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Date: Tue, 3 Jul 2001 11:31:15 -0500
From: APIC <[log in to unmask]>
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Subject: Africa: AIDS Assembly Summary, 1

Africa: AIDS Assembly Summary, 1
Date distributed (ymd): 010703
Document reposted by APIC

Africa Policy Electronic Distribution List: an information
service provided by AFRICA ACTION (incorporating the Africa
Policy Information Center, The Africa Fund, and the American
Committee on Africa). Find more information for action for
Africa at http://www.africapolicy.org

+++++++++++++++++++++Document Profile+++++++++++++++++++++

Region: Continent-Wide
Issue Areas: +economy/development+  +health+

SUMMARY CONTENTS:

This series of three postings contains brief topical excerpts from
the official United Nations Declaration of Commitment on HIV/AIDS,
June 27, 2001, paired with related excerpts from parallel
statements released by youth, African civil society groups, and
international civil society groups at the UN General Assembly
Special Session. Because of the exceptional importance of
evaluating the outcome of this unprecedented global gathering, we
are making an exception of sending out three postings for your
reference.

This posting contains excerpts on prevention and treatment. Related
postings focus on rights and discrimination and on resources.

The full UN Declaration is available at:
http://www.un.org/ga/aids/coverage/FinalDeclarationHIVAIDS.html

The full Youth Position Paper is available at:
http://www.africapolicy.org/adna/ung0106c.htm

"HIV/AIDS and Civil Society: Africa's Concerns and Perspectives" is
available at:
http://www.africapolicy.org/adna/ung0106d.htm

"A Civil Society Perspective on the UNGASS Declaration of
Commitment" is available at:
http://www.africapolicy.org/adna/ung0106.htm

+++++++++++++++++end profile++++++++++++++++++++++++++++++

PREVENTION AND TREATMENT

*UN Declaration, June 27, 2001*

Prevention must be the mainstay of our response.

[47] By 2003, establish time-bound national targets to achieve the
internationally agreed global prevention goal to reduce by 2005
H.I.V. prevalence among young men and women aged 15-24 in the most
affected countries by 25 percent and by 25 percent globally by
2010, and to intensify efforts to achieve these targets, as well as
to challenge gender stereotypes and attitudes, and gender
inequalities in relation to H.I.V./AIDS, encouraging the active
involvement of men and boys. . . .

[52] By 2005, ensure that a wide range of prevention interventions
which take account of local circumstances, ethics and cultural
values is available in all countries, particularly the most
affected countries, including information, education and
communication in languages most understood by communities and
respectful of cultures, aimed at reducing risk-taking behavior and
encouraging responsible sexual behavior, including abstinence and
fidelity; expanded access to essential commodities, including male
and female condoms and disposable syringes; harm-reduction efforts
related to drug use; expanded access to voluntary and confidential
counseling and testing; safe blood supplies; and early and
effective treatment of sexually transmissible infections. . . .

[54] By 2005, reduce the proportion of infants infected with H.I.V.
by 20 percent and by 50 percent by 2010, by insuring that 80
percent of pregnant women accessing antenatal care have
information, counseling and other H.I.V. prevention services
available to them, increasing the availability of and by providing
access for H.I.V.-infected women and babies to effective treatment
to reduce mother-to-child-transmission of H.I.V., as well as
through effective interventions for H.I.V.-infected women,
including voluntary and confidential counseling and testing, access
to treatment, especially antiretroviral therapy and, where
appropriate, breast- milk substitutes and the provision of a
continuum of care. . . .

[55] By 2003, ensure that national strategies supported by regional
and international strategies are developed in close collaboration
with the international community, including governments and
relevant intergovernmental organizations, as well as with civil
society and the business sector, to strengthen health-care systems
and address factors affecting the provision of H.I.V.-related
drugs, including antiretroviral drugs; inter alia affordability and
pricing, including differential pricing; and technical and health
care systems capacity. Also, in an urgent manner make every effort
to: provide progressively and in a sustainable manner, the highest
attainable standard of treatment for HIV/AIDS, including the
prevention and treatment of opportunistic infections, and effective
use of quality-controlled anti-retroviral therapy in a careful and
monitored manner to improve adherence and effectiveness and reduce
the risk of developing resistance; to cooperate constructively in
strengthening pharmaceutical policies and practices, including
those applicable to generic drugs and intellectual property
regimes, in order further to promote innovation and the development
of domestic industries consistent with international law;. . .

*Youth Caucus Position Paper, June 27, 2001*

Young people have a right to protect themselves against HIV, and
our prevention efforts must use this as a basis for all activities
geared toward stopping the spread of AIDS.

Youth commitments

+ We will address the power relations between young women and men
as central to prevention, ensuring that all prevention programs are
gender sensitive and provide young women with the skills to
negotiate safer sex while teaching young men to respect the human
rights of girls and young women.

+ We will obtain and provide full and complete sexual and
reproductive education, information and services to allow youth to
make informed decisions about sex.

+ Our prevention efforts will confront the range of situations in
which young people may find themselves, in order to address all
vulnerable youth, including but not limited to: young women, people
confined to prisons and institutions, young people in refugee
settings, homeless youth, unemployed youth, out of school youth,
young people from ethnic minorities and/or stigmatized social
groups, young people living with AIDS, rural youth, young injecting
drug users, young commercial sex workers, young men who have sex
with men and young people living in extreme poverty;

+ We will demand access to male and female condoms for all young
people who are sexually active, and will support and encourage
young people who choose to abstain from sex;

+ We will take HIV/AIDS tests and encourage our peers to find out
their sero-status so that we can live healthy and productive lives.

