Q.What changed from Vancouver to Vienna?
At the time of the International AIDS Conference in Vancouver, we were stuck in the emergency phase of the global AIDS response. Less than $300M were available in global resources, experimental treatment was just being introduced, and HIV was still considered to be a death sentence.
In the last 15 years, we have broken conspiracy of silence about the magnitude and impact of the epidemic. The rapid scale-up of AIDS programmes and services, thanks largely to support from the US Government and the Global Fund, are unprecedented and in the history of global public health. Today 5 million people are alive and on treatment on low and middle income countries. New infections have decreased by 17% since 2001.
In a country such as Botswana, which was devastated by over 20% HIV prevalence, has shown that universal access can be achieved, with the majority of people in need now on treatment, and the costs covered by the national government.
As the world prepares to mark 30 years since the start of the AIDS epidemic in 1981, the challenges for the Vienna International AIDS Conference and beyond are completely different. In the midst of the global financial austerity, how do we sustain and scale-up this progress? How do we make our programmes more efficient and ensure we deliver better results? How do we take AIDS out of isolation and leverage synergies with other health and development programmes?
The AIDS 2010 Conference in Vienna will be a pivotal event – but not just for the 25,000 people that will be in attendance. It will provide the momentum and hope for the 33 milllion people living with HIV whose lives depend on what Vienna will deliver.
Q: You have been the Executive Director of UNAIDS since 1st January 2009. Looking back since you took up office, what do you think has been the most challenging so far?
I took office as the Executive Director of UNAIDS against a backdrop of a major backlash against the AIDS response and the unfolding of the worst recession since the 1930s. It was a toxic combination. My greatest challenge has been to get people to understand that the AIDS response is an excellent investment. It reduces HIV transmission, TB infection and maternal and child mortality within communities, and improves work productivity. I am convinced that the AIDS movement can be leveraged to deliver dramatic social change – as a vehicle for addressing human rights, focusing on the needs of the most vulnerable members of society, and ensuring equity and accountability. United Nations Secretary-General Ban Ki-moon could not have been clearer when he wrote, “Universal access to HIV prevention, treatment, care and support represents an essential bridge towards achieving the full range of Millennium Development Goals.” And I believe that the international community is beginning to understand the value of the AIDS response and want to work with us to bring down maternal and child deaths, strengthen health systems and promote gender equality.
Q: What are your priorities for the organization?
One of the first actions I took as EXD was to get UNAIDS to focus on achieving results in a few key priority areas. Areas where progress was lagging; hard issues where the UN can and should make a difference in people’s lives at country level.
First, we have put HIV prevention pack on the global agenda. We have established the UN High-Level Prevention Commission to galvanize a global political campaign to support the prevention revolution. It will enable the high levels of members of the Commission, led by the Nobel Laureates Professor Professor Barré-Sinoussi and Archbishop Desmond Tutu, to carry prevention messages to audiences that we never had access to before.
Second, we are moving to articulate the next generation of HIV treatment – Treatment 2.0. The massive cost of treatment has been portrayed as a financial debt. But we know treatment is a smart global health investment that reduces HIV transmission, reduces TB infection, maternal and child mortality within communities, and improves work productivity. UNAIDS dialogue on Treatment 2.0 aims to rapidly scale-up access by simplifying regimens that will save lives, save resources and dramatically reduce new infections. With 10 million people still awaiting access to treatment, this is the quantum leap-forward needed to bridge the treatment gap.
Third, we still have punitive laws that criminalize men who have sex with men, sex workers and their clients, and people who injecting drugs remain wide-spread—and in many countries are on the rise. For example, travel and residence restrictions in 52 countries are still barriers for millions of people living with HIV. We have made some progress this year, welcoming the lifting of HIV travel restrictions in the United States, China and Namibia.
We cannot reach people with life-saving public health services if their behaviour is against the law. This is why UNAIDS is supporting the launch of the Global Commission on HIV and the Law, which will be critical to identifying and promoting the kinds of laws and policies that will reduce people’s vulnerability to HIV.
Forth, UNAIDS is moving to take AIDS out of isolation, by integrating the AIDS response with other health and development efforts.
