World AIDS Experts Call for Urgent Action, Say Leaders Must Demonstrate Financial and Political Commitment

Mont Pelerin, Switzerland -- Some 30 world class experts on AIDS have met with the Joint United Nations Programme on HIV/AIDS (UNAIDS) in an effort to help shape the next phase of the global response to the epidemic. The high-level private meeting in advance of the United Nations General Assembly Special Session on AIDS sought to clarify global goals and targets under discussion by UN member states and to set priorities in defining how to deal with AIDS.

"There has never been a more important opportunity for concerted world action against the HIV epidemic," said Gordon Perkin, Director of the Global Health Program at the Bill and Melinda Gates Foundation. "There is an urgent need for a massive increase in access to proven prevention and care tools."

The call for urgent action comes at a time when antiretroviral drugs are becoming more affordable in the wake of commitments made recently by some of the world's major pharmaceutical companies.

While calling for antiretroviral therapy to be made as widely available as possible, the expert group warned against unmonitored or careless use. "Antiretroviral therapy is an integral part of the response to AIDS, so we must strengthen health systems in the poorest countries to make it accessible," said Stefano Vella, President of the International AIDS Society, "Antiretroviral therapy must be applied with care and consideration. Without careful use it can do more harm than good, as the therapy rapidly loses its effectiveness if the virus becomes drug-resistant."

The group also called for urgent action by the world's leaders to commit both the financial resources and the political will to bring the AIDS epidemic under control. The experts reviewed statistics on the costs of the epidemic and endorsed the US$ 7-10 billion figure estimated to be needed to mount an effective response to AIDS in developing countries. According to the expert group, investment now would prevent tens of millions of new infections while extending the lives of additional millions of people already living with HIV.

"The world does not need to make a choice as to whether to care for AIDS patients or prevent the spread of HIV," said Dr Peter Piot, Executive Director of UNAIDS. "The two are complementary and work in tandem -- this is not an either/or situation."

The expert group was convened by UNAIDS, the International AIDS Society, and the Bill and Melinda Gates Foundation, and met with the UNAIDS Cosponsors -- UNICEF, UNDP, UNFPA, UNDCP, UNESCO, WHO and the World Bank -- government representatives, and medical, behavioural and policy experts worldwide.

At the close of the meeting, the experts issued a declaration calling on leaders to take advantage of the UN Special Session on AIDS in New York from 25-27 June to mobilize funds and commitment to halt the spread of the epidemic.

"AIDS is a crisis of unprecedented proportions," the declaration warned. "It is the most devastating pandemic in human history. But the world is not powerless to respond. We now have an historic opportunity to commit the political will and the billions of dollars required to change the course of the epidemic."

AIDS: The Time to Act

A statement issued by an expert group convened by UNAIDS, The International AIDS Society and the Bill and Melinda Gates Foundation*

AIDS is a crisis of unprecedented proportions. It is the most devastating pandemic in human history. 36 million people around the globe are living with HIV, 22 million men, women and children have died, there are 15,000 new infections every day. If current trends do not change, by 2010, in Africa alone, more than 40 million children will have been orphaned by AIDS.

In the worst affected countries, the epidemic is eroding decades of development gains, undermining economies, threatening security and destabilising societies.

In sub-Saharan Africa, where the epidemic has already had a devastating impact, the worst is yet to come. Overall, the epidemic is in its early and mid stages, particularly in Asia where the majority of world's population lives.

But the world is not powerless to respond. We now have an historic opportunity to commit the political will and the billions of dollars required to change the course of the epidemic. Investment now will prevent tens of millions of new infections and extend the lives of millions already living with HIV.

Over two decades of experience we have developed tools of prevention, treatment and support. Their effectiveness has been shown in many communities, and in diverse national contexts including Brazil, Thailand, Uganda and Senegal.

We have learnt that prevention and care are inextricably linked. Prevention, medical treatment and social support are all critical components of effective responses. Their effectiveness is immeasurably increased when they are used together. They must also meet the unique needs of men and women and address the underlying causes that make some people more vulnerable to HIV than others.

