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| (Speech Check against Delivery) Dr Peter
Piot UNAIDS Executive Director's speech at the JOINT LEARNING
INITIATIVE ON CHILDREN AND HIV/AIDS: International Symposium.
Harvard Medical School. 24 September 2007. |
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| I first want to thank Jim Kim, Peter Bell,
Agnes Binagwaho for inviting me here today, and to pay tribute
to the tremendous work they and all of you are doing. It
is a privilege to be here today with so many experts and activists.
The issue of children and AIDS was overlooked for far too long.
UNAIDS was one of the first to welcome the creation of the Joint
Learning Initiative on Children and AIDS, and I look forward
to hearing about the progress you've made. |
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| Let's start by looking at progress on AIDS
in general. It's a mixed picture, but there definitely is progress. |
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| Today, 2.5 million people in developing
countries are taking anti- retroviral treatment up from 100,000
in 2001. |
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| And in some populations in East Africa,
the Caribbean, and Asia, HIV infections are falling. |
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| But if HIV is declining in some populations,
it is rising in others. In some Asian countries there's an upsurge
in HIV infections among men who have sex with men, but infections
are declining in other groups. The most striking overall increases
have taken place in East Asia, Eastern Europe, and Central Asia:
the number of people living with HIV went up by one fifth here
between 2004 and 2006. |
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| Globally, young people (15-24) accounted
for 40% of new HIV infections last year. |
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| One in seven new HIV infections last year
occurred among under- fifteens. By the end of 2006, 2.3 million
(1.7-3.5 million) children (under 15) were living with HIV. |
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| Let's just remind ourselves that the United
Nations Convention on the Rights of the Child defines children
as people up to the age of 18. |
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| But AIDS epidemiologists compile information
for under fifteens and for 15-24-year-olds. Lack of disaggregated
data for children makes it even harder to take effective action
on their behalf. |
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| One reason for this is the feminization
of the epidemic: almost half of all adults living with HIV are
women. Only one in ten pregnant women with HIV in low and middleincome
countries receives anti- retroviral prophylaxis to prevent transmission
of HIV to their children. Every year, more than 500,000 children
are infected via transmission from their mothers. |
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| But this is just one way children become
infected with HIV. Sexual abuse is another. |
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| The second (and main) way is through sex
whether it's between young girls and older men, sex between
adolescents, or sex between trafficked girls or boys and clients,
sexual violence and rape, or incest. |
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| A third cause of infection is injecting
drug use, which often starts in adolescence. In Russia, 76%
of all people living with HIV are or have been injecting drug
users. |
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| This is all fuelled by ignorance about
HIV transmission. It's amazing how prevalent this still is in
2007. I've just come back from China where most young people
have barely a clue about how HIV is transmitted. |
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| At the same time, only one in ten children
needing HIV treatment can get it even though paediatric drug
formulations are much more widely available, and the price of
antiretroviral drugs for children has dropped in some cases
to less than 16 US cents per day. Just 4% of children born to
HIV-positive mothers receive cotrimoxazole, which WHO recommends
providing to children when early diagnosis of HIV infection
is unavailable. In Botswana and Zimbabwe, child mortality rates
have nearly doubled since 1990. |
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| Last eek UNICEF reported some remarkable
declines in child mortality throughout the world, for the first
time fewer than 10 million children under five died except
in countries with high HIV prevalence and those in conflict. |
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| More than 15 million children worldwide
have now been orphaned by AIDS over 12 million in Southern
and East Africa. Orphan populations are increasing in some populations
in Asia, Latin America and the Caribbean, and Eastern Europe
too. |
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| This much we know. Now let me turn to what
we don't know. |
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| We are constantly striving to know more
about the AIDS epidemic, through better and more accurate data
collection. But there's still a long way to go. |
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| Today's surveillance categories are too
broad and too blurred. Collecting data for children up to the
age of 15 and then for young people between the ages of 15 and
24 doesn't give us the sort of information we need: there's
a huge difference in terms of action between HIV infection at
15 and acquiring HIV at 24. |
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| We need much more refined data about different
