The price of success, the cost of failure: Special Session on HIV/AIDS.

It is hard to believe it was only twenty years ago this June that the first clinical evidence for acquired immune deficiency syndrome (AIDS) was reported in the medical press. In the two intervening decades, more than 56 million men, women and children-a number nearly equal to the population of France or the United Kingdom-were infected with human immunodeficiency virus (HIV); some 22 million--about twice the, population of Mali or Zimbabwe--died of AIDS-related illnesses; and of those, 4.3 million--greater than the entire population of Uruguay or New Zealand--were children.

At the time, it shook our understanding of how to combat the disease. In 1981, it seemed medicine had few Limits and that the individual cases reported were more a medical mystery than the beginnings of a rampaging disease that would claim so many millions of lives. If it were not so frightening, it would seem almost quaint. How did we forget that deadly diseases could crop up at any moment, and that without targetted medicines, which could neutralize their complex methods of attack, we could face an incredibly quick-spreading epidemic-one that, before we could stop it, would turn into a worldwide pandemic?

Now, only a dogged, determined "battle plan"--in the words of United Nations General Assembly President Harri Holkeri-could hope to stop and reverse the spread of HIV/AIDS. In order to come up with such a global plan of action, the General Assembly in September 2000 decided to convene a special session.

The special session on HIV/AIDS opened in New York on 25 June 2001 and it was the first to be devoted to what, on the surface, appears to be a clear-cut health issue, which, however, proved to be anything but clear-cut. When the session ended on the evening of 27 June, Secretary-General Kofi Annan told the press that "some painful differences have been brought into the open. But that is the best place for them. Like AIDS itself, these differences need to be confronted head-on, not swept under the carpet."

The differences--and they were, significant--were met head-on. The extraordinary three-day meeting closed with every single Member State of the United Nations uniting behind an ambitious but vital Declaration of Commitment. More than a straightforward issue of health and medicine, the Declaration treats AIDS as a political, human rights and economic peril.

Heads of State and Government and representatives of all 189 UN Member States called for resources to be found for the battle plan. They committed themselves to reaching a target by 2005 of an overall annual expenditure on the HIV/AIDS epidemic of between $7 billion and $10 billion in low- and middle-income countries, as well as those experiencing or at risk of its rapid expansion. They also called for the implementation of measures to ensure that needed resources are made available, particularly from donor countries and from national budgets.

The Declaration also has Member States' undertaking to: confront the stigma, silence and denial; address gender-and age-based dimensions of the epidemic; and end discrimination and marginalization, putting human rights into the middle of the solution of a health epidemic.

In his closing remarks, Mr. Holkeri said that the concrete targets and follow-up mechanisms contained in the Declaration represented "the first global 'battle plan' against AIDS. It contains concrete targets for all of us to implement. It also contains mechanisms to follow-up: how those targets are to be reached. The beauty and significance of this Declaration of Commitment is in its pragmatic and straight-forward approach." It would serve as a tool for specific strategies to turn the tide of the epidemic. He also said that despite the overwhelming statistics and the real human suffering they represented, "there was hope". The international community must reach out to those who most needed that hope, or be held responsible for not acting when it had the chance.

The special session ended with a moment of silent prayer. Now, hard work lies ahead.

Waging War Against HIV/AIDS

Calling the Declaration of Commitment an "instrument for accountability", Dr. Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said it would form "a strong basis for future action". In the document, the General Assembly supported the establishment of a Global HIV/AIDS and Health Fund to finance an urgent and expanded response to the pandemic, based on an integrated approach to prevention, care, support and treatment. The Fund will also assist Governments in their efforts to combat HIV/AIDS, with priority to be given to the most affected countries.

Contributions to the Fund will be mobilized from public and private sources, with a special appeal to donor countries, foundations and the business community; including pharmaceutical companies, as well as from individuals. The Assembly also committed itself to launching by next year a worldwide fundraising campaign, conducted by UNAIDS and other partners, aimed at the public and private sector, to contribute to the Fund.

