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Dr. Kazatchkine's closing speech at the International AIDS Conference in Mexico

11 August 2008

Dear Colleagues and Friends from around the world:

Good afternoon. Buenas tardes. Bonjour. Bon dia. Dobri dien.

It really is an honour for me to participate in the closing of this conference.

A conference that has brought together 25 000 people from nearly every country in the world. An event that embodies the commitment and creativity that is our global AIDS movement.

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Congratulations to everyone involved in the organization: Luis, Pedro, Julio, Craig and the wonderful IAS team.

Congratulations and thanks to all those who spent many hours in the organizing committees, and everyone else who has contributed to making this conference, once more, such a unique event.

Asistierón cinco mil Mexicanos a la conferencia!!

Quisiera agradecer de manera muy especial al Gobierno de México, a la Ciudad de México, y a todos los habitantes de la región, por su hospitalidad, su calidèz y su compromiso.

Above all, let me congratulate every one of you here. Not just for making this conference a success, but, even more importantly, for what each of you does in the fight against AIDS every day, and for what you have collectively accomplished.

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Congratulations - for being champions of human rights.

Congratulations - for defending the poorest and most vulnerable people in the world.

Congratulations - for aspiring to the highest possible standard of health care in every single country.

Congratulations - for standing up to stigma, discrimination, and intolerance.

And congratulations for your persistence in the face of this epidemic.

Congratulations, dear friends and colleagues, for keeping up the fight.

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These conferences are a moment when we come together, every two years, to take stock and reflect on how far we have come, and how far we have yet to go.

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We can be justly proud of what has been achieved in science.

Today, we can say with some degree of confidence that a 20-year old diagnosed with HIV can expect to live a nearly normal life span if he or she receives and stays on treatment.

And now we are recovering human capital in the developing world. Because of your efforts, having 3 million on treatment in developing countries is no longer a dream.

Think of what these numbers mean: More than two million on treatment in Africa overall; 420 000 in South Africa, 85 000 in Mozambique, 90 000 in Ethiopia. In China 35 000 are on treatment, in Cambodia 27 000, in India 160 000. Here in this region, 400,000 have accessed ARVs.

Lives are being saved on an unprecedented scale.

In addition, contrary to some predictions, there is no alarming evidence of widespread drug resistance. Data are increasingly showing that treatment access for women is broadly equitable. There is a substantial body of clinical evidence to show that the drugs work well, regardless of the setting. And each time we have come close to exhausting the options for those on treatment, we find new solutions, new drugs.

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The need to drastically scale up prevention has dominated this conference. But let’s not allow our quest for the perfect to blind us to the good that has been accomplished. The number of pregnant women receiving ARVs to prevent mother-to-child transmission has increased from 10% to 33% in the last three years. Largely through Global Fund support, harm reduction programs have been established in many countries, including in Eastern Europe and Central Asia, where there was absolutely nothing before.

At this conference, it is clear that we have moved on from the fruitless debate between prevention and treatment that plagued us in the past. We have seen a tremendous mobilization to better address the needs of gay and other men who have sex with men. And the discussion about the preventive benefits of treatment has become more sophisticated.

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We are more aggressive in our efforts against TB and HIV, and understand much better the urgency of this challenge. In Kenya, the percentage of TB patients tested for HIV increased from 19% in 2004 to 70% in 2007. In Malawi the proportion of those tested for both infections has jumped from 25% to 83%. Surveillance of MDRTB and, particularly, improved infection control, must be higher priorities.

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Above all, after 25 years of AIDS, we leave Mexico knowing that our movement remains strong. In many respects, leadership is passing to the South: to highly-engaged Ministers and Heads of State, to health care providers, to communities, to young people, to people living with HIV.

We can leave Mexico feeling confident that, in the course of fighting AIDS, we have created the most dynamic movement for health and justice that the world has ever seen, and we are rightly proud of it.

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All this is the result of your collective efforts, this extraordinary coalition of the North and the South, men and women, black and white, rich and poor, gay and straight, old and young, working together.

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So congratulations to you all.

***

But of course, we cannot leave Mexico with any sense of complacency.

The conference has highlighted many challenges we still face. As we go back to our homes and as we think ahead to Vienna, let me highlight just four of the issues that will test our persistence and determination for at least the next two years.

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The first is human rights. AIDS advocates have given voice to basic, universal rights like few others.

The right to health and decent care. But also the right to freedom from discrimination. The right to equality before the law. The right to privacy. The right to freedom of expression and of peaceable assembly. The right to social security. The right to work, and to education. He rights of children and young people. The right for all to share in the advances of science.

