'Bold Decisions' Needed in AIDS Struggle

  • by Elizabeth Whitman (united nations)
  • Thursday, March 31, 2011
  • Inter Press Service

The report, entitled 'Uniting for universal access: towards zero new HIV infections, zero discrimination and zero AIDS- related deaths,' assessed major obstacles in the path to this ideal world.

The secretary-general listed five recommendations to help bridge the gap between this vision and the reality for people living with HIV/AIDS, calling for a 'prevention revolution' that relies upon the energy of young people and new methods of communication to empower people to protect themselves from HIV infection.

Creating a sustainable infrastructure that includes preventing HIV transmission as well as treating persons infected with HIV will require both political commitment and the recognition that non-discrimination is critical, said the report. It called for people to 'take the bold decisions that will dramatically reshape the AIDS response.'

Ban also listed six concrete goals for 2015 whose fulfillment would significantly decrease HIV/AIDS and its devastating implications. Some of the goals included reducing the sexual transmission of HIV by 50 percent, eliminating transmission of HIV as a result of drug use, completely eliminating HIV transmission from mother to child, and guaranteeing access to education for children orphaned by AIDS.

Mari Ortega, deputy director of UNAIDS in New York, acknowledged in a press briefing that these goals were 'ambitious'. But, in an interview with IPS, he firmly defended the possibility that they could be achieved, saying, 'I think one has to be ambitious to be able to go somewhere.'

'If you set a goal, then you are able to work out the challenges,' he added.

So far, several governments have taken initiatives that appear to be working. For instance, several countries reported significant decreases in percentages of girls who had sex before the age of 15 and positive trends in condom use. Broadly speaking, access to resources and treatment has increased and prevention has improved as well.

Still, programmes and efforts to fight the global AIDS epidemic face many challenges. Although rates of HIV infection have fallen in the past 10 or so years, the sheer number of people living with HIV has increased, from 26.2 million in 1999 to 33.3 million in 2009. Each day, 7,000 new people, 1,000 of them children, are infected with HIV.

The report and its five recommendations to combat these challenges will be used as the basis for a U.N. General Assembly High-Level Meeting in June. This report follows two others, issued in 2001 and 2006, which also set goals to be reached after four years of being issued.

Heavy burden of discrimination

One of the most serious challenges to combating HIV effectively is discrimination against persons with HIV.

'Globally, governments cite stigma as the single greatest impediment to accelerated progress in the response,' the report stated. 'Social attitudes need to be transformed, and resources must be allocated to anti-stigma strategies and other initiatives to promote and protect human rights.'

The report found that fewer than 60 percent of countries have a way to document HIV-related discrimination. Forty- nine countries, territories and entities impose some form of restriction on the entry, stay and residence of people living with HIV, and dozens of countries criminalise certain forms of HIV transmission, including same-sex sexual relations.

Such policies discriminate against key populations who are at higher risk and therefore need greater access to resources, whether as part of prevention or treatment.

These policies can also severely jeopardise public health and limit access to prevention and treatment services. In countries with anti-discrimination policies, these policies are often not fully enforced, said the report.

Despite the fact that the Declaration of Commitment on HIV/AIDS, adopted in 2001 by the General Assembly, called on all U.N. member states to implement 'strong, enforceable measures to eliminate discrimination against people living with HIV or vulnerable groups,' almost three in 10 countries do not have such laws or regulations.

Rising Costs

Another serious obstacle to HIV prevention and treatment is funding. Although certain costs have dropped significantly, such as those of medicine and of condoms, the report declared that the overall 'upward trajectory of costs' was 'wholly unsustainable', and that 'more effective use of resources, streamlined donor reporting requirements, [and] alignment with national strategies and institutions' were necessary.

It called on middle-income countries to take on greater responsibility in absorbing HIV-related costs in their own countries. Lower income countries are expected to remain dependent on international assistance.

Ortega described the situation as being on a 'precarious slope in terms of funding'. For the first time in the past 10 years, annual funding has decreased, he said, although overall resources have increased from 350 million dollars in 2000 to 16 billion dollars in 2009.

Despite the rising costs, the issues in resources and spending can be resolved somewhat if funding, regardless its source, is spent more efficiently and countries focus their limited resources on populations or initiatives where they will have the most impact.

Successfully overcoming these obstacles will require a multi-faceted, integrated effort by governments, NGOs, and civil society in dealing with discrimination, rising costs, educating people about HIV, and other matters. Although accomplishing the secretary-general's goals by 2015 is indeed ambitious, Ortega is convinced, 'It can be done.'

© Inter Press Service (2011) — All Rights ReservedOriginal source: Inter Press Service

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