Remarks by Kul Chandra Gautam·
at UNAIDS Regional Management Meeting
Bangkok, 27 October 2014
It is a tremendous honour to follow the brilliant presentation by Professor Praphan Phanuphak, and to precede my good friend and the dynamic head of UNAIDS, Michel Sidibe.
I have been a bit out of touch with latest developments in HIV/AIDS since my retirement from the UN seven years ago. So, I want to thank UNAIDS for this wonderful opportunity to refresh my memory and update my knowledge of the status of HIV/AIDS in the world.
In the Nepali language, there is an expression that says: “Don’t light a candle when there is bright sun shine”. That expression is used to caution people with limited knowledge, not to pontificate in front of people who are much more knowledgeable than you are.
Everyone at this meeting is far more knowledgeable about HIV/AIDS and UNAIDS than I am. So I am not going to speak much about HIV/AIDS as such, and make a fool of myself.
Instead, please allow me to share some thoughts on lessons learned from UNICEF’s experience in pursuing some ambitious goals for child survival and development in the 1980s and 90s, that might be helpful in shaping an implementation strategy for HIV/AIDS in the post-2015 development agenda.
In my remarks, I will share with you some anecdotes of my association with people and events dealing with HIV/AIDS and UNAIDS that have made a deep impression on me, and a huge impact on containing this pandemic.
Let me start by sharing with you my impression of a handsome, tall, and a little shy, Program Officer at UNICEF Headquarters in New York in the early 1990s when I was the Director of its Program Division.
When this young Program Officer came to see me first, he started by apologizing that his English was not very good; that he had just come to New York from Zaire – which is now known as the Democratic Republic of the Congo – where he had been a UNICEF project officer for immunization.
He said that he was still struggling to adapt to a large Headquarters office in a basically English-speaking environment. He asked for my understanding, support and guidance to enable him to better support about a dozen countries in Francophone Africa to implement UNICEF’s global policies, especially the ambitious goals for children and development adopted by the historic 1990 World Summit for Children.
I told this young man not to be too self-conscious about his English, but to work at improving it. I said that English was not my mother tongue either, and that for most professional at UNICEF’s Program Division, English was our second or third language, anyway.
I asked him to focus on the substance of UNICEF’s work – on child survival, development and protection, and broader social policy advocacy. I reminded him that our boss, Jim Grant, accorded very high priority to Africa. And we all wanted to see some success stories coming out of sub-Saharan Africa.
The young Program Officer smiled and said that his ambition and passion were also to see at least some African countries succeed and shine in promoting child survival; and that he was optimistic and enthusiastic about the prospects.
I noticed a certain twinkle in the eyes of this Program Officer, which made me feel that this man had the potential to be a high achiever and a leader. Later that day, I told his direct supervisor, the Chief of Africa Section in my department, to nurture this young professional. I specifically asked him not to limit this man’s job to just dealing with French-speaking countries, but to add in his portfolio a few English speaking countries as well, to help him hone his English.
This young man did quite well as Program Officer at our Headquarters, and later we arranged for him to be assigned as head of UNICEF office in several English speaking countries, including Swaziland and Uganda.
I am so glad and proud that that young Program Officer is the dynamic Executive Director of UNAIDS today.
The leadership that Michel Sidibe is providing to UNAIDS reminds me of Jim Grant – whom both of us admired immensely.
For those of you in the audience who did not know Jim Grant, let me say this:
Grant was the Executive Director of UNICEF from 1980 to 1995. He was a visionary leader with a missionary zeal. His faith in human capacity for doing good was so profound that he saw a silver lining in every dark cloud.
He was a man of holistic vision who was very aware of the great complexities of development issues. But he was a great master at simplifying complex issues until they became easily understandable and readily doable.
A few of his close colleagues, including yours truly, compiled this book “Jim Grant: UNICEF Visionary” that highlights his personality, vision and contribution. But let me share with you a single quotation that best captures Jim Grant’s genius and contribution from someone who never met him personally.
The New York Times columnist, Nicholas Kristof, had this to say: “…the late James P. Grant, a little-known American aid worker who headed UNICEF from 1980 to 1995 and launched the child survival revolution with vaccinations and diarrhea treatments, probably saved more lives than were destroyed by Hitler, Mao and Stalin combined”.
Under Jim Grant’s leadership UNICEF led a child survival and development campaign in the 1980s and 90s with impressive results. 40,000 children used to die every day in 1980. That number came down to 30,000 a decade later, and 20,00 in the next decade.
