“We must constantly ask ourselves: what are we doing to fight this global emergency, and what more can we do?” said General Assembly President Sheikha Haya Rashed Al Khalifa ( Bahrain), stressing that the 192-member body needed to continue to monitor progress and keep the issue at the top of its agenda.  “Future generations will either praise us, or hold us accountable for our failure to prevent the spread of this disease.  This is a make or break time, but beating this disease is entirely within our reach.”

Speakers in the debate agreed that the pandemic had had a serious impact on countries all over the world, having undermined development, overwhelmed health systems, destroyed families and caused despair among those affected. The representatives of the United Republic of Tanzania (on behalf of the African Group) and Lesotho (on behalf of the Southern African Development Community) were among those who drew attention to the plight of the African continent, and in particular sub-Saharan Africa -- home to only 10 per cent of the world’s population, but which accounted for about 62 per cent of all infected cases.

Speaking on behalf of the Caribbean Community (CARICOM), the representative of Trinidad and Tobago pointed out that the Caribbean still had the second highest prevalence of the disease after sub-Saharan Africa.  Of special concern was the fact that the face of HIV/AIDS in the Caribbean was increasingly female, with a higher proportion of females than males living with the disease in some countries.  As the pandemic in the Caribbean continued to evolve, the importance of gender in every consideration of national plans and programmes needed to be stressed.

Stressing the gravity of the situation, several speakers, including the representative of the Dominican Republic (on behalf of the Rio Group), stressed the need for adequate financing to assist countries in the implementation of their national plans, noting that it would cost an estimated $18 billion in 2007 and $22 billion in 2008 to fight HIV in low- and middle-income countries. Many expressed concern about the funding gap, particularly for low- to middle-income countries, which had just half of the resources needed to fight HIV/AIDS.  They urged the international community to make good on its promise of additional funding for public health and development programmes, and encouraged public-private partnerships to address the pandemic.

Also emphasized in the debate was the need to address such obstacles to universal access as gender inequality, stigma, discrimination, insufficient human resources and weak health systems. “We cannot and must not ignore legal, social, economic and cultural issues that drive the epidemic, but have to deal with them proactively,” said the representative of Germany (on behalf of the European Union), urging those countries that had not yet done so to ensure that all national HIV/AIDS plans addressed the drivers of the epidemic. 

Sweden’s representative said it was necessary to find ways to ensure that the United Nations, international financial institutions, major global initiatives and mechanisms and bilateral donors harmonized in the best possible ways.  For more than 1.25 million people, the Global Fund to Fight AIDS, Tuberculosis and Malaria had meant a new life, and more than 3,000 additional people survived each day thanks to programmes financed by the Fund.  Support to the Fund needed to be matched, however, by similar support for the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO) and others.  Partners at all levels must translate words into deeds and deliver on their promises and commitments.

France’s representative said that discrimination and stigma were slowing access to prevention, care and treatment.  The fight against HIV/AIDS would be won if the tools for prevention were proportionate to the speed at which the epidemic spread, and the treatments proportionate to the needs.  The challenge ahead lay in devising new strategies for prevention.  Education programmes on health and prevention needed to be redesigned and tailored to communities where those programmes were implemented.  All effective means of prevention, especially for women, had to be available and adapted to specific socio-cultural situations.

Statements were also made by the representatives of Canada, Netherlands, Botswana, Philippines, Australia, United States, Denmark, Monaco, Egypt, Cuba, Poland, United Kingdom, Ireland, Ukraine, India, Bangladesh, Indonesia, Myanmar, Sudan, Japan, Honduras, Kenya, Thailand, Benin, New Zealand, Belarus, Switzerland, China, Zambia, Armenia and Mauritius.

The Assembly will meet again at 10 a.m. tomorrow, 22 May, to continue its debate on HIV/AIDS, as well as hold elections for the Peacebuilding Commission.

Background

The General Assembly met today on follow-up to the outcome of the twenty-sixth special session: implementation of the Declaration of Commitment on HIV/AIDS.  The meeting will build on the outcome of last year’s high-level meeting on AIDS in New York, on 2 June 2006, during which Members States declared a new global objective: to move towards the goal of universal access to HIV prevention programmes, treatment, care and support by 2010.  That commitment was expected to strengthen the 2001 Declaration of Commitment on HIV/AIDS, adopted by the General Assembly at its twenty-sixth special session, entitled “Global Crisis -- Global Action”. 

Before the Assembly was the Secretary-General’s interim report on the Declaration of Commitment on HIV/AIDS and Political Declaration on HIV/AIDS: focus on progress over the past 12 months (document A/61/816), which provides an overview of the most recent developments in the global AIDS response.  A more comprehensive review is planned for 2008, after countries submit progress reports as provided for in the Political Declaration on HIV/AIDS.

According to the report, by the end of 2006, 90 lower- and middle-income countries have set national targets towards universal access to services, and 25 countries have incorporated those targets into a costed national plan.  However, the goal of scaling up services and reaching universal access in the shortest time possible must be balanced against the need to strengthen existing infrastructures, including the capacity of civil society, to ensure the long-term sustainability of services.  For example, few countries have demonstrated clearly how they will overcome key obstacles, such as weak health systems, insufficient human resources, lack of predictable and sustainable financing and lack of access to affordable services.

The report says that, as of December 2006, an estimated 2 million people out of a total of 7.1 million were receiving antiretroviral therapy in low- and middle-income countries, representing an increase of 700,000 from the number estimated to be on antiretroviral therapy in December 2005.  Nevertheless, the number of people dying from AIDS increased from 2.2 million in 2001 to 2.9 million in 2006, which is largely the result of an increase in the number of people with advanced HIV infection in need of antiretroviral therapy.  Their numbers are rising faster than the scale-up of retroviral therapy.  Past failure of prevention measures to keep pace with the epidemic’s growth are largely attributable to three problems: insufficient investment in prevention; low coverage of HIV prevention services for populations with higher rates and risks of HIV infection; and lack of action against the social, economic and cultural drivers of HIV infection, including gender inequality, stigma and discrimination and the failure to protect other human rights.

In low- and middle-income countries, current estimates of global resource needs for HIV are $18 billion in 2007 and $22 billion in 2008, the report says.  An estimated $10 billion -- an increase over the $8.9 billion available in 2006 -- will be available for HIV-related programmes in those countries in 2007, slightly more than half of what is needed.  As many countries, especially low-income countries, cannot achieve the universal access goals without external resources, there is a pressing need for more international funding for public health and development.

The report says that strengthening the global response and fully implementing prior commitments made by Member States requires that countries “know their epidemic” and intensify HIV prevention; chart their course towards universal access to HIV prevention and treatment; fund credible national HIV plans and align them with their existing national systems; be able to review and report on progress regularly; and build capacities for a stronger, more sustainable response.

Statements

Opening the meeting, SHEIKHA HAYA RASHED AL KHALIFA ( Bahrain), President of the General Assembly, said that the numbers related to HIV/AIDS were shocking beyond belief, but they helped to understand the magnitude of the pandemic.  Since HIV/AIDS had been first discovered in 1981, it had killed more than 25 million people worldwide.  Currently, about 40 million were infected; with about 4.1 million new infections last year alone.  Some 12 million children in Africa were orphaned by AIDS; 8,000 people died and 6,000 were still infected every day.  Each and every one of those facts and figures told an individual story in its own way.  Put together, those stories reflected unimaginable tragedies of those who were living with the disease and taking care of someone suffering from it, day in and day out.  “HIV/AIDS is a nightmare that haunts us all and demands [the] immediate and sustained engagement of the world community.”

“We are all tested by this crisis –- not only in our willingness to respond, but also in the divisions that shape our response,” she said.  The response to HIV/AIDS was not a question of either treatment or prevention –- or even what kind of prevention; it was all of them combined.  It was also not an issue of either science or values; it was both.  The world would never be entirely secure, unless the international community tackled poverty, injustice and inequality, and HIV/AIDS was related to all three.   There was a security dimension to the situation, as well.  As HIV/AIDS had spread, it had devastated entire populations leaving some countries more fragile and exposed to all sorts of dangers, including civil wars.  HIV/AIDS also hindered development, devastating economies in the developing world, widening even further the gap between the richest and poorest countries.  It destroyed hope, dreams and aspirations.

The spread of HIV/AIDS was most severe in sub-Saharan Africa, which accounted for 62 per cent of global infections, and the majority of overall deaths due to the disease, she continued.  HIV/AIDS infections were up to six times higher for young women than for young men.  As a result, nearly 1,000 innocent children died everyday in Africa.  That could be halted.  Better still, it could be reversed.  In 2005, donors had agreed to support free basic healthcare, universal access to HIV/AIDS treatment and primary education for all.  Developing countries had agreed to develop national plans to defeat the spread of the disease as part of their overall strategy to achieve the Millennium Development Goals. 

Though Governments played a central role in the response, she went on, they could not tackle that global emergency alone; nor could the United Nations.  “What we need is a partnership between Governments, multilateral institutions, civil society, NGOs, scientists, doctors, as well as individuals,” she said.  “Most importantly, we need to engage those living with HIV/AIDS and those at greatest risk of infection –- women and children –- to be at the centre of the response.”

