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March 28, 2006
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| Race Against Time: Searching for Hope in AIDS-Ravaged Africa |
Introduction
JOANNE MYERS: Good morning. I'm Joanne Myers, Director of Public
Affairs Programs at the Carnegie Council. I would like to welcome our members
and guests, and thank you all for joining us today.
Before we begin, I would like to take a moment to thank the Canadian
Consulate, especially Jennifer Kay, for her assistance in arranging this
breakfast program.
It is a great pleasure to host Stephen Lewis, especially on the day that the
United Nations is to launch the progress report on global HIV treatment. Mr.
Lewis, as many of you know, is the UN Secretary-General's Special Envoy for
HIV/AIDS in Africa. He will be discussing his book, Race against Time, in which he talks about what AIDS
has done to the African continent and what needs to be done to eradicate this
disease. AIDS is no ordinary pandemic, as it not only threatens individual
lives, but its tentacles reach into the very core of society, destroying
everything it touches in its path.
As someone who has known our guest for a very long time, I have asked Pamela
Wallin, the Consul General of Canada in New York, to formally introduce Mr.
Lewis.
Before taking up her first diplomatic posting in our city four years ago,
Pamela was one of Canada's most accomplished and respected journalists and
broadcasters. In fact, in recognition of her achievements, in 2002 she was named
to the Canadian Broadcasting Hall of Fame. Knowing of her vast experience, first
as a reporter for the Toronto Star, as a commentator for CBC Radio, and,
later, anchoring the nightly network newscast for CTV and CBA, I know she is
more than qualified to anchor our breakfast program this morning.
Please join me in welcoming Pamela Wallin and Stephen Lewis.
PAMELA WALLIN: Thank you, Joanne, for this opportunity. A lovely
introduction. I have appreciated working with you over the last four years. You
do a superb job in putting the right people in front of us to listen to.
I have the extraordinary pleasure of introducing a man who is an icon and a
hero in Canada. He works tirelessly on behalf of all of us, and I don't
exaggerate when I say, on behalf of humanity.
Stephen is currently the UN Secretary-General's Special Envoy for HIV/AIDS in
Africa, a post which he has held since 2001. He is also a senior adviser to the
Mailman School of Public Health at Columbia University, and chair of the board
of the Stephen Lewis Foundation, an organization which is dedicated to helping
those living with HIV/AIDS in Africa.
To risk understatement, I will warn you that Stephen is passionate. He is
determined. He is a true humanitarian. He has spent a lifetime working on these
issues abroad, going to Africa first when he was just a boy, and continuing this
work throughout his life, as Canada's Ambassador to the United Nations and as
the Deputy Executive Director of UNICEF. He has also served as a member of the
International Panel of Eminent Personalities to investigate the 1994 genocide in
Rwanda.
Stephen has been named a Companion of the Order of Canada, our highest honor
in the country. In April 2005, Stephen was named by Time magazine as one
of the 100 Most Influential People in the World, along with the Dalai Lama, Bill
Gates, Oprah Winfrey, and Nelson Mandela.
Race against Time was published last fall in Canada. It has held the
number-one spot on the bestseller list for months, not only in Canada, but
internationally. Reviewers of Stephen's book have called it "a verbal shelling
from inside the tent."
Stephen argues very forcefully that the world, including his very own
organization, the United Nations, needs a completely different approach to
Africa, and indeed to the whole question of values as it surrounds the way the
West deals with some of these issues. The ongoing plight of Africa forces him
into perpetual rage, that it is all so unnecessary that hundreds of millions of
people should be so abandoned.
Please welcome Ambassador Stephen Lewis.
Remarks
STEPHEN LEWIS: I am delighted to be here. I very much appreciate
having the Canadian Ambassador to the United Nations, Allan Rock, with me to
fortify my anxieties about being part of a lecture series which is truly
auspicious. Even to be on the same page as Joe Stiglitz and Wole Soyinka and,
above all, Amartya Sen is almost more than my frail psyche can endure.
I believe that Americans should have to endure a Canadian speaker from time
to time. After all, in an act of almost supernatural generosity, we signed the
Free Trade Agreement with the United States, thereby rescuing your economy and
engaging in a degree of self-immolation with our own.
