
In this powerful episode of A Shot in the Arm Podcast, host Ben Plumley dives deep into the intersection of human rights and global health with two inspiring leaders: Honorable Deputy Minister Steve Letsike from South Africa and Dr. Mandeep Dhaliwal, head of HIV at the UN Development Programme (UNDP) — Together, they explore the evolving HIV response, challenges in addressing stigma and discrimination, and the critical role of governance and community leadership in achieving the global goal of ending AIDS as a public health crisis by 2030.
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A
Welcome to A Shot in the Arm podcast. I'm Ben Plumlee and this is a podcast about innovation and equity in global health. This episode is one of a few that we're producing in and around World AIDS Day in 2024, a time of deep soul searching and the potential for some dark times ahead of us. We're going to be looking more closely at the interrelationship between human rights and hiv. And I can't think of of two better people to join me on this discussion to guide us and provide some pretty unique insight. First up, and I am so excited to say this, the honorable Deputy Minister for Women, Youth and Disabled Persons, Steve Letzeke, who's joining us, I think, from an airport in South Africa. So we gotta get on and make sure we keep this to a Time League clip. Hey there, Steve. Hey there, honorable Deputy Minister. How are you?
B
How are you doing this evening?
A
Doing good and thank you so much for joining us.
Where are you and where are you heading to?
B
No, thank you so much for the invitation and greetings to your listeners. You know, I think this is a. A great platform to be in. I mean, Johannesburg heading, of course, to Cape Town. And we just came out of launching the 16 Days of Activism of no violence against Women, Children and vulnerable troops. So it's really, you know, an important day also to observe some of the programs that we've been doing.
A
Absolutely. And really, really appreciate you giving up some valuable time to be with us. We're also joined by the head of.
HIV at the UN Development Program, UNDP. It's Dr. Mandeep Dhaliwal. Mandeep, welcome to A Shot in the Arm podcast. This has been a long time coming, Right?
C
Thank you so much, Ben. It's an honor to be here with you. This is an exciting podcast which I don't miss an episode of. So fantastic to join you and the Deputy Minister, the honorable Deputy Minister. It's great to. I'm looking forward to the conversation.
A
So, Mandeep, I realized in preparing for this episode that you and I have known each other really for a very, very long time when you were at the International HIV AIDS alliance, head of Access, head of Care and Treatment Access, and of course, the International HIV AIDS alliance became Frontline aids.
B
But.
A
You'Re looking as youthful and inspiring as you did then.
C
Thank you, Ben. I can't even remember that must have been about 24 years ago. That's a long time.
A
It's a while. Hey, it's a while.
C
It's a while. And there's still a lot to do.
A
Oh, isn't there just. And that, of course, is what we're going to cover. But, Steve, could I start with you first? I mean, you really have been at the front of a wave of human rights, LGBT and HIV activists moving into elected roles. And I just wonder, what is it like moving from an activist into, well, being a deputy minister, a member of the government, the very organization that you have spent your life, your passion, sort of advocating and lobbying with?
B
No, thanks, Ben. Look, I think it's important to also mention that I have been part of the organization in my teens, since then, but I have, you know, later on in my early.
You know, days moving from school into, you know, the workspaces. I chose to focus on social justice, focus on human rights, and focus on nonprofit sector, which really is the passion around ensuring that we can actually get to a just society, equal society. And so it's a different thing, you know, to spend about 20 years in the social justice movement outside, you know, driving things in the government or even in the political space. But I think I've opted, you know, a few years ago to say there's a kind of a snail pace and, you know, that we're moving into. And sometimes it's not about doing it from outside, but sometimes it's really taking addition to do it from inside. You know, governments belong to people. And when we can actually get to a point where we appreciate that the people can be that change we want to see and we allow people to contribute. Because anyway, political space is everywhere, and it's not only a selected few that we get to it. So the feeling of transitioning, sometimes it feels, you know, like a betrayal to the nonprofit sector, to the civil society sector. Many activists who say, oh, no, but yeah, you know, we've been working to hold the state accountable. Are you betraying us now? Because you're going to be like them. And I don't think it's a betrayal. It's actually much more of how do we all contribute differently? And we've been dealing with policy, and going politically is really about lawmaking and doing things and getting things done for that matter.
A
I think it's really important that people like you do play leadership roles in government, because.
I really don't accept the sort of the purity argument that, you know, you have to be on the outside pushing and advocating and calling to attention change. If we really want to speed it up, is going to have to be done by us assuming different roles. I mean, I remember you. Gosh, I guess it must be about A decade ago, when you were one of the co chairs of the task force looking at LGBT hate crimes after this appalling rash of murders of lesbians. And it really struck me at the time that there was a, both a passion, a dedication, but also something very articulate that.
Would really go places and would really be necessary for a leadership role within, within government even. But.
