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Statement by UNICEF Deputy Executive Director, Kul Gautam, on Child-friendly Strategies to Combat HIV/AIDS and Malaria

Given at the Special Summit of the African Union on HIV/AIDS, Tuberculosis and Malaria
ABUJA, 4 May 2006 – My colleagues Dr. Feacham and Dr. Piot have just outlined eloquently what we all need to do to overcome the challenges of HIV/AIDS, tuberculosis and malaria.  I have little to add to their wise counsel borne out of their vast experience and expertise.

I would therefore like to concentrate my remarks on what strategies might yield the best results for protecting children – our future generation – from the impact of HIV/AIDS and malaria, two of the greatest enemies of children in our times.

AIDS and malaria are devastating the life chances of millions of children.  In a cruel twist of fate, children born today in some parts of Africa can expect to live a shorter life than their parents and grandparents.  This has never happened for a prolonged period in human history.

Malaria is the biggest killer of children in sub-Saharan Africa.  But it does not only kill, it also debilitates its victims, leaving millions of them unable to fulfill their potential to learn as children and earn as adults.

We are assembled here today to discuss how we can ensure sustainability of the impact of our actions to combat these diseases.  Let us remember that the only thing we have been able to sustain so far is low coverage of high impact interventions and services.

That is why even the relatively modest Abuja targets remain unachieved, even as we now embark on a far more ambitious target of universal access by a United Africa by 2010.

I am all for ambitious targets: the devastating impact of HIV/AIDS and malaria calls for nothing less.  But let us watch out and be self-critical.  In international conferences like this one, goals are ever set, but rarely met.  And people become cynical about goal and target-setting.  Let us make sure that our ambitious goals and targets are matched with equally ambitious investment and action plans.

For HIV/AIDS, my organization, UNICEF, along with UNAIDS, WHO and several other partners has launched a campaign called ‘Unite for Children, Unite against AIDS’. The campaign focuses on achieving four key results for children – the so-called ‘Four P’s’.

• Prevent mother-to-child transmission.  We need to dramatically increase the coverage of PMTCT services from less than 10 percent of HIV positive pregnant women today to 80 percent by 2010. PMTCT has been an area of gross failure since the Abuja summit. We need to redouble our efforts in PMTCT as it can avert a million new child infections every year and prolong the lives of mothers.

• Provide paediatric treatment.  We need to move from less than 5 percent of children with AIDS having access to anti-retroviral treatment at present to 80 percent by 2010. This will help avert over a million child deaths.

While every effort should be made to ensure universal access to paediatric ARVs, we must also provide cotrimoxazole prophylaxis to children, an intervention that has proven to significantly reduce child mortality, to exposed and infected children.

• Prevent infection among adolescents and young people.  We need to reduce new infections among young people by 25 per cent globally by 2010.  Such primary prevention is the key to stopping the spread of HIV in the long run.

• Protect and support children affected by HIV/AIDS.  At present fewer than 10 per cent of the 12 million AIDS orphans receive adequate care, support, schooling and protection.  This should be increased to 80 per cent by 2010, so that these vulnerable children reach adulthood safely to protect themselves and their own children.

While it is our moral imperative to provide universal access to treatment, primary prevention is the only sustainable way to combat HIV/AIDS.  And empowering young people to protect themselves is the key to stopping the AIDS pandemic in the long run.

I would urge this Summit to strongly endorse this agenda of ‘Unite for Children, Unite against AIDS’. I would also urge African leaders to take the message of this Summit to the high level review of UNGASS in New York later this month, and to make their presence felt and their voice on behalf of future generations heard at the UNGASS review.

Turning now to malaria, it is clear that with a few honourable exceptions, action against this number one killer of children in Africa has fallen short of the targets of the Abuja Declaration on Roll Back Malaria.

Yet, there has been a tremendous increase in availability of three key resources to combat malaria.  We now have substantially more financial resources for malaria programmes.  And the production of insecticide treated bednets and artemesinin-based combination therapy has increased dramatically since the initial Abuja summit.

But community level coverage of these commodities and services is substantially lower than the global availability of essential commodities and funding resources.  It is obvious that what is needed are better strategies and increased political commitment even more than increased resources.

We must learn from the positive experience of countries such as Eritrea, Malawi, Mali, Senegal, Tanzania, Togo and Zambia that have reached or are close to reaching the Abuja target of 60 per cent insecticide treated net coverage.  If these countries can do it, so can many others.

Strategies used in these countries, such as distributing bednets during antenatal visits by women, or during measles or other immunization campaigns, should be used to provide bednets, vitamin A, and deworming medicines to children.  This is part of the Immunization Plus strategy that WHO and UNICEF have been promoting.

It is clear that Millennium Development Goal Four on child survival will not be achieved in Africa unless HIV/AIDS and malaria are tackled more effectively.  So we at UNICEF see tackling HIV/AIDS and malaria, MDG Six, as part of a more integrated ‘continuum of care’ approach to child survival and maternal health – i.e. MDGs Four and Five.

AIDS, malaria, TB as well as other major causes of high child and maternal mortality and morbidity in developing countries are ultimately the diseases of poverty.  They must therefore form part of a broader poverty reduction agenda.

And as our dear friend Ambassador Stephen Lewis never tires of emphasizing, and we all agree, an underlying cause of the slow and unequal progress in combating HIV/AIDS, reducing maternal mortality, closing the gender gap in basic education is the deeply-rooted gender inequality and low status of girls and women in most of our societies.

These need to be tackled in a comprehensive manner as part of the Millennium Agenda comprising the MDGs and the protection and promotion of social justice, human rights, peace and human security.

This special Summit on universal access to AIDS, TB and Malaria services by a United Africa presents to us all yet another challenge and opportunity to build an Africa where its future generations – starting with the children of today – can grow up to their full human potential.

UNICEF and the whole United Nations system stand shoulder to shoulder with the African Union to help build an Africa that one day will be free of AIDS, TB and malaria and truly fit for its future generations.

Thank you.

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