Nafis Sadik: Winning ways
While in Egypt for the World AIDS Day -- this worldwide commemoration of the disease, an attempt to raise awareness of it, extends till the end of the month -- United Nations Secretary-General Kofi Annan's Special Envoy for AIDS, Nafis Sadik illuminated many a significant issue.
Sadik is fond of drawing historical parallels. HIV/AIDS is fast spreading in the Arab and Muslim world. The official number of people infected might be low in comparison with some African countries south of the Sahara at the moment, but many of the countries currently worst hit by the HIV/AIDS pandemic used to have very low infection rates. Asked whether some countries in the Arab world could end up with high HIV/AIDS comparable to those of southern African countries, Sadik would not rule it out. But she stressed she was in Egypt primarily to draw attention to the growing problem of HIV/AIDS in the Arab world and to stop the spread of the disease in the region. This was the first ever high-level UN mission on HIV/AIDS in Egypt. During her visit, she spoke on a wide range of domestic, regional and international topics relating to the dreaded disease.
Nafis Sadik is no stranger to Egypt. She served as chair of the landmark International Conference on Population and Development (ICPD) in Cairo in 1994. Nor does she lack for recognition. For endeavours in population and development she received an Order of Merit (First Class) by President Hosni Mubarak. She is the recipient of the 1993 International Award from the National Family Planning and Reproductive Health Association (NEPHRA) and the "Hilal-i-Imtiaz" Award from the government of her native Pakistan. She is also the recipient of honourary degrees from United States universities such as Johns Hopkins, Brown, Duke, Michigan and Claremont as well as from Nihon University, Japan. This year, Sadik was designated UNFPA's Goodwill Ambassador for Obstetric Fistula. Sadik, a member of the Board of Governors of the Foundation for Human Development, the UN Foundation, the Asia Society and several other international foundations, is the author of numerous publications on reproductive health and family, population and development, women, and gender and development. She was the first woman in the history of the United Nations to lead one of its major voluntarily-funded programmes, the United Nations Population Fund (UNFPA), when she became its executive director in 1987. But it was not until November 2003 that Sadik was appointed a member of the UN secretary-general's High-Level Panel on Threats, Challenges and Change.
Resplendent in an exquisite russet sari, Nafis Sadik acknowledged me with the slightest inclination of her head. She is an invaluable adjutant to governments the world over, who balks at the idea of being viewed primarily as the resource person who holds the purse strings.
"I don't provide resources," Sadik said, twisting her head from side to side. She suddenly cleared her throat and burst into a coughing fit. "I am the resource -- the interlocutor for many countries," she continues, recovering from her spasm. "I try to persuade high-profile people to do more," she clarifies in a croak.
Sadik doesn't look as severe in the flesh as she sometimes looks in photographs. Her gusty approach to combating the spread of HIV/AIDS has won her many accolades, and earned the enmity of some. But she weathers on. There is a relentlessness about her. She is a determined woman, a high- flying achiever, particularly punctilious about transforming dreams into results. The tactic worked brilliantly.
A handsome woman with a loose, plump-lipped mouth, a swarthy complexion and large doleful eyes, she recounts the sadness, hopelessness and pain of HIV/AIDS sufferers. But, when she speaks of her hopes and successes her face lights up.
She comes across as a bundle of positive energy.
Sadik tells me what she's up to. At the moment she wants leaders -- at national, business, women and youth levels -- to encourage a multisectoral response to HIV/AIDS, bringing together key sectors working towards a common national strategy in each and every country to combat the spread of HIV/ AIDS.
In an unprecedented move, she commemorated the 2005 International HIV/AIDS Day in Egypt "to draw attention to the growing problem of HIV/AIDS in the Arab region." She regards Cairo as the regional nerve centre. Immediately before she came to Cairo she toured India, where she "learnt many valuable lessons". From Cairo she will head to the Nigerian capital Abuja to attend a UN-sponsored "Prevention of Mother to Child Transmission" conference.
