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Last Updated: Monday, 17 November, 2003, 11:55 GMT
Ask the head of UNAids
As part of a BBC season on Aids, you put your questions to our panel of experts in a special two-hour edition of Talking Point, our worldwide phone-in programme.
HOUR ONE:
Peter Piot



  • Transcript - Part I

    In the first hour of the programme, we spoke to the Head of UNAids Peter Piot.


    HOUR TWO:
    Carol Bellamy



    Gillian Anderson
  • Transcript - Part II

    In the second hour of the programme we were joined by Carol Bellamy of Unicef and actress / campaigner Gillian Anderson.


    Transcript - Part II

    Robin Lustig:
    Welcome to Talking Point, I'm Robin Lustig broadcasting on television on BBC World, on radio on the BBC World Service and on the internet on BBC News Online. For the next hour we're going to be discussing the global epidemic of HIV and AIDS. More than 40 million people worldwide are now living with HIV and AIDS, more than two-thirds of them are in Southern Africa. But now the virus is spreading fastest in the countries of Central Asia and Eastern Europe. The BBC's commissioned a special global survey in which 16,000 people in 15 countries were asked for their views about HIV and AIDS. More than half of the people questioned think that their governments are not doing enough about HIV and AIDS. In Tanzania and Nigeria more than half said that HIV and AIDS is what worries them most. Yet in India, Russia and China where there is a real risk of a major AIDS disaster the figures are much lower. Fewer than one-third of the respondents in India said it was their main concern, fewer than one in ten in Russia, fewer than one in twenty in China. When people were asked if children under the age of 14 should be taught that using a condom can protect people from the virus there were huge majorities in favour, more than 90% in Brazil and Mexico, which have two of the largest Catholic populations in the world, despite the Catholic church's opposition to the use of condoms. So what are your concerns? Are you living with HIV and AIDS? Do you know someone who is? We want to hear from you.

    Well let me now welcome our guests. From New York we're joined by Carol Bellamy, the head of the United Nations children's agency UNICEF and here with me in the studio in London is the actress Gillian Anderson who is an active campaigner in the fight against HIV and AIDS.

    Let me turn to you first Carol Bellamy. What do you make of the results of this survey that's been commissioned by the BBC around the world, what strikes you about it?

    Carol Bellamy:
    Well what strikes me is that clearly the issue is starting to break through in Africa in terms of people's awareness but in so many other parts of the world, where as you point out the matter of AIDS is a very important one, it really hasn't been raised to a level of public awareness.

    Robin Lustig:
    And why do you think that is?

    Carol Bellamy:
    I think as occurred in Africa there is enormous denial but this is just what should not be happening in Asia, such as China or India, or in Russia or Ukraine. I mean it's doubling in virtually in one year in places like Russia and Ukraine and yet as long as this denial goes on or as long as it's assumed it's just in a limited community the kind of reaction that needs to take place to confront it will not be taking place.

    Robin Lustig:
    Gillian Anderson, people know you around the world as an actress, how did you come to be involved in this campaign?

    Gillian Anderson:
    I've been involved in an organisation called Artists for a new South Africa, for a while and I'm on the board and I was invited to join Zackie Achmat of Treatment Action Campaign, when they came here over the summer. And he introduced me to ACTSA, which is Action for Southern Africa. And then I was asked to speak at a conference which took place last weekend and my initial thought was why not, that would be great, I can be of service in that way and then I realised while I was doing research for my speech that I was completely na´ve about the seriousness of the pandemic and even now I have been actively working here and there over the past few years around the issue of AIDS/HIV it really hadn't - the import of this particular - of this pandemic, of this catastrophe - had not really hit me.

    Robin Lustig:
    So what you're trying to do then is to get that message across to millions of other people who like you perhaps until recently .

    Gillian Anderson:
    Well I think so yes, and say I had been na´ve, and I'm still na´ve, I'm not an expert, there's so much that I don't understand but what I do understand is that - is the absolute necessity for our governments, our Western governments, our wealthy governments to put a huge amount of energy, more energy than they have been putting, in a financial way towards certain aspects that will promote the biggest change in this issue that we can.

    Robin Lustig:
    Well we have a lot of callers, a lot of e-mailers, who want to talk to you, who want to ask you questions. Well our first caller is in America, Heidi Ramirez is on the line from Phoenix in Arizona, Heidi hello.

    Heidi Ramirez:
    Good morning.

    Robin Lustig:
    Good morning. What did you want to say on this?

    Heidi Ramirez:
    Well I wanted to say that I think it is very important that we continue our outreach, even here in the States, as big as all the media has been, it has recently died off. And I was infected in 1990 unknowingly by AIDS, a boyfriend at the time while I was in college. For the past 10 years unknowingly I had carried this virus in my system and it was just non-progressive - I had three very healthy children, I had my fourth child in January of 2001 and at five and a half months old he was diagnosed with full blown AIDS and it wasn't something that my doctors ever even looked at. I was low risk and married for 10 years and had three, like I said, very, very healthy children and it has affected our family in many different ways.

    Robin Lustig:
    Did you know, Heidi, that it was possible to transmit the virus from mother to child?

    Heidi Ramirez:
    I did know that, however, I was - I did test negative with my first two children in 1992 and also in 1995, I tested negative in my prenatal care. And when it came time for my fourth child - when I first became pregnant - they told me I was low risk, there was no need to be tested. And with this information that I now have and with my ability and my son who touches so many people's lives to get the word out we have now started an outreach here in Phoenix. I'm working with OB officers and getting everybody tested and I think mandatory testing when women are pregnant is a much needed issue.

