General Assembly Plenary
Twenty-sixth Special Session
1st Meeting (AM)
OPENING ASSEMBLY SPECIAL SESSION ON AIDS, SECRETARY-GENERAL SEES ‘TURNING POINT -–
AIDS CAN NO LONGER DO ITS WORK IN DARK’
International Gay - Lesbian Human Rights Commission to Participate
At Session Roundtable, Despite Opposition From Group of Member States
After almost three hours of debate during the opening session of its special session on HIV/AIDS this morning, the Assembly adopted an amendment adding a representative of the International Gay and Lesbian Human Rights Commission to the list of civil society participants in one of its round tables.
The amendment submitted by Canada, Norway and Sweden was adopted by a vote of 62 in favour and 0 against with 30 abstentions. (Annex III.)
Several Member States said they would not participate in the vote on the amendment and dissociated themselves from the process. Most of them saw the exercise as setting a dangerous precedent and a violation of accepted and long-standing procedures.
Prior to that action, the Assembly, by a vote of 46 in favour and 63 against with 19 abstentions, rejected a no-action motion on the amendment proposed by Egypt (Annex I). Following that, several delegations asked the President, Harri Holkeri (Finland), to inform the Assembly whether the required quorum existed to proceed. As Egypt (on behalf of the Organization of the Islamic Conference) challenged the President’s ruling on the quorum, the Assembly then proceeded to vote on that ruling. By a vote of 85 in favour and 2 against (Saint Lucia and China) with 1 abstention (Algeria), the Assembly upheld the President’s ruling that the quorum did, indeed, exist. (Annex II.)
The Assembly then adopted without a vote, the full list of civil society participants, as amended.
In his opening address to the session this morning, Secretary-General Kofi Annan said “All of us must recognize AIDS as our problem. All of us must make it our priority”. He added: "Let no one imagine that we can protect ourselves by building barriers between us and them. In the ruthless world of AIDS, there is no us and them.” This year, he said, the world had started to wake up. Never, since the nightmare began, had there been such a moment of common purpose.
He called for frank discussion and solidarity between the healthy and the sick, between the rich and the poor, and above all, between richer and poorer
nations. Spending on the battle against AIDS in the developing world, he said, needed to rise to roughly five times its present level. Developing countries were ready to provide their share, but they could not do it alone. That is why he had called for a Global AIDS and Health Fund of $7 to 10 billion, open to both governments and private donors, to help the international community finance a comprehensive, coherent, coordinated strategy.
Statements by high officials of many of the most-affected countries, as well as those active in the struggle against the epidemic, followed the Secretary-General's remarks. The Prime Minister of Mozambique, Pascoal Manuel Mocumbi, cautioned that contributions to the Secretary-General's proposed Global Health Fund should be made without resulting reductions in resources for development and poverty eradication. The fund should enhance the national capacities of recipient countries without cumbersome bureaucratic mechanisms.
United States Secretary of State Colin Powell said that his country had announced a contribution of $200 million to jump-start the Fund. The United States continued to be the largest bilateral donor to efforts to overcome the epidemic. In his request for the budget for the next fiscal year, his country's President, George W. Bush, had requested $680 million for that purpose, with
$3.4 billion being requested for AIDS research.
During their respective statements, the Secretary of State for International Development of the United Kingdom pledged $200 million to the global fund, Norway's Minister of International Development pledged one billion Norwegian kroner (approximately $110 million) and the First Deputy Prime Minister of Uganda pledged $2 million. The representative of Japan noted that his country's contribution would be commensurate with its overall high commitment to funding crucial initiatives in developing countries.
The Vice-President of Cuba, Carlos Lage Davila, on behalf of his Government, offered to the poorest countries 4,000 doctors and other health-care workers, professors to create 20 medical schools, educational specialists, equipment and diagnostic kits for basic prevention programmes and anti-retroviral treatment for 30,000 patients.
The special session was opened by the Temporary President, the Chairman of the delegation of Finland, with one minute of silent prayer or meditation. The Assembly then took note of the information contained in a letter addressed to the President of the General Assembly by the Secretary-General, in which he informed the Assembly that 16 Member States were in arrears in the payments of their financial contributions to the United Nations within the terms of Article 19 of the Charter.
[Under that Article, a Member State in arrears in the payment of its financial contributions to the Organization shall have no vote in the Assembly if the amount of its arrears equals or exceeds the amount of the contributions due from it for the preceding two full years.]
The Assembly then proceeded with the appointment of the members of the Credentials Committee. Acting without a vote, it decided that, in accordance with
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precedents and with Assembly resolution 55/242, the Committee should have the same membership as that for the fifty-fifth regular session of the Assembly, namely the Bahamas, China, Ecuador, Gabon, Ireland, Mauritius, Russian Federation, Thailand and United States.
Also this morning, the Assembly elected Mr. Holkeri as President of the special session by acclamation. It also decided by acclamation that the Vice Presidents of the special session would be the same as those of the regular session -- Belarus, Bhutan, Burkina Faso, China, Comoros, El Salvador, France, Gabon, Guinea, Haiti, Kuwait, Maldives, Mozambique, Russian Federation, Suriname, Tunisia, Turkey, United Kingdom, United States, Uzbekistan, and Yemen.
The Assembly, again acting without a vote, also decided that the Chairpersons of its main Committees for the fifty-fifth session would serve as the Chairs for the special session. They are Myanmar -- First Committee (Disarmament and International Security); Romania -- Second Committee (Economic and Financial); Trinidad and Tobago -- Third Committee (Social, Humanitarian and Cultural); Uganda -- Fourth Committee (Special, Political and Decolonization); Guatemala -- Fifth Committee (Administrative and Budgetary); and Italy -- Sixth Committee (Legal).
It was further decided that in the absence of the Chairpersons of the Main Committees, the following would serve: Uruguay -- First Committee; Antigua and Barbuda -- Fourth Committee; and Ecuador -- Sixth Committee.
The President also appointed Penny Wensley (Australia) and Ibra Deguène Ka (Senegal) as co-facilitators.
