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Getting Ahead of the Epidemic

Transcript of a Speech From the Closing Ceremony of the XV International AIDS Conference

July 16, 2004

The closing ceremony of the XV International AIDS Conference is available in its entirety in PDF, RealPlayer video and Windows Media video formats.

Good afternoon. Minister Sudarat, Prime Minister Douglas, Excellencies, dear friends, colleagues, thank you for a great week and it may be hard to believe, but I really enjoyed it. This conference happens in a fundamentally different context from any other conference and I've been to all of them. I truly believe that for the first time there is a chance, a real chance that we will get ahead of the epidemic. And this momentum has its roots in both the science and the activism of the last decades. But our challenge remains how to raise action on both fronts to the level we need to achieve full success.

For me, this week was clearly about taking responsibility and we heard it loud and clear at this session by the great leaders who took the time to come and address us. And it's now our collective responsibility to make the money work for people and the way we use this opportunity has tremendous implications for the future. We will not get this chance again. Unless we fully embrace country and community ownership, we will be inviting chaos ten years down the road. Unless we invest in institution and human capacity, we will only have applied band-aids instead of building a sustainable response to AIDS. Unless we scale up prevention with a passion and the urgency that is being brought to treatment, access for all will remain a dream. And let me tell you what I think we need to do now.

First, ownership. The time for strategies imposed from the outside is over. We need to address locally defined needs and allow staff to do their work, but the reality in many countries is quite different today as we heard so many times during this conference. Scores of AIDS donor missions, numerous evaluation frameworks, rival coordination mechanisms, and epidemic of workshops and meetings, and piles of paperwork, fragmentation has real costs in money and in lives. And with new funding and new actors coming in we urgently must turn the three ones principles from a concept to a reality.

Second, capacity. One of the most acute challenges we face is capacity building that can deliver treatment and prevention now, but also in 10 and 20 years from now. Such investments should be part of every single AIDS project and should include strengthening community capacity, not only medical institutions.

Third, prevention. Between today and the deadline for the 3x5 initiative, 8 million people will become infected with HIV at the current pace. 8 million. And without a greatly expanded prevention effort, treatment is simply not sustainable. And of course we need condoms and we need clean needles, but we need to go way beyond them, way beyond ABC. ABC plus, many times plus. This means promoting education for girls and equality for women as the Global Coalition for Women and AIDS is doing. It means insisting on the human rights and dignity of all people. It means breaking the vicious circle of poverty, lack of nutrition and HIV infection. It means involving young people and people living with HIV in the response. And it means avoiding falling into the trap of over medicalizing prevention.

Our response can only be successful if it is comprehensive. And at the Durban conference four years ago I called for moving from the M word to the B word. From millions to billions of dollars in funding for AIDS. The most frequent reaction then was that this was an irresponsible statement for someone in my position, but here we are with around 6 billion dollars available for funding, spent for funding the AIDS response. The Global Fund is up and running. The U.S. Government, the European Union Members, Japan, and the World Bank are bringing substantial new resources to the effort. And this week we heard new commitments from Thailand, the UK, Canada, Australia, European Commission, and the Gates Foundation. So also from that perspective it was quite a good week. Now in treatment, we must move from the T word to the M word. From thousands to millions. And I believe that 3x5 is already changing the dynamics of how we deal with AIDS as we just heard from my good colleague and friend, J. W. Lee.

Let me now turn to an agenda that is largely unexplored and that is our long-term agenda. The priorities I have just discussed are acute, but they still largely represent a reactive agenda. Now is the time to move from tactics to strategy. To combine long-term investments with crisis management of today. And I didn't hear much of that debate at this conference, but it is vital. And let me mention just a few aspects of it.

First, of course, there remains the key issue of fully funding the response, and with Secretary General Kofi Annan, I appeal to all donor nations to contribute their share, including to the Global Fund. But also to all developing nation governments to give priority to AIDS in their budget allocations. And Madame Sonia Gandhi gave us some good news for India. But sustaining the billions will require much more than words and speaking up. It will require results. It will require support from mainstream public opinion in rich countries. And it will require recognition of the need to maintain special funding for AIDS for many, many years to come. And to maximize resource mobilization we will need to use multiple channels and explore new avenues as well. And an obvious resource is to convert the public debt of developing countries for AIDS action. Africa's crippling debt must be relieved. The 15 billion dollars annually that disappears down the money pit every year. That is four times more than is spent on health and education, the building blocks of the AIDS response. Four times.

Second, we need to accelerate investments in desperately needed vaccines and microbicides, as well as better treatments in all of them.

Third, let's be honest with ourselves. Treatment access today has consequences for the future. It means that increasing numbers of people will be on treatment for life. That's what we want. For 40 years or 50 years. And that the more expensive second-generation therapies will need to be made accessible globally, just as the first generation. So while we deal with the emergency today, which is real, it's imperative that we plan for a system-aimed effort on treatment. And AIDS is far from being a chronic disease like any other. We are definitely not there yet. And as much as universal access to HIV treatment is about the best we can do against stigma, the impact of treatment will be limited as long as stigma haunts people living with HIV.

And then we have the fourth, long-term challenge, we barely understand how fundamentally AIDS is changing the very fabric of society and how the worst-affected societies will handle challenges such as millions of orphans, children taking care of families, schools without teachers, states without fiscal revenues, fields without farms, and rising numbers of people living in extreme poverty.

And finally, the world must accept the exceptionalism of AIDS. There simply is no precedent in history for this crisis. And please, let's not have an illusion that in a few years the world will return to what it was before AIDS. It's simply not possible.

Friends, in short, AIDS has rewritten the rules. To prevail, we too, we must rewrite the rules. And an exceptional threat demands exceptional action, be it on financing, development, be it on trade rules, activist strategies, public service delivery, or fiscal ceilings. So let's now design these longer-term strategies, as otherwise we risk discouragement and demobilization and we will achieve out the best results, temporary results only. Therefore, addressing AIDS in the long term will require even more of the best brains, of the most creative entrepreneurs, of the most determined leaders. And I'm committed with UNAIDS to tackle this agenda with you.

Above all, every community needs to rewrite the rules of how it deals with those sensitive issues at the heart of this epidemic. Sexuality, homosexuality, commercial sex, drug use, rape, gender, masculinity. We heard it so many times. But some of the greatest challenges we face today are of our own making. The obstructions of bureaucracy, which I find even in NGOs. The injustice of stigma, the rivalry, the lack of coherence, and the failure of political leadership. There is no time to be divided by institutional agendas. We all have the same goals and we much work together each playing to our individual strengths. And today I reiterate my own commitment and that of the whole UNAIDS family to doing so.

Friends, let's not forget that all the tools to change the course of this epidemic are in our hands, as Graca Machal said. But are we really willing to change our institutional behaviors as much as our personal behaviors? Are we ready to radically take on these challenges, to leave our flags behind? Every person in this room will provide part of that answer. But what I know is that if we are not willing, we will massively fail. Isn't it after all one of the main lessons of the past 20 years that with AIDS we never gain time when we wait for action, when we are indecisive, when we are divided, when we neglect rights, when we replace science by feel-good projects? We fought hard for the money, very hard for the money, and we will continue to fight for more, but now let's fight equally hard for making the money work for people. Thank you very much.

Peter Piot, M.D., is executive director of UNAIDS. makes every effort to ensure the accuracy of written transcripts, but due to the nature of transcribing recorded material and the deadlines involved, they may contain errors or incomplete content. We apologize for any inaccuracies.

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This article was provided by Henry J. Kaiser Family Foundation. Visit the Kaiser Family Foundation's website to find out more about their activities, publications and services.
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