> ADDIS ABABA – With your indulgence, I’m going to deviate from the assigned
> topic. I shall address the Millennium Development Goals, but not in the
> way that was anticipated. There are two reasons. First, I want to speak in
> an unusually personal way, and from the heart, and in a fashion that
> leaves no room for ambiguity. Second, I consider the attack on the Global
> Fund to be the most serious assault it has endured in its ten-year
> history. I would feel utterly delinquent to let the issue slide.
>
> I am seized by frustration and impatience. Let me explain.
>
> I’m thrilled when UNICEF tells us of the possibility of the virtual
> elimination of pediatric AIDS by 2015. But I know-as knowledgeable people
> in this audience know-that it remains an unlikely prospect, but more
> important, that we lost several precious years during the last decade
> where we simply didn’t apply the knowledge we possessed to prevent
> vertical transmission. It was a terrible failure on the part of
> international agencies and governments. Worse, the mother barely factored
> into the so-called “PMTCT” equation at all. As we come to this thrilling
> moment of progress, I cannot forget the millions of infants who died
> unnecessarily and the women who were never given treatment.
>
> I’m thrilled at the creation of UN Women, and the possibility, once they
> join as a formal co-sponsor of UNAIDS, that the focus on women will be
> given a new lease on life. But I can’t dislodge from my mind the
> experience of my years in the role as Envoy, and subsequently working with
> AIDS-Free World, when it became clear that in every aspect of the pandemic
> women were rendered subordinate. Gender inequality doomed their lives.
> Sexual violence fed and feeds the virus. The entire survival of
> communities and families was placed on their shoulders. Men were the
> social determinants of women’s health, and men simply didn’t care. As we
> come to this thrilling moment of potential progress, I can’t avoid the
> spectral faces of stigma, discrimination, isolation, and pain, and they
> are the faces of women. That doesn’t mean that women aren’t the core of
> courage and strength in this pandemic; it simply means that they have to
> struggle valiantly to challenge the phalanx of male privilege, of male
> hegemony. Just a few days ago, coincident with World AIDS Day, the Harvard
> School of Public Health held a symposium called AIDS@30 to assess the past
> and plot the future. The symposium had a Global Advisory Council of
> nineteen eminent experts on the pandemic: 17 men and 2 women. It is ever
> thus. It’s the rare woman indeed who doesn’t ultimately report to a man
> in the world of HIV, or who can command, ever-so-rarely, the place and
> presence that legions of men command automatically.
>
> I’m thrilled when I hear animated talk of male circumcision. But I know
> that we didn’t need to wait for the results of the three studies in
> Uganda, Kenya, and South Africa. Nothing would have been lost if we’d
> focused immediately on making circumcision safe and available for informed
> parents to choose for their male babies; it’s a minor procedure that has
> been performed for centuries. Instead, during nearly a decade as the
> evidence piled up that circumcision was a defense against AIDS-evidence
> provided by experts in the field-we waited and waited and waited, in that
> self-justifying paralysis of excruciating scientific precision. As we come
> to this thrilling moment of progress I cannot forget the numbers of lives
> that might have been saved had we acted sooner.
>
> I’m thrilled with all the talk of “Treatment as Prevention” and how it has
> suddenly become the mantra of the international AIDS community. But back
> in 2006, I sat beside Dr. Julio Montaner, about to become President of the
> International AIDS Society, when he first expounded the proposition at a
> press briefing at the International AIDS Conference in Toronto. His
> evidence and argument were rooted in science and common sense in equal
> measure. But he had to endure scorn and derision, and we had to endure a
> five-year delay until Treatment as Prevention was definitively
> authenticated by the National Institutes of Health in Washington. Julio’s
> theory suddenly became the 96% solution five years later, and it doesn’t-I
> emphasize-it doesn’t apply only to discordant couples. As we come to this
> thrilling moment of progress, I cannot forget the numbers of lives that
> might have been prolonged if we hadn’t waited nearly five years to create
> the momentum that now propels us.
