Sixty-second General Assembly

Plenary

105^th, 106^th & 107^th Meetings (AM, PM & Night)

NEED TO EMPOWER WOMEN, ESTABLISH COMPLETE HEALTH-CARE SYSTEMS UNDERLINED,

AS GENERAL ASSEMBLY CONTINUES REVIEW OF PROGRESS ON HIV/AIDS

Senior Government officials meeting in the General Assembly to review global progress in fighting HIV/AIDS stressed today that the empowerment of women and the building of complete health-care systems were of crucial long-term importance in overcoming the epidemic and other infectious diseases.

“HIV and reproductive health programmes must be integrated,” the Environment Minister of New Zealand said, as the Assembly began its second day of a comprehensive review of the progress achieved in realizing the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.

He said the world had witnessed the feminization of HIV/AIDS, with women now making up at least half of the newly infected and a greater percentage in sub-Saharan Africa.  Violence against women and social practices that subordinated them kept the epidemic going, and a human rights approach to ending the scourge was essential.

Current treatments could prevent mother-to-child transmission, the Permanent Secretary in the Netherlands Ministry of Foreign Affairs said, noting that women with access to education, health services, rights protection and income were less vulnerable to HIV infection in the first place.  Women should have access to the female condom and other means of protecting themselves.

The Minister for Family, Youth, Sports and Environment of Barbados emphasized the need to integrate HIV/AIDS services into national health-care systems, noting that, although her country had made much progress in fighting the disease, the Caribbean region had the second highest prevalence of AIDS after sub-Saharan Africa.

Emphasizing the need to redouble efforts to eradicate HIV/AIDS, she said the provision of universal access to prevention, care, treatment and support services required more than access to antiretroviral drugs.  It required trained health-care professionals, suitable facilities, current information and increased funding, integrated within a fully functional health-care system.

In addition to those issues, speakers continued to review progress made in their respective countries and their cooperation with international programmes.  Others continued to stress the need to maintain international funding for programmes targeted at AIDS and to assist in the building of health-care systems in developing countries. 

A concern voiced by several speakers in that regard was the need to reverse the brain drain of trained health workers from developing countries.  Many others continued to emphasize that HIV/AIDS was a development issue that should be integrated in a cross-cutting manner into the development agenda.  Numerous participants also continued to call for an end to the stigmatization of persons living with HIV and AIDS.

Of greatest concern to many speakers was the continuing increase in new infections.  In response, many representatives said their countries were strengthening awareness campaigns and increasing programmes to distribute condoms and clean needles for intravenous drug users.

Libya’s programmes in that context included the reinforcement of traditional religious attitudes towards sex and marriage, that country’s delegate said, while the representative of Spain maintained that the best way to manage the disease was not to try to change sexual habits and orientations, but to reduce risky practices and offer solutions that did not clash with reality and that were acceptable to vulnerable sectors of the population.

A panel discussion convened around the theme “Aids:  A multigenerational challenge -– Providing a robust and long-term response” was chaired by Mantombazana Tshabalala-Msimang, Minister for Health of South Africa.  Another panel, entitled “Resources and universal access:  Opportunities and limitations”, was chaired by Gudlaugur Thor Thordarson, Iceland’s Minister for Health.

Also speaking in today’s plenary debate were Government ministers from the Russian Federation, Lao People’s Democratic Republic, Djibouti, Mauritania, Serbia, Brunei Darussalam, Cameroon, Fiji, Mongolia, Gambia and Singapore.

Others making statements today were Costa Rica, Trinidad and Tobago, United States, Turkey, Argentina, Poland, Cuba, Norway, Romania, Saudi Arabia, Egypt (on behalf of the African Group), United Kingdom, China, Chile, Madagascar, Czech Republic, Uzbekistan, Switzerland, Uruguay (on behalf of the “Group of 77” developing countries and China, and the Rio Group), Burundi, Peru, Angola, Finland, Dominican Republic, Kazakhstan, Greece, Bangladesh (on behalf of the Least Developed Countries), Zimbabwe, Thailand, Australia, France, Sweden, Pakistan, Tajikistan, Armenia, Georgia, Congo, Ghana, Canada, Haiti, The former Yugoslav Republic of Macedonia, Nigeria, Uganda, Syria, Lebanon, Kuwait and Rwanda.

Representatives of Denmark, Japan, Luxembourg, Philippines, Bosnia and Herzegovina, Iran, Venezuela, Montenegro, Liechtenstein, Bhutan, Sudan, Myanmar, Solomon Islands, Malaysia, Nicaragua, Maldives and Surinam also addressed the meeting.

The General Assembly expects to conclude its review of progress achieved on HIV/AIDS when it reconvenes at 3 p.m. tomorrow, 12 June, in Conference Room 4.

Background

The General Assembly met today to continue its high-level meeting on a comprehensive review of the progress achieved in realizing the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS.

Statements

ESTHER BYER-SUCKOO, Minister of Family, Youth, Sports and Environment of Barbados, said the Caribbean region had the second highest prevalence of AIDS after sub-Saharan Africa.  It was the leading cause of death in persons between 25 and 49.  Prevention efforts had been redoubled.  As a result of the prevention programme on mother-to-child transmission, only one HIV-positive child had been born in Barbados during the past three years.

She said responses to the disease at every level must reflect the dynamics of the disease and must adapt to address the key issues encountered.  Central was the provision of universal access to HIV prevention, care, treatment and support services, which required more than access to antiretroviral drugs.  It required trained professionals, suitable facilities, current information and funding.  Even further, it called for the elimination of barriers to access through the formulation and implementation of integrated policies and programmes.

In Barbados, she concluded, efforts had been focused on capturing public and private sector partners and engaging civil society partners, including persons living with HIV.  The new HIV policy was multisectoral, developmental and human rights based.  It would serve as a benchmark in related areas of governance.  The Strategic Plan for 2005 to 2025 represented a dynamic approach to addressing the HIV epidemic.  It placed human capital at the heart of the national response and the Government would invest heavily in behaviour-change communication interventions.

GENNADY ONISHCHENKO, Head of the Federal Service for Consumer Rights Protection and Human Well-Being of the Russian Federation, said that, in combating the epidemic, his country, as well as the international community, was guided by the Declaration of Commitment on HIV/AIDS adopted at the twenty-sixth special session of the United Nations General Assembly in 2001.  The International Conferences on AIDS in Eastern Europe and Central Asia, which were held in Moscow in 2006 and 2008, reviewed the results of organizational and prevention activities in the region and charted the course to effectively combat the epidemic.  In the Russian Federation, the underlying principles of State policy and strategy in the field were determined by the federal law on the prevention of the spread of diseases caused by HIV that guaranteed universal access for all HIV-infected citizens to a comprehensive array of services.

To ensure the realization of those principles, the Governmental Commission on HIV Infection and the Coordinating Council on HIV/AIDS were functioning in the Russian Ministry of Health and Social Development, in which members of civil society and people living with HIV actively participated, he continued.

His country had always attached great significance to international cooperation in the humanitarian field and, in particular, public health.  Combating infectious diseases, and especially HIV/AIDS, had been included as one of the priorities in the concept of the Russian Federation’s participation in international development assistance, approved by the President in June 2007.  To that end, it had decided to reimburse another $217 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria, in addition to previously committed $40 million.  Of that amount, $118.5 million had already been disbursed to the Fund to extend assistance to developing countries.

TREVOR MALLARD, Minister of Environment of New Zealand, said his country was highly committed to achieving universal access to prevention, treatment, care and support for people affected by HIV/AIDS by 2010.  He strongly supported the focus of the Joint United Nations Programme on HIV/AIDS (UNAIDS) on “knowing your epidemic:  making it count”.  It was necessary to seek out the correct evidence and know the truth about epidemics.  Data collection could not reflect reality, when people were afraid to tell the truth.  The world had witnessed the feminization of HIV/AIDS.  Violence against women and negative and harmful practices that subordinated women were fuelling the HIV/AIDS epidemic.  Human rights approaches were essential.  The global community must eliminate stigma and discrimination from the lives of all people affected by, and infected with, HIV.  HIV and sexual and reproductive health programmes must be integrated.  Bringing HIV-related programmes into the mainstream of health systems and through multisectoral approaches would deliver cost-effective outcomes.

HIV/AIDS was a major obstacle to development and a constraint to achieving the Millennium Development Goals, he continued.  It cut across sectors and the response to HIV/AIDS was linked to the reduction in child and maternal mortality and gender equality.  Better coordination at the country level promoted stronger country ownership and leadership.  The Pacific Regional Strategy on HIV/AIDS was a good example of such coordination.  It included working with all partners to strengthen the health systems and to build workforce capacity to sustain progress made thus far.  New Zealand was a world leader in evidence-based prevention.  It had one of the lowest rates in the world in HIV prevalence.  It had achieved that by putting human rights at the centre of its response, decriminalizing men who had sex with men and making discrimination on the basis of sexual orientation and HIV status illegal.

PONMEK DALALOY, Minister of Health of the Lao People’s Democratic Republic, said that his country continued to be classified among the low-prevalence countries, with less than 1 per cent prevalence among the general population.  The cumulative number of people living with HIV from 2000 to 2007 was around 2,500, while 1,600 people had AIDS and 800 had already died.  Despite the low prevalence, the country was not complacent.  To face the threat, the Government was fully committed to fighting HIV/AIDS and involved the whole society in that undertaking.  To that end, it had incorporated HIV/AIDS into the National Growth and Poverty Eradication Strategy and other Government development policies.  By doing so, it believed that it could prevent the epidemic among the general population.

He said that higher political commitment and external support was required in order to fully achieve the ambitious goal of universal access by 2010.  To date, the support by the Global Fund, the United Nations system and development partners, as well as other stakeholders, had proved that the universal access indicators could be realized.  In that regard, his country was thankful to the donor community for the continued support rendered to it, and hoped that it would continue to enjoy such support.  The country was pleased that it remained a low-prevalence nation and believed that national efforts to date had contributed to that state of affairs.  It was, however, a nation at risk.  Continued action was necessary.  His country was one of the least developed nations in the world.  Its economy was growing, but its resources were limited.  It required continued and increased support for future efforts, so it would remain a low-prevalence nation.  Modest support now could forestall a much greater problem in the future.

BERNAT SORIA, Minister of Health and Consumer Affairs of Spain, said his country had experienced the greatest impact from the AIDS epidemic in Europe and yet it had declined since the mid-1990s due to a framework approach that involved all sectors in a coordinated way towards universally available prevention and treatment.  Involving non-governmental organizations and the affected persons themselves was crucial for drafting preventive policies and for reaching out to the most vulnerable sectors.  Damage reduction strategies were pivotal to the preventive strategy.  One lesson learned was that managing the disease was not about changing the habits or sexual orientation of people, but about reducing risky practices and offering solutions that did not clash with reality and were acceptable to vulnerable sectors of the population.  Spain’s new five-year plan on HIV/AIDS centred on fighting the stigma and discrimination associated with the disease.

He said the protection of human rights through solidarity, tolerance, respect for diversity, defence of confidentiality and voluntary diagnostic testing had enabled early detection and better response.  Apart from being an ethical imperative, reducing the cases of AIDS and other diseases was a necessary common goal for achieving harmonious and sustainable human development.  A policy allowing universal access to essential drugs was needed.  Also essential was the need to prevent new infections and increased resources towards international cooperation.  Spain’s official development assistance (ODA) would exceed €5.5 billion in 2008.  That would be 0.5 per cent of its gross domestic product (GDP), putting it on track to reach the 0.7 per cent goal in 2012.

ABDALLAH ABDILLAHI MIGUIL, Minister of Health of Djibouti, said HIV continued to spread insidiously in the Middle East and North Africa, where most countries had an increased number of reported HIV and AIDS cases.  In Sudan, an estimated 2.6 per cent of the adult population was infected with HIV.  In Djibouti, it was an estimated 2.9 per cent.  Those figures contrasted with other countries in the region.  Iran was experiencing a concentrated epidemic among injected drug users, while in other countries there was increasing evidence of elevated HIV prevalence in specific geographical locations and populations.  Many countries in the region had recently set or revised targets within their respective National Strategic Plan on AIDS, in an effort to move towards universal access to HIV prevention, treatment, care and support.

However, several challenges hampered sustained progress towards achieving universal access, he said.  These challenges included sustaining public resources for AIDS in areas perceived to have a low prevalence rate; increasing HIV prevention services for those most in need; ensuring affordable and sustainable treatment and commodities; addressing the impact of conflict, including on health systems and services; improving and increasing medical follow-up and psychosocial support for people living with HIV; and decreasing stigma and marginalization of the most at-risk populations.  Since 2003, Djibouti had adopted a multisectoral approach involving 12 ministries and civil society, in order to mitigate the spread of HIV/AIDS through an efficient, concerted response.  Thanks to national efforts to achieve universal access, the prevalence rate had dropped from 2.9 per cent in 2002 to 2.1 per cent in 2007.  Voluntary counselling and testing was provided in more than 29 of the country’s 44 hospitals and health centres.

MOHAMED OULD MOHAMED EL HAFEDH OULD KHIL ( Mauritania) said that the efforts at combating HIV/AIDS had seen a qualitative leap in recent times.  That situation had raised hopes that the international community could succeed in combating the disease and reaching the objectives to which all aspired.  His country had seen great changes in the last few years with the enthronement of democratic changes, particularly the establishment of a State based on the rule of law.  Realizing that HIV/AIDS was one of the most serious problems facing the contemporary world, the Government had put combating it at the top of its priorities.  It believed that the eradication of AIDS was linked to the issue of poverty, since there was a direct relationship between the two.  In that regard, the Government cooperated with development partners on a strategy to combat poverty.

Combating HIV/AIDS required the renovation of the whole health-care system, he continued.  The Government had undertaken efforts to establish a public policy that enabled it to get the necessary funds to respond in various sectors.  Its efforts, in that regard, had been distinguished by the serious participation of religious and mosque imams, as well as the use of Islamic education to spread awareness.  The country had also established a large number of free voluntary testing centres, in addition to carrying out mobilization efforts and raising awareness.  Women and parliamentarians were playing a very important role in that effort.  Mauritania’s efforts had been recognized internationally with an award presented to the country in March.  The country commended the efforts of the international community in confronting that devastating disease, but believed the improvements that had been achieved did not lesson the seriousness of the disease.  HIV/AIDS was not just a health problem; it was also an economic problem, as well.

TOMICA MILOSAVLJEVIĆ, Minister of Health of Serbia, said the number of AIDS patients and AIDS-related deaths had decreased in his country in the last eight years, due to increased accessibility of therapies, confidential testing and promotion of friendly counselling services.  Media coverage had also intensified and helped to reduce the stigma and discrimination associated with HIV testing.  The National Commission to fight HIV/AIDS, instituted in 2002, was headed by the Minister of Health, but also included other provisions, civil society representatives and non-governmental organizations dealing with HIV/AIDS.  People living with HIV were also involved.  A National Strategy for 2005-2010 had been implemented.  A National Office for HIV/AIDS had been instituted in 2006 for surveillance and monitoring and guidelines had been adopted in 2007, in line with the European AIDS Clinical Society.

