Despite Reservations Voiced over Elements Contradicting National Legislation, Member States Support Broad Efforts to Reduce Infection Risks, Stamp Out Epidemic
The General Assembly today opened a three-day high-level meeting on ending AIDS with the adoption, without a vote, of a Political Declaration calling for urgent action and intensified efforts to ensure that the global response to HIV and AIDS left no one behind.
The adoption of the “Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and the End the AIDS Epidemic by 2030” followed on the outcome of the last such meeting on the issue five years ago and placed it in the context of the Sustainable Development Goals.
By its terms, the General Assembly noted with deep concern that the HIV epidemic remained a paramount health, development, human rights and social challenge worldwide. It expressed grave concern that young people aged 15 to 24 accounted for more than one third of all new HIV infections among adults and that women and girls were still the ones most affected by the epidemic.
Among the commitments set out in the document, Member States would remove obstacles that limited the ability of low- and middle-income countries to provide affordable HIV treatment. They would also step up efforts, relevant to cultural contexts, to provide adolescents and young people with information on sexual reproductive health and HIV prevention. In addition, Member States would eliminate stigma and discrimination to ensure universal access to HIV treatment.
Ban Ki-Moon, Secretary-General of the United Nations, said that the next five years represented a window of opportunity to “radically change” the epidemic’s trajectory and wipe out AIDS forever. “If we do not act, there is a danger the epidemic will rebound in low- and middle-income countries,” he said, adding that action now could avert an estimated 17.6 million new infections and 11 million premature deaths by 2030.
General Assembly President Mogens Lykketoft (Denmark) called ending the AIDS epidemic “one of the greatest achievements of our lifetime”. In a world of incredible possibility, he said, it was hard to believe that 6,000 new HIV infections occurred daily and that 36.9 million people were living with AIDS.
Michel Sidibé, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said the Political Declaration would open a new door for ending AIDS. But, he warned that gains were fragile, with women being infected at the same rates as 20 years ago, adolescent girls “shockingly” vulnerable and discrimination pushing people into the shadows.
During the discussion, Heads of State, ministers and representatives reported national progress, voiced concerns and pledged further support to help stamp out the epidemic and reach the “90-90-90” goal of 90 per cent of children screened, 90 per cent in treatment and 90 per cent viral suppression.
Ruhakana Rugunda, Prime Minister of Uganda, said the number of new HIV infections had declined to 83,265 from 162,000, and prevalence among HIV-exposed infants had fallen to 3 per cent from 19 per cent in 2007. Furthermore, the number of people receiving antiretroviral therapy had increased to 834,931 in 2015 from 588,039 in 2013. Regarding efforts to achieve the 90-90-90 targets, he noted that 65 per cent of the HIV-infected population had been diagnosed and given access to care.
In that regard, he went on to say, Uganda’s population HIV impact assessment survey, which would begin in July, would provide the Government with better and current estimates. Despite those achievements, challenges remained in order to fast track the response, he said, expressing concern that only 55 per cent of Ugandans had ever been tested for HIV and 43 per cent of those eligible for antiretroviral therapy were not receiving treatment.
Regional groups addressed triumphs and challenges, with Timothy Harris, Prime Minister of Saint Kitts and Nevis, speaking on behalf of the Caribbean Community (CARICOM), reporting great strides between 2006 and 2015. Despite progress made, the region was second to sub-Saharan Africa in its prevalence rate.
Indeed, Ginette Michaud Privert, First Lady of Haiti, said hers remained one of the worst affected countries, noting that women make up 60 per cent of all people living with HIV/AIDS. She said the Political Declaration had been built on the ideas of ramping up actions to tackle HIV/AIDS and bolstering commitments to do so. To make tangible progress, she said, it was essential to ensure cooperation among all relevant actors, including international organizations, Governments, private sector, academia and pharmaceutical companies.
Prior to the adoption of the Political Declaration, the high-level meeting heard from Loyce Maturu, a Zimbabwean living with AIDS since the age of 12. She described how stigmatization had led to young people being denied jobs and scholarships. She urged Governments not to overlook such high-risk persons as sex workers, prisoners, migrants and those who inject drugs.
Participants also heard from Ndoba Mandela, a grandson of former President of South Africa, the late Nelson Mandela, who called for the end of travel bans imposed by 35 countries on persons with HIV. He also suggested told delegates to “always carry two condoms — one for you to use without fail and another to give to someone who isn’t carrying their own”. For a pittance, he said, they could make a difference and save lives.
Following the adoption of the Political Declaration, some delegates expressed reservations. Several, among them the representatives of Libya, Yemen and Sudan, had drawn attention to paragraphs that ran counter to their national legislation, religions and traditions. The representative of Iceland questioned the use of the term “sex worker”. His counterparts from Canada and Australia said they would have preferred stronger references to stigma, violence and discrimination facing people affected by the epidemic.
Making statements were ministers and representatives of Burkina Faso, Honduras, Saint Kitts and Nevis (on behalf of the Caribbean Community), Swaziland, Uganda, Lesotho, Gabon, Ghana, Côte d’Ivoire, Haiti, Monaco, Zambia (on behalf of the African Group), Botswana (on behalf of the Southern African Development Community), Mexico, Ukraine, Costa Rica, India, Central African Republic, Russian Federation, Armenia, Germany, Cambodia, Sweden, Kenya, Cuba, Namibia, Thailand, Zimbabwe, Tunisia and Algeria.
Speaking in explanation of vote after the Political Declaration’s adoption were representatives of Argentina (on behalf of a group of countries), Cuba, Singapore, Sudan, United States, Djibouti, Trinidad and Tobago, Indonesia, Egypt, Iran, Saudi Arabia, Mauritania, Libya, Russian Federation and Yemen, as well as the Holy See.
The high-level meeting will continue at 10 a.m. on Thursday, 9 June.
MOGENS LYKKETOFT (Denmark), President of the General Assembly, said it was hard to believe that some 34 million people had died from AIDS-related diseased and that 14 million had been orphaned as a result. It was harder to believe that approximately 6,000 new HIV infections occurred daily and that some 36.9 million people were living with AIDS. That was unacceptable in a world of incredible possibility. “Today is the moment, therefore, that collectively, we signal our intentions to strike out for victory, to fast-track efforts over the next five years and to end the AIDS epidemic by 2030,” he said, emphasizing the impact of HIV/AIDS on development, economic growth and conflict and post-conflict situations. He also noted how the epidemic had affected women and girls more than any other group, particularly in sub-Saharan Africa, and had an impact on young people, those who injected drugs, sex workers, men who have sex with men, transgender people and prisoners.
In recent years, he said, there had been strong progress towards the goals and targets set out in 2011. While reflecting on that progress and preparing for the next five years, the high-level meeting would identify best practices and lessons learned while determining how to overcome obstacles, plug gaps and address evolving challenges and opportunities. “If we want to reach our 2030 target,” he said, “all stakeholders must now step up to the plate”, with greater global solidarity, more resources and greater collaboration and partnership. More attention needed to be paid to equality, inclusion and the empowerment of women and girls by ensuring that key populations were included in AIDS responses and services were made available to them. Ultimately, he said, there needed to be accountability for commitments made. “Ending the AIDS epidemic would be one of the greatest achievements of our lifetime,” he said. “It can be done and it must be done.”
BAN KI-MOON, Secretary-General of the United Nations, said that a decade ago, AIDS was devastating families and communities. In many low-income countries, treatment had been scarce. In 2007, only 3 million people — one third of those in need — had access to life-saving antiretroviral drugs.
Enormous progress had been made, he said. Since 2000, the global total of people receiving that treatment had doubled every three to four years because of less expensive drugs, increased competition and new funding. Today, more than 17 million people were being treated, saving millions of lives and billions of dollars. Moreover, the world had achieved Millennium Development Goal 6, to combat HIV/AIDS, malaria and other diseases, and had halted and begun to reverse its spread. New HIV infections had declined by 35 per cent since 2000, while AIDS-related deaths had fallen by 43 per cent since 2003.
He said such success could not have happened without the leadership of people living with HIV and civil society partners, who had broken the silence and shone a light on discrimination and intolerance. Investment in the AIDS response had strengthened health systems, social protection and community resilience.
Yet, AIDS was far from over, he went on to say. In the next five years, there was a window of opportunity to “radically change” the epidemic’s trajectory and end AIDS forever. “If we do not act, there is a danger the epidemic will rebound in low- and middle-income countries,” he said. Action now could avert an estimated 17.6 million new infections and 11 million premature deaths between 2016 and 2030. Such successes would require commitment at every level, from the global health infrastructure to all Member States, civil society and non-governmental organizations, and to the Security Council, which had addressed AIDS as a threat to human and national security.
