At UNAIDS the Deputy Executive Director of the Programme branch Dr Paul De Lay has been known to many as the “voice of reason”, deftly handling complex issues, generating consensus and providing clear direction.
A medical doctor with training and experience in family practice, infectious and tropical diseases, Dr De Lay started working on AIDS at the very beginning of the epidemic. He worked with the Global Programme on AIDS at the World Health Organization and served as Chief of the HIV/AIDS Division at USAID before joining UNAIDS in February 2003. He was appointed the Deputy Executive Director, Programme, in June 2009.
After 10 years with UNAIDS Dr Paul De Lay is taking up his retirement, however before he left unaids.org caught up with him to ask if he would share a few of his thoughts and memories of working for the global AIDS response.
Q: What do you think is the greatest accomplishment to date in the AIDS response?
Dr De Lay: The very fact that affected communities have kept AIDS so high on the global agenda over the past 30 years. This is a truly remarkable accomplishment. We also have seen the incredible advances in understanding the complexity of the virus, the development of effective treatments, better knowledge about combination prevention, and deeper awareness about the role of human rights and gender in the response. However, none of these would have happened without the constant pressure for the world to keep paying attention to the devastation caused by HIV and to improve the range of tools we have to respond to it.
Q: In your vast career what do you consider the biggest advancement in public health?
Dr De Lay: Not sure how “vast” my career has been. I feel that in many areas of public health, I have barely scratched the surface of a problem. Thus, my response is based on my own, rather narrow perspective. Undoubtedly, there have been astounding biomedical breakthroughs—in vaccine research, the importance of micronutrients like Vitamin A, modern contraceptives, oral rehydration therapy, and many others. However, for me, I think the most important advancement has been the realization as to how the health of individuals and populations reflects a wide range of broader societal issues, like security, nutrition, physical activity, living conditions, basic rights to services, etc. The AIDS response has done a lot to wake us all up on how important the broader social context of any specific disease really is.
Q: You have been associated with the AIDS response from the very beginning, what were the biggest obstacles you faced?
Dr De Lay: I think my experiences echo those of many others. Clearly one of the most challenging obstacles has been the stigma around how a person is infected and, in the early days, the lack of treatment and the inevitable death sentence that was associated with HIV infection. For me, one of the other major challenges was the lack of a simple, inexpensive, reasonably effective biomedical intervention. In the history of global public health, most resources went to campaigns that used a limited set of cheap interventions, like treating diarrhoea with oral rehydration therapy or preventing malaria with insecticide treated bed nets. Responding to AIDS went against this very narrow thinking and broke the prejudices towards more complicated and more comprehensive solutions.
Q: A new generation is now taking over the AIDS response, what advice would you give them?
Dr De Lay: I think that in some ways it’s harder for the next generation of responders than it was when I first got engaged back in the early 1980’s in San Francisco. There are so many competing priorities and the politicians and Ministries of Finance look to quick fixes and foster the competition between social ills, using mortality and financial impact to decide which problems deserve funding. I would definitely advise anyone who was considering a career in global health to nurture long term thinking and solutions. He or she should also focus on the broader societal problems and not limit themselves to a single disease. I think that the new enthusiasm around non-communicable diseases and their importance all over the world will not only strengthen the AIDS response but continues the same line of thinking that was generated by AIDS- that solutions for health problems need more than just a medical response.
Q: As a film enthusiast, if you were to write a blockbuster about AIDS, what would be your plot?
Dr De Lay: There have been a number of very informative and poignant films and plays about HIV over the past three decades. I still remember how the film Philadelphia in the U.S. reached a very broad audience and helped them to understand not just HIV infection and disease but the real impact it had on people and the limitations of the existing response. Recently, there have been a number of films about the critical role that infected people and activists have played, (for example, How to survive a plague.) However, many of these films are set in high-income countries. It would be good to see more films about activism in low income countries and both its toll for the individual and the successes it can achieve. But for me, if I could make a film, I would rather it would be about the broader issues facing a community in Africa or Asia and the heroism of individuals in dealing with social problems. AIDS would only be part of the social picture and not the sole focus.
Q: How would you define the “end of AIDS”?
Dr De Lay: It would not be the same definition as for the end of smallpox or the current campaigns to end polio. We don’t have the same biomedical tools at our disposal, so the concept that the virus would cease to exist and all infections would stop is not really relevant in the current context of AIDS. For me, the idea of ending AIDS is to take every tool we have available (regardless of cost, complexity, etc.) and to use them in a rational and optimum way that doesn’t violate basic rights. If we really did that, we could drop annual new infections from 2.6 million to just a few thousand, and the same for mortality.
Staff at UNAIDS are proud to have had Dr Paul De Lay as a colleague and mentor and the organization is thankful for his outstanding service.