United Nations: Special AIDS Session Next Week

On June 25-27 the entire United Nations General Assembly will focus on AIDS. The goal is worldwide commitment and consensus on dealing with the epidemic. The negotiations leading up to this Special Session have been contentious, even more so than most diplomatic meetings.

No matter what the outcome, this meeting will be historic and will be a major focus of world attention. Here is some background, and resources that you can use as a starting point for finding information.

Official Web Page

The Web page for the United Nations General Assembly Special Session on HIV/AIDS (often called UNGASS) is http://www.un.org/ga/aids.

Here are some of the important documents available there before the meeting:

• Under the heading "A call to action" are several recent statements by United Nations Secretary General Kofi Annan, who has provided exceptional leadership on this issue in advance of the United Nations special session;

• The "Documents" section includes the "Revised Draft Declaration of Commitment on HIV/AIDS" -- a single-text statement that is being negotiated in order to reach as much agreement as possible. (At this time, June 16, the current draft is the 2nd published version, dated May 11.)

• The "Bulletin" is an electronic news bulletin to keep participants informed. At this date (June 21) only one issue has been published, with general background such as AIDS statistics, overview of the meeting, and media accreditation. Two more issues are planned by June 25.

• A "calendar" of dozens of official UN and unofficial events around the time of the session.

• Other sections on background information, NGOs and civil society, and media.

From the official media advisory:

Live Webcast, Plus Archive and Transcript

Kaisernetwork.org, a service of the Henry J. Kaiser Family Foundation, is webcasting the entire UN Special Session on HIV/AIDS, June 25-27. Anyone around the world can watch it for free.

An archive and transcript will also be available, a few days after the session.

For more information, or to watch the webcast, visit http://www.kaisernetwork.org/health_cast/hcast_index.cfm?display=detail&hc=253.

Areas of Agreement

On June 16 the Background section of the official Web site includes a one-paragraph summary under "What Will the Outcome Be?" It summarizes some of the major areas of at least nominal agreement:

"Given the urgency of the epidemic, at the special session governments are expected to agree on a Declaration of Commitment that will outline priority areas where stronger action must be taken. These are likely to include prevention, improved access to care and treatment, care of children orphaned by AIDS, expanded public/private sector partnerships, the need for an accelerated multisectoral response to the epidemic and for resources commensurate with the crisis."

Controversies

Some of the major areas of disagreement are:

Declaration of Commitment

Whether to name vulnerable groups, such as men who have sex with men, in the Declaration of Commitment. The current draft includes the following section, which some countries object to:

"By 2003, develop national strategies, policies and programmes, through a participatory approach, to promote and protect the health of those most vulnerable to, and at greatest risk of HIV infection, such as: children in especially difficult circumstances, men who have sex with men, sex workers and their clients, injecting drug users and their sexual partners, persons confined in institutions and prison populations, refugees and internally displaced persons and people separated from their families due to work or conflict."

According to a June 15 Associated Press story, an Egyptian diplomat commented, "Does it have to be so explicit? This is shocking for my society." He proposed "irresponsible sexual behavior" instead. And the Iranian Ambassador said negotiations should "not be considered as an opportunity by certain quarters in the Western world to push the envelope on areas where there is cultural sensitivity, ideological sensitivity, ethical sensitivity" (from same Associated Press story).

Apparently the U.S. wants to use general language such as "vulnerable individuals" instead of naming the groups.

Many AIDS professionals and activists consider the issue important because they want to use the document that emerges to pressure their governments to focus prevention resources where the epidemic is spreading fastest. Many countries, including the U.S., have targeted prevention resources irrationally because of a population's disadvantaged or unpopular political position, or minority status.

Human Rights

Here is the current text, which some countries want changed, although as of today (June 21) there seems to have been progress toward narrowing the areas of controversy:

Apparently the U.S. does not want any movement toward health care as a human right. And some countries do not like the idea of human rights and are reluctant to see it extended.

Treatment Access vs. Prevention and/or Intellectual Property

The current draft focuses on prevention and only two paragraphs on treatment and care. But pharmaceutical companies -- and therefore the U.S. and some other delegates -- have problems with the following paragraph, apparently because they do not want any language suggesting collective action toward differential pricing or other ways of making medications affordable:

"By 2003, ensure that national strategies are developed in close collaboration with the international community, civil society and the business sector to increase substantially the availability of antiretroviral drugs and of essential drugs, for the treatment of HIV infection and opportunistic infections, by addressing factors affecting the provision of these drugs, including technical and system capacity, pricing, including differential pricing, and by examining alternatives for increasing access and affordability of HIV/AIDS related drugs."

There is also controversy over whether to provide antiretroviral treatment in Africa and other poor regions, vs. focusing on prevention and limiting treatment to low-cost, unpatented antibiotics, and only using antiretrovirals for prevention of mother-to-infant transmission.

Recently two U.S. officials created a firestorm of controversy by suggesting that Africans could not take their medicines on time -- first an unnamed senior Treasury Dept. official in late April, then over a month later, Andrew Natsios, the new director of the U.S. Agency for International Development -- leading to calls for the latter's resignation, including an op ed in The Washington Post, June 15, and a student campaign to send him watches. Some observers are less concerned about the unfortunate remarks themselves than by what they may reveal about moves toward a U.S. policy of writing off tens of millions of people already infected in poor countries -- whether to defend prevention program funding, to save money, or to avoid intellectual-property challenges resulting from raised expectations and efforts to obtain access to patented antiretrovirals.

One code word to watch is "care." Often it means hospice care or other inexpensive treatment -- not including antiretrovirals to address the central cause of the illness.

For More Information

To follow these and other issues during and after the United Nations General Assembly Special Session on HIV/AIDS, see:

• The official session Web site (described above), http://www.un.org/ga/aids.

• The official email discussion forum, Break the Silence. To join, send an e-mail message to: join-break-the-silence@hdnet.org To see the archive of messages already sent, go to http://www.hdnet.org (at this time there is a full archive for those who have joined the list, and a selected, categorized archive open to anyone).

• The news bulletin of the meeting. The easiest way to find is it to check the official Web site for copies as they are published.

• For information about the campaign for treatment access in developing countries, see: http://www.accessmed-msf.org (You may need to click on the logo to enter the site), and http://www.globaltreatmentaccess.org.

ISSN # 1052-4207

Copyright 2001 by John S. James. Permission granted for noncommercial reproduction, provided that our address and phone number are included if more than short quotations are used.

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