Feature Story

Dr Marijke Wijnroks, Netherland AIDS Ambassador, at UNAIDS Head Quarters in Geneva. January, 2010.
Credit: UNAIDS

The Netherlands’ AIDS Ambassador Dr Marijke Wijnroks recently visited UNAIDS Secretariat to meet with Michel Sidibé UNAIDS Executive Director and senior management of the Joint Programme. We took the opportunity to ask Dr Wijnroks about her role as her country’s AIDS Ambassador, and discussed some of the key issues in the Dutch approach to the global issue of HIV.

UNAIDS: Dr Wijnroks, you were appointed Dutch AIDS Ambassador in July 2009. What do you see as your role in the global response to HIV?

Marijke Wijnroks: As the Dutch AIDS Ambassador I represent the Netherlands’ Ministry of Foreign Affairs in the area of AIDS.

Our government has a policy covering both HIV and Sexual and Reproductive Health and Rights (SRHR), since we believe that these two areas are strongly linked.

One the one hand, the policy focuses on prevention, and on the one hand the promotion and protection of rights associated with Sexual and Reproductive Health. Issues covered by the policy are prevention of HIV infection, prevention of unwanted pregnancies, and preventing maternal morbidity and mortality, coupled with promotion and protection of the human rights of people who are vulnerable to HIV infection, sexual and reproductive rights included.

Within that broad policy framework, I try to focus on two areas. Firstly, what you can call the “normalisation” of the AIDS response. This means integrating AIDS services within the health system, and highlight the linkages between AIDS and Sexual and Reproductive Health and Rights. I believe that this is very close to what Michel [Sidibé] calls the “AIDS plus MDG” agenda or taking AIDS out of isolation.

Secondly, I focus on an area of the AIDS response which still requires exceptional attention. That is, the position and vulnerability of key populations including injecting drug users, sex workers and sexual minorities. These groups of people are often discriminated against and marginalized within their community and unfortunately there are not too many agencies and donors who speak out for them. So I think I bring an added value by being outspoken about the needs and rights of these groups.

UNAIDS: You mentioned the important link between Sexual and Reproductive Health and Rights and HIV prevention. Can you describe this?

Marijke Wijnroks: Well, since the main mode of HIV transmission is still sexual we cannot talk about preventing HIV without talking about sexuality, reproductive health services, or sexual and reproductive health and rights — this concerns heterosexual partners and men who have sex with men.

Even when you talk about concentrated epidemics among injecting drug users, yes they inject drugs which is a risk for HIV transmission, but they also have sexual relationships. So actually, in most part of HIV transmission sexuality is an issue.

In the absence of an AIDS vaccine or a cure, we need sustained behaviour change to stop new infections. For this to happen many different elements are needed. People must have the knowledge and the means to prevent HIV, and they must have an enabling environment in which they are free to take decisions to protect themselves — which is not always the case, in particular for women and girls.

UNAIDS: How has the financial crisis affected the donor community’s response to AIDS and broader health and development?

Marijke Wijnroks: The impact is very serious. We are also not immune to impact of the financial crisis in the Netherlands. Our budget for ODA [overseas development assistance] is linked to our gross national product. For years we were in a luxury position where our budget grew with our economy. But now that the economy is shrinking, we are faced with a declining budget so we’ve had to make very difficult choices about budget cuts, which is very unfortunate.

But the financial crisis does not only affect donor countries, it also affects developing countries. As a country’s revenues decline, that is when tax income and income from exports reduces, the money available to support AIDS or health programmes decreases.

Household incomes are also under pressure. We have accounts of people dropping out of treatment programmes because they cannot pay for associated cost such as transport or people do not have access to food and therefore cannot sustain treatment anymore.

A report was presented on the impact of the financial crisis on the AIDS response by the World Bank and UNAIDS to the latest meeting of UNAIDS Programme Coordinating Board. Its clear that lot of countries expect that there will be a direct impact on treatment programmes. There are fears that the impact will be even more severe for HIV prevention programmes; these cuts will disproportionally affect prevention programmes targeting key populations as these are considered politically easier to drop. So it’s a worrying trend, yes.

UNAIDS: Finally, how do you frame the AIDS response as a way to leverage health system strengthening?

Marijke Wijnroks: There have been some very unproductive discussions on AIDS versus health systems as if these were two competing elements. But I think that the AIDS response has given a lot of energy to the health movement.

The AIDS community have been able to mobilize a lot of focus around health system strengthening that I don’t think would have been there without it.

AIDS has exposed many weaknesses within health systems, for example highlighting staff shortages as a bottleneck for scaling up treatment and services for people living with HIV.

Also, a sustained AIDS response requires a functioning health system for access to treatment and also when it comes to HIV prevention. So the AIDS response needs health systems to be effective and to be sustainable.

I remember visiting a district hospital in Zambia. I was shocked to see their “chronic disease department” overburdened with handling AIDS-related illness. In many countries we’ve since seen that the burden of AIDS on health systems has lessened with the scaling up of treatment programmes.

The other area that I think the AIDS movement has contributed enormously in is the expansion in the number of stakeholders involved in planning and implementation including civil society and community based organisations, and very importantly people living with HIV. The AIDS movement has created a much more bottom-up approach, with a clearer call for accountability.

I think there are a lot of elements within both the AIDS movement and AIDS funding that have helped to strengthen health systems. But we also need to invest in health system building, staff, infrastructure, and policy implementation, to make sure that we have health systems strong enough to deliver AIDS services and other programmes as well.