UN conference on AIDS settles on compromise statement

New York

Janice Hopkins Tanne

Last week’s UN high level meeting on AIDS in New York agreed on a declaration of commitment that was stronger than some countries would have liked but weaker than what non-governmental and pressure groups wanted. Nevertheless it goes further than the previous declaration of 2001.

The secretary general of the United Nations, Kofi Annan, said that the HIV and AIDS epidemic "has become the greatest challenge of our generation … the epidemic continues to outpace us."

He said, "Last year, globally, there were more new infections than ever before, and more people died than ever before. There were more women and girls living with HIV/AIDS than ever before … If we don’t step up the fight dramatically, we will not reach the millennium development goal of halting, and beginning to reverse, the spread of HIV and AIDS by 2015."

The declaration recognised HIV and AIDS as a global socioeconomic problem as well as a medical and public health problem. It said the disease is becoming feminised. Nearly 39 million people are infected with HIV; and now almost half of them are women, who are vulnerable to infection because of violence and lack of power in relationships.

The declaration is a political statement, not a plan of action. The meeting agreed that every year $23bn (£12.2bn; €17.7bn) would be needed to tackle the epidemic by 2010, an increase from previous projections. An interim meeting in 2008 will review progress.

The three day session at the UN headquarters aimed to evaluate progress made since the UN’s 2001 declaration of commitment to HIV and AIDS—many targets of which have not been met—and to spell out a plan for the years ahead. For the first time representatives of more than 800 non-governmental organisations and pressure groups participated in the meetings, as well as representatives of more than 140 of the UN’s 191 member states.

The secretary general said that most countries had failed to meet important goals from 2001. For instance, they had not provided education to young people so they could protect themselves, and they had not taken measures to fight the spread of AIDS among women and girls.

Increasingly HIV and AIDS affect women, said Mary Robinson, former UN high commissioner for human rights and president of Ireland and founder of Realizing Rights, an organisation that aims to strengthen responses to HIV and AIDS in Africa. She said that worldwide 17.5 million women are infected with HIV, with the highest number in sub-Saharan Africa. Women aged 15 to 24 are particularly vulnerable.

Recognising that coinfection with tuberculosis is the leading cause of death among HIV positive people, Mr Annan appointed Jorge Sampaio, the former president of Portugal, as the UN’s special envoy to stop tuberculosis. Mr Sampaio said that curing tuberculosis among people who are infected with HIV would give them many years of life. He said he would use his political connections to bring together organisations fighting tuberculosis and those fighting HIV.

The "vibrant and passionate" participation of non-governmental groups in discussions helped move decisions forward, said the president of the UN’s general assembly, Jan Eliasson of Sweden. In negotiations behind the scenes to arrive at the final document Mr Eliasson helped overcome many objections. Some countries objected to moves to identify particular "vulnerable groups" and to statements concerning the empowerment of women, and some complained that abstinence was not emphasised enough.

Mr Eliasson said he was struck by how much the divide between developed and developing countries had disappeared. He said, "This is a true global epidemic and a test of solidarity. We are all in this together."

He said the new document included detailed, stronger language on prevention, including the need for condoms; on vulnerable groups; on empowerment of young people and of women and girls so they can protect themselves against infection; on provision of testing, treatment, and universal access to antiretroviral drugs; and on the importance of good nutrition. However, the document does not specify targets for funding and treatment.

Peter Piot, executive director of UNAIDS, said he was especially pleased that the document called for providing clean needles for injecting drug users and for the empowerment of women and girls.

The UK’s secretary of state for international development, Hilary Benn, said that although the document mentioned "responsible sexual behaviour, including abstinence and fidelity," it should also have mentioned sex workers, injecting drug users, men who have sex with men, and young women and men who exchange sex for money and food, rather than referring to them generally as "vulnerable groups."

"Abstinence is fine for those who can abstain, but human beings like to have sex. They should not die because they do have sex. Dying is permanent," Mr Benn told the assembly.

The draft declaration is at www.un.org/ga/aidsmeeting2006/declaration.htm.