Global Policy Forum

On World Aids Day 2005, UN Special Envoy for HIV/Aids in Africa Stephen Lewis - answering questions from Pambazuka News - adds his voice to those telling western leaders to keep their promises made on fighting the HIV/AIDS epidemic, warning that 'resting easy' once promises are made is 'pure folly' and pointing to evidence of backsliding following G8 commitments earlier this year. In the interview, Lewis answers questions on the slow-footed global response to the epidemic, his often outspoken statements and where the 'big breakthrough' in the fight against HIV/Aids will come from. The gender dimension of the epidemic is a frequent theme, with Lewis concluding: 'I do think it's dawning on even the most regressive policy makers, though, that the AIDS pandemic is part of the price we are paying for allowing unabated gender-based violence and inequality. But that dawning awareness is excruciatingly slow, and we just don't have time for incremental progress. Entire countries run the risk of being depopulated of women!'

PAMBAZUKA NEWS: The theme of World Aids Day 2005 is 'Stop AIDS: Keep the Promise'. On World Aids Day 2005, what would you like your message to be about the fight against HIV/AIDS?

STEPHEN LEWIS: Without a doubt, I'd want to add my voice to those urging western leaders to keep the promises they've already made - including the solemn commitments of financial resources proffered as recently as last July, at the G8 Summit in Gleneagles. We are at a turning point, and the level of resources brought to bear on AIDS will decide which way we turn. It's now clear, though, that resting easy once promises of aid are made is pure folly: we needn't look further for evidence of backsliding on commitments than the replenishment conference of the Global Fund to Fight AIDS, Tuberculosis and Malaria, held just two months after the G8's promises to Africa were announced. In spite of the pledge to increase aid to Africa to $50 billion annually by 2010, and notwithstanding the G8's statement in support of universal HIV/AIDS treatment - that is, access to antiretroviral drugs for all who need them - the donors dealt a crippling blow to the Global Fund in September, giving it roughly half of the money it needs for 2006 and 2007. So yes, I think "keep the promise" is a timely message, and one that bears repeating over and again until it sinks in.

PAMBAZUKA NEWS: In a passage from your book 'Race Against Time' you say the following: "I'll devote every fiber of my body to defeating this viral contagion, but I cannot abide the willful inattention of so much of the international community. I cannot expunge from my mind the heartless indifference, the criminal neglect of the last decade, during which time countless people have gone to their graves - people who should still be walking the open savannah of Africa." What, in your mind, causes this inattention towards HIV/AIDS? Why are people able to read or hear about the pandemic, yet do so little about it? And how do politicians and policy makers justify their inaction?

STEPHEN LEWIS: Frankly, it's a mystery to me. I didn't understand when the world stood by and allowed the genocide in Rwanda to unfold before our eyes, and I can't comprehend now how it's humanly possible to do so much less than the minimum required to end the suffering inflicted by AIDS.

I think I understand why it is that such dramatic natural disasters as the tsunami provoke outpourings of concern: sudden catastrophes, particularly when they're captured on camera, attract attention and strike a sympathetic chord. With a surprise calamity of that magnitude, we suddenly see the world turned upside down, and follow the natural instinct to set things right again. The AIDS pandemic, on the other hand, is a long, drawn-out catastrophe. Although its mortality rates dwarf the tsunami's, which claimed some 200,000 lives compared with over 25 million deaths to AIDS so far - in an odd way, it seems that the very characteristics that make AIDS the worst plague in recorded history also mitigate against an urgent response. The inexorable nature of the AIDS pandemic, its slow-motion destruction, its longevity, its enormity: these are all characteristics that distinguish AIDS from other emergencies. For those in its grip, of course, the past history or projected future of the pandemic are of no consequence. For them, the suffering and death they face is the most urgent of emergencies.

PAMBAZUKA NEWS: You have been vocal in your criticism of the policies and actions (or inactions) of many governments, both in the West as well as Africa. World Bank and International Monetary Fund policies have also come under attack for their inability to deal with the HIV/ AIDS pandemic appropriately. Indeed, the very organization that you represent, the UN, and its leaders, have been fair game. Usually this type of criticism comes from outside of these organizations, but rarely from inside. Others in positions like yours are rarely willing or able to be so analytical and forthright when it comes to questioning these superpowers - how did you come to your analysis, and how are you able to be so vocal, without making enemies/getting fired?

STEPHEN LEWIS: My analysis is uncomplicated: with a staggering emergency like AIDS, the usual diplomatic proprieties simply don't apply. As envoy for AIDS in Africa, my job is to represent the African position, no matter how critical that requires me to be. I'll grant you that in the diplomatic arena, it's unexpected to hear opinions stripped bare of comfortable cushioning. But I feel confident that my colleagues are aware that my criticisms are always offered in the spirit of reform - which is a worthy as well as a loyal pursuit, and one that's currently high on everyone's agenda.

PAMBAZUKA NEWS: News about the release of your recent book "Race Against Time" highlighted the rift between you and the South African government over their attitude to fighting the pandemic. While the honesty with which you have aired your concerns is refreshing, surely it can't be helpful to have such an open grievance between a government and a major agency responsible for fighting HIV/AIDS? What is it going to take to mend the rift?

