PHA-Exchange> UN AIDS Envoy (Steven Lewis) speaks on NEPAD and the Global Fund

[George(s) Lessard]

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Subject:        	UN AIDS Envoy  (Steven Lewis) speaks on NEPAD 
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Date sent:      	27 Jun 2002 00:41:31 -0400


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Subject: UN AIDS Envoy (Steven Lewis) speaks on NEPAD and the Global
Fund



>I've wrestled with this speech for two reasons.
>
>First, I recognize that many people here would wish this keynote to 
>be an omnibus exploration of the perverse and destructive nature of 
>globalization. It will be, but only in narrow part, and only in a 
>particular way. I am appeased, however, by the recognition that you 
>have significant numbers of plenary and panel sessions which will 
>bare the heartless soul of this globalized world for all to see.
>Second, what I intend to do instead, is to deal directly with NEPAD, 
>the G8 Summit response and HIV/AIDS, especially HIV/AIDS. I've been 
>travelling through Africa for more than a year now, and it's 
>impossible to emerge unscathed, intellectually or emotionally, by 
>the monumental devastation of the pandemic. But I must admit that to 
>deal with these Summit matters head on raises, for me, some awkward 
>considerations which I'd like to confront directly.
>
>I live two lives: one is speaking within Canada to a variety of 
>groups; the other is the role of UN Envoy on AIDS in Africa. 
>Inevitably the two roles intermingle. But tonight, of all nights, I 
>want to retain at least twelve degrees of separation. Tonight I'm 
>speaking in what diplomacy elegantly
>calls "my personal capacity".
>
>But of of course there's more. Implicit and explicit in my remarks 
>will be criticism of NEPAD, which gives me some anxiety. NEPAD, 
>after all, has been fashioned within Africa itself, indeed, four 
>African Presidents, the Secretary-General of the United Nations and 
>the head of the Economic
>Commission for Africa are here to act as advocates for NEPAD. That 
>doesn't compromise my determination to deal with difficult issues; 
>it would be insulting were any of us to back away from intellectual 
>engagement just because the document and its authors are indigenous 
>to the continent. But it does give me pause, because far too often 
>in the past, western criticism has been gratuitous and insufferably 
>overbearing. I should add, I guess, that some of the members of the 
>auspicious African delegation are friends with whom I have worked 
>closely, at one time or another, over the last several years. I have 
>known the Secretary-General for seventeen years now, and I report to 
>him today. The President of Nigeria, President Obasanjo, is a man 
>for whom I have the greatest regard, and one of the African leaders 
>moving heaven and earth to defeat the pandemic of AIDS --- in fact 
>we have worked together on AIDS in Nigeria --- and it pains me that 
>we should find ourselves at odds. So I confess to all of you that on 
>various grounds, I am somewhat clutched about some of the views I 
>intend to disgorge. That doesn't mean I won't deliver them. It means 
>only that beneath the rhetorical
>broadsides, there are heavy duty palpitations.
>
>Let me proceed to deal with the issues.
>
>NEPAD --- the New Partnership for African Development --- is a 
>document driven by the fashionable current tenets of liberalized 
>trade, governance, democratization and anti-corruption. They all 
>sound fine in themselves, but I happen to believe that that 
>prescription is faulty; indeed it is reminiscent of many similar 
>analyses of Africa which have gone before, and have come to naught. 
>I say this with some feeling and a strong sense of history. I 
>vividly remember chairing the first UN session ever held on a single 
>region of the world's the Special Session on Africa in May/June of 
>1986. After two weeks
>of gruelling and relentless negotiation we emerged --- even though 
>the western and eastern blocs were still locked into the Cold War 
>--- with a consensus document. That document had similarities to the 
>document of today.
