HIV/AIDS Ambassador

Besides the well known medical professions such as physician, medical specialist or researcher, there are a lot more interesting career possibilities in (global) health care. With these short interviews we would like to introduce other interesting, sometimes unknown, professions.

Let’s introduce

Marijke Wijnroks lives in the Netherlands and currently is HIV/AIDS ambassador for the Ministry of Foreign Affairs. She is also a doctor.

How would you describe your career path?

I have always wanted to work abroad as a doctor. After I graduated in 1986 I specialized in tropical medicine and traveled for Médecins Sans Frontières (MSF) to Southern Sudan. There I became more interested in public health, seeing how little curative care I could offer. After my work in Sudan, I became medical coordinator of a public health programme in Uganda. Later I worked in Bangladesh for a NGO and in El Salvador in a primary health care project for the WHO. Gradually I had moved from being a practicing doctor to a policy maker. In 1998 I started working at the Dutch Ministry of Foreign Affairs. Over the years I became involved in HIV/AIDS and linked international organizations. I can use a lot of my practical experiences now that I am HIV/AIDS ambassador and I truly believe that I have the most interesting job in the world.

Could you describe your work as HIV/AIDS ambassador?

As HIV/AIDS ambassador I represent the Dutch policy and priorities on HIV/AIDS, both in the Netherlands and international. So I speak at meetings, visit countries that are affected by HIV/AIDS, discuss policies and represent the Netherlands in international organizations. The Netherlands is an important donor and we also have experiences at the national level that have been very effective. For instance, we have one of the lowest rates of teenage pregnancies and abortion in the world and managed the spread of HIV among injecting drug users by providing clean needles, methadone and so on. So people are certainly listening to us.

Which moment in your career made the greatest impression on you personally?

I started my career in Southern Sudan in a war situation. The town I worked in was under siege by SPLA and road transport was not possible. The plane that brought supplies was shot down four weeks after I arrived. So we were pretty much on our own without supplies or communication. The situation became more unsafe in the months that followed. It was pretty tough, also for my family who heard little news except for the occasional newspaper article about fighting and killing around the town I was based. I finally managed to leave after ten months with a military convoy. It was a formative experience, also because I had just turned 25 when I arrived, so I was really inexperienced. After surviving such a situation – mentally and physically – there are few things that scare you off afterwards. So it certainly meant a lot of personal growth in the end.

What are your future expectations for your own career?

I feel really passionate about the work I am doing at the moment in health and HIV/AIDS so definitely hope to continue in that field. Not sure yet whether that would be in the Netherlands or abroad but confident that something interesting will come on my way. At the moment I have no aspirations to become involved in national politics.

You have been a representative of the Netherlands in The Global Fund to fight Aids, Tuberculosis and Malaria. What is the most important development concerning these diseases in the last years?

The most important development is no doubt that we are seeing that we can turn the tide to these epidemics and that our investments are producing results.

The number of new infections with HIV is leveling off and the number of people accessing treatment has increased dramatically. However treatment needs to be sustained for life and universal coverage will be unattainable and unsustainable unless we invest in prevention now. We have also seen great advances in detection rates and treatment of tuberculosis, and as a result TB prevalence and mortality has declined in many countries. TB is still a major killer in people with HIV – so fighting the HIV/TB co infection will remain a priority for years to come. The increase in the number of cases with multidrug resistant tuberculosis is certainly a worrying trend  and one that will also pose a direct threat to people in the developed world. I hope that with the increasing coverage of good quality detection and treatment programmes this trend can be reserved. And malaria is probably the greatest success of all. The reduction of morbidity and mortality due to coverage of bed nets and effective treatment regimes is really impressive. Several African countries are now making plans for eliminating malaria– which is something I would never have considered feasible a few years ago.

Thirty years ago HIV was discovered. The number of infection has increased from 60 000 in 1990 to 33 million in 2008. How do you see the future of the fight against HIV-AIDS?

The AIDS2031 project – a group of people studying future implications of the AIDS epidemic has done interesting modeling exercises, looking at different scenarios i.e. maintaining the current trends, rapid scale up to universal access, targeting and prioritizing groups that are most at risk and promoting structural changes, for example in gender norms and roles. The cost estimates for these scenarios vary greatly – from  USD 19 billion per year in 2030 for the targeted approach to USD 35 billion for the rapid scale up while the number of new infections in 2030 will be lowest in the structural changes scenario and highest if we continue the current trend. Although these models need careful interpretation, I believe they demonstrate the importance of thoughtful funding. The study concludes that a combination of prevention efforts, focusing on groups most at risk (young girls, men having sex with men, drug users, sex workers) together with long-term efforts to address drivers of the epidemic, such as the poor status of women and poor quality health care will be most effective.

The current economic crisis could have a disastrous impact on HIV prevention and treatment as donor assistance to developing countries may be reduced or cut. How do you think the crisis affects the fight against HIV/AIDS?

Developing countries are hit hard by the crisis. They can spend less of their resources on HIV/AIDS programmes. The crisis also hits at the community and individual level. Even if AIDS treatment is provided for free (which is not always the case) people have associated costs they have to pay for, e.g. for transport to the clinic, which may become unaffordable. I have heard many stories of people stopping treatment because they have no money to buy food and side effects of the medication can be really bad on an empty stomach. On a different level we also know that in times of crisis people sometimes resort to risky behaviour such as sex work or transactional sex (have sex in exchange for goods or services) so this might increase their risk of HIV. And as the crisis also hits the rich countries aid budgets go down or do not increase as was planned, which will affect the funding available for the fight against HIV/AIDS.

There are however things we can do to mitigate this impact. Making sure that programmes are well integrated – such as HIV prevention programmes and sexual and reproductive health services – is necessary to increase efficiency but will in the end also improve outcomes. I also believe that prevention funding should be better targeted to address the needs of populations at greatest risk, such as sex workers, men having sex with men and people who use drugs – so for me this would be another way to get efficiency gains at the same time as getting better outcomes.

One of the most important achievements of the international health is the eradication of smallpox in 1977. After that several attempts were taken to eradicate Malaria, poliomyelitis and other diseases, but without success. Do you think that eradication of diseases should be the main goal of the global health community? Or are primary health and prevention programs more important?

Eradication has huge benefits and the eradication of small pox was indeed an important achievement in global health. However eradication of small pox was easy compared to other diseases such as poliomyelitis and malaria. In the case of polio we have seen a rapid decrease in the number of cases but it has proven very hard to eradicate the virus from the last areas where transmission is still ongoing. I believe that eradication of poliomyelitis is technically possible but especially the last stretch is really tough and needs an ideal environment in terms of political support, stability and availability of funding. As far as I know experts are not even sure whether eradication of malaria is possible. So I would favour an approach aiming at elimination as a public health threat, and I believe that a number of countries are thinking along those lines when it comes to malaria.

Finally, which message would you like to give to future doctors who consider a career in global health?

Go for it! Global health is an absolutely fascinating field to work in.