Outlines Strategies for combating HIV/AIDS   

07/02/2001

IN ADDRESS AT AWARDS BANQUET OF GLOBAL HEALTH COUNCIL, SECRETARY-GENERAL

OUTLINES STRATEGIES FOR COMBATING HIV/AIDS


Following is the text of the keynote address by Secretary-General Kofi Annan to the Awards Banquet of the Global Health Council Annual Conference, Washington, D.C., 31 May:


Thank you very much, Dr. Daulaire, for that very kind introduction.

I would want to recognize several people here tonight in addition to
Dr. Daulaire: Melinda Gates, Graça Machel, and Dr. Rosenfield.

It is an honour to be here with you. The awards being presented tonight pay tribute to many different individuals and organizations. But all of them are united by courage, conviction, and a common understanding -- the understanding that we live in an age when the separation between national and international on the issue of health agendas no longer works and no longer exists.

With globalization, the same sea washes all of humankind. We are all in the same boat. There are no safe islands. There is no dividing line between "foreign" and "domestic" infections. As the motto of the Global Health Council tells us: "There is no them: only us."

Let me join you, therefore, in paying tribute to the staff of the Centre for Health and Population Research and to the other men and women who are being honoured tonight. Let me also applaud the Global Health Council, and the Bill and Melinda Gates Foundation, for their generosity and vision in making these awards.

And let me commend the Council on the theme of its annual conference this year: healthy women, healthy world. It expresses, in four words, an insight that can save and transform many millions of lives.

We know that poverty lies at the root of many ills, and that ill health in its turn has a devastating effect on the economies of developing countries. If we are going to break this vicious circle, and build a more prosperous and equitable global society, we will have to make a major investment in public health in the developing world. The most effective way to channel that investment is to give priority to the health of women, and, above all, to make sure they have the freedom, the power, and the knowledge to take decisions affecting their own lives and those of their families.

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Study after study has shown that there is no effective development strategy in which women do not play a central role. When women are fully involved, the benefits can be seen immediately: families are healthier; they are better fed; their income, savings and reinvestment go up. And what is true of families is true of communities -- ultimately, indeed, of whole countries.

Conversely, when women suffer ill health, the whole of society pays a higher price.

No example illustrates this relationship more graphically than HIV/AIDS.

In many parts of the world, HIV/AIDS has now become one of the main obstacles to development. It is further impoverishing some of the world's poorest nations, and standing in the way of their recovery.

Last year alone, three million people died from the virus -- the highest annual total of AIDS deaths ever. It is as though the population of five cities the size of Washington D.C had been wiped out in the space of one year. Moreover, AIDS is killing people at what should be their most productive age.

The epidemic has reached its most catastrophic proportions in Africa. But parts of Asia and the Caribbean have been hit almost as hard. And it is also spreading at an alarming rate in Eastern Europe, too.

That is why I have made the fight against AIDS my personal priority. When African leaders met in Abuja last month, I issued a call to action to the whole world, focusing on five clear objectives which I believe we can all rally round.

-- First, to ensure that people everywhere -- particularly young people -- know what to do to avoid infection;

-- Second, to stop perhaps the most tragic form of HIV transmission -- from mother to child;

-- Third, to provide treatment for all those infected;

-- Fourth, to redouble the search for a vaccine, as well as a cure;

-- Fifth, to care for all those whose lives have been devastated by AIDS, particularly the orphans.

The effort to meet those five challenges will need to engage every community, every society, every sector. But today I would like to focus on the way AIDS affects women and girls, and their crucial role in meeting all of those five objectives.

At the beginning, many people thought of AIDS as a disease striking mainly at men. Even a decade ago, statistics indicated that women were less affected by it. But a terrifying pattern has since emerged. Today, in sub-Saharan Africa,
55 per cent of HIV-positive adults are women. Infection rates in young African women are far higher than in young men. And in the world as a whole, at least half of all new infections are among women.
Why does this happen? There are many reasons, ranging from poverty, abuse and violence to lack of information, coercion by older men, and men having several partners. As AIDS forces girls to drop out of school -- whether they fall sick themselves, or are forced to take care of an infected relative -- they fall deeper into poverty. Their own children in turn are less likely to attend school -- and more likely to become infected. Thus, society will pay a deadly price many times over for allowing AIDS to deprive girls of an education.

This vicious circle can appear unbreakable. But we can and we must break it. How?

-- We must make sure that girls -- who run a particular risk of infection -- have all the skills, the services and the self-confidence to protect themselves. Across all levels of society, we need to see a deep social revolution that transforms relationships between women and men, so that women will be able to take greater control of their lives -- financially as well as physically. And we must encourage men to replace risk-taking behaviour with taking responsibility.

Obviously, no government decree or planning document can achieve all this. It requires a national broad-based effort, involving communities, churches, women's groups, micro-credit organizations and trade unions. It requires more partnerships like the African Youth Alliance, which works to build up the life skills of girls -- and was made possible by a visionary grant from the Gates Foundation. It requires a global information campaign. And it requires condoms to be available to all who need them.

-- We must reduce parent-to-child transmission. That means, first of all, redoubling our efforts to ensure that women are not infected in the first place. But it also means guaranteeing every pregnant woman's right to know whether she is infected or not. And if she is infected, we must give her information about -- and access to -- the treatments that can prevent transmission to her baby; and when her baby is born, the means to avoid the risks of transmission in breast-feeding, if that is her choice.