Thus, the lives of nearly 7 million children were saved annually, thanks to the spectacular increase in childhood immunization from less than 20 percent to nearly 80 percent, and similar rise in oral rehydration therapy and other child survival interventions.
Cumulatively, it was estimated that the child survival and development revolution that UNICEF spearheaded during Jim Grant’s tenure saved the lives of some 25 million children, and protected the health and well-being of millions more.
Besides saving lives, the child survival and development campaign led to improved health and nutrition, enhanced learning and earning capacity of millions of children, meaningful empowerment of women, and protection of children from all kinds of risks, including HIV/AIDS.
Most importantly, UNICEF’s focused and action-oriented advocacy of child survival and development led to elevating the well-being of children high on the world’s development and political agenda.
Indeed, many of today’s UN Millennium Development Goals (MDGs), were inspired by the goals of the World Summit for Children, and hence they focus heavily on the survival and development of women and children.
Among the MDG’s, the focus on child survival as the cutting edge of primary health care has been so successful that reduction of under-5 mortality – MDG-4 – is probably the most successful of all MDGs.
What strategies did Grant and UNICEF employ to help achieve such remarkable results? And what lessons can be learned from his approach to the issue that is close to all of our hearts – HIV/AIDS?
Now, some would argue that Grant was a one-of-a-kind phenomenon, and he lived in very different times than what we face in our world today. So, perhaps the approaches he followed may not be applicable today.
Of course, the world has changed a lot and we must adapt our strategies to the changing times. But in terms of some core human values, how we reach and touch people’s minds and hearts, and inculcate behaviour change, some approaches are timeless, or as they say, plus ca change, plus c’est la meme chose.
Indeed, many of the strategies Jim Grant used, are being applied today in many countries, communities and organizations throughout the world, with good results.
I attempted to summarize those strategies in this book in an essay entitled: “The Ten Commandments of Jim Grant’s leadership for development”.
I happen to believe that most of those strategies, with due adaptation, can be quite effective in pursuit of the post-2015 sustainable development goals, including our overarching goal of “Ending the epidemic of HIV/AIDS by 2030”.
Borrowing from Grant’s approach, here are the ten strategies I propose:
# 1. Articulate your vision for ending HIV/AIDS in terms of inspiring and measurable goals: Grant believed in the mobilizing power of measurable goals. Fuzzily formulated general aims of development tend to be a prescription for symbolic action that do not foster accountability for results. Broad development goals such as “Sustainable Development” or “Health for All” or “Education for All” or even “Ending AIDS by 2030” describe what is desirable, but do not show us a roadmap for how to get there.
Such broad aims need to be translated into more concrete goals and targets that are time-bound, measurable and for which leaders at different levels can be held accountable.
I was happy to see, how Michel articulated his vision for ending AIDS by 2030 at the recent 20th International AIDS Conference in Melbourne: “…voluntary testing and treatment reaching everyone, everywhere; each person living with HIV reaching viral suppression; no one dying from an AIDS-related illness or being born with HIV; and people with HIV living with dignity, protected by laws and free to move and live anywhere in the world.”
Elsewhere, I have noted this goal being expressed even more memorably as: “achieving zero new HIV infections, zero discrimination, and zero AIDS-related deaths”.
I am happy to note that this formulation was endorsed by the ASEAN countries, and by the African Union. At the global level, I understand that the UNAIDS PCB, the UN ECOSOC, and other inter-governmental bodies have also endorsed the “Getting to Zero” goals. So, there seems to be some ownership and a momentum towards adopting these goals.
I must say I am, frankly, very worried about the post-2015 SDG agenda as it is evolving, because it is getting so crowded with so many desirable things under the sun, without any serious consideration of what is actually achievable, affordable, and sustainable.
When we formulated the goals for children in 1990, and the Millennium Development Goals in 2000, we were not trying to be comprehensive and all-inclusive, but rather we were deliberately selective in choosing a limited number of goals that the international community would put its weight and resources behind.
Many other desirable development outcomes were not included in the MDGs, although the Millennium Declaration referred to them to encourage Member States to pursue as they saw fit, in addition to the MDGs.
At the time of the Summit for Children in 1990, we had a big debate within UNICEF on what to include, and what not to include, among the many desirable goals for the well-being of children. There were many constituencies which wanted to ensure that the issues they care most about figured prominently in the Summit outcome document.