Yet, many still found it difficult or embarrassing to talk about HIV/AIDS, she said.  Many women would rather not get the treatment that they needed to save their lives, or stop their children from contracting the disease, because they did not want, or did not know how to cope with the fear and stigma of HIV/AIDS.  Only one in five young women knew how to prevent HIV/AIDS transmission, and less than one in ten HIV-positive pregnant women received anti-retroviral drugs.  She hoped that the feminization of the epidemic would be a major element of today’s deliberations, with tangible impact on young women’s lives.  More than 17 million women lived with HIV/AIDS worldwide, and an additional 225 young women became infected each hour.  Almost 140 million women did not have access to contraception and, as a result, had no choice in deciding if and when to have children.  

Among the practical things that could be done, she mentioned the need to establish healthy behaviour when children were young, rather than ask them to change later.  If world leaders honoured their commitment and lived up to their promises, then young people would have the reproductive health services and information to meet their needs.  Young people needed a good education.  It was also necessary to remove the stigma attached with getting tested for HIV/AIDS.  In some places, nine in 10 people with HIV/AIDS had no idea that they were infected.  It was also necessary to work with drug companies to reduce the costs of antiretroviral drugs; and work with developing countries to help them build their health systems in order to treat those infected.  That meant more resources for hospitals and more training for doctors and nurses.  Those efforts should be coupled with making sure that those getting treatment had enough food to eat.

As the Secretary-General had noted in his report, a comprehensive approach was needed, she said.  Going forward, it would be essential for the General Assembly to continue to monitor progress and keep the issue at the top of the agenda.  “We must constantly ask ourselves: what are we doing to fight this global emergency, and what more can we do?” she said.  “Future generations will either praise us, or hold us accountable for our failure to prevent the spread of this disease.  This is a make or break time, but beating this disease is entirely within our reach.”

BAN KI-MOON, United Nations Secretary-General, noted that in the course of a quarter of a century, HIV/AIDS had infected 65 million people, and had killed more than 25 million.  Today, 40 million people were living with HIV; almost half of them women.  More women –- including married women -– were living with HIV than ever before.  Without adequate treatment, all of those infected would die.  Some 8,000 people died of AIDS-related illnesses every day.  For every person who started antiretroviral treatment, six more became infected.  Those numbers were humbling, but even they did not convey the full and true reality of AIDS.  They did not tell of the human implications for individuals directly affected, for their families and communities. 

He said that was why he would be meeting with a group of United Nations staff living with HIV.  He was proud that those staff members had the courage and strength to challenge stigma and discrimination, and to work to make the United Nations a model of how the workplace should respond to AIDS. 

“But make no mistake; in some way or another, we all live with HIV,” he said.  Everyone was affected by it, and everyone needed to take responsibility for the response.  Governments had recognized that when they adopted the Political Declaration on HIV/AIDS a year ago, renewing the pledges that had been made in the Declaration of Commitment five years before, and setting a new global objective towards universal access to treatment, prevention, care and support by 2010.  Ensuring such access was critical to achieving the Millennium Development Goal of halting and beginning to reverse the spread of HIV among women, men and children by 2015.  It was also a prerequisite for meeting most of the other Goals. 

“We cannot win the fight for development if we do not stop the spread of HIV,” he said.  All four elements of the response -– treatment, prevention, care and support –- were essential and interconnected.  Progress was possible on all four fronts.  Over the past year, important groundwork had been laid to ensure universal access.  Ninety countries had set national access targets, and many aimed to double or triple the coverage of antiretroviral treatment by 2010.  Two million people in low- and middle-income countries were now receiving treatment.  In countries with generalized epidemics where there had been sustained prevention efforts, HIV prevalence was declining.  And yet, the epidemic was still spreading. 

Over the past two years, he continued, the number of people living with HIV had increased in every region in the world –- not least in his own home continent, Asia.  As an Asian Secretary-General, he was determined to speak up about the spread of AIDS on the continent.  Every day of denial took a terrible toll.  Every new infection added to the burden on individuals, families, households, communities and society as a whole.  Every day, prevention became more urgent.  Around the world, including in Africa, where AIDS had wreaked its worst devastation so far, many examples had been seen of effective prevention programmes.  Those must be scaled up and made accessible to all, including by overcoming the obstacles that kept so many people from accessing prevention services, including women, girls and members of vulnerable groups.  It meant adopting a comprehensive approach to tackle diseases intimately linked with HIV, especially tuberculosis, and investing further in tools for prevention and treatment, including vaccines and microbicides.

It also meant mustering the political will to address the factors that drove the epidemic, including gender inequality, stigma and discrimination, he said.  It meant ensuring full and predicable funding for infrastructure, human resources and credible national AIDS plans, based on an honest understanding of the specific nature of the local epidemic.  It meant building partnerships with all Governments, the private sector and civil society to make AIDS money work more effectively.  “And it meant sustaining those efforts not just for years, but for decades to come,” he said.

For his part, he promised that AIDS would remain a system-wide priority for the United Nations, that the Organization would deliver as one on AIDS, and that the already pioneering coordination efforts of the Joint United Nations Programme on HIV/AIDS (UNAIDS) and its co-sponsors would be strengthened further through system-wide coherence.  He would make every effort to mobilize funding for the response to AIDS, now and in the longer term.  Only when the international community worked together with unity of purpose –- unity among Governments, the private sector and civil society -- could it defeat AIDS.  He looked forward to working together with the international community on that vital mission in the years ahead.

THOMAS MATUSSEK (Germany), speaking on behalf of the European Union, said progress had been made since the adoption of the Declaration in 2001 and the Political Declaration last year.  The declarations could be regarded as milestones in the fight against HIV/AIDS.  He hoped those global objectives would serve the international community well in successfully fighting HIV/AIDS and in reaching the Millennium Development Goals by 2015 at the latest, and also the goal of universal access to comprehensive HIV/AIDS prevention programmes, treatment and support by 2010.  He welcomed the fact that 57 States had set interim national targets by the end of 2006, and urged all countries that had not yet done so to set ambitious national targets to achieve universal access by 2010.

For targets to be successful they must be rooted in national priorities, plans and budgets, he said.  Tackling HIV/AIDS must become part of affected countries’ overall planning processes and strategy work.  He noted with concern that only some one third of the 90 countries that had set national targets had actually incorporated them into an updated, costed and prioritised national plan.  He appealed to the remaining countries to develop costed and prioritised national HIV/AIDS plans, which was a prerequisite for the international community’s commitment to ensure that costed, inclusive, sustainable and evidence-based national HIV/AIDS plans were funded and implemented.  It was important to ensure that a process was developed to assess the credibility of HIV/AIDS plans and to ensure that countries with credible plans were financed without delay.

While progress had been made to finance the fight against HIV/AIDS, much remained to be done, he said.  In that regard, he recognized the pivotal role of the Global Fund to Fight AIDS, Tuberculosis and Malaria, and noted that the European Union had provided more than 50 per cent of the total contributions to the Fund.  He welcomed the recent decisions to move towards trebling the Fund to allow national HIV/AIDS plans to form the basis of funding applications and to allow rolling contributions where performance had been good.  The Union remained committed to further strengthening the Fund’s potential, including through its forthcoming replenishment focussing on the period 2008 to 2010, and strongly invited other donors to follow suit.  The Union was also concerned to learn that many national HIV/AIDS plans did not address the main obstacles to universal access, including gender inequality; stigma and discrimination; weak health systems; insufficient human resources; lack of predictable and sustainable financing; and lack of full access to affordable health care services and commodities.

“We cannot and must not ignore legal, social, economic and cultural issues that drive the epidemic, but have to deal with them proactively,” he said, urging those countries that had not yet done so to ensure that all national HIV/AIDS plans addressed the drivers of the epidemic.  Policymakers and programmes must identify the drivers and risk factors of the epidemic in order to successfully set national targets and develop national HIV/AIDS plans.  Only 49 countries had satisfactory processes in place for regular participatory reviews of progress, including monitoring and evaluation mechanisms. 

Many women became infected, or were at risk of being infected, even if they did not practice high-risk behavior, he said.  The current challenge posed by HIV/AIDS underlined that gender inequality, discrimination on the basis of gender and all forms of violence against women were some of the root causes that fostered the spread of the epidemic.  Gender equality should be the focus of renewed international and European efforts to combat HIV/AIDS. 

Equitable and pro-poor health systems that were accessible and provided affordable and high quality health care were key in the fight against HIV/AIDS and other diseases, he said.  That applied particularly to sexual and reproductive health.  Unfortunately, the crisis in human resources in the health sector was a global one, with 75 countries having fewer than 2.5 health workers per 1,000 people.  He welcomed the expansion of treatment services, an increasingly important aspect in the fight against HIV/AIDS.  More than two million people were on antiretroviral treatment in low- and middle-income countries by December 2006, a 54 per cent increase compared to the previous year.  Comprehensive evidence-based prevention must be at the centre of the response to HIV/AIDS. 

