Governance

World Leaders in General Assembly Adopt Political Declaration Pledging Urgent, Transformative Action to Stop Global AIDS Epidemic by 2030

World leaders in the General Assembly today committed to “urgent and transformative action” to end the gender inequalities, restrictive laws and multiple forms of discrimination that perpetuate the global AIDS epidemic, adopting a lengthy Political Declaration that spells out measures to stop the disease in its tracks by 2030.

The text — titled “Political Declaration on HIV and AIDS: Ending Inequalities and Getting on Track to End AIDS by 2030” (document A/75/L.95) — passed by a recorded vote of 165 in favour to 4 against (Belarus, Nicaragua, Russian Federation, Syria), with no abstentions, following charged attempts by the Russian Federation to excise contentious provisions through three proposed amendments, all of which failed by recorded vote under intense scrutiny.

“The end of AIDS is within reach, but urgent action is needed,” world leaders said through the Political Declaration, reaffirming their international resolve to meet that objective. They expressed deep concern that the AIDS epidemic remains a global emergency, committing to reduce new HIV infections to under 370,000 and annual AIDS-related deaths to under 250,000 by 2025. They pledged to end inequalities faced by people living with HIV and reinforce HIV responses through enhanced engagement with a broad range of stakeholders.

In opening remarks, Yana Panfilova, a 23-year-old woman from Ukraine living with HIV, called for radical change. “We are dying from the pandemics of stigma, discrimination and the lack of TRIPs [Trade-Related Aspects of Intellectual Property Rights] flexibilities,” she said, referencing the World Trade Organization (WTO) agreement establishing minimum standards for the regulation of intellectual property.

Speaking for the 38 million people living with HIV, she urged the United States President to make the health technologies and cutting-edge treatments in that country available to everyone, everywhere. All Governments must provide comprehensive sex education in all schools, psychosocial and peer support for all adolescents living with HIV, community-led HIV services and an HIV vaccine. “We demand you step up and finally do your work,” she said.

Driving home that point, Assembly President Volkan Bozkir (Turkey) affirmed that AIDS is an “epidemic of inequalities”. Half of the people newly infected with HIV in 2020 were women and girls. Ending AIDS by 2030 is both a prerequisite for — and a result of — implementing the Sustainable Development Goals. “We must listen to the voices of those affected, the civil society representatives, the health workers and the epidemiologists who have been ringing the alarm,” he said.

Winnie Byanyima, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), agreed. She welcomed the Political Declaration as the basis of renewed global efforts to end a disease that has ravaged communities for over 40 years, fomented by imbalances in power, status, rights and voice.

She advocated for bold shifts — first and foremost to prioritize the best data and evidence, as “science moves at the speed of political will”. She also called for guaranteed health education for everyone, everywhere, and for an end to tax avoidance. Fair debt resolution mechanisms to prevent national debt from undermining efforts to tackle HIV/AIDS will also be important.

“UNAIDS remains at the heart of our efforts to support countries to achieve the Sustainable Development Goals,” said Amina J. Mohammed, Deputy Secretary General of the United Nations. She rallied leaders to garner their political will, stressing that, with strong community engagement, rights-based and multisectoral approaches and consistent use of scientific evidence, the world can end AIDS as a public health threat by 2030.

Throughout the day — during both general debate and vigorous discussion on harm reduction programmes, perceived interference in national legislation and “rights-based” approaches to ending AIDS that preceded the Declaration’s adoption — Heads of State and Government, ministers and other senior officials, predominantly from Africa, cast a spotlight on the most vulnerable. Delegates spoke in a sparsely populated Assembly Hall, with Heads of State and Government delivering their remarks exclusively via webcast, due to COVID-19 restrictions.

The President of Rwanda said that “waiting to respond to HIV in Africa was a mistake, because the virus was spreading, even though it was treatable”, recalling that a decade and countless lives were lost. He cited the need for more investment in health infrastructure, pointing out that national health systems in Africa depended upon to fight COVID-19 were largely built with HIV funding. “It is difficult to find any family in sub-Saharan Africa today that has not lost someone to HIV/AIDS,” added Rwanda’s representative from the General Assembly Hall. African girls aged 15 to 19 are at particular risk of being infected.

In that context, the President of the Democratic Republic of the Congo, speaking on behalf of the African Group, said HIV/AIDS remains one of the most serious public health threats and a leading cause of death in Africa, a point bolstered by the Health Minister of Mozambique, who said that 2.1 million Mozambicans were living with HIV in 2020, including 130,000 children under age 15. While the country reduced new infections by 25 per cent between 2021 and 2020 — driven by a mix of behavioural, biomedical and structural interventions — more must be done to fill gaps in legal protections and safeguard citizens’ rights. The Deputy President of South Africa meanwhile echoed calls to temporarily loosen intellectual property protections, which would enable local production of medical commodities and encourage technology sharing to meet public health objectives.

A few leaders pointed to actions already under way, with the European Commissioner for International Partnerships of the European Union stressing that “Team Europe” has contributed €2.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. She expressed support for strengthening health systems pursuant to the Rome Declaration adopted in May at the Global Health Summit.

“If there was ever a time to remotivate ourselves […] that time is now,” Thailand’s Prime Minister agreed. He called for rapidly scaled-up innovations and expanded coverage, delivered through a user-friendly, rights-backed package of services. Canada’s Minister for International Development vowed that her country will continue to stand up for the rights of key populations. “This is the time for the global community to come together to acknowledge and confront the intersecting inequalities, and other reasons behind why pandemics continue to disproportionately affect those with the least power in our societies,” she said.

Also speaking in the general debate were Heads of State and Government and other senior officials from Burkina Faso, United Republic of Tanzania, Seychelles, Liberia, Central African Republic, Zimbabwe, Sierra Leone, Nigeria, Guyana, Niger, Malawi, Botswana, Namibia, South Sudan, Eswatini, Ireland, Serbia, Indonesia (also on behalf of the Association of Southeast Asian Nations (ASEAN)), Spain, Denmark, Switzerland and Luxembourg.

Also speaking in explanation of position were representatives of Australia, Namibia, United States, Portugal (on behalf of the European Union), Canada, Mexico, South Africa, Cameroon, Equatorial Guinea, Morocco, Algeria, Brazil, Canada, United Kingdom, Bahrain (on behalf of the Gulf Cooperation Council), China, Russian Federation, Japan, Iran, Hungary, Guatemala, Iraq, Belarus, Libya, Egypt, Sudan, Malaysia, Israel, Nicaragua, Bangladesh and Syria, as well as observers for the Holy See and the European Union.

The representative of the Russian Federation introduced three amendments during a point of order.

Charlize Theron, eminent person actively engaged in the response to HIV/AIDS, United Nations Messenger of Peace, and Founder of the Charlize Theron Africa Outreach Project, also delivered opening remarks.

The Assembly will reconvene at 4:30 p.m. on Wednesday, 9 June, to continue the general debate of its high-level meeting on HIV/AIDS.

Opening Remarks

VOLKAN BOZKIR (Turkey), President of the General Assembly, said that, over the next three days, world leaders, decision makers at the highest political levels, those on the front lines of the AIDS response, a diverse range of civil society representatives, academics and young people will convene to review the progress made since 2016. Citing gains made over four decades, he said AIDS related deaths have fallen by 61 per cent since their 2004 peak. And since the Assembly’s 2016 high-level meeting, dozens of countries have met — or exceeded — the targets set out to fast-track the AIDS response.

Yet, the global targets set out five years ago have not been met, he acknowledged, and due to underinvestment, many countries have fallen short. He underscored the tragic reality that the most vulnerable are hardest hit by HIV. “AIDS remains not just a health issue, but a broader development challenge,” he said, adding: “Put simply: AIDS is an epidemic of inequalities.” To end AIDS by 2030, he called for ending inequalities. Ending the disease is both a prerequisite for — and a result of — implementing the Sustainable Development Goals.

Drawing attention to the gender dimension, he said that half of the people newly infected with HIV in 2020 were women and girls. Six out of every seven new HIV infections among people between the ages of 15 and 19 in sub-Saharan Africa are girls, and 6 out of every 7 young women are twice as likely to be living with HIV as young men. Stressing that every girl and woman must be free to exercise their human rights, make their own decisions and live a life free from violence, he said all girls must have equal access to quality education. “If we are to end AIDS, we must end gender inequality,” he said. “We must listen to the voices of those affected, the civil society representatives, the health workers and the epidemiologists who have been ringing the alarm.”

