University of Zambia Medical Library

"Global Anti-AIDS Strategy Adopted."
UN Integrated Regional Information Network, June 28, 2001

The UN General Assembly's historic Special Session on HIV/AIDS ended on Wednesday with what Secretary-General Kofi Annan described as a "clear strategy" for tackling the epidemic.

"What is important is that, after today, we shall have a document setting out a clear battle plan for the war against HIV/AIDS, with clear goals and a clear timeline. It is a blueprint from which the whole of humanity can work, in building a global response to a truly global challenge," Annan said.

After three days of deliberations, the Final Declaration establishes a consensus on a framework for action. It highlights general issues of leadership, prevention, care, support and treatment, human rights, vulnerability, orphans and the impact on development. "If there is one idea that stands out clearly from the declaration, it is that women are at the forefront of this battle," Annan noted.

Civil society groups, generally welcomed the declaration as a step in the right direction. "Although we would have liked to see greater detail with regard to identifying particular vulnerable groups and HIV/AIDS as a human rights issue, we believe this declaration represents a significant commitment by the international community with regard to their roles and responsibilities in combating HIV/AIDS," CARE spokesperson Phillipe Leveque said in a statement.

The real test, however, is whether the words can be turned into deeds - particularly in terms of contributions by wealthy countries to the Global AIDS and Health Fund due to be operational by the end of the year. The declaration called for an annual target of US $7-10 billion to be reached annually by 2005 for the fund.

"The UN did what it could: Leaders of nations, rich and poor, had to confront the need for a truly global effort to tackle the AIDS pandemic by treating the sick and preventing its further spread. Now it's up to the leaders of the G-8 rich nations to underwrite this effort at their meeting next month in Genoa," said health advisor to Oxfam, Mohga Kamal Smith.

Tanzanian President Benjamin Mkapa, who chaired the General Assembly panel on international funding, said at a press conference that African countries were committed to raising their health spending but "at the same time traditional development partners should be forthcoming". He said a well-endowed fund would "consolidate the flow" of resources.

Stressing the connection between poverty and the spread of HIV, Mkapa called for deeper debt relief for African countries. According to an Oxfam report, out of 17 states that have qualified for debt relief under the Highly Indebted Poor Countries (HIPC) initiative, 8 were still paying more in servicing loans than it would cost to establish a basic HIV/AIDS treatment, care and prevention programme based on the HIV rates in their respective countries.

"New Determination Is Seen Emerging in AIDS Battle." By Barbara Crossette
New York Times, June 27, 2001

It was billed as a world assembly on AIDS, but by the time three days of tumultuous meetings ended today, the leaders of Africa, often at odds and sometimes at war, had come together to dominate the session, showing a markedly new determination to fight the disease that has decimated their homelands. African leaders and international health experts said this week that this united approach evolved in recent weeks and months, most notably since President Olusegun Obasanjo of Nigeria was host for a summit-level meeting of Africans in April.

Until then, many leaders had been in denial, trying to obscure mounting evidence that AIDS was spreading rapidly. Now they have numerous proposals for fighting H.I.V., the virus that causes AIDS, and, more broadly, for taking a new look at shortcomings in national development.

But missing from this united effort and open debate was President Thabo Mbeki of South Africa, the country with the largest infected population. His absence was widely noticed and described as inexplicable. Although Mr. Mbeki was in the United States this week, he sent his health minister, Mantombazana Edmie Tshabalala-Msimang, to the special session.

In a speech, Dr. Tshabalala-Msimang — her training included public health as well as obstetrics and gynecology — alluded to Mr. Mbeki's questions about what causes AIDS and whether priority should be given to antiretroviral drugs in dealing with the epidemic. While other leaders from areas hard hit by AIDS also sent their health ministers, Africa was represented by presidents and prime ministers — even a king. They had seen AIDS invade their families, strike down cabinet ministers and decimate their civil services and economies. Of the 36 million people in the world infected with the virus that causes AIDS, three- fourths of them live in Africa. So these leaders all had stories to tell this week.

For President Obasanjo, a former general, the seriousness of the epidemic became evident when AIDS invaded his nation's army. "When I took over the reins of government in Nigeria, H.I.V.-AIDS had not been given the type of attention it should be given," he said, looking back to his election in 1999. "It was still a sort of hush-hush affair." "What really spurred me on was when I got back some of our soldiers from Sierra Leone," President Obasanjo said, "and said that there should be tests carried out on them. We found that they were, on average, about 11 percent infected." That was more than twice the national rate: "That really gave me cause for alarm," he added.

Secretary General Kofi Annan, a Ghanaian, has tried to raise the consciousness of his fellow Africans on numerous trips and in reports. He has spoken out against stigmatization and denial in dealing with AIDS, and has urged African governments to make themselves attractive to investors rather than blaming the global economy for all their economic ills. Gro Harlem Brundtland, a doctor and the director general of the World Health Organization, said in an interview that rising international attention to Africa — including campaigns for cheaper drugs, for debt cancellation and for significant aid to weak public health systems — has helped encourage African efforts.

The falling price of vital drugs has also given many African health officials new hope. Meetings on AIDS, including one in the Security Council last year, set the stage, she said. AIDS was elevated to an issue of national security, and government leaders could no longer ignore the importance of the disease.

Still, several leaders interviewed this week all pointed to the huge obstacles that remain. "Over the last year, we have seen a quantum jump in the level of awareness and response to H.I.V.," said Mark Malloch-Brown, administrator of the United Nations Development Program. "The H.I.V. crisis has coincided with some pretty talented new democratically elected governments in Africa." The richer nations will be taking the lead from them, he said. Mr. Malloch-Brown continued: "The silver lining to this problem is that it is forcing the West to engage with Africa, not just on the old basis of `You've got problems, we want to help,' but out of a much more fundamental sense of self-interest, of a global war where — like it or not — the front-line generals are African leaders. It is forcing a partnership, and the West is not in the lead in this partnership. Africa is."

Model programs for preventing and treating AIDS have been introduced by Botswana, Senegal and Uganda. Based on those and other experiences, said Dr. Peter Piot, the executive director of Unaids, international experts expect Africans to devise future programs, with the help, but not the direction, of foreign advisers. Tanzania's president, Benjamin William Mkapa, said at a news conference here today that in Africa the wars against disease and underdevelopment "must be country led and internationally supported."

Africa and the Africans have become so prominent here this week, Dr. Brundtland said, that officials from the Caribbean and Asia who not very long ago did not want to talk about rising epidemics in their regions, are now demanding to know why they are not getting more of the world's attention.

President Obasanjo said at a news conference on Monday that poverty was an issue everywhere, but that this should not derail a new determination to fight AIDS. "We in Nigeria are battling with other things," he said. "About 70 percent or thereabout of our people are living below the poverty line. We are battling inadequacies of power or water supply and so on. We are battling our own inadequate infrastructure. In spite of all this, we still believe that this scourge, which has taken its toll on Africa, must have our attention and our contribution." He pledged $10 million to a global fund of up to $10 billion that Secretary General Annan has called for.

Bernard Kouchner, the founder of Doctors Without Borders who is now minister of health in France, said in an interview that intellectual resistance to what are seen as western prescriptions is not new, and he predicteds that the controversy generated by Mr. Mbeki will fade. "Twenty years ago African intellectuals didn't want us to treat malaria," he said. They described the work of foreign doctors as charity or accused them of bringing colonial ideas to treating an illness for which there were traditional cures.

Now Dr. Kouchner and other Europeans are creating a system of twinning hospitals in rich countries with the best hospitals in Africa so that medicines, equipment and expertise can be shared. "Every country has some good hospitals," Dr. Kouchner said. "We can help strengthen them." Several American foundations and the Pfizer pharmaceutical company are supporting research centers in African universities and medical centers.

President Abdoulaye Wade of Senegal is one of the recently elected leaders who has been most active in promoting public health and development reforms. He has devised a strategy for plugging Africa into the global economy, known as the Omega plan, focused on investment in infrastructure, education, health and agriculture. President Wade recently recruited a Senegalese health expert working with Unaids, Dr. Awa Marie Coll- Seck, and made her health minister.

At a press conference on Tuesday, they explained how Senegal had contained the epidemic getting an early start, in 1986, and erasing the taboos around the disease. In a country that is 95 percent Muslim, Dr. Coll-Seck said, religious leaders as well as teachers were "trained and sensitized" to talk about sexually transmitted diseases. Women's groups were enlisted from the grassroots up into urban society. "We didn't wait for the disaster to happen," she said.

At the United Nations Development Program, Mr. Malloch-Brown, the administrator, said that as a new phase in the fight against AIDS begins, African leaders and donors to the newly created global fund "will be out on a long limb." The anti-AIDS campaign has to work, he said. Only then will it be possible to talk about long-term partnerships. Mr. Malloch-Brown said he has been meeting African leaders this week and telling them that "if we come out of this with a renewed sense of trust and confidence in African leadership" the next goal is public investment in the infrastructure of Africa. For the moment, he said, richer nations shy away from building roads or other large projects because they are "too difficult, too controversial, and it always raises the red flag of corruption and mismanagement."

Paradoxically, he said, the AIDS crisis in Africa — so damaging in the short term to foreign business interests in Africa — may improve the investment climate in the long run if the battle is led effectively. In the joint fight against AIDS, he said, there is a chance of "a restoration of Western confidence in African leadership."

"U.N. Redefines AIDS as Issue of Rights and Peril to Poor."By Jennifer Steinhauer
New York Times, June 27, 2001

The General Assembly approved an ambitious declaration tonight outlining how the world should proceed in its fight against AIDS. Concluding its three-day special session on the pandemic, the world body also made a plea to nations and private industry alike to provide the billions of dollars needed to help pay for the mission.

The Declaration of Commitment, as the document is known, while in no way enforceable by the international community, is nonetheless extraordinary in both its language and its tact. It views the AIDS problem as something far beyond a medical issue, framing it instead as a political, human rights and economic threat. It also addresses head-on issues like the role that the exploitation of poor women and discrimination has played in spreading H.I.V., the virus that causes AIDS.

Calling the document an "instrument for accountability," Dr. Peter Piot, executive director of Unaids, the United Nations agency coordinating the fight against the disease, said that it would provide "a strong basis for future action" that would be measurable in many ways in the near future. A key goal is a 25 percent reduction of H.I.V. infection among young men and women in the most affected countries by 2005.

Recognizing that many of the document's elements would be a hard sell in nations where rural women enjoy few rights, where gays are heavily stigmatized and where sexual education is generally eschewed, Dr. Piot and Secretary General Kofi Annan said that all countries will be pushed to put cultural mores aside to save lives. "It is our job to push the edges now," Dr. Piot said.

