‘We Have the Power’, Tools to Fast-Track HIV/AIDS Response, Yet Will Is Needed for Progress, General Assembly President Says at Close of High-Level Meeting
The General Assembly’s three-day high-level plenary meeting on HIV/AIDS concluded today amid calls for redoubled efforts and greater funding to eradicate the epidemic by 2030, as called for in the Sustainable Development Goals.
In closing remarks, Assembly President Mogens Lykketoft (Denmark) said speakers had repeatedly stressed that “together, we have the power, the resources, the knowledge and the technology to fast-track our HIV/AIDS response and to make ending the AIDS epidemic one of the first — and one of the many — amazing successes of the SDG era.”
“The question now, however, is whether we have the will and the humanity to make this happen,” he said, emphasizing that the epidemic had haunted millions of people, denying them their dignity for far too long. “The time for that to change is now and the opportunity to do so has never been greater.”
During the plenary session, many speakers shared their support for the “Political Declaration on HIV and AIDS: On the Fast-Track to Accelerate the Fight against HIV and the End of the AIDS Epidemic by 2030”, adopted, without a vote, at the opening of the high-level meeting 8 June.
Speakers also raised a number of issues and concerns, including from countries that had reached middle-income status — based on their per capita gross domestic product (GDP) — only to find themselves losing access to much-needed financial assistance from international donors as a result. Highlighting that point, Mongolia’s representative said that with an estimated 70 per cent of all HIV-positive people living in middle-income countries, a reduction in development assistance risked jeopardizing progress to reach the global vision of zero new HIV infections, zero HIV-related deaths and zero HIV-related discrimination.
Several speakers spoke of the promise of generic medication. Brazil’s representative emphasized the crucial role of States in reducing drug prices through actively negotiating the public procurement of medicine. Half of the 22 antiretroviral drugs used in Brazil were locally produced, he said, with domestic pharmaceutical company prices lower than the international average.
In a similar vein, Israel’s delegate, stressing the role of science and technology, explained how Hebrew University researchers believed they had developed a treatment that could destroy HIV-infected cells. He went on to tell how an Israeli company had come up with a non-surgical method of circumcision shown to reduce the likelihood of contracting HIV by nearly 60 per cent.
Several speakers raised issues unique to their countries. Mali’s delegate drew attention to the threat posed by “unorganized” gold mining sites to HIV prevalence. Such operations, which were “growing like mushrooms” amid rampant poverty, risked bringing to naught Government efforts to combat HIV/AIDS, potentially changing HIV epidemiology in the region, he said.
Delegates also shared unique approaches to combating HIV/AIDS. Malaysia’s representative discussed national efforts to reverse the epidemic from a Muslim perspective. Religious leaders, physicians and non-governmental groups representing those key populations and people living with HIV had been drafting a training module, available in local languages, English and Arabic, aimed at increasing awareness and advocacy among imams and Muslim scholars, especially to reduce stigma and discrimination, he said. Sudan’s representative underscored the importance of the family, cultural and other values and the principle of sovereignty. He also called for international assistance in lifting unjust sanctions, which had hindered the Government’s efforts to fight AIDS.
The Assembly also heard from representatives of two non-governmental organizations. A representative of MENA-Rosa said the humanitarian crisis in the Middle East and North Africa had compounded women’s vulnerability to HIV, through rape, early marriage, trafficking, gender-based violence, prostitution and poverty. A representative of the Asia-Pacific coalition APCOM said the Political Declaration had turned a blind eye to the reality of HIV/AIDS by omitting, excluding and misrepresenting, among others, gay men, sex workers and people using drugs.
Kieran Daly, of the Gates Foundation, called for a revolution in the way the world was responding to AIDS. “We cannot simply keep doing what has worked so far,” he said. “We must be faster and smarter in the ways we work.” Investments in new, game-changing prevention tools were needed, he said, as were long-acting options that harnessed the power of the immune system.
Delegates also pointed to funding shortfalls. In that regard, Canada’s delegate, who called 2016 “a big year for the fight against HIV/AIDS”, drew attention to the fifth replenishment conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria, which would be held in Montreal in September.
Summaries of panel discussions during the high-level meeting were presented by their respective chairs: Ratu Nailatikau, Former President of Fiji; Lorena Castillo de Varela, First Lady of Panama; Barnabas Sibusiso Dlamini, Prime Minister of Swaziland; Alexis Nguema Obame, Deputy Director-General of the AIDS Prevention Department of Gabon; and Mothetjoa Metsing, Deputy Prime Minister of Lesotho. The fifth and last panel discussion, on the theme “children, adolescent girls, and young women: preventing new HIV infections”, was held earlier in the day.
Also speaking in the plenary debate today were ministers and other senior officials from Bahamas, Montenegro, the Former Yugoslav Republic of Macedonia, South Sudan, Ethiopia, Greece, Bangladesh, Nepal, Luxembourg, Liechtenstein, Belgium, Tajikistan, Jordan, Iran, Georgia, Morocco, Seychelles, Belarus, Colombia, Bulgaria, Nicaragua, Cabo Verde, Uruguay, Czech Republic, Peru, Estonia, Cameroon, Mauritius, Australia, Sri Lanka, Maldives, Guatemala and Finland, as well as the Holy See.
Representatives of the International Federation of Red Cross and Red Crescent Societies, Inter-Parliamentary Union, League of Arab States, Partners in Population and Development and the International Labour Organization also spoke.
Statements
PERRY GOMEZ, Minister for Health of the Bahamas, affirming his Government’s commitment to taking a fast-track approach, said a significant effort would be needed to prevent new HIV infections, reduce AIDS-related deaths and eliminate HIV-related discrimination. It was not business as usual, he said, adding that fast-track implementation would require a multipronged, multisectoral approach. Underscoring the Bahamas’ investment in addressing the epidemic, he said major challenges had included a lack of financing and the inefficient use of available resources. In addressing inequality gaps, the Sustainable Development Goals would be important global planning tools, he said. In a new era of developmental partnerships, the Bahamas’ HIV/AIDS programme would tackle the underlying factors that had rendered people vulnerable to HIV infection.