>
>African governments undertook certain commitments to change, in 
>response to which the rich nations made certain commitments to 
>resources, trade and the dramatic reduction of debt. That document 
>--- known by the excruciating acronym of UNPAAERD, the United 
>Nations Programme of Action for African Economic Recovery and 
>Development --- was betrayed within months of its embrace. The 
>western commitments took the form of structural adjustment 
>programmes, bogus promises on trade (witness the abject travesty of 
>the Uruguay Round), and dismal debt relief. And that began a 
>procession of similar programmes, within multilateralism, every five 
>years, each and every one of which made a mockery, on both sides, of 
>the promises so eagerly tendered. It was a culture of willful, 
>mutual, repetitive deceit.
>
>And so we come to NEPAD, for the first time ever a comprehensive 
>programme fashioned by Africa alone. I intend to withhold final 
>judgement on NEPAD overall. I know that there are numbers of people 
>in this hall with strong reservations, but they, as I, hope against 
>hope that it works. I should add that there are those within Africa 
>itself , who argue that NEPAD is intellectually scarred by the 
>inadequate consultation or the absence of consultation at the grass 
>roots. And that obviously gives further pause. It was the 
>North-South Institute in Ottawa that recently produced an excellent
>monograph on NEPAD, vigorously making the same point about 
>consultation.  On the broad economic and consultative dimensions of 
>NEPAD, therefore, I'm going to leave the debate to others, although 
>there is one matter I must raise. It seems to me that the element of 
>manipulative deceit rears its head again on the question of 
>liberalized trading arrangements. The mantra of the aristocratic 
>patricians of the G8 countries is that trade will set you free. But 
>how in God's name can you promise a liberalized trading regimen on 
>the one hand, while promulgating $190 billion worth of domestic 
>agricultural subsidies on the other? And that's just the United 
>States. Add another $160
>billion or more from the European Union, throw in other heavily 
>protected industries, and you effectively deliver a message to 
>Africa that the new round of trade talks under the WTO are a 
>Machiavellian illusion.
>
>It was the Prime Minister himself, just ten days ago in Montreal, 
>who called the avalanche of subsidization an exercise in hypocrisy. 
>It was the Minister of Finance himself, who three days ago took the 
>American Secretary of the Treasury out behind the woodshed to 
>administer a metaphysical beating, so angered was John Manley by the 
>subsidization frenzy. Someone has to explain how the cornerstone of 
>NEPAD, namely liberalized trade, is going to work under present 
>circumstances. I agree with my Prime Minister: it won't work. Why 
>then the self-congratulatory exuberance of the G8 countries? You 
>can't have it both ways: you can't have the announcement of a 
>stirring new
>partnership on the one hand, when the economic centrepiece is an 
>illusion. You end up with orchestrated hype rather than reality.
>
>A footnote, and I'll move on. In 1988, before I left the UN, I 
>attended a lunch in honour of Michel Camdessus, the then Managing 
>Director of the International Monetary Fund, who explained, in 
>exquisite detail, to several developing country ambassadors, how the 
>emerging Uruguay round of trade talks would be their salvation. I 
>remember vividly to this day the Ambassador of Ghana saying to Mr. 
>Camdessus that it was all transparent poppycock (although it's 
>possible he didn't use those exact words). Mr. Camdessus, hand on 
>heart, promised otherwise. Michel Camdessus was wrong.
>The Ghanaian Ambassador was right. The Uruguay Round did nothing for 
>Africa. In fact, as is well-known, Africa's terms of trade declined. 
>There is an unsettling resonance between then and now.
>But allow me to get to the main burden of my remarks.
>
>It seems to me that there's a critical flaw at the heart of the 
>NEPAD document. For all its talk of trade, and investment, and 
>governance, and corruption, and matters relating to financial 
>architecture, there is only a pro forma sense of the social sectors, 
>only modest references to the human side of the ledger. And in a 
>fashion quite startling, in fact, disturbingly startling, NEPAD 
>hardly mentions HIV/AIDS at all. But how can you talk about the 
>future of sub-Saharan Africa without AIDS at the heart of the 
>analysis? The failure to do so leads to a curious and disabling 
>contradiction.
>
>NEPAD has a number of stunning goals. They are essentially the 
>Millennium Development goals: an annual growth rate of 7% for 
>fifteen years; cutting poverty in half by the year 2015; reduce 
>infant mortality rates by two-thirds; reduce maternal mortality 
>rates to three-quarters of what they were before; have every child 
>enter school who is eligible, thereby re-enforcing the principle of 
>gender equality. A more admirable agenda could not be imagined.
