Progress Remains Fragile, Uneven, Says Secretary-General;
Assembly President Adds: We Are on Right Path, Should Be Hopeful, Never Complacent
Having made considerable progress in reducing the rates of new HIV infections and expanding the availability of antiretroviral drugs, the global community must resist the temptation to “rest on its laurels” and instead redouble efforts to completely eradicate the virus, the General Assembly heard today, as delegates outlined national progress towards meeting testing and treatment benchmarks to that end.
Many speakers spotlighted the ultimate target — enshrined in Sustainable Development Goal 3 — of ending AIDS as a public threat by 2030. Others, focusing on the shorter term, underlined the importance of achieving the “90-90-90” target, wherein 90 per cent of all people living with HIV would know their status, 90 per cent would be receiving antiretroviral treatment and 90 per cent of those would have achieved viral suppression — all by 2020.
“The world is making good progress towards ending the AIDS epidemic by 2030,” Secretary-General António Guterres said in opening remarks. Today, more people had access to HIV testing and treatment, treatment had been expanded to more than 20 million people since 1990 and mother-to-child transmission rates had fallen. However, progress remained fragile and uneven, with young women and marginalized communities at higher risk, he cautioned. Calling for stronger efforts to empower people to protect themselves, he said that would include providing a full range of sexual and reproductive health services and rights, harm reduction for people using drugs and access to treatment for young people living with HIV.
General Assembly President Miroslav Lajčák (Slovakia) agreed that more must be done to end the AIDS epidemic despite the progress achieved to date. While the goal was eradicating AIDS by 2030, the context must be examined, he said, emphasizing the importance of examining such issues as universal health coverage since survival rates varied across the world. “We are on the right path and should be hopeful, but never complacent,” he added.
Cuba’s delegate, noting that her country had adopted its National Programme for the Prevention and Control of HIV/AIDS more than 30 years ago, said that its approach — like its entire health‑care system — was based on the principle that health care was a basic human right. The programme allowed for research and development of generic drugs, provided broad-ranging sexual education and offered free antiretroviral treatment to all who needed it. As a result of those efforts, Cuba had been certified in 2015 as the first country in the world to eliminate mother-to-child transmission of HIV, and today the prevalence of the virus among people aged 15 to 49 stood at well below 1 per cent, she said.
Brazil’s representative, emphasizing that the international community must remain vigilant in its continued efforts to overcome HIV/AIDS, described his country’s strong national public health system and its recent decision to offer universal pre-exposure prophylaxis. Brazil was also investing more in reducing the gap between HIV diagnosis and treatment, including by working to reduce therapy prices, he said. “The imperative of public health must always prevail over commercial interests,” he stressed, adding that the flexibility allowed by the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights was a powerful and effective tool for accomplishing universal access targets.
Kenya’s representative, speaking on behalf of the African Group, described continuing challenges to addressing the risk of new HIV infections in the continent’s eastern and southern regions, particularly among women. Calling for a comprehensive approach and the necessary investment, he said those affected must have access to treatment, and robust awareness-raising activities must be wide‑reaching. Ending AIDS by 2030 would require a strong focus on mothers and children, he said, stressing that progress would depend on advances in gender equality, the empowerment of women and girls, improved prevention and increased resources.
Canada’s representative, emphasizing that the 2020 deadline to meet the “90‑90‑90” targets “is at our doorstep”, said her country had launched its first Feminist International Assistance Policy focusing on its poorest and most vulnerable women and girls. “Our goal is to reach the hardest-to-reach”, providing them with the HIV prevention, treatment and care they deserved, she said. Efforts were also under way to end the stigma and discrimination faced by such vulnerable and marginalized groups as lesbian, gay, bisexual, transgender and intersex persons, ethnic minorities, indigenous peoples and intravenous drug users.
The Russian Federation’s delegate, however, expressed concern over such controversial practices as “harm reduction” programmes — including needle exchanges and opioid replacement therapy — saying they were neither universally recognized nor scientifically proven. Instead, it was critical to eliminate non‑medical drug use completely, he added, underlining the need for young people feel ready and able to seek help, and to prevent high-risk behaviours while cultivating a more responsible attitude towards their own health.
Australia’s representative warned of the danger that hard-won gains would be lost, noting that the current rate of decline in HIV-related deaths and infections was too slow to reach global targets. Also, it was increasingly difficult to reach consensus on sexual and reproductive health and on ending stigma and discrimination against marginalized groups — issues at the heart of an effective HIV response.
Haiti’s representative recalled that his country had fallen prey to a massive HIV epidemic, with major repercussions for all strata and segments of society. However, the country had since been able to reduce HIV prevalence among the adult population from 2.2 to 2 per cent in recent years. Since the Government’s adoption of a “test and treat” strategy, 86 per cent of HIV-positive persons now knew their status, 85 per cent of those had been placed on antiretroviral treatment, and a high percentage of those now experienced an undetectable viral load, he said.
Malawi’s delegate called attention to the alarmingly low attendance at the session, and expressed hope that the empty hall did not indicate an attitude of “it’s your problem, it’s not ours. That is what got us into this situation in the first place,” he pointed out.
Also speaking were representatives of the United Republic of Tanzania (on behalf of the Southern African Development Community), European Union, United States, Thailand, Armenia, Zambia, Namibia, Argentina, Liechtenstein, Norway, Colombia, Panama, Switzerland, Jamaica, Eswatini, Botswana, China, Mexico, Cambodia, Kazakhstan, Belarus, Lesotho, Rwanda, Nepal, Myanmar, India and the Netherlands.