"Numerous African countries have shown us what can be achieved with sound health-care policies, tolerance and understanding in spite of the challenge of meagre resources."
Her views are independent, but hardly incendiary. Governments in the region have tremendous power. But, that power is seldom brought to bear on the side of tolerance and open- mindedness.
"Initially there was a sense of denial," she explains. "People in this region believed that HIV/AIDS is an African problem. That it doesn't impact Muslim countries. But you see, it does."
Sadik's extraordinary self-belief has brought wondrous results. She is in the public eye on a global level and she cleverly manipulates her high-profile international position to yield the intended results.
It's not so much about counter-factual thinking, she says. It is essentially about what moulds our thinking. This has big implications for solving the problem of HIV/AIDS.
It's about being pushy and being proud of being pushy, she says. "I push governments into action and I push the private sector and non-governmental organisations to act and act fast."
Many of our countries are grappling with their cultural values, she observes. In Egypt, there is an awareness that the numbers of infected people are small. "Moreover, the majority of HIV-infected people don't know that they are," she adds.
The remark appeared casual and throwaway, but it was not. The authorities, the media and civil society need to do something about the impending dangers of an HIV/AIDS pandemic in some of the countries of the region. Egypt might be relatively safe for the moment, but it cannot continue to be shielded from the ravages of HIV/AIDS if the pandemic hits Sudan, for example. Egyptians cannot afford to remain indifferent to the problem of HIV/AIDS.
This is also true, although not everybody appears to have got the message. According to UN statistics, HIV prevalence in Egypt's general population remains relatively low.
"However, the number of reported HIV cases is steadily rising. The Egyptian government has taken early steps to prevent the spread of HIV by creating a National AIDS Programme within the Ministry of Health and Population. Recently, the Ministry of Health and Population established voluntary counselling and testing sites allowing individuals to obtain HIV blood tests along with counselling, as per UNAIDS and WHO international recommendations. Life-saving HIV treatment has also recently become available to those who need it."
During her visit to Egypt, Sadik met Mrs Suzanne Mubarak, ministers, representatives of the country's business community and civil society. She commended the Egyptian authorities for their efforts, but urged a more concerted national strategy to combat HIV/AIDS.
"Poverty is often the primary cause for the spread of HIV/ AIDS. Poverty is also closely related to survival rates. If the patients are not well nourished, they don't respond positively to anti-retrovirals. It is a question of nutrition," Sadik says.
"What has also changed dramatically is the nature of the spread of the disease itself."
Sadik is convinced that women and the young are the highest-risk groups and that traditional cultural inhibitions and religious prohibitions are not always effective in combating the spread of HIV/AIDS.
"In many Arab and Muslim countries, for example, parents object to their children learning about sex at school. Teachers don't want to teach sex education and religious leaders can be a serious problem."
Quite naturally, the prickly issue of identity politics, so currently in vogue in the region is particularly poignant when the relevance HIV/AIDS to it is heightened. Politics and religion are a combustible mix and when combined with HIV/AIDS can be cause for grave concern.
"They fear that sex education might be synonymous with a sharp increase in sexual activity among teenagers.
"But half of all new infections are among young people, especially adolescents," Sadik says. She has gone to great pains to emphasise the differences between the precise nature of the spread of HIV/AIDS in different countries and regions. But she is equally conscious of the similarities. Every country has to grapple with young people's safety and health. Most World Health Organisation (WHO) and UNAIDS reports suggest that sexual activity among young people outside marriage is fast increasing -- even in the Arab and Muslim worlds.
"Even if young people want to indulge in sexual activity, they must be informed." Delayed sexual activity is not always the preferred course of action in some societies. "The topic of sex is not discussed in our societies. Even within our own families any discussion about sex is frowned upon and considered taboo."
Within her capacity as the UN Secretary-General's Special Envoy for HIV/AIDS, Dr Sadik advocates an exceptional response to AIDS at global, regional and national levels.
Sadik is not given to indulgence in do-gooding fantasies. "I use my programme experience," she says. "I speak from experience. I deal with statistics and I take scrupulous note of developments -- local, regional and international."