    Robin Lustig:
    So Heidi what then is the message you want to get out? Here we are, we're addressing an audience of millions of people both on radio and television and online on the internet, you have a very direct personal experience, you and your child, of what all this means, what do you want people to understand from that?

    Heidi Ramirez:
    I want people to understand that this is not just a gay or drug user disease, that everybody - everybody is being affected by this - moms and brothers and sisters and babies - and it is important to be tested and it is important to stay safe and use condoms and not to judge people when they are diagnosed, the stigma is still out there and it's horrible and I want my son to grow up without being chastised for being HIV positive.

    Robin Lustig:
    Have you been stigmatised yourself, directly?

    Heidi Ramirez:
    Not as much in our community because we do have a very open positive community here in Phoenix. I have seen it in other areas and we have been verbally attacked by denialists who claim that this is just a myth and it's not real and that I'm killing my child with medicine and giving him blood tests is a cruel and unusual punishment and he should be taken from me. I have been attacked in that form, yes.

    Robin Lustig:
    Heidi, thanks for calling in, we appreciate the call. Carol Bellamy in New York, mother to child transmission is a huge problem in southern Africa, in other parts of the world how well acknowledged is it?

    Carol Bellamy:
    Very little acknowledged but as Heidi just indicated it doesn't happen in all cases but it does happen in some and so it is important that pregnant women know their status so that they can make some choices about what will happen. There is actually a drug treatment for a woman who is pregnant that can work in the majority of cases to prevent the transmission.

    Robin Lustig:
    Gillian Anderson what do you think when you hear a story like Heidi's?

    Gillian Anderson:
    It's an incredibly powerful story, I don't think that a lot of people realise how possible it is still for people, and heterosexual people, to have access to AIDS in America. And I heard a statistic recently and I just wanted to check whether that was true or not but that 50% now of people who get AIDS in America are actually heterosexual and the amount of transmission quite frequently happens from the woman to the man, men are increasingly getting AIDS and HIV from women and I think it's dumbfounding them. And I was just curious about whether you knew whether that was .

    Robin Lustig:
    I think it's certainly true, Carol Bellamy isn't it, that more than half of the people worldwide now who are infected are women?

    Carol Bellamy:
    Yes it is. AIDS has taken on a women's face in much of the world. I'm not sure that's true about the United States. What's happened in the richer countries is that increasingly it is found among drug users and those that have some resources are able to be treated. So much of the urgency has left the agenda around HIV/AIDS in richer countries. But it is devastating, it is a catastrophe in poorer countries in the world.

    Robin Lustig:
    No more than so than in South Africa, which is the country where there are more people living with HIV/AIDS than in any other country in the world. Our next caller is in South Africa, Christina Marcham is in Durban, Christina hello.

    Christina Marcham:
    Hello. I'd like to ask a question please to Carol. My question actually has two parts and relates to increasing HIV/AIDS awareness and education amongst children which is a priority area for UNICEF. I've been in South Africa for about four months now and since I arrived I've been really shocked to find that many young people I've come into contact with at the university where I teach have not received formal AIDS education at school and many people I've met claimed that they have not knowingly met anyone who is HIV positive, which is truly alarming in a country where adult HIV prevalence is around 20%. So I'd like to know what programmes UNICEF is involved in to reduce stigma and to increase awareness and education in schools in South Africa. And the second part of my question relates to street children. I've been doing some work with the street children in Durban where the children receive very little AIDS education and I would like to know if UNICEF's involved in any specific educational programmes in South Africa to target this particular high risk group?

    Robin Lustig:
    Alright Christina, thank you. Carol Bellamy.

    Carol Bellamy:
    Well we are supporting some programmes, both at the ground level and some other organisations - Love Life comes to mind in South Africa, a very active programme of young people's information. In the long run unless the government is prepared to do everything possible, whether it's South Africa or any other country, then a single UN agency or several UN agencies will not be able to breakthrough very much. And we know from studies that even when there's information campaigns out there for young people there is enormous misunderstanding. They say no they can't get AIDS if the man looks healthy, they don't know how AIDS is transmitted and street children, as you mentioned, are probably the least able to understand because they are the least reached, it doesn't mean they're not smart enough to understand but there is little outreach to the street children.

    Robin Lustig:
    Gillian Anderson you were talking about your experience in South Africa and what you've been told by the people you met there, was it your experience that there was still a huge amount of ignorance?

    Gillian Anderson:
    I think there is a lot of ignorance. I also think that South Africa is doing more than they ever have before and I'm not sure whether you've spoken about this on the programme yet but about the quadrupling of the budget recently in South Africa towards support of work in AIDS. And I think that a lot of countries in Africa are actually making huge and positive steps and the awareness is being raised. I think there's always more that can be done and certainly there are organisations that can lead someone to the right information that you're looking for - an organisation like Treatment Action Campaign, TAC which is tac.org - you can get in touch with them and they might be able to put you in touch with people who specifically deal with children.

    Robin Lustig:
    But it's difficult with a taboo isn't it, because anything to do with sex is very difficult for young people to talk about, it's difficult sometimes for teachers to talk to children about, if it's to do with something - an infection that is the result of sexual activity it's tough.

    Gillian Anderson:
    Sure it's tough but it's a fact of our life in the world that we are living in today. And I think it's absolutely necessary for us to put all our squeamishness and the taboo behind us in - effectively to save lives. And that should come first and foremost.

    Robin Lustig:
    Let me read this e-mail that comes from Daniela who's in Berlin in Germany: I am a mother, I believe that parents have an obligation to speak to their children about HIV. Children should have access to condoms and information because they won't ask for help if parents take the stand that sex is a no, no. Carol Bellamy, the role of parents.

