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1 December 1999

Press Briefing



While 200,000 people had died last year in Africa as a result of conflicts and natural disasters, 2 million had died because of AIDS, Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UN-AIDS), told correspondents at a Headquarters press conference this morning. The world had to face the fact that AIDS was the most deadly undeclared war -- that was the challenge that the international community was facing.

Also speaking at the press conference, which was held in connection with the World AIDS Day, were the Regional Director of Eastern and Southern Africa of the United Nations Children's Fund (UNICEF), Urban Johnson; the UNICEF Goodwill Ambassador Harry Belafonte; and the Chief Executive Officer and President of the National Black Leadership Commission on AIDS, Deborah Fraser Hauz.

The briefing was moderated by the Director of the United Nations Public Affairs Division, Therese Gastaut, who said that today's "The Children Left Behind" -- a symposium on children orphaned by AIDS held in observance of World AIDS Day -- had been organized by the Department of Public Information, the National Black Leadership Commission on AIDS, the Magic Johnson Foundation, UN-AIDS, UNICEF, the United Nations Development Fund (UNDP), the United Nations Population Fund (UNFPA), the World Bank and the Global Health Council. (Two new documents were presented to correspondents at the press conference: the UNICEF report on the matter, and a Call to Action issued by UN-AIDS, UNICEF and the National Black Leadership Commission on AIDS. Both documents came out today.)

Mr. Piot said World AIDS Day, which was being commemorated all over the world, was the day to remember all those who had died of AIDS and to "re-energize" the battle against the disease. Among the most tragic consequences of the AIDS epidemic were the children who had become orphans because of it. The UNICEF report, entitled "Children Orphaned by AIDS", stated that since the beginning of the epidemic their number had reached more than 11 million. For every adult who died of AIDS, from 4 to 6 children were left behind.

In the past, the traditional family and the community would step in to care for orphans, who constituted about 2 per cent of children in developing countries, he continued. However, in some countries that figure had jumped to 7, 9 and even 11 per cent by 1997. The crisis also meant that grandparents now had to take care of the whole family. By far the most terrible news was that things would get worse before they got better. By the end of next year, a cumulative total of 30 million children would have lost a mother, or both parents to AIDS.

About 95 per cent of AIDS orphans lived in sub-Saharan Africa, he said. For that reason, the UNICEF report focused on that part of the world. It was important to convince the international community to act on that issue far more urgently than before. That was one of the forgotten aspects of the AIDS epidemic, and therefore a joint call for action had been issued. The epidemic was an emergency, and clearly the poorest countries of the world could not deal with that relentless tragedy by themselves.

Urban Johnson, Regional Director of UNICEF, Eastern and Southern Africa, said that sub-Saharan Africa continued to suffer from two major complex emergencies -- armed conflict and the HIV/AIDS pandemic. Last year, AIDS had killed almost 10 times more people than armed conflict. Wars attracted international attention and seemed to have access to almost unlimited resources. In the future, HIV/AIDS would be described as the greatest social catastrophe in modern history. Both military conflict and AIDS killed parents and created orphans. In the United States, 183,000 children were orphaned over a 6-year period as a result of the Second World War. In sub-Saharan Africa, that number of orphans was created nearly every month.

Although there were many similarities between war and AIDS orphans, there were some important differences, he continued. While war orphans received sympathy from everybody, AIDS orphans bore part of the stigma of their parents. While war orphans could proudly talk about their father killed in combat, AIDS orphans were made to feel shame. Most often children did not see their parents die in war. For AIDS orphans the death was the last step in an extremely painful process of watching their parents die. Orphans in most war situations would benefit legally from survivors' and social security benefits, special scholarships, and so on. Instead, many AIDS orphans saw their few possessions robbed by greedy relatives. As opposed to most AIDS orphans, war orphans knew the cause of their parents' death.

A whole generation would grow up where many had no father or mother, he said. In the next generation, many young children would have no grandparents. Nobody knew the social and psychological impact of that ongoing catastrophe. HIV/AIDS should be declared a global emergency. The United Nations had a great responsibility to mobilize the world in the war against HIV/AIDS. Solutions should be discussed and found in intergovernmental forums and brought up in the Security Council.

The national and international resources allocated to prevent HIV/AIDS and to care for its victims were non-commensurate with the size and the impact of the problem, he said. Last year, $150 million had been spent on HIV/AIDS programmes in Africa -- the cost of one Boeing 747. Future historians would find it difficult to understand why there had been no real global response to the greatest social catastrophe in modern history. The required response to the problem of HIV/AIDS in Africa was most likely in the range of $2 billion to $4 billion a year for the next 10 to 15 years. That meant that the funding of HIV-AIDS-related programmes could not and should not compete for funds at the "shrinking market of Official Development Assistance".

As if that were not enough, he continued, sub-Saharan Africa was burdened with debt. Several countries spent more on servicing their debts than on crucial social services, including health and education. Some of them spent 30 per cent of their national budget on debt service. Mwalimu Julius Nyerere once asked: "Should we starve our children to pay our debt?". Now one could ask: "Should we forget the millions of AIDS orphans -- the next generation -- to pay off the past generation's debt?".

He said that Africa was written off economically, marginalized politically and now left alone with the greatest social catastrophe of modern times. Africa had survived slavery, apartheid and colonialism. Now Africa was suffering from HIV/AIDS. This time, the silent enemy lurked amongst the people -- in their households and communities -- but there also lay the key to defeating that enemy. That struggle would require bold political choices, strong international solidarity and sustained peace.

