30 November 2012

Africa: The Fight Against Aids - No Time to 'Rest on Our Laurels'


Saturday marks World Aids Day. Stephen Lewis, chair of the Stephen Lewis Foundation, which helps fight HIV/Aids, says the human face of the disease needs to be restored and that it is no time for "resting on our laurels". In an interview with AllAfrica's Bunmi Oloruntoba after the Aids2012 conference in Washington DC in late July, Lewis spoke Lewis spoke about the future of fighting HIV/Aids. Since 2003, his organization has funded over 700 initiatives in the 15 African countries hardest hit by the pandemic by working with community organizations to support to women, orphaned children, grandmothers and people living with the disease.

What are the key issues that concern you about HIV/Aids prevention?

There is too much self-congratulation about what we have achieved, and not enough recognition of how much more we have to achieve. There are 33 or 34 million people that are going to require treatment in the immediate future. There are 2.5 million children or more between the ages of five and 16 that are receiving no treatment at all. While there is a lot of public relations around the elimination of pediatric Aids by 2015, there isn't the kind of determined leadership from United Nations agencies which would make it happen in the countries where it is desperately important, like Nigeria, where you have 27 percent of the needs.

So I am a little concerned that the rhetorical blandishments about human rights for men who have sex with men (MSM), and sex work, and injecting drug use and prison populations never gets down to the serious detail on the ground. The rhetoric always flagellates or criticizes countries in the most generalized way but doesn't go to Uganda and say to President Yoweri Museveni, 'You are going to be internationally condemned at every turn unless you get rid of that legislation' that criminalizes homosexuality. Nobody ever goes after him from the UN system where the power lies. There has to be an international effort.

And on all of these issues, it's important to give the world the sense that not only is the pandemic not over, but we haven't yet crossed the threshold. We don't have a vaccine. We don't yet have a microbicide. They are talking of a cure in some abstract way, but that's decades and decades off.

So, we're just resting on our laurels.

Do you think part of that has to do with the recent mobilization around male circumcision, and the great results that are being claimed?

I think the resting on laurels is the statistical ability to say, 'There were 300,000 people in treatment in 2003 and there are eight million people in treatment in 2012, and isn't this an astonishing achievement?' It's an achievement - it's not astonishing. It's the responsibility of UN organizations and of governments to do exactly that. And you don't sort of fall to the ground patting yourself on the back because you have done what morally you should do.

Male circumcision is a good example of how slow everything has been. We've known that male circumcision works since back in the late 90s and early part of the last decade, and we are only getting around to it now. We knew that prevention of vertical transmission (mother-to-child) worked back in the very late 90s and early part of the last decade. Indeed UNAIDS in its recent report admits that between 2000 and 2005 they treaded water. Why? How many lives were lost?

What is happening here is an inadequate recollection of the price we have paid, of the toll.  Leaders should be more measured in the indulgence of their instincts, and take time to think what has happened and must be avoided, and how much more there is to do.

Vertical transmission - it's something we have known about for a while. Why is it still a problem?

And why is it suddenly fixated upon? It has a public relations value doesn't it? If you eliminate pediatric infections by 2015, that is to say reduce by 90 percent the levels which existed in 2009, which is their target, then you can say to the world, 'Oh my God, what a magnificent success. Continue to give us money. We can break the back of this pandemic - look at what we have done.' And who would deny that? I mean, you want these kids to be born HIV negative, you want the mothers to live, but we lost a complete decade.

I remember when the Guardian correspondent left South Africa about two years ago, he wrote a piece that said, 'By refusing to roll out treatment to prevent vertical transmission, Thabo Mbeki presided over the death of 82,000 children.' And that's absolutely true. That's called a crime against humanity and one day Mbeki will end up in front of the International Criminal Court if any of us have capacity to do it.

But all over the world that happened. It's the fault of governments, obviously. But I was the deputy executive director of Unicef and I handled international programs for four years. I know where the responsibility lies, and it lies with Unicef and UNAIDS. It lies mostly with Unicef because they are in the field.

We have been so slow on this because Unicef couldn't get its act together, because it didn't consider it a sufficient priority in the early part of the last decade to take advantage of exactly what you've described - the easiest intervention there is.

Who are the heroes?

The heroes are the people on the ground who get to small communities, and small projects and find a few pennies to rub together and respond at community level to the drama and exigency of the virus. They are the people whom we should be appreciating and talking about and heralding and giving real focus to. And we never do or we do it in passing.

And the other area that is completely absent, and I am very proud of, is the whole world of disability. You know the World Health Organisation last year published a report showing that 15 percent of the world's population is disabled. That's a billion people. The intersection of Aids and disabilities is very important. The disabled persons, whether blind or deaf, or in a wheelchair, they are subject to sexual assault. They are very vulnerable and there hasn't been enough attention paid to them.
But it is typical of the way in which this preoccupation with numbers, commodities, drugs, condoms, is losing the human face of the pandemic. There was a time when you heard about orphans. How many times do you hear about orphans anymore? There was a time when you heard about grandmothers. How often do you hear about grandmothers anymore?

The human face of the pandemic is being swallowed up by the statistical face, and again it is up to the leadership to restore the balance, to make the world understand that there is more at stake than documenting.

And from my understanding, it's the statistical face of it which is being pushed because that is the easiest way to get the money?


Aside from the people on the ground who are doing the heroic work, what can people who care do?

The most important thing is to keep the human face alive, to talk about this issue as much as possible in the schools, in the churches, in the unions, at community centers, in rotary clubs, in bureaucratic and governmental offices, at conferences. You just have to keep the awareness-raising, the consciousness-raising alive. The way we made such progress in Africa was largely through the Treatment Action Campaign. There was lobbying, there were demonstrations, there were the use of legal interventions, Aids Free World is using legal interventions around men who have sex with men in the Caribbean - we're having great success with it.

It's finding every opportunity there is to give profile to the issue, and urge people either to contribute financially, or to join an NGO which is doing good work in the field like CARE, or Save the Children, or Oxfam, or Doctors Without Borders, whatever the NGO is. And in this endless, repetitive, statistical spasm, where you are constantly saying, 'So many more million people are on treatment, so many more million are needed,' it dulls the senses, and in part it makes you feel that it's over.

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