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Canada needs to shed its "delinquent" and "hypocritical" position on AIDS and step up as a world leader in fighting the global pandemic, Stephen Lewis, the UN secretary-general's special envoy for AIDS in Africa says.

Mr. Lewis, one of the key participants in the international conference on AIDS in Toronto this week, was on-line earlier today to take your questions on his views, his UN role, Prime Minister Stephen Harper's refusal to speak to the conference which has attracted more than 31,000 participants from more than 120 countries, and other AIDS/HIV issues.

Mr. Lewis also heads the Stephen Lewis Foundation, a charitable organization that helps victims of HIV/AIDS in Africa.

The former leader of the Ontario New Democrat Party, Mr. Lewis stepped down as party leader and as an Member of Provincial Parliament (MPP) in 1978.

After working for several years as a labour mediator, columnist and broadcaster, Mr. Lewis was appointed Canadian Ambassador to the United Nations from 1984 until 1988.

From 1995 to 1999, Mr. Lewis was Deputy Director of UNICEF and he is currently working for the United Nations as the Secretary-General's Special Envoy for HIV/AIDS in Africa. In his role as Special Envoy, it has been his job to draw attention to the HIV/AIDS crisis and to convince leaders and the public that they have a responsibility to respond. He has been widely praised for his effectiveness in this role.

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Jim Sheppard, Executive Editor, globeandmail.com: To our readers: Mr. Lewis verbally answered your questions earlier this afternoon. A partial transcript follows.

You can also listen to an edited audio of his answers here. The full audio is about 33 minutes in length.

Jim Sheppard, Executive Editor, globeandmail.com: Welcome, Mr. Lewis, and thanks for joining us today to take questions from the readers of globeandmail.com about the international fight against AIDS/HIV. Let me ask you this to start: What do you hope will be the main accomplishments of this conference and what do you think the impact will be of Prime Minister Harper's absence, and his government's apparent inability to make a decision about its AIDS policy?

Stephen Lewis: I think the main accomplishments will be two-fold.

One, the thoughtful engagement around important and emerging issues from circumcision to microbicides.

And two, the meeting of the conference theme of trying to deliver a much stronger focus on getting things done at a country level at the grassroots.

Prime Minister Harper's absence is something that sticks in the craw of many of the conference delegates. They are offended by it and insulted by it. I think it was a serious mistake in judgment on his part because he lost the opportunity to set out Canada's policy and the confusion around Canada's position where funding is concerned.

The constant cancellation of press conferences and delays in answering questions — that has introduced a level of uncertainty that doesn't inspire confidence. I suspect that before the conference is over, there will be an announcement of funding around vaccines and microbicides and research and World Health Organization and Global Fund. There will be all of these things. But it will be seen to be a desperate effort to restore credibility, rather than a serious contribution.

Kevin Leal, Toronto: Mr. Lewis, I have worked in trying to educate youth in Toronto concerning HIV/AIDS and I have noticed that many of the youth here seem to believe that HIV is not in issue in Canada. They have told me that HIV is really only a problem in Africa. My question to you is this: Do you believe that the attention given to HIV/AIDS in Africa might make some people here in Canada feel like they don't have to worry about HIV/AIDS? Thank you very much for your time and please keep up the great work.

Stephen Lewis: Thank you, Kevin. I don't think we have to work in compartments here.

My sense in raising these issues in Canada is that people in Canada, particularly young people in Canada, feel deeply about AIDS in Africa and often want to be of help.

There is no question that the situation around AIDS in Canada, the growing level of incidence amongst women in Canada, and the very, very serious problem in aboriginal communities, particularly caused by injecting drug use, does not get nearly enough attention in the country and that's a problem of the political leadership again, not wishing to give a profile to these issues.

What is really fascinating and worrying is that we're right on the verge of deciding whether or not the safe-injection site in Vancouver will remain open. That will have a huge impact on the risk exposure to injecting drug-users amongst whom are many aboriginal people. If the government decides to shut it down, that would be an act of almost impossible political irresponsibility. But there is no question that the government is considering that.

