PRESS BRIEFING BY ENVOY FOR HIV/AIDS IN AFRICA

PRESS BRIEFING BY ENVOY FOR HIV/AIDS IN AFRICA

The World Health Organization (WHO) initiative, in conjunction with the Joint United Nations Programme on HIV/AIDS (UNAIDS), aimed at treating 3 million people by the year 2005 with antiretroviral drugs -- the “3 by 5 initiative”-- was one of the most important initiatives emerging from the United Nations system in the life of the HIV/AIDS pandemic, correspondents were told at a Headquarters press briefing today.

Steven Lewis, the Secretary-General’s Special Envoy for HIV/AIDS in Africa, said the World Health Organization (WHO), under new leadership, had launched a “Herculean” effort to confront and subdue HIV/AIDS.  An extraordinary undertaking suffused by courage and commitment, the 3 by 5 initiative deserved the international community’s unqualified support.  Millions of lives were at stake.

Astonishingly, however, that support had not been forthcoming, he said.  The WHO needed $200 million in 2004 to 2005 to put 3 by 5 in place.  So far, donor governments had been unwilling to contribute the money.  The WHO needed the money to train some 100,000 people to marshal the expert groups to provide technical assistance, to establish the logistical supply lines and to improve and upgrade every aspect of the health system’s infrastructure. 

“Without the money”, he said, “3 by 5 will be a pipedream”.  So far, only the United Kingdom, Spain and Sweden had indicated the willingness to consider some relatively modest sums.  The 3 by 5 initiative was the best chance in more than 20 years to turn the pandemic around.  The challenge was huge.  Currently some 300,000 people were in treatment around the world.  To ramp that up tenfold in two years might sound difficult, but it could be done.  It simply required single-minded political will to reverse the moral paralysis of the last two decades.

The Millennium Development Goals were being held hostage by AIDS and entire societies were staring into an abyss, he added.  While some 20 million people were already dead and 3 million were begging for the right to cling to life, it had been impossible to raise one-tenth of 1 per cent of what was being spent in Iraq and Afghanistan.  

During a recent visit to Botswana, which had one of the highest known prevalence rates in the world, he had observed the free provision of antiretroviral drugs.  Where there had been despair, there was now hope because people living with AIDS knew they had a chance to prolong their lives.  While the process of testing and the provision of drugs had been a slow experience, some 12,000 people were now in treatment.  Adherence rates were high.  Botswana provided a vivid glimpse of what could be done with resources when a country resolved to do it and the world rallied in support.

By way of contrast, last year he had visited in Uganda the parish of Mbuya at ground zero of the Ugandan pandemic, he said.  There, the community-based organization “Reach Out Mbuya” was doing a remarkable job of prevention and care.  He had recently received a letter from the project’s administrator who told him that on one particular day, five women had died.  Normally, 10 or 11 women died each month.  While Uganda had reduced prevalence rates to single digits, without adequate resources to put a universal treatment plan in place, the sense of a death sentence still hung over the land.

Virtually every African country with medium to high prevalence rates had a treatment plan in place, he said.  Almost every African country had done some training to create minimal staff requirements.  Many of the countries had some money from various sources, including the Global Fund, the World Bank or bilateral donors.  For the first time they had a chance to sever the cycle of despair.  What they needed was what the WHO could provide, namely the overall direction and coordination so that the treatment regimens could succeed. 

Continuing, he said the World Bank and the WHO had set out the increments towards the goal, namely: 500,000 in treatment by June 2004; 700,000 by December 2004, 1.6 million by June 2005, and 3 million by December 2005.  There had never been a more determined plan of action.  With the 3 by 5 initiative, however, there could be no excuses, only the “mass graves of the betrayed”.

Responding to a question on allegations that Bulgarian doctors had deliberately infected Libyan children with HIV/AIDS, Mr. Lewis said that while he had not heard of that allegation, he would look into the matter.  On balance, he dealt with sub-Saharan Africa. 

Asked why there had been such a “pitiful” response to the campaign, he said his reasoning on the matter was a vacuum.  He had tried to understand why the international community had responded so slowly to the Secretary-General’s request when the Global Fund on AIDS, Tuberculosis and Malaria had been established.  It remained inexplicable to him.  What was most painful was that 3 by 5 constituted a potential breakthrough.  It was the single most dramatic undertaking orchestrated by the members of the United Nations family.  If the initiative worked, life, hope and prevention would be brought to countless numbers of people.  There was a clear relationship between treatment and prevention.  In every sense, the WHO had initiated something tremendously important. 

Did he consider AIDS to be a moral issue and if so, what kind of efforts were moral leaders making to contribute to the fight? a correspondent asked. 

Within Africaitself there had been a long period of silence and denial as leaders were overwhelmed and as they found it difficult to publicly discuss sexuality, he answered.  However, that had changed dramatically in the last three to four years.  Now, almost all the leaders on the continent were openly confronting the pandemic.  What had not yet changed, however, was the response of the donor community to prolong millions of lives.  Every day people were needlessly dying.  To him, that was a moral issue and a simple reality.  While there was never a problem soliciting funds for conflict, there was a tremendous problem soliciting funds to end the pandemic.

Asked what role religious leaders played in the fight, he said the religious leaders had been slow, both internally and externally, to respond to the fight.  That was changing.  Internally, there was much greater focus in the churches and mosques of Africa.  Externally, more religious voices were being raised.  The pandemic could be defeated.  In Africa, there was tremendous sophistication and capacity at the grass-roots level to implement what was required.  It was not beyond capacity.  What had been lacking, however, were the resources to sustain that capacity.

How did Muslim sub-Saharan Africa compare with Catholic sub-Saharan Africa in terms of the change in dealing with the problem? a correspondent asked.  Mr. Lewis said Catholic sub-Saharan Africa had been more vigorously engaged, in part because the strongly Christian countries of southern Africa had felt the greatest brunt of the pandemic.  There was always the tussle with the Catholic Church over condom use.  There was also a tendency on the part of many to play to the strength of the church, such as home-based care and education. 

On the part of the Islamic community, he said the response had been a little slower, because the Islamic ethos in Africa was concentrated in countries that did not have as high a prevalence rate.  But, they were coming around and, when they did get engaged, they did so quite strongly.

Responding to a question on prevention, he said tremendous prevention programmes were under way.  Uganda was a wonderful example of where political leadership had managed to reduce the prevalence rate from some 18 to 20 per cent to about 6.5 per cent.  Prevention programmes had worked in a number of countries.  Senegal, Mauritania and Mali had kept the prevalence rates very low.  The prevalence rate in Ghana was about 3.5 per cent. 

In other countries, including in the youth of Kenya, Zambia and Namibia, prevalence rates had leveled off and there were glimmers of hope, he said.  Changing male sexual behaviour was a long-term proposition.  The culture of gender inequality, the vulnerability of women and the behaviour of men tended to be what ultimately drove the pandemic.  Because it took time for prevention to click in, treatment was necessary.

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