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26 July 2012
Guest Contributor

The Political Declaration on HIV/AIDS: Bill Bowtell responds to Australian Ambassador to the United Nations

Executive Director of Pacific Friends of the Global Fund, Bill Bowtell has provided a response to the address given by Gary Quinlan, Ambassador and Permanent Representative of Australia to the United Nations, 11 June 2012. Gary Quinlan’s original address can be found here. In his response, Bill Bowtell highlights the commendable work of both UNAIDS and the Australian Agency for International Development (AusAID) and their tireless response to combat the HIV & AIDS epidemic in Papua New Guinea.

Response to Statement on 11 June 2012 by H.E. Gary Quinlan, Ambassador and Permanent Representative of Australia to the United Nations

Implementation of the Declaration of Commitment on HIV/AIDS and the Political Declaration on HIV/AIDS”

By Bill Bowtell AO

The 2011 United Nations Political Declaration on HIV/AIDS commits all countries to a series of bold policy and program actions, supported by clear time-bound targets to measure progress, to reduce, and eventually eradicate the global HIV/AIDS pandemic.

This landmark UN Declaration also comes at a time of tremendous advances in the science of HIV prevention and treatment. However, these advances need leadership and action to realize the goals of dramatically reducing new HIV infections and HIV illness and related deaths.  The 2011 UN Political Declaration on HIV/AIDS provides the global framework for transforming the global response to the epidemic and capitalizing on these important advances.

However, as noted by Gary Quinlan in his statement of 11 June 2012, the lack of progress in implementing the goals and commitments as agreed in the Political Declaration is deeply disappointing. This lack of progress results directly in avoidable new HIV infections and more HIV related illness and deaths.

For example, Papua New Guinea has the region’s largest HIV epidemic, with approximately 0.92% of the adult population living with HIV in 2009. Commendably, AusAID has committed $A185 million to the Papua New Guinea-Australia HIV/AIDS program that runs from 2007 to 2012.

Since 2007, through AusAID and its supported partners, the Australian government has helped over 72,000 Papua New Guineans, including 11,000 pregnant women, to be tested for HIV. In 2010, the program helped more than 7500 Papua New Guineans access treatment for HIV. New HIV infections in the Pacific region have declined from 4700 in 2001 to 4500 in 2009.  Between 2007-8, there has been an increase of 50% in the number of Papua New Guineans tested for HIV, and a 260% increase in the number of people tested between 2008-9. The number of Papua New Guineans infected with HIV that are receiving life- saving anti-retroviral treatment has increased exponentially, with coverage increasing from 23% in 2007 to 65% in 2008 and 74% in 2009.

Australia’s support for the Papua New Guinea response to HIV has therefore clearly been important. Though recent analysis by UNAIDS suggests that the HIV epidemic is beginning to level off , the response to HIV in Papua New Guinea remains extremely fragile with sub-optimal access to treatment and care in many areas of the country. Papua New Guinea can reverse the rate of new HIV infections and optimize the impact of HIV treatment by fully implementing prevention and treatment measures outlined in the 2011 UN Political Declaration on HIV/AIDS.

Similarly, Australia must also fully integrate the 2011 Political Declaration on HIV/AIDS into its national, state and territory HIV strategies. Our tardiness in doing so is highly regrettable and undermines our efforts to encourage other countries, particularly in our region, to adopt bold, evidence-based HIV responses.

UNAIDS has worked tirelessly with a plethora of agencies to encourage the full implementation of the 2011 Political Declaration. However, Australia must provide greater support for this effort, through multi- year core funding to UNAIDS and by recognising the importance of promoting evidence-based HIV prevention and treatment as the core of the global response. Australia should allocate its international HIV/AIDS budget at a level commensurate with the solemn commitments we made at the United Nations in 2011.

Australia played a commendable role in securing international support for the 2011 Political Declaration on HIV/AIDS. This reflected well on our three decades of commitment to bringing the HIV pandemic under control domestically, regionally and globally. In the years ahead, the challenge is to consolidate the great gains that have been made in the past several years, to increase access to HIV treatment for all and to fund the global response at the level that will ensure the rapid decline in the numbers of new HIV infections. Only by doing this can we bring about the beginning of the end of HIV/AIDS.

Bill Bowtell AO is the Executive Director of Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria.

Pacific Friends would like to thank UNAIDS and AusAID for their support of this statement.

24 July 2012
Tim Siegenbeek van Heukelom

Australia to host high-level malaria conference

On 13 July the office of the Australian Minister for Foreign Affairs, the Hon Bob Carr, announced that Australia will host a high-level conference in October this year called “Malaria 2012: Saving lives in the Asia Pacific” to help combat the challenge of malaria.

