General Assembly Session 62 meeting 102

The President

Pursuant to resolution 62/178 of 19 December 2007, the General Assembly will convene, under agenda item 44, a high-level meeting on a comprehensive review of the progress achieved in realizing the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS. The two-day comprehensive review will consist of plenary meetings, an informal interactive hearing with civil society and five panel discussions.

The President

Addressing the global challenges of sustainable development, climate change, extreme poverty, hunger, and the HIV/AIDS pandemic, are the moral and political imperatives of our times. These challenges are all interconnected as progress in one issue leads to positive possibilities in other issues. This is why we are gathered here today.

Combating HIV/AIDS is fundamental to our quest for the dignity and worth of the human person and for better standards of life in larger freedom, words contained in the Charter of the United Nations. Sixty years later these words remain relevant in describing the challenges we face today. I welcome you all to this high-level meeting of the General Assembly to review the progress achieved in realizing the 2001 Declaration of Commitment on HIV/AIDS and the 2006 Political Declaration on HIV/AIDS.

I would like to acknowledge and welcome Mr. Anthony Fauci, a leading figure in the scientific and research community, and Ms. Ratri Suksma, a representative from civil society. At my invitation they will both address the opening session. This high-level meeting provides the opportunity for us first to take stock of the implementation of our commitments, and secondly to assess where we are falling short in meeting the targets in universal access by 2010 and the 2015 Millennium Development Goals (MDGs).

We are making progress towards achieving the 2010 targets for universal access and attaining the 2015 MDG to halt or reverse the spread of the disease.

However, this progress is not nearly fast enough. The failure to make sufficient progress in our response to HIV/AIDS profoundly impacts on all aspects of human development. The HIV/AIDS pandemic is not only a major public health issue, but also a major cause of what we now refer to as a development emergency. We cannot make progress on reducing poverty and hunger when millions of people die of AIDS each year in the most productive years of life, or are too ill and weak actively to contribute to economic and social development. We cannot make progress on universal primary education when, in some countries, more teachers die of AIDS than are being trained to teach. As a result, children are forced to stay at home to care for their sick relatives. We cannot make progress on gender equality and empowerment of women when the majority of HIV-infected adults are women, and infection levels among adolescent girls are still several times higher than for boys of the same age.

I also wish to pay tribute to the 147 Member States that made national submissions, and on this occasion to commend the Secretary-General for his report based on the national reports. As the Secretary-General's report correctly points out, mitigating the pandemic impact will advance the first MDG -- to eradicate extreme poverty and hunger; promote Goals 4 and 5 -- to improve child and maternal health; and contribute to Goal 3 -- to empower women and promote gender equality.

Given the devastation wrought by HIV/AIDS on the education sector, particularly in sub-Saharan Africa, combating HIV/AIDS would also positively impact on efforts to achieve universal primary education. Improving our goal of global response to the HIV/AIDS pandemic must therefore become a central feature in all development efforts. We must continue to devote special attention to the pandemic in sub-Saharan Africa, which in 2007 accounted for 68 per cent of adults living with HIV, 90 per cent of HIV-infected children and 76 per cent of AIDS deaths.

The pandemic remains the leading cause of death among adults in that subregion. Here, the number of people in need of HIV treatment continues to outstrip financial, human and logistical resources, and will fall short of the 2010 universal access target.

The 2001 Declaration of Commitment recognized prevention as the mainstay of the response. Knowledge about the disease is critical for prevention. Yet, as the Secretary-General's report (A/62/780) says, knowledge about the disease among young adults is far below the targets set in 2001. Consequently, it is troubling that in 2007 the rate of new HIV infections was 2.5 times higher than the increase in the number of people on antiretroviral drug therapy. We must therefore step up our prevention efforts.

The situation of some vulnerable groups merits a special focus at this meeting. Children living with HIV, for example, are significantly less likely to receive treatment than HIV-positive adults. Diagnosis of infants is more difficult than in the case of adults, and medicines currently are more appropriate for adults than for children. Women and girls also merit our special attention. According to the Secretary-General's report, women now represent 61 per cent of the HIV-infected adults in Africa, and infection levels among adolescent girls in Africa are several times higher than for boys of the same age.

Addressing this issue, together with the broader issues relating to MDG 3, the promotion of gender equality and the empowerment of women would significantly improve the capacity of women to address the day-to-day challenges associated with the disease.

