It is a particular honour for me to be able to address the Economic Commission for Europe, and to be able to link aspects of the Commission's work on economic conditions in Europe to the work being done by the International Federation of Red Cross and Red Crescent Societies to combat the crippling effects of the HIV/AIDS pandemic and associated diseases.
The opportunity to speak to this situation is available today because of the excellent work done by the ECE Secretariat and UNFPA in organising the European Population Forum in January this year. That Forum stands as one of the most successful and informative regional activities marking the tenth anniversary of the International Conference on Population and Development, held in Cairo in 1994. It's success should be marked as a real achievement for ECE.
The background document for this item on the Commission's agenda cover this Conference and its European follow-up in some detail, but only up to the preparatory stages for the Forum, and we are indebted to the Executive Secretary for her introductory presentation on what happened at the meeting. We are also grateful to the Swiss Government for the production of an excellent Summary of the Deliberations during the Forum, and it is from them that I would like to offer some remarks.
The International Federation profoundly hopes that the attention which was given by the Forum to HIV/AIDS as an urgent top priority issue for Europe will be taken up by the Commission. The Summary of Deliberations makes it clear that HIV/AIDS cannot be seen as a simple health problem - it has an overwhelming impact on social structures and economies, and must be addressed with that understanding clear. In our view it is an issue that should be mainstreamed into all agenda items with potential relevance to the topic.
I will not go over the statistics related to HIV/AIDS infection in Europe - they are well-known - other than to note that the size of the problem and the numbers of new infections already pose issues of social and economic stability in some European countries. These are issues at the top of the agenda of the European Red Cross Red Crescent Network on HIV/AIDS and TB (ERNA), which I have the honour to chair.
ERNA, with membership from virtually all the National Red Cross and Red Crescent Societies in Europe, is embedded in the struggle against HIV/AIDS with the mission of raising the capacity of National Societies to take an effective role in partnership with their governments and civil society. ERNA works in a wider partnership environment with UNAIDS, WHO, UNFPA, GNP+ and ENP+, and I look forward to the opportunity to expand our cooperative relationship to include ECE in the future. ERNA is headquartered in Bratislava, and we would be glad to welcome any visitors from ECE member states wishing to know more about what we do.
We are often asked what HIV/AIDS has to do with economic policy questions. The answer is easy. HIV/AIDS, in Africa and prospectively in many other parts of the world including the eastern regions of the ECE map, is shredding societies of their most productive human resources. It is creating situations of poverty and despair, and removing any chance of prosperous stable growth for the communities concerned. It is the worst such catastrophe since the Black Death 700 years ago and there is no upper limit to what it might do. It is a problem which is sometimes difficult to measure through official statistics, for experience has shown that many governments are willing to deny the problem until it is too late to address it in a meaningful or constructive way.
This denial by affected countries is matched, most regrettably, by failure on the part of too many other countries to recognise the global nature of the catastrophe, and to contribute to the mechanisms set up to help combat the pandemic. The most notable of these is the Global Fund to fight Aids, TB and Malaria (GFATM), on the Board of which the International Federation is represented.
The experience of the Global Fund is worth noting in this context. It was established in 2002 as a broadly based response to the identified crippling effects of the pandemic, with partnerships including governments, international organisations, NGOs and the private sector. Its goals were straightforward, and its funding requests were modest, given the scale of the problem and the gravity facing all humankind.
Many promises were made, but it has proved exceptionally difficult to translate those promises into actual financial resources. The International Federation strongly supports advocacy aimed at translating those pledges into delivered commitments, and does so in tandem with the national-level efforts of its member National Red Cross and Red Crescent Societies.
GFATM and the International Federation share a common concern, which we trust will also be shared by ECE, to gain commitments from pharmaceutical companies and governments to a long-term continuous program guaranteeing universal access to anti-retroviral drugs and other drugs used against opportunistic infections. We have been pleased by the interest of some leading pharmaceuticals manufacturers to the presentations we have made, but we believe this is a program area which could be furthered by the active involvement of ECE. It is of critical importance, for access to and the use of anti-retroviral drugs has proved to be the most effective measure to save human life and limit the damage the pandemic would otherwise do to communities and national economies.
I said at the outset that I would not bring statistics into this presentation. I do, however, want to use some to show the situation now faced by Europe. " Almost 2 million people were living with HIV/AIDS in Eastern and Central Europe at the end of 2003.
- Approximately 5 persons are infected with the virus every minute.
