Concerns Raised about Escalating HIV Rate in Eastern Europe, Central Asia, Lack of Access to Treatment for 15 Million Infected People
While the global fight to defeat AIDS has produced remarkable progress over the past decade — with HIV infections among children and deaths from related illnesses among people of all ages nearly cut in half — greater efforts are needed to overcome one of history’s greatest health crises, delegates told the General Assembly today as they registered mixed results in reversing negative trends.
Opening the Assembly’s annual debate, Maria Luiza Ribeiro Viotti, Chef de Cabinet of the Secretary-General’s Executive Office, said that, when AIDS was first identified more than 30 years ago, suffering and death seemed unstoppable. Years later, nearly 8 million deaths have been averted since 2000 and three quarters of people living with the virus now know their status.
But, she expressed concern that progress remains uneven. Since 2010, Eastern Europe and Central Asia have witnessed a 30 per cent increase in HIV infections. Meanwhile, 15 million people living with the virus are unable to access treatment, often due to shame or stigma, while AIDS-related illnesses remain the leading cause of death among women aged 15 to 49. “Ending AIDS is about righting power imbalances”, as well as expanding health services, she stressed.
María Fernanda Espinosa Garcés (Ecuador), Assembly President, called for greater efforts to fulfil the aims of the 2016 Political Declaration on HIV and AIDS: On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030. In particular, it is essential to meet the 90‑90‑90 targets: diagnose 90 per cent of all HIV-positive persons, provide antiretroviral therapy to 90 per cent of those diagnosed and achieve viral suppression for 90 per cent of those treated by 2020.
During the half-day debate, delegates decried that millions of people around the world still live with HIV and described both national and collective efforts to rapidly expand HIV prevention, testing and treatment by 2020. The challenges and opportunities loom large, several said.
In the Caribbean, the classification of countries based on gross domestic product (GDP) has restricted access to concessional funding for HIV and other key health and development areas, said the representative of Saint Kitts and Nevis on behalf of Caribbean Community (CARICOM). “Such classification fails to include other conditions and vulnerabilities that impede our small island developing States and limit the gains we can achieve,” he said.
The Russian Federation’s delegate expressed concern about increasing infection rates in Eastern Europe and Central Asia, noting that new infections in his country have not increased for three years. He expressed regret that the Secretary-General’s report (document A/73/824) once again put forward controversial approaches — including harm reduction and general sexual health education, or so-called “sexual rights”.
In that context, the representative of Belarus said his country considers the run up to 2020 a “major window of opportunity”. It is providing services to key populations in Eastern Europe and Central Asia and working with the Joint United Nations Programme on HIV/AIDS (UNAIDS) to reduce infection rates. It will use the European Games to be held in Minsk in June as a platform to combat stigma and provide on-site HIV testing.
South Africa’s representative, speaking on behalf of the Southern African Development Community (SADC), said the continent’s southern region bears the world’s greatest HIV/AIDS burden. Since 2016, testing in Botswana, Eswatini and Namibia has nearly reached or surpassed 90 per cent, while treatment rates in Malawi, Lesotho and South Africa have recorded gains. Underpinning such achievements is a commitment to universal health coverage.
In Mali, said that country’s representative, a human rights-based approach has helped to curb the HIV spread and bring the infection rate down to just over 1 per cent. However, since 2012, the region’s security crisis has amplified Mali’s vulnerabilities, threatening health workers and exposing young people working in the region’s emerging illegal gold mining industry to safety risks.
Stressing that 80 per cent of her country’s confirmed HIV cases were recorded in the last five to seven years, the representative of the Philippines said victims come from all walks of life: people who engage in transactional sex, overseas Filipino workers, children and adolescents. She voiced concern that the average age among those diagnosed has fallen. “It is clear that we are facing a fast-growing epidemic,” she said, citing efforts to reverse such trends by 2022.
“We cannot afford to backtrack,” said Norway’s delegate, noting that one third of new infections are in people aged 15 to 25, and almost everywhere, young women aged 15 to 24 are far more likely than their male counterparts to contract HIV. More than 80 per cent of HIV cases are transmitted sexually — and girls and women are more than three to five times more likely to become infected. Any response must therefore reach them. “It is irresponsible to turn a blind eye to these facts.”
Against that backdrop, India’s delegate said her country’s pharmaceutical industry supplies 70 per cent of the antiretroviral drugs used globally. On the domestic front, she drew attention to a landmark HIV and AIDS act that provides the legal framework for ensuring that a person with HIV/AIDS can live a life without stigma.
