7 April 2005
In Population Commission, Keynote Speaker Calls for Marshall Plan by Rich Countries to Counter AIDS Epidemic
Most Speakers Say Achieving Millennium Goals, including Those on AIDS, Requires Increased Resources for Reproductive Health Services, Care, Education
NEW YORK, 6 April (UN Headquarters) -- The AIDS epidemic was a public health catastrophe unparalleled in the history of mankind, and tackling it required the adoption of a Marshall Plan by rich countries, the Commission on Population and Development was told today.
We need a global strategy that takes into account the AIDS epidemic in all actions to promote development and to fight poverty, including economic adjustment plans and foreign debt relief, Paulo Roberto Teixeira, STD/AIDS State Program, Sao Paulo, Brazil, told the Commissions thirty-eighth session this morning in a keynote address. Today, he said, at least 40 million people lived with HIV/AIDS, most of them in poor and developing countries. Over the past 20 years, 22 million lives had been lost to the epidemic, and every year, there were 5 million new infections and 3 million deaths, most of them young people.
Although most of the countries affected had already adopted public policies and allocated funds to fight the epidemic, he felt a much greater effort would be necessary, nationally and internationally, to face the spread of the infection, to treat the people affected and to minimize its impact on populations. Unprecedented funds, although not enough, were available to fight the epidemic. The Joint United Nations Programme on HIV/AIDS (UNAIDS) estimated that, in 2010, the international community would need up to $12 billion to fight the problem.
In controlling the epidemic and offering support to affected people, there were successful experiences in developing countries that might be taken into account to guide future steps, he said, highlighting the experiences of his own country, which had managed to stabilize the epidemic over the past six years. One of the conclusions that could be drawn from Brazils experience was that the country could not have achieved positive results without the adoption of a strategy, including prevention, treatment and the advocacy of the human rights of affected people. The false dilemma between prevention and treatment had caused unnecessary losses and should be avoided in the future.
A second message was that prevention worked, even when it involved groups of people that were difficult to reach, he said. The positive impact of anti-retroviral treatment, even in scenarios of adverse social and health structure, was real and could no longer be ignored. He added that, based on international experiences, there was no evidence whatsoever that moral recommendations, such as abstinence and fidelity, had any impact on infection prevention and curbing the epidemic. Although the promotion of safer sex involved serious cultural, ethical and religious matters, that could not be allowed to become a barrier to prevention.
The inequality of gender, poverty, sexual violence and difficulty to access health services meant that women were the most vulnerable group in all developing countries, he added. The only way to increase the possibilities of prevention and early diagnosis and treatment was to guarantee womens sexual and reproductive rights.
Indeed, stated the representative of the UNAIDS New York Office, women now represented half of those living with HIV/AIDS, despite the fact that there was little evidence to suggest that women were, in fact, as prone to risky behaviours as men were. The AIDS epidemic was an emergency with huge development implications, given its devastating impact on the social fabric and human capital. Put simply, AIDS was an exceptional problem that required an exceptional response.
Responses to HIV/AIDS must be comprehensive, if they were to be effective, she said. While prevention remained the mainstay of the response, treatment, reducing vulnerability, empowering women and alleviating the socio-economic impact of the epidemic were also among key elements of a successful response. An important initiative of UNAIDS was the Global Coalition on Women and AIDS, which was aimed at reducing the impact of the virus on women and girls and stimulating effective action to prevent the spread of HIV. Key action areas included reducing violence against women, promoting equal access to care and treatment, and promoting access to new prevention options for women.
During todays discussion, delegations focused on actions taken at the national level to address HIV/AIDS, including the appointment of HIV/AIDS ambassadors, the establishment of national committees on the issue, and the elaboration of policies and strategies. Nearly all speakers agreed that achieving the Millennium Development Goals, including those on HIV/AIDS, would require an increase of available resources for sexual and reproductive health and rights and HIV/AIDS.
Stating that a broad approach was essential to halt the pandemic, Swedens representative emphasized that HIV/AIDS prevention was about changing attitudes and behaviour, increasing knowledge through sex education, and ensuring access for all to sexual and reproductive health information, care and services. Condoms were a vital component of a broad prevention strategy. Programmes that focused on abstinence did not provide comprehensive knowledge, but reduced opportunities to protect against HIV/AIDS, other sexually transmitted diseases and unwanted pregnancies. Like many others, she stated that real progress in the fight against HIV/AIDS could be achieved if all people could enjoy their sexual and reproductive health and rights.
Highlighting the link between HIV/AIDS and mobility, the Observer of the International Organization for Migration said that link was one of the most critical challenges confronting governments, donors and humanitarian and development agencies this century. Failure to address HIV/AIDS in relation to migration potentially entailed enormous socio-economic and political costs. Key challenges to addressing HIV/AIDS within the context of migration included inadequate and inappropriate attention, stigma and discrimination and the lack of access to prevention, care and treatment to migrants.
Government policies on HIV/AIDS to date had given limited attention to migrants, he noted, adding that a first direct policy priority was to ensure that migration was included in national AIDS strategic plans and proposals to funding institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Another key policy challenge was how to address the double stigma of the disease and the foreignness of migrants. Experts agreed that attempts to block the virus from entering a country by barring access to people with HIV had no public health justifications.
Also this afternoon, Hania Zlotnik, Director of the Population Division, introduced the report on the Commissions working methods.
Statements were also made by the representatives of Ireland, Ghana, Nicaragua, Jordan, Jamaica, Venezuela, Gambia, Netherlands, China, Cuba, Uganda, Zambia, Belgium, United States, Armenia, Norway, Bulgaria, Suriname and Luxembourg (on behalf of the European Union).
The representatives of the following organizations also spoke: Asian Forum of Parliamentarians on Population and Development; International Planned Parenthood; Franciscans International; International Union for the Scientific Study of Population; Family Care International; World Population Foundation; and the Committee for International Cooperation in National Research in Demography.
The Commission will meet again at 11 a.m. tomorrow, 7 April, to continue its consideration of programme implementation and future programme of work of the Secretariat in the field of population.
The thirty-eighth session of the Commission on Population and Development met this morning to continue its general debate on national experience in population matters. It was also expected to hear a keynote address by Dr. Paulo Teixeira, Senior Consultant, São Paulo State STD/AIDS Programme.
This afternoon, the Commission is expected to continue its consideration of population, development and HIV/AIDS, with particular emphasis on poverty, and to start consideration of the programme implementation and the future programme of work of the Secretariat in the field of population. It would also review its methods of work. Reports before the Commission have been summarized in press release POP/920 of 31 March.
JOHN JACKSON (Ireland) focused on the ways in which his countrys development aid programme had attempted to address population issues within the framework of the Millennium Development Goals. Substantial advances had been made in its official aid programme in recent years with a threefold increase from 158 million euros in 1997 to 475 million euros for 2005. Those resources were aimed at strengthening assistance in the countries most in need, particularly in sub-Saharan Africa. Of the total commitment for 2005, about 10 per cent was devoted to combating HIV/AIDS. Consistent with the Millennium Development Goals, efforts in relation to HIV/AIDS had been directed at global level (largely through the Global Fund and the United Nations system), as well as at regional, national and community levels.
