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Still a long way to go: Overview of the UN High Level Meeting on HIV/AIDS

Once every two years a high level UN meeting is held to assess the status of HIV/AIDS countrywise. This year, the report card showed some gains in access to treatment and increasing awareness, but emphasised that there was a long way to go to provide affordable drugs, universal access to treatment and gender equality, reports Ranjita Biswas

The recent UN High Level Meeting on HIV/AIDS (June10-11, 2008) was roll-call time for member states to showcase their progress in tackling this health problem. In compliance with the UNGASS (United Nations General Assembly Special Session) Declaration of Commitment on HIV/AIDS signed by UN member states in June 2001, every two years countries report to UNAIDS on the status of the disease at home. This year, 151 member states and six observers had requested to take the floor at the UN Assembly.

As the heads of states, health ministers and experts took the floor, it was clear that some of the niggling problems around HIV/AIDS continue in most countries, like the stigma and discrimination associated with the disease, lack of availability of antiretroviral treatment (ART) for all those in need, and lack of adequate resources. Homophobia, too, is no less prevalent after years of campaign.

Government and civil society representatives also highlighted the need for greater accountability, particularly in relation to funds spent by all stakeholders, the need to adapt HIV prevention programmes to local contexts, and the lack of effective programming directed to populations that are especially vulnerable to the disease, especially sex workers, men who have sex with men, transgender populations and injecting drug users.

Participants also recognised AIDS as a public health as well as a development issue needing a multi-sectoral response. The issues of right to free travel, health and work figured prominently too. More than one-third of the member states still have no regulations governing these questions, it was pointed out. The other focus area was the increasing feminisation of HIV, with women bearing the greater burden of the disease because of social as well as biological factors.

While presenting the report, UN Secretary General Ban Ki-Moon said: "Our challenge now is to build on what we have started, bridge the gaps we know exist, and step up our efforts in years to come. We can do this only if we sustain and step up our levels of commitment and financing."

With these problems remaining and with millions of people dying of AIDS each year, the international community could make no real progress on poverty, health, gender, the situation of children and other international development goals, said General Assembly President Srgjan Kerim. He stressed that a wider development agenda was inconceivable without resolving problems relating to the global pandemic. Later, speaking at a press conference, Kerim reiterated that implementation of the Millennium Development Goals to attain the HIV/AIDS target -- now on a slow track -- was critically important for overall progress.

Still, the scenario today is not as bad as a few years ago, reminded Dr Peter Piot, the outgoing UNAIDS executive director, at the opening session. "We are now finally seeing real results in almost every region. Results many once said could never happen - because of denial or because there wasn't enough money, because health systems were too weak, because they didn't think people would take their medication on time. Just imagine what would have happened if we had waited to resolve all these issues," he said.

Despite the optimistic note, Piot admitted that much remains to be done. Currently three million people in poor countries get antiretroviral (ARV) drugs, but more than two-thirds who need ARV still cannot obtain them. At current rates of scale-up, most low and middle income countries will still fail to meet universal access targets by 2010. "Many will be unable to meet them by 2015 - unless we urgently change the way we operate," he warned. Piot suggested shifting to a new phase in the AIDS response - "a forward-looking phase in which we treat AIDS as both an immediate crisis and as a long-wave event."

As a roadmap Piot suggested a multi-pronged approach:
- Sustain the gains so far on HIV treatment by investing in health, services and workforces
- Make HIV drugs - first, second, and third line - available and affordable to all people, whoever they are, whatever their lifestyle
- Intensify HIV prevention measures making it accessible to everyone - including MSM, sex workers and injecting drug users
- Establish closer links between HIV, tuberculosis, maternal and child health, and sexual and reproductive health programmes.

Piot especially mentioned gender inequality and its effect on the increase in infection among women. Various speakers echoed him on this in later speeches. "Stigma and discrimination around AIDS remain as strong as ever," Piot admitted, and echoing Ban ki-Moon, he called on all countries to drop restrictions on entry of people living with HIV, a statement that was loudly applauded.

Ratri Suksma, representative of Coordination of Action Research on AIDS (CARAM Asia Berhad), Malaysia, while addressing the Assembly also called for removal of travel restrictions on Positive people practised by many countries. On universal access to medication, as a person living with HIV she demanded, "Keep your promise on ARV. I will keep mine. Will you keep your commitment?"

Of late, there have been murmurs of "too much money for AIDS" at the cost of other diseases in some sections following the scaling down of numbers of infections in some countries, including India, and particularly increase in tuberculosis cases without adequate funds to tackle it. Piot took the issue head-on saying that "nothing could be further from the truth." True, there are more resources available today than before, but last year there was a shortfall of $ 8 billion. "If we are to get anywhere near universal access to HIV prevention, treatment, care and support, the world will need to significantly increase investment in AIDS," he reiterated. "Never ever give up!" was Piot's farewell remark.

