NGLS Roundup 76, August 2001
UN GENERAL ASSEMBLY SPECIAL SESSION ON HIV/AIDS
INTRODUCTION
Member States at the United Nations Special Session on HIV/AIDS, held at UN headquarters in New York from 25-27 June 2001, unanimously adopted an ambitious Declaration of Commitment outlining measures to be taken by the world community to curb the spread of the HIV/AIDS pandemic and to reduce its impact on societies.
Calling for global action to solve a global crisis, the Declaration of Commitment sets the current situation of the HIV/AIDS pandemic; reaffirms previous commitments made; and spells out new measures to be taken and targets to be achieved at national, regional and international levels to curb the spread of the disease. The Declaration of Commitment, a non-binding political document, describes HIV/AIDS as a complex medical, social, economic, political, cultural and human rights problem. The text outlines priority areas for international action, such as leadership, prevention, treatment, human rights, and resources needed to fund the response to the disease.
Negotiations leading up to the Special Session were difficult because of the sensitivity of some of the issues and the short time available. In a resolution (A/RES/55/13) adopted in November 2000, the General Assembly decided to convene a Special Session on HIV/AIDS as a matter of urgency, leaving less than eight months for the preparations. The negotiations on the draft Declaration of Commitment, headed by two co-facilitators, Ambassador Penny Wensley (Australia) and Ambassador Ibra Deguene Ka (Senegal), continued during the Special Session and were finalized on 26 June 2001.
FOCUS ON AFRICA
The Declaration of Commitment recognizes that all people without distinction of age, gender or race are affected by the HIV/AIDS pandemic. The document says that Africa is the worst affected region in the world—accounting for 75% of people worldwide living with HIV/AIDS—and that women, young adults and children are the most vulnerable to the disease. The Declaration says that poverty, underdevelopment and illiteracy are some of the main contributing factors to the spread of the disease, worsened in many societies by gender inequality, human rights violations, stigma and denial.
In his opening statement, UN Secretary-General Kofi Annan drew attention to the devastating scale of the pandemic. More than 36 million people worldwide are living with HIV/AIDS today. Every day, some 15,000 more people are infected by the virus. In some African countries, Mr. Annan pointed out, HIV/AIDS has set back development by a decade or more. Spending on the battle against HIV/AIDS in the developing world needs to rise to approximately five times its present level. The developing countries had demonstrated their willingness to provide their share, Mr. Annan said, referring to the outcome of the Organization of African Unity (OAU) Summit held in Abuja (Nigeria) in April 2001, but they could not do it alone. “We must mobilize the money required for this exceptional effort—and we must make sure it is used effectively.” This was why, Mr. Annan said, he had called for a Global AIDS and Health Fund to help finance a comprehensive and coordinated strategy against the disease.
During the general debate, many of the high-level African speakers outlined the disastrous impact of the pandemic on their societies and supported the establishment of a global fund to help the worst-hit developing countries in their fight against the disease. Many also called for measures such as debt relief, the acceleration of the Enhanced Heavily Indebted Poor Countries (HIPC) Debt Initiative, and the reversal of declining levels of official development assistance (ODA) to help finance the response to HIV/AIDS. Mathias Sinamenye, Vice-President of Burundi, told the General Assembly that the fight against HIV/AIDS had become a fight for survival in his country, where 15% of the population in the urban zone and 7.5% in the rural areas are sero-positive. “AIDS kills the people who are most productive as well as young citizens,” he said, pointing out that AIDS had become the most frequent cause of death for adults. According to Ashock Jugnauth, Minister of Health and Quality of Life of Mauritius, despite considerable efforts made by the Southern African Development Community (SADC), HIV infections and AIDS-related deaths continued to increase at an alarming rate in sub-Saharan Africa, having a drastic impact on the region’s socio-economic development.
The close links between HIV/AIDS and poverty was further stressed during the roundtable on the socio-economic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS, which was chaired by Abdul Malik Kasi, Health Minister of Pakistan. The background document (A/S-26/RT.3), prepared by the United Nations Development Programme (UNDP) for the roundtable, points out how low levels of human development, widespread poverty and inadequate access to education and health, which are all greatly exacerbated by HIV/AIDS, fuel the spread of the disease. The document points out that steady progress in reducing poverty is the long-term and sustainable solution to the health crisis in the developing world. In the long run, the document says, prevention and care will only succeed if people and nations can lift themselves out of poverty.