>
>But there's a dreadful conundrum. And it lies, somewhat elusively 
>--- you might almost say in hiding --- in the middle of the document 
>at paragraph 125. Let me quote the two key sentences: "One of the 
>major impediments facing African development efforts is the 
>widespread incidence of communicable diseases, in particular 
>HIV/AIDS, tuberculosis and malaria. Unless these epidemics are 
>brought under control, real gains in human development will remain 
>an impossible hope". Let me repeat --- and remember, this isn't the 
>gentle ranting of a maniacal socialist; this is straight from the 
>NEPAD text itself --- "Unless these epidemics are brought under 
>control, real gains in human development will remain an impossible 
>hope".
>
>There's actually a faintly comic aspect to this paragraph. Until a 
>recent revision, the original text read that real gains in human 
>development will remain a "pipedream". The word 'pipedream' became 
>too evocative in a text that was otherwise a model of somnambulant 
>bureaucratese, so they dumped it in favour of 'impossible hope'. The 
>meaning, however, remains clear: unless we deal with HIV/AIDS, all 
>the proud declarations of NEPAD are doomed.
>
>I cannot put the case too strongly. There will be no continuous 
>seven per cent annual growth rate in the twenty-five countries where 
>the prevalence rate of HIV is above five per cent --- considered to 
>be the dangerous take-off point for the pandemic --- unless the 
>pandemic is defeated. In fact, it is virtually certain that several 
>of those countries will experience a negative rate of growth year 
>over year under present circumstances. There will be no cutting 
>poverty in half by the year 2015 unless the pandemic is defeated; 
>poverty exacerbates the pandemic, but the reverse is equally true. 
>When family income is gutted as wage earners die, as plots of land 
>are left untended, as every penny goes to the care of the sick and 
>the dying, it is preposterous to pretend that poverty will be 
>halved. There will be no reduction in infant mortality by 
>two-thirds, unless the pandemic is defeated. How can there be? Two 
>thousand infants a day are currently infected S a certain death 
>warrant S maintaining or elevating the already impossibly high 
>infant mortality rates. There will be no reduction in maternal 
>mortality rates unless the pandemic is defeated. How can there be? 
>We've learned over the years that maternal mortality is one of the 
>most intractable health problems throughout the developing world; in 
>a situation where the health systems are under assault, where 
>hospitals and community
>clinics can't cope, there's no chance of reducing maternal mortality 
>by three quarters. Seldom has the word pipedream been more 
>applicable.  And there is certainly no chance of putting every 
>eligible child in school, especially the girls, unless the pandemic 
>is defeated. UNESCO has very recently released a study showing that 
>four out of every ten primary school age children are now not in 
>school in sub-Saharan Africa. Young girls are regularly pulled out 
>of classrooms to look after ailing parents. There are thirteen 
>million orphans in Africa, the numbers rising inexorably, huge 
>cohorts of them living on the streets, or attempting to survive in 
>child-headed households after the extended family is gone and the 
>grandmothers are dead. These kids have nothing; they certainly have 
>no money to afford school fees, or books, or uniforms. And it's not 
>just the children, it's the teachers. I was in New York last month 
>for the Children's Summit, sharing a Panel with Peter Piot, head of 
>UNAIDS, when he used the startling figure that last year alone, a 
>million African children lost their teachers to AIDS. The government 
>of Mozambique just issued a statement that seventeen percent of its 
>teachers will die of AIDS by the end of this decade. As I travel, 
>when I speak to Ministers of Education, they haven't the faintest 
>idea how they're going to replace the teachers that are gone, or how 
>they will ever find trained or adequate substitute teachers to fill 
>in for the regular classroom teachers who are off sick for extended 
>periods of time. We're talking about an unprecedented  calamity. 
>There's nothing more noble than the objective of putting every child 
>in school, but
>if the objective is not to be more than some kind of ephemeral 
>mockery, then AIDS must be defeated.
