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27th UNAIDS Program Coordinating Board Meeting
December 6, 2010

Joint UN program for AIDSDecember 6, 2010

Statement on behalf of the United States and Spain by

Deborah von Zinkernagel
Principal Deputy Global AIDS Coordinator

Office of the US Global AIDS Coordinator

Geneva, Switzerland

Thank you, Michel, for your report and your leadership in the development of the new UNAIDS Strategy. It lays out a compelling global agenda for action guided by a common vision of a world free of HIV/AIDS. It’s an agenda that truly can break the trajectory of the epidemic.

Indeed, the global HIV/AIDS response is a responsibility we all share, and speaking on behalf our constituency partner Spain, we believe it is only through collective efforts at the global, regional, national, and local levels that we will realize this vision. The presence of so many colleagues from Member States and co-sponsors demonstrates the importance of joint effort in achieving durable success in the fight against AIDS.

As we approach the 10th anniversary of the Declaration of Commitment on HIV/AIDS, we are heartened by the achievements reported in the recent 2010 UNAIDS epidemic update and continued progress towards universal access. However, we also see the continuing obstacles on the path to zero new infections, zero AIDS-related deaths, and zero discrimination.

Ten years ago, in the infancy of the global HIV/AIDS response, we realized that an effective response to global HIV/AIDS had to be bold, comprehensive, and urgent. Indeed, for us in the United States, this was the driving vision of PEPFAR – a Presidential and Emergency Plan for AIDS Relief.

Now, we all have the opportunity to take stock of lessons from the past decade. Let me focus briefly on three questions: what are the key elements of today’s epidemiological scenario, how do we ensure we’re making smart investments, and how do we ensure that responses are country-led and sustainable?

Epidemiologic scenario

In terms of today’s global epidemic, we know from UNAIDS that the number of new HIV infections has been steadily declining for years – even in many of the hardest-hit countries in sub-Saharan Africa. We must deepen our understanding of this welcome trend.

We are pleased that PEPFAR has been a part of the tremendous progress that has been made. Last week we announced that through our PEPFAR bilateral program:

  • Over 3.2 million people are receiving treatment;
  • Over 450,000 infant HIV infections have been averted; and
  • Over 11 million people have received care and support, including nearly 3.8 million orphans and vulnerable children.

However, it remains true that there are still two people newly infected with HIV for every one person people newly put on treatment. We must do more – much more – for prevention. We are pleased to see that the new UNAIDS Strategy calls for a true Prevention Revolution.

Under the 5-year PEPFAR strategy, the U.S. is thus focusing on HIV prevention, and on matching interventions and investments with epidemiological trends and needs in order to improve impact. At the same time, we are expanding access to high quality treatment, care, and support, which will be critical to sustaining our achievements and creating new ones.

Our constituency also believes that respecting human rights is critical for an effective HIV response, and we know promotion of human rights is an essential and settled component of the work program of UNAIDS. We must ensure that populations at higher risk for infection – men who have sex with men, people who inject drugs, and sex workers – do not face stigma, discrimination, or violence.

We applaud the focus on gender equality as a strategic direction of the UNAIDS Strategy. Gender-related inequalities compromise the health of women and girls and, in turn, affect families and communities. Gender-based violence is a serious and widespread human rights violation, as well as a key driver of the HIV epidemic.

Addressing gender issues is a critical component not only of the PEPFAR strategy, but the overall commitment by President Obama to the Global Health Initiative. PEPFAR has worked to integrate gender into all aspects of our programming, especially those that address the linkages between HIV and gender-based violence. In fact, we are now the largest international donor on the issue.

Women and girls increasingly shoulder the burden of new HIV infections, and they are often the primary link to healthcare for families. Women are not merely “targets” of our efforts, but they are key partners, and they must be central participants in the response.

Smarter Investments and Efficiencies

Next, how do we ensure we’re making smart investments? The sobering financial climate and uncertainty we face today gives urgency to our efforts to stretch available resources.

We strongly support the UNAIDS strategy’s focus on identifying synergies within the Joint Programme and efficiencies, which programs work and which don’t, and how better use of data and evidence heighten our impact. Our metric for success is not dollars spent but lives saved, with smart investments that strengthen health systems and communities.

Similarly, as part of President Obama’s Global Health Initiative, PEPFAR is building on successful programs by scaling up proven interventions, heightening efficient integration and coordination, and identifying opportunities for innovation. Our metric for success is not dollars spent but lives saved, and that means smart investments that strengthen health systems and communities.

We also commend UNAIDS for its hard work in implementing the recommendations of the Second Independent Evaluation (SIE) to become “more focused, strategic, flexible and responsive, and accountable and more efficient.” We look forward to hearing the progress on implementation of the recommendations.

Country ownership

Finally, how do we ensure country ownership? As a constituency, we strongly support the emphasis on country ownership in the new Strategy. For our part, PEPFAR has established Partnership Frameworks that place countries at the center of development, implementation, management, and leadership of programs. These are frameworks between the U.S. and partner governments, with civil society participation, to obtain measurable financial, programmatic, and policy commitments to HIV and health systems.

True partnerships with countries are essential to promoting a sustainable approach, characterized by strengthened country capacity, ownership, and leadership. To date, we have signed 18 Partnership Frameworks, with more to follow.

As we move forward with our work with governments, we will also emphasize another dimension of activity – community empowerment. It is local community and civil society organizations that can play the critical role in ensuring accountability for country structures in a way that outsiders never can.

In early October, Michele and Ambassador Goosby and Michel Sidibé hosted a dialogue with civil society groups on strengthening community-based networks as an essential element of country ownership. We all want to empower these communities – including those directly affected by programs, such as people living with HIV – to have the ability to provide that feedback to government ministries and the international community.


We have witnessed enormous achievements in the global AIDS response in the last decade – millions of infections averted, millions of lives saved around the world.

But these achievements can only be multiplied if we share the responsibility and work together as partners to make smart investments that respond to the challenges that still await us.

We believe the UNAIDS Strategy will help to keep us on the path towards an HIV-free world.