AMINA J. MOHAMMED, Deputy Secretary General of the United Nations, recalled that it has been 40 years since the first cases of AIDS were reported. As that pandemic unfolded, fear, denial, stigma and neglect engulfed societies across the world. Communities on the front lines called for political leadership, while caring for loved ones who were dying. Stressing that the Joint United Nations Programme on HIV/AIDS (UNAIDS) has been a crucial part of the response, marshalling unprecedented global solidarity and catalysing reforms to outdated laws and policies, she said it also showcased the value of “One UN” — a joint programme that unites 11 co-sponsors and with civil society at its heart.

“UNAIDS remains at the heart of our efforts to support countries to achieve the Sustainable Development Goals,” she assured. Among the valuable lessons learned from the HIV response is one about the critical role of civil society. Alongside public systems, community-led responses help build resilient and inclusive systems for health. Without the engagement of civil society, 26 million people would not be on life saving antiretroviral treatment today. At the turn of the millennium, less than 1 per cent of people living with HIV in low and middle income countries had access to antiretrovirals. Thanks to tireless advocacy, prices of HIV medicines dropped dramatically and access to treatment expanded to the global South.

“With political leadership, strong community engagement, rights-based and multisectoral approaches and consistent use of scientific evidence, we can achieve our goal of ending the AIDS epidemic as a public health threat by 2030,” she said. Since the first Declaration of Commitment on HIV/AIDS in 2001, the Political Declarations have been a powerful instrument to secure progress. At the same time, HIV raises issues often considered sensitive or taboo — involving gender, sexuality, identity, exclusion and power. Acute and intersecting inequalities are hindering progress. Women and girls are experiencing violence, while people living with HIV are being marginalized, and even criminalized.

As pandemics thrive in — and widen — social fault lines, she urged States to fully implement the new UNAIDS five-year Global AIDS strategy focused on addressing the inequalities that drive HIV infections and deaths. With global, local structures and strong health systems aligned to achieve the targets in the strategy, the world will dramatically reduce HIV infections and AIDS deaths by 2025. She called for an explicit focus on tackling inequalities, upholding human rights and achieving gender equality, as well as increased domestic and international funding. She closed by hailing the role of communities, people living with an affected by HIV — and the entire HIV movement — for leading the struggle against AIDS and standing up fearlessly for equality.

WINNIE BYANYIMA, Executive Director of UNAIDS, welcomed today’s draft Political Declaration as the basis of renewed global efforts to end a pandemic that has ravaged communities for over 40 years. Noting that the HIV/AIDS crisis is far from over, she declared: “Amid the fallout from the COVID-19 crisis, we could even see a resurgent [HIV] pandemic.” However, such an outcome is not inevitable if the world comes together and moves beyond a business-as-usual approach. The evidence that “inequalities kill” is clear, she stressed, noting that imbalances in power, status, rights and voice are still driving HIV/AIDS infections and deaths.

However, she said, there is reason for hope. The same laws, policies and people-centred health services needed to end HIV/AIDS will also help the world overcome COVID-19, prepare to tackle future pandemics and promote inclusive economic growth around the globe. Advocating for three bold shifts in approach, she said ending inequalities in health outcomes must be prioritized, drawing on the best data and evidence. “Science moves at the speed of political will,” she said, advocating for long-lasting antiretroviral therapies to be made available to women and girls in poor countries first, not years after other countries already have them. Such drugs must be made by multiple producers — including those in the global South — and the current failing rules of intellectual property rights must be reformed to ensure that access to live-saving science “is no longer dependent on the passport you hold”.

Next, she called for guaranteed health education for everyone, everywhere. For many countries, new HIV infections have become rare, and living long and healthy lives with HIV is the norm. However, a widening gap separates those people who have access to treatment and services, and those who remain excluded. “Today, we are setting bold ambitious goals to reach 95 per cent of those in need with HIV prevention and treatment,” she said, calling for reimagined HIV services that are easy to access and designed around people’s lives. All girls must be able to complete a secondary education and have access to reproductive health services and rights. She also called for an end to tax avoidance — which drains domestic resources for crucial health services — and for fair debt crisis resolution mechanisms that will prevent national debts from continuing to undermine national efforts to tackle HIV/AIDS. Finally, she advocated for stronger laws to promote gender equality and end stigma. “We need to keep moving forward in our common journey against harmful, punitive, outdated and often colonial laws,” as well as all forms of discrimination, she stressed.

YANA PANFILOVA, person openly living with HIV, member of GNP+ Global Network of People Living with HIV, said she is a 23-year-old from Ukraine who was born with HIV. While she was born free, bad laws and social stigma put a label on her. She was 10 when she developed AIDS, and like 27 million other people, she took life-saving pills. “This little pill gives us hope,” she said, that treatment is available, that she can live unafraid of transmitting HIV, able to have healthy children — and be alive to see them grow. This is not a reality for people living in isolation and fear.

When she was learned of her HIV status, she wondered why her mother kept this fact a secret, whether she would have to take pills forever. As she grew older, her teacher told her classmates not to talk to people with HIV. “I realized my HIV status was a dark secret for everyone else in my life — but not me,” she said. Doctors would not talk to her because of parental consent laws, so she turned to Google for answers about whether she could safely have sex or what might happen if she stopped taking her pills.

Realizing that millions of adolescents were in the same position, she created “Teenergizer”, the first peer support group for adolescents with HIV in Eastern Europe and Central Asia. She and others took to streets and meeting rooms to get laws and policies changed, fighting for sexual and reproductive health and rights, and comprehensive health and sex education. They lacked funding and experience — and were told that they were “only kids”, while decisions about their lives were being made by adults. Speaking for the 38 million people living with HIV, she said “we are dying from the pandemics of stigma, discrimination and the lack of TRIPs [Trade-Related Aspects of Intellectual Property Rights] flexibilities.”

Against that backdrop, she called on the United States President to make the health technologies, cutting edge treatments and vaccines in the United States available to everyone, everywhere. Urgent attention to resources is needed for those most affected, notably across Eastern Europe and Central Asia. She called for radical change by providing comprehensive sex education in all schools in all countries, psychosocial and peer support for all adolescents living with HIV, community-led HIV services and an HIV vaccine. There are 1 billion young people ready to take the lead, but “we cannot do it alone”, she said. “We demand you step up and finally do your work.”

CHARLIZE THERON, eminent person actively engaged in the response to HIV/AIDS, United Nations Messenger of Peace and Founder of the Charlize Theron Africa Outreach Project, said she is here today for Yana, for young people across her home country of South Africa and around the world. While South Africa and a handful of other countries are on track to end AIDS by 2030, as a global community, “we are still missing the mark”, she said, pointing to inequity as the reason. “Whether you live or die from AIDS is too often determined by who you are, who you love and where you live,” she underscored.

Stressing that vulnerable populations most likely to become HIV positive are least likely to have access to the services they need to survive, she said “that does not happen by accident. That happens by design.” The Outreach Project sees first-hand how gender inequality and gender-based violence fuel the HIV epidemic among young women and girls. Noting that 8 out of 10 teenagers who become HIV positive in Southern Africa are girls, she more broadly drew attention to gender based violence, which not only causes deep physical and emotional damage, but leaves victims much more vulnerable to HIV.

She said transgender people, sex workers, men who have sex with men, people who inject drugs, people in prison, migrants and refugees are also at risk — and prevention programmes that meet their needs must be designed. Most of all, she called for an end to the blaming, shaming and discriminating against people in need. Enabling environments must be created to provide real help and hope. Support should include quality education, as well as sex education, in and out of school. Safe and user-friendly health care must also be offered, with people allowed to make choices about their own bodies, and about their partners. “We must respect and protect the rights of everyone, everywhere,” she insisted, stressing: “We cannot keep prioritizing the people who are politically safe to save.”

The representative in the Russian Federation, in a point of order, said today’s topic is multidimensional and complex. While countries normally work to find mutually acceptable solutions, “something went wrong”. The Russian Federation was one of several countries that conveyed its priorities and concerns during meetings with coordinators before the drafting of the Political Declaration. However, the text that emerged afterwards entirely ignored its proposals. The text did not “stand up” to standards of neutrality and universally accepted terms, and it would be difficult to characterize the approach taken by various delegations as impartial. Previously agreed wording was used when it was acceptable for a select group of countries. Likewise, references to scientific data worked when they corresponded to previously established goals in the text.

