Interview with UNAIDS head Bunmi Makinwa

Bunmi Makinwa is the newly appointed head of UNAIDS in Ethiopia. Here ahead of World AIDS Day he tells PlusNews that total mobilisation is needed to win the fight against the virus that has infected 2.2 million in Ethiopia. QUESTION: What is the current situation with regard the global fund? ANSWER: There are a number of countries especially in Africa who are receiving support from the global fund. We are beginning to see the disbursement of those funds at the moment in areas that were poorly funded before - especially in the area of treatment. Most countries have got money now to begin to do treatment for HIV/AIDS including specialised use of anti-retroviral drugs. This is a very welcome addition. But there are challenges. One is how to quickly put in place the structures to handle the money. Some of this is very big money and this is particularly an issue for Ethiopia. We are optimistic we can get this going. Q: Is UNAIDS taking the lead role, outside government in combating AIDS? A: UNAIDS is the lead advocate on HIV/AIDS worldwide – that is the role we play. Our main effort is in mobilising the UN system, government, and all sectors to support the fight against HIV/AIDS all over the world. So we want to help mobilise especially in the area of funding and we are happy to say that the funding for HIV/AIDS has increased many times over in the last three to five years. Indeed we are getting to a situation where we are advocating on how to use those resources available in a timely and effective manner. So the role of UNAIDS is in advocacy, in mobilising resources including human resources, it is in providing leadership and the right direction for governments and civil society to take. Q: How will UNAIDS judge itself on its success or failure in Ethiopia? A: The most important benchmark of success is in the declaration of commitment made by countries at the UN General Assembly Special Session on HIV/AIDS. No matter what we do, no matter what any external party does, it is the governments of countries, the leaders who are elected by the people, who lead them out of whatever problem or crisis they may face, into a stable life. The Declaration of Commitment gives clear indicators of what should be achieved and this is how governments are being held responsible. Q: Is there a clear vision among all groups, donors, the UN, civil society on how to combat the spread of HIV/AIDS? A: Yes but we keep on learning. We have examples of what is working and where it is working. We need to be sure that we are committed to facing the problem of this epidemic at every level and with all the assets that we have. Indeed we are talking about a mass mobilisation. HIV/AIDS cannot be dealt with by just mobilising one sector of the community. We are talking about total mobilisation, total resources. We also have to be aware that we are in this for the long haul. AIDS is not going to go away in the next few months or few years. Q: In Ethiopia the prevalence rate is 6.6 percent. Does that reflect reality on the ground? A: With the instruments we have now, the prevalence rate is based on antenatal service, which is concentrated in a number of cities. Coverage is low in rural areas and the sites are few. But with the surveillance study that is coming up early next year those figures should be more accurate. The official figures are what we have but the figures have shortcomings. Q: Based on those shortcomings how can surveillance be improved? Training is underway to improve data collection, financial support has been provided and technical support offered. In addition the number of sites has been increased and this will result in a more accurate picture. UNAIDS would like to see some behavioural awareness surveillance. There has been some work on awareness and behavioural change but we would like to see more. We look more at the trend rather than the absolute figures. If you look at Ethiopia in the past three years over what has been happening you will see there has been significant increase in the numbers of infections being recorded and that is what has been happening in most countries. What we need to focus on is this trend and focus on where it has been increasing. It is more important to look at the trend. Transmission rates are increasing in many countries but there are pockets where the rates one stabilising or even decreasing. Q: Should anti-retroviral drug treatment be free? A: Ethiopia is a very poor country. It may be beyond the capacity of the country to have free treatment. The government announced a few weeks ago that treatment would be available for those who cannot afford anti-retroviral treatment (ART). At a global level every country has to examine its own abilities. We don’t have a universal policy. Q: Is the groundwork and infrastructure there to scale up treatment? A: The ministry of health has been carrying out a series of training for health professionals and support staff for the last five or six months so that this treatment can be possible but more work still needs to be carried out. Q: Does the health service have the capacity to implement ART? A: That is where the strengthening training and capacity building comes into play and that is what they are doing. The infrastructure is being put in place. I think the training is being successfully carried out. Understandably the health infrastructure was not adequate. They are more equipped now than six months ago. But this is not just a health issue and it is important not to overemphasis ART as a medical issue. Q: Now that Ethiopia’s political leaders have taken notice how do you move forward? A: There are many ways. We realise a critical area is stigma. This is a major problem in Ethiopia, in Africa, around the world. We need to decrease stigma and remove it. That requires commitment at a political level, civil society and the private sector. We need to focus on how to use increasing resources. That is a challenge we didn’t have to deal with two or three years ago. Education has to change. It is no longer acceptable to have children go to primary school and not learn about HIV/AIDS. Religious groups can no longer go to church and not talk about HIV/AIDS. Every aspect of our life is being touched by HIV/AIDS. Q: Are you now 100 percent satisfied that political commitment is there? A: Ethiopia has made a lot of progress comparatively. The commitment is evident and is being shown. If the question is can it be better, then I would say definitely yes. There are a lot of areas where we really ought to move, to do more. I think at the beginning of doing more is where we are now. Q: Is the government’s HIV/AIDS Prevention and Control Office (HAPCO) sufficiently strong at the regional and local level to tackle the crisis? A: It definitely needs to be strengthened in the region and HAPCO would be one of the first to admit this. But that is not unique to Ethiopia. One of the things we have learnt about this epidemic is that we have to be much more flexible and faster. Things have changed so fast so organisations and governments have to change to meet new and emerging issues, like the enormous mobilisation of resources or the availability of drugs. So HAPCO has to be more flexible and malleable to meet these changes. HAPCO’s budget has gone from a few million to over US $100 million in a year. How does one deal with that? This is where the international community must support HAPCO. The challenge to HAPCO is to be more effective, more responsive and have the ability to use the huge resources. Even by using those resources there is a strong possibility that more will be available. We are working very closely with HAPCO to see how it can re-tool itself to be able to deal with this. Q: Do you feel that the funding to Ethiopia to combat HIV/AIDS is sufficient? A: There needs to be more because a great deal more needs to be done. But that is not to minimise what has come in because it has been significant. Are those resources sufficient for the scale of the problem? No they are not. We estimate the whole world needs US $10 billion a year to fight HIV/AIDS but so far only US $6 billion has been committed to. We are still short.