HIV prevalence stood at 3.7 per cent for pregnant women and 3 per cent for the general population, he said.
The epidemic in the Democratic Republic of the Congo was characterized by feminization, he continued, adding that HIV also disproportionately affected youth, with infections particularly concentrated along the Congo River. Today, 1.2 million citizens were infected, with women accounting for roughly 71,000 new infections each year. He further noted that the Government was paying particular attention to mother-to-child transmission, among other areas of focus. Underlining his country’s commitment to working towards the global vision of zero infections, he appealed for support for its efforts to curb the spread of HIV.
HANNO PEVKUR, Minister for Social Affairs of Estonia, said the epidemic was expanding faster than it could be dealt with, creating an economic burden. Estonia had a relatively high rate of infection, with 7,850 people diagnosed, or 0.6 per cent of the population. About 236 per 1,000,000 people had been diagnosed in 2010, with the main group being drug users, he said, emphasizing that it was essential to provide them with services to prevent further transmission to other drug users, sex partners and the general population. Results from a conference held in Tallinn last month had concluded that scaling up assistance for drug users was the key to stopping transmission, he said.
Since HIV also affected people through reproductive health, that should remain a high-level priority, he stressed, adding that preventing vertical transmission was a common goal. Eliminating stigma and discrimination, as well as ensuring the sexual and reproductive rights of girls, were the cornerstones of a healthy society. A stronger commitment was needed to provide the best care for those affected, he said, adding that Estonia’s strategy set clear national targets to be achieved by 2015. There had been a decline in the number of new infections, which meant the country was on the right path. Having gathered to express support for the Secretary-General’s goals in the fight against HIV/AIDS and fulfil them to the highest degree possible, members of the international community needed to work together and share their experiences, he emphasized.
STEPHEN LASHLEY, Minister for Family, Culture and Sport of Barbados, outlined his country’s efforts to combat HIV and AIDS, saying that each Government Ministry had an annual action plan. Together, those plans provided a framework to support domestic and international goals aimed at addressing the epidemic. Among other things, Barbados was intent on reducing mother-to-child transmissions, increasing the funds dispersed to civil society organizations, raising the number of persons in high-risk populations with access to health services and augmenting the number of sex workers using condoms. He stressed, as a matter of urgency, the need to address the lack of access to concessionary funding among countries like his own, due to its relatively high per capita income.
Highlighting the national bipartisan approach to addressing HIV, he said it was illustrated by a recent declaration signed by both the Prime Minister and the Leader of the Opposition. Barbados recognized its shared responsibilities in the effort to reach the “zero goals” of 2015 — zero new infections, zero discrimination and zero AIDS-related deaths. Further, the Government also recognized its own domestic goals, including supporting those living with HIV. As a country, Barbados would continue to take appropriate programmatic action to improve monitoring and evaluation for evidence-based planning, ramp up civil society partnerships and adopt rights-based approaches, among other measures.
MARIE-JOSÉE JACOBS, Minister for Development Cooperation and Humanitarian Affairs of Luxembourg, said that despite significant advances in ensuring that all those requiring care received it, that the global rate of HIV infection continued to drop and that the fundamental rights of every person exposed to the virus were respected, stigma and discrimination continued to threaten that progress. The Meeting provided the opportunity to move forward and come up with equitable treatment programmes in all the world’s regions. Emphasizing the importance of equal and universal access to basic health care, and of fulfilling Government commitments, she welcomed the fact that the Meeting would adopt a political declaration affirming actions to guide the global response to HIV/AIDS for years to come.
She went on to say that efforts to realize zero new infections, zero discrimination and zero new deaths must be based on a new political commitment to more effective long-term actions, stressing that the United Nations had a decisive role to play in coordinating programmes through UNAIDS. Health was among Luxembourg’s major priorities, and 13 per cent of its development aid for 2010 had been devoted to that sector. Luxembourg devoted considerable resources to programmes to combat HIV/AIDS, including research, antiretroviral treatment for children and mobilizing public opinion, she said, adding that it had committed to provide €5 million for the development of an anti-AIDS strategy. Experts were following the epidemic’s development and advising the Government on the necessary steps.
DÉDÉ AHOEFA EKOUÉ, Minister for Planning, Development and Territorial Administration of Togo, said her county’s Government had recently evaluated its national efforts to tackle HIV and AIDS, and the infection rate today was half what it had been in 2001. The number of new infections among children and youth had also been reduced, she said, stressing that Togo was nevertheless moving to extend coverage to prevent mother-to-child transmission, with the goal of reducing that rate from 10 per cent in 2010 to 2 per cent by 2015. She went on to note the recent passage of a law to protect those living with HIV from discrimination and stigma.
While expressing satisfaction with the support provided to her country as well as to regional and subregional organizations in Africa by the Global Fund to fight AIDS, Tuberculosis and Malaria, she stressed the need for more both financial and human resources. For its part, Togo had moved ahead to allocate long-term budget support for HIV and AIDS, but continued to need external support. Highlighting the efforts of UNAIDS, she stressed that enhancing and consolidating previous results would require mobilizing further financing. “Together, we can go further still; we can go faster towards a world with zero new infections, zero discrimination and zero deaths tied to AIDS,” she said.
HOUSSEYNOU HAMADY BA, Minister for Health of Mauritania, said his country had had its first known case of AIDS in 1987 and currently had a prevalence rate of 0.7 per cent, which had increased from 0.2 per cent in 1990. The country focused on prevention, treatment, the development of programmes and good governance. As a Muslim country, Mauritania had been able to implement legal texts and laws that focused on the rights of the ill, he said, adding that its prevention policies included the opinions of imams and other religious leaders.
Efforts by Member States to combat HIV and AIDS would only be possible with the continued support of the international community, he said, emphasizing the need for financial resources to carry out research and development. Mauritania had high hopes for the results of the High-Level Meeting, and wished to express its support for the Global Fund and UNAIDS, which had done “remarkable” work. The Government invited the international community to provide them with more resources in support of their efforts. Mauritania also called on all non-governmental organizations, civil society and bilateral partners to fight HIV and AIDS.
CELSIUS W. WATERBURG, Minister for Public Health of Suriname, said his country had made important strides in many areas related to HIV and AIDS. After steady increases through 2006, the number of newly registered HIV infections had begun to decline in 2007. Moreover, Suriname was one of the few Caribbean countries where the incidence of infection had decreased by more than 25 per cent. Mortality rates had also dropped by 10 per cent since 2006, he said, describing those advances as the result of implementing the National Strategic Plan on HIV. Its strategies included strengthened coordination and leadership through the creation of a national multisectoral HIV council; the establishment of additional structures such as the Centre of Excellence in HIV treatment and care; and the introduction of the “combined prevention tool”, which had proved effective in the HIV response.
Suriname was also the only Caribbean country to implement successful pilot projects to mobilize men for circumcision as an additional preventive measure, he said. It was working to integrate HIV and AIDS services into regular health programmes, while also involving people living with HIV in care and support programmes. Turning to the challenges still facing his country, he cited harmful traditions and customs, misconceptions and adverse beliefs, language barriers in a multilingual society and the vulnerability of small communities due to HIV-related stigma, gender inequalities and poverty. While appreciating the financial and technical support it had received thus far from the Global Fund and other donors, Suriname needed continued international support, he emphasized, noting that in order to move towards the goal of universal access to comprehensive HIV prevention programmes, treatment, care and support, resources and political will must be mobilized on the national, regional and global levels.
ANDREAS LOVERDOS, Minister for Health and Social Solidarity of Greece, stressed that the AIDS epidemic had deepened the gap between the global North and South, as the cost of prevention and medical treatment, especially for the countries most affected, was excessive. The epidemic had increased the risk of social stigma for populations, such as men having sex with men, drug users and people in need of transfusions, and the High-Level Meeting offered an opportunity to remind that “the danger is not over”. For its part, Greece’s main objective was to ensure access to public health services and, currently, all people in need could receive medical treatment, even the poor, uninsured or illegal immigrants.
In line with the Secretary-General’s recommendations, Greece also planned to reinforce those initiatives with expanded free condom distribution and needle-exchange programmes, he said, adding that, in those efforts, the Government was working closely with vulnerable groups, civil society and non-governmental organizations. Human trafficking was a main concern and Greece had seen a “significant” increase of recorded HIV infections in 2010, many of which concerned women from sub-Saharan Africa, who had been brought into the country illegally and forced to work as prostitutes. Such problems could only be addressed through closer international cooperation.
PABLO MARIN, Minister for Health of Belize, said that while his country had the highest prevalence rate of HIV in Central America and one of the highest in the Caribbean, there had been a 33 per cent decrease in the number of new infections, and the mother-to-child transmission rate was now less than 6 per cent. Due to scaled up treatment plans aimed at meeting complete universal access by 2015, the Government was now able to cover above 70 per cent of those needing care.
The ever growing dynamics of HIV/AIDS required an innovative approach. To maintain current successes and overcome challenges, developing countries like Belize needed to invest in cost-effective interventions and best practices, and seize national ownership at all levels. A broader and more integrated health-sector response to HIV was necessary to confront the growing pandemic of non-communicable diseases. Vertical programming and donor agency-driven programmes had proven largely unsustainable. Sustainable health initiatives required country ownership and a focus on the affected individuals.
TUITAMA LEAO TALALELEI TUITAMA, Minister for Health of Samoa, said his country, like most Pacific islands, was facing the reality of an increasing number of HIV cases since the first case had been detected in 1990. Although Samoa considered itself a low-prevalence country, with a total of 22 HIV cases to date, concern remained due to the high prevalence of sexually transmitted infections and subsequent implications for the spread of HIV. Samoa acknowledged with gratitude the support of the international community in improving health systems and encompassing all facets of sexual and reproductive health. Samoa had invested in a sector-wide approach programme for its health sector and set clear national health outcomes and national health strategies. The Government was advocating for greater health consciousness for its people, one example of which was the formation of the Samoa Parliamentarian Advocacy Group for Healthy Living, which highlighted political commitment towards responding to global health challenges.
