General Assembly Session 57 meeting 44

The Acting President

In connection with this item, the President of the General Assembly has asked me to announce that he has appointed Mr. Enrique Manalo, Deputy Permanent Representative of the Philippines to the United Nations, as facilitator to negotiate a draft resolution on this item.

Ms. Reds (Norway)

HIV/AIDS is the worst pandemic in human history. HIV/AIDS is frustrating development efforts. It is undermining educational programmes, health systems, public administration and agriculture -- the entire fabric of society. It is reversing decades of development gains. An extraordinary effort will be needed by all development partners to achieve the goal of halting and reversing HIV/AIDS and other major diseases. And a great deal of work must be done before 2015 if we are to fulfil the promises made in the Millennium Declaration. Business as usual is not an option. With the adoption by the General Assembly last year of the United Nations Declaration of Commitment on HIV/AIDS (S-26/2, annex), the world community demonstrated its readiness to march. The Declaration sets out a number of concrete and time-bound goals. We know where we are going, and what tools to use to combat the epidemic. Now we must translate our political commitment into action.

The Declaration of Commitment has been an important framework and instrument for creating awareness about the epidemic. The report of the Secretary-General on progress towards the implementation of the Declaration (A/57/227) points out the achievements that have been gained and the challenges that remain.

There is cause for optimism, especially in the fields of leadership, partnership and resource mobilization. More and more countries are adopting national plans and strategies to combat HIV/AIDS. However, the results at the country level are not satisfactory. There is still a long way to go before national strategies are truly multisectoral. Many countries report difficulties in involving a range of sectors. The HIV/AIDS response is still, to a large extent, centred in the ministries of health.

We encourage the UNAIDS secretariat and sponsors to assist countries in integrating HIV/AIDS programmes into their poverty reduction strategies and sector-wide approaches. It is also essential that all stakeholders coordinate their work to ensure that efforts to combat HIV/AIDS at the national level are integrated into national plans and strategies.

Too many of the efforts against AIDS are still being conducted as small-scale interventions. We need more nationwide comprehensive programmes. Many prevention programmes have been shown to work, but they are still confined to small geographical areas. The time has come to apply good practices on a much larger scale.

The main reason why this has not been done is reported to be a lack of resources. Many countries report that their high debt burden prevents them from allocating sufficient resources to fight HIV/AIDS. We strongly encourage the donor community to step up its funding to combat the pandemic. We urge all partners involved to ensure the effective implementation of the Heavily Indebted Poor Countries Debt Initiative.

The resources allocated to HIV/AIDS have increased by 50 per cent since 2001. This increase has come from developing countries' own budget allocations, donor nations, multilateral allocations, civil society and private sector funds. But this is still less than one third of the resources needed to fund the global response to HIV/AIDS. According to UNAIDS estimates, $10.5 billion is needed annually. By 2007 this figure will have risen to $15 billion. We strongly encourage the donor community to step up its funding to combat the pandemic.

One of the instruments for raising the necessary resources is the Global Fund to Fight AIDS, Tuberculosis and Malaria. Although the Fund is not part of the United Nations, Norway encourages United Nations agencies and the Fund to continue to cooperate closely. The Fund should make use of existing mechanisms and expertise of the United Nations system. The roles of UNAIDS and the Global Fund are complementary and mutually reinforcing: one provides expertise and technical assistance, whereas the other is purely a financing instrument. The United Nations family has vast country and programme experience, which will be extremely valuable to the Fund when identifying which programmes are ready to be scaled up. We are also concerned about the need for the United Nations family to strengthen and better coordinate its efforts at the country level, not least with the relevant national authorities, especially as a result of the establishment of the Fund.

Education is the only known vaccine against HIV/AIDS -- at least for the time being. Respect for the right to information and reproductive health care is essential if we are to halt the spread of the epidemic. Lack of knowledge kills thousands of people every day. In the fight against HIV/AIDS, we must break down the walls of silence and denial. The price of not doing so has become too high. Prevention and care programmes are being hampered by the discrimination and stigmatization that surround the epidemic. We must speak up against this.

The Global Fund does not cover research and development. However, we have committed ourselves to increasing global efforts to develop and put into use new, efficient prevention tools such as HIV-preventive vaccines and microbicides.

We have also committed ourselves to implementing strategies for creating supportive environments for orphans and other children affected by HIV/AIDS. But more than half of the countries that responded to the Secretary-General's questionnaire lack strategies to cope with the steadily increasing number of children who are orphaned as a result of the epidemic. Donor countries and civil society must support national Governments' efforts to cope with this grave problem.

For a long time the international fight against HIV/AIDS was exclusively concerned with prevention. This has now changed. Part of this change came with the Declaration adopted at the General Assembly's special session on HIV/AIDS in the summer of 2001. The Declaration recognized care and treatment, including anti-retroviral therapy as a central tool in the global campaign against HIV/AIDS. There is no doubt that access to medical treatment is a legitimate demand. An effective HIV/AIDS response also requires giving people who are already infected the support, care and treatment they need.

Although the cost of HIV/AIDS drugs has declined sharply during the past few years, it remains too high for most people in the developing countries. We must continue our efforts to ensure that the developing countries gain access to inexpensive drugs produced under licence, and that the pharmaceutical industry assumes its share of the responsibility. At the same time, local health care systems must be strengthened so that they can offer an effective chain of health-related services designed to meet the needs of individuals, regardless of their HIV status or the stage of infection.

The importance of the General Assembly's special session on HIV/AIDS should not be underestimated. It marked a definite turning point in how we perceive and respond to the epidemic. We have agreed on the strategies for combating the HIV/AIDS epidemic. The next step is to turn our good intentions into action. We must ensure that we follow up the various declarations and summits in a consistent manner. We would encourage the General Assembly to devote a full day of next year's session to a discussion of the implementation of the Assembly's HIV/AIDS Declaration of Commitment.

Ms. Marzec-Boguslanska (Poland)

It is a great honour for me to address this Assembly today, during this meeting devoted to the implementation of the Declaration of Commitment on HIV/AIDS. As the time has come to assess the outcome of enhanced coordination and intensification of our efforts, I appreciate having this opportunity to describe activities being carried out in Poland aimed at putting our efforts and commitments into practice.

