Perspectives
Michel Sidibé, Executive Director of UNAIDS, has the storyteller’s persuasive powers. He recounts a turning point in his life, when he had been charged with responsibility by UNICEF for promoting immunisation in Zaire, now the Democratic Republic of Congo (DRC). In those days, he says, it was hard to get an audience with the President, then Mobutu Sese Seko, but Sidibé persuaded the local governor to admit him, arguing that all he needed was 3 minutes of the President’s time. Sidibé found Mobutu sitting with President Habyarimana of Rwanda and President Buyoya of Burundi. They invited him to take a seat but he refused, saying “I have only 3 minutes to convince you”. Mobutu, intrigued, said go ahead. “I want you to be the first vaccinator of the children of Zaire”, said Sidibé. Mobutu replied: “For noble causes like that they give you 3 minutes?” Sidibé won over all three presidents. Mobutu duly administered polio drops to a child in front of a packed stadium. It is one of a wealth of anecdotes that illustrate Sidibé’s charm and ability to approach African leaders on the basis of a shared culture, which later he would use at UNAIDS to tackle them on the rights of marginalised populations— notably, the human rights of gay men. In 2009, he visited then President Abdoulaye Wade of Senegal after nine gay AIDS activists had been sentenced to 8 years in jail, and successfully pleaded for an understanding of minorities by speaking to Wade about the challenges he himself must be facing in an African society by being married to a white Frenchwoman. He interceded again in Malawi about the same issue. Peter Piot, the founding Executive Director of UNAIDS and now Director of the London School of Hygiene & Tropical Medicine, said Sidibé had been “very courageous about homosexuality and also drug use, but especially homosexuality in Africa. He could have kept rather a low profile on it, but he has been very outspoken on it. He chose the difficult stuff to be associated with. Frankly, I think that as an African that is far more difficult and valuable than if a white European like me did this.” Sidibé’s own family has been a powerful influence in his life. His Malian father met his French mother in France during World War 2. They went to live in Mali and, says Sidibé, were rejected by both sides. But his father decided to stay and became one of the founders of a progressive social democratic party. Sidibé had to do his best to fit in: “That for me meant not to focus so much on being the son of a white lady and a black man but focusing on how I can really integrate into a society which is hostile to me.” He recalls how on the way to school, he would take off his shoes and hide them in his bag to go barefoot like his classmates. Later, he went to France and studied economics followed by further diplomas at the University of Clermont-Ferrand. Taught by his parents that he should give back to his community, he www.thelancet.com Vol 386 July 11, 2015
returned home to work for the NGO Terre des Hommes with the Tuaregs of northern Mali. It was a remote area, and Sidibé hesitated to take his wife and young children there. But his father advised him not to leave them in Bamako. Life, said his father “when it is good it should be good for the whole family. When it is tough it should be tough for the whole family. So you have to go together—that is the meaning of a family.” He joined UNICEF in 1987 and was country representative for Uganda when Piot recruited him to UNAIDS in 2001. In 2007, he became his deputy and, in 2009, succeeded him as Executive Director. By then, said Sidibé, he realised that the era of AIDS exceptionalism was at an end. The AIDS response needed to integrate with campaigns to improve maternal and child health, as well as addressing at-risk populations who were increasingly concentrated in marginalised groups. “The first time I talked about taking AIDS out of isolation there was a crisis at home, a crisis with civil society because they thought it would just push AIDS in the corner and it would be finished”, he said. But the reality was that AIDS could not be defeated without tackling other health and social problems. The lessons of the AIDS response for sustainable development are described in the report of the UNAIDS–Lancet Commission, which, according to Sidibé, also explores the lessons from the AIDS response that can inform—and transform—other spheres of global health. Sidibé has political skills, said Piot, ”both in the UN system but also maintaining AIDS on the agenda, which I think is one of the biggest challenges today, because there is a lot of fatigue”. He used his persuasive powers with South Africa’s President Jacob Zuma, who substantially increased the HIV budget and broke a taboo, in 2010, by publicly declaring the negative result of his HIV test. Sidibé saw the possibilities of treatment as prevention and pushed for a target of 15 million people on antiretroviral therapy by 2015, against advice of his staff who said it was too ambitious. He also pushed for zero transmission of HIV from mothers to their babies. “People were telling me you will never be able to eliminate babies born with HIV—and now we are seeing Botswana eliminate, Swaziland eliminating, and Namibia and South Africa and we can be there if we reach it in Nigeria and DRC,” he said. If there is AIDS fatigue, Sidibé does not have it and is working towards ending the AIDS epidemic as a public health threat by 2030. His mother, who now lives with him, tells him every day, he says, “don’t forget those people at home who don’t have anything. You are a privileged child. Fight for the causes of those people.” Sidibé clearly has been reminded of the meaning of inequity all his life: “I think for me that’s given me the reason to continue to do what I’m doing.”