Susan Spicer, Peterborough, Ont.: Mr. Lewis, thank you for your work. Last night, on CBC news, Tony Clement, the minister of health, was asked why our government hasn't been able to honour its commitment to send generic drugs to Africa. He seems to be saying that there are WTO barriers and other barriers imposed by the big drug companies. What's going on with this? Why can't we get these drugs on a plane and get them to these people who so desperately need them? It's appalling and heartbreaking.

Stephen Lewis: There are no barriers. The WTO exemption to getting manufactured drugs in Canada, or any donor country, and sending them to Africa, that exemption emerged in 2003 and it was consolidated as a permanent part of the WTO just a couple of months ago. To suggest that there are WTO problems is to raise a fraudulent red herring.

The problem is the big pharmaceutical companies. They are negotiating with the generic companies forever, always stalling, and because governments -- both Liberal and Conservative -- don't seem to have the backbone to stand up to these pharmaceutical companies, this never gets resolved. What you have to do here is issue a compulsory licence. That's what it's called. That's the procedure. If the big pharma companies will not grant to the generic companies . . . a voluntary licence, then the government steps in and amends the regulations and delivers a compulsory licence, which the legislation allows them to do and provides for.

The fact that they [the government] haven't done this is what is stalling this process. And this [current government] review is just another delay. So we'll be 3.5 to 4 years before a pill ever leaves Canada which, in the context of the pandemic, is outrageous.

Ellen Fiore, Toronto: The HIV/AIDS incidence rate for aboriginal peoples in Canada, especially women, is soaring. In addition to comprehensive prevention strategies, what else do you think would be required to bring the incidence rate for aboriginal peoples more in line with other Canadian populations?

Stephen Lewis: Like everything else with AIDS, Ellen, you have to give it particular attention and primacy. And, frankly, the way you do that is to teach the elements of prevention in aboriginal communities, provide anti-retroviral drugs in aboriginal communities and -- most important of all -- provide facilities for counselling and testing in aboriginal communities, and encourage aboriginal people to be tested.

The other way to do it is to keep the safe-injection site in Vancouver open -- indeed to open another one in Vancouver and two or three more across the country, and engage in harm-reduction exchanges of needles and the provision of methadone so that people who use drugs are not put at risk.

It is crazy to criminalize drugs. This is a public health problem -- and that is particularly true in aboriginal commmunities.

N. Patterson, Ontario: Mr. Lewis, from the HIV infection rates in Africa, either these people have the highest affinity for promiscuity or, as I suspect, there is a sexual subjugation of females either by violent or economic means. If my suspicion is correct, then, in the absence of medical cures or vaccines, any educational programs about AIDS or condoms, or any supply of cheap drugs will not control this disease. What is needed is changes to the culture and capability of police/judicial systems and changes to economic opportunities for females, the latter probably supported by an enhanced education system, in other words, an extensive cultural and economic overhaul of these societies. With all due respect to you and your efforts, what is the realistic prognosis for HIV in Africa without a magnitudinal change of mandate and budget for an enterprise such as yours?

Stephen Lewis: It is certainly true that gender inequality is driving the virus and that one of the problems is the lack of economic opportunity for women to be able to detach themselves from partners, for example, who they feel may infect them. The lack of sexual equality means that men feel that they have an absolute sense of entitlement to sex and women are often in a position where they cannot say "no," particularly in marital situations where you have younger women and older men.

On the other hand, there is a tremendous effort being made in many African countries to overcome the gender inequality and there are preventive technologies in prospect which will work. It is wrong to say that there isn't an effort made to deal with condoms, because there is. And it's wrong to say that there isn't an effort made to deal with cheap drugs, because there is -- generic anti-retrovirals. There is also a very considerable effort to discover microbicides and to discover a vaccine. A microbicide might only be five to seven years off. That feels a long way but we are going to keep at it persistently.

