2 June 2006
Hearing Reports on Round Tables, Panel Discussions, General Assembly Told that 2001 Commitments on HIV/AIDS Not Met
Assembly President Calls for Strong Outcome Document from Tomorrow's High-Level Meeting
NEW YORK, 1 June (UN Headquarters) -- The General Assembly this afternoon completed its comprehensive review of progress made in implementing the 2001 Declaration of Commitment on HIV/AIDS by hearing reports on the results of five round tables, five panel discussions and an informal interactive hearing with civil society that had been held during the two-day event prior to the High-Level Meeting taking place tomorrow.
In his report on the civil society hearing, Assembly President Jan Eliasson of Sweden emphasized the important role that civil society had played in shaping the outcome declaration. He said a clear sense had emerged from the hearing that the 2001 commitments had not been met and he called for a strong outcome document commensurate with the size of the human tragedy and the size of the political challenge that all now faced.
Reporting on results of the five round tables in succession were Denzil Douglas, Prime Minister of Saint Kitts and Nevis; Annmaree O'Keeffe, Australia's Ambassador for HIV/AIDS; Silvia Masebo, Zambia's Minister of Health; Anna Marzec-Bogusławska, Director of Poland's National AIDS Centre; and Oscar Fernandes, India's Minister of State.
Turning to the outcome of the five panel discussions, the Assembly heard from the panel Rapporteurs, again in sequence. Reporting on breaking the cycle of infection for a sustainable AIDS response was China's Wu Zunyou of the National Centre for AIDS/STD Control and Prevention. Reporting on overcoming health worker shortages and other health systems towards universal access was Sigrun Møgedal, an AIDS Ambassador from Norway.
Continuing, Keesha Effs, a National Youth Ambassador for Positive Living from Jamaica, reported on ending the increased feminization of AIDS; Omolou Falobi of Journalists against AIDS from Nigeria reported on sustainable and predictable financing for scaled-up AIDS responses; and Raminta Stuikyte, Director of the Central and Eastern European Harm Reduction Network of Lithuania, reported on overcoming stigma and discrimination and changing responses to people living with HIV.
In addition to hearing those reports, the Assembly decided that tomorrow's high-level meeting would take place in the format of parallel meetings to accommodate the number of speakers wanting to express their views concerning HIV and AIDS.
The Assembly will meet again at 9 a.m. Friday, 2 June, to begin the High-Level Meeting on HIV/AIDS following an address by Laura Bush, First Lady of the United States as representative of the host country.
Civil Society Hearing
JAN ELIASSON, president of the General Assembly, offered a summary of the informal interactive civil society hearing. He said there was a clear sense that the 2001 commitments had not been met. People living with HIV and AIDS and vulnerable groups needed to be seen as partners, and they should hold Governments responsible for their performance. Their involvement was essential to success in responding to HIV and AIDS.
He said members of civil society had expressed strong views that the lack of commitment had failed children, jeopardizing everyone's future. The feminization of the epidemic was another recurring theme. Gender inequality placed the burden of the epidemic on women, and HIV and AIDS targeted those who could not negotiate safer sex.
In the area of human rights, he said there had been calls for States to enact laws and policies to protect people living with HIV and AIDS. There also had been strong calls for meeting the commitment of providing $20-23 billion annually to respond to AIDS by 2010. There had been rich interactive discussions between Member States and civil society. The task now at hand was to finalize work on the political declaration. He called for a strong outcome commensurate with size of the human tragedy and the size of the political challenge faced by all.
Reports on Round Tables
DENZIL DOUGLAS, Prime Minister of Saint Kitts and Nevis, reporting on Round Table 1, said the discussion had shown that much more work needed to be done to curb HIV and AIDS. The discussion had considered questions such as how to expand the delivery of health services, how young people could learn about the disease, how to overcome financial bottlenecks and how to engage key partners.