Ireland sought to maintain a balance between prevention, treatment and care, he continued. It attached great importance to Joint United Nations Programme on HIV/AIDS (UNAIDS), which worked effectively at country level with its partner agencies, including the United Nations Population Fund (UNFPA). Ireland fully supported the guiding premises of the Three Ones initiative promoted by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The country had also instigated a study to track the effectiveness of the Global Fund in beneficiary countries. Ireland supported the Three by Five initiative of the World Health Organization (WHO) and had invested about 3 million euros annually in the development of microbicides and HIV vaccines. In addition, agreement had been reached with the Clinton Foundation to assist the preparation of treatment, care and prevention programmes in Mozambique.
Recognizing that the governments had national ownership for their policies and programmes, he said that in each of the countries, efforts were made to support government capacity to respond to the HIV/AIDS pandemic. Ireland also supported district and local community responses through non-governmental organizations and faith-based organizations, particularly regarding to the delivery of home-based care. Support for orphans and vulnerable children was another area of great importance. Ireland recognized that long-term sustainability was an essential approach to addressing the effects of HIV/AIDS pandemic, including its consequences for economies and communities. In light of that, he welcomed the emphasis placed by the Secretary-General in his In Larger Freedom report on infant and maternal mortality, universal access to reproductive health services and the fundamental issues of gender, which were essential for womens empowerment.
FREDERICK T. SAI (Ghana) said his country enjoyed the highest political commitment to control and management of the epidemic. A national strategic framework enhanced the multisectoral response. HIV/AIDS had been reported in all regions of the country and in all age groups, but the most affected were those in the 15-40 age group. Extremely high rates of infection had been recorded among sex workers in some major cities and towns. Infection rates were also higher in border areas and migrant centres.
Despite progress being made, there was still a high incidence of poverty, he said. Two thirds of AIDS cases reported were females, due to the same socio-economic factors as in other African countries. The Government had initiated steps to promulgate a domestic violence bill, and a womens investment fund had also been established to assist women to become economically self-reliant. The Government had also put in place prevention programmes for in- and out-of-school youth to ensure safer sex practices and adherence to the ABC [abstinence, being faithful and condoms] messages of HIV/AIDS prevention.
He said knowledge about HIV/AIDS was almost universal in Ghana. However, efforts needed to be intensified to ensure behavioural change. Other interventions included reduction of stigma and discrimination and active promotion of voluntary testing. Within the ABC approach, the Government was vigorously promoting condom use. Budgetary allocation to combat HIV/AIDS had consistently been increased, with reliance on development partners. Among challenges faced was the need to develop behaviour change communication strategies, to sustain momentum for voluntary counselling and testing, and to mobilize adequate financial and human resources to implement a national response and to address gender inequalities. Ghana had made progress in helping to diminish its rate of increase. With the current enabling environment and support of development partners, Ghana could make even better progress.
OSCAR JARQUIN BARBERENA (Nicaragua) said that in his country, demographic changes continued to be an important factor that had a significant effect on the countrys policies and development strategies. Among other demographic information, he presented the figures regarding the countrys average fertility rates, which stood at 2.6 among urban women, but in rural areas it reached 4.4. In view of population growth, in the next 15 years, an increase in population-related services was anticipated. The countrys Government and society realized the need to create jobs to overcome the negative effects of the exodus of working population out of the country.
To overcome the effects of HIV/AIDS on the countrys economy, the Government had invested some $200,000, with the help from the Global Fund, in treatment, including the purchase of anti-retroviral drugs, he said. That did not fully cover the need, however. Focus was also placed on preventive measures, including public awareness campaigns. Regarding poverty eradication, he said the Government continued its firm policy against corruption at all levels. The culture of transparency was needed in public administration.
The Government of Nicaragua reaffirmed its commitment to the International Conference on Population and Development (ICPD) Programme of Action, the priorities outlined by ICPD+5 and the Millennium Development Goals, he continued. The Government of Nicaragua was against abortion, which in no way should be considered a means of regulating fertility or birth control. Nicaragua accepted the documents of the ICPD, while recognizing that there was no language in its outcome that could be interpreted to be in favour of abortion. It also had reservations regarding some terminology related to sexual and reproductive health, sexual rights and sexual and reproductive health services, which should not include abortion. The Government thanked the UNFPA, UNAIDS, WHO and other agencies for their support. Much still remained to be done, but he hoped his Governments efforts would be more effective, with continued international assistance.
ZUHAIR AL-KAYED (Jordan) said his country had done much, following the 1994 Cairo Conference that had been reflected in its population growth. That growth had been reduced from 3.3 per cent in 1994 to 2.5 per cent in 2004, and the fertility rate from 5 per cent to 3.6 per cent. Infant mortality had been reduced from 35 for each 1000 births to 22. Contraceptive use had increased from 48 per cent to 56 per cent. As for gender equality, he said there were now four women ministers, six women in the Lower House and nine in the Senate House. Certain laws and by-laws pertaining to securing healthy marriage and reproductive health services had been enhanced.
HIV/AIDS fortunately was not a big problem yet, he said. Until March 30, there were only 386 accumulated cases, 55 per cent of them a result of sexual relations. The small number was due to Islamic religious values and habits of sexual interrelationship. However, there was concern about protecting the youth. Poverty had declined significantly between 1997 and 2002, from 21 per cent to 14 per cent. However, progress had been geographically uneven. Furthermore, poverty among women-headed families indicated that divorced women had higher incidence of poverty than widowed women. His country still suffered from high fertility and population growth rates, which exacerbated the problem of poverty and unemployment. Contraceptive commodities were needed at an affordable cost, but UNAIDS intended to stop financing those commodities within three years. The United Nations and other international agencies should take care of that issue.
Mr. WILLIAMS (Jamaica) said that his country had made significant progress in its transition to lower fertility rates and reduction of population growth. The total fertility rate was now estimated to 2.5 children per woman, and the outward migration flows were high. Lately, the positive achievements were threatened by high rates of death, due to such reasons as HIV/AIDS and traffic accidents. Rapid ageing of the population posed significant challenges for the Government. A recent review of the countrys performance with respect to the Millennium Goals had placed the country in the green, which meant that it was on target with most goals. Progress was uneven, however. The country had attained universal primary education and was on the way to economic sustainability, but it was lagging behind in achieving womens equality and in the fight against HIV/AIDS.
Regarding HIV/AIDS, he said that cumulative number of cases in the country stood at over 8,000, but it was estimated that there were at least 22,000 persons who were HIV-positive. Some 65 per cent of those were unaware of their status. Research showed that adolescent females were three times at risk for contracting HIV/AIDS than males in the same age group. The number of deaths had recently declined, partly due to access to anti-retroviral treatment. Prevention, treatment and care were the basic pillars of the countrys strategy.
The national HIV/AIDS programme was coordinated by the national AIDS Committee, he said. The national policy on HIV/AIDS had been submitted to the Parliament for adoption. Over 20 workshops had been held on management of HIV/AIDS in schools. In June 2004, Jamaica had received a grant from UNAIDS to facilitate public access to ARV drugs. The programme to prevent mother-to-child transmission had been relatively successful, with some 90 per cent of pregnant women attending clinics and being tested. A major new initiative to identify persons most a risk had been initiated. Other strategies targeted prison populations, sex workers and other categories of vulnerable people. A comprehensive and integrated approach was needed in the fight against HIV/AIDS.
