Miami Herald - June 7, 2009
Miami Herald Staff Report

On Tuesday of last week, Sidibé -- actual title: executive director of UNAIDS -- made his first official visit to the United States. He sat down for an interview in New York with Miami Herald World Editor John Yearwood to discuss local grassroots efforts, status of the AIDS fight in Latin America and the Caribbean, and his global vision. Here are excerpts:

MH: In Miami, Barbara Gaynor founded Mothers' Voices 14 years ago after her son died of AIDS. As the global AIDS czar, what do you say to people like Barbara and how critical are organizations like hers to your success?

MS: Without them, we will fail. Because of people like Barbara, we've been able to break the conspiracy of silence. We've been able to remove the silence and create a real movement which helps us to mobilize resources to help people. Because of them, people without a voice are having a voice. I want to just say thanks to Barbara and thanks to millions of Barbaras throughout the world fighting to make sure that at least AIDS will become part of the story. Their fight is a noble one.

MH: Latin America and the Caribbean have antiretroviral therapy coverage of 62 percent. That's the highest of any region in the world, according to 2007 figures. What do you credit for that?

MS: A major, major breakthrough has been made during the last five years of increasing the coverage of treatment. Not just in the Caribbean or Latin America. If you take for example, Africa. Just five years ago, there were only 50,000 people on treatment. Today, we're talking about over 2.2 million. In the Caribbean and Latin America, governments and health system are responding quickly and the number of people who need treatment was not so high compared to the rest of the world. The Caribbean was the first region in the world to negotiate a reduction of the price of drugs for treatment, which made a big difference in increasing coverage.

MH: The region's biggest epidemics are in countries with the largest populations, such as Brazil, which is home to 40 percent of people living with the virus. How difficult is it to fight the disease in these large cities?

MS: I think the biggest problem is mainly access to the slums. We didn't have a strategy in the early days to be able to penetrate the slums and organize proper outreach services, which could help young people with necessary information and helping them to be able to protect themselves. In terms of accessing services and ensuring continuity of services, it was also difficult, given the violence [and] poverty levels.

MH: How active is UNAIDS in Cuba and what problems is your agency confronting there? Are you getting good cooperation from authorities?

MS: Cuba is a particular situation. We're covering Cuba from Jamaica so we're not directly established there. From the beginning, the leadership in Cuba has been very, very clear in terms of dealing with HIV. They have decided to move very quickly toward universal treatment. One of the big challenges for us was the whole issue of stigma and discrimination. That's still continuing to be a problem for even Cuba.

MH: What kind of impact is discrimination having on the effort to combat AIDS.

MS: One of the major challenges is fear. People are really scared to be discriminated [against], to be stigmatized and lose their job. That's a way of also being excluded from communities and not being part of transformation of their societies as normal human beings. Our major challenge today is punitive laws and practices that are not really giving space or access to services for vulnerable communities like homosexuals, sex workers and drug users.

MH: Haiti has had some major governance issues over the years. What hopeful signs are you seeing there?

MS: Haiti is very paradoxical because it's always the same. You have a major challenge with governance, you have a major challenge with economic stability and growing poverty. But at the same time, it's a country that has been able to demonstrate a different type of solidarity by using alternative service delivery systems to reduce the number of new infections. It's a real interesting case because it's a place where most of the indicators were not necessarily the most encouraging ones and you have AIDS showing that now you have an alternative approach that has been working.

MH: You have been to Brazil. Any immediate plans to visit Haiti and other countries in the Caribbean?

MS: I haven't had a chance to visit the Caribbean yet but I had a meeting with all the ministers of health of the Caribbean just three weeks ago. What came out of this meeting is that it's time to have a subregional vision. This vision could really help to make sure that they eliminate completely the vertical transmission from mother to child. The Caribbean can be the first region in the world to show that they achieved universal access on treatment. It's also important for them to have the difficult debate around punitive laws. We can have a different point of view but I don't think it's right to consider someone who has a different point of view a criminal.

MH: Criminalization of homosexual behavior is a big issue in the Caribbean. Are you hopeful after your meeting with the ministers that progress can be made?

MS: I think it could be addressed from the inside. We need to have allies. We need to have an open debate on those issues to make sure it is owned by all leaders. It's not a situation that could be changed by imposing external views. We have more than 80 countries today with laws that criminalize homosexuality and people due to their status.

MH: Some say the global economic crisis and response to the H1N1 virus have reduced the money for fighting AIDS? Are you seeing that happening and what can you do about it?

MS: No, I don't want to say that's already happening but it's a major risk. There's reduction of remittances in poor countries, reduction of resources from exports and more and more countries are using restrictive measures. That will probably push more of the poor countries to not invest in health and AIDS in general because they'll consider those expenditures and not investments.

MH: You've listed universal access to health care by 2010 as one of your main goals. It's a hugely expensive commitment. Are you being realistic?

MS: For me, universal access is not about a number. It's about people. People forget that the fight against HIV/AIDS is not just about the plight of people who are affected. The universal access debate is really about sharing opportunities and making sure that the poorest are not excluded. That's why with universal access, if we commit ourselves to support and bring global solidarity, we can avoid 2.6 million new infections before 2010. If that is not worth it, I don't know what is.

MH: How would you define success?

MS: For me, success means that three things are happening. First, we stop transmission from mother to child because that is the beginning of the end. Two, we're stopping people living with HIV dying of tuberculosis. Three, really making a major effort globally to remove all the punitive laws, policies and practices which are affecting the vulnerable groups who don't have a voice.

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