Raising Social Awareness, Strengthening Health Systems among Key Measures
The international community must increase efforts to address the inequalities driving the HIV/AIDS epidemic as the global response to that virus has been hindered by COVID-19 and other crises, Member States told the General Assembly today as it concluded its high-level meeting on HIV/AIDS after taking note of its President’s solemn appeal to observe an Olympic Truce during the upcoming Tokyo Games.
Through that text (document A/75/956), circulated on 6 July, the General Assembly President recalled the ancient Greek tradition of the ekecheira, or Olympic Truce, born in the eighth century B.C., and called upon all warring parties of current armed conflicts around the world “to boldly agree to true mutual ceasefires” for the duration of the upcoming Olympic and Paralympic Games in Tokyo.
The Assembly then concluded the general debate of its high-level meeting on HIV/AIDS, having previously adopted a Political Declaration (document A/75/L.95) on 8 June that detailed measures to end the disease as a threat to global public health by 2030. (For background, see Press Release GA/12333.)
In the discussion, Member States highlighted COVID-19’s negative impact on the global HIV/AIDS response, as the coronavirus strained health-care systems around the world — many already weakened by conflict or other crises — and interrupted medical supply chains. Many speakers detailed national efforts to address the HIV/AIDS epidemic in light of this challenge, including measures aimed at raising social awareness, fighting discrimination and strengthening domestic health systems to provide necessary services to the most vulnerable.
Member States also stressed the need to tackle inequality — also exacerbated by the COVID-19 pandemic — as a critical part of the global HIV/AIDS response, which includes assisting key populations that suffer increased vulnerability not only to the virus, but also to the stigmatization associated with it. Many welcomed the language in the Political Declaration to this end, but others urged that the text must comport with national legislation, as well as religious and cultural values.
Like many others, the representative of Guinea pointed out that the COVID-19 crisis in his country — along with that of Ebola — highlighted the weaknesses of the national health system and hindered the domestic HIV response. While the Government has worked to strengthen health institutions, many challenges remain in the form of inequality, poverty and a dependence on external financing to purchase medicine.
“Ultimately, inequalities fuel the HIV pandemic,” emphasized the representative of the Dominican Republic, who noted that, while new HIV infections have been reduced to 1.7 million in 2019, this figure is more than three times higher than the international community’s original goal for 2020. In many countries, key populations still face increased vulnerability to the virus and discrimination based on economic status, sexual orientation or gender identity.
Papua New Guinea’s representative said that his country, for its part, has committed to work with those key populations — including sex workers, men who have sex with men, transgender people and prisoners — to reduce inequality in accessing health services. He also stressed the need for increased partnership with civil society, community and faith-based organizations and the private sector to strengthen the world’s ability to respond to pandemics.
The representative of Malta, speaking for the LGBTI Core Group, welcomed the United Nations inclusion of lesbian, gay, bisexual, transgender and intersex persons in its AIDS-related endeavors, but expressed regret that these individuals, once again, were not explicitly included in the Political Declaration. Discriminatory laws and practices that reinforce intersecting and compounding forms of inequality across demographics must end, she urged.
Iran’s representative joined others in insisting, however, that the implementation of HIV/AIDS policies — including the Political Declaration — must be consistent with national legislation and respect various religious values and cultural backgrounds. He also pointed out that unilateral coercive measures — like those imposed by the United States on his country — are adversely impacting HIV/AIDS responses and health systems by hindering access to medical products and affordable technology.
The representative of Myanmar also pointed out threats to the global AIDS response that go beyond the COVID-19 crisis, stating that the 1 February military coup in his country hindered Government efforts to reduce the risk of HIV infection. Violent and inhumane acts by the military are threatening humanitarian services, and he called on the international community to act immediately to end the military’s brutal conduct towards civilians and health-care personnel.
At the outset of the meeting, the General Assembly observed a moment of silence for the late President of Haiti, Jovenel Moïse, who was killed on 7 July. A formal tribute in the Assembly will be convened at a later date.
Also speaking today in the HIV/AIDS debate were representatives of Sudan, Nepal, Uganda, Saudi Arabia, Panama, Qatar, Hungary, Mali, Kuwait, Lesotho, Belgium, Egypt, Japan and the Bahamas, as well as observers for the Holy See, the International Development Law Organization and the Inter-Parliamentary Union. Civil-society representatives from the United States People Living with HIV Caucus, the Kenya Legal Ethical Network on HIV/AIDS and Johnson and Johnson also delivered statements.