Inexpensive and effective drugs to treat and prevent opportunistic infections exist. They are urgently needed and should be made rapidly available, together with broader care and support, including in the poorest countries.

Where it has been available, antiretroviral therapy has reduced mortality and prolonged healthy lives. Recent reductions in prices create an historic opportunity to extend this benefit across the globe. Antiretroviral therapy can and should be made widely available in all countries. The degree to which poor countries are able to extend access to antiretroviral therapy varies, but in every case a beginning can be made. The poorest countries need donor resources to extend this capacity. In all cases, antiretroviral therapy must be used in a careful and monitored manner, to improve adherence and reduce the risk of resistance.

While the changed global environment has increased attention to the treatment side of the equation, the core strategy of all countries must continue to emphasise widespread and effective prevention, including education, information and condoms. However the scale of this work must be dramatically increased, especially among young people.

Building on existing programmes, many countries, and many of the poorest, have shown political commitment and made detailed preparations and are ready for greatly scaled up treatment and prevention programmes. What they lack are the resources.

In view of the urgent need and opportunity, the recent call to action by Secretary-General and the decision of the UN General Assembly to hold a special session on AIDS, is especially appropriate. We agree the time to act is now.

Based on an analysis of the cost of effective responses, we estimate that global funding for AIDS in middle and low-income countries should rise to not less than $7 billion per year within 5 years. This commitment must be sustained for at least a decade.

At the forthcoming UN General Assembly Special Session on AIDS we call on the world's political leaders to commit the financial resources and the political will to bring this epidemic under control. We call on citizens around the world to lend their support. We will not succeed until leaders in every sector of society come together in a historic global response to this most urgent of crises.

The time to act is now.

* UNAIDS, including its Cosponsoring agencies UNICEF, UNDP, UNFPA, UNDCP, UNESCO, WHO, and the World Bank, convened a meeting together with the International AIDS Society and the Bill and Melinda Gates Foundation, from May 6th-8th at Mont Pèlerin, Switzerland, with the following individuals, at the meeting in their personal capacity as medical, behavioural and policy experts: Professor Peter Aggleton, University of London, UK; Professor Roy Anderson, Imperial College, UK; Dr Stefano Bertozzi, Instituto Nacional de Salud Publica, Mexico; Dr Mabel Bianco, Ministry of Health, Argentina; Rev. Gideon Byamugisha, Church of Uganda; Dr Hoosen M. Coovadia, University of Natal, South Africa; Dr Tim Evans, The Rockefeller Foundation; Dr Margaret Gachara, National AIDS Control Council, Kenya; Dr Duff Gillespie, USAID, USA; Dr J. Edward Greene, Assistant Secretary-General, The Caribbean Community & Common Market; Mr Anand Grover, Lawyers Collective HIV/AIDS Unit, Mumbai/Delhi, India; Mr Moustapha Gueye, African Council of AIDS Service Organisations, Sénégal; Dr Scott M. Hammer, Columbia University, USA; Dr Catherine Hankins, Institut national de santé publique de Quebec & McGill University, Canada; Professor Michel Kazatchkine, Agence Nationale de Recherches sur le SIDA, France; Professor Marie Laga, Institute of Tropical Medicine, Belgium; Ms Marina Mahathir, Malaysian AIDS Council, Malaysia; Dr Purnima Mane, The Population Council; Dr Nancy Padian, University of California San Francisco, USA; Dr Gordon Perkin, Bill & Melinda Gates Foundation; Professor Praphan Phanuphak, Thai Red Cross Society, Thailand; Mr J.V.R. Prasada Rao, Ministry of Health & Family Welfare, India; Professor Jeffrey Sachs, Harvard University, USA; Mr Eric L. Sawyer, HIV/AIDS Human Rights Project, USA; Mr Wojciech Tomczynski, Badz Z Nami, Poland; Ms Sandra Thurman, The International AIDS Trust, Washington D.C., USA; Dr Stefano Vella, President, International AIDS Society; Ms Wendy Wertheimer, National Institutes of Health, USA; Dr Alex Wodak, St Vincent's Hospital, Australia.