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U.N. proposals. The United Nations is undertaking a massive campaign to generate the political leadership and the resources necessary to contain the disaster. "Half-measures do not work against this epidemic," says Peter Piot, Executive Director of UNAIDS. At the General Assembly, the United Nations proposed that an AIDS fund be established with contributions from governments and private enterprises worldwide. To prove how serious a commitment it was making, the world body appointed Richard Holbrooke, former U.S. Ambassador to the U.N. and veteran mediator in the Balkan conflict, as president of the Global Business Council (GBC), a group of international firms that will lead private-sector support for the fight against AIDS. Coca-Cola, AOL, Unilever and Viacom are among the multinationals participating in the GBC.

UNAIDS estimates that from $7 billion to $10 billion is required every year to meet basic AIDS prevention and care needs worldwide. The goal is to reach that amount by the year 2005. Currently, about $2 billion is invested in such efforts annually.

The U.N. Declaration of Commitment on HIV/AIDS includes a compendium of the social and economic ills that represent obstacles to be overcome in the fight against AIDS. The declaration demands that governments commit themselves and demonstrate unwavering leadership in this fight, and urges them to adopt national plans and multisector strategies that directly address the epidemic by 2003.

Among the key goals established by the U.N. are: to reduce HIV prevalence by 25 percent among men and women aged 15 to 24 in the most affected countries by 2003 and globally by 2010; to provide appropriate information to 90 percent of people in the same age group by 2005 and to at least 95 percent by 2010; to reduce the proportion of infants infected with HIV by 20 percent by 2005 and by 50 percent by 2010; and to address factors affecting adequate provision of HIV-related drugs by 2003.

The declaration also lists economic objectives such as debt relief for the most affected countries and increased international development aid.

A new attitude. Until recently, the highest-level social and political leaders in Latin America and the Caribbean, as well as the general public, appeared unaware of the true scope of the AIDS problem in the region. Some leaders have voiced skepticism about the scale of the epidemic and sent lower-level officials to international conferences and symposiums.

During the U.N. special session, however, the statements made by the Latin American and Caribbean delegates showed a marked change. "If urgent measures are not taken now, we are going to see infection rates as high as in the most affected countries," declared the representative for Argentina. "We have a basically heterosexual epidemic, and our country is one of the most affected in the Americas," noted the Dominican envoy. "In Colombia, AIDS cases have tripled in just two years," reported the Colombian representative. "Our national program estimates that 50 percent of cases go unreported," said the Guatemalan delegate. "An unprecedented number of children are being orphaned," noted the envoy from Guyana. "I think that the key is increasing citizen awareness and community planning," said the representative of Panama. "No other problem is compromising the future of our people as seriously as HIV infection," stated the Peruvian delegate.

Breaking the silence and building partnerships. Now that they are fully aware of the scope of the problem, what do the nations of Latin America and the Caribbean need to do to overcome the crisis? The Global Strategy Framework, drawn up by the U.N. in June, clearly and decisively establishes objectives and guidelines. But an example to be followed can be found in the region itself: Brazil has become a model for addressing AIDS and is already reaping excellent results (see sidebar at right).

According to Piot, (see interview at right), the region needs to go further in raising awareness of the problem and showing strong political leadership to combat it. In other words, it needs to break the silence. Among Piot’s recommendations: launch aggressive public information campaigns; treat the epidemic like a development problem as well as a health problem; eliminate the stigma associated with the disease; and, above all, protect the most vulnerable groups–youth, children and women.

Another key to success, lies in regional partnerships. Dr. Mirta Roses, assistant director of PAHO, advocates strategic planning to achieve national commitments to fight the disease, stronger surveillance systems, social communication and behavioral interventions, and enhanced support systems. During her stay in New York, she urged building on the foundation that has already been laid. The Shared Agenda for Health in the Hemisphere was signed by the IDB, the World Bank and PAHO "as a way to foster our values of equity and pan-Americanism to attain health and development in the Americas."

K. Burke Dillon, IDB executive vice president, expressed the Bank’s commitment to fighting AIDS at the U.N. meeting and explained the kind of support the Bank can provide. "One area where we have extensive experience is in strengthening national health systems," she said. "The Bank will look for opportunities to address HIV/AIDS across the spectrum of our projects," she said. Quoting Piot, she added, "investments that do not consider AIDS are poor investments."

Date posted: September 2001

Brazil: Against the odds
HIV/AIDS clouds the Caribbean
Peter Piot: The cost of silence