- Estonia, Ukraine and the Russian Federation are the worst affected countries, but sharp rises in infection rates are being reported from Latvia, Lithuania, Moldova, Belarus and Kazakhstan. The disease is reaching epidemic proportions in Kyrgyzstan and Uzbekistan - where more than 50% of those living with Aids are young people.
- Ukraine, with a prevalence rate of approximately 1% now should be compared with South Africa, which had a prevalence rate of 0-7% in 1990. If we don't attack the problem now, we could be facing the current South African prevalence rate of 24.8%. This is what we must address, now.
- Evidence from many countries points to a very low level of public awareness about the means of transmission. This is an eminently correctable problem, and Red Crescent work in Uzbekistan has already won the Society a best practice award.
- One of the principal transmission factors in the region is the high incidence of drug injection among youth, including the sharing of needles. 75% of infections in Ukraine are traceable to increasing drug use. These are among the reasons why the International Federation has now accredited a Permanent Observer to the UN Offices in Vienna, with a particular focus on the Office on Drugs and Crime.
- The simultaneous emergence of TB co-infection is a matter of the most serious concern in the region.
With respect to economic indicators, the following summary might also be helpful to the Commission:
- HIV/AIDS has already started to reduce the labour force in some countries, both through an increased death rate and a reduced productivity rate among affected workers.
- The impact on youth (62% of those infected in the Russian Federation) has dramatic consequences for the labour force and its sustainability.
- Some projections for the economy of the Russian Federation suggest that GDP in 2010 will be 4.15% lower than it would have been without the severity of the HIV/AIDS pandemic.
- In the region as a whole, economic growth rates will be lower and health care costs will be much higher if the pandemic is unchecked.
- An increasing number of children will be forced out of school and into employment to care for their families, reducing the human capital of future generations.
I should also note that the International Federation has been most impressed by the quality of the work done by UNDP on this issue in Central and Eastern Europe and the CIS. The recent report entitled "Reversing the Epidemic: Facts and Policy Options" [http://www.undp.sk/hiv/?english] provides many cogent arguments in support of the position I am articulating today.
The International Federation does not expect ECE to be able to solve these problems, but we do appeal to you make the kind of contribution that an organisation like yours is best equipped for. We ask you to
- Work energetically for improved statistics on HIV/AIDS and its impact. Build understanding among policy-makers of the socioeconomic impacts of HIV/AIDS and associated infections.
- Fund the Global Fund. Commitments must be met if there is to be any prospect of ending the epidemics of AIDS, TB and malaria.
- Work with us in the Red Cross Red Crescent, and civil society, to ensure access to affordable treatment for HIV/AIDS and opportunistic infections, including through alliances with the pharmaceutical industry, and to emphasise and provide Voluntary Treatment and Counselling (VCT),
- Support harm reduction programs, including needle and syringe exchange, and substitute treatment.
- As part of this, actively support programs that reach the main transmission factors, MSM, CSW, IDUs, and immigrants. This means that heterosexual transmission is a much bigger problem in Europe than most people are willing to admit.
- Support anti-stigma programs and ensure anti-discrimination legislation is in place to protect all vulnerable groups and individuals.
- Work with and build partnerships with Red Cross Red Crescent Societies and their International Federation, and with all relevant civil society organisations. (Please note that governments need these partnerships if they are to do their work effectively. Civil society needs them too, and above all the population needs the partnerships, without which there cannot be adequately protection and support for those most at risk).
- Include the relevance of HIV/AIDS as a mainstream issue in all agenda items of potential relevance, with a view to making a substantial contribution to the elimination of the pandemic as required by the Millennium Development Goals set as a priority for the whole international community by the United Nations General Assembly.
It is the International Federation's earnest hope that ECE will move in the same directions as the other regional commissions of the UN system and take up the challenges this issue poses. They are deeply intertwined in the Cairo outcome from 1994, and can be discussed in that context, but it is now time for ECE to take them into these challenges into own context.
It is critically important that Europe recognises these challenges now, although it may already be too late for some countries. Nevertheless, we are very pleased to see the priority that the European Union attaches to the issues, with the meeting earlier this week in Dublin organised by the Irish Presidency (at which I had the honour to chair a panel on partnerships) standing as an excellent example of what can and must be done. The Dublin Declaration, issued only yesterday, should motivate all governments in Europe and the world to build the partnerships which are so critical to the prospects of progress.