International Federation of Red Cross and Red Cresent Societies - 14 July 2003

No organization can defeat AIDS on its own; governments cannot do it all themselves. Nor will politically correct speeches and debates change the course of the epidemic. Not unless they really lead governments and donors into changing the policy environments that fuel the epidemic and implementing organizations approach collaboration and local responses differently.

When more than 14 million people faced the threat of famine last year, a pre-emptive intervention with food aid began. By February 2003 it had averted mass starvation in southern Africa. A sigh of relief could be heard from New York to Rome. Another crisis had passed and world attention focused elsewhere. The preparations for the war in Iraq won the battle for media sound bites and images to shape public consciousness. HIV/AIDS reverted back to being what it has been for so long, a silent disaster.

The disaster unfolding in front of us is that of community erosion, the slow but inexorable destruction of southern AfricaÆs social fabric, and HIV/AIDS is driving it. Not unlike conflict and war, HIV/AIDS leaves behind a sequel of futile deaths, destitute wives and orphans, and a heavy burden of debt, both private and public, which individuals and states can ill afford.

A killer on its own right, HIV/AIDS, when combined with other hazards such as drought and cyclical food shortages becomes an overwhelmingly weakening force that undermines the ways in which people bounce back from adversity using age-old coping mechanisms. What is happening today in Southern Africa is a new kind of complex emergency, something the world has never experienced before, and itÆs only now that we are beginning to understand how the different factors interplay to produce the terrible reality we are confronting.

Poor access to health care, the accelerated spread of tuberculosis, malaria and other disease, an appalling absence of safe water and sanitation and ineffective agricultural practices are among the aggravating factors. This with the backdrop of a general neglect for people living in rural areas, as evidenced by the almost total absence of state services available to them. If something is bad, HIV finds it and joins forces to make things worse.

If the Millennium Development Goals are to be more than just the aspiration of a better world, and the eradication of extreme poverty and hunger a viable objective, then necessarily the interventions strategies must factor in the HIV/AIDS pandemic. Short of that, HIV/AIDS will continue to keep poor people, and particularly the rural poor, in a vicious circle of poverty and disease, and at risk of other hazards which they will not be able to cope with by themselves.

You need not look far to find the aggravating factors that have combined with HIV/AIDS to make this a disaster of such magnitude. But you need to look, and the thinking and analysis of humanitarian response must change. Food aid may have saved more than 14 million lives but it only postponed a disaster. It did nothing to address the causes, or the wider, threatening context.

What is happening is unprecedented, and doing business as usual will not halt it. The humanitarian world is deep in uncharted territory, and the map from the past will not guide us through the future. Clearly, policy and practice - that of donors and governments as well - have begun to lag behind the emerging challenges.

Forget dealing with the challenges separately. HIV/AIDS rules that out. There is need of an integrated community-level response, a comprehensive package of strategies to curb a patchwork of problems. I have mentioned the links of HIV/AIDS to food security and the need for a comprehensive response. But HIV affected households and communities are also more vulnerable to tuberculosis (the main killer of HIV infected people) and malaria, in more acute need of having a safe water supply near by. Children from AIDS affected households are less likely to receive a vaccine that will save them from measles, that continues to kill well over 400.000 children a year in Africa alone.

We all know what needs to be done to prevent measles, to prevent or cure malaria and tuberculosis, we can continue distributing food... but in regions with mature HIV/AIDS epidemics none of that will work in isolation. Only by addressing this complex disaster holistically can the world address it adequately, by recognizing the interconnectivity of all sectors and actors, and harnessing the will to act collectively and with a common purpose. We must do the right thing, not continue doing the same things we have always done right.

The Red Cross and Red Crescent has itself taken a new and long-term approach to the crisis in southern Africa. There is no exit strategy at the end of a one-year food relief operation. Instead, the International Federation is now committing to a strategy that combines food security with integrated community care involving HIV/AIDS prevention, care and treatment, the provision of safe water and sanitation, health services and the promotion of economic self-reliance. We now need other agencies, donors and governments to fund and drive a "coalition of the willing", you will excuse the term, to revert this major disaster. The Red Cross is ready to participate.

And it is not only in Africa that HIV/AIDS is highlighting the inadequacy of our systems. In the region I come from, Europe, HIV/AIDS is putting in evidence the widespread inhumane treatment of injecting drug users. In many places people needing treatment are forced to the margins by government policies, forcing them into situations where transmission of HIV is more likely. Just last month Human Right Watch reported the instances of police brutality, lack of due process, harassment and stigmatization that drive drug users and sex workers in Kazakhstan underground and impede their access to life saving HIV prevention services, fuelling one of the fastest growing AIDS epidemics in the world.

We all know that social evils policies, condemnation, harassment, incarceration, and even killing of drugs users does not work. The scientific evidence is clear: harm reduction works. Needle and syringe exchange, drug substitution, and condoms are vital components of the response to HIV/AIDS. Government co-operation with Red Cross Red Crescent in anti-discrimination campaigns and necessary legal reform is urgently needed to enable these life saving measures to be used, and to build the social cohesion necessary to stop AIDS. We all know it, but we donÆt do it! Looking at the plethora of challenges faced by individuals and communities at risk of HIV/AIDS infection or living with AIDS, it would be difficult to find a situation where affronts to the dignity of human beings are more evident than in the HIV/AIDS pandemic. That is a strong reason why the theme of the International Conference of the Red Cross and the Red Crescent, which will take place in Geneva in December of this year is "Protecting Human Dignity", and why one of the outcomes of the Conference, the Agenda for Humanitarian Action, includes reducing the risk and impact of HIV/AIDS and other infectious diseases with regard to vulnerable people as one of its four objectives.

Finally, I would like to say a few words about the Global Fund to fight AIDS, TB and malaria (GFATM). This fund was created two years ago as an innovative instrument that would contribute to an integrated, more comprehensive response to these deadly but largely preventable diseases. Today the fund is suffering because the governments that sit on its Board and fund it are not living up to their commitments. They are falling short of the principles of civil society participation that made it such an innovative instrument and falling even shorter in terms of funding commitments.

When we say that the Millennium Development Goals will be no more than a dream if the epidemics of HIV/AIDS, TB and malaria are not halted... we all agree. When I say "business as usual" will not defeat this epidemic... we all seem to agree. But Southern Africa remains today a lacerating testimony of the inadequacy of our response. What is it that is preventing us from allocating adequate resources to a jointly planned and implemented multi-sector response that enables and reinforces the local response?

For the sake of the millions of people now dead from this disaster, so that their death may have some sort of meaning, and for the sake of those whose lives are still salvageable, I urge you to address this question.

Thank you.
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