Combating AIDS in Poland is carried out in accordance with its National Programme for HIV Prevention and Care for People Living with HIV/AIDS. The Minister of Health, on the advice of the Country Coordinating Mechanism on AIDS and non-governmental organizations, especially those participating in the National Programme, sets up the National Plan and determines the overall framework of Poland's national policy on HIV/AIDS.

Implementation of the national policy is accomplished through intersectoral cooperation and implementation of the national plan. The Minister of Health acts through his adviser on AIDS and drug addiction, with the National AIDS Centre playing a leading role on his behalf. The National AIDS Centre, being an agency of the central Government, coordinates all activities concerning HIV/AIDS control in Poland and cooperates with other countries, in particular with the countries of Central and Eastern Europe.

The national plan includes the most important instruments for HIV/AIDS prevention and therapy and aims mainly at the prevention of HIV infection, formulating an appropriate stance based on contemporary knowledge in the field, on human rights and on the provision of integrated care through the national programme. One of the national programme's priorities is reducing the prevalence of HIV, with a view to curbing the spread of HIV infection in Poland through: education of society, with particular emphasis on the education of youth -- since approximately 64 per cent of HIV-positive people are under the age of 29; carrying out prevention activities among people in the groups at greater risk of HIV infection; encouraging people to take HIV diagnostic tests; permanently monitoring safety standards for blood and blood-replacing agents; and preventing diseases that favour HIV transmission. Subsequent actions target particularly vulnerable groups.

The development of a network of anonymous and confidential testing in Poland is a crucial part of prevention activities. Model testing centres began operation in Poland in 1997, offering anonymous, confidential and free testing, as well as pre-test and post-test counselling.

In the context of HIV/AIDS, drug abuse is becoming an increasingly serious problem. Methadone-based substitution therapy has started as a pilot project. At present, there are 11 such programmes, involving approximately 800 people.

In order to prevent mother-to-child HIV transmission, pregnant women are encouraged by family doctors to take an HIV test on a voluntary basis. Anti-retroviral prophylactics, since the very beginning of their use, have been offered to HIV-positive pregnant women. There are a number of programmes, implemented mainly by the Institute of Mother and Child Health in cooperation with the National AIDS Centre and non-governmental organizations. Accordingly, the rate of vertical transmission has decreased from 23 per cent to 0.3 per cent.

With respect to HIV/AIDS prevention in the workplace, an inventory of the existing situation is being carried out in cooperation with the United Nations Development Programme in order to prepare guidelines concerning HIV/AIDS and human rights in the workplace, addressed to employees, employers and civil society institutions.

Since 1990, all patients covered by the national programme have had access to specialized treatment. There are 14 State reference centres for AIDS therapy in Poland. Currently, many initiatives have been implemented in cooperation with Eastern European countries.

It should also be noted that psychological and social support for HIV-positive patients and their families is provided by ensuring support for hospitalized persons and by providing the opportunity to participate in group, individual, marital and family therapy. Special attention is given to HIV-positive children and to those living in families with HIV/AIDS problems.

With respect to the issue of HIV/AIDS and human rights, Polish law lacks rules and regulations on the issue of HIV/AIDS in the context of human rights. Despite some cases of a discriminatory reaction by society in the early years, when HIV infections first appeared in Poland, social pressure did not result in legislative changes. In addition to the increase in social awareness and HIV/AIDS social education, there seems to be greater tolerance and less stigmatization in the workplace. People who are willing to work can find jobs in non-governmental organizations and other institutions, where they can help others, as well as do something for themselves. HIV-infected persons may decide whether or not to disclose their status; no one is informed without their consent. There is no compulsory testing for admission to schools, for employment or for any kind of immigration or visa procedures.

Legislative policy is oriented towards solutions preventing any discrimination against persons living with HIV/AIDS. Except where blood donations, organ transplants, criminal proceedings and court warrants are concerned, Polish law does not permit HIV/AIDS diagnostic tests without consent or against a patient's will. HIV/AIDS data protection strictly requires that doctors and other hospital staff keep those cases confidential. Relevant regulations impose the strict obligation of treating all medical and official information as confidential.

The national programme supports the principle of full protection and promotion of human rights based on the inalienable dignity of an individual.

The issue of gender is fully reflected in the national programme. There are a number of education programmes carried out in schools, and they address girls and boys equally. There are also a number of non-governmental organizations assisting sex workers. Moreover, there are prevention activities and educational materials that take into account different needs according to gender and age.

Poland contributes significantly to the international community's efforts on the issue of human rights in the context of HIV and AIDS. Every two years since the beginning of the 1990s, Poland has introduced in the Commission on Human Rights a draft resolution on the protection of human rights in the context of HIV/AIDS.

Recognizing the importance of the family, youth-friendly information, sexual education, counselling services and cultural, religious and moral factors, our activities focus on society as a whole, with special attention to women of childbearing age and parents of adolescent children. Educational actions are aimed at shaping responsible attitudes towards one's health and at preventing situations that favour infection. Special attention is given to youth at schools and to the staff responsible for their education. Training is provided to the personnel responsible for the education of youth. Issues of HIV/AIDS and sexually transmitted infections are included in the standards for training teachers in the framework of pedagogical studies, qualification tests and postgraduate studies.

Let me point out in conclusion that the State leadership in my country brings together institutions and organizations at the central and local levels of administration, together with civil society. Legislative policy is oriented towards solutions preventing any discrimination against persons living with HIV/AIDS. Programmes for the prevention of epidemics in Poland are well developed. Through the preventive measures, medical treatment and social support provided by the national programme, the scale of the epidemic in Poland is relatively stable. However, in spite of that relatively stable situation, Poland recognizes that the region of Central and Eastern Europe actually has a very rapidly rising rate of infection, which could result in a rapid escalation of the epidemic throughout Europe.

The Polish Government will continue its efforts to ensure broader involvement in civil society for people living with HIV/AIDS, and to promote and protect their rights. We are open to sharing our experience in the prevention of HIV/AIDS and of other communicable diseases with our partners in the region, thus promoting cross-sectoral and transnational cooperation.