With that in mind, Liechtenstein’s delegate applauded the 89 countries that have repealed or reformed laws since 2012 which criminalized HIV, same-sex relations and drug possession. But, she expressed worries that some laws continue to prevent young people, women, people who inject drugs, sex workers, transgender people, prisoners, gay men, other men who have sex with men, and indigenous peoples, migrants and refugees from accessing HIV services.
Pointing to his country’s internationally recognized response to HIV/AIDS, with universal access to treatment and diagnosis, Brazil’s delegate underscored its commitment to ending AIDS by 2030 and pressed all Governments to take a multisectoral approach to fighting the disease.
Also speaking today were representatives of Thailand (on behalf of the Association of Southeast Asian Nations (ASEAN), Kenya (on behalf of the African Group), Armenia, Switzerland, Liberia, Indonesia, Jamaica, Argentina, Namibia, France, United States, Ecuador and Cuba, as well as the European Union.
MARÍA FERNANDA ESPINOSA GARCÉS (Ecuador), President of the General Assembly, said that, years ago, the AIDS epidemic was marked by fear and exclusion. Today, thanks to exceptional global action, “the end of this scourge is within our grasp”, she said, underscoring the Assembly’s role in keeping the spotlight on the fight against the epidemic. The huge achievements made in response to HIV and AIDS in recent decades, under the leadership of the Joint United Nations Programme on HIV/AIDS (UNAIDS), are among the best examples of multilateral action that has rallied behind a common cause. Thanks to such endeavours, what had been a death sentence has become chronic illness, when treated with antiretroviral drugs. Noting that today some 21.7 million people receive such therapy — 5.5 times more than 10 years ago — she said children also can avoid being born with HIV when mothers receive effective treatment.
However, “there is no room to rest on our laurels”, she asserted, calling for stepped-up efforts to achieve the goals outlined in the 2016 Political Declaration on HIV and AIDS: On the Fast Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030, notably as progress has not been even. Many countries and regions will not be able to reach the 2020 goals outlined in the 2016 Declaration, impacting their ability to reach the Sustainable Development Goals. It is fundamental to achieve the 90-90-90 targets, broadening access to screening and antiretroviral drugs, as well as launch initiatives to ensure those vulnerable to HIV have access to integral services for prevention and treatment. Such gains will be impossible if these communities continue to face discrimination and neglect. All people must be empowered to protect themselves from HIV, meaning it is paramount to guarantee gender equality and women’s empowerment, provide education on sexual and reproductive health, allow access to comprehensive health services and end gender-based violence.
Stressing that indigenous peoples, migrants and refugees must be included in the fight against the epidemic, she called for countries to have access to new technologies for prevention and treatment, as well as partnerships among Governments, the private sector, academia and civil society. It is also important to close the funding gaps, she said, calling for more commitments from donors. The upcoming conference in Lyon, France, on the replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria will be a decisive step forward. Moreover, she recalled the link between action and the General Assembly’s forthcoming high-level meeting on universal health coverage, stressing that there is still time to take the urgent measures required to achieve a world free of AIDS by 2030 — success which is owed to both future generations and the millions of people the world was unable to save.
MARIA LUIZA RIBEIRO VIOTTI, Chef de Cabinet of the Executive Office of the Secretary-General, delivering a statement on behalf of Secretary-General António Guterres, recalled that, when AIDS was first identified more than 30 years ago, suffering and death seemed unstoppable and stigma was rife around the world. However, that era also saw the stirring of a global response that is still making remarkable progress today. Nearly 8 million deaths have been averted since 2000 and three quarters of people living with the virus now know their status. Many countries have eliminated mother-to-child transmission of HIV — “a major public health triumph” — and much of that work has been accomplished by communities themselves. Emphasizing that fighting AIDS requires ending stigma, educating people and allowing them to make choices about their lives, she recalled that, by signing onto the 2030 Agenda for Sustainable Development in 2015, countries committed to expanding community-led services and ending AIDS by 2030.
Expressing concern that progress made against the spread of HIV remains uneven, she noted that, since 2010, Eastern Europe and Central Asia have witnessed a 30 per cent increase in HIV infections. Meanwhile, some 15 million people living with the virus are still not accessing treatment, often due to shame or stigma. “When people hide their condition, or are not aware of it, they can miss out on treatment,” she said. Member States need to step up their efforts to ensure that no one feels stigma or discrimination, she stressed, spotlighting the need to expand health‑care access to all people. Indeed, she warned, AIDS-related illnesses remain the leading cause of death of women aged 15 to 49. “Ending AIDS is about righting power imbalances”, as well as expanding health services, she stressed. In that context, she called on countries to make progress on expanding health care, ending discrimination, increasing public funding and ending AIDS by 2030. “The remarkable progress we have made so far shows that we can do it,” she said.
