Activists outraged at what they see as move to dilute targets for boosting numbers receiving anti-AIDS drugs
LONDON (AlertNet) - Some of the world's biggest government donors to HIV/AIDS programmes are trying to water down targets for reducing HIV transmission and boosting the number of people on treatment ahead of June's high-level meeting at the United Nations, health campaigners say.
"We are highly concerned, and consider it shameful that we could have a summit with a political declaration but no political commitment," said Sharonann Lynch, HIV/AIDS policy advisor for medical aid group Medecins Sans Frontieres (MSF).
In late March, U.N. Secretary-General Ban Ki-Moon unveiled a major report on progress in the fight against HIV/AIDS, highlighting the achievements and gaps in the global response, 30 years into the epidemic. He called on governments to sign up to six global goals, including halving the sexual transmission of HIV by 2015 and ensuring HIV treatment for 13 million people by the same year - more than double those receiving it today.
But in amendments to a draft outcome declaration for the June 8-10 meeting, seen by AlertNet, the European Union suggested removing any specific figure for the number of people living with HIV who are provided with access to antiretroviral treatment by 2015. It suggested replacing it with a pledge to "take immediate action to ensure that between now and 2015 we continue to significantly increase the numbers". It also deleted a 2015 target date for cutting sexual transmission by half.
Washington, even before inserting key numerical targets and deadlines, proposed substituting several firm pledges with looser language to "work towards" them. It also deleted a commitment to "measures to fully meet resource needs for prevention". The EU version kept this, but avoided reference to a target date.
U.N. member states have already failed to reach a goal set in 2006 of providing universal access to HIV prevention, treatment, care and support by 2010. In terms of treatment, that is defined as reaching 80 percent of those who need it, or around 15 million people.
Activists are outraged at what they see as an attempt to dilute the outcomes of the upcoming U.N.-led gathering as donor budgets remain squeezed by the financial crisis of recent years.
Stephen O'Brien, Britain's parliamentary under-secretary of state for international development, denied that London is resisting any specific outcomes in the declaration.
“Discussions over what will come out of the meeting in New York are still at an early stage but the UK is pushing hard for a renewed and shared commitment to universal access to HIV prevention, treatment, care and support by 2015,” he said.
Through contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, between 2011 and 2013, Britain will provide 37,000 HIV-positive women with treatment to prevent transmission of the virus to their babies, and 268,000 people with treatment for HIV, he added.
TREATMENT FOR PREVENTION
Some U.S. activists accuse the Obama administration of a lack of leadership on HIV/AIDS. They feel more should be done following the release this month of results from a large-scale international trial sponsored by the U.S. National Institutes of Health showing that, if an HIV-positive person adheres to an effective antiretroviral therapy (ART) regimen that begins when their immune systems are relatively healthy, the risk of transmitting the virus to their uninfected sexual partner can be reduced by 96 percent.
"This breakthrough is a serious game changer and will drive the prevention revolution forward. It makes HIV treatment a new priority prevention option," Michel Sidibe, executive director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), said in a statement.
Campaigners are now urging the U.S. government - which provides nearly 60 percent of donor government resources for fighting global AIDS - to capitalise on this fresh evidence by making a firm commitment at the U.N. meeting to expand access to treatment.
"Instead of embracing (the study results) and turning it into a solid strategy for HIV prevention, what we have is lukewarm endorsements and replacing commitments with 'maybes," said Matthew Kavanagh, director of U.S. advocacy for Health GAP, an organization of U.S.-based activists working to eliminate barriers to HIV treatment around the world.
Kavanagh said a divide has opened up between Asian and African countries that want to see bold targets adopted next month, and major donor nations that are reluctant to sign up. But pressure from developing states could yet "shame" richer governments into shifting their positions, he noted.
A spokesperson for the U.S. President's Emergency Plan for AIDS Relief (PEPFAR) said negotiations on the outcome declaration for the June meeting are ongoing, adding that: "The U.S. strongly supports setting ambitious and realistic global goals moving forward."
Around 30 heads of state and government are expected to attend the high-level gathering, but Washington has yet to announce who will make up the U.S. government delegation. Some civil society groups fear their calls for President Barack Obama to lead it may go unanswered.
FUNDING SHORTFALL
Officials and activists alike acknowledge that real progress has been made in curbing the spread of HIV/AIDS worldwide and helping those living with HIV stay healthy.
Between 2001 and 2009, the rate of new HIV infections in 33 countries - including 22 in sub-Saharan Africa - fell by at least a quarter, according to the United Nations. And by the end of 2010, more than 6 million people were on antiretroviral treatment in low- and middle-income countries, a level that seemed far-fetched even a decade ago when a landmark special session on HIV was held at the United Nations.
Yet medical organisations like MSF, which treats more than 170,000 people living with HIV in 19 countries, are calling for a renewed political and financial effort to roll out ART - which is becoming cheaper and easier to administer - to the additional 10 million people in urgent need who still don't receive it.
Worryingly, international funding for HIV assistance declined for the first time in 2009. The Global Fund faces a shortfall of several billion dollars after inadequate donor pledges at last year's replenishment conference and is having to turn needy nations down.
A report issued by MSF this month says financial constraints are preventing some poor countries, including Malawi and Zimbabwe, from changing their guidelines to put people on treatment earlier and with better drugs.
In Democratic Republic of Congo, the number of HIV-positive people starting treatment programmes dropped by 18 percent last year from 2009, and some clinics have had to close or put caps on new patients, according to MSF. The war-torn nation is suffering from a shortage of drugs due to an end to funding from three key sources - including PEPFAR and the World Bank - and the rejection of its 2009 and 2010 proposals to the Global Fund.
In DRC, only 17 percent of people in need currently receive ART, and only 2 percent of pregnant women are treated to prevent HIV transmission to their babies. Those living with HIV have to pay $15-$60 for tests needed to get their treatment right, on top of consultation fees.
"Whether we have a piece of paper (with a funding commitment from donors) or not, we know we can't slow down or stop; we need to quicken the pace (of expanding HIV treatment)," said MSF's Lynch. "The money is there - it's a political choice."
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