Transcript: Stephen Lewis on Global Health | Jun 26, 2004

Stephen Lewis walks up to the podium in a packed university auditorium.

[Cheers]
[Applause]

Stephen is in his late fifties, clean-shaven, with wavy gray hair. He’s wearing glasses, a white shirt, and a red tie.

He says IT'S BEEN A
TUMULTUOUS COUPLE OF WEEKS IN
CANADA AROUND AN ISSUE WHICH I
HAVE FELT ATTACHED TO FOR SOME
TIME AND WHICH I KNOW HAS
ENGAGED THE ATTENTION OF
INTEREST -- ATTENTION AND
INTEREST OF ALL OF YOU WHO ARE
INVOLVED IN HEALTH AND RELATED
MATTERS.
AND IN A SENSE, THIS LECTURE
COMES AS A MOMENT OF PROPITIOUS
TIMING, ALLOWING ME TO RESPOND
AND REFLECT ON SOME OF THE
THINGS WHICH HAVE OCCURRED
WITHIN CANADA.
IT SEEMS TO ME, AS I'VE WATCHED
THE EVENTS OVER THE LAST COUPLE
OF WEEKS, THERE ARE THREE AREAS
THAT ARE WORTHY OF CONCENTRATION
AND ILLUMINATION AND THEY ALL
RAISE INTERESTING QUESTIONS,
HAVING BEEN INITIATED BY THE
GOVERNMENT OF CANADA.

A caption appears on screen. It reads "Stephen Lewis. U.N. Special Envoy for HIV-AIDS. Global health. University of Toronto. May 14, 2004."