I get a kick out of speaking in the United States, because I'm always
introduced as "Ambassador Lewis." It's a delicious encomium. In Canada, when you
have finished your diplomatic tenure, you lose your title and you revert to
mortal obscurity. It's only in the United States where once an ambassador,
always an ambassador; once a governor, always a governor; once a senator, always
a senator; once a president, always a president. The entire country is sustained
by titular self-aggrandizement which Canadians look upon with a bemused
affection.
HIV/AIDS is the ultimate ethical issue. It is a coincidence that the World
Health Organization and UNAIDS are issuing a document today to examine the results of
the 3 by 5 Initiative,
the program launched around World AIDS Day, December 1, 2003, to attempt to put
3 million people into treatment by the end of 2005. We have reached only
1,300,000 people. We are less than halfway there.
There will be a lot of caterwauling about failure. From my own point of view,
WHO, in an entirely visionary way, broke through the paralysis which was
infecting the response of the international community, and multilateralism
generally, and has now unleashed a momentum which is irreversible. Country after
country is moving heaven and earth to put people into treatment. Although it is
sad and lamentable that we are only 20 percent along the way, it is nonetheless
a significant and important 20 percent.
The point of departure for me today will therefore be the question of ethics,
on the one hand, and what we have achieved thus far in these areas of the
pandemic, on the other. I would like to ask a series of questions, which speak
to the ethical conduct of international affairs, and frame the issues, perhaps,
slightly differently than would otherwise have been the case.
1) Why are there only 1,300,000 people by 2006 whose lives will be
prolonged and sustained by antiretroviral treatment?
We have the drugs, at very low cost, generic compositions largely coming out
of India—fixed-dose combinations, three drugs in one pill, taken twice a day. In
the next few months the brand-name pharmaceuticals may well have a fixed-dose
combination which will require only one pill a day.
We have regimens which are easy to follow, and the adherence to the regimen
in Africa is often better than in the United States. Why are we only 20 percent
along the way?
Matters of infrastructure and capacity in Africa lie at the heart of the
problem. But there is also no question that the sustained flow of resources and
the contribution of technical assistance where it is most needed from the
Western world, from the industrial community, would undoubtedly have facilitated
much larger numbers of people in treatment. Whatever deficiencies there may be
on the ground—and I spend my life tramping around the continent—there is still a
great deal of room for intervention to save lives. Intervention has been
compromised time and time again by an inadequate flow of resources and
inadequate technical assistance from the international community.
What kind of ethical default is this? How is it possible for the world to
endure millions of unnecessary deaths?
2) Let's talk for a moment about the matter of resources. There is
much self-congratulatory rhetoric these days as people note that in 2005 we
spent roughly $8.3 billion on AIDS, which is an exponential increase from what
we were spending in the late 1990s. But UNAIDS, in a very careful assessment,
has indicated that in 2006 we will need $15 billion; in 2007, $18 billion; in
2008, $22 billion. Any straight-line projection gets you to $30 billion by 2010.
That is for only one disease. We are nowhere near generating that kind of
money.
If we were to approximate internationally the 0.7 percent of GDP upon which
the world generally agreed back in the year 1969—orchestrated and fashioned by a
Canadian, Lester Pearson, I should note in a spasm of nationalism—all of
the Millennium
Development Goals could be put in place, and certainly we could subdue the
pandemic of HIV/AIDS.
But we are nowhere near it, and we will not reach it based on the commitment
which the G8 countries have thus far made.
At Gleneagles in July 2005, there was an orgy of triumphalism
about the way in which the world would provide Africa with an additional $25
billion by the year 2010 and the way in which this money would facilitate the
recuperation of the continent. We will not get an additional $25 billion in
2010.
The desperate efforts now on the part of superb people, like the Chancellor
of the Exchequer in the United Kingdom, Gordon Brown,
to introduce the International Financial Facility so there is some significant
front-end-loading, and the efforts by the French government to put in place the
surtax on airline tickets to generate money for development—all of these are
compensatory efforts to make up for what everybody knows will be a significant
shortfall in official development assistance from the G8 countries.