The General Assembly will reconvene at 11:30 a.m. Wednesday, 21 July, to discuss improving global road safety.
The General Assembly first took note of a solemn appeal by the President on 6 July in connection with the observance of the Olympic Truce (document A/75/956).
Through that text, the General Assembly President solemnly appealed to all Member States to demonstrate their commitment to the Olympic Truce for the upcoming Olympic and Paralympic Games in Tokyo and to undertake concrete actions at the local, national, regional and world levels to promote and strengthen a culture of peace and harmony, based on the spirit of the Truce.
Recalling the ancient Greek tradition of the ekecheira, or Olympic Truce, born in the eighth century B.C., the President also called upon all warring parties of current armed conflicts around the world “to boldly agree to true mutual ceasefires for the duration of the Olympic Truce, thus providing an opportunity to settle disputes peacefully”.
[Through its resolution 48/11 of 25 October 1993, the Assembly urged Member States to observe the Olympic Truce from the seventh day before the opening of each Olympic Games to the seventh day following their closing. The Tokyo Olympics will begin on 23 July and end on 8 August, with the Paralympics to follow from 24 August to 5 September.]
High-Level Meeting on HIV/AIDS
The Assembly then resumed its high-level meeting on HIV/AIDS.
ASIL SIDAHMED, Strategic Adviser of the Federal Minister of Health of Sudan, associating herself with the African Group, said that poverty, illiteracy and displacement caused by years of armed conflict have put much of her country’s population at risk of HIV. Given its fragmented health system, less than 25 per cent of those living with HIV benefit from treatment programmes. The COVID-19 pandemic has further complicated the situation by interrupting the supply of HIV medicines. She noted that the transitional Government has cancelled travel restrictions based solely on HIV status and has also criminalized female genital mutilation. Sudan is committed to addressing HIV-related challenges, including the weak capacity of its health system, and looks forward to international support to scale up HIV interventions, she said.
ROSHAN POKHAREL, Chief Specialist, Ministry of Health and Population of Nepal, said that his country’s success in reducing AIDS-related deaths by 55 per cent between 2010 and 2020, and the rate of new infections by 64 per cent, conceals gaps in full access to essential HIV and related services for people who are most at risk of HIV infection. “Ending inequality of access to health services is sine qua non for ending AIDS.” Nepal works closely with civil society and community-based organizations in combating HIV/AIDS, but it looks forward to enhanced cooperation from its bilateral and multilateral development partners as well. Only by putting people and communities at the heart of response efforts, and by ensuring that they benefit from HIV/AIDS-related development goals, can the AIDS epidemic in Nepal be overcome by 2030, he said.
FRANCESCA MARIA GATT (Malta), speaking on behalf of the LGBTI Core Group, welcomed the United Nations inclusion of lesbian, gay, bisexual, transgender and intersex persons (LGBTI) in all its AIDS-related endeavours, but expressed regret that they are once again not explicitly included in the Political Declaration on HIV/AIDS adopted by world leaders in the General Assembly on 8 June. Discriminatory laws and practices which reinforce intersecting and compounding forms of inequality across demographics must end. Data shows that HIV infections among gay men has increased by 25 per cent since 2010; that the risk of acquiring HIV is 26 times higher among gay men and other men who have sex with men; and that the risk of acquiring HIV is 13 times higher for transgender persons. “Without specialized strategies that recognize the higher vulnerability of key populations … we will not see the end of HIV,” she said. Everyone, regardless of sexual orientation or gender identity, must enjoy access to HIV prevention methods and treatment. Otherwise, LGBTI will be left behind on the path towards an AIDS-free world by 2030. She went on to request more international cooperation for those countries whose HIV programmes have been limited by the COVID-19 pandemic.
FRED SARUFA (Papua New Guinea) said that HIV has been a great teacher — and COVID-19 a frightening reminder — that pandemics require a well-coordinated response across countries and borders. “We must regroup and build back better our responses to HIV and AIDS and other pandemics” with stronger and reimagined health-care systems, as well as greater partnerships with civil society, community and faith-based organizations and the private sector. Papua New Guinea’s commitment to work with key populations — including sex workers, men who have sex with men, transgender people and prisoners — has demonstrated that inequalities in accessing health services can and must be reduced, he added.
