Africa: Hope and Disappointment, 05/30/03

Africa: Hope and Disappointment, 05/30/03

AFRICA ACTION Africa Policy E-Journal May 30, 2003 (030530)

Africa: Hope and Disappointment (Reposted from sources cited below)

This posting contains excerpts from two recent speeches by Stephen Lewis, the UN Envoy for HIV/Aids in Africa. The first, from early May, highlights new commitment to action on AIDS under the new government in Kenya, and the hope that that country could join other African countries such as Uganda, Senegal, and Botswana as another example of strong efforts to fight back against the pandemic. The second, on the eve of the G8 summit of rich countries in Evian, France, highlights the failure of rich countries to match promises with real action in addressing Africa's problems, or, indeed, to account for the damage their own policies continue to cause in Africa.

African leaders and non-governmental organizations in Africa and around the world continue to demand that the G8 address global issues of peacekeeping, debt cancellation, and health, that have particular impact in Africa. But news reports suggest the G8 are retreating even from earlier commitments. According to a May 30 article in the Toronto Globe and Mail, the Bush administration has pressed for exclusion of any mention in the summit statement on health of either the Global Fund to fight AIDS or of the World Trade Organization Doha Declaration prioritizing public health over patent rights.

Today Africa Action joined with other U.S. based advocacy groups in calling on President Bush to keep his promises to devote additional resources to Africa and to immediately reschedule his trip to Africa that was cancelled earlier this year. See

Appearing on the PBS Newshour on May 28 to discuss the crisis in the Democratic Republic of the Congo, Africa Action executive director Salih Booker called on the U.S. and other rich countries to provide resources adequate for support not only for immediate humanitarian action but also for the longer-term implementation of the peace plan in that country. See:

Also on the eve of the G8 summit, two British groups, Christian Aid and ActionAid, released reports documenting the failure of G8 countries to keep their promises to Africa. See


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New Action on AIDS in Kenya

Briefing by Stephen Lewis, UN Envoy for HIV/Aids in Africa

United Nations (New York)

May 2, 2003

[excerpts; for full text see:]

These notes by Stephen Lewis were issued to journalists on May 2 at a press briefing in the United Nations, New York, regarding his recent visit to Kenya.

Just last weekend, I returned from a trip to Kenya, during which I met, at length, with the new President, and Ministers of Health, Education and Information. I also met with the leadership of the National AIDS Control Council, the UN country team, various representatives of civil society and People Living with HIV/AIDS, and made a trip to Kabera, the huge, sprawling, abject slum in Nairobi, to meet with over a hundred commercial sex workers, all of whom are involved in a program of HIV prevention. ...

All too often, when I report back to the media after a visit to Africa, I'm consumed by gloom and apocalyptic utterance. But not this time. This time I came away with a greater degree of hope and optimism than I've felt for months. It's hard to describe the sense of change from the previous administration: suffice to say, where HIV/AIDS is concerned, the change is night and day. Where before, senior officials' attention to AIDS was perfunctory, on this occasion every conversation, without exception, demonstrated a new leadership that is intense, committed to confronting the pandemic, determined to put policies and programmes in place, and consumed by the recognition that every single family in Kenya is affected in some way by the ravages of HIV/AIDS.

I guess it's a trifle presumptuous to make personal comment on a conversation with President Kibaki, but I'm going to do so nonetheless. The President has appointed an HIV/AIDS Cabinet Committee of nine members, which he personally chairs. He's providing very open and public leadership on the issues of AIDS, and demands the same of his cabinet colleagues. What was particularly impressive --- and unusual --- in the meeting with the President (there were ten senior members of the bureaucracy present) was his refusal to accept, at face value, any reassurances that his administration has the pandemic well in hand. President Kibaki frequently challenged what others said, asserting --- almost by instinct ---that the crisis is far from under control, and insisting that the fight against the pandemic must be intensified.

