POP/923
6 April 2005
World Bank Official Stresses Need to Capitalize on “Unprecedented Global Solidarity” to Fight HIV/AIDS, as Population Commission Continues
To Date, More Than 60 Million Infected; 20 Million Have Died, as Epidemic Continues to Grow
NEW YORK, 5 April (UN Headquarters) -- With increased political commitment and an unparalleled amount of funding, which had reached about $6 billion in 2004, the international community had, more than ever, an opportunity to tackle the HIV/AIDS epidemic, the Commission on Population and Development was told, as it continued its five-day session today.
In her keynote address that opened an interactive discussion on the implications of the epidemic for African development, Debrework Zewdie, Director of the World Bank’s Global HIV/AIDS Programme, stressed the need to capitalize on the unprecedented global solidarity to provide treatment and care for millions of people infected and affected by HIV/AIDS. The simple truth was that inaction was expensive. “We need to act faster than ever”, she said. “While other regions might not have Africa’s fate, arresting the epidemic or driving it downwards ... needs a clear strategy now, before it is too late.”
Outlining the devastation the epidemic had caused, Ms. Zewdie cited its shocking statistics: to date, more than 60 million people had been infected; 20 million had died; and 40 million were living with HIV/AIDS. The epidemic continued to grow, as evidenced by the fact that more people had been infected in 2004 than in any previous year. More than 15 million children had been orphaned by the disease, 12.3 million in sub-Saharan Africa alone. The disease seriously jeopardized the attainment of most of the Millennium Development Goals in African countries, worsening poverty, reducing life expectancy and striking people during their most productive years. In some countries, it had wiped out up to 40 years of progress.
As there were no quick solutions, it was necessary to make a long-term commitment to HIV/AIDS prevention, care and treatment, she said. It was important to focus on mainstreaming and scaling up programmes that had proven to be effective, where they were most needed. “We have very few success stories to date”, she said. “Success can only be declared when we manage to stop new infections.”
Whereas in 1996 the international community had had only $300 million in global funding, in 2004 it had about $6 billion. While that was only half of what was needed, effective implementation of the available resources was of paramount importance. The main priorities should be coordination, evidence-based programming, tackling of HIV/AIDS as a development problem, and implementation of the “Three Ones” initiative -- one national HIV/AIDS action framework; one national AIDS coordinating authority; and one monitoring and evaluation system. The rich countries needed to provide sustained support, and recipient countries needed to “put their house in order”. Fighting stigma and discrimination did not require external funding -- fighting its consequences required millions.
The global nature of the HIV/AIDS crisis and the need for urgent action were also emphasized in the debate that preceded the keynote address. The representative of Guyana, speaking on behalf of the Caribbean Community (CARICOM), said that high prevalence of the disease in the Caribbean -- the second highest in the world -- compounded the vulnerability faced by the countries there. He called for a stronger accent on prevention and pointed out that access to affordable care and treatment must be an integral part of the global response to HIV/AIDS. International support to South-South cooperation in addressing HIV/AIDS and poverty eradication could have a multiplier effect in tackling the epidemic, including by fostering more cost-effective modes of cooperation and the sharing of experiences and best practices.
Participants in the session also touched upon such vital issues as feminization of HIV/AIDS and the needs to integrate the HIV/AIDS and reproductive health services, provide resources for national programmes, and do away with stigmatization of people living with AIDS. Emphasized in the discussion was countries’ commitment to the fight against AIDS and the need to not only raise the necessary financial resources, but also to spend them wisely, particularly on education and modifying risky behaviour.
Among the main points made in the debate was the need to transform existing HIV/AIDS policies and programmes to ensure that sexual and reproductive health and other initiatives built on the commitment to protect, promote and respect human rights. Comments were also made on the importance of capitalizing on the contribution from non-governmental organizations, civil societies, organizations of people living with AIDS, and organizations dealing with culture and tradition.
HIV/AIDS was only one of the issues that the Commission addressed in two meetings today. Numerous speakers also took the floor to assess the follow-up to the Programme of Action agreed upon during the 1994 International Conference on Population and Development (ICPD) in Cairo, Egypt, and the role that document played in the implementation of internationally agreed development goals, including those contained in the United Nations Millennium Declaration. Representatives of many countries also shared their national experiences in population matters, in the light of the main topic of the Commission’s current session: “Population, development and HIV/AIDS, with particular emphasis on poverty”.
Statements were also made by the Minister for Planning and National Development of Kenya; the Director of the National AIDS Centre of Poland; the Director of South Africa’s Department of Population and Development; and the Deputy for Family Planning and Reproductive Health, National Family Planning Coordinating Board of Indonesia.
Other speakers included the representatives of Bolivia, Luxembourg (on behalf of the European Union and associated States), Canada, China, Australia, Argentina (on behalf of the Rio Group), El Salvador, Russian Federation, Algeria, Portugal, Canada, France, Philippines, Ethiopia, Malaysia, Brazil and Mexico.
The Representative of the Inter-American Parliamentary Group on Population and Development also took the floor.
Responding to questions and comments from the floor were Larry Heligman, Chief, Population Studies Branch, Population Division; Steve Kraus, Chief, HIV/AIDS Branch, United Nations Population Fund (UNFPA); and Mary Beth Weinberger, Chief, Population and Development Section, Population Division, Department of Economic and Social Affairs.
The Commission will continue its work at 10 a.m. tomorrow, 6 April.
Background
The Commission on Population and Development met this morning to conclude its general discussion on follow-up actions to the recommendations of the International Conference on Population and Development (ICPD). It will continue its consideration of contribution of the implementation of the Programme of Action of the ICPD, in all its aspects, to the achievement of the internationally agreed development goals, including those contained in the United Nations Millennium Declaration. The Secretary-General’s report (document E/CN.9/2005/6) was introduced yesterday and is summarized in Press Release POP/920 of 31 March.
Statements
GEORGE TALBOT (Guyana), speaking on behalf of the Caribbean Community (CARICOM), on follow-up actions to the recommendations of the ICPD, said the session’s theme “Population, development and HIV/AIDS, with special emphasis on poverty” held particular importance for CARICOM. Africa, however, remained home to the worst manifestations of the HIV/AIDS tragedy. Beyond Africa, there were growing problems in parts of Asia and Eastern Europe, as well as in Latin America and the Caribbean. AIDS-affected countries presented relatively poor socio-economic indicators and there was evidence to suggest that poverty levels were relatively higher in those countries. It was difficult, however, to discern a correlation between the levels of poverty and of HIV prevalence. Prevention was the central pillar in action against HIV/AIDS. More had to be done to educate people to protect themselves and others.