Stephen says THE FIRST IS
BILL C-9, AS IT'S CALLED.
THE BILL WHICH PERMITS THE
MANUFACTURE AND EXPORT OF
GENERIC DRUGS, PROBABLY DRIVEN
BY THE NEED TO EXPORT GENERIC
ANTI-VIRAL DRUGS FOR THE
TREATMENT OF FULL-BLOWN AIDS.
A BILL WHICH
WENT THROUGH THE HOUSE OF
COMMONS LAST WEEK AND ACTUALLY
WENT THROUGH THE SENATE JUST
YESTERDAY, SO IT IS, AS IT WERE,
IN PLACE.
AND IT IS A BILL WHICH TAKES
ADVANTAGE AND CANADA THEN
BECOMES THE ONLY DONOR COUNTRY
IN THE WORLD THUS FAR TO TAKE
ADVANTAGE OF A CONSENSUS
AGREEMENT WHICH WAS REACHED AT
THE WORLD TRADE ORGANISATION AT
THE END OF AUGUST LAST YEAR,
WHICH WOULD ALLOW FOR COUNTRIES
TO PRODUCE AND EXPORT GENERIC
ANTI-RETROVIRAL DRUGS AND
THEREFORE CONTINUE TO MAKE A
TREMENDOUS IMPACT ON THE
TREATMENT PROCESSES IN COUNTRIES
THAT ARE REELING FROM THE FORCE
OF THE PANDEMIC.
AND IF THE GENERIC COMPANIES IN
CANADA, AND THIS IS A QUESTION,
IF THE GENERIC COMPANIES IN
CANADA CHOOSE TO TAKE ADVANTAGE
OF THE ESSENTIAL PRINCIPLE OF
THE LEGISLATION, I'M NOT
PRETENDING THAT IT'S PERFECT
LEGISLATION, IT HAS SOME
QUESTION MARKS AND SOME FLAWS
WHICH HAVE BEEN SUGGESTED AND
EXAMINED BY EXCELLENT, NON-
GOVERNMENTAL ORGANISATIONS,
INCLUDING THE, THE LEGAL
ALLIANCE ON H.I.V. AND AIDS IN
CANADA AND DOCTORS WITHOUT
BORDERS IN CANADA, BUT I THINK
IN PRINCIPLE, IT'S GOOD
LEGISLATION, AND IF IT'S TAKEN
ADVANTAGE OF BY THE GENERIC DRUG
COMPANIES, THEN CANADA WILL BE
ABLE TO PROVIDE, DOWN THE ROAD,
NOT IMMEDIATELY, PROBABLY NOT
FOR A YEAR OR TWO, BUT DOWN THE
ROAD, A TREMENDOUS RANGE OF
MEDICAL INTERVENTIONS WHICH WILL
KEEP MILLIONS OF PEOPLE ALIVE.
NOW THERE IS INHERENT, IN THIS
ISSUE, A FASCINATING QUESTION
AND THAT IS THE PRODUCTION OF
WHAT WE CALL FIXED DOSE
COMBINATIONS.
TWO OR THREE DRUGS, USUALLY
THREE DRUGS, IN ONE PILL, TAKEN
ONCE IN THE MORNING AND ONCE IN
THE EVENING, SIMPLY TWICE A DAY.
THESE FIXED DOSE COMBINATIONS
ARE IN USE AS A RESULT OF THE
GENERIC MANUFACTURE IN INDIA BY
TWO MAJOR COMPANIES, CIPLA AND
RANBAXY, THEY ARE IN USE ALL
OVER THE DEVELOPING WORLD IN
SMALL MODELS.
MEDICINS SANS FRONTIERES,
DOCTORS WITHOUT BORDERS, HAS
ROUGHLY 13,000 PEOPLE IN
TREATMENT IN 20 COUNTRIES USING
FIXED DOSE COMBINATIONS.
AND THE FIXED DOSE COMBINATIONS
HAVE BEEN SHOWN TO BE A REGIMEN
WHICH IS MOST EASILY ADHERED TO,
WHICH PROVIDES VERY LITTLE
RESISTANCE, WHERE THE SIDE
EFFECTS SEEM MANAGEABLE, WHERE
THE COSTS ARE INCREDIBLY LOW,
THE CLINTON FOUNDATION HAS
NEGOTIATED WITH THE INDIAN
GENERIC DRUG COMPANIES A PRICE
OF 139 dollars PER PERSON PER YEAR,
WHICH IS, RELATIVELY SPEAKING,
QUITE PHENOMENAL, IF WE CAN
GENERATE THE KIND OF
INTERNATIONAL RESOURCES TO MAKE
IT POSSIBLE, SO THAT IS A
TREMENDOUSLY IMPORTANT REALITY
AND IT WOULD BE POSSIBLE WITHIN
CANADA, BECAUSE CANADA HAS
APPROVED THE INGREDIENTS FOR
FIXED DOSE COMBINATIONS,
ALTHOUGH THE COMBINATION ITSELF
HAS NOT YET BEEN PRODUCED
GENERICALLY IN CANADA.
IF, IF CANADA DECIDES TO DO IT,
WE WILL MAKE A SIGNIFICANT
CONTRIBUTION.
ON THE OTHER HAND, THE PRESIDENT
OF THE UNITED STATES HAS
LAUNCHED A PARTICULAR PROGRAM
WHICH SEEMS DETERMINATELY TIED
TO THE PROVISION OF BRAND NAME
PHARMACEUTICALS FOR THE PURPOSE
OF TREATMENT.
THESE BRAND NAME PHARMACEUTICALS
DO NOT HAVE A FIXED DOSE
COMBINATION.
THEY ARE PROVIDED ON THE BASIS
OF SIX PILLS A DAY, NOT TWO
PILLS A DAY.
SIX, AS A MATTER OF FACT,
MINIMUM AND THEY ARE PROVIDED AT
A MINIMUM COST, SO FAR AS I'M
AWARE, OF 562 dollars PER PERSON PER
YEAR, COMPARED TO 139 dollars PER
PERSON PER YEAR, SO YOU CAN SEE
HOW MUCH MORE WE CAN DO IF WE
FOCUS ON THE GENERIC MEDICATION.
BUT RATHER MORE IMPORTANT THAN
THAT AND I MUST SAY IT CAUSES
ME, IF I MAY LEAN ON A WORD
WHICH JEAN EVANS USED, IT CAUSES
ME INCREASING IMPATIENCE, IS THE
CLEAR DETERMINATION ON THE PART
OF THE PROGRAM IN THE UNITED
STATES, IN CONJUNCTION WITH THE
BRAND NAME PHARMACEUTICAL
COMPANIES, TO ATTEMPT TO
UNDERMINE THE SCIENTIFIC
INTEGRITY OF THE WORLD HEALTH
ORGANISATION.
'CAUSE THE WORLD HEALTH
ORGANISATION HAS PRE-AUTHORISED
AND PRE-QUALIFIED, WITH AN
ABSOLUTELY SCRUPULOUS SCIENTIFIC
PROCESS, THESE FIXED DOSE
COMBINATIONS.
