Civil Society Recommendations for the Political Declaration

May 18, 2006


We the Heads of State and Governments and Representatives of States and Governments participating in the comprehensive review of the progress achieved in realizing the targets set out in the Declaration of Commitment on HIV/AIDS on 31 May and 1 June 2006 and the High-Level Meeting on 2 June 2006, 

Note with alarm that we are facing an unprecedented human catastrophe:  today 40 million people are living with HIV, access to treatment is limited with only about one in five people in low- and middle-income countries who need antiretroviral drugs obtaining them, and the disproportionate and increasing burden of HIV/AIDS on women and girls,

Acknowledge that while much has been accomplished since 2001, we have failed to mount a response sufficient to reverse the spread of HIV infection and the toll of HIV/AIDS related illness and death, and that we have fallen short on our efforts to fully implement the Declaration of Commitment and many targets and milestones have not yet been reached,

Recognize that we now have the means to begin to reverse the global epidemic, bring an end to millions of needless deaths, halt further devastation in families and communities around the globe, and make strides towards eradicating poverty and achieving the Millennium Development Goals, 

Recognize that our commitment in the 2005 World Summit Outcome to a massive scaling up of HIV prevention, treatment, care and support, with the aim of achieving the goal of universal access to treatment by 2010 for all those who need it and achieving universal access to reproductive health by 2015, provides us with an opportunity to reverse the HIV pandemic,

Recognize that gender inequality, stigma, discrimination, particularly discrimination based on race and sexual orientation, social exclusion and denial of human rights and fundamental freedoms are major drivers of the global HIV epidemic and must be fully and urgently addressed at all levels of society. 
  
Recognize that to be effective, we must deliver an intensified, much more urgent and comprehensive response in partnership with civil society, people living with HIV/AIDS, and the private sector; to remove the legal, regulatory, and trade barriers that stand in the way to prevention, treatment, care and support; to commit adequate resources; to promote and protect human rights and fundamental freedoms for all; to strengthen health systems and support health workers; to base prevention interventions on evidence of what is effective;  to do everything necessary to ensure access to life-saving drugs and prevention tools; and to just as urgently develop better tools—drugs, diagnostics and prevention technologies, including vaccines and microbicides—for the future.




Therefore, we:

Reaffirm and commit to fully implement the Declaration of Commitment on HIV/AIDS adopted at the twenty-sixth special session of the General Assembly and the outcomes of the major conferences and summits in the economic, social and related fields, and to achieve the Millennium Development Goals, particularly goal 6 to halt and reverse the spread of HIV/AIDS, malaria and other infectious diseases,

Also reaffirm and commit to fully implement the 2005 World Summit Outcome and in particular to scale up HIV prevention, treatment, care and support, with the aim of achieving the goal of universal access to treatment by 2010 for all those who need it;

Welcome the report of the Secretary General, Report on Declaration of Commitment on HIV/AIDS: 5 years later (A/60/736), which outlines progress and challenges in implementing the Declaration of Commitment on HIV/AIDS;

Welcome the inclusive, country driven processes for scaling up HIV prevention, treatment, care and support prescribed by GA resolution 60/224 and facilitated by UNAIDS and its cosponsors, the report of UNAIDS on these processes “Scaling up HIV prevention, treatment, care and support” (A/60/737), and the important recommendations and timelines for rapidly and dramatically improving the quality and scale of HIV prevention, treatment, care and support with a view to achieving universal access contained therein;

Commit ourselves, by the end of 2006, to complete and implement multisectoral national strategies and financing plans, including ambitious national targets, that reflect the urgent need to scale up significantly HIV prevention, care, treatment and support in order to achieve universal access by 2010, with the full involvement of civil society including people living with HIV and AIDS; 

Commit to ensure and enable the involvement of civil society—especially people living with HIV/AIDS in accordance with the GIPA (Greater Involvement of People Living with HIV/AIDS) principles—at all levels of and as equal partners in the national and international response, including in the setting of goals and priorities; allocation of resources; and design, planning, implementation, monitoring  and evaluation of HIV/AIDS policies and programs; 

Request the Secretary-General to commission a report by 2007 on barriers to the realization of the GIPA principles, and to include recommendations to Member States, the UN system, donors, and the Global Fund to Fight AIDS, Tuberculosis and Malaria, on steps necessary to fully support incorporation of GIPA into the global response to HIV/AIDS. 

