An Interview with Stephen Lewis

Waiting for a breakthrough

Stephen Lewis

Stephen Lewis is the Special Envoy to the United Nations (UN) for HIV/AIDS in Africa. He has served in this capacity for four years and has become an unwavering voice in the battle for the development of new prevention technologies like AIDS vaccines and microbicides that could help to slow or end the pandemic, as well as for the rights of women. Lewis was born in Canada and resides in Toronto, but the majority of his time is spent on the road or in a plane. Whether visiting with affected communities in Africa or at the UN headquarters in New York City, Lewis always commands attention.

Prior to his role as envoy, Lewis served as the deputy executive director of the UN Children’s Fund (UNICEF) and also as the Canadian Ambassador to the UN. He spent the early part of his career entrenched in national politics and was once leader of the New Democratic Party in Ontario, Canada. His humanitarian efforts and outstanding oratory skills have earned him numerous honors, including more than 20 honorary degrees. Earlier this year Lewis was named one of the world’s one hundred most influential people by US-based TIME magazine. And at 67, Lewis shows no signs of slowing.

Lewis recently gave a rousing speech at the opening ceremony of the HIV Pathogenesis and Treatment meeting held by the International AIDS Society in Rio de Janeiro, Brazil. He used the speech to criticize the recent meeting of the G8 nations for “getting caught up in celebrity.” He leveled an abundant amount of praise on the ‘3 by 5’ initiative of the World Health Organization, the progress of The Global Fund to Fight AIDS, Tuberculosis, and Malaria, and the continued dedication of UNAIDS, saying these efforts have made all the difference in the world. Lewis also emphasized the pressing importance of vaccine research.

VAX and IAVI Report Science Writer Kristen Jill Kresge recently spoke with Lewis about progress in battling AIDS in Africa and what new initiatives he thinks may help halt the epidemic’s unchecked spread there.

As envoy for HIV/AIDS in Africa, you are reporting directly to the Secretary General on an entire continent’s epidemic. How do you accomplish this and what do see as your main activities as UN envoy?

The primary activities of my job are to visit African countries, meet with the political leadership, meet with groups of people living with AIDS, and spend time seeing projects in the field. I’ve always seen these last two activities as critical so that I can see how the diplomatic community can be of greater use. When I come back to New York I hold a media briefing so that the international media has a sense of what I have found. Then I meet with the Secretary General and discuss with him what I’ve seen and together we discuss how that might influence the way in which he, and the UN more generally, responds.

In the process I have come to understand that advocacy is also a very important component of the envoy role. I’ve therefore spent a great deal of time speaking around the world at conferences and meetings in order to convey what is happening in Africa and why it is so desperately important for the world to respond.

How has the response to the HIV epidemic in Africa changed in your four years as envoy?

That’s a difficult question. The envoy role has clearly evolved since the early days when I or anyone at the UN didn’t have a substantial sense of what it would be. The sense of hope right now is more alive than at any time during the previous four years. The tremendous efforts by the World Health Organization to put millions of people on treatment and the evidence, although very slight, of increased resources has made people feel glimmers of hope in the midst of pervasive anguish. This pandemic has been going on for over 20 years and we are only now, literally at this moment in time, beginning to come to grips with it. So the job has changed in the sense that I feel now more keenly than ever before that we must do something to subdue the pandemic. Unfortunately, on the ground things are as painful as they’ve always been because people are dying in such vast numbers.

How has your attitude changed during your tenure as envoy? Do you find it difficult not to get discouraged?

When I started as envoy I was swamped with despair. Now I live in a perpetual rage. I feel an even greater sense of urgency four years into it. At first I heard all these numbers about the situation in Africa and I was lost in the data. Now when I travel I just want to save individual lives. You reach a point where every single human life becomes a matter of obsession. Instead of getting discouraged I get angry because when you are surrounded by death you can’t get over it.

One example is the situation with orphans. Everyone understands that one of the single most important things for orphans is to eliminate all school fees so that these kids can get into school, have peers to play with, and gain some self-worth. And even though everyone knows that we should abolish school fees, nothing changes year after year. I’ll never forgive those who have been indifferent, insensitive, and just paralyzed over such long periods of time. But there’s no point in being discouraged because futility leads nowhere. Instead, I get neurotic.