-- We must support and train the many heroic women's groups and cooperatives that are already doing such remarkable work, in Africa and elsewhere, to care for people with AIDS. As anti-retroviral and other HIV-related drugs become more widely affordable in poor countries, we will not be able to rely on five-star hospitals to administer treatment. Qualified women's groups and community-based organizations are a vital resource. They must be trained to provide care and supervise treatment, and must be given the support they need.

-- We must ensure that women, who may be particularly attuned to the needs of their sisters in the most affected countries, can play their full part in stimulating the research process -- whether as advocates, or as researchers themselves. Let us look to the example of Dr. Mary Lou Clements-Mann, who played both parts so well. Until her tragic death three years ago, she was a pioneer in the field of HIV vaccine research -- not only in her own laboratory, but in her work with her colleagues in developing countries.

-- And we must help the women who care for AIDS orphans, of whom there are an estimated 13 million in the world today. That heart-breaking figure is equivalent to more than the total number of children in California and Texas combined. And their numbers are growing. This generation of children -- marginalized, malnourished and at great risk of infection themselves -- desperately need nurturing and encouragement. Once again, it is women -- particularly older women -- who are in the front line of this battle, and they especially need help.

Ladies and gentlemen, it is clearly women who are working hardest to keep humanity going against the onslaught of AIDS. We must help them to carry out that role to the best of their ability. But we must do more. We must empower every woman, from girlhood, to play her full part in mobilizing all society against this scourge. We already have inspiring examples to draw upon.

One of them you will hear about in a moment: Dr. Gao Yaojie, who is being honoured tonight for her work in launching a one-woman education campaign about HIV in Chinese villages. Like all of you, I much regret that she is not able to receive the award in person.

Let me tell you about another example: a young woman I met in Ethiopia who had been diagnosed with HIV one week after her twenty-first birthday. Two years on, she had made it her full-time mission to go out and talk in schools about prevention. I told her that young people would probably listen more to her than to me. She immediately agreed. And I will never forget what she told me next: that it was important for young people to see how healthy she looked -- meaning you cannot rely on looks to tell you whether a potential partner has AIDS or not.

Women like her are showing just the kind of leadership we need to win this war.

We need that leadership at every level, from the family through local communities to national governments and international institutions. We must all speak out openly about HIV, and raise our voices against stigma and discrimination.

It must begin with presidents and prime ministers of all nations. They must not shy away from this fight. At the government level in the most affected countries, a growing band of national leaders are speaking up about the epidemic. They are leading the mobilization against it, and making their people understand that owning up to AIDS is a point of honour, and not a source of shame. We need all leaders to follow their example. It is an example set by people like you, Graça, and by your husband -- our inspiration and my good friend, Nelson Mandela. I will always be deeply grateful to the two of you for being among the first to break through the wall of silence on AIDS in Africa.

And now, we must take that leadership to the whole world. We must join together local alliances in every community into one great global alliance to combat AIDS.

I see a fine cross-section here tonight of the kind of people who will be crucial to that alliance -- from government planners and policy-makers to researchers and health educators; from doctors and nurses to social workers and health economists.
Just as crucially, our alliance must include donors. In the United Nations, we calculate that the total spending on AIDS prevention and care in low- and middle-income countries needs to rise to something between seven and ten billion dollars each year.

That is why I have called for the establishment of a Global AIDS and Health Fund, to be open to both governments and private donors. It would support a comprehensive strategy against HIV/AIDS, and also target other diseases that blight the prospects of many developing countries -- starting with TB and malaria.

Three weeks ago, President Bush pledged 200 million dollars to the Fund, with the promise to do more as it evolves. I am convinced that this founding contribution -- this seed money -- by the United States -- which testifies to the President's personal engagement and leadership in this cause -- will encourage and energize others to act.

Graça, in this context -- I know I will make you blush -- I cannot resist quoting you: "If you can mobilise resources for war, why can't you mobilise resources for life?" Which brings me back to my earlier point: in this fight women not only have the right answers. They also ask the right questions.

I am moved that one of the awards being presented tonight commemorates Jonathan Mann, the husband of Mary-Lou Clements Mann, whom I mentioned a moment ago. Jonathan is someone to whom we all owe a great debt, for he was the one who started the first AIDS programme of the United Nations.

Under his ground-breaking leadership, something that began on the wings of hope, a shoestring budget and the help of one assistant grew into the biggest programme of the World Health Organization. It became the precursor of Joint United Nations Programme on HIV/AIDS (UNAIDS), the partnership of United Nations agencies which is today led so ably by Dr. Peter Piot.

Dr. Mann had a favourite saying: that the way you define a problem will determine what you do about it. That is what I would like us to remember in our struggle against HIV/AIDS.

In less than a month from today, delegates from all over the world will gather at United Nations Headquarters for the Special Session of the General Assembly on HIV/AIDS. That Session will be a test for all of us who call ourselves the international community. How we define the problem of HIV/AIDS today will determine what we do about it in the next generation.

We must define AIDS as our problem; as a threat to our common future; and as a test of our common humanity. Because -- let me quote your own motto once more: there is no them: only us. Thank you very much.