Toespraak aidsambassadeur bij Aids Foundation of Chicago (Engels)
Mr. Chairman, distinguished Members of the Board of the AIDS Foundation of Chicago, ladies and gentlemen,
It is both a pleasure and an honour to stand here before you today. Through our consulate, through my new friend Fred Eychaner and by looking at your website, I’ve learned about the Aids Foundation Chicago. I am impressed with the good work you do in the greater Chicago area, the State of Illinois and at the national level.
I understand you are now working on a global plan and I suppose you have invited me to speak about AIDS as the global challenge on which we must stand together. There are so many aspects of the fight against HIV/AIDS, so I had to make a choice.
What I will do today is first speak about the global picture. Then I will focus on prevention, especially on two important drivers of the epidemic. Then I will illustrate the approach the Netherlands practices in addressing these drivers and argue that it is preferable to and more effective than that of the US. (I do realise that 15 minutes is short and I can only ‘scratch the surface of that complicated issue of SRHR).
In every corner of the world, every minute of the day, innocent lives are being destroyed by a faceless enemy. An enemy that exploits any chink in our armour of unity and purpose. 25 million deaths in two decades – more than the aggregate battle deaths of the twentieth century combined. The terror instilled and the pain inflicted by this plague are beyond our imagination. Fortunately, the strategy to beat it is not. We can win the war on HIV/AIDS. …
HIV/AIDS is a pandemic that is overshadowing anything we know in human history. A pandemic that is creating an entire generation of orphans in Africa, where average life expectancy is now 47 years, when it would have been 62 without AIDS. A pandemic that has catastrophic consequences for workers and employers, thus undermining prosperity and development.
Of the 40 million people worldwide infected with HIV/AIDS, more than two-thirds live in sub-Saharan Africa, the epicentre of the storm.
Five years ago, the United States chose to listen to its moral conscience and step up efforts in the fight against HIV/AIDS. Without hesitation I will state that, as far as I am concerned, making that choice will go down in history as a positive legacy of the Bush administration. Credit where it’s due.
Ladies and gentlemen,
Last January, when I had the honour and opportunity to brief US Congress members on the AIDS-policies of a number of European countries, including the Netherlands, I conveyed our appreciation and respect for the leadership and the tremendous efforts of the US in the global AIDS response. And I want to repeat this today. Your government provides twenty-five percent of all assistance to combat AIDS worldwide. As I’m sure you’re aware, Congress will shortly debate a budget request, that – if approved – will bring the total commitment to $18.3 billion over these five years. This is very encouraging. Richard Holbrooke who is president of the Global Business Coalition on HIV/AIDS, Tuberculosis and Malaria, in his column in the Washington Post of October 9 said that Americans should take pride in the fact that (…..),“the United States has led the world in a manner that evokes generous programs of the past such as the Marshall Plan.” Since the 2003 State of the Union, the United States has shown much-needed leadership. I have described the pandemic as a storm, and as Faye Wattleton said, when you’re in a storm, leadership is the only safe ship. No global challenge can be tackled without the United States on board. But at the same time, no leadership can be effective without the critical voices of allies.
Ladies and gentlemen, the US and the Netherlands are allies in so many ways, also in the area of development. Both our countries have subscribed to the Millennium Development Goals, goals agreed by the global community to accelerate work towards a healthy, prosperous and just world. On both sides of the Atlantic we are acutely aware of a responsibility to book results and therefore of the need to constantly rethink what to do and how to do it. I take my presence here today as proof that we are united in the desire to learn from each other and in the determination to join forces in the fight against poverty, disease and preventable death.
While in absolute terms the US is the biggest contributor, in relative terms, the Netherlands have, for decades now, earmarked 0.8 percent of national income to development assistance. This earned us the highest rank in the Commitment to Development Index. This is a measure developed by the Washington-based Centre for Global Development which rates 21 rich countries on how much they help poor countries build prosperity and peace. In spite of its small size, my country ranks third in terms of total aid volume! For your information, I am sorry to say, the United States ends up near the bottom of the CDI (19 of 21).
Back to AIDS. In spite of hugely increased efforts (e.g. global expenditure rose from about $250 million in 1996 to about $10 billion this year) the HIV/AIDS epidemic continues to expand. AIDS is the leading cause of death in Africa. Its impact in terms of loss of human and social capital is already throwing some sectors into crisis in the most affected countries in Africa where - by 2010 - one in five workers will have died because of AIDS. I refer to the mining industry in Botswana, to the tourism sector in Zambia for example. Not to mention the human resources crisis in the health and education sectors all over sub-Saharan Africa, AIDS is slowly but surely killing doctors, nurses and teachers, the very fabric of society. Not to mention the tragedy of orphans and other vulnerable children. In Swaziland this already bears upon one third of all children.
When we talk about fighting HIV/AIDS, we distinguish between prevention, treatment and care or mitigating the impact of HIV/AIDS. Of course, prevention is core. Richard Holbrooke sounded the alarm bell, stating that on any given day an estimated 12,000 people worldwide will contract HIV. Ninety percent of them, that is more than 10,000 people, will not learn that they are infected until 5 to 8 years later, when full-blown AIDS hits them and they are certain to die. Until then, those people will unintentionally spread the virus to their wives, lovers, newborn children, people with whom they share needles to inject drugs ..…
There is only one possible conclusion and that is that the world is not investing enough in prevention ! Therefore I concur with Dr. Peter Piot, Executive Director of UNAIDS, who says that we need to improve our understanding of the societal drivers of the epidemic in order to come up with effective prevention strategies.
