February 16, 2001
In the two decades since it has been with us, the acquired immunodeficiency syndrome (AIDS) epidemic has continued its relentless spread across continents, hitting harder in some places than others but sparing no country. In these two decades, it has become a truly global emergency.
That the world finally recognizes the scale of this crisis is clear in the Millennium Declaration (General Assembly resolution 55/2) adopted by the Millennium Summit of the United Nations, held in September 2000. In the Declaration, the world's leaders committed themselves to halting and beginning to reverse the spread of the human immunodeficiency virus (HIV)/AIDS by 2015; providing special assistance to children orphaned by HIV/AIDS; and helping Africa build up its capacity to tackle the spread of the HIV/AIDS pandemic and other infectious diseases. The decision by the General Assembly to convene a special session to review and address the problem of HIV/AIDS as a matter of urgency followed quickly after the Millennium Summit, and is seen as the first step in the realization of the commitments expressed in the Declaration.
The present report examines the spread of the epidemic and reviews its impacts -- demographic, social, economic and from the standpoint of the security of people and nations. It approaches the epidemic from all levels, recognizing that although a global problem requires a global response, the mobilization of people and communities is also essential. It is at the household and community level, supported by civil society groupings, that open dialogue about norms, values, gender issues, health and sexuality takes place and can have a real impact on people's ability to reduce their vulnerability to infection.
The present report outlines key lessons learned, including successes achieved, since the start of the epidemic: that a greater epidemic can be prevented in future; that capacity and commitment have increased; that cross-sectoral approaches are expanding; that prevention works; that intensified efforts are needed to procure widespread and affordable access to care and treatment; that successful responses have their roots in communities; that empowering young people and women is essential; that people living with HIV or AIDS are central to response; and that the epidemic must be tackled on several fronts -- by addressing risks associated with behaviors and situations, vulnerability to the risk of infection and impact on the lives of individuals and their communities.
The present report assesses the response to the epidemic through the triple lens of leadership, coordination and the need for adequate resources. Leadership -- at the global as well as the country level -- is the single most important factor in reversing the epidemic.
One of the most important leadership challenges is to ensure that the full power and authority of the State is brought to bear on the epidemic, securing the mobilization of all sectors and levels of government, a decentralized implementation of interventions, solid partnerships with non-governmental actors, adequate funding from national budgets, and appropriate resource allocations across sectors and down to the district/municipal levels.
A second factor in the success against HIV/AIDS, both nationally and globally, is improved coordination across all sectors of social and economic planning between Governments, among government and non-governmental partners, and among international and national civil society. At a time when resources and the number of actors intervening against AIDS are increasing, the coordination of efforts becomes even more critical in a strong response. By encouraging the collective approaches and problem-solving that are crucial to a cross-cutting issue like AIDS, coordination can help focus energy and resources on specific goals in order to avoid duplication and enhance cost-effectiveness. In this way, collective approaches and problem-solving add significant weight to what might otherwise be seen as piecemeal solutions. A large-scale synergistic and systematic response is required.
A third critical factor is the need for adequate resources. Worldwide, financial resources allocated to HIV/AIDS, particularly in the most affected regions, is only a fraction given the magnitude of the epidemic. For example, a well-resourced response for prevention and basic care programs in Africa alone would require at least US$ 3 billion a year, not including antiretroviral therapy. Yet only a fraction of this amount is available despite growing evidence of political will and commitment.
These challenges are described in a conference room paper that will be issued to complement the present report.
Considerable success has been achieved in addressing the epidemic in many parts of the world. Declining HIV infection rates in many communities and in some cases across nations, especially among young people, have proven that prevention strategies work. Declining death rates from AIDS in industrialized countries and some developing countries have also demonstrated recent benefits of HIV treatment and that care is effective.
Meeting the challenge 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 increasing 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.