I’m just one person out of thousands who are responding to this from within the UN family and when I think of all the people who are in the field, I don’t know how they hold their emotional fabric together. It’s so incredibly painful on a daily basis and I’m in a rage about it.

AIDS is now disproportionately affecting women. What is the situation like in Africa?

I feel more deeply now than I ever did before that the vulnerability of women is possibly the most terrifying component of the pandemic and about which the world is doing almost nothing. This is true in Africa, as well as in other regions of the world. The women are the core of the society—they do the farming, they carry the burden of care—yet they are really under siege. The disproportionate number of infections is huge and women are suffering so extensively. Women are fighting more and more for their voices to be heard because they themselves are so appalled at the carnage.

What is being done on the ground to address the vulnerability of women?

I see very little change on the ground. There is little progress in building a legal infrastructure and getting laws in place to protect the property and inheritance rights of women. It moves from inertia to paralysis. We need the toughest laws imaginable against sexual violence and marital rape, and we need ways to enforce them. We need to encourage the social empowerment of women, whether it’s putting girls in school or starting income-generating projects. But I just can’t get over how slowly this is happening. What we have is an absolute vindication of the feminist analysis: when you’re dealing with the inability of men to relinquish power and authority, then you are in real trouble.

So what do you think can be done to alter the course of the epidemic in women?

I’ve come to the conclusion that we must have an international women’s agency rooted in the UN. There is a United Nations Fund for Women (UNIFEM) and it has a budget of around US$20 million a year for the whole world. In comparison, UNICEF has a budget of over $1 billion and the United Nations Development Program (UNDP) nearly $2 billion. So more than half of the world’s population gets a pittance of support from within the UN system. This is not the fault of the UN; it’s the fault of the member states. And maybe you could get away with that until the dramatic expansion of the pandemic in women, but now there must be an international agency for women. This is the single most important reform that could happen within the UN as far as I’m concerned. It dwarfs all other development issues.

UNAIDS (the Joint United Nations Programme on HIV/AIDS) must also take on AIDS as a women’s issue as though there were no tomorrow, because for the women of Africa there is no tomorrow.

The UK government recently released a report from their Commission on Africa. Did this commission’s report confront the situation facing women?

The one major flaw in the Blair Commission report, an excellent report in all other respects, was that it is lousy on women. I just ask the question, how is it possible that they had 17 commissioners and only 3 were women? How do you strike a commission, where you can appoint anyone in the world, and only find three women? What does that immediately say about what you think is important?

If we had a Commission on Africa with 14 women and 3 men, we would get a much more valid and significant view of the continent

Research into new preventive technologies like AIDS vaccines and microbicides is seen as a critical way for women to become empowered and be able to protect themselves from HIV infection. Do you think there is enough political action into the search for an AIDS vaccine?

I remember the first time I met Seth Berkley of IAVI and he said to me the most obvious thing in the world—a vaccine is the ultimate answer. It’s really strange that we don’t integrate that into absolutely everything we say and do because it is the ultimate answer for women, and for everyone. But this urgency has not gripped everyone yet, and we’re still not putting enough money, or energy, into it.

I think the excitement that has been growing around a microbicide is pretty legitimate. It looks as though there may be something not that far down the road and, even with all the limitations, over time millions of lives could be saved. But I love the sense that a vaccine and a microbicide are marching together and that these aren’t separate initiatives as they have tended to be seen. You have to fight like hell on both fronts simultaneously. The traditional prevention vehicles, indispensable though they are, need a tremendous shot in the arm, and a vaccine or microbicide may be just that.

How important a role does debt relief play in reversing the trend of poverty on the African continent?

The cancellation of debt in the poorest developing countries is absolutely an obligation that the Western world should fulfill. If we were able to cancel over $30 billion of Iraqi debt overnight just because the US wanted us to, then surely the world can come together on the cancellation of African debt. That would free a good deal of money, otherwise used for servicing debt, to invest in social sectors where the needs are great.