In other business this afternoon, the Assembly adopted two resolutions. By a recorded vote of 81 in favour to 16 against, with 62 abstentions, it adopted the resolution “Status of internally displaced persons and refugees from Abkhazia, Georgia, and the Tskhinvali region/South Ossetia, Georgia”.
Later in the afternoon, it unanimously adopted the resolution “International Day of Family Remittances”.
The Assembly will reconvene at 10 a.m. on Wednesday, 13 June, to elect members of the Economic and Social Council.
MIROSLAV LAJČÁK (Slovakia), President of the General Assembly, said that, despite the progress achieved, more must be done to end the AIDS epidemic. Today’s meeting could be used to explore opportunities for further action in the period leading up to United Nations meetings in September on tuberculosis and on non-communicable diseases. While the goal was eradicating AIDS by 2030, the context must be examined. He said that, since survival rates varied across the world, it was important to examine such issues as universal health coverage. “We are on the right path and should be hopeful, but never complacent,” he added.
ANTÓNIO GUTERRES, Secretary-General of the United Nations, said the world currently stood at the halfway point to the “Fast-Track” commitments to end HIV, agreed by the General Assembly in 2016. “The world is making good progress towards ending the AIDS epidemic by 2030,” he added, noting that, today, more people had access to HIV testing and treatment, and antiretroviral therapy had expanded by more than 20 million people since 1990. As mother-to-child transmission continued to decline and fewer children were living with HIV, the world was moving closer to bringing about an AIDS-free generation.
However, progress remained fragile and uneven, he cautioned, pointing out that, on all continents, key populations at higher risk of infection continued to be left further and further behind. “Young women remain unacceptably vulnerable,” he said, calling for stronger efforts to empower young people to protect themselves against HIV. That would include providing a full range of sexual and reproductive health services and rights, harm reduction for people using drugs and access to antiretroviral treatment for young people living with the virus. “Prevention is the key to breaking the cycle of HIV transmission,” he emphasized, noting that the Prevention 2020 Road Map focused explicitly on adolescent girls, young women and key at-risk populations. That sharpened focus on human rights, key populations and gender equality was crucial, he stressed.
Calling for greater leadership and investment to remove social and political barriers that kept needed services out of the reach of many people, he said the 2030 Agenda for Sustainable Development outlined an integrated approach to development challenges. Efforts to end HIV were connected to other key areas, such as malaria, tuberculosis, access to medicine and the rising threat of anti‑microbial resistance. The high-level meetings of the General Assembly on tuberculosis and non-communicable diseases, to be held in September, would provide a key opportunity to inform a new way of thinking that would move beyond the “disease-specific silos of yesterday”, he said. Noting that progress made towards ending the HIV epidemic would not have been possible without forceful advocacy and solidarity, he commended the United States President’s Emergency Plan for AIDS Relief — known as PEPFAR — marking its fifteenth anniversary in 2018, declaring: “At this pivotal moment, we must renew our focus and shared commitment to a world free of AIDS.”
LAZARUS O. AMAYO (Kenya), speaking on behalf of the African Group, said the risk of new infections remaining in Eastern and Southern Africa, particularly among young women, must be addressed. The global goal of ending AIDS as a public health threat required a comprehensive approach and necessary investments. Those affected must have access to treatment and robust awareness-raising activities must be wide-reaching. Describing a range of projects in Africa, he said the AIDS response to affected children was lagging and treatment for them, as well as for pregnant women, must be improved, especially to eliminate mother-to-child HIV transmission. Indeed, ending AIDS by 2030 would require a strong focus on mothers and children, he emphasized. Meanwhile, the goals of zero new infections, zero discrimination and ending AIDS deaths were achievable before 2030 if efforts were boosted. Progress would depend on, among other things, advances in gender equality, the empowerment of women and girls, improved prevention, diagnosis, treatment and surveillance systems and increased resources for an effective response.
Speaking in his national capacity, he said that to address the needs of the 1.5 million people living with HIV in Kenya, the Government had adopted programmes that included testing and treatment. At the end of 2017, about 75 per cent of those living with HIV had been receiving treatment and the number of AIDS-related deaths had dropped by 52 per cent. Highlighting other gains, he said that wide‑reaching efforts — from the provision of clean hypodermic needles for drug users to broadly available family planning services — had reduced the number of new HIV infections. There had also been positive developments in terms of social protection efforts targeting poor and vulnerable households, he said. However, at the global level, Member States should commit to closing the $7 billion investment gap required to end AIDS and achieve the Sustainable Development Goals.
MODEST JONATHAN MERO (United Republic of Tanzania), speaking on behalf of the Southern African Development Community (SADC), said that despite global progress, that region’s share of AIDS remained high. Outlining approaches and achievements, he said members had worked to coordinate national responses and cooperate in cross-border initiatives to reduce the number of HIV, AIDS, tuberculosis and other diseases among at-risk groups. Prevention coalitions had made inroads in reaching many age groups and increased political support had boosted efforts and results, he said, citing such initiatives as extended condom distribution and strengthened education programmes alongside plans to step up efforts to engage young women to in improving their access to the means to protect themselves and to health services. Calling on Member States to step up efforts to reach young women and other at-risk groups, he said global action must be scaled up to achieve the common goal of eradicating AIDS by 2030.
