resilient health systems were a prerequisite for ending AIDS. Bernice Dahn, Minister for Health and Social Welfare of Liberia, said the Ebola epidemic had shut down routine delivery of primary services, including for HIV/AIDS. Without resilient systems, disease-specific programmes would fail to withstand a crisis, she said.
“We need to think holistically about how to build health systems that will support and enable quality HIV/AIDS prevention and treatment, instead of funding vertical programmes without sustainable foundations,” she asserted.
Abdourahmane Diallo, Minister for Health of Guinea, said the Ebola epidemic had revealed weaknesses in the health system, causing a drop in voluntary HIV/AIDS testing and prenatal consultations, during which mother-to-child transmission was identified. Technical and financial support was needed to meet the 90-90-90 targets, as was local funding for the production of treatment and research for a vaccine.
Still others focused on the “feminization” of HIV/AIDS, with Moumina Houmed Hassan, Minister for Women and Family of Djibouti, providing a national example that 4,900 of a total 9,900 citizens living with HIV/AIDS were women. She urged rethinking strategies with strict respect for social, cultural and religious values.
On that point, Omar Sey, Minister for Health and Social Welfare of Gambia, said his country had banned female genital mutilation and domesticated gender equality in line the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol). Women had better health-seeking behaviour than men, which had reduced the number of babies born with HIV. They also played a lead role in economic growth and could be an engine for ending poverty, which was a root cause of HIV/AIDS.
Often, different forms of inequality went hand in hand, said Lilianne Ploumen, Minister for Foreign Trade and Development and Cooperation of the Netherlands. Rape victims, for example, often were at higher risk of being HIV infected because they were often poor, as were their rapists, and likely to die from a lack of access to therapy. She urged placing women above cultural beliefs and recognizing their rights.
Nazira Vali Abdula, Minister for Health of Mozambique, stressed that the role of men was critical, as data had shown that few knew their HIV status or were receiving treatment. “We have to find ways for greater involvement of men in prevention, care and treatment,” she observed.
Also today, the Assembly held two panel discussions, the first of which was on the theme, “getting ahead of the looming treatment crisis: an action agenda for reaching 90-90-90”, and the second on the theme of, “leaving no one behind: ending stigma and discrimination through social justice and inclusive societies”.
Also speaking in the plenary debate today were ministers and other senior officials of the Netherlands (on behalf of the European Union), El Salvador, Cyprus, Guyana, Benin, Myanmar, Angola, Malawi, France, Barbados, Senegal, Niger, Republic of Moldova, Papua New Guinea, Jamaica, Philippines, Nigeria, Malta, Antigua and Barbuda, South Africa, Suriname, Madagascar, Democratic Republic of the Congo, Saudi Arabia (on behalf of the Gulf Cooperation Council), Japan, Norway, United States, Denmark, Kazakhstan, Panama, Italy, Paraguay, Argentina, Switzerland, Poland, Ecuador, Republic of Korea, Rwanda, Kyrgyzstan, Dominican Republic, Egypt, United Republic of Tanzania, Pakistan, United Kingdom, China and Chile.
The high-level meeting will continue at 10 a.m. on Friday, 10 June.
LILIANNE PLOUMEN, Minister for Foreign Trade and Development and Cooperation of the Netherlands, speaking on behalf of the European Union, endorsed a human rights-based, gender-responsive and inclusive approach to fast-track the end of AIDS, especially with regard to children, adolescents, young women, migrants and key populations, including men who have sex with men, people who inject drugs, sex workers, transgender people and prisoners. Noting that HIV disproportionately affected sub-Saharan African populations and that new infections in Eastern Europe were on the rise, she said the European Union would share its experiences, as it had “practically eliminated” mother-to-child transmission. Transmissions among heterosexuals and injecting drug users were also declining, with the only upward trend being among men having sex with men.
The HIV response would need to involve all relevant actors, especially civil society, she said, stressing that the selection of non-governmental organizations (NGOs) to the high-level meeting had neither been transparent nor inclusive. She strongly advocated a more open process, regretting that it had not been possible here. The European Union would continue to support action to address HIV at home, in the neighbourhood and the world through financial, technical and political instruments.
Speaking in her national capacity, she recalled that last year, 1.1 million people had died of AIDS-related illnesses and 2.1 million more had become HIV infected. An estimated 18.7 million people living with HIV were not receiving antiretroviral therapy, a sign of social, cultural, economic and gender inequality. Often, different forms of inequality went hand in hand. Rape victims, for example, were at higher risk of being infected with HIV, as they were more often poor, as were their rapists, and likely to die from a lack of access to therapy. To find solutions, “we only need to look to each other”, she said, noting that sex industry policies had reduced HIV infections by three quarters in some countries, while harm-reduction programmes had had “spectacular” results in Asia and Kenya. In the Netherlands, people with HIV could own life insurance policies. She urged placing women above cultural beliefs, recognizing their rights and those of lesbian, gay, bisexual and transgender people. The poor required access to care and therapy. In closing, she said “do not give in to religious objections to condoms.”
ELVIA VIOLETA MENJÍVAR ESCALANTE, Minister for Health of El Salvador, said the Government had upheld its commitment to contain AIDS, with evidence showing falling numbers of new cases amid strategies to increase HIV testing. El Salvador had decreased mother-to-child transmission, with only three children having been infected in the last year. Trained health personnel cared for people with HIV, following World Health Organization (WHO) guidelines, while a national AIDS commission had been established. With 80 per cent of investments for HIV care coming from public funds, she said that since 2010, El Salvador had promoted health-care system reforms, with cross-cutting strategies for social participation and human rights, and a view to guaranteeing comprehensive, discrimination-free services. The Government was also working on a new HIV law from the perspective of children, adolescents, the work place and prisoners. It was committed to the “90-90-90” goal (90 per cent of children screened, 90 per cent in treatment and 90 per cent viral suppression), she said, in order to ensure that adolescents and adults living with HIV could have improved quality of life, and was working to eliminate mother-to-child transmission.
IOANNIS KASOULIDES, Minister for Foreign Affairs of Cyprus, associating himself with the European Union, said the national HIV/AIDS epidemic was still limited by global standards, despite a small increase since 2005 in the number of new HIV cases diagnosed annually. Protection of human rights was a cornerstone of its AIDS response policy. Despite remarkable global progress, if the status quo remained unchanged, the epidemic would rebound and treatment costs would rise sharply, he said. A fast-tracked multisectoral response to AIDS would mean concurrent progress on all the Sustainable Development Goals. Forward efforts must be driven by political leadership and practical and financial support, particularly to the most vulnerable.
TERRENCE DEYALSINGH, Minister for Health of Trinidad and Tobago, associating himself with the Caribbean Community (CARICOM), reported an 80 per cent national decline in AIDS cases between 2005 and 2014 alongside a 70 per cent reduction in AIDS-related deaths. The Government was enhancing efforts to eliminate HIV-related stigma and discrimination and offering public education to promote awareness of HIV and AIDS with a focus on prevention. However, it faced real challenges due to changed economic circumstances arising from the collapse of global energy prices, including a capacity to test persons in high-risk or stigmatized groups with a view to meeting the 90-90-90 targets. The new “test and treat” model proposed for achieving those targets would require sustained funding and Trinidad and Tobago was counting on continued support from its partners to reach that goal.
VU DUC DAM, Deputy Prime Minister of Viet Nam, recalled that while attending a world AIDS summit in 1994, there was fear and confusion among delegates, no effective treatment available and very little hope. Today, HIV prevention had been strengthened, more people could access life-saving treatment and stigma and discrimination had been reduced. Yet, 2 million people were newly infected in 2015 and more than 20 million still lacked access to antiretroviral treatment. In Viet Nam, HIV prevention and control was among the highest priorities and the epidemic had been largely controlled. Noting that it had been the first country in Asia to commit to the 90-90-90 targets, he said Viet Nam nonetheless required international partnership. To make that point, he said a woman living with HIV, Lu Thi Thanh, was attending the high-level meeting today as part of his delegation. She and her HIV-positive husband had become parents to a healthy baby girl — a miracle made possible by an internationally financed project aimed at preventing mother-to-child transmission. “Without this she would probably not be with us today,” he stressed.
