No Time to Lose: A Life in Pursuit of Deadly Viruses (30 page)

AT MARK’S CLUB,
in London, in March 1998, over some smoked haddock and a superb Chateau Haut Brion, Bill Roedy—the president of MTV Networks International—and I hit it off. He was a very unusual business executive: a West Point and Harvard graduate, former commander of a nuclear missile unit, and friend of just about every rock star in the world. He had turned MTV into the first global communication network, with strong local roots across the world—with the exception of Africa. His channels regularly reached 800 million young people. The title of his autobiography,
How to Make Business Rock
, says it all.

Bill agreed on the spot to become a special UNAIDS ambassador—there were no clearance procedures then for this kind of honorary appointment—and we agreed that MTV would launch the “Staying Alive” initiative (now a foundation) to promote HIV prevention among young people. It was clear that if we wanted to reach young people, we needed to go through their channels, and clear too that journalists and communicators might save more lives than doctors, at least in terms of preventing new infections.

Organized religion was a final piece of the puzzle of the brilliant coalition I was hoping to shape. It was not my idea: I had seen so many churches and religious figures react judgmentally to the use of condoms, or brand people with HIV as sinners. However, Sally Cowal convinced me that all those who are part of the problem should be part of the solution, and she very sensibly pointed to religion’s influence on billions of people. From my experience in interior Zaire I knew that outside major cities, religious organizations are often the only source of medical care and education: if we wanted to reach rural populations, we had to enroll them in our efforts.

In 1995 I made an eye-opening visit to the venerable monk at the Wat Pra Baht Nam Phu Temple near Chiang Mai in northern Thailand, a region where then about 8 percent pregnant women were HIV positive—the highest rate in Asia. The venerable monk was sitting on a dais surrounded by at least 50 small bags. These contained the unclaimed ashes of people who died from AIDS: their families had rejected them even after death. He explained that his temple was the only place in the area where people with AIDS could receive any care and support (this was before antiretroviral therapy) and that many were thrown out of their families’ homes. Some were young women who had become infected with HIV while working in the brothels of Bangkok, often encouraged by their family to seek work in the capital—an extra source of income in this poor region.

That encounter had a profound impression on me, as did meeting Canon Gideon Byamugisha of the Anglican Church of Uganda, who was openly living with HIV. A priest with HIV—I thought that this must be one of the most stigmatized situations you can be in, and I felt for him. But he was utterly joyful, his big eyes full of vitality and a twinkle of laughter. He told me that his congregation had excluded AIDS patients, and how he had struggled to disclose his HIV status to his wife, his colleagues, and his congregation. But his bishop had asked him to head the Anglican Church’s AIDS mission in Uganda. He surprisingly became a speaker on AIDS across Africa, and did a great deal to take the sting of stigma away from HIV in Christian communities and beyond.

A few weeks after that meeting I attended a health education session for young women in a Catholic mission in Côte d’Ivoire, near Yamoussoukro, the town where President Félix Houphouet-Boigny had at great public expense built the second-largest cathedral in the world at his birthplace. At some point, a drawing of a condom appeared on the flip chart, and I asked the (European) nun who was making the presentation, “Sister, are you promoting condoms?” She blushed, and replied, “Doctor, when I show this chart, I think as a woman”—meaning, I assumed, rather than as a devout Catholic nun.

I wondered what her superiors would think of this deviation from doctrine, and received an answer when I visited a Catholic hospital in Namibia in southern Africa. An array of condoms was available to all in a basket at the outpatient clinic. I asked the same question to the nun in charge: “Sister, are you promoting condoms?” Her answer was short: “Doctor Piot, Rome is a long way from Namibia.” Away she went. It made me understand that even a religion with a hierarchical structure as apparently rigid as the Roman Catholic Church’s is not in reality monolithic, but guided in its daily work by the variable styles of individual humans.

A former Dominican monk from Sweden, Kalle Almedal, who worked at UNAIDS, helped us establish an agreement with Caritas, the Catholic aid organization that is active on the ground in most countries. This was in 1996, a few years before most UN organizations started courting organized religious groups. Our project work with Caritas went smoothly, but some Catholic priests continued to preach against condoms in a fairly obsessive way, and Pope John Paul also spoke out firmly against them when visiting African countries.