“I call on the international community to reinforce and expand the unique, multisector, multi-actor approach of the Joint United Nations Programme on HIV/AIDS (UNAIDS),” he asserted, and ensure that the annual target of $26 billion in funding, including $13 billion over the next three years, was met through the Global Fund’s fifth replenishment. That required continued advocacy and approaches that promoted gender equality and women’s empowerment. It also meant removing punitive laws, policies and practices and providing access to HIV services without discrimination.
The future of people with HIV/AIDS must be central to every decision, he said. Indeed, the AIDS response was a source of innovation and inspiration, showing what was possible when science, community activism, political leadership, passion and compassion came together.
MICHEL SIDIBÉ, Executive Director of UNAIDS, said today’s important Political Declaration would open a new door for ending AIDS. “We, the peoples, have broken the trajectory of the HIV/AIDS epidemic,” he declared, highlighting that the number of new infections and related deaths had significantly been lowered and results had been delivered on the 2011 Political Declaration. Recalling that in the General Assembly Hall, in 2001, someone had stated that treatment could not be provided to the poor, as it would be too expensive, he pointed out that at that time, treatment for each individual had cost $15,000 annually whereas today, that figure had dropped to less than $100 per person per year.
Providing some concrete results, he said it was the first time in history of HIV/AIDS that Africa had reached the “tipping point”, with more people on treatment than being newly infected. While that was truly amazing, West Africa and Central Africa had been left behind, he said, urging leaders to mobilize energy to triple the initiation rate of treatment within three years. It was important, after all, not to have a “two-speed” approach to the disease on the continent.
In addition, he said, the once distant dream to end mother-to-child transmission and create an AIDS-free generation was becoming a reality. Cuba had eliminated such transmission and, yesterday, the World Health Organization (WHO) had certified that Thailand, Belarus and Armenia had done the same. Many other countries would follow, he said.
Continuing, he said that four years ago, more than 58,000 babies in South Africa had been born with HIV/AIDS. Today, there were less than 6,000 such cases. Further, more than 80 countries had shown they would soon achieve the goal, as they had less than 50 babies born each year with HIV. One by one, the bonds of discrimination and exclusion were being broken, he said, underlining the importance of including prisoners, migrants, people with disabilities, men having sex with men, people who used drugs, sex workers and transgender people.
“The door to the United Nations should be open to all,” he stressed. “We cannot afford to silence their voices, as we come together to chart a course towards ending AIDS.” The rights to health and dignity must be universal, as enshrined in the United Nations Charter. The AIDS response had always been about partnership, innovation and social transformation and had produced unprecedented results: 8.8 million deaths had been averted.
But, those gains were fragile, he said. Women were being raped, exploited and infected at the same rates as 20 years ago. Adolescent girls remained “shockingly” vulnerable, with discrimination still pushing people into the shadows and preventing them from accessing life-saving treatment. A prevention revolution was needed that placed young people at its centre. It was unacceptable that 20 million people continued to die because of a lack of access.
“AIDS is not over,” he stressed, emphasizing that the next five years would be critical in placing countries on the “fast track”. Testing should be normalized and the 90 million people who did not know their status must be reached. “If we do not act now to break the backbone of the epidemic, once and for all, the world will never forgive us,” he said. “We can do it. We must do it.”
LOYCE MATURU, from Zimbabwe, described how in 2002 she lost her mother and brother to tuberculosis and AIDS and how, two years later, at the age of 12, she learned that she too had the same illnesses. “It was the most depressing moment for me,” she said. “I cried. I thought I was going to die, but here I am today.” In 2010, facing emotional and verbal abuse from a family member, she tried to kill herself with an overdose of medication. After going to the hospital and receiving “massive counselling”, she told herself she would live to make sure that peers living with HIV became confident, healthy and hopeful for the future. She said that today, she was thankful to be among 17 million people who represented the success of HIV treatment, but she was tired to see others with HIV die every day.
Identifying access and availability of treatment as a major challenge, she went on to emphasize the need for Governments not to exclude such persons as sex workers, those who inject drugs, prisoners and migrants. While HIV treatment might be free, most clinics charged administrative fees that many could not afford. Stigma remained a big barrier that had led to adolescents being denied jobs and scholarships, she said, appealing for investment in support mechanisms and advocacy for adolescents and young people with HIV/AIDS. Without training for health-care workers on providing client-friendly treatment services, the next generation would face the same problems as the current one. Noting that ending the epidemic would require teamwork, she said the Political Declaration on HIV/AIDS must take advantage of the upcoming International AIDS Conference to start drawing a road map towards that objective, and for the Global Fund to End AIDS, Tuberculosis and Malaria to be fully funded. She concluded by urging participants to trust and believe adolescents and young people in their countries to help shape the way society thought about HIV/AIDS.
NDOBA MANDELA, a grandson of former President Nelson Mandela, from South Africa, recalled the death of his father from AIDS. Citing his grandfather’s determination that his only son would not die in vain, he said the former president had prompted a national dialogue on AIDS in South Africa and global action around the world. Given those efforts, he asked that participants at the high-level meeting continued Madiba’s legacy and ensured that none of the 34 million people who had died with AIDS did so in vain. Going forward, “90-90-90 by 2020” should be a milestone for every country. Yet, the epidemic would not be ended by treatment alone. It would be a crime for the tools that stopped HIV infections were not used fully and immediately, he said, asking participants to ensure that persons at risk were able to live unafraid of arrest, physical danger or discrimination simply because of who they were or who they loved.
“Bigotry and fear do nothing but spread the [HIV] virus,” he said, asking the 35 countries with travel restrictions on foreigners living with HIV/AIDS to lift them immediately. Echoing the call of his mentor, Michel Sidibé, he called for the end of AIDS to be the first target of the Sustainable Development Goals to be achieved by his generation. Asking that all high-level meeting participants get tested for HIV, he said “always carry two condoms — one for you to use without fail and another to give to someone who isn’t carrying their own”. Doing so did not cost much, but its impact would be priceless. Lives would be saved and it would be the best down payment on ending AIDS. The eyes of millions of people living with HIV were on the high-level meeting and they were counting on delegates to make an unprecedented commitment to end AIDS and for promises to be kept.
A number of delegations took the floor before the vote on the draft resolution titled “Political Declaration on HIV/AIDS: On the fast-track to accelerate the fight against HIV and to end the AIDS epidemic by 2030” (document A/70/L.52).
The representative of Argentina, speaking also for Albania, Australia, Austria, Belgium, Bosnia Herzegovina, Brazil, Bulgaria, Canada, Chile, Colombia, Costa Croatia, Czech, Denmark, Dominican Republic, Estonia, Finland, France, Germany, Greece, Iceland, Ireland, Italy, Japan, Latvia, Liechtenstein, Lithuania, Luxembourg, Mexico, Monaco, Montenegro, Netherlands, New Zealand, Norway, Papua New Guinea, Panama, Peru, Philippines, Portugal, Romania, Serbia, Slovenia, Spain, Sweden, Thailand, United Kingdom, United States and Uruguay, welcomed gains achieved in addressing HIV/AIDS. At the same time, he acknowledged critical gaps, reaffirming the commitment to full implementation of the Beijing Declaration and Platform for Action, the International Conference on Population and Development and its Programme of Action and the outcomes of their review conferences, and the previous HIV/AIDS political declarations.
He strongly reaffirmed the commitment to end new HIV/AIDS infections by 2030, including in conflict, post-conflict and other humanitarian crises. Through evidence-based policies, he reaffirmed all human rights for all without distinction, with an emphasis on addressing structural inequalities for those who were living with or affected by HIV/AIDS. He called for enhancing health-care systems and capacities for broad public health measures, condemning discrimination, stigma and violence, including hate crimes, against people living with, presumed to have, at risk of and affected by HIV, including by strengthening legal protections. He committed to respecting the full enjoyment of sexual and reproductive health and rights for all, expressing grave concern that AIDS was the second leading cause of death among adolescents globally.
The representative of Cuba said he had joined consensus on the Political Declaration, recognizing with concern that some challenges it contained should have been reflected more clearly. The right to health must prevail over material, technological or intellectual ownership. No legislation or practice should limit universal access to treatment, he said, stressing that it was unacceptable that price limited such access. Comprehensive sexual education was essential to working with young people and adolescents, requiring resources to transfer the best technologies without conditions, under the auspices of the WHO and UNAIDS. Realization of the right to development would ensure victory over HIV/AIDS, he said.
The General Assembly then adopted draft resolution “L.52”.
Speaking in explanation of position after the action, the representative of Iceland said he had joined consensus on the text and aligned with Argentina’s statement, reiterating the commitment to end the AIDS epidemic. Iceland was against the term “sex worker”, as it was an incomplete reference to a key population group. Thirty-five per cent of women globally would experience sexual and intimate violence in their lifetimes. Bold actions were needed through a health system response and a multisectoral approach. Also, Iceland qualified prostitution in all its forms as sexual violence, as the act of buying sex was incompatible with human dignity. Iceland’s approach supported access for those who sold sex to health commodities. The term “sex work” implied that selling sex was legalized, which was not the case in a large majority of countries. In that context, it was important to recall the Convention on the Elimination of all Forms of Discrimination against Women referred to prostitution, rather than “sex work”. When referring to “sex workers”, there was a risk that those who did not sell sex for a profession were not covered by that term. It excluded those forcibly sold into the sex industry. UNAIDS had defined the sale of sex of those under 18 as “sexual exploitation”. The term also excluded people younger than 18 years old.
