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Coping with the AIDS tragedy

KAMPALA, Uganda, (CNN) -- CNN's Charles Hodson interviewed the head of UNICEF in Uganda, Michel Sidibe

Q: How serious a problem is HIV/AIDS in Africa?

A: It is already clear that in terms of death and destruction it is the worst calamity that this continent is facing.

I was visiting a village just a few days ago when I met an old woman. She had lost eight of her children and was trying to care for 24 orphans. More than 25 million people have already been infected by AIDS in Africa, but what is worse is the orphan problem.

Sub-Saharan Africa accounts for nearly 70% of the world's 36 million cases of HIV and AIDS
Uganda spends $7 per person per year on health care

We are talking about 1.7 million orphans in Uganda alone. How will we cope with children who are already failing? More than 40 percent of pupils are already living on less than $1 a day. When you are facing this type of tragedy, you need a new kind of global solidarity without which you cannot make a big difference.

Their families are stretched, the traditional mechanism cannot cope any more and you cannot put 1.7 million children in orphanages. No institution in Africa today is able to finance, support and sustain this type of tragedy.

Q: Clearly prevention is very important but how important is it to get anti-retroviral (ARV) drugs into villages and places in Uganda where people need them?

A: Access to drugs is crucial. It's morally unacceptable that the disease is mainly in the south but the solution is in the north. No access to drugs is a crime against humanity.

In Africa, 25 million people are infected and less than 25, 000 have access to drugs. That is a crime, but for me it's possible. It's possible because we have demonstrated that in the case of Uganda and in the case of Senegal, we can really advocate and reduce the price of drugs. In the case of Uganda the price has been reduced by 90 percent. We are talking about $80 a month, but that is still a very high price because you are talking about almost $1,000 a year in a country where the GDP is less than $200 per person per year.

Q: Sceptics say it is difficult to persuade people who in many cases can't read or write particularly well, to take their drugs correctly. What do you think?

A: I think this is a wrong. The reality is that first we must reduce the cost of the drugs, which is possible. All the analysis and surveys have proven that we can produce the drugs at a marginal cost for the poor.

If that is possible, I feel that what we are proposing is a comprehensive care approach which means that the whole mechanism of the distribution of the health care system can be reinforced. We can also treat opportunistic infection with other drugs. When the world is really determined, it's possible.

Look at what happened with the immunisation programme, for example. I remember, 15 or 20 years ago when we were trying to immunise 80 per cent of the children in the world. They told us it was not possible as we didn't have a health system.

Believe me, we achieved it. The world achieved it. We distributed the vaccines in communities where there was no electricity, where trains did not exist. It helped us develop our outreach system. It's helped us train more people. I believe it is more difficult to administer tuberculosis drugs then distribute ARV to people everywhere. It is a matter of global solidarity.

Q: How are you going to get drug prices down for people in countries like Uganda?

A: If you don't have a commitment, a moral commitment globally to advocate and continue to make sure that pharmaceutical companies understand that they need to collaborate with the poorest segment of the world and make sure they can provide the drugs at a marginal cost, it will not happen.

Q: Some people would say that the approach taken for example by the president of Uganda, Yoweri Museveni, is to sign a pact with the devil -- that signing up with the drug companies, reaching an accommodation with them is wrong and really they should be bullied by whatever means. What do you think?

A: When you are a president of a country you are facing a dilemma. When you have one million people infected in your country, when you have 1.7 million children already orphaned, when you have 43,000 children infected every year through the transmission from mother to child, you would try to make anything possible to get the drugs available for your people.

On the other hand, I think it is time to really say that it's not acceptable. When you have a tragedy touching practically 25 million people in one continent at their most productive age and say you that you can't give them access because the firms will lose their R&D investment, it is morally unacceptable.

Q: How will drug companies pay for research and development if they don't have the assurance of healthy profits?

A: Other drugs could compensate for anti-retroviral drugs. I think it's important to have a global solidarity and think about global social justice. I think that is very important from my perspective and is lacking somewhere.

Q: How effectively are you, from the United Nations, able to work with the local government authorities here in Uganda?

A: We are lucky in Uganda. It is one of the countries that have been the most assertive in terms of dealing with AIDS. They started 10 years ago to break the silence of "conspiracy" about AIDS by talking about it and fighting against the stigma and making the whole process of decentralisation effective. Today, we have a district response initiative. I think our environment for working in Uganda is very good. It's helping us to make a difference every day.



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