As the disease strides ahead with greater determination from obscurity to a global emergency, the question before each nation should be: why is the pandemic outpacing us, or are countries acting too slowly to address the menace that has killed 25 million people and affected another 40 million worldwide?
In early June, when heads of state gathered in New York for the review meeting to the United Nations General Assembly's Special Session on AIDS (UNGASS), the world watched with expectation. Instead what were mouthed were platitudes without specific action plans and firm commitments.
UN Secretary General Kofi Annan asserted that the 2001 UNGASS Declaration of Commitment had "galvanized global action..... and helped guide national decision-making." True. The 2001 UNGASS was a landmark in global efforts to the AIDS crisis because for the first time in the history of the pandemic, the Declaration, signed by leaders from 189 countries, had set out a series of time-bound targets to halt and reverse the disease.
The 2006 Report on Global AIDS Epidemic revealed that the epidemic is slowing down globally and there is a five-time increase in international funding to $8.3 billion in 2005. But the harsh reality, according to the report, is that a condom was used on average in only nine per cent of "risky" sex in the past year. Less than 10 percent of pregnant women with HIV have access to the relatively simple drug treatments that prevent mother-to-child transmission: the main reason why three million children were born with HIV in the past five years. More than 15 million children in the world have been orphaned by AIDS and receive practically no care or support.
India's performance too created dramatic headlines. According to the report, India was leading with 5.7 million HIV infections followed closely by South Africa's 5.5 million. The 'panic and shock' the announcement created was because the world always believed that India ranked second after South Africa. The numbers game was solved when it was discovered that the figure in the report prepared by UNAIDS includes children below 14 years and adults above 50 years. For unknown reasons, India's National AIDS Control Organisation (NACO) bases its estimates only on the 15-49 years age group.
But the real concern for India is not to confine itself to quibbling over ranking but asking hard questions as to why despite the commitment to halt and reverse one of the most challenging diseases, the pandemic proliferated. Despite some progress in expanding access to HIV prevention and treatment, why has, since UNGASS 2001, there been 32 percent rise in HIV infection in the country? And why have, for example, only 2.74 percent HIV-affected pregnant women received antiretroviral (ARV) therapy, when the UNGASS goal is 20 percent coverage, as a result of which there are thousands of HIV-affected newborns? Why is it that despite the Indian government's promise to provide free ARV drugs to 100,000 people living with HIV/AIDS by the end of 2005 it postponed the target date?
The UN high-level review, instead of a frank analysis and commitment on resources to urgently fill the funding gap of $10 billion to reach universal access to prevention and treatment, came out with a weak declaration. "Three painful drafts later, the irresponsible language being proposed by some countries is bordering on the criminal!" said Aditi Sharma of ActionAid International, who along with other global NGOs, had organised a protest march to the UN headquarters during the meet.
Vulnerable groups such as intravenous drug users, sex workers and gay men have been made invisible in this document. Even the mention of the word "condom' - essential in the prevention of the spread of HIV infection - has disappeared from the UN lexicon. NGOs are also outraged that critical women's rights issues that are central to the goal of halting the pandemic - such as the right to health and the right to live free of sexual coercion and violence - are now perceived to be 'controversial'.
Said Anandi of India HIV/AIDS Alliance: "The countries were backtracking, and we ended up fighting to hold on to the 2001 UNGASS commitment. We did not move forward."
At an earlier meeting, UNAIDS head Peter Piot had commented that he hoped the UNGASS 2006 review will not be "one of those summits where we say: 'We've failed, we've failed, and we have no results and we need more money,' and then we go home." Unfortunately, his apprehensions may turn out to be true.
India, for one, needs to examine honestly why it failed in meeting the targets. Perhaps then it can lead Piot and the world into galvanised action - but only if nations have the courage to first admit collective failure in making available care and treatment for people affected by HIV/AIDS.