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Speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa,
to the Global Health Council's Annual Conference


Wednesday, May 28, 2003

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I sometimes think that the continent I love, and the continent to which my UN role is devoted --- Africa --- is under some kind of other worldly curse. So many factors conspire against it that one could imagine inexplicable forces at work, except that we know, we emphatically know that every factor haunting Africa has a quite straightforward explanation.

It's the relationship amongst the factors that we sometimes fail to understand. What I therefore want to do in this speech is to make the connections and attempt to demonstrate that Africa reaps what the world sows, and with a vengeance.

In January of this year, along with James Morris, Executive Director of the World Food Program, and a number of UN agency experts, I made a trip to four countries in Southern Africa on the verge of famine: Lesotho, Zimbabwe, Malawi and Zambia. The reason was to explore the link between food shortages and HIV/AIDS. Morris had been there in September of last year and was palpably stunned by the carnage exacted by AIDS. I was there in December of last year, and I was equally aghast at the way in which AIDS was deepening hunger and hunger was deepening AIDS.

The assumption, shared by many, was that drought and erratic rainfall were the primary culprits leading to the food shortages, and that poor agricultural policies and poor planning had made a bad situation desperate. We came to a different conclusion. While there's no question that weather played a powerfully destructive role, there's equally no question that HIV/AIDS was the heart of the matter. We said so. Let me quote from our report: "It has taken the loud emergency of a severe food shortage affecting 15.1 million people to demonstrate … the insidious potential of HIV/AIDS to undermine entire societies and nations … HIV/AIDS is the most fundamental underlying cause of the Southern African crisis … the link between food security and HIV/AIDS must be fully recognized".

The shredding of the agricultural economy, driven by AIDS, has even spawned a persuasive academic construct called the "New Variant Famine". It's based on an analysis that argues that the presence of AIDS changes everything, and that nothing is as it was before.

In previous episodes of hunger and famine, the toll was taken on the very young and the very old. In this age of AIDS and food insecurity, it is the productive age group in its twenties, thirties and forties who are paying the ultimate price. In previous episodes of hunger and famine, there was always a huge quotient of resilience, which allowed beleaguered communities to bounce back. In the present circumstance, even where sound policies are in place, the coping strategies of communities and families are so mangled and eroded by AIDS that full recovery simply isn't possible. In previous episodes of hunger and famine, there was still time for the parents, especially the agricultural workers, the mothers, to teach the children about alternative agricultural techniques and foraging for food. Now the parents are so often sick or dead that the transfer of knowledge between generations cannot take place.

Inevitably, the theory of the New Variant Famine has its detractors. That always occurs with the pandemic: denial is Pavlovian. But I must admit that I have little patience for it.

You need no more than empirical evidence, your own eyesight, your own commonsense to understand what is happening. When one travels through those rural villages and hinterlands, as I have done for the last two years, the human toll is desolating. The immune systems of huge numbers of women farmers are desperately weak; seven million agricultural workers have died of AIDS since 1985, FAO estimates that another sixteen million may die by 2020; the household assets have been exhausted by attending to parental illness; children have been pulled out of school to care for sick and dying parents, losing, in the process, the one meal a day that might have been available from a school feeding program; malnutrition is everywhere evident; fields are left untended; crops aren't grown; food isn't taken to market, and if it is, no one has money to pay for it … what we're talking about here is the way in which this virus --- the cause of the most appalling communicable disease in human history --- attacks the fabric of every sector, making the interplay of health and agriculture but one more shortcut to carnage.

When the body has no food to consume, the virus consumes the body. That's the essential meaning of the New Variant Famine. For millions of Africans already infected by HIV, the onset of full-blown AIDS, and the rapid descent to death is the inescapable finale of a shortage of food. And the shortage of food, in its turn, opens up new pathways for the virus to spread.

To say that, however, is only part of the story. The other part is indeed the destructive weather patterns which I referred to earlier on. This is where the plot thickens.

The weather cycles for large swathes of Southern Africa are decidedly unfriendly. Even while our mission was traveling, we witnessed violent extremes in individual countries … intolerable heat and drought in one region, massive downpours and flooding in another. There was something eerily primordial about it: climate ricocheting like some biblical pox. In Lesotho, the government even told us of hailstones and frost at a time of year when hailstones and frost had never gone before. There were whispered mutterings of the El Nino effect. Predictably, in combination with HIV/AIDS, and agriculture in crisis, the weather became a bizarre roiling feature. I'm surprised that no one has yet coined the term "New Variant Weather".

What we're dealing with in southern Africa, entwined with everything else, make no mistake about it, is the most ominous environmental threat on the planet: climate change.