Prevention of HIV transmission from mother to child is an important and related issue. Measures undertaken in high-income countries have almost eliminated that type of HIV transmission. There has been similar success in lower-income countries that have prioritized such prevention measures. Yet, mother-to-child HIV prevention remains a challenge because children accounted for one in six new infections in 2007.

We should also focus our attention on the plight of children and orphans following the loss to AIDS of one or both parents. In 2001, Member States agreed to implement national strategies to strengthen the capacity of Governments, families and communities to support children orphaned by AIDS. Governments agreed to protect orphans and other children from discrimination, and to prioritize children-focused programmes. However, as the report illustrates, much remains to be done to implement these commitments. Children are our future. However, our own future is at risk if millions of children made vulnerable by AIDS continue to live in situations of dire poverty and hunger.

As Member States concluded during the General Assembly thematic debate on the MDGs in April of this year, success in addressing the health goals depends on building stronger national health-care systems, including better basic science and diagnostic tools. Leadership from national governments in prioritizing health and developing effective plans to combat disease is critical. Leadership, at all levels -- international, national and local -- is critical for an effective response to HIV/AIDS. Experience has demonstrated that courageous leadership at the forefront of prevention efforts contributes to a reduction in the rates of infection. Leadership can ensure that adequate resources are allocated to HIV prevention, treatment and care, and that those resources are spent prudently. Leadership also ensures that those made vulnerable by the disease are also protected.

As we conduct our deliberations, we must remember that the lives of millions depend on our decisions to make universal access a reality. Let us allow this high-level meeting to inspire us through our various forms of leadership. Government leaders, members of civil society and United Nations officials must take the necessary steps in order to see a major turning point in the effort to combat the global HIV/AIDS pandemic.

I now give the floor to the Secretary-General of the United Nations, His Excellency Mr. Ban Ki-moon.

The Secretary-General

Two years ago, States Members of the United Nations pledged to scale up efforts towards attaining universal access to HIV prevention, treatment, care and support by 2010.

We meet today to review how we have fared in living up to that pledge. In that regard, I welcome the General Assembly's initiative in convening this very important meeting.

As my report to the General Assembly makes clear, there have been some important achievements (A/62/780).

By the end of last year, three million people had access to antiretroviral treatment in low- and middle-income countries, allowing them to live longer and have a better quality of life.

There are encouraging trends in the provision of health services for women and children. More mothers now have access to interventions that prevent transmission to their infants. More HIV-infected children are benefiting from treatment and care programmes.

This shows what political will can achieve. It shows what we can do when we have solid commitment and resources to make a real difference.

And yet, there were two and half million new HIV infections last year. There were more than two million deaths. There were twice as many people in need of antiretroviral treatment who had to go without, as there were receiving it.

This situation is unacceptable.

Our challenge now is to build on what we have started, bridge the gaps we know exist and step up our efforts in years to come.

We can do this only if we not only sustain but step up our levels of commitment and financing. Let us make sure that we do that.

This year is a milestone year in several ways. In September, we will meet in this Assembly to review progress on the Millennium Development Goals after passing the midpoint to the deadline of 2015. Halting and reversing the spread of AIDS is not only a goal in itself; it is a prerequisite for reaching almost all the others. How we fare in fighting HIV/AIDS will impact all our efforts to cut poverty and improve nutrition, reduce child mortality and improve maternal health, and curb the spread of malaria and tuberculosis.

Conversely, progress towards the other goals is critical to progress on HIV/AIDS -- from education to the empowerment of women and girls.

This year is also the year that marks the sixtieth anniversary of the Universal Declaration of Human Rights. Six decades after the Declaration was adopted, it is shocking that there should still be discrimination against those at high risk, such as the individuals living with HIV. This discrimination not only drives the virus underground, where it can spread in the dark, but just as importantly, it is an affront to our common humanity.

One of my most moving experiences as Secretary-General has been my meetings with the Organization's own group of HIV-positive staff, UN Plus. They are wonderfully courageous and motivated people. I am determined to make the United Nations a model workplace in embracing them and all our staff living with HIV.

In the world as a whole, I call for a change in laws that uphold stigma and discrimination, including restrictions on travel for people living with HIV.

Finally, let me end on a note of gratitude. This is the last General Assembly high-level meeting to be attended by Dr. Peter Piot as Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS). Let me pay tribute to this tireless leader, who has been at the vanguard of the response to AIDS since the earliest days of the epidemic, and who has shaped UNAIDS into a living example of United Nations reform in the best and truest sense of the word.

