ADDRESSING GLOBAL CHALLENGE OF AIDS, SECRETARY-GENERAL STRESSES THAT WALL OF SILENCE AND PREJUDICE SURROUNDING DISEASE MUST BE TORN DOWN
Press Release
SG/SM/7045
ADDRESSING GLOBAL CHALLENGE OF AIDS, SECRETARY-GENERAL STRESSES THAT WALL OF SILENCE AND PREJUDICE SURROUNDING DISEASE MUST BE TORN DOWN
19990625 Kofi Annan Notes Devastating Effect of AIDS on Africa; Challenges Business To Take Measures to Combat Disease; Summarizes UN-System AIDS-Related InitiativesFollowing is the text of the first Diana, Princess of Wales, Memorial Lecture, entitled "The Global Challenges of AIDS", which was delivered today in London by Secretary-General Kofi Annan:
Thank you, Professor [Michael] Adler [Chairman, UK National AIDS Trust], for that most generous introduction.
Let me also thank the National AIDS Trust for organizing this event, and for inviting me to speak to all of you today. It is a great honour.
First, of course, I am deeply moved at being asked to deliver the first lecture in memory of Diana, Princess of Wales. Today, we pay tribute to Diana's name; but more than that, we give thanks for her life, and for what she did to improve the lives of so many others.
It is also an honour to address you within the hallowed halls of the Bank of England. Not many outsiders are given such access to the venerable "Old Lady"!
But above all, I am grateful for this opportunity to speak about the global challenge of HIV-AIDS, which ranks very high among the current concerns of the United Nations.
In fact, there can never have been a disease that is so international.
I want to speak particularly about the devastating impact of AIDS on the developing world - especially on Africa. But I also want to tell you some good news -- about new kinds of cross-border and cross-sector partnership, which are making the world a better, safer place. And I want to tell you how business leaders, in particular, can and must respond in larger numbers and more varied ways to the challenge of the AIDS epidemic.
Some may think that because better medicines have been found, the AIDS emergency is over. Alas, no. There is still no cure for AIDS. The advance of HIV has not been stopped in any country. Even in the industrialized world, the rate of new infections has held steady for the last ten years.
In short, the AIDS emergency continues - and it continues to grow.
But my friends, we are not powerless against it. Together we can fight this epidemic. But to do so, we must first fight the conspiracy of silence and prejudice that has for too long surrounded it. For those living with HIV and AIDS, this conspiracy is an enemy no less deadly than the disease itself.
Let us begin by admitting some hard facts:
-- AIDS is far more than a medical problem.
-- AIDS is far more than a national problem.
-- AIDS is far from over.
Today, more than 33 million people are infected. More than 14 million have died. Already by the end of 1997, more than eight million children had lost their mothers to AIDS.
And the epidemic is expanding in new directions -- for instance into Eastern Europe, where even five years ago the virus was still almost unknown.
In India, HIV is now firmly embedded in the general population. It is spreading even into rural areas that were thought to have been spared. In the southern state of Tamil Nadu, which has a population of 45 million, a survey revealed last year that almost half a million people are already infected, and that the infection rate is now three times higher in villages than in cities. India as a whole now has more people living with HIV than any other single country in the world.
In East Asia and the Pacific, new HIV infections rose by 70 per cent between 1996 and 1998.
Unless we act fast, these regions could soon face a crisis comparable to what we already see in many parts of Africa, where whole nations now live under the shadow of AIDS.
A child born during the next six years in Botswana should have had an average life expectancy of 70 years. Thanks to AIDS, that child will in fact have an even chance of dying by the time he or she is 41.
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Every minute that passes, as you and I go about the routine business of our lives, four or more young Africans are infected.
And every day, Africa buries five and a half thousand of its sons and daughters who have died of AIDS.
This is not only an unspeakable tragedy for so many individuals and their families. It is also devastating to the economies of their countries. AIDS is unravelling fragile and hard-won success stories throughout the developing world. It is taking away both breadwinners and those who look after the young, the old, and the infirm. It is destroying the very fabric of society.
Already in 1997, Nelson Mandela warned the Economic Forum in Davos: "AIDS kills those on whom society relies to grow the crops, work in the mines and the factories, run the schools and govern nations and countries."
