The UN and the Global Fight Against HIV/AIDS: Myth and Reality

Sep 20, 2001

Will the "new war" on terrorism usurp resources that might otherwise have gone to causes such as the global fight on AIDS? UN official Louise Fréchette presents the case for spending $7-10 billion per year on a global AIDS prevention campaign.

I am especially glad to have the opportunity to speak to such an informed audience about a cause that has engaged the United Nations more than any other over the past year: the global fight against HIV/AIDS.

Some of you may be familiar with some of the most often quoted—and all too real—facts of the AIDS tragedy. For example:

  • 22 million people have died;
  • 13 million children have been orphaned; and
  • 15,000 people become infected every day.

But there are also a number of myths about AIDS that seem to have taken hold in the consciousness of many, even otherwise enlightened, people—misperceptions that are singularly unhelpful in the fight against this dreadful disease.

This morning, I would like to focus on five of these myths, and suggest that the reality is very different from what many people believe.

Myth number one: AIDS is an African problem. Reality: AIDS is a global problem.

In the twenty years since the world first heard of AIDS, the epidemic has spread to every corner of the world. While it has taken its heaviest toll in Africa so far, it is now spreading with frightening speed elsewhere—including in regions not far from here.

In the Caribbean and Central and South America, almost 1.8 million people are now living with HIV/AIDS. Last year alone, more than 200,000 became infected. Haiti, with five per cent of the population living with the virus, has the highest HIV adult prevalence rate in the world outside sub-Saharan Africa. The rate in five other Caribbean countries is around two per cent of the adult population.

In Asia, the statistics are equally alarming. An estimated 6.4 million people are infected, some 3.7 million of them in India. China is also a source of enormous concern, with a drastic rise in HIV infections in the past year alone.

In Eastern Europe and in Central Asia, a rapid increase is being fuelled by injecting drug use and a rise in sexually transmitted infections. In the Russian Federation, an estimated 300,000 people were living with HIV at the end of last year—twice as many as the year before. In Ukraine, the figure is more than 250,000 people. New epidemics have emerged in Estonia and Uzbekistan.

In North Africa and the Middle East, infections are also rising. There were an estimated 80,000 new cases in 2000, bringing to about 400,000 the number of people living with HIV/AIDS.

And in the prosperous West—including this country—the threat of HIV/AIDS is by no means over. While we saw decreases in the number of new infections after a peak in the 1980s, we have seen no decline for the past three years. Statistics point to stalled prevention efforts, with a dangerous trend towards more relaxed attitudes and risky behaviour, as compared to the relatively successful prevention campaigns of the 1980s and 1990s.

Globalization, travel, and migration also add to the risk of increased spread to what we might think of as "safe" countries.

The reality is that in our globalized world, there are no safe countries. In the ruthless world of AIDS, there is no "us and them." This leads me to:

Myth number two: In some societies, HIV/AIDS prevention efforts cannot work because of cultural obstacles. Reality: Examples and experience tell us prevention can work in any culture.

It is true that when we talk about prevention, we raise very sensitive subjects and discuss highly intimate things—aspects of life that many societies find it difficult to address publicly. But it is also true that we have convincing examples of successful prevention campaigns in very different societies.

Look at Uganda—one of the first countries to be devastated by AIDS, but also the first in sub-Saharan Africa to reverse its own epidemic. The Government there has fought back with a campaign of public education so relentless that Ugandans call it "the big noise." Virtually every Ugandan man, woman and child now knows what it takes to protect oneself against AIDS.

Look at Senegal, where as soon as the first cases were reported in the 1980s, the government responded with a national AIDS programme ranging from media prevention campaigns to screening of blood transfusions. Most strikingly, Senegal's religious leaders—including Muslim clerics—became the first in Africa to join the prevention effort. As a result, Senegal has kept infection rates to between 1 and 2 per cent.

Look at Thailand, where authorities have supported a 100-per cent condom strategy for those at particular risk, backed up by pioneering information campaigns targeting the whole population.

Look at Brazil, where for the past ten years, concerted prevention efforts have focused both on the population as a whole and on the most vulnerable groups. This strategy, together with advances in care, has resulted in a much smaller epidemic than was predicted ten years ago.

Look at Belarus, where prevention programmes among injecting drug users have fostered safer behaviour and are estimated to have prevented thousands of infections.

These are examples of effective prevention efforts from a wide cross-section of cultures. All of them were developed by actors inside the country rather than imposed from outside. All of them take account of the local cultural context.

But they all have something in common: they stem from a political will to fight AIDS, and a recognition that facing up to the problem is the first step towards conquering it. I am convinced that, given that will, every society can do the same.

Myth number three: We have to choose between prevention and treatment, and effective treatment is not a realistic choice in the developing world. Reality: The choice between prevention and treatment is a false one, for the two are inextricably linked. Experience and science show that treatment does work even in the poorest societies.

Without the hope of treatment, people will have no incentive to come forward for testing, and the spread will continue further. Moreover, treatment can decrease a person's viral load, thus making him or her less likely to infect others.