We need many more leaders like Dr. Piot in every sector of society. May we all be equal to the mission in the crucial years ahead. I thank the Member States for their commitment and leadership.

The President

I thank the Secretary-General for his statement. In accordance with resolution 62/178 of 19 December 2007, I now give the floor to the Executive Director of the Joint United Nations Programme on HIV/AIDS, Mr. Peter Piot.

Mr. Piot (Joint United Nations Programme on HIV/AIDS)

I take the floor today to speak on behalf of the 10 organizations that co-sponsor the Joint United Nations Programme on HIV/AIDS (UNAIDS).

As the report of the Secretary-General shows, we are now finally seeing real results in almost every region, results that many once said could never be obtained because of denial of the AIDS epidemic or because there was not enough money or because health systems were too weak or because they did not think that people would take their medication on time. Just imagine what would have happened if we had waited to resolve all these issues -- these real issues. Where would those three million people who are now receiving antiretroviral treatment be now? I know that most of them would not be alive.

It is always good when optimism triumphs over pessimism. But much remains to be done. At current rates of scaling up, most low- and middle-income countries will still fail to meet universal access targets by 2010. Many will be unable to meet them by 2015, unless we urgently change the way we operate.

As we heard from the Secretary-General, more than two thirds of people who need antiretroviral drugs still cannot obtain them. Six thousand people continue to die of AIDS every day, and AIDS is still the number one cause of death in Africa, ahead of malaria and lower respiratory tract infections, and is the seventh highest cause of mortality worldwide. For every two people who initiate antiretroviral therapy, five become newly infected.

The implications of HIV prevention failures are clear. Unless we act now, treatment queues will get longer and longer. It will become more and more difficult to get anywhere near universal access to antiretroviral therapy.

That is why I have been insisting on the importance of shifting to a new phase in the AIDS response, a forward-looking phase in which we treat AIDS as both an immediate crisis, which it is with 6,000 deaths every day, and as a long-wave event. This approach represents our best opportunity to reach universal access, and we cannot let this chance slip by. Continuing with business as usual or giving in to those who pretend that AIDS has been fixed or has not become a heterosexual epidemic or a generalized epidemic will simply condemn millions of people to perfectly avoidable deaths.

So where do we start? First, we must sustain the gains we have made in HIV treatment. That depends partly on investing in health services and health work forces. It also depends on making first, second and third-line HIV drugs available and affordable to all people, wherever they live, whoever they are and whatever their lifestyle. It means investing in new drugs for the future, and it means making sure that antiretroviral treatment is available where mother-to-child transmission prevention programmes are operational, and vice-versa.

Secondly, we must urgently intensify HIV prevention. Do not believe anyone who claims there is one simple shortcut or one simple solution to doing that. There is not. Over and over again, we have learned that there is no magic bullet for HIV prevention and that success depends on multiple approaches, while we continue to intensify research into HIV vaccines and microbicides. It also means working harder to make HIV prevention accessible to everyone, including men who have sex with men, sex workers and injecting drug users, for whom harm reduction is the most effective approach.

We also need to make closer links between HIV programmes and tuberculosis programmes, as we heard yesterday at the very dynamic session on HIV and tuberculosis, with programmes for maternal and child health and sexual and reproductive health. If we can provide every teenager around the world with access to HIV prevention, ranging from sex education, through programmes to promote mutual respect between boys and girls, to access to HIV prevention, we will be well on the way to a generation of HIV-free adults.

It is time now to speak out and take concrete action to address gender inequality and the special vulnerabilities of women, homophobia and other human rights violations that make AIDS such a complex and challenging issue. The stigma and discrimination around AIDS remain as strong as ever, and in this context I join my voice to that of the Secretary-General in calling on all countries to drop restrictions on entry to people simply because they are living with HIV.

It is time to increase funding. Sometimes I hear that there is "too much money for AIDS". Nothing could be further from the truth. Since the creation of the Global Fund to Fight AIDS, Tuberculosis and Malaria and the United States President's Emergency Plan for AIDS Relief, there has been a tremendous increase in resources for AIDS, with the results we know. But the sobering reality is that the AIDS response remains under-funded. Last year, there was an $8 billion shortfall. So if we are going to sustain the gains we have made already and not waste the investments and the results we have, if we are going to get anywhere near universal access to HIV prevention treatment and care, the world will need to significantly increase investments in AIDS.