Many NGOs, for example, would have liked to see a stronger commitment to a long list of child protection issues with specific goals and targets to be endorsed by the Summit.
Some of us wanted to see specific targeted goals on HIV/AIDS which was becoming a huge issue, especially in Africa, and some parts of Asia, including here in Thailand.
But Jim Grant did not want the Summit for Children to endorse a laundry list of too many desirable goals but for which there were no proven and cost-effective solutions. He wanted us to focus on a smaller number of highly ‘doable’ goals for which we could hold governments accountable and produce demonstrable success.
For example, we knew that HIV/AIDS was emerging as a huge development challenge, but there were not any proven, cost-effective solutions in the late 1980s. There was no vaccine, no anti-retroviral drugs, no intervention really that could be taken to scale to make a major impact. The only thing we knew – which we learned mainly from Thailand – was that condoms worked.
The same was the case with malaria. There were no insecticide impregnated bednets, no artemisinin therapy, no vaccine, or other proven and low-cost solutions that could be taken to scale.
So, the approach we took was to highlight these issues as deserving priority attention for further research and development of practical solutions, but not to clutter the outcome document with desirable wish-lists as quantifiable goals. To do so, we feared, would inadvertently undermine the already proven, cost-effective and doable goals.
But when effective approaches to tackling HIV/AIDS emerged in the course of the 1990s, including Nevirapine, other ARVs, better knowledge of prevention and protection measures, UNICEF threw its full weight behind HIV/AIDS.
By 2002, when we organized the second World Summit for Children – known as the UN General Assembly’s Special Session on Children, HIV/AIDS figured so prominently that it was listed as one of the four overarching goals for children, with nearly a dozen bold, measurable goals and targets, and a strong call to action and significant resource allocation.
This brings me to the 2nd key strategy:
# 2. Break down HIV/AIDS goals into specific, time-bound, “doable” targets: Even concrete national (or international) goals need to be translated into specific actions that can be taken at the sub-national, community or family level. Often this means setting proxy goals and intermediate targets. Sometimes it requires subsidiary goals to mobilize ways and means to create a conducive environment for achieving the larger impact goal.
An example of this would be Michel’s call, endorsed by UNAIDS PCB, for: 90-90-90 by 2020. I like the ring of that: 90 % of people tested, 90% of those on treatment, and 90% of them with suppressed viral loads by 2020.
If we are to achieve the goal of “ending AIDS by 2030”, we will need more such intermediate goals to be achieved by 2020 and 2025. Otherwise, my friends, most of us will be retired, some of us will be in heaven, and no one will be held accountable for success in 2030.
Indeed, even these intermediate targets should be further broken down to actionable propositions within the time-frame of today’s political leadership, at the national and sub-national levels, before the next election or change of government.
Time-bound, measurable goals and targets can be very powerful means for mobilizing action and resources, for ensuring accountability, and enhancing the efficiency and effectiveness of service delivery systems.
But a goal-oriented approach also has its downside. Sometimes, it can lead to too much attention on the end results, and neglect of participatory processes. It can distort priorities by emphasizing the measurable versus the truly important. It can lead to imposition of national or even global goals on reluctant local communities. And it can corrupt the development process by giving disproportionate attention to programmes for which funding is readily available from governments and donors.
We have seen many examples of such distortion in the case of AIDS, malaria and TB.
I recall the case of Burma/Myanmar when the Global Fund first allocated some funds. As Burma’s military regime was under international sanctions, donors, including most UN agencies, were discouraged and even prohibited from channeling funds through the government. So a parallel NGO channel was established to administer donor funds.
Other than a small cell of some capable medical doctors in the Government’s Ministry of Health dealing with malaria, TB and AIDS, Burma had an acute shortage of trained and qualified manpower. So, when the donors established a parallel NGO structure to administer the Global Fund grant, practically all experienced government doctors deserted their posts and moved over to the parallel structure. Thus, instead of building national government capacity, donor support actually destroyed it.
We must guard against such unintended consequences when donor-backed, goal-oriented projects are pursued with pressure for quick disbursement of funds to show good implementation record. We must be prudent in the selection and adaptation of goals and targets that help build national capacity, and empower local communities. We must craft goals that inspire people, and are ambitious, but achievable.
