Select Committee on International Development Minutes of Evidence

Memorandum submitted by UNICEF


I.  Statement of the Problem

  HIV/AIDS continues to wreak a path of devastation through sub-Saharan Africa and other developing regions, with nearly 34 million people now living with the virus and more than half a million children infected last year alone.

  Some 14.8 million women and 1.2 million children under the age of 15 are living with the nightmare of HIV/AIDS, almost all of them in sub-Saharan Africa and other parts of the developing world. These figures evoke a vast scale of death and destruction and tempt us to throw up our hands in despair. But we must resist that temptation. There is hope, and the fight against the HIV/AIDS pandemic in the developing world is just beginning.

II.  UNICEF's priority programme areas

  UNICEFs concern about the impact of HIV/AIDS on vulnerable women and children dates back to the mid-1980s. Following extensive consultation among UNICEF field offices in countries then experiencing the initial explosive trajectory of the disease, a report was presented to the Executive Board to advise the membership regarding the potential impact of the pandemic and the importance of ensuring appropriate sterilisation of all equipment used in immunisation programmes. In 1988, a report to the Executive Board analysed the impact of HIV/AIDS on women and children and outlined an HIV/AIDS policy and programme approach for children. These initial years were marked by limited but ground-breaking work, focused mainly on AIDS orphans and developing AIDS curriculum and life skills education programmes for schools as we have seen in Uganda and Zimbabwe.

  By the close of 1995, virtually all of UNICEF's 125 principal country offices works have HIV/AIDS-specific programmes. As bleak as the picture may be in some countries where the rate of HIV infection exceeds 20 per cent of the population, UNICEF's message is that in all areas of AIDS activity, there is hope so long as there is knowledge and accompanying change in behaviour.

  For those of us working among women and children whose lives are threatened by the prospect of HIV infection, we now know about affordable drug treatments to reduce mother-to-child transmission. There are also effective prevention programmes under way for young people. There are exemplary pilot voluntary testing and counselling centres for women. And there are projects that are beginning to address the immense needs of children orphaned by AIDS.

A.  Breaking the conspiracy of silence

  At the national level in all countries affected by HIV/AIDS, there must be political commitment at all levels, involving a variety of partners in coordinated public and private action to address the disease. This includes breaking the "conspiracy of silence" that in too many countries continues to hide the dimensions of the HIV/AIDS crisis from the very people most affected by it.

  In the south, breaking the conspiracy of silence means acknowledgement of the problem at the highest levels of government; broad national engagement leading to the development of prevention and treatment policies and strategies; the building of HIV/AIDS partnerships with international organizations, and international and local non-governmental organizations; and, a willingness to mobilise both internal and external resources. Nations that have taken these steps deserve the support of the donor community, whether in the form of direct aid and/or through debt relief.

B.  Prevention of Mother to Child HIV Transmission

  In 1999 alone, an estimated 570,000 children were infected with the virus that causes AIDS, the large majority through mother-to-child transmission. For this reason, UNICEF and its partners have assigned top priority to supporting the efforts of national governments in many of the most severely affected countries of sub-Saharan Africa to help reduce the transmission of HIV from mother to child.

  The principal aim of UNICEF's partnership with national governments and NGOs is to provide voluntary HIV testing and counselling for pregnant women. Pregnant women who test HIV-positive are provided with one of the recently developed anti-retroviral drug regimens; counselling on infant feeding options; and support for the feeding method of their choice. These interventions can reduce transmission rates by half.

  UNICEF is continuously encouraged by the news of promising and dramatically more affordable drug regimens to prevent mother-to-child transmission. A relatively new drug, nevirapine, can reduce HIV transmission by 50 per cent with a single dose to the mother and infant—at a per-treatment cost of about $4.

  More recently, we welcome the consensus reached by experts to recommend the prophylactic use in Africa of cotrimoxazole, a drug that wards off some of the opportunistic infections to which HIV-infected people are prone. This is particularly good news for women, who can live longer, healthier and more productive lives.

C.  Primary prevention among young people

  One of the most encouraging developments regarding actions to prevent the spread of the HIV/AIDS is the drive and energy of young people who are becoming principal actors in national efforts to address the pandemic. UNICEF has learned that young people understand even better than many adults that, through prevention, they can slow the rate of infection—and eventually stop the spread of infection. This is already beginning to happen. There are indications of a decrease in the spread of HIV in Zambia, particularly among young people between 15 and 19. And there are encouraging trends in Uganda, Senegal, and Thailand.

  UNICEF has stressed the importance of focusing on young people (a) because they are at the centre of the pandemic, (b) because they are often more open than adults to do things differently and (c) because they are a force for change among their peers and in society generally.

D.  Access to HIV voluntary testing and counselling

  It has been estimated that up to 90 per cent of HIV-positive people in Africa are unaware of their infection. There is increasing evidence that awareness of one's HIV status can be a powerful motivating force for behavioural change.

  However, providing people with information about how to protect against infection is not enough. UNICEF believes that we must help create the right conditions and circumstances for people to be able to act on the basis of the information we make available to them. Such conditions can include a supportive social environment; access to condoms; clean needles and syringes; and access to appropriate health and other services such as HIV counselling and testing.