Bob
Geldof had apoplexy at the G8 meeting. I judge that that is his normal
state. He said, "We'll have ten out of ten as a commentary on what we've
achieved at this meeting."
But the fact of the matter is that just eight weeks later, the pattern of
betrayal which has become systemic in the behavior of the G8 countries towards
Africa began again. We had the Global Fund Replenishment Conference in London, in September
2005, chaired by the Secretary-General of the United Nations himself. Even the
most jaded skeptics among us felt that the momentum that had been generated, at
least rhetorically, at Gleneagles would sweep over the Replenishment Conference
and provide the additional dollars that were necessary.
The Global Fund said, "We need $7.1 billion for 2006 and
2007," and they received $3.8 billion. We fell $3.3 billion short, which will be
counted in millions of lives.
The Global Fund is not yet in a position to have a new round in 2006 or 2007
to receive the proposals so desperately and urgently needed on behalf of Africa,
because they simply cannot guarantee the provision of the funds.
What kind of moral delinquency is that? What kind of ethical conduct is that?
If you will forgive the juxtaposition, 2005 was the first year since the end of
the Cold War when we spent over $1 trillion on the arms race. I am reminded of
Major
Barbara and Lazarus and Undershaft, munitions makers to the world, when
I see the ever-escalating amounts of money that we spent on the arms race. It is
not invidious to point out that we are spending hundreds of billions of dollars
to prosecute wars in Afghanistan and in Iraq, and we cannot find a relative
smidgen of that amount to intervene to ameliorate the human condition.
Where lies the ethical compass?
3) One of the chief problems is, within the African continent, the
fact of capacity, which is eviscerated by so many people who are ill and are
dying or are dead. But there is another dimension of the capacity problem which
is particularly grievous, and that is the way in which the Western world poaches
on the very few professionals which Africa is able to train—taking the doctors,
nurses, pharmacists, clinicians, and even some of the community health workers,
and pulling them into the orbit of the industrial world. If people were urgently
conscripted into the fray, we could break the back of the pandemic.
The United Kingdom has been a leader. Its development agency, DFID, is
showing what can be done by providing the budgetary support to Malawi to
increase significantly salaries and benefits within the public service, so that
for the first time the entire graduating class of nurses in Malawi remained in
the country, because they had an adequate income and benefits.
We all understand what can be done in response to these desperate human
predicaments. But I ask you, what kind of ethical conduct is it for Western
countries to continue to poach on those who can intercede to save lives?
4) What about the children? How is it that it is only in 2006—and 2007
and 2008 thereafter—that we are finally responding to the needs of infected
children? We have had treatment available since 1996. We have treated very large
numbers of adults, but only a microscopic portion of children who need
treatment. We have never had the pediatric formulations to do so.
We take the capsules, break them in half, take out the powder, and try to
estimate how much powder a child might require based on age and weight. It
doesn't work for doctors, it doesn't work for nurses, it doesn't work for
grandmothers who are looking after orphaned kids, it doesn't work for
caregivers. We need special pediatric drugs and pediatric formulations.
But 2,300,000 children in this world are infected, 700,000 new infections
every year, 570,000 deaths. Why have we come to it so late? Why are children
always at the bottom of the social and economic ladder in human priorities?
Where is the ethical default?
That leads me to the dimension of it which is even worse, because the vast
majority of infections for children occur during the birthing process. If the
child emerges HIV-positive, it's likely that 50 percent of children will be dead
by the age of two, 80 percent by the age of five. Since when have children
become expendable in the international human equation?
We have a wonder drug called nevirapine. A single dose given to the mother
during the birthing process, or a liquid equivalent to the child within the
first forty-eight or seventy-two hours after birth, and we can reduce the
transmission from mother to child by 50 percent.
No one in this room knows of HIV-positive children being born to infected
mothers, because it doesn't happen in the Western world. We provide full
antiretroviral therapy to the mother for a sufficient number of weeks of the
pregnancy so that the child emerges HIV-negative.
We are still losing 50 percent of the children in Africa that we need not
lose, hundreds of thousands, millions of children, because of the grotesque
disparity between the priorities of the North and the realities of the
South.
