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PENELOPE WENSLEY: This isn’t just a matter for the health ministry. It’s a long, slow process. It’s called diplomacy.
KEITH PORTER: This week on Common Ground, the global AIDS fight.
HASMY AGAM: It is not that the Islamic countries are in denial. We all accept that this problem exists in every Muslim country. Except that some of the things that we are discussing offend the sensitivities of Islamic countries.
KRISTIN MCHUGH: Common Ground is a program on world affairs and the people who shape events. It’s produced by the Stanley Foundation. I’m Kristin McHugh.
PORTER: And I’m Keith Porter. Thirty-six million people worldwide are living with HIV/AIDS. Another 21 million, three times the population of Switzerland, have died since the disease was first identified nearly two decades ago. And despite the advancement of modern medicine the infection rate continues to rise at an alarming rate in much of the world.
MCHUGH: HIV/AIDS’ deadly grip extends well beyond the infected population. Several global leaders say the epidemic is now a development and human rights issue. This June, the harsh reality prompted the United Nations to hold an historic special session on HIV/AIDS. Outgoing Australian Ambassador Penelope Wensley cofacilitated the special session. Hasmy Agam is Malaysia’s Ambassador to the United Nations and Chairman of the Islamic Group of Countries for this conference. I had the opportunity to speak with both just days before the special session was convened. Ambassador Wensley said HIV/AIDS is a global epidemic that requires global action.
PENELOPE WENSLEY: The Special Session on HIV/AIDS has really two clear purposes. The first is to raise the level of awareness internationally of the crisis that the HIV/AIDS pandemic represents to the international community. And secondly to mobilize resources to deal with it.
MCHUGH: Well, you have called this a landmark session. What makes this one different?
WENSLEY: Well firstly, there never has been a UN General Assembly Special Session on HIV/AIDS. HIV/AIDS is not a new problem. We’ve been dealing with it for nearly two decades. The difference now, however, is that it isn’t a localized problem. It isn’t a problem that affects a small number of individuals. It’s a problem that is actually threatening communities, nations, regions. It is unraveling the fabric of many societies. And that carries with it significant implications for the international community. It is now no longer a health issue. It is a development catastrophe in many parts of the world. A looming catastrophe in others. And it is certainly now a risk to security. For all of those reasons this is a landmark event. It is bringing together the international community to develop a better understanding of just how threatening this crisis is to human development and to security. And it is trying to define some solutions.
MCHUGH: We’re also joined today by the Malaysian Permanent Representative. Do you also agree that this is a landmark session?
HASMY AGAM: Yes, I agree. I entirely agree with what my friend Penny has said. Malaysia is also affected by this problem. It started with a very small scale. It has increased over the years because of movements of people, trans-border, cross-continental, and all that. So it is a matter of concern to us.
MCHUGH: The session concluded with a Declaration of Commitment that set specific goals and time lines to fight the epidemic. But the commitment was not without controversy. The draft language included references to sex and drugs that offended a number of Muslim nations. The final version did not include the explicit language. I asked Hasmy Agam if he thought the language was too explicit.
AGAM: It is not that the Islamic countries are in denial. We all accept that this problem exists in every Muslim country. Except that some of the things that we are discussing, are as I said, very specific, very graphic, that kind of offend the sensitivities of Islamic countries. This pertains to lifestyle, OK? Now, in Islamic countries this thing exists. I mean, this type of lifestyle exists since time immemorial. We all understand they happen. But it was kind of limited, contained. What is happening in the modern world is that there is not only an effort to get this recognized-we all recognize it-but somehow or other after recognition there is an assertion of these rights and a flaunting of it, even. You see in terms of very open display of these kind of lifestyles. Now, Islamic countries are generally conservative countries. There are some more open or less conservative than others, but basically what I think binds the Islamic countries together as a group is their conservativeness to certain things.
And to be frank, for instance, sodomy in Islamic countries is not only a moral offense, but it is also a criminal offense. And therefore the tendency is to discourage these kind of lifestyles. Not that we don’t recognize it, to discourage it. Our concern is, if you describe in graphic language in an attempt to identify one of the groups, you are actually giving the impression to our people that somehow or other it is fine; in fact, go ahead, do your own thing. It will have the intent of encouraging a certain lifestyle that we in Muslim countries in general frown upon. This is a problem, you know. And these very systems, the prohibition against this kind of lifestyle, is from our standpoint, is divine law. How do you go about it? Divine law cannot be challenged.
MCHUGH: This again is Ambassador Penelope Wensley.