Further, he said the text had “barely changed” between the second and third negotiating rounds. Important questions were excluded. The option of postponing action to 10 June to allow for compromise was “clearly not considered at all”. As a result, the current text contains elements that his delegation finds problematic. He proposed three amendments, the first of which would address changes to national legislation, as the current paragraphs contain an attempt to interfere with national legislation, by repealing so-called restrictive laws under the pretext of “combating discrimination”, including laws persecuting prostitution and drug use. There is also a proposal to repeal laws in 92 countries stipulating prosecution for concealing HIV status — yet, nothing is said about how this de-criminalization should apply to unintentional and unwitting transmission of the disease.

Moreover, a passage was introduced on the repeal of age-of-consent laws without clarifying that this refers to access to HIV services, he said, stressing that the Russian Federation’s repeated calls for attention to these aspects were not heeded. He thus proposed the full deletion of paragraphs 1(c), 28, 37, 65(a), and 65(b). The second amendment concerns harm reduction, he said, calling attention to mentions of replacement opioid therapy, which in essence, means “replacing a heroin addiction for a methadone addiction”. References to harm reduction programmes are widespread, however those for treatment programmes that end access to psychotropic substances are missing. The same goes for the Russian Federation’s proposal on family values. The second amendment thus proposes deleting footnote 15 to paragraph 36 and paragraph 60(a).

He said the third amendment focuses on the mandate of UNAIDS, drawing attention to the introductory section of paragraph 70 and to the entire paragraph 70(c), and citing the controversial term of “rights-based approach”, which aims to enshrine a shift in the Agency’s focus, in contravention of resolution 1994/24, under which the Joint Programme was established. He went on to stress that sexual rights are not enshrined in relevant legal instruments. He denounced paragraphs that refer to expanding the unique model of the Agency, ideas led to the creation of an imbalanced UNAIDS strategy in 2021. The third amendment proposes deleting the term “rights-based” from introductory passage of paragraph 70 and deleting paragraph 70(c) entirely.

The representative of the United States asked about the sequence, as the Political Declaration has not yet been presented to the General Assembly.

A representative of the Secretariat, citing Rule 153 of the Assembly’s rules of procedure, said that under terms of resolution “L.95”, the General Assembly would decide to convene a high-level meeting in 2026 and to reach an agreement on the modalities no later than its eightieth session. The adoption of the draft would not entail any programme budget implications, and the date for the high level meeting would be determined with the Department for General Assembly and Conference Management.

The representative of Australia, speaking in explanation of vote, opposed the deletion of paragraphs 1(c), 28, 37, 60(b), 65(a) and 65(b), stressing that reforming laws and policies to ensure that they are grounded in evidence and human rights is essential for an effective HIV/AIDS response. International evidence demonstrates that de-criminalization results in significant health benefits by reducing stigma and supporting access to HIV services. In contrast, punitive laws increase HIV vulnerability and hinder health service delivery. It is not unusual or exceptional for a ministerial declaration to articulate aspirational pledges for legislative reform. While not binding in any way, the aspirational targets set are key components to achieving final goals of such declarations.

In fact, countries took this approach in 2016 when acknowledging that to reach the Sustainable Development Goals, legislation that reinforces stigma and discrimination needed to be reformed, he said. They did so again in adopting the 2030 Agenda for Sustainable Development, committing to the adoption of enforceable legislation to promote gender equality by ending end discriminatory policies and practices. These paragraphs should be understood in the context of the national sovereignty clause, and caveats in these and other paragraphs.

He went on to reject the proposed deletion of footnote 1 to paragraph 36 and of paragraph 60(a), stressing that evidence demonstrates that syringe exchange, naloxone and other services reduce blood borne infections, overdose and death. The footnote to paragraph 36 lists the nine interventions that comprise a comprehensive package of services for the prevention, treatment and care for intravenous drug users. The guidelines are used by the World Health Organization (WHO), United Nations Office on Drugs and Crime (UNODC) and UNAIDS itself. Countries that have scaled up harm reduction, have seen steep declines in HIV incidence.

Australia itself has used harm reduction programmes, including all those listed in the footnote, to virtually stop infections among those who use drugs. It is critically important to maintain these provisions or “we will not end AIDS”. The 2021 Declaration does not mandate their use. Rather, it reflects a compilation of best practice in an evidence-based context. On the proposed deletion of references to “rights based” and all of paragraph 70(c), he said UNAIDS mandate has continued to develop since resolution 1994/24 was adopted.

He went on to stress that Australia and other delegations, including the Russian Federation, are members of UNAIDS Programme Coordinating Board, with the understanding that all its work is based on human rights. He supported inclusion of the term “human rights” as it is agreed language, underscoring that delegations have engaged in an exhaustive process, as mandated by the Assembly President, convened regional consultations, held three full readings of the text, circulated four versions and organized final meetings on 5 June and 7 June. “This has been a full, through and appropriate process,” he assured, and the Declaration was subject to open, transparent and inclusive negotiations among all Member States. It now has the support of an overwhelming majority of Member States.

The representative of Namibia said that, as the Political Declaration’s co facilitators, his delegation and that of Australia sought to draw up a bold text that will get the world back on track to ending AIDS by 2030. The negotiations leading to its drafting were inclusive and conducted in good faith, he said, expressing regret over the representative of the Russian Federation’s assertion that, unless the text addresses each and every one of their concerns it is not adequate. The text before the Assembly today represents a delicate balance in which all delegations have made “huge compromises”, he said, adding that undermining that balance at this late stage represents a departure from the Assembly’s work and the message it is trying to send. “We all know who the real losers will be at the end of the day” should the Political Declaration not be adopted, he stressed, calling on delegations to vote against the proposed amendments.

The representative of the United States described the Russian Federation’s proposed amendments as severe and said they would leave scant or no references at all to key populations. They also question the very core of the UNAIDS mandate and response to the HIV/AIDS epidemic. Requesting a vote on those “hostile amendments” and urging all countries to reject them, she said that, rather than following the science, the global community has long been mired in fights over social issues that left millions around the globe to die. Bold leadership is now needed to end HIV/AIDS by 2030, she said, declaring that “precious time is being wasted by efforts to make the circle fighting the virus smaller”, rather than welcoming the contribution of a broad range of stakeholders.

Stressing that the world is still being held captive to those who question the ways that virus is spread, she said the Political Declaration in its original form two months ago was both strong and evidence-based. However, the text before the Assembly today lacks teeth, having been weakened by a minority of delegations who failed to negotiate in good faith. In particular, the movement of the sovereignty clause to a more prominent place in the document allows countries to fail their populations under the guise of “social context”. Noting that the United States will disassociate itself from paragraph 60(g), she advocated for the rights of women and all people to have freedom of their sexual health and rights. Outdated and ineffective interventions must be dropped and the needs of the most vulnerable populations, including women and girls, must be addressed, she said, adding that the United States will nevertheless vote in favour of the Political Declaration should it be put to a vote.

The representative of Portugal, speaking on behalf of the European Union, echoed the points raised by the representative of Australia regarding the proposed amendments. He expressed regret that consensus on a document aimed to fight HIV/AIDS was broken, and that such a crucial fight has become even more politicized. Noting that the Political Declaration represents a delicate balance, he urged all delegations to vote against the proposed amendments.

The representative of Canada expressed full confidence in the integrity of the process and the inclusivity of the negotiations. While Canada is not fully satisfied with the outcome, the text represents the collective views of Member States, and for that reason, it will support the draft. He encouraged the Russian Federation to withdraw the amendments.

The representative of Mexico said the facilitators worked to balance various differing positions and today’s text reflects an adequate balance, which is why it has Mexico’s support. To the proposed amendment on harm reduction, she said the original text is adequate as wording refers to a crucial aspect in the fight against HIV/AIDS. Mexico will therefore support the draft declaration.

The representative of Rwanda said young people in Africa are the most affected by HIV/AIDS, noting that girls aged 15 to 19 are at real risk of being infected. She called for political will to address this fact. Describing the Political Declaration as a vehicle for delivering political will, she said the lack thereof — for over 10 years — after HIV medicines were readily available in developed countries, allowed these life saving drugs to remain unavailable in Africa. “That has cost millions of lives,” she stressed, adding that it is difficult to find any family in sub Saharan Africa today that has not lost someone to HIV-AIDS. While Rwanda would have wanted to see a stronger, more concise and ambitious declaration, today’s text is the result of a delicate balance. “We cannot afford to fail in terms of political will,” she said, underscoring her country’s support for the text.

