Winnie Byanyima (UNAIDS Director) at the World Economic Forum 2020 on needed action

Winnie Byanyima (UNAIDS Director) at the World Economic Forum 2020 on needed action

This week, at the World Economic Forum 2020 in Switzerland, Winnie Byanyima, UNAIDS Director, put the fight against AIDS on the agenda as she took a strong stand during a session on shaping the future of health and healthcare systems

An issue of rights, human rights
She openly discussed the dangers of universal health coverage (UHC) and success of community-led approaches with industry leaders from the health-tech, private healthcare, pharmaceutical and political fields. 

"From our world in fighting HIV and AIDS. 24.5 million people are now in treatment, and another 15 million are still waiting to be treated. There's progress, but it's still a big journey. We also saw reductions in new infections, but still last year alone, 1.7 million people were newly affection. 770,000 people died of AIDS. That's unacceptable. We're at a point where we can stop AIDS-related deaths. We are at a point in which the science for prevention and treatment is there. But what we saw last year for the first time, is that the increase for new infections is mostly among those we call key populations: gay men, men having sex with men, sex workers, prisoners, people who inject drugs, those on the margins of society. In reality, it is about inequality, millions are being left behind, not because the scene isn't there, but because we make choices that privilege the mainstream and not the weakest, poorest and most vulnerable. It's an issue of rights, human rights. Sexual minorities are at stake here — criminalisation, stigmatisation, discrimination. In Africa, the face of HIV is a young woman. It is about sexual violence and social norms. We have to address these. We have to continue looking for science. Without removing social barriers, human rights issues, laws that criminalise, we will not win this."  

UHC and community-led work
As the world is moving towards UHC, there are many opposing perspectives of its implementation. Byanyima sketches a picture of reality and the role of community-led success. 

"We are now in the world of SDGs and universal health coverage, not care. The coverage seems to be more about bringing in the private sector and saying that public provision is not possible. Now you need health insurance sold by profit makers. This is going to leave communities behind - those who have supported and provided HIV services. In Africa, you find small community-based organisations that are part of the prevention and delivery system. Without that, UHC is giving treatment the main focus. Yet, it is prevention we should be at, and prevention is the work of communities. It is communities who educate children, help families, and take care of the ecosystem that is needed. So communities rights are at the centre of this epidemic. It is not a disease; it's a social justice issue, of poverty, exclusion, denial of rights. This is the focus of communities."

The role of health systems 
Byanyima responds to statements made on the responsibility of health systems. 

"I agree it's about health systems and we'll know how good it is by seeing how well it caters for the poorest most vulnerable. But here are the problems I see. In Africa, the face of this epidemic is the face of a girl, as I said. Out of every 5 infections amongst adolescent, 4 are of young girls. This is clearly an issue of protecting young girls and preventing them from getting infected. It's a lot about sexual violence. Now PEPFAR was looking at their recent expenditure. It found it had spent $5 billion on preventive measures. But from that, it only spent $600 million on sexual reproductive health. Image the difference there. There are inequities in this system, and they worsen when you sell health. 

I met a woman called Victoria, who lives in a sum in Kenya. She was infected when she was about 12 years old. She was raped. She found out when she was 16 because she had fallen sick and was expelled from school. But she fought, became an activist and got treatment. And now she is a community volunteer: again, communities. She goes to the facility, helps people in the community to go and test. She helps women to understand how to prevent them from passing HIV on to their children and dealing with so many issues. For all that works she does, solving the problems of people from their home to the facility, she receives $20 a month from the facility. That's all she lives on in her slum: $20 for all the work that gets people from their homes to their facility. The facility is free, is a government provision, but the government doesn't take care of the whole issue. 

Unless we have a system were the whole need is taken care of, you're passing that burden onto a few people in the community, who are not paid for it. This is what I fear about the health insurance systems that are privately provided, profit-centred. They narrow healthcare to the facility and everything else is paid by volunteers, mostly women, and inequity continues to grow."

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