CARLOS LAZO (Venezuela), aligning himself with the statement made on behalf of the Group of 77 and China and of the Rio Group, said HIV/AIDS was a global crisis affecting the poorest nations in the world. The essential aspects contributing to the spread of the disease were poverty and social exclusion of a large sector of the world population. While changes in treatment had improved mortality levels in developed countries, HIV/AIDS was still a mortal disease in developing countries. At the end of 2003, Venezuela had 107,280 cases. The age group most affected was between 25 and 34 years old. The main means of transmission was sex among males (57 per cent), but there was an increase of heterosexual transmission.
He said that between 1997 and 2002, poverty had declined from 75.5 per cent to 45.3 per cent, which was largely due, among other things, to strengthening citizens participation in decision-making and implementing social policies, and cooperation with partners such as the Mission Robinson and Cuba. The Ministry of Health and Social Development was trying to get adequate levels of care and free drugs for treatment of HIV/AIDS. Governing principles guiding the policy on HIV/AIDS were prevention, care and treatment and education. Free access to health care, including anti-retroviral drugs was universal. The Government had decided to institute mandatory AIDS testing for all pregnant women that came for check-ups. A national strategic plan for HIV/AIDS had been developed in cooperation with civil society, as well as guidelines for anti-retroviral treatment.
ABDOU TOURAY, Permanent Secretary, Department of State for Finance and Economic Affairs of Gambia, said that his country was one of the developing countries that confirmed their national ownership of the ICPD Action Programme and affirmed that policies and programmes promoting reproductive health and gender equality were now indispensable parts of their development plans. Gambia had attained significant progress, but faced numerous challenges in the 10-year implementation of the ICPD Programme of Action.
The countrys achievements included the reduction of population growth from 4.2 to 2.8 per cent between 1993 and 2003; a decline in infant, child and maternal mortality; increased enrolment of girls in schools; ratification of the Convention on the Elimination of All Forms of Discrimination against Women; and integration of reproductive health services into the public heath system. An AIDS council had been established in the country. Gambias relatively low prevalence rate of 1.2 per cent had been maintained, in part due to the availability of anti-retroviral drugs. HIV/AIDS concerns had been integrated into the public health system.
Among the main challenges, he listed inadequate funding for population and reproductive health activities, socio-cultural constraints, inadequate training of health sector personnel, high levels of poverty, the high cost of debt servicing and low use of condoms in spite of the high level of knowledge on HIV/AIDS. Gambia was implementing a poverty reduction strategy paper, which took cognizance of the ICPD Programme and HIV/AIDS issues as a central part of its macro-strategic objectives and programmes. The main thrust of the poverty reduction strategy centred on income enhancement and human development, with special programmes geared towards better population management and other cross-cutting issues, like HIV/AIDS.
If we recognized that poverty perpetuates the spread of HIV/AIDS, and women are the most vulnerable due to their powerlessness, why are we spending so many resources in combating the AIDS pandemic, but spending very little in addressing the root causes of poverty and powerlessness of women? he asked. We should adopt a holistic and integrated approach in combating the AIDS pandemic, knowing the symbiotic relationship between poverty and HIV/AIDS. To achieve womens empowerment and protect vulnerable groups, he emphasized skills training, better access to quality education and health services, and income-generating activities. Only through effective and efficient collaboration and partnership at national, regional and international levels could the international community succeed in its fight against the scourges of poverty and HIV/AIDS.
PAULO ROBERTO TEIXEIRA, STD/AIDS State Program, São Paulo, Brazil, todays keynote speaker, introduced by Hania Zlotnik, Director, Population Division, said the AIDS epidemic, as a public health catastrophe, did not find any parallel in the history of mankind. Today, at least 40 million people lived with HIV/AIDS, most of them in poor and developing countries. Over the past 20 years, 22 million lives had been lost to the epidemic. Every year, there were 5 million new infections and 3 million deaths, most of them people who were young and at a productive age.
He said that, although most of the countries affected had already adopted public policies and allocated funds to fight the epidemic, a much greater effort would be necessary, nationally and internationally, to face the spread of the infection, to treat the people affected and to minimize its impact on populations. Unprecedented funds, although not enough, were available to fight the epidemic. UNAIDS estimated that in 2010, the international community would need to provide $12 billion to fight the problem.
In controlling the epidemic and offering support to affected people, there were successful experiences in developing countries that might be taken into account to guide future steps, he said, mentioning Uganda, Senegal, Malawi, Cameroon, Thailand, Brazil, Uruguay and Costa Rica.
Focusing on the approach Brazil had taken, he said his was a country of continental dimensions, with a population estimated at 182 million. Although it had medium development rates, it also had enormous social inequalities that varied accordingly to the region and the respective population groups. In the early 1980s, it had started to live with the HIV/AIDS epidemic that was dangerously expanding. However, with the engagement of the entire society and an aggressive and proactive programme, Brazil had managed to reach the year 2000 with less than half the number of estimated cases. Over the past six years, the epidemic had been stabilized.
So far, 350,000 cases of the disease had been reported and the prevalence rate had been kept below 0.6 per cent, he continued. The country had managed to keep the life expectancy of the Brazilian population at pre-epidemic levels. A conclusion that could be drawn from Brazils experience was that the country could not have achieved those results without the adoption of a strategy including prevention, treatment and the advocacy of the human rights of affected people. The false dilemma between prevention and treatment had caused unnecessary losses and should be avoided in the future. It is not possible to wait for people to take in the message of prevention when their children, brothers and friend do not have the treatment that could save their lives, he said.
A second message was that prevention worked, even when it involved groups of people that were difficult to reach. The positive impact of anti-retroviral treatment, even in scenarios of adverse social and health structure, was real and could no longer be ignored. Moreover, access to treatment was certainly one way to facilitate and encourage prevention. Likewise, he continued, if there was fear of stigma and discrimination resulting from the violation of the human rights of affected people, they would not be involved in prevention and control actions. Brazil had learned that vulnerable groups, such as injecting drug users, sex workers and homosexuals, would fully comply with treatment and prevention measures and that there was no acceptable excuse for excluding them.
As prices fell in the international market, and thanks to a firm negotiation strategy with the pharmaceutical industry, the amount spent on anti-retroviral drugs in Brazil had gone down. In 1999, $336 million had been spent on the treatment of 85,000 people, while in 2004, expenses were $172 million to treat 150,000. The impact of treatment had brought a positive balance of $200 million to Brazil between 1998 and 2002.
He stressed that in order to have effective control actions, it had to be recognized that sexual activity was an inherent part of human behaviour and that clear information and availability of inputs, such as male and female condoms, were the most realistic and safe way to promote prevention. In all countries where the epidemic had been curbed, the use of condoms had been promoted. Recent studies had shown that youngsters, when suitably oriented, might incorporate the use of condoms in their first sexual relation. One of the pillars of such work in Brazil was the inclusion of issues related to STD/AIDS prevention and drugs in high school curricula. A pilot project had been started to distribute condoms in the high schools of 230 cities in the country. In a previous evaluation, 95 per cent of parents approved.
