3 June 2005
Progress ‘Significant But Insufficient’, General Assembly High-Level Meeting on HIV/AIDS Told
Achievements Noted in Political Leadership, Funding, Prevention, But 2004 Saw More New Infections, AIDS-Related Deaths Than Ever Before
NEW YORK, 2 June (UN Headquarters) -- United Nations Secretary-General Kofi Annan today shared his hope with a gathering of senior world officials at Headquarters that the 2001 Declaration of Commitment on HIV/AIDS would have heralded a response that matched the epidemic’s scale, yet progress had been “significant but insufficient”.
Citing achievements in the core areas of political leadership, funding, the intensity and reach of prevention programmes, and the availability of drug therapies, he said, however, that last year saw more new infections and more AIDS-related deaths than ever before. With the epidemic expanding at an accelerating rate and on every continent, treatment and prevention efforts were “nowhere near enough”. For example, only 12 per cent of the people in need of antiretroviral therapies in low- and middle-income countries were receiving them.
He called for increased resources, better planning, better and more vocal leadership, and real investment in the empowerment of women and girls. Women now accounted for about half of all people living with HIV worldwide, but they were also the most courageous and creative champions in that fight. How the international community fared in the fight was crucial; only by meeting the challenge could it succeed in its efforts to build a humane, healthy and equitable world.
General Assembly President Jean Ping (Gabon) said that the HIV/AIDS threat in 2005 was much greater than when the Assembly met here four years ago. In every way, that threat had attained alarming proportions. In fact, he said, in 2004, the number of infected people had grown to about 5 million, and the number who had died had also grown, to 3.1 million in 2004, much more than for the four preceding years. The pandemic had also grown disturbingly worldwide, affecting new countries and new populations within countries, particularly women and girls, and 95 per cent of those infected were in low- and medium-income countries.
Given the quantum worsening in the epidemic’s trajectory, Joint United Nations Programme on HIV/AIDS (UNAIDS) Executive Director Peter Piot said the gap between need and action remained enormously wide. Unless AIDS was controlled, the epidemic would expand for decades, killing large numbers and wrecking entire societies. The global response required that several milestones be met: world leaders should give AIDS the same level of attention as they gave to global security; universal access to prevention and treatment must be ensured; money must be made to work for people on the ground; long-term strategies must be incorporated into planning and actions; and the United Nations system should maximize collective effectiveness by pooling efforts in every country.
Round tables were also convened, as follows: on prevention, chaired by Anna Marzec-Boguslawska, Head of the National Centre for HIV/AIDS of Poland; on HIV/AIDS and Human Rights with an emphasis on gender, chaired by Marcus Bethel, Minister of Health of the Bahamas; on resources, chaired by Jean-Louis Schlitz, Minister of Cooperation and Humanitarian Action of Luxembourg; on treatment, care and support, chaired by Anupong Chitwarakorn, Senior Expert, Preventive Medicine, Ministry of Public Health of Thailand; and on orphaned children, chaired by Paulette Missambo, Minister of Public Health and Population of Gabon.
Wrapping up those discussions this afternoon, Assembly President Ping said that the debates had raised certain essential questions and recommendations. On resources, it appeared that they had grown considerably, but they were still not commensurate with the problem, and efforts to improve services were encountering difficulties in the health and other sectors. Among the recommendations, apart from the need for governments to increase their national budgets, it was necessary to ensure that commitments and pledges made at the global level were honoured.
In the round-table discussion on orphans, it had been emphasized that efforts undertaken thus far had not been sufficiently matched with the scope of the problem. Recommendations included redoubling efforts at the national level and stepping up programmes for children at risk, including by eliminating the cost of schooling and broadening nutritional programmes in schools, and strengthening prevention of mother-to-child transmission.
In the round table concerning human rights with an emphasis on gender, it was stressed that human rights violations and inequality between men and women continued to increase the transmission of HIV/AIDS and undermine access to prevention and treatment. The growing feminization of the epidemic had made it ever more necessary to establish programmes to attack the vulnerability of women and girls. Among the recommendations was the need to strengthen measures to combat discrimination against people with AIDS, to draw up special programmes for women and girls, and to enhance efforts to eliminate violence against women and educate men and boys.
