The United Nations General Assembly Special Session on HIV/AIDS ( UNGASS ) was historic for two reasons, said Secretary-General Kofi Annan. "First, the level of attendance shows that the world is at long last waking up to the gravity of the HIV/AIDS crisis. And second, the Declaration [ of Commitment on HIV/AIDS ] provides us with a clear strategy for tackling it."
Annan made his remarks at a June 27 news conference near the close of the three-day event. It marked the first time that the UN had ever focused on a single health issue in the more than half century of its existence.
Main points of the Declaration include cutting the rate of new infections in young people by at least 25 percent by 2005; recognizing access to care as a fundamental component of curbing the epidemic; a human rights framework for reducing stigma which foments silence about the disease; and recognizing the contribution that those most at risk for contracting HIV can make to containing the epidemic. The 103 paragraphs of the document offered more than something for everyone.
Annan called the Declaration "a yardstick" by which citizens can measure and challenge their own governments. "We need government and the private sector," he said, "This is a fight that everyone must get involved in."
Most of the conference attendees could point to what had transpired over the previous three days and to the final language that was adopted in the Declaration as grounds for optimism, albeit often somewhat less than what they had hoped for. Such is the nature of shaping consensus in the complex arena of international endeavors.
Peter Piot, director of UNAIDS, said the Declaration has "helped to end this false debate" of choosing between prevention and treatment. One without the other is incomplete, both must be implementing in the developing world.
Annan was most impressed with "the strong participation of non-governmental activists" as members of national delegations and as observer/participants. He said they "transformed the atmosphere" of the meeting. Those AIDS advocates are allies in a cause that he has made his own. He said this opening up of the political process at the UN is "the order of things to come."
"Women are in the forefront of this battle" against AIDS, said the Secretary-General. The Declaration made that clear in emphasizing "women's full enjoyment of all human rights" including the empowerment of women "to have control over and decide freely and responsibly on matters related to their sexuality."
The issue of gender equality has been an ongoing source of tension at UN conferences for many years. He believes, "Any society that refuses to use the talent of 50 percent of its population is likely to lose out."
Annan was questioned about "the need to respect cultural diversity even when it results in oppression" of groups such as women and gays. His response coupled a strong support for human rights with a careful avoidance of words such as homosexual, sex worker, or drug user.
While he welcomed the debate over gays and other marginalized groups that took place in the General Assembly and in revising the Declaration, he also acknowledged "the fight is not going to be won in a day."
Piot said what was new about the debate over groups such as gays and drug users is that "for once it was not covered under a blanket of incomprehensible diplomatic language." It was explicit and out in the open. And that is a necessary step in breaking the silence about AIDS.
"It is our job to push the edges now," said Piot. He argued that failure to promote sex education and safer-sex practices "means a death sentence for many children and adolescents." Such early education has been the hallmark of successful prevention programs in countries from Senegal to Thailand.
"The epidemic itself is going to change politics," said Gudmund Hernes, director-general of UNESCO the educational arm of the UN. He was elated that "Ministers were talking about condoms" in the General Assembly session.
SHOW ME THE MONEY
Annan has called for creation of a Global AIDS and Health Fund to fight HIV "in a much more cohesive way." He has bandied about the need for some $7-10 billion annually in new money, and is committed to having the Fund operational by the end of this year.
Part of that multibillion dollar commitment must come from the governments of developing nations through redirecting and increasing resources in their own health budgets. The sub-Saharan African governments, meeting in Abuja Nigeria in April of this year, agreed to set a goal of devoting a minimum of 15 percent of their national budget to HIV.
But some of the nations hardest hit by AIDS spend only $5 per person a year on all healthcare, compared with about $4,000 per person in the United States, said James Wolfensohn president of the World Bank. "You really get a sense of how limited the capacity for contribution that many of these countries have."
It is clear that much of the additional money will have to come from the wealthy nations of the world.
Wolfensohn said those nations must be convinced that "it is not just charity but self-interest" for them to contribute to the Global Fund.
In a parallel move, the International Labor Organization ( ILO ) released a "code of practice" for workplace issues surrounding HIV. It was approved in record time, just days before the conference opened. The ILO is composed of representatives from government, business and labor, and the code represents a consensus view.
ILO director-general Juan Somavia called the code "a plan of action" for implementing change in the workplace. "It introduces pressure from below" in the spirit of the activism that led to the downfall of apartheid in South Africa. He said, the alternative is "to sit back and say it is the government's responsibility."
Another encouraging sign is growth of the Global Business Council, which aims to enlist the world's international corporations in the fight against AIDS. Richard Holbrooke, former US Ambassador to the UN who many speculated would have been Secretary of State in a Gore administration, made his first public appearance as the new president of the Council.
"Business has done a fraction, maybe 10 percent of what they should have done," said Holbrooke. He pointed to Coca-Cola as an example of what business needs to be doing. Africa's largest employer recently announced that it would add its marketing and distribution expertise to the fight against AIDS, as well as begin offering therapy to its employees.
Other large employers, such as mining companies in South Africa, are looking to extend HIV therapy to employees and their immediate family. The disruption of illness and the recruitment and training of replacement workers has become so expensive that it makes economic sense to extend the medical benefit.
AIDS is "bad for the balance sheet and bad for the bottom line. That's how you get business's attention," said Holbrooke. And that is the most likely route that therapy will be introduced on a large scale in the nations of sub-Saharan Africa.
