5 June 2006
General Assembly High-Level Meeting Adopts Declaration Committing to Halt, Reverse Spread of HIV/AIDS
Recognizes Estimated 20 to 23 Billion Dollars Needed Per Year by 2010 to Support Scaled-up Responses to Counter Pandemic
NEW YORK, 2 June (UN Headquarters) -- Recognizing that HIV/AIDS constituted a global emergency that posed formidable challenges to development, progress and stability of societies and the world at large, participants in the high-level General Assembly meeting on AIDS, including Heads of State and Government, solemnly declared their commitment to address the crisis through action.
In a Political Declaration adopted this evening, they reaffirmed their intention to fully implement the 2001 Declaration of Commitment on HIV/AIDS called "Global Crisis - Global Action" and internationally agreed development goals and objectives, including the Millennium Development Goals, in particular the goal to halt and begin to reverse the spread of HIV/AIDS. The Declaration was adopted unanimously after the Assembly had heard from over 150 speakers today, including 11 Heads of State or Government and numerous other high Government officials.
"If we don't see radical change, we will get nowhere close to universal access to HIV prevention, treatment, care and support by 2010 -- the goal that you committed yourselves to at the World Summit last September. If we don't step up the fight drastically, we will not reach the Millennium Development Goal of halting, and beginning to reverse, the spread of HIV and AIDS by 2015", United Nations Secretary-General Kofi Annan said in opening remarks this morning.
The epidemic continued to outpace the response, he said, while noting some progress made since the 2001 special Assembly session. Nevertheless, in some countries, there were fewer young people being infected than five years ago, and seven times more people had access to treatment. Every President and Prime Minister, every parliamentarian and politician, needed to decide and declare that "AIDS stops with me".
According to the Political Declaration, participants recognized that the means to reverse the global pandemic and to avert millions of needless deaths were available. However, to mount a comprehensive response, any legal, regulatory, trade and other barriers that blocked access to prevention, treatment, care and support must be overcome. Adequate resources must be committed. All human rights and fundamental freedoms must be protected, and gender equality and empowerment of women promoted. The rights of the girl child must also be promoted and protected in order to reduce girls' vulnerability to HIV/AIDS.
Participants committed to pursue all necessary efforts to scale up nationally driven, sustainable and comprehensive responses to achieve broad multisectoral coverage for prevention, treatment, care and support, with full and active participation of people living with HIV, vulnerable groups, most affected communities, civil society and the private sector, towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010.
The participants also pledged to provide the highest level commitment to ensure that costed, inclusive, sustainable, credible and evidence-based national HIV/AIDS plans were funded and implemented with transparency, accountability and effectiveness, in line with national priorities. They recognized that an estimated $20 billion to $23 billion was needed per annum by 2010 to support rapidly scaled-up AIDS responses in low- and middle-income countries.
The Declaration reaffirmed that prevention of HIV infection must be the mainstay of the national, regional and international responses to the pandemic. Prevention programmes must take account of local circumstances, ethics and cultural values and must be available in all countries. They should include information, education and communication, in languages most understood by communities and respectful of cultures. They should be aimed at reducing risk-taking behaviours and encouraging responsible sexual behaviour, including abstinence and fidelity. There should also be expanded access to such essential commodities as male and female condoms and sterile-injecting equipment.
Participants reaffirmed that prevention, treatment, care and support for those infected and affected by HIV/AIDS were mutually reinforcing elements of an effective response and must be integrated in a comprehensive approach to combat the pandemic. Deeply concerned by the overall feminization of the pandemic, participants pledged to eliminate gender inequalities, gender-based abuse and violence, and to increase capacities of women and adolescent girls to protect themselves from the risk of HIV infection. They also committed to intensify efforts to eliminate all forms of discrimination against people living with HIV and members of vulnerable groups.
The Political Declaration further addressed issues of children and youth, legal and regulatory barriers to effective HIV prevention, HIV/AIDS education, reduction of mother-to-child transmission, human resources and intellectual property rights in relation with pharmaceuticals, among other things.
Finally, participants committed themselves to set, in 2006, ambitious national targets, including interim targets for 2008 in accordance with core indicators recommended by the Joint United Nations Programme on HIV/AIDS (UNAIDS). They decided to undertake comprehensive reviews in 2008 and 2011 in the General Assembly on the progress achieved in realizing the 2001 Declaration of commitment.
In closing remarks, Assembly President Jan Eliasson said that, during the meetings, over 20,000 people had died as a result of AIDS and over 30,000 people had been newly infected with HIV. The Assembly had heard from the global AIDS community and people living with HIV as never before. No country, no leader, could say that, in 2006, they did not know about the human reality of HIV/AIDS, about the size of the threat, or about what needed to be done. There had been an unprecedented level of constructive and substantive interaction between Member States and civil society. The impact of that interaction had been evident in the negotiations on the Political Declaration.
He said the Declaration just adopted included many vital points that much of the global AIDS community was asking for, just a few days ago. The Declaration fully reaffirmed the 2001 Declaration of Commitment. It also acknowledged that many of the targets had not been met. It included several references to vulnerable groups and explicitly mentioned many prevention approaches, including male and female condoms and harm-reduction efforts related to drug use. It had strong language on young people, and on women and girls. It unambiguously extended, for the first time, the definition of universal access to include comprehensive prevention programmes, treatment, care and support and recognized that an estimated $20 billion to $23 billion was needed per annum by 2010.
Addressing Member States before the meeting, Laura Bush, First Lady of the United States, the host country, said HIV/AIDS spared no country, race or religion, devastating men and women alike. No country could ignore the crisis. Fighting HIV/AIDS was an urgent calling, as every life had value and dignity.
Everyone needed to know how AIDS was transmitted, and every country had a responsibility to educate their citizens so that they could make wise choices, she said. There were too few doctors and nurses to meet the demands of the crisis. The United States had dedicated resources of the President's Emergency Plan for AIDS Relief (PETFAR) to train health workers in African cities and villages. Treatment never reached those people who did not know they were infected, however. The United States would soon propose the designation of an international HIV-testing day.
During this morning's opening session, the Assembly was addressed by: King Mswati III, Head of State of Swaziland; Denis Sassou Nguesso, President of the Republic of the Congo; François Bozize, President of the Central African Republic; Arnold Rüütel, President of Estonia; Elias Antonio Saca, President of El Salvador; Edward Ngoyani Lowassa, Prime Minister of the United Republic of Tanzania; Bertie Ahern, Prime Minister of Ireland; Denzil L. Douglas, Prime Minister of Saint Kitts and Nevis, on behalf of the Caribbean Community (CARICOM); Macky Sall, Prime Minister of Senegal; Pakalitha Bethuel Mosisili, Prime Minister of Lesotho; Suchai Chareonratanakul, Deputy Prime Minister of Thailand; Isehngul Boldjurova, Acting Deputy Prime Minister of Kyrgyzstan; Pham Gia Khiem, Deputy Prime Minister of Viet Nam; and Yoshiro Mori, former Prime Minister of Japan.
Statements were also made by Peter Piot, Executive Director of UNAIDS, and Richard Feachem, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The Assembly then broke up into two parallel segments, in order to accommodate all speakers. In segment A, statements were made by high-level Government officials and representatives of: Guyana (on behalf of the Rio Group), Morocco, the Sudan, Brazil, Philippines, Argentina, Cambodia, Spain, Qatar, Armenia, Netherlands, Sierra Leone, Chile, Cuba, Monaco, Côte d'Ivoire, Nicaragua, Malaysia, Bulgaria, Ukraine, Peru, Sri Lanka, Lao People's Democratic Republic, Madagascar, Tuvalu, Zimbabwe, Saint Vincent and the Grenadines, Mali, Ethiopia, Gambia, Ghana, Kiribati, Haiti, India, Liberia, Sweden, Venezuela, China, Myanmar, Uzbekistan, Costa Rica, Egypt, United Arab Emirates, Georgia, Honduras, Australia, Papua New Guinea (on behalf of the Pacific Islands Forum), Bahrain, Fiji, Greece, Malawi, Mauritania, Rwanda, Benin, Uruguay, the former Yugoslav Republic of Macedonia, Cyprus, Mauritius, Italy, Syria, Republic of Korea, Libya, Maldives, and the Dominican Republic; as well as by the Permanent Observer of the Holy See.
In segment B statements were made by high-level Government officials and representatives from: Austria (on behalf of the European Union), United Kingdom, Namibia, Botswana, France, Denmark, Luxembourg, South Africa, Algeria, New Zealand, Liechtenstein, Zambia, Russian Federation, Burkina Faso, Bosnia and Herzegovina, Norway, Bahamas, Pakistan, Burundi, Germany, Brunei Darussalam, Trinidad and Tobago, Albania, Nigeria, Mongolia, Canada, Cameroon, Iceland, Jamaica, Colombia, Mexico, Saint Lucia, Gabon, Equatorial Guinea, Grenada, Ecuador, Singapore, Barbados, Finland, Portugal, Kazakhstan, Poland, Tajikistan, Saudi Arabia, Angola, Kenya, Turkey, Guatemala, Paraguay, Indonesia, Uganda, Switzerland, Turkmenistan, San Marino, Bangladesh, Cape Verde, Belgium, Lebanon, Romania, Republic of Moldova, Panama, Solomon Islands and Azerbaijan.
Statements were also made by representatives of the International Federation of Red Cross and Red Crescent Societies, the European Commission (on behalf of the European Community), Inter-Parliamentary Union, Sovereign Military Order of Malta and the International Organization for Migration. Civil Society was represented by Gideon Byamugisha of the African Network of Religious Leaders Living with and Personally Affected by HIV and AIDS and the private sector by William Harvey Roedy, President, MTV Networks International and Chairman, Global Media AIDS Initiative.
After that, participants gathered again in the General Assembly Hall to adopt the Declaration, contained in document A/60/L.57, as orally corrected. The representative of the United States spoke in explanation of position.
The General Assembly met today to hold its high-level plenary on HIV/AIDS. The morning segment will include opening statements by the Secretary-General and the Assembly President, statements by executive directors of United Nations programmes and funds, and statements by Heads of State and Government. The Assembly will then split up in two parallel segments to facilitate participation of all speakers inscribed in the list. After that, the High-Level Meeting will reconvene in the General Assembly Hall for the adoption of the Political Declaration.
LAURA BUSH, First Lady of the United States, the host country, said it was a hopeful moment in the fight against HIV/AIDS, but the Meeting was also tinged with sadness with the loss of the Director-General of the World Health Organization (WHO), Dr. Lee Jong-Wook. He recognized HIV/AIDS as one of the great humanitarian crises of the current time. Some 40 million people worldwide were infected. HIV/AIDS spared no country, race or religion, devastating men and women alike. No country could ignore the crisis. Fighting HIV/AIDS was an urgent calling, as every life had value and dignity.
At the General Assembly's 2001 special session, Member States had committed themselves to action, she said. In the United States, the President's Emergency Plan for AIDS Relief (PETFAR) was reaching some 120 countries. With increasing contributions each year, the American people were on track to meeting or exceeding their commitment. The Emergency Plan worked in partnership with the hardest-hit countries, and even more people were being reached through America's contribution to the Global Fund. Direct medical care kept people in good heath, and education was spreading hope. In parts of sub-Saharan Africa, new data showed that Africa's "ABC" model of AIDS prevention had led to dramatic declines in young men and women. Pregnant mothers now knew that their unborn children did not need to inherit the disease.
Despite such progress, however, much work remained, she said. Everyone needed to know how AIDS was transmitted, and every country had a responsibility to educate their citizens so that they could make wise choices. There were too few doctors and nurses to meet the demands of the crisis. The United States had dedicated PETFAR resources to train health workers in African cities and villages. Every worker trained helped build sustainable health-care infrastructure that could also curb other diseases, such as malaria and tuberculosis. Treatment never reached people who did not know they were infected, however.
In the United States, 27 June was National HIV Testing Day, she said. The United States would soon propose the designation of an international HIV-testing day. She urged all Member States to support that initiative. Millions of people could have a second chance at life. Their needs were great, but so was the inspiration they survived. The United States looked forward to working with the international community to finally win the fight against AIDS.
General Assembly President JAN ELIASSON (Sweden) said he had seen a new dynamic at the United Nations over the last few days, with Member States and civil society coming together as never before. There had been a genuine, and sometimes vibrant, interaction between two sets of representatives, actors who had not had a tradition of working together in that way. For instance, there had been the voices of those living with HIV and from other groups, and they all had been powerfully heard in the hallways and corridors. He hoped to capture that dynamic and make it a driving force to achieve practical results, both here and at home.
He said there was now a final draft for Member States' consideration, after many hours of hard work by delegates, who finished last night at 3:30 a.m. To him, it was a good, substantial and forward-looking document, which he hoped the Assembly would adopt at the end of today's deliberations. He hoped for another, less grim reality for the peoples of the world, and life and dignity for all. He was now ready to hear from Governments to learn what they were doing at home towards that goal.
United Nations Secretary-General KOFI ANNAN said, in 25 years, AIDS had changed the world. It had killed 25 million people and had become the leading cause of death among women and men aged 15 to 50. It had inflicted the single greatest reversal in the history of human development. "In other words, it has become the greatest challenge of our generation."
He said since the Assembly held its special session on AIDS five years ago, the response had started to gain real strength. In some countries, there were fewer young people being infected than five years ago, and seven times more people had access to treatment. But the epidemic continued to outpace the response. Last year, there were more new infections than ever before. There were more women and girls living with HIV/AIDS than ever before. "If we don't see radical change, we will get nowhere close to universal access to HIV prevention, treatment, care and support by 2010 -- the goal that you committed yourselves to at the World Summit last September. If we don't step up the fight drastically, we will not reach the Millennium Development Goal of halting, and beginning to reverse, the spread of HIV and AIDS by 2015."
Every president and prime minister, every parliamentarian and politician, needed to decide and declare that "AIDS stops with me", he continued. Real, positive change was required that would give more power and confidence to women and girls, and transform relations between women and men at all levels of society. Greater resources, better laws and more seats for women at the decision-making table were required. "It requires all of you to make the fight against AIDS your personal priority -- not only this session, or this year, or next year - but every year until the epidemic is reversed."
PETER PIOT, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said that the results on the ground had shown that the 2001 declaration of commitments on AIDS had marked a true turning point in the fight against HIV and AIDS worldwide. He understood that agreement had been reached on a draft this morning; he hoped it could be improved, as that would take the world to the next stage in the fight against AIDS. Because the world had come so far, the stakes were even higher today, and to fail now would be unforgivable. The world had come a long way, but it still had a long way to go and that way forward was clear: everyone must be resolved that the fight would get the highest priority - as high as promoting economic growth or ensuring national security. AIDS was a long-term development crisis, and not just a passing emergency that would disappear one day. Some $20 billion-plus were needed annually from 2008 onward; nothing else would do. Every dollar shortfall was a "killing shortfall". Prevention, treatment, care and support, and nothing less would do because only universal access to that could keep the epidemic from engulfing the next generations. He sought an HIV-free new generation.
He said that Member States must conclude this Meeting with the resolve that rich and poor would do everything possible to ensure access to the necessary vaccines. It must conclude with the resolve to add a long-term response to AIDS to the still much-needed crisis-management approach -- a response that was embedded in social change. The fundamental drivers of the epidemic must be addressed, including women's low status, sexual violence, homophobia, AIDS discrimination, and so forth. When participants returned to work next week, they must further build the large coalition essential to realizing such an ambitious agenda. The Meeting had shown that everyone was here for just one thing -- defeating AIDS, even if differences existed on tactics. Everyone was a critical piece of the same strategy. Not only was there room for everybody, but there was a need for everybody. "Let today mark the beginning of a new era in the fight against AIDS -- an era responsive to the changing world around us", he concluded.
RICHARD FEACHEM, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria, said five years ago the Secretary-General had proposed the creation of a war chest to fight AIDS in Africa. Today, the Fund was supporting 386 programmes in 130 countries with a combined value of $10 billion. Results showed that 544,000 people were receiving antiretroviral therapy because of the Fund. That was a 40 per cent increase in the last six months. Millions more were benefiting from testing and more than half a million orphans were receiving care and support.
More must be done, however, he said. For next year, $18 billion was required, $22 billion for 2008 and beyond. It was a modest assumption that the Fund should provide one quarter of that. Current income, however, was less than half of that. In order to achieve the goal of universal access, the Fund must finance at least one round of new programmes each year. An additional income of $900 million was required for a fully funded round VI in 2006.
He said: "Let all countries contribute fully to this global priority according to their means. Let the business community optimize its contribution. Let all individual citizens join in solidarity with those affected by this scourge through the RED campaign and other initiatives. Finally, let us all raise our voiced to demand that no child, no woman and no man should suffer or die because we could not find the few extra billion of dollars that are needed."
King MSWATI III, Head of State of Swaziland, said the fight against HIV and AIDS was more difficult for developing countries because their economies were characterized by poverty, unemployment and emerging disasters that often diverted resources from the war on the scourge. The presence of tuberculosis and malaria in Africa further complicated the problems. The high cost of treating opportunistic sicknesses was beyond their means. In addition, skilled human resources were being lost to developed countries. Moreover, some developing countries had been classified as middle-income States and, thus, been deprived of certain assistance. That unacceptable position must be reviewed without delay, as the pandemic had negatively affected their fragile economies. The pandemic had no respect for the classification of countries.
He said it was clear that the prevalence rate was not showing any signs of decreasing. It was also clear that HIV/AIDS was a serious disease which required commitment from all. In his country, the pandemic had been declared a national disaster in 2001. A National AIDS Council had been established in 2003. Over the years, there had been a significant increase in the allocation of resources. Through a multi-sectoral approach, his country had been able to address, manage and mitigate the impact of the epidemic at all levels of society, despite its meagre resources. With the assistance of the Global Fund and other partners, it had successfully managed to apply the "Three Ones" principle: one national coordinating body, one monitoring and evaluation plan, and one HIV and AIDS national strategic plan.
Among other accomplishments, he mentioned that Swaziland had scaled up preventive strategies targeting young men and women. It had also accelerated prevention of mother to child transmission. It had successfully rolled out antiretroviral therapy in all hospitals. It was one of the few countries in sub-Saharan Africa that had met the "3 by 5" target. Tuberculosis HIV and AIDS services were free and accessible to communities. HIV testing had been increased from less than 3 per cent to 10 per cent of the total population. His country also had a successful malaria programme and had achieved more than 90 per cent coverage of indoor residual-house spraying in targeted areas.
DENIS SASSOU NGUESSO, President of the Republic of the Congo, on behalf of the African Union, said AIDS was the cruellest of pandemics the world had confronted in the last quarter of a century. "What cry must Africa utter in its anguish for its pain to be heard and heeded and properly understood?" he asked. Of all continents, Africa was hardest hit by the ravages of the cruel scourge. Unfortunately, Africa was also the continent that was most lacking in resources to deal with the scourge. Every day, the situation only got worse and no segment of the population was spared. Women and children, the very foundation of the continent's future, were the hardest hit.
Continuing, he asked what could be done to achieve universal access to prevention, treatment and medical care for HIV. Africa was attempting, with its limited resources, to organize itself so as to tackle the scourge through prevention and universal treatment. It was a united Africa that had met in Nigeria in May 2006 to take stock of the HIV/AIDS situation on the continent and to make the use of best practices. Following that special summit, the African Union had kept its rendezvous with history by reaffirming its commitment to combating AIDS, tuberculosis and malaria by the Abuja Appeal and the African Common Position. The African Common Position was a convergence -- a continent-wide approach to meet the challenge of the HIV pandemic. While those commitments might appear too ambitious, in face of a pandemic that had already killed more than 20 million, it was only rapid and massive action that would achieve the Millennium Development Goals.
Obstacles to universal access to prevention, treatment and medical care were still numerous, he said. They included poverty, food insecurity, economic constraints, recurrent armed conflict, natural disasters, fear, ignorance, stigmatization and discrimination. He welcomed international initiatives to provide financing for Africa in its struggle against HIV and other infectious disease. He was profoundly grateful to development partners and the Group of 8 countries, which had undertaken to mobilize $50 billion by 2010 to accelerate universal access to prevention, treatment and medical care. It was only by raising awareness and general mobilization that the international community would be able to meet the challenge posed every day by AIDS to the whole of mankind. The international community's responsibility was a historic one, for the destiny of millions depended on the commitments entered into today. It must ensure that the immense reservoir of help did not come to grief against a wall of shame, a wall of promises not kept.
FRANÇOIS BOZIZE, President of the Central African Republic, said that considerable efforts had been undertaken by African countries to deal with the scourge, which was not only a problem for Africa's development, but for the very survival of the African people. Those efforts had shown improved global and regional indicators, but certain countries such as his own, viewed in isolation, had indicators still far from the targets established for 2010. For example, in the Central African Republic, despite resource mobilization, of the 40,000 people requiring antiretroviral drugs, fewer than 2,500 had received it, or 6 per cent. Of the 1.3 million people being treated for AIDS in developing countries, the number treated in his country represented only 0.2 per cent of the total, yet the Central African Republic had one of the highest incidences of AIDS in all of Africa. In terms of prevention, increasing AIDS education in schools had not been possible in countries like his, because of the high number of teachers that had died of AIDS and the lack of financial resources to launch campaigns. In short, what had been accomplished had fallen far short of the needs of his country, as was very likely the case for most lower-income States.
He said that, in about 40 developing countries, the fight against AIDS was being waged at the level of Head of State and Government, as was the case in his country. For three years, he had personally presided over the general assembly mandated to combat AIDS, and he had organized periodic meetings of the President's cabinet to take stock of the progress achieved in that fight. Several African Heads of State had undertaken commitments at the special summit of the African Union last month, which he had personally attended. Two important documents had been adopted, including a common African position on HIV/AIDS and the Abuja appeal for accelerating action to provide universal access to services to combat HIV/AIDS, tuberculosis and malaria in Africa. In view of the scope of the AIDS scourge in Africa, he endorsed all of the Secretary-General's recommendations, and those were also in line with the decisions taken by the Union in Abuja in May. Accelerating the effort could be modelled on the current endeavour to defeat avian flu. Only solidarity of purpose and action would rid the continent of AIDS.
ARNOLD RUUTEL, President of Estonia, said that, where in earlier years military conflicts were of concern, today the world faced different challenges, among them the spread of HIV. AIDS was, according to some, not just a pandemic but also a security risk. In order to prevent a pandemic, it was not enough to manufacture drugs. Poverty, social exclusion and other factors must also be addressed. The fight could only be effective if all those activities were tackled together, with concerted international efforts.
He said yesterday the International Day of the Child had been celebrated. Children were the weakest members of society and over 10 million of them were affected by HIV. Many of them had no access to care. Therefore, there should be a focus on children and prevention of mother-to-child transmission. In the initial period, the disease spread through risk groups, such as injecting drug users. Drug addiction and alcohol abuse, therefore, had to be addressed, as well. Stigmatizing people with HIV should be avoided. In order to win the battle, social prejudice and shame should be overcome so that people could talk openly about the problem. Antiretroviral therapy must be available to everyone, he said, but treatment was often too expensive.
He said, just about 20 years ago, most Estonians did not know much about HIV. Today, however, the disease was spreading, even outside the risk groups. His country had, therefore, taken serious steps to stop the spread of HIV. Prevention was now more systematic. A new HIV strategy had been drafted. The number of new cases was decreasing and funding had increased, among other things, through the Global Fund. No country could win the fight alone. International solidarity was needed.
ELIAS ANTONIO SACA, President of El Salvador, noted that 25 years ago when the first cases of HIV/AIDS had been registered, El Salvador had been suffering an armed conflict that had taken the lives of 80,000 Salvadorans. Today, El Salvador had left behind those unfortunate days and had healed the majority of its deep social wounds, having achieved the implementation of a successful peace process. El Salvador was confronted today with new challenges, including poverty and hunger. El Salvador was also suffering the effects of the pandemic, with more than 30,000 persons living with HIV/AIDS. Together, civil society, Government and persons living with HIV could transform today's reality. It was essential that everybody become involved in order to combat the pandemic.
