Your Excellency,

Medecins Sans Frontieres (MSF) the independent international medical aid organization and recipient of the 1999 Nobel Peace Prize urges you to ensure that the final language of the Declaration of Commitment on HIV/AIDS being prepared for the United Nations General Assembly Special Session on HIV/AIDS (UNGASS) is strengthened substantially to emphasize the critical importance of treatment for people living with HIV/AIDS in developing countries.

MSF welcomes the fact that the U.N. is convening UNGASS as a matter of urgent concern. The report of the Secretary General on HIV/AIDS rightly identifies HIV/AIDS as a complex social, economic, and health emergency requiring "a global commitment for intensified and coordinated action at the global and national levels" (B6123). We particularly appreciate the Secretary General's recognition that "a comprehensive approach to care must be adopted [that] includes equitable access to medical treatment, including drugs for opportunistic infections and antiretroviral therapy" (B697), and that "we need to find ways of more effectively using trade policy provisions, such as compulsory licensing or parallel importation, to increase access to care" (B6101). We further applaud the Secretary General's acknowledgement of the need for adequate financial resources for effective and comprehensive treatment, care, and support programs (including antiretroviral therapy), as well as the recognition of the central importance of the participation of people living with HIV/AIDS in the UNG ASS process and in community, national, and global responses to the epidemic.

We are deeply disappointed, however, with the Draft Declaration of Commitment which states that "prevention must be the mainstay of our response" and urge your government to ensure that treatment for the 34 million people already infected with HIV in the developing world be placed at the same level of priority as prevention of new infections. Anything short of this is will be woefully inadequate and morally unacceptable.

Treatment and prevention are mutually dependent and equally necessary elements of any effective strategy to address HIV/AIDS. MSF doctors, nurses, and other health professionals working to provide treatment as part of a full continuum of care for people with HIV/AIDS in South Africa, Malawi, Cameroon, Uganda, Thailand, Cambodia, Guatemala, and elsewhere witness daily the myriad benefits of providing treatment. Our field experience has taught us that, in addition to improving and extending the lives of people living with HIV/AIDS, offering anti-retroviral treatment and treatment of opportunistic infections and sexually transmitted diseases significantly enhances prevention activities. We therefore strongly urge you to adopt language in the final Declaration that reflect s this (please see attached document for suggested modifications; modifications should appear in blue in the document).

The guarantee of treatment provides a powerful incentive for people to be tested for HIV and a greater possibility that those already infected with HIV will adopt risk-reducing behaviors. Of course, treatment of pregnant mothers with HIV/AIDS directly reduces mother-to-child-transmission of HIV, and there is strong evidence that treatment reduces viral load thereby reducing the risk of transmission of HIV. In addition to these benefits, we have seen that offering treatment addresses the stigma and denial associated with HIV. By keeping people healthier and alive longer, treatment naturally helps alleviate the social and economic impact of the disease. Finally, we have seen that offering treatment actually strengthens local health infrastructure by galvanizing resources and increasing the technical capacity of health workers.

People with HIV/AIDS in poor countries cannot afford to wait a day longer for the medicines that would improve their health and extend or save their lives.

Your willingness to recognize the inextricable link between treatment and prevention, the necessity of specifying measures that will assist countries in overcoming all barriers to access to treatment, including trade-related barriers, the need to ensure adequate resources for a comprehensive response to the pandemic, and the importance of the full participation of people living with HIV/AIDS at all levels and your pledge to ensure that this is reflected in the final Declaration of Commitment will be an important demonstration that the world's leaders are prepared to provide real leadership in the fight against AIDS.

Thank you for your immediate attention to this urgent matter.

With my highest consideration,

Morten Rostrup, MD, PhD President, Medecins Sans Frontieres International Council

P.S. If you need additional information or clarifications, please feel free to contact my colleague, Dr. Anne-Valerie Kaninda in the MSF office in New Y ork at 212-655-3773 or by email at

anne-valerie_kaninda@newyork.msf.org