Addressing actions to be taken at the national level, Member States said they would ensure, by 2003, the development and implementation of multi-sectoral national strategies and financing plans for combating HIV/AIDS. These are to confront stigma, silence and denial; address gender- and age-based dimensions of the epidemic; end discrimination and marginalization. They are also to involve civil society, the business sector and people with HIV/AIDS, vulnerable groups, people at risk, women and young people. According to the Declaration, national strategies should fully promote and protect all human rights and fundamental freedoms; integrate a gender perspective; address risk, vulnerability, prevention, care, treatment and support; reduce the impact of the pandemic; and strengthen health, education and legal system capacity.

Also by 2003, there should be a commitment to integrate HIV/AIDS prevention, care, treatment and support, as well as impact-mitigation priorities, into the mainstream of development planning, including poverty reduction strategies, national budget allocations and sectoral development plans.

Addressing prevention, described as the mainstay of the international community's response, the Declaration states that by 2003 time-bound national targets should be established to achieve the agreed goal of reducing by 2005 HIV prevalence by 25 per cent among young men and women aged 15 to 24 in the most affected countries, and by 25 per cent globally by 2010.

On the issues of care, support and treatment, there is also a commitment to make every effort to progressively provide in a sustainable manner the highest attainable standard of treatment for HIV/AIDS. There is also a call for constructive cooperation to strengthen pharmaceutical policies and practices, including those applicable to generic drugs and intellectual property regimes, in order to promote further innovation, and the development of domestic industries consistent with international law.

There is also a commitment to improve by 2005 the effectiveness of supply systems, financing plans and referral mechanisms required to provide access to affordable medicines, including anti-retroviral drugs, diagnostics and related technologies, as well as quality medical, palliative and psycho-social care.

By 2005, measures will be implemented to increase the capacities of women and adolescent girls to protect themselves from the risk of HIV-infection, principally through the provision of health-care services, including sexual and reproductive health, and through prevention education that promotes gender equality within a culturally gender-sensitive framework.

RELATED ARTICLE: The Human Rights of HIV/AIDS

* Deliberate exclusion or forcible inclusion of people in mandatory HIV-testing schemes, including migrant workers, whether implemented for case-finding or other purposes (right to security of person).

* Lack of suitable prevention and care programmes and therefore increased risk of infection as a result of criminalization of certain behaviours (rights to association and equal protection).

* Inadequate access to HIV care and treatment, including anti-retrovirals and other medications for opportunistic infections, for individuals living in poorer communities (right to health, right to the benefits of scientific progress).

* Travel and immigration restrictions imposed on the basis of HIV status (right to travel, freedom of movement).

* Inadequate alternative care situations (extended family, foster families, group homes) for children orphaned owing to one or both of their parents dying from AIDS (right to adequate standard of living, right to family life).

North America 920,000

Caribbean 390,000

Latin America 1.4 million

Western Europe 540,000

North Africa and Middle East 400,000

Sub-Saharan Africa 25.3 million

Eastern Europe and Central Asia 700,000

South and South East Asia 5.8 million

East Asia and Pacific 640,000

Australia and New Zealand 15,000

More than 21,000,000 people have died of AIDS Since the 1980s, over 75 per cent of them in sub-Saharan Africa and at least 4,300,000 of them children.

Last year, 5,300,000 new infections occurred, and some 3,000,000 people died of the disease. About one half of new infections now occur among young people ages 15 to 24.

In sixteen countries, more than 10 per cent of adults ages 15 to 49 are infected.

In seven countries, all in southern Africa, at least one in five adults is HIV-positive.

AIDS is destroying the hard-won development gains that have been made in many countries in recent years.

In the most affected countries, half of all 15-year-olds alive today will eventually die of AIDS, even if infection rates do drop in the next few years. If infection rates remain high, more than two thirds of them may die.

Over 36,000,000 people are currently infected with the HIV virus more than 25,000,000 of them in Africa. Most of those infected do not know it.

Over 13,000,000 children have been orphaned by AIDS. That figure may reach 30,000,000 before the end of the decade.