Clark: HIV Prevention - What can be done to get to Zero New Infections?
Statement by Helen Clark
Administrator of the United Nations Development Programme
On the Occasion of the High Level Meeting on AIDS
Panel 2 on “Prevention – What can be done to get to Zero New Infections?
Wednesday, 8 June 2011, New York
“What stands in the way of getting to zero new infections? How do we renew HIV prevention 30 years into the epidemic?”
While the global annual rate of new HIV infections declined by nearly 25 per cent between 2001 and 2009, the epidemic continues to outpace the response. Two people were newly infected for each individual who started antiretroviral therapy in 2009.
To get to zero new infections, there must be a massive focus on prevention. If we are prepared to do whatever it takes, we can beat this epidemic.
So what must be done ?
First, we need to get rid of stigma and discrimination. We need to tackle the health and social inequalities, the myths, and the violence which drive the HIV/AIDS epidemic, stand in the way of effective prevention and treatment, and stop people from being able to live their lives with the dignity each one of us deserves as a human being.
We have to confront head on the social, sexual and gender norms which drive vulnerability to HIV. Particular issues here are:
- gender inequality, violence against women and girls, and their disempowerment in many societies;
- discrimination against homosexual and transgender people, and in many places the criminalization of their sexual behaviour;
- the marginalization and often criminalization of people who use drugs;
- the particular vulnerability of sex workers and prisoners; and
- the denial of adequate information and support to young people to enable them to make safe choices.
Second, successful prevention needs strong leadership at all levels to bring HIV out of the shadows, to encourage people to make responsible choices, and to drive interventions which will meet the needs of vulnerable groups.
Presidents, prime ministers, ministers, and parliamentarians; community and faith leaders; village elders; businesses; women’s, civil society and youth organizations - all have roles to play. So too do sexual partners to make sure that they practise safe sex, and fathers, husbands, and sons who support and affirm the rights of women and girls in families and communities.
Third, legal frameworks need to accommodate effective responses to HIV. So often the law stands in the way of reducing risk and vulnerability, and of spreading access to treatment and prevention services.
Where human rights are not upheld, genuine universal access to services is impossible.
In many countries, we see effective HIV responses undermined by the broad criminalization of HIV transmission and exposure and of other behaviours and practices.
The Global Commission on HIV and the Law convened by UNDP on behalf of the UNAIDS family is compiling evidence on how legal environments impact on HIV responses. It will make recommendations on how to make the law more conducive to fighting the epidemic.
Fourth, there is the matter of funding the HIV/AIDS response, and making every dollar count by applying resources where they are most needed and on effective interventions.
Where HIV is prevalent in the general population, effective prevention strategies are needed for couples in which one person is living with HIV and for those people in multiple concurrent partnerships.
In other settings, where HIV is concentrated among injecting drug users, sex workers and their clients, and/or men who have sex with men, strategies need to be focused on meeting the specific needs of those populations and to be scaled up.
Recent studies suggesting that the drugs used to treat HIV/AIDS may also reduce its transmission highlight the importance of significantly scaling up treatment programmes.
In summary, with strong leadership at every level; with a willingness to tackle inequality, stigma, and discrimination; with a determination to change laws which impede effective responses; and with sufficient and well targeted resources, we can strive for zero infections through renewed attention to prevention strategies.
“What are the targets that are most important to support prevention? What is the significance of treatment for prevention? How are rights integral to prevention?”
There is renewed hope for an HIV prevention revolution.
A recent study has suggested that if an HIV-positive person adheres to an effective antiretroviral therapy regime, the risk of transmitting the virus to their uninfected sexual partner may be reduced by 96 per cent.
This could be a game changer in approaches to prevention, and make HIV treatment an important prevention option too. In other words, increasing access to antiretrovirals may also help break the chain of HIV transmission.
Still, we cannot treat our way out of the epidemic. We need to deploy all available prevention options to make the vision of “zero new HIV infections” a reality.
“Treatment for prevention” also requires individuals to know their HIV status before they opt to take antiretroviral therapy. This again raises the importance of the right laws, strong leadership, and zero discrimination.
Overall, countries need to be ambitious in setting targets for both prevention and treatment. With sufficient resources and coverage of quality prevention and treatment services, we can improve HIV, health, and development outcomes for many millions of people.
All moves we make on advancing gender equality and empowering women and girls will help too. Globally, slightly more than half of all people living with HIV are women. Women and girls must have access to an essential package of quality sexual and reproductive health services where they are treated with dignity and respect, and they are entitled to live free of violence, coercion, stigma, and discrimination.
People with HIV are our most important partners in prevention, especially those in couples where only one person is infected. We also need to target other prevention efforts more effectively, paying particular attention to young people at risk; those who inject drugs; men who have sex with men; transgender people; and female, male and transgender sex workers. Coverage of prevention services remains low for all these groups.
About one third of new HIV infections are among under-25 year olds. Progress toward the goal set in 2001 of ensuring comprehensive HIV knowledge among young people has been slow. Young people need to be reached with effective prevention programmes before they are sexually active or are exposed to other high risk behaviour like drug use.
Harm reduction and drug dependence treatment programmes reach less than ten per cent of the people who inject drugs worldwide. Yet, this group is experiencing some of the fastest growing rates of HIV.
The Global Commission on Drug Policy has reported recently that countries which have implemented evidence-based harm reduction policies have been able to achieve consistently low levels of HIV among drug users. Conversely, countries which have continued to resist implementing harm reduction programme at sufficient scale are experiencing explosive HIV epidemics among injecting drug users.
Men who have sex with men are nineteen times more likely to acquire HIV than the general population in low and middle income countries; yet it is estimated that fewer than ten per cent of them have access to HIV prevention interventions.
Turning the tide on HIV also requires us to uphold the human rights of the very people societies so often misunderstand, stigmatize, or exclude. Without upholding their rights, we will not be effective in meeting their HIV and health needs.
Two thirds of countries have laws and/or policies which stand in the way of key at risk populations getting effective prevention and treatment services. That has a direct bearing on coverage rates of services, and reinforces negative social attitudes towards at risk populations.
We need to expand coverage of human rights- and evidence-based prevention to at risk populations to halt and reverse the spread of HIV.
Sexual transmission accounts for about 80 per cent of all new infections. Tackling the epidemic requires having frank and honest discussions about topics which may make some people uncomfortable.
It requires getting rid of the stigma and discrimination which fuel the epidemic, and partnering with those groups living with HIV or vulnerable to infection, so that we can focus resources where they are needed and on measures which have been proven to work.
Effective responses require strong leadership at all levels, predictable resources, and supportive legal environments.
HIV prevention and treatment are integral to achieving the MDGs, including the targets related to poverty reduction, achieving universal primary education, promoting gender equality, reducing child mortality, improving maternal health, and combating tuberculosis.
We need a 21st century Marshall Plan for prevention. With all partners working together, we can turn the tide on HIV, and improve HIV, health, and development outcomes for countless millions of people.