>
> I’m thrilled with the turnaround in South Africa. The dramatic roll-out of
> treatment is nothing short of miraculous. But I remember all those years
> of denialism, and not a single voice at the most senior levels of the
> United Nations-Under-Secretaries-General, the Secretary-General himself.
> Not one of them said publicly to Thabo Mbeki, “You’re killing your
> people”. Oh, to be sure, it was said in private by everyone. They took
> Thabo Mbeki aside and begged him to reverse course. He didn’t budge an
> inch. Around him, in every community in South Africa, and in communities
> throughout a continent heavily influenced by South Africa, were the
> killing fields of AIDS. As we come to this thrilling moment of progress, I
> can’t forget the millions who died on Thabo Mbeki’s watch, while those who
> should have confronted him before the eyes of the world stood mute.
>
> I’m thrilled by the embrace of the slogan “Know Your Epidemic; Know Your
> Response” and the current concentration on high-risk groups. But I note
> that there were many voices, over the years, not all of them eccentric,
> calling attention to concurrent sexual partners and discordant couples, to
> MSM and sex work and sexual violence, and particularly injecting drug use,
> and they were contemptuously dismissed. I cannot but remember that
> magnificent gay activist from the Caribbean, Robert Carr, who died such an
> untimely death . back at the pre-conference on MSM in advance of Vienna
> last year, Robert made one of those speeches that leaves you gasping. When
> you hear what the experts say, said the normally tactful Robert, it’s
> bullshit – and he repeated bullshit so many times in the course of thirty
> minutes that the crass word became a cry of mobilizing dignity. As we come
> to this thrilling moment of progress, I can’t forget the casual delays in
> responding to vulnerable groups. Experts fiddled while human rights
> burned.
>
> So if you sense a certain impatience in me, you’re right. We don’t have
> another day to lose. Peter Piot did the arithmetic yesterday . 1,350,000
> put on treatment in 2010; 2,700,000 new infections, exactly double the
> number in treatment in the same year. It works out to 7,397 new infections
> every day. And it’s 2011, for God’s sake. It’s appalling that such numbers
> continue to haunt us; it’s heart-breaking beyond endurance to contemplate
> further exponential agony. We cannot delay another minute in putting the
> ‘prevention combination’ to work.
>
> And I think, judging from the mood in the corridors, that’s what seizes
> this conference. But right at the moment when we know, irrefutably, that
> we can defeat this pandemic, we’re sucker-punched at the Global Fund.
>
> What’s a sucker punch? It’s when a boxer in the ring gets a punch below
> the belt that he doesn’t see coming. No one expected a complete
> cancellation of Round Eleven, with new money unavailable for
> implementation until 2014.
>
> It’s just the latest blow in a long list of betrayals on the part of the
> donor countries, in this instance the Europeans in particular. I’ve heard
> from several people that the politics of the Global Fund meeting in Accra
> two weeks ago, when the decision was made, were not just complicated, but
> amounted to miserable internecine warfare. Certain governments on the
> Board of the Global Fund simply discredited themselves. They give a soiled
> name to the principle of international solidarity. The Chair of the Board,
> in a remarkably convoluted effort, tried to explain things in a press
> release. He would have done far better to remain silent.
>
> The decision on the part of the donor countries is unforgiveable. In a
> speech a few days ago, I addressed the Global Fund predicament by talking
> of the moral implications of a decision that you know will result in death
> . death on the African continent.
>
> I asked: “Do they regard Africa as a territorial piece of geographic
> obsolescence? Do they regard Africans themselves as casually expendable?
> Is it because the women and children of Africa are not comparable in the
> eyes of western governments to the women and children of Europe and North
> America? Is it because Africans are black and unacknowledged racism is at
> play? Is it because a fighter jet is worth so much more than human lives?
> Is it because defense budgets are more worthy of protection in an economic
> downturn than millions of human beings?”
>
> These are not phrased as rhetorical questions. I mean each and every one
> of them.
>
> Spare me, I beg of all the speakers . spare me the economic crisis.
