Thu, 29 May 2003


Peter Piot Executive Director UNAIDS Geneva

France will soon host the leaders of the G-8, those countries whose global economic power shapes the way the rest of the world lives. Last week, one G-8 member, the United States, substantially increased its commitment and resources devoted to fighting AIDS, recognizing the disease as a significant threat to global development and security. If the rest of the G-8 took similar action, the global outlook on AIDS would be rapidly transformed.

The G-8 meeting in Evian comes at a time when the destinies of the world's citizens are not only interconnected, they are intertwined-potently illustrated by SARS, which is but the latest disease to dog the footsteps of people on the move around the world. But our "global village" is also, paradoxically, more unequal than ever. The gulf between those nations and communities thrust into a downward spiral by the burden of AIDS, and those that have the resources to cope, is one of the clearest indicators of this growing global disparity.

AIDS is preponderant in developing countries and its effects are most devastating among the poor. The financial, technological and institutional capacities to bring AIDS under control, however, are concentrated elsewhere -- in a handful of wealthy countries. The G-8 nations can bridge this gap.

Life-prolonging AIDS treatment exists, and, more importantly, HIV infection is preventable. UNAIDS is involved in coordinating more effective responses to the epidemic in the world's most severely affected countries-yet much more support is needed. On a global scale, AIDS is tightening its grip, claiming more than 3 million lives each year and undermining efforts to achieve developmental progress, economic growth, and social stability. If AIDS is allowed to worsen, all of the world's development goals will be reduced to a pipe dream.

This is not the first time the G-8 has heard this plea. In Okinawa in 2000, world leaders pledged to harness the resources of governments, industry, academia, and NGOs to improve health systems and access to medicines, including vaccines, in poor nations. The G-8 lent momentum to the creation of a new Global Fund to Fight AIDS, Tuberculosis and Malaria, and in Genoa in 2001 gave it their blessing, while at the same time pledging further action to increase access to vital medicines in the poor nations.

At last year's G-8 Summit in Kananaskis, Canada, the leaders adopted an Africa Action Plan, which acknowledged that AIDS "undermine(s) all efforts to promote development in Africa," and which pledged to support the development of health care capacity in Africa through the training of health personnel, support for partnerships with employers to increase AIDS awareness, and support for effective programs for prevention, care, and treatment.

These commitments are important, but what is most important is action on the ground. Since the 2000 G-8 meeting in Okinawa, AIDS has killed some 9 million people.

There has been progress in taking the necessary steps to reduce this toll. Annual spending on HIV/AIDS in developing countries has doubled since the beginning of 2000, reaching almost US$ 3.5 billion in 2002. The strong initial support for the Global Fund to Fight AIDS, TB, and Malaria created a new global funding source -- and it needs additional capacity to continue to pump new funds into AIDS responses, while simultaneously other international and national funding sources themselves increase their effort.

Investments in fighting AIDS are bearing fruit. Even where the AIDS epidemic is most severe, gains are being made. In Cambodia, high-risk behavior has measurably decreased, stabilizing the epidemic. Uganda has experienced steady drops in HIV prevalence. Among one of the nation's hardest hit groups -- young women aged 20 to 24 in the country's urban areas -- HIV prevalence has dropped from more than 33 percent in 1990, to less than 8 percent today. In Addis Ababa, Ethiopia, since 1995 infection levels among pregnant women aged 15-24 have declined from 24 percent to 15 percent.

Developing countries are increasingly leading the way in the struggle for health and development, even in the face of AIDS. They are devising new strategies for fighting poverty, fighting diseases and stoking economic growth, such as the New Partnership for Africa's Development (NEPAD) -- which over the past year has paid increasing attention to countering the impact of AIDS on every facet of development.

But even as they strive to reach those development goals, many poor nations are locked in David and Goliath struggles. Fragile economies, smothering debt burdens, unfair trading environments, weakened public sectors and depleted institutional capacities mean countering an epidemic on the mammoth scale of HIV/AIDS too often eclipses their best efforts.

The G-8 countries can and must level that playing field. They command the financial and technological resources-and the political power-to do so.

A just and equitable system of access to life-saving prevention tools and HIV and other essential medicines must be put in place. The World Trade Organization's Doha Declaration, which affirms countries' right to protect public health and ensure access to medicine for all, pointed towards such an achievement; the subsequent disputes must be settled speedily in a way that advances the right of people everywhere to lead a healthy, dignified life.

New development approaches are required, so that resource- constrained countries can rebuild their public institutions, and achieve sustainable health and education systems. A viable framework for truly global technological collaboration and transfers is needed, as is needs-driven research that will focus sufficient resources and scientific attention on challenges such as the development of microbicides and vaccines to prevent HIV infection.

Wider and deeper debt relief could free up vast financial resources for development. A fair international trade system would boost countries' abilities to sustain their efforts.

All this is eminently achievable. We know how to prevent HIV infection and how to treat AIDS, and stop its rapid depletion of the human resources of much of the developing world. Doing so may be the most important thing we can do to ease the widening gulfs between rich and poor.