Ms. THANH then expressed her thanks for “giving her back her life, hope and future”.
Mr. VU then urged delegates to respond with “100-100-100 per cent commitment”.
GEORGE NORTON, Minister for Public Health of Guyana, associating himself with CARICOM, said the national HIV/AIDS response was guided by the HIVision 2020, with federal budget financing and support from partners. HIV prevalence had fallen to 1.4 per cent in 2013 from 3.4 per cent in 2004. In 2014, 751 cases of people living with HIV had been diagnosed, down from 1,176 in 2009. Gains could be attributed to policy and programme actions and increased access to antiretroviral treatment. Financing a sustained response had been challenging due to inadequate national resources and reduced or withdrawn donor funding. Closer collaboration with national, regional and international partners was needed, he said. HIVision was underpinned by human rights, gender equality, inclusiveness, accountability and value-for-money approaches. With the second highest HIV/AIDS prevalence, the Caribbean was indeed working to end the epidemic, but it was being excluded from funding on the basis of per capita income. Assistance should take full account of developing country vulnerabilities, he concluded.
AURELIEN AGBENONCI, Minister for Foreign Affairs and Cooperation of Benin, associating himself with the African Group, said that despite encouraging progress, there was no room for complacency. In several developing countries, new infections were on the rise, while stigmatization, discrimination, prejudice and repressive legislation remained widespread. Millions were meanwhile not getting appropriate treatment, he said. Fighting HIV and AIDS required sustained financial support, but that was a challenge in the context of declining international assistance. To meet the objectives of its new national HIV/AIDS plan for 2015-2017, Benin would require 52 billion CFA francs. Such a paradoxical situation called for innovative financing strategies, he said, calling upon Governments to make greater efforts to turn back the trend of reduced external financing.
NILA F. MOELOEK, Minister for Health of Indonesia, recalled that the Association of Southeast Asian Nations (ASEAN) Summit Declaration on HIV/AIDS had been guided by the goal of “zero infections, zero discrimination and zero deaths”. For its part, Indonesia’s efforts included a harm-reduction programme that was among the first in the region. As a result, HIV prevalence among injection drug users had fallen to 29 per cent in 2015 from 42 per cent in 2011. In Indonesia, strengthening the health-care system was crucial as it was a platform to integrate different programmes. Her Government recognized that the first “90” was essential to achieve other “90s”, which required resources and expanding services to hard-to-reach key populations, such as men who have sex with men, transgender people, sex workers, injection drug users, adolescents and young people. Indonesia must enhance its prevention efforts to reach all populations where HIV prevalence had continued to rise, while leveraging the use of information and communications technologies and community-based screening.
MYINT HTWE, Union Minister for Health and Sports of Myanmar, said the Political Declaration stressed the importance of moving from a focus on “one disease” to a more integrated approach to address broader health needs. Recognizing that human rights were essential for an effective HIV response, he supported the removal of laws, policies and practices that blocked access to HIV services for key populations. Noting that the third national strategic plan for HIV/AIDS contained a number of goals, he said Myanmar was committed to the Declaration and would involve national NGOs, civil society and community-based groups as partners in its HIV response. HIV/AIDS situations would be monitored from technical, management, administrative, logistic and social perspectives. In addition, he urged partners and donor agencies to maintain, and not reduce, funding, as Governments would need to review the epidemiological scenario to ensure that interventions could be tailored to specific situations.
LUIS GOMES SAMBO, Minister for Health of Angola, associating himself with the Southern African Development Community (SADC), said sub-Saharan Africa had borne the highest share of the global HIV/AIDS burden. However, as the Political Declaration had outlined, the situation worldwide was diverse and complex. Joint endeavours therefore called for a holistic approach and creative solutions that considered global and local perspectives. In Angola, where an estimated 500,000 people were living with HIV/AIDS, the national AIDS control programme was a priority. It was committed to reaching the 90-90-90 targets, paying particular attention to children, adolescents and women, and allocating national financial resources, including from the private sector, in combination with international funding. Angola endorsed the Political Declaration and would work with national and international stakeholders to put its provisions into practice.
FRANCIS KASAILA, Minister for Foreign Affairs and International Cooperation of Malawi, said that 1.1 million of 16 million citizens were living with HIV. Many challenges stood on the path to achieving the 90-90-90 targets, but various successes in Malawi gave cause for optimism, such as implementation of the Option B+ programme for HIV-positive pregnant and lactating women and their partners. Malawi had also improved HIV treatment programmes so that in 2015 more than 600,000 people living with HIV were getting treatment, compared with 23,000 in 2005. The Government had meanwhile increased domestic resource investment on HIV programmes to 14 per cent in 2015 from 1.7 per cent in 2010. There remained a need to expand HIV treatment, particularly for children, and to reverse the epidemic among women and girls, who were most affected, he said, stressing also the need to address stigma and discrimination they faced.
MARISOL TOURAINE, Minister for Social Affairs and Health of France, said HIV was responsible for 1.2 million global deaths each year. “We need to innovate in the way we prevent the illness,” she said, stressing that France’s health-care system targeted marginalized people, with agencies in all territories working to prevent and diagnose the virus. Starting 10 June, the Government would extend care “100 per cent” to associated centres to serve local populations while professional associations made efforts to reach remote areas. The initiative would also diagnose minors without parental consent. She regretted to note that the General Assembly had not fully considered all key populations. To believe AIDS could be eradicated without targeting men having sex with men, inmates and drug users was deceptive. States must do a better job treating AIDS through improved antiretroviral coverage. France’s AIDS agency ranked second in the world, she said, noting that the July 2017 HIV conference, which France would host, would be another important step. “We need to innovate financing,” she added, noting that the President had proposed a tax on financial transactions to combat the epidemic.
STEVEN BLACKETT, Minister for Social Care, Constituency Empowerment and Community Development of Barbados, welcomed the inclusion in the range of key populations sex workers, men who have sex with men, transgender people, persons who inject drugs and prisoners. Through the national AIDS programme, Barbados had sustained universal access to antiretroviral therapy, which had virtually eliminated mother-to-child HIV transmission, and sought to expand access to HIV testing, treatment and care while addressing gaps for marginalized populations. Its national strategy for HIV identified three priority groups: men, men who have sex with men and sex workers. Embedded into the national development agenda, priorities included addressing the social and economic determinants of HIV through poverty alleviation, comprehensive health education and ensuring social justice. Barbados also had adopted WHO’s “treat all” policy, making all people with HIV eligible for free therapy, he said, calling that a “bold” step. Its high-income status had made Barbados ineligible for Global Fund financing, which failed to consider the challenges it faced as a small island developing State, including a high debt-to-gross domestic product (GDP) ratio.
AWA MARIE COLL-SECK, Minister for Health and Social Action of Senegal, associating herself with the African Group, said a turning point had been reached in the national fight against AIDS. Its prevalence rate had held steady at around 0.7 per cent for 10 years while new infections were down 50 per cent. Those results had been made possible by the engagement and leadership of the President, she said. In the context of diminishing financing in affected countries, there was no option but to combine efforts and become more inventive in mobilizing resources and partners. Africa, which had paid the heaviest price of AIDS, must step up the mobilization of its resources, both internal and external, in order to end the AIDS epidemic by 2030.
MOUTARI KALLA, Minister for Public Health of Niger, associating himself with the African Group, said Goal 3 of the 2030 Agenda, which called for the end of the AIDS epidemic by 2030, offered immense possibilities. Meeting that goal would require robust solid health-care systems and ample attention paid to vulnerable groups, including girls, young women, minors, prisoners, migrants and displaced populations. Each State must have the latitude to define its own key populations, according to its context and realities, so that no one was left behind.
