UNAIDS - October 20, 2008

In the second of a series of interviews with the UN Special Envoys for HIV/AIDS, Professor Kallings shares his views on his role and the challenges facing the AIDS response in Eastern Europe and Central Asia.

Professor, what motivates or inspires you to work on AIDS?

As a boy during the 1930s I was struck by the ravages of tuberculosis on the Swedish countryside, in particular, witnessing a bonfire made of all the belongings of a whole family annihilated by tuberculosis made a deep impression on the mind of me as eight years of age. On a clay field in the ice-cold March wind, still with snow in the furrows, I watched everything burning, the grandfather's clock, furniture, clothes, even a beautiful shotgun on the top. The local health authority did not know better than to order everything burnt to eradicate the bacilli - that big was the fear of the disease.

As a doctor I specialized in clinical microbiology and infectious diseases, especially interested in opportunistic infections among immune-compromised patients, such as children with leukemia.

When I became Director of the Swedish Institute for Infectious Disease Control public health was in focus for my responsibilities. In addition, I was all the time engaged in international projects, not the least with World Health Organization.

The second strong motivation, and also my inspiration, is meeting with people affected by HIV in poor countries, be it in African villages and hospitals or in brothels in Mumbai, India or Chiang Mai, Thailand, or among injecting drug users in Belarus or Ukraine. The courage, warmth and concern of the people I have met for fellow human beings in spite of their own misfortune have touched and inspired me deeply.

How do you see your role as Special Envoy of the UN Secretary-General for HIV and AIDS?

My role as a UN Special Envoy as I see it, is to reach the highest political leadership of countries to address the central and sensitive issues directly circumventing bureaucracy and conventional avenues. I am not paying courtesy visits, but heading for results. There are no special rules for a Special Envoy-that is what makes them special!

For instance, my meetings with President Viktor Yushchenko of Ukraine have resulted in directives of key importance to the National AIDS Programme, including allowing the importation of methadone for substitution treatment for injecting drug users.

What unique qualities do you bring?

My white hair serves me well. Knowledge, experience, and always having justified and verifiable views. My words can have the impact of a volley hitting a ship at the waterline.

How can you make a difference?

I can make a difference by being well prepared, basing recommendations on impartial facts, while being empathic and intensely engaged.

What's your proudest achievement as Special Envoy for HIV and AIDS?

As Special Envoy, the proudest achievement has not happened yet! Before that, my proudest achievement was to bring the International AIDS Conference to Durban, South Africa in 2000. That was a landmark event and opened the eyes of the world to the enormous catastrophe of HIV. The "Durban effect" cannot be overestimated. Without that global awareness I do not think that the 2001 UN General Assembly Special Session on HIV/AIDS would have happened, nor the creation of the Global Fund to Fight AIDS, TB and Malaria.

What are the main challenges facing the Special Envoy in Eastern Europe and Central Asia?

The main challenge in Eastern Europe is to overcome the traditional, deeply-rooted contemptuous view of drug users, sex workers and homosexuals.

Also much of my efforts focus on getting civil society recognized by Governments in Eastern Europe. During the Soviet Union, non-governmental organizations (NGOs) did not exist as by definition the State was supposed to take care of everything the people needed and civil society activities were considered as subversive actions.

Still today, in some countries, NGOs are looked upon with suspicion as potential Trojan horses supported by Western countries. Therefore, I am attempting to bring people living with HIV and NGO representatives to sit alongside me at the table of the Presidents, which has made a difference and been welcomed for instance in Ukraine.

Another Special Envoy activity is to bring focus to neglected areas such as prisons which are breeding grounds for intravenous drug use, HIV, hepatitis C and tuberculosis (TB). For instance, I visited a prison with prisoners living with HIV and multi drug resistant TB outside Tbilisi, Georgia together with the First Lady who has a key role in the national HIV programme. Despite some progress in the region, I still see no harm reduction and substitution treatment allowed in prisons in Ukraine, while those programmes are widely available outside prison settings.

What in your view are the particular challenges facing this region?

Improving living conditions, including expanded employment possibilities for young people as well as improving the self esteem of both girls and boys and including education on sex and personal relations in schools are all important social challenges, as well as improving gender equity.

The widely different socio-economic conditions between nations and within parts of countries make the HIV epidemics in Eastern Europe and Central Asia very heterogeneous.

Another problem is that the region faces a future health care crisis unless many more people currently living with HIV get antiretroviral treatment to prevent them developing AIDS and becoming ill.

What do you think are possible solutions?

The only possible solution is to scale-up access to HIV prevention and treatment services. That has not happened yet, but the region has that capability should the political will be there. Good attempts on a small scale are fine but only a full response will help. In these efforts, the leadership of the governments is a key. I also look forward to developing activism around HIV prevention as activism in HIV treatment alone won't get us too far with combating the HIV epidemic.

Which successes in the AIDS response make you optimistic about the future?

There seem to be some inborn difficulties to coordinate efficient responses in some countries and several countries continue to overly rely on foreign aid instead of increasing spending from their own national budgets. However, the greatly increased awareness about the AIDS epidemic among the political leaders compared to only a few years ago makes me optimistic.

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