AND THERE IS A NOT SO SUBTLE
EFFORT TO THROW INTO QUESTION
WHETHER OR NOT THESE FIXED DOSE
COMBINATIONS REALLY DO THE JOB
WHEN THEY ARE PRE-QUALIFIED BY
THE WORLD HEALTH ORGANISATION
AND IN USE IN EXCELLENT WAYS IN
A NUMBER OF MODEL SETTINGS ALL
AROUND THE WORLD.
SO THERE IS THERE A REAL
QUESTION OF SCIENCE AND THERE IS
THERE A REAL QUESTION OF
ADVOCACY AND I HOPE THAT THE
GOVERNMENT OF CANADA, AS IT HAS
PROVIDED THIS VERY SPECIAL
LEGISLATION, ALSO DEALS WITH THE
ISSUES INHERENT IN THE
LEGISLATION.
NUMBER TWO.
EARLIER THIS WEEK, THE PRIME
MINISTER OF CANADA ANNOUNCED
THAT CANADA WOULD CONTRIBUTE
100 MILLION dollars TO THE WORLD HEALTH
ORGANISATION FOR ITS SO-CALLED 3
BY 5 PROGRAM.
AND YOU WILL KNOW THAT THE 3 BY
5 STANDS FOR THE INTENTION TO
PUT THREE MILLION PEOPLE INTO
TREATMENT BY THE END OF THE YEAR
2005.
IT WAS ANNOUNCED ON DECEMBER 1st
LAST, ON WORLD AIDS DAY, IN
2003, IT HAS BEEN RE-ANNOUNCED
ON A, ON A NUMBER OF OCCASIONS,
IT IS PROBABLY THE MOST DRAMATIC
AND VISIONARY INTERVENTION WHICH
THE UNITED NATIONS SYSTEM HAS
MADE IN THE LIFE OF THE
PANDEMIC.
AND I HAVE TO TELL YOU THAT THE
UNITED NATIONS SYSTEM, LIKE
EVERYONE ELSE, HAS RESPONDED
MORE SLOWLY THAN ANY OF US WOULD
HAVE WISHED.
BUT IN THIS
CASE, IT SHOWS AN EXTRAORDINARY
VISION AND IN THIS CASE, IT
SHOWS A DETERMINATION WHICH
REFLECTS A CHANGE IN LEADERSHIP
IN THE WORLD HEALTH ORGANISATION
AND WHICH HOLDS OUT A BEACON OF
HOPE IN THIS FIGHT AGAINST THE PANDEMIC.
BECAUSE OF COURSE, IF YOU CAN PUT VERY
SIGNIFICANT NUMBERS OF PEOPLE IN
TREATMENT, SO THAT THEY KNOW IF
THEY TEST AND THEY FIND
THEMSELVES TO BE H.I.V.-
POSITIVE, IT ISN'T A DEATH
WARRANT, BUT THERE IS HOPE TO
PROLONG AND SUSTAIN LIFE, THEN
IT CAN TRANSFORM THE WHOLE SENSE
OF OPTIMISM AND TESTING AND
PREVENTION AND INTERVENTION
THROUGHOUT THE ENTIRE DEVELOPING
WORLD.
IT IS A PARTICULAR BREAKTHROUGH.
NOW THE GOVERNMENT OF CANADA,
WITH ITS 100 MILLION dollars, HAS
EFFECTIVELY PROVIDED ROUGHLY 50 percent
OF WHAT THE WORLD HEALTH
ORGANISATION NOW REQUIRES TO PUT
IN PLACE THE APPARATUS FOR THE
THREE MILLION PEOPLE IN
TREATMENT BY THE YEAR 2005.
AND THIS APPARATUS WILL REQUIRE
THE TRAINING OF 100,000 DOCTORS,
NURSES, PHARMACISTS, COMMUNITY
HEALTH WORKERS, COUNSELLORS, IT
WILL OPEN UP THE SUPPLY LINES
FOR THE CONSTANT FLOW OF DRUGS,
IT WILL IMPROVE THE
INFRASTRUCTURE, WHERE COUNTRIES
HAVE FREIGHT INFRASTRUCTURES, AS
SO MANY OF THEM DO, IT WILL TRY
TO DEVELOP HUMAN CAPACITY,
BECAUSE HUMAN CAPACITY HAS BEEN
DECIMATED BY THE PANDEMIC.
THE WORLD HEALTH ORGANISATION
WILL NOT ITSELF PROVIDE THE
TREATMENT, BUT IT WILL ATTEMPT
TO CO-ORDINATE ALL THE MULTI-
VARIED INTERVENTIONS WHICH
EXIST, FROM THE, FROM THE GATES
FOUNDATION TO THE CLINTON
FOUNDATION TO THE GLOBAL FUND ON
AIDS, TUBERCULOSIS AND MALARIA,
THE VARIOUS BILATERAL
INTERVENTIONS, THE WORLD BANK,
THESE MAGNIFICENT GROUPS LIKE
DOCTORS WITHOUT BORDERS WHO HAVE
MOVED INTO COUNTRIES AND SHOWN
HOW, IN RESOURCE CONSTRAINED
SETTINGS, AS WE CALL IT, YOU CAN
ACTUALLY DO EXCELLENT TREATMENT
TO WHICH PEOPLE ADHERE AND FROM
WHICH THEY BENEFIT HUGELY.
BUT REMEMBER, THERE ARE SIX
MILLION PEOPLE WHO REQUIRE
TREATMENT AS WE'RE SITTING HERE,
AROUND THE WORLD.
THAT MEANS TO SAY THAT THEIR CD4
COUNTS ARE BELOW 200 NOW.
4,100,000 OF THEM ARE IN AFRICA.
AFRICA IS PRESENTLY TREATING
BETWEEN 100 AND 150,000 OF THOSE
OVER FOUR MILLION.
WE'RE IN A TREMENDOUS RACE
AGAINST TIME.
AND EVEN IF WE REACH THE THREE
MILLION FIGURE BY THE END OF
2005, WE WILL HAVE LOST AN
EXTRAORDINARY NUMBER OF LIVES
ALONG THE WAY.
THAT'S WHY WHAT THE WORLD HEALTH
ORGANISATION IS DOING IS SO
EXEMPLARY.
THEY'RE FINALLY MOBILISING THE
WORLD, WHAT THEY NEEDED WAS THE
DOLLARS TO BREAK THROUGH.
WHAT THEY NEEDED WAS THE MONEY
TO LEVERAGE THE ADDITIONAL
RESOURCES TO LET THEM PUT
EVERYTHING IN PLACE.
AND IT IS TO THE EVERLASTING
CREDIT OF THE GOVERNMENT OF
CANADA THAT THEY HAVE MADE THIS
CONTRIBUTION.
I WILL SHOWER PLAUDITS UPON THEM
FOREVER.
I WILL NOT VOTE FOR THEM, BUT I
WILL --

[Laughter]
[Applause]

Stephen continues I WILL, I WILL
PAY TRIBUTE TO THEM WITHOUT ANY
CHURLISH RESERVOIR WHATSOEVER.

