Stephen Lewis, the former United Nations special representative on HIV/AIDS in Africa, recently made his first major trip around the continent since leaving his UN post in December last year. He now heads up the Toronto-based Stephen Lewis Foundation, which helps fund grassroots efforts to combat HIV/AIDS in Africa. The foundation is perhaps best known for spearheading the Grandmother to Grandmother campaign, which has seen thousands of Canadian grannies raising funds to support their African counterparts, who have been left to raise the some 13 million children orphaned by AIDS on the continent. CBC Africa correspondent David McGuffin caught up with Lewis during a stop in Nairobi, Kenya. The two discussed what role Lewis sees for himself post-UN, the granny phenomenon, the renewed reluctance of the South African government to tackle the AIDS pandemic, and what could alleviate the damage of HIV/AIDS in Africa.

The last time we met, you were the special representative to the secretary general dealing with AIDS in Africa. Now you are back, as a private citizen, head of your own foundation. What is your sense about what you can accomplish in this new role?

Lewis: I'm still hoping that the advocacy voice can be sustained post-envoy and I'm now working with the little envoy team that came together to do the advocacy. We're going to try and do it through another vehicle, and then there is the foundation, which is working at the grassroots in Africa, and gives some legitimacy both to the issue and my claim to be able to speak to the issue.

I was curious, post-envoy, if I would have the same access to activists and government officials, to civil society. This tour through three countries [Lesotho, South Africa, Kenya] has left me feeling much more optimistic, because everyone seems to be open and to be willing to meet with me and talk about the issues as we used to talk about them. I'm now feeling hopeful that using my voice to delineate the issues and hammer them home and be unrelenting, that there still will be an audience for that.

For you, for your foundation, what do you see as your role in Africa?

When I started the foundation, I had very little idea of what it might lead to. We are now deeply ingrained in 14 countries. We have put out millions upon millions of dollars just to grassroots organizations, to communities.

We have been faithful to the vision of getting the money right to the ground where it is needed. And in the process, in large part because of the inventiveness of the foundation staff and I think of my own older daughter who runs the foundation, we made this grandmothers connection between Canada and Africa, something that begins to resemble a social movement rather than just the allocation of funds.

So it's this constant traffic now between Africa and Canada, which is thrilling, and the fact that the grandmothers marched on Parliament in Ottawa and made demands of the government. The African grandmothers who the foundation brought over were there as well, to have their voice heard.

At the moment, we're talking internally about what role we can play around youth, which is this cadre of people between 15 and 24, or 12 and 24, about whom everyone speaks as being most susceptible to the virus, and yet in response to whom there is so very little. So we are wondering, that having unleashed a kind of grandmothers movement, is there something we can do around youth that is similar?

The grandmothers in Canada have been a big success — I believe they've now raised over a million dollars, haven't they?

Oh yes, they've raised a million and a half dollars. In one year!

What do you think the appeal is with them? Why have they been such a success?

I think we touched on a whole age group which was feeling vaguely abandoned. Many of the grandmothers in Canada, of course they feel a great attachment to their grandchildren. I understand that. I have grandchildren myself. It renews life.

But the idea that at that particular age, with a lot of life experience, sometimes some resources and a lot of time on their hands, that they would somehow suddenly have an objective, a real fulfillment of the natural compassion which Canadians have, and the idea of the grandmothers in Canada helping with grandmothers who are afflicted by AIDS or dealing with the consequences of AIDS, it really struck a chord. It's one of those moments in life where everything comes together and you don't anticipate it. It's thrilling, and the African grannies are absolutely transported by it.

I was in Cape Town not long ago with GAPA, Grandmothers Against Poverty and AIDS. I spent the day with them and joined in their various sessions and shared lunch and stories and they were so thrilled and delighted that there were Canadian grandmothers to send them resources. And occasionally they write back and forth and occasionally the Canadian grannies come to Africa and the African grandmothers come to Canada. It's just lovely.

And important, too, isn't it. As you know, there is no infrastructure to help these grandmothers here in Africa. To actually know that there is someone on the other side of the world who is understanding, let alone supporting you, must be an incredible morale boost for these women.

