AIDS in Africa
Young Maasai listen to their warrior chiefs during a graduation to manhood ceremony December 20, 2003 in Kisaju, 80 km (50 miles) east of Kenya's capital Nairobi.
Taking control of the fight against AIDS in an unprecedented move, the warrior leaders pronounced changes in the centuries-old rules for sexual and social actions in order to stop the spread of the scourge among their people, a precedent which must be followed by all of the 400,000 Maasai and their Maa speaking neighbors.
AIDS in Africa
Africa has been hit harder by the HIV/AIDS virus than any other region of the world. More than 17 million Africans have died from AIDS and another 25 million are infected with the HIV virus, approximately 1.9 million of whom are children.
Sub-Saharan Africa had 30 million people living with HIV/AIDS by early 2003 after 3.5 million new infections in 2002. 2.4 million Africans died in 2002. 10 million young people (aged 15–24) and almost 3 million children under 15 are living with HIV.
Very, very few with HIV or AIDS in Africa get antiretroviral treatment. Many millions are not receiving medicines to treat opportunistic infections.
Much greater numbers of people who acquired HIV over the past years are becoming ill - it takes up to 10 years from infection to illness, so AIDS in Africa is often hidden. In the absence of massively expanded prevention efforts, the AIDS in Africa death toll will continue rising for another decade. The worst of the AIDS in Africa impact will be felt in the next decade and beyond. It is not too late to introduce measures to reduce that impact, including wider access to HIV medicines and help for the poor.
In four southern African countries, national adult HIV prevalence has exceeded over 30%: Botswana (38.8%), Lesotho (31%), Swaziland (33.4%) and Zimbabwe (33.7%). Food crises faced in the latter three countries are linked the HIV/AIDS epidemic, especially on the lives of young, productive adults.
Yet, there hopeful signs that the epidemic of AIDS in Africa could eventually be brought under control. In South Africa, HIV prevalence rates fell to 15.4% in 2001 (down from 21% in 1998) for pregnant women under 20. Syphilis rates among pregnant women attending antenatal clinics also fell to 2.8% in 2001, from 11.2% four years earlier - suggesting that awareness campaigns and prevention programmes are working.
Every day in Africa:
- HIV/AIDS kills 6,300 people
- 8,500 people are infected with the HIV virus
- 1,400 newborn babies are infected during childbirth or by their mothers' milk.
- 25 million people in Africa have HIV – this is 70% of global infections. Almost 2 million of African cases are children under the age of 15.
- Currently more than 12 million children in Africa have lost at least one parent to HIV/AIDS; that number is expected to reach 18 million by 2010.
- In sub-Saharan Africa, there are currently 4.1 million people with AIDS who are in immediate need of life-saving anti-retroviral drugs (ARVs). At the end of last year, only an estimated 50,000 of these people were able to take these drugs.
- AIDS experts estimate that it will cost more than $10.5 billion a year to fight AIDS globally - that price tag will escalate to more than $15 billion a year by 2007. Wealthy countries currently spend less than $4 billion on global AIDS.
- The main ways AIDS is transmitted are sexual intercourse, unsafe injections, transmission from mother to child at birth or through breastfeeding, and transfusion of contaminated blood or blood products.
People with AIDS don't suffer alone. The disease attacks their families and communities as well. AIDS has stripped out an entire generation of parents, farmers, doctors, leaders. 12 million African children have already lost one or both parents to AIDS, and unless we take serious action now, there will be more than 18 million AIDS orphans by the end of the decade.
Millions of children will have lost not only their parents, but their teachers, nurses and friends too. Businesses are losing their workers, governments are losing their civil servants, families are losing their breadwinners. As a result, entire communities are devastated and economies that are already crippled by poverty, debts and unfair trade policies are further compromised.
While the moral case stands alone as a reason to act, richer countries also have economic and security reasons to fight this emergency. As we've seen in the case of Afghanistan, devastated, unstable states can become breeding grounds for terrorists.
Seeing Africa as our neighbor, and acting now to stop the spread of AIDS, is not only the moral thing to do - but it's also the practical thing.