Mr. Rodríguez Parrilla (Cuba)

Scarcely a year ago, we held an urgent special session of the General Assembly to confront the problem of HIV/AIDS in all its aspects and to coordinate and intensify national, regional and international activities to combat the pandemic in an integrated way. At that time, 36.1 million people were living with HIV/AIDS, 90 per cent of them in developing countries and 75 per cent of them in sub-Saharan Africa. Currently, 40 million people are infected with the virus. Of those, 3 million are children and 28.5 million live in sub-Saharan Africa.

It is true that HIV/AIDS affects all countries and peoples, rich and poor, without distinction, but it is also true that all do not have the same opportunities to attack and prevent the disease, and therein lies the difference. Today, millions of persons die of AIDS and other millions continue to be infected with the virus. More than 80 per cent of those deaths occur in Africa, where the majority of the millions affected by the epidemic have no access to the medicines or the therapies that are necessary to fight the disease, to prevent other opportunistic diseases and to relieve pain.

Developing countries -- particularly those in Africa -- have made a great effort and have created national anti-AIDS programmes. However, they cannot cope with the disease with the limited resources available to them -- resources that they must use to pay their external debt or to achieve sustainable development. Today, Africa spends four times as much on servicing its external debt as on education and health combined.

World action against AIDS requires financial resources. According to the report of the Secretary-General (A/57/227 and Corr.1), the Global Fund to Fight AIDS, Tuberculosis and Malaria -- created as a mechanism for financing additional resources -- has to date received more than $2 million in pledged contributions and has approved subsidies for programmes in low- and medium-income countries totalling $616 million for a five-year period. Obviously, the world response falls far short of the goal of $10 billion in annual expenditures by 2005.

International cooperation is imperative. Only if developing countries receive special treatment, if they are guaranteed market access, if the deterioration in the prices of basic commodities ends, if their external debt is forgiven, if they are guaranteed access to technology, if official development assistance increases and if the necessary financial resources are allocated without interference and conditions -- only in this way will the necessary resources to fight this disease be released.

My country, despite the fact that it is poor and has been subjected to an iron-fisted blockade for more than four decades, is developing an anti-AIDS programme that ensures integrated health care for both carriers and the sick -- free anti-retroviral therapy for all who are ill and centres of specialized care for the cases that require it -- and is fighting tirelessly for broader social integration of the sick and of carriers, with full rights and without discrimination. Also guaranteed is access to 100 per cent certified blood donations for AIDS, hepatitis and other illnesses. Voluntary tests of all those who are pregnant have resulted in a zero mother-to-child transmission rate since 1997, and we are implementing a prevention and education strategy directed at vulnerable groups, at young people and at the entire population. We have the lowest prevalence rate in the Americas and one of the lowest in the world, at 0.03 per cent of those between 15 and 49 years of age.

Despite the fact that Cuba has no access to 50 per cent of the new medicines produced in the world because they are formulated by pharmaceutical companies and produced by medical equipment manufacturers in the United States and by their subsidiaries in third countries, we have contained the epidemic and have achieved a life expectancy of more than 76 years and an infant mortality rate of 6.2.

Cuba wishes to share its modest experience. I should like to reiterate my Government's offer to help the brotherly African peoples in the fight against the HIV pandemic by sending 4,000 doctors and health care personnel to create the necessary infrastructure in order to provide the population with essential medicines, prescriptions and follow-up. Those personnel could train a great number of specialists, nurses and medical technicians. Cuba also offers to provide the necessary teachers to create 20 medical schools, many of whom could be chosen from among the 2,359 Cuban doctors who today are providing their services in 17 African countries as part of an integrated health programme. In such schools, thousands of doctors could be trained each year in the countries that need them most.

I wish to reiterate our offer of doctors, teachers, psychologists and other specialists who will be required to advise and coordinate prevention campaigns against AIDS and other illnesses. We can supply free medical equipment and diagnostic kits needed for basic prevention programmes in 17 countries. We are offering free anti-retroviral therapy for 30,000 patients. All we need is for the industrialized countries to provide the minimum resources to make all of that possible.

Mr. Atta (Egypt)

The holding of the twenty-sixth special session of the General Assembly, in June 2001, marked the high point of the Organization's concern over the problem of HIV/AIDS, whose toll on humanity over two decades is matched only by that of the Second World War. At the time, hopes were high that collective international effort was the only available way to help the countries most affected by this disease to confront it, within the framework of an integrated international plan that would take all the aspects of the disease into account, from prevention, care and treatment to other economic and social factors and results. Such were our hopes a year and a half ago. Today we meet to consider what the Secretary-General tells us in his report about the extent to which those hopes have been met.

The report shows that the international community remains unable to deal with the disease: effective prevention programmes cover only 20 per cent of those affected, and of the 34 million people infected with the virus, 86 per cent are in sub-Saharan Africa and in South-East Asia. Of that group only 60,000 are receiving the anti-retroviral therapy that can stop or delay the progress of the disease.

The gravest of the statistics is that of 40 million affected by HIV/AIDS less than 10 per cent receive treatment for this disease, which causes the body to collapse for lack of immunity. The report shows clearly that internationally the expenditure on combating AIDS is decreasing. It shows that despite the increase to $2.8 billion of expenditure in the low- and medium-income countries on AIDS programmes in 2002, international resources pledged to the Global Fund to Combat AIDS, Tuberculosis and Malaria since its establishment have amounted to some $2 billion. The total is one third of the amount required every year. The report says that the Fund has provided some $616 million for national programmes over the next five years. Analysis of the data shows that the Fund's Board has given only 32 per cent of the amounts required to finance national programmes, and that countries are not receiving the necessary financing immediately but over five years, whereas $400 million is needed over a period of two years. We have several questions regarding this analysis.

Is the slow pace of the Fund's work sufficient to cope with the tremendous speed of the spread of the disease? Have resources increased or decreased in comparison with those directed to the secondary channels that existed before the Fund was established? That is to say, has the establishment of the Fund increased international spending on the disease or is the Fund simply a forum to give specific direction to national programmes for combating the disease? Finally, where is the United Nations role in combating AIDS?