How difficult that challenge could be was evident early in the week as some Islamic countries strongly opposed mentioning gays as one of the groups at highest risk for AIDS. (Language about high-risk groups was eventually deleted from the declaration.) "Some painful differences have been brought into the open," Mr. Annan said. "But that is the best place for them. Like AIDS itself, these differences need to be confronted head-on, not swept under the carpet."

The declaration says that by 2003 countries should identify the factors in their area leading to the spread of AIDS and come up with specific targets for improving prevention. It also calls on them to develop national strategies for combating the spread of H.I.V. and to provide treatment for all those infected. The document says that by 2005 countries also need to increase access to male and female condoms, expand AIDS testing and counseling, ensure safe blood supplies and provide sterile equipment to drug users.

Mr. Annan said the United Nations will follow up with countries to see if they are setting and meeting these goals, and will chastise them if they fail to do so. Calling AIDS a "global emergency," the declaration details where the disease has hit hardest, namely Africa, and outlines the many factors contributing to the spread of AIDS that were explored at length this week, including rural poverty, poor health care systems and the stigma associated seeking treatment. But the declaration also calls for legislation and regulations to protect the rights of infected citizens and states explicitly that "empowering women is essential for reducing vulnerability," noting that social exclusion, illiteracy and sexual exploitation have contributed to new infections.

The document calls for eliminating things like "harmful traditional and customary practices" which appears to be an allusion to things like genital mutilation, a procedure in which reused knives increase the risk of contracting AIDS through infected blood. "If there is one idea that stands out clearly," Mr. Annan said, "it is that women are in the forefront of this battle." The declaration recognizes the role of local groups operating outside of the government in helping stem the illness in ways that Mr. Annan noted was unprecedented, and calls on governments to help these groups reach out to the most vulnerable populations. Asking the entire world to start educating rural women and help them gain economic and social currency is a tall order, considering that many countries permit things like wife inheritance and that literacy rates for women are low. Cultural impediments also exist in allowing groups to offer services to people whose behaviors are stigmatized if not severely punished.

There was an absence of leaders from Asian and Eastern European nations where infection rates are rising, a point that Dr. Piot noted with alarm. But in spite of these impediments, officials at the special session encouraged optimism that the world had taken on such a polarizing and difficult subject in such a large forum after 20 years of not having dealt with the topic.

During the week, women from the desert regions of Western Africa were seen sitting cramped togetherwith English businessmen in a conference room discussing microbicides. Other participants from the world's most conservative nations considered sex education for unmarried citizens. Gudmund Hernes, an official with Unesco, noted that he would never have believed that he would sit in the General Assembly of the United Nations, "discussing condoms."

Before the session, controversy erupted over treatment versus prevention, with each side arguing that one should not be subordinate to the other. The document accepted today ties the two strategies together outlining the desired world response to AIDS, but it calls for "acknowledging that prevention of H.I.V. infection must be the mainstay of the nation, regional and international response to the epidemic." The "false debate" about the two strategies is over, Dr. Piot said.

Seeking a stepped-up response to AIDS will require new money, and there was a call for public and private efforts to generate roughly $9 billion for a Global AIDS and Health Fund that Mr. Annan hopes to be up and running by the end of the year. While the specifics of how that fund would operate are to be worked out over the next month, Mr. Annan, who held up a check for $1,000 from a private donor, suggested that the fund would be run by a small and efficient board of donor and recipient counties, United Nations officials and people from governments and private industries.

Mr. Annan said that despite the stubborn nature of AIDS and many countries' continued denial of its pervasive threat, "All in all, I feel even more confident today than I did three days ago that we can defeat this deadly disease."

"Annan Calls for Global Action Against HIV/AIDS."
UN Integrated Regional Information Network, June 26, 2001

UN Secretary-General Kofi Annan called on Monday for a global partnership based on a common purpose to defeat the global scourge of the HIV/AIDS epidemic.

Addressing the opening of the Special Session of the UN General Assembly on HIV/AIDS, Annan noted that up to now, the world's response had not measured up to the challenge. "But this year, we have seen a turning point," he said. "AIDS can no longer do its deadly work in the dark. The world has started to wake up."

Annan added: "Never, since the nightmare began, has there been such a moment of common purpose. Never have we felt such a need to combine leadership, partnership and solidarity. Leadership is needed in every country, in every community - and at the international level, where the entire United Nations system is now engaged. All of us must recognise AIDS as our problem. All of us must make it our priority."

He insisted that solidarity was needed "between the healthy and the sick, between rich and poor; above all, between richer and poorer nations." Annan said increased resources were key to the battle against the epidemic, and spending on anti-AIDS initiatives in the developing world needed to rise to roughly five times its present level of about US $2 billion.

"We must mobilise the money required for this exceptional effort - and we must make sure it is used effectively," he said. "That is why I have called for a Global AIDS and Health Fund, open to both governments and private donors, to help us finance the comprehensive, coherent, coordinated strategy we need."

UNAIDS Executive Secretary Peter Piot, in his address to the General Assembly, also stressed the issues of collective responsibility and improved resources. "We know what works. We know what to do," Piot said. "And with uncompromising determination, we must ensure that no country, no community fails in its response to AIDS because of a lack of financial, technical and human resources."

Piot pointed out that there were only two alternatives leading from the three-day Special Session: either the "collective shame" of continuing to fight HIV/AIDS - and losing, or the building of a new path in which members of the international community "declare their commitment to stop this epidemic".

"The Challenge to Sustainable Development in Africa: The Gender dimension of HIV/AIDS, Peace and Economic Security."
UNIFEM (Geneva) June 25, 2001

This background paper was prepared by UNIFEM, the United Nations Development Fund for Women, for a high-level panel of the UN Economic and Social Council, which is convening in Geneva, Switzerland in July.

An understanding of the gender dimensions of HIV/AIDS is one of the key challenges to sustainable development in Africa. This is not simply a "body count" of who has died or is dying from the disease- but of how women are affected through loss of family and community structures, loss of income and security, (including land and food security), increased responsibilities for caring for the ill, the social and economic costs that are not calculated in traditional economics, and the complex interactions between armed conflict and the spread of the HIV virus through sexual acts of violence and abuse.

Experts and governments worldwide now routinely acknowledge that gender inequality drives the HIV/AIDS pandemic and is resulting in alarming rates of infection in women and girls. In spite of the now universally recognized cause-and-effect relationship between women's low social status and HIV transmission, concrete solutions are absent from international resolutions and national strategic plans that address HIV/AIDS. Twenty years into the pandemic, it is not enough to acknowledge its deadly gender dimensions. Policy makers and society at large must find ways to share power and autonomy with women.

The HIV/AIDS virus has taken full advantage of humankind's social infirmities: its most effective allies are gender inequality and poverty. The virus travels with aggressive efficiency among those who lack the information, resources or power to put up effective barriers against it. Divested by society of status, authority and control over their own lives and bodies, it is increasingly females - especially poor and young females - who most often become the virus's unwilling and unwitting hosts.

The Social and Economic Costs of HIV/AIDS on Women's Lives Although very few women were among those infected in the early years of the epidemic, their numbers have since soared to 47 per cent of the 34.7 million adults living with HIV/AIDS worldwide by the end of 2000 and to 55 per cent of infected adults in sub-Saharan Africa. The reasons for this rapid escalation are undisputed. Wherever HIV/AIDS takes hold, females are at heightened risk for two reasons: biology works against them, but so do the societal and cultural norms that give men more control over decision-making at every level, from the personal to the political. Gender roles and expectations nearly guarantee that whenever HIV/AIDS insinuates itself into a family or a community, it is women and girls who will find themselves burdened most by its impact and supported least. It is not only women, but men as well who are in turn placed at higher risk due to these factors.

HIV/AIDS demolishes economic resources, and that wreckage, too, is suffered most acutely by women. Women's predominance in Africa's lower levels of the economy - including the informal sector and small and medium enterprise, where labour protections are nearly non-existent - increases their economic vulnerability. That same lack of effective legal protection divests many of homes, property and custody of their children when their husbands die of AIDS. In many cases, it is customary and religious law that deprives women of the independent legal right to resources through inheritance when a spouse dies. Women in such circumstances, who may also find remarriage impossible, are often forced into the further economic peril - and increased vulnerability to HIV infection - of migrant labour. Countless women and girls must make the horrific choice between certain death and possible survival through sex work. In such circumstances, the immediate risk of violence or income loss often pressures women into short-term survival activities that put their long-term health and lives at risk.

Girls and women, including the very young and very old, manage most of the care that sustains millions of people left sick, orphaned and incapacitated by the pandemic. Governments must first acknowledge and then address the fact that to understand that women are currently subsidizing the State by sustaining the social safety net for infected family members. Social service programmes and other emergency support services are needed to relieve women and girls of this inequitable and additional burden.

Societies' perceptions of female worth prevent many women from getting tested, and may cause them to delay or forego seeking health care. In 2000, 52 percent of the adults who have died of AIDS so far have been women. Studies in Africa show that women fall sick from any cause, they are less likely than men to be admitted to hospital or to have access to the family's resources. Studies have also shown that, when Anti-Retrovirals (ARVs) become available, doctors may not offer the drugs to HIV-positive women because they doubt that women can follow complicated medication regimens . Governments, as well as communities, have an obligation to care for - rather than isolate and stigmatize - HIV positive women who are trying to piece together their livelihoods and lives. Families need to be encouraged to share their resources to providing health care for their HIV-infected mothers, wives, sisters and daughters rather than only for the men.

An Epidemic Fueled by Violence Against Women The intertwining forces of conflict and gender equality threaten international peace and security. Rape and sexual violence continue to be used as weapons of war. Nearly all girls abducted into army groups are forced into sexual slavery. The vast majority become infected with sexually transmitted infections (STIs) and those increasingly include HIV/AIDS . The chaotic and brutal circumstances of war aggravate all the factors fuelling the HIV/AIDS crisis. This has a devastating impact on women and girls. In the absence of functioning health and education systems in conflict situations, emergency humanitarian relief must support HIV/AIDS awareness, prevention, care and treatment while contributing to the longer-term national policies. Even at times of peace, women and girls are frequently forced or coerced into sex, in and outside of marriage, which exposes them to HIV. When infected, it is not unusual for them to be abused, abandoned or murdered if their status becomes known. Women, often the first in the family to be tested when pregnant, are then commonly blamed for infecting their husbands and partners, although it is usually men who bring the virus into the family. Societies' perceptions of female worth prevent many women from getting tested, and may cause them to delay or forego seeking health care.

The rights of all people living with HIV/AIDS to information, treatment, quality care, confidentiality and privacy must be promoted, protected and respected. But it is especially critical that unprecedented efforts be made to ensure that women and girls can realize those rights at regional, national and community levels.

