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Stephen Lewis is the UN Secretary-General's special envoy for HIV/AIDS in Africa, and the author of Race Against Time. In 2003 MacLean's magazine named him "Canadian of the Year," and Time magazine in 2005 called him one of the 100 most influential people in the world.

***

May 15, 2006

SUFFERING THROUGH ENDLESS DEBATES:
Forty-five Inspiring Minutes with Stephen Lewis

As horrendous suffering continued to rage across the globe in this spring of 2006, Amnesty International released its report on what it believes are the negative side effects of the so-called War on Terror. Secretary General Irene Khan did not mince words:

"When the powerful are too arrogant to review and reassess their strategies, the heaviest price is paid by the poor and powerless."

Khan went on to say, "There is no doubt that [the War on Terror] has given a new lease on life to old-fashioned repression...You cannot extinguish fire with petrol."

This type of comment from Amnesty International infuriates those who disagree—who despise both the sentiment and its writer.

It raises an aggravation similar to all of the so-called Right-Left/have-have not/Republican-Democrat/Bomb them-don't bomb them/globalization-global justice/us-them/evil-good arguments.

I say so-called because these arguments are generally so much more from the head and the organs (government and the media) than from the heart.

Those who agree with the Amnesty comment also suffer this ire—feeling contempt for those who disagree, and fury at the collateral brutality inflicted upon the 'poor and powerless.'

So from these perceived differences, then what happens?

I think in the West it goes something like this: literally millions of people of varied political attachments (mostly men with much to eat and thus to chew on—myself included) will rush with agitated gusto to their computers to type and post detailed attacks full of vitriol against cyberspace enemies.

Well-educated politicians across the hemispheres will stand up in Parliaments and salivate (I saw this saliva with a Provincial leader once) at the chance to lob vicious insults (often on behalf of their lobbyists) at equally willing opponents.

Healthy friends and family members will gather at barbecues and restaurants and vociferously—sometimes cruelly—debate (myself included) over ideological minutiae that leave us all hopelessly bellowing inside a giant, cosmic navel.

And all of this is done in the name of personal freedom. Fair enough, right?

Well, for some.

I had the privilege of recently interviewing the remarkable humanitarian Stephen Lewis for a UNICEF project on the AIDS crisis in Africa. Stephen spends his life reminding the West what is happening "on the ground" in Africa to real people, so many of whom against all odds—hunger, racism, injury, neglect, terror, illness and desperation—remain heroically resilient.

In his passion and intensity, Stephen reminded me that these people have no time for debate.

The older I get (and it isn't always pretty), the more I see how every human being I know lives tangled (sometimes beautifully) within an infinitely complex and humbling moral/spiritual/physical dilemma known as the human condition—even if they don't know it.

Are they not my sisters and brothers?

I've heard it said that if words will not improve on the silence, don't say anything.

Maybe the only debate that needs to continue is inside myself—at this moment so inexplicably blessed with health, love, relative peace and good fortune. How can I better serve and understand friends, family, strangers—even enemies (again, so-called)?

In which direction will I shift the world today, by shifting what I feel, think, say and do?

 

Pete McCormack : Explain a little bit about the significance in Africa of the mother-to-child transmission of AIDS.

Stephen Lewis : The great majority of children are infected [with HIV] around the birthing process. There are 700,000 new paediatric infections a year, minimum, mostly among infants. And 570,000 of those children died last year. If a child is born HIV-positive, there's a fifty percent chance the child will die before the age of two. Eighty percent die before the age of five. It is a nightmare. So you want to prevent the mother-to-child transmission and there is an easy route to that. It is not that difficult.

There is a wonder drug called Nevirapine. You give the mother a tablet during the birthing process and you give to the child the liquid equivalent within 72 hours after birth, and you will cut the transmission by between 50 and 60 percent. Now the irony, the bitter irony, is that only 10 percent of HIV-positive pregnant women have access to nevirapine and the prevention of mother-to-child transmission.