In addition, we must keep prioritizing the UNAIDS mantra of making the money work for people on the ground. The money must be there where it makes an impact. There are still many areas where we can reduce unit costs of delivery, strengthen local ownership, improve coordination and increase accountability.

We have come a long way since the 2001 special session on HIV/AIDS, a special session that showed the power of this Assembly and of joining the forces of all nations. It was an historic turning point in the global response to AIDS, as it triggered political leadership, financing and action on the ground. AIDS may be one of the defining issues of our time, but it is clearly now a problem with a solution. Equally clear, however, is the fact that achieving that solution will take time and that we have still only just started what is going to be a long, tough job. The challenge to us all now is to stay the course right through to the very end and never, ever give up.

The President

In accordance with General Assembly resolution 62/178 of 19 December 2007, I now give the floor to the representative of civil society, Ms. Ratri Suksma, of the Coordination of Action Research on AIDS.

Ms. Suksma (Coordination of Action Research on AIDS)

I stand before you as a woman from the Asia-Pacific region, where women's highest risk of HIV infection is through marriage. For more than 25 years now, we have known how HIV is transmitted and can be prevented. But some Governments still believe that they can protect their country from HIV by stopping non-nationals infected with HIV from entering their country. Attitudes and policies such as those will not contribute to reaching the goal of universal access. It will, however, contribute to increased stigma and discrimination against people living with HIV. Yet, your countries have committed to the goal of universal access by 2010. So, we are halfway there, and I ask, how strongly do you hold that commitment?

In my region, experts say there is a concentrated epidemic. By that they mean that HIV is contained within marginalized and vulnerable groups such as drug users, sex workers, gay men, men who have sex with men -- many of whom are married -- transgendered people, migrant workers, prisoners and even refugees, who are being infected with HIV at a higher rate. Yet, they are often denied or have limited access to HIV prevention, treatment, care and support. I ask you, why? Are we not all human and deserving of the same rights and treatment? Those communities are not only at a higher risk of HIV in Asia, it is the same everywhere. If you allow one group to become infected with HIV, you will never stop the epidemic. Is that not the lesson we have learned?

In fact, the epidemic is moving out of the concentrated groups into the general population. Look at the increasing rates of infection among women, children and youth. That is where you can see the effects of falsely believing that HIV will remain isolated among certain groups. Those groups need services that are sensitive to their needs, supported by adequate finances and resources. Instead, many countries have criminalized behaviours that push people underground and make them afraid to come forward to receive proper prevention and treatment.

Secretary-General Ban Ki-moon recently noted that we must guard against legislation that blocks universal access by criminalizing the lifestyle of vulnerable groups. We have to find ways to reach out to sex workers, men who have sex with men and drug users, ensuring that they have what they need to protect themselves.

Here, communities, non-governmental organizations and people living with HIV can complement and build upon our efforts. No one can do it alone. We have to work hand in hand, together.

Here are some of the recommendations: decriminalize behaviours associated with the risk of HIV that are associated with specific groups; eliminate mandatory testing of migrant workers and travel restrictions for people living with HIV; pass enabling laws that make it easier to get prevention methods to people who need them, especially clean needles for drug users and condoms for sex workers and their clients; stop treating HIV as a separate issue; link the special sessions of the General Assembly on HIV with its sessions on drugs; integrate reproductive health, gender and human rights into HIV prevention; address co-infection with hepatitis-C and tuberculosis using urgent prevention and treatment responses; make treatment affordable and easily accessed by all; explore exercising the flexibility of the trade-related aspects of intellectual property rights, such as compulsory licences for HIV, hepatitis-C, tuberculosis and other essential medicines; and let us, the community, sit at the table together with the Assembly to make decisions.

I am also a person living with HIV. By revealing my HIV status publicly, I am taking the risk of being banned from entering this country and 70 other countries around the world. When I found out about my HIV status, in 2006, it was thought in my country that only sex workers and drug users became infected; I am neither. But, really, what does it matter how I got infected? As a woman living with HIV, I could be accused of bringing HIV into my home -- even for something I did not do -- stripped of any inheritance rights and thrown out in the streets because of a health condition. As a woman, I need my human rights respected, as well as the rights to property and inheritance. I need protection against domestic and sexual violence. I need to be able to manage and control all matters related to my sexuality and reproductive health. As a person living with HIV, I need equal access to prevention, treatment, care and support. And as a mother, I ask this not only for myself but for my daughter and my future generations.

