The Positive Side

Spring/Summer 2006 

To the Heart of Africa

Night and day, in as many places as he’s invited, Stephen Lewis works away at the issues surrounding HIV/AIDS in Africa. His hope? To help build momentum for change

Interview by Ann Silversides

NAMED ONE OF THE MOST 100 INFLUENTIAL people in the world by Time magazine in 2005, Canadian diplomat Stephen Lewis has emerged as arguably the best-known non-African advocate for people living with HIV/AIDS (PHAs) in Africa. He is an eloquent and compelling public speaker whose advocacy as United Nations Secretary-General’s special envoy for HIV/AIDS in Africa galvanizes audiences. Lewis’s message gained a much wider audience when a series of his talks were broadcast on cbc Radio as the 2005 Massey Lectures and subsequently published in his best-selling book Race Against Time. The book’s dedication reads: “To the women living with AIDS in Africa. Indomitable. Resilient. Courageous. One day the world will come to its senses.” Several years ago, when Canadians began to spontaneously send him donations to address the AIDS crisis in Africa, he set up the Stephen Lewis Foundation (www.stephenlewisfoundation.org) to put the money to work supporting grassroots organizations. Donations to the foundation — none solicited — total $10 million to date. An astonishing 95 percent of that has been donated by individual Canadians.

Journalist and author Ann Silversides interviewed Stephen Lewis for CATIE in his Toronto home.

SILVERSIDES: What is your job description?

LEWIS: There was no definition — the job defined itself as I did it. It is primarily an advocacy role. It is a job of exploration of issues, reporting back, finding the themes that need advocacy (treatment, capacity, women, orphans — the obvious areas of emphasis) and doing that advocacy night and day everywhere, in as many places as I am invited. I’ve just been pounding away at the issues, hoping that it will help build the momentum for change.

I spend as much time on the envoy role as I possibly can, but if it were a full-time job, I’d be spending even more time in Africa. I try to get there roughly once a month. In the interim I do a lot of speaking in Europe, America and Canada about the issues.

When I visit a country I try to meet with the political leadership, the civil society leadership, the UN family, the diplomatic community and always — as a matter of principle — with groups of PHAs whose position I promote as strongly as possible during my visit. I ask them what they need, what questions they have, and then I take their questions to the various political leaders I meet as I travel. Before I leave, I report back to them because it is really important that they recognize that they have friends in the UN who will treat them with the kind of respect that governments frequently don’t display. I also try to spend roughly 50 percent of my time in the field, visiting projects. I then do an exit press conference in the country to lay out exactly what I have seen.

Back in New York I do a briefing with the international press at the UN. I try on an intermittent basis to see the Secretary General [Kofi Annan] and we talk about how the UN might more vigorously or effectively support the work that governments are doing.

Tell me more about your interaction with PHAs in African countries.

They pour their hearts out. One of the things they always say is that no one listens to them. They are the experts — they know more about the virus than anyone else — and no one listens to them. They are treated so often with indifference and contempt, and it is really unacceptable because they are so courageous, so strong, and they do such magnificent prevention work. They’re moving through schools, community centres, religious groups. PHAs do a tremendous job of prevention; it even extends to the commercial sex workers who wave condoms above their heads and go out into the community and talk about preventing infection. A government that doesn’t pay attention to PHAs, or that diminishes them, demeans them or disregards them, is making a terrible mistake in judgment. Boy, they are a powerful crew in every country!

Canada has made important contributions to the World Health Organization’s “3 by 5” initiative (to get 3 million PHAs in the developing world on treatment by 2005), the International AIDS Vaccine Initiative, and the Global Fund to Fight AIDS, Malaria and Tuberculosis. And you were instrumental in lobbying for the 2004 Jean Chretien Pledge to Africa Act (JCPAA), so that generic [less expensive] versions of AIDS drugs still under patent can be manufactured here for use in the developing world. How are we doing as a country?

Relatively speaking, Canada’s contribution to the fight against AIDS has been admirable, in part because the JCPAA legislation may turn out to be a real breakthrough. [Médecins Sans Frontières (MSF) has placed the first order under the JCPAA for a fixed-dose combination drug.] Canada provided the core of the money to make 3 by 5 possible and I continue to regard it as an extraordinarily inspired intervention which broke the logjam of inertia and made hope and momentum possible. I am sorry we didn’t make the 3 million, but we have set in process a treatment rollout that is irreversible. Everything had been so immobilized that it was really important that there be a visionary breakthrough of the 3 by 5 kind — so that finally the world would understand that there had to be targets.

So now everyone talks about universal access. Country after country is asked to set realistic targets — how many people to be tested and counselled, how many pregnant women to have access to drugs to prevent transmission to the child, how many to be in treatment, how many kids to be in pediatric treatment.

