Exclusive: Interview with UNAids Director on HIV Control and Covid-19 pandemic

How has Covid-19 affected HIV services in Africa?

Even before Covid-19 hit the HIV response in Africa was already off track. Last year, 1.7million people globally were newly infected. That is three times more than the target that had been set. Also, 690,000 people died of Aids-related illness which again is above the target.

More people were placed on treatment but we were failing so much in the area of prevention, young girls and young women were newly infected and had a higher risk than men and boys of the same age particularly in Africa. We had 5,500 adolescents and young women infected every week. This is a global crisis

For Sub-Saharan Africa, the figure stands at 4,500 young women being infected every week, only a few counties including Botswana are hitting the target.

The pandemic is getting us even more off track in the disruption of services. We have fewer people coming forward for testing than we had last year, people living with HIV going without treatment, and on the side of prevention, many countries suspended condom programmes to pay attention to Covid-19.

We could have up to 150,000 more deaths resulted from Aids-related causes and 293,000 new infections.

Lockdown and safety measures mean more HIV-positive people go without services hence increasing their vulnerability.

It's barely a year since the Covid-19 attack and already we have a vaccine, what happened to HIV, almost four decades without a vaccine? What's the problem?

It is because it is not a priority. HIV vaccine has been controlled from the resource-rich countries with HIV/Aids becoming more chronic and a neglected disease in our countries. We have made HIV agenda a business.

We must bring it back to the attention of the whole world to help us cure it or prevent it with a vaccine. We must use the success of Covid-19 to push for the science on HIV. This should tell you that the trials to get the HIV vaccine has been made a business agenda.

The technologies that have been used in getting the Covid-19 vaccine can be used to get a HIV one. We need to start the conversation afresh.

International communities have stopped Aid to African countries as they put stimulus to their economy due to Covid-19 disruptions. What's our way forward?

This is a big problem in Africa. Countries are highly dependent on the kindness of donor countries yet the funders are withdrawing. We need serious and concerted efforts towards self-financing. Donors just give a little for ARV drugs which have been reduced as well.

Kenya has been moving steadily but is still dependent on donors for 60 per cent of the HIV response. This is better than many other countries that are 95 donor-dependent.

We are going to support countries on these. African lose a lot on taxes, we can gain and pull more through digital taxation if countries work together. I was at a fair here in Nairobi where I saw amazing crafts which are sold online, for every dollar they get, someone who is seated abroad gets nine dollars of their money just for opening the platform and no tax comes to Kenya, we lose everything on our products to digital companies abroad.

Africa is one of the continent majorly affected with HIV yet all the drugs that we are using are imported, what are your plans to ensure that ARVs are made available locally?

This is a sad situation we are in. This tells you how dependent we are on our HIV commodities. Even the condom, which our young men are so much in need of are not made in the continent. All our bedroom affairs, sexual and reproductive products are imported. This kind of dependence undermines our sovereignty as a continent.

We must make the common market work and start producing our products.

We have the manufacturing capacity in Africa, we just need to work more towards putting together the resources to produce our medicines. Already South Africa and Kenya are in the process.

One of my agenda in the organisation is to ensure that we promote local manufacturing in the African Union.

Rich countries are buying billions of doses of Covid-19 potential vaccines for their population, however, nothing is going on in African countries, where does this leave the continent?

I have been campaigning for the people's vaccine. I see an opportunity as the vaccine is needed by the whole world. I have been advocating for the producers of the Covid-19 vaccine to share their technology so that every region can produce for themselves. If the technology is shared, then Africa must be able to produce and scale.

African leaders must commit and invest in local production and give access to the whole market, if we don't do that, then we will be the Covid-19 victims of the crisis.

We must put the vulnerable first in all the countries. Rich countries must now consider equitable access to the vaccine.

As the new head of UNAids, what are your priorities in the fight against HIV/Aids?

My priorities are shaped by the voices of the fighters, the communities, the health workers, and the key populations.

In Africa, we must step up to protect adolescent girls and young women from infection and give them access to services and treatment.

The human rights of key populations are lagging. We are making progress while discriminating against and criminalising sex workers and gay people. We are not making any progress in reducing new infections in key populations.

In a night they can infect even ten people, what is the sense of criminalising them and making them afraid of coming for prevention services.

Kenya is doing very well when it comes to the reduction of new HIV infections in adults, but we are forgetting our children population, what can be done differently?

We are letting down our children and they can't speak for themselves. In the past, we have done so well in the prevention of mother-to-child transmission but we have fallen back.

We have also a huge number of children lost to treatment and the technologies are not so friendly to children. Some of the drugs need to be mixed with food yet some parents are so poor that they cannot buy food and they mix the drug with water which corrodes the baby's stomach.

Researchers need to stimulate more innovation for child-friendly treatment and put more effort into preventing mother to child transmissions. We must fight the discrimination and stigma that prevents women from going for services so that they give birth to healthy HIV-free children.

How are African Countries responding to Covid-19 and HIV disruption?

Even before the crisis, more than half of the African countries were at risk of getting into debt distress. Many had moved to a situation where their debt repayment was higher than their health budget.

Kenya has cut its budget by nine per cent in the last three years. The figures are more frightening for Zambia that has now defaulted.

The debt situation of these countries found them in a situation where they lack the resources to respond to the pandemic. And having locked down their economies, the African economy has shrunk by more than three per cent. There is no physical space to respond to HIV and Covid-19 and most of them are struggling.

This is why we are calling for more long time debt relief and debt cancellation for countries.

What do you think should be done for HIV services to remain in place without disruption?

1) We need to go back to the communities, empowering them to fight for themselves they have the solutions.

2) Put human rights at the centre because should we discriminate against them, then they are the same people who continue spreading the virus.

3) Health systems must be available for all at no cost. In about 43 countries in Africa, there are user fees, where one has to pay to get services. It beats logic that even during a pandemic, you have to pay to get the service.