Speakers Highlight Community-Based Service Delivery, Programmes to Protect Women against Violence as Key Elements in Comprehensive Response
People living with and affected by HIV and their communities must be at the centre of the response to the global AIDS epidemic, which has claimed more than 33 million people globally, speakers said today as the General Assembly continued its high-level meeting on ending the scourge by 2030.
Cynthia Forde, Minister for People Empowerment and Elder Affairs of Barbados, was among those who expressed support for the new Political Declaration adopted on 8 June, the first day of the summit, which has brought together heads of State and Government, ministers and other senior leaders from across the globe.
“This Declaration builds on previous ones, embraces the Sustainable Development Goals’ 2030 Agenda, and speaks to the creation of people-centred systems to improve universal health coverage, community—based service delivery and empowerment,” she said, adding that it also seeks to eliminate gender inequality and increase investment in HIV responses.
Anna Goławska, Undersecretary of State at the Ministry of Health of Poland, said that strong partnership among the Government, local municipalities and community-based and civil society organizations has ensured uninterrupted drug supplies and treatment for all, including for HIV-positive people who found themselves stranded in Poland due to the COVID-19 pandemic.
Along the same line, Jose Ruales, Vice-Minister for Governance and Health Surveillance of Ecuador, underscored the need for a focused response on people and their needs through collective work and commitment by civil society. He called on countries to guarantee sexual and reproductive rights for all and to prioritize the role of community-based organizations, especially those led by people living with HIV, in their national HIV response plans. Programmes to protect women from abuse and provide them with a safe environment — notably by preventing gender‑based violence — are also important, he stressed, as are measures that strengthen person-centred health systems that respect human rights.
For its part, Georgia has sought to strengthen the involvement of primary health‑care providers, as well as decentralize and integrate HIV services into the wider health systems, said Tamar Gabunia, First Deputy Minister for Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs. Most challenging amid the COVID-19 pandemic has been improving HIV detection. With that in mind, the Government has introduced an online self‑testing platform accessible via a mobile distribution company and through vending machines.
Martine Etienne Moise, First Lady of Haiti, speaking for the Caribbean Community (CARICOM), said Governments and other stakeholders in the region adopted the strategic framework for 2019-2025, aimed at reducing new HIV infections, and tackling both health and social disparities. Underscoring the need to empower persons living with, at risk of and affected by HIV/AIDS to practise safe and healthy lifestyles, she highlighted the importance of combining prevention with treatment, as well as accessible, equitable, high-quality testing in environments that are free from discrimination.
Jelena Borovinić Bojović, Minister for Health of Montenegro, said many of her country’s HIV/AIDS prevention measures aim to educate the general population, including by promoting positive changes in risky behaviour. Its national HIV/AIDS programme (2021-2024) includes medical, public health, educational and community measures that, among other things, enable respect for human rights and cooperation between partners.
Also speaking today were ministers and representatives of Jamaica, Peru, Republic of Moldova, Colombia, Venezuela, China, Belarus, Portugal, Italy, Romania, Pakistan and Uruguay.
The General Assembly will resume the high-level meeting on HIV/AIDS at a date and time to be announced.
Summary of Thematic Panel Discussion
Continuing its work from 10 June, the Assembly heard a summary of the third of five thematic panel discussions it convened over the course of its high-level meeting.
The representative of Ghana delivered a statement on behalf of Ken Ofori‑Atta, Minister for Finance of Ghana and Chair of panel three, which focused on the theme “Advancing Gender Equality and empowering women and girls in the AIDS response”. He said participants noted that the HIV/AIDS response is currently at a crossroads as the HIV and COVID-19 pandemics collide. Over the last year, many countries have lost significant portions of their revenue, and treatment and care services were interrupted. Against that backdrop, they underlined the need to maximize resources through domestic taxes, ending tax evasion, canceling of national debt and use of International Monetary Fund (IMF) special drawing rights. They also pointed out that achieving the goal of ending AIDS as a public health threat by 2030 will require the mobilization of more resources for low- and middle-income countries, to a peak of $29 billion by 2025. “We have the tools, but we need to use them wisely,” he said.
CYNTHIA FORDE, Minister for People Empowerment and Elder Affairs of Barbados, expressed support for the Political Declaration adopted by the Assembly on 8 June. “This Declaration builds on previous ones, embraces the Sustainable Development Goals’ 2030 Agenda, and speaks to the creation of people‑centred systems to improve universal health coverage, community—based service delivery and empowerment,” she said. It also seeks to eliminate gender inequality and increase investment in HIV responses. Welcoming its attention to previously ignored social determinants of health, in particular, she agreed that COVID-19 has affected Barbados’ HIV response and led to setbacks in achieving the “90-90-90” targets. “COVID-19 has taught us many lessons — one is the need to ensure the ongoing delivery of routine health‑care services, despite competing priorities and during emergencies,” she stressed, reiterating the need for extended access to financing mechanisms for small and vulnerable countries.
