New Delhi: Michel Sidibé, executive director of UNAIDS, attended the national convention of parliamentarians on HIV/AIDS in New Delhi on Monday, where India’s health minister Ghulam Nabi Azad called homosexuality a disease. In an interview, Sidibé talks about why educating the leadership about HIV/AIDS is important and what India should do at a time when funding for AIDS programmes is drying up. Edited excerpts:
Was it shocking for you to hear health minister Ghulam Nabi Azad call homosexuality a disease and describe it as unnatural?
It is shocking for me for the simple reason that I don’t think it is in line with the policy of this country. India is one of the unique countries that has always fought against stigma and discrimination of any kind. Go to Mahatma Gandhi, the father of the nation, and you read any of his texts and you will find he always (advocated) that society should be inclusive... He rejected stigmas, discrimination. And that is what I heard from all the participants yesterday (Monday)—the Prime Minister of India, (Congress president) Sonia Gandhi, the leader of the opposition (in the Lok Sabha, Sushma Swaraj) that it is important to deal with these societal issues and help to integrate people who (are) at the margins to have access to AIDS services... UNAIDS’ stand is very clear on this: during the high-level meeting that occurred two weeks ago in New York, for the first time marginalized populations were named and men having sex with men (MSM), sex workers and people who inject drugs were among them. We want equal access to services for all. I could not understand what was said at the New Delhi convention because it was said in the local language and the translation was not available. If these are his personal feelings, it is unfortunate.
What would you have done if you had understood at the time what he was saying? Would you have walked out?
... I would not have walked out. I would have debated with him. I will debate with him today. I will tell him to correct this unfortunate statement. Probably he did not mean it...
Will this statement be a blow to the work that Indian agencies have been doing to educate people about MSM?
In 1996 in Vancouver, India was branded as the world capital of AIDS. It was projected that in 2010 we would have 20 million people with HIV in this country. But India has demonstrated the opposite. It has reduced new HIV infections by more than 50% in the last decade. That was my message yesterday and this kind of statement should not take away from such an achievement. The world should remember, in spite of the unfortunate statement from the health minister, India is contributing to keep more than 6 million people alive throughout the world, particularly in developing countries. It manufactures 86% of the first line drugs that are distributed in low and middle income nations like Botswana, Namibia, Vietnam, Nigeria.
India has to look towards larger targets and should now fight for universal access to HIV services (prevention and treatment) for all classes of people within India. When India can send drugs abroad, which are saving millions of lives, it is important that India itself should have a plan that allows universal access to prevention methods and treatment for Indians who are at the margins of society. It is paradoxical—you in India are helping me in Mali to have more than 80% of people who need treatment to have access to it whereas, in your own country, only 26% of the people eligible for treatment have the same facility. The coverage level is still very low in India.
The debate which I want to open in India is more about legal reform (which) could help sex workers, MSM, people who inject drugs and also pay attention to the epidemic in (the) North-East. Those are the critical issues to be addressed.
Funding commitments post-March 2012 to the Indian AIDS programme seem to be low. You have also talked about the need to revamp the funding process. What should India be doing?
What is important is to open a new debate on funding. All (existing) paradigms of funding from my point of view are dead. Thinking that some part of the world has money and another part of the world waits to get this money to make their AIDS programmes happen—from my perspective, those days are over. What we need today are shared visions and responsibility with mutual accountability. It is no longer acceptable that the dependency rate on outside agencies remains high for AIDS programme funding. We need to look at more in national budget towards AIDS programme allocations. We need to make sure that the dependency rate is reduced to minimum. South Africa is reviewing their programme completely. They increased their national budget for AIDS funding by 30%... because they know they cannot keep providing treatment for people if they rely totally on resources coming from outside the country.
What do you think India has done right in the last decade in managing AIDS?
Leadership plays an important role. The programme with prevention focus was critical. Also, targeting the specific populations where they could have maximum impact, that has been one of the reasons why India is successful. To give more autonomy to the states was good as was the engagement of civil society with the issue. I think in the future it is important to pay more attention to finding a legal framework that can be conducive for a larger population. Also, look after the North-East carefully and... pay serious attention to women’s position in society.