World AIDS Day 2006: Calling everyone to account

none 30 Nov 2006 – 17:10 (modified on 30 Nov 2006 – 17:27)

by mlepeska

Advocates for a stronger global response to HIV and AIDS march in Toronto in advance to the International AIDS Conference, August 2006

In 2000, heads of state made a promise to halt and begin to reverse the spread of AIDS by 2015.

New reports by UNAIDS and the World Health Organization (WHO) indicate that, as of 2006, the epidemic continues to spread in every region of the world. By now more than 65 million people have been infected with HIV and well over 25 million people have died of AIDS since 1981, 2.9 million in 2006 alone. At this rate, the WHO predicts that in the next 25 years another 117 million people will die, making AIDS the third leading cause of death worldwide.

The promise made in 2000 as part of the Millennium Development Goals has been followed by many other targets and commitments over the past six years.

With “accountability” the theme of this World AIDS Day on 1 December, campaigners across the globe are calling leaders to account not just for good intentions, but for action to make those promises a reality.

The promise of Universal Access

In 2000, world leaders set ambitious global targets through the Millenium Development Goals, including halting and reversing HIV and AIDS by 2015. In 2001, the first United Nations Special Session on a health issue resulted in a Declaration of Commitment on HIV/AIDS which itself set targets to be reviewed every several years to ensure progress.

Then came the most ambitious public target of all. In 2003, the World Health Organization and UNAIDS launched the "3 by 5" initiative, to provide three million people living with HIV in low- and middle-income countries with antiretroviral treatment (ART) by the end of 2005. While falling far short of the goal, the campaign gave everyone a glimpse of what was possible – a rapid increase in access to life-prolonging treatment – as well as spotlighting obstacles that prevent so many from receiving ART in the first place.

In 2005, echoing the calls of civil society campaigners, leaders at the G8 Gleneagles Summit declared that they would work with “WHO, UNAIDS and other international bodies to develop and implement a package for HIV prevention, treatment and care, with the aim of as close as possible to universal access to treatment for all those who need it by 2010”.

Since then, the promises have only gotten bigger while efforts to fulfil earlier promises continue to fall far short. The high level review of the 2001 UN Declaration of Commitment acknowledged that most of the targets set had been missed, but, the political declaration adopted unanimously on 2 June 2006 called for reaching Universal Access not just for treatment, but also to prevention, care and support in just four years.

The first phase of reaching Universal Access is already off to a rocky start. Countries were to set national targets specifying the steps to Universal Access by the end of the year. In a briefing note to Civil Society, UNAIDS reported in November that 84 countries had already set at least some of the needed targets. However the ambitious targets are already criticized for the lack of meaningful involvement, in many cases, of civil society, who are key partners in the delivery and reception of services.

Other campaigners point to more fundamental flaws. Chris Collins, of the International Treatment Preparedness Coalition (ITPC), questions whether the targets are strategic, with resources to back them up, or just “a shopping list”. “One of the major problems,” he notes, “is that we have not defined what Universal Access is. If you haven’t defined the goal, you can’t figure out how to get there.” A report issued by ITPC earlier this week is critical of current efforts to scale up treatment.

Not surprisingly, the financial implications of Universal Access are huge. UNAIDS estimates that it will take USD 20-23 billion per year by 2010 to support rapidly scaled-up AIDS responses in low- and middle-income countries alone. A resolution passed by the European Parliament today in support of Universal Access calls for “a clear plan for funding”.

Marcel van Soest, executive director of the World AIDS Campaign, points out that countries, especially donor countries, have yet to reflect the need to scale up the response in their budget lines.

In fact, while it appears that there is more money being spent on AIDS than every before, the reality, van Soest says, is that this is not “new money.” Instead, it is being shifted from other health and development budgets, which also need to be strengthened for an effective response to AIDS.

As a result, in 2005 only 9% - not 80% as had been committed in 2001 - of pregnant women were receiving treatment that would stop them infecting their baby – treatment that only costs a few dollars.

By 2005, 90 percent of young people were supposed to know how to prevent AIDS. In reality only 20 percent of young women and 30 percent of young men have this knowledge.

Recent UNAIDS figures indicate that less than 1 out of every 5 people at risk of infection have access to basic prevention services. Only 1 of every 8 people who want to be tested, to know their status and protect others, are currently able to do so.

The rationale of Universal Access

Given current figures, achieving Universal Access by 2010 seems impossible. But AIDS campaigners recognize that, one way or the other, every sector must work together to achieve Universal Access to treatment, prevention, care and support. And the sooner this happens, the better – not just for lives saved but because the costs will only rise.