JELENA BOROVINIĆ BOJOVIĆ, Minister for Health of Montenegro, spotlighted her country’s national HIV/AIDS programme, which is implemented with a special emphasis on transparency, openness, control and supervision. It has been supported in those efforts by the Global Fund for HIV/AIDS, Tuberculosis and Malaria, the leading donor of funds for HIV prevention, followed by the United Nations system as a long-term coordinator of the global HIV/AIDS response. Meanwhile, Montenegro’s National HIV/AIDS Program (2021‑2024) includes medical, public health, educational and community measures that take into account ethical and legal principles, social and economic factors, respect for human rights and the importance of cooperation between partners. Many of the country’s HIV/AIDS prevention measures are based on efforts to educate the general population, including by promoting positive changes in risky behavior, she said.
ANNA GOŁAWSKA, Undersecretary of State at the Ministry of Health of Poland, drew attention to her country’s long history of responding to HIV/AIDS, resulting in a low HIV incidence rate of 3.4 per 100,000 inhabitants. It was among the first in its region to widely offer free-of-charge access to care for people living with HIV/AIDS. A new National Program for the Prevention of HIV Infections and Combating AIDS for 2022-2026 will feature prevention strategies such as pre‑exposure prophylaxis. Strong partnership between the Government, local municipalities and community-based and civil society organizations has ensured uninterrupted drug supplies and treatment for all, including for HIV-positive people who found themselves stranded in Poland due to the COVID-19 pandemic.
JULIET CUTHBERT FLYNN, Minister of State, Ministry of Health and Wellness of Jamaica, said that the COVID-19 pandemic has diverted limited available resources away from combating HIV/AIDS, putting it at risk of losing hard-won gains. Its main challenges included threats to service delivery, disruption of global supply chains and psychosocial stressors for people living with HIV and for health‑care providers. While Jamaica is coming up with ways to deal with dual epidemics, “we simply cannot do it alone”, she said. She called on the international community to do more, including through the sharing of technical expertise and resources.
ROSELL DE ALMEIDA, Deputy Minister for Public Health of Peru, noting that 87,000-plus people in his country are living with HIV, said that, despite the challenges imposed by the COVID-19 pandemic, the Government has the responsibility to ensure that those living with HIV have access to treatment. He detailed several measures towards this end, including the use of mobile brigades in both urban and remote areas — particularly in the Amazon — and the provision of both in-person and digital services to ensure continuity of treatment. Acknowledging the need to strengthen primary care, the Government has also implemented brigades for people with comorbidities, particularly tuberculosis. Education and communication are also crucial, he added, to avoid new infections and ensure that people are well-informed about their health from the earliest stages of life.
TATIANA ZATÎC, State Secretary for the Ministry of Health, Labour and Social Protection of the Republic of Moldova, expressed support for the Political Declaration, and its goals to reduce inequality, streamline gender equality and protect human rights. The Republic of Moldova has made significant progress in recent years in aligning its legal framework and public policies on HIV with international recommendations and ensuring the observance of human rights. The country has in place a number of internationally recognized good practices, including a comprehensive package of prevention, harm-reduction and substitution therapy services, which are implemented in prisons and elsewhere. It was among the first countries in the region to develop and implement a holistic, evidence‑based and financially quantified National Programme on Sexual and Reproductive Health and Rights. Regrettably, many of those successes were overshadowed in 2020 by the COVID-19 pandemic, with health‑care coverage seriously affected.
LUIS ALEXANDER MOSCOSO OSORIO, Deputy Minister for Public Health and Service Provision of Colombia, said that his country sees 10,000 new cases of HIV each year on average, with the epidemic particularly concentrated in key groups — namely, men who have sex with men and transgender women. In some cities, prevalence rates among these populations exceed 20 per cent; in response, the Government has implemented combined prevention strategies and provides universal coverage for HIV treatment. The COVID-19 pandemic has generated significant challenges, however, hindering access to health services. To counter this trend, the Government will strengthen its response, focusing on community participation and eliminating all forms of stigma and discrimination. He added that efforts to implement the Political Declaration must likewise work to promote sexual and reproductive rights.