Children orphaned or made vulnerable by HIV/AIDS generally needed focused attention, he said.  There was a connection between HIV/AIDS prevention and the length of time that a young person attended school.  Progress in achieving universal education, in particular at secondary level, was a salient factor in halting the spread of HIV/AIDS.  Schoolchildren presented a “window of hope” into an AIDS-free future.  Globally, injecting drug users, sex workers, prisoners, migrants and men who had sex with men were regularly denied access to information, services, treatment and care.  People living with HIV/AIDS and vulnerable groups were central to ensuring successful responses to the epidemic, as they could represent the interests of affected groups.

AUGUSTINE MAHIGA (United Republic of Tanzania), speaking on behalf of the African Group, said that while HIV/AIDS affected all regions, sub-Saharan Africa -- where, according to UNAIDS, 63 per cent of all HIV-infected people lived -- continued to bear the brunt of the global pandemic.  In 2006, 72 per cent of all AIDS-related deaths occurred in sub-Saharan Africa.  The pandemic had demographically, socially and economically devastated the region, and had increasingly become the disease of the poor, particularly women and children.  Sub-Saharan Africa was home to 80 per cent of children who had lost both parents to HIV/AIDS.  The international community’s efforts must focus on protecting the rights of children, particularly girls.  In sub-Saharan Africa, there were 14 women living with HIV for every 10 men living with the virus.  The feminization of AIDS must be reversed.

He lauded the fact that several low- and middle-income countries had developed national plans to combat the AIDS pandemic, but warned that they were only a first step.  Such plans must address the pandemic’s root causes -- legal, social, cultural and economic -- in every country if universal access to HIV prevention and treatment programmes were to be achieved by 2010.  The plans must also set both ambitious and realistic targets and be backed by adequate financing.  He expressed concern over the funding gap, particularly for low- to middle-income countries, noting that the Secretary-General had said that those countries had just half of the resources needed to address the pandemic.  He urged the international community to make good on their promise of additional funding for public health and development programmes.  He also encouraged public-private sector partnerships to address the HIV/AIDS pandemic. 

According to the Secretary-General, as of December 2006, an estimated 2 million people in low- to middle-income countries received antiretroviral therapy, just 28 per cent of those in need, he continued.  That figure fell short of the “3 by 5” target [launched by UNAIDS and the World Health Organization (WHO) in 2003, “3 by 5” was a global target to provide three million people living with HIV/AIDS in low- and middle-income countries with antiretroviral treatment by the end of 2005].  Only eight per cent of HIV-positive children in need of antiretroviral therapy in those countries actually received it.  The number of pregnant women receiving treatment to prevent mother-to-child HIV transmission had increased from only 9 per cent in 2005 to 11 per cent in 2006 –- still far below the transmission increase rate.  Much greater investment was needed in health care infrastructure, as was addressing the challenge of food insecurity and promoting good nutrition.  It was crucial to continue to lower the price of medicine and to encourage innovation and research into new vaccines and microbicides, traditional medicine and other forms of therapy.

LIPUO MOTEETEE (Lesotho), speaking on behalf of the Southern African Development Community (SADC), said that Southern Africa had the highest HIV and AIDS prevalence in Africa.  Indeed, home to only 10 per cent of the world’s population, sub-Saharan Africa had more than three quarters of all people living with HIV.  According to the UNAIDS report of 2006, 32 per cent of people living with HIV and AIDS globally were in Southern Africa.  HIV and AIDS remained the greatest challenge in the region, which was faced with ever-increasing numbers of orphans and vulnerable children, as well as child-headed households.

With HIV/AIDS reported to be one of the leading causes of death, SADC members had individually and collectively accorded the highest priority to the full and speedy implementation of the targets set at the twenty-sixth special session of the Assembly and the five-year review held last year.  SADC Heads of State and Government had signed the Maseru Declaration on combating HIV/AIDS in 2003, pledging to scale up programmes for the prevention of mother-to-child transmission, strengthen initiatives to increase the capacities of women and adolescent girls to protect themselves from infection, and to put in place national strategies to address the spread of the disease among national, uniformed services, including the armed forces.  SADC members were well aware that all those could not be achieved without adequate education, changing sexual behaviour patterns, and such preventative measures as male and female condoms.

Countries of the region increasingly channelled financial resources to addressing HIV/AIDS, which affected resources for other development sectors, she continued.  The factors that affected the situation included widespread ignorance related to the disease in the SADC region; stigma associated with HIV/AIDS; the fact that the pandemic was mostly affecting young people; and lack of access to basic necessities, including safe water and sanitation.  She pleaded for the international community to increase development aid to SADC members to assist in the fight against HIV/AIDS.

SADC had fully embraced the goal of universal access, which had been declared as a global objective in 2006, she said.  The Community was fully committed to working towards achieving that goal by the set date of 2010.  The region’s efforts included actions to promote safe sex education, distribution of condoms and making available antiretrovirals to curb mother-to-child transmission. Despite their efforts, SADC continued to struggle in curbing the spread of the pandemic.  It would not be easy, but there was enough dedication on the part of the Governments and the people, so that with time, the statistics would tremendously decrease.  SADC promised to stay committed and continue to make HIV/AIDS a priority, as winning that fight would open many doors, including economic growth.

ENRIQUILLO DEL ROSARIO CEBALLOS (Dominican Republic), speaking on behalf of the Rio Group, said that while HIV/AIDS did not discriminate and affected all sectors of society, recent data revealed that 2.3 million children lived with the disease and it was becoming increasingly feminized.  The 2006 UNAIDS report stated that almost half of all new cases occurred in people under 25 years of age.  He recognized the direct link between development and HIV/AIDS.  The pandemic was one of the most serious health problems facing mankind and it must be combated effectively to avoid negative socio-economic consequences in developing countries, particularly the discrimination and stigmatization.  The fight against HIV/AIDS must be in the context of achieving the Millennium Development Goals.  Access to treatment meant the difference between life and death.  People should not be denied treatment because of cost.  Guaranteed access to medicine was a human right and fundamental freedom.

The countries of the Rio Group had made universal treatment and free medicine distribution for those in need a national priority, he said.  He lauded the important advances in the Political Declaration on HIV/AIDS adopted last June by Heads of State and Government, particularly as it referred to intellectual property rights in public health.  He saluted the international community’s determination to help developing countries take advantage of the expected flexibilities in the World Trade Organization regulations.

Adequate financing was also essential, he continued.  The Secretary-General’s report said it would cost an estimated $18 billion in 2007 and $22 billion in 2008 to fight HIV in low- and middle-income countries.  Many countries, especially low-income countries, would need external funds to provide universal access to treatment.  He called on the international community to provide more money for public health and development, and for supporting innovating financing mechanisms such as the Global Fund and UNITAID, the international drug purchase facility established by Brazil, France, Chile, Norway and the United Kingdom as an innovative funding mechanism to accelerate access to high-quality drugs and diagnostics for HIV/AIDS, malaria and tuberculosis in countries with a high burden of disease.

PHILIP SEALY ( Trinidad and Tobago), speaking on behalf of the Caribbean Community (CARICOM), said the Caribbean still had the second highest prevalence of the disease after sub-Saharan Africa.  Of special concern was the fact that the face of HIV/AIDS in the Caribbean was increasingly female, with a higher proportion of females than males living with the disease in some countries.  As the pandemic in the Caribbean continued to evolve, the importance of gender in every consideration of national plans and programmes needed to be stressed.  Noting that CARICOM countries had a strong tradition of working together to meet development challenges, he cited the existence of a high level of political commitment to halt the spread of HIV/AIDS.

When the Assembly had adopted the Declaration in 2001, there had been deep concern that the HIV/AIDS epidemic constituted a global emergency through its devastating scale and impact.  The Political Declaration emanating from the 2006 high-level meeting on AIDS set out the requirements for moving countries towards the goal of universal access to comprehensive prevention programmes, treatment, care and support by 2010.  Progress was being made, but not at the level required to meet successfully the 2010 target of universal access. 

Regarding care and treatment, most countries had initiated prevention of mother-to-child transmission programmes and some countries in the region had registered success with the implementation of antiretroviral therapy.  Specifically, the morbidity and mortality previously associated with AIDS had declined.  As a region, the Caribbean had scaled up public awareness and education programmes, which was an important tool.  Efforts to scale up prevention strategies, however, had fallen short.  If incidence were to decline, it would be necessary to focus on sustained behaviour change communication targeting vulnerable groups.  The success of treatment programmes depended on the cost and availability of drugs.  Efforts must be continued to lower the cost of antiretroviral therapy and make it more affordable to CARICOM countries.

Access to affordable medication remained a fundamental element in the fight against HIV/AIDS, he said.  The international community now had the means to treat every person infected with HIV.  In that regard, he stressed the importance of the support and cooperation from the business sector, including pharmaceutical companies, to offer affordable medication for the treatment of HIV/AIDS, particularly in developing countries.  It was of utmost importance to work towards the elimination of any legal, regulatory, trade and other barriers that blocked access to affordable medication and a high standard of health care.  Regrettably, he added, many of the countries in the region had now been classified by the World Bank as middle-income countries, severely hampering the ability to receive funds from bilateral and multilateral donors along with international financial institutions and donors. 