The high level of political commitment had mandated the formation of the National AIDS Coordinating Council and its Technical Advisory Committee to mobilize national concerted efforts in the fight against HIV and AIDS, he said. The work of the Council had led to the development and endorsement of the National HIV/AIDS Policy and Plan of Action from 2011 to 2016. The Technical Advisory Committee was engaged in funded activities, such as voluntary counselling and confidential testing clinics; capacity-building training programmes for health personnel; care for people living with HIV through antiretroviral treatment; multimedia campaigns targeting youth; and the establishment of the Women in Leadership Advocacy Group on HIV/AIDS. Samoa had also made progress towards the achievement of the Millennium Development Goals through the development of sector policies and strategic frameworks to facilitate multisector efforts to control HIV/AIDS. The Government’s HIV/AIDS response was supported by the Global Fund and the Regional Strategy for Implementation Plan 11 Response Fund. Despite the progress made thus far, more work remained to improve communication, equalize gender power relations, overcome cultural and religious barriers, uphold equity, maintain respect for human rights and strengthen health systems.
GEEGANAGE WEERASINGHE, Consultant Venereologist of the National STD/AIDS Control Programme of the Ministry of Health of Sri Lanka, said that while his country’s vulnerability to HIV remained relatively high, it maintained a lower prevalence rate at below 0.1 per cent of the adult population. That was termed, he said, a “latent” HIV epidemic. Among the major factors contributing to that success were a high level of literacy, which laid a solid foundation for social achievements; the country’s universal free health-care system; and the introduction of a condom social marketing programme in the early 1970s. Moreover, Sri Lanka had first introduced an anti-venereal disease campaign in 1952, and its National STD/AIDS Control Programme had been introduced in 1985. The State had also been providing free antiretroviral therapy since 2004, he said.
Despite Sri Lanka’s low HIV prevalence, there remained significant potential for the epidemic’s expansion among concentrated groups, he said. The Government was, thus, working to mitigate that potential through coordinated and focused measures targeting groups with high-risk behaviours, such as female sex workers and their clients, men who have sex with men, vulnerable youth in tourist areas and migrant employees. The Government had formulated a proposal for the period 2011-2015, which contained the country’s national response to HIV/AIDS epidemic for Round 9 of the Global Fund. That response aimed to increase the scale and quality of comprehensive interventions for the most at-risk populations. Sri Lanka also expected to map and reach those populations, in order to provide the first- and second-line antiretroviral therapy for adults and children, among other things. Underlining the need to establish an enabling environment, he said it was crucial for the wider international community to address that issue jointly and comprehensively.
HABIBA ZAHI ROMDHANE, Minister for Public Health of Tunisia, noted that the High-Level Meeting had come at the same time as the “Arab Spring”, which had been a driving force for the people of the world to use all their energies to combat inequality, whether economic or social. She commended the United Nations for its positive stand with regard to Tunisia, including the Secretary-General’s visit to the country, during which he had saluted the efforts of all Tunisians in all fields. Tunisia expressed a commitment to work with the international community to fight HIV and AIDS, and lift all the obstacles to halting the disease. To confront the pandemic, Tunisia would work in cooperation with all stakeholders and all organizations throughout society and the private sector. Tunisia had been able to control transmissions through controlling blood transfusions and providing free testing and care to all people living with HIV, including antiretroviral treatment to all those requiring it, without any discrimination. That treatment was guaranteed through a special endowment for HIV/AIDS.
More coordinated international efforts and more collaboration with civil society were needed to lower risky behaviour, she said. Tunisia would take all the necessary steps, with full respect for the highest principles of human rights. Tunisia was committed to protecting vulnerable groups, such as women, children and youth. The Meeting was an excellent opportunity for the country to stress its concern for youth and to address all the health risks they faced. Tunisia paid tribute to the vast efforts of all United Nations bodies, but stressed the need to continue technical and financial support through further funding from the Global Fund. Tunisia welcomed the proposed declaration of the Meeting and was committed to contributing and putting an end to the pandemic by preventing more infections and ensuring no discrimination.
DOUGLAS SLATER, Minister for Foreign Affairs, Commerce and Trade of Saint Vincent and the Grenadines, said his country and the Caribbean region had experienced notable progress — including a more than 25 per cent decrease in the incidence of HIV infections — while providing treatment and care for significant percentages of persons infected with or affected by HIV. However, achieving appropriate behavioural changes remained a major challenge in the HIV/AIDS response, he said, noting that such changes were critical in ensuring or improving efforts to reduce the transmission of HIV. The issue of stigma and discrimination of people living with AIDS and other vulnerable groups remained an important task. In that regard, he stressed that multifaceted education initiatives and shared responsibility were key in sparking positive behavioural changes. He stressed that efforts to reduce mother-to-child transmission by 2015 must be reinforced by strong emphasis on general prevention. To that end, the international community must pursue and collectively champion a veritable “prevention revolution” involving, in particular, the energy of the world’s youth.
Noting his Government’s continued investment of its limited resources in achieving universal access to HIV prevention, treatment, care and support, he stressed that more efficient and sustainable ways of achieving those goals must still be found. In that context, he reminded and encouraged its partners to provide additional resources to the various funding agencies, particularly the Global Fund. “We also call for exploration of innovative means to generate the necessary financing to step up our war against this scourge,” he said. He also noted that the willingness of States to not only allow, but to champion, the widest and most flexible distribution of all generic medications remained the standard by which the developing world would judge their commitment to eradicating HIV/AIDS. “Three decades into this struggle, no human being should be suffering and dying simply because the necessary medication is priced out of their Government’s reach,” he said.
SABYRBEK DJUMABEKOV, Minister for Health of Kyrgyzstan, said that stopping the spread of HIV was one of the highest priorities of his Government. The Government had a central coordinating committee to combat HIV/AIDS, which acted in accordance with national and international laws. Kyrgyzstan received aid from the international community and, with financial support from the Global Fund, had increased the amount of testing and number of detections of HIV cases. Despite that effort, the rate that the disease was spreading remained fairly high in the country. The morbidity rate from 2001 to 2010 had risen, with the annual growth of cases reaching approximately 30 per cent. Drug users and sex workers were a significant part of those infected.
Kyrgyzstan was promoting progressive measures to prevent HIV/AIDS among drug users and jail inmates, including through methadone substitution and needle exchange, leading to a drop in infections, he said. There had been a substantive rise in the use of antiretroviral therapy by drug users. Now, there were 48 centres for needle exchange and 40 centres for methadone therapy, including within the prison system. HIV continued to affect the most active age groups, as 78 per cent of those affected were between the ages of 20 and 39. It was also necessary to note the feminization of the infection, as the percentage of women infected from 2001 to 2010 had grown from 9 to 30 per cent. Ninety-three per cent of all pregnant women in Kyrgyzstan were tested for HIV. A great deal had been achieved, and Kyrgyzstan, a small country still in the process of formation, was convinced that new political will, the full commitment of the leadership and the dedication of Member States and civil society could put an end to HIV and AIDS.
NELSON EDUARDO SOARES MARTINS, Minister for Health of Timor-Leste, noted that, because his country was emerging from conflict, it faced particular challenges in establishing its health systems and addressing HIV and AIDS. From 2003 to 2010, 2,002 cases of HIV, including 15 among children under the age of five, had been reported. Most of the new infections were among those between ages 15 and 24. Of the 39 people receiving antiretroviral therapy, 3 were children. Further outlining his country’s care and treatment response, he particularly thanked Brazil for its support.
Although Timor-Leste remained a low-prevalence country, its transmission rates were high, he said. In addition, its high population of youth was particularly vulnerable to HIV and AIDS. In its efforts to combat HIV and AIDS, the Government was focused on prevention, as well as on larger legal and social justice issues surrounding the epidemic. He cited collaboration among diverse groups, including civil society, the Government, the military and faith-based groups, in that regard. He further noted that the Government had established an enabling environment in which the issues of HIV and AIDS could be openly addressed. It was also working to scale up care and treatment along the border, to support life-based education, to ensure access to treatment to those infected and to strengthen broader health services. He voiced support for the goals of zero new infections, zero discrimination and zero AIDS-related deaths, stressing that continued research and increased financial support were essential for reaching those goals. “We must act as one global community to protect the lives of future generations,” he said.
HANIF HASSAN ALI AL QASSIM, Minister for Health of the United Arab Emirates, said that, despite the efforts of the international community, AIDS and its virus remained one of greatest health challenges facing the world today, ever since it had emerged 30 years ago. The illness was a humanitarian health threat and an economic threat, especially in less developed countries. International efforts were needed to achieve the objectives of UNAIDS, provide treatment preventing transmission and assist those living with HIV. Statistics showed that 33 million patients suffered from HIV/AIDS, and 30 million people had died since the disease had emerged. Activities must be stepped up, as laid out in the Political Declaration on AIDS. Less developed countries must be helped and provided with resources to mitigate the disease and provide proper treatment to patients suffering from the virus.
Although AIDS and the virus were not a problem in the United Arab Emirates, the country acknowledged the need to pull together efforts and to promote international cooperation and partnership, he said. The Government reiterated its commitment to deal with the problem in the Middle East and the region as a whole. The country had a national strategy to combat the epidemic and the political support to consult with all players, including the World Health Organization and UNAIDS. To control the epidemic and minimize its rates, the country promoted several mechanisms that prevented the illness, such as volunteer blood banks; the use of diagnostic tools so that the illness cannot be transmitted through blood supplies; a programme for those wishing to get married to prevent infection; and programmes promoting behavioural change to prevent the illness. The report prepared by the country’s Ministry of Health in 2010 outlined the situation concerning HIV/AIDS in the country, including care provided to positive individuals. A decree in 2010, further, underlined the need to protect human rights.
VANDA PIGNATO, Secretary of Social Inclusion of El Salvador, said that after many years of petitioning for legal recognition, different civil society organizations — particularly those representing specific at-risk groups — had finally attained recognition from her country’s current Government. Likewise, a decree had been issued against discrimination on the basis of gender and sexual orientation. Moreover, a Government office for raising the profile of sexual diversity now existed. Noting that the World Health Organization (WHO) and the United Nations Children’s Fund (UNICEF) had, in 2005, made a call for the definitive elimination of the transmission of HIV and syphilis in low- and middle-income countries, she said El Salvador had been a pioneer in implementing that strategy. Indeed, it had seen a reduction of 88 per cent of the number of children born with HIV, and a wider provision of antiretroviral therapy. The Government had also changed its outreach approach, focusing on, among other things, sexual education. It was also working to build a national response to HIV, including through the multisectoral participation of those living with HIV, as well as members of civil society.