E.  Children and families affected by HIV/AIDS

  Half of those infected in 1999 were people under the age of 25. They will probably die before they turn 35. They will leave behind children who face a future as orphans and often the added burdens of poverty and stigma. The scale of the orphan crisis is almost unimaginable. By the end of 1999, there were approximately 11.2 million children who lost one or both parents to HIV/AIDS. In many cases, a remaining parent is found to be quite ill and dependent on the child for assistance.

  Before AIDS, about 2 per cent of all children in developing countries were orphans. By 1997, the figure had jumped to 7 per cent in many African countries—in some countries the figures run as high as 11 per cent.

  In developing countries, AIDS orphans face extreme economic uncertainty and are at higher risk of malnutrition, illness, abuse and sexual exploitation than children orphaned by other causes.

  In response to the crisis, some African communities have developed innovative care and support programmes. While communities are clearly still in the forefront of the response, the sheer numbers of orphans threaten to overwhelm their efforts. The response of the donor community to the AIDS pandemic must include support to communities that seek to address the physical and emotional needs of the millions of children whose parents have been taken from them by this disease.

III.  What are the Challenges?

  Early in the 21st century, we still have no cure for AIDS. Nor do we have a vaccine to prevent the spread of HIV. We have seen a growing number of successes in the global fight against the epidemic, but they are not nearly numerous nor widespread enough.

  But there is hope. The future course of the HIV/AIDS pandemic lies in the hands of young people. It is absolutely vital that we do everything necessary to arm them with the knowledge they need to protect themselves and their communities.

  UNICEF has moved to redouble our efforts to mobilise and support programmes to address the rights of young people to development and to participation. While young people are constantly receiving information about HIV/AIDS, consultations with them and existing data show that they do not have all the information they need and furthermore, information does not necessarily translate into knowledge and skills.

  We urgently need to address this knowledge gap, using language and formats that young people can appreciate. For example, in many sub-Saharan African countries, it has been found that more than 25 per cent of women aged 15 to 19 are unaware of even one effective way of avoiding HIV infection (see graph).

  And in recent representative surveys, over 30 per cent of young women in many sub-Saharan African countries expressed the view that a healthy looking person could not possibly be infected with the AIDS virus (see graph).

  What began nearly two decades ago as a mysterious ailment that seemed confined to specific groups has now shown itself for what it really is: a plague that is systematically devastating entire societies, reducing life expectancy at an uncontrollable rate in many developing countries. Life expectancy at birth in southern Africa rose by a full 15 years from 44 years in the early 1950s to 59 in the early 1990s. However, because of AIDS life expectancy is set to recede to just 45 years between 2005 and 2010. This decline has enormous impact on national economies. In South Africa where the infection rate exceeds 20 per cent of the young population, continual loss of trained workers to illness and death has become a major problem for business. AIDS also has had a great impact on certain sectors such as education. In numerous sub-Saharan countries, teachers are dying at a rate faster than new ones can be trained.

  By comparison, life expectancy in South Asia, another of the world's poorest regions, is evolving very differently. While South Asians born in 1950 on average could survive barely to their 40th birthday, by 2005 they can expect to live 22 years longer than their counterparts in the AIDS-ravaged southern African region. However, there are concerns that South Asia, and the former Soviet Union as well, could see the trajectory of HIV/AIDS growth in these regions if national governments do not acknowledge the problem already in existence and take action to address it.

IV.  Resources Needed

  To capitalise on the hope provided by those in developing countries, already working to prevent HIV/AIDS infection, will require far more commitment and resources than we have yet seen—from governments, donors, and civil society at every level, including non-governmental groups, communities, families, and the private sector. The success stories cited above must be brought up to scale in country after country. UNICEF estimates that an additional US$ 2-4 billion per year for 10-15 years will be needed to control the epidemic. Much of these resources will come from within affected countries. However, as HIV/AIDS is a global problem, its response demands global action.

V.  Special Regional Focus: Sub-Saharan Africa

  Currently, two complex emergencies and catastrophes threaten sub-Saharan Africa. Approximately 200,000 people die annually due to armed conflicts in this region; the lives of millions more are severely disrupted and their food, security, access to adequate health, nutrition and education is reduced. The resumption earlier this week of full-scale war between Ethiopia and Eritrea is but one example of the growing crisis of war on the continent. It is a conflict like this that will capture the attention of the media.

  However, somewhat more quietly a silent, almost invisible, though massively larger tragedy has devastated sub-Saharan Africa. HIV/AIDS is the greatest undeclared war with nearly 2 million deaths last year and a budget of less than two 747 aircraft last year alone.

  In Eastern and Southern Africa UNICEF has declared HIV/AIDS as a number one priority. All offices have been requested to convey to their government partners that UNICEF has taken an agency-wide decision to put HIV/AIDS programmes and advocacy on a much more urgent footing in the light of the devastating consequences of the pandemic on the well-being of children and their families. They have been urged to discuss with government partners the possible reorientation of the existing programme of co-operation to make HIV/AIDS the central element of the programme, including the reallocation of resources earmarked for other components of the programme and the possibilities for mobilising new resources locally or internationally.

  Positive outcomes will require political commitment at all levels. We cannot give in to a pervasive mood of writing off whole generations in sub-Saharan Africa and Asia. We know how to start tackling the HIV/AIDS pandemic. We must be willing to pay what it costs to turn that knowledge into the lifeline that it could be for millions of people. And we must ensure that what works in one place is transported to another until the pandemic is in full retreat.


May 2000

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