UNAIDS
Profile Michel Sidibé: working to end AIDS as a public health threat
Published Online June 25, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)61143-6 See Comment page 108 See The Lancet Commissions page 171
Sarah Boseley 127
Michel Sidibé, Executive Director of UNAIDS, has the storyteller’s persuasive powers. He recounts a turning point in his life, when he had been charged with responsibility by UNICEF for promoting immunisation in Zaire, now the Democratic Republic of Congo (DRC). In those days, he says, it was hard to get an audience with the President, then Mobutu Sese Seko, but Sidibé persuaded the local governor to admit him, arguing that all he needed was 3 minutes of the President’s time. Sidibé found Mobutu sitting with President Habyarimana of Rwanda and President Buyoya of Burundi. They invited him to take a seat but he refused, saying “I have only 3 minutes to convince you”. Mobutu, intrigued, said go ahead. “I want you to be the first vaccinator of the children of Zaire”, said Sidibé. Mobutu replied: “For noble causes like that they give you 3 minutes?” Sidibé won over all three presidents. Mobutu duly administered polio drops to a child in front of a packed stadium. It is one of a wealth of anecdotes that illustrate Sidibé’s charm and ability to approach African leaders on the basis of a shared culture, which later he would use at UNAIDS to tackle them on the rights of marginalised populations— notably, the human rights of gay men. In 2009, he visited then President Abdoulaye Wade of Senegal after nine gay AIDS activists had been sentenced to 8 years in jail, and successfully pleaded for an understanding of minorities by speaking to Wade about the challenges he himself must be facing in an African society by being married to a white Frenchwoman. He interceded again in Malawi about the same issue. Peter Piot, the founding Executive Director of UNAIDS and now Director of the London School of Hygiene & Tropical Medicine, said Sidibé had been “very courageous about homosexuality and also drug use, but especially homosexuality in Africa. He could have kept rather a low profile on it, but he has been very outspoken on it. He chose the difficult stuff to be associated with. Frankly, I think that as an African that is far more difficult and valuable than if a white European like me did this.” Sidibé’s own family has been a powerful influence in his life. His Malian father met his French mother in France during World War 2. They went to live in Mali and, says Sidibé, were rejected by both sides. But his father decided to stay and became one of the founders of a progressive social democratic party. Sidibé had to do his best to fit in: “That for me meant not to focus so much on being the son of a white lady and a black man but focusing on how I can really integrate into a society which is hostile to me.” He recalls how on the way to school, he would take off his shoes and hide them in his bag to go barefoot like his classmates. Later, he went to France and studied economics followed by further diplomas at the University of Clermont-Ferrand. Taught by his parents that he should give back to his community, he www.thelancet.com Vol 386 July 11, 2015
returned home to work for the NGO Terre des Hommes with the Tuaregs of northern Mali. It was a remote area, and Sidibé hesitated to take his wife and young children there. But his father advised him not to leave them in Bamako. Life, said his father “when it is good it should be good for the whole family. When it is tough it should be tough for the whole family. So you have to go together—that is the meaning of a family.” He joined UNICEF in 1987 and was country representative for Uganda when Piot recruited him to UNAIDS in 2001. In 2007, he became his deputy and, in 2009, succeeded him as Executive Director. By then, said Sidibé, he realised that the era of AIDS exceptionalism was at an end. The AIDS response needed to integrate with campaigns to improve maternal and child health, as well as addressing at-risk populations who were increasingly concentrated in marginalised groups. “The first time I talked about taking AIDS out of isolation there was a crisis at home, a crisis with civil society because they thought it would just push AIDS in the corner and it would be finished”, he said. But the reality was that AIDS could not be defeated without tackling other health and social problems. The lessons of the AIDS response for sustainable development are described in the report of the UNAIDS–Lancet Commission, which, according to Sidibé, also explores the lessons from the AIDS response that can inform—and transform—other spheres of global health. Sidibé has political skills, said Piot, ”both in the UN system but also maintaining AIDS on the agenda, which I think is one of the biggest challenges today, because there is a lot of fatigue”. He used his persuasive powers with South Africa’s President Jacob Zuma, who substantially increased the HIV budget and broke a taboo, in 2010, by publicly declaring the negative result of his HIV test. Sidibé saw the possibilities of treatment as prevention and pushed for a target of 15 million people on antiretroviral therapy by 2015, against advice of his staff who said it was too ambitious. He also pushed for zero transmission of HIV from mothers to their babies. “People were telling me you will never be able to eliminate babies born with HIV—and now we are seeing Botswana eliminate, Swaziland eliminating, and Namibia and South Africa and we can be there if we reach it in Nigeria and DRC,” he said. If there is AIDS fatigue, Sidibé does not have it and is working towards ending the AIDS epidemic as a public health threat by 2030. His mother, who now lives with him, tells him every day, he says, “don’t forget those people at home who don’t have anything. You are a privileged child. Fight for the causes of those people.” Sidibé clearly has been reminded of the meaning of inequity all his life: “I think for me that’s given me the reason to continue to do what I’m doing.”
UNAIDS
Profile Michel Sidibé: working to end AIDS as a public health threat
Published Online June 25, 2015 http://dx.doi.org/10.1016/ S0140-6736(15)61143-6 See Comment page 108 See The Lancet Commissions page 171
Sarah Boseley 127