WENSLEY: The references that are causing particular difficulty-and I think it’s understandable-we have political, cultural, religious differences amongst 189 member states. And I believe fundamentally that we have to be sensitive to each others’ beliefs, values, moral systems, and so on. And take account of it. But at the same time, we also need to ensure that the UN, which sets the standards, a norm-setting organization, a leader in this, particularly in the areas of human rights, does not resign from dealing directly with problems. And it is hard to imagine how we can have a major world conference, the first world conference on HIV/AIDS, that does not speak explicitly about vulnerable groups. In order to deal with a problem we have to acknowledge the existence of the vulnerable groups. In the case of the, finding the right language, we have to bridge a gap between the Islamic countries-and they are a very large group-and some others, which are sensitive about very explicit references-and those countries that maintain fundamentally that if the UN does not identify in this document the fundamental groups in a clear and direct way, that the UN itself will be endorsing an approach of denial.
I thought it was very important that Hasmy said that the Islamic countries are not in denial. But there is certainly a perception out there amongst active groups, civil society, that we are at risk of the UN being too coy about these issues. The references that are particularly difficult are men having sex with men-MSMs for short-sex workers and their clients, and injecting drug users and their sexual contact. That is seen as too graphic by the Islamic countries. There are no references to gays because women having sex with women, lesbians, are not a problem. They are not a vulnerable group. They are not a vector for transmission. The term, ‘men having sex with men,’ is actually a technical term developed when this was fundamentally seen as a health issue. And as I say it has moved well beyond that. Because it described exactly the groups that were principally responsible in some areas for transmission. But transmission now is very, very diverse. It is mother to child transmission, it is through infected blood supplies. It’s through unsafe needle usage. And it is fundamentally through heterosexual sex as well. So we have to find a way, perhaps through qualifying language that says something like, ‘Taking into account particular cultural contexts and circumstances,’ some formulation like that, which might be seen by some of the NGOs and civil society as a Copt, as a retreat. But realistically has to be done in order to recognize the very important points that Hasmy made that are of fundamental importance to particular cultures and societies.
MCHUGH: Perhaps we are really getting to the heart of this subject. And that is that we are talking about in many ways things that are taboo to talk about publicly in many cultures. And how do you get past the taboo of talking about sex and drugs, especially in the United Nations?
WENSLEY: This is fundamentally about human rights, about values. It’s not so much about lifestyles. And the way you get past these things are to have member states talk as openly, as honestly, as directly as they can. That’s very difficult in a very large general assembly hall where there is an element of public presentation and drama. Where you can get greater understanding through the everyday interaction between missions, between delegations, between experts. Bringing the NGOs from their own communities together who will help to drive governments’ responses. It’s a long, slow process. It’s called diplomacy. The UN General Assembly decided in November 2000 that the crisis was of such alarming proportions and was threatening so many areas of the international community-there’s not a single country that’s unaffected-that it was vitally important to accelerate the process. And instead of spending a couple of years talking, thinking, debating, discussing how to deal with it, that we would put it on the agenda.
This isn’t a legally binding document. It is a document that sets out specific targets, timetables, objectives, drawn on success stories and best practice. Above all it’s meant to galvanize the political will, the political leadership, backed up with the financial muscle to deal with the problem. We can get there but it is difficult. It is delicate. But because this is such a devastating crisis we have to do it.
MCHUGH: Hasmy, Penelope Wensley has called this a human rights issue. But I think that many people view AIDS as an individual medical issue. Do you feel that the AIDS epidemic in the world is a human rights issue?
AGAM: Well, from the perspective of the Islamic countries it is a health issue. Perhaps not just an individual health issue, it is a public health issue because of the nature of the disease. And it’s spread over the years is a matter, you know, of public concern. So I would just, I wouldn’t just confine it to an individual health issue. So that is our perspective. And we are concerned like the rest of the international community. We have in the negotiation been trying to be as much as possible cooperative and constructive. But as I said, these are very difficult terrain for Islamic countries and some countries are more concerned than others or more vocal in the negotiation, some less. But in the meeting that I convened before we came here last week, without exception, all the Muslim countries spoke in more or less similar fashion. We have formed a group among the Muslim countries, a working group, to try to find language that can bridge the gap. But as far as the Islamic countries are concerned, it should be language that would somehow not have as explicit a reference to, as Penny mentioned just now, a graphic description that is particularly offending to the Islamic countries.