So obviously, the greatest number of births are occurring without any protection, which means hundreds of thousands of children are being born positive and will die dreadful deaths for no reason whatsoever except that we haven't rolled out Prevention of Mother-to-Child Transmission, which in the lingo of the day is referred to as PMTCT.

Let me take it one step further, a step which is not often dealt with. In Africa, they use single-dose Nevirapine during the birthing process. In the western world, we put the mother who is HIV-positive and pregnant on a full course of antiretroviral drugs, through roughly half of the pregnancy. What happens to the rate of transmission? It is cut not between 50-60 percent, but by over 99 percent.

You virtually never hear of a child in North America born HIV-positive from an HIV-positive mother. It doesn't happen. We remove the risk entirely.

Now, what does that say about the world? That we place so much less value on the life of an African child or infant compared to the life of a western infant?

That is part of the grotesque disparity, that's part of the brutal double standard between the developed and the developing world. We're losing all these kids simply because we haven't provided the support to Africa to save them during mother-to-child transmission.

P: Your frustration and anger are palpable and understandable. Where do you find hope?

S: In concrete terms, I generally believe that the possibility of treatment taking hold significantly in country after country can open a wellspring of hope. If people know they can get tested, and that if they're positive, they can get treated, the need for testing and treatment becomes inseparable, so prevention and treatment work together. I actually think that becomes the turning point. When we have three or four million people in treatment, then everybody will say, ah ha! We can subdue this scourge.

Maybe by the year 2010 there will be the sense of a turnaround—because everybody is talking about universal access to treatment, prevention and care. And that's what sustains me. I'd like to be around when the breakthrough comes. I don't know whether I will. It's a pretty intractable disease but I think it will come in the next few years. It may even be felt towards the end of 2006 and into 2007, that there is some light at the end of this bleak and dark tunnel.

P: So if we could raise this pitiful number of 10% of HIV+ mothers getting access to this treatment to say 70 or 90%—or the near hundred it is in the West—what would that look like for Africa?

S: Imagine if instead of 570,000 children dying, of those 570,000, 550,000 lived. So instead of an apocalypse, you had a containable number of sad and tragic deaths that would have to be reduced to zero but you didn't feel overwhelmed and you didn't wake up every morning feeling as though the world was coming to an end with all of these children dying unnecessarily. And if that pattern was duplicated at all the levels of the pandemic, then one would see the possibility of turning it around.

One would know that if you've got 40 million people infected in this world now, and 28 million of them in Africa, you're going to lose those people prematurely somewhere along the way.

But if you started to reduce the numbers of infections and you were prolonging life1 amongst the 40 million and your children in particular seem to have hope, then this talk of an AIDS-free generation suddenly becomes real. It is no longer an illusion, no longer an abstraction.

We should have had almost 100 percent coverage for HIV+ mothers across Africa by now. What we are doing now on every front in the AIDS pandemic is scrambling frantically to save lives.

I have so far met only two organizations in the last five years who are seized with an incredible sense of urgency about it, as though every minute meant another life. And that is The Clinton Foundation , I just can't get over how good they are, and the combination of Doctors Without Borders and Partners In Health2—these extraordinary NGOs who just have no time for delay, no patience for nonsense. They just go in and do the job in conjunction with the governments. I love them for it. I honour them for it. And if the same sense of urgency can be summoned by the UN, we would break the back of the pandemic pretty speedily, I can tell you.

You've caught me at a moment when, you know—I'll tell you why: I just came back from visiting a little district clinic hospital outside of Nairobi, literally two or three days ago. It is the only post-rape-counseling centre in the country and they are now up to 46 reported rapes every month. That was the number for April.

With 46 rapes reported, just imagine how many are not reported. In that one little centre in the middle of the country, 22 out of 46 rape cases were children under the age of 18. Eleven were children under the age of 12.

