|Department of Public Information • News and Media Division • New York|
Sixty-fifth General Assembly
94th & 95th Meetings (AM & PM)
Adoption of Political Declaration Promises ‘Bold and Decisive Action’ to Wipe Out
What Remains of Global Human Tragedy of HIV/AIDS, as High-Level Meeting Concludes
‘We Must Succeed; We Must Win Our Battle
Against AIDS, and We Will’, Says General Assembly President
Deeply concerned that AIDS already had claimed 30 million lives and orphaned 16 million children since it was first discovered in 1981, the United Nations General Assembly today promised to partner with all stakeholders to implement “bold and decisive action” to wipe out what remained of an unprecedented global human tragedy despite significant progress in the past decade to combat the disease.
“We solemnly declare our commitment to end the epidemic with renewed political will and strong, accountable leadership,” the Assembly stated in a 17-page Political Declaration on HIV/AIDS, unanimously adopted this afternoon by its membership.
Wrapping up a three-day High-Level Meeting on HIV/AIDS, which heard presentations from representatives of more than 160 Governments, intergovernmental and civil society organizations, and the private sector, the Assembly expressed deep concern that many countries had been unable to achieve the goals set forth in its 2001 and 2006 declarations on the subject. It stressed the urgent need to recommit to them, as well as to commit to and fully implement “new, ambitious and achievable targets”.
Member States also promised to “seize this turning point” and redouble efforts to achieve by 2015 universal access to HIV prevention, treatment, care and support, with a view to realizing the sixth Millennium Development Goal of halting the spread of HIV by the same year. Those efforts included programmes for HIV education, particularly among youth, expanded HIV testing and counselling, improved access to condoms and sterile injecting equipment, and stronger health-sector prevention intervention, particularly in remote areas.
Furthermore, they committed, also by 2015, to halve sexual transmission of HIV and transmission among intravenous drug users, eliminate mother-to-child transmission, significantly reduce AIDS-related maternal deaths, halve tuberculosis deaths in people living with HIV, and put 15 million people living with the disease on antiretroviral drug therapy. They asked the Secretary-General to report annually on progress towards those aims.
In addition, Member States committed to accelerate research and development for a safe, affordable, effective, accessible vaccine and for a cure for HIV, as well as to deploy new biomedical interventions — such as microbicides, HIV treatment prophylaxis and early treatment as prevention — as soon as they were validated.
The Assembly noted with concern the extent to which the epidemic had afflicted mankind: an estimated 33 million were living with HIV and another 7,000 were newly infected with it everyday, mainly in low- and middle-income countries; less than half of them were aware they were infected. Sub-Saharan Africa remained the worst-affected region, where poverty was a major obstacle to lifelong treatment.
But the text also recognized important successes thus far in defeating the menace, notably the more than 25 per cent drop in the rate of new HIV infections in more than 30 countries, the greater than 20 per cent reduction in AIDS-related deaths in the past five years, thanks to expanded access to antiretroviral treatment, and the more than eight-fold funding increase since 2001 to $16 billion last year — the largest single amount ever committed to combat a disease.
Still, the Assembly was deeply concerned, according to the text, that funding for the HIV/AIDS response was not commensurate with the epidemic’s scale and was negatively impacted by the global economic crisis. Last year marked the first time global aid levels had not increased. Moreover, the more than $30 billion in donor commitments to the Global Fund to Fight AIDS, Tuberculosis and Malaria had fallen short of the Fund’s targets to expedite progress towards universal access to treatment, prevention, care and support.
Also by the Declaration, Member States committed to work to close the $6 billion annual HIV/AIDS resource gap by 2015 through greater strategic investment and funding, and to reach a “significant level of annual global expenditures on HIV and AIDS”, which the Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated to be between $22 billion and $24 billion in low- and middle-income countries, by increasing national and traditional sources of funding, including official development assistance (ODA).
They strongly urged African countries that adopted the Abuja Declaration and Framework for Action for the Fight against HIV/AIDS to meet its target to spent at least 15 per cent of their annual budgets on health-care sector improvements.
Noting that national prevention strategies often did not adequately reflect infection patterns or sufficiently focus on high-risk populations, notably men who had sex with other men, sex workers and drug users, Member States furthermore committed to ensure that financial resources went towards evidence-based prevention measures that addressed the specific nature of each country’s epidemic to ensure they were spent cost-effectively.
The Assembly committed to remove before 2015, where feasible, obstacles to affordable HIV prevention and treatment products in low- and middle-income countries, and called for early acceptance of the 2005 amendment to article 31 of the World Trade Organization Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPs), which made it easier for poor countries to obtain cheaper generic versions of patented medicines.
Deeply concerned that women and girls were disproportionately affected by the epidemic, the Assembly pledged to increase their capacity to protect themselves from the risk of HIV infection by working to eliminate gender-based violence and inequalities, saying the newly created entity, UN Women, could play an important role in that regard.
Member States also committed to intensify national efforts to create enabling legal, social and policy frameworks to eliminate stigma, discrimination and violence related to HIV and to promote non-discriminatory access to HIV prevention, treatment, care and support.
The Political Declaration drew some mixed reviews from delegates. Mexico’s speaker, among many others, praised the text for setting goals for universal coverage, prevention, commitment to eliminating stigmas, and the development of human rights and ethics in connection with fighting HIV/AIDS. Its references to financial resources, strengthening health-care systems, and action and innovations were also crucial.
An observer for the Holy See, however, rejected the text’s references to so-called “harm reduction”, and efforts related to drug abuse, saying that those terms falsely suggested that those suffering from HIV/AIDS could not break free from the cycle of addiction. Governments and society must not accept such a dehumanization and objectification of persons. What was needed was a value-based approach to counter the disease of HIV and AIDS, which provided the necessary care and moral support for those infected and promoted living in conformity with the norms of the natural moral order, respecting fully the inherent dignity of the human person.
Syria’s representative, speaking on behalf of the Arab Group, voiced his “complete rejection” of the inclusion of certain groups among the list of populations considered to be the most vulnerable, saying that all groups should be treated equally and that none should be put above others. Similarly, Iran’s representative said the “overly targeted” document — particularly paragraph 29, which noted that many national HIV prevention strategies inadequately focused on higher risk populations, including men having sex with other men, drug users and sex workers — failed to recognize the detrimental role of risky and unethical behaviours in the spreading of the disease.
But Brazil’s representative described the inclusion of references to those groups as “far-reaching achievements”, lauding such groups for their important role in developing policies to fight the epidemic. In addition, it was important that, for the first time, targets had been set on reducing mother-to-child transmission and achieving access to antiretroviral drugs.
Reaction to the text was largely favourable during the general debate, with Australia’s Minister for Foreign Affairs, for example, pointing out that, while figures in the document that expressed the toll of the epidemic were stark, they contained real elements of hope if built upon. The world now must ask: “what if we had done nothing” — on prevention, antiretroviral drugs or research, where breakthroughs had occurred. “The challenge would have become an apocalypse.”
However, Liechtenstein’s representative regretted that, while the Political Declaration acknowledged the importance of providing universal access to sexual and reproductive health care, it had missed the opportunity to address the human rights dimension of stemming from the socio-economic marginalization of higher-risk populations, which often were prevented from fully enjoying their human rights and fundamental freedoms, particularly the right to health.
Trinidad and Tobago’s Minister of State worried that today’s action could become a fruitless endeavour, saying that the adoption of resolutions, treaties and agreements on any subject was useless if there was no commitment to implementing them. HIV was “everyone’s business”, he said, and it was time to “get down to it”.
Representatives of other developed countries with a low HIV prevalence stressed the need for increased action and innovative strategies, including those involving youth, which accounted for 40 per cent of people newly infected with the disease. Germany’s representative said young people must be allowed to take strong leadership roles in reducing infection. Finland’s representative said they could be positive agents of change if given proper access to comprehensive sexuality education, and sexual and reproductive health services.
In closing remarks, Assembly President Joseph Deiss ( Switzerland) underscored the importance of this week in the fight against HIV/AIDS, saying “these bold new targets set by world leaders will accelerate our push to reduce the transmission of AIDS”. Mothers and their future children would benefit immeasurably from the new “Global Plan towards eliminating new HIV infections among children by 2015 and keeping their mothers alive”, which was launched on Thursday.
He noted, too, the Security Council’s adoption on Tuesday of an important resolution on HIV/AIDS in the context of peacekeeping, which addressed the issue of sexual violence and the rights of women and girls in conflict and post-conflict situations, he said. The challenge now was to implement those commitments. Leadership and mutual accountability would be crucial. “We must succeed; we must win our battle against AIDS. And we will”, he said.
Also today, summaries of the five panel discussions held during the High-Level Meeting were presented by their respective chairs: Denzil L. Douglas, Prime Minister of Saint Kitts and Nevis; Olivier Maes on behalf of Marie-Josée Jacobs, Minister of Cooperation and Humanitarian Affairs of Luxembourg; Ratu Epeli Nailatikau, President of Fiji; Margus Kolga on behalf of Hanno Pevkur, Minister of Social Affairs of Estonia; and Gervais Rufyikiri, Second Vice-President of Burundi.
During the plenary debate, Ministers and other senior Government officials from the following countries also spoke: Uganda; Grenada; Nepal; Kuwait; Israel; and Ecuador.