He proposed that “people who sell sex” was a more complete reference to those vulnerable to HIV as a result of selling sex. It was the term UNAIDS had used for those under and over the age of 18 years, and had allowed for variation among countries that had different legal frameworks, such as his own, which criminalized only the buyer. Nothing in the text gave UNAIDS a mandate to advocate for the legalization of sex work. The aim was to focus on the equitable deliver of treatment, care and support to those living with and affected by HIV/AIDS.
The representative of Singapore reaffirmed her country’s commitment to the fight against HIV/AIDS. While joining consensus on the Political Declaration, she said the reference to “harm reduction” in paragraph 43 called on States to consider ensuring access to such approaches. However, a range of approaches should be available to States. It was not useful to attempt to prioritize strategies at the global level. In Singapore, harm-reduction strategies were not relevant, since it had only a few cases of transmission through drug use. Singapore took a balanced approach to drug policies, with effective enforcement, rehabilitation and community partnerships to facilitate reintegration.
The representative of Canada said his delegation would have preferred that the Political Declaration had contained a call to end stigma, discrimination and violence against key populations. Canada strongly supported evidence-based harm-reduction measures and called upon Member States to consider their implementation. Going forward, Canada would continue to work in close partnership with civil society and those at risk of infection.
The representative of Sudan, expressing a number of reservations, said the Political Declaration included several not-agreed-upon terms, such as “sexuality”, which ran counter to the legal frameworks of several countries, and “comprehensive education”, which meant comprehensive sexual education, a notion that violated the United Nations Charter and the Convention on the Rights of the Child. “Key populations” referred to a few groups and other parts of the Political Declaration included principles that contradicted several traditions and religions. Sudan supported the principle of sovereignty, which was every Member State’s right, and renewed its commitment to ending the proliferation of HIV/AIDS.
The representative of the United States said that while the Political Declaration was necessary step, it was far from perfect and its language could have been stronger with regard leaving no one behind. Despite medical advances, there had not been so much progress on preserving human rights and preventing stigma, discrimination and violence against those living with HIV/AIDS. Comprehensive services needed to reach the most vulnerable populations and it was imperative to measure and change the dynamics driving stigma and discrimination, she said, adding that AIDS would not end without the protection of sexual and reproductive rights. She went on to express a number of reservations, including the United States’ concern regarding the right to development, which had no internationally agreed meaning.
The representative of Australia called the Political Declaration “a milestone” in the fight against HIV/AIDS, placing a human rights approach to ending HIV at its core, and recognizing the need empower women and girls, including their sexual and reproductive rights, as central to ending HIV. She urged States to see it as a minimum starting point to ending AIDS. The Political Declaration should have gone further to include key populations. Australia’s HIV/AIDS response was informed by “evidence of what works”, which included engaging key populations with services that delivered a high impact at lower cost. Disappointed the text did not call to end stigma violence facing lesbian, gay, bisexual, transsexual and transgender people globally, she condemned any efforts to interpret HIV/AIDS transmission as a criminal issue.
The representative of Djibouti underscored a national determination to implement non-discriminatory policies to eliminate AIDS by 2030. Emphasizing the importance of leadership and national ownership in those efforts, she welcomed paragraph 4 for reaffirming States’ sovereign rights and the need to implement the Political Declaration in line with federal laws, development priorities and different cultural, religious and other values. For Djibouti, key and vulnerable populations were women and young people. References to sexual and reproductive health should not be interpreted as an appeal for people living with HIV/AIDS to interrupt their pregnancies, she said. National efforts on that issue consisted of eliminating mother-to-child transmission and she urged continued support for those initiatives. Djibouti ensured access to sexual and reproductive health services for all women under commitments made at the International Conference on Population and Development in Cairo. Paragraphs 14 and 61 of the Political Declaration did not imply a reinterpretation of the Cairo Programme of Action and could not be interpreted as a guarantee of uncontrolled access to sexual and reproductive health services.
The representative of Trinidad and Tobago recognized the importance of paragraph 4, noting that health-care services, including in HIV/AIDS prevention, treatment and care, were provided to all citizens. The provision of pre-exposure prophylaxis, however, went against his country’s post-exposure prophylactic policy. Such an approach could give a false sense of security and encourage risky behaviour. He was pleased to join consensus and pledged to implement the Political Declaration in line with national priorities.
The representative of Indonesia said the most effective way to eradicate HIV/AIDS was outlined in paragraph 57, through differentiated responses based on national ownership, local priorities, drivers, vulnerabilities and aggravating factors. Paragraph 42 emphasized that each country should define vulnerable populations. For its part, Indonesia recognized that such populations included those at a higher risk of HIV transmission. On paragraph 39, he supported reducing risk-taking behaviour. Stopping the virus required encouraging avoidance behaviours, such as abstinence and fidelity, which were the most effective ways to stop transmission. Any reference made to adolescents should be interpreted as a reference to a “child”. He was concerned at the use of “people who use drugs” as it had a different meaning than the agreed term. More broadly, he said terms used in the Political Declaration would not serve as precedents for future decisions in other fora.
The representative of Egypt said his country had joined consensus on the Political Declaration, despite that it contained controversial points that did not reflect consensus on social, cultural and religious diversity. His Government would implement its commitments as part of international and regional strategies to combat HIV/AIDS. He dissociated himself from paragraphs 42, 62 (e), (g) and (h), as well as 61 (n) and (j), expressing concern at the multiple terms used, such as “people at high risk”, “key populations”, “high-risk populations” and “populations at risk because of epidemiological evidence”, which were not in line with Egypt’s values.
The representative of Iran said his country was committed to providing the widest possible access to care, treatment and support to people living with HIV/AIDS. It was a public health issue and Governments were obliged to ensure the highest attainable health and well-being standards for all citizens. It was expected that the Political Declaration would have avoided discriminatory approaches, but it was unacceptable that it had avoided appreciating risk-avoiding measures, such as fidelity and abstinence. He expressed a reservation to any part of the Declaration that contravened Iran’s legal framework or religious and cultural values. He reserved Iran’s position on de facto definitions, in paragraphs 42 and 62 (e), as they disregarded national circumstances. Also, any reference to “children and adolescents” would take into account the roles and responsibilities of their parents. He expressed concern that such misplaced terms as “people who misused drugs” were being used in the context of HIV/AIDS.
The representative of Saudi Arabia, on behalf of the Gulf Cooperation Council, reiterated States’ sovereign right to implement national programmes that were in line with legislation and religious, ethical and cultural values. He expressed reservations about paragraphs 42 and 62 €, which used “key populations”, 60 (h) and 62 (g), which discussed “vulnerable populations”, as well as paragraph 61 (l). Forced and early marriage was a crime under various conventions, including the Convention on the Rights of the Child. He expressed a reservation about the term “sexual rights”, as it was important to consider national and regional specificities, cultural values and other aspects.
The representative of Mauritania said it was clear that AIDS was a serious danger and a huge challenge. However, the Political Declaration included principles with which he could not agree, he said, expressing reservations about all concepts that ran counter to national legislation.
The representative of Libya echoed the view expressed by some other delegations that the Political Declaration ran counter to national legislation and Muslim traditions. However, his delegation had joined consensus, mindful of the need to address the illness. Once his country had achieved stability, it would contribute to eliminating the illness so that Africa could enjoy sustainable development by 2030.
The representative of the Russian Federation said there was no doubt about the need to step up efforts to combat the spread of HIV infections. However, she said, the main responsibility for protecting populations from infections rested with the States themselves. She expressed disappointment that, unlike the 2011 declaration, the focus had shifted from real measures to help countries to end the epidemic to other questions that did not enjoy a large consensus. She expressed a number of reservations, including the obligation to reform national legislation with respect to infected populations and the language regarding key groups and sexual education. In her country, implementation would be carried out only in line with national policies and traditions.
The representative of Yemen, echoing concerns that had been raised by some of his counterparts, expressed reservations about terminology that ran counter to national legislation.
The representative of the Holy See said that, in combating discrimination and stigmatization, a difference needed to be made with measures to prevent risk-taking behaviour. The only safe and reliable method of preventing the sexual transmission of AIDS was abstinence before marriage and respect for fidelity in marriage. The Holy See did not consider abortion as a dimension of reproductive health. Regarding contraception and condom use, he reaffirmed his support for the family planning methods that the Catholic Church considered morally acceptable. Among other reservations, he said his delegation understood the term gender as referring to persons born male or female.
