[Ip-health] FW: Speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa

[Paul Davis]

From: Christina Magill <clmagill@shaw.ca>
Date: Fri, 09 Jan 2004 12:52:00 -0500
Subject: Speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa

Dear colleagues;

Please find attached and below a copy of the remarks to be delivered at
approximately 13:00 (Eastern) today by Stephen Lewis, UN Special Envoy for
HIV/AIDS in Africa, to the luncheon meeting of the Toronto Rotary Club.  The
speech is embargoed until 13:00, but is available for distribution and
publication immediately thereafter.

If you have any follow up requests, please contact me directly.

Regards,

Christina Magill
Assistant to Stephen Lewis
TEL: +1-416-657-4458
FAX: +1-416-946-1371
clmagill@shaw.ca

Address by Stephen Lewis to the luncheon meeting of the Rotary Club of
Toronto,

Royal York Hotel, Toronto, Friday, January 09, 2004

I want to begin with three anecdotes from which lessons can be drawn.

First: Not long ago, I had occasion to speak with an infectious disease
specialist in New York City. She was telling me that she had followed
the entire course of the HIV/AIDS pandemic, for its more than twenty-two
years, and for the first fifteen years, what she remembers most vividly
is sitting in shadowed hospital rooms, holding the hands of mothers as
they watched their sons die. And then she stopped talking,
contemplatively silent for a moment or two, and added: you know, all my
patients in treatment are flourishing today . they're gaining weight,
feeling well, working, enjoying their families . in fact, I can't
remember when I last attended the funeral of one of my patients.

I thought to myself: those words capture, vividly, the greatest double
standard which besets the modern world. In the west, HIV/AIDS, with
drugs, has become a chronic illness. In the high HIV prevalence
countries in Africa, where I do my work for the United Nations, funerals
are the leitmotif of life. Attending funerals is a painful and
ubiquitous national activity. Three million people died of AIDS last
year, the vast majority in Africa. There are an estimated fifteen
thousand new infections every day, the vast majority in Africa. Dealing
with death, anticipating death, preparing for death, are eerily
measurable components of a country's Gross National Product.

Second: I was in Botswana last month, a small country --- 1.6 million
people --- but the country with the highest HIV prevalence rate in the
world . between 35 and 40% of everyone between the ages of 15 and 49 is
infected with the virus. I was sitting and chatting with several groups
of people living with AIDS, represented, as always by women, because
women comprise such a hugely disproportionate share of infections, and I
asked them, as I always do, what it is that they most need? Food, they
said, blankets, money for school fees for their children, soap, and
employment . any kind of income-generating project. Wait a minute, I
said, what about treatment? They all looked positively bemused.
Treatment, they replied, that's not a problem . it's free; when we need
it we just get it.

I was stunned. No one in Africa had ever said that to me before. But you
see, Botswana has money . reserves of wealth from diamonds, and it has a
remarkable public-private partnership with Merck and the Gates
Foundation, each of which has contributed $50 million, and it has state
of the art laboratory facilities orchestrated by Harvard, and it has a
health infrastructure of reasonable integrity, and most important, it
has unprecedented commitment from the government. At the Princess Marina
Hospital in the capital city, Gabarone, 5,700 people are in treatment
with antiretroviral drugs; the largest public sector programme of its
kind on the continent. And it's free for all, because that's government
policy. It's an astonishingly impressive initiative, demonstrating what
can be done if the circumstances are propitious, although it must be
said that even with the infrastructure and the resources, there have
been lots of difficulties along the way, and for a variety of reasons,
treatment has progressed far more slowly than the Government of Botswana
would have wished.

The problem, however, is, that with the possible exception of parts of
South Africa, no other country in sub-Saharan Africa has even the
approximation of the setup in Botswana. And again, with the possible
exception of South Africa, no other country in Africa has the resources
--- let alone the infrastructure or capacity - of Botswana. Botswana has
shown what can be done . but at the moment, no one else comes close. So
treatment is a mirage for millions.

Third: In Alexandra Township in South Africa, an impoverished township
in Johannesburg, I met last month with a wonderful group of women known
as the "Go-Go Grannies". There were eighteen grandmothers, all of whom
had lost one or more of their children to AIDS, and all of whom were now
bringing up one or more grandchildren. That's the stark perversity of
AIDS which turns the rhythm of life on its head: grandparents bury their
children, and sometimes their grandchildren, before they themselves are
buried.

We must have talked, under the trees, outside a friendly little
community health clinic for nearly two hours. The grandmothers spun
their sad, sad, desolate stories, one by one, interspersed with the
moments of fun and hilarity and mock teasing that this sort of group
networking can provide to ease the pain. But sometimes the pain can
never be assuaged. Not even for a moment.