HIV/AIDS awareness was very high in Serbia, he continued.  A 2006 survey had shown that 90 per cent of adolescents and 91 per cent of adults had heard about the disease.  Funding for the national AIDS programme came from the national budget and from the national insurance fund.  Local and municipal authorities were increasingly committing resources to implementing local health programmes, implemented both by local health institutions and non-governmental organizations.  On the national level, targets had been adjusted to the actual situation and possibilities.  Indicators had been selected, so as to enable monitoring of the basic situation across several years.

PEHIN DATO SUYOI OSMAN, Minister of Health of Brunei Darussalam, said his Government provided free and comprehensive health care to all citizens and permanent residents.  Antiretroviral drugs were readily available with 100 per cent coverage, including second and third-line therapies.  All pregnant mothers were screened for HIV and those found positive were given treatment, so that the risk of mother—to-child transmission had been virtually eliminated.

The fact that only 39 cases of HIV had been reported in Brunei in the past 22 years was no basis for complacency, he said.  Sexually transmitted infections were on the rise and the population was increasingly mobile.  Unsafe sexual practice was the main mode of transmission and efforts had been directed towards prevention programmes aimed at increasing awareness of sexual health.  Youth were targeted through multisectoral collaboration between the Government, non-governmental organizations and community leaders.  Interventions utilizing the efforts of civil society in prevention were important.  Other prevention and control strategies included ensuring safe blood supplies and blood products and intensifying surveillance of high-risk groups.

MAMA FOUDA, Minister of Health of Cameroon, said in 2006 Cameroon had set up a multisectoral strategic five-year plan involving the coordinated participation of several ministries and local non-governmental organizations.  The high prevalence rate of HIV among people age 15 to 49 was a true public health challenge.  Women and young people, in particular, were paying a high price.  In 2007, 46,000 adults died of AIDS, bringing the number of children orphaned by AIDS to 305,000.  The Government had adopted a resolution making the fight against AIDS one of its top priorities.  It was working towards prevention, achieving universal access to care and providing support to orphans and vulnerable children.  HIV counselling and screening was free for students, inmates, pregnant women and people suffering from tuberculosis.  Programmes worked particularly to end mother-to-child transmission.  HIV/AIDS education was now part of primary and secondary school curricula.  In 2007, Cameroon conducted major training programmes for teachers, thanks to support from the United Nations Educational, Scientific and Cultural Organization (UNESCO), and a major condom distribution programme.  Almost 500,000 young people were made aware of the pandemic in 2007, thanks to educational campaigns.

The Cameroon Government was continuing to intensify its policy to decentralize the health-care system, he continued.  The number of health-care clinics nationwide rose from 91 in 2005 to 113 in 2007.  Since May 2007, antiretroviral treatment had been free.  In 2006, 400 community officers were recruited to ensure psychosocial follow-up.  A national programme to support orphans and vulnerable children was set up.  Thousands of orphans had been assisted, thanks partly to funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Children’s Fund (UNICEF).  Life expectancy had risen, thanks to antiretroviral treatment.  The big challenge was to ensure that such treatment was free and sustainable.  It was crucial to provide funding for the Global Fund.  He supported the 2001 objective to mobilize $10 billion for low-income and middle-income countries to fight HIV/AIDS.

JIKO LUVENI, Minister for Health, Women and Social Welfare of Fiji, said that her country was fully committed to achieving universal access to HIV prevention, care, treatment and support.  It had already made important progress towards that goal.  It was the first country in the Pacific region to conduct national consultations to set targets for the scaling up of universal access.  That had provided a framework to monitor and evaluate the impact and outcomes of HIV-related programmes.  The Government made a specific allocation to national HIV and AIDS programmes.  The Government was now in the process of passing legislation to give legal status to the National Advisory Committee on AIDS to function as an independent body to coordinate national HIV-related activities and policy implementation.  The membership of that council would be drawn from all sectors of the society, including the most at-risk populations and people living with HIV.  Overall, 40 per cent of the members of the council would represent non-government organizations.

Fiji had maintained a low rate of HIV prevalence and stakeholders were committed to keeping that rate low, she went on.  Like other Pacific Island Countries, it had a small population but one that was highly vulnerable to the HIV epidemic.  Fiji and its neighbouring countries were at high risk because of the high proportion of youth in their populations, the fast rate of social change, the high mobility of the populations and the growing levels of poverty and unemployment.  Fiji recognized that HIV went far beyond being only a health issue.  Containing and reversing the epidemic was critical to all aspects of national development, to the maintenance of the well-being and the preservation of its cultures.  In that respect, women played a vital role and their involvement in the decision-making process was very important.  In 2008, the minister responsible for women was included as one of the five members of the National Security Council and all hospital boards now included women.

BATSEREEDENE BYAMBAA, Minister for Health of Mongolia, said although Mongolia was among the low-prevalence countries, it was highly vulnerable to the HIV/AIDS epidemic due to the high prevalence of sexually transmitted diseases, excessive alcohol use, prostitution, the high number of sexually active young people, increased migration and recent indications of drug use injections.  Mongolia had applied the “three ones” principle to improve its national response.  It adopted the 2006-2010 National Strategy on HIV/AIDS and re-established the National AIDS Committee.  Despite efforts to implement an agreed HIV/AIDS Action Framework under the guidance of one National AIDS Coordinating Authority and one country-level monitoring and evaluation system, it faced a number of challenges in its national response.  For example, the lack of evidence made it difficult to get a true picture of the country’s HIV and sexually-transmitted disease epidemic.

Mongolia’s country report last year showed that prevention, public awareness, treatment and care had been conducted at a reasonable level, she said.  But, many stakeholders questioned the quality and reliability of the reported indicators from the 2005 sentinel surveillance.  Mongolia was well aware of the need for policymakers and decision-makers to be well-informed about the epidemic to develop an effective anti-AIDS policy framework.  Funding was also a challenge.  Ongoing programmes and interventions were mainly funded by external resources.  In order to take ownership, the Government had to improve its commitment to a sustainable financing mechanism and provide proactive policy.  There was also weak involvement and collaboration by various stakeholders, including non-health sectors, civil society and the private sector.  The Government had taken steps to gradually expand the outreach network by setting up local AIDS committees and sub-committees at non-health ministries.  Strengthening human and institutional capacity remained a major challenge.

MALICK NJIE, Secretary of State, Department of State for Health and Social Welfare of the Gambia, said that HIV/AIDS was one of the greatest threats to the security and development of the world and was a big obstacle to the attainment of many of the internationally agreed development goals, including the Millennium Development Goals.  The HIV/AIDS pandemic was a genuine global emergency taking the lives of 8,000 people a day and threatening the lives of tens of millions more, as infection continued to spread around the world.  It was a social disease, had no barriers and did not discriminate when it came to sex, race, class, location, education or sexual orientation.  The national sentinel surveillance study in 2006 revealed a national prevalence rate of 2.8 per cent for HIV1 and 0.9 per cent for HIV2 in the Gambia.  In the past few years, the country had created a National Aids Council chaired by the President and a National AIDS Secretariat under the President’s office, charged with the responsibility of coordinating a multisectoral national response to HIV/AIDS.  The country had also succeeded in providing additional resources in its efforts to win the battle against the epidemic.

Notwithstanding its achievements, there were still significant obstacles needing urgent action in the country, he went on.  One such obstacle was fear, stigma and discrimination.  That was a real concern, as after two decades of HIV/AIDS, stigma and discrimination still remained a problem in the Government’s effort to control the epidemic.  Another challenge was the critical shortage of skilled human resources for health-care delivery.  Over the past few years, the Government’s response had led to wider participation of non-governmental organizations and community-based organizations in the fight against HIV/AIDS.  Although that multisectoral approach was commendable and very positive, it had compounded the problem of coordination of interventions.

BALAJI SADASIVAN, Senior Minister of State for Foreign Affairs of Singapore, said HIV/AIDS remained an ongoing challenge for Singapore.  The HIV prevalence rate was low, at 0.1 per cent to 0.2 per cent, but there had been a 33 per cent rise in the number of people newly diagnosed with HIV/AIDS during the past three years.  Singapore had set up a high-level multisectoral National HIV/AIDS Policy Committee to better coordinate a broad-based and inclusive response across different sectors of society.  The Committee had successfully coordinated and scaled up implementation of HIV education programmes across different sectors.  It had introduced an enhanced school-based education programme on sexually transmitted diseases and HIV in secondary schools nationwide, and HIV education in workplaces was being scaled up.  Education of specific at-risk groups, such as high-risk heterosexual men and men who had sex with other men, had increased.

Singapore had introduced the use of non-invasive or minimally-invasive rapid HIV test kits in primary care clinics throughout the country, he said.  Several public hospitals had begun HIV testing for inpatients.  In the last two years, Singapore had implemented an enhanced positive prevention programme for newly diagnosed patients to help them adopt safer sex behaviour.  HIV was mainly transmitted in Singapore through unprotected sex.  Under the Infectious Diseases Act, a person who knew he was infected with HIV was required to inform his sexual partner of his status prior to sexual intercourse.  Despite easy access to HIV testing, it was estimated that, for every known HIV case, there could be another one or two infected cases that were not diagnosed.  The Act had been amended to require a person who believed he may be infected to take reasonable precautions to protect his sexual partner, such as using condoms.  Singapore had allocated $27 million for the next three years to:  strengthen educational programmes, especially for at-risk populations; support HIV testing efforts; enhance clinical management of HIV patients; and build up surveillance and monitoring systems.

LIDIETH CARBALLO QUESADA, Vice-Minister of Health of Costa Rica, said that her country had been advocating in international forums for a new approach to international cooperation and official development assistance.  Through the Costa Rica Consensus, it urges donor countries and international organizations, including international financial institutions, to respond to the needs of middle-income countries, in particular those that had shown a real commitment to the human development of their people.  Through that initiative, Costa Rica intended to change the current approach to international cooperation and official development assistance, which punished those countries that were fulfilling their responsibilities by complying with their international obligations and commitments.

She called on the Global Fund to Fight AIDS, Tuberculosis and Malaria to pay attention to the needs of countries like Costa Rica, and support the enormous efforts undertaken by such countries to fight HIV/AIDS.  Those countries needed the support of the international community to be able to address and provide an effective response to the pandemic.  The criteria that the Fund had been using to allocate resources for cooperation was based on indicators that, in the case of middle-income countries, revealed a prevalence of HIV/AIDS that was higher than 1 per cent of the total population or over 5 per cent of the vulnerable people.  Given the socio-epidemiological characteristics of HIV/AIDS, no country should be excluded from a comprehensive and inclusive response.  She outlined the many steps taken by Costa Rica in an inclusive and preventive approach that had achieved significant progress against HIV/AIDS.

WESLEY GEORGE, Permanent Secretary of the Ministry of Health of Trinidad and Tobago, said, as of December 2007, 18,735 cases of HIV infection were reported to his country’s National Surveillance Unit.  Heterosexual intercourse continued to be the main mode of transmission among newly diagnosed cases.  There was a trend toward feminization of the epidemic.  Women accounted for 53 per cent of newly diagnosed cases and 74 per cent of those between the ages of 15 and 24.  A National AIDS Coordinating Committee had been set up to manage the response to the epidemic.  It included persons living with HIV and representatives of public-sector agencies, faith-based organizations, other civil society groups and the private sector.  The national response was funded primarily through the Government’s budget, a World Bank loan and a European Union grant.  There was ongoing support from the Central Statistics Office for the national HIV response.  Several research studies, including a national knowledge, attitude, practice and behaviour household study, provided baseline information that informed Government policies and programmes.

The 2004-2008 National Strategic Plan aimed to reduce the incidence of infection, as well as mitigate the negative impact of HIV/AIDS on infected and affected people, he said.  It was founded on inclusion, sustainability, accountability and respect for human rights, and focused on prevention, treatment, care, advocacy and human rights, surveillance and research, and programme management, coordination and evaluation.  In Trinidad and Tobago, HIV testing was available in all health-care facilities and the number of sites offering same-visit results had expanded.  Since April 2002, antiretroviral therapy was being offered free of charge and AIDS-related deaths had fallen 15 per cent from 2005 to 2007 mainly due to the availability of antiretroviral therapy.  The prevention programme for mother-to-child transmission promoted testing of pregnant women and a human rights desk documented discrimination.  The natural response continued to be galvanized by the political will of the leadership, including through the launching of the National AIDS Coordinating Committee.

MARK DYBUL, Assistant Secretary of State and United States Global AIDS Coordinator, said that, while much remained to be done, the sceptics had been proven wrong.  Millions of people were on life-saving antiretroviral treatment in developing countries.  Millions more had benefited from prevention and care programmes.  In the past five years, the United States President’s Emergency Plan for AIDS Relief had provided $18.8 billion and was on track to reach accountable and transparent results.  The unprecedented progress on HIV/AIDS should be understood as part of a larger global health and development agenda.  The global infrastructure to prevent, treat and care for HIV/AIDS must be a platform for expanding general health and development.  The world must make sustained progress towards fulfilling the Paris Declaration and the Monterrey Consensus.  That involved one national strategy for development and health supported through varied, but coordinated mechanisms.  At the heart of support for country ownership was support for local people, families and communities.

Five years ago, sceptics said treatment was not possible in resource-poor settings, he said.  They had been proven wrong.  Now the sceptics were saying health systems could not be built by focusing on specific diseases with definable outcomes.  However, they were being proven wrong by the building of health systems for chronic prevention, care and treatment, including human resources, logistics, communications and supply-chain systems.  Such efforts had resulted in decreases in infant mortality and increases in life expectancy.  A quantum leap was needed in prevention.  It was necessary to develop “combination prevention” to parallel the intensity, focus and success of combination antiretroviral treatment, integrating social and behavioural change with proven scientific and medical methods.

SERHAT UNAL, Special Representative of the Prime Minister of Turkey, said that HIV/AIDS was not only a health issue; it was a matter of human security.  As such, the fight against the pandemic was very much part of the global efforts to achieve the Millennium Development Goals and, thus, to defeat poverty, ensure gender equality, prevent discrimination and secure the universal application of human rights.  According to figures from the Turkish Ministry of Health, the number of HIV-positive cases in the country was 2,920 as of November 2007, with male patients constituting approximately 70 per cent of that population.  Although it had a relatively small number of HIV-positive cases, the country was concerned that certain factors had the potential to contribute to an increase in that number.  The current National Strategic Plan on HIV/AIDS laid out the national strategies from 2007 to 2011 to enhance the country’s activities in the fields of prevention and support; voluntary counselling and testing; diagnosis and treatment; supportive environment; monitoring and evaluation; social support; and intersectoral collaboration.

Turkey’s domestic efforts had been quite sufficient and satisfactory given the low incidence of HIV/AIDS cases, he went on.  The country, however, realized that it needed to exert more effort to maintain solidarity and cooperation with those countries that were less fortunate, both in terms of economic capability and the burden of HIV/AIDS.  The total amount of Turkish humanitarian assistance since 2005 had exceeded $250 million.  In addition, the combined official and private-sector development assistance provided by the country in 2006 amounted to some $1.7 billion.  While official figures for 2007 had not yet been published, the combined official and private-sector development assistance was expected to be around $2.5 billion.  In that regard, it was obvious that Turkey needed to channel a portion of its aid to the global fight against HIV/AIDS.  It needed to review its existing foreign aid programmes, so that it could also assist countries that were facing the threat of HIV/AIDS.