Now, our concern is this, basically. Over the years there is a perception among Islam countries, that because you are-and you don’t want to assert our, you know, fundamental position, on this-there’s been a kind of an encroachment of these kind of issues that affect Islamic countries. In other words, language that we would have objected to found its way into various international documents, from Beijing and other places. And then this conference, again we see there is further encroachment into areas that we feel will be, you know, very difficult for us as a group of Muslim countries, to countenance. So there is a feeling that perhaps this conference we should try to find language that is less offending to the Islamic countries, while at the same time cooperating with the international community in addressing this issue. This is basically the problem, you know. And our, our focus should be, we think as a group, on the plans of action, on what we should do. As opposed to actually getting, wasting a lot of time in the disputation over the language, of a the description. As Penny said, the description is important. I agree. But if it’s offending to a particular group of countries why don’t you find language that is less offending to them but concentrate on the plans of action. On what we Islamic countries, and collectively as a community, in the world should do.
MCHUGH: More on the historic UN AIDS Special Session, next on Common Ground.
PORTER: This summer the United Nations declared war on HIV/AIDS during a special session of the General Assembly. The Declaration of Commitment issues at the conclusion of the session marks the first time the UN has set specific goals in the battle to reduce the spread of HIV/AIDS. Kristin’s conversation with the session’s cofacilitator, outgoing Australian Ambassador Penelope Wensley, and Malaysia’s Ambassador Hasmy Agam, continues.
WENSLEY: I do think that there is a lack of knowledge and understanding in many parts of the world about the extent of the threat that his pandemic represents. The basic statistics are really very alarming. We’ve got nearly 22 million people dead. That’s more than the entire population of Australia. I try to put it in those sort of terms. There are 36 million people infected and, of course, far more because there’s a lot of incidence which is unknown and unreported. A majority of people who have it don’t know they have it. There are 13 million orphans at this point. There will be 40, four-zero million, within the next decade. There are countries in sub-Saharan Africa where one in five adults is infected. Where 50 percent-more than 50 percent-of the 15-year-olds will die within the next ten years even if infection rates drop. And two-thirds of them if infection rates don’t’ drop.
But it’s not just sub-Saharan Africa. It is growing exponentially, dramatically, in Russia, in Ukraine, in Estonia, in Central and Eastern Europe. The Caribbean has the second highest rate of infection in the world, after Africa. In the Pacific it’s relatively quiescent. In Asia there’s only-only!-7.3 million infected. But when you have such huge populations as India and China, even relatively low infection rates involve millions and millions of people. And all the predictions for the Indian subcontinent and for China are alarmingly high. We have to grapple with this problem.
We have to deal with it. The reason we have to deal with it is not just because of the tragedy for individuals, but because of the impacts on society. The impact on business, on development. It’s very hard at the moment, it’s quite complex to make the judgments about the macroeconomic impacts. But certainly all the studies that we’re able to do in places where the infection rates are high are showing the graphic impact on employers, on business, on development. We’re seeing development set back by decades.
Botswana was the richest, I think the highest GDP in Africa. Diamond-rich Botswana. Well-organized. Democratic. Excellent infrastructure. Has a life expectancy which has dropped now to the low 30s. Expected to go to 29. South Africa: $22 billion will be wiped off their economy over the next few years. Those sorts of figures mean that all of us have to recognize that HIV/AIDS isn’t a problem for a small number of countries. That it is a global crisis. That it does demand a global response. And we’ve got to get concrete outcomes and decisions from the international community to deal with it.
MCHUGH: What are the solutions that need to happen in the next five years?
WENSLEY: Mobilization of political will and of resources and commitment by governments, by world leaders, by the business community, to specific targets. Things like reducing the incidence of mother-to-child transmission through the availability of drugs, through screening. Things like the commitment of resources to assist with the development of a vaccine. We need more research. We know we can prevent this disease but we need the funds to do it. And you’re not going to solve it by just shifting money from one part of an aid bucket to another. We need new and additional resources. The estimates are $7 to $10 billion is needed over the next ten years to deal with the least developed and lowest income countries alone.
There has been a call to establish an international fund. It’s close to being established. The details are yet to be worked out. There are governments that are announcing commitments. The American government has announced $200 million. My own government announced, in fact, last year a $200 million global AIDS initiative. Someone told me that a wealthy individual has just donated a significant amount of money. I believe the resources are out there. But they need to be mobilized and they need to be channeled into very specific prevention and response strategies. Public information; public education; education of vulnerable groups. There’s a whole range of very specific things that can be done based on success stories in different parts of the world. Part of it is affordable drugs made more widely available. But that’s only part of it. This has to be a response that combines education with prevention with care and treatment for those already suffering.