GILLIAN BIRD (Australia), speaking also on behalf of Canada and New Zealand, said that, despite significant progress the HIV epidemic remains a critical challenge. Recent UNAIDS data show that 36.9 million people are currently living with the virus globally, and every week some 7,000 young women become newly infected. “Current rates of decline of HIV infections are too slow, and some countries are experiencing rising incidences,” she said. Expressing deep concern that it is increasingly difficult to reach consensus on issues related to sexual and reproductive health and rights — as well as on ending stigma and discrimination of marginalized populations — she said those issues are at the very heart of an effective HIV response. Among other things, the 2016 Political Declaration on Ending AIDS placed human rights at the core of that response, recognizing the need to empower women and girls through comprehensive sexuality education, universal access to sexual and reproductive health and rights, and the elimination of gender-based violence. It is also essential that efforts to achieve universal health coverage encapsulate a comprehensive HIV response, strong community engagement anchored in primary prevention and appropriate funding, she said.
XOLISA MABHONGO (South Africa), speaking on behalf of the Southern African Development Community (SADC), said the Secretary-General’s report paints a positive picture of gains made over the past 10 years. Emphasizing that Southern Africa bears the world’s greatest HIV/AIDS burden, he said that the SADC Regional Strategy for HIV and AIDS Prevention, Treatment and Care and Sexual and Reproductive Health and Rights Among Key Populations, adopted in 2017, is guiding its member States in the design and implementation of programmes that focus on major issues which must be addressed. Since the adoption of the 2016 Political Declaration, SADC countries have recorded higher levels of testing, which have nearly reached or surpassed 90 per cent in Botswana, Eswatini and Namibia. Malawi, Lesotho and South Africa have meanwhile recorded high rates of treatment as they strive to meet their 90-90-90 targets. With help from the Global Fund, SADC has set up cross-border clinics, enabling truck drivers and others to be tested, to receive treatment and to obtain information on preventative measures.
Underpinning such achievements is a commitment among SADC countries to universal health coverage, he said. Despite many challenges, its member States are giving priority to investment in the health sector, thus demonstrating the paramount importance of health in southern Africa. He said SADC looks forward to the political declaration on universal health care that is currently under discussion in the General Assembly. That text should be strong, action‑oriented and collaborative, with elements that are important for the region, including financing through official development assistance (ODA), access to quality and affordable medicines, vaccines, diagnostics and health technologies, and a strengthened health sector work force, he said.
Speaking in his national capacity, he described South Africa’s progress, noting that in line with the 90-90-90 targets, the Government provides millions with life‑saving antiretroviral drugs. It has dramatically reduced mother‑to‑child HIV transmission and its understanding of disease has improved, with efforts to bring treatment to the vulnerable, notably those in correctional facilities and mining towns, which has contributed to gains made. Voicing concern about the needs of adolescent girls and young women, he said gender-based violence and gender stereotypes have limited service provision. As such, he cited a Government campaign to alleviate teenage pregnancy and gender-based violence, underscoring the importance of strengthening health systems in combating HIV and AIDS and advocating for access to quality health services, as well as to quality, safe medicine and diagnostic tools under the trade-related aspects of intellectual property rights. Middle-income country efforts require support, including through contributions to the Fund.
VITAVAS SRIVIHOK (Thailand), speaking on behalf of the Association of Southeast Asian Nations (ASEAN), said the bloc’s efforts are guided by the 2016 Political Declaration, which aligns with the Sustainable Development Goals. Noting that the 90-90-90 targets called for in the Declaration are within reach, he said ASEAN is working to attain them by 2020, aiming to improve the HIV “treatment cascade” to ensure continuum of care, prevent resurgence of HIV infections and reduce AIDS‑related deaths. He described such community-based and people‑centred approaches as the “ASEAN Cities Getting to Zeros Project”, noting that financing remains a challenge for many countries amid declines in international funding. He recognized the need to transition towards sustainable financing from domestic resources through needs-based prioritization of funding and investment harmonization, drawing attention to the needs of the key affected populations who are at risk or carry the greatest HIV burden, as well as those facing stigma and discrimination. ASEAN is ready to foster partnerships within and between regions to build on progress made.