ANTONIO PARENTI of the European Union, reaffirming the bloc’s commitment to achieving all health-related Sustainable Development Goals, welcomed the Secretary-General’s report on leveraging the United Nations response to ending the HIV epidemic. Noting the strong link between HIV/AIDS prevention and the provision of sexual and reproductive health and rights, he declared: “We must do everything possible to provide women with sexual education, health and rights.” Meanwhile, men and boys must be engaged in efforts to end the epidemic. The European Union maintained a strong global health agenda, including ensuring community engagement. Additionally, the bloc was among the leading donors to the Global Fund to Fight AIDS, Tuberculosis and Malaria, with the European Commission and its member States together accounting for about half of the Fund’s financing. Calling for other partners to provide more resources, he said the European Union also supported research into and development of treatment, dialogistic and other innovative health tools. Understanding the disease better and improving patient empowerment were among the bloc’s research and policy priorities. Also expressing full support for the fight against tuberculosis, which was often co-morbid with HIV — including multi‑drug‑resistant tuberculosis — he called for greater efforts in tuberculosis research and development. It was also paramount to end stigmatization in order to safeguard the human rights of people living with HIV, he added.
DEBORAH BIRX (United States) declared: “We are closer than ever to ending AIDS.” What had once seemed impossible was now possible through the power of partnership and a strategic and targeted collective approach. Emphasizing the role of data, she said it was fundamentally important that Joint United Nations Programme on HIV/AIDS (UNAIDS) produce the world’s most extensive data collection on HIV epidemiology. Without the right data to track progress, pinpoint unmet needs and effectively direct resources, it would not be possible to end the AIDS epidemic by 2030, she stressed. “The United States’ commitment to ending the HIV/AIDS epidemic through the Trump Administration and bicameral and bipartisan congressional support is unwavering.” The global community had a historic and unprecedented opportunity to control a pandemic without a vaccine or a cure, laying the groundwork for the elimination of HIV, she said, adding that, to seize the moment, all must focus their efforts on where the burden of HIV/AIDS was greatest.
FREDERICO SALOMÃO DUQUE ESTRADA MEYER (Brazil) said the international community must remain vigilant and cautious because much remained to be done to overcome HIV/AIDS in the coming years. The AIDS response must be based on protecting the human rights of those infected with HIV, universal access to prevention and treatment, and ensuring necessary financing, he emphasized. Brazil had made some progress thanks to a strong national public health system, he said, adding that the Government had started this year offer pre-exposure prophylaxis on a universal basis. It had also invested more in reducing the gap between HIV diagnosis and treatment. Emphasizing the need to reduce therapy prices, he said: “The imperative of public health must always prevail over commercial interests.” Full implementation of the flexibilities allowed by the Trade-Related Aspects of Intellectual Property Rights was a powerful and effective tool for accomplishing universal access targets. Affordable medicine was a long-standing human rights priority for Brazil, he said, adding that innovative mechanisms, such as the Global Fund, the Gavi vaccine alliance, the Drugs for Neglected Diseases initiative and Unitaid, had helped to reduce the cost of HIV treatment while expanding the number of people benefiting from medications.
VITAVAS SRIVIHOK (Thailand), outlining his country’s National AIDS Strategy (2017-2030), said it was closely aligned with the Sustainable Development Goals target of ending AIDS by 2030. In particular, it included fast-tracked commitments and an all-out effort to reach the “90-90-90” target by 2020, having already achieved the first target — whereby 90 per cent of people living with HIV knew their status. The other two “90 targets” were also within reach, with 75 per cent of those who knew their HIV‑positive status having access to treatment and 83 per cent of those receiving the treatment being virally suppressed. Emphasizing that HIV/AIDS could not be tackled in isolation, he said the effort must be integrated with actions addressing such diseases as tuberculosis at a single point of care. He noted that Thailand had already been certified as the first country in the Asia-Pacific region to have eliminated mother-to-child transmission of both HIV and syphilis, and was working to reach out to vulnerable populations, whether or not they were Thai nationals, while making use of innovative technologies to deliver interventions such as pre-exposure prophylaxis nationwide. Engagement with civil society organizations and stronger efforts to combat stigma, were also critical, he stressed.
MHER MARGARYAN (Armenia) said that his country’s national plan to combat HIV was aligned with the global and European Union strategies to end AIDS by 2030. The national strategy’s objectives included reducing the number of new infections — especially among high-risk populations — as well as reducing mortality levels associated with HIV/AIDS, and combating stigma. Armenia had put a tightly integrated system in place, bringing together diagnostic tools and providing effective health care for both HIV and tuberculosis, he said. Additionally, it had been certified as one of the countries that had ended mother‑to‑child transmission of HIV, an important step towards ending the epidemic by 2030. While progress had been made, however, HIV/AIDS was far from over, he noted, cautioning that a recent decrease in donor funding could seriously undermine the progress made in combating HIV in Eastern Europe, and threaten pursuit of the Sustainable Development Goals in the region’s resource-limited countries.
LLOYD L. MULENGA, National HIV Programme Manager, Ministry of Health, Zambia, associated himself with the African Group and SADC, saying that a decline in new HIV infections from 77,500 in 2010 to 46,000 in 2016, indicated that his country’s multisectoral response to AIDS was not in vain. HIV remained a priority in all policy areas, he said, adding that innovation was the key to reaching Zambians most at risk. Contributions from such donors as PEPFAR, the Global Fund and the European Union had been essential, but a decrease in resources would threaten the progress made, he said, calling on partners to affirm global responsibility and maintain their contributions with a view to achieving an AIDS-free generation by 2030. He went on to spell out Zambia’s steps to implement the targets set at the 2016 high-level meeting on ending AIDS, noting in particular his Parliament’s adoption of the National Health Insurance Act in April.