I think, however, that doubling the official development assistance to reach the famous target of 0.7% GNP [gross national product] is probably the single most important immediate response. And there we’re in trouble because the US refuses to embrace the objective. We’re surprisingly also in trouble because Canada refuses to set a timetable for that objective. The development assistance is so important because if the disease burden of a country is as high as it is in the case of these AIDS-afflicted countries, then you never get economic growth until you deal with the disease burden, and that requires resources. This is the argument that Jeffrey Sachs makes—once you’ve dealt with the disease burden you can start talking more vigorously about economic growth.

However even with debt cancellation and foreign aid, you don’t build economies until you have fair international trading laws. There is not yet any substantive movement to give the producers in Africa a chance to compete fairly in the world, which would be the strongest way to repair the economies.

The UN general assembly recently held its special session on HIV/AIDS (UNGASS) in New York City. Were AIDS vaccines or microbicides high on the agenda? Was there discussion on the pressing needs of women?

I sat in on the “so-called” session on gender and AIDS and there was no meaning to that meeting, and I don’t care who is offended by that. I would say it ranged from fatuous to nondescript. There was nothing in that meeting that would galvanize a response by governments to what is happening to women. There was a lot of rhetoric, which is symptomatic of what’s happening—we’re not responding. The Secretary General opened UNGASS by saying that although we have made some progress, most countries have failed to meet their promises. This isn’t just Stephen Lewis being Cassandra; I’m just mirroring what others are saying.

In the materials on prevention produced for the meeting there was absolutely no mention about AIDS vaccines or microbicides. How is it humanly possible that the people who are responsible for setting out the details on prevention forget these important technologies? It just isn’t rooted in the minds of those who have to respond.

You have become such a strong voice for women’s rights that I wonder how your wife has influenced your work.

My wife, Michele Landsberg, has been one of the strongest feminist voices in print in Canada for a quarter of a century, and the feminist analysis has very much become part of my own ideology because of her influence. She’s been an absolutely extraordinary and uncompromising voice and the power and force of her ideas has been unquestionably the greatest influence on my life.

We have been married for 42 years and Michele always says that it took her 20 years to turn me into a human being, and then the next 20 years were tolerable. I think that’s probably accurate. I also inherited a lot from family, of course, and was deeply engaged in politics for a while, but in terms of what I think is and isn’t important in this world, the benchmark for me has been my wife.

How important was your work in politics and how has it shaped your current position?

I love politics and I regarded it as a principled and useful profession. I served in parliament for more than 15 years and I am very sad that politics has now descended into such personal animus and vitriol in the US and in Canada. It’s very different from the days when I was in politics, or when my father was in politics in the 60s and 70s. But I was very lucky, I got into politics when I was 25 and out when I was 40. My political experience has helped me most in the advocacy around AIDS.

What are the most critical steps the international community can take in advocating for a suitable response to AIDS?

Let me say something that is a trifle provocative. The world is now assessing questions of how the UN and the international community are responding to critical issues like Darfur, the way it responded to Rwanda, and the way in which it is failing to respond in Northern Uganda. And national governments have every right to disagree with the interpretation of the international community and say go to hell, but I think that with this pandemic everything changes. We can’t allow ourselves the diplomatic privilege of always working behind the scenes and being silent.

If you think that treatment is rolling out too slowly in South Africa, the country with the highest absolute number of infections in the world, then something has to be said about that. If in a country like Zimbabwe you see the pandemic eviscerating the population, there has to be a desperate effort made to confront the turbulent political situation. It just seems to me that the UN cannot be seen as complicit in the passivity and slowness that characterizes some of the responses, because people’s lives are at stake. We have a responsibility, in a thoughtful way, to say to recalcitrant countries that this isn’t good enough and we expect more because we’re fighting for every life.

How do you get the world to realize the consequences of this pandemic?

You have to keep at it relentlessly by driving home your arguments, trying to persuade people, and never allowing your voice to be silenced. You have to be tenacious and indefatigable. We know that we can save lives because we have generic antiretroviral drugs at a low enough cost that they should be available to everyone. But even though treatment is now being rolled out it’s happening too slow, too late, and too incrementally. That drives me crazy.

The criminal negligence on the part of the Western world has lasted for so long that we’ll never be able to compensate for the deaths that have occurred. But you have to continue fighting, and one day, unexpectedly, you break through. That’s what I’m waiting for.