From those early days, how do you see the, the evolution of LGBT rights and safety in South Africa?
B
Yeah, I think there's been quite a number of pieces trying to tie them together.
You know.
In many cases, you know that these issues are interlinked intersectionalities. You cannot disconnect people's lives whenever you are dealing either with health, whether you're dealing with their safety, you're dealing with a lot of social and structural drivers or social and structural challenges.
And we find that if you can't Whaley, try to force to tie some of these, that if you're going to respond to violence against LGBTI people or violence generally against, you know, women and other vulnerable groups, 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 of academic.
Poverty is an impact, a challenge that leads to even much more of this violence if you're not going to deal with unemployment, substance use and abuse. So all these.
Social fabric issues, constantly going to have to try tie them together.
But you also see that movements and civil society movements are sometimes approaching things in a narrowly approach. So there's a grouping that only will focus and say I'm dealing with hiv and there will be a group that will say I'm only focusing on tb, but yes, this co infection, why can't we focus and deal with these issues together?
And I think this isolation makes the world to move in a slow movement to really resolving some of the challenges. And I think that's constantly what we suffer from. And I found that in the different spaces that are occupied was to actually try to bring these issues together.
To say that we all can work together, we can speak climate, we can speak just transition, but we also can speak on other things. So I find.
That we cannot just speak about activism if we don't show the direction, if you don't deal with data, the evidence, everything that brings everybody together. And because solutions are there, but it's only the will that says, are we ready to work and advance those steps.
A
And joining the dots together? And I guess, Mandeep, the same thing sort of applies to you in your journey. You're a doctor, you're a lawyer.
B
You.
A
Have been in the NGO field and then you became an international civil servant. And I just wonder how the change was for you.
As you had to adapt to the uniqueness of your role in undp.
C
Thanks, Ben. I was just reflecting exactly on that as I was listening to the honorable Deputy Minister. It was very much a similar journey from being outside the United nations and really being very critical and pushing for the UN to respond and then coming to undp, which is one of the founding co sponsors of the Joint UN Program on aids and looking at just the platform that it provided to be able to really drive change at an international level across over 190 countries and what that meant. And you know, UNDP's mandate is in governance. So it's about, you know, working at, you know, working at the leadership level, working government at governance of community based responses, national responses, looking at laws and policies, looking at the institutions of governance, whether that's the courts, parliaments, you know, anything to do with access to justice. And that for me was very, very exciting. And I think the, I think we've made some incredible progress and contributions to the HIV response, whether it was through supporting the independent Global Commission on HIV and the Law, whose report is still sadly very much on topic these days, given the climate that we find ourselves in. But it's been, you know, to be able to work at that level, at that scale, I think it's fantastic. And one of the things that I've been really deeply committed to in this role is to really bring communities and civil society into the un. So not doing things. Some people in the UN think about member states, they just think government, not us. We think, and I think this is from my history with the HIV response that you simply would not have the response that you have today without communities, without leaders like Steve and many, many others. And really now focusing very much on strengthening local leadership, whether that's in communities of key populations, people living with HIV or civil society, and also trying to really use our convening power as UNDP to convene communities that are most affected together with the governance institutions. It's very exciting. I just come from Malawi where we had a national HIV and law policy dialogue where we brought key population groups that we're supporting through an initiative called scale, together with the National Human Rights Commission, the Law Commission, the judiciary, media and UN partners in the government. I mean, it was just a fantastic dialogue. And it's only by bringing these, you know, creating these new spaces for dialogue that we're going to move ahead on these very, very difficult issues around human rights, stigma, discrimination. Yeah.
A
One of the other things about UNDP that has always interested me and I think made it invaluable is the, the, the one UN in country, the, the, the role of undp, providing the resident coordinator that sort of helps coordinate and oversee the, the array of UN personnel in country.
B
Indeed.
A
Steve, I wonder whether from a governmental perspective now.
How you have navigated the UN system and the extent to which it remains a force for good, a force for relevance, as the rainbow nation continues to throw off the.
The burdens of.
Are you being told you've got to get onto a.
B
No, no, no, it's another deputy.
A
Oh, okay. Now for those of us watching us in Technicolor audio only, someone popped into the background image. But anyway. Yeah, so, Steve working with the U.N.
B
Ben, I think one of us appreciate the privilege I had in my country.
Even when I was in civil society, that, you know, the organization that I led, which was Access Chapter 2, became an ally, you know, in government, trusting that civil society is not an enemy.
So one was able to at the time, to be able to be included in delegations of the country, to advise the country, you know, on specific things so that, you know, you can really advance the relationship. But of course, now doing it in government and I mean, we've been, we've just had our own government election in May 2024. So it's just been a couple of months into this task. So the first un.