Civil society also played an important role, and the engagement of civil society organizations was essential to the successful creation of an enabling and supportive environment.  The region subscribed to the principles of the Greater Involvement of People Living with HIV/AIDS (GIPA).  The socio-economic impact of HIV/AIDS on the small and diverse economies of the CARICOM members was devastating, he said.  AIDS was one of the leading causes of death among those aged 15 to 44 years in the Caribbean, a region that was primarily dependent on service industries, which required significant human resources input. 

JOHN MCNEE ( Canada) said that the HIV pandemic had tragically transformed the social, economic and demographic landscape of the world.  Fuelled by human rights abuses, gender inequalities, stigma and discrimination, AIDS had killed over 25 million people, with millions of new infections every year.  The disease had undermined development, overwhelmed health systems, devastated families, destroyed livelihoods and caused despair among those affected.  It had also generated a tremendous response from all levels of society.  People living with HIV had come together to shape responses to the disease.  Civil society groups had fought for the recognition of the human rights of those infected and affected by HIV.  Women and girls from all walks of life had demanded the tools to protect themselves.  And the international community had mobilized in an unprecedented manner.  New international organizations had been set up and billions of dollars had been contributed to combat the disease.  In addition, new international goals had been established, including the groundbreaking commitment in the 2006 Declaration to move towards universal access to comprehensive prevention, treatment, care and support by 2010.

Attaining the goal of universal access would require much more effort and commitment from everyone involved, he said.  While progress had been made, the world had a long way to go.  Less than 30 per cent of those who required treatment actually received it.  A mere 8 per cent of children in need received antiretrovirals.  While treatment was a critical lifesaving intervention, prevention remained the key to fulfilling the Millennium Goal of halting and reversing the spread of HIV.  Yet, groups most vulnerable to infection lacked access to comprehensive prevention methods.  Women and girls remained extremely disadvantaged.  Young people lacked access to comprehensive information on sexuality, reproductive health services and commodities, and too many infants and children were infected.  The proportion of women receiving services to prevent mother-to-child transmission remained at only 11 per cent.

More Canadians were living with HIV than ever before, and the number of new infections kept rising, he said.  An estimated 58,000 Canadians had been living with the virus at the end of 2005.  Through its “Leading Together” initiative, Canada had set up an ambitious, coordinated and nationwide approach to tackling HIV/AIDS and the underlying health and social issues.  The “Federal Initiative to Address HIV/AIDS in Canada” supported activities to prevent the acquisition and transmission of new infections; reduce the social and economic impact of the disease; and mitigate the impact of HIV/AIDS on people living with it and those vulnerable to infection.   Canada would continue to work with the international community towards the goal of universal access.  On World AIDS Day 2006, the country had committed to scale up its contributions to the global fight.

He added that Canada’s long-term integrated approach was based on promoting and protecting human rights, sound knowledge and public health evidence.  The country would focus its resources on what it knew worked: evidence-based prevention strategies, reducing poverty, promoting gender equality, women’s empowerment, building health systems to ensure equitable access to health care, promoting the rights of children and protecting children infected and affected by HIV.   Canada also recognized that more research was needed to develop female-controlled prevention methods, such as microbicides, and to achieve the ultimate objective of an effective vaccine.   Canada was committing up to $111 million to its HIV Vaccine Initiative, which would work closely with the Global HIV Vaccine Enterprise.  His country had also committed $30 million to the International Partnership for Microbicides.

ARJAN HAMBURGER ( Netherlands) said that without progress in the fight against HIV/AIDS, tuberculosis and malaria, the world would fail on other Millennium Development Goals, such as those on gender equality and maternal health.  Reproductive rights and access to reproductive health services were essential for development, and were currently far from being achieved.  The world must increase its efforts on HIV/AIDS prevention, which the Secretary-General said was “lagging”.  There was insufficient investment in prevention programmes; low coverage of prevention for groups that were most at risk, such as intravenous drug users and people engaging in risky sexual behaviour; and lack of action against the drivers of the epidemic.  Young people should be given comprehensive sex education and access to services and commodities, such as male and female condoms.

He expressed disappointment at the unwillingness of many countries to focus on the legal, social, economic and cultural issues that drove the epidemic.  That implied that international funding was not being used optimally, and that prevention interventions were not well targeted or evidence-based.  It was also important to increase access to treatment services; coverage for children in need of treatment was particularly vital.  Only 8 per cent of children in low- and middle-income countries received antiretroviral therapy.  Furthermore, antiretroviral treatment could only be effective if administered by health professionals working in functional national health systems.  Insurance schemes were important tools to make health systems more sustainable, to guarantee predictability and sustainability of funding, and to mitigate the risk of poor households.  Some €100 million had been invested in a health insurance fund in the Netherlands to increase coverage of health insurance in developing countries.

SAMUEL O. OUTLULE ( Botswana) said that the fight against the epidemic should remain a top priority on the global agenda.  Last year’s high-level meeting had recognized notable successes in expanding treatment, the positive impact on prevention efforts and the increase in the availability of financial resources to assist countries in their national AIDS response.  Despite the progress made, “we must also acknowledge the hard reality that we are not yet out of the woods,” he said, calling for continued vigilance in the face of “an enemy that is unrelenting and takes no prisoners”.  Sub-Saharan Africa clearly continued to be the epicentre of the epidemic, with about 72 per cent of all adult and child deaths in 2002 due to AIDS.  That was a human tragedy of unimaginable proportions, which called for greater assistance, as well as consistent and assured support in all efforts to combat the epidemic.

Botswana’s national response was in line with global efforts to combat the epidemic, he said.  The country was strongly committed to the “three ones” principles -- one national action framework; one coordinating authority; and one monitoring and evaluating system.  His delegation also wanted to commend UNAIDS for its excellent country support work.  Botswana was committed to working with UNAIDS in its national efforts and in sharing best practices and lessons learnt.  His country was maintaining its political commitment to increase services for prevention, treatment, care and support.  This year, Botswana had allocated some $194.9 million towards its HIV/AIDS programme.

Prevention was a top priority, he said.  In addition to providing access to testing facilities, the country was making concerted efforts to encourage people to get tested and know their status, remain negative if tested negative, live positively with the virus if tested positive and get help on time.  Routine testing for all patients visiting health facilities had been introduced in 2004.  As a result of the country’s programme to prevent mother-to-child transmission, some 92 per cent of women confirmed HIV positive now received treatment at the time of delivery.  Mother-to-child transmission had been reduced from about 40 per cent in 2002 to about 6 per cent in 2006.  There were now over 70,000 patients on antiretroviral treatment, with over 60 per cent of those in need receiving it by the end of 2006.  However, the epidemic remained a serious threat.  Apart from human resource constraints, the cost of drugs continued to challenge meagre budgets of many developing countries.

A fundamental part of an effective solution was ensuring reliable and sustained financing in the long term, he added.  During last year’s high-level meeting on HIV/AIDS, there had been recognition that $20 billion to $23 billion was needed annually by 2010 for low- and middle-income countries to scale up towards universal access to antiretroviral treatment.  Estimates now suggested that the international community would only be able to raise $10 billion in 2007.  There could be no doubt that a shortfall of $13 billion would have a negative impact.  It was imperative for the international community to do everything possible to ensure predictable and long-term funding for HIV/AIDS.  The epidemic remained both a global emergency and human tragedy.  The international community must make greater efforts to combine its scientific, technological and industrial capacities, as well as financial resources, in the search for an AIDS vaccine and cure.

HILARIO G. DAVIDE ( Philippines) said HIV/AIDS was not just a medical or health problem but a development problem.  Achieving universal access, though critical for combating the disease, must be complemented by good quality coverage such that the responses were sustainable and “not just quick emergency palliatives”.  In the Philippines, efforts were decentralized and channelled through local Government units and non-governmental organizations so that as many people as possible could be reached.  Local AIDS councils existed to ensure that the HIV/AIDS responses would fit the particular needs of localities, as guided by national and regional Governmental bodies.  The “Joint Programme on Migration and HIV/AIDS”, an initiative of the Philippines Department of Health and the Department of Labour and Employment, in partnership with the United Nations country team, sought to increase access to HIV interventions for overseas Filipino workers.  Work was currently taking place to address the situation of injecting drug users, involving a review of legislation and policies.

He said that efforts to scale-up HIV/AIDS prevention would soon take place through an enhanced system of voluntary counselling and testing, and improved blood safety strategies.  Implementation of the “100 per cent Condom Utilization Programme” might be widened.  Partnerships with civil society groups, including church groups and faith-based organizations, had been strengthened, with noteworthy contributions by the Roman Catholic Church.  In addition, the National AIDS Council was working with UNAIDS to promote meaningful engagement of Filipino people with HIV/AIDS.  A national monitoring and evaluation system was being implemented in nine sites, and a report would be provided in 2008.  Although current global and financial mechanisms were much appreciated, the predictability and sustainability of funding must continue to be enhanced.  Legal and trade barriers must also be overcome, in line with the World Trade Organization’s Trade-Related Aspects of Intellectual Property Rights (TRIPs) agreement, since tactics that undercut agreements compromised the objective of universal access, particularly to antiretroviral drugs.

