U.N. Adopts a Global Plan to Fight AIDS

After rancorous debate, the U.N. General Assembly agreed Wednesday on the first global action plan to battle the AIDS pandemic, laying out tough targets over the next decade for reducing infection rates and protecting the rights of those with the disease.

“After today, we shall have a document setting out a clear battle plan for the war against HIV/AIDS, with clear goals and a clear timeline,” Secretary-General Kofi Annan said at the end of a three-day conference here. “It is a blueprint from which the whole of humanity can work in building a global response to a truly global challenge.”

The declaration says in part that by 2003, governments should craft national strategies to combat acquired immune deficiency syndrome and start making treatment widely available. By 2005, comprehensive prevention, education and health-care programs aimed at curbing the disease should be in place.

Pregnant women and breast-feeding mothers who have the virus that causes AIDS increasingly should receive treatment to prevent transmission to their babies, with the goal of reducing the number of infants infected with HIV by 20% in four years and 50% by 2010.

Document’s Language Proves Contentious

Nearly every element of society affected by the disease showed up at the conference, as almost 3,000 diplomats, activists, scientists and health experts convened to exchange ideas. But not all groups were clearly represented in the final 16-page Declaration of Commitment, which was adopted by acclamation in the 189-member General Assembly.

Strong objections by Islamic and other conservative countries kept references to high-risk groups such as homosexuals, prostitutes and intravenous drug users out of the final text. Such language would have offended moral and religious sensitivities, they argued, and run up against some countries’ legal restrictions on homosexuality and even the use of condoms.

In a last-minute compromise after the conference nearly collapsed this week over the dispute, negotiators bridged differences with diplomatic euphemisms. Instead of saying “countries will” carry out the commitments outlined in the document, the text says countries will “commit to address” them.

Rather than mentioning “men who have sex with men,” the substitute language refers to those who are at risk due to “sexual practice.” Prostitutes are mentioned as those vulnerable to infection due to “livelihood” and prisoners as those at risk through “institutional location.”

In exchange for diluting that language, all parties agreed to a vigorous clause on women’s rights.

“In the last two days, some painful differences have been brought into the open--but that is the best place for them,” Annan said. “Like AIDS itself, these differences need to be confronted head on, not swept under the carpet.”

Many AIDS activists criticized the world body for not spelling out the ways in which the disease is transmitted. But others, such as Zambian health worker Jennifer Chiwela, said it was the clear targets in the document--not semantics--that mattered.

“I believe it will change a few things,” she said. “Now we have a document, a tool we can use to urge the government to act and hold them accountable.”

At Least $7 Billion Sought for Global Fund

Overriding the conflicts were the surprising agreements. Groups from the Vatican to ACT UP, a radical activist organization, concurred on the importance of lowering prices on drugs to make treatment available to everyone who is HIV-positive. Javier Lozano Barragan, a representative of Pope John Paul II, said collective need outweighs the importance of profit or the protection of intellectual property.

To help governments and grass-roots groups implement the goals outlined in the document, Annan has called for gathering $7 billion to $10 billion in new funds. He cited a recent Harvard University study estimating that the disease has cost the world $500 billion so far in lost productivity and health-care expenses, and he said his ultimate goal of “$10 billion a year is eminently sensible.”

By the end of the conference, Annan’s Global Fund for AIDS and Health had garnered more than $700 million in pledges, plus promises by countries to increase spending for their own programs. The Bush administration so far has pledged to contribute $200 million to the effort. More donations are expected at next month’s meeting of the Group of 8 industrial nations in Genoa, Italy.

But as the possibilities for solutions proliferate, so does the wrangling over how the money will be distributed and who most deserves help. Asian leaders lamented that the conference focused too heavily on Africa, home to 25 million of the estimated 36 million people worldwide infected with the human immunodeficiency virus, which causes AIDS. Asia and Eastern Europe have the fastest-growing infection rates, they argued, and so resources should flow there. Some African leaders countered that they had the greatest immediate need.

Women Get Special Mention in Declaration

Groups such as the U.S.-based Health Gap Coalition said more money should be focused on treatment for people already infected, while others made the case that financing prevention programs is much cheaper and more effective.

And health workers such as Pearl Nwashili, who educates prostitutes and their truck driver customers in Nigeria, said women deserve the biggest piece of the pie.

“There’s a triple whammy for women,” she said. “They are hit as lovers, as mothers and as caregivers. They will give their last bite of food to a child or a husband who is ill. But when they are sick, who cares for them? Women deserve a special allocation of any new funds.”

The declaration does make special mention of women’s role at the forefront of the fight against AIDS, and the need for them to help shape society’s response to the disease.

“It has been said that ‘girl power’ is Africa’s own vaccine against HIV,” Annan said Wednesday, “and that should be true for the whole world.”