The Egyptian delegation believes that greater emphasis should be placed on the role of the Joint United Nations Programme on HIV/AIDS. The Programme's position as an observer is not in line with that of other funds with longer experience and a track record in the field. The Egyptian delegation strongly supports the conclusion of the Secretary-General that the issue of HIV/AIDS should be integrated into programmes to combat poverty and promote sustainable development, and the call to substantially increase assistance to countries in need. The persistence of this humanitarian and social situation and the real suffering of the tens of millions who are infected with AIDS represent challenges to the human conscience. Mankind remains unable to mobilize the resources to combat the disease. The existence of the disease without a cure is saddening, but the fact that most people cannot afford the medicines that exist is a source of shame to humanity and is psychologically destructive. We cannot call on one hand for globalizing the economy and on the other for privatizing poverty and disease.

Mr. Zhang Yishan (China)

The Chinese delegation wishes to put on record its appreciation to the Secretary-General for the report (A/57/227) submitted under this agenda item and for the recommendations it contains.

Over the past two decades, the scourge of HIV/AIDS has been spreading unchecked around the world, resulting in more than 40 million infections and more than 21 million deaths. It is projected that an additional 45 million people will be infected between 2002 and 2010. HIV/AIDS poses a great challenge to social development, economic growth and political stability worldwide and, indeed to the safety and survival of humankind.

As a global crisis, HIV/AIDS requires a concerted response through global action. Addressing the HIV/AIDS epidemic was high on the agenda of a whole series of major conferences, including the Millennium Summit, the World Summit for Social Development and the Second United Nations Conference on Human Settlements (Habitat II).

At its twenty-sixth special session, on HIV/AIDS, held last year, the General Assembly adopted the Declaration of Commitment on HIV/AIDS resolution (S26/2), setting out the goals, tasks and responsibilities in the international fight against the epidemic. The Declaration has become an important document guiding our struggle against HIV/AIDS.

Many countries have developed national prevention strategies in line with the Declaration. International organizations, governmental bodies and civil society have adopted a series of positive measures in the fields of legislation, mobilization of resources, extensive provision of drugs for prevention and treatment, and increase of public awareness.

What merits particular mention is that the Global Fund to Fight AIDS, Tuberculosis and Malaria, which was established only at the beginning of the year, has attracted over $2 billion in pledges and has approved the disbursement of $616 million in funds to low- and middle-income countries over the next 5 years. Nonetheless, that figure is still a far cry from the target of $10 billion per year by 2005.

We still have a long way to go in combating HIV/AIDS. As the Secretary-General points out in his report, due to ineffective implementation, inadequate funding and a shortage of medical supplies, progress in stemming the epidemic lags far behind its unrelenting advance and destructive trend. In that connection I wish to make a few observations on international cooperation on HIV/AIDS.

First, prevention and treatment should go hand in hand in an effective struggle against HIV/AIDS. While prevention is fundamental, treatment is the key. We should therefore take a two-pronged approach by making a concerted effort to reach the targets and implement the tasks set forth in the Declaration for 2003 and 2005. These include formulating national strategies for combating HIV/AIDS, incorporating them into national development plans and poverty eradication programmes, setting out clear goals and taking measures for prevention and treatment, raising public awareness, strengthening health care systems and ensuring that monitoring and enforcement take place.

Secondly, we must mobilize financial resources and provide access to drugs in fighting HIV/AIDS. In his report, the Secretary-General points out that funding for international cooperation in the fight against HIV/AIDS should grow by at least 50 per cent annually in order to meet the annual requirement of $10 billion by 2005, and that only a small fraction of the world's 40 million people living with HIV/AIDS have access to treatment due to patent-related problems and the high cost of related drugs.

It is our hope that the United Nations and its relevant specialized agencies, funds and development programmes, UNAIDS in particular, will play an active and leading role in enhancing cooperation between Governments and the private sector, exploring both traditional and innovative means of mobilizing financial resources and making HIV-related drugs widely available, so that poor populations in developing countries who are afflicted with HIV/AIDS are given access to these drugs. This will help effectively to resolve one of the major problems in our fight against HIV/AIDS and benefit people living with the epidemic.

Thirdly, research and development should be promoted in order to bring HIV/AIDS under control. It is essential to develop HIV-related vaccines as a means of eventually bringing HIV/AIDS under control. We hope that this issue will receive adequate attention as part and parcel of the global strategy in that respect. To this end, it is imperative to increase investment in, and speed up the development of, HIV-related vaccines; build up the research and development capability of all countries, particularly those of developing countries and those with high infection rates; carry out international cooperation; increase the transfer of relevant technologies; and establish mechanisms for regular exchange.

The fight against HIV/AIDS has received great attention from the Chinese Government, which formulated and started implementing an AIDS strategy in 1998. Our budget for combating HIV/AIDS registered a five- to seven-fold increase in 2001. We have also invested 1.2 billion yuan renminbi to improve our blood-collection and supply facilities. In addition, following the special session of the General Assembly on HIV/AIDS last year, China convened its first national conference on that subject and co-sponsored a regional seminar for Asia and the Pacific under the Global Fund. In this endeavour, UNAIDS provided China with great support, for which we wish to record our gratitude.

As a country with a huge population, China faces special difficulties in preventing and controlling HIV/AIDS. We are prepared to continue our cooperation with the countries and international agencies concerned in such areas as financing; developing prevention and treatment projects; lowering drug prices; and further leveraging the advantage of traditional Chinese medicine in treatment in a bid to contribute to the fight against the epidemic in China and around the globe.

Mr. Abdul Ghafor (Brunei)

I have the honour of speaking on behalf of the members of the Association of South East Asian Nations (ASEAN), namely Brunei Darussalam, Cambodia, Indonesia, the Lao People's Democratic Republic, Malaysia, Myanmar, the Philippines, Singapore, Thailand and Viet Nam.

Realizing the serious socio-economic consequences that the HIV/AIDS pandemic could have for every member of this Assembly, we succeeded in adopting a Declaration of Commitment during the special session of the General Assembly on HIV/AIDS held in June last year. Our leaders pledged to enhance the coordination and intensification of national, regional and international efforts to combat HIV/AIDS in a comprehensive manner. We are pleased to note that these commitments have been translated into many encouraging developments in our continuing efforts to fight HIV/AIDS.

