• Specials 40 years of AIDS: from death sentence to chronic disease

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  • AIDS Emergency doctors, the key to detecting silent cases of HIV

Faced with a local problem, acting as a society does not seem complicated.

You study it, look at your options and tackle it according to your possibilities.

When something doesn't just happen to you and the solution isn't even in your hands, you have to come to an agreement with everyone involved, each with an interest, a budget or a will.

Coordinating the response to a pandemic is a titanic task, especially when there are so many lives at stake,

it is unknown how to stop it, and when a vaccine is achieved, the world reigns for every man for himself.

About this,

about pandemics, about inequality, about helping each other to put an end to a disease that affects all of humanity

, there is someone who speaks, not only on behalf of the most disadvantaged, but of all of us.

It is the voice of

Winnie Byanyima

(Mbarara, Uganda, 1959), the former executive director of Oxfam International and now

director, since 2019, of the Joint United Nations Program in the fight against AIDS (UNAIDS)

, the pandemic that was already here when the Covid arrived.

Although Byanyima trained as an aeronautical engineer at the University of Manchester, his passion is in the fight against inequality, poverty or the violation of human rights.

That is why

coordinating UNAIDS is quite a challenge

.

11 organizations collaborate in it

, such as the WHO, UNHCR, UNICEF, Unesco, the World Bank or the WFP World Food Program

.

"It's very similar, in a way, to what he was doing at Oxfam International, when we had 20 organizations working together to fight poverty in 95 countries," he says without flinching.

"I like to challenge inequalities and injustices. And this is also what HIV is about, which is a social injustice."

With Covid, we have forgotten the battle against the other pandemic, that of HIV.

What are the priorities in the fight against HIV/AIDS?

HIV/AIDS has been with us for 40 years.

The world came together through the United Nations, 25 years ago, creating this program (UNAIDS) to help in the fight against AIDS.

And since that happened, little progress has been made.

Today, even though we don't have a vaccine for HIV and we don't have a cure, we have tools to prevent HIV infection, to test, and to treat people.

Now it can be like a chronic disease.

You take a pill and you can lead a healthy life.

Today we have at least 27 million people around the world who live with that tablet.

And they will live as long a life as anyone else. That's fine.

But we have almost 10 million other people who need treatment.

I can say that there has been great progress in many countries.

But we still have a long way to go to serve those 10 million others.

In 2020, 690,000 people died waiting for treatment in the world.

Y

1.5 million people were recently infected.

Most are girls and young women.

So the challenge is very much to prevent these girls and young women in Africa from becoming infected for the first time.

And this has to do with sexual violence.

The fact that a girl who has no control over her body and has unwanted sexual intercourse leads to HIV infection.

She also has to do with discrimination, with not being in school, not being in a safe and protected place.

We must work to address the inequalities that women face and that make them more vulnerable. In addition, we must address this problem in other groups that are still newly infected, such as gay men, sex workers, people who inject drugs or women. transgender women.

In them, the reason they are getting infected is because they are criminalized.

They have this stigma and discrimination against them, so they can't come forward to get the benefit of prevention and treatment.

In other countries they are not criminalized,

At the same time that women are victims of a situation of inequality that leads them to get infected, do you think they could also be a useful arm to lean on to end it?

Yes, of course, but what we see is that social norms are pushed from one generation to another by various actors in society.

Women are part of them because they socialize children, transmitting values ​​to them.

That's true.

But women also learn social norms from others.

They have traditional leaders, religions, political leaders.

There is a whole range of influencers and opinion leaders who must work in the same direction to challenge the stigma of discrimination.

For example, discrimination against homosexuality or transgender women cannot be a problem only for women.

It is necessary that the churches preach love and not hate.

It is necessary that the traditional leaders who transmit our cultural values ​​to us also welcome people from sexual minorities.

Teachers are needed in schools and mothers in their homes to teach the new values ​​and make society adopt them, because societies change.

Your country [Spain] was one of the first European countries to allow same-sex marriage.

However, this is a country that also has deep Catholicism.

People changed their minds even though their churches didn't.

So it's also about civil society.

It is about allowing people to organize and assert their own rights.

People changed their minds even though their churches didn't.

So it's also about civil society.

It is about allowing people to organize and assert their own rights.

People changed their minds even though their churches didn't.

So it's also about civil society.

It is about allowing people to organize and assert their own rights.

HIV is a complicated virus, with many variants, so vaccines have not been successful.

Suddenly we suffer a Covid pandemic and we see how in a short time a totally new vaccine is developed.

What do you think of this rapid reaction to Covid against HIV that has been with us for 40 years?

That's true.

Covid had good things and bad things.

One of the good things is that, hitting the whole world, the rich countries of the north put up a lot of money with which, in a year, the innovators came up with a vaccine.

That was very positive.

We learned that if you put money first, you can get scientists to find a solution quickly.

In addition, we hope that there will be other discoveries based on this RNA technology, with which a vaccine against HIV can be reached.

We are optimistic, although it is not the same disease.

HIV and Covid are two very different viruses. But we also learned things that were not positive, like that even after finding the vaccine, there was a serious problem of distribution, of producing enough vaccine to save our lives around the world and end the pandemic.

We saw that there was a monopoly problem.

That monopolies are enabled by trade rules, intellectual property rules, and that a few companies held on to their knowledge, producing only a few vaccines.

In some countries people died while others were able to get vaccinated three to four times.

This was not good. So I mobilized together with civil society in the so-called Alliance of Vaccines for the People, to challenge companies to share their technology, so that full access to Covid technology is shared and that others countries can produce by themselves.