Women at the Forefront of Solutions to the HIV/AIDS Pandemic Women can and should drive the process of change. Women and girls take up the burden when families and communities fall on hard times. They are intimately familiar with the most critical needs that must be met and to responding at great cost to themselves to these needs, when HIV/AIDS takes its toll within households and extended families. It is this experience and knowledge that is able to lead a community toward integrated efforts to address the pandemic and to fairly distribute the work of attending to those most affected.

Women are not solely victims of HIV/AIDS, but they are also the hope for the future-as leaders in process for change in the family, community and nations of Africa. We can find inspiration in the many ways that women are responding to this epidemic. In all regions, there are inspiring examples of women organizing new livelihood opportunities for networks of women living with HIV/AIDS, launching community research and advocacy strategies to educate other women about their risks and rights, and linking strategies to end HIV/AIDS with strategies to end violence and poverty.

While it is devastating communities and countries, the HIV/AIDS epidemic can also be heard as a wake up call. UNIFEM is launching a new initiative inspired by the African Plan of Action from the African Development Forum at the end of last year, which stated "The struggle against HIV/AIDS will be won community by community, in every village, township and settlement across Africa." Building on this, UNIFEM will be supporting communities to develop gender equality zones. The initiative is inspired by an extraordinarily brave young woman named Gugu Dhlamini from KwaZulu, South Africa. After Gugu declared her status as a woman living with HIV/AIDS on World AIDS Day in December 1998, she was stoned to death by a group of young men in her community. This initiative seeks to create communities in which such acts are unthinkable. Other UN agencies are invited to work with UNIFEM in demonstrating that if we address the challenges of gender inequality and discrimination, and of the lack of rights of women and men living with HIV/AIDS, we can find a way to stem the rapid spread of the disease.

UNIFEM and its partners have been involved in numerous pilot projects that have yielded important information about how to address the scourge of HIV/AIDS. Now support and political will are needed to ensure that lessons learned underpin all policies and strategies related to ending HIV/AIDS, and that women are central to prevention and treatment plans, as well as to finding sustainable solutions to this pandemic.

Some specific areas that the international community should consider and pursue in regard to the gender dimension of HIV/AIDS, peace and economic security include the following:

• An enabling environment for gender equality in strategies to address HIV/AIDS
• Use CEDAW, and its overarching principles to ensure women's rights, as a guiding framework in the development of all HIV/AIDS prevention, treatment and care strategies;
• Ensure that women's rights and gender equality are explicitly taken into account in the composition of and policies and programmes promoted by National AIDS Councils and in National AIDS strategies; and
• Disaggregate by sex all data collected on the incidence and impact of HIV/AIDS so that policy-makes and planners can respond to gender-related trends and the particular needs and contributions of women and girls.
• Gender-responsive prevention, care and treatment
• Disseminate information about HIV/AIDS and Sexually Transmitted Infections that will reach girls and women -- especially those who are illiterate, outside of the normal channels of mainstream media, and need materials in indigenous languages - so that they can understand and act upon the information;
• Rapidly accelerate research to improve and develop women-controlled prevention methods, including affordable female condoms and microbicides that women can use without fear of recrimination;
• Support community-based NGO's and community leaders to address the harmful cultural practices that discriminate against women and result in spreading the virus.
• Involve girls and women in production and dissemination of information about HIV/AIDS, education and communication (IEC) strategies;
• Recognize and account for women's domestic and reproductive roles in caring for those infected by HIV/AIDS and in supporting families left destitute by the epidemic;
• Establish free, accessible centres for voluntary and confidential counseling, testing and referrals in and outside of antenatal and health clinics to ensure privacy;
• Produce and widely disseminate gender-sensitive materials to help adults introduce girls and boys to reproductive health education at home, in schools and in religious and community centres so that young people are aware of strategies to prevent HIV/AIDS before they become sexually active; and
• Support NGOs and governments to develop training approaches and information materials that help women to negotiate safe sex and avoid unwanted and unprotected sex.
• Addressing the impact of violence against women in peace and in war on HIV/AIDS transmission
• Ensure gender-sensitive HIV/AIDS awareness, prevention, care and treatment in humanitarian assistance during conflict and as an integral part of post-conflict rehabilitation and reintegration programmes;
• Call for the Code of Conduct for peacekeeping personnel to provide for the establishment of clear reporting mechanisms on sexual violence and accountability for perpetrators of sexual violence in a peacekeeping environment; and - Develop and enforce laws to end impunity for perpetrators of violence against women, including those who perpetrate marital rape, domestic violence, conflict-related abuse and abuse of minors.

AIDS can no longer do its deadly work in the dark. The world has started to wake up. We have seen it happen in the media and public opinion -- led by doctors and social workers, by activists and economists, above all by people living with the disease. We have seen it happen among Governments. And we have seen it happen in the private sector. Never, since this nightmare began, has there been such a moment of common purpose. Never have we felt such a need to combine leadership, partnership, and solidarity.

Leadership is needed in every country, in every community -- and at the international level, where the entire United Nations system is now engaged. All of us must recognize AIDS as our problem. All of us must make it our priority. Partnership is needed between governments, private companies, foundations, international organizations - and, of course, civil society.

Non-governmental organizations have been at the forefront of the fight against AIDS from the very start. All of us must learn from their experience, and follow their example. How right it is that they are playing an active part in this Session.

Finally, solidarity is needed -- between the healthy and the sick, between rich and poor; above all, between richer and poorer nations. Spending on the battle against AIDS in the developing world needs to rise to roughly five times its present level. The developing countries themselves are ready to provide their share -- as African leaders pledged at the Abuja summit. But they cannot do it alone. Ordinary people in developed countries are now showing that they understand this. I urge their leaders to act accordingly.

We must mobilize the money required for this exceptional effort -- and we must make sure it is used effectively. That is why I have called for a Global AIDS and Health Fund, open to both Governments and private donors, to help us finance the comprehensive, coherent, coordinated strategy we need. Our goal is to make the Fund operational by the end of this year. I will continue to work with all the stakeholders to ensure that we meet that goal. Let me applaud those who have already pledged contributions. I hope others will follow their example, during and after this Special Session.

"Action Needed Now On HIV/AIDS."
UN Integrated Regional Information Network, June 27, 2001

Down in the basement of UN headquarters is where the anti-AIDS militancy is brewing. It is here, among the civil society groups attending the three-day UN Special Session on HIV/AIDS, that the loudest and most insistent calls for action are being made.

On Tuesday, crowded into a tiny conference room, a coalition of campaign groups demanded that Western governments and pharmaceutical companies shoulder their responsibilities in the fight against the epidemic. To the shaking of money tins, activists chanted "Treatment Now" and "Pills Cost Pennies - Greed Costs Lives".

For the Global Treatment Access Campaign, the issues are stark. They revolve around the funding and control of the UN's Global AIDS and Health Trust Fund, the immediate availability of affordable drugs in the developing world, and the burden of poverty most especially affecting African countries.

UN Secretary-General Kofi Annan launched the Global Health Fund initiative in April. He called for US $7-10 billion from wealthy countries each year for the next decade for the care, treatment and prevention of HIV/AIDS, tuberculosis and malaria in the developing world. The first and largest contribution so far has come from the United States with US $200 million. Washington has promised more, but has set no date. Oxfam contends that, based on gross national product, the US contribution to the fund should be in the region of US $4 billion a year. And rather than for just a decade, allocations need to be stretched over 20 years.

That sounds an awful lot of money. But, according to the Drop the Debt pressure group, Nigeria with 120 million people and facing an exponential growth in HIV rates, is expected to pay creditors US $1.2 billion a year in debt servicing. Zambia, where one in five adults have HIV, is spending US $176 million annually on debt, compared to US $76 million on health. The US $200 million that the United States has so far promised the fund is equivalent to the sum paid by sub-Saharan Africa each week in debt. [For more information visit: http://www.dropthedebt.org/home.html]

"We want total debt cancellation, we will only know that the world is serious about HIV/AIDS when they give us another chance to start with a clean sheet," Sheila Kibuka of Kenya's Society for Women with HIV/AIDS told the treatment access campaign meeting.

Meanwhile, contributions to the global fund are running at only around US $500 million. Even with expected pledges in July at the G-8 summit, total contributions are not expected to reach US $1 billion by the end of the year, according to the 'New York Times'. That, by default, would force treatment and care initiatives off the agenda.

A concern among activists is that Western governments would be far happier to spend on cheaper preventive programmes - condoms and AIDS education - rather than the provision of treatment for the 36 million people infected with HIV worldwide. Inadequate health infrastructure and complicated antiretroviral regimens are frequently cited to justify a prevention-focused strategy in developing countries.

But, the US-based Health Gap Coalition points out that "vast numbers of people with AIDS are dying (or within reach of) hospitals and clinics that can dispense prescriptions, but lack the medications necessary to save their lives". It can typically take just three pills, swallowed in one gulp twice daily, to keep somebody infected with HIV alive. [For more information visit: http://www.globaltreatmentaccess.org/]

What is increasingly being recognised at the UN Special Session is the need for an "integrated approach" involving both treatment and prevention. "Treating patients plays a crucial role in preventing infection, and hope of treatment in turn is an incentive for those infected to seek diagnosis and advice," an Oxfam report said. "The fund should be designed to support a range of health needs - both preventive and treatment. It should also be available to support the development of infrastructure and service delivery systems where their absence prevents the poor from accessing health services." [To access the report visit: http://www.oxfam.org.uk/policy/papers/globalhiv.html]

The Oxfam report also urges that anti-AIDS drugs be procured under competitive tender, open to generic drug manufacturers, rather than just the major pharmaceutical companies. Bulk buying through regional governmental organisations would also help reduce prices. In a challenge to patent monopolies, the Oxfam report champions the use of compulsory license and parallel imports to enable countries to access drugs from the cheapest source.

"In most African countries I am confident that the leadership has woken up to the threat of HIV/AIDS," Kibuka told IRIN. "It is not just poor people who are affected, it also effects people in government." What is urgently needed, she argued, is to begin. "We cannot wait for these bureaucracies," she said, in reference to the fund. "Let's just start and move on. We have mission hospitals in the villages, all this talk of lack of infrastructure are just lame excuses."

"58 Countries to Boost HIV/AIDS Care & Treatment."
UNAIDS, June 25, 2001

Efforts to improve and speed up access to care for people living with HIV/AIDS are gaining new momentum, the Joint United Nations Programme on HIV/AIDS (UNAIDS) said today.

A total of 58 countries have now expressed interest in gaining access to lower-price drugs - including treatments for opportunistic infections and antiretroviral therapy - in the context of the public-private partnership started in May 2000 by five United Nations agencies and five private sector companies.

Five research-based pharmaceutical companies (Boehringer Ingelheim, Bristol Myers Squibb, Glaxo Wellcome, Hoffman La Roche and Merck) and the World Health Organization, World Bank, UNICEF, UNFPA and the UNAIDS Secretariat have been exploring ways of speeding up access to HIV/AIDS-related care and treatment in developing countries.