Participants agreed that poverty reduction, including debt relief and increased flows of ODA, had a key role in the campaign against the disease. Poverty reduction and the increased availability of resources for prevention, care, and treatment were of paramount importance, they said. International action, participants noted, should be limited to making resources available to be used for prevention, care and treatment. The responsibility of devising and implementing country-level strategies against the pandemic rests with each country. The strengthening of health care infrastructures to ensure broader access to health care and treatment, including counselling and testing, prevention of mother-to-child transmission, and management of HIV/AIDS-related diseases and infections were also underscored.
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“Over the last year there has been an extraordinary shift towards a collective responsibility. In coming here today, the Member States of the United Nations declare their commitment to stop this epidemic. Those who have been involved in this process know how hard it has been to clear the forest of denial and fear to build this path. None of us should be surprised. These are difficult issues. The behaviours and social circumstances that drive this epidemic are not easy to understand or to talk about. Many are associated with shame and discrimination. We often exclude what we fear. Negotiating the declaration has required that Member States address these issues in much the same way that communities, families, and couples across the world have had to—with respect, sensitivity and compassion. ”
—Statement by UNAIDS Executive Director Peter Piot to the General Assembly
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SENSITIVE ISSUES BROUGHT INTO THE OPEN
The text of the Declaration recognizes that HIV/AIDS constitutes one of the greatest challenges to human life and dignity and to the enjoyment of human rights. According to the text, stigma, silence, discrimination, denial and the lack of confidentiality undermine prevention and treatment efforts and increase the impact of the epidemic on societies. The Declaration also clearly states that it is women and girls who bear the brunt of the disease in many regions. As Pascoal Manuel Mocumbi, Prime Minister of Mozambique, told the General Assembly: “Poverty, stigma, lack of information and weak health infrastructures have been acknowledged as hindering the struggle against the epidemic, but there has been silence regarding the sexual behaviour and gender inequalities that drive the epidemic.” He said that in Mozambique the overall rate of HIV infection among girls and young women is twice that of boys their age. This is mainly because girls are married young to older, sexually experienced men who may expose them to HIV/AIDS.
In her statement to the General Assembly, Noeleen Heyzer, Executive Director of the United Nations Development Fund for Women (UNIFEM), said that gender inequality and power imbalances between women and men in every society heighten women’s vulnerability to infection and leave them with heavier burdens when HIV/AIDS enters households and communities. At the same time, she said, the world is gradually acknowledging that because of their sex, women and girls have more limited access to HIV/AIDS-related information, prevention, treatment, care, support and services. Addressing a press conference, Kofi Annan pointed out “[The battle against HIV/AIDS] can only be won if women are fully educated and enjoy their full rights, including a full say in devising society’s collective response. It has been said that ‘girl power is Africa’s own vaccine against HIV’ and that should be true for the whole world.”
During the negotiations on the Declaration, some of the contentious issues were HIV/AIDS and human rights, women’s empowerment, and how to refer to and describe vulnerable groups. From the outset, the Organization of the Islamic Conference (OIC) had made it clear that it had profound concerns about language that might be in conflict with their religious and cultural values. The recognition of specific vulnerable groups to be targeted by national strategies, policies and programmes was especially contentious. The draft Declaration recognized these groups to include, among others, children in especially difficult conditions, men who have sex with men, sex workers and their clients, injecting drug users and their partners, persons confined in institutions and prison populations, refugees and internally displaced persons, and people separated from their families due to work or conflict. The identification and inclusion of certain groups in the list was problematic as these groups were not recognized by the OIC countries. The reference in the draft declaration to the UN Guidelines on HIV/AIDS and Human Rights adopted at the 1996 Second International Consultation on HIV/AIDS and Human Rights was equally contentious and was finally removed from the agreed text, mainly because of the explicit language it contained.
