PHA-Exchange> Speech by Stephen Lewis at the Official Opening of 13th ICASA

[Claudio]

From: "Dieter Neuvians MD" <neuvians at mweb.co.za>
> Speech by Stephen Lewis at the Official Opening of 13th ICASA
> -------------------------------------------------------------
> --
> Address by Stephen Lewis UN Secretary-General's Special Envoy for
> HIV/AIDS in Africa at the Official Opening of the XIIIth Interna-
> tional Conference on AIDS and STIs in Africa Nairobi, 21 Septem-
> ber 2003 5:00 p.m.
>
> Your Excellency, Mr. President, Madam the First Lady of Gabon,
> Honourable Ministers (including the Minister of Health, who just
> yesterday joined the ranks of Kenya's famous long-distance run-
> ners), Distinguished Guests, Ladies and Gentlemen
>
> I am obviously delighted to have the privilege of participating
> in this opening session of ICASA. But I'm also aware that the
> speaking list is lengthy. So quite frankly, I m going to scrap
> the remarks I intended to make --- primarily on financial re-
> sources and treatment --- which would have required elaboration
> and time, and I will use this opportunity instead to pursue the
> theme of Access to Care in the context of children orphaned by
> AIDS, and other vulnerable children.
>
> I choose to focus on orphaned children because they remain per-
> haps the most intractable of all issues related to care and sup-
> port We've obviously been dealing with legions of orphaned chil-
> dren-- sometimes adequately, mostly inadequately - for well over
> a decade But something startling is happening: the increased spi-
> ral of adult deaths in so many countries means that the numbers
> of children orphaned each day is expanding exponentially. Africa
> is staggering under the load. In late July, early August I made a
> trip to Uganda and Zambia with Mrs. Graça Machel. Graça Machel
> is, as you know, the former Minister of Education of Mozambique,
> the former First Lady of Mozambique, and is now married to Nelson
> Mandela. Graça knows every corner of Africa intimately. The trip
> left us both with an overwhelming sense of dismay, anxiety, even
> dread at the situation of orphans.
>
> Uganda and Zambia aren't unique; they are mirrors of the conti-
> nent. Let me attempt to illustrate some of what we experienced
> with four brief anecdotes. First, in Kampala, Graça and I visited
> Mulago Hospital and the clinic running Prevention of Mother to
> Child Transmission Plus. The Plus as you re surely aware, repre-
> sents overall care for the family -- not only the treatment of
> the mother, but where necessary, her partner and any children who
> are HIV-positive. It's a new initiative in Africa, with pilots in
> a number of countries, overseen by the Columbia University School
> of Public Health working in conjunction with governments, UNICEF
> and the Elizabeth Glazer Pediatric AIDS Foundation. The principle
> here --- and it s the most powerful principle that could be in-
> voked --- is that the one foolproof way to reduce the orphan
> population is to keep the mothers alive.
>
> At Mulago, we met with a number of women enrolled in the pro-
> gramme who were on antiretroviral treatment. You will know that
> in most countries, eligibility for treatment requires a CD4 count
> below 250 or 200. We met a woman whose CD4 count had dropped to
> one -- yes, 1 when she was given drugs. It was unheard of. When
> we saw her, she was a month into treatment, looking good, feeling
> good, and equally important, her two lovely children played at
> her feet while their mother laughed with us. If ever the skyrock-
> eting orphan population - already pushing 13 million -- is to be
> brought under control, then treatment is absolutely imperative to
> success. When WHO says three million people will be treated with
> anti-retrovirals by 2005, the world must make it happen. Anything
> less is an ethical abomination.
>
> Second, this time in Zambia, Graça and I were taken to a village
> where the orphan population was described as out of control. As a
> vivid example of that, we entered a home and encountered the fol-
> lowing: to the immediate left of the door sat the 84-year-old pa-
> triarch, entirely blind. Inside the hut sat his two wives, visi-
> bly frail, one 76, the other 78. Between them they had given
> birth to nine children; eight were now dead and the ninth, alas,
> was clearly dying. On the floor of the hut, jammed together with
> barely room to move or breathe, were 32 orphaned children ranging
> in age from two to sixteen. Graça and I looked at each other, and
> wordlessly communicated the inevitable fear: What in God's name
> is the future for these youngsters?
>
> It is now commonplace that grandmothers are the caregivers for
> orphans --- I've certainly seen it in every country without ex-
> ception --- but that is no solution. The grandmothers are impov-
> erished, their days are numbered, and the decimation of families
> is so complete that there's often no one left in the generation
> coming up behind. We re all struggling to find a viable response,
> and there are, of course, some superb projects and initiatives in
> all countries, but we can't seem to take them to scale. In the
> meantime, millions of children live traumatized, unstable lives,
> robbed not just of their parents, but of their childhoods and fu-
> tures. How can this be happening, in the year 2003, when we can
> find over $200 billion to fight a war on terrorism, but we can t
> find the money to prevent children from living in terror?
>
> Third, towards the end of the trip to Zambia, I visited an un-
> planned community of approximately five thousand people in a tiny
> settlement just outside Lusaka. The people were bursting with
> pride: they had graded a rough road and built a community centre,
> with two of the rooms used as a makeshift school-- albeit without
> benches, desks, blackboards, chalk, paper or pencils. They showed
> me around and then asked me to say a few words as they gathered
> in their hundreds on some rocky ground in front of the community
> centre. I looked out at the crowd, and was suddenly jolted by a
> shock of recognition. In the front row were a handful of young
> mothers, their babies at their breasts. And then, as far as the
> eye could see into the crowd, made up mostly of women, everyone
> else was elderly. I asked: how many of you are grandmothers? and
> a forest of hands shot up. I asked: how many of you are caring
> for children? and the same hands shot up. And I suddenly real-
> ized, in a vivid momentary photograph of life, that the entire
> middle generation seemed to be missing: there were children, very
> young women, old women, and a handful of older men - - and almost
> nothing in between.