> Everyone knows that when it comes to financing wars, or bailing out the
> banks, or bailing out Greece, or reinstituting corporate bonuses, or even
> responding to natural disasters that threaten economies, there’s always
> enough money. We’re drowning in crocodile tears. It’s not a matter of the
> financial crisis; it’s a matter of human priorities. We have a right to
> ask the G8: what do you sanctify as governments: profits and greed or
> global public health?
>
> That’s especially true in the case of the United States. I was, like
> everyone else, delighted by President Obama’s endorsement of the
> proposition that PEPFAR could treat a total of six million people rather
> than four million people by 2013 with the same money. And I congratulate
> Ambassador Goosby for seeing that through. It’s wonderful. No one would
> take issue. How could you? There’s no additional money involved: it’s just
> greater efficiency and more targeted spending.
>
> And then the President went on to affirm his support for the money that’s
> supposed to be destined for the Global Fund . $4 billion over three years,
> 2011-2013; $1.3 billion a year.
>
> Now let me take you back a step. In 2010, when the three-year pledge for
> the Global Fund was being discussed, the activists in the United States
> were asking for $6 billion over three years, believing that this was a
> fair share for the United States and an inducement to all the other
> donors. They feared that the President would stay at $3 billion over the
> next three years . roughly the previous allocation for the Global Fund.
> When he endorsed $4 billion, it was considered a partial victory.
>
> In my respectful submission, it’s time for the United States to take a
> hard look at $6 billion. Many American speeches glow with the words that
> the US is the largest donor to the Fund. Well of course they’re the
> largest donor; they’re the most dominant and wealthy economy in the world.
> I really think that apart from calling on the European governments to
> reverse their decision, President Obama should tell Congress he wants a
> full $6 billion.
>
> I don’t expect that anyone ever listens to me. But I do point out what was
> emphasized at the opening of the conference: money to do battle against
> HIV/AIDS is the singular non-partisan issue in Congress. Even those
> irascible philistines who want to cut foreign aid, or global health, have
> shown in the past that they’re prepared to shore up funding for HIV/AIDS.
> It seems to me that President Obama should put his moral authority on the
> line, and ask Congress to raise the ceiling from $4 billion to $6 billion
> for the Global Fund.
>
> It’s not a matter of comparison with other countries; it’s a matter of
> doing what’s right. And that means doing your fair share regardless of
> whether others are doing theirs. There are many commentators who agree
> that the salvation of George Bush’s presidency was PEPFAR. President Obama
> doesn’t need salvation. But I can’t imagine a greater act of
> statespersonship than to say to the world: I, Barack Obama, cannot stand
> the thought of another unnecessary death; if the United States of America
> has to bail out the Global Fund, we will.
>
> Is the extra $2 billion dollars outrageous? The economist Jeffrey Sachs
> has answered that question. He points out that the United States defense
> budget amounts to $1.9 billion a day. In other words, we’re asking that
> HIV/AIDS receive an additional amount, over three years, that equals
> American military spending in one day.
>
> It seems to me that that’s an argument that African political leaders can
> effectively pursue amongst the many arguments they should employ in
> dealing with the donor community. I agree with Michel Sidibe-who’s given
> significant and visionary leadership to this struggle-that there must be a
> high-level crisis meeting, and that Prime Minister Meles should convene
> it.
>
> We’ve waited for this moment for a long time. This is an opportunity for
> the African political leadership to show its muscle, and to demand that
> the Global Fund be restored to its intended level. Remember, at the last
> formal replenishment in 2010, the funding came in at a dismal $11.7
> billion, far short of the $20 billion that the Global Fund really needed
> in order to scale up to meet universal access. Now we’re being told that
> even the $11.7 billion is out of reach. It’s unconscionable, indefensible,
> outrageous. It’s murder, that’s what it is: murder. And the donor
> countries expect to get away with it because there’s a culture of fiscal
> impunity.
>
> As I wind my way to a conclusion, let me relate an anecdote that I think
> is relevant.