RUXANDA GLAVAN, Minister for Health of Republic of Moldova, said she was from a region where new HIV infections were on the rise and only “modest” progress had been made in reducing them. The right mix of prevention, treatment and care policies and services could reverse that trend. The only sustainable approach was one that focused on locations and well-defined populations living with, at risk of and affected by HIV. Welcoming the Political Declaration’s call for promoting access to high-quality, evidence-based HIV information, the Republic of Moldova had been among the first in Eastern Europe and Central Asia to pilot a life skills-based education initiative. One challenge was to ensure the financial sustainability of the HIV response. As a low middle-income country, the Republic of Moldova was likely to miss the fast-track targets without adequate investments, she said, calling for a reasonable balance between global solidarity and national commitments. “We need country-driven, credible, well-costed, evidence-based, all-inclusive, sustainable and comprehensive national HIV strategic plans,” she observed.
NAZIRA VALI ABDULA, Minister for Health of Mozambique, said Government efforts had adapted the Political Declaration’s targets into the national context, integrating indicators into existing strategic plans. Mozambique had reduced sexual HIV transmission by 50 per cent, and reduced mother-to-child transmission to 6.2 per cent in 2015 from 11.9 per cent in 2013. Also, to minimize financial challenges, the Government had decentralized the HIV/AIDS response and was devising a related financial strategy for health that focused on domestic resource mobilization. The role of men in collective efforts to end AIDS was critical because data had shown that few knew their HIV status or were receiving treatment. “We have to find ways for greater involvement of men in prevention, care and treatment,” she said, noting that the 2030 Agenda for Sustainable Development was the foundation for ending the epidemic because it included important areas associated with its spread.
MICHAEL B. MALABEG, Minister for Health and HIV/AIDS of Papua New Guinea, said that since the first case of HIV nationwide had been diagnosed in 1987, there were now an estimated 40,000 people living with the virus. Acknowledging the need for a greater focus on adolescent sexual and reproductive health and rights, including comprehensive sexuality education, he said that access to antiretroviral medicine was important. Yet, physical terrain, remoteness and limited infrastructure made universal coverage a challenge. His Government had allocated approximately $5 million a year for antiretroviral medicine, which was free of charge for everyone living with HIV. While ending AIDS was possible, it would require a social transformation and a shift away from punitive approaches, he said, adding that the integration of human rights in the response to HIV/AIDS should be non-negotiable.
CHRISTOPHER TUFTON, Minister for Health of Jamaica, associating himself with CARICOM, said although national progress in reducing HIV infection and eliminating the AIDS epidemic had advanced, much remained to be done. Jamaica recognized the need to reduce stigma and discrimination and HIV prevalence among men who have sex with men and transgender persons. But, there had been significant resistance to reforming HIV-related laws. The Government fully supported the fast-track approach to ending AIDS and achieving the 90-90-90 targets, but that would require significant sustained investments. Determining middle-income country status solely on the basis of GDP risked stifling efforts to improve on past gains and getting on the fast track to 2030, he said. While Jamaica was committed to maintaining essential services, he reiterated a call for continued eligibility for donor resources up to 2020, at a minimum, in support of the 2020 targets.
MOUMINA HOUMED HASSAN, Minister for Women and Family of Djibouti, associating with the African Group, said national prevalence stood at 1.6 per cent in 2015, with data showing feminization of disease, with 4,900 women living with HIV/AIDS, of a total 9,900 people. Instability and population movement had fostered HIV/AIDS “vulnerability”. Djibouti offered free antiretroviral access for all patients on a non-discriminatory basis, with a 2007 law protecting against such behaviour for people living with HIV/AIDS and vulnerable groups. Djibouti also was the first country to ratify the Arab Convention for the Prevention of HIV/AIDS and implemented a human rights-based approach in its HIV response. She cited various policies and strategies in that context, including the five-year national health plan and strategic initiative to fight HIV/AIDS for 2015-2017. She advocated partnerships with the United Nations, Arab League, the Intergovernmental Authority for Development (IGAD), World Bank and others to encourage access to services for migrants, including in port towns and refugee camps. She also urged rethinking strategies with strict respect for social, cultural and religious values.
JANETTE LORETO GARIN, Secretary for Health of the Philippines, said that despite a low national HIV/AIDS prevalence, a recent alarming increase was a concern. The Philippines had adopted evidence-based interventions and would review laws, policies and mechanisms to ensure service delivery to all in need, without discrimination. The “High Impact 5” strategy aimed at meeting the universal health-care goal and, ultimately, the Sustainable Development Goals, with one intervention focused on improving access to testing, counselling and antiretroviral treatment for at-risk populations. Expressing support for the Joint United Nations Programme on HIV/AIDS (UNAIDS) fast-track strategy, she said the Philippines would improve the availability of data, disaggregated by income, sex and transmission mode, among other areas. The Government also gave special attention to the vulnerabilities of migrants and was working to ensure access to antiretroviral drugs as part of the 90-90-90 targets for 2020. However, until an HIV vaccine was found, developing countries needed significant support to achieve the 90-90-90 targets through access to cheaper antiretroviral drugs, point-of-care tests and simplified monitoring protocols, she said.
ISAAC ADEWOLE, Minister for Health of Nigeria, said a national antiretroviral treatment programme, one of the largest in Africa, served more than 750,000 people, representing an astronomical increase from 2002, when less than 10,000 had participated. With an additional 2.5 million people expected to be put on treatment over the next three years, more needed to be done, he said. Since adopting a multisectoral approach, the Government had expanded universal access to HIV prevention, treatment, care and support and had promoted the needs and rights of vulnerable groups, including legislation in 2013 criminalizing discrimination against those living with HIV/AIDS. Nigeria had also led a region and subregional mechanism to address HIV/AIDS in Africa, he said, adding that the race to end HIV/AIDS by 2030 would be incomplete without specifically targeting such vulnerable and high-risk groups as women and children.
BERNICE DAHN, Minister for Health and Social Welfare of Liberia, associating herself with the African Group, said the Ebola epidemic of 2014 and 2015 had weakened the national health-care system and shut down the routine delivery of primary care services, including those for HIV/AIDS. “Many of the gains that we had made in previous years were lost,” she said. Emphasizing how a robust and resilient health-care system was a prerequisite for ending AIDS, she said that any HIV/AIDS-related activities could have a positive ripple effect on other health-care work. “This interactive effect needs to be acknowledged and built on,” she said, adding that without resilient health-care systems, efforts to establish disease-specific programmes would fail to withstand a crisis. “We need to think holistically about how to build health systems that will support and enable quality HIV/AIDS prevention and treatment, instead of funding vertical programmes without sustainable foundations,” she said.
ABDOURAHMANE DIALLO, Minister for Health of Guinea, said the Ebola crisis between 2013 and 2016 had resulted in a total of 3,814 cases, with 2,544, or 67 per cent, of people dying. That epidemic had revealed weaknesses in the health-care system, presenting challenges for combating HIV/AIDS. A drop in the use of health services had been seen. For HIV/AIDS, that had impacted voluntary testing and mother-to-child transmission as part of prenatal consultations. There had also been gains. According to the 2015 UNAIDS report, new infections and AIDS-related deaths had fallen. Guinea, as part of the Economic Community of West African States (ECOWAS), had adopted the Declaration of Intent on HIV/AIDS and agreed with fast-tracking the response to end the disease by 2030. In Guinea, those most affected included men in uniform, fishermen, transport workers, miners, men having sex with men, sex workers, drug users, inmates, children and adolescents. More than 35,000 people were receiving antiretroviral treatment, he said, adding that the Government had committed to the 90-90-90 targets with zero discrimination. He called for technical and financial support in those efforts, advocating innovative solutions, such as local financing, in treatment production and the search for a vaccine.
CHRISTOPHER FEARNE, Minister for Health of Malta, supported the Global Health Strategy on HIV for 2016 to 2021, which contained the target of zero new HIV infections, zero HIV-related deaths and zero HIV-related discrimination. Supporting the European Union’s statement, he said the number of new HIV infections was too high, with figures showing that declines among heterosexuals and people who injected drugs had been counter-balanced by a significant rise in cases among other high-risk groups. He advocated increased efforts for testing, treatment and prevention, including those targeting men who have sex with men. In 2017, Malta would host a technical meeting on HIV, in collaboration with the European Centre for Disease Prevention and Control, which would produce a declaration of commitment, he said.