SAM CONDOR (Saint Kitts and Nevis), speaking on behalf of the Caribbean Community (CARICOM), said that the Caribbean is well on its way to becoming the first region to end paediatric AIDS, with seven countries having eliminated mother-to-child transmission of HIV and new infections per year among adults having declined by about 18 per cent from 2010 to 2017. The number of deaths from AIDS-related illness also declined by 23 per cent over the same period, and the prevalence rate was 0.05 in 2017, edging towards the 0.03 epidemic transition benchmark, he added. The region was able to achieve these results thanks to indigenous approaches consistent with its political, social and cultural environment, including through two major frameworks, the Caribbean Justice for All Roadmap and the Every Caribbean Woman Every Caribbean Child Initiative.
However, there is still much to be done, he emphasized, pointing to the need to redirect efforts to ensuring early diagnosis, testing and treating for persons living with HIV/AIDS, to drastically reducing the number of new infections — at least by 75 per cent by 2020 and 90 per cent by2030 — and to eliminating prejudice, violence, stigma and discrimination associated with HIV/AIDS. CARICOM will continue to galvanize ambitions among leaders and health officials and to develop and sustain partnerships, including with civil society and other stakeholders. He said, however, that the classification of countries based on gross domestic product (GDP) has restricted the Community’s access to concessional funding for HIV and other key health and development areas. “Such classification fails to include other conditions and vulnerabilities that impede our small island developing States and limit the gains we can achieve in our AIDS and other health burden responses,” he said.
SILVIO GONZATO of the European Union said the Secretary-General’s most recent report calls for an accelerated response to the global HIV/AIDS epidemic and provides concrete recommendations aimed at galvanizing political will. Pointing out that HIV is both preventable and treatable, he underlined the need to reduce the volume of new infections and ensure timely access to antiretroviral treatment, which allows for the reduction of viral loads to undetectable levels and halts the further transmission of the virus. “In order to leave no one behind, we must strengthen the response and ensure universal access to prevention, early diagnostics, treatment and care, including for the most vulnerable,” he stressed. Advocating for the promotion of comprehensive sexuality education, he said the European Union and the European Economic Area are on track to achieve the 90-90-90 targets. In the region, 86 per cent of people living with HIV have been diagnosed; 91 per cent of diagnosed people receive treatment; and 92 per cent of those are virally suppressed. However, challenges remain and require a stronger focus on prevention, training and health services, including for men having sex with men and transgender people, he said.
DMITRY S. CHUMAKOV (Russian Federation) said the spread of HIV remains a serious global health problem that continues to cause human and economic losses. Expressing concern about increasing infection rates in Eastern Europe and Central Asia, he said the Russian Federation’s own national strategy provides free diagnostic testing for some 37.9 million people. New cases of infection have not increased for three years in the country and the risk of mother-to-child transmission declined in 2019. Meanwhile, the Russian Federation is expanding its international cooperation and its collaboration with UNAIDS and is working in neighbouring regions to reduce the risk of new infections. Among other things, it made a $17.8 million contribution to UNAIDS for 2019-2021 period, aimed at funding testing, treatment and research in Eastern Europe and Central Asia. Expressing regret that the authors of the Secretary-General’s most recent report once again put forward controversial approaches that lack consensus support from all countries — including harm reduction and general sexual health education, or so-called “sexual rights” — he said the Russian Federation nevertheless remains committed to working with partners towards the eradication of HIV around the world.
LAZARUS OMBAI AMAYO (Kenya), speaking on behalf of the African Group, said the 2030 Agenda’s target of leaving no one behind requires the rapid expansion of HIV testing, treatment and cure. Behaviour change communications strategies and condom‑distribution programmes have helped reduce the number of new infections in many countries, including in high-burden countries. However, he voiced concern that in regions such as sub-Saharan Africa — where children and young adults comprise a large portion of the population — the “youth bulge” is not being consistently reached by HIV‑prevention efforts. Knowledge of prevention remains stagnant and high infection rates continue to impact women and young girls. Spotlighting insufficient funding, inadequate health care and stigma, he pointed out that two vaccine candidates are currently being tested in large phase III trials in Africa — the first in a decade. The 2018 confirmation of long-term remission in a person who received a bone marrow transplant provides new hope, as do the development of long-term injectable forms of antiretroviral drugs and novel gene‑editing techniques currently being tested in animals.
Welcoming recent global commitments to end stigma, he warned that migration and poverty put people at greater risk of HIV infection. Migrants and refugees face high risks of discrimination based on their infection status and may suffer from treatment disruption. Calling on countries to provide health‑benefit packages that include a comprehensive set of HIV services, he cautioned that declines in domestic and donor‑financed prevention services have had a major impact in high-prevalence countries. Meanwhile, “user fees” and other expenses, including for diagnostic tests and consultations, constitute obstacles for people at the highest risk. In that context, he stressed that the global movement towards universal health care coverage should include commitments to providing free, accessible and adequately-funded HIV testing and treatment services in all countries and communities.