Only 10 percent of all the pregnant women in Africa even have access to a
clinic which provides the prevention of mother-to-child transmission through a
single dose of nevirapine. How is that possible in 2006, when this pandemic has
raged for over a quarter-century? What is the ethical default?
5) What do we do about the continuing depredations of the
international financial institutions? I am probably treading on shaky ground
here, but I am too old, impatient, and angry to wrestle my natural maniacal
spasms to the ground. What the international financial institutions have done to
Africa is utterly unforgivable. The impact of the structural adjustment programs
in the late 1980s and early 1990s shredded the social sectors so that Africa
today is not in a position to respond adequately, even were it to wish to
respond.
One of the aspects which I deal with at length in the book is what has
happened to school fees, which tended to be imposed as a condition in return for
the loans that were granted by the international financial institutions.
Suddenly the requirement of conditionality was user fees—user fees for health,
user fees for education. The consequences in the early part of the 21st century
are quite direct. Many children who should be in school, and desperately want to
be in school, cannot be in school because they cannot afford the fees.
We know what an emancipation it is when the school fees are removed. Look at
the example of Kenya. The government under President Kibaki
eliminated school fees, and within a matter of weeks, 1,300,000 children
turned up who had not been in school before—fully 20 percent of the school-aged
population.
We understand what it means when you eliminate school fees and allow children
to return to school, which they so determinedly crave. But the consequences of
structural adjustment programs have compromised that process, and we are only
now beginning to consider seriously again the removal of school fees in those
countries which still apply them.
Where have we been over the last several years? How do you abandon so many
children to a fate external to the school, when we could have made it possible
for them to attend? Where were those of us in the multilateral system who could
have intervened?
The World Bank apologizes now, as it always does in ten-year cycles. They
say, "We were wrong. Those economic nostrums were mistaken, so we'll impose a
new and draconian set of economic nostrums for the next ten years, so that the
cycle of apology can rhythmically be repeated."
What happens to the behavior of these international financial institutions
even now?
Kenya, for example, has a gifted and talented minister of health, Charity
Ngilu. Kenya also has 4,000 retired nurses, and it has a very severe problem
with HIV/AIDS. It wants to hire the retired nurses, put them back into the
health-care system to respond to the pandemic. But they can't hire the nurses,
because were they to do so, they would breach the "macroeconomic framework"
imposed by the IMF.
What is wrong with these people? Things shift when you are dealing with the
pandemic. You have a tragedy of such intense human toll, such intense human
carnage, that it is necessary to abandon the rigidity of economic prescription
and to understand what is at stake. To this day, we can't get the international
financial institutions to do that.
In case you feel that these are the polemical rantings of the democratic
socialist which I am, let me point out that at a recent gathering here at the
Carnegie Council, Mary Robinson, a person sober, thoughtful, careful,
dispassionate, objective, made exactly the same argument and asked exactly the
same questions about the behavior of the international financial
institutions.
Where is the ethical compass? Why the ethical default?
6) Women lie at the heart of this pandemic. Women are
disproportionately vulnerable in numbers that make the mind reel. I have never
in all my adult life imagined that gender inequality should wreak such damage on
women. I have never imagined that one communicable disease would exhibit such a
ferocious assault on one sex. What is happening to the women of the continent of
Africa is perhaps the most distressing dimension of the entire pandemic, and it
is beyond me how the world watches it occur without emergency intervention. Of
the 7 million or 8 million people between the ages of fifteen and twenty-four
living with the virus in Africa, 76 percent are young women and girls.
All of the international human rights conventions and covenants are violated
when it comes to the rights of women. Everything we thought we had achieved at
the Human Rights Conference in Vienna, the Population Conference in Cairo, and
the Women's Conference in Beijing is sabotaged by the force of the virus. What
is happening to women—their lack of sexual autonomy and the predatory male
sexual behavior which drives the virus and the lack of response from indigenous
African states and the international community—is heartbreaking. We need an
international women's agency within the United Nations to drive this.
I am an ultimate multilateralist. I am a shameless apologist for the United
Nations. But I am not hesitant to identify those areas where it seems not to
work. On women's issues, the UN has been curiously diffident, timid, and
begrudging.