She went on to note that the Ministers for Health of Latin America and the Caribbean had agreed on regional responses to the epidemic, including zero new infections, zero discrimination and zero AIDS-related deaths. Pointing to the Global Fund’s recognition of the transparency of projects undertaken in El Salvador, she nevertheless acknowledged that the country’s advances could be undermined if international support diminished. To that end, she called for the international community to direct efforts on HIV/AIDS through a human rights-based focus. Finally, she underscored the need to be completely inclusive to those who were marginalized, particularly those with disabilities.
ERIK SOLHEIM, Minister for the Environment and International Development of Norway, said the approaches that worked well on HIV were those based on rights and promoting peoples’ dignity, and important partners in the response were people living with the virus, as well as key populations, such as men who have sex with men, transgender persons, drug users, prisoners and sex workers. “Remarkable” results had been achieved in the last 30 years, and transforming those gains was crucial to the next phase of the HIV response. HIV/AIDS programmes should be mainstreamed into national health systems, with links to sexual and reproductive health programmes being particularly important. An integrated approach to AIDS and tuberculosis was also vital.
Women’s social, political and economic empowerment was crucial, he said, urging States to provide the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) with tools to advance women’s rights. In the declaration to be adopted, Norway would have wanted to see clearer messages on several issues to curb the epidemic, especially an acknowledgement of the importance of sexual and reproductive rights. Nonetheless, the text contained ambitious targets and he was confident that new strategies of UNAIDS and the World Health Organization (WHO) would serve as good tools to implement it. Some religious preaching had added to the burden of persons living with HIV, and Norway was disappointed that, during negotiations, representatives of faiths had not been helpful in fighting sigma, promoting dignity and addressing the needs and rights of marginalized groups.
ADAMA TRAORE, Minister for Health of Burkina Faso, said his country had a national council to fight HIV/AIDS and sexually transmitted infections, and was sharing its experiences with other countries in the region. The Government had a new strategic framework and was focused on efforts to promote a national response to the problem of HIV/AIDS. In the area of governance, Burkina Faso had a law concerning the fight against HIV/AIDS that was disseminated at all levels. On the operational level, there was an increase in the amount of locations where people could receive care. Antiretroviral treatment to individuals had increased from 26,000 people in 2009 to 31,000 in 2010. There was progress in the area of preventing mother-to-child transmission; since the end of 2010, 1,492 individuals had been trained and 92 per cent of the country’s territory covered.
Despite progress, there were significant challenges, he said. His country needed to maintain prevention programmes, eliminate mother-to-child transmission, address stigma and discrimination, create programmes targeting people aged 15 to 25, reduce the vulnerability of girls, fight against tuberculosis — since it was the main cause of death of those with HIV/AIDS in Africa — mobilize financing and address the absence of regional and subregional programmes. In conclusion, he paid homage to those living with HIV and reiterated that the Government was willing to work with all parties to find solutions.
PONMEK DALALOY, Minister for Health of the Lao People’s Democratic Republic, said that today, there was more integration in preventing and controlling communicable and non-communicable diseases, even as the identity and specificity of individual approaches remained. Since 2006, his country had reiterated its determination to establish a strong national HIV response, aiming at universal access to a comprehensive prevention, treatment, care and support programme. Among the key milestones in that effort were the establishment of a multisectoral coordination body and the adopting of a new National Strategic Action Plan on HIV/AIDS/STI 2011-2015. To monitor possible emerging epidemics, the State’s HIV surveillance system had been progressively strengthened. At the same time, its prevention programme was made more comprehensive through the launch of a 100 per cent condom initiative, as well as a national treatment programme that now had five operational centres across the country.
He also highlighted the National Assembly’s endorsement of an HIV law, as well as the integration of the domestic HIV programme into regional initiatives. His Government was thankful, he said, for financial support from the Global Fund, as well as the financial and technical assistance provided by UNAIDS, bilateral development partners and international non-governmental organizations. He acknowledged, however, that the virus continued to pose social and economic threats to the Lao People’s Democratic Republic, which was surrounded by five fast-growing neighbours. Indeed, the virus was spreading in specific population segments where transmission was especially prevalent. Current projects indicated there would be 1,000 new infections every year, with rates particularly rising among men having sex with men and intravenous drug users. That data suggested that efforts to combat the spread of HIV had to be strengthened, in terms of both coverage and the sustainability and quality of services, he said.
JOSÉ VAN-DUNEM, Minister for Health of Angola, said his country was in sub-Saharan Africa, the region most affected by HIV/AIDS. It had a population of mostly young people and was experiencing an intense phase of economic and social reconstruction. Health infrastructure was still lacking and access to basic social services had not yet reached desired levels. While the AIDS epidemic varied in profile and behaviour depending on the province, Angola was considered a low-prevalence country. Noting that the Government had gradually expanded free access to prevention, treatment, care and support, he said more than 60,000 HIV-positive adults and children had enrolled in care and support programmes, half of whom had received free antiretroviral therapy.
While Angola had rapidly expanded HIV-specific services, “we quickly realized that this is not the best way to create sustainable services”, he explained, adding that the Government was committed to integrating HIV services into existing health services, enhancing systemic response and making HIV care an essential part of primary care. Continued investment in knowledge, access to health services and education, gender equality and youth leadership, among other things, would allow Angola to ensure that no man, woman or child was infected with HIV. “We want to make sure that every girl and boy has correct knowledge about HIV and AIDS”, he said, and that pregnant women had access to services to prevent mother-to-child transmission.
NASSIROU BAKO-ARIFARI, Minister for Foreign Affairs of Benin, said his country had a low prevalence of 2 per cent, with 60,914 cases in 2010. There was a large difference between urban and rural areas, and women were the most vulnerable, reflecting a feminization of the disease, with two women for every man infected. The risk of an epidemic explosion continued to exist, considering that HIV prevalence was thought to be at 26.5 per cent for sex workers. The epidemic was the focus of the Government’s work, and a multisector committee was presided over by the President. There was also a presidential decree creating a national body that coordinated the efforts of all stakeholders. Benin had a national strategic framework, and financing was provided through budget allocations in each ministry to support the implementation of policies and measures. The Government was working with the Global Fund, the World Bank and the United Nations system, among other partners.
The country’s efforts in the fight against HIV and AIDS had allowed for greater care and treatment, as the number of people receiving antiretroviral treatment had increased from 40 to 84 per cent, and the prevention of mother-to-child transmission had also greatly improved, he said. The country’s national strategy to eliminate mother-to-child transmission and its national plan to reduce mortality among women addressed vulnerabilities among that population. In 2006, the Government had also voted in a law that fought stigma and discrimination. Personnel had been trained on the link between human rights and HIV/AIDS. Civil society, private organizations and religious organizations were participating actively in the fight. Expressing support for UNAIDS, he said progress had been made, but results were still fragile because of the lack of resources. He urged the international community to continue to support Benin, so that results would be achieved by 2015.
YIN LI, Vice Minister for Health of China, said his Government was fulfilling its commitments to halt the spread of HIV by providing universal access to prevention measures and treatment, and by eliminating social discrimination. A series of laws, regulations and policy measures had also been introduced as part of a broader mechanism to confront the disease. Through several years’ effort, the spread of the epidemic had slowed, mortality had decreased and the quality of life for those living with HIV had significantly improved.
Expressing support for the UNAIDS “three zeros” campaign, he stressed that, in order to achieve those goals, developed and developing countries needed to face their common challenge together, with the latter making HIV control as important as economic development. The private sector and relevant organizations should shoulder more social responsibility, and more resources should be mobilized. Multinational drug manufacturers should greatly reduce the costs of drugs, testing equipment and reagents. For its part, China was contributing positively to the global struggle, and planned to strengthen Government leadership, multisectoral coordination and participation by the whole society.
MARTIN DAHINDEN, Secretary of State of Switzerland, said the fight against HIV and AIDS would remain both a national and international priority for his country. While the epidemic had been stabilized on a global level, the situation in individual countries was not always as encouraging. Switzerland was working to combat its spread, focusing particularly on prevention among men having sex with men, sex workers and intravenous drug users, he noted, underscoring its positive experience working with the latter group. Indeed, the drop of infection rates among intravenous drug users demonstrated that the persons directly affected by HIV must be included in the search for solutions. In that context, he expressed Switzerland’s commitment to a human rights focus, which should be at the heart of any and all action against HIV and AIDS. The individual must have the right to decide the future of their sexual health, he emphasized.
Underlining the critical role of men and boys in the areas of sexual and reproductive health in combating HIV and AIDS, he said homophobia and other discrimination must be banned through vigorous legislation. Because young people very often did not have access to sexual education and to sexual health services adapted to their specific needs, Switzerland had, and would continue to, step up its efforts on that front, he said. He further underscored the importance of strategic partnerships among the various sectors and players in guaranteeing access to basic health services and medications, noting the private sector’s increasing awareness of its responsibilities in that regard. In addition, he stressed that mobilization must continue at the global level.
JORGE DÍAZ, Deputy Minister for Health of Chile, speaking on behalf of a delegation made up of representatives of his Government, persons living with HIV and non-governmental organizations, outlined numerous achievements in his country. Coverage of antiretroviral treatment for all who needed it was guaranteed by law, and controls had increased the survival rates of persons affected. Access to HIV testing for all pregnant women was guaranteed, and a protocol for the prevention of vertical transmission had been developed, resulting in a sharp decline in the number of children born with HIV. Regarding prevention, important progress had been made through an annual prevention campaign, with a stable budget established by law. There were new generations of adolescents and young people in Chile who were better informed about HIV and AIDS, which was an essential prerequisite for the implementation of measures of prevention and self-care in sexual health. Chile also had legislation banning discrimination, which prohibited making job recruitment, retention and access to education dependent on a person’s serostatus, and ensured that HIV testing was free, voluntary and confidential. The country was engaged in removing barriers preventing access to diagnosis and included prevention as a central strategy of its policy of comprehensive HIV/AIDS care.