Speaking in his national capacity, he said Kenya remains on track to achieve the 90-90-90 targets by 2020. The country has pushed forward a rapid scale-up of antiretroviral treatment, with more than a million Kenyans now on long-term treatment. Recognizing the need to rethink HIV prevention, the country revised its national strategy, developing a bold new approach that has become the global standard. Since it was implemented, Kenya has seen a more than 51 per cent reduction in new HIV infections, with incidence now standing at 1.8 per cent of the population. “Mentor mother programmes” and similar initiatives have helped to reduce mother-to-child transmission rates by 3 per cent and the country’s social protection schemes and cash transfer programmes provide strong support for those living with HIV or at risk of infection. Noting that Kenya’s response is largely community-led, he added that its one-of-a‑kind HIV Tribunal also ensures that people living with the virus do not face stigma or discrimination based on their status.
MHER MARGARYAN (Armenia) underscored his country’s commitment to implementing the 2016 Political Declaration, noting that over the last five years, HIV prevalence in each of the key population groups at higher risk of HIV exposure has been below 5 per cent, and well below 1 per cent among pregnant women. Recalling that Armenia is among the first countries certified by the World Health Organization (WHO) for elimination of mother-to-child HIV transmission, he said to improve access to early diagnosis and treatment, it is revising testing strategies and protocols in line with WHO guidelines. It has also developed a tightly integrated system of services on HIV/AIDS, tuberculosis, maternal and child health care. Globally, he said the high proportion of late‑diagnosed HIV patients, high mortality and insufficient prevention interventions for such populations as labour migrants persist, and donor funding has fallen, noting that Armenia looked forward to further cooperation with United Nations agencies to galvanize the action needed to reach the Assembly’s targets.
DOMINIQUE MICHEL FAVRE (Switzerland), describing how his country supports commitments made in the 2019 Political Declaration, said that, at the international level, the Government partnered with the International AIDS Society to rapidly bring the latest scientific evidence to the country level and adapt it to a given context. In Southern Africa, Switzerland supports SADC in preventing new infections among young people, and as a result, contributed last year to reaching 11 million people at risk of or infected with HIV. In Switzerland, efforts are under way to eliminate HIV/AIDS by 2030, he said, noting that, last month, the Federal Commission for Sexual Health — an extra-parliamentary expert commission advising the Government — handed over its “Roadmap for eliminating HIV/AIDS in Switzerland”, which strongly recommends that elimination by 2030 should be the principle target of the future National Programme for HIV and other Sexually Transmitted Infections. Efforts will be grounded in human rights and focused on such populations as men who have sex with men and migrants.
DEE-MAXWELL SAAH KEMAYAH (Liberia) described his country’s persistent efforts to enhance collaboration with local and international partners, pursue research and assessment and explore ways to mobilize domestic resources. There are an estimated 39,000 people living with HIV in Liberia, 1,900 new infections annually and 1,800 deaths related to AIDS. As such, the National AIDS Commission developed a “catch up” plan in 2016, which came into effect in January 2017 and is expected to end in December 2020. The two-phase plan supplements the national strategic plan, seeking to triple current testing and treatment figures within a short window of opportunity. By the end of 2018, 26,000 people of the estimated 39,000 people who knew their status were on antiretroviral treatment, and 1,452 patients of the 2,804 screened for viral load showed that they were virally suppressed. “The plan is set to meet its goal of achieving the 90-90-90 targets by December 2020,” he asserted, noting that mother-to-child transmission has been on a steady decline, and progress continues to create the necessary environment to address the epidemic among men who have sex with men and female sex workers.
DIAN TRIANSYAH DJANI (Indonesia), associating himself with ASEAN, underscored his country’s commitment to setting the three zero targets: reducing the number of new infections, lowering HIV-related deaths and ending HIV/AIDS‑related stigma and discrimination. It is focused on preventing mother‑to-child transmission by providing tests and counselling services. Noting that the Government considers continuous HIV and sexually transmitted disease care in its national HIV/AIDS programme, and incorporates the role of community in those efforts, he said strengthening the health system at every level is a priority, especially for those susceptible to stigma. Indonesia provides free antiretroviral drugs to all those who can be assessed in centres throughout the country. It offers education on reducing the negative stigma surrounding HIV and AIDS, notably by engaging with affected populations and advancing community-based testing and counselling. Indonesia is also working to ensure access to HIV services and there are up to 450 appointed hospitals providing such care. Defeating the epidemic requires “responsibility and sensible behaviour”, he said, advocating measures to prevent HIV transmission and the involvement of all stakeholders in efforts to bring about greater awareness.