ROCH MARC CHRISTIAN KABORÉ, President of Burkina Faso, said the fourth national HIV response document covering 2016 to 2020 was part of national strategic plans that prioritized high-impact methods. In turn, the strategic national framework was part of international efforts to end HIV/AIDS by 2030. Citing gains, he said Burkina Faso had lowered and stabilized HIV/AIDS prevalence, increased access to treatment and was seeking innovative ways to mobilize resources. Prevalence had fallen to 0.9 per cent in 2014 from 1.2 per cent in 2011, with priority given to reducing mother-to-child transmission. The Government had been providing free antiretroviral treatment to people with HIV/AIDS since 2010, he said.
Urging more needs-based adaptions of strategies, including for vulnerable and high risk groups, in order to control transmission, better target interventions and strengthen both the gender and human rights aspects of care and support, he said additional efforts were needed to reduce new infections among women and young people and from mother-to-child with a view to achieving the 90-90-90 objective by 2020. For its part, Burkina Faso was also determined to improve budget allocations to fight HIV/AIDS and sexually transmitted infections, he said.
ROXANA GUEVARA, Vice-President of Honduras, said intelligent investments were needed to reduce new HIV/AIDS infections and related deaths, stressing the strategic importance of prevention and guaranteed access to key populations, with an emphasis on adolescents and young people. Condemning the assassination of a well-known leader of the lesbian, gay, bisexual, transsexual and/or intersex community of Honduras, a crime that had had homophobic characteristics, she stressed that the Government had ordered an investigation to bring the perpetrators to justice. Honduras was limited by resources, but had the will to enhance care, treatment and support for people living with HIV. She appealed to donors to continue their support and to others that had withdrawn their assistance to restore it. Violence and discrimination persisted, she said, urging that barriers to testing and care be dismantled. Emphasis must be placed on young people and their rights. Resources must also be used to target key populations, people of African descent, indigenous peoples, migrants, women, men, adolescents and young people, she said, calling for the allocation of resources, increased availability of diagnostic tests, promotion of responsible sexual conduct and the protection of the lives of the unborn.
TIMOTHY HARRIS, Prime Minister of Saint Kitts and Nevis, speaking on behalf of the Caribbean Community (CARICOM), said the region had made great strides between 2006 and 2015. The HIV prevalence rate had been halved and the estimated number of people receiving antiretroviral therapy had increased from 5 to 44 per cent. Despite progress made, the region was second to sub-Saharan Africa in its prevalence rate. The vast majority of people living with HIV were concentrated in three countries, where prevalence among the key risk groups could be as high as 32 per cent.
Expressing support for the global and regional leadership of UNAIDS, he noted that the organization had demonstrated what could be achieved through coordinated policies. As the 2030 Agenda for Sustainable Development provided new challenges and opportunities, CARICOM placed greater emphasis on capacity-building, lessons learned, universal health-care coverage and affordable medicine. In 2002, the region had become the first to negotiate and sign an agreement with six pharmaceutical companies, reducing drug prices by about 85 to 90 per cent. Turning to the Political Declaration, he recognized that it provided useful guidelines, but stressed the need to take into consideration cultural, political, social and economic circumstances. On the financing required to end AIDS, he decried the calculations of contributions based on gross domestic product (GDP) alone because it had failed to include other factors that were impeding small economies.
BARNABAS SIBUSISO DLAMINI, Prime Minister of Swaziland, expressed his country’s hope to end AIDS by 2022. That meant accelerating efforts in reducing new infections and eliminating all forms of stigma and discrimination. It would require greater involvement of people living with HIV and of men as strategic partners, he said, underscoring the need to address the vulnerabilities of young women and girls. He then went on to stress that HIV treatment must be extended beyond the health-care system by strengthening the role of communities. That would improve adherence to life-long treatment, create efficiencies in service delivery and reduce new infections, he pointed out.
While his country remained committed to financing the HIV/AIDS response, he said it was crucial that global development fora prioritized discussions about sustainable financing. The agenda for ending the epidemic by 2030 would be accomplished through the improved collaboration within regional blocs, he said, noting that it would create efficiencies in areas including HIV research.
RUHAKANA RUGUNDA, Prime Minister of Uganda, said national strategies had attached great importance to fast-tracking the fight against HIV and ending the AIDS epidemic. In partnership with development partners, the private sector, civil society, religious and cultural leaders and local communities, Uganda had made significant strides in combating that epidemic since 2011. The focus of national efforts had been to implement high-impact structural, behavioural and biomedical interventions on a sufficient scale and intensity.
Sharing the outcomes of some of those initiatives, he noted that the number of new HIV infections had declined to 83,265 from 162,000, and prevalence among HIV-exposed infants had fallen to 3 per cent from 19 per cent in 2007. Furthermore, the number of people receiving antiretroviral therapy had increased to 834,931 in 2015 from 588,039 in 2013. Regarding efforts to achieve the 90-90-90 targets, he noted that 65 per cent of the HIV-infected population had been diagnosed and given access to care. In that regard, Uganda’s population HIV impact assessment survey, which would begin in July, would provide the Government with better and current estimates. Despite those achievements, challenges remained in order to fast track the response, he said, expressing concern that only 55 per cent of Ugandans had ever been tested for HIV and 43 per cent of those eligible for antiretroviral therapy were not receiving treatment.
MOTHETJOA METSING, Deputy Prime Minister of Lesotho, said his country had one of the highest adult HIV prevalence as there were an estimated 52 new infections and 26 deaths each day. Although the epidemic had been stable over the years, the level was too high to realize the target of 90-90-90. Lesotho had adopted the WHO 2015 HIV testing services and prevention, care and treatment guidelines and the Prime Minister had launched a “test and treat” strategy in April. “We are focusing on innovative targeted community-based HIV testing services,” he said, emphasizing that the aim was to reach key populations, such as sex workers, people with disabilities and tuberculosis patients. To ensure that no one was left behind, the international community must do more to reach the most affected populations. While Lesotho was on the right path, existing testing and treatment were not enough and the global community must provide support through increased and innovative funding, he concluded.
PAUL BIYOGHE MBA, Deputy Prime Minister of Gabon, said that HIV in Africa remained a major public health threat, like malaria and non-transmittable diseases. Gabon had not escaped its multiple devastating effects and despite enormous efforts, the struggle against HIV/AIDS was far from being won. More needed to be done, he said, emphasizing the impact of the economic and financial crisis on developing countries. Progress that had been made so far on HIV/AIDS would be in vain if some countries, including middle-income countries like Gabon, were excluded from international aid. Only greater solidarity and the intensive mobilization of meaningful financing would enable a fast-tracked response to HIV/AIDS, he said.
KWESI BEKOE AMISSAH-ARTHUR, Vice-President of Ghana, said that between 2009 and 2014, HIV infections had dropped by 30 per cent, while AIDS-related deaths had fallen by 43 per cent. Yet, HIV infections continued to spread, with women being disproportionately affected and comprehensive knowledge of HIV among those aged 15 to 24 years remaining low. Ghana was working to accelerate access to HIV testing and treatment. It had launched a national campaign to accelerate testing and achieve universal treatment, which could result in 43 per cent of the population knowing their status. Access to safe, affordable and effective medication was critical to improving the quality of life. Sub-Saharan Africa was the worst HIV-affected region, yet it relied on imports of antiretroviral medications. He reaffirmed Ghana’s commitment to the African Union Road Map on AIDS, Tuberculosis and Malaria and noted national efforts to reduce child marriage and gender-based violence. While domestic mobilization of resources was needed, a scaling-up of global funding would be required to avoid a rebound in HIV/AIDS infections. International support to complement domestic funding was critical in sub-Saharan Africa, he said, urging continued efforts to harness the AIDS machinery to tackle broader global health and development challenges.
DOMINIQUE FOLLOROUX-OUATTARA, First Lady of Côte d’Ivoire, said the HIV/AIDS pandemic continued to claim countless victims, especially women, youth and children, requiring significant investments. While more must be done, Côte d’Ivoire had made significant progress, with new HIV infections falling by more than 50 per cent to 25,000 in 2014 from 52,000 in 2000. More than 150,000 people were on antiretroviral treatment and a law now protected people living with HIV/AIDS from discrimination. Such results had led the Executive-Director of UNAIDS to state that Côte d’Ivoire could be among the first sub-Saharan African countries to eliminate mother-to-child transmission. She advocated strong partnerships in order to eliminate AIDS and to reach the 90-90-90 goal. The recent meeting in Abidjan on ending paediatric AIDS had shown Africa’s commitment to those objectives.
GINETTE MICHAUD PRIVERT, First Lady of Haiti, said the Political Declaration had been built on the ideas of ramping up actions to tackle HIV/AIDS and ensuring commitments to do so. Making tangible progress depended on cooperation among all relevant actors, including international organizations, Governments, private sector, academia and pharmaceutical companies. Despite recent achievements, the scale and magnitude of HIV/AIDS required stronger efforts to put an end to the epidemic. Haiti remained one of the worst affected countries, she said, also noting that women make up 60 per cent of all people living with HIV/AIDS. In that regard, the Government had undertaken various measures, such as increased investment in preventive care and improving access to health clinics and screening tests.
