Making the money work for the people on the ground - Dr Peter Piot speaks at ICASA 2005

Africa?’s leading forum for discussion of HIV developments and trends on the continent, the 14th International Conference on AIDS and STIs in Africa (ICASA), opened on 4 December in Abuja. Speaking at the opening ceremony, UNAIDS Executive Director Peter Piot underlined the priority to ensure that funds are available to those who need it.

Dr Piot's speech follows:

Presidents, Excellencies, colleagues and friends,

It is an honour and a pleasure to be with you today, among so many old friends and comrades who are truly at the frontlines of this continent?’s response to HIV/AIDS.

I am speaking here on behalf of the Secretary-General of the United Nations, Mr Kofi Annan. He is unable to attend but has asked that I reiterate his steadfast personal commitment to Africa?’s AIDS response and convey his best wishes for a successful conference. I?’m also joined here by senior representatives of the 10 UNAIDS cosponsors and together we are committed more than ever to give priority to Africa?’s efforts.

Excellencies, friends,

It is because of your collective efforts, at every level, that there has been more progress in Africa?’s HIV/AIDS response in the past couple of years than ever before. And while this progress has come about because of the dedication of many, many people, let me begin by saluting the exceptional leadership of President Obasanjo, Chairperson of the African Union and President Konare, Chairman of the Commission, for their determination in confronting this epidemic.

There is no doubt that we have traveled a long distance in recent years.

Since the last ICASA in 2003 in Nairobi, the money available for the HIV/AIDS response in sub-Saharan Africa has nearly tripled. Because of this, the response to HIV/AIDS has entered the era of implementation.

At the time of the Nairobi conference 75,000 Africans were on antiretroviral therapy ?– by June 2005, about half a million were.

At the time of the Nairobi Conference, only one country had a well documented nationwide decline in HIV prevalence ?– Uganda. Two weeks ago the UNAIDS/WHO AIDS Epidemic Update announced that in 2 additional African countries such a decline is now firmly happening ?– in Kenya and in Zimbabwe.

While there are many reasons for the fall in HIV prevalence in several African, Caribbean and Asian countries the major reason is that HIV prevention efforts are working! In all these countries, there is strong evidence of changes in behaviour ?– people have increased their use of condoms, are delaying the first time they have sexual intercourse, and are having fewer sexual partners.

But for all this proof that HIV/AIDS is a problem with a solution ?– it is still the case that this epidemic continues to far outstrip our efforts to halt it.

There were more people newly infected with HIV in sub-Saharan Africa in 2005 than in any previous year ?– about 3.2 million adults and children. Could there be clearer evidence of our failure to reach every single person with effective HIV prevention programmes?

Over half of all new infections were among young people with the worst toll on young women. Could there be clearer evidence of how this crisis continues to endanger Africa?’s future generations?

And more Africans died of HIV/AIDS in 2005 than in any year so far ?– about 2.4 million adults and children. Could there be clearer evidence of our collective failure to reach the ?‘3 by 5?’ goal for HIV treatment access?

Friends,

It is clear that in Africa the response to HIV/AIDS has entered a new era ?– the era of implementation.

And for the first time the political commitment exists to work towards universal access to HIV prevention and treatment, as expressed at the UN World Summit in September, the African Ministers of Health Summit in Gabarone and the G8. But getting there will require that once more we change gear and further accelerate the response to HIV/AIDS. We have no other option that will save entire societies.

How will we get there?

First, we need to make the money work for the people on the ground. It requires all of us to become truly committed to inclusive ownership, efficient management, transparency, accountability and coordination. We need nothing less than the brightest brains and the best managers if we want to have a chance to take HIV/AIDS programmes to the scale that is needed. A major outcome of the Nairobi conference in 2003 was the development of the now familiar ?‘Three Ones?’ principles. In the meantime we have learned the hard way that poor coordination costs lives. The UNAIDS family is now working hard to get its own act together by implementing the recommendations of the Global Task Team on improving coordination and serve better the interests of the people of Africa.

Second, if we are to reach all the people, we need to get serious about capacity - not only in the health and social sectors but also of the many grassroots initiatives that have emerged across Africa in response to HIV/AIDS, led by people living with HIV, by the churches and mosques and by local business. Donors should stop funding grants for HIV/AIDS programmes without a strong capacity building component and governments and NGOs should stop accepting them.

Building capacity will also require that the role of the public sector be strengthened ?– not undermined! ?– by national and international fiscal policies otherwise it is the poor who suffer.

Third, to have the greatest impact on the course of the epidemic, we must scale up HIV prevention and HIV treatment programmes jointly. And remember: anything that has the word ?‘only?’ doesn?’t work for HIV/AIDS! Be it prevention only, treatment only, abstinence only, condoms only or male circumcision only. I wish it were different, but whether we embark on HIV prevention or HIV treatment, we will only be successful if we use a sound combination of actions.

Nonetheless, strategies that include the use of condoms for HIV prevention are of course essential ?– and as at ICASA 2003 let me voice my concern again about the huge shortfall of condoms in sub-Saharan Africa. There is no way to do effective prevention with just 4 condoms available annually for every African man!

Finally all these agendas should come together under the umbrella of the new movement for universal access to HIV prevention and treatment.

The full speech can be downloaded on the righthand side of this page