The representative of South Africa, noting that the text represents a compromise, said the last-minute amendments hinder the Assembly’s work. Stressing that sub-Saharan Africa is the region worst affected by HIV/AIDS, she said having non-consensual outcome further sets the continent behind. She encouraged delegates to support the consensus document and expressed support for the text.

The representative of Cameroon said that, with HIV/AIDS, just as with COVID 19, “we are facing extremely serious public health problems”. Addressing them requires a unity of views and collective action. The proposed amendments demonstrate that, in the face of a serious problem, there is no unity of views, and the Assembly therefore will not be unified in action. That is the “sad observation” of today, he said, warning: “If we are not careful, we might end up leaving this meeting without a political declaration.” The text contains negative ambiguities. Throughout the negotiations, several countries pursued a “one size fits-all” approach. However, no one can take one colour of a rainbow and make the text that colour. Cameroon will support the Declaration, but will apply it only in accordance with its laws and regulations relating to its historical context, which is in constant flux. “What is good today, might not be good tomorrow,” he explained.

The representative of Equatorial Guinea said that, while the draft Political Declaration “may not make everyone happy”, it is the result of a delicate compromise and significant negotiations and should be adopted.

The representative of Morocco said the negotiations leading to the drafting of the Political Declaration were inclusive and conducted in good faith. Emphasizing the importance of ensuing its consensual adoption, she described the text as a crucial road map for countries as they steer their future efforts to combat HIV/AIDS. “We know that this process was delicate […] to reach what we have today as a compromise text,” she said, urging all delegations to come support it.

The representative of Algeria said all delegations worked tirelessly throughout the negotiation process to ensure that the final draft would be holistic, balanced and address the gaps remaining in global efforts to tackle HIV/AIDS. However, those talks were not easy, divergence remains in national positions, and there are references in the text that Algeria would have preferred to omit. “For the sake of compromise, flexibility and consensus, we should all be looking at the overall balance of the text,” he stressed, noting that Algeria will vote in favour of the draft and urged other delegations to do the same.

Action

The Assembly then rejected the proposed amendment to delete operative paragraphs 1(c), 28, 37, 65(a) and 65(b) by a recorded vote of 116 against to 13 in favour, with 19 abstentions.

It likewise rejected the proposed amendment to delete footnote 15, and operative paragraph 60(a) by a recorded vote of 117 against to 3 in favour (Nicaragua, Russian Federation, Syria), with 28 abstentions.

The Assembly next rejected the proposed amendment to delete the words “rights based” in operative paragraph 70, and to delete operative paragraph 70(c) in its entirety by a recorded vote of 119 against to 5 in favour (Belarus, China, Russian Federation, Syria), with 24 abstentions.

The representative of the Russian Federation said his delegation worked openly on the draft, participated in all formal and informal meetings and “honestly and constructively” worked to achieve a balanced text and adoption by consensus. It made a vast number of concessions — more than those offered in return. Given that many of its concerns remain unaddressed, he requested a vote on the political declaration.

The Assembly then adopted the Political Declaration as contained in “L.95” by a recorded vote of 165 in favour to 4 against (Belarus, Nicaragua, Russian Federation, Syria), with no abstentions.

The representative of Brazil said his country maintains international and national engagement in the enactment of HIV/AIDS prevention and treatment policies. His delegation supported today’s Political Declaration based on the belief that the final document, while not ideal, represents a compromise. Terminology that lacks international consensus will require more efforts to achieve concrete results in 2030. “Each country has its own priorities,” he said, and as such, differentiated responses are required, in accordance with national legislation, to address the AIDS epidemic, while always recognizing human rights.

The representative of Canada said that, as a young gay person growing up in the 1980s, he remembers first hand the fear, stigma and discrimination that many speakers have described today. While he is astounded by the scientific developments in recent decades, he is also astounded by the delta that remains in allowing all people living with HIV around the globe to live full, long healthy lives. Thanking all those involved in the negotiations leading up to the drafting of the Political Declaration, he said that, while “the road ahead is indeed hard […] I am absolutely convinced that it is a matter of will” that will guide efforts going forward.

The representative of the United Kingdom, speaking on behalf of a group of States, welcomed the rejection of the amendments put forward by the Russian Federation, as well as the adoption of the Political Declaration as a whole. The text includes bold new targets in such areas as treatment and human rights, and it includes references to the key populations that comprise most new HIV infections today. Welcoming the inclusion of references to gender equality and sexual and reproductive health, rights and services, he nevertheless voiced regret that the text does not reflect the need for greater ambition on certain issues. To succeed in ending HIV/AIDS, countries will have to go beyond today’s Political Declaration, he said, noting that the challenge is now being further compounded by the COVID-19 pandemic. Responses must be guided by evidence, supported by adequate investments and based on equity, he said, declaring: “We are at a precipice in the global response.”

The representative of Bahrain, speaking on behalf of the Gulf Cooperation Council, underlined the need for renewed multilateral efforts guided by the principles enshrined in the Sustainable Development Goals. Those must always be implemented in line with national priorities and based on specific countries’ cultural and religious values, he said, spotlighting the particular importance of the family.

The representative of China said the international community must send a positive message of unity through the Political Declaration. He expressed regret that the current text does not enjoy consensus and voiced concern about wording around “human rights defenders” and a human rights-based approach, which harms the political authority of the Declaration. As such, China abstained from the voting on relevant paragraphs, he said, stressing that his country has always promoted international cooperation in preventing and treating HIV/AIDS. It is committed to a positive approach and will work with the general membership to achieve success during the high-level meeting.

The representative of the Russian Federation expressed disappointment that the document adopted today contains destructive elements. Its constructive elements include a new international 95-95-95 target and provisions on the eradication of vertical transmission, fighting discrimination and on the importance of conducting campaigns to fight HIV/AIDS. Expressing the Russian Federation’s commitment to that fight through a State strategy covering the years to 2030, and internationally, through its cooperation with UNAIDS, he denounced that HIV/AIDS is being used as a pretext to advance a contentious agenda. He cited the refusal to include references to the promotion of a healthy way of life and family values, which speaks for itself. States have seen concepts like sexual education imposed upon them. Several delegations opposed the inclusion of references on compliance with the United Nations Charter and on the sovereign rights of States. They misused references to scientific data. They also ignored the concept of undetectable transmission, he said, adding that the current wording was not written in accordance with scientific documents. The Russian Federation will cooperate on provisions that are constructive but will not consider those voted upon to be agreed, and therefore, will not be bound by them.

The representative of Japan reiterated the importance of placing HIV/AIDS in context of universal health coverage, and of strengthening the health agenda within the United Nations system. Japan is not convinced of the need to hold a high-level meeting in 2026 when COVID-19 has not subsided. He called for comprehensive coordination, stressing that it is time to integrate efforts in the health arena that have been disbursed by disease and by field. HIV should not be treated as a stand-alone issue. A comprehensive approach to it should be taken in concert with tuberculosis, emerging infectious diseases and other ailments. The aim should be for an all-inclusive approach. Recognizing the importance of a bottom up approach to human security, Japan welcomed the diverse civil society participation in these meetings.

The representative of Iran said aspects of the Political Declaration contradict his country’s rules, cultural background and national development priorities, notably in the epidemiological context. He therefore disassociated from the relevant provisions in the Declaration.

The representative of Hungary voiced her country’s support for efforts to end HIV/AIDS around the globe through evidence-based interventions that target those population most at risk and without discrimination. However, she expressed concerns about singling out specific groups, such as migrants, which could erode broader efforts to leave no one behind. For that reason, she dissociated herself from paragraphs 26, 58 and 60(b) of the Political Declaration.

The representative of Guatemala, noting that her country voted in favour of the Political Declaration, expressed concern about references and interpretations relating to sexual and reproductive rights. Guatemala’s Constitution protects the right to life from the time of conception, and therefore disassociated itself from paragraphs 9, 24, 30 and 60(e), which could be interpreted as support for abortion or abortion services in contravention of her country’s national laws.

The representative of Iraq said his delegation also voted in favour of the Political Declaration in the spirit of compromise, even though some of the references in it are not in line with Iraq’s national position. He disassociated himself from the term “key populations” in paragraphs 25, 28, 58 and 60(b), noting that each country has a sovereign right to define the populations most at risk as they see fit.