    Carol Bellamy:
    Well that's a very nice e-mail and as you pointed out I think it comes from Germany. But there are many parts of the world where in fact there is still a very big taboo - whatever you want to call it - in terms of children talking to their parents or parents talking to their children about sex. Additionally in schools, you just mentioned a moment ago, there are countries now that have education courses but whether the teachers teach that course is another question. I've heard from many young people who say but our teachers won't tell us about this. It's one of the reasons to try and involve religious leaders, get parents and communities to be more comfortable with this, we have to break through the wall of silence. And it's nice to say well we need to do it but the fact is there are many, many cultural and social and historical reasons why that wall of silence still exists.

    Robin Lustig:
    So if there are people watching this, listening to this now, who want to know more, more facts, what do you suggest they do?

    Carol Bellamy:
    Well there is enormous information out there from the web, to radio, to TV, they can get information from their health ministries, they can get information through their governments, they can get information through the United Nations, the United Nations has a coalition of UN agencies called UNAIDS and you heard earlier in the show about this. They can go to non-governmental organisations, there's a range of information out there, it's a matter of getting that information.

    Robin Lustig:
    There is also of course information on the BBC website which is linked to this series of programmes bbc.news.com/aids. We've had some questions that have come in on tape, let's hear from one of those now, this comes from Washington DC.

    Michelle Renee:
    Hello I'm Michelle Renee. I'm a resident of the Washington DC area and I do have a couple of questions in regards to our horrible AIDS epidemic. One of them, the first one being, why, since we have an epidemic that's worldwide, why is the money not distributed more evenly? Second, how often should a person get checked, is it annually or every two years or every six months?

    Robin Lustig:
    I hope you heard that Carol Bellamy. Two questions really. First of all why isn't the money that is spent on AIDS related programmes more evenly distributed and secondly a straightforward health question, how often should somebody get themselves checked?

    Carol Bellamy:
    Well again we're talking about rich countries and poor countries and the reality is the majority of money spent on AIDS today is spent on treatment and it is largely in the industrialised countries - North America, Western Europe if you will. Whereas the majority of the cases are in the poor countries, you mentioned before at this point of time sub-Saharan Africa most heavily impacted but Caribbean second most impacted area of the world, former Soviet Union countries the fastest growing, China, India, it exists there but so little in the way of resources. Now there is more money coming but it is coming slowly and taking a long time to get down. In terms of being checked I mean we're talking about parts of the country where people don't even have basic health - parts of the world I should say - where there are not even basic health systems. So that if they're even checked once they will be lucky. In terms of the industrialised world, again I think that this should be something that one has every year, that they have a check up they should check to make sure that they are HIV negative.

    Robin Lustig:
    Gillian Anderson on the money issue, is part of what you're campaigning for just very simply to persuade more of the richer countries to make available more money to help those in the poorer parts of the world?

    Gillian Anderson:
    Yeah, I think so on the whole. I mean there's the Global Fund right now which is very young but is a really wonderful idea and set up to have some of the richest countries in the world contribute money to the Fund so that it ends up getting siphoned to the right governments and the right countries according to their need. And they also are aware of the need within the individual countries to specifically relate it to how it's necessary culturally within that area. And something like that is an opportunity for huge change to happen globally. But it's a matter of getting the funds in there and there have been many promises made by governments about the amount of money that would be put to the Global Fund and it just has not happened. And the Global Fund right now is in a really scary place and it's a one opportunity for us to be incredibly effective. And it's not only something for our governments but also for multinational companies, businesses, to really take a positive proactive approach and not just a one time only donation towards the fund but to do it over time. But it's absolutely necessary in order to get the funds distributed.

    Robin Lustig:
    We'll take another call, this one is from West Africa, Fanon Meia who is in Cameroon, Fanon hello.

    Fanon Meia:
    Hello.

    Robin Lustig:
    Yeah hi, go ahead.

    Fanon Meia:
    I think that your debate on HIV on the BBC is a wonderful initiative because it creates public awareness. So I'm Italian but living here in Africa in Yaounde. I had a very bad experience with AIDS because it has killed three members of my family and what I've been hearing in the African society is that I'm not satisfied on what they've been doing to combat HIV because if we take, for instance, tradition in Africa considers sex as a taboo and it prevents people from talking on HIV in families, in schools and universities and churches and so I think this is - we have to change it, we have to create an open and dynamic tradition. And if we take poverty, for instance, we see a lack of an adequate medical infrastructures, the lack of an appropriate diet for infected people and the lack of personal investment and even collective investment against HIV.

    Robin Lustig:
    Fanon you talked about the effect of the disease on members of your family, presumably there are children in the family as well, what has been the effect on them?

    Fanon Meia:
    In Africa there is a personal concern for children left by parents. So now I'm looking after them.

    Robin Lustig:
    You're looking after the children yourself?

    Fanon Meia:
    Yes I'm looking after looking after them by myself because there's no other person.

    Robin Lustig:
    How many are there?

    Fanon Meia:
    There are six of them.

    Robin Lustig:
    So you're looking after six children who were left orphaned by AIDS were they?

    Fanon Meia:
    Yes, they are not infected but the parents died of AIDS. They are not infected but I have to look for money to educate them, to feed them and you know even to host them.

    Robin Lustig:
    Fanon thank you for the call, I want to stop you there. I want to read an e-mail that comes from Zambia from Jonathan Mbewe in Lusaka who says: I'm a foster parent to my AIDS orphaned nieces, I think the greatest challenge to the UN programme is to have more time and resources channelled to the grass roots of HIV/AIDS. What's being done to increase this?