MILORAD ŠĆEPANOVIĆ, Director-General for Multilateral Affairs at the Ministry of Foreign Affairs and European Integration of Montenegro, associating himself with the European Union, said the AIDS pandemic was being driven by punitive laws, policies and practices that denied access to effective services to vulnerable populations. Progress would depend on advancing social justice and equality. Montenegro’s current HIV/AIDS prevalence rate was 0.017 per cent, but regional trends indicated a real potential for the rapid spread of HIV if prevention among key target groups was not improved. Montenegro was looking into ways to increase its response in such areas as stigmatization, discrimination and the lack of research, data, technical expertise, human resources and financing. HIV/AIDS could not be addressed by a traditional State-centric approach, he said, adding that success would only be possible through global solidarity.
ZVONKO MILENKOVIKJ, National Coordinator for HIV/AIDS of the former Yugoslav Republic of Macedonia, said the Government was drafting a new HIV/AIDS strategy for the next five years, aiming at maintaining low HIV prevalence through a universal approach and upholding human rights and non-discrimination principles. The number of people diagnosed had increased in recent years and there was growing prevalence among men who have sex with men and male sex workers, a trend that warranted early attention. A significant proportion of people living with HIV were not aware of their status, with 41 per cent of those newly diagnosed in 2014 already battling AIDS. The five-year plan was being developed in a “very new funding climate”, amid concerns for the sustainability of the national HIV response. An expected reduction in international assistance for HIV financing was a challenge, he said, noting that optimizing current spending could reduce deaths and new infections.
ESTERINA NOVELLO NYILOK, Chairperson of the HIV and AIDS Commission of South Sudan, said there was a “mixed” HIV epidemic, with a national prevalence of 2.6 per cent, 179,000 people living with HIV and 16,000 new infections seen in 2015, and 13,000 AIDS-related deaths. The HIV response had been growing, with the number of those on treatment increasing to more than 19,000 in 2015 from 3,512 in 2011. Yet, those numbers were far from the targets set for 2015, due to inaccessibility of some areas during the civil war conflict and mass population displacement. A number of ministries had mainstreamed HIV programmes into their work, including the education ministry, which had incorporated comprehensive sexuality education into school curricula, and the defence and veterans’ affairs ministry, which had instituted HIV programmes. Further, the President had pledged to end child marriage by 2030.
MALICK SENE, Executive Secretary of the National High Commission of Mali, said that for 35 years, the Government had prioritized its response to HIV/AIDS, having made progress in terms of prevention, treatment and the protection of human rights. Mali aimed to eliminate mother-to—child HIV transmission and protect people in conflict areas. Gold mining areas had become zones for high-risk populations. The Government was developing a political declaration to eliminate HIV in the next 15 years, spelling out responsibilities for each sector. It would also work to mobilize internal resources and innovative financing to that end. In that context, he drew attention to the threat posed by “unorganized” gold mining sites to HIV prevalence, which were “growing like mushrooms” amid rampant poverty and could bring to naught Government efforts to combat HIV/AIDS. Further, they could dangerously change HIV epidemiology in the region. In closing, he urged the Secretary-General to train peacekeepers on the prevention and spread of HIV/AIDS.
KESETEBIRHAN ADMASU, Minister for Health of Ethiopia, associating himself with the African Group, noted that the continent continued to bear the brunt of the global HIV epidemic, with nearly 71 per cent of all cases worldwide and 90 per cent of HIV transmissions to children. Outlining the policy, legal, institutional and administrative measures taken by Ethiopia to fight the HIV epidemic, he reported an unprecedented decline in the rate of new infections. However, there were substantial variations in prevalence and the risk of infection between population groups and geographic areas. To address that challenge, Ethiopia was following an investment case approach that focused on prevention, care and treatment, in line with the 90-90-90 targets set by the Joint United Nations Programme on HIV/AIDS (UNAIDS). An urban fast-track HIV initiative to stem the transmission would be followed soon by a programme to identify HIV-positive individuals and connect them with care and treatment.
THEOFILOS ROSENBERG, President of the Hellenic Centre of Disease Control and Prevention of Greece, said the national socioeconomic crisis had contributed to a devastating outbreak of HIV among people who injected drugs, which the Government had been able to reverse by scaling up harm-reduction policies, HIV testing and treatment. “We know what works,” he said, recognizing the critical need to speed up the global response to HIV/AIDS. “History will judge us harshly if we fail to act according to history-based practices.” He commended UNAIDS for setting the 90-90-90 targets and called on the global community to scale up interventions for key populations. He went on to express concern over an increased rate of new HIV infections in Eastern Europe and noted how in Greece, and countries worldwide, men who had sex with men had been disproportionately affected by HIV.
LOKMAN HAKIM SULAIMAN, Deputy Director-General for Public Health at the Ministry of Health of Malaysia, said national strategic plans had been shaped by strong political commitment, workable policies and the full participation of various agencies, non-governmental organizations (NGOs), religious leaders and key populations. Following a harm-reduction programme in 2005, new HIV infections among people who injected drugs had dropped to 16.8 per cent in 2015, from nearly 80 per cent in 2000. Malaysia was working to reverse the epidemic from a Muslim perspective. Religious leaders, physicians and non-governmental groups representing those key populations and people living with HIV were drafting a training module, available in local languages, English and Arabic, aimed at increasing awareness and advocacy among imams and Muslim scholars, especially to reduce stigma and discrimination. The Government also had launched a strategic plan on ending AIDS for 2016 to 2030 to complement global initiatives.
SYED MONJURUL ISLAM, Secretary at the Ministry of Health and Family Planning of Bangladesh, said the Political Declaration should have acknowledged the social, cultural and religious norms and values and the legal frameworks of all Member States. Bangladesh was a low-prevalence country, with less than 0.1 per cent of people affected by HIV. However, it had a concentrated epidemic among people who injected drugs in Dhaka. Despite risks posed by neighbouring countries and migrant workers, Bangladesh had kept HIV from gaining ground for more than two decades though the evidence-based implementation of prevention, care support and treatment. Earlier 2016, the Government had co-hosted the twelfth International Congress on AIDS in the Asia Pacific, which had reviewed needs and urged political commitment and investment in the HIV response. He advocated scaling-up case detection through mixed models for community-based and provider-initiated HIV testing, ensuring universal access to antiretroviral therapy and integrating prevention services into the existing infrastructure.