In conclusion, I am committed to working for the best possible life for people everywhere. While it is not my intention to embarrass anyone or point fingers, I do want to ask: What is more embarrassing and shameful than a tragedy that could have been prevented? We have the tools and knowledge. We need the will. But more than anything else, we need action. Keep your promise and renew your commitment of universal access by 2010. Not to do so would mean to condemn many people living with HIV, like me, to unnecessary pain, suffering and even death. I will honour my commitment. And, so I ask, will you honour yours?

The President

In accordance with resolution 62/178, of 19 December 2007, I now give the floor to the eminent person actively engaged in the response to AIDS, Mr. Anthony Fauci, Director of the National Institute of Allergy and Infectious Diseases of the National Institutes of Health of the United States of America.

Mr. Fauci (United States)

It is a true honour and a privilege to share with the General Assembly my perspectives as a physician and scientist on the global HIV/AIDS pandemic, the progress we have made and the many challenges that remain.

As we have all sadly witnessed, AIDS is one of the most devastating scourges in human history, and its full impact has yet to be realized. As this body well knows, most cases have occurred in poor countries, where HIV/AIDS is superimposed on other serious problems, such as poverty, food insecurity, a lack of clean water and sanitation and endemic infections such as malaria, tuberculosis and diarrhoeal, respiratory and parasitic diseases.

Looking back as physician and a scientist who was involved in caring for and studying the earliest cases of HIV/AIDS in the United States, those early days were the darkest of my professional career. Those of us caring for patients with AIDS had few tools at our disposal. The only treatments we could provide were largely palliative. Most of our patients, sadly, died within months of coming to our attention.

Then, with the discovery of HIV as the cause of AIDS, in 1983, we launched an extraordinary and breathtaking odyssey of scientific discovery. In the developed world, those discoveries were translated to the benefit of patients almost immediately, but not so in the developing world. A diagnostic test for HIV was rapidly developed. Basic research studies unlocked many of the mysteries of the virus and how it causes disease. In turn, those scientific advances facilitated the development of nearly 30 life-saving drugs to treat HIV infection.

But as is the case with most diseases, the developed world would benefit first and foremost from the fruits of AIDS research. What I call the implementation gap between biomedical research discoveries that my colleagues and I have made over the years and the delivery of those advances to those who need them, particularly in the developing world, was most dramatic in the provision of HIV/AIDS drugs. However, in the past several years, as the Assembly has heard from the other speakers, programmes such as the Global Fund to Fight AIDS, Tuberculosis and Malaria, the United States President's Emergency Plan for AIDS Relief and individual Governments, non-governmental organizations (NGOs), philanthropies and many others have done heroic work in making AIDS drugs available to those who need them.

Again, as we have heard, 3 million people with HIV are now receiving antiretroviral drugs in low- and middle-income countries. Much progress has been made. Nonetheless, just 30 per cent of HIV-infected people in those countries who need treatment based on established medical criteria are actually receiving those life-saving treatments. We clearly need and must do more. These recent successes provide us with the impetus to accelerate our efforts to develop the fruits of biomedical research and deliver them, as well as sound public policies, to these countries.

It would be naive for me or you to think that that task will be simple and straightforward. Providing life-long, but life-saving, therapy for any disease is challenging in most settings, and certainly in the case of poor countries with many other health, social and economic problems. The argument has been put forth that it is futile to attempt to provide universal access to therapy for HIV in poor countries because viral resistance to the drugs will inevitably develop. As a scientist, I reject that argument. The answer to that dilemma is not to withhold therapy and care; it is to develop new and better drugs and to perform the operational research that would guide the best practices appropriate for resource-poor settings to minimize the emergence of drug resistance.

That brings up the broader issue of health systems in the developing world and the goal, again, of narrowing the implementation gap. As we all know, even with the availability of HIV drugs or drugs for other important diseases, treatment does not just happen spontaneously. In much of the world, a shortage of trained health-care workers remains an important rate-limiting factor in efforts to scale-up services to people with HIV infection. Significant resources are needed to train doctors and nurses in resource-poor areas, as well as community health-care workers to provide care for HIV/AIDS and, importantly, for other diseases in the settings in which they occur.

Furthermore, medications alone rarely solve problems inherent to the settings in which catastrophic diseases such as HIV/AIDS occur. We also must provide services that enable HIV-infected individuals to overcome the social and economic impediments to successful adherence to HIV/AIDS treatment and care. These services include food supplements, transportation to clinics, child care and housing, as well as care for other health issues.