The 1980s were known as the “lost decade” for development, particularly in Africa and Latin America. I can tell you that the situation then was much more difficult than the challenging times we face today. Even in those dark days, Jim Grant led a movement that brought about a child survival revolution against great odds.
It showed that under creative and dynamic leadership, and with clear goals and strategies, the United Nations system can make a great difference. And I can see that happening in combating HIV/AIDS in the coming decade under the leadership of all of you with your Captain Michel Sidibe leading the charge.
# 3. Demystify Techniques and Technologies: Many development programmes are expressed in such technical terms as to be understood only by specialists. For any programme to develop a large following and public support, it is vital to communicate the required actions and techniques in the simplest possible terms.
Presented or demonstrated in ways that voters and politicians can understand, large-scale actions develop their own constituencies of concerned citizens and activists. The ubiquitous ORS packet that Jim Grant always carried and waved, and how he encouraged Presidents, Prime Ministers, Governors and Mayors to personally administer polio vaccine or test iodized salt, left a lasting impression, and led to major changes in policy and resource allocation for these catalytic interventions for child survival.
I see Michel Sidibe being a similar masterful communicator and advocate. The story of how he persuaded President Jacob Zuma of South Africa to join him to take HIV/AIDS test publicly, and to reverse the obscurantist policies of his predecessor, Thabo Mbeki, has now become a legend. How he persuaded South Africa’s traditional Zulu King to resume the practice of male circumcision which his ancestor had banned a century earlier, is another impressive story.
As the Huffington Post remarked, this guy, born with his umbilical cord around his neck, is a charmer who lives up to his childhood nickname of the “Fooler of Death”.
In the fight against HIV/AIDS, we have many other charmers and we need more. One great charmer here in Thailand is Khun Meechai Viravaidya of the “Cabbage and Condom” reputation. He has probably done more to combat HIV/AIDS and other sexually transmitted diseases in Thailand and beyond than any medical specialist.
Behaviour change is undoubtedly the most important action to prevent HIV/AIDS. Effective and empathetic communication to demystify the causes and consequences of this disease is vital, especially, to encourage young people to take responsibility to protect their health.
# 4. Generate and Sustain Political Commitment: Quite often, social development programmes are the domains of weak and underfunded ministries that are vulnerable to budget cuts in times of austerity. Securing commitment of top political leadership, at national as well as provincial and local levels, and the buy-in of departments that control resource allocation is vital. Once secured, political commitment must be sustained, and re-secured whenever there is a change in government leadership.
Fostering a national consensus on goals like the prevention and treatment of HIV/AIDS, helps ensure that such goals do not become vulnerable to periodic changes in political leadership.
Jim Grant was able to mobilize the political commitment of a wide spectrum of leaders, democrats and dictators alike, for the well-being of children. The convening of the World Summit for Children, the largest gathering of world leaders in history until that time was a pinnacle of his achievement that has left a lasting legacy.
In the field of HIV/AIDS we have been extra-ordinarily lucky to have a galaxy of great leaders who have helped generate and sustain great political commitment and generous financial support.
Thanks to leaders like Gro Harlem Brundtland, Kofi Annan, Nelson Mandela, Bill Gates, Bill Clinton, Peter Piot, Richard Feacham, Bono, Khun Anand Panyarachun here in Thailand, and many others, HIV/AIDS has received far more publicity and resources than perhaps any other disease or development program in recent times.
But we are beginning to see signs of some fatigue and slackening of support in recent years. Here in the Asia Pacific region, while there has been increasing domestic investment on the AIDS response – most countries – other than China, Thailand, and Malaysia – rely on external donors for over 50% of their AIDS funding. In several countries, including Nepal, Cambodia, and Bangladesh, over 90% of investment in AIDS is from external sources.
This region needs to spend an estimated US$3.5 billion annually to achieve the targets of reducing HIV incidence and AIDS-related deaths, for virtual elimination of mother-to-child transmission, and to reduce the heavy disease burden among the key affected populations of men having sex with men, sex workers, drug users, migrant workers, prisoners, etc not to discount the still huge challenge of PMTCT.
But under current scenario, the funding gap for an adequate AIDS response is of the order of US$1.4 billion annually. This will be further exacerbated by the trend in flattening or declines in international funding. To meet the challenges of this funding gap, countries will need to find new and innovative sources of funding priority interventions.