He said HIV prevalence in the Caribbean was the second highest in the world. The high incidence of HIV/AIDS compounded the vulnerability faced by the countries there, attributable to economic, social and environmental factors. Among specific areas of concern were the dramatic increase of HIV/AIDS among Caribbean women and increase in children born with the disease; the impact on the labour force; and longer-term impact on productivity, gross domestic product (GDP) and other aspects of socio-economic development. The primary regional instrument in the fight against HIV/AIDS was the Pan-Caribbean Partnership against HIV/AIDS (PANCAP). The PANCAP confronted the HIV/AIDS challenge through action in seven priority areas: advocacy; policy development and legislation; care; prevention with focus on young people; prevention among especially vulnerable groups; prevention of mother-to-child transmission; and resource mobilization.
The global dimensions of the pandemic pointed to the need for urgent action at all levels, national regional and global, he said. The CARICOM called for a stronger accent on prevention. It was a matter of concern that resources currently donated amounted to just 30 per cent of estimated requirements. Access to affordable care and treatment must be an integral part of the global response to HIV/AIDS. International support to South-South cooperation in addressing the HIV/AIDS challenge to development and poverty eradication could have a multiplier effect in tackling the epidemic, including by fostering more cost-effective modes of cooperation and the sharing of experiences and best practices. The advancement of women was critical to the successful pursuit of sustainable development and for addressing the AIDS crisis in particular. The CARICOM, therefore, called for special attention to the particular needs of women and girls, including with respect to reproductive health.
RENE PEREIORA MORATO (Bolivia) said that 10 years after the adoption of the ICPD Programme of Action, his country wanted to reaffirm its commitment to its goals. His country emphasized that the sexual and reproductive rights of a population were a central element of development. His country had recently launched a national programme for sexual and reproductive health for 2004-2008. A law was under debate on sexual and reproduction rights.
A serious problem of HIV/AIDS placed sexual behaviour and rights at the centre of attention, he continued. In certain societies, taboos on sexuality made it difficult to change the sexual behaviour of men and women. Achieving safe sexual relations was a serious challenge when great parts of society were characterized by gender inequality. In Bolivia, the prevalence of HIV/AIDS was less than 1 per cent in urban areas, but it reached 50 per cent among such vulnerability groups as sex workers, intravenous drug users, and populations of men who had sex with men.
The serious nature of the epidemic required action at the international, national and local levels, he said. Accessible prevention should be emphasized. It required such measures as better education to achieve change in sexual behaviour and access to condoms for both men and women. For the efforts to combat HIV/AIDS to be more sustainable, he recommended working in the framework of national programmes of sexual and reproductive health and, if possible, within the context of laws on sexual rights. He agreed that the goal of universal access to reproductive health had to be added to the Millennium Development Goals to improve the health of mothers. Reproductive health would then be visibly integrated in the Millennium Goals.
MARIA ANTONIETY SAA, representative of the Inter-American Parliamentary Group on Population and Development, said in Cairo, in 1994, 179 governments of different regions had adopted a Programme of Action which clearly recognized that health and sexual and reproductive rights constituted a pillar for development. Implementation of the Programme of Action was crucial to realization of the Millennium Development Goals. Implementation of the Millennium Goals would only have effect if governments adopted measures to address reproductive health. There was a clear link between health and sexual and reproductive health and the Millennium Goals. That relationship had to be strengthened, and a new goal had to be added to the fifth Millennium Development Goal regarding maternal health, to include universal access to information and to sexual and reproductive health services by 2015.
She noted with concern the growing spread of HIV/AIDS in Latin America and the Caribbean, in particular, among women, young people and those in the most vulnerable groups. Prevention was important, as well as information on sexual and reproductive health. Laws on HIV/AIDS must be placed in the international context of human rights. Legal voids existing in many countries in the region regarding the pandemic must be eliminated. Those voids included: the lack of gender perspective in legislation; absence of guarantees to the right of intimacy and sexual orientation; lack of care for young people; lack of care for people living with HIV/AIDS; and lack of care for the migrant population. She urged governments, the international community and UN agencies to continue to support the promotion and defence of sexual and reproductive rights and the Millennium Development Goals.
In response to questions and comments raised during yesterday’s and today’s discussion, LARRY HELIGMAN, Chief, Population Studies Branch, Population Division of the Department of Economic and Social Affairs, said the statements underlined the commitment of countries to take the necessary steps to put an end to the pandemic. They also underlined the necessity of raising the necessary financial resources and spending them wisely, particularly on education, and modifying risky behaviour. It was also necessary to provide treatment and care for those infected and those affected by the disease. The deliberations had highlighted that HIV/AIDS was closely intertwined with poverty. The two must, therefore, be at the top of the international agenda. The outcome of the current deliberations would be a very important input for the September Summit.
STEVE KRAUS, Chief, HIV/AIDS Branch, United Nations Population Fund (UNFPA), said that 21 Member States and international organizations had taken the floor during the debate on the matter, in many cases, on behalf of groups of States. Many had referred to previous declarations, commitments and meetings that had taken place in various parts of the world. Yesterday and today, he had heard a strong reaffirmation of linkages between HIV/AIDS and sexual and reproductive health. Broader issues of health, poverty, development and human rights had been raised in the discussion. There was strong reaffirmation of the outcome of recent international conferences, including those in Cairo, Beijing, the Millennium Summit and United Nations commitment on HIV/AIDS. That made sense.
Highlighting the main points made in the debate, he mentioned the need to transform existing HIV/AIDS policies and programmes to ensure that sexual and reproductive health and other initiatives built on the commitment to protect, promote and respect human rights. It was necessary to capture the creativity and capacity of non-governmental organizations (NGOs), civil societies and organizations dealing with culture and tradition. There was a clear need to promote a coordinated and integrated response based on the “Three Ones” principles: one national HIV/AIDS action framework; one national AIDS coordinating authority; and one monitoring and evaluation system. He encouraged all players to work together as advocates and leaders to energize the global community on the need to build stronger links between HIV and sexual and reproductive health. The views expressed in the debate needed to find their way in the resolutions to be adopted at the international level.
As the Commission turned to the contribution of the implementation of the Programme of Action of the ICPD in all its aspects and achievement of the internationally agreed development goals, including those contained in the United Nations Millennium Declaration, ELISABETH COLOTTE (Luxembourg), speaking on behalf of the European Union and associated States, said that access to sexual and reproductive health information and services was an internationally agreed goal and an end in itself. Population and development issues were inextricably linked. The Millennium Development Goals and the overarching goal of poverty eradication simply would not be achieved without achieving also the ICPD goals. As the world was focused on those goals, the European Union would like to remind that population trends had a strong impact on social and economic development.
