Remarks by Alec Mally, Counselor, On Agenda Item 46: Implementation of the Declaration of Commitment on HIV/AIDS, in the General Assembly

We welcome this opportunity to focus attention on the continuing fight against HIV/AIDS and thank the Secretary-General and his staff for their great work in putting together an excellent report that underlines the challenge before us.

All of us need to follow through on the Declaration of Commitment. In this spirit, the United States remains focused on action and results in this fourth year of President Bush’s Emergency Plan for AIDS Relief (PEPFAR). PEPFAR is supporting individuals, communities and nations to take control of their epidemic and thus take control of their lives. In selected countries, we are beginning to turn the tide against the HIV/AIDS pandemic. The Emergency Plan reflects the heart of a new approach to development embodied in the 2002 Monterrey Consensus, which calls for country ownership, good governance, performance-based partnerships, and engagement of all sectors.

The Secretary-General’s Report speaks of the commitment to scale-up towards universal access as “not a target itself,” but rather as an emphasis on the need for greater urgency, equity, affordability and sustainability in national responses to AIDS, as well as a comprehensive and multisectoral approach to AIDS. This new model of partnership is already producing encouraging results in the Emergency Plan. Through September 30 of last year, the United States has been privileged to support life-saving antiretroviral treatment for 822,000 people in 15 focus countries and care for 4.5 million people -- including 2 million orphans and vulnerable children. PEPFAR has supported scale-up of the most comprehensive and evidence-based prevention program in the world: evidence-based behavior change messages for millions of people of all ages and social strata, the development of safe blood systems, and services to prevent transmission of HIV from pregnant women to their children during more than 6 million pregnancies, averting an estimated 101,000 infant infections.

One of the most useful suggestions contained in this year’s Secretary-General Report is to "Know your epidemic." We must be aware of what is driving the epidemic in communities, countries and regions, and plan prevention strategies accordingly. Along with “knowing our epidemic,” there are two priority areas where we can have a huge impact and make progress in the scale-up towards universal access to comprehensive prevention programs, treatment, care and support. First, we must recognize that the crisis in human resources for health is limiting the ability of many of the hardest-hit countries, especially in sub-Saharan Africa, to scale up HIV/AIDS prevention, care and treatment services. Human resource needs must be built into national strategies and plans for scale-up, and together we must support those plans. We will also continue working with the World Health Organization and others to promote potential solutions like “task-shifting,” which moves health care tasks from higher-skilled to lower-skilled cadres of health care workers.

Second, so that people can know their status and get treatment if needed, we must work together to promote HIV counseling and testing, including provider-initiated “opt-out” testing. We must ensure that such programs include a focus on stigma reduction and reach populations at highest risk. One way to promote broader coverage of counseling and testing services and stigma reduction is voluntary HIV counseling and testing days. We were pleased when the General Assembly adopted a decision calling for such days to be observed in 2007, and we are working with interested countries to act on this decision in appropriate ways. The 2006 Political Declaration represented a renewal of our commitment to achieve the ambitious goals we set for ourselves through the 2001 Declaration of Commitment on AIDS. What the developing world needs now is for us to fulfill the commitments we have made. The United States looks forward to working with member States and other partners to transform those declarations into a better life for the tens of millions of people living with or affected by AIDS.

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