The President informed the Assembly that the Chairs of the round tables of the special session were: Denzil Douglas, Prime Minister of Saint Kitts and Nevis -- round table 1; Grzegorz Opala, Minister of Health of Poland -- round table 2; Dato Seri Suleiman Mohamad, Deputy Minister of Health of Malaysia -- round table 3; and Benjamin William Mkapa, President of the United Republic of Tanzania -- round table 4.
In further action this morning, the Agenda was adopted without a vote.
Also speaking in the general debate were the Presidents of Gabon, Botswana, Senegal, Ghana, Nigeria, Portugal, Kenya and Rwanda, as well as the Prime Ministers of Saint Kitts and Nevis, Mozambique and the Bahamas.
Government Ministers of South Africa, Pakistan, Iceland, Liechtenstein, Ukraine, and Peru also spoke.
In addition, the representatives of Algeria, Japan, Azerbaijan, Morocco and Ecuador made statements.
The Executive Director of the United Nations Programme on Aids (UNAIDS), Peter Piot, also spoke.
With regard to the list of civil society participation in the work of the session, the representatives of Canada, Sweden (on behalf of the European Union),
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Norway, Japan, Croatia, India, Nigeria, Iraq, Mexico, South Africa, and Saint Lucia also spoke on procedural issues and in explanation of position before and after the vote.
On the amendment to the list of civil society participants in one of the special session round tables, the representatives of Iran, Egypt, Pakistan, Sudan, Malaysia, Djibouti, Qatar, Saudi Arabia, Bahrain, United Arab Emirates, Kuwait, Oman, Syria, Mauritania, Jordan, Lebanon, Libya, and Bosnia and Herzegovina did not participate in the vote on the amendment, dissociating themselves from the process.
The General Assembly resumed its special session on HIV/AIDS after a short break, immediately following the morning session.
Background
The General Assembly met this morning to begin its twenty-sixth special session for the review of the problem of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in all its aspects. For background, please see press release AIDS/22 issued on 21 June.
Statements
HARRI HOLKERI (Finland), President of the General Assembly, said that today, the international community had gathered to mount a global response to the worst epidemic in human history. Unknown until 20 years ago, HIV/AIDS had turned into a global crisis. Fifty-eight million people were infected worldwide, of which
22 million had already died, leaving families, communities and entire nations seriously affected. More than 36 million people around the world were currently living with HIV/AIDS, with 14,000 becoming infected every day. The statistics were overwhelming. It was hard to imagine 10 million children orphaned by AIDS. It was also difficult to imagine that in some regions, one in four adults was living with the virus.
Today, he continued, the Assembly welcomed the many who were living with the virus who had come to the session. It was they who made the session unique. That the General Assembly had decided to convene the session proved that the international community was serious about combating the crisis. Efforts would not be successful without strong leadership. The session, which was a landmark in the history of the United Nations, would galvanize that leadership. With concerted efforts, the international community would be able to turn the tide in combating the disease. He regretted that there still remained differences in views on certain issues and appealed to delegations to work to solve those differences as soon as possible.
Statement by Secretary-General
KOFI ANNAN, Secretary-General of the United Nations: An unprecedented AIDS crisis has a solution: an unprecedented response from all the participants, who are here to agree on the action to be taken. In the 20 years since the world had first heard of AIDS, the epidemic has spread to every corner of the world, having killed almost 22 million people. It has left 13 million children orphaned, and today, more than 36 million people are living with HIV/AIDS. Every day, another 15,000 people acquire the virus. In some African countries, it has set back development by a decade or more. And now, it is spreading with frightening speed in Eastern Europe, Asia and the Caribbean.
Up to now, he continued, the world’s response had not measured up to the challenge, but this year, there has been a turning point. AIDS can no longer do its deadly work in the dark. The world has started to wake up. Never, since the nightmare began, has there been such a moment of common purpose. Never has there been such a need to combine leadership, partnership and solidarity. Leadership is needed in every country, in every community, as well as at the international level, where the entire United Nations system is now engaged. “All of us must recognize AIDS as our problem. All of us must make it our priority.”
Partnership is needed between governments, private companies, foundations, international organizations -– and, of course, civil society. Non-governmental organizations have been at the forefront of the fight against AIDS from the very start. Everybody must learn from their experience, and follow their example. It is right that they are playing an active part in the current session. Solidarity is needed between the healthy and the sick, between rich and poor; above all, between richer and poorer nations.
Spending on the battle against AIDS in the developing world needs to rise to roughly five times its present level. The developing countries are ready to provide their share, as African leaders pledged at the Abuja summit. But they can not do it alone. Ordinary people in developed countries are now showing that they understand this. I urge their leaders to act accordingly.
We must mobilize the money required for that exceptional effort, and it is necessary to make sure that it is used effectively. That is why I have called for a Global AIDS and Health Fund, open to both Governments and private donors, to help the international community finance the comprehensive, coherent, coordinated strategy that we need. The goal is to make the Fund operational by the end of this year. I applaud those who have already pledged contributions and hope that others will follow their example.
“When we urge others to change their behaviour, so as to protect themselves against infection, we must be ready to change our own behaviour in the public arena,” he said. “We cannot deal with AIDS by making moral judgements, or refusing to face unpleasant facts –- and still less by stigmatizing those who are infected, and making out that it is all their fault. We can only do it by speaking clearly and openly, both about the ways that people become infected, and about what they can do to avoid infection. And let us remember that every person who is infected -– whatever the reason -– is a fellow human being, with human rights and human needs. Let no one imagine that we can protect ourselves by building barriers between us and them. In the ruthless world of AIDS, there is no us and them.”
EL HADJ OMAR BONGO, President of Gabon: I pay tribute to the personal involvement of the Secretary-General with the issue of HIV/AIDS and his skill in mobilizing the international community. This session has also demonstrated his effectiveness in implementing the decisions of Member States: “we are all on the right track".
Huge progress has been made in research in the major laboratories. Drugs which slow down the development of HIV/AIDS now exist. Yet this is not a victory. Treatments that cured and a preventive vaccine still have to be found. Research in laboratories must therefore continue. Fairness and solidarity also demand that whatever drugs exist, must be made available to all. The rich countries therefore have a duty to humanity and must display solidarity.
