October 19, 2017 Newsletter Sign Up Subscribe



Anger Management: Stephen Lewis

Former UN Special AIDS Envoy Stephen Lewis
says new levels of action are required to keep the virus
from destabilizing the world economy.
Illustration by David Johnson

IT'S BEEN MORE THAN 25 YEARS since the Centers for Disease Control reported the first cases, in Los Angeles, of what was to become known as HIV/AIDS. Since then, some 25 million men, women, and children have died from the virus and some 40 million more are now infected, according to the CDC. To help assess the global response to the crisis since that now-famous 1981 report, CONTRIBUTE reporter Jesse Andrews Ellison caught up with Stephen Lewis, the United Nations special envoy for HIV/AIDS in Africa. Lewis, a Canadian and author of the 2006 national bestseller, Race Against Time, talks about what he calls an "appalling gap between vision and reality" in the scramble to contain the disease, and says new levels of philanthropy, new levels of awareness, and greater commitments of foreign aid are required by the United States and other Western nations over the next decade to help keep the spread of AIDS from destabilizing the global economy. "Forgive me for saying this, but I think the United States isn't, by and large, as aware of the world outside of its own interests as other countries are," Lewis told CONTRIBUTE from his home in Toronto. "...Why is the U.S. spending nearly $120 billion a year on war and $3 billion, one-fortieth of that amount, on a virus that has 40million people in its grip and has already cost the lives of 25 million people? I mean, something is morally wrong about that." What follows is an edited transcript of his remarks.

Before you recently stepped down as the UN Special Envoy for AIDS, you often referred to the rage that you felt on the issue, to the point of telling a Columbia University audience more than a year ago now, "I'm getting closer and closer to those embracing physical violence." Perhaps anger came with the job. Even so, I think people were struck by your level of outrage.

Well, I think that anyone who spends a good deal of life observing the carnage of the AIDS pandemic, watching what it does to communities,to families, to individuals, how heartbreaking it is to see women (in particular) and children so decimated by the force of the virus when we know we can keep them alive, and when we have the drugs to keep them alive and its a matter of getting the drugs there and supporting the countries in their response and helping to roll out the treatment and working to intensify the prevention it is enraging. The failure of the Western world to rally adequately behind the struggle in Africa, naturally, is enraging. How could it not be enraging? How can one feel anything but rage at the idea that millions of people are allowed to die unnecessarily? There's something profoundly wrong with a world that permits that.

What about the philanthropic response to AIDS? Can it compensate for what is not beingdone by the West?

Philanthropy has become a vehicle to compensate for the failures of government. We've always known that when it comes to domestic philanthropy everything from the United Way, food banks, homelessness, Childrens' Aid Societies, difficulties with kids that all of those things inevitably spawns support from domestic and national philanthropies. That's well-known. What isn't as vigorous in its response is filling the default of government on the international scene, dealing with international poverty, disease, conflict, and the environment. And it's only with the emergence of the Gates Foundation, really, that you've had this tremendous consciousness-raising about the needs internationally.

Would you rather see governments more committed to this, or would you be satisfied seeing this dealt with mainly through the private sector or private foundations?

Well, first of all, the private sector's not dealing with it. The private sector deals with it only when its balance sheet is directly affected. So if you have a DeBeers in Southern Africa or a Debswana Mines in Botswana or if you have the oil companies in Angola or Coca-Cola across the continent—I'm thinking primarily of Africa—they do some excellent work in the prevention and treatment of AIDS for their own employees...but they don't make contributions to overall need in response to the pandemic.
The foundation world is terrific. I do nothing but applaud it, but it's never enough. Not even Bill Gates is enough, and now that he's got the Buffett money, he'll give much more than does the government of Canada. And that's wonderful. And it's particularly wonderful because he's on our side. But what if he weren't? What if he were a real reactionary who was fighting progress in public health? We'd be in terrible trouble. One of the benefits of Bill Gates is that he is on our side, and so we value him.

But it is still not enough, is it?