Managing population growth was a basic tool of managing worldwide food supply and vital environmental resources, such as water, she said. Access to sexual and reproductive health services and rights was the main key to managing demographics, reducing maternal and child mortality, preventing an exponential spread of HIV/AIDS, ensuring gender-specific action, promoting health and alleviating poverty. Reproductive health commodities were an essential tool in the fight to reduce maternal and child mortality and the spread of HIV/AIDS. Some 200 million poor women in developing countries had an unmet need for effective, accessible and affordable contraception. Meeting their needs was entirely feasible, with adequate funding and an effective partnership that would include the private sector and civil society. To alleviate the most immediate funding gap, the Union in 2004 had contributed over $80 million to the Reproductive Commodities Trust Fund of the UNFPA.
Among other problems, she listed unsafe abortions and complications during pregnancy and childbirth as the leading cause of death for women of reproductive age in developing countries. The lack of safe motherhood was still one of the world’s urgent concerns. Meeting unmet demand for contraception could do much to improve maternal outcomes and women’s choice. To reduce maternal mortality, it was necessary to focus on the provision of human rights-based, integrated reproductive and sexual health services through the primary health-care system. It was necessary to invest more in women’s empowerment, recognizing their rights and enabling them to make choices that would influence their and their families’ health and quality of life. An integrated approach should include such issues as the promotion of human rights, protection from abuses and violence, trafficking of women, early marriage and female genital mutilation.
She agreed that access to sexual and reproductive health services was a “quick win” for development. For that reason, population and sexual and reproductive health and rights should be fully integrated into macroeconomic and sustainable development policies, poverty-reduction strategies and sectoral plans. Stronger health systems were essential as a foundation for better services. Progress at the country level would be achieved through the inclusion of the ICPD agenda into the “Millennium Development Goals-friendly” Poverty Reduction Strategy Papers and other national planning frameworks.
In conclusion, she said that the Cairo Programme continued to be under-funded and substantial increases in official development assistance (ODA) must be secured if the goals of the ICPD, ICPD+5 and Millennium Development Goals were to be met. The Union was making steady progress in fulfilling its commitment to ODA. Those Member States that had not yet reached the goal of 0.7 per cent of gross national product (GNP) committed themselves to increasing their ODA volume in the next four years, within their respective budget allocation processes.
GILBERT LAURIN (Canada) said there was no doubt that any efforts to meet the Millennium Development Goals needed to include full implementation of the ICPD Programme of Action. At the core of such efforts must be the promotion and protection of human rights, in particular, sexual and reproductive rights. Like the Millennium Goals and the Beijing Fourth World Conference on Women, the ICPD Programme of Action put gender equality and the empowerment of women at the centre of development. The Programme also addressed other issues important in the context of the Millennium Development Goals, including changing of age structures; urban-rural and international migration patterns; the environment; sexual and reproductive health; access to affordable and appropriate family-planning services; and the linkages between population growth and economic development.
He said the HIV/AIDS pandemic placed additional burdens on societies. More must be done to halt and reverse the spread of that devastating pandemic and to lessen the exacerbating effect of HIV/AIDS on poverty. His country was proud to be making its contributions towards meeting the Millennium Development Goals and those of the ICPD. On World AIDS Day last December, Canada had announced a multi-year pledge and significant increase in its funding to both the UNFPA and the UNFPA Trust Fund for Reproductive Health Commodities.
RU XIAOMEI (China) said a “people first” principle, combined with the philosophy of “comprehensive, coordinated and sustainable development”, was now guiding China’s population and development programme. Since 1994, her country had been actively carrying out the ICPD Programme of Action. It had taken the lead in introducing the ideas of reproductive health and quality of care into the population and family planning programme, shifting priority from focusing exclusively on quantitative population control to an integration of the population programme with socio-economic development, harmonious family-building and improvement of living standards. Other measures included a reward and aid programme targeting rural households practising family planning.
She said that since 1998 all provinces, municipalities and autonomous regions of China had reported HIV/AIDS cases. HIV/AIDS was spreading from high-risk groups to the general public, and the proportion of women contracting HIV was also increasing. People’s knowledge about prevention remained inadequate. Other risky factors, such as poverty, gender inequality and discrimination, still remained widespread.
Her Government had taken numerous actions to address those challenges, including: establishment of an AIDS/sexually transmitted diseases coordination mechanism under the State Council; formulation of a mid- and long-term plan for HIV/AIDS prevention and control; and increased funding for prevention tailored to local needs. The Ministry of Health had, among other things, set up 127 pilot sites for integrated HIV/AIDS prevention and control. Incorporating reproductive health and family-planning services with HIV/AIDS prevention and treatment had proved to be the most cost-effective best practice, she said, and went on to describe how that concept was implemented in her country.
Reacting to comments raised by delegations, MARY BETH WEINBERGER, Chief, Population and Development Section, Population Division, Department of Economic and Social Affairs, noted the strong endorsement expressed for the ICPD Programme of Action and also for the point that full implementation would significantly contribute of the universally agreed development goals, including those in the Millennium Declaration. She also noted that speakers had stressed that ICPD implementation was essential to meeting the Millennium Development Goals.
She said of particular note was the strong endorsement for the importance of reproductive health and reproductive rights for achieving the development goals. Many speakers had enumerated ways in which those various goals were linked. In addition, many delegations had drawn attention to the many ways in which population factors were linked to achievement of development goals, including: rapid population growth; rural and urban population growth; and migration. Many delegates had drawn attention to the link among the ICPD goals, reproductive health and HIV/AIDS, and the strong link between the reproductive health goals and achievement of gender equality.
Keynote Address
Outlining the current state of the epidemic, DEBREWORK ZEWDIE, Director of the World Bank’s Global HIV/AIDS Programme, said that the numbers were shocking. To date, more than 60 million people had been infected, 20 million had died and 40 million were living with HIV/AIDS. The epidemic continued to grow, as evidenced by the fact that more people had been infected in 2004 than in any previous year. The impact of AIDS was also felt by more than 15 million children who had been orphaned by the disease, 12.3 million in sub-Saharan Africa alone. Home to just over 10 per cent of the world’s population, that area had more than 60 per cent of the people living with HIV/AIDS -- more than 25 million people. In sub-Saharan Africa, the international community was dealing with multiple epidemics requiring multiple strategies. Another issue, which had dire consequences, was the fact that the face of the epidemic was becoming more feminine. HIV/AIDS spared no one. It had already hit hard in such regions as the Caribbean and was growing fast in others. It was truly a global emergency.