Q: In Europe, most people no longer consider HIV/AIDS a threat. Do you share this point of view? In the 1980s and in the 1990s, everybody was afraid of AIDS, and people with AIDS were stigmatized. However, we do not seem to feel the same “fear’ as earlier. Do you think that the risk has gone down, or it is simply that people do not consider it a danger anymore?
Young Europeans no longer see their friends dying of AIDS, and has virtually eliminated mother-to-child transmission of HIV. But I am concerned that it is short-sighted and dangerous for Europeans to no longer consider HIV as a threat. New infections among MSM continue to rise in a large number of European cities.
Epidemic is constantly shifting. In Eastern Europe epidemics among IDUs, their sexual partners are increasingly a population at high risk of infection.
But we should not forget: there is still no cure for AIDS, and every HIV infection happening in Switzerland and elsewhere in Europe should have been easily avoided. In a globalized world, epidemics in far away places like St. Petersburg and Shanghai are felt right here in Geneva.
Q: Recently, during the annual ILO conference, one of the major points of discussion was discrimination of people with AIDS in the work place. Why is it, in your opinion, so important to spend so much time on this subject in these economic difficult times, and how do you view the new ILO recommendations?
The new international labour standard on HIV and AIDS adopted by the recent annual conference of the ILO is a landmark achievement, supported by an unprecedented vote. As Juan Somavia said, nine of every ten people living with HIV will get up today and go to work. This standard will reinforce and extend anti-discrimination policies in the workplace for millions of workers around the world. In the midst of these economic times, this standard will protect workers from discrimination and dismissal on the basis of their HIV status.
This is an example of how UNAIDS leverage extends far beyond the secretariat. As a joint programme, each of the UN cosponsors lead in their area of expertise in the development and implementation of HIV policies and programmes.
Q; Some years ago there was considerable controversy about the figures and the statistics that UNAIDS was publishing. What is the situation today?
HIV has one of the most comprehensive and up to date systems for data collection and use. This year 178 UN member states submitted reports to UNAIDS on country progress – a record response rate in the history of UN reporting. Most countries are now producing their own national HIV estimates, based on extensive data on the status and trends of the epidemic.
UNAIDS has always used the best information available from countries to produce global estimates on HIV and AIDS. Over the past years, both data sources and the methods we use have been improved.
We continue to work with all partners to constantly improve our estimates to provide the evidence needed to support planners and decision makers in programme implementation.
Q; Recently UNDP and UNAIDS set up the Global Commission on HIV and the Law. Why?
When I became EXD of UNAIDS I asked a lot of people – what will change the game for the AIDS response? What have we not been doing, so that 30 years into this, we still don’t have the success we seek? Many answered, “Deal with the laws out there. They are blocking the response.” And I listened to those who are being punished, not protected, in the context of HIV and have seen what it does to people.
Today, 84 countries report having laws and regulations that present real obstacles for vulnerable sub-populations to access HIV prevention, treatment and care. 49 countries have HIV-specific laws that criminalise HIV transmission or exposure. 86 countries have laws that prohibit homosexuality, with seven providing the death penalty for it; and numerous countries criminalise harm reduction measures in the context of drug use.
So we are dealing with the harmful laws and law enforcement, and I fully expect it to be the game-changer it is. Now with the clout and commitment of this Commission, UNDP and the Commission will help make sure the world no longer ignores a critical area of the HIV response.
Q: What about access to medication and treatment for those living with HIV/AIDS who are poor? Has there been any progress?
The scale-up to antiretroviral treatment has been one of the greatest success stories in global health. By the end of 2009, 5 million people living with HIV had access to ART in low and middle income countries, up from virtually nothing in 2002. However, about 10 more million people living with HIV are still lacking access to treatment. Treatment coverage for women, children, poor and vulnerable populations such as injecting drug users remains a major challenge in many parts of the world.
This is why UNAIDS is leading a new initiative entitled Treatment 2.0 – the next generation of HIV treatment. It is now clear that universal access to ART will not only have a significant impact on AIDS morbidity and mortality but also on TB morbidity and mortality, maternal and child mortality, and on reducing HIV transmission. Treatment 2.0 calls for a paradigm-shift in the global thinking about HIV treatment.