MCHUGH: Hasmy, you mentioned goals. Would you agree that these are the goals that need to be achieved in the next five to ten years?
AGAM: Yes, I entirely agree. And I will particularly emphasize the last point Penny mentioned. The public awareness. Education. Because I think it’s in some, some societies there is recognition that the things out there, there is not enough public information on the steps that should be taken by society, by individuals, by groups, as to how to overcome this problem. And I think for logical countries that there should be emphasis on this. And I think in certain Islamic countries we all know this thing happens but sometimes there is not much public discussion of it because of the conservative nature of society. I mean it’s, it takes a lot of courage for someone to go public for instance, or even, I mean, to get these people to know that he’s having this disease.
So of course, some people consider this an aspect of denial. But it is not denial in the sense that ‘I don’t have it.’ But there’s recognition that ‘I have it but I don’t know how to go about to tell my loved ones that I have it.’ So this is a problem, you know. It is a cultural problem. I think what’s happening here, there are some other countries that admit it openly, freely. Once you have done this then you can, you can take the steps that need to be taken to overcome this problem. This is why I emphasize on public information, public campaign, on highlighting the enormity of this problem that Penny has mentioned. Perhaps this has not been driven home to certain groups of people. Because it’s not rampant. In Asia, for instance, is the numbers are big in terms of, you know, certain countries, but are relatively quite small when compared to, say, other places, Africa. I think there needs to be, you know, this campaign in the public domain.
WENSLEY: One of the encouraging things is that there are many examples of success, where infection rates have been able to be brought down. And we need to draw very heavily on those success stories, on best practice, to ask why is it that Thailand has been able to reduce the incidence. Why Uganda? Why Senegal? Why Australia? To ask ‘why’ is, are the numbers kicking back up again in some sectors of the United States? There is very valuable information available from countries. So we have to draw on these. And there are some common lessons coming through. Public information, major education programs targeting the young. Not just because they’re vulnerable groups but because there are really effective ways of getting the message out to teaching them how to protect themselves, how they are at risk, why they are at risk. We have to target all sorts of groups. Hasmy mentioned mobile populations. It’s a very big problem, high mobile populations. Not just people like refugees and internally displaced persons and people in situations of conflict who are more vulnerable, but truck drivers, immigrants, people who are highly mobile moving across borders. There can be campaigns to target truck drivers. There have been They’re very effective. Campaigns to target people who do, because of their mobility, resort to commercial sex. We target the commercial sex workers, to provide screening, clinics, information, treatment centers. A whole range of things that can be done.
Two factors shine through in terms of success. Leadership. Absolutely critical factor. And it is highlighted in the Declaration of Commitment. The engagement of leaders who will drive a process that involves a coordinated and comprehensive response at the government level, whole of government responses. This isn’t just a matter for the health ministry. It’s for the transport ministry, the foreign ministry, the minister of defense; armies, security forces, can be very vulnerable, but they can also be effective forces to inform, to educate, to take these issues out into the community.
The second thing that shines through is the involvement of civil society and people living with AIDS. Where there have been effective responses in many countries it has been because these groups have mobilized ahead of governments and their experience, their involvement. The engagement of the church. In many countries this is more rural than an urban phenomenon. And in least developed countries where the health infrastructure is not well developed we need the churches, the NGOs, the community groups, to help deal with all the problems, including care and treatment. So, we do have positive experiences from which to draw but we need to bring all of these together to share them and to go well beyond UN AIDS and a handful of health ministries working on it. We need a comprehensive response involving governments, civil society, and people living with AIDS.
MCHUGH: We are running short of time. But I wanted to mention that the numbers that you have been talking about throughout this interview are staggering and in many ways very pessimistic. Do you still hold out hope?
WENSLEY: I have to say candidly the worst is yet to come. Nevertheless, we have it within our capacity to set the strategies, to take the decisions, to show the leadership that’s needed to deal with this problem. HIV/AIDS is a preventable problem. But the size of the problem confronting the international community, the level of the resources that’s needed, means that the worst is yet to come.
MCHUGH: Penelope Wensley is Australia’s outgoing Permanent Representative to the United Nations. She cofacilitated this summer’s UN AIDS special session. We also heard from Malaysian Ambassador Hasmy Agam.
Our theme music was created by B.J. Leiderman. Common Ground was produced and funded by the Stanley Foundation.
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