So let us take a closer look at two of these societal drivers, two sources of vulnerability, two risk factors.
First and foremost, especially in sub-Saharan Africa, it is gender inequality that lies at the root of women’s disproportionate vulnerability to HIV infection. The statistics are overwhelming:
Worldwide, women now account for nearly 50% of all individuals living with HIV/AIDS. However, in Africa, in the age group from 15 to 24 years, women account for 76% of all infections. In South Africa, Zambia and Zimbabwe, young women aged 15-24 years have rates of infection that are between three to six times that of their male peers. These staggering figures, ladies and gentlemen, illustrate a trend that is becoming ever more pronounced: the feminization of the HIV/AIDS epidemic.
Second driver of the epidemic: the vulnerability of young people. The vulnerability of young people could not have been captured more aptly than in the metaphor used by Dr. Fred Sai, former director of the International Planned Parenthood Federation, who said that “to withhold sexuality education to young people is tantamount to sending them blindfolded into a mine-field”.
It is in connection with these staggering figures that I call on the United States to listen to its allies. I call on the United States to have their decisions informed by evidence, not by moral convictions. I refer to the earmarking of funds for abstinence-only programmes and to the withdrawal of support to the United Nations Fund for Population Activities, for example. Abstinence until marriage does not always ensure safety, because marriage in itself provides no protection from infection. On the contrary, nowadays the biggest risk for infection for women is marriage. Why: because while they are faithful, their husband is not. What is more, abstinence is not a realistic option for the millions of women and girls who are in abusive relationships, or those who have been taught always to obey men. In return for good grades, teachers abuse their pupils. In return for payment for their schooling, so-called “sugar-daddies” demand sex in return.
Allow me to speak a bit about the Netherlands.
Risk-reduction vs. risk-elimination
The Dutch approach to HIV prevention is based on a risk-reduction strategy. In the Netherlands, teenage pregnancies, abortions, HIV/AIDS and sexually transmitted diseases are among the lowest in the world. We would not have achieved these outcomes without a pragmatic approach that, I believe, is appropriate in a diversity of contexts, religions and cultures. Risk-reduction implies acceptance of the known fact that young people do have sex, some because they simply want to, some because of peer-pressure. People who do not abstain should do everything possible to reduce risk, including using condoms.
Let me be clear, that does not mean we do not also convey the message that it is important to be faithful. This approach does not mean that we do not raise our children with the message that it is respectable and morally right to have ones first sexual encounter at a later stage. And it works: the average age for the first sexual experience in NL is 17 while it is 15.5 in the US. However, it also means accepting the realities in life, in your country, in mine, in the rest of the world.
Risk-reduction also implies acknowledgement of gender inequality as illustrated when we look at the reality of millions of young women aged between 10 and 20 years in sub-Saharan Africa. Especially in resource-poor settings, the vast majority of these girls and young women will not be in school. Who are they ? Where are they ?
They are girls living outside the protective structures of family and school, including 10-14 year olds, working in domestic service and other forms of unsafe exploitative work. They are poor girls on their own, or managing AIDS affected families. They are under pressure to exchange sex for gifts, money and shelter. They actually are married girls: if present patterns continue, over the next 10 years, 100 million girls will be married while they are still children. And it is not exceptional that a girl – being infected with HIV through her husband – gets expelled by the same husband because she is then HIV positive.
Sexual and reproductive health and rights
The question is how can we reach these girls and young women with life-saving information and education, with contraceptives, with health care ? The answer is: in focussing much more on sexual and reproductive health and rights.
The term Sexual and Reproductive Health and Rights was defined during the 1994 International Conference on Population and Development (ICPD) held in Cairo. Its objective was – and it remains valid today ! – to uphold the right to comprehensive sexuality education to family planning methods, to basic health services, to mother- and childcare, to help of midwives, to post- and prenatal care, in order to prevent unwanted pregnancies and abortions, maternal mortality, HIV and other diseases in connection with sexuality and reproduction. And last but not least: to end violence against women. It is a fact that for one in every three girls in South Africa, their first sexual encounter involves coercion or violence.
Ladies and gentlemen, abstinence and faithfulness are beyond the control of the women we are talking about.
Considering that 80% of HIV infections are sexually transmitted and that 500,000 women die each year from pregnancy-related complications, it is difficult to envisage HIV-prevention as a stand-alone project. What can make more sense than integrating programs that address the risks associated with sex and reproduction. In other words: integrate reproductive health services with fighting HIV/AIDS. Thát is our policy: evidence-based and effective.
In the approach elected by the US government, reproductive health and HIV/AIDS services are generally funded separately and operated separately as well. As a result, clients in need of both services must seek different providers for each service, even though both services aim to prevent illness and mortality related to sex and reproduction. (This is extremely problematic for women and girls living in resource-poor countries.) If the government of the United States wants to save as many lives as possible – and there is no doubt in my mind it wants to – it should revise some of the operational principles that govern PEPFAR.
Ladies and gentlemen,
In conclusion. As I stated before, the US is on the forefront of the international battle against HIV/AIDS. I hope it will continue to do so. The PEPFAR programme is effective and efficient if it would allow evidence to speak for itself and it would integrate programs that address the root causes/drivers of the epidemic/risks associated with sex and reproduction.
We admire the United States.
Americans are known and valued for their “can do” mentality and they should be proud of it. “Can do” is fine as long as it is not synonymous with “can do alone”.