Remarks by Ms. Alessandra Tisot, Resident Representative a.i. on the occasion of the launch of the Regional Human Development Report: HIV/AIDS and Development in South Asia, 2003

10 Jun 2003

Remarks by Ms. Alessandra Tisot, Resident Representative a.i. on the occasion of the launch of the Regional Human Development Report: HIV/AIDS and Development in South Asia, 2003,

10 June 2003,
Hotel Himalaya, Kathmandu, Nepal
Honourable Member of the National Planning Commission Dr. Yubaraj Khatiwada
Mr. Mahendra Nath Aryal, Secretary Ministry of Health
Ms. Sapana Malla Pradhan, Coordinator, Forum for Women, Law & Development
Members of the Human Resource Development Centre, New Delhi,
Distinguished guests,
Ladies and Gentlemen

It is with pleasure that I welcome you all to the Launch of the Regional Human Development Report on HIV/AIDS and Development in South Asia 2003.

Every day, 14,000 people between 15-24 years and 2,200 under 15 years are infected by HIV. Between now and 2020, 70 million people will have died prematurely because of AIDS. Countries all over the world are losing their most economically active and productive population.

The economies and societies of South Asia are poised to make great advances over the next decade. But the looming shadow that may destroy these prospects is AIDS. The HIV/AIDS epidemic in South Asia today is at what epidemiologists refer to as a tipping point. It is still relatively small compared to the population size, but left unchecked it will rapidly and ruthlessly grow.

Only immediate, comprehensive action will prevent at least 5 million new HIV infections in South Asia this decade, and begin successfully turning back the epidemic. Delay will produce a larger, more damaging, and more intractable epidemic.

The action that is taken, or not taken, by leaders at all levels of government and society in South Asia in the coming months and years will determine whether the future faced by the region's children is bright- or falls further under the shadow of HIV/AIDS.

Stigma and discrimination associated with HIV and AIDS are the greatest barriers to preventing further infections, providing adequate care, support and treatment and alleviating impact. HIV/AIDS-related stigma and discrimination are universal, occurring in every country and region of the world. They are triggered by many forces, including lack of understanding of the disease, myths about how HIV is transmitted, prejudice, lack of treatment, irresponsible media reporting on the epidemic, the fact that AIDS is incurable, social fears about sexuality, fears relating to illness and death, and fears about illicit drugs and injecting drug use.

All over the world, the shame and stigma associated with the epidemic have silenced open discussion, about its causes and the appropriate responses. This has caused those infected with HIV and affected by the disease to feel guilty and ashamed, unable to express their views and fearful that they will not be taken seriously. And they have led politicians and policy-makers in numerous countries to deny that there is a problem, and that urgent action needs to be taken.

People with HIV/AIDS are often believed to have deserved what has happened by doing something wrong. Often these ‘wrongdoings’ are linked to sex or to illegal and socially frowned-upon activities, such as injecting drug use. Men who become infected may be seen as homosexual, bisexual or as having had sex with prostitutes. Women with HIV/AIDS are viewed as having been ‘promiscuous’ or as having been sex workers. The family and community often perpetuate stigma and discrimination, partly through fear, partly through ignorance, and partly because it is convenient to blame those who have been affected first.

Images of HIV/AIDS in the media and television, which impress upon the public opinion that it is a ‘foreign disease’, a “junkies” disease, a ‘Black disease’, or a ‘gay plague’, also create HIV/AIDS-related stigma and discrimination and reinforce these stereotypes and beliefs.

Although images associated with HIV/AIDS vary, they are patterned so as to ensure that HIV/AIDS-related stigma plays into, and reinforces, existing social inequalities. These include gender inequalities; inequalities that deny sex workers their dignity and rights; inequalities based on race and ethnicity; and inequalities linked to sexuality in general, and homosexuality and transgendered status, in particular.

But HIV/AIDS respects no border, region or class of people.

It is a well-documented fact that the impact of HIV/AIDS at the household levels especially the poor households has devastating consequences for the family members, the consequences of which are passed on inter-generationally.

Silence, denial, stigma and discrimination are still featuring in the HIV/AIDS discourse in South Asia.

UNDP, keeping up with its tradition to advocate for human development is about to launch the Regional Report to counter attack some of these positions providing space for open and frank discussions, for research data to be disseminated, for new findings to be examined, for new solutions to be sought.