ULLA STRÖM ( Sweden) highlighted the need for a clear focus on evidence-based prevention activities, the special needs of women and young girls and the connection between HIV/AIDS and sexual and reproductive health and rights.  It was necessary to expand treatment services, particularly in poor countries.  A special focus should be put on the need to address the drivers of the pandemic and to identify vulnerable populations in need of support.  Funds available for HIV/AIDS were growing steadily each year, as was the number of new actors.  While that was encouraging, the positive trend would of course require better coherence, increased collaboration and coordination. 

She said that, in many ways, the international response to HIV/AIDS had shown that there was a widespread willingness to reform the system to work better together towards the same shared goals.  The United Nations system would continue to play a critical role.  Broad United Nations support for the “Three Ones” principles and the implementation of the recommendations from the Global Task Team Process constituted inspiring examples of the will to move forward.

“This is not only about the United Nations,” she added.  The need for better coherence, collaboration and coordination was true for all actors.  It was necessary to find ways to ensure that the United Nations, international financial institutions, major global initiatives and mechanisms and bilateral donors harmonized in the best possible ways.  Most important was the absolute need to support national ownership and leadership in order to align efforts with national priorities, plans and budgets.  Only then would the response be sustainable.  For more than 1.25 million people, the Global Fund to Fight AIDS, Tuberculosis and Malaria had meant a new life, and more than 3,000 additional people survived each day thanks to programmes financed by the Fund.  Support to the Global Fund needed to be matched, however, by similar support for UNAIDS, WHO and others.  Partners at all levels must transform words into deeds and deliver on their promises and commitments. 

ROBERT HILL ( Australia) commended the significant increase in funding to tackle the HIV/AIDS epidemic since the 2001 Declaration, but added that the disease was still spreading.  Gender inequality was known to be a key cause of HIV vulnerability, with women and girls disproportionately impacted.  The vulnerability of women to HIV was aggravated by lower literacy levels and violence, including sexual assault.  The statistics were alarming.  In communities in Africa and Southeast Asia that were heavily affected by HIV, one third to one half of new infections acquired by women were from husbands within marriage.  A vicious circle was perpetuated by another fact -- that men who were violent to women were likely to have more sexual partners.  As a result, HIV rates were higher among women who experienced violence at the hands of their partners.

He said effective responses to HIV must focus on addressing the social determinants of vulnerability and gender-specific barriers to accessing and maintaining treatment.  Strategies to address gender inequality must be integrated into all HIV/AIDS activities and must be mainstreamed into all development activities.  Further, creative, innovative and effective ways must be found to ramp up the response and “make the money work”.  Partnerships must be broadened and deepened, while business did more to use its wherewithal and expertise in shaping attitudes to influence employees, partners and customers.  Together, business and Government could create a formidable opposition to HIV.  In the Asia-Pacific region, for example, Australia was supporting a nascent and vibrant group of business coalitions, who would meet with regional ministers in July to harness and strengthen business engagement with HIV.

ALEC MALLY ( United States) said his country remained focused on action and results in the fourth year of President Bush’s Emergency Plan for AIDS Relief (PEPFAR/Emergency Plan).  The Plan was supporting individuals, communities and nations to take control of the epidemic and, thus, take control of their lives.  Together, they were beginning to turn the tide against the HIV/AIDS pandemic.  The Plan reflected the heart of a new approach to development embodied in the 2002 Monterrey Consensus, which called for country ownership, good governance, performance-based partnerships and engagement of all sectors.  The United States supported life-saving antiretroviral treatment for some 822,000 people in 15 focus countries and cared for 4.5 million people, including two million orphans and vulnerable children.  It was necessary to be aware of what was driving the epidemic in communities, countries and regions, and plan prevention strategies accordingly. 

Along with “knowing the epidemic”, two priority areas could have a huge impact in the scale-up towards universal access to comprehensive prevention programmes, treatment, care and support, he said.  It was first necessary to recognise that the crisis in human resources for health was limiting the ability of many of the hardest-hit countries, especially in sub-Saharan Africa, to scale up HIV/AIDS prevention, care and treatment services.  Human resource also needed to be built into national strategies and plans for scale-up.  For people to know their status and get treatment, it was necessary to work together to promote HIV counselling and testing, including provider-initiated “opt-out” testing.  Such programmes must include a focus on stigma reduction and reach populations at highest risk.  One way to promote broader coverage of counselling and testing services and stigma reduction was voluntary HIV counselling and testing days.  “What the developing world needs now is for us to fulfil the commitments we have made,” he said.  

CARSTEN STAUR ( Denmark) recalled that last year’s meeting had ended with the adoption of the Political Declaration setting out the key priorities for the fight against AIDS.  But 25 years into the epidemic, the world continued to face new challenges.  As the epidemic varied greatly across regions and population groups, successful responses must be based on evidence-based analysis of the epidemiology of HIV infection, as well as the behaviours and social conditions that drove the epidemic.  He said the report’s catch phrase “knowing your epidemic” could not be stressed enough, and that “we must be honest, objective and transparent” in structuring the best response.  The effort of UNAIDS in helping improve data collection and analysis was commendable. 

He said that spending wisely was a key element in building long-term capacities, which required coordination among the growing number of partners in the fight against the disease.  Denmark’s efforts to support the global campaign against HIV/AIDS were closely linked with national plans and programmes.  In 2006, a doubling of financial support to HIV/AIDS programmes had been announced, bringing the level of funding to approximately $182 million each year until 2010.  The country had worked for many years on strengthening health systems at the central and district levels, and took pride in being a reliable ally to developing countries in that area.  A contribution of DKK20 million had been allocated to the WHO, to bolster its efforts to help strengthen health systems in developing countries.

He noted that four million people were newly infected each year, and found it troubling that there was a continued unwillingness to give young people information and access to services, including condoms.  Furthermore, only 11 per cent of pregnant women had access to services, perhaps tied to weak links between the HIV/AIDS and sexual and reproductive health efforts, and the failure to address gender aspects in the HIV/AIDS response.  The feminization of AIDS was due to social restrictions, lack of financial security, lack of decision-making power in the household and other factors, and must be addressed with “strength and determination”. 

ISABELLE F. PICCO ( Monaco) said today’s meeting would allow the international community to assess progress since the new objective of universal access had been set last year.  Statistics provided politicians, scientists and civil society with the means to make aid more effective, matching it to national needs.  Increased resources were required to help countries meet national needs.  As recommended in the Secretary-General’s report, the fight against the epidemic involved setting national goals, and assessing the needs and the resources required, as well as undertaking efforts to achieve universal access to treatment and intensifying prevention efforts.

Prevention, which remained the best means of combating AIDS, was a priority for Monaco, she said.  The country’s information campaign included conferences and debates led by doctors for young people in schools.  The efforts to raise awareness among the population included articles in the press, television announcements and the establishment of a free hotline.  Non-governmental organizations played an important role in that daily struggle.  Among other things, a screening centre had been set up in the country for anonymous and free testing.  Also proposed were measures to provide social and psychological support to those affected.

Monaco’s exemplary approach at the national level was complemented by its international efforts, she continued.  The country had contributed to UNAIDS since the Programme’s inception and had recently signed a framework agreement, whose main objective was to provide direct assistance to the countries affected by the pandemic towards the implementation of their national plans to fight HIV/AIDS.  Among other things, Monaco was also participating in a United Nations Children’s Fund (UNICEF) project to fight transmission of the virus from mother to child.

MAGED ABDEL AZIZ ( Egypt) said that HIV/AIDS represented one of the major challenges to the achievement of the Millennium Goals by 2015.  If the world did not deal with it effectively, HIV/AIDS could become the third leading cause of death by 2030.  The realization of the goal of universal access by 2010 required addressing more effectively the lack of national capacity to ensure HIV prevention, treatment and care in many developing countries, especially low-income ones.  It was also necessary to support the efforts of those countries to launch vast awareness campaigns and correct social misconceptions in the public domain.  Such efforts required large investments in capacity-building for Governments and societies, including training of qualified personnel, and making antiretrovirals available at reasonable prices.  It was also essential to support regional capacities, especially in light of the 2005 decision of the African Union –- based on an Egyptian initiative –- to establish an African Centre to promote cooperation in the fight against AIDS and coordinate the work of specialized centres all over the continent.

The international community had a responsibility not only to provide the necessary financial resources to fill the expected gap of $8 billion this year, but also to arrive at solutions concerning the trade-related aspects of the intellectual property rights associated with existing HIV drugs.  He also emphasized the need to strengthen the infrastructures of developing countries and transfer the know-how and technologies, as well as change the social perspective vis-à-vis the disease and enhance efforts in the area of early diagnosis and treatment.  Also, the United Nations needed to do more to resolve armed conflicts, which contributed to the drainage of resources in countries where the epidemic was spreading.  Conflicts also contributed to the enlargement of the marginalized sectors of society, because of the fear of infection, the growth in the number of orphaned children and the burgeoning of sexual violations that led to the spread of the infection.