Major challenges and gaps, particularly regarding preventative services, continued to exist, however, he said. Because vulnerable groups included the poor, young women, men who have sex with men, refugees, migrants and persons deprived of liberty, it was necessary to address socio-structural causes and inequalities. Diversity and different realities needed to be taken into account, and strategic alliances needed to be developed. There had to be a stronger involvement of stakeholders and mainstreaming of the topic in society. Total respect for the human rights of persons living with HIV was a duty of the State, requiring legal and political conditions to protect the most vulnerable. Chile also welcomed the creation of collective forums to combine efforts and narrow the economic gap, as well as reiterated its participation in the UNITAID mission to scale up access to treatment for HIV/AIDS, malaria and tuberculosis. Additionally, Chile highlighted the initiative of universal access to HIV/AIDS prevention, care and treatment, and expressed support for the WHO HIV strategy and UNAIDS work strategy for 2011-2015.
STEPHEN O’BRIAN, Minister for International Development of the United Kingdom, reiterated that in today’s world, no one needing HIV treatment should have to go without it. Ten years ago, it would have been hard to believe that more than 5 million people would now be on treatment, and that infection in many parts of the world would be levelling off. He called on all countries and parts of the United Nations system to deliver on their commitments to fight the evolving epidemic, noting that in many parts of the world, particularly sub-Saharan Africa, HIV remained a severe threat, particularly for women, and especially when combined with tuberculosis.
As the epidemic developed, groups on the margins of society were increasingly unable to gain access to the necessary HIV-related services due to stigma, discrimination or violence, he said. While the United Kingdom respected the right of sovereign States to make their own laws and of people to live according to their own cultural standards, the international community must make a pragmatic approach in order to make progress, on the basis of how the world actually was, not as some thought it should be. What worked was respecting human rights and ensuring access to services for all, he said, adding that his country was putting women and girls, who were particularly vulnerable, at the forefront of the struggle. The international community must better understand how to fight stigma, develop new products like micro-biocides, and keep the hope of a research breakthrough alive. A world of zero stigma, zero new infections and zero AIDS-related deaths was worth fighting for, he added.
AGUNG LAKSONO, Coordinating Minister for People’s Welfare of Indonesia, said the global community must do four things to maintain momentum of efforts to bring the epidemic under control: learn from experience; focus efforts and resources on strategically important interventions; address critical social and human rights issues that reduced access to information and services; and work in broad partnerships, bringing together the knowledge, influence and expertise of all players. He asked whether the global community, which had the necessary knowledge and technology, had the will and courage to mitigate the impact of HIV and AIDS. Indonesia had worked hard to achieve agreed-upon goals and move towards universal access. It had developed collaborative networks, increased coverage and moved towards sustainability.
He said the Government took pride in the birth of five national networks of key affected populations — HIV-positive women, people living with the virus, survivors of drug use by injection, sex workers, as well as men who have sex with men and transgender persons. In 2010, national expenditures had reached $90 million, with 49 per cent coming from domestic sources and 51 per cent from international sources, primarily the Global Fund. However, there were many challenges ahead, as too many people remained out of reach and unserved, he said. Too many were still victims of ignorance and counterproductive stigma and discrimination. Indonesia had identified three new categories to whom it would direct additional attention: girls and women, who represented the growing proportion of HIV-positive people; high-risk men, millions of whom were in the mobile workforce; and young people aged 15 to 24, who were at risk because of their lifestyles, or their involvement in sex work or drug use by injection. Without increasing prevention and services for such people, it would not be possible to bring the epidemic under control, he warned.
ALEXANDRE PADILHA, Minister for Health of Brazil, also spoke for the Foreign Policy and Global Health Initiative, saying that a public health environment free from discrimination was fundamental to universal access. Stigma and discrimination prevented people from accessing diagnoses and treatment. A gender perspective was needed in all policies and actions, and special attention must also be paid to populations vulnerable to HIV infection. Special international action, such as taking advantage of Trade-Related Aspects of Intellectual Property Rights (TRIPs) flexibilities must be taken to ensure access to affordable generic and new-generation antiretroviral and other drugs, he stressed.
The international community would fail in its battle against situations of vulnerability to HIV if it ignored them, besides failing to combat the disease if it tried to exclude such situations from its maps, he warned. In the past, global political leadership had been needed to establish the existing mechanisms for combating the epidemic, and it would take global political leadership to move forward, he emphasized. Without local production of medicines or incorporation of technology, universal access would not be sustainable. For Brazil’s part, Congress had just approved a Government initiative that would guarantee additional and permanent funding to increase contributions to UNITAID, he said.
FRANKLIN VERGARA, Minister for Health of Panama, recalled that in 2001, his Government had entered into a commitment to strengthen the response to HIV/AIDS. In 2006, it had committed to broadening that response, and remained committed to universal access, including through broadening information services, social policies and clinical care. Universal access was linked to the fulfilment of a broad array of global commitments relating to prevention, treatment, respect for human rights, reducing vulnerability, care for orphaned children, mitigating social and economic effects, research and development, resource mobilization and monitoring and evaluation. One of the best indicators of Panama’s work was its expenditure on HIV/AIDS, which had nearly doubled since 2002, rising from $14 million to more than $21 million, he said.
However, the country could and must do more to increase that expenditure and ensure cost efficiency so that State commitments could be backed by resources, he continued. Panama had promoted HIV testing, making it available to pregnant women with a view to reducing mother-to-child transmission. Over the past five years, the percentage of pregnant women being tested had exceeded 75 per cent, preventing infections among newborns. Young people, the indigenous population, sex workers and men who have sex with men also remained vulnerable, he said. In addition, 12 per cent of people aged 15 to 49 had been tested and received the results. However, a great deal of work remained to be done, he said, noting that the sex workers and men who have sex with other men were the most exposed, and stressing that more must be done to broaden their access. A national study had been conducted to obtain information in order better to target those groups.
YASMINA BADDOU, Minister for Health for Morocco, said that over the past two decades, her country had taken steps to fight HIV/AIDS, extending support for patient care. Despite Morocco’s low HIV incidence, at less than 0.1 per cent, the rate of infection among at-risk groups remained high. The low prevalence was due to constant vigilance and joint Government action with civil society and international organizations, she said.
The National Strategic Plan enabled universal access to prevention, treatment and support, she said, adding that it had achieved important results, particularly among high-risk groups. The budget for implementing the Plan was estimated at about $47.76 million, 31 per cent of which had been contributed by the Global Fund. Emphasizing that the global fight against HIV/AIDS depended on international solidarity, the sharing of experiences among Member States and the development of best practices, she said those elements must be decisive in meeting the goals of the “three zeros” by 2015.
SANDA SOUMANA, Minister for Health of Niger, discussing at-risk groups in his country, said the Government had created a national council in 2002 to combat HIV/AIDS. In 2004, the Government had initiated antiretroviral treatment and there had been progress in preventing mother-to-child transmission, he said, adding that operational centres dealing with that aspect were located across the country. Niger was also focused on combating stigmatization. In 2007, a law on prevention had been adopted. Assistance was provided for vulnerable groups, in particular widows and orphans, thanks to financing from the World Bank and International Monetary Fund (IMF), he said.
However, it was difficult to achieve results as civil society had lagged and only the public sector had been taking action, he said. There were also difficulties in providing medicine, and a need for health-care training, though significant political commitments had led to new hope for continuing free antiretroviral treatment. The Government hoped to establish a system of levying taxes on luxury goods, he said, adding that plans were in place for an evaluation system and to ensure that data collection continued. Niger was also planning a national, multisector plan and round table to mobilize resources.
ZAINAB HAWA BANGURA, Minister for Health and Sanitation of Sierra Leone, said her country had a five-pillar approach to fighting HIV/AIDS. The pillars were “know your epidemic”, a final joint programme review of the 2006-2010 National Strategic Plan on HIV and AIDS, developing a national strategic plan for the years 2011-2015, developing a national monitoring and evaluation plan for the period 2011-2015 and developing a two-year operational plan for the 2011-2015 period.
She went on to say that her country’s health-care infrastructure was overstretched and characterized by a shortage of skilled health-care personnel, which had left Sierra Leone struggling to reach high-risk groups. Sustaining whatever gains had been made so far required resources well beyond the capabilities of the country’s small economy, she said, adding that it needed sustained support from partners in order to realize Millennium Development Goal 6. Sierra Leone’s needs should not be assessed on the basis of its HIV prevalence, but rather on the structures and initiatives it had put in place, she said.
MARIA ADIATU DJALÓ NANDIGNA, Minister for the Presidency, Parliamentary Affairs and Social Communication of Guinea-Bissau, said her country had reduced the number of new infections by 25 per cent, and the great challenge it faced was expediting action and consolidating antiretroviral treatment. Its new approach focused on the “three zeros”, in line with the international context, she said, adding that it entailed providing universal access, reducing the impact of HIV and AIDS, and reforming coordination efforts. Guinea-Bissau had achieved positive results in terms of prevention, and the rate of contraception use had grown. The Government reached out to marginalized groups, such as sex workers, and hundreds of community agents were under training. Hundreds of pregnant women had been helped to reduce mother-to-child transmission, the survival rate among the infected had risen and thousands of people had received clinical treatment, she said, adding that orphans and children received free care.
Despite those encouraging results, much remained to be done, she said, noting that financial programmes must be implemented and vertical transmission prevented. There had been positive results in two treatment centres, where only 2 out of 200 children of HIV-positive mothers had been infected with the virus. There was a need to ensure the safety of blood transfusions and to develop external quality controls. Sex professionals, youth, drivers and uniformed personnel all remained vulnerable, and the Government needed financing to fulfil its commitments, she said, pledging that her country would continue adhering to regional agreements and building upon the successes realized to date as a result of international cooperation within the United Nations system.
ANDRÉ MAMA FOUDA, Minister for Public Health of Cameroon, said his country had a 5.1 per cent prevalence rate and remained in a situation of widespread epidemic. In 2010, there had been 33,000 AIDS-related deaths, and in spite of awareness-raising, 2011 had seen 50,000 new HIV infections, he said, adding that some 305,000 children had been orphaned. In response, the Government had made the fight against HIV/AIDS a national priority, and the National Strategic Plan had made it possible to obtain positive results.