JUAN CARLOS NADALICH, Secretary for Health Programmes and Promotion, Ministry of Health of Argentina, said his country had made important progress in the response to HIV/AIDS.  The right to health was a constitutional right and had precedent over commercial interests.  Intellectual property rights could not preclude the adoption of public health protection measures.  He advocated effective implementation of safeguards and flexibility, including in the Trade-Related Aspects of Intellectual Property Rights (TRIPs) and the Doha Declaration.  In 1990, Argentina became one of the first countries in Latin America to enact an AIDS Act, which aimed to control the pandemic and guaranteed confidentiality for persons living with HIV/AIDS.  In fiscal year 2008, Argentina’s national budget for HIV/AIDS and sexually transmitted diseases was $80 million.  In addition, $15 million was allocated by the social security system and health providers to assist people living with HIV and AIDS.

Since 2005, the AIDS prevalence rate dropped from 48 per 1 million people to 42, while the HIV prevalence rate among pregnant women between the ages of 15 and 24 dropped from 0.36 per cent to 0.32 per cent, he said.  Further, the mortality rate fell from 3.7 per cent to 3.5 per cent over the same period.  Argentina guaranteed universal access to diagnostic studies and follow-up, as well as to antiretroviral medication and medication for opportunistic diseases.  Access to medication had been fostered through a quality generic drug policy.  Active participation in joint bargaining with other countries’ pharmaceutical industries in the region had helped to lower costs.  At present, 38,242 people received free antiretroviral treatment.  Gender perspectives and identity had been taken into account in national HIV/AIDS policy.

ADAM FRONCZAK, Under-Secretary of State, Ministry of Health of Poland, said 700 HIV infections were diagnosed in Poland annually.  Since the epidemic began in 1985, a total of 11,500 infections had been reported and there were about 30,000 people infected with HIV or suffering from AIDS.  Since the epidemic began, the Minister of Health had provided financial support to non-governmental organizations to implement prevention programmes and programmes to reduce the epidemic’s negative impact.  In 2007, the Government supported some 50 civil society organizations working to tackle HIV/AIDS.  Poland implemented the “three ones” principle.  The 2007-2011 National Programme of Combating AIDS and Preventing HIV Infections reflected the Government’s commitment to implement the relevant millennium targets through a comprehensive anti-AIDS programme.

Poland was the first country in Eastern and Central Europe to offer free access to antiretroviral medicines and tests to monitor therapy, including genotyping, to patients who met medical criteria, he said.  Since 2001, the number of patients on antiretroviral therapy had more than doubled.  In 2007, $45 million was earmarked for the antiretroviral therapy programme.  Poland struggled with limited financial resources.  Still, it had developed a system of purchasing antiretroviral drugs and drug management monitoring, in order to obtain optimal prices and made the best use of funds at the country’s disposal.  International guidelines on HIV/AIDS and human rights had been translated into Polish, in order to ensure their more effective promotion and accessibility.  In early 2007, methadone substation therapy programmes were introduced and harm-reduction programmes for intravenous drug users were developed.  By 2008, there were 26 sites nationwide providing free voluntary testing and counselling.

LUIS ESTRUCH RANCANO, Vice-Minister of Health of Cuba, said that no country had escaped the suffering as a result of HIV/AIDS.  Cuba had demonstrated a high political commitment in its response to the HIV/AIDS epidemic.  The priority that the State gave to the health of the population was demonstrated by the national health system, which was characterized by universality, free care and accessibility.  Further, society itself was organized in community grass roots, with a tradition in social work and participation of all factors of civil society.  The Cuban Programme for HIV/AIDS prevention and control, with a multisectoral character, had been implemented since 1986.  It guaranteed access to services to 100 per cent of the population.  It carried out educational, monitoring and investigation interventions, as well as antiretroviral treatment to everyone who needed it.  In addition, it provided care and support for HIV/AIDS patients, including such aspects as the right to employment, full salary, differentiated nourishment and social and political rights with free access to medicines and medical services.

He described Cuba’s contribution to the health programmes in 78 countries and said that the estimated financing to tackle the epidemic in the world in the next year was necessary and still insufficient.  That assessment took into account the need to educate the population on aspects of prevention and promotion of healthy lifestyles, guarantee free antiretroviral treatment and create the health infrastructure to carry out those actions, while also increasing research to find more effective medicines and a vaccine, and improving health care and access to health services.  As previously stated by Cuba, the only possible cure to the HIV pandemic was to put the infinite resources of the planet at the service of humanity, without mean commercial interests or national selfishness.  It was the responsibility of the international community to achieve that.

RIGMOR AASRUD, Deputy Minister of Health and Care Services of Norway, said AIDS remained a global challenge, despite major progress in access to treatment.  Social drivers in society were as hard to deal with as the virus itself.  Major obstacles to effective prevention remained.  Powerful social and economic forces continued to make women and girls vulnerable.  Many countries refused access to clean needles for drug users.  Reproductive and sexual health services were not of an acceptable standard and were not available to young people.  Further, services were not designed to deal with co-infection.  National laws discriminated against people living with HIV and against key at-risk populations.  Travel restrictions compromised the movement of HIV-positive people across borders, violating their rights and exposing them to risks, without having any positive public-health benefits.  HIV-positive people continued to face severe stigma and discrimination in most countries.

In Norway, people living with HIV were entitled to free treatment and care, she said.  Funding for HIV prevention was available.  The number of people diagnosed as HIV-positive was low, at an estimated 0.06 per cent of the population, a third of them women.  Harm-reduction strategies had contributed greatly to the low level of HIV infection among injecting drug users.  However, there was an increase in HIV transmission among migrants, and persons living with HIV still faced discrimination in the workplace and in health services.  A recent study showed that there had been little improvement in people’s knowledge and awareness of HIV during the past 20 years.  That was unacceptable and required urgent action.  The Government, in collaboration with civil society and other key actors, was drawing up a new strategic plan to combat discrimination and stigma.

MIRCEA MANUC ( Romania) said that the epidemiological situation in his country had been stable during the last years with no major changes in incidence of HIV/AIDS.  The country had a significant group of over 7,000 adolescents living with HIV/AIDS who were, in fact, children infected in the 1987 to 1991 period.  The level of the epidemic was low and there was no sign of concentration among vulnerable groups, despite high-risk behaviour identified among them.  The significant results that had been obtained by Romania during the last decade were the direct result of a multisectoral approach to the effort against the pandemic.  The country had developed multi-annual strategies in which both prophylaxis and treatment had been included.  In addition, it had included all stakeholders in its effort, while also providing universal free access to antiretrovirals.  Moreover, it had promoted adequate social support and better social inclusion, while also building a political and financial international partnership.

He noted that, after January 2007, when the country became a member of the European Union, it had faced new challenges, such as cross-border migration of persons from high-risk groups and the limitation of non-European Union funding while European Union financing was still inconsistent.  That was why the country planned to increase its efforts in order to develop a comprehensive approach to the HIV/AIDS threat at the national and global levels.

Mr. AL-ATTAF, Deputy Director of the Saudi Fund for Development of Saudi Arabia, said the HIV/AIDS epidemic was the main cause of death of people between ages 15 and 49.  It thwarted socio-economic development.  Despite some progress in combating the epidemic, the number of new cases of HIV/AIDS was greater than the number of people receiving treatment.  The international community must, therefore, step up treatment and prevention efforts.  Saudi Arabia, despite its low prevalence rate of HIV/AIDS, was aware of the fatal aspect of the scourge and had taken preventive measures since 1986.  It had set up a national programme based on health-care awareness-raising, safe blood transfusions, and fighting discrimination.

At the international level, Saudi Arabia had stepped up its aid for health-care services in developing countries, including aid for 79 hospitals and more than 50 health-care clinics, he said.  It had contributed $10 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria.  Recently, it decided to give an additional $18 million to the Global Fund by the end of 2010.  The world must be more committed to achieving the goals set forth in the Declaration of Commitments on HIV/AIDS and the Political Declaration on HIV/AIDS, and must step up efforts in that regard.

MAGED ABDEL AZIZ (Egypt), speaking on behalf of the African Group, said that HIV/AIDS represented a major challenge to the realization of the Millennium Development Goals by 2015, especially the target under Goal 6.  Recent progress was still insufficient to obscure the epidemic’s continuing human toll.  Estimates indicated that the total number of people living with HIV worldwide reached 33.2 million, with some 2.5 million new infections in 2007 and 2.1 million deaths from AIDS-related infection.  Although the rate of new infections had fallen globally, as a result of national HIV awareness campaigns and prevention programmes being implemented in coordination with the United Nations and its relevant organs, the number of new infections had increased in a number of countries, including in Europe and North America.  Those alarming indicators posed a great challenge to international efforts to contain and reduce the spread of the epidemic, which threatened to become the third leading cause of death in the world by 2030.  Africa had a particular concern in that regard, as it accounted for over 68 per cent of all adults living with HIV, 90 per cent of the world’s HIV-infected children and 76 per cent of AIDS-related deaths in 2007.

The realization of the goal of universal access by 2010, adopted by the General Assembly, required addressing the need to strengthen national capacities to combat HIV/AIDS more effectively in low-income countries, he continued.  More than 80 per cent of countries, including 85 per cent in Africa, had in place policies to ensure equal access to HIV prevention, treatment, care and support.  In addition to strengthening national capacities, it was also essential to enhance national cooperation, especially in light of the decision by the African Union in Sirte, Libya, in 2005, to establish an African Centre aimed primarily at promoting cooperation in the fight against AIDS and coordinating between specialized centres in that field all over the continent.  The international community had a particular responsibility in that regard, not only to supply the necessary financial resources, which the report of the Secretary-General had highlighted, in order to ensure sustainability of the response to HIV/AIDS, but also to reach sound solutions to the trade-related aspects of the intellectual property rights of existing drugs, as well as the microbicide vaccines currently being researched and developed, in order to provide affordable medications for all.

ED KRONENBURG, Permanent Secretary of the Ministry of Foreign Affairs of the Netherlands, said curbing the spread of HIV and mitigating the impact of AIDS required political courage, an effective, pragmatic and inclusive approach, and respect for human rights.  Human rights were at the core of Dutch foreign policy.  Tradition, culture or religion could not be an excuse for not respecting people’s sexual and reproductive rights.  Sexual minorities had the right to be guaranteed a life free from discrimination.  Respect for human rights was also at the core of the Netherlands’ action on development cooperation.  People and communities were not just recipients.  They were also active participants.  Human rights formed the basis of the response to the AIDS pandemic.  AIDS activists had successfully claimed access to treatment as a human right, not an act of charity.  That strong and focused advocacy had helped transform the thinking on HIV/AIDS.  AIDS programmes must respond to the specific needs of people and should not be based on judgements about gender, sexual orientation or behaviour.

An effective, pragmatic and inclusive approach was necessary, he continued.  Treatment could prevent mother-to-child transmission.  Women with access to education, health and income were less vulnerable to HIV infection.  Women should have access to the female condom and other means of protection.  Evidence-based comprehensive sex education at school, combined with access to commodities, would avert risky behaviour.  An integrated approach to HIV and tuberculosis was essential.  Poverty reduction contributed to reducing inequalities in income, education, employment, health status and vulnerability.  Meaningful participation of young people increased the effectiveness of HIV interventions.  Sex workers who were empowered and had access to condoms and health services did protect themselves from HIV infection.  Greater involvement of and investment in the most affected groups was crucial.

ANDREW STEER ( United Kingdom) said that response to HIV/AIDS needed to be improved in certain areas.  First, greater investment was needed in health systems.  The United Kingdom believed that, if universal access was to be achieved, access to effective and integrated service delivery needed to be expanded across a range of health systems and other services, including scaling up services for populations most at risk.  While the overall response to AIDS needed to be multisectoral, the current global underinvestment in health in developing countries was fundamentally compromising national and international efforts to tackle AIDS.

Response also needed to be improved with regard to the issue of rights, he went on.  The United Kingdom joined the Secretary-General’s call to respond to the needs and rights of the most vulnerable and to develop a far stronger commitment to making services available to those groups.  That meant meeting the needs of orphans and vulnerable children, particularly by scaling up social protection programmes.  There was a need to greatly increase efforts to reduce the impact of stigma and discrimination, which drove the epidemic in many parts of the world.  National responses needed to enable those who were most affected to participate in the design, implementation, monitoring and evaluation of services.  Another area where response needed to be improved was in making the money work harder and ensuring value for money.  The considerable resources that were now available needed to be used more effectively in working together in a harmonized way, strengthening partnerships -- especially with non-governmental organizations and civil society -- and greatly improving monitoring and evaluation.  There was a responsibility to ensure value for money and to consider the sustainability of the response.  International partners needed to support country-led responses and to align behind national plans.

LIU QIAN, Vice-Minister of Health of China, supported the position of the “Group of 77” developing countries and China, adding that his country attached great importance to issues of health.  Social assistance to those affected by AIDS and assistance for orphans were among the measures taken by his Government, which was also providing increased funding to combat HIV/AIDS.  In particular, it had allocated ¥50 million to build assistance and accommodation centres for AIDS orphans.  The scaled up prevention measures included steps to stop mother-to-child transmission.  More and more patients were taking antiretroviral drugs on a voluntary basis, and assistance was provided to AIDS victims at the community level.  Additionally, the Government was promoting scientific studies on HIV/AIDS prevention and treatment, and supporting related research.  Education and care also featured high on the agenda.

He said that efforts had been made to establish epidemiological patterns in China, which had also engaged in the development of antiretroviral drugs, scaled up international cooperation and that of non-governmental organizations.  China had also launched productive cooperation with many countries and kept contacts with organizations such as UNAIDS.  HIV/AIDS was the enemy of the entire human race, and to defeat it was a common goal.  China had set important benchmarks in fighting the epidemic and would forge ahead with key studies, including on vaccines and epidemiological studies.  The country stood ready to work with the international community in the search of prevention and treatment, and contribute to containing the epidemic worldwide.

JEANETTE VEGA, Vice-Minister of Health of Chile, said that, although progress had been made in treatment, major challenges and gaps remained regarding access to preventive services, which was one reason why the epidemic continued to spread.  Many of the inequities existing all over the world exacerbated vulnerabilities to the virus, especially in the poorest countries and among the poorest people.  There was a need, therefore, to focus more on social factors and inequities.  Social, cultural and regional realities should also be taken into account, and health policies must be adapted to the realities.  The involvement of all players was needed in addressing the problem, which should become more of a cross-cutting issue involving all segments of society.

She said that Chile had an unreserved respect for the rights of people living with AIDS.  There was a need, however, to create legal and political conditions to protect the human rights of those people.  She attached great importance to the Global Fund, in order to bridge the huge gaps between developed and developing countries, but noted that the Fund must be sustainable.  In Chile, treatment for HIV/AIDS was guaranteed for 100 per cent of the population.

PAUL RICHARD RALAINIRINA, Secretary-General, Ministry of Health and Family Planning of Madagascar, endorsed the common African position, as well as the position of the Southern African Development Community (SADC), adding that a recent regional meeting in Madagascar had highlighted the commitments on fighting HIV.  The barriers in trying to deal with HIV/AIDS included the poor quality of the health-care system and universal access to prevention, treatment and care; lack of engaged leadership; and the weakness of coordination and accountability.  A call for strong leadership, commitment and investment was needed.  To meet all the Millennium Development Goals, the authorities in his country had heeded that call.