In his country -- the same South Africa which became such a lodestar of hope to all Africans five years ago -- one in five pregnant women is today infected with HIV.
Africa's health sector is consumed with caring for people with AIDS, at the expense of other needs. In some countries, AIDS-related costs will soon absorb half or more of health budgets.
In the Ivory Coast, a teacher is dying of AIDS every other day.
Throughout southern Africa, girls are taken from school to nurse their dying parents. Boys leave school to look after their orphaned siblings.
The vulnerable position of women leads to an increase in infections among them, which in turn leads to an increase in infections among infants. This leads to a double or triple burden for women, since they must care for their sick husbands and children at the same time.
And so it goes on. Driven by poverty, AIDS leaves society even poorer, and thus even more vulnerable to infection. It brings in its wake discrimination, prejudice, and often violations of human rights.
In this way, AIDS is taking away not only Africa's present; it is taking away Africa's future.
The economic impact of AIDS ranges from the global to the local, from financial forecasts to the factory floor. A Kenyan business survey found that HIV/AIDS costs companies nearly 4 per cent of their annual profits, and that by 2005, thanks to AIDS, Kenya's gross domestic product will be 15 per cent smaller than it would otherwise have been.
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The effects on individual firms can be crippling. Africa's businesses must cope with increased absenteeism, the decline of an already limited skilled labour force, and higher payments for sickness, disability and death.
These micro-economic effects have already been felt, to some extent, by all companies in all developing countries. Cumulatively, they have a severe macro-economic impact, which is felt even in the industrialized world.
Africa, once eagerly anticipated as a market by potential trading partners, is now unlikely to play this role for years to come, as AIDS siphons off its resources. And if the Asian epidemic continues expanding, trade with Asia too will suffer, as the millions of infected people begin to fall ill and die.
It seems an unending downward spiral of death and despair.
In the words of my colleague Dr. Peter Piot, the head of The Joint United Nations Programme on HIV/AIDS (UNAIDS), the epidemic has become "a permanent challenge to human ingenuity and solidarity".
This challenge cannot be met without resources. Clearly the 150 million dollars a year currently being spent on AIDS in Africa comes nowhere near what is needed. To carry out a minimally effective package of interventions, the affected countries would require at least a six-fold increase in resources.
In this country, and elsewhere in the prosperous West, drug "cocktails" have made a huge difference - even though HIV mutates so fast and so effectively that researchers and clinicians are hard pressed to keep ahead of it. But even if the cocktail were medicine's answer to AIDS, it is at present far beyond the reach of the countries where answers are most desperately needed. For most people living with HIV/AIDS today, the ten-thousand-to- sixty-thousand-dollar annual price tag of an anti-retroviral regime belongs, quite simply, in a different galaxy.
One of our aims must be to bring it down within their reach. We must find low-cost, effective therapies that developing countries can afford - for instance, to prevent mother-child transmission and to fight AIDS-related infections like tuberculosis. We must strengthen health systems to deal with the increased demand.
This is particularly urgent in sub-Saharan Africa, where the largest number of AIDS patients live, health systems are weak, and the ability to pay is very low. Experience in several countries is beginning to show that it can be done.
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But, whatever our success in improving and increasing treatments, our strongest hope and our prime objective must be to prevent people becoming infected in the first place.
The missing piece, the secret weapon we crave remains an effective vaccine. To find it will take patience, commitment and funds. But we must keep trying.
The many scientific and ethical challenges involved can only be met through global collaboration between government, academia and industry. UNAIDS and its co-sponsors are working on many fronts to speed up development of new vaccines, and to find scientifically and ethically appropriate ways of testing them, for the benefit of the developing world.
For example, the UNAIDS secretariat is helping to ensure that pharmaceutical companies use HIV strains from developing countries as the base for the vaccines they are working on. And years of preparatory collaboration by WHO and UNAIDS helped to make possible Uganda's first HIV vaccine trial, in February this year.
The World Bank, another UNAIDS co-sponsor, is exploring the market failures which lead to under-investment in an AIDS vaccine, and designing financial instruments which should stimulate private investment.
And through its international Vaccine Advisory Committee, UNAIDS provides a forum for global planning and coordination. Research partners include the Medical Research Council of the United Kingdom, and the International AIDS Vaccine Initiative -- a truly universal partnership in which the National AIDS Trust is the United Kingdom partner.
