‘Providing education, sexual reproductive services to young girls key to ending AIDS’

Winnie Karagwa Byanyima is the new Executive Director of the Joint United Nations Programme on AIDS (UNAIDS). The United Nations Secretary-General appointed her as the Executive Director of UNAIDS on August 14, 2019. Before her appointment, Byanyima was the Executive Director of Oxfam International since 2013. Prior to that, she served for seven years as the Director of Gender and Development at the United Nations Development Programme (UNDP). Byanyima began her career as a champion of marginalized communities and women 30 years ago as a member of parliament in the National Assembly of Uganda.

In 2004, she became the Director of Women and Development at the African Union Commission, working on the Protocol on the Rights of Women in Africa, an international human rights instrument that became an important tool for reducing the disproportionate effect of Human Immuno-deficiency Virus (HIV)/Acquired Immune Deficiency Syndrome (AIDS) on the lives of women in Africa. She holds an advanced degree in mechanical engineering (in energy conservation and the environment) from the Cranfield Institute of Technology and an undergraduate degree in aeronautical engineering from the University of Manchester. Byanyima assumed her functions as UNAIDS Executive Director on November 1, 2019. Byanyima in this phone interview with CHUKWUMA MUANYA, among other issues, said providing education and sexual reproductive health services to young girls is key to ending the disease. Excerpts:

Congratulations on your appointment as the new Executive Director of UNAIDS. What does it feel like moving from Oxfam to UNAIDS?
THANK you very much. I am humbled to be going from one great organisation to another. The memories made from leading Oxfam for seven years will last me forever. UNAIDS feels like a natural calling for my next challenge, one that is very personal to me. I am proud and determined to lead the fight against HIV/AIDS.

Ahead of the World AIDS Day, the issue is now about the end game, to end HIV/AIDS. What is your blueprint on how to end HIV/AIDS if possible before 2030?
It is not going to be business as usual. I am here because Africa is the continent still most affected by the HIV epidemic. More than 25 million people are living with HIV in sub-Saharan Africa—more than two-thirds of the global total of 37.9 million people living with HIV.

I am also here because many countries in Africa are leading the way to end AIDS. We are heroes, fighting the epidemic.

Nigeria has the second largest HIV epidemic in the world. Although HIV prevalence among adults is much less (1.5 per cent) than other sub-Saharan African countries such as South Africa (20.4 per cent) and Zambia (11.3 per cent), the size of Nigeria’s population means 1.9 million people were living with HIV in 2018. Recent drops in prevalence estimates for the country has been attributed to better surveillance.

Today, I can announce that 24.5 million people living with HIV around the world now have access to life-saving treatment.

Today we have so people living with HIV on treatment and it is quite amazing. Today, I am committing UNAIDS to take some big steps in a new direction.

The first step is to address inequality and the injustices that fuel the HIV epidemic.

AIDS hurts people who live in poverty. This is a problem for everyone, but a big problem for the poor. We have to address inequality. It cannot be right that some people get treatment and live long lives, while others cannot access health care and die. We must fight inequality; lift all people up out of poverty.

We need to provide more services—education, health, and social protection. That is how we will end AIDS.

We must advance women’s rights if we are to end AIDS, so our second big step in the race to end AIDS must be to tackle gender inequality.

Keeping girls in school reduces their risk of HIV. We need to ensure that all young people can stay in school and that every school provides quality comprehensive sexuality education—to know about their bodies, their health.

Nigeria is one of the countries with the highest HIV burden. But despite this, we budget less than one per cent for HIV. The funding is very low. 80 per cent of HIV funds in Nigeria are from international donors. How are you going to help change the situation and make the government spend more on HIV?

We encourage governments all over the world especially in Africa to allocate more resources for health, education and fighting poverty. We know that there are different sectors competing for the scarce resources of nations. But providing education to young girls and sexual reproductive services is key to end HIV/AIDS.

Despite progress in recent years, there are still not enough resources available to end the AIDS epidemic. Poor countries are struggling to pay for everything they need—health, education, roads, water, sanitation.