Princess STÉPHANIE of Monaco said, over the past centuries, humanity had had to face many pandemics that had lasted decades. Although a vaccine had yet to be found, HIV/AIDS would be eradicated one day. Expressing support for the international community’s commitment to combat the epidemic at national, regional and international levels, she noted that the conspiracy of silence had been weakened. “AIDS is not the disease of others, it touches us closely,” she said, emphasizing that access to treatment should not be limited to the rich. Welcoming the Secretary-General’s report, she underscored the need to change the existing approach to produce effective results.
JOSEPH KASONDE, Minister for Health of Zambia, speaking on behalf of the African Group, reiterated the Common African Position towards the Political Declaration, noting that “key populations” varied from country to country and that each State should define specific groups based on local epidemiological contexts. Since 2006, when African leaders had declared 2010 the year of universal access to HIV prevention, treatment, care and support, Africa and its partners had made “considerable” progress. New infections had declined or stabilized in many African countries, while AIDS-related deaths were falling. He reaffirmed the need for technology transfer, capacity-building, market access and support to make use of trade-related aspects of intellectual property rights by strengthening health regulatory procedures.
“The AIDS response is failing children and young people in Africa,” he said. He urged partners to triple their investments for treatment in West and Central Africa. Formulas for paediatric antiretroviral therapy were also a challenge and in Eastern and Southern Africa, only 10 per cent of young men and 15 per cent of young women were aware of their HIV status. The African Group was committed to a collective response to HIV, he said, expressing concern about restrictive laws, policies and practices around the world that maintained structural conditions while excluding people from access to HIV care.
Speaking in his national capacity, he said Zambia had co-facilitated the Political Declaration. Urging all stakeholders to commit to ambitious testing targets, including the 90-90-90 target, he said the global commitment to end AIDS by 2030 was an opportunity to address a myriad of health challenges, citing Sustainable Development Goal 3.3 in that context. Ending poverty, ensuring health care and achieving gender equality would be addressing the underlying factors that left people vulnerable to HIV/AIDS, along with creating peaceful inclusive societies. Zambia had a synergistic relationship between poverty and HIV/AIDS, based on the idea that the disease was a development issue, which had led to a multisectoral, multidimensional response. Zambia was coordinating HIV/AIDS activities to ensure monitoring and evaluation of activities. Reducing HIV incidence required a mix of prevention, treatment, advocacy, care and support alongside interventions for comprehensive sexual and reproductive health. Zambia was committed to adopting game-changing interventions to increase voluntary male circumcision, he said, stressing that comprehensive sexual education was an important tool for empowering young people with information to combat infection.
DORCAS MAKGATO-MALESU, Minister for Health of Botswana, speaking on behalf of the Southern African Development Community (SADC), associated herself with the African Group. Southern Africa had made tremendous progress in the areas of HIV/AIDS treatment, but prevention efforts had lagged. More innovation was needed, she said, calling for “bold” action in that area. Testing was essential for mapping out prevention efforts. Noting that the region was affected by HIV/AIDS, tuberculosis and malaria, she advocated “integration” as a way to leverage health systems and urged the General Assembly to promote it as a key strategy in the global response to HIV/AIDS. Globally, regionally and nationally, there had been remarkable efforts to attain the UNAIDS Three Ones principles and universal access targets. Recognizing the importance of increased domestic financing, she also requested continued, increased, predictable and sustainable financial assistance to augment country shortfalls. Such help should be aligned with priorities defined in the SADC HIV/AIDS, Sexual and Reproductive Health, Tuberculosis and Malaria Programmes Integration Strategy.
Speaking in her national capacity, she said Botswana was committed to ending AIDS by 2030, having allocated more than 17 per cent of its budget to health, surpassing the Abuja Declaration’s 15 per cent target. Since the first case of HIV/AIDS emerged in 1985, Botswana had put in place programmes to prevent and control the epidemic. It had been at the forefront of the HIV response as the first country in Africa to introduce antiretroviral treatment. Now, more than 95 per cent HIV-positive people had access to such drugs. Just one week ago, the President had launched the national Treat All strategy, which aimed to treat all HIV-positive people with antiretroviral drugs. Mother-to-child transmission had dropped to 1.6 per cent, setting the country on track to eliminate it by 2030. The national response also required a change in the delivery of services. Studies had shown that Botswana was now within reach of achieving the 90-90-90 target by 2020. Eighty-three per cent of HIV-positive people knew their status, and 96 per cent of those on treatment had received viral suppression.
JOSÉ NARRO ROBLES, Minister for Health of Mexico, said there was a possibility of ending HIV/AIDS by 2030 and emphasized that progress achieved had not been a coincidence. To move forward, it was crucial to identify high-risk groups, including people with disabilities, men having sex with men, people who used drugs, sex workers and transgender people. Including key populations in the response efforts would enable the international community to achieve the Sustainable Development Goals. In that regard, overcoming homophobia and transphobia was essential, he said, noting that the Government had ensured that lesbian, gay, bisexual and transgender people fully exercised their rights. Drawing attention to the lack of awareness regarding HIV status, he stressed the need to adopt holistic strategies, such as science-based sexual education and access to universal health care. In addition, new technologies must be used based on confidentiality, he noted.
VIKTOR SHAFRANSKY, Minister for Health of Ukraine, said HIV prevalence was an unfortunate reality. Ukraine had the second highest HIV epidemic rate among Eastern European and Central Asian countries, with an estimated 220,000 people living with HIV and 11,000 new cases each year. At the moment, Ukraine was struggling to build stability and security due to the annexation of Crimea and military aggression backed by the Russian Federation. Despite that challenge, Ukraine stood committed to fight the epidemic. In April, for instance, Kyiv had joined the Paris Declaration to end the AIDS epidemic, subsequently becoming the first city in the region to begin the implementation of a fast-track strategy.
FERNANDO LLORCA CASTRO, Minister of Health of Costa Rica, associating himself with Argentina on behalf of a group of countries, said the Government had grappled at the institutional level to reduce HIV/AIDS prevalence, especially among key and vulnerable populations. To take stock of whether it had eradicated vertical transmission, Costa Rica was working to collect data. To combat discrimination against vulnerable groups, the Government had decreed, for humanitarian and public health reasons, compulsory care and treatment of sexually transmitted infections, including HIV-positive people, irrespective of whether people had health insurance or were citizens or foreigners. It had also rolled out a programme, financed by the Global Fund, to diagnose HIV in situ and was working on universal coverage for rapid testing. There had been resistance against rapid testing over concerns it would replace the commonly used ELISA test. In addition, the Government urged international and local non-governmental organizations to ensure that pilot projects included the institutionalization of good practices and structural change.
JAGAT PRAKASH NADDA, Minister for Health and Family Welfare of India, noted that strong political will and concerted action over the last decade had contributed to strong achievements in pushing back the epidemic. As the number of HIV-affected people benefitting antiretroviral therapy had increased substantially and the number of annual AIDS-related deaths had dropped considerably, the target of ending that epidemic by 2030 was realistic. For its part, India had been able to manage the challenge effectively. AIDS-related deaths had been reduced by 55 per cent since 2007 and around 1 million affected people were currently receiving antiretroviral therapy. Those remarkable successes would not have been possible without access to affordable medicine, he said, noting that the low cost generic medicines had been instrumental in scaling up access to necessary treatment. To make further progress globally, it was essential to adopt fast-track targets that had been proposed by UNAIDS, increase investments, ensure access to affordable medicines and commodity security and to create an inclusive society.
FAUSTIN ARCHANGE TOUADERA, President of the Central African Republic, said given the current and unprecedented humanitarian crisis, national efforts had been slowed alongside the Government’s multisectoral approach to combat AIDS and improve various indicators. Between 2013 and 2014, almost one third of those receiving antiretroviral treatment had been unable to continue, due to the massive population displacement and related difficulties in organizing their care.
Still, he continued, with support, the Central African Republic had maintained a decrease in HIV/AIDS prevalence, with initial results of a screening survey showing a rate of 4.4 per cent. To address the many challenges ahead, the Central African Republic had adopted a national strategic plan covering 2016 to 2020, with the goal of climbing to a 90 per cent level of antiretroviral coverage, which stood currently at 24 per cent. To help further combat the epidemic, he requested international support and assistance.