In order to reach all those in need, we must radically simplify the current treatment approaches, reduce costs and integrate treatment with prevention programmes. This is possible if all partners from researchers to programme managers, civil society and the pharmaceutical pull together.
Q: Many NGOs are always complaining about lack of funding to HIV/AIDS. Is this exaggerated, and what is the situation for funding for UNAIDS?
Global funding for AIDS has increased significantly over the past decade, reaching $16B per year at the end of 2009. This is a remarkable sign of commitment in times of a global financial crisis. However, it is clear that current levels resources, both national and interactional, are not sufficient to fully meet the commitments made in achieving Universal Access to prevention and treatment, and to achieve the MDGs.
Many non-governmental organizations rightly complain that they do not receive adequate funding. NGOs deliver some of the most innovative HIV programmes and services, often on a shoe-strong budget. Governments are often not using the capacity of civil society to scale-up these services in hard to reach populations or remote communities. UNAIDS remains committed to ensure that NGOs not only have a role in deciding how the resources should be best targeted, but also in delivering the services in partnership with government and international organizations. This is the kind of mutual accountability that the AIDS movement can foster.
UNAIDS is also facing funding challenges. In the current economic climate, we cannot expect donors to sustain the continued scale-up of resources that UNAIDS has received in recent years. Our budget will remain stable or see a minor decrease. But this period is also an opportunity to ensure we are becoming a more efficient organization. Delivering greater results with fewer resources. And ensure that ever cent given to UNAIDS is well spent.
Q: Where do you see the organization in a couple of years from now, and what would you like to achieve under your steermanship?
Over the longer term, we need to be thinking how we can put ourselves out of the AIDS business—my vision is Zero new infections. Zero discrimination. Zero AIDS-related deaths. More immediately, and in the present climate, I think that like all United Nations organizations—we must push ourselves to be more focused, more strategic, more flexible and responsive, more accountable and more efficient—delivering value-for-money.
I spoke earlier about making UNAIDS more focused. Strategically, we are working on the next generation of treatment, provoking a prevention revolution, intensifying our work to get rid of punitive laws that block the AIDS response and bringing the AIDS response out of isolation. Recognizing that we will be better positioned to deliver country-focused results, we are planning for the optimal deployment of Secretariat staff in the field based on the needs of the epidemic. Under my steermanship—I want to see the virtual elimination of mother-to-child transmission of HIV and the end of travel restrictions based on HIV status.
Q: When you work with impoverished HIV+ people, you tend to see what some people would call the misery of the world. How do you cope with that, and how do you manage to keep a positive attitude to the beauty of life?
I have been to all fronts of the epidemic and I have seen true horrors and injustices—people making choices no on should be forced to make—like the so-called choice between feeding your child and taking treatment. Orphaned children robbed of their childhood. These are painful realities in my job.
Holocaust survivor Primo Levy once said, “If we know that pain and suffering can be alleviated and we do nothing about it, we, ourselves, are the perpetrators.” Just as the world is compelled to respond to AIDS, we have a moral imperative to speak up to decry such acts, and act up to protect and empower people affected by HIV.
But I also draw tremendous strength from the AIDS response. The millions of courageous people living with HIV who have challenged the world and in so doing have changed the planet we live on. They give me hope—they get me out of bed in the morning with fresh resolve to give voice to the voiceless, to democratize problem-solving and to redistribute opportunity. To use my privilege and the responsibility of my post to support the AIDS movement to build a more just, more equitable and tolerant world.
Q; Finally, on a more personal note, in what sense has this work changed your life, and do you have a special message for the international community?
As I mentioned, working with the AIDS movement gives me the strength and conviction that change is possible. The first year and a half in this job has reinforced my belief that the United Nations works best when it works in partnership—I can really see that in the case of UNAIDS. It is only through partnership that we can truly change the world. My message to the international community would be to paraphrase Andy Warhol: They always say time changes things, but you actually have to change them yourself.