We have agencies that deal with health, with labor, with education and
science and culture, with food. The World Food Programme is doing a particularly
good job. We have UNICEF, with a budget of $2 billion a year and over 8,000
employees, which deals with children; the United Nations Development Programme,
which deals broadly with questions of governance; the United Nations Fund for
Population Activities, which deals with women and men and their sexual and
reproductive health in a rather narrow definition, without the broad mandate
addressing the whole panoply of issues that involve women.
But we have nothing by way of a significant agency for women, nothing for
more than half the world's population. Were there a voice, were there a
ceaseless response to the predicament of women in Africa, it would save
lives.
When I first took on the envoy role, I thought in terms of abstractions. I
thought of 20 million dead, 40 million infections, 5 million new infections a
year, 3 million deaths a year, 14 million orphans. Now, almost five years later,
all I want to do is save that life, rescue that child, prevent that woman from
dying. Your whole Weltanschauung narrows, and you want to overcome this
terrible decimation of communities and families and individuals, which is
indescribable in its carnage.
And it's happening to young women particularly. They are dying in their
twenties and thirties, in hallucinatory numbers. They come up to me with their
children in tow, and ask, "What's going to happen to my children when I die?" I
have absolutely no way of answering that question.
I have always been taken with the feminist analysis of male authority and
power. I have never seen an example of that analysis more riveting and more true
than what is happening to women in the presence of gender inequality.
7) Finally, let me say a word about orphans. We have a desperate
problem, hardly understood yet in the world, as though no one calculated that
when you had so many adults dying, you would inherit a deluge of orphans.
Everywhere I go, the numbers of orphans are overwhelming. You are constantly
confronted with the realities of the pandemic.
I was just in Swaziland. In the antenatal clinics where the testing takes
place, for the women between the ages of twenty-five and twenty-nine, the
prevalence rate is 56.3 percent. It's like an apocalypse for women in that age
category who happen to be pregnant.
I attended a school outside a community center where the women were doing an
income-generating project. There were 350 children singing vigorously, as
children in Africa always do for a visitor. The principal, a young woman, took
the microphone and said, "Mr. Lewis, I want you to know that while we welcome
you enthusiastically, of the 350 children in my school, 251 are orphans." That's
70 percent of the school.
Swaziland is a country where between 10 and 15 percent of the entire
population will be orphans by the year 2010—not 10 to 15 percent of the child
population, but 10 to 15 percent of the entire population.
The torrent of orphans is absolutely overwhelming to these countries, and
they have no idea how to handle it. The communities desperately try to absorb
the orphaned children, but extra mouths can push impoverished families right
over the edge. The unsung heroes of the continent are the grandmothers. They
bury their own adult children and then, at the age of fifty, sixty, seventy,
eighty, they begin to parent again. If it weren't for the grandmothers holding
the society together, I don't know what would happen in some countries.
Then, the grandmothers die, and you have the phenomenon of child-headed
households, where the oldest sibling in the family looks after the younger ones.
Sometimes the age of the child heading the household is eight or nine or ten. It
defies comprehension.
Children who are orphaned by AIDS go through a particularly excruciating
emotional experience. They do not become orphans when their parents die. They
become orphans while their parents are dying. You enter hut after hut, and you
have a spectral figure lying on the ground, the mother in the last stages of
full-blown AIDS, and the children frantically scrambling for an aspirin to
reduce the pain of an opportunistic infection or wiping the mother's brow with a
cold cloth or, in a mutual experience of humiliation, cleaning up the mother
when she is incontinent. Then these kids stand in the hut and they watch their
mothers die. The trauma that is part of that, the emotional dismemberment that a
child experiences, is something that is not easily repaired.
This pandemic has been going on for a long time. When I am introduced to
orphans now in Africa, they are often in their twenties. They are beginning to
have children of their own. They have had no experience of parenting. The
responses are slow, tentative, and limited. It was only in the fall of 2005 that
UNICEF finally fashioned a plan to respond in a significant way to the orphaned
children.
Why the ethical default? Why have we taken so long? Why do we move with such
limited urgency?