PHILIP ODIDA (Uganda) said that HIV/AIDS remains a leading cause of death in his country, where the burden on the health-care system has been further exacerbated by the COVID-19 pandemic. Nevertheless, Uganda is committed to ending inequalities and getting back on the track to end AIDS by 2030. Its efforts include a Presidential Fast Track Initiative which calls for engaging men in HIV prevention, closing the tap on new infections among adolescent girls and young women, and consolidating progress on ending mother-to-child HIV transmission, among other things. Overcoming challenges going forward — including scaling up prevention programmes for key populations and ensuring safe and equitable access to medicines for all — will require closer cooperation and coordination at the international level and within the United Nations system, he said.
ABDALLAH Y. AL-MOUALLIMI (Saudi Arabia) said that the Government works to promote individual and collective health through preventative treatment programmes for AIDS, to counter stigmatization and discrimination and to protect the rights of the infected, including children, women and youth. Detailing a national programme and a royal edict established to this end in 1994 and 2018, respectively, he said that national efforts also focus on information campaigns designed to raise social awareness and measures to protect the right to education and work for those infected with the virus. These efforts have helped Saudi Arabia to significantly reduce the number of new infections. Turning to the Political Declaration adopted on 8 June, he disassociated from a number of paragraphs therein, as they contain “highly controversial phrases” and give the impression that the international community encourages practices that are illegal and unacceptable both morally and religiously in Saudi Arabia.
MAJID TAKHT RAVANCHI (Iran) said that unilateral coercive measures imposed by the United States on his country are having an adverse impact on its HIV/AID response and health systems. They are hindering access to medical products and affordable technology, as well as partnerships with international financial institutions. Jeopardizing the health and safety of entire populations for political ends is not only illegal, but also a war crime and a crime against humanity which the international community must strongly oppose. He went on to say that implementation of HIV/AIDS policies, including the Political Declaration, must be consistent with the laws and development priorities of Member States. They must also respect various religious values and cultural backgrounds.
FLOR KRISTEN FLORES TELLO (Panama), welcoming the Political Declaration adopted on 8 June, said that the Government continues to work to reduce inequalities and provide quality treatment for those infected with the virus. She stressed that the disease’s differentiated impact requires increased focus on gender inequalities in response, particularly through measures to assist women and girls. Panama is among the most-affected countries by HIV/AIDS in the region and, over the last few years, the nation’s most infected group has been young people aged 20 to 34. In response, the Government launched a national strategy in September 2020 to extend health coverage to include HIV services and provide antiretroviral treatment free of charge. She called on the international community to work towards eliminating taboos and shedding light on the struggle against the virus in order to move towards fairer, more inclusive societies.
JOSÉ ALFONSO BLANCO CONDE (Dominican Republic), noting that COVID-19 demonstrated the destructive power of a microscopic virus, said that, while new HIV infections have been reduced to 1.7 million in 2019, this figure is more than three times higher than the international community’s original goal for 2020. The global goals set out in the political declaration adopted in 2016 have been largely missed, which has allowed the AIDS pandemic to grow in many countries and regions around the world. Some countries are regressing, particularly with respect to key populations who are not only vulnerable to the virus, but also to discrimination based on economic status, sexual orientation or gender identity. Underscoring that “ultimately, inequalities fuel the HIV pandemic”, he detailed national policies aimed at assisting key populations, including those designed to ensure community participation and access to services and to reaffirm principles of non-discrimination.
TALAL RASHID N.M. AL-KHALIFA (Qatar) said that his country supports all international efforts to combat HIV/AIDS and to help all those affected by the virus. Its national programme to combat AIDS prioritizes awareness-raising and providing the best care possible for infected persons. To guarantee a healthy life for all, and on the Emir of Qatar’s directive, the Qatar Fund for Development has agreed to give $50 million to the Global Fund to Fight AIDS, Tuberculosis and Malaria with the aim of eradicating those epidemics by 2030, he said.
SARA ZALANYI (Hungary) said that with a collective push, it is possible to end the scourge of HIV/AIDS once and for all. Steps being taken by Hungary include fighting stigma and discrimination aimed at those living with HIV/AIDS, with special attention given to at-risk groups in rural areas where detection levels are lower. Prevention efforts target the lay public, at-risk groups such as men who have sex with men, and pregnant women. All HIV patients have access to the latest antiretroviral drugs “almost free of charge” and receive care in central hospitals and facilities which specialize in infectious diseases. Due to such effective policies, the number of people in Hungary newly diagnosed with HIV is below 200, with 42 recorded AIDS cases in 2020, in a country of 9.8 million. That shows that it is indeed possible to prevent and suppress HIV/AIDS through comprehensive and targeted action, she said.
