Interview with Michel Sidibé during the 9th ICAAP

China Daily, People’s Daily, CHAIN

6 August 2009

  1. As we know, you are from an African country. What are the biggest differences between the AIDS epidemic in Africa and Asia Pacific region? What do you think Asia-Pacific can learn from Africa?

The AIDS epidemics in Africa and Asia are quite different. Africa’s epidemic is generalized with multiple sexual partnerships, including concurrent relationships, being the made mode of HIV transmission. Asia’s epidemic is still largely concentrated among vulnerable groups – sex workers, men who have sex with men, injecting drug users, and transgender. In Asia, the various modes of HIV transmission make it one of the world’s most diverse, but HIV prevalence rates remain low (mostly below 1%).

There is however one country in Asia whose epidemic dynamics mirrors that in Africa – Papua New Guinea. Concurrent and multiple sexual relations are driving a generalized epidemic in the country, but this is an exception in the region.

The epidemics in Asia will continue to be concentrated in vulnerable groups and their intimate sexual partners and an effective response will require a prevention strategy which is targeted at high-risk behavior.

  1. You have an educational background in social science and economics. Do you think your background will help you lead UNAIDS to address today’s AIDS issues?What has impressed you the most so far as UNAIDS Executive Director?

My education underscores that AIDS is a multidisciplinary challenge that draws on my training and experience in economics, politics and other fields of study. But my most valuable training has been my field work in some of the most challenging countries in Africa. It is in countries such as Swaziland, Burundi, and Uganda I first watched the HIV epidemic pose challenges to health, human rights and development. It is also in these countries that I learned first-hand how to create bold, bottom-up responses to the epidemic that can and will reverse the spread of HIV.

Since starting in my role as Executive Director, I have been most impressed by the people living with HIV that I have met throughout the world. From Brazil to South Africa to Ethiopia to Norway, I have met people living with HIV that inspire me with their courage, leadership and perseverance. I have met living heroes whose professionalism and dedication inspire me every day. Listening to their stories of triumph over adversity, I am inspired to lead UNAIDS to support them and millions of other people living with HIV to live their lives in health and dignity.

  1. How do you think the financial crisis is impacting the global AIDS response?

We are experiencing the worst economic crisis of our generation. The crisis is a direct threat to progress in health and development and to gains made in the AIDS response - just as investments in AIDS are beginning to show results. This is a time for scaling up, not scaling down.

Any interruptions or slowing down in funding now would be a disaster for the four million people on treatment and for the delivery of services for 12 million AIDS orphans.

  1. AIDS has evolved compared to when UNAIDS was set up in 1990s. What do you think about UNAIDS’ role in next 5 years, particularly in theAsia Pacific region?

UNAIDS will continue to strive for increased efficiency and effectiveness in the response to AIDS, and demonstrate the added value of coherence in the UN system and its collective impact at the country level.

We have identified nine outcomes that we will focus on to achieve results. We can eliminate mother-to-child HIV transmission. We can stop sexual transmission of HIV. We can protect drug users from getting infected and we can ensure that people living with HIV get treatment and do not die of TB.

  1. The theme of the 9th ICAAP emphasizes the community roles in AIDS response. What do you expect from this conference?What are the key factors to involve civil society?What are your messages to governments regarding civil society involvement?

I strongly believe that the AIDS response in Asia-Pacific needs to be transformed so that it works for people – especially for those who have been marginalized and are left voiceless. This means protecting sex workers, men who have sex with men, transgender, injecting drug users and women.

To effectively tackle the epidemic, leaders in the region must:

  1. Decriminalize consensual adult sexual behaviour and drug use -- many countries are changing laws that criminalize consensual adult sexual behaviour (including sex work) and drug use and courts are helping clarify bad laws.
  1. Address HIV transmission among intimate partners -- many women in Asia are becoming infected because their husbands and male partners contracted HIV through drug use or through sex with another man or a sex worker.
  1. Invest in evidence-informed programmes – Existing HIV services must be expanded to reach the most vulnerable. This includes: setting up needle exchange programmes and offering oral substation therapy for drug users (particular strides have been made in China); increasing access to antiretrovirals; distributing condoms and offering voluntary HIV counselling services to those most at risk.
  1. Adopt an “AIDS plus Millennium Development Goal” approach -- Asia and the Pacific region can combine the development and AIDS response. Reducing poverty, increasing education levels and investments in health must become the foundations for sustainable economic growth in the region.
  1. China’s economy has developed very fast, with the capacity and commitment to respond the emergent situation well, such as financial crisis and earthquake. What do you think about the progress of achieving MDG and Universal Access in China? What are your recommendations?

The rapid economic development actually better equips China with the capacity of responding to AIDS. I am very happy to see that there continues to be strong high-level political commitment in the AIDS response. China launched its first National Five Year Action Plan of 2006-2010 to strengthen its AIDS response nationwide and, despite the current economic crisis, has maintained domestic investments to tackle HIV and AIDS.

Comprehensive HIV prevention initiatives are increasingly focused on behavioural change among the most at-risk populations, including a number of advocacy campaigns directed at migrants, women, youth and minority populations. HIV treatment, support and care serviceshave also been expanded.

In spite of progress, however, a significant gap exists in the AIDS response where at-risk populations have limited access to HIV prevention services and people living with HIVhave limited access to quality first line and second line ARV drugs. Without a significant scaling up, it will be difficult to meet the 2010 target of universal access to HIV prevention, care and treatment and Millennium Development Goal 6 (focusing on AIDS and other infectious diseases).

  1. Have you had chance to visitChina? What’s your message to Chinese social workers living with HIV? And what’s your message to Chinesereaders?

Yes, I have visited China before, and I look forward to meeting with my Chinese colleagues and friends again later this year.

The AIDS response needs the involvement of people from all walks of life, especially in a large country like China, where the situation varies from one place and population to another. Social workers are critical in creating a supportive environment that will help us to respond against AIDS effectively.

AIDS won’t disappear or even fade away any time soon. Our generation and the generations of our children and grand children will have to live in a world with AIDS. Each and every one of us has a role to play in tackling AIDS by fighting stigma and discrimination in our families, communities, schools and workplaces. With that we shall carry the response to all parts of China and to the world at large. I believe everyone can make a difference in the battle against AIDS where ever you live and I count on the Chinese people to do their part.