LOUIS-CHARLES VIOSSAT, Ambassador in charge of the fight against HIV/AIDS of France, said remarkable progress had been made in the past ten years in the fight against AIDS, especially with the Global Fund’s establishment.  He was alarmed, however, that the new cases of infection had stabilized at about four million a year.  Also alarming was the sharp rise in the number of people dying of AIDS, from 2.2 million in 2001 to 2.9 million in 2006.  “We are truly in a race against time,” he said.  The fight against HIV/AIDS continued to be a health emergency.  The challenge posed by universal access to prevention, care and treatment was, in the final analysis, one of generalized access to health services.  The right to health, which was gradually being recognized, still had too little effect in many countries.  It was, therefore, necessary to concentrate aid so as to reduce the gap between right and reality.  The preparation of national action plans had made it possible to identify the barriers to universal access without actually defining solutions to overcome them. 

“We must now help countries solve these questions if they want us to,” he said.  Discrimination and stigma were slowing access to prevention, care and treatment.  The fight against HIV/AIDS would be won if the tools for prevention were proportionate to the speed at which the epidemic spread, and the treatments proportionate to the needs.  The challenge ahead lay in devising new strategies for prevention.  Education programmes on health and prevention needed to be redesigned and tailored to communities where those programmes were implemented.  All effective means of prevention, especially for women, had to be available and adapted to the socio-cultural situations of groups in society.  Mobilization and political commitment was the principle engine in the fight against AIDS.  While progress had been made in the past few years, there was still a long road ahead if the international community was to achieve the objective of universal access by 2010. 

ILEANA NUNEZ MORDOCHE ( Cuba) said the commitment to achieving universal access to AIDS-related prevention, treatment, care and support by 2010 was an important landmark in the pursuit of Millennium Development Goal 6 -- on reducing the spread of HIV/AIDS -- as well as the pursuit of more general objectives related to poverty, education, infant mortality and maternal health.  Despite the progress made by some countries to fight the disease, the landscape had barely changed since 2001, with the number of persons living with HIV/AIDS rising from 32 million to 40 million at the end of 2006.  The poor were the most vulnerable, with two thirds of the infected population living in sub-Saharan Africa and three fourths of all deaths occurring in that region.

She said that to break the cycle of infection, it was necessary to address issues such as lack of health care and education and the denial of the right to reproductive health and gender equality.  National action against HIV/AIDS should take place in tandem with regional and international actions against the pandemic.  Fulfilling the objective of allocating 0.7 per cent of gross domestic product to official development assistance (ODA) was paramount in overcoming the lack of human resources in healthcare and to mitigate the impact of poverty in developing countries.  The Trade-Related Aspects of Intellectual Property Rights (TRIPs) agreement should be implemented so that it upheld everyone’s right to produce generic antiretroviral drugs and other essential pharmaceuticals to fight HIV/AIDS-related infections.  That issue should be reviewed more comprehensively next year.

For its part, Cuba had one of the lowest prevalence of HIV/AIDS in the world among 15 to 49 year olds, she said.  In 2001, antiretroviral treatment was implemented alongside a policy of free universal access.  After 2003, the number of AIDS patients had dropped, despite the United States blockade that hindered access to almost half of the world’s new medicines.  The national prevention programme included four components: epidemiological monitoring, healthcare, education and research.  There was active participation by key members of society, and priority had been given to work with the youth, among whom the incidence of HIV/AIDS had fallen from between 2001 and 2005.  In addition, the quality of life of HIV patients had risen, shown by the decrease in mortality and longer life span after infection, and reduced hospitalizations and prevalence of opportunistic diseases.  Cuba actively shared its expertise with others -- almost 30,000 Cuban health professional served in more than 60 countries, and more than 1,200 doctors from many countries of the South graduated from schools in Cuba in 2006.

ANNA MARZEC-BOGUSLAWSKA, Director of the National AIDS Centre of Poland, said a new comprehensive Polish national strategy on HIV/AIDS was being implemented this year and would remain the fundamental policy paper on the matter until 2011.  While there was a low prevalence of the epidemic in the country with nearly 10,800 people diagnosed since 1985, the number of 700 infections detected yearly was still significant.  Currently, 3,200 patients received comprehensive, free of charge antiretroviral treatment, which included treatment for infections such as tuberculosis.

She said universal access to treatment was a priority for her Government and its partners, with treatment offered to all who needed it without discrimination on any grounds.  The high price of medications was a challenge for which current initiatives to reduce the cost of antiretroviral drugs was welcome.  Her country had also worked out a system of purchasing drugs centrally for a substantial reduction of the cost.  Measures toward prevention included free, confidential testing at centres that also provided counselling and which were now being opened in smaller towns.  A national multimedia campaign was conducted each year and targeted messages to vulnerable populations were delivered continuously.

She said her country was continually improving its response to gender inequality and the feminization of the epidemic.  A programme had been initiated last year to offer free HIV testing to all pregnant women.  A report on women’s sexual and reproductive health had also been conducted by the Health Ministry in concert with partners such as the United Nations Population Fund (UNFPA).  Some excellent local and community-based prevention programmes had already been implemented, she added.

ALISTAIR FERNIE ( United Kingdom) said that, while progress had been made in the past year, the international community needed to redouble its efforts to achieve universal access to comprehensive HIV prevention programmes, treatment, care and support by 2010.  While supporting the report’s recommendations, he was concerned that it did not track progress on the political commitments to support the active participation of people living with HIV, vulnerable groups, most affected communities, civil society and the private sector in moving forward the universal access agenda.  While the report recognized the crucial role of civil society and people living with HIV/AIDS in scaling up treatment, it did not sufficiently emphasize the need for the involvement of people living with HIV/AIDS in all responses to the epidemic, which remained a crucial element in the fight against AIDS.

He said he was concerned that some national AIDS plans remained uncosted, and that many did not address the obstacles identified in their national consultations.  He also acknowledged the difficulties of some countries in trying to balance realism with ambition in establishing their targets.  Target setting was important in motivating action and mobilizing resources.  In that regard, he urged countries that had not done so to develop costed and prioritised national plans, incorporate targets and address any obstacles to scale-up.

The United Kingdom strongly supported the importance given to “knowing your epidemic”, he added.  Data on the epidemic in individual country contexts was crucial for formulating and implementing evidence-based AIDS policies.  The United Kingdom recognized the need for stronger linkages between HIV/AIDS and sexual and reproductive health service provision.  Given that over 90 per cent of the HIV infections were a result of heterosexual or mother-to-child transmission, that linkage was an important strategy for improving access to health care. 

Concluding, he said bilateral and multilateral partners needed to work together in a more harmonized way to support the Global Task Team’s recommendations to achieve a more effective response to the pandemic at the global and country levels.  Progress to date was slow, and there were few incentives and many practical barriers to joint efforts by the United Nations and international partners, at country level.  The international system needed to work together to overcome the barriers, reduce inefficiencies and deliver results on the ground.

DAVID COONEY ( Ireland) said AIDS was undoubtedly a development issue.  Fighting HIV/AIDS was a core priority of Ireland’s overall development strategy, and its White Paper on Irish Aid committed the Government to reach the spending target of 0.7 per cent of gross national product on ODA by 2010.  Currently, the country spent €100 million per year on HIV/AIDS and other diseases, and had increased its annual funding to the Global Fund to Fight AIDS, Tuberculosis and Malaria to €20 million, and to UNAIDS to €6 million.  In early 2007, a five-year agreement had been signed with UNAIDS to provide longer-term predictable financing, and a similar commitment of three years was being considered for the Global Fund.  To address HIV treatment in Mozambique and Lesotho, a €70 million agreement had been signed with the Clinton Foundation.

He said resources available for HIV/AIDS must be targeted at interventions that addressed both the underlying causes of HIV infection and specific measures to save lives, increase productivity and reduce suffering.  That meant bringing the global AIDS community together with the international development community in support of joint programming; strengthening local leadership; and supporting national development plans that reflected a cross-sectoral analysis of HIV/AIDS.  Only a small number of communities were accessing such services and support, despite growing evidence of the increased number of women, men and children being pushed deeper into chronic poverty due to HIV/AIDS, leaving much to be done.

He said the fight against AIDS “was a test case of United Nations reform in action”, and UNAIDS, and its Global Task Team, had demonstrated leadership in that area.  Less duplication and stronger coordination was also being seen at the country level, such as in Ghana, where UNICEF and UNFPA were supporting the Government to address HIV prevention among youth; and in Zimbabwe, where the United Nations country team was collaborating on a comprehensive treatment and care programme.  At the same time, the United Nations could work faster to institutionalize the changes necessary to do better.  Capacity-building successes in Mozambique, Ethiopia and Malawi must be replicated elsewhere, and a code of best practices agreed upon.  Efforts at donor harmonization must be put in practice, so that developing countries were not faced with “a proliferation of donor-driven committees, competing agencies and endless demands for reports and assessments”.