NEVILLE GERTZE (Namibia), associating himself with SADC, said his country had domesticated the 2016 Political Declaration on Ending AIDS by 2030 through various national strategic plans. Among other things, the Government had taken the lead in fast-tracking the agenda by committing 30 per cent of its HIV response budget to prevention. Namibia was also exploring innovative means of male engagement, the delivery of innovations such as HIV self-testing, pre-exposure prophylaxis and the deeper engagement of local councils, he said. The National Strategic Framework for HIV took a two-pronged approach, incorporating such prevention strategies as voluntary male circumcision and condom distribution with treatment strategies. Among the country’s next steps, to be carried out by 2020, were: enhancing public-private and other non-traditional partnerships; implementing plans to eliminate mother-to-child HIV transmission; and increasing synergies with social protection and legal/policy systems to better enable the delivery of the HIV response.
MARTÍN GARCÍA MORITÁN (Argentina) noted that considerable progress had been made in the two years since the global community adopted the Political Declaration on HIV/AIDS, committing to fast-tracking efforts to end the virus by 2030 and achieving the 90‑90‑90 target by 2020. “We cannot rest on our laurels,” he said, noting that States must ensure that resources met the needs of an ever-greater number of people and that the policies designed actually reached them. Efforts were also needed to put human‑rights-based approaches in place, increase access to medical care, end stigma and increase the engagement of people living with HIV in decision-making processes. More resources and technical cooperation were needed, as were strategic partnerships, such as the one embodied by UNAIDS, he said, adding that the participation of women, men, boys, girls and youth — especially those most at risk of discrimination, violence, stigma and exclusion — must also be prioritized.
ANAYANSI RODRÍGUEZ CAMEJO (Cuba) outlined her country’s progress towards ending HIV infection since the adoption of its National Programme for the Prevention and Control of HIV/AIDS more than 30 years ago. It had ensured effective prevention, diagnosis and treatment actions based — like Cuba’s entire health‑care system — on the principle that health care was a basic human right, she said. Among other things, it allowed for research and development of generic drugs and ensured a highly educated population who could rely on their national public health system. In addition, Cuba had a broad sex education programme covering all population groups, and provided anonymous, free tests for all who requested them. It provided free antiretroviral treatment and a wide range of counselling and support services to patients, while civil society groups actively participated in prevention activities and the design and implementation of such programmes, she said. As a result of those efforts, Cuba had been certified in 2015 as the first country to eliminate mother-to-child transmission of HIV, she noted, adding that the prevalence of the virus among people aged 15 to 49 stood at well below 1 per cent. There had also been sustained progress in raising awareness in order to end discrimination based on gender, sexual orientation, gender identity and HIV status, she said.
SERGEY B. KONONUCHENKO (Russian Federation), reiterating his country’s commitment to the 2016 Political Declaration as an important instrument for mobilizing international efforts to combat HIV, welcomed enhanced efforts towards widespread testing and decline in new infection rates. It was critical to ensure that those living with HIV received treatment at the local level. Welcoming approaches focused on specific geographical regions and groups, he said they were critical to winning the fight against the HIV epidemic. There was also need to break down social and cultural barriers preventing access to treatment and care, while respecting national cultural specificities. He expressed concern over such controversial practices as “harm reduction” programmes — including needle exchanges and opioid replacement therapy, which were neither universally recognized nor scientifically proven — he emphasized that it was critical to eliminate non-medical drug use completely. Young people must feel ready and able to ask for help, he said, stressing the need to prevent high-risk behaviours and cultivate a more responsible attitude towards one’s own health.
LOUISE BLAIS (Canada), underlining that “2020 is at our doorstep”, voiced concern over significant gaps in meeting global targets by that year. Calling for intensified efforts to promote human rights and gender equality in that context, she said Canada had launched its first Feminist International Assistance Policy, focusing on its poorest and most vulnerable women and girls. “Our goal is to reach the hardest-to-reach,” providing them with the HIV prevention, treatment and care they deserved, she said. Efforts were under way to end the stigma and discrimination faced by such vulnerable and marginalized groups as lesbian, gay, bisexual, transgender and intersex persons, ethnic minorities, indigenous peoples and intravenous drug users. Expressing concern that many young people still lacked the knowledge and skills needed to prevent HIV infection, she said that, during the recent “Group of 7” Summit, ministers had agreed that their investments in adolescent girls must be holistic, multisectoral and integrated, and must take an intersectional approach. It was also critical to address the gender dimensions of tuberculosis, she said, calling for tailored and evidence-based approaches to fighting both diseases.
GEORG HELMUT ERNST SPARBER (Liechtenstein) said that, while HIV and AIDS was a public health issue, it was also a human rights and development issue. Emphasizing the need to address discrimination, he said the fact that homosexuality was illegal in some 60 countries remained an obstacle, as was the stigmatization of intravenous drug users and other at-risk groups. Granting women and girls access to reproductive health care was one effective prevention tool, but more must be done to ensure the availability of those services, he said, adding that gaps in testing and treatment must also be addressed. Meanwhile, there was need for predictable financing, and need to reach young people in order to help them protect themselves.
NATALIE COHEN (Australia), warned of the danger that hard-won gains would be lost, noting that the current rate of decline in HIV-related deaths and infections was too slow to reach global targets. Also, it was increasingly difficult to reach consensus on sexual and reproductive health and on ending stigma and discrimination against marginalized groups — issues at the heart of an effective HIV response. “We cannot meet the targets without compassion, understanding, respect and partnership with key populations — not just because it’s the decent thing to do, but because it’s proven to be the most effective approach to tackling the epidemic,” she said. Structural drivers of the epidemic must be addressed, including through universal health coverage and equal access to health services. Emphasizing the importance of an integrated approach to health, she acknowledged the important work done by UNAIDS and thanked the Secretariat for its efforts to address the agency’s funding shortfall.
