PRESS BRIEFING ON HIV/AIDS, POPULATION AND DEVELOPMENT

 

HIV/AIDS has killed some 22 million people over its tragic, two-decade existence, and with 5 million new infections and 3 million deaths each year -- most of them young people -- a renowned epidemiologist and AIDS expert today said it was time to put an end to competing strategies aimed at combating the disease.  The false dilemma between prevention and treatment had caused unnecessary losses, wasted precious time and should be avoided in the future.

Prevention worked, even when it involved groups of people that were difficult to reach, but the positive impact of anti-retroviral treatment -- even in settings characterized by abject poverty and weak health-care systems -- was also real and could no longer be ignored, said Dr. Paulo Roberto Teixeira, Senior Consultant for the National STD/AIDS Programme in Brazil’s Ministry of Health.  He was addressing a press briefing in connection with the annual session of the United Nations Commission on Population and Development, concluding tomorrow, which had chosen to focus this year on population, development and HIV/AIDS, with particular emphasis on poverty.

“To conduct effective strategies, countries need to recognize that sexual activity is an inherent part of human behaviour and that clear messages and inputs like male and female condoms were indispensable”, he said, drawing on his experience as one of the architects of Brazil’s pioneering national AIDS strategy, created in 1983, when there were only four known cases of the disease.  A follow-on national programme during the 1990s had been hailed worldwide for controlling the spread of the epidemic, and for maintaining very low levels of prevalence in that huge country.  One of its key aspects had been free and universal provision of antiretroviral drugs and the promotion of local manufacturing of those drugs.

Without exception, in all the countries where the epidemic had been curbed or decreased, policies to promote the use of condoms had been adopted, Mr. Teixeira said.  There was no evidence that moral recommendations, such as abstinence and fidelity, had any impact on infection prevention and curbing the epidemic.  Although the promotion of safer sex involved serious cultural, ethical and religious matters, that could not be allowed to become a barrier to prevention.

One of the conclusions that could be drawn from Brazil’s experience was that the country could not have achieved positive results without the adoption of an integrated strategy, including prevention, treatment and the advocacy of the human rights of affected or marginalized people, including women, commercial sex workers, homosexuals and intravenous drug users, he said, adding:  “We also need a global strategy that takes into account the AIDS epidemic in all actions to promote development and to fight poverty, including economic adjustment plans and foreign debt relief.”

Although most of the countries affected had already adopted public policies and allocated funds to fight the epidemic, he felt a much greater effort would be necessary, nationally and internationally, to face the spread of the infection, to treat the people affected and to minimize its impact on populations.

Some of the urgent issues that needed to be given priority in national agendas included:  moving forward with strategies to reduce the costs of antiretroviral and other drugs; providing universal and free access to those drugs to guarantee the necessary compliance and regularity of treatment; and reducing the vulnerability of women by fully implementing the Action Plan adopted by the 1995 International Conference on Population and Development (ICPD).  Ensuring access to adequate sexual and reproductive health services was the only possibility of controlling the epidemic among women.

Asked what his message would be to the United States and other governments promoting abstinence campaigns as the answer to stopping the spread of the virus, Mr. Teixeira stressed that the international community should not mix ethical and moral concerns with public health problems.  If the two were not reconciled, the lives of many people would be put at risk.  The unnecessary, 10-year debate over prevention versus treatment had been costly in terms of the lives lost.  “The reality is that all data shows that people lived active sexual lives and, if you don’t provide them with necessary information, support, along with condoms, it will be virtually impossible to stop the epidemic.”

Asked how the United States position had affected the global fight against AIDS, he said that AIDS programme workers had been reporting that the United States had begun tying economic support to the adoption of abstinence promotion initiatives.  “This is extremely complicated”, he said, giving the example of Uganda, which had recently announced that it would stop promoting the use of condoms, although it had been precisely the Government’s decision to back condom use that had led to such dramatic decreases in prevalence rates throughout the country.

He added that the United States position could also hinder the work of relevant United Nations agencies, because it “is important to have all the major donors on board to implement national strategies”.  Nevertheless, major strides in the debate had been made last year as acceptance widened for the World Health Organization’s  (WHO) “3 by 5” programme to provide antiretroviral treatment to 3 million people living with AIDS in developing countries and those in transition by the end of 2005.

But he feared the debate would rage on, particularly because it was cheaper to promote prevention.  In Brazil’s case, the early global consensus -- and even among some agencies within the country -- was against its treatment policy.  Even the World Bank’s stated official position at the time was that it was irresponsible of Brazil’s Health Ministry to spend so much money.  But once the positive results became clearer, the international community had perhaps been “embarrassed” into looking more closely at the issue, he said.

Hania Zlotnik, Director, United Nations Population Division, joining Mr. Teixeira at the briefing, said treatment costs were not small and could be particularly onerous for poor nations.  So the international community would have to provide assistance to the most affected countries, which were also some of the poorest in the world.  It would be important to stress that although the initial costs of treatment were high, eventually enormous sums could be saved in medical costs because high-cost, in-hospital treatment would decrease dramatically.  A lot of money could be saved in the long run, but it took some investment up front, she said.

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