VERONIKA SKVORTSOVA, Minister for Health of the Russian Federation, outlined the Government’s strategy for combatting HIV/AIDS, which included educational programmes targeting youth. Through preventive measures, 98 per cent of Russian children born to HIV-positive mothers were healthy. Drug users were motivated to abstain from narcotics and they had access to modern rehabilitation centres. No-cost HIV screening was available for more than 30 million people, anonymously, if desired. In Crimea, a spike in HIV infections in 2014 based on increased drug use was followed in 2015 by a decline in the HIV-related death rate. The use of WHO-recommended standardized treatment modules, among other measures, had lowered the price of treatment. Activities to combat HIV in the Russian Federation were financed from the federal budget, freeing those who had been infected from financial burden. Her country also extended financial support to HIV/AIDS programmes elsewhere in Eastern Europe. The success of the Political Declaration adopted today would depend on the efficacy of national programmes that were based on common global goals and took into account national situations and legislation.
ARMEN MURADYAN, Minister for Health Care of Armenia, said the national situation included a low HIV prevalence rate. Yet, the epidemic was growing in the Eastern Europe and Central Asia region. Armenia had a tightly integrated system of services on HIV/AIDS, tuberculosis, maternal and child health, which ensured early diagnosis and quality health care for those in need. As an important accomplishment, since 2007, no HIV case had been registered among the children born to HIV-positive mothers that had been provided with antiretroviral prophylaxis. In fact, Armenia had reached the WHO targets for validating the elimination of mother-to-child transmission. Donors and international organizations had played a crucial role in the fight against that epidemic. As one of the recipient countries of the Global Fund and Russian Technical Assistance Programme for HIV/AIDS Control in Eastern Europe and Central Asia, Armenia had created new infrastructure and improved access to prevention and treatment services.
HERMANN GRÖHE, Minister for Health of Germany, said that, as HIV was affecting the most disadvantaged groups, political leadership was of utmost importance. Social exclusion and the stigmatization of people, based on their gender or sexual orientation, ethnicity or behaviour, had promoted the spread of HIV infections. The fast-track goals would not be achieved without removing laws that punished homosexuality or failed to recognize drug addiction as an illness. Advancing gender equality and the empowerment of women and girls were also central to ending the AIDS epidemic. States must ensure that young people could access comprehensive sexuality education and youth-friendly health services. Germany had increased its commitment to global health to €800 million annually. It would strengthen national efforts to reduce new HIV infections, especially among men having sex with men. To that end, it had adopted an integrated strategy for HIV, hepatitis B and C viruses and other sexually transmitted infections. He urged political leaders to engage youth and work with both civil society and people living with HIV.
IENG MOULY, Senior Minister and President of the National AIDS Authority of Cambodia, said national achievements were not a coincidence, but a result of a strong and high political commitment, with the cooperation of development partners, civil society, the private sector and people living with HIV. The national AIDS response had evolved and adapted to new challenges and opportunities, moving from epidemic control towards the elimination of new infections. Citing an example, he said the Government had drafted HIV and AIDS laws to create positive enabling environments to mobilize participation and tolerance from the society at all levels. In addition, it had undertaken various measures to ensure that high-risk populations had better access to the continuum of prevention, care, treatment and support.
GABRIEL WIKSTRÖM, Minister for Public Health, Health Care and Sports of Sweden, said that ending the AIDS epidemic meant eradicating discrimination and stigma against people who were lesbian, gay, bisexual, transgender or questioning, men who have sex with men, people who injected drugs, people who sold sex and people who lived with HIV. Gender equality needed to be strengthened, he said. Asylum seekers needed to be reassured that their HIV status would not affect their applications. Everybody should have access to comprehensive sexuality education and young people should be included in planning and implementing HIV programmes. It was important to remember that people living with HIV and key populations knew more about the problems and solutions than many attending the current high-level meeting, he said. Also essential to recognize was that poverty eradication was at the core of an effective response to HIV and AIDS.
CLEOPA MAILU, Health Cabinet Secretary of Kenya, said a committed multi-sector HIV response could rally resources of different Government agencies, communities and stakeholders towards a common goal and accelerate access to services. Sharing national experiences, he noted that Kenya had made significant progress. HIV prevalence had dropped from 13 to 6 per cent, and new adult infections had been reduced from 110,000 to 72,000. Furthermore, the Ministry had aggressively scaled up treatment and put over 900,000 people living with HIV on life-long antiretroviral therapy. In addition, he noted that 72 per cent of Kenyans had been tested at least once, and stigma levels stood at 45 per cent. The gains made had been driven by many factors such as high quality research, implementation of innovative approaches, and availability of commodities, he said, while acknowledging existing gaps and challenges. To address them, it was crucial to adopt bold commitments in the Political Declaration.
ROBERTO GONZÁLEZ OJEDA, Minister for Health of Cuba, said the Secretary-General’s report had acknowledged global progress in reducing HIV/AIDS cases. “We cannot rest on our laurels,” he said. Guaranteeing the 90-90-90 goals required guaranteeing the right to health and greater cooperation in addressing the social determinants of health. Developed countries should fulfil commitments towards the 90-90-90 goals. Cuba had been certified by the WHO as the first country to eradicate mother-to-child HIV transmission and syphilis, he said, citing its prevention, diagnosis and antiretroviral treatment in that context. Its health-care system was based on universality and free delivery, which had allowed it to control 29 communicable diseases and eliminate 14 of them. In addition, child mortality had been below 5 deaths per 1,000 live births over the last five years. Rights to education and health were crucial to ending AIDS, and universal health-care coverage would only be achieved by increasing primary health care.
BERNARD HAUFIKU, Minister for Health and Social Services of Namibia, drawing attention to national achievements, noted that his country could be the first in Africa to eliminate transmission of HIV from mothers to babies by 2020. The Government had decided to allocate 30 per cent of its HIV/AIDS budget to prevention programmes without jeopardizing the treatment and care plans. In addition, the Government had adopted 2030 Vision and various national development plans. At the operational level, his country had deliberate programmes to enhance prevention and treatment, including the implementation of WHO treatment guidelines and the provision of treatment irrespective of CD4 cell counts. On tackling new infections among young people and treatment of adolescents, the Ministry had developed an action plan to promote comprehensive sexual education as an essential component of the school curriculum. Furthermore, increasing human resources for health was a priority for his country. In 2016, 36 doctors had trained 295 enrolled nurses, 36 pharmacist’s assistants and 12 environmental health assistants. Describing low rates of male circumcision and HIV testing among men, shortage of human resources, and unmet family planning as challenges to overcome, he noted that going forward was possible with the effective implementation of universal health-care coverage and increased cooperation between the public and private sector.
PIYASAKOL SAKOLSATAYADORN, Minister for Public Health of Thailand, said that his country tackled AIDS first by stabilizing it, then rolling it back, then reversing it with strong determination. Besides a strong and consistent political commitment, Thailand had focused its efforts on “five I’s” — innovation, investment, intersectorial actions, intelligence and an intensive approach that involved reaching key populations, testing those at risk, treating those found to be HIV positive and retaining both negative and positive key populations in the prevention, care and treatment continuum. Going forward, additional social innovations would be needed, in parallel with biomedical innovations, in order to assist hard-to-reach groups, including migrants, men who have sex with men and people who inject drugs.
DAVID PAGWESESE PARIRENYATWA, Minister for Health and Child Care of Zimbabwe, said the HIV and AIDS pandemic remained a major challenge for his country, which had nevertheless recorded some progress towards ending AIDS by 2030. A sustained focus on prevention had seen its HIV incident rate drop from 0.95 per cent in 2013 to 0.81 per cent in 2015, while the prevalence rate held steady at around 15 per cent. Services for key populations, including youth people, truck drivers, sex workers and prisoners, had been prioritized. A total of $5 million had been allocated for community-driven HIV prevention interventions, prompted in part by a hotspot mapping exercise that showed some areas having more cases of infection than others. Through a public-private partnership, antiretroviral drugs were being made available to private pharmacies at a reduced price, targeted at those who did not like to attend public medical facilities. Although Zimbabwe’s home-grown National Aids Trust Fund was growing, it still experienced funding gaps, he said, appealing to partners and donors to renew their commitments.
SAÏD AÏDI, Minister for Health of Tunisia, said global efforts must be intensified to end AIDS by 2020, stressing that his country’s approach was people-centred and based on rights and equality in health care. The 2014 Constitution offered the opportunity to strengthen respect for human rights, equality and access to healthcare without discrimination. National strategic plans to combat AIDS had been systematically implemented and always included screening, combined prevention, access to treatment and anti-discrimination provisions. The current national strategic plan aimed to achieve the three zeros, while reforms of health care prioritized prevention. Among its aims was to address new challenges in combating HIV. Tunisia had joined the UNAIDS global call to fast-track the response, as well as contributed to the development of the Arab Strategy to combat HIV/AIDS. More broadly, he said challenges faced by countries included unsatisfactory access to screening and treatment, gender disparity and a lack of funds.