When societies are falling apart, sexual extremism often takes over and the statistic which absolutely clobbered me—I've been haunted by it, I still haven't gotten my mind around it—is that they've started to see a pattern of the rape of women between the ages of 65 and 80. Why? Because the young men who rape them believe that they can commit rape without the hazard of contracting AIDS.

So AIDS has changed everything. It induces a change in human relations, human dynamics, human behaviour, that is impossible to fathom or to make coherent. And it's children who are often the targets.

P: That's shocking and disturbing. You mentioned in your book Race Against Time the virtual lack of help from corporations—The Gates Foundation's remarkable generosity the exception—and the unwillingness of pharmaceutical multinationals to give more. What does this corporate model say to you?

S: I don't live in the world of self-delusion. Corporations require a profit; balance sheets are important. I must say, I've been somewhat surprised—maybe this is just monumental naiveté on my part—but I've been somewhat surprised how much the quest for profit and a buoyant balance sheet has outweighed the concern for the human condition. I'm really surprised that corporations will not even settle for a slightly lesser profit, given the tremendous meaning it would have to save human lives.

None of these corporations, not a one of them who have benefited from Africa—for example, in the resource sector, the mining companies, the oil companies, et cetera—not a one of them has yet given a penny to the Global Fund to Fight AIDS, Tuberculosis and Malaria.

It doesn't mean that they are not treating their own workers and trying to help in their own plants and the immediate community, but that also speaks to the bottom line, also speaks to their balance sheets. You keep the workers well, they're producing for you, and it's less costly ultimately for the company. It's a very decent and important thing to do but it can be reconciled nicely, thank you very much, with profit and loss.3 But that they cannot find it in themselves to make a contribution...? Not a single pharmaceutical company? And that doesn't mean Pfizer doesn't build a training centre in Uganda and Merck [Frosst] doesn't do treatment in Botswana and Bristol-Meyers Squibb doesn't build a centre of excellence for children in Swaziland. But still, no additional dollars for the Global Fund to fight AIDS overall.

These multinational corporations, they also have a lot to atone for. They'll join Bono in his RED campaign to have product lines labeled red to generate additional income from which the corporations will give some money to the Global Fund. Does that mean that unless you provide them with an additional stream of profit, they will not make a contribution?

P: I have heard that the percentage of people with AIDS in Africa is nearly 60% female, and in some areas, the rate among young women is six times that of young men. How important is the gender issue, and how important is it to look at AIDS in Africa as a gender-biased disease?

S: It's not just a gender-biased disease, it is the most ferocious assault on one sex, on women, that any disease has every unleashed. Disproportionate numbers of young women and girls are infected and subjected to the assault of the virus. That disproportionate number compromises women overwhelmingly.

And you won't break the back of the pandemic until you deal with the reality of gender inequality, until you deal with the reality of sexual inequality, because the lack of sexual autonomy for women is what so compromises their position.

And the male sexual behaviour—predatory behaviour—is what is driving the virus. So for anyone who understands the meaning of gender equality, the AIDS virus is kind of the crucible test. As long as gender inequality prevails, then in the presence of AIDS, for women, it's death—and death in incredible numbers.

P: How important is education for this equality?

S: Education is everything because education emancipates young girls...A good educational system can begin to get young boys to have respect for young girls. That is really an important message to get through. It can also convey how the virus is transmitted and how to protect yourself.

I've sat in classes of 10-year-olds in Grade 5 in the David Livingston public school in Harare, Zimbabwe, in a life skills class, and watched kids cope with all of these questions—which are driving them crazy, because all they know is death. It is wonderful to see the way in which you can gradually influence impressions, assumptions and perceptions. I don't know whether it will eventually change behaviour. I hope so; we all do. But at the moment, behaviour change is proving to be very difficult.

One of the things about education though, of course, is the number of children who are barred from school because they can't afford the school fees. I know that one of the intrinsic targets of the UNICEF campaign is to eliminate school fees everywhere. You also have to eliminate the cost of uniforms and the costs of books—anything that stands as an obstacle to a kid going to school.

