Statement by Ambassador Thomas Matussek, Permanent Representative of the Federal Republic of Germany, to the United Nations on behalf of the European Union, at the Plenary Meeting of the General Assembly on the follow-up to the outcome of the 26th special session: implementation of the Declaration of Commitment on HIV/AIDS, New York
I have the pleasure of speaking on behalf of the European Union.
1. The European Union would like to thank you, Mr. Secretary General, for your informative report and fully supports the recommendations you highlight therein.
Progress has been made since the adoption of the Declaration of Commitment on HIV/AIDS in 2001 and the Political Declaration on HIV/AIDS at the High Level Meeting last year. Therefore these declarations can be regarded as milestones in the fight against HIV/AIDS. We hope that these global objectives will serve us 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, care and support already by 2010. The EU also recognizes the importance of fulfilling the goals and objectives of the ICPD Cairo Agenda as well as the Beijing Declaration in the fight against HIV/AIDS.
But, to be able to reach these goals the political emphasis should now move to the implementation of our commitments.
2. We believe that the goal of universal access will have an impact on reaching the MDGs, in particular poverty reduction, education, gender equality, maternal health and combat of child mortality. The HIV/AIDS epidemic can not merely be seen as a health issue but must be looked at as a barrier undermining human security, human rights, gender equality and sustainable development as a whole. Despite the fact that international funding for the fight against the HIV/AIDS epidemic has increased and efforts to reach universal access to comprehensive prevention programmes, treatment, care and support have been intensified, challenges for developing countries are still enormous.
3. We welcome the fact that 57 states have set interim national targets by the end of 2006, in accordance with the Political Declaration. These national targets aim, for instance, at improved treatment, prevention, care for orphans and vulnerable children, condom distribution and prevention of mother-to-child transmission. The European Union recognises the challenge for countries to set ambitious, yet realistic national targets; and that the impact of setting overly ambitious, but realistic targets is minimal as they are unlikely to be achieved. Despite these challenges, we urge all countries that have not done so to set ambitious national targets to achieve universal access by 2010!
4. For targets to be successful they must be rooted in national priorities, plans and budgets. Tackling HIV/AIDS must become part of affected countries overall planning processes and strategy work. We note with concern that only about one third of the 90 countries that have set national targets have actually incorporated these targets into an updated, costed and prioritized national plan. We therefore appeal to the remaining countries to develop costed and prioritised national HIV/AIDS plans, which is a prerequisite for our commitment to ensure that costed, inclusive, sustainable, credible and evidence-based national HIV/AIDS plans are funded and implemented. Where national HIV/AIDS plans have been costed, it would be useful to collate and highlight information on the level of resource gaps. We also feel it is important to ensure that a process is developed to assess the credibility of national HIV/AIDS plans and to ensure that countries with credible plans are financed without delay. This should be harmonised with the independent review mechanism for GFATM funding as it is developed.
The EU recalls the conclusions of the 2001 Abuja Summit concerning the share of 15% of national budgets to be allocated to public health. While progress has been made to finance the fight against HIV/AIDS, much remains to be done. The EU recognizes in this regard the pivotal role of the GFATM to which it has provided more than 50% of the total contributions. We welcome the recent decisions made at the GFATM board to move towards trebling the fund ($6-8 billion by 2010), to allow national HIV/AIDS plans to form the basis of funding applications and to allow rolling contributions where performance has been good. The European Union remains committed to further strengthen the funds potential, including through its forthcoming replenishment focussing on the period 2008 to 2010. We strongly invite other donors to follow the EU on this way.
5. The European Union is also concerned to learn that many national HIV/AIDS plans that have been established do 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. The rising trend of feminization of the epidemic – women today account for almost 50%, in some African countries even for almost 60% of all people living with HIV/AIDS – is unacceptable as is the rising number of infections among young people, mostly girls and young women, who accounted for 40% of new infections in 2006. We can not and must not ignore legal, social, economic and cultural issues that drive the epidemic but have to deal with them proactively. And we urge those countries that have not done so, to ensure with support from the UN that all national HIV/AIDS plans address these drivers of the epidemic.
6. The European Union fully agrees that policymakers and programmers must identify the drivers and risk factors of the epidemic in order to successfully set national targets and develop national HIV/AIDS plans.