Thanks to an integral prevention strategy, based on moral values and scientific measures, El Salvador had been able to prevent an increase in the number of new infections, reducing by three points the annual HIV rate, and by four points the annual AIDS rate, constituting a significant step forward in reaching the goal of reducing the epidemic by 2015. Committed to ensuring treatment for persons with HIV, El Salvador had made significant progress towards that goal. He acknowledged the participation of civil society in that regard. Since 2001, El Salvador had increased 50-fold the number of persons that received therapy. During the past few years, El Salvador had reduced by more than 85 per cent the number of children born with HIV. The young generation was the world's hope and future, and it was for them that the world needed to act now. Universal access, more than a goal, must become a daily reality in today's world.
Speaking on behalf of the more than 500 million Latin American people, he said Latin America demanded a sustainable and authentic support of donor countries and organizations, such as the Global Fund, in order to combat the epidemic in its countries. The struggle against HIV required effective measures and responses on the part of Governments and civil society. He begged the international community not to delay such aid.
EDWARD NGOYANI LOWASSA, Prime Minister of the United Republic of Tanzania, said he was deeply concerned that, despite much effort and resources, the threat of HIV and AIDS had not abated, especially in developing countries and among women and youth. Of particular concern was the interrelationship between HIV and AIDS, poverty and inequality. As the world charted the way forward, it needed to tackle the multifaceted threats posed by the pandemic. In that regard, the Secretary-General's recommendations warranted serious consideration. His country was committed to the Declaration of Commitment and was making all efforts to fulfil its obligations. It had observed the "three ones" principles, and its national priorities had consistently emphasized prevention. Several measures were being undertaken for that purpose, including education programmes targeting various groups such as workers, armed forces and refugees, and voluntary counselling and testing had been made available.
Also being addressed in policies and strategic frameworks were prevention of mother-to-child transmission and the management of sexually transmitted infections, distribution and social marketing of male and female condoms, information related to human rights issues, stigma reduction and gender-based concerns. As a result, awareness had increased considerably, especially through peer group counselling. Testing was a major limitation, owing to the high purchase cost of equipment and the training required to operate it. Additional legislation was also under consideration to further ensure the legal protection of people living with HIV and AIDS, orphans and other vulnerable children. In that regard, collaboration with civil society and the private sector should be strengthened. In implementing the global target of "3 by 5", his Government, in collaboration with some of its development partners, formulated an HIV/AIDS care and treatment plan in 2003. It sought to provide antiretroviral drugs, free of charge, to some 440,000 people by 2007. Thirty-thousand people were enrolled in the programme and being monitored.
Financing HIV/AIDS control programmes was a big challenge, further taxing already overburdened national budgets, he said. AS the multi-sectoral response evolved, more predictable and sustainable funding would be required. The Global Fund to Fight AIDS, Tuberculosis and Malaria had brought very high expectations in developing countries. The enthusiasm generative five years ago and the Fund's encouraging track record thus far needed to increase and be sustained. He appealed to the international community to increase its political and financial support to the Global Fund. As the global community continued to grapple with HIV and AIDS and strove to scale up its efforts, new challenges were emerging. Those included a serious shortage of trained medical personnel, equipment, and health-related infrastructure. Sustaining care and treatment plans was another challenge, as was sustaining support to the increasing number of orphans, and overcoming the resistance emerging to some of the drugs for AIDS and malaria.
BERTIE AHERN, T.D., Prime Minister of Ireland, noted that five years ago he had committed the Irish Government to spend €30 million per year on the fight against HIV/AIDS. Ireland had more than lived up to the commitments he had made. Through its national programme of development assistance, Irish Aid, his country had spent over €250 million in the past five years. From this year forward, he pledged that Ireland's spending on HIV and other communicable diseases would increase to at lest €100 million per year. During the past five years, over 30 million men, women and children had been infected with HIV, over 3 million had died and over 15 million children had been orphaned by AIDS. Behind those dreadful statistics lied a grim reality of pain, suffering and destitution.
What was now required was uncompromising global leadership and commitment to scaling up efforts so as to make AIDS history, he said. He had committed the Irish Government to reach the United Nations target of 0.7 per cent gross national product (GNP) on official development assistance (ODA) by 2012. That major scaling up of the Irish Aid Programme would enable the country to be at the forefront of the fight against HIV/AIDS in the years ahead. Ireland would, among other things, double its funding to UNAIDS to €6 million per year, increase funding to the Global Fund and spend an additional €30 million per year on HIV in its partner countries.
He said United Nations leadership was crucial to the global HIV challenge. The global progress made owed a great deal to the Secretary-General's tireless commitment and leadership. The United Nations must continue to lead efforts to ensure that resources were spent effectively. That meant an end to the duplication of effort, a strengthening of coordination on the ground, a trustworthy system of monitoring and a single-minded focus on achieving results. The fight against HIV/AIDS was a test case of United Nations reform in action. HIV infection did not respect borders. The European Union and its neighbouring countries were facing the fastest-growing HIV-infection rates. "We need to act now", he said, calling on European Union members to live up to the ambitious commitments made in Dublin in 2004 and demonstrate leadership to fight the expanding epidemic.
Prevention was at the core of the HIV strategy, he said. The single biggest priority must be to stop new infections. With a staggering 5 million new infections in 2005, the international community needed to spend more, build capacity, and mobilize political will to reach those most at risk. Ireland was gravely concerned about the growth of the epidemic among women. A combination of HIV/AIDS and gender inequality was proving lethal for women and girls. Progress in access to HIV treatment was evident. The price of life-saving drugs had fallen since 2001. While the reduced cost had facilitated a substantial increase in the number of people accessing treatment, only one in five in need of treatment had access to it. The world urgently needed adequate qualified staff and health supplies for the treatment of HIV and related infections such as tuberculosis.
DENZIL L. DOUGLAS, Prime Minister of Saint Kitts and Nevis and Chair, Pan Caribbean partnership against HIV/AIDS (PANCAP), speaking on behalf of the Caribbean Community (CARICOM), said a coordinating mechanism had been established in his region that was based on a broad partnership of all actors in HIV/AIDS, established by Heads of State after the 2001 special session. In several countries, programmes had been established that had had demonstrable successes, such as in extending treatment to many, reducing mortality, and reducing mother-to-child transmission. In order to achieve the 2010 goal of universal access, indicators had to be established at regional and national levels, and the region would not be reticent about admitting shortfalls.
He said there were obstacles, however. There was the need for sustained financing; for increased human resource capacity, given the high rate of skilled labour migration; the need to mobilize technical and financial resources; the need to strengthen the health, education and other social systems. To achieve that, international partners must be encouraged to harmonize and align programmes and to simplify funding requirements. The "intractable" eligibility criteria imposed by multilateral and bilateral agencies, which disqualified medium-income countries of the Caribbean from access to front-line awards, must be challenged.
The Caribbean region was a complex mosaic of 29 countries and overseas territories with a population of about 38 million, characterized by tremendous diversity in size, culture, language and governance structures. HIV prevalence was second highest only to sub-Saharan Africa; 300,000 people were living with HIV. The prevalence rate in women of 15 to 24 years was two to six times higher than men. The Caribbean total death toll had been estimated between 350,000 and 590,000. However, by 2010, the region would have reaped the benefits of a harmonized international partnership. He hoped that, by that year, every country in the Caribbean would have introduced supportive legislation and a policy framework to protect the vulnerable populations, in particular men who have sex with men, commercial sex workers and prisoner.
MACKY SALL, Prime Minister of Senegal, said the strengthened international mobilization in the fight against HIV and AIDS had led to significant financial flows and commitments from States. However, despite that mobilization, financial and technical efforts had not been enough to provide a response to lower rates of new infections. The High-Level Meeting must, therefore, be seen as a critical juncture in the remobilisation of the fight. Africa was in an emergency health situation.
He said, if the problems of HIV/AIDS were not solved, achieving the Millennium Development Goals would become impossible. Three major challenges had to be addressed: prevention; universal access to treatment; and human resources. While prevention efforts must be strengthened, the lack of information for adolescents and children about HIV was disturbing. Commitments must be made to make antiretroviral therapy, including paediatric formulas, accessible in a sustained way.
Developing countries must be inspired by Brazil, Thailand and Senegal, he said. In Senegal, 70 per cent of antiretroviral therapy was free and funded by the State. However, research on prevention, including on microbicides, must be funded. Predictable and sustainable financing was necessary to achieve the goal of universal access. Furthermore, a sustainable partnership between Government, civil society and people living with HIV was crucial. It was time for the world to change its paradigm vis-à-vis the pandemic. Now was the time to act. Tomorrow, it would be too late.
PAKALITHA BETHUEL MOSISILI, Prime Minister of Lesotho, said his country had a population of 2.2 million and a prevalence rate of HIV infection of 23.2 per cent. Some 266,000 of its nationals were estimated to be living with HIV, of whom 16,000 were children under the age of 14. The estimated number of people in need of antiretroviral therapy in Lesotho was now 43,000. An estimated 24,000 people died of AIDS in 2005, and the estimated number of orphans under the age of 17 was 97,000. Those grim statistics had, nevertheless, neither deterred his Government nor blinded it. Instead, that had spurred it on with more resolute conviction and commitment to win the war against HIV and AIDS. It had embraced the "three ones" principle to guide all stakeholders in the national response. Moreover, it had integrated HIV and AIDS into the strategic national development agenda. His Majesty King Letsie III had declared HIV and AIDS a "national disaster" in 2000. That had been followed by a "know your status" campaign, launched in 2004, involving public testing. That programme was regarded as the gateway to universal access to prevention, treatment, care and support services.
He said that, as an integral part of the "know your status" campaign, the primary focus was on communication and education for behavioural change, particularly for the youth. The level of HIV and AIDS awareness had significantly increased due to ongoing public education and the exemplary commitment of the nation's leaders to awareness-raising efforts. There had also been an increased level of the use of protective and preventive devices, such as condoms. Peer education and establishment of adolescent health "corners" had been successful in influencing behavioural change and meeting the reproductive health care needs of adolescents. Lesotho had also started providing services to prevent mother-to-child transmission in 2003. There were approximately 11,000 people on antiretroviral therapy, of whom 500 were children under the age of 14. The main challenge was to upgrade existing health facilities, establish new infrastructure and increase resource allocation through active mobilization of the private sector and external donor support. Community home-based care and support had been a main pillar for those on treatment, including orphans and vulnerable children.
Lesotho had mobilized and committed its limited resources in the struggle to beat the pandemic, he said. The major challenge had been to provide adequate human, physical and financial resources commensurate with the magnitude of the problem and level of effort required to address the HIV and AIDS threat. While he commended the funding pledged for the Global Fund, he advocated the "pool or basket funding", as well as debt relief, in order to free up additional resources. He also strongly urged all stakeholders to ensure that the funds reached and benefited the target groups of orphans and the infected, instead of paying huge salaries to external consultants. It was "sinful" that the Group of 8 and others in that category had not yet deemed it right or reasonable to cancel debt for all least developed countries. Lesotho was third in the world in terms of HIV-infection prevalence after its neighbours, Botswana and Swaziland, but it had yet to see a commensurate commitment of resources in the region. "It's time to put our money where our mouth is, to put up or shut up. For, there cannot be any economic development, or any technological development to talk about, unless and until we subdue and defeat the HIV and AIDS pandemic", he said.
SUCHAI CHAREONRATANAKUL, Deputy Prime Minister of Thailand, said Thailand was one of a growing number of countries that had reduced rates of HIV transmission through effective prevention programmes. However, more than
1 million Thais had been cumulatively infected by HIV. Therefore, his country had to fight to address two aspects of HIV and AIDS simultaneously. It had to fight for universal access to prevention services for high-risk and vulnerable populations. His country had announced a commitment to reducing new HIV infections in half by 2010. It would continue prevention efforts among the vulnerable groups, including men having sex with men, injecting drug users and sex workers.
At the same time, Thailand had to fight for universal access to treatment, care and support, he said. Access to antiretroviral treatment had been integrated into the national social and health security programmes. All Thais were now guaranteed access. Expanding social services would improve access for at least 80 per cent of needy individuals and families, including vulnerable children, orphans and the elderly.
He said the effective mobilization of all sectors would be an essential pillar for success of those ambitious efforts. Civil society, which had contributed significantly to previous successes for the past 20 years, would continue to have a critical role to play. Another essential pillar was the availability of the human, material and financial resources.
ISEHNGUL BOLDJUROVA, Acting Deputy Prime Minister of Kyrgyzstan, said that, unfortunately, difficulties in the country had led to a growth of migration, and citizens were leaving the country in search of work. The entry and exit of workers had led to an increased spread of AIDS. Drug use was on the rise, as were sexually transmitted diseases. Health-care facilities did not have sufficient financing, further contributing to worsening the threat of HIV and AIDS through blood transfusions and other common medical procedures. In fact, the officially recorded cases of HIV and AIDS infections had increased by 53 per cent in the past five years. The State was taking measures to prevent the epidemic. Policies were being implemented on the basis of a multi-sectoral approach, which provided for activities of the State and civil sectors for people living with the disease. New laws had also been adopted, and several more were pending.
In addition, she said, a coordinating monitoring capacity had been established within the office of the Prime Minister. In June 2005, a multi-sectoral coordinating committee to fight AIDS, tuberculosis and malaria had been established. It had prepared a State programme for 2006 to 2010 on AIDS prevention, which was based on adequate legislation, human rights priorities, overcoming stigmatization and discrimination, and the development of partnerships in accordance with the country's international obligations. Its implementation would be very difficult, however, without the necessary resources. She hoped that the commitment of Parliament, the government leadership, the private sector and donors would contribute to defeating AIDS in Kyrgyzstan and curbing its spread, with all its social and economic consequences. Hopefully, the declaration to be adopted later today would go far towards preventing that global threat.
PHAM GIA KHIEM, Deputy Prime Minister of Viet Nam, said humankind was at a crucial stage in the fight against HIV/AIDS. HIV-prevention programmes had yet to reach the most vulnerable groups, and four of the global targets on HIV were still far from being achieved. National leaders' growing concern about HIV/AIDS, increased financing for HIV programmes, and improved prevention capabilities were encouraging signs. Viet Nam was no less concerned, however, about its ability to drive back the pandemic in the next 10 years. That was why everyone had the responsibility to hammer out bolder and more effective measures to achieve the 2001 goals. This Meeting would produce more effective measures to curb the HIV/AIDS pandemic.
His Government had always been determined to implement the Declaration of Commitment on HIV/AIDS, he said. Fully aware of the danger of HIV, the Government and people had responded early to the fight against HIV/AIDS with strong preventive measures. This month, the law on the prevention of and combat against HIV/AIDS would be adopted, which would help create changes in addressing complex issues. Strong, uniform and systematic preventive measures had also been undertaken nationwide. Public awareness had been raised substantially. Prevention programmes targeting high-risk groups had been widely launched, and importance had been attached to preventive education for youth. Programmes to prevent mother-to-child transmission had also been implemented. Efforts to eliminate discrimination and stigma against people living with HIV/AIDS were strongly promoted.
To fulfil the 2001 commitments, nations should intensify efforts to eliminate discrimination and help people living with HIV better integrate into society, he said. Better coordination among donors and the international organizations in mobilizing resources to assist developing nations in implementing HIV-prevention programmes was also needed. The international community, including the business sector, should ease the conditions for developing nations to gain better access to generic drugs. Technical cooperation, research and development of new types of medicine and vaccine should also be enhanced. Increased regional and subregional cooperation was needed to prevent and control the cross-border spread of HIV/AIDS. In that regard, it was necessary to include the issue of HIV/AIDS prevention in the cooperation programmes of regional and subregional arrangements. Viet Nam was committed to working closely with all countries and international organizations in the fight against AIDS.
YOSHIRO MORI, former Prime Minister of Japan, said he dreamed of a world free of HIV/AIDS. The Global Fund and other agencies played a central role in raising awareness of the need for a truly worldwide endeavour and strategy. That had been translated into a number of concrete actions. It was widely recognized that, for those actions to be truly effective, it was vital for all stakeholders to cooperate across national borders -- not only Governments, but also people living with HIV and AIDS, non-governmental organizations, private enterprises, private foundations, health-care workers, mass media, and others who shaped public opinion. In 2004, the leaders in the private sector in Japan had established the "Friends of the Global Fund, Japan", on which he served as president. The association sought to enhance national support for the Global Fund. It also encouraged and promoted cooperation among countries in East Asia.
He said that the HIV and AIDS problem was closely linked to such issues as poverty, development, peace and order, social prejudice, and governance, all of which required a long-term approach. It was essential to achieve greater access to prevention, care, support and, particularly, treatment, to which access should be universal by 2010. The fight against HIV and AIDS must be won by setting such mid-term goals, and implementing and reviewing them periodically at the United Nations. As part of Japan's efforts in that area, the Government had pledged last June to increase its contributions to the Global Fund by donating half a billion dollars in the coming years. Since its inception, it had contributed $480 million. His Government's commitment to the Fund remained firm.
The fight against HIV and AIDS was an embodiment of the idea of human security, which stressed the importance of protecting human lives and preserving human dignity. In rugby, a sport he loved, the players' motto was, "One for all, all for one". The world community must make a joint team effort, one working for all and all working for one, so that when world leaders next met, they would be able to agree that they had scored many "tries" against HIV and AIDS.
Morning Session: Parallel Segment A
LESLIE RAMSAMMY, Minister of Health of Guyana, speaking on behalf of the Rio Group, said that, if the response to HIV/AIDS was not intensified, the goals would not be met. Rio Group countries were making extensive efforts against the disease despite resource limitations but the global response was not consistent worldwide. As a result, the Rio Group countries were learning lessons about South-South cooperation both within the region and further afield.
He said the Rio Group had concerns about funding arrangements in the region. The Global Fund, for example, was intended to support the efforts of low and middle-income countries to deal with the pandemic, but its doors remained closed to most countries in the region. Solidarity, not exclusion should be the guiding principle, with developed countries meeting commitments since poverty was a major obstacle to managing the pandemic and achieving the goal of universal access that was now stymied by lack of affordable drugs. First-line drugs might have become affordable but not second-line drugs or other materials needed for the effort. Barriers that made Trade-Related Aspects of Intellectual Property Rights (TRIPs) meaningless must be removed by a global effort. His own country and others had the capacity to produce drugs, and resources such as those should be encouraged, not restricted.
The Rio Group remained firmly committed to the global response to HIV/AIDS, and was concerned about the increasing impact of the disease on women and children, he said. The continuing stigma that made some countries require HIV/AIDS testing prior to entry was a violation of the right to free movement. The high prevalence rates among vulnerable groups must be addressed by ensuring full access to services and to protection of the rights of individuals. A comprehensive approach involving all stakeholders must be put into place to address all dimensions of the challenge.
MOHAMED CHEIKH BIADILLAH, Minister of Health of Morocco, said that some progress had been achieved since 2001, but the overall results had fallen short of expectations and had not matched the objectives set for the decade. The latest indicators and recent assessments proved that the pandemic was resisting all efforts to be contained and continued to spread, despite the various measures undertaken. The fight against the HIV and AIDS scourge should be part and parcel of the fight against underdevelopment and exclusion. All cooperation and partnership mechanisms to defeat the infection should be used, including allocation of .7 per cent of gross domestic product (GDP) to official development assistance (ODA), debt cancellation, affordable cost for imported laboratory equipment and therapeutic medications, increased awareness of the developed countries' responsibility, triangular cooperation and South-South cooperation for training and acquisition of know-how.
He said that no measure would be adequate, however, unless it was accompanied by innovative financing mechanisms. No region of the world was immune from AIDS' devastating impact, and Africa, particularly the sub-Saharan region, deserved special attention. The continent had become a breeding ground for all the scourges plaguing the world, and was host to 30 million HIV/AIDS-infected people. More efforts were needed, therefore, to provide its scientific community with adequate means for developing an anti-AIDS vaccine. He paid tribute to the Forum of First Ladies in Africa, which gave high priority to the fight against AIDS and other infectious diseases. Morocco had also launched an awareness information campaign, in which the national media participated actively, it had instituted a voluntary, anonymous and free testing system. In addition, it provided all infected persons with tri-therapy drugs, free of charge, and outreach programmes targeting risky behaviour and vulnerable groups were being implemented.
TABITHA BOTROS SHOKAI, Minister of Health of the Sudan, said her country had been a victim of the scourge of HIV/AIDS for several years as a result of such factors as long geographical borders and persistent poverty. The Sudan also suffered from unilateral measures which had harmed its economic growth and stopped its development cycle. As a result, the people of the Sudan had not been able to obtain adequate financial, technical and medical support, including prevention and treatment for HIV/ AIDS. A main priority was to achieve peace and stability through peaceful solutions to domestic problems, and international support, with the African Union's assistance, had allowed the country to reach a global peace agreement, which had ended its 20-year war -- the Darfur Peace Accord. She called on other parties concerned to give priority to peace in order for the country to obtain stability.
The Sudan would fight all destructive diseases, including AIDS, she said. Indeed, the fight against AIDS was one her Government's most important priorities, and it had established a single national policy to combat the scourge. The Sudan's national strategy, which would extend to 2009, took into account issues concerning education, women, youth, students and access to treatment services. Her country would also try to adopt necessary laws to remove discrimination.
Concluding, she expressed appreciation to the United Nations, in particular the Global Fund for its support and assistance. The Sudan awaited more aid as it sought to achieve peace in the region.
CELSO AMORIM, Minister for Foreign Affairs of Brazil, said that the 2001 declaration had been a turning point in the fight against HIV and AIDS. Contrary to the prevailing views at that time, the international community had realized that an effective strategy to confront the pandemic had to include access to treatment, along with prevention, care and support. It had also become clear that the cost of treatment should not impede the access of poor people to life-saving drugs. In Brazil, ever since the first antiretroviral drugs had appeared, the country had adopted a policy of universal treatment. The World Bank had estimated that 1.2 million people would have been infected in Brazil by 2000. The adoption of a policy based on free and universal treatment, however, had led to a significant reduction in those estimates, and the number of infected people was actually 600,000. The number of AIDS-related deaths had also been halved.
He said, however, that treatment globally remained a major challenge, and the aim of universal access to treatment, prevention, care and support by 2010 was an ambitious goal. He congratulated UNAIDS and its Executive Director for their work in that direction. To ensure the success of the "3 by 5" initiative [a global target to provide 3 million people living with HIV and AIDS in low- and middle-income countries with life-prolonging antiretroviral treatment by the end of 2005], the production of antiretroviral drugs in developing countries should be encouraged. Advantage should also be taken of the flexibilities built into the Doha Ministerial Declaration and subsequent public health-related agreements. The issue of affordability was also crucial. While he recognized the importance of intellectual property rights, no commercial right could be upheld to the detriment of the right to life and health. Bilateral, regional and global efforts to promote bulk procurement, price negotiations and licensing aimed at reducing prices must also be encouraged. Together with France, Chile, Norway and other interested States, Brazil was engaged in an initiative to create an international drug purchase facility explicitly for that purpose.
FRANCISO DUQUE III, Secretary of the Department of Health of the Philippines, noted that, despite the low prevalence rate in the Philippines, an increasing threat of a full-blown epidemic prevailed. Since 2001, the country had been scaling up prevention and targeting the most at-risk groups. The Government was also expanding the programme, targeting migrant workers through, among other things, collaboration with its Association of South-East Asian Nations (ASEAN) partners. The Philippines was also establishing a National Monitoring and Evaluation System on HIV and AIDS following the "three ones" principle promoted by UNAIDS, and implementing the second generation surveillance system on HIV and AIDS. The Philippines had recently included antiretrovirals in its National Drug Formulary and had set up a mechanism to provide affordable antiretrovirals. The country's business sector had also rallied behind the achievement of the Millennium Development Goals and had committed full support to efforts to combat HIV/AIDS.