Turning to the cost of inaction, she said that while there was now consensus that HIV/AIDS was no longer only a health problem, but a major development concern, much work still had to be done to make sure that HIV/AIDS was actually factored into development planning. The disease reduced life expectancy, orphaned children, struck people during their most productive years and worsened poverty. In some countries, it had wiped out up to 40 years of progress. In fact, HIV/AIDS threatened entire economies, as it would shrink the workforce and lead to declines in economic growth and household income. While its impact on the health sector was the most evident, it could also jeopardize practically all sectors, including food security, education, infrastructure, as well as mining and transportation. Exacerbating poverty, HIV/AIDS was also seriously jeopardizing the attainment of most of the Millennium Development Goals in African countries.
Both the countries directly affected by the epidemic and the international donor community were partially to blame for the current situation, she continued. Traditional response to the epidemic left much room for improvement. The international community took a long time to respond, and when it did the response was an emergency one without a strategy that took into account the dynamics of the epidemic. It was a “one size fits all” approach. That was one of the reasons why the international community saw no scaled-up programmes after many years of saying “we know what to do”. Some governments were not fully committed; there was a lack of coordination between donors; funding was insufficient and unfocused; and there were no monitoring and evaluation systems in place to see what was working and what was not.
Early responses had been too few, too small, lacked focus and were not evidence-based, she said, but epidemics in Manzini, Kampala and Dakar, for example, had progressed differently over the years and would require different mitigation approaches. In developing responses, it was necessary to take into account the nature of the epidemic, including local transmission patterns and sources of vulnerability. For instance, in one country where prevalence among sex workers was nearly 80 per cent, prevalence among general population was less than 2 per cent. At the same time, less than 1 per cent of the funding for HIV/AIDS was used to target sex workers. In such cases, it was not surprising that there were no quick results. While funding was required to implement programmes, such issues as creating an enabling environment, putting in place appropriate policies, fighting stigma and discrimination and attacking the epidemic on a war-like footing were not a priority in many of the affected countries.
Looking at the way forward, she said that, with increased political commitment and an unparalleled amount of funding, the international community had now, more than ever, an opportunity to tackle the epidemic. Realizing that there were no quick solutions, it was necessary to make a long-term commitment to HIV/AIDS prevention, care and treatment. It was important to focus on mainstreaming and scaling up programmes that had proven to be effective, where they were most needed. “We have very few success stories to date. Success can only be declared when we manage to stop new infections”, she said.
In the last few years, there had been major changes in the global response to HIV/AIDS, she continued. There had been shift from a narrow, health-sector approach to a multi-sectoral focus. Declining anti-retroviral drug prices had made treatment on a large scale possible. There were now more players and resources available than ever before to fight the epidemic. The World Bank had led the way by putting over $1 billion to fight the epidemic in Africa. Its commitment was for 15 to 20 years, until countries built sustainable capacity to fight the epidemic. Since 2000, the Bank had committed more than $1.1 billion in 29 countries. It also had traditional investment projects focusing on HIV/AIDS, as well as technical assistance projects, institutional development funds and new regional initiatives, such as the Treatment Acceleration Project and the Africa Regional Capacity Building Network for HIV/AIDS Prevention, Care and Treatment.
The Global Fund to Fight AIDS, Tuberculosis and Malaria had committed $1.74 billion to fight the HIV/AIDS epidemic globally, she added. The United States President’s Emergency Plan for AIDS Relief had pledged $10 million in new resources for 15 focus countries. Whereas, in 1996, the international community had had only $300 million of global funding, in 2004, it had about $6 billion. While that was only half of what was needed, effective implementation of the available resources was paramount. Among the main remaining challenges, she listed a need to ensure coordination at the country level, provide evidence-based programming, and overcome a huge implementation gap. In the health sector, the problems ranged from lack of basic drugs to debilitated facilities and erosion of the workforce. Donor support in building health systems had been sporadic and insufficient.
She said that, while the global donor community had made a commitment to put 3 million people on treatment by the end of 2005, there were many challenges to making that goal a reality, including insufficient resources, equity issues, ensuring programme effectiveness, maintaining the emphasis on prevention, coordination and long-term commitment. “How we deal with treatment and the challenge of balancing it with effective prevention programmes will determine how we respond to this epidemic in the next decade”, she said.
It was necessary to embrace and implement the “Three Ones” to improve harmonization and coordination, she said: one agreed AIDS action framework that would provide the basis for coordinating the work of all partners -- not mere strategic plans; one national AIDS authority with a broad-based multi-sectoral mandate -- led by government, but not about only government control; and one agreed country-level monitoring and evaluation system –- not merely reporting, but accountability. Another step forward would be joint programming and annual reviews, as in the case of Kenya, and common implementation units, as in Rwanda. True coordination would involve the pooling of funds, as in the case of Malawi.
Today, it was important to capitalize on the unprecedented global solidarity brought about by the epidemic. “Every time we let go a little, the virus gains more ground”, she said. “We need to act faster than ever.” What the international community needed to do now was to sustain the good things that the changing landscape had brought. While the rich countries needed to provide sustained support, the recipient countries needed to “put their house in order”. Fighting stigma and discrimination did not require external funding; yet, fighting its consequences required millions.
Interactive Discussion
During the ensuing discussion, moderated by HANNA ZLOTNIK, Director of the Population Division, speakers raised questions, among other things, on the importance of integrating reproductive health services with HIV/AIDS services, the stigmatization of vulnerable groups, lack of resources for national programmes, the problem of porous borders in Africa, and the “demonization” of condoms.
In answer to questions raised, Ms. ZEWDIE, said that the feminization of the pandemic had to do with the lack of integration of reproductive health services and services regarding HIV/AIDS. There should be no credible programme regarding basic reproductive health that did not take HIV/AIDS into account. Such integration would also offer an opportunity to ensure that men became more responsive both to reproductive health issues and HIV/AIDS.
Regarding stigmatization of vulnerable groups, she said a lot of time had been wasted on blaming sex workers and homosexuals. While infection rates of sex workers was 80 per cent, most of the money went elsewhere, for instance. A better way of dealing with the problem would have been to co-opt the vulnerable groups and make them agents of change instead.