He said that, based on international experiences, there was no evidence whatsoever today that moral recommendations, such as abstinence and fidelity, had any impact on infection prevention and curbing the epidemic. Moreover, the Brazilian Government considered that sexual practice was an intimate and private issue and that it should not be regulated by the State. Although the promotion of safer sex involved serious cultural, ethical and religious matters, that could not be allowed to become a barrier for prevention. Inputs available for preventing sexual transmission did not reach more than 40 per cent of the vulnerable population, and that situation needed to be dramatically changed.
Also, blood transmission between intravenous drug users would continue to feed the epidemic if harm reduction strategies, including the distribution of disposable needles and syringes, were not adopted officially by government, he continued. The results in countries that had adopted harm reduction had been extremely positive.
He said the entire national capacity and all international support had to be mobilized to provide anti-retroviral treatment. The World Health Organization (WHO) had prepared simplified technical guidelines so that treatment could be offered in places with limited infrastructure. Although the necessary means, technical knowledge and financial resources were available, the number of people who benefited from them in developing countries was still unacceptably low. There was a need to move forward with strategies to reduce the price of anti-retroviral drugs and for the treatment of associated diseases. The production of generic drugs had proved to be a vital resource to provide treatment and should be expanded and consolidated through national policies and international agreements involving government, companies and multilateral bodies such as the World Trade Organization (WTO).
The inequality of gender and poverty, sexual violence and the difficulty in accessing health service meant that women were today the most vulnerable group in all developing countries, he continued. The only way to increase the possibility of prevention and early diagnosis and treatment was to guarantee womens sexual and reproductive rights. UNAIDS had estimated that only a small portion of seropositive pregnant women was receiving prophylaxis for the infection of their babies in developing countries. Even in Brail, estimated coverage was only 60 per cent.
He said nothing would have been accomplished in the countries that had been successful in curbing the epidemic if there had not been, in addition to political decisions, an input of multiple sectors. All had a role to play, he said, including government, private sector, churches and civil society. It was impossible to overestimate the importance of an organized civil society. Non-governmental organizations (NGOs) had a role to ply in the advocacy of the rights of vulnerable groups and affected people, and they could be effective prevention agents.
In light of the resources available today and in order to use them appropriately, all cooperation and technical assistance mechanisms should be used, he said. United Nations organizations had a key role to play in guiding the global response and in coordinating the required care. However, the experience had shown that, in the long term, it would be difficult to curb the epidemic unless there was a vaccine. Tests had been disappointing. However, experts said it was perfectly possible to overcome the technical barriers for the production of a vaccine for developing countries, like microbicides, if there was the necessary investment.
In conclusion, he said that richer countries, like the United States, Japan and the European Union countries, had to play their role and adopt a new Marshall Plan. This year, the United Nations would evaluate the results and commitments adopted by countries at the Millennium Summit and at the UN General Assembly special session. It was vital to arrive at a more optimistic scenario than todays. We need a global strategy that takes into account the AIDS epidemic in all actions to promote development and to fight poverty, including economic adjustment plans and foreign debt relief.
Several speakers in the debate -- moderated by HANIA ZLOTNIK, Director of the Population Division -- expressed concern over the financial implications of the measures to combat HIV/AIDS and addressed difficulties in providing treatment for the affected populations.
There was nothing deadlier that HIV/AIDS in sub-Saharan Africa, a speaker said, but the costs of anti-retroviral therapy could triple health allocations in the countries involved. Poor countries could not afford that and needed international assistance to help them with their budgetary constraints.
Prevention was key to success, another member of the Commission said, stressing the need to involve decision makers in spreading the message about the dangers of HIV/AIDS. As a national problem with global impact, HIV/AIDS should also be tackled on a regional and international basis, another speaker added.
The introduction of sex education had met a lot of resistance from religious groups in Kenya, a representative of that country said, inquiring about the approach taken by Brazil in that respect.
Questions were also asked about the impact of the pandemic on indigenous peoples, voluntary counselling and testing, the lack of trained personnel and measures to protect women.
Dr. TEIXEIRA agreed that it would be very difficult to ensure progress, unless decision makers in each country recognized the importance of the epidemic. The expenditures on treatment were likely to increase in the coming years, even if the spread of infection was stopped today. In the long term, however, inaction would cost more. While taking into account the national situation of each country and placing emphasis on governments efforts, it was also important to recognize that, with the widespread nature of the epidemic, international involvement was vital. The main responsibility would probably rest on the international community, which would have to provide technical assistance and mobilize funds for the fight against HIV/AIDS. He was convinced that it was possible to mobilize up to $10 billion a year. In his region, the aspect of HIV/AIDS had started to be integrated in regional instruments. Such an approach would be beneficial to all the countries involved. Agreements were needed to coordinate national efforts at the regional level.
To another question, he responded that Brazil had launched a programme that targeted the countrys indigenous population, but the efforts needed to be extremely rigorous, because poverty was particularly widespread among the indigenous groups of population.
The evidence from countries where universal access to treatment had been provided was very positive, he added. The number of people under treatment had recently doubled. It was uncomfortable to go to the community and say please adopt safe sex, but we dont have means of providing you with treatment. Necessary support from States was required in that respect. Creation of voluntary testing centres was of great importance.
Regarding the efforts to overcome resistance from religious and other groups, he said that the national debate on the issue had been going on for years in his country, which evolved around the issues of syringes, condoms and other measures. Resistance could not be a reason to drop the issue from the agenda, however. The only way to control the epidemic was to recognize that some delicate problems needed to be addressed. He was sure that each culture and society could find a way to resolve the problem. One could not wait, because the spread of the epidemic was acquiring catastrophic proportions in many regions.
With the lack of trained personnel, it was important to change the strategies to include community-based institutions and organizations, he added. Haiti, for example, had adopted a strategy where people from local communities took responsibility for providing care.
Women in stable partnerships in Brazil were at high risk as a result of their partners extra-marital affairs, exactly because their perception of risk was low. Women needed to be informed, and improvement of sexual and reproductive health structures was needed to address that issue.
MONIQUE HALLMANN (Netherlands) said that, in her country, a comprehensive approach to HIV/AIDS had been implemented since early 1980s. The country believed it was important to accept peoples sexuality, respect human rights, support people living with HIV/AIDS and complement Governments efforts with those of local organizations and NGOs. Among the examples of successes of such a comprehensive approach, she cited frequent information and awareness-raising campaigns, needle exchange programmes, and the involvement of vulnerable groups. Successful treatment with anti-retroviral therapy was important to qualify for life insurance in the country. Insurance in the Netherlands was affordable, and its costs were comparable to those of people living with diabetes and obesity.
While there were successes, vigilance and monitoring remained of utmost importance, she continued. Contraceptive use, including pill and condom use together, was increasing, but the number of young people failing to use contraception at first sexual intercourse still remained high. Interventions and campaigns remained necessary, as new generations confronted the dangers of HIV/AIDS. Education and information efforts needed to continue. An increasing number of countries had shown interest in implementing her countrys Dance for Life anti-AIDS campaign.