The good news is that we know what works. Successes in a handful of countries such as Uganda and Senegal have shown that HIV rates can be brought down through effective AIDS prevention campaigns. Education, media campaigns, and community work with the most vulnerable can stop people from getting the HIV virus in the first place. AIDS drugs also have the potential to make a huge difference to the impact of the pandemic. In the past year, people living with AIDS in Africa have dared to hope that they might get access to anti-retroviral drugs (ARVs) that will keep them alive to work and care for their families. These drugs work so well that they produce a ‘Lazarus' effect - patients at death's door can be back at work within 2 months of starting treatment. Evidence shows that Africans taking the life-saving anti-retroviral drugs (ARVs) adhere to their regimens much better than Americans or Europeans - the success rate is about 90%.
Though the pace has picked up tremendously in the past year, the fact remains that only 700,000 of the 6 million people world-wide in immediate need of ARVs have access to them. This is partly because of the price - the cheapest drugs are a dollar a day, but most Africans cannot afford this. It is also because of availability. In some places, only more expensive drugs are available, plus in many communities, there is not infrastructure or trained health care workers to monitor and administer the treatment. The scarcity of treatment results in doctors and families having to make the hardest choice of all - in the community, in the family, who will live and who will die.
Other Facts
- More than 300 million people in Sub-Saharan Africa—nearly half the population—live on less than $1 a day. This number is expected to rise to 345 million by 2015.
- Africa is home to five of the world's fastest-growing low income countries– but also 34 of the world's 49 poorest countries.
- Sub-Saharan Africa is the region of the world that is least likely to achieve the internationally agreed poverty reduction targets, known as the Millennium Development Goals.
- Per capita income in Africa is falling - in 2000 it was 10% below the 1980 level.
How, and How Not, to Stop AIDS in Africa
William Easterly in the New York Review of Books:
One of the classic works of journalism of the last couple of decades was Randy Shilts's And the Band Played On about the sluggish response to AIDS in the 1980s in the United States, which indicted both the Reagan administration and the leaders of the gay community. I still remember the sense of outrage I felt when reading Shilts's book; it struck just the right note, leaving one both horrified about the tragic incompetence of so many and yet also hopeful that someone, somewhere could do things better next time.
Yet after reading Helen Epstein's masterful new book, the response to AIDS in America now looks in retrospect like a model of courage, speed, and efficiency by comparison with the response in Africa. In the US, the government publicized the threat and funded research, the gay community reduced its infection rates by encouraging less risky sexual behavior, the dreaded breakout into the heterosexual population never happened, and AIDS receded to become a disease that, while still tragic, could in most cases be kept under control with expensive new antiretroviral drugs (ARVs).
The opposite is true in every respect of AIDS in Africa, which was anticipated as a looming crisis already in the 1980s, yet governments, foreign aid agencies, and even activists reacted with denials and evasion.
aIDS LOSES LUSTRE AFTER BEING EXPOSED AS A BULLY 
AIDS LOSES LUSTRE AFTER BEING EXPOSED AS A BULLY
December 2 2008
London, UK – AIDS and HIV have for decades been one of the most prominent and ubiquitous of diseases. Outside cancer, there hasn’t been a disease that has captured the public’s attention and interest so thoroughly as AIDS has done. From celebrity endorsements to utter domination in research grants, AIDS and HIV have been a one-two punch that has cemented its place as the triple-A virus. Now though, as the global infection rates start to decline and treatments become more and more effective, critics are are starting to bring bare their syringes.
“Diarrhoea kills five times as many kids as AIDS,” said John Oldfield, executive vice president of Washington, D.C. based Water Advocates that promotes clean water and sanitation. “Everybody talks about AIDS at cocktail parties but nobody wants to hear about diarrhoea.”
Other diseases such as malaria, measles, and pneumonia have long been suffering under the very long shadow that AIDS casts, soaking up the majority of grants and donations leaving only scraps for arguably more dangerous diseases. Even in the most HIV infected continent, Africa, malaria is by far the largest killer.