I will not take the continent of Africa off the hook. The long period of
denial and silence is absolutely unforgivable. By and large, at the turn of the
century, the year 2000 and 2001, Africa came alive to what was happening, and
with very few exceptions, those countries are truly engaged and attempting to
allow their people to survive.
It's very rare that you have a situation like that of South Africa, where the
political leadership is not actively engaged, in an almost obsessive way. One
would think or hope that would be true of South Africa because it has 5.5
million to 6.5 million infections, the highest number of absolute infections in
the world. There is still tremendous anxiety in the external community about
commenting upon it. I regard that as our ethical default.
But most African countries are deeply engaged. The resilience of Africa is
truly remarkable. The intelligence, sophistication, generosity, camaraderie,
engagement that lie at the grassroots, at the community level, in Africa,
particularly amongst the women, are what hold it all together. If the rest of
the world responded adequately by way of resources, by way of technical
assistance—no neocolonial or neoliberal impulses, just a decent response to the
human predicament—Africa has the capacity to turn it around, because of this
extraordinary network at the grassroots.
By the year 2012, there will be 100 million people in this world, based on
present realities and projections, who will either have died as a result of AIDS
or will be living with the virus. There is no excuse for that. There is nothing
that can rationalize the indifference of the international community to what has
happened.
I was in rural Zambia, traveling with one of the district commissioners to
see his income-generating project. We trekked down a number of trails for a very
long time and finally came upon an open field. One half of the field was a
cabbage patch and in the other half, a group of women, fifteen or twenty of
them, stood holding a banner aloft proclaiming their HIV-positive status. They
talked to me with enormous animation and feisty pugnacity about what they
thought of the men who had infected them.
Then, almost to break the tension, I asked, "This is your income-generating
project, this cabbage patch?"
"Oh, yes," they said.
I said, "You eat the cabbages to reinforce your immune system and to allow
you to withstand opportunistic infections in AIDS?"
"Oh, yes," they said.
"Do you use all the cabbages?"
"No, no, no. We have many left over."
"What do you do with them?"
"We take them to market."
"Do you sell them all?"
"Yes, we sell them all."
"What do you do with the profits?"
"What do we do with the profits?" they said. "We buy coffins. We never have
enough money for coffins."
It is at moments like that that I feel as though the world has gone mad.
There is something inexcusable, ethically indefensible about millions of people
dying unnecessarily, when the world knows how to intervene. We have lost the
moral anchor of the international community, and we must reclaim it.
JOANNE MYERS: Thank you for that extraordinary and moving
presentation. I would like to open up the floor to questions.
Questions and Answers
QUESTION: In the unwillingness of the G8 countries to follow through
on their promises, what role do you see in the Christian reconstructionists
among them who believe that AIDS is God's punishment and it is moving forward to
the coming kingdom by getting rid of those who are sinful?
STEPHEN LEWIS: The construct which assigns sin and guilt to people who
have AIDS is not a fashion which is widely shared any longer, internationally or
in Africa. Indeed, recently in Africa, a number of clerics in the Protestant
world have apologized publicly for attributing sin to the transmission of the
virus. There is an ever-greater understanding that this is a sexually
transmitted disease, but it's a disease like other diseases and has to be
responded to in much the same way, with a great deal of urgency and with
appropriate medical interventions.
There is a tremendous focus on prevention, particularly amongst the
fifteen-to-twenty-four-year-old group, who move from community to community and
school to school, using all of the cultural artifacts of Africa—the drumming,
dancing, poetry, song, and particularly drama—speaking with tremendous, almost
brazen forthrightness about sexuality and about what must be done.
That awareness-raising and consciousness-raising tends to diminish the views
of those who live lives of attributing guilt.
QUESTION: I am straying from your geographical area of expertise, but
I've followed the situation in Brazil, which is a country of great income
disparity, tremendous poverty. Yet it seems to have broken out of the mold, and
refused to follow the established norms of international order, intellectual
property protection. It is reputed to have done a rather spectacular job of
dealing with its own HIV problem.
Does this represent a model for a poor country?
A second question: Why didn't you mention our last Pope, who ran around the
world telling people not to use condoms?
