AFFORDABLE TREATMENTS, EXPANDED ACCESS TO CARE, URGENT NEED FOR RESOURCES ARE MAJOR ISSUES AS SPECIAL SESSION ON HIV/AIDS CONTINUES

General Assembly Plenary

Twenty-sixth Special Session

4^th Meeting (AM)

AFFORDABLE TREATMENTS, EXPANDED ACCESS TO CARE, URGENT NEED FOR RESOURCES

ARE MAJOR ISSUES AS SPECIAL SESSION ON HIV/AIDS CONTINUES

As the General Assembly continued its twenty-sixth special session on HIV/AIDS this morning, Ireland's Prime Minister urged the international community to take the devastating impact of the pandemic into account when assessing debt relief, and even cancel the debt of those countries with a high prevalence of HIV/AIDS.

He also called on the international community to place the debate on access to medicine within a wider context of care, stating that "we must work to support the widows, orphans and the elderly, for their need for support is immediate and they cannot wait".  He expressed strong support for European Community efforts to establish a system of tiered pricing of medicines, and informed the special session that Ireland would spend an additional $30 million per year directly on helping the poorest in the fight against AIDS.

Also addressing the issue of affordable treatments, the President of the United Republic of Tanzania said that pharmaceutical companies did not really make most of their profits in developing countries.  The prices of anti-retroviral drugs should therefore be lowered further.  He asked the developed countries to agree to a mechanism which would absorb genuine losses sustained by the pharmaceutical companies.

In connection with the Secretary-General's proposed Global Health Fund, Nauru's representative submitted a proposal from her Government calling for each Member State to contribute to that Fund an amount equal to $1 per head of its population.  Her Government was ready to pledge its share, she added.

The representative of the Philippines said that an effective response to the pandemic must include attention to the plight of migrant workers and their families.  Governments must consider providing a basic minimum package of information on the prevention of sexually transmitted diseases (STDs) and HIV/AIDS and the corresponding diagnostic, early treatment and counselling services to people moving across their borders.  He hoped to see those requirements as part of this session's collective programme.

The Minister for Development Cooperation of Denmark informed the special session that in 2001 her Government would allocate an additional $9.5 million in direct support to specific preventive HIV/AIDS interventions in sub-Saharan Africa in cooperation with the United Nations system.  That amount would also rise substantially over the next two to three years, she added.

The Minister of Health and Social Services of Finland said that no single approach would contain the epidemic.  To meet all necessary demands, billions of dollars and other resources were needed.  His Government would therefore contribute some 40 million Finnish marks to UNAIDS this year.  Also, in the future, the Finnish Government intended to support HIV/AIDS programmes at a considerably higher level than in the past. 

The Prime Minister of Benin as well as the Vice-Presidents of Gambia and Panama also made statements.

Ministers and high government officials from Kyrgyzstan, Cambodia, Egypt, India, Lao People's Democratic Republic, New Zealand, Slovenia, Namibia, Croatia, Côte d'Ivoire, Monaco, Sudan, Republic of Korea, Lithuania, Russian Federation and Myanmar, made statements.

Also addressing the Assembly were the representatives of Uruguay, Syria, Bosnia and Herzegovina, Kazakhstan, Brunei Darussalam, Federal Republic of Yugoslavia, Bahrain, Greece and Bolivia.

The Assembly will continue its special session at 3 p.m. today.

Background

The General Assembly met this morning to continue its twenty-sixth special session on the review of the problem of human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) in all its aspects.  For background on the session, please see press release GA/9883 issued on 25 June.

Statements

BENJAMIN WILLIAM MKAPA, President of the United Republic of Tanzania:  For a country like Tanzania, even developing the national capacity to effectively and efficiently treat all sexually transmitted diseases, tuberculosis, malaria and opportunistic infections on our own is impossible; so is the prospect of building the national capacity for blood screening, for widespread HIV testing and counseling, for measuring viral loads in patients, for the infrastructure to deliver and monitor the dispensation of anti-retroviral drugs, and finally the cost of the anti-retroviral drugs themselves.  We thank those pharmaceutical companies that have agreed to offer the drugs at cost.  But for Tanzania, where half of the people lives on less than a dollar a day, drugs that cost a dollar a day remain only a dream for most of the victims. 

This special session should, therefore, not only make an eloquent call for help and partnership, but also determine the form it should take.  I thank those that have already made or promised contributions to the Global Fund, and I call for more to restore life.  Secondly, the least developed countries should be accorded total debt forgiveness, on the understanding that considerable relief will be directed towards combating HIV/AIDS.  Pharmaceutical companies do not really make most of their profits in those countries.  So the prices of the anti-retroviral drugs should be lowered further.  We ask developed countries to agree to a mechanism whereby they can absorb the genuine losses to the pharmaceutical companies.

There are those who say cheap drugs are not a priority for Africa.  We also do not think they are a panacea.  But we so say they are important.  Every life they extend is as important in Africa as it is in rich countries.  For every baby that is saved from being infected by its mother, we are building the foundation of the future of our continent. 

There are those who accuse the Secretary-General of raising unrealistic expectations.  To us, that is not the problem.  The real problem is lack of political will among some of the rich countries and corporations.  No, the Secretary-General is not raising unrealistic expectations.  He is only asking the world to do what is in its collective power to achieve in partnership, in human solidarity, to save millions of lives, particularly in Africa.  What are the limits of realism when nearly three million people in sub-Saharan Africa died of AIDS-related diseases last year alone, and more will die this year? 

BERTIE AHERN, Prime Minister of Ireland:  I have come to this General Assembly to pledge Ireland’s support for a comprehensive global partnership to fight the global HIV/AIDS emergency.  As part of that effort, I wish to announce that Ireland will spend an additional $30 million per year directly on helping the poorest of the poor in the fight against AIDS.