Thanks to support from the United Nations Educational, Scientific and Cultural Organization (UNESCO), 760 schools had been provided with HIV education as part of the school curriculum for 2009-2010, he said, adding that significant efforts had been exerted to make contraceptives available. An annual average of 20 million contraceptives had been distributed, and the number of female contraceptives given out had increased six-fold. The Government had established a framework to cover the next five years, he said. Under the slogan “Mobilization for an AIDS-free generation”, Cameroon would work towards universal access and realizing the relevant Millennium Development Goals.
WILLMOTH DANIEL, Minister for Health, Social Transformation and Consumer Affairs of Antigua and Barbuda, said that an unprecedented international, broad-based approach had contributed in no small way to arresting the spread of HIV and AIDS. Endorsing the statement made yesterday on behalf of the Caribbean Community (CARICOM), he noted the high prevalence of HIV and AIDS in the region, as well as the progress made there, in particular the stabilization of the prevalence rate and the decline in the number of new infections. Still, an estimated 17,000 people in the region had been infected in 2009 and the battle was far from over, he cautioned. There was now an emphasis on securing long-term and sustainable financing, so as to avoid a reversal of the gains made.
He called on the international community to work with the CARICOM countries in scaling up universal access to treatment, breaking the tragedy of high-cost treatments, promoting innovation and technology transfer and bolstering country ownership through new values and shared responsibility. Antigua and Barbuda had made the necessary investments to strengthen its health systems, he said. It had been able to achieve zero mother-to-child transmissions, increase education on condom use in schools and provide employment opportunities for those living with HIV. However, the country was still in need of simple, inexpensive diagnostics and medication that it could make available to those most affected.
YUTAKA BANNO, State Secretary for Foreign Affairs of Japan, said that under his country’s national health programme, effective health and medical systems had been established by locating health-care facilities throughout the nation and developing health human resources such as doctors, nurses and pharmacists. Japan had also realized universal medical-care insurance to enable everyone to gain access to sufficient services. Those efforts had contributed to a mother-to-child transmission incidence of less than 1 per cent, he said, adding that Japan would share its experiences with the international community.
Reaffirming Japan’s “promise to the next generation”, announced by Prime Minister Naoto Kan at last September’s High-Level Meeting on the Millennium Development Goals, he said the country would provide $5 million in assistance over five years, beginning in 2011, in contributions to the realization of health-related Millennium Goals, particularly in those areas where progress had been slow. Further, Japan had pledged to make an $800 million contribution to the Global Fund in the coming years. Noting Japan’s active bilateral and multilateral support for the efforts of developing countries, he expressed his country’s deep gratitude to the international community for its support following the “unprecedented disaster” arising out of the Great East Japan earthquake in March. “I have to tell you that the people of Japan are firmly stepping forward to rehabilitate disaster-affected regions with your kind support,” he said.
ADAM FRONCZAK, Under-Secretary of State in the Ministry of Health of Poland, said his country’s efforts to maintain effective, equitable and sustainable responses to HIV must be based on a stable and coherent State strategy, independent of political influences. The Polish policy had been developed in accordance with the “three zeroes” recommendations and the multisectoral response. Its creation had involved Government ministries, people living with and affected by HIV, international partners and the private sector.
Since 2001, the Ministry of Health had offered antiretroviral therapy to every patient who fulfilled the necessary medical criteria, he said. Thanks to that strategy, Poland had achieved a significant decrease in the number of AIDS cases, and HIV patients were living longer and enjoying a higher quality of life, which enabled them to re-establish their social and family roles. Still, the country was struggling to secure the continuous universal access and accurate preventive measures that would enable it to continue confronting the changing epidemiological trends, he said, adding that its actions were focused on protecting human rights and eradicating stigma and discrimination.
KARIN JOHANSSON, State Secretary in the Ministry of Health and Social Affairs of Sweden, said that in the decade ahead, the most strategic choice the international community could make towards comprehensively tackling the HIV/AIDS pandemic would be to focus on young people. Indeed, even though they made up half the world’s population, their needs were sorely neglected. Investing in future generations was one of Sweden’s top priorities, and evidence-based prevention was the only way to reach the goal of zero new infections. Young people should have access to comprehensive sex education so they could make informed choices. “For the youngest, it’s about getting to know how the body works and understanding the concept of physical integrity,” she said, adding that, for teenagers and others, empowerment was the key, as well as ensuring that they were at ease with raising the issue of condom use in intimate situations with a partner.
She said her country also believed that young people must be involved in the development of sexual and reproductive health services and information. Indeed, there was no better way to empower and enable them to protect themselves and others. Human rights, of which sexual and reproductive health rights were an integral part, were a prerequisite for HIV prevention and treatment. In that regard, criminalization of homosexuality was a violation of human rights, as were laws that discriminated against HIV-positive individuals. Whenever human rights were not respected and protected, or were violated, stigma increased and prevention and care efforts were undermined, she said, calling for an end to discrimination and more efforts to meet the needs of HIV-positive young people.
MOHSEN ALI FARIS EL-HAZMI, Member of the Majlis Ash Shura of Saudi Arabia, noting the harm caused by the HIV/AIDS epidemic, said that the UNAIDS programme focusing on the three zeros had laid out a road map, which his Government hoped to see implemented. The cornerstone of efforts to eliminate HIV/AIDS was prevention, treatment and ensuring reintegration. In Saudi Arabia, the prevalence of the infection among the population of foreign workers was three times higher than among Saudi citizens, so the Government had developed a comprehensive strategy, with the participation of governmental leaders in implementing it. In order to curb the pandemic, the Government focused on strengthening prevention efforts through launching education and awareness campaigns, medical surveys and research. Responsible sexual conduct among those groups most at risk was encouraged, and prenatal screening and examinations of pregnant women were carried out.
He said the country attributed great importance to moral undertakings, and religious leaders were drawn upon to raise awareness and strengthen efforts and protection based on Islamic Sharia through the practice of abstinence, chastity and prohibition of sexual relations outside of the marital context. The Government worked to combat stigmatization of HIV through monitoring programmes. Saudi Arabia had halted the entry of infected individuals, set up treatment centres and supported research efforts. It was coordinating efforts of its Ministries, as well as working with UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. It had made donations to the Global Fund. Saudi Arabia respected the commitments made and welcomed all efforts to combat HIV/AIDS.
DAVID LOZADA JR, Under-Secretary in the Department of Health of the Philippines, noted that the global community was expected to implement revolutionary strategies for an AIDS-free world as his country and six others faced challenges similar to those prevailing during the early years of the epidemic, when high-prevalence countries had struggled to reduce the impact of the then-rapidly spreading disease. He contrasted that with at least 33 other countries that had been able to reduce their HIV incidence by 25 per cent between 2001 and 2009, noting that such efforts to reduce the burden were generally believed to be consistent with targeted outcomes.
He said it was important that the accumulated experience to reverse the trends of the past 30 years be shared with similarly affected countries, which today struggled from inadequate resources to sustain universal access and eliminate discrimination. While following a “best practice approach” model was advantageous, HIV was a chronic illness with acute life-threatening complications at later stages, which meant no country was exempt from having to cope with significant numbers of afflicted persons. That was true despite the zero strategy and gains achieved from universal access. It should also be recognized that factors that influenced the evolution of the epidemic remained complex, as they could also influence other developmental issues, such as poverty and sustainable development. It was paramount that a zero strategy be sound and realistic, given the evolving epidemiology of the disease, the emergence of new technology to halt its spread, and the collective effort to end the epidemic altogether.
CALLISTA MUTHARIKA, First Lady of Malawi, said she had been appointed as the Coordinator of Safe Motherhood, Nutrition, HIV and AIDS, including preventing mother-to-child transmission. In recent years, Malawi had raised $300 million, which had helped to decrease new infections, reduce HIV prevalence and increase HIV testing. Now, 100 per cent of HIV-positive pregnant women were attending antenatal clinics to receive a complete dose of antiretroviral prophylaxis. Health systems were being strengthened, with 2,800 health workers and 5,300 front-line health workers trained and retrained.
Additionally, she noted, more than 35,000 households with orphans and vulnerable children were receiving social support, and some 240,000 had benefited from direct-cash transfer. Still, Malawi faced inadequate financial and human resources, insufficient capacity to track clients on antiretroviral therapy to ensure adherence and low community and male participation in the national response. To address that, the new HIV and AIDS policy should be reviewed and finalized and its resources strategy mobilized. Additionally, efforts towards local production of antiretroviral drugs must be advanced.
LUIS ESTRUCH RANCAÑO, Deputy Minister for Public Health of Cuba, said that with the HIV/AIDS epidemic having afflicted 60 million people worldwide, no country in the world had escaped its effects. Cuba had been proactively involved in the negotiation and adoption of the Political Declaration on HIV/AIDS and had complied with its duties. In Cuba, mother-to-child transmission of HIV had been eliminated and blood-borne transmission of the virus had been controlled. The estimated HIV prevalence was low among the population aged 15 to 49 years, pregnant women and people with sexually transmitted diseases. The treatment programme initiated in 2001 had greatly impacted AIDS incidence and mortality, with over 90 per cent of patients in treatment remaining alive. Civil society had also been a driving force, giving rise to strong activism in health-care centres, scientific institutions and community organizations. The proportion of the population using condoms, mostly youth, had increased. Additionally, Cuba had developed a high-cost comprehensive health-care programme, together with international agencies and the Global Fund. It boasted its own technological and biological products, through which it conducted some 2 million HIV tests yearly.
He said that Member States had committed themselves to achieving universal access to HIV prevention and treatment, but the achievements had been insufficient. Stigma, discrimination and gender inequality hindered efforts, and the rise in costs prevented sustainability in low- and middle-income countries. Cuba, although subjected to a blockade by the United States, had fulfilled its commitment to ensuring universal access to HIV care and treatment. The health-care system guaranteed the access of the entire population to services. Conditions had also been created for the development of educational interventions, access to diagnostic tests and compilation of information for the monitoring, evaluation, treatment and follow-up care of those affected. It was the responsibility of the international community to renew political commitment and expedite actions to halt and reduce the spread of the virus, however, as international cooperation was the only path to sustainable solutions.
MOHAMMAD HOSSEIN NIKNAM, Acting Health Minister of Iran, said that strengthening overall health infrastructure was a prerequisite for a successful and replicable response to HIV/AIDS. In the absence of a well-functioning and vast primary health-care network, it was unlikely that comprehensive and integrated services for controlling the epidemic would ever become a reality. In any case, a successful response must take fully into account the socio-cultural circumstances and cultural sensitivities of the respective communities in which they were carried out, he said. “In this regard, the role of the family in reducing risky behaviours, especially among young people, should be emphasized.”
