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| Home » Interview » Dr. Daniel J.M. Tarantola |
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INTERVIEW - Dr. Daniel J.M.
Tarantola, |
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Senior Policy Advisor to
the Director General, World Health Organisation |
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| “Social movement against gaps
needed.” |
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| How serious is the epidemic
in Asia Pacific? There are projections that Asia Pacific is
going to be worst hit. Is the comparison with Africa real? |
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| One should first recognise the wide diversity
in the way HIV epidemics have emerged and spread over the last
two decades. This region has some epidemics fuelled by injecting
drug practices (e.g. Thailand, Nepal, south-eastern China);
others by sexual and parent-to-child transmission (e.g. India);
while some epidemics have been fuelled due to unsafe blood transfusion
practices, as was witnessed in India and China. The seriousness
of the epidemic varies considerably across countries and within
each country, across provinces. |
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| Overall, Asia Pacific will remain the larger
contributor to new cases during this decade, although it is
unlikely that the continent will become the site of a massive
heterosexually transmitted epidemic as was experienced by Africa.
HIV rates in the population at large will remain low (below
1/100). But given the size of the population, the number of
cases produced each year will be considerable. |
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| The macro-economic impact of HIV/AIDS in Asia Pacific is likely
to remain minimal for a number of reasons, including low prevalence
rates, the vast pool of people who can participate in economic
production, family systems, which can provide some safety nets. |
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| How have culture and religion played a
role in the campaign against HIV/AIDS in Asia Pacific? |
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| Historically, most countries in Asia Pacific
went through a period of denial through the late 1980s. Thailand
was the first country to rise against HIV/AIDS with a national
plan drafted in 1987 (apart from Australia and New Zealand,
where the epidemics behaved like those in Western Europe and
America). The first reaction to the emergence of HIV/AIDS was
to deport HIV-positive visitors or students (e.g. India, China),
to incarcerate nationals living with HIV (e.g. several States
in India) or to quarantine people on remote islands (as was
proposed in Tonga). Being largely associated with sexual practices
of men having sex with men, sex work and injecting drug use,
HIV/AIDS suffered from major cultural and social stigma. |
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| The 1990s witnessed massive information campaigns,
which helped reduce the fear and stigma attached to HIV. These
campaigns were conducted mostly by NGOs, but governments supported
them financially and through other means. Dealing with injecting
drug use was and remains an issue most governments are not willing
to engage in. |
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| Some religious groups (e.g. Bhuddhists in Thailand,
Christians in India and the Philippines) helped minimise the
individual impact of HIV by opening day care centres or hospices,
to which people with AIDS-related diseases were admitted. |
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| What populations in your view
are more vulnerable in the Asia Pacific region? |
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| Mobile populations (migrants for social or economic
reasons) and among them, young women in particular are most
vulnerable to the HIV/AIDS epidemic. |
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| Do the experiences elsewhere
in the world provide any opportunities to the region? |
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| Asia has constantly learned from outside and
has contributed to the advancement of knowledge as well. Applying
openness and compassion, rather than repression, in dealing
with certain social and behavioral issues is one of the experiences
learned by Asia from other continents and adapted to their own
situation. |
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| What do you think are urgently needed in
the region? |
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- An effective combination of prevention and care strategies,
which will help to de-stigmatise HIV/AIDS and encourage
people to come forward for testing.
- A major social movement, which reduces the cultural, social
and economic gaps between men and women. This requires greater
access to education by women and equal employment opportunities
with equal wages.
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| With generic drugs, access to ARV has become
a reality. Still majority can’t afford it. What needs
to be done? |
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- Clarify intellectual property laws and their application.
- Establish treatment centres in every district.
- Apply government subsidy to cover drug and treatment cost.
- Put pressure on big pharmaceuticals, as well as generic
manufacturers for further price reduction.
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| What are your observations about the PLWHA
situation in Asia Pacific - their rights vis-à-vis vaccine
trials, access to treatment, medical insurance etc.? |
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| It is impossible to answer on a regional basis.
The official and public attitude towards PLWHA varies considerably
from one country to the next. Vaccine clinical trials in Asia
have not involved vaccine candidates used in people already
HIV-positive, but among those who are not. Access to treatment
remains generally poor and medical insurance is the exception
rather than the rule. So, all in all, the situation is not bright. |
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| How has AIDS become a human
rights issue in the region? |
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| The initial debate around human rights revolved
around the right to privacy, which emerged because several governments
had imposed HIV testing on some population groups and restricted
the rights of people found positive. NGOs became active - in
Thailand and later in Nepal and India - emphasising protection
of human rights in a global context, where human rights were
becoming an integral part of HIV prevention strategies. (See
AIDS in the World II, by Mann and Tarantola, Oxford University
Press 1996.) The World Health Organisation Global Programme
on AIDS, UNAIDS and UNDP played a significant role in keeping
human rights on the HIV agenda. |
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| For historical background, see the special
issue of the Journal AIDS, AIDS in Asia in the Pacific, edited
by John Kaldor et Al., 1996. For epidemiological data, check
the WHO and UNAIDS websites and the site of Monitoring the AIDS
Pandemic (MAP) which provides an independent analysis of HIV/AIDS
globally and regionally. |
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| About
Dr. Daniel J.M. Tarantola |
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