Harry Belafonte, UNICEF Goodwill Ambassador, said that HIV/AIDS had been frequently likened to the Black Death of the fourteenth century - the bubonic plague, which had killed over 75 million people. AIDS was already beginning to close in on that record. The AIDS virus had infected more than 50 million people so far. Of those, more than 16 million died, with 2.6 million deaths just this year. The majority of the infected people lived in sub-Saharan Africa and in the developing world. In Africa for the first time, infected women aged from 15 to 49 outnumbered infected men. According to the UNICEF/UN-AIDS report released today, the disease was also making orphans out of millions of children. By the end of this month, 11.2 million children worldwide would be in that category. That figure would rise to more than 13 million by the end of the year 2000.

Those were terrifying numbers, which also carried a "dangerous virus of despair and indifference", he continued, because they invited people to ponder the vast scale of destruction and death. It was necessary to resist the feelings of impotence and intimidation. Despite all the apocalyptic rhetoric that the numbers inspired, the battle against HIV/AIDS was far from over. In fact, it had hardly begun. There was still hope. That was UNICEF's message to the last World AIDS Day of this century. There were signs of progress in research science as well as treatments to stop the spread of the virus and limit its impact on children. Some of the ten hardest hit countries in the world were mobilizing themselves to meet the needs of orphans. That progress must be built on. A massive global response was needed, and it was necessary to talk about that today and in the days to come -- until the disease was reversed and ended.

Chief Executive Officer and President of the National Black Leadership Commission on AIDS, Deborah Fraser Hauz, said that the symposium represented more than 40 million children, and those children were real. They were the reason why her organization had initiated the dialogue with the Office of the Secretary- General, which resulted in today's event. Children were the most important topic today. Equally important was the report released this morning, which outlined the plight of the children left behind.

As sombre as the AIDS Day was worldwide, there was something wonderful happening too; as a result of the symposium, the joint national and international partners had come together for the first time to set forth a plan and a call to action. It would become a definitive guideline for all people of goodwill to embrace. The plan called for communities, governments, civil society, the private sector and international partners to vigorously address the plight of the children affected by the AIDS epidemic. It ensured the rights of those children to life, liberty and happiness. Action was needed at all levels. The people at the conference would be asked to give their consensus to the call to action. The national and the global leaderships together would do everything possible to ensure that the needs of the children were met.

Asked about the prospects for the development of a successful AIDS vaccine, Mr. Piot said there were two aspects to the problem. The bottom line for the future required the development of a vaccine to stop the epidemic. However, the bottom- line for today was that everything possible needed to be done to stop the spread of HIV; to ensure decent care and support for the infected people and to deal with the consequences of the epidemic. In very practical terms, the world should not count on an effective vaccine for at least another five years and, he was afraid, much longer.

To a question on measures to make existing medicine available and affordable in Africa, Mr. Piot said that several types of drugs were needed, including the medicines to treat so-called "opportunistic infections", associated with AIDS. In many cases, those infections could be treated even with generic drugs, which were quite affordable. That was primarily a matter of strengthening the infrastructure and the healthcare system which had collapsed in many African countries. He said the most difficult part were the medicines used for treatment -- and not cure -- of HIV and AIDS. That was where the problem of price arose. There was a realistic option of making available drugs preventing transmission from mother to child. It would not be easy, and it would require major investments, but UNICEF and UN-AIDS together with other partners had started to make efforts in that regard. As far as the treatment itself was concerned, including combination therapy, there was an option of preferential pricing. However, even with a 60 to 90 per cent price reduction, many drugs were still unaffordable. It was necessary to concentrate on improving the quality of life, extending life through better care and treating opportunistic infections, at the same time working with pharmaceutical companies to make more sophisticated drugs available.

To a question about "donor fatigue", Mr. Piot said that in Western countries there was certainly a perception that the AIDS epidemic was under control. Nothing could be further from the truth. On the other hand, resource flows for HIV/AIDS treatment and prevention were far from sufficient. This year, there had been breakthroughs in many areas, in particular in political will, which was an important pre-condition for any action. New commitments had been made. For example, the United States President had requested $100 million for new initiatives, doubling the funds for HIV activities in the developing world. That was not enough, but certainly a good start. The same thing was happening in some European countries. However, the magnitude of the problem was still underestimated in most countries. For that reason, it was necessary to make sure that AIDS was on the agenda of most debt relief initiatives and poverty reduction strategies.

Mr. Johnson added that while there was no donor fatigue for such areas as Kosovo and East Timor, there was often a lack of public response for African crises. There was even a tendency to say that African problems should be left to the Africans.

Ms. Hauz said collaboration between the national and international community had worked towards the common good, with the assistance from the Congressional Black Caucus. A hundred million dollars had been set aside for HIV/AIDS in Africa. Last year, for the first time in the history of the AIDS epidemic, the Congress had actually appropriated $150 million for prevention in the African-American community.

Asked about the links between development, education and AIDS prevention in the call to action, Mr. Johnson said that in Africa, HIV infection was becoming a question of poverty. Poor and less educated people ran a higher risk of infection, which in its turn, also generated poverty. In the rich industrialized world the danger of AIDS was certainly not so threatening as in Africa, which was increasingly marginalized and left in poverty to take care of its problems. Thus, the linkage with poverty and lack of education was very clear.

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