She said the World Bank was aware of the porous border problem in Africa and had put several programmes in place that took that issue into account. As for condoms, she said the World Bank did not dictate to countries the kind of programmes they put in action. If a country had a programme for condoms, the Bank would fund it. As for insufficient funding and the problems developing countries had in putting their own money into HIV/AIDS programmes, she said that the problem was a cyclical one. The epidemic was a long-term problem, but donors would grant money in two- to three-year cycles. Requiring Africa to foot the bill for the HIV/AIDS problem was a dream. It was up to the international community to assist in funding.
Asked about regional problems, she said in the Latin American hemisphere, Brazil had a very good programme, with government and donor commitments, and a strategy that was being implemented by everybody, including NGOs and civil society. The Caribbean countries were the hardest hit in the region. The World Bank had a programme in place similar to that in Africa. The World Bank had focused on sub-Saharan Africa and the Caribbean, the regions that had been hit hardest, but had also programmes in place in Asia and South Asia.
Among the initiatives for the post-conflict countries, Ms. Zewdie mentioned a Great Lakes programme, adding that there was a direct correlation between conflict and spread of HIV/AIDS. Most of Africa’s countries receiving funds for fighting HIV/AIDS from the World Bank were getting assistance in the form of grants and not loans.
It was also said that, while not a cure, anti-retroviral drugs, when taken properly, could significantly prolong the lives of people infected with AIDS. Their greater accessibility was an important step forward. The emphasis on mitigating and stopping new infections became critical at this point. Prevention was of utmost importance in that regard. Even in Swaziland, which now had 38 per cent prevalence, some 62 per cent of the population had a good chance of avoiding infection, if prevention measures were taken.
PETER ANYANG’ NYONG’O, Minister for Planning and National Development of Kenya, reported on his country’s response to the challenges of population, poverty and HIV/AIDS, saying that out of approximately 31 million people, 60 per cent were under 20 years of age. The population was estimated to grow at the rate of 2.5 per cent per annum, while life expectancy had declined to a low of 48 years for women and 47 years for men as a result of HIV/AIDS. Rapid population growth had led to the scarcity of employment opportunities, as a result of which poverty levels had increased from 52 per cent living below the poverty line in 1997 to 56 per cent in 2003. The high population growth had grave implications for the Government’s ability to provide health care, education and social services over the long term, besides its negative effects on the capital-formation capacity of the economy as a whole.
Recognizing the dragging effect of rapid population growth upon social and economic development efforts, and the paralysing effect of massive poverty, he said Kenya had put in place population, development and poverty-eradication policies and strategies, including a National Population Policy for Sustainable Development, a National Poverty Eradication Plan (1999-2015) and a Poverty Reduction Strategy Paper. In order to address the menace posed by HIV/AIDS, the Government, in collaboration with other stakeholders, had initiated a National Strategic Plan on HIV/AIDS; a cabinet subcommittee on HIV/AIDS chaired by the President; a National “Home-Based Care” policy, as well as a handbook and care training curriculum; national blood-safety policy guidelines, as well as the development of a national urban tuberculosis control strategy; and the targeting of electoral constituencies as units of development by introducing AIDS funds in all 210 constituencies.
HIV/AIDS prevalence had continued to slow down from 13 per cent in 2001 to 10.2 per cent in 2002 and 7 per cent in 2003, he said. The pandemic had entered a “death phase” in which more people were dying from AIDS-related complications than were being infected. That number was expected to go down drastically as anti-retroviral drug treatment programmes were rolled out to the people. Kenya hoped to provide treatment to 50 per cent of those requiring it by the end of July 2006 and up to 75 per cent by mid-2010. Prevalence rates had declined from 13 per cent to 7 per cent, which, however, remained an epidemic by any standard. It was vital to avoid complacency and maintain the momentum for success, which was critical for Kenya as a country and as a member of the global community of nations.
NATASHA SMITH (Australia) said HIV/AIDS was not just a health issue but also an economic, humanitarian, human rights and security issue. The response to the challenge must be comprehensive and multifaceted. Australia’s role in the international area was focused on Asia and the Pacific, and new infections in Asia last year totalled 1.1 million. Papua New Guinea was showing all the characteristics of an Africa-style epidemic. Last year, the Australian Government had launched its international HIV/AIDS strategy, called “Meeting the Challenge”. It had committed $A 600 million to the fight against HIV/AIDS by 2010. There were five key priorities: promoting leadership and advocacy; building capacity; changing behaviour; addressing HIV/AIDS transmission associated with intravenous drug use; and supporting treatment and care.
She said her Government was also mainstreaming HIV/AIDS issues through all its development assistance programmes. She then described some of the programmes in Papua New Guinea, Indonesia, and in African countries and her country’s cooperation with United Nations agencies. Australia had made an initial contribution of $A 25 million over three years to the Global Fund.
Australia itself was not immune to the epidemic, she added. It had developed a domestic response guided by its national HIV/AIDS strategy based on cooperative partnership with the Government, the health and medical community, civil society and those affected by HIV/AIDS.
SISWANTO AGUS WILOPO, Deputy for Family Planning and Reproductive Health, National Family Planning Coordinating Board of Indonesia, said that the HIV/AIDS epidemic was a relatively recent phenomenon in his country. Last December, there had been 2,682 reported cases of AIDS, and 3,368 people had been diagnosed with HIV in Indonesia. The estimated number of infected persons stood at 120,000. By the year 2010, there would be more than 1 million HIV-positive people, and approximately 110,000 people suffering from AIDS. The largest challenge for his country was preventing a large-scale epidemic among adolescents, for almost half of HIV infections were among that group.
Responding to the challenge, the Government had enacted the national AIDS strategy and established a national commission in 1994, he continued. The country was implementing the “Three Ones” principle. The current HIV/AIDS plan covered the period 2003-2007, focusing on a multi-sectoral partnership, as well as an expanded and comprehensive response for prevention and control of the disease. The strategy was based on the premise that prevention, treatment and support for care, especially from family, must work hand in hand. A key strategy “condom for dual protection” was being promoted as part of the country’s efforts to integrate HIV/AIDS prevention into the family planning programme. Girls and boys were being provided with reproductive health information. Measures had also been taken to allocate national and international resources to meet the growing demand for access to information, counselling and services, including a full range of safe and effective contraceptive methods and anti-retroviral drugs.
Turning to poverty-reduction efforts, he said that the Government would be launching a national poverty-alleviation strategy at the end of this month. It had been adapted to respond to local needs, and had been integrated into the medium-term national development strategy. Indonesia had been able to gradually reduce the number of its poor, which currently stood at about 36 million. In 2000-2004, 14 ministries and government agencies had been involved in the implementation of 16 poverty-reduction programmes.