This session can be a real milestone in the battle against HIV/AIDS.  We have a United Nations Secretary-General who has led the global response, and I agree with him that leadership is the single most important factor in reversing the epidemic.  The Member States must match his determination to reach out to people in communities devastated and isolated by the epidemic, which has claimed more victims than any conflict since World War II.

I am convinced that to combat AIDS, we must accelerate and strengthen global efforts to eradicate extreme poverty.  We will not win the fight against the disease without improved international terms of trade, an end to the impossible debt burden on poor countries, increased development and the achievement of international development goals.  My Government has targeted prevention campaigns at vulnerable groups, and cases of HIV infection are now rising among heterosexuals.  These trends deeply concern me.  They show the absolute importance of continuing to work to overcome the forces of denial, prejudice and fear.

The debate on access to medicine must be placed within a wider context of access to care.  We must work to support the widows, orphans and the elderly, for their need for support is immediate -- they cannot wait.  We welcome the participation of the pharmaceutical industry in the dialogue to improve access to medicine.  We also strongly support the efforts of the European Community to establish a system of tiered pricing.  Our response to the AIDS crisis will fail without substantial additional resources.  The United Nations target of spending 0.7 per cent of gross national product (GNP) for official development assistance (ODA) is very important in this respect.  A sustained global effort to reach that target would release enough resources to fight poverty and tackle the global AIDS crisis.  And I firmly believe that the devastating impact of the disease needs to be taken into account when assessing debt relief.  If that means that the countries with high prevalence of HIV/AIDS should receive debt cancellation, Ireland would agree. 

IBRAIMOV OSMONAKYN, State Secretary of Kyrgyzstan:  The Kyrgyz Republic is on one of the main drug-trafficking routes of the world, and this has brought the spread of HIV infection through drug users.  In the last four months the number of those infected has increased 15 times in the southern part of the country.  To combat the problem, we have developed a multi-sectoral approach addressing targeted populations.  The United Nations Development Programme (UNDP), the United Nations Fund for Population (UNFPA) and the Joint United Nations Programme on HIV/AIDS (UNAIDS) have assisted with implementation of programmes.  Our Government has provided $100,000 in support of such projects, and has helped with the mobilization of funds from other donors.

There is a satisfactory programme, but it remains incomplete due to lack of funding.  For that reason, a National Strategic Programme has been developed.  Youth, IV drug users, and commercial sex workers have been targeted.  Much has been accomplished within the National Programme, but inter-governmental action would provide the most efficiency.  Central Asia has a unique opportunity to prevent further spread of the disease.  For that reason, regional conferences have been held in preparation for the special session of the General Assembly.  The governments involved are ready to accelerate their programmes to combat HIV/AIDS.

Vulnerable groups and partnerships are priorities for future actions; the experience of Africa provides a warning to those countries that still have low levels of infections.  Preventive programmes must be expanded now.

ISATOU NJIE-SAIDY, Vice-President of Gambia:  the special session is most timely; in fact it is long overdue.  The AIDS virus is the single most significant threat to the very survival of humankind.  Last year alone, 5.6 million people were newly infected with HIV and 2.8 million deaths have occurred.  More depressing is that about half of all people who acquire HIV become infected before they turn 25 and die of AIDS before their 35^th birthday.  This age factor makes HIV/AIDS a most urgent problem for all nations.  Contributing to the crisis is a conspiracy of silence that shrouds HIV/AIDS. 

Countries such as ours still have a window of opportunity that is growing smaller in diameter with the passage of each day.  It is in this context, therefore, that the special session provides the framework for efforts at the global, regional and country levels.  The Health for Peace Initiative proposed by my Government was launched in Dakar, Senegal, last November.  This Initiative is about enhancing partnership and peace in our subregion through the promotion of health and the prevention of epidemics. 

The Government, in collaboration with civil society organizations, has worked tirelessly to educate and create awareness on HIV/AIDS.  Religious leaders, community and political leaders, and women’s and youth groups have all been sensitized on HIV/AIDS prevention and control.  These efforts, coupled with our resolve to strengthen the health care delivery system and other related institutions, such as the Department of State for Education, augur well for our fight against HIV/AIDS. 

However, there are still some who even question the very existence of HIV.  This form of denial only inhibits the maintenance of positive behaviours and attitudes necessary for the prevention of infections and diseases.  Denial only breeds complacency with all its negative consequences.  Another inhibiting factor is the assumption that HIV/AIDS is a matter exclusively for the Department of State for Health.  This is largely why the Government, in collaboration with the World Bank and other partners, has developed the HIV/AIDS Rapid Response Project. 

ARTURO VALLARINO, Vice-President of Panama:  We have all agreed that the disease does not respect national borders and is not limited to exclusive social groups.  Any State action to deal with the pandemic must go hand in hand with a social contract defining the rights of citizens, including those affected by AIDS. We must also educate our people from an early age to effectively eradicate the scourge.  A large number of young people being infected by AIDS testifies to the fact that it is necessary to pay special attention to the types of behaviour which lead to infection. 

My Government has chalked up some achievements in the fight against AIDS, including the improvement of social attention to those suffering to the disease. Our health policies stress prevention, research, treatment and psychological support.  In January 2000, AIDS was declared a State problem.  Recently, a law on AIDS was passed, and a national programme against HIV/AIDS is being implemented.  The key to future success can be found in the citizens’ awareness and human solidarity.  It is important to stress that no person can avoid his or her responsibility in the fight against AIDS.  Community involvement is also important. 

In the more advanced countries, the fight against AIDS is easier due to the availability of resources.  The proposed world fund for HIV/AIDS will foster the development of projects linked with the problem.  However, it needs to be fair and non-exclusive in allocation of resources.  In the meantime, each country must promote policy of social responsibility to raise the resources needed to alleviate the impact of the scourge.  Not a single cooperation instrument should be ignored.