Harvey Mushman, Cambridge, Ont.: Mr. Lewis, thank you for being here today and for all your work on behalf of this cause. It is truly admirable. My question will (I'm sure) seem totally heartless and politically incorrect, but it is a question I have not heard raised in the debate about funding and providing cheap or free HIV/AIDS drugs to (primarily) sub-Saharan victims of the disease. Does this program not run the risk of "throwing gasoline on the fire" of the AIDS pandemic? Unless lifestyles and (primarily sexual) habits and activities of infected individuals suddenly change, do we not run the risk of them just infecting more and more people during their extended lifetimes? I understand that issuing free drugs is only one part of a several-pronged attack . . . but is now really the right time to implement it, or should we put all our efforts into preventive measures? Could we, in our compassion and desire to help the those afflicted with this disease actually be contributing to its spread? Do you think this is a valid concern and if so what measures being undertaken to minimize it?

Stephen Lewis: Well, the concern is misplaced -- first because there is no competition between prevention and treatment. Both are equally needed and are inseparable.

Second, because in fact people who learn that they are HIV-positive and end up going on anti-retroviral drugs are usually much, much more aware of the dangers of high-risk sexual behaviour and don't engage in it because there is a signficant counselling program before and after the test. And, if you are found HIV-positive, you learn very quickly of the dangers you pose to others.

Number 3 . . . when you are on anti-retroviral drugs, the viral load in your body is reduced so significantly -- often to undetectable levels -- that your capacity to infect others is similarly reduced.

So, to be treated works benefically in every way.

El Gordo: According to the Global Health Council, the number of people in the world with AIDS/HIV has doubled between 1995 and 2005, and currently sits at approximately 40 million. Would it be accurate to say that prevention programs have been a dismal failure, especially in Africa?

Stephen Lewis: Yes, prevention obviously hasn't worked. I don't know if you can say "a dismal failure" because I suppose one could argue that the numbers would be even higher had the prevention programs utterly failed. The prevention programs have been profoundly inadequate. We all know that. Everybody is working harder at prevention and looking harder at new prevention technologies as well.

Heather Lunergan, Fredericton, N.B.: Hello, Mr. Lewis. Can you tell us how each of us can help, from home, here in Canada? Thanks, again, for being so outspoken and brave in your various UN roles.

Stephen Lewis: I've always felt that the best way for individual Canadians to help is to get in touch with one of those wonderful non-governmental organizations working at the grassroots in Africa and other countries, to make a real difference at the ground [level] . . . like Save The Children, CARE International, Doctors Without Borders, certainly World Vision. You can turn to UNICEF if you want a UN organization. There is no question that these organization are worth supporting -- not just with money but with participation in their policy discussions and their conferences and maybe even picking up and going off to Africa under the auspices of one of these NGOs, if it should suit one's life.

I don't usually talk about my own foundation. But a program we have recently launched . . . building solidarity between African grandmothers and Canadian grandmothers . . . in particular working to help hold life together for the African grandmothers who are themselves holding the continent together. I think it might be interesting [for readers] to go to the Web site of the Stephen Lewis Foundation and take a look at the grandmothers program. It may have some appeal.

T.J.: Why doesn't the [Bill and Melinda] Gates Foundation just buy the drugs which are so desperately needed for those infected by HIV? Since so many are dying each day, why wait for sluggish, foot-dragging countries such as Canada which promised generic drugs two years ago -- the delivery of which is now tied up with red tape?

Stephen Lewis: The problem is not the purchase of drugs. There is quite a flow of drugs now. The reason we need the Canadians drugs at a low price is because the quantum of drugs needed over time will increase as more and more people who are now infected require treatment. We've got about six [million] to seven million people now who require treatment -- 1.65 million of them are in treatment as of today. So that's just about a quarter of them at best, and the numbers rise every year. But the drugs are flowing at the moment -- generic drugs from India and Brazil and Thailand, and there is some indigenous drug production now in South Africa. So, in truth, the drugs are flowing. The problem isn't that.

The problem is to get Canada's sluggish foot-dragging to become a race to a more hopeful future for Africa by manufacturing the generic drugs ourselves at low prices and getting them over there.