Twenty three countries have indicated interest in the past month alone. Eleven of the participating countries (ten of them in Africa, one in Latin America) already have reached agreements with manufacturers on significantly reduced drug prices.

The process is gaining new momentum as regional groups of countries recognize the potential of driving drug prices lower through regional procurement. This regional approach potentially also offers people moving between countries in a region access to fairly standard levels of care. Countries in Southern, Eastern and West Africa are actively pursuing this option.

"A regional approach holds strong potential to expand the benefits of improved access to care, for example through the possibility of bulk purchasing, shared technical assistance and joint resourcing," said Dr. Peter Piot, Executive Director of UNAIDS.

Competition from generic manufacturers and a proactive attitude on the part of the research and development-based industry have helped reduce drug prices. Uganda’s approach to lowering prices, for example, has involved direct competition between generics and research and development-based manufacturers.

Aiding the process is a database of drug suppliers set up by UNICEF, WHO and the UNAIDS Secretariat, in conjunction with Médecins Sans Frontières. The database identifies prices and sources of selected drugs used in the care of people living with HIV/AIDS, including essential drugs to treat opportunistic infections and several antiretroviral drugs. A total of 34 manufacturers of drugs (29 of them manufacturers of generic products) have applied to be listed as potential suppliers. "Significant price discounts are being achieved, but prices of HIV/AIDS drugs are still far beyond the reach of the majority of people who need them," said Dr. Piot.

Several other approaches are being used to ensure sufficient resources are allocated to comprehensive care programmes in hard-hit countries. Governments are devoting more public funds toward prevention and care. Some - like Côte d’Ivoire, Cameroon, Gabon, Mali, Morocco and Senegal - are allocating special funding to subsidize access to antiretrovirals for people who are unable to afford the drugs. Other countries, including Burundi and Rwanda, contribute to a special fund for purchasing drugs at subsidized prices.

Countries are also directing debt relief funds toward HIV/AIDS prevention and care programmes. Cameroon and Mali, for example, have converted part of their debt into a fund for care and subsidizing access to drugs. Some governments have invited private companies to subsidize access to drugs for their employees and their families. In countries like Brazil and South Africa, regulation of existing insurance schemes has provided access to HIV/AIDS care for thousands of people who would otherwise have been unable to afford it.

"We have seen a sea change in the way many governments approach the HIV/AIDS epidemic," said Dr Gro Harlem Brundtland, Director-General of WHO. "The possibility of treatment has given new hope, making countries scale up their efforts to fight the disease, through prevention and better diagnostics as well as beginning to provide care for those already infected."

Despite these advances, there remains a pressing need for even stronger progress on a range of other fronts. Access to care and treatment will remain uneven until countries are able to afford AIDS-related drugs and diagnostic equipment, strengthen their health systems with the necessary infrastructure and trained staff, and provide adequate voluntary counselling and testing services, and psychosocial support.

While significant price discounts for antiretroviral therapy have been achieved, the vast majority of people affected by HIV/AIDS remain without access to even basic drugs and medicines. Ensuring that essential care - palliative care, prophylaxis and treatment for opportunistic infections - is rolled out rapidly is as critical a challenge as making antiretrovirals more widely available.

No matter how low prices go, additional funds will be needed to meet the costs of care for the poorest. Most of it would need to come from increased development assistance that adds to what is already being spent on other, common and deadly diseases such as malaria.

Developing countries and donor agencies increasingly act on the awareness that care and prevention efforts are intimately linked. Consequently, they are viewing AIDS-related care as a good investment that holds direct benefits for people living with HIV/AIDS and brings indirect spin-offs for AIDS prevention in the wider community. At least, 90% of the world’s 36.1 million people living with HIV/AIDS live in developing countries... 25.3 million of them in sub-Saharan Africa.

"Involve Churches in Fight Against AIDS, WCC Tells UN." By Sheila Mesa
African Church Information Service, June 26, 2001

United Nations organisations, and especially the governments of member nations, should involve faith-based organisations and churches more closely in the fight against HIV/AIDS in future, says Manoj Kurian of the World Council of Churches WCC Issues and Themes cluster, as preparations go ahead for the Special Session of the UN General Assembly on HIV/AIDS, to be held in New York from June 25 - 27.

The Malaysian doctor, whose mandate includes facilitating the WCC's HIV/AIDS programme, will attend the Special Session as part of a four-member WCC delegation. "The HIV/AIDS pandemic is so serious that it challenges all of us - UN agencies, faith-based organisations and local communities - to work intensively together. I would hope that such a commitment will be reflected in the text submitted to the Special Session," he said.

According to Kurian, churches and church organisations provide between 40 and 70 percent of health care in Sub-Saharan Africa. "It is time that UNAIDS and other UN agencies further recognised the tremendous potential of churches and faith-based organizations and involved them in the planning, implementation and monitoring of HIV/AIDS programmes at local, national and international level," he noted. "In the WCC, we recognize that church leadership needs to mobilize communities to equip them not only to take care of the sick and suffering, but also to prevent the spread of HIV/AIDS," Kurian says.

This view also comes out clearly in a statement by church and faith-based organisations to be submitted to the UN Special Session by the WCC. In this statement, the faith-based organisations urge the UN organisations to involve religious leaders to the fullest possible extent in the fight against HIV/AIDS and to make use of their great moral and spiritual influence.

"The statement is an offer of close collaboration and a call for all partners involved to utilize capacities and resources to the fullest extent," explains Kurian. At the same time, the church and faith-based organisations also address religious leaders, urging them, amongst other things, to consider putting in place "programmes that would eliminate all traditional and cultural inequalities that exacerbate the vulnerability of women and children".

The ecumenical movement took up the challenge of HIV/AIDS back in the 1980s. Since then the WCC has been chiefly active in the fields of pastoral care, social ministry and preventive education, as well as networking with national and international bodies. A few weeks ago, Kurian presented a wide-ranging study, covering ten countries in West Africa, on how churches and ecumenical organisations in the region are facing up to the challenges of HIV/AIDS. Similar studies for other regions in the world are also underway.

A public briefing is planned for Wednesday, 27 June, 13.30-15.00, in UN Conference Room B. Media representatives are cordially invited to attend. Members of the ecumenical delegation were Dr Christoph Benn (German Institute for Medical Mission DIFAEM) and Rev Gideon Bymugisha (Director, Archbishop Carey Regional Resource and Training Centre Anglican Church of Uganda). The others are Kurian (Programme Executive for Health and Healing WCC Cluster on Issues and Themes) and Sr Patricia Walsh (International Christian AIDS Network, Zimbabwe). June 27, 2001

"U.N. United in AIDS Fight but Split Over What to Do." By Jennifer Steinhauer
UNew York Times, June 26, 2001

While a special session of the United Nations grasps this week for a show of unity on the worldwide AIDS epidemic, participants are divided among hundreds of different views on how to approach the problem, how to spend the money promised for a global AIDS fund and even who should take part in the debate. Those differences have played out in ways both dramatic and small during the special session, which began here on Monday.

Twenty years after AIDS first began to take its toll, officials could not agree on which groups they should even proclaim at risk. Because of objections by Islamic delegates, debate continued over whether to mention gays and prostitutes — groups long acknowledged to have been hit hardest by the disease — in the official declaration. A draft of the declaration, scheduled for a General Assembly vote on Wednesday, urges all countries to protect the rights of people with AIDS.

At the outset, the special assembly was sidetracked with a lengthy and acrimonious debate over whether a representative from a gay group should be permitted to participate in a roundtable discussion (nearly a dozen assembly members opposed it, with a Malaysian delegate openly condemning the eventual decision to include the representative). Outside the assembly's formal sessions, small conference rooms are filled with accounts of the devastation of AIDS around the world, the underlying causes of its spread in certain countries and the implied competing interests over how a proposed $9 billion pot of new money to fight AIDS globally will be distributed.

Indeed, while the official debate has centered largely around the cost of AIDS drugs and their availability, most people outside the official delegations are more concerned with addressing the basic problems that have contributed to or resulted from AIDS: a lack of even rudimentary health clinics in districts of Nepal where thousands have died from diarrhea; grandmothers in Uganda who have no income and are raising a half dozen orphans, many of them infected with AIDS; widespread starvation in various African villages where everyone who used to farm the crops is either dead or sick.

"There has been an overemphasis in this conference about drugs," said Vijay Rajkumar, a Nepal-based AIDS adviser for Save the Children. "The lack of drinking water is a much bigger priority in most countries than anti-retroviral treatments." The wide chasm between those who write policies and pay for programs and those who have to make them work on the ground is as old as the international development field itself. But the stakes have never been as high: AIDS has killed nearly 22 million people worldwide, and infection rates are rising rapidly in many countries.

This session, the first that the United Nations has devoted to a health care subject, has made it clear that stemming AIDS requires complex and sensitive strategies that vary greatly from country to country, perhaps frustrating Secretary General Kofi Annan's plea to "combine leadership, partnership and solidarity." What to do about Mauritania, for instance, where condoms are all but illegal? What about rural Kenya, where the practice of passing wives down from one infected brother to another is common in some villages with high illiteracy among women? "We are looking for solutions like everyone else," said Jane Mumbi Kiano, who represents the National Council of Women of Kenya. "You have all kinds of posters but some of our women cannot read or write. We are very concerned about this global fund."

The clashes among cultures became evident on the first day of the session. Besides the scuffle over the representative from the gay group, trouble immediately erupted when the official delegation began its central task of working out a universal "declaration of commitment" on the fight against AIDS. Some Islamic countries quickly objected because a draft of the declaration included gays and prostitutes in the groups of people particularly at risk for contracting the disease.

The issue created heat in the hallways and in the Café Vienna, the smoke-filled cafeteria where visitors deconstruct the day's events. A woman with a large floppy hat who identified herself simply as Pamela carried around a sign condemning the exclusion of sex workers from the proposed declaration. Equally concerned was Roma Debabrata, who runs an organization in India to stop the sexual trafficking of women and children. "The language is a problem," Ms. Debabrata said. "You must be absolutely clear, with no side tracking about who needs intervention in this draft."

And while some groups drew controversy, others seem to have been largely ignored. For instance, when most health organizations tally up those who are most at risk for AIDS, they tend to identify sexually active people as those under 49 years. Safe- sex literature tends to be written for younger people and distributed in places where they congregate. "People over 50 are not considered sexual beings," said Paul Godfred, a training adviser from HelpAge International, citing a town in Thailand where 394 people out of 4,000 with H.I.V., the virus that causes AIDS, are over 60. Mr. Godfred recalled an education session for older people in India where the group addressed asked for condoms. Confused but agreeable, the AIDS worker brought a basket the next day, and they immediately disappeared.