MOLWYN JOSEPH, Minister for Health of Antigua and Barbuda, recognized the need for a fast-track approach to addressing HIV/AIDS, but emphasized the high cost of doing so at a time when a small national economy was being buffeted by exogenous and unrelenting shocks, such as climate change. Other factors included the unfair branding of the Caribbean as a “high-risk area” by large banks in the United States and some European countries and the region’s restricted access to concessional financing from international financial institutions based on the misleading criterion of per capita income. Such unnecessary barriers to economic development were being erected when Antigua and Barbuda should be concentrating resources on critical health issues, he said. National responses included providing antiretroviral drugs, improving the quality of life of those with HIV, working to reduce stigma and discrimination and eliminating mother-to-child transmission. “At the end of the day, we all have to be realistic about the challenges that confront small States in the Caribbean,” where one hurricane could wipe out several years of GDP, he said. If Governments and the private sector came together, overall investment in HIV prevention and treatment could go up from $19 billion in 2014 to $26 billion by 2020, he said.
AARON MOTSOALEDI, Minister for Health of South Africa, said that over the years, the Government had intensified its efforts to deal with HIV/AIDS. South Africa had the largest programme in the world with more than 3.4 million people on antiretroviral therapy. “We need to intensify our prevention efforts otherwise we will not be able to reach the Sustainable Development Goals,” he said, expressing the Government’s commitment to reach the 90-90-90 targets. South Africa had benefited and contributed to the Global Fund. Drawing attention to its successful results, he urged donors to continue their support. Furthermore, for more than a decade, the price of first-line antiretroviral treatment had dropped significantly, contributing to success in reaching millions of HIV-positive people. However, he expressed concern that legal, socioeconomic and structural issues continued to drive the epidemic. In order to ensure that no one was left behind, it was essential to find ways to be more inclusive and responsive to the needs of all.
PATRICK PENGEL, Minister for Health of Suriname, recognized the increase in access to antiretroviral drugs and the decrease in the number of new infections. Despite those achievements, worrisome gaps remained in identifying people living with HIV and linking and retaining them in the health-care system. Estimates had shown that one third of those identified with HIV had failed to enter into care. In that regard, the “doing business as usual” approach did not enable the international community to reach key populations, he said, stressing the importance of strong collaboration with civil society. Further, it was essential to address root causes of inequities in access to health care. In conclusion, he described the high-level meeting as a stepping stone to new global frontiers in alternative funding mechanisms and improving efficiency.
OMAR SEY, Minister for Health and Social Welfare of Gambia, said that across the globe, growing numbers of people living with HIV had access to life-saving treatment, the number of deaths from AIDS-related causes had declined and fewer babies had been infected with HIV. Such progress was the result of concerted efforts and global leadership commitments, he said, recognizing the meaningful participation of civil society and key populations. While much had been achieved, more remained to be done because evidence had shown that high-risk populations were being left behind. Girls and young women often lacked formal paid jobs and, in many societies, early marriage and harmful traditional practices had remained deeply rooted, preventing adolescent girls and young women from seeking services. For its part, the Government had made remarkable strides, banning female genital mutilation and expecting to continue to contribute to the national response to HIV/AIDS. In addition, Gambia had achieved gender parity in education and had aligned the priorities of gender equality with related instruments, including the African Union Agenda 2063 and the Protocol to the African Charter on Human and Peoples’ Rights on the Rights of Women in Africa (Maputo Protocol).
MAMY LALATIANA ANDRIAMANARIVO, Minister for Health of Madagascar, associating himself with the African Group and SADC, said there was a relatively low national rate of HIV prevalence. However, risk factors were real and included first-time sex at a young age, high rate of sexually transmitted illnesses, multiple sex partners, low use of condoms and the sharing of syringes among drug injectors. Madagascar was therefore not sheltered from an explosion of the HIV epidemic. All stakeholders must be prepared to take up the challenge of speeding up the end of AIDS through a number of measures, including high-impact interventions among key populations and strengthening the health system. Now was the time to act as it was the best chance to put an end to the AIDS epidemic.
FELIX KABANGE, Minister for Health of the Democratic Republic of Congo, said there was an opportunity to step up the fight against HIV and to create an AIDS-free generation. The President was committed to that goal, he said. Welcoming remarkable progress in fighting HIV in his country and throughout Africa, he underscored the importance of community involvement. Caring for children remained a major challenge, but that did not prevent making a greater commitment to eliminate paediatric AIDS, he said, adding that experience in fighting AIDS could be applied to fighting other illnesses such as Ebola.
SALEH ALAMR, Deputy Minister for the Economy and Planning of Saudi Arabia, on behalf of the Gulf Cooperation Council (GCC), said member countries were least affected by HIV/AIDS due to a community culture based on religious, social and other values that encouraged avoiding behaviour that could lead to HIV prevalence. For example, Qatar had a national programme to fight HIV/AIDS and invested in an initiative that featured awareness raising, early diagnosis and care for those affected. To address related issues, the Doha Institute for Family Studies had organized a conference in 2011 with UNAIDS and the United Nations Children’s Fund (UNICEF).
Providing a snapshot of several member States, he said the United Arab Emirates was keen to adopt a national HIV/AIDS strategy while Kuwait had provided free treatment for all those infected. In Bahrain, a national committee for HIV prevention had established a multisectoral strategy. Saudi Arabia had a programme to prevent sexually transmitted infections and was keen to provide prophylactic and curative services in a manner that preserved patient privacy. Oman had a national HIV/AIDS programme and was working on community awareness. The Riyadh Charter on HIV/AIDS called on countries to implement 10 recommendations on care, support and improved civil society engagement, among other things, he said.
MASAKAZU HAMACHI, Vice-Minister for Foreign Affairs of Japan, said that with support from the Global Fund, increased access to antiretroviral drugs had greatly reduced the number of deaths and new infections. One of the most effective means of ensuring human security was the achievement of universal health-care coverage, he said. It was important to create a world where HIV prevention methods, including condom use, education, diagnosis, treatment and care, were universally accessible, HIV-tuberculosis co-infections were managed and mother-to-child transmission was prevented. To meet the needs, health-care systems must mobilize large financial and human resources, he said, welcoming the recent trend in developing countries to prioritize health sector development. At the Group of Eight (G8) Kyushu-Okinawa Summit in 2000, Japan had introduced infectious disease control to the agenda for the first time. Through that action, his country had paved the way for the establishment of the Global Fund to fight AIDS, tuberculosis and malaria. Prime Minister Shinzo Abe had recently announced that the Government would provide $800 million to the Global Fund in the coming years.
TONE SKOGEN, Deputy Prime Minister for Foreign Affairs of Norway, said the drivers of HIV/AIDS were poverty, social exclusion, discrimination, gender inequality and norms and perceptions of masculinity. “If we don’t succeed in addressing the needs and challenges of key populations of high risk, we will not end the epidemic,” he said. For its part, over the past 15 years, Norway had continuously increased its global health investments and had rallied behind the Global Strategy for Women’s, Children’s and Adolescents’ Health. He then stressed the need to ensure a strong focus on quality education. Evidence had shown that school attendance reduced the rates of HIV infection in young people. In that vein, access to comprehensive sexuality education and sexual and reproductive health services for young people were critical.
DEBORAH BIRX, Global Aids Coordinator, Department of State of the United States, said her Government’s commitment to ending the AIDS epidemic could not be overstated. “We have saved millions of lives at home and abroad,” she said. Through the President’s Emergency Plan for AIDS Relief (PEPFAR), the United States would create a $100 million Key Populations Investment Fund to support innovative, tailored, community-led approaches to address critical issues and gaps faced by key populations, she announced. It would work to identify, measure and change the complex dynamic that drove stigma and discrimination, she explained. It would also support multi-year and comprehensive approaches to ensure that key-population- and community-led organizations were directly funded to develop and improve their capacity for sustainable HIV responses at the local level. “Key populations require and deserve the support of all partners,” she said, adding that PEPFAR encouraged public- and private-sector donors to contribute to the Fund.