The effective response to AIDS in the Philippines would require the implementation of the 2005 to 2010 Medium-Term Plan which followed the principles of the Universal Access Initiative, he continued. His country was concerned about the worsening global HIV situation where 5 million adults and children were reported to be infected each year, including greater numbers of women and children. Increased mobility and migration throughout the world required innovative approaches to enhance HIV prevention, treatment, care and support; however, the response to those issues was being hampered by the inaccessibility to affordable drugs, particularly in the developing and least developed countries. In that regard, he hoped the High-Level Meeting would muster the political will to implement measures and strengthen partnerships at national, regional and international levels to overcome all barriers to universal access to treatment. He advocated a paradigm shift to focus prevention strategies from mere risk reduction to a combination of risk, vulnerability and impact reduction.
GINÉS GONZALEZ GARCIA, Minister of Health and Environment of Argentina, said that Governments and civil society had been somewhat responsive to the crisis, however, efforts must be redoubled. For policies to be efficient, all sectors should be included, even those that preferred not to talk about the issue. In Argentina, although there were quite a few that resisted discussing HIV and AIDS, there was a strong commitment to do so. Universal access to promotion, prevention and treatment by 2010 in all countries must be guaranteed. Despite the fact that the Latin America and the Caribbean region had the least access to global resources, important efforts had been made, and the region might be the first to reach the goal of universal treatment. In Latin America, there were already countries that provided 100 per cent coverage, among them, Argentina.
He stressed that Latin America should not be discriminated against, either in terms of access to the resources of the Global Fund or at the price level for medical care or medication to curb the disease. Another challenge was to pursue price negotiation strategies. Thanks to some in the region, some very important discounts had been achieved, allowing for a widening of coverage in treatment with antiretroviral medication. Important advances had also been made in Brazil in developing and producing tools, medication and diagnostic equipment. He was committed to improving access to tests and antiretroviral drugs for the people of the region. Also crucial was to intensify the focused and massive awareness-raising campaign. With that goal in mind, Argentina favoured access to tools for prevention, such as condom use and the damage reduction kits for drug users. Regrettably, some multilateral organizations and some of the most powerful countries in the world had defended the ultimate right to intellectual property, thereby limiting availability and access to medication and vaccines. No matter how much they wanted to hide it, the result had been an elevated number of deaths.
HONG SUN HUOT, Senior Minister, Minister of Health and Chairman of the National AIDS Authority of Cambodia, said his country had been confronted with a serious epidemic of 3 per cent of the population living with HIV in 1997. By 2003, it had been reduced to 1.9 per cent due to a strategic national plan that coordinated development partners and civil society into nation-building and development challenges. The focus for his country here at the High-Level Meeting was to urge that development partnerships be sustained over the long term.
Describing the national plan, he said the vision for the country's economic development and social well-being was contained in a strategy for the period of 2004-2008. The interconnectedness of addressing the HIV epidemic and development was apparent in that framework, and that served as a guide for setting priorities. Over the next five years, the solution to the AIDS epidemic would come by breaking the silence and securing the active participation of families in public discourse, policy planning and programme implementation. The July Group of 8 meeting in Russia should also address the matter of the global response to HIV/AIDS. The effectiveness of the Global Fund was gratifying.
ELENA SALGADO, Minister of Health and Consumer Affairs of Spain, said AIDS was not only a health problem but also a social problem which required new policies and commitments. It was necessary to eliminate economic or ideological barriers that prevented or limited access to prevention measures, in particular the use of condoms and strategies to reduce damage associated with drug consumption. The disease had already caused some 4,600 deaths. Those figures could have been much more dramatic without a broad prevention programme, which included opiate substitutes and the provision of sterile injection materials. Spain had, in short, been able to reduce mortality and the risk of infection.
Human rights must constitute the framework for the response to HIV infection, and the stigma and discrimination against those living with HIV/AIDS, particularly the most at-risk groups, must be avoided, she said. Those groups of people must be able to participate in the design, implementation and evaluation of preventive measures. Women were also vulnerable due to social, cultural and economic factors. While AIDS had brought with it death and suffering and was a threat to human development, the epidemic had also resulted in greater solidarity, equality and broader coordination. That was why the Spanish Government had increased its contribution to the Global Fund. The special session had generated changes in the global AIDS agenda, and the number of people with access to treatment, while not a total success, represented progress. A great deal remained to be done, however. The international community already had a solid basis to formulate a broad based response, and Spain would be heavily involved in the global response.
GHALIA BINT MOHAMMED AL-THANI, Chairperson, National Health Authority of Qatar, said that more than 65 million people had been infected with HIV. Every minute, every hour, and every day, more and more people were infected, and more than one child was dying every minute of AIDS. Despite the world's combined efforts, the global AIDS problem was getting worse, not better. That single fatal virus was touching everyone unlike any other disease before it. AIDS destroyed families and intruded on the most intimate relations between them. It spread silently, killing and tearing the fabric of society. It even threatened the security of nations, shrinking economies and threatening people in their most productive years. That was not just a public health matter, but an educational, economic, political and human rights issue. Hence, everyone needed to work together under United Nations auspices in a vigorous and accelerated effort to address that challenge, as it was the most critical socio-economic development issue of the day.
She said there was a great need to re-evaluate, and, perhaps, redesign, the AIDS strategy. The international community should increase the flow of funds to affected countries, which, in turn, should give due concern to the issue of prevention and act forcefully without further delay. Despite the fact that the number of HIV/AIDS patients in Qatar was still relatively small, the country was fully aware and cautious concerning that fatal disease. HIV was well established and considered to be an endemic in Qatar. The total number of diagnosed cases was 212 as at the end of 2005, and 48 people had so far died from the virus. Significant support had been provided by both the public and private sectors, and consultants from the WHO and the United Nations Development Programme (UNDP) had discussed the matter with health planners and suggested a national plan of action. Precautions were being taken at health-care facilities to prevent transmission, and information and education activities were being conducted to raise public awareness. In addition, a national AIDS committee was being set up to develop a national strategy, coordinate action and provide counsel and advice to the concerned departments. It would also help implement the national plan of action.
NORAYR DAVIDYAN, Minister of Health of Armenia, said a new political commitment had been made to increase the effort against the HIV/AIDS epidemic in his country after the 2001 special session. A mechanism had been created to coordinate the response using the implementation and monitoring indicators set out in the Declaration. The first two of the "three ones" elements were already in place, and the third was in process. Within the international framework, national programmes had been instituted to set up educational initiatives that focused on children and other vulnerable groups. Also emphasized were harm reduction and risk reduction initiatives to raise awareness and provide broad access to services, particularly for youths.
He said the Global Fund had played a significant role in supporting national efforts and that it was difficult to imagine the national platform succeeding without it. Resources to support the national programme would be increased every year since a key goal of the new political commitment was to achieve universal access by 2010. An antiretroviral treatment programme had begun in 2005, and new drugs had been created to fight the effects of infection and improve the quality of life for those with HIV. National recommendations had been made to scale up universal access and preventive measures. They would be reflected in the 2007-2011 national programme to be carried out with the support of UNAIDS, the Global Fund and other partners. Armenia supported the Political Declaration to be adopted today and believed it would serve as a solid foundation for global efforts focusing on prevention.
AGNES VAN ARDENNE-VAN DER HOEVEN, Minister for Development Cooperation of the Netherlands, said four dollars were all that was needed to prevent transmission of HIV during childbirth and prevent newborn babies coming into the world with a death sentence. Unlike five years ago, the money was available and yet no more than 9 percent of infected mothers had been treated when world leaders had promised an 80 per cent rate at the special session. Africa was at the heart of the storm, and it was now clear that the AIDS crisis could not be solved by simply throwing money at it.
The task at hand was to make money work for people by building strong in-country capacity, she said. Led by national Governments, all actors must take responsibility to take simplification and harmonization seriously. If things continued as they had and the AIDS response went in all directions, the little national capacity in Africa and elsewhere would drain away. The principle of the "three ones" must be applied at the country level: one action framework, one coordinating authority and one system to monitor and evaluate. And in building the capacity to fight AIDS, the focus should be on prevention. That would contribute to saving resources for treatment.
ABATOR THOMAS, Minister of Health and Sanitation of Sierra Leone said that, to tackle the scourge, African Governments had manifested their will by adopting the Brazzaville Declaration on commitment on scaling up access to treatment, care and support. Sierra Leone was firmly committed to the Declaration's implementation. While the prevalence rate in Sierra Leone was some 1.5 per cent, the pandemic constituted a formidable challenge to human life and dignity. In that regard, Sierra Leone had, among other things, set up a national HIV Council. It had also established a national policy on the pandemic, a national HIV/AIDS secretariat, and counselling and other social programmes. It had also approved a zero tariff on drugs and had increased the number of treatment centres. Grappling with the aftermath of civil conflict, Sierra Leone faced other health issues, including a shortage of trained health personnel. She reminded partners to make good on their commitment to tackle the challenges posed by AIDS, to mobilize and allocate additional financial resources.
To achieve universal access to HIV prevention, treatment, care and support, she said the Government had set immediate targets, including providing the most vulnerable segments of society with information on HIV, continuing to provide regular budgetary support and strengthening health care and social systems. She thanked the World Bank and the Global Fund for their support and assured the Assembly of its commitment to the global fight.
MARIA SOLEDAD BARRÍA, Minister of Health of Chile, noted that, five years ago, Member States had heeded the Secretary-General's appeal and entered into a covenant that the international community would spare no effort to reverse the pandemic. While substantial progress had been made, those commitments had not been sufficient to contain the epidemic. It was in the pandemic that the international community recognized much of the inequity and inequality in the world today, especially those of poverty and hunger. The poorest countries were most affected by the pandemic and young people, men who had sex with men and migrants were among the most vulnerable segments of society. Despite different values and interests, mankind's commitment was needed to halt the pandemic. More decisive involvement of the relevant social stakeholders was needed to achieve those goals.
Cooperation between Governments and civil society also needed to be expanded, she said. National and international policies for the promotion of human development that recognized diversity as a cultural asset were also needed. For her Government, unconditional respect for the human rights of persons living with HIV/AIDS was not only a duty but also a requirement of an increasingly democratic society. It was necessary, therefore, to create legal and political conditions for the protection and promotion of human rights. Chile welcomed the creation of collective forums and initiatives, which considerably enhanced action to reduce the huge economic gap in responding to HIV that existed between the industrialized world and countries with fewer resources. Chile reaffirmed its commitment to continue working to halt the spread of AIDS and to cooperate at the international and regional levels. It was time to intensify efforts to obtain a more effective response.
ILEANA NÚÑEZ MORDOCHE, speaking on behalf of José Ramón Balaguer Cabrera, Minister of Health of Cuba, said she was addressing the high-level conference as her minister was unable to attend because the United States had denied him a visa.
What her Minister had intended to say, she continued, was that poverty still created enormous inequalities that were kept in place by policies of certain countries such as the United States, which prevented others from developing the medicines and other tools needed for an appropriate response to HIV/AIDS. The incidence of the disease in the country's population had been decreasing since 2003 due to an aggressive campaign despite such unfair constraints. The costs of implementing prevention and treatment measures were high to begin with. Selfishness should not be allowed to make the challenges even harder to meet.
Princess STEPHANIE of Monaco said she had come today to declare solidarity with those who were fighting against AIDS, a disease that did not spare any and which still represented a terrible threat to all populations. Unfortunately, access to prevention, screening and treatment remained impossible for many. Monaco had, as early as 1997, been associated with the actions of UNAIDS. The principality also contributed to the Global Fund and had, since last year, taken part in the Accelerated Funds of UNAIDS. She had already committed herself personally through her Association, Fight AIDS Monaco, to provide more comprehensive and accessible information for all and for the establishment of effective prevention programmes.
The Association, she added, fought on a daily basis to protect the dignity of each HIV-positive person. Any form of discrimination was intolerable, even more so when stigmatization worsened the physical pain caused by the disease. Monaco was committed to supporting the outstanding work of UNAIDS, which contributed relentlessly to gather efforts, overcome challenges and act with determination. "I think that it is my duty as a woman and a mother to continue fighting with all my strength against this pandemic", she said.
CHRISTINE NEBOUT-ADJOBI, Minister in Charge of HIV/AIDS of Côte d'Ivoire, said her country had created a special ministry to fight the HIV/AIDS pandemic and stop it by the target date of 2015. While education had increased the efficacy of prevention measures among young people, obstacles remained. The national plan of action was being implemented with development partners. Her request at this high-level follow-up on the Declaration of the Special Session was for international efforts to continue supporting national ones.
JULIO VEGA PASQUIER, Minister of the Interior of Nicaragua, said his country was young and one of the poorest in Latin America. Without immediate action, its future would be affected. Commitment was of no use, however, if it was not supported by solid, financial support. In that regard, Nicaragua's budget to fight AIDS was greater than in previous years, and his country appealed to all countries to join in efforts to achieve access to antiretrovirals. Such drugs were a question of life and death, as was prevention, which could not be disregarded because of stigma or discrimination. While Nicaragua had the lowest AIDS prevalence, it was also the most vulnerable. In that regard, he asked the United Nations to consider his country a top priority.
CHUA SOI LEK, Minister of Health of Malaysia, said his country's strategic plan on HIV/AIDS for 2006-2010 demonstrated a political commitment at the highest level by the establishing of a cabinet-level Committee on AIDS chaired by the Deputy Prime Minister. Guided by the "three ones" principle, the plan focused on strategies to strengthen leadership and advocacy; conduct training and enhance capacity; reduce HIV vulnerability; and improve access to treatment, care and support.
Concrete, specific steps had been taken in the areas of both prevention and treatment, he continued. Cheaper generic medication had been imported through compulsory licensing so as to triple the number of people on antiretroviral therapy over the past three years. Free treatment was provided to HIV-infected mothers and their newborns. Recognizing that drug use was the main driver of the epidemic, bold steps had been taken to address the problem, including by instituting harm reduction programmes in October of last year to scale up activities such as opiate substitution therapies and needle exchange programmes. The political declaration to be adopted today would be another milestone in the fight against AIDS. It should be followed by urgent action.
Morning Session: Parallel Segment B
URSULA HAUBNER, Federal Minister for Social Security, Generations and Consumer Protection of Austria, speaking on behalf of the European Union and associated countries, recommended making the largest possible use of the flexibilities foreseen in the Trade-Related Aspects of Intellectual Property Rights (TRIPs) agreement. Efforts to rapidly expand and sustain access to antiretroviral treatment, including paediatric formulations of antiretroviral drugs and care, would be undermined if the spiralling cycle of new HIV infections was not broken.
She underlined the importance of comprehensive sex education. Similarly, information, knowledge and services, particularly on sexual and reproductive health and rights, were key tools to raise awareness among young people. About 80 per cent of HIV infections were sexually transmitted, which made a sustainable supply of male and female condoms crucial. Transmission through intravenous drug use was also a big problem, in Europe and other parts of the world, requiring large-scale implementation of harm-reduction programmes, including needle exchange programmes, which had proven effective.
The European Union recognized that the poor had limited access to education, health services, stable livelihoods and food, and were, therefore, often forced into situations that made them more vulnerable to HIV exposure and infection, she said. Such vulnerability was often aggravated in humanitarian contexts, and the European Union regarded HIV/AIDS as a cross-cutting challenge, concerning all aspects of development and requiring urgent responses. That demanded action to reduce poverty, as well as placing the protection of human rights, including gender equality, the elimination of gender-based violence, stigma and discrimination at the centre of all AIDS policy and programme planning and implementation. In doing so, it was necessary to take into account all key populations, particularly young women, girl children and adolescents.
Successful HIV prevention should be comprehensive and evidence-based, she said, adding that, ultimately, it must use all possible approaches known to be effective, rather than one or a few selective actions. The European Union was profoundly concerned about the resurgence of partial or incomplete messages on HIV prevention that were not grounded in evidence and had limited effectiveness. It must be recognized that sexual and reproductive ill-health and HIV/AIDS shared the same root causes, including poverty, gender inequality and exclusion of the most vulnerable groups. It was vital, therefore, to link sexual and reproductive health with HIV/AIDS and sexually transmittable infections services, as well as to strongly involve sexual and reproductive rights organizations in the prevention and treatment process, if the Millennium Development Goals were to be met, in full and on time.
HILARY BENN, Secretary of State for International Development of the United Kingdom, said countries on the front line of the fight against AIDS must set out how they intended to defeat the killer disease. Countries must link AIDS programmes to 10-year health plans, build clinics and hospitals, eliminate user fees so that people could have access to treatment, employ doctors and nurses, test people for the disease, purchase antiretroviral drugs and offer treatment. Decent health care must be available to all. No costed and credible plan should go unfunded. The international community must support AIDS plans with long-term, predictable funding for health and education. That required increasing aid and replenishing the Global Fund to fight AIDS, Tuberculosis and Malaria. The United Kingdom was doing its part, as the world's second largest donor for AIDS treatment and prevention. AIDS plans must have targets to measure progress. The declaration needed interim targets for 2008.
Tackling AIDS was not only about money, he continued. It was also about cultural and social attitudes, and recognizing that prevention was a key to achieving an AIDS-free generation in the future. Honesty was also essential. He lamented that leaders had not been more frank in the declaration about the fact that sex workers, drug users and men who had sex with other men were at greater risk; that some young women exchanged sex for money or food; that stigma and discrimination and the unequal position of women and girls in society made it more difficult to fight the disease; and that accurate information, access to sexual and reproductive health and rights, and upholding human rights was essential. He also called for more frankness about the fact that condoms protected people from HIV, clean needles prevented injecting drug users from passing on the virus, and that, while abstinence was fine for some people, human beings did like to have sex and should not die because they had sex. While such truths might be difficult and uncomfortable, they could not get in the way of saving lives.
RICHARD NCHABI KAMWI, Minister for Health and Social Services of Namibia, said his country was implementing a comprehensive prevention strategy that went beyond the ABC approach to include life-skills education for youth, both in and out of school; promotion of the rights of women, children, vulnerable groups and of people living with and affected by HIV and AIDS; and the provision of comprehensive workplace programmes. In addition, Namibia was implementing a broad health sector response, incorporating voluntary and routine counselling and testing services, prevention of mother-to-child transmission, diagnosis and treatment of sexually transmitted infections, and safe blood and injection programmes.
Namibia was currently implementing a national coverage and sentinel survey that would give a better understanding of progress towards reaching target populations across all the country's regions, he said. That would enable the identification of areas where progress was slow and where redoubled efforts were needed. That information would also enable the mobilization of further resources for an expanded national response, both from within the country and from additional sources, including the Global Fund and the United States President's Emergency Plan for AIDS Relief. Namibia intended to strengthen integrated community responses, workplace programmes and specific response strategies in regions and for specific target groups where access to a comprehensive service package remained inadequate.
SHEILA TLOU, Minister of Health of Botswana, said, since the first AIDS case in Botswana was diagnosed in 1985, the epidemic had spread rapidly. Prevalence rates had risen more than 30 per cent by the late 1990s. Hospital bed occupancy and mortality rates had also jumped during that period. The President of Botswana had led a national multi-sectoral response and assumed chairmanship of the National AIDS Council. In 1999, Botswana had set up a national programme to prevent mother-to-child transmission of HIV, as part of a larger effort to prevent HIV infection. More than 83 per cent of HIV-positive pregnant women had enrolled in the programme, up from 28 per cent in 2002 and 61 per cent in 2004. Mother-to-child transmission of HIV had dropped from about 40 per cent in 2002 to about 6 per cent in 2006. That, coupled with increased treatment access, meant more children were being saved.
In January 2002, Botswana's authorities had introduced a national antiretroviral programme that offered free treatment to all, she continued. By the end of 2005, more than 50 per cent of patients were receiving treatment, thus exceeding the World Health Organization (WHO)/UNAIDS target for the country of
"3 by 5" [a global target to provide 3 million people living with HIV and AIDS in low- and middle-income countries with life-prolonging antiretroviral treatment by the end of 2005]. To date, approximately 64,000 patients were receiving treatment. Botswana's experience demonstrated that accessible, affordable and effective HIV-treatment programmes created a more favourable environment for HIV prevention. A decline in HIV prevalence among pregnant women, from 37.4 per cent in 2003, to 33.4 per cent in 2005, suggested a levelling off of the epidemic. Still, the high disease burden had directly impacted Botswana's human resources. It was essential to develop a national strategic HIV/AIDS plan with a strong human resources component. Botswana continued to actively involve men and family members of patients, in order to erase the stigma and discrimination that threatened the success of programmes. The high cost of drugs and laboratory tests challenged the nation's budget, she said, stressing the need for innovative strategies to sustain programmes.
PHILIPPE DOUSTE-BLAZY, Minister for Foreign Affairs of France, reading a statement on behalf of President Jacques Chirac, said it was morally reprehensible, politically dangerous and economically absurd that the virus continued to spread, destroying more than 3 million lives a year, in a situation where the vast majority of sufferers were in the South, while medicines remained in the North. It was all the more unacceptable, given the availability of all the means necessary to succeed. Both in the South and the North, Governments and civic society had been mobilized; available financial resources had increased tenfold since 2001; the Global Fund, to which France was the second largest contributor, had become a major force in the fight against the pandemic; and intellectual property rules at the World Trade Organization had been made more flexible to enable access to generic medicines. Yet, of the 40 million people who were HIV-positive, only 1.5 million had the benefit of antiretroviral treatments in countries of the South.
The first priority was to increase resources, which meant increasing official development assistance (ODA), he said, adding that, in 2007, France would raise its contribution to the Global Fund to €300 million. New financing mechanisms must be set up to raise the necessary resources when required, and France, alongside Brazil, Chile and Norway, proposed that the sums raised in that way be allocated to an international drug purchasing facility to complement existing institutions, particularly the Global Fund. A new economic model would, thus, be established, whereby manufacturers would have the visibility necessary to invest in research and new pharmaceutical production capacity, as well as consolidate price reductions. That would ensure that poorer countries had the capacity to access effective treatment for everyone. Another priority was to strengthen coordination between bilateral and multilateral donors to support national strategies. Other priorities included helping countries in the South to strengthen their health services, which was clearly essential to national prevention and treatment efforts, and research, since only a preventive vaccine could really curb the epidemic's progress.
ULLA TØRNÆS, Minister for Development Cooperation of Denmark, said that, since 2001, the international community had made a strong commitment to fight AIDS. But, as evidenced by the Secretary-General's report, there was no room for complacency. The figures showed the complexity of the disease, its multiple impact on families, villages and countries, and how it was fuelled by poverty and inequality. Financing for HIV/AIDS had increased substantially. But the international community was far from the target of $22 billion that was estimated to be needed by 2008. Denmark had exceeded the ODA target of 0.7 per cent and had pledged no less than 0.8 per cent in ODA.
Last year, Denmark had presented a new strategy to support the international fight against HIV/AIDS, and had decided to double the funding for HIV/AIDS activities, enabling Denmark to continue long-term and consistent support to strengthen the capacity of national health systems, which were an essential part of an effective, sustainable response to the HIV/AIDS crisis. Denmark would increase assistance to reach more women and young girls with preventive services, strengthen cooperation with civil society and help more orphans and vulnerable children. However, much more must be done. Denmark was committed to strong national leadership and coordination to ensure a stronger, more coherent and effective response to HIV/AIDS. The commitments made during the World Summit last September to achieve universal access to reproductive health by 2015 through integrated strategies, and to include the fight against HIV/AIDS and other diseases in national poverty reduction strategies, should form the basis of future action. Denmark was ready to do its part in reversing the spread of HIV/AIDS and achieving universal access to prevention, treatment and care.