One outcome of the negotiations is that the adopted Declaration has, as Peter Piot, Executive-Director of United Nations Joint Program on HIV/AIDS (UNAIDS), pointed out “a clear gender orientation.” Among the strongest texts on women’s empowerment in a negotiated UN document, the Declaration calls for Member States “to develop and accelerate the implementation of national strategies that promote the advancement of women and women’s full enjoyment of all human rights; promote shared responsibility of men and women to ensure safe sex; to empower women to have control over and decide freely and responsibly on matters related to their sexuality to increase their ability to protect themselves from HIV infection.” The text also calls for Member States to “ensure by 2005 the development and accelerated implementation of national strategies for women’s empowerment, promotion and protection of women’s full enjoyment of all human rights and reduction of their vulnerability to HIV/AIDS through the elimination of all forms of discrimination, as well as all forms of violence against women and girls, including harmful traditional and customary practices, abuse, rape and other forms of sexual violence, battering and trafficking in women and girls.”
Addressing the round table on HIV/AIDS and human rights chaired by Grzegorz Opala, Minister of Health of Poland, UN High Commissioner for Human Rights Mary Robinson asked: “Is there any greater human rights problem today in the world than the fact that 36 million people suffer from HIV/AIDS?” Participants at the roundtable highlighted the principles of non-discrimination and equality, especially in relation to health care and services, employment, education and freedom of association. Participants also stressed that the measures against the epidemic needed to be inclusive and that all individuals and communities, such as people living with HIV/AIDS, children, women and other vulnerable groups needed to be involved in both the development and implementation of HIV/AIDS responses.
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“I am perhaps even more impressed by the strong participation of non-governmental activists—within national delegations, at a wide range of parallel events, in the round tables, and as observers in the plenary sessions. You can feel their presence and you feel the presence of these activists everywhere, and they really have transformed the atmosphere of the building—as they do at all the best United Nations events. I am more than ever convinced that such partnerships are essential to our success in the new century. Of course they bring problems and controversy with them, but so does every new idea....I have been very clear right from the beginning that we need to open up this Organization, we need to bring the United Nations closer to the people, and we need to work in partnership with civil society, with the private sector, with foundations. I think I have demonstrated that I am determined to do that. I think that the Member States are beginning to open up; the Member States are accepting it, and they are working very closely with non-governmental organizations. I think you can take it that we are moving in the right direction, and that that is the order of things to come.”
—Kofi Annan, UN Secretary General, at a press conference at the Special Session
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PREVENTION AND TREATMENT
The text of the Declaration separates the section on prevention from that of care, support and treatment, and states that prevention must be the mainstay of the response against HIV/AIDS. According to Dr. Piot, there is no conflict between the two, and many of the statements made to the General Assembly emphasized the strong link between them. José Serra, Minister of Health of Brazil told the General Assembly: “Prevention and treatment are mutually reinforcing and must be considered in an integrated approach.” He explained how in Brazil, the integrated approach to prevention and treatment had yielded good results in reducing the transmission rate. The number of people living with HIV/AIDS in Brazil amounts today to less than half of what estimates used to predict.
The inseparable and mutually reinforcing nature of prevention and care, and treatment was echoed during the roundtable on prevention and care chaired by Denzil Douglas, Prime Minister of Saint Kitts and Nevis. Participants said that the notion of prevention ranged from immediate preventive methods, such as abstinence and condom use, to long-term behavioural change, including the empowerment of women to say no to unsafe sex, and advocacy efforts. They underlined that interventions must be culturally sensitive and respond to the needs of a variety of groups.
Leadership at all levels of society as well as the involvement and empowerment of communities and civil society, particularly people living with AIDS, were seen as critically important to render prevention measures effective. Strong appeals were made during the roundtable to the international community and the pharmaceutical industry to provide the necessary resources and medical supplies, and to help build the infrastructure and capacity needed to combat HIV/AIDS in highly-affected countries.
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--UN Secretary-General Kofi Annan called for the establishment of a global fund on AIDS and health at the Organization of African Unity summit in Abuja (Nigeria) in April 2001.
--The fund will be focused on HIV/AIDS, tuberculosis and malaria, and it will promote an integrated approach to the three diseases. The fund will be geared at strengthening and expanding existing efforts rather than designing new projects.
--The fund will have an independent governing body. It will be open for contributions from governments, foundations, the private sector and individuals. By 7 August 2001, the total amount of contributions pledged to the Fund was approximately US$1.395 billion. Updated information about the fund can be accessed on UNAIDS website (www.unaids.org).