MARTIN BILLE HERMANN, State Secretary for Development Policy of Denmark, said without a fast-track approach, there was a risk of losing years of achievements. “We cannot treat ourselves out of the HIV epidemic,” he said, noting that global HIV incidence was stagnating, not declining. Treatment must go hand in hand with a range of interventions, as there was a rise in incidence among some groups due to discrimination and gender inequality. Closing those gaps involved meeting the rights of everyone to access information, services and treatment without fear of stigmatization or punishment. Promoting and protecting sexual and reproductive rights were imperative. He cautioned against letting yesterday’s taboo stand in the way of tomorrow’s results, noting that adolescent girls in sub-Saharan Africa represented one in four of every new HIV infection.
ALEXEY TSOY, Vice Minister for Health and Social Development of Kazakhstan, stressed the importance of North-South, South-South and triangular cooperation to combat HIV/AIDS alongside partnerships with organizations such as the Arab League. HIV/AIDS not only imperilled development advancements, but decimated the social fabric. Kazakhstan was ready to address the Secretary-General’s recommendations and implement actions in different world regions. Referring to national ownership and far-reaching strategies, he advocated systematic and holistic measures, noting that his country would work with others. In Kazakhstan, such efforts had been entirely State-funded without donor assistance, upon graduation to a middle-income country. It was important to include women and other groups in such efforts, he concluded.
MIGUEL MAYO, Vice Minister of Health of Panama, said civil society activism was vitally important to achieving the 90-90-90 targets and the fast-track strategy. Panama had taken a number of steps to fight HIV/AIDS, including the provision of free testing for pregnant women, which had enabled the prevalence of mother-to-child transmission to be reduced. Stressing the importance of women’s access to education, he said Government actions had included increasing, in 2015, the minimum age of marriage in Panama. State-funded clinics had also enabled men who had sex with men, sex workers and transgender people to be cared for in an atmosphere free of stigma and discrimination. Despite many challenges, achieving the 90-90-90 targets by 2020 was a commitment that Panama had every intention of fulfilling.
MARIO GIRO, Deputy Minister for Foreign Affairs of Italy, said his country was a strong supporter of the Global Fund, having played a major role in its 2001 creation. It would increase its commitment, a decision to be announced at the fifth Global Fund replenishment conference in Montreal in September. Addressing prevention and treatment in a more integrated manner was central to Italy’s strategy, which featured investment in building human capital and increasing access to medicine. Italy recognized the seriousness of the shortage of medicine, with broken supply chains, poor indicators and unsatisfactory responses to be addressed. Innovative approaches were needed to target key populations, especially refugees, migrants and sex workers. He encouraged stronger global and local alliances that included patient groups to promote the rise of new public and private donors.
MARIA TERESA BARAN, Vice Minister for Public Health of Paraguay, said the national programme for combating HIV/AIDS had taken a comprehensive, integrated response and provided decentralized management with a human rights- and gender-based approach. HIV infections were higher among men than women, with the highest number of cases found in the capital and border areas. It was important that those most affected by HIV/AIDS have access to services, free from discrimination, including groups such as men who have sex with men, sex workers, drug users, transgender persons, prisoners and indigenous peoples. She called for increased global investment in the prevention and treatment of HIV, with private sector involvement. She appealed to the United Nations, regional organizations, the private sector, civil society and the scientific community to strengthen solidarity to end AIDS by 2030.
CARLOS FORADORI, Deputy Minister for Foreign Affairs and Worship of Argentina, said the Constitution had enshrined the right to health. Calling HIV/AIDS a global health emergency and a development priority, he said addressing those challenges required a comprehensive global response to prevent its spread. Advancing progress through coordination, funding and firm political will was a priority. Reaching the final objective would require action on human rights, including those of women and girls, gender equality, universal access to health care and access to affordable medicine. As part of its national response, his Government had established a policy entirely funded from the national budget that included free and confidential testing.
TANIA DUSSEY, Secretary of State of Switzerland, quoted Mark Twain as saying that “they did not know it was impossible, so they did it.” Sometimes, she said, it was necessary to support men and women who said “yes” so that they could do the impossible. If the number of new infections was not reduced and if those living with HIV lacked access to adequate services, the epidemic would reverse the progress made so far. The risk of a setback should incite more action. A fast-track response called for more attention to be paid to social, economic and political factors such as poverty and inequality. Fighting the epidemic could not be done in isolation or through parallel structures. Discrimination and stigma could never be justified, she said, emphasizing the importance of the tireless work of civil society.
JAROSLAW PINKAS, Secretary of State at the Ministry of Health of Poland, said national efforts were among the first in Central and Eastern Europe to offer wide and free access to diagnostics, antiretroviral treatment and care for people living with HIV/AIDS. Poland had a very low HIV prevalence, with approximately 1,000 new infections each year. However, estimates indicated that 20,000 people were unaware of their HIV-positive infection status. At the national level, the Constitution guaranteed and ensured that all citizens, irrespective of their financial situation, had equal access to health services. The Ministry had developed a sustainable financing of antiretroviral treatment, providing $75 million in 2015. Furthermore, addressing mother-to-child transmission was one of the key elements of the national strategy on HIV/AIDS. Results of national programmes had shown that the percentage of perinatal infections had dropped from 23 per cent to none, he said.
VERONICA ESPINOSA, Vice Minister for Governance and Health Vigilance of Ecuador, said her country was committed to a fast-track response to HIV/AIDS, noting that health was a right, not a privilege. By respecting human rights as a pillar of development, Ecuador had shown unprecedented political will, lifting more than 1 million people from poverty. Its public health system provided care for 38 million people and ensured universal coverage, including free treatment for people with HIV/AIDS. The world would be held accountable for initially having produced antiretroviral treatment, which was capable of halting AIDS and improving life quality, and then having limited access through unaffordable prices. She urged guaranteed access to essential generic drugs and the elimination of the barriers to access, encouraging debate on a binding instrument on human rights and transnational companies, promoted by Ecuador. That would foster agreement on how to correct existing imbalances stemming from human rights violations by transnational companies.
JUNG KI-SUCK, Director of Centers for Disease Control and Prevention of the Republic of Korea, said prevention was key to slowing the transmission of HIV and reducing the number of people requiring treatment. While antiretroviral drugs were effective, only an estimated 50,000 people out of 3 million were at high risk of exposure to HIV had access to pre-exposure prophylaxis, he said. More prevention options and HIV testing for underserved populations would help to stop transmission, but there also needed to be a better understanding of target populations and service delivery models. Only through the provision of proper treatment and universal medical services could the 90-90-90 targets be achieved. It was essential to review and reform laws and policies in order to eliminate HIV- and AIDS-related stigma and discrimination, he said, emphasizing a need for more investment in research and development leading to better diagnostics, easier and more tolerable treatment regimens and therapeutic vaccines.
PATRICK NDIMUBANZI, Minister of State in Charge of Public Health of Rwanda, attributed the remarkable progress in fighting AIDS to extraordinary global solidarity, which had testified to outstanding collaboration between various stakeholders. Going forward, sustained resources and partnerships would be needed. African countries had made significant progress, but up to now, many programmes had been highly donor-dependent, meaning gains were very fragile, he said. The high-level meeting was an opportunity to draw appropriate strategies that would consider national contexts for greater ownership and sustainability. Only with global solidarity could remaining gaps be closed and AIDS brought to an end, he said.
OLEG GORIN, Deputy Minister for Health of Kyrgyzstan, said despite a low HIV prevalence, with a 0.4 per cent rate among pregnant women, there was an alarming increase among women living with HIV, citing drug use as a factor. Stigmatization had led to late identification of those living with HIV, low commitment to treatment and high mortality rates. Kyrgyzstan had seen success through a multi-sectoral approach that was bringing vulnerable people into treatment. It was among the first countries in the Commonwealth of Independent States (CIS) to adopt opioid replacement therapy and harm-reduction programmes in prisons. Economic difficulties had limited financing for HIV/AIDS programmes, he said, noting that the first initiatives had been started by UNAIDS and the United Nations Development Programme (UNDP). Gains had included uninterrupted antiretroviral treatment, with more than 90 per cent of HIV-positive mothers receiving prophylaxis. He expressed concern at rapid HIV growth in Eastern Europe and Central Asia, due mainly to injected drug use. A global approach was needed, he said.
