OneWorld.net (U.S.)

It’s like winning a battle. The war is on. The findings of the 3 by 5 Progress Report that the world has reached the interim target of providing life-prolonging anti retroviral treatment (ART) to 700,000 people living with HIV/AIDS is encouraging. At the same time, it underscores the need to go all out to achieve the global target of reaching three million people living with HIV/AIDS in developing and middle income countries with ART by the end of 2005. Dr Suman Mehta, associate director of Joint United Nations Programme on HIV/AIDS (UNAIDS), who is responsible for providing policy and programme support on HIV/AIDS to countries in Asia, Pacific, Middle East and North Africa, spoke to Rajiv Tikoo of OneWorld South Asia on the progress and the challenges ahead. Excerpts from the interview:

How would you sum up the report’s findings? We are on target as the report says. At the same time it means that we have a big challenge ahead. The target is that three million people should be receiving ART by 2005. However at present the number stands at 700,000 only, which means that 2.30 million are to be recruited this year.

Given the current numbers, isn’t the target of three million by the end of 2005 too ambitious? The target was set at three million by 2005. The review was done at the end of 2004. Seeing the figures in June, one would have thought that we can’t meet the target. But the numbers doubled between June and December. If this doubling keeps on happening at the same rate or at a faster rate, then we can say that we can meet the target.

Are we also likely to achieve the Millennium Development Goal on HIV/AIDS? Firstly, I think HIV/AIDS has an impact on all development goals. Though there is a specific goal on HIV/AIDS, I don’t think it will help to look at it in isolation. If we are not able to reach the goal on poverty and hunger, education or gender empowerment, I don’t think we will be able to reach the goal on HIV/AIDS. One has to keep in mind gender dimension and increased feminisation of the epidemic. So to fulfill all the goals is important. That is why we keep on talking about the importance of mainstreaming HIV/AIDS in different sectors. It’s very important. I think we will wait to see what gets reported at the review.

Even environmentalists say that the environment should be mainstreamed. So do activists from other sectors. How viable is it? I think all development sectors have to work together but right now there is an opportunity. There is no other issue that affects the most productive life spans of people as HIV/AIDS does. Which disease kills people, stigmatises them or makes outcastes of women as does HIV/AIDS? Which environmental issue does that?

Other sectors should understand what HIV/AIDS can do to their sectors. For example in Africa, every day school teachers are dying. Doctors and nurses are dying. So, the affect is on education. It’s on healthcare. So, why is there this feeling that `my sector' should be mainstreamed. There is only one way to integrate. Integrate your sector with HIV/AIDS and it allows you to maintain your sector as well. If you don’t do that, your sector may be affected. We have to fight HIV/AIDS on all fronts.

ART is just one of the steps. What next? It’s very clear and everybody knows and it’s universally agreed that comprehensive response is the way to go. ART by itself cannot ensure that the epidemic will stop. But 3/5 initiative also opens up avenues for prevention. So the whole gamut of responses from prevention to treatment to care and support is what we call comprehensive response and that is what is needed. Without prevention there can be no stopping of the epidemic. We want to use the opportunity of 3/5 to strengthen prevention response because once 3/5 is achieved, then it gives hope to people who hesitate to find out their status. Particularly those who think that if they know they are positive, there is nothing they can do. So 3/5 tells them that they can live their life with good quality.

Prevention makes sense even for people who are suffering from HIV/AIDS. They can prevent it from spreading to their loved ones. They can become strong advocates for prevention. They can prevent secondary infection in themselves. They can prolong their own life. And that’s a very important component. But when we say prevention, it has to be voluntary counseling and testing (VCT).

Besides, 3/5 will have to continue to expand its coverage and the next challenge will be to make sure that those who have got it continue on the therapy. They don’t give up. And also those who develop side effects or develop resistance have alternatives available to them. So 3/5 is just a starting point. There are many steps to go. And it calls for a national response—and not merely a government response.

How is a national response different from government response? The national response is not a government response. National response is the response of the civil society, private sector, people living with HIV/AIDS and others. Various constituencies make a national response. The government alone can’t ensure effective response. Everybody does not go to them and their channels and doesn’t want to be seen accessing their help. And the government doesn’t have that kind of network, which can reach each and every individual. That is where the NGOs and the private sector come in. The partnership with NGOs needs to be strengthened tremendously. The private sector too should come forward and make funds available for a comprehensive national response.

But the some companies are doing it already. They are doing it mostly for their staff, which is good. Since they have the resources and they have the concern, they should step out of their premises. They should try to link up their work with the public sector or government or UN response. It does not help beyond a point unless all the initiatives are connected so that we can avoid duplication.

Besides, it would help if they say that 0.5 per cent of their earnings would go to a private sector consortium through which funding will go to government agencies, the civil society or some kind of public-private partnership.

How do you assess Indian pharmaceutical industry’s role? The Indian pharmaceutical industry has contributed a lot at the global level. What I can’t understand is why are they not doing more for the domestic market itself. Why are they not making drugs cheaper for their own countrymen? They also have some moral and ethical responsibility to make cheaper drugs available in their country. What is stopping them? It’s worthwhile listening to them. They may have issues, but these are not unsolvable. Someone has to make the first gesture. Let the pharmaceutical industry take the first step. Let them say that for every 50 dose they will give one dose free. My very humble but strong request to private sector is to come forward. I know they can do it. They want to do it. May be they are looking for a mechanism. If it’s so, UNAIDS will be happy to bring them together.