MARISELA BERMUDEZ, Vice‑Minister for Social Health Networks, Ministry of the People’s Power for Health of Venezuela, stressed the need to preserve life, describing health as a fundamental human right. Venezuela’s 2014 master plan aimed at providing free-of-charge HIV treatment and eliminating discrimination against those living with the virus has produced tangible results, despite the unilateral cohesive measure imposed by the United States. Efforts by the Joint United Nations Programme on HIV/AIDS (UNAIDS) and other international organizations have complemented national action, she said, calling for more financing to sustain the fight against the AIDS epidemic. She thanked those countries calling for an end to the economic blockade, which negatively impacts medicine supplies.
WANG HESHENG, Vice‑Minister of National Health Commission and Commissioner of National Disease Prevention and Control Administration of China, said his country has attached great importance to HIV/AIDS prevention and treatment for many years, having adopted a science-based approach in successive five-year plans. With the broad participation of actors across society, quality of life has improved for people living with HIV and discrimination against them has decreased. China will continue to promote international cooperation, he stressed, urging the global community to focus on common interests.
ALEXANDER TARASENKA, Deputy Minister for Health and Chief State Sanitarian of Belarus, said his country’s HIV infection rates are falling and its national HIV policy ensures the availably of testing and counselling to all. Recalling that Belarus was the first country in its region to develop a national action plan to combat the virus, he said it has undertaken a range of related activities with the strong support of the United Nations Development Programme (UNDP) and civil society partners. In addition, Belarus has embarked on an assessment of its legal framework as it relates to people living with HIV, and is amending various laws in an effort to drive down stigma. All such work, including its international cooperation to end AIDS, is aligned with its national sovereignty, he said.
ANTONIO SALES, Vice‑Minister for Health of Portugal, welcomed the adoption of the Political Declaration, which will guide country responses to HIV over the next decade and represents a shared commitment and responsibility. Highlighting its focus on the Sustainable Development Goals, human rights-based and community‑led approaches, as well as legal and administrative reforms, he also welcomed its calls for the effective involvement of civil society. Portugal has adopted WHO’s “Treat All” recommendation and achieved the UNAIDS “90-90-90” targets. It has also rolled out pre-exposure prophylaxis, HIV self-testing and free hepatitis C treatment for all. In addition, Portugal decriminalized drug consumption, a policy which marks its twentieth anniversary this year, he said.
MARINA SERENI, Vice-Minister for Foreign Affairs of Italy, underscoring COVID‑19’s massive impact on HIV testing and treatment, called for greater investment in eradicating the root causes of HIV/AIDS. That means targeting key populations who are socially marginalized and vulnerable to HIV; give more attention to gender equality and education for young girls; and investing in comprehensive sexual education that lays the foundation for life-saving awareness and self-determination. Well before the COVID-19 pandemic, HIV/AIDS revealed the interconnected nature of health security within and between nations, she said, adding that that is why multilateralism and coordination are key to global health security.
ANDREI ROMICĂ BACIU, Minister for Health of Romania, said his country’s work to ensure universal access to HIV treatment and care began in the early 1990s with a focus on the paediatric cohort. Care and therapy were provided to all patients, irrespective of their CD4 count [which shows the robustness of the immune system] or viral load threshold. On the “95-95-95” testing and treatment targets put in place by UNAIDS, he said work remains to consolidate testing efforts, in particular for injecting drug consumers, commercial sex workers and homeless persons. Noting Romania’s successful elimination of mother-to-child HIV transmission, he went on to stress that COVID-19 has negatively impacted efforts to counter HIV, resulting in lower testing rates and declines in access to treatment. He also outlined recommendations emanating from a recent meeting of the European AIDS Clinical Society, held in Romania, in such areas as early detection, randomized screening and ensuring “access, best-in-class treatment, universality and equity”.
FAISAL SULTAN, Minister for State for National Health, Services, Regulations and Coordination of Pakistan, said ending AIDS by 2030 requires the international community to assess the setbacks caused by the COVID-19 pandemic and learn from one another’s experiences. Noting that the health-related Sustainable Development Goal targets remain high priorities for Pakistan, which is making significant progress in combating HIV/AIDS, he said COVID-19 impacted those efforts. In response, the Government increased its health staffing and outreach, provided personal protective equipment to all health workers and facilitated the multi‑month distribution of antiretroviral drugs. More broadly, Pakistan has implemented universal health coverage for all people that includes HIV testing and counselling, as well as the provision of treatment to infected persons and prophylaxis to those in high-risk groups. Stressing that the COVID-19 pandemic has reminded the global community to rise above its narrow differences, he welcomed the Political Declaration adopted this week and called for a global compact that would ensure no person is ever denied the right to health care.