>
> We all know that that's the way the pandemic works. But there
> comes a moment when the statistics on paper, the intellectual ab-
> stractions suddenly hit home. And at that moment, they hit home
> for me with an almost visceral force. Thus it is that orphaned
> children are the most vexing issue related to care, because there
> are not enough adults left to do the care giving no one to hand
> down knowledge or experience, or -- perhaps most important of
> all-- values -- from one generation to another. It's appalling
> that so many children are growing up without the kind of emo-
> tional anchor that leads to a life of stability.
>
> The final anecdote takes place in Uganda, in Masaka Distrist, at
> what is known as ground zero in the pandemic. It was there that
> the first case of HIV/AIDS was diagnosed in 1982. The villagers
> were anxious that we visit one of the many child-headed house-
> holds, in this instance headed by a fourteen-year-old girl, with
> two sisters, 12 and 10, and two brothers, aged 11 and 8. Theirs
> was not a dramatic story of sexual violence or property theft.
> The injustice of their young lives was much more straightforward,
> but as deeply compelling. We went into the children's hut, and
> Graça told everyone to leave: media, UN staff, hangers-on. The
> only people who remained behind were a translator and the local
> World Vision staff woman who helped tend to the village. We sat
> down side by side with the children, our backs to the wall, the
> two boys on my left, and the three girls on Graça s right. I had
> no idea what to expect. Graça turned to the young girls, and very
> gently asked: Have you started to menstruate yet? Very shyly, the
> 14-year-old and the 12-year-old girls said they had. Do you know
> what it means? said Graça. What did you think was happening to
> you? Do you talk about it with other girls at school? Do you talk
> about it with your teacher? And as the two girls answered, in
> whispered voices, I suddenly realized that they were experiencing
> their first act of parenting around one of the most anxious mo-
> ments of a young girl's life. I couldn't get over it. I thought
> to myself: this is the gap that women all over Africa are trying
> to fill, but the ratio of children to adults is completely out of
> whack. (In both Uganda and Zambia, orphaned children constitute
> 10% or more of the population.)
>
> The depth of psychological distress that plagues an entire gen-
> eration of children numbering in the millions is simply over-
> whelming, and the struggle to cope is complicated fiercely by a
> lack of resources at the grass roots. There are emerging, inter-
> nationally, strong plans for dealing with orphaned children,
> plans focusing on the removal of school fees, on school feeding
> programmes, on the cultivation of school gardens, on health care
> for vulnerable children, on protection from sexual violence, on
> significant and lasting community support. Here in Kenya, there's
> reason for optimism. When you removed primary school fees, Mr.
> President, and nearly one and a half million new children turned
> up at school, you set a precedent for the entire continent. Eve-
> ryone is talking about it, and a campaign to abolish school fees
> in Africa is now in the works.
>
> What is more, just yesterday, the Women s AIDS Run showed the as-
> tonishing solidarity that exists at community level amongst women
> across this country, in providing access to care and support. De-
> spite their disproportionate levels of infection, and the poison-
> ous absence of any semblance of gender equality, African women
> are incredibly strong. But the women can't do it alone. That's
> how I want to end. You can't do it alone. The women of Africa,
> all the people of Africa, the governments of Africa: they can't
> do it alone. This is a full-blown emergency; in every emergency
> there is a division of labour. Africa is struggling to hold up
> its end; the west is not. I have to say that what's happening to
> the continent makes me extremely angry. And I don't feel I have
> to apologize for being angry. The job of an Envoy isn't merely to
> observe and to report back, but also to identify with those he
> serves. And I serve Africa. And I'm enraged by the behaviour of
> the rich powers how much more grievous, by their neglect, they
> have made the situation in Africa. That isn't to take Africa off
> the hook: the behaviour of many former African leaders was inde-
> fensible. But Africa has moved mountains in the last couple of
> years, while the western world remains mired in the foothills.
> Africa needs no instructions from the west; Africa needs no arro-
> gance from the west; Africa needs no churlish lectures from the
> west. Africans know HIV/AIDS in all its manifestations and re-
> quirements.
>
> Admittedly, no one in the world has yet developed a plan for cop-
> ing with this new phenomenon of millions of orphaned children,
> but Africa has vastly more experience of orphans than the rest of
> us, and we should simply stop barracking, and provide the re-
> sources for Africa to find solutions. The knowledge and human re-
> sources are there: organizations of People Living With AIDS, the
> inspired youth peer counsellors, the political leadership, the
> religious leadership, the activist women s groups, the community-
> based and faith-based organizations: there is overwhelming so-
> phistication and strength on this continent. What's missing are
> the tools and support to do the job. Provide those to Africa, and
> we can break the back of this pandemic. But that requires money.
> Money, for example, for the Global Fund -- and the money is not
> there.
>
> Africa is unrelievedly poor. In the straitjacket of poverty,
> whole countries are fighting for survival. And that, my friends,
> is morally unconscionable. There's just no time for debate: the
> crisis has gone on for so long that those who were once orphaned
> children are now young adults having children of their own. How
> do you bring up a child, when you've had no parenting to fall
> back on? It's a blessed thing that against all odds, there re-
> mains such tremendous determination and spirit among Africans to
> save this continent. The world need only feed that spirit, and
> Africa will prevail.