A former politician, diplomat and aid worker, few people have witnessed the fight against HIV from as many international vantage points as former UN Special Envoy for AIDS in Africa, Stephen Lewis. Now co-director of the international advocacy organization, AIDS-Free World, Lewis spoke to IRIN/PlusNews about the direction of the international response to HIV.
Question: Reduced funding, a lower donor profile, and arguments against AIDS exceptionalism – has the fight against HIV lost momentum?
Answer: The fight against HIV is at a very difficult moment, there's no question and for two reasons. First, the decline in funding could be truly catastrophic by or before the end of this year. Western governments, which are reducing their contributions to the Global Fund to Fight AIDS, Tuberculosis and Malaria, and the United States, which is flat-lining the US President's Emergency Plan for AIDS Relief, do it all on the ostensible rationale of the financial crisis but that's just utter nonsense. There's never a financial crisis when you have to bail out the banks or provide a stimulus package... there's only a financial crisis when you’re dealing with global public health and putting people at risk.
We have 10 million people who require HIV treatment urgently and there is no guarantee we'll be able to roll out the drugs fast enough to keep people alive. There are already many projects in Africa that cannot enrol new patients. This is preposterous. It's happening in Malawi, it's happening in Uganda, it's happening in Zambia, and there are drug stock-outs. It's becoming increasingly clear that the hazard of cutbacks financially is putting more and more lives at risk.
The other factor: there is a determination to expand the portfolio of health interventions in a way that is prejudicial to the work on HIV and AIDS. HIV is possibly the worst pandemic in human history - 30 million people dead, 33 million people infected... 15 million orphans – how in God's name is [this] not exceptional?
That doesn't mean that other things should be prejudiced by AIDS... no one who works on HIV and AIDS would deny funding for maternal and child health or for non-communicable diseases... You have a moral obligation to enlarge the pie to encompass all the requirements of health and what [funders] are doing in a kind of Pavlovian, unthinking way is to fail to analyze the overall needs.
Q: What is the hardest truth about the fight against HIV that we are not facing?
A: The recognition that there are HIV prevention interventions that would work if only the world would galvanize around them.
Prevention of mother-to-child transmission – it should be called vertical transmission – that should have been the easiest. Instead, for the past 10 years, we have been stagnated by the lack of urgency in the response. Countries like India and Ethiopia continue to use single-dose Nevirapine. Everyone now knows that single-dose Nevirapine has the possibility of inducing drug resistance in the mother and the child, and therefore puts their lives at risk. [Agencies and governments] still put single-dose Nevirapine into the percentages of success when they say, extravagantly, that we have 53 percent of the women who are HIV positive and pregnant on drugs, they include single-dose Nevirapine, which covers roughly a third of those women. That's completely irresponsible, that's not an intervention. It's incredible that there hasn't been a single-minded crusade to get everyone off single-dose Nevirapine.
Look how long it took us to implement male circumcision. We knew in the 1990s that male circumcision was a way of reducing HIV infection for men. We waited until we had a plethora of studies and didn't get going until 2005. Paula [Donovan, AIDS-Free World co-director], in the year 2000, suggested circumcision [should] coincide with immunization for babies. If that had been done, we would soon be receiving the benefits of that but everybody laughed it off.
It isn't one item, it's just item after item after item in which the international community is failing. If I can make an obvious observation, recently UNAIDS and WHO [World Health Organization] put out a joint press statement saying, 'We're worried about the funding. We're very, very worried we're not going to have the funding, people are going to be put at risk, there will be great calamities.'
UNAIDS in its epidemic update report last year said that we'd turned the corner, had all this success, we can see that the virus is in retreat. Well, you can't on the one hand tell the donors that everything is moving along nicely, and then expect them to take you seriously when there's not enough money. There's just not enough thinking about what is said and what is done.
Q: HIV activism has moved from Act-Up in the United States in the 1980s to South Africa's Treatment Action Campaign in the 1990s – both groups have had to scale back due to funding problems. What does that mean for the future of HIV activism?
HIV is possibly the worst pandemic in human history - 30 million people dead, 33 million people infected ... 15 million orphans - how in God's name is [this] not exceptional?
A: I think HIV activism has been stalled momentarily, and I emphasize 'momentarily', because of the crises around funding and the retreat from the serious responsibility around the pandemic on the part of many, western, governments in particular. [Activists'] voices aren't being listened to as they used to. TAC is sort of the spiritual leader of [HIV activism] and if TAC feels compromised, in any way, it's a great pity because they are – for all of us – the beacon of activism.
Q: How much time do you think countries have until they have to fund the bulk of their HIV responses?
A: There is no way of avoiding the international responsibility, this is an international pandemic and no country escapes it... There will always have to be a significant component of international aid, these countries are so poor; the majority of people in most of the beleaguered countries are living on less than US$1 a day, how can they be expected to handle the costs of treatment, prevention, care and support? It's just not realistic. It is necessary for them to put more and more money into the fight against AIDS and necessary for them to achieve the 15 percent national budget allocation for health [set out in the Abuja Declaration] but there will always have to be an international component.
Q: If donors do not want to give, what can the HIV/AIDS community do?
A: We just keep fighting. I think of the Global Fund getting $11.7 billion when really what they needed at minimum was $17 billion, and for the best trajectory of getting to those extra 10 million people, they really needed $20 billion, so they're way down. What is even more worrying of course, is that for obvious reasons, Japan will probably not fulfil its financial commitments [to the Fund]; the right-wing in the Unites States will, to some extent, cut the American contribution; and Germany and Sweden still have not committed to their funding. In Japan’s case this is understandable; in everyone else’s case this is reprehensible.
One grits one’s teeth and one doggedly continues to hammer away at the injustice, the inequality, at the misogyny because women suffer most, at the insensitivity and irresponsibility because race is involved. The [withdrawal from the fight against HIV] violates all the basic moral principles of the struggle for social justice so you make the arguments as strongly as you can and you document them. You do the research and show the shortfalls and the consequences in human terms, and one day the pendulum swings. The pendulum has swung in the wrong direction but one day it will swing back and more money will become available.
This article was produced by IRIN News while it was part of the United Nations Office for the Coordination of Humanitarian Affairs. Please send queries on copyright or liability to the UN. For more information: https://shop.un.org/rights-permissions
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