To make matters worse, the high level of political commitment that was generated in the last decade, is gradually waning. National HIV/AIDS coordinating bodies earlier headed by Presidents and Prime Ministers are being downgraded. High-level multi-sectoral, inter-ministerial bodies are becoming dysfunctional. Even Health Ministries are downgrading HIV/AIDS response from full-fledged departments to lower level units, as we saw in India recently.
Thus we have our work cut out for us to cultivate strong and enduring partnership for HIV/AIDS. This will be even more challenging because of the proliferation of many other competing goals in the post-2015 development agenda.
# 5. Mobilize a Grand Alliance of All Social Forces: Even the best run Government ministries and departments cannot reach all people and help bring about the desired behavioural changes on a large scale. But with today’s information and communications capacity, it is possible to mobilize a vast array of actors into a “grand alliance” involving the media and academia, the NGOs and faith-based organizations, private marketing channels and public policy forums, in a campaign to end HIV/AIDS as a public health challenge.
We have seen great success in mobilizing many actors, pastors, politicians, philanthropists and celebrities in support of HIV/AIDS in the past two decades. But recently, we are beginning to see the HIV/AIDS movement becoming a victim of its own success. Because of the involvement of many celebrities, HIV/AIDS is seen as a “glamourous” disease. Many people struggling to get attention for other neglected diseases resent the aggressive advocacy for HIV/AIDS as deserving exceptional treatment.
Decision makers who have to allocate scarce budget among competing priorities resent the pressure for allocating what they see as disproportionately high amounts for HIV/AIDS for relatively small number of poor people involved, compared to other diseases and health issues with more cost-effective measures.
I know, we have here representatives of gays/MSM, sex workers, drug users, etc. whom we see as important partners without whose involvement the AIDS epidemic cannot be tackled. But let us be honest, in most of our societies, these groups are not viewed with empathy or sympathy, not to mention solidarity.
In many HIV/AIDS conferences, vocal and sometimes militant activists representing these groups are seen as demanding their “rights”, supported by organizations like UNAIDS. This does not go down well with not only conservatives but many ordinary people who do not view such activists and advocates with sympathy or empathy, but deride them as social deviants.
Most of us here, I presume, are strong believers in the rights-based approach to development. So discrimination of any kind is offensive to us. But let us be aware that rights-based approach generally appeals more to people’s head than to their heart.
Just imagine in our own personal lives, what would melt your heart more – your little child coming to you with a list of demands for the fulfillment of his or her rights, or your own spontaneous feeling of the little child’s need for your tender loving care and protection from adversities?
Really effective development programmes must win both people’s hearts and their minds. Those of us involved in the HIV/AIDS work must be extra sensitive that our advocacy is not overly militant and self-righteous, as we try to build bridges of solidarity with advocates of other health and development priorities.
We need to show greater humility, and recognize that the period of AIDS “exceptionalism” is no longer so tenable. We need to be more innovative and persuasive in presenting our case for additional investment in HIV/AIDS as a matter of common sense, cost-effectiveness and solidarity, not seeking special favours, extra entitlements, or “exceptional treatment” because we feel or claim to be more deserving than others.
# 6. Go to Scale: The development landscape of the world is littered with pilot studies and demonstration projects. Few such projects attempt to take action on a scale commensurate with the problems they are trying to tackle. Jim Grant taught us the mantra of “going to scale”, and always striving for ways to craft programmes with the potential for large-scale replication and nationwide impact.
Among various public health initiatives of our times, the campaign against HIV/AIDS has actually been more successful than many others in its ambition to trigger action that is commensurate with the scale of the problem. Globally, the AIDS response has averted 10 million new infections since 2002, and prevented more than 7 million deaths. Today, almost 14 million people are on life-saving HIV treatment. This is a remarkable achievement.
The Asia Pacific region too has made significant progress over the last 15 years. Prevention efforts have resulted in a 26% reduction in new infections since 2001. There has been a huge decrease in AIDS-related deaths due to expanding access to effective treatment. However, many countries continue to experience growing epidemic among the key population groups in localized geographical areas.
In the early years of the AIDS epidemic, many countries of this region demonstrated strong political leadership and innovation. But there has been a sense of complacency and stagnation in recent years.
This region lags behind others in several areas. It is sad and ironic that we have one of the lowest ARV treatment coverage in the world – of only 33% of those living with HIV/AIDS – although this region accounts for nearly 90% of the generic ARV supply to the world.
