VI. Challenges for an Expanded Response: The Way Forward
February 16, 2001
Action by Governments should focus on the following seven critical challenges for the present response:
In responding to the HIV/AIDS epidemic, the special session of the General Assembly on HIV/AIDS provides a unique opportunity to set out a global agenda and create consensus around a set of core commitments. These are described in greater detail in a conference room paper that will be issued to complement the present report.
Leadership and CoordinationThe AIDS epidemic has been described as a crisis of governance and a crisis of leadership. Leadership is fundamental to an effective response. One of the key issues facing the global community is the development and sustenance of such dedicated leadership, which is vital if the nature of the epidemic is to be clearly understood throughout society and a national response mobilized. Such an understanding is essential in order to avoid stigma, secure the full commitment, involvement and accountability of all sectors, and avoid fragmentation of efforts.
Only through a society-wide commitment, within a framework established by strong political leadership that involves community-led interventions as well as civil society and effective partnerships with the private sector, can a response emerge that is consistent with the scale of the epidemic.
Alleviating the Social and Economic ImpactThe broad spread of the impact underlines the need for a broad multisectoral response that addresses both institutional capacity and human resources. In many countries, the epidemic has substantially undermined the capacity of the key social and economic sectors in society. The negative impact of HIV/AIDS is evident in the labor force, the education sector, the health sector and agriculture, to name but a few. Economic performance in all its dimensions is affected. Each sector needs support in order to become a stronger partner in the coordinated response to the epidemic. Assistance for poverty alleviation, infrastructure development, and education- and health-sector development needs to take into account the sectoral impact of the epidemic.
Reducing VulnerabilityResponding to the epidemic therefore requires effective measures to support risk reduction and reduce social and economic vulnerability. Social, economic and political intervention strategies that systematically promote social inclusion and greater participation, by extending access to information and essential services and supportive legal and social norms, can serve to reduce vulnerability and help overcome the impact of the epidemic.
PreventionAn expanded prevention effort is vital to containing the spread of the epidemic and to restraining the costs of responding to it.
A focus on prevention is essential to significantly reduce the spread of the epidemic and the current impact. A focus on youth is needed to reduce impact in the future. Over 30 per cent of people currently living with HIV/AIDS are young people aged under 25. Targets for prevention encompass preventive methods, such as expansion of health and sex education, increased supply of female and male condoms and other commodities, expanded provisions for preventing mother-to-child transmission, measures aimed at prevention among injecting drug users, and greater access to voluntary counselling and testing.
Care and SupportPreventing HIV infection is inseparable from care and support for those affected by HIV/AIDS. Prevention of infection and amelioration of the impact of the epidemic go hand in hand.
Governments must commit themselves to ensuring health care and support to those infected and affected by HIV/AIDS. The challenge is to provide a broad approach which includes adequate care for individuals, households and communities affected by HIV/AIDS; ensuring access to voluntary counselling and testing and the continuum of affordable clinical and home-based care and treatment; essential legal, education and social services; psycho-social support and counselling; and care for children orphaned by HIV/AIDS. The capacity of health systems and social services to deliver the required interventions must be ensured.
Through advances in the management of opportunistic infections and the development of effective antiretroviral therapies, the treatment of HIV has reduced its social and economic impact. Access to these treatments is uneven, however, and people in developing countries are dying needlessly for lack of appropriate care. Continuing inequities in access to effective care and treatment must be specifically addressed through all possible means, including tiered pricing, competition between suppliers, regional procurement, licensing agreements and the effective use of the health safeguards in trade agreements.
International Public GoodsA focus of international research and development should be to produce microbicides and vaccines for HIV/AIDS. Either by using current knowledge more effectively or focusing on key unresolved problems, global and national players should act in partnership to ensure that priority is given to researching and developing new HIV medicines and to making them accessible and affordable. Efforts should also be made to develop and market female-controlled contraceptives.
ResourcesThe primary challenge for Governments is to mobilize resources to meet the scale and devastating impact of the HIV/AIDS epidemic. Greatly increased resources are needed to expand the national capacity to respond to the epidemic; to support essential infrastructure and training; to mitigate the social and economic impacts; to expand successful prevention interventions; and to implement a broad care agenda, including access to drugs. One important way of ensuring that national budgets are reallocated towards HIV prevention is to make sure that HIV/AIDS priorities are properly integrated into the mainstream of development planning, including poverty reduction strategies, public investment plans and annual budget processes. Increased investment from donors, domestic budgets and private companies and foundations will need to be added to additional funds released through debt relief to meet global resource needs.
Thus, meeting the challenges of HIV/AIDS requires a combination of approaches: strengthening leadership, alleviating the social and economic impacts of the epidemic, reducing vulnerability, intensifying prevention, increasing care and support, providing international public goods and scaling up resources.
HIV/AIDS is the most formidable development challenge of our time. The General Assembly, in calling for a special session on HIV/AIDS, has recognized this, and at the special session will aim to secure a global commitment for intensified and coordinated action at the global and national levels.
This article was provided by UNAIDS. It is a part of the publication Review of the Problem of HIV in All Its Aspects. Visit UNAIDS' website to find out more about their activities, publications and services.