The representatives of Kazakhstan, San Marino, Zambia, Spain, Austria, Ireland, Myanmar, Ethiopia, Costa Rica, Montenegro, Cyprus, Bahrain, Colombia, Czech Republic, Italy, Afghanistan, Bahamas, Gambia, Pakistan, Bulgaria, Guyana, Republic of Korea, Albania, Eritrea and Bolivia also delivered statements.
Additionally, an observer for theHoly See delivered a statement.
Also making statements were the representatives of: International Federation of Red Cross and Red Crescent Societies; International Organization for Migration; Asian Development Bank, Commonwealth Secretariat; Global Fund to Fight AIDS, Tuberculosis and Malaria; Inter-Parliamentary Union; Sovereign Military Order of Malta; International Development Law Organization; Organization of the Islamic Conference; International Labour Organization.
Making comments on behalf of civil society and the private sector were representatives of Anglo American PLC, Foundation Esther Boucicault Stanislas and Global Network of People Living with HIV.
The General Assembly met this morning to continue and conclude its High-Level Meeting on HIV/AIDS. Delegates 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 of 8 June for further details.)
KIHUMURO APUULI, Director General of the AIDS Commission of Uganda, said that, while global figures showed that efforts to combat AIDS were bearing fruit, the response demanded a high level of solidarity. Like many developing countries, Uganda faced challenges in meeting the Millennium Development Goals. About 1.2 million Ugandans, of a total population of 32 million, were HIV-positive. “The task for us is enormous,” he said, calling for a shift in resources to enhance efficiencies and generate results. Political commitment at the highest level would be invaluable to mobilizing resources, especially from the private sector. With support from the Joint United Nations Programme on HIV/AIDS (UNAIDS), among others, studies had reviewed the changing face of the epidemic.
He went on to say that in Uganda, 550,000 needed antiretroviral drugs, but as of December 2010, only 270,000 people had access to them. He noted with optimism research breakthroughs, however, saying that HIV-positive persons should be given hope to live a normal life. The biggest challenge on that front was to mobilize resources. Commendable efforts had been made to find new drugs and implement other strategies, and he called on partners to increase research funding in order to find a cure. Uganda supported the African Union’s position on implementing programmes in line with national laws and due respect for religious and ethical values. In Uganda, women and girls bore the brunt of the epidemic.
ANN PETERS, Minister of Health of Grenada, associating herself with the Caribbean Community (CARICOM), said that, despite the challenges of taboo and stigma, social and religious norms, limited resources and the need for more public education, Grenada had made several gains in the fight against HIV and AIDS. Describing them, she said that more than 80 per cent of women in antenatal clinics had accepted testing at their first visit. Vast improvements in reducing mother-to-child transmission of HIV had been seen, with Grenada achieving the first “global zero”: no child born to an HIV-infected woman had tested positive for the virus. That had been the result of strategic, rights-based interventions in primary health care.
That model could be used to achieve the other two zeros, she explained, adding that Grenada had seen an increase in the number of young people who voluntarily tested, thanks to growing awareness and reduced stigma. Plus, the use of antiretroviral drugs had made it possible to put all patients on treatment and significantly increase the numbers of people with access to services. Home visits and referrals to specialists also were making a difference in the quality of life of HIV-positive people. Other gains included improved testing, local and regional training for medical personnel and more intersectoral activities. The human rights of all Grenadians must be honoured without distinction.
DHARMASHILA CHAPAGAIN, State Minister of Health and Population of Nepal, said the HIV/AIDS pandemic was a major global health problem affecting low- and middle-income countries, in particular. The scourge severely undermined people’s health and well-being, as well as development efforts. While the resource flow to fight that menace had increased over the years, millions of people remained outside the basic coverage of minimum health services in many parts of the world. In that regard, shared responsibility must be based on equity and equality. Also critical in an effective and accountable response were the provision of sustainable financial resources and funding flows, the consolidation of national health systems, and the integrated efforts of all stakeholders. “Needless to say, prevention is better than cure,” she said, stressing that prevention must be the cornerstone of the global response. Further, access to safe, effective, affordable, good quality medicine and commodities, including generic medicines would aid efforts towards prevention, treatment, care and support. Intellectual property rights provisions in trade agreements must remain favourable for easy access to affordable medicine.
Turning to the situation of HIV/AIDS in Nepal, she said there were 63,000 cases, and 5,500 people were currently receiving antiretroviral treatment, indicating a that a large proportion of people needed treatment, care and support. As a least developed country, Nepal lacked adequate resources to effectively deal with HIV/AIDS; however, it accorded it top priority in its national health-care policy, and measures had been adopted to that end. The multi-stakeholder response targeted the most vulnerable populations, including intravenous drug users, men having sex with men, migrant labourers and clients of female sex workers. The Government was seeking to reduce stigma and discrimination and had formed a National AIDS Council. Yet, it needed support: “We have the means, but we need to summon global political will and resources to intensify our response in an effective manner,” she said.
MIGUEL BERGER ( Germany) said HIV was a challenge for every society, not just from a health perspective. It called for every country to take responsibility and show national leadership. Germany engaged people living with HIV and AIDS in the development and implementation of its AIDS strategy. Social exclusion and discrimination of certain groups promoted the spread of new infections. No future goals related to HIV and AIDS would be achievable with laws that punished homosexuality or drug users. Also important in that fight were the promotion of gender equality and efforts to curb gender-related violence. Germany supported bilateral programmes on HIV in more than 40 countries, as well as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Reacting to the rapid growth of new HIV cases in Eastern Europe, Germany had increased its support for programmes in that region. “We are willing to do our part,” he said. “At the same time national partners must increase the prevention activities and remove barriers to those efforts.”
Stressing that 40 per cent of new infections occurred among young people under 25 years old, he said that rate of infection must be reduced, for which youth must be allowed to take strong leadership roles. Young people wanted to be heard, he stressed, noting that their commitment raised hopes of finding a solution to HIV/AIDS. Today, as the General Assembly came together to recommit itself to the goals of the last 10 years, it must be committed to zero new infections, zero discrimination and zero new AIDS-related deaths.
JARMO VIINANEN (Finland), aligning with the European Union, focused on the crucial role of young people, who must be well equipped to make informed choices in their lives. Young people could be positive agents of change if provided with proper support. They must have access to comprehensive sexuality education, as well as sexual and reproductive health services. Adolescents and young people must be informed about responsible sexual behaviour and respect both themselves and others. In Finland, comprehensive formal and informal sexuality education was offered from an early age, and the country was moving from a “biological” focus to a wider perspective that included emotional and social aspects. The results of that approach had been seen in a reduction in the number of teenage pregnancies and sexually transmitted infections and abortions. Young people were also delaying sexual activity.
Noting that Finland had been a long-term supporter of UNAIDS, he said the country also had channelled aid through the Global Fund, as well as non-governmental organizations, and it fulfilled its international aid commitments. In addition to traditional official development assistance (ODA), countries must look into other financing sources. Also essential were national ownership and domestic resource mobilization. Emerging economies also must have a role. Moreover, comprehensive, people-centred policies were needed to achieve internationally agreed development objectives. Everyone should be involved in promoting the common vision of zero new HIV infections, zero discrimination and zero AIDS-related deaths, including civil society, parliamentarians and the private sector.
HIND AL-SHOMER, Adviser at the Ministry of Health of Kuwait, said the international community should be pleased with progress made thus far, but “we have to acknowledge that much remains to be done to achieve goals outlined in the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration”. Since the diagnosis of the first HIV case, Kuwait had formed a multisectoral AIDS committee through a ministerial decree, which developed a strategic plan focused on education, prevention and treatment. A law also had been devised that provided for pre-marital HIV testing for couples. It did not deter people from marrying, she added.
Among other efforts, Kuwait also had hosted four HIV/AIDS conferences in the last two decades, she said, and it had undertaken research to understand the behaviour of the virus. To ensure blood safety, all donations were screened for HIV and other infections. Kuwait’s protocol to treat HIV was in line with guidelines set by the World Health Organization (WHO). Mother-to-child transmission was addressed through early treatment for HIV-positive mothers. Kuwait also helped other nations, she said, underlining that the Government would donate $500,000 to the Global Fund. It also had submitted a report in 2010 on the HIV/AIDS situation in Kuwait, which contained ideas for implementing its strategic plan to combat the epidemic.
RODGER SAMUEL, Minister of State of Trinidad and Tobago, aligning with the statement made on behalf of CARICOM, said the adoption of resolutions, treaties and agreements on any subject was useless if there was no commitment to implementing the intentions of those instruments. As a result of the High-level Meeting, the international community must asses the effectiveness of agreed measures and devise new means to achieve the objectives. Within its limited resources, his Government was doing its part to bring relief to those living with HIV/AIDS and to curb the spread of the disease. In that regard, he stressed that Trinidad and Tobago was leading an active campaign in the fight; its efforts aimed to ensure universal access to treatment, care and support and to insulate future generations from the threat.
Outlining his country’s national response, he noted the development of national strategic plans, which coordinated activities to keep the disease from spreading. An “elimination objective” had been adopted to eradicate transmission of HIV from mother to child by 2015. In his country, awareness of the modes of HIV transmission had increased to 77 per cent of the general population. Fifty-two faith-based and civil society organizations had been funded to develop education and counselling programmes in local communities. At the same time, the Government provided free antiretroviral drugs who needed it. Underscoring his country’s commitment to remaining engaged at the international level, he said “The moment has come to renew our commitment and intensify our efforts in the fight against the global pandemic”. In that regard, Trinidad and Tobago agreed with the adage that “HIV is everyone’s business”, and believed it was time to “get down to it”.
