A Charm Offensive Against AIDS

Soweto, South Africa — Shortly after Michel Sidibé became executive director of the United Nations’ AIDS prevention agency, a court in Senegal sentenced nine gay men, all AIDS educators, to eight years in prison for “unnatural acts.”

In one of his first moves as the new chief of U.N.AIDS, Mr. Sidibe flew to Senegal to ask its aging president, Abdoulaye Wade, to pardon the men.

Mr. Sidibé, the son of a Muslim politician from Mali and a white French Catholic, asked the president — who is married to a white Frenchwoman — if he had ever suffered discrimination.

“Oh, Sidibé, you have no idea,” came the reply. “And for not marrying a Muslim.”

“Then, Uncle,” Mr. Sidibé said, using the African way to politely address an older man, “why do you accept that men here are put in jail for eight years just for being gay?”

Mr. Wade thought about it and promised to call his justice minister. Shortly afterward, the charges were dropped.

Asked if his predecessor — Dr. Peter Piot, a Belgian and one of the discoverers of the Ebola virus — could have gotten the same results, Mr. Sidibé said, “Without doubt, it would have been more difficult. It would be very automatically perceived as ‘the white people moralizing to us again.’ Since I’m African, I can raise it in a way that is less confrontational.”

Asked about that, Dr. Piot laughed and agreed, saying he sometimes thought his African missions, like those of the U2 singer Bono, “felt like a junior Tanzanian economist and Hugh Masekela coming to Washington to scold Congress for its budget deficit” — with Congress having to grin and bear it because it needed Tanzania’s cash.

Mr. Sidibé, 59, is a former relief worker, rather than a physician, and, along with English and French, he speaks West African Mandingo, the Tamashek of the Tuaregs and other languages.

With a combination of bonhomie and persistence, he has delivered difficult messages to African presidents very persuasively in his three years in office: Convince your men to get circumcised. Tell your teenage girls not to sleep with older men for money. Shelve your squeamishness and talk about condoms. Help prostitutes instead of jailing them. Ask your preachers to stop railing against homosexuals and order your police forces to stop beating them. Let Western scientists test new drugs and vaccines, despite the inevitable rumors that Africans are being used as guinea pigs.

“You can’t say ‘no’ to Michel,” said Dr. Piot, who hired him away from Unicef. “I was at a conference in Ethiopia in December, and for the first time, I felt I was hearing ‘ownership’ of AIDS by African countries. They weren’t talking so much about the donors, but about it as their own problem. I think he had a lot to do with that.”

Thanks, in part, to Mr. Sidibé’s intensive lobbying, South Africa and China are rapidly revising their approaches to the epidemic, and he hopes Russia and India soon will too. And the notoriously conservative African Union has created a committee to help populations it previously ignored: homosexuals, prostitutes and drug abusers.

Mr. Sidibé is from so deep in Africa that his professional career actually began in Timbuktu, helping Tuareg nomads. (His grandfather, he said, was a Fulani nomad in the same desert.)

He has the African shtick down. He calls anyone younger than him “my brother” or “my sister.” He seems to remember, and hug, everyone he has met before, from drivers to senators to journalists. He regales guests at cocktail parties with long parables about chameleons that he learned as a teenager in circumcision school (a bonding ritual that many African men remember with a mix of fondness and terror — a cross between boot camp and a bar mitzvah, but ending with a collective bris, sometimes done with a spear blade.)

And he is a relentless joker.

In South Africa, he passed through a maternity clinic in Soweto and greeted the women, whose bellies were bulging out of their robes. Ten minutes later, passing by again, he stopped. “Ladies, you are still waiting?” he teased. “What is happening here? You must complain.”

Minutes later, in the circumcision ward, he was introduced to a stunning young surgeon, Dr. Josephine Otchere-Darko.

“Oh, my goodness, my sister, it is too late for me,” he said flirtatiously. “But do men here not mind being circumcised by a woman? In my country, it would be culturally impossible.”

Some men refused, Dr. Otchere-Darko acknowledged, but most didn’t mind.

“Let us see,” he said, wrapping his arm around her and sweeping her down the line to the first man waiting.

“My brother, I am a doctor, and so is this beautiful young woman. Whom do you choose to do your operation?”

The poor man gulped and looked nervously from one to the other, until Mr. Sidibé patted him on the shoulder and let him in on the joke.

Minutes later, the kidding ended as he met with infected women who had just given birth.

“You are the age of my last daughter,” he said to a 21-year-old woman cradling her newborn. Crouching down so he could touch her knees, he asked if she knew how she had been infected.

“I am not sure,” she answered softly, “but when I was 12, I was raped by my cousin.”

Another cousin, sitting beside her, added, “He raped all of us girls in the family as we came of age.”

“Where is he now?” Mr. Sidibé asked, clearly upset.

“He is in jail,” she said. “But not for that.”

For the rest of his South Africa trip, Mr. Sidibé used that story to push politicians to attack their country’s rape crisis.

Dr. Aaron Motsoaledi, South Africa’s health minister, said Mr. Sidibe pursued him relentlessly at a United Nations conference in New York until they met. They became co-conspirators in getting Jacob Zuma, the country’s new president, to budget more money for AIDS drugs and to press drug companies to lower prices. “I was new to my office, and this man was just chasing me,” Dr. Motsoaledi said. “He insisted South Africa must take leadership on AIDS for Africa. I said: ‘What about Botswana?’ But he insisted.”

Mr. Sidibé then pursued Mr. Zuma.

When the two finally talked, Mr. Sidibé said, he appealed both to Mr. Zuma’s sense of social justice and to his vanity, telling him the lives saved would be his noblest legacy.