age groups. We also need to distinguish between the different
categories of orphan "double", "one parent", maternal and
paternal. And we need to become much more systematic in pinpointing
the differences between epidemics within countries. |
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| We also need to re-evaluate the way we
perceive the issue of children and AIDS. As so often happens,
we have tended to only do this through the medical lens, with
a primary focus on mother to child transmission. But this is
to over-simplify, and to ignore critical social and rights-related
issues. |
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| One problem is that we don't know enough
about what these issues are. We sense that AIDS is breaking
up families and communities and challenging traditional safety
nets. We know that the impact on household welfare is greater
on the poor than on the better off, and that gender inequities
make girls more vulnerable than boys. We are aware that it is
threatening children's rights - civil, political, economic,
social and cultural. |
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| And then there's the new reality: older
children living with HIV. In recent years, I've been meeting
increasing numbers of HIV positive adolescents and young adults. |
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| But we often still lack hard, empirical
data: the impact of AIDS on children remains under-researched
and poorly understood. We simply don't know enough about what
is happening. That's why the Joint Learning Initiative is so
badly needed. |
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| Now let's look at what action is being
taken today. |
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| It's nearly 20 years since world leaders
decided that people under 18 needed their own convention. That
convention - the 1989 United Nations Convention on the Rights
of the Child, famously ratified by all UN Member States except
the US and Somalia stresses the importance of making the "best
interests of the child" a primary consideration and lists a
series of rights. These include such basics as information,
education, non-discrimination, health, social security, an appropriate
standard of living, to be protected from violence and different
forms of exploitation, and the right not to be separated from
their parents. All are critical if children are to grow up to
live safe and healthy lives in a world with AIDS. |
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| Since then, a series of international meetings
and declarations have highlighted the urgent need to address
the issue of children and AIDS. But to what extent are these
declarations being acted on? |
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| A few countries have substantially increased
access to services to prevent transmission of HIV from parents
to children. For example, in Argentina, Botswana, Jamaica, and
Ukraine, more than 85% of HIV- positive pregnant women received
antiretroviral drugs to prevent transmission of HIV to their
children. |
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| Some countries - including Botswana, Rwanda,
and Thailand - have scaled up HIV treatment for children by
integrating it into treatment sites for adults. Thailand is
getting antiretrovirals to more than 95% of the under-15s in
need. |
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| Several countries in southern Africa have
provided child grants and other benefits on a national scale.
Kenya, Malawi and Mozambique have piloted cash-transfer programmes
in poor areas. |
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| In 58 countries surveyed last year, 74%
of primary schools and 81% of secondary schools said they were
providing AIDS education. This is critical if adolescents are
to protect themselves from infection. To be effective, AIDS
education must fulfil the right to information (as required
in the Convention on the Rights of the Child). It must provide
information about all risks, and offer a broad palette of prevention
options including abstinence, condoms, and measures to address
inequalities between girls and boys. |
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| More efforts are being made to see that
children get a fair share of AIDS funding. A number of donors
including the US and UK have earmarked at least 10% of their
AIDS money to go towards services for children. |
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| And lastly, more is being done to integrate
services to forge links across diseases and sectors and bring
partners closer together. In Kenya, Rwanda, Tanzania and Zambia,
strategic investment of AIDS funding is improving services such
as immunization and antenatal care. And Norway's Women and Children
First Initiative sets out to provide a continuum of care for
mothers, newborns, and children. |
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| Many organizations are providing support
to help countries look after their children better. UNAIDS co-sponsor
UNICEF, for example, has made tackling children and AIDS one
of its top priorities |
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| In 2005, UNAIDS joined UNICEF to launch
"Unite For Children, Unite Against AIDS", which sets targets
for scaling up "The Four Ps": prevention of HIV transmission
from mother to child, paediatric treatment for HIV, prevention
of HIV among adolescents and young people, and protection and
support for children affected by HIV |
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| And as Peter mentioned earlier, civil society