In that connection, he emphasized the importance of national ownership of the response, and multisectoral partnerships, as well as efforts to strengthen the machinery to fight HIV; decentralization of the response with a focused community-based approach; adoption of laws and regulations protecting the rights of those living with AIDS and vulnerable groups; and focused communication to take initiatives and actions.  As a result of that approach, the rate of HIV in his country amounted to less than 1 per cent.  However, it was still necessary to be vigilant.  Now, everybody had to speak the same language and take equal steps at all levels.  It was also necessary to address the causes of the epidemic and strengthen prevention measures, while also strengthening the partnership with civil society.  Services for those in need should also be improved.  In short, a strategic vision, political will and active solidarity were needed.

MICHAEL VIT, Deputy Minister of Health of the Czech Republic, said his country had had a very low incidence of HIV/AIDS.  At the end of 2007, the number of registered cases was 1,042.  Although there had been some feminization of the epidemic, it was still dominated by the transfer between men who had sex with other men.  For its fourth Medium-Term Plan for HIV/AIDS for 2008-2012, the internationally approved UNAIDS indictors were used.  The country was now moving towards a system in which all antiretroviral medicines were paid for by the public health insurance system.  Those with no health insurance would also have access to antiretroviral therapy. 

He said that a new commission was being established to monitor HIV/AIDS, with the aim of limiting new cases, using targeted intervention programmes and the dissemination of information on HIV/AIDS.  A precondition for success was that clinical staffs would cooperate with epidemiologists, biostatisticians and experts in HIV/AIDS prevention.  In that regard, he highlighted the irreplaceable role of non-governmental organizations.  Over the next five years, his country would seek to stabilize the epidemic and reduce the annual increase in new cases.  

BAHTIYOR NIYAZMATOV, Deputy Minister of Health of Uzbekistan, said that protection of the population’s health was one of the country’s priorities.  The year 2005 had been designated as the Year of Health, and 2006 as the Year of Charity and Medical Workers.  Uzbekistan had been faced with the AIDS problem later than other countries and was currently comparatively safe in terms of its spread.  However, the Government attached great importance to improving the population’s health and living standards.  The national policy on HIV/AIDS had been developed at the highest governmental level and provided for significant results.  The Government had established a coordination committee to deal with HIV/AIDS, tuberculosis and malaria.  The national policy was aimed at creating a tolerant attitude towards HIV-infected people, fighting stigma and discrimination, and implementing the national programme, based on United Nations principles.  The country’s strategic programme for 2007-2011 foresaw effective prevention programmes to meet the needs of vulnerable groups; access to medical care; provision of antiretroviral therapy; and working with vulnerable groups.

He said that, since 2001, funding AIDS programmes had increased threefold, and access to key prevention and care services had expanded.  The Global Fund and other United Nations partners, as well as the World Bank, had assisted.  Effective implementation of the HIV/AIDS programme also depended on close cooperation with civil society and non-governmental organizations.  While guided by the “three ones” principles, which included one unified coordination system, one unified programme and one unified national monitoring and evaluation system, the experience learned in the implementation of that concept at the national level did not always meet the country’s main HIV/AIDS priorities.  In particular, taking into account the Secretary-General’s view on the need to strengthen effective management of financial flows from various sources to promote HIV prevention, the Deputy Health Minister proposed adding to the existing three United Nations principles a fourth principle -- one unified financial mechanism.

THOMAS ZELTNER, State Secretary, Director of the Federal Office of Public Health of Switzerland, said his country strongly advocated that the promotion and protection of human rights, including rights regarding sexual and reproductive health, as well as gender equality, should be at the heart of all efforts to fight HIV/AIDS.  Efforts must be scaled up to ensure that all had unrestricted access to education, information, decision-making, support services, voluntary counselling and testing, means of protecting their sexual and reproductive health, and treatment.  It was also necessary to improve the prevention, therapy and distribution of syringes to injecting drug users.  Economic, social, cultural and legal factors that denied fundamental rights to girls and women must be eliminated.  The access of young people to sexual education and to sexual and reproductive health services was also crucial.

He said that, although Switzerland had seen a slight decrease in prevalence, that masked an ongoing increase in new infections, particularly among men who had sex with men.  Transmission had been reduced among intravenous drug users, thanks to prevention programmes, distribution of syringes, and treatment offers.  Among international efforts, Switzerland was working to ensure that children and communities affected by HIV/AIDS, especially in sub-Saharan Africa, would benefit from quality psycho-social support and that more weight was given to prevention.

MIGUEL FERNANDEZ GALEANO, Vice-Minister of Public Health of Uruguay, speaking on behalf of the Group of 77 and China, and the Rio Group, said the national strategy to combat AIDS consisted of a programme devoted to sexually transmitted diseases and AIDS, linked to CONASIDA-MCP (Consejo Nacional de Prevención, y Control del SIDA) and the National Programme of Women, Health and Gender.  Work on HIV/AIDS had taken on a gender equity perspective, focusing on correcting unequal power relations between men and women.  There were also well-defined protocols, norms and clinical guides relating to the diagnosis, treatment, monitoring and counselling of HIV/AIDS patients.  Social networks were also in place to improve the quality of life of people living with the disease. 

He said that more needed to be done, however, to promote a healthy lifestyle.  Preventive interventions were needed among drug users, and at border, tourist and port areas.  Reducing the impact of congenital syphilis was also a goal, as was eliminating the stigma associated with HIV/AIDS.  The national health system was currently undergoing deep reform, with the aim of strengthening the basic level of assistance.  The country counted on an active civil society to work for the realization of everyone’s right to health, while demanding accountability from the Government.  As for funding, Uruguay did not receive support from the Global Fund because it was a middle-income country.  For that reason, changes in the criteria for eligibility were welcome.

SPECIOSE BARANSATA, Vice-Minister in Charge of HIV/AIDS of Burundi, endorsed the positions of the Group of 77 and China, the African Group and that of the least developed countries, and presented the efforts made by her country to curb the spread of the epidemic.  Burundi was among the most affected African countries, with a prevalence rate of over 3 per cent.  The figures were stabilizing in the cities, but the infection rates were still growing in the countryside.  The Government was implementing various programmes through its ministries and public agencies, as well as private sector institutions.  A national strategic plan had been adopted, along with a national follow-up assessment plan.

She said Burundi had opted for a multisectoral strategy, aiming to reduce the transmission of the disease, broaden prevention, work with people living with HIV/AIDS, reduce poverty, and coordinate the national response.  Universal access was the backbone of the national response, along with the “three ones” principles.  The New Partnership for Africa’s Development (NEPAD) offered new opportunities to deal with HIV/AIDS.  Subregionally, Burundi was an integral part of the Great Lakes region’s efforts to combat the disease.  It had also joined several international initiatives and had eliminated tax on antiretroviral drugs.  Now, there were more than 12,000 patients on those medications, and efforts were being made to stop transmission from mother to child.

However, Burundi was still far from reaching all of its goals, she said, highlighting the fact that the treatment centres only covered 6 per cent of all needs.  Tremendous efforts were needed to stop new infections and deal with all those who were infected and affected.  She hoped that, with support of its partners, the country would win that battle.

MELITÓN ARCE RODRÍGUEZ, Vice-Minister of Health of Peru, said that, since the first case had been diagnosed 25 years ago, Peru had been developing actions that included people living with HIV/AIDS and those affected by the epidemic.  A mutltisectoral strategic plan had been developed that also included actions against other sexual transmitted infections.  That plan had been proposed to significantly reduce the current prevalence of 0.6 per cent of HIV and to reduce the vertical transmission from 14 per cent to less than 2 per cent.  A major target was to avoid mother-to-child transmission of HIV.  Screening of mothers had increased from 31 per cent in 2004 to 71 per cent in 2007.

He said that antiretroviral treatment had been offered free of cost to people in need from the beginning, thanks to support from the Global Fund.  The cost was now assumed by the national budget.  Cooperation with the Global Fund remained necessary, but would be oriented towards technical assistance, prevention and the strengthening of health services.  The current focus was now on promoting healthy ways of life and preventing infections.  That difficult task was being carried out in close cooperation with the education sector.  Peru also participated in the Andean Subregion negotiations for the purchase of antiretrovirals at reduced cost. 

JOSÉ VIEIRA DIAS VAN-DÚNEM, Vice-Minister of Health of Angola, associated himself with the statements made on behalf of the Group of 77 and China, the African Union and SADC.  He said he strongly believed that prevention was the key to future action against HIV/AIDS in sub-Saharan Africa.  Preventive efforts, however, must be built on evidence, based on human rights and must fully recognize the complexity of the challenge ahead.  In comparison with other countries in the region, Angola had a relatively low rate of HIV infection (less than 3 per cent) and it pursued a multisectoral national strategy that had availed itself of international support.

The main challenges facing the national strategy, he said, included awareness-raising among young people, especially women, access to free testing and counselling, as well as the distribution and use of condoms and stopping mother-to-child transmission.  All provincial capitals now had free access to HIV treatment, but difficulties remained in reaching all 182,000 persons living with the virus.  A fight against stigmatization of those persons had been led by educational institutions, media artists and opinion leaders.

TERTTU SAVOLAINEN, State Secretary, Ministry of Social Affairs and Health of Finland, said that, while important advances had been made since the adoption of the Declaration of Commitment, there was a serious risk that too little was being done in the area of primary prevention.  It was worrisome that basic prevention services and knowledge of the true risks of HIV were not available to far too many, particularly the young.  It must be acknowledged that, with the current level of effort, the target of universal access might not be achieved within the original time frame.  Efforts should be increased and a strong focus put on prevention to ensure that especially vulnerable groups were reached.  It was inhumane to deny prevention tools to those who needed them.  The development of a vaccine had not progressed as hoped, and the international community simply could not afford to wait yet another 10 or 20 years for the “magic bullet” to appear.  The efforts at all levels of prevention, using existing tools, were more important than ever.

She also highlighted the need to address the feminization of the epidemic, strengthen health systems and find the human resources to deliver services.  There was a clear need to strengthen linkages between HIV/AIDS and sexual and reproductive health and rights.  Everyone should have the right and means to make informed choices.  Civil society was an invaluable asset in the fight against HIV/AIDS.  All people living with HIV/AIDS should be able to enjoy full human rights, free of stigma and discrimination, including travel restrictions.  It was simply not acceptable that, seven years after the adoption of the Declaration, the majority of injected drug users, men who had sex with men, sex workers, prisoners, migrants and far too many women and children still lacked real access to prevention tools and services.  Sustained access to clean and safe injection equipment and easy access to male and female condoms were not just important –- they were essential to stopping the epidemic. 

HUMBERTO SALAZAR, Executive Director of the Presidential Council on AIDS (COPREISIDA), Dominican Republic, said that, being aware that HIV/AIDS was the sixth leading cause of death worldwide, his country had concentrated its efforts against the epidemic on early detection and on those requiring antiretroviral drugs.  Since 2005, the State’s provision of free antiretroviral drugs had increased from 11.9 per cent to 29.1 per cent in affected adults, and from 24.4 per cent to 46 per cent in children.  Likewise, acknowledging the feminization of the epidemic, the country was placing emphasis on the protection of children, young people and women by promoting human rights, reducing stigma and countering discrimination.  It also promoted gender equality and women’s empowerment within the structure of sexual and reproductive health rights as the key elements for making women, adolescents and girls less vulnerable to HIV/AIDS.

He said his country acknowledged the importance of the United Nations “three ones” principles.  Through the National Strategic Plan for Prevention and Control of STI/HIV/AIDS 2007-2015, the Dominican Republic was implementing the “One National AIDS Coordination” component and the “One National AIDS Coordination Authority” through its Presidential AIDS Council.  In addition, it was immersed in strengthening the “One agreed country-level monitoring and evaluation system”.  At a time when significant advances were foreseen to halt the spread of the epidemic, it was also the time to look into a promising future in the short, medium and long terms.  That called for the active participation of all actors involved in advocating for greater funding for developing countries from donors like the Global Fund to Fight AIDS, Tuberculosis and Malaria.

SERIK AYAGANOV, Member of Parliament of Kazakhstan, said his country had achieved some progress in combating AIDS.  It had amended its law on “Prophylactics and Treatment of HIV Infection and AIDS” in order to meet international standards.  Modern standards of epidemiological surveillance of HIV had been introduced, thereby increasing voluntary testing.  Treatment and care, including access to antiretroviral treatment, for HIV-infected persons and those suffering from AIDS, was an important component of the strategy.  The complexity and scope of all programmes called for the participation of civil society, and the Government now made allowance for the financing of non-governmental organizations.

He said that transmission still mainly occurred through intravenous drug users.  The number of cases of sexual transmission was also increasing at an alarming rate.  There were still acute problems such as stigmatization and discrimination, and treatment of concomitant diseases.  In 2006, Kazakhstan had faced the unprecedented outbreak of HIV infection of 149 children through blood transfusion in medical hospitals, which had happened due to the existing misconception that HIV/AIDS was a problem of the risk groups.  It was clear, therefore, that medical organizations were not ready to meet the challenge.

PANAGIOTIS SKANDALAKIS, Member of Parliament of Greece, associating himself with the European Union’s position, said that achieving the Millennium Development Goals depended largely on successfully fighting HIV/AIDS.  Comprehensive policies were needed to ensure universal access to prevention, treatment, care and support.  Despite the low prevalence rate, Greece had spared no effort in addressing the challenges posed by the virus.  In 2007, it had updated its strategy and issued a national action plan to combat AIDS, putting emphasis on prevention, elimination of stigma and discrimination, and further improvement of treatment, care and support.  The Government had enhanced its cooperation with civil society and focused on training health professionals, as well as on biomedical, clinical, social and cultural research.

Last year, he said, Greece had spent €45 million on the fight against HIV/AIDS, focusing on awareness campaigns, surveillance, antiretroviral treatment and funding for non-governmental organizations.  Some €7.2 million had been allocated to bilateral and multilateral development cooperation, including support for UNAIDS and the Global Fund.

The fight against AIDS required strong, sustained political commitment and leadership involving all sectors of society, he continued.  Parliamentarians had a specific role to play in that regard, together with Governments, civil society, the business community and the private sector.  The first global parliamentary meeting on HIV/AIDS, held in Manila last year, had called for strong leadership by parliamentarians in addressing HIV/AIDS.  Members of Parliament could use their leverage to effectively monitor Governments and civil service, and initiate and promote a rights-based response to the epidemic.

ABDUL KALAM AZAD, Additional Secretary, Ministry of Health and Family Welfare of Bangladesh, speaking on behalf of the least developed countries, said that up to 70 per cent in need of antiretroviral treatment worldwide still did not have coverage.  If the current trend continued, the number of people receiving those drugs in 2010 would reach approximately 4.5 million, less than half of those in urgent need of treatment.  The pandemic was a global emergency, and robust collective effort was needed in response.  In many least developed countries, a heavy burden of disease posed significant risks to development.  The absence of basic medicines, poor health infrastructures, poverty, gender inequality and lack of awareness were among the main constraints.  Acute shortages of health-care professionals, further aggravated by the brain drain, impeded the scale up of treatment and prevention.  That must be addressed with urgency.  With only two years to the target date of achieving universal access to HIV prevention, the gap between available resources and actual needs was increasing.  Without greater advances, the burden on households and communities would continue to mount.