VICTOR TERRERO, Director of the National Council on HIV and AIDS of the Dominican Republic, said lesbian, gay, bisexual and transgender people, sex workers, poorly educated women, drug users, people with disabilities, older adults and migrants were among the most vulnerable populations. Describing gains, he cited an anti-discriminatory HIV/AIDS law and an increase in the number of people receiving antiretroviral treatment, including mothers, which had helped to reduce mother-to-child transmission. Resources should be provided for developing countries working to effectively respond to HIV/AIDS, including for antiretroviral treatment. It was possible to halt HIV and achieve a generation free from AIDS through collective work towards those ends, he said.
TAREK SALMAN, Deputy Minister for Health of Egypt, associating himself with the African Group, described how the Government had intensified efforts through a national strategy based on human rights, universal access to prevention and treatment services and gender equality. Bolstered efforts aimed at promoting a treatment system that encouraged patients to benefit from services and addressing stigma and discrimination. Underlining such challenges as the misuse of intellectual property, failure to transfer technology and persisting monopolies, he stressed the role of the family in promoting social values, adding that homosexuality, sex work and injecting drugs were part of the problem. Egypt had renewed its commitment to cooperate with its partners to halt HIV/AIDS through strategies in line with its social, religious and cultural traditions.
HAMISI KIGWANGALLA, Deputy Minister for Health, Community Development, Gender, Elderly and Children of the United Republic of Tanzania, associating himself with the African Group and SADC, expressed concern that sub-Saharan Africa remained the most affected region. Urgent and exceptional action was needed at all levels. In the United Republic of Tanzania, HIV and AIDS had had a significant negative impact on development, with an estimated 1.5 million people infected and a disproportionate burden falling on women and girls. Having started “test and treat” initiatives in several districts, the Government was expanding the programme nationally, but in a staggered manner to allow for capacity-building among health-care workers, streamlining logistics and fostering community engagement. He called on the international community to complement and supplement national efforts by mobilizing more resources for the region.
DARSHAN PUNCHI, Parliamentary Secretary for National Health Services of Pakistan, urged all actors to rise above narrow interests and focus on the need to end HIV. Pakistan had a low HIV prevalence, below 1 per cent. Yet, prevalence among injection drug users was 27.2 per cent, followed by transgender sex workers. Ending HIV/AIDS and alleviating poverty must be supported by international cooperation. Scientific breakthroughs and lessons learned from scaling up the AIDS response provided the tools to end AIDS by 2030. Pakistan was committed to controlling the epidemic, providing strong national and provincial support for prevention, treatment and care and reducing stigma and discrimination, for which the Government had invested 300 million rupees.
FELICITY HARVEY, Director General of the Department for Health of the United Kingdom, associating with the European Union, said adolescent girls had been insufficiently included in the HIV response. HIV was among the most common causes of death, and shame, discrimination, inequality and poverty continued to fuel the epidemic. Often the most marginalized, including adolescents, women and girls and key affected populations, were least able to access prevention, treatment and care they needed. Men who have sex with men were 19 times more likely to live with HIV than the general population, while prevalence among sex workers was 12 times greater. She urged a focus on people and countries most in need. The basis for an effective response was gender equality, ensuring girls and women had the services they needed, including comprehensive sex education, family planning and a decent income. Efforts must also include working with men to change harmful social norms and end violence against women and girls.
XIA GANG, Deputy Director-General of the Bureau of Disease Prevention and Control, National Health and Family Planning Commission of China, said HIV/AIDS was both a social and a global health issue. China had integrated an AIDS programme into its overall national health goals and made efforts to address stigma and discrimination. Thanks to many years of hard work, it had largely been able to keep prevalence levels low while reducing the death rate. Noting how the Political Declaration highlighted a global determination to win the fight against AIDS, he stressed the need for responsibility to be shared by developing and developed countries, with the latter selflessly extending support to the former. With demand for testing and treatment poised to grow rapidly, multinational pharmaceutical companies had to dramatically reduce the price of medicine and transfer technology, he said.
JORGE LASTRA, National Direction or the Assistance Networks, Ministry of Health of Chile, said that “we clearly know what to do”, yet HIV/AIDS still affected the most vulnerable countries and communities. It was important to end the epidemic through a commitment to human rights and quality of life, the efficient use of technology, greater involvement by relevant stakeholders and policies that included all groups, including indigenous peoples, and that recognized diversity as a cultural wealth. Success depended on addressing social, cultural and family environments and adopting a comprehensive approach to health.
This morning, the Assembly held the third panel discussion of its high-level meeting, which focused on the theme “getting ahead of the looming treatment crisis: an action agenda for reaching 90-90-90”. Co-chaired by Barnabas S. Dlamini, Prime Minister of Swaziland, and Ruhakana Rugunda, Prime Minister of Uganda, it heard from panellists in two rounds. The first round featured: Abdelmalek Boudiaf, Minister for Health, Population and Hospital Reform of Algeria; Jagat Prakash Nadda, Union Minister for Health and Family Welfare of India; Isaac Folorunso Adewole, Minister for Health of Nigeria; and Hermann Gröhe, Minister of Health of Germany.
The second round featured: Deborah Birx, United States Global AIDS Coordinator and United States Special Representative for Global Health Diplomacy; Ren Minghui, Assistant Director-General for HIV/AIDS, Tuberculosis, Malaria and Neglected Tropical Diseases, World Health Organization (WHO); Souhaila Bensaid, President, Tunisian Association of Positive Prevention; and Andrew Witty, Chief Executive Officer, GlaxoSmithKline.
Mr. DLAMINI, opening the first round, said the world was at an important turning point in the AIDS response. HIV treatment saved lives and prevented new infections; however, the current level of HIV treatment coverage was not sufficient to prevent the large number of AIDS deaths and the epidemic from rebounding in many countries. There must be a further massive scale-up in the provision of antiretroviral treatment, which must happen as fast as possible. Furthermore, half of all people living with HIV were unaware of their status, underscoring the urgency of closing the treatment gap. Aiming to reach the set global targets would mean doubling the number of people on treatment within the next five years, he said, stressing the need to ensure a sustainable supply of affordable and quality-assured antiretroviral medicines. However, many countries were pressured to adopt Trade-Related Aspects of Intellectual Property Rights (TRIPs)-Plus provisions which could limit access to affordable medicines.
Mr. RUGUNDA, taking the floor, asked Mr. Boudiaf how Governments could overcome stigma and discrimination to save lives.
Mr. BOUDIAF responded that Governments had the necessary tools to ensure that the right to health was ensured for all. That was the basis of the Algerian approach, which had proved that it was possible to overcome stigmatization and discrimination so they were not an obstacle to treatment. Algeria had eliminated the financial obstacle to treatment by making health care free to all and had covered the entire country with health-care facilities. The country had maintained high levels of funding for the AIDS response, with more than 95 per cent of financing coming from the State budget. Civil society was also integrally involved in overcoming stigmatization.
Mr. RUGUNDA asked Mr. Nadda what India was doing to achieve the 90-90-90 treatment target, and whether the production of generic, low-cost antiretroviral drugs in India would continue to meet the world’s needs.
Mr. NADDA responded that India’s role as the “pharmacy of the world” was well-recognized, with more than 85 per cent of generic antiretroviral drugs used globally coming from the country. The Government was committed to a partnership with industry to ensure the accessibility of low-cost drugs. It was committed to the Doha agreement on TRIPS and public health, he said. The general prevalence of HIV in India continued to be on the decline, he said, noting that there had been a 66 per cent reduction in new infections from 2000 to 2015. Some 29 million people in India were tested for HIV each year, and the country was considering expanding its test-and-treat approach to all key populations. Implementing the 90-90-90 goal would require almost doubling the spending on treatment, he said, underscoring the need for sustained funding from donors and developed countries.