The Global AIDS Fund must be made fully operational as soon as possible. Thanks to the Fund, financing for research and access to drugs by developing countries, there is now real hope of finding a cure. Smallpox has gone, polio is vanishing and AIDS too must go. Gabon has created a solidarity fund to fight AIDS. Now is the time to act together. "This is an opportunity to show future generations that in the face of such a scourge, the world was able to demonstrate solidarity, and that that word itself lived up to its true meaning.”
FESTUS MOGAE, President of Botswana: the HIV/AIDS pandemic is severely limiting development prospects in affected countries through the loss of skilled human resources, decline in productivity and reallocation of budgetary and human resources from development activities towards actions to address the disease. The unchecked spread of the pandemic poses a serious threat to the goal of reducing global poverty by half by the year 2015. In today's global village, no country is safe from the ravages of the pandemic. "It is therefore in the interest of each and every one of us to ensure that we do everything in our power to eliminate the spread of HIV/AIDS in the quickest possible time and in the most effective way."
The international community must support strengthened HIV/AIDS prevention strategies and provide assistance to develop and extend social support systems to deal with the consequences of HIV/AIDS. There must be improved access to anti-retroviral drugs for the poor and for the most affected countries, while drugs must be made available at affordable prices on a sustained basis. Traditional, cultural and religious beliefs, as well as practices that inhibit the fight against the pandemic, must also be dealt with decisively. Most importantly, it must be ensured that the fight against HIV/AIDS is not waged at the expense of sustainable development and improved living standards for developing nations.
In Botswana, the National HIV/AIDS Strategic Plan embodies a multi-sectoral approach and a close working relationship among the public and private sectors as well as non-governmental organizations (NGOs). The implementation of the Plan is overseen by committed leadership across the broad spectrum of my country's society. "Our key prevention strategies include: house-to-house counselling, behaviour change, voluntary counselling and testing as well as prevention of mother-to-child transmission programmes.”
A combination of hospitalization and community home-based approaches is the cornerstone of care for AIDS patients and support to orphans, vulnerable children and affected families in my country. Treatment strategies include pain management and symptomatic treatment as well as prevention and treatment of opportunistic infections. "We shall shortly introduce retroviral treatment in our public health facilities to complement all these activities.
Needless to say, substantial resources are necessary to mount an effective fight against the disease. Botswana fully supports the proposal to establish a Global Fund for HIV/AIDS. It is important, however, that such a Fund embrace the criteria to ensure that its resources are used to meet the needs of the countries most seriously affected by the pandemic, such as Botswana. "It would be unjust to exclude countries like my own on account of per capita income.”
DENZIL L. DOUGLAS, Prime Minister of St. Kitts and Nevis: arresting the spread of HIV/AIDS is a monumental task but a necessary one, since the reality for people living with the disease tragically grim. The stigma of the disease, the wider social ostracism, alienation within families, and lack of resources to get treatment represent serious obstacles to addressing the problem. Additionally, people living in the small economies of the Caribbean are especially troubled by the fact that the disease can decimate a generation of young people, weaken their economies, and set human development back by decades.
Although the rate of infection in the Caribbean is a fraction of that of the worst-affected countries in Africa, it had been reported that the Caribbean region ranks second behind sub-Saharan Africa. In percentage terms, it is higher than that of North America and Southeast Asia. Regrettably, the institutions and private foundations that have pledged to assist the countries of Africa do not appear to have recognized the seriousness of the situation in the Caribbean.
The disease did not discriminate, but it has proved to be overwhelmingly devastating to the young, the poor and women. Caribbean countries have taken steps to build the requisite national infrastructure and to strengthen regional mechanisms to stem the spread of the disease. However, like African countries, the countries of the Caribbean have little access to the oft-expensive anti-retroviral medicines that can prolong life or improve the health of infected persons. The prohibitive cost of those drugs also puts them out of the reach of even the budgets of most Caribbean governments. Antiretroviral drugs and inexpensive access are fundamental to any viable treatment approach to the HIV/AIDS pandemic. In their absence, most patients with AIDS may die within two years.
ABDOULAYE WADE, President of Senegal: this three-day meeting at the highest possible level to discuss the problem of HIV/AIDS rightly reflects the concern of the international community. The problem requires a response commensurate with its scale. The time for simple statements has passed. We must break the conspiracy of silence, raise awareness of the problem and sensitize the public to the suffering of people with AIDS.
In Africa, the pandemic has created a particularly serious situation, and the problem was addressed by Heads of State and Government during the Organization of African Unity summit on HIV/AIDS in Abuja, Nigeria, last April. In Senegal, since the appearance of the first cases of AIDS in 1986, the Government has been making serious efforts to fight the disease, setting up a national committee on AIDS, introducing blood transfusion policies and detection tests.
The country is also involved in public sensitization and awareness-raising efforts. As a result, the infection rate has been held down to about 2 per cent of the population. The Joint United Nations Programme on HIV/AIDS (UNAIDS) has acknowledged my country’s success in fighting the disease. Hence, it is not always correct to connect under-development with the spread of HIV/AIDS. My country is prepared to share its experience with others.
Problems of access to care and lack of access to treatment undermine the basic right of people to life. The exorbitant cost of medicines and profit-making are simply immoral and unacceptable. For that reason, through a constructive dialogue with all partners, my Government is trying to lower the cost of treatment. Later this year, it plans to hold an international meeting to address the problem of access to care. The millions of people around the world suffering from AIDS cannot be content with declarations of intent. The international community must face the problem squarely.
JOHN AGYEKUM KUFUOR, President of Ghana: In Ghana, since 1986 when the first cases of HIV/AIDS were reported, the Government has instituted measures to combat the disease. These measures culminated in the formulation of a National HIV/AIDS Strategic Framework and the establishment of the Ghana AIDS Commission under the Office of the President. Today HIV/AIDS concerns are being mainstreamed into sector plans with specific roles assigned to private and public sector organizations. This is helping to eliminate the moral squeamishness towards sufferers and encourage open discussion and increased information to enhance management of the pandemic.