... [this was followed by a meeting with the Minister of Education. This is the arena where the full force of the new Government has been felt. As most people doubtless know, the key promise of the election campaign was the abolition of fees for primary school. No sooner was the present Government elected, than the promise was fulfilled. And an extraordinary thing happened: when school reconvened in January, 1.2 million new children poured into the educational system within one week --- an increase of over 20 per cent! --- and the numbers are still rising, expected to reach one and a half million by June.

The implications are stunning. One million two hundred thousand children who had not been in school turned up for school. Kenya has an estimated one million two hundred thousand children orphaned by AIDS. Are they identical cohorts? Of course not. Is there a significant overlap? Everyone agrees that the overlap is large. What, then, is the situation on the rest of the continent for millions of other children orphaned by AIDS, particularly in the high prevalence countries? How is it possible that a campaign to eliminate school fees has not been launched across Africa? Where is the leadership to come from? Why should such vast numbers of children, who have lost one or both parents to AIDS, who have little if anything to eat, who have no guarantee of shelter, no guarantee of health or nutritional care, no guarantee of a home or of love or of nurture & why on top of it all, should they be denied the right to go to school and the prospect of a future simply because they're impoverished? There's something truly dreadful about all of this.

If the experience of Kenya proves anything, it proves that those who have argued for the abolition of fees, as a way of liberating the lives of millions of children, were right. ...In the view of the Minister of Education, the policy is driven by the guarantees contained in the Convention on the Rights of the Child and the internationally agreed principles of "Education for All". ,,,

I don't want to pretend for a moment that there isn't a very tough, hard slog ahead. The new government and the voters understood that abolishing school fees would be costly in financial terms, but the free education campaign slogan said it all: "If you think education is expensive, try ignorance." The Ministry is scrambling to put together the dollars to finance the policy (a government task force announced in March that it would cost $97.1 million through June, and another $137.1 million through the 2003-2004 school year)& a major portion of it from the Kenyan national treasury, part of it from the World Bank, part of it from bilateral donors. ...

For the orphaned children of Kenya, the policy is a salvation. Why, then, is it not in place across the continent? The time has more than come to champion this cause with every Government, and to champion it with unrelenting tenacity. No one should forget that all of the governments in question have ratified the Convention on the Rights of the Child, article 28 of which reads, in part: "Make primary education compulsory and available free to all".

Let me now move to the Minister of Health. Again the conversation was illustrative of a Government determined to break the grip of the pandemic on Kenyan society. This Minister speaks with passionate clarity, knowledge and resolve about the need to proceed simultaneously on care, prevention and treatment. More, in a fashion with few parallels, this is a Minister who understands the appalling toll being taken on the women of her country, and the need to address their extreme vulnerability.

The Government of Kenya has just received money from the Global Fund. The $56 million allocated to the next two years will help to provide anti-retroviral treatment for another three thousand Kenyans. There are roughly seven thousand in treatment now, mostly in the private sector, so that will bring the total to ten thousand. Already the new Government has set a target of 40,000 in treatment by the year 2005.

How will they achieve it? In four ways. First, the Government is examining legislation to introduce a National Health Insurance Plan. It is the intention of the Ministry of Health that treatment for opportunistic infections, and for full-blown AIDS, be covered, at least in part, by the Plan. In my respectful view, that's an astonishingly enlightened and courageous position, worthy of international support. Second, the Government hopes to persuade the private sector to further expand its coverage. Third, the Government has set aside, in this fiscal year, with increased recurrent funding in mind, the sum of $4 million for laboratory infrastructure to address HIV/AIDS, and it is hoped that, inevitably, some of the money will be directed to treatment. Fourth, the Government is even now preparing its next proposal for the Global Fund, which will include financing for the treatment of another ten thousand people. In that regard, it should be added that the Government will wish to purchase generic drugs, from the WHO list of approved anti-retrovirals, probably from India, in order to keep the prices down. This, then, emphasizes yet again the desperate urgency of adequate resources for the Global Fund.