SHANTA BAHADUR SHRESTHA, Secretary for the Ministry of Health of Nepal, said HIV/AIDS was a priority in the National Health Sector Strategy for 2016-2021. Since 2010, Nepal had seen declines in new infections, AIDS-related mortality and prevalence among those aged 20 to 49 and it was close to achieving a reduction of 90 per cent of new infections among children. Its multi-stakeholder approach to HIV/AIDS focused on the most vulnerable populations, including intravenous drug users, men who have sex with men, transgender people, labour migrants and clients of female sex workers. Emphasizing the importance of prevention, he said access to safe, effective, affordable and good-quality generic medicine for HIV treatment would be a great help. Like other developing countries, Nepal faced the triple burden of communicable disease, non-communicable disease and disaster-related emergencies. Fighting HIV/AIDS was an additional burden. Nepal looked forward to continuous and enhanced support from the international community to achieve the target of ending AIDS by 2030.
SYLVIE LUCAS (Luxembourg), associating herself the European Union, expressed concern about children affected by HIV/AIDS. Despite successes in prevention of mother-to-child transmission, one child in two infected by HIV was condemned to die before the age of 2 without treatment. That was unacceptable. She emphasized full respect for the sexual and reproductive rights of young women and girls, including their access to sexual health services and thorough sexual education. It would not be possible to end the AIDS epidemic if the needs of male and female sex workers, men who had sex with men, injection drug users, transgender persons, prisoners, migrants and persons with disabilities continued to be ignored and their access to care limited. Luxembourg would increase by 8 per cent its contribution to the fifth replenishment conference of the Global Fund and it hoped others would follow suit.
CHRISTIAN WENAWESER (Liechtenstein) recalled that each day more than 6,000 people were infected with HIV. The threat posed by HIV/AIDS 15 years ago was different than it was today, making it possible to claim many things had been done right. Providing some examples, he said there had been a 58 per cent reduction of children newly infected with HIV, while gains in treatment had created a 26 per cent decline in AIDS-related deaths in since 2011. Fully considering the human rights dimension was essential and the global response must address the needs of the most vulnerable, including people who injected drugs and men having sex with men, the latter of whom were 26 per cent more vulnerable than the general population. The Political Declaration should have stated that ending AIDS would only be possible through ending the marginalization and criminalization of certain groups, he said, underscoring the importance that the HIV/AIDS response must also focus on women and girls.
BÉNÉDICTE FRANKINET (Belgium) said quelling the spread the epidemic did not mean there were fewer needs for investment to achieve its complete eradication. She supported strengthening the central role of UNAIDS in coordinating the response. Policies must be based on scientific data and take a multisectoral approach towards key populations, such as young women, men having sex with men, sex workers and drug injectors, as “troubling” setbacks had been seen among some groups that had previously shown substantial progress. It was important not to create a hidden epidemic that stemmed from stigma. A zero-tolerance approach in that regard was needed to meet the goal of no new infections, discrimination and AIDS-related deaths. She also urged reinvigorating prevention efforts, with services adapted to adolescents.
MAHMADAMIN MAHMADAMINOV (Tajikistan) emphasized the connection between human rights and preventing the spread of HIV/AIDS. In that regard, he noted the removal in 2014 of all restrictions on foreigners entering and living in Tajikistan on the basis of their HIV status. All foreigners were also granted civil rights similar to those of Tajikistan’s citizens, including access to HIV treatment. Antiretroviral therapy was provided free of charge through fruitful cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United Nations Development Programme (UNDP) country office. Tajikistan fully supported the UNAIDS strategy, which was being adapted to current realities and would be considered when developing a new five-year programme to fight AIDS.
DINA KAWAR (Jordan) said regional instability, including the movement of persons, could lead to new communicable diseases such as HIV/AIDS. Jordan enjoyed low HIV prevalence. A health ministry programme to fight AIDS had been developed, with the first case detected in 1986. UNAIDS was supporting an update to Jordan’s first policy, which covered 2005 to 2009. A new plan would present the current status of the epidemic and any gaps in the existing national response. It would be based on enhancing the availability of information, focusing on the most at-risk populations; improving detection; providing care to people living with HIV; creating a legally supportive environment; and building institutional and technical capacities to implement the response. Committed to the International Labour Organization (ILO) code of practice to protect the right to work for people living with HIV/AIDS, Jordan would bring national legislation into line with international criteria. It also observed the 2013 Arab Strategic Framework for HIV/AIDS, aimed at reducing HIV by more than 50 per cent by 2020.
GHOLAMALI KHOSHROO (Iran) said national steps had included taking a pragmatic approach to HIV/AIDS, which had been implemented with the participation of civil society. An effective harm-reduction programme, in both closed and community settings, had allowed for control of HIV transmission among injecting drug users. Transmissions via other modes, however, were growing and the AIDS response was evolving to address the next wave of infections. Iran had adopted a national strategy incorporating the 90-90-90 targets that aimed to end the AIDS epidemic by 2030. The HIV response must be integrated into existing primary health-care structures, while strategic information must be “rigorously” used to improve scope and quality. The Government was providing more than 95 per cent of HIV spending. Stressing the need for technology, knowledge and expertise transfers, he welcomed international collaboration in order to reduce treatment costs, improve access to prevention, care and treatment and provide universal health coverage with the aim of meeting the 90-90-90 targets.
KAHA IMNADZE (Georgia) said the Government’s programme was the only one in the region to provide universal access to antiretroviral therapy to all HIV-positive persons regardless of his or her immune status or disease stage. That was important in terms of increasing life expectancy and preventing new infections. From 2017, Georgia would be the first country in the region to have a pre-exposure prophylaxis programme for high-risk men who had sex with men. Despite the absence of a wide-scale epidemic, Georgia had seen a slow but steady increase in the number of new infections. A major factor behind that development was a low level of testing among key populations, he said. Although 5,700 cases of HIV infection had been officially registered, the estimated number was more than 9,000. He went on to describe a ground-breaking programme to eliminate hepatitis C in Georgia, with support from the Centers for Disease Control and Gilead Sciences, which had provided a unique opportunity to leverage broader health outcomes.
ANTONIO DE AGUIAR PATRIOTA (Brazil) said national efforts had pioneered the universalization of access to care with a 1996 law making free treatment available to all infected persons. Today, 474,000 people received antiretroviral therapy. He emphasized the crucial role of States in reducing prices through actively negotiating in the public procurement of medicine, creating markets for generic drugs and developing industrial policies for the medicine sector. Half of the 22 antiretroviral drugs used in Brazil were locally produced, he said, noting that domestic pharmaceutical company prices were lower than the international average. In that context, he said innovative mechanisms, such as the Global Fund and the GAVI Alliance, a public-private global health organization dedicated to immunization for all, had helped to overcome institutional and market failures that had hindered lowering prices and, in turn, access to medicine. Key stakeholders were fundamental allies in the HIV/AIDS response and should be empowered by national policies. Regional and national variations should be recognized, he said, citing people who used stimulant drugs and young men who have sex with men.
