Interview With Stephen Lewis: International Aids Activist
by Am Johal
On the Phone from Nairobi Serena Hotel
This week former UN Stephen Lewis, former UN special envoy for HIV/AIDS in Africa, was invested as Knight Commander of
the Most Dignified Order of Moshoeshoe – a knighthood which is Lesotho’s highest honour.
First of all, congratulations on the honour that you received yesterday in Lesotho. How do you feel about it and what
are some of your reflections now that you have been away from the UN position for the last 9 months?
I don’t think there’s any new revelations about the 5 and a half year that I had that role. I tried to chronicle and
document it in the reports on the country visits at various meetings and gatherings. There was clear evidence of
improvement in terms of anti-retroviral drugs and pediatric drugs for children. There is a continuing focus on
prevention which has been increasingly encouraging over time. But, to be honest, there’s a huge amount left to be done.
There are aspects of that job that continue to prey on the mind. There is too little improvement towards women and their
disproportionate risk to violence and sexual violence from men. Addressing this issue continues to be central to dealing
with the pandemic.
There are also many orphans and that has by no means been responded to in any adequate way. I think that it’s almost
unconscionable. Countries are now trying to implement birthing programs, when it should have happened years ago. Things
moved painfully slowly at the beginning. The failure of the G-8 to respond to the crisis, which only now British Prime
Minister Gordon Brown acknowledges, will hopefully lead to the honouring of their commitments in Gleneagles in 2005.
There are hopes that stir in treatment and prevention. Kenya’s prevalence rate is down to 5.1%. There are empty beds in
some of the hospitals. There is an accelerating rate of treatment. There has been a major dent in the pandemic, but
there is a world left to conquer.
What is the kind of work your foundation is undertaking right now?
The Stephen Lewis Foundation in Canada is engaged in grassroots community projects in Africa with grandmothers, orphans
and we are funding many, many projects.
We are engaging in unusual and inventive work. There has been great solidarity between Canadian grandmothers and African
grandmothers. Other organizations have been instrumental. I honour them and salute them. Global fund money is important
but small organizations on the ground are doing the most interesting work. The large organizations are doing invaluable
work, but they rarely get to the ground.
I am still moved by the resilience and strength of communities, the sophistication and intelligence at the grassroots.
In the aftermath of the pandemic, we must continue to do the advocacy. A small team is creating an AIDS-free world. We
need to now take a strong focus on women and disabled persons which has been neglected and an opportunity to get some
money to the grassroots advocacy of these activities so the issues can be adequately articulated.
What are your thoughts about the International Narcotics Control Board’s positioning related to HIV/AIDS and harm
reduction? Could you talk about what happened after the Toronto speech where you spoke about Insite, North America’s
only supervised injection site, last year?
The INCB is a highly problematic organization which should be challenged on every front. It should be fought at every
level and the UN agencies should publicly stand up to their agenda which is ultimately dangerous.
Harm reduction is a viable health intervention – the INCB’s position, on the other hand, is abominably indefensibly
given that they continue to depreciate harm reduction. It is morally problematic what they are doing.
They shouldn’t act like a branch plant of American drug policy and what worries me is that the Government of Canada
could close down the Insite facility (safe injection facility) if they don’t sign the exemption at the end of this year.
Drug addicts are desperately in need of help and support and are open to further infection if they can’t access health
services. It is the height of irresponsibility and to make Canadian drug policy a mirror of American drug policy doesn’t
make sense – it would really be a step backwards and the INCB fuels that paranoia.
I don’t have much friendly feelings towards them to say the least. When I spoke in Canada, in support of harm reduction
and having alternatives available such as Insite, the Executive Director of the INCB called me up the next day and said,
“Don’t you know that places like Insite are opium dens?”
I’ve been to Insite - it’s absolutely the appropriate way to deal with this issue in that particular context.
The INCB is a terrible organization, and when it comes to AIDS, it should be placed under intense public scrutiny.
In which way should the INCB be reformed so that it realistically acknowledges harm reduction and what would be your
message to the Harper government regarding Insite?
The Harper government should extend the exemption which they’re perfectly entitled to give.