The Netherlands had always been a strong supporter of the ICPD Programme of Action, she said, and reproductive rights were a strong priority for her country. She fully endorsed a call for universal access to reproductive health services by 2015 to be included in the Millennium Development Goals. While mobilization of resources for combating HIV/AIDS had been increasingly successful, it was also very important to provide sufficient funding for the family planning and reproductive rights components of the ICPD Programme.
RU XIAOMEI (China) said that combating HIV/AIDS required close partnership and the mobilization of various resources, which should be used in an equitable and effective way. It was also important to maximize the benefit of international assistance through inter-agency cooperation and promotion of tested experiences and models. Chinas HIV/AIDS prevention project, under the China-UNFPA reproductive health/family planning framework, had successfully piloted the model of integrating reproductive health/family planning services with HIV/AIDS prevention in provinces hardest hit by AIDS. An advocacy project sponsored by the Ford Foundation had conducted a two-day HIV/AIDS workshop among directors of the population and family planning commission in 31 provinces, municipalities and autonomous regions. Among the countrys other efforts, he listed a recent capacity-building project, a baseline survey of the sexual and reproductive health of the migrant population supported by Japan, and a series of education and information projects. A condom promotion initiative had been recently launched.
Special attention was paid in China to disadvantaged groups, he continued. For example, a project in HenanProvince sought to help women living with HIV/AIDS and children orphaned by the disease. Also, as the Secretary-General had pointed out, customs and cultures could have a positive or negative effort on HIV/AIDS prevention and control. Chinas population and family planning authorities had established ties with religious leaders in several provinces, who were invited to disseminate knowledge about HIV/AIDS prevention, and publicity materials were made available in local languages. Campaigns were also launched at ethnic festivals and fairs.
ORLANDO REQUEIJO GUAL (Cuba) said in his country, development policies were based on the concept that development was an integral process with an economic and social aspect. Equity was understood as a multidimensional concept, including equal opportunity and access. Cuba had already achieved some of the Millennium Goals, while others were not applicable to his country. Cuba had achieved, among other things, a decrease in infant mortality, guarantees for sexual and reproductive rights for all citizens and the control of HIV/AIDS. There was constant improvement of the cultural level of the population and universalization of education, as well as gender equality. Adolescents had also been a priority through various programmes to achieve behavioural change that would lead to decreases in pregnancy, abortion and sexually transmitted diseases, including HIV/AIDS, as well as school dropouts.
He said that since 1996, Cuba had had a programme for prevention and control of the HIV/AIDS epidemic that encompassed prevention, care and monitoring. Fortunately, there was a low prevalence among vulnerable groups, with a rate of 0.05 per cent in the age group of 15-24, and 0.02 per cent among pregnant women. The Government, with community participation, was working on education programmes for the population in general and vulnerable groups in particular. Epidemiological monitoring included notification of those infected. Care was offered at all levels and included social care. Anti-retroviral treatment was provided to all who needed it.
JOTHAM MUSINGUZI (Uganda) said the HIV/AIDS prevalence rate had been reduced from 18.5 per cent in 1992 to 6.2 per cent currently. Poverty had been reduced from 56 per cent in 1992 to 38 per cent now. However, that poverty level meant that 10.5 million Ugandans were still living below the poverty line. Those statistics, both for HIV/AIDS and poverty, were not good enough. In his country, HIV/AIDS was exacerbating poverty and had led to a large increase in the number of orphans. Chronic illness and reduced productivity of infected persons contribute to poverty. That threatened Ugandas food security, as it depended largely on agriculture. In addition, loss of skilled manpower continued to undermine development efforts, especially in the fields of education and health.
He said the HIV/AIDS epidemic had also put major strains on human resources requirements in the health sector, as well as on resources for expensive anti-retroviral drugs. That had constrained Ugandas already weak health-care system, especially if it was to respond adequately to the prevention, treatment and care requirements of those infected and affected. Against that background, he appealed to the international community to continue supporting his country and other developing countries in addressing development priorities.
PATRICIA CHANDA CHISANGA KONDOLO (Zambia) said that the interrelationship between HIV/AIDS and poverty was complex. The manifestations of HIV/AIDS led to poverty, and the state of poverty directly or indirectly created vulnerability to HIV/AIDS. The pandemic led to poverty by eliminating the productive sector of society, and had added a new and devastating dimension to the food security situation in both rural and urban areas. It increased the number of female-headed households, and reduced household income, due to the added burden of caring for HIV/AIDS patients and orphans.
She noted a number of accomplishments in various areas, including the development of appropriate policies, plans and institutional frameworks to guide multisectoral action. Most opponents of the National HIV/AIDS Intervention Strategic Plan had been operationalized, such as information, education and communication for behaviour change, and monitoring and evaluation of implementation. However, challenges remained in the areas of service delivery, where improvement was required on the low coverage of voluntary counselling and testing; prevention of mother to child transmission; and anti-retroviral therapy. The national orphan problem was also critical, and there was a need to address more urgently the inadequate involvement of organizations of people living with HIV/AIDS, by addressing key issues such as funding and human rights, in order to challenge existing stigma and discrimination.
CECILE CHAROT (Belgium) said she was convinced that sexual reproductive health and rights, as well as HIV/AIDS prevention, were crucial for achieving the Millennium Development Goals. The Goals could not be implemented unless the commitments agreed to in Cairo were implemented. Fighting HIV/AIDS was a priority area for Belgium. Among other things, her country was making fighting HIV/AIDS a priority in poverty reduction policies, scaling up resources, and developing AIDS partnerships.
It was crucial to adopt a balanced approach combining, among other things, prevention, treatment and care. She also stressed the need to combat sexual violence, which impacted HIV/AIDS prevention. Sexual violence endorsed gender inequality and perpetuated poverty. She highlighted a programme of her country to combat sexual violence in the Democratic Republic of the Congo. Belgium was sparing no effort in combating sexual violence and supported the implementation of Security Council resolution 1325 for a world of peace and security.
KELLY RYAN (United States) said the United States accepted that elements of the ICPD Action Programme were relevant to the attainment of the internationally agreed development goals contained in the Millennium Declaration, but her Government did not support the addition of new goals or targets. The Millennium Declaration was internationally agreed in 2000, and the United Nations Secretariat had drafted the Millennium Development Goals in 2001, building on the Millennium Declaration with targets, indicators and an additional goal. In fact, neither the Goals nor the targets or indicators had ever been negotiated by the Economic and Social Councils functional commissions. In addition, the notion of adding new goals in the midst of trying to achieve the existing goals would undermine the integrity of the process. General Assembly resolution 57/270B recognized that the Statistical Commission was the intergovernmental focal point for the elaboration of indicators used by the United Nations system in the context of the outcomes of major conferences. It was, therefore, not appropriate for the Commission to enter into negotiations on the issue.
Regarding the Secretary-Generals report, she agreed with the conclusions, particularly that good governance could facilitate human resource development and employment creation. The United States agreed that not all countries experiencing a decline in fertility had seen economic growth increase markedly. While she acknowledged the logic of the demographic bonus, she emphasized that family size affected economic growth far less than did the right enabling environment. The United States would not agree that governments should adopt measures to improve income distribution if that implied income redistribution. Any income-generating and employment strategies should consist of establishing the right enabling environment to allow entrepreneurs and the market to create jobs, from the bottom up.