--On 30 July Secretary-General Kofi Annan appointed Crispus Kiyonga as Chair of the Transitional Working Group for the Establishment of the Global AIDS and Health Fund. Mr. Kiyonga, who was the Health Minister of Uganda, is currently a cabinet minister without portfolio.
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ADDITIONAL RESOURCES NEEDED
According to the Declaration, the HIV/AIDS challenge cannot be met without new, additional and sustained resources. The Declaration says that the annual expenditure target needed for the epidemic should be between US$7 and US$10 billion in low- and middle-income countries. The resources are to be made available both from donor countries and from national budgets. Moreover, the text urges the developed countries to meet the targets of 0.7% of their gross national product (GNP) for ODA, and the international community to increase international development assistance to developing countries, particularly those most affected by HIV/AIDS that have committed to increase national funds to fight the HIV/AIDS epidemic. According to the Declaration, HIV/AIDS actions need to be integrated into development assistance programmes and poverty eradication strategies. The text also calls for the implementation without further delay of the enhanced HIPC initiative and the cancellation of all bilateral official debts of HIPC countries as soon as possible. During negotiations on the draft Declaration many delegations pushed for stronger language on the alleviation of the debt burden of the least developed countries (LDCs), low- and middle-income developing countries, particularly those affected by HIV/AIDS. This was opposed by others who said that negotiations should be taken up in a more appropriate venue, such as the upcoming International Conference on Financing for Development to be held in Monterrey (Mexico) in March 2002.
Kumba Yala, President of Guinea-Bissau, said that his country has one of the highest rates of HIV/AIDS in the world. Yet it was not able to obtain antiretroviral medication. He said that the health infrastructure of Guinea-Bissau needed to be strengthened so that effective prevention and treatment could be provided, such as proper education, access to public health-care institutions, medication and condoms. Justin Malewezi, Vice-President of Malawi, told the General Assembly that African countries carried two burdens—HIV/AIDS and external debt. He said that the US$227 billion debt burden diverted scarce foreign exchange from the fight against poverty and HIV/AIDS in Africa, and that African states urgently needed to expand investment in basic social services and HIV/AIDS prevention and care. If the international community was serious about promoting human rights and addressing the global pandemic, he said, debt cancellation was a moral imperative. In his statement, Bertie Ahern, Prime Minister of Ireland, affirmed that the global response to the HIV/AIDS crisis would fail without substantial additional resources. Mr. Ahern said that he firmly believed that the devastating impact of the disease needed to be taken into account when assessing debt relief. “If that meant that the countries with high prevalence of HIV/AIDS should receive debt cancellation, Ireland would agree,” he told the General Assembly.
THE GLOBAL HIV/AIDS AND HEALTH FUND
The Global HIV/AIDS and Health Fund proposed by the UN Secretary-General received widespread attention during the Special Session. The Declaration supports the urgent establishment of a global fund to finance an urgent and expanded response to the epidemic and says that the fund is to be based on an integrated approach to prevention, care, support and treatment. The aim of the fund is to assist governments in their efforts to combat HIV/AIDS with due priority given to the most affected countries and countries at high risk, notably in sub-Saharan Africa and the Caribbean. While not specifying the financial amount planned for the fund, which would also help to finance efforts to fight malaria and tuberculosis, the Declaration calls on both public and private sectors to mobilize resources. The text makes a special plea to donor countries, foundations, the business community including pharmaceutical companies, the private sector, philanthropists and wealthy individuals. To contribute to the fund, the Declaration also calls for the launch by 2002 of a world wide fund-raising campaign aimed at the general public and the private sector. The campaign is to be conducted by UNAIDS with the support of interested parties.
In their statements Member States generally supported the fund and called for it to be operational as soon as possible. The management of the fund needed to be transparent, many emphasized. It needed to have a small and effective secretariat and a lean governing body to be able to respond swiftly to emerging needs. While the specifics of the structure and function of the fund still remain to be worked out, many governments, such as Norway, the United States and the United Kingdom announced financial contributions to support its start-up.