Prevention was reaffirmed as the pillar in combating AIDS in another round-table discussion, but coverage of prevention programmes was still low. Globally, fewer than one person in five had access to services to prevent AIDS, owing to the hesitation of leaders and to persistent taboos relating to sexuality and high-risk behaviour. The main recommendations included targeting prevention efforts in countries where the epidemic was concentrated among very vulnerable populations, and tightening the bonds between sex, hygiene and procreation programmes.
The round table devoted to treatment had reaffirmed the urgent need to expand treatment programmes, he said. Considerable difficulties still hampered the attainment of that objective, including the lack of public health infrastructure and qualified health staff. The main recommendation included reviewing national testing policies to, among other things, increase financial aid from donors for testing initiatives; continuing to reduce the cost of antiretroviral treatment, making such treatment more accessible, in particular for children; and strengthening monitoring mechanisms and ensuring maximum recourse to health-care workers.
The General Assembly met today in a high-level special session to review progress in realizing the commitments set out in the 2001 Declaration of Commitment on HIV/AIDS. The Assembly was expected to hold opening and closing plenary sessions, as well as five interactive round tables on such themes as prevention, human rights, resources, treatment, care and support, and children orphaned by HIV/AIDS with many countries participating in the one-day session at the ministerial level.
Before the Assembly was the Secretary-General’s report on progress in the implementation of the Declaration of Commitment on HIV/AIDS (document A/59/765). The report draws on a broad range of data sources, including national data on key AIDS indicators from 17 countries and territories in Africa, Asia, the Caribbean and Eastern Europe, other national surveys, commissioned studies and evidence-based estimates of coverage for key AIDS interventions. It tracks the current state of the epidemic and summarizes overall progress made in realizing the commitments set out in the Declaration, with a special focus on those set out for 2005.
Despite encouraging signs that the epidemic is beginning to be contained in a small but growing number of countries, the overall epidemic continues to expand, with much of the world at risk of falling short of the targets set forth in the Declaration, the report states. While the expansion of AIDS treatment programmes has brought fresh hope to communities and re-energized community-based prevention and care efforts, the roll out of treatment programmes has been insufficient to avoid a deepening of the epidemic’s impact on some of the world’s most vulnerable communities. AIDS-related mortality continues to erode the fragile base of human capital on which sound development depends and threatens to undermine critical social institutions in hard-hit countries.
The report notes that the Declaration of Commitment on HIV/AIDS has served as a critical mechanism for advocacy, transparency and accountability in the global fight against the epidemic, establishing clear time-bound targets that underpin the Millennium Development Goals. More than 8,000 people die every day from AIDS-related conditions. As of December 2004, some 39.4 million were living with HIV. Women now account for just under one half of all people living with HIV. The epidemic continues disproportionately to affect adolescents and young adults, with one half of the new infections occurring among this age group. Some 2.3 million children under the age of 15 are living with HIV, the vast majority of them infants who contracted HIV during gestation or delivery or as a result of breastfeeding.
Worldwide, one in every 90 adults in low- and middle-income countries is living with HIV, representing some 95 per cent of the world’s HIV infections, the report adds. Sub-Saharan Africa remains the hardest-hit region, accounting for 64 per cent of the world’s HIV infections and 74 per cent of all AIDS deaths in 2004. The epidemic has yet to display a natural saturation point. In Swaziland, the country most affected, adult prevalence continues to climb, with 42.6 per cent of pregnant women testing HIV-positive in 2004. Reaching the targets set out in the Declaration of Commitment and the Millennium Development Goals requires a comprehensive response in scope and coverage. Unknown to the world less than 25 years ago, AIDS represents a unique threat to international development, which undermines the hope of achieving the Goals.
Citing several key findings, the report notes that many of the most affected countries are at risk of falling short of the target of reducing by 2005 the level of infection in young men and women aged 15 to 24. While the number of people on antiretroviral therapy increased by nearly two thirds during the second half of 2004, in low- and middle-income countries only 12 per cent of those who need antiretroviral therapy were receiving it as of December 2004. While many surveys of national AIDS responses and policies reveal the existence of human rights safeguards, such measures frequently lack the specificity and enforcement mechanisms necessary to combat the associated stigma and gender-based discrimination.
