Buenos Aires, Argentina.
20 April 2007.
Closing address
IV LATIN AMERICAN AND CARIBBEAN FORUM ON HIV/AIDS/STI
Dr. Mirta Roses Periago *
Director of the Pan American Health Organization.
Two years ago, many of us present here today gathered in El Salvador. In November 2005, within the context of the III Latin
American and Caribbean Forum on HIV/AIDS/STI, the IV Central American Congress on STI/HIV/AIDS (CONCASIDA 2005), and the IV
Central American Encounter of People Living with HIV/AIDS, PAHO reiterated its commitment and programmatic determination to
alter the face of HIV/AIDS in the Americas.
The official launch of the Regional HIV/STI Plan for the Health Sector 2006-2015 is a step toward this goal. By 2015 we should
have put the breaks on the epidemic and begun to turn it around.
During the event, hundreds of participants--health workers, activists, people living with HIV, civil society organizations,
international agencies, and all the groups participating in this Forum, an important venue for sharing experiences and debating
the issues to respond to the epidemic--proclaimed and celebrated the Americas' great achievement in meeting the goal set for the
3 x 5 Initiative, signifying the rapid expansion of access to treatment in virtually all the countries of the Region.
At the same time, we discussed the enormous gaps that currently exist and the inequities, obstacles, the rapid spread of the
epidemic, which continues to exceed our capacity to respond: We have significantly expanded treatment coverage but continue
lamenting the premature loss of lives and the difficulty preventing new infections.
Every day in our Region, AIDS claims approximately 230 lives and nearly 450 new infections appear, many of them in adolescents
and the babies of HIV + mothers.
We have come to the Buenos Aires Forum with growing challenges, but also with renewed commitment. These days of intense discussions
on the theme "Latin America and the Caribbean: United in Diversity toward Universal Access", have shed light on the most recent
successes and the challenges before us; and above all, we have reaffirmed the importance of responsible, intelligent action based
on the experience gained in the Region.
The American region, like other regions of the world, has shown us that the only way to halt the HIV epidemic and turn it
around is through an integrated response that adequately balances prevention, care, and treatment in a social environment marked
by respect and the exercise of human rights, including the right to health, inclusion, and zero tolerance for stigma and
discrimination.
At this time, it is imperative to broaden access to treatment for those who need it, intensifying and reorienting our action to
achieve a drastic and sustained reduction in new infections. This implies structural and personal changes to modify situations
and behaviors that heighten people's risk and vulnerability. More than ever before, it is necessary to strengthen the participation
of organized civil society and communities themselves in the management and implementation of a visible, permanently active, and
up-to-date evidence-based prevention agenda that respects and includes diversity, so well-expressed in the theme of this Forum.
universal access to prevention, care, and treatment services. Hence, it must be strengthened. In this regard, the following
points should be mentioned.
Responsibility of the Health Sector in Constructing an Integrated Response
1. The need to continue redoubling and multiplying efforts to ensure quality services and compassion for people living with
HIV: this translates into the health services' capacity to ensure early detection of people with the infection and to continuously
deliver timely comprehensive care, including treatment, to slow the progression of the disease as much as possible and ensure
the maximum benefits of antiretroviral therapy. In many health centers in our Region, over three-quarters of the HIV+ patients
who arrive at the facility gravely ill first learn about their status during the consultation, which often ends with their
hospitalization. In addition, unfortunately, in many health services in the Region, people who are known or presumed to be infected
are even stigmatized and, as a result, suffer discrimination and abuse. We must eliminate this access barrier.
2. The need to improve maternal health services to guarantee the reduction of vertical HIV transmission and the elimination of
congenital syphilis: Despite the availability of highly cost-effective interventions in this field, coverage levels in many
countries leave much to be desired, and children continue to be born with perfectly preventable HIV and congenital syphilis.
We will never eliminate congenital syphilis in the Region or reduce pediatric HIV infection if we do not improve maternal health
services.
3. Strengthening sexual and reproductive health services and the prevention of sexually transmitted HIV in priority groups
such as young people, especially young women, men who have sex with men, sex workers, and migrants. The health sector has a
fundamental responsibility in the implementation of evidence-based interventions to reduce the efficiency of sexual transmission
of HIV. Primary prevention activities should have visible priority in national and international cooperation agendas for response
to the HIV epidemic. Reducing the number of new cases, especially through sexual transmission, should become a work objective within
the broader agenda of sexual and reproductive health promotion and protection.