Health should be a top priority. Without healthy people, we will not make progress. Two-thirds of countries in Africa still charge fees for health care, and millions of people are just one sickness away from falling into extreme poverty.

Despite the world’s commitment to implement universal health coverage, the percentage of people paying catastrophic health costs out of their pocket has only increased in the past five years. Health cannot be a privilege for the rich—it should be a right for everyone.

Public debt has climbed above 50 per cent of gross domestic product in half the countries in sub-Saharan Africa. In a constrained fiscal space, governments must find pathways to sustainable long-term financing of their HIV responses. We want to work with governments to see how to create fiscal space and manage their priorities within budgets reduced by debt repayments.

During the recent replenishment of the Global Fund to Fight AIDS, Tuberculosis and Malaria, countries and foundations made a historic down payment to advance the end of AIDS. But more work is also needed to ensure that every dollar, euro and shilling is being used effectively.

In many middle-income countries, governments are still paying thousands of dollars more for the same quality medicines that are available to low-income countries for just pennies a day. This is unacceptable. We will try hard to see that prices come down.

Universal access to quality health care is not a commodity—it is a human right.

You are coming from the world of activism to a diplomatic terrain and it is a different ball game. How are you going to use your background to protect the rights of the vulnerable group like women and children?
I am an influencer and social justice warrior. I am proud of that name. All my life I worked to prevent people from poverty. It has been my passion. This is a development job and not a diplomatic job. We are not diplomats. We provide social justice and human rights to vulnerable people.

The partnership between government and civil society, together with the meaningful involvement of communities, has allowed us to significantly reduce new HIV infections and AIDS-related deaths. Communities are the very centre of the AIDS response and are critical to ending AIDS.

When people and communities have power and agency, change happens. Communities have put rights-based, people-centred principles at the heart of HIV programmes, ensuring that AIDS responses tackle the inequalities and injustices that fuel the epidemic.

Women and girls are the backbones of care support in their families and communities, providing unpaid and often undervalued work in caring for children, the sick, the elderly and the disabled and underpinning fragile social support systems. This must change. The involvement and leadership of communities of women are vital in the response to HIV.

In Nigeria, a lot of people are coming up with claims for a cure for HIV. Is there hope for a cure for HIV?
One thing I want to do is to work with the scientific community. There are new innovations. Working with the scientific community will allow us to have the solutions that we all crave for. I want to work with pharmaceutical companies to bring out new innovations at affordable prices. We are also working with the World Health Organisation (WHO).

You know that ensuring that people and communities have the power to choose, to know, to thrive and to demand is the key to ending AIDS

Interestingly, there are game-changing approaches, such as medicine to prevent HIV (PrEP), integration of contraceptive services with HIV testing, viral load suppression (U = U), harm reduction, and comprehensive sexuality education, give people the power to protect themselves from HIV and, for people living with HIV, the power to thrive.

The power to know allows people to keep themselves free from HIV or, if living with the virus, keep healthy. However, people are finding out their HIV status too late, sometimes years after they became infected, leading to a delay in starting treatment and facilitating HIV transmission. In Mozambique, for example, the average time for diagnosis after infection for men was four years.

Adherence to effective treatment suppresses the virus to undetectable levels, keeping people healthy and preventing transmission of the virus. Knowing this allows people living with HIV the opportunity to lead normal lives, confident that they are protecting their loved ones, and confronting stigma and discrimination.

The work of community-led organisations is unique and powerful and can have a substantial impact on how the world fairs towards ending AIDS.

What is your message to Nigerians on World AIDS Day?
My message to Nigerians is that you Nigerians you are the powerhouse. One out of eight black people in the world is a Nigerian. You are powerful, you are big, and you are the biggest economy in our continent. This is what we need to harness to drive the HIV elimination programme. We can do it. We can do it.

I urge all countries to fully support and enable their community-led organisations, ensure they have a seat at all decision-making tables concerning the health and well-being of their community members and remove any barriers to their active engagement in the response to HIV. Only by fully funding and fully supporting the work of community organisations will the end of AIDS become a reality.