STEPHEN LEWIS: Brazil has about 150,000 people in treatment now. But
Brazil is a high-middle-income country, with a great deal of revenue generated
through an operational tax system and with a president who recently attacked the
international community on exactly the grounds I have disgorged this morning. I
wasn't attempting to mirror his views, but he was talking about the default of
the international community in areas of resources and in responses to particular
pandemics and poverty.
Brazil was blessed with having money and also blessed with having a tough
government that was prepared to defy the pharmaceutical industry and the United
States and break patents when they had to and indigenously manufacture generic
combinations which could be used for their own people.
I was in Rio recently at an international scientific conference, and I was
fascinated when the Brazilian exponents of the AIDS experience there talked of
how they were going to move to second-line drugs.
Over time, resistance and side effects develop to the first-line drug
interventions, which involve roughly 10 percent to 15 percent of the treated
population. The second-line drugs are more complicated and expensive, and Brazil
is now trying to figure out what to do. In Brazil, it took an average of only
four years of treatment for the side effects and the complications to start to
show in significant numbers. So, inevitably with AIDS, one has to have a variety
of interventions down the road, different clinical diagnoses and medical
intervention.
They are an excellent model for a belligerent indifference to intellectual
property rights. I'm not sure that Lesotho or Zambia or Malawi or Namibia or
Swaziland or Mozambique or many other southern and eastern African countries
would have the courage to take on the World Trade Organization and to give the
back of its hand to major international powers.
The Catholic Church has an anti-condom position. I don't spend my time
fighting with them about that, because it's largely futile. They will not change
their position. But they do some remarkable work at parish level with home-based
care and raising consciousness and a lot of prevention.
Pamela mentioned my foundation. The Canadian people have been tremendously
generous, and we are now supporting over 100 projects in some fourteen
countries. Many of those projects are Catholic parishes—Catholic AIDS Action in Namibia,
PASADA
in Tanzania, Reach Out
Mbuya in the heart of the district of Rakai in Uganda. These Catholic
groupings are remarkable on the ground. We'll look for condoms elsewhere. We'll
go to the UN Population Fund or to USAID or to PSI or a variety of other groups. You deal from strength. You
don't spend your time excoriating those who are otherwise doing useful work in
other areas.
QUESTION: Martin Meredith, the British author, in his new book, The Fate of Africa, takes issue with all that you have had
to say about the optimism of contemporary Africa. He says that, contemporarily,
huge amounts of Western money, both government and private, continue to be
wasted by the corrupt and inept leadership of African leaders.
David
Reiff, Michael Mann, and others have made the same observations.
Robert Root-Bernstein, the epidemiologist, has indicated that
hygiene has been the complicating factor in creating conditions in Africa that
have led to the deterioration of people's immune systems. So it's not that one
silver bullet that we are looking for to offset AIDS; it is a whole range of
social and medical problems that come from inadequate conditions in the country.
You have blasted the international community, the United States, the
institutions. Yet generic research for that silver bullet to offset AIDS is
still needed. So if you criticize the pharmaceutical companies, where do you
expect all of this research to be done?
STEPHEN LEWIS: Number one, I was extremely gentle with the
pharmaceutical industry today. I have a serious representative of the industry
sitting in front of me. He had neither apoplexy nor cardiac arrest. He sat
through it with equanimity.
Not only have I read Martin Meredith, but I had a long discussion with him on
Canadian Public Radio. He has written a remarkable book called The Fate of
Africa.
What he said in our discussion was quite unlike what you've said today. He's
very tough on the way in which the Western world, from slavery through
colonialism to structural adjustment, prejudiced the possibilities of Africa to
reform and to endure.
But, in truth, what Meredith argues is not that Africa is inherently or
abjectly corrupt, but that the way in which Africa has been manipulated, carved
up, exploited, inappropriately used over the centuries has resulted in a
situation which is truly grievous. In that context, the Meredith alarums about
corruption have a different sensibility.
I don't dispute the corruption, but I also note that there are fifty-three
governments in sub-Saharan Africa, not just five or six. There are not just the
Zimbabwes. There are not just the Nigerias. Although allegations of corruption
occur, many governments, many of whom have been democratically elected now
several times, are trying very hard to root out corruption.