The Regional Human Development Report on HIV/AIDS and Development in South Asia 2003 to be launched in a little while has been prepared under the aegis of the Regional HDR initiative of the UNDP Regional Bureau of Asia and the Pacific, anchored in the Human Development Resource Centre (HDRC), New Delhi. The Report examines the complex interplay between disease and destitution in a scenario where major successes in human development are reversed by persistent challenges.

The report brings together for the first time an analysis of HIV and human development under a common lens in South Asia and assesses the adverse impact of HIV on Human Development Index.

Highlighting the linkages between the epidemic and the larger challenge of human deprivation in South Asia, the main objectives of the Report are to create an understanding of the causes and consequences of HIV/AIDS within a human development framework and thereby advocate for a shift in development priorities and approaches to HIV and, on this basis, identify key points for HIV/AIDS and development strategies in the region.

It also emphases the importance of dialogue in the region between governments and civil society that should be focused on cooperation in arenas such as affordable drugs and treatment through trade agreements, sharing best practices in harm reductions and an enabling policy environment where the struggle against the epidemic is an integral part of the road map of human development.

It warns that the cost of complacency will be high. Again because women are doubly vulnerable to HIV/AIDS promoting gender equality is crucial for combating the epidemic. Similarly, social attitudes for HIV positives must change. Because of the pervasive nature of HIV/AIDS, all sectors of the society must be involved in this struggle.

Stated simply, HIV/AIDS is much more than simply a public health concern. Preventing its spread requires a range of policy and programme initiatives under strong national political leadership.

We are therefore delighted that in testimony of their commitmment, we have with us today, a representative from civil society, the Secretary Ministry of Health and the Honorable Member of the National Planning Commission who is also a recognized champion of the human development campaign in Nepal.

Compared to other countries in Asia and the world, available data suggest that Nepal has a low level of HIV among the general population. In Nepal, the first cases of AIDS were reported in 1988 and since then the number of people living with HIV/AIDS has increased considerably.

Data regarding HIV/AIDS is scarce in Nepal; however, available data indicate that around 0.5 percent of the general population is HIV positive. As of May 2003, the Ministry of Health has reported 644 cases of AIDS and 2,883 HIV infections with 159 deaths reported so far.It is estimated that there are approximately 60,000 people living with HIV/AIDS. In Nepal HIV/AIDS is considered to be in a concentrated epidemic stage among the most vulnerable sub population groups of Injecting Drug Users, sex workers, and returning sex workers from India. However the risk of it spilling into the general population is a real one. The dynamics of the epidemic are especially dramatic in the Kathmandu Valley where HIV/AIDS prevalence was 2% or below among female sex workers and Injecting Drug Users in 1992. It is now recorded at 68% among Injecting Drug Users in KTM and is 17% among the sex workers.

It is commendable that His Majesty’s Government of Nepal has established the National AIDS Council chaired by the Right Honourable Prime Minister. The Council, with representation from government, non-government organizations and civil society, will go a long way in advocating for active participation in the fight against this epidemic among all strata of society.

HIV/AIDS is already included as one of two cross cutting issues in the 10th Development Plan, which will cover the period 2002-2006.

The National Centre for AIDS and STD Control (NCASC) has developed the National Strategy on HIV/AIDS, 2002-2006 which takes into account the Millennium Development Goals and the Commitments made at the Special Session of the UN General Assembly on HIV/AIDS.

The National strategy emphasises that an effective and efficient response will result from a shift from individually funded ‘projects’ to a ‘programme’ approach; from outputs to results orientation; from donor interest to national priorities; from capacity building of central structures to strengthening implementation capacity, and that the graduation from a health sector response to a multi-sector approach will require time and resources.

Also, work has been going-on to strengthen the role, function and structure of the National Centre for AIDS and STD Control, as the main Government agency tasked to oversee the implementation of the National Strategy.

The Global Fund for AIDS is now supporting national initiatives on HIV/AIDS in Nepal. There are also several other bilateral and multilateral donors who are willing to support the governments both technically and financially and it is heartening to note that the civil society and the business sectors are actively participating in the response.

Shortly, a presentation will be made on the Report, and its findings correlating HIV/AIDS, human development, poverty and gender. I hope this Report will be a useful tool for all of us who are engaged in addressing HIV/AIDS and development to find pragmatic ways to fight the epidemic and minimize its negative impact on humanity.

Looking forward to joining hands with all of you, I thank you for your attention.