The success of these policies and programmes in Ghana, like elsewhere in Africa is, however, dependent on the availability of financial and material resources, which are woefully inadequate on the continent. Despite budgetary constraints faced by governments in Africa, it was decided at the Abuja summit that at least 15 per cent of our annual budgets would be allocated to the improvement of the health sector to combat the pandemic. Significant as this initiative is, it must be admitted that it will be inadequate without sustained and concerted international assistance directed at both prevention of the disease and mitigation of its impact on sufferers and society.
In this regard, we lend our support to the call by the Secretary-General for the establishment of a global HIV/AIDS and Health Fund which could be administered by the United Nations. Poverty, underdevelopment, and illiteracy have been identified as some of the challenges to effective HIV/AIDS response in developing countries. It is, therefore, imperative that this session resolves to assist these countries in implementing internationally agreed strategies to eradicate these handicaps.
To this end, my delegation calls for international cooperation and solidarity with Africa in the combat against HIV/AIDS. We also call for the following measures: debt relief; acceleration of the enhanced Heavily Indebted Poor Countries Initiative (HIPC); reversal of the declining levels of official development assistance; and additional resources from donor countries and the private sector. It is also our expectation that this session will address the issue of accessibility and affordability of essential drugs for people living with HIV/AIDS in Africa and the promotion of their rights.
PASCOAL MANUEL MOCUMBI, Prime Minister of Mozambique: Southern Africa is the region hit hardest by HIV/AIDS, making our families increasingly impoverished, our workforce drastically reduced and our children increasingly orphaned. The basic fabric of communities and political stability is threatened. The magnitude of the pandemic has been duly recognized by the international community, and this session has been convened with the realization that this global crisis must be addressed through global action. The declaration to be adopted should ensure a global commitment towards coordinating and strengthening of national, regional and international efforts to combat the epidemic in an integrated manner.
Poverty, stigma, lack of information and weak health infrastructures have been acknowledged as hindering the struggle against the epidemic, but there has been silence regarding the sexual behavior and gender inequalities that drive the epidemic. In Mozambique, the overall rate of HIV infection among girls and young women is twice that of boys their age because they are married younger, to older, sexually experienced men who may expose them to HIV/AIDS and other diseases.
Valuable regional initiatives to reverse the current situation include the Abuja Declaration, the Southern African Development Community (SADC) HIV/AIDS Strategic Framework and Programme of Action, and work towards a multilateral instrument within the framework of the Community of the Portuguese Speaking Countries (CPLP). It is also a priority area for Government action in Mozambique, with the Government adopting a multi-sector approach, coordinated by a National Council to Combat HIV/AIDS, which also ensures that Mozambicans have access to information and services. There is, in addition, a national strategic plan that focuses on prevention and reduction of impact, focusing on the individual, particularly vulnerable groups such as women, orphaned children and youth, especially girls.
The key to the national policy to combat HIV/AIDS is prevention, and this requires speaking without taboos and ensuring adequate dissemination of information. Vulnerable groups must be provided both information and skills to empower them to protect themselves. Frank awareness campaigns, through leaders at all levels must be advanced without disrupting moral values. In addition, the manner in which people living with HIV/AIDS are treated is also a matter of great concern, and is soon to bring about Governmental action to protect their rights and make sure their voices are heard. For all these efforts to be successful, a genuine partnership with civil society and the private sector is fundamental. In addition, this session must call on countries that have managed to halt the spread of HIV, as well as those in a position to do so, to support countries in need.
Contributions to the special fund should be made by those countries without a resulting reduction in resources for development and fighting poverty. Access to the fund should be aimed at enhancing national capacities of recipient countries without cumbersome bureaucratic mechanisms. In addition, the management of the fund should be transparent. No commitment made today will achieve the desired results if adequate resources are not provided consistently and sustained over time. Mozambique, for its part, remains committed to supporting all international initiatives aimed at defeating HIV/AIDS.
OLUSEGUN OBASANJO, President of Nigeria: Africa, a continent already crippled with problems of underdevelopment, poverty, internal conflicts and external debt, is the hardest hit by the HIV/AIDS pandemic. The future of our continent is bleak, and the prospect of extinction of the entire population of a continent looms larger and larger. In the Framework Plan of Action for the implementation for of the Declaration on HIV/AIDS, Tuberculosis and Other Related Infectious Diseases during the Abuja Summit, African leaders resolved to accord the fight against HIV/AIDS the highest priority in their respective national development plans. We agreed, among other things, to set up “Leadership AIDS Watch for Africa”, to be made up of leaders from seven African countries and the Executive Director of the UNAIDS.
African peoples are looking to this special session with renewed hope, and expect that it will address all aspects of the problem, including the issue of international funding and cooperation. We are encouraged by the success story in the industrialized countries and urge the international community to make a firm commitment to helping Africa achieve similar results. We support the initiative of the Secretary-General to create a Global AIDS Fund that would focus on prevention, with special attention to treatment through the provision of drugs at affordable prices by the leading international pharmaceutical companies. Furthermore, the circumstance and the situation of HIV/AIDS underscore our call for total cancellation of Africa’s debt in favour of investment in the social sector.
I wish to make a plea for the millions who are already infected with the HIV virus. Those people living with HIV require primary attention, including the millions of children orphaned by the disease. This special session must therefore consider and adopt a comprehensive approach that accords priority to: the treatment and improvement of life for infected persons; the prevention of mother-to-child transmission; and adequate welfare and provision for AIDS orphans. Let us come up with a programme that respects and saves people living with AIDS as part of humanity. Let us help them to overcome the stigma of society, and they can join the crusade against further spread of the killer disease.
JORGE SAMPAIO, President of Portugal: The problem of AIDS is a priority for the international community. The figures regarding the spread of AIDS are appalling, yet -– and the world cannot ignore this -– every estimate of the spread of the epidemic has been lower than its true dimension. Therefore, there is no room for complacency and hesitation. Through this forum, the question of AIDS should be placed at the top of the international political agenda as a humanitarian issue that cannot be put off, and as a serious threat to the security and development of many countries and regions.