MYRIAM OEHRI (Liechtenstein), noting a remarkable reduction over the last decade in AIDS-related deaths thanks to greater HIV testing and treatment, alongside an overall decline in new HIV infections, said the 2016 “fast track” strategy for a rapid scale-up of evidence-based HIV prevention, testing and treatment services by 2020 has catalysed efforts. While the 90-90-90 targets have been conducive to that end, “we have yet to fully implement them”. It is crucial to find responses for the 10 per cent of people living with HIV and not knowing their HIV status. She advocated for comprehensive health facility-based HIV services, public health and social protections, and structural changes to ensure that the vulnerable can access the services they need, noting that Liechtenstein has contributed almost 1.3 million Swiss francs to the Global Fund and 285,000 Swiss francs to UNAIDS since 2009. She applauded the 89 countries that have repealed or reformed laws since 2012 that criminalized HIV, same-sex relations and drug possession. But, she voiced concern that laws continue to prevent young people, women, people who inject drugs, sex workers, transgender people, prisoners, gay men, other men who have sex with men, indigenous peoples, migrants and refugees from accessing HIV services.
DIEDRE MILLS (Jamaica), associating herself with CARICOM, said more needs to be done if the Caribbean region is to be “the first to get to zero”. Noting that 32,000 people live with HIV in Jamaica, she said a 2017 survey by its Ministry for Health revealed that 65.3 per cent of those in the 15‑to‑24 age group had multiple sex partners, while knowledge of how HIV is transmitted has declined. In response, the Government is speeding up its efforts to achieve the 90-90-90 goals. As of March, she said, 78 per cent of HIV-positive individuals in Jamaica had been diagnosed, 49 per cent knew their status and 57 per cent achieved viral suppression. Special attention is going towards the prevention of mother-to-child transmission through improved laboratory testing and services. To address negative behaviour among young people, a “teen hub” was set up in Kingston where health-care workers provide mental wellness and sexual and reproductive health clinics. The Government is also redoubling efforts to confront discrimination and marginalization faced by those living with HIV, she said.
ALEJANDRO GUILLERMO VERDIER (Argentina), recalling that Member States have committed to achieving the 2030 Agenda, as well as stigma-reduction plans and the 90‑90‑90 targets, said major strides have been made in expanding treatment and reducing mortality around the world. Countries in many regions are well on their way to achieving those goals, but more remains to be done. “We cannot focus on progress already made,” he stressed, noting that the 2030 Agenda’s commitment to leave no one behind must underpin all efforts to tackle stigma, discrimination and other social barriers to testing, treatment and service. In that context, he called for the adoption of a human rights-based focus and gender-based approaches, including attention to women’s sexual and reproductive rights. Many vulnerable people also suffer from multiple forms of discrimination whose intersection put them at greater risk. Argentina, for its part, provides people with access to health information, includes vulnerable people in decision-making processes and works to combat stigma and discrimination. Among other things, it has created community centres for HIV testing, advice and treatment consultation. At the international level, Argentina plans to participate in a United Nations high-level meeting on universal health coverage in September, and hopes that it will result in an ambitious, action-oriented outcome document.
LAHYA SHIKONGO (Namibia) said that 77 per cent of all HIV-positive adults in her country have achieved viral load suppression, a widely used measure of effective HIV treatment. Despite Namibia’s accomplishments in the fight against the virus, high infection rates among young people aged 15 to 24 continue to worry the Government. “Key to tackling the spread of HIV among young and adolescent girls will be strategies that include access to sexual and reproductive health and rights, access to essential health care in regard to sexual health, and gender empowerment policies,” she stressed. Another challenge is getting more men tested and promoting prevention in that cohort. In this regard, male circumcision has been proven to work and the Ministry of Health and Social Services has been increasing advocacy in that area. Noting that the fight against HIV/AIDS requires strong pollical will from all sectors, she also stressed the need for adequate funding for programmes and urged Member States to scale up any-and-all funding. Namibia is also exploring ways to make innovations such as HIV self-testing accessible to people living with HIV/AIDS.