Most high-prevalence countries are making considerable efforts to protect children orphaned or made vulnerable by the epidemic, but available evidence indicates that national efforts and the level of donor support are currently not sufficient to address the growing crisis, the report continues. A major barrier to the implementation of essential AIDS programmes is the acute shortage of trained personnel who possess requisite skills and expertise. If current spending trends continue, by 2007 there will be a significant shortfall between the funds available and the resources needed to finance a comprehensive response.
Outlining major themes, namely prevention, treatment, care and support, orphans and children made vulnerable by HIV/AIDS, human rights and gender equality, resources, monitoring and evaluation, the Secretary-General makes several recommendations under each category. Among the recommendations in the area of prevention, he recommends scaling up proven prevention activities under the leadership of national authorities and targeting prevention efforts to achieve maximum impact, especially in countries in which epidemics are concentrated among highly vulnerable populations. Regarding treatment, care and support, he recommends increased donor financial support for testing initiatives and global action to lower the price and accessibility of first- and second-line antiretroviral therapy regimes, including the current high-priced and often unavailable antiretroviral therapy regimens for children.
Concerning children and orphans, he recommends implementing the Framework for the Protection, Care and Support of Orphans and Vulnerable Children Living in a World with HIV and AIDS by taking urgent steps to develop action plans for each of the Framework’s key tools. Developed by the United Nations Children’s Fund (UNICEF), the Framework contains priority programmatic responses to protect children, including access to antiretroviral therapy to keep one or both parents alive and healthy. Recommendations regarding human rights include enacting meaningful laws to prohibit discrimination against people living with HIV/AIDS, strengthening gender equality initiatives, and undertaking efforts to increase women’s knowledge of their legal rights. On the issue of resources, the Secretary-General recommends mobilizing financial resources to provide full funding for an expanded response to the epidemic, including full funding for the Global Fund to Fight AIDS, Tuberculosis and Malaria as one of the major channels for financing the global effort. He also suggests narrowing expected shortfalls by securing the commitment of national leaders of low- and middle-income countries to increase allocations to AIDS from domestic budgets.
In 2006, the Assembly will receive a comprehensive report on international progress in implementing the Declaration, with special reference to the targets set for 2005, the report concludes. As the impact of the epidemic becomes increasingly apparent, failure in the global response to AIDS is a possibility too disturbing to contemplate, yet one that will surely occur if effective action is not taken.
JEAN PING (Gabon), General Assembly President, welcomed representatives of all regions and multilateral organizations, and civil society, as well as people living with HIV/AIDS. Who better than them to inform the Assembly on efforts made and on what remained to be done? The 2001 Declaration of Commitment on HIV/AIDS had set forth several specific actions and specific timetables. The pandemic remained both a critical challenge for societies and a global emergency, which must be identified as a major obstacle to effective implementation of the Millennium Development Goals. It must also be concluded that the HIV/AIDS threat in 2005 was much greater than when the Assembly met here four years ago. In every way, that threat had attained alarming proportions.
In fact, he said, in 2004, the number of infected people had grown to about 5 million, and the number who had died had also grown, to 3.1 million in 2004, much more than for the four preceding years. The pandemic had also achieved a disturbing rate of growth worldwide, affecting new countries and new populations within countries, particularly women and girls. Moreover, 95 per cent of those infected were in low- and medium-income countries. In an ever-growing number of countries, the pandemic was in the process of decimating human resources and soaking up financial and material resources. Between now and 2006, 11 sub-Saharan African countries would probably have lost more than one tenth of their workforce due to AIDS. In light of that grim picture, participants should proceed to a vigorous assessment of the recommendations in the Secretary-General’s report.
The time had come to ask Member States if they had the necessary political will to meet the commitments set forth in the Declaration, he said. Everyone should do their utmost to answer a number of critical questions: had every low- and medium-income country taken on enough responsibility in the search for solutions; had the political leadership been sufficiently involved; had the high-income countries honoured their commitments to support the others in combating that global threat; what had been done to ensure that populations at risk, particularly young people who consisted of more than half of all new cases of infection, provided the tools, communication and means to protect them; and had Member States been able to extend the necessary treatment, health care and support?
