HIV/AIDS response at a crossroads; The 2006 UN High-level Meeting: 'Uniting the World against AIDS'.

ON THE OCCASION OF THE twenty-fifth anniversary of the first identification of HIV/AIDS cases, the UN General Assembly held a high-level meeting on "Uniting the World against AIDS" and called upon hundreds of participants--from Heads of State or Government to civil society, and from AIDS researchers to people living with HIV--for a joint review of the progress made in the global fight against the epidemic. In a quarter of a century, more than 65 million people have been infected with HIV, 25 million have died and 40 million are living with the virus.

In his closing remarks, General Assembly President Jan Eliasson told participants that "while we have been meeting, over 20,000 people have died as a result of AIDS" and 30,000 have been newly infected with HIV. However, he commended the increasingly united response to the epidemic by recognizing the "unprecedented level of constructive and substantive interaction between Member States and civil society.... We come from different backgrounds and have different tactics, but we need each other."

Many individuals from the business world and AIDS advocacy supporters from the entertainment industry also attended the conference, which was held from 31 May to 2 June 2006 at UN Headquarters in New York. In order to plan for a collaborative response, participants reviewed a number of important documents: the Secretary-General's progress report on the Declaration of Commitment on HIV/AIDS: five years later, as well as two reports by the Joint United Nations Programme on HIV/AIDS (UNAIDS)--Towards universal access, an assessment on scaling up HIV prevention, treatment, care and support, and the 2006 Report on the global AIDS epidemic. The result was a set of new initiatives and targets that were summed up in the Political Declaration on HIV/AIDS (see box), adopted by the Assembly at the end of the meeting on 2 June.

The conference also came at the five-year point since the adoption by the historic 2001 Special Session of the General Assembly of the Declaration of Commitment on HIV/AIDS, in which Member States committed themselves to comprehensive, time-bound targets in the areas of prevention, treatment, care and resource allocation. Attempts to reach these goals were recorded in the UNAIDS 2006 Report--the most extensive set of data ever released on the response to the crisis, detailing the varied progress made by countries since 2001 in their fight against the HIV/AIDS epidemic. Virtually every indicator cited in the report shows a wide range of responses.

The report also clarifies many issues that have emerged with analysis of the epidemic, including human rights violations and gender inequalities in relation to treatment and prevention services. It also reveals that there are 40 million people infected with HIV, 95 per cent of them living in developing countries. HIV/AIDS is still raging in sub-Saharan Africa--currently the epidemic's epicentre--and it "shows no evidence of a decline". In the Caribbean, the second-worst afflicted region, AIDS is the leading cause of death among people aged 15 to 44 years and is aggressively expanding in Eastern Europe, specifically in the Russian Federation and Ukraine, as well as in Central Asian and Latin American countries, namely Honduras and Belize.

The report also gives some positive news, noting that "in most countries a strong foundation now exists on which to build an effective HIV response". It highlights the successes of some developing nations, such as Burkina Faso, Haiti, Kenya and Zimbabwe, which are seeing decreasing HIV prevalence, and attributes favourable trends in incidence to social changes and prevention programmes. However, the report notes that other countries, including China (an emerging economic powerhouse), Indonesia, Papua New Guinea and Viet Nam, are seeing increases in the number of infected persons. It indicates that HIV-incidence rates worldwide probably peaked in the 1990s, but maintains that "there are still significant weaknesses in the response to HIV". Data show the stark reality that only one in five who needs antiretroviral therapy treatment is receiving it and that prevention programmes are not reaching those most susceptible to the virus; young people's ignorance of the disease also poses a threat to future generations.

Despite advances in education and in women's rights around the world, the report asserts that, as a result of discrimination and stigma, women and girls are disproportionately infected with HIV/AIDS in comparison to men and boys. Efforts to provide preventative treatments and care are hampered by political inequality and insufficient information on the virus. For instance, in poverty-stricken Zambia, where nine out of ten people live on less than $2 a day, there is a 23-per-cent HIV prevalence among women aged 15 to 49, more than double the 10-per-cent prevalence among men in the same age group. Reverend Cannon Gideon Byamugisha of the African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS declared at the conference that "we have shared responsibility to ensure that stigma and discrimination and denial are defeated so that we can have everyone accessing treatment, prevention services and information".

