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
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
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
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
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
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
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.