To what extent had Member States honoured their human rights commitments and put an end to the stigma and discrimination faced by people stricken with HIV/AIDS? he asked. Had they been able to contain the impact of the pandemic? In order to present a summary of the five round tables at the plenary this afternoon, he urged delegations to focus their discussion on the recommendations contained in the Secretary-General’s report.
Statement by Secretary-General
Secretary-General KOFI ANNAN said that since the Assembly met in a special session four years ago and unanimously committed itself to addressing the HIV/AIDS scourge, the world had faced an unprecedented crisis, requiring an unprecedented response from all. He had hoped that the resulting Declaration of Commitment would herald the emergence of a response that matched the scale of the epidemic.
He said that, four years on, the response in every key category had been significant –- in political leadership, in funding, in the intensity and reach of prevention programmes, and in the availability of drug therapies. But, it had also been insufficient; the response had succeeded in some areas, but it had not matched the epidemic in scale.
Last year saw more new infections and more AIDS-related deaths than ever before, he said. HIV and AIDS had expanded at an accelerating rate and on every continent. Treatment and prevention efforts were “nowhere near enough”. Only 12 per cent of the people in need of antiretroviral therapies in low- and middle-income countries were receiving them. And, while young people -- especially young women -– accounted for more than half of all new infections, most of the world’s young people still lacked meaningful access to youth-oriented prevention services.
“The epidemic continues to outrun our efforts to contain it”, he said. If the Millennium Development Goal of halting and beginning to reverse the HIV/AIDS spread by 2015 was to be met, then the world must do far, far more. Everyone knew what worked; they knew it was possible to break the cycle of new infections. They had seen what happened when prevention programmes succeeded, such as in Brazil, Cambodia, Thailand and India. The world was witnessing similarly encouraging signs in several other countries, from the Bahamas to Cameroon, Kenya and Zambia.
He said that some of those countries had managed to arrest the epidemic at an early stage. Others had reversed the spread after it had already made inroads. Real progress had also been seen in providing access to treatment. By the end of last year, more than 700,000 people in low- and middle-income countries had access to antiretroviral therapy -- thanks to the combined efforts of initiatives such as “three by five” run by the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS); the work of the Global Fund; the United States President’s Emergency Plan for AIDS Relief; and the World Bank’s Multi-Country AIDS Programme.
Those successes must be replicated and built on, he continued. That would require increased resources from traditional donors, the private sector, and the most affected countries, themselves. That meant full financing of the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as vastly increased funding of organizations that provided direct services to those in need. That would also require better planning to ensure that resources were used as effectively as possible.
He said that success would also require greater, better and more vocal leadership at every level and in every area -– from efforts to stamp out stigma and discrimination, to the need for strengthening public health systems and infrastructure. That would also require real investment in the empowerment of women and girls. Women now accounted for about half of all people living with HIV worldwide, but they were also the most courageous and creative champions in the fight against the epidemic.
In September, world leaders would meet here at the United Nations to assess progress in implementing the Millennium Declaration, and to chart the road ahead. In many ways, the task this year would be much tougher than it was in 2000, when the Declaration was adopted. Instead of setting targets, this time leaders must decide how to achieve them. They must decide on a plan to achieve the Millennium Development Goals.
“In that mission, how we fare in the fight against AIDS is crucial”, he said. Halting the spread is not only a Millennium Development Goal itself; it is a prerequisite for reaching most of the others. “That is why the fight against AIDS may be the great challenge of our age and our generation. Only if we meet this challenge can we succeed in our other efforts to build a humane, healthy and equitable world. Let us ensure we are equal to it”, he said.
PETER PIOT, UNAIDS Executive Director, noted that, given the quantum worsening in the epidemic’s trajectory, the gap between need and action remained enormously wide. Looking back over the past four years, two disquieting facts became evident: AIDS was an unprecedented global crisis; and unless it was controlled, the epidemic would continue to expand for decades, killing large numbers and wrecking entire societies. A quantum leap in commitment, both in terms of goals and action, was required. The international community’s response would be equal to the challenge only when several milestones had been met. The first milestone was that world leaders give AIDS the same level of attention and concern as they gave to global security. The second milestone was the need to ensure universal access to both HIV prevention and HIV treatment. Nothing less than universal access to effective HIV prevention and treatment would be sufficient to keep the epidemic from engulfing the next generations. For universal access to become a reality, the huge funding gap must be closed.