Dr Anthony Fauci of the National Institute of Allergy and Infectious Diseases, a leading research scientist, also disagreed that the provision of services and care for HIV patients took attention away from other diseases. The failures over the last year or so in attempts to develop a vaccine was disappointing but then "it's not unusual in the history of vaccine development", Fauci pointed out. He recalled that "the early years were dark years in my life" when in the 1980s this unknown disease puzzled doctors and researchers and only palliative care was given to the patients. Today, as many across the world are on ARV and are enjoying a better quality of life, Fauci said that the scientific community needs to "develop new and better drugs to minimise drug resistance".

But the scientist was more than willing to admit that "medication alone does not solve problems. We need people, we need care-givers." In many countries there is a shortage of trained care-givers. "Prevention is the key," he said. Encouragingly, new ways of prevention are being explored. For example, male circumcision, a practice limited mostly to the Muslim community, is now getting recognition as a viable option; for women who lack negotiating power, microbicides, gels, etc, give them an option. As Fauci reminded those present, HIV is very different from immunisation against other diseases, and thus it needs responses which are different too.

The large participation of civil society in the two-day session was noticeable but then it is an essential part of the UNGASS reporting process where civil society has a particularly important role to play in the compilation of the National Composite Policy Index (NCPI) indicators. NCPI indicators were developed by the UNAIDS Secretariat in collaboration with national governments, UNAIDS co-sponsors and development partners.

The panel discussions involving the NGO sector brought out many local issues that are nonetheless relevant to HIV/AIDS as a whole. In fact, it was a platform for organisations across the world to learn, compare and evaluate their work in their individual countries, whether it was the issue of introducing sex education in schools, sex workers' demand to be recognised as an important component in the fight against the disease, or involving the men in prevention programmes.

Suggestions ran in many directions pointing to the wide range of problems faced by countries though the goal is the same. Rosa Gonzales of Honduras said, "Eliminate school fees so that girls don't have to leave school", whereas a representative from Australia working with indigenous people said, "Education can be liberating but restrictive too; women may not have formal education but they are not stupid; it should be put in the right perspective." A fact that relates to India too.

India, however, had a very unobtrusive presence at the High Level Meeting. No minister or high official was present. Not even the head of the National Aids Control Organisation (NACO). The Additional director general, Health Services, NACO, was the sole representative from the country. Considering that India has an estimated 2.47 million living with HIV (NACO 2006), and still has the third highest number of affected in the world, it was considered rather unusual by many present at the UN. "Has India become complacent, or does it think this meeting is not important enough to put its case, achievements, drawbacks, whatever?" asked a journalist reporting from the UN. One guess is as good as another.

Srgjan Kerim’s closing statement that "history will judge how effectively we rose to the challenge of AIDS. We must not lose the momentum of our global response," is something to ponder about deeply as complacency threatens to slow down the process of fighting against a disease that has devastated many societies within a very short time.

The UNGASS Country Progress Report 2008: India, published by the National AIDS Control Organisation, contains statistics on UNGASS indicators from various official sources. It notes that of the 25 UNGASS indicators, 23 are relevant to India but comparative data from previous years is available only for 13 indicators.

Some key figures:

  • Since 2005, 100 per cent of donated blood is screened for HIV in a "quality assured manner".
  • Six per cent of adults with advanced HIV infection received antiretroviral treatment (ART) in 2005. By December 2007, 19.6 per cent of those needing ART received it; in addition, by 2007, 35.1 per cent of children needing ART received it.
  • In 2006, 7.5 per cent of HIV infected pregnant women received Nevirapine prophylaxis to reduce the risk of mother to child transmission of HIV; in 2007, the number increased marginally to 8.3 per cent.
  • There is no comparative data on the percentage of HIV positive TB cases that received treatment for TB and HIV. But today, of the 85,000 patients with TB and HIV, an estimated 23 per cent are under treatment.
  • The 2001 Behavioural Surveillance Survey found that 22 per cent of young men and women (aged 15 to 24) had "comprehensive and correct knowledge" about HIV transmission and prevention. That number went up to 28 per cent in the BSS 2006.
  • The BSS surveys also found no overall change in the percentage of men and women aged 15-49 reporting sexual intercourse with more than one partner -- it was 6 per cent in 2001, and 6 per cent in 2006. However, the numbers shifted slightly between surveys, with fewer men and more women reporting multiple sex partners in 2006.
  • The BSS 2001 and 2006 also found that of those who have multiple partners, more reported using condoms.
  • Likewise, in BSS 2001, 76 per cent of female sex workers reported using a condom with their client; in BSS 2006, 88 per cent reported the use of condoms.

UNGASS Country Progress Report 2008: India can be accessed at:

(Ranjita Biswas is a journalist based in Kolkata writing mainly on women and gender issues, HIV/AIDS and environment. She is also Editor of Trans World Features)

InfoChange News & Features, July 2008