HONG SUN HUOT, Minister of Health and Chair of the National AIDS Authority of Cambodia:  Since HIV was first diagnosed in Cambodia in 1991, the country has experienced a rapid rise in infections.  Response has come from the national level, with the King and Queen working to reduce the stigma of people living with the disease and the legislature working to ensure their rights.  From civil society, the private sector, Government ministries and the communities, a multi-sectoral approach is being fostered.  The country is now considering HIV/AIDS as a development issue as well.

However, these efforts are in urgent need of resources and capacity development.  Intensified awareness-raising, education and treatment for young people –- especially for young girls -– need to become an increased priority.  Our next goal is to provide care to those who are already infected and for whom facilities and affordable drugs are needed.  Community support systems also need to be strengthened. 

Cambodia fully supports the global fund to fight HIV/AIDS and endorses the Global Declaration of Commitment.  There is no room for complacency:  efforts against AIDS must expand.

BRUNO AMOUSSOU, Prime Minister of Benin:  Benin has great hope in the present session.  My country has a population of 6.2 million and had its first case of HIV in 1985.  The prevalence of HIV/AIDS has increased tenfold over the past 10 years and primarily affects young people.  It has had an impact on health expenses and compromises the achievements of development.  It has caused Benin to elaborate a strategic national plan covering the period 2001-2005 to combat HIV/AIDS. 

A glance at the evolution of the pandemic in Africa reveals that it is impossible to tackle it with isolated actions.  It is this reality that led African leaders at the Abuja Summit in April to take a decision to act, and to act together.  There is a shared political will on the continent to assign to the struggle the attention it deserves.  It is also important for the international community to commit to help not only national efforts but also regional programmes in Africa.

The implementation of all these actions requires effective logistical support and adequate financial resources.  Benin, placed on the list of least developed countries (LDCs), would not have been able to evolve a national response to AIDS without the support of its development partners.  I would like to make a special mention of UNAIDS and its Executive Director, Peter Piot, for the attention they have given to my country's efforts.

Benin decided to use part of the funds saved from the lightening of its debt burden in the fight against HIV/AIDS.  Around $3 million had been allocated to national efforts.  Benin welcomes the initiative of the Secretary-General to create a Global Fund and hopes that the Fund will be fed by additional resources  -- and not by reassignment of funds allocated for development aid. 

ISMAIL SALLAM, Minister of Health and Population of Egypt:  Poverty and bad socio-economic conditions are accelerating the spread of AIDS in poor countries. Prevention should take priority and affordable therapy should be available.  Weak health infrastructure, however, seriously limits those measures, and its strengthening needs to be a priority.  Health policies for under-privileged groups should also be carefully addressed.  The empowerment of women is particularly important. 

In addition, research should be encouraged, and, most importantly, we must solve the problem of affordable and accessible medicine.  A realistic approach must be developed.  We believe that a partnership between multinational and local pharmaceutical industries could be one of the most promising solutions for this major problem. 

It is important to ensure a sustainable, holistic, multi-sectoral approach to the entire problem, integrating the efforts of non-governmental organizations (NGOs).  Those are especially important for under-privileged and inaccessible groups.  Moral and religious values have protected many countries, and we should not omit these resources when they are now desperately needed.  Finally, financial support is a major limitation to all our strategies.  For that reason, the development of a global fund is a good start.  But sustainability, effectiveness and correct priority determination must be ensured.  Egypt will work with solidarity towards this noble cause.

SONIA GANDHI, Leader of the Opposition in the Parliament of India:  Sub-Saharan Africa has borne the brunt of the epidemic so far, but its ravages are beginning to be felt in Asia and elsewhere.  To prevent the high prevalence rates now seen in Africa, the declaration we adopt must address the needs of all affected countries.  The thrust of our global effort should be on prevention, not restricted to the high-risk groups, but reaching out to all sections of the population, particularly such vulnerable groups as students, youth, migrant workers, rural women and children.  Large-scale prevention programmes can be put into operation only by involving community representatives and grass-roots democratic institutions, and, with them, leaders from social, cultural and faith-based groups.  The aim should be to bring about a behavioural change among people at large.

Resource-poor developing countries need strategies different from those followed in the developed world -- strategies rooted in their socio-cultural environment, with communication strategies tailored to the sensitivities of people in traditional societies.  While the civil society has an important role to play, where it is weak or ill-organized, Governments have an even more crucial part. 

In India, we have an all-party consensus on this issue.  We also have a scientific methodology to monitor prevalence levels in the general population.  While prevention is paramount, care and support for those infected cannot be secondary in importance, or restricted only to the provision of medical services. Support from the family and the community at large is vital. 

The introduction of anti-retrovirals presents a serious challenge in India.  Substantial additional resources are needed through international funding over at least a decade.  The issue of additional resources, as identified in the Secretary-General’s report, is the most critical.  The special session is topical in view of the recent commitment to create a global mechanism to fund HIV/AIDS programmes in developing countries.  The norms for eligibility for this fund must be flexible, its resources must be equitably apportioned, and it should be designed to serve the needs of all regions of the world carrying high burdens of the disease. 

PONEMEK DALALOY, Minister of Public Health of the Lao People’s Democratic Republic:  The first case of HIV was detected in my country in 1990 and the first case of AIDS in 1992.  By December 2000, there were 717 cases of HIV and 190 cases of AIDS, and there has been a slow increase in infections.  Despite the low prevalence of AIDS in the country, we recognize that as a full member of the Association of South-East Asian Nations (ASEAN) and a land-locked country, we are increasingly a transit country and we are seeing increasing tourism.  Since Asia is, after Africa, the most vulnerable region, the threat must not be under-estimated. 

The emphasis in our national HIV/AIDS policy is prevention through the promotion of safer sexual behaviour.  While addressing the issues of care, support and mitigation and not stigmatizing the high-risk groups, we will focus on primary prevention.  We are committed to the concept of safer sexual behaviour.  This includes making condoms available in 100 per cent of risky sexual situations, as well as frank and explicit health education aimed at high-risk groups, school children and the general population.  The risk of not disseminating correct information is too high.  Voluntary testing, counselling, care and support all have a role, but our emphasis must be on prevention through safer sexual behaviour. 

