Speech Date:

17 July 2010

Good afternoon ladies and gentlemen.
I would also like to thank Mrs. Karen Vance Wallace, Executive Director of the Teresa Group, for her kind introduction
 I wish to further thank the organizers, the Teresa Group and the Coalition on Children Affected by AIDS (CCABA), for the invitation to make the closing remarks at this Symposium. In turn, I wish to congratulate you, the organizers, on this excellent two-day symposium, and participants, colleagues and friends, who have enriched it with your knowledge and expertise: drawing attention to and discussing models of family-centred services for children affected by HIV and AIDS from clinical, community, legal and policy perspectives.
Indeed, there are many advancements around children affected by HIV that we should be celebrating in the context of the International AIDS Conference and more broadly as we conclude this symposium. We are truly moving beyond the rhetoric of the importance of greater focus on children, to concrete action toward holistically addressing the needs of children affected by HIV, with a longer term, visionary perspective.
Highlights of such advancements include the symposium becoming an affiliated event of the International AIDS Conference, together with the Youth Pre-Conference and the 2nd International workshop on HIV Paediatrics. This in addition, to initiating with the International AIDS Society, an Award for Children and HIV and AIDS Research, and the launch of a special issue tonight of the International AIDS Society on Family-Centred Services for Children Affected by AIDS, bringing together for the first time in one place, the arguments for family-centred approaches and evidence of the effectiveness of such approaches for prevention, treatment and care. Moreover, the issue and papers presented at this symposium raise awareness of what has been a neglected area – the need for better understanding and more support for the families of people in extremely marginalized groups – men who have sex with men, injecting drug users and sex workers, among others.

And lastly, I wish to congratulate your successful advocacy for a post of Senior Specialist (Health of Vulnerable Children) at the Global Fund to Fight AIDS, Tuberculosis and Malaria to spearhead expansion and improvements in the health of vulnerable children and their families.  Together these achievements reflect the efforts of many people associated with this symposium working on behalf of children and families affected by HIV and AIDS in all parts of the world.
These efforts contribute to my own work in Africa. The continent is vast, well-endowed and young. Its potential is enormous. But this potential is unrealized and cut short by, amongst others, HIV/AIDS, poverty and conflict – and our failure to date to make a significant dent on the combined effects of AIDS, Tuberculosis and Malaria, made worse by hunger, food insecurity and enduring gender disparities.
Africa is entering into the window of a youth bulge – when more of the population is of working-age and there are fewer dependent people who are either young or old. This ‘demographic dividend’ yielded substantial economic benefit in some South East Asian countries who enjoyed the advantage of a greater proportion of educated young people in good health.

However, it is clear that HIV and AIDS has taken a heavy toll on the almost 400 million young people in Africa – 40% of the total population - below the age of 15 , especially girls. Limited progress has been made towards achieving the United Nations General Assembly Special Session (UNGASS) targets contained in the June 2001 Declaration of Commitment (DoC) on HIV/AIDS. In 2000, 36.1 million people worldwide were living with HIV/AIDS, 90 per cent in developing countries and 75 per cent in sub-Saharan Africa. The UNGASS noted, with “grave concern that Africa, in particular sub-Saharan Africa, is currently the worst affected region where HIV/AIDS is considered as a state of emergency, which threatens development, social cohesion, political stability, food security and life expectancy and imposes a devastating economic burden and that the dramatic situation on the continent needs urgent and exceptional national, regional and international action”.
The situation today in sub-Saharan Africa is not very different
In one year, 2008, 1.9 million people living in Sub-Saharan Africa (SSA) became newly infected with HIV. While the rate of new infections started to slow down in 1996, the numbers of people living with HIV/AIDS has increased. Similarly, while deaths attributable to AIDS have declined by 18% of all deaths per annum, still a million and a half loved ones, friends, and colleagues die every year.

Progress is being made – just  far too slowly and on far too limited a scale, sometimes threatening to increase inequality because many people in Sub-Saharan Africa have no access to any health service, let alone to HIV and AIDS-specific provisions.
As of December 2008, 44% of adults and children (nearly 3 million people) were in need of antiretroviral treatment in the region were estimated to be receiving it. This is up from 2% estimated in 2003. But, far fewer children, proportionately, are on treatment than adults. In 2008, 45% of HIV-positive pregnant women received antiretroviral drugs to prevent transmission to the child, and although this is up from 9% in 2004, the averages masks huge variations across countries and the gaps remain enormous.

