UN Matters

World AIDS Day: Getting to Zero, December 1, 2011

This column discusses what the United Nations can do to ameliorate the medical and psychosocial devastation caused by HIV/AIDS, as well as the launch of its new campaign, "Getting to Zero."

By Juneau Gary and Neal S. Rubin, PhD

World AIDS Day will see the launch of a new campaign at the United Nations on December 1, 2011, called "Getting to Zero." Targets for this campaign include zero new HIV infections, zero discrimination, and zero AIDS related deaths.

Communities, organizations, and individuals have the choice of selecting one, two, or all three "Zeros" targets. This campaign runs through 2015.

The “Getting to Zero” campaign is a global initiative that spotlights how our fundamental right to health is intrinsically and inextricably linked to other basic rights such as the right to food, shelter, freedom, clean water, and safety. The campaign calls for the following:

  • A push toward access to treatment for all;

  • A call for governments to act now;

  • A demand that governments honor promises, such as the 2011 Abuja Declaration, in which African leaders declared that "AIDS is a state of emergency in the continent" and made a series of pledges to address it; and,

  • A challenge that African governments, at the very least, hit agreed targets for domestic spending on health and HIV in support of their citizens’ human rights to the best attainable level of health care.

APA’s UN Team works actively with the UN System (e.g. World Health Organization (WHO), UNICEF) to provide information to ameliorate the devastation of HIV/AIDS and mitigate its psychosocial consequences. When a psychological perspective is overlooked, but relevant to the problem and its solution, we advocate for the use of current psychological science and provide psychological expertise for interventions and proclamations.

Recently, an APA team member and intern participated in the High Level Meeting on HIV/AIDS and provided current research to highlight the psychosocial impact of HIV/AIDS. Our participation highlights that health and mental health needs must be addressed in UN intervention programs to treat and prevent those individuals and families impacted by HIV/AIDS. The UN Team’s influence is important because the psychological health of vulnerable people is often secondary or tertiary to shelter needs, food and water distributions, and safety concerns.

Many humanitarians, policy makers, and peacekeepers are often unaware that the degree of one’s psychological resilience impacts the ability to benefit from vital philanthropic resources (e.g. medical care) to promote overall resilience during periods of adversity. Therefore, people affected with HIV/AIDS and their caregivers are in a position to respond affirmatively to medical, nutrient, and shelter interventions, if these interventions also include a focus on psychological resiliency.

As part of our UN Matters column on World AIDS Day, we invited Dr. Beatrice Krauss, APA Special Project Associate at the UN, to provide an overview of AIDS issues and activities of the NGO Committee on HIV/AIDS. Her report follows.

Juneau Gary, PsyD (main representative to DPI) is Professor in the Department of Counselor Education at Kean University in New Jersey, and Neal S. Rubin, PhD, ABPP (representative to DPI) is Professor at the Illinois School of Professional Psychology of Argosy University in Chicago. Both are associated with the United Nations Department of Public Information and are co-editors of this column.

The United Nations Combats HIV/AIDS: Getting to Zero

By Beatrice Krauss, Special Projects Associate, APA at the UN

Fifty-five hundred people die each day from AIDS-related illnesses; 22 million infected people live in sub-Sahara Africa; and new HIV infections are rising in Eastern Europe and Central Asia (UN Summit, 2010). These are staggering statistics at a time when prevention strategies and treatment are available for HIV- and AIDS-related illnesses.

The medical, psychological, and financial impact has been devastating on the affected person, the family/caregivers, and the community, especially in low- and middle-income countries. Without prompt medical treatment, the devastation has impacted family life, leaving 17.5 million orphaned children or single parent families (UN Summit, 2010). Throughout the deterioration stage, family members and caregivers may experience wide fluctuations of emotions and reactions ranging from negative ones such as anger, loss, grief, emotional and physical abandonment, and depression to positive ones such as an appreciation of a support system and strengthened family relationships. The person’s death may trigger psychosocial crises that may include shelter needs for surviving relatives, social stigma of having a relative die from HIV/AIDS, financial support of the family, and childcare needs. Clearly, the deleterious effects of HIV/AIDS affect many, in addition to the infected person, and families are overwhelmed by psychosocial needs.

What can the United Nations (UN) do to thwart the medical and psychosocial devastation of HIV/AIDS? The Joint UN Programme on HIV/AIDS (UNAIDS) is responsible for assembling the resources and services of ten co-sponsoring UN System organizations to assist countries with technical support in the implementation of their national AIDS plans. In addition to UN System organizations, non-governmental organizations (NGOs), such as the NGO Committee on HIV/AIDS, partner with UNAIDS. Partners debut their new campaign on December 1, 2011, World AIDS Day: Getting to Zero — or, zero new cases, zero stigma, and zero deaths. The campaign addresses a UN goal to combat HIV/AIDS through its Millennium Development Goals (End Poverty, n.d.). This campaign unites the efforts and resources of the UN System, national governments, the private sector, global institutions, and people living with and most affected by HIV/AIDS. This year, World AIDS Day events include the following:

  • Three days of HIV testing at the UNICEF Office in New York City;

  • Opening remarks by the UN Ambassador from the Philippines;

  • A panel of speakers, each focusing on one of the campaign’s themes: no new cases, no stigma, or no new deaths.