Comprehensive Services
Affirm the right of all people to comprehensive HIV/AIDS services, including those to help people safely discover their HIV status; to delay progression to AIDS; for diagnosis, prevention and treatment of HIV-associated conditions and opportunistic infections, such as tuberculosis, cervical cancer, hepatitis C and STIs; palliative care; and the full range of prevention and harm reduction services, including services for the prevention of mother-to-child transmission, access to male and female condoms, opiate substitution therapy and clean injecting equipment, information and education, and post-exposure prophylaxis; 

Commit to remove by 2007 major barriers—in pricing, tariffs and trade, regulatory policy, and research and development—to speed up access to affordable, quality HIV prevention commodities, medicines and diagnostics;

Treatment
Commit to accelerate efforts to ensure that at least 10 million people living with HIV/AIDS have access to high quality and sustainable treatment by 2010, with the goal of achieving universal access;

Emphasize the need for accelerated scale-up of collaborative tuberculosis and HIV activities in line with the Global Plan to stop TB: 2006-2015 and investment in new drugs, diagnostics and vaccines appropriate for people with TB-HIV co-infection;

Urge Member States to develop by 2007 clear targets in national treatment and care plans to ensure the inclusion of all vulnerable populations, so that the goal of universal access to treatment, care and prevention is realized in an equitable and sustained way;

Prevention 
Commit to redouble our efforts to ensure that by 2010, at least 80 per cent of pregnant women living with HIV have access to information, counseling and other HIV-prevention services, including in particular antiretroviral treatment in order to more effectively decrease the rates of parent-to-child-transmission, and to ensure that they have sustained access to treatment and care following pregnancy and childbirth; 

Pledge to accelerate efforts to reach the goal of ensuring that by 2010 at least 95 percent of young men and women ages 15 to 24 have access to the information, education, skills, and services necessary to reduce their vulnerability to HIV infection, including by implementing evidence-based prevention strategies, providing access to comprehensive sexual education, and expanding access to youth-friendly services, while safeguarding young people’s rights to privacy confidentiality and informed consent; 

Commit to ensure by 2008 safe blood supplies, consistent application of universal precautions and other forms of infection control, safe and appropriate injections, and other health care practices that minimize the risk of HIV transmission;

Commit ourselves to remove by 2007 all legal, regulatory, trade, tax, tariff or other barriers that block access to effective HIV prevention interventions, commodities and services such as male and female condoms, harm reduction, including opiate substitution therapy and safe injecting equipment and other prevention measures;

Urge Member States to develop by 2007 clear targets in national prevention policies and plans to ensure the inclusion of all vulnerable populations, so that the goal of universal access to treatment, care and prevention is realized in an equitable and sustained way;

Protection and Promotion of Human Rights and Gender Equality

Commit to redouble our efforts to protect and promote the AIDS related human rights of people living with HIV, women and children, and people in vulnerable groups;

Commit to prevent, investigate and provide redress for human rights violations that fuel the HIV/AIDS pandemic, to promote the full realization of the right to the highest attainable standard of physical and mental health and related rights, and in this regard commit to design and implement responses to HIV/AIDS by 2007 in accordance with the UN International Guidelines on HIV/AIDS and Human Rights as well as other international human rights instruments; 

Commit by 2007 to review, adopt, implement, and enforce legislation and policies to protect and promote the rights of people living with and affected by HIV and AIDS, those who are particularly vulnerable to HIV infection, including women and girls, youth, older people, men who have sex with men, injecting and other drug users, sex workers, transgender people, people living in poverty, prisoners, migrant labourers, orphans, people in conflict and post conflict situations, refugees and internally displaced persons, as well as HIV/AIDS outreach workers and advocates for people living with HIV/AIDS and vulnerable groups; 

Pledge to ensure the full enjoyment of human rights for children orphaned and made vulnerable by HIV and AIDS; intensify efforts to register all births, provide legal frameworks for children to access services, and protect their inheritance rights, and request that by 2007 all relevant United Nations agencies review and enhance strategies and measures to achieve these objectives.

Commit to protect and promote the human rights of injecting drug users and, in this regard, by 2007 review and reform drug policies and legislation that restricts their ability to exercise their right to the highest attainable standard of physical and mental health and access services for HIV prevention, treatment, care and support, including harm reduction measures, such as opiate substitution therapy and clean injecting equipment; 
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Commit to take all necessary measures to create an enabling environment for the empowerment of women and to protect and promote their full enjoyment of all human rights and fundamental freedoms, including their sexual and reproductive rights, including by enacting and enforcing laws and policies to protect their rights to own property and inheritance, in order to enable them to protect themselves from HIV infection.