As for Iran’s national response, he said the Government had developed a strategic plan that addressed the specific needs of the general population, as well as targeted at-risk groups, including those living with or affected by HIV and AIDS. Iran’s national strategic plan focused on providing age-appropriate information and education, voluntary counselling and testing, reducing harm, and HIV care and treatment. The Health Ministry, working closely with members of the National AIDS Control Task Force, had rolled out comprehensive programmes to achieve the goals of the national strategic plan — universal access to prevention, care, treatment and support. Iran’s activities also included establishing drop-in centres, launching outreach programmes and peer-group education initiatives, as well as establishing counselling and harm-reduction centres for vulnerable women.
VERONIKA SKVORTSOVA, Deputy Minister for Health and Social Development of the Russian Federation, said her country’s main priority in combating HIV infection was enhancing the multisectoral programme for primary prevention and promoting healthy lifestyles with the aim of motivating people consciously to give up risky behaviour patterns. Of particular importance were measures to prevent HIV infection among groups at high risk, including those engaging in risky behaviour, she said. In order to motivate them to accept voluntary HIV testing, systematic treatment, counselling and social support, the Government cooperated actively with civil society, non-governmental and religious organizations.
Putting it all in context, she said the annual coverage of the population, particularly at-risk groups, by voluntary HIV testing was 22 million to 25 million people, or 15 to 17 per cent of the total population. Besides prevention services, the Government provided free antiretroviral drugs to all who needed them. To that end, Government budgetary allocations for universal access for HIV-positive people to dispensary observation and treatment had increased six-fold, amounting to more than $1.3 billion. In line with the international commitments adopted by the G-8, the Russian Federation had been an active contributor to the strengthening of international efforts to combat HIV infection and improve access to treatment, she said, recalling that, since 2006, her country had contributed some $317 million to the Global Fund and was now increasing that support.
ZARELA SOLÍS, Deputy Minister for Health of Peru, said the HIV/AIDS situation in her country remained at epidemic level, with sexual transmission constituting about 97 per cent of all infections. The prevalence among men who have sex with men was 13 per cent, she said, adding that it stood at 30 per cent among the transgender population. Many of those infected were quite young, which indicated that most cases were acquired in the teen years or in young adulthood, she said, noting that the prevalence rate among pregnant women was 0.23 per cent.
In the past six years however, there had been a decline in both the number of HIV cases and in AIDS-related mortality, she said. Peru had developed norms and polices aimed at preventing vertical transmission, and there had been tangible improvements in the number of screening tests for pregnant women, which was currently over 80 per cent. Peru needed to redouble its efforts to improve the interaction between the Health Ministry and other sectors, she said, adding that so far, that coordination, along with an increase in resources, had contributed to improving the efficacy of interventions to prevent infection and treat the population.
EDGAR GIMÉNEZ, Deputy Minister for Public Health of Paraguay, said there had been progress in his country to defeat HIV/AIDS, based on a consolidated national response, which had improved financing and coordinated sectors. The Ministry of Public Health was leading that national response, which incorporated the strategy for primary health care and worked with professionals in hospitals and family health units. New care centres were established to diagnose and provide early treatment. Diagnostic testing was available for the whole population, based on the consent of the individual. A strategy of peer education had been implemented, and measures were aimed at vulnerable groups. The number of testing centres had increased, which also increased the number of women using them. Legislation had been developed regarding the rights of individuals with HIV/AIDS. The budget had been increased for the purchase of medications included on the national list of essential medications. In all that, civil society organizations had been crucial.
He said that the increased access for individuals living with HIV/AIDS had led to their survival and better quality of life, as well as to reduced mother-to- child transmission. However, while progress had been significant, there were still gaps, as well as stigma and discrimination. Paraguay was developing new strategies to help strengthen the health system and to introduce management tools to better implement the necessary actions. Much needed to be done to develop appropriate human resources and ensure universal coverage. Partnership was crucial, such as regional integration to address the high costs of essential medications.
DAGVADORJ ORCHIBAT, Member of Parliament from Mongolia, said the HIV prevalence rate remained low in his country due to strengthened political commitment and continuous Government action. However, despite the decline in global HIV incidence, the epidemic continued to accelerate in some low-prevalence countries, including Mongolia, he noted, urging the international community to mobilize increased investment for countries currently reporting low-level epidemics in times of declining international funding for responses to HIV.
Expressing support for the “three zeros” campaign, he pledged that his country’s Government would work towards zero vertical transmission of HIV and zero new infections resulting from blood transfusions. Additionally, Mongolia would work to eliminate gender inequalities through an amended law on the prevention of HIV/AIDS, while continuously increasing the required financial resources within its national budget. A week before this week’s Meeting, he recalled, Mongolia, United Nations agencies, and other stakeholders had organized the Fifth National Forum on HIV/AIDS, which had played a crucial role in reviewing the current standing of national responses to HIV/AIDS and the progress made on Millennium Development Goal 6.
SERGEY KHACHATRYAN, Deputy Minister of Health Care of Armenia, said that the country had instituted several programmes and changes. In 2010, it had started a healthy lifestyle training course in the curriculum of its secondary schools to promote HIV knowledge among youth. Harm reduction programmes targeting at-risk populations and youth had stabilized the epidemic by raising awareness. The HIV epidemic remained constant in Armenia, but the country was located in a region where that rate increased as a result of labour exchanges. The cases that were registered in Armenia were connected to immigration, as half of those infected were labour workers who contracted the disease outside of the country.
He said the number of HIV tests performed in the country had increased and detection had improved. The Global Fund had provided unique support, and antiretroviral drug treatment and programmes to prevent mother-to-child transmission were available. All women had access to those services, more than 95 per cent of the women who needed consultations were receiving them. Further scaling up was needed to help reach the common goal, namely, the elimination of transmission. It was also important to make the lives of those with HIV/AIDS as comfortable as possible and to remove restrictive barriers. Armenia was hopeful that institutions like the Global Fund would continue to play an active role, because global solidarity was the key to fighting the disease. Finally, the Government expressed confidence that the Meeting would establish a road map that included affordable care and holistic support.
MARINA KOSACOFF, Under-Secretary for Prevention and Risk Control in the Ministry of Health of Argentina, said her country had made significant progress in responding to the HIV/AIDS epidemic. There were now some 130,000 people living with HIV in Argentina. Treatment was free, and 43,000 patients were receiving it. Of that figure, 70 per cent received medication directly from the National Ministry of Health. The rate of new infections had stabilized. AIDS-related deaths had dropped 15 per cent in the last five years. Argentina had implemented a comprehensive education programme to promote prevention, and sexual and reproductive health services were offered for people living with HIV, including women, children, sex workers and their clients, transgender people, men who have sex with men, prison inmates, drug users, indigenous communities and migrants.
She said that Argentina’s same-sex marriage law was a pioneering piece of legislation in the region. This year, the Argentine Senate would discuss a series of initiatives on gender identity laws that would facilitate health-care access for transvestite, transsexual and transgender populations. It would also discuss legislative proposals concerning drug use. She called on Latin American nations to continue collaborating to negotiate prices for drugs to treat HIV and to ensure that they reached those in need. She urged international donors to help the region achieve the Millennium Development Goals. It was important to effectively implement the Doha Declaration on the Trade-Related Aspects of Intellectual Property Rights (TRIPs), particularly paragraph 4, which stated that the agreement did not prevent and must not prevent members from taking measures to protect public health.
MARÍA RUBIALES DE CHAMORRO, Deputy Foreign Minister of Nicaragua, said her country was committed to the protection and promotion of people’s rights, as well as free access to health services and the restoration of other human rights. Social exclusion encouraged by the recent Government had “castrated” many aspects of the human rights of the people of Nicaragua, and increased poverty, leading to greater deterioration of living conditions, which, in turn, favoured the spread of epidemics such as HIV/AIDS. A “concentrated epidemic” persisted in Nicaragua, stemming from sexual transmission. The epidemic was also increasingly affecting women.
She said the country aimed to promote healthy behaviour for the prevention of HIV/AIDS among adolescents, young people, women and other key population groups. Communications professionals should be employed in order to relay the necessary messages, as well as to promote human rights and fight against stigmatization and discrimination. The challenges of the coming years would be to improve medical care, thereby enhancing overall quality of life for people with HIV, and to facilitate their re-entry into the labour market, as well as to provide access to housing. Those challenges would be taken up within a framework guided by dedication, love and dignity.
GEORGE TSERETELI, Deputy Chairman of the Parliament of Georgia, said his country had become, and remained, the only one in its region that had ensured universal access to antiretroviral treatment. By expanding those programmes, it had been able to provide the lifesaving treatment to the entire country. Georgia had also ensured universal access to services, including HIV testing, counselling and prophylactic antiretroviral therapy. As a result, there were no new cases of mother-to-child transmission among those enrolled in the programme, he said.
While Georgia was a low-prevalence country, intensive migration trends in the region placed the country at high risk for the expansion of HIV infection, making international and regional cooperation a very important factor in limiting that threat. Parliamentary, intergovernmental and professional networks served as good bases for such cooperation, he said, noting that one of the keys to Georgia’s successes was its innovative approach to interventions, including the establishment of palliative care and the implementation of home-based antiretroviral adherence support programmes. First Lady Sandra Roelofs had recently been appointed a WHO Goodwill Ambassador for health-related non-governmental organizations, he said, adding that the move would foster new opportunities for strengthening effort, not only in Georgia, but also in the entire region.
AHMED MOHAMED ABDEL HALIM (Egypt) said the elimination of HIV infection required that special attention be given to strengthening national capacities, particularly of African States, to take into account the specific community and social aspects of each State in order to enhance efforts for prevention. That would also strengthen the ability to implement national awareness campaigns to address harmful traditional practices, reduce risk behaviour and encourage responsible practices with regard to sexual activity.