>
>In other words, quite simply, taken all in all, and I emphasize 
>again, taken from NEPAD itself, the development goals of Africa are 
>an "impossible hope" until we have turned the pandemic around.
>I remember visiting a little Catholic community centre in Windhoek, 
>Namibia, in February. It was a place where people living with AIDS 
>could network, find a support group, have a meal, try to earn some 
>money through an income generating project. What was the project in 
>that instance? The Sister running the centre took me out back to 
>show me. A group of men were making miniature paper mache coffins 
>for infants, and as they affixed the silver handles, they said to me 
>with a mixture of pride and anguish: "We can't keep up with the 
>demand".
>
>I guess that was, for me, the nadir of this last year of traveling 
>through Africa. This is a sophisticated and knowledgeable audience; 
>I don't have to drive the nail through the wall. It's simply 
>self-evident truth, that in country after country where the pandemic 
>is grievously rooted, the development process has been dealt a 
>mortal blow. The G8 Summit next week is, in a way, the last best 
>chance for Africa. The G8 leaders, straight jacketed in the kind of 
>denial that afflicted the African leaders for twenty years, must 
>make an herculean effort to break free and provide a binding 
>commitment to the continent.
>
>On Wednesday of this week, In the Globe and Mail, there was a 
>brilliant piece of journalism from Malawi by Stephanie Nolen. With a 
>profusion of images and examples which linger in the mind, Stephanie 
>Nolen chronicled the devastation to the continent, some of it 
>irreversible, exacted by the
>scourge of AIDS. Towards the end of the piece, she wrote: "Next 
>week, when the G8 looks at Africa, the rest of the world will have a 
>chance to look at the bigger picture. There will be much talk of the 
>continent's wars, its corrupt governments and its disastrous 
>economic policies, which keep it mired in poverty. And there will be 
>just as much talk about the great hope that peace, trade, investment 
>and better management can bring to the world's poorest continent. 
>But to assess any of these, and to decide what role the North should 
>play in Africa's future, the leaders of the world's richest nations 
>must grapple with the impact of AIDS as never before. First and 
>last, it has become the dominant force in African development. The 
>reality of AIDS means that nothing short of a new approach to Africa 
>will work".
>
>That argument mirrors the views of the recent remarkable study, from 
>the World Health Organization, authored by Jeffrey Sachs, the noted 
>former Harvard economist, now an advisor to Kofi Annan, entitled the 
>"Report of the Commission on Macroeconomics and Health".  For many 
>years now, some might say decades, the argument has always been that 
>if you generate sufficient economic growth, the health of a society 
>will be secured. It's essentially the old trickle-down theory. Those 
>who explain the current G8 process are making the same argument, 
>indeed embroidering it further to say that AIDS can soak up all our 
>money, but until Africa has investment, trade, pays taxes, and 
>grows, nothing will change for Africa.
>
>In the first instance, no one has suggested it's all or nothing. 
>Surely, even the most elemental pragmatism indicates that a mix is 
>possible. But far more important is the argument of Sachs, based on 
>what seems to me to be irrefutable analysis, that the existing 
>paradigm has to be turned on its head. He says, in part: "The 
>linkages of health to poverty reduction and to long-term economic 
>growth are powerful, much stronger than is generally understood. The 
>burden of disease in some low-income regions, especially sub-Saharan 
>Africa, stands as a stark barrier to economic growth and
>therefore must be addressed frontally and centrally in any 
>comprehensive development strategy. The AIDS pandemic represents a 
>unique challenge of unprecedented urgency and intensity. This single 
>epidemic can undermine Africa's development over the next 
>generation".
>
>In this international primer of common sense development 
>imperatives, Sachs is not about to take the developing countries off 
>the hook. He demands of them what the African governments, in NEPAD, 
>demand of themselves: transparency, accountability, good governance. 