The last grandmother to speak, with great reluctance and fighting for
control, was a 73-year-old woman, who explained, in strangled whispers,
that she had lost all five of her children to AIDS between the years
2001 and 2003. She was left to care for four orphan grandchildren, and
emotionally, let alone physically, she can't cope, because she's falling
apart. And I learned, as I left the compound, that all four of the
children --- all four --- are HIV Positive. So within a mere blink of
time, she will bury her entire family, two generations, all of whose
lives were prematurely savaged by a plague that knows no bounds.

At some point in the future, historians are going to look back at this
period and ask, quite simply, how in God's name the world allowed this
to happen? Over twenty million people have already perished, the vast
majority in the developing world. It's of the same genre as General
Romeo Dallaire's question: how did the world stand by and watch the
genocide in Rwanda without lifting a finger? There seem to be these
historical moments, these historical periods when moral resolve either
freezes or evaporates. It's not just unconscionable; it's inexplicable.

The excruciating truth is that the pandemic need not have come to this.
If the African leadership, early on, had not been consumed by denial and
fear, if the industrial nations, early on, had made resources available,
if the world had been energized around the pandemic as it has been
energized around Afghanistan, Iraq and terrorism --- the unequal
distribution of war and compassion drives me crazy --- then millions of
people would still be alive today, and millions of others would have a
fighting chance of prolonging life, and you wouldn't have between eleven
and fourteen million orphans, no different in any way from your children
and mine, from your grandchildren and mine, wandering the landscape of
Africa, bewildered, forlorn, anguished, abandoned, exploited, hungry,
despairing . cared for by grandmothers or older siblings or communities
already reeling and further impoverished by the impact of AIDS. It's a
real shock to the system to encounter these orphan kids. Early last
month, improbably enough, I accompanied Oprah Winfrey on a tour of
orphan settings in and around Lusaka, Zambia. Oprah wants to extend her
unrivalled, powerful voice to the cause of African children orphaned by
AIDS, and I could see, as we travelled from one orphan environment to
another, that even Oprah Winfrey, with her cosmic sophistication, was
shaken to the core by what we saw. These are children who are losing, or
have lost, their childhood.

In many of the countries of east, central and southern Africa, the clock
is ticking backwards. The development gains of the last decades are in
reverse; the major millennium development goals which the United Nations
set for 2015 will never be reached. Life expectancy in many countries
has dropped from an average age of 60 to 62, down to age 37 to 40. Can
you imagine it: losing over 20 years of longevity in roughly a decade?
Infant mortality rates are up; children are leaving school to care for
sick and dying parents; whole sectors of society . agriculture, health,
education, the private sector .diminished and compromised by the loss of
the most productive age groups. It is an astonishing tribute to the
people of Africa --- their resilience and their determination --- that
countries continue to function, heroically, even as they are assaulted
by the pandemic.

When you're on the ground in Africa, watching the pandemic unfold, it's hard
not to be gloomy, to be despairing. People are so lovely; death is
so pervasive. The needless loss of so many lives, especially the young
women in their late teens, and twenties and thirties, victims of a
brutal gender inequality . it's all so heartbreaking. And yet it would
be wrong of me not to acknowledge the glimmers of hope as we enter 2004.

Finally, resources are inching upwards from many sources; finally, we're
going to have a concerted programme of treatment, led by a rejuvenated
World Health Organization, determined to put three million people into
treatment by 2005 (3 by 5 is the catch-phrase) . it's indescribably
exciting . finally, we've moved the price of anti-retroviral drugs,
generic drugs, down to a level of roughly $150 per person per year, so
that African governments, with the help of external resources, can begin
prolonging human life; finally, the superb examples of successful
prevention initiatives, in Uganda and Senegal, have captured the
imagination of the continent; finally, the issue of orphans is being
addressed, even if not yet solved; finally, finally, there is a growing,
irreversible recognition that the pandemic has a woman's face, and that
if women and girls are not empowered, above all in the control of their
own sexuality, the pandemic will never be broken; finally, there is a
new energy within the international community, almost palpable, which
suggests that this year may see a breakthrough.

But there's something else I want to say that I've never addressed in a
speech before, and for which omission, I am deeply self-conscious. I
feel frankly ashamed that I haven't yet embraced the full logic of
certain arguments. I think inevitably one gets so caught up in the
emergency of the here and now, that perspective is dimmed.