Do you agree with those who argue that Canada has not stood up to the United States on key issues such as patent laws and harm reduction?

We should have been standing up to the U.S. not just on patent issues but on the question of abstinence and condoms. Canada’s voice should be heard on these things, but then, to be fair, no one stands up to the U.S. on these issues or about the amount of money they give to the Global Fund or many of the serious limitations around PEPFAR [U.S. President’s Emergency Plan for AIDS Relief]. I got in tremendous trouble with the U.S. — I think for a while my job was on the line — over criticisms of the disproportionate emphasis on abstinence in situations where it makes no sense, like marriage.

You argue in your book that Canada’s contribution to fighting AIDS has been undermined because Canada has not set a timetable to reach a target of contributing .7 percent of gross domestic product to foreign aid — a target that has already been surpassed by the Nordic countries.

The inability to meet .7 has compromised our integrity on everything else, even though we have done good stuff on AIDS. We were the authors [of this goal, in 1969] and we are the only G7 country with budgetary surpluses. Everyone thinks we are just a bunch of hypocrites.

I assume .7 is important because you see the issues and needs in the developing world going far beyond AIDS.

Poverty lies at the heart of it all.

And AIDS?

I see AIDS as the centrepiece of the human dilemma in southern Africa at this moment in time. Everything is linked to everything else and poverty lies at the heart. I recognize that you can’t address the other dimensions until you address AIDS. Or, alongside everything else, AIDS must be dealt with. Orphan children have to go to school, so you deal with school fees and uniforms. You can’t do treatment if people are malnourished. They need nutritious foods. If you have opportunistic infections everywhere then sanitation and latrines are going to be important — after all, you don’t die of AIDS but from whatever disease or complication afflicts the dismantled immune system.

I was struck by what you said in your book about AIDS treatment bringing along AIDS prevention, about treatment and prevention being inseparable.

I’m not going to make any apologies for this simple truth: People are dying unnecessarily in huge numbers and one of the things a civilized society does is to keep people alive. I consider that the strongest of imperatives. I will not retreat from it. And it is an utterly false dichotomy to pit prevention against treatment, or to pit AIDS against any other disease. You are not diminishing anything by treatment. In fact, you are opening doors everywhere. Treatment gives hope. People come to get tested because they know there is the possibility of a prolonged life. With treatment can come openness and an end to stigma.

How is treatment progressing in Africa?

The numbers of people who have access are growing all the time because treatment is moving out of the urban centres into the rural hinterland, and out of hospitals into the districts. The critical problem is capacity — everywhere, absolutely everywhere. The flow of drugs is a problem, the continued sustainability of resources is a problem, and capacity is an overwhelming problem.

What keeps you from becoming jaded or burnt out?

I think the explanation is simple, and I don’t think it reflects on any particular qualities I have. It is ideological. My entire period of growing up was in a family, a democratic socialist family, where social injustice was considered to be the great evil of the world. Inequality, indignity and injustice were seen to be the objects of life’s passion — to reverse them, turn them around, eradicate them. From the age of 5 that is all I heard: Social injustice was bad, poverty shouldn’t exist, inequality shouldn’t exist, racism shouldn’t exist, and you are on this planet to fight those things.

For me, what’s happening in the pandemic is the ultimate expression of inequality and social injustice and poverty, and therefore everything that I believe comes into play. I probably have as much compassion as the next person, but it is much more ideological. The anger and rage I feel is an anger and rage at — I have to phrase it this way — at capitalism, at the way the world is organized, at the way in which the privileged and powerful care hardly at all for the uprooted and disinherited. And that is for me what this is all about. As well, I live in a feminist family. Feminism is an absolute bulwark of the convictions of this family, and the gender inequality of the pandemic is the ultimate violation of the feminist impulse for the rights of women.

What lies ahead for you?

At the moment, the assumption is that my job as special envoy will end at the end of 2006. There are a number of avenues [opening up], including a “scholar-in-residence” role at McMaster University. But whatever I do, Africa and AIDS will remain a centrepiece. I don’t intend for a minute to relinquish that. I am also working on another book. I love the UN, but I’m happy to anticipate a more unencumbered platform. I am allowed now an unusual amount of freedom to speak forthrightly, but I’d like even more. I’d like to be able to say some things that I now have to bite my tongue about, choke back, and I’ll feel a moment of significant liberation when the end comes and I can speak even more frankly.

Ann Silversides is the author of AIDS Activist: Michael Lynch and the Politics of Community (2003, Between the Lines), a history of the early days of AIDS activism in Toronto and Canada.

Photo: Tamela Hultman / allAfrica.com