'UNAIDS will continue to fight to ensure that laws reflect the rights of people'

The solidarity of India's gay, lesbian, bi-sexual and transgender community played a key role in the Delhi High Court's judgement reading down Section 377 of the Indian Penal Code, said Michel Sidibe, Executive Director of the United Nations Joint Programme on HIV/AIDS (UNAIDS)

Mr Sidibe called for the repeal of other punitive laws against sex work and drug use as these were detrimental to implementing the AIDS programme.

Mr Sidibe, who was appointed UNAIDS Executive Director on January 1, 2009, with the rank of under-secretary general of the United Nations, joined UNAIDS in 2001.

In early October,he made his first official visit to India as UNAIDS Executive Director. He met Prime Minister Manmohan Singh, Home Minister P Chidambaran and Finance Minister Pranab Mukherjee to discuss India's progress in achieving universal access to HIV prevention, care and treatment.

Excerpts from an interview with Rashme Sehgal in Delhi:

Michel Sidibe, Executive Director of the United Nations Joint Programme on HIV/AIDS (UNAIDS)

What role does UNAIDS play in supporting India's HIV programme?

I would first like to point out that the primary aim of UNAIDS is to restore the dignity of people. Criminalisation can further marginalise communities who are already at risk of HIV. This undermines our efforts to ensure universal access to HIV prevention, care and support services. That is why the Delhi High Court's judgement on Section 377 of the IPC that criminalised consensual sex between adult men is so important to us.

The rainbow coalition that was formed here is the product of persistence. Following your model, Nepal is now trying to repeal their law. There are 80 countries which continue to criminalise same sex behaviour. By collaborating with civil society as well as other stakeholders, UNAIDS is working towards removing these punitive laws.

We must remove taboos which are not needed. UNAIDS will continue to fight to ensure that laws reflect the rights of people. Vulnerable groups must enjoy the same rights as others. We need to create an environment where people have access to justice.

People most at risk of HIV face five main obstacles: social prejudice, stigma, discrimination, homophobic laws and criminalisation. We need to make the world more inclusive rather than exclusive.

What progress has India made in providing universal access to HIV prevention and treatment?

India has done well but not as well as many of the African countries. India's HIV/ AIDS programme provides 31% of Indians with HIV, access to AIDS treatment, whereas in Mali, from where I come, 80% of the population needing treatment has access to drugs which are being manufactured in India. UNAIDS is pushing for 100% access and this is one of our priority areas.

To achieve this goal, we are working closely with the Indian government and NGOs to ensure wider access. We have also launched a special initiative in eight states in the north-east to ensure better community engagement around HIV issues.

What are UNAIDS' priorities for India?

We have many priorities. For example, I have repeatedly expressed concern for 14 million AIDS orphans who are victims of the pandemic across the globe. These children do not have access to any kind of social security and can become an easy target for ill-intentioned people.

The Indian government needs to take steps to ensure that kids must not be taken out of schools because they are HIV-positive. We need to address the broader issue of stigmatisation. We also need to stop transmission from mother to child. Even if the mother gets infected, we have to ensure the child remains safe and this can only happen if we adopt an integrated response to reproductive health care.

Statistics highlight that in 2008, 4,234,400 pregnant women in India were tested for HIV. This covered 16% of all pregnancies that year. From these, it is estimated around 49,000 women tested positive and should have received ART to prevent transmission of HIV to their children. However, only 10,700 were provided drugs under the Prevention of Mother to Child Transmission programme. This figure needs to be improved.

There have been comments that UN organisations sometimes work at cross purposes. For example, UNIFEM (the UN's development fund for women) opposes UNAIDS in the matter of the Immoral Traffic Prevention Act (ITPA). What is your take on this?

I agree that on the question of gender, we have not been as consultative as we should have been. We are supporting what is being done by other UN agencies. We did spend three years and over one million dollars in trying to narrow down our differences with the other agencies (UNIFEM and the UN Office on Drugs and Crime which supported amendments to ITPA that would criminalise clients of sex workers). My own stand is that we should have enough operational guidelines to get people to move. The fact is that MSM, the trangender community and other criminalised groups want violence against them to end. This point of view must be kept in mind in our consultations.

What has the impact of global recession been on funds for HIV/AIDS programmes in India?

I don't think we should use the pretext of the financial crisis to say that we cannot provide services to the poor. These people are not responsible for the financial crisis. We cannot stop their treatment; we cannot shatter the hopes of 14 million orphans who are waiting for care. It is an obligation that has been placed on politicians who must fix the market and make the economy work better. These children must be provided with proper nutrition and be given access to psycho-social programmes.

Governments need to work towards creating greater social justice. The global financial crisis is a wake-up call for countries. They cannot depend on external assistance for their HIV programmes. The affected countries need to put in their own resources and take over these programmes. I am speaking about countries such as China, India and Thailand.

What has the response of the Indian government been to this situation?

Yesterday, I had a long interaction with parliamentarians. I told them that they must help us to ensure kids are not pushed out of school because they have been found to be HIV-positive. The Minister of Labour, Oscar Fernandes, was the first to discuss this in the context of hospital settings also, because no hospitals can stop accepting HIV-positive patients. This must be taken up at the national level.

Do you have any comment to make about the fact that the HIV bill drafted some years ago is still to be placed before the Indian parliament?

A major hurdle was the repeal of Section 377 of the IPC. Now that this hurdle has been removed, legislation (the HIV bill) can be brought in much faster. But getting a bill passed in Parliament is not enough. We need to take concrete steps in this direction. Health care institutions cannot be discriminatory. It is not acceptable.

Education is central to our programme. If we don't integrate sex education in all our messages, we will not be able to move forward. Having laws is one thing, changing attitudes is another.

What proportion of funding for India's AIDS programme is externally funded? Where is this funding from? The UNAIDS report has expressed concern about the "cost-effectiveness and sustainability of HIV interventions that are donor dependent, for example free treatment, special HIV link workers and financial support for PLHIV." Any comment?

I do not have the time to go into specifics. All I would like to emphasise is that while our policies and strategies are well defined, targets linked to our objectives will help lead to better allocation of resources.

Resources from outside can only be a complement to our own resources to ensure we have a sustainable programme. I have spoken to a cross section of leaders, including your finance minister, to explain that investment in health is not a cost but a means of development. This can happen only with political leaderships.

This brings us back to issues of social leadership. To fight the battle against AIDS, we are looking at a budget of $2.5 billion. But all this can happen only if there is a better integration between policies and health and people who need treatment. Excellent services can help them expand programmes, but we need to make sure that people at the grassroots level, for example sex workers, are equipped with enough information to protect themselves and be part of the process that can integrate them in larger social change.

I am a political broker. My job is to identify issues and create a space that can combine different players in order to create an agenda for change.

InfoChange News & Features, October 2009