    Carol Bellamy the whole phenomenon of AIDS orphans, as they're called, is a huge one isn't it?

    Carol Bellamy:
    It is, it's estimated that even as we sit here there are 14 million children who've been orphaned by AIDS around the world, about 11 million are in sub-Saharan Africa, so that's the - again the most heavily impacted area, estimated that that could go to 20 million by the year 2010. You've heard both in the phone call and in the e-mail that other members of the family are now having to intervene but that tradition of the extended family is now breaking apart because there's just so many children to be taken care of. So it really is going to require strengthening of grass roots organisations for these children. They tend to be stigmatised whether they are infected or not, again the gentleman from Cameroon said the children are not infected. They tend to drop out of school, they tend to be less healthy, they tend to be poor. This is a time bomb which is already exploding but is going to explode even more.

    Robin Lustig:
    So when you talk about grass roots organisations what specifically can they do and in what way can other people specifically help them?

    Carol Bellamy:
    Well I'm talking about communities themselves helping, I'm talking about church groups, I'm talking about members of the community helping other family members. They can make sure that the children at least have food to eat each day, they can make sure that the fees for the children to go to school are paid, they can try and make sure that the children learn how to take care of themselves. Many of these children are growing up not even learning how to plant or grow the food that historically they would have learned as part of an overall family. So it's very simple things, it doesn't require huge expenditures of money but it's going to require a network, if you will, in the community to support these children.

    Robin Lustig:
    A very specific question comes into us in another e-mail from Zambia, Loveness Chansa wants to know: What age does a typical child born with AIDS reach before they die?

    Carol Bellamy:
    I think that differs because what we're talking about in so many cases now is the fact that these children tend to be poor, have less available to them, even if they are already poor. So certainly in Africa a child born with AIDS or infected with AIDS is not going to live very long.

    Robin Lustig:
    Gillian Anderson I know when I was in South Africa three years ago I saw some children who had been born HIV positive who were in a very sorry state indeed, I don't know if you saw any as well, but do you have any thoughts on what can be done most effectively to help them?

    Gillian Anderson:
    Well I think what Carol was saying about a network, about the necessity for networks to understand what is needed within each community and also what the caller was talking about, about what we were discussing before, in terms of the taboo and having conversations between social workers or church based groups with local communities about how it needs to be approached most effectively to allow even the conversation to take place. But I think that one thing that Carol was pointing towards which is it's very easy to forget, when you think of children somewhere else, in other countries, that's one thing, but we have to remember that these children are also the future of those countries and these children are meant to be the ones who are going to help the countries to develop and build up their social structures and if they're not around either, as well as the communities right now that are being wiped out because AIDS affects people so much in the most vital ages of their life, it's wiping out teachers, it's wiping out doctors, nurses, children. So there are going to be no members of society left to help these countries develop, even once the funds get in there to help them develop.

    Robin Lustig:
    We have a lot of calls from Southern Africa obviously because that's where the disease is so prevalent. We'll take another call from Botswana, it comes from Gaborone in Botswana, Isaac Raditladi is on the line from there, Isaac hello.

    Isaac Raditladi:
    Hello.

    Robin Lustig:
    What is it that you wanted to say?

    Isaac Raditladi:
    I just wanted to ask about the importance of counselling for the grieved families.

    Robin Lustig:
    Sorry grief counselling you said?

    Isaac Raditladi:
    Yes.

    Robin Lustig:
    Because?

    Isaac Raditladi:
    Because I am an orphan, an AIDS orphan, but I have never received such counselling.

    Robin Lustig:
    And you're an orphan because of AIDS?

    Isaac Raditladi:
    Yes and it has never happened to me that I received counselling.

    Robin Lustig:
    And was it both your parents died, one of your parents?

    Isaac Raditladi: The only parent that I had, I am from a single parent family.

    Robin Lustig:
    Alright Isaac, let me ask Carol Bellamy. Grief counselling.

    Carol Bellamy:
    Right I actually think there's probably very little infrastructure on all these areas when one understands, as the gentleman from Cameroon and now this person, so many families have been affected if not infected by HIV and AIDS that as Gillian just said a moment ago it's going to the absolute functioning of society. May be you're not infected but your cousin is or your uncle has died and it eats away at society. We already see now hourglass societies in many of these sub-Saharan countries - old people and young people. But with the young people dying the whole foundation of society is disappearing. So whether it's grief counselling, whether it's counselling when you're pregnant and you're worried about whether you're going to transmit to you child, so much of this doesn't exist today because everybody's just trying to stem this terrible, terrible flood of death that's coming.

    Robin Lustig:
    There is some work being done in some countries isn't there in which parents themselves who are infected prepare their children for what is going to happen next. I remember hearing about memory books, for example, which mothers were preparing for their children in Uganda for example, in order to help their children come to terms with what was going to happen.

    Carol Bellamy:
    Well Uganda again is one of those countries where from the top of the government, the President himself, the entire society has been mobilised, which is what you need. This is why in countries like Uganda and Thailand actually they have begun to lower the incidence or hold it back because the whole society was mobilised. There are many lessons to be learned from the Uganda's of the world. There are groups out there that help in preparing wills so that there's anticipation of some of the problems. There is some of this grief counselling but it is still so limited in its presence.

    Robin Lustig:
    We'll take another call, Linley Chiwona-Karltun is on the line from Uppsala in Sweden. Linely hello.