DANIEL FERNAN GIMENEZ (Norway) said that, while gains had been made in reducing new infections, much must be done to address increasing death tolls in Eastern Europe, Central Asia, Middle East and North Africa, as well as the epidemic’s spread in some regions. Welcoming the Global HIV Prevention Coalition’s work, he also highlighted areas of concern, including costly treatment and the need to step up prevention initiatives. While special services must be targeted at high-risk groups, HIV could and should not be tackled in isolation, but with a holistic response, he emphasized. Noting that prevention required access to sexual and reproductive health services, as well as harm‑reduction programmes, he said the sensitivity of such topics was a major reason why the world had only seen limited success in HIV prevention. Good results hinged on building partnerships with affected populations and giving them a key role in prevention work, he noted, adding that in Norway, a paradigm shift in social and health policies had led to the provision of harm reduction services and inclusive programmes that empowered participants.
FRANCISCO ALBERTO GONZALEZ (Colombia) said AIDS remained a public health problem requiring a long-term response. While realizing global goals was possible, Colombia was concerned about the slow rate of progress in reducing new infections and the need for predictable financing. Prevention and awareness-raising activities were needed and legal and normative frameworks must also be developed. For its part, Colombia had already taken steps, including efforts to end discrimination. Combating the epidemic was costly and challenging, he said, calling for innovative strategies to tackle the work that remained at national and international levels.
MELITÓN ALEJANDRO ARROCHA RUÍZ (Panama) shared examples of national gains, including initiatives promoting human rights and zero discrimination with a view to ending the public health threat of AIDS. Welcoming the Secretary-General’s report, he said Panama had implemented programmes including awareness-raising campaigns and free testing. Eliminating mother-to-child transmission was now possible through innovative programmes, such as mobile clinics that targeted populations in remote areas, he said, adding that efforts were also being made to develop a vaccine. UNAIDS continued to be a valuable partner, he said, adding that “we must be the change we want to see”.
JÜRG LAUBER (Switzerland), expressing concern about the low attendance at today’s meeting, said that, despite the progress made so far, implementation of the fast-tracked strategy had not yet reached its goals. However, both the tools and strategies needed to eradicate HIV were available, he said, calling for accelerated efforts to reach key populations while fully respecting their rights and leaving no one behind. He also expressed particular concern about reduced financial support for civil society organizations on the frontlines of the fight against the virus.
TYESHA O'LISA TURNER (Jamaica) said that 35,904 persons in her country had been diagnosed with HIV since 1982, 72.6 per cent of whom were still alive. At the end of 2016, an estimated 30,000 people were living with HIV. Commending the accelerated fast-track approach as a valuable tool for achieving the 90-90-90 targets, she said Jamaica had also made progress in reducing AIDS-related deaths and mother-to-child transmissions. However, challenges remained, including the need for wider testing, significant gaps in treatment and a lag in realizing targets set for reducing mother-to-children transmissions. However, Jamaica was maintaining its focus on a whole-of-government, whole-of-society multisectoral approach by engaging persons living with HIV, other civil society stakeholders, the private sector and international development partners, he said.
SIPHELELE W. DLUDLU (Eswatini) said the AIDS response in Africa had been extraordinary thanks to several factors, including dynamic leadership at UNAIDS as well as political will on the part of States. Eswatini was committed to ending AIDS by 2022, eight years ahead of the target set in the Sustainable Development Goals, he said, noting that new infections had dropped 44 per cent between 2011 and 2016 while AIDS-related deaths had fallen significantly, resulting in Eswatini being one of the few countries to have achieved a viral suppression rate of 91.9 per cent among those receiving antiretroviral treatment.
EDGAR SISA (Botswana) said that his country’s Government and its partners had put in place several initiatives to bring the epidemic under control, including targeted HIV testing and the integration of services dealing with HIV, sexual and reproductive health, tuberculosis and non-communicable diseases. It had enjoyed success in the area of preventing mother-to-child transmission, but urgently needed to revitalize HIV prevention alongside treatment, with a particular focus on adolescent girls and young women. He went on to list several outstanding challenges, including inadequate investment in sociobehavioural change interventions, proliferation of illicit drugs, insufficient resources for civil society and community-based organizations, and competition for financial and human resources.
XU ZHONGSHENG (China) said the international community was at a critical moment in its response to the HIV epidemic, adding that the 2016 Political Declaration had helped it to intensify commitments to combating HIV/AIDS. Spotlighting China’s strong national programmes, he said it was a member of the Global AIDS Prevention Coalition and had made steady progress in addressing the ever-evolving HIV crisis. New infections had dropped substantially in recent years, and all pregnant women received free screening and services to prevent mother-to-child transmission. In addition, China had expanded treatment services and helping community organizations providing services to hard-to-reach groups on the ground. China was also supporting other countries in developing similar interventions, as well as helping them bolster their national health systems, he said.
JUAN SANDOVAL MENDIOLEA (Mexico), welcoming recent global progress in achieving global HIV reduction targets, nevertheless called on the international community to “breathe new life” into its response. Especially crucial were the sexual and reproductive health care and outreach to at-risk populations. Mexico had increased its investment in HIV response services by 89 per cent in recent years, and was pursuing cost-effective prevention policies, he said. Testing among a broad range of populations and key groups was critical, as was providing treatment and services for those diagnosed with HIV. Efforts were under way to eliminate new cases, he said, adding that Mexico had set a reduction target of 84 per cent by 2020. It had also established a specific protocol for providing access to medical services — free from discrimination — to lesbian, gay, bisexual, transgender, queer and intersex individuals, which UNAIDS had recognized as a good practice. Among other things, the Government had also put special policies in place to promote health and wellness among young people and substantially reduce teenage and child pregnancy, he said.
