June 13, 2011 — All United Nations (UN) member states have formally adopted a declaration that calls for redoubled efforts to end the global AIDS epidemic through universal access to care and preventive services.
The 2011 United Nations Political Declaration on HIV and AIDS, which was released at the 2011 High-Level Meeting on AIDS in New York City last week, sets the course for the global response to HIV/AIDS for the next decade by defining measurable targets for achieving universal access to HIV prevention, treatment, care and support by 2015.
Among its many goals, the document sets a target of having 15 million HIV-positive people on antiretroviral drugs by 2015. That’s more than double the number of people currently receiving this treatment.
The 16-page, 105-point declaration includes commitments to work toward cutting sexual transmission of HIV by half by 2015, to work toward reducing the spread of HIV among injection drug users by half by 2015, and to work toward eliminating mother-to-child transmission of HIV by 2015 and substantially reducing AIDS-related maternal deaths.
"These bold new targets set by world leaders will accelerate our push to reduce the transmission of HIV," said UN General Assembly President Joseph Deiss. "The challenge that remains is to implement these commitments; here, leadership and mutual accountability are crucial."
"These are concrete and real targets that will bring hope to the 34 million people living with HIV and their families," said Michel Sidibé, executive director of UNAIDS. "Through shared responsibility, the world must invest sufficiently today so we will not have to pay forever."
Member states also pledged to close the global resource gap for AIDS and work toward increasing funding to between $22 and $24 billion per year for low- and middle-income countries by 2015. According to UNAIDS, this pledge comes at a time when international aid for the AIDS response dropped for the first time since 2001.
Besides defining commitments, the declaration broadly defines principles to achieve the goals. For example, in a section on advancing human rights to reduce stigma, discrimination, and violence related to HIV, the declaration calls for intensified national efforts to create legal frameworks to eliminate stigma, discrimination, and violence related to HIV and to promote access to HIV prevention, treatment, care, and support services.
Reaction to the declaration has been mixed. Staff at the Global Forum on MSM and HIV (MSMGF) were heartened that the declaration is the first General Assembly statement on AIDS to explicitly include men who have sex with men (MSM).
The declaration represents "a huge step forward," George Ayala, PsyD, MSMGF executive officer, told Medscape Medical News, but significant challenges remain. He noted that although the declaration commits to getting 15 million people on antiretroviral therapy by 2015, that number equals 80% of the 18 million people who are projected to need antiretroviral therapy at that time. "We need 100% coverage and universal access," he said.
He also expressed concern about provisions in the final text that could undermine or dilute a targeted focus on men who have sex with men, injection drug users, and sex workers. "Although important, culture, values, and sovereignty should not take precedence over international human rights obligations," he said.
For people concerned about HIV/AIDS among injection drug users and those trying to promote an evidence-based approach to address the HIV epidemic among drug users, Evan Wood, MD, PhD, told Medscape Medical News that the declaration is "obviously a real disappointment."
Dr. Wood is director of the Urban Health Research Initiative at the BC Centre for Excellence in HIV/AIDS in Vancouver, British Columbia, and coauthor of the Vienna Declaration, which called for drug policy reform in 2010 to halve the spread of HIV among injection drug users.
One issue that incensed Dr. Wood is the language surrounding the guidelines for reducing HIV infections among injection drug users, which only asks states to "give consideration, as appropriate."
"Can you imagine any other disease where the [World Health Organization] and other UN partners would write evidence-based guidelines and then the best the international community can do is suggest that states consider them?," Dr. Wood asked.
Despite clear evidence from clinical trials and Cochrane Reviews that prevention tools, such as methadone maintenance therapy, work in the West, Dr. Wood noted, the approach is still illegal in Russia, where more than 1 in 100 adults is now infected with HIV as a result of injection drug use.
The UN declaration stands in stark contrast to the recently released Global Commission on Drug Policy report, which notes the clear links between drug policies and the spread of HIV, Dr. Wood said.
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