But in addition, you've got schools where the classes are abnormally large, where the teachers are sick and dying. Now again, I remember this from Swaziland, I sat down with the Minister of Education, a very, very able woman, and I said, "Madame Minister, how many teachers are you losing every month?"

She said we're losing ten a month.

I said that's awful but it is not as high an attrition rate as I thought likely, given that you've got the highest HIV prevalence rate in the world.

She said, "No, Mr. Lewis. You don't understand. Ten teachers die but hundreds never report for work because they are too sick to come to school. So our classes are over 100 kids. Children decide they don't want to come because they can't learn, and parents take the children out of school. Children are being taken out of school to look after sick and dying parents anyway."

So education is the vehicle of change where you can liberate young girls and you can educate young boys. But an education that is so frail and so fragile never gives you quite the impact you want.

P: You mentioned in Race Against Time the man from the World Bank who responded to your request for a small percentage of money for treatment of people with AIDS with a sort of: "You see, Stephen, it's difficult. Let's face the painful truth: the people with AIDS are going to die. The money would probably be better used for prevention. It's all a matter of trade-off." How does one counter this attitude of ignorance and hopelessness from the West about Africa?

S: In large measure, you counter it by explaining the tremendous resilience and courage at the grassroots of Africa—and the fact that the women in particular have such extraordinary resources to draw on, emotional and physical resources, when their lives are entirely devastated.

I'll never understand fully how they do it but there's a tremendous generosity of spirit and basic human decency and intelligence and sophistication. I mean, very few people in the west understand what a knowledgeable continent it is and how good people are, fundamentally, to each other and with each other.

That strength at the grassroots is what sustains them because otherwise, frankly, you'd have a tremendous reservoir of hopelessness. You do anyway—let's not pretend. The levels of despair and anguish when so many people are dying in such large numbers are profound.

But on the other hand, you always have that ultimate resilience to draw on. And you know that if they can just get the resources flowing adequately and if they can just have the technical assistance, the drugs and some additional capacity which they so desperately need, they'll subdue this pandemic. It is entirely possible.

It is primarily the unutterable failure of the western world to respond which has compromised Africa's integrity.

P: Despite pledges set by the Millennium Development Goals for the year 2015, you mention in Race Against Time that there has been an international reluctance in recent years to provide sufficient funding for food to feed the hungry. This seems shocking. How do you explain it?

S: It is almost inexplicable. It's as much the reality of poverty as of AIDS. How else do you account for the fact that in the middle of 2005 in Niger,4 children were dying because there had been a drought?

This wasn't AIDS, this was a simple climate [problem], and the western world could not provide the food fast enough. How do you explain the fact that around Darfur, where we've heard about more suffering than one would need to hear about in a lifetime, the World Food Program had to cut the caloric intake from 2000 to 1000 a day because there hasn't been enough food aid given from the western countries?

And in southern Africa, in southern countries now, you have near-famine in parts of the countries and you've got tremendous hunger. How is it possible that the world is reneging on food? It's bad enough that they've been reneging on resources and support around AIDS;   how do you renege on food?

What in god's name is wrong with the rich countries of the world?

P: What is wrong with the rich countries of the world? Is it racism? Is it economics? Is it political?

S: I don't know. I will admit to you, I don't understand it and I pretend to search for reasons which seem vaguely explicable but I'm not sure I'm right. I think sometimes it is racism. I think sometimes it is just that Africa has fallen off the geopolitical map after the end of the Cold War.

Sometimes everybody succumbs to this slander that all African governments are corrupt and you don't give them any money because it will never get to the people. I don't know how you choose to explain it: that we're far away, insensitive, indifferent...?

I just do not understand the moral lapse. I'm not a wildly self-righteous person. I'm on the democratic left so I tend to be more self-righteous than most—but I'm not naturally self-righteous—but I have to say to you that the loss of the moral anchor is pretty evident internationally. We're really distorting things.