OMAR HILALE (Morocco) said the battle against AIDS must be waged through collective action, responsibility and commitment. Morocco had taken measures in partnership with civil society, caring for patients without discrimination and implementing the 2006 and 2011 political declarations on HIV/AIDS. It had also prioritized the protection of those infected and halting the disease without stigma and under universal norms, such as equality and sensitivity. Noting Morocco's low prevalence of less than 0.1 per cent, he said the majority of new cases were among the most marginalized populations. More than 150,000 people from those groups had benefited from prevention programmes that had been implemented through a community-based approach. Morocco had created a national diagnostic strategy to integrate screening into primary health centres, increasing by 10-fold those that had been tested between 2011 and 2015. There was also a national strategy to provide free access to care and treatment.
MARIE-LOUISE POTTER (Seychelles) said tremendous progress had been made in mitigating the national prevalence of HIV. However, despite its best efforts, Seychelles had been unable to meet Goal 6 of the Millennium Development Goals. Last year saw the highest number of HIV cases in Seychelles, with the 25-34 age group being most affected and intravenous drug use the most common mode of transmission. Initiatives undertaken by the Government included universal and free access to antiretroviral therapy, the establishment of a wellness centre and a needle exchange programme. In a historic move, it decriminalized homosexuality. As a small island developing State, Seychelles still needed financial assistance to combat AIDS, but it had not been able to benefit from the Global Fund as an individual country, she said.
DAVID YITSHAK ROET (Israel) said AIDS trapped families and communities in a cycle of poverty, deepening inequalities and exclusion. “We must seize this turning point in the HIV epidemic and, through decisive and accountable leadership”, revitalize the global response, he said. Ending AIDS required more than doubling the number of people on treatment. Young girls and women must have access to education and sexual and reproductive services. States were obliged to provide key populations with full access to health-care services with dignity and respect, while innovations in science and technology must be pursued. HIV treatment costs had fallen to just $80 per person per year, from $15,000, while dosage would soon be reduced to a single injection every four months, from 18 pills a day. Further, Israeli researchers at the Hebrew University believed they had developed a treatment that could destroy HIV-infected cells, while Circ Med-tech had developed a non-surgical method of circumcision shown to reduce the likelihood of contracting HIV by nearly 60 per cent. In such efforts, no one could be left out, especially the most vulnerable and key populations.
ANDREI DAPKIUNAS (Belarus) said national priorities had included the building of an effective health system. Measures to prevent the spread of HIV/AIDS, notably through prophylaxis use, were integral to its policy. State financing in the last decade had more than tripled and measures had been enhanced through partnerships with the Global Fund and UNAIDS. Belarus was working to reduce antiretroviral treatment costs, understanding the importance of those efforts for Eastern European countries. It planned to hold a thematic interregional event on that issue at the end of 2016. Also, combating stigma and discrimination had been prioritized using the contemporary methods and approaches. Combating HIV/AIDS would succeed only through a coordinated multisectoral approach, he said, noting an important role to be played by civic groups and businesses. Expressing support for the family, based on traditional values, he called on Governments to consider that young people must spend time not only on professions and education, but also have the desire and possibility of creating a family. Ending HIV/AIDS would not succeed without addressing the illegal spread of narcotics, and he urged being merciless on those spreading the plague.
CARLOS ARTURO MORALES LÓPEZ (Colombia) said AIDS was a development problem and without political commitment, cooperation and action, progress could be reversed. Colombia had a 0.47 per cent prevalence rate among the general population, with higher rates among men who have sex with men, transgender persons and people who injected drugs. It was committed to the 90-90-90 targets, followed World Health Organization (WHO) recommendations and supported the adoption of combined prevention strategies. He urged redoubled efforts to fight the epidemic, with action focused on, among other things, social health determinants, access to good quality medicine, comprehensive sexual education and research and development to optimize diagnosis. Efforts also must focus on key populations, for example, by guaranteeing access to condoms and disposable syringes. Colombia had taken a rights-based approach, recognizing that sexual and reproductive rights were inviolable and must be promoted and protected without discrimination. Drawing attention to high medicine prices, he urged guaranteeing affordability, ensuring access to safe and quality medicine through investment and technology transfers and support for health systems with “robust” local pharmaceutical production.
STEPHAN TAFROV (Bulgaria), associating with the European Union, emphasized the importance of leaving no one behind, including key populations and those subjected to stigmatization and hatred as a result of their sexual orientation and gender identity. It was unacceptable that many young people did not know enough about HIV prevention. Given how the epidemic in Eastern Europe had been growing over the past decade, Bulgaria, with support from the Global Fund, had established a prevention programme that reached more than 50,000 people in high-risk groups. He underlined the importance of integrated, holistic and high-quality services that protected and promoted the right to health for all, including human rights training for health-care providers.
MARÍA RUBIALES DE CHAMORRO (Nicaragua), emphasizing the promotion and protection of the rights of persons, described how the Sandinista Government had implemented an HIV policy that called for affordable prevention, diagnosis and treatment. In that regard, it had provided the region with an example of an effective approach. Where once there was only one hospital for those with HIV, there now were more than 53 that provided care and a day of solidarity had been established to raise awareness and address issues related to stigmatization. To date, the purchase of HIV testing materials had been carried out using State funds, without depending on external cooperation. Tests for HIV were available in all rural and urban centres, she said.
FERNANDO JORGE WAHNON FERREIRA (Cabo Verde) urged that commitments made in the Political Declaration be implemented, noting that sub-Saharan Africa was most affected by HIV/AIDS, especially among women and girls, which was posing problems for the continent’s sustainable development efforts. Ending AIDS required eradicating poverty and promoting and protecting human rights. Governments must prioritize the supply of good quality medicine and technology transfers in order to build health systems as part of a multisectoral response, while education and both physical and mental health must be offered without discrimination. All forms of violence against women must be fought against and gender equality promoted. Cabo Verde had a 0.8 per cent HIV prevalence rate among the general population. Its national strategic plans included all stakeholders and support measures were being developed for key high-risk populations.