At the regional level, ASEAN's efforts started about a decade ago, when our ASEAN leaders met during the fourth ASEAN Summit in Singapore in 1992. HIV/AIDS was considered a threat of regional concern, and our ASEAN leaders agreed to make a coordinated effort to curb its spread. An ASEAN Task Force on AIDS was established in 1993 to strengthen regional coordination, build regional capacity and address cross- border issues. With the assistance of the World Health Organization, ASEAN member States were able to develop the ASEAN Regional Programme on HIV/AIDS Prevention and Control for the period 1995-2000.

Our ASEAN leaders continued to strengthen their commitment to intensify efforts to combat HIV/AIDS when they met during the seventh ASEAN Summit in Brunei Darussalam in November last year -- just five months after the special session. A Declaration on HIV/AIDS was adopted, and the leaders also endorsed the Second ASEAN Work Programme on HIV/AIDS for the period 2002-2005 to implement the provisions contained in the Declaration. Both the Declaration and the Work Programme were the result of extensive consultations with the affected communities, including those living with HIV/AIDS. It covers not only the health sector but all those related to HIV/AIDS.

HIV/AIDS is now a national and regional priority in South-east Asia. ASEAN continues to strengthen its efforts, including in areas related to regional networking; access to drugs for people living with AIDS; mobile communities; inter-sectoral collaboration; research; improving HIV/AIDS surveillance; education and awareness programmes for young people and drug users; and other areas, to reduce vulnerability to HIV/AIDS transmission and to ensure the provision of care and support for people living with AIDS.

I am pleased to inform the Assembly that the implementation of the Second ASEAN Work Programme is now well under way, with the holding of various projects and activities related to joint actions to increase the affordability of drugs and testing reagents; mainstreaming HIV/AIDS into the development agenda; inter-country activities on mobile populations; and the ASEAN AIDS Information and Research Reference Network.

We would like to express our appreciation to UNAIDS for its continued and invaluable support for our regional efforts. We are also pleased to see that bodies of the United Nations system such as the United Nations Children's Fund (UNICEF), the United Nations Development Programme (UNDP), the United Nations Population Fund (UNFPA), the United Nations International Drug Control Programme (UNDCP) and others such as the World Health Organization and the World Bank are actively incorporating the issue of HIV/AIDS in their development, technical and funding programmes.

We look forward to strengthening cooperation with our dialogue partners and other international agencies in realizing our collective goals. In addition, we welcome the convening of the 15th International Conference on AIDS, which will be held in our region, hosted by Thailand, from 11 to 16 July 2004, and we look forward to active participation and contributions by all concerned.

It is clear that HIV/AIDS will remain one of the most serious social and economic problems to confront us in the coming decades. It is in our best interests, therefore, that we resolve to prevent the further spread of the disease and to continue our fervent search for a cure. In that context, we in ASEAN reaffirm our commitment to do our utmost, individually and collectively, in addressing HIV/AIDS and supporting greater action and collaboration by the many stakeholders in tackling the pandemic.

Mr. De Alba (Mexico)

My delegation would like to thank the Secretary-General for his report on progress towards implementation of the Declaration of Commitment on HIV/AIDS, as well as for his personal commitment to combating that epidemic, which is already considered to be the worst in the history of humankind.

We also express our appreciation to the secretariat of the Joint United Nations Programme on HIV/AIDS (UNAIDS), and in particular to its Executive Director.

My delegation supports the recommendations contained in the Secretary-General's report with regard to the redoubled efforts that the United Nations will have to make in order to attain the objectives set out in the Declaration of Commitment.

The HIV/AIDS pandemic has become a global emergency that threatens the security and development of all countries, not just those located in the worst affected regions. This emergency will require an energetic response based on collective action by countries through international cooperation.

The Secretary-General's report presents us with the stark fact that 40 million people worldwide are living with HIV/AIDS, and the statistics show that the situation is worsening. According to information from UNAIDS, the social and economic consequences of the epidemic manifest themselves most dramatically approximately 10 years after HIV appears in each country or region. Taking into account the fact that there are 5 million estimated new infections each year, the cost for the world will be enormous, even if the epidemic is quickly brought under control.

In sub-Saharan Africa and South and South-East Asia, regions that are home to more than 34 million of those affected by HIV/AIDS -- 86 per cent of the world total -- only some 60,000 people are receiving anti-retroviral therapy. If we do not significantly bolster the global response to HIV/AIDS, it has been estimated that between 2002 and 2010 there will be 45 million new infections. If, on the other hand, available preventative measures were extended with a view to combating the epidemic, we could avoid 28 million such infections.

UNAIDS has also reminded us of the enormous funding challenges that we must overcome. We must move from the $2.8 billion that will probably be devoted to combating the epidemic in 2002 to $10.5 billion per year from 2005 and $15 billion per year from 2007.

Despite the enormous challenges that we face in the short, medium and long term, the report of the Secretary-General also provides us with encouraging information. First, the report emphasizes that the Declaration of Commitment on HIV/AIDS was a watershed in our joint efforts to control this global scourge. Secondly, it highlights the fact that over the past 16 months, enormous progress has been made, both in mobilizing human and financial resources and in designing strategies and cooperation programmes.

The Government of Mexico reaffirms its support for the principles of the Millennium Declaration, the UNAIDS Framework for Global Leadership and the joint strategic plan of UNAIDS and the Global Fund to Fight AIDS, Tuberculosis and Malaria. Strengthening them will help to strengthen global security.

Mexico actively participated in the special session on HIV/AIDS, and put forward proposals to deal with the impact of AIDS on women's health, to reduce the vulnerability of young people to the disease and to provide special care for orphaned children. It has also promoted respect for the human rights of people who are infected, with a view to preventing discrimination and stigmatization.