In terms of the INCB, as an organization, it should be open rather than closed. The positions of the various
participants should be known and not kept secret. There may be legitimate issues of drug trafficking, but public reports
should be subject to public scrutiny. It should be open to public exposure. We’re dealing with life and death here.
Drug addicts are not criminals, they are victims. Why should they be subject to the transmission of the virus and be
criminalized? It will result, ultimately, in the prevalence of AIDS.
Is harm reduction being implemented properly in Africa?
Africa is just at the beginning of taking harm reduction measures. There is more injection drug use occurring now. The
virus is overwhelmingly transmitted heterosexually. It is being talked of more widely now.
The International Aids Conference in August 2008 in Mexico will give more focus on harm reduction which is crucial. Harm
reduction must be a central theme – it must not be an afterthought. The world has to awaken.
The spread of HIV/AIDS is a huge risk in Asia. There must be an expansion of harm reduction principles and their
implementation.
For Canada, to now beat a retreat is ridiculous. The INCB is a pawn in the chess game for American drug policy – this is
not acceptable in this age.
What is your view of Canadian foreign policy today in places such as Africa and Afghanistan?
Canada’s unwillingness to set a timetable for investing 0.7% of GDP for foreign aid. This is international delinquency.
We, unfortunately, have a militarization of our foreign policy. The development side of the foreign policy agenda has
been undermined. You won’t achieve anything if you are not doing work in development when there is such a large military
intervention.
Regarding Afghanistan, in early 2009, the situation will be virtually the same as it is today when the current mission
ends. Harper seems to have an interest in Latin America and there has been a shift in emphasis – a terrible mistake in
judgment on purely humanitarian grounds. We are making mistakes based on underestimating what we’re capable of.
The capacity of Canada to trade wouldn’t be accomplished by gutting development dollars. You shouldn’t do one at the
expense of the other.
There is on the development side where there is nowhere near sufficient attention as evidenced by the reduced level of
GDP going to development. We must honour the obligations that the other G8 countries such as Britain, Germany, France
and Italy have set.
Canada is waging a campaign against making poverty history.
We’re losing our place in the world. The dilemma we’re facing in Africa is largely because of a naïve negotiation.
Canada has a disproportionate burden militarily in Afghanistan. We are not sophisticated in the decisions we make.
Under Brian Mulroney, a Conservative Prime Minister, we had a higher rate of foreign aid than any other Prime Minister
when it reached near 0.5% of GDP. Why can’t we set a target to reach 0.7% now?
You have recently been talking about the need for a women’s agency at the UN. Could you explain why this would be
necessary and what it would accomplish?
One of the most crucial factors at this moment in time before the UN General Assembly is to create an agency for women.
I feel strongly the need for this at every front. How can you marginalize 52% of the population and think realistically
about achieving social justice?
An opportunity to create a new agency with an undersecretary general to do targeted work in countries on the ground is
long overdue. Then you could do something about maternal deaths, HIV/AIDS, incredible vulnerability and predisposition
to violence, an agency that advocates for change like UNICEF does for children.
There is a tremendous job ahead. There is sexual violence in Eastern Congo; there is a need to compile the litany of
early alarms and comments that are being made and to document the horror stories that have etched the landscape of
public commentary and how much worse it has to become before we end this war on women.
The international system only deals with this on the occasional press release. Instead of a strong women’s agency, the
issues get lost as only part of the broader violations of human rights. They are without precedent. Soul destroying. We
don’t have an organization to speak about essential human rights components like these. It’s an idea whose time has
come. It is only one of the components. You’ve got to create the agency and give it the support that has been abysmally
denied. There are occurrences of female genital mutilation, international sexual trafficking, we need powerful voices
who feel strongly about these issues to get the resources they need to articulate these issues and push for reform on
the ground. There is no sexual autonomy for women right now. It is very much a major factor in the spread of the virus.
You’ve said that, at the heart of Western ambivalence toward health and human rights in Africa, that racism was at the
heart of it? Have things changed over the years…is the situation just as dire now? Are there things to be optimistic
about?
One of the things that worries me is that there is still some kind of subterranean racism at work. When I try to
describe to about Rwanda when 800,000 people get killed in a genocide and then, a few years later, comes Darfur.