This Initiative succeeded in raising funds from Governments, starting with the United Kingdom last year; from business leaders such as Bill Gates, who has pledged 25 million dollars; and from society at large.
More and more people are coming to understand that "AIDS is everybody's business". That is the motto of UNAIDS, the partnership which brings together seven co-sponsors from different parts of the United Nations family, with mandates ranging from health to development. The United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the United Nations International Drug Control Programme, the United Nations Educational, Scientific and Cultural Organization (UNESCO), the World Health Organization (WHO) and the World Bank are all working together, with the help of the UNAIDS Secretariat, to ensure that countries get the benefit of their combined expertise and support.
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Increasingly, UNAIDS is also joining forces with bodies outside the United Nations system -- from grass-roots activists through private and public corporations to heads of State.
In the past two decades, we have learnt from both successes and setbacks in Africa and elsewhere. We now know much more about how to prevent new infections, how to care for those with HIV, and how to alleviate the impact of AIDS on families and nations.
The challenge now is to replicate and adapt the successes, on a larger scale and in many more countries. To that end, UNAIDS is bringing together national Governments, voluntary relief agencies, pressure groups and, not least, the private sector.
As I said at the outset, the first battle we must win in the war on AIDS is the battle to tear down the wall of silence and prejudice that surrounds it.
Nowhere is this more crucial than in Africa. In the last year or so many African governments have at last come to understand that official recognition of the AIDS problem, as a first step towards dealing with it, is a way to attract potential investors, not to frighten them off. Many African leaders are now speaking out on AIDS, and making a real effort to involve all sectors of society in the battle against it.
In Botswana, a nationwide plan for combating AIDS was launched last September by President Mogae. Eighty per cent of the funding comes from within the country.
In Lesotho, the AIDS budget has been doubled.
In Swaziland, the Government has declared war on AIDS "not in words only, but in deeds".
In Namibia, the Cabinet has approved a new national AIDS programme, and in South Africa a new partnership, engaging all sectors of Government and civil society, was launched last October.
People are also becoming more and more aware that responses to AIDS must take full account of human rights. Throughout the world, people with AIDS and HIV have seen their rights violated and their fundamental freedoms curtailed.
That will only change when governments and employers, with the affected communities themselves, work together to change it. Last year, to help them do that, the United Nations published international guidelines on AIDS and Human Rights, setting out the responsibilities of both government and business. In particular, we urged the private sector to develop codes of
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professional conduct guaranteeing full respect for the human rights of all those affected by HIV and AIDS.
No company and no government can take on the challenge of AIDS alone. What is needed is a new approach to public health -- combining all available resources, public and private, and using all opportunities, local and global.
If the money is found it will not be wasted. Experience in Uganda and Thailand - to name just two developing countries - has shown that there can be real success in reducing new infections, when the scale of HIV and AIDS is acknowledged and there is a well-thought-out, well-funded prevention response.
Business can play a critical role, by providing a venue for HIV education, and by giving leadership within the wider community.
A leading British company, Glaxo Wellcome, has launched "Positive Action", an international fund which has so far invested over 25 million pounds in community and partnership projects. To give one example, it has helped fund a four-year programme of prevention and therapy for selected groups of patients in the Ivory Coast, with emphasis on preventing infected mothers from passing HIV to their infant children.
So there is one business, at least, which has understood that AIDS is indeed "everybody's business". Happily, it is not alone.
A Nepalese company, "Get Paper", for instance, has helped create a health promotion organization where six years ago none existed. Encouraged by its British customer The Body Shop, it started by establishing an AIDS information booth for truck and bus drivers. Today it is taking HIV prevention to 12 per cent of the country, and its efforts regularly attract foreign aid.
In Nigeria, the oil company Chevron has taken an equally imaginative and tenacious approach to HIV prevention, working to protect the community as well as its own employees.
In South Africa, Eskom, the electricity generating company, which has over 37,000 employees, made HIV/AIDS a strategic priority six years ago. As a result, it can now guarantee benefits to employees with AIDS and their families, and fund its medical clinics to cover tests, immune-system monitoring, and medical support.
In Zimbabwe, Rio Tinto has taken steps to protect its skilled workforce. It has formed volunteer, employee-led AIDS action groups to act as peer counsellors and lead education campaigns among colleagues. And it is providing condoms to the largely male staff in its mining camps, many of whom face long periods of separation from their wives.