>
> When I left my diplomatic post at the United Nations in 1988, I took on a
> role as the Secretary-General’s Advisor on Africa. (I admit that seems
> odd, but there is an explanation that more or less justifies the
> appointment.) There was an Inter-Agency Task Force established, and there
> was a kind of executive committee of four. The Chair was the noted African
> economist, Professor Adebayo Adedeji of Nigeria and at the time Executive
> Secretary of the Economic Commission for Africa; the Vice-Chair was the
> remarkable, brilliant Richard Jolly, Deputy-Executive Director of UNICEF;
> the Rapporteur was the accomplished economist Sadig Rasheed, also with the
> ECA, and I was the fourth, a sort of honorary post. (Note that then, as
> now, men were tapped to lead the way.)
>
> We met, often in Addis – where the ECA was and still is located – with
> many of our colleague agencies working in Africa. The World Bank was
> almost always in attendance, and intermittently, the International
> Monetary Fund.
>
> It was the height of “structural adjustment” programs. Every meeting was a
> battleground, filled with heated imprecations, accusations, and malice.
> Our little executive cabal of four detested the international financial
> institutions, and they detested us.
>
> In the midst of endless angry discussions of conditionality, we looked
> carefully at the financial data, and suddenly realized a staggering truth:
> when you took into account the interest payments and some capital payments
> as well, and ran the statistics carefully, it became clear that Africa was
> paying out far more than it was taking in . hundreds of millions more. The
> continent was financing the World Bank; the World Bank wasn’t financing
> the continent.
>
> And it continues to this day. Again, I remind you of Peter Piot’s
> reference yesterday. I have a close friend who writes columns for the
> newspaper The Globe and Mail in Canada. Commenting on the study that Peter
> Piot referenced, the title of his column was, “Africa: The World’s Most
> Generous Foreign Aid Donor”. It confirms the fact that a study of nine
> African countries, Ethiopia, Kenya, Malawi, Nigeria, South Africa, Uganda,
> Tanzania, and Zimbabwe showed that they had exported doctors to Canada,
> the United States, the UK, and Australia, costing Africa between $2
> billion and $13 billion in education and training, and saving the four
> western countries more than $4.5 billion in education and training. The
> nurses’ financial ratios would be even higher.
>
> This is an AIDS conference. We talk endlessly about capacity building.
> Africa desperately needs its doctors and nurses. Instead, in the vital
> field of health professionals, Africa loses billions in exporting its
> human resources.
>
> I say all this to challenge the artificial debate on dependency. From
> slavery to today’s extractive industries of minerals and oil, Africa is
> financing the world. The modern world’s economy was built on Africa’s
> human and natural resources, and it depends on them to this day. The money
> from the Global Fund and PEPFAR amount to partial reparations. Western
> donors are not engaged in some kind of financial philanthropy: we owe
> Africa what we give to Africa. And a hell of a lot more to boot.
>
> That’s the debate that Prime Minister Meles should induce. The donor
> countries to the Global Fund, having ransacked the continent for six
> hundred years, have no right to withdraw. They must be confronted. And all
> of you, who make up civil society in so many countries, must press your
> Presidents and Prime Ministers into action.
>
> Let me end by coming full circle to the Millennium Development Goals.
> Africa will never reach the MDGs if AIDS is not vanquished. AIDS adds to
> the desolate state of poverty. Obviously, it affects both maternal and
> child health. It continues to leave children parentless (though the
> millions of orphans whose plight seemed a priority at past AIDS
> gatherings, increasingly, mysteriously, disappear from view). Gender
> equality is a mockery in the face of AIDS. And the so-called partnership
> between the haves and the have-nots is rendered laughable. Even
> sustainable development is influenced, because climate change feasts on
> weakened populations.
>
> If the MDGs are as important as everyone says, then AIDS must be subdued.
>
> As a last parting thought, in respect of the Global Fund, I beg you to
> mobilize as a truly civil society and stand up to the reckless
> nation-states who dare to decide whether Africans will live or die.
>
> Online at:
> http://safaids.net/content/remarks-stephen-lewis-co-director-aids-free-world-delivered-plenary-session-2011-icasa
>
>