What's happening should come as no surprise. Back in June of 1988, I found myself chairing, in Canada, what became known as the first International Conference on Climate Change. It consisted of visceral exchanges between scientists and politicians, with the scientists ultimately prevailing. The conference statement began with one of the starkest pronouncements yet uttered about global warming; a pronouncement with which many would now agree: "Humanity is conducting an unintended, uncontrolled, globally pervasive experiment whose ultimate consequences could be second only to a global nuclear war". The statement then went on to identify a number of damaging consequences of climate change, amongst which two stand out: the direct peril to human health, and the diminution of food security, as a result of uncertainties in agricultural production, particularly in vulnerable regions.

Let it be understood that the findings of that original conference have since been confirmed time and again by the Intergovernmental Panel on Climate Change, a multilateral consortium of several thousand scientists whose words, carefully chosen, are seen --- except by professional apologists for corporate and political interests --- as definitive positions on global warming.

The 2001 "agreed statement" of the IPCC, in a section specifically devoted to Africa, raises the following concerns: Quote: "Adaptive capacity of human systems in Africa is low due to lack of economic resources and technology, and vulnerability high as a result of reliance on rainfed agriculture, frequent droughts and floods, and poverty". Quote: "Grain yields are projected to decrease for many (climate) scenarios, diminishing food security …". Quote: "extension of ranges of infectious disease vectors would adversely affect human health in Africa". Quote: Increase in droughts, floods and other extreme events would add stress on water resources, food security, human health … and would constrain development in Africa".

On the one hand, then, you have the poisonous interaction of hunger and AIDS, and on the other you have the debilitating interaction of agriculture and weather. It is my contention that everything is related; it's a cyclical pattern of Western neglect and self-centredness, juxtaposed with African disasters and death.

These problems must be seen as global, in every sense of the word. So must the solutions be global.

Just yesterday at the White House, there was a celebratory signing of the President's laudable initiative to provide $15 billion over five years to fund the fight against HIV/AIDS. It is no caviling on my part to point out that only $200 million of that large sum is guaranteed, per year, to the Global Fund on AIDS, Tuberculosis and Malaria. The Global Fund is the best new international financial instrument in the last many years to confront these annihilating communicable diseases, AIDS in particular. It was fashioned by experts with a worldwide overview of this vast pandemic, and a clear understanding of how to address it in a coordinated way. The Global Fund has already programmed over $1.5 billion for 150 projects in 92 countries, and it's been programmed in response to proposals submitted by the countries themselves, reflecting a government/public consensus on the priorities within those countries.

And now the Global Fund is virtually out of money. According to the GAO, the Government Accounting Office here in the United States, the Fund needs at least $5 billion for 2003 and 2004 alone, and that money is nowhere in sight. A third round of proposals for the Fund is to be held this October, but you can't approve proposals without the dollars to make them real. The G8 meets in three days' time. There is not a single G8 country which has even pledged, let alone delivered, an equitable amount to the Fund. Will that change next week? I very much doubt it, and even if it marginally does, it will leave the Fund limping into next year, unable to deliver on its promises, and on the huge human expectations which hang in the balance.

It's not possible to rescue the vulnerable countries in southern Africa without the resources. The United Nations can appeal for and distribute food aid to stave off starvation, and it has magnificently done so, but everything is stop-gap, everything is ad hoc, unless the pandemic itself is turned around. What is so intolerable about the continued funding crisis --- UNAIDS estimates that we will need, globally, $15 billion a year by 2007 for AIDS alone --- is not just the staggering loss of life, so much of it completely unnecessary, but it's what it says about us, the donor nations, and our lamentable, incomprehensible behaviour. Is it that the price tag is simply too high for the world to bear? I think not. This week's Economist gives us a clue to our priorities: the global perfumes industry is worth $15 billion --- per year.

And that's what I mean about the cycle and the self-centredness. Our collective refusal, thus far, to significantly reduce our dependence on fossil fuels, and as a result of that refusal, to continue to blight the planet with carbon dioxide emissions, plays itself out, yet again, at the expense of Africa. We're responsible for climate change. We're responsible for the extremes of weather. It's our greed which serves to compromise, in significant part, food security in Africa, and stokes the pandemic in the process. Even the Kyoto accord promises little relief, so ambiguous is its implementation.

When you're dealing with AIDS, every major international public policy has an impact, and so far those policies are a nightmare for Africa. Official Development Assistance has fallen to abysmal levels. Environmental legislation is hostage to the insatiable lust for resources. North American and European agricultural subsidies doom African agricultural trade. Debt relief for developing nations is a profound disappointment. Despite what was thought to be a breakthrough at Doha, access to pharmaceuticals remains suffocated by patents and intellectual property rights.

We know what we're doing, and we do it anyway. It's as though we have chosen to pursue and protect our own prosperity and comfort at all costs, and then have dehumanized Africa so that we can live with ourselves. It's as though the communities, families, women, children, orphans are figments, illusions, abstractions. We're not barbarians; we don't choose willfully to kill and to maim. But in watching and neglecting and allowing and, incredibly enough, abetting the cumulative loss of life in Africa, which we know we could bring to an end, we have become the latterday King Leopolds of the continent.

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