[Laughter]

Stephen continues NUMBER THREE,
IN THE PRESENCE OF HIS APPARENT
CHARISMATIC CULTURAL IDOL, PRIME
MINISTER MARTIN AND BONO
ANNOUNCED A, ANNOUNCED A 70
MILLION dollar CONTRIBUTION, DOUBLING
CANADA'S ANNUAL CONTRIBUTION TO
THE GLOBAL FUND ON AIDS,
TUBERCULOSIS AND MALARIA.
THIS WAS A FUND WHICH GREW OUT
OF A TREMENDOUS SENSE OF
IMPATIENCE AND ANXIETY
EVERYWHERE.
AS WE MOVED INTO THE 21st
CENTURY AND IT WAS CLEAR THAT
THE WESTERN WORLD WAS STILL
LOCKED IN THIS KIND OF CRIMINAL
NEGLIGENCE, THIS PSYCHOLOGY OF
PASSIVITY, INDIFFERENCE AND
BEGRUDGING RESPONSE, WHERE WE
COULDN'T GET FROM THEM, FROM THE
DONOR WORLD, THE KINDS OF
CONTRIBUTIONS WHICH WOULD HAVE
KEPT MILLIONS OF PEOPLE ALIVE.
AND SO IN APRIL OF 2001, KOFI
ANNAN, THE SECRETARY GENERAL OF
THE UNITED NATIONS, WENT TO A
CONFERENCE IN ABUJA IN NIGERIA
AND SUGGESTED THE CREATION OF A
GLOBAL FUND, HE HOPED TO RAISE
SOMETHING IN THE VICINITY OF
SEVEN TO TEN BILLION DOLLARS A
YEAR OVERALL, MUCH OF WHICH
WOULD FLOW THROUGH THE FUND AND
YOU CAN IMAGINE THE
DISAPPOINTMENT EVERYWHERE THAT
THE GLOBAL FUND RAISED ONLY 2.1
BILLION dollars IN THE FIRST 2 and a half YEARS.
AND INDEED, FOR NEXT YEAR, FOR
2005, THE FUND IS THREE BILLION,
600 MILLION DOLLARS SHORT OF
WHERE IT KNOWS IT MUST BE AT
MINIMUM.
NOW THE 50 MILLION AMERICAN dollars
WHICH CANADA HAS NOW CONTRIBUTED
NEXT YEAR IS THEREFORE PRETTY
PALTRY IN TERMS OF WHAT IS
REQUIRED OVERALL AND EVERY
COUNTRY HAS FAILED TO PROVIDE AN
AMOUNT OF MONEY WHICH WOULD
REFLECT A FORMULA INDICATIVE OF
THE GROSS NATIONAL PRODUCT OF
THAT COUNTRY RELATIVE TO THE
WORLD ECONOMY.
NOBODY IS CONTRIBUTING WHAT IS
REQUIRED, NO ONE, NOW, EVEN
TODAY.
BUT THE FACT THAT CANADA MADE
THE CONTRIBUTION, IN ADDITION TO
WHAT IT GAVE TO THE WORLD HEALTH
ORGANISATION, HAS PROVIDED A
TREMENDOUS FILLIP OF MOMENTUM TO
THE INTERNATIONAL COMMUNITY.
I GOT AN e-mail THIS MORNING FROM
RICHARD BEECHAM, WHO IS THE
EXECUTIVE DIRECTOR OF THE GLOBAL
FUND, AN e-mail WHICH CONVEYED
HIS OWN EXCITEMENT AT THE SENSE
THAT THERE WAS REAL MOVEMENT NOW
AND THAT GENEVA WAS FEELING VERY
GOOD ABOUT IT, THIS WEEKEND
THERE IS THE WORLD HEALTH
ASSEMBLY IN GENEVA, WHICH BRINGS
TOGETHER ALL OF THE HEALTH
MINISTERS OF THE WORLD.
AND THE SENSE OF MOVEMENT WHICH
CANADA HAS NOW PROVIDED WILL
UNDOUBTEDLY ANIMATE THEM ALL.
BUT AGAIN, THERE IS THIS CAVEAT.
WE RAISED, IN 2003, A LITTLE
OVER FOUR BILLION DOLLARS FOR
AIDS INTERNATIONAL.
WE WILL REQUIRE BY 2005 SLIGHTLY
MORE THAN TEN BILLION.
WE WILL REQUIRE BY 2007 15
BILLION.
THESE ARE THE CALCULATIONS DONE
BY UNAIDS, THE BODY WHICH CO-
ORDINATES ALL OF THE ACTIVITIES
OF THE VARIOUS UNITED NATIONS
AGENCIES.
WE ARE NOWHERE NEAR WHAT IS
REQUIRED.
THERE IS A SENSE OF RESOURCES BEGINNING TO
MOVE, BUT WHEN YOU THINK OF IT
DOWN THE ROAD, THE MILLIONS UPON
MILLIONS OF PEOPLE WHO WILL
REQUIRE TREATMENT AND THE NEED
TO CONTINUE TO EMPHASISE
PREVENTION AND CARE AND SUPPORT,
ALL OF THESE FACTORS INTEGRATED
INTO A HOLISTIC RESPONSE TO THE
HUMAN CONDITION, THE BILLIONS
THAT ARE NECESSARY ARE, AT THE
MOMENT, NOWHERE IN SIGHT.
AND LEST YOU THINK ME
CURMUDGEONLY IN MAKING THAT
POINT, I REMIND YOU THAT BY THE
END OF 2005, THIS WORLD WILL
HAVE COMMITTED AND PROBABLY
SPENT 225 BILLION dollars ON THE WARS
IN AFGHANISTAN AND IRAQ AND THE
RECONSTRUCTION OF THOSE
COUNTRIES AND WE CANNOT FIND,
RELATIVELY SPEAKING, PENNIES TO
RESPOND TO THE HUMAN
PREDICAMENT.
WE CANNOT FIND PENNIES TO FIND
MILLIONS OF PEOPLE ALIVE.
AND IT IS A
KIND OF MORAL DEFAULT AT THE
BEGINNING OF THE 21st CENTURY,
WHICH MAKES ONE WONDER WHAT HAS
HAPPENED TO THE MORAL ANCHOR OF
THE INTERNATIONAL COMMUNITY.
SO THOSE ARE THREE FACTORS, THE
DRUG BILL, W.H.O., THE GLOBAL
FUND, TO WHICH CANADA HAS GIVEN
CONSIDERABLE ADHERENCE, THERE IS
A FOURTH.
WE PROVIDED IN THE DAYS OF THE
PREVIOUS REGIME, THE PREVIOUS
GOVERNMENT, A SIGNIFICANT
CONTRIBUTION OF ROUGHLY 50
MILLION dollars OVER FIVE YEARS, IF
MEMORY SERVES ME, TO THE
INTERNATIONAL AIDS VACCINE
INITIATIVE, IAVI, AS IT'S
CALLED, WHICH IS THE ONE GROUP
AMONGST MANY WHICH IS LEADING,
IT HAS A TREMENDOUSLY
CHARISMATIC AND ARTICULATE VOICE
IN A FELLOW NAMED SETH BERKELEY
WHO WORKS OUT OF NEW YORK, IT'S,
IT'S LEADING, CERTAINLY IN ITS
ADVOCACY AND ALSO IN ITS
ORGANISATION OF THE SCIENCE, THE
QUEST TO FIND A VACCINE, BECAUSE
OBVIOUSLY A VACCINE IS THE ONE
CONCLUSIVE ANSWER TO THE SPREAD
OF THE VIRUS.
BUT IT IS STILL MANY YEARS AWAY.
PETER PIOT, THE EXECUTIVE
DIRECTOR OF UNAIDS TALKS ABOUT
TEN YEARS, SOME PEOPLE ARE EVEN
LESS OPTIMISTIC, OTHERS LIKE
SETH, I THINK, WOULD SAY WE CAN
DO IT SOONER THAN THAT IF WE
PROVIDE THE RESOURCES AND
TREMENDOUS ENERGY AND WE DO A
GREAT DEAL OF TESTING AT THE
VARIOUS PHASES IN COUNTRIES ALL
OVER THE WORLD.
SO THAT'S THE FOURTH INGREDIENT,
THE VACCINE.
THE FIFTH ITEM, WHICH MUST BE
ADDRESSED AND I HOPE PROFOUNDLY,
THAT THE GOVERNMENT OF CANADA
WILL IN SHORT ORDER MAKE YET
ANOTHER ANNOUNCEMENT OF A
SIGNIFICANT CONTRIBUTION, IS THE
DEVELOPMENT OF A MICROBICIDE OR
OF SEVERAL MICROBICIDES.
AND THIS IS A MATTER OF
FASCINATING SCIENTIFIC INQUIRY,
FOR THOSE OF YOU WHO ARE ENGAGED
IN RESEARCH, THE RESEARCH
IMPLICATIONS OF ALL OF THIS ARE
INFINITE.
WHAT, WHAT WE'RE TRYING TO FIND
WITH THE MICROBICIDE OBVIOUSLY
IS A, IS A, IS A GEL OR A CREAM
OR A SUPPOSITORY WHICH WOMEN CAN
APPLY TO THEMSELVES TO PREVENT
INFECTION.
IT GIVES TO THE WOMAN CONTROL
OVER HER OWN SEXUALITY, WHICH
HAS BEEN SO MERCILESSLY VIOLATED
BY PREDATORY MALE SEXUAL
BEHAVIOUR DURING THE COURSE OF
THE PANDEMIC.
AND MICROBICIDES COULD EMERGE,
IT IS SAID, IN, IN AS SOON AS
FIVE TO SEVEN YEARS, IF THE
RESEARCH IS REALLY INTENSE AND
WE WORK AT IT.
THERE IS EVEN A DISCUSSION AND
IT LOOKS AS THOUGH IT IS
REALISTIC AND WHEN MY COLLEAGUE
WHO'S IN THE AUDIENCE, ANNE-
