Higher self-esteem helps avoiding contaminating others
England may have it right about the HIV/AIDS global fund unlikely to
meet the minimum 10 billion dollars target. Thailand may be just as
correct in saying that "each of the world's 29 richest individuals
has more than that figure in assets" (see below). But something
arises from a perusal of these heart-breaking accounts, country by
country, of what AIDS has caused to them: poor countries, those af-
fected by HIV/AIDS, are believing in this fund. Some "leitmotivs"
even start to "percolate" across African countries (legal prevalence
of the right to life over trade, generic production). It may not be a
renaissance, but a common solemn sense of the need of solidarity. I
had the impression sometimes that poor countries are ready to start
with this fund with or without the help they need from rich coun-
Brazil puts the fund into prospective (see below): <<following the
antiretroviral treatment, they [people living with HIV/AIDS] have
their viral load brought down. Their self-esteem gets higher; they
feel more able and prone than in the past to be more cautions in
avoiding contaminating other persons. Thus, treatment has a positive
and formidable impact on prevention, which has been rightly recog-
nised by the Special Session.>>
Christian Labadie \
Statement by H. E. Minister of Health of Brazil Senator José Serra
Special Session of the General Assembly of the United Nations on
HIV/AIDS New York, 27 June 2001
Twenty years have gone by since the first cases of what became known
as AIDS were identified. In such a short time frame, the impact of
the epidemic has been devastating. Almost 60 million people have been
infected with HIV. Almost 22 million have died. Over 36 million are
living with HIV/AIDS and need treatment.
Unfortunately, the dissemination of the epidemic and the death rates
related to AIDS are swiftly increasing in the world and this trend
will not be reversed unless the international community takes deci-
sive actions to face this huge challenge. Last year, more than 5 mil-
lion people were infected and 3 million died.
Until very recently, it was a commonplace to affirm that HIV affected
the human body's immune system in the same way as the epidemic af-
fected the countries' immune system, which is composed of its people,
its economy and its health and education systems.
Nowadays, this assertion does not hold true anymore. Although we do
not have a cure for AIDS, we do know that consistent and courageous
policies can halt the spread of the disease and let those infected
with HIV live a normal and dignified life. To meet these objectives,
our commitment must contain four essential elements: prevention,
treatment, human rights and resources.
Prevention and treatment are mutually reinforcing and must be consid-
ered in an integrated approach. As far as prevention is concerned,
there is a wide range of measures that have proved successful, such
as: universal access to condoms, women's empowerment, adoption of
programs relating to mother-to-child transmission; implementation of
strategies directed to the most vulnerable groups and to the groups
at highest risk of infection; and the inclusion of issues related to
HIV/AIDS in schools' curriculum.
In Brazil, these policies have yielded excellent results, allowing us
to control the transmission rate. The number of people living with
HIV/AIDS now amounts to less than half of what estimates used to pre-
dict. Our integrated approach to prevention and treatment was essen-
tial in reaching this success. Because of our policy of ensuring free
and universal treatment, the population feels encouraged to accept
voluntary and confidential testing, improving notification of aids in
earlier stages that otherwise would be hidden. Moreover, people liv-
ing with HIV/AIDS are kept in close contact with the health system,
both the Governmental one and the NGO's having access to information,
counselling and preventive supplies; and, following the antiretrovi-
ral treatment, they have their viral load brought down. Their self-
esteem gets higher; they feel more able and prone than in the past to
be more cautions in avoiding contaminating other persons. Thus,
treatment has a positive and formidable impact on prevention, which
has been rightly recognized by the Special Session.
1996 represents a landmark in AIDS history. It was the year in which
the efficacy of the antiretroviral therapy was proved. Since then,
every Brazilian living with HIV or AIDS has had free access thereto.
Nowadays, almost 100,000 people are taking these drugs in Brazil. Our
strategy has been paying off. The death rate has fallen by approxi-
mately 50%. Hospitalizations had a 75% drop. Opportunistic diseases
have substantially decreased. The epidemic has been stabilized and
our public health services are much less overburdened. Actually, pro-
viding adequate treatment has even led us to upgrade them.
The reason for the affordability of our policy is the local produc-
tion of drugs. Brazil produces 8 generic versions of non-patented
antiretroviral drugs at low costs. Most of the medicines provided by
Brazilian laboratories are much cheaper than those imported. Last
year, only 2 imported drugs amounted to as much as 36% of the whole
purchase costs of antiretroviral medicines. Nevertheless, effective
or potential competition from the local companies is inducing foreign
industries to bring their costs down on average by 70%. It is also
worth noting that the local production is controlled through the ap-
plication of the Good Manufacturing Practices, pharmaceutical plants
inspection and bio-equivalence testing. No problem related to the
quality of medicines has ever been reported.