CRISTINA CARRIÓN (Uruguay), noting that Latin America and the Caribbean had the second-highest HIV incidence of all regions, urged expanding financial resources so all those in need could access antiretroviral treatment and national efforts could be maximized. Uruguay had made progress in addressing the social determinants of the epidemic. Mortality had stabilized in 2012, with new cases decreasing since 2013 and fewer late-stage diagnoses. Also, vertical transmission had fallen to less than 2 per cent in 2015 from 8.3 per cent in 2005. Citing men who have sex with men, gay and transgender persons, sex workers, prisoners and women living with HIV in situations of violence, among others, she underscored the importance of naming vulnerable groups in order to prevent them from becoming invisible. The process of offering free and accessible diagnoses also must be “de-medicalized” through the provision of male and female condoms, she said, stressing that Uruguay was working to meet the 90-90-90 targets.
JIŘI ELLINGER (Czech Republic), associating himself with the European Union, said the Government was committed to ending the AIDS epidemic by 2030. It had strengthened its prevention and control efforts and welcomed the sharing of international experience and good practices. The Czech Republic was updating its national programme for HIV/AIDS, taking on board all relevant stakeholders and building on national and international evidence. He noted such measures already in place, such as health education from early childhood, anonymous HIV testing, increased accessibility and affordability of quality treatment and care and the avoidance of mother-to-child transmission. The Government was also proactively seeking to remedy cases of discrimination in order to eliminate the stigmatization of vulnerable groups.
GUSTAVO MEZA-CUADRA (Peru) said that the indigenous Amazonian population was among the most vulnerable to HIV, with a prevalence rate between 1 and 2 per cent. Geographical barriers and cultural difficulties had impeded their access to preventative measures and comprehensive care. To address that and other challenges, the Government had implemented a number of initiatives, including the provision of free and universal access to antiretroviral therapy and a package of preventative measures including condoms and post-exposure prophylaxis. It also reaffirmed the importance of addressing homophobia, transphobia and discrimination against persons living with HIV. To raise awareness among the general population, Peru had designated 10 June as a national day of testing for HIV.
OMER DAHAB FADL MOHAMED (Sudan), associating with the African Union, said his Government was keen to keep pace with activities to fight AIDS undertaken by African and Arab Groups through common plans. It was addressing the root causes of poverty and immigration at national and regional levels, working towards peace among its peoples through national dialogue, which ultimately would help to enhance health. Sudan attached special importance to health services for HIV-positive persons through universal health coverage. It had integrated health into all policies and was taking coordinated efforts to eliminate discrimination and stigma. Expressing support for the Political Declaration, he pointed out several reservations, some of which contradicted cultural and ethical values on which Sudan’s policies were based. Sudan was committed to eradicating AIDS by 2030, he said. He regretted to point out the unilateral penalties against Sudan that could target national economic growth and called for international assistance in lifting unjust sanctions, which had hindered the Government’s efforts to fight AIDS. He also underscored the importance of the family, cultural and other values and the principle of sovereignty.
SVEN JÜRGENSON (Estonia), associating himself with the European Union, said scaling up the AIDS response required evidenced-based policies and programmes and increased investments. Expressing support for an approach based on human rights and gender, he emphasized the need for universal access to comprehensive sexual and reproductive education. Prevention of mother-to-child transmission was the most effective way to end new infections and he urged universal access to life-saving prevention, treatment, care and support. Estonia was working to ensure that all people living with HIV knew their status through expanded testing at the primary care level. Co-morbidities presented another challenge. Containing tuberculosis among those with HIV/AIDS was of utmost importance and he cited combined services for those diseases in that context. Injecting drug use comprised almost half of the new cases in Eastern Europe and central Asia. He supported strengthening health-care systems and capacities for broad public health measures and access to essential services and medicine for the prevention of HIV/AIDS.
MICHEL TOMMO MONTHE (Cameroon), associating with the African Group, stressed the importance of national ownership and leadership in the fight against HIV/AIDS. Cameroon was a highly affected country, with a 4.3 per cent prevalence rate in its adult population. The Government had prioritized combating the epidemic. Along with development partners, the private sector and civil society, Cameroon had expanded care and support to infected people and worked to reduce maternal transmission. It also was studying the epidemic and its sociological impacts and care costs, especially for antiretroviral drugs, and was working to intensify prevention activities. Going forward, testing campaigns must be enhanced and other medicines must be made more available. Efforts had been made to provide psychological, legal and socioeconomic assistance to vulnerable children. The main challenge was mobilizing the required funds, he said, urging support for the Global Fund.
SUKHBOLD SUKHEE (Mongolia) said the number of reported cases of HIV infection was growing exponentially nationwide, with more than half of all notified cases reported in the last five years. Modelled projections had shown that HIV prevalence could triple without an expanded national AIDS response. Awareness of HIV infection and prevention among young people was far below global targets. With Mongolia’s transition to middle-income status and the ensuing decline in donor support, prevention programmes among key populations had been cut back, demonstrating how a decrease in development assistance was likely to lead to an HIV funding crisis. He asked UNAIDS and other international partners to focus not only on countries, but also on poor and vulnerable groups. An estimated 70 per cent of HIV-positive people lived in middle-income countries, he said, and scaling back development assistance to those countries would put at risk those with the greatest needs while jeopardizing progress to reach the global vision of zero new HIV infections, zero HIV-related deaths and zero HIV-related discrimination.
JAGDISH DHARAMCHAND KOONJUL (Mauritius) said policymakers needed to pursue advocacy and strengthen preventive measures while ensuring that words were followed by deeds. Those in Mauritius who had been most affected by HIV/AIDS included people who injected drugs, prisoners and pregnant women. Rigidly following international guidance, Mauritius expected to meet the 90-90-90 targets by 2020 and it was aiming to become the first country in the region to completely eliminate mother-to-child transmission. Noting that the Government was the major source of HIV-related financing, he made a special plea for contributions to the Global Fund and enhanced collaboration from its partners.
SHARON APPLEYARD (Australia) said the Political Declaration should have “gone further” on language around key affected populations and had represented the minimum needed to end AIDS. She urged a focus on key populations and evidence-based programmes targeting those groups, an approach that had worked in Australia, which could be seen in its low HIV transmission rates. Over the last decade, Australia had provided AUD$1 billion to support HIV programmes in the region. Since 1992, it had supported programmes in Papua New Guinea, in line with that Government’s strategy, and last year, had provided testing for 115,000 people, including 22,000 pregnant women. Nationally, its strategy recognized key populations as people living with HIV, Aboriginal and Torres Straight Islanders, people from high-prevalence countries and their partners, travellers, sex workers, people who injected drugs and those in custodial settings. By working with affected communities, female sex worker and mother-to-child transmission was “virtually non-existent”.
