Barcelona
09 July 2002

XXIV World AIDS Conference 
International Collaboration In Scaling Up The Response to Aids

Many of the worst predictions on HIV/AIDS have been fulfilled. The epidemic is devastating societies. It is an enormous obstacle to world development and results in untold human suffering.

The spread of the virus is still way ahead of our efforts to contain it. We are still not doing enough to confront HIV and empower societies to fight it.

The silence was broken in Durban, two years ago, as the International AIDS Community came together. Since then, the independent Commission on Macroeconomics and Health has examined the ways in which illness is keeping billions of people in poverty. When they reported to me in December last year, the Commissioners - both macroeconomists and public health specialists - had reached a unanimous conclusion. The world must scale up its response to HIV/AIDS, and that must include ensuring that people affected by the virus can access care that enables them not only to survive, but to function to their full potential.

Commitments have been made to scale up the response. Activists from all walks of life - from the UN Secretary-General to rock stars, from civil society to private sector, and including many people living with AIDS, have spurred the international community to act. In June 2001, world leaders committed themselves to a clear strategy against AIDS: commitments against which they will be held to account. AIDS is now being taken seriously by Presidents and Prime Ministers.

Prevention will always be the bedrock of this expanded response. Commitments that have been made include reducing the proportion of infants born with HIV by 20%; enabling 60% of people to have access to HIV testing and counselling services; and ensuring that 90% of reproductive health service providers promote the use of condoms - all in the next two and half years.

There are several promising reports. In Uganda, infection rates in pregnant women have dropped from 30% to less than 10% in urban areas. In Thailand, comprehensive prevention efforts mean that the number of new HIV infections today is less than a quarter of the number a decade ago. In Senegal, too, rates have been kept low. Such success on a global scale would mean that 29 million new infections could be prevented by 2010.

We know how to make prevention work. Young people need the knowledge that helps them decide under what circumstances to enter into relationships, whether to change partners and how best to protect themselves from infection. In Mozambique, 70% of girls and 60% of adolescent boys do not have this knowledge. In Ukraine, 99% of girls have heard about AIDS, but less than 10% knew how to avoid infection.

Young people need to be trusted with this knowledge: they use it well. We know that if they have this knowledge, can make use of it, are able to access the services they might need, and are protected from exploitation and abuse, they behave responsibly. Indeed, they are often more responsible than the adults who are supposed to protect their rights. There should be no hiding place for adults whose behaviour increases the vulnerability of young people, or who cloud scientific evidence with untenable moral judgements.

Young girls face the greatest danger. Girls and boys in the 15-19 year age group, and often younger, are most at risk. Particularly girls: in five African countries, for every teenage boy infected there are five infected girls in the same age group. In the region as a whole, more than two-thirds of newly-infected 15-19 year olds are girls.

Prevention efforts will fail if young people are not involved more. It is great to see so many at this Conference: full of energy and ideas, but impatient at our slow pace. They are at the heart of effective responses in countries. We will support their efforts to exert influence and promote change.

Mr Chairman, friends,

AIDS drives and perpetuates the poverty of individuals, families and societies. That is why the response to HIV/AIDS must be at the core of public policy, of poverty reduction strategies, of action for sustainable development, and of human security. That is why we need intensive and concerted action by many different actors across different sectors.

New kinds of alliances are changing the public perception of the AIDS epidemic. The collective energy of governments, activists, private entities and community groups, changes the prospects for people affected by HIV. But the underlying reality is that HIV infection leads to illness. This energy cannot yield results without functioning and effective health systems that reach those who need them.

That is why there is an urgent need to scale up the capacity of health systems in communities affected by HIV and AIDS. Systems must enable people to combat the risk of HIV infection, AIDS, suffering and death. We seek ways to reduce costs of HIV prevention and care, to enable more people to access essential services, and to ensure that those who are poor are not denied their needs because of their poverty.

The issues are stark. Does anyone deserve to be sentenced to certain death because she or he cannot access care that costs less than $2 a day ? Is anyone's life worth so little ? Should any family become destitute as a result ? Should children be orphaned ? The answers must be no, no, no and no. Yet this is what is happening. Every day.

We know how to design low cost health systems that confront HIV and AIDS. We have developed straightforward guidelines so that sophisticated anti-retroviral treatments can be used also where there are limited medical staff. We know how to manage ARV treatment for large numbers of people, even in the poorest countries. We have included ARVs in the WHO list of essential drugs.

The question is no longer whether people living with AIDS in low- income settings should have access to treatment, but when and at what cost ?

Many of the communities most affected by AIDS are served by health systems which are run on less than $20 per person each year. This is a hundred times less than in OECD countries. It is simply not enough to cover priority health care needs of poor communities with high HIV prevalence. However, successes have been reported within developing country systems with quite small amounts of additional funding.