He added that inadequate funding was the main impediment in achieving the full implementation of the ICPD Programme of Action and the Millennium Development Goals and called on the donor countries, the funds and programmes and specialized agencies of the United Nations to continuously render financial support and technical assistance to developing countries. At the same time, there should be enhanced collaboration among member countries of Partners in Population and Development in halting the HIV/AIDS epidemic by seeking more support from donor communities.
CESAR MAYORAL (Argentina), speaking on behalf of the Rio Group, said that although in Latin American countries the HIV/AIDS scourge had not been of the same magnitude as elsewhere, it had affected the most vulnerable groups. Threats to public health such as HIV/AIDS were also a threat to security. It was necessary to broaden the equal, universal and permanent access to health-care systems and social security, focusing on excluded sectors, ensuring primary health care for the entire population and access to essential drugs, while respecting and promoting customs and values in each culture. Policies to combat HIV/AIDS must be based on prevention, treatment, respect for human rights and on the active participation of the whole society.
He said it was imperative that the international community mobilize more resources to respond to the gravity of the pandemic and to support developing countries in their fight against HIV/AIDS. He underscored in that regard the importance of the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria. The ICPD Programme of Action, based on human rights, represented an effective and practical strategy to reach the objectives of the Millennium Declaration. The Rio Group recognized the existing link between sexual and reproductive health and HIV/AIDS. It was concerned about the increase of infected women. In that regard, it was necessary to provide more information on the exercise of sexuality and guaranteed access to reproductive health care for the entire population.
He said the number of infected people in Latin American countries continued to grow. There was concern that of the approximately 5.5 million people in low- and middle-income countries in need of anti-retroviral therapy, only about 300,000 received those drugs. Access to medicine was one of the fundamental elements towards achieving the full realization of the right of each person to enjoy the highest possible level of health. Regional efforts had been made to get a reduction in the price of drugs. The countries of the Group committed themselves to continue developing a comprehensive policy to improve the quality of life of people with HIV; to guarantee the continuity in drug supply; to foster strategies of prevention that focused on young people, women and vulnerable groups; and to raise awareness.
ANNA ELISABETH CUBIAS (El Salvador) said that her country had developed an agenda that was constantly adjusted to meet the needs of the people. In its health policies, the Government had incorporated various components of sex and reproductive health. The country had elaborated its national strategic plan for the prevention, care and monitoring of HIV/AIDS in order to strengthen the response capacity and decrease the incidence of the disease, particularly among the vulnerable population. The national commission was responsible for the implementation of the national plan. A law on the prevention and control of HIV infection had been recently elaborated. Among the Government’s main priorities were promotion and access to information at all levels, educational campaigns and efforts to eliminate stigma against people living with HIV/AIDS. Many projects were supported by the Global Fund.
Among the main achievements was universal access to anti-retroviral drugs, she said. The cost of those drugs had recently been significantly reduced, and the funds saved as a result could now be used to enhance the country’s other programmes, including those related to social security. The “Three Ones” principles were being incorporated in the government plans.
Reduction of poverty was one of the pillars of the nation’s development policies, she continued. Rural areas required special attention, and the Government was taking measures to improve the standard of living of the rural population. Among the steps taken by the country, she listed social services projects and programmes in the areas of nutrition, health, housing, water and basic sanitation. Microcredit programmes were in effect. She was convinced that the governments were the main agents for change, but they often needed international help. Joint work with NGOs and the private sector was also important.
NIKOLAY V. CHULKOV (Russian Federation) said HIV/AIDS was one of the most serious problems in the area of health care and social development and was impeding on achievement of the Millennium Development Goals. It was undermining the basis of national sustainable development. Over the past few years, the epidemic in his country was spreading quickly. This year, there had been 300,000 reported cases so far. The rapid increase of infections had been linked to intravenous drug use. Of those who were positive, 80 per cent were between 20 to 30 years old. In 2003, new cases of HIV/AIDS among young women under 20 outnumbered their male counterparts. The risk of mother-to-child transmission was the third leading cause for infections. Over 7,500 children had been identified. Of those, 40 per cent were registered in 2003.
State policies and strategies were set forth in a 1995 Federal Law to prevent the spread in the Russian Federation, he said. The national policy focused on combating the epidemic through prevention, halting the spreading of the epidemic, prolonging the life of HIV-positive people, minimizing the socio-economic consequences, and treating all those who had been infected. Within the framework of the anti-HIV/AIDS programme, there was centralized procurement of medication under way to prevent mother-to-child transmission. The Government had also created a National Coordination Committee to prepare and present plans and programmes to the Global Fund.
He was heartened by the intensification of international cooperation to halt the spread of the pandemic and welcomed the work of the Fund. Due replenishment of funds should be ensured, as well as the effective management of the programmes. His country had contributed $20 million to the Fund and was considering increasing the amount. His country was also willing to supply inexpensive chemicals for diagnosis, as well as training to foreign students in medical and research centres.
ANNA MARZEC BOGUSLAWSKA, Director of the National AIDS Centre of Poland, said that since 1992 life expectancy had been rising slowly, but systematically, in Poland. It stood at 70.5 years for men and 78.9 years for women. The infant mortality rate was 6.76 per 1,000 live births. Primary prevention and screening tests were among the key reasons for improvements in women’s health. However, the spread of poverty among certain social groups could lead to various health problems, including spread of HIV/AIDS. According to 2003 data, some 11.7 per cent of people were living below the minimum level of existence, and 19.6 per cent below the relative poverty level.
Turning to HIV/AIDS, she said that the third national programme for HIV/AIDS prevention and care was now under way. The National AIDS Centre played a key role in its implementation, which was also enhanced by a partnership with governmental institutions and civil society. The Polish policy on fighting HIV/AIDS had been elaborated with significant involvement of People Living with HIV/AIDS. Though 9,500 infections had been reported in the country so far, the number of infected people was estimated at 20,000 to 30,000. In recent years, there had been an increase in the number of infections through heterosexual contacts and growth in the number of infected women.
Among the main challenges, she listed the availability of anti-retroviral treatment and testing. The country’s Ministry of Health had allocated almost $27 million for anti-retroviral therapy and diagnostics in 2005. The number of people taking voluntary, anonymous and free tests had been rising in recent years, mostly due to educational media campaigns. Persons taking the HIV test were provided with counselling. Attention was also paid to educating various social groups and fighting discrimination against people living with HIV/AIDS in the workplace.
