Carla Bruni-Sarkozy: Mothers, babies and HIV

Carla Bruni-Sarkozy, France's first lady, is one the world's best known Aids campaigners. Here, she answers questions about her work from The Independent.

Carla Bruni-Sarkozy is an Italian-French singer, songwriter, actress and former model. In 2008 she married the French President Nicolas Sarkozy. Later that year, she joined The Global Fund to Fight Aids, Tuberculosis and Malaria.

Her role at the Global Fund sees her acting as a voice for mothers and children infected with or affected by HIV/Aids and her drawing attention to the need to give pregnant women and their children the means to prevent HIV infection.

In 2006 her brother Virginio Bruni-Tedeschi, a photographer, died of an Aids-related illness at the age of 46. Before she joined the Global Fund, the Bruni family set up a foundation in his name to promote Aids education.

Aids is an indiscriminate killer. Why have you decided to focus upon mothers and children?

Aids is actually not an indiscriminate killer: it affects most those who are poorer and weaker, as these are the people whose immune systems are more vulnerable.

It also affects anyone who doesn't have access to adequate information (to ensure that they are able to prevent contracting HIV in the first place) and, of course, those who don't have access to the necessary treatment. This is the reason I decided to focus on the most vulnerable of all: babies in the developing world.

In Europe and the United States, pediatric HIV is extremely well-managed. In France last year just four babies were born with HIV, while in the developing world more than 350,000 babies were born with HIV, most of these in sub-Saharan Africa.

This dramatic difference is absolutely unacceptable. There is no reason that Africa and other developing regions cannot get close to a single-digit number.

Without treatment, half of all children infected will die within two years. Whether an infant lives or dies cannot turn on how much money you have. It is not acceptable in the 21st century – when treatment is available, effective and inexpensive – that there is such a difference between developing countries and wealthy ones.

So many of the UN Millennium Development Goals remain unmet, including maternal mortality. Again, why prevention of HIV transmission to babies specifically?

The protection of mothers and children against HIV is a crucial aspect of maternal health and of global health. The fact that treatment exists – both to prevent transmission from mother to child and to safeguard the mother's own health – is very motivating.

Women are the heart of society – earners, caregivers, nurturers, drivers of change. It is our shared responsibility to help ensure that our sisters in developing countries also have access to the basic rights and services that most of us have the luxury to take for granted. By investing in women, we are investing in the health and development of families, of communities andultimately of entire countries.

More than 90 countries signed up to eradicate mother-to-child transmission of HIV by 2015. What will happen if we fail?

We should think of continuing the fight rather than of failure; 2015 was chosen as a target date because it coincides with the [UN's] Millennium Development Goals and their broader health targets.

It is important to set these kinds of goals to help us all to move forward. The progress that has been made in preventing mother-to-child transmission in just the past few years, meaning that now more than half of all HIV-positive pregnant women who need this treatment receive it, should prove that reaching this goal is totally achievable.

I do sometimes fear that the world will get discouraged. It's true that after 30 years of the fight against HIV and Aids, it can sometimes still be difficult to mobilise the international community for this cause. But, ending mother-to-child transmission, while it's an ambitious goal, is really a reachable one, if concerted global efforts don't falter and, most of all, if the different organisations working towards this work increasingly together. Defining an end to the transmission of HIV from mothers to their children in the near future is a feasible victory that should inspire hope and courage to all those involved in the fight against HIV and Aids.

What have you learnt since taking up your role as global ambassador for the protection of mothers and children against Aids?

When I first became involved as ambassador three years ago, with the Global Fund to Fight Aids, Tuberculosis and Malaria, I felt very insignificant when confronted with the enormity of the issue.

Then I went to visit a few of the hundreds of programmes being funded and I heard the accounts of those living with HIV, of doctors and nurses, of NGO's and international organisations and scientists. I saw their incredible commitment, their determination and their successes. And so I really felt a renewal of hope that this disease can be conquered. I understood then how much some issues need to be highlighted and how important it is to raise awareness – and keep awareness raised, not just of the problem but of the amazing successes that are ongoing – apart from the money that is needed to implement the day-to-day work on the ground.

