In the wake of the International AIDS 2012 Conference that took place between 22nd and 27th July 2012 in Washington, a milestone biannual global event bringing together 20 000 people from nearly 200 countries to translate recent advances into action that will address means to end the HIV/AIDS epidemic, the UNODC Global Coordinator for HIV/AIDS, Christian Kroll, unravels some of the biggest challenges to fighting the global spread of HIV/AIDS. He was interviewed by the European Ideas Ambassador at Cambridge University and the University of Vienna Nadia Bonifačić.
1. As a unit within UNODC, your team specialises in HIV/AIDS among drug users and in prison settings. Is the key to combatting HIV/AIDS focusing on most-at-risk-populations?
The HIV/AIDS epidemic started 30 years ago among most-at-risk populations. We’re talking about sex workers, drug users, men who have sex with men and prisoners. Politicians don't like to publicly talk about these populations, it is politically less controversial to talk about youth, for example. The result was that these populations were grossly neglected in fund allocations. A couple of years ago UNAIDS launched a large campaign called ‘Know your epidemic’ and the aim was to channel the money to where the epidemic actually was. Now we very much focus on these populations.
2. You have just come back from the International AIDS Conference in Washington. The US have lifted the 25-year long travel ban for HIV-positive people just in time for the Conference to take place in their capital. Is hypocrisy characterizing the global fight against AIDS?
We have to understand the background of US policies towards sex workers and drug users. In the US, sex work is seen as abuse of women, as no woman would voluntarily choose to do sex work. Equally, drug use is criminalised, so declared drug users and sex workers are not allowed to travel into the country. I wouldn’t call it hypocrisy, rather an inhibiting polarisation of opinions between Republicans and Democrats around this issue. The imperative of the international community and the UN is to support the liberal actors so that they can continue to do their work. There was a lot of pressure from the UN and the general public for US to ban travel restrictions for HIV-positive people and hosting the AIDS Conference was seen as a reward or a celebration of the easing of restrictions. There is a positive trend in the US towards further relaxiation on travel restrictions and this is something we should focus on.
3. The spread of HIV/AIDS among injecting drug users is a serious problem in Eastern Europe. Is there a secret formula composed of harm reduction measures and the human rights approach which could halt the epidemic?
Certainly. Although there has been a historical problem with the term, harm reduction is proven to be the only thing that works. Needle and syringe programs and opioid substitution therapy are the only way to stop the HIV/AIDS epidemic among injecting drug users. A human rights approach is equally the only thing that works. Everything else is unsuccesful. But to this formula, you have to add alternatives to punishment for posession of (a certain amount of) drugs for personal use. For instance, depenalisation doesn’t rule out strict laws against drug trade, but it implies that an alternative to prison exist. Judges in the UK or in Portugal, for instance, are allowed to send drug users to drug dependence treatment facilities instead of prison.
4. Do you think the war on drugs can realistically be reversed?
Drug war is a term that stems from the Nixon administration and it is complete nonsense. It never works. Drug dependence is a behavioural, social and perhaps a medical problem, but you do not declare a war on it. In the same way as you would not declare a war on diabetes. The problem is that drug users may engage in criminal activity. If there is crime in the neighbourhood, however, they are more likely to be accused for it than other people, regardless of whether that is true or not. By targetting this issue, politicians can get votes and this contributes to the stigma and negative discrimination of drug users. They are labelled as bad people. None of this helps for an effective response to the HIV/AIDS epidemic among drug users.
5. There is no cure and no vaccine for HIV/AIDS. Yet a lot of people don’t know that there is a range of prevention and treatment measures that can enable HIV-positive people to go on living as healthy people for the rest of their lives.
This general attitude is linked to early experiences of HIV/AIDS. If I told you in the 80s that you were HIV-positive, that would most certainly be a death sentence for you. In some countries, people lived another 6 months and before they died. This is not the case any more. With the antiretroviral therapy, you can live with HIV for 25-30 years or even longer. But the general attitude has remained. If you tell a patient that they have a heart disease, they will of course not be happy about it, but they will not take it as a death sentence. If you tell a person today that they are HIV-positive, they will live through an immense shock, to the point where they could even become suicidal. This reflects the level of ignorance and discrimination surrounding the issue of HIV/AIDS. On the other hand, some studies have shown that some members gay population engaging in risky sexual behaviour adopt a very complacent attitude towards HIV/AIDS because they know they can succesfully enroll in antiretroviral therapy if they get infected and that they will not suffer many consequences from HIV-infection.
6. Has the general public also become too complacent about the epidemic?
Well, that is an issue of public relations. It is difficult to keep the public supportive of a project for 30 years. Especially when there are other global problems entering the scene, like climate change. HIV/AIDS has gone down on the priority list.
7. The Clinton Health Access Initiative helped lower the costs of antiretroviral treatment from $10,000 to $100-200$ per person per year by cooperating with pharmaceutical companies? Is their lobbying power too strong?
Pharmaceutical companies are still very powerful, but the public opinion is becoming increasingly negative. It has become unacceptable that these companies are purely profit-oriented, they also have a social responsibility. The real problem when it comes to pharmeceuticals are the patent rights. They prevent developing countries from producing their own antiretroviral medicine at lower prices. The issue is therefore not whether to keep the pharmaceutical companies on the free open market, but how to circumvent the issue of intellectual property rights in this industry.
8. Final thoughts?
This year’s AIDS conference theme was very fitting for our current situation: Turning the Tide on HIV/AIDS. We really are at a historical moment where we have all the necessary tools to reverse the trend of HIV and AIDS.