MARIE TOBAINS AND I MET WITH THE
MICROBICIDE PEOPLE JUST A, JUST
A FEW DAYS AGO IN, IN
WASHINGTON, THEY TALKED OF THE
DEVELOPMENT OF AN INTRAVAGINAL
RING, WHICH WILL, OVER THE
COURSE OF SOME MONTHS DISCHARGE
INGREDIENTS WHICH WILL PROTECT
AGAINST INFECTION AND THEN THE
MAN SIMPLY DOESN'T HAVE ANYTHING
AT ALL TO DO WITH THE PROTECTION
WHICH THE WOMAN APPLIES TO
HERSELF.
THIS WOULD BE ENORMOUSLY
EXCITING, YOU PEOPLE WHO HAVE
MASTERY OF SCIENCE WILL
UNDERSTAND FAR MORE THAN I WHAT
SEEMS TO ME TO BE ALMOST
MIRACULOUS, WHICH IS THAT YOU
CAN PREVENT THE TRANSMISSION OF
THE VIRUS, BUT STILL PERMIT
CONCEPTION.
AND THAT IS WHAT THEY ARE
LOOKING AT WITH THE INTRAVAGINAL
RING.
SO YOU SEE, IN THE FIELD OF
MICROBICIDES, THERE IS
TREMENDOUS SCIENTIFIC WORK GOING
ON AND FASCINATING IMPLICATIONS
FOR THE RESTORATION OF SEXUAL
CONTROL FOR THE WOMEN IN
DEVELOPING COUNTRIES AND
PARTICULARLY THE WOMEN WHO ARE,
UH, ARE UNDER THE SIEGE OF
GENDER INEQUALITY IN SO MANY
PLACES.
AND ONE OF THE WAYS IN WHICH THE
MICROBICIDE PEOPLE PHRASE WHAT
THEY CAN ACHIEVE IN SHORT ORDER
IS RENDERED THUS, LET ME READ IT
TO YOU.
“A PRODUCT THAT IS ONLY 60 percent
EFFECTIVE IN PROTECTING AGAINST
H.I.V. COULD AVERT 2½ MILLION
NEW INFECTIONS OVER A THREE-YEAR
PERIOD, EVEN IF IT IS USED IN
ONLY 50 percent OF SEX ACTS NOT
PROTECTED BY CONDOMS AND
ASSUMING IT IS USED BY ONLY 20 percent
OF PEOPLE EASILY REACHED BY
EXISTING HEALTH SERVICES.”
SO YOU SEE, EVEN IN MARGINAL
APPLICATION, THE NUMBERS OF
WOMEN WHO WOULD BE PROTECTED ARE
HUGE.
AND THAT BECOMES ANOTHER
COMPONENT OF THIS PACKAGE OF
RESPONSES.
WELL, THIS WEEK, AS WELL, IT'S
BEEN QUITE A WEEK, THE WORLD
HEALTH ORGANISATION RELEASED ITS
ANNUAL REPORT.
IT IS A BRILLIANT DOCUMENT.
I HAVE BEEN REACHING UNITED
NATIONS' REPORTS FOR LONGER THAN
I CARE TO CONVEY AND THEY ARE
MOSTLY UNINTELLIGIBLE AND
IMPENETRABLE.
THEY, THEY, THEY REFLECT THE,
UH, THE WISH TO MAKE AMBIGUITY A
KIND OF CONSUMMATE IMPULSE IN
THE, IN THE HUMAN CONDITION.
BUT THIS REPORT IS INTELLIGENT,
LITERATE, DIRECT, IT'S MOST
EXTRAORDINARY, I THINK IT IS THE
BEST DOCUMENT OF ITS KIND THAT I
HAVE READ IN SOME TIME, IT IS
DEVOTED ENTIRELY TO THE 3 BY 5
INITIATIVE AND TO THE ENTIRE
APPARATUS THAT HAS TO BE PUT IN
PLACE AND IN WAYS THAT I DON'T
WANT TO PRETEND TO HAVE A GRASP
OF, IT SUGGESTS AN ENTIRE
RESEARCH AGENDA.
AND I WOULD
THINK THAT IF THE UNIVERSITY OF
TORONTO, WHETHER IT'S, WHETHER
IT'S A MATTER OF SURGERY OR
BIOETHICS OR ANY OTHER OF THE
AMALGAM OF HEALTH SCIENCES, IF
THE UNIVERSITY OF TORONTO GOT
INVOLVED IN VARIOUS ASPECTS OF
THIS, BECAUSE IT IS BEHAVIOURAL,
AS WELL AS IT IS HEALTH AND
SCIENTIFIC, IT WOULD BE
EXTRAORDINARY.
LET ME GIVE YOU A SENSE OF THE
RESEARCH SUBJECTS WHICH THEY
THINK NEED LOOKING AT.
THEY CALL IT
OPERATIONAL RESEARCH, BECAUSE
THEY WANT ALL OF IT APPLIED.
NUMBER ONE.
ASSESSING THE PERFORMANCE OF THE
VARIOUS TREATMENT PROGRAMS.
WE'RE RIGHT ON THE VERGE OF
ROLLING OUT TREATMENT IN A MOST
EXTRAORDINARY WAY.
WHAT CAN WE PUT IN PLACE BY WAY
OF MONITORING AND EVALUATION
WHICH WILL GIVE US A SENSE OF
HOW ONE TREATMENT PROGRAM MIGHT
BE USEFULLY EMBRACED BY ANOTHER.
NUMBER TWO, PROVIDING ACCESS AND
EQUALITY OF ACCESS.
HOW, ONCE YOU'VE GOT TREATMENT
IN PLACE, BUT YOU CAN'T POSSIBLY
TREAT THE NUMBER OF PEOPLE WHOSE
CD4 COUNTS REQUIRE TREATMENT,
HOW DO YOU CHOOSE AMONGST THEM?
I'VE TRAVELLED AND DEALT WITH
THIS CONUNDRUM TIME AND TIME
AGAIN WITH NATIONAL AIDS
COUNCILS IN VARIOUS COUNTRIES IN
AFRICA, IT'S VERY DIFFICULT,
IT'S AN ULTIMATE ETHICIST'S
QUESTION.
WHAT DO YOU DO?
DO YOU TREAT THE DOCTORS AND THE
NURSES BECAUSE THEY SUSTAIN YOUR
HEALTH CARE SYSTEM?
DO YOU TREAT THE TEACHERS
BECAUSE THE SITUATION OF
CHILDREN IN THE COUNTRY IS SO
DESPERATE AND AN EDUCATIONAL
ENVIRONMENT SO NECESSARY?
DO YOU TREAT ON A FIRST-COME,
FIRST-SERVED BASIS?
DO YOU TREAT URBAN RATHER THAN
RURAL, WHERE OFTEN THE INFECTION
LEVELS WILL BE EVEN HIGHER IN
POCKETS OF, OF RURAL AREAS OF
THESE COUNTRIES?
WHAT ABOUT GENDER?
HOW DO YOU GUARANTEE THAT THE
WOMEN WHO ARE SO
DISPROPORTIONATELY INFECTED WILL
HAVE ACCESS TO TREATMENT
EQUIVALENT TO THOSE NUMBERS?
THERE WAS A RECENT ARTICLE IN A
ZAMBIAN NEWSPAPER WHICH FOLLOWED
THE FIRST LITTLE TREATMENT
EPISODE THAT WAS, THAT WAS
UNDERTAKEN IN THE COUNTRY OF 40
PEOPLE AT A PARTICULAR CLINIC
ASSOCIATED WITH A HOSPITAL AND
OF THE FIRST 40 PEOPLE TO
RECEIVE TREATMENT, THREE WERE
WOMEN.
THIS RAISES THE QUESTION.
WOMEN TEND TO USE HEALTH
FACILITIES MORE OFTEN THAN MEN
IN THE DEVELOPING WORLD, BUT
WHEN IT COMES TO LIFESAVING
INTERVENTIONS, MEN ARE SUDDENLY
AT THE FRONT OF THE LINE.
HOW DO YOU DEAL WITH THOSE
REALITIES OF GENDER INEQUALITY?
IF YOU LOOK AT THE, AT THE
TERRIFYING CONSEQUENCES OF THE
GENOCIDE IN RWANDA, MY, MY, MY
GOOD, GOOD FRIEND AND COLLEAGUE,
GERALD KAPLAN, WILL SPEAK TO YOU
ABOUT IT TOMORROW, IF YOU, IF
YOU LOOK AT THE CONSEQUENCES,
YOU WILL NOTE THAT THE WOMEN WHO
WERE RAPED DURING THE GENOCIDE
AND WHO ARE NOW SHOWING FULL-
BLOWN AIDS ARE NOT AS EASILY AND
QUICKLY RECEIVING THE TREATMENT
WHICH THE GOVERNMENT ROLLS OUT
AS ARE SOME OF THE MEN WHO RAPED
THEM.
AND THESE BALANCES OF HOW YOU
ACHIEVE EQUALITY AND, AND, AND
ACCESS, THESE ARE VERY, VERY
DIFFICULT QUESTIONS AND EVERY
COUNTRY HAS TO LEND THEIR MIND
TO IT.
NUMBER THREE, QUESTIONS OF
BEHAVIOUR CHANGE ARE MONUMENTAL
AND THEREFORE THE WHOLE PATTERN
OF SOCIO-BEHAVIOURAL
INTERVENTION BECOMES CRUCIAL AND
WE HAVEN'T EVEN BEGUN TO SCRATCH
THE SURFACE OF THE RESEARCH
THAT'S REQUIRED.
IN SOME COUNTRIES, YOU HAVE AN
AWARENESS LEVEL OF 90 OF 95 percent, OR
HIGH.
BUT CROSSING THE BRIDGE BETWEEN
AWARENESS AND BEHAVIOUR CHANGE,
PARTICULARLY THE CHANGE IN
SEXUAL BEHAVIOUR, SEEMS TO BE
ALMOST IMPOSSIBLE TO ACHIEVE.
AND CHANGING MALE SEXUAL
BEHAVIOUR FEELS AS THOUGH IT
