San Francisco Chronicle - Thursday, June 28, 2001
Sabin Russell, Chronicle Medical Writer

A 16-page "Declaration of Commitment" lays out a plan to meet a five-year goal of boosting AIDS spending in low- and middle-income nations to between $7 billion and $10 billion -- as much as five times current levels.

The document sets specific goals for rich and poor nations, urges debt relief for impoverished nations, and places special emphasis on the need for equal rights for women and girls, who have borne a disproportionate share of the AIDS burden.

"We now have a clear battle plan for a war against HIV/AIDS," said U.N. Secretary-General Kofi Annan. "Women are in the forefront of this battle."

A succession of world leaders spoke boldly about the victimization of women by HIV and urged the world to keep to the same direct tone to combat the epidemic.

"We must summon the courage to talk frankly and constructively about sexuality," Mozambique Prime Minister Pascoal Mocumbi declared from the lectern. "We must recognize the pressures on our children to have sex that is neither safe nor loving."

DOCUMENT'S MAJOR THEMES

Written in broad strokes, the new U.N. document amounts to a blueprint to roll back the AIDS epidemic. Among the major themes:

-- Prevention is to be the mainstay of the global response.

-- Care, support and treatment remain fundamental elements of an effective response.

-- Respect for human rights is "essential to reduce vulnerability."

-- The vulnerable should be given top priority.

It also sets specific goals, such as reducing the rate of HIV infection among young people ages 15 to 24 in the "most affected countries" by 25 percent by 2005.

The unanimous approval of the document will set aside a bitter dispute over its wording in which conservative religious states -- led by the Organization of Islamic Countries -- prevailed over European efforts to list groups such as homosexuals, prostitutes and injection drug users among those deemed most in need of assistance.

The issue was resolved through diplomatic euphemism: The sensitive words were replaced by the phrase "identifiable groups which currently have high or increasing rates of HIV infection or which public health information indicates are at greatest risk . . ."

A reference to an obscure set of guidelines that addressed such highly charged issues as same-sex marriage, decriminalization of prostitution and safe needle-exchange programs was dropped from a preamble to the declaration.

A TRIUMPH FOR U.N. CHIEF

What remains is a powerful statement of intent to devote dollars and human resources against a virus that has already killed 22 million people and has infected an estimated 36 million others.

It is widely viewed as a triumph for Annan, a quietly forceful African from Ghana, who called for the special session, guided its agenda and clearly shaped the outcome.

"This is a truly historic event," Annan said yesterday morning, after it was clear that an accord had been reached. "The world is at long last waking up to the gravity of the AIDS crisis . . . and now we have a clear strategy for tackling it."

Alluding to the debates that raged among participating nations in the weeks before the session, Annan said it was all for the good. "Painful differences have been brought into the open," he said. "That is the best place for them." The declaration, in somewhat convoluted prose, appears to endorse the concept of competition among generic drug producers to supply inexpensive versions of the costly AIDS drugs available in industrialized nations.

"What matters here is that we get the best deal possible, whatever the source, as long as it is in accordance with international law," said Peter Piot, executive director of UNAIDS.

The inclusion of language urging anti-retroviral treatment encouraged advocates who had often been bitterly critical of the process leading up to the United Nations debate.

"We are glad that generics are specifically mentioned, but we still have to work on barriers to effective competition in developing countries," said Anne- Valerie Kaninda, of the French medical advocacy group Doctors Without Borders.

PANEL BACKS BOOST IN FUNDING

Meanwhile, the events at the United Nations appear to have loosened the purse strings in Washington, D.C. The Republican-controlled International Relations Committee yesterday voted 32-to-4 to increase U.S. contributions to individual states and a proposed global AIDS fund to $1.2 billion -- an increase of $840 million over current authorizations.

Money lies at the heart of the question of whether this week's compassionate rhetoric at the United Nations will translate into action.

Annan had separately proposed a global AIDS and health fund of $7 billion to $10 billion -- and until this week the fund had pledges well short of the goal, led by $200 million in "seed money" from the United States.

As of yesterday evening, the pledges had grown to $644 million, including $2 million from impoverished and AIDS-ravaged Uganda.

The meeting closed on a note of optimism as delegates and observers congratulated each other.

Thoraya Obaid, a Saudi woman who as executive director of the United Nations Population Fund played a key role in negotiating final terms of the declaration, summed up their work during a late afternoon address to the General Assembly.

"We came from a wide spectrum of cultural backgrounds, but we are committed to one purpose: saving people's lives," she said. E-mail Sabin Russell at srussell@sfchronicle.com.

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