He said the international community had a responsibility, not only to provide the necessary financial resources, but to find radical solutions to the problems of trade-related intellectual property, especially regarding medicine and vaccines. The spread of HIV often was caused by poverty and underdevelopment, and therefore successful elimination of the infection required a successful sustainable development process where support was given to develop infrastructure and economic, educational and social systems. The transfer of knowledge and technology also was crucial in that effort. Also instrumental to curb the spread of infection was combating illicit drug trafficking, decreasing gender inequalities and working to eliminate all forms of violence against and exploitation of women.
PATRICE DEBRÉ, AIDS Ambassador of France, said his country had waged a considerable battle against the disease over the last 30 years, and it must continue. The rate of new HIV infections and transmissions was still too high, and the global community must not halt its efforts at the halfway mark. It must ensure universal access for all, so as to achieve the goal of zero new infections. Women and children were most affected and their rights must be guaranteed, he said, stressing the importance of outreach to drug users, sex workers and men who have sex with men. Additionally, the outcome document to be adopted on Friday should call for the decriminalization of homosexuality, he said.
Too often, HIV/AIDS and other health-care plans did not target vulnerable groups, he continued, emphasizing that programmes for preventing mother-to-child transmission must be well integrated into all health-care efforts. It was also important to continue the search for an HIV vaccine, he said. Treatment must be provided systematically, and financing for treatment and prevention must be bolstered and new financing methods found. To that end, France would increase its contribution by €60 million annually, he said, encouraging other countries also to bolster funding. He added that France supported the creation of an airplane ticket tax to fund treatment. Noting that the high cost of drugs was often a major obstacle to treatment, he stressed that organizations including WHO, UNAIDS, the Global Fund and others must act together. The struggle against HIV and AIDS was a collective responsibility, and there would be no progress without real political will, he added, reiterating France’s commitment to the struggle.
RAINER ENGELHARDT, Assistant Deputy Minister, Infectious Diseases Prevention and Control Branch, Public Health Agency of Canada, said that despite many successes in the battle against the pandemic, many political, social, economic and scientific challenges remained. Moreover, the progress made was not evenly distributed, and universal access to prevention, treatment, care and support remained out of reach for many countries and certain populations. Canada was committed to achieving universal access, and recognized that getting there required a comprehensive, integrated and coordinated response to HIV and AIDS, he said, stressing that such a response must be founded on actions that were evidence-based and sensitive to diversity, respect for human rights and gender equality. “The value of local knowledge, lived experiences and meaningful inclusion of people living with HIV/AIDS is vital to achieving success.”
By working with partners and aligning with developing-country Governments, Canada was fighting the pandemic in a harmonized way so as to more efficiently reach those most affected, he continued. The Government, which had provided more than $780 million to support programmes in developing countries, recognized that prevention remained the most effective tool to address HIV/AIDS. “Finding more effective methods of prevention is the best way to mitigate the human and financial costs of the epidemic,” he said, stressing in that vein that the Canadian Government was investing in new prevention methods. It was also strongly backing the development of a safe, effective, affordable and globally accessible HIV vaccine through its Canadian HIV Vaccine Initiative. Additionally, Canada was examining the ways in which social, cultural and economic factors could make some people more vulnerable to HIV infection than others, and how those factors could affect the quality of life for people living with the disease.
HASAN ABDUL RAHMAN, Director-General of Health of Malaysia, emphasized that stopping and reversing the epidemic required progress in all the world’s regions. While the burden of HIV/AIDS fell disproportionately on developing countries, the responsibility for combating it fell on all nations. The majority of those infected with HIV faced barriers in obtaining affordable life-prolonging drugs, he said, stressing that access should not be restricted by trade- and patent-related issues. Outlining his country’s current HIV incidence, he noted a consistent downwards trend in newly reported cases. In 2010, the figure had stood at 12.8 per 100,000, and the Government aimed to reduce it to 11 per 100,000 by 2015. Malaysia’s most recent National Strategic Plan on HIV and AIDS placed strong emphasis on strengthening the multisectoral collaboration undertaken under the previous plan, although an estimated $170 million in additional funding would be needed for its implementation, he said.
Highlighting the steps that had proven successful in his country, he said they included a harm-reduction initiative aimed at intravenous drug users, which included a syringe exchange programme and methadone substitution therapy; a national mother-to-child transmission prevention initiative; and expanded provision of, and access to, antiretroviral therapies, including for people living with HIV in prisons and drug rehabilitation centres. Malaysia was working to surmount challenges related to other, most at-risk populations, including men who have sex with men, sex workers and transgender persons, by partnering with non-governmental organizations. He emphasized that young people must be provided with correct and useful information on HIV and AIDS while at school, and even out of school, noting that the information must promote healthy lifestyles and good moral values.
ALEXIS GUILARTE, Director-General of Health Programmes, Ministry of the People’s Power for Health of Venezuela, said his country’s national response to HIV and AIDS was organized around prevention, care and epidemiological vigilance. Outlining current national statistics on the epidemic, he said 11,000 new cases were reported annually, of which 70 per cent occurred in people over 15 years of age. In 2008, 1,632 people had died from diseases attributable to HIV, he said, pointing out that while the trend in mortality had been rising since 1982, it had recently tended to stabilize at an average of 5.84 deaths per 100,000 people.
Emphasizing that universal access to treatment was an operational reality in his country, he noted in particular that all pregnant women living with HIV had access to antiretroviral drugs so as to prevent vertical transmission. Venezuela’s investment in antiretroviral therapy for 2010 was approximately $64 million, representing 2 per cent of the Health Ministry’s annual budget. Noting that the national response to HIV and AIDS included the constant participation of civil society and persons living with HIV, he emphasized that the inclusive approach in national plans and policies was aimed at eliminating stigma and discrimination. The national action plan for 2011-2015 aimed, among other things, to strengthen monitoring and evaluation systems while boosting the quality of treatment, care and support services for people living with HIV.
OLEKSANDR FEDKO, Head of the State Department for Countering HIV/AIDS and Other Socially Dangerous Diseases of Ukraine, said the President had created the Department in 2010, which was evidence of the country’s commitment to fighting the epidemic. It had adopted a national HIV/AIDS strategy and the Government had made it a priority to bolster measures to prevent the epidemic’s spread while providing treatment to those living with HIV. In January 2011, a law to overcome the spread of HIV and provide legal and social protection to those living with HIV had entered into force, he said, adding that civil society had also contributed significantly to the fight against AIDS.
Five years ago, Ukraine had had the highest rate of HIV transmission in Eastern Europe, he recalled, noting that today, it was in fifth place. The country had made significant progress in preventing mother-to-child transmissions, which was a priority of the national response to AIDS. However, new infections were still on the rise, and a further consolidation of efforts to fight the disease was needed. Ukraine supported the “getting to zero” strategy and the “countdown to zero” global plan aimed at preventing new cases of HIV infection among children and saving mothers’ lives, as well as the outcome document to be adopted on Friday.
MUSTAPHA EL-NAKIB, Director of the National AIDS Programme of Lebanon, reiterated his country’s commitment to the fight, noting that it was working to provide coverage for all citizens living with HIV. Full coverage was also extended to Palestinian refugees living in Lebanon, he said, adding that the Government was still trying to provide coverage for other nationalities living in the country. The National AIDS Programme worked under the Ministry of Health, in cooperation with WHO, and with a special budget set aside for that programme.
Lebanon’s response to HIV and AIDS was not limited to Government efforts, he continued. In fact, the active participation of non-governmental organizations and civil society was critical to the Government’s efforts and it was working with a network of non-governmental organizations in a number of areas, particularly in reaching the most marginalized people. The Government was also trying to overcome all barriers to, and to reduce all forms of discrimination and stigma against, the most at-risk populations. He noted that representatives of men who have sex with men as well as drug users had been included in those efforts. Moreover, the Government had established a committee of social and medical specialists to develop practical plans and protocols for those at-risk groups, he said, adding that a volunteer testing programme had also been established.
GABRIEL THIMOTHÉ, Director-General for Public Health and Population of Haiti, said political will was needed to support the cross-cutting global response to AIDS. The disease was still a generalized epidemic, with a 2.2 per cent prevalence rate, he noted, adding that since HIV disproportionately affected women, mother-to-child transmissions were on the rise. Haiti’s recent earthquake and cholera outbreak had exacerbated the country’s woes and made it more difficult to fight the epidemic. Nevertheless, the Government was taking comprehensive steps to combat the disease, he said, recalling that in 2010, the number of people tested for HIV had risen to more than 431,000, and a total of 125 voluntary HIV testing sites were in operation. The number of women undergoing testing in prenatal clinics had also increased, he added.
To guarantee quality health-care for people living with HIV, the Government had established a monitoring model in 2008, he continued. Prevention strategies had been enhanced, particularly to target young people, sex workers and men who have sex with men. Popular theatre, among other communications strategies, was being used to ensure that people understood their rights vis-à-vis HIV/AIDS, he said. However, major challenges remained despite the significant progress made. It was necessary to improve the quality of services and ensure universal access to treatment. Decentralizing interventions was an imperative, he said, adding that a draft law on AIDS would be submitted to Parliament.
PEDRO SERRANO, Acting Head of the Delegation of the European Union, said the bloc provided more than 30 per cent of global funding against HIV to low- and middle-income countries, and was proud to have contributed to the achievements of the last 10 years. However, there was no room for complacency despite recent successes, he said, emphasizing that the epidemic remained a global challenge requiring continued political commitment and a sustained, long-term response. Prevention was the key to building a world with zero new HIV infections, and the epidemic’s main drivers must be identified and addressed. In that regard, a comprehensive approach was needed to address, for example, harmful gender norms, gender-based violence and poverty.
Moreover, gender equality and the empowerment of women were central to fighting HIV, he continued, stressing that maternal and newborn health must be strengthened. There was also a need for access, for boys and girls, to sexual education as well as male and female condoms. Inadequate attention was paid to the prevention needs of key at-risk populations — particularly men who have sex with men, intravenous drug users, as well as sex workers and their clients — and the world would not be able sharply to lower HIV transmission rates if that did not change, he warned. Furthermore, there was an urgent need to scale up efforts to strengthen health systems. Long-term, sustainable health-financing policies were needed to increase the number of people accessing prevention, treatment, care and support programmes, as well as to ensure that the poorest and most affected were reached, he said, adding that previous commitments must also be honoured.
