INTERVIEW: Egypt's leadership should fight HIV stigma, says UNAIDS official

Ingy Deif, Friday 2 Oct 2015

The UNAIDS deputy executive director reflects with Ahram Online on the new HIV/AIDS challenges in Egypt and the region

Luiz Loures
UNAIDS deputy executive director Luiz Loures (Photo: UNAIDS official website)

The official number of people living with HIV in Egypt is around 8,800, most of whom came to know about their infection by coincidence through routine medical tests conducted for reasons other than HIV detection, according to the Ministry of Health.

World Health Organisation (WHO) statistics state that at the end of 2014, there were 36.5 million people living with HIV worldwide.

Contrary to many regions, the rates HIV continue to rise in the Middle East and North Africa (MENA), where the number of AIDS-related deaths between 2005 and 2013 rose by 66 percent, and new HIV infections rose by 7 percent.

Only 11 percent of those in need get the treatment, which makes it among the lowest treatment rates in the world.

Shortly after his return from the New York General Assembly, Ahram Online interviewed Dr Luiz Loures, deputy executive director of UNAIDS, the Joint United Nations Programme on HIV/AIDS.

The interview was made during his two-day visit to Egypt on the sidelines of the Regional Consultation on Strengthening National Capacities for a Resilient HIV Response in Middle East and North Africa Countries, organised jointly by UNAIDS MENA, UNHCR, the Regional Arab Network of NGOs working on AIDS and the Arab League.

Ahram Online (AO): What were the reasons behind choosing Egypt as a destination for a visit at this time?

Dr Luiz Loures (LL): There are several reasons, but most importantly is the partnership we have always maintained with Egypt in regards to humanitarian work. Dr Yamina Chakkar, the UNAIDS regional director, hosted a regional meeting in Cairo with our partners on what can be done in terms of strengthening the response towards the AIDS epidemic in this region, especially in humanitarian settings. The response on the Egyptian and Arab side was reassuring.

Secondly and very importantly for me, is to have an opportunity to talk to the Egyptian leadership. I aimed to ask the leadership to help us move forward with the response.

(AO): Why do you think Egypt in particular can play a big role in that regard?

(LL): I am positive about the role that Egypt can play, and that reassurance stems from the achievement of Egypt in regards to mobilising against Hepatitis C.

HIV is an epidemic here and everywhere. We have the science and drugs, but they are not accessible to everybody because the price is too high.

The Egyptians did a very good job to reduce the price of Hepatitis C drugs and making them accessible for their people.

They believed that this was the right thing to do, and by doing so they helped us very much globally.

This is the response we need for HIV/AIDS drugs as well, and we are looking forward to the Egyptian government helping to lower the price of these drugs.

(AO): The HIV issue has come a long way since the 1980s, from being a vague scare to a medical challenge to a societal challenge; can you please reflect on that?

(LL): It is not a medical challenge any more than it is a societal challenge.

At this point I want to be positive, because I saw [Egyptian President Abdel-Fattah] El-Sisi talk to the United Nations General Assembly, and he was very strong and clear on this point and on his intentions to fight discrimination. If you want success in combating the stigma, make sure the leadership is on board.

Exclusion is so strong and deep-rooted that you really need very strong measures to change it. It has to come from the top and all the way down to other levels of decision makers.

(AO): What are the current trends in regards to the spread of HIV in the region?

(LL): People are getting infected with HIV all over the world and are dying from AIDS-related illnesses. This should not be happening anywhere in any country, regardless where it is on the globe.

The main point is that we have the instruments and the tools. It is not HIV that is holding us back, but rather the exclusion and the discrimination.

Science has given us the tools to end this epidemic, but the key is to let everybody have access to the treatment regardless of sexual orientation, whether they inject drugs, young or old, male or female, they should all have the medication. This is the real challenge.

What is happening today in the region is that there is an increase in infections, especially among those excluded.

The epidemic is rising not only in MENA, but in Europe and all over the world. What is different is that it is rising specifically within groups that are excluded.

(AO): Tell us more about the recent declared sustainable development goals (SDGs), what really changed and how they would be better implemented in our region?

(LL): The SDGs are some of the best opportunities for the work on HIV. The main difference between SDGs and MDGs (millennium development goals) is that the former focuses mainly on the issue of fighting discrimination and exclusion. It focuses on ending inequality.

Again, I stress on the role of the leadership and the policy makers. I met during my short stay in Egypt with the minister of health and population, the minister of international cooperation and with leaders of the Arab League. From their responses I was very reassured that they will give support in moving in the direction of attaining the SDGs.

(AO): The stigma in Egypt is still overwhelming in regards to HIV/AIDS, what are the best means to eradicate it?

(LL): For sure the stigma is embarrassing, but I believe that resolving stigma is not done by science, but rather the solution lies in the hand of leadership, from the highest level.

Combating exclusion and combating discrimination depends on the leaderships. They should enact regulations and decisions to fight discrimination. This is when change begins to happen, and we have seen this many times.

(AO): The WHO's latest guidelines advise treatment upon diagnosis. How do you foresee this impacting the response in countries like Egypt where treatment relies on external funding?

(LL): There are many things to work on in making drugs accessible upon diagnosis. The first of which is to create the pressure needed to bring down the prices of the medications.

Negotiations with manufacturers should be conducted, as well as trials to produce the medicine locally. What happened with Hepatitis C in Egypt, the way the Egyptians dealt with it, was a good example.

Of course more funds are needed, but first there must be more commitment domestically on behalf of the government.

More than 50 percent of funds spent today in regards to HIV/AIDS in countries worldwide are from domestic resources, not international, and this includes many countries in this region.

What cannot really go on is a situation where there is such a low level of access to treatment in a society that is so vibrant and that has so much capacity.

(AO): In Egypt, the burden of containing the spread of HIV and providing support to high risk categories is shouldered by the civil community. How can these efforts be reinforced in the future?

(LL): I am very optimistic after what I saw here; a very vibrant movement, whether it was the members of the civil society or the cabinet.

We are talking about sectors that are the most discriminated against and conflict situations. If the civil society is not on board, things will not function.

There are two ways to support the efforts of the civil society. First we need to open the policies, meaning that we need to issue regulations from the leadership that support the civil society.

President El-Sisi has spoken on the highest level in regards to his commitment to ending discrimination, but the only way for him to attain that is through a partnership with the civil society.

The second way is to provide this civil society with resources. There is a governmental responsibility in that regard.

(AO): Are you optimistic in regards to the eradication of HIV by 2030? And in light of turbulence in the region, how can UNAIDS function best?

(LL): Of course the region has many places deep in turbulence, and their societies have to be given a priority. Through our meetings there was a general consensus on supporting the Syrian refugees.

Conflict should not be something that cripples our efforts to improve the situation in the field of HIV, but in regards to reaching the SDGs, whether globally or regionally, again I stress on the importance of the political leadership in leading the way forward.

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