Death is often only the beginning of the problems for communities in some of the world's poorest nations, especially the elderly. In much of Asia and Africa, the elderly are often left to care for their grandchildren orphaned by AIDS, without the financial support of their own children, now dead, that they had counted on all their lives. Many are widowed and with few resources. Livestock is often sold to pay for medications and funerals. When children die, government subsidies to care for them end too.

AIDS has also created other public health problems that require vast resources, like widespread hunger among the rural poor. The United Nation's Food and Agriculture Organization estimates that roughly seven million agricultural workers with AIDS have died since the mid-1980's, leaving hunger and economic devastation; in Kenya, for instance, between 49 percent and 78 percent of household income is lost when one person with AIDS dies.

Poverty in rural areas in turn leads to the spread of H.I.V., as men seek work in cities and contract the virus and women turn to prostitution themselves as a means of income. Prevention messages, an area where much AIDS money is spent, are often inconsistent with the way people live. "The rural poor are impervious to traditional prevention methods," said Gary Howe, the director of the International Fund for Agricultural Development in the East and Southern African division.

In official speeches from the delegates, there is vague language about cultural sensitivity in safe-sex literature. But the causes of the spread of AIDS are often so specific to a particular country that they defy any global solution. In Kenya, wife inheritance and genital mutilation with shared needles has been a contributing factor, said Ida B. Odinga, from that nation's League of Women Voters. Mali Bent Sidi, a women's rights worker in Mauritania, described how the sharing of needles to pierce children's ears had contributed to the spread of AIDS, as well as an almost official ban on condoms.

Many groups said that discussions about anti-retroviral drugs was highly irrelevant in many areas where there are no clinics to distribute them, no clean water or food to take them with and a lack of even basic antibiotics to stave off the less onerous infections that stem from H.I.V. All of these concerns need money, and many of the nongovernment groups feared that the new money that world leaders have called for to stop AIDS will get sucked up by administrative costs, corrupt governments and the single area of AIDS drugs. "I fear that a major chunk of the global health fund will go to drugs," said Mr. Rajkumar, of Nepal. "And that means money for drug companies and not for infrastructure."

Using local groups familiar with the problems of their region is a long- held practice by the United Nations, but many fear that the flow of money will not come their way. "International AIDS agencies have come with money before and it all goes to overhead and not where it belongs," said Pearl Nswahili, founder of STOP AIDS in Nigeria. "This meeting has huge talk but not a lot of action. "There are lots of documents," she added, but "we still don't have any condoms."

"Vigorous Leadership And Adequate Resources Prerequisites to Fighting HIV/AIDS, UNAIDS Says."
Joint United Nations Programme on HIV/AIDS (UNAIDS), June 21, 2001

The magnitude of the AIDS effort requires vigorous leadership and additional resources, according to a report released today by the Joint United Nations Programme on HIV/AIDS (UNAIDS). The report, entitled "Together We Can," notes that leadership is fundamental to effective action against HIV/AIDS and that leaders at every level have been at the forefront of the many successes achieved in fighting the epidemic. "The successes have hinged on the perseverance of visionary and courageous people," the report says.

"Some are high-powered political and religious leaders and international icons. Others, less visible, have been no less effective in their actions as workers, students, business people, entertainers, politicians, community activists and village leaders."

Speaking at the launch of the report in advance of the opening of the United Nations General Assembly on HIV/AIDS, being held in New York from 25-27 June, the Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), Peter Piot, said, "Responses to the HIV/AIDS epidemic have shown humanity at both its worst and its best. Denial, blind panic and victim-blaming have been among the worst responses. But gradually courage, creativity and care have come to the fore. This collective humanitarian effort means the world now knows what it will take to turn the epidemic around."

The report highlights advances in the response to the epidemic and gives concrete examples of the successes achieved in the 20 years since the first clinical description of AIDS was made. It singles out leadership as one of the critical factors in mobilizing action and resources to fight HIV/AIDS.

The report says that while too many people still seek shelter in silence, the corrosive effects of secrecy and denial can be offset by the determination and courage of those who speak out. Communities are becoming more aware of what works best for them, and activists and responsive leaders everywhere are alerting institutions and businesses to the threats of the epidemic. Many political leaders have created legislative and policy environments that make it possible to sharpen and widen responses, such as workplace programmes to protect workers against HIV infection. Plans by the heavily indebted poor countries initiative to trim developing countries' debts are also a step forward, but remain a far cry from the level of resources needed.

The report makes the point that while leadership from the 'top' has been forthcoming, especially in some of the worst affected regions, commitment must be measured by action on a wide range of fronts. Prevention, care and support efforts reinforce one another and must occur together.

"Economic insecurity, displacement caused by conflicts and disasters, illiteracy, violence and abuse, and exclusion from information deprive millions of the ability to protect themselves and others," the report notes. "It has become evident that more decisive steps are needed to reduce people's vulnerability."

While notable successes and the lessons to be learned from them are the launching pad for an extraordinary global response to curb AIDS, the scale of the emergency tends to eclipse the successes. The report highlights the lack of resources available to fight the epidemic and says only a combination of resources and leadership will fuel the extraordinary response that is needed. Worldwide, 36.1 million people are now estimated to be living with HIV or AIDS. Already, 21.8 million people around the world have died of AIDS, 4.3 million of them children. In 2000 alone, 5.3 million people were infected with HIV.

The report sets the tone for the start of the United Nations General Assembly Special Session on HIV/AIDS which brings together world leaders, activists, service and community organizations and the private sector in an effort to mobilize a greatly accelerated global response to the epidemic. Government leaders are expected to adopt a Declaration of Commitment at the Session which sets out key targets and goals to be met over the next few years. A key focus of this Declaration will be the need for more concerted leadership.

"Turning the Tide Against HIV/AIDS: Time for Global Action to Match a Global Threat."
World Bank (Washington, DC), June 21, 2001

Calling HIV/AIDS "a catastrophe for development" that is reversing life expectancy by decades in some countries, World Bank President James D. Wolfensohn appealed today to government and business leaders, charitable foundations and other groups attending next week's the United Nations General Assembly Special Session on HIV/AIDS to mobilize their political and financial support behind a global action plan to fight the spread of AIDS.

More than 36 million people are now living with HIV/AIDS worldwide, 95 percent of them in developing countries. 21.8 million people have died already from the disease, 4.3 million of them children. Last year alone, 5.3 million people became newly infected with HIV.

"HIV/AIDS is no longer just a health problem, but a global development problem, threatening to reverse many of the gains made over the last half century," Wolfensohn said. "There is simply no reason why generations of people should disappear as a result of AIDS when a determined global movement of governments, communities, private companies, development agencies, and civil society groups can make a dramatic difference. AIDS is an international security problem, and as such, it needs a war chest and a rigorous strategy for achieving results."

World Bank research shows that the development impact of HIV/AIDS has been devastating, not only on families, communities, and regions, but also on peoples' livelihoods and national economies. The Bank estimates that annual per capita growth in half the countries of sub-Saharan Africa, the region worst hit by the epidemic, is falling by 0.5-1.2 percent as a direct result of AIDS and that by 2010, per capita GDP in some of the hardest hit countries may drop by as much as 8 percent.

Need for increased global funding
While money alone will not solve the problem, it is a vital part of the solution, and funds earmarked for confronting the epidemic are currently much too low. Although dramatic reductions in prices of anti-retroviral drugs are key to treatment, at $400 - $500 a year, down from $10,000, they are more affordable, but still well out of reach for the vast majority of infected people in developing countries where per capita income is less than $500 per year, and where many governments spend less than $5 per person on healthcare.

Overall external aid declined throughout the 1990s, to a new low as a share of donor countries' collective GDPs. Although the proportion of ODA committed to HIV/AIDS grew during this time, this growth was largely offset by the overall decline in aid. The Joint United Nations Program on HIV/AIDS (UNAIDS), of which the Bank is a co-sponsor- estimates that a basic HIV/AIDS program in all developing countries would cost at least $9.2 billion per year?six times the current level of investment which is approximately $1.5 billion a year. This estimate does not include the cost of improving the health infrastructure in developing countries, an important ingredient for a successful response.

To turn back the epidemic and reduce its impact, the World Bank says that funding from rich countries, private business leaders, charities, and other sources needs to be substantially increased, and countries need to architects of their own AIDS-fighting strategies which draw heavily on popular support and active community leadership to achieve any chance of success.

"In throwing their weight behind a global trust fund for the prevention and treatment of HIV/AIDS and other communicable diseases, rich countries must ensure that their pledges of financial support represent genuinely new money over and above existing volumes of foreign aid", says Wolfensohn." To reallocate existing funds would simply be a shell game. I hope and trust that they will respond generously to the challenge of throwing back the spread of HIV/AIDS and contribute significantly to the war chest that will be needed".

Wolfensohn also said that civil society organizations should be invited into the global campaign against HIV/AIDS. Its contribution to the campaign could be enormous, he said. "Civil society has played a pivotal role in all countries that have had success against HIV/AIDS. At the global level, representatives of civil society should be involved at all stages in the design, decision-making, and implementation of HIV/AIDS-related activities. At the country level, civil society should also play a significant role in any national AIDS-fighting strategy, and a large share of HIV/AIDS resources should go to the local level and to community organizations."

World Bank Lending on AIDS
Over the past year, the World Bank has committed more resources to combating the spread of HIV/AIDS than ever before. This follows a pledge made by Wolfensohn last year that no country with a credible HIV/AIDS program in place would go without funding from the World Bank.

Between 1996 and 2000, the Bank committed approximately US$493 million for new HIV/AIDS components and stand-alone projects in 39 countries. By the end of this fiscal year, the Bank will have committed an additional US$740 million for new HIV/AIDS prevention and care efforts, mostly in Sub-Saharan Africa.

The World Bank, in collaboration with UNAIDS, the International Partnership Against AIDS in Africa, key bilateral donors, and leading NGOs, has launched the first phase of the Multi-country AIDS Program (MAP) for Africa, which over the past year has provided $500 million in new money to help ten African countries scale up effective prevention, care, and treatment. The MAP makes significant resources available to civil society organizations and communities, which have developed some of the world's most innovative HIV/AIDS interventions. It is expected that $500 million more will be made available next year to reach another 15 African countries.

A similar effort is being carried out in the Caribbean, where HIV/AIDS infections may have reached 12 percent in some urban areas, an infection rate comparable to some of the worst-affected countries in Sub-Saharan Africa. Next week, the Bank's Board will consider a $155 million, five-year program for the region. Although most Bank assistance focuses on prevention, some loans also support improvements in treatment for people living with HIV/AIDS. Under the impending Caribbean program, Barbados would become the first country to receive Bank assistance to finance the use of anti-retrovirals?a cocktail of drugs that vastly reduces HIV levels in the blood?allowing people to live healthier and longer lives.

