Dr Helene Gayle is one of the world’s
most powerful voices on HIV. Martin Flynn caught up with
the formidable public health doctor at the World Aids Conference to talk about
global access, the point of Aids conferences and working with Bill Gates
Photos: John Clarkson
When
Helene Gayle went to work for the US Centers for Disease Control in Atlanta
20 years ago she was warned: “‘Stay away from HIV. It’s
just a strange disease affecting gay men.”
Little did she realise that HIV would become one of the biggest threats to
global health or that she would end up leading the global fight against the
virus. But Dr Gayle stuck to her guns and the rest is history.
“We didn’t know HIV was a major pandemic back then,” explains
Dr Gayle. “People thought it would go away soon and suggested I focus
on something more important.
“But I soon realised HIV was not going to go away; that it was not just
some strange political disease and that it was going to become the defining
public health issue of our times.”
Powerful and independent
Dr Gayle is a remarkable and rare phenomenon: a powerful and independent black
woman in a field dominated by white male doctors and activists. She was, until
last month, president of the International Aids Society (IAS) and, until December
2005, head of the Bill and Melinda Gates Foundation’s global access
progress. Dr Gayle is also sharp as a blade and glamorous with it.
Before stepping down from the IAS presidency at the Toronto World Aids Conference
in August, she issued a stern warning to the G8 leaders to keep their promise
on universal access to HIV drugs by 2010. She also told the 25,000 conference
delegates that now was the time deliver on promises made to millions of people
with the virus with no access to life-saving medications or effective prevention.
“Universal access to HIV prevention, care and treatment will remain
elusive until there is a global commitment to programmes and policies driven
by the human rights of affected communities,” Dr Gayle told the conference
opening ceremony. “Poverty, inequity, discrimination. All the evidence
tells us unless we move on these drivers of the epidemic, our response to
HIV and Aids will be incomplete.”
Ivy League girl
Helene Gayle was raised the middle child of a big family in Buffalo, up-state
New York. Her father owned a small company and her mother was a social worker.
She went to Columbia University in New York, trained as a doctor at the University
of Pennsylvania and did a Masters in Public Health at the prestigious Johns
Hopkins University, before specialising in paediatric medicine in Washington
DC.
“I decided to be a doctor because I wanted to make a contribution to
human kind and in some way give back. Medicine is one area where we can have
a tangible way of addressing human need.
“I realised fairly early on that I wanted to combine my interest in
social change and social justice with a career in medicine. Paediatrics is
a speciality that has a public health aspect as well as addressing the needs
of children’s health globally.”
Microsoft matters
When the richest couple in the world, Bill and Melinda Gates, started their
charitable foundation in the late 1990s, Helene Gayle saw an opportunity to
make a big difference in the battle against HIV.
“Both Melinda and Gates came from philanthropic families. They’d
both been very involved with their communities in Houston and Seattle. The
foundation was a natural move since they were people who had been blessed
with considerable wealth.
“I came in as they set up their global health programme and HIV was
one of the highest priorities. The foundation does a lot of work developing
new technologies that impact on diseases in developing countries. We
did two major field programmes in Botswana and India and funded research
into HIV, microbicides and new prevention technologies like pre-exposure prophylaxis.
“Now the Bill and Melinda Gates Foundation donates hundreds of millions
of dollars to HIV programmes around the world and to the Global Fund To Fight
Aids, TB and Malaria.”
Making it happen
The key theme at this summer’s conference was ‘Time to Deliver’;
time to get the drugs to millions of people in desperate need in resource
poor countries. Achieving this must be extremely complicated?
“Right. We have a lot of resources, we know how to treat people with
and prevent HIV, and we should use our time and our talents to make that happen.
When we talk about delivery, it’s got to be across the board. Making
sure we have prevention services as well as making sure the drugs are available.”
Aids
conferences matter
I asked Dr Gayle about the growing criticism of Aids events like the World
Aids Conference and the perception they were vast talking shops that cost
millions and achieved little?
“Conferences like the World Aids Conference make a difference because
it is a time for the world to shine a light on this issue. We get media attention
but also a chance to share the latest information.