ANNETTE KING, Minister of Health of New Zealand:  Prevention and treatment of HIV/AIDS will work only if we are prepared to be honest about who is at risk, and about how we can effectively respond.  Political leaders must provide leadership.  In order to do that, they must constantly learn and be able to adapt programmes and policies.  In New Zealand, prevention targeted to the most-affected groups involved heated debate, but it worked.  Hiding behind taboos about prostitution, sex before marriage, the use of condoms, homosexuality, and drug use by injection will doom millions. 

The fight must be on many fronts.  Heterosexual transmission is the major challenge worldwide and, therefore, women’s voices must be listened to.  Discriminatory attitudes towards people with HIV and AIDS must be honestly addressed.  While prevention is the key, treatment is also important. 

New Zealand supports the right of developing countries to utilize all available avenues to them, within international law, to obtain affordable drugs.  It calls for a focus on small nations, particularly those in the Pacific, where the growing risk of an uncontrolled epidemic needs attention at the highest levels. 

DUSAN KEBER, Minister of Health of Slovenia:  Slovenia is a low-level epidemic country.  Far less than one individual per 1000 inhabitants is living with HIV/AIDS.  In contrast with many other countries of Central and Eastern Europe, there is as yet no evidence of a rapid spread of HIV/AIDS among the growing population of injecting drug users and their sexual partners.  The latest national strategy for HIV/AIDS prevention and care has been adopted at the multi-sectoral national conference in 1995 and confirmed by the Ministry of Health in 1996. 

The Government of Slovenia has responded early and effectively.  Information, education and communication activities in the country have aimed at reducing risk-taking and encouraging responsible sexual behaviour.  In addition, groups at highest behaviourial risk have been also targeted.  Men who have sex with men were supported in designing their own preventive interventions.  A network of centres for the prevention and treatment of drug addiction was established on a primary healthcare level.  The Government has also supported the NGO involvement in the programmes for injecting drug users.  Everyone in need has access to voluntary and confidential counselling and HIV/AIDS testing, effective treatment for sexually-transmitted diseases and high-quality care for HIV/AIDS.

There is no room for complacency.  Current activities need to be sustained and strengthened.  We are fully aware that investment now will result in a lower HIV/AIDS burden in the future.  Slovenia is ready to share its knowledge and experience with other countries, and to participate in any regional and global initiatives for developing effective strategies in response to the epidemic.

LIBERTINA AMATHILA, Minister of Health and Social Services, Namibia:  That the protection and fulfilment of human rights is essential in the context of the HIV/AIDS epidemic.  My Government has thus developed a policy and legal framework in partnership with civil society.  This provides a rights-based approach to the epidemic and outlaws discrimination on the basis of infection.  A Namibian HIV/AIDS Charter of Rights was also adopted in December 2000.

Since independence in 1990, the Government has consistently allocated no less than 15 per cent of its operational budget to health.  A substantial part of this budget is spent on HIV/AIDS prevention and treatment programmes.  The pandemic is also adequately covered in our Second National Development Plan.  In addition, at the regional level member States of the Southern African Development Community (SADC) have taken joint initiatives including the SADC Multi-Sectoral HIV/AIDS Strategic Framework and Programme of Action 2000-2004.

My delegation calls for research in the development of vaccines against HIV strains prevalent in the regions most affected by the pandemic.  Life-saving drugs must be made available and affordable to those most in need.  National governments need to take ownership of HIV/AIDS programmes.  For developing countries to contain the spread of the epidemic, they need additional resources.  We therefore commend the initiative to establish the Global Health Fund, welcome the pledges made so far and encourage the donor community to make more contributions.  The criteria for the allocation of funds should also be based on the magnitude of the problem and not on the perceived level of country income.

ANA STAVLJENIC-RUKAVINA, Minister of Health of Croatia:  With a total of

171 AIDS cases registered between 1986 and 2000, it could be said that Croatia is a country with a low prevalence of HIV/AIDS.  Nonetheless, Croatia appears to be in the initial phase of the epidemic.  With the rate of HIV/AIDS infection increasing ominously in the region, building a committed and supportive environment is a priority for many of our governments, including Croatia.  Our national policy of fighting HIV/AIDS has been in place since 1985. 

Through implementing this national policy, Croatia has devised a number of essential programmes, which include the institutionalization of treatment and awareness through the creation of a Centre for HIV/AIDS in 1986 and a Reference Centre for AIDS in 1992.  In addition, a national educational campaign was launched in 1987.  Numerous educational activities have also been undertaken in the media and publications designed for elementary school children, adolescents, HIV/AIDS patients and the medical profession.  Furthermore, Croatia has been committed to providing the best possible care for those infected with HIV/AIDS, including the provision of highly active anti-retroviral treatment fully covered by the national health insurance scheme. 

Despite relatively good results in prevention and treatment in Croatia, there remains no room for complacency.  Many factors exist in the country which favour the spread of HIV/AIDS, including high unemployment, migration and an economy in transition.  The immediate overriding task for Croatia is to develop a more multi-sectoral approach to tackling HIV/AIDS.  We agree that partnerships should be further developed, and recognize the valuable role of the private sector. 

ABOU DRAHAMANE SANGARE, Minister of State for Foreign Affairs of Côte d’Ivoire:  From the time of the first cases of HIV/AIDS diagnosed in Côte d’Ivoire in 1985, there has been a growing national response in the country, through the National Institute of Health and a central coordinating bureau.  In 1997, at the international conference at Abijan, a solidarity fund was established.  But the prohibitive cost of anti-retroviral drugs does not permit the treatment of many people.

Today, Côte d’Ivoire is extremely affected by HIV, with more than a million people infected out of 15 million inhabitants.  Because of this dire situation, many national initiatives have recently been put into place and progress has been made. 

