Conference on AIDS and STDs in Africa
Lusaka, 15 September 1999
Mr. Chairman, Professor Luo, Excellencies, Distinguished Delegates, Ladies and Gentlemen:
On behalf of the United Nations Children’s Fund, I am very pleased to join you for this vitally important Conference. The high level of representation here is a sign of the gravity with which Africa and the international community are treating the crisis of HIV/AIDS -- and of the urgent need to set priorities for prevention and treatment.
Mr. Chairman, I will not dwell for long on the statistics. The litany of devastation is familiar to all of you:
Some 200,000 people, most of them children and women, died in 1998 as a result of armed conflict on the African continent -- and yet as you have heard, 2 million Africans were killed by AIDS in that same year.
In sub-Saharan Africa, there are 22 million people living with HIV -- two-thirds of the world’s total.
Mother-to-child transmission continues to be the leading cause of infection among young children.
More than 8 million children have lost their mother or both parents to AIDS, with the total expected to reach 13 million by the year 2000, with the vast majority of them in sub-Saharan Africa.
The number of child-headed households is rising sharply;
Millions of children are suffering the effects of being stigmatised;
And decades of gains for child survival and development are being wiped out, threatening prospects for social progress and better standards of life for all.
By any measure, Mr. Chairman, the HIV/AIDS pandemic is the most terrible undeclared war in the world, with the whole of sub-Saharan Africa a killing field.
The international community, the United Nations, the Organisation of African Unity (OAU) and African leaders at many levels have worked tirelessly to bring peace to places like Liberia and Sierra Leone, using the same combination of tenacity and skill that President Chiluba recently brought to bear in talks to end the conflict in the Democratic Republic of the Congo -- talks that were concluded in this very hall just a few weeks ago, before throngs of world media representatives.
Mr. Chairman, we must ratchet up the fight against HIV/AIDS to that same level of intensity and public visibility -- and we must do it now.
As Peter Piot put it, AIDS in Africa, far from being "a larger-than-usual medical problem," is in fact a massive development catastrophe requiring an emergency response. The question is how to organise a response that is both urgent and commensurate with the scale of the pandemic.
UNICEF has identified five priority areas as part of our contribution to the International Partnership Against AIDS in Africa.
First, we must mobilise commitment and capacity to act. This includes breaking, once and for all, the "conspiracy of silence" that continues to hide the dimensions of the HIV/AIDS crisis from the very people most affected by it. It means supporting the development of policies and strategies; building partnerships; and mobilising resources.
Second, we must focus prevention efforts among young people, through such efforts as promoting youth-friendly health services, life-skills training and social mobilisation.
Third, we must reduce the risk of mother-to-child transmission of HIV by encouraging all women to learn their HIV status, and by supporting preventative measures, including advice on infant-feeding options.
Fourth, we must provide greatly expanded care for orphans and children affected by HIV/AIDS. This means strengthening families and community capacities to protect and care for children and providing access to basic services.
Fifth, UNICEF intends to take the lead to provide care and support for our own staff who are living with HIV, and to help ensure that we provide a model that other organisations and industries can emulate.
Mr. Chairman, we can achieve these goals only with the sustained support of officials at the highest levels of government.
At the same time, the international community and multilateral agencies and non-governmental groups have a major role to play.
Prevention can succeed only if we help vulnerable countries to strengthen their health systems to cope with the huge new demands that are being placed on them by the pandemic.
Poor countries need more than encouragement. They need income support, debt relief and strong social safety nets.
Most of all, they need resources. Mr. Chairman, if the international community is to come to grips with HIV/AIDS, it must eliminate the staggering inequities and inequalities that are contributing to the spread of the pandemic -- along with many other consequences of global poverty.
The United States, for example, spends $880 million a year fighting HIV/AIDS, in the face of 40,000 new cases annually. But Africa, which must deal with 4 million new cases a year, spends only between $149 million and $160 million. This is simply unacceptable.
UNICEF, for its part, is moving to significantly strengthen our support of governments and non-governmental partners to combat HIV/AIDS in Africa, bolstering our staff in regional and country offices while stepping up our country-level support for practical action. At the same time, UNICEF, with the help of its partners in UNAIDS, is working to coordinate closely with other UN agencies.
All these things are more essential than ever, for the explosive spread of the virus is straining resources and capabilities at all levels.