There is absolutely no question. The grandmothers here are actually thrown by it. They have been so isolated, marginalized and abandoned for so long that it's hard for them to imagine that there are groups of people in another part of the world who want to be their friends and their advocates and their supporters.

And they are gaining an infrastructure because of this. They are actually coming together and setting up councils and reporting to each other and using the money artfully. It's excellent, and I'm just tickled.

And frankly, I had nothing to do with it. I got involved once it had emerged. But it emerged because the foundation had this extraordinary creative instinct.

That's what I like about a foundation. I almost feel disembodied as far as the foundation is concerned. It bears my name, but I just sit on the board and watch it and occasionally render judgment.

And suddenly I see that they have understood that you have to have a sensitive and ongoing relationship, that you have to disperse money quickly, that you have to respond constantly because people are sick and people are dying, that you have to have people in the field in Africa … to see do they know how to handle the money, is it getting to the people who need it, do they have the administrative framework, is it getting to the rural areas? It's utterly fascinating.

You say the creativity of the foundation recognized that the grandmothers movement was a good direction to head in, but this is something you have obviously seen yourself first-hand. I've been to villages in Africa, and I'm sure you have too, where there is no adult population — AIDS has killed off everyone in the prime of their lives.

I remember when I was travelling with Graca Machel [wife of Nelson Mandela, former first lady of Mozambique] in Uganda, we ran into actual villages where there were no people in the middle. It was bizarre. You had very young people and then you had grandparents, and you lost the people in their 20s, 30s and 40s. They just weren't there; they weren't physically there. When you brought together the village in a crowd, there was this huge generational gap. So yes, I have fully understood and assimilated what is happening and like talking about it on public platforms to make people understand.

What does that mean for a rural village?

Well, who does the farming? Who carries the water? Who does the cooking? Who looks after the kids? Who maintains the food security? Who makes sure a child goes to school? Who pays the school fees? It puts the entire village at risk when everyone is either under the age of 15 or over the age of 55 or 60. And it puts a tremendous burden on the elders of the village to sustain things. No, it's a visible phenomenon when you are there.

Especially on this continent, where to be 50 years old is to be well into old age.

Well, this continent judges people of 50 to be very much in the elder realm. I judge myself to be virtually 70 and feel entirely youthful. But in Africa, because people die so young, and of course the pandemic has changed life expectancy entirely, so life expectancy of the countries of southern Africa is now overwhelmingly in the 40s, and there are some countries, like Zambia and Zimbabwe, where the life expectancy is in the 30s. So if you are 50, you have made it through a tumultuous period of likely death.

So what does need to be done to break the back of the AIDS pandemic on this continent?

Well, apart from the provision of antiretroviral drugs, and tremendous work on prevention, and discovering a preventive technology like male circumcision and implementing it, and working with children and the legacy of the virus, like orphans and pediatric drugs for children — apart from all the obvious things you have to do, the biggest challenge at the moment is the capacity challenge. How do you have doctors and nurses and pharmacists and teachers and community health workers? How do you overcome what the virus has wrought by way of destruction of the anatomy of the country? And that is where the Western world has really fallen down.

Because there is no question that if one provides the resources for a country to service salaries, to improve working conditions, to find the appropriate housing, to provide new cadres of semi-professional disciplines, not doctors or nurses, but people who have learned enough to do their job adequately, it would overcome the capacity problem. And that is what is slowing everything now. How do you move treatment from the urban centres into the rural hinterlands, where they have got no people to dispense the drugs? How do you do community health work if the health workers die?

The one place where there has been an appropriate Western response has been in Malawi, where DFID [Department for International Development], the development fund in the United Kingdom, has put in extraordinary amounts of money into civil service salaries and working conditions and housing. And for the first time, in 2006, there wasn't a significant migration of nurses to South Africa or the U.K. from Malawi. You could see they had instilled a new fabric.

So a country like Canada, instead of looking to leave Africa, should say okay, the United Kingdom have done it Malawi, the Irish have the resources to do it in Lesotho, we in Canada, we are going to do it in Mozambique, or Tanzania and Kenya. We're going to provide the resources as we promised to do as a member of the G8. We're going to deliver them instead of betraying. We're going to provide the resources on the capacity front, which is the significant problem. That would be superb.

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