JOHANNESBURG, 9 June 2011 (PlusNews) - More than 30 heads of state and government are at the 2011 UN High-Level Meeting on AIDS in New York - one of the biggest events on the HIV/AIDS calendar. It has been 30 years since the first case of HIV was diagnosed, 10 years since the landmark UN General Assembly Special Session on HIV/AIDS, and 5 years since countries met to commit to universal access to HIV services. The meeting couldn't have come at a better time - funding for AIDS is on the decline, while competing global priorities such as climate change have captured the world's attention.

The discussions are expected to produce a political declaration that will guide the global response to HIV/AIDS, but opinion is divided on the impact of such declarations. At the 2006 UN High-Level Meeting on AIDS, world leaders committed to providing universal access to treatment, prevention, care and support by 2010 and agreed to set national targets. By the end of 2010, very few countries had achieved these ambitious goals.

IRIN/PlusNews has produced a briefing on the role of the 2011 UN High-Level Meeting on HIV/AIDS.

Do we still need a meeting on this scale?

It's easy to be cynical about the value of such high-profile gatherings, which seem far removed from the coalface of the AIDS epidemic, but UNAIDS Director for East and Southern Africa Sheila Tlou points out that it was after a similar meeting 10 years ago - the landmark 2001 UN General Assembly Special Session on AIDS - that countries began to take HIV/AIDS more seriously. "Had it not occurred, I don't think a lot of heads of state would have moved [on AIDS]; I don't think that the Global Fund [to fight HIV/AIDS, Tuberculosis and Malaria] would have been formed."

Activists argue that a large high-level meeting is vital at such a crucial point in the global HIV response. "If countries do not commit now to breaking the back of the virus - getting people on treatment and ensuring that there are the affordable medicines available to do it - then we never will," cautioned Sharonann Lynch, HIV policy advisor for the Medecins Sans Frontieres (MSF) Campaign for Essential Medicines.

"UNAIDS has projected that 12 million new infections and 7 million new deaths can be averted by 2020 if everyone who needs treatment gets treatment. When you have statistics like these, it's clear that now is the time for governments to take a stand and choose to stop the spread of HIV," Lynch added.

At a juncture when financial support for AIDS is waning, and hard-hit countries are under pressure to produce results with less funding, this meeting could have been a hard sell to donors and governments grappling with other challenges. But last month's announcement that treating people living with HIV earlier could reduce HIV transmission by up to 96 percent has reignited the HIV/AIDS field - the game has changed. "There's hope out there. I think this alone will give this meeting more energy and momentum than past meetings," said Lynch.

What's on the agenda?

The goals and targets agreed by member states in 2001 and 2006 expired at the end of 2010, so the 2011 High-Level Meeting needs to come up with a "bold new strategy" to overcome the remaining challenges and sustain the global AIDS response. Countries have been negotiating a new declaration for the past two months through their Missions to the United Nations in New York, and a civil society hearing in April 2011 ensured that the sector�s input was included in the negotiations.

The process is still far from ideal. Ahead of the meeting, African civil society groups and governments discussed a common position in Windhoek, Namibia, which has not been reflected in the negotiations so far. Nonkosi Khumalo, chairperson of South Africa's Treatment Action Campaign, said the African group's proposed amendments to the negotiations "greatly weaken the proven effective means to reduce new infections, especially among the most-at-risk populations. Without strong prevention and treatment targets, and the means to achieve them, we are actually setting ourselves up for nothing more than another talk shop with little to show for it, come 2015."

Tlou attributes this to the fact that some of the staff at embassies and missions conducting the negotiations have little interest in or knowledge of HIV/AIDS issues, while regions sometimes also disagree among themselves. Consequently, the final document is a "watered down" version. "The commitment is there, but the people who make the decisions are not the right people," she noted.

UN Secretary-General Ban Ki-moon has proposed a treatment target of putting at least 13 million people on treatment by 2015, while others have called for a target of 15 million people. According to MSF, in closed meetings the US and some European governments such as the UK have been reluctant to support such a target.

Money, or the lack of it, is undoubtedly a key issue at the 2011 meeting. In sub-Saharan Africa, millions of HIV-positive people rely on external donors for the drugs that keep them alive. A UNAIDS report found that in 56 developing countries, international funders supply at least 70 percent of all AIDS resources.

Sustainable financing of the AIDS response will be an even more pressing issue for countries in east and southern Africa, which shoulder the largest burden of the world's HIV-positive population, and where an estimated 3.2 million people are on antiretroviral (ARV) drugs. Most countries in these regions have changed their treatment protocols to provide people with medication earlier, in line with recent World Health Organization recommendations, but funding constraints could not only hamper these changes, they could also jeopardize the lives of people already on treatment.

The responsibility of national governments to spend their own resources will also be in the spotlight, and Tlou hopes the meeting will spur countries to prioritize their actions, and "spend less on the military and more on AIDS - the war is within."

The extent to which at-risk populations - sex workers, men who have sex with men (MSM), injecting drug users - are mentioned in these declarations has long been a bone of contention, particularly in more conservative countries. Tlou, for one, would like to be at the sessions where these issues are discussed. "It would be really great for MSM and sex workers to stand before heads of state and say, 'I'm as much entitled to access HIV services as the rest of the heterosexual population - so why exclude me?'"

Promises, promises?

The failure of governments to meet targets set at previous meetings does not mean there has been no progress. While targets are still important to monitor any improvements made at national level, Pride Chigwedere, the UNAIDS regional focal point for the High-Level Meeting, suggests that the time has come to look at quality, rather than quantity. Instead of looking at how many clinics in a country provide services to prevent mother-to-child-transmission of HIV, the focus should now be on whether the mothers and babies survive, and the rate of transmission between HIV-positive mothers and their infants.

The true test of whether the 2011 meeting will be of any value to global AIDS efforts will be in the outcomes. When the promises have been made and the hoopla has come to an end, will governments deliver?

Lynch commented: "Once countries sign the piece of paper demonstrating their commitment, people living with HIV, their friends, and their families will put the pressure on countries to make sure that they follow through on their promises and hold them accountable."