Mr. RUGUNDA asked Mr. Adewole what Nigeria’s plans were to reach the 90-90-90 treatment target by 2020.
Mr. ADEWOLE stressed the need to improve efficiency in existing funds, eliminate overlap and reinvigorate the country’s health sector. In that regard, a new health-care plan had been devised and the country had agreed on the provision of universal coverage. Nigeria had received over $1 billion in outside financing to date and it now recognized the need to complement those funds with more domestic resources. It was strengthening critical capacities in HIV programming and building the capacities of health-care workers, as well as working with UNAIDS to develop more strategic interventions.
Mr. RUGUNDA then asked Mr. Gröhe how the world could ensure that AIDS financing adequately addressed the needs of populations that tended to be left behind.
Mr. GRÖHE advocated for coordinated efforts at the global level to strengthen health systems and develop systems that protected individual from the financial risks associated with ill health. The weakness of national health-care systems had been exposed during the Ebola outbreak in West Africa, he said, stressing that sustainable domestic financing efforts needed to be placed at the centre of efforts to strengthen those systems. All States must be convinced to address the needs of key populations and fight against stigma and discrimination. It would take all stakeholders to advocate for inclusion, equality and justice for all. Moreover, to reach universal health-care targets innovative financing strategies would be needed.
When the floor was opened for an interactive discussion, a number of speakers made points relating to the availability and costs of HIV treatment.
In that vein, the representative of Chile said her country faced challenges related to drug patents, which drove up the cost of antiretroviral medications. Chile had been working with Argentina for joint purchases of such drugs through the Southern Common Market (MERCOSUR). Pharmaceutical companies should behave ethically, she said, calling for agreements at the global level to “walk the talk” of the Political Declaration adopted yesterday.
A representative of the civil society organization Procela, however, warned that lower costs for antiretroviral drugs could threaten incentives for pharmaceuticals to produce them. The prices of those medications had been dropping dramatically and margins had been reduced to a point where there was no profit associated with manufacturing them. The burden of supplying treatment to 30 million patients in the coming years would be far too great for a handful of companies, he said, underscoring the need to make the market more attractive to new companies. “Price decreases must stop,” he stressed, calling for economic models to make the production of generic antiretroviral drugs more viable.
Meanwhile, a number of speakers underscored the need for strengthened national health systems, which would also be critical to improving access to treatment.
The Minister for Health of Benin said his country was defending itself against the HIV epidemic with available resources, including support from the international community. However, significant reform of Benin’s health-care institutions was clearly needed, he said, describing efforts to improve access to treatment across the country. Ending AIDS was a historic opportunity to create a world that was safer and more just for generations to come.
The representative of Italy said that, in addition to increasing access to treatment, research towards developing a prevention vaccine must be pursued. Innovative models of care were needed to increase retention and improve HIV prevention literacy. Approaches targeting key populations were also needed in order to curb the epidemic.
Also participating were the Minister for Health and Population of Haiti and the representative of Malawi.
Mr. DLAMINI, opening the second round, asked Ms. Birx what needed to be done differently to put an additional 15 million people on treatment by 2020.
Ms. BIRX responded that the looming treatment crisis was compounded by the changing demographic situation in Africa, where there was a steep rise in the number of adolescents. The United States President’s Emergency Plan for AIDS Relief, known as PEPFAR, was moving from a generic approach to a tailored approach which addressed the structural and social issues associated with HIV infection. Preventing new infections in young men, in particular through voluntary circumcision, was also crucial. The Emergency Plan had increased its coordination with the Global Fund to Fight AIDS, Tuberculosis and Malaria in order to improve access to treatment. Finally, she announced the establishment of a new $100 million key population investment fund, which would ensure that the words of “leaving no one behind” was translated into emergency action.
Mr. DLAMINI then addressed a question to Mr. Minghui, asking how the health sector should adjust in order to adopt community models of service delivery.
Mr. MINGHUI said the 90-90-90 treatment target would require “doing things differently”. The WHO had been forward-thinking in that respect, developing differentiated care models that promoted community-based service delivery. The organization had recognized the critical importance of reaching all people living with HIV, including those who had traditionally been left behind, and was working to ensure that HIV testing reached more people where they lived and worked. It was also exploring the use of self-testing and would issue formal recommendations later this year. The treatment scale-up needed to be integrated with prevention methods, he said, adding that there was still a need for innovation to create a daily single-pill treatment programme.
Mr. DLAMINI asked Ms. Bensaid why the Middle East and North Africa region had a low rate of treatment coverage, and what should be done about it.
Ms. BENSAID responded that fewer than 1 out of 5 HIV-positive people had access to treatment in her region, despite it being one of the places with the fastest growing infection rates. Referring to the well-publicized exclusion of certain civil society groups from the present meeting, a move which had been supported by some countries in her region, she said “it is still a long path for these countries to accept reality” — namely, that key populations, such as injecting drug users, sex workers, men who had sex with men and others, existed and needed support. With that in mind, she said, the Middle East and North Africa region needed urgent international support. States of the region also suffered from high drug costs.
Mr. DLAMINI then asked Mr. Witty to describe the partnership model for ensuring innovation, while at the same time making lifesaving medicines a public good.
Mr. WITTY, noting that there were now fewer companies than ever involved in HIV research and development, underscored GlaxoSmithKline’s continued commitment to that work. In advance of a vaccine, which remained a far-away goal, it was critical to make medications safer, easier and more effective against resistance. There was also an opportunity to move away from daily treatment towards drugs that could be administered only once every two or three months. A mechanism was needed to balance the return for innovation with the priority of access, he said, describing the current tiered cost approach in which poor countries paid less than wealthier ones. With regard to intellectual property, he said about 94 per cent of people living with HIV today lived in countries where GlaxoSmithKline did not assert its intellectual property rights or had entered into royalty-free licence agreements.
In the ensuing interactive discussion, many speakers voiced concern over the looming treatment crisis and outlined efforts their countries had taken to avoid it.
The representative of Kenya, in that regard, said that while his country had increased domestic funding, it still faced challenges in financing treatment. Among other things, he stressed the need to enhance TRIPS flexibility and direct funds to support countries’ general health-care systems.
The representative of Thailand said antiretroviral treatment was the most powerful tool available to end the HIV epidemic. Like other middle-income countries, Thailand struggled with how to get people tested. For the last year and a half, the country had successfully launched a testing programme for men who had sex with men and other key populations, with PEPFAR’s support.
The representative of Morocco emphasized that it was vital to fast-track medical research in the HIV response. It was equally crucial to ensure that all countries, including middle-income States, benefitted from the lowest-cost drugs. Endeavours to reduce the cost of antiretroviral treatment must also address access to third-line medications, which remained extremely expensive.
A representative of the civil society organization Adolescent HIV Treatment Coalition said treatment access needed to be centred around the lives of those who needed it, not those who developed it. Companies must not be allowed to profit from the health of communities, he added.
Also speaking were the representatives of Sudan, United Republic of Tanzania, Cuba and Brazil.
This afternoon, the Assembly held the fourth panel discussion of its high-level meeting, which focused on the topic “leaving no one behind: ending stigma and discrimination through social justice and inclusive societies”. Co-chaired by Faustin Archange Touadéra , President of the Central African Republic, and Paul Biyoghé Mba, First Vice-Prime Minister of Gabon, it featured panellists in two rounds. The first round featured: Piyasakol Sakolsatayadorn, Minister for Public Health of Thailand; Marisol Touraine, Minister for Social Affairs and Health of France; Lilianne Ploumen, Minister for Foreign Trade and Development Cooperation of the Netherlands; and Celso Amorim, Co-President of the High-Level Panel on Global Response to Health Crises.
The second round featured: Phumzile Mlambo-Ngcuka, United Nations Under-Secretary-General and Executive Director of the United Nations Entity for Gender Equality and the Empowerment of Women (UN-Women); Ochonye Bartholomew Boniface, Country Director, Heartland Alliance Nigeria; and Laxmi Narayan Tripathi, President, Astitva Transgender Network.