WILL TAKE GENERATIONS.
BUT WE DON'T HAVE GENERATIONS.
WOMEN ARE DYING NOW IN HUGE
NUMBERS.
HOW DO YOU EMPOWER WOMEN QUICKLY
ON THE ONE HAND, WHAT RESEARCH
DO YOU APPLY AND LEARN FROM TO
ACHIEVE THAT AND AT THE SAME
TIME, MANAGE TO, TO DEAL WITH
CHANGES IN MALE SEXUAL
BEHAVIOUR.
NUMBER FOUR, HOW DO YOU
ENCOURAGE TESTING AND
COUNSELLING PROGRAMS ACROSS THE
COUNTRY SO THAT PEOPLE KNOW
WHETHER OR NOT THEY'RE POSITIVE
AND THEY COME TO BE TREATED?
IN THE COUNTRY OF BOTSWANA,
WHICH, UNTIL RECENTLY, HAD THE
HIGHEST PREVALENCE RATE IN THE
WORLD, 38.8 percent UNTIL RECENTLY,
IT'S COME DOWN MINUTELY, 38.8 percent
OF ALL THOSE BETWEEN THE AGES OF
15 AND 49 INFECTED, AND WHEN
THEY OPENED UP A TREATMENT
PROGRAM WHICH WAS FREE, BECAUSE
BOTSWANA HAS THE RESOURCES TO DO
SO, THEY FOUND A VERY, VERY LOW
UPTAKE ON THE TESTING THAT WAS
PRELIMINARY TO THE TREATMENT.
THERE'S A LOT OF RESEARCH THAT
HAS TO BE DONE IN ORDER TO FIND
OUT WHAT'S MISSING WHEN YOU HAVE
OPENED UP TREATMENT.
IS IT STIGMA IN THE COMMUNITY SO
PROFOUND THAT PEOPLE STILL WILL
NOT COME FORTH TO BE TESTED?
OR IS IT A QUESTION OF ACCESS?
NUMBER FIVE, WHAT ABOUT THE NEXT
GENERATION OF NEW DRUGS?
WHAT ABOUT THE SECOND-LINE
INTERVENTIONS AND THE THIRD-LINE
INTERVENTIONS AND THE
SPECIALISED DRUGS TO DEAL WITH,
WITH CONSEQUENCES OF TREATMENT
WHICH ARE NOT IMMEDIATELY
APPARENT?
NUMBER SIX, WE HAVE, ALL OVER
THE CONTINENT, EMERGING PROGRAMS
ON THE PREVENTION OF MOTHER TO
CHILD TRANSMISSION.
I WAS FASCINATED WHEN I READ THE
WORLD HEALTH ORGANISATION
DOCUMENT THAT THE MATTER OF
TRANSMISSION THROUGH BREAST-
FEEDING WAS RAISED VERY
STRONGLY.
WE KNOW, I GUESS, HOW TO HANDLE THE
INTERRUPTION AND TRANSMISSION
MOTHER TO CHILD DURING THE
BIRTHING PROCESS, WHETHER IT'S
THE USE OF THE DRUG NEVIRAPINE,
WHICH REQUIRES ONE TABLET TAKEN
BY THE MOTHER AT THE MOMENT OF
BIRTH AND A LIQUID EQUIVALENT
TAKEN BY THE INFANT WITHIN 48
HOURS, AND YOU CAN CUT THE RATE
OF TRANSMISSION BY 50 TO 53 percent.
OR, IF YOU
INTRODUCE A FULL ANTI-RETROVIRAL
REGIMEN IN THE 26th WEEK, IT'S
POSSIBLE TO CUT THE RATE OF
TRANSMISSION BY UP TO 98 percent.
WHAT WORKS BEST?
HOW CAN IT BE INTRODUCED IN
THESE IMPOVERISHED ENVIRONMENTS?
AND WHAT ABOUT THE TRANSMISSION
OF THE VIRUS THROUGH BREAST-
FEEDING?
AND MOST OF THESE COUNTRIES ARE
SIMPLY NOT IN A POSITION TO
PROVIDE INFANT FORMULA.
FOR THE VAST MAJORITY OF WOMEN
IN THESE COUNTRIES, THERE WILL
BE BREAST-FEEDING.
WHAT THEN DOES IT RAISE, THERE
ARE VERY, VERY STRONG
DIFFERENCES OF SCIENTIFIC
OPINION.
THERE IS A MAGNIFICENT FELLOW IN
DURBAN, WHO HEADS THE RESEARCH
CENTRE AT THE UNIVERSITY OF
NATAL, DR. JERRY COOVADIA, WHO
IS IN THE MIDST OF AN
OVERWHELMING STUDY OF WOMEN WHO
BREAST-FEED AND THERE IS
EMERGING MORE AND MORE EVIDENCE
THAT SUGGESTS THAT BREAST-
FEEDING EXCLUSIVELY FOR THE
FIRST SIX MONTHS PROVIDES NO
GREATER DEGREE OF TRANSMISSION
THAN ANY OTHER VEHICLE OF
TRANSMISSION IN THE ALTERNATIVE.
THESE ARE FASCINATING SCIENTIFIC
QUESTIONS WHICH MUST BE LOOKED
AT, NUMBER SEVEN.
THERE HAS TO BE A MORE FREQUENT
AND SERIOUS ANALYSIS OF
ADHERENCE, OF THE VARIOUS
REGIMENS, OF THE SIDE EFFECTS,
OF RESISTANCE, OF DRUG TOXICITY,
OF THE USE OF THE MEDICATIONS IN
A FASHION WHICH IS TRUSTED.
NUMBER EIGHT, THERE HAS, HAS
EMERGED, OF COURSE, THE WHOLE
QUESTION OF USER FEES AND OF CO-
PAYMENTS AND THE EXTENT TO WHICH
THE REQUIREMENT OF PAYMENT MAY
SERVE TO, TO PREVENT THE USE OF
THE HEALTH CARE SYSTEMS AND, AND
TREATMENT GENERALLY.
NUMBER NINE, THERE NEEDS TO BE A
GREAT DEAL MORE STUDY ON
QUESTIONS OF CO-INFECTION,
TUBERCULOSIS AND H.I.V.
I VISIT WARD AFTER WARD IN
VARIOUS HOSPITALS AND IN THE
ADULT MEDICAL WARDS AND IN THE
ADULT MALE MEDICAL WARDS, IN THE
ADULT FEMALE MEDICAL WARDS, YOU
FREQUENTLY FIND 45, 50, 55 percent
LEVELS OF CO-INFECTION, AIDS AND
TUBERCULOSIS.
NUMBER TEN, THERE'S A NEED TO
ASSESS THE PERFORMANCE OF
GOVERNMENTS AND OF NON-
GOVERNMENTAL ORGANISATIONS AND
OF THE PRIVATE SECTOR AS THEY
EMBRACE TREATMENT.
NUMBER 11, THERE IS EMERGING, IN
SEVERAL COUNTRIES OF SOUTHERN
AFRICA, PARTICULARLY ZIMBABWE,
ZAMBIA, MALAWI, LESOTHO,
SWAZILAND AND MOZAMBIQUE, A
DIRECT LINK BETWEEN FAMINE AND
AIDS, BETWEEN HUNGER AND AIDS
AND THE WAY IN WHICH THE LEVELS
OF SICKNESS AND DEATH HAVE
UNDERMINED AGRICULTURAL
PRODUCTIVITY, BECAUSE IT IS THE
WOMEN WHO ARE THE FARMERS.
AND YOU CANNOT RETAIN HOUSEHOLD
FOOD SECURITY AND WHEN THE BODY
HAS NO FOOD TO CONSUME, THE
VIRUS CONSUMES THE BODY.
WHAT ARE THESE RELATIONSHIPS
BETWEEN HUNGER AND FOOD ON THE
ONE HAND AND AIDS ON THE OTHER?
NUMBER 12, EVERY SINGLE ASPECT
OF GENDER YOU CAN NAME, FROM
PROPERTY AND SUCCESSION RIGHTS
TO LAWS AGAINST SEXUAL VIOLENCE
AND RAPE AND THE CRIMINALISATION
FOR MEN OF THEIR BEHAVIOUR, SO
THAT THERE IS SOME UNDERSTANDING
IN THE SOCIETY THAT THE LAWS
WILL BE ENFORCED.
AND FINALLY THE WHOLE QUESTION
OF SUSTAINABILITY OVER THE
YEARS.
HOW DO YOU ACHIEVE IT?
HOW DO YOU MEASURE IT?
HOW DO YOU APPLY IT?
THE RESEARCH QUESTIONS ARE
ENDLESS.
SOME OF THEM ARE BASIC
SCIENTIFIC RESEARCH AND SOME OF
THEM ARE MORE ADVANCED
SCIENTIFIC RESEARCH.
SOME OF THEM ARE BEHAVIOURAL IN
CONTENT, BUT FOR ANYONE WHO
CARES ABOUT ENGAGING IN THESE
VAST HEALTH PROBLEMS, THERE IS A
WORLD TO DEAL WITH.
I HAVE TO BRING THESE REMARKS TO
AN END BUT I, I, I DO WANT TO
SAY TO YOU, I'VE BEEN DOING THIS
JOB NOW FOR THREE YEARS.
EXACTLY THREE YEARS THIS MONTH
AND I HAVE FIVE REALLY POWERFUL
IMPRESSIONS.
NUMBER ONE, YOU SIMPLY CANNOT
IMAGINE THE PERVASIVENESS OF DEATH.
I MUST ADMIT
TO YOU THAT I WAS PERHAPS, IN
SOME MISGUIDED NAIVETÉ,
COMPLETELY UNPREPARED FOR THE
PERVASIVENESS OF DEATH.
EVEN WHEN YOU'RE VISITING
PAEDIATRIC WARDS, THE CHILDREN
AND INFANTS INEVITABLY DIE
DURING THE VISIT AND THE VOLUBLE
ANGUISH OF THE MOTHER LIVES IN
YOUR MIND.