Information on who is most vulnerable to HIV/AIDS infection and on the linkages between certain risk behaviours, vulnerabilities and the economic, legal, political, cultural and psychosocial conditions is crucial for developing evidence-based HIV/AIDS policies and plans. As the report recognises, failure to address existing barriers and the drivers of the epidemic will result in failed prevention efforts.
7. The report also indicates that only 49 countries have satisfactory processes in place for regular participatory reviews of progress including monitoring and evaluation mechanisms. This means that the third component of the Three Ones Principle is far from being implemented. It is alarming to read in the report that international partners are not yet fully respecting their commitments under the 2003 Rome Declaration on Harmonization and the 2005 Paris Declaration on Aid Effectiveness and that engagement and involvement of civil society in discussion and resource allocation is often not guaranteed. These two critical declarations on aid effectiveness have been further translated into the HIV/AIDS reality by the Global Task Team on Improving AIDS Coordination among Multilateral Organisations and International Donors (GTT). The recommendations from this Task Team focused on both the need to empower national ownership and leadership and on the necessity for international partners to align, harmonize and cooperate better than before, building on comparative advantages and established division of labour. The recommendations have been endorsed by all relevant Boards and other decision making fora and therefore the EU strongly urges all partners in the fight against HIV/AIDS, within the international system and at national levels, both in affected countries and among donors, to fully adhere to commitments made during the GTT-process.
8. Gender Inequality and womens empowerment: The report states that many women become infected or are at risk of being infected even if they do not practice high-risk behaviours. Their vulnerability derives mainly from the behaviour of others, from their limited autonomy and other external factors including social and economic inequities beyond their control. Gender inequality and discrimination of women in general, and violence against women and girls in particular, are often perceived in an isolated manner. However, the current challenge posed by HIV/AIDS underlines that gender inequality, discrimination on the basis of gender and all forms of violence against women are some of the root causes that foster the spread of the epidemic, which need to be addressed. Women and girls often lack the social and economic power to control key aspects of their lives, including control over their own sexual and reproductive health. Women and girls who become victims of human trafficking, genital mutilation, forced prostitution, transactional or survival sex, sexual violence, exploitation and child marriage are at an especially high risk of becoming infected. Violence against women and girls is not only a human rights problem but directly affects the progress we make towards achieving the Millennium Development Goals. Yet, the response to date has been grossly inadequate and resources to tackle gender-based violence are limited.
The rising figures clearly demonstrate that gender equality should be the focus of renewed international and European efforts to combat HIV/AIDS. In striving to focus on the empowerment of women, it is also important to involve men and boys and to challenge norms around gender, sexuality and identity that fuel the epidemic. The European Union welcomes the adoption by the World Bank of a new health strategy in which sexual and reproductive health and rights as set out in the ICPD receive the focus they deserve. Under the German Presidency, the European Union has also recently adopted Council Conclusions focussing on
- ? the feminization of the HIV/AIDS epidemic and the linkage between HIV/AIDS and sexual and reproductive health and rights in that context,
? existing and new female-controlled prevention methods, such as the female condom and the development of safe microbicides
? the linkage between education and HIV/AIDS as well as
? increasing the availability of human resources for health.
9. Weak health systems/ lack of human resources for health: Equitable and pro- poor health systems that are accessible and provide affordable and high quality health care and services on a sustainable basis as well as adequately trained health workers are key in the fight against HIV/AIDS and other diseases. This applies particularly to sexual and reproductive health. Unfortunately, the crisis in human resources for health is a global one, with 75 countries having fewer that 2.5 health workers per 1000 population.
Therefore in its communication of December 2006, the European Commission presented a European Programme for Action to tackle the critical shortage of health workers in developing countries for the time period 2007-2013. This Programme for Action contains defined actions at country, regional and global levels to be taken forward by the EU and actions to be supported directly by the EU and the EU-member states. Moreover, the European Union under the German EU Presidency undertook the development and formal adoption of conclusions on the same topic.