We mobilize countries to agree to an exemption from intellectual property rules so that any country that is going to produce the vaccine itself does not face a legal challenge over intellectual property.

That resolution is still there and more than 100 countries support it.

But

a handful of rich countries whose companies own the knowledge have refused to join the conference.

That's unfortunate.

That scientific discovery should save all lives.

And that does not mean that there are no benefits.

Big profits are made by sharing royalties and granting licenses.

But not those billions they are getting now.

This model is wrong and has collapsed the economy.

Look at the crisis we are in.

Many countries sank, millions of people became unemployed, lost their homes, and hunger returned home because some people wanted to become super billionaires.

You say there are rich people who cruise the Mediterranean on yachts while other people die trying to cross it.

But this pandemic, as well as the war in Ukraine, has shown us how unstable our wealth is.

Are we living in a fiction?

The Secretary General of the United Nations, António Guterres, has said that with Covid we are not safe until everyone is safe.

That we would only be when all countries are vaccinated.

And he is right.

That can be seen here in Spain.

People are going back to their normal lives.

But, in other countries, look at Africa, less than 20% of people are vaccinated.

And, what can happen is that other variants are created in those countries.

If we're lucky, they can be mild, like Omicron.

But there is no scientist who will tell you that he is 100% sure that another dangerous variant cannot be created, like delta or even worse.

Also, another deadly virus may arrive and sweep the world again.

Let us remember that this started somewhere in China and spread throughout the world in a short time.

It could happen again.

So you are right to say that we live in a false sense of security.

Pandemics must be fought globally. With HIV, the world came together.

A plan was made and some goals were set.

Which countries mobilized?

A lots of.

A program was made.

We produce data every year to show where the epidemic is, so that all countries know how to fight.

We raise money

But with the Covid we didn't get it.

We could not.

Governments did not come together to make a program.

They set goals, but without a plan.

They said that by next year we will have vaccinated 60%.

Okay, you set a goal, but you don't have a plan or money for it.

Yes, we learned that the world, this time, was not ready to act together.

Every country has looked inward.

There has been a lot of nationalism trying to save itself.

And this is counterproductive.

We have to understand that pandemics are global and that we need a global solution.

We must act in solidarity to save ourselves because there is no part that can be isolated.

A 2021 UNAIDS report warned about the vulnerability of patients with HIV/AIDS and Covid.

In addition, immunosuppressed people are the ones who react worst to the disease and in which certain variants arise.

Why do we ignore them?

The evidence shows that if you are HIV positive and contract Covid, you are more likely to suffer more and for longer.

That's why it was important for these people to be on the front lines to get the vaccine sooner.

As this did not happen,

the secretary general asked that all countries make sure to vaccinate vulnerable groups first.

But they paid no attention.

There are rich countries that vaccinate children, even if the children have no symptoms, while health workers in developing countries die on the front lines.

This is not good.

In the pandemic, what we have learned from HIV is that the response must be informed by science, not just politics or nationalism.

Since science shows us who is vulnerable, we should start with them, which is good for everyone.

Is that how it works.

But what we saw was that politicians came up with an answer to suit their political needs, not driven by scientists.

The United States, which has invested a lot of money in the development of Covid vaccines, could also give a big boost in the fight against HIV/AIDS.

What do you think of the emergency plan promoted by John Nkengasong in this country?

In the United States they spent a lot of taxpayer money and got two of the most effective vaccines.

But when you look at how the Covid pandemic impacted the United States, when you look at their vaccination rate and you compare it to Spain, which is way ahead (Spain has one of the highest vaccination rates around 92%) , we find that it

is necessary to have a very solid health system that can be accessed by all people without discrimination and that people trust.

Spain has a publicly funded healthcare system that is available to everyone.

In this country you are 15 minutes from a health center or a doctor to receive a service.

This system is also applied in the prevention of diseases, not only in curing them, it responds forcefully to emergencies and prevents stress, whether from AIDS or Covid.

This

is just as important as having vaccinations.

In some countries, even rich countries that have privately funded health systems, people who are rich have access.

Others cannot because they are poor.

Such systems, when there is a health emergency or a public health crisis, they can't reach everyone, so they don't have a good system to stop a pandemic.

In developing countries health systems are very weak.

Many countries, to pay their debt, were already cutting back on health and the crisis caught them very weak.

They too had serious challenges in stopping the pandemic.

So having the money to invest in science is one thing, but having a health system that doesn't deliver science to people is another.

And you need both.

In the case of Spain, you did not have the vaccine, but you could buy it and the system could distribute it to everyone.

Also important is the ability to produce the vaccine, which would have stopped this pandemic if the technology had been shared and there was production on all continents, within a year of finding the vaccine.

But we didn't.

Because production was limited and is monopolized.

Our health system, with its flaws, has proven its effectiveness.

But science does not suffer the same fate.

Our country, which develops vaccines for Covid and HIV, has found it difficult to move on to clinical trials.

The health model that Spain has, which was built recently, in the 1980s, is strong and important.

Many countries are studying how to finance a health system of this type, because Spain is not the richest country in the world, but it is capable of providing health efficiently to all its people and that is what we want.

More money is now being poured into the research and development of a vaccine for HIV, which is different from Covid.

We need more investment and many countries have reduced investment in science.

We also know that the Covid vaccine benefited a lot from the research that was already being done on HIV vaccines.

Now HIV and even other diseases can benefit from this emerging technology if more money is invested.

We will all benefit.

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