Moreover, it is important to stress that this production fully com-
plies with the World Trade Organization Trade Related Intellectual
Property Rights Agreement. Brazil is a founding member of this agree-
ment and adapted its legislation thereto in 1997, eight years before
the 2005 deadline. No one disputes the relevance of the international
agreements on intellectual property rights. Patent rules strike a
balance between two desirable objectives - on the one hand, the pri-
vate interest of individual creators, needing funds for innovations
and seeking maximum opportunity to exploit their inventions; on the
other, the public interest of immediate and widespread dissemination
of life-saving technology. The TRIPS Agreement itself, for all its
provisions on scientific knowledge protection, contains measures al-
lowing for the promotion of public health. We are pleased that this
Special Session has acknowledged the efforts of countries to develop
domestic industries in order to increase access to medicines and pro-
tect the health of their populations. It has also recognized that af-
fordability of drugs is a significant factor in the fight against the
Another essential factor in combating HIV/AIDS is the strict respect
for human rights. This approach should be twofold. On the one hand,
we must combat the stigma that unfortunately still is associated with
HIV/AIDS and eliminate other forms of discrimination that contribute
to the spread of the epidemic. On the other, we must take into ac-
count that access to medication is a fundamental element in achieving
the full realization of the human right to the enjoyment of the high-
est standard of physical and mental health.
In Brazil, we have also learned how strongly NGOs, in particular
those of people living with HIV/AIDS, must participate in this huge
effort. In the last seven years, more than 1,500 partnerships with
non-governmental organizations have been put in place. This coopera-
tion, in which the government has invested more than 40 million dol-
lars, has proven efficient and creative. Over 600 NGOs work with the
government now, highlighting critical issues and contributing to the
elaboration and implementation of public policies.
As a matter of fact, cooperation is fundamental both at the national
and the international levels. Based on our national experience, the
Brazilian government has carried out technical cooperation with Latin
American, Caribbean and African countries.
However, a stronger effort is expected from developed countries,
which can contribute more to meet the goals established in this Spe-
cial Session. In this regard, Brazil fully supports the establishment
of a global AIDS fund - the resources of which should be commensurate
to the magnitude of our challenge - to finance prevention and treat-
ment, particularly for those most in need.
I am also pleased that the Special Session has recognized the princi-
ple of differential pricing. Developing countries should not pay as
much as developed countries for AIDS-related drugs. I hope that the
pharmaceutical companies will take this principle, into account.
Another initiative that should be move forward, and that has been
successfully implemented in Brazil, is the establishment of an Inter-
net data bank to disseminate drugs prices in different countries,
which would certainly lead to competition and price reduction.
In concluding, let me emphasize that this Special Session represents
an important breakthrough in that the international community has
agreed upon a set of global principles and strategies regarding
HIV/AIDS, even though countries have their particular circumstances.
This meeting has shown that there is a way out, that it is possible
to fight the epidemic even in the poorest regions.
The Special Session should not be a final event. On the contrary, it
must be a starting point, or rather a turning point, especially for
the most affected countries. The final document of the Special Ses-
sion will be a Declaration of Commitment. And actually all depends on
our commitment. A commitment to human rights, prevention, treatment
and affordable medicines. In a word, a commitment to life.
Statement by H.E. Mr. Pitak Intrawityanunt, Deputy Prime Minister of
Thailand, Chairman of the National AIDS Prevention and Control Com-
mittee, Head of the Thai Delegation
before the Twenty-sixth Special Session of the United Nations General
Assembly on HIV/AIDS New York, 25 June 2001
Mr. President, Mr. Secretary-General, Excellencies, Ladies and Gen-
On behalf of the Government of Thailand, it is a privilege and a
pleasure for me to address the Twenty-sixth Special Session of the
United Nations General Assembly on HIV/AIDS. In view of the time con-
straints, I will make only a few brief remarks as the full text of my
statement will be circulated.
This Special Session, the first high-level intergovernmental confer-
ence dedicated to the issue of HIV/AIDS, is indeed a timely initia-
tive and opportunity for all of us to pledge our political and finan-
cial commitments to fight against the HIV/AIDS epidemic.
Over the past two decades since the first case of HIV/AIDS, more than
22 million people worldwide have been killed. More lives have been
lost due to HIV/AIDS than to any kind of weapon of mass destruction.
Currently, more than 36 million people are afflicted with the epi-
demic. HIV/AIDS is a silent global menace which threatens not only
development and human security, but also international security, to
the extent that the global nature of this threat has already been ac-
knowledged by the Security Council.