Care-givers throughout sub-Saharan Africa -- ordinary people, mostly women -- are rendering heroic services in tending to so many terminally ill people through home-based care, and helping orphans and other vulnerable children through informal networks. They are to be congratulated for their efforts, for they are working against tremendous odds.
For example, we are seeing that the traditional African way of relying on the extended family to care for children orphaned by AIDS is becoming increasingly untenable. Many households can barely afford to keep the children, let alone afford to send them to school -- and as a result, orphans are often among the first to be denied the right to an education.
Given these worsening conditions, it is clear that alternative models of orphan care are needed.
Important groundwork has already been laid. Since the early part of the decade, the Government of Uganda has actively promoted new approaches for orphan care, drawing on the collaborative energy of non-governmental organisations and community-based groups.
One outcome has been the establishment of the Ugandan Community-Based Association for Children, a national association set up with assistance from UNICEF that provides training to local groups in such areas as child care, organisational management, and information exchange.
In Malawi, the Government began formulating a national policy for orphans in 1991, a policy that it has kept up and developed. It includes actively promoting community-based programmes for orphans with the cooperation of NGOs and churches and the support of UNICEF.
A National Coordinating Board -- a collaborative body not controlled by a Government ministry and without paid staff -- trains communities and organisations in all aspects of child care. Malawi also offers free primary education for all children.
In another area, the prevention of mother-to-child transmission of HIV, UNICEF -- working closely with WHO and UNFPA and the UNAIDS Secretariat -- is taking the lead in supporting government efforts in many of the most severely affected countries of sub-Saharan Africa.
Last year, we began launching pilot interventions in 11 countries -- interventions designed to reduce the paediatric HIV infection rate while simultaneously strengthening health facilities for women and their partners.
The principal aim of these efforts is to provide voluntary HIV testing and counseling for pregnant women. An estimated 30,000 women who are found to be HIV-positive will then be provided with one of the recently developed short anti-retroviral drug regimens; advice on infant feeding; and support for the feeding method of their choice. These interventions can reduce transmission rates by half.
In this connection, Mr. Chairman, we are greatly encouraged by the very recent news of a promising and dramatically more affordable drug regimen to prevent mother-to-child transmission of HIV.
UNICEF is working on an urgent basis with WHO and other UNAIDS partners assess the implications of this drug, nevirapine, whose effectiveness has undergone initial study in Uganda by the US National Institutes of Health -- the results of which are described in the latest issue of the medical journal The Lancet. The indications are that nevirapine can reduce HIV transmission by 50 per cent with a single dose of the drug to the mother and infant -- at a per-treatment cost of about $4.
Mr. Chairman, it is true that even a $4 drug treatment will challenge the health budgets of many African countries -- but the cost of failing to introduce this preventative regimen will be incalculably higher.
If immediate steps are not taken to dramatically reduce the risk of mother-to-child transmission, already overburdened health services will simply be unable to cope with the needs of the huge numbers of very sick and dying young children.
The problems that communities face in coping with orphans is enormous, but they will be far much worse if a substantial proportion of those orphans are also sick with AIDS -- a problem that we hope can be substantially prevented.
Mr. Chairman, the figures on HIV/AIDS in Africa that you have heard in recent days are framed by one terrible, inescapable fact -- that it is young people, people up to the age of 24, who are bearing the brunt of the casualties. This is especially true of young girls, who have significantly higher infection rates.
Young people are disproportionately at risk because, in a time of sexual awakening, they are deprived of the right to health services and nutrition, and to a safe and supportive environment free of exploitation and abuse -- including protection from coerced sex. And more often than not, they are denied the right to participate and to make their views heard in matters that affect them.
Mr. Chairman, the future course of the HIV/AIDS pandemic lies in the hands of young people. It is absolutely vital that we do everything necessary to arm them with the knowledge they need to protect themselves and their communities.
That is why UNICEF has moved to redouble our efforts to mobilise and support programmes to address the rights of young people to development and to participation.
Supporting the right of adolescents to information and life skills, which UNICEF and its partners are doing through a range of activities in schools and through NGOs and the media in countries like Uganda, Zimbabwe, Zambia and Namibia;
Promoting youth-friendly services, such as health care in countries like Zambia and Kenya;
Building safe and supportive environments with programmes that draw on the help of peers, parents, teachers and health workers in countries like Côte D’Ivoire and Mali;
And providing opportunities for adolescents to participate in decisions, not only in matters that affect them directly, but in the larger decisions that are taken in civil society.
