‘We can do more and we can do it faster’: one woman’s fight against HIV in Africa

Date: 28/11/02

Dr Lieve Fransen has been at the forefront of the battle against AIDS since 1983, first in Kenya and now as a senior official in DG Development. She talks to David Cronin about the crisis that won't go away

NAIROBI, 1983. Lieve Fransen, a young Belgian doctor, is researching sexually transmitted diseases in Kenya. She notices that prostitutes and truck drivers are falling victim to a mysterious illness, which seems to wage war on the immune system.

Its symptoms appear to correspond with a medical condition she learned about while studying tropical medicine but never came across during her previous work in Rwanda and Mozambique.

She learns that a similar malady - believed to be a viral infection - is being detected in Zaire (now Congo) and among San Francisco's gay community.

Later that year American and French scientists isolate the virus that causes acquired immune deficiency syndrome. Its acronym, AIDS, will become synonymous with dirty needles, unprotected sex and premature death. 'A big disease with a little name,' a Prince song will call it.

Brussels, 2002. Today Lieve Fransen is a senior official in the European Commission's directorate-general for development. The 52-year-old has been head of its human and social development unit since 2000. With a 13-strong team, she has to deal with a myriad of health and education issues.

None of the officials assigned to her works exclusively on AIDS, but a framed 'charter' on her wall from 1993 demonstrates her enduring commitment to fighting the disease. Among its signatories is Nelson Mandela; the South African hero had been released from his Robben Island prison cell three years previously.

When the Commission had to choose its representative on the Global Fund to fight AIDS, tuberculosis and malaria, Fransen was the obvious choice. The body was set up in 2001 following calls by UN Secretary-General Kofi Annan.

Just before our interview Fransen printed out the latest report on the fund's activities. The paper makes for bleak reading. Up to 100 million new HIV infections are 'on the horizon by the end of this decade', it says.

'An urgent response of unprecedented scale can contain the impending disaster and mitigate the social, economic and political impact of the current burden,' the report adds. To date, international donors have pledged €2.2 billion to the fund for 2002-2006 but only €644 million has been paid in. The fund calculates that at least €3 billion will be needed for next year so that it can sign up to 'high-quality proposals'.

'If this amount isn't pledged soon, I wouldn't say the fund will be bankrupt,' says Fransen. 'The fund will not be able to start new projects because all of the money pledged to the fund is already allocated to projects.'

The Commission promised €117 million to the fund and had paid €58.5 million of this by 5 November. It is in discussions with MEPs about a longer-term pledge.

Fransen emphasises that she wants the EU's executive to be more generous. She believes Poul Nielson and Pascal Lamy, the development and trade commissioners, and Romano Prodi, the Commission president, are strong supporters of the anti-AIDS drive.

But she doesn't feel their enthusiasm or sense of urgency is shared by the entire bureaucracy.

'I'm very frustrated by the slowness of procedures and processes,' she says. 'Some people are still in denial in the Commission. A lot of people prefer to do business as usual. But it cannot be business as usual in the case of AIDS.

'In Botswana a huge percentage of young people in the 15-45 age group are infected with HIV and AIDS. Every night I go to sleep with these figures in my head. We cannot just do business as usual in Botswana and build roads and schools there and think that AIDS is just going to disappear. If AIDS kills so many, how is the next generation going to go to school? We can do more and we can do it faster. I'd love to have more officials being even more impatient about this.'

She considers, though, that the Global Fund has worked remarkably well, considering that Richard Feachem, its executive director, only took up his post in July. Last week Ghana became the first country to receive aid. Projects in Haiti and Tanzania are due to benefit from it next, with plans to support 40 countries in the near future.

Fransen is also quick to correct some of the misunderstandings about the fund. Anti-poverty campaigners have argued that the €2.2 billion earmarked to the fund is just a fraction of what is needed to cut AIDS-related deaths. Last year Kofi Annan recommended that annual sums of more than €10 billion be donated to combating the AIDS pandemic.

She points out that Annan never said all that money had to be channelled through the fund. Indeed, she feels it may struggle to absorb such vast sums.

More importantly, she contends that governments in poor countries must not use the fund's existence as a pretext for cutting their own spending on health care. She is distressed by a proposal from Uganda's Finance Minister Gerald Ssendaula to trim his country's health budget by 4%. According to the minister, the amount saved would be used in a €40 million military offensive against a rebel group, the Lord's Resistance Army.

'We'll need to watch that discussion in Uganda,' adds Fransen. 'We have to increase the cake by additional funding, not by shuffling money around.'

A two-pronged attack on AIDS - based on both prevention and treatment - is necessary, Fransen explains. Aside from her work with the Global Fund, she is negotiating with the European Investment Bank about providing finance to condom factories in poor countries.

Ensuring that people in the developing world have ready access to cheaply available condoms is essential in reducing the rate of infection, she feels. 'It would be a good thing if South Africa produced its own condoms, for example, and exported them elsewhere in the African continent. And if people know condoms or drugs are produced in their own country, maybe this would lead to more debate and openness.'

She is optimistic that an agreement will be found at World Trade Organization level by the end of this year on cutting the price of live-saving drugs in countries where AIDS is rampant. The recent meeting of WTO ministers in Sydney 'showed a strong commitment to having results very soon', she remarks.

'I don't want to get into the debate currently taking place on access to medicines. It [the expected WTO agreement] is not going to give a full solution to the AIDS problem. But it is part of the jigsaw.'

Another part concerns efforts to develop an AIDS vaccine and more effective anti-AIDS drugs. Fransen welcomes a €200 million initiative launched by Research Commissioner Philippe Busquin in August.

This 'clinical trials partnership' will see scientists from EU states and Norway jointly try to develop new products for poverty-linked diseases with counterparts from poor countries.

It follows the Commission's 2001 'programme of action' on AIDS, tuberculosis and malaria, which pivots on three principles: impact, affordability and research and development.

Before rushing off to another meeting, Fransen recounts a conversation she had with South Africa's EU envoy Jerry Matjila about how AIDS is ravaging his country. 'He said he had gone to funerals where old people are burying young people. It's funerals of young people all the time.'

Interview with Dr Lieve Fransen, a senior official in DG Development.