For the Mexican Government, the epidemic is a serious public health problem with social, economic and political consequences. Accordingly, combating it is a priority that must involve the public and private sector, specialists and educational institutions, civil society organizations, individuals and communities. In accordance with the recommendations made at the special session of the General Assembly, Mexico, through its Health Secretariat, has adopted a programme of action for the prevention and control of HIV/AIDS for the period 2001-2006. The Government of Mexico is giving priority to, first, education strategies and preventive measures; secondly, policies aimed at the prevention of perinatal HIV/AIDS; thirdly, access to information and treatment to prevent perinatal transmission of HIV and syphilis; fourthly, discounted prices for anti-retroviral drugs; fifthly, the establishment of mechanisms to penalize individuals, businesses and institutions that violate the provisions of Mexican regulations for the prevention and control of HIV/AIDS; and sixthly, campaigns to combat discrimination against people infected with the virus.

Mexico recognizes the importance of the international community's strengthening and intensifying its cooperation with and technical assistance for countries with a high incidence of HIV/AIDS and few resources. Mexico therefore supports multisectoral, regional and international cooperation as a fundamental element in the global response to the pandemic. In this context, we have worked actively with the countries of Central America and the Caribbean to prevent and control HIV/AIDS. In a collaborative effort with the ministers for health of the region, important activities have been carried out in the framework of the Central American cooperation programme for 2001-2002, through a project to strengthen the prevention and control of HIV/AIDS, with special attention to the migrant population.

Furthermore, in June 2002, an intensive course entitled "HIV/AIDS: Watchfulness, Prevention and Care", was held in Mexico, organized by the National Institute for Public Health. That course was attended by specialists from seven countries of the Central American region, as well as by Spanish- and French-speaking Caribbean countries.

My delegation believes that the eradication of AIDS would benefit the entire world, and funding and cooperation to combat this scourge must therefore occupy a priority position in the policies of multilateral bodies, bilateral donors and private foundations.

The Government of Mexico believes that the AIDS pandemic has very grave implications for international security. The immediate future of the world will depend on the capacity of the United Nations to deal with it.

Mr. Singh (India)

We thank the Secretary-General for his report on progress towards implementation of the Declaration of Commitment on HIV/AIDS (A/57/227). The report is fair and balanced, as well as useful.

The report states that the Declaration of Commitment established, "for the first time ever, time-bound targets to which Governments and the United Nations may be held accountable". The purpose of today's debate is to consider the report with the objective of taking stock of progress achieved in realizing the commitments set out in the Declaration, with a view to identifying problems and constraints and making recommendations on actions needed to make further progress. Such actions would, in our view, also include measures required for the further refinement of the mechanisms used for measuring progress.

The Secretary-General's report arrives at the conclusion that, in the absence of a substantial strengthening of the global response to HIV/AIDS, 45 million new infections are projected to occur between 2002 and 2010. It bases this conclusion on the finding that only 15 per cent or so of the people at risk of HIV infection have access to basic protective services, that only 4 per cent of people in low- and middle-income countries who qualify for anti-retroviral therapy obtain it and that even the coverage for preventing mother-to-child transmission is only 10 per cent.

The report finds that the political commitment to implement the Declaration of Commitment continues to increase and that spending on HIV/AIDS in low- and middle-income countries increased by more than 50 per cent in this year alone. It, however, also points out that the implementation of national AIDS strategies is slow, in large measure owing to lack of resources. According to the report, only 60,000 people in sub-Saharan Africa, South and South-East Asia receive anti-retroviral therapy. The high cost of anti-retroviral drugs is cited as the principal barrier to care. The report finds further that debt repayment has, in many cases, impeded the capacity of countries to allocate sufficient resources to fight HIV/AIDS.

The Declaration of Commitment was unambiguous in asserting that the HIV/AIDS challenge cannot be met without new and sustained additional resources. This led to the establishment of a Global Fund to Fight AIDS, Tuberculosis and Malaria, to finance an urgent and expanded response. We are pleased that the Fund has approved grants for projects totalling $616 million for the next five years. We understand, however, that the Fund has found additional certain projects meritorious and has, in principle, approved them, totalling a much larger quantum of money. The shortfall in international resources to finance these projects is estimated to be $2 billion for 2003. For 2004, the figure is $4.6 billion.

In our view, it is important to diligently track progress towards the fulfilment of the commitments that we have undertaken. The Joint United Nations Programme on HIV/AIDS (UNAIDS), along with its co-sponsors, have developed core indicators for monitoring such progress. These indicators will measure, at the country level, the percentage of HIV-infected pregnant women receiving the complete course of anti-retroviral prophylaxis, the percentage of people with advanced HIV infection receiving anti-retroviral combination therapy and the percentage of people with sexually transmitted diseases who have been appropriately diagnosed, treated and counselled. The indicators will, however, not measure commitment at the country level to international development assistance for combating HIV/AIDS.

The Declaration of Commitment on HIV/AIDS was not adopted in a meeting of the Group of 77. It was adopted by a special session of the United Nations General Assembly and represents, we think, a global compact bringing together all Member States, both developed and developing. It is clear from the report that the compact will remain unfulfilled unless commitments are met by all parties, both developed and developing. In order for there to be any meaningful tracking of progress, we call on UNAIDS to further refine the mechanisms that it proposes to use for this purpose.

India, despite its resource constraints, has been doing its share as a responsible member of the international community. The role played by its pharmaceutical industry has been responsible for the reduction in the cost of anti-retrovirals by 85 to 90 per cent in most developing countries. The World Trade Organization (WTO) Ministerial Declaration of November 2001, which clarified that the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS Agreement) could and should be interpreted in a manner supportive of the right of Member States to protect public health and promote access to medicines, represents some movement on the part of our development partners as well. India is now working on what could become a fairly substantive contribution to the prevention of HIV/AIDS. There is on-going research in India, both original and collaborative, in the area of vaccine development. Recent breakthroughs in genomics and related areas offer possibilities. We are focusing on the C subtype of the HIV virus, which is prevalent in India and some other developing countries. We have already, through biotechnology research, made a breakthrough in HIV diagnostic kits. Two of them, in particular, have been successful in India and many other countries. We would be happy to share these technologies.