You know, visit that we had was during the congas in September and also focusing, you know, on the summit of the future. And I think it was actually a good, timely effort, one of which RINDA speaks to, you know, how do we actually achieve the SDGs.
And the time that is ticking fast, that requires political will, that requires shared responsibility. So you have a kind of revitalized.
Government, you know, that has been enacted into administration of, you know, what we call the seventh administration for us since our democracy.
And we went there to navigate that space to actually inform the negotiators, but also to inform a conversation with other countries. I think one thing that was interesting for me, Ben, was what has happened during engagement with the African Women Network. And these are women ministers, women champions from other countries who knew me in my previous capacity. And of course, because you've challenged the status quo that challenges countries like Uganda and Ghana and many that still have criminalization of same sex practicing individuals, criminalization of sex work, and also still challenges in relation to people with people living with hiv. So when you challenge and you come now in, in your new role, people here and they said, oh, this is the same person who always speak out is, are they going to tackle us now in that name? But I think it was quite interesting conversation that took place and a kind of a reassurance that, you know, we still are not going to compromise human rights. We're still going to face.
Some of the challenges that existed and those challenges that needs to be resolved. So me in government does not change the kind of tone of restoring justice and trust to the people we are serving.
A
So that, that brings us very nicely onto the issue of human rights and HIV. And in many ways, in the end of 2024, it's sort of insane that we have to explain why it's important and how they fit together. But, Mandeep, I guess I really have to ask you, what is the connection between human rights and hiv? Why should be, why should we be focusing on this? Why shouldn't we just be focusing on biomedical innovation?
C
Well, I mean, I have to say that it's been really clear, and HIV is perhaps one of the most clear, compelling examples of this, that if you don't protect the rights of those who are most vulnerable, you are not going to achieve your public health goals of driving down new infections, of having people access care and treatment. And we are really at a. But we're at a 1996 moment. And what do I mean by that? So in 1996, antiretrovirals were found to be an effective biomedical tool. And thanks to, in large part, the advocacy of people living with hiv, including in this wonderful country of South Africa, calling for the right to treatment, the right to health. We have seen a massive scale up of treatment. We're at a stage now where I think only 9.3 million people still lack treatment. There's almost 39 million people living with HIV, many of whom are on treatment. Where we have high treatment coverage and good viral suppression, we're starting to see infections go down. We have the most extraordinary set of prevention tools now and technologies. And without human rights, you are not going to get those prevention technologies to the people who need them. And that is key populations. That's people, you know, sex workers, transgender people, men who have sex with men, prisoners and their sexual partners. And if you don't, if we don't protect their rights, reduce stigma and discrimination, we're just not going to get these prevention technologies and, and realize the potential of ending AIDS as a public health threat by 2030. I feel so hopeful about this technology, but there is so much to do on the Triple 10 targets which were endorsed by Member States in 2021, in the Political declaration about reducing stigma and discrimination, reducing gender based violence and removing punitive laws. So the human rights argument is more persuasive than ever. And if we don't really, really being better in terms of promoting and protecting the rights of those who are most vulnerable, these tools are not going to be effective.
A
Mandeep, help us join the dots. From respecting human rights to bringing the HIV epidemic under control. I mean, what, Again, it's perhaps a little crazy that we're having to do this in 2024, but it is worth having to repeat because the, the issue is that if people are penalized, are prosecuted, are driven underground, they don't access the services that are available. I mean, we, we see that in Uganda with the anti LGBT laws preventing and scaring people off from accessing, testing, and even some of these new prevention technology. So how do we make the links?
C
Well, I think it's exactly as you've described. If you have laws which criminalize people living with hiv, laws which criminalize HIV transmission or criminalize the populations that are most vulnerable, they aren't going to access testing, they aren't going to access services. And I think you'll see data that's coming out in the World AIDS Day report that shows that where you have criminalization, you have lower levels of awareness, knowledge and understanding about hiv, you have lower levels of access to services. So if we want to reach people with services, the only way to do it is to promote and protect their rights and to remove laws which criminalize, which add to stigma. There's been modeling data for years which shows that actually if you have enabling legal and policy environments that respect dignity, that respect human rights, you can drive down the curve of new infections much faster than if you don't. So it's, you know, it is, it sounds simple, but unfortunately this, you know, changing these laws is a, is a, is quite political and politicized in countries, I have to say. It is not all doom and gloom. There are many countries that are making the kind of changes that, that need to be made. But there is also, you know, in terms of, you know, getting rid of old, you know, colonial laws which are on the books, which criminalize same sex relationships, including in Africa, which is phenomenal.
A
Yeah, thank you. The British. Yeah.
C
Yes. Yeah. And, you know, you have this extraordinary resolution of the African Commission for People in Human Rights on, you know, on ending stigma, discrimination, violence and Criminalization of key populations. That is an LGBTI people. That's phenomenal. So there are a lot of commitments we have to help countries and work with them to deliver all these commitments. And it's central, it is absolutely central to getting us to the end of AIDS as a public health threat by 2030. We're not going to get there if we don't move much faster.