His voice breaks.

He continues
EVEN WHEN YOU
GO TO VISIT A LITTLE N.G.O. LIKE
CATHOLIC AIDS ACTION IN
WINDHOEK, NAMIBIA, AND SISTER
RAFAEL TAKES YOU OUTSIDE TO SHOW
YOU THE INCOME-GENERATING
PROJECT FOR THE, FOR THE WOMEN
WHO COME TOGETHER TO NETWORK,
THE WOMEN WHO ARE INFECTED, AND
THE PROJECT CONSISTS OF YOUNG
MEN MAKING PAPIER MACHE COFFINS
FOR INFANTS THIS LONG.

He gestures the size of a small child and continues
AND THEY PUT THE HANDLES ON THE
COFFINS AND THEY TURN TO ME AND
THEY SAY, MR. LEWIS, WE SIMPLY
CAN'T KEEP UP WITH THE DEMAND.
YOU SEE A CLUTCH OF CHILDREN IN
BRIGHTLY COLOURED UNIFORMS ON A
STREET IN, IN ONE OF THE CITIES
OF SOUTHERN AFRICA AND YOU THINK
THAT THEY'RE, THEY'RE IN A
SCHOOL YARD AND THE PARK FOR A
MOMENT AND YOU SUDDENLY REALISE
THEY'RE IN A CEMETERY.
THE SENSE OF DEATH IS
OMNIPRESENT.
THE PEOPLE WHO WERE INFECTED IN
THE LATE 1980s AND EARLY 1990s
ARE NOW DYING IN HUGE NUMBERS.
AND IT WILL GROW THROUGH THE
NEXT SEVERAL YEARS, WE ARE
SIMPLY ON THE EDGE OF THE DEATH
SPIRAL.
AND THESE COUNTRIES ARE SO HEROIC!
THERE IS SUCH SOPHISTICATION AT
THE GRASS ROOTS.
THERE IS SO MUCH GENEROSITY AND
SOLIDARITY AND DETERMINATION TO
OVERCOME IT.
BUT IT WEIGHS YOU DOWN.
YOU MEET WITH A GROUP OF PEOPLE
LIVING WITH AIDS IN, IN JUNE AND
THEY SIT AROUND THE TABLE AND
YOU HAVE AN INTENSE DISCUSSION
OF, OF WHAT THEIR GRIEVANCES ARE
AND HOW THEY WANT TO BE TAKEN
SERIOUSLY AND WHAT THEY CAN
CONTRIBUTE TO FIGHTING THE
PANDEMIC AND YOU COME BACK IN
DECEMBER AND HALF OF THEM ARE
GONE.
JUST OVERNIGHT, GONE.
AND THE OTHER IMPRESSION IS OF
THE WOMEN.
I JUST CAN'T GET OVER THAT.
I BELIEVED IN THE STRUGGLE FOR
GENDER EQUALITY ALL MY ADULT
LIFE, I'VE ALWAYS BELIEVED THAT
THE STRUGGLE FOR GENDER EQUALITY
IS TOUGHER THAN THE STRUGGLE FOR
RACIAL EQUALITY, BECAUSE MEN ARE
ABSOLUTELY IMPERVIOUS TO THE
RELINQUISHMENT OF POWER AND
AUTHORITY.
AND, AND THIS TERRIBLE
DEVASTATION FOR WOMEN, SO THAT
NOW, IRONICALLY, TELLINGLY,
STARTLINGLY, ONE OF THE MOST
DANGEROUS SITUATIONS FOR A WOMAN
IN, IN SUB-SAHARAN AFRICAN, BUT
IT IS NOW TRUE IN CHINA AND
INDIA AND RUSSIA, IS TO BE
MARRIED.
BECAUSE THEY'RE BEING INFECTED
BY THEIR INTIMATE PARTNERS,
THEY'RE BEING INFECTED BY THEIR
PERMANENT PARTNERS, THEY'RE
BEING INFECTED THROUGH WHAT THEY
THOUGHT WAS A MONOGAMOUS
RELATIONSHIP AND THE INFECTION
LEVELS WITHIN MARRIAGE ARE OFTEN
HIGHER THAN THE INFECTION LEVELS
AMONGST WOMEN IN THE COMMUNITY
OUTSIDE.
AND THESE WOMEN, THEY CARRY THE
WHOLE BURDEN OF CARE, THEY,
THEY, THEY LOOK AFTER THEIR
HUSBANDS WHO GET INFECTED IN THE
CITIES AND COME HOME TO THE
RURAL VILLAGES TO DIE AND THEN
THEY GET INFECTED THEMSELVES AND
THEY LOOK AFTER THEMSELVES, THEY
LOOK AFTER THEIR NEIGHBOURS,
THEY HAVE THE ENTIRE BURDEN OF
CARE OF THE ORPHAN CHILDREN, THE
POSITION OF WOMEN, THEY ARE
MONUMENTAL IN THE LIFE OF THE
SOCIETY.
BUT THEY ARE INFECTED SO
DISPROPORTIONATELY, OF THE 11
MILLION PEOPLE IN SUB-SAHARAN
AFRICA BETWEEN THE AGES OF 15
AND 24 WHO ARE LIVING WITH AIDS,
67 percent ARE WOMEN AND GIRLS.
IT'S LIKE SOME PERVERSE
DARWINIAN SELECTION OF ONE SEX
FOR A FEROCIOUS ASSAULT.
AND THEN YOU LOOK AT THE
QUESTIONS OF CAPACITY.
IN MOST SITUATIONS THAT WE'RE
FAMILIAR WITH, WHEN YOU HAVE
FAMINES OR NATURAL DISASTERS OR
EARTHQUAKES, THE PEOPLE WHO DIE
ARE THE VERY YOUNG AND THE VERY
OLD.
HERE YOU LOSE ALL THE PEOPLE IN
THE MIDDLE!
ALL THE PEOPLE IN THE SO-CALLED
SEXUALLY ACTIVE YEARS!
AND IT'S ALMOST VISUAL AT TIMES,
YOU ALMOST HAVE THE SENSE THAT
YOU CAN SEE THE WAY IN WHICH A
SOCIETY IS ROBBED OF ITS
PRODUCTIVE ART METHODICALLY,
YEAR BY YEAR, YOU DON'T HAVE TO
HAVE 35 OR 40 percent INFECTION RATES,
YOU CAN HAVE 10, 12, 15, 5 percent
INFECTION RATES, IF IT HAPPENS
YEAR AFTER YEAR AFTER YEAR
UNENDINGLY, THEN YOU LOSE YOUR
SOCIETY.
THE MINISTER OF AGRICULTURE IN
ZAMBIA SAYS TO ME, STEPHEN, I, I
WENT TO MEET WITH A TEN-PERSON
DELEGATION FROM THE EUROPEAN
UNION YESTERDAY, THEY WANTED TO
TALK ABOUT GENETICALLY-MODIFIED
FOODS AND I WENT TO SEE THEM
ALONE, HE SAYS PROUDLY.
AND I LIKE THIS MINISTER VERY
MUCH, HE'S A BRIGHT, ABLE,
EXCELLENT FELLOW AND I SAY, MR.
MINISTER, WHY DID YOU GO ALONE?
THAT'S A PRETTY SOPHISTICATED
DELEGATION.
AND HE SAYS, FRANKLY, STEPHEN,
SO MANY OF THE SENIOR PEOPLE IN
MY MINISTRY HAVE DIED OR ARE
ILL, I HAD NO ONE TO TAKE WITH
ME.
IT'S REALLY IMPORTANT TO
UNDERSTAND WHAT'S HAPPENING TO
CAPACITY.
AND THEN THERE ARE THE ORPHANS,
I CAN'T, I CAN'T POSSIBLY DRIVE
THIS NAIL THROUGH THE WALL,
BECAUSE THERE IS NO WAY OF
CONVEYING TO YOU WHAT IS
HAPPENING TO THE CHILDREN OF
SUB-SAHARAN AFRICA.
25 MILLION ORPHANS ARE
ANTICIPATED BY THE YEAR 2010.
THERE HAS NEVER BEEN
HISTORICALLY ANY PRECEDENT FOR
WHAT WE'RE DEALING WITH, EVER,
NO ONE KNOWS HOW TO HANDLE IT.
WE DO HAVE A SENSE OF HOW TO
HANDLE AFRICA ABSOLUTELY HAS A
SENSE OF HOW TO HANDLE
TREATMENT, PREVENTION, CARE,
SUPPORT, BUT NO ONE KNOWS HOW TO
HANDLE THE ORPHANS.
THEY OVERWHELM INDIVIDUAL
COUNTRIES.
YOU HAVE COUNTRIES WHERE, BY
2010, 10 TO 15 percent OF THE TOTAL
POPULATION, NOT JUST THE CHILD
POPULATION, BUT THE TOTAL
POPULATION WILL BE ORPHANS.
TRY TO IMAGINE
THREE TO FOUR MILLION CANADIAN
ORPHANS AND WE ARE A SUBSTANTIAL
AND SOPHISTICATED AND
TECHNOLOGICALLY ASTUTE SOCIETY,
WE'RE RICH AND WEALTHY BEYOND
THE DREAMS OF AVARICE, IMAGINE
THAT IMPOSED ON COUNTRIES OF
SUCH IMPOVERISHMENT AND THESE
LOVELY KIDS, THEY WANDER THE
LANDSCAPE OF AFRICA, THEY,
THEY'RE BEWILDERED, THEY'RE
CONFUSED, THEY'RE ANGRY, THEY'RE
TRAUMATISED, THEY'RE DESPERATE