“We all leave better equipped to do what we can to make a difference
whether on prevention and treatment, care and support or changing policies.
These meetings are one of the most effective ways to make sure we have the
best information possible.
“We need to get the message out that HIV and Aids is still a serious
threat to humanity and more needs to be done. Our focus should be on real
issues like stigma, poverty, gender inequality, racism, homophobia and lack
of political will.
“We should use these conferences to re-energise ourselves and redouble
our commitment to the fight against HIV and hold ourselves accountable for
tangible progress. The 40 million people living with HIV, their families and
communities deserve nothing less.”
Was she optimistic this World Aids Conference would benefit people living
with HIV?
“It will provide good information on new therapies and new prevention
options. I hope these meetings continue to inspire and guide political will.
“We can have all the medications in the world and all the prevention
tools in the world but, without resources and political will, they are for
nought. This conference should shine a light on the epidemic and hopefully
galvanise our commitment to make a difference.
No big breakthroughs
“The difference between the Aids conferences today and back in the mid
1980s is that the breakthroughs are not the same. We’re not making the
huge leaps forward because we already have a fair amount of knowledge. So
from now on we can expect incremental new knowledge which can lead to new
solutions.
“We’re developing cheaper and simpler drugs as well as new ones.
And we are hearing a lot about new approaches to prevention and how we can
reduce people’s risk of acquiring HIV. Pre-exposure prophylaxis may
soon be a reality. Microbicide research is exciting but developing an HIV
vaccine is still far away.
“There is no one answer. We have to look at it holistically. We understand
the virus much better now and how it interacts with the host.”
Sexual fidelity
What is your view on the ABC model of HIV prevention?
“Behaviour change, which is what ABC is all about, is just one part
of a comprehensive approach. Abstinence is obviously the only 100 per cent
foolproof method of eliminating risk of HIV. But we know abstinence is not
an option for many women. A woman might be faithful but her partner may not.
And condoms require a willingness to use them.
“All of these approaches are effective if used. But they are not used
and are unavailable for many, so there’s a need to find more prevention
options where ABC is impossible or inappropriate.
“We also have to look at some of drivers of the epidemic; what puts
some people more at risk than others; gender and poverty inequalities and
how we shift the balance so women feel empowered to ask their husbands to
wear a condom or to demand monogamy within the relationship.
“And we have to look at the male side of the equation. Are we doing
enough to make men feel responsible for their behaviour in situations when
they may be putting their partners at risk?”
A
future for activism in HIV?
People living with HIV themselves along with other activists have driven new
treatments and the battle for human rights for the last 25 years. Does activism
still have a role in 2006?
“There’s clearly a role for activism. Any time it looks like we’re
falling short in our response to this epidemic, the voice of people living
with and affected by HIV and Aids needs to be heard.
“But we have to make sure activism is strategic and just not re-fighting
battles we’ve already won just for the sake of fighting. We have to
choose our battles carefully so they can be most effective and we have to
think whether our activism is actually helping.
“We have to think about what will work and unite people and what will
antagonise the very people we need on our side. But without activism we wouldn’t
be where we are today.”
The Canadian Prime Minister declined his invitation to the Toronto conference.
Was he afraid of a few boos?
“I don’t know. In a country that has been pretty courageous on
issues of HIV it’s just unfortunate their Prime Minister was not here.”
Moving on
The IAS is an association of over 10,000 HIV professionals from 153 countries;
attending international conferences are just part of what they do, says Dr
Gayle.
“We are a voice for people working on HIV and Aids and a place for sharing
information and providing education on prevention and treatments. We advocate
for strong policies on HIV and we want to be a strong voice enabling our membership
to do their job and make a difference in this epidemic.”
Dr Gayle is currently stepping down from her presidency of IAS to become president
and chief executive at Care USA, making her the first black women to head
the international poverty reduction organisation in its 60-year history.
Many will mourn Dr Gayle’s departure from the international HIV movement,
not least because she is one of the few black women at the top of the profession.
But her new role makes it unlikely she will fade from public view - or the
fight against HIV. And this writer, doubts we have heard the last of this
formidable lady.
www.aids2006.org
www.ias.org
www.care.org
www.gatesfoundation.org