While there had been remarkable progress since 2001, the shortfall was widening.
He said a third milestone was to make the money work for people on the ground. For the money to work effectively, all actors needed to support nationally led strategies through the “Three Ones” principles, which had been endorsed by governments, civil society and donors worldwide since 2004. The rights of the most vulnerable people must be accorded the highest priority in practice. People living with HIV needed to be accorded their rightful leadership role at every level. A fourth milestone was to incorporate a long-term horizon in planning and actions. Several other things had to be achieved, namely putting in place the systems needed to realize longer-term solutions, such as vaccine and microbicide. The fundamental drivers of the epidemic must also be tackled, such as lack of education, gender equality, poverty and discrimination. The enduring obstacles to development created by the epidemic also needed to be overcome, including the orphaning of generations of children.
The United Nations system needed to maximize collective effectiveness by pooling efforts in every country as a full joint United Nations team and programme on AIDS, he said. While the 2001 Declaration had been a brave and great leap forward, success against the epidemic required that almost every country executed a far stronger plan, far stronger action and clear targets that went beyond 2015. If the AIDS crisis were resolved, a major hurdle to achieving the Millennium Development Goals would be removed. When the Assembly met a year from now, he called on it to discuss not what had been done, but to agree on action to address the material and political obstacles in the path of universal access to HIV prevention and treatment.
Summary of Round Tables
Summarizing the round table discussions held throughout the day, General Assembly President JEAN PING said participants had been universal in stressing the serious nature of the HIV epidemic. A number of common questions had been emphasized, including the need to combat the taboos associated with HIV, as well as the need to find new funding sources and greater civil society participation. The debates had raised essential questions and recommendations.
The round table on resources had noted that while the resources devoted to combating HIV had grown considerably since the 2001 Special Session, resources were not commensurate with the problem. Improving services to combat the epidemic had encountered difficulties, including a lack of qualified health personnel. The panel had stressed the need to provide sufficient resources to combat AIDS. While governments had to increase national budgets, international commitments also needed to be honoured. Countries needed to specify their human resource needs and elaborate innovative means to combat the epidemic. The round table had also stressed the need to ensure effective and timely use of available resources, including through the implementation of the “Three Ones” principle.
The round table on children made vulnerable by HIV and orphans had noted that current efforts were insufficient to deal with the problem. The primary role of the family in supporting HIV children had also been recognized, and the round table had recommended doubling efforts at the national level and increased donor support to protect orphans and provide them with treatment, support and care. It had also recommended stepped up programmes for children at risk by, among other things, eliminating the cost of schooling and broadening nutritional programmes in schools. Steps also needed to be taken to prevent new infection among parents and children.
He said the round table devoted to human rights and gender had emphasized the fact that gender inequality continued to increase the transmission of HIV. The growing feminization of the epidemic had made it increasingly necessary to establish programmes to attack the cause of women’s vulnerability. The main recommendations included strengthening measures to combat discrimination against people with HIV; promoting the protection of people living with HIV; the creation of special programmes for women and girls to reduce their vulnerability to infection; strengthening initiatives to improve their socio-economic condition and enhancing efforts to eliminate violence against women.
Prevention remained the pillar in combating AIDS, the round table on that issue had concluded, he said. Fewer than one in five had access to basic services to prevent AIDS. Partial measures were not useful. The hesitation of leaders and social taboos regarding sexuality compounded by poverty, inequality among the sexes, and non-respect of human rights, continued to undermine the implementation of effective prevention measures. The discussion’s main recommendations included increasing proven prevention activities and tightening the ties between sex, hygiene and procreation and prevention programmes.
The round table devoted to treatment had reaffirmed the need to urgently expand treatment programmes, he said. Considerable difficulties still hampered the attainment of that objective, however, including the lack of public health infrastructure and qualified health staff. The main recommendation included reviewing of national testing policies to, among other things, increase financial aid from donors for testing initiatives; continuing to reduce the cost of antiretroviral treatment, making such treatment more accessible, in particular for children; and strengthening monitoring mechanisms and ensuring maximum recourse to health-care workers.
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