13th International AIDS Conference
Durban, 11 July 2000
Mr. Chairman, Excellencies, Dr. Brundtland, Distinguished Delegates, Colleagues, Ladies and Gentlemen:
I am very pleased to be here, both on behalf of the United Nations Children's Fund -- and in UNICEF's capacity as chair of the committee of co-sponsoring organizations of UNAIDS.
Mark Malloch Brown, the Administrator of the United Nations Development Programme, is unable to join us today. But he has asked me to reaffirm the strong commitment of UNDP to the fight against HIV/AIDS -- and to stress that UNDP has made HIV and its development implications a top priority in sub-Saharan Africa.
To this end, UNDP is working closely with UNICEF, UNFPA and all development partners at country level to ensure that issues related to HIV/AIDS form an integral part of all development planning and poverty reduction strategies.
Mr. Chairman, we are here today to discuss what are termed "outstanding issues." There are obviously many.
But there is one, among all others, that we must address with special urgency, and with a degree of bluntness as well -- and that is the need to break the unconscionable silence that surrounds this disease.
Silence about HIV/AIDS is much more than the absence of sound or the quiet of inaction. Where HIV/AIDS is concerned, silence is emblematic of much of the world's consent -- consent that has been willfully imposed over repeated shouts of warning, rising cries for assistance, and desperate pleas for global action.
Make no mistake: the silence that surrounds HIV/AIDS will remain impervious to efforts by individuals, communities, organizations and nations until -- and unless -- the entire global community joins forces to fight back.
Mr. Chairman, we are gathered here in a hall in South Africa, a country whose triumph against apartheid followed many years of struggle -- and the lifting of an earlier, and equally inexcusable, conspiracy of silence that had been sustained by much of the rest of the world.
The end of apartheid was a shining affirmation of faith in fundamental human rights -- and in the dignity and worth of the human person. More than anything else, it was a victory for children, and for the future. And it was, in the end, a testament to the power of courage and commitment -- and to the transforming effects of global solidarity.
We have seen more recent proof of that power in the global ban on anti-personnel landmines, which continue to kill or maim far more children than soldiers while thwarting post-conflict reconstruction and development; and in the international consensus to confront atrocities and the culture of impunity, which resulted in a global agreement to create a fully empowered International Criminal Court.
And we saw it 54 years ago, when the global community created UNICEF, in horrified recognition of the immense suffering of children as a result of World War II and its aftermath.
Since then, children have continued to be caught up in the unspeakable effects of armed conflict between States -- and now, increasingly, within them.
Governments and the public have responded with aid, and UNICEF has continued to provide assistance to children wherever it is needed.
Now, with the HIV/AIDS pandemic, the world faces a new threat, with consequences for children around the globe as devastating to humankind and as potentially long-lasting as any war in history -- and yet the global community has failed to mount an adequate response. The consequences of that inaction are already apparent.
Before the end of this day, some 15,000 people will acquire HIV -- and 60 per cent of these new infections will occur among children and young people.
In 1999 around 570,000 children under 15 were infected -- and of these, 500,000 were in sub-Saharan Africa.
Mother to child transmission, or MTCT, is by far the major cause of HIV infection in young children, accounting for over 90 per cent of infection in infants and children during late pregnancy, childbirth or breastfeeding.
Without intervention, fully one-third of infants born to HIV-infected women will be infected with the virus. With 30 per cent of pregnant women infected in several countries in Southern Africa, this means that 10 per cent of infants will be born with HIV infection and will suffer the misery of AIDS within a few years.
Of course, when we speak of mother to child transmission, we must not forget that it is usually men and fathers who infect the mothers -- and that the best way of preventing mother-to-child transmission is to prevent mothers from becoming infected in the first place.
Among older children and young people, the risk is primarily from unprotected sex, sexual abuse and intravenous drug use. Nearly half of all infections occur in this group.
Almost 3.2 million children under 15 have died from AIDS since the beginning of the pandemic -- and because of HIV infection and the loss of family care, child mortality is likely to double in the worst affected countries by 2010.