The representative of Belarus said her delegation was not able to support the Political Declaration as presented. Expressing concern over the drafting process, she said the negotiations’ participants were “on an unequal footing” and compromise could not be reached on several issues. Despite repeated objections, the concerns of her delegation were not adequately addressed. Emphasizing that paragraph 10 confirms the sovereign rights of Member States as enshrined in the United Nations Charter, she said each country retains the right to determine which specific population groups which it considers as “key”, while taking into account the epidemiological situation on the ground. Strategies that encourage healthy and responsible relations, especially between young people and in the context of the family, should be encouraged. Primary responsibility for the responsibility and upbringing of children lies with their parents. She voiced particular reservations on paragraphs 1(c), 28, 37, 65(a) and 65(b) concerning obligations to reform national legislation; 25 and 60(b) on defining key groups; and 60(g) on the wording of sexual and reproductive rights.

The representative of Libya said her delegation joined consensus, convinced of the Political Declaration’s importance, adding that Libya’s implementation will be done in accordance with national laws and development priorities. She expressed reservations on paragraph 25, disagreeing with the term “key populations” and the related list, which cannot be considered a strategic list for fighting HIV/AIDS. On paragraphs 28, 65(a) and 37, covering screening for sexual partners, sex workers, drug users and age of consent, she said laws covering these issues are prevention laws. They cannot be described as discriminatory laws. Also, the terms sexual and reproductive health and rights cannot be accepted, as these concepts contravene Libya’s national legislation, and she therefore disassociated from them.

The representative of Egypt said all people have equal rights to enjoy highest levels of health care. She expressed concern over controversial notions in the declaration, which could harm international efforts to fight HIV/AIDS. Underscoring the importance of culture, family religion and ethics, as well as the sovereign right to implement provisions in accordance with national development policies and particular cultural characteristics, she said the study encouraging screening does not constitute scientific evidence. Its results therefore cannot be followed. She disassociated herself from paragraphs 25, 29, 36, 37, 38, 60(b) and 63(d).

The representative of Sudan said her delegation voted in favour of the declaration given the importance of ending AIDS by 2030. She disassociated herself from paragraph 6(b) as drafted.

The representative of Malaysia reaffirmed the commitment to “get on track” to end AIDS by 2030. He expressed concern over sensitive terminology in the declaration, which Malaysia finds problematic. He disassociated from the terms “multiple and intersecting forms”, sexual and health rights, and comprehensive sex education, which do not represent internationally agreed consensus language. Malaysia will implement the Political Declaration in accordance with its national laws and development priorities. He welcomed the partnership of non-governmental organizations and civil society in work to end AIDS as a public threat by 2030.

The representative of Israel said her delegation would have preferred a more ambitious Political Declaration, as well as one that could be adopted by consensus.

The representative of Nicaragua said her country has tripled its budget for HIV/AIDS interventions since 2016. Outlining a range of national initiatives to fight the virus, she said there is no discrimination against people living with HIV in Nicaragua. The country believes in the right to life from the moment of conception, and supports the principle of national sovereignty in implementing all global declarations.

The representative of Bangladesh, while underlining the importance of efforts to combat HIV/AIDS, nevertheless voiced reservations to some of the terms mentioned in the Political Declaration, including “multiple intersecting forms of discrimination” and “comprehensive sexual education”. His country cannot support the creation of an enabling environment to promulgate the laws outlined in the Political Declaration, he said.

The representative of Syria took issue with several provisions that contradict national legalization, including the term “key populations”, whose formulation was retained without explanation. Paragraph 60(b), covering sex workers and people injecting drugs, may be interpreted as encouraging sex work and drug use, while paragraph 65(a) is aimed at interfering with national legalization, as is wording on the age of consent for sexual relations. Paragraphs 70 and 70(c) — featuring the controversial term “rights-based approach” — aim to expand the mandate of UNAIDS, in contravention of Assembly resolution 1994/24.

The Permanent Observer of the Holy See voiced regret that the Political Declaration could not adopted by consensus due to its inclusion of controversial language. Warning that the lack of consensus weakens the text’s impact, he said ending HIV/AIDS will not be achieved without addressing the needs of the most vulnerable, including those affected by discrimination, stigma and poverty. However, policies to discourage risk-taking behaviors and encourage responsible and healthy relationships — especially among young people — is also important. The only safe and completely reliable method to completely prevent HIV transmission is abstinence before marriage and mutual fidelity within marriage.

Noting several reservations to the Political Declaration, he said the Holy See views the terms “sexual and reproductive health”, “health services” and “reproductive rights” as applying to a holistic concept of health, and rejects the inclusion of abortion, access to abortion or abortifacients as part of that concept. Reiterating his delegation’s long standing position on family planning services or contraception, he said it also views the term to be grounded in biological differences between males or females, and rejects the idea that gender is socially constructed. Turning to the matter of comprehensive education or information on sexual health, he said the primary responsibility lies with parents in the upbringing of their children and underlined the centrality of the family. The Holy See’s positions are laid out in more detail in its reservations to the 1994 Conference on Population and Development and the 1995 fourth World Conference on Women, as well as their respective follow-up conferences, he said.

The representative of the European Union, in its capacity as observer, said today’s meeting comes at an historic moment, 40 years since the first case of HIV was identified. “Yet, we still have to get the world on track,” she said, noting that the fight is not over, and HIV still claims many lives around the world. Noting that every case that receives care brings new hope, she said negotiations towards drafting the Political Declaration also began with high hopes. However, it is deeply disappointing that consensus could not be reached and that some countries sought to disrupt the process “until its very end”. Describing it as unacceptable that HIV/AIDS responses can fall victim to political games, she said the numerous approaches laid out in the Declaration mirror the knowledge collected in recent decades. Among other things, the high risks of gender-based and intimate partner violence are spotlighted, as are the needs of key populations and their partners, who today account for over 80 per cent of new infections globally. She also voiced disappointment that no agreement could be reached on language reflecting age-appropriate, comprehensive education on a disease that is largely sexually transmitted.

General Debate

FÉLIX ANTOINE TSHILOMBO TSHISEKEDI, President of the Democratic Republic of the Congo, speaking on behalf of the African Group, said the continent’s comprehensive response to the challenges of HIV/AIDS and tuberculosis — as laid out in the 2001 Abuja Declaration — remains relevant today. While significant progress has been made since that time, HIV/AIDS remains one of the most serious threats to public health and one of the leading causes of death in Africa, a situation which has deteriorated further due to humanitarian crises, poverty and socioeconomic challenges aggravated by the COVID-19 pandemic. Calling for dedicated and concerted action, he said the African Union speaks with one voice in the Common African Position to the 2021 Political Declaration on HIV/AIDS, namely in its commitment to end inequalities and “get on the right track” to end AIDS by 2030.

To that end, he said, the African Union put in place a road map focusing on leadership, ownership, governance and accountability; universal and equitable access to prevention, diagnosis, treatment, care and support; sustainable financing of the HIV/AIDS response through domestic resources and the support of partners; community response and the engagement of affected communities; and the promotion of human rights and gender equality. Welcoming the Political Declaration adopted today, he also outlined national efforts by the Democratic Republic of the Congo to respond to HIV/AIDS since 2016. He also spotlighted the crucial need for sustainable financing of the response at a time when the global economy is facing a severe recession linked to the COVID-19 pandemic.

PAUL KAGAME, President of Rwanda, said good progress has been registered since the 2016 adoption of the Political Declaration on HIV/AIDS. Rwanda, like many other countries, has achieved nearly all of the 90-90-90 targets: 90 per cent of people living with HIV know their HIV status; 90 per cent of those who know their status are on treatment, and 90 per cent of people on treatment have suppressed viral loads. The HIV prevalence rate has been stable at 3 per cent since 2005. “But, it is not yet time to celebrate,” he said, welcoming the adoption of a new Political Declaration which is needed to truly end HIV by 2030. Spotlighting several common lessons learned during both the HIV/AIDS and the COVID-19 pandemics, he said the quality and speed of response is still mostly determined by wealth and poverty. “Waiting to respond to HIV in Africa was a mistake, because the virus was spreading, even though it was treatable,” he added, recalling that a decade and countless lives were lost. He also cited the need for more investments in health infrastructure, pointing out that the national health systems that Africa has depended on to fight COVID-19 were largely those built with HIV funding. For example, Rwanda’s National Reference Laboratory — originally build as an HIV lab — has performed thousands of COVID-19 tests per day throughout the pandemic. The world must also seize the moment to increase scientific research collaboration with Africa, and to invest in drug and vaccine manufacturing capacity on our continent, he said.