Among the messages that had come through, he continued, was the repeated emphasis placed on the importance of developing comprehensive national plans that addressed all aspects of the epidemic while tying into a respect for the cultural environment. Another message that had emerged was that access to funding had to be increased. Serious concerns had been expressed about the inability of middle- and low-income countries to develop and implement measures to promote prevention and de-stigmatization efforts. Also, high-prevalence countries should be made a priority, and donor funding should be harmonized. Capacity must be built, and national bureaucracies accommodated apolitically.
Another point of emphasis, he said, was the need to improve health-care services, with the wealthier countries assuming the obligation to assist those with middle or low incomes. The delivery of treatment needed to be modified so as to make access easier, more available and more socially acceptable.
ANNMAREE O'KEEFFE, Australia's Ambassador for HIV/AIDS, said the discussion in Round Table 2 had revolved around four aspects related to management of HIV and AIDS. Those were the expansion of services, changing information into knowledge and then into behaviour change, bottlenecks in financing and the engagement of civil society. Participants agreed that prevention had taken a back seat to treatment, and that the skewed focus had to be redressed so that both were addressed in a multipronged approach. Also stressed were the need to address the feminization aspect of the disease and the important role of youth in curbing its spread. Knowledge wasn't enough where youth was concerned. Empowerment was key to turning knowledge into behaviour change.
Great emphasis had been placed on the critical role of ensuring the predictability and sustainability of funding for programmes and the need to engage all sources of resources, including public-private partnerships. She said participants had also stressed the need to improve the delivery of health care and the importance of Governments engaging with civil society, particularly by involving people with HIV in decision-making processes concerning them. Participants had emphasized that civil society monitoring would ensure that resources went to the right places.
Finally, she said, the call had come through repeatedly that the needs of women regarding HIV and AIDS must be addressed as a priority. Among other measures, they must be involved in decision-making processes. Finally, naiveté and denial concerning HIV and AIDS had to be overcome. Civil society was the best guarantee of human rights.
SILVIA MASEBO, Minister of Health of Zambia reporting on Round Table 3, said that the strong financial and political commitment that had been built since 2001 must now be translated into concrete action to reverse the epidemic. Participants had concluded that strengthening of prevention efforts required scaling-up simultaneously HIV prevention, treatment, care and support programmes and that there was no "one size fits all" solution. Innovative programmes and messages were needed that were accessible to all. Respect for human rights, the reduction of stigma and discrimination attached to HIV and achievement of gender equality were essential for successful prevention programmes.
She said participants had noted that despite high levels of awareness, people often engaged in risky behaviours. There was a correlation between individual behaviour and collective attitudes. Comprehensive responses that addressed the underlying factors driving the epidemic included addressing poverty and discrimination against woman and vulnerable populations. Young people, particularly young women, needed to be reached at an early age with appropriate messages and sexual education to empower them.
Participants stressed that, while resources for addressing HIV and AIDS had increased substantially, they had yet to reach an appropriate level to reverse the epidemic. Domestic budgets needed to be increased, and resources must reach their intended beneficiaries. Participants recognized that civil society had been at the forefront of the response and had contributed greatly to successes achieved. Civil society should be engaged as true partners, and a national response must involve all stakeholders to be effective. Governments, civil society and cooperating partners must increase transparency and accountability.
ANNA MARZEC-BOGUSŁAWSKA, Director, National AIDS Centre, Poland, and Chairperson of Round Table 4 reported that participants had agreed that a comprehensive and holistic approach was the most effective way forward in the fight against AIDS and that prevention, treatment, care and support could not be separated. Increasing access to treatment must not allow prevention efforts to wane. The response to HIV and AIDS must be firmly grounded in the promotion, protection and fulfilment of human rights. The capacity of health, education and social systems must be strengthened and sustained.
Participants had stressed that political will and commitment at all levels was a key element in strong national responses, and that coordination and strengthened partnerships were essential, she said. Education, including sexual education, remained a key part of the effective progress on HIV and AIDS. Such education would be most effective when it was rights-based, culturally appropriate, available at an early age, gender responsive and provided both in and outside of school.