The impact of the epidemic on families affects children's physical, mental and social health and development.
More than 11 million children have already been orphaned by AIDS -- and the number of orphans is expected to rise to over 40 million by 2010, more than 90 per cent of whom will be in sub-Saharan Africa.
Mr. Chairman, there are some injustices so stark, so obvious and so appalling that it is impossible to draw attention to them too often. And among the most intolerable of modern inconsistencies is this: in a world in which many countries and people are awash in knowledge and resources, humankind is merely standing by, barely making an effort to defend its young against the siege of HIV/AIDS.
The result is that children are suffering and dying in ways and in numbers that no earlier generation could have imagined possible.
Mr. Chairman, it is time to fight back. UNICEF is committed to this struggle -- and to mobilising and strengthening the capacity of the governments and people of affected countries to successfully fight this war.
Building on our early experience, and guided by the Convention on the Rights of the Child, UNICEF is now supporting governments and civil society in nearly 160 countries to effectively fight the pandemic.
Two years ago, UNICEF identified five priority areas in which to focus our efforts and resources in all countries, but particularly in those most seriously affected.
The first priority is aimed at bringing the magnitude of the problem of HIV/AIDS to the attention of policy makers at all levels. Thus the theme of this 13th International AIDS Conference -- "Breaking the Silence" -- could not be more appropriate.
But the silence will not be broken until every family and every community fully realises its own particular risks and vulnerabilities -- and has the capacity to care for those already infected and to stop future infection.
And the silence will not be broken until government and civil society at every level take measures to support and protect those who have the courage to share their HIV status with others.
UNICEF's second priority is to prevent HIV infection among young people by working with them to ensure that they have the requisite knowledge and skills -- and access to the services they need to help them reduce their risk of infection.
Mr. Chairman, this is an eminently feasible goal, for HIV infection among young people is 100 per cent preventable.
Even in communities that face the highest risk, we find groups of 15-year-old girls with HIV prevalence rates of just 1 or 2 percent. Yet within just three or four years, without dramatic action, one quarter or more of these girls will be infected.
There are three things we must do to prevent HIV/AIDS from infecting young people.
There must be better access to information and knowledge about the virus and how to prevent it, communicated through schools and other channels.
There must be support for young people to adopt safer behaviours, including abstinence, delay in onset of sexual activity, fidelity and safer sex practices, including the use of condoms.
There must be improved access by young people to friendly health services where voluntary and confidential HIV testing, treatment of sexually transmitted infections and condoms will be available.
Mr. Chairman, UNICEF's third overall priority is to prevent the transmission of the HIV virus from mothers to their children. UNICEF, together with WHO, UNFPA and the UNAIDS Secretariat, is presently supporting pilot programmes to prevent mother-to-child transmission in 12 countries.
In this connection, UNICEF is working with governments to provide voluntary HIV testing and counselling to pregnant women, as well to supply short antiretroviral drug regimes and advice and support for infant feeding for those who are found to be HIV positive.
Properly implemented, these interventions can reduce HIV transmission rates by half. And while we do not have all of the answers in this area yet, we have sufficient confidence to begin planning large-scale programmes to reduce mother-to-child transmission.
We are also very hopeful that ways will be found in the near future to ensure access to drugs to treat all HIV/AIDS-infected individuals. For now, we have drug regimens that are 50 per cent effective in totally preventing AIDS in young children, and these are potentially available for just a few dollars or less.
Let us show that we can implement such programmes now, while working urgently to increase the options available to treat mothers living with HIV.
Mr. Chairman, UNICEF's fourth priority is to strengthen the capacity of families and communities to identify and respond to the needs of orphans and vulnerable children; to ensure their rights to inherit family resources, and to ensure their protection and access to basic health, education and child welfare services.
Finally, UNICEF is also engaged in workplace initiatives with staff. HIV/AIDS is taking a substantial toll on UNICEF personnel and their families, and our fifth priority is to develop strategies to both strengthen prevention and to provide support and services for staff and dependents affected by HIV/AIDS.