10. Expansion of treatment services: We welcome the expansion of treatment services, an increasingly important aspect in the fight against HIV/AIDS. According to WHO, UNAIDS and UNICEF more than 2 million people are on ARV treatment in low- and middle-income countries by December 2006, a 54% increase compared to the previous year. More than half of those, 1.3 million, live in Sub-Saharan Africa. But currently only 28% of the estimated 7.1 million people in need are receiving antiretroviral therapy and coverage for children in need of such treatment is still especially low (only 8%). These facts must encourage us to increase our efforts on rolling out treatment and, in particular, on availability of paediatric treatment and diagnostics, affordability of second-line treatment, use of TRIPS flexibilities and strengthening health systems. In this regard, the European Union welcomes the development and exploration of innovative sources of financing including through such mechanisms as the International Drug Purchase Facility (UNITAID), the International Finance Facility (IFF), Advance Market Commitment (AMC) for Vaccines and others. And we welcome the recent action by UNITAID and the Clinton Foundation to secure price reductions on second line Antiretroviral treatment and to improve availability of paediatric diagnostics and medicines.
Tuberculosis is one of the most common causes of illness and death for people living with HIV/AIDS. An integrated approach to testing and treatment of HIV/AIDS and tuberculosis is required in order to tackle the high rates of co-infection and the emergence of extensively drug resistant TB.
11. Prevention: As has been highlighted repeatedly by the European Union in the last years – e.g. in the EU-Statement on the occasion of world AIDS day in 2005 -, comprehensive evidence-based prevention must be at the centre of our response to HIV/AIDS. Still, coverage of basic prevention services for populations at risk is still under 20%. We also cannot understand that there remains an unwillingness to give young people comprehensive information and education, services and commodities in a timely manner despite sound evidence about the effectiveness of certain interventions, such as condom distribution in schools. It is time that we accept the need to provide as many people as possible, not only adults, but also young people who account for 40% of all new infections with adequate information about this disease. In addition, it is crucial to both scale up access to existing prevention programmes and to increase investment in the development of additional prevention options, particularly those that improve choices of women such as HIV/AIDS vaccines, microbicides and female condoms. Also the number of pregnant women receiving services to prevent mother-to-child-transmission (PMTCT) is alarmingly low with 11%, and needs more attention Therefore we appeal to countries to include targets focusing on PMTCT in their national HIV/AIDS plans and take action to strengthening health systems to improve coverage of PMTCT.
12. Children orphaned or made vulnerable by HIV/AIDS generally need our focused attention. We welcome initiatives by several countries, with regard to minimum packages of service, including access to education, health care, social welfare and protection services in their poverty reduction strategy papers (PRSPs). We recognize there is a connection between HIV/AIDS prevention and the length of time that a young person attends school and that progress in achieving universal education, in particular at secondary level, is a salient factor in halting the spread of HIV/AIDS. School children present a Window of Hope into an AIDS-free future. Nearly all school age children are free of HIV/AIDS infection, even in countries with the highest HIV/AIDS prevalence rates. In Swaziland, for example, two-thirds of teenage girls in school are free from HIV/AIDS, while two-thirds of out-of-school girls are HIV/AIDS positive. If children were to remain free of infection as they grow up they could change the face of the epidemic within a generation. Therefore we also commend countries efforts to increase school attendance, inter alia through the abolition of school fees.
13. Addressing the drivers of the epidemic: Globally, injecting drug users, sex workers, prisoners, migrants and men who have sex with men are regularly denied access to information, services, treatment and care and are often subjected to discrimination and violence. These groups and their partners as well as buyers of commercial sex are among the populations most at risk of HIV-infection. A number of countries are now starting to gather information on those segments of their population which are most at risk of infection in order to enable targeted prevention programmes a key step in knowing ones epidemic and the drivers of it and preparing evidence-based policies and programmes.
14. Involvement of people living with HIV/AIDS: People living with HIV/AIDS and vulnerable groups are central to ensuring successful responses to the epidemic, as they can represent the interests of affected groups. We support the meaningful involvement of people living with HIV/AIDS, vulnerable groups, most affected communities, civil society and the private sector, as set out in the Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration. We encourage stronger analysis on the involvement of these groups in future reports.
15. In concluding I would like once again to express our thanks for the present report. The European Union is now looking forward to UNAIDS annual report of 2007 and a more extensive review by the Secretary General in 2008 which will also take into account countries submitted progress reports.