But socio-cultural factors hamper the struggle.  In addition to behavioural patterns, the debt burden and other problems are also obstacles.  Therefore, the struggle must not only be a medical one.  The problem is one of society, of behaviour, of development and of the survival of humanity.  But, in addition, affordable medicine must be available to all those with the disease, resources must be made available and political leaders must make a renewed commitment.  We appeal to the entire international community to devote appropriate and exceptional efforts to the struggle against HIV/AIDS.

OSMO SOININVAARA, Minister of Health and Social Services of Finland: Prevention of the further spread of the pandemic should be the major focus of our response.  Quality primary health care structures are the key issue here.  A sound, universally accessible health care system, including sexual and reproductive health as well as social and psychological support and care, is a cornerstone of prevention and the basis for treatment.

Sub-Saharan Africa is the worst-affected region for the HIV/AIDS epidemic and needs to be the focus of action.  The situation has also worsened in other regions, thus calling for urgent preventive measures.  We lost many important years in prevention because of shame to call things by their correct names.  We do not have any other alternative than to overcome our taboos, like people in Africa have done in recent years.  How can prevention be successful if we do not identify the vulnerable groups and call them by their correct names?

We have learned that no single approach will contain the epidemic.  To meet all necessary demands we need billions of dollars and other resources.  To show our commitment to this task, my Government has decided to contribute some

40 million Finnish marks to UNAIDS this year.  Also, in the future, the Finnish Government intends to keep the support to HIV/AIDS programmes at a considerably higher level than in the past.  Along with the Union, we welcome the establishment of the new global fund.  We feel strongly that there should be only one such fund for this purpose.

ANITA BAY BUNDEGAARD, Minister for Development Cooperation of Denmark:  Only prevention can halt the spread of the pandemic and it must be given a clear priority.  Evidence from African countries such as Uganda and Senegal, and lately also South Africa and the United Republic of Tanzania, are encouraging in this respect.  Political leadership at all levels of society, breaking the silence and confronting stigma and denial, will eventually pay off in millions of lives saved.

We welcome the Declaration of Commitment as a comprehensive normative framework for the fight against HIV/AIDS, both in scope and in substance.  But we are disappointed by the continuing controversy surrounding human rights, and in particular the issue of gender equality and the sexual and reproductive rights of girls and women.  Inequitable gender relations and opportunities lie at the very heart of the pandemic.  Only by improving the status of women can we hope to curb the pandemic.

Now is the time to move from words to deeds.  There is a clear lack of new and additional resources.  Furthermore, we are in it for the long haul and we had better recognize it.  Denmark will strengthen efforts against HIV/AIDS, not only in health sector programmes but also in education, agriculture and other sector programmes.  In 2001, we are allocating additional funds of $9.5 million in direct support to specific preventive HIV/AIDS interventions in sub-Saharan Africa in cooperation with the United Nations system.  This amount will rise substantially over the next two to three years.

PHILIPPE DESLANDES, Government Counsellor for the Interior of Monaco:  The pandemic is an international security issue, and the heads of State of the Organization of African Unity made a statement to that effect in Abuja this year. There is a particular need to provide assistance to AIDS orphans.  Resources that may be established at the international level will be effective only if all the infected can be identified and treated, while education continues to protect the rest of the population.  The difficulty stems not only from the gap between the developed and the developing countries but also from cultural differences, which must be taken into account.  The identification of vulnerable groups is a sine qua non for implementation of both national and global plans.

Governments and citizens alike must take charge of education and information efforts.  In particular, it is important to educate girls regarding the dangers of premature sexual activity.  The use of condoms and microbicides should be encouraged.  Screening campaigns are not conceivable without guaranteed social services and access to cure.  The example to follow is Brazil, where access to triple therapy is guaranteed by the Government.  The big pharmaceutical companies must be involved in the efforts to obtain a vaccine as soon as possible.

The resources needed for the fight against AIDS are considerable, and ODA will not be enough.  We must attract private and private contributions, and Monaco would contribute to the new global health fund.  It will also provide financial support to UNAIDS.

AHMED BILAL OSMAN, Federal Minister of Health of Sudan:  We welcome the global fund to combat AIDS and hope it will be available to countries on an equitable basis.  The African continent has the lion’s share of the world’s suffering, burying three-quarters of those who have fallen in the world since the start of the epidemic.  That impact represents a severe obstacle to development.

The numbers of infected are on the increase in the Sudan as well, because of geographic and political factors and natural disasters.  Repressive measures against us are also obstacles in all areas.  In spite of these challenges, Sudan has committed itself to combating the disease.  It has participated in regional initiatives and has created a National Council to coordinate all sectors in the struggle against AIDS.  Taxes on tobacco and cigarettes will help to fund such programmes.

In these efforts, we require the support of the international community to end the war in southern Sudan, and also to end the international blockade against our country.  In addition, further regional cooperation will enhance all individual country efforts.  We are fully convinced that national success stories in combating the epidemic rely on sound programme planning and mobilization of the necessary financial support.

LEE KYEONG-HO, Vice-Minister of Health and Welfare, Republic of Korea: Bearing in mind that young people aged between 15-24 years are the most vulnerable to HIV/AIDS, special programmes targeting them should be developed.  My country has implemented various education, information and counseling initiatives for adolescents and youth.  All middle and high schools have specially trained teachers in charge of sex education and counselling for students.  In addition, we have implemented a special peer programme that trains students to educate their classmates and other youth on sexual health.

Recognizing the mutually inclusive relationship between prevention and care, and the necessity of a multi-faceted response, the Republic of Korea enacted a special law on HIV/AIDS in 1987.  According to this law, everyone, including migrant workers, has the right to a free confidential blood test.  Anyone infected with the virus can confidentially receive special care and medical treatment with Government support.  We have also encouraged and facilitated various care and treatment programmes led by NGOs, including organizations for people living with HIV/AIDS.  As a result, many infected people have voluntarily dedicated themselves to work as counsellors to or assistants for other infected people.