JEAN-LOUIS SCHILTZ, Minister for Cooperation, Development and Humanitarian Action of Luxembourg, noting the international community's unprecedented response to the General Assembly's 2001 appeal on HIV/AIDS, said that a common declaration should be followed by concrete efforts. The words of 2001 were not a dead letter; lives had been saved and national, regional and international initiatives had multiplied to fight a pandemic, which, unfortunately, continued to spread. Similarly, there had been a noticeable rise in funding levels. But the international community could not rest on its laurels, believing that the progress made would lead to the eradication of HIV/AIDS. The virus continued to spread and take on new faces, especially a female face. It continued to tighten its murderous grip, year after year, and create millions of orphans, especially in Africa.
He said that, if the world wished to see the end of the disease that destroyed more than merely those dying from it, the High-Level Meeting must empower a renewed drive to fight against HIV/AIDS. The international community must devote more funds to the struggle. The financing had increased, as had the quality of aid, which would guarantee the sustainability of interventions. The strengthening of human resources capacity and the intensification of anti-HIV/AIDS activities would be a lever to improve results. Initiatives by the European Union countries had shown the possibility of increasing sustainability, as had been seen in Rwanda, a model that could, perhaps, be replicated in other cases. Ignorance of the risks and the precautions required was the worst aspect of the fight against HIV/AIDS. Everyone, including the private sector and the pharmaceutical industry in particular, must shoulder their responsibility. Self-congratulation was not the purpose of the Meeting, but rather to ensure the knowledge of what to build upon in the future.
MANTO TSHABALALA-MSIMANG, Minister of Health of South Africa, said much progress had been made in implementing prevention, care and treatment programmes that were found to be effective. The scaling up of HIV/AIDS treatment and prevention services, as well as building better partnerships, were essential. It was important to promote healthy lifestyles, maintain optimal health and prolong the progression of HIV infection to the development of AIDS. It was critical to continue to reduce the price of medicines and other essential commodities for an effective response to HIV and AIDS. Innovation and research to create vaccines and microbicide, traditional medicine and other therapies was needed.
South Africa fully supported scaling up towards universal access to HIV and AIDS prevention, treatment, care and support, she stated. Ambitious and realistic targets were important to measure progress in that regard. Such targets should be coupled with indicators and tools for monitoring progress. Targets must be set at the country level, coordinated at the regional level and aggregated at the global level. The epidemiology of HIV and AIDS depended on local socio-economic, cultural and other dynamics. Success in the fight against HIV and AIDS required doubling efforts to meet the Millennium Development Goals. Financial commitments must urgently be honoured, and aid must be aligned to national priorities. The challenges of food insecurity and promoting good nutrition must be addressed. Special focus was also needed to emancipate women and protect the rights of children, particularly girls.
AMAR TOU, Minister for Health, Population and Hospital Reform of Algeria, said that his country, with an infection rate of only 0.07 per cent, was developing a cross-sectoral campaign of information, education and communication. It had also established voluntary detection centres to treat sexually transmittable diseases on a free and confidential basis, and which, in more than 50 centres countrywide, also dealt with other diseases like hepatitis, tuberculosis and syphilis. In addition, infected people were treated in seven referral centres, which ensured good treatment, as well as psychosocial support through the inclusion of civil society in all aspects.
He said that the inclusion of civil society and the creation of the first association of persons living with HIV in the Middle East and North Africa, as well as the inclusion of all sectors, had helped significantly in better dealing with those infected and overcoming cultural questions. Algeria also supported migrants and other vulnerable groups, despite the difficulty of caring for them. However, despite those achievements, the country was still working to guarantee the regular availability of medicines and to sensitize health professionals on how best to make available the proper medicines and care to those in need.
PETE HODGSON, Minister of Health of New Zealand, said five years had passed since the international community had agreed to a comprehensive strategy and formed the Declaration of Commitment on AIDS. Progress in the fight against AIDS had since fallen short. That lack of progress had cost lives and would cost many more. The virus won when a young girl was vulnerable to the sexual advances of an infected adult; when people with the virus were victimized, blamed and banished from their families; when young people did not have access to condoms; and when drug users lacked access to clean needles. The virus also won when women could not exercise control of their sexual and reproductive rights, free from violence; when the existence of transgender people and men having sex with other men was denied; when poverty was not addressed; and when world leaders failed to see HIV/AIDS as a global challenge.
The virus was winning, he said, stressing the need for global leadership to reverse that trend. He lamented that fundamental strategies to beat the pandemic continued to be controversial, and that there had been attempts to renegotiate the 2001 Declaration of Commitment. In the last five years, New Zealand had needed to adapt in the face of unexpected increases in HIV infections. It had done so by forming close working partnerships with the country's most at-risk communities, which included people living with HIV, men having sex with men, and migrant and refugee communities. The developing world was bearing the brunt of the pandemic. Women and young people were disproportionately affected. The disease was reaching epidemic levels in Papua New Guinea, and the Pacific Islands were at very high risk. He called on all States to note that alarming trend. HIV/AIDS was not just a health issue. It was a global development, security and human rights challenge. Action was needed on all fronts.
RITA KIEBER-BECK, Minister of Foreign Affairs of Liechtenstein, said the HIV epidemic was exceptional, because of its scale and the complexity of factors contributing to its spread. The inclusive approach of the current Meeting should set the example for international cooperation and national partnerships in the future. For its part, Liechtenstein had scaled-up the financial resources to assist others in their struggle against the disease. It had used innovative approaches to generate new funds, such as doubling the amounts raised by non-governmental organizations and pooling its contribution to AIDS-related activities of the United Nations Children's Fund (UNICEF) with other small States, to enhance aid effectiveness.
She said Liechtenstein's bilateral assistance efforts, in particular to African countries, stood at $2.2 million, and that the country was committed to maintaining that level of support. Access to education and information about sexual and reproductive health should be widened, while gender inequality and violence against women should be given more focus. More priority should also be given to reducing the impact of AIDS on children.
RONNIE S. SHIKAPWASHA, Minister of Foreign Affairs of Zambia, said AIDS had been declared a national crisis in his country, and that anti-AIDS strategies had been incorporated into the 2006-2010 National Development Plan. Zambia offered optional routine testing for all pregnant mothers; had launched a vaccine trial; and had introduced free antiretroviral therapy services since August 2005, by which 25 per cent of the 200,000 people living with AIDS had already been given treatment. Close attention had also been given to paediatric treatment and prevention of mother-to-child transmission.
He said free basic education, skills training and AIDS prevention programmes had been set up to address the 750,000 orphans living with HIV, of which 6 per cent were living on the streets. Programmes established by civil society organizations had also been created to assist widows who had lost their spouses to HIV/AIDS, as well as children vulnerable to the disease. Some 20 per cent of children in Zambia were projected to be orphaned by AIDS by 2015.
MICHAIL ZURABOV, Minister of Health and Social Development of the Russian Federation, said that joint regional approaches to fight HIV infections had been the main topic of discussion at the first Conference on HIV/AIDS for countries of Eastern Europe and Central Asia (Moscow, May 2006). Within Russia itself, more than $100 million had been allotted to the prevention, diagnosis and treatment of people affected with HIV and viral hepatitis, and that was expected to more than double in 2007. A country coordination committee had also been established to implement projects financed by grants from the Global Fund to Fight AIDS, Tuberculosis and Malaria.
He said measures would soon be taken to negotiate an acceptable price on patented medicines. After being certified as having "good manufacture practices", Russian pharmaceutical companies could begin to produce antiretrovirals at lower cost. Meanwhile, special programmes targeted at drug users, commercial sex workers, migrants and youth were being developed, and a set of "agreed leading principles" as a guiding tool for creating anti-discriminatory legislation to protect all categories of vulnerable people had been proposed.
BÉDOUMA ALAIN YODA, Minister for Health of Burkina Faso, said the results that his country had obtained in five years of implementing the 2001 Declaration were more than encouraging, but still less than had been hoped for. The rate of prevalence had fallen from 4.2 per cent in 2001 to 2.3 per cent in 2004. Similarly, the number of counselling and voluntary testing centres had increased from 10 in 2001 to 93 in 2005, while the number of those tested had risen from 675 in 2002 to 200,000 in 2005.
He said the number of districts operating sites to combat mother-to-child transmission had also risen, as had the number of centres providing monitoring, care and antiretroviral treatment. Since March 2006, 2,000 people were now receiving antiretroviral treatment. But, in spite of those very encouraging results, a number of challenges persisted, as shown in the Secretary-General's report. Burkina Faso had undertaken decisive commitments at the national and continental levels to increase financial support, an objective that would not only be the basis for assessing progress in 2010, but also for determining progress in attaining the Millennium Development Goals by 2015.
SAFET HALILLOVIC, Minister of Civil Affairs of Bosnia and Herzegovina, said his country was one of several with a relatively low prevalence of HIV, and where infection did not exceed 5 per cent of any defined subpopulation. But, the 1992-1995 war had caused the country's human, economic, political, social and health systems to suffer enormous damage, which would encourage further transmission and spreading of HIV infections. For that reason, activities on HIV/AIDS had been intensified in 2000, culminating in the establishment of the United Nations Thematic Group on HIV/AIDS to assist the country in carrying out its long-term goals under the Joint United Nations Programme on HIV/AIDS (UNAIDS).
He said the resulting programme, the Bosnia and Herzegovina Strategy to Prevent and Combat HIV/AIDS, had aimed to prevent the spread and transmission of HIV; ensure adequate treatment for those infected by the virus; create a legal framework for the protection of the human rights of people living with HIV; and to strengthen the country's cooperation with international organizations. The Bosnia and Herzegovina Advisory Board for HIV/AIDS had also proclaimed 2006 the year to fight stigma and discrimination.
ERIK SOLHEIM, Minister of International Development of Norway, said that taboos and prejudices surrounding HIV/AIDS had had a limiting effect on efforts to combat the epidemic, because a discourse that excluded references to sexism, sexual abuse, injecting drug use, prostitution, premarital sex or homosexual relations only served to protect existing power structures, while preventing change.
He said an increasing percentage of the newly infected were women, as a consequence of unequal power relations between the sexes. The young were similarly vulnerable, especially those facing poverty, lack of education and information, stigmatization, marginalization and destructive cultural practices. Also, little had been done internationally to change national discriminating laws against homosexuality, even as HIV continued to spread among men who had sex with men. Some countries still refused to distribute clean needles to drug users, even though it was known that a large number of HIV-infected people were injection drug users. In countries where national law formally protected such vulnerable groups, tradition and cultural practices sometimes contributed to continued discrimination against them. "We must dare to name these practices when we see them, and to condemn them openly," he said.
BERNARD NOTTAGE, Minister for Health and National Insurance of the Bahamas, said that, last September, the commonwealth had been one of the few countries recognized by the Secretary-General as having turned the tide against AIDS. The Bahamas National AIDS Programme had enjoyed significant success, as evidenced by the continued reduction in the prevalence rates of HIV and the successful scaling up of treatment, care and support. That, in turn, had led to a marked reduction in mother-to-child transmissions, from 30 per cent to 1 per cent; the placing of approximately 60 per cent of the initial target population on treatment with antiretroviral drugs; a greater than 50 per cent reduction in the number of AIDS deaths; and a marked decrease in hospital bed occupancy.
It was clear that the road ahead would require continued political will and commitment, and the continued intensification of prevention efforts in tandem with treatment, care and support, he said. It was necessary to commit to ensuring the integration of HIV/AIDS care into primary care and community clinics to assist in facilitating universal access; combating stigma and discrimination, which remained a major obstacle in all countries; and the continued building and retention of human-resource capacity, in order to deliver comprehensive programmes. However, none of that would be possible without the provision of predictable and sustainable financing for low- and middle-income countries.
Afternoon Session: Parallel Segment A
RADOSLAV GAYDARSKI, Minister of Health of Bulgaria, expressed the hope that, through unified efforts, mankind would stop the AIDS epidemic. Bulgaria had proven that there existed strong political will and real commitment to meet global objectives. There should be additional activity in all areas to fight AIDS, including in political will and governmental leadership.
He called for an increase in national financial resources for AIDS response, as well as greater access by the civil sector to financial resources. International donors should continue to support the response to AIDS. He called on Governments to acknowledge the civil sector as an essential partner in implementing programmes and providing real access to vulnerable groups. Services aimed at prevention should be increased. All should work together in an effective manner so that the world might be a better place without AIDS.
YURIY POLYACHENKO, Minister of Health of Ukraine, reading a statement of his country's president, said 2001 had become a turning point in the response to HIV/AIDS. Based on the global plan of action contained in the Declaration, national programmes for prevention, treatment, care and support of the affected people had been elaborated and implemented in Ukraine. As a result of actions taken, there had been substantial progress, particularly in providing access to antiretroviral therapy. Ukraine highly appreciated the cooperation with and assistance from the Global Fund, the World Bank and the United Nations system agencies.
Regardless of all measures taken, he said the epidemiological situation in Ukraine was of great concern. Regrettably, the rate of HIV/AIDS spread in Ukraine remained among the highest in Eastern Europe. Ukraine was committed to the implementation of the United Nations Declaration on HIV/AIDS. The country was determined to act decisively and halt the spread of the epidemic, and looked forward to continued productive cooperation both with the donor community and with the entities of the United Nations system. He expressed the hope that the current political declaration would add new impetus to that process. We should all be aware of our responsibility to other generations.
PILAR MAZZETTI, Minister of Health of Peru, aligning herself with the Rio Group, said that Peru's fight against HIV was rights-based and part of the country's poverty alleviation programme. Those programmes were focused on providing antiretroviral treatment access to all, among other things, as well as incorporating the gender perspective across strategies. Attention had been given to building a social and financial infrastructure to provide broader access to treatment, with multisectoral participation from the Health Ministry, other Ministries and civil society.
Assistance from the Global Fund had enabled the treatment of 4,452 people living with HIV, she said. It was hoped that by September, antiretroviral treatment would be fully covered by the Government, and a publication detailing the process had been released for use by other countries. Working closely with civil society had not been easy, she added, but the Government had been successful in building mutual trust with the assistance of the Global Fund and UNAIDS. Remaining challenges include increasing prevention among vulnerable populations -- indigenous women, men who had sex with men, transsexuals, the transgender community, and children at special risk. Rapid changes in treatments also required the retraining of health workers. New financial and technical modes of assistance were currently being sought to ensure sustainability, as well as to help provide access to low-cost medicines.
NIMAL SIRIPALA DE SILVA, Minister of Health Care and Nutrition of Sri Lanka, said HIV had become a kind of weapon of mass destruction and that, to fight it, it was necessary to employ a wider holistic approach. Biomedical efforts must be supplemented by social and attitudinal changes, including a desire to eliminate the stigma attached to the disease. Sri Lanka's newly elected president had gone public with speaking about HIV, and had given high priority to increasing the awareness of political leadership towards the disease.
Currently, over 45 non-governmental organizations were working actively with the National AIDS Control Programme, in an effort to mobilize civil society fully. Since free health care had always been seen as an important investment in Sri Lanka, antiretroviral medicine would be extended free of charge to all needy persons, with assistance from the World Bank, the United Nations Population Fund (UNFPA), WHO, UNAIDS and other multilateral and bilateral organizations. Ideally, programmes to combat HIV should target women and children as part of a wider reproductive health programme, and that area had been given special attention by the country. In August 2007, Sri Lanka would host the Eighth International Congress on AIDS in Asia and the Pacific, with the theme "Waves of Change -- Waves of Hope".
PONMEK DARALOY, Minister of Public Health of the Lao People's Democratic Republic, said that, with the support of UNAIDS, the WHO and other key stakeholders, his country had developed a new national strategy and action plan for 2006 through 2010 on HIV and AIDS. Its aim was universal access to prevention, care and support for all in need. HIV and AIDS were also included as a priority in the country's national socio-economic development plan, and the Government was actively engaged in the ASEAN Task Force on AIDS. The emphasis of the national strategy and action plan was on the promotion of safer sexual behaviour, especially for the most vulnerable groups. The integration of prevention services into reproductive health programmes; addressing the vulnerability of women, young people and children; and the provision of such services as voluntary counselling and testing and prevention of mother-to-child transmission were among the key strategies. Efforts in that regard were aimed at the provision of adequate, accessible, and affordable supplies of essential sexual and reproductive health-related commodities, diagnostics and drugs.
He said that, last month, a second antiretroviral treatment site had been opened in the capital, and others would follow. He was confident that, with the continued support of external partners and the United Nations system, that the target of treating 100 per cent of adults and children in need would be reached by 2010. Universal prevention and treatment required renewed and substantial efforts at the global, regional and country levels. His country still had a low prevalence of the infection, and much had been achieved in the past five years, but much remained to be done. A country like his would need long-term increased commitment by external development partners to support its response financially, and the support of the Global Fund and the United Nations system was highly appreciated.
JEAN-LOUIS ROBINSON, Minister of Health and Family Planning of Madagascar, said that, in February of this year, his country's first family had initiated a national mobilization campaign to boost HIV voluntary testing. Even now, less than 1 per cent of the population was HIV-positive but the rate had increased 100 per cent since 1987, in part because of socio-economic factors. The response to the pandemic had been on the national agenda since 2002. The reality of HIV/AIDS was being acknowledged, but testing was still hindered by the stigma associated with the disease and by reluctance to discuss prevention issues.
Describing the regional strategy for increasing the testing sites from 56 to 367 in the current year, he said a referral system, counselling, treatment, care and support would be provided when required. Emphasis would also be placed on strengthening the infrastructure of health services in general, intensifying the preventive programme, assuring access to treatment and accelerating the process of development. With continued international support in both financial and technical areas, the HIV/AIDS pandemic and epidemic diseases such as tuberculosis and malaria would be defeated.
LETI PELESALA, Minister of Home Affairs of Tuvalu, said that although his country was a small, independent and isolated island nation with limited resources, it had also been affected by the unfortunate migration of the global epidemic of HIV/AIDS. The situation was especially serious due to the high population mobility that resulted from people seeking overseas employment. Assistance was appreciated, and much had been achieved through that support. Still more assistance was needed to ensure the success of HIV programmes.
The epidemic was also of critical concern when it came to sustainable development, he continued. The global fund was useful, and regional bodies had a role to play in accessing the Fund. The global response to HIV/AIDS must accelerate the provision of financial and technical support to Government and civil society. Since the first high-level meeting, Tuvalu had formulated a development strategy that placed high priority on HIV/AIDS. Tuvalu still needed help implementing that strategy.
He said he appreciated the support from donor partners. The global response and fight against HIV/AIDS was waged not only with money but also with political will and moral values throughout the entire civil structure of society. HIV/AIDS was not a faceless enemy. The battle was between civil society and itself, where the battle line was drawn in the minds of society.
DAVID PARIRENYATWA, Minister of Health and Child Welfare of Zimbabwe, said the Government had established a National AIDS Trust Fund, supported through taxes. The country had recorded a steady decline in the prevalence of HIV, from 35 per cent in the 1990s to the current 20.1 per cent, mainly due to positive behavioural changes.
The Government had also drafted a National Plan of Action for Orphans and Vulnerable Children, and community structures had been put in place to ensure child protection. Faith-based organizations had spearheaded initiatives promoting fidelity and faithfulness, having recognized multi-partnering as a major driver of the epidemic, as the Southern African Development Community (SADC) had also recognized.
He said his Government was committed to meeting targets and had scaled up the programme to provide access to antiretroviral and other relevant drugs. The infrastructure to establish laboratories for the production of further medications was also being put in place. Special measures had been implemented to protect vulnerable members of society, particularly those living with HIV, orphans and other children. Still, regardless of how severe the effects of the HIV/AIDS epidemic were, international support for Zimbabwe's health sector had been withdrawn in protest against a long overdue but justified land reform. But HIV/AIDS knew no political boundaries. The resources to fight the epidemic must be made available to stem the brain drain of health-care professionals, which made the situation even worse.
DOUGLAS SLATER, Minister of Health and the Environment of Saint Vincent and the Grenadines, said his country had been sorely affected by the pandemic. Extensive resources had been invested in efforts to respond appropriately to the myriad challenges posed by the disease, including for treating and controlling it. The allocation of substantial resources to HIV and AIDS, however, came at a time when small developing countries, such as his, were confronting other major development challenges brought about by global events beyond their control, such as "9/11" and other acts of international terrorism. His country's development and standard of living had also been negatively affected by rulings of the World Trade Organization, which threatened to destroy its banana industry and other agricultural exports constituting the major share of the nation's foreign earnings. The vulnerability of other service sectors, such as the tourism industry and the fledgling offshore finance industry, together with the global increase in commodity prices and the decrease in ODA had presented the island with a task of significant magnitude.
Nevertheless, he said, Saint Vincent and the Grenadines had made the issue of HIV and AIDS a top priority. It had continued to develop and implement programmes in response to the pandemic, and now a fully staffed HIV unit was in place, as well as a national AIDS Council. Significant financial resources had also been allocated to the Council, including a World Bank loan to complement finances from other partners, such as the Global Fund. The Government was also committed to working closely with civil society, and believed that the private sector should also be fully engaged. Two years ago, it implemented a programme of treatment free of cost to all persons infected with HIV. That had resulted in a marked decrease in the mortality of infected persons, as well as a significant improvement in their quality of life. The number of new infections remained a concern, however, as well as the issue of stigmatization and discrimination.
MAIGA ZEINA MINT YOUBA, Minister of Health of Mali, said her country's Head of State had not been able to respond to the Secretary-General's invitation to be present. The subject was close to his heart, as the character of HIV/AIDS was such that it could destroy a whole society. In Mali, a national policy had been established to defeat the epidemic with a coordinating mechanism included. Government, civil society and people with AIDS were all involved in setting and implementing policy. Free antiretroviral treatment and other drugs were provided. Empowerment and democratic principles were stressed, along with a strong structural framework and coordination of efforts to respond to needs.
Current efforts focused on decentralizing the responses and putting them into the hands of local entities, he said. Another priority was the transfer of technology for the production of medical and related goods to make them accessible, and more coordination at the regional level was needed. Development partners must also coordinate better to meet needs and to achieve global and regional initiatives towards universal access to needed services. The High-Level Meeting and the Declaration should provide the basis for achieving the objectives set out at the special session.
TEDROS ADHANOM GHEBREYESUS, Minister of Health of Ethiopia, said the multisectoral response to HIV/AIDS since the 2001 Declaration had shown positive development in the three pillars of prevention, treatment and care and support. To intensify prevention efforts, Ethiopia was using an innovative community-based approach, by which 30,000 health extension workers would be trained and deployed to achieve blanket coverage by 2008. Those health extension workers reached out to every household and ensured a localized approach to HIV/AIDS prevention for the communities they served.
He said Ethiopia had made great advances in the area of free treatment, with 34,000 people enrolled in May 2006, and a target set for universal access by 2010. The signing in January 2006 of a Memorandum of Understanding with the Global Fund and the United States President's Emergency Plan for AIDS Relief contributed greatly to accelerating the implementation of major activities. Although encouraging results had been registered, the challenges ahead required greater action than what had been done so far. Ethiopia remained fully committed to achieving universal access by 2010.
TAMSIR MBOWE, Minister of Health of the Gambia, said his Government was fully engaged in responding comprehensively to the pandemic. HIV was the most formidable pathogen to confront modern medicine. Therefore, the response to it had to be focused, concerted, sustained and relentless. Since the 2001 Declaration, the Gambia had scaled up and intensified a comprehensive campaign. It had provided antiretroviral drugs at no cost to people living with AIDS. The Gambia also recently had launched its own Programme of "Acceleration of Prevention".