AHAMED LEBBE SABARULLAH KHAN (Sri Lanka) said an estimated 36.9 million people around the world lived with HIV/AIDS. Stressing that Sri Lanka had a low HIV prevalence rate, he said that in 2015, it had registered an increase and had enhanced efforts to obtain more information. Sixty-eight new cases had been reported in the first quarter of 2016, which the Government believed represented only a fraction of HIV-infected people. HIV transmission due to male-to-male sex was increasing. The national HIV/AIDS control programme offered preventive and curative services. Hospitals offered blood testing and antiretroviral therapy, notably through 14 centres across the country. Treatment of sexually transmitted infections, increased condom use, HIV testing and peer education had been also used to increase awareness.
AHMED SAREER (Maldives) said that, despite a prevalence rate of less than 1 per cent, research had shown that there was “a high epidemic potential”. Emerging trends had raised the risk of increased exposure among locals to a wide range of diseases, including HIV and sexually transmitted infections. Injecting drug use and high-risk sexual behaviour remained the most likely triggers of an HIV epidemic in the Maldives, he added. The geographical distribution of the Maldives made it expensive to implement and deliver HIV prevention and control measures. Since graduating from least developed nation status, its ability to access the Global Fund was a challenge. “Arbitrary classifications based on income levels unfairly disadvantaged genuine needs,” he said, hoping that a renewed commitment to combating HIV/AIDS would bring about changes and allow countries like the Maldives to tap into funding and technical expertise.
MICHAEL DOUGLAS GRANT (Canada), noting high-burden countries such as South Africa and Nigeria where girls accounted for more than 80 per cent of all new HIV infections among adolescents, stressed the need to reach women and girls with comprehensive sexual and reproductive health services and education. In addition, he said, meaningful steps must be taken to halt domestic violence and abuse, with the involvement of men and boys. It was also important to recognize the vulnerability of indigenous populations, whose needs were often unique. Innovation to make treatment cheaper and more effective and to find a cure to HIV meant investing in research and development. Canada, which had recently announced a 20 per cent increase to its Global Fund contribution, to CAD$785 million for 2017-2019, was proud to host the Fund’s replenishment conference in Montreal in September. “This will be a big year for the fight against HIV/AIDS [and] Canada will be there,” he said.
JOSÉ ALBERTO ANTONIO SANDOVAL COJULÚN (Guatemala) underlined the importance of addressing the needs of key populations, noting that the Government had prioritized the human rights of people living with HIV/AIDS, without discrimination. It was also working with other countries to eliminate legal barriers limiting access to treatment, and working to meet the 90-90-90 targets. “We have a problem,” he said, noting that there were not enough resources and that available funds must be used rationally, especially for people in high-risk groups. The struggle against corruption was among the Government’s priorities. It would not be able to complete its work without the help of UNAIDS and the Global Fund, he said, emphasizing that the fight against HIV/AIDS was a joint effort, which implied contributions from each sector in order to reach zero deaths, infections and discrimination. With such assistance, barriers to a better world would be overcome.
JOUNI LAAKSONEN (Finland) endorsed a human rights-based and gender-responsive approach to combating HIV/AIDS, taking into account those most affected and at risk. Addressing the needs of young women and adolescent girls, children, young men and migrants, as well as men who have sex with men, people who inject drugs, sex workers, transgender people and prisoners, was essential for an effective global response. In particular, it was crucial that all women and girls had the knowledge needed to make decisions concerning their bodies, sexuality and reproductive health. He urged investing in gender-transformative HIV programmes that engaged men and boys, stressing that comprehensive sexuality education was important for advancing tolerance and non-violence in relationships. More investment was also needed in advocacy, civil society and community-based services.
BERNARDITO CLEOPAS AUZA, Permanent Observer of the Holy See, said global goals and targets must integrate countries’ concerns when considering peoples’ holistic well-being. “Discrimination and stigmatization can never be an excuse to exclude,” he said, urging that every effort be made to distinguish among policies that discriminated and those established to discourage risk-taking behaviour. Access to prevention, treatment and care services would never be enough by themselves and it was important to address root causes. HIV/AIDS and related infections required urgent political attention and the international community must find the will, technical expertise, resources and methods to provide universal access to diagnosis and treatment. In closing, he urged that attention be paid to the plight of children living with HIV.
ALASAN SENGHORE, of the International Federation of Red Cross and Red Crescent Societies (IFRC), said efforts to reach key populations were much too limited, while stigma, discrimination and human rights violations were rampant and commitments were needed to remove barriers to access for HIV services for those groups. To reduce HIV transmission among people who injected drugs, evidence-based harm-reduction policies and greater efforts to reduce discrimination were needed. In developing countries, community health systems must be bolstered in rural and remote areas, while people caught in emergencies — 1 of every 19 people living with HIV — must not be revictimized through human trafficking, gender or sexual-based violence or lack of access to life-saving drugs.
PATRICIA ANN TORSNEY, Permanent Observer of the Inter-Parliamentary Union, recalled that in a recent meeting, parliamentarians had shared legislation and programming aimed at protecting vulnerable populations. In too many places, stigma and legal discrimination presented barriers to voluntary HIV/AIDS testing and treatment. Parliamentarians could enlighten people in fighting such behaviour, both at the national level and within local constituencies. Several participants had expressed concern at an overreliance on donor assistance in AIDS responses, recommending that the political commitment translated to stronger domestic financing for programmes. She welcomed the Political Declaration’s strong references to rights, inequalities and effective laws and policies.
AHMED FATHALLA, Permanent Observer of the League of Arab States, presented the Arab AIDS Strategy that had been endorsed by the Council of Arab Ministers of Health. Arab States had shown political will by accepting regional and global commitments, he said, noting also an initiative to accelerate and expand HIV/AIDS treatment in the Eastern Mediterranean region. He expressed appreciation for the leadership provided by UNAIDS and looked forward to the end of AIDS within the targets set in the Sustainable Development Goals.