ITAMAR GROTTO, Director of Public Health Services, Ministry of Health of Israel, said his Government signed its first-ever multi-year cooperation agreement with UNAIDS in April, enhancing its relationship with that important organization. As a low-burden country for HIV, Israel had increased incidence among specific risk groups, namely its 220,000 migrant workers and men who had sex with men. To further its prevention efforts, Israel carried out national research-based AIDS prevention campaigns that emphasized condom-use and testing focused on young people and drug users. Israel also applied harm-reduction methods and ran a nationwide syringe exchange project. That evolving project was expanding to include, not only the syringe exchanges, but also primary medical treatment for participants. Further, a number of universally available free clinics operated in areas with high-risk populations.
Offering suggestions from his country’s experiences to mitigate the greatest impacts of the AIDS pandemic, he stressed that public health infrastructures must be strengthened. Collaboration within and between countries on local, regional and international levels must also be promoted and should include, not just various governmental ministries, but non-governmental organizations as well. Universal access to HIV/AIDS screening was also necessary and should take into account the needs and practices of local cultures. He further noted Israel’s cooperation with other countries, including partnerships in sub-Saharan Africa and other developing nations. Among those, he cited Israel’s ongoing partnership with Ethiopia to provide training to doctors, nurses and technicians. Training, he stressed, must explore the feminization of HIV/AIDS to ensure that the specific needs of women and girls were met.
FATIMA FRANCO, Under-Secretary for Coastal Region, Ministry of Health of Ecuador, said that, in the 1970s, it was believed that transmissible diseases would be overcome by developed countries and end up on the long list of problems for developing nations. Today, the HIV/AIDS pandemic was among the world’s greatest challenges, especially in the context of the right to health. The scant understanding of the disease made it tough to tackle. Stigma and discrimination, coupled with a lack of or inadequate access to services, had affected vulnerable populations most. For its part, Ecuador had developed a national “Live Well” plan to combat the disease and was working on free universal health-care access focused on the rights and responsibilities of those living with HIV/AIDS. The Government had increased its budget for prevention and comprehensive care, and had examined the sectors of people living with HIV.
In other areas, Ecuador had improved efforts to fight mother-to-child transmission of HIV, ensure safe blood transfusions and provide care through social protection and empowerment programmes. As about 97 per cent of HIV transmission was sexual, Ecuador still faced the challenge of ensuring that information was improved for decision-making. Ecuador also was working to implement a policy to do away with stigma and discrimination. While the path had not been easy, the Government was working to guarantee the right to health for HIV-positive people, harmonizing health registries and taking innovative approaches. States must pull together to reduce the vulnerability of women and girls to HIV and AIDS by developing policies of social and economic equality.
KEVIN RUDD, Minister for Foreign Affairs of Australia, said: “we are not here to describe a problem. The purpose here today is to make a difference”, as nations in 2000 had resolved to halt and reverse the spread of HIV by 2015. That was why they had had the audacity to embrace the Millennium Development Goals a decade ago, a pursuit which Australia fully embraced. The country had increased its ODA by 50 per cent; its ODA budget was among the fastest-growing in the world and the country aimed to be among the top 10 ODA providers. In that context, he said that in over 30 years, 30 million people had died of HIV/AIDS. Today, 33 million people were living with HIV and 16 million children had been orphaned by the epidemic.
“These figures are stark,” he said, adding, however, that they contained real elements of hope if built upon. The world now must ask: “what if we had done nothing” — on prevention, antiretroviral drugs or research, where breakthroughs had occurred. “The challenge would have become an apocalypse.” Indeed, HIV/AIDS was about faces across the breadth of the human family. It did not respect gender, age or sexuality. It was a challenge for everyone and particularly affected the poor, which was why its impacts were most seen in Africa. Australia had invested $1 billion in AIDS programmes worldwide, and increased by 50 per cent its contributions to the Global Fund. In closing, he said that, without appropriate care, more than 50 per cent of newly infected infants would die because of the disease. Australia fully embraced the goal outlined in the new declaration to eliminate all infections in newborns by 2015. “Global declarations are not worth the paper they are written on unless they galvanize action,” he declared.
BYRGANYM AITIMOVA ( Kazakhstan) said the AIDS epidemic continued to outpace the response, despite enormous financial investments and intellectual efforts, which were offset by the 2008 financial downturn, donor fatigue, and diminished financial inflows. However, those impediments came at a time when programmes and services were most needed. Since 2001, Kazakhstan had made significant progress in addressing the problem nationally through a number of measures. A national monitoring and evaluation system to address HIV/AIDS had been operational since 2005, and in 2008, a substitution therapy initiative for injecting-drug users was launched.
She said that the complexity and scope of the problem required the concerted efforts of all stakeholders. There were 97 State-funded non-governmental organizations responding to HIV/AIDS in Kazakhstan, and civil society representatives actively participated in the development, implementation, and evaluation of prevention, care and support measures for people living with the disease. Yet despite the efforts of many, the epidemic remained “out of bounds”. In that regard, Kazakhstan supported an ambitious time-bound framework, and the vitally important aspects of the “three zeros” campaign.
DANIELE D. BODINI ( San Marino) said that 30 years ago when a new killer virus unleashed an unexpected incurable devastating plague, the world was at a loss. Indeed, over the last three decades, 27 million people had died and, today, approximately 36 million people were HIV-positive, amounting to .5 per cent of the world’s population. Echoing the words of United Nations Secretary-General Ban Ki-moon, it was time to end new infections and AIDS-related deaths and to wipe out the stigma accompanying the disease. Towards that end, he called for new effective prevention strategies, as well as reductions in the cost of available medicines. The delivery of treatments must also be improved. It was also time to motivate through financial incentives. The pharmaceutical industry and the scientific community should multiply their efforts to find more effective medicines and, above all, a working vaccine. He stressed that the United Nations was the appropriate forum to embrace the collective efforts of Governments, civil society and the scientific community to put an end to AIDS, underlining the moral obligation to ensure a safer life for the current generation’s children and grandchildren.
LAZAROUS KAPAMBWE (Zambia), aligning with statements made on behalf of the African Group and Southern African Development Community (SADC), said his country was among those most affected by the epidemic, which had negative and economic impacts on all Zambians. Yet the country had managed to turn the tide, scoring many successes in achieving the related Millennium Development Goals. Among other things, the gains had been guided by successive national AIDS strategic frameworks. Zambia had also recorded significant achievements in service delivery, including the provision of antiretroviral therapy and access for pregnant women to services aimed at preventing vertical transmission. Comprehensive legislation on gender-based violence also had been enacted and a national action plan for women and girls in connection with HIV and AIDS had been implemented. Mechanisms also had been designed to take stock of progress made to address women’s empowerment.
He said there were observable signs that more young people were delaying their first sexual activity and increasingly using condoms when they finally engaged. Deliberate efforts were directed at persons affected by HIV and AIDS who were in prison settings. A greater number of people living with the disease, including young people and women, were now involved in fighting it. Recognizing the value of a concerted, multisectoral, decentralized and a rights-based approach to the epidemic, Zambia had adopted a civil-society framework that was meant to build, direct and realign the capacities of all organizations involved in the fight. Zambia had committed to being free from the threat of HIV and AIDS by 2030. With a high prevalence of 14.3 per cent, however, it had recognized that it could not “treat its way out” of the epidemic. Thus, a first-ever Prevention Convention had been held in 2009, and prevention interventions had been reprioritized, he said, adding that those efforts would be dependent on full, sustainable and predictable resourcing at the national and international levels.
JOSÉ LUIS SOLANO ( Spain), aligning with the European Union, said that in the 1990s, the AIDS epidemic was concentrated among drug users. Through the participation of all stakeholders, use of scientific evidence and commitment of policymakers, Spain had adopted stringent measures to halt the spread of the disease. The country’s epidemiological pattern was similar to that of its neighbours, and it had adopted measures like universal coverage of free antiretroviral treatment. It promoted preventive measures, such as condom use, and harm-reduction strategies for all populations. He also cited the success of needle-exchange programmes in prisons.
Equal rights for women and men were another important achievement, he said, adding that an ethical and effective response to the HIV epidemic must involve the full integration — on equal terms — of homosexual and transgender people. Quality sexual education in schools, and its adaptation to student diversity, was essential in that integration process. Among the challenges, people with HIV still faced stigma and discrimination, and he stressed the importance Spain attached to that issue. Spain would contribute to achieving the targets set out in new strategies of UNAIDS and the World Health Organization for the 2011-2015 period. In sum, it was essential to understand that the HIV pandemic was determined, not only by biology and behaviour, but also by culture, and social and economic inequalities. Thus, interventions should address those aspects.
THOMAS MAYR-HARTING ( Austria) said his Government had passed legislation establishing stringent safety standards to prevent nosocomial infections, guaranteeing blood and product safety, and providing free access to HIV/AIDS testing and medical treatment. Those legislative measures were accompanied by comprehensive informational campaigns targeting both the general public and specific vulnerable groups, disseminating information about transmission and prevention, while addressing gender-specific and discrimination issues. Those measures were supported by an additional package of harm reduction programmes for people at risk, including programmes for the provision of clean needles and syringes, as well as drug-substitution programmes. Especially effective had been measures in the field of vertical transmission and reproductive health, which had nearly eliminated mother-to-child transmission in Austria. Since 1997, Austria had instituted advanced procedures to provide access to treatment and care for all, which had dramatically decreased the numbers of both new infections and AIDS-related deaths.
