United Nations

DSG/SM/159
AIDS/40
8 May 2002

HIV/AIDS Treatment, Prevention Can Work in Any Culture, Even Poorest, Deputy Secretary-General Says

NEW YORK, 7 May (UN Headquarters) -- Following are the remarks of Deputy Secretary-General Louise Fréchette to the Pacific Council on International Policy in San Francisco today:

Thank you for that kind introduction. It is a pleasure and honour to be here. I am very happy to have the opportunity to speak to such an informed and engaged audience about the United Nations and the fight against HIV/AIDS worldwide.

Let me begin by saying that the global AIDS crisis is an issue that isn't going away. Even though other serious challenges call on the international community and the United Nations -- from terrorism to Afghanistan to the Middle East -- that does not mean we can let up in the struggle against the epidemic.

The statistics should speak for themselves.

Sixty million people have already been infected, and of those, more than 20 million have died.

More than 13 million children have been orphaned.

Forty million people are now living with the virus.

Every hour of every day, almost 600 people are infected.

But there are also a number of fallacies about AIDS that seem to have taken hold in the consciousness of many, even otherwise enlightened, people -- misperceptions that are singularly unhelpful in the fight against this dreadful disease.

Today, I would like to focus on four of these fallacies, and suggest that the facts are very different from what many people believe.

Fallacy number one: AIDS is an African problem.

Fact: AIDS is a global problem.

In the 20 years since the world first heard of AIDS, the virus has travelled to every corner of the world. Experts now agree that it is the worst epidemic humanity has ever faced. It has spread further, faster and with more catastrophic long-term effects than any other disease. While it has taken its heaviest toll in Africa so far, it is now spreading with frightening speed elsewhere -- including in regions not far from here.

In the Caribbean and Central and South America, more than 1.8 million people are now living with HIV/AIDS. Last year alone, about 200,000 became infected. Haiti, with 5 per cent of the population living with the virus, has the highest HIV adult prevalence rate in the world outside sub-Saharan Africa. The rate in five other Caribbean countries is around 2 per cent of the adult population.

In Asia, the statistics are equally alarming. More than 7 million people are infected, more than half of them in India. China is also a source of enormous concern, with a major rise in HIV infections in the past two years.

Eastern Europe -- especially the Russian Federation -- is experiencing the fastest-growing AIDS epidemic in the world. In 2001, there were an estimated 250,000 new infections in this region, bringing to 1 million the number of people living with HIV. Given the high levels of other sexually transmitted infections, and the high rates of injecting drug use among young people, the epidemic looks set to grow considerably.

In North Africa and the Middle East, infections are also rising. There were an estimated 80 000 new infections last year, bringing to about 440, 000 the number of people living with HIV/AIDS.

And in the prosperous West -- including this country -- the threat of HIV/AIDS is by no means over. While we saw decreases in the number of new infections after a peak in the 1980s, we have seen no decline for the past three years.

Statistics point to stalled prevention efforts, with a dangerous trend towards more relaxed attitudes and risky behaviour, as compared to the relatively successful prevention campaigns of the 1980s and 1990s. Some startling figures from the Centers for Disease Control, released just two months ago, show that half of those in the United States infected with the virus either do not know it or are not receiving treatment.

Globalization, travel and migration are constantly adding to the risk of increased spread to what we might think of as "safe" countries.

The fact is that in our globalized world, there are no safe countries. In the ruthless world of AIDS, there is no "us and them".

That leads me to fallacy number two: that in some societies, HIV/AIDS prevention efforts cannot work because of cultural obstacles.

Fact: examples and experience tell us prevention can work in any culture.

It is true that when we talk about prevention, we raise very sensitive subjects and discuss highly intimate things -- aspects of life that many societies find it difficult to address publicly. But it is also true that we have convincing examples of successful prevention campaigns in very different societies.

Look at Uganda -- one of the first countries to be devastated by AIDS, but also the first in sub-Saharan Africa to reverse its own epidemic. The Government there has fought back with a campaign of public education so relentless that Ugandans call it "the big noise". Virtually every Ugandan man, woman and child now knows what it takes to protect oneself against AIDS.

Look at Senegal, where as soon as the first cases were reported in the 1980s, the Government responded with a national AIDS programme ranging from media prevention campaigns to screening of blood transfusions. Most strikingly, Senegal's religious leaders -- including Muslim clerics -- became the first in Africa to join the prevention effort. As a result, Senegal has kept infection rates to between 1 and 2 per cent.

Look at Thailand, where authorities have supported a 100-per cent condom strategy in the commercial sex industry, backed up by pioneering information campaigns targeting the whole population.

Look at Brazil, where for the past 10 years, concerted prevention efforts have focused both on the population as a whole and on the most vulnerable groups. This strategy, together with a policy of universal access to HIV care, has resulted in a much smaller epidemic than was predicted 10 years ago.

Look at Belarus, where prevention programmes among injecting drug users have fostered safer behaviour and is estimated to have prevented thousands of infections.

These are examples of effective prevention efforts from a wide cross-section of cultures. All of them were developed by actors inside the country rather than imposed from outside. All of them take account of the local cultural context.

