Newsday - June 28, 2001
Laurie Garrett, Staff Correspondent

Despite vigorous debate and controversy, the nations of the world agreed to a remarkably detailed document that sets timetables for achievement of AIDS control goals, the most ambitious of which is a 25 percent reduction by 2005 in the prevalence of HIV among 15- to 24- year-olds.

Though several sections of the declaration were toned down as a result of strong protest from the Organization of Islamic Countries, or OIC, nearly universal support for the document was expressed by General Assembly delegates, country representatives, UN agencies and advocates for people with AIDS.

UN Secretary General Kofi Annan said in a news conference yesterday that the special session on AIDS should be recognized as "historic for two reasons. First, the level of attendance shows that the world is at long last waking up to the gravity of the HIV/AIDS crisis. And second, the declaration...provides us with a clear strategy for tackling it."

Dr. Peter Piot called the declaration "an instrument of international accountability...that we will use with governments."

As director of the UNAIDS Programme, Piot continued, "I will wave this document and say [to government leaders], 'this is what you agreed to.'"

Stu Flavell, who heads the Global Network of People With AIDS, applauded the declaration and said his group "will be looking at how we can make these targets real to people with AIDS. We're really prepared to be partners in implementation of this document."

Most of the world's nongovernmental AIDS groups are members of the International Council of AIDS Service Organizations. Council General Secretary Richard Burzynski warned in a news conference that "there's no question in my mind that [AIDS organizations] are going to look at this document, like it and then say, 'now let's use it.'"

Even seemingly unrelated organizations, such as the World Association of Girl Guides and Girl Scouts, vowed yesterday to use their international network of girls and young women to monitor how well governments comply with the details of the declaration. And the key concern of the Girl Scouts, its representatives said, is implementation of the declaration's call for female empowerment.

"If there is any one idea that stands out clearly in the declaration, it is that women are in the forefront of this battle," Annan, who yesterday was nominated by the UN Security Council for a second five-year term, said. "It can only be won if women are fully educated and enjoy their full rights, including a full say in devising society's collective response. It has been said that, 'girl power is Africa's own vaccine against HIV,' and that should be true for the whole world."

But as much as the declaration offered strong language in support of girls and women, it avoided offering similar levels of support for gays, intravenous drug users and prostitutes-an omission demanded by the OIC and encouraged by the Vatican.

"Regarding the sexual transmission of the disease, the best and most effective prevention is training on the authentic values of life, love and sexuality...no one can deny that sexual license increases the danger of contracting the disease," Archbishop Javier Lozano Barragan told the General Assembly, speaking on behalf of the Vatican. "It is in this context that the values of matrimonial fidelity and of chastity and abstinence can be better understood."

AIDS is about sex. History was made at this week's gathering because the nations of the world had to discuss and debate what may well be the culturally and spiritually most divisive issue-human sexuality. Though in the end, many groups were disappointed to see supportive references to gays and other groups deleted from the declaration, most still said that they viewed the document, and the process of its creation, as victories.

"In the last two days, some painful differences have been brought into the open," Annan said, "but that is the best place for them. Like AIDS itself, these differences need to be confronted head on, not swept under the carpet."

Flavell and other advocacy group representatives shared Annan's sense that open debate about sex and drug use was extremely positive- even historic.

"For once it wasn't covered in a blanket of indecipherable or diplomatic language," Piot noted.

Burzynski said the advocacy groups backed off in negotiations, allowing deletion of several points they consider vitally important, because they feared the entire declaration would be killed if the back room battles persisted.

But in his address to the General Assembly last night, Burzynski, a Canadian gay activist, castigated the political leaders, saying, "we cannot shy away from being very specific about the groups who are most vulnerable to infection...you have decided that you cannot name them-I can. They include men who have sex with men, injecting-drug users and their sexual partners and sex workers and their clients.

"Religious beliefs and cultural practices cannot impede the progress we have made thus far. Governments that place religious tenets above a candid and comprehensive response to the epidemic are committing an egregious sin. No god, in any religion, in any culture, could countenance the death and devastation this disease has caused. It is up to us, not to any deity, to stop this thing now," Burzynski said in his address.

Implementing the 103 goals of the declaration will require intense political commitment. And billions of dollars.

World Bank President James Wolfensohn yesterday assured Annan that the World Bank is prepared to manage the Global Fund for AIDS and Health, if so requested. And it will spend $1.2 billion on AIDS this year. That's $1.2 billion, out of a total World Bank budget of $16 billion.

Next year, Wolfensohn told Newsday, the World Bank hopes to create a 30-year no-interest loan program for AIDS, totaling some $500 million, which would be dispensed through the bank's mechanisms, rather than the Global Fund. And yesterday the World Bank agreed to loan $155 million to Caribbean nations for AIDS control efforts.

And it will cost many billions to fulfill the goals set out in the declaration, including providing sterile syringes and infection control equipment to all health care workers by 2003, ensuring that the world's blood supplies are HIV-free by 2005 and by that date also having AIDS education programs effectively reaching 90 percent of the world's teenagers.

The most expensive targets to meet will involve HIV treatment and development of strong public health infrastructures the world over. Within two years, the declaration says, programs and infrastructures should be in place to allow dispensing of anti-HIV drugs. And by 2005, people with HIV all over the world should have access to comprehensive packages of health care.

Those treatment targets garnered strong, diverse support-from activist ACT-UP groups to the Vatican. Speaking on behalf of the Vatican, Archbishop Barragan insisted that there was a moral imperative to provide treatment to all of the world's HIV patients. And he chastised the pharmaceutical industry, saying, "that there is a 'social mortgage' on all private property, and that this concept must also be applied to 'intellectual property.' The law of profit alone cannot be applied to essential elements in the fight against hunger, disease and poverty."

Finally, the declaration sets political goals concerning the human rights of people with HIV and those groups most vulnerable to infection-though the groups are not named. And it called for all nations-within four years-to create systems of care and support for children orphaned by the epidemic.

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