He said the Gambia was among those few African countries with declining HIV prevalence rates. To maintain that momentum, it put special emphasis on distributing resources through grass-roots organizations. The involvement of people living with HIV/AIDS was an important component in the country's national strategy, and five support groups had been established to fight against stigma and discrimination. People living with AIDS must move from the margin of hopelessness into the centre of courage and positive living. HIV/AIDS could not be contained by working in isolation as members of specific sectors, but by working together as members of a concerted multisectoral force.
He said HIV/AIDS did not recognize geographical or political boundaries. Therefore, Taiwan's exclusions from international health interventions and control networks posed a serious threat both to Taiwan itself and the world community at large. Taiwan should be accorded full and unhindered access to global disease prevention.
FRED SAI, Presidential Adviser on Reproductive Health and HIV/AIDS of Ghana, said the effort against HIV/AIDS was a key component in his country's poverty reduction strategy. Thanks to the Global Fund, as well as health and other development partners, the incidence of HIV/AIDS had declined. Civil society and community-based organizations had also responded remarkably. With stigma and discrimination recognized early, a campaign had been in place to reduce it since 2003, and it was now being scaled up to a sustainable "know your status" and stigma reduction campaign for 2006 to 2010.
Prevention was a major component in the fight against the pandemic, he continued. Initiatives in line with the national policy focused on improving access to care, service points for voluntary counselling and testing, prevention of mother-to-child transmission and antiretroviral therapy. Key challenges were the loss of trained manpower to the more resource-endowed countries, the feminization of the disease and the outreach to those most at risk, including sex workers and displaced persons. Investment in both financial and technological resources should be increased to meet the challenges, including that of nutrition for the infected and affected. Also urgently needed was local-specific social science research assistance to inform strategies and prevention programmes. The outcome of the present meeting would be judged by history, and succeeding generations must not be let down.
NATAENARA KIRATA, Minister of Health of Kiribati, said he spoke also on behalf of the Pacific Island countries to address frustrations. His country was not yet a Member of the United Nations system at the time of the special session but had already benefited from programmes such as the Global Fund and regional initiatives to control the HIV/AIDS epidemic. While national efforts were the most important, there weren't enough resources to fund them, and international support was imperative, particularly since economic challenges and lack of opportunities for young people drove them to be vulnerable to drivers of the HIV/AIDS epidemic. The lack of opportunities must be addressed.
In addition to HIV/AIDS, he said his country had one of the high incidences of tuberculosis. Prevention should remain the focus of a comprehensive response. The High-Level Meeting would hopefully bring a new spirit of commitment to global action on all the urgent issues involved in reversing the pandemic.
JOSETTE BIJOU, Minister of Health of Haiti, said that, despite many constraints, Haiti had successfully implemented the policies to which it had committed itself in the 2001 Declaration. Significant progress had been made in multisector approaches such as justice, women's issues, planning and finance. There had also been tangible progress in prevention and stopping mother-child transmission. Thanks to a significant awareness campaign, a 2005 study showed 95 per cent of Haitians were informed on issues of HIV/AIDS.
She said HIV/AIDS was also a human rights issue. Rape victims and those affected at their workplace must be protected. The health ministry had set up a solidarity fund to facilitate economic and social assistance for people living with HIV/AIDS. It was still too early to evaluate that programme, and resources were too thin on the ground.
She said Haiti was in the process of preparing a national follow-up and evaluation campaign, as well as a strategic plan for 2006-2011. Much still remained to be done. In the future, Haiti hoped to guarantee universal access and provide social justice. She thanked the partners who had left no stone unturned in fighting HIV/AIDS by using a model of partnership, and asked friendly countries to continue their support. On behalf of the incoming President and his future Government, she reiterated Haiti's commitment to build a country free of new HIV infections between now and 2010.
OSCAR FERNANDES, Minister of State of India, said that his country's young, mobile population and the rapid economic and social transformation that it was experiencing added to the complexity of the epidemic. Recognizing the gravity of the problem, the Government had made a strong commitment to reverse further progression of the epidemic. The Prime Minister was leading the efforts by chairing the National Council on AIDS, which consisted of leading representatives from Government and civil society. Local governments at the village level were now being involved as well.
He said prevention was key, and India's strategy focused on expanding access to preventive services. The soundness of that strategy had been vindicated by data showing a stabilization of the epidemic in the State of Tamil Nadu, but it was important not to become complacent. India was close to finalizing a law that aimed to provide extensive protection to women, children and people living with AIDS. Such a rights-based approach was necessary in the struggle against HIV/AIDS.
MORRIS DUKULY, Minister of State for Presidential Affairs and Chief of Staff to the President of Liberia, said the first case of HIV/AIDS had been reported in his country 25 years ago and the prevalence rate had risen from less than 1 per cent in 1986 to 8.2 per cent in 2001. The highest rate of infection occurred among those between 30 and 39 years of age. The highest infection rate was found among females between the ages of 15 and 29. Heterosexual transmission was the most common route of infection.
A national strategic plan had been developed in 2000 and upgraded in 2004, he continued. Now a new results-driven partnership had been instituted that relied on community-oriented participation at every level. Leadership at the national level defined targets, benchmarks and indicators. It coordinated country health teams based on input at the district and community levels. While the Government was fully committed to the effort and its pledge to turn 15 per cent of its annual budget to improving the health sectors, two contributors to the spread of HIV/AIDS must also be addressed: poverty and deprivation. Ignorance, social instability, illiteracy and inaccessible health services were impediments to curbing the spread of HIV/AIDS.
ANNIKA NILSSON, State Secretary for Public Health of Sweden, said silence and denial caused stigma and discrimination, undermining prevention, treatment and care measures. The human rights effort regarding HIV/AIDS was still too weak and fragmented. Compliance with human rights instruments must be strengthened to ensure that relevant policies, laws and regulations were in place.
She said prevention was key, and efforts must be built on evidence. They must be rights-based and must fully recognize the complexity of the challenge. Since poor people were the least equipped to cope with the effects, poverty must also be addressed when considering HIV/AIDS approaches. A comprehensive and sustainable response was a must, as were long-term commitments and predictable financing. Rights must be strengthened and all must be ensured the same opportunities. The meeting today was an opportunity to reinforce the commitment to fighting the pandemic. Those gathered must lead the way by committing more resources on a sustainable basis to the needs already identified, by acknowledging the contributions of civil society actors and by fighting the harmful and prejudiced attitudes in societies.
JOSÉ MENDOZA GRACÉS, Vice-Minister of Health and Social Development of Venezuela, said the world fight against the HIV/AIDS epidemic was emblematic of the social advances and challenges the planet faced and the great contradictions in the approaches that Governments took towards them. Venezuela's region had been unjustly excluded from bodies for international cooperation for fighting HIV/AIDS. That fight would not be successful and sustainable if the general strategy did not include improving the health and quality of life for entire populations, including the most impoverished.
He said women and the poor were most threatened by the expansion of the disease. Giving them real power, by giving them female condoms and microbicides, was a fundamental policy priority. The level of vertical transmission, from mother to child, was zero in Venezuela. Governments must guarantee social justice and human rights for the most vulnerable groups, such as men who have sex with men, lesbians, transgendered people, prisoners, injecting drug users, and male and female sex workers.
When it came to universal access to antiretroviral treatment, he said some would give priority to intellectual property rights over the right to life. Venezuela guaranteed free antiretroviral coverage to anyone, and categorically contested estimates by UNAIDS that only 4 per cent of Venezuela's pregnant women with HIV received antiretroviral therapy. The country's resource production could not be measured by traditional wage-income methodologies.
The world could not continue shirking its responsibilities because 90 per cent of HIV/AIDS cases were in low-income countries, where only one in five people had access to antiretroviral therapies. If the country that most defended the rights of multinational medicine manufacturers couldn't even guarantee universal access to its own people, what sincere cooperation could the poor of the world expect from that nation?
WANG LONGDE, Vice-Minister of Health of China, said that, in the past three years, China had taken a series of comprehensive actions to fight the HIV/AIDS epidemic. By the end of 2005, a working mechanism that featured Government leadership, multisector cooperation and public participation had taken shape. Free antiretroviral treatment, free prevention of mother-to-child transmission, free voluntary counselling and free testing services were widely available. Condom use was promoted, and methadone maintenance programmes and clean needle exchange programmes had been accelerated. Public awareness had greatly improved through media campaigns, and exchange and cooperation with the international community had been markedly strengthened.
He said China was aware that the HIV/AIDS epidemic had not been effectively controlled, and it planned to intensify its work to strengthen prevention and treatment measures. In the future, it planned to establish a prevention and care responsibility system at various levels of Government while incorporating HIV/AIDS control into the local socio-economic development agenda. It would also further popularize and disseminate HIV/AIDS knowledge, protect the rights of people living with HIV/AIDS and fight against social discrimination. China would also provide interventions such as condom promotion and methadone maintenance programmes to high-risk populations. Finally, it would conduct active international cooperation and give full play to the role of non-governmental organizations.
MYA OO, Vice-Minister for Health of Myanmar, said 70 per cent of his country's population of 54 million people was rural. The national HIV/AIDS programme was focused on preventing transmission by bringing about behavioural change and on enhancing the quality of life of those infected. The plan covered six basic areas: advocacy; education; targeted interventions; care and treatment; programme management; and support, including monitoring and supervision, and capacity-building.
Detailing each area, he said the effort to mobilize resources for efforts had improved over the years, but the Global Fund support had been abruptly terminated in August of last year. Activities that had been supported by the Fund would be completely phased out by August of the current year. The Ministry of Health was exploring avenues with other donors and entities such as UNAIDS to see how alternatives could be developed to bring tangible results from the efforts. With a focus on prevention and control, Myanmar would continue its efforts to fight the epidemic within available resources.
BAKHTIYOR NIYOZMATOV, Vice-Minister of Health of Uzbekistan, said that protection of health was one of the priorities of his country, which had the largest population in central Asia. It also had the distinction of having 45 per cent of its population under 18 years of age. That, combined with a largely rural place of residence, required specific approaches to the public health system, though the epidemiological situation had been brought to a stable level in recent years with the partnership of WHO.
He said a large-scale effort was being carried out to prevent an HIV/AIDS epidemic in the country. Second-generation epidemiological centres were being established, and the scientific and technological capacity of regional centres were being strengthened. In addition, post-contact treatment initiatives were being implemented, as well as pre-treatment of opportunistic infections. Finally, packaged social services for those infected were being created.
LIDIETH CARBALLO QUESADA, Vice-Minister of Health of Costa Rica, said the first cases of AIDS in her country had been reported in the early 1980s. The epidemic was considered to be concentrated and of low prevalence. The urban area, particularly the metropolitan area, registered a higher number of cases. The work being done in the country was coordinated across sectors and institutions. Government, civil society and cooperation agencies joined efforts to offer the services needed by persons who lived with HIV, within the framework of the "Three Ones". Since 1997, antiretroviral therapy had been guaranteed to 100 per cent of the population. Efforts were undertaken to provide holistic care to persons with HIV and AIDS and their families.
She said Costa Rica had undertaken innumerable efforts to strengthen education and prevention, with an emphasis on the most vulnerable groups, using a gender perspective, and advocating for holistic sexual and reproductive health. Citizens needed the tools that enabled them to confront discrimination, promote and defend their human rights, and diminish transmission. It was worth noting the impact of migratory flows on HIV/AIDS prevention and treatment, both for countries of origin and destination. Bilateral and multilateral international cooperation was, therefore, a keystone in achieving the goals of universal access to holistic care with equity and solidarity.
NASR EL-SAYED, First Under-Secretary for Preventive and Endemic Affairs, Ministry of Health and Population, Egypt, said 64 per cent of those infected with HIV were from Africa, severely impacting the region's economic growth. But work conducted over the past five years required adequate funding to be successful. It was also important to ensure that medicines were affordable for countries that most strongly felt the disease's ravaging effects.
He said Egypt had endorsed international efforts to fight the pandemic, and had taken steps to establish a hotline for HIV-infected persons and to improve the system of blood transfusions in hospitals. Large-scale media campaigns to raise public awareness of the disease had also been developed; AIDS prevention had been introduced as part of the school curriculum; and antiretroviral treatment was being provided to the needy. Efforts had been undertaken to raise the awareness of young people and increase the role of women in combating the spread of HIV. The number of affected people in Egypt stood at 877 among 25-year-olds. Social practices in the Arab world called for abstinence, and the low rate of infection in Egypt seemed to suggest that it was a good model. A research centre in Cairo had been established to help introduce low-cost, generic medicines to the public.
MAHMOUD FIKRI, Assistant Under-Secretary for Preventive Medicine, Ministry of Health of the United Arab Emirates, said it was necessary to redouble financial resources to poor countries to enable them to implement their strategies to combat the disease. It was necessary to facilitate access to drugs needed to tackle the disease, as well as to promote preventive measures, such as controlling behaviours that contributed to infection.
He said his country had succeeded in maintaining the lowest rate of infection in the world through its national AIDS programme. In fact, no new cases had been recorded in recent years. Contributing actions include increasing screening of blood donors; screening couples planning to marry, as well as prisoners and drug addicts; and instituting laws forbidding behaviours that promoted HIV infection, such as trafficking and drug abuse. Government officials and civil society had been working to raise awareness among young people, and to keep apace with changing developments in the field, and updating national strategies accordingly.
SANDRA ELISABETH ROELOFS, Special Envoy of the President of Georgia, said hers was a high-risk country, due to trafficking and high injecting drug use. Universal access to free, comprehensive treatment was being provided by the Government, including antiretroviral treatment for AIDS patients. Attention was also being paid to prevent mother-to-child transmission.
She said it was not only important to raise funds but to spend them wisely and efficiently. Current programmes to promote health partnerships, such as through the coalitions of women leaders in the Baltic region, had been created to oversee the efficient management of funds. Also, a programme had been developed to target mothers in the most remote areas of Georgia to break taboos on contraception, abortion and sexually transmitted diseases, and to teach those women how to raise health-conscious adolescents. The country's main AIDS coordination body was the Country Coordination Mechanism, whose activities were largely financed by the Global Fund. Its work involved representatives of academic and religious circles.
XIOMARA CASTRO DE ZELAYA, First Lady of Honduras, said her country had established comprehensive health-care coverage for its population, resulting in more health-care centres and laboratories being built, and greater progress being achieved in the country's prevention programmes. Success had been due in part to good working relationships with the international community and civil society. In Honduras, it was common to react "in a scandalized way" to those suffering from the diseases, while ignoring the social and economic inequities that were at its root cause, and efforts were being taken to eliminate such attitudes.
Today, there were more women with HIV than four years ago, which would lead to more children being infected and more communities becoming split. The media was encouraged to abandon its double standards, where prevention and promotion of moral values and a healthy lifestyle existed side by side with messages that converted women into sex objects, for example. Honduras recognized the relationship between the spread of the disease with economic structures and its society's sexual practices, and was working to deconstruct such social structures.
ANNMAREE O'KEEFFE, Australia's Ambassador for HIV/AIDS, said the High-Level Meeting was a critical opportunity to reinvigorate the global response to HIV and AIDS. As many speakers had already noted, that devastating epidemic had now claimed more than 25 million lives, and more than 40 million people were currently living with HIV. Ninety-five per cent of them lived in developing countries. In the Asia Pacific region, HIV and AIDS was spreading rapidly, and by 2010, without vigorous and effective prevention responses, the region could become the new epicentre of the epidemic. Australia was taking the lead in terms of the regional response; its commitment to work alongside its regional partners to prevent the spread of HIV and providing treatment and care for those living with the disease was unprecedented. Australia's own experience in developing a largely successful HIV response had enabled it to share lessons learned with its neighbours.
She said that the foundation of Australia's success had been the close collaboration among affected communities, the people living with HIV and AIDS, all levels of government, and the health and research sector. Adoption of innovative education and prevention initiatives had also contributed. Australia's work in the region now encompassed many different levels of leadership. For example, it had developed the Asia Pacific Leadership Forum on HIV/AIDS and Development. Nevertheless, the challenges faced by small nations to address such a complex problem must not be underestimated. Island States, such as those in the Pacific, were constrained in their ability to scale up comprehensive resources. Australia worked hand-in-hand with its Pacific neighbours to assist them in developing their capacity and commitment to respond to HIV and AIDS and to build leadership in the region. It also developed partnerships with the private sector.
At the same time, her country was extremely concerned about the feminization of the epidemic, and she stressed the importance of ensuring that HIV responses tackled the social, cultural and economic factors that made women and girls vulnerable to the disease. The people who were not infected with HIV, but were at risk of infection, must also not be forgotten. Continuing strong prevention approaches were vital, even as access to treatment was being scaled up.
ROBERT AISI (Papua New Guinea), speaking on behalf of the Pacific Island Forum, said the cost of antiretroviral drugs was a major challenge to achieving universal access. Pacific leaders and strategic partners needed to negotiate for better prices for the drugs and to ensure the long-term sustainability of treatment programmes. While the numbers of those infected were still small in the region, it was better to start implementing measures before the epidemic was out of control.
He said all actors must be involved for a comprehensive strategy against HIV/AIDS to be effective, including non-governmental organizations, the private sector and churches. The HIV/AIDS pandemic had strategically divided many countries into Governments and civil society in opposite camps but both those sides should be focused on fighting the disease as the enemy instead of each other. If there was anything to learn from the epidemic, it was to be strategic, united, anticipative, comprehensive and pre-emptive in approach. The responsibility on those attending today's session should not be taken lightly. "The challenge is not what we can do for ourselves but what we can do for others", he said. The future of humankind was in the hands of those in attendance. The declaration to be adopted should be bold, strategic and realistic.
AHMED MAHDI AL-HADDAD, Assistant Under-Secretary for Political Affairs and International Cooperation of Bahrain, said his country was committed to achieving the goals by 2010. Universal access was a priority but, despite increased efforts over the past year among those of middle and low income, the infection rate was rising even with international assistance. HIV/AIDS had a low prevalence in the country but measures were still being taken, including the screening of blood for transfusions and educating those involved on the realities of the disease.
He said that today, the world had been called together to renew the commitment made during the special session. The cost of measures to address the pandemic through prevention and treatment must be taken into consideration.
ISIKIA SAVUA (Fiji) said that, although HIV/AIDS had been initially perceived as a health issue, it was now increasingly recognized as an issue of development and human rights that affected population segments differently. It was a global emergency that posed one of the most formidable challenges to sustainable development, progress and stability in the world at large. The international community accelerate the reversal of the global pandemic, and there was still a lot to be done. A human rights approach was central. The relationship between migration and HIV/AIDS was complex, and the gender dimension of HIV/AIDS could not be ignored. The interconnectedness of HIV infection and the vulnerability of women due to traditional, cultural and sexual mores must be addressed.
He said HIV/AIDS would continue to be a challenge for the South Pacific region and developing countries like Fiji. While the recorded numbers of those living with HIV/AIDS in the region were relatively small compared to elsewhere in the world, numbers should not be the sole factor in deciding how to distribute assistance. A single patient today could easily lead to a full-blown pandemic tomorrow.
He said the HIV infection trend in Fiji was escalating, and true figures could not be ascertained until compulsory testing was in place. Fiji had made much recent progress in the area of HIV legislation development and distribution of antiretroviral drugs. Funding for those medications came through the Global Fund, however, and Fiji's quota would be exhausted by 2007.
ADAMANTIOS TH. VASSILAKIS (Greece) said his country had, from the very beginning, established programmes for prevention, care, treatment and support. It was fully committed to coordinating its efforts within the European Union, South-Eastern Europe and neighbouring countries, the United Nations and other international partners. The challenge faced was to implement all the targets of the Declaration of commitment and to find new ways to tackle the disease. That could not be the work of one man or one nation. Strong leadership and strong partnerships were the way forward. The principles of "three ones" had been incorporated in Greece's new national HIV/AIDS strategy. The new multisectoral strategy had been developed with the help of civil society and would be open for public consultation.
He said key elements of the strategy were coordination and cooperation in national and international activities with prevention as the cornerstone of the response. One of the main targets was to continue to provide adequate therapy for persons infected with HIV. To maximize the safety of blood transfusions, the use of new technologies on single donations had been implemented. Investments were being made in the improvement of the surveillance system for HIV and sexually transmitted infections. Continuous evaluation of achievements would improve the quality of work. That could only be accomplished through mechanisms for overall monitoring and evaluation of the national HIV/AIDS strategy.
MARY SHAWA, Principal Secretary in the Office of the President and Cabinet of Malawi, said that 1,500 organizations in the country received $47 million in grants to expand action and improve services in combating HIV. A health survey had shown that 85 per cent of Malawians between 15 and 24 years old were able to correctly identify ways of preventing HIV transmission, and that condom use among men with non-regular partners had increased from 39 per cent to 47 per cent. A policy to guarantee equal access to antiretroviral therapy, free of charge in public health facilities and at a subsidized rate at private sector health facilities, had led 50,000 patients to receive treatment in April. A Six-Year Emergency Human Resource Relief Programme for the Health Sector had been established to oversee the training of new health workers, the improvement of wages, and the recruitment of international volunteer doctors.
She said a nationwide programme on prevention of mother-to-child transmission of HIV had also been launched, with services offered at 89 sites throughout the country. Orphan registration at national, district and community levels had been set in place, and investments had been made given to provide them with economic skills and psychosocial support. "Pool funding" for HIV and AIDS, the first of its kind, with contributions from Canada, Norway, the World Bank, the United Kingdom and the Malawi Government, had been established to reduce transactional costs associated with the Government's programmes. But despite all those efforts, there was a great need to scale up HIV and AIDS care, treatment and support -- the national adult HIV prevalence stood at 14 per cent, and mother-to-child transmission of HIV stood at 27 per cent of infants born to infected mothers.
COUMBA BA (Mauritania) said that, in 1988, a programme on HIV and AIDS had been established, and in 2002, her country had adopted a multisectoral policy regarding prevention and treatment. Civil society, the private sector and ministerial departments were conducting awareness campaigns. The role played by religious leaders against the pandemic was enormous, and the country had also contributed to subregional initiatives. One initiative had associated religious leaders, people living with the virus and journalists, aiming to fight against stigmatization of victims of the pandemic.
She said ambulatory treatment centres had been established to improve geographical accessibility, and commitments had been made to fight the enemy that recognized no borders. Her country was convinced that the fight could only be won in a context of a global effort, and the international community and technical and financial partners must redouble efforts to help developing countries. The AIDS virus had declared war, and it was gaining ground, but together "we will be victorious".
AGNES BINAGWAHO (Rwanda) said her country had come a long way since 2001. It had adopted a multidisciplinary, decentralized and community-based approach to HIV and AIDS. Monitoring structures and systems were now in place under an effective coordination by the National AIDS Control Commission (CNLS). Key policies were being implemented, including for antiretroviral therapy, HIV and AIDS in the workplace, and for condoms. A national policy had been drafted in 2005 and was presently in the legislative process. Good relationships had been established with leading international partners.
She said those efforts had begun to bear fruit. The most recent findings on HIV/AIDS prevalence showed an adult prevalence of 3 per cent nationally -- 2.3 per cent male and 3.6 per cent female; 7.3 per cent urban against 2.2 per cent rural. Reports suggested a decline in adult HIV prevalence, although those reports had to be verified. However, challenges remained regarding long-term commitment from partners, creation and retention of health sector professionals and health infrastructure.
SIMON IDOHOU (Benin) said national efforts must be strengthened along with the local initiatives to make sure that young people were protected against HIV/AIDS infection. Regional efforts must help build national capacities, as was the case in his region where networks were being established for building an environment conducive to defeating the disease and for making medicines such as antiretroviral drugs accessible. Sustainability and effective coordination were priorities if the goals set out were to be reached. The special needs of vulnerable populations must be addressed, including those of children and infected mothers. The resources on an international level must be mobilized to support national efforts.