FREDERICO SALOMÃO DUQUE ESTRADA MEYER (Brazil) said his country’s coordinated response to HIV/AIDS, with universal access to treatment and diagnosis, is internationally recognized and a testament to its commitment to human rights. In 1996, Brazil was the first to put in place legislation that guaranteed free treatment for persons with HIV/AIDS. Brazil was also the first developing country to adopt the “treatment as prevention” approach, recommending antiretroviral therapy to all people living with HIV. In 2014, the Ministry of Health diversified HIV testing and delivery of health care by establishing a community-based programme which enabled civil society organizations to conduct rapid HIV testing in a peer-to-peer approach. Brazil remains committed to ending the AIDS epidemic by 2030 through the full implementation of the 90-90-90 goals. He called on all Member States to commit to a multisectoral approach in fighting AIDS, as well as hepatitis and tuberculosis. Brazil is committed to eliminating the inequalities, discrimination and stigma that often surrounds the issue based on the tools provided by the 2030 Agenda and the Political Declaration on HIV and AIDS: On the Fast-Track to Accelerating the Fight against HIV and to Ending the AIDS Epidemic by 2030.
VALENTIN RYBAKOV (Belarus) said HIV prevention is a priority enshrined in his country’s national health strategy. Belarus is working to achieve the 90‑90‑90 targets and considers the time remaining until 2020 as a major window of opportunity to combat HIV. Among other things, the Government provides universal access to anonymous and free testing, including self-testing, and 81 per cent of those infected in the country now know their status. In line with the Minsk Declarations of 2016 and 2018, Belarus is working to expand access to reduced‑price antiretroviral treatment across the Eastern European region. At the national level, 75 per cent of those being treated have an undetectable viral load. Belarus also works to provide sustainable services to key population groups in Eastern Europe and Central Asia and cooperates closely with UNAIDS to curb the spread of HIV and reduce infection rates. As a prelude to the European Games to be held in Minsk in late June, Belarus signed a memorandum of understanding underscoring its commitment to using the games as a platform to raise awareness and combating stigma. Among other things, on-site HIV testing will be provided, he said.
PAULOMI TRIPATHI (India) said that her country significantly contributes to the international fight against HIV/AIDS, noting that more than 70 per cent of the antiretroviral drugs used globally are supplied by its pharmaceutical industry. “These affordable generic medicines have helped scale up access to treatment across developing countries,” she added. In the context of HIV/AIDS response within the country, she reported that there has been a more than 80 per cent decline in estimated new infections from the peak of the epidemic in 1995. Tuberculosis deaths among people living with HIV dropped by 84 per cent by 2017, three years ahead of the 2020 decline. In its attempts to meet the 2030 targets, India has revamped its prevention and intervention strategy through strengthening outreach activities, biomedical waste management, community-based screening and providing peer navigation services. Around one third of people living with HIV/AIDS are being offered free treatment and support services. Moreover, a landmark HIV and AIDS act provides the legal framework to ensure that a person with HIV/AIDS can live a life without stigma and discrimination. “This Act is a milestone; it empowers a person living with HIV,” she said. Among other things, the legislation has provisions to safeguard the property rights of HIV-positive people and requires Governments to appoint an ombudsperson to inquire into complaints.
HAYET ZEGGAR (France) noted that the sixth international funding conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria — to be held in Lyon in October — will seek to mobilize at least $14 billion for the 2020-2022 period. Emphasizing that the conference’s success is critical to preserve fragile progress made in combating HIV, she pointed out that infection rates are still rising in more than 50 countries around the globe and that drug resistance now poses additional threats.
ISSA KONFOUROU (Mali), associating himself with the African Group, said his nation has long made the response to HIV/AIDS one of its top priorities. Its adoption of a human rights-based approach has helped to curb the spread of the virus and bring the infection rate down to just over 1 per cent. However, since 2012, the region’s security crisis has rendered existing vulnerabilities more acute, threatening health workers and the causing the breakdown of institutions. Today, another challenge is the flow of young people seeking work in the region’s emerging illegal gold mining industry. The Government is working to combat terrorist groups and transnational organized criminal networks, while also protecting the human rights of those living with HIV. As part of its national strategy, is has created a fund to mobilize both domestic and international resources. Emphasizing that the progress made to date remains fragile and requires consolidation, he also welcomed the provision of predeployment training on HIV-related issues to all personnel of the United Nations Multidimensional Integrated Stabilization Mission in Mali (MINUSMA).