    Linley Chiwona-Karltun:
    Yes hello Robin. Thank you very much for this wonderful programme and I would like to commend you on the survey that you did which shows of course the results which are not so unexpected, that governments ought to do more. And I also am very happy to hear Carol Bellamy's comments saying that this also goes to show that awareness is on the increase especially in Southern Africa where the problem is quite acute. And I, speaking from my experience, basically research, which I am conducting in rural Malawi and this is in the agriculture sector, which as you know has hit quite a lot of resources that were there and that were available. What you do see and what is very common is that sex is really a very sensitive issue and as you pointed out it's also an issue which has so many taboos, that are not enabling it come out in the open. But at the same time there is an issue which is not often discussed or brought up in public and that is sex is also a major negotiating factor for women, especially if these women are poor. Father Dowling from South Africa in the first hour of the programme mentioned that women are often led into prostitution because there aren't any options and there are very few choices for them and this is quite true. In our studies and research in Malawi we find that women that are single, women that do not have any power or they're not connected to any families that have come in with power these women more often than not will use sex as a negotiating factor and this sex, they sell their bodies and they acquire money or in kind a certain kind of protection which enables them to get food and/or to fend for their families.

    Robin Lustig:
    And are you saying Linley that that in itself increases the risk that they are then exposed to HIV?

    Linley Chiwona-Karltun:
    Very much so, I mean if you listen there was a meeting recently where the ex-President of Ghana, Rawlings, said that the spread of AIDS is not unconnected from African men's inappropriate use of power and patronage. And at the same time you say how can then a woman that is poor, that is looking for alternatives to feed her parents, to feed her siblings, to feed her children, how can she protect herself when she's in such a weak position to negotiate?

    Robin Lustig:
    Okay Linley thanks very much indeed for that, that's very interesting. Gillian Anderson the whole subject of the relationship between men and women, it all comes together in this one issue doesn't it, because sex is at the centre of it so often and HIV is there?

    Gillian Anderson:
    Well I was doing some reading recently and there are many roads going throughout Africa and Southern Africa specifically that are truck routes and there are these truck stops along the way where men stop overnight and they have rooms in the back of the truck stops that are specifically sex rooms basically for prostitutes. So here's the situation where it's been carried from place to place to place across the continent and how do you stop that, how do you go in there and hand out condoms, how do you go in there and try and educate the truckers or the prostitutes? It's a very, very complicated and serious situation.

    Robin Lustig:
    And yet I think Carol Bellamy there are programmes in which people try to do just that aren't there?

    Carol Bellamy:
    Well there clearly are, I was just going to say it's not only just truck drivers and prostitutes, we know that young girls often sell their bodies to their sugar daddies to get money for school fees. We know that in other parts - not only in sub-Saharan Africa but in Asia particularly - the most hit communities are the sex workers. So that is why the face of HIV/AIDS is increasingly a female face around the world and it's a female face because of this violence.

    Robin Lustig:
    Okay thanks for that. Let's go now to Dr Nils Daulaire who is on the line. He was a senior AIDS advisor to President Clinton, he's now president of the Global Health Council, which brings together health professionals around the world to discuss issues such as this. Nils Daulaire, I don't know how much of the programme you've been able to hear but in your mind what is the most important priority now as people try to come to terms with what has to be done?

    Nils Daulaire:
    Well it's clear that there are three major sets of issues that need to be addressed simultaneously. First is resources and with the Global Fund to fight AIDS, TB and malaria, the new initiative proposed and now partially funded that President Bush proposed last January, for $15 billion over the next five years and other commitments from governments around the world we are finally, after almost 20 years, getting to the point where adequate resources are beginning to appear on the horizon. So that's one. Secondly, political commitment and leadership is critical. I just heard your caller from Gaborone, certainly President Festus Mogai of Botswana and his commitment has played an important role, the work that's happened in Uganda has been to a considerable extent driven by President Museveni. And we see it around the world that the countries where this leadership and commitment is there programmes begin to move forward. But the third thing, which is often left for later consideration and really should not be, is the profound connection with communities to provide the education and the services in a trustworthy way and this is where non-governmental organisations, community based organisations and faith based organisations play a critical role, this cannot be left just to governments and the international agencies.

    Robin Lustig:
    I want to ask you just one question on the money issue. So many people in the richer countries say there's no point providing huge sums of money to these poorer countries because it never goes to the people who need it most, it gets wasted, it gets spent on the wrong things, it gets badly administered. How confident are you that when money is made available it does go to the people who need it, it is properly administered?

    Nils Daulaire:
    I think those kinds of arguments are an easy cynicism that are not borne out by the facts. We know that both governments and the non-governmental organisations that are committed to dealing with HIV and AIDS are applying the meagre resources they have to getting services and programmes and prevention activities out to the people who need it. Certainly this is not a perfect world, it's not perfect in any of the other things we do either, but what we've seen is time after time when the commitment, when the resources and when the connection with the communities is in place, things move and they can move quite quickly.

    Robin Lustig:
    Let me just put to you one question that's come in, an e-mail from California, Andres asks: What are your opinions on President Bush's $15 billion plan to assist with the HIV/AIDS epidemic?

    Nils Daulaire:
    I think it's a wonderful commitment from the highest level of the United States government to do something meaningful and important in HIV and AIDS. I know that there are questions about how this is going to be administered, questions of policy, but what we've seen over the last two years working with the Bush administration is a serious commitment to trying to do something that will actually have an impact. Having $15 billion on the table over the next five years I think makes a huge difference in terms of what we can anticipate doing. Two years ago nobody would have expected this.

