AFRO-NETS> Interview with Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa

[Dieter Neuvians MD <neuvians@mweb.co.za>]

Interview with Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa
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Source: IRIN <IRIN@irinnews.org>

JOHANNESBURG, 29 November (PLUSNEWS) - Stephen Lewis is the UN Secre-
tary-General's Special Envoy for HIV/AIDS in Africa. He spoke to 
PlusNews about the crippling impact of HIV/AIDS on women and the "hu-
man rights violations" of people living with HIV/AIDS.

QUESTION: Why is stigma and discrimination still a problem, what is 
it that people are afraid of?

ANSWER: Because AIDS is essentially a matter of sexuality, a matter 
of sexual intimacy, because AIDS results in such terrifying and gro-
tesque death and because families fall apart, [because] everyone who 
comes in contact with AIDS thinks its a death warrant. AIDS remains a 
stigma even in the countries which are most beset by the pandemic and 
have the highest prevalence rates. I remember meeting just three or 
four weeks ago with a dozen women in Arusha, Tanzania, and they were 
all living with AIDS and I said to them, "this is unusual, you're all 
living with AIDS you're meeting with me here in this little community 
centre, what is the reaction of the people in your own communities". 
And they looked at me as though I was crazy, and they said, "nobody 
in our communities knows we're living with AIDS, only in Arusha, in 
an urban centre are we prepared to say we're living with AIDS, where 
people don't know us. Where people know us we'll be subject to rejec-
tion, exclusion ostracism, there's no way our families will deal with 
us, they'll throw us out, we'll be isolated and alone so we just 
don't tell anybody except where its safe", and its safe in an urban 
setting, and that is increasingly true right across the continent, 
its true everywhere.

Overcoming the stigma and the discrimination against people living 
with AIDS is one of the chief ways of being able to respond ade-
quately to the pandemic, because the stigma and discrimination are 
paralysing, they prevent programmes from taking place, they prevent 
issues from being discussed openly, they prevent open talk of sexual-
ity. One must remember that it's only a couple of years ago now that 
a women in South Africa, who said publically she had AIDS, was stoned 
to death. These horrendous things happen and people living with AIDS 
know.

Q: Twenty years after AIDS was first diagnosed it's still not treated 
like any other disease...

A: Its absolutely not treated like any other disease and people liv-
ing with AIDS are subject to a great deal of discrimination, and the 
relationship between AIDS and human rights is hardly yet established, 
whereas any other communicable disease and human rights is very much 
established. We prevent people with AIDS from maintaining employment, 
we discriminate against their children in school, we don't give them 
the medicines they should be entitled to as a matter of right. The 
levels of discrimination against people living with AIDS are almost 
enough to fill a catalogue of human rights violations.

Q: Even in UN reports on HIV/AIDS, they still include classifications 
of people - intravenous drug users, high-risk groups - but we are yet 
to see AIDS as a holistic problem that affects us all. Is that a fair 
assessment?

A: Well I think we're much more holistic now than we were, and I 
think the tendency to classify and segment is less obvious now than 
it was. But its very interesting, what's been true of AIDS for some 
time as it unfolds, comes to light always very late. We've known for 
years now that AIDS was disproportionately striking women in Africa, 
and young women in particular. But it's only in the last year we've 
begun to focus in on the fact we were annihilating a gender, that we 
were depopulating a continent, in parts, of its women. We've know for 
some time that AIDS in combination with a given sector could result 
in a dreadful collapse in that sector. It's only now, with the hu-
manitarian crisis and the famine in Southern Africa, that we're fi-
nally linking AIDS and agriculture in that kind of apocalyptic sense 
that everyone intuited years ago might come, but wasn't prepared to 
confront. Where will it happen next, in education, in areas of con-
flict, in refugee camps? I think it should be possible now to learn 
from what we know, and think through the implications. What happens 
in a community where your women are reduced catastrophically in num-
bers? What happens to the children, what happens to the new families 
that emerge that haven't had skills in love and affection and nurtur-
ing. What happens to your agricultural workers when women do 60 to 80 
percent of the productive agricultural work, what are the implica-
tions for what we are seeing? It's not merely overcoming the segmen-
tation of groups, in China it's caused by the contamination of blood 
supplies, in Russia its caused by intravenous drug use, in Latin 
America it's mostly men having sex with men, in Africa it's hetero-
sexual sex. After you've finished these classifications, we must now 
surely understand that everything is linked, and no society with even 
a modest prevalence rate can escape the hugely damaging impact of 
AIDS.