HIV/AIDS is thus not a threat which any one country alone can ad-
dress. It is a global crisis that needs not only national action but
also regional and global cooperation. We must find ways and means to
make good our resolve in the Millennium Declaration "to have halted,
by 2015, and begun to reverse, the spread of HIV/AIDS" as well as
"the scourge of malaria and other major diseases that afflict human-
ity." To tackle the scourge of HIV/AIDS effectively, we must take
shared responsibility in managing worldwide economic and social de-
velopment as well as threats to international security, as called for
by our leaders at the Millennium Summit just last year.
Recently, in our region, the Economic and Social Commission for Asia
and the Pacific (ESCAP) at its 57th annual session, adopted by con-
sensus a resolution tabled by Thailand entitled "Regional call for
action to fight HIV/AIDS in Asia and the Pacific". In Southeast Asia,
ASEAN Leaders have also recognized the urgency of the HIV/AIDS prob-
lem and will convene a special ASEAN Summit on HIV/AIDS this coming
Thailand also has the honour to host two very important international
conferences, namely, the 5th International Conference on Home and
Community Care for Persons Living with HIV/AIDS from 17 to 20 Decem-
ber this year, and the International Conference on AIDS in 2004.
As a country hard hit by HIV/AIDS, Thailand is gratified to be cited
by United Nations agencies, the World Bank and many other organiza-
tions as having conducted one of the world's most successful AIDS
prevention and awareness programmes. Indeed, our record in tackling
the AIDS epidemic shows that the AIDS epidemic can be contained. From
the drastic projection made in 1991 that by 2001, 4 million people in
our country would be infected with HIV/AIDS, we have instead seen the
number of HIV/AIDS carriers drop by 77% from those projections to
less than 1 million today.
As part of our contribution to fight this global epidemic, Thailand
is prepared not only to share our experiences, but also to provide
the appropriate technical assistance to other developing countries,
including our friends from the African continent, in the spirit of
One of the key lessons we have learned from our HIV/AIDS experience
is that the leadership must recognize the devastating scale of the
epidemic and be willing to discuss openly the enormity of the
HIV/AIDS problem. Thailand was the first Asian country to break the
silence and face the crisis head-on.
Secondly, we need to tackle the HIV/AIDS problem from both the pre-
vention and treatment perspectives. Thirdly, we also need to take a
holistic approach which addresses human, social, economic and cul-
tural aspects of the HIV/AIDS problem.
In particular, concerted nationwide education, prevention and aware-
ness programmes do work in controlling the spread of HIV/AIDS. And to
be effective, such programmes need to encompass all sectors of the
society, involving efforts from the highest level to the grass-roots
level, including NGOs and people living with HIV/AIDS.
In tandem with preventive measures, it is a must that care, support
and treatment be an integral part of our effective response to the
epidemic. However, for developing countries, prohibitively high
prices of essential drugs limit access of people to treatment.
We are very pleased to see that the United Nations has finally taken
the lead in recognizing that HIV/AIDS is not only a medical and
health care issue, but also a humanitarian issue, and convening this
Special Session. We appreciate the role of the UNAIDS in this regard.
We also support the draft Declaration of Commitment to be adopted at
this Special Session.
In this connection, Thailand wishes to urge drug-producing countries,
regional and international organizations and institutions, especially
the United Nations, and civil society, in particular pharmaceutical
companies, to be actively involved in research and development of
HIV/AIDS vaccines and drugs, and to help make HIV vaccines and
HIV/AIDS-related drugs more widely accessible and affordable by all
who need them in developing countries. The production of such life-
saving drugs needs to be guided more by humanitarian concerns and
less by purely commercial motives.
All efforts and programmes against HIV/AIDS require not only politi-
cal commitment but also financial resources. Some may claim that the
costs of tackling the HIV/AIDS epidemic are too high - requiring 7-10
billion US dollars annually according to UN estimates. But consider-
ing that each of the world's 29 richest individuals has more than
that figure in assets, and if the developed countries and the private
sector, including these wealthy individuals, were to pitch in for the
global struggle against HIV/AIDS, then 7-10 billion dollars is not at
all a high figure and certainly within our reach.
Mr. President, Mr. Secretary General, Excellencies, Ladies and Gen-
We have been fighting HIV/AIDS since the first incident of HIV/AIDS
for over two decades. Experiences have been shared. Lessons have been
learnt. Still, much remains to be done as millions of infected and
affected people are dying every minute while waiting for our help.
Surely, we cannot remain indifferent. This is one "humanitarian in-
tervention," which no one should have objection to. This Special Ses-
sion is a promising beginning of our global crusade against this
global crisis. With determination, sacrifice and good faith, I am
confident that we will attain our goal of "halting the spread of
HIV/AIDS by 2015," for the good of mankind. Thailand, for its part,
is more than ready to play its active role in this endeavour.
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