Recognize that violence against women and girls, inter alia rape, including marital rape, female genital mutilation, incest, early and forced marriage, violence related to trafficking and sexual and economic exploitation increases their vulnerability to HIV/AIDS, that HIV infection further increases women’s and girls’ vulnerability to violence, and that violence against women and girls contributes to the conditions fostering the spread of HIV/AIDS and create, reform and enforce legislation to protect women and girls from violence, and, in this regard, stress that women have the right to have control over and decide freely on matters related to their sexuality, including their sexual and reproductive health, free of coercion, discrimination, and violence 

Build and Sustain Human Resources and Systems
Adopt large-scale measures to strengthen human resources to provide HIV prevention, treatment, care and support and to enable health, education and social systems to mount an effective AIDS response, including by inter alia adopting alternative and simplified delivery models, and supporting existing health workers and the development of a cadre of community based health workers through improving working conditions, training and remuneration and other measures;

Commit to support the strengthening of national health and social systems, inter alia through the better integration of HIV/AIDS and other services, including prevention, care and treatment for tuberculosis, hepatitis C and other co-infections with HIV, treatment for substance use, child health, nutrition, social protection systems for orphans and vulnerable children and caregivers, primary health care, and sexual and reproductive health;

Research and Development 
Commit to invest in research and development of new prevention technologies, including vaccines and microbicides, as a critical element of a comprehensive response to HIV/AIDS, and commit that by 2010 to reach the target of US$1.2 billion for vaccine research, as defined by the partners of the Global HIV Vaccine Enterprise and to expand the human capacity and the scientific and health system infrastructure of developing countries.

Financing
Commit to secure sufficient resources to finance rapidly scaled up HIV prevention, treatment and care programs, estimated to be between 18 billion and 22 billion US dollars by 2008, from domestic and international sources, including through developed countries working towards meeting the target of providing 0.7% of GNP as official development assistance to developing countries and developing countries allocating at least 15% of national budgets to the health sector;

Further commit to support and strengthen existing financial mechanisms, including providing sufficient resources to approve yearly rounds of proposals for the Global Fund to fight AIDS, Tuberculosis and Malaria, through the provision of funds in a sustained and predictable manner, whilst generating additional funds through innovative approaches, and identifying by 2007 more flexible mechanisms for funding civil society to deliver services to the community; 

Commit to ensuring that international institutions and donor policies support more expansionary fiscal and monetary policies by national governments, so that spending on rapidly scaled up comprehensive HIV/AIDS programming is commensurate with needs;

Commit to ensure that access to comprehensive HIV/AIDS services is in no way dependent on the ability to pay, with the removal of user fees for all basic heath services, and support is provided for social protection measures, such as cash payments for carers, nutritional support and payment of school fees, that mitigate the economic impacts of AIDS, in particular to address women’s disproportionate burden of care;

Pledge to provide the highest-level commitment to ensure that all costed, inclusive, sustainable, credible and evidence-informed national HIV/AIDS plans should be fully funded without the imposition of conditionalities, and implemented with full transparency and effectiveness;

Trade
Commit ourselves to encourage bilateral, regional and international efforts in promoting price negotiations, bulk procurement, price negotiations, and licensing to lower prices for HIV prevention, diagnostic and treatment commodities;

Agree to make use of the flexibilities as outlined in the World Trade Organization’s Agreement on Trade-Related Aspects of Intellectual Property Rights, as well as in the Doha Declaration on TRIPS Agreement and Public Health, to increase further affordability of medicines that are currently available and that will be developed in the future to address public health problems such as HIV/AIDS, including production of generic medicines, microbicides, vaccines, diagnostic kits and other essential drugs, including paediatric formulations of antiretroviral drugs in ways that strengthen health care delivery;


Strongly urge the United Nations system, the Global Fund to Fight AIDS, Tuberculosis and Malaria, and other international and regional organizations, to adopt the measures and timelines recommended in the Report of UNAIDS on “Scaling up HIV prevention, treatment, care and support” (A/60/737), to support efforts by Member States to finalize and implement credible, costed, evidence-informed, inclusive and sustainable national HIV/AIDS plans and in achieve the targets outlined above;

Commit ourselves to participatory reviews at the General Assembly of AIDS responses to ensure mutual accountability at all levels on an annual basis and to comprehensive reviews and high-level meetings, in 2008 and 2011, to assess implementation of the Declaration of Commitment on HIV/AIDS and progress towards scaling up towards universal access to HIV prevention, treatment, care and support.












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