The fight against AIDS has always been delayed and hindered by the stigma attached to the disease and by the fact that the discussion of the most vulnerable groups of people, of the forms of transmission and of the behaviour that favours it, involves the questions that, for many, are still taboo. But we cannot allow the touchiness about these questions to silence us, to make people avert their eyes before the insidious advance of the epidemic. The struggle should mobilize us all. This is surely the understanding of the heads of State and Government who, through their participation in this meeting, are signalling their commitment to the fight against AIDS. The NGOs represented here are essential partners in calling attention to and fighting the infection. Also fundamental is the contribution of those who carry HIV/AIDS.
Although the virus strikes every region, culture and social group, it is most prevalent among populations socially and economically less favoured. AIDS and poverty go hand in hand. At the bilateral level, and through the Community of Portuguese-speaking Countries, we endeavour to raise awareness among the Portuguese-speaking countries of Africa about the need to increase their efforts against AIDS, and to support their efforts. At the multilateral level, we support the constitution of a Global Fund for Health and HIV/AIDS, which will also cover other transmissible diseases. There is undoubtedly a need for the allocation of greater financial resources for AIDS prevention, treatment and research programmes. Nevertheless, without political leadership and social mobilization, greater resources alone will be insufficient to win the fight.
International support must be implemented effectively, at the national level, in the field of prevention and treatment. The cost of medication cannot be allowed to jeopardize the need for treatment, since one of the main problems in that field is access to care. It is important not to forget the anti-retroviral therapies that allow improvement of the quality of life and life expectancy of patients and, in fifty per cent of the cases, prevent the transmission of the virus from mother to child. The initiatives already taken in this field by the pharmaceutical industry are very positive, but efforts must continue to make those medicines more accessible, particularly through greater use of generics. It is also necessary to pay special attention to specific groups that are more vulnerable to infection.
In the case of Portugal, I would like to underscore the measures taken in the field of drugs. Damage reducing policies have proven to be effective in reducing the risk of transmissible diseases and in preventing social exclusion. As a general concern at the international level, I would like to single out particular importance of the situation of women. Governments cannot stand aside from the fight against AIDS -– nor can they stand alone. A multifaceted response to the increasingly complex issue of AIDS must be intensified: public authorities, universities, NGOs, donors, international organizations, private companies, volunteers -– all must be called upon to cooperate.
I would address a very special word to the churches and religious groups. I would like to see them play a strengthened part in the fight against AIDS. Here, too, for imperative humanitarian reasons, a commitment is essential, based on compassion and solidarity, a commitment that does not have to call into question the beliefs and moral values of each group.
DANIEL T. ARAP MOI, President of Kenya: In my country, AIDS has been designated a national disaster. Kenya is therefore participating at the forefront of research for a vaccine, other preventive measures or a cure. We are determined to fight the spread of this dreadful disease. But the indications are that it will be at least 10 years before significant tangible developments are available. In the meantime, the people of my country must not be deprived of the most basic human right -- the right to life.
It is therefore incumbent upon myself and my fellow leaders to turn this suffering into history, rather than destiny. Human life must surely come before anything else. Nonetheless, we must pursue our choice in a balanced way -- balanced to protect the interest of further research and development so that life can be further protected and enhanced. We believe this balance can be achieved by making available the best possible medication at the lowest possible cost. At the present time we are unable to pay international prices for the medicines we need.
My Government has thus enacted emergency legislation to deal with life-threatening epidemics. The sole purpose of the legislation is to make high-quality AIDS drugs available to my people at the lowest possible cost. There will be no question of corporations or individuals making handsome profits at the expense of my people, the people of Africa, or at the expense of valid patent holders. Instead, it is our intention that this will signal the start of a life-saving crusade -- a crusade that will stimulate and enthuse our people, and the people of Africa, enabling them to fight this disease with energy and courage.
Our culture of self-help will be reborn. This will ultimately lead to a scientific ability within Africa. We shall at the same time seek to maximize the protection of valid patent holders currently in existence. They will be given preference to supply the active ingredients or finished dose form, provided that its meets the European or American pharmacopoeial specification. Second, treatments will be offered at the same or better prices and not infringe valid patents. Furthermore, my country will work in close cooperation with its African neighbours for the purposes I have outlined.
PAUL KAGAME, President of Rwanda: Rwanda is among the 14 sub-Saharan African countries most seriously affected by HIV/AIDS. It is currently estimated that some 400,000 Rwandans out of a total population of 8 million are infected. In our case, one of the contributing factors was the 1994 genocide, in which untold numbers of women and young girls were systematically raped. The impact of this episode of our history has not yet been fully grasped. The massive internal and external dislocation and movements of millions of people during this period also contributed to the spread of HIV/AIDS.
Despite these challenges, we have undertaken a number of initiatives to combat HIV/AIDS. A national campaign to sensitize leadership at all levels of society has been mounted, leading a significant proportion of our people to volunteer for HIV/AIDS testing. A programme for prevention of mother-to-child HIV transmission is now in place. The Government has initiated a scheme of purchasing anti-retroviral drugs, which are made available to the public at subsidized rates. In addition, Rwandan youth have taken a leading role in their own right, as demonstrated by the establishment of anti-AIDS clubs in almost all secondary schools in the country.
HIV/AIDS can be tamed and eventually defeated. The immediate goal in this quest is a focused global strategy that is realistic, practical and effective, particularly in regard to resource mobilization and management. Prevention programmes, among other things, should become central in the unfolding strategy. It is imperative that accountability and transparency become the hallmark of this strategy and its implementation.
HUBERT INGRAHAM, Prime Minister, Bahamas: Last year, the G-8 countries made a commitment to establish a Global Fund to combat HIV/AIDS, tuberculosis and malaria in developing countries. The purpose of the Fund is to mobilize, manage and disburse grant resources to support country and regional programmes to combat those three diseases because they decimate large percentages of populations in the developing world. The Fund is also intended to support national development in line with the goals of the Millennium Summit.
