Waiting for a breakthrough — An interview with Stephen Lewis

Stephen Lewis 

tephen Lewis is the Special Envoy to the United Nations (UN) for HIV/AIDS in Africa. He has served in this capacity for four years and has become an unwavering voice in the battle for women's rights and the development of new prevention technologies like AIDS vaccines and microbicides that could help to slow or end the pandemic. Lewis, a Canadian citizen, lives in Toronto and reports to the UN headquarters in New York. His humanitarian efforts and outstanding skills as a speaker have earned him numerous honors. Earlier this year he was named one of the world's one hundred most influential people by US-based TIME magazine. 
Prior to his role as envoy, Lewis was the deputy executive director of the UN Children's Fund (UNICEF) and was the Canadian Ambassador to the UN. Lewis spent the early part of his career entrenched in national politics and was a former leader of the New Democratic Party in Ontario, Canada. At 67, Lewis shows no signs of slowing—he travels almost constantly. His wife, a feminist writer from Canada, can barely remember his whereabouts on a daily basis. VAX Science Writer Kristen Jill Kresge recently spoke with Lewis about the current situation with AIDS in Africa and what new initiatives he thinks may help halt the epidemic's unchecked spread there.

As envoy for HIV/AIDS in Africa, you are reporting directly to the Secretary General on an entire continent's epidemic. How do you accomplish this and what do see as your main activities as UN envoy?

The primary activities of my job are to visit African countries, meet with the political leadership, meet with groups of people living with AIDS, and spend time seeing projects in the field. I've always seen these last two activities as critical so that I can see how the diplomatic community can be of greater use. When I come back to New York I hold a media briefing so that the international media has a sense of what I have found. Then I meet with the Secretary General and discuss with him what I've seen and together we discuss how that might influence the way in which he, and the UN more generally, responds.

In the process I have come to understand that advocacy is also a very important component of the envoy role. I've therefore spent a great deal of time speaking around the world at conferences and meetings in order to convey what is happening in Africa and why it is so desperately important for the world to respond.

How has the response to the AIDS epidemic in Africa changed in your four years as envoy?

That's a difficult question. I think that the sense of hope at this moment in time is more alive than at any time during the previous four years. The tremendous efforts by the World Health Organization to put millions of people on treatment and the evidence, although very slight, of increased resources has made people feel glimmers of hope in the midst of pervasive anguish. This pandemic has been going on for over 20 years and we are only now, literally at this moment in time, beginning to come to grips with it. Unfortunately on the ground things are as painful as they've always been because people are dying in such vast numbers.

How has your attitude changed during your tenure as envoy? Do you find it difficult not to get discouraged?

When I started as envoy I was swamped with despair. Now I live in a perpetual rage. I feel an even greater sense of urgency four years into it. At first I heard all these numbers about the situation in Africa and I was lost in the data. Now when I travel I just want to save individual lives. Instead of getting discouraged I get angry because when you are surrounded by death you can't get over it.

AIDS is now disproportionately affecting women. What is the situation like in Africa?

I feel more deeply now than I ever did before that the vulnerability of women is possibly the most terrifying component of the pandemic and about which the world is doing almost nothing. This is true in Africa, as well as in other regions of the world. The women are the core of the society—they do the farming, they carry the burden of care—yet they are really under siege. The disproportionate number of infections is huge and women are suffering so extensively.

Is there any progress towards building a women's movement in Africa?

I see very little change on the ground. There is little progress in building a legal infrastructure and getting laws in place to protect the property and inheritance rights of women. We need the toughest laws imaginable against sexual violence and marital rape, and we need ways to enforce them. But I just can't get over how slowly this is happening. What we have is an absolute vindication of the feminist analysis: when you're dealing with the inability of men to relinquish power and authority, then you are in real trouble.

So what do you think can be done to alter the course of the epidemic in women?

I've come to the conclusion that we must have an international women's agency rooted in the UN. There is a United Nations Fund for Women (UNIFEM) and it has a budget of around US$20 million a year for the whole world. In comparison, UNICEF has a budget of over $1 billion and the United Nations Development Program (UNDP) has a budget of nearly $2 billion. So more than half of the world's population gets a pittance of support from within the UN system. This is not the fault of the UN; it's the fault of the member states. And maybe you could get away with that until the dramatic expansion of the pandemic in women, but now there must be an international agency for women. This is the single most important reform that could happen within the UN as far as I'm concerned. UNAIDS (the Joint United Nations Programme on HIV/AIDS) must also take on AIDS as a women's issue as though there were no tomorrow, because for the women of Africa, there is no tomorrow.

Research into new preventive technologies like AIDS vaccines and microbicides is seen as a critical way for women to become empowered and be able to protect themselves from HIV infection. Do you think there is enough political action into the search for an AIDS vaccine?

I remember the first time I met Seth Berkley of the International AIDS Vaccine Initiative (IAVI). He said to me the most obvious thing in the world—a vaccine is the ultimate answer. It's really strange that we don't integrate that into absolutely everything we say and do because it is the ultimate answer for women, and for everyone. But this urgency has not gripped everyone yet, and we're still not putting enough money, or energy, into it.

Do you think this might change with the initiatives that have recently been announced, including the upcoming meeting of the G8 nations in Scotland?

I think the British are very much engaged in vaccines but I don't know whether we're going to be able to convert the G8 summit into something that can confront the pandemic in a serious way. If they cancel the debt and raise a good deal of money from Europe then it will be an excellent meeting. But it won't be the dramatic turn-around everyone hopes for unless the US makes a dramatic shift in the amount of foreign aid.

The UN general assembly recently held its special session on HIV/AIDS in New York. Were AIDS vaccines or microbicides high on the agenda? Was there discussion on the pressing needs of women?

I sat in on the "so-called" session on gender and AIDS and there was no meaning to that meeting, and I don't care who is offended by that. There was nothing in that meeting that would galvanize a response by governments to what is happening to women. This is symptomatic of what's happening—we're not responding.

In the materials on prevention produced for the meeting there was absolutely no mention about AIDS vaccines or microbicides. How is it humanly possible that the people who are responsible for setting out the details on prevention forget these important technologies? It just isn't rooted in the minds of those who have to respond.

I hope that vaccines and microbicides will receive a boost at the G8 meeting and that there will be a new sense that we haven't done enough and we had better do it now. We have to fight like hell on both fronts simultaneously.

You have become such a strong voice for women's rights that I wonder how your wife has influenced your work.

My wife, Michele Landsberg, has been one of the strongest feminist voices in print in Canada for a quarter of a century and the feminist analysis has very much become part of my own ideology because of her influence. She's been an absolutely extraordinary and uncompromising voice and she has shaped me. The power and force of her ideas has been unquestionably the greatest influence on my life. I also inherited a lot from family, of course, and was deeply engaged in politics for a while, but in terms of what I think is and isn't important in this world, the benchmark for me has been my wife.

How do you get the world to realize the consequences of this pandemic and mount a suitable response?

You have to keep at it relentlessly by driving home your arguments, trying to persuade people, and never allowing your voice to be silenced. We know that we can save lives because we have generic antiretroviral drugs at a low enough cost that they should be available to everyone. But even though treatment is now being rolled out it's happening too slow, too late, and too incrementally. That drives me crazy. The criminal negligence on the part of the Western world has lasted for so long that we'll never be able to compensate for the deaths that have occurred. But you have to continue fighting, and one day, unexpectedly, you break through. That's what I'm waiting for.