During the roundtable organized on HIV/AIDS, international funding and cooperation, chaired by Benjamin Mpaka, President of Tanzania, many participants said they expected the global fund to be functional by the end of 2001. The fund was seen as an essential complement to existing mechanisms. It could also increase overall resources for HIV/AIDS by attracting more contributions from both public and private donors. It was generally agreed that civil society needed to be centrally involved in global cooperation and funding. At the global level, participants said, representatives of civil society needed to be involved in the design, decision making and implementation of cooperative undertakings. At the national level, civil society and communities needed to have ready and reliable access to resources. As the NGO participant Moustapha Gueye from the African Council of AIDS Service Organizations (AfriCASO) told the roundtable: “We need dollars.” Mr. Annan said that he was working with all stakeholders—the Group of Eight countries (G-8), comprising Italy, Canada, France, Germany, Japan, the Russian Federation, United Kingdom and the United States, other donors, developing countries, foundations, NGOs and the private sector—to convene a group to finalize the details of the fund. He was gratified by the strong support expressed to the fund during the Session and believed that it will be operational by the end of 2001.
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During the Special Session, the General Assembly held an unusual and heated debate on the list of accredited civil society actors to participate in four roundtable meetings. The roundtables focused on: prevention and care; HIV/AIDS and human rights; socio-economic impact of the epidemic and the strengthening of national capacities to combat HIV/AIDS; and international funding and cooperation. The participation in the roundtables was limited to a number of Member States, heads of UN agencies and selected civil society actors with specific expertise in the topics discussed.
The debate was triggered by the attempt of a number of countries to reject the participation of the International Gay and Lesbian Human Rights Commission (IGLHRC) in the roundtable on HIV/AIDS and human rights on the basis of the “non-objection” principle. Applying the principle, contained in the General Assembly resolution A/RES/55/242 on the Organizational arrangements for the Special Session of the General Assembly on HIV/AIDS and its preparatory process, 11 Member States objected during consultations by the President of the General Assembly to the participation of the United States-based NGO in the roundtable on HIV/AIDS and human rights. IGLHRC was consequently removed from the list of civil society participants. When the final list was presented to the General Assembly for action, Canada, Sweden, on behalf of the European Union, and Norway questioned the removal of IGLHRC. As the grounds for objection had not been communicated to the General Assembly, they said, it was impossible for them to take informed action on the list of participants. The UN Office for Legal Affairs, interpreting the meaning of the words “for consideration on a non-objection basis for final decision by the General Assembly” used in resolution A/55/242, said that it gave a State the right to object to the participation of a civil society actor but that the final say rested with the General Assembly. If a country so wished, the Office for Legal Affairs said, it could object to the objections made. The General Assembly would then need to decide on the matter. Canada, supported by a number of other co-sponsors including Sweden, on behalf of the EU, Norway, Chile and Argentina, presented a written amendment to the General Assembly that reinstated IGLHRC among the list of civil society participants. Canada proposed that a recorded vote be held on the amendment, and then on the list as a whole. Rather than proceeding to a vote on the list, Egypt, on behalf of the Organization of the Islamic Conference (OIC), proposed a motion to take no action citing the Canadian initiative. The motion was not adopted: there were 63 votes against it, with 46 votes in favour and 19 abstentions. Japan explained its vote against the no-action motion by saying that it limited countries’ liberty to express their views. Sudan said that as a member of the UN Committee on NGOs, the country was for transparency and proper procedure. According to Sudan, the principle of non-objection was a creative innovation that had been introduced to facilitate NGO participation in the work of the UN. The Assembly would now create an unfortunate precedent, it said.
The Assembly then adopted the proposed amendment by a vote of 62 in favour, none against with 30 abstentions. After the nearly three-hour debate, the Assembly adopted the amended list of civil society participants, reinstating the IGLHRC.
Several members of the OIC—including Bahrain, Bosnia Herzegovina, Djibouti, Egypt, Iran, Jordan, Kuwait, Lebanon, Libya, Malaysia, Mauritania, Oman, Pakistan, Qatar, Saudi Arabia, Sudan, Syria, and the United Arab Emirates—indicated that they would not vote and dissociated themselves from the process. Some said that the vote was a violation of long-standing procedures and the non-objection principle, and warned that it could jeopardize NGO participation in future UN meetings.
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PARTNERSHIP WITH CIVIL SOCIETY CRUCIAL
Throughout the Special Session the crucial role of civil society in the fight against the disease was underscored. The Declaration affirms that the key role in prevention, care, support and treatment of people affected and infected by HIV/AIDS is played by communities and families, and that the involvement of people living with HIV/AIDS, young people and civil society is crucial to developing an effective response to the HIV/AIDS epidemic.
