U.N. Conference Endorses Plan to Fight HIV/AIDS on a Global Scale
Delegates to the U.N. General Assembly special session on HIV/AIDS unanimously endorsed a Declaration of Commitment outlining a global strategy for the fight against HIV/AIDS yesterday, the New York Times reports. The document, "while in no way enforceable by the international community, is nonetheless extraordinary in both its language and its tact," and acknowledges that HIV/AIDS is "something far beyond a medical issue, framing it instead as a political, human rights and economic threat," the Times reports (Steinhauer, New York Times, 6/28). U.N. Secretary-General Kofi Annan called the declaration a "clear battle plan for the war against HIV/AIDS, with clear goals and a clear timeline. It is a blueprint from which the whole of humanity can work in building a global response to a truly global challenge" (Farley, Los Angeles Times, 6/28).
Goals and Targets
Labeling AIDS a "global emergency," the document "details" the demography of the disease and outlines many factors in the spread of the virus. The document also lists a series of targets for the reduction of HIV infections, increased education and prevention measures and implementation of treatment programs (Steinhauer, New York Times, 6/28). One of the main goals of the declaration is a 25% reduction in infections among young people between the ages of 15 and 24 in the worst affected nations by 2005 and an international reduction of 25% by 2010. The declaration also seeks to establish "national prevention targets" that "recogniz[e] and addre[ss] factors leading to the spread of the epidemic and increasing people's vulnerability" by 2003 (AP/South Florida Sun-Sentinel, 6/28). That language is part of a compromise reached when members of the Organization of Islamic Countries objected to references to homosexuals, sex workers and intravenous drug users as specific HIV "vulnerable groups." Document framers agreed to drop the language in exchange for a stronger stance on the rights of women. The document "explicitly" states that "empowering women is essential for reducing [HIV] vulnerability" and notes that illiteracy, "social exclusion" and "sexual exploitation" of women have all contributed to the spread of the disease. The declaration also asks nations to do away with "harmful traditional and customary practices," which "appears to be an allusion to things like genital mutilation," a procedure that may spread the virus through the use of contaminated knives. "If there is one idea that stands out clearly, it is that women are in the forefront of this battle," Annan said (New York Times, 6/28). Archbishop Javier Lorenzo Barragan, the representative from the Vatican, which also opposed the references to vulnerable groups, told the assembly that although "many groups were disappointed to see supportive references to gays and other groups deleted from the declaration," most still viewed the document as a "victor[y]." Annan acknowledged that the debate brought "painful differences" to the surface. He added, "Like AIDS itself, these differences need to be confronted head on, not swept under the carpet" (Garrett, Newsday, 6/28).
Treatment Called 'Integral'
The declaration calls prevention the "mainstay" of international HIV/AIDS efforts, but acknowledges that treatment "must be an integral part of all national and international programs." The document asks countries to "cooperate constructively in strengthening pharmaceutical policies and practices, including those applicable to generic drugs and intellectual property regimes." The Washington Post reports that "[e]ven the United States, which has been the most powerful proponent of prevention over treatment," appears to have "shift[ed]" policies. Secretary of State Colin Powell, who co-chaired the U.S. delegation to the conference, said "only an integrated approach," including treatment, "makes sense." Duff Gillespie, a USAID official, said that prevention remains the United States' "highest priority," but added that antiretroviral treatment is "also important." Doctors Without Borders, which has advocated treatment, said that the declaration "puts treatment firmly on the map [and] confirms ... that there can be no choice between prevention and treatment -- they are mutually reinforcing" (DeYoung, Washington Post, 6/28). Barragan said treatment is a "moral imperative," adding "that there is a 'social mortgage' on all private property, and that this concept can also be applied to 'intellectual property'" (Newsday, 6/28). However, the Health GAP Coalition, a group of American AIDS activists, said the document only makes the "vaguest of gestures" toward treatment, "barely mentioning drug patents as a hindrance to drug access and failing to insure that the bulk purchase of generic drugs will be included in the portfolio of the proposed global AIDS fund." Paul Davis, a Health GAP organizer and a member of ACT UP/Philadelphia, called the document a "very weak tool" for advocates (Collins, Philadelphia Inquirer, 6/28).
Using the Declaration
UNAIDS Executive Director Peter Piot called the declaration a "major instrument for accountability" that can be "forcefully" used with governments. Annan called the document a "yardstick, a standard" that people can use to "challenge their governments on what they are doing and not doing." However, Davis said it is "hard to imagine how" people can use the declaration (Zimmerman/Harris, Wall Street Journal, 6/28). Phillipe Leveque, director of CARE-France and head of CARE's 13-member delegation to the conference, said his group was "obviously hoping for a more strongly worded document," but called the declaration a "step in the right direction," adding that the "test now is whether the nations of the world can translate words into a global response" (Ahmed et al., Atlanta Journal-Constitution, 6/28).
Setting Up the Fund
Much of the uncertainty surrounding the plan revolves around the proposed AIDS trust fund. Although the declaration endorsed the Global AIDS and Health Fund, it did not lay out the specifics of how the fund will operate or who will oversee it. Annan said that the details of operation will be determined "by year's end" and added that he "expects" the fund to be run by an "independent, not-for-profit board" that will include representatives from the United Nations and WHO, as well as representatives from donor and recipient nations. So far, $961 million has been contributed to the fund (Wall Street Journal, 6/28). The Global AIDS Alliance, a coalition of AIDS advocacy groups from the United States and Africa, said yesterday that it is concerned about the direction of the fund because "key" decisions about its design and operation are "still being made behind closed doors among the wealthy donor nations, with little civil society input." Dr. Paul Zeitz, GAA co-director, said, "That reflects a domineering, colonialist pattern of behavior, not a real partnership with people in affected nations," and called for greater inclusion of other groups in the decision-making process (GAA release, 6/27). To view a copy of the declaration, click here. To view video coverage of the special session on kaisernetwork's HealthCast Web page, click here. Please note that links are available only to readers of the report's Web version.