But they all have something in common: they stem from a political will to fight AIDS, and a recognition that facing up to the problem is the first step towards conquering it. I am convinced that, given that will, every society can do the same.

Fallacy number three: we have to choose between prevention and treatment, and effective treatment is not a realistic choice in the developing world.

Fact: the choice between prevention and treatment is a false one, for the two are inextricably linked. And experience and science show that treatment can work even in the poorest societies.

Without the hope of treatment, people will have no incentive to come forward for testing, and the spread will continue further.

It is true that until recently, administering HIV/AIDS drugs was both prohibitively expensive and excruciatingly complicated -- involving many different pills to be taken at exact times every day. But not only are AIDS drugs now more available and affordable in poor countries; scientific progress has been such that the treatment regimes are far simpler to administer. And the industry predicts an AIDS cocktail may soon be possible to administer in a single pill.

It is equally important to recall that treatment need not require the five-star hospitals we are used to in this country. The key is a political commitment to provide treatment, backed up by community involvement.

Again, look at Brazil, where a committed Government has built up a well-run network of AIDS clinics, supported by a well-organized network of civic groups. The director of the Brazilian AIDS programme told me recently that nearly all its patients -- including those living is slums -- were able to keep to their drugs regime.

It is not realistic to expect that treatment can be offered overnight to all infected people in poor countries.

But it is realistic to expect that some measures -- for example, reducing mother-to-child transmission -- can be introduced quickly; and that the number of patients receiving the full AIDS cocktail can be gradually and steadily improved. There will be hard choices for governments to make -- but I know they are ready to make them

Which takes us to the fourth and final fallacy: Fighting AIDS globally is too expensive and we can't afford it.

Fact: Doing nothing costs far more.

We estimate that a global campaign to fight AIDS requires $7 billion to $10 billion a year for an effective response in low- and middle-income countries. Depending on the country concerned, a sizeable proportion of that money will come from the country itself. The rest will have to be provided through international assistance.

Compare that to the cost of inaction. Unchecked, AIDS unravels whole societies, communities, economies. In this way, AIDS not only takes away the present. It takes away the future.

AIDS is a major economic and social problem for every sector of society. It is one of the biggest obstacles to development itself.

AIDS is uniquely disruptive to economies, because it kills people in the prime of their lives. Four out of five people dying from AIDS are in their twenties, thirties or forties. And half of those living with the virus are under 25.

The loss of every breadwinner's income reduces the access of dependents to health care, education and nutrition -- leaving them in turn more vulnerable to infection. This cycle need be repeated only a few times and AIDS destroys an entire community.

Especially in the early stages of the epidemic, AIDS tends to strike urban centres, the better educated, the leadership elite and the most productive members of society. A study in the Democratic Republic of the Congo found the highest prevalence rates among white-collar executives, followed by foremen, and then workers.

In the worst affected countries -- where more than one in five adults are infected -- infrastructure, services and productive capacity are facing total collapse. The spread of the pandemic has caused business costs to expand, and markets to shrink.

Indeed, companies have determined that with anti-retrovirals increasingly affordable, it is now far more profitable to treat HIV-positive employees than to recruit and re-train new ones as untreated workers die. One recent study in Africa showed that treating HIV-positive workers paid for itself up to ten times over.

In other words, ladies and gentlemen, the global fight against HIV/AIDS is both necessary and winnable.

The key ingredient is political commitment on the part of all countries -- both those most severely affected by the epidemic and those who have the means to help.

At a special session of the General Assembly last June, all 189 Member States agreed on a set of ambitious but realistic time-bound targets and goals. Among them was a commitment to reach, by 2005, an overall target of annual expenditure on AIDS of $7 billion to $10 billion each year in low and middle-income countries.

That will require an effective channeling of resources. That is why, in April of last year, the Secretary-General proposed a Global Fund. A year later, the Global Fund to Fight AIDS, Tuberculosis, and Malaria is already operational.

It is not a traditional United Nations entity, but a new form of independent public-private partnership governed by a board of representatives from governments, the private sector, non-governmental organizations and foundations.

Contributions from both private and public donors stand at almost $2 billion. Two weeks ago, the Fund announced its first round of grants -- a total of almost $400 million over two years going to 40 programmes for prevention and treatment in 31 severely affected countries. This already represents a significant increase in international spending to combat AIDS and other infectious diseases.

The United Nations family has been engaged for a long time on the front lines against AIDS. UNAIDS brings together the efforts and resources of eight United Nations system organizations to help the world prevent new HIV infections, care for those already infected, and mitigate the impact of the epidemic.

The United Nations Children's Fund (UNICEF) runs programmes for children's health, school AIDS education, and the prevention of mother-to-child HIV transmission. The United Nations Population Fund works for reproductive health, including family planning and the prevention and management of sexually transmitted diseases. The World Health Organization provides medical advice to health ministries in developing countries through standards, guidelines and research.

Ladies and gentlemen, multiple partnerships at many different levels are the only way of meeting the challenge of HIV/AIDS.

Everybody has a part to play: national governments, international organizations communities, business, universities, foundations, individuals -- people like you here today.

I hope I can count on your engagement. I hope I can count on you to spread the word in your various and vast constituencies, and help us dispel the fallacies, and disseminate the facts, about the global fight against HIV/AIDS.

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