ABDELMALEK BOUDIAF, Minister for Health, Population and Hospital Reform of Algeria, reaffirmed his political commitment to respond to AIDS, and make the country a proactive stakeholder in tackling the epidemic through sharing its experiences. Obstacles related to the high cost of medicine and new technologies, and to universal access for all vulnerable populations must be removed, new financing raised and discrimination tackled. Fighting AIDS was a national priority. The country sought to address risky behaviour and cross-border migration, which were factors that increased vulnerability. Algeria’s response had been enshrined in its international commitments and objectives. Ninety-five per cent of HIV/AIDS response costs were covered and free health care was provided for those living with HIV/AIDS. Such efforts were based on results-based planning. Algeria also had integrated the 90-90-90 target into its 2016-2020 strategic plan to combat HIV/AIDS. It was important to analyse the interdependence of health, human rights and environment-related problems, as well as the growing scarcity of budgetary sources.
This morning, the Assembly held a panel discussion on the theme, “AIDS within the Sustainable Development Goals: leveraging the end of AIDS for social transformation and sustainable development”. Co-chaired by Kwesi Bekoe Amissah-Arthur, Vice-President of Ghana and Ratu Epeli Nailatikau, former President of Fiji, it heard from panellists in two rounds. The first included: Cleopa Mailu, EBS, Cabinet Secretary, Ministry of Health of Kenya; Veronika Skvortsova, Minister for Health Care of the Russian Federation; and Tania Dussey, Secretary of State Foreign Affairs of Switzerland. The second round included: Tedros Adhanom Ghebreyesus, Minister for Foreign Affairs of Ethiopia; Gerhard Pries, CEO and Managing Partner, Sarona Asset Management Inc.; and Shannon Kowalski, Director of Advocacy and Policy, International Women’s Health Coalition.
Mr. AMISSAH-ARTHUR, opening the first round, said “we have a historic opportunity that is not to be missed to put an end to the AIDS epidemic in our lifetime”. The 2030 Agenda for Sustainable Development and its 17 Sustainable Development Goals reflected a multisectoral, rights-based, people-centred approach, which was needed today more than ever. The opportunity of those Goals must be seized, as they provided stepping stones to deepen and strengthen efforts to end the AIDS epidemic. Among other things, he urged panellists to explore lessons learned from the HIV/AIDS response so far and to consider how technology and innovation could bolster that response.
Mr. NAILATIKAU said health and sustainable development must go hand in hand. Against the backdrop of global inequality and conflict, it was extraordinary that the world had adopted the 2030 Agenda. “Let us use the AIDS response as a pathfinder” for respecting human rights and the dignity of the human person, he said. Fiji had worked to pave the way towards a more inclusive society, and was investing in its youth. He urged all participants to leverage the synergies presented by the Sustainable Development Goals to make the journey to end AIDS “a journey of social transformation”.
He then addressed a question to Mr. Mailu, asking how Kenya’s HIV Equity Tribunal had made a difference in the lives of people living with HIV and how such initiatives could contribute to ending the epidemic.
Mr. MAILU responded that, up to 2006, Kenya had been fighting HIV/AIDS without a legal framework. That year, it had passed the HIV Control and Prevention Act, which had also established the HIV Equity Tribunal, aimed at ensuring justice and dignity for those living with the disease. The body had been very useful in addressing the issues of stigma and discrimination, he said, noting that it had heard some 300 cases to date, involving such issues as gender discrimination, workplace stigma and inheritance. Kenya hoped to further strengthen the tribunal, giving people living with HIV an even stronger voice. Other avenues must also be opened to remove barriers to treatment and reach out to adolescents and young people in particular.
Mr. NAILATIKAU then asked Ms. Skvortsova about restrictions that the Russian Federation had placed on people living with HIV, and whether the country planned to lift them.
Ms. SKVORTSOVA said her country, like many others, had placed restrictions on foreign citizens with HIV who were seeking to travel, live and work in its territory. That was the case largely because there had been no treatments available at the time. However, since the advent of antiretroviral drugs, the Russian Federation had made many changes. The country intended to take a number of further steps to lift remaining restrictions.
Mr. NAILATIKAU asked Ms. Dussey how the world could make sure that ending AIDS would not be lost among the many other targets of the 2030 Agenda.
Ms. DUSSEY responded that 37 million people around the world were currently living with HIV, and they could not be ignored. Furthermore, the HIV/AIDS epidemic was influenced by social and other factors; to put an end to the epidemic by 2030, that interrelation must be better understood. The 2030 Agenda was a unique opportunity to work in a cross-sectoral way, she said, citing the holistic and cohesive work of UNAIDS as an example of good practice. “We cannot make progress towards ending the epidemic by 2030 without involving civil society and the 37 million people who are so affected,” she concluded.
In the ensuing interactive dialogue, a number of speakers reiterated their commitment to ending the HIV/AIDS epidemic by 2030 and shared national efforts towards that goal. Specifically, they described initiatives to improve access to antiretroviral treatment, reduce stigma and reach key populations.
In that regard, the representative of Kenya said his country’s HIV prevalence rate — as well as the rate of new infections — had fallen significantly, while access to treatment had increased. Countries must address HIV against the backdrop of stronger overall health-care systems, he said, stressing the need to reduce the financial burden of health care on families around the world.
Meanwhile, other speakers, including the representative of Brazil, stressed the need to accelerate the pace of efforts to combat the HIV epidemic. “It’s not enough to do more of the same,” she said, calling on States to incorporate HIV prevention and treatment into their primary health-care systems.
The Minister for Foreign Affairs and International Cooperation of Malawi stressed that the other Sustainable Development Goals could only be achieved in his country if HIV was tackled first. While strides had been made in that respect, there was a need to mobilize more resources, he said.
The representative of Cuba said her country had taken strong political decisions to deliver a robust health-care system, including HIV prevention and care, to its people. In particular, it had made great strides in reducing mother-to-child transmission of the virus.
Also participating were the representatives of Thailand and Morocco. A representative of civil society also took part in the discussion.
Mr. AMISSAH-ARTHUR then opened the second round of the panel, asking Mr. Ghebreyesus how the HIV/AIDS response could be kept high on the agenda of Governments around the world.
Mr. GHEBREYESUS said that HIV today was not a death sentence, as it could be treated as a chronic illness. In order to keep the issue at the top of the international priority agenda, however, it must be made clear that “AIDS is not yet defeated”. The number of people dying from the disease was still equivalent to five or six jumbo jets crashing every day. The world had committed to the Sustainable Development Goals, which had to be implemented in an integrated fashion; HIV/AIDS must take its place in that global agenda. In fact, far from causing competition among its targets, the way the 2030 Agenda had been crafted would support the HIV/AIDS agenda.
Mr. AMISSAH-ARTHUR asked Ms. Kowalski about the risks posed by continuing the HIV/AIDS response without the meaningful participation of civil society, as the space for such organizations was shrinking in many countries.
Ms. KOWALSKI responded that there would be have been no HIV/AIDS response to date without the participation of civil society. Those organizations would be needed to help the global response change course, she said, citing a number of areas where such a change was crucial. One such area was Eastern Europe, in particularly the Russian Federation, where punitive measures against key populations were being put in place. Another necessary change was for Governments to accept the fact that young people would be sexually active, and to put in place programmes to educate and empower them. Governments should also decriminalize sex work and work in partnership with organizations of sex workers to prevent the spread of the virus.
Mr. AMISSAH-ARTHUR asked Mr. Pries what the private sector could bring to the table to help implement the 2030 Agenda.
Mr. PRIES stressed the need to focus on sustainability, which was one of the key priorities of the business community. The private sector could bring “true partnership” to the 2030 Agenda, he said, noting that philanthropy would not be enough to achieve those goals. The business community was changing quickly, and now recognized its responsibility to society and the environment. “We need you to hold our feet to the fire,” he said, asking the international community to engage the private sector in problem solving. It was not just about investing in health care, but about building relationships and creating jobs.
In the interactive dialogue that followed, speakers raised a range of issues related to the panellists’ statements, with the representative of Pakistan calling for a “change of mindset” to end stigma and ensure the dignity and rights of people living with HIV.
The representative of the United Kingdom said the move from the Millennium Development Goals to the Sustainable Development Goals risked losing the momentum of the global HIV/AIDS response. Events, such as the current meeting, were crucial to keeping it high on the international agenda. Given the political and cultural differences and sensitivities around the world, he asked how the international community could prioritize the human rights-based interventions critical to combating the HIV/AIDS epidemic.
The representative of Mongolia said her country’s newly declared middle-income status had resulted in a drop in development assistance, and warned that, as a result, its national HIV/AIDS response was increasingly being neglected.
The representative of Peru emphasized the importance of the “moral dimension” of the 2030 Agenda, stressing that no one should be left behind in ensuring access to health care and HIV/AIDS prevention and treatment in particular.
Also participating were two members of civil society organizations.
