Part 1: HIV/AIDS and UNGASS: a new era of commitment (from the Background Paper for Communication for Development Roundtable)

The HIV/AIDS pandemic arguably presents the starkest, gravest, most complex development challenge the development communication community has ever faced. The remorseless escalation of the epidemic in developing countries provides a devastating backdrop to this Communication for Development Roundtable. While important advances have been made in the effort to contain HIV, the reality behind this meeting is that more than 36 million people are now HIV+ and up to one in four of the adult population of the most heavily affected countries now carry the virus.

Conversely, there is also greater optimism, energy and commitment surrounding the epidemic than there has been for many years. HIV/AIDS has over the last two years become the focus of more intense international attention than any other public health issue facing the developing world, a process which culminated at the UN General Assembly Special Session on AIDS (UNGASS) in June this year and the establishment of a new global fund (the Global Fund to fight AIDS, Tuberculosis and Malaria). After years of conferences, lobbying by international agencies and civil society organisations, and the growing evidence of the scale of the crisis, 2001 saw the potential turning point where the international community made HIV/AIDS a major international priority.

Arguably we have been here before. In the late 1980s there was a similar (although not as intense) upsurge of international policy and public debate on HIV/AIDS with donors increasing their funding to tackle the epidemic and with intensive international media coverage focused on the issue. This international attention waned in the 1990s, partly because the epidemic did not materialise as a significant problem in the North, partly because of the decline in political advocacy in the North around the epidemic once antiretroviral treatments became more widely available, and partly because of complexity of the epidemic and the lack of short term gains.

In the last few years, however, two issues have brought the issue firmly back on to development agendas. The first is the (re)recognition of the scale of the epidemic itself. The second is the development of combination therapy of antiretroviral drugs, which quickly became widely available in the North, but unavailable to most people living with HIV/AIDS. This issue became the catalyst and focal point for arguably the first genuinely southern driven global movement in response to the epidemic.

The efforts of individuals and organisations to bring HIV/AIDS back onto the agenda of Northern governments paid fruit in 2000, when the G8 group of nations discussed the issue at the Okinawa summit. That meeting, combined with many other initiatives brought about the process that led to UNGASS in June 2001 - the first time the such a session had been called to discuss a health issue - and the establishment of the Global Health Fund (now known as the Global Fund for AIDS, TB and Malaria) in the same year.

The Declaration of Commitment on HIV/AIDS that emerged from UNGASS was subject to intense and prolonged debate during its drafting, with some of the language, particularly on groups most at risk, being watered down. Nonetheless, it remains a stronger document than some critics had feared and, if applied, a potentially powerful tool mandating governments and others to undertake a wide range of actions. These include the development of "national strategies and financing plans for combating HIV/AIDS that address the epidemic in forthright terms" and to "confront stigma, silence and denial; address gender and age-based dimensions of the epidemic; eliminate discrimination and marginalization."

Furthermore, actors are urged to "involve partnerships with civil society and the business sector and the full participation of people living with HIV/AIDS, those in vulnerable groups and people mostly at risk, particularly women and young people - fully promote and protect all human rights and fundamental freedoms, including the right to the highest attainable standard of physical and mental health."

Now that the epidemic is once again on the international agenda, the hope is that this time, compared to the 1980s and 1990s, commitments made will be met. However, it remains to be seen how effective the Declaration will be. Many observers doubt that the deadlines and evaluation mechanisms it imposes for developing strategies will be met by many countries. Nonetheless, they believe that the language in the Declaration will provide a tool for NGOs and others to pressure their governments to take appropriate action and the Declaration will prove itself over time as the concepts it describes are incorporated into other documents and the general discourse on HIV/AIDS and development.

The biggest question marks hang over the newly created Global Fund. There remain a number of areas of uncertainty over the likely impact of the Fund; there are major concerns as to whether the fund will actually lead to new money being made available: there is continuing uncertainty as to the differing emphases on prevention and treatment; there are concerns over how the funds will be channelled, and particular concerns over representation (particularly from civil society) on involvement in setting spending priorities for the fund.

Nevertheless, there is a demonstrable new energy and commitment around HIV/AIDS from the international community, with new funding not only being channelled into the new Fund but also from existing and major new donors in this field. One of the challenges facing the Communication for Development Roundtable is identifying the most effective strategies on which this still inadequate resource based can be used.