Far more than a health issue.

Ten years ago, a handful of health professionals and leaders like Elhadj Sy asked, prodded and cajoled Governments and ministers to pay attention to a disease called HIV/AIDS (human immunodeficiency virus/acquired immune deficiency syndrome).

"HIV/AIDS was impacting development", said Mr. Sy, the Joint United Nations Programme on HIV/AIDS (UNAIDS) Representative in New York and whose work on the disease began in the eighties. "But there were many people, many government officials who didn't think so. One minister of health told me 'we can discuss malaria but not this AIDS of yours."'

Ten years later, as the number of global infections hit 36.1 million, the HIV/AIDS battle is gaining momentum. On three occasions in 2000, the United Nations Security Council discussed HIV/AIDS. The story of HIV/AIDS when addressed as a health problem offers vastly different endings compared to when it is addressed as a human security threat.

Take the example of Senegal. In 1986, when the first six cases of HIV/AIDS were reported, the Government responded immediately and created a national AIDS programme. By 1987, blood transfusions were systematically scanned in ten regions of the country. By 1992, awareness of the disease had become part of primary school curriculums. Soccer games included messages about HIV/AIDS on stadium banners and on t-shirts of players. Young people mobilized to fight the disease, "even though they had never seen a person living with AIDS", recalled Mr. Sy. The Government incorporated HIV/AIDS across development policies, and today Senegal boasts one of the lowest HIV/AIDS rates in Africa--1.77 per cent.

In Brazil, President Fernando Cardoso, in a 1996 Presidential Decree, recommitted providing universal access to HIV/AIDS antiviral therapies under his country's public health care system. "The health authorities in Brazil determined that the cost of the spread of AIDS in Brazil would be extremely high", said Ambassador Gelson Fonseca, Jr., Brazil's Permanent Representative to the United Nations. "They determined it was better to spend money on prevention, because it will save money in the long run." By 2001, Brazil's national AIDS policy decreased the numbers of HIV/AIDS-related deaths by 50 per cent and of hospitalizations by 75 per cent.

In 1992, when the Uganda AIDS Commission began coordinating their national HIV/AIDS strategy, the Government faced a 14 per cent infection rate. By December 2000, the rate decreased to 8.3 percent.

And the list goes on. When top leaders pay attention, changes can happen.

Look at the United Nations. "Even in 1998, AIDS was still very much seen as a health disease to be dealt with in a health forum, not as a social development problem", said David Lawson, a Liaison Officer for UNAIDS in New York. But today, beyond the seven co-sponsoring bodies of UNAIDS--the UN Children's Fund, the UN Development Programme, the UN Population Fund, the UN Educational, Scientific and Cultural Organization, the UN Office for Drug Control and Crime Prevention, the World Health Organization and the World Bank--every UN body addresses HTV/AIDS.

When the United States first pushed to have HIV/AIDS discussed in the Security Council, many nations protested for procedural reasons. "They felt that the Security Council was not the appropriate venue for social and economic issues", said Mr. Lawson. But the United States persisted. "Unless we act effectively and decisively now HIV/AIDS might be the worst pandemic we have ever seen", said former United States Vice-President Al Gore, who presided over the Council's first meeting on HIV/AIDS. "Absolutely the United States should address HIV/AIDS as a national security issue", he said in a recent interview with the Chroncile. "AIDS is a security issue, just as the environment is a security issue."

Two results emerged from the Council's first meeting in January 2000 on the "impact of AIDS on peace and security in Africa". First, national governments increased funding. The United States pledged a total of $300 million per year; Canada increased funding to address HIV in Africa by $50 million; the United Kingdom pledged an additional $38 million; Australia, $10 million over the next four years; Italy, $20 million to international partnerships working with AIDS in Africa; Norway, an additional $3.6 million; and the Netherlands pledged an additional $1.5 million.

Second, Ambassador Volodymyer Yu. Yel'chenko, Ukraine's Permanent Representative, floated the idea of a General Assembly special session on HIV/AIDS in his remarks to the Council. "It is high time for the United Nations to update a comprehensive agenda for action against this pandemic. In this connection, it might be appropriate that the Security Council use its prerogatives and recommend to the General Assembly that it convene a special session to consider new strategies, methods, practical activities and specific measures to strengthen international cooperation in addressing this problem."

Further persistence by a coalition of Member States, spearheaded by Ukraine, led to Assembly resolution 55/13. From 25 to 27 June, Member States, civil society representatives and individuals living with HIV/AIDS will review the problem of HIV/AIDS in all its aspects.