    Robin Lustig:
    Nils Daulaire thanks very much indeed for joining us on the programme. Let's take another of our taped questions now, this one comes from Moscow:

    Victoria Kasikova:
    My name is Victoria Kasikova. I work for the AIDS Foundation East West, Moscow. I started to work in this field, HIV and AIDS prevention, not a long time ago but I have already realised that it's very difficult, even impossible, to struggle against HIV and AIDS without commitment of the high officials. That is why I would like to ask, what should be done to make HIV and AIDS a top priority for the highest political leaders here in Russia. Thank you.

    Robin Lustig:
    Carol Bellamy, in Russia what can be done to encourage political leaders to make it a higher priority?

    Carol Bellamy:
    Well you know these same political leaders have come to the United Nations a couple of times, at a special session specifically around HIV/AIDS and a year later at a special session around children, they've made statements, they've signed on the dotted line but when you take a look, whether it's Russia or other countries, the commitment at the top is still not there. Too many countries still park HIV/AIDS off in the health ministry and they don't really give it the commitment they should. It will not be confronted or responded to unless the presidents and the prime ministers take it on as their number one priority.

    Robin Lustig:
    And is there anything that other countries can do, that the United Nations as an organisation can do, to encourage them to do that?

    Carol Bellamy:
    Well you know it's out there in black and white, if you take a look at the countries where the head of the government has made a commitment they've either stabilised it or reduced the number of cases. Their countries will be in better shape or at least they have a possibility of being in better shape. So this isn't just hopeful, this is the truth.

    Robin Lustig:
    Gillian Anderson I know that your interest is primarily in South Africa, there's been a lot of controversy about the political degree of seriousness that the government has been showing towards it, are you persuaded that the government there is now doing what needs to be done?

    Gillian Anderson:
    And in other areas of Southern Africa as well, which is where a great deal of my interest is, there have been huge movements recently in - actually Zimbabwe showed some surprising statistics in terms of the funds that are going towards helping HIV and AIDS.

    Robin Lustig:
    So there is a change is there?

    Gillian Anderson:
    There is definitely a change and it's a very, very positive change but one thing that I keep wanting to stress is that yes the quotes of the billions of dollars, when you hear, as a civilian, billions of dollars that are going from our government towards HIV and AIDS worldwide it sounds absolutely phenomenal and it is but it's not enough. If we're spending $300 billion a year on subsidising agriculture we can put $10-15 billion a year towards fighting HIV and AIDS. And the way to get other governments to be interested - the Russian government to be interested and proactive as well - is to show that we have the political will that's appropriate to the situation to move forward and if we stand up and say this is far and beyond the most serious dilemma that's facing our entire planet right now and we are going to put as much effort and energy forward to putting the money into the Global Fund to getting it to the right places, so it goes from the communities down to the grass roots, and this is at the top of our priorities, then the other governments might start to pay attention too.

    Robin Lustig:
    We'll take another call, this is from South Africa as well, Dr Larry Guerney is on the line, Larry hello.

    Larry Guerney:
    Hello.

    Robin Lustig:
    Do you think that things are changing for the better in South Africa?

    Larry Guerney:
    Well I think it's very difficult for me because I've been positive for 13 years and I've moved down to work in South Africa from the UK and I'm working mostly with children and also doing training with adults and I find that I'm kind of like floating upstream sometimes, battling against all the work that does need doing, but what I really think that needs to be done is that everybody talks about large amounts of money that's needed to make a difference and my feeling is that in fact what we can actually do is do small things and sometimes those of us that are positive can be involved, although it's frightening sometimes to actually kind of like go in the face of the stigma.

    Robin Lustig:
    Give me an example of the kinds of small things that you're thinking of Larry?

    Larry Guerney:
    . we'll never get a chance to actually change people's attitudes.

    Robin Lustig:
    I was just wondering you talk about doing small things rather than spending billions of dollars, what kinds of things are you thinking of, what kinds of small things?

    Larry Guerney:
    Well the organisation - I set up an organisation about three years ago we were using art as a way of allowing children to present themselves a visual story of their lives and then we take that art and we bring that up to the northern countries - to the UK, to other countries in Europe - in order to engage with the kids up there so that those kids can become involved in actually doing something also to make a difference. And in that way it becomes a whole way of bridging the divide, a way of allowing kids in the north to understand what's happening to kids in the south. We are going to have 2.2 million orphans and memory books work, for example, is another things that we do, which costs nothing hardly to do. You get a cardboard box and you make memories and you allow the kids to have something so that if their parents do die at least they have something that they can cling to in the future. And it's those types of impacts that are going to make the big changes.

    Robin Lustig:
    So your message then Larry is that - whereas I'm sure you would say that more money would be most welcome it isn't the be all and end all, there are other things that need to be done that don't cost money?

    Larry Guerney:
    I think there are many things that don't cost money and we've managed to work in this organisation, that I set up, in very small ways, we've allowed people to see the images of the pictures that the kids are experiencing, the feelings that they're feeling, the emotions that they're feeling and in this way it allows people to actually - and for the first time in working in HIV and AIDS for 15 years and I know that it's not all about just creating a picture that people accept and do something when they see a picture but instead of creating images of sad faces these images that the children draw or paint have a way of speaking out to people, they have a way of actually kind of engaging people in ways that I have never experienced before. And you know in 15 years it was the first time when I started doing this work that anybody ever actually said oh that's a real shame. And that doesn't happen often in HIV and AIDS in the UK anymore.

    Robin Lustig:
    Larry thanks very much for that. Let's go now to Namibia to Razia Kauaria, who's the Secretary General of the Namibian Red Cross. Razia Kauaria what's your experience and what do you believe ought to be focussed on in this debate now?