groups the Elizabeth Glaser Paediatric Foundation, the Ecumenical
Advocacy Alliance and, of course, the Francois-Xavier Bagnoud
Association are doing tremendous work. |
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| But most importantly of all, communities
are responding and adapting to the new realities around children
and AIDS often with tremendous resilience. So how do we build
on this progress and intensify its impact? |
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| We're here today because there are no simple
answers to these questions. |
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| AIDS, as many of you have heard me say
before, is an exceptional issue in terms of its threat to
humanity and its complexity. The Joint Learning Initiative was
itself born out of recognition that the issue of children and
AIDS is immensely complex and that it requires a complex response. |
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| I would like to suggest seven elements
that I regard as key to making that response effective. |
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| First, it must be firmly grounded in human
rights principles in line with the 2003 Comment on the Convention
on the Rights of the Child that "the child should be placed
at the centre of the response to the pandemic, and strategies
should be adapted to children's rights and needs". To be effective,
those strategies have to work equally well for seven-year-olds
as seventeen-year-olds. |
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| Second, it must involve a wide range of
actors not least the children concerned, their parents, grandparents,
and members of the communities they live in. This means bringing
children and family members including those living with HIV
- to the table when programmes are designed. |
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| Third, it must prevent new HIV infections
for example by scaling up access to services to prevent mother
to child transmission and by making HIV prevention more available
and accessible to adolescents. By addressing vulnerability and
though I know this is controversial by preventing sexual
transmission. Universal Access to HIV prevention, treatment,
care and support is not only for adults |
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| Fourth, it must provide treatment for children.
This will mean scaling up testing and counseling, and making
antiretroviral drugs and cotrimoxazole more easily available.
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| Fifth, it must provide adequate levels
of social welfare to children infected and affected by HIV,
and to their families and communities for example through
cash transfers |
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| Sixth, it must be fully funded at international
and national level. This means more money for children and AIDS
from international donors and a higher priority for children
in national development plans. At UNAIDS, we estimate that $2.7
billion will be needed for programmes for orphans and vulnerable
children in 2008. |
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| And finally, as I mentioned earlier, it
must be based on more accurate information. |
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| This means not just improving surveillance
but also clarifying how children become vulnerable, looking
more closely at socio-economic contexts, and intensifying research
into psychosocial impacts and responses. It means looking at
children in the contexts of their families and communities,
improving monitoring and evaluation systems, studying how households
cope and what local care-giving practices involve. |
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| To turn this wish-list into reality, high
levels of political will and commitment will be required. To
inform and drive the process forward, we will need a growing
body of knowledge about children and AIDS. |
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| We will need evidence from successful interventions
to show what can be done. And we will need sustained activism
to make sure the right action is taken now and in the years
to come. |
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| This brings me to my conclusion: it is
time now to bite the bullet and start thinking and acting in
the context of the longer term something we have repeatedly
failed to do up to now. Here, children clearly have a major
role to play. |
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| We need to be confident that what we are
doing now works on two levels both now and in the years to
come. We must take steps now so a girl born today doesn't grow
up to produce an HIV positive baby and so children born with
HIV get anti-retroviral treatment and live longer, healthier
lives. |
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| This means doing what you are doing in
the Joint Initiative: taking a long, hard look at what we are
doing, identifying what works and coming up with new approaches
and new research to address new trends. |
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| It means working together in a coherent
fashion, on long-term, integrated programmes: the day of the
short-term, ad-hoc project is over. |
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| And it means ensuring that our response
is comprehensive, flexible and anticipatory - tailored to different
epidemics and ready to change as epidemics evolve: AIDS doesn't
stand still, and the world around it is not standing still -
nor can we. |
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| Thank you. |
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