Q: Access to antiretrovirals is still so far from the realities of 
most people, is it a problem in your mind that we keep focussing on 
pills as a cure-all when there are also issues of poverty that need 
to be addressed in terms of care and treatment?

A: I've never regarded antiretroviral treatment as a cure-all, I per-
sonally have regarded it as a way of prolonging the lives of millions 
of people and I think that's a pretty darn good objective, as well as 
providing hope in prevention campaigns - it's the kind of hope that 
says if you happen to be infected, there are ways of keeping you 
alive. It restores a sense in the community that they have to deal 
with the pandemic, but it's quite clear that we don't have the money 
for antiretroviral drugs, and therefore questions of access are theo-
retical anyway, they're purely hypothetical. What kind of access can 
you have when you don't have the drugs? It's something we're going to 
have to overcome, we're trying, the UN has said three million people 
in treatment by the year 2005, that obviously means well over two 
million in Africa, that obviously means every country will have some 
component of people in treatment. The World Health Organisation said 
it, they don't say things in a cavalier way, one assumes that they 
meant it. So it may be that the "pills" as you say, will ultimately 
have an impact, but I don't think you can face the pandemic without 
dealing equally with care, prevention and treatment. I think you have 
to deal with all three.

Q: Turning to Southern Africa and the link between food insecurity 
and AIDS, and the deeper structural problem of poverty, you need such 
a broad-ranging response where do you begin? Is the recognition there 
of the need for a multisectoral approach?

A: No, I don't know if the recognition is there. I know that when we 
started responding to the pandemic we all responded to it as a health 
issue. Gradually, over the last two or three years in particular, 
there has been an increasing multisectoral response, and the national 
AIDS councils, national AIDS commissions, have programmes in place - 
three year plans, five year plans - which say all the sectors have to 
be involved. I think the nexus, the dreadful combination of AIDS and 
famine, will serve, if I can use the phrase, as a wake up call, as a 
recognition to the rest of the world that AIDS in combination with 
any sector can lead to its ultimate collapse, and that we're dealing 
with something so different from what we've ever dealt with before. 
Isn't that the truth that's now emerging? That the impact of AIDS is 
so monumental on societies as a whole, and on communities and fami-
lies in particular, that there is no precedent in human history, that 
there's nothing, from the Black Death [a European plague in the four-
teenth century] to the world wars of the twentieth century, that even 
approximates it. That we've never had such numbers, we've never seen 
the focus on a gender, we've never had so many orphans, we've never 
had so many societal breakdowns in various sectors, that what's hap-
pening here is just an overwhelming concatenation [linkage] of 
events, of which there are no modern parallels, and therefore we have 
to respond in ways that are unprecedented.

--
See also the articles in the IRIN World AIDS Day web special:
http://www.irinnews.org/webspecials/aids/ illustrating that fear is 
at the heart of much of the stigma and discrimination that surrounds 
HIV and AIDS: fear of death, fear of the unknown, fear of rejection, 
and, as Eric Nachibanga, an HIV-positive Zambian points out, "fear of 
helplessness".

[This Item is Delivered to the English Service of the UN's IRIN hu-
manitarian information unit, but may not necessarily reflect the 
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Copyright © UN Office for the Coordination of Humanitarian Affairs 
2002

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