Information and communications technologies (ICTs) are effectively being used as a comprehensive response to the HIV/AIDS epidemic.  Web sites raise public awareness on the issue, destroy bias and stigmatism, disseminate effective prevention and care information, and provide counselling and help.  The declaration adopted at this session must be translated into meaningful action.  For this to succeed, strong cooperation at regional and international levels in the future is essential.  Furthermore, we support the establishment of a Global Health Fund and will contribute to it.

EDUARDAS BARTKEVIČIUS, Vice-Minister of Health, Lithuania:  The low prevalence of HIV/AIDS in my country may be attributed to the success of joint efforts by the National AIDS Centre and other authorities, which respond in a timely manner to situation changes and take lessons from both the negative and positive experiences of other nations.  The epidemic is mainly confined to injecting drug users and their partners, who constitute the gravest threat for the immediate and explosive spread of HIV in the country.

The increase in sexually transmitted diseases (STDs) in my region since 1990, and the emergence of sex workers on intravenous drugs, however, indicate the potential for a slower, albeit more generalized, heterosexual HIV/AIDS epidemic. Young people are particularly at risk of infection.  Special education programmes for different age groups were therefore launched in Lithuania.  The first National AIDS Programme was carried out in 1990-1994.  This Programme is based on the assumption that the epidemic can only be stopped with the participation of the whole society.

The National Programme is designed to fight all forms of discrimination and stigma associated with HIV/AIDS, and seeks to provide comprehensive social and medical services to infected people.  Healthcare objectives, however, cannot be achieved without appropriate financing.  Therefore we have implemented strong advocacy strategies to raise the awareness of the Government, policy makers, ministries, opinion leaders and the general public about the impact of HIV/AIDS.  Today, the Lithuanian example shows how a small State is able to take coordinated preventive actions to tackle HIV/AIDS and prevent it from spreading.  We are prepared to share our experience and are open to cooperation with other States in this field.

GENNADY ONISHCHENKO, First Deputy Minister of Health of the Russian Federation:  it is crucial to set forth scientifically based and realistic goals and benchmarks to fight HIV-infection.  Measures to confront HIV/AIDS and other dangerous infectious diseases should be taken alongside national and international efforts to address such global challenges as conflicts, hunger and poverty.  We support the activities of the United Nations and its specialized agencies, aimed at mobilizing broad international participation to stop the spread of HIV/AIDS. 

The timely initiative of the Secretary-General to establish the global fund for HIV/AIDS is of special importance.  Such a fund should be open and universal in terms of resource mobilization and allocation, as well as in providing assistance to all countries that might be in need of it.  This means that the fund should take into account the specific needs of countries facing the risk of rapidly increasing rates of infection.  We are ready to cooperate with all partners on issues related to the establishment of the fund and on defining the forms of our intellectual and material input. 

In recent years, rising infection rates of HIV were registered in Russia.  That is why combating the spread of HIV/AIDS is one of our priority areas, both at national and international levels.  Presently, we are actively engaged in involving the business community, NGOs and religious groups in activities aimed at seeking solutions to HIV/AIDS-related problems. This serious deterioration is also taking place in the wider region of Central and Eastern Europe and the Commonwealth of Independent States.  The problem received special attention at the meeting of the Council for Health Cooperation in CIS member States, held on

19 June in Baku, Azerbaijan. 

KYAW MYINT, Deputy Minister for Health, Myanmar:  Despite the gloomy picture painted by reports, including some by the United Nations, I wish to categorically state that HIV/AIDS is not rampant in my country.  This misconception arose from statistics taken in high-risk areas, which are now being used as representative figures for the whole nation.  We are therefore grateful for recent attempts by international organizations to correct this distortion and to arrive at a more realistic assessment. 

Although the disease is not endemic in my country, we are fully aware of the tremendous toll it could exact, not only on the victim but on society as a whole.  Consequently HIV/AIDS has been designated as a disease of national concern, and we are committed to fighting it by using all of our available resources.  Even though international assistance has been limited, the Ministry of Health has implemented a comprehensive HIV/AIDS prevention and control programme.  Health education geared towards behaviour change, care and compassion, condom promotion, intravenous drug use, and blood safety are some of the priorities of the programme. 

Early in the year, the National AIDS Programme and UNAIDS drafted a joint plan of action for prevention and control of the disease in Myanmar.  This plan reflects the cultural characteristics and priorities of the country.  It contains technically sound strategies and is comprehensive in nature, covering all aspects –- preventive, curative and rehabilitative.  Implementation of the plan, however, will require considerable financial resources.  Thus we are mobilizing support for the plan from international as well as local agencies.

ROSLYN HARRIS, First Lady of Nauru:  Today, a disease that requires no passport or visa to enter our country and whose presence can only be detected when it is too late, is in our midst, posing a threat to our existence as a race.  This is why Nauru has prevention as the mainstay of its national strategy, coordinated by the Ministry of Health and involving the Ministry of Education, the various religious groups and civil society.  We believe that preventive measures are a crucial and cost-effective means of impeding the spread of HIV/AIDS to our shores.  Our efforts are complemented by prevention-based activities in the Pacific by regional intergovernmental organizations, NGOs and international agencies, such as UNAIDS.

The universal population at risk far exceeds that which is already living with HIV/AIDS.  Resources are limited and dwindling, due to the imbalance in the rate at which the epidemic and health care costs are escalating compared to the rate at which resources are being maintained and replenished.  There is no cure for HIV/AIDS and, as yet, there is no vaccine.  These factors underscore the point that prevention must be the mainstay of the campaign against the pandemic. 

Respect for and protection of all human rights, particularly the rights of women and girls, must be an integral part of any programme against HIV/AIDS.  In this regard, we support the call for governments that have not done so to ensure that their national laws, policies and practices are inclusive and enhance equality and participation for all, especially persons living with HIV/AIDS.