In July 2000, the Security Council met again--this time to discuss UN peacekeeping operations and their impact on HIV/AIDS--unanimously adopting its first resolution (1308(2000)) on a health issue. "The draft resolution that the Council is considering is historic", said Dr. Peter Piot, Executive Director of UNAIDS. "It would be the first recognition in this body and by the international community of a link between AIDS--an infection--and human security and development." In a follow-up meeting in January 2001, the Council renewed political commitment. While it did not resolve to revisit the issue, "you can guess that if the Security Council discussed AIDS three times in a year, they may address it in the future if need be", said Mr. Lawson.

While the role of, and dangers to, peacekeeping forces in the HIV/AIDS crisis is only one leaf on a complex tree, the impact of the Council's discussions in mobilizing top leadership is undisputed. "It was important for the Security Council to address HIV/AIDS to increase global awareness", said Ambassador Fonseca. "But AIDS in itself is not a security issue. It could affect the social fabric by weakening the capacity of the State, but I don't know if we have reached that state yet."

"I have seen AIDS as a human security threat' says Mr. Sy. "I have seen fields without crops, communities without adults, communities where the main weekend activity is going to funerals, organized together so they don't have to go to funerals everyday." In Thailand, farm output and income fell 52 per cent among rural families affected by HIV/AIDS. In the Ivory Coast, seven teachers a week die as a result of HIV/AIDS. In Botswana, average life expectancy without AIDS was 69 years. Today, with over one third of the population infected with the disease, average life expectancy is 44 years.

In India, 3.7 million people were estimated to be living with HIV/AIDS at the beginning of the millennium--more than any other country, bar South Africa. Only 5 per cent of cases are estimated to be reported in China, and the Russian Federation registered 50,000 new infections in 2000--a number more than the previous 10 years combined.

A 2000 World Bank study estimates that Zimbabwe and Zambia will see a 30-per-cent drop in gross domestic product (GDP) over the next 10 years due to HIV/AIDS. And most infected people do not know they are HIV-positive. Rene Bonnel, lead Economist for the AIDS Campaign Team for Africa at the World Bank, says HIV/AIDS is a long-term economic problem. His recent report found the economic, costs of AIDS staggering. "In a typical sub-Saharan country, with a prevalence rate of 20 per cent, the rate of growth of GDP would be 2.6 percentage points less each year. At the end of a 20-year period, GDP would be 67 per cent less than otherwise." He also notes a recent change in attitude as leaders see the effects of AIDS. Children run households and fathers can no longer teach their sons how to grow crops. Economic development and physical, social and human capital erode as HIV/AIDS prevalence rates rise.

Incentives to train workers or send children to school diminish as shorter life expectancies due to HIV/AIDS reduce the rate of return on human capital investments. It kills managers, teachers, mothers and fathers in their most productive years. "One year ago there was a division between people working in the health field and staff in the Ministry of Finance. The Staff at the Ministry of Finance felt that HIV/AIDS was a health problem, not a problem. of the highest level", recalled Mr. Bonnel. "In September 1999, no Government would raise HP/AIDS with the World Bank during annual country meetings. Now most Governments raise the issue of HIV/AIDS themselves."

Although the Security Council has addressed AIDS, and the Secretary-General has called HIV/AIDS his personal priority, some Governments still resist decisively addressing AIDS. Some Governments, according to Mr. Sy, still want to present themselves to the world as a clean nation. He added: "AIDS is about sex and blood and procreation. Because it affects everyone, it wakes up many fears and apprehensions at the individual level. If you're talking to a government official who has had many sexual partners and has his own fears, he may repress or deny his own fears before taking on AIDS ,as a minister or social servant."

Finally, HIV/AIDS poses a security threat in one area that receives scarce attention: women, children, refugees and internally displaced persons caught in emergency settings. Assistance in emergency settings among vulnerable populations was largely ignored until last year, according to Dr. Lianne Kuppens, a WHO medical doctor who is the Desk Officer for Africa, Indonesia and East Timor, as well as WHO's focal person for HIV/AIDS in Complex Emergencies.

Women in particular find themselves at higher risk of HIV/AIDS infection. While the numbers remain unclear, during the Rwanda and Sierra Leone conflicts the infection rates increased due to rape and "survival sex", where women who were desperate to gain access to food, shelter or water traded sex for necessities.

In emergency situations, a country's first priority is not HIV/AIDS. Health infrastructures and HIV/AIDS sentinel surveillance systems collapse. "Even those that deal with HIV/AIDS professionally cannot in a conflict situation", said Dr. Kuppens. "No one is addressing this in a coordinated way." Providing condoms, a safe blood supply and health education materials can make a difference in acute emergency settings, but resources remain a problem. "I don't see any funds going to HIV/AIDS in conflict situations", said Dr. Kuppens. "We need to add funding for HIV/AIDS and vulnerable populations in complex emergencies."

Maybe, when world leaders consider HIV/AIDS in emergency settings as an urgent hum an security threat will those women, children, refugees and internally displaced persons at risk of contracting it have stories with healthier endings.