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Stronger leadership needed at every level in fight against HIV/AIDS says UN Secretary-General Kofi Annan
Press release SG/SM/9418 AIDS/77
United Nations
July 11, 2004

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Following is Secretary-General Kofi Annan's address to the XV International AIDS Conference in Bangkok, 11 July:

I am delighted to be here today, among so many leading lights in the fight against HIV/AIDS. It is the dedication and resolve of people like you that is our best hope in the struggle.

It is fitting that we are meeting in Thailand, which has had such remarkable success in curbing the spread of HIV/AIDS. Prime Minister, your recipe for success was a powerful combination: visionary political leadership at an early stage of the epidemic; allocation of serious resources; strong civil society involvement; along with massive campaigns for public awareness and condom use promotion. Thank you, Thailand, for showing us that progress is possible. Continued leadership is now crucial in ensuring that you sustain that success, despite very real challenges.

It is also appropriate that this conference is being held in Asia, where the virus is spreading at an alarming rate. One in four infections last year happened on this continent. There is no time to lose if we are to prevent the epidemic in Asia from spinning out of control.

At this conference, many countries around the world are being represented by their health ministers. But let us be clear: the fight against HIV/AIDS requires leadership from all parts of government -- and it needs to go right to the top. AIDS is far more than a health crisis. It is a threat to development itself.

That is why, three years ago, the Governments of the world made a promise. At the General Assembly Special Session on HIV/AIDS -- the first General Assembly session devoted to a disease -- they pledged to deliver the resources and action needed to defeat the epidemic. They adopted a number of specific, time-bound targets, in a document we know as the Declaration of Commitment.

Three years on, there has been progress on many fronts.

Significant new resources have been pledged, both by individual Member States and through the Global Fund to Fight AIDS, Tuberculosis and Malaria.

The vast majority of Member States have adopted comprehensive, national strategies to combat HIV/AIDS.

Increasingly, Governments are working with civil society as a full partner in the struggle.

And yet, we are not doing nearly well enough.

We failed to reach several of the objectives the Declaration set for last year.

Even more important, we are not on track to begin reducing the scale and impact of the epidemic by 2005, as we had promised.

Meanwhile, over the past few years, we have seen a terrifying pattern emerge: all over the world, women are increasingly bearing the brunt of the epidemic.

Women now account for nearly half of all adult infections. In sub-Saharan Africa, that figure is around 58 per cent. Among people younger than 24, girls and young women make up nearly two thirds of those living with HIV.

And yet, one third of all countries still have no policies to ensure that women have access to prevention and care. Knowing what we do today about the path of the epidemic, how can we allow that to be the case?

It is clear that if the Declaration of Commitment is to live up to its name, we will have to do much, much better on several fronts.

Today, allow me to outline three specific areas we must focus on.

First, we need to scale up infrastructure to support both treatment and prevention.

Successful programmes in Africa, in Latin America, and here in Asia, have demonstrated that prevention and treatment can work in any setting, but only if:

• interventions are scaled up to reach whole societies;
• they are developed inside the country, rather than imposed from outside;
• there is strong engagement by people living with and affected by HIV; and
• there are enough trained people to implement successful programmes from community centres for awareness-raising, counselling and testing, to clinics for treatment and care.

That means doing everything possible to ensure that health workers living with HIV have access to anti-retroviral therapy. In many of the most affected countries, AIDS drives a cruel and vicious circle by striking at those who are most badly needed to fight the epidemic.

It means stepping up efforts to train new people, and calling in reinforcements among health workers not yet involved in the struggle.
And it means drawing on unconventional capacity where formal skills may be lacking. Enlisting and empowering untapped talent among community workers, volunteers, and people living HIV/AIDS will both help to scale up the efforts and contribute to breaking the stigma and silence.

No less pressing is our second priority: empowering women and girls to protect themselves against the virus.

Why are women more vulnerable to infection? Why is that so even where they are not the ones with the most sexual partners outside marriage, nor more likely than men to be injecting drug users?

Usually, because society's inequalities puts them at risk -- unjust, unconscionable risk.

A range of factors conspires to make this so: poverty, abuse and violence, lack of information, coercion by older men, and men having several concurrent sexual relationships that entrap young women in a giant network of infection.

These factors cannot be addressed piecemeal. What is needed is real, positive change that will give more power and confidence to women and girls. Change that will transform relations between women and men at all levels of society.

In other words, what is needed is the education of girls.

Only when societies recognize that educating girls is not an option, but a necessity, will girls and young women be able to build the knowledge, the self-confidence and the independence they need to protect themselves from HIV/AIDS.

Once they leave school, we must work to ensure they have job opportunities, as well as enjoy the rights to land ownership and inheritance that too many are denied today.

And we must ensure they have full access to the practical options that can protect them from HIV -- including microbicides, as they become available.

That brings me to the third priority: stronger leadership at every level -- including at the top.

Leadership means showing the way by example:

• by breaking the deadly wall of silence that continues to surround the epidemic;
• by achieving the cultural shift needed to fight it effectively;
• by working to scale up the response -- including providing treatment to all those who need it.

We need leaders everywhere to demonstrate that speaking up about AIDS is a point of pride, not a source of shame. There must be no more sticking heads in the sand, no more embarrassment, no more hiding behind a veil of apathy.

Your leadership must then translate into adequate resources from national budgets. It must mobilize the entire state apparatus, from Ministries of Finance down to local governments, from Ministries of Education to Ministries of Defence. And it must generate partnerships with every sector of society -- business, civil society, and people living with HIV/AIDS.

But leadership comes not only from those who hold positions of power. Leadership comes from partners who make sure they always use a condom. Leadership comes from fathers, husbands, sons and uncles who support and affirm the rights of women.

Leadership comes from teachers who nurture the dreams and aspirations of girls. Leadership comes from doctors, nurses and counsellors who listen and provide care without judgement. Leadership comes from the media who bring HIV/AIDS out of the shadows, and encourage people to make responsible choices.

Leadership comes from men working to ensure that other men assume their responsibility -- in abstaining from sexual behaviour that puts others at risk.

Leadership means freeing boys and men from some of the cultural stereotypes and expectations that they may be trapped in -- such as the belief that men who don't show their wives "who's boss at home" are not real men; or that coming into manhood means having your sexual initiation with a sex worker when you are 13 years old.

Leadership means finding ways to reach out to all groups, and devising approaches for prevention and treatment that are suited to their needs -- whether young people, sex workers, injecting drug users, or men who have sex with men.

Leadership means daring to do things differently, because you understand that AIDS is a different kind of disease. It stands alone in human experience, and it requires us to stand united against it.

I am grateful to every one of you for joining me in that mission.

Thank you very much.

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