ROCH MARC CHRISTIAN KABORÉ, President of Burkina Faso, associating himself with the African Group, said now is a crucial time to assess progress made in implementing the 2016 Political Declaration and embark on new plans going forward. He outlined a range of national programmes to combat HIV/AIDS, which are aligned with global strategies, noting that Burkina Faso reduced its infection rate by 13 per cent in recent years. The number of people on antiretroviral therapy increased during the same period. However, such successful efforts are now at risk in the face of escalating terrorism in the region and the impacts of the COVID-19 pandemic. In that regard, he thanked all of Burkina Faso’s technical and financial partners and pleaded with the international community for redoubled support.

SAMIA SULUHU HASSAN, President of the United Republic of Tanzania, said recent decades have seen impressive progress and many gains in fighting HIV/AIDS, which was first identified in the United Republic of Tanzania 38 years ago. AIDS related deaths have steadily declined from their peak in 2010 to a new low in 2020, mother to-child transmission has dropped, and treatment is now much more widely available. However, she said, women continue to bear the disproportionate burden of the disease, accounting for 63 per cent of all those people living with HIV in her country. While COVID-19 has complicated the HIV/AIDS response, and all pandemics should be addressed in their own right, lessons can be learned from the global response to HIV/AIDS and the two epidemics can be tackled in tandem. Emphasizing that States should be able to determine their sovereign right to implement responses in line with their own cultural and legal frameworks, she welcomed the adoption of the Political Declaration and underlined the need for global solidarity.

WAVEL RAMKALAWAN, President of Seychelles, praised his country’s record in HIV/AIDS prevention, treatment and care. “In the face of health and economic hardships, and in the advent of the COVID-19 pandemic, we left no one behind,” he stressed, spotlighting the country’s commitment to the Sustainable Development Goals, the UNAIDS Strategy to end AIDS, the WHO Health Sector Strategy on HIV and its own pledges to its people. “I do not deny, nonetheless, that there is still a lot more for us to do,” he said. Seychelles will continue to address remaining legal and policy barriers, meet required financial commitments, provide resources and make investments where needed. It will also continue to foster greater community empowerment, and above all else, strengthen respect for human rights by ensuring that HIV/AIDS services remain free and all people have access to them. Turning to the impacts of the COVID-19 pandemic — which “has shown the world just how fragile health gains are” — he said progress can quickly erode when the availability of services, access to them and their continuity are at risk. “Countries and leaders must rise to the occasion,” he said, calling for them to innovate, fund opportunities, embrace data and inspire hope.

GEORGE WEAH, President of Liberia, said that, while the world is preoccupied with COVID-19, efforts must also remain steady to address HIV/AIDS. Aligning himself with the Common Africa Position on HIV/AIDS, he outlined national efforts, gains and challenges. Effective Government policies developed and implemented with assistance and guidance from key international stakeholders have strongly focused on community mobilization. Despite incremental progress, however, Liberia has still been unable to effectively eradicate the disease. At the same time, improved HIV testing has doubled the number of people who know their status, and tests are now required for pregnant women and couples intending to formalize their civil unions. People who test positive are immediately counselled and placed on a course of treatment. However, COVID-19 has placed enormous pressure on various economies and health systems, consequently affecting HIV response mechanisms. Even with great effort and the strong political will on the part of its leaders, Africa remains the most affected continent and is off track in its goal to end AIDS by 2030, partly due to lack of access services, stigma and discrimination, gender inequalities and gender-based violence. Today’s meeting must be the springboard for a decade of action to reduce inequalities and root out socioeconomic and cultural barriers that fuel the spread of HIV, and it is important and imperative that words are matched with practical actions.

FAUSTIN-ARCHANGE TOUADÉRA, President of the Central African Republic, said the country’s progress in tackling AIDS is a demonstration of his holistic approach to valuing the whole human being. The Central African Republic’s fight against HIV is part of a comprehensive package of measures that includes access to education and gender equality. However, progress is being hamstrung by recurrent violence, attacks against humanitarian workers and gender-based violence, he said, calling for redoubled international efforts to curb the root causes, whether internal or external, of the conflicts hindering the health of the population. He also called for breaking down barriers, notably around pharmaceutical patents, to reposition the fight against HIV at the heart of a new global order based on equality and equity.

EMMERSON DAMBUDZO MNANGAGWA, President of Zimbabwe, said the Secretary General’s report exposes glaring inequalities in today’s world, which have only been worsened by the ongoing impact of the COVID-19 pandemic. The HIV/AIDS epidemic has negatively impacted global economies, livelihoods of communities and individual households alike. “Together with COVID-19, the two challenges give us reason to strengthen multilateralism, solidarity and cooperation,” he said, calling for renewed efforts to match bold, ambitious and achievable global targets with the requisite funding. Zimbabwe has finalized its National Strategic Plan for 2021-2025, which focuses on investments in areas such as health and social protection among others, while also seeking to protect the gains achieved so far. The country achieved the 2020 targets of 90-90-90, and recorded a 44 per cent decline in new infections between 2010 and 2019. “It is our hope that the ambitious and bold new goals espoused by the Political Declaration we are adopting will guide us and serve as a reference as we continue the fight against AIDS,” he said, also calling for a broader recommitment to multilateralism in the face of the reality laid bare by COVID-19.

JULIUS MAADA BIO, President of Sierra Leone, said the global response to HIV/AIDS over the last three decades largely reduced AIDS-related deaths and prevented new infections. More community engagement, greater use of innovative technology and the introduction of new medications have contributed to that progress. However, most countries have missed the 2020 Global 90-90-90 fast track prevention and treatment targets, and the COVID-19 pandemic has deepened inequalities and reversed economic progress in many countries. Women, girls and vulnerable key population groups continue to suffer sexual and gender-based violence and human rights violations that increase their vulnerability to HIV/AIDS. “Addressing those gender and structural inequalities within the context of human capital development is therefore critical,” he stressed. Describing Sierra Leone’s response to those challenges, he said it has strengthened sexual offence laws, fast-tracked prosecution and established one-stop centres for rape. Water, sanitation and hygiene interventions, comprehensive sexuality education and a reverse on the ban against pregnant girls in school have all contributed to higher retention and school completion rates for girls. Nevertheless, more predictable investments are needed to avoid reversing the progress made, he said.

MUHAMMADU BUHARI, President of Nigeria, said an evidence-driven political agenda on AIDS aims at addressing and ending the disease as a public health threat by 2030. The results of the largest AIDS indicator and impact survey in 2018 turned Nigeria into a data-rich country, enabling it to set realistic targets and identify those who were not being reached with the necessary services. Citing other gains, he said Nigeria and its partners enrolled almost 1.5 million Nigerians for life-saving HIV treatment. In addition, he said he personally granted an exceptional waiver for the use of competitive international tender facilities to procure antiretroviral medicines at more than 30 per cent cost efficiency, enabling more people to receive life-saving treatment with the same budget. The Government is fully committed to the Sustainable Development Goals and other international and regional initiatives towards eliminating HIV/AIDs in Africa and the world by 2030 and will continue to work with Heads of State and Governments across the continent to ensure sustained high-level political engagement in achieving these objectives. Reiterating Nigeria’s full support for a clear and ambitious Common African Position and new Political Declaration that can help to reduce the public health threat of HIV and strengthen resiliency to end AIDS, he said the Government is committed to urgently translating all new and agreed political declarations into country action as a means of decisively addressing the HIV epidemic in the African region.

