Under an ambitious timetable approved Wednesday by a United Nations special session on AIDS, countries pledged that by 2010 they would cut the prevalence of HIV among young people by 25 percent and among infants by 50 percent, establishing the first worldwide targets in fighting an epidemic that has killed 22 million people.
Calling the epidemic a “global emergency and one of the most formidable challenges to human life and dignity,” the session’s final resolution sets forth a broad array of measures aimed at improving treatment for the 36 million people infected with the virus that causes AIDS and at slowing the rate of new infections.
The resolution, the approval of which was in doubt for much of the three-day session because of objections from Islamic countries, does not provide an enforcement mechanism for achieving any of the goals. Nonetheless, negotiators and advocacy groups monitoring the meeting said the document establishes benchmarks against which countries can be measured.
“In the last two days, some painful differences have been brought into the open, but that is the best place for them,” said UN Secretary General Kofi Annan, referring to the insistence of Islamic countries that references to homosexuality and prostitution be removed from the resolution.
“They need to be confronted head-on, not swept under the carpet. What is important is that after today we shall have a document setting out a clear battle plan for the war against HIV/AIDS, with clear goals and a clear timeline,” he said.
In addition to setting worldwide goals for reducing HIV infections by 2010, the declaration calls on the countries most affected by the epidemic to cut prevalence rates among 15- to 24-year-olds by 25 percent in four years. By 2005, 90 percent of the world population in that age group is targeted to have access to information about how to avoid HIV infection, and 80 percent of pregnant women who seek prenatal care are supposed to receive information or counseling on how HIV-positive women can prevent transmission of the virus to their infants.
Less concrete and likely less attainable goals include eliminating discrimination against people with HIV and improving the rights of women so they have a greater say in insisting on safe-sex practices.
The declaration, which was adopted by consensus Wednesday evening, was the most tangible result of the first UN special session to be devoted to a public-health issue. But the meeting also achieved the less measurable goal of focusing the world’s attention on the disease, according to Annan, who received the endorsement of the Security Council on Wednesday for a second 5-year term as secretary general.
“When you come to a gathering like this, it is sometimes difficult to quantify the achievement,” Annan said afterward.
“But what I can tell you is that people are going to walk away from this with new ideas, new contacts, and an awareness of the best practices around the world. There are many, many positive aspects of a meeting like this that are not patently obvious today.”
Many representatives of the scores of non-governmental organizations that were on hand as observers or participants said that the UN’s AIDS strategy was not all they had wished for but that it represented the best hope yet for a worldwide campaign to slow the spread of HIV.
“This is not a perfect document,” said Stu Flavell of the Amsterdam-based Global Network of People Living with AIDS, reflecting the homosexual community’s disappointment that gays were not named as one of the groups most vulnerable to AIDS.
`A tremendous change’
But, he added, the declaration contains “some really remarkable parts. This is a tremendous change.”
In calling on nations to protect the health of those most at risk of becoming infected with HIV, the final version of the declaration avoids explicit reference to homosexuals, intravenous drug users and prostitutes; instead it refers to “sexual practices, drug using behavior, [or] livelihood.”
“This is not going to slow us down,” said Richard Burzynski, executive director of the International Council of AIDS Service Organizations. “We felt this is one recognition that would have been useful, but the world was not ready to name these groups.”
A UN official said the percentage goals of reducing the rates of infection among young adults and transmission from mother to child are realistic because they are based on existing evidence of effective programs.
Uganda, one of the few African nations that has contained the spread of HIV, reduced infection rates in five years by starting an aggressive public education campaign coupled with a program to make condoms widely available.
“Even though it’s a very poor country, they did achieve it because of a strong commitment by their national and local leaders,” said Dr. Bernhard Schwartlaender of UNAIDS, the Geneva-based agency coordinating the UN’s efforts to combat the disease.
AIDS organizations had feared that the UN’s strategy would emphasize prevention of new HIV infections while neglecting to explain the importance of improving care for those already carrying the virus. Prevention programs are far cheaper than the costly drug regimens necessary to keep AIDS patients alive.
Call for patient care
But one of the cornerstones of the declaration deals with improving patient care. By 2005, countries are supposed to “make significant progress” in providing better hospital conditions and affordable medicine, including expensive anti-retroviral drugs.
Some drugs that control HIV have become more affordable recently as several American and European pharmaceutical companies that make the medications have reduced prices for developing countries.
As part of its call for improved treatment for HIV patients, the UN declaration urges all countries to cooperate in fostering generic drug industries in developing countries or arranging technology transfers under international trade laws.
“The declaration puts treatment firmly on the map,” said Dr. Anne-Valerie Kaninda of Doctors Without Borders, the international medical aid organization. “However, without international financial support, the declaration will remain empty words.”
Need for funding
Funding a global strategy to fight AIDS has received as much attention at the special session as the particulars of the plan, but relatively little money has been forthcoming.
In April, Annan called for the creation of a global fund to finance AIDS prevention and care programs in the developing world, setting a goal of raising $7 billion to $10 billion a year. By the end of the special session, nations and individuals had pledged about $645 million, including a $200 million U.S. contribution.
On Wednesday, a House committee approved a measure that would increase that amount to $750 million.
Annan said he expected to receive more contributions in the weeks leading up to the G-8 summit of major industrialized nations next month in Genoa, Italy.