Mr. BIYOGHÉ MBA said the AIDS epidemic had unveiled social and economic fractures and gaps within and among countries. It had also deepened levels of stigma, prejudice, discrimination and violence towards those who were most vulnerable. Those living with the disease had called for protection, justice, dignity, fairness and access to services. They had demonstrated the value of the rule of law and inclusion, he said, calling AIDS a “pathfinder” to identify vulnerabilities. In many countries, law reform, protective frameworks and other measures had been adopted to ensure social justice, which was crucial to the response to the epidemic. However, progress remained limited, as continuing exclusion meant that some populations were still left behind. The present meeting was an opportunity to recognize the interrelated nature of health, the rule of law and development. It must call for a move towards action.
He then asked Mr. Sakolsatayadorn to describe lessons learned by his country in its implementation of innovative programmes to respond to the HIV epidemic.
Mr. SAKOLSATAYADORN responded that stigma and discrimination were the critical barriers to an effective AIDS response. Those phenomena were measurable, he said, adding that they were still prevalent in the health-care setting, with key populations affected more than others. Thailand’s stigma- and discrimination-reduction programmes were tailored and would soon cover all provinces of the country. The active participation of all stakeholders created more ownership and sustainable action.
Mr. BIYOGHÉ MBA then asked Ms. Touraine why the rule of law, along with human rights protection, was so critical to ending AIDS.
Ms. TOURAINE agreed that the fight against AIDS was not just a medical issue, but a political one and related to human rights. Today, more than 90 per cent of new infections were in the most exposed populations — men who had sex with men, drug users, victims of prostitution, transgender people, prisoners and migrants. It was the responsibility of States to target their actions and diversify their approaches to reach those populations, she said, noting that France had adopted that approach since 2012. Describing national policies and programmes in that regard, she underscored that “we can no longer tolerate refusal of care”, which was often related to stigma and discrimination. France supported the UNAIDS plan for 2016-2021, which strongly addressed the issue of stigma.
Mr. BIYOGHÉ MBA asked Ms. Ploumen to describe priority actions for ensuring treatment access for key populations.
Ms. PLOUMEN stressed the need to make use of all available data on key populations. “If you’re not part of a data set, it’s all too easy to be overlooked,” she said in that regard. For example, evidence had led insurance companies in her country to allow HIV-positive to purchase life insurance. She also underscored the need to decriminalize people who were at risk, as well as unintentional HIV transmission, and to remove age limits for testing and prevention services. An inclusive approach also implied joining forces with others, including schools, employers, media and civil society organizations.
Mr. BIYOGHÉ MBA asked Mr. Amorim what the main challenges and opportunities were for the use of TRIPS-flexibility by lower- and middle-income countries.
Mr. AMORIM responded that the questions raised today needed to be considered in the context of poverty. That was why, in 2001, World Trade Organization members adopted a Doha Declaration which created a “human rights exception” to the TRIPS rules. That flexibility preserved countries from trade retaliation, but not from other types of threats. He proposed the inclusion of the question of TRIPS and health as part of the universal periodic review of the Human Rights Council, where countries that were imposing unfair pressure could be “blamed and shamed”. “The human right to health should take precedence over profit”, he stressed.
As the floor was opened for an interactive discussion, several speakers echoed the warning that vulnerable populations often could not access HIV care and treatment due to the barriers of stigma and discrimination. Many described national experiences in reaching those key populations through targeted policies and programmes.
In that regard, the Minister for Foreign Affairs of Malawi said that, in his country, men who had sex with men, female sex workers and other vulnerable populations were disproportionately affected by HIV/AIDS. As part of its response, his country had imposed a moratorium on laws criminalizing same-sex relationships — the first such action in the subregion.
The representative of Mauritius said his country’s 2016-2021 HIV Action Plan set ambitious targets and reaffirmed the UNAIDS vision of the “three zeros” — zero new infections, zero discrimination and zero AIDS-related deaths. It had scaled up and decentralized its HIV service delivery and all parts of the island now had access to antiretroviral therapy.
The representative of the Russian Federation said those with HIV or who were threatened with infection should be treated as patients, and not as special groups of society. “In facing AIDS, all are equal, and all can be affected,” she said, calling for an inclusive approach supporting “all rights for all”.
Meanwhile, other speakers underscored the need to put public health interests before economic ones, in particular in international trade agreements that could affect the availability and cost of antiretroviral drugs.
In that vein, the representative of Ecuador said that it was vital for the right to health to prevail over intellectual property rights. International trade agreements could become methods of extortion, and there was a need to ensure that low- and middle-income countries had the tools and resources necessary to confront the epidemic.
Also participating were the representatives of Cuba, United Kingdom, Morocco, Chile, Brazil, Mongolia, Sudan, Colombia and Bahamas, as well as two representatives of civil society.
Mr. TOUADÉRA, opening the second round, asked Ms. Mlambo-Ngcuka how to ensure that women and girls were not left behind in the AIDS response and that their access to services was free from discrimination and violence.
Ms. MLAMBO-NGCUKA said the 2030 Agenda for Sustainable Development put the imperative of ending gender inequality and gender-based discrimination at its heart. Gender and sexuality had long been recognized as affecting the dynamics of the HIV epidemic, she said, stressing that “to defeat HIV we must end gender discrimination”. Inequality fuelled stigma, fear and misconceptions about the virus. Violence and the fear of future violence could play a major role in the reluctance of an individual to get tested and seek care. Women and girls who had sex with much older partners were much more vulnerable to infection. Intersecting inequalities must be tackled, she stressed, underscoring the need to promote the participation and leadership of women in the global AIDS response.
Mr. TOUADÉRA then asked Mr. Boniface to describe how laws against key populations and civil society organizations were impacting his work.
Mr. BONIFACE said Nigeria long had laws in place against sodomy, and another law criminalizing same-sex marriage had recently been enacted. Seventy-five countries around the world criminalized same-sex relations, which was counterproductive to all efforts of the global HIV response. Due to such punitive laws, communities were forced to become clandestine, and it was more difficult to reach them. Indeed, criminalization had been shown to increase the vulnerability of key populations to new infection. Civil society had played a critical response to the HIV response in the last 20 years, ensuring that marginalized populations were able to access treatment through a human rights-based approach.
Mr. TOUADÉRA, noting that transgender people were 49 times more likely to become infected with HIV than other adults, asked Ms. Tripathi what should be done to ensure that trans people were not left behind in the HIV response.
Ms. TRIPATHI responded that transgender people had been treated as if they were invisible. “My sisters and my community members around the globe don’t have access to medicine, to treatment, or are even considered human,” she said, underscoring that, despite such discrimination, the trans community had the strength to demand their dignity. The United Nations was the biggest platform in the world, and still countries bowed down to the pharmaceutical lobby, as if dollars were more important than blood. No religion had been taught to discriminate against any of God’s children, she said, adding that community ownership had given momentum to the HIV response movement. “Be as human as you can be,” she concluded.
In the ensuing interactive discussion, several speakers took the floor to condemn discriminatory laws and practices aimed at key populations.
The representative of Canada said racism, sexism, homophobia and transphobia negatively impacted the ability of people to live healthy lives. Respect for the dignity and rights of all people must be at the core of all HIV interventions, she said, calling for work across all sectors to end stigma and discrimination. Furthermore, accessible solutions would only be found if key populations were meaningfully involved in the HIV response.
A representative of a civil society organization from the Russian Federation said she was appalled by the situation of people living with HIV in her country. States must stop denying specific support to key populations, she stressed, noting that drug users in her country faced discrimination and lacked access to WHO-approved medications.
A civil society representative from Ukraine, who shared his personal history as a former drug injector, said opioid substitution therapy had saved his life. Today, he was a harm-reduction activist. The Political Declaration mentioned harm reduction only one time, he said, stressing that the HIV epidemic could not be ended without providing such rights-based interventions. In the annexed eastern part of his country, drug users were denied access to harm-reduction services and treatment due to the “geopolitical games” of neighbouring countries.
Also speaking was the representatives of the United Kingdom, as well as two other civil society representatives.
Source: United Nations