SUSANA RIVERO (Uruguay) said one would have thought that some discussions had been concluded in 2001. Apparently, there were still issues that could not be talked about openly, and that prevented progress. Only a global response would enable the goals set to be achieved. Uruguay had been excluded from resources of the Global Fund because it was a middle-income country -- that was an unfair situation. For developing countries, it was fundamental to have flexibility regarding intellectual property.
She said progress could only be made through a comprehensive approach that included health policies that guaranteed sexual and reproductive rights. It was fundamental in that respect to cooperate with civil society. Prevention programmes should focus on vulnerable groups, including injecting drug users, commercial sex workers and men having sex with men. In her country, civil society was very proactive, cooperating with the Government.
IGOR DZUNDEV (former Yugoslav Republic of Macedonia) said his was a low-prevalence country with the lowest clinical diagnostic rate of incidence in the region, as well as in all of Europe. However, regional trends indicated that there was a potential for increased spread of HIV. A national strategy had been developed with priority interventions focused on prevention through a multisectoral approach and cooperation between Government, local communities, civil society, international organizations, private sector and media. Programmes were geared to vulnerable groups, such as injecting drug users, commercial sex workers, men having sex with men, mobile groups and members of the Roma community. Progress had been made in increasing the engagement of non-governmental sectors.
He said one issue of concern was the price of drugs. The market for antiretroviral drugs in most countries in the region was still modest. That limited demand did not create strong incentives for pharmaceutical companies to ensure registration and negotiate price reductions of the drugs. A different approach was needed. Sustainable and predictable financing, strengthening of monitoring and evaluation mechanisms and using resources efficiently were keys to supporting national programmes. Global and regional solutions offered during the meeting, if implemented, could make a difference. Prevention was the only way to reverse the trend of the pandemic. It meant education, information, training at all levels of society and awareness.
ANDREAS MAVROYIANNIS (Cyprus) said that, while the international community had accomplished much in its efforts to halt the spread of HIV/AIDS, the epidemic continued to defeat the global response. It was now time for bold action, and strong political leadership was essential. The statistics contained in the Secretary-General's report were most alarming, especially those regarding women, young people and children. It was equally concerning that more than 95 per cent of infected people were in developing countries.
He said important progress had been made since 2001, particularly in the areas of greater resources, stronger national policy frameworks and wider access to treatment and prevention. Such developments provided a solid basis for stepping up global response, but much more needed to be done, especially in the fields of sustainable financial resources and prevention. Legal and regulatory barriers to prevention, treatment and care needed to be removed. Human rights, fundamental freedoms and gender equality must be secured and protected.
He said the prevalence of HIV/AIDS in Cyprus remained low, at 0.1 per cent of the population. Since HIV/AIDS first appeared in 1986, the Government had made the issue one of its highest priorities. In order to secure the rights of patients and eliminate stigma and discrimination, legal or regulatory barriers inhibiting access to prevention, treatment, care and support had been removed.
SOMDUTH SOBORUN (Mauritius) said prevention and treatment were two mutually reinforcing components of successful strategies for HIV/AIDS prevention and impact mitigation. Maximum effort must be deployed to protect those who were safe now while continuing to provide maximum treatment for those infected. The ultimate aim should be to reach out to everyone everywhere in a sustained manner so that precious human lives were saved.
He said stigma and discrimination produced damaging effects. A global partnership must be built to shield women and children from any kind of discrimination as a result of infection. Gender issues must be addressed to reduce women's vulnerability, and the human rights of those infected must be safeguarded. Finally, all segments of society must be committed, adequate resources mobilized and a supply of prevention tools disseminated and maintained to achieve behavioural change so as to make the world a better, safer and healthier place to live.
MARCELLO SPATAFORA (Italy) said there was still a long way to go in fighting HIV/AIDS. The starting point was the recognition of the fundamental human rights of people infected and affected, especially women, young people, and children. For any strategy to be effective, a strong commitment to fully funding the response, both by scaling up resources and better utilizing the money invested, was required. If there was a lesson to be learned from the 25-year history of combating the disease, it was that the front line of the battle was to strengthen the health-care system in the hardest-hit countries.
If the goal of universal access by the year 2010 was to be met, the international community needed to establish adequately resourced national action plans. Italy was also paying special attention to the funding of research for the development of new prevention tools, such as vaccines. In the past five years, Italy had invested approximately €400 million to fight the disease. It intended to strengthen its present and future commitments by pursuing the cancellation of the debt of Heavily Indebted Poor Countries, as many had a high prevalence of HIV/AIDS.
He said it was all too commonplace in forums such as the present one to say that, while much had been done, a great deal still remained. It was important not to confront the suffering of the world through platitudes and clichés. It must be ensured that the declaration was followed up by strong, concrete and effective action in the field.
MILAD ATIEH (Syria) said stopping the pandemic was a national and international challenge. The scourge not only killed people but placed a heavy burden on the shoulders of the world. Effective measures had to be adopted in the sectors of awareness and behavioural change. Also, access to treatment had to be facilitated, and the necessary financial resources had to be mobilized.
He said Syria had made the fight against the epidemic a priority, despite the fact that the number of infections was limited in his country. A national plan had been established that included a prevention strategy, development of evaluation services, and prevention of mother-child transmissions. Programmes were being developed for free treatment, awareness improvement, especially among young people, and voluntary testing. The humanitarian rights of the sick should be taken into account. Syria also strove to help refugees who had left their land because of foreign occupation. His country was trying to guarantee appropriate financing for national programmes, but wanted to benefit from international support.
BAN KI-MOON, Minister for Foreign Affairs and Trade of the Republic of Korea, said HIV/AIDS was not only an unprecedented health challenge but a profound threat to prospects for poverty reduction, childhood survival and economic development. The steps to combat HIV/AIDS had already been set out in the Declaration. Now, concerted action and increased resources were needed for the effort. Prevention was key. While the prevalence rate in his country was low, worldwide the rate of new infections had risen by nearly 20 per cent in the past three years.
He said there was increasing scientific confidence that a safe and effective HIV vaccine could be developed. The search for that vaccine and for a treatment cure should be stepped up as efforts were redoubled to make treatment drugs available. Close cooperation with the private sector and generous contributions were critical in that regard. It was heart-wrenching to see already poverty-stricken countries staggering under the burden of HIV/AIDS cases.
His country would make a $10 million contribution to the Global Fund for the 2007-2009 term, he announced. That was in memory of the late Dr. Lee Jong-wook who had so ably led WHO in the fight against HIV/AIDS and other diseases.
AHMED OWN (Libya) said that, in 2001, world leaders had drawn attention to the seriousness of the pandemic and, since then, some progress had been achieved. The current meeting paved the way for realizing the goals envisioned in the 2001 Declaration.
He said his country had confronted the scourge through prevention and educational programmes. It had also helped other countries in Africa, in particular in sub-Saharan Africa. Every member of the international community should bear their responsibilities to combat the scourge, especially developed countries. Numerous measures were required to meet the financing needs through increasing international and domestic spending. Human resources policies must be adopted to respond to the disease. Obstacles in pricing and trade for medications and other items related to AIDS must be eliminated. Pharmaceutical companies and international donors must develop partnerships for developing new drugs. Factors that contributed to the pandemic, such as poverty and social exclusion, should also be addressed.
MOHAMED LATHEEF (Maldives) said much had been achieved since the 2001 special session. Proper planning, sustained resources and effective implementation of prevention programmes had yielded proven positive results; however, much still needed to be done.
Since the first case of HIV/AIDS had been detected in the Maldives in 1991, he said, a total of 11 cases had been confirmed. Although that number was relatively small, the potential threat looming over the country could not be overemphasized. The population had become increasingly mobile, while dependence on a floating migrant worker population had grown. Combined with a large circulation of tourists, that created an unprecedented level of vulnerability. Other factors contributing to fears of an epidemic included the high rate of divorce and remarriage, high unemployment among youth, the rise in drug and substance abuse among young people, and the 2004 tsunami, all of which could create a fertile environment which would further enhance the country's vulnerability.
He said it was absolutely essential for all to demonstrate full political will, and commit adequate resources to achieve the HIV/AIDS targets. The active involvement of civil society and private sector stakeholders, such as the pharmaceutical industry and large multinational corporations, was a prerequisite to fighting the epidemic in a meaningful manner.
ERASMO LARA-PEÑA (Dominican Republic) said that since 2001, his country had mobilized a considerable amount of financial, scientific and human resources to address the problem of HIV and AIDS and to build a strong and comprehensive national response. The Presidential AIDS Council had adopted the "three ones" strategy, and the participation of non-governmental organizations was being strengthened. Strategic alliances between public service organizations, community-based organizations and faith-based organizations were being created.
He said that his country, recognizing the feminization of HIV and AIDS, emphasized the protection of women and children by promoting citizenship status, gender equality, equal opportunity and the empowerment of women. As HIV did not recognize social barriers and national borders, a bilateral strategy with Haiti was being developed. In order to scale up technical and financial sustainability of prevention and comprehensive care, measures were being developed to include the costs in the spending application of the national budget. He recognized in that regard the assistance the international community offered. Measures were also being developed to reduce stigma and discrimination against people living with HIV.
CARDINAL JAVIER LOZANO BARRAGAN, President of the Pontifical Council for Health Pastoral Care of the Holy See, said Pope Benedict XVI was deeply concerned about the spread of the illness. Since the beginning, the Catholic Church had offered its contribution in the fight against HIV/AIDS on the medical, social and spiritual levels. In fact, 26.7 per cent of the centres that treated people with HIV/AIDS in the world were Catholic-based.
He said major programmes for training were addressed to health-care professionals, priests, religious, youth, families, and to sick people themselves. In prevention, the Holy See insisted on formation and education towards proper behaviour, so as to avoid the pandemic. It found that, in the field of education and formation, the contributions of the family proved to be extremely helpful. It fought the stigma and facilitated testing, counselling and reconciliation while providing antiretrovirals. It was also helping with the social reintegration of people living with HIV and collaborating with Governments and other institutions, both on the civil and ecumenical levels.
SHIMELIS ADUGNA, Vice-President, International Federation of Red Cross and Red Crescent Societies (IFRC), said that over the last five years, the Federation had, among other things: formed partnerships with people living with HIV; created the Masambo fund to provide antiretroviral treatment to staff and volunteers; scaled up harm reduction work including needle exchange; and campaigned in 128 countries against HIV-related stigma and discrimination. He hoped Governments and others would pay attention to the crucial part volunteers played in complementing the formal health sector, even in the most developed countries. The Federation had developed eight training modules to prepare home-based care volunteers for their role in antiretroviral treatment support.
He said Governments should ensure that "Round 6" of the global fund would be fully funded, and that the Fund would be able to maintain its commitments. Governments should also help develop and implement accountability mechanisms for all. Accountability in the non-governmental organization response could be supported through financial commitments to a phase two of the Code of Good Practice for non-governmental organizations responding to HIV. Accountability could also be greatly enhanced if those making commitments measured their own results. Governments should further consider funding the development and maintenance of Red Cross/Red Crescent volunteer networks in each country when they were engaged in government HIV-related activities.
FERNANDO M. VALENZUELA, European Commission, speaking on behalf of the European Community, said that in order to ensure the implementation of its commitments, the European Commission continued to mobilize and allocate resources to confront HIV/AIDS. In the period 2003-2006, the Commission had allocated an overall amount of more than €1 billion -- an almost fourfold increase over the period 1994-2002. A significant part of the European Community funding was channelled through the Global Fund. Together with European Union member States, the Commission provided 65 per cent of the total financing to that Fund.
He said the Commission was particularly concerned about the feminization of the epidemic. Women and children should, therefore, be at the focus of renewed international responses to HIV/AIDS. The Commission worked in close collaboration with a great number of non-governmental organizations, private foundations and other civil society organizations, including associations of people living with HIV. Focus in addressing the issue must be on: affordability of new drugs; research on preventive technology; and awareness in order to stop complacency.
Afternoon Session: Parallel Segment B
MOHAMMAD NASIR KHAN, Minister of Health of Pakistan, said HIV/AIDS had emerged as the single most formidable challenge to public health, human rights and development in the new millennium. Despite the significant increase in the global commitments to control the pandemic in recent years, the virus continued to spread with alarming speed. At the end of 2005, some 40 million people worldwide were living with HIV infection or disease, a notable rise from the 35 million infected with HIV in 2001. Since the signing of the Declaration of Commitment, more than 20 million people had become infected with HIV worldwide, including 3 million infants, who contracted HIV during gestation or as a result of breastfeeding.
Since HIV/AIDS cut across all socio-economic groups, its transmission followed paths created by economic, social, political and gender inequalities, which included, but were not limited to, poor access to diagnosis and treatment of sexually transmitted infections. In South Asia, the epidemic had become a major public health threat. Considering the social construct of society and economic disparities in the region, control and prevention should go beyond biomedical interventions only. That warranted broader, comprehensive and inclusive policies and programmes, involving all stakeholders. Despite relatively lower prevalence, the epidemic was a growing concern for Pakistan, where some 75,000 people were living with HIV/AIDS. Pakistan recognized the importance of a comprehensive policy framework that must seek to protect and promote all human rights.
Stressing the need to formulate effective policies to respond to the epidemic, he said there was a sense of urgency to expand the scope of services of HIV/AIDS prevention and care. The challenge of HIV could be met more effectively only by considering it an integral component of overall human-development policies, plans and programmes. Many of the ambitious targets of the Declaration could not be implemented at the national level until supplemented by a strong commitment from the international community in providing sustained and predictable support. One of the crucial factors in that regard was access to antiretroviral drugs, which must be available at affordable cost.
There was a long way to go to realize the goal of halting the spread of HIV/AIDS and reverse the tide by 2015, he concluded. Realization of that goal would require, among other things, strong political commitment and action by the national and global leadership, more allocation of funds for research and development, and active civil society engagement. Above all, peace and development remained imperative to combating the crisis of HIV/AIDS.
TRIOPHODIE NKURUNZIZA, Minister at the Presidency in Charge of AIDS of Burundi, said that her country was close to completing its five-year national HIV plan. The country's struggle against AIDS was based on the awareness of the fact that it was a national problem, with some 6 per cent of the population infected. Decentralized and multisectoral structures, chaired by the President of the country, were involved in national efforts. One single plan, single coordinating authority and single monitoring assessment system were being implemented. Significant progress had been achieved in the areas of prevention, care and support. High-risk conduct was being reduced through the provision of information to the people. More screening and prenatal centres were being established. With support from international partners, there had been an increase in the number of people receiving antiretroviral therapy.
Orphans and vulnerable people were being identified and provided with support, she continued. The country was also making efforts to address the stigma associated with AIDS. Despite the extent of the challenge, the Government was firmly resolved to stop the spread of AIDS. The country knew it could rely on support from the international community, including the United Nations.
ULLA SCHMIDT, Minister for Health of Germany, said respect for human rights played a pivotal role in the prevention and treatment of HIV/AIDS. She was staggered that stigmatisation and discrimination were continuously obscuring people's access to prevention and treatment in many parts of the world. Nobody, neither drug users, nor men having sex with men, nor female sex workers, must be ostracized. "It should be in our own interest to stand up for the protection and the support of human rights. This is the only ground on which a successful AIDS policy will have sustainable growth," she said.
The world could no longer ignore sexual violence against women, their suppression and exploitation or violation of their fundamental human rights, she continued. The higher vulnerability of women and girls had to be met with improved opportunities for education, strengthening of their social and economic status and functioning health services. Germany supported about 50 partner countries in their efforts to combat HIV/AIDS, including overcoming existing deficits within their health care systems.
She said the prevention of new infections should remain the mainstay in combating the pandemic in the long run. Germany stressed the need for consistent implementation of the so-called "three ones" principle. The rapid operationalizaton of the Global Fund had been a resounding success. The international community needed to act with determination, so that young people in all countries could grow up to be healthy. To ensure that, education was indispensable, and social and cultural obstacles needed to be overcome. She was deeply convinced that young people would handle their sexuality with a strong awareness of their personal responsibility, if they were given factual and comprehensive information.
PEHIN DATO PADUKA HAJI SUYOI BIN HAJI OSMAN, Minister of Health of Brunei Darussalam, said that, despite the commendable achievements attained since 2001, more remained to be done. It appeared that prevention strategies had not been fully focused on tackling the epidemic. That had resulted in a rise in infection rates, with over 4.9 million new infections in 2005 alone. He, therefore, strongly supported the Secretary-General's call for a renewed emphasis on HIV prevention. He was also pleased to note that a plan had been launched in January 2004 to expand collaboration between national tuberculosis and HIV/AIDS programmes. Such a collaboration could deliver effective, comprehensive care and prevention at the community level, and help in reaching the "3 by 5" target.
While Asia had been identified as one of the regions with a high concentration of HIV/AIDS, he continued, his country had been categorized as a low-prevalence country. Sociological and religious factors contributed to those low numbers. The Government was also playing an active role. In particular, it had adopted the principle of ensuring universal and equitable access to better and comprehensive health-care services. That was reflected in the provision of free treatment and counselling for citizens of the country and permanent residents who suffered from HIV/AIDS.
Political will was growing globally, with an increase in new financial resources to support the global response, as well as knowledge to combat the epidemic, he said. The pharmaceutical industry had lowered the price of antiretroviral drugs for low-income countries. However, despite all those commitments, inequalities in financial distribution and access to prevention, care, support and treatment still persisted globally. Prevention, care, treatment and support could, and must, be made available to all who needed them. That was achievable if all countries, regions and organizations gave their full support to the Declaration of Commitment on HIV/AIDS. Obstacles and barriers to the success of those programmes must be overcome for the international community to move forward and achieve its targets. The pivotal role of regional and international cooperation needed to be further enhanced. Experiences and lessons learnt also needed to be shared to enrich each other's efforts.
JOHN RAHAEL, Minister of Health of Trinidad and Tobago, said a National AIDS Coordination Committee within the Office of the Prime Minister had been launched in 2004 to manage the country's five-year HIV/AIDS Strategic Plan. It was a multisectoral body, comprising civil society, persons living with HIV, youth groups, faith-based organizations, development organizations, the private sector and key Government ministries. Some successes included a reduction of AIDS mortality by 60 per cent, as well as the incidence of AIDS cases going down by 48 per cent and HIV cases down by 16 per cent from peak levels.
He said a sustained and comprehensive response to HIV was critical for the country's economic and social development. As such, Trinidad and Tobago was committed to legislative and social reform to combat stigma and discrimination against those infected with HIV and those vulnerable to the disease. In addition, access to treatment would be expanded country-wide, attention would be paid to improving the sexual and reproductive health of young women, and persons living with HIV would be encouraged to participate meaningfully in the cause.
MAKSIM CIKULI, Minister for Health of Albania, stressed the need to adapt prevention programmes to real-life settings, and to ensure Government responsibility, as well as the involvement of the most vulnerable in developing them. Health systems must increase data collection and improve its quality. That could not happen without an adequate number of trained personnel and good monitoring systems. There was also a need to invest in developing and adapting the infrastructure of prevention programmes, and increasing human resources, education and information campaigns, and specific community programmes.
He said that major changes in deeply entrenched behaviours could be effected through targeted strategies. All services and interventions should ensure full access to effective prevention commodities, which remained a challenge. It was also necessary to eliminate barriers to the use of sexual and reproductive services, which could only be achieved through a structural and multisectoral approach, underlining the importance of fully respecting sexual and reproductive rights in the context of HIV prevention. Instead of prosecuting drug users, they must be provided with services and programmes aimed at addressing their addiction. Figures from Albania showed that policies and laws that respected the health and human rights of drug users and provided harm-reduction programmes at the community level were indispensable in stopping the epidemic.
EYITAYO LAMBO, Minister of Health of Nigeria, said that his country strongly stood by the African common position on the need to take immediate action to ensure universal access to HIV/AIDS, tuberculosis and malaria services by 2010. His Government had carried out a massive nationwide advocacy and public awareness campaign involving major stakeholders, which had led to a change in the sexual behaviour of men and youth. There was a greater demand for condoms and men were increasingly reducing the number of their sex partners. There had been a significant reduction in the number of people afflicted with the disease, from
5.8 per cent in 2001 to 4.4 per cent in 2005. Appropriate legislation was being enacted, which would make stigmatization of and discrimination against people living with the virus an offence. It would also ensure access to social services and employment on a non-discriminatory basis.
Coordinating efforts at the national level was the National Action Committee on AIDS, he continued. The Government was incorporating participation by a wide range of stakeholders, including state and local governments, the networks of people living with HIV/AIDS, civil society groups and faith-based organizations. A percentage of the proceeds from the debt relief extended to Nigeria by the Paris Club had been set aside for efforts to combat HIV/AIDS. Nigeria had far exceeded the modest target of treatment of 10,000 adults, which it had set for itself following the 2001 special session. Over 70,000 adults and 1,500 children had been placed on free antiretroviral therapy, with a plan to scale up treatment to 250,000 by the end of this year.
In spite of the many successes recorded globally since 2001, substantial obstacles remained, he said, including the lack of human and institutional capacity. It was necessary to collectively and resolutely respond to the many challenges posed by HIV/AIDS in a comprehensive manner, including through the development of new partnerships and strengthening national health systems. In the area of prevention and cure, the international community must continue to devote funds for research and development of medicines and vaccines and microbicides. He was convinced that it was not beyond the capacity of the present generation to find a cure. He called on the international community, particularly the donors, to strengthen its partnership with Africa, by providing continuous predictable support to the Global Fund and by increasing technical and financial assistance to African countries.
GUNDALAI LAMJAV, Minister of Health of Mongolia, said a radio and television campaign had recently been launched to raise awareness about the importance of voluntary counselling and testing, as well as to promote 100 per cent condom use among sex workers. A national seminar would be held in June on how to achieve the "three ones" principle in combating the disease, and an international conference on HIV/AIDS among low-prevalence countries would be held in Mongolia later in the year. However, further support from international organizations and donor countries would be needed to help Mongolia reach its HIV/AIDS goals.
He said Mongolia had only 21 known cases of AIDS, with 5 cases being reported between 1992 and 2004, and 16 cases reported in the last two years. "This is an alarming trend for a country of only 2.5 million people," he said.
JOSÉE VERNER, Minister of International Cooperation, La Francophonie and Official Languages of Canada, noted that, at the 2005 World Summit, the international community had committed to develop and implement a package of HIV prevention, care and treatment, and was committed to working with all partners to make rapid progress toward the goal of "universal access". To meet that challenge, it was necessary to build on and scale up access to male and female condoms, information and education, including comprehensive sex education. It was equally important that research and development into new and more effective tools for HIV prevention, care and treatment continue, such as AIDS vaccines, female-controlled prevention methods, such as microbicides, and the development of treatment formulas for children.
Canada was committed to playing a leading role in the global response to HIV/AIDS and in ensuring that it was comprehensive, integrated and based on human rights, sound knowledge and public health evidence. That included its recent contribution of some $250 million to support the Global Fund. Additional support included $100 million to the WHO/UNAIDS "3 by 5" initiative. Canada was also making progress in meeting the targets set forth in the Declaration of Commitment and was working to ensure its efforts addressed the specific needs of those most vulnerable to HIV infection. She was pleased to inform the Assembly that Canada would be hosting, this August, the sixteenth International AIDS Conference, in Toronto. Everyone had made strong commitments to end the horrible pandemic. It was time to deliver on them.
URBAIN OLANGUENA AWONO, Minister for Public Health of Cameroon, said his Government had encouraged the use of condoms, particularly among young people and those at risk. Young people and women had been flocking to mobile monitoring and testing centres, which Cameroon wished to establish throughout the national territory and make available to the entire population. The country was also focusing on district centres. There had been a drop in the cost of antiretroviral drugs and testing, and the Government was trying to provide free treatment for children under the age of 15 years and those suffering from tuberculosis and other infectious diseases.