KIRA DANGANAN-AZUCENA (Philippines), associating herself with ASEAN, said that, since the first case of HIV infection in her country was reported in 1984, there have been 65,467 confirmed cases reported to its Department of Health, 80 per cent of which occurred in the last five to seven years. Victims come from all walks of life: people who engage in transactional sex, overseas Filipino workers, children and adolescents. She voiced concern that the predominant age among those diagnosed has shifted from those aged 35 to 49 years in 2001-2005 to those aged 25 to 34 in 2006 onwards. Moreover, the proportion of HIV-positive cases among 15 to 24 year olds nearly doubled over the last 10 years — from 17 per cent in 2000‑2009 to 29 per cent in 2010‑2019. “It is clear that we are facing a fast-growing epidemic in the Philippines,” she said. The development plan aims to reverse the increasing trend of new HIV infections by 2022, while the HIV and AIDS Policy Act requires all Government health facilities and workers to incorporate awareness into their work, urges stakeholders to accelerate access to free HIV treatment, embeds HIV and AIDS care within universal health care, clarifies the mandates of Government agencies and institutionalizes the national strategic plan to fight HIV, which includes multi-year strategies and interventions to reverse the epidemic. City and local executives have also signed the UNAIDS “Fast‑Track” HIV and AIDS intervention and developed their 2019‑2022 strategies and investment plans around it.
CHERITH NORMAN-CHALET (United States), stressing that “we are closer than ever to ending AIDS”, pointed to the power of partnership and being both strategic and focused in the collective approach. The United States continues to partner with Governments, the private sector, philanthropic organizations, multilateral organizations, faith-based groups, people living with HIV and AIDS and others in those efforts. Noting that lives have been saved through rapid prevention and treatment, she said the United States President’s Emergency Plan for AIDS Relief uses data to assess national and other areas where the needs are greatest. The 90-90-90 targets will only be reached when efforts reach all groups, including harder-to-reach populations. Meeting 2030 targets cannot be done without the right data to pinpoint unmet need and direct resources, she said, underscoring her country’s unwavering commitment to ending AIDS and advocating a focus on areas where the HIV/AIDS burden is largest. Those hardest hit must receive life-saving prevention and treatment, she said.
DANIEL FERNAN GIMENEZ (Norway) said that too many people are still infected every year with the virus and stigma continues to disproportionately affect marginalized people. “We cannot afford to backtrack,” he stressed, expressing concern that about a third of new infections are in people aged 15 to 25. And in almost all countries where HIV affects many groups, young women and girls aged 15 to 24 are far more likely than their male counterparts to contract HIV. “Any successful HIV response must therefore be aimed particularly at reaching young women and girls,” he stressed, calling the link between girls’ education and positive health outcomes “irrefutable”. Girls who have been in school can take informed choices and take better care of themselves and their families. They have stronger political and economic power in their communities. “Girls, as well as boys, need knowledge about their bodies, health and rights to be able to make informed decisions and create positive relationships,” he added. Ample evidence shows that comprehensive sexuality education delays sexual debut and increases the use of contraceptives. “As a man growing up in Western Europe, I’ve had many privileges,” including access to productive and sexual health, he continued. “An unfortunate realization working on these issues, even here at the United Nations, is that we hold women to a dramatically different standard than men,” he noted. More than 80 per cent of HIV cases are transmitted sexually, and girls and women are more than 3 to 5 times more likely to get infected than their male counterparts. “It is irresponsible to turn a blind eye to these facts,” he stressed. The future of the HIV response will require looking beyond HIV care provision. It will require working with and including marginalized and vulnerable groups in the response to the epidemic.
HELENA YANEZ LOZA (Ecuador) said today’s meeting provides countries an important opportunity to step up their effort to eradicate the HIV epidemic. As part of Ecuador’s national strategy, the Government provides universal, fast-tracked third‑generation diagnostic tests and monitors the treatment of patients around the country. To reduce mother-to-child transmission, new mothers and pregnant women are offered viral load testing, as well as breastmilk substitutes and caesarean sections. Ecuador has also developed health guidelines for mothers, including those caring for children with HIV, and has adopted a gender-based approach which ensures the provision of sexual and reproductive health services.
JORGE LUIS CEPERO AGUILAR (Cuba) expressed concern that financing devoted to combating HIV/AIDS in developing countries has stagnated in recent years. Cuba’s national strategy to combat the disease – based on the principle that health care is a human right — has evolved in line with WHO guidelines, and the country now also focuses on the development of generic antiretroviral drugs. Spotlighting Cuba’s highly informed population, he said the Government provides comprehensive and universal sexual health education, anonymous and free testing, antiretroviral treatment, counselling and advice. Underlining the importance of ensuring that people trust their Government health institutions, he said Cuba was the first country in the world to completely eliminate mother-to-child HIV transmission. It is also making sustained progress in eradicating discrimination based on gender and sexual orientation and ensuring dignified living standards among all those living with HIV. All that progress is being achieved despite the continuing economic blockade imposed against his country by the United States, he stressed, noting that the embargo seriously constricts the resources available for Cuba’s HIV response.