Feature story

General Assembly review on HIV/AIDS

16 June 2009

As the HIV response represents one of the soundest of all possible global investments, it is critical that commitment to HIV efforts be maintained and strengthened in the midst of these economic challenges - Report of the Secretary-General to the 63rd General Assembly.

Dr Aaron Motsoaledi, Minister of Health of South Africa addressed the General Assembly on 16 June 2009
Credit: UN Photo/Jenny Rockett

At the 63rd session of the General Assembly held in New York on 16 June 2009, the United Nations Secretary-General Ban Ki-moon presented a report on the progress made in the implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS. The first address by UN member states was delivered by Dr Aaron Motsoaledi, the new Minister of Health of South Africa. Speaking on behalf of the Southern African Development Community (SADC), Motsoaledi noted recent progress made in South Africa and in the SADC region in confronting AIDS.

This year’s report provides an update on developments in the AIDS response, looks forward to the agreed 2010 milestones, recommends key actions to accelerate progress and urges renewed commitment to the goal of universal access to HIV prevention, treatment, care and support.

In June 2008, the General Assembly held a High-level Meeting on HIV/AIDS that assessed progress in the response to the global HIV epidemic. Reports from 147 countries showed that important progress had been made, including in the areas of access to antiretroviral therapy and the prevention of mother-to-child transmission.

However, the report shows that, despite such encouraging developments, considerable challenges remain, including significant access gaps for key HIV-related services. The pace of new infections continues to outstrip the expansion of treatment programmes, and commitment to HIV prevention remains inadequate. While funds available for HIV in low- and middle-income countries increased from $11.3 billion in 2007 to $13.7 billion in 2008, there has been a global economic downturn since the 2008 High-level Meeting.

As the HIV response represents one of the soundest of all possible global investments, it is critical that commitment to HIV efforts be maintained and strengthened in the midst of these economic challenges, report of the Secretary-General.

The Secretary-General’s report also highlights that despite the many commitments made by Member States to protect the rights of people living with HIV and people vulnerable to HIV infection, many countries have laws and policies that are inconsistent with the commitments and result in reduced access to essential HIV services and commodities.

In 2007, one third of countries reported that they still lacked laws to prohibit HIV-related discrimination, and many countries with anti-discrimination legislation have problems with adequate enforcement. A total of 84 countries reported that they have laws and regulations that present obstacles to effective HIV prevention, treatment, care and support for vulnerable subpopulations. Furthermore, some 60 countries have laws that restrict the entry, stay and residence of people living with HIV based on HIV-positive status only. Finally, an increasing number of countries have enacted overly broad laws that criminalize transmission or exposure to HIV, as well as non-disclosure of HIV status. Such measures are likely to lead people to avoid HIV testing, thereby undermining efforts to achieve universal access. Therefore, the report recommends that laws and law enforcement should be improved and programmes to support access to justice should be taken to scale to prevent discrimination against people living with HIV. HIV-related travel restrictions should be eliminated; the criminalization of HIV transmission should be limited to intentional transmission; and laws that burden or impede service access among sex workers, men who have sex with men and injecting drug users should be repealed.

Improved analytic methods have enabled countries to better characterize the magnitude and dynamics of their epidemics, to select appropriate interventions and tailor evidence-informed strategies to address their specific national context. The strategic tailoring of national responses magnifies the results of HIV programmes and reduces waste and inefficiency. Improved monitoring and evaluation systems also permit countries to revise national strategies as their epidemics evolve over time. In their efforts to closely align national strategies with actual national circumstances, countries should work to understand and address the social and structural determinants of HIV risk and vulnerability, such as gender inequalities, social marginalization and stigma and discrimination.

The HIV epidemic presents a long-term global challenge and requires a sustained commitment for an effective long-term response. As the coverage and quality of HIV programmes increase, the report calls to intensify efforts to strengthen the health, education, social welfare and other key sectors, and to integrate HIV with tuberculosis, sexual and reproductive health and other health services.

The long-term AIDS response will be sustainable only if substantially greater success is achieved in slowing the rate of new HIV infections, while providing optimal services for people living with HIV, the report underlines. Bringing to scale the appropriate mix of behavioural, biomedical and structural HIV-prevention strategies would more than halve the number of all new HIV infections between now and 2015. Access to such a combination of prevention strategies, however, remains sharply limited in most countries according to the Secretary-General’s report.

Finally, the report emphasizes that achieving national universal access targets by 2010 will require an estimated annual outlay of $25 billion within two years, necessitating renewed commitment from all providers of HIV-related funding. Sustaining an effective AIDS response will require unprecedented leadership at all levels, including from Governments, civil society and affected communities.