As you heard during Monday's presentation on "young people’s perspectives on HIV programmes," many young people have some knowledge about HIV/AIDS -- but consultations with them and existing data show that they do not have all the information they need. Indeed, in sub-Saharan Africa, it has been estimated that 90 per cent of HIV-positive people are unaware that they are infected.
We urgently need to address this knowledge gap, using language and formats that young people can appreciate.
At the same time, we also know that the acquisition of knowledge about how to prevent and treat HIV does not necessarily bring about broad behavioural change among youth. However, there is increasing evidence that awareness of one’s HIV status can be a powerful motivating force for behavioural change.
To counter the rising HIV infection rate among young people, the UNAIDS World AIDS Campaign has focused on young people for the last two years. This year’s theme, Listen, Learn, Live, is aimed at promoting the participation of young people in prevention efforts, raising public awareness of the crisis, harnessing public and private resources -- and strengthening support for young people affected by the pandemic.
The UNAIDS Secretariat together with its co-sponsors has been particularly active in widening the network of public and private-sector partnerships.
You may have seen Bill Roedy, the President of MTV, discussing HIV/AIDS issues with young people at the Youth Village this week. MTV deserves immense credit for its ongoing efforts to broadcast the importance of HIV-prevention messages on their music television throughout the world, which are reaching and influencing millions of young people.
What is needed now are increased efforts to promote youth participation and commitment; more services aimed at youth; more parental involvement; more education and information, using schools and other sites; more protection for girls, orphaned children, and young women; and more partnerships with people with HIV and AIDS.
Those measures are already being applied in such places as Zambia, where increasing numbers of young people are working as educators and peer counselors, helping to de-stigmatise HIV/AIDS for other youths, and easing the burden on health workers.
These are important beginnings. But more effective approaches are needed -- and they must be put in place quickly if Africa is to make significant headway in stemming the pandemic.
Mr. Chairman, Excellencies, Distinguished Delegates: let us speak frankly.
It is already obvious that at the rate the disease is spreading, governments cannot keep up with increasing demands to help support children orphaned by AIDS; provide adequate levels voluntary and confidential testing; or mount effective and widespread prevention and treatment programmes for young people.
The seriousness of the situation can be seen in the number of seemingly simple things that have not been done.
For example, in many sub-Saharan African countries, it has been found that more than 25 per cent of women aged 15 to 19 are unaware of even one effective way of avoiding HIV infection. And in recent representative surveys, over 30 per cent of young women in virtually all countries expressed the view that a healthy looking person could not possibly be infected with the AIDS virus.
What I am suggesting, Mr. Chairman, is that we have reached a point at which governments may need to consider new ways in which to do business.
It is a process that national leaders can begin by recognising the capabilities of communities and the poor to help themselves.
This means empowering communities -- especially poor people -- to mobilise themselves to act, and to do so in ways that they are able to see and understand the results of their actions.
Mr. Chairman, the very complexity of the HIV/AIDS problem is why no standard solution exists. But there is every reason to believe that those most directly affected by the problem are in the best position to find solutions that work for them. The key is to recognise the poor as key actors in their own development, rather than as passive recipients of services and commodities dispensed by health care workers, teachers, religious leaders and others.
Distinguished Delegates, I am convinced there is a need to identify some practical things that all countries in sub-Saharan Africa can do to bring about real results in a short period of time.
I am talking about a very limited number of goals -- goals that we know can be achieved in a short time if we pull together -- that would be relevant to all of the countries in this part of the world -- and that could be easily monitored.
You yourselves need to identify what these goals are. But let me suggest some possibilities:
Begin an effort to ensure that by a target date -- say the end of the year 2002 -- that most adolescent women will have sufficient knowledge of the risks of contracting HIV/AIDS -- and of the ways in which they can protect themselves.
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.
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 to basic health care.
Mr. Chairman, Excellencies, Distinguished Delegates: time is running out.
The monstrous proportions of the HIV/AIDS pandemic in sub-Saharan Africa show that, far from simply another new problem among other development problems, the disease is rapidly becoming a significant and growing threat to peace and stability in the world.
Let us ensure that all our actions are commensurate with the danger.