Executive director of UNAids Michel Sidibé tells Rowenna Davis of his hope and fears for the future, and how HIV can be an opportunity
You might expect to meet a man with the weight of the world on his shoulders. As head of the UNAids programme, Michel Sidibé is the international community’s most senior leader in the fight against HIV.
Day in day out, he presides over heartbreaking statistics. Seven million without access to treatment. 1.7 million Aids-related deaths last year. Seven thousand new infections a day. But the thing that strikes you first about Mr Sidibé is his dogged energy and enthusiasm. Surprisingly, he tells me HIV isn’t just problem, it’s also an opportunity.
“I’m an incorrigible optimist,” he says with a laugh. “I will always see the positive side. In Abuja ten years back, I met a man on his deathbed. Today I saw him with three girls working as a peer educator with a wife. He has his reproductive health, he’s a parent and his kids are free of HIV. When I see these things, I keep going.”
Mr Sidibé’s whole life has been about defying the odds. It started when he was a baby. Born with his umbilical cord tied around his neck, he was nicknamed “Trompe la Mort” – fooler of death – for staying alive. The son of a white French Catholic mother and a Muslim politician from Mali, his parents fought through fierce stigma to be together. Changes that people thought were impossible are now taken as given.
People with HIV came out and we gave a voice to the voiceless, showing they could live positively with HIV
He says the same is true with HIV. “The whole story of the fight against HIV is one characterised by going from despair to hope,” says Mr Sidibé. “I remember the days when people were just refusing to acknowledge it, when political leaders were not listening. Try to bring it up and they would say it was a creation of Western forces or start to pass blame – saying it was the disease of sinners.
“Over the years we’ve managed to break that conspiracy of silence. People with HIV came out and we gave a voice to the voiceless, showing they could live positively with HIV. When I joined UNAids 11 years back, there were less than 100,000 people on treatment in Africa, now there are 6.4 million. That’s a major impact.”
Mr Sidibé has good reason to be proud. He’s presided over a reduction in new infections in 33 countries as prevention and treatment programmes have been rolled out. Epidemics have been halted and lives saved as African countries that once refused to acknowledge the problem are now taking action. China and Eastern Europe are following suit. But can it really be right to describe HIV as an “opportunity”?
“It is an opportunity because HIV is not like a classic disease,” he says, “It’s about sensitive issues that give us a chance to have a discussion… for years all over Eastern Europe and Central Asia, for example, young people were injecting drugs and no one was talking about it. It has brought forward debates about minorities and enabled them to come out of the shadows. It’s given people a chance to change their lives and access services. It’s forced health services to improve.”
He believes that the fight against HIV has demonstrated an even bigger lesson. It’s taught us how to come together as a world to fight against odds that seem impossible. “It’s the only disease that has helped create a social movement. In Doha, the public pressure from people meant that we could push for a reduction in the price of medicine. That price has now gone from $15,000 a year to just $850. The HIV movement shows that we can produce results for people.”
But for all his positivity, Mr Sidibé is not blind to the challenges of this fight or the heartwrenching stories of human suffering on the ground. He talks movingly about a young girl who came up to him in Uganda and introduced herself as the daughter of his old driver. The driver had recently died from HIV, her mother followed shortly afterwards and now the girl had dropped out of school to sell tomatoes. He says this experience left him feeling helpless. “I have such an important role, but I couldn’t even stop this death happening in my own office.”
To help more people like the girl’s father, Mr Sidibé knows he has to surmount huge barriers. There might be a stronger global consensus on the need to tackle HIV, but there seems to be deteriorating agreement on who should pay for it. In a time of austerity, budgets are being cut and UNAids now estimates that there is a 30 per cent funding gap to meet world targets. If we are going to continue to make progress, Mr Sidibé says that HIV has to stop being seen as a cost, but as an investment in healthy human life that will help rebuild the economy.
“People are saying that because of the financial crisis we can’t continue the effort, but we need readjustment with a human face. We need to maintain the commitment because we’re producing results… If the funding is removed it will be terrible. The lives of eight million people will be put at risk. People are on funded treatment today and if we stop we are literally killing them.”
But even Mr Sidibé admits that the way we fund HIV programmes is unsustainable. In some parts of Africa, more than 90 per cent of the resources for treatment come straight from the north. Now those budgets are being cut, poorer countries must find new ways to solve their own health problems.
He says African leaders should learn from India, which currently produces 85 per cent of the world’s HIV medicines. He has also called for the development of local health systems, including health insurance, to make sure communities have control over their own security. At a global level, he supports the introduction of a so-called “Robin Hood tax”, which takes a small amount from every financial transaction, to help fund future health programmes.
Convincing global leaders to take actions like these isn’t always easy, particularly when there is still a lingering stigma about HIV. But with his African heritage and charming persona, this is one of Mr Sidibé’s greatest strengths. He has a way of convincing leaders to work with him. One of his most famous acts was to win the support of President Jacob Zuma of South Africa, who went on to announce an increase in his national HIV budget by 30 per cent in 2010.
Mr Sidibé says his trick is to appeal to a leader’s desire for legacy and security. “My experience has taught me that leaders don’t have more than two minutes’ attention. If you’re not capable of showing the benefits in that time, they’ll never be with you… what I’m trying to say to them is that a society without social justice or inclusiveness has a problem because it causes instability.”
This then is the heart of Mr Sidibé’s message. Winning the battle against HIV isn’t just about giving drugs to the sick. It’s also about what kind of society we want to create. Ending the HIV pandemic doesn’t just need more medicine, but greater respect for human rights, more effective health systems and deeper, more stable democracies.
This is impossible to complete alone, but Mr Sidibé feels optimistic about the possibility of working with others around the globe. As he says: “This job I do is the job of all of us, together.”