Overall, Cameroon's responses had improved, but there were still a number of challenges, he said. The country needed more resources to improve the quality of prevention and treatment services, while providing care for those who needed it. Stigma and discrimination must be overcome and the role of civil society must be recognized. All those challenges must be taken up courageously and boldly. While Cameroon enjoyed support from the Global Fund, it needed additional financing in order to ensure that resources were available to deal with the crisis. More research must be done, and Africa must invest in that regard to defeat the scourge, which had existed for more than 25 years with no cure in sight.
SIV FRIDLEIFSDOTTIR, Minister for Health and Social Security of Iceland, expressed deep concern over the overall expansion of the epidemic, especially among young women, as well as the increasing number of children affected and orphaned by HIV/AIDS. To address that problem, it was necessary to increase the possibilities for women and adolescent girls to protect themselves. That must be done not only through the provision of health care and reproductive health programmes, but also through prevention education and the promotion of gender equality. To accomplish that, Iceland had engaged civil society, including people living with HIV/AIDS. And, in order to assist other parts of the world, Iceland had contributed to the Global Fund, the "3 by 5" initiative, the Icelandic Red Cross and the International Federation of Red Cross and Red Crescent Societies.
Iceland had adopted legislation on compulsory licensing, to make it possible to help those in need of affordable medicine, she said. Legislation, policies, education and public awareness campaigns were needed, in order to eliminate the stigma and discrimination associated with HIV/AIDS. The human rights of those living with the disease must be protected and promoted. It was essential to ensure that women, children and people belonging to vulnerable groups were centrally involved in all aspects of HIV/AIDS responses. It was also necessary to increase efforts to provide sustainable antiretroviral treatment. The tide could be turned in the battle against HIV/AIDS through the combined efforts of all nations.
HORACE DALLEY, Minister of Health of Jamaica, said the United Nations had achieved much in alerting the world to the pandemic. Indeed, the United Nations system had achieved much, but much was left to be done. The Global Fund must be financed and the developed countries must put more into the fight against HIV/AIDS. Stigma and discrimination needed to stop. As the Assembly prepared the final political declaration, it must commit itself to the tasks ahead. Jamaica was fully committed to the ideas put forward by civil society to ensure that the international community moved forward in the struggle against HIV/AIDS.
DIEGO PALACIO BETANCOURT, Minister of Social Protection of Colombia, noted that, since 2001, Colombia had moved forward in achieving the goals set out in the Declaration. As an essential step, the country was in the process of improving the monitoring and evaluation of HIV/AIDS programmes, in order to develop a more reliable and precise set of indicators. The development and implementation of the Sexual and Reproductive Health Policy was a key element of Colombia's response. The country had addressed the links between sexual violence, teen pregnancy, maternal mortality and HIV within health services. Gender inequality, poverty and the social marginalization of vulnerable populations had a negative effect on sexual and reproductive health indicators, including those that dealt with HIV/AIDS.
In the area of prevention, Colombia had, with the support of the European Economic Community and UNAIDS, consolidated the component aimed at reducing the transmission of HIV from mother to child, he said. His country had worked intensively to reduce the vulnerability of teenagers in municipalities affected by forced displacement. It was necessary to emphasize prevention for vulnerable populations that had been affected the most by HIV, such as men who had sexual relations with men, sex workers and those deprived of their freedom. Only through focusing efforts where the epidemic was concentrated would it be possible to stop the advance of HIV/AIDS and prevent its spread to wider sectors of the population. The complexity of the work at hand required greater donor support. Only by stopping the poverty-sickness-poverty cycle would Colombia and other countries be able to avoid a generalized epidemic. The challenges and complexities posed by the AIDS pandemic meant that the international community needed to work together in a more coordinated fashion.
JULIO FRENK MORA, Minister for Health of Mexico, said his country had adopted a three-pillar strategy in the fight against HIV/AIDS: an emphasis on prevention; universal access to medical care for people living with HIV; and combating stigma and discrimination. From the very onset of the epidemic, the Mexican Government had adopted evidence-based and scientific measures, including a ban on the selling of blood, and the promotion of condom use. That early response had been instrumental in eliminating transmission through blood transfusions and had significantly reduced the incidence of perinatal transmission. Indeed, the epidemic in Mexico had been kept at one of the lowest levels in Latin America and the Caribbean. However, it was concentrated within specific population groups where the incidence was high.
He said that, in order to confront that challenge, the Government had intensified preventive measures targeted at young people, men who had sex with other men, intravenous drug users, men and women engaged in commercial sex and migrants. Those actions were carried out mainly through civil society organizations. In the area of medical care, Mexico was undertaking comprehensive structural reform to provide universal coverage under a new People's Health Insurance scheme, covering groups excluded from the traditional social security system. Thanks to the increase in public investment in health, resulting from reforms, Mexico had achieved, since 2003, universal access to comprehensive medical treatment for people living with HIV/AIDS and their families, including high-quality drugs. The concentration of the disease among certain groups meant that aggressive strategies must be developed to combat stigma and discrimination. Mexico now had a legal framework for eliminating all forms of discrimination based on the health status or sexual orientation of individuals.
DAMIAN GREAVES, Minister for Health, Human Services, Family Affairs and Gender Relations of Saint Lucia, said his Government was committed to reversing the spread of HIV/AIDS. The Government was dedicated to the development and implementation of a comprehensive and integrated package of prevention, treatment, care and support programmes. The process involved the participation of a wide range of stakeholders, including civil society organizations and persons living with HIV/AIDS. HIV prevention and treatment must be given top priority. It would be impossible to provide antiretroviral therapy to all who needed it, if HIV prevention failed and new infections continued to increase, year after year.
The movement towards universal access must be supported by a social movement, he added. Five critical points must be addressed to realize the goal of universal access by 2010, including sustainable, predictable and guaranteed long-term funding. Human-resource capacity was absolutely critical for small resource-constrained countries, such as Saint Lucia, not only in health services, but also in social services. Availability and access to medicines and diagnostics needed to be accelerated to reach all who needed them, in the shortest time possible. Concerted efforts were needed to discuss and resolve the issues around generics versus patents, within the context of fundamental and basic human rights. Concerted effort was also needed against the drivers of the epidemic, namely stigma and discrimination. Sustained leadership and political support from all levels and walks of life was also critical to tackle the epidemic.
ALICE LAMOU, Minister in Charge of HIV/AIDS and Orphans of Gabon, said that, since the adoption of the Declaration of Commitment, her country had undertaken several actions, the most important of which had been the establishment, in 2002, of a national fund that had made it possible to treat, free of charge, 6,000 people living with HIV. The Government had also included in the budget a supplementary fund devoted to the free treatment of opportunistic infections related to HIV, and built a pharmaceutical factory to manufacture generic medicines. In addition to many awareness-raising campaigns, confidential, voluntary screening centres had been made available, as had services aimed at preventing mother-to-child transmissions.
She said that the Government, aiming to realize universal access to anti-AIDS services, had developed, in cooperation with specialized United Nations agencies, civil society, people living with HIV, and the private sector, a very broad programme of action, based on national surveys of prevalence; the improvement of monitoring systems; a study of the impact of the epidemic at the national level; and aligning national anti-AIDS actions with the Millennium Development Goals. However, with an 8.1 per cent prevalence rate in a population of 1.4 million, Gabon still needed additional resources to combat HIV/AIDS.
OBAMA NVE, Minister of Health of Equatorial Guinea, said his Government had undertaken many activities to address the HIV/AIDS pandemic, including the adoption of a strategic framework to combat AIDS, the establishment of a national council and the mobilization of national and international resources. With the implementation of such initiatives, AIDS was no longer taboo in society. Much remained to be done, however, to create awareness of the disease. A law protecting the rights of affected persons with HIV/AIDS had entered into force in May 2005. Some 10 per cent of people living with HIV had been receiving antiretroviral therapy. The Government hoped to extend treatment units throughout the country.
Equatorial Guinea was committed to working with the international community to fight the scourge of HIV/AIDS, as international cooperation was the best way to fight the disease, he said. He called on the international community to share the many excellent strategies to fight HIV/AIDS, to reduce the effects of the pandemic in countries such as his. He expressed appreciation to the Global Fund for the projects it had financed in his country, and reaffirmed the Government's interest and support in their implementation. He hoped the international community would continue to support Equatorial Guinea, as it sought to fight the main health issues facing its health sector.
ANN DAVID-ANTOINE, Minister for Health of Grenada, said her country had enacted the "three ones" principle, which had established a National HIV/AIDS Programme incorporating an Infectious Diseases Control Unit to manage the treatment, care and support of those infected and their family members. The World Bank had granted Grenada assistance through a loan scheme for the implementation of activities in the National HIV/AIDS Strategic Plan. In 2003, Grenada had benefited from the William J. Clinton Foundation negotiations, which had resulted in a reduction in the costs of antiretroviral therapy for the countries of the Organization of the Eastern Caribbean States.
She said that, since the diagnosis of the first case 22 years ago, Grenada had enhanced its programmes in the treatment of HIV and, to date, the cumulative number of people diagnosed stood at 293; 202 had developed AIDS; and 162 had died. Those figures might seem insignificant in relation to the scope of the pandemic throughout the world, but given Grenada's size (133 square miles) and population (approximately 100,000), they did not diminish its vulnerability to the effects of the disease. Grenada continued to develop new strategies to keep HIV/AIDS under control. Everything humanly and scientifically possible would be done to that end, with the help of local, regional and international partners.
GALO CHIRIBOGA, Minister of Labour of Ecuador, said his country's national policy on health guaranteed universal access to health services and non-discrimination. The fact that HIV/AIDS had increased in his country in the last few years was a source of concern. Ecuador cooperated with the Global Fund and had introduced, since 2002, antiretroviral therapy. The fight against HIV/AIDS required major cooperation at the international level, as well as stronger national efforts. Ecuador was fully committed to an integral response in confronting the epidemic. The last few years had not been easy. While the country had problems, it also had the will to overcome them. The Ecuadorean Government had established a ministry to promote a strategic national plan in line with regional agreements.
He said it was also necessary to improve the laws that protected people living with HIV/AIDS. Ecuador was committed to a multisectoral approach to the fight against HIV/AIDS in different Government sectors. Increasing the budget for national AIDS programmes would require not only technical and economic external cooperation, but also solid political will. Access to medication was fundamental. Intellectual property rights should not be considered more important than the right to health and the right to life. The declaration to be adopted today should go beyond the 2001 Declaration. States must demonstrate the political will to implement it.
BALAJI SADASIVAN, Senior Minister of State for Health and Information, Communications and the Arts of Singapore, said that the local epidemic in his country was but a small component of the global pandemic. The prevalence of the disease in Singapore was still low, at 0.1-0.2 per cent, but each year, the country was seeing increasing numbers of patients who were newly diagnosed with HIV/AIDS. With rapid globalization, increased travel and a new generation of young people approaching sexual maturity, it was essential to continue devoting attention and resources to prevention and control of the disease through a broad and inclusive approach.
Prevention education was the cornerstone of Singapore's control programme, he continued. Health education was targeted at the general population and tailored for specific high-risk groups, such as sex workers and men who had sex with men. Education programmes were also directed at teenagers and young people as another vulnerable group. Among the country's other initiatives, he listed an intensified voluntary antenatal HIV screening programme and efforts to reduce stigma and discrimination through education of the community and health-care workers.
Regarding HIV/AIDS in the workplace, he said that it made business sense for companies to become actively involved in the fight against AIDS. Last year, an AIDS Business Alliance had been set up in Singapore to champion HIV/AIDS education for workers and advocate for a supportive and non-discriminatory working environment for HIV-infected workers. Together with the Alliance, the Government had also launched an educational programme called "RESPECT", or Rallying Employers to Support the Prevention, Education and Control of STI/HIV/AIDS. Control measures would not work unless people engaged in frank, open discussions about the disease and sexual behaviours. That had traditionally been difficult for his country, as a conservative Asian society, but it would continue towards that goal.
JOSEPH ATHERLEY, Minister of State of Barbados, said that his country had launched a national AIDS programme, which focused on a sensitization campaign, widespread provision of antiretroviral therapy, psychological support services, research and strengthened multisectoral partnerships at all levels. He also emphasized the country's commitment to prevention, treatment, care and support programmes for not only vulnerable and marginalized groups, but for the general population as a whole. In that connection, he stressed the need for a broad spectrum of resources, including facilities, current information, skilled professionals, adequate financing and the elimination of barriers to access.
Although much attention was being placed on the "second wave" countries in Asia, the Caribbean region remained second only to sub-Saharan Africa in terms of prevalence, he said. Barbados had been able to break the proverbial "back" of the epidemic as it related to treatment. Since the opening of its state-of-the-art antiretroviral treatment facility in 2002, it had reduced the mortality rate among persons living with HIV/AIDS by more than 50 per cent. Unfortunately, Barbados could not make a similar boast in the area of prevention. Multi-partnering, inconsistent condom use and early sexual initiation were making prevention efforts difficult. There was, therefore, an urgent need for targeted communication campaigns.
TERTTU SAVOLAINEN, State Secretary of Health of Finland, urged the international community to put a renewed emphasis on HIV prevention. It should take into account gender equality and human rights, and make extra efforts to reach vulnerable groups. The principles and practices of the UNAIDS policy paper "Intensifying HIV Prevention" should be put into everyday use. It was not acceptable to deny those in need of any prevention tools that had been shown to work. Male and female condoms should not just be offered as the last option, but made acceptable and easy to obtain.
She also addressed the need to fight the increasing feminization of the epidemic through empowerment of women and investment in girls and women's education, and improvement of their health and social and legal status. Women must be aware of their human and sexual rights. Regarding the users of injected drugs, she said that they often did not have sustained access to clean and safe injection equipment or to antiretroviral treatment and care. That must change, not only because a failure to do so fuelled the epidemic, but because it was the right thing to do. Finland now exchanged more than 1.8 million needles and syringes annually. Combined with universal access to all treatment and care, that policy had a clear and measurable effect on the situation in the country.
Urging the international community to work together to reach the targets of comprehensive access to HIV/AIDS prevention, treatment and care throughout the world, she said that access was not an option -- it was a human right.
CARMEN PIGNATELLI, Deputy Minister for Health of Portugal, aligning herself with the European Union, acknowledged that, since the 2001 special session, much of the targets for 2005 remained unmet in her country. Monitoring and evaluating progress posed an undeniable challenge, in spite of the remarkable role played by former President Jorge Sampaio in keeping HIV/AIDS on the national and international political agendas. Portugal saw in his appointment as United Nations Special Envoy for the fight against tuberculosis a sign of the clear recognition of his commitment. Stigma and discrimination remained serious obstacles to HIV protection. Responses were insufficiently grounded in the promotion and protection of human rights.
She said that Portugal, with one of the highest incidences of HIV/AIDS in Europe, had taken some important political measures to reverse the rate of new infections among intravenous drug users and to address other issues affecting the most vulnerable. The Government had established a national syringe exchange programme, the automatic approval of new antiretroviral medicines, the scaling up of substitution programmes, the decriminalization of drug consumption and the provision of access to health-care services for both legal and illegal immigrants. The Government had recently appointed a group of experts to address public health concerns in prisons. Also, evidence had shown that special attention to women's health and rights was the cornerstone of achieving the highest attainable standard of health. That had led to a reduction of mother-to-child transmission to almost undetectable levels, including in the country's large migrant community.
ALEXANDER BELONOG, Vice-Minister of Healthcare, Chief State Health Inspector of the Ministry of Health of Kazakhstan, said that equal partnership between developed and developing countries, international and local non-governmental organizations, as well as the involvement of civil society constituted key elements of the successful strategy against AIDS. The "three ones" principle should form the basis of future policies and programmes. Full realization of the targets set out in the Declaration on HIV/AIDS and the attainment of the Millennium Development Goals in the set timeframe largely depended on strong leadership, political understanding of the problem and sustainable financing of HIV/AIDS programmes and projects.
Turning to Kazakhstan's national efforts, he said that an inter-departmental commission on HIV/AIDS had been established in the country, which also engaged international and non-governmental organizations. The country had been implementing a national programme to combat HIV/AIDS and was improving its legislative framework in that regard. Among other things, work was under way to deliver substitution therapy to drug addicts. Prevention and raising public awareness, especially among the most vulnerable groups, were at the centre of efforts. Fighting stigma and discrimination, respect for human rights, provision of medical care, including treatment of AIDS-related diseases, social protection of people living with HIV and their full participation in social and productive life remained priority targets. The country was interested in further cooperation with UNAIDS, the Global Fund, UNFPA, UNICEF and other parts of the United Nations system.
ANDRZEJ WOJTYŁA, Under Secretary of State, Ministry of Health of Poland, aligning himself with the European Union, said that, this year, his country, which had a population of 38 million, had registered its 10,000th case of HIV infection. It was estimated that 20,000 more people were unknowingly living with the virus. The country's health system guaranteed a continuity of both preventive actions and antiretroviral therapy. Since 1996, a multisectoral anti-HIV/AIDS programme had been run and coordinated by the National AIDS Centre, a government structure under the auspices of the Ministry of Health. Non-governmental organizations and associations of people living with HIV/AIDS played a substantial part in extending and further developing that programme.
The Polish national policy on HIV/AIDS, based on the principles of human dignity and respect for human rights, provided a better quality of life for people living with HIV/AIDS, as well as a higher awareness of the issue, he said. Antiretroviral therapy had been administered since 1996 and all patients with medical prescriptions, including those who were incarcerated and intravenous drug users, had free access to the therapy. Since 2001, the number of patients on therapy had increased by 100 per cent, and 2,700 people now received it. Over the past five years, the financing of antiretroviral therapy under the Ministry's budget amounted to €100 million. Thanks to the strict implementation of measures to prevent mother-to-child transmissions, the percentage of transmissions had decreased fortyfold since 1989, and was now less than 1 per cent.
RANO ABDURAKHMANOVA, Head of the Health Department of the Executive office of the President of Tajikistan, said the High-Level Meeting provided an opportunity to map out the international community's future route in the fight against HIV/AIDS. HIV/AIDS was being used like other threats to inflict fear and terror. She was disturbed at the rate, at which the disease was spreading in her country. Over the last three years, the disease had spread at a rate six times greater than during previous periods. The main reasons for that increase included drug abuse, inadequate information and inadequate access to HIV prevention, particularly among vulnerable groups of the population.
Since the adoption of the Declaration in 2001, Tajikistan had had some success in its HIV/AIDS programme, she said. It had developed a national strategic plan for 2003-2005 and had begun work on a plan that would cover the period up to 2010. The plan would be based on providing better access to prevention, treatment, care and support. AIDS was not just a medical problem, but a social one, which could only be solved through increased political will. In that regard, she stressed the need to ensure gender equality, increase literacy and respect cultural values.
HUSSEIN BIN MOHAMMED AL-ATTAS, Deputy Minister of Health of Saudi Arabia, said that HIV/AIDS had interfered with human development and was a threat to human life and well-being. Governments must exercise their responsibility to fight the pandemic at the national level, while donors exerted their responsibility at the international level, especially with regard to low-income countries. Everybody must be involved in combating the disease. The United Nations must ensure that developing countries were able to wage national campaigns to stamp out HIV/AIDS.
He said that his country respected human rights and worked with the public sector in combating HIV/AIDS. The Government attached special importance to supporting the health sector and had established many hospitals and health centres in developing countries. It also supported the Global Fund and had contributed $10 million to it, most recently in September last year. It would offer an additional $10 million to the Global Fund, to be made in different tranches.
JOSE VIEIRA DIAS VAN-DUNEM, Vice-Minister for Health of Angola said HIV/AIDS was a problem that affected all humanity and one that required greater international effort and accountability. For that reason, today's meeting constituted a singular opportunity to evaluate the commitments contained in the 2001 Declaration. He commended the commitment of UNAIDS and the African Union, especially in the area of technical cooperation. The creation of the Global Fund had been a significant step in reducing mortality rates and overcoming the barriers imposed by poverty and social inequalities.
He said the evolution of the AIDS pandemic required an urgent, multisectoral response. In that connection, in 2003, the Government had initiated a national strategic plan for 2003-2008, starting with the implementation of a programme to cut vertical transmission and allow HIV-positive mothers to give birth to healthy children. In 2004, a national treatment centre had been created and, in 2005, the National Institute for the Fight against AIDS had been created, boosting the expansion of treatment with antiretroviral medicine to 11 of the 18 provinces in the country. While joint HIV programmes had improved health-care coverage to vulnerable populations, the response was still just beginning. In that regard, he appealed to the pharmaceutical industry to reduce the prices of antiretroviral medicine, including new formulas, in order to reach universal access by 2010.
WILFRED MACHAGE, Assistant Minister for Health of Kenya, said HIV/AIDS continued to be a major concern, with 12 million adults and 100,000 children living with it. Of those, 72,000 (30 per cent) were on antiretroviral therapy. Kenya continued to face problems of funding, shortage of workers, inadequate health infrastructure, stigma and high poverty levels, which hindered the realization of universal access. The Government had taken the fight against HIV/AIDS seriously, due to its devastating social, economic and development impact. Its efforts had been relatively successful.
He said that, in spite of the progress made, Kenya still faced enormous challenges in the fight against the scourge, notably financing for the scaling up of HIV/AIDS responses; human resources, as responses required a critical mass of qualified health workers; affordable commodities and low-cost technologies; and human rights, stigma and gender equity. Among the areas requiring urgent follow-up were sustainability of HIV/AIDS funding, which was critical; financial support for fighting HIV and AIDS, which should be in the form of grants rather than loans; and the need of Kenya and other low- and middle-income countries for debt relief without conditionality.
CIHANSER EREL, Deputy Under-Secretary of the Ministry of Health of Turkey, said that, despite being a low-prevalence country, Turkey was fully cognizant of its high percentage of young and vulnerable people, as well as existing stigma in its society. The country had been implementing policies to mitigate the negative impacts of HIV/AIDS and to scale up efforts towards ensuring universal access to prevention and treatment. Moreover, it was making sure that people living with AIDS had equal rights with other sick people in Turkey. National measures included the creation of the National AIDS Commission, the adoption of the national action plan, and such important programmes as the HIV/AIDS Prevention and Support Project, which was funded by the Global Fund. Within its limited resources, the country was also committed to providing financial assistance to the most affected countries and relevant international organizations.
While important responsibilities fell upon national Governments, Turkey strongly believed that the international community must act together and increase its efforts to ensure effective cooperation and coordination at the global level. In that context, the country was urgently addressing the increasing feminization of the epidemic, through empowerment of women and measures to ensure gender equality. It was necessary to ensure the involvement of all stakeholders in national responses, and to find ways to ensure the sustainability of financing for scaled-up AIDS responses.
WENDY DE BERGER, First Lady of Guatemala, said her country was progressing steadily on the road to universal access to HIV/AIDS treatment. Guatemala had made major progress and had improved access to testing and treatment for pregnant women. Quite recently, Guatemala, with the aid of international partners, had doubled the number of women receiving antiretroviral treatment through the country's social security and public health systems. Those commitments had been backed by greater financial resources. Indeed, the Government had multiplied its budget on AIDS fourfold since 2002.
Underlining Guatemala's efforts in the fight against HIV/AIDS were two programmes, including a comprehensive national strategic plan on AIDS for the period from 2006 to 2010, she added. Developed through a participatory process, the plan sought to ensure the coherence of efforts in Guatemala, so that the money it spent was truly effective. While Guatemala was far better prepared to meet the challenge of HIV/AIDS today, considerable challenges remained. Guatemala was a society of great diversity and enormous contrast. No segment of the population, however, had been spared from the spread of AIDS. New ways were needed to overcome inequality. The peace accords signed 10 years ago had ended four decades of conflict. The same effort was needed in the fight against HIV/AIDS. AIDS must not be allowed to undermine the promise of peace.