He said his country was convinced that prevention and access to affordable medication were essential to reach the goal of zero new HIV infections. He stressed the importance of a comprehensive approach, including biomedical treatments, behavioural change, and structural interventions to modify harmful gender norms, as well as access to comprehensive sexuality education and prevention options, particularly for young people. It was important to pay special attention to the prevention needs of key populations at higher risk, including men who had sex with men, and intravenous drug users and sex workers, providing them with non-judgmental, non-coercive services. It would not be possible to achieve the goal of zero new HIV infections, zero discrimination and zero AIDS-related deaths without a social and legal environment that promoted the rights of women and girls. Austria was especially worried by the increasing feminization of HIV/AIDS and, to reverse that trend, efforts should be stepped up to guarantee access of women and girls to sexual and reproductive health information and services.
ANNE ANDERSON ( Ireland) recalled that five years ago, Ireland had pledged to spend over €100 million annually on HIV and AIDS and other communicable diseases. “ Ireland has kept that promise,” she said, noting that in the five years leading to 2010, the Government had spent €695 million of its ODA in that fight, which, at today’s rate, amounted to almost $1 billion. In the current year, Ireland would allocate over €100 million of its ODA budget. In parallel, Ireland had maintained a deep policy engagement, having committed to allocating 0.7 per cent of its gross national product (GNP) to ODA. Lauding the Security Council’s attention to the link between HIV/AIDS and international security, she also was encouraged by the scope and substance of the political declaration to be adopted at the Assembly’s High-Level Meeting.
Turning to another “stark” truth, she said: “the fight against HIV and AIDS is unwinnable unless the international community does more to protect and empower women”, and Ireland looked to the United Nations Entity for Gender Equality and the Empowerment of Women (UN Women) to address women’s vulnerabilities in a resolute and integrated manner. Adequate nutrition for pregnant and lactating women with HIV was crucial to improving their well-being and for reducing mother-to-child transmission of HIV. Ireland resolutely supported the goal of eliminating that transmission by 2015, and voiced unreserved support for the goal of zero discrimination. The United Nations must continue to lead efforts to ensure that resources were spent effectively, by strengthening coordination on the ground, among other things. Leadership cost nothing, but was vital to combined efforts.
THAN SWE (Myanmar) said that weak national infrastructures, financing shortfalls, stigma, discrimination and gender inequality destabilized efforts to achieve universal access to HIV prevention, treatment and support. Current commitments were inadequate, and the Secretary-General’s call to strengthen the AIDS response should be heeded. Sufficient financial resources and assistance from the United Nations system and the international community should be mobilized, as that would be indispensable in effectively implementing the recommendations.
He said his country was now keeping abreast with the international community in the fight against HIV/AIDS, and was coordinating a national AIDS programme with the assistance of seven United Nations agencies, non-governmental organizations, and civil society to help implement the UNAIDS “three ones principles”. Still, while 76,000 people were in need of antiretroviral drug treatment, only 30,000 were receiving it as at the end of 2010. Myanmar had tried its best with limited resources to overcome its difficulties in the fight, and had made remarkable progress in its national response. Prevalence among key populations had begun to decline, and among young adults, had dropped from 0.94 per cent in 2000 to 0.61 per cent in 2009.
TEKEDA ALEMU (Ethiopia) aligning with the African Group, said much progress had been made in the fight against HIV and AIDS around the world, while in Ethiopia, new HIV infections had significantly declined. HIV prevention, treatment, care and support programmes had become part of the overall national development agenda. The accelerated expansion of primary health-care facilities, coupled with decentralization of HIV and AIDS services, had increased access to HIV services. The number of people tested annually had grown from 564,000 in 2005 to 9.4 million in 2010. Free antiretroviral therapy had been expanded, while progress also had been made in preventing mother-to-child transmission. The deployment of health extension workers in rural areas had helped create a popular movement against HIV and AIDS and increased active engagement at the local level.
He said that, despite the progress made, however, the fight was not yet won. That was particularly the case for low-income countries. Insufficient and unpredictable funding and costly treatment programmes threatened countries’ ability to provide universal access to drug therapy. In many low-income countries, a significant proportion of people living with HIV still lacked access to treatment. Similarly, millions of babies were born with HIV and many more were orphaned by the epidemic because of low access to services that prevented mother-to-child transmission. Stressing that it was vital to renew political commitment and partnership to sustain the progress made, he said it was also critical to accelerate access to treatment to millions of people in low-income countries to prevent deaths and stop the spread of HIV. International cooperation and the availability of predictable funding were paramount in supplementing national efforts. The sixteenth International Conference on AIDS and Sexually Transmitted Infections in Africa would be held from 4 to 8 December in Addis Ababa, he noted.
EDUARDO ULIBARRI ( Costa Rica) said that, in the fight to stop the spread of HIV, gender equality must be promoted and the human rights of everyone protected, regardless of a positive status. Otherwise, it would be impossible to provide universal access to prevention, treatment, care and support programmes. While prevention must be the cornerstone of the national response strategies, prevention efforts must be based on sound epidemiological evidence. Initiatives must target men who have sex with men, as well as other vulnerable groups, and political and ideological considerations must be avoided in discussions of those issues. To truly make a difference and curb the epidemic, public health must be promoted. Also, facts and empirical evidence must be the basis of all action.
In Costa Rica, there had been no cases of mother-to-child transmissions in the last two years, and health-care services were provided to all patients who needed them, he reported. To deal with people living with HIV, national health systems must be strengthened. Further, mechanisms to buy antiretroviral drugs were needed, he said, pointing to the Trade-Related Aspects of Intellectual Property Rights (TRIPs) in that regard. Stigma and discrimination must be eliminated in the workplace, as well as in health systems, through effective legislation. It was clear that stigma and discrimination could not be ended without further gender equality. Highlighting Security Council resolution 1983 (2011), he said the United Nations must ensure that its staff, as well as its troop- and police-contributing countries, did their part. Finally, the participation of those living with HIV and AIDS, as well as of young people, in designing and implementing relevant programmes was critical.
MILORAD ŠĆEPANOVIĆ (Montenegro), aligning with the European Union, said that, with extremely high infection rates in some parts of the world, HIV/AIDS was a threat to health, development, life quality, security and stability. Progress in combating the pandemic was linked to the broader global development agenda, and a prerequisite for reaching development targets. Eastern Europe was seeing “alarming” increases in infection rates, which must be addressed by the region as a whole. While prevalence in Montenegro was at 0.13 pre cent, regional trends indicated real potential for the rapid spread of HIV if prevention among key target groups was not improved.
Montenegro was strongly committed to combating HIV/AIDS, he explained, with the first national strategy providing a special focus on safe blood, populations most at risk and improved diagnosis, treatment and care. The country had made gains in various areas, notably with the development of national guidelines and protocols for prevention and treatment. Target groups had received information about prevention, and medical services and health workers’ capacities had been built. Moreover, a national coordination body, established to ensure an appropriate response to related complex medical, social, legal and human rights issues, had launched a project cited as among the most successful in Eastern Europe. In sum, he said HIV/AIDS was an immediate and long-term crisis for the international community that could not be addressed by a State-centric approach.
MINAS HADJIMICHAEL ( Cyprus) said his country had a low HIV/AIDS prevalence rate of 0.1 per cent. Since the disease had first appeared in Cyprus, his Government had been addressing it as a top priority. It had set up time-bound action plans against the epidemic that were systematically updated and adjusted, based on new knowledge and experience, as well as technological advances. Cyprus’ policy was in line with European Union directives. In 2008, the Government had updated national epidemiological surveillance to confirm with requirements of the EuroHIV programme. HIV prevention and human rights protection were the cornerstone of Cyprus’ strategic plan through 2014. Treatment, including a combination of antiretroviral therapies, care, voluntary counselling and testing, were free for all Cypriot and European Union citizens, as well as for political refugees.
He noted that data patterns of HIV infection were stable. Nevertheless, the Government continued to strictly monitor the situation by conducting studies to asses the threat posed by drug trafficking and use, and the intense cross-border population movements, including across the dividing line. Health and HIV/AIDS were important priorities for CyprusAid, the island’s development cooperation service, which had financed several health projects on HIV and sexual and reproductive health rights. As of 2010, more than €2 million had been channelled to complete health projects or those under way in HIV/AIDS treatment and prevention, as well to combat malnutrition in those afflicted with the disease. In 2009, Cyprus had joined UNITAID, the leading group of innovative financing, and was contributing €2.5 million over six years. Innovative financial mechanisms were important for mobilizing resources and should be encouraged and explored.
TAWFEEQ AHMED ALMANSOOR( Bahrain) said HIV was one of the most significant challenges of our time. The virus had hit different parts of the world in varying ways. Bahrain was less affected than other countries, perhaps because of a social system that was based on religious concerns and the family. Nonetheless, his Government shared the international community’s concerns regarding HIV and AIDS. Financial resources represented a constraint for developing countries, as did barriers posed by trade agreements and intellectual property rights. In Bahrain, the worst-affected people were drug users, particularly those who injected drugs and shared needles, he said, adding that sex was the second main avenue of transmission.
He stressed that Bahrain was working towards primary, secondary and third-level prevention to meet the “three zeros” goal of zero new infections, zero discrimination and zero AIDS-related deaths. Towards that end, his Government had set up a national prevention committee under the auspices of the Ministry of Health, and a multisectoral action plan had been drafted. Involved in that effort were people living with HIV and AIDS, as well as representatives of civil society and the private sector. He went on to say that prevention and treatment medication were provided for free to people living with HIV. At the same time, awareness campaigns sought to educate the public on how the disease was spread.