In connection with the global fund, I have instructions from my Government to submit to this Assembly a proposal that calls for each Member State of the United Nations to contribute to the Fund an amount, in United States dollars, equal to one dollar per head of its population.  My Government is ready to pledge its share.  

FELIPE PAOLILLO (Uruguay):  The traditional weapons to fight the enemy are no longer effective.  The scale of the epidemic has reached global proportions, and it continues to spread uncontrollably.  It is not with declarations that we can overcome the problem.  It is necessary to act urgently, adopting flexible and comprehensive approaches and seeking new modalities of action.  We should bear in mind the specific characteristic of the situation in each country, taking into account the question of human rights.  It is vital to overcome the prejudices and stigma associated with AIDS. 

The disease mostly affects vulnerable groups, and we are focusing on them in our approach.  In 1997, we created a national programme on AIDS, which is working with several international agencies.  All AIDS patients in Uruguay receive medical coverage and treatment, including major anti-retroviral drugs.  These efforts have been rewarded with reduction in the hospitalization rates, transmission from mother to child, and improvement of patients’ standard of living. 

International cooperation against AIDS can only succeed if all players concerned take part in the efforts.  All possible solutions can be summarized in one word:  resources.  That implies the resources needed to provide the necessary care and treatment to victims and those affected, to educate the population and take care of orphans left behind.  Despite a serious economic crisis, Uruguay has established a national fund to combat AIDS.  At the international level, the beneficiaries of the globalized economy must contribute to the global fight against the epidemic.  It should be possible to collect the $10 billion needed to establish the global fund to combat AIDS. 

MIKHAIL WEHBE (Syria):  This special session is a great opportunity to combat the epidemic, which is destroying the world.  We must live up to our responsibilities.  Early on, the Government of Syria understood the danger of this disease and saw that it was a cause of alarm.  Since 1987, we have had a programme to combat HIV/AIDS.  We treat our citizens free of charge and include AIDS treatment in our medical policies.  Also, we have a national committee to combat AIDS, comprising government officials, representatives of trade unions and grass-roots organizations.  We want to raise the consciousness of the population and educate the most vulnerable groups.

We are also conducting surveys on the epidemiological situation in the country, as well as trying to give AIDS patients both physical and psychological treatment, free of charge.  We are coordinating with blood banks to ensure that donated blood is healthy.  As a result of these efforts, the epidemic has not spread greater in Syria.  At the end of the first quarter this year, there were

139 Syrians with AIDS and 86 non-Syrians.

Each State must draw up strategies to combat and treat the disease.  Global efforts should focus on mobilizing resources as well as promoting scientific research.  Poverty is among the factors which contributed to the spread of the epidemic.  We need to set aside differences in combating the disease, and to respect other’s cultures and religious differences. 

ENRIQUE A. MANALO (Philippines):  My country's HIV/AIDS situation can be described as low infection/slow progression.  Although our response to the disease has preceded any rapid increase in its prevalence, it does not alter the urgent need to significantly reduce its prevalence and incidence.  An effective response begins with the recognition of HIV/AIDS as a serious challenge to a people's health and a nation's development.  In meeting this challenge, Governments must adopt measures that ensure non-discrimination and the protection of the rights and dignity of those living with AIDS.  Alternative livelihood opportunities must be provided to reintegrate afflicted people with their families and communities.

For countries with low HIV/AIDS prevalence, attention must be given to the more visible sexually-transmitted diseases (STDs).  The reality in developing countries is that even the cost of prompt and effective treatment of STDs remains prohibitive.  It must be made affordable.  Moreover, in allocating international donor resources for HIV/AIDS, it would be wise to maintain a constant portfolio for STDs, including HIV/AIDS, so as to have a forward defence strategy against a future HIV/AIDS epidemic. 

An effective response to the pandemic must include attention to the plight of migrant workers and their families.  Governments must consider providing a basic minimum package of information on the prevention of STDs and HIV/AIDS and the corresponding diagnostic, early treatment and counselling services to people moving across their borders.  We hope to see these requirements as part of this session's collective programme.  The Association of South-East Asian Nations (ASEAN) has also included HIV/AIDS on the agenda of its upcoming November Summit, in order to place the pandemic at the top our respective national agendas to facilitate collaboration on inter-State/cross-border issues, as well as the exchange of technical expertise and experience.

HUSEIN ZIVALJ (Bosnia and Herzegovina):  It is high time for a strong and united world action plan.  Now more than ever we need solidarity among rich and poor, healthy and ill.  The poorest countries in Africa are the most affected, and we should request the rich and developed countries to significantly increase their assistance for medical treatment and research.

At the same time, the poorest and least developed countries must be assisted in building their own capacities to establish accurate databases for easier follow-up, without which it will be impossible to estimate achievements and to plan future action.  Educating people and explaining all hazardous sexual behaviour that leads to the fatal disease could contribute to preventing infection.

We strongly support the adoption of the decision requesting the Secretary-General to present an annual special report to the General Assembly containing all relevant data at the national and regional levels to assess success in fulfilling the tasks set out in the final document to be adopted at the end of the special session.  The countries with the highest percentage of people living with HIV/AIDS should submit national reports even more often.

JAKSYLYK DOSKALIEV, Head of the delegation of Kazakhstan:  My country has not been spared the effects of the HIV/AIDS pandemic.  As early as the 1980s we established a strategic programme to combat AIDS.  In recent years we have created a Council for the coordination of preventive measures, aimed at developing strategies for dealing with high-risk groups. 

The spread of the disease is causing some concern in Kazakhstan, where

39 out of the country's 1799 HIV-positive patients have developed AIDS.  Moreover, the number of HIV-positive women is on the rise, although only two of the

22 babies born of HIV-positive mothers are themselves HIV-positive.  The national anti-AIDS programme, taking into account specific national behaviours, has launched initiatives that seek to limit the infection rate among IV drug users.  In fact, Kazakhstan lies on a major heroin trading route, which fosters the spread of the disease.  Finally, Kazakhstan has introduced an anti-AIDS programme in its prisons, which harbour 40 per cent of the country's HIV-positive patients.