“By putting more money into AIDS, we are implicitly saying it's OK for more kids to die of pneumonia,” said Roger England of Health Systems Workshop, a think tank based in the Caribbean island of Grenada. “The global HIV industry is too big and out of control. We have created a monster with too many vested interests and reputations at stake... too many relatively well paid HIV staff in affected countries, and too many rock stars with AIDS support as a fashion accessory.”
And while much of those dollars have gone towards the current declining reach of the disease, much of the funds are allocated to special projects like HIV ribbons.
“We don’t see people walking around with diarrhoea ribbons or see movies about people dying from leishmaniasis,” continued England. “The days of AIDS and HIV dominance has to come to an end for the good of all diseases.”
Others though disagree with England, arguing that having a prominent ailment helps bring exposure to smaller and less desirable diseases.
“It’s like Hollywood having huge big budget movies. They may or may not make money off those films, but it keeps people interested in going to the theatres and that ultimately helps movies of all sizes,” said David Helmbert of the London based RDUSC. “The big boys take in a lot of water, but they also help keep the lake filled. HIV coming to the forefront in the eighties was the best thing to happen to disease research since the black plague. The interest in finding the cure has led to a whole new generation of researchers and virologists, as well as people willing to part with their money. Without AIDS we’d run the risk of people forgetting about diseases entirely and then there would be people dying left right and centre. Either that or we’d just have boring old cancer to talk about.”
While there have been other ailments, such as mad cow or flesh eating bacteria, that have come into the public eye, none have been able to wrest public attention from HIV.
“AIDS is like the United States of diseases. The young buck who comes around and grabs all the attention but eventually its influence will dwindle,” said Scrape TV Health analyst Rebecca Phelps. “Britain and Russia would be cancer. While places like India and China, with their disease equivalents Diarrhoea and Malaria, are up and comers, the world is still dominated by the stalwarts. There may come a day when people wear Diarrhoea ribbons we aren’t there yet. There will come a day when a major celebrity will die of something other than cancer or AIDS and a whole new light will be shone on it. I have my money on some kind of brain parasite but we will see.”
To the Heart of Africa
Night and day, in as many places as he’s invited, Stephen Lewis works away at the issues surrounding HIV/AIDS in Africa. His hope? To help build momentum for change
Interview by Ann Silversides
Named one of the 100 most influential people in the world by Time magazine in 2005, Canadian diplomat Stephen Lewis has emerged as arguably the best-known non-African advocate for people living with HIV/AIDS (PHAs) in Africa. He is an eloquent and compelling public speaker whose advocacy as United Nations Secretary-General’s special envoy for HIV/AIDS in Africa galvanizes audiences. Lewis’s message gained a much wider audience when a series of his talks were broadcast on cbc Radio as the 2005 Massey Lectures and subsequently published in his best-selling book Race Against Time. The book’s dedication reads: “To the women living with AIDS in Africa. Indomitable. Resilient. Courageous. One day the world will come to its senses.” Several years ago, when Canadians began to spontaneously send him donations to address the AIDS crisis in Africa, he set up the Stephen Lewis Foundation (www.stephenlewisfoundation.org) to put the money to work supporting grassroots organizations. Donations to the foundation — none solicited — total $10 million to date. An astonishing 95 percent of that has been donated by individual Canadians.
Journalist and author Ann Silversides interviewed Stephen Lewis for CATIE in his Toronto home.
SILVERSIDES: What is your job description?
LEWIS: There was no definition — the job defined itself as I did it. It is primarily an advocacy role. It is a job of exploration of issues, reporting back, finding the themes that need advocacy (treatment, capacity, women, orphans — the obvious areas of emphasis) and doing that advocacy night and day everywhere, in as many places as I am invited. I’ve just been pounding away at the issues, hoping that it will help build the momentum for change.
I spend as much time on the envoy role as I possibly can, but if it were a full-time job, I’d be spending even more time in Africa. I try to get there roughly once a month. In the interim I do a lot of speaking in Europe, America and Canada about the issues.
