1 June 2006

AIDS Panel Focuses on Need to Implement Prevention Measures, Increase Testing, Strengthen Education, End Stigma to Reduce HIV Infections

NEW YORK, 31 May (UN Headquarters) -- Health experts gathered at United Nations Headquarters in New York today warned that the world might fall significantly short of agreed goals to turn back the HIV/AIDS pandemic unless prevention measures were systematically implemented to reduce HIV infections, and Governments and civil society worked together to curb violence against women, end stigma surrounding testing, and fight prejudice against men having sex with men, sex workers, injecting drug users and prisoners.

During a panel discussion on "Breaking the cycle of infection for sustainable AIDS responses", one of the highlights of the first day of the General Assembly's three-day High-Level Meeting on AIDS, speakers recognized, among other things, that prevention, care, treatment and support were not mutually exclusive and must be integrated with broader public health and social services, such as programmes for primary health care, mother and child health, sexual and reproductive health, nutrition, and formal and informal education.

The first cases of AIDS were documented in June 1981, and the Assembly's meeting marks the anniversary of the epidemic's tragic quarter-century arc, which has left an estimated 25 million dead, and which United Nations Secretary-General Kofi Annan has called "a devastating obstacle to the progress of humankind". The United Nations estimates that there are some 40 million people living with the disease.

The High-Level Meeting will also review promises made in 2001 at the Assembly's twenty-sixth special session, which put forth the first comprehensive plan for combating the disease. Government officials this week will seek to craft a document that charts a course to provide universal access for HIV/AIDS prevention and treatment by 2010.

Moderator Sheila Sisulu, Deputy Executive Director of the World Food Programme (WFP), opened this afternoon's discussion warning that HIV/AIDS was not just one epidemic, but many, many epidemics, requiring prevention programmes that comprehensively addressed myriad social, economic and cultural specificities of affected groups. Adding that she was afraid statistics masked the real truth -- that AIDS was not an "emergency" but a long-term obstacle to human development -- she called for open and frank discussions among all stakeholders about sex, gender equality, children's rights, sexuality and drug use.

She also stressed that there was strong agreement that education was the best hope for bringing down infection rates, noting that, in some countries, youth-targeted programmes in the media or in schools had been dubbed "education vaccines". All stakeholders must insist that the world's children had access to education and forthright information on how to protect themselves from the disease and on how to affect positive health behaviours that lasted a lifetime. And while women and children must be at the heart of global efforts, the role of men and boys in the struggle "could not be overlooked or overemphasized", particularly in areas such as reproductive health and childcare responsibilities.

Botswana's President, Festus G. Mogae, said he was pleased that HIV/AIDS was firmly entrenched in the global agenda, particularly since new infections were occurring at alarming rates and with the dawning recognition that such increases were outstripping countries' capacities to respond. There was a need, therefore, to confront all aspects of the epidemic, especially those that affected the overall development of societies. The bottom line was to stop new infections among the uninfected and to prevent re-infections that might create new strains of the virus among infected populations.

"People must know their status", he said. It was only through testing that people would be empowered. He went on to describe the voluntary testing and counselling programme that had been instituted in Botswana, one of the countries hardest hit by the disease. He said the people had embraced that strategy, and those who were not HIV-positive were empowered to affect low- or no-risk behaviours so that they could remain that way for life. It also reduced stigma as more and more people knew their status. He added that the testing programme had also sparked an uptick in other prevention programmes, such as mother-to-child health care.

Panellist Carim Jamtin, Sweden's Minister of International Development, echoed both Ms. Sisulu and President Mogae, saying that HIV/AIDS was more than an "emergency", it was "everyday life" for many people and would be for years to come. She agreed that prevention and treatment must always be discussed in tandem, and stressed that research proved people would protect themselves if they knew how. It also showed that people would get help, if they knew their status and knew where to go for such support or treatment.

She added that AIDS strategies must also focus on research, as well as removing stigma and promoting and protecting human rights for all -- including the most vulnerable and most affected groups, who were usually those who had their rights ignored. She also called for more action to ensure gender equality and youth empowerment.

Speaking frankly about the heated debate over the semantics that had already snarled negotiations on the Meeting's outcome document, Joanne Csete, Executive Director of the HIV/AIDS Legal Network in Canada, said she was troubled by delegations' struggles to find effective and useful wording. It was difficult to understand that, in any document about HIV/AIDS, some would disagree with mentioning such terms or phrases as "harm reduction", "men who have sex with men", or "violence against women". Could that be a problem of not having an adequate image of the real suffering of the people who stood in the path of the devastating disease? she asked.

In too many parts of the world, gay men were criminalized and even beaten for whom they loved with little or no outcry from the communities in which they lived. Member States still kept them from participating in the work of the Organization, even though some of the most creative strategies to fight the HIV/AIDS epidemic had been elaborated by gay men living with the disease. She went on to say that people who used drugs were routinely considered society's "low-hanging fruit", only worth a second glance when police wanted to fill their arrest quotas. When they wanted to seek treatment for addiction, many lived in countries where such treatment amounted to little more than torture, and apparently the international community felt the only way to deal with the sickness was to criminalize it, since that was the tenor of the relevant international treaties that bore the United Nations name.

She went on to say that prisoners in many countries were barely recognized as human beings; they were considered "throwaways". Protection of prisoners from sexual violence was not even on the political agenda in many places. That was most disturbing because HIV prevalence rates were often higher in prison populations than in outside communities. Those people would return to the community eventually, but would the outcome document even mention prisons? And why were sexual violence, coercion, domestic abuse and marital rape paid scant attention?

There were those sitting in this very room who would find it hard to imagine the level of disdain faced by sex workers in many parts of the world. The idea of working respectfully with them did not figure in global AIDS strategies. She added that, in her view, stigma was not removed by routine testing, especially when certain behaviours were unduly criminalized and dehumanized in society and in health services as well. It was all well and good for everyone here to be "inspired" by those who fought against HIV/AIDS, she said, but added that the global effort to turn back the virus would not be sustained until those most affected by it were respected and listened to.

When the floor was opened for discussion, many speakers picked up that thread, calling for frank discussions about which groups AIDS strategies should really target. But some cautioned that terms like "high-risk groups" or "at-risk groups" inadvertently stigmatized people living with AIDS. One speaker from Africa said that she did not consider herself "at risk": hers was the virus' "other face", an HIV-positive woman who was in treatment, but who felt healthy and had just given birth to a health baby. Still, she called for more sensitivity to all people living with AIDS, asking that strategies not judge or punish. "How long will it be before we realize that people are not their behaviour?" she asked.

Still, other speakers called for more attention to be paid to the situation of caregivers, to nutrition, to the development of health systems designed to promote access to antiretroviral medicines and to facilitate adherence to treatment regimens, and among others, to support, mobilize and facilitate efforts of developing countries to scale up antiretroviral treatment in a manner that focused on poverty, gender equality, and the most vulnerable groups, within the context of strengthening national health systems while maintaining a proper balance of investment between prevention, care and treatment.

Panellists Dr. Wu Zunyou, National Centre for HIV/AIDS Control and Prevention (China), and Mikhail Grishankov, Member of Duma (Russian Federation), also shared their country experiences. In addition, Norbert Otten of Daimler Chrysler spoke about HIV/AIDS and the workplace.

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