The amount of money we're ploughing into Afghanistan and Iraq, and conflict engagement generally, compared to the amount of money we're pouring into alleviating the human predicament? I mean, there is no comparison and there is no justification.

It's criminal, really, the way the western world has not adequately supported the World Food Program and its needs to buy and distribute and produce food. It's just horrendous because, for children in particular, if you don't have food, then you really can't handle the medication. Anti-retrovirals can have side effects which are quite unpleasant and the side effects can overwhelm you if you don't have adequate nutrition—if you don't have food in your stomach.

It's a real conundrum. The absence of food is terrible. And it is felt by everyone—except that women feel it more, because they receive food from men when the men deign to distribute it.

P: What keeps you going?

S: You know, it embarrasses me when people say, "Oh he's such a great humanitarian" or "person of compassion." I'm no more a person of compassion or with humanitarian instinct than anyone else in this world—or certainly in Canada.

I'm driven ideologically. My entire life has been filled with the conviction, which I imbibed from my father in particular, that you've got to spend a part of your life fighting social injustice and inequality or there's no point being on the planet.

For me, the AIDS virus is the ultimate expression of social injustice and that's why I'm so mad about it. Because it's so profoundly wrong. I'm neither animated by spiritual inclinations, and nor do I retreat into them. For me, it is frankly my own social philosophy, my own ideology. I just think the struggle for social justice is the most important struggle there is. If AIDS violates it, then you fight AIDS.

 

Stephen Lewis is the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, the author of 'Race Against Time' and director of the Stephen Lewis Foundation. In 2003 MacLean's magazine named him "Canadian of the Year," and Time magazine in 2005 called him one of the 100 most influential people in the world. He lives in Toronto.
www.stephenlewisfoundation.org

Pete McCormack is fortunate to interview him. He lives in Vancouver.
www.petemccormack.com

Footnotes:

(1) Antiretroviral drugs (ARV) are essential for prolonging life expectancy in people with AIDS. According to UNAIDS (as of December, 2005), of the 6.5 million people in "developing and transitional countries" who are in desperate need of ARVs, 1.3 million (or 20%) are receiving treatment.

(2) Dr. Paul Farmer, who has done extraordinary work in Haiti with the poor, and co-founded Partners In Health , has said that: "... making strategic alliances across national borders in order to treat HIV among the world's poor is one of the last great hopes of solidarity across a widening divide." Quite a thought--quite a challenge.

(3) See The Globe and Mail, August 6, 2006. Doing Business With HIV:

"At least one in five Anglo American mine workers in South Africa has HIV. That astronomical rate has led the London-based multinational to a hugely successful HIV/AIDS strategy...

Today, Anglo's experience with four years of AIDS treatment has redefined the debate in Africa. "The benefits outweigh the costs and we've got data to prove it," Dr Brink said. In the 12 months before and after ARV therapy, sick leave at Anglo fell 69 per cent and total absenteeism was down 53 per cent. "The death rates are coming down and I can tell you, it's not due to fewer accidents."

Anglo has 28,000 HIV-positive employess. Every month, 150 of them begin ARV therapy...

Dr Panter [at DaimlerChrysler South Africa] says "...it's much more expensive in the long run to treat the consequences of HIV than paying for counselling and treatment, getting people in early. The bottom line is that AIDS will cost the business, in death benefits and health plan [expenses], two to five times salary."

(4) Economist Jeffrey Sachs (The End Of Poverty) from a speech he gave in Waterloo, Ontario, October 22, 2005:

"What you have been reading about Niger and the struggle for food--don't believe that it's Niger this summer. I saw it in Mali this summer. I saw it in Nigeria this summer. I saw it in Ethiopia this summer. I saw it in Uganda this summer. I saw it in Rwanda this summer. I saw it in Malawi this summer.

The reporters happened to pick Niger this time. They could as easily have picked any of the other locations. It's just the place they happened to land on. You know how the media are--they chose it. That's what we read about. That's not because it was in any discernible way different."

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copyright 2006 Pete McCormack