We endorse and support the Fund and the goal of giving donors with no traditional country base an opportunity to fund work directly at national levels. However, small nations are concerned about accessing the Fund if they have no resident donor-based infrastructure, or no United Nations development agency offices. Also, we should not put all our eggs in one basket. The Fund must assist in acquiring drugs, but providing affordable drugs should not disproportionately skew the Fund's assets from other concerns. Equally urgent matters that need funding include the promotion of health, research, training, the building of health infrastructure, the forging of partnerships, coordination of networks and providing follow-up care.
No single health problem compares to the threat posed by HIV/AIDS to development within my country or in the Caribbean region. Despite early recognition by the Government, the disease has spread to the general population through heterosexual contact and by the infection of children from mothers. A National Standing Committee for the Prevention and Control of AIDS was established in the Bahamas in 1985. The programme is now a sophisticated multi-sectoral response involving the public and private sectors.
Since prevention and care are inextricably bound, it has been recommended that the Bahamian HIV/AIDS treatment, research and training facilities become a regional training centre. The Government has offered to undertake actions in that direction. In January, training assistance was given to the two sister Caribbean countries of Antigua and Barbuda, and Belize. Such programmes deserve funding by international donors through the Global Fund.
CARLOS LAGE DAVILA, Vice-President of Cuba: A few -– the privileged and rich -– have managed to reduce mortality through the use of drugs with high and irrational prices. Many others –- the unfortunate and poor -– are facing a harrowing drop in the average life expectancy of their peoples, and a demographic decrease that could lead them to extinction. There are 2,565 people with HIV in our country, of whom 388 have developed AIDS.
Our programme to fight AIDS guarantees comprehensive care and support for all those with HIV/AIDS, free treatment and anti-retroviral drugs. We have specialized medical care centres for those who need them, and are trying to ensure full social integration of people with HIV/AIDS. All blood donations are tested for AIDS, hepatitis and other diseases. Voluntary testing is provided for pregnant women. A prevention and education campaign has also been initiated, aimed at high-risk groups, youth and the population as a whole. As a result, we have the lowest rate of infection in the Americas and one of the lowest in the world. We have contained the epidemic.
The Secretary-General has proposed raising between $7 and 10 billion for the fight against AIDS. This amount is not sufficient, and money alone cannot solve the problem. But this is a necessary beginning. Is it conceivable that this money cannot be raised in a world that spends 40 times more than this on illicit drugs, 80 times more on military budgets, and 100 times more on commercial advertising?
The wealthiest, most powerful nation in history, fails to comply with its financial obligations to the United Nations, tries to reduce its contribution to the World Health Organization, devotes less than 0.2 per cent of its gross domestic product to development, and votes alone against a resolution that enshrines the right of all people to access to AIDS drugs: nothing more needs to be said to make clear that the current international economic order is criminally unjust. This special session should proclaim that drugs to fight AIDS and other vital drugs cannot be protected by patents. Profits cannot be made at the expense of human lives. It should also proclaim immediate cancellation of external debt of the poorest countries. The Group of Seven, at its next meeting, should agree to reduce military spending and to raise at least the $10 billion requested by the United Nations. This is but a fraction of the social debt to the Third World.
On behalf of the Government of Cuba, I have been charged with offering to the poorest countries 4,000 doctors and other healthcare workers; professors to create 20 medical schools; educational specialists; equipment and diagnostic kits for basic prevention programmes; anti-retroviral treatment for 30,000 patients. The international community would have only to contribute the drugs, equipment and material resources needed for those products and services. Cuba would pay the participants’ salaries.
ERIYA KATEGAYA, First Deputy Prime Minister of Foreign Affairs of Uganda: My country, which was the "epicentre" of the epidemic in the mid-1990s, is today frequently cited as a "success story". Yet whatever considerable dent has been made in the spread of the disease is merely modest progress. There is no room for complacency. We must continue to reach out to communities -- urban and rural -- with advocacy and social mobilization for the fight against HIV/AIDS.
HIV prevalence in Uganda has declined from an average of 18.5 per cent in 1993 to 8.3 per cent in 1999 and 6.2 per cent in 2000. Since our people have grappled with the disease for nearly 20 years, we therefore largely know what works. A number of factors are clearly unique in our response to the pandemic. It was recognized at an early stage that HIV/AIDS required a multi-sectoral approach. In addition, the fear, panic, denial and stigma as well as discrimination have now been dramatically reduced. President Museveni has also adopted an attitude of openness about the disease. The involvement of people living with the disease is also critical in the mobilization and awareness campaign. Uganda is now poised to intensify and accelerate activities that have proved effective, and pledged $2 million as a contribution to the Global Fund for Aids and Health.
Declining trends must be accelerated towards zero-prevalence. Innovative strategies must be found to accomplish the daunting task of behaviour management. Cultural and religious values must be taken into account if interventions are to succeed. We must also plan comprehensively for effective strategies to address the critical issue of the AIDS orphan crisis. Prioritization of AIDS issues in poverty-eradication programmes is fundamental to addressing the epidemic as well. National government and global disease must provide the national resources for increased demands.
African countries will need long-term international financing arrangements in order to have viable sustainable growth, generate adequate resources and build capacities for poverty eradication and combating HIV/AIDS. Equitable access to effective treatments is an urgent necessity. Future strategies must include accelerated vaccine development -- the ultimate weapon against HIV.
ANNE KRISTIN SYDNES, Minister of International Development of Norway: We welcome recent progress in making AIDS-related drugs more accessible and affordable. We must push on to deal with structural and systemic barriers to such access. The pharmaceutical industry must be held morally responsible. However, drugs alone will not bring us victory. Even much cheaper drugs must still be paid for, delivered and administered. Patients must receive treatment and care. It is irresponsible to talk about drugs without talking about additional resources and health delivery systems.
Prevention must remain the mainstay of our response to halt the spread of AIDS. At the same time, we must assume responsibility for those already infected. Young people must be given tools and life skills to protect themselves, and condoms must be widely available and affordable. We must increase efforts to prevent mother-to-child transmission, and women must be empowered so that they may truly protect themselves. We must promote male responsibility and harness the desire of trade unions to protect their members and the interest of employers in protecting their workers. No government can deal with the challenges of the epidemic alone. It requires an extraordinary partnership with civil society and the private sector.
