Transcript: Interview with Dr. Heidi Larson, Executive Director of the aids2031 Project
September 17, 2010
CSIS - We’re here today with Dr. Heidi Larson, Senior Lecturer at the London School for Hygiene and Tropical Medicine, beginning in October, and Executive Director of the aids2301 Project. Dr. Larson thank you so much for joining us today. Dr. Larson I’m wondering if you could begin by describing the origins and objectives of the aids2031 Project?
Dr. Larson – Sure. aids2031 as an idea came about in 2006, which was 25 years of AIDS and I think the world was looking at where we were. The idea for the Project came because a lot of the attention was on the last 25 years and no one was really taking much of a look at the next 25 years. It was also clear that AIDS was going to be with us for a long time. It was an emergency outbreak in the beginning, but it was clear that this was related to kind of shifting response from an emergency to a longer term plan. So that was the birth of it as it were. Then we started to pull together a few people to sort of think through, well, how do we go about that? And UNAIDS launched it but then a number of other funders and partners came on board. And we defined a number of working groups with different angles and themes. It was a pretty decentralized approach, but I think it’s really created a bit of a movement
CSIS - And today you joined us at CSIS to give us a preview of the major findings of aids2031, particularly because you’re launching a book on world AIDS day in December, so the Project is wrapping up. Would you like to tell us about some of the major findings?
Dr. Larson – The book will be called – “AIDS: Taking a long term view,” It’s published by Financial Times Science Press and as you said will come out in December and be launched on world AIDS day.
AIDS is really not over. And the attention to it cannot be over. It’s taking new shapes; we have a lot more information on it; but we recognize that it will not be one single epidemic moving forward; it’s really multiple epidemics around the world, each with their own character –the politics, the economics, and the social drivers are very distinct in different settings. And we’ll have to be much more tailored about responses. We’ll have to be much more efficient. We could do a much better job of using our resources and putting the money where the problems are. We have a lot of evidence that certain countries have not put money where the real issue is for various reasons; sometimes it’s too sensitive, sometimes the information is not there. That’s one of the findings.
It also involves a push. I don’t want to go into all the findings. I’ll just highlight a few and you can look forward to the book in December. A lot of things from the financing perspective, particularly in this economic crisis, is that we need to move away from short, 3-5 year budget horizons to more like 10-20 years. If we’re really going to make a difference we need to think of indicators of success that are not what you can achieve in two years, but what you can achieve and the impact you can have in 10-20 years.
CSIS: Because the aids2031 Project is all about the 25 year time horizon, when you think of that time horizon, what do you think is the biggest challenge the world will face in terms of creating a long term response to HIV? 
Dr. Larson – I think the world’s biggest challenge is not a new challenge – and we haven’t really dealt with it well – and that’s morality, judgment, and stigma. Morality can be a good thing, but I think sometimes the judgment that comes with it has gotten in the way of scientific evidence of what works and what doesn’t. Policies are being made that are perhaps comfortable politically but not effective for the response an in fact, in some cases, have actually contributed to an increase in HIV because people aren’t getting access to the services that they need for prevention. Also in terms of treatment there is still deep discrimination and stigma. We’ve made a lot of progress in some areas, but I think the most difficult things for the world to come to terms with is some of the issues around sexual behavior, around drug use, around marginalization of… marginalized populations both economically and ethnically. There’s a lot of different dynamics of AIDS that make it politically and culturally very sensitive. We need to get past some of those challenges and really look at the importance of saving people’s lives.
CSIS: In today’s discussion you talked about the importance of settings in looking at the response. Could you expand on that thought some? Why are settings so important and what does it mean in tailoring an effective response?
Dr. Larson – One of the things we did in 2031 was a documentary series with BBC World, called “Love in a Time of HIV.” And it followed 5 people living with HIV in 5 different cities: London, New York, St. Petersburg, Johannesburg, and Mumbai. And each of those young people were facing different challenges for what reasons? For some, it was more policies reasons. One discordant couple, for example, one with HIV one without in London were trying to have a baby. And similarly in St. Petersburg [another couple was living with the same situation] and the challenges they faced were quite different from an economic point of view and from a policy point of view – what the government supported and didn’t support. Also from a social acceptance or not point of view, from a cultural point of view. And also in different settings, in South Africa, the key character called Tender, she was in the final stages of – the South African equivalent of American Idol –brilliant voice, a musician. She was the #2 finalist but was cut out [of the competition] because she disclosed her HIV status. The impact HIV can have on your personal, family, professional life varies so differently depending on the setting. And I think we highly underestimate the impact of that… I mean I’m an anthropologist so I have a particular interest and sensitivity to that, but it really does have a profound impact. And when we talk about tailoring the epidemic and tailoring the response, if your epidemic in Russia or Eastern Europe is vastly among drug users and reducing harm among drug users, you don’t put your money into something else. [That’s] an example one setting. If a problem is in one place, you have to understand what the issues are and invest in that area to ensure that you’re really reaching the program where the problem is. Particularly in this difficult economic time you need to be more efficient.
CSIS – Thank you so much for taking the time to sit down and talk with us. Interested listeners can find more information about the aids2301 Project at www.aids2031.org and you can also listen to our full recording or Dr. Larson’s September 16th discussion at CSIS entitled, AIDS 2031 – Looking beyond 2015 and the Millennium Development Goals, at SmartGlobalHealth.org.
