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NITED NATIONS, June 27 -- The General Assembly approved an ambitious declaration tonight outlining how the world should proceed in its fight against AIDS. Concluding its three-day special session on the pandemic, the world body also made a plea to nations and private industry alike to provide the billions of dollars needed to help pay for the mission.
The Declaration of Commitment, as the document is known, while in no way enforceable by the international community, is nonetheless extraordinary in both its language and its tact. It views the AIDS problem as something far beyond a medical issue, framing it instead as a political, human rights and economic threat. It also addresses head-on issues like the role that the exploitation of poor women and discrimination has played in spreading H.I.V., the virus that causes AIDS.
Calling the document an "instrument for accountability," Dr. Peter Piot, executive director of Unaids, the United Nations agency coordinating the fight against the disease, said that it would provide "a strong basis for future action" that would be measurable in many ways in the near future. A key goal is a 25 percent reduction of H.I.V. infection among young men and women in the most affected countries by 2005.
Recognizing that many of the document's elements would be a hard sell in nations where rural women enjoy few rights, where gays are heavily stigmatized and where sexual education is generally eschewed, Dr. Piot and Secretary General Kofi Annan said that all countries will be pushed to put cultural mores aside to save lives. "It is our job to push the edges now," Dr. Piot said.
How difficult that challenge could be was evident early in the week as some Islamic countries strongly opposed mentioning gays as one of the groups at highest risk for AIDS. (Language about high-risk groups was eventually deleted from the declaration.) "Some painful differences have been brought into the open," Mr. Annan said. "But that is the best place for them. Like AIDS itself, these differences need to be confronted head-on, not swept under the carpet."
The declaration says that by 2003 countries should identify the factors in their area leading to the spread of AIDS and come up with specific targets for improving prevention. It also calls on them to develop national strategies for combating the spread of H.I.V. and to provide treatment for all those infected.
The document says that by 2005 countries also need to increase access to male and female condoms, expand AIDS testing and counseling, ensure safe blood supplies and provide sterile equipment to drug users.
Mr. Annan said the United Nations will follow up with countries to see if they are setting and meeting these goals, and will chastise them if they fail to do so.
Calling AIDS a "global emergency," the declaration details where the disease has hit hardest, namely Africa, and outlines the many factors contributing to the spread of AIDS that were explored at length this week, including rural poverty, poor health care systems and the stigma associated seeking treatment.
But the declaration also calls for legislation and regulations to protect the rights of infected citizens and states explicitly that "empowering women is essential for reducing vulnerability," noting that social exclusion, illiteracy and sexual exploitation have contributed to new infections.
The document calls for eliminating things like "harmful traditional and customary practices" which appears to be an allusion to things like genital mutilation, a procedure in which reused knives increase the risk of contracting AIDS through infected blood. "If there is one idea that stands out clearly," Mr. Annan said, "it is that women are in the forefront of this battle."
The declaration recognizes the role of local groups operating outside of the government in helping stem the illness in ways that Mr. Annan noted was unprecedented, and calls on governments to help these groups reach out to the most vulnerable populations.
Asking the entire world to start educating rural women and help them gain economic and social currency is a tall order, considering that many countries permit things like wife inheritance and that literacy rates for women are low. Cultural impediments also exist in allowing groups to offer services to people whose behaviors are stigmatized if not severely punished.
There was an absence of leaders from Asian and Eastern European nations where infection rates are rising, a point that Dr. Piot noted with alarm.
But in spite of these impediments, officials at the special session encouraged optimism that the world had taken on such a polarizing and difficult subject in such a large forum after 20 years of not having dealt with the topic.
During the week, women from the desert regions of Western Africa were seen sitting cramped togetherwith English businessmen in a conference room discussing microbicides. Other participants from the world's most conservative nations considered sex education for unmarried citizens.
Gudmund Hernes, an official with Unesco, noted that he would never have believed that he would sit in the General Assembly of the United Nations, "discussing condoms."
Before the session, controversy erupted over treatment versus prevention, with each side arguing that one should not be subordinate to the other. The document accepted today ties the two strategies together outlining the desired world response to AIDS, but it calls for "acknowledging that prevention of H.I.V. infection must be the mainstay of the nation, regional and international response to the epidemic." The "false debate" about the two strategies is over, Dr. Piot said.
Seeking a stepped-up response to AIDS will require new money, and there was a call for public and private efforts to generate roughly $9 billion for a Global AIDS and Health Fund that Mr. Annan hopes to be up and running by the end of the year.
While the specifics of how that fund would operate are to be worked out over the next month, Mr. Annan, who held up a check for $1,000 from a private donor, suggested that the fund would be run by a small and efficient board of donor and recipient counties, United Nations officials and people from governments and private industries.
Mr. Annan said that despite the stubborn nature of AIDS and many countries' continued denial of its pervasive threat, "All in all, I feel even more confident today than I did three days ago that we can defeat this deadly disease."