World AIDS Day is an annual event begun in 1988. It is an opportunity for people worldwide to unite in the fight against HIV, show their support for people living with HIV, and commemorate people who have died. World AIDS Day was the first ever global health day (World AIDS Day, 2011).

I co-chair the NGO Committee on HIV/AIDS, along with Thomas Brennan. Brian Davis, its secretary, was formerly an APA intern at the UN (2010-2011). We collaborated with UNAIDS to co-sponsor the "High-Level Meeting on HIV/AIDS" in June 2011. Many country heads of state attended and participated in debates and presentations. This meeting concluded with the production of a resolution, "Political Declaration on HIV/AIDS: Intensifying our Efforts to Eliminate HIV/AIDS," which was adopted by the UN General Assembly (UN General Assembly, 2011). The "Declaration" facilitates international dialogue and guides country-by-country strategic plans to address HIV and its impact.

The declaration was seen by many as a watershed moment to address the medical and psychosocial effects of HIV/AIDS and mother-to-child transmission of the virus. Despite the availability of effective medications, mother-to-child virus transmission still exists. Approximately 2.1 million children were infected while in the womb, at birth, or while breastfeeding (UN Summit, 2010). Moreover, antiretroviral medications have reached over five million people but for every two people receiving medical treatment, five more are newly infected (UN Summit, 2010). For those fortunate enough to receive treatment, discontinuation remains a possibility, especially in low- and middle-income countries, and might be related to disruptions resulting from inadequate transportation or civil conflict.

While the declaration was couched in terms of human rights, it called for the scale-up of efforts for universal access to prevention, treatment, care, and support, as well as advocated for a reduction in its social stigma, a decrease in discrimination, and a decline in violence against persons, families, caregivers, and communities living with HIV. It supports a 25% reduction in new transmissions in over 30 countries; a significant reduction in mother-to-child transmission; and enhanced access to antiretroviral medication (UN General Assembly, 2011).

According to the declaration, these changes are expected to result in a 20 percent reduction in AIDS-related deaths during the next five years. Moreover, the declaration used imperative language such as "grave," "deep," and "alarm" to address the needs of vulnerable populations, specifically women, girls, intravenous drug users, young people ages 15 to 24, men who have sex with men, and those engaged in sex work.

Finally, the declaration calls for country-specific strategic plans that will assist its most vulnerable populations and will address its unique circumstances.

The UN System organizations and NGO partners created the World AIDS Campaign, which publicized World AIDS Day events, launched a website, and are preparing for presentations at upcoming meetings of the Commission for Social Development, the Commission on the Status of Women and the Committee on the Status of Women. These respected bodies develop a series of “Agreed Conclusions” that have the same form, but not force, as political declarations. They use their conclusions to advise the Economic and Social Council, one of six coordinating bodies of the UN. At the meetings, the NGO Committee on HIV/AIDS will emphasize the influence of poverty as a cause and a consequence of HIV as well as focus on the link between HIV and immigration.

Finally, the NGO Committee on HIV/AIDS is in the process of completing another project that will benefit persons with HIV/AIDS and their families/caregivers. The Committee has prepared a document that provides guidance for the disclosure of HIV status (of a child or a caregiver) to children 12 years and under. The document will be available shortly on the World Health Organization (WHO) website. APA was wholly involved with the systematic review and meta-analysis of the supporting literature contained in the document.

Individually and collectively, the NGO community, the UN System organizations, professional organizations such as the American Psychological Association, local and federal governmental agencies, and individuals are working at "Getting to Zero." We will continue our promotion of prevention, treatment, care, and support for persons affected by HIV/AIDS, along with identifying ways to reduce psychosocial stressors experienced by their families, caregivers, and communities.

Beatrice Krauss, PhD is Professor of Urban Public Health at Hunter College, City University of New York, and Executive Director of the Hunter College Center for Community and Urban Health. She is also an APA Associate Representative to the UN and Vice Chair of the UN's NGO Committee on HIV/AIDS.

References

End Poverty: 2015. (n.d.). Goal 6: Combat HIV/AIDS, malaria and other diseases.

UN General Assembly (GA/11093). (2011). Adoption of political declaration promises “bold and decisive action.”

UN Summit. (2010). Fact sheet:Combat HIV/AIDS. 

World AIDS Day. (2011). About World AIDS Day.