How the World is Failing Africa

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Lewis on a visit to Zimbabwe

Stephen Lewis, the UN Secretary-General's Special Envoy for HIV/AIDS in Africa, took his impassioned one-man crusade to New York City's Carnegie Council on Ethics and International Affairs yesterday, calling HIV "the ultimate ethical issue." In an hour-long speech, Lewis made the case that, despite a few optimistic advances, the developed world has failed to control the spread of the deadly disease throughout the poorest continent.

"There has never been anything like this in human history," he told the audience of more than a hundred, which included a mix of policy specialists, legal professionals, and academics. He said the international community has lost "its moral anchor" and cited the industrialized world's systemic failure to provide adequate aid to countries where the infected population of dead and dying could reach 100 million before the pandemic's end.

Lewis specifically lamented the plight of women and called for the creation of an international UN agency to deal specifically with women's issues. "Women are at the heart of the pandemic," he said, with women and girls making up 76% of those infected between the ages of 15 and 19.

He also said that on many of his travels, women approach him and ask plaintively, "What is going to happen to my children when I die?" The problem of a generation of AIDS orphans, who have experienced the emotional trauma of witnessing their family members perish, is "hardly understood around the world," Lewis said. "We will be dealing with it over the next several decades."

Touching one of the central topics in his recent book, Race Against Time, he recounted how international financial institutions like the International Monetary Fund crippled the African nations' capacity for progress by insisting on conditionality for financial support. Children were among the victims of such rigidity, he said. School fees, for example, were a condition of loans and thus deprived millions of children from free basic education.

An expressive orator, Lewis has recently carved out a speaking circuit that has included the British Columbia Nurses' Union, the United Nations and Columbia University. With stories infused alternately with wit and heartbreak, he elicits both guffaws and gasps from his audiences. Relating one tale from his book, he described how he asked members of a community project growing cabbages how they spent their profits. "Why on coffins," they answered, almost surprised at the question. "We never have enough money for coffins."

Lewis has called for nations to donate 0.7% of their GDP, and private-sector corporations to follow suit with 0.7% of their pre-tax earnings. ("Although I would accept post-tax earnings," he added to some laughter.) While $8.3 billion was spent on AIDS internationally in 2005, he added, the projections for 2006 have climbed as high as $15 billion and could reach $30 billion by 2010. "We are nowhere near generating that money," he said.

Lewis has his doubts about this year's upcoming G8 summit in July, which will be chaired by Russia. "I think it will be tough to get Russia to give priority to the pandemic," he told TIME. "The solace I have is that the British are single-minded; they're very determined. They will keep it on the agenda." He's also counting on Prime Minister Stephen Harper to fulfill a Conservative promise made during their stint as opposition to donate 0.7% of Canada's GDP. "Harper may give more money than Martin did. The Conservatives may be stronger supporters of foreign aid than the Liberals."

Lewis's lecture coincided with a release of a WHO-UNAIDS report on global access to HIV therapy. Begun in 2003, the "3 by 5" initiative--to provide antiretroviral treatment to 3 million people in low- and middle-income countries by the end of 2005--missed its target numbers. A total of 1.3 million received treatment, and the largest improvements being made in Sub-Saharan Africa where 700,000 more people gained access to treatment in the past two years. The WHO has said that the lessons learned from the "3 by 5" strategy will aid in its new goal to provide universal access to HIV treatment by 2010. "The headlines will probably read ‘WHO falls short of goal,'" Lewis told TIME. "For me that is an utterly misleading characterization. What it should be saying is 'WHO starts a process that will save millions of lives.'"