SERBINI ALI, Chairman of the delegation of Brunei Darussalam:  The HIV/AIDS pandemic is a global crisis threatening peace and stability and undermining economic development efforts and social cohesion.  Despite the fact that the infection rate in our country remains low, the Government has taken measures to make sure the situation does not deteriorate. 

The foremost response has been to address the care of infected individuals, but, at the same time, efforts have concentrated on prevention and control.  That includes protection of the blood supply, surveillance of high-risk groups, and management and encouragement of the efforts of various non-health sectors.  Main approaches also include awareness and education campaigns, consistent with cultural beliefs and traditional values.

At the regional level, Brunei Darussalam is working with the task force of the ASEAN.  At the international level, the Programme of Action to be adopted by this session has laid down important goals for effectively addressing the issue in a comprehensive manner.  Of utmost importance is, of course, the political will and commitment to act on our promises.

DEJAN SAHOVIC (Federal Republic of Yugoslavia):  In years past, the HIV/AIDS epidemic followed its slow, but steady pace in Yugoslavia.  At present, there are 900 AIDS patients in the country, with just over 1000 registered HIV-infected persons.  However, by some estimates, up to 10,000 people may be HIV-positive.  While Yugoslavia is among the countries with low prevalence of the disease, it has the agglomeration of all the factors known to favour the outbreak and fast progress of the epidemic.  They account for the vulnerability of young people, for whom risk-taking behaviour becomes the basic life-style and a matter of choice.

Yugoslavia is prepared to make considerable efforts in mobilizing resources to combat HIV/AIDS, including the establishment of a national committee on HIV/AIDS; assistance to NGOs and civil society at large; special focus on young people and preventive programmes for them; and measures to protect the rights of the people living with AIDS.  We are also ready to join forces with others and address the problem at the regional level.

Unfortunately, resources are scarce and cannot be shifted from other sectors.  Like many other countries, including those in southeastern Europe, Yugoslavia is not in the position to fight the disease alone.  We know that the scope of the epidemic is enormous in Africa and some other regions.  We therefore support the concept envisaged in the draft declaration of commitment, providing for special attention to those regions.  However, our region needs appropriate international assistance, as well.  Prevention now will save many lives later. In this context, Yugoslavia welcomes the proposal by the Secretary-General to set up a fund as a mechanism to mobilize additional finances in order to help national programmes and strategies and to ensure the use of resources in the most effective way.

JASSIM MOHAMMED BUALLAY (Bahrain): the problem of HIV/AIDS continues to threaten the whole of mankind.  No region is immune to this pandemic.  Though HIV/AIDS is not a serious problem in Bahrain, we are taking preventive steps to stop its spread.  A national programme was set up in 1982 and the Government has taken necessary measures, such as checking the blood supply.  This, however, did not mean we did not have sympathy for those who suffered from the disease.  We are willing to cooperate with leaders to help stem this problem, whose victims outnumber the casualties of war.  The HIV/AIDS cases in Bahrain are mainly among drug users and those engaging in irresponsible sexual behaviour.  We have made concerted efforts to prevent its spread, particularly among young people who are at the highest risk.  I wish to pay tribute to all efforts in the Middle East region to prevent and combat HIV/AIDS. 

The special session must renew international and national commitments to combat HIV/AIDS by taking practical action to examine the disease and the conditions that surround it.  If we pool our efforts, we will be able to eliminate this disease.  The first job is to make people aware of the disease and its causes.  This has to be done by a well thought-out plan, and sensitization has to be started at an early stage to prevent people from being exposed to the disease.  Treatment is long and costly, so drugs must be made affordable to the most disadvantaged people affected by the disease.  International cooperation is essential. 

ELIAS GOUNARIS (Greece):  We would like to stress the need to face human suffering in the spirit of unconditional care and support.  It is also necessary to dissociate our personal beliefs and prejudices from the harsh reality of the pandemic.  We need openness, information and the breaking of taboos surrounding issues such as sexual orientation.  We must also combine affordable access to care and medicine with appropriate quality control, management and structures, and avoid superficial and ineffective approaches.  Priority should be given to removing political and legislative obstacles, and to providing decent care to people with HIV/AIDS, with special emphasis on vulnerable groups, including undocumented migrants.

There is also a need to ensure access to information and education on interpersonal relations and HIV/AIDS, and to strengthen gender equality in order to avoid behaviour which endangers the health of women.  We must also endeavour to reduce the impact of natural disasters and armed conflicts on the spread of the disease.  In addition, there is also a need to:  reduce poverty, since the poor are the most vulnerable and least equipped to cope with the epidemic; and to fight the discrimination, stigmatization and alienation associated with HIV/AIDS.  We also stress the necessity of building an international society based on solidarity.

Strong multi-sectoral partnerships are vital to the struggle against AIDS. In addition, civil society has participated actively in the identification of major issues and problems related to HIV/AIDS and in the fight against the epidemic.  We commend and praise their solidarity.

ERWIN ORTIZ, Chairman of the delegation of Bolivia:  HIV/AIDS, through our collective error, has become a threat to humanity.  Now we must create an alliance of action to undertake a struggle at all levels, particularly at the level of the individual.  It is imperative that we empower each community and each region to protect individuals.

The international community now has the scientific and technical knowledge, as well as the financial resources, to achieve our common objectives.  We know that HIV/AIDS is concentrated in the least developed countries, the lack of infrastructure providing a hotbed for the spread of the disease.

We must increase awareness campaigns at all levels, and make sure all have access to drugs, with shared scientific knowledge.  The community network document adopted in February in São Paolo contains many valuable policy contributions, including free access to anti-retroviral drugs.  The coverage of the Bolivian health system only reaches 70 per cent of the population because of problems of accessibility.  International assistance is needed to make it effective against the AIDS epidemic.  We fully support the draft declaration of commitment and the global fund proposed by Secretary-General Annan.

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