The UN's rebel advocate on Aids

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Nov. 30, 2006

The first UN special envoy on Aids in Africa is stepping down in December. Daniel Cook spoke to the outspoken Canadian about the highs and lows of his five years in office.

Despite working with a tiny - $200,000 (£106,000) - UN budget, Stephen Lewis has done much to open the world's eyes to one of history's worst human health disasters.
He is also credited with influencing African governments' attitude to Aids, in particular in South Africa.

'No cop-out'

His fiery speeches have generated headlines in the West, and raised awareness of the paucity of Western funding to prevent and treat HIV.

"Either you're going to act on behalf of the people living with Aids and do everything that's possible to bring the world's attention to it, or it's a cop-out," Mr Lewis told the BBC News website.


We have to stop this pattern of imposing conditions on Africa in return for the dollars they receive. That seems to me to be part of a neo-colonial mentality
Stephen Lewis
Special UN Envoy for Aids  

It is not only the sluggishness of the West's response to the pandemic which has frustrated Mr Lewis during his time in office, but also the conditions some aid agencies have imposed, notably the US.

The President's Emergency Plan For Aids Relief (PEPFAR) programme has, for example, demanded that some African governments promote abstinence policies in return for aid.

"We have to stop this pattern of imposing conditions on Africa in return for the dollars they receive.

"That seems to me to be part of a neo-colonial mentality," he says.

Funding shortage

However, he said the US programme was now making an "appreciable and positive impact" and working more closely with the Global Fund to Fight Aids, Tuberculosis and Malaria.

But the Global Fund, the largest HIV programme in Africa, was half a billion dollars (£260m) short of funds this year.

"The G8 promise is in tatters," he said, referring to the commitment made by the world's richest nations to fund universal global access to Aids treatment by 2010.

And the shortages were probably even greater.

"The word is out, and it's often reinforced by western diplomats at country level: 'Don't ask for too much because the Global Fund just doesn't have the resources'."

South Africa target


It is for South Africa that the Canadian has reserved his most consistent criticism.


An estimated 5.5 million South Africans live with HIV, 18.8% of the population.

But the government only began making antiretroviral drugs available in 2004, and most say the dispersal of treatment has been slow.

"It is the only country in Africa whose government is still obtuse, dilatory and negligent about rolling out treatment," the UN envoy thundered at the International Aids Conference in Toronto in August.

South Africa's Health Minister, Manto Tshabalala Msimang, has publicly stated that "natural remedies" such as garlic and lemons offer an effective alternative to Aids drugs.

She has since denied making such statements, and her ministry reportedly accused Mr Lewis of waging a "vendetta" against the South African government.

But, at the Toronto conference, the South Africa health ministry displayed such lemons and cloves of garlic next to condoms and anti-retroviral drugs.

Weeks later, Ms Tshabalala Msimang was sidelined from South Africa's Aids response.


Grounds for hope?

Although Aids in Africa has yet to peak, history may show that 2001-2003 were the darkest days of the epidemic, when infection rates were rising exponentially and it was impossible to predict how many would die.

"People who'd been infected in the 80s and early 90s were suddenly developing full-blown Aids and dying in huge numbers. It was shocking," Mr Lewis said.

But, in 2006, there are signs in some African nations that give grounds for a little hope.

Uganda, Rwanda and Zimbabwe were singled out by Mr Lewis for their success in reducing infection rates or providing treatment.


Shackle-free

His outspokenness has drawn fire, but UN Secretary-General Kofi Annan had been "extraordinarily supportive" during his tenure, he said.

There was only one occasion when he was "ordered for a period of time to lay off". That warning came as Washington was controversially putting pressure on Uganda to promote abstinence, rather than safe sex, in the fight against Aids.

"I was told that I should not be critical of the US government because they hoped to get the US president to appear at a particular conference on Aids, and that they had been told that if I attacked the US, the president wouldn't come," he said.

"I told Mark Malloch Brown [now UN deputy secretary general] that I would observe that request.

"And he said as soon as the conference is over, you can say what you want. Which is exactly what happened. Bush never came. As I knew he wouldn't."

Mr Lewis plans to remain an advocate for the tens of millions affected by HIV for some time to come - and without the diplomatic shackles of the UN.

"I admit I have spent a lot of time biting my tongue, because [as a UN envoy] you can't say what you deeply believe, and you can't name the recalcitrants.

"But I have come as close as I can and when my tenure is over, I shall try to be much more forthright."


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