Simply stated, the treatment and care of people with HIV cannot be done in a vacuum, but must be implemented in the context of their overall health needs. In this regard, as terrible as HIV/AIDS is, the global attention and momentum that has been generated to address this challenge, particularly in developing countries, may serve as a lens to focus our attention on other equally compelling health needs. This approach need not have AIDS services compete for scarce resources required for those other diseases -- as some have suggested, and I believe incorrectly -- but should serve as an opportunity for synergism in addressing the multiple health problems that beset so many poorer nations and communities.

I believe that striving for universal access to AIDS therapy and related services is a public health and moral imperative that should be embraced by all. However, it may be logistically impossible to achieve this goal, as newly acquired infections are outstripping our ability to treat everyone infected with HIV. As participants have heard, in 2007, 2.5 people were newly infected for every person put on treatment. We cannot end the HIV/AIDS pandemic merely by treating infected people -- even if that were logistically possible. This fact, however, does not relieve us of the moral responsibility to treat HIV-infected people where possible. But treatment alone is not the solution to the problem.

The solution is prevention. Robust HIV prevention efforts, hopefully with but possibly without a safe and effective HIV vaccine, are critical to slowing the trajectory of the AIDS pandemic.

Scientifically proven prevention approaches such as behavioural modification, condom distribution, prevention of HIV transmission from mother to baby and the provision of clean needles and syringes to drug users have been successfully deployed in many countries. But sadly, only one fifth of people at risk of HIV infection have access to such preventive services.

In scaling up and applying preventive services, we can draw important lessons from common elements of the prevention efforts in those countries that have had documented success in this area. Such factors include the strong support of political, religious and community leaders; adequate and sustained -- and I underline "sustained" -- funding; the use of the media to raise HIV awareness; efforts to encourage respect, tolerance and compassion for HIV-infected people; and, importantly, the use of evidence-based strategies derived from a detailed understanding of the specific dynamics and epidemiology of the epidemic in various settings.

Encouragingly, new means of preventing HIV infection are emerging through well-designed and well-implemented clinical research studies. Recent studies in Africa have confirmed that adult male circumcision can help prevent men from becoming infected with HIV by heterosexual intercourse, if the procedure is properly and hygienically performed and accompanied by appropriate counselling and post-surgical care.

Medical research can help address other societal impediments to the control of HIV. In this regard, under certain circumstances and in some countries more than others, the spread of HIV infection is linked to the lack of empowerment of women. As participants have heard, globally, nearly half of all HIV infections have occurred among women and girls. In many countries, including my own country, women may find themselves in situations in which they lack the power to protect themselves from sexual transmission of HIV. Ongoing research to develop microbicidal gels or creams to be applied before sex offers the hope of empowering women to protect themselves from HIV infection when the use of condoms or the refusal of sexual intercourse is not feasible for them.

Finally, a preventive HIV vaccine still remains the greatest hope for halting the relentless spread of the HIV/AIDS pandemic. As I have personally witnessed, the search for an HIV vaccine has been extremely challenging because of the unique nature of the virus, particularly its uncanny ability to elude the body's natural attempt to contain it. HIV has proven to be very different from those viruses for which we have developed effective immunizations. We must solve the mystery of how to prompt the human body to produce a protective response to HIV, something that, puzzlingly, natural infection does not seem to be able to do.

As participants know from reading the newspapers and other media, this past year was disappointing in the search for a safe and effective HIV vaccine. The top candidate proved to be ineffective when clinically tested. Although this result was disappointing, such disappointments are not unusual in the history of vaccine development. Historically, it has taken decades to find vaccines to combat most infectious diseases. Researchers usually experience numerous setbacks and disappointments before they reach success; yet they have persevered. Finding a safe and effective HIV vaccine demands an equally intense resolve, even as treatment and non-vaccine prevention efforts are ramped up.

In summary, during the first 27 years of this terrible pandemic, much has been accomplished, but we are sobered by the many challenges that remain.

Developing HIV interventions and delivering them to the people who need them, regardless of where they happen to live, will require political will, a long-term commitment of considerable financial resources, scientific and public health vision, and dedication from all of us in society. We should be proud of the many scientific advances that have been made in the fight against AIDS. However, much, much more needs to be done by all of us, because the implementation gap must be closed.

To be sure, history will judge us as a global society by how well we address the next 27 years of HIV/AIDS as much as -- or more than -- by what we have accomplished in the first 27 years.