Mabel Bianco, from Fundación para Estudio e Investigación de la Mujer (FEIM) notes that, in Argentina, Universal Access to treatment has almost been achieved. But access to treatment may be under threat because access to prevention is not addressed.

“If this epidemic continues to grow”, she says, “in a few years, the government will not have the money to give drugs.”

Bianco notes that in her country, young women are more at risk and infections are growing. “Not to give them the means to protect themselves is the same as not giving them treatment.” For her, prevention will require speaking openly of sexuality and supporting harm reduction.

The first step towards Universal Access, though, is overcoming the stigma and discrimination that still surround people living with or affected by HIV. Rev. Japé Heath, of the African Network of Religious Leaders Living with or Personally Affected by HIV and AIDS (ANERELA+), warns that universal access “will never be a reality in a world in which people are too frightened to know their HIV status.” Not only delivery of services has to be tackled, Heath states, but the ability of people to live openly with HIV.

The bottom line, as Sipho Mthathi, Treatment Action Campaign in South Africa stated in their recent newsletter, is: “We need to give communities the resources they need to address the socio-economic and cultural drivers of the epidemic.”

Civil society – making Universal Access a reality

Collins credits civil society activism as the major reason why the response to HIV and AIDS is as mobilized as it is today, although so much more has to be done. “‘Accountability’ as the theme for World AIDS Day shows that civil society has to work with government with much more focus. If we don’t do that we’ll see a serious lack of energy in the whole process.”

Energy from civil society activism on HIV and AIDS is directed not only to governments, but society itself.

Prateek Suman, a member of the Youth Coalition, states, “We have to wake up to the reality that AIDS presents us. We need to wake up and realize that we can do something about it. That’s the accountability part of it,” he says. “Governments have a major role to play, and we do as well, especially around stigma and discrimination. We want to stop it before it gets worse.”

Labour unions are increasingly involved and vocal about the response to HIV and AIDS, from advocacy with the G8 to action in the workplace. This World AIDS Day, unions are launching a campaign calling on the G8 to set up a high-level working group on AIDS. Alan Leather, Global Unions’ AIDS Programme Steering Committee, says of the G8 meeting in 2007, “By making AIDS a regular feature of this and future G8 agendas, we will use our energy to fight AIDS rather than fighting to make sure it is recognized as an issue worthy of constant attention.”

Lucien Royer, of the Trade Union Advisory Committee to the OECD, says that cooperation on HIV and AIDS models a new way of working with employers. “Historically, unions are created because of worker dissatisfaction, and the processes they engage in are long and confrontational,” he notes. To include HIV and AIDS in the current 2.3 million collective agreements involves “not just tacking on a current issue” but a “reconfiguration of occupational safety mechanisms that requires more cooperation with employers.”

Heath says that there has been such demand from people in other countries that ANERELA+ will be expanded into an international network. “ANERELA will be transformed in the coming months to INERELA to enable us to support people across the world to be agents of change.”

Charles Kaduwa, working with Women Fighting for AIDS in Kenya, highlights their advocacy work with the government to ensure that Universal Access can become reality, “We need to attain universal standards to treatment and prevention, and community workers and government have to work towards that,” he stated.

Accountability – the first step to stopping AIDS

“AIDS is the biggest challenge humanity has had to deal with,” says van Soest. More than the technical problem of developing drugs and making sure they are delivered, AIDS “is related to all the taboos and vulnerabilities that affect all our societies” he states. “AIDS challenges us more than any other infectious disease.”

In the face of the overwhelming complexity and rampant stigma that surround AIDS, failed promises have become the norm. The change that is desperately needed is radical, but also shockingly simple.

In his World AIDS Day message, Kofi Annan, secretary-general of the United Nations, perhaps said it best: “Accountability — the theme of World AIDS Day on Friday — requires every president and prime minister, every parliamentarian and politician, to decide and declare that "AIDS stops with me."

By Sara Speicher, World AIDS Campaign

For further information:

World AIDS Day takes place each year on 1 December. The theme for 2006 is “accountability”, with the slogan, “Stop AIDS. Keep the Promise”. The theme is set by the World AIDS Campaign in consultation with civil society organisations around the world. See for information on the theme, World AIDS Day events by campaigners all over the world, free photos, PSA and videos that can be provided for broadcast, and other visual material.

Special World AIDS Day statements from leading personalities can be found at the World AIDS Campaign website:

Detailed information about country processes to set targets:

The website offers a campaigning and information platform for civil society groups tracking Universal Access progress.

Missing the Target #3: Stagnation in AIDS Treatment Scale Up Puts Millions of Lives at Risk

Photos to accompany this story can be viewed here.

For more information, links to local campaigns and interviews, contact Sara Speicher, , phone: +44 1524 727 651. fax: +44 1524 727 829.