Jacquie Menezes, Toronto: Bill and Melinda Gates opened the conference [by urging] put "the power to prevent HIV in the hands of women" . . . [but] by putting "the power to prevent HIV in the hands of women," are we not allowing the male population to abdicate its responsibility to prevent the sexual and domestic violence and change the attitudes that they have sexual control over the women in their groups? Doesn't this send a very wrong message to the males of the most highly HIV/AIDS susceptible areas that "hey, we understand that men are men and their behaviour and attitudes won't change, so we'll put the onus on the women to make the change?" . . . Mr. Lewis, what are your views on the prevailing attitudes that allow the males in these populations to abdicate their responsibilities in preventing HIV/AIDS? Do you think more can be done to change their attitudes and behaviour? Or is the only viable solution going to come through putting "the power to prevent HIV in the hands of women?"

Stephen Lewis: I actually quite agree with Bill and Melinda Gates. In the immediate term, we have to put "the power to prevent HIV in the hands of women" because the women are dying now in hugely disproportionate numbers.

And while it is important to work with men on their sexual behaviour, that's going to take a couple of generations -- minimum -- to change. Therefore, you can't wait that long.

So what we're trying to do is empower women as much as possible and as quickly as possible to withstand predatory sexual overtures.

That's why there is such a focus on developing a microbicide and a vaccine so that, as preventive technologies, they can be the answer for women -- at least to reduce the number of infections by millions, rather than waiting for the men to "come around."

That doesn't mean that you don't work with the men. You work very hard with the men. But you recognize that that's the long haul. In the short haul, the women are incredibly vulnerable -- dying in incredible numbers. Something has to be done for and with the women immediately.

Vincent N., Peterborough, Ont.: Bravo, Mr. Lewis. Keep up the good work. Is there no way to get abstinence advocates and public health officials to agree to disagree so that both can help the public? Can not those who distribute condoms encourage religious instruction for what is it worth? Can the church not understand that sinning with a condom on may allow you to live another day and hopefully repent? Can't each of these two sides accept that the other helps to some degree?

Stephen Lewis: That's a very, very good point.

Unfortunately, the two sides -- and I guess I'm on one of those sides myself -- have their heels dug in.

I think it would be very wise to acknowledge that there are advocates on both sides and that we just do the best we can, rather than battling it out. But since I'm guilty of that myself, I will take a lesson from Vincent N. in Peterborough and attempt to be more generous in my descriptions of the people whose policies I dislike.

Diane Wood, Newmarket, Ont.: Good afternoon Mr. Lewis, A friend of mine, Dr. Margaret Ogala, who runs an AIDS hospice in Kenya, tells me that it is food that is more important than medicine for those suffering with HIV. My understanding, though, is that corruption takes most of the money that we would send to help those in need. Would it be a better solution to set up schools and teach the people ethics so they can change the type of environment they are in, rather than to give them medicine that will only make them sick if they have an empty stomach?

Stephen Lewis: Well, I think there are two items here.

First, Margaret Ogala is right in large measure. You can't be on anti-retroviral treatment without having sufficient food -- and it has to be nutritious food, not just food but food which has all of the elements of carbohydrates and proteins which will give you a combination to strengthen your body and your immune system. And it is desperately important to have the food. There is no question about that. There is study after study demonstrating that if you don't have [sufficient nutritious] food when you're on anti-retroviral treatment, you are in trouble and the treatment may not be successful.

The business of corruption is an unnecessary slander . . . Corruption in Africa, in some places, is extreme but in most places it is not. I remind you that we held an election in this country based on the issue of corruption last time. And, God knows, in the United States, there is a great deal of corruption. So one shouldn't be overly smug or precious about corruption being confined to Africa . . .

My reply would be that corruption [in Africa] is not at a level where you should reduce your commitment to treatment and to food.

Jim Sheppard, Executive Editor, globeandmail.com: To our readers, thanks again for joining us for this important discussion. Just a reminder that this is a partial transcript only. You can also listen to the edited audio of his answers here. The full audio is about 33 minutes in length. And thank you for submitting more than 100 questions to this discussion. We're sorry we did not have time to get to all of them.