This afternoon, the Assembly held a panel discussion on the theme, “Financing the end of AIDS: the window of opportunity”. Co-chaired by Roch Marc Christian Kaboré, President of Burkina Faso, and Lorena Castillo de Varela, First Lady and head of the delegation of Panama, it heard from panellists in two rounds. The first featured: Peter Boehm, Deputy Minister for International Development of Canada; Saïd Aïdi, Minister for Health of Tunisia; Awa Coll-Seck, Minister for Health of Senegal; and Jeffrey Sachs, University Professor and Director, Earth Institute, Columbia University.
The second round featured: Jorge Daniel Lemus, Minister for Health of Argentina; Philippe Douste-Blazy, United Nations Special Adviser on Innovative Financing for Development and Chair of the UNITAID Executive Board; Mark Dybul, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria; and Rachel Ong, Communications Focal Point, Global Fund Community Delegation.
Mr. KABORÉ said there was a need to increase and focus resources in the next five years to put an end to AIDS as soon as possible, and to ensure that the fight against the virus remained high on the international agenda. “A better approach is needed to put an end to AIDS as a threat to public health, leaving no one behind,” he said, calling for “social fairness and justice”. It was unfair that Africa, which bore the greatest burden of the disease, had to import antiretroviral medications at high costs.
Ms. CASTILLO DE VARELA recalled that, over recent decades, millions of people had died prematurely of AIDS. While “we now have what we need to confront the epidemic”, the world’s poorest people still suffered disproportionately from HIV/AIDS. Special attention must be paid to those who used injectable drugs, transgender people, men who had sex with men, prisoners and other key populations. Countries must mobilize resources to give priority to the continued fight against AIDS, and countries that did not have the necessary resources should be supported.
She then addressed a question to Mr. Boehm, noting that Canada had recently announced an increase of 20 per cent to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and asking what was needed from a financial standpoint to end AIDS by 2030.
Mr. BOEHM said more than 50 per cent of those living with HIV still lacked access to treatment. “This is simply not acceptable,” he said, stressing the need to reach vulnerable populations. Empowerment and gender equality were critical, and access to education was key. Aboriginal populations remained underserved and should be at the table in discussions on ending HIV. Pooling resources under country-driven models used by the Global Fund created the best returns. The replenishment of the Global Fund for 2017-2019 was critical to ensuring that the necessary funds were in place for the critical next five years. Stressing the need to better engage the private sector, he said “we need to ensure that everyone delivers on their promises”.
Ms. CASTILLO DE VARELA asked Mr. Aïdi what could be done to turn the goal of the Abuja Declaration — the allocation of 15 per cent of the national budgets of African countries to improve health sectors — into reality.
Mr. AÏDI described the modernization and reform of the Tunisian health system, which now gave priority to HIV prevention. “We’re talking about a political commitment, a social commitment,” he said, underscoring the globalized nature of today’s HIV epidemic. The 15 per cent target might not be sufficient for some countries that were hard hit by HIV, or which needed extra support. Part of that 15 per cent should be earmarked for innovation and capacity-building for the target populations. Moreover, the 15 per cent target was a “message of hope” and should be seen as an investment, not an expense.
Ms. CASTILLO DE VARELA asked Ms. Coll-Seck what she felt were the three key elements for investment to end AIDS, and how Africa could produce its own high-quality, accessible antiretroviral medications.
Ms. COLL-SECK recalled that her country had always had a low prevalence of HIV, which had now stabilized at about 0.7 per cent. The first priority intervention that was needed was to strengthen work for vulnerable or “key” populations. For example, she said, Senegal had established a centre to treat and care for injecting drug users. The local production of antiretroviral drugs was needed, and countries of the region were working with the Economic Community of West African States (ECOWAS) to begin such efforts. “Countries need to make an effort, but international solidarity must continue as well,” she concluded.
Ms. CASTILLO DE VARELA then asked Mr. Sachs about financing the HIV/AIDS response, in particular in the context of the new Addis Ababa Action Agenda for Financing for Development agenda.
Mr. SACHS responded that “we’re fighting over tiny little bits of money”. Over a decade ago, he had issued the first call for a Global Fund, and countries had begun investing in it. People had begun to get treatment. “We made great progress, but then it stopped,” he said, recalling that the global financial crisis had led to a decision to level off funding. The money that was needed was only about $5-10 billion a year, which was “small change” to make the world different. “The technical side has spoken the truth” and shown that the fight against HIV could work. Funding to end the disease was readily available, he stressed, concluding: “This is not a puzzle, it’s a choice.”
In the ensuing discussion, a number of speakers underscored the need to ensure that global efforts to combat HIV — in particular, the work of the Global Fund — were sufficiently funded. They also described national experiences in financing prevention and treatment initiatives.
The Minister for Foreign Affairs and International Cooperation of Malawi declared: “Today we stand at the point of a once-in-a-generation achievement” — the end of the HIV epidemic. With support from the Global Fund, his country had made significant strides in reducing its HIV prevalence rate. More remained to be done, however, and political will and commitment were urgently needed.
The representative of Thailand agreed that the world was at a critical juncture in its struggle against HIV/AIDS. Noting the need for domestic resources to combat the disease, he urged developed countries, in particular, to ensure that adequate resources were available around the world.
The Minister for Health of Niger said his country would continue to increase its investment to fast-track the eradication of HIV/AIDS.
The Minister for Public Health of Madagascar said the implementation of the Declaration adopted today should be a priority. Countries with a relatively low prevalence of HIV, such as his own, should not be set aside in the global HIV response over the next five years.
A representative of the civil society organization Teocha Dove Foundation said all Governments must be held accountable for the funding commitments they had made. He called, in particular, for the creation of a global fund for advocacy in middle-income countries.
The representatives of Kazakhstan and Panama also participated in the discussion, as did a second representative of civil society.
Mr. KABORÉ opened the second round of the panel, asking Mr. Lemus how a country such as Argentina, which had recently been classified a high-income State, but which still struggled with inequality, could work to eradicate HIV/AIDS.
Mr. LEMUS said more than 99 per cent of the HIV response in his country came from local funds. What was needed was an increase in budgets throughout the region to combat HIV/AIDS and other diseases, as well as to bolster research and innovation. The Southern Common Market (MERCOSUR) had been promoting a drop in prices for anti-retroviral drugs.
Mr. KABORÉ asked Mr. Douste-Blazy about the future of innovative financing for the HIV/AIDS response.
Mr. DOUSTE-BLAZY said the international community must continue to put pressure on developed countries to fund the HIV/AIDS response, and that more domestic resource mobilization was also needed. Innovative financing mechanisms, including levies, taxes, “debt securitization” and “debt swaps” were also critical, as were market incentives and the growing role of the private sector. Next week, there would be a crucial meeting in Brussels, where there was a chance to raise $35 billion a year from a European financial transaction tax. That was more than the amount needed to end AIDS, tuberculosis and malaria, he stressed.
Mr. KABORÉ asked Mr. Dybul what he felt was the best model for financing the end of HIV, and what role the Global Fund could play in that respect.
Mr. DYBUL responded that the best model was shared responsibility and partnership. That formula required value for money, he said, describing an innovative new online pooling mechanism for cost-savings on drugs. In addition, more domestic financing — in addition to funding from external sources — were needed. If all stakeholders came together, “we can absolutely end HIV, tuberculosis and malaria for good”, he said.
Mr. KABORÉ then asked Ms. Ong what she felt was needed to end the HIV/AIDS epidemic.
Ms. ONG emphasized that initiatives to support key populations, such as men who had sex with men, trans people and drug users should be prioritized by States. In addition, unfair global economic policies must be addressed in order to better fund the HIV response, and States should demonstrate political will “beyond the rhetoric” by funding the Global Fund. “We are increasingly leaving some regions behind,” she warned, calling on stakeholders to address the epidemic in all regions. The continued reluctance of some Governments to fund interventions for key populations must be addressed. Indeed, interventions must not be linked to discriminatory policies, and punitive measures against key populations must end.
During the interactive dialogue that followed, some speakers echoed the panellists in saying that international funding for ending the HIV epidemic must be maintained and more domestic resources should also be mobilized. Others emphasized the importance of innovative financing mechanisms and explored recent macroeconomic trends that had impacted their national efforts to fight the disease.
In that regard, the Minister for Health of Jamaica warned that the economic hardships resulting from the global economic crisis threatened to reverse gains made in tackling the HIV epidemic. Small middle-income countries such as Jamaica faced particular challenges to adequately fund its health-care systems, including HIV interventions.
The Minster for Health of Lesotho said it was crucial for Governments to have both the political will and the financial support necessary to strengthen their health systems.
The representative of the Russian Federation stressed that financing to fight HIV was an important investment. Her country had brought down the cost of medication by introducing new generic drugs, and was providing assistance to other countries to combat HIV and other diseases.
The representative of Lebanon described the situation of overstretched resources in his country, which was host to a massive flow of refugees from Syria and other neighbouring countries. In that context, he called on the international community to assist Lebanon with its HIV interventions.
Also taking part in the discussion was the Minister for Health and Population of Haiti, as well as the representatives of Kenya, Cuba, Ecuador and Mongolia.