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United Nations (New York) -
In December 2002, I spent two weeks
touring four countries in Southern Africa: Lesotho, Zimbabwe,
Malawi and Zambia. The primary purpose was to view the link between
hunger and AIDS. I want to look back at that visit, because little
will have changed between then and now (except, perhaps, that
things will have deteriorated further), and then look forward
to the prospects for addressing the pandemic in 2003.
by
Stephen Lewis
At the outset, however, let me express, yet again, the fundamental
conviction I have every time I visit Africa: there is no question
that the pandemic can be defeated. No matter how terrible the
scourge of AIDS, no matter how limited the capacity to respond,
no matter how devastating the human toll, it is absolutely certain
that the pandemic can be turned around with a joint and herculean
effort between the African countries themselves and the international
community.
I am weary to the point of exasperated impatience at the endless
expressions of doubt about Africa's resolve and Africa's intentions
and Africa's capacities. The truth is that all over the continent,
even in the most extreme of circumstances, such as those which
prevail today in the four nations I visited, Africans are engaged
in endless numbers of initiatives and projects and programmes
and models which, if taken to scale, if generalized throughout
the country, would halt the pandemic, and prolong and save millions
of lives.
Murder by complacency
What is required is a combination of political will and resources.
The political will is increasingly there; the money is not. A
major newspaper in the United States, reflecting on the paucity
of resources, used the startling phrase "murder by complacency".
I differ in only one particular: it's mass murder by complacency.
You will forgive me for the strong language. But as we enter the
year 2003, the time for polite, even agitated entreaties is over.
This pandemic cannot be allowed to continue, and those who watch
it unfold with a kind of pathological equanimity must be held
to account. There may yet come a day when we have peacetime tribunals
to deal with this particular version of crimes against humanity.
As bad as things are in Southern Africa - and they are terrible
- every country I visited exhibited particular strengths and hopes.
The
little country of Lesotho has a most impressive political leadership,
but is absolutely impoverished. If it had some significant additional
resources, with which to build capacity, it could begin to rescue
countless lives. I vividly remember the Prime Minister of Lesotho
saying to me "We're told repeatedly by donors that we don't
have capacity. I know we have no capacity; give us some help and
we'll build the capacity". It's worth remembering that Lesotho
has a population greater than that of Namibia and Botswana, but
it has nowhere near the same pockets of wealth. It has, however,
one of the highest prevalence rates for HIV on the continent ...
higher than Namibia; almost as high as Botswana... and is fatally
compromised in its response by the lack of resources.
Zimbabwe, whatever the levels of political turbulence, has created
a sturdy municipal infrastructure for the purpose of dealing with
AIDS. You will know that for the last couple of years, Zimbabwe
has had a 3% surtax on corporate and personal income, devoted
to work on AIDS. A good part of that money has been channelled
down to district and village level, through a complex array of
committees and structures which actually get the money to the
grassroots. It's visible in the work of youth peer educators,
outreach workers and home care through community-based and faith-based
organizations. In other words, for all the convulsions to which
Zimbabwe is subject, there remains an elaborate capacity to implement
programmes, if only there were more programmes to implement.
 In
Malawi, we may be about to see the most interesting of experiments
in the provision of anti-retroviral treatment in the public sector.
The Government of Malawi had originally intended to treat 25,000
people based on receipt of monies from the Global Fund. They then
realized that the calculation of 25,000 was based on the purchase
of patent drugs, but now that it is possible to purchase generic
drugs, the numbers eligible for treatment could rise to 50,000.
There has been, predictably, a great deal of skepticism in the
donor and other communities. However, while we were in Malawi,
the country was visited by a WHO team which carefully examined
the capacity and delivery issues, and came to the conclusion that
treating 50,000 people, phased in of course, was entirely possible.
This is an exciting prospect: the treatments are meant to be free
of charge, and delivered through the public health sector.