YURIY SERGEYEV ( Ukraine) said that his country was among the hardest hit by HIV/AIDS in Eastern Europe.  HIV transmission had grown by 16.8 per cent between 2005 and 2006, and death by AIDS was more than 10 per cent higher in 2006 than in the prior two years.  Some 44 people were infected by, and 6 died from, the disease each day.  Central and local executive powers were mandated to introduce and implement activities directed at reducing the spread of HIV/AIDS in the Ukraine, with priorities in awareness-raising among children and youth; increasing access to retroviral treatment; and reducing the risk of infection among vulnerable groups.  Efforts were also being made to ensure donor blood safety, and to provide health care and social services to people living with HIV/AIDS.

He said civil society and the private sector must work with the Government to combat discrimination faced by HIV-positive people.  The Millennium Development Goals could not be achieved without clear national strategies on achieving universal access to HIV/AIDS prevention, treatment and support programmes.  For its part, Ukraine appreciated the assistance given to it by the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank and United Nations agencies such as UNAIDS, WHO and UNICEF. 

NIRUPAM SEN ( India) said enormous progress had been made in recent years in dealing with the HIV pandemic.  The Global Fund had pledged over $10 billion in assistance to over 130 countries to fight HIV/AIDS, malaria and tuberculosis.  The affected countries had in turn laid strong foundations for effectively responding to the epidemic.  Yet, what had been achieved so far fell short of what needed to be done.  While two million people in low- and middle-income countries were receiving antiretroviral therapy, some 2.9 million people had died from AIDS in 2006.  The Secretary-General rightly highlighted the need for enhanced resources, particularly international funding for public health and development, as many countries could not achieve universal access goals without external resources.

India remained a low prevalence country with overall HIV prevalence of some 0.9 per cent, he said.  Given its large population, however, that low percentage converted into a large number of HIV-infected people.  A young, mobile population coupled with rapid economic and social transformation added to the complexity of the HIV/AIDS epidemic.  The last few years had seen the epidemic moving from high-risk groups to the general population with women, youth and the rural population being highly vulnerable.  India was making significant progress in addressing the challenges posed by the HIV epidemic.  Integrated with the National Rural Health Mission -- India’s flagship programme for addressing inequities in accessing health services in rural areas -- the HIV/AIDS strategy sought to balance prevention with the continuum of care and treatment. 

He noted that research and development efforts on HIV/AIDS remained strong.  In view of their enormous potential, vaccine development initiatives continued and the fruits of those efforts should be available in a few years.  India was a source of inexpensive and effective drugs for several countries in the developing world.  Indian pharmaceutical companies had been able to obtain United States Food and Drug Administration approval for over 14 drugs, which would further enhance the availability of affordable drugs. 

MUHAMMAD ALI SORCAR ( Bangladesh) said prevention of HIV infection should be the mainstay of the national, regional and international response to the epidemic, with awareness raising and the availability of the means for prevention forming the bedrock.  Integrating prevention, treatment and support, while taking into account social values and local circumstances, was also important.  If the expansion of care and treatment continued at the current pace, the number of people receiving antiretroviral drugs in 2010 would reach only about 4.5 million, which was less than half of those in urgent need of treatment.  Far greater investment was needed in the infrastructure of health systems, including human, administrative, procurement and financial resources.  Innovative sources of financing, such as the airline levy and the international drug purchasing facility, were welcome.

He said achieving universal access also required the participation of a wide range of stakeholders, including the private sector, civil society and non-governmental organizations.  Easy access to medicines was critical; every citizen of the world had the right to access essential medicines and treatment at an affordable price.  Technology transfer and capacity-building in the pharmaceutical sector formed the cornerstone of affordable treatment, and agreements in the World Trade Organization and elsewhere should not compromise the possibility of affordable medicines for the poor.

He said Bangladesh was a low-prevalence country, with HIV rates found to be below 1 per cent in all groups except injecting drug users.  There were 874 reported cases of HIV, with 240 cases of AIDS.  Some 109 people had died.  A well-defined strategy paper had been drawn up in 1997 to combat the disease, and a law on safe blood transfusion was enacted in 2001, leading to the establishment of 98 blood transfusion centres.  A new strategic plan for 2004 to 2010 was being implemented at present.  Meanwhile, a South Asian Association for Regional Cooperation (SAARC) expert group meeting took place in Bangladesh in April 2006 to develop a regional work plan.  Indeed, Bangladesh was vulnerable to HIV/AIDS due to the prevalence of HIV in neighbouring countries, increased migration and lack of awareness among the general population about HIV infection. 

In addition, Bangladesh was firmly committed to incorporating HIV/AIDS prevention awareness among peacekeeping forces, in line with Security Council resolution 1308 (2000).  Out of 57,000 deployments, only three seropositive cases had been detected, testifying to the effectiveness of the country’s programme on reducing HIV transmission among its peacekeeping personnel.

ADIYATWIDI ADIWOSO ASMADY ( Indonesia) said that since 1999, injecting drug use and risky sexual behaviour had been the major causes for the growth of HIV/AIDS in Indonesia.  In Papua, an increasing number of HIV/AIDS cases were attributable to men engaging in commercial sex work and premarital sex without condom use.  There were an estimated 193,000 HIV-infected people in 2006, and there were over 8,000 people with fully developed AIDS.  The highest prevalence of AIDS was found among 20 to 29 year olds.

She said national leadership came from the ministerial level, under the guidance of the National AIDS Commission.  Management at the provincial level was in the hands of local AIDS commissions, which were multisectoral bodies comprised of Governmental and non-governmental representatives.  They worked within the framework of the national AIDS strategy, which emphasized family welfare and religion in combating the spread of HIV.  The strategy provided strong support for a practical public health approach to the HIV challenge, including condom promotion and harm reduction strategies for injecting drug users.  The Government had enhanced the capacity of the National AIDS Commission to provide sterile needles and condoms to high risk groups, among other things.

She said the health sector budget had increased annually and currently amounted to $13 million.  Regional Governments received $1.6 million in 2006, a 100 per cent increase from the 2004 budget.  The President had meanwhile expressed interest in tackling the HIV/AIDS epidemic by making a 250 per cent increase to the health sector budget in 2007.  In light of the continued growth of the global AIDS epidemic, the international community was called on to renew its commitments made in 2001 and 2006.  It was particularly important that low- and middle-income countries received the financial backing that they needed to achieve their national targets.

U MAUNG WAI ( Myanmar) said that many countries, including low- and middle-income ones, had laid down important groundwork in the past year for a long-term effort to move towards universal access.  The Secretary-General’s report not only provided an overview of progress achieved, but also included useful recommendations for moving towards universal access.  Myanmar was committed to fighting HIV/AIDS by using all of its available resources.  Myanmar’s National Strategic Plan for 2006-2010 included six broad strategic areas:  advocacy to authorities and decision-makers; prevention education; targeted interventions; care and treatment; programme management and support; and capacity-building. 

He said that since 2005, antiretroviral therapy for the public sector had been provided in 13 hospitals in various townships.  Myanmar was also collaborating with regional countries, including through the Association of South-East Asian Nations (ASEAN) Taskforce on AIDS.  Due to extraneous factors, the Global Fund had unilaterally terminated its programme in Myanmar in August 2005, a move Myanmar deeply regretted.  To bridge the gap, however, a group of six donors had agreed to set up the Three Disease Fund to support the National Strategic Plan.  Myanmar would continue to cooperate with regional and international partners to further strengthen efforts to address the pandemic.

AKEC KHOC ( Sudan) said a number of factors facilitated both the continued spread of HIV/AIDS in Sudan and increased vulnerability to the disease, regardless of vigorous programmes to control it.  Those included climate change and its effects of economic disruption, low food security and social unrest.  Poverty, wide borders and open frontiers were also contributing factors to the spread of the disease, while economic sanctions against the country delayed development and forced a reduction in both curative and preventive measures in combating HIV/AIDS.  However, the Government had concluded a number of agreements aimed at creating an atmosphere conductive to stability, peace, socio-economic progress and equal opportunity for all.  The Comprehensive Peace Agreement (CPA), the Darfur Peace Agreement (DPA) and the Eastern Sudan Peace Agreement (ESPA) were among them.  Success in implementing those agreements could lead to economic revival, sustainable development and an energetic programme to combat HIV/AIDS.

However, the importance Sudan attached to fighting the disease was already evident by its scaled-up national framework, which was headed by both the President of the Republic and the First Vice-President and President of the government of South Sudan, and implemented by a multisectoral national response team that itself was headed by the Minister of Health.  The strategy centred on public awareness, enactment and enforcement of protective laws, and outreach to the most vulnerable.  The priorities were to improve the living conditions of infected persons and to build capacities for fighting the epidemic, including by mobilizing resources.  Special emphasis was laid on encouraging traditional beliefs and practices that reinforced positive behavior.