On the human rights piece, especially in the environment.
A
Yeah, Steve, I just wanted to come back to you and sort of think about the rights agenda in a slightly broader way in that there's also an issue, I suppose, of countries rights when you think of reliance on donor aid, when you think of reliance, as we saw in Covid, on.
Intellectual property that prevented technologies from reaching the countries and the people that were most in need. And I guess the question is, how do you balance both the human centric respect for human rights, but also.
Embracing the idea that countries have to lead and run with the.
With the response to the pandemic looking bit.
B
The issue of over reliance on resources.
Particularly from development partners and aid.
I think one, we must look at it in two ways. It can have a positive impact, but it also have. It can potentially have.
A negative impact. You know, Mandeep was sharing the South African story, you know, and also linking to what was needed. And here is a medical intervention in 96 that was proven to be working.
And here is our own political.
Principles in our own government that did not believe.
You know, it's right for the people.
And even when we had to take this legal through a litigation.
And the outcome of a court that has forced South Africa in what I always say, South Africa in the HIV response has experienced what we call and.
Malicious compliance. Millions of South Africans needed treatment.
Millions of people were experiencing stigma and discrimination and lives were under threat. And should it not have been that the US government did not have that PEPFAR Presidential Emergency response, we would have lost more people in South Africa.
So that what is called malicious compliance, that ultimately, with the emergency response from the US government, with the court that forced our own government to comply, it was necessary. Now, of course, there are lessons to that and lessons to that is it has now gotten a whole shared responsibility aspect, which took a lot from people living with hiv, took a lot from activists. Now, South Africa is the world's biggest HIV program, treatment program. You know, we have over 12% of our population living with HIV and at least nothing less directly. You know.
5.4 million people, which is really above that stage. People are on treatment on that. So I'm just mentioning this because it's quite important that we realize the will that took place and our biggest investment goes into it. But the negative aspect, and the negative aspect was that.
If we don't put much more resources and invest on our people, we're going to suffer. Because then if any development country or a pulls out, we have this negative that's going to impact our people. And we do have our second biggest, which is pepa. We do have our third biggest, which is Global Fund that invest. Should these two pull out, we will suffer drastically because the marginalized community, the vulnerable groups are the ones that actually are receiving these services. So there is that positive and negative aspect to it.
A
Thank you. Well, I realize that we're getting close to the top of the hour and we need to let you, Steve, get onto your plane. But before you both go, one question that I think listening to, the conversation keeps coming back in my mind. Ending the AIDS response, ending AIDS as a public health crisis by 2030. Mandy, maybe I can just start with you very briefly. Do you think we can achieve that goal? Really?
C
I think we could get close if we are able to really, you know, really do something spectacular with the criminalization, with the human rights violations and stigma and discrimination that persists. And we have it. We have these 10, 10, 10 targets. They're historic. Never ever in the history of HIV have we had member states committing to removing harmful laws, to ending gender based violence, and to reducing stigma and discrimination. So we have these targets. I think we have the kinds of alliances and innovations that we need to move on these, but we have some headwinds. And I think the backlash around.
The backlash that we're seeing, which is very organized and well funded on human rights, on shrinking civic space, on gender equality, is really a foe. But if I always think the AIDS movement has just been incredible, as has the movement around LGBT rights. And I think if we can join forces, find new alliances in government and other sectors, I think we're going to get close. 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, you know, legal and policy barriers standing in the way of getting these out to people. So I'm hopeful. I have to be hopeful.
A
Yeah. And Steve, I can see that you are taking your camera and I think moving to the, Moving to the airplane itself, but why don't. If you have a moment for any last words, that would be great. Otherwise, I'll take this opportunity to invite you onto a another episode of A Shot in the Arm where we can explore South Africa's strategy for ending HIV by ending AIDS by 2030.
B
Yeah, Ben, I do apologize that I had to start moving because the gate is closing. But really, thank you for that.
A
That's the way we do it on A Shot in the Arm. Well, look, with that. Thank you to Steve, thank you to Mandy. Thanks to Erica Spera, our director and producer. Thanks to you, our listeners and viewers. Have a great week and a safe week, everyone.
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
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.
[04:01–10:24]
Steve Letsike’s Path:
The Value of Having Activists in Power:
[07:41–10:24]
[10:24–13:47]
[15:01–18:22]
[18:36–24:39]
Dhaliwal directly links human rights protection to public health outcomes:
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:
Dhaliwal:
"It is absolutely central to getting us to the end of AIDS as a public health threat by 2030." [24:36]
[25:05–29:19]
[29:50–31:56]
Dhaliwal’s Perspective:
Letsike’s Farewell:
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]
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.