When I visit a country I try to meet with the political leadership, the civil society leadership, the UN family, the diplomatic community and always — as a matter of principle — with groups of PHAs whose position I promote as strongly as possible during my visit. I ask them what they need, what questions they have, and then I take their questions to the various political leaders I meet as I travel. Before I leave, I report back to them because it is really important that they recognize that they have friends in the UN who will treat them with the kind of respect that governments frequently don’t display. I also try to spend roughly 50 percent of my time in the field, visiting projects. I then do an exit press conference in the country to lay out exactly what I have seen.
Back in New York I do a briefing with the international press at the UN. I try on an intermittent basis to see the Secretary General [Kofi Annan] and we talk about how the UN might more vigorously or effectively support the work that governments are doing.
Tell me more about your interaction with PHAs in African countries.
They pour their hearts out. One of the things they always say is that no one listens to them. They are the experts — they know more about the virus than anyone else — and no one listens to them. They are treated so often with indifference and contempt, and it is really unacceptable because they are so courageous, so strong, and they do such magnificent prevention work. They’re moving through schools, community centres, religious groups. PHAs do a tremendous job of prevention; it even extends to the commercial sex workers who wave condoms above their heads and go out into the community and talk about preventing infection. A government that doesn’t pay attention to PHAs, or that diminishes them, demeans them or disregards them, is making a terrible mistake in judgment. Boy, they are a powerful crew in every country!
Canada has made important contributions to the World Health Organization’s “3 by 5” initiative (to get 3 million PHAs in the developing world on treatment by 2005), the International AIDS Vaccine Initiative, and the Global Fund to Fight AIDS, Malaria and Tuberculosis. And you were instrumental in lobbying for the 2004 Jean Chretien Pledge to Africa Act (JCPAA), so that generic [less expensive] versions of AIDS drugs still under patent can be manufactured here for use in the developing world. How are we doing as a country?
Relatively speaking, Canada’s contribution to the fight against AIDS has been admirable, in part because the JCPAA legislation may turn out to be a real breakthrough. [Médecins Sans Frontières (MSF) has placed the first order under the JCPAA for a fixed-dose combination drug.] Canada provided the core of the money to make 3 by 5 possible and I continue to regard it as an extraordinarily inspired intervention which broke the logjam of inertia and made hope and momentum possible. I am sorry we didn’t make the 3 million, but we have set in process a treatment rollout that is irreversible. Everything had been so immobilized that it was really important that there be a visionary breakthrough of the 3 by 5 kind — so that finally the world would understand that there had to be targets.
So now everyone talks about universal access. Country after country is asked to set realistic targets — how many people to be tested and counselled, how many pregnant women to have access to drugs to prevent transmission to the child, how many to be in treatment, how many kids to be in pediatric treatment.
Do you agree with those who argue that Canada has not stood up to the United States on key issues such as patent laws and harm reduction?
We should have been standing up to the U.S. not just on patent issues but on the question of abstinence and condoms. Canada’s voice should be heard on these things, but then, to be fair, no one stands up to the U.S. on these issues or about the amount of money they give to the Global Fund or many of the serious limitations around PEPFAR [U.S. President’s Emergency Plan for AIDS Relief]. I got in tremendous trouble with the U.S. — I think for a while my job was on the line — over criticisms of the disproportionate emphasis on abstinence in situations where it makes no sense, like marriage.
You argue in your book that Canada’s contribution to fighting AIDS has been undermined because Canada has not set a timetable to reach a target of contributing .7 percent of gross domestic product to foreign aid — a target that has already been surpassed by the Nordic countries.
The inability to meet .7 has compromised our integrity on everything else, even though we have done good stuff on AIDS. We were the authors [of this goal, in 1969] and we are the only G7 country with budgetary surpluses. Everyone thinks we are just a bunch of hypocrites.
I assume .7 is important because you see the issues and needs in the developing world going far beyond AIDS.
Poverty lies at the heart of it all.
And AIDS?