JIRO KODERA ( Japan) noted that the Secretary-General’s report stressed the importance of a comprehensive and multisectoral approach to HIV/AIDS.  Japan was following that approach ever since it adopted the Global Issue Initiative on Population and AIDS in 1994.  His Government had helped improve national responses to HIV in developing countries, and was pleased that the report recognized signs of improvement in several Asian and African countries with which Japan had cooperated.  However, the report also pointed out that many national plans failed to take into account the costs of non-health sector interventions, such as programmes focusing on youth, both in and out of school, and community mobilization.  Non-health sector interventions had long been a part of Japan’s support for responses to HIV/AIDS.

He said Japan’s 2005 “Health and Development Initiative” put forward the concept of economic cooperation to achieve three health-related Millennium Goals.  In particular, his country would help developing countries to lower the risk of infection by supporting the development of human resources for prevention awareness activities and providing condoms; fight the spread of sexually transmitted diseases, particularly among vulnerable members of society; promote voluntary counseling and testing; expand antiretroviral therapy programmes and support the treatment of opportunistic infections and measures against mother-to-child transmission, as well as encourage social participation among people living with the disease.  Japan would also help those countries to provide care for AIDS orphans and support the creation of safe blood supply.

DON PRAMUDWINAI ( Thailand) said that an estimated 580,000 people in Thailand were infected with HIV at the end of 2005, and the Government had adopted a national plan for HIV prevention and resolution of HIV/AIDS-related problems for the period from 2007 to 2011.  The current public health budget was more than 11 per cent of the overall public budget, second only to education.  With over 4.4 billion Baht allocated to fighting HIV/AIDS, Thailand was one of the few developing countries to mobilize over 50 per cent of resources from domestic spending.  Thailand’s experience had shown that reversing the HIV infection rate was possible, and also highlighted the importance of adapting to the changing nature of the epidemic.  For instance, a large percentage of new HIV infection occurred in groups previously considered low risk, such as married women and men who had sex with men.

He said the National AIDS Committee had established a subcommittee to monitor prevention efforts in the country, and was being led by a figure that had been internationally recognized for reversing the infection rate through promoting condom use among sex workers.  It was expected that new infections for 2008 would be reduced to between 6,000 and 7,500 cases in 2011, and target groups would be “discordant couples”, men who have sex with men, intravenous drug users and youth.  The budget earmarked for access to antiretroviral drugs for 2007 was more than $100 million, representing a ten-fold increase in six years.  Since 2006, universal access to antiretroviral therapies had been guaranteed for all Thai citizens in need.  Voluntary counselling and testing, and care, were integrated into the universal health care schemes, in collaboration with non-governmental organizations and networks of people living with HIV/AIDS.  Thailand was the only country in Asia to succeed in achieving more than 50 per cent treatment coverage of those in need.

He said second-line antiretroviral drugs remained beyond the reach of the majority of those in need, due to their high cost.  Since 2004, negotiations had taken place with patent holders of those second-line drugs in Thailand, to ensure greater affordability and accessibility.  A working group had been set up for that purpose in 2005, but there had been little cooperation from drug companies.  As a result, the Ministry of Public Health authorized compulsory licensing for public, non-commercial use of two Thai-patented antiretroviral products through TRIPS.  That decision had not been legally contested.  The decision did not come lightly, since the Government recognized the importance of intellectual property protection to maintain incentive for innovation.  But with the lives of 500,000 citizens at stake, the Government could not “stand idly by”.  Patent holders still had the right to produce, import and sell their products in Thailand as before, and those who could afford those drugs out of their own pocket and were not covered by the Government’s universal health care schemes must pay for them at market price.

JEAN-MARIE EHOUZOU ( Benin) said that, despite the fact that Benin’s rate of HIV infection had been largely stable since 2002, the country could not expect to be immune from an epidemic explosion.  That was particularly true if the national response to the disease was not scaled up.  Accordingly, Benin was seeking to promote an environment favourable to multisectoral partnership in the fight against HIV/AIDS, and one that was well-coordinated.  Regional cooperation on the prevention of HIV/AIDS on the Abidjan-Lagos migration axis was also viewed as important, and for that reason, Benin participated in “Project Corridor” to address the needs of drivers and mobile populations, with the involvement of Nigeria, Togo, Ghana and Cote d’Ivoire.

Unfortunately, contributions from 2005 were too little to support prevention services, and only two per cent of pregnant women had benefited from the programme to prevent mother-to-child transmission between 2005 and 2006.  Because of under-investment in prevention efforts, new cases of HIV infections continued to appear.  A multisectoral approach was needed to better determine how the disease was spread, and to identify risk factors.  There was also a need to improve the level of care and treatment services to meet new pressing demands, the lack of which had resulted in the death of 2.6 million AIDS sufferers in 2006.  Funds needed to be invested in public health systems.

He said it was necessary to address the long-term sustainability of funding devoted to the cause, which would enable affected nations to assume the costs of second-line antiretroviral drugs and to care for orphans, among other things.  Bilateral and multilateral donors were called on to increase their contributions to the Global Fund.  Partnerships between people living with HIV, at-risk groups, religious organizations, the private sector and international institutions must be reinforced.

ROSEMARY BANKS ( New Zealand) said her country fully supported global efforts to address HIV/AIDS, which was one of the greatest threats to the socio-economic development, stability and security of developing countries.  AIDS had caused over 20 million deaths and had left tens of millions of children orphaned.  Globally, half of the 40 million people living with HIV were women.  While young people aged 15 to 24 accounted for nearly half of new HIV infections, some two thirds of those were young women.  Without addressing gender issues, HIV/AIDS would never be halted or reversed.  The protection and promotion of women’s human rights, including the right to be free from violence and to control their own sexuality, was crucial to combating the epidemic.  Stigma and discrimination must also be addressed as root causes fostering the spread of the epidemic if programmes were to be truly effective. 

New Zealand regarded HIV/AIDS as a domestic, regional and international development priority, she said, adding that it supported national Governments in their efforts to address HIV/AIDS, especially in countries with pressing poverty and development issues.  She recognized the crucial role that civil society played in supporting people vulnerable to and affected by HIV/AIDS.  New Zealand was also deeply concerned about the HIV/AIDS threat in the Pacific.  Regional cooperation was an important element in addressing the problem.  Tackling the underlying causes of vulnerability to infection was critical in the response to HIV/AIDS in the Pacific.  Agreement had been reached on a package of support over the next three years to assist the Pacific countries’ fight against HIV/AIDS through implementation of the Pacific Regional HIV/AIDS Strategy. 

SERGEI RACHKOV ( Belarus) welcomed the results of the high-level meeting in 2006 to carryout a comprehensive review of progress in attaining the goals contained in the Declaration of Commitment.  Belarus supported the text of the Political Declaration, which not only summed up efforts to implement the outcome of the special Session but also outlined areas for adjusting efforts to halt the spread of HIV/AIDS by 2015.  The international community was far from reaching that goal.  Some 40 million people lived with HIV; 95 per cent of whom lived in developing countries.  Regional meetings provided the forums for discussion on finding the right response to the highly dangerous, modern pandemic.  He commended UNAIDS, WHO and UNFPA for organizing such meetings.

Although central and eastern Europe was, on the whole, fortunate when it came to prevalence rates, the spread of the epidemic in the region was a cause for concern, he said.  In that regard, his Government focused on the coordination of measures to combat the pandemic.  An interdepartmental council had been established to halt the spread of HIV/AIDS.  It had also implemented a state programme to prevent HIV, as well as a strategic plan of action.  As a result of such measures, the situation in the country in terms of HIV/AIDS prevalence had stabilized.  In Belarus, the main way of transmitting the infection was through injection drug use.  There had, however, been an increase in the number of people infected through sexual contact, which was a cause of great concern.  Notwithstanding the relatively low level of HIV infection, Belarus realized the importance of measures to prevent AIDS and was willing to cooperate within the United Nations system to counter the pandemic.

PETER MAURER ( Switzerland) stressed the importance of “knowing the epidemic” before settling on a strategy, identifying target groups and developing the necessary indicators to measure progress in the fight against HIV/AIDS.  Switzerland shared the Secretary-General’s concerns regarding the failure to prevent the spread of the epidemic, and believed that constant effort was needed on the part of Member States to achieve Millennium Development Goal 6, relating to the fight against AIDS, malaria and other such diseases.

He said it was easy enough to collect data on the number of HIV-infected individuals and how many among them were undergoing antiretroviral treatment.  But proper country indicators were needed regarding the disease, based on a clear understanding regarding its spread, and on how many members of society had access to preventive measures.  Such data should be disaggregated by sex, which, in turn, would help promote a gender-sensitive approach to the fight against AIDS, and help reduce the stigma encountered by infected individuals, sex workers, men who had sex with men and drug users.  It would also help towards combating the feminization of AIDS.

He said that, amid increased efforts towards United Nations reform at the country level, UNAIDS was a commendable model.  The organization played a major role in designating roles and responsibilities among various partners, strategically and institutionally.  The UNAIDS integrated budget and work plan was an important coordinating instrument among its various co-sponsors, which resulted in concerted action at the country level.  UNAIDS must be open to new partners, notably financial partners.  It might be useful to explore the possibility of producing a joint report among UNAIDS co-sponsors, so as to describe their activities and results.