I will now say a few words about our national programme. We have had, since 1992, a National Strategic Plan on HIV/AIDS. The second phase of the National AIDS Control Programme, initiated in 1994, is a multisectoral programme aimed at reducing the spread of infection and strengthening capacity to respond to the spread of the disease on a long-term basis. Our strong political commitment, which cuts across party lines, is evidenced by the establishment of a parliamentary forum on HIV/AIDS prevention. Over 700 non-governmental organizations (NGOs) are involved in the implementation of targeted intervention projects for high-risk groups. We make extensive use of the electronic and print media to disseminate HIV/AIDS messages in all the languages used in our country. India's health system provides free treatment for opportunistic infections in HIV-positive persons. A programme to prevent mother-to-child transmission is also being implemented. Adolescent information needs are being addressed through a school aids programme. In addition to programmes for raising general awareness regarding safe sex, there are specific programmes that focus on sex workers, men who have sex with men, street children, injecting drug users and migrant workers. Special emphasis is placed on the right to privacy of individuals who are vulnerable to or affected by HIV/AIDS. We hope, with these efforts, to achieve our time-bound national targets, which are consistent with those contained in the Declaration of Commitment on HIV/AIDS.

A variety of strategies is required to address both the preventive aspects and the care and support aspects of HIV/AIDS. What is required is to fulfil the commitments undertaken by the international community as a whole, developed and developing alike, in the special session on HIV/AIDS. We need to monitor progress towards the fulfilment of those commitments.

Mr. Ivanov (Belarus)

At the outset, the delegation of Belarus wishes to express its gratitude to the Secretary-General for his report on the subject before us today. We believe that the report is an important source of information on how the international community should act to combat the spread of the HIV/AIDS pandemic in order to achieve the indicators agreed upon at the twenty-sixth special session of the General Assembly. Belarus had the honour of making a practical contribution to the preparation of the Secretary-General's report by providing detailed information for the corresponding questionnaire.

With the adoption of the Declaration of Commitment on HIV/AIDS, we agreed that the measure of our success should lie in responsible coordinated action at all levels -- national, regional and global. In that connection, we should like to briefly address some practical steps that are being taken by the President, Government and civil society of Belarus to fulfil the provisions of the decisions taken at the twenty-sixth special session.

With regard to leadership, Belarus has developed a State programme for the prevention of HIV infection for the period 2001-2005, as well as a strategic plan for forward-looking measures to prevent the expansion of the epidemic from the period 2001 to 2003. Those strategies provide for a number of measures in terms of organizational, legal, preventive and rehabilitation measures among various groups of highly vulnerable populations. They include the organization of activities for the prevention of HIV infection for drug users and the development within educational institutions of programmes on healthy living, including prevention of HIV infection and publicizing the use of contraceptives among young people, spreading prevention information throughout institutions that provide assistance to people with AIDS and planning programmes for people at high risk of infection. Action in those areas involves the participation of different sectors of society, including non-governmental organizations, ministries and departments.

Regarding care, support and treatment, the State programme for AIDS prevention provides for the free provision of anti-retroviral drugs to HIV-positive persons at medical institutions, as well as distribution through pharmacy networks. At the same time, research shows that our country is currently encountering difficulties in providing a multi-component HIV-infection therapy, largely because of the limited number of authorized medicines and because of their high cost. Work is therefore being done to introduce mechanisms that will make it possible to develop local production, in keeping with international standards. With a view to expanding opportunities for HIV-infection therapy, Belarus is providing a local product called Zametcit. Use of that local product will make it possible to reduce costs and ensure greater access. We are currently considering the issue of simplifying the registration procedure for imported anti-retroviral preparations, which will expand the list of medicines that can be used.

Regarding HIV/AIDS and human rights, people with HIV/AIDS are guaranteed the rights of all citizens, as set out in the Constitution of Belarus. Moreover, there is a set of legislative acts that reflects different aspects of the HIV/AIDS problem. Discrimination is prohibited, the interests and rights of HIV-infected persons are guaranteed, the principle of confidentiality is assured and the rights and legitimate interests of relatives may not be infringed upon.

As to research and development, we have elaborated a national system for monitoring HIV infection, including through the study of the scope of HIV infection among risk groups. We have introduced computer-based standard systems of accountability. HIV/AIDS-related issues are included in programmes for medical workers and specialized training is provided. Training of sociologists working on HIV/AIDS-related research is carried out at seminars involving international consultants. The training of specialists working with groups at risk is being conducted at national and international seminars and training sessions.

One of the main obstacles to carrying out those measures at the national level is the lack of resources and technical potential; we fully agree with the Secretary-General's conclusion on that point. Approaching its obligations responsibly, Belarus, nevertheless, is not now in a position to greatly increase the volume of financing for corresponding State programmes. That is due to the transitional nature of our economy, which is experiencing difficult social and economic changes. The situation is also particularly difficult for our country because of the fact that the HIV/AIDS problem is not just a national problem but, to a considerable extent, an imported one. It is very closely linked to dangerous phenomena such as illegal drug traffic and illegal migration. Here we look for the support and understanding of the international community. Such support appears to us to be fully justified because, as can be seen from the recent report of the Joint United Nations Programme on HIV/AIDS, the Eastern European region, to which our country belongs, unfortunately has the highest current rate of increase in infection.

Belarus has initiated practical cooperation with the Global Fund to Fight AIDS, Tuberculosis and Malaria, with a view to mobilizing international support for its own efforts. We also greatly appreciate our interaction with the World Bank in combating the spread of HIV/AIDS in Belarus.

In conclusion, allow me to express my country's conviction that the support of a dedicated, coordinated and comprehensive international approach to combating HIV/AIDS will enable us to achieve progress with a view to attaining the objectives on which we have agreed.

Ms. Løj (Denmark)

I have the honour to speak on behalf of the European Union. The Central and Eastern Europe countries associated with the European Union -- Bulgaria, the Czech Republic, Estonia, Hungary, Latvia, Lithuania, Poland, Romania, Slovakia and Slovenia -- and the associated countries Cyprus, Malta and Turkey, as well as the European Free Trade Association country member of the European Economic Area, Iceland, align themselves with this statement.

At the Millennium Summit, our heads of State or Government resolved by 2015 to have halted and begun to reverse the spread of HIV/AIDS, the scourge of malaria and other major diseases that afflict humanity. This commitment was followed up last year in June when we all met at the special session and adopted the United Nations Declaration of Commitment on HIV/AIDS. The Declaration sets out a number of concrete and time-bound goals, which constitute an important framework for our actions in the global fight against HIV/AIDS. But it is after all just a Declaration; our true commitment must be shown through our joint actions. We have a great challenge in translating political commitment into action.