MOHAMMAD NURUL ALAM, Permanent Observer of Partners in Population and Development, said HIV and AIDS remained a global emergency and a serious threat to development, progress and stability around the world. Their spread was often the cause and consequence of poverty and inequality. Official development assistance (ODA) would remain crucial, he said, underscoring the importance of enhanced international cooperation, particularly South-South efforts, to support the goal of ending the AIDS epidemic by 2030. Such cooperation fostered a spirit of solidarity among peoples and countries of the South and that notion needed to be optimally harnessed, he said, adding that such an approach was a complement — not a substitute — to North-South cooperation.
VINICIUS CARVALHO PINHEIRO, Director of the International Labour Organization (ILO), said to fast-track the end of AIDS, enabling legal and policy frameworks must be implemented at the national level to prevent stigma, discrimination and violence that only increased the risk of HIV, especially for vulnerable groups. Vigorous and effective protection of human rights was essential. The rights to privacy, confidentiality and to work and freely choose one’s occupation must be defended. Noting that 2016 marked the twentieth anniversary of the International Guidelines on HIV/AIDS and Human Rights, which provided for protection from discrimination in employment and occupation, equal opportunity and treatment for male and female workers, protection of worker’s privacy and safety and health at work, he said ILO Recommendation 200 offered protections against workplace discrimination and had influenced the development of national legislation, applied in at least a dozen national and regional court decisions upholding the rights of HIV-positive workers
RITA WAHAB, of MENA-Rosa, said the right to health included access to affordable, timely and quality care, noting that the Middle East and North Africa region had the lowest antiretroviral coverage, at 17 per cent. Stigma and discrimination, gender inequality, punitive laws and legal barriers along with cultural and social practices had prevented women and adolescents, among others, from seeking comprehensive services and enjoying their rights. The humanitarian crisis in the region had compounded women’s vulnerability to HIV, through rape, early marriage, trafficking, gender-based violence, prostitution and poverty. She urged more financing for key populations in the region, advocating for regional solidarity and increasing investment in innovative prevention programmes for young people, including comprehensive sexuality education.
MIDNIGHT POONKASETWATTANA, Executive Director of APCOM, a coalition working in Asia and the Pacific, said it was time for urgent and greater investment in innovative regional and national approaches and programmes for, and led by, key populations. As a proud gay man and member of the lesbian, gay, bisexual, transgender and intersex community, he expressed disappointment that the Political Declaration had omitted, excluded and misrepresented gay men and other men who had sex with men, sex workers, people who used drugs and transgender people. By not mentioning them, the Political Declaration turned a blind eye on the reality of HIV and AIDS. Although the Asia and Pacific region had the largest HIV epidemic outside of sub-Saharan Africa, it was barely mentioned, he said, noting a rapid escalation of the epidemic in Asia alongside drastic cuts in financial assistance. He hoped there would be other opportunities for more progressive action and commitments on the ground and asked that Member States explore, develop and maintain effective partnership with community organizations led by, and serving, key communities.
KIERAN DALY, of the Bill and Melinda Gates Foundation, underscored the need revolutionize the AIDS response. When the disease had emerged, it was impossible to imagine there would be such novel ways to protect against infection. “We cannot simply keep doing what has worked so far,” he said. “We must be faster and smarter in the ways we work.” Significant gaps remained in the ability to comprehensively address HIV/AIDS. Without urgently addressing plateauing declines in new infections, there was a risk of reversing gains. There had been increases in access to life-saving treatment, yet too few people were able to maintain regimens to suppress the virus. It was essential to tailor delivery to diverse needs, from self-testing to simplified care approaches.
He said many people most at risk lacked the tools and services to meet their needs. Young women in sub-Saharan Africa lacked prevention options that fit with the realities of their lives. Understanding the structural barriers to services for young women, men who have sex with men, transgender people and those who used drugs, among others, was essential, as was a response driven by the use of better data that addressed each of those unique circumstances. Investments in new, game-changing prevention tools were needed, as were long-acting options that harnessed the power of the immune system, which must be factored into the cost of the epidemic. The Global Fund must be fully funded to the $13 billion it was requesting, he said.
Panel V
This morning, the Assembly held its fifth and final panel discussion, which focused on the theme “children, adolescents, girls and young women: preventing new infections”. Co-chaired by Ava Rossana Guevara Pinto, Vice-President of Honduras, and Mothetjoa Metsing, Deputy Prime Minister of Lesotho, it heard from panellists in two rounds. The first featured: Aaron Motsoaledi, Minister for Health of South Africa; Pagwesese David Parirenyatwa, Minister for Health and Child Care of Zimbabwe; Raymonde Goudou Coffie, Minister for Health and Public Hygiene of Côte d’Ivoire; and Joseph Kasonde, Minister for Health of Zambia.
The second round featured: Babatunde Osotimehin, Executive Director of the United Nations Population Fund (UNFPA); Olena Stryzhak, All Ukrainian Network of People Living with HIV, Ukraine; and Chip Lyons, CEO, Elizabeth Glaser Pediatric AIDS Foundation, United States.
Mr. METSING described reductions in the rates of new infections among children, as well as progress in closing the treatment gap among children. Four countries — Cuba, Thailand, Armenia and the Republic of Moldova — had eliminated mother-to-child transmission of HIV, with more countries well on their way. Nevertheless, half of children living with HIV were not on life-saving treatment and few knew they were HIV positive. AIDS and childbirth were the leading causes of death among adolescent girls and young women in sub-Saharan Africa. Much of that preventable mortality resulted from a lack of sexual health education and an underlying culture of gender inequality and gender-based violence.
Every year, more than 200 million women had unmet needs for contraception, leading to approximately 80 million unintended pregnancies, he said. Progress in improving access to comprehensive sexual and reproductive health and rights education and services was not sufficient and was not reaching many of the populations most at risk of HIV infection. He described promising examples of HIV prevention approaches, which needed to be brought to scale, including: social protection and economic empowerment including the provision of cash transfers, school enrolment and addressing gender-based violence, as well as comprehensive sexuality education and sexual and reproductive health services and rights.
He then asked Mr. Motsoaledi to share his country’s experiences with protecting adolescent girls and young women.
Mr. MOTSOALEDI said South Africa was engaged in a “whole of society campaign” that targeted adolescent girls as well as the men who impregnated them. The three-year campaign was based on data that showed a cycle of HIV infection, and had several aims, including: decreasing teenage pregnancies, keeping girls in school, decreasing sexual and gender-based violence and increasing economic opportunities for young people. The campaign would link adolescent girls to health care, get them tested for HIV, talk to their parents and also work with their older male partners.
