By David Brown
Washington Post Staff Writer
Saturday, June 3, 2006
UNITED NATIONS, June 2 -- Delegates to a United Nations conference on AIDS reached agreement Friday after difficult negotiations on a policy declaration that sets no targets for the number of people who should be treated and makes only indirect reference to high-risk groups such as homosexuals, prostitutes and intravenous drug users.
The statement, however, contains language acknowledging the "feminization" of the global AIDS epidemic, as well as the importance of teaching young people about the disease and the need for drugs specifically formulated for children.
The eight-page statement, completed early Friday morning, is a compromise that provided victories to the United States, which opposed numerical treatment targets; Islamic countries, which did not want "vulnerable populations" spelled out in detail; and many activist groups that sought statements that empowering women is a tool against AIDS.
The new "Declaration of Commitment" updates one adopted five years ago that proved crucial in turning resources and attention to AIDS in the developing world.
Response to the document varied among the 800 civil society groups attending the three-day meeting. It was the largest participation of outsiders in U.N. history.
"The final outcome document is pathetically weak," said Sisonke Msimang, a South African activist from the African Civil Society Coalition. "It is remarkable at this stage in the global epidemic that governments cannot set the much-needed targets, nor can they name in the document the very people that are most vulnerable."
But others praised the acknowledgment of the links between AIDS and gender inequality, an assertion that women should have control over their own reproductive health, and language condemning "harmful traditional and customary practices, abuse, rape and other forms of sexual violence."
"From that perspective we feel that we have gained ground," said Zonny Woods, a Canadian with the International Women's Health Coalition, in New York. "In that regard I would say it is a success."
Peter Piot, the Belgian physician who directs UNAIDS, called it "a strong declaration that will move response to AIDS forward," although he said of the reluctance "to name the unnamable groups, here I agree with the activists."
Piot was among many who had called for the declaration to lay out targets for dollar amounts to be spent on AIDS and for the fraction of people who should be getting drug treatment and testing, or prevention interventions during pregnancy. The previous policy document in 2001 contained all of those.
The new one mentions $20 billion to $23 billion as an "estimate" for annual needs starting as of 2010, but it does not commit donors or recipient countries to come up with that amount. There are no clinical targets set out.
An American official not involved in the negotiations said one reason the U.S. delegation opposed numerical targets is that they might be construed as committing money for global AIDS in advance of actual appropriations requested by the executive branch and voted on by Congress.
The contentious negotiations were led by the U.N. ambassadors from Thailand and Barbados and featured many countries acting as blocs.
Numerous African nations agreed earlier this year in Abuja, Nigeria, to push for a common position -- that 80 percent of pregnant women have access to drugs preventing transmission of the virus to their infants, that 80 percent of the population have access to testing and that 80 percent of infected people needing antiretroviral drugs get them, among other goals.
The Africa Group, however, fractured with the defection of Egypt and South Africa from that position and by the alliance of Gabon with several Islamic countries in opposing language in favor of the "empowerment of girls." This helped doom the naming of goals.
"The continent that is most ravaged by AIDS has demonstrated a complete lack of leadership. It is a sad, sad day as an African to be represented by such poor leadership," Omololu Falobi of the African Civil Society Coalition said in a statement released at the end of the meeting.
The Organization of the Islamic Council, a bloc of many Islamic countries, opposed even using the term "vulnerable groups" to describe sex-industry workers, gay men and drug users. The Rio Group of South American countries favored naming them. An American official familiar with the negotiations, who demanded anonymity to describe confidential discussions, said the U.S. delegation had no strong position on the matter.
The phrase "vulnerable groups" appears several times in the final document, and the declaration also contains references to specific materials that the people at risk need to protect themselves: "male and female condoms and sterile injecting equipment."
The document asserts the importance of "harm-reduction efforts related to drug use" -- a reference to needle-exchange programs, which the United States has opposed as a matter of policy under both Republican and Democratic administrations. Some activist groups, however, wanted the declaration to go further and criticized it for not mentioning "substitution therapies" for opiate addiction, such as methadone.
Yesterday's General Assembly began with a speech from Laura Bush, who praised her husband's $15 billion, five-year global AIDS plan, including its effort to train health-care workers in affected countries. Many have been leaving for higher-paying jobs abroad.
The first lady also put in a plug for literacy, one of her personal causes, calling it especially important "for women and girls, so they can learn to make wise choices that will keep them healthy and safe."
The meeting featured a cavalcade of prime ministers, presidents and one king, Mswati III of Swaziland. More than 140 people spoke.
For the first time in its history, the General Assembly divided itself in half and had people speak simultaneously in two rooms in order to fit their speeches into one day.