HIV/AIDS Care and Support s1
The Secretary-General’s Global Call to Action against HIV/AIDS
Calling the battle against AIDS one of his personal priorities, United Nations Secretary-General KofiAnnan has embarked on a campaign to spur a large-scale mobilization of political commitment and funding. In three major speeches -- in Abuja on 26 April, in Philadelphia on 30 April, and in Geneva on 17 May -- the Secretary-General laid out the essential elements for a global strategy to defeat HIV/AIDS.
The Secretary-General has set five priorities for action:
n Preventing further spread of the epidemic, especially by giving young people — those at greatest risk of infection — the knowledge and power to protect themselves. Large-scale awareness campaigns must be mounted, and access provided to voluntary counselling, testing and, when appropriate, condoms. About a third of the 36 million people living with HIV/AIDS are aged 15-24, and half of the 5 million people infected last year were under 25.
n Reducing HIV transmission from mother to child, which the Secretary-General called “the cruellest, most unjust infections of all”. All mothers must be able to find out whether they are HIV-positive, and those who are must have access to short-term anti-retroviral therapy, which has been shown to reduce mother-to-child transmission by up to half. In the year 2000 alone, some 600,000 children worldwide acquired HIV, the vast majority in this way.
n Ensuring that care and treatment is within reach of all. The Secretary-General noted, based on his recent meeting with leaders of six of the world’s largest pharmaceutical companies, that they are now ready to sell life-saving drugs to developing countries at greatly reduced prices. Some 95% of the world’s 36 million HIV-infected people live in developing countries, and fewer than 25,000 people in sub-Saharan Africa currently have access to anti-retroviral therapy. Access to affordable HIV-related drugs, however, is only one part of a comprehensive HIV care package, which includes voluntary counseling and testing, home and community-based care, and simple treatments for opportunistic infections.
n Delivering scientific breakthroughs. Higher priority must be given in scientific budgets to finding both a cure for HIV/AIDS and, even more importantly, a vaccine against the disease, to save succeeding generations.
n Protecting those made most vulnerable by the epidemic, especially orphans. Help must be provided to the estimated 13 million children — most of them in sub-Saharan Africa — who have lost their mother or both parents to AIDS. In his Philadelphia speech, the Secretary-General asked the audience to imagine the human faces behind that statistic, noting that it is more than all the children in Pennsylvania, New York, New Jersey, Connecticut, Maryland, Virginia and North Carolina combined.
The Secretary-General has also identified six key factors needed to achieve these goals:
n Leadership and commitment is required at all levels — and especially from national leaders — to break the wall of silence and stigma around AIDS, to set strategies to fight the epidemic, and to give it the priority it needs in national budgets.
n Local communities must be engaged, for it is ultimately at this level that the battle will be fought and won. Young people will need the support of their families and communities to change their behaviour and protect themselves. Above all, those already living with HIV-AIDS — the “ultimate experts” — must be involved in the struggle.
n Women must be empowered, and relations between men and women must be transformed at all levels of society. It is only when women have a full say in decisions affecting their lives that they will be able to protect themselves — and their children — against HIV.
n Public healthcare systems must be strengthened in developing countries. In order to make care and treatment available to all those infected, far more efficient and extensive systems of public health must be put in place. Without this, cheaper anti-retroviral drugs may even do more harm than good, if life-threatening side effects are not addressed, or if therapy is interrupted, leading to drug-resistant forms of HIV. Many patients do not have access even to relatively cheap antibiotics and other drugs to treat the illnesses that prey on their weakened immune systems.
n New money must be committed. According to UNAIDS, total spending on AIDS prevention and care in low and middle income countries needs to rise to between seven and ten billion dollars each year. This is at least five times the amount that citizens, national governments and international donors are currently spending. Some of the new funds needed for this “war chest” are expected to come from within affected countries themselves, both from governments shifting budget priorities and from private spending. But a major mobilization of funds is also needed from governments and the private sector in industrialized countries. The Secretary-General has proposed that new resources from donors could be effectively channeled through a Global AIDS and Health Fund. Such a Fund must be able to deliver money quickly where it is most needed, and each country or community receiving support would have to show that it is actually bringing results to those most at risk. The Fund must be governed by open and transparent decision-making, and it should support a range of organizations working to fight the epidemic and help those affected, within a national framework. Details of the Fund are still being worked out in consultation with governments, donors and experts, but the Secretary-General expects it to be up and running by the end of 2001. Initial pledges totalling over $400 million have already been made by France, the United Kingdom and the United States, as well as by Credit Suisse, the International Olympic Committee and the Secretary-General himself, who donated the proceeds of the Philadelphia Liberty Medal he will be awarded in July. Other firm commitments of serious money are expected at the United Nations Special Session on HIV/AIDS in late June and the G8 Summit in July 2001.
Many partners must work together in order to make this campaign a reality:
n All governments must do their part, but governments of the industrialized world must do the heavy lifting on funding. At last year’s Millennium Summit, they made a commitment to halt and to begin to reverse the spread of HIV/AIDS, malaria and other infectious diseases by 2015, to help AIDS orphans and to build Africa’s capacity to tackle the spread of the disease. Government leaders in affected countries must commit to a national strategic plan to fight AIDS, give this priority in their budgets and raise a public voice against the shame and stigma of AIDS.
n Non-governmental organizations must be recognized as vital partners, on the ground in developing countries, as advocates against stigma and discrimination, and as creative contributors to policy-making.
n The corporate sector – not just pharmaceutical companies – must assume its share of responsibilities. Every company doing business in a developing country should inform its own employees, and the wider community, about protection against HIV; provide voluntary testing and counselling for its workforce and their dependants; and give both material and moral support to those who are living with HIV/AIDS. Pharmaceutical companies have the additional responsibility to lower prices on life-saving drugs. Six major companies have agreed to accelerate price reductions in AIDS drugs for the least developed countries, especially in Africa, and to cut prices to other developing countries.
n Foundations must make use of their clout to mobilize public opinion. Foundations are also encouraged to align their programmes and plug funding gaps accordingly. Several foundations have already shown strong leadership in the battle against AIDS.
n The United Nations family must organize itself better to intensify its efforts and coordinate the struggle within a coherent framework, laying aside turf battles and doctrinal disputes.