P Piot: South African AIDS conference

5 June 2007

Madam Deputy President
Mrs Machel
Dr Shisana
Ms Mavasa
Friends and colleagues

To reduce HIV and AIDS globally, South Africa should succeed

It is good to be back in South Africa. I was last here two years ago and
there have been many changes since then; some for the better, some still
difficult.

One obvious change for the better is the one of the world's largest
anti-retroviral treatment programmes. By the end of 2006, more than 360 000
people were taking anti-retroviral therapy with remarkable progress in just two
years. The scale of programmes to prevent the transmission from mothers to
children, and paediatric treatment, is now starting to catch up, but
slowly.

On the downside, up to 500 000 people are still being infected with HIV each
year. We have seen the emergence of deadly extreme drug-resistant tuberculosis
(TB) strains in every province, and more people are dying from AIDS than ever
before.

Nevertheless, this conference takes place at a time of new energy and new
hope. There is an expanded National AIDS Council that brings together
government, civil society, and business. You have an ambitious and credible new
five-year National Strategic Plan for AIDS.

Seven years ago, many of us met here in Durban at the 2000 International
AIDS conference. That conference marked a watershed in the global response to
the epidemic because, for the first time, it was possible to discuss developing
country access to anti-retroviral treatment and a global movement was
initiated.

Today's meeting could be another turning point. If South Africa can achieve
its aims, the country will be well on the way to leading Africa into a new
phase in the AIDS response.

Globally, while the epidemic continues to expand, spreading fastest of all
in Eastern Europe and Central Asia. Twelve thousand people are newly infected
every day; half of them women worldwide, at the same time 8 000 die, making
AIDS the worlds top cause of death for 15-59 year olds and the fourth highest
cause of death for people of all ages.

We have made some real progress. By the end of last year, two million people
in low and middle-income countries were receiving anti-retroviral therapy. In
many populations in East Africa, the Caribbean, and Cambodia, HIV infection
levels are falling. Finally! In others, however, there are worrying signs that
the gains of the nineties are being lost.

In Uganda, Thailand, and Western Europe, HIV infections are edging up again
due to a lethal combination of complacency among populations and their
leaders.

Over and over again we see that effective leadership depends on strong
activism and bold personal commitments from those in power. In more than 40
countries, the National AIDS Council is currently led by the President, Vice
President, or Prime Minister. Madam Deputy President, it is good to see you in
charge of South Africa's AIDS Council.

A strong global AIDS response depends on maintaining high level
international political leadership. This is not easy, given the many other
important issues competing for politicians' attention, such as poverty, climate
change, and economic instability. But this is exactly the league AIDS is
in.

The challenge is further complicated by the mixed messages circulating
around the world. Denialist statements such as that "UNAIDS overestimates the
size of the epidemic," and "There is too much money for AIDS" do not help, not
least because there is clearly a massive gap between what is needed and what is
available.

So I am pleased that last month my new boss, Secretary-General Ban Ki-Moon
he pledged that AIDS would remain a priority for the United Nations, and
promised to "make every effort to mobilise funding for the response to AIDS,
now and in the longer term".

AIDS is a crisis by any standard.

Nowhere is this truer than here in southern Africa, where the epidemic has
thrived on decades of colonialism, migration, gender inequality and apartheid,
combined with denial and inadequate action on AIDS.

But making the plan is just the beginning. The real work starts now. UNAIDS
is committed to support this work by strengthening capacity in the National
AIDS Council Secretariat to co-ordinate, monitor, and evaluate progress.

The first task will be to prioritise what is most important.

I believe that there are a number of key areas where investment now will
reap rewards for South Africa in the short and longer term.

The first of these is to scale up and sustain quality prevention programmes.
Our ambition should be nothing less than a new, HIV free generation. Currently,
for every one person who starts taking anti-retroviral therapy in South Africa,
another five become infected with HIV. If we do not reduce infection levels
today, tomorrows treatment bills will be exorbitant, and millions more will
die.

To reduce infections it will be vital to tackle the gender inequalities that
fuel the epidemic. This will involve changing some deep-rooted traditions and
practices. A better programme to reduce violence against women is another, but
the first step is for us men to stand up; speak out; and live up to our
responsibilities.

It is encouraging to see that, building on the 1994 National Plan, this new
plan aims specifically to address the needs of migrants, sex workers, and men
who have sex with men. But it will be critical to bring the millions of South
Africa's marginalised men into the mainstream.

A third priority is to maintain momentum on treatment, and to ensure greater
equity among those accessing it.

And to support equity in services, the investment of human resources in
health must be treated as a human right.