It is true that so far, administering HIV/AIDS drugs has been both prohibitively expensive and excruciatingly complicated—involving many different pills to be taken at exact times every day. But not only are AIDS drugs now more available and affordable in poor countries; scientific progress has been such that the industry predicts an AIDS cocktail may soon be possible to administer in a single pill.

It is equally important to recall that treatment need not require the five-star hospitals we are used to in this country. The key is a political commitment to provide treatment, backed up by community involvement.

Again, look at Brazil, where a committed Government has built a well-run network of AIDS clinics, supported by a well-organised network of civic groups. The director of the Brazilian AIDS programme told me recently that nearly all its patients were able to stick to their medication regime.

It is not realistic to expect that treatment can be offered to all infected people in poor countries. But it is realistic to expect that some measures—for example, reducing mother-to-child transmission—can be introduced quickly; and that the number of patients receiving the full AIDS cocktail can be gradually and steadily improved. There will be hard choices for Governments to make—but I know they are ready to make them.

Which takes us to:

Myth number four: Fighting AIDS globally is too expensive and we can't afford it. Reality: Doing nothing costs far more.

We estimate that a global campaign to fight AIDS requires seven to ten billion dollars a year for an effective response in low- and middle-income countries. Some of that money will come from the countries themselves. The rest will have to be provided through international assistance.

The current level of the world's official development assistance (ODA) stands at around US$55 billion dollars. To meet the needs of an effective AIDS campaign, it would have to increase by five to ten per cent. This is an ambitious amount, but not unreasonable. And the total would still be well below the internationally agreed target for ODA—0.7 per cent of GNP.

Compare that to the cost of inaction. Unchecked, AIDS unravels whole societies, communities, economies. In this way, AIDS not only takes away the present. It takes away the future. That is the cost of AIDS.

And that leads us to:

Myth number five: AIDS is a health problem. Reality: AIDS is a major economic and social problem for every sector of society, and one of the biggest obstacles to development itself.

AIDS is uniquely disruptive to economies, because it kills people in the prime of their lives. More than four out of five people dying from AIDS are in their 20s, 30s or 40s. And half of those living with the virus are under 25.

The loss of every breadwinner's income reduces the access of dependants to health care, education and nutrition—leaving them in turn more vulnerable to infection. This cycle need be repeated only a few times and AIDS destroys an entire community.

Especially in the early stages of the epidemic, AIDS tends to strike urban centres, the better educated, the leadership elite and the most productive members of society. A study in the Democratic Republic of the Congo found the highest prevalence rates among white-collar executives, followed by foremen, and then workers.

In the worst affected countries—where more than one in five adults are infected—infrastructure, services and productive capacity are facing total collapse. The spread of the pandemic has caused business costs to expand, and markets to shrink.

Indeed, companies have determined that with anti-retrovirals increasingly affordable, it is now far more profitable to treat HIV-positive employees than to recruit and re-train new ones as untreated workers die. One recent study in Africa showed that treating HIV-positive workers paid for itself up to ten times over.

The impact of AIDS affects regional and global security and stability. Last year, the UN Security Council held its first meeting devoted to a disease—the impact of HIV/AIDS on peace and security in Africa. A CIA report stated that the burden of AIDS and other infectious diseases would add to political instability and slow democratic development in Sub-Saharan Africa, parts of Asia, and the former Soviet Union.

In other words, ladies and gentlemen, the global fight against HIV/AIDS is both necessary and winnable.

That is why, earlier this year, the Secretary-General issued a Call To Action to the whole world—governments, civil society and business, focusing on five priorities:

  • Preventing further spread of the epidemic;
  • Reducing mother-to-child transmission;
  • Caring for those already infected;
  • Delivering research breakthroughs, especially a vaccine; and
  • Alleviating the impact of AIDS on the most vulnerable, particularly orphans.

That is why the membership of the United Nations met in a Special Session in June 2001 to issue a Declaration of Commitment setting out a number of ambitious but realistic time-bound targets and goals.

Among them were commitments to reach by 2005: an overall target of annual expenditure on AIDS of 7-10 billion dollars each year in low and middle-income countries; ensure that a wide range of prevention programmes are available in all countries; and support the establishment, on an urgent basis, of a global AIDS and health fund to finance a rapid and expanded response to the epidemic.

Work on the Global AIDS and Health Fund is proceeding well. A transitional working group has been established, chaired by Crispus Kiyonga, a member of Uganda's cabinet who has invaluable experience as both health and finance minister of his country.

In a few short months, contributions to the Fund from both private and public donors have risen to almost 1.5 billion dollars—starting with a founding contribution from President Bush last May.

We are all determined that the Fund will be launched in December 2001, based on an integrated approach to prevention, care, support, and treatment. And please note, it will not be a United Nations Fund, but an international facility built on the principle and necessity of public-private partnerships.

Indeed, multiple partnerships at many different levels are the only way of meeting the challenge of HIV/AIDS. While the United Nations' family, through UNAIDS and other agencies, is fully engaged on the front lines of this fight, it cannot do it alone.

Everybody has a part to play: national governments, communities, business, universities, foundations, individuals—people like you here today. I hope I can count on your engagement. I hope I can count on you to work in your various and vast constituencies to help us dispel the myths, and propagate the reality, about the global fight against HIV/AIDS.

Thank you all very much.

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