More than 500 civil society organizations, representatives of pharmaceutical companies and the business community attended the Special Session in New York. Civil society representatives were also included in several Member States’ delegations. Among the participants were grassroots organizations, activists, people living with HIV/AIDS, medical professionals and youth representatives. One of the most discussed issues at the beginning of the meeting turned out to be the attempt by some Member States on the basis of the “non-objection principle” to reject the participation of the International Gay and Lesbian Human Rights Commission in the roundtable on HIV/AIDS and human rights. After a heated debate in the General Assembly, the NGO was reinstated in the list of participants to address the roundtable (see box on page 5).
In general, NGOs were not satisfied with the arrangements for their participation in the preparatory process leading up to the Special Session. Most of the negotiations on the draft Declaration were held in private meetings from which NGOs were excluded. Representatives of many NGOs were, however, pleased with the outcome of the Special Session even though NGOs did not get all that they wanted in the Declaration. Many NGOs, who distributed during the meeting a text Civil Society Perspective on the Declaration of Commitment, had pushed for much stronger language on human rights in the document and were disappointed with the removal from the final text of both the reference to the UN Guidelines on HIV/AIDS and Human Rights, and the list of specific vulnerable groups. But it was emphasized that the adoption of a document that sets real targets for prevention, funding and access to essential medicines was a watershed. NGOs had from the beginning emphasized the strong link between prevention and care, support and treatment. The link is confirmed in the Declaration, and it was strongly echoed in the statements made by governments. NGOs were also satisfied with the strong gender approach of the document. NGOs working on drug abuse from a harm reduction perspective were pleased to see that sterile injecting equipment and harm reduction efforts were included in the final text as part of preventive measures.
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“We will hold governments accountable to the commitments made in this document, and we will be your allies in making this more than just another global policy statement—we will help you make this document a viable program of action, that defines our collective ambitions, that provides governments with reasonable, attainable goals, and that can be easily translated into more effective and aggressive programs. You have provided a comprehensive global policy—now we will be your partners and turn it into action.”
—Statement by Richard Burzynski, International Council of AIDS Service Organizations (ICASO) to the General Assembly
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UN SYSTEM-WIDE RESPONSES TO HIV/AIDS
During the Special Session, different UN entities introduced new initiatives developed as a response to HIV/AIDS. The International Labour Organization (ILO) presented a new Code of Practice on HIV/AIDS to the Special Session. Juan Somavía, Director-General of the ILO, said that of the 36 million people infected with HIV/AIDS, 23 million are in the workplace. The aim of the wide-ranging Code, which provides a “map” for employers on “best practice,” is to protect worker’s rights in fields such as job security, social security and occupational health and safety. Mr. Somavía said that the Code, which he called pragmatic, had been negotiated between representatives of workers, employers and governments.
The UN Security Council announced that UNAIDS and the UN Department of Peacekeeping Operations (DPKO) had developed an HIV/AIDS awareness card to be distributed to all UN peacekeeping operations after testing in the United Nations Mission in Sierra Leone (UNAMSIL). The initiative, built on the Security Council resolution 1302 adopted in July 2000, recognizes that the HIV/AIDS pandemic is exacerbated by violence and instability and stresses that HIV/AIDS may pose a risk to stability and security. The card contains basic information on the disease, how it is transmitted and how to protect oneself against the virus. The Council encouraged further cooperation between UNAIDS and DPKO, such as the inclusion of HIV/AIDS advisors in peacekeeping operations, and revision, as required, of relevant codes of conduct.
CONTACT
Dominique De Santis
Press Officer
UNAIDS
20 avenue Appia
CH-1211 Geneva 27, Switzerland
telephone +41-22/791 4509
fax +41-22/791 4898
e-mail <desantisd@unaids.org>
websites (www.un.org/ga/aids/coverage), (www.unaids.org) or (www.hdnet.org)
This edition of NGLS Roundup was prepared by the United Nations Non-Governmental Liaison Service (NGLS). The NGLS Roundup is produced for NGOs and others interested in the institutions, policies and activities of the UN system and is not an official record.