I feel especially sad that we have not made greater progress on PMTCT in this region. At least in that area there should be no controversy, but only solidarity. I think we should feel collectively ashamed of this situation. Is UNICEF playing a leadership role in this area these days? This calls for more self-critical introspection by all of us.
Less than a third of people with AIDS know their HIV status in this region. This is another statistics of shame. Combating the high level of stigma and discrimination, and pursuing the 90-90-90 approach with greater vigour and innovation is a real test for all of us.
Currently, an estimated 4.8 million people are living with HIV in the Asia Pacific region, most of them in India, China, Indonesia, Thailand, Viet Nam, and Myanmar. I trust that these six countries – that account for over 90% of the epidemic and 90% of new infections are really given not just regional but global priority by UNAIDS, even as we scale-up appropriate interventions in other countries of the region.
# 7. Select Your Priorities and Stick to Them: Many development agencies and programmes attempt to do too many things, often in a mediocre manner, rather than doing a few important things, and doing them well. Jim Grant had the reputation of selecting just a few high impact priorities and sticking to them, even at the risk of being accused of being mono-focal and tunnel-visioned.
Given his very broad perspective on development, Grant could have taken the easy path of doing many miscellaneous good things for children in a “small is beautiful” scale. That would have satisfied a larger number of constituencies clamouring for UNICEF’s attention. But it would probably have left a legacy of great underachievement, which is a sad characteristic of many U.N. agencies.
In the case of HIV/AIDS, there is, of course, room for many useful, small-scale community action by local NGOs, church groups and others. However, organizations like UNAIDS, Global Fund, PEPFAR, etc. need to set their sights on actions that have large scale coverage.
As a coordinating mechanism for 11 UN agencies, UNAIDS can play an important role in encouraging these agencies to select a few key interventions in the areas of their mandate and comparative advantage, and make a real impact.
The UNAIDS consolidated guidance note on the division of labour offers a good listing of priorities for the participating agencies. Even within those parameters, it would be worthwhile for the various agencies to pick an area in which they can shine, eschewing the temptation to be involved in many activities.
For example, UNICEF could focus on prevention of mother to child transmission of HIV/AIDS, and AIDS orphans; UNDP on law reform to ensure non-discrimination; perhaps UNFPA could support interventions involving sex education and men having sex with men; the World Bank could focus on financing expansion of social protection measures; WHO on research and development of ARVs and vaccines; ILO could concentrate on sex workers and migrant labourers; and UNODC on injecting drug users; and so forth.
UNAIDS and its partners should also encourage bilateral donors, foundations and large INGOs to select a few priorities and stick with them until good results are achieved.
The amount of resources mobilized globally for HIV/AIDS is considerable. Avoiding scattering of those resources by encouraging various partners to specialize in large-scale provision of service in specific areas of need and opportunity can help us break the back of HIV/AIDS and produce great success stories.
# 8. Institute Public Monitoring and Accountability: The beauty of measurable goals is that progress can be regularly monitored and publicized. But beyond technical expert analysis, monitoring reports should be used to inform the general public, and to accelerate progress or to take corrective actions. Publicizing progress as well as retrogression, by using indicators that the public can understand, is essential to derive maximum benefit from large scale, goal-oriented programmes.
Generating healthy competition by comparing the performance of neighbouring districts or neighbouring countries is often a great catalyst for faster progress. UNICEF used to produce annual reports entitled the “Progress of Nations” with league tables naming, shaming and praising countries at similar levels of income but very dissimilar achievements in terms of child-specific targets of MDGs and the Summit for Children goals.
It is important that indicators used for various targets for “Ending HIV/AIDS by 2030” goal lend themselves to comparative analysis of inputs, coverage, outcomes and impact. Preparing and publicizing such reports to trigger action and healthy competition, would be a valuable contribution of UNAIDS.
# 9. Ensure Relevance to Broader Development Agenda: A corollary to being selective and focused is not to lose sight of how HIV/AIDS relates to the broader context of sustainable development.
I suppose most of us at this meeting think that HIV/AIDS is or ought to be considered one of the most important development priorities of our times. Let me be the devil’s advocate and tell you, frankly, that I disagree. As a development professional, I do not think that HIV/AIDS as such is the most pressing development issue confronting humanity.
There are many other diseases that kill or maim or disempower many more people than HIV/AIDS. Diarrhoea, pneumonia, malaria, etc have been bigger threats to human well-being over centuries or even millennia than HIV/AIDS.