To me, the Vatican’s opposition to condoms was irresponsible and shocking. Nonetheless, we continued to work with members of the Church’s hierarchy on the ground, and I met regularly with successive papal nuncios in Geneva—very reasonable men, whom I found both pragmatic and cultivated. Then one day in 2003, Cardinal Lopez Trujillo, head of the Pontifical Council of the Family, made a widely publicized statement that condoms could in no way prevent HIV: they had little holes through which the virus could penetrate. This was too much for me to tolerate. I called the papal nuncio in Geneva and expressed my dismay, saying that this was scientific nonsense and that I would publicly hold men like Trujillo accountable for people dying from AIDS. The nuncio was actually embarrassed, I think. We agreed that I should discuss the matter directly with the Vatican, where I had met twice with Archbishop Javier Lozano Barragan, the courteous head of the Pontifical Council for Health Pastoral Care. Somewhat the Vatican minister of health, he was an imposing man—a former teacher of Latin in his native Mexico—who reminded me of Francis Bacon’s famous painting of Pope Innocent X.

Several weeks later the nuncio informed me that the Holy See had agreed to an appointment. I went to Rome with two objectives: I wanted to find more solid common ground between UNAIDS and the Church, and I wanted an armistice on the condom. I knew that Pope John Paul II would never promote condom use, and my inner chameleon told me that it was totally nonproductive to have our relationship dominated by this issue. But the Catholic clergy should at the least refrain from preaching against condoms, especially when such preaching involved misinformation.

I spent two fascinating days in the Vatican, walking from one cardinal’s office to another through Renaissance and Baroque corridors festooned with cherubs, talking about AIDS. They were very well organized: by the time I saw someone, he had already received a briefing on my meeting with all his other colleagues. After a delicious lunch in a small trattoria in Trastevere Archbishop Lozano and I reached an agreement: UNAIDS had no competency in theological and moral matters, but, as he put it, the Church had no competency regarding “the quality of materials.” In other words, the Church would refrain from statements about condoms and UNAIDS would refrain from criticizing the Church. This carefully worded verbal agreement saved, I think, many lives, and isn’t the preservation of life the highest moral imperative of them all?

There is more than one pope in the world, and in 1997 in Cairo, I met Shenouda III, Pope of the Egyptian Coptic Church, together with Sally Cowal (who had to cover her hair with a big scarf). The Pope was accompanied by five bishops, who looked like clones of him: all six were wrapped in black, with long beards. All I could see of him under his vestments were his impressive nose and vivid eyes. I asked him to send a message to all churches to inform his flock about AIDS, and preach tolerance toward people living with HIV. He immediately accepted, but then in loud and heavily accented, but fluent, English pronounced, “Professor, AIDS is caused by illegal fornication.”

His white beard nodded emphatically as he spoke and his sonorous, plummy voice lingered over every syllable: “
Forrr
nication. There are those who are born like that, and they should be treated, and there are those who do it for fun. And they should repent.”

I glanced at Sally; we did not dare to look at each other or at the rest of the meeting. It was a silly, schoolboy reaction, for we then had a very interesting and open discussion about the nature of homosexuality. It was certainly not as bad as the conversation I had had the day before with Suzanne Mubarak, the First Lady of Egypt, who had told me that no tree could be high enough to hang “these homosexuals.”

Our next appointment was with one of the most respected religious scholars in Sunni Islam, Sheikh Said Tantawy, the Imam of El Azhar Mosque. He seemed more like a professor than a cleric, in his office crowded with books. That too was a productive and essentially benign conversation, and as a result he too regularly talked about AIDS.

It can be very powerful when the whole religious leadership of a country comes together to send a message about openness and against discrimination of people living with HIV. That is what happened in 1999 in Addis Ababa, the capital of Ethiopia, following some meetings I had with Patriarch Abune Paulo of the Ethiopian Orthodox Church and President Negasso Gidada. It created a safe space for a few men with HIV to come out and give a face to AIDS in a country where the disease had been completely hidden, even though close to a million people were infected. Dawn of Hope, the first association of people living with HIV in Ethiopia, was born, and I was proud to have helped make it happen.