And yet, time and again, affected communities are still being denied these basic rights. Women and girls continue to be raped, subject to violence, and denied sexual and reproductive health services and the basic means to protect themselves from HIV.

Although there is no public health or economic justification for restrictions on entry, stay and residence, people with HIV are still not able to travel freely. We welcome the steps taken by the United States to repeal such laws, but 71 other countries must now do the same.

Gay and other men who have sex with men still endure unacceptable oppression. The Mayor of Moscow says that gay men are “satanic”, while the Gambian President declares that he will “cut off the head” of any homosexual caught in his country.

Injection drug users in Russia are still denied access to methadone and large scale harm reduction services. In some neighboring countries, the programs that do exist are little more than a masquerade. This is the result of what can only be called a deliberate blindness to the evidence of what works. Worldwide, drug users who do access antiretroviral treatment have among the lowest life expectancies of all people on therapy.

In Iran, our physician colleagues are taken into custody, for no apparent reason. Worldwide, as we just heard from Edwin Cameron, criminalization of HIV, laws and prosecutions are hampering our efforts in HIV prevention.

And so, advancing human rights is one of the key strategies that we have in the fight against AIDS. The fight - not just against stigma and discrimination – but for human rights, for equality, and for dignity, must remain at the core of everything we do.

***

My second point is about AIDS research.

With a few exceptions, operational research that really guides and informs implementation is still under-represented at this conference. Too often, investments worth many millions of dollars are being made in the absence of good data, and too often we fail to learn from and share all our experience in scaling up AIDS programs.

The AIDS field has always been innovative, unafraid to criticize and challenge. It now needs to be much more creative in fostering collaboration between science and implementation, so that research becomes an integral part of all programs. Similarly, we must also do more to link science and policy.

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Thirdly: As we leave Mexico, let us now strongly and confidently advance the health systems agenda.

We know only too well that AIDS has highlighted weaknesses in health systems as never before. That is why the Global Fund and PEPFAR are among the biggest investors in health systems in the world today. AIDS programs are investing not only in the “hardware” of health systems - such as laboratories, clinics and other facilities – but also in the “software” that is needed to keep the systems running: drugs, other commodities, and human resources.

Last week in Managua, I was proudly shown the tremendous laboratory infrastructure that has been put in place with Global Fund support. Neither there nor anywhere else is their evidence that such greatly improved conditions are a distortion of health systems. On the contrary: the improvements I saw in Nicaragua, and that are occuring in countries throughout the world, remind us that health systems exist, not in the abstract, but to deliver care and prevention, for diseases that have names, to people in need.

This is why we leave Mexico with a strong consensus, united in our commitment to the Millennium Development Goals as our roadmap for another seven years. I believe that Mexico marks the point when the tiresome and damaging debate between disease programs and broader health systems strengthening is finally over. Let us continue to show that, far from being “the problem” in global health, AIDS will always be part of the solution.

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The final point I wish to make, and which should preoccupy us all in our advocacy from here to Vienna, is about the sustainability of the global response to AIDS.

The Global Fund has helped to change the development paradigm by introducing a new concept of sustainability; one that is not based solely on achieving domestic self-reliance, but on sustained international support, as well. We should therefore be deeply concerned that with less than two years to go before our deadline for universal access, the G8 has committed little more than a third of the resources that it has promised to deliver by 2010.

If we are to ensure sustainability in the years ahead, countries themselves must also do more to make AIDS and health a financial priority. And, in poor countries - as well as some rich ones - we must work to put in place the long term building blocks of social protection, another area where the AIDS movement has begun to lead the way.

Sustainability is not just about resources. It is also about ensuring that our responses are the most effective, based on science and epidemiology, and targeted to those who need them.

Sustainability is also about partnership. The AIDS movement provides a remarkable example of community engagement in the development field. As the response to AIDS leads and becomes part of a revitalized movement for global health, we must never lose this vital principle of inclusiveness.

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My name – one that so many of you struggle to pronounce - is Russian. So it seemed to me appropriate that I should close with a reflection from Aleksandr Solzhenitsyn, one of the greatest campaigners for the oppressed in the 20th century, who died in Moscow as we arrived here last Sunday.

In a letter to students written from exile, Solzhenitsyn said that:

“Justice is conscience. Not a personal conscience, but the conscience of the whole of humanity. Those who clearly recognize the voice of their own conscience, usually also recognize the voice of justice.”

Dear Colleagues and Friends:

By coming here, by following your conscience to join the fight against AIDS, each of you is giving voice to a global fight for justice and to the conscience of all humanity.

***

I wish you all a safe journey home.

Muchas gracias. Merci. Spasiba. Thank you very much.

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