I see AIDS as the centrepiece of the human dilemma in southern Africa at this moment in time. Everything is linked to everything else and poverty lies at the heart. I recognize that you can’t address the other dimensions until you address AIDS. Or, alongside everything else, AIDS must be dealt with. Orphan children have to go to school, so you deal with school fees and uniforms. You can’t do treatment if people are malnourished. They need nutritious foods. If you have opportunistic infections everywhere then sanitation and latrines are going to be important — after all, you don’t die of AIDS but from whatever disease or complication afflicts the dismantled immune system.
I was struck by what you said in your book about AIDS treatment bringing along AIDS prevention, about treatment and prevention being inseparable.
I’m not going to make any apologies for this simple truth: People are dying unnecessarily in huge numbers and one of the things a civilized society does is to keep people alive. I consider that the strongest of imperatives. I will not retreat from it. And it is an utterly false dichotomy to pit prevention against treatment, or to pit AIDS against any other disease. You are not diminishing anything by treatment. In fact, you are opening doors everywhere. Treatment gives hope. People come to get tested because they know there is the possibility of a prolonged life. With treatment can come openness and an end to stigma.
How is treatment progressing in Africa?
The numbers of people who have access are growing all the time because treatment is moving out of the urban centres into the rural hinterland, and out of hospitals into the districts. The critical problem is capacity — everywhere, absolutely everywhere. The flow of drugs is a problem, the continued sustainability of resources is a problem, and capacity is an overwhelming problem.
What keeps you from becoming jaded or burnt out?
I think the explanation is simple, and I don’t think it reflects on any particular qualities I have. It is ideological. My entire period of growing up was in a family, a democratic socialist family, where social injustice was considered to be the great evil of the world. Inequality, indignity and injustice were seen to be the objects of life’s passion — to reverse them, turn them around, eradicate them. From the age of 5 that is all I heard: Social injustice was bad, poverty shouldn’t exist, inequality shouldn’t exist, racism shouldn’t exist, and you are on this planet to fight those things.
For me, what’s happening in the pandemic is the ultimate expression of inequality and social injustice and poverty, and therefore everything that I believe comes into play. I probably have as much compassion as the next person, but it is much more ideological. The anger and rage I feel is an anger and rage at — I have to phrase it this way — at capitalism, at the way the world is organized, at the way in which the privileged and powerful care hardly at all for the uprooted and disinherited. And that is for me what this is all about. As well, I live in a feminist family. Feminism is an absolute bulwark of the convictions of this family, and the gender inequality of the pandemic is the ultimate violation of the feminist impulse for the rights of women.
What lies ahead for you?
At the moment, the assumption is that my job as special envoy will end at the end of 2006. There are a number of avenues [opening up], including a “scholar-in-residence” role at McMaster University. But whatever I do, Africa and AIDS will remain a centrepiece. I don’t intend for a minute to relinquish that. I am also working on another book. I love the UN, but I’m happy to anticipate a more unencumbered platform. I am allowed now an unusual amount of freedom to speak forthrightly, but I’d like even more. I’d like to be able to say some things that I now have to bite my tongue about, choke back, and I’ll feel a moment of significant liberation when the end comes and I can speak even more frankly.
The Senate has passed three different bills concerning stem cell research. The Senate passed the 
I have a close friend who spent many years researching the genetic structure of both HIV1 and HIV2. As the primary elections began, he looked at me in a mix of fear and self-loathing as he stated, “I never thought I would say this, but I want to vote for Al Gore. I want someone who understands science to be running the country. I mean you can pass a law telling me I can’t research on stem cells and you don’t even fucking believe in evolution? We live in an anti-science religious state, man!” I nodded in agreement with the “anti-science religious state,” but couldn’t go as far as ever thinking I would vote for Al Gore.
Back when I was 17, I worked at a gigantic national chain video store. One day while smoking a cigarette on break with one of my managers, he looked over at me and said, “I don’t understand how you can work in the service sector and still have radical politics. People are just assholes. We see it everyday. People treat us like shit because it is human nature to be greedy and mean.” 16 years later I still have my politics and I remember that conversation like it was yesterday. There is an inherently sinister notion of defeatism in this sentiment. I recognize that this Hobbesian notion of human nature is not new, but more recently these ideas of “human nature” have become understood in genetic terms.