HIV/AIDS treatment is a fundamental human right, and is
indispensable for effective prevention.

+ We dedicate ourselves to work at community levels to develop
programs in which young people assist their peers and women, who
bear the brunt of caring for the sick and providing psycho-social
support, in ways that promote community acceptance of HIV/AIDS,
positive living, and the sharing of responsibility for the care and
treatment of people living with HIV/AIDS.

+ We demand that governments adopt and implement trade agreements
that will guarantee access to AIDS medicines.

+ We call on the private sector and governments to significantly
scale up financing for infrastructure and treatment.

*African Civil Society Statement, June 26, 2001*

In addition to the major issues already highlighted in the
Declaration, we call upon our Governments to prioritize
re-investment in primary health care infrastructure and systems in
rural areas, as a way of scaling up HIV/AIDS response in Africa.

1. We recommend that an Essential Prevention and Care Package
should be developed and made widely accessible.   We recognize the
importance of research in enhancing prevention, care and treatment,
however, such research should not delay the implementation of
prevention, care and treatment.

2. The centrality of community-based responses in the African
context for prevention and care needs to be recognized and
nurtured.

3. Civil society demands that there be full access to quality ARVs,
and drugs for opportunistic infections for all, at affordable
prices, taking into account the low purchasing power of vulnerable
groups.

8. We call for the review of TRIPS in relation to the production
and distribution of ARVs, such that the central concern is saving
lives rather than profit.

*Civil Society Statement, June 27, 2001*

Though the Declaration notes that prevention, care, support and
treatment are mutually reinforcing elements of an effective
response to the epidemic, it is necessary to link these components
within a comprehensive approach that recognises the impact of
HIV/AIDS on multiple sectors. Additionally, these measures should
actively involve people living with HIV/AIDS and organizations
working in the economic, social, legal, political and cultural
sectors. Such an approach is essential to address one of the
underlying contributory factors to the widespread advancement of
the epidemic -- poverty.

The Declaration refers to making prevention programmes "available",
or "efforts" to provide high standards of treatment--wording which
implies a passive approach. This does not acknowledge the dominant
role communities and self-empowerment efforts have played and
continue to play in the response to HIV/AIDS. The role of
communities, however, must be complemented by government
programmes; governments must be held accountable for actual
implementation of such programmes, in great part by actively
empowering vulnerable groups and civil society in the design,
implementation and monitoring of programmes within a human-rights
framework.

Such empowerment, including the mobilization of financial and
human resources, is a necessary condition for the success of
programmes; only when people are aware that they have rights to
prevention and care programmes and services can they adequately act
to defend and implement those rights.

Prevention efforts for the most vulnerable groups should include:

- full access to comprehensive sexuality and sexual & reproductive
health education and services, regardless of race, gender, age, HIV
status, socio-economic status and sexual orientation;

- risk- and harm-reduction strategies, including the availability
and accessibility of STI diagnosis/treatment, condoms, microbicides
and lubricants, as well as needle and syringe exchange and drug
substitution and maintenance programmes, for all people;

- consideration of breast milk substitutes for babies of mothers
living with HIV/AIDS only when they are acceptable, feasible,
affordable, sustainable and safe; otherwise their use could lead to
greater infant morbidity and mortality in resource-poor countries;

- political leadership, commitment and action to address policies,
legislative, cultural and economic factors that increase
vulnerability to HIV/AIDS, including reviews of the extent to which
current prohibition laws on illegal drugs and sex work contribute
to the spread of HIV infection.

An effective response to HIV must include prevention, care and
support (including treatment) and impact mitigation, especially the
continuing support for orphans and vulnerable children.

In many countries, the burden of care has gone beyond the
capacities of families, communities and institutions. Therefore, we
insist that more attention be given to supporting care-givers, with
special attention for women and older persons, who bear a
disproportionate part of this burden.

Care packages should be comprehensive and relevant to the local
context. Client-centred counselling and education on all the
elements of promoting a healthy life, as well as nutritional
support, constitute an essential component of treatment and support
for people living with HIV/AIDS. Within this context, it is
essential to provide ongoing education and training for health-care
providers on internationally recommended treatment protocols and
regimens, and on appropriate client-centred counselling.

Human rights are not negotiable: the global threat posed by
HIV/AIDS does not allow people's health and lives to be traded
against companies' intellectual property rights. Antiretroviral
drugs and medications for the treatment of opportunistic infections
must be made available and accessible to all people living with
HIV/AIDS. The international community, governments, civil society
and the business sector should take extraordinary initiatives to
fully exploit existing trade agreements or adapt them where
conditions require to do so, in order to guarantee access to
treatment and care. The pricing of treatments should be
differentiated and adapted, so that all countries have equitable
opportunities to provide such treatment. These efforts must be
integrated into national treatment and care programmes by 2003, not
2005 as stated in the Declaration.

Provision of treatment should be continuous and sustainable in
order to avoid drug-resistance. This implies that governments
should make investments in the health-care infrastructure and human
resources to ensure such continuity and sustainability.

************************************************************
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