The consequences of the epidemic are alarming. In 2001, 5 million people became infected with HIV and 3 million died from AIDS. Today, more than 40 million are living with HIV/AIDS. The disease has a major impact -- and in some areas, especially in sub-Saharan Africa, a devastating one -- on life. However, it is also expanding rapidly in other regions of the world, which, unless early action is taken, threaten to be engulfed by the epidemic. It halts social and economic development; thousands of children are left as orphans; and it contributes to a shortage of food, a slowing in production and lower education standards.

There is an urgent need for a strengthened effort to fight HIV/AIDS. The response required is more complex than that to other diseases. It requires action through all aspects of society, not just health. Our efforts to fight HIV/AIDS must therefore be an integral part of our work in all fields -- in relation to education, agriculture, industrial development, trade, human rights and social development. It is a true cross-cutting issue and must be treated accordingly.

Many countries have developed multisectoral plans and strategies for combating HIV/AIDS, but the concrete responses to the epidemic often remain enclosed in health ministries. This must be changed. The epidemic should be counteracted through a broad set of interventions. The capacity to coordinate a wide range of initiatives must be enhanced. Taking into account the multisectoral nature of the problem, the need to ensure ownership of national Governments and the proper coordination as well as cooperation of the various actors, all HIV/AIDS activities should be integrated into national poverty reduction programmes, such as the Poverty Reduction Strategy Papers.

The report of the Secretary-General rightly underlines the crucial importance of national leadership in the fight against HIV/AIDS. We must speak openly about HIV/AIDS and confront stigmatization and discrimination. Sexual health education for young persons is part of such openness, as is recognizing the gender dimensions of HIV/AIDS and the importance of the active involvement of men and boys in prevention efforts. Only by doing so can we achieve the maximum impact of our efforts.

Civil society forms an intrinsic part of a national response. It is imperative that we complement political leadership with the full and active participation of civil society, including people living with HIV/AIDS, as well as the private sector. This is indeed happening in many countries. However, in the global perspective participation remains inadequate. The EU would like to acknowledge and support the role played by civil society through participation in planning exercises, in providing care and support to orphans and other vulnerable groups, and in monitoring HIV-related human rights violations.

Last year, United Nations Member States at the General Assembly special session on HIV/AIDS agreed that by 2005 we would mobilize in total between $7 and $10 billion a year to fight the epidemic. The establishment of the Global Fund to fight AIDS, Tuberculosis and Malaria provides an important global financial mechanism for securing the necessary resources for the fight against the three diseases. The EU is committed to helping the Global Fund establish itself as an effective mechanism for the delivery of essential support to those most in need.

In Monterrey, we agreed to increase the resources for development -- both domestic resources and assistance from the international community -- and to enhance aid effectiveness. This should include prioritizing interventions that are known to be effective in responding to HIV/AIDS. We must increase spending in health and education if we are to achieve by 2015 the goal of halting and reversing the spread of HIV/AIDS. An increase in official development assistance and the speedy and effective implementation of the Heavily Indebted Poor Countries Debt Initiative will, among other things, be targeted towards the social sector and contribute to freeing domestic resources for social sector investment.

But lack of financial resources is not the only obstacle. Human capacity, especially at the country level, is stretched beyond its limits. Indeed, we are now reaching the point where the extent to which HIV/AIDS is contributing to the erosion of human capacity to respond to the disease must be acknowledged. External assistance often supports specific interventions but pays less attention to the challenge of building sufficient capacity at the local level in order to sustain these activities over the long term. In a situation of insufficient capacity, the scaling-up of successful pilot projects, which could increase efforts aimed at combating HIV/AIDS, may not yield sustainable results.

The United Nations system must address this challenge through strengthened inter-agency collaboration, especially at the country level, with a view to ensuring the most effective utilization of its resources. The effectiveness of strategies to combat HIV/AIDS depends very much on improved coordination and coherence between all stakeholders at the global, regional, national and local levels. In this context, the EU welcomes the ongoing evaluation of the Joint United Nations Programme on HIV/AIDS (UNAIDS). The EU very much looks forward to the debate on the findings of the evaluation at the Programme Coordinating Board of UNAIDS, to be held in Portugal in December this year. Further consideration in order to strengthen the mandate of UNAIDS might be called for by the Economic and Social Council.

The EU stands ready to intensify its efforts, also through the United Nations system -- and above all UNAIDS -- aimed at eliminating the scourge of HIV/AIDS. We would like to stress the important role that UNAIDS plays in coordinating the United Nations response to HIV/AIDS. We would like to reaffirm the importance we attach to an enhanced but balanced approach in order to address all dimensions of the epidemic. Prevention must be the mainstay of our response. Prevention and treatment are complementary in a fundamental way and care, support and treatment together are closely linked to effective prevention. We underscore the need to develop national and sectoral policies and plans, in which reproductive health care and services, and population -- including focusing on adolescents -- and gender issues are integrated, along with the need to strengthen primary health care systems and community-based care.

The EU is working actively to increase access to and affordability of key pharmaceuticals and to promote research into and development of new global public goods to confront HIV/AIDS. The EU Action Plan on aid for poverty diseases in developing countries provides a comprehensive package of interventions for the three major communicable diseases -- HIV/AIDS, tuberculosis and malaria -- and includes actions at all levels related to development, trade and research in order to improve health conditions and access to medicines.

In conclusion, we agree with the Secretary-General that the United Nations is a unique instrument available to the world for dealing with critical global issues, such as the fight against HIV/AIDS. We would also in this context like to highlight the importance we attach to the Secretary-General's initiative to strengthen the United Nations. Thus, we have to point out the need to ensure coherence between the follow-up to the special session on HIV/AIDS, the Millennium Declaration and other major United Nations conferences and summits. We must also take a holistic approach to the monitoring and evaluation of our efforts in relation to HIV/AIDS, and find a way to involve all stakeholders, including civil society, in our deliberations.

The Acting President

We have heard the last speaker on the list for this meeting.