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January 27, 2006

UN Special Envoy Urges More Action on AIDS in Africa

Stephen Lewis, the United Nations Special Envoy for HIV/AIDS Africa, paints a devastating picture of the AIDS pandemic that has swept across the African continent.

Stephen Lewis

Stephen Lewis, UN Special
Envoy for HIV/AIDS in Africa
 Photo Credit: Nicole Toutounii, UNICEF

In a Jan. 26 lecture at the Johns Hopkins Bloomberg School of Public Health, Lewis leveled sharp criticisms against Western governments and corporations for failing to act as the crisis unfolded over the past decade, and invoked images of dying mothers and orphaned children to make his point.

“It’s an apocalyptic moment in human history,” said Lewis, Canada’s former ambassador to the UN, “and a moment that should not only extract compassion, but a degree of rage, because it need not happen.”

Since his appointment to the special envoy post in June  2001, Lewis has traveled throughout Africa, meeting with government officials and talking to people infected with  HIV.

“I was completely unprepared for what I would encounter,” said Lewis, whose new book, Race Against Time, addresses the AIDS crisis in Africa. “There’s a pervasive atmosphere of death, a sense that death is everywhere,” he said. “Sometimes you feel as if you’re walking through a cemetery instead of a country.”

Lewis recalled a recent experience in Zambia that in his mind illustrates the enormity of the problems that Africa faces. A government health official took him to visit a group of women with AIDS, who grew cabbages that they sold at market. Standing in the cabbage patch, Lewis talked with the women. “I asked them, ‘What do you do with the profits? And they looked at me strangely as though it was an odd question. Then the leader of the women said, ‘Well, we buy coffins, Mr. Lewis, we never have enough coffins.’ ”

The plight of women in Africa is particularly heartbreaking, Lewis said. They are subjected to marital rape and men who refuse to use condoms, even when they have multiple sex partners. In many cases women have no property rights, and the stigma of having HIV/AIDS prevents them from seeking treatment.

“The women are dying in hugely disproportionate numbers,” Lewis said. “Marriage becomes one of the most hazardous environments for a woman to be in. It’s necessary to assemble the apparatus of women’s empowerment now.”

Across Africa, Lewis said, people who became infected with HIV in the late eighties and early nineties, now have full blown AIDS, and are dying at a rapid rate. These are middle-aged people?teachers, doctors, farmers, civil servants?succumbing to the epidemic. Many agricultural workers have also died, putting Africa’s food supply in jeopardy.

“You can visit villages in Africa where there is the Kafkaesque experience of not seeing people in the middle years of life,” he said.

Lewis delivered scathing critiques of Western world leaders, saying they have not committed nearly enough resources to make a dent in the African AIDS pandemic. He cited the G-8 meeting last July in which the leaders of the largest industrialized countries made extravagant promises of funding to address AIDS in Africa.

Yet, eight weeks later, at a meeting of the Global Fund to Fight AIDS, Tuberculosis and Malaria, Western leaders failed to fully fund a $7.1 billion request for aid in 2006.

“There’s something profoundly wrong in the way our international institutions are responding,” Lewis said. “Where is the world’s moral anchor?”

He also lamented the brain drain of professionals from African countries, many of whom go to school in the West and choose to remain there. In Malawi, a country of 12 million people, there are 94 doctors and 2 pediatricians. 

Despite the devastation of the AIDS pandemic in Africa, Lewis said there are glimmers of hope. The Clinton Foundation negotiated with India drug manufacturers to provide fixed doses of AIDS drugs to Africa. Researchers are working to develop a microbicide against HIV. And there is an increasing emphasis on HIV testing in Africa.

But Lewis’ main focus is opening people’s eyes to the spread of AIDS across Africa, and the destruction in its wake.

“You’re in the most noble series of disciplines of them all, and you have within your power the opportunity to rescue this world, and few are given that opportunity.”

“Some things are in place, but we’re not taking it to scale,” he said. “It’s criminally negligent that the international community simply will not provide the resources it promises.”

Lewis called on the audience of public health students to become voices and advocates for Africans suffering from AIDS. “You’re in the most noble series of disciplines of them all,” he said. And you have within your power the opportunity to rescue this world, and few are given that opportunity.” —Jackie Powder

Stephen Lewis’ lecture was sponsored by the JHSPH Student Assembly.