Feature story

Dr Nafis Sadik: A decade as UN Special Envoy for AIDS in Asia and the Pacific

04 July 2012

Dr Nafis Sadik (second from the left, back row) with people living with HIV during an official visit to Viet Nam.

Dr Nafis Sadik, a national of Pakistan, was appointed Special Envoy of the Secretary-General for AIDS in Asia and the Pacific in 2002. In ten years as Special Envoy, she has travelled extensively across the region to promote key issues and advocate for an expanded, multisectoral response to HIV in Asia and the Pacific at the highest levels.

In the last decade, Dr Sadik has consistently called attention to the importance of addressing the needs of women and key affected populations in national AIDS responses and the need to involve key populations directly in making and carrying out development policy.

As her Special Envoy tenure came to an end on 30 June 2012, Dr Sadik shares her reflections on her decade of work as UN Secretary General’s Special Envoy for AIDS in Asia and the Pacific and why she feels speaking out about HIV is the only way to advance progress.

UNAIDS:  When you were first appointed as Special Envoy for AIDS in Asia and the Pacific, what were the key HIV-related issues and challenges at that time in the region?

Dr Sadik: The main challenge was that countries were not recognising that they had a problem with HIV. In 2002 we already had the Millennium Development Goals (MDGs), with halving HIV infections by 2015 as one of the goals, but many countries in the region were not paying attention to that MDG at all. For the United Nations this was a concern. We needed to do something ‘now’ and we knew that if countries took action they could avert big epidemics.

UNAIDS: In beginning, what kind of missions were you undertaking as Special Envoy?

Dr Sadik: I had been the Executive Director [of UNFPA] and knew many Heads of State, so the idea was to do strong advocacy with them on the need to have a policy and an action programme on HIV. My first visit was to Nepal, to be a keynote speaker at a regional conference. I was rather bold. I used the opportunity to talk about issues that people weren’t talking about—men who have sex with men, sex workers, drug use etc. The speech was quite dramatic and I think people got a bit shocked. I even went so far as to say that I thought these behaviours should be legalized immediately! Of course, I gradually saw that things don’t change that dramatically, that instantly, but bit by bit change can be encouraged.

UNAIDS: The Asia-Pacific region has seen significant progress in the last 10 years. HIV infection rates are down more than 20% and nearly one million people are now receiving antiretroviral treatment. In the last decade, what has shifted in the region?

Countries have realised AIDS is a reality for all their societies. All the countries in the region now have policies and programmes on HIV and that wasn’t the case when I started

Dr Nafis Sadik, former Special Envoy of the Secretary-General for AIDS in Asia and the Pacific

Dr Sadik: Countries have realised AIDS is a reality for all their societies. All the countries in the region now have policies and programmes on HIV and that wasn’t the case when I started. Some countries are turning back their epidemics; the number of people on HIV treatment is tremendous; more people are getting access to services; and there’s been a big push on understanding issues of gender and about key affected populations.

I have been impressed by the attention that lawmakers are giving to HIV. And a great deal has been accomplished to bring high risk and vulnerable groups into the mainstream. Laws have changed in several countries, for example, Nepal and Pakistan now give transgender people an official ‘identity’. This makes a huge difference, with human rights in general being recognized.

UNAIDS: What are some of the on-going challenges you see in the region?

Dr Sadik: People are still not speaking out consistently about AIDS at all levels. Leadership makes a difference but this should not be leadership just for one day a year on World AIDS Day. Advocacy needs to be done often and at all levels. If there is more consistent advocacy from the top, leaders speaking out more frequently on HIV and related issues, this will address stigma and discrimination a lot.

UNAIDS: As the HIV response in Asia and the Pacific moves forward, what do you think is most important for the region to ‘get to zero’?

Dr Sadik: Changing male behaviour is very important. The Asia Commission report was very clear that male behaviour is key to addressing the epidemic in the region. If we can help change this into safe behaviour, this can make a difference. Having more male champions is very important.

The breakthrough on ‘treatment as prevention’ is very important but we also need to remember that access to affordable HIV treatment is under threat. Many people receiving treatment in the region are getting it thanks to funds provided by external donors—which may now be phased out or reduced. A number of countries gaining middle-income status won’t be eligible for certain external funding anymore. This is a matter of some concern and we have to work more effectively with the countries and development partners to have phase-out plans that ensure on-going treatment.

In July 2012, Mr Prasada Rao—India’s former Secretary for Health and Family Welfare and former Director of the UNAIDS Regional Support Team in Asia-Pacific—was appointed as the new UN Secretary General’s Special Envoy on AIDS in Asia and the Pacific.