In addition to financial support, the Bank is helping developing countries to put HIV/AIDS prevention and treatment efforts in the forefront of their poverty reduction strategies. The Bank is also assisting poor countries which have benefited from debt relief under the World Bank Heavily Indebted Poor Countries Initiative (HIPC) to devote a share of their subsequent savings to prevention and care for people suffering from the disease. For example, debt relief resources are now programmed to finance HIV/AIDS efforts in Burkina Faso, Malawi, and Uganda.

"UN Anti-AIDS Effort Enlists Coca-Cola to Curb Spread of Epidemic in Africa."
United Nations, June 20, 2001

The Joint United Nations Programme on HIV/AIDS (UNAIDS) today announced a partnership with The Coca-Cola Africa Foundation to bring new impetus to the battle against the virus. Under the terms of the three-year agreement, the Foundation will co-ordinate the efforts of Coca-Cola Africa and its bottling partners across the continent to support AIDS education, prevention and treatment programmes, UNAIDS said in a statement issued in Geneva.

The initiative is in line with the philosophy behind the International Partnership against AIDS in Africa. "The Coca-Cola Africa Foundation brings substantial resources to the international battle against AIDS," said Peter Piot, UNAIDS Executive Director. "Coca-Cola Africa's special strength is its ability to bring its unrivalled marketing and logistics expertise to responses to the epidemic - from the community to the highest political level. We are excited about this partnership and what it means for the fight against AIDS."

UNAIDS brings together seven UN organizations to help the world prevent new HIV infections, care for those already infected and mitigate the epidemic's impact. The new partnership with Coca-Cola is the first major initiative for The Coca-Cola Africa Foundation, a private non-profit organization dedicated to implementing the company's philanthropic and corporate citizenship programmes in Africa.

"We are proud to be joining the UNAIDS team in the fight against AIDS," said Alexander B. Cummings, President of Coca-Cola Africa Group. "Coca-Cola is completely committed to the future of the African continent, its economy, people, communities and health. We will do all that we can to enable Africans to reach their full potential."

"HIV/AIDS: Experts To Develop African Medical Training Center."
www.unfoundation.org, June 16, 2001

African and Western infectious disease experts have formed an alli- ance to build the first state-of-the-art AIDS medical training facil- ity in Africa in an effort to combat the HIV/AIDS pandemic. The fa- cility, whose creation was formally announced yesterday, will be built in Uganda and is expected to be completed in early 2002 with funding provided by the Pfizer Foundation. "It's going to be a gold- standard kind of place, which is unrealistic in terms of care (else- where) in Uganda, but we think we need that kind of facility for training," said Canadian physician Allan Ronald, one of the co- founders of the alliance.

The center will be run by the Academic Alliance for AIDS Care and Prevention in Africa and the Ugandan government. The center will train health care personnel all over Africa in the latest AIDS treat- ment techniques, including management of complex drugs. Those profes- sionals are then expected to return to their hospitals and clinics to pass on the knowledge to their staffs. The alliance is already work- ing with pharmaceutical companies to make available donated or low- cost clinic supplies (Canadian Press, 11 Jun).

Besides training as many as 80 African clinicians a year, the center is also expected to treat up to 50,000 patients "with the kind of care that is available in the developed world but not yet widely used in Africa," said Nelson Sewankambo, dean of Uganda's Makerere Univer- sity medical school (Karl Vick, Washington Post, 12 Jun).

"This new approach will complement the work our own doctors are doing and enrich the experience and knowledge of experts involved in the project both in Uganda and in North America and Europe," said Ugandan President Yoweri Museveni in a statement. "The clinic will have an influence far beyond the doctors trained in it and the patients whom we treat," said Dr. Jerrold Ellner, another founding alliance member and one of the world's leading tuberculosis experts. "It is a reverse pyramid. Each doctor can train dozens of other doctors and each doc- tor can treat 200 to 300 AIDS patients at any one time" (Canadian Press).

One of the US doctors involved in the project, Thomas Quinn, said that Kampala was chosen as the site for the training center because Uganda has been the most successful African country in its campaign to fight HIV/AIDS (Andrew Craig, BBC Online, 11 Jun).

Pfizer Inc., the world's second largest drug maker, said it will spend $11 million over the next three years to establish the training center. Pfizer chair Henry McKinnell said he also intends to lobby fellow manufacturers of AIDS treatment drugs to donate or deeply dis- count another $50 million annually of advanced anti-retroviral drugs. "We're eliminating their excuses," said the alliance's co-director, Merle Sande, referring to pharmaceutical companies (Vick, Washington Post).

McKinnell also said he hopes his company will maintain support for the project for at least a decade. Members of the alliance are hope- ful the new center will prove it is possible to establish an effec- tive and sustainable HIV/AIDS care system in Africa, and said the project's success could negate arguments that improving drug afforda- bility is futile in a region lacking proper health infrastructure. "No one would have an excuse any more to say we cannot introduce anti-retrovirals into Africa because we do not have an effective in- frastructure," Sande said (Mark Turner, Financial Times, 12 Jun).

The alliance is working closely with the public health and medical communities in Uganda and intends to actively seek assistance from the Ugandan Health Ministry, local organizations, the staff and fac- ulty at Makerere University Medical School and Mulago Hospital, the national hospital of Uganda (Academic Alliance for AIDS Care & Pre- vention in Africa release, 11 Jun).

"Now Africa Targets HIV/AIDS Stigma." By Diane Zulu
Zambia Daily Mail, Friday, June 15, 2001

Since time immemorial, stigma has been identified as a stumbling block that needs to be addressed urgently if HIV/AIDS has to be successfully managed.

A recent consultative meeting on Stigma and HIV/AIDS in Africa held to set the operational agenda for research, in Dar-es-Salaam, the capital of Tanzania, brought to the fore the crucial need to stamp out the stigma related to HIV/AIDS, especially in Africa where it is deeply rooted because of cultural and traditional beliefs. Participants at the meeting defined stigma as the out-casting of individuals and minority groups, an attribute that is significantly discrediting and also the identification of negative or favourable characteristics in a person which results in treating them as not deserving respect or less worthy than others. The meeting observed that while stigma was viewed as a barrier to successful prevention, care and support programmes in the community for people living with HIV/AIDS, many governments in Africa could be faulted as they neither have a budget for addressing stigma related to HIV/AIDS nor have it on their health agenda.

It is because of stigma that a lot of people living with HIV/AIDS do not want to come out in the open and tell their spouses, friends or families that they are HIV positive. And because of shame, fear of rejection, a number of others who have lost their spouses from AIDS are in denial and will not even consider going for testing. The downside is that a lot of people living with HIV/AIDS inevitably continue with risk behaviour, thereby putting the lives of many others in danger.

Participants at the end of the three day meeting came up with a declaration and a plan of action intended to help Africa move forward in the fight against HIV/AIDS related stigma. It was recognised that stigma, silence, fear, discrimination and denial fuel the spread of HIV/AIDS and also undermined prevention, care efforts and increase the impact of the epidemic on individuals, families, communities and nations. Addressing stigma in relation to HIV/AIDS must be made a priority, it was observed.

While most African governments have mounted huge AIDS awareness campaigns, it was generally felt that awareness alone does not negate stigmatising attitudes and discriminatory behaviours. The recognition of the importance of human rights underpins meaningful and sustainable approaches to addressing discrimination arising from stigma in many contexts. Additional approaches will also be required to address stigma within homes and communities of people affected by HIV/AIDS , the health and religious sectors, and the media.

It is also important that the links between stigma, discrimination and denial, all of which require forms of action and redress are incorporated into HIV/AIDS planning initiatives in all countries. The meeting observed that people living with HIV/AIDS are a vital voice in the fight against stigma because meaningful, accessible and sustainable interventions require their input.

The following are the recommendations for action in the Dar-es-salaam Declaration:

• STIGMA and the FAMILY: At family level, stigma poses one of the greatest challenges for those living with HIV/AIDS. It is one of the most subtle and painful forms of stigma and women and children are most hit by stigma. Among the interventions were the provision of essential package of care to enable knowing status and receiving necessary treatment and involving families and communities in new interventions such as prevention of parent to child HIV transmission.
• STIGMA and the HEALTH CARE SECTOR: Health care workers have roles that give them unique advantages in overcoming stigma considering the impact of HIV/AIDS on the health and social well being of clients, families and communities and, considering the general perception that health care workers can make a difference in their lives, health care can be a change agent for reduction of stigma. This can be accelerated through their roles as careers of people living with HIV/AIDS and as educators and role models for their communities. Among the interventions in the health care sector were: opening up discussions on HIV for health care providers.
  • Addressing the declining quality of health facilities for providing care such as lack of supplies, shortage of staff and minimal support.
  • Improve HIV work skills, strengthen professional codes for care, including confidentiality and provision of treatment.
  • The establishment of AIDS referrals clinics, charter of patient's rights, strengthening and increasing accountability towards codes of conduct for health care workers.
• STIGMA and the RELIGIOUS SECTOR The religious sector, with an important role in education and guiding society, have a responsibility to provide care, comfort and spiritual support to HIV infected and affected communities. And because the religious sector has such far reaching influence throughout Africa, contributors emphasised the potential of religious leaders to play an active role in promoting health preventive messages about HIV and in leading the fight against stigma in diverse settings across the continent. Interventions: Develop communication strategy to avoid stigmatising value laden vocabulary, faith based counseling by trained religious leaders and members. -Integration of HIV information into all religious leaders training and seminars, identify religious teachings and values which do not promote stigma and reinforce these and mobilise faith based organisations for care, prevention, support and advocacy.
• STIGMA and the MEDIA: the media have a responsibility to report accurately and simply and to give clear messages when reporting on AIDS. The media whether print, radio, TV or internet has potential to reach a larger number of people and with careful reporting, this potential can be harnessed and used to reduce stigma. Among the interventions were: developing media policies related to HIV/AIDS, identifying and promoting use of non-stigmatising language, addressing myths that lead to fear, isolation and stigma and supporting media HIV/AIDS monitoring projects.
• STIGMA and LEADERSHIP: leaders also have a clear responsibility to create a society that is free from stigma: To do this, leaders should speak out and be open about AIDS in their countries. Just as important as making political commitments to combat HIV/AIDS is acknowledging that they are personally as well as professionally affected by HIV. With the declaration in force, the stage for action has been set. Stigma in relation to HIV/AIDS must be addressed by all so that people living with HIV/AIDS can be free to seek services in health care institutions and speak openly about HIV/AIDS . After all, AIDS is a disease and not a sin.