Media release: Australia to host high-level malaria conference

Minister for Foreign Affairs Bob Carr announced the Malaria 2012: Saving lives in the Asia Pacific conference at the East Asia Summit Foreign Ministers’ meeting in Cambodia yesterday.

“Despite recent progress in tackling malaria, there are still more than 200 million malaria cases globally, with around 30 million cases in our region,” Senator Carr said.

Malaria has a profound impact on some of the poorest and most vulnerable people in our region causing 42,000 deaths in 2010 and leaving many more unable to work and care for their families. Malaria also threatens economic growth and business interests in the region.

“Gains in controlling and eliminating malaria are threatened by emerging drug resistance in the region.

“Addressing global health issues has been a priority for Australia at the East Asia Summit Foreign Ministers’ meeting and I am pleased that we will continue this work at the malaria conference later this year.

“The conference will provide an opportunity for Asia-Pacific leaders to build on our successes, protect the gains and further develop regional responses to malaria.

“It will also provide a forum to discuss how we can work together to combat emerging drug resistant strains in the region and explore ways of contributing to the global effort to eliminate deaths from malaria by the end of 2015, as called for by UN Secretary General Ban Ki-moon.”

Australia has been working with developing countries in Asia and the Pacific regions to combat malaria. Australia currently supports the Asia Pacific Malaria Elimination Network and provides investments to save peoples’ lives, including through funding treatment and the distribution of bed nets in Asia Pacific.

Our support has helped to achieve significant results in reducing malaria cases in the Solomon Islands and Vanuatu. Since 2003, our investments have helped to reduce malaria cases by 70 per cent in the Solomon Islands and 85 per cent in Vanuatu.

Malaria 2012 will be held over three days in Sydney from 31 October – 2 November 2012. Representatives from governments and development partners across Asia and the Pacific will attend the conference along with leading health and development experts.

Senator Carr will host a ministerial meeting as part of the event with the UN Special Envoy for Malaria, Mr Ray Chambers.

16 July 2012
Guest Contributor

Decriminalisation integral to the fight against HIV

Last week, Michael Kirby, former justice of the High Court of Australia, together with Michael Wong from Pacific Friends wrote on the Australian Broadcasting Corporation’s The Drum. In an opinion piece highlighting the recent release of the ‘Risks, Rights & Health’ report of the Global Commision on HIV and the Law, Kirby and Wong explore how the law can protect people vulnerable to HIV and bring home lessons to be learnt from Australia.

MICHAEL KIRBY & MICHAEL WONG, The Drum Opinion, July 12, 2012

This week in New York, a report by the Global Commission on HIV and the Law was delivered to the United Nations secretary general Ban Ki-moon, recommending the decriminalisation of sex work, homosexual adult activity, and individual drug use.

Its core message is that criminalising the actions of those who are vulnerable to HIV hampers efforts to fight the spread of the disease.

This is a lesson that Australia was quick to learn after the global AIDS epidemic struck in the 1980s. Unfortunately, it remains a lesson much of the world is reluctant to accept.

The good news is that we now know and understand how the spread of HIV can be halted across the world, and Australia can be used as a prime example of how effective the recommendations of the Global Commission report can be.

Across the globe, some 34 million people are living with HIV and another 7,400 are infected daily. In 78 countries, same-sex activity is a criminal offence, with penalties ranging from whipping to execution.

The United Nations Office on Drugs and Crime along with volumes of research now confirm beyond all doubt that fear of arrest in these countries drives vulnerable populations underground and away from HIV harm-reduction programs.

A recent Lancet study revealed that worldwide coverage of HIV prevention, treatment, and care services in at-risk groups is alarmingly low.

The criminalisation of homosexual activity, voluntary sex work, and injecting drug use is keeping affected people away from accessing treatment services and thus exacerbating the disease’s spread.

Even in cases where the threat of punitive action is less direct, legal environments overseas can create barriers which act to prevent the most vulnerable groups from receiving the services needed to put a dent in overall infection numbers.

In South-East Asia, for example, only one of seven countries that responded to a World Health Organisation survey had provisions that enabled minors to access contraceptives, HIV testing, or harm-reduction services without parental consent.

This is where the Australian example has the capacity to light the way forward.

Our history shows how targeting HIV-vulnerable groups not with criminal charges but with assistance and protection is the best means of halting the epidemic.

It is estimated that by 2000, Australian Needle Syringe Programs had prevented an incredible 25,000 HIV infections. By 2010, such programs prevented 4,500 AIDS deaths. The projected economic cost avoided is up to $7.7 billion.

Our Needle Syringe Programs drew criticism domestically at the time of their introduction due to perceptions that they represented a state sanction for illegal drug use. Yet we now know the cost we would have paid if such criticisms had been allowed to shift public policy.

Similar debates have been framed all over the developing world, yet unfortunately the results have been very different. There is now hope for this to change.

