A Shot in the Arm Podcast

Episode: World AIDS Day 2024: Human Rights In Action Against HIV
Host: Ben Plumley
Guests: Steve Letsike (Deputy Minister for Women, Youth and Disabled Persons, South Africa), Dr. Mandeep Dhaliwal (Head of HIV, UNDP)
Date: December 1, 2024

Overview

This special World AIDS Day episode delves into the crucial intersection of human rights and the global HIV response. Host Ben Plumley facilitates a rich conversation with two influential leaders: Steve Letsike, a pioneering South African human rights and LGBT activist turned government official, and Dr. Mandeep Dhaliwal, a longtime advocate and global leader in the HIV field from the UNDP. The discussion explores how progress in ending AIDS as a public health threat by 2030 is fundamentally tied to human rights, politics, and grassroots activism—making the case that biomedical innovation alone isn’t enough.

Key Discussion Points & Insights

1. The Activist-to-Government Journey: Changing the System From Within

[04:01–10:24]

• Steve Letsike’s Path:

  • Transitioned from decades of outside activism into a government role to create change from within.
  • Recognizes feelings of betrayal among some activists but frames civic and political engagement as different avenues to the same goal: justice and equality.
  • Quote:
    "Sometimes it feels, you know, like a betrayal to the nonprofit sector, to the civil society sector... I don't think it's a betrayal. It's actually much more of how do we all contribute differently?" — Steve Letsike [05:42]

• The Value of Having Activists in Power:

  • Plumley:
    "I really don't accept the sort of the purity argument... if we really want to speed it up, it’s going to have to be done by us assuming different roles." [06:23]

2. Interconnectedness of Issues: Human Rights, Health, and Social Justice

[07:41–10:24]

• LGBT rights, gender-based violence, poverty, and health (including HIV and TB) are deeply interconnected.
• Single-issue approaches among civil society and NGOs can slow progress because structural societal drivers are shared.
• Letsike:
  "If you're going to respond to violence against LGBTI people or violence generally... you are not going to disconnect it from the public health challenges such as HIV, because, you know, gender based violence is also the driver..." [08:13]

3. The UNDP & Systems Change: Bringing Communities Into Governance

[10:24–13:47]

• Dr. Mandeep Dhaliwal shares her journey from critical NGO leader to shaping global HIV policy at the UNDP.
• UNDP leverages its global mandate in governance, working across governments, parliaments, judiciaries, and community leadership to drive systemic change.
• She emphasizes the leadership of communities—especially key populations—in achieving meaningful progress.
• Dhaliwal:
  "You simply would not have the response that you have today without communities, without leaders like Steve and many, many others." [12:06]
• Example: Malawi’s national HIV and law policy dialogue, convened by UNDP, modeling best practice in multisectoral collaboration.

4. Navigating the UN System From Government & Civil Society Perspectives

[15:01–18:22]

• Letsike describes moving from an NGO advising government to being part of government delegations.
• South Africa’s approach: Inclusive, with an ongoing commitment to not compromising on human rights, even when facing international pressures, especially in African contexts that criminalize LGBT people and sex work.
• "Me in government does not change the kind of tone of restoring justice and trust to the people we are serving." — Steve Letsike [18:22]

5. Why Human Rights Are Central to Ending AIDS

[18:36–24:39]

• Dhaliwal directly links human rights protection to public health outcomes:

  • No effective HIV control without removing stigma, discrimination, and punitive laws.
  • Biomedical advances (like ARVs and new prevention tech) are only impactful if people can access them without fear of criminalization or violence.
  • Dhaliwal:
    "If you don't protect the rights of those who are most vulnerable, you are not going to achieve your public health goals..." [19:14]

• The 1996 parallel: Huge medical breakthroughs are only transformative if the political and human rights environment allows access.

• Host Plumley underlines with examples from Uganda, where anti-LGBT laws have driven communities underground and away from care.

• Dhaliwal highlights new evidence:

  • Countries with criminalization have lower awareness and service uptake.
  • Enabling legal and policy environments drive infections down much faster.

• Dhaliwal:
  "It is absolutely central to getting us to the end of AIDS as a public health threat by 2030." [24:36]

6. National Sovereignty, Donor Dependence & Shared Responsibility

[25:05–29:19]

• Letsike on balancing country-driven responses vs. donor dependence:
  • The positive: PEPFAR and the Global Fund were crucial in scaling South Africa’s HIV program after legal battles forced compliance during government denialism about ARVs.
  • The negative: If donors withdraw, most vulnerable populations face catastrophe.
  • "If any development country or [donor] pulls out, we have this negative that's going to impact our people..." [28:38]

7. Can We End AIDS by 2030? Hope & Headwinds

[29:50–31:56]

• Dhaliwal’s Perspective:

  • Progress is possible if countries fulfill historic commitments to:
    • Remove harmful laws and end gender-based violence.
    • Combat stigma and discrimination.
  • The main challenge: a well-organized political backlash against human rights and gender equality.
  • Still, historic alliances and policy targets provide hope.
  • Dhaliwal:
    "We can get close, but we need to be able to make sure that these new prevention technologies are affordable, accessible, and we don’t have legal and policy barriers standing in the way." [31:17]

• Letsike’s Farewell:

  • Leaves to catch a flight but reaffirms commitment to justice, promising to return for a future episode on South Africa’s HIV strategy.

Notable Quotes & Memorable Moments

• Steve Letsike:
  "Sometimes it feels, you know, like a betrayal to the nonprofit sector... I don't think it's a betrayal. It's actually much more of how do we all contribute differently?" [05:42]

• Ben Plumley:
  "If we really want to speed it up, it’s going to have to be done by us assuming different roles." [06:23]

• Steve Letsike on interconnectedness:
  "You are not going to disconnect it from the public health challenges such as HIV, because... gender-based violence is also the driver..." [08:13]

• Dr. Mandeep Dhaliwal:
  "You simply would not have the response that you have today without communities, without leaders like Steve and many, many others." [12:06]
  "If you don't protect the rights of those who are most vulnerable, you are not going to achieve your public health goals..." [19:14]
  "We can get close [to ending AIDS by 2030], but we need to be able to make sure that these new prevention technologies are affordable, accessible, and we don’t have legal and policy barriers standing in the way." [31:17]

Timestamps for Key Segments

• Intro & Guest Introductions: 00:00–03:16
• Steve Letsike’s Activism/Journey: 04:01–10:24
• UNDP & Community-Led Governance (Dhaliwal): 10:24–13:47
• Working With & Navigating the UN System: 15:01–18:22
• Human Rights & HIV—The Core Arguments: 18:36–24:39
• National Sovereignty, Donor Dependence: 25:05–29:19
• Ending AIDS by 2030, Hope & Challenge: 29:50–31:56

Conclusion

The episode powerfully articulates that the battle against HIV is inseparable from struggles for human rights, governance reform, and community leadership. Scientific innovation cannot succeed without inclusive policies and societal will. While setbacks and global backlash threaten progress, activism at every level—from local communities to global institutions—remains the most potent weapon. Achieving the end of AIDS as a public health threat by 2030 is within reach, but only if human rights remain at the center of the response.