STEPHEN LEWIS: Actually, I have a rather different view of disagreement: a rift isn't destructive if it's the result of an honest appraisal. On the contrary, the liberty - even the responsibility - to take issue with those in power is indispensable to real progress. In any case, the rift in question exists between me, individually, and members of the government of South Africa. The United Nations and its agencies continue to enjoy an amicable and productive relationship with the government.

PAMBAZUKA NEWS: In a recent Globe and Mail article you say that you "want to be around for the breakthrough." What is the breakthrough? What is it going to take to put an end to this pandemic?

STEPHEN LEWIS: The ultimate breakthrough, of course, will be the release of a vaccine, the development of which must continue to command our utmost attention. Short of a vaccine, however, the big breakthrough in my mind will come with the achievement of universal access to treatment. Now that we have the drugs that can transform HIV/AIDS from a fatal disease to a chronic condition, and now that prices have been driven down to entirely affordable levels - the Clinton Foundation has negotiated generic drug prices for several countries that bring costs down to $140 per person per year - the big question is, when will the money materialize?

PAMBAZUKA NEWS: You speak often of gender inequality, and not just of the inequality faced by women in Africa. This inequality is found too in the powerful agencies, like the UN, for example, that represent these women. Women are barely represented in positions of power in various government and other administrations. What will it take for women to be meaningful players in determining their futures?

STEPHEN LEWIS: I've long believed that the desire for gender equality is the most difficult of all quests for equal rights - even more elusive and complex than racial equality. Gender inequality is universal, so I wouldn't presume to diminish this age-old injustice by suggesting that there are easy solutions. But to answer your question with regard to governments and bureaucracies - what will it take? - there are three common-sense prerequisites to gender equity and equality that seem to be fundamental. First, the notion that women will gradually arrive at equal representation by assuming positions of power through attrition is neither acceptable nor realistic. Men must be required to relinquish to women half the power they hold - power, incidentally, that was obtained under false premises, and is often retained by force. Second, all current-day gender equity targets that are set below 50 per cent should be recognized as inherently unjust. It is preposterous that half the world's population should settle for one-third representation, or for anything less than half. And third, gender inequality is a universal curse. It will require forceful action and strong leadership from the international community. That should start, I'd submit, with the establishment of an international agency dedicated entirely to supporting women in their own pursuit of justice, equality and self- determination.

PAMBAZUKA NEWS: The following quote struck me as very interesting, especially in terms of your emotional ability to deal with this pandemic, given your involvement in the issue: "I'm not some sweet innocent. I'm 67 years old. I've learned something about politics, diplomacy and multilateralism. I thought I understood the way the world works. I don't." What has this learning process been like? What emotional toll has this work taken on you, and how do you counter it?

STEPHEN LEWIS: There is no question that this work provokes deep frustration and profound sadness. And yes, my frustration escalates to rage at times, and the sadness often feels irreconcilable. I think that's to be expected - there's just too much death, and it demolishes one's equilibrium. But my emotional turmoil is as nothing compared with what the millions of infected, dying and grieving people on the ground suffer every day. I suppose one learns how to counter the feelings of hopelessness by watching how the indefatigable people of Africa struggle through this horrendous pandemic, and by doing as they do. You persist.

PAMBAZUKA NEWS: What motivates you?

STEPHEN LEWIS: My ideology is my motivator. I'm a democratic socialist; all my life, I've been driven to act by deep convictions, instilled in me from the time I could think coherent thoughts. The drive for social justice, for human rights, for equality, for recognition of the dignity of all humankind - these are the only pursuits that really matter.

PAMBAZUKA NEWS: Much of the attention in Africa placed on HIV/AIDS has been ABC (Abstinence, Be faithful, and use Condoms). But can the pandemic seriously be addressed without dealing with the question of power relations between men and women? Safe sex campaigns assume that women are in a position to negotiate on equal terms, when the reality is quite different. What is it going to take to make governments and policy makers realize this, and how should they address these issues?

STEPHEN LEWIS: The dreadful truth is that governments are being forced to come to that realization the hard way - and that's particularly, but not exclusively true of African governments. The statistics themselves tell a story of gender inequality gone berserk: a million more women are living with HIV now than in 2003, bringing the world total in 2005 to an incomprehensible 17.5 million HIV- positive women. More than three-quarters of those women are African. Young women and girls between the ages of 15 and 24 in sub-Saharan Africa are at least three times more likely to be infected than young males in the same age group. With disparities that pronounced, it's impossible to deny the straight line between cause and effect.

New studies show that even marriage can be a dangerous undertaking for young women, who are frequently wed to older and more sexually experienced men, or to husbands whose infidelity brings HIV infection into the marital bed. And as you mentioned, power relations between men and women can be so out of kilter that the idea of a wife negotiating safer sex with her husband is not even up for consideration.

I do think it's dawning on even the most regressive policy makers, though, that the AIDS pandemic is part of the price we are paying for allowing unabated gender-based violence and inequality. But that dawning awareness is excruciatingly slow, and we just don't have time for incremental progress. Entire countries run the risk of being depopulated of women! Nothing short of a global social movement demanding an immediate end to all forms of gender inequality can begin to reverse the trend.

Many thanks!

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