Acting now to make a difference - Michael Merson, executive director WHO Global Program on AIDS - Fight AIDS Worldwide - Cover Story - Interview

UN Chronicle, June, 1994

With an estimated 5,000 people infected each day with HIV, urgency is a feeling Dr. Michael Merson knows well. The devoted Executive Director of WHO's Global Programme on AIDS (GPA) speaks movingly to groups and individuals around the world about the need to act now to fight the deadly virus that leads to AIDS.

"In Africa, south of the Sahara, some communities have been hit so hard that there are funerals every day or two. Soon this will be happening in parts of Asia and Latin America as well", he said on World AIDS Day--1 December 1993--in New York. "For a family already living at the poverty line or below, the loss of their breadwinner and caretaker is catastrophic for those left behind--the children and the elderly."

Encouraging people to talk frankly about a sexually transmitted disease (STD) that's often shrouded in fear and mystery, dealing with Government and public denial about the gravity of the AIDS epidemic, and confronting insufficient resources to care for victims of the disease--these are daily challenges for Dr. Merson, who has been head of WHO's global efforts to fight AIDS since May 1990. Originally from New York, he joined WHO as a medical officer in 1978 and became Director of the Diarrhoeal Disease Control Programme in 1984, where he served until joining the GPA.

"One of my most vivid personal memories is being surrounded by hundreds of people with AIDS in a clinic in Uganda", he recalled recently. "They were just clamouring for medicines to treat their throat infections, so they could at least swallow their food. Can you think of a more basic necessity of life?"

Despite the tragic numbers of AIDS-related deaths, this compelling advocate takes heart in the fact that attitudes are changing and Governments are showing greater commitment to combatting the epidemic.

In an interview with the UN Chronicle, Dr. Merson shared his reflections on the daunting task ahead in preventing the continued spread of AIDS.

How effective has the GPA been? How has it changed?

If you look at the early stages of the epidemic, most of the initial work was in advocacy and focusing on prevention. That remains a large amount of what we do. The other part of what we do, which I added when I became Director, was the treatment of sexually transmitted diseases. People who have an STD, such as chlamydia or gonorrhea, are at greater risk of getting and transmitting HIV.

I think this Programme has done a great deal to raise awareness. I can't think of any country in the world that is not undertaking some kind of response. There's been a fivefold increase in condom sales in Africa in the past three years. In Thailand, the national budget for AIDS awareness and prevention was less than $100,000 a few years ago; now it is $50 million. In country after country, we're seeing a greater sense of commitment.

Has the annual incidence of HIV infection dropped in any country since WHO's Global AIDS Strategy was introduced in 1987?

There are some indications of stabilization in Central and Eastern Africa. That's not to say that it's getting any better, but it's not getting worse. One of our top priorities for the next few years is to help the countries where the disease has not spread as greatly to prevent that from happening.

Tell us about the proposed new joint and co-sponsored UN programme on HIV/AIDS. How will it improve coordination of the UN's fight against AIDS?

We haven't finished working out the details of the programme, but the main objective is to strengthen the UN response to the AIDS epidemic. We want UN agencies to work in the most cohesive and coordinated manner. I also hope such a united effort would be more attractive to donors. it will be administered by WHO, with its headquarters in Geneva, but it would be a truly inter-agency effort.

How strong is the political commitment to national AIDS programmes? Are you still encountering government denial regarding the extent of the AIDS crisis?

Just about every developing country has a programme and every developed country has one. But political commitment is a big issue. It seems to occur late. What we advocate is the sooner the commitment, the better. I worry about this in country after country. I try to convince Heads of State that preventive measures taken later are a lot more costly and less effective than if they were taken earlier.

As for denial, in low-prevalence countries in Asia, Latin America and the Middle East, there's still a tendency to think that "it won't happen

here", that we're protected by our culture. One of our main jobs is to keep raising political awareness.

You've mentioned that there is one universal problem AIDS patients sufFER from--the shame and stigma attached to the disease. Have advocacy efforts by WHO reduced this problem? How do you approach changing attitudes?

Fear about AIDS is complex due to the fact that it's fatal and sexually transmitted. People must be made to understand how you get the disease and how you don't. The issue is what I call learning to live with AIDS. You can only obtain strong community-based support for care of AIDS patients if there is no discrimination.