CHRISTIAN WENAWESER ( Liechtenstein) said that many of the ambitious development goals set by the international community depended on the success in combating the epidemic. While progress made in containing the spread was encouraging, the epidemic continued to outpace the global response and risked the failure to achieve universal access to prevention, treatment, care and support for the people affected by it. There were still too many barriers — nationally and internationally, and legally, financially, socially and culturally — which undermined efforts to provide such universal access. Only a comprehensive strategy that addressed all aspects of the complex phenomenon would enable the world to deliver on its commitments, and today’s political declaration pointed in the right direction.
He emphasized that HIV/AIDS was as much a human rights imperative as a health and development issue. While several countries had positively contributed to de-stigmatizing affected persons, his Government remained concerned about ongoing discriminatory legal and factual situations in other countries. Specifically, the criminalization of homosexuality in almost 80 countries remained an obstacle to effectively addressing the epidemic. In addition, the social and economic marginalization of populations at higher risk of HIV infection often prevented them from fully enjoying their human rights and fundamental freedoms, particularly the right to health. Thus, an adequate response to HIV/AIDS must fully recognize all structural determinants of HIV risks and vulnerabilities, including the gender dimension. In that regard, Liechtenstein regretted that, while the political declaration acknowledged the importance of providing universal access to sexual and reproductive health care, it had missed the opportunity to address the human rights dimension of the question.
MIGUEL CAMILO RUIZ ( Colombia) said her country’s implementation of inclusive strategies had reduced barriers to comprehensive HIV prevention, treatment and care. Though the epidemic was concentrated in the most vulnerable groups, Colombia shared the concern that more than 50 per cent of those living with HIV were women. As such, it had adopted gender equality and empowerment strategies for women and girls to reduce their vulnerability. Given the large percentage of adolescents living with HIV, Colombia also had improved access to sexual and reproductive health and condom use, and developed approaches to reduce risk. The Government had also set more demanding goals for reducing HIV prevalence.
She went on to insist that free trade barriers, and the costs of both diagnostic tests and antiretroviral drugs be brought down. Stigma and discrimination also must end. A successful international response to the HIV epidemic must include strategies to improve prevention, and Colombia fully supported the goal of zero new cases, zero discrimination and zero AIDS-related deaths. Underlining the need to strengthen health systems, and research and development, she called for new, sustainable funding sources. Also, there must be more international interest in understanding specific country contexts.
EDITA HRDÁ (Czech Republic) said the fight against HIV/AIDS could only be sustainable if it targeted the most at-risk populations — which included drug users, men who had sex with men, and sex workers — as well as geographic areas most affected by the pandemic. Efforts must be linked to the development of strong health systems. For injecting-drug users, the most affected group in her country, there was a need for universal access to harm-reduction strategies. The Czech Republic had included such measures among the four pillars of its 1999 drug policy, which aimed to reduce risks associated with all types of drug use.
She went on to say that the last review of that strategy showed that the Czech Republic was among the most successful countries in achieving low-prevalence of HIV. Attaching great importance to achieving the Millennium Development Goals, especially Goal 6 (combat of HIV/AIDS), she said her country had integrated its HIV response into its broader development strategies, both bilaterally and in close cooperation with UNDP. In closing, she said this week’s High-Level Meeting brought an opportunity to generate political impetus to combat HIV/AIDS.
CESARE MARIA RAGAGLINI ( Italy) said his country was committed to fighting HIV/AIDS, and not just within its borders; it was also working with its partners in the developing world. Prevention was the heart of Italy’s strategy, he said, stressing that to be successful, that strategy required a holistic approach, combining the benefits of science and social policies. The Italian Government, in October 2010, had approved a national anti-drug action plan, which recognized that drug addiction was a preventable, treatable and curable disease and that the health of drug users should be protected by a “continuum of care” aimed at the individual’s full recovery and the prevention of drug-related diseases such as HIV, hepatitis and tuberculosis. If applied in isolation and outside a medical context that was focused on treatment, rehabilitation, reintegration and recovery, such harm-reduction strategies would not bear full results over the long-term. Thus, the additional concept of “risk reduction”, which was more directly linked to preventing HIV, must be applied.
He stressed that HIV/AIDS was a main concern in Italy’s development cooperation health policies. Italy considered national ownership, alignment with national policies and mutual accountability to be additional cornerstones in the fight against HIV/AIDS. Italian development policy treated that effort — as well as the fight against other infectious diseases such as tuberculosis and malaria — to be integral in its strategy to strengthen the structure of its health services. Recalling the important role played by the Global Fund, he noted Italy’s contribution of more than $1 billion since 2001. He further underlined the role of poverty in HIV/AIDS, saying it was difficult to envision universal access without helping the poor families so heavily afflicted by the consequences of the disease.
GHULAM SEDDIQ RASULI ( Afghanistan) reiterated his country’s full commitment to the global fight, and stressed that his Government was working with its development partners to strengthen national efforts. In that respect, Afghanistan’s HIV/AIDS response was aligned with its National Development Strategy and the Millennium Development Goals. Despite current security constraints, the Ministry of Public Health had managed to provide HIV/AIDS services covering prevention, treatment and care even in the most insecure and remote provinces. The implementation of voluntary counselling and testing services, as part of the basic package of health services, had successfully increased the provision of HIV testing and provided a key entry point to life-sustaining care and treatment, which was essential for preventing the vertical transmission of HIV.
Continuing, he said that while poverty was a critical underlying driver of the epidemic in Afghanistan, the Ministry of Public Health aimed to alleviate any social or economic barriers to accessing health services by providing free care, in order to improve the health of all Afghans. The Government had reached out, in partnership with civil society, to society’s most vulnerable segments: drug users, prisoners and sex workers. Because stigma and discrimination continued to pose obstacles to accessing prevention and care services, the Ministry of Health had stepped up efforts to decrease those phenomena through information, education and communication campaigns. The country’s programme and priorities were encapsulated in the its national HIV/AIDS policy and the new HIV/AIDS Strategy (2011-2015), which served as a guide to achieving zero news infections, zero stigma and zero HIV-related deaths.
PAULETTE A. BETHEL ( Bahamas), aligning with the Caribbean Community (CARICOM), said: “we cannot be sceptical about what we can achieve”, especially if States were to secure the safety of future generations. In the Bahamas, no child last year had been born HIV-infected. The AIDS mortality rate had declined since access to antiretroviral drugs had been introduced in 2001. Resources to improve the national health-care system were needed, she said, noting that national, regional or global conditions could not be allowed to prevent the achievement of zero new infections, zero discrimination or zero AIDS-related deaths. Prevention efforts must target those people most at-risk and marginalized, which required resource mobilization.
In that context, she underscored the importance of investment in sexual and reproductive health services for all ages, and in the empowerment of girls and women. Shaping the national response required support for new technologies that were affordable and accessible, especially as some people needed second- and third-line antiretroviral drugs. New technologies also were needed for microbicides and “telemedicine”, in order to deliver preventive and curative treatment throughout her archipelago. Finally, she said: “We need renewed leadership and more involvement of young people”, as well as expanded services, more attention to the social determinants of the pandemic and an overall strengthening of health systems.
SUSAN WAFFA-OGOO ( Gambia) said this week’s forum should galvanize more action and see a recalibration of all strategies that had borne fruit over the decades in the fight against AIDS. Lauding the work of UNAIDS and the Global Fund, she said this week’s Meeting also marked another opportunity to reinforce and improve the performance.
Gambia, she said, had the strong political will to respond to HIV and AIDS, as shown by its creation of the National AIDS Council, chaired by the President, and the National AIDS Secretariat. Her Government also had championed partnerships across the social spectrum. Prevalence was relatively low in Gambia, but in 2008, HIV-1 prevalence had shown an increase. Over 2,500 people with advanced HIV infection were receiving antiretroviral treatment, while about 3,000 orphans and vulnerable children were receiving external support. “We need to do more,” she said, noting that resource mobilization, a goal of Gambia’s strategic framework, was a major challenge. Stigma and discrimination also had hampered the response.
RAZA BASHIR TARAR ( Pakistan) echoed the call made by the Secretary-General to all stakeholders to renew and strengthen their commitment to universal access, which should form part of the bridge towards achieving the Millennium Development Goals. Until recently, Pakistan was a “low-prevalence, high-risk country”, but it was now in a “concentred phase” of the epidemic, with HIV prevalence at more than 5 per cent among injecting-drug users. The proportion of HIV infection among other categories — such as sex workers, unemployed youths and urban injecting-drug users — was still increasing. The geographic trend of the epidemic was also expanding from major urban cities to smaller cities and towns. The country’s response was coordinated by the Government, along with bilateral and multilateral donors, the United Nations system and civil society. The National AIDS Control Programme had come a long way since 1986 in developing a comprehensive response, which took a multisectoral approach starting in 2003. Over the next five years, gains would be consolidated and services scaled up across wider geographic coverage.
He stressed that combating HIV/AIDS and eradicating poverty must proceed hand-in-hand, emphasizing that that coordination could not be achieved without the international community’s active and determined cooperation. He called for the special participation of the developed countries, which had a moral obligation to set aside part of their wealth to reduce the burden of poverty and alleviate human suffering. Further, low-cost drugs, lower profits, new scientific research and knowledge sharing and facilities were also needed to achieve common and sustainable solutions. He called on international donors not to reduce HIV spending as a result of the global economic downturn, urging them instead to commit to further funding to meet agreed commitments on universal access.