>But he requires a quid pro quo: "The high-income countries would 
>simultaneously commit vastly increased financial assistance, in the 
>form of grants, especially to the countries that need help most 
>urgently, which are concentrated in sub-Saharan Africa". Then, in 
>the only sentence in the report which is italicized, Sachs writes: 
>"They would resolve" i.e., the G8  "They would resolve that lack of 
>donor funds should not be the factor that limits the capacity to 
>provide health services to the world's poorest peoples".
>And therein lies the rub. In fact, therein lies the rot. Sadly, 
>inexplicably, the G8 is guilty of a profound moral default. They 
>simply will not meet the commitments which they have previously 
>pledged - pledged as far back as 1970, when Lester Pearson chaired 
>the committee of the OECD
>countries which agreed that 7/10ths of 1 percent of Gross Domestic 
>Product, i.e. the famous .7% of GDP, should be the foreign aid quota 
>for the wealthy nations. The present official development assistance 
>equals .22% or $53 billion for the entire developing world. If it 
>were at .7%, it would yield
>$175 billion today, and $200 billion by 2005. In other words, by any 
>calculation, we would have enough money to staunch the fatal 
>lacerations of AIDS, to provide free universal primary education, 
>and to deal with nutrition, potable water and sanitation. The result 
>would be the virtual eradication of poverty by 2015; the Millenium 
>Development Goals would be exceeded.
>
>Over the last months, days and weeks leading up to next week in 
>Kananaskis, there has been such a proliferation of figures as to 
>make the mind reel. We hear about George Bush at the Financing for 
>Development conference in Monterrey increasing American aid by 50%; 
>we hear about the European Union at Monterrey providing an 
>additional $20 billion; we hear about Jean Chretien increasing the 
>CIDA budget by 8% ad infinitum; we see a Toronto Star headline 
>announcing $60 billion for Africa over the next decade, based on the 
>G8 contributing half of its new foreign aid (whatever that means) to 
>Africa; we see a headline in the Globe and Mail indicating G8 
>support for a schools package which, according to the World Bank, 
>would be another $4 billion a year; we hear a new announcement from 
>the US President of $500 million, or $300 million, depending on the 
>interpretation, over two years, or three years, depending on the 
>interpretation, for the prevention of
>mother-to-child transmission in 8 countries, or 12 countries, 
>depending on the interpretation, and so it endlessly goes in a 
>welter of unfathomable arithmetic configurations until the mirrors 
>and smoke sting the eyes with incredulity.
>
>Look, the calculations don't have to be that complicated. George 
>Bush said, at Monterrey, that he would increase American foreign aid 
>by $5 billion overall, annually, by the year 2006. The current level 
>is $10 billion; hence the claim of a 50% increase. The truth is that 
>the increase in American
>aid, brings them to .15% of GDP, or roughly to 20% of the target. 
>The EU said, at Monterrey, that by the year 2006, it would add, 
>overall, annually, another $7 billion dollars, equivalent to .39% of 
>GDP, or roughly 50% of the target. But let's be clear about what's 
>being said: the United States and the European Union, four to five 
>years down the road from now, will be providing, together, an 
>additional $12 billion is foreign aid annually. That's not today; 
>that's in the future. In fact, if I may put it starkly,
>another ten million people will have died before we reach those 
>levels of assistance. Nor, by the way, does it all go to Africa. Nor 
>by the way, does it come without conditions.
>
>Jean Chrétien said, at Monterrey, that he would increase Official 
>Development Assistance by 8% a year until the level of aid had 
>doubled by around 2008. Alas, our CIDA budget has been so severely 
>cut by the present administration over the last eight or nine years, 
>that to double it over the next eight or nine years will bring it, 
>as a percentage of GDP, roughly back to the level of 1985! There is, 
>to be fair, the promise of a one-shot additional $500 million for 
>Africa, but when that will become available, and over what period of 
>time and for what purpose, no one can figure out.
>
>The truth is that over the next several days, we're going to witness 
>an avalanche of competing figures and contributions, most of which 
>would challenge the beautiful minds of the best mathematicians. 