FEDERICO ALBERTO CUELLO CAMILO (Dominican Republic) said 80 per cent of all HIV cases in the Caribbean were to be found in his country. As such, it was very important to increase national and international efforts to create effective mechanisms that would help stem the epidemic’s spread. Special attention was needed for high-risk populations such as sex workers, intravenous drug users and people working in sugarcane fields, among others. In recognition of the importance of respecting the human rights of people living with HIV, the Dominican Congress had approved an HIV/AIDS bill in May, he said, adding that, once signed by the President, it would repeal previous laws, while guaranteeing treatment for people living with HIV and AIDS.
The Government was taking steps to end discrimination in the workplace for people living with HIV and AIDS, in line with recommendation 200, adopted by the International Labour Organization (ILO) in 2010, he said. Since 2006, the Dominican Republic had had a national policy for children orphaned or left vulnerable because of HIV and AIDS, he said, adding that the Ministry of Education had taken steps to implement sex education policies. Since 2008, the number of people living with HIV who had received antiretroviral therapies had risen, which was helping to prevent mother-to-child transmission. The national social security system provided benefits to 7,000 people living with HIV and AIDS, and the Government was working with its Haitian counterpart to design binational responses to HIV and AIDS, he said.
NARCÍS CASAL DE FONSDEVIELA (Andorra) said it was necessary to continue creating partnerships between stakeholders and raising awareness among youth and young adults in order to mobilize them. Andorra continued to do everything possible to contribute positively to the struggle against HIV and ensure the success of prevention and treatment programmes, he said. It had eliminated the requirement for medical tests, including for HIV in persons wishing to live in Andorra, thereby doing away with possible discrimination against people living with HIV and AIDS. Care for AIDS patients was managed through a free health-care system, he added. Regarding education and schools, he said the country had held educational activities in all schools on preventing HIV and other sexually transmitted diseases. Andorra had also contributed to programmes in Africa and Latin America, by providing psychological care for AIDS orphans, among other measures.
GRÉTA GUNNARSDÓTTIR (Iceland) said her country was witnessing a steady increase in HIV infections, due mainly to intravenous drug use. Different approaches by the Government, non-governmental organizations and the private sector had been used to fight that trend, and the national Red Cross had recently established a mobile clinic to offer services directly to the most vulnerable drug addicts. That service aimed to minimize the harmful effects of their lifestyles by providing them with clean needles to prevent further HIV and hepatitis C infections. Primary school students were being taught about reproductive health and rights, the use of condoms and protection. On the basis of “youth educating youth”, medical students had been reaching out to other college students on those same issues, she said, adding that the public and private sectors had recently launched a joint national campaign to promote the use of condoms so as to prevent infection by sexually transmitted diseases, including HIV. She went on to say that young people had access to confidential medical testing and counselling in public health clinics. Social media such as Facebook were also being used to guide them and provide confidential counselling. She called for more attention on achieving gender equality and empowering women so as to ensure that girls and women were not disproportionately burdened by the epidemic, in terms of infections, care-giving and discrimination. Promoting human rights was also an essential part of Iceland’s approach, she said.
ISABELLE PICCO (Monaco) said that the collective political awakening to the plight of HIV must further be strengthened in the current vital period. The promise in 2006 to provide universal access for HIV care, coupled with the development of new research in the field of combating the disease was responsible for promising progress, but the international community needed to go further.
Inequalities persisted according to gender and region, and 9 million people were still waiting for antiretroviral treatments. Reducing infection was a matter of education, prevention, and de-stigmatization. Improving communications methods would make this task easier, so that human rights could be upheld. As a roving United Nations AIDS ambassador, Princess Stephanie of Monaco was involved in the struggle against discrimination. In closing, she praised possible upcoming cooperation with pharmaceutical companies to increase access to necessary drugs for those in need.
HENRIQUE BARROS, National AIDS Coordination of Portugal, said that while his country had been one of the most affected nations in the Western hemisphere, over the past three decades, it had been able to significantly decrease the number of AIDS-related cases and deaths; virtually eliminate mother-to-child-transmission; and dramatically decrease transmission among intravenous drug users. Portugal had also registered great advances in the promotion of voluntary and free HIV-testing, directed at the general population and the most affected communities. It also now guaranteed universal access to treatment.
“Knowing one’s epidemic is the major catalyst to success in fighting HIV,” he said, adding that, in Portugal, the epidemic had mainly been driven by unsafe drug injections, but all the major vulnerable groups had been affected. Prevalence rates were still high among prison inmates, sex workers, migrants from highly endemic countries, and among men who had sex with men — the one community facing a recent up-tick of new diagnoses. While Portugal had maintained a human rights approach that integrated evidence-based approaches, and included the active engagement of affected communities, the Government’s main objective was to reduce the number of overall infections and get more people the treatment and support they needed. Portugal was currently the coordinator of the AIDS Programmes of the Community of Portuguese Speaking Countries, which was a crucial opportunity to promote cooperation, mutual learning and better understanding of solutions.
ZOYA KOLONTAI ( Belarus) said her country was implementing a national HIV prevention programme and working to achieve universal access to treatment and care. It aimed to stabilize the rate of new infections, increase life expectancy for those living with HIV, and lower AIDS-related deaths through a set of treatment measures, she said, adding that the Government was working with civil society to that end. Belarus had established a national inter-agency council to deal with HIV infection and venereal diseases, which had undertaken programmes with the help of the Global Fund, she said. That had enabled the country to ensure the implementation of national HIV-prevention programmes. Thanks to those efforts, as well as legislation, Belarus had managed to keep the spread of infections under control. Thanks to political support and increased State funding, Belarus had been able to provide access to preventive services and treatment, she said, adding that all those in need of antiretroviral therapy had access to it. Vertical transmissions had fallen by 3 per cent in 2010, thanks to programmes to prevent mother-to-child transmissions.
BERNADETTE CAVANAGH (New Zealand) urged the international community to reinvigorate its collective effort to ensure that the gains of the past decade were not lost, starting with the integration of HIV/AIDS intervention with broader health-care programming, in particular, sexual and reproductive health. Bringing HIV-related programmes into mainstream health systems would help deliver cost-effective outcomes and achievement of the health-related targets of the Millennium Development Goals. Stigma, discrimination and punitive laws and polices undermined efforts to prevent new infections, with at-risk populations, including men who had sex with men, sex workers and injecting-drug users often reluctant to seek help.
She said that protecting and promoting human rights was a prerequisite to a successful response to HIV and AIDS, ensuring that key populations had equitable access to necessary services, including sexual and reproductive health, as well as to life-saving drugs. “We call for an inclusive approach to HIV programming and service delivery, which also encompasses those with disabilities,” she added, also noting that such programming often overlooked the disproportionate impact HIV/AIDS had on women and girls. New Zealand’s own approach had been evidence-based and focused on, among other things, empowering women, decriminalizing sex work, and making it illegal to discriminate against anyone on the basis of sexual orientation or HIV status. “We urge States that have not done so to reform laws that stand in the way of an effective response,” she said, calling for meaningful and transparent measures to monitor national efforts to address HIV stigma and promote effective responses for higher-risk populations.
SIMONA MIRELA MICULESCU (Romania) said classical epidemiological dogmas should be replaced with an avant-garde approach, based on therapy, not on rhetoric. Facing a true HIV/AIDS epidemic among small children at the beginning of the 1990s, Romania had taken measures which then would have seemed unimaginable, including establishing a special centre for AIDS patients and implementing antiretroviral treatments instead of simply isolating persons affected by the virus. Public-private partnerships undertaken in 1997 resulted in the establishment of nine regional centres dealing with the disease working to create a national database, introduce antiretroviral treatments, and implement testing for vulnerable groups, as well as the testing of couples before marriage.
Those measures contributed to the sustainability of Romania’s national program, resulting in the granting of a second chance at life for HIV infected children, and in creating an epidemiological profile. After 26 years of the evolution of the HIV epidemic, the resulted had proven that without a doubt, there was political will that could find a solution for any problem, even one of public health. For its part, Romania had established the European Academy on HIV/AIDS and Infectious Diseases which provided professional training, established standards of care, and promoted research in the field. If there was truly to be a “cure” for HIV/AIDS — so that it was not just words — every one must: ensure free access to therapy; ensure sustainable prevention of vertical transmission from mother to child; and proactively address vulnerable groups.
MAJEED YOUSSIF (Sudan) said his country had an HIV prevalence of about 2.6 per cent. But, the rate was reported to be over 3 per cent among pregnant women in Southern Sudan. With peace prevailing and mobility restored, Southern Sudan was likely to experience a rapid increase in HIV prevalence that could reach as high as 6 per cent by 2015. Sudan had achieved progress, however. It had developed a five-year national strategic framework and monitoring system, guidelines for treatment and prevention of mother-to-child transmission and for mainstreaming HIV treatment and issues into the line ministries. Those efforts aimed to reduce mother-to-child transmission from 30 per cent to 10 per cent and to increase care and support services for people living with HIV from 10 per cent to 30 per cent by 2014. Sudan was working to finalize a biological and behavioural survey to determine HIV prevalence accurately.
The Government was committed to fighting HIV/AIDS by ensuring universal access to prevention, treatment, care and support services, he said. To do that, it was developing an effective resource mobilization and utilization strategy, scaling up access to quality services, building national and local capacity to plan and coordinate a response to HIV, and developing sustained public awareness campaigns. The Global Fund currently was the only source of funding for antiretroviral therapy and HIV care services in Sudan. The multi-donor trust fund supported the capacity-building of relevant Government institutions and civil society organizations. The two sources of HIV funding in Southern Sudan would end in July, creating a huge gap in service delivery. He urged the international community to enhance capacity-building support to Sudan and other developing countries to ensure continuity of HIV/AIDS services to needy people.
Right of Reply
Speaking in exercise of the right of reply, the representative of the Russian Federation responded to the statement by Georgia, saying his delegation regretted that the Georgian delegate’s statement had politicized the discussion on such an important issue as the global struggle with HIV/AIDS. That representative had not taken into account the new realities in the region following the new independence of the states of Abkhazia and South Ossetia. Those Governments had a responsibility to combat the spread of HIV/AIDS in those territories. Turning to Russia’s actions in 2008, they had been triggered by the criminal activities of Georgian troops in South Ossetia and the need to protect civilians there.
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