RAYKO RAYTCHEV ( Bulgaria) said that, while his country had maintained a low HIV prevalence among its general population, it had every reason to remain vigilant, given its common borders with the regions of Eastern Europe and Central Asia, which were known for having the fastest growing number of infections. As early as 1996, the National Committee for AIDS Prevention had been established to coordinate Bulgaria’s response. Since 2001, significant financial resources had been allocated annually by the Government to implementation of the National Programme for Prevention and Control of HIV and Sexually Transmitted Infections. For more than 14 years, the country had been providing up-to-date and free-of-charge antiretroviral treatment to all in need, and antiretroviral prophylaxis to prevent mother-to-child transmission. With the support of the Global Fund, Bulgaria, since 2004, had successfully scaled up access to prevention services among most-at-risk and vulnerable populations.
He said that Bulgaria’s integrated and balanced approach incorporated prevention, treatment, care and support, and strengthened human and institutional capacity. National standards and best practices had been established for the provision of specific services for the most at-risk groups, primarily through civil society partners. Among other things, mobile medical units, “low-threshold centres” for people who injected drugs, and community-based health and social centres facilitated access. People living with HIV also received quality medical care and psycho-social services, and participated in the planning and provision of those services. Welcoming the political declaration, he highlighted its reaffirmation of commitments for implementing national programmes among the most at-risk populations, as well as its use of human rights-based public health approaches. Among other notable aspects was its reaffirmation of strong financial commitments of national Governments and international organizations to ensure universal access.
GEORGE TALBOT (Guyana), noting that the 2001 and 2006 outcomes had guided global efforts in the fight against AIDS, said that, with today’s expected adoption of a new declaration, the international community would seek to intensify its efforts. For its part, Guyana had seen significant progress in combating AIDS, which was first diagnosed in the country in 1987. Resource allocation to the health sector, especially for HIV and AIDS, had been scaled up. As a result, infection rates and deaths continued to drop, while access to HIV prevention, treatment, care and support had increased. In addition, Guyana had seen substantial decreases in mother-to-child transmission of HIV.
Moreover, female sex workers and men having sex with men, among the most vulnerable groups, had seen decreases in prevalence, he said, noting that the Government was committed to enhancing programmes for access to prevention, treatment, care and support. Overall, Guyana’s advances could be attributed to political commitment at the highest level, as seen in its Presidential Commission, as well as dedication to a multisectoral approach and the forging of partnerships, including at the regional and international levels.
PARK IN-KOOK ( Republic of Korea), citing gains, said there had been a visible reduction in HIV incidence and mortality, as well as an overall promotion of the human rights and dignity of those living with HIV. Nevertheless, “this progress is not enough”: more than 7,000 people were infected worldwide with the HIV virus every day. Such challenges should be considered in the context of undermining development and human rights. Voicing support for zero new infections, zero discrimination and zero AIDS-related deaths, he said meeting those aims could contribute to the overall success of the Millennium Development Goals.
Sharing ideas on how stakeholders could have an impact, he said entire societies must participate in the fight against AIDS, without stigma or discrimination. It was essential to raise awareness of HIV/AIDS, based on accurate information, especially by using social networking services to target young people. Universal access to medical services was crucial to reduce the risk of transmission. While more than 6 million people had received antiretroviral treatment, the compliance rate was low and robust health systems were needed to ensure the effective care of HIV-positive persons. A country with low HIV-prevalence, the Republic of Korea would host the Tenth International Conference on AIDS in Asia and the Pacific, in August.
FERIT HOXHA ( Albania) said HIV/AIDS was not just a health issue, but was emerging as one of the most important elements in economic development and security of current times. Noting that this week’s High-Level Meeting took place three decades after the epidemic was first identified and 10 years after the General Assembly’s 2001 Special Session on HIV/AIDS, he said it was fitting to commend the efforts of the international community and the United Nations, particularly its specialized agencies, which had strengthened the capacity of communities to fight the disease. Those efforts and other practical measures had enabled significant reductions in new HIV infections in a substantial number of countries. Albania, still considered to be a “low HIV prevalence country”, was nonetheless using a national strategy to strengthen its national response at both the Governmental and civil society levels. Its messy legal framework had been strengthened and HIV education was included in the school curricula.
He said that, despite those advances, there was an upward trend in the reported cases of new HIV infections and estimates suggested there were a number of unreported cases as well. Several new cases were occurring in persons under 25 years of age and comprehensive knowledge of HIV/AIDS among that age group remained low. In that context, he stressed that particular sectors of civil society played an important role in the fight against AIDS, including through the organization of a variety of programmes. Albania was conscious that much more needed to be done.
ARAYA DESTA (Eritrea) said that, today, a growing number of countries had joined in adopting appropriate policies, strategies and programmes essential to reducing HIV prevalence, expanding access to treatment and enhancing respect for the dignity and human rights of those affected by the killer disease. But the world could not be complacent or remain unaffected by the continued suffering. In sub-Saharan Africa, alone, 22 million people were living with HIV and AIDS, and in 2009, roughly 2 million people were reportedly newly infected, while another 1.3 million AIDS-related deaths had occurred.
Against that backdrop, he said that, whatever efforts were employed, the key words were “scaling up”. Thus, the review process should give serious consideration to scaling up collective efforts towards universal access to comprehensive HIV prevention, treatment, care and support programmes. “Time is of the essence,” he said. “Let’s not forget that the infectious disease was first reported in the eighties, yet it took us over a decade to get together and acknowledge its occurrence and the danger it posed to humanity.” Pledging Eritrea’s commitment to the full implementation and realization of the time-bound and measurable goals and targets of the document before the Assembly, he said the text’s implementation must be followed by unified action.
RAFAEL ARCHONDO ( Bolivia) said that, despite his country having a low prevalence of HIV, fighting the HIV/AIDS scourge was one of its major priorities. The Ministry of Health had a national HIV/AIDS plan in place aimed at achieving the Millennium Development Goals, especially Goal 6. The clear demonstration of the Government’s commitment in that regard had been the enactment of a law to prevent AIDS, which underscored respect for the human rights of those affected, and emphasized a holistic approach to health care, without discrimination or stigmatization. However, discrimination persisted in communications, in the working world, and in the media.
He said there were nine departmental centres and three regional centres in place responsible for prevention and control of the disease, and a massive public awareness campaign under way to help prevent and fight HIV/AIDS. With a view to detecting HIV at early stages, the national programme hoped to improve diagnosis and strengthen treatment for all, especially HIV-positive pregnant women. It was very important to take bold decisions in order to radically transform responses to AIDS, and it was key that medication be made available and accessible, and that obstacles to intellectual property not impede the defence of life. Health-care centres must be able to bring down the walls of discrimination, and be open and friendly to all. Furthermore, the international community must not act on behalf of young people, only, but “with” them.
Action on Political Declaration
Before continuing with the general debate, the Assembly turned to the text before it, entitled, “Political Declaration on HIV/AIDS: Intensifying Our Efforts to Eliminate HIV/AIDS” (document L/65/L.77), adopting it by consensus.
Speaking after adoption in explanation of position, the representative of Syria, on behalf of the Arab Group, said that Group’s member States had adopted measures to facilitate the integration into their societies of people living with HIV/AIDS. Those measures were based on those countries’ cultural, religious and moral values and had led to reductions of HIV incidence. That, he stressed, demonstrated their effectiveness.
He reiterated the Group’s firm position — which was based on its firmest conviction — of the importance of the role of family in society and of moral, cultural and religious values in preventing the spread of HIV/AIDS and in raising the awareness of younger generations of that scourge. He reasserted the sovereign right of all States, as enshrined in the United Nations Charter and international law, regarding the implementation of programmes aimed at curbing HIV and AIDS. He added that such implementation must occur in a manner that respected the cultural and religious beliefs of a State’s peoples, as well as its national legislation.
He further emphasized the principles of respect and mutual understanding among Member States, taking into account their religious and cultural values. Despite Syria’s accession to consensus, he reiterated its “complete rejection” of those parts of the text that mentioned certain groups among the list of populations considered to be the most vulnerable. Syria’s position was based on its conviction that all groups should be treated equally and that none should be put above others. The determination of those groups was a national issue.
Iran’s representative said that, while his country was committed to providing the widest possible access to care, treatment and support for people living with HIV/AIDS, it found the Declaration to be discriminatory to the health care of the general public. Governments had the responsibility to support the health of all its citizens. Moreover, the “overly targeted” Declaration — particularly paragraph 29 — failed to recognize the detrimental role of risky and unethical behaviours in the spreading of the disease. Accordingly, the Iranian Government wished to put on record its reservation to that paragraph. Iran also was not committed to those parts of the Declaration that might in one way or another be interpreted as promoting unethical behaviour that ran counter to the religious beliefs and cultural values of Iranian society.
Brazil’s representative said it was important that, for the first time, targets had been set regarding such goals as reducing mother-to-child transmission and achieving access to antiretroviral drugs. In that vein, he stressed that, “there is no success without access”. He described as “far-reaching achievements” the inclusion of references to key populations, such as men having sex with men, sex workers and injecting-drug users, noting that those groups had been the focus of public policies on HIV/AIDS worldwide, including in Latin America and the Caribbean. Those groups also played an important role in developing policies to fight the epidemic. The Government of Brazil was fully committed to recognizing the need to scale up access to affordable medicine. In that context, treaty agreements must be interpreted in a manner that protected public health.