In a historical context, providing universal access to clean water and sanitation, nutrition, basic education; promoting gender equality and women’s empowerment; tackling the issues of climate change and global warming, are of far greater transcendental importance than HIV/AIDS.
HIV/AIDS is a very recent, and hopefully a temporary phenomenon – a sad and horrific blip in human history, like the bubonic plague or the current dreadful threat of the ebola virus.
I make this provocative statement about the relative un-importance of HIV/AIDS deliberately, remembering that some people used to criticize Jim Grant for his obsessive focus on child survival as if it was the only and the most important development challenge in the world.
Some critics asked why focus so much on reducing the quantity of child deaths rather than on the quality of children’s lives? Would not child survival actually lead to population growth and greater misery for children? Is not the real long-term solution to the problems of children, family planning, poverty reduction and economic growth?
These were legitimate questions, just like the questions I raised about the relative importance or lack of importance of HIV/AIDS as a major development priority. Jim Grant’s answer to his detractors was to say that he agreed with them. Yes, all those issues they raised about the importance of family planning, women’s empowerment, poverty reduction, and economic growth were very valid.
Then, he went on to argue how child survival was of critical importance to make lasting progress in all of those important areas.
I do not have the time today to explain Grant’s full rationale for his thesis. But he used the analogy of a “Trojan Horse” to describe child survival as the kingpin of all other developments. I would commend to you a fascinating speech by Grant in which he argued how the achievement of the ambitious goals for children could be the “Trojan Horse” for attacking the citadel of poverty, for undergirding democracy, dramatically slowing population growth and accelerating economic development.
I would say, we need to make a similar argument for HIV/AIDS. Not that HIV/AIDS is the most important development priority by itself, but that skillfully tackling HIV/AIDS will help bring about many socio-economic changes that will be instrumental in achieving other larger and lasting development priorities.
For example, our advocacy for rights-based approach, for non-discrimination, for overcoming unfair stigma, for treating vulnerable people with empathy, compassion and solidarity – these are not only helpful to tackle HIV/AIDS, but for building a world of such human values that promote social justice, human rights, a democratic culture and economic well-being, which are the ultimate goals of all our development efforts. In that sense, HIV/AIDS too can be a “Trojan Horse” to tackle the most complex development issues of our times.
# 10. Unleash the Full Potential of the United Nations System: Jim Grant was a true believer in the principles of the United Nations and its great – if under used – potential for promoting peace and development. He was masterful in exploiting the potential of the UN system: in mobilizing sister agencies to help accelerate action for children, in influencing other agencies’ policies and priorities, in finding common ground and forging solidarity among agencies, and by offering, without being pretentious, a leadership model of vision and action.
I believe that UNAIDS, even more so than UNICEF, has a great opportunity and obligation to harness the power and potential of the UN system to tackle HIV/AIDS. After all, UNAIDS was created precisely for that purpose, bringing together almost a dozen UN agencies and funds and programs.
On behalf of UNICEF, I was fortunate to have had the opportunity to meet and brief Australian Ambassador to the UN Richard Butler who led a working group that helped establish UNAIDS in 1994. Jim Grant was very supportive of the establishment of UNAIDS. But he was very sick towards the end of 1994, and on his behalf, I was involved in interviewing Peter Piot before he was appointed as the first head of UNAIDS.
When I was UNICEF’s Regional Director here in Bangkok in the late 1990s, I had the opportunity to chair a UN inter-agency coordinating mechanism for HIV/AIDS hosted by ESCAP. That is when I first met Steve Kraus, and many Thai leaders and activist dealing with HIV/AIDS.
I know from all of those experiences, and its proven track record, that UNAIDS offers a very good model of harnessing the potential of the UN system to tackle a major development challenge of our times.
Regrettably, today we see much cynicism and pessimism about the work of the UN, and how it has failed to tackle so many issues of war and peace; of terrorism and intolerance; of social injustice and inequity; of poverty and environmental degradation.
Although our nightly news tends to be dominated by stories of such failures, the fact is that the daily lives of three-quarters of humanity are now characterized by unprecedented progress, and success stories of development.
I believe that the fight against HIV/AIDS is a winnable proposition. Ending HIV/AIDS as a public health problem by 2030 is, in my view, eminently doable. If we succeed, or rather, when we succeed, it will be a great triumph for humanity and for the United Nations.
I wish our great leader Michel Sidibe, and all other leaders here under his command, great success in this noble mission.