Summary of UNGASS and the Declaration of Commitment
June 29, 2001 - At the conclusion of the United Nations Special Ses-
sion on HIV/AIDS, the international community adopted on June 27,
2001, a sweeping action plan to fight the epidemic, with extraordi-
nary attention and commitment given to the special vulnerabilities,
needs and rights of women.
The "Declaration of Commitment", approved by governments from around
the globe recognizes the massive scope of the HIV-AIDS epidemic,
whose death toll is nearing 25 million and affecting social, economic
and political stability, particularly in sub-Saharan Africa. Perhaps
the most striking aspect of the three day meeting was its recognition
of the gender aspects of the epidemic and its increasing impact on
the lives of women. The Declaration finds that women and young girls
in developing countries are "the most vulnerable" to the disease.
Where women once accounted for only a fraction of infections, almost
50% of all persons living with HIV/AIDS are women. The conference re-
vealed that the implications of the feminization of the HIV/AIDS cri-
sis are profound. In poor countries, women's quiet, often unpaid work
is crucial to meeting basic family needs - for food, shelter, fuel
wood and water. There are also complex issues associated with women's
roles as caregivers to those infected with the virus, and to children
orphaned by the disease. Responding to the global HIV/AIDS crisis is
crucial to saving women's lives.
DECLARATION OF COMMITMENT
The Declaration of Commitment constitutes an agreed global action
plan for stemming the spread and impacts of HIV/AIDS. The corner-
stones of the Declaration include:
Declaring the prevention "must be the mainstay of our response," gov-
ernments agreed on the goal of reducing HIV prevalence among young
people (15-24) by 25% -- to be achieved in the most affected coun-
tries by 2005, and globally by 2010. Thirty percent of all people
living with HIV/AIDS are currently under the age of 25. Reductions of
25% in young-people's prevalence have occurred over five-year periods
in the past, but achieving this kind of reduction in the most af-
fected countries over the next five years represents a formidable
In order to ensure effective prevention efforts, the declaration
calls for resolute political leadership and an integrated, cross-
sectoral response. In addition, successful prevention efforts will
promote broad community engagement from key groups, such as non-
governmental organizations, the business community and people living
with HIV/AIDS. It also includes the idea of targeted attention to
vulnerable segments of the population, including youth, intravenous
drug users, sex workers, women and the gay community.
Creative information, education and communications efforts are also
key components of effective prevention efforts, according to the Dec-
laration. Also known as social marketing campaigns, educational ef-
forts help to identify for the public key risk factors as well as
steps that individuals can take to protect themselves from infection.
In order to be effective, informational and educational programs must
be relevant to the culture in which they occur - what works in one
country may not work in others. In certain locations, educational
themes in soap operas have been successful; in others identification
with national sports has been helpful.
Governments also agreed that provision of essential health services
is also key - from commodities to counseling. In countries with suc-
cessful HIV/AIDS prevention programs like Senegal and Thailand, in-
creased use of condoms has been critical. In Uganda, male condom use
increased to 55% in 1995, from 15% in 1989; similarly, Uganda's out-
standing prevention efforts have significantly reduced early sexual
activities by adolescents. Intravenous drug-users also require ser-
vices to help reduce risky behaviors.
Finally, prevention efforts are to be complemented by effective moni-
toring of the epidemic and of key behaviors that are responsible for
risks and causes related to infection.
Mother To Child Transmission:
Transmission of HIV/AIDS from mother to child is the primary, near
exclusive cause of infection for infants and young children. The dis-
ease can be spread during the course of pregnancy, delivery or post-
partum in the course of breastfeeding. More than 5 million infants
have been infected since the onset of the HIV/AIDS crisis, with
600,000 new infections last year alone. In seriously affected coun-
tries, the risk that an HIV-positive mother will infect her child is
as high as 35%.
Antiretroviral drug therapies and provision of alternatives to
breastfeeding have been shown to dramatically reduce the risk of
mother-to-child transmission rates. In order to make these services
available in places of greatest risk, there is a need to dramatically
expand voluntary testing and counseling services for women, enhanced
access to antiretroviral drugs, as well as prenatal and post-partum
care services for HIV-positive women.
At the Special Session, nations agreed to the goal of reducing the
number of infants infected by HIV by 20 percent in 2005 and by 50% by
2010. To achieve this ambitious goal, counseling and testing coverage
for HIV-positive pregnant women will have to increase to 80% and spe-
cial efforts will have to be made to reduce infections in young
There is an important research component related to HIV/AIDS preven-
tion. Of special interest is the search for a safe, effective and af-
fordable HIV vaccine. More than 30 candidate HIV vaccine trials have
been conducted since 1987. About 20 vaccines are now at various
stages of clinical evaluation, and only two are at the advanced,
phase III stage. According to experts, late 2002 or the beginning of
2003 is the earliest date at which a vaccine could become available,
and it is likely to take many more years still.