Through my visits to Burkina Faso, Benin and India with the Global Fund, it has also been brought home to me that mothers and children are the least empowered to make their needs heard, especially in developing countries. So I hope that I can add my voice to theirs, and help raise the visibility and the urgency of this issue among audiences where they definitely don't get much of a hearing.

Also, it is still sadly the case that HIV often carries great stigma and is a difficult subject to broach. Dealing with maternal health overall allows this issue – among others – to be dealt with. This is why I decided to launch the "Born HIV Free" movement in 2010, to bring to this issue the spotlight it really needs.

Are we winning the battle against Aids?

We are getting there – and we have everything we need to ensure that we do finally win it. Amazing progress has already been made, even in some of the least developed and most fragile countries in the world. We have never been this close. Today, antiretroviral treatment has been proved to prevent new HIV infections, and more and more people are able to access this treatment – thousands more every day. What seemed utopian a few years ago is now completely within our reach.

There is also the economic aspect to consider, especially in the crisis period we are currently going through – treating an HIV-positive woman to prevent the infection of her child is obviously much more affordable than treating someone (the baby to be born) for life. And treating someone with antiretrovirals to keep them healthy, before they are gravely ill, is more affordable than paying for repeated stays in hospital. All that is lacking is sufficient resources, globally, to be able to expand these measures.

Is Aids/HIV now primarily a problem for Africa and the developing world? Does it raise different issues in Europe?

HIV infection is still a significant risk in Europe and must be taken very seriously. People have become complacent because of the existence of effective treatment – in France there are still numerous new infections per year. But we must not let down our guard and should remember that HIV remains a complicated condition for which there is no cure and for which you need to be on treatment for life. Just because HIV is more manageable – for those of us lucky enough to have access to treatment in Europe – doesn't mean we should treat it lightly.

In different parts of the world the epidemic also raises some complex social issues, which can vary according to each culture. These questions need to be dealt with individually, country by country, if we are going to be able to tackle HIV effectively. This is especially the case in sub-Saharan Africa, which remains the area most severely affected, and where stigma, discrimination and gender issues all play a role in the epidemic. So far, 6.6 million people around the world, mostly in developing countries, are now on antiretroviral treatment. This proves that extraordinary progress is possible – but we must keep going.

HIV and Aids require a global response and a long-term vision. The solution will always be based on adequate information about the disease, effective prevention and universal access to treatment.

Are we doing enough to develop effective vaccines against HIV, or would it be better to concentrate our limited resources on prevention and antiretrovirals?

The world has been making enormous efforts in the search for vaccines against HIV for decades. It is important that those efforts continue – it is not impossible that an effective vaccine is in our near future and it would make a huge difference to how we approach the disease. In the meantime, we need to not settle for limited resources but need to continue to encourage additional funding for HIV and Aids – this is what will allow millions more people around the world to access prevention and antiretroviral treatment, which are both, and will continue to be, essential for the more than 30 million people around the world living with HIV and Aids.

It is 30 years since HIV, the virus that causes Aids, was first identified. What do you hope to see in the next 25 years?

Achieving the virtual elimination of HIV transmission from mothers to their babies – which is what UNAids, the Global Fund and others have called for by 2015 – is a key aspect of turning the tide against HIV among all populations, not just babies. But if we can prevent nearly half a million children every year being infected, over time that translates to millions of people being spared HIV infection. The effects of that – socially, economically, politically – are exponential.

So I dream of an HIV-free generation in the next few years – and of all generations being HIV-free from then on. I hope that in the very near future, people will be astounded to know that in the past babies were born with HIV. I am convinced that these visions of hope today will drive forward our joint fight against HIV and Aids.

www.youtube.com/bornhivfree

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