International Federation of Red Cross and Red Cresent Societies - 17 July 2003
Statement by Bernard Gardiner, HIV/AIDS Global Programme Manager, International Federation, to the ECOSOC Substantive Session of 2003, Geneva.

The International Federation of Red Cross and Red Crescent Societies approaches this debate on HIV/AIDS against the background of the address to the High Level Segment of this Session of the Council on 1 July by our President, Mr Juan Manuel Suarez del Toro.

In that statement, the President made it clear that the International Federation sees a need for a more courageous, more determined approach to the crises affecting the world than has traditionally been taken by the international community. I will not repeat the details of his statement, but will note that he described the International Federation's position that language must change, attitudes must change, and new ways of achieving results must be found. Nowhere is this new approach more needed than in the HIV/AIDS pandemic, and nowhere is this need more evidenced than in Southern Africa, where HIV/AIDS has combined with other hazards such as drought and cyclical food shortages to create a disaster that has left countless communities unable to bounce back from adversity using age-old coping mechanisms.

In our view this new way of thinking must include three elements: First, a resolve to address problems with an integrated approach, recognizing the interconnectivity of all sectors and actors. What is needed is a strategy to address the patchwork of problems, not just to curb one. Second, in all interventions a long-term perspective must be incorporated from the outset. Only then will local capacities be strengthened in a durable way, empowering communities towards self-reliance. Third, and perhaps most importantly, everything we do must have built-in strategies to highlight and promote the role and contribution of women.

Mr. President,

The International Federation is fully engaged with UNAIDS as a Collaborating Centre in two areas:

The first one is reducing stigma and discrimination through collaboration with Global Network of PLWHA and its affiliates at the global, regional and national levels. The other is community mobilisation through volunteers.

I would like to comment on issues arising from both these areas of work.

Collaboration with GNP+ has helped to renew the Red Cross Red Crescent mandate for the 21 century, and the Movement owes a debt of gratitude to both GNP+ and the HIV+ humanitarians within the National Societies of the Red Cross and the Red Crescent who have given inspired leadership and practical day to day assistance to the vulnerable, by providing not only home-based care for people with AIDS but volunteering in prevention education work. However, when it comes to collaboration at the country level we observe the neglect of PLWHA organisations in nearly every country. How can these groups provide self-help and be a viable voice of PLWHA when they have absolutely no money? Most countries pay lip service to involvement of PLWHA in their national strategy and even have it 'endorsed' by PLWHA, but neglect keeps the voice of PLWHA weak. Neglect is no basis for partnership. We cannot afford to squander what PLWHA have to offer in this way.

Therefore, the International Federation supports the recommendations of the recent UN GIPA consultation that UNAIDS play a key role in ensuring basic operational funding for the key PLWHA groups in each developing country, urging governments to fulfil their responsibility to develop and provide adequate resources to this essential part of civil society in the response to HIV/AIDS.

On the issue of community mobilisation the International Federation makes the observation that a consensus seems to have emerged that treatments of HIV/AIDS will not be successfully delivered to PLWHA unless mobilisation of communities occurs. This mobilisation is necessary to overcome the stigma and discrimination that blocks people seeking VCT and treatment, and to ensure even a basic understanding of the treatments and the right to them. The community is also the major source of day to day support for treatment delivery with issues as basic as ensuring people are able to take the medicines effectively. And yet, the International Federation finds itself in the position of having to point that this mobilisation will not just happen on its own. The models for treatments delivery which do not include this mobilisation have to be adjusted and 'demedicalised' so the contribution of civil society is well articulated and properly funded. WHO and partners are investing in the 'technical' aspects of scaling up treatments delivery, but so far 'technical' work is almost exclusively addressing 'clinical' issues. We all know from past experience that if the health system only extends down to the clinic level, the vulnerable, including the poor, are not guaranteed access. This is where the extensive Red Cross and Red Crescent volunteer base, drawn from within the affected communities and working door to door, can 'go the last mile' to deliver universal access to home care treatment as well as prevention education services. This needs to be appreciated, and the system will fail if we chose not to recognise it. It is time we put the horse before the cart, and put people at the centre of the response strategies.

Mr. President,

When the predecessor of the International Federation, the League of Red Cross, was founded in Paris in 1919 a major goal was to 'spread the light of science', particularly in the field of health care. Yet 84 years later we are still advocating that the light of science guide programmes. Donor dictates based on other than science continue to hinder the work.

Nowhere is the gap between science and practice more evident that in the inhumane treatment of injecting drug users. These people are in need of care and real alternatives, but instead routinely face harassment, stigmatisation, violence and deliberate marginalisation. This approach creates a public health disaster, by forcing them underground into situations where transmission of HIV/AIDS is more likely, and denying them life-saving access to treatment and prevention services. This happens even though the science and cost benefit analysis is overwhelmingly in favour of harm reduction programming which includes needle exchange, drug substitution treatment and condoms as part of the response to HIV/AIDS. The evidence is clear. It is time for States to be guided by the light of science, not by the darkness of ignorance and fear.

From this perspective, it is not casual that the theme of the International Conference of the Red Cross and the Red Crescent, which will take place here in Geneva in December, is ôProtecting Human Dignityö, and that one of the outcomes of the Conference, the Agenda for Humanitarian Action, includes reducing marginalisation so the risk and impact of HIV/AIDS and other infectious diseases can be contained. We trust that the deliberations taking place in the context of this session of ECOSOC will contribute to making this Agenda for Humanitarian Action a reality.

Thank you.
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