Among the many efforts underway to develop and test prospective HIV
vaccines is the International AIDS Vaccine Initiative, which has
raised more then $250 million and has four different prospective vac-
cines for Africa in development. Experts believe that different types
of vaccine may be required for different geographic areas because ge-
netically distinct subtypes of HIV have been identified in different
The Declaration of Commitment urges rapid development of vaccines, as
well as a substantial research agenda related to women. In particu-
lar, there is a need for expanded research on female-controlled meth-
ods of HIV prevention. The male condom is the most widely known means
of prevention and obviously requires male acceptance. But the lack of
control women have over use even of a female condom illuminates the
need for more advanced female-controlled methods. In many places,
women lack the ability to refuse sex or ensure the practice of safe
sex. Of special interest to researchers is development of microbi-
cides, which are substances (creams, gels, etc.) that women can use
to guard against HIV transmission.
Treatment and Care:
60 million people have been infected with HIV and millions more af-
fected by the death and illness of loved ones. Today, there are 37
million people living with the disease. To these individuals and
their families, compassionate care and effective treatment are urgent
priorities. In developed countries like the United States, many citi-
zens have become complacent about the HIV/AIDS crisis in view of the
effectiveness of drug therapies that have prolonged the lives of peo-
ple living with the disease. However, these therapies cost tens of
thousands of dollars and have much more significant effects than most
people realize. In addition, antiretroviral drugs are not a cure for
the disease. Moreover, in poorer parts of the world, these therapies
are prohibitively expensive and thus a distant hope for people living
Significant progress has been made in terms of encouraging broader
access to expensive treatments. The UN and others have made great
strides in working with pharmaceutical manufacturers to establish
tiered-pricing structures whereby poor nations can more realistically
afford drugs, consistent with patent protections and international
Caring for people living with AIDS and their families extends beyond
antiretrovirals, however. In many cultures, this includes reducing
the stigmatization of HIV/AIDS infection. In many places the pres-
sures associated with a positive diagnosis are enough to discourage
testing and to deny the truth about infection. That is why ensuring
the dignity and human rights of people living with HIV/AIDS is high
on the international agenda. The care agenda also includes providing
support to caregivers and health care workers, who face special pres-
sures, risks and challenges.
At the Special Session, nations agreed that access to antiretroviral
drugs that can significantly extend the lives of HIV-infected people
and that special efforts should be made to ensure availability and
Emphasis was also given at the Special Session to issues associated
with caring for the more than 13 million AIDS orphans, most of whom
reside in sub-Saharan Africa. The action plan sets a goal of 2005 for
significantly enhanced community, national and international efforts
to care and assist children orphaned by HIV/AIDS.
After two decades of experience, a great deal has been learned about
how to respond to the global HIV/AIDS crisis. The challenge is not in
identifying how to respond, but rather how to marshall the political
and financial commitments needed to implement effective responses.
In the poorest countries of the world, approximately $2 billion is
spent annually on HIV/AIDS prevention, treatment and care. In prepa-
ration of the Special Session, the United Nations assembled experts
to estimate global resource requirements needed to reverse the spread
of the epidemic and mitigate its impact. According to these experts,
annual expenditures of more than $9 billion are needed on a sustained
basis. More than half of these resources are needed for prevention
efforts, and half for treatment and care.
The Declaration endorses creation of the fund and efforts to ensure
that annual global expenditures on HIV/AIDS reach $7-10 billion by
2005 - with recipient nations contributing up to half of these re-
sources and donors the remainder.
SAVING WOMEN'S LIVES
Addressing the gender aspects of the HIV/AIDS crisis was among the
most important themes raised at the three-day conference. "If there
is one idea that stands out clearly in this declaration, it is that
women are in the forefront of this battle," UN Secretary-General Kofi
Annan said upon conclusion of the conference.
During the conference the UN Women's Fund reported that teenage girls
in many southern African countries are 5-6 times more likely to be
infected with HIV than male adolescents. Similarly, women account for
a growing share of annual infections, including 55% of annual infec-
tions in sub-Saharan Africa last year.
To help save women's lives, the Declaration calls for a broad range
of measures, particularly realization of women's basic human rights
and empowerment of women so that they are to say not to unwanted sex
and to protect themselves from the risk of infection. Accordingly,
the text promotes research on women-controlled methods of prevention,
such as microbicides.
On the human rights front, the Declaration calls for realization of
all human rights for women by 2005. It also calls for steps to reduce
the incidence of all forms of violence against women and girls and
elimination of all forms of discrimination.
The Declaration also recognizes that advancing women's socio-economic
status is imperative to reducing vulnerability and promoting develop-
ment. Therefore, the document calls for universal girls education and
legal and policy changes to ensure that women have access to credit,
rights of inheritance and economic opportunities.
written by David Harwood for PLANetWIRE.org
Cecilia Snyder - Managing Editor
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