PARIS, Dec 10, 2006 (AFP) - African countries are now getting serious about fighting AIDS but their efforts are once more at threat from an impending funding crisis, United Nations envoy Stephen Lewis says.
Lewis painted a picture of stark contrasts in an interview before he steps down this month as UN Secretary General Kofi Annan's special envoy for HIV/AIDS in Africa.
The high points of his five-year tenure have been the rollout of antiretroviral drugs to poor African countries and a lasting shift in perception among African governments, he said.
But "there are many low points," said Lewis.
"One, overall, is simply our inability to confront the pandemic successfully... the pandemic is still outstripping our capacity to respond, which is a lamentable commentary on the international community."
AIDS has slain more than 25 million people in the 25 years since it was identified, and Africa has borne the brunt of the toll.
Around 40 million people today are living with AIDS or the human immunodeficiency virus (HIV), nearly two-thirds of them south of the Sahara. At the end of last year, only 810,000 Africans had access to anti-HIV drugs out of an estimated 4.7 million who needed it.
Africa has 12 million AIDS orphans, a tally set to reach 15 million in 2010, and this problem is already having huge social repercussions.
Lewis, speaking by phone from Canada, said that at the start of his term, "there was still a lot of silence" about AIDS at top level in Africa.
"In the last two or three years, my impression is that things have really changed, and now when I meet with cabinets or speak with presidents or prime ministers, there's a tremendous level of anxiety, it's quite intense.
"They're determined to overcome what is happening in their country although they're often completely bewildered about what to do, particularly about the orphans."
Asked to give a scorecard, Lewis said he was "particularly impressed" with Lesotho; Botswana, Rwanda and Zambia were "impressive"; Malawi and Tanzania "are working very hard" and Kenya was "pretty admirable" in its commitment to public health care for infected people.
He wondered, though, whether a recent uptick in prevalence rates in Uganda had been due to a failure of its much-vaunted programme to encourage sexual abstinence.
And he cast doubt on Zimbabwe's figures that said the infection rates were at last coming down.
"I can't help but think that's because so many people have died or that so many people have left the country, they've had such an exodus. I'm not really persuaded that some great prevention campaign in Zimbabwe has brought it down," said Lewis.
A fierce critic in the past of South Africa's AIDS policies, Lewis this time said the country had made "a breakthrough" in its new plan for prevention and treatment and for what he described as the sidelining of its controversial health minister, Manto Tshabalala-Msimang.
Tshabalala-Msimang -- blasted over her claims that a vegetable diet can combat HIV -- appears to have been replaced in the lead role of South Africa's AIDS programme, said Lewis.
"The destructive nonsense surrounding garlic and lemon and sweet potatoes and beetroots and all that, which so confused South Africans, I think that is now on the back burner as it were.
"It's safely stowed away in a vegetable bin somewhere and is no longer available as an appetiser for AIDS response. The simple absurdity of it is no longer central, and that's all to the good."
Such verbal broadsides are typical of Lewis. His impassioned pitch on AIDS -- especially for orphans, women and carer grandmothers, the most beleaguered and least visible victims of the pandemic -- has won him the devotion of campaigners and the animosity of the politicians he targeted.
His office has a tiny budget and no authority, other than the moral weight of his job title and the strength of his advocacy.
In the interview, Lewis bluntly accused politicians of posturing and smugness, singling out the Group of Eight for what he said was backsliding on promises made at the G8 summit in Gleneagles, Scotland, in July 2005.
"Everybody talks with a kind of self-satisfaction about the increases in money," he said.
"They say we only had 300 million dollars a year at the end of the 1990s and, lo and behold, at the end of 2005 we had 8.3 billion.
"But in truth that's absolutely nothing to crow about. As a matter of fact, it should induce shock and anxiety, because UNAIDS and the WHO [World Health Organisation] have shown that in 2006 we needed 15 billion but we didn't get anywhere near it, in 2007, we need 18 billion, in 2008 22 billion and in 2010 by any projection, 30 billion.
"If the western world were to deliver on its promises, we would have that money, but they betray the promises the moment they're made. For example the promises at Gleneagles in 2005 are already falling apart."
The funding crisis derives chiefly from the fact that the people who take HIV drugs have to take them all their lives, unless some day a cure appears.
And the longer they take them, the higher the risk that they develop resistance or side-effects to these medications. That means they have to turn to "second-line" treatments that are far costlier than the front-line drugs.
Lewis conceded President George W. Bush had made a "pretty significant" contribution with his AIDS initiative for Africa and the Caribbean, known by the acronym of PEPFAR.
"It put hundreds and hundreds of thousands of people into treatment, it's done some good prevention work, it's done some good orphan work," said Lewis, adding though that the effort had been "absurdly undermined by this nonsensical focus on [sexual] abstinence-only programmes."
Lewis, 69, is a former left-of-centre Canadian politician, Canada's former ambassador at the UN and previously deputy executive director of the UN Children's Fund (Unicef).
He said there were good signs the UN would appoint an African woman as his successor, in line with his wishes. He believes this will give insights to Africa's specific problems, especially that of gender inequality.
"My sense is that they will do that," he said, adding drily: "If they don't, they will be confronted by mass political outrage."
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