Far greater investment was required for the infrastructure of health systems, he continued.  Additional international funding was also necessary for public health and development.  Such innovative sources of financing as the airline levy and the international drug purchasing facility were welcome.  Harmonization and stability, and predictability of funding were critically important.  Unprecedented human resources should be mobilized to effectively address the crisis.  Universal access also required the participation of a wide range of stakeholders.  He also emphasized the importance of the transfer of technology and capacity-building in the pharmaceutical sector.  However, the current international intellectual property regime was not conducive to technology transfer, favouring the producers and holders of intellectual property rights, mainly found in developed countries.  Full and universal access to basic medicines required an innovative differential pricing system.  Least developed countries should have affordable access to modern technologies and know-how.

He added that Bangladesh remained among the countries with the lowest prevalence, but it was situated in a high-incidence zone.  The key factors for vulnerability included high prevalence of HIV in the neighbouring countries, increased population movement and lack of adequate awareness of the dangers of HIV.   Bangladesh’s response to the pandemic had received high praise.  The country had developed a well-defined policy document on the matter in 1997.  In 2006 and 2007, two national prevention projects had been implemented.

TAPUWA MAGURE, Chief Executive Officer, National Aids Council of Zimbabwe, on behalf of P.D. Parirenyatwa, Minister of Health and Child Welfare, said that sub-Saharan Africa remained the worst affected region, and the disease had reversed most of the gains achieved over the years.  HIV/AIDS remained the leading cause of morbidity and mortality in the history of mankind.  His country had established a National AIDS Trust Fund, contributions to which were calculated at 3 per cent of taxable income.  The Council had been established to coordinate and facilitate a multisectoral response to the pandemic and the implementation of the National AIDS Strategic Plan.  Zimbabwe continued to ensure access to prevention services for its citizens and the Prevention of Mother-to-Child Transmission Programme had been expanded to cover all districts.  Testing and counselling remained one of the major prevention interventions.

He said that, currently, 105,000 people out of 300,000 people who needed antiretroviral treatment were receiving it.  The Government was strengthening health systems, and a local company had been manufacturing antiretroviral drugs and opportunistic infection drugs.  Civil society was involved in prevention, treatment literacy and mitigations services.  He appreciated the support currently being provided by the Global Fund and urged it to scale it up.  Despite massive investments in the training of health professionals, Zimbabwe continued to suffer from “brain drain”, thereby losing skilled human resources to the developed world.  With the increased cooperation from the international community, Zimbabwe could still come close to meeting the targets for universal access to HIV and AIDS prevention, treatment, care and support by 2010.

PRAT BOONYAWONGVIROT, Permanent Secretary, Ministry of Public Health of Thailand, said that his country’s response to the epidemic had been globally recognized as a success story.  Strong and sustained commitments and coordinated efforts, including national public information campaigns and the promotion of 100 per cent condom use, had led to a dramatic decrease in the HIV incidence, with a 10-fold reduction in new infections.   Thailand had adopted a preventive strategy, with an ambitious target to halve the number of new infections by 2010.  That initiative targeted five specific vulnerable groups, including discordant couples, men who had sex with men, injecting drug users, female sex workers and their clients and youth.  Among the measures taken were counselling, free condom distribution and sexual health education, as well as a methadone maintenance programme for injecting drug users.  For the first time, this year, the cost for methadone maintenance was covered under the country’s universal coverage scheme.

He said his Government had harmonized efforts among relevant sectors, international organizations, non-governmental organizations and the community to scale up HIV prevention among youth.  Condom use among youth had begun to rise from 30 to 60 per cent.  In 2006, the Government had made a commitment to ensure universal access to antiretroviral drugs.  At present, all Thais who were in need of treatment could access it through three main schemes, which covered both first-line and second-line drug regimes, treatment for opportunistic infections and HIV-related services.  More than 180,000 patients already had access to antiretroviral treatment.  To meet the needs of those who were ineligible under those schemes, including migrant workers and displaced persons, Thailand had been working with the Global Fund to ensure access without discrimination.

MURRAY PROCTOR, Ambassador for HIV/AIDS, Australia, said that innovative partnerships had helped bring about a dramatic increase in the number of people in low- and middle-income countries with access to treatment, which had gone up by 42 per cent in the past two years.  If that increase was maintained, universal access to treatment would be almost within grasp.  However, the number of new infections was more than twice that of people receiving antiretrovirals, which meant that all treatment gains would be rapidly undermined unless prevention became the mainstay of the AIDS response.  Against that backdrop, he noted that 5 million people in Asia and the Pacific were living with HIV, with the epidemic expanding in many populous countries like China, Indonesia and Viet Nam.  HIV prevalence in Papua New Guinea, a neighbour to Australia, was estimated to rise to over 4 per cent by 2011, without an enhanced response.  The epidemic was outpacing the response.

He said it was no time for half-measures.  There were enough resources and knowledge to halt the spread of HIV.  What was needed was political courage and leadership for effective action.  In the Asia Pacific region, the delivery of prevention services to key populations was insufficient.  New data showed that men who bought sex would be the most powerful driving force in Asia’s epidemic over the next decade.  Male-to-male sex would also become a main source of new infections.  Australia was committed to working in partnership with other Asia Pacific countries to pioneer harm reduction approaches, relying on its own successful experience as a model.  It would also contribute as much as $200 million to various United Nations agencies to realize the Millennium Development Goals over the next four years.  He urged nations to seize the moment and make good on the promise of universal access to prevention in the remaining two years.

LOUIS-CHARLES VIOSSAT, Ambassador in Charge of the Fight against AIDS and Transmittable Diseases of France, aligning himself with the statement of the European Union, said there was progress in Africa and the world, thanks to mobilization by many Heads of State and Government of a decisive effort.  Building on that progress, efforts must be intensified to curb the pandemic and meet the Millennium Development Goal.  AIDS affected in particular minorities and women.  In France, AIDS affected migrant women, injecting drug users and men having sex with men.  France had worked hand-in-hand with the groups concerned and had achieved significant success.  New infections had declined from 30 to 2 per cent.  France also addressed the specific situation of women lacking sufficient access to prevention, as well as of men having sex with men, and transgender persons. 

He said it was vital to intensify research into vaccines and microbicides to prevent transmission.  That would be possible only if there were sustainable mechanisms.  France had made its contribution, for instance, in the tax on airline tickets in the context of UNITAID, and would continue to do so.  There would be no sustainable improvement without addressing the lack of human resources in the health-care sector and financing in the health sector.  Fighting HIV/AIDS was everyone’s responsibility and the participation of civil society was crucial.

LENNARTH HJELMAKER, HIV/AIDS Ambassador, Ministry of Foreign Affairs of Sweden, said that efforts to halt and reverse the spread of HIV and AIDS must be based on the basic principles of human rights and gender equality.   Sweden had increased threefold its financial contributions to the fight against HIV and AIDS.  Prevention must stay at the top of the agenda.  One had to talk openly about sexuality, intimacy, men having sex with men, sexual violence, drug use, people who sold and bought sex and trafficking in human beings.  Prevention was about power relations -- between men and women, parents and children, rich and poor.  Access to male and female condoms was crucial.  Long-term support was also needed to develop effective vaccines and microbicides. 

He said that gender inequality was a key driver in the spread of the pandemic, as many women and girls were infected through unequal relationships, sexual harassment, violence and rape.  The strong links between HIV and AIDS and sexual and reproductive health and rights was undeniable.  The needs of women, whose only way to support themselves and their families was to sell their own bodies, must be met.  All vulnerable groups must be provided with support, including gays, lesbians, bisexual and transgender people, as well as sex workers, injecting drug users and people who lived on the street.  Migrant workers and refugees were also at-risk groups.  Travel restrictions and visa policies must be lifted, wherever they were applied.  The role of civil society in HIV and AIDS actions was essential, as was the active and meaningful participation of people living with HIV and AIDS.

NAWAB MUHAMMAD YUSUF TALPUR, Member of the National Assembly of Pakistan, said that the progress in many regions was encouraging, but it had been uneven, and the expansion of the epidemic was often outstripping the pace at which services were being brought to scale.  In countries where HIV prevalence exceeded 15 per cent, the scaling-up of response was a formidable task.  The sustainability of response should be central to all HIV-related planning and implementation.  Towards that goal, financing mechanisms should be strengthened at the national, regional and global levels.  Official development assistance at the targeted levels was very important in that respect.

He said that, currently, some 85,000 people were living with HIV in Pakistan, with the HIV prevalence of less than 1 per cent.  The proportion of HIV infection among such categories as sex workers, unemployed youth and urban injected drug users was still increasing, representing a potential threat to the overall prevalence of the disease.  However, the current low prevalence among the general population would provide a vital window of opportunity to influence the future course of the epidemic in Pakistan.  The Government had launched a coordinated effort, together with bilateral and multilateral donors, the United Nations system and civil society.  The national programme, with the allocation of $30 million for 2003-2008, aimed to create awareness and promote blood safety.  It also included expansion of interventions for vulnerable populations, prevention of transmission through blood transfusion and targeted intervention for youth and labour.  A comprehensive legislation on HIV/AIDS was also under consideration.

HIV/AIDS could not be dealt with as a health issue only, he warned.  Combating it and eradicating poverty should go hand-in-hand, but that required the active and determined cooperation of the international community, with the special participation of the developed countries, which had a moral obligation to set aside a part of their affluence to reduce the burden of poverty and alleviate human suffering.  Low-cost drugs, lower profits, new research, facilities and knowledge-sharing were needed to achieve common and sustainable solutions.  Debt relief, market access and official development assistance were also crucial.

ZEBO YUNUSOVA, Head of the Department of Health of Tajikistan, said that, despite the fact that Tajikistan was among the countries that were least affected by HIV, the situation was worsening and the number of new cases continued to grow.  The causes of new infection remained injection of drugs and migration.  The epidemic had also started to affect women.  Tajikistan had been one of the first countries to have developed a national strategy to achieve the Millennium Development Goals, which included HIV/AIDS.  Concrete goals had been set up to achieve universal access to treatment and prevention by 2010, including through a national programme for 2007-2010. 

She said that her country was developing prevention programmes for the vulnerable groups and had begun to provide antiretroviral therapy.  New legislation was being introduced for the protection of people living with HIV.  There was a lack of financing for programmes, however, both from the State budget and by international donors.  Training was insufficient, and stigma and discrimination remained a problem.  The quality of services was another focus for improvement, as was the systematic use of data for tracking. 

SAMUEL GRIGORYAN, Head of the National HIV/AIDS Prevention Centre of Armenia, aligning himself with the position of the European Union, said that Armenia’s efforts to combat HIV/AIDS had included the adoption of a national framework and approval of a national programme, with broad participation of both Government and non-Government actors, as well as infected persons.  The process for establishing one agreed country-level National Monitoring and Evaluation System had already started.  In particular, the Government had radically changed its approach towards HIV prevention in recent years.  It was now emphasizing education and awareness-raising, as well as the provision of information for all target populations, including those most at risk.  The level of knowledge among injection drug users and sex workers, for example, had significantly increased.

He said that the Global Fund was providing unique support to the country.  There had been a strong national response, and antiretroviral drug treatment was now available to those in need.  Currently, 90 patients with HIV/AIDS received it, and 285 were under follow-up.  All HIV-diagnosed pregnant women were provided with prevention of mother-to-child transmission services.  Further scaling-up of those activities would allow Armenia to reach universal access to HIV prevention, treatment, care and support.  Additionally, the original medicine, developed by the group of scientists in Armenia, possessed immunomodulatory and antiviral activity that improved the patients’ quality of life, restored their capacity for work and brought them back to an active lifestyle.  One of the country’s targets under the national Millennium Development Goals framework was halting the spread of HIV/AIDS by 2015 and starting to reverse it, with a relevant set of indicators for monitoring achievements.  He hoped that the Global Fund, United Nations agencies and other partners would play an active role in supporting the realization of the national AIDS programme, without which, Armenia would find it difficult to achieve the universal access targets. 

SANDRA ELISABETH ROELOFS, First Lady of Georgia and Special Envoy of the President, aligning herself with the statement of the European Union, said her country was a low-prevalence but simultaneously high-risk country due to migration and transit flows.  Georgia bordered Ukraine and the Russian Federation, where the pandemic was taking its toll.  Meanwhile, Georgia itself was characterized by wide-spread intravenous drug use.  Fortunately, Georgia enjoyed the status of being the only country among low- and middle-income nations to guarantee close to universal access to treatment, 75 per cent, and had had no cases of “vertical transmission” of HIV in the past two years.

She said that, in addition to being First Lady, the Stop TB Ambassador and Chair of the Global Fund’s country coordinating mechanisms in Georgia, she had recently qualified as a medical nurse.  Her salary from nursing would benefit the harm reduction programmes currently serving drug users on a small scale in Georgia.  However, the Government and the public were not yet convinced of the programme’s impacts on halting infectious diseases, reflecting the difficulty in achieving a balance between respect for human rights and freedoms, and promoting healthy lifestyles and safety on the streets.  As First Lady, she would continue her work on the Millennium Development Goals relating to extreme poverty, reduction of infant and mortality rates and infectious diseases.  She called on Governments of countries in transition to show their commitment through increases in the health budget.  “Informed individuals will make healthy choices, but informed Governments will make healthy budgets,” she stressed.

MARIE FRANCE PURUEHNCE, Executive Secretary of the National AIDS Control Council of the Congo, said her country had made significant progress regarding the HIV/AIDS pandemic.  The number of infected people was now an estimated 140,000 of 3.5 million inhabitants, which meant a prevalence of 4.1 per cent.  The scourge, therefore, was a real public health problem, as well as an impediment to development.  Since 2003, the Congo had implemented several measures in its national strategic framework.  Her country was aiming to provide universal care for the population in need, including provision of free antiretroviral drugs.  The number of voluntary testing sites had increased to 66, and there were now 28 centres for people living with HIV. 

She said there were still many challenges.  Only 7 per cent of those in need were covered by services, and of the 30,000 people needing antiretroviral therapy, only some 8,000 were getting it.  She called upon the international community to redouble its efforts in the fight against HIV/AIDS and related diseases.  Success in combating HIV/AIDS required synergistic and coherent interventions by the entire international community. 

FRED T.SAI, Presidential Adviser on Reproductive Health and HIV/AIDS of Ghana, said that HIV/AIDS was a key component of his country’s poverty reduction strategy.   Ghana appreciated the support of the Global Fund, World Bank and other partners for the national response, which had resulted in a decline in the prevalence rate to 1.9 per cent in 2007.  The country had increased the number of persons on antiretroviral drugs from under 6,000 in 2006 to about 13,500 by the end of 2007, 66 per cent of them women.  Another significant achievement was the expansion of the prevention of mother-to-child transmission.  There were more than 420 centres across the country, and access to antiretroviral drugs by pregnant HIV-infected women had increased four-fold.  The role of civil society was remarkable.  People living with HIV were active members of the National AIDS Commission and various subcommittees and working groups.  However, funding for those associations had diminished in recent years, due to reduced donor funding.

He said that approval was being sought from the Government for the establishment of an AIDS fund, which would be financed from multiple sources, including levies on consumables, such as alcohol.   Ghana had ratified a national TB/HIV policy and developed national guidelines for the management of co-infection.  All persons accessing HIV testing were screened for tuberculosis, and all persons screened for tuberculosis were routinely offered HIV counselling and testing.  Prevention should remain the mainstay of the fight against HIV.  He also called for increased and predictable financing for HIV response, especially in support of civil society organizations, as well as the infusion of massive resources to revamp and sustain the weak health-care systems and recognition of nutrition as a fundamental and essential component of treatment, care and support.  He also stressed the importance of newer and rapid methods for testing for tuberculosis globally, and emphasized the need to intensify HIV and Aids-related research.