RY TUY (Cambodia), highlighting national progress, said it included reduction in the frequency of new infections, the provision of prevention services for pregnant women living with HIV, lower numbers of AIDS-related deaths and a new law to ensure access to affordable treatment. While such efforts depended on external financial and technical support, with international investments amounting to 82 per cent of funding for HIV response programmes in 2015, donor support was predicted to diminish, he noted. To address that transition, a national working group was partnering with UNAIDS to facilitate a readiness assessment that would identify risks in areas of service delivery, cost and financing. In addition, Cambodia had developed a road map towards a sustainable AIDS response, he said. Yet, the transition would affect at-risk groups, he cautioned, requesting that UNAIDS and international donors close the financial gap and maintain a focus on fast-track countries and those close to eliminating AIDS as a public health threat.
YERKIN AKHINZHANOV (Kazakhstan), outlining national plans, said the Government had provided much of the funding for programmes that were engaging partners and civil society while coordinating with United Nations agencies. Examples of progress included the considerable improvements in the quality of life of people living with HIV, and the decline in the number of AIDS-related deaths and mother-to-child transmissions. Emphasizing Kazakhstan’s commitment to maintaining its programmes and realizing common goals, he said working with neighbouring countries to address cross-border concerns, with the United Nations playing its coordinating role in such partnerships, was critical to achieving those objectives.
VALENTIN RYBAKOV (Belarus) said prevention efforts required greater attention if States were to achieve their goals. Underlining the importance of engaging non‑State partners, he said Belarus was focusing on broadening treatment and social support for affected people. In 2016, the country had received a certificate in recognition of its having reduced the number of mother-to-child HIV transmissions, he recalled, adding that Belarus was undertaking efforts to lower treatment costs and adopting policies to address the needs of affected children.
NTHABISENG MONOKO (Lesotho), associating herself with the African Group and SADC, noted with concern that her country had the highest HIV incidence rate, as well as the second-highest HIV prevalence rate. More than 330,000 people in Lesotho were living with HIV and 13,000 new adult infections occurred every year. Prevalence among women aged 35 to 39 was the highest at 49.9 per cent, but among children under the age of 14, it was 2.1 per cent, she said. However, Lesotho had made tremendous strides in responding to the epidemic, including a five-year HIV strategic plan to be launched in August. While acknowledging strong support from and partnership with PEPFAR, UNAIDS, the Global Fund and others, she said Lesotho still faced challenges, including a high rate of new infections among adolescent girls and young women.
LOT THAUZENI PANSIPADANA DZONZI (Malawi), associating himself with the African Group and SADC, called attention to the worrying low attendance at the present session, and expressed hope that the empty chamber did not indicate an attitude of “it’s your problem, it’s not ours. That is what got us into this situation in the first place,” he pointed out. Outlining Malawi’s national strategy to end AIDS as a public health threat by 2030, he said his country had progressively achieved a national status of “88-84-86” — very close to the “90-90-90” targets — while also introducing self-testing and improving outreach to key vulnerable populations. A special cadre of health‑care workers had been created to assist those affected by the virus, and undertake activities that would help them to better understand it. As the national treatment regimen was rolled out further, even more of the 750,000 people diagnosed with HIV would reach undetectable virus levels, marking a major step forward. Meanwhile, a new AIDS prevention and management law aimed to provide prevention and treatment services for all — without fear of stigma or discrimination — and the Government had implemented a new strategy for the distribution of condoms, he said. Describing the 2016 Political Declaration on HIV as one of the international community’s boldest but most achievable instruments, he said: “We must forge ahead with renewed commitment and determination to end AIDS by 2030.”
WILLY LOUIS (Haiti), outlining significant progress, said HIV nevertheless remained a major concern for Member States. The virus and other health challenges were exacerbated by stigma, discrimination, poverty, food insecurity and other social and economic inequalities. Recalling that Haiti had fallen prey to a massive HIV epidemic, with major repercussions for all strata and segments of society, he said the country had been able to reduce HIV prevalence among its adult population from 2.2 to 2 per cent in recent years. Since the Government’s adoption of a “test and treat” strategy, 86 per cent of HIV-positive persons now knew their status, 85 per cent of those had been placed on antiretroviral treatment, and a high percentage of those now experienced an undetectable viral load. Haiti’s priority was prevention, especially among such key populations as young people and sex workers, and aimed to end mother-to-child transmission by 2020, he said. Spotlighting the need for additional resources to continue to implement those concrete activities, he welcomed the recommendations contained in the Secretary-General’s report and expressed hope that they would not remain mere words on paper.
URUJENI BAKURAMUTSA (Rwanda), describing developments in her country, said the HIV prevalence rate among adults had remained stable, at 3 per cent, for the past decade, and was on target for the 90-90-90 objective. Under its universal health coverage policy, more than 90 per cent of all citizens had already enrolled in insurance schemes, she said, adding that community health workers and dedicated local and global partners were helping to broaden access to primary health. Taking a gender approach was also key in implementing national efforts. Collective action towards challenges would support further progress by, among other things, filling financial gaps, developing and implementing cost-effective as well as sustainable service delivery models.
NIRMAL RAJ KAFLE (Nepal) said his country had already rolled out a national strategic plan to reach the 90-90-90 targets, with efforts geared towards procuring needed medicine, preventing new infections, effectively managing patient case and scaling up testing for pregnant women. Results had already seen a drop in new infections and a rise in the reach of testing and treatment. Within the health system, efforts had been made to improve the reach and quality of services. At the half-way point to reaching its goals, Nepal was committed to work towards further gains and was grateful to partners that were engaged in a number of related projects.
