Hunger looms large UN says on World AIDS Day.

The importance of battling stigma and discrimination was a focus this year of World AIDS Day, observed on 1 December. A commemoration at the Cathedral of St John the Divine in New York City, under the theme "Live and Let Live", highlighted one of the major issues raised by world leaders at the UN General Assembly High-level Meeting on HIV/AIDS last September in a recorded message, UN Secretary-General Kofi Annan called on the people of the world to "tear down the walls of silence, stigma and discrimination that surround the epidemic".

The Joint United Nations Programme on HIV/AIDS (UNAIDS) identifies the harmful effects of stigma and discrimination against people with the disease as serious obstacles to successful mobilization against the pandemic and as particularly threatening to those who are most vulnerable. Minorities, the poor and the uneducated are primary targets and face the danger of deteriorating enjoyment of human rights and perpetuation of their marginalized status. Former UN High Commissioner for Human Rights Mary Robinson at the commemoration emphasized that "the pandemic is a major human rights crisis".

World AIDS Day was held against the backdrop of still climbing numbers of infections worldwide, with the vast majority of victims living in sub-Saharan Africa. UNAIDS reported that 2003 marked the highest number of deaths and new infections, while little had been done to realize basic prevention programmes in the regions most devastated by the pandemic. Linkages with issues such as development, food security and gender are being addressed by the UN system. Among them, the relationship between the recent food crises in southern Africa and the HIV/AIDS prevalence rates--over 30 per cent for some countries, including Lesotho, Swaziland, Zimbabwe and Botswana--is of acute concern.

The Food and Agriculture Organization of the UN (FAO) reported that the target of reducing the number of hungry people by half by 2015 may now be unreachable, in large part due to the effects of the AIDS epidemic. For populations that depend mainly on local agriculture for survival, the devastation wrought by sharply declining workforces is deeply felt. At current rates, African countries such as Uganda, Botswana and Namibia are projected to experience declines in their workforces of 13, 23 and 26 per cent, respectively, between 1985 and 2020.

HIV/AIDS has been identified as one of the main underlying forces behind food shortages and the realization of the Millennium Development Goal of reducing hunger.

The FAO State of Food Insecurity in the World 2003 indicates that "hunger cannot be combated effectively in regions ravaged by AIDS unless interventions address the particular needs of AIDS-affected households and incorporate measures both to prevent and to mitigate the spread of HIV/AIDS". At the end of 2002, 14.4 million people were affected by the famine in the six most affected countries alone, as the cycle of poverty and inequality, food insecurity and malnutrition led to and were worsened by the increasing progression of HIV to AIDS.

The International Fund for Agricultural Development in 2001 had developed a response strategy to the epidemic for eastern and southern Africa on both project and country levels, while promoting awareness, capacity development and informational resources. Two years later, it has become clear that "southern Africa may be the first case of an HIV/AIDS-related, large-scale emergency, but it is unlikely to be the last", said Deputy Executive Director Sheila Sisulu of the World Food Programme, and cited the FAO findings, that "the HIV/AIDS epidemic requires a multi-sectoral response And providing drugs is only part of the solution."

Efforts are being undertaken to simplify and lower the price of antiretroviral medication and to make them more widely available. In conjunction with World AIDS Day, the World Health Organization and UNAIDS launched a major programme to enhance local capacities to absorb assistance in combating the epidemic. The "3 by 5" Initiative aims to initiate life-long treatment of 3 million people in poor countries by 2005, by training and encouraging the use of standardized and simplified tools for tens of thousands of community workers. This will complement the work being done to raise and channel funds by organizations such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, as well as other local and regional country initiatives.

"We know what works to prevent infections", said Deputy Executive Director Kathleen Cravero of UNAIDS. Antiretroviral medication treatment has proven to be effective in resource-poor settings and, having substantially dropped in price, it is now financially feasible. That such hopeful signs exist was a central theme of the commemoration, which was addressed by a number of people living with HIV/AIDS. While prominent musicians such as Lila Downs of Mexico and the eclectic jazz/karnatic fusion artist Nitin Sawhney dedicated performances to those living with the virus, one statement by a singer from South Africa's Sinikithemba Choir stood out. "I haven't missed a single dose and I haven't experienced any serious illnesses", said Zinhle Thabethe, a woman who has been receiving antiretroviral therapy for several years. "And I am living more and more each day."