DJIHED EDDINE BELKAS (Algeria) said the links between population and development were one of the most important principles in the ICPD Programme of Action. Goals aimed at reducing poverty, education for all, reduction of maternal and infant mortality, and access to health care, particularly reproductive health, were important for sustainable development. Algeria had actively participated in all the international conferences and had addressed problems of population and development in its national policies. It had advisory commissions providing recommendations in areas such as economy, education, health, youth and women and in combating poverty. Reforms had been undertaken to raise living standards. The growth consolidation plan 2005-2009 would allocate $50 billion to improve housing.
The average life expectancy for men in Algeria stood now at 73.4 years, in contrast with 70.76 years in 2003, he said, and infant mortality was 31.2 per cent in 2003. Gross domestic product per capita went from $1,548 in 1999 to $2,136 in 2003, thereby attaining Millennium Development Goal 1. The unemployment rate, which was 29.9 per cent in 1999, stood now at 17 per cent. The HIV/AIDS incidence in Algeria was low at .01 per cent. In 2004, there had been 21 new AIDS cases and 202 HIV infections reported. The Global Fund had supported the fight against AIDS which was based on a three-pronged approach: prevention, action and participation.
JOAO SALGUEIRO (Portugal) said his country attached great importance to the subjects of poverty and HIV/AIDS and its links to sexual and reproductive health and rights. The link between disease and poverty was well established. The poor were the worst affected. In that sense, the country was aware of the need to achieve the ICPD goals, as well as the goals of the Declaration of Commitment and the Millennium Development Goals.
Regarding HIV/AIDS, he said his Government intended to launch new prevention policies to combat the disease. In the strengthened national plan to fight HIV/AIDS, particular attention would be given to information campaigns in order to change social attitudes and behaviour. Among other things, the Government intended to implement a second generation epidemiological surveillance system, decrease by 50 per cent the mother-to-child transmission, guarantee universal access to treatment, and increase by 70 per cent the number of health centres that had multidisciplinary teams for HIV/AIDS and sexually transmitted diseases.
Turning to Portugal’s international assistance, he said the country was engaged in supporting the initiatives of its partners from developing countries. His country had contributed $150,000 to Cape Verde for a United Nations Development Programme (UNDP) project to support the implementation of their national anti-AIDS strategy plan. It also promoted an information and awareness-raising campaign addressing the issue of HIV/AIDS in the media, involving the Presidents from all Portuguese-speaking countries. Portugal’s Hygiene and Tropical Medicine Institution collaborated with other parties in the scientific research of the impact of malaria, tuberculosis and AIDS in Mozambique, Guinea-Bissau, and Sao Tome. Portugal had contributed $1 million to the Global Fund for infectious diseases and $200,000 to the Reproductive Commodities Trust Fund of the United Nations Population Fund (UNFPA), under the European Union response to alleviate the most immediate funding gap.
GAIL STECKLEY (Canada) said research suggested that Canadians living in poverty were more likely to be at risk for HIV infection and to progress from HIV to AIDS more quickly. Housing was one dimension of poverty that had been shown to affect vulnerability to HIV infection. Homeless drug users were 59 per cent more likely to contract HIV than drug users with housing. Poverty also affected access to treatment. A study had found that one third of people who died from AIDS-related causes did not receive anti-retroviral treatments and were most likely aboriginal, poor, and/or living in an area with high levels of intravenous drug use.
The Public Health Agency of Canada was leading the domestic response to HIV/AIDS through the Federal Initiative to Address HIV/AIDS, she said. Support for a human rights approach was a key element of the Initiative. The number of Canadian women living with HIV was increasing. Women’s vulnerability was often exacerbated by lack of access to sexual and reproductive health services. It was, therefore, essential to promote the integration of HIV/AIDS with sexual and reproductive health programmes and to promote the sexual and reproductive health rights of all individuals. Action was needed to address women’s inequality as manifested in unequal economic opportunities, discrimination, sexual violence and a lack of power to negotiate safer sex.
JACQUES VAN ZUYDAM, Director, Department of Population and Development of South Africa, outlined his country’s main demographic trends and said that South Africa had undergone a very sharp fertility transition during the past two decades. Its current total fertility rate stood at 2.7 children per woman of reproductive age. There were indications of increased contraceptive prevalence. However, there was still concern about the high rates of premature mortality attributable to preventable causes, and high rates of infant, child and maternal mortality were a major concern. The AIDS epidemic had reduced the country’s life expectancy to about 50 years.
The Government’s response to HIV and AIDS was holistic and comprehensive, he said, as it was not exclusively a health problem. South Africa’s AIDS and STD Strategic Plan had been elaborated in 2000. Subsequently, the Comprehensive HIV/AIDS prevention, care, management and treatment plan had been adopted in 2003. The programme had a strong prevention focus and was built upon the principle of strengthening health services. Life skills education, social support and public-awareness programmes were among the priorities.
It was South Africa’s experience that reproductive health measures to prevent HIV transmission needed to be supported by measures to address poverty and income inequality, he said, as well as gender inequality, education and access to information. Income support, nutrition, decent housing, water, electricity and sanitation, child and orphan care services also needed to be tackled. The country’s Poverty Relief Programme was geared towards relieving poverty, particularly in rural areas, assisting in human development and capacity-building, providing jobs and infrastructure in poor areas, and having an impact on households in which single women were the main breadwinners. Notable progress had been made to address both direct and environmental conditions that fed the HIV/AIDS epidemic. Many challenges remained, however.
PIERRE-ALAIN AUDIRAC (France) said the group of HIV-infected people in France consisted of homosexuals, drug addicts, heterosexuals born in France and immigrant heterosexuals. The proportion of each group in the contaminated population was changing, with the number of immigrants increasing. Screening had been free since the 1980s and practically the whole population was covered by health insurance. In 2003, the average age of infected people was 43. In the 1990s, public policies had played a decisive role in helping drug addicts with, among other things, distribution with free syringes. Progress had been made in the prevention of mother-to-child transmission through anti-retroviral drugs. Migrants had a high incidence of infection.
He mentioned a number of examples of France’s bilateral and multilateral policies regarding the fight against HIV/AIDS, and said his country had contributed €130 million to the Global Fund. France was the second biggest donor to the Global Fund. Its contributions to the World Health Organization (WHO) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) amounted to €2.7 million.
TOMAS OSIAS (Philippines) said development must be people-centred, equitably distributed and environmentally and economically sustainable. Those goals were integrated into the Philippine development agenda. His country was committed to development programmes that were cognizant of the relationship between and among the population factors, the biophysical environment, as well as socio-economic and cultural forces. To date, the Philippines had one of the lowest rates of HIV infection in Asia, with an estimated prevalence of 0.03 per cent among those 15 to 49 years of age. Despite the low infection level, however, there was a need to remain vigilant. A considerable number of overseas Filipino workers were returning home infected with HIV. There was also an increased sexual risk behaviour among young people. It must, thus, be ensured that confronting the HIV/AIDS problem remained high on the national development agenda.
