PHA-Exchange> The UN's rebel advocate on Aids

[claudio at hcmc.netnam.vn]

from Vern Weitzel <vern at coombs.anu.edu.au> -----
    
http://news.bbc.co.uk/2/hi/health/6059206.stm


The UN's rebel advocate on Aids

The first UN special envoy on Aids in Africa is stepping down in December. 
Daniel Cook spoke to the 
outspoken Canadian about the highs and lows of his five years in office.

UNAIDS envoy on Aids in Africa, Stephen Lewis (pic: UNAIDS/Ruben del Prado)
Stephen Lewis has been particularly critical of US policy on Aids

Despite working with a tiny - $200,000 (£106,000) - UN budget, Stephen Lewis 
has done much to open 
the world's eyes to one of history's worst human health disasters.

He is also credited with influencing African governments' attitude to Aids, in 
particular in South 
Africa.

'No cop-out'

His fiery speeches have generated headlines in the West, and raised awareness 
of the paucity of 
Western funding to prevent and treat HIV.

"Either you're going to act on behalf of the people living with Aids and do 
everything that's 
possible to bring the world's attention to it, or it's a cop-out," Mr Lewis 
told the BBC News website.

	
UNAIDS envoy on Aids in Africa, Stephen Lewis (Copyright: Allafrica.com/Tamela 
Hultman)
We have to stop this pattern of imposing conditions on Africa in return for 
the dollars they 
receive. That seems to me to be part of a neo-colonial mentality
Stephen Lewis
Special UN Envoy for Aids

It is not only the sluggishness of the West's response to the pandemic which 
has frustrated Mr Lewis 
during his time in office, but also the conditions some aid agencies have 
imposed, notably the US.

The President's Emergency Plan For Aids Relief (PEPFAR) programme has, for 
example, demanded that 
some African governments promote abstinence policies in return for aid.

"We have to stop this pattern of imposing conditions on Africa in return for 
the dollars they receive.

"That seems to me to be part of a neo-colonial mentality," he says.

Funding shortage

However, he said the US programme was now making an "appreciable and positive 
impact" and working 
more closely with the Global Fund to Fight Aids, Tuberculosis and Malaria.

But the Global Fund, the largest HIV programme in Africa, was half a billion 
dollars (£260m) short 
of funds this year.

"The G8 promise is in tatters," he said, referring to the commitment made by 
the world's richest 
nations to fund universal global access to Aids treatment by 2010.

And the shortages were probably even greater.

"The word is out, and it's often reinforced by western diplomats at country 
level: 'Don't ask for 
too much because the Global Fund just doesn't have the resources'."

South Africa target

It is for South Africa that the Canadian has reserved his most consistent 
criticism.

Protestors line up with lemons, garlic, signs and slogans in front of the 
South African Embassy in 
Washington (August 2006)
Lemons, garlic and slogans in protest at South Africa's policies

An estimated 5.5 million South Africans live with HIV, 18.8% of the population.

But the government only began making antiretroviral drugs available in 2004, 
and most say the 
dispersal of treatment has been slow.

"It is the only country in Africa whose government is still obtuse, dilatory 
and negligent about 
rolling out treatment," the UN envoy thundered at the International Aids 
Conference in Toronto in 
August.

South Africa's Health Minister, Manto Tshabalala Msimang, has publicly stated 
that "natural 
remedies" such as garlic and lemons offer an effective alternative to Aids 
drugs.

She has since denied making such statements, and her ministry reportedly 
accused Mr Lewis of waging 
a "vendetta" against the South African government.

But, at the Toronto conference, the South Africa health ministry displayed 
such lemons and cloves of 
garlic next to condoms and anti-retroviral drugs.

Weeks later, Ms Tshabalala Msimang was sidelined from South Africa's Aids 
response.

Grounds for hope?

Although Aids in Africa has yet to peak, history may show that 2001-2003 were 
the darkest days of 
the epidemic, when infection rates were rising exponentially and it was 
impossible to predict how 
many would die.

"People who'd been infected in the 80s and early 90s were suddenly developing 
full-blown Aids and 
dying in huge numbers. It was shocking," Mr Lewis said.

But, in 2006, there are signs in some African nations that give grounds for a 
little hope.

Uganda, Rwanda and Zimbabwe were singled out by Mr Lewis for their success in 
reducing infection 
rates or providing treatment.

Shackle-free

His outspokenness has drawn fire, but UN Secretary-General Kofi Annan had 
been "extraordinarily 
supportive" during his tenure, he said.

There was only one occasion when he was "ordered for a period of time to lay 
off".

HIV drugs
Sub-Saharan countries have limited access to anti-retroviral drugs

That warning came as Washington was controversially putting pressure on Uganda 
to promote 
abstinence, rather than safe sex, in the fight against Aids.

"I was told that I should not be critical of the US government because they 
hoped to get the US 
president to appear at a particular conference on Aids, and that they had been 
told that if I 
attacked the US, the president wouldn't come," he said.

"I told Mark Malloch Brown [now UN deputy secretary general] that I would 
observe that request.

"And he said as soon as the conference is over, you can say what you want. 
Which is exactly what 
happened. Bush never came. As I knew he wouldn't."

Mr Lewis plans to remain an advocate for the tens of millions affected by HIV 
for some time to come 
- and without the diplomatic shackles of the UN.

"I admit I have spent a lot of time biting my tongue, because [as a UN envoy] 
you can't say what you 
deeply believe, and you can't name the recalcitrants.

"But I have come as close as I can and when my tenure is over, I shall try to 
be much more forthright."


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