KANISSON COULIBALY (Mali) said that his country is heartened by the progress that has been made against HIV/AIDS in recent years, including in the areas of mother-to-child transmission and medical research. Going forward, Mali will continue to focus on providing health-care services and access for its people, especially the most vulnerable. With the support of partners and civil society, Mali has reduced the HIV prevalence rate to about 1 per cent, but that progress is fragile, particularly given the security situation that the country has faced since 2012. International cooperation must be ramped up, together with efforts to mobilize the private sector and civil society, including traditional and religious leaders, he said.
TAHANI R.F.A. ALNASER (Kuwait), aligning herself with Bahrain, Qatar, Saudi Arabia, Oman and the United Arab Emirates, noted various successes achieved by global efforts to combat HIV/AIDS, including the bolstering of national health-care systems. This progress falls short of the goals the international community set for itself, however, and those suffering from AIDS continue to be subjected to social exclusion, discrimination and stigmatization. COVID-19 has added to these challenges, demonstrating the weakness of health-care systems and exacerbating the inequalities that hinder the provision of health care to those infected with HIV/AIDS. Stressing the importance of the Political Declaration as AIDS remains a danger to global public health, she emphasized that the Declaration must comport with national legislation, as well as cultural and religious values.
NKOPANE RASEENG MONYANE (Lesotho), associating himself with the African Group, said that his country of 2 million is among those hardest hit by the HIV epidemic, with a prevalence rate of 23 per cent and women more affected than men. Main drivers of HIV/AIDS include poverty, migration, sexual violence and low levels of awareness about HIV prevention and transmission in the general population. Nevertheless, Lesotho has met the 90-90-90 targets for adults living with HIV, prompting the Government to aim for 95-95-95 by 2023 as the number of HIV- and AIDS-related deaths falls. He emphasized that the COVID-19 pandemic has seriously threatened Lesotho’s HIV response, with restrictions on movement hampering HIV identification efforts, treatments and the distribution of antiretroviral drugs.
IBRAHIMA KOMARA (Guinea), aligning himself with the African Union, pointed out that the Ebola and COVID-19 crises in his country have highlighted the weaknesses of the health system and exacerbated both health challenges in general and those related to HIV in particular. With support of its bilateral and regional partners, the Government is working to rebuild the national health system, which currently provides antiretroviral treatment to 61,000 living with HIV and annual testing to over 500,000 pregnant women. He said that, even though these results are encouraging, work yet remains to overcome national challenges such as inequality, poverty and a dependence on external financing to purchase medicine. Calling on the international community to “move from words to deeds”, he stressed the need to significantly increase support to State budgets to combat AIDS and related discrimination.
JEAN-FRANÇOIS BRACKMAN (Belgium) said that the fight against HIV/AIDS is a collective political responsibility that requires a comprehensive approach based on human rights. Since the start of the pandemic, Belgian research institutes and the pharmaceutical industry have contributed significantly to the global response. However, the epidemic will only come to an end if all Member States adopt policies tailored to realities on the ground. The Political Declaration adopted by the Assembly is significant, but the international community must be more ambitious, he said, stressing the need to focus on such issues as women’s sexual and reproductive rights, sex education and universal health coverage.
AYA KAMAL IBRAHIM HASSAN (Egypt) said that her country, which has low HIV infection rates, is committed to achieving the objectives of the Global AIDS Strategy as part of the Sustainable Development Goals. Since the onset of the COVID-19 pandemic, Egypt has continued to provide medical services to those with chronic illnesses and to distribute three-month doses of antiretrovirals to HIV patients. She emphasized the importance of cultural, family, ethical, moral and religious values, as well as the sovereign right of States to apply the Global AIDS Strategy in line with their respective national situations and cultural specificities.
KIMURA TETSUYA (Japan) pointed out that the global spread of COVID-19 serves as a reminder of the need to ensure timely, effective responses to infectious diseases. For its part, Japan focuses on comprehensive and sustainable support to strengthen health systems as a whole. Noting that many living with HIV do not have access to appropriate health services due to discrimination and socioeconomic inequality, he said that Japan is committed to efforts aimed at delivering such services to those in need. On this, close collaboration between finance and health authorities is necessary to provide sustainable financial resources for the global AIDS response. He also stressed the importance of investment in innovation — noting that Japan will continue to provide financial support to Unitaid — and expressed hope that the high-level meeting provides the opportunity to both protect the health of those living with the virus and strengthen global preparedness to respond to infectious diseases.