    Razia Kauaria:
    Well thank you very much, I think the BBC will play a major role in keeping HIV/AIDS issues in the consciousness of the world. What we need is real help in our part of the world, which is the epicentre of the global AIDS pandemic. People really try, our governments try, but we need HIV/AIDS to be a global humanitarian crisis that receives the requisite response it deserves. It breaks my heart to see how after all the promises made the Global Fund remains under-funded. So my appeal is really to all the governments who promised to fund the Fund to do so now. We need help. I mean HIV/AIDS devastates peoples at an individual, family, community and national level. And in Southern Africa the thing that worries us most in the Red Cross is the impact of AIDS on food security. Many people in our part of the world they live on subsistence agriculture and once you have an adult member of the family affected by AIDS food security is gone for the entire family. I have also a big dream, a dream that one day we will find an AIDS vaccine and also that HIV and AIDS will become a chronically manageable illness, like it is in the West. So my appeal is that from us in Southern Africa we try very, very hard to address the various issues, it's a very complicated issue this, I mean why does HIV and AIDS spread here so fast? The power relationships between men and women, poverty, the migrant labour systems that we inherited from colonial rule, it's a multifaceted problem that deserves attention as well. But for now we need to focus on those that are infected and affected, it is causing immense suffering.

    Robin Lustig:
    Razia Kauaria thank you very much indeed, the Secretary General of the Namibian Red Cross.

    Let me read this e-mail that comes from Bangkok in Thailand. Nick Walters writes to say: I am a missionary physician and I worked in Ethiopia, money doesn't always help with AIDS, the local government in rural Ethiopia was afraid that if they didn't use the money they would lose it in the coming year so they simply gave cash to HIV positive people. Carol Bellamy we were talking a moment ago about ensuring that money that is made available is spent properly, in your experience is it?

    Carol Bellamy:
    I think it generally is, again I think the answer before was a correct one, that's an easy and cynical way of responding. I don't think it's just a question of money, it is a question, as has been suggested, political will, you need some money to back it up, ultimately in the long run, certainly for treatment, money is going to be necessary, but you also need to be able to build these networks at a community level.

    Robin Lustig:
    I want to stop you there Carol Bellamy. Just to take very quick last call, I'm sorry to interrupt you but we've got Roger Taylor on the line, who's a drummer with the famed rock group Queen and an AIDS activist now. Roger Taylor thanks for coming on the show, we've only got about a minute left I'm afraid.

    Roger Taylor:
    Hello my pleasure.

    Robin Lustig:
    I know you're going to get involved in a big concert shortly, just tell us a bit about it.

    Roger Taylor:
    Yes it was Nelson Mandela's idea, his big idea is to promote AIDS to the level of a basic human right and the concert is the hub of a sort of global telethon in order to raise not just funds but, as your previous speaker was saying, awareness and pressure - politically and on the pharmaceutical providers. So it's a multifaceted drive using our sort of platform of internationally known music - we must use whatever we have and that's our particular tool - and there will be a massive array of very talented artists from all over the world appearing in a concert in Cape Town on the 29th November.

    Robin Lustig:
    Roger, sorry to interrupt you but I'm afraid we're out of time, thanks very much indeed for that and that concert will of course be broadcast on the BBC. That I'm afraid is all we have time for today so my thanks to our guests - the actress Gillian Anderson, the head of UNICEF Carol Bellamy in New York and of course my thanks to all of you who've taken part in the programme.

    Carol Bellamy:
    Well you know it's out there in black and white, if you take a look at the countries where the head of the government has made a commitment they've either stabilised it or reduced the number of cases. Their countries will be in better shape or at least they have a possibility of being in better shape. So this isn't just hopeful, this is the truth.

    Robin Lustig:
    Gillian Anderson I know that your interest is primarily in South Africa, there's been a lot of controversy about the political degree of seriousness that the government has been showing towards it, are you persuaded that the government there is now doing what needs to be done?

    Gillian Anderson:
    And in other areas of Southern Africa as well, which is where a great deal of my interest is, there have been huge movements recently in - actually Zimbabwe showed some surprising statistics in terms of the funds that are going towards helping HIV and AIDS.

    Robin Lustig:
    So there is a change is there?

    Gillian Anderson:
    There is definitely a change and it's a very, very positive change but one thing that I keep wanting to stress is that yes the quotes of the billions of dollars, when you hear, as a civilian, billions of dollars that are going from our government towards HIV and AIDS worldwide it sounds absolutely phenomenal and it is but it's not enough. If we're spending $300 billion a year on subsidising agriculture we can put $10-15 billion a year towards fighting HIV and AIDS. And the way to get other governments to be interested - the Russian government to be interested and proactive as well - is to show that we have the political will that's appropriate to the situation to move forward and if we stand up and say this is far and beyond the most serious dilemma that's facing our entire planet right now and we are going to put as much effort and energy forward to putting the money into the Global Fund to getting it to the right places, so it goes from the communities down to the grass roots, and this is at the top of our priorities, then the other governments might start to pay attention too.

    Robin Lustig:
    We'll take another call, this is from South Africa as well, Dr Larry Guerney is on the line, Larry hello.

    Larry Guerney:
    Hello.

    Robin Lustig:
    Do you think that things are changing for the better in South Africa?

    Larry Guerney:
    Well I think it's very difficult for me because I've been positive for 13 years and I've moved down to work in South Africa from the UK and I'm working mostly with children and also doing training with adults and I find that I'm kind of like floating upstream sometimes, battling against all the work that does need doing, but what I really think that needs to be done is that everybody talks about large amounts of money that's needed to make a difference and my feeling is that in fact what we can actually do is do small things and sometimes those of us that are positive can be involved, although it's frightening sometimes to actually kind of like go in the face of the stigma.