HOWARD NJOO, Director-General of the Public Health Agency of Canada, said that stopping the epidemic required progress in all regions of the world, and Canada remained committed to the promises made in that regard.  The uneven nature of progress in reaching international targets was unacceptable.  Real progress could only be made through increased and coordinated global action, including the integration of affected communities into the design and development of country responses.  The value of local knowledge, lived experiences and meaningful inclusion of people living with HIV/AIDS could not be over-emphasized.  At the international level, there had been support for greater involvement of non-governmental organizations.  Canada had included two members of Canadian AIDS service organizations in its delegation.  He was pleased that the interactive hearing with civil society had focused on a number of groups who were either infected or most vulnerable to infection.  Awareness of how those populations were dealing with HIV was vital to combating related stigma and discrimination.

He said that future global action must include enhanced national leadership, scaled-up responses in “hyper-endemic” countries, and focused responses for those populations with concentrated epidemics.  National responses should be scaled up in a way that guaranteed their sustainability and the continuation of the global commitment.  As greater numbers of people were able to access antiretrovirals, part of the response should be to ensure that persons living with HIV/AIDS had the tools and support they needed to live healthy, full lives, while also ensuring that the transmission of HIV was prevented.  “Prevention for positives” must become an increasingly important part of the global response.

Canada was particularly concerned about the impact of HIV/AIDS and HIV-tuberculosis co-infection on marginalized populations, including indigenous peoples, he said.  As such, it was proud to support the collaboration of the Assembly of First Nations and the World Health Organization on the Global Indigenous Stop TB initiative.  Canada remained committed to the Declaration on HIV/AIDS and to the development of a comprehensive, integrated and coordinated response to the epidemic.

GABRIEL THIMOTHE, Director-General, Ministry of Public Health and Population of Haiti, said his country had felt early on the need to provide a serious response to HIV/AIDS through innovative approaches that had survived political upheaval.  Consequently, prevalence had dropped, while screening had increased, alongside treatment facilities and awareness, through the national strategic plan, international solidarity and cooperation with civil society.  Haiti had also been a test site for HIV strategies and behavioural studies.  The multisectoral strategy had taken a long time to take hold, however, and coordination had been a major challenge.  Nevertheless, national efforts had been undertaken through consensus.

MILENA STAVENOVIC, National Coordinator of HIV/AIDS in The former Yugoslav Republic of Macedonia, aligned herself with the European Union and said her country had a low prevalence of HIV, but infection among at-risk populations was rising.  Disease knew no borders, and for that reason the national response focused on preventing infection, keeping in mind the epidemic’s regional aspects.  HIV programmes supported by the Global Fund had enabled the country to implement an effective plan from 2003 to 2006, helping it build capacity in the non-governmental sector, including networks formed by HIV-positive people.

She said the 2007-2011 national strategy would define the country’s future direction with regard to HIV/AIDS and to meeting all the other Millennium Development Goals.  The Government would also devote attention to social, cultural and educational approaches to fighting the disease, creating conditions for continued successful prevention.  Investment in health was seen as an investment in overall economic growth.  The Government believed everybody had a right to health, with society responsible for providing treatment.

BABATUNDE OSOTIMEHIN, Director-General, National Agency for the Control of AIDS, Nigeria, said that, at the end of the first quarter of 2008, his country had provided access to the guidelines for the prevention of mother-to-child transmission in 250 sites across the nation, marking a major change from 2006 when only 50 sites had been covered.  The number of HIV counselling and testing sites had also increased substantially to 813, with about 3 million Nigerians having received counselling and been tested.  In 2007, 285 million condoms had been distributed, an 11 per cent increase over the previous year.  With regard to antiretroviral treatment, cumulatively, 269,000 persons living with AIDS, out of an estimated 500,000 who needed treatment, had accessed treatment during the period.  The different arms of the Government provided that service free in 251 sites, compared to only 97 sites in 2005.

Nigeria had adopted the principles of the “three ones”, signed the Paris Declaration on Aid Effectiveness and domesticated the Global Task Team recommendations for donor coordination and alignment, he said.  That enabling environment had given the coordinating agencies, the National Agency for the Control of AIDS, and the relevant State agencies and committees the necessary authority to provide ownership and leadership at all levels.  Furthermore, it had facilitated the active participation of people living with HIV/AIDS, civil society organizations, the private sector and faith-based organizations, which contributed to the national response.  Nigeria’s development partners had also made major contributions to the country’s efforts in fighting the epidemic, including United Nations agencies, the Global Fund and the United Kingdom’s Department for International Development.

DAVID KIHUMURO APUULI, Director-General, Uganda AIDS Commission, speaking on behalf of President Yoweri Kaguta Museveni, recalled that his country had been at the epicentre of the AIDS epidemic in the early 1990s, but national prevalence had since dropped from as high as 30 per cent in some places to a national average of 6 per cent.  While UNAIDS deserved praise for its work in generating data through statistical modelling of HIV/AIDS transmission, the world would do well to note the strategy adopted in Uganda, which used clear messaging to affect the behaviour of its citizens.  “Your first choice is not to become infected but to remain healthy” and “Antiretrovirals and other interventions are only the second choice” were among the messages broadcast to the public, who were now experiencing a second-generation epidemic.

He said people’s perception of risk had changed greatly with the arrival of antiretroviral therapy, resulting in a resurgence of risky sexual behaviour.  Scaling up antiretroviral treatment required careful and targeted messaging, which was also true of any new prevention or treatment technologies that might be introduced in the future.  Also, countries should move away from earmarking and rely instead on evidence-based strategic planning.  In Uganda, it had been estimated that the country would need $700 million to achieve 80 per cent coverage of people needing antiretroviral drugs in the next five years.  In the meantime, Uganda strongly urged a continuing search for an AIDS vaccine.

HALTHAM SWEDAN, Director of the Foundation for Fighting HIV/AIDS of Syria, associating himself with the Group of 77 and China, said HIV/AIDS remained a danger to society since the number of infections continued to grow.  It was difficult to predict the scope of its consequences if behaviour did not change, a vaccine was not developed or other strategies were not found to stop the spread of the epidemic.  Though prevalence remained low in Syria, the country had a national strategy to combat the spread of the disease.  It involved awareness, prevention, combating stigma and rights legislation.  The role of traditional culture was also important in the context of reinforcing behaviour that could stem the spread of the disease.  Syria hoped donors would continue to support the Global Fund and that the quest for a vaccine would be intensified.

MUSTAPHA EL-NAKIB, Manager of the National AIDS Programme of Lebanon, speaking on behalf of Mohammad Jawad Khalife, Minister for Public Health, said his country had a low HIV prevalence, yet it had still adopted firm policies to keep the virus from spreading.  An AIDS Control Programme had been established in 1990 to promote awareness of the disease and educate different populations and age groups.  The pioneering National Strategic Plan followed a scientific, multisectoral approach towards halting the progress of the disease, while an operational plan enabled the attainment of set targets within the Strategic Plan.

Recalling that his country had signed the Declaration of Commitment to fight HIV/AIDS at the 2001 special session and adopted its outcome recommendations, he said that had been done despite a heavy debt burden of more than $40 billion and a gross domestic product classification that denied it eligibility to apply to the Global Fund.  The international community must help Lebanon fight HIV/AIDS now that it has passed through the recent political and military turmoil that had held the Government back from making progress in curbing the disease.

ALI YOUSEF AL SAIF, Assistant Under-Secretary for Public Health, Ministry of Health of Kuwait, said that in 1988 his country had established a national high-level committee comprising ministries and non-governmental organizations.  It had also enacted legislation in 1994 with the aim of preventing the disease and protecting the rights of the stricken.  Training had been provided so that workers in the field could participate in preventive programmes and centres had been established to provide awareness, guidance and voluntary testing.  Medication was provided free of charge.

He said his country had been among the first to hold conferences on the subject of HIV/AIDS.  Kuwait had and now hosted five such international meetings with the aim of exposing the medical sector to the latest developments and preventive measures.  Public seminars were held on the margins of those conferences to raise awareness.  The World Health Organization (WHO) had approved Kuwait’s Viral Laboratory as its laboratory of reference in the East Mediterranean region.

CARSTEN STAUR ( Denmark), aligning himself with the European Union, emphasized that women were increasingly and disproportionately harmed by the HIV/AIDS epidemic because of gender discrimination and lack of empowerment.  In many parts of the world, a woman did not even have the right to question her partner’s behaviour or ask her husband to use a condom, even when he had several sex partners.  “Gender equality is key to accelerating progress on development goals, including the Millennium Development Goal on the fight against HIV/AIDS.”  This year, Denmark had taken the lead in a “Call to Action” on gender equality and the economic empowerment of women.  It had also increased assistance for HIV/AIDS programmes specifically.  In that light, it was important to stress the connection between combating HIV/AIDS and building better maternal health services.

YUKIOO TAKASU (Japan) noted that, while large amounts of public and private financial resources had been mobilized to tackle HIV/AIDS, it was crucial to scale up, strengthen and implement efficient interventions, and to increase support programmes in order to achieve universal access to prevention programmes, treatment, care and support by 2010, in addition to attaining the Millennium Goals by 2015.  Japan would continue to cope with global health issues from the human security perspective, a human-centred and integrated approach.  An integrated approach was essential and Japan would work with developing countries by making use of its own experience of having overcome high rates of tuberculosis in its post-war history.

He said his country had extended $850 million to the Global Fund’s activities and, on 23 May, Prime Minister Yasuo Fukuda had pledged an additional $560 million.  Last month, the Fourth Tokyo International Conference on African Development (TICAD IV) had reaffirmed the importance of strong commitment on the part of national leaders and sustained partnerships in the fight against infectious diseases.  TICAD IV had stressed the particular importance of strengthening health systems and improving maternal, newborn and child health by building the capacity of health workers and halting the brain drain of skilled workers from developing countries.  The TICAD Action Plan called for striving to promote training and retain health workers in order to achieve the WHO goal of at least 2.3 health workers per 1,000 people in Africa.  Japan had committed itself to provide training for 100,000 health and medical workers, including skilled birth attendants.  The outcome of TICAD IV would be taken fully into account in the high-priority discussion of health issues at the Group of Eight (G-8) Hokkaido Toyako Summit in early July.

JEAN-MARC HOSCHEIT (Luxembourg), aligning himself with the European Union, said that a large proportion of his country’s official development assistance for 2006 had been directed to fighting HIV/AIDS and strengthening health systems in general by supporting programmes aimed at developing treatment and raising awareness about risky behaviour.  In 2007, Luxembourg had devoted €5 million to combating HIV/AIDS through UNAIDS until the year 2031.  The country was expected to assume the Economic and Social Council presidency in 2009, when it hoped to devote its attention to implementing the health-related Millennium Goals.

He said his country enjoyed a low prevalence of HIV/AIDS, but the number of infections had doubled since 1990.  Because as much as 15 per cent of HIV infections resulted from intravenous drug use, Luxembourg had an active needle exchange programme, even in prison.  In addition, people could benefit from confidential testing and counselling.  There were no restrictions on travel for those who were HIV-positive.  The next stage of the struggle must focus on strengthening global structures, including expanded access to services for everyone on an equal basis, whether they were sex workers or prisoners, and regardless of sexual orientation.  Progress would require partnership with civil society and political will on the part of leaders.

ADEL ALAKHDER ( Libya) said his country had been one of the first to support international efforts to combat the epidemic and had taken many measures to continue that endeavour.  It had established a national programme to raise awareness using various media.  In addition, the health-care planning commission had established specialized facilities to fight drug addiction.  However, there had been considerable inconsistency in the progress made in fighting HIV, including the fact that the infection rate exceeded the treatment rate.  Human and material resources must be mobilized against the scourge of the modern age by increasing awareness and reinforcing religious morality, which could stem dangerous behaviour.

YVETTE BANZON-ABALOS ( Philippines) said that her Government, recognizing that HIV/AIDS was not only a health challenge but also an obstacle to development, had developed a strategy that would “act ahead of the virus” and prevent its further spread, even though the rate of HIV prevalence was extremely low.  That effort was largely concentrated in the Philippines AIDS Prevention and Control Act, amendments to which were under consideration to ensure it was responsive to the evolving dynamics and mutability of the disease.  The Philippines had integrated the UNAIDS-backed “three ones” strategy and, with the National AIDS Council as the coordinating hub, developed medium-term plans to determine where resources could have the greatest impact.

She went on to say that the fight against HIV/AIDS could only be successful if it closely involved the communities and groups that were most at risk.  With that in mind, the decentralized Government structure had allowed municipalities to set up HIV/AIDS and STD prevention and control programmes, featuring information dissemination programmes carried out at the community level so as to reach vulnerable groups.  Despite the negative perceptions surrounding harm-reduction programmes, the Philippines had managed to use them as a means to involve and empower groups such as men who had sex with men and intravenous drug users.

Finally, she said that, in all its efforts, the Government had recognized the need for enhanced monitoring and evaluation systems in order to track the spread of the disease.  The Government had also discovered the importance of developing better data collection methods, having the right technologies in place and improving the lines of communication between all stakeholders, including Government and civil society actors.

AGNES BINAGWAHO, Executive Secretary, National AIDS Control Commission of Rwanda, said her country had certainly “stepped up to the plate” in combating HIV/AIDS; having lost a million people in the 1994 genocide, it did not wish to loose more.  Access to treatment was now available to a large portion of the population, and the Government was working actively with non-governmental organizations.  Progress was being made because the issue was treated as integral to development and recovery from the genocide.

However, there was still a 3 per cent prevalence rate and many people did not receive treatment or testing, she said.  Deaths continued to occur, demonstrating that much work remained to be done.  The multisectoral approach must be enhanced, decentralizing the fight against the disease to all areas of the country.  The use of international funding must be directed towards the real problem -- achieving sustainable development.  The fight against HIV/AIDS must be incorporated into efforts in the education, health and poverty fields, especially in Africa.

MILOS PRICA ( Bosnia and Herzegovina) said that, despite his country’s low HIV/AIDS prevalence, the current social, economic and political transition made the whole population particularly vulnerable to infection.  The devastating effects of the 1992-95 war in Bosnia had contributed to that increased vulnerability, particularly due to migration and gaps in the health, social and education systems caused by their extreme fragmentation.  Activities to combat HIV/AIDS had been intensified in 2001, with a stronger governmental commitment towards fulfilling the obligations contained in various international documents and declarations, as well as an active response by international organizations in the country and the establishment of the United Nations Thematic Group on HIV/AIDS.

The National Advisory Board to Combat HIV/AIDS, established in 2000, played an increasingly important role in raising awareness and developing strategic documents and policies, he continued, adding that the Bosnia and Herzegovina Strategy to Prevent and Combat HIV/AIDS 2004-2009 was almost ready for review.  That document took into account all identified gaps and new global and local trends in prevention, treatment and care of HIV/AIDS patients.  In addition, the National Advisory Board had declared 2006 the year of the fight against stigma and discrimination, with various national and local events targeted at the health, social and educational sectors.  Those activities also sought to strengthen action involving the media and the workplace.  With a new programme proposal for 2009-2014, Bosnia and Herzegovina aimed to ensure further support from the Global Fund while enhancing its own activities and resources for continuous support to the health sector in developing needed legislation.

