Jimmy Kolker, chief of HIV/AIDS for UNICEF since 2007, has been a critical player in the fight against AIDS for years. Prior to UNICEF, he was deputy US global AIDS coordinator and served for 30 years as a US diplomat, including several postings in Africa.
Q: What’s been interesting so far in the meeting?
JK: I’ve attended these meetings for the past five years. This year, the level of real activity has risen, and now we’ve been able to analyze what’s been done and learn some lessons and change course. People are telling some hard truths, based on implementing programs. PEPFAR itself has expanded its mandate – whereas it once focused on prevention, treatment, and care, now it’s moving into the status of women, nutrition, family planning, issues of social norms, health systems.
Q: What are some of the hard truths?
JK: Well, we heard some in the PMTCT talk this morning. The coverage rates are impressive, but we are missing opportunities. The qualities of the programs are not widespread. Just by doing a few more simple things – working with clients already identified, following women through antenatal care, involving more men – that has been missed. Also, the unease that prevention programs aren’t working among adolescents and sexually active young people — that is still a puzzle. There has not been a highly successful program that has really brought down the rate over the last 10 years – not since the Uganda program.
Q: What about the high rates – up to 40 percent of all pediatric infections – from breast feeding?
JK: With breast feeding, science gives mixed messages. An alternative feeding is preferred to avoid passing HIV to the baby, but we also know that for child survival overall, breast feeding is the best choice. The issue now is how to lower mother’s viral load during breast feeding to minimize the risk.
Q: What are UNICEF’s priorities at the meeting?
JK: We have four priority interventions: PMTCT, pediatric treatment, prevention among adolescents, and protection of orphans and vulnerable children. It‘s clear from this meeting, and even more dramatically from the AIDS meeting in Mexico last year, that those four issues are front and center in the response to AIDS right now. The attention given to those four issues is encouraging and remarkable compared to where we were a few years ago. One is the opportunity we have to eliminate vertical transmission (from mother to child). Relatively simple proven interventions can reduce mother to children transmissions virtually to zero.