'Incomprehensible' that AIDS resources are flatlining: Stephen Lewis

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Stephen Lewis, a former United Nations envoy on AIDS in Africa, calls the ongoing HIV/AIDS crisis the "most difficult and damaging pandemic we've ever experienced."

In advance of World AIDS Day, which is on Dec. 1, Mr. Lewis spoke to The Globe and Mail about the "tremendous amount of work" that remains, funding that is "flat lining and reducing," the Canadian government's lack of resolve and Pope Benedict's recent condom comments.

Mr. Lewis, whose Stephen Lewis Foundation helps people affected by the disease, is speaking Monday night in Toronto in an event dubbed The Great Canadian Conversation about HIV/AIDS in Africa.

To listen to the audio of Mr. Lewis's interview with The Globe, click on the photo to the left.

Here's a transcript of the interview:

Hello, everyone. My name is Jill Mahoney and I'm a reporter with The Globe and Mail. I'm joined by Stephen Lewis, a humanitarian and former diplomat who now spends his time helping those affected by HIV and AIDS.

Stephen, thanks for joining us.

A pleasure, a pleasure.

The United Nations' AIDS agency recently said that there has been a 20 per cent decrease in new HIV infections over the past decade. But there are still 7,000 new infections each day. How do you continue to find hope amid such staggering statistics?

It's interesting the way in which the statistics are interpreted. If you compare what's happening today with the lowest and worst point of the pandemic, which is what UNAIDS does on a regular basis, then obviously there would be areas of improvement. And it is true that we have more people in treatment and we have fewer infections, as they say, and fewer deaths and the pandemic has stabilized, albeit at very high levels in some countries. But the numbers of infections are still significantly outstripping the people we are putting into treatment to stay alive. For every person we put into treatment, there are two new infections. So it remains a terribly, terribly difficult situation. And I guess you can read hope into it by the gradual improvement over time. But if you looked at it as it stands today and you know that there are 10 million people who require treatment now in order to stay alive, and there are over 30 million people living with the virus, which makes it the most difficult and damaging pandemic we've ever experienced, you'd have to take a deep breath and realize there's a tremendous amount of work to be done.

Of all the challenges - from lack of funding to drug access - what would you say is the single biggest obstacle to turning the tide on HIV/AIDS in Africa?

At the moment, the biggest single obstacle is resources, is the dollars. There's just no question about that. We have made progress in providing treatment. We have various forms of prevention, from microbicides to male circumcision to behaviour change. We are working very hard, increasingly hard, with high-risk groups, like men having sex with men and sex workers and injecting drug users. There is a sense of some momentum as the application of treatment results in prevention. You know, you treat people and their viral load descends to undetectable levels and if they then have unprotected sex, the virus is not transmitted. We have some reduction in the number of babies who are being born HIV positive. There are significant things happening; you sense that we might turn the tide on this pandemic. But now the resources are flat lining and reducing and that is incomprehensible. It's just outrageous that the people of Africa in particular should be considered expendable because the donor countries will not honour their commitments.

I wanted to ask you about that. How do you rate the Canadian government's commitment to tackling this pandemic?

The Canadian government commitment is very modest. We made a modest increase to the Global Fund to Fight AIDS, Tuberculosis and Malaria. We should have doubled the amount we were giving, rather than a 20 per cent increase, given the proportion we should assume of the overall costs. We have refused to pass the legislation, the generic drug legislation, CAMR, the [Canadian] Access to Medicines Regime. That is a piece of political ideology, which is inexplicable. The government could be providing generic drugs to save the lives of children, pediatric generic formulations. There's no reason in the world not to do it. Except for the behaviour of the pharmaceutical industry behind the scenes and the way in which they seem to have persuaded Conservatives and some Liberals to join them. We should be giving funding to microbicides; we've stopped. The International Partnership [for] Microbicides. We've stopped the funding. We should be giving funding to vaccines, the International AIDS Vaccine Initiative. We've stopped the funding. We should be increasing our funding dramatically to the new international women's agency, UN Women, instead of making a paltry opening contribution of $10-million. And frankly that $1-billion that was set aside at the G8 meeting last [June]in Canada, which was to apply to maternal and child health. That would be perfect for the Global Fund to Fight AIDS, Tuberculosis and Malaria because AIDS is exacting such a toll on maternal and child health. It fits the government's priorities but the government is being obtuse and intractable about how the money is used.

What about HIV/AIDS in Canada? What challenges do we face here at home?

The biggest challenge is the aboriginal community. We know that there is increasing incidence among First Nations communities and we have not viewed it as an emergency, we have not viewed it as urgent. We know of the great difficulty around injecting drug use in the Downtown Eastside of Vancouver and the vulnerability of injecting drug users, many of whom have aboriginal origins. It's really imperative that the government of Canada look closely at the spreading infection rates amongst the aboriginal community. We're also incrementally increasing amongst women. I think it's important to say that overall, whether it's in Canada, the U.S., United Kingdom, Japan, amongst the donor countries, the Western countries, or whether it's in the developing world generally, we still have not come to grips with what the pandemic is doing to women. I mean, women remain the disproportionately vulnerable group and for whatever reason, and it's largely rooted in gender inequality, we are deficient, hugely deficient, in responding with critical urgency to the position of women. And that's true in Canada, where the virus is concerned, as it is true outside.

What do you make of Pope Benedict's recent comments that condom use is sometimes morally justifiable to stop AIDS?

Well, when the comment first came out, I must admit I regarded it as pretty inconsequential because I thought it applied to male prostitutes. And I smiled to myself that the Pope seemed to be sanctifying commercial paid sex but he couldn't extend it to consensual activity between consenting adults. And now he has extended it. At his press conference, it would appear that he moved from male prostitutes to female prostitutes and then he moved to heterosexual use of condoms if you were going to prevent a fatal disease like AIDS. That's quite a shift in Vatican thinking. The ground shakes a little. On the other hand, being objective about it, it makes very little difference to the fight against the pandemic except for its rhetorical value. Because frankly in most parts of the world with which I'm familiar, like sub-Saharan Africa, the papal views have never been taken seriously. Condoms have been increasingly used and where we have made some progress, everybody attributes it in part to the use of condoms. The Pope's words are simply not taken seriously on this issue. People are too smart to be taken in by the previous opposition to condoms.

Stephen, thank you so much for speaking with us.

Fair enough. Thank you.