UN Secretary General’s Special Envoy Dr Nafis Sadik urges a broader approach to AIDS in China
24 October 2008
“Know your epidemic,” advised UN Special Envoy on AIDS in Asia, Dr Nafis Sadik, at a public lecture held on 16 October 2008 in Beijing. “Because we’ve learned that there’s no return on policies made in ignorance, nor on programmes directed at the wrong population demographic.”
In particular, Dr Sadik urged focus on the following areas: the social stigma and discrimination affecting people living with HIV in China; the connections between women’s reproductive health and HIV; and the differential risks borne by various groups, including people you inject drugs, men who have sex with men, commercial sex workers, youth, and the sexual partners of people who engage in high risk behaviours.
“Prevention is not a health matter; it’s a behaviour matter”
Addressing shortfalls in these areas requires changing people’s behaviour, a task that is broader than treating a disease. As Dr Sadik explained, by categorizing HIV as a communicable disease problem, China is missing an opportunity for prevention efforts. “A hospital’s role in preventing HIV is important but limited because it doesn’t see people until they are ill,” she cautioned. “But prevention is not a health matter; it’s a behaviour matter.”
In China, patients with AIDS-related illnesses are treated in specialized rather than in general hospitals and Dr Sadik cautioned against the effect this has on stigma and discrimination. During her visit to Ditan Hospital in Beijing, Dr Sadik met with seriously ill patients living with HIV. Many of them have developed multiple resistance to tuberculosis and antiretroviral drugs but none are receiving lifesaving so-called 2nd line therapy.
While the Chinese government’s prioritization of HIV is sincere, and impressive progress has been made, Dr Sadik emphasizes the importance of political commitment. In countries like Cambodia and Thailand, and in the Indian state of Tamil Nadu, where HIV prevention efforts are seeing greatest results, the common factor is political commitment. Moreover, top-level government involvement is particularly useful for combating stigma and discrimination. “Cambodia’s prime minister never misses an opportunity to work AIDS into a speech,” she reports.
“China can be a leading success story,” Dr Sadik maintains, a message that she drove home during a meeting yesterday at the Red Ribbon Center, a support centre for men, women and children living with HIV. The centre is housed in Ditan Hospital and provides HIV testing and care, information, psychological support, training for volunteers, and legal aid support.
Tenacious problem of stigma
Discussing the tenacious problem of stigma and discrimination against people living with HIV, the staff at the Red Ribbon Centre expressed the opinion that better education is necessary. Agreeing, Dr Sadik also recommended more effective advocacy. “The message shouldn’t be that AIDS is a terrible disease, and that people who have it will die. The message should be that people with HIV can have a normal life expectancy.”
Dr Sadik rejects the notion that AIDS education and advocacy are antithetical to Asian culture because they necessitate frank discussion of sex or other issues that might cause embarrassment. “We hear the argument that Asian value systems are being preserved by not discussing matters like HIV and AIDS,” she admitted, “but what value system wants to put their young people at risk of contracting a serious condition?”
Studies from around the world, in Asian cultures as elsewhere, shows that knowledge and education to youth on sex and AIDS issues does not promote promiscuity, but on the contrary is a very important way to ensure that young people are informed to protect themselves – by postponing first sexual intercourse, remaining faithful and using condoms. Traditional culture and the health of young people cannot be effectively protected by ignorance.
“Changing the focus of HIV and AIDS efforts from health to social issues doesn’t necessarily require a lot of money,” she reflected. “But it does require a lot of champions.”
High-Level Forum on Poverty Reduction and Development
During her visit to Beijing Dr Sadik gave a keynote speech on HIV and Gender at the High-Level Forum on Poverty Reduction and Development in Beijing on 17 October which was organized by UNDP. She also met with government officials and people living with HIV to advocate for a strengthened and gender sensitive response to HIV in China.
Dr Sadik, a national of Pakistan, was appointed Special Envoy of the Secretary-General for HIV/AIDS in Asia in 2002. She earlier served as Executive Director of the United Nations Population Fund (UNFPA) from 1987 through 2000.