While individual philanthropists have tried to help solve the world's health problems, that's not an adequate way to respond. You have to have more than that. You must have governments. In a sense, Bill Gates is compensating for the default of governments. That's the same with all of the initiatives that are now emerging. Gordon Brown in the UK has a plan for what he calls the International Financial Facility, which is a way of front-loading foreign aid and amortizing it over many years. Bono now has what he calls his RedCampaign—big companies like American Express and the Gap creating new product lines, with a portion of the profit going into a global fund to fight AIDS, tuberculosis, and malaria. The government of France and three other gov- ernments—Chile,Brazil, Norway—recently announced a tax on airline tickets, which would go to fund the fight against AIDS and other communicable diseases.
All of these initiatives are a frantic, almost desperate effort to fill the gap that governments have vacated, as the governments betray the promises they make. This is not a question of asking governments for too much; this is about a lack of follow-through. When governments get together as they did in July 2005 at the G8 Summitand make commitments, but then a year later start betraying thosecommitments, it's so painful. So everybody scrambles to make up for that, and the philanthropists scramble most of all.

Are philanthropists more innovative than governments in funding programs?

Yes, I think philanthropists are not constrained by the same bureaucracy. They're sometimes not constrained by the same ideology. It is easier for them to move money around, easier for them to initiate creative projects. That's on eof the great boons of modern philanthropy. Philanthropists today are more flexible. They're more imaginative. Governments tend to be a little plodding. But on the other hand, we can't do it without governments. We just cant. I think todays philanthropists understand that you have to be able to persuade governments to keep their promises.

You need both private philanthropy and government aid.

Absolutely. I'm fascinated by the fact that Melinda Gates, Bill Gates, Bill Clinton, and then along with them Bono and Bob Geldof and Oprah Winfrey and Madonna and Richard Gere and Angelina Jolie and Brad Pitt and Alicia Keyes, this emergence of celebrity leadership internationally on these big issues is taking the place of political leadership. There is no political leadership. So the celebrities move in. Two of the celebrities, Melinda and Bill Gates, happen to be wealthy, and that's a happy coincidence, and it results in tremendous philanthropic contribution. So whether it's Rockefeller or Ford or Carnegie or McArthur or Kaiser or Hewlett or Packard, it's never enough. I mean, they are all doing so much good but they cannot do it on their own without significant government involvement.

What would be the ideal balance of public and private support?

Well, I think that governments should be responsible for the foreign aid targets on which they agreed in 1969, which was that 0.7 percent of gross national product would go for foreign aid from the Western world, and that would have yielded in 2006/2007 something in excess of $200 billion a year. Instead, we give by way of foreign aid something in the vicinity of $60 to $70billion a year, and a lot of that is debt relief, so it doesn't really count for foreign aid. It would pretend to count. But the truth is that we're nowhere near the 0.7. We're really at around 0.3. We're less than halfway there. If we met the target, which the governments themselves agreed to and which has been reaffirmed ad nauseam for the last 38 years, then we would have enough money to deal with the critical social sectors—with education, with health, with social welfare, to some extent with agriculture, with food. We would be able to deal with the social sectors, which make for a healthy economy so you can have economic growth.

In your mind, what doesn't the world realize about the AIDS epidemic at the moment?

The world doesn'tunderstand the tremendous human and economic and social toll down the road. I don't think anybody begins to comprehend what it will mean to have 20 million orphaned children in the year 2010 and what that means for the future. AIDS has been going on for more than 25 years, and these children are now adults and they're having children of their own, and they have no experience parenting. It's a real question mark about what happens to the children in the future and what happens to the children who are aimless and require nurture and love and who don't receive it and don't have any jobs to turn to and can't pay the schools to be educated. I don't think anyone has calculated the human costs of orphans. I don't think anyone fully understands what happens a generation or two generations hence, when you've torn the heart out of your productive age groups from15 to 49. When you lose your doctors and your nurses and your pharmacists and your clinicians and your community health workers and your teachers and your farmers and your civil servants. And when you have such a toll amongst the people who normally keep the society going, how do you compensate for that? How do you train quickly enough? How do you rebuild the society when the society is falling apart? What happens in the year 2025, in the year 2050? Do you inherit the world? What is left of so many of these countries struggling for survival? That's what I think the world doesn't understand. I'm not sure any of us understands that this is an apocalypse, that this isn't just a catastrophe were dealing with at the moment, but that this is going to have catastrophic consequences down the road which no one has measured or can measure, and that really, really frightens me.

In a May 2006 Kaiser Family Foundation poll of 2,500 Americans, only 17 percent said HIV/AIDS is the nation's most urgent health problem. More recent polls haven't produced much of a change in that figure. Does this kind of poll data convey an accurate picture of how people really feel in the United States, or in your country, Canada?

Well, I think that in the Western world generally, there isn't the same sense of terror and emergency [as there is in the rest of the world about HIV/AIDS], despite the fact the number of infections is going up and that they're particularly going up among African-American women and in the Latino population as well. And that's because in the West, we have turned AIDS into a chronic disease and because antiretroviral treatment has been available here since1996, and because AIDS is now used in the same breath as diabetes and hypertension and a number of other chronic conditions that can betreated by drugs and life sustained.

