HEALTH | HIV/AIDS | BYANYIMA

Winnie Byanyima is Executive Director of UNAIDS and Under-Secretary-General of the United Nations. 

The passionate and longstanding champion of social justice and gender equality is leading the United Nation efforts to end the AIDS epidemic by 2030. Hilary Bainemigisha talked to her about the global effort to end AIDS.

From your vantage point, is the end of AIDS by 2030 possible for Africa? 

Yes, it is absolutely possible. That is not just my view; that’s what UNAIDS latest expert modelling shows. 

But what it also shows is this: unless we end the inequalities which drive the AIDS pandemic, we will not end AIDS by 2030, we will be trapped with colliding pandemics for decades, and millions more people will die completely preventable deaths. 

In sub-Saharan Africa, around 4,200 young women and girls (15 - 24) become infected with HIV every week; and six out of seven of the new HIV infections among adolescents in the region, 15 – 19, are among adolescent girls. We, therefore, need to strengthen girls and women’s rights and tackle gender inequalities.

We need to stop punishing, ignoring and stigmatizing key populations; such approaches hinder progress against HIV.

If we take on the inequalities which hold back progress, we can deliver on the promise to end AIDS by 2030. It is in our hands.  

I am afraid this enthusiasm doesn’t reflect the COVID-19 impact on the momentum of the fight against AIDS. How bad has this been for Africa and for Uganda in particular?

The community-based networks, which are the heart of the AIDS response, have shown exceptional resilience to keep working through a crisis. 

They helped pioneer innovative approaches to maintain key services. People were enabled to take home several months of supplies of HIV treatment rather than just weeks, which reduced the need for clinic visits and helped people to continue their treatment without interruption.

But COVID-19 has placed great strain on the HIV response across the world in so many ways – including pushing millions of girls out of school, increasing violence against women, and interrupting vital HIV prevention programmes. Uganda, for example, reported a 41% decline in HIV testing due to the Covid pandemic and a 37% decline in referrals for diagnosis and treatment.

It’s important also to be clear, though, that the world was already off track to end AIDS by 2030, even before COVID-19. 

How do we get out of this quagmire?

The only way to get back on track is to end the inequalities which drive the AIDS pandemic. Furthermore, tackling those inequalities is also key to overcoming the COVID-19 crisis and to preparing for the pandemic risks to come. 

We need to work boldly and together to end the inequalities which drive pandemics. 

UNAIDS new report sets out five of the elements to end AIDS that are also needed to be truly pandemic prepared. 

They are, one; Community-led and community-based infrastructure - delivering services, building trust and holding leaders accountable. Two; Affordable access to cutting-edge health technologies — whether it i’s new long-acting antiretroviral medicines or COVID-19 vaccines. 

Three; Supporting workers on the pandemic front lines. Four; Building human rights capacity as part of pandemic response and five; Data systems capable of identifying inequalities so we can act on them.

Inequality kills. Ending inequalities fast is what needs to be reflected in every leader’s policy programme and every country’s budget.

You have been a strong advocate for richer nations to be humane in dealing with pandemics; has their response disappointed you?

The COVID-19 pandemic has reminded us of a simple truth: We are not only interconnected, but we are also inseparable. So when richer nations act in a way that hinders progress on tackling pandemics in Africa, they also put themselves at risk. 

Keeping the world safe from AIDS, COVID-19 and other pandemics requires that we tackle the hoarding of the rights and recipes of life-saving medicines by big corporate monopolies. 

That is holding up mass production of enough COVID-19 vaccines for everyone, and it is also in the way of ensuring that the new drugs to fight HIV reach everyone. 

Today just 6.6% of people in Africa are fully vaccinated against COVID-19 compared to 66% of people in the European Union. As the South African President noted, this is ‘vaccine apartheid’. 

If governments had forced pharmaceutical companies to share the know-how, technology and intellectual property, we would already have had many million more doses available in our countries by now. If governments do not act now to ensure this sharing, we will be in the same situation year after year. 

What is so disappointing for me, as an activist, is that we are seeing the same happen today with access to COVID vaccines as we saw in the mid-1990s when antiretrovirals for HIV arrived. While ARVs were made available to rich countries that could afford them, millions of people in poor countries were left to die because they could not afford the $10,000 price tag. 