    Robin Lustig:
    Give me an example of the kinds of small things that you're thinking of Larry?

    Larry Guerney:
    . we'll never get a chance to actually change people's attitudes.

    Robin Lustig:
    I was just wondering you talk about doing small things rather than spending billions of dollars, what kinds of things are you thinking of, what kinds of small things?

    Larry Guerney:
    Well the organisation - I set up an organisation about three years ago we were using art as a way of allowing children to present themselves a visual story of their lives and then we take that art and we bring that up to the northern countries - to the UK, to other countries in Europe - in order to engage with the kids up there so that those kids can become involved in actually doing something also to make a difference. And in that way it becomes a whole way of bridging the divide, a way of allowing kids in the north to understand what's happening to kids in the south. We are going to have 2.2 million orphans and memory books work, for example, is another things that we do, which costs nothing hardly to do. You get a cardboard box and you make memories and you allow the kids to have something so that if their parents do die at least they have something that they can cling to in the future. And it's those types of impacts that are going to make the big changes.

    Robin Lustig:
    So your message then Larry is that - whereas I'm sure you would say that more money would be most welcome it isn't the be all and end all, there are other things that need to be done that don't cost money?

    Larry Guerney:
    I think there are many things that don't cost money and we've managed to work in this organisation, that I set up, in very small ways, we've allowed people to see the images of the pictures that the kids are experiencing, the feelings that they're feeling, the emotions that they're feeling and in this way it allows people to actually - and for the first time in working in HIV and AIDS for 15 years and I know that it's not all about just creating a picture that people accept and do something when they see a picture but instead of creating images of sad faces these images that the children draw or paint have a way of speaking out to people, they have a way of actually kind of engaging people in ways that I have never experienced before. And you know in 15 years it was the first time when I started doing this work that anybody ever actually said oh that's a real shame. And that doesn't happen often in HIV and AIDS in the UK anymore.

    Robin Lustig:
    Larry thanks very much for that. Let's go now to Namibia to Razia Kauaria, who's the Secretary General of the Namibian Red Cross. Razia Kauaria what's your experience and what do you believe ought to be focussed on in this debate now?

    Razia Kauaria:
    Well thank you very much, I think the BBC will play a major role in keeping HIV/AIDS issues in the consciousness of the world. What we need is real help in our part of the world, which is the epicentre of the global AIDS pandemic. People really try, our governments try, but we need HIV/AIDS to be a global humanitarian crisis that receives the requisite response it deserves. It breaks my heart to see how after all the promises made the Global Fund remains under-funded. So my appeal is really to all the governments who promised to fund the Fund to do so now. We need help. I mean HIV/AIDS devastates peoples at an individual, family, community and national level. And in Southern Africa the thing that worries us most in the Red Cross is the impact of AIDS on food security. Many people in our part of the world they live on subsistence agriculture and once you have an adult member of the family affected by AIDS food security is gone for the entire family. I have also a big dream, a dream that one day we will find an AIDS vaccine and also that HIV and AIDS will become a chronically manageable illness, like it is in the West. So my appeal is that from us in Southern Africa we try very, very hard to address the various issues, it's a very complicated issue this, I mean why does HIV and AIDS spread here so fast? The power relationships between men and women, poverty, the migrant labour systems that we inherited from colonial rule, it's a multifaceted problem that deserves attention as well. But for now we need to focus on those that are infected and affected, it is causing immense suffering.

    Robin Lustig:
    Razia Kauaria thank you very much indeed, the Secretary General of the Namibian Red Cross.

    Let me read this e-mail that comes from Bangkok in Thailand. Nick Walters writes to say: I am a missionary physician and I worked in Ethiopia, money doesn't always help with AIDS, the local government in rural Ethiopia was afraid that if they didn't use the money they would lose it in the coming year so they simply gave cash to HIV positive people. Carol Bellamy we were talking a moment ago about ensuring that money that is made available is spent properly, in your experience is it?

    Carol Bellamy:
    I think it generally is, again I think the answer before was a correct one, that's an easy and cynical way of responding. I don't think it's just a question of money, it is a question, as has been suggested, political will, you need some money to back it up, ultimately in the long run, certainly for treatment, money is going to be necessary, but you also need to be able to build these networks at a community level.

    Robin Lustig:
    I want to stop you there Carol Bellamy. Just to take very quick last call, I'm sorry to interrupt you but we've got Roger Taylor on the line, who's a drummer with the famed rock group Queen and an AIDS activist now. Roger Taylor thanks for coming on the show, we've only got about a minute left I'm afraid.

    Roger Taylor:
    Hello my pleasure.

    Robin Lustig:
    I know you're going to get involved in a big concert shortly, just tell us a bit about it.

    Roger Taylor:
    Yes it was Nelson Mandela's idea, his big idea is to promote AIDS to the level of a basic human right and the concert is the hub of a sort of global telethon in order to raise not just funds but, as your previous speaker was saying, awareness and pressure - politically and on the pharmaceutical providers. So it's a multifaceted drive using our sort of platform of internationally known music - we must use whatever we have and that's our particular tool - and there will be a massive array of very talented artists from all overver the world appearing in a concert in Cape Town on the 29th November.

    Robin Lustig:
    Roger, sorry to interrupt you but I'm afraid we're out of time, thanks very much indeed for that and that concert will of course be broadcast on the BBC. That I'm afraid is all we have time for today so my thanks to our guests - the actress Gillian Anderson, the head of UNICEF Carol Bellamy in New York and of course my thanks to all of you who've taken part in the programme.




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