But despite all of that, there is acertain false security in knowing that it can be contained. Forgive me for saying this, but I think the United States isn't by and large as aware of the world outside of its own interests as other countries are. I mean, Canada is engaged in the war in Afghanistan, and is losing lives, but the country is also deeply aware of poverty and AIDS on other continents. With the United States, it is different. People in the United States would tend to be completely aware of the war in Iraq, but not nearly so aware of AIDS in southern Africa. The United States has always had a somewhat different culture, which comes from being the world's only superpower.

Surveys show that AIDS is an issue that strikes a particularly resonant chord among younger people.

Oh, yeah, that's true. I remember speaking at the Harvard School of PublicHealth to a fairly large audience, and you could see how passionate the students felt and how they wanted to charge out of the room and just go straight to Africa and work on the ground. And I remember being in the Canadian Province of New Brunswick, and I was speaking to about 700 high school students, all in their last year of high school. And these young people, they were pitched so high, they wanted to hear what they could do, how they could raise money for good causes, howthey could participate in the policy for their causes, how they could write letters to their parliamentarians, how they could make public speeches, how they could go to Africa and help. There's a whole different feeling about it now. I'm so fascinated. I did quite a bit of speaking to groups in the United States and to universities, and I'm very much taken with the intensity of feeling. It doesn't take much to harness it. Just give them a few NGOs to call, and they're on their way.

You have hope, then, for real change?

You know, I have rage, but I'm not going to submit to futility. My hope is always reinforced by a sense of young people wanting to do something.

What has the U.S. done right in tackling thisproblem?

I think that PEPFAR, the Presidents Emergency Plan for AIDS Relief, has, in fact, done a great deal of good on the ground. I mean, you can't pop $3 billion a year into a response to this holocaust and not make a difference. This has resulted in many, many hundreds of thousands of people in treatment who would otherwise be dead. It has resulted in some good prevention programs and in some very good responses to orphaned kids and in building capacity.

I have my differences with thePEPFAR program—the emphasis on abstinence over condoms, the limited number of countries, the fact that not enough of the money goes to the GlobalFund to Fight AIDS, tuberculosis, or malaria, the fact that at the outset so much money was spent on brand-name drugs rather than on equally good generic drugs at much lower cost. But now Congress is going to have to decide soon at what level it will renew the program. When it started at$3 billion a year back in 2003, that represented more than 50 percent of the costs internationally. But by now, that $3 billion level isn't nearly enough—only 41 percent of the total overall international need.

So the needs will have grown, while the [government] monies remain the same. The Congressional Research Service said recently that the U.S. government is spending something like $8 billion a month in Iraq and $1.5 billion a month in Afghanistan, and $3 billion a year on AIDS, tuberculosis, and malaria.

Now, obviously, the government has the right to spend whatever it wants on conflict—and whether I agree with it or not, that's a government's right. But why is it so disproportionate? Why areyou spending nearly $120 billion a year on two wars and $3 billion, one-fortieth of that amount, on a virus that has 40 million people in its grip and has already cost the lives of 20 or 25 million people? I mean, something is morally wrong about that. There are tremendous pressures on international philanthropy to make up the difference. Philanthropists are going to feel very strong pressures soon because everybody is going to be frantic.

So the biggest challenge faced by those on the front lines of the AIDS fight is getting the right level of government funding and commitment?

Yes, that's the biggest outside challenge.

And do you think this is also a capacity problem, or a failure of imagination?

It's a political problem, it's a failure of imagination, it's the unwillingness for reasons that I will never understand for governments to honor the commitments that are made. It just staggers me that you can allow so many to die unnecessarily.

What can young people do to help?

Simply this: One of the greatest innovations internationally in my lifetime was the Peace Corps. It had a tremendous impact on the countries where it was rooted. And it began gradually to atrophy, into not as many Peace Corps volunteers, not as much focus, not as much embrace by governments and the government of the United States. I think that getting young people into the developing world to experience it first hand—whether it's in a conflict area or in a refugee camp or in a beleaguered community that is fraught with disease—its one of the best things that could be done. Youth has this buoyant capacity to change the world, and it would be lovely to see a new revival of the Peace Corps. It would be wonderful to see another vehicle through which, in response to rage, young people could be mobilized. Their contribution could be absolutely critical to breaking the back of the pandemic.




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