As so often, it was Archbishop Desmond Tutu from Cape Town who said it best, in an advertisement campaign on AIDS in South African newspapers:
Sex is a beautiful gift of God
. If only all his colleagues would think the same.

NOT EVERYTHING WE
tried worked. In June 1998, I addressed the plenary session of the Organization of African Unity Summit in Ouagadougou, the capital of Burkina Fasso, in West Africa. It was a rare privilege for a non-African and non–head of state, and I felt it reflected an increasing realization among Africans that bold action needed to be taken against the epidemic. I foresaw an international partnership that would bring together African governments and civil society, as well as donors and the UN, to mobilize money and action for HIV prevention and treatment.

But we did not succeed in mobilizing political commitments or the new money that was so badly needed. The partnership plan was, I think, too UN-focused; it gave African governments little sense that they “owned” the project. Also, at the time donor agencies were not ready to commit serious money to AIDS in Africa.
They
wanted to control the agenda, instead of UNAIDS, so they undermined the initiative in many subtle and not-so-subtle ways. They still didn’t “get” that the epidemic was destroying their own programs for African development.

On the positive side, at their annual meeting in May 1999 in Addis Ababa, all the finance ministers of every African country discussed AIDS together for the first time. After I spoke about the epidemic’s threat to economic development there was dead silence. I thought it was yet another moment of supreme denial—that, following this pause, everyone would manage to compose a straight face and go back to business as usual. But then the minister of finance of Benin took the floor, saying, “Yes, we have a problem, and it is high time we face reality.” One after another the ministers spoke, sometimes referring to AIDS in their family or colleagues. That evening many joined me for a drink in the hotel, continuing the discussion, and asked how they could be of practical help.

The same year, the World Bank established an AIDS Campaign Team, ACT Africa, in the office of its vice president for Africa, with Debrework Zewdie as its head—another important development, as the bank wields great power in Africa. We also forced all the major aid agencies to discuss AIDS for the first time, among themselves, in London in April 1999, and again in December 1999—this time with African ministers, activists, and business leaders, at a meeting convened by UN Secretary-General Kofi Annan.

That meeting was a big gamble and it nearly cost me my job. I assured Annan’s deputy, Louise Frechette, that there would be high-level participation at the meeting, and I concentrated my efforts on convincing Africans to be there. They came. But we then learned that, led by the United Kingdom and Sweden, the donors planned to take a passive-aggressive approach and send only junior staff. In desperation, Jim Sherry and I called upon some personal friends to break this de facto boycott by the donors. Sandy Thurman, Clinton’s AIDS czar, and my compatriot from Antwerp, Eddy Boutmans (the Belgian state secretary for international development) changed their plans and arrived just in time to deliver strong messages of support. Annan was at his best, and the African participants made it clear then that they wanted to act on AIDS.

This, alongside Kofi Annan’s newly visible commitment, signaled to the donors that they needed to get their act together. It also meant that Africa started slowly to take ownership of the AIDS issue. We had been the catalyst in this realization. But it had taken a long time—far too long—to get to this point.

By 1999 about 26 million adults and children were living with HIV, two thirds of them in Africa. More than 9000 new infections occurred every day, or over six every minute. More than one-fifth of those newly infected were young people aged fifteen to twenty-four. Some 5.9 million African children had been made orphans because of AIDS. In 16 African countries, 1 in 10 adults had the AIDS virus. And barely one-tenth of 1 percent of them were receiving life-saving antiretroviral treatment. Our annual report on the state of AIDS in the world suggested that in 1999 AIDS had become the first cause of death in sub-Saharan Africa. Out of nothing a few decades before, a virus had taken over all causes of ill health.

But by the turn of the millennium our “brilliant coalition” was taking shape in all its diversity and apparent chaos. What could the South African Chamber of Mines, Anglican Church, Communist Party, and trades unions have in common with the Treatment Action Campaign, Médecins Sans Frontières, and UNAIDS? A common goal: defeating the AIDS epidemic and caring for its victims. A powerful joint desire to be a force for change.