The counter-offensive against AIDS cannot be won without a bigger war chest. We welcome the proposal for a new global fund on AIDS, tuberculosis and malaria. The operational framework must be set out in close cooperation with the developing countries most affected. The Fund must tie in with and complement existing efforts and structures, particularly the UNAIDS umbrella. My Government pledges an additional one billion Norwegian Kroner (approximately $110 million) over the next five years to international efforts against HIV/AIDS, tuberculosis and malaria.
COLIN L. POWELL, Secretary of State of the United States: The promising new century has arrived at the time of plague, and humankind has just begun to grasp the full implications of the HIV/AIDS epidemic. AIDS respects no man, woman or child. No community, country or continent is immune from its ravages. Our response to AIDS must be no less relentless and swift than the disease itself. New thinking and concerted action are needed to confront the problem. Only through sustained international cooperation can we address the spread of AIDS.
For its part, the United States has announced a contribution of $200 million to jump-start the global fund to combat HIV/AIDS, tuberculosis and malaria. The United States continues to be the largest bilateral donor to the efforts to overcome the epidemic. In his request for the budget for the next fiscal year, the President has requested $680 million for this purpose, and $3.4 billion is being requested for AIDS research. The country is also committed to being at the head of research. A special task force has been established to ensure comprehensive and coordinated efforts, which are needed to combat the global scourge.
No war on the face of the world is as destructive as the AIDS pandemic, and the war against AIDS has no frontlines. Only an integrated approach makes sense, which should include treatment, care of orphans, prevention of transmission from mother to child, medical training and research. Unless a strong emphasis is placed on prevention, the pandemic will continue to rage without control. Everyone can and must be a leader in the fight against AIDS. My nation is prepared to play a leadership role in this war. Corporations must also step to the challenge, and I urge all nations to join international efforts and make substantial pledges.
The global fund is not only for big donors. UNICEF is also trying to raise money. Leadership also comes from NGOs, individuals and religious organizations. Silence kills, and breaking it is a powerful tool in combating the disease. Courage is needed, or more people will die. Our enemy is the virus –- not the people who carry it. Those with AIDS must be treated with dignity, instead of disdain. Many speakers have noted the dreadful toll of the disease, but after
10 or 20 speeches, the impact of the awful numbers begins to dull. However, in some countries the infection is so high that one in three people will be HIV-positive. We must not let the disease rob us of our future. We must act, and we must act now. We must not fail the people of the world who are looking to us for leadership.
MANTOMBAZANA TSHABALALA-MSIMANG, Minister of Health of South Africa: our country is one of the most affected by HIV/AIDS and has had to contend with this catastrophe against the background of pervasive poverty, underdevelopment and a range of other public health challenges. Fundamental among the strategies before us is the need to anchor our efforts in strong preventive programmes, with a specific focus on the empowerment of women and the girl child and ensuring that men become part of the solution. Our national programmes incorporate all of these elements.
Programmes to reduce mother-to-child transmission pose significant challenges in developing countries, where breastfeeding is the norm and lack of access to safe water and sanitation is a reality. Thus, South Africa has embarked on a programme at selected sites in all of our nine provinces to provide a package of care for pregnant women who are HIV positive. Concerns raised about the emergence of resistant viral strains following exposure to the drug will be examined at these pilot sites. Let us continue to support scientific inquiry, and let us not forget that some simple interventions, such as the management of opportunistic infections and the provision of nutritional support for infected individuals, significantly affect the quality of life. Also, let us not shy away from the simple truth that many facets of the virus need further elucidation.
Our task is to mobilize the resources needed for a comprehensive programme. We should assist formal and informal social support networks, since the greater involvement of communities, especially people living with AIDS, is key to our success. AIDS is a global crisis in which no one country has the luxury to "opt out". What may seem to be an act of generosity may in fact be enlightened self-interest. In this regard, we should leverage and strengthen regional efforts. The growing number of pledges to the global AIDS fund is welcome and we eagerly await its escalation in keeping with the magnitude of the problem. Affordable access to pharmaceuticals is a basic requirement if this century is truly to be an African century.
ABDUL MALIK KASI, Minister for Health of Pakistan: HIV/AIDS is no longer a health problem; it has become a security issue, with millions of people on the verge of extinction. Yet resources devoted to combating the epidemic at both national and international levels are not commensurate with the magnitude of the problem. Last year only $1 billion was spent on combating the pandemic in developing countries -- a sum totally inadequate to cope with the challenge. The Global AIDS Fund launched by the Secretary-General thus lays out a solid foundation on which a global response to HIV/AIDS should be built. We hope that with generous contributions, the Fund will eventually add $7 to $10 billion annually to the current level of spending.
While we welcome the representatives of the international pharmaceutical companies here today, we urge them to consider HIV/AIDS as a humanitarian issue and not a commercial venture. Human life is much too precious to be used for profit. We hope that besides making generous contributions to the Fund, they will complement it by providing treatments for HIV/AIDS, at least to victims in the least developed countries (LDCs) of sub-Saharan Africa, at affordable prices. The pandemic in Africa is also the cross-cutting theme of this session, since the continent is the most severely affected and the one where combating the disease is proving the most difficult task.
We fully agree with the observation of the Secretary-General that Asia must act upstream to prevent new infections, rather than reacting downstream to the impact of HIV/AIDS. This should not, however, distract the international community from the need to plan an effective campaign to combat the pandemic in South Asia. Since the diagnosis of the first AIDS case in Pakistan in 1986, the challenge to address the disease has been taken seriously. My Government recognizes that HIV/AIDS poses a potentially serious threat to the health and well-being of our people. While prevalence rates are currently low, we know we must take preventive action now to control the epidemic from spreading and devastating lives. We are proud to say that our Government has put the building blocks of a strong prevention programme in place.