It had been pointed out that addressing the needs of particularly vulnerable populations was a prerequisite for turning the tide of the epidemic. That included expanding access to services for sex workers, men who had sex with men and injecting drug users. The importance of harm reduction programmes was stressed as was the necessity of efforts to address the needs of victims of conflicts, displaced people and migrant populations. Reducing the vulnerability of key populations included the need for men to behave responsibly, including through using condoms and respecting women as equals.
OSCAR FERNANDES, Minister of State of India, said the discussion in Round Table 5 had focused on the need for strong political will and leadership. Several participants had forcefully expressed the need for a strong declaration, based on the 2001 Declaration that clearly spelled out visionary ways to move forward with ambitious targets. Despite the greater availability of resources to address HIV and AIDS, some middle-income countries had pointed out the difficulty of accessing funds, for which they were often ineligible. Often, interventions were hijacked by donor agendas and their priorities. Funding needed to be sustainable and predictable in order to make the money work.
A recurrent theme had been the necessity of scaling up evidence-based prevention, and faith-based organizations had an important role to play, he said. Stigma and discrimination, human rights violations and gender inequality were also highlighted as key challenges to the HIV/AIDS response. Vulnerable groups, such as injecting drug users, sex workers and men having sex with men, were often excluded from the national responses. Several speakers had indicated that excluding mentioning them in the political declaration would not make them disappear.
Many participants had emphasized the need for culturally appropriate sex education for young people, he said. Addressing HIV/AIDS epidemics in drug injecting populations involved harm reduction measures, including substitution treatment and needle syringes. The lack of human resources in many countries had been mentioned as an impediment to scaling up prevention, treatment and care. The migration of skilled health workers from developing to developed countries was seen as a major obstacle.
Reports on Panels
Dr. WU ZUNYOU, of the National Centre for AIDS/STD Control and Prevention from China, reported on Panel 1, entitled: "Breaking the cycle of infection for sustainable ADIS responses". He said the discussion had included a cross-section of commentary representing Governments, the United Nations, the private sector and civil society. To break the cycle of infection, it was necessary to address the entire cycle, including prevention, treatment, care and support. A response that addressed all sectors of society was also needed. Education, food and nutrition and income-generating activities were among the essential inputs.
Participants had stressed that evidence-based programmes were critical for stemming the spread of HIV, and effective prevention programmes needed to understand and address the specific behavioural and cultural aspects of different HIV/AIDS-affected groups. An open dialogue about sex, sexuality, gender, and drug use was essential. Women and youth were disproportionately affected by the epidemic and required special attention. Much greater strides needed to be made in eliminating stigma and protecting human rights through legislation, which should be supported by political will and community campaigns. All sectors and groups had a role to play in the response, especially civil society groups, people living with HIV and AIDS and the private sector.
Reporting on Panel 2, entitled "Overcoming health worker shortages and other health systems and social sector constraints to the movement towards universal access to treatment", SIGRUN MØGEDAL, AIDS Ambassador from Norway, said the discussion had left no doubt that there was a crisis in the health workforce and that that crisis severely limited the ability to scale up a comprehensive strategy towards universal access for treatment, prevention, care and support. It was also a major obstacle to achieving many of the Millennium Development Goals.
She said that in discussing potential strategies to address the crisis, participants had noted that, at the local level, relatively simple changes in policy and practice could make a big difference, including simplified service delivery and standardized approaches to record-keeping, testing, treatment and monitoring. AIDS could drive a response that encompassed support for health and social systems beyond AIDS. The global Health Workforce Alliance provided a unique framework for accelerating action. As there was unprecedented momentum for massive scale-up, the imperative was to mobilize all possible contributors, but to do so always within a nationally-owned framework.
Participants had stressed that decent pay for work was as important as health and AIDS. There had been a call for global approaches and solidarity, particularly in the challenge of health worker migration. That included financial mechanisms and bilateral conventions to compensate for the brain drain. The North could do more to reduce its dependency on foreign health workers. An emerging theme in the discussion had been the need for partnerships, especially public-private partnerships. Faith-based organizations, trade unions and employee associations also needed to be involved.