>Somehow we have to emerge from the G8 Summit with a true and clear 
>accounting of what's been
>pledged. And I use the word "pledged' advisedly: there has so often 
>been a chasm between promise and delivery that it is truly difficult 
>to trust what is announced. Just look at what has happened to the 
>debt initiative of the World Bank and the International Monetary 
>Fund and countless G7 incarnations
>of debt relief; just look at what has happened to the guarantee of 
>the eradication of hunger made back in 1996; just look at what has 
>happened to the pledges on universal primary education, dating back 
>to 1990; just look at the gap between promise and fulfillment of the 
>goals which were set at
>the first Summit for Children twelve years ago, and to bring it 
>right up-to-date, just look at the striking shortfall between the 
>pledges for Afghanistan and the actual delivery.
>
>It's painful to be so skeptical. But history dictates that judgement 
>be suspended until we see what happens twixt cup and lip.  Except in 
>one instance. And for me, albeit not for others, that instance
>will be the litmus test for the G8 Summit. What are they going to 
>pledge to the Global Fund for AIDS, Malaria and Tuberculosis - the 
>three communicable diseases specifically identified in NEPAD?  Let 
>me provide the context. Last year, at the AIDS Summit in Abuja, 
>Nigeria, the Secretary-General of the United Nations formally 
>proposed the Global Fund, and asked for $7 to $10 billion dollars 
>per year from all sources, but particularly from governments. After 
>a great deal of cajoling and persuasion, the rich nations have 
>contributed, thus far, $2.1 billion dollars, but over three years. I 
>repeat: over three years. At the higher and more realistic level of 
>$10 billion, it then amounts to about 7% of the need over those 
>three years. It's a shocking piece of international financial 
>delinquency, and it's a shocking rejection of Africa. It's so deeply 
>disappointing that words are hard to find.
>
>The Global Fund has an excellent apparatus for the disbursement of 
>monies. It has a Board representing governments of South and North, 
>and civil society, and the private sector. It has the capacity to 
>expertly evaluate individual country proposals. It has the 
>administrative backup of UN
>agencies. It is already in the process of distributing hundreds of 
>millions of dollars of the $2.1 billion in the coffers. At present 
>rates, it will very soon run out of money.
>
>If the G8 Summit takes NEPAD seriously, if it wishes to make 
>development more than an "impossible hope", if it adds to trade and 
>investment a pledge to rescue the human condition in Africa, if it 
>wants to redeem the Summit process, so tainted by previous posturing 
>and irrelevance, then it will provide a guarantee, year by year, of 
>the monies that Kofi Annan has requested for the Global Fund. In one 
>fell swoop, the entire Summit would then be credible. Jean Chrétien 
>will have his legacy, a legacy of principle, compassion and honour.
>
>If, however, nothing, or an infinitesimal sum, is ear-marked for the 
>Global Fund, then a number of countries in sub-Saharan Africa will 
>be in a desperate struggle for survival. The possible neglect of the 
>Global Fund is not conjecture. The New York Times has an editorial 
>today pointing out that the most recent announcement from President 
>Bush involves purely bilateral money, and in the process deals a 
>serious blow to the prospects for the Global Fund. And by the way, 
>the use of the word  'survival' is not mine.
>
>It's the word used by African leaders when they addressed the United 
>Nations General Assembly Special Session on HIV/AIDS in June of last 
>year.  One of the interesting things about the Global Fund is that 
>no one ever proposed a schedule of payments, including the amounts 
>that might
>legitimately be expected from each of the contributing countries. So 
>in the interest of fair play, I'd like to make such a proposal.