MOHAMED IRFAAN ALI, President of Guyana, recalled that when his country launched its HIV National Strategic Plan 2021-2025, it recommitted itself to the UNAIDS Global AIDS Strategy and the goal of ending AIDS by 2030. Guyana’s HIV programme results are among the best in the Caribbean, with a total of 95 per cent of those living with HIV having been diagnosed. Seventy-three per cent who are aware of their HIV status are in treatment and nearly 9 out of every 10 of these are virally suppressed. Guyana has also cut its new HIV infections by more than half in the last 20 years, and came close to — but missed — the United Nations 90 90 90 targets by 2020. The country is now committed to reaching the new UNAIDS global goal of 95-95-95. Spotlighting the Government’s comprehensive Pre-Exposure Prophylaxis programme, which ensures that anyone at risk of HIV infection can access the programme, he said another innovative focus is on an increase in self-testing. Guyana is also making discrimination based on HIV status unacceptable, illegal and punishable; reaching out to vulnerable groups such as lesbian, gay, bisexual, transgender and intersex (LGBTI) people, sex workers and immigrants; integrating metal health services into HIV policies and programmes; and transforming its current paper-based HIV monitoring system into an information technology-based system, he said.

MOHAMED BAZOUM, President of Niger, said HIV and AIDS has dealt humanity with a socioeconomic blow, noting that people living with the virus continue to suffer discrimination. As such, Niger has aligned its approach with the UNAIDS seeking to combat stigma. Its infection rate has remained low and stabilized with 0.4 per cent prevalence. There has been a constant decline in the number of deaths from 4,000 in 2012 and 973 in 2020. Noting that 65 per cent of the population was treated with antiretrovirals in 2020, Government efforts involved civil society and persons living with HIV. Niger provides early screening for children and services to measure their viral load. To end HIV by 2030, testing and treatment for children under age 5, support for pregnant women, efforts to fight mother-to-child transmission are among the challenges to address.

LAZARUS MCARTHY CHAKWERA, President of Malawi, said his country has made unprecedented progress in the implementation of the 2016 Political Declaration in terms of treatment for men, women and children by meeting the 90-90-90 targets with current overall results on treatment at 92, 95 and 94 per cent, respectively. On the other hand, Malawi did not meet its target for reducing new HIV infections and continues to face challenges to smoothly eliminate HIV as a public health threat by 2030. Its willingness to increase domestic resources has been significantly affected by the structural challenges deepened by the COVID-19 pandemic. The 2021 Political Declaration will set new and ambitious targets to accelerate efforts towards ending AIDS as a public health problem, he stressed.

SLUMBER TSOGWANE, Vice President of Botswana, said his country has demonstrated a high level of political commitment to ending AIDS by 2030. Among other things, the First Lady has been appointed Special Ambassador of UNAIDS for the empowerment and engagement of young people, in order to champion the agenda on Adolescent Girls and Young Women, Gender Based Violence, Sexual and Reproductive Health and Rights, and economic empowerment of young people. Citing commendable progress in Botswana to combat the virus — with an estimated 95 per cent coverage of HIV-positive pregnant women on antiretroviral treatment — he said the country has also surpassed the 90-90-90 fast-track targets. However, it is missing its target of reaching epidemic control by reducing new infections by 75 per cent from 2010. New infections in Botswana have declined by 37 per cent and AIDS deaths by 22 per cent since that year, but adolescents and young people — especially girls and young women — continue to bear the burden of HIV infections. Outlining the National Comprehensive Plan to Remove Human Rights Related Barriers to Accessing HIV and Tuberculosis Services, he echoed other speakers in noting that the COVID-19 pandemic has adversely affected HIV services with disruptions in condoms distribution, HIV testing, voluntary medical male circumcision and sexual and reproductive health services.

DAVID MABUZA, Deputy President of South Africa, said women and girls continue to be disproportionately affected by the burden of HIV/AIDS, especially adolescent girls and young women between the ages of 15 and 24. “This calls on us to address inequalities that hinder progress towards ending AIDS,” he stressed, noting that his country continues to advance a multisectoral response that is grounded on human rights principles and equal access. That includes scaling up the economic empowerment of young women and girls, and ensuring that they have access to sexual and reproductive health services, as well as comprehensive sexuality education that is free of stigma and discrimination. Notwithstanding prevailing challenges, South Africa has made significant strides in responding to the HIV/AIDS epidemic. It has the largest treatment programme in the world, with 5 million people currently on antiretroviral therapy. Expressing concern that progress towards reducing new HIV infections remains insufficient, he advocated for a combination of prevention and response initiatives and efforts around the globe to ensure that COVID-19 does not reverse achievements made in responding to HIV/AIDS and other epidemics. In that regard, he reiterated his call for flexibility in Trade-Related Aspects of Intellectual Property Rights rules to enable the local production of medical commodities and encouraged technology-sharing mechanisms to meet public health objectives.

NANGOLO MBUMBA, Vice-President of Namibia, aligning himself with the Southern African Development Community (SADC) and the African Group, said that while the scope of HIV treatment has never been greater “a plethora of challenges remain”. At the global level, advancements in science and technology have been leveraged to improve prevention and treatment options across the HIV care continuum. Progress has been remarkable, but regrettably highly unequal, including in the area of new HIV infections. Too many vulnerable people left behind remains a serious concern. Additionally, stigma and discrimination, together with other social inequalities and exclusion, remain key barriers. “The progress made is fragile and at risk of being reversed if we do not renew our commitment and accelerate action,” he said. Agreeing with other speakers that young women and adolescent girls in Africa are still disproportionately affected, he called for scaled-up efforts to address the structural factors that increase their vulnerability to new HIV infections. Investments are also needed in community interventions to prevent new infections and address gender inequalities. Outlining a range of national efforts and progress made, he said Namibia has reduced its adult HIV incidence rate and achieved viral load suppression in more than 73 per cent of people living with HIV.

JAMES WANI IGGA, Vice President of South Sudan, said that, while his country has made progress in the treatment and prevention of mother-to-child transmission of HIV and seen some reduction in AIDS-related deaths, the global AIDS response has yet to meet the targets the international community established in 2016. In countries¬ like South Sudan — that are facing frequent humanitarian crises including protracted conflict, food insecurity and the negative effects of climate change, health services are depleted, communities are isolated and vulnerabilities are increased, particularly among refugees and internally displaced persons. As fragile health systems struggle to provide HIV services, countries will not be able to meet the goal of ending AIDS as a threat to public health by 2030 without adequate support and investment. Equal access to HIV services must be ensured for all, which requires the deliberate identification of communities and groups that have been left behind. Noting the constraints that the COVID-19 pandemic has placed on the global AIDS response, he stressed that the international community cannot afford a reversal of gains made so far.

PRAYUT CHAN-O-CHA, Prime Minister of Thailand, said world leaders have gathered today to agree to a new road map for ending HIV by 2030. The landscape has shifted dramatically, as COVID-19 has upended economies and set back gains in the HIV response. People living with HIV and AIDS have become more vulnerable. “If there was a time to remotivate ourselves…that time is now,” he said, calling for rapidly scaled up innovation and expanded coverage, delivering services based on new technology, and offering user-friendly and a rights-backed package of services available to all in need, especially young people and key populations. Universal health coverage is particularly important as it would integrate HIV services, sexually transmitted disease diagnosis and treatment, and harm reduction programmes. “We want people to know their HIV status quickly,” he said, and to access services early. He also called for strong political will in taking a whole-of society approach to ending stigma. Community engagement is critical to advancing an effective response, he said, adding that Thailand will chair the UNAIDS Programme Coordinating Board in 2021.

THEMBA N. MASUKU, Acting Prime Minister of Eswatini, said his country has turned the tide against the pandemic and changed the devastating impact of HIV and AIDS into one of success and survival. Ninety-eight per cent of people living with HIV and AIDS in the country are now on antiretroviral treatment, he said, thanking international partners for their support. Outlining a range of priority programmes — which are guided by human rights and gender-based considerations, as well as the need to ensure that public health service delivery is accessible to all free of discrimination — he said Eswatini has not only met, but surpassed, the 95-95-95 global target. It has also cut in half the number of new HIV infections. Concluding, he noted that the rise of new epidemics, especially COVID-19, poses a threat not only to his country but to the entire global community.

MICHEÁL MARTIN, Taoiseach of Ireland, said the world needs to work collaboratively in its response to COVID-19 just as it is doing to deepen its response to HIV/AIDS. That means continued investment in the public health infrastructures, aimed at ensuring that public health systems everywhere will be ready for future pandemics. Noting that tackling HIV is a long standing priority for Ireland, he recalled that he served as Minister for Health in 2000 when Ireland established a dedicated HIV/AIDS unit within the Irish Aid programme, and when it partnered with UNAIDS a year later. In 2021, Ireland will contribute to an investment of over €100 million in support to global health, including addressing HIV/AIDS. Progress over recent decades has not been equal, and even within countries, some people receive better care than others. “I am optimistic, however, that we can turn the corner on this pandemic, and meet the target we set for ourselves in the Sustainable Development Goals of ending AIDS as a public health threat,” he said, pledging that Ireland will contribute actively to that process. COVID-19 revealed that no one is safe until everyone is safe, and the same is true for HIV. “We must tackle the underlying drivers of this disease,” he stressed, calling for efforts to put human rights and gender equality at the centre of responses and end violence, stigma and discrimination.