Orderly international immigration could have positive impacts on development, especially through remittances. Migration could have positive impacts on both sending and receiving countries. The United States did not agree that the international community should strive for the fulfilment of the agreed target of 0.7 percent of gross national product for overall development assistance. At Monterey in 2002, leaders had acknowledged that each country had primary responsibility for its own development. At Monterey, the United States had pledged to increase foreign assistance by 50 per cent over 2000 levels by 2006. It had met that pledge three years early, providing $16.3 billion in 2003, and its official development assistance (ODA) was now up 90 per cent over its 2000 level. The 0.7 per cent target had no relationship to demonstrated need or the ability of recipients to use the aid effectively.
DZIUNIK AGHAJANIAN (Armenia) said that, despite the economic crisis and tremendous setbacks of the early 1990s, her country had registered some progress in implementing the ICPD goals, particularly in the areas of reducing maternal and child mortality. Turning to HIV/AIDS, she noted that the scope of infection was relatively low in Armenia. At the same time, Armenia belonged to the region with the highest growth rates of the pandemic. Close migration ties with countries where HIV/AIDS was highly prevalent posed an additional threat of increasing the spread of the disease in Armenia. The adoption of the first National Strategic Programme on HIV/AIDS in 2001 was an important step towards recognition of the problem as a major threat to the countrys development. The Programme identified the main problems related to halting the spread of HIV/AIDS in the country and set the medium-term goals and the strategies for their achievement.
Armenia recognized the link between HIV/AIDS and poverty, which increased the vulnerability to infection and affected access to treatment, she said. Accordingly, the issue of HIV/AIDS was included in the poverty reduction strategy paper, which envisaged redistribution of resources to strengthen prevention measures, and promote early diagnosis and treatment. While registering a number of advancements, some serious challenges in combating HIV/AIDS remained, including the scarcity of financial resources and lack of awareness and knowledge of the issue, particularly among high-risk groups and in remote rural areas. Another concern was stigma and possible social exclusion of persons with HIV/AIDS, which could be addressed through awareness raising and educational campaigns.
Ms. NANVIK (Norway) said the HIV/AIDS pandemic represented a global development challenge. Although the impact had been small in Norway, her country was increasingly affected by the global pandemic. Central elements of its strategy included HIV testing, availability of condoms, trained health workers and teachers, special services to immigrant women and close cooperation with relevant interest groups. It was high time to bridge the divide between sexual and reproductive health and HIV/AIDS prevention. Reproductive health services were an entry point for HIV prevention and awareness. While HIV treatment needed to continue, more emphasis was needed on HIV/AIDS prevention.
The gender aspect of HIV/AIDS was increasingly important, she continued. The increasing number of affected girls called for urgent action and drastic rethinking on how the spread of the virus could be curbed. Gender inequality and violence and harmful traditional practices were forceful factors in the spread of HIV/AIDS. Such social factors must be discussed by all elements of society.
Stressing the need for prevention work to address womens realities, she said a majority of women wanted to become pregnant and avoid the risk of being infected. Many married women did not have the choice of abstaining, and it could be difficult for a woman to negotiate the use of condoms. Half of the worlds population was under the age of 25. Recognizing youth as leaders was of vital importance in addressing HIV/AIDS. Societies must not be afraid of talking about sexuality. The particular vulnerability of youth and the need to focus on girls were key elements of Norways youth strategy, and access to education remained the central pillar for human development and poverty reduction. International actions were needed to face the complex challenge of assuring the availability of health workers. Norway fully supported the proposal of the Millennium Project and the Task Force to add universal access to reproductive health services by 2015. 2005 was a year of renewed commitment to common development goals, she added.
ULLA STRÖM (Sweden) said her country had placed sexual and reproductive health and rights, and the fight against HIV/AIDS, at the top of its development agenda, and it was a strategic priority in its bilateral cooperation. Sweden had appointed an HIV/AIDS ambassador and had set up an HIV/AIDS secretariat within its development agency, among other things. Together with the UNFPA, Sweden was hosting a high-level meeting next week in Stockholm on poverty, the Millennium Development Goals and reproductive health and rights. It would be a strategic meeting to ensure that sexual and reproductive health and rights were reflected in the high-level meeting on the follow-up of the Millennium Declaration. Achieving all the Goals, especially those for poverty eradication, maternal health, child mortality, gender equality and HIV/AIDS, would require an increase of available resources for sexual and reproductive health and rights and HIV/AIDS.
A broad approach was essential to halt the pandemic, she stressed. HIV/AIDS prevention was about changing attitudes and behaviour, increasing knowledge through sex education, and ensuring access for all to sexual and reproductive health information, care and services. She saw condom programming and commodity security as vital components of a broad prevention strategy. Programmes that focused on abstinence did not provide comprehensive knowledge, but reduced opportunities to protect against HIV/AIDS, other sexually transmitted diseases and unwanted pregnancies. Real progress in the fight against HIV/AIDS could be achieved if all people could enjoy their sexual and reproductive health and rights. Another vital part of the rights-based agenda was the right to non-discrimination for persons living with HIV/AIDS. Also, involving persons living with HIV/AIDS strengthened the design and implementation of programmes.
SHIRING MESTAN (Bulgaria) said that, knowing well the constraints of a country in transition, his countrys national institutions and civil society were working hard to get more positive results in dealing with population matters. There had been some encouraging improvements in most spheres, including lowering the childrens death rate, providing better education and combating the spread of HIV/AIDS. However, the most complicated and difficult issue to deal with was the demographic crisis. Bulgarias population had fallen sharply from 8.2 million in 1999 to 7.76 million people in 2004, heading to 7.1 million in 2015. The majority of the people, comprising members of all ethnic groups who were better educated and with higher incomes, tended to consolidate on a child per family reproductive figure. A growing second group, represented by members of the Roma ethnic minority, comprised of families with seven to eight children.
The Bulgarian society and Government were trying to encourage members of the first group to give birth to more children, and to assist members of the second group in choosing and adopting the child-oriented family-planning approach traditional for Bulgaria, the representative said. When dealing with both conflicting situations, however, measures useful for solving the first problem tended to be counterproductive for the second one, and vice-versa. Despite the consistent application of known techniques and policies, there had been no significant progress in both groups.
MINA MANGRE (Suriname) informed the Commission about her countrys National Population Policy 2005-2010, which was a package of measures and programmes to establish a balance between meeting the rights, needs and demands of the individual in the society, on the one hand, and establishing sustainable development, on the other. The policy was formulated primarily in the context of the ICPD Declaration, the Millennium Declaration and the Beijing Platform for Action. Suriname had started implementation of sectoral policies for the health, education, agriculture and housing sectors. Integrated in the sector plans were issues of gender, institutional capacity, environment, poverty and good governance.