CHET DONOVAN NEYMOUR (Bahamas) said that his country is making considerable strides towards ending HIV/AIDS, with its HIV prevalence rate and AIDS-related deaths both on the decline. Its national HIV response is fully domestically funded. Strategies to combat HIV/AIDS must be tailored to those most at risk, with interventions and service delivery that are both community-led and people-centred. He emphasized the need for age-appropriate comprehensive sex education to young people, adding that the Bahamas has no laws which prohibit same-sex relationships between consenting adults.
KYAW MOE TUN (Myanmar) recalled that his country’s elected Government launched an HIV/AIDS plan in 2017 which adapted the Fast-Track strategy to end the AIDS epidemic by 2030 to the local context. Measures to reduce the risk of HIV infection continued even with the onset of the COVID-19 pandemic. However, the military coup on 1 February put those efforts on hold. Violent and inhumane acts by the military are threatening humanitarian services, including those aimed at persons living with HIV, he said, expressing alarm at the ongoing arrests of doctors, health-care workers and volunteers. The right to health is a fundamental human right and the international community must act immediately to end the military’s brutal conduct towards civilians and health-care personnel, he said.
FREDRIK HANSEN, observer for the Holy See, said that the global HIV epidemic will not end without addressing the root causes for its spread. That means discouraging risk-taking behaviours and encouraging responsible and healthy relationships, particularly among young people. This can be done in ways that do not stigmatize or discriminate against those who are living with HIV, he said, adding that national ownership, cultural sensitivity and community involvement are key to successful HIV responses. Children are among those least served by HIV prevention and care efforts, with many slipping through the cracks due to weak health systems and poor follow-up. He noted that Catholic institutions, which provide 25 per cent of AIDS care worldwide, are attending to those living with HIV/AIDS and ensuring that everyone who needs care receives it.
JAN BEAGLE, Director-General, International Development Law Organization, said that effective laws and institutions can be a powerful force in the fight against AIDS. Good legal and policy frameworks contribute to preventing infectious diseases by enabling rights-based service delivery and facilitating the screening, counselling, education and treatment of those at risk. Empowering people and communities is also essential. When people know their rights — and how to seek remedies for their violation — they are better able to challenge the discriminatory laws, social norms and stereotypes which have contributed to the human cost of the AIDS epidemic. In addition, underlying inequalities and discrimination must be urgently tackled, she said, noting that the COVID-19 pandemic has reinforced the lesson of the AIDS epidemic that while no one is entirely immune, those most severely affected are those already experiencing poverty, marginalization and exclusion.
DUARTE PACHECO, President, Inter-Parliamentary Union, said that his organization is calling on parliaments to make full use of their powers to realize the right to health and to end AIDS by 2030. Legislation can help open the door to better access to HIV and health services, but weak laws can lead to discrimination and criminalization and stop people from fully enjoying their rights. Parliamentarians can bring community voices to the forefront so that gender, social and inequalities do not leave women, people living with HIV and key populations more vulnerable. Despite budgetary pressures aggravated by the COVID-19 pandemic, investing in HIV/AIDS means investing in a more equal, fair and prosperous future for all, he added.
CECILIA CHUNG, Co-Founder, United States People Living with HIV Caucus, asked Member States to set aside their differences when discussing strategies to end both HIV/AIDS and COVID-19 “and to see the humanity in all of us”. She also requested that data on HIV/AIDS include transgender women and men, explaining that behind every statistic is the story of someone who wishes to be happy, loved and accepted.
ALLAN MALECHE, Executive Director, Kenya Legal Ethical Network on HIV/AIDS, said that the real pandemic is the discrimination and criminalization of people living with HIV. So, too, is gender inequality and tuberculosis, which remains the primary cause of death for those living with HIV. The time to act is now, he said, noting that rich countries are pulling back their funding to the Joint United Nations Programme on HIV/AIDS (UNAIDS). In some cases, States are adopting laws that punish people for being who they are or fighting over language that was agreed ages ago. Member States must respect human rights and commit to the availability of affordable medicines, he said.
PAUL STOFFELS, Vice Chairman of the Executive Committee and Chief Scientific Officer, Johnson and Johnson, said that the first time he encountered AIDS was in in 1983 in Kinshasa as a medical student. In 1990, Johnson and Johnson embarked on what became a 20-year mission to find a treatment that would ensure the long-term survival of people living with HIV. Antiretrovirals have come a long-way, but HIV/AIDS will not be eradicated without a vaccine. To that end, he said that stage two and three clinical trials of a potential vaccine are now under way.
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