The recommendations of the Global Commission on HIV and the Law come at a critical time, arriving just before the International AIDS Conference in Washington on July 22. National leaders, policymakers and civil society figures will be drawn together in a forum that is capable of starting the process of progressive legal reform. The support of the United Nations can help propel us toward a sustainable global HIV response.

The UNAIDS Global AIDS Strategy aims at reducing the sexual transition of HIV by half, including among men who have sex with men, young people, and in the context of sex work. However, if private same-sex sexual acts and voluntary sex work remain criminalised, it is highly unlikely that this goal will be met.

The commission has presented persuasive evidence and recommendations that can save lives, save money and help end the AIDS epidemic.

In 2009, Ban Ki-moon urged all countries to remove punitive laws, policies and practices that hamper the AIDS response. The UN secretary general stated in the political declaration on HIV/AIDS:

In addition to criminalising HIV transmission, many countries impose criminal sanctions for same-sex sex, commercial sex, and drug injection. Such laws constitute major barriers to reaching key populations with HIV services. Those behaviours should be decriminalised, and people addicted to drugs should receive health services for the treatment of their addiction.

The Global Commission has now urged a similar approach, calling on its diverse ethnic, professional and religious/cultural backgrounds.

In 2012, it is high time that the world took note of the Australian example and understood that heeding the UN secretary-general’s words is not just a moral imperative, but a deeply pragmatic one as well.

The key to success during the 1980s and 90s was the strength and courage of politicians to make decisions. They reached across the corridor to establish a bipartisan law reform policy. This saved lives and money and prevented much needless suffering.

Of course, we must urge similar strategies respectfully and appropriately. But the Global Commission gives us a chance to do this with the support of the United Nations. We should do so respectfully and appropriately. But we should do it, because it has worked for us, and may work for them.

As the Global Commission report states, we “cannot continue to let people suffer and die because of intolerance, inequality, ignorance, and indifference. The cost of such inaction is simply too high.”

Michael Kirby is a member of the Global Commission on HIV and the Law of the UN Development Program. He served on the High Court of Australia between 1996-2009.

Michael Wong is a researcher at Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria. 

2 July 2012
Guest Contributor

HIV infection, people who inject drugs and drug prohibition

© Ari Hatziz

Alex Wodak commented for Pacific Friends on the recent Global Commission on Drug Policy, which released its groundbreaking report on 26th June. The Commission, which includes six former national presidents, Richard Branson and other world leaders, argues that the global War on Drugs is driving the HIV pandemic among people who use drugs and their sexual partners. The report is released in advance of the world’s largest gathering of HIV & AIDS experts, the International AIDS Conference, to be held in the US this July 22-27, in Washington, DC.

Dr. Wodak comments:

30% of the new HIV infections in the world occur outside Sub Saharan Africa and 30% of these involve the sharing of injection equipment in people who inject drugs. The world has known for more than two decades how to substantially reduce new HIV infections in people who inject drugs but mostly too little has been done too late. The major barrier preventing an effective response in many countries has been and still is an entrenched commitment to global drug prohibition.

As UN Secretary-General Ban Ki-Moon said in 2009 ‘In addition to criminalizing HIV transmission, many countries impose criminal sanctions for same-sex sex, commercial sex and drug injection. Such laws constitute major barriers to reaching key populations with HIV services. Those behaviours should be decriminalized, and people addicted to drugs should receive health services for the treatment of their addiction’.

In low and middle income countries, funding allocated to prevent HIV among people who inject drugs is estimated to be only 3% of that required to control the number of new infections. Global drug prohibition began just over a century ago but the contemporary system began in 1961 with the first of three international drug treaties. In the last half century, global drug production and consumption has soared and adverse consequences including deaths, disease, crime and corruption have increased in many countries. So drug prohibition has greatly magnified the twin epidemics of injecting drug use and HIV.

Fortunately civil society, including Pacific Friends of the Global Fund to Fight AIDS, TB and Malaria, have been an important part of a global push back urging respect for human rights of all citizens, protection of public health and the prudent use of scarce resources. In the last 12 months, there has been a growing recognition that drug prohibition is ineffective, often seriously counter-productive and always expensive. The Global Commission on Drug Policy has played a critical role in changing the international perception about drug prohibition and increasing support for a new and more effective response to drugs and HIV infection among people who inject drugs. 

Why has this all taken so long?  