A fourth key element will be to scale up the prevention of transmission of
HIV from mother to child. This should be a simple thing to do, but only 30
percent of pregnant women have access to these services. This represents a
major missed opportunity to integrate HIV services into the regular health
system particularly antenatal and reproductive health services.

Finally, it will be vital to change to a higher gear on tuberculosis (TB)
control. The emergence of extremely drug resistant TB strains is a dramatic
wake-up call: if we do not factor and integrate TB into everything we do, we
will get nowhere.

The National AIDS Plan represents an incentive for all of us, wherever we
work, to take a cold, hard look at what we are doing and to change what needs
to change. Failure to reach the ambitious, but necessary, goals would be a
collective failure on all our parts. Nobody can remain on the sidelines.

One key change we must make is in the way we work. This is a major
preoccupation for us at UNAIDS.

Another is the need to keep one eye fixed permanently on the future.

Friends, the pressure for you to succeed is intense. Fortunately, you are
well placed to do so.

Admittedly, South Africa has its problems. Although the economy is robust,
the difference between the haves and the have-nots is staggering. South African
doctors and nurses are among the best in the world, but too many of them are
not working in the public sector. Levels of violence are shocking.

Nevertheless, the health system has established some good models for HIV
treatment and prevention. The constitution and judicial systems are strong. You
have some world-class activists. Cutting-edge research is going on here in
Durban and in other cities that can inform and influence global policy on
AIDS.

In sum, you have a better chance than any other country in the region to
deliver on AIDS. If you cannot, who can?

South Africa is also part of the new world in the making. It can link up
with the other key players in Africa to keep AIDS high on regional agendas.

You are in a position to leverage important elements of commitments made by
the African Union and the South African Development Community.

South Africa is also in a position to build alliances with the fast emerging
economies of Brazil, Russia, India and China to negotiate better deals on HIV
drugs. Together, these countries can play a lead role to negotiate greater
equity on the AIDS response.

And finally, you have a tried and tested determination to succeed. As you
said earlier this year, Madam Deputy President, "We must dare to dream of an
African continent that is free of HIV, if we dream it we can work for it. If we
are united and committed like we were when we fought apartheid we can conquer."
This is a fitting pledge in the fiftieth year of African independence.

Friends, the road ahead is long and difficult.

As I said ten years ago at the South African governments first
Inter-departmental meeting on AIDS, the end of the epidemic is nowhere in
sight. We are societies living with HIV. Our descendents will still be living
with HIV and its legacy, long after we have gone.

But we can influence what they inherit by what we do now, by ensuring that
what we put in place can be sustained over the longer term.

As I mentioned earlier, for every person who starts taking HIV drugs,
another five become infected.

If we continue like this, the queues for treatment will just get longer and
longer.

The thought of these lengthening queues haunts me. It is constant reminders
of the dilemmas we face as we struggle to deal with today's emergencies and at
the same time avert further crises developing later on. It is a call to us all
to put every AIDS programme to the test: Does it work now? Will it still work
five, ten, twenty-five years from now?

This is why UNAIDS has launched a new project: AIDS2031. AIDS2031 seeks to
answer some of the difficult questions we are grappling with today, so that 50
years after AIDS was identified the world will be in a better place.

Your budgeting commitments have been commendable, but responding to AIDS is
going to get more, not less expensive in the foreseeable future. So we need to
think hard how we pay for an AIDS response in the poorest countries that lasts
not just for years but for generations.

It will be increasingly important that everything we do goes hand in hand
with a collective drive towards social change as South Africa continues to
build a new country and a regenerated continent.

It will be vital to speed up development of new generations of HIV medicines
and vaccines and microbicides.

It is increasingly that arguments that we should "fund health systems not
AIDS" are totally false. Clearly, we have to fund both regular health systems
and AIDS programmes, so that one supports the other!

A long-term view underscores the dangerous naivety of normalising AIDS as a
regular development issue. True, AIDS must be at the core of any development
strategy for southern Africa, but it must also be treated as a distinct and
extraordinary entity.

AIDS demands nothing less than exceptional, and that we can tackle it
through anything less than an exceptional response.

As Chief Justice Langa pointed out last year that, "There is no reason to
believe that we as a nation do not have the capacity to win the fight against
HIV and AIDS. We are a nation that has overcome many obstacles."

South Africa has come a long way. The new AIDS Council and the National Plan
have set a good course for the next five years. But the way ahead is long,
hard, and littered with obstacles. We at UNAIDS are here to support you, and
wish you the very best as you set out to overcome them for the sake of people
in South Africa and Africa as a whole.

Thank you.

Issued by: United Nations
5 June 2007