Mr. METSING turned to Mr. Parirenyatwa, noting that Zimbabwe had shown impressive results in scaling up treatment coverage, and asked what it would take to protect girls and young women and to break the cycle of “business as usual”.
Mr. PARIRENYATWA responded that, despite his country’s strides in reducing its HIV prevalence, more remained to be done to close the gap of new infections among girls and young women. Some 90 per cent of HIV-positive females received prevention of mother-to-child transmission services in Zimbabwe. However, sexuality education was needed for girls beginning at 10 years of age. Three months ago, child marriage had been outlawed in Zimbabwe, which was a good way forward. A multisectoral approach was also needed to address the problem of high HIV infection rates in secondary schools and universities. Proven preventive methods, such as condom use, must be further promoted.
Mr. METSING then asked Ms. Coffie why it was difficult for people to accept key populations and provide them with services.
Ms. COFFIE responded that the key populations in her country were being targeted through overall HIV prevention programmes. Contact, communication and access to health care and treatment were critical. Her country’s education programmes helped to target children with HIV awareness at an early age.
Mr. METSING asked Mr. Kasonde about Zambia’s work using social media to improve adolescents’ awareness of their sexual and reproductive health and rights, and whether those programmes were working for young women and girls.
Mr. KASONDE said that less than half of Zambia’s adolescent population was knowledgeable about HIV and how it was transmitted. The country was using SMS messages to reach that population, facilitating real-time communication between young people and trained health counsellors. Among other things, it was also using radio to share tailored information to enhance knowledge of HIV and other sexually-transmitted infections.
When the floor was opened for an interactive discussion, a number of speakers acknowledged the feminization of the HIV epidemic and described national approaches to reduce the vulnerability of young women and girls.
The representative of Thailand said his country was working to protect that population, in particular through post-natal care for women and their families, prevention of unintended pregnancies and the avoidance of mother-to-child transmission. It was providing youth-friendly health services, promoting condom use and raising awareness of HIV prevention among young people. Those services extended not only to Thai people but also to migrants.
The First Lady of Haiti agreed with other speakers that new programmes were needed to galvanize HIV prevention, in particular among adolescent girls and young women. In her country, the situation had been exacerbated by poverty and natural disasters; as a result, young women were more exposed to prostitution and rape. Combating those crises could not be achieved without money, she said, underscoring the importance of international solidarity and financial support.
The representative of Denmark said that every day an estimated 10,000 girls and young women were newly infected with HIV. The solution lay in empowering that population and providing access to education and sexual and reproductive health and rights. “We must empower young people to become agents of change in their own societies,” he said, stressing that young people must be part of the global conversation on how to end AIDS.
The representative of Kenya said that, like many others, his country struggled with young women having sex with much older men or “sponsors”. Kenya was working to bring down the rate of new HIV infections among that population through specific, targeted, youth-friendly interventions.
Also participating was the Minister for Foreign Affairs and International Cooperation of Malawi, as well as the representatives of Germany, United Kingdom, Sweden and the Russian Federation.
A representative of civil society also participated.
Ms. GUEVARA PINTO, taking the floor to open the second round, asked Mr. Osotimehin what could be done to address the lack of “straight talk” on the sexual rights of women and girls.
Mr. OSOTIMEHIN said that the reason why HIV still thrived was that the world had been unable to break through some of the difficult circumstances under which many women and girls lived. Those included gender-based violence, early and forced marriage, gender inequality, unenforced or non-existent protective laws and religious barriers. There was a need to work with young people in decision and policymaking. “Sexual and reproductive health and rights” had been overly politicized, he said, underscoring the universal right of each human being to make their own health choices. The spread of HIV among young women was largely due to the irresponsible actions of some older men, he added.
Ms. GUEVARA PINTO then asked Ms. Stryzhak why she felt 71 per cent of new HIV infections in her region were among adolescent girls and what could be done to fully engage that population in the HIV response.
Ms. STRYZHAK expressed her hope that the recently adopted Political Declaration would not become “just another piece of paper”. Governments needed to recognize and address key populations, including men who had sex with men, drug users, sex workers and others, and take steps to meet their needs. Noting that today’s panel had been male-dominated, she underscored the need for leadership among women and girls in policymaking and in the HIV response in general. The promotion, respect for and fulfilment of the human rights of women and girls must be a key part of the AIDS response, which should also make use of harm-reduction programmes. “Women and girls deserve better,” she stressed.
Ms. GUEVARA PINTO then turned to Mr. Lyons. Recalling his statement that Fast Track was not sufficient to rapidly improve children’s access to treatment, she asked what other options he proposed in that respect.
Mr. LYONS said Fast Track was an ambitious, appropriate programme. However, it needed to be matched with an ethos of pragmatic problem solving. Among other things, “we need better paediatric formulations” as well as better testing, he said. “It is entirely in our hands,” he said, underscoring the importance of the new “Start Free, Stay Free, AIDS-Free” super fast-track framework recently launched by the United States President's Emergency Plan for AIDS Relief (PEPFAR), UNAIDS and partners.
In the ensuing discussion, a number of speakers underscored the importance of addressing the underlying inequality drivers of today’s HIV epidemic.
Several delegates, including the representative of Chile, stressed the importance of involving men in the conversation about HIV transmission and respect for women’s rights. That was particularly necessary because traditional male hegemony was prevalent in much of the world.
A representative of the civil society organization Global Business Council declared: “We cannot solve this issue only working with women and girls, because the primary cause is men.” The first sexual intercourse for approximately 25 to 40 per cent of girls was forced, he said, noting that after being raped by an HIV-positive man, a girl had 72 hours to access post-exposure prophylaxis. “These are urgent intervention needs,” he said in that regard.
The representative of Canada also expressed the need to involve men, as well as women and adolescent girls, as change agents in their own lives. There was a need to continue to support the development of an HIV vaccine, which she said would greatly help young women and the children they bore.
The representative of Gambia warned that “we cannot use a one-size-fits-all solution to end AIDS”. In that regard, she called for States to tailor interventions to their own cultural contexts.
Also speaking were the representatives of Cuba, Costa Rica, Ireland, Mauritius, United Republic of Tanzania, Mali, Bahrain and Namibia.
Three other civil society representatives also took part in the discussion.