This sparked outrage around the world; activists rose up and called for change. 

Eventually, this movement succeeded: Prices were brought down, pharmaceutical companies were forced to share their knowledge, and cheaper generic medicines were made which were affordable to people in the poorest countries – but this took years. 

During that time, 12 million people in poor countries had died needlessly because of big pharmaceutical greed.

This is why in early 2020, even before the COVID-19 vaccines were developed, I co-created a movement called the People’s Vaccine Alliance, a movement of world leaders, health and human rights experts, faith leaders and economists all advocating that COVID-19 vaccines be manufactured rapidly and at scale, as global public goods, free of intellectual property protections and made available to all people, in all countries, free of charge.

It is urgent. The arrival of the Omicron variant sends a clear message: vaccinate the world as soon as possible. 

That is why we are saying to richer nations that global solidarity, as well as being a moral obligation, is also in their national self-interest.

Is Uganda impressing you with its HIV fightdoing?

Yes! Since 2010, new HIV infections have been reduced by 60%. Deaths have also declined by 61%. And, of the 1.4 million people living with HIV in Uganda, 90% had access to treatment in 2020, up from just 20% in 2010. 

Uganda has also made progress in stopping new HIV infections among children. 

Between 2010 and 2020, Uganda reduced the annual number of children acquiring HIV by more than 70%. 

What else should Uganda do to consolidate the achievements?

As elsewhere, women and girls are more affected by HIV in Uganda. HIV prevalence in 2020, which was 3.9% among men, was 6.8% among women. In addition, 37% of all new HIV infections were among young people aged 15-24 years, with 79% of these being among young women.

To reduce these new HIV infections, we need to focus on young people, and tackle gender inequalities and end gender-based violence which fuels the spread of HIV. Girls need to be enabled to stay in school – if a girl completes secondary school it can reduce her HIV risk by 50%, and even more if that schooling is complemented by a comprehensive package of rights and services (that we call “Education Plus”) alongside that. 

Uganda should do more to protect the human rights of everyone and should drop the law on same-sex relationships and sex workers, which is preventing access to HIV services. 

Those people should not be denied their right to access health care. They have the same human rights as any other Ugandan.

Uganda needs to raise the stagnating levels of health financing, strengthen the tackling of financial inefficiencies and corruption, and find ways to increase the national allocation to the AIDS response. More than 90% of the AIDS response in Uganda is funded externally. Uganda is one of several African countries that will soon become middle-income and so will need to find a pathway to be able to manage that transition. 

What can Uganda learn from others? 

The policies which work are not a mystery. We have evidence from them being applied and monitored. Experience from across the world of the implementation of these policies has demonstrated that the AIDS targets are not aspirational but are achievable for all countries. 

Where investments have met ambition, there has been the strongest progress against HIV. 

From Cabo Verde’s leadership on the elimination of vertical transmission of HIV, to Cameroon’s decision last year to eliminate user fees for all HIV services at public health facilities and accredited community sites. Countries as diverse as Eswatini and Switzerland have already reached the 95-95-95 targets. 

That is 95% of all their people living with HIV testing, 95% of them put on ART and 95% virally suppressed (VS) among treated. The examples that light the way are already there.

On my recent visit to Senegal, I saw the power of leadership in driving down new HIV infections. 

In Dakar, I met with the inspirational Mariama Ba Thiam, a peer educator at a harm reduction programme for people who inject drugs. 

The programme helps them protect their health and to secure economic independence. Mariama’s approach works because it starts by considering the whole person, connecting the medical with the social. 

It rejects the failed punitive and stigmatizing approaches taken by so many, and it instead respects the dignity of every person. 

It is succeeding because it involves frontline communities in service provision and in leadership and because it recognizes that access to the treatments grounded in the best science is a human right and a public good. We know what success looks like, and it looks like Mariama. 

Thousands of Mariamas worldwide have shown the way by walking it.

I am so inspired by the communities leading at the frontlines of the HIV response, that have pioneered the approaches shown to be most effective, that have driven the momentum for change and that are pushing leaders to be bold. I urge you: keep pushing.