HIV/AIDS was a major concern for her nation, she said. Suriname had launched aggressive actions to control the spread of the disease. The National Strategic Plan on HIV/AIDS and the central coordination by the National AIDS Programme were recently supported in their actions by the Global Fund. In spite of scarce financial resources, the Government contributed monthly to the Emergency Fund for HIV/AIDS, which was managed by a local NGO. Young people was considered as a window of opportunity to halt the spread of the disease, and were involved at the policy level and in implementation and monitoring. With the support of the UNFPA, a policy on sexual reproductive health was currently being drafted by the Ministry of Health and should be finalized very soon.
LUCA DALLOGLIO, Permanent Observer of the International Organization for Migration, said the relationship between migration and the Millennium Development Goals had not been widely explored, although both the migration and development communities had become increasingly aware of the link between international migration and development. The comprehensive integration of international migration in the international development agenda was still lacking. Migration might have a direct and positive influence on the achievement of the Millennium Goals. It could equally constitute a challenge, however, which needed to be addressed in order to move towards attaining the Goals.
He said the link between HIV and population mobility was one of the most critical challenges confronting governments, donors and humanitarian and development agencies this century. Failure to address HIV/AIDS in relation to migration potentially entailed enormous socio-economic and political costs. Key challenges to addressing HIV/AIDS within the context of migration included inadequate and inappropriate attention, stigma and discrimination, and the lack of access to prevention, care and treatment by migrants. Factors driving migration could also increase migrants vulnerability to HIV, such as human rights abuses and economic deprivation.
Government policies on HIV/AIDS to date had given limited attention to migrants, he added. A first direct policy priority was to ensure that migration was included in national AIDS Strategic Plans and proposals to funding institutions such as the Global Fund to Fight AIDS, Tuberculosis and Malaria. Another key policy challenge was how to address the double stigma of the disease and the foreignness of migrants. International efforts to reduce the stigma related to HIV/AIDS provided some useful lessons. Active outreach with HIV/AIDS prevention information was important, but policy changes to reduce risk and vulnerability in the first place were even more important. One area of consensus among experts was that attempts to block the virus from entering a country by barring access to people with HIV had no public health justification.
SONIA ELLIOTT, speaking on behalf of Desmond Johns, Director of the UNAIDS New York Office, said the scale and complexity of the AIDS epidemic was such that it represented the most important challenges to development in many heavily affected countries. Almost 40 million people were now estimated to be living with HIV, and around 13,000 new HIV infections occurred each day. Women now represented half of those living with HIV/AIDS, despite the fact that there was little evidence to suggest that women were, in fact, as prone to risky behaviours as men were. The global epidemic continued to grow despite the fact that more was known about the epidemic than ever before. The AIDS epidemic was an emergency with huge development implications, given its devastating impact on the social fabric and human capital. Put simply, AIDS was an exceptional problem that required an exceptional response.
Responses to HIV/AIDS must be comprehensive, if they were to be effective, she said. While prevention remained the mainstay of the response, treatment, reducing vulnerability, empowering women and alleviating the socio-economic impact of the epidemic were also among key elements of a successful response. UNAIDS Three Ones initiative provided a framework to support inclusive and multisectoral national responses, based on national priorities. An equally important initiative of UNAIDS was the Global Coalition on Women and AIDS, which was aimed at reducing the impact of the virus on women and girls and stimulating effective action to prevent the spread of HIV. Key action areas included reducing violence against women, promoting equal access to care and treatment, and promoting access to new prevention options for women.
YOSHIO YATSU, Chair, Asian Forum of Parliamentarians on Population and Development, said that the challenge of population growth and HIV/AIDS, the fight against poverty, and implementation of the Millennium Development Goals and the ICPD recommendations needed political will. That was possible with the involvement of elected leaders, including parliamentarians and other political leaders. The Asian Forum of Parliamentarians had been formed in 1981 based on the need for a movement to involve elected representatives in population and development issues in order to create political will to support the population programmes and to mobilize resources. The Forum had adopted a sector-wide approach, by which it involved parliamentarians with specific professional backgrounds, such as lawyers, teachers and doctors, to come together and discuss their roles and contributions in population and development issues, not only in Parliament but also with the members of their constituencies.
The Forum had been able to evolve a dedicated cadre of elected leaders from the grass-roots to national levels, leading to measurable results regarding resource allocations for ODA and new and revised legislation. The Forum pledged to fulfil the Secretary-Generals call for mass mobilization of every section of society, unheard of to date in public health to address HIV/AIDS, and would further mobilize elected representatives for HIV/AIDS prevention and treatment and to reverse the incidence of the pandemic.
CARMEN BARROSA, of the International Planned Parenthood, noted that in the 10 years since the international conference, what remained a reality was the fact that women must be at the heart of international development. At the ICPD and Beijing, womens sexual reproductive rights were ends in themselves. With the five-year review of the Millennium Development Goals, Member States must not ignore the vital contribution of sexual reproductive health and rights and gender equality to meeting poverty-reduction goals. Unless reproductive health and rights were promoted, there could be little progress in reducing poverty. It was also critically important that the Commissions outcome document reflected the vital role of sexual reproductive health in reducing poverty. The entire programme of action must be reaffirmed without reservation. She also called for specific recommendations addressing the Millennium Goals on HIV/AIDS. The integration of HIV/AIDS programmes with sexual and reproductive health services was essential for both. A focus on youth was needed to address their great vulnerability.
Overcoming ideological barriers to widespread condom access was needed in order to save lives, she said. Addressing gender power relations was also required to give young women a chance of survival. Universal access to reproductive health services was essential, both to power reduction and womens health. The attainment of the Millennium Goals could not be achieved without prioritizing sexual reproductive health and services. The Secretary-Generals report In larger freedom took up the recommendation of the Millennium Project that ensuring access to sexual health services was essential for achieving gender equality. It was critically important that the target of ensuring universal access to reproductive health services appeared in the annex to the Secretary-Generals report, as it would form the basis of the political declaration for the September summit.
Ms. DEACON, of the Franciscans International, said that even if the spread of AIDS were stopped immediately, the number of deaths would continue to rise for several years because so many were already infected. While many of the interventions this week had stressed the health and financial costs to a country, the experience of her organization in AIDS-affected communities indicated another urgent issue that must be addressed in AIDS-related policies and programmes. When extended families were overwhelmed, and traditional community structures could no longer meet their responsibilities to socialize children, alternative means to carry out that role must be developed and adopted as part of a holistic response to the AIDS pandemic. She recommended that countries with high rates of AIDS infection adopt and actively implement national action plans to provide for the culturally appropriate education and socialization of all children affected by the pandemic.
Some elements to include in the plan, she said, were to identify and build capacity among local community leaders, men and women, who could be part of a network to provide special protection and assistance for children while assuring them a culturally appropriate upbringing; and to provide those who cared for children orphaned by HIV/AIDS with the support and resources necessary to ensure that the children received proper care, socialization and development. She suggested using an accompaniment model developed out of the communal experience of indigenous cultures, whereby resource persons walked side by side with those who were responsible for the education and socialization of younger members of society. Also, she called on the international community to provide the necessary resources for the development and implementation of that aspect of national planning by fulfilling their ODA commitments.