We also have to get more of the building blocks for prevention in place to avoid building a house on a very skewed and unequal foundation. Too few young people, especially women, have sufficient accurate knowledge about ways to protect themselves from acquiring HIV – only 57% in Rwanda, for example, and 23% in Angola.  And, while more people know their HIV status, in few countries is the estimate above 20%. New technologies for prevention and treatment are desperately needed – including vaccines, microbicides and pre-exposure prophylaxis, but efficacious therapies will not go far if the majority of people do not know how to protect themselves, don’t know their HIV status and have no free access to health facilities.
As such what is needed, to ensure a better future for children come 2020?
Of course, much is needed – human and social development, an end to corruption, better targeted foreign aid, expansion of education and health and so on.  The International AIDS Conference in Vienna is making further urgent calls for up-scaled prevention and treatment of HIV and AIDS. And, indeed, we need universal access to treatment and universal access to prevention. For every 2 people who are put on ART today, an additional 5 are newly infected with HIV.
But I would like to leave this symposium with my BIG FOUR candidates for urgent action.

• Comprehensive sexuality education
• Reduction of maternal mortality
• The virtual elimination of paediatric AIDS
• Holistic, family-centred prevention, treatment and care
• Comprehensive sexuality education

Literacy, including sexuality literacy, is a right and is fundamental to the personal and physical autonomy to which every human being is entitled. Like the literacy of reading and writing, sexuality literacy needs to begin early, when children are young. Every child needs to know how their body functions, what foods are nutritious, how infections invade and how they may be prevented by hygiene and other safe practices. Girls, and boys, must have the knowledge to support their decisions about sexuality and partnerships. Education systems, schools, families and communities will have to play a stronger role if we are to achieve the levels of sexuality literacy needed to halt the HIV and AIDS epidemic and related health threats that may come down the road.
Reduction of maternal mortality
Nearly one in five maternal deaths – more than 61 000 in 2008 – can be linked to HIV. In 10 southern African countries, HIV causes up to one half of all maternal deaths, and in one country, South Africa, between 2005-2007, the maternal mortality ratio was nearly 10 times higher in women known to be HIV positive.
It is critical, as has been endorsed by the United Nations, and Global Fund board to integrate the aims of HIV, TB and malaria programmes with maternal and child health. Indeed, the UN Secretary-General Ban Ki-moon’s recent announcement of the development of a joint action plan for accelerating progress on maternal and child health which will be endorsed at the United Nations MDG Summit in September 2010 is but one example of such commitment.

Women contribute so much to Africa’s development – we cannot afford to lose one of them, and a mother’s survival and health is the first and most robust warranty of a good start in life for a child. Few PMTCT programmes incorporate TB case finding and treatment, or follow up for women for a sufficient length of time to allay the threat of mortality related to childbirth. HIV and AIDS services need to be integrated with maternal and child health, as well as with TB, nutrition and family planning programmes in order to serve the health and wellbeing of women, and of their children and families.
The virtual elimination of mother to child transmission
The world is now in possession of knowledge and pharma-technology to virtually prevent vertical transmission of HIV from mother to child. This is a triumph for HIV prevention generally. But too little political commitment, too few resources, too little organization, and too little forward planning, execution and monitoring is on hand or has been mustered to make this life-saving technology available to all women and their children. Large scale initiatives and champions, such as Michele Sidibe, the UNAIDS Executive Director’s push around the elimination of mother to child transmission, the Campaign to Eliminate Pediatric AIDS (CEPA) run out of the Global AIDS Alliance and the Global Fund’s Born HIV Free campaign to raise the resources needed are an encouraging start.

But successful PMTCT is not the number of drugs distributed, but the lifelong wellbeing of women, children and families affected by HIV. The expansion of PMTCT is an opportunity to implement holistic health care. At the very least, PMTCT should include:
-    HIV testing for partners and related children, and entry into treatment for HIV+ pregnant women, their partners and family members if needed

• Sexual and reproductive services, as well as TB screening and treatment as required
• Infant diagnosis and treatment, including cotrimoxazole prophylaxis
• Follow up of mother and child after delivery to ensure their survival and promote their wellbeing through health checks, immunization, growth monitoring and nutrition support
• Assistance to access state and community resources, including social protection, social support, and palliative care
  Family-centred services for HIV prevention, treatment and care
  HIV and AIDS, like TB and malaria, create hubs for infection in the home and in the family. When one member of the family is infected, everyone is affected and put at risk. Nonetheless, if we are ensure a better future for children come 2020, families are the first and last bastion of assistance for those in difficulty, suffering and in need of care. Moreover, new evidence including papers presented in the special issue of JIAS to be launched this evening, point to the effectiveness of family-centred approaches. HIV testing in the home reaches more people and increases disclosure and support; adoption of preventive actions and entry into treatment are facilitated and improved when family members are included and give their assistance. Family-centred approaches will enable us to reach more people, provide more holistic care more effectively and reach our health and development targets in a more sustainable way. As task-shifting moves health systems outwards into the community through new cadres of health personnel, so can family-centred approaches reach out from the home to demand and receive services.

  Finally, I wish to congratulate you once again, on this excellent symposium and the progress we have made thus far. I wish to further reaffirm, the UN family’s commitment towards ensuring the health and wellbeing of children and young people affected by HIV.