4. We must reduce the cost of antiretroviral therapy even further. Despite the success of the negotiations, we have seen that not
all countries have managed to procure these drugs at the competitive prices agreed to in the negotiations, resulting in significant
differences that can be reduced. Furthermore, it is imperative to reduce the cost of second-line drugs, which are still extremely
expensive. In this regard, we applaud the resolution of the
XXVIII REMSAA to open the III ARV Negotiation in the Region, and we will
be lending our full support to this endeavor. PAHO will continue supporting the efforts of the
GAN (Consultative Group on
Antiretroviral Negotiations--GAN/ARV), created at the request of the Ministers of Health of the 11 South American countries and
Mexico that participated in the II Round of Negotiations with the Pharmaceutical Industry, held precisely here in Buenos Aires,
Argentina, from 3 to 5 August 2005.
5. We must pay attention to the sustainability of the responses and services and in particular, to their financing and expenditure,
above all given the presence of a substantial volume of external resources in most of the countries. From the standpoint of resource
allocation aimed at maximizing social gains, the objective should be to provide care for people living with HIV while at the same
time working intensely to reduce the speed with which the virus is transmitted and improve health system response capacity.
Otherwise, the response will always be one step behind the epidemic. Therefore, in addition to the job of improving service
delivery, we must address the procedures and criteria employed in resource allocation. Now more than ever, cost-effective use
of the resources at hand is required. Many countries are still experiencing a significant funding gap when it comes to providing
universal access. Improving the quality and effectiveness of expenditure will significantly reduce the funding gap. This implies
investment based on the epidemiological situation in each country, which will make it possible to target actions to the needs of
the people most likely to be exposed to HIV. It is imperative to bridge the funding gap and advocate for a guaranteed response
to HIV in the Region.
6. The Region's epidemiological surveillance systems should be improved. The capacity for effective rational planning will depend
on our knowledge of the epidemic: the people most affected and why, where they are found, and the dynamics of the epidemic.
This will only be possible with better epidemiological surveillance, which at present is still partial, outdated, and deficient
in our Region.
7. We must continue to advocate for more active and effective participation by other sectors in the response to HIV,
particularly the education and development sectors. Quality education and the right to work are key elements outside the health
sector that must be clearly and explicitly addressed in national public policy and international cooperation priorities.
With these challenges, we begin another part of our work. We successfully conclude the 2007 Forum with numerous lessons learned
and, moreover, renewed commitments. For our part, through the Joint UNAIDS Program, PAHO and the agencies of the United Nations
System reiterate our commitment to intensifying efforts to support the countries and the mechanisms of the subregional and
regional networks. We have the extraordinary response of the international community and the concerted mobilization of civil
society to advance the regional agenda and come to the next Forum with fewer deaths, fewer infections, and more people in treatment.
This commitment is currently expressed in a Regional Work Plan, approved by all the Regional Directors of the United Nations
organizations, with the support of the UNAIDS Secretariat, which will guide our work over the next two years and facilitate the
necessary synergies to ensure a more effective response from our system. A key element in this Joint Regional Work Plan is
heightening our Region's visibility internationally and promoting specific forums, such as a Regional UNGASS, that will make it
possible to keep HIV/AIDS at the forefront of the political agenda of our Region and the rest of the world.
Therefore, with the conclusion of the 2007 Forum, we are immediately setting our sights on an important meeting that represents
a unique opportunity for the Region: the XVII International AIDS Conference, which will take place in Mexico in August 2008.
Today, we are stating our commitment to ensuring that Mexico 2008 will be an event that promotes greater visibility for Latin
America and the Caribbean in the global context.
We hope that the XVII International AIDS Conference will serve as an additional opportunity for concerted regional action
by all actors that will create a very high profile for the Region's needs, in addition to the progress made.
Our Region can, our Region wants, our Region has the will, our Region has successful experiences to move forward.
Let us all, united, continue our efforts and step up the pace…
More information:
Primary Health Care: Platform for the Universal Access in HIV. /
Atención Primaria: Plataforma para el Acceso Universal en VIH.
Dr. Roses' Article. [Spanish version]
XVII International AIDS Conference