The terrible reality is that with the best prevention programmes in the
world --- and many of them are truly inspired at community level ---
we're still facing several million new infections all over the planet,
not just Africa, every year. And an equal reality, which must be faced,
is that it's going to take generations to change male sexual behaviour,
if ever. And as everyone surely by now understands, treatment itself
will prolong life, but it's not a cure. So so much of what we're doing
in response to the pandemic, while monumentally vital, will not,
ultimately, subdue it.

The question then that must be asked is why such limited focus, in
speeches and advocacy, is given to the matter of a vaccine? I'm going to
try to deal with that in speeches over the next number of weeks and
months, but for the moment allow me merely to say the chillingly
obvious: only a vaccine will write an end to the pandemic. Until that
day comes, we will forever count the bodies.

Just yesterday, in New York, I visited the offices of IAVI, the
International AIDS Vaccine Initiative, headed by its creator, a
remarkably intelligent and charismatic CEO, Seth Berkley by name. IAVI
is actually an NGO --- non-governmental organization --- which in only
five years has managed to put together the largest number of
public/private vaccine trials on the ground in developing countries.
Only the pharmaceutical company Merck, rivals IAVI in the energy with
which a vaccine is currently being pursued. Seth Berkley points out that
in the 23 years of the pandemic, only one potential vaccine has gone to
phase three, human trials (unsuccessful by the way), a situation which
he describes as crazy. And when you begin to probe the reasons, it's not
simply because of the huge scientific complexity --- although that is
undoubtedly a major factor --- but like so much else with AIDS, it's
also a matter of resources and priorities and political will, although
it must be said in this forum that Canada to its credit is one of the
largest contributors to the Vaccine Initiative (which is not to say that
the contribution is sufficient).

As things now stand, even with the best possible results of the various
trials underway, we're still several years away from a vaccine. And
every year the infections mount and the lives are lost in the millions.
It seems to me a matter of the most elemental logic that the political
and scientific establishments, in developed and developing countries
alike, should be maniacally obsessed with the quest for a vaccine.
Despite the magnificent efforts of IAVI, the issue still lacks the
profile it must have. Something, somewhere, is deeply, profoundly, out
of whack.

And that brings me to the conclusion of these remarks, with special
reference to Rotary. The current issue of the New Yorker magazine
carries an article titled "The End of Polio; a disease on the edge of
extinction". The article, in fascinating exposition, describes how, over
fifteen years, millions of lives have been rescued from death and
paralysis by the unremitting campaign of immunization, led by WHO and
UNICEF, to wipe polio from the face of the earth. It will be achieved by
2005. But the article also faithfully points out that Rotary has
contributed well over half a billion dollars to the campaign, earning
the kudos and recognition which accompanies a magnificent contribution
to human well-being.

Rotary International needs another cause. Forgive my presumption if I
say that the cause should be HIV/AIDS, and Rotary Canada could well be
the advocate body that makes the case at the international level. And if
you want a focus, in addition to the inevitable work on the ground,
perhaps that focus can be on a vaccine. I know that there are already
Canadian members of Rotary who are pursuing the international
possibilities.

But I can add, in an intensely personal way, that you are also making an
extraordinary contribution to the Foundation which bears my name. When
my daughter and I decided to establish the Foundation in March/April of
last year, we had no idea that Rotary, and the unions and the churches,
and what feels like a legion of individuals would be so profoundly
generous. The Foundation has now received in that relatively brief space
of time, over a million dollars, with minimal solicitation, and we're
getting the money out as responsibly and quickly as possible to a number
of grass-roots projects in several countries, addressing issues of
palliative care, and orphans, and yes, grandmothers, and associations of
people living with AIDS . fundamentally all of the groups who are so
vulnerable and so incredibly poor, and yet can perform miracles of human
intervention with a few thousand dollars.

It makes me proud to be a Canadian. There's a real yearning in this
country . often expressed through Rotary . to extend a hand of help to
the uprooted and disinherited of the world. People are so intensely
caring, so intensely generous, wanting to make a personal difference as
a kind of antidote to the cynicism about governments. I hope that that
cynicism changes, and quickly, but until it does, all of the wonderful
Canadian NGOs and Foundations, who make such a difference in the lives
people lead in developing countries, are truly worthy of support.

In terms of the Stephen Lewis Foundation, I can't thank you enough. I'm
66 years old; I've had the privilege of working in politics, diplomacy
and multilateralism: I've never encountered a cause more consuming than
the battle against HIV/AIDS.

Thank you.

- END -


(For information about the Stephen Lewis Foundation, please visit:
www.stephenlewisfoundation.org <http://www.stephenlewisfoundation.org/>)