(Mr. Zuma’s predecessor, Thabo Mbeki, spent years questioning the existence of the virus and made drugs hard to get. Dr. Piot called his own dealings with Mr. Mbeki “a total failure.”)

In a major speech in 2010, Mr. Zuma increased the national AIDS budget by 30 percent and, along with Mr. Sidibe, publicly took an AIDS test.

Thirteen million South Africans have done so, and nearly 500,000 people are getting treatment.

Mr. Sidibe also met with King Goodwill Zwelithini of the Zulus, one of South Africa’s largest tribes, to give him evidence that circumcision — which the king’s ancestor Shaka had banned in the 1820s — protected men against AIDS. In 2010, the king ordered all Zulu men — perhaps five million — to have the operation.

They aren’t legally required to obey, but more than 75,000 have done so, said Dr. Zwele Mkhize, the premier of KwaZulu-Natal, the Zulu homeland.

Globally, Mr. Sidibé says, he is trying to “be a voice for those without one.” The groups that most need help, he argues, are the ones that no politician wants to be photographed with: gay men, prostitutes, transvestites, heroin users.

The only category in which there has been major progress is cutting transmission from mothers to babies.

“That’s populist,” Mr. Sidibé noted. “Even the Tea Party would not oppose that.”

While the global battle against AIDS is still being lost, it is being lost less badly. Four years ago, 250 people were newly infected for every 100 people getting treatment; that number is now down to 200.

Mr. Sidibé gives most of the credit for that to a combination of generosity of donors, particularly from the United States, and to mundane but important societal changes like adults having fewer extramarital affairs and parents talking to their children about sex.

He fights conservatives on his agency’s board, even allowing one agency magazine to be printed with a busty beauty on the cover — and no clue until the photo spread on Brazilian transsexuals inside that she had once been a man.

He publicly congratulated India’s “hijra” community of eunuchs and transsexuals on a court’s overturning of the country’s 160-year-old colonial-era sodomy laws.

Mr. Sidibé has also fought hard against harsh anti-gay laws in Africa, against hate crimes like the “corrective rapes” of lesbians by South African gangs — and against the widespread belief that homosexuality is a Western import. He pressed China to admit that H.I.V. was spreading rapidly among gay men and drug users and that the 500,000 Chinese working in Africa and 40 million migrant laborers, many of whom visit prostitutes, were potential risk pools.

In 2009, he appeared in an awareness campaign with the basketball star Yao Ming.

China, which Mr. Sidibé described as “immune to pressure, but very pragmatic,” soon reversed several policies.

Prime Minister Wen Jiabao spoke at the United Nations in 2010 about holding the hands of AIDS patients, and zero-tolerance drug policies were dropped in favor of methadone and syringe-exchange. Mr. Sidibé was also one of the first to call for changing global policy to “test and treat,” which means putting infected people on drugs as soon as they are infected. While initially expensive for donors, it makes patients 96 percent less likely to infect others, ultimately saving money.

He is, of course, frustrated that donors have cut back, and has endorsed the controversial proposed “Robin Hood tax,” which would charge a fraction of a cent on every currency exchange transaction, and channel it to global health programs.

Mr. Sidibé focuses his lobbying on the BRICS countries — Brazil, Russia, India, China and South Africa. If each takes the lead in its region, he says, it will drag others along.

For example, without South African leadership, efforts in Lesotho and Mozambique will fail because their men work in South African mines and its hospitals are so advanced.

“In my village they said: If you want to kill the snake, you must hit the head,” he said. “In Africa, South Africa is the epidemic’s head.”

Similarly, he said, former Soviet satellites still depend on Russia and have similar heroin-driven epidemics, so he is pushing for syringe-exchange and methadone programs.

Mr. Sidibé attributes his diplomatic skills to his unusual family.

His father was sent to France during World War II and fell in love. “He was one of the first Africans married to a white lady, and when she came down to Mali in 1946, it was very difficult for them,” Mr. Sidibé said.

Both families initially rejected the union, but they stayed married for 55 years, till his father’s death.

In Marxist post-colonial Mali, Mr. Sidibé’s father was a leader of the Social Democrats, risking imprisonment.

Mr. Sidibé had a traditional Malian birth, at home, with a midwife, protected by his grandmother’s “magic water.”

His first nickname was “Trompe la Mort” — Fooler of Death — because the umbilical cord was around his neck.

His family was well enough off to buy him shoes — which he always took off on his way to school so his classmates wouldn’t find out.

And when his brother, who was born in France and lived with his grandparents, finally rejoined the family at age 9, Michel, who was 6, had to fight for him every day. (One reason for the constant school punch-ups was that his lighter-skinned brother refused to admit being African; he also ran home at the first sign of trouble.)

Mr. Sidibé still calls his 88-year-old mother daily. When she saw him on TV getting an award from an American gay rights group, she asked, “So, my son — are you gay now?”

“No, Mama, not yet,” he replied.

But his “true mentor,” Mr. Sidibé said, was a mentally ill man he used to pass on his way to school. He slowly befriended the man, who was known as Makan the Geek, to protect him from other boys who threw stones.

And when Makan was taken to an asylum, his mother let Michel take him food.

Helping someone who offered no more than a mute smile in return, he said, was a good lesson in empathy.

His father also “told me to see people first as human beings, not as president or prime minister. That’s why I can relate to a lady in the U.S. or to King Mswati in Swaziland.”

And whenever he declares a new goal, like zero new mother-to-child infections, he describes it as the one he wants to retire on.

“If we can win this one,” Mr. Sidibé will say, “I can go back home and sit under my mango tree and feel proud.”

by Donald G. McNeil Jr.
source – The New York Times