ANA BRNABIC, Prime Minister of Serbia, recalled the immense threat that AIDS posed to public health in the mid-1980s and early-1990s and said that, while the once-lethal disease is now manageable, that epidemic is reminiscent of the current battle against COVID-19. She expressed hope that, similar to the fight with AIDS, science will again give the world the ability to control the virus and save lives. Turning to domestic efforts to combat AIDS, she said that only 0.88 per 100,000 people in Serbia are infected with the virus and 1,852 of the 2,562 people living with AIDS are being treated with modern therapy. Serbia’s success against AIDS is the result of huge efforts by all stakeholders, across Government, public health and non-governmental organization sectors. She added that, while HIV might be under control in Serbia, there is still work to be done; namely, early diagnosis must be prioritized.

VU DUC DAM, Deputy Prime Minister of Viet Nam, said his country has maintained strong political commitment to the HIV response over the years, noting most countries have not achieved the 90-90-90 targets. “We have to accelerate our actions,” he said, underscoring the importance of ensuring sufficient resources for the HIV and AIDS response, non-disruptive supply of antiretrovirals and accelerating the development of HIV vaccines and cure medicines. For its part, Viet Nam has made good use of international support for the sustainable financing of the national HIV/AIDS response, he said, allowing it to surpass the “third 90 target”. It is important for people to learn their HIV status faster. To achieve the 90-90-90 and the 95-95-95 targets, “we need to have 100 100 100 per cent commitment, and even more”, he said.

JUTTA URPILAINEN, European Commissioner for International Partnerships of the European Union, said the global AIDS response should focus on gender inequality and put people and community-led initiatives first. Further, stigma and discrimination must be ended. For its part, Team Europe has contributed €2.6 billion to the Global Fund to Fight AIDS, Tuberculosis and Malaria. She also expressed support for strengthening health systems pursuant to the Rome Declaration adopted at the Global Health Summit and hope that the international community can collectively end the HIV/AIDS epidemic by 2030.

BUDI GUNADI SADIKIN, Minister of Health of Indonesia, speaking on behalf of the Association of Southeast Asian Nations (ASEAN), said progress on ending HIV in the region has been uneven, due in part to inequalities embedded within societies. As such, he welcomed the 2021-2026 strategy to end inequality — and AIDS — which provides guidance for re-energizing strategies in accordance with national legislation. “Getting back on track” requires commitment to ensure equitable access, meaning that Governments must accept innovations, address co-infections — such as tuberculosis — strengthen people-centred services, community-based initiatives for screening and self-testing, and improve the security of commodities. Efforts also must involve breaking down barriers, which requires better policies that consider religious and cultural aspects. Equitable access must be ensured by taking leadership, he stressed.

Speaking in his national capacity, he expressed Indonesia’s commitment to end the “forgotten pandemic” of HIV and AIDS by ensuring equal access to therapeutics and other services and products. Efforts to combat COVID-19 through wavers of certain therapeutics and diagnostics is a signal of solidarity, he explained, urging Governments to ensure waivers for certain intellectual property rights as a reflection of common efforts to end the forgotten pandemic.

DANIEL TIAGO, Minister for Health of Mozambique, said HIV/AIDS remains a national emergency even amid the COVID-19 pandemic and Mozambique remains the country with the second-highest record of new HIV infections in the Southern African Development Community (SADC) region. An estimated 2.1 million Mozambicans were living with HIV in 2020, including 130,000 children under age 15. Citing several major strides made in recent years, he said the country reduced the rate of new infections by 25 per cent and the number of AIDS related deaths from 34 to 14 per cent between 2021 and 2020. Various national initiatives spearheaded those reductions, including a mix of behavioural, biomedical and structural interventions focused on vulnerable populations. Mozambique also made progress in areas related to care and treatment and in efforts to fight stigma and discrimination, especially by filling gaps in legal protections and safeguarding citizens’ fundamental rights. However, much remains to be done, and the country stands committed to mobilizing all stakeholders in support of the new Political Declaration, he said.

KARINA GOULD, Minister for International Development of Canada, vowed that her country will continue to stand up for the rights of key populations and other groups disproportionately affected by HIV. “We will not put an end to HIV until we address the intersecting inequalities, stigma and discrimination that fuel this epidemic,” she stressed, calling for the active involvement of people living with HIV, of men who have sex with men, people who use drugs, sex workers, transgender people, people in correctional facilities and indigenous populations in all aspects of the response. The global community should continue to scale up prevention initiatives, in particular by empowering adolescent girls and young women whose disproportionate risk of new infection requires urgent action. Noting that four decades of research and data have underpinned and enabled some of the world’s most successful responses during the COVID-19 pandemic, she said the latter has proven that it is feasible to respond quickly and globally to health crises. However, COVID-19 has also regrettably reversed some important progress made in fighting HIV/AIDS and reducing inequalities. “This is the time for the global community to come together to acknowledge and confront the intersecting inequalities, and other reasons behind why pandemics continue to disproportionately affect those with the least power in our societies,” she said.

CAROLINA DARIAS SAN SEBASTIAN, Minister for Health of Spain, said her country has worked to improve financing for antiretrovirals, as well as post- and pre-exposure prophylaxis. The Government is combining those programmes with others focused on condoms and testing to prevent new infections. Explaining that it is also working to achieve the 95-95-95 targets and zero discrimination, she said Spain has also prohibited the exclusion of older persons living with HIV from shared homes. “We wish to put an end to this epidemic in 2030,” he stressed, pointing to Spain’s projects and involvement in global cooperation to that end.

FLEMMING MOLLER MORTENSEN, Minister for Development Cooperation of Denmark, noting that 700,000 people die annually from AIDS-related illnesses, expressed regret that — five years after the last high-level meeting on this issue — none of the international community’s goals for preventing the spread of HIV/AIDS have been met as the virus continues to devastate regions and communities. He stressed that the fight against AIDS will not be won without a strong commitment to human rights and dignity and ensured access to affordable, high-quality HIV services. Further, young people must be empowered to protect themselves through comprehensive sexual education. Adding that some groups are more vulnerable than others — including young people, LGBTI individuals, sex workers, drug users and prisoners — he stressed that their voices must be included at all levels.

A Global Youth Adviser to Denmark said that, despite progress made in the treatment of AIDS, young women between the ages of 15 and 25 lack the power, knowledge and means to protect themselves and continued stigma surrounding the virus leaves those most at risk behind. She called for the promotion of gender equality and for young people to have access to comprehensive sexual education.

IGNAZIO CASSIS, Federal Councillor and Head of the Federal Department of Foreign Affairs of Switzerland, said he had seen the beginning of the HIV/AIDS epidemic, marked by physical and mental suffering, as well as stigma and discrimination. “Many of the things we saw back them are still extremely relevant in the context of COVID-19,” he stressed, including the positive aspects of solidarity, the role of scientific research and investments. Much progress has been made, due in large part to international cooperation: partnerships between Governments, the private sector, academia and civil society. He called for a focus on vulnerable populations, young women and girls in Africa, who need access to prevention, care, intervention and information. He expressed full support for the new strategy for HIV and AIDS, calling for greater prevention efforts and medical research.

FRANZ FAYOT, Minister for the Economy and Minister for Development Cooperation and Humanitarian Affairs of Luxembourg, said the goals outlined in the 2016 Political Declaration have not been met. COVID-19 has disrupted the important strides made against HIV/AIDS, setting countries back from achieving the target to end the epidemic. “We need to get back on track,” he insisted, calling for an end to inequalities as the most important objective. The lack of attention to the needs of vulnerable populations, marginalized and criminalized for their gender identity and sexual orientation, must be addressed. Expressing Luxembourg’s commitment to support key populations, he said that, by empowering girls and women, promoting sexual and reproductive health and rights, addressing gender-based violence, reforming punitive laws and investing in infrastructure for comprehensive HIV services, the world can achieve the global targets by 2025. To that end, he called for political will.

Source: United Nations