"Coca-Cola Joins United Nations' Fight Against AIDS in Africa." By Don Melvin
The Atlanta Journal and Constitution, June 20, 2001

The United Nations program dedicated to stemming the spread of AIDS around the world will announce in Geneva today that it has a new partner in the fight against AIDS in Africa, Coca-Cola, the con- tinent's largest private sector employer. At the heart of the soft drink giant's strategy is the belief that if it can deliver Cokes all across Africa, not to mention its fabled ad- vertising reach, it also can distribute pamphlets, equipment and in- formation to help prevent AIDS.

The disease has wreaked greater devastation on Africa than on any other continent. Of the world's estimated 36 million people with AIDS, 26 million, more than 70 percent, are in Africa. Last year in sub-Saharan Africa, a million people died of the disease. The non-profit Coca-Cola Africa Foundation, which was created in Feb- ruary, will co-ordinate the effort with the Joint United Nations Pro- gram on HIV/AIDS, which is known as UNAIDS. The program brings to- gether seven different U.N. agencies in an effort to prevent new in- fections and care for people already affected. "The Coca-Cola Africa Foundation brings substantial resources to the international battle against AIDS," said Peter Piot, the executive director of UNAIDS.

"Coca-Cola Africa's special strength is its ability to bring its un- rivaled marketing and logistics expertise to respond to the epidemic, from the community to the highest political level." A spokesman for Coca-Cola Africa declined Tuesday to put a dollar figure on Coca-Cola's three-year partnership with the United Nations. Much of the work will involve the use of Coke's warehouses, trucks, delivery networks, logistical expertise and marketing know-how. "It's basically impossible to quantify," Robert Lindsay, vice presi- dent of public affairs for Coca-Cola's Africa Group, said in a tele- phone interview from London.

Coca-Cola and its bottlers have a presence in every African country but Libya and Sudan. Together, Coke and its bottlers employ 100,000 people on the continent, Lindsay said. Alexander Cummings, president of the Coca-Cola Africa Group, said the company is proud to join the fight against AIDS. "Coca-Cola is completely committed to the future of the African con- tinent, its economy, people, communities and health," Cummings said. "We will do all that we can to enable Africans to reach their full potential." Today's announcement comes amid increasing global recognition of the severity of the epidemic in Africa and the resources that will be needed to contain it.

In April, U.N. Secretary-General Kofi Annan proposed raising $7 bil- lion to $10 billion a year to create a global fund to fight AIDS. On Tuesday, the Bill and Melinda Gates Foundation donated $100 mil- lion to an international health fund to fight AIDS and called on European Union nations and other countries to make further contribu- tions. Bill Gates is the founder of Microsoft and one of the world's richest men. The long-time in-house champion of involving the Coca-Cola Co. in the fight against AIDS has been Carl Ware, executive vice president for global public affairs, Lindsay said. Ware, who became the company's highest-ranking black executive last year, is a former president of Coca-Cola's Africa Group and a former president of the Atlanta City Council.

Two weeks ago in Washington, Coca-Cola hosted a U.S. Chamber of Com- merce meeting of corporate leaders at which Annan spoke. According to Ware, Annan's "urgent call to action for private indus- try to step up its efforts" to fight AIDS prompted the company to speed up its announcement of the partnership with the United Nations. Lindsay said Coca-Cola in Africa "will deploy its unique infrastruc- ture and presence in local communities to support local prevention, education and treatment programs."

As an example, he said, representatives of Coke and its bottler in Zambia will provide assistance to the Family Health Trust, an educa- tion project that works with young people in more than 2,500 anti- AIDS clubs throughout the country. Coca-Cola in Zambia will store education materials at its facilities in Lusaka, the capital, and as- sist in their distribution to 72 district education officers country- wide, Lindsay said.

And in Nigeria, Coca-Cola will provide marketing help in developing materials to increase awareness of national programs, assist in the printing and distribution of 10,000 pamphlets, and provide expertise in logistics and help in distributing testing kits in every state in the country. Coca-Cola Africa also will provide marketing expertise to develop in- formation campaigns for UNAIDS and international and local partners across Africa.

The Coca-Cola system in Africa will try to lead by example, as well, developing "leading-edge workplace policies," Lindsay said. The com- pany will cover all medical costs of employees with AIDS and will not test any job applicants for HIV, the virus that causes AIDS. Last week, the Coca-Cola Co. settled a class-action racial discrimi- nation suit in the United States for $192.5 million. Lindsay said the Africa initiative was not related to the lawsuit. "Absolutely not. This has absolutely nothing to do with it in any form," said Lindsay, a native of Ghana. "To us in Africa, this is something we just want to do because we have to do it."

"Bill & Melinda Gates Foundation Announces $100 Million Commitment to the Global Fund For AIDS and Health." By Don Melvin
AHILA-NET, June 14, 2001

Signaling that stopping the transmission of AIDS is the foundation's top global health priority, the Bill & Melinda Gates Foundation today announced that it will commit $100 million to the Global Fund for AIDS and Health. The foundation used the occasion to call on other organizations and governments around the world also to support the new fund. The foundation is making this commitment over a multi-year period for innovative HIV/AIDS prevention efforts.

"As we reflect on 20 years of AIDS and the 22 million lives it already has claimed, we believe that there is no higher priority than stopping transmission of this deadly disease," said Bill Gates, co-founder of the Bill & Melinda Gates Foundation. "We are pleased to join those who have already contributed and those who will in the weeks and months ahead."

"The data on HIV/AIDS is overwhelming, and it only begins to tell of the suffering families experience every day. We have to respond," said Patty Stonesifer, co-chair and president of the Bill & Melinda Gates Foundation. "This is only part of a comprehensive and unprecedented effort that is needed to stop this pandemic. Governments, the private sector and the nonprofit community all have to redouble efforts so that together we can break this chain of transmission."

According to recent reports, HIV/AIDS transmissions continue to rise. Around the world, more than 36 million people are living with HIV/AIDS. Nearly half are women and the vast majority of those infected live in sub-Saharan Africa, where nearly four million people became newly infected just last year. Of the more than 16 million AIDS orphans living worldwide, over 90 percent live in sub-Saharan Africa.

The new fund also will address other infectious diseases including tuberculosis and malaria. Worldwide tuberculosis affects more than 23 million people. Malaria continues to be a public health problem in 90 countries affecting 40 percent of the world's population.

The Bill & Melinda Gates Foundation's Global Health Program: The Global Health Program of the Bill & Melinda Gates Foundation is dedicated to improving people's lives by sharing advances in health with the global community. Within the field of global health, the foundation focuses its efforts in three areas: vaccine preventable diseases; reproductive and child health; and conditions associated with poverty. In terms of the program's HIV/AIDS focus, the goal is to reduce and ultimately stop HIV transmission, improve access to care for those infected, and improve conditions for children affected by HIV/AIDS. Specifically, the foundation's HIV/AIDS strategy relies on the following key priorities:

• AIDS Vaccine Development -- The foundation is a major contributor to the International AIDS Vaccine Initiative, which is working to speed the discovery and distribution of a safe, effective and accessible AIDS vaccine.
• Prevention/Protection -- Innovative and critical programs that demonstrate success in stopping the spread of AIDS are also a priority. The foundation supports a number of major initiatives in this area, including the Harvard School of Public Health for AIDS Prevention in Nigeria and the Elizabeth Glaser Pediatric AIDS Foundation.
• Microbicide Development -- The foundation is supporting efforts to develop new and effective microbicides to help women protect themselves against HIV/AIDS. It has contributed to the Consortium for Industry Collaboration in Contraceptive Research.
• Comprehensive Approaches -- The foundation funds comprehensive approaches such as the African Comprehensive HIV/AIDS Partnership to reduce the spread of HIV and to increase significantly the awareness, prevention, diagnosis and treatment of the disease.
• AIDS Orphans -- AIDS has orphaned more than 16 million children. The foundation supports programs such as PLAN, an unprecedented pan-African effort for children under age 15 who are living with or at risk for HIV/AIDS. ### The Bill & Melinda Gates Foundation is dedicated to improving people's lives by sharing advances in health and learning with the global community. Led by Bill Gates' father, William H. Gates, Sr., and Patty Stonesifer, the Seattle-based foundation has an asset base of $23.5 billion.

"Global Fund to Concentrate On Prevention."
UN Integrated Regional Information Network, June 9, 2001

A proposed new multi-billion dollar global health fund is expected to concentrate on AIDS prevention rather than the mass purchase of antiretroviral drugs, a UN conference in Geneva reportedly concluded on Monday.

Britain's 'Financial Times' said that the planned fund is likely to be formally launched later this month at the UN's General Assembly Special Session on HIV/AIDS or at the Group of Eight meeting in Genoa in July. UN Secretary-General Kofi Annan wants to raise US $7-10 billion annually, but according to the 'Financial Times', the "war chest" is likely to receive only around US $1 billion this year. This week, Britain pledged around US $100 million, following an earlier US $200 million contribution by Washington.

Governments and aid agencies have been split over whether the money should be used for the purchase of antiretroviral drugs. However, David Nabarro, executive director at the office of Gro Harlem Brundtland, director-general of the World Health Organisation, said there had been "an extraordinary degree of convergence" during the conference. He said it was agreed that the fund should concentrate on AIDS prevention, with a limited and carefully-targeted amount of drug treatment for AIDS sufferers. Nabarro estimated that 70-80 percent of the fund would be used to combat AIDS, with the remainder used for the prevention and treatment of malaria and tuberculosis. But delegates said the Geneva conference was marked by continued conflict over the administration of the fund, which has been proposed in various forms by Japan, Italy and the UK.

Meanwhile, Annan addressed over 500 members of the US Chamber of Commerce in Washington last Friday in an appeal to the business community for help in the global fight against AIDS, which he described as an "unparalleled nightmare." "As 42 percent of US exports go to markets in the developing world," he argued, "the negative impact of AIDS on American business should be obvious." The epidemic is not only bad for business, he said, but also undermines regional and global security and stability. He called on business to respond, saying, "business is used to acting decisively and quickly. The same cannot always be said of the community of sovereign states. We need your help - right now."

He urged business to help his effort to raise spending on fighting the disease by an additional US $7 billion to US $10 billion a year. Harvard University estimates that AIDS has already cost the world more than US $500 billion, he argued, so, he added, "US $10 billion a year to defeat it seems fairly reasonable - in fact, a bargain."

Last Friday, Annan appointed Stephen Lewis as his Special Envoy for HIV/AIDS in Africa. Lewis, who served as Deputy Executive Director of UNICEF from 1995-1999, and is a former Canadian Ambassador to the United Nations, will be responsible for ensuring follow-up to April's African summit on HIV/AIDS, tuberculosis and other infectious diseases held in Abuja, Nigeria, and next month's UN General Assembly special session on HIV/AIDS, as related to Africa.