I spend my life hoping that we'll discover a vaccine. Merck is in the
third-phase trial of something that is relatively optimistic. In fact, it's the
one pharmaceutical company which is doing serious research on vaccines. The
experts say it may be ten years off.
I, therefore, hope against hope that we'll discover a microbicide so that
there is a gel or foam or cream which women can use which will prevent
transmission and save millions of lives. That is allegedly four to seven years
off, which is more optimistic.
While I may have been unkind to some groups, on balance, what I've said is
rooted in truth. The pharmaceutical companies have to be able to have a return
on investment sufficient to do the research into their products—although not
enough is attributed to the amount of money which is provided by the public
sector and by the university community in the process of researching major drug
products.
It's not just the pharmaceutical companies. They do some of it, but not all
of it. If one looks carefully at their public relations budgets compared to
their research budgets, it's an interesting juxtaposition. I notice that Merck
joins with Bill Gates in Botswana to provide an important treatment program,
with the government of Botswana as well; Pfizer builds a training center in
Uganda; Bristol-Myers Squibb has children centers of excellence in Botswana,
Swaziland, and Lesotho; Glaxo gives a voluntary license to an indigenous generic
firm in South Africa.
The pharmaceutical companies are trying desperately to seek redemption, and
they are doing a number of excellent things in the process.
But the rest of the world, particularly the corporate world, must begin
contributing more directly to what is happening. I have suggested 0.7 percent of
pretax. I'm prepared to take post-tax earnings, in order to help.
QUESTION: In showing great concern for women and women's situation in
Africa, and talking about the pharmaceutical companies and the money, I almost
jumped out of my seat and asked, "What about men?" In dealing with the ethical
issues, with Africa, with all the points that you made about the needs of women,
the needs of orphaned children, the problems of pharmaceutical companies, the
lack of money from donors, one of the major areas which is conspicuously missing
is the role of men in spreading the disease, the role of the ethics of the macho
man in Africa that you didn't approach at all.
In many cases, the reason women are an issue is because men are an issue.
STEPHEN LEWIS: In the United Nations and the international community,
there is a lot of prevention work done with men, particularly in what we call
the high-risk groups, like truck drivers and migrant laborers, who are kept away
from families and partners for months on end and naturally turn to commercial
sex workers to satisfy sexual yearnings.
However, a number of studies have demonstrated that the sexual activities of
African males are not that different from the sexual activities of North
American and European males. It's the context of poverty, it's the context of
the truck routes across the continent, the context of taking thousands of men
from Mozambique, Swaziland, Lesotho, putting them in the mines of South Africa
or Botswana, living in male-only communities for months at a time, separated
from women.
Some situations for men speak less to the macho and more to the
predicament.
That does not mean that the point you make is wrong. The United Nations
Population Fund produced a monograph on male sexual attitudes in Zimbabwe. By
the time you come to the end of the monograph, you feel, "What hope is there?"
The sense of sexual entitlement is absolutely staggering. The prevalence of
sexual violence in many countries is desperately worrying.
The whole circumstance of a patriarchal culture and gender inequality
produces a worrisome pattern. But one shouldn't diminish the environs and the
context within which it occurs. People are trying desperately to get men to
focus on prevention, to use condoms, to understand the nature of
transmission.
The problem is that the women are dying now. It will take two or three
generations to change male sexual behavior. So we have to find a way to change
the legislative infrastructure around property rights, inheritance rights,
sexual violence—empower women now so that they remain alive and deal directly
with the men along the way, both in the terms you have described and in terms of
prevention.
But understand that the focus has to be on women, because they are the ones
who are dying. Part of the answer surely is to empower them. I have seen some
wonderful girls' schools, empowering young women who will not allow themselves
to be subjected to predatory sexual assault.
They are trying very hard to educate the young boys in a greater sense of
respect and understanding of young girls—not unlike the need for this to be done
in Canada or the United States. The same macho culture exists in our societies.
The same sense of young boys filling a particular role and young girls filling a
particular role continues to exist in North America and Europe. Some countries
approximate gender equality a little closer than others, but there isn't a
country on the face of the earth where you have real gender equality.
JOANNE MYERS: Thank you for a very extraordinary morning.
Thank you, Pamela, for hosting this.
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