MOHAMMAD KHAZAEE ( Iran) said that HIV/AIDS, the greatest threat to human health, was a social, economic and psychological challenge affecting the entire spectrum of human existence.  Although the Eastern Mediterranean remained the region least affected by the scourge, Iran, nevertheless, supported all efforts to confront it.  Moreover, there were indications that infections were expanding in the region, especially among high-risk groups such as intravenous drug users.  Tuberculosis and AIDS formed a deadly partnership, with nearly one third of the 42 million people living with HIV also infected with tuberculosis.

The most practical way to deal with the dual epidemic was to adopt a two-pronged strategy focused on preventing both tuberculosis and HIV/AIDS and ensuring close cooperation between existing programmes dealing with the issues, he said, calling for “high-level political leadership and good communication at all levels”.  The fight against HIV/AIDS should also include efforts to erase the stigma and discrimination associated with the disease, which were among the greatest barriers to an effective response.  Religious values and principles undeniably helped countries prevent “wrong and high-risk” sexual behaviours and drug addiction.  To that end, Islam played a significant and determining role in saving societies from such dangerous behaviour.  Indeed, religious training and education for young people might be an effectible additional strategy.

AURA MAHUAMPI RODRIGUEZ DE ORTIZ ( Venezuela) said respect for rights underpinned her country’s pursuit of social development, and Venezuela had made the greatest progress in the provision of public health to those previously left by the wayside.  The struggle against HIV/AIDS fit within that effort, as did the fight against poverty.  In 1999, the country had adopted a multidimensional national strategy involving all sectors of society.  Treatment was increasing, particularly in the area of mother-to-child transmission, and at-risk groups were being targeted for special services.  Today more than ever, however, universal access for such services must be achieved through international cooperation.

NEBOJSA KALUDJEROVIC ( Montenegro) said HIV/AIDS was undermining the important achievements made so far in eradicating extreme poverty and hunger, promoting gender equality and empowerment of women and reducing child mortality, among other goals.  The international community had a moral responsibility, therefore, to reaffirm the commitments made in 2001 and 2006 and to work on scaling up efforts to reverse the epidemic.  Even though prevalence was worse in sub-Saharan Africa, Eastern European countries were witnessing alarming yearly increases in infection rates with a twenty-fold increase recorded in less than a decade.  While that might not affect every country equally, it affected the whole region and was, therefore, a problem that the region must address jointly.

While Montenegro was a low-prevalence country with an estimated HIV incidence of 0.01 per cent, experts estimated that the actual incidence might be 6 to 11 times higher than that current value.  The cumulative number of people registered with HIV since 1989 was 71, out of whom 40 had developed AIDS and 26 had died.  The Government was strongly committed to combating HIV/AIDS at the country level.  It had formed a national coordination body to ensure a common direction in partnerships and establish an appropriate response in tackling complex medical, social, legal and human rights issues raised by the disease.  It had 15 members, including representatives of ministries, non-governmental organizations and people living with HIV/AIDS.

CHRISTIAN WENAWESER ( Liechtenstein) said the experience of the past few years had shown the importance of leadership on HIV/AIDS, particularly in the areas of universal access to prevention, treatment, care and support.  In addition, strong and sustainable financing mechanisms must drive an effective response.  Liechtenstein took its responsibilities in those areas very seriously and had, over the last years, continuously increased the resources devoted to fighting HIV/AIDS, both domestically and at the international level.

He said efforts to combat the epidemic must become increasingly rights-based with respect to discrimination against people living with HIV and gender inequalities that exacerbated the risk of new infections.  In addition, it was necessary to ensure that life-saving information spread faster than the epidemic.  Liechtenstein, noting the high participation in the current meeting, advocated seizing the present critical opportunity to fulfil the international community’s 2001 commitments on HIV/AIDS.

DAW PENJO ( Bhutan) said progress in responding to HIV/AIDS had been uneven and the epidemic was most acutely felt by the most vulnerable sections of society.  Any progress towards achieving the 2010 universal access target and halting or reversing the spread of the disease by 2015 would fall short unless progress was made in reducing poverty and hunger and ensuring universal primary education.  Bhutan had drawn up a strategic plan in 1989, about four years before the first case of HIV had been detected in the country, as a cautionary measure in terms of prevention and capacity-building.  The Royal Decree on HIV and AIDS, issued on 24 May 2004, reflected Bhutan’s deep concern over the threat of HIV/AIDS and the high priority that the Government accorded to addressing it.

The absolute number of detected cases in Bhutan remained small, but, given the exponential rate of increase in relation to the small population, the epidemic presented a critical development challenge with the potential to become a widespread epidemic.  Experience from countries around the world had shown the devastating social and economic impact that the disease could have and Bhutan was now looking at ways to prevent a full-blown AIDS epidemic.  The new Government had endorsed the National Strategic Plan for the Prevention and Control of STIs and HIV/AIDS.  Some of its major activities to stem the spread of the disease included promoting greater public awareness, establishing surveillance systems, implementing mandatory screening of blood donors, training health workers, decentralizing HIV/AIDS activities and ensuring 100 per cent access to antiretroviral therapy.  However, the scarcity of resources remained a critical constraint with wide gaps between available resources and actual needs.

AKEC KHOC ( Sudan), aligning himself with the African Group, the Group of 77 and China, and the least developed countries, said displacement, civil strife, natural disasters and economic factors had all had their impact on the Sudanese population’s vulnerability to HIV/AIDS.  The Government had developed a multisectoral strategic plan to control the epidemic, with strong support from the President.  The plan provided for free voluntary counselling, testing and free treatment throughout the country.  At-risk groups, such as prisoners, truckers and others, were given a high priority.

Regarding women and youth, he said a coalition against HIV/AIDS involving those segments of society had been formed under the auspices of the First Lady.  In addition, the education sector had begun incorporating training in HIV/AIDS life skills into school curricula.  A law protecting the rights of people living with HIV was in the ratification process, and groups had been formed throughout the country to provide social and economic support to those living with HIV.  Efforts had also been expended to decentralize the delivery of HIV/AIDS-related care and ensure that those services reached the target communities.  Such national responses had benefited greatly from the Global Fund’s support.

KYAW TINT SWE ( Myanmar), aligning himself with the Group of 77 and China, said his country had developed a multisectoral national strategic plan to tackle AIDS, in line with the “three ones” principle.  The National AIDS Programme acted as the focal point, charged with overseeing implementation of 10 areas, ranging from advocacy to the provision of safe blood supply.  The Programme was designed to reduce and prevent HIV/AIDS transmission through increased coverage in terms of health services, and by encouraging changes in lifestyle.  The highest priority was given to sex workers, men who had sex with men and injecting drug users, with particular attention to promoting the use of condoms.  Programmes devoted to preventing mother-to-child transmission had also been established in hospitals located in towns around the country.

He said antiretroviral treatment had been provided to 11,000 AIDS patients in 2007, but there was still a wide gap between needs and availability.  An estimated 75,000 people needed treatment.  Based on research using the latest methodology developed by WHO and UNAIDS, it had been found that adult HIV prevalence had peaked in 2000 and was now declining.  Myanmar’s efforts to combat the disease had been made possible by various international partners.  In general, per capita domestic spending on HIV in lower-income and lower-middle-income countries had more than doubled through 2005 and 2007.  A commensurate response by the international community through funding for HIV-related activities would contribute greatly towards universal coverage.

COLLIN BECK ( Solomon Islands) said the statements delivered during the debate showed the mixed results of the fight against HIV/AIDS.  The Northern Hemisphere countries as well as a number of middle-income and a select few developing countries had provided widespread coverage for infected people, but the pandemic continued to advance in many States that had not been able to keep up with its spread, especially among the poor who died while awaiting treatment.  The situation had arrived whereby the rich lived while the poor died.

He said that with 2010 just around the corner, his country was showing the early signs of HIV/AIDS spreading with all the hallmarks of a bubble ready to burst.  Teenage pregnancies were increasing and the transmission of STDs among youth was frightening.  Yet, the multilateral system acted like a fireman designed to put out bigger fires and ignore the smaller ones, allowing global threats to fester in some quarters and creating weak links in the global fight against HIV/AIDS.  That culture must be changed.  Response must not be aimed at threats that had reached the crisis level; the multilateral system must treat all problems with equal attention.

He said access to treatment and sustainable national health programmes were crucial if commitments were to be translated into action.  Cheaper alternatives of providing a holistic approach to treatment deserved consideration, as did making more affordable medicines available to all.  Testing and treatment must be viewed from two sides of the same coin -- reluctance to be tested could be a result of non-availability of treatment, and low testing in developing countries did not fully reflect the real status of the HIV/AIDS pandemic.

CHRISTOPHER K.C. LEE ( Malaysia) expressed disappointment at the barriers preventing the majority of HIV-infected individuals from obtaining equitable and affordable life-prolonging drugs.  Access should not be restricted by trade- and patent-related issues.  Within Malaysia itself, there was a consistent decrease trend in the reported number of HIV cases since 2003, with much of the transmissions taking place among injecting drug users.  Although young males still comprised the majority of reported cases, the proportion of women with HIV was rising.  The Government had increased its budget for responding to the epidemic to $30 million per year until 2010.  Sixty per cent of the overall budget was devoted to harm reduction among injecting drug users and their partners, through needle exchange programmes and the promotion of increased condom use.

He said Malaysia would scale up methadone maintenance therapy so that 25,000 injecting drug users would be covered by 2011, including those in prison.  Government health clinics were also beginning to participate in needle exchanges for the first time this year.  In order to reach out to marginalized and at-risk groups –- men who had sex with men, sex workers and the transgender population -- the Government was working closely with non-governmental and community-based organizations.  But the challenge remained formidable.  The Government was already conducted a healthy lifestyle campaign directed at young people.  Lectures inculcating awareness and behavioural change had been integrated into the syllabus of the national service exercise for the first time in 2007, reaching almost 100,000 young people.  Access to cheaper antiretroviral drugs had made free treatment possible for all patients, and those living in prison and drug rehabilitation centres were now starting to benefit.

JAIME HERMIDA CASTILLO ( Nicaragua) said greater resolve was required if the scourge of HIV/AIDS was to be addressed with the necessary urgency.  Progress had been made, but it was uneven.  Starvation of children affected by the disease had now reached the critical point.  The time had come to recognize the basic link between sustainable development and health.  There could be no talk of prevention without talking about providing basic health care and achieving gender equality.  The magnitude of the impact of AIDS reflected the differences in living standards.  Only an aggressive programme of prevention would be adequate to defeat it.

He said stigma and discrimination must be eliminated along with macho attitudes that prevented the infected from getting tested and using condoms.  All those aspects should be approached from an integrated perspective, and resources must be dedicated to developing the legal and communications tools to accomplish the task.  Initiatives must be agreed upon by those impacted and must involve civil society.  International cooperation had contributed enormously to boosting national efforts, but the availability of resources must not be made conditional.  Nicaragua had hosted a regional conference on HIV/AIDS last December and would continue its advocacy.

AHMED KHALEEL ( Maldives) said that, although his country remained among the low-prevalence nations for HIV and other sexually transmitted diseases, it was situated in a region where HIV/AIDS was spreading at an alarmingly high rate.  High drug use prevalence, especially intravenous drug use, and the mobility of Maldives natives represented a serious threat.  The growing number of foreign visitors to the country and the presence of a large expatriate workforce had contributed to the exposure of locals to the risks posed by the disease.

He said the National AIDS Control Programme had been established long before the detection of the first case in the country.  Sentinel surveillance sites were being set up where laboratory facilities were available, and the distribution of condoms at all health facilities and pharmacy outlets was encouraged.  But being a small island developing country with a fragmented geography, the Maldives encountered many difficulties in carrying out effective surveillance programmes to understand social and behavioural changes.  Expertise such as epidemiological skills and specialized counselling must be made available through training, so as to implement effective national control activities.  Providing universal access to AIDS-related services should be the ultimate goal of all nations.

HENRY MACDONALD (Suriname), aligning himself with the Group of 77 and China and the Caribbean Community, said his country had identified sex workers and men who had sex with men as the most at-risk groups, as in other countries.  Co-infection of HIV and tuberculosis was also an increasing area of concern.  Suriname shared the view that the most effective way to fight the pandemic was through prevention.  Recently, the country had introduced a programme whereby teens would inform their peers about the risks of HIV, because the traditional way of adults providing information to teens did not show results.  AIDS was the second leading cause of death among the 25-49 age group.

He said his country had a long-standing and effective working relationship with various bilateral and multilateral partners in response to HIV.  Those partnerships were essential for providing much-needed financial and technical support.  There had also been greater involvement by Government ministries at the national and district levels, as well as by civil society organizations.  The newly developed United Nations Development Assistance Framework (UNDAF), to which the Government had agreed in 2007, could serve as a source of programme support.  Indeed, Suriname was aware that there was no room for complacency; there was a need to improve national monitoring and evaluation systems.  Meanwhile, the international community would do well to scale up resources and provide affordable drugs to developing countries.

Panel Discussion III

The panel discussion on “Making the response to AIDS work for women and girls –– Gender equality and AIDS”, was chaired by Anna Marzec-Bogusławska, Head of the National AIDS Centre in Poland, and included the following panellists:  Jessie Fantone, Director, Philippines National AIDS Council Secretariat; Rosa Gonzalez, Latin American and Caribbean Council of AIDS Service Organizations and the International Council of AIDS Service Organizations; Ines Alberdi, Executive Director, United Nations Development Fund for Women (UNIFEM).

Opening the panel, Ms. MARZEC-BOGUSŁAWSKA noted the rising levels of HIV-infections in women wherever they resided in the world.  Although best practices had been recognized by international organizations, most interventions had not been fully implemented.  Not surprisingly, women were twice as likely to contract HIV from a single act of sex because most still relied on their partner to ensure protected sex -- for example, by putting on a condom.  Perhaps more research was needed on protective measures over which women had more control, such as microbicides.  Another possibility was to encourage HIV-positive women to play a more active part in prioritizing the needs of young women and girls.

Mr. FANTONE said that his country, the Philippines, was a confusing mix of conservatism and liberalism because “that’s what you get after spending more than 300 years in a convent, followed by 50 years of exposure to Hollywood”.  That aspect of Filipino culture contributed to the vulnerability of women and girls to HIV.  Girls were excluded from government health services because they were not “supposed to be having sex”, even if the number of youths engaging in premarital sex was increasing, and at ever younger ages.  It took years of pleading before Government agencies that were members of the National AIDS Council were allowed to include HIV/AIDS programmes in their budget, even if those agencies were not health-oriented, as such.  The AIDS Council also promoted gender-responsive good governance by working through the National Commission on the Role of Filipino Women, with the understanding that tackling gender discrimination, stigma and empowerment were important aspects in the fight against AIDS.