Regarding Panel 3, entitled "Ending the increased feminization of AIDS", KEESHA EFFS, Jamaica's National Youth Ambassador for Positive Living, reported that participants had found that the AIDS response was not working for women and girls, because gender inequalities that drove the epidemic were not taken sufficiently into account. Because of a lack of access to education, women and girls knew less about how to protect themselves from infection. Also, women lacked economic opportunities, and their human rights, including sexual and reproductive health rights, were not respected. Gender-based violence was still the reality of many women's lives, and men did not take sufficient responsibility for their behaviour towards women. Also, cultures and religions colluded to keep women subordinate.
Participants had underscored that more money needed to go into programmes that benefited women and girls, she said. Women and girls must be at the centre of the AIDS response. Women must have equal seats at the tables where AIDS policies were designed and funded. Gender expertise was as important as gender balance in shaping AIDS policy and programmes. Women's rights should be secured, especially sexual and reproductive rights, property and inheritance rights, economic rights and the right to a life free of violence. The funding gap for existing and new prevention technologies, such as the female condom, vaccines and microbicides, should be closed.
Participants in the discussion had noted that men and boys needed to take responsibility for transforming expectations of men's behaviours at home and in the world, she said. They had stressed that the private sector must take a role in addressing the feminization of the response, because "when business talks, Governments listen". Participants were united in their call for a strong, progressive declaration which put women at the centre of the response to HIV and AIDS.
OMOLOU FALOBI of the Journalists against AIDS from Nigeria, said the discussion in Panel 4 had focused on how, despite a dramatic increase in access to available resources, including medicines and treatments, there remained huge shortfalls in meeting the need for more sustainable and predictable financing to stop the epidemic. To close that gap, new financing mechanisms were needed; new commitments must be made; and existing commitments must be achieved. All possible sources needed to be tapped. Schemes to provide money for care from taxes and insurance needed to be explored in countries where schemes did not exist.
He said that a long-term effort to end AIDS must include public expenditure, especially by low- and middle-income countries. Zimbabwe had offered the suggestion of organizing new resources locally, for example, by having employees donate 3 per cent of their income to fight aids. The panel had agreed that new responses for sustaining the fight against HIV and AIDS could be achieved by utilizing savings from debt relief.
Longer-term financial commitments were also needed, for periods of up to 15 years or longer, he said. The costs of interventions must also be brought down. There were recommendations that prevention, care and treatment be treated as joint initiatives. Targets, milestones and goals were important benchmarks for measuring responses. There needed to be an increased focus on performance, on programmes that delivered results and that sent funds to where they were most effective.
RAMINTA STUIKYTE, Director of the Central and Eastern European Harm Reduction Network in Lithuania, reported on Panel 5, entitled: "Overcoming stigma and discrimination and changing the way societies respond to people living with HIV". Participants had discussed obstacles to effectively addressing stigma and discrimination and focused on key challenges such as the insufficient involvement of people living with HIV and representatives of other marginalized groups in the design, implementation and monitoring of responses. Other challenges included inadequate political commitment and resources to address human rights and inadequate enactment, review and enforcement of legislation to protect the rights of people living with HIV. There was also insufficient information about HIV and people living with HIV.
She said participants had noted that 25 years into the epidemic, what had to be done was known. People living with and affected by HIV must be empowered. Their rights must be enshrined in law, and adequate funding must be ensured to eliminate stigma and discrimination. Universal access to care could not be achieved without empowering, involving, and protecting the rights of injecting drug users, sex workers, men who have sex with men, prisoners and undocumented migrants.
Participants stressed that all must be accountable to the human rights commitments already made, she said. Real commitment and resources were needed from all sectors of society, including from: political leaders at all levels, civil society advocates, religious authorities, employers, trade unions, the private sector and people living with HIV. No progress had been made without the involvement of people living with HIV. Only in partnership with affected communities was true progress possible.
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