We now know what is needed for an effective scale-up of health systems to reach all in need. The first requirement is extra resources. The Commission on Macroeconomics and Health has estimated that a minimum of between $35 and $50 per person, annually, is needed. Then the systems would be in a position to provide the basics needed to tackle the major causes of ill-health, including care for those affected by HIV.

The total additional sum required each year for an adequate global response to the AIDS epidemic is in the order of $10 billion. Without these resources, the prospects for an effective scale up in service provision are slim. Unless there are real prospects of the funds being made available, within the next three years, we cannot expect to see health systems performing at the level required to stem the progress of the epidemic.

The consequences of failure to invest will be millions more people dying. These deaths could be prevented if wealthy nations were prepared to invest an additional 0.1% of their gross domestic product in health outcomes.

There is no choice: resources must be made available now.

I have stressed that, in many countries, particularly those in sub-saharan Africa, the AIDS epidemic is, quite simply, a national emergency. It undermines development, compounding the impact of conflict, food shortages and other causes of poverty. We must move quickly to agree how such countries can have sustained access to good quality essential medicines - including anti-retrovirals - at the lowest possible prices.

Countries should be able to obtain essential medicines through procurement processes that represent the best value for money. This usually means bulk-purchasing from pre-qualified suppliers, whether research-based or generic manufacturers. Even though the prices of anti-retroviral treatments have dropped dramatically in the last two years, it is our responsibility to see them fall much lower, and quickly.

We are doing more to enable countries to monitor medicine prices so that national purchasers have transparent and accurate information on how to find the medicines they need at lowest cost.

We are doing more to help check that treatment for people affected by HIV is of adequate quality - that precious medicines get to those who need them most and that the clinical progress of individual patients is monitored.

We are doing more to support country-level mechanisms that bring together government, civil society, private entities and local communities in ways that enable all to work together effectively.

Additional resources have started to become available. Within the last year we have moved from a call to action to a functioning Global Fund to fight AIDS, TB and malaria with $2 billion in pledges. Within WHO, our country and regional teams have worked tirelessly to respond to requests from many Ministries of Health for help in interacting with this new funding mechanism, and its extremely tight timetable for the first round of proposals.

HIV/AIDS is a top priority for WHO.

WHO has systems that can demonstrate the results achieved. We have invested in systems that help national and regional authorities monitor the use - and impact - of resources for confronting the AIDS epidemic. We now have ways to measure progress: not just in reducing rates of infection and death - which is, of course, the bottom line. But, we also have systems to show that peoples' understanding of how to protect themselves is increasing; that coverage of basic services is improving; that more people have access to testing, to advice, and to treatment. These are the milestones by which technical progress is measured, but they are also the milestones on the path away from economic decline and personal tragedy.

WHO staff have combined their Global Fund work with their existing duties - often working extremely long hours. They do this because we want to use our experience to enable this Fund to succeed: to get the resources to where they are needed and to make sure they are properly accounted for. WHO needs to be able to help countries scale up effective responses to AIDS, Tuberculosis and Malaria. WHO will need increased resources so that we can respond properly - at country, regional and global level - to the requests we receive.

Mr Chairman,

We are aiming for 3 million people world-wide to be able to access ARVs by 2005 - around half of those who will need such treatment. The current total of people in low income countries on treatment is around 230,000 and over half of these are from one country, Brazil. It is a promising start, but we have much further to go.

WHO is working with countries as they follow up their commitments to treat people affected by AIDS. We will continue to estimate the costs of essential service packages, and to work for medicine prices that can be funded within budgets of government, donors or families. We help countries establish novel health systems that deliver these services efficiently through trained and properly remunerated health personnel. We help them establish systems for monitoring progress of individuals and populations. And, of course, we will strive relentlessly to raise more money to confront the epidemic. A great deal more money. Not just through the Global Fund, but money committed by development banks, bilateral donors, foundations and technical agencies.

No government has enough money to finance an ideal health system that responds to the needs of all. Choices have to be made. Priorities for using scarce resources must be set, and revised in the light of data that becomes available. But, whatever the economic arguments, no government should have to chose between preventing HIV infection, or caring for those affected by the virus.

It is not reasonable for any society to be expected to accept the deaths of thousands of AIDS-affected adolescent girls, young mothers, health workers and teachers when care is available to those similarly affected in wealthy nations. In this era of increasing globalization, we must seek the best and most cost-effective way of saving future generations, as well as the best and most cost-effective way of prolonging the productive life of those who are with us now.

The international community needs to respond not only with strategies and plans but - most important - through effective action. We know that we still have far to go, but we know how to get there. We must respond to calls for action with adequate funding and concerted efforts to bring effective health systems, staffed by skilled personnel, and equipped with essential medicines, to those who need them.

There is no other way to seriously confront this terrible epidemic.

Thank you.