We haven’t been able to protect the basic human rights of people in Africa, but how come it happens in the Balkans, NATO
responds immediately? And there are ambiguous responses to HIV/AIDS and why, when it comes to this continent, there is
no need to engage in an emergency response. This is the equivalent of the Black Death. I don’t think people are
conscious.
This continent is expendable to most political leaders – but it is sophisticated and intelligent at the grassroots.
There is incredible resilience here. They are not asking for neo-colonial responses. They are saying, “give us the
technical support, we will ourselves rout the violence.” The G-8 needs to meet their development goals.
Why are countries not allowing for debt relief; it is unjust given the need for health resources. Even Jeffrey Sachs
says it’s crazy not to provide the dollars when those dollars have been pledged. The current British Prime Minister is
flummoxed. We can’t make promises, the turn them in to pledges and then make them broken promises.
It is embarrassing how appallingly bad the whole thing has become, this issue of promises being dishonored. The
emergence of Gordon Brown in Britain is very significant. This is one of the pivotal moments of hope related to
international support for development in Africa. He cares more about poverty and disease than his predecessor and if the
Democrats win in the US, there could be the possibility of a natural affinity to move on some of these policy matter. It
would be a much happier coalition of principle than what it has been a cynical alliance between Blair and Bush.
Join to that Sarkozy and Merkel in France and Germany, despite their conservatism seem to be genuinely interested in
African development, there may be changes forthcoming - a real change in development and human rights. I foresee that
Brown and a new American President will do much to fix what is happening on the ground.
They must, however, understand the need for a women’s agency within the international system. Brown understands that
2015 is only a few years away from the original millennium development goals, but we are a million miles away. Gordon
Brown has taken a strong stand – it is a complete change in tone and emphasis. This is complete shift in how the G8 will
be seen if they actually act on their commitments.
What are the deficiencies of the international system today?
If I look at the system of multi-lateralism which includes peace and security, development and human rights, I would say
that Secretary-General and Security Council place to great an emphasis on the area of peace and security, to the
detriment of development and human rights. They simply don’t get enough attention.
We need to make certain, individual agencies perform as they should and are intended to be doing. We need to ensure that
the tremendous contribution they make is actually felt on the ground.
Multi-lateralism is not performing as well as it can on the development side. We need to move more forcefully in
improving the lot of humankind. We need to keep hammering away at the Millenium Development goals.
I’ve always been an apologist for the UN, and have always believed that it could make a huge and profound difference.
But its constant plodding and misdirection can make people cynical, but one of the elements to keep it in check comes
from civil society – a role that is desperately needed.
Civil society should not write polite letters and engage in diplomatic games, but should take on institutions directly.
It should be insistent and uncompromising. Without civil society, we would not have brought the South African government
to acknowledge the HIV/AIDS crisis.
Civil society is absolutely more vital than it has ever been. The world is on the knife’s edge. The tremors of climate
change are terribly disconcerting unless there are profound changes brought about by civil society. 30,000 kids that die
every day from preventable causes.
Civil society has to root out the problems and bring intelligence to bear on the great international debates. With a
strong civil society, governments must shift their public policies. We are ushering in a terrible area, where we will
inherit the whirlwind of disease, poverty, war and climate change. There is no excuse in the world on why we should sit
back.
How can we afford to fight wars in Afganistan and Iraq and not invest in development? Our priorities are twisted and are
out of whack.
Would you ever run for politics again in Canada?
I am going to continue advocacy on the AIDS portfolio. I was in politics for 15 or16 years in Ontario - it is sufficient
penance in an individual’s life. I honour the process and I am a lifelong social democrat, but I am not interested in a
return to politics.
Any thing else?
As tough as the AIDS struggle has been, as slow as the progress feels, it’s important that we don’t lose sight of the
end game. We need more and more funding, we need to make male circumcision more widely available and respond to these
vexing problems creatively. Every day we lose lives. We can’t lose our willingness to confront the pandemic. Every
government needs to know this. I recently met with the Minister of Health in Kenya and in Lesotho – I know how hard they
are struggling. They need encouragement and support rather than dismissiveness and passivity from international leaders.
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