JOSE LUIS SATDJIAN, Vice‑Minister for Health of Uruguay, urging that “we must focus on people”, said that work to combat HIV in his country is based on permanent dialogue between all involved in that national mission, including civil society, the Government, academia and United Nations entities. In 2021, Uruguay is measuring COVID-19’s impact on HIV treatment — an example being a reduction in testing despite no interruption to care — and certifying the elimination of vertical transmission. The COVID-19 crisis has demonstrated that science-based approaches can obtain successful, effective results in a short time, he added, calling on States to collectively assume their commitments set for 2030 to seek a solution to the HIV crisis that began 40 years ago.
TAMAR GABUNIA, First Deputy Minister for Internally Displaced Persons from the Occupied Territories, Labour, Health and Social Affairs of Georgia, said her country is vigorously fighting COVID-19 which is impacting all of Georgia’s other disease responses, including its efforts to combat HIV/AIDS. Outlining national strides in providing universal access to HIV prevention, diagnostics and treatment and effectively addressing structural and social barriers, she said Georgia was one of the first countries in its region to implementation WHO’s “Treat ALL” strategy in 2015. Over the last two years, the Government has paid special attention to strengthening primary health-care providers’ involvement, as well as decentralizing and integrating HIV services into the wider health system. Most challenging amid the COVID-19 pandemic has been improving Georgia’s HIV detection rate, she said, noting that in response the Government has introduced an online HIV self-testing platform accessible via a mobile distribution company and through vending machines.
JOSE RUALES, Vice‑Minister for Governance and Health Surveillance of Ecuador, noting that over 33 million lives have been lost to HIV, underscored the need for an effective response that focuses on people and their needs through collective work and commitment by civil society. Further, combined prevention strategies must be strengthened, with a particular emphasis on key affected groups. He called on countries, in their national HIV response plans, to guarantee sexual and reproductive rights for all and to prioritize the role of community-based organizations, especially those led by people living with HIV. Programmes to protect women from abuse and provide them with a safe environment through the prevention of gender-based violence are also important. He urged States to eliminate barriers to equitable, reliable access to diagnosis, medicine and health technologies; to increase financing for implementing the Political Declaration and Sustainable Development Goals; and to strengthen person-centered health systems that respect human rights.
MARTINE ETIENNE MOISE, First Lady of Haiti, speaking on behalf of the Caribbean Community (CARICOM), said a review of progress made “presents a sober outlook of the journey ahead” if the world is to end the HIV/AIDS epidemic by 2030. While life-saving medications and new health technologies are finally beginning to reach people in the developing countries hardest hit by the virus, more remains to be done. The CARICOM region is on its way to achieving the “90‑90-90” targets. As of 2019, 77 per cent of people living with HIV were aware of their status, 81 per cent of the people diagnosed with HIV were on treatment and 80 per cent of those on antiretroviral therapy were virally suppressed. AIDS‑related deaths decreased by 37 per cent, and new HIV infections fell by 29 per cent, since 2010. However, she voiced concern that the Caribbean continues to have the highest prevalence of HIV/AIDS outside of sub-Saharan Africa. Governments and other stakeholders adopted the Caribbean Regional Strategic Framework for 2019‑2025, aimed at reducing new HIV infections, tackling health disparities and social inequities. Noting the need to empower those persons living with, at risk of and affected by HIV/AIDS to practise safe and healthy lifestyles, she stressed the importance of combining prevention with treatment, as well as providing accessible, equitable, high-quality testing and championing environments free from stigma, discrimination and marginalization. As COVID-19 has complicated the HIV response, exposing gaps in public health systems, and she spotlighted the need for technology transfer and capacity building in developing countries.
Speaking in her national capacity, she said HIV/AIDS remains a main public health in Haiti despite major strides and the recent stabilization of the infection rate at 3 per cent. Haiti uses a targeted testing strategy that focuses on the most vulnerable groups, and some 550,000 tests were conducted in 2020, even against the backdrop of constraints related to COVID-19. People living with HIV, pregnant women, sex workers and other high-risk individuals are prioritized in the national health‑care system. However, achieving the goal of ending AIDS by 2030 requires a renewed commitment on the part of all stakeholders, she stressed, citing such remaining obstacles as social stigma and limited resources.
PRINCESS STEPHANIE of Monaco welcomed the high-level meeting as an important opportunity for the global community to take stock of progress made and challenges remaining in the war against HIV/AIDS. “We must fight this battle to the very end,” she stressed, calling for efforts to apply the lessons learned during the COVID-19 pandemic to HIV and other health challenges. Monaco has set ambitious national targets based on human rights, with a special focus on fighting inequality and HIV prevention for key populations. Monaco has long been involved in supporting the work of UNAIDS and provides financial support to a range of global public health initiatives, she said.