She expressed some disappointment that the governments in the Arab world are not taking the problem of HIV/AIDS seriously. But there have been increasing signs that governments in the region are getting far more serious about fighting HIV/AIDS.
"Are the figures right?" she asks rhetorically. "The press doesn't believe the official figures. People in the know don't. Still, many leaders have started to take action."
Sadik warns that we need to eliminate stigma and discrimination associated with HIV/AIDS sufferers. "You can go to a mosque and pray with a man who is HIV positive and has AIDS. You can sit, eat, shake hands with them. We need to eliminate the people's fear of and utter contempt for HIV/ AIDS sufferers."
The prevalent attitude is that HIV/AIDS sufferers were infected because of their debauched sexual behaviour. But, as Sadik stressed, some 95 per cent of woman sufferers got the disease from their husbands.
"There is so much misinformation about HIV/AIDS. People known to have AIDS are kicked out of their jobs, socially ostracised and even shunned by their own extended family. In Pakistan sometimes they are required to live outside the village," she laments.
"There is the notion that the victims of the disease deserve what they get. Some religious leaders even say that HIV/ AIDS is an example of the wrath of Allah, that the disease is God's retribution for sexual deviance and debauchery."
Sadik disclosed that, according to the latest research findings, some 60 per cent of homosexual men in Egypt are married. In her native Pakistan, 98 per cent of homosexual men are married.
"We need to take such figures into account when formulating strategies to combat the spread of HIV/AIDS."
Commercial sex is illegal in most Muslim countries. Small wonder then that there is a large underground army of commercial sex workers there.
In Senegal, a predominantly Muslim West African country, the highest incidence of HIV/AIDS was found to be among commercial sex workers. The Senegalese government could not legalise sex workers, but initiated injunctions that require them to use condoms.
Sex workers and brothel owners were encouraged to refuse transactions and even though commercial sex was outside the legal framework, the policy soon brought about results. "The Senegalese example shows that we need to adopt a more pragmatic approach to fighting the spread of HIV/AIDS."
Sadik has traveled extensively in Asia and Africa in search of answers to the challenge of HIV/AIDS. Asked whether she recommended the policies of a particular country, she indicated that she was most inclined to champion the Iranian experience. "I was quite impressed with Iran's HIV/AIDS control programme. Infections were quite high among prisoners and the Iranian authorities focused their campaign on prisons and reducing homosexuality in prisons by increasing the number of visits by the wives of prisoners."
However, she quickly added that what works in Iran might not necessarily work in other countries. "Every country must adopt the policies and strategies that are best suited to it," she says.
Iran adopted a very successful needle exchange programme. And, other countries ought to take note. High-risk behaviour groups such as intravenous drug users were targeted by the Iranian authorities. But in some countries intravenous drugs are not necessarily the main conduit for the spread of HIV/AIDS.
"As countries see that others are taking action they are encouraged to do the same."
Sadik stressed the vulnerability of women. In Asia, the AIDS epidemic erupted 10 years later than Africa, but it is fast spreading in countries of South and Southeast Asia and China. Women are far more susceptible to HIV/AIDS than men.
Migrant workers, men who work abroad, are often the main transmitters of the disease. These men often have illicit sex with prostitutes abroad and return to infect their wives.
In many countries in Asia and Africa, women first detect that they are infected by chance when they become pregnant, Sadik says. It is important, therefore, to encourage women's groups, especially in rural areas, to prevent mother-to-child transmission. The number of women being treated with retrovirals is increasing, but women must be made more aware of how they contract the disease.
"If a man dies of AIDS, his children invariably survive. If a woman dies, her children also die."
That being the case, men are often treated first. Maternal mortality is exceptionally high among women in many developing countries. And that does note bode well in light of the fact that innocence in matters of intimacy is supposed to be the hallmark of a virtuous girl in traditional Arab and Muslim societies.
"Women and girls must not be kept in the dark about sexual matters. In many Muslim countries, they are often clueless about sex, let alone safe sex. That is unfair."
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