FOR NURTURE AND LOVE.
THE COMMUNITIES TRY SO HARD TO
ABSORB THEM, BUT ONE MORE MOUTH
OFTEN PUSHES A FAMILY OVER THE EDGE.
THE MORE A CHILD MOVES FROM THE
CORE FAMILY TO WHICH HE OR SHE
BELONG, THE MORE THAT CHILD IS
SUBJECT TO EXPLOITATION, OFTEN
SEXUAL EXPLOITATION.
YOU KNOW WHAT ONE OF THE PRIMARY
FORCES IN AFRICA NOW IS AROUND
ORPHAN CHILDREN, IT'S
GRANDMOTHERS.
GRANDMOTHERS LOOK AFTER ORPHAN
CHILDREN, YOU HAVE THIS PERVERSE
VIOLATION OF THE RHYTHM OF LIFE,
WHERE THE GRANDMOTHERS BURY
THEIR OWN CHILDREN AND THEN THEY
LOOK AFTER THE GRANDCHILDREN AS
ORPHANS, IN HUGE NUMBERS.
I'VE MET GOD KNOWS HOW MANY
GRANDMOTHERS LOOKING AFTER FIVE,
TEN, 15, 20 KIDS WHO CAN'T GO TO
SCHOOL BECAUSE THEY CAN'T AFFORD
THE SCHOOL FEES OR THE BOOKS OR
THE UNIFORMS, WHO HAVEN'T GOT
FOOD TO EAT, WHO ARE SCRAMBLING
FRANTICALLY.
AND WHEN THE GRANDMOTHERS DIE
AND THERE'S NO ONE COMING UP
BEHIND AND THE EXTENDED FAMILY
HAS EFFECTIVELY BEEN DESTROYED,
YOU END UP WITH CHILD-HEADED
HOUSEHOLDS.
WHERE THE OLDEST SIBLING LOOKS
AFTER THE YOUNGER KIDS.
I'M, I'M PRESUMING ON YOUR TIME,
BUT I WANNA TELL YOU ONE
ANECDOTE BECAUSE IT COMPLETELY
TRANSFORMED MY SENSE OF WHAT
WE'RE DEALING WITH.
I HAD A TREMENDOUS PRIVILEGE
LAST SUMMER, I TRAVELLED TO
AFRICA WITH GRACA MACHEL, WHO IS
A VERY GOOD FRIEND.
GRACA MACHEL, AS MANY OF YOU
WILL KNOW, IS THE FORMER
MINISTER OF EDUCATION IN
MOZAMBIQUE, THE FORMER FIRST
LADY OF MOZAMBIQUE, SHE'S
MARRIED TO NELSON MANDELA, SHE
IS MAMA AFRICA, SHE IS AN
ASTONISHINGLY CHARISMATIC AND
COMPELLING AND EMPATHETIC AND
GENEROUS HUMAN BEING.
AND WE WENT TO GROUND ZERO IN
UGANDA, WE WENT TO THE DISTRICT
OF RAKAI, WHERE THE FIRST CASE
WAS DISCOVERED IN 1982, BECAUSE
THE PEOPLE WANTED TO SHOW US
CHILD-HEADED HOUSEHOLDS.
AND WE WENT INTO ONE LITTLE HUT,
WHERE THERE WERE FIVE KIDS,
THREE GIRLS, 14, 12 AND TEN, TWO
LITTLE BOYS, 11 AND EIGHT.
AND WE WENT INTO THE HUT AND WE
SAT WITH OUR BACKS TO THE WALL
AND I HAD THE TWO LITTLE BOYS ON
MY LEFT AND GRACA HAD THE THREE
LITTLE GIRLS ON HER RIGHT AND
SHE SHOOED EVERYBODY OUT OF THE
HUT, EXCEPT FOR ONE, I REMEMBER,
WORLD VISION WORKER AND ONE
TRANSLATOR.
AND SHE SAID, IN THAT GENTLE WAY
THAT GRACA HAS, SHE SAID TO THE
TWO LITTLE GIRLS, THE OLDER
GIRLS, HAVE YOU STARTED TO
MENSTRUATE YET?
AND THE TWO LITTLE GIRLS, IN THE
SHYLY WHISPERED VOICES
CHARACTERISTIC OF AFRICAN
CHILDREN SAID, YES.
AND GRACA SAID, DO YOU KNOW WHAT
IT MEANS?
DO YOU TALK TO THE OTHER KIDS
ABOUT IT, DO YOU TALK TO YOUR
TEACHERS ABOUT IT, DO YOU TALK
TO PEOPLE IN THE VILLAGE ABOUT
IT?
AND I REALISED, AS I WAS SITTING
THERE, THAT I WAS WITNESSING THE
FIRST ACT OF MOTHERING WHICH
THOSE GIRLS HAD EVER HAD, ON
SOMETHING WHICH IS ONE OF THE
MOST MOMENTOUS MOMENTS OF A
YOUNG GIRL'S LIFE.
AND THAT'S WHAT'S HAPPENING IN
SO MANY PARTS OF THE CONTINENT.
THE PARENTS ARE GONE.
AND SO THEY DON'T TRANSFER THE
VALUES, THEY DON'T TRANSFER THE
KNOWLEDGE, THERE ISN'T THIS
INTERGENERATIONAL SHARING OF, OF
THINGS WHICH WE TAKE FOR
GRANTED.
KIDS DON'T KNOW HOW TO FARM
BECAUSE THEIR PARENTS ARE DEAD,
SO SCHOOLS TRY TO SET UP SCHOOL
GARDENS SO THAT CHILDREN WILL
LEARN.
AND WHEN I SAID TO THE KIDS, AS
I WAS LEAVING, WHO PUTS YOU TO
BED AT NIGHT, THE YOUNG 14-YEAR-
OLD LOOKED AT ME WITH A KIND OF
IMPATIENCE AND SAID, WELL, I PUT
THEM TO BED AT NIGHT.
I SAID, THE NEIGHBOURS DON'T
COME IN, NOBODY COMES IN, OH NO,
SHE SAID, I ALWAYS PUT THEM TO
BED AT NIGHT.
AND I THOUGHT, THIS IS JUST,
IT'S JUST MADNESS.
MADNESS, WHEN ANYA RITA AND I
WERE SITTING WITH THE CABINET IN
SWAZILAND A MONTH AGO, THE
MINISTER OF LABOUR SUDDENLY
BURST OUT IN THE MIDDLE OF THE
CONVERSATION, YOU DON'T
UNDERSTAND, MR. LEWIS, THERE'S
BEEN AN EXPLOSION OF ORPHANS IN
THE COUNTRY, WE HAVE CHILD-
HEADED HOUSEHOLDS WHERE THE AGE
OF THE CHILD HEADING THE
HOUSEHOLD IS EIGHT.
AND I THOUGHT, WHAT KIND OF
GROTESQUE ABERRATION OF, OF WHAT
WE SEE TO BE A FAMILY IS THIS?
AND IT LEADS ME TO SAY THAT THE
FINAL THING I REALISED MOST
STRONGLY IN, IN BEING IN AFRICA
IS THAT THIS IS AN INCREDIBLE
TRAGEDY WHICH HAS NOT BEEN
GRASPED BY THIS WORLD.
WHEN I WAS CHATTING WITH GERRY
KAPLAN YESTERDAY MORNING, I WAS
SAYING IT REMINDS ME OF THE
HUNDRED YEARS' WAR, THIS IS
GONNA GO ON FOR A HUNDRED YEARS,
THE CONSEQUENCES.
AND THE, THE, THE EVISCERATION
OF SOCIETIES IS, IS
HALLUCINATORY.
AND I ACTUALLY THINK THAT 20,
30, 40 YEARS DOWN THE ROAD, WE
MAY LOSE WHOLE COUNTRIES!
THE WORLD BANK, IN A PRETTY
SOPHISTICATED STUDY, SAID THAT
IF THINGS DON'T TURN AROUND IN
SOUTH AFRICA, THEY WILL FACE
ECONOMIC COLLAPSE IN THREE
GENERATIONS.
AND IT WASN'T SOME GRATUITOUS
ABSTRACTION, THEY WENT THROUGH
AN ECONOMETRIC ANALYSIS.
WE'RE REALLY STRUGGLING FOR
SURVIVAL, I HEARD THE PRESIDENT
OF BOTSWANA USE THE WORD, USE
THE WORD “ANNIHILATION” WHEN HE
TALKS ABOUT WHAT THEY'RE FACING,
AS DOES THE PRIME MINISTER OF
LESOTHO, AS DO OTHERS.
EVERYBODY TALKS OF THE HOPE
THAT'S COMING, THAT THERE ARE
MORE RESOURCES AND THEY'RE RIGHT
AND THERE IS NOW THIS TREATMENT
AND THEY'RE RIGHT.
AND THIS IS TREMENDOUSLY
EXCITING AND IT'S WORTH ALL OF
THE INTERVENTION AND SUPPORT
THAT YOU CAN COLLECTIVELY
MOBILISE.
BUT I WANT YOU TO KNOW THAT ON
THE GROUND, IN THOSE COUNTRIES
NOW, IT'S NOT YET FELT.
THERE IS STILL A TREMENDOUS
SENSE OF ANGUISH AND
DESPERATION.
SO WE HAVE TO MOVE IT FAST.
THERE IS NOT A SINGLE DAY TO BE
LOST IN THIS STRUGGLE.
THANK YOU FOR HAVING ME HERE.

The audience rises and gives him a standing ovation.

Watch: Stephen Lewis on Global Health