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Last month, UNAIDS helped launch an initiative by a new partner in Africa: Bristol-Myers Squibb. This company has committed 100 million dollars over five years to a new public/private partnership called "Secure the Future", which supports medical research projects, education efforts, and social support mechanisms throughout southern Africa.
These are encouraging examples. They show that corporate engagement can make a big difference. And here I must acknowledge the pioneering work in this field done by the Prince of Wales Business Leaders Forum, which has been working closely with UNAIDS, WHO and the Global Business Council.
These actions are born neither of mere old-fashioned philanthropy, nor of narrow self-interest, but from a marriage between deeply held values and stark realism.
Increasingly, business leaders recognize that their responsibility -- and their interest -- lie not only in how their actions affect their shareholders, but in their impact on the societies in which they operate, and on the planet as a whole.
The spread of AIDS is partly a tragic by-product of globalization. At least we now see the beginnings of a global response.
So today I should like to issue three challenges to business, whether here in the United Kingdom, in other industrialized countries, or in the developing world:
-- First, embrace your workforce and their families, by working to end prejudice and discrimination against those affected by AIDS. Allow people with HIV to continue working, and so to remain useful members of society.
-- Second, do everything you can to protect the communities where you work, by preventing the spread of HIV in your workplaces and beyond. You can do this by spreading AIDS awareness and by distributing condoms.
-- And third, look to the global picture: realize the implications of this world epidemic, and join in the effort to combat it. Join forces with the many organizations, governmental and non-governmental, which are in the forefront of the fight for survival.
The struggle against AIDS is a moral imperative - who could deny it? Happily, it is also a commercial imperative. It makes good business sense.
Many of you here today represent some of the key players already acting in effective partnerships to fight HIV and AIDS. Through its work to keep a spotlight on the global epidemic, the United Kingdom's National AIDS Trust and
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its supporters could serve as a model to other countries in the developed world.
I know you still have challenges to meet here in the United Kingdom; but you have also started to make a crucial difference in some of the countries whose needs are most acute.
Together, Governments, non-governmental organizations, business and the media have an immense store of knowledge, expertise, influence and funds. The Global Business Council on HIV/AIDS, in which Glaxo Wellcome has played a leading role, is helping to mobilize these resources, notably by providing encouragement to national councils in Botswana, Brazil, Mexico, South Africa and Thailand. You in the National Aids Trust have now taken the initiative in establishing a United Kingdom Business Council on HIV and AIDS, as part of this network. I hope other countries will soon follow.
Let me conclude by repeating my most important message:
AIDS is not over. This is not about a few foreign countries, far away. It is a threat to an entire generation -- indeed, a threat to human civilization as a whole.
The question is not whether more people will die. Many more will die. The question is whether it will be only the generation AIDS is claiming now, or the next one too, and the one after that.
And finally, to Diana, Princess of Wales, were she with us today, I would say this:
You won the hearts of millions by acknowledging your own human vulnerability. And you were among the first in this country to fight the conspiracy of silence and prejudice against AIDS.
Maybe it was precisely your own vulnerability that gave you the commitment to match your compassion. Maybe that was what gave you your singular gift for listening, your need to hear and to help, your courage to speak up on behalf of the most vulnerable on this earth. Maybe that was what gave you your talent for making others want to do the same.
Perhaps it takes that special kind of sensitivity to do what Diana did. The rest of us can only draw inspiration from it. Faced with her example, we simply cannot leave the neediest on this earth to needless death and degradation. She gave too much, and cared too deeply, for us not to honour her memory with action.
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In some parts of Africa, the name for AIDS translates as "shame has fallen on the Earth". My friends, shame will indeed fall on the Earth if we turn our backs on those affected by AIDS and cast them into the shadows. Shame will fall on all of us if we do not wipe out every trace of prejudice and discrimination surrounding this disease.
Today, we have the chance to practise hard-headed realism and heartfelt idealism at the same time -- to combine self-interest with a sense of shared responsibility. It is a chance that does not come often.
For Diana, for the millions living with AIDS today, and the many more who will live under its shadow tomorrow, we must seize the chance now, or bear the shame for ever.
Is the choice really so hard?
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