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Africa Renewal: As the new head of UN AIDS, what are your priorities in the fight against HIV /AIDS?

Ms. Byanyima: UNAIDS was created to fight HIV/ AIDS globally. We have about 24.5 million people on anti-retroviral (ARV) treatment, and there is another 15 million people who are HIV-positive but have not been tested yet.

our report shows that there were 1.7 million new HIV infections globally in 2018 alone and another 770,000 people died of AIDS in the same year. While we are seeing the rate of infections is coming down, these numbers are still high.

Our priority for the next 10 years is to work extremely hard on prevention, especially among vulnerable groups. For women and girls, we have to address the structural causes of their vulnerability which including culture, traditions and poverty, among others. The fact that sexual violence is so pervasive, we have to tackle that. We will be working closely with our other partners UN Women, UNFPA, UNICEF, UNESCO, UNDP and others to fight the causes of the vulnerability in Africa.

On the other hand, we have to work on human rights because as long as gay men and sex workers remain criminalized, they are driven underground and hence don't come forward for prevention or treatment. It's important to remove those criminal laws, so that these people can come forward for testing, prevention, and treatment.

Who is most at risk of new infections?

The most vulnerable in Africa are mostly women and girls. In other parts of the world, it is gay men, sex workers, prisoners, migrants, and people who inject drugs. Prevention isn't happening fast enough. Up to 1.7 million new infections and 770,000 deaths in one year are too many. We can still reduce the overall new infections and deaths significantly.

What needs to be done?

We need more tools of science, for example, we need more PrEP (Pre-exposure prophylaxis where people at risk or those that have been exposed to HIV take daily medicine to prevent the infection). Recently, there have been more innovations in PrEPs which could be used more among gay men and sex workers. However, if in some places these people are called “illegal”, they are not able to go get these services.

We also need to deal with some of the constraints, including the lack of comprehensive age-appropriate sex education in schools to empower girls with knowledge to understand their bodies and take control of them.

What are your plans to put more people on ARVs in Africa?

The fact that we are the continent that is the most affected by HIV and AIDS and yet most of the ARVs are manufactured elsewhere is a loss to us. Even the prevention commodities are imported. These products should be produced in Africa, creating jobs and raising taxes to put back in our health systems.

It is important that we build our manufacturing capacity in Africa. There may be some in South Africa, a few Nigeria and may be in Egypt, but we need to pool together, produce our own medicines and share the African market. That is something we feel strongly about at UNAIDS.

We are working with the African Union and have some collaborations with China to promote local manufacturing. This is high on our agenda.

This brings the issue of the free trade area in Africa. How do you think African pharmaceuticals can benefit from the African Continental Free Trade Area (AfCFTA)?

Integration of our market is critical and urgent for us to build our manufacturing capacity. We cannot compete with pharmaceuticals in India, Europe or USA, unless our companies have the benefit of the whole African market. You can’t have, for example, Uganda compete with India which is the ‘pharmacy of the world’.

We have to build a common market, so that whether the company is in Burkina Faso or in Kenya, it is supplying the entire African market.

What is it like to be African, female and a leader on the global stage?

First, it is a great honor. Because I have within me many axes of inequality—being a woman and being an African. But on the other hand, these have been my strengths, because as an African girl I was able to get a good education, and then rise up in my career.

So, when sitting where I am now, I feel very much like a survivor because I know where I come from, many girls didn't even go past primary school. They were as good as I was but the opportunities were so limited, they were poorer while some got pregnant when were 13 or 14 years old and were expelled from school. Girls face all kinds of obstacles to stop them from moving up. I made it and I feel a huge responsibility towards people like me.

I am a global leader, but I feel a huge responsibility towards those who suffer disadvantages of different kinds, whether it is race, gender or disability. ?I feel strongly for them because I know I could have been one of them. In this position I can empathize with the people we serve because I've seen suffering all around me. I come from a village where there are poor people, some die when they could have been saved because they have no money.??

I know that things aren't always smooth. They haven't been smooth for me also, as I've been rising. However, I feel confident in this role, I feel as good as any other because somehow, wherever I have been, I have always been pushed upwards by the people I worked with approving what I do. So, I feel empowered and I feel that people have confidence in me. That gives me confidence.

What role can women in Africa play towards a better Africa — the Africa we want?

African women already contribute so much to the African economy and societies. Maybe the question you should ask me is, how much less should African women do so that the men can also pick up from there. And I'm saying this with the most sincerity.

African women work in the economy as hard as men, they will be in the farm, in the office, in the small market stalls selling, they will go out to earn money. But they will also come back home to care for the children, the elderly, those with disabilities in the home, and do some other work that may arise in their community, church and even schools. They carry the burden of three jobs - family, office work, and a job in the community.

Some of that work should be lifted first by their governments for example, by bringing clean water near the home, when on average, an African woman walks six miles a day to fetch water. This is not just for reducing the burden on women but for health reasons as well, as you have seen with COVID-19. Providing energy for domestic use, good roads and childcare facilities should be a top priority.??

So, what should be done?

We need to get girls, and boys, into secondary schools. ?Too many of our best girls and boys do not proceed to secondary school. Girls, especially, need it because it's also for their own safety from HIV infection and gender-based violence.

African women can be empowered by giving them a chance in secondary education particularly, that teaches them life skills. They should get more into decision-making. We are making progress here but too slowly. There are still too many countries that don't use quotas and therefore women are very few in local and national government. We need to get their voices heard and respected.

For me, I am proud of African women. Wherever they are, they are in the trenches fighting for their families and for their countries. It is their countries which owe these women more. It is their brothers and husbands who owe them more.

How will the COVID-19 pandemic affect those living with HIV?

The AIDS-related death toll could double in sub-Saharan Africa from 2020 to 2021 if HIV services are severely disrupted – this would mean an additional 500,000 AIDS-related deaths.

But not only that, new infections among children through mother-to-child transmission could increase by even more than 100 per cent in some countries in Africa. We could see the progress made in fighting AIDS reversed by 10 years. And that's dangerous.

So, it's so important to put the message out there that we should keep up the two struggles, on HIV and COVID-19. Do not drop one for the other.