There was no question that the pandemic could be defeated through joint and Herculean efforts by the African countries and the international community, he told correspondents. All over the continent, Africans were engaged in endless numbers of initiatives, projects and programmes, which, if taken to scale, would halt the pandemic, prolonging and saving millions of lives. What was required was a combination of political will and resources.
While the political will was increasingly there, the money was not. The pandemic could not be allowed to continue, and those who watched it unfold "with a kind of pathological equanimity", must be held to account. "There may yet come a day when we have peacetime tribunals to deal with this particular version of crimes against humanity", he said.
Describing his visit to four countries of southern Africa last month -- Lesotho, Zimbabwe, Malawi and Zambia -- he said that the crucial new component from the trip was the role of the Global Fund, which people from Cabinet Ministers to those living with HIV/AIDS felt was the best vehicle to finance the struggle against the pandemic. Every country asked the same questions: When would the money come? Did the Fund have enough money? Why didn't governments contribute to it? What would happen after it went bankrupt? The Fund had enough resources to get through the next round of proposals at the end of the month, he added, but then it faced "the moment of truth". After January, it could be said to be in crisis.
"But it gets worse," he added. "I want to say what we're all saying privately to each other. If ... there is a war against Iraq come February, then the war will eclipse every other international human priority, HIV/AIDS included. In other words, if the United States and the other members of the G7 don't augment their contributions to the Global Fund in the immediate future, we will be in desperate trouble." People living with HIV/AIDS were in a race against time. What they had never imagined was that over and above the virus itself, there would be a new adversary -- war.
As bad as things were in southern Africa -- and they were terrible -- every country he had visited exhibited particular strengths and hopes, he said. Lesotho had a most impressive political leadership, but it was absolutely impoverished. With significant additional resources, it could begin to rescue countless lives. Zimbabwe, whatever the levels of political turbulence, had created a sturdy municipal infrastructure for dealing with AIDS. For the last couple of years, the country had had a 3 per cent surtax on corporate and personal income, devoted to work with AIDS. In Malawi, there was a prospect of public health efforts being introduced to provide anti-retroviral treatment. If that were to happen, some 50,000 people would be treated. The change of presidency in Zambia had qualitatively changed the country's response to the epidemic.
Turning to the aspects of his trip that had made the greatest impression on him, he said that, first of all, there was no doubt that hunger and AIDS had "come together in a Hecate's brew of horror". In Malawi, for example, 50 per cent of poor households were affected by chronic illness due to HIV/AIDS. "Add to that the reality of erratic rainfall and drought, and the World Food Programme (WFP) and the broader United Nations family have a hugely daunting job", he said.
Remembering his visit to a paediatric ward in Lusaka, he said that the infants were clustered, stick-thin, three and four to a bed, most so weakened by hunger and ravaged by AIDS that they really had no chance. "We were there for 45 minutes. Every 15 minutes, another child died, awkwardly covered with a sheet, then removed by a nurse, while the ward was filled with the anguished weeping of another mother. A scene from hell."
AIDS could also be associated with "the grinding down of society", he said. The fact that the agricultural sector was beginning to decay could simply be a harbinger of worse to come. With many teachers dead and dying, education was on the brink. Children, especially girls, were being taken from school to tend to sick and dying parents. Orphans could not afford the school fees. In Zambia, 1,967 teachers had been lost in 2001, and over 2,000 in 2002. In Malawi, an analysis of the impact of AIDS on four different ministries had demonstrated "erosion in each", which to a lesser or greater degree, was inescapable. It was necessary to recognize that even at a prevalence rate of 10 to 15 per cent -- never mind the astronomic rates of 30 to nearly 40 per cent -- the incessant cumulative death of so many productive members of society ultimately meant that things fell apart.
One of the saddest manifestations of a society "coming apart at the seams", was the growing rate of sexual abuse of children and adolescents, which had reached shocking proportions. Cases of sexual violations reported to the Lusaka YWCA clinic numbered 88 in 2000, 110 in 2001, and 152 in the first ten months of 2002. And those were only the reported cases in just one of 11 clinics.
An astronomic number of orphans was a new phenomenon, for which the world had no evident solution, he said. There was an escalating reality of orphaned street children, orphan gangs and orphan delinquency. Orphans were a high-risk group, posing a collective threat to social stability. It was also necessary to empower women, who were at the centre of the pandemic.
On the question of anti-retroviral treatment, there was a crescendo of rage and desperation, which governments would ignore at their peril, he said. In Zambia, the amorphous prospect of perhaps 10,000 people entering into treatment over time, the eligibility criteria not yet known, prompted nothing but anger. In Zimbabwe and Lesotho, where treatment was at the earliest stage of discussion, there was a festering despair among those who needed it now. What had changed was the maturity, vehemence and confidence of the organizations of people living with HIV/AIDS.
Responding to several questions related to the "complacency" of the international community and the level of political will of the political leaders in southern Africa, Mr. Lewis said that multiple international, community-based and non-governmental organizations were engaged in projects and programmes, which worked. However, they "just did not have the dollars" to turn the situation around. While it was necessary to improve African countries' capacity, he believed that, even with the structures in place now, it was possible to save and prolong millions of lives, if the required resources were available. People who could be saved were dying needlessly.
The issue of political leadership "defaulting" in its obligation around AIDS existed in Africa and outside of it, he continued. Within Africa, there had been a dramatic turn-around in the last two years, owing mostly to the January 2000 Security Council resolution, by the terms of which AIDS was recognized as an issue of international peace and security. Also, a series of international conferences had increasingly engaged the African leadership. It had been impossible, however, to achieve increased commitment outside of Africa. In April 2001, the Secretary-General had said that an amount of $7 billion to $10 billion annually was needed to cope with AIDS, tuberculosis and malaria. What was now available was some $2.1 billion over 4 to 5 years. Obviously, the rich world had not been engaged.
Even those critical of South Africa would have to concede that things were moving there, he continued, with new medications being used to prevent mother-to-child transmission and the budget having been increased exponentially. AIDS had been put at the top of the agenda. Where things were not moving was within the international community. There had been no significant contributions to the Global Fund since Germany had made a contribution of $50 million in Barcelona. [Following the briefing, an announcement was made that since then, contributions had been received from Thailand and Monaco.]