HMWAY HMWAY KHYNE (Myanmar) said that, despite progress, more must be done to address challenges. Myanmar had launched a national strategy and road map to track the HIV response and end the AIDS epidemic, with a focus on quality care, community mobilization and ending the stigmatization of those affected. Testing, treatment and prevention initiatives included projects aimed at reducing mother-to-child transmission and at increasing awareness. From 2017 to 2018, $14 million had been allocated for antiretroviral treatment. Despite an overall decline in the HIV epidemic across the country, pockets of vulnerable populations required attention. Refining and reinforcing the work of UNAIDS would better support the global AIDS response, she said, calling for the international community’s continued support.
SANDEEP KUMAR BAYYAPU (India) said further efforts and political will were needed to achieve the 90-90-90 targets by 2020 to ensure the expansion of people-centred approaches to HIV treatment. For its part, India had taken a range of steps to address an AIDS epidemic in the country 15 years ago, managing to reduce by 55 per cent since 2007 the number of new HIV infections, expand testing and treatment and establishing the world’s largest public-private partnership to provide viral load testing and monitoring of patients under antiretroviral treatment. Synergies had also been forged between HIV and tuberculosis programmes aimed at eliminating both in a time-bound manner. Thanking UNAIDS for its leadership in mobilizing the world against the HIV and AIDS epidemic, he said lessons learned from that public health model would continue to enrich and inform strategies to address other global epidemics.
ELEONORA VAN MUNSTER (Netherlands) highlighted several important elements in the fight against HIV and AIDS, including a need for evidence-based, innovative and inclusive efforts and for a human rights-based approach to reach key groups, such as youth, young women, intravenous drug users and mem having sex with men, and to engage stakeholders. “We should not just talk the talk, we should also walk the walk,” she said, outlining national efforts, including a harm reduction programme. Taking stock of current achievements, she said it was time now to further roll out evidence-based and effective policies to reach common goals. Much remained to be done, he said, adding that the objective would only be achieved by truly working together, exchanging best practices and learning from scientific research.
Protracted Conflicts in Georgia, Ukraine, Azerbaijan, Republic of Moldova Area
KAHA IMNADZE (Georgia) introduced draft resolution A/72/L.55 titled “Status of internally displaced persons and refugees from Abkhazia, Georgia and the Tskhinvali region/South Ossettia, Georgia”, saying that of the record 65.6 million people around the world displaced by conflict, violence, persecution and natural calamities, up to 400,000 were from his country. The draft resolution before the Assembly today, similar to those adopted for the past 10 years, would emphasize the importance of the Guiding Principles of Internal Displacement while supporting the work of the Geneva International Discussions mandated by the ceasefire agreement of 12 August 2008. Regrettably, however, Georgia’s commitment to the Discussions had not been reciprocated, he said. Instead, it had been confronted by a policy of concerted disrespect by relevant participants vis-à-vis the issue of return.
Recent security and human rights developments in the occupied Georgian territories were extremely alarming, he continued, noting that human rights violations were happening daily. For the second consecutive year the Human Rights Council had expressed its serious concerns, he said, adding that opening Georgia’s occupied regions to international human rights monitoring and reporting would be a major step towards ending impunity and lawlessness. Recalling his country’s new peace initiative, he said commitment to a rules-based order and a surge in diplomacy were the only means by which to achieve sustainable peace. While today’s draft resolution addressed the situation in a single country, he said, the issue at stake was an integral part of a global challenge — forced displacement. Now was the time for the Assembly to adhere firmly to principles and demonstrate its commitment to sustainable peace, he emphasized. “We need to continue sending the message of hope to the hundreds of thousands of victims of forced displacement,” he added urging Member States to vote in favour of the draft.
VICTOR MORARU (Republic of Moldova), speaking on behalf of the Organization for Democracy and Economic Cooperation, said millions of people in the region had been forced to leave their homes as a result of armed conflicts, leading to a range of humanitarian challenges. Urging the Assembly to prioritize their needs and to ensure their safe and dignified return home, he expressed support for the draft resolution introduced by Georgia’s representative, pointing out that, 10 years since the Assembly had first adopted it, no progress had been achieved.
Expressing regret that the conditions for their safe and dignified return had still not been achieved, and that hundreds of thousands of people continued to be deprived of their rights, he voiced support for the Geneva International Discussions process and said the draft before the Assembly today would serve as another important tool to encourage participants to redouble their efforts to address issues under their mandate. He expressed concern about the human rights situation in the Georgian regions of Abkhazia and Tskhinvali region/South Ossetia and reiterated the support of the “GUAM” States for Georgia’s sovereignty and territorial integrity within internationally recognized borders.
AUDRA PLEPYTĖ (Lithuania), speaking on behalf of the Baltic and Nordic States, expressed regret that Georgia was among the countries affected by forced displacement. Ten years since the Assembly had first adopted a resolution on the issue, hundreds of thousands continued to be displaced from their homes and deprived of their right to a safe, dignified and voluntary return. The draft resolution before the Assembly today echoed the Secretary-General’s goals — to prevent displacement, address its root causes and support affected communities — and would commit the international community to protect and assist those forcibly displaced from the Abkhazia and Tskhinvali region/South Ossetia regions of Georgia. The human rights situation in those occupied regions remained a cause for concern, with the Russian Federation violating various commitments made in 2008, she said, citing kidnappings and arbitrary detentions as a consequence of ongoing “borderization”. New restrictions on freedom of movement and lack of access to health care and education in native languages had had a major impact on the population, she noted, expressing concern that no international human rights monitoring mechanism had been granted unrestricted access to the impacted regions. She called for the continued engagement of the United Nations and urged all Member States to vote in favour of the draft.