"Diamond Giant Leads the Way."
UN Integrated Regional Information Network, June 9, 2001

Botswana's giant diamond company Debswana has announced that all companies wishing to do business with it will be required to support the firm's progressive HIV/AIDS policy, the 'Botswana Gazette' reported.

"The companies will be responsible for providing a safe working environment both physically and mentally through empowering their employees with knowledge to avoid risks and protect themselves from contracting HIV/AIDS," explained Debswana's spokesman Jacob Sesinyi. The companies will have to demonstrate that they have a work place policy and programme on HIV and AIDS both at the home base company and on site at the Debswana premises which includes a statement on non discrimination based on HIV status, confidentiality and privacy, the ability to work and criteria for ill-health retirement.

Meanwhile, Botswana is to provide free antiretroviral drugs (ARVs), President Festus Mogae announced on Monday. "We have not yet started the full antiretroviral programme, but we hope it will be running by the end of the year," Mogae told reporters.

The diamond-rich country has already begun handing out free drugs to prevent HIV-positive pregnant mothers passing the virus to their unborn children, AFP reported. "We have been told we have a good chance of prevention in the majority of cases," Mogae said. He added that a campaign would be launched soon for people to adopt Botswana's 60,000 to 80,000 AIDS orphans, with the government paying for the childrens' upbringing, AFP reported.

"AIDS Fungus Drug Offered to Poor Nations." By Barbara Crossette
New York Times, June 6, 2001

The Pfizer pharmaceutical company announced today that it will offer the governments of more than 50 of the world's poorest nations an unlimited free supply of a powerful drug to combat fungal infections associated with AIDS. The company began providing the drug, which it markets under the brand name Diflucan, to South Africa early this year under a program that company officials said will cost $50 million over two years. At a news conference here today, Henry McKinnell, Pfizer's chairman and chief executive officer, said that the project will now be extended to five other countries in the region — Botswana, Lesotho, Malawi, Namibia and Swaziland.

Pfizer said that it was inviting the governments of all 50 countries that the United Nations considers to be the world's poorest and most affected by AIDS to participate in the project. "There is no time or dollar limit set on this program," Dr. McKinnell said. "We are ready to begin providing Diflucan immediately." Governments would be expected to sign an agreement assuring Pfizer that the drug would be distributed free.

Dr. McKinnell said that Pfizer would also provide "medical training and patient education." Next week, the company is expected to announce its participation in the establishment of an AIDS medical training center in Uganda. Pfizer's plan to provide a leading drug free of charge to governments follows a round of price reductions by pharmaceutical companies on antiretroviral treatments that can prolong the lives of people infected with the virus that causes AIDS.

Diflucan is used to treat cryptococcal meningitis, an infection of the membranes around the brain and spinal cord that occurs in one of every 10 AIDS patients and kills more than 20 percent of those affected. The drug is also used to treat a condition known as esophageal candidiasis, a fungal infection of the esophagus found in 20 percent to 40 percent of AIDS patients. It can cause chest pain, nausea and vomiting as well as impair the ability to swallow, which leads to weight loss and fatigue.

The announcement by Pfizer was welcomed guardedly by groups for greater generosity from pharmaceutical companies in the fight against AIDS. American drug manufacturers have been widely criticized for pricing products out of the reach of most nations, then opposing efforts by foreign companies to make and sell the same or similar medicines at considerably lower prices.

Joel B. Pressley, executive director of the New York AIDS Coalition, who shared the platform with Dr. McKinnell at the news conference today, said that he "truly applauds" Pfizer's decision. He added: "Crypto meningitis is but one of the numerous serious issues that have to be addressed in a comprehensive public health approach in dealing with the H.I.V.-AIDS epidemic. Pfizer has made a step in the right direction, a major step. However, it and other pharmaceuticals along with policymakers near and far must make giant strides to find proactive, creative and comprehensive solutions to stem and stop the tide of despair and misery."

Pfizer has been under pressure for several years from the makers of generic copies of Diflucan. The leading competitors are three Thai companies, a Bangladeshi firm and Cipla in India, which admits that under Indian law it can produce knock-offs of all Pfizer drugs. Pfizer patented Diflucan in 1982 and it remains patented until 2004 in the United States and many other countries. The drug is used in the United States to treat toenail fungus, and several kinds of thrush as well as cryptococcal meningitis.

Dr. McKinnell acknowledged today that the company was intent on keeping its market share even after patents expire. The provision of free supplies of the leading drug in its field can boost the image of the company, critics say.

Paul S. Zeitz, a physician and epidemiologist with 12 years of work on AIDS in Africa, described Pfizer's move today as "a strategy to block access to generically manufactured drugs." Dr. Zeitz earlier this year founded the Global AIDS Alliance, based in Philadelphia, to campaign on many fronts for faster and more effective help for poor countries caught in the AIDS crisis.

He said that the agreements Pfizer concludes with poor nations should be scrutinized carefully. "We don't know the details of the written deal," he said. "What kind of influence are they buying with this? Are there unwritten ways that the pharmaceutical companies are influencing the governments? We think there should be open, fair competitive bidding between generics and competitive brands. A free donor program effectively blocks the demand for the generically manufactured drugs."

The Pfizer announcement was welcomed by Peter Piot, the director of Unaids, the joint program of the World Health Organization and other United Nations agencies involved in dealing with the epidemic. He said it would have "a significant impact." South Africa's ambassador to the United States, Sheila V.M. Sisulu, also endorsed the project today at the news conference. In the United States, Pfizer officials say, Diflucan costs about $10 a daily dose, and must be taken for life in cases of cryptococcal meningitis.

"Four AIDS Vaccines to Be Tried in Uganda." By Charles Wendo
New Vision (Kampala), June 6, 2001

Four more experimental vaccines against AIDS are to be tried in Uganda, officials said yesterday. This would bring to five the number of possible AIDS vaccines tested in Uganda. The first trial was begun in February 1999 and its first phase has been completed.

The Director for Research and Policy in the Uganda AIDS Commission, Prof. John Rwomushana, said trial of the second candidate vaccine would begin before the end of this year. "They (vaccines) are in various stages of review and approval," Rwomushana told journalists during a press conference at the Unicef office to mark 20 years of AIDS. The Uganda AIDS Commission Director General, Dr. Kihumuro-Apuuli, the UNAIDS Country Programme Advisor, Dr. Jantine Jacobin and a Unicef Programme Officer, Dr. Mugabe Mulawe, were present. Rwomushana said one of the new vaccines was designed to prevent HIV positive people from progressing to AIDS while the others are meant to prevent people from contracting the virus.

Uganda in 1999 became the first African country to test a vaccine against AIDS. Scientists last year said blood drawn from some of the people in the trial had neutralised HIV in test tubes, indicating that it might protect against infection. Kihumuro said in view of the ongoing research, in five to seven years, a vaccine against AIDS would be available to the public.

"Annan Urges Support for Women As Key Warriors in Global Battle Against AIDS."
United Nations, June 4, 2001

Continuing his rallying cry against AIDS, Secretary-General Kofi Annan has called for increased support for women - as researchers, activists, mothers and caregivers - in their struggle to combat the deadly pandemic, which took 3 million lives last year alone.

Delivering the keynote address to the awards banquet of the Global Health Council Annual Conference on Thursday evening, the Secretary- General praised the theme of the event - healthy women, healthy world - saying it expressed "an insight that can save and transform many millions of lives." He pointed to a "terrifying pattern" in the gender breakdown of statistics on the disease, which showed that infection rates in young African women are far higher than in young men, while globally, women suffer at least half of all new infections.

In response, the Secretary-General called for a "deep social revolution that transforms relations between women and men, so that women will be able to take greater control of their lives - financially as well as physically." He added that men must be encouraged "to replace risk-taking behaviour with taking responsibility." In order to achieve this, it would be necessary to marshal broad- based national effort, conduct a global information campaign, and make condoms "available to all who need them," he said, adding that pregnant women must have a guaranteed right to know whether they are infected, and to receive care if they are.

The Secretary-General also urged support for "the many heroic women's groups and co-operatives that are already doing such remarkable work, in Africa and elsewhere, to care for people with AIDS." In addition, he advocated ensuring that women can play their full part in conducting scientific research, and in helping to care for the world's 13 million AIDS orphans. "That heart-breaking figure is equivalent to more than the total number of children in California and Texas combined," Mr. Annan told his audience.

Looking to next month's UN General Assembly special session on HIV/AIDS, the Secretary-General said it would 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 for the next generation," said Mr. Annan. "We must define AIDS as our problem; as a threat to our common future; and as a test of our common humanity."

"Annan's New Envoy Pledges to Build Momentum in Fight Against AIDS in Africa."
United Nations, June 4, 2001

Stephen Lewis, a veteran Canadian diplomat and humanitarian advocate, named by United Nations Secretary-General Kofi Annan as his Special Envoy for HIV/AIDS in Africa, pledged today to work tirelessly in an effort to harness recent momentum in the global fight against the pandemic.

"I feel truly privileged to receive this appointment and to have the confidence of the Secretary-General to undertake this work," Mr. Lewis told reporters at a news conference in New York. "I shall plunge into it with full heart."

Underscoring the growing momentum in the fight against AIDS, Mr. Lewis said he felt "a cautious but insistent sense of hope." Drug prices had plummeted, African leaders were engaged as never before, and the Secretary-General's own "dramatic personal commitment" to rally the international community marked a "galvanic movement in addressing this dreadful disease," he said. "At no time, over the last 20 years in dealing with this incomparable tragedy in sub-Saharan Africa, has there ever been such a sense of collective resolve and collective possibility," he said.

While acknowledging the magnitude of the task ahead, he added, "it will be painfully slow and incremental, but this is the moment in time." "What the world needs is a sense of hope and momentum, and we are on the cusp of that now," he said, pledging, as a first step, to sit down with senior officials in African countries to determine which anti-AIDS measures could be implemented as soon as possible "and gradually build outwards to a sub-regional level so that finally the whole continent is brought in."

Introducing Mr. Lewis at today's press briefing, Deputy Secretary- General Louise Frechette called him a "passionate advocate" for Africa. "He has devoted many, many years of his life to Africa and the Secretary-General could not choose a better person I think to do this very important work on HIV/AIDS.

The new envoy, who served as Deputy Executive Director of the UN Children's Fund (UNICEF) from 1995-1999, will be responsible for ensuring follow-up to the African summit on HIV/AIDS, tuberculosis and other infectious diseases held in Abuja, Nigeria, last April, and to next month's UN General Assembly Special Session on HIV/AIDS, as related to Africa. Mr. Lewis has had extensive experience as a politician, diplomat and humanitarian. A passionate advocate of the rights and needs of children, since leaving UNICEF in 1999 he has been raising his voice in support of various humanitarian causes around the world, particularly in Africa and on HIV/AIDS.

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