Ms. ALBERDI said the United Nations Global Coalition on Women and AIDS, comprising six agencies including UNIFEM, was presently advocating for increased commitment and financial support to address the gender dimensions of HIV/AIDS.  Because the disease was sexually transmitted, unequal relationships between men and women, together with gender stereotypes, only helped fuel its spread.  Thus, transforming gender relations must be part of the solution, and young men and boys should be encouraged to take part in that transformation.  At the same time, addressing the link between HIV/AIDS and violence against women and girls was also important because violence sometimes made it difficult for females to refuse sex or have men use a condom.  To address that link, the United Nations Trust Fund to Eliminate Violence against Women had agreed to fund a first ever global learning initiative on the topic.  Most national HIV/AIDS programmes tended to focus on mother-to-child transmission, sex workers, and discourage girls from having sex.  While important, those aspects obscured the complexity of men’s and women’s lives.

Ms. GONZALEZ, who had been living with HIV for 14 years, was married to a man who had been HIV-positive for 16 years and had an HIV-positive daughter, talked of the discrimination faced by people like her.  Such discrimination blocked progress in mitigating the impact of HIV/AIDS, especially in marginalized places, where traditional gender roles often left women too busy to care for their own needs because domestic work took up too much of their time.  The women there also faced violence because gender-based discrimination persisted with impunity.  Health programmes directed at men were sometimes counter-productive -- for instance, wherever male circumcision was introduced in Africa, the false sense of security bred in men had adverse effects on women’s health.  Cultural patterns needed to change so that a more just society could rise in its place.  Only then would resources be channelled to save women dying from preventable diseases and guarantee at-risk women a life of dignity.

In the question-and-answer period that followed, participants from various Governments and civil society organizations in Portugal, Zambia, Norway, Sweden, Canada and elsewhere, agreed that the gender dimension of HIV/AIDS had to do with power relations between the sexes.  To create an enabling environment to roll back HIV/AIDS, societies must be able to talk about sex and sexuality openly, and that discussion must involve women and girls, as well as men and boys.  The goal of such a dialogue was to foster respect for human rights while espousing gender equality.  School was a good place to conduct sexuality education and could act as a platform for the dialogue between the sexes.  Ms. ALBERDI suggested that resources should be spent in a gender equitable context to allow women to achieve lasting normative changes regarding femininity and masculinity.

Some participants stressed the importance of what the representative of Zambia called “knowing your epidemic”.  HIV/AIDS policies must be based on observable evidence that corresponded with up-to-the-minute realities on the ground.  For instance, preventive measures with unanticipated negative impacts on women and girls should be modified.  A speaker representing a South African group said funding should not continue to be pumped into male circumcision programmes at the expense of a programme promoting, say, female condoms, if the first was shown to have adverse consequences compared to the second.  Also, the policymaking process should be inclusive -- as representatives of sex workers’ groups from Peru and Argentina said, the people of their profession were, simply, women who worked.  As such, they should be included in policy discussions concerning their trade.

A participant from Australia also noted that being uneducated or illiterate was not synonymous with being “stupid”.  Others, from the United Kingdom and elsewhere, agreed, saying that women should have the ability to negotiate for safe sex, access to education and work regardless of their educational background.  They should be actively encouraged to participate in Government mechanisms dealing with HIV/AIDS.  Some 40 per cent of new infections were among young people, which went hand-in-hand with their continuing low levels of knowledge regarding HIV.  Society must recognize the vital contribution that women could make to reverse that trend.  Ms. GONZALEZ noted that lack of medication led women to die in droves, which meant that Governments must be encouraged to open up on those taboo subjects.

Panel Discussion IV

The panel on “AIDS:  a multigenerational challenge -- Providing a robust and long-term response” was chaired by Mantombazana Tshabalala-Msimang, Minister of Health of South Africa, and included the following panellists:  Maret Maripuu, Minister of Social Affairs of Estonia; Gregg Gonsalves, Global Network of People Living with HIV/AIDS (GNP+); and Jimmy Kolker, Chief of the HIV/AIDS Section and Global HIV/AIDS Coordinator of the United Nations Children’s Fund (UNICEF).

Opening the panel, Ms. TSHABALALA-MSIMANG said that many of the current impediments to eradicating AIDS would prove to be powerful obstacles over the long-term.  The panel would look at what needed to be done to overcome those obstacles.  In addition, it would examine the needs of orphans and others who had been made vulnerable by the pandemic.

In South Africa, she pointed to an exponential increase in prevention activities over the past years, resulting in a significant decrease in the rates of sexually transmitted diseases.  Social mobilization campaigns had resulted in a 98 per cent awareness of HIV/AIDS, and health and behaviour-change programmes had been expanded in schools.  She described caretaker support and other programmes in her country, for which, public funding had increased.

She also described research programmes being pursued in South Africa, which included studies of traditional medicines, as well as poverty eradication programmes, which targeted women and other at-risk groups.  Challenges remained, however, and she hoped that panellists would explore combined approaches to multiple diseases, alternative medicines, the integration of HIV/AIDS concerns into development issues and other matters that affected the future.

Ms. MARIPUU focused on the importance of building health systems and providing access to them.  Estonia had systematically approached prevention and care of people living with HIV, with a broad-based, sustainable strategy that united the efforts of all sectors under a well-functioning health system.  Building such a system required a comprehensive, well-funded, sustained approach.  In addition, strategic planning was required, with a strong, well-motivated workforce that constantly received updated training on such matters as HIV and tuberculosis services.

She described the important role of personal physicians to track individual patients, as well as the importance of monitoring to determine which therapies and approaches were most effective.  Outreach for at-risk populations and young people had been particularly effective in Estonia.  In order to make sure all such programmes continued to be built systematically, constant political attention was required.

Mr. KOLKER noted that every baby kept alive through treatment meant a commitment for care through most of this century; it was important to keep the parents healthy as well.  In the same way, the struggle against AIDS was related to other development issues.  Dealing with the HIV issue in a holistic way, which was required, necessarily involved many sectors of Governments, as well as civil society.

The lack of integrated maternal and neonatal health, as well as complete health systems, remained one of the obstacles to universal coverage of HIV/AIDS care.  Lab systems, improved data collection, and future planning were essential, as was awareness-raising of health issues within the family structure.

Mr. GONSALVES said that a true transformation in the way that the world thought about health and development had to take place, building upon the global responses to AIDS.  Through the struggle to mitigate the effects of that disease, it was realized that health issues had to be politicized, so that they mattered to the politicians that decided the fate of people.  In addition, it was learned that underfunding for health was not acceptable and that life-supporting programmes must be made sustainable through proper funding.  Finally, it was shown that such funding must be made sufficient to provide universal access to necessary care.

Following panellists’ presentations, JORGE SAMPAIO, United Nations Special Envoy to the Stop TB Partnership, reported on the proceedings of the first HIV/TB Global Leaders’ Forum, which was held here yesterday.  He said that tuberculosis and HIV frequently occurred together and it was necessary to provide an integrated response.  That meant integrated primary health services able to focus fully on patients and not on separate diseases.  To build such services worldwide, it was essential to develop meaningful partnerships between programmes, affected communities and the broader civil society, including the private sector.

Tuberculosis and HIV required the same targeted interventions for vulnerable communities, and faced similar health system challenges for scaling up towards universal access, he said.  In addition, urgent investment was needed to research new tools to improve prevention, diagnosis and treatment of tuberculosis in people living with HIV, alongside the scaling up of proven joint HIV/TB strategies.  Finally, tuberculosis, like HIV, must be dealt with as a development issue.  Unless commitments were made to all of those areas, there was a risk that the gains achieved in wide HIV treatment could be reversed.

In the ensuing question-and-answer period that followed, several speakers followed the lead of Ireland’s representative in pointing to the overarching importance of women’s empowerment in the long-term approach to the disease, as well as the need for donor nations to maintain their funding commitments over time.  Denmark’s representative pointed to the need to stop the drain of health-care workers from low-income countries to developed countries, suggesting that a circulation of workers be assured through scaled-up training programmes and other strategies.

Other speakers highlighted the importance of real political commitment to a wider, integrated approach to the HIV scourge.  Senegal’s representative said that the task of mobilizing support for an approach that included all the concerns of development was ongoing.  The representative of Pakistan urged greater focus on the macroeconomic implications of the epidemic, due to the fact that HIV attacked a greater proportion of people in the prime earning period of their lives.  Broad agreement emerged on the crucial need to build effective health systems worldwide, with Morocco’s representative making an impassioned plea for North-South cooperation towards that goal.

Panel Discussion V

The panel on “Resources and Universal Access; Opportunities and Limitations” was chaired by Gudlaugur Thor Thordarson, Minister of Health of Iceland, and included the following panellists:  Daniel Kwelagobe, Minister of Presidential Affairs and Public Administration of Botswana; Asia Russell, Director of International Advocacy of the Health Gap Global Access Project; and Michel Kazatchkine, Executive Director of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Opening the panel, Mr. THORDARSON said it would focus on sources of funding, resource allocation, spending, accountability, predictability and multi-year funding.  It would discuss how to ensure sustainable funding at the country level.  He noted the importance of donations to the Global Fund from Members States and multilateral institutions and from bilateral donors.  Prices of some HIV medicines had been reduced, enabling millions of people to be on antiretroviral therapies.  The 2001 Abuja Declaration called on countries most affected by HIV to allocate 15 per cent of annual national budgets to improve the health sector.  Participation of receiving countries in financing the fight against AIDS was the best insurance for effectively using resources.

The panel should look at what countries could do to minimize the impact of uncertain and variable external financing and how they could ensure sustainability, he said.  Could additional sources of financing be mobilized to ensure sustainable financing in the future?  Was there time to develop international health insurance through a private partnership?  Was it time for the global community to create a safety net to cover at least half the costs of HIV programmes in each given country?  Should the United Nations set up such a global insurance, where all Member States were obliged to pay a premium?  What role were such initiatives likely to play in bringing additional resources to the HIV response?  Such questions should be addressed.

Mr. KWELAGOBE said, since the call in 2001 for increased resources to support the global AIDS response, new initiatives had been launched by multilateral institutions, such as the World Bank’s Africa Multi-Country HIV/AIDS Programme, and by bilateral donors, such as the United States President’s Emergency Plan for AIDS Relief.  The Global Fund was also set up to provide low-income and middle-income countries with additional funding.  Thanks to that contribution, it was possible for the first time to mobilize the targeted $10 billion in 2007.  However, the actual response requirements exceeded that figure.  At the current pace of scaling up HIV services, the currently projected $15.7 billion in 2010 would not be enough to achieve universal access.  Existing donor commitments must be fulfilled and new ones made in order to close that resource gap.

HIV was a long-term epidemic that needed long-term resources and solutions, he said.  To make those resources work, it was necessary to develop and implement credible, costed strategic action plans.  Investment in HIV programmes must be informed by evidence and tailored to local realities.  National and international partners must use transparent policies and procedures to prevent waste and misallocation.  Botswana was currently funding more than 90 per cent of its national response from domestic resources.  He urged other African countries to meet their Abuja commitments, as external resources should complement, but not substitute for national resources.

Ms. RUSSELL said seven years ago the cost of ensuring access to lifesaving treatment and prevention was used by countries as an excuse not to increase AIDS spending.  Many development agencies considered investment in HIV treatment in the developing world inappropriate.  Since then, people living with HIV worldwide had challenged them to step up spending.  At present, 3 million people were on antiretroviral therapies.  Ten million people would be in urgent need of such therapies by 2010.  The Joint United Nations Programme on HIV/AIDS estimated that, globally, the cost of reaching universal access by 2010 was $40 billion annually.  But the world spent only $10 billion annually.  The tremendous funding gaps were caused by countries’ refusal to allocate adequate money.  Moreover, several Group of Eight (G-8) donor countries were breaking their commitments concerning the Global Fund and other mechanisms.  She lauded the United Kingdom’s commitment to fund health system strengthening with $12 billion by 2015, but said it did not include a clear spending target for HIV/AIDS.  Only two countries had reached the 2001 Abuja target of earmarking 15 per cent of national budgets to improve the health sector.

Due to the vast majority of services funded by the Global Fund, recent changes in eligibility criteria meant that essential programmes would lose access to funding at a time when such funding needed to be increased, she said.  Countries also lacked plans for men having sex with men.  Sex workers lacked human rights protection.  In order to scale up rapidly to reach universal access to treatment, the severe shortage of health-care workers, primarily in Sub-Saharan Africa, must be addressed as part of a shared response.  She called on donors to end their refusal to invest in recurrent costs, such as increased salaries for health-care workers, and to end harmful recruitment practices that contributed to the haemorrhaging of health-care workers from the developing to the developed world.  From 1999 to 2005, the 74 per cent increase in funding for HIV/AIDS to sub-Saharan Africa was actually spent on paying down debt or increasing currency reserves.  The global community must commit to having 4.1 doctors, nurses and midwives per 1,000 people by 2015.  She also called on Governments in wealthy nations to close the funding gap and reach universal access to treatment and prevention by 2010.

Mr. KAZATCHKINE said, since the early 2000s, health had become a major recipient of aid and it was no longer seen as a consequence of development, but rather as a necessary and priority investment for development.  Most aid was targeted at disease-specific programmes, notably HIV/AIDS, and global health partnerships, such as the Global Alliance for Vaccines and Immunization (GAVI) and the Global Fund.  Since its creation in 2002, the Global Fund had approved $10.7 billion in 572 grants to 136 countries, with 60 per cent supporting programmes in sub-Saharan Africa and AIDS programmes.  In 2007, the Global Fund’s contribution currently represented one third of all international aid to fight AIDS and two thirds of global funding for tuberculosis and malaria.  But, demand expressed by countries for HIV funding was estimated to be at least double the actual funding.  To accelerate the response, the Global Fund’s Board had approved a second round of grant proposals in 2008.

The political commitment of donors to close the funding gap was needed more than ever, he said.  At the Global Fund’s replenishment meeting in Berlin, donor Governments pledged at least $10 billion for the 2008-2010 period.  Long-term donor pledges up to 2014 were an important step towards sustainability.  Innovative financing mechanisms, such as UNITAID, Debt2Health and Product RED could also help increase resource mobilization and enhance long-term sustainability.  The demand for health care must be promoted at the country level, in the form of free packages of HIV care, direct subsidies for HIV programmes, prepayment schemes, and health care and social protection insurance mechanisms.  Closing the funding gap would also help strengthen health systems, he said, noting that one third of the Global Fund’s expenditures were invested in upgrading health-care infrastructure, training and capacity-building.  He strongly encouraged programmes to be nationally owned, with civil society and the private sector helping to draft proposals and provide grant oversight, thus facilitating more participatory democracy in health policy.

During the ensuing discussion period, several participants urged developed countries to increase funding to fight HIV and AIDS in the developing world and expressed concern over the declining level of official development assistance worldwide.  Some developed nations took the floor to announce their funding commitments in health care.  One participant, noting that financial resources would not be useful if countries lacked the institutional capacity to use them, said support systems for monitoring and evaluation were essential.  Another urged donors to provide resources for grass-roots organizations, noting that women at the grass-roots level were not given the technical support needed to access resources and meet donors’ criteria.  One speaker lamented that aid fatigue continued to be an excuse not to provide more money.

Some African participants noted that, while infection rates were falling in Western Europe, they were rising in Africa.  That disparity must be addressed.  Africans were largely absent from high-level global decision-making in the fight against AIDS.  One participant said people living with HIV should inform other victims about their experience with antiretroviral therapies and provide peer support.  Another called for greater investment in education and socio-economic wellness for girls, which would contribute to ending poverty and lowering the risk of HIV infection.  One participant warned that health care could not be sustained without food security.

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For information media • not an official record