MARY M. KRITZ, Secretary-General of the International Union for the Scientific Study of Population, said her organization was the international professional association of population specialists. Through its activities, the Union acted as a catalyst for the development of scientific knowledge and policies about a wide range of population issues. Since the mid 1990s, the Union had held a number of scientific programmes focusing on the issues related to the expanding of the HIV/AIDS epidemic. In 2004, for example, a seminar was held in Burkina Faso, focusing on the principal determinants of HIV, tuberculosis and malaria in Africa and their effects on socio-economic development. In 2005, the organization was proposing the holding of a seminar in South Africa. Poverty and HIV/AIDS were cross-cutting themes in all the Unions activities.
The Unions upcoming international population conference in July would be held in Tours, France, she said. That conference would provide an opportunity for scientists, programme managers and policy-makers from around the world to review advances made in the study of population issues and to debate the possible actions or policy responses to the challenges posed by population dynamics. The United Nations had been decisive in influencing the development of population policies and programmes, and it had made a critical contribution to the scientific understanding of population dynamics.
Ms. EYUKUZE-DI DOMENICO, of the Family Care International, said that over the past 10 years, services for reproductive and sexual health and AIDS had remained separate. At the ICPD, it had been recognized that, without effective action to stem HIV/AIDS, 30 million to 40 million people could be affected by the end of the decade. That had been surpassed. Interventions for sexual and reproductive health and AIDS must be linked and complementary for them to have greater impact. Family Care International was convinced that policies to address sexual and reproductive health and AIDS must be based on the fundamental commitment to protect the rights of all people. Young people must be included in all programmes to address sexual and reproductive health and AIDS. The contributions of non-governmental organizations, affected communities and other stakeholders must also be taken into account.
The sexual and reproductive needs of people living with HIV/AIDS must be recognized and responded to, she said. Also, efforts must be increased to tackle the stigma and discrimination against people living with HIV/AIDS. Information and services on HIV/AIDS must be provided to all, and more initiatives were needed on HIV/AIDS prevention through, among other things, the media and education campaigns. Young people must also have access to a full range of reproductive health services. The social and cultural factors increasing womens vulnerability must be addressed. Women must have equal and equitable access to treatment and care, as they became available.
YVONNE BOGAARTS, of the World Population Foundation, said the Cairo Conference was a historic moment, when sexual and reproductive health issues were firmly recognized as part and parcel of the human rights framework. The realization of sexual and reproductive health and human rights could empower women, men and their families to take control over and make decisions concerning sexuality and reproduction, free of discrimination and violence. Women were highly vulnerable to infection and were often unable to negotiate safe sexual relations. Without access to sexual and reproductive health education, information and services, young people would be less informed about their sexuality and bodies, less able to make their own decisions and to protect themselves from abuse.
She offered several remedies to address the issue, including ensuring the realization of sexual and reproductive rights through laws, programmes, policies and practices. The Commission should endorse the Millennium Projects recommendation of the inclusion of a target to achieve universal access to sexual and reproductive health by 2015. She also recommended the integration of sexual and reproductive health and HIV/AIDS services into innovative programmes that truly addressed the needs of the people.
Mr. GUILMOTO, of the Committee for International Cooperation in National Research in Demography, said that his organization had been sensitive to the social and demographic environment of the AIDS plague. Most traditional organizations had been unable to respond to the growing demand for serological statistics and qualitative studies, and had found themselves superseded by new organizations, including new public health centres or grass-roots non-governmental organizations. A survey his organization had conducted about AIDS research among its members in 2004 indicated that demographic centres felt that beyond the usual complaints about the lack of resources, a major difficulty they were facing was due to the disciplinary barriers and the lack of a framework for examining social and epidemiological conditions simultaneously.
It was suggested, he said, that cultural taboos were a big obstacle to research on sexual behaviour in many developing countries. He added that poverty itself might be another taboo when it came to understanding the dynamics of the pandemic today. There was a great need today to expand the usual approach centred on risk behaviour. For while the public health dimension of AIDS could not be underemphasized, it was also crucial to stress how AIDS affected individuals, families and communities that were themselves embedded in their local economy, and how, in turn, the fabric of society was disrupted by the spread of the disease and its debilitating impact on all institutions, social or economic, that formed the backbone of local societies.
Review of Commissions Methods of Work
Introducing the report on the Commissions working methods, HANIA ZLOTNIK, Director of the Population Division, said the Commission had continually reviewed and revised its working methods in order to fulfil its role as the central intergovernmental body responsible for the follow-up to international conferences on population, including the 1994 International Conference and the 1999 General Assembly special session. The report documented changes in the periodicity and length of the Commissions meetings, the most recent of which dated from 1995.
Regarding its work programme, she said that in 1995 the Commission had recommended a multi-year programme for the period from 1996 to 1999. Since 1995, the Commission had been selecting themes for future sessions at least two years in advance of each session, but a five-year work programme had not been adopted again. The Commission might want to set a strict planning horizon for a multi-year plan and endorse the periodic review of the Programme of Actions implementation.
She said the adoption of a multi-year work programme and the selection of special themes had been guided by the need to review the follow-up and implementation of the Programme of Action in a structured manner over a given period. Although there was generally good correspondence between the themes selected and particular chapters of the Programme of Action, themes had often implied a clustering of topics treated in different chapters of the Programme of Action or the key actions. Such clustering, however, had been driven by the selection of a relevant theme and not by the intent of focusing on the clusters per se. In that regard, the Commission had been giving priority to the consideration of key or emerging issues in the field rather than to the more mechanical coverage of all issues covered in the Programme of Action. The Commission might want to reconsider that practice and opt for the comprehensive review of the Programme of Action through a multi-year work plan organized in terms of thematic clusters.
ANOUK VANESSA KIRPACH (Luxembourg), on behalf of the European Union and associated States, said the Union attached great importance to the improvement of the working methods of the functional commissions. The Commissions reform had to be seen in the larger context of Economic and Social Council reform and resolution 57/270B. The Unions aim was to have a more streamlined and focused Commission, with more transparency in its work. The Commissions primary responsibility was to ensure the review and appraisal of the implementation of the ICPD Programme of action. The Commission should identify progress, constraints and lessons learned and decide on measures and policies to overcome obstacles. With that aim in view, the Commission should change the way in which it conducted its business.
The Commission had become an increasingly effective forum to discuss issues pertaining to population and development matters in the Cairo framework, she said. There was always room for improvement, however. The Union favoured close cooperation with the Population Division and the UNFPA, as well as with other relevant international organizations. Regarding keynote speakers, she welcomed the format of information exchange, but proposed that the Bureau approved those speakers and the themes they addressed. The Union would strongly favour that the Population Division submit the names of the keynote speakers and their topics to the Bureau after consultation with the UNFPA. Written reports of the Bureaus inter-sessional meetings should be made available at the earliest possible opportunity after those meetings.
The Commission should revisit its method of work to allow for a more effective follow-up of the ICPD and to be able to make the necessary decisions, she said. The Commissions reform should involve the organization of work around general themes covering the ICPD. For each general theme, the Commission should devote a session to the assessment of the situation. Time should be allocated to exchanges of lessons learned and best practices. The Commission should continue to debate on topical or emerging issues related to the ICPD. In that regard, each annual session should have a special theme, possible based on a two-year programme of work. The Commission could consider the use of expert group meetings prior to each of its sessions to further enhance its deliberations.
* *** *