VOLODYMYR YELCHENKO (Ukraine) noted that said 2018 marked a decade since the Russian Federation’s aggression, and the situation on the ground was deteriorating. Condemning discrimination in the area, he expressed concern about the right of internally displaced persons to return to their homes, and called upon the Russian Federation to grant human rights workers access to the affected areas. He also condemned the Syria’s decision to recognize the occupied areas. Urging the Russian Federation to respect its obligations under international law, he said Canada supported the draft resolution.
The representative of Canada, explaining his delegation’s support for the draft, described the Russian Federation’s occupation of the areas of concern as a flagrant violation of international law. Condemning Syria’s recognition of those occupied areas, he voiced concern about the plight of displaced persons and encouraged further dialogue on related issues concerning protracted displacement around the world. Supporting the draft would be a valuable step forward, he added.
The representative of the Russian Federation noted that for a second year, the draft resolution’s authors had stated that people had lost their homes and been forced to leave their neighbourhoods. However, that perspective had been politicized, he said, adding that Georgians, Abkhazians and Ossetians had suffered under the nationalist policies of Georgian authorities whose actions had stalled a solution to the problem of refugees. It was time for the Georgian authorities to instead choose constructive solutions to humanitarian issues, he emphasized. The draft resolution was subjective, pursuing the narrow political interests of only one party to the conflict, he said, calling for a vote voicing his delegation’s intention to oppose the draft.
The representative of the United Kingdom, expressing his support for the draft resolution, said it reaffirmed the right of internally displaced persons — regardless of ethnic origin — to return to their homes in a safe and dignified manner. “This is a human rights issue,” he said, emphasizing that it should not be linked to any political processes. Voicing support for those internally displaced in Georgia, he said the Assembly should send a strong message that it had not forgotten them. Welcoming Georgia’s efforts in support of internally displaced persons, as well as its regular reporting to international organizations, he called upon the Russian Federation to end its “borderization” activities, which were a direct impediment to the right of internally displaced persons to return to their homes.
The Assembly then adopted the resolution by a recorded vote of 81 in favour to 16 against, with 62 abstentions.
The representative of Israel, welcoming constructive discussions and progress made in the context of the Geneva International Discussions, also voiced support for the constructive spirit demonstrated by the Government of Georgia. The way to resolve the situation was through a negotiated political solution, not unilateral actions, she said.
The representative of Brazil, while noting that his delegation had abstained, explained that the resolution might prejudge the consideration of sensitive issues that should be negotiated in the Geneva process. Nevertheless, Brazil reaffirmed its support for Georgia’s territorial integrity and urged all parties to create conditions favourable to the safe and dignified return of internally displaced persons, he said.
International Day of Family Remittances
TEODORO L. LOCSIN, JR. (Philippines), introducing a draft resolution titled, “International Day of Family Remittances” (document A/72/L.56), said its main co‑sponsors — Algeria, Guatemala, Madagascar and his own country — had worked to accommodate the views, concerns and inputs of all delegations throughout the negotiation process. The text’s objective was to raise global awareness of the link between remittances and sustainable development, and to acknowledge the fundamental contribution of migrant workers to the well-being of their families and communities of origin. The International Day of Family Remittances to be proclaimed by the draft resolution — which would be celebrated annually on 16 June — would provide an opportunity for the global community to unite in recognizing those important contributions, he said, noting that an impressive $466 billion in remittances to developing countries had been recorded in 2017 alone. Between 2015 and 2030, as the Sustainable Development Goals were being pursued around the world, remittances to developing countries were projected to exceed a cumulative $6.5 trillion, he said.
The Assembly adopted the resolution without a vote.
The representative of the United States, clarifying his delegation’s position while nevertheless joining the consensus on that item, emphasized that the 2030 Agenda and the Addis Ababa Action Agenda — both referenced in the resolution — were non‑binding documents that did not create any rights or obligations under international law. The 2030 Agenda recognized that each country must work towards implementation within its own national policies and priorities, he said, adding that it did not represent a commitment to provide new market access for goods or services. “This Agenda does not interpret or alter any [World Trade Organization] agreement or decision, including the Agreement on Trade‑Related Aspects of Intellectual Property Rights,” he said.
Keeping remittances flowing through regulated channels served the dual purposes of ending the abuse of the financial system by illicit actors, while providing access to funds in areas of need, he said. The United States, therefore, supported the robust implementation of international standards to fight money‑laundering and financing of terrorism by all jurisdictions. In addition, the resolution’s references to migrants and migration, without any qualifiers, were unacceptable. The United Nations should not be “regularizing” irregular or illegal migration as a positive contribution to development, as it occurred contrary to national laws, he stressed, disassociating himself from the consensus on that language.
The representative of China expressed his delegation’s support for the draft resolution.
The representative of Guatemala, noting that his country was among the main co-sponsors, said remittances could help to reduce poverty and contribute to achieving other Sustainable Development Goals, from broadening access to health care to providing education. While remittance flows were a sensitive issue, a decrease in remittances because of external shocks could affect poverty levels, as families receiving those payments depended on those funds to live. For its part, Guatemala supported those receiving remittances with advice and financial education, he said, commending the recognition of the International Day, which recalled migrants’ efforts to contribute to supporting their families and communities.
The representative of El Salvador expressed appreciation for the resolution’s adoption, paying homage to the many migrant workers who helped their families and communities.