Saying that more must be done to halt the epidemic even in the face of significant gains, he underlined the need to guarantee the rights of key populations — stressing that that included, not just men having sex with men, sex workers and injecting-drug users, but also transgendered persons, and prisoners. Meanwhile, gains in the area of intellectual property rights must be through the public health “lens”. As stated in TRIPs, countries had to enforce intellectual property rights, but after patent expiration, the right to trade generic medicines must be guaranteed. He added that the lack of financial resources was an impediment to access.
Also explaining his position, the representative of Mexico said it was important that the final text contained paragraphs on stakeholders’ main concerns, including setting goals for universal coverage, prevention, commitment to eliminating stigmas, and the development of human rights and ethics in connection with fighting HIV/AIDS. References to financial resources, strengthening health-care systems, and action and innovations were also key. The adopted declaration made explicit reference to highest-risk populations for infection and the various types of advances that would no doubt be a platform for the future. The pandemic of HIV knew no nationality, and it was thus important to adopt a broad focus that did not zero in on specific factors. Whether it was desirable or not, there existed situations in society that were risky, and it was extremely important, therefore, to combat discrimination, particularly homophobia and transphobia, not just for those infected, but for all at-risk populations.
Speaking after the vote, a representative of the Permanent Observer Mission of the Holy See said that the Catholic health care knew well the importance of access to treatment, care and support for the millions of people living with HIV/AIDS. However, the reference to “young people” did not enjoy international consensus. The international community must respect parents’ right to provide appropriate guidance to their children, which included the primary responsibility to raise their children as they wished. States must acknowledge that the family based on marriage was indispensable for the fight against HIV and AIDS. It was the family that taught children moral values, and it was there that care and support was provided. The Holy See rejected references to terms such as “populations at high risk” since those references treated persons as objects and gave the impression that some types of behaviour was morally acceptable.
Additionally, she said the Holy See did not promote the use of condoms in sexual education and HIV prevention. Efforts should focus, not on trying to convince the world that dangerous behaviour formed part of an acceptable lifestyle, but on risk-avoidance that was ethically and empirically sound. The only safe and completely reliable method to prevent HIV was abstinence before marriage and respect and mutual fidelity within marriage, which was and must always be the foundation of any discussion of prevention and support. The Holy See did not accept so-called “harm reduction”, and efforts related to drug abuse, as such an approach did not respect the dignity of those suffering from drug addiction, as it only falsely suggested that they could not break free from the cycle of addiction. Such persons must be provided with the necessary spiritual and psychological support to restore dignity and encourage social inclusion.
She said the Holy See also rejected the characterization in the text of persons who engaged in prostitution as that gave the impression that prostitution could be a legitimate form of work. Governments and society must not accept such a dehumanization and objectification of persons. What was needed was a value-based approach to counter the disease of HIV and AIDS, which provided the necessary care and moral support for those infected and promoted living in conformity with the norms of the natural moral order, respecting fully the inherent dignity of the human person.
Following action, General Assembly President JOSEPH DIESS ( Switzerland) underscored the importance of this week in the fight against HIV/AIDS, saying “the world has watched as we forged a new Declaration that will shape the endgame of the AIDS epidemic”. By that text, Member States had committed to clear targets to ensure that by 2015 no children were born with HIV; close the global resource gap for AIDS and work towards increasing funding to between $22 billion and $24 billion by 2015; increase universal access to antiretroviral therapy to get 15 million people onto lifesaving treatment by 2015; reduce deaths from tuberculosis in people living with HIV, by 50 per cent; and reduce transmission of HIV among people who injected drugs, also by 50 per cent.
“These bold new targets set by world leaders will accelerate our push to reduce the transmission of AIDS,” he stated, admitting that he had been heartened by the resolve shown by Heads of State and Government during the week. He stressed that mothers and their future children would benefit immeasurably from the new “Global Plan towards eliminating new HIV infections among children by 2015 and keeping their mothers alive”, which had been launched yesterday. Meanwhile, the Security Council on Tuesday had adopted an important resolution on HIV/AIDS in the context of peacekeeping, which addressed the issue of sexual violence and the rights of women and girls in conflict and post-conflict situations.
The challenge now remained to implement those commitments, he said, noting that leadership and mutual accountability would be crucial. Thanking the facilitators, as well as UNAIDS and all co-sponsors of the Declaration, he said, “We must succeed; we must win our battle against AIDS. And we will”.
JANE ADOLPHE, speaking on behalf of Archbishop Francis Chullikatt, Permanent Observer for the Holy See, said that, through its approximately 117,000 health-care facilities around the world, the Catholic Church alone provided more than 25 per cent of all care for those living with HIV and AIDS, especially children. Those Church-affiliated institutions were at the forefront of providing a response that viewed people with dignity and worth as brothers and sisters and neighbours of the same human family, rather than as statistics. There was a growing international consensus that abstinence and fidelity-based programmes in parts of Africa had been successful in reducing HIV infection, where transmission had largely occurred within the general population. However, despite that, groups continued to deny those results and were instead largely guided by ideology and the financial self-interest spawned by the disease. HIV/AIDS was also a moral question, and the causes of the disease reflected a serious crisis of values. Prevention, first and foremost, should be directed towards individual development and education in proper human behaviour.
MARWAN JILANI, International Federation of Red Cross and Red Crescent Societies (IFRC), said that since the onset of the HIV pandemic, actions had focused on implementing comprehensive HIV programmes at community and household levels, by empowering people with information on prevention, carrying out home-based care programmes, promoting adherence to antiretroviral therapy and implementing harm-reduction programmes for injecting-drug users, among other initiatives. Despite “remarkable” achievements in improving the quality of life of people living with HIV and AIDS, many millions still awaited antiretroviral therapy and the prevalence of HIV infection was on the rise in some countries. The Federation’s strategy for the next decade focused on “saving lives and changing minds”, and the organization would work closely with Governments and civil society to promote country- and people-owned responses.
ROSILYNE BORLAND, speaking on behalf of William Lacy Swing, International Organization for Migration, said that in order for the bold vision set out by UNAIDS to be achieved, countries needed to focus their HIV prevention strategies on those facing the highest risk of HIV infection. HIV strategies must also begin to have an impact on the social determinant of health, which required cooperation across sectors, across borders, and with a wide range of partners. Nowhere was that truer than with migrants. Numbering more than 1 billion worldwide, migrants were not a homogenous group, and those in need of HIV information and services were often overlooked in national and regional HIV strategies. Those diverse groups had varying levels of HIV risk and vulnerability, and the health of migrants was the shared responsibility of origin, transit and destination countries. The international community should partner together in order to ensure that migrants, regardless of their legal migration status, also enjoyed the right to the highest attainable standards of physical and mental health.
URSULA SCHAEFER-PREUSS, Asian Development Bank, said the Asian region was home to nearly 5 million people living with HIV, 360,000 of whom had been newly infected in 2009. While no Asian country presented with a generalized epidemic, the next four years would be critical in achieving the Millennium Development Goals for the region by 2015. Most new infections occurred within identified high-risk groups, and responses must be tailored to fit those most in need. Governments could not face the problem alone, but required the engagement of the private sector, civil society, communities and development partners. Progress was impeded by a lack of data. Men who “bought sex” constituted the largest infected group, and because many were or would be married, their wives — usually considered low-risk — were then at high risk of infection. Eliminating gender inequalities and increasing the capacity of women to protect themselves must be made a high priority. Expansion of regional and South-South cooperation also could help address the needs of mobile and migrating populations, generate evidence-based good practices, and stimulate technology development.
SYLVIA J. ANIE, Director of the Social Transformation Programmes Division of the Commonwealth Secretariat, said many Commonwealth countries had made great strides in applying a multisectoral approach to increasing antiretroviral drug access. Concerned with women’s heightened vulnerability to the disease, the Plan of Action for Gender Equality recognized the need to put women at the centre of the development agenda and also at the heart of the global health agenda. Other efforts included incorporating HIV and AIDS in school and teacher training curricula, commissioning a pan-Commonwealth research project on women’s unpaid work in HIV care, and supporting efforts to increase universal access to antiretrovirals. As 60 per cent of Commonwealth citizens were under the age of 30, there was a strong focus on young people, and the Plan of Action for Youth Empowerment sought to ensure youth participation at all levels of development, including in response to the HIV epidemic.
MICHEL KAZATCHKINE, Global Fund to Fight AIDS, Tuberculosis and Malaria, said that the Fund was supporting half of the 6 million people on antiretroviral treatment in developing countries and was the major international funder for HIV prevention, including for prevention of mother-to-child transmission and harm reduction. Programmes supported by the Fund had saved at least an estimated 7 million lives from the three diseases in the last eight years. In 2001, the idea of treating millions of people with HIV, or virtually eliminating mother-to-child transmission, seemed almost utopian. Five years ago, those goals began to seem achievable. Today, they were realistic objectives.
As for the achievements in HIV treatment and prevention over the past years, the representative said that more still needed to be done to maximize the impact of investments, consistent with the UNAIDS investment analysis. That meant striking a balance between country ownership of programmes and ensuring that prevention targeted those most at risk, as well as accelerating the uptake and coverage of such new approaches, such as male circumcision and couples testing. Also needed were strengthening health systems and improving the health of women and children; more strategically leveraging markets for pharmaceutical products; promoting human rights and ensuring equitable HIV services; and obtaining new resources. It was also crucial for donors to continue to invest in the fight against AIDS and other diseases. The Global Fund would pursue each of those areas.