In a watershed on HIV/AIDS discrimination issues, the report says that the human rights of certain groups, namely sex workers, men who have sex with men and injecting drug users, are being denied. They are the most susceptible to HIV and other sexually transmitted diseases, yet only 9 per cent of men who have sex with men and fewer than 20 per cent of injecting drug users received any type of prevention services in 2005. Stressing the need to reach out to these vulnerable groups, Dr. Peter Piot, Executive Director of UNAIDS, declared: "I refuse to accept that the life of a poor migrant, men who have sex with men, an injecting drug user or a sex worker is worth less than the life of my children."

According to UNAIDS, 25 years of HIV/AIDS has orphaned over 15 million innocent children. A recent survey of sub-Saharan African households found that orphaned children are 13 per cent less likely to attend school than the non-orphaned ones and the reality is that 1 in 20 children in the region have been orphaned by the disease. The report cautions that "a quarter century into the epidemic, the global AIDS response stands at a crossroads" and asserts that if the response does not improve significantly, the countries most affected will not achieve the Millennium Development Goal of eradicating poverty and hunger, including childhood mortality. The report forewarns that "countries whose development is already flagging because of HIV and AIDS will continue to weaken, potentially threatening social stability and national security, if the response does not increase significantly".

RELATED ARTICLE: THE WORLD'S FUTURE IN FIGHTING HIV/AIDS POLITICAL DECLARATION

After extensively examining the world's progress in fighting the HIV/AIDS epidemic, the UN General Assembly on 2 June 2006 adopted the Political Declaration on HIV/AIDS, which outlines what the world must do in order to break ground in the reversal of the epidemic by the year 2015. The Declaration reaffirms the commitments to achieving the goals set by the 2001 Declaration of Commitment on HIV/AIDS "Global Crisis--Global Action", while also introducing new initiatives.

In the Political Declaration, the General Assembly pledged to empower all women, especially those plagued by violence and inequality, so that women and adolescent girls can protect themselves from falling victim to the epidemic. The Declaration notes that this can only be achieved by helping women to have access to education, care and other health services, and through the protection of their rights to freely make decisions, particularly personal sexual choices. It pinpoints human rights violations and urges Governments to eliminate all forms of discrimination, whether legislative or regulatory, against those with and susceptible to HIV, to facilitate their access to preventative and health-care services, education and employment. This groundbreaking clause extends especially to men who have sex with men, injecting drug users and sex workers.

The General Assembly expressed grave concern that children and young people under the age of 25 account for half of all new HIV infections; many have fallen victim simply because they are not informed about the disease. The Declaration also addresses the deficiency of paediatric drugs in many countries, which significantly hinders efforts to protect the health of children. It explains the importance of giving children knowledge, protection, treatment and support through various programmes in order to provide them an escape route from HIV/AIDS. Additionally, the Declaration aims "to ensure an HIV-free generation" through youth-directed education, prevention plans and health services.

Financial, human and medical resources are crucial to the fight against the HIV/AIDS epidemic, as emphasized in the Declaration, which stresses that all obstructions to resources--legal, trade or otherwise--must be eliminated in order to obtain universal access. It also reiterates that low- and middle-income countries will need global financial support amounting to what UNAIDS estimated to be between $20 billion and $23 billion by 2010, as compared to an available $8.3 billion in 2005, to keep pressing the fight against the epidemic. Moreover, the Declaration recognizes that "the spread of HIV/AIDS is a cause and consequence of poverty, and effectively combating HIV/AIDS is essential to achieving internationally agreed development goals and objectives, including the Millennium Development Goals".

The Declaration demands a stronger, firmer fight against HIV/AIDS. It realizes the weak points in the struggle, but also gives hope to the world, with new promises to achieve the 2015 target goal of embarking on the reversal of the epidemic. It is a necessity to "translate this Declaration into action", Assembly President Jan Eliasson urged, "to make a difference between life and death for many and give a life in dignity for all affected by HIV/AIDS".

For more information please visit the UNAIDS website (www.unaids.org).