>
>Some little time ago, it occurred to me that there was an obvious 
>analogy to be employed. All of the member states of the United 
>Nations have accepted a formula to be applied to the budget of the 
>UN and to its peacekeeping operations. The formula is based on 
>population, and per capita income and
>other relevant indices. Simply put, it provides a scale of 
>contributions in which each country pays a given percentage of the 
>UN budget and the UN peacekeeping budget. In the case of Canada, 
>that's 2.579% per annum. We've accepted the calculations as valid, 
>we've always paid the equivalent dollar
>amount in full and on time, as have other countries. Even the United 
>States, although lamentably delinquent in its payments, has accepted 
>the existing formula. It seems to me logical, therefore, to apply 
>the formula, universally agreed upon, to the Global Fund. After all, 
>it is a Fund suggested by the Secretary-General of the United 
>Nations. The calculation then becomes remarkably simple - if, for 
>Canada, it's 2.579% of $7 billion, that amounts to 180 million US 
>dollars per annum. If it's 2.579% of $10 billion, that amounts to 
>250 million US dollars per annum. As it happens, the Canadian Centre 
>for Policy Alternatives just this week issued a statement which 
>includes the calculations, based on the same formula, for the other 
>G8 countries. It would be an act of extraordinary statecraft, an act 
>that would truly revive a sense of international idealism, an act 
>that would restore hope to an entire continent were the leaders of 
>the world to make such a commitment.
>
>At the end of Jeffrey Sach's stirring exegesis, he says: "There is 
>no excuse in today's world for millions of people to suffer and die 
>each each year for lack of 34 dollars per person needed to cover 
>essential health services. A just and far-sighted world will not let 
>this tragedy continue".
>
>Alas, it is not a just and far-sighted world.  Let me be clear: 
>while the situation feels apocalyptic, it can be addressed. AIDS has 
>done and is doing terrible things to Africa, but we know how to 
>defeat it. That's what drives me crazy S we know how to defeat it. 
>We know all about voluntary counseling and testing; we simply have 
>to train more counselors and get rapid testing kits into the hands 
>of those who administer the tests. We know all about the prevention 
>of mother-to-child transmission.
>We know about the wonder drug nevirapine; one tablet to the mother 
>at the onset of labour, one tablet during the birthing process, one 
>dose of liquid equivalent to the baby within hours of birth and 
>transmission of the virus can be reduced by up to 53%. We know about 
>anti-retroviral treatment, the
>so-called drug cocktails that keep people alive. Largely as a result 
>of competition from generic manufacturers in India, Thailand and 
>Brazil, the cost of "ARVs" has dropped dramatically, but no matter 
>how dramatic, the drugs are still beyond the capacity of Africans to 
>afford when people live
>on less than a dollar a day. But it could be afforded through 
>external financing, and it is one of the gruesome iniquities of the 
>present situation that people are dying, everywhere, in huge 
>numbers, unnecessarily.
>
>We know about prevention, particularly in the key youth communities 
>aged 15 to 24. Through what they call peer counseling and peer 
>education, using music, dance, drama, drums and poetry, questions of 
>sexuality and condoms and abstinence and behaviour change are 
>confronted in a fashion so explicit, so real, so frontal as to take 
>your breath away. What has to be done of course,
>is to generalize prevention programmes throughout any given country, 
>that is, to take prevention to scale. And it's possible if only 
>Africa had the resources. We know about care at community level, 
>where the sickness and the dying takes place. The women of Africa, 
>in particular, are incredibly
>sophisticated at the grass roots, with networks of community-based 
>and faith-based organizations to provide care and compassion and 
>love where there would otherwise exist only isolation, stigma and 
>fear. In this instance, adequate resources would serve a two-fold 
>purpose. Voluntary 'home-based care' as we now know it, is really 
>conscripted labour for women, an extension of gender oppression, the 
>kind of oppression which, along with the absence of sexual autonomy, 
>and predatory male behaviour, has made AIDS a gender-based disease. 
>Fifty-five percent of the new infections are amongst women. If we 
>had the money, we could encourage a network where men and women
>together provided the care, and women could assert their sexual and 
>reproductive rights. We know about the strength of the associations 
>of People Living With AIDS; we know about National AIDS Councils and 
>National AIDS Control Commissions; we know about five-year plans; we 
>know about
>dealing with high risk groups --- truck drivers, commercial sex 
>workers, mobile populations --- we now know about engaging political 
>and religious leadership - we know, in short, enough about the 
>pandemic to turn it around.