ELADIO LOIZAGA (Paraguay), aligning himself with the Rio Group, said that, in spite of his country's prevention efforts, the HIV/AIDS crisis, which had initially been considered as a low-level priority, had now grown to assume intermediate-level priority. Paraguay stressed prevention through communications strategies to ensure non-risky behaviour among young people, particularly those outside the education system. The prevention of perinatal infection was an absolute priority. The Government was trying various responses to ensure the prevention of mother-to-child transmissions, which took a large proportion of the national budget. However, national resources were not sufficient to support such an effort.
He said that, even before undertaking its commitment under the 2001 Declaration, Paraguay had helped hundreds of people living with HIV/AIDS, but it still required external assistance and support. The country was committed to promoting the human rights of those living with HIV/AIDS and was currently engaged in discussing reform of its national legislative framework, in order to ensure that the laws complied with international standards, in terms of ensuring that human rights were respected, and in terms of reducing vulnerability to HIV/AIDS.
NAFSIAH MBOI, Special Envoy of the Coordinating Minister for People's Welfare of Indonesia, said that reading the Secretary-General's report on the progress in the response to the global epidemic since 2001, she had been struck by some similarities between Indonesia's experience and the global situation. As in the rest of the world, the face of the epidemic was diverse across her large, multi-island nation. While up to 80 per cent of new infections in Indonesia were related to injecting drug use, sexual transmission continued to be a major cause of infection in some areas. As with the global epidemic, HIV had first appeared among men, but, over time, the percentage among women had grown. Since the earliest days, the response to the epidemic in her country had been at the ministerial level, under the guidance of the National AIDS Commission. Leadership, management and coordination at the local level had been in the hands of local commissions.
The country's national strategy emphasized the importance of the values of family welfare and religion in combating the spread of HIV, she said. It also provided strong support for a public health approach to HIV, including condom promotion and harm-reduction strategies for injecting drug users. Needle and syringe exchanges and methadone maintenance therapy were among the country's initiatives. A 2003 memorandum of understanding between the AIDS Commission and the national Narcotics Board had been a milestone in overcoming legal obstacles to the implementation of harm-reduction efforts. Since 2004, the Government had fully subsidized all treatments for AIDS, including antiretroviral therapy. Treatment had reached some 5,000 people thus far. Other efforts included training of hospital personnel and increased budget allocations.
MOHAMMED KEZAALA (Uganda) stressed the critical need for committed leadership and civil society partnership in ending the scourge of HIV/AIDS. Africa had been hit hardest by the pandemic. It was also least endowed in terms of resources to deal with the scourge. Africa required urgent international support to help it overcome the numerous challenges it faced in terms of prevention, care, treatment and support. Uganda was committed to tackling HIV/AIDS at the national, regional and local levels. While HIV had devastated communities the world over, significant progress had also been made in fighting the pandemic. The number of new infections was, however, unacceptably high. It was clear that Uganda would not be able to sustain the provision of antiretrovirals at current rates.
Stressing the need to respond to the crisis, including by finding an AIDS vaccine, he said Uganda, with continued international support, would continue in its quest to find a solution to the pandemic. Citing recent progress, he noted that Uganda had surpassed its "3 by 5" target. By the end of 2005, more than 67,000 people were on antiretroviral therapy in accredited treatment sites across the country, with around 1,000 new patients being enrolled in such programmes each month.
JACQUES MARTIN (Switzerland) said that only a rights-based approach would ensure the achievement of concrete and lasting results in eliminating the ostracism and discrimination experienced by people infected and affected by HIV/AIDS, including both male and female sex workers, male homosexuals, and drug users. Only an approach of that kind would protect women and children, boys and girls, against exploitation, violence, abuse and the denial of their property and inheritance rights, and of their fundamental right to education. A rights-based approach must also guarantee access to prevention, health care and antiretroviral drugs for all who needed them, including refugees and displaced persons. In particular, respect for sexual and reproductive health rights was an essential condition for ensuring effective prevention, which was guaranteed only if every person had fair and unrestricted access to services and means of protecting their sexual and reproductive rights, particularly to condoms.
In Switzerland, it had been noted that messages about prevention appeared to be losing some of their effect, he said. That was particularly evident among young homosexual men, among whom the number of new infections was on the rise again. Now that the prospect of a rapid and inevitable death had receded, thanks to the advent of antiretroviral treatments, an attitude of complacency had emerged. An appropriate and targeted information campaign should aim at correcting the impression that "AIDS is after all not all that bad". To ensure that people engaging in risky behaviour protected themselves properly, it was vital to introduce preventive measures that made a real contribution to minimizing those risks. Switzerland welcomed United Nations efforts to take up the challenges of combating AIDS.
AKSOLTAN ATAEVA (Turkmenistan) said that, although her country had a low level of HIV/AIDS prevalence, it had evaluated the present-day regional and global situations regarding the spread of the infection and its consequences. Measures at the national level included the adoption of the national law on the prevention of diseases caused by HIV, which was the main tool for combating HIV/AIDS in cooperation with international organizations and foundations.
The new national programme for the period from 2005 to 2010 took into consideration national identity, ethical norms and national values, as well as accumulated international experience. Among other things, it provided for enhancement of prevention, especially among young people, provision of prophylactics, access to voluntary and confidential counselling and testing, early treatment of sexually transmitted diseases and protection of reproductive health of the family.
DANIELE D. BODINI (San Marino) said that HIV/AIDS had been spreading like wildfire in many countries and continents. It was quite appalling that, in 2006, despite the vast resources employed and success in discovering new powerful medicines, the HIV/AIDS pandemic had grown to the point of decimating entire generations and creating social collapse, especially in developing countries. Some 2,000 children were getting infected every day, and if the international community did not fight that scourge with a global alliance, AIDS orphans would amount to 100 million in 2010. It was necessary to reach the goals stated in the 2001 Declaration and in the Millennium Declaration.
The disease, prevalent among the most productive portions of the population, created major economic chaos in developing countries, and especially in sub-Saharan Africa, he continued. The idea of making the impact of HIV/AIDS a core indicator for poverty was a very sensible one, because the two were deeply interrelated. All countries must act fast to remove barriers in pricing tariffs, trade, regulatory policy, procurement and supply chain management, research and development of anti-HIV medicine. The more accessible the diagnosis and treatment, the less deadly the disease. Among the preventive measures, he listed education and information as very powerful weapons. "We must act on the young generation and promote information and the use of condoms, we must be able to count on mass media to disseminate information, and we must create youth-friendly infrastructures to provide assistance and support," he said.
For its part, San Marino had been very active at the national level, with educational and preventive measures in the school system, he added. Its national health system provided free treatment to all infected people. The country had always been very sensitive to the global size of the problem. In fact, together with Andorra, Liechtenstein and Monaco, it had decided to participate in a UNICEF initiative called "Unite for Children, Unite against AIDS". Those countries had jointly financed a programme to fight mother-to-child transmission and educational activities on AIDS in Africa. The work done by UNICEF and UNAIDS was of vital importance, to say the least, and it should be supported, encouraged and expanded.
IFTEKHAR AHMED CHOWDHURY (Bangladesh) said his country had developed a national policy for the prevention and control of HIV/AIDS and sexually transmitted diseases in 1997, which was bolstered by 2001 legislation on safe blood transfusion. Meanwhile, a work plan to implement a regional strategy was developed at an expert group meeting in April. Success was shown through the low rates of HIV infection in 2005, which stood at 658 out of 140 million people. Of those infected, 134 cases had turned to AIDS, resulting in 74 deaths.
He said that, although Bangladesh was a low prevalence-rate country, it was vulnerable to a HIV/AIDS epidemic, due to the high prevalence of HIV in neighbouring countries, increased population movement through migration, and lack of adequate awareness of the general population about the disease. Significant support from development partners would be essential to strengthen the technical and logistic capacity of stakeholders to stem the potential wave of the disease, and the international community was urged to provide long-term predictable resources towards that end.
MARIA DE FÁTIMA LIMA DA VEIGA (Cape Verde) said that, during the last two days of discussion, the issue of ownership and partnership had emerged as essential to strategies to counter HIV/AIDS. The fight against AIDS was at the centre of Cape Verde's national strategic agenda. Prevention was a top priority in Cape Verde's 2002-2006 programme to combat the epidemic, as was close cooperation between public institutions and civil society. That multisectoral approach had produced positive results, including better access to antiretroviral drugs and paediatric antiretroviral formulas; wider use of condoms, including female condoms; and better human rights protections under the new Penal Code for people living with HIV/AIDS, including injecting drug users, sex workers, youth and prisoners. Her Government was devising new strategies to target vulnerable groups, and would rely on ongoing bilateral and multilateral support from the public and private sectors to close funding gaps for HIV/AIDS prevention, treatment, care and support.
In November, Cape Verde would host a South-South conference on capacity-building for HIV/AIDS programmes, she said. While welcoming international initiatives to improve access to financing for HIV/AIDS treatment, she advocated for simplified procedures and improved management of resources. Innovative treatment methods were needed to improve the living conditions of people infected with the disease. She applauded the political declaration drafted during the past two days for addressing the need for international guarantees to reduce the risk of HIV/AIDS transmission and to give people access to affordable drugs. She also welcomed the launch earlier in the day of the International Facility to purchase medicines.
JOHAN VERBEKE (Belgium) emphasized the importance of the prevention of mother-to-child transmission, access to paediatric medicines and testing, prevention among young people, and the need to take care of children who were victims of HIV/AIDS or who were affected by the social consequences of the pandemic. Belgium insisted on the need to improve prevention. Without a non-discriminatory prevention and detection policy based on respect for human rights, no treatment or care could be effective, as had been stressed by the European Union last December.
He said that prevention implied universal access for women, men, young people, male and female sex workers, men who had sex with men, drug users and, in particular, people infected with HIV/AIDS, to a full scope of information and services regarding reproductive health. It also implied delivering accessible and integrated services regarding the promotion of sexual and reproductive health, as well as continuation of medical research, in order to develop microbicides and vaccines. It was also necessary to ensure reliable access to essential commodities in the field of sexual and reproductive health, drug use and treatment. Among other things, that meant access to substitution therapies and clean needles for drug users. Also important was security for all children, as well as protection against violence, rape, unwanted pregnancies and sexually transmitted diseases. It was necessary to promote voluntary testing, promote good practices in workplaces and ensure blood safety, particularly in medical circles. When needed, action should be taken to combat gender-based violence and to protect and support its victims.
CAROLINE ZIADE (Lebanon) said her country was currently undergoing an economic crisis that hindered its ability to achieve many of its future targets, including on HIV/AIDS. National resources remained inadequate, making external support necessary. Unfortunately, as a high middle-income country, Lebanon was not eligible for support from the Global Fund.
However, UNAIDS and its inter-country teams had been working actively to assist the region to build the capacity of their national AIDS programmes, especially in awareness-raising and prevention activities. Information technology had also been used to build strong networks between Lebanese non-governmental organizations and those from neighbouring countries, with the help of UNAIDS. Continued funding through the UNAIDS infrastructure was desirable, if not essential, to ensure lasting success of the country's HIV and AIDS strategies.
MIHNEA MOTOC (Romania) said the number of registered cases of HIV infections in his country in 2005 stood at 7,623, of which 465 were children. Overall, Romania had the largest number of people living with HIV/AIDS in Central and Eastern Europe. A comprehensive and evidence-based prevention and reduction strategy was currently being embarked on, with support from the Global Fund, and antiretroviral treatment was being provided free of charge, resulting in 6,400 persons being treated. Some 63,494 pregnant women were given HIV testing.
He said that, while there had been some notable accomplishments in Romania's fight against the disease, more could be done. The corporate world could be a key component in responding to HIV/AIDS relief, and partnerships that had been reinforced over the past few days could be put to use in mobilizing additional resources and know-how.
VSEVOLOD GRIGORE (Republic of Moldova) outlined the situation in his country, saying that the alarming trends that the Secretary-General referred to in his report were visible in small countries, like the Republic of Moldova. In the past five years, the spread of the epidemic in his country had been characterized by geographical expansion, in particular in urban areas and among people of productive age. It was difficult to imagine what the situation would have been, not only in his country, but in the whole world, had the Declaration on HIV/AIDS not been adopted. Guided by that document, his Government had placed the fight against HIV/AIDS among its priorities. Adopted this year, the new national plan of prevention and control of HIV/AIDS and tuberculosis had launched a number of programmes for reducing the spread of the infection and minimizing its effects on society.
He added that, for the past five years, his country had benefited from international support, which amounted to almost $17 million, mostly in the form of subventions. He expressed his Government's deep gratitude for the support and assistance provided to it, and reiterated its dedication to the responsible use of resources. According to the experts from the World Bank, his country's programme for the prevention of HIV/AIDS and other infectious diseases was among the best in the region.
RICARDO ALBERTO ARIAS (Panama) said that his Government was deeply concerned by the expansion and feminization of the disease. It was through the concerted efforts of the whole society that the advance of HIV/AIDS could be stopped. The country's efforts had resulted in a reduction of HIV-related deaths. Free universal treatment for pregnant women was among Panama's priorities. National programmes were being implemented with the help of international organizations.
The country was determined to continue with the implementation of the 2001 Declaration, he continued. That required firm leadership and commitment. Continued implementation of the national multisectoral plan involved all institutions of the State, so that all persons who needed it would have access to treatment. Preventive measures among the vulnerable groups were very important. A system of monitoring the public health sector was being implemented. The national response to HIV/AIDS was also part of the national efforts to overcome poverty. Stable financing, strengthening of human resources, protection of human rights and accountability to society were of great importance.
COLLIN BECK (Solomon Islands) said the bulk of his country's population was young and sexually active. Malaria, a preventable disease, was the country's number one killer. The Government's 2003-2006 National Multi-Sectoral Strategic Plan aimed to reverse the scourge of HIV/AIDS and other sexually-transmitted diseases. However, Government resources for implementing the plan were limited. Only through domestic and international partnerships, involving all stakeholders, could a real difference be made. HIV/AIDS placed a special burden on countries already under stress, particularly countries like the Solomon Islands that were recovering from conflict situations. A new approach was needed to halt the spread of infection and fill gaps already identified. HIV/AIDS must be treated globally and holistically, in a fair and equitable manner. The Pacific and Asian region was home to two thirds of the world's 1 billion poor, but it lacked sufficient attention from the wider international community, creating weak links in the global fight against HIV/AIDS.
The international community must accord HIV/AIDS the same attention given to other security threats, he continued, noting that more people died from the disease than from wars. HIV/AIDS prevention must be addressed from a development perspective, tackling poverty head on. The fight must be more coherent and coordinated, and with more timely, predictable financing. More flexible financing was needed for small island developing States to tap into the Global Fund. The recent Pacific regional HIV/AIDS proposal was prepared at a cost of $350,000, only to be rejected. By some estimates, 40 per cent of all new HIV/AIDS cases would appear in small island developing States, if nothing was done. He pleaded to the international community to invest in people and avoid paying a high cost in treating a preventable problem by matching commitments with resources.
YASHAR ALIYEV (Azerbaijan) said that his Government had undertaken specific measures to address the prevention, treatment and monitoring of the disease through a national strategic plan for 2002-2006. The Global Fund to Fight AIDS, Tuberculosis and Malaria had granted $6 million to facilitate the implementation of the plan, which involved scaling up prevention programmes for the most vulnerable groups; strengthening treatment, care and support for those affected; and using a multisectoral approach to strengthen the institutional capacity of the country. However, some gaps still remained. Refugees and internally displaced persons faced particular difficulties, due to low living standards and inadequate access to health-care services, which increased their vulnerability to the disease. In that regard, the Government placed particular emphasis on prevention and awareness raising, particularly among women, young people and people migrating from countries with high incidence of HIV/AIDS. Addressing social taboos and stigmatization was among the priorities.
Ensuring wide and equal access to treatment was an important element of the country's policy to address the pandemic, he said. That required action to reduce prices of medications and technologies. That was also an element of a regional meeting on HIV/AIDS for the member States of the Commonwealth of Independent States (CIS), recently hosted by Azerbaijan. The full and active involvement of civil society was a key element in ensuring an effective response. Continued dialogue with non-governmental organizations, religious and community leaders, groups at risk and organizations of people living with HIV were of great importance. Eliminating stigma and discrimination was of paramount importance, and he believed international organizations could play a more active role in assisting countries in their efforts to overcome challenges arising from persisting discriminatory stereotypes.
MARGARET MENSAH WILLIAMS, Vice-President of the Inter-Parliamentary Union (IPU) Executive Committee and Deputy Chairperson of the National Council of Namibia, said parliaments wielded much influence and were a force for change in many different ways. They debated and adopted the national budgets that provided the funds for AIDS prevention and control. Parliamentarians also had advocacy powers, and could scrutinize Government spending and demand explanations when results were not satisfactory. They also played a role in mobilizing their constituencies, including those affected by HIV, to participate in the policy-making process.
She said a landmark resolution was adopted at the IPU Assembly in Manila last spring on the role of parliament in advocating and enforcing the observance of human rights in strategies for dealing with the pandemic. Building on that resolution, the IPU had organized panel debates on children and AIDS and other vibrant discussions with parliamentarians that were committed to carrying forward AIDS-related work, both nationally and internationally.
ROBERT SHAFER, Observer of the Sovereign Military Order of Malta, said slowing the spread of HIV/AIDS was inextricably tied to larger development issues, including the Millennium Development Goals of reducing poverty, hunger and childhood mortality. Effective and efficient methods of prevention and treatment must be available. Mother-to-child transmission of HIV/AIDS accounted for 90 per cent of new infections in children under 15 years of age. Malta sought to end such transmission by providing access to screening, prenatal therapies and treatments. Malta had set up medical and palliative care programmes in Argentina, Mexico, Kenya, Angola, South Africa, the Democratic Republic of the Congo, and the Sudan for people living with HIV/AIDS.
Training health-care workers was essential to treatment, he said. According to the World Health Organization (WHO), 1.3 billion people worldwide lacked access to basic health care, in part due to the lack of trained health-care workers. Often doctors, nurses and other health-care workers from developing countries migrated to the developed world for employment. Africa would need 1 million new health workers to achieve the Millennium Goal targets. His organization sought to alleviate the strain placed on overburdened health-care workers and to actively engage the population in its own health. Training of local community members in vital health-care tasks was a priority, including in the most remote medical centres. The response to HIV/AIDS must be part of a comprehensive strategy addressing basic health-care needs. Good health care could prevent many illnesses and, thus, shift the health paradigm from treating acute problems to preventing them.
LUCA DALL'OGLIO, Observer of the International Organization for Migration (IOM), said that it was imperative that the issue of migration entered the debate. Five years ago, 189 countries had committed to developing and beginning to implement, by 2005, national, regional and international strategies for HIV prevention for migrants and mobile workers. However, the draft country reports for the High-Level Meeting showed a mixed picture. Many of those reports recognized the vulnerability of cross-border migrants, mobile populations, victims of trafficking, refugees and displaced populations, but less than half described programmes. Very few transit or destination countries took into account the issue of return migration, although reports from some countries of origin illustrated its importance. In at least three countries, a significant proportion of those living with HIV were nationals infected while working abroad. Particular difficulties were described in providing access to treatment, care and support for migrants and mobile populations.
Improved data-gathering and knowledge-sharing were essential, along with more systematic programme evaluation, he said. Partnerships between Governments and organizations at community, national and regional levels must be strengthened to improve access to prevention, treatment and care for all mobile populations. Such programmes must be funded, and the IOM joined civil society in stressing the importance of the Global Fund in reaching universal access by 2010, and in supporting the call for all technically sound "Round 6" proposals to be fully funded in 2006. He also called for increased attention to population mobility by country coordinating mechanisms. Effective prevention meant that the global community must address the factors that increased vulnerability to HIV, including poverty, illiteracy, inequality and all forms of discrimination and social exclusion.
BILL ROEDY, President of MTV International and UNAIDS Ambassador, said if the 43,000 people infected by HIV worldwide during the three-day High-Level Meeting had been chickens with bird flu, they would dominate the media. Instead, HIV and AIDS had received different treatment because they were considered a disease of the marginalized. HIV and AIDS programming must become part of the "DNA" of media companies globally, if they were to play a role in educating the world.
Earlier in the day, the Global Media AIDS Initiative, a network involving 140 media companies around the world, presented its report to the Secretary-General on its activities worldwide. In Asia, 14 broadcasters had developed World AIDS Day programming, a 20-nation broadcast partnership had been formed in Africa, and 40 media firms had conducted a public health campaign in the Russian Federation. However, that response had not kept pace with the disease. Widespread resistance to testing had resulted in a vast majority of infected people not knowing they were carrying the virus, making voluntary testing more of a necessity than ever. Also, testing must become normal and accepted by all, rather than be bound in myth, fear and prejudice.
GIDEON BYAMUGISHA, from the African Network of Religious Leaders Living With and Personally Affected by HIV and AIDS, said that the lack of political will and commitment by those in leadership positions was the most obvious gap in the current fight against HIV and AIDS. The 2006 High-level Meeting represented a crossroads, where a choice must be made between making token contributions and making life-saving commitments and sacrifices. That meant ensuring the full participation of people living with HIV/AIDS; embracing and meeting firm targets by 2010; promoting and protecting the rights of women and their empowerment; implementing comprehensive, evidence-informed and rights-based prevention strategies; ending stigma and discrimination; naming and responding to the needs of vulnerable groups; and insuring that well-planned national strategies did not go unfunded or underfunded.
However, he stressed that political leaders were not alone in the journey of choice and responsibility. People of faith and others within civil society could be responsible and effective partners if given the space and support, to make their contribution. The hope for a world without AIDS would be real only if political will was firm.
Adoption of Declaration
The Assembly adopted the draft without a vote, as orally corrected.
Speaking in explanation of position, the representative of the United States said his delegation understood the reference to the International Conference on Population and Development and the phrase "reproductive health" did not create any rights and could not be interpreted to constitute support, endorsement or promotion of abortion. Furthermore, he understood that all references in the Declaration to "responsible sexual behaviour" denoted abstinence and fidelity.
In closing remarks, Assembly President JAN ELIASSON (Sweden) said that, during the meetings, over 20,000 people had died as a result of AIDS, and over 30,000 people had been newly infected with HIV. As many speakers had said, AIDS was not only killing people, it was killing development, particularly in the worst affected area: sub-Saharan Africa. Without a greatly stepped up response to AIDS, the Millennium Development Goals would be unattainable in that region.
He said the size and impact of the pandemic had been brought to the world's attention over the last three days in an unprecedented way. The Assembly had heard from the global AIDS community and people living with HIV. No country, no leader, could say that in 2006 they did not know about the human reality of HIV/AIDS, about the size of the threat, or about what needed to be done. There had been an unprecedented level of constructive and substantive interaction between Member States and civil society. The impact of that interaction had been evident in the negotiations on the Political Declaration.
He said the Declaration just adopted included many vital points that much of the global AIDS community had been asking for just a few days ago. The Declaration fully reaffirmed the 2001 Declaration of Commitment. It also acknowledged that many of the targets had not been met. It included several references to vulnerable groups and explicitly mentioned many prevention approaches, including male and female condoms and harm-reduction efforts related to drug use. It unambiguously extended, for the first time, the definition of universal access to include comprehensive prevention programmes, treatment, care and support, and recognized that an estimated $20 to $23 billion was needed per annum by 2010. It also committed all countries to set in 2006, this year, ambitious national targets for 2010, with interim targets for 2008.
"We can be proud of what we have achieved. We have recommitted; we have raised the bar; we have made new, important and specific commitments; and we have put this issue, once again, at the top f the global agenda", Mr. Eliasson said. But, the true test of the Declaration would be the extent to which all went back to their countries and implemented it with a sense of urgency and purpose.
* *** *