12 July 2004

A few days ago we saw the start of the XV International AIDS Conference in Bangkok. The fact that the world has not managed to stop the pandemic must be seen as a major failure. This is at least the view of the Director General of the Swedish International Development Cooperation Agency, Sida, which is now intensifying its efforts to combat this devastating disease.

Efforts to stop the HIV/AIDS pandemic must be stepped up: Sweden will play its part

Despite having known about HIV/AIDS for 20 years, the world has failed to stop its spread. This is a political disappointment for the countries hit by the disease, a moral defeat for the international aid community and a failure when it comes to preventing the spread of the virus. Only last year, five million people were infected by HIV, equivalent to more than half the population of Sweden. Experts believe, however, that this is just the tip of the iceberg. We are far from being able to reach the Millennium Goal agreed on by world leaders to reverse the trend of new HIV infections by 2015.

Foremost the pandemic affects the millions of people who die of AIDS every year (22 million up to now) and the 40 or so million who have to live with the disease. Ultimately it also affects the families of those infected, economically and emotionally. Even so, many people do not know their HIV status. There is loss of labour and income, the need fore care giving, as well as treatment costs. One of the worst effects of the pandemic is that there are now 14 million orphaned children in Africa alone.

Nearly 20,000 people, among them the world's leading experts, have gathered in Bangkok for the International AIDS Conference. It is a timely conference. For Sida, the pandemic is viewed as one of the most serious threats ever to development and as much high–level attention as possible need to be brought to that fact. We are therefore now intensifying our efforts to combat the pandemic. We anticipate that between EUR 100 and 200 million of Sida's development cooperation appropriations will be allocated to combat HIV/AIDS. But interventions are not enough - we are also changing our approach. The HIV/AIDS situation will be the point of departure for all development cooperation in Africa.

Sweden and Sida must share some of the blame for the poor progress made in the fight against the disease. We have supported many innovative and effective interventions, but in retrospect we have not managed to support the hardest-hit countries to a sufficiently large extent. We can no longer ignore the wide consequences of the pandemic.

Accountability, leadership and political commitment are corner stones of the global response.

HIV/AIDS has become the greatest obstacle to development in sub-Saharan Africa; around 70 per cent of all those infected live in these countries. In the future, however, it is estimated that half of all new infections will occur in Eastern Europe and Asia. Eastern Europe has the world’s fastest growing epidemic, with the virus moving from risk groups into the general public. Asian countries have relatively low prevalence rates, but because of their large populations have high numbers of people living with the disease. HIV/AIDS is turning into a global disaster.

The virus is as much about rights and gender as it is about sexual and reproductive health.

More women than men are infected in sub-Saharan African and at younger ages. A human rights based approach includes the right to information about sexuality and HIV/AIDS, the right to protect oneself against HIV transmission, the right to care and treatment, and the right to non-discrimination. The fact that people living with HIV/AIDS in rich countries receive life-prolonging treatment, in which is not accessible and affordable in many poor countries, is the height of injustice.

Many low and middle-income countries are scaling-up care and treatment programmes, including provision of antiretroviral drugs. But, for patients in poor countries to benefit, health systems must be strengthened so that they can manage the complex administration of care and treatment.

We are now seeing how entire countries are being affected when so many people die or become ill as a result of the disease. How, for example, can children in Tanzania go to school when many of their teachers have died of AIDS? How can society plans its teacher training when its school authorities and education ministry has been similarly undermined by the disease? How can we alleviate poverty in countries where one in five adults suffers from a fatal disease? This means we cannot continue with “business as usual”; governments must plan for and adapt to the changing situation.

In countries where the epidemic has been curbed, such as in Uganda, Thailand and Senegal, there has been strong political commitment and leadership. Governments in these countries have also joined efforts against HIV/AIDS with civil society. In addition to increasing our support in interventions for HIV/AIDS, we will give priority to these issues in our dialogue with our partners. All HIV/AIDS interventions in the hardest-hit regions will focus on prevention,  care/treatment and support for efforts to alleviate the effects of the disease in the community.

There are though many positive examples of how communities are dealing with the pandemic. In South Africa, I recently met HIV-positive youth working voluntarily to help other sufferers. They are doing a fantastic job in a spirit that radiates both vitality and hope. Their actions are also helping to fend off the shame and hopelessness that so often are associated with the disease. Their attitude also sends a message to us in the rich countries of the world; we shall never surrender to the threat of HIV/AIDS. It is a problem the world is capable of solving. 

Globally the HIV/AIDS response is moving into a new phase with greater political commitment and mobilisation of civil society. Funding is also increasing dramatically. Sida and other donors already provide assistance to important projects being carried out by the Global Fund for malaria, TB and AIDS, UNAIDS and other world-wide actors.

In Tanzania Sida is already financing HIV/Aids interventions through other partners such as UNICEF and several national and international NGOs, particularly with regard to education and communication on adolescent reproductive health as well as support for vulnerable children. Sida will continue to concentrate on prevention activities, which are viewed as essential to the successful outcome of the battle against the pandemic. We will continue working with non-governmental organisations,community based organisations and government agencies in order to respond to Tanzania’s National Multi-sector strategy. Preparations are also on going for an initial three-year contribution to the National Care and Treatment plan which is foreseen to assist HIV positive Tanzanians in accessing medication and treatment.   

I sincerely hope that the Bangkok meeting will help to consolidate this new era. That it takes up HIV/AIDS as a serious threat to development. We must achieve results on the ground.  The world needs to take up the challenge of HIV/AIDS in earnest and start achieving real results. Both the countries hit by the disease and the low prevalence regions of the world need to take their common responsibility. We all have an obligation to act - and there is not a moment to lose!

Maria Norrfalk
Director-General, Sida
Sweden