Zambia, whatever the difficulties – and they are overwhelming
- is emerging from the bleak and dark ages of denial into the
light of recognition. The bitter truth is that in the regime of
the previous President, nothing was done. He spent his time disavowing
the reality of AIDS, and hurling obstacles in the way of those
who were desperate to confront the pandemic. I can recall personally
attending an annual Organisation of African Unity (OAU) Summit
on behalf of UNICEF, and sitting down with the then President
Chiluba, and asking him what he intended to do about AIDS, and
he simply wouldn't talk to me about it. Well there's a new President
in Zambia. And although he's been in place for only one year,
everyone agrees that there's a dramatic change in the voice of
political leadership around the subject of AIDS.
The fact is that in every country, even under the most appalling
of human circumstance, there are signs of determination and hope.
Whether they can be harnessed in the name of social change will
be known in the year 2003. God knows, there are incredible hurdles
to leap.
What has changed is the maturity, vehemence and confidence of
the organizations of People Living With HIV/AIDS. Time and again
we met activists who know everything there is to know about CD4
counts and viral loads; they know the cost of generic drugs; they
know about the treatment regimens; they know that WHO has undertaken
to have three million people in treatment by 2005; they know that
the rich members of society vault down to South Africa for treatment,
while the poor remain helplessly behind; they know about Doha
(see pg. 11) and intellectual property rights and the World Trade
Organization (WTO); they know, from bitter experience, about all
the false political promises. Increasingly, we're dealing with
sophistication and determination in equal measure.
When I met with the group of People Living With HIV/AIDS in Lusaka,
they presented me with a powerful and encyclopedic brief, a small
part of which read as follows: “...for each day that passes
without people accessing treatment we attend funerals. People
die. We hear a hundred reasons for not providing people with treatment.
For each reason given, lives are lost.” The government must
realize that it has a responsibility to provide health care for
its people. Any government that fails to put in place measures
to ensure the health of its citizens is not a government worth
its name. Such governments should resign. If it does not do so,
then people are justified to remove it by any means necessary.
The right to life and dignity should not be a preserve of the
rich and powerful.
“What we are seeing in Zambia is a microcosm of what is
happening globally. The HIV/AIDS crisis is not a crisis of lack
of resources. It is a crisis of lack of conscience. It is the
obscene gap between the haves and the have-nots that is driving
this holocaust ...”
That issue of the obscene gap brings me to the end of these notes,
and to the beginning of 2003.
The Global Fund
The crucial new component that emerged from the trip to Southern
Africa was the role of the Global Fund. It is impossible to overstate
how strongly people feel - from Cabinet Ministers to People Living
With HIV/AIDS - that the Global Fund is the best vehicle we have
to finance the struggle against the pandemic.
Every country yielded the same questions: When will the money
come? Does the Global Fund have enough money? Why don't governments
contribute to it? What happens if it goes bankrupt? The questions
are germane. As I understand it, the Global Fund has enough resources
to get through the next round of proposals at the end of this
month, but then it faces the moment of truth. The Global Fund,
after January, can be said to be in crisis. It's legitimate to
ask: what's wrong with this world? What's wrong with the rich
countries? Why are they willing to jeopardize the integrity of
the most hopeful financial instrument we have to combat the cruelest
disease the world has ever seen? But it gets worse. I want to
say what we're all saying privately to each other. If, as some
suggest, there is a war in Iraq come February, then the war will
eclipse every other international human priority, HIV/AIDS included.
In other words, if the United States, and the other members of
the G7 don't augment their contributions to the Global Fund in
the immediate future, we will be in desperate trouble. Wars divert
attention, wars consume resources, wars ride roughshod over external
calamities.
People living with HIV/AIDS are in a race against time. What they
never imagined was that over and above the virus itself, there
would be a new adversary, and that adversary would be a war.
From a press briefing given at the United Nations,
New York, 8 January, 2003.
Stephen
Lewis is the UN Secretary-General's Special Envoy for HIV/AIDS
in Africa.
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