Dr Alex Wodak AM is a Director of Australia 21, an independent, non-profit organisation whose core purpose is multidisciplinary research and inquiry on issues of strategic importance to Australia in the 21st century. Dr Wodak has been Director of the Alcohol and Drug Service at St. Vincents Hospital, Sydney, Australia since 1982. Dr. Wodak is also President of the Australian Drug Law Reform Foundation and was President of the International Harm Reduction Association (1996-2004). He helped establish the first needle syringe programme and the first medically supervised injecting centre in Australia (when both were pre-legal) and often works in developing countries on HIV control among injecting drug users.
27 June 2012
Guest Contributor

A funding boost from AusAID to help control spread of drug-resistant TB

© Michael Wong, Pacific Friends

A new $8 million plan has been announced to strengthen PNG’s national health capacities in addressing the burden of Tuberculosis (TB). The new AusAID funded program will enable strengthening of the support and facilities of remote clinics in Daru and along the coastal villages of the Western Province of Papua New Guinea.

The strengthening of these national PNG authorities will be assisted by the work of bodies such as World Vision PNG; which are already delivering positive results in the area of treating and monitoring existing TB cases. Following a recent handover from the Queensland and the Australian Federal Governments, concern has been raised that that the closure of Australian clinics in the Torres Strait at the end of this month may be premature and that there may be no guarantee that services in Daru and surroundings will be accessed by PNG nationals.

Having advocated on the issue of tuberculosis for some years, grassroots anti-poverty organisation RESULTS International (Australia) hopes that success in this initiative will help to generate improved management of TB across the country.

National Manager, Maree Nutt, said:

RESULTS members will continue to monitor the situation to ensure that communication pathways are open between PNG clinicians and those who have been managing TB in the Torres Strait, to facilitate a sharing of skills, advice and experience. [These] improved hospital facilities, faster diagnostic tools (such as Gene Xpert) and health workers to supervise the long course of drug treatment are all essential for treating and minimizing the threat of TB and drug resistant TB.

The strengthening of national services will enable clients to better access to life-saving TB treatment as well as being a significant safeguard against the threat of drug-resistant TB to the Australian border. The issue of TB and drug resistant TB is not only a concern for the Western Province, but also for PNG more broadly. Recently ABC’s 7:30 Report warned of the threat of drug-resistant TB to Australian borders. Now, with improved health care facilities and increased capacity to treat TB, existing cases will be effectively managed on the PNG side of the border. Moreover, this will prevent PNG citizens from accessing treatment across the border, which is likely to result in irregular treatment and the development of drug-resistant forms of the disease.

As key organisation managing TB programs in PNG, World Vision PNG is one of the principal recipients of funding from the Global Fund to Fight AIDS, Tuberculosis and Malaria. Over the last three years of the implementation of their DOTS project, World Vision has seen an improvement in the detections of TB from 21% to 81% of cases. The World Vision DOTS program coincides with the National TB Program, and provides feedback to the National Department of Health through provincial offices. World Vision PNG remains optimistic on the issue of integrating new patients into national programs in the effort to fight TB and its drug-resistant forms. World Vision PNG is mobilising its Stop TB Program in the Western Provinces, a program designed to forge a partnership between World Vision, AusAID, the Western Province Health Division and the National TB Program and utilise the skills and resources of each agency and maximize these for the benefit of the Western Province people so that TB services and case management can be dramatically improved in the region.

World Vision commented:

World Vision recognises that multi drug resistant TB on Australia’s border poses a major risk of the disease spreading further. However, like all issues it is important to locate these threats within a broader context. TB is clearly not a disease that is limited by provincial or international boundaries. When reviewing the broader TB landscape in PNG it is important to note that Western Province comprises just 1.7 percent of the total cases, with more than a third of the cases coming form Port Moresby. With this in mind it is important that we continue to push for nation-wide strengthening of TB services so that an inconsistency of care, such as that experienced on the Western Province Border, is not repeated.

World Vision views its work in Western Province as a high priority and is critically aware of how the often negative political debate around this cross border issue has the potential to have real ramifications on patient well being. From World Vision’s experience in managing TB across the country we know that if patients have to travel to receive TB treatment their likelihood of defaulting (stopping medication prematurely) increases significantly and the rise of drug resistant cases is only a matter of time. Therefore, with this injection of funding (AusAID), we believe that treating Western Province TB patients on the PNG side of the border, is not only within our technical capacity but also the only just way of providing TB care to these patients – the only way that is likely to provide increased cure rates.

The work of World Vision PNG and other PNG authorities remains a key force in identifying and treating TB in the Pacific region, and with the announced $8 million plan to better address the burden of TB in PNG, it will reduce the threat of the disease crossing the Australian border.

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Pacific Friends operates as a program within the Kirby Institute at the University of New South Wales.

Pacific Friends

Professor Janice Reid AC
Chair
Bill Bowtell AO
Executive Director

Pacific Friends of the Global Fund to Fight AIDS, Tuberculosis and Malaria is a high-level advocacy organisation which seeks to mobilise regional awareness of the serious threat posed by HIV & AIDS, tuberculosis and malaria to societies and economies in the Pacific. In pursuing its goals Pacific Friends has a specific interest in highlighting the need to protect the rights of women and children in the Pacific.

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