In acting on these priorities, UNICEF is using every opportunity to assess if more can be done to intensify the fight against HIV/AIDS. We have recruited additional staff in each of these areas to strengthen country programming -- and are training all staff to expand HIV/AIDS programming using a rights based approach.
We are also strengthening our partnerships within UNAIDS, and with NGOs and the private sector to rapidly expand the coverage and quality of HIV/AIDS interventions.
And UNICEF has initiated a resource-mobilization strategy to raise an additional $250 million to support intensified action in the priority areas in Eastern and Southern Africa alone.
Mr. Chairman, in supporting these priorities, UNICEF is committed to using a combination of proven techniques of community mobilization and empowerment, all linked to the rapid introduction of newer communications technologies.
For many years UNICEF has supported a range of successful communications activities aimed at promoting behaviour change and development -- and increasingly focussed on HIV/AIDS prevention and care.
These projects have met with some success, but it is clear that they have not been implemented on the scale necessary to achieve the rapid change we need. Clearly we need to continue to use existing media and communications links. But we also need to harness new channels to reach new audiences in innovative and forceful ways, including digital broadcasting by satellite and the Internet.
Mr. Chairman, many of us last met just nine months ago at the landmark ICASA conference in Lusaka. Since then, the nature of the HIV/AIDS crisis has become more widely recognised -- and a number of heads of State or Government have declared that HIV/AIDS is a national emergency or disaster -- while other high-ranking leaders have characterised it as an outright threat to peace and security.
UNICEF is encouraged by these declarations -- but we have yet to see the commensurate follow-up. Where, for example, are the massive internal re-allocations of resources? Where is the public identification of the enemy and the informed mobilization of all segments of society against this enemy? Where is the social unity and solidarity?
Mr. Chairman, I would here simply reiterate what I said at the Lusaka ICASA Conference.
We urgently need to set some very clear goals and targets to gauge our progress.
We now have global agreement, established at the ICPD+5 Conference and endorsed at the recent World Conference on Social Development (Copenhagen +5) , on one over-arching goal: that "by the year 2005, HIV prevalence in age group 15-24 years is reduced globally, and by 25 per cent in the most affected countries, and that by 2010 prevalence in this age group is reduced globally by 25 percent."
Mr. Chairman, this goal forms a very useful "umbrella" -- but I believe we need to establish more specific targets to help galvanize actions in specific areas. I am talking about a very limited number of specific targets -- objectives that we know can be achieved in a short period of time if we all pull together, and that could be relatively easily monitored.
Countries and communities themselves need to identify what these goals are, but at ICASA we suggested some possibilities.
They include beginning an effort to ensure that by a target date -- conceivably by the end of the year 2002 -- that most adolescent women will have sufficient knowledge of the risks they face of contracting HIV/AIDS, and of the ways in which they can protect themselves.
We should take steps to ensure that within two years, at least 70 per cent of all women attending ante-natal clinics will have access to voluntary and confidential testing so that they will know their HIV status.
We should institute steps to make sure that by the end of 2002, at least half of all local authorities will have found a way to make sure that families caring for orphans are able to supply them with adequate food, access to education, and basic health care.
Mr. Chairman, two decades ago, most of us had not even heard of AIDS. Today, the pandemic presents us with one of the greatest challenges of our time.
But as bleak as the prospects may sometimes seem, UNICEF's message today is that in all areas of AIDS activity, there is hope.
In research for treatments, in stopping the spread of the virus, in limiting the impact on children, adolescents and women -- in all these areas we have seen signs of progress. That is why UNICEF will continue to focus on primary prevention among young people, programming for families and children affected by AIDS, particularly those orphaned, and prevention of mother-to-child transmission.
But we must act, using the knowledge and tools we have in hand. For the greatest results in slowing this disease will only come from working together -- with governments, businesses, universities, NGOs, religious organizations, communities, families, grassroots groups, the media, young people.
Our collective task, Mr. Chairman, is clear. We must do more, we must do it better, and we must do it now.