RYUHEI KAWADA, a member of the House of Councillors of Japan, speaking on behalf of the Inter-Parliamentary Union Advisory Group on HIV/AIDS, said that many countries had adopted positive legislation prohibiting discrimination against people living with HIV, and promoting legislation for HIV education for schoolchildren, and laws that instituted and protected harm-reduction services. However, laws that criminalized drug use, men having sex with men, and sex workers were a significant legal impediment to implementing those programmes. When a person was labelled as a criminal, it was harder for that person to receive treatment. Some countries had even criminalized HIV transmission. A lack of careful consideration of HIV-specific legislation could easily stigmatize people with HIV, de-motivate them from testing, and create a false sense of security. The IPU Advisory Group provided parliamentarians with access to relevant policy expertise and skills to properly exercise their duties of lawmaking, oversight, leadership and advocacy. Another key theme was access to medicines, and the Union also was providing guidance to support the enactment of appropriate intellectual property legislation and encourage achievement of universal access to treatment.
ROBERT L. SHAFER, Permanent Observer for the Sovereign Military Order of Malta, noting that mother-to-child transmission of HIV/AIDS accounted for 90 per cent of new infections in children under 15 years old, said that in the first two years of the Order’s “Save a Child from HIV/AIDS” programme in Mexico, more than 600 HIV-positive mothers had delivered healthy babies. As weak, fragmented health systems were among the biggest barriers to accessing HIV/AIDS services, especially in sub-Saharan Africa, the Order was creating structures and mechanisms that blended into communities. Touching on work in Kenya, Myanmar, India and South Africa, he said the Order also had programmes of medical and palliative care in Argentina, Mexico, Cameroon and the Democratic Republic of the Congo. There was a $7.7 billion gap between available global AIDS resources and the needs of developing countries, he added.
DAVID PATTERSON, Head of Delegation for the International Development Law Organization, said that legal reform to prohibit discrimination was not the only element for enabling a legal environment because the law could not eliminate discrimination without accessible and affordable quality legal services. To provide such services, lawyers needed to understand HIV, and relevant national and international law, as well as client needs. His organization had undertaken an extensive process of professional and community consultation to identify how to improve HIV-related legal services. Its health law programme had started in 2009 with a focus on eight countries; the organization would provide technical and financial support to strengthen HIV-related legal services in 17 countries.
He said his organization had undertaken groundbreaking work on HIV, law and development, including pilot projects to expand HIV-related legal services. In 2009, the organization had hosted the first regional training seminar on HIV law and policy in Asia and the Pacific, and then adapted the course for its online e-learning platform. It also had co-hosted regional consultations on HIV-related legal services and rights with local partners in Latin America, Middle East, North America and sub-Saharan Africa. With UNAIDS and the United Nations Development Programme (UNDP), the organization had developed the publication, “Toolkit: Scaling up HIV-related Legal Services”, over 4,000 copies of which had been distributed in English to Government and civil society partners. Experience had proven that people living with HIV would seek and use quality legal services to address discrimination, and that legal services made a difference. There was renewed political will to act on the commitments of Member States, but the challenge now was to expand legal services and integrate them into national plans and budgets for HIV and Government legal aid programmes.
UFUK GOKCEN, Permanent Observer for the Organization of the Islamic Conference, said the scourge was a global crisis with disastrous consequences for the social and economic progress of all nations, including the organization’s member States. Ensuring universal access to HIV prevention, treatment, care and support was the cornerstone in reversing the epidemic. A Memorandum of Understanding between the organization and the Global Fund, signed in May 2009, aimed at strengthening cooperation between the two to combat the three diseases. Since the creation of the Global Fund, 46 member States of the organization had benefited in the form of $4 billion allocated for fighting HIV/AIDS, $3 billion for malaria, and $2 billion for tuberculosis. He noted that an event held on the sidelines of the General Assembly in 2010 had been aimed at increasing the number of countries in the organization contributing to the Global Fund.
SOPHIA KISTING-CAIRNCROSS, Director of the International Labour Organization (ILO) Programme on HIV/AIDS and the World of Work, said that HIV-related stigma and discrimination fuelled the spread of the virus and led to human rights violations. Outlining considerable strides in the fight against HIV/AIDS, such as the number of people receiving treatment — 6.6 million — and legislation on non-discrimination in many Member States, she noted that the voluntary ILO Code of Practice launched in 2001 informed workplace policies on HIV and AIDS throughout the globe. However, because stigma and discrimination resulted, not only in the loss of jobs, but also loss of lives, the tripartite constituency of the ILO had embarked on a standard-setting process, resulting in recommendations. Key among the principles of those recommendations was that the response to HIV and AIDS should be recognized as contributing to the realization of human rights and fundamental freedoms and general equality for all, including workers, their families and their dependants.
She said that stigma and discrimination on the basis of real or perceived HIV status remained pervasive. Implementation of workplace policies, leading to much-needed universal access for people with HIV, reduced work absenteeism, increased treatment adherence, enhanced sustainable employment and provided access to social protection. However, for millions of small and medium-sized enterprises, where the majority of new jobs were created, it often was not possible to sustain a participatory policy environment for universal access, without outside support. In that context, public-private partnerships had shown great promise. Additional concerns included people at risk in such sectors as mining, tourism, transport, education and health; the occupational safety of health workers exposed to HIV and tuberculosis; and unemployment, particularly among young people.
BRIAN BRINK, Anglo American PLC, dedicated his remarks to a woman who had recently died from AIDS, leaving her child orphaned. “This is the story of AIDS in sub-Saharan Africa,” he said, noting that young women were dying of HIV and AIDS and that treatment often was “too little too late”. The social consequences were devastating and the economics made no sense. “This is what we have to tackle if we wish to stop the epidemic,” he said. He had seen how AIDS and tuberculosis had increased the costs of doing business, exacting a toll on employees. He had been particularly shocked by the impacts on women.
Among other things, Anglo American plc had learned that a human rights foundation for the AIDS response was vital and non-negotiable, and that partners and dependants must be part of the programmes. Counselling and voluntary testing were also essential. He had learned about the importance of making testing easy and confidential, and of the need for regular, repeated testing as a way to improve performance, as well as of knowing that an HIV-positive status would be followed up with ongoing care and support.
Most importantly, the business of AIDS response was a remarkably good investment, he said. Annual returns significantly exceeded the price of adopting that approach, as seen in reduced health-care costs, turnover and benefit payments. Liberating communities from the disease burden would allow new potential for business growth. Investments must be scaled up and benefits quantified in economic terms. Finally, he said violence against women must end. Comprehensive sexual and reproductive health services and education were also needed.
ESTHER BOUCICAULT STANISLAS, Foundation Esther Boucicault Stanislas, expressed gratitude to the efforts of all countries, North and South, that had helped to give hope to millions of people. While today’s needs were even more urgent, support from the Global Fund and her organization had supplied antiretroviral treatments to those in need in Haiti. She had been one of the first Haitians to publicly live with HIV. She drew attention to the “closing window of opportunity” to rebuild Haiti and provide the necessary resources for people living with HIV/AIDS. The lack of resources compromised daily the health and emotional well-being of Haitians living with HIV. The unplanned encampments in Haiti exposed women and girls to sexual violence and to the risk of infection. HIV affected the poorest, like so many others in Caribbean countries. Access to treatments must be increased, and Haitians must be empowered through employment.
She said that mothers with HIV were now able to give birth to uninfected children, but that was not happening in the more remote areas of her country, where access to treatment was limited and, thus, where hope had dissipated. While she was grateful to the wealthy nations for their contributions, she said the world would never be able to afford second-line drugs as long as pharmaceutical patents were more important than people’s lives. Haiti needed a stable health-care system to enjoy access to health care and basic human rights. With the Global Fund, her own and all other grass-roots organizations, treatment for pregnant women with HIV could be doubled, and all mother-to-child transfer of HIV could be eliminated by 2015. That was not a dream, but a hope, and she knew the struggle would be victorious. What were needed was treatment, housing and jobs.
SILVIA PETRETTI, Global Network of People Living with HIV, said people living with HIV must be at the centre of the AIDS response. When the draft declaration was released, she wondered: “are you truly listening to us?” She was concerned, after hearing women with HIV calling for recognition “as women”, that the only target in the text relating to women had to do with mother-to-child transmission. “We don’t have value just as baby makers”, she said. “Our rights must be promoted and uplifted at every stage, whether we have children or not.” Every woman had discussed how gender-based violence was a cause and consequence of HIV, an issue which affected her. The text needed concrete, numeric targets and investment in that area.
She said she also was concerned at the absence of a target for key populations like transgender people, and at the disappearance of a housing provision as a priority intervention. How could collective work to reverse the epidemic be carried out when essential rights had not been met? The involvement of persons with HIV made sense for various reasons, not least of which had to do with history. All civil rights movements had placed the people affected at the core. On a legal level, States were bound by the Declaration of Human Rights to uphold rights that provided for the freedom from degrading treatment, to have a family and to have access to information. Sadly, many of those rights were being denied to people living with HIV, even in so-called “developed Europe”.
“We need more than medication to live with dignity and safety,” she said. “We need your acknowledgement.” It was better for States to have people living with HIV on their side rather than against them. It made economic sense to work together in the current era of limited resources. Further, the voice and visibility of people living with HIV must be strengthened. There also was a health reason to involve them: HIV had not just damaged bodies; it had deepened existing wounds in communities caused by stigma and discrimination. “We all need to heal together,” she declared.
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