JON KRISTJANSSON, Minister of Health and Social Security of Iceland: Although drugs against AIDS can save lives and reduce the odds of infected mothers passing the disease on to their children, they will not work unless they reach the people who need them. This is only possible if the health services of the afflicted countries are functional. Drug treatment of HIV infection is not a simple matter and health services must be strengthened; otherwise we will not make progress.
Some success has been achieved in the struggle in the fight against AIDS. This has been achieved by improving the conditions of women; the dissemination of knowledge about the transmission chain and how to break it; recruiting young people in the struggle against the pandemic; and making drug treatment available to those in need. It has also been achieved through the active participation of HIV-infected people in the struggle against the disease and governments leading the way, and actively supporting preventive measures and treatment.
The struggle now is to keep the epidemic in check and reduce it where possible. Governments of all countries will therefore have to take the initiative regarding long-term plans designed to reduce the social and financial impact of the epidemic. They also need to take steps to improve the position of social classes which are disadvantaged, and therefore at a greater risk of infection. They need to promote the achievement of goals established in the fight against the epidemic. It is also necessary to encourage the development of drugs and vaccines against the HIV infection and ensure the availability of sufficient resources for the campaign against the epidemic
Iceland is now supporting the initiative of the Council of the Baltic Sea States on Communicable Disease Control in the Baltic Sea Region, both financially and with medical expertise. My Government will also support the Declaration from this special session.
HANSJORG FRICK, Minister for Public Health and Social Affairs of Liechtenstein: the epidemic has to be addressed in different ways in different countries and regions. The underlying issues of a structural nature, such as poverty and education, pose enormous difficulties in certain countries and regions, while in others they are less important factors. Cultural factors are important everywhere, but they are not the same everywhere. The groups and individuals at particular risk also vary from country to country and from region to region. Thus, an approach which is effective in one country may be misdirected somewhere else.
Prevention is indeed the core of an effective response to halt the spread of HIV/AIDS. This approach has proved effective not only in our region, but also in many other countries. Prevention is based on information and education, access for everyone to related services and the promotion and protection of human rights. It requires openness and the political will to address the real issues and their root causes as well as the ability to recognize that marginalization and stigmatization of infected persons only exacerbate the crisis and contribute to further spreading the disease.
Clearly, prevailing local and national circumstances have to form the basis of all prevention strategies, particularly the identification of groups at special risk. Government action and leadership are critical, as is the involvement of civil society, particularly people living with HIV/AIDS. The focus on prevention should not undermine the attention given to the issue of care and treatment. Access to medication is certainly the key issue in that respect. The human right of every individual to the highest attainable standards of health could and must be reconciled with the existing legal standards in the area of intellectual property rights.
VITALIY MOSKALENKO, Minister of Health Care of Ukraine: At present there are more than 38,000 officially registered HIV-infected people in Ukraine. These include 2,000 people living with AIDS; of those, more than 1,000 have already died. The President and the Government of Ukraine have defined the fight against HIV/AIDS as being among the most important priorities of our national policy. The decree signed by the President in 2000, which provides for the implementation of emergency measures aimed at preventing the spread of HIV/AIDS in Ukraine, testifies to his commitment to addressing this global challenge.
The national strategy to address the epidemic is based on the establishment of a variety of national institutions covering the whole socio-humanitarian sphere, as well as developing effective cooperation with the international community and close collaboration with NGOs. National policy in this sphere is implemented by the special Government Commission on HIV/AIDS Prevention, which coordinates all aspects of the response against the disease. A network of health-care institutions for HIV/AIDS patients has been established, and measures are being implemented to prevent mother-to-child transmission of HIV.
The HIV/AIDS epidemic struck Ukraine immediately after the Chernobyl catastrophe, which resulted in weakened immunity of the entire population. Clearing up the aftermath of the accident and the closure of the Chernobyl plant require significant resources. We therefore call on the international community to assist Ukraine in the implementation of the large-scale activities aimed at addressing the HIV/AIDS epidemic –- whose destructive power could exceed the consequences of the Chernobyl disaster.
CLARE SHORT, Secretary of State for International Development of the United Kingdom: We have no reason to congratulate ourselves on the holding of this meeting. We have been aware of the infection for 20 years, and have known that it was spreading out of control for at least 10 years. We must not fool ourselves that the holding of a United Nations special session leads to any automatic improvements in prevention or treatment. Indeed, it is my strongly held view that we waste too much time and energy in United Nations conferences and special sessions. We use up enormous energy in arguing at great length over texts that provide few, if any, follow-up mechanisms or assurances that governments and United Nations agencies will carry forward the declarations that are adopted.
Prevention has remained crucial, because there is still no cure for HIV/AIDS. We must, of course, press on with research for a vaccine and for microbicides. We must make anti-retroviral drugs available, where we can do so responsibly. But let no one pretend that anti-retrovirals are a cure, or that whatever the price, most people who are infected will receive them. The truth is that most people who are infected are not served by any basic health-care system, and most suffer with poor nutrition and little basic care. We must do more to make condoms and drugs available -- but be absolutely clear that without a much greater commitment to building basic health-care systems, most of the more than
30 million people already infected will not be helped.
The proposed Global Health Fund is designed to provide drugs and commodities for the treatment and prevention of HIV/AIDS, tuberculosis and malaria. It cannot fund the development of health systems. But the Fund can ensure that drugs are available at reasonable prices, and encourage the development of effective delivery systems. We want to model the Fund on the success of the Global Vaccine Initiative (GAVI). To be successful, the Fund needs a small, effective secretariat and a lean governing body that includes representatives of the United Nations system, development agencies and developing countries. My Government stands ready to contribute $200 million to the Fund if these conditions can be agreed.
ARTURO VASI PAEZ, Vice-Minister of Health of Peru: the task ahead of us must be governed by the full understanding that it is a problem of global nature. Prevention, support, care and treatment must be dealt with in an integrated manner, since each of them reinforces the others. It is also essential to indicate that the reduction and elimination of this phenomenon inevitably must involve a frontal attack in all regions of the world, without exception. The nature of the problem, and its profound linkage with elements which are theoretically preventable -- but which in practice are beyond the control of public health measures -- have transformed our understanding of the health-illness binomial.
In response to the epidemic, Per
