When the HIV pandemic is finally contained, the Red Cross Red Crescent volunteers will have mobilised a key part of the response. Their work, and that of the communities in which they live, is central to our message today.
This contribution was acknowledged in the Declaration of the UNGASS on AIDS in 2001, as we all committed to scale up. However, the potential of almost 100 million volunteers is still not fully realised. Ministries of Health cannot do the job on their own, so need to do their part in ensuring their partners can deliver auxiliary roles and functions that ministries cannot deliver.
The Federation has convinced WHO '3 x 5' and World Bank MAPS projects that volunteer mobilisation is part of the health service system, but so far this part of the system in the community is under-funded, under-developed and under-appreciated.
Nevertheless the Federation has pushed ahead with keeping its promise to scale up, of course focused on building household level capacity. We can cite many instances of excellent work in care and treatment, prevention, reduction of stigma and discrimination, and in partnership with people living with HIV/AIDS. However, a large gap remains between needs and extent of mobilisation, and few countries have a comprehensive response.
Isolated instances of excellent work, at small scale, simply do not do the job. However, with insufficient investment in community mobilisation it is almost impossible to scale up without compromising on quality. Most funding is channelled to country-led responses, but so far little of this funding reaches beyond ministries and to the places where a real difference can be made through community involvement.
In our view, which is shared by many of our partners, especially in civil society, four areas of weakness need urgent attention in the global HIV/AIDS response:
1. Prevention. The current response is a bit like putting a band-aid on a broken arm. Without wishing to denigrate this approach, we have to advance beyond an energetic implementation of 'ABC' to address gender inequity and other underlying causes of vulnerability.
With WHO's '3 x 5' there is an urgent need to revitalise prevention, or treatment roll out will create a public health disaster rather than progress. The 'AB and C' approach does not address the risks women face. If abstinence programming is implemented in isolation and neglects the skills of young people, it still leaves them at risk when sexual activity begins.
Similarly, the 'be faithful' strategy does not by itself remove the threat of exposure to infection faced by huge numbers of women. Skills are needed for marriage and the management of the high level of risk inherent in 'be faithful' arrangements. This means that both partners must be empowered to the point that they can comfortably and regularly review their arrangements, even to the point of withdrawal if the necessary high level of trust is not there. It also means that condom promotion needs to be widespread and backed up with access to quality condoms.
Regrettably, infection rates continue to rise dramatically, so we are forced to conclude that the policy approaches on which the international community has been relying are not succeeding. One reason is that approaches in different countries, and sometimes in different regions in the same country, are not consistent. This has led many people at community level to lose their faith in prevention as a means of containment of the epidemic, which in turn deepens their sense of hopelessness and fatigue.
2. Empowerment. Traditional medicalised approaches that do not fully engage PLWHA cannot mobilise high levels of treatment compliance. The human resources of all are needed to respond to this emergency. Those living with HIV, and those at risk of HIV must be allowed and encouraged to contribute their all.
Our experience in the Red Cross Red Crescent network is that PLWHA are very willing to contribute, but the level of stigmatisation and ignorance is so high that this willingness is dismissed. Testing for HIV is not the same as testing for poor eyesight. Again, our experience shows that HIV testing must be within an empowering process, and this only happens when health providers enter into partnership with the people they serve.
Living with HIV and complying with complex treatment regimes for life, requires high levels of motivation. Voluntary counselling and testing, particularly when provider initiated, must be an empowering process to ensure PLWHA are not turned into passive recipients of care, but encouraged to be central to their own care in partnership with health care providers.
All those involved in empowerment must play their parts, including health care professionals. Doctors and nurses need to overcome their stigma and discrimination against PLWHA, and learn to engage with the health system operating in the home as well as the clinic.
3. Partnership. Resources for the community based response are not reaching those who can mobilise them. Not only are Red Cross and Red Crescent volunteer networks under-utilised and under-resourced, but the problem is much worse for PLWHA organisations.
Despite their central place in empowerment and prevention, and community education, they receive so little support that it is a miracle that they exist at all. Their work, without significant resources, speaks volumes for their dedication.
We in the International Federation and National Societies urge Ministries of Health in particular to prioritise effective partnering with PLWHA and other community-based groups in their countries, and to ensure the provision of adequate resources for the partnerships, in recognition of their central role in containing the spread of the epidemic.
Volunteer effort and community mobilisation is very cost effective, but it is not free.
4. Inclusion. Discrimination against PLWHA has not been overcome, even in health care settings. Despite long ago agreeing to do so, most countries have yet to enact anti-discrimination legislation to protect PLWHA and marginalised groups vulnerable to infection.
The International Federation has consistently raised this as an urgent issue in UN and other bodies responsible for anti-discrimination work, and our commitment has a key place in the Pledge we delivered to the International Conference of the Red Cross and Red Crescent in December 2003.
As a UNAIDS Collaborating Centre to reduce stigma and discrimination in partnership with GNP+, the International Federation has mobilised 120 national societies to participate in 'The Truth about AIDS' 'Pass it on….' and 'Come closer…' campaigns to overcome myths about HIV transmission so that PLWHA are included.
The 'Come closer…' campaign recently had a high profile during the Eurovision Song Contest, and our hope is that a strong message against stigma and for inclusion will be received by youth all around the world. This action is a good indicator of partnership involving the Ukrainian Red Cross Society and a large number of community groups, with the support of the Government.
Many other speakers in this debate have noted the place of work against HIV/AIDS within the UN Millennium Development Goals. We strongly share the view that the MDGs will not be achieved unless they are pursued in an integrated fashion.
This requires a clear understanding of the pandemic, of what works and what does not, and of the place of partnerships to help communities overcome the problems as only they can.
That is why the International Federation is such a willing partner of government and other civil society actors. It is our hope now that partnerships can be built which will help galvanise a community-driven response equal to that which mobilised to support those who suffered after the tsunami struck their countries in December 2004.
Without that spirit of generosity and commitment, from the whole world, it is difficult to see real success in the struggle against HIV/AIDS.
That is the world's challenge, and we in the International Federation and its member National Societies are mandated to do our part.
It is a challenge we will discuss with WHO in the cooperation advanced by the joint letter signed by our Secretary-General and Dr Lee just before this Assembly, as well as with other partners.