>
>To be sure, there are vexing, sometimes overwhelming problems of 
>infrastructure, and overwhelming problems of finding the human 
>capacity to do the job. When funerals are more pervasive than any 
>other form of social gathering, when hospital wards are chambers of 
>horrors, the life force of a
>society is slowly being strangled. But as I stand here, I genuinely 
>believe, to the depths of my being, that we could save and prolong 
>millions of lives, if only we had the resources to do so.
>
>Let me end on an intensely personal note. Over the last few days, 
>people have told me --- not unpleasantly --- that I get very 
>emotional about the subject of AIDS in Africa. Some of my good 
>friends worry about my psychological equanimity. I guess, in part, 
>men are supposed to be stoic and bravely unfeeling, or at least 
>self-contained.  I make no apologies for the occasional emotional 
>catharsis. I can't help it. All my adult life, along with countless 
>colleagues, sometimes in partnership
>with people of other ideological beliefs, I've raged against 
>injustice. But I've never seen anything like this. I don't know how 
>to get a grip on it. I don't know how to make sense of it. Is the 
>behaviour of the western world just appalling insensitivity, is it 
>unacknowledged racism, is it sheer unbridled indifference, is it the 
>comfortable assumption of hopelessness in order to avoid 
>contributing money; is it possible that the political leadership is 
>completely out of touch with the vast populations --- like the 
>people of Canada --- over whom it holds sway?
>
>I feel so angry and so impotent simultaneously. I privately wish 
>that the African leadership had openly confronted the G8 on the 
>issue of AIDS, rather than muting its impact within NEPAD. I know 
>how tough it is to ask for money --- Africa is asking for $64 
>billion a year, most of it from outside --- to finance NEPAD, so 
>it's intensely human and political not to want to disconcert your 
>donors. But that makes it far too easy for the donor nations.
>
>I carry around with me the images of young mothers, sitting on 
>makeshift benches, in the shade under a tree, fifteen or twenty at a 
>time, all of them exhibiting AIDS-related symptoms, and urgently, 
>with great dignity, asking who will care for their 
>soon-to-be-orphaned children, asking about medicines for 
>straightforward opportunistic infections, asking about treatment, 
>and so help me, I can't give any answers.  Somehow, this G8 Summit 
>has to be a turning-point. Africa is coming to us, pledging reform, 
>asking for help. If we raise it to the intellectual and academic 
>level, it really does become a question of globalization. Can 
>globalization respond to global issues? If we see it at a human 
>level, it demands from all of us the best we have to give. I note 
>that the Secretary-General of the United Nations has recently 
>written to the G8 leaders saying, in part, "The peoples of the 
>developing world (will be) bitterly disappointed if your meeting 
>confined itself to offering them good
>advice and solemn exhortations, rather than firm pledges of action 
>in areas where your own contribution can be decisive". And by 
>contribution, he includes dollars. On another occasion, writing the 
>preface to the Declaration of Commitment which emerged from the 
>HIV/AIDS Special Session
>last year, the Secretary-General said: "In the war against HIV/AIDS, 
>there is no us and them, no developed and developing countries, no 
>rich and poor --- only a common enemy that knows no frontiers and 
>threatens all peoples.
>
>But we must all remember that while HIV/AIDS affects both rich and 
>poor, the poor are much more vulnerable to infection, and much less 
>able to cope with the disease once infected. The leadership and 
>commitment shown in this Declaration will (allow)  the millions of 
>suffering (to) S know that the
>world is finally summoning the will --- and committing the resources 
>S to win this war for all humanity".
>
>Interesting that he uses the metaphor of war. In times of war, 
>everything is a national emergency. In times of war, every apparatus 
>of the state is conscripted into battle. In times of war, resources 
>are somehow found that are thought not to exist --- just think of 
>the so-called war on terrorism, with scores of billions of dollars 
>hurled into the fray overnight to avenge the horrendous deaths of 
>three thousand people. So explain to me why we have to grovel to 
>extract a few billion dollars to prevent the deaths of over two 
>million people every year, year after year after year?  Why is the 
>war against terrorism sacrosanct, and the war against AIDS equivocal?
>
>In the answer to that question lies the challenge for NEPAD and the 
>true test for the G8.
>
>-30-

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