He said his country had also been strengthening its population policy. The Philippine Commission on Population spearheaded the development and publication of the country’s major accomplishments, initiatives and challenges in population and development, reproductive health and reproductive rights, gender equality and equity, empowerment of women and male involvement in fertility management. A grand Alliance for Population and Reproductive Health had been formed composed of labour, women, youth and non-governmental organizations. Adoption of the Reproductive Health Module with an Islamic perspective had been another milestone. That Module was intended to address the culturally sensitive and other issues unique to Filipino Muslim communities. However, the need for family planning was still unmet and the less educated, the poor and those in rural areas also had the highest fertility rate. He called, therefore, for continued support from the international community.
TERUNEH ZENNA (Ethiopia) said that the main challenge of achieving the goals contained in the Programme of Action of the ICPD and the Millennium Declaration remained in the least developed countries of the world. His delegation was deeply concerned over the continued devastating impact that HIV/AIDS was having on the developing countries, particularly in that region. The prevalence of the disease in the least developed countries was nine times that of the developed world. HIV/AIDS had compromised hard-won gains in development and had significantly reduced life expectancy in most affected countries. It also gave rise to a higher level of infant and under-five mortality. The epidemic must be treated as both an emergency and a long-term development issue.
Turning to national efforts, he said that Ethiopia had issued its population policy in April 2003. Its overarching objective was integration of population and development in the efforts to achieve sustainable development and poverty reduction. In the areas of reproductive health, Ethiopia had made considerable effort in all the essential elements proposed in the Programme of Action. Efforts were under way to reduce child, infant and maternal morbidity and mortality, with emphasis on maternal care, prevention and control of communicable diseases. The country also aimed at promoting reproductive and sexual health and tackling the problem of HIV/AIDS, which was having a wide-ranging impact on the country. Life expectancy in Ethiopia had been 53 years in 2003, but had declined to 46 years when the effects of HIV/AIDS were taken into account. The economic and social costs of the epidemic were also a serious source of concern.
The Government had developed a national plan to combat the disease and was taking measures to ensure participation of all stakeholders. Ethiopia would do its utmost to combat the disease and encouraged its partners to stay engaged in their support of the country’s efforts. In connection with the implementation of the ICPD Programme of Action, he said that the population and health situation had changed dramatically since the Conference, especially in respect of poverty and reproductive health and the spread of the HIV/AIDS pandemic. Noting with satisfaction the increased commitment shown by developed countries, he encouraged them to further strengthen their support to their developing partners in the area of population issues, in particular, as far as HIV/AIDS in sub-Saharan Africa was concerned.
FATIMAH SAAD (Malaysia) said her country had succeeded in a relatively short period in achieving growth and addressing the problems of poverty and economic imbalances. The incidence of poverty had decreased from 17.1 per cent in 1995 to 11.4 per cent in 2002. Equal attention was given to the serious threat of HIV/AIDS, and those infected were predominantly from the poor segments of society. Among the best options in addressing the challenge was to take preventive measures. Over the last four years, the average yearly number of newly reported HIV cases had been more than 6,000. The main mode of transmission was intravenous drug use (75.5 per cent), followed by heterosexual transmission (13.2 per cent).
She said inadequate access to correct information, cultural and religious constraints, social stigma and discrimination, denial and ignorance were some of the factors contributing to the epidemic. The HIV/AIDS prevention and control programme had been established in 1987. Several programmes had been initiated to address the needs of adolescents and young people. The Malaysian AIDS Council, an umbrella organization of multiple NGOs, had played an important role in advocacy, capacity-building and coordination. The main challenge for Malaysia was to increase the geographical coverage of HIV/AIDS services and their reach to vulnerable populations and those living in poverty. Poverty-eradication programmes would go hand in hand with the present programmes for combating HIV/AIDS, which would be based on the National Strategic Plan on HIV/AIDS 2005-2009.
FREDERICO S. DUQUE ESTRADA MEYER (Brazil) stressed that prevention, treatment, care, support and human rights were mutually reinforcing elements of an effective response. They must be integrated in a comprehensive approach to combating the epidemic. Prevention, treatment and human rights were the basis of Brazil’s national strategy, and he was proud to say that the numbers proved that the country was on the right track. Brazil’s prevention campaigns were based on frank awareness messages. A wide range of measures had proven successful, such as universal access to condoms, women’s empowerment, initiatives to avoid mother-to-child transmission, and inclusion of HIV/AIDS-related issues in schools curricula. The Government had long called on constituencies like sex workers and men who had sex with men to assume strong roles in prevention efforts.
Brazil’s positive experience with the impact of free and universal access to medication, including anti-retroviral therapy, was widely acknowledged, he continued. Since 1996, AIDS-related mortality had fallen by 50 per cent. Hospital admissions had dropped by 75 per cent. Access to treatment had had a positive impact on prevention efforts. It reduced stigma and discrimination by reducing fear and enabling people to openly address the issue. Where treatment existed and was accessible, individuals were more likely to seek voluntary testing and counselling. Brazil had recently launched a campaign called “be in the know”, which emphasized expanded HIV testing. The country was not only committed to the fight against discrimination and stigma, but also to dealing with the needs of different groups based on sex, race, age or sexual orientation. It encouraged participation by NGOs and working with others at the international level.
ZUNIGA HERRERA (Mexico) said the documents before the Commission acknowledged the challenges presented by the ageing process, as well as the opportunities that the change of the social age structure provided to national economies. She called upon the international community to anticipate and to respond appropriately to those changes and to avoid the potential adverse effects in poverty levels if the ageing process would advance without the adequate resources to address it. She agreed with the statement that the internationally approved development goals could not be achieved if it was not possible to guarantee the full practice of human rights, including the sexual and reproductive health rights and universal access to services and information.
She said the preventive strategies regarding HIV/AIDS had helped to keep the disease at one of the lowest incidence rates in the Americas. Preventive strategies aimed at men who had sex with men, intravenous drug users and sex workers had been strengthened in close collaboration with civil society organizations. Universal public health coverage had been established which provided financial protection for persons with HIV/AIDS and guaranteed their medical attention. Currently, 28,600 people received anti-retroviral drugs. The goal set for 2006 to ensure free access to anti-retroviral therapy had been reached by the end of 2003. Also, a constitutional amendment had been passed, as well as a federal law, that prohibited all kinds of discrimination, including discrimination related to health conditions and sexual preferences.
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