While all of these intentions are truly exciting, and a dramatic departure from the previous administration, it must be pointed out that over two million people are living with the virus in Kenya, and it is estimated that two hundred thousand would qualify for immediate treatment. As always, the gap between need and reality is measured in the appalling foreshortening of hundreds of thousands of lives. With additional resources, Kenya could treat thousands more. With additional resources and a transfer of technology, Kenya could establish an indigenous capacity to manufacture anti-retroviral drugs. When will the resources come? When will the needless carnage end? ,,,

It's hard to convey the startlingly changed atmosphere in the political precincts of Nairobi and by extension, in the population overall. If ever there was a time to turn the pandemic around in Kenya, that time is now. There is no reason in the world, given the commitment of the new Government to tackle HIV/AIDS, why Kenya cannot become the next Uganda. But they'll need lots of help: they must get it.


'Africa Reaps What the World Sows - With a Vengeance'

United Nations (New York)

May 28, 2003

By Stephen Lewis

Washington, DC

Speech by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa, to the Global Health Council's Annual Conference, Washington, Wednesday, May 28, 2003

[excerpts; for full text see:]

I sometimes think that the continent I love, and the continent to which my UN role is devoted - Africa - is under some kind of other-worldly curse. So many factors conspire against it that one could imagine inexplicable forces at work, except that we know, we emphatically know, that every factor haunting Africa has a quite straightforward explanation.

It's the relationship amongst the factors that we sometimes fail to understand. What I therefore want to do in this speech is to make the connections and attempt to demonstrate that Africa reaps what the world sows, and with a vengeance.

In January of this year, along with James Morris, Executive Director of the World Food Program, and a number of UN agency experts, I made a trip to four countries in Southern Africa on the verge of famine: Lesotho, Zimbabwe, Malawi and Zambia. The reason was to explore the link between food shortages and HIV/AIDS. Morris had been there in September of last year and was palpably stunned by the carnage exacted by AIDS. I was there in December of last year, and I was equally aghast at the way in which AIDS was deepening hunger and hunger was deepening AIDS.

The assumption, shared by many, was that drought and erratic rainfall were the primary culprits leading to the food shortages, and that poor agricultural policies and poor planning had made a bad situation desperate. We came to a different conclusion. While there's no question that weather played a powerfully destructive role, there's equally no question that HIV/AIDS was the heart of the matter. ...

In previous episodes of hunger and famine, the toll was taken on the very young and the very old. In this age of AIDS and food insecurity, it is the productive age group in its twenties, thirties and forties who are paying the ultimate price. In previous episodes of hunger and famine, there was always a huge quotient of resilience which allowed beleaguered communities to bounce back. In the present circumstance, even where sound policies are in place, the coping strategies of communities and families are so mangled and eroded by AIDS that full recovery simply isn't possible. .... Inevitably, [this] theory of the New Variant Famine has its detractors. That always occurs with the pandemic: denial is Pavlovian. But I must admit that I have little patience for it.

You need no more than empirical evidence, your own eyesight, your own commonsense to understand what is happening. When one travels through those rural villages and hinterlands, as I have done for the last two years, the human toll is desolating. The immune systems of huge numbers of women farmers are desperately weak; seven million agricultural workers have died of AIDS since 1985, FAO estimates that another sixteen million may die by 2020; the household assets have been exhausted by attending to parental illness; children have been pulled out of school to care for sick and dying parents, losing, in the process, the one meal a day that might have been available from a school feeding program; malnutrition is everywhere evident; fields are left untended; crops aren't grown; food isn't taken to market, and if it is, no one has money to pay for it & what we're talking about here is the way in which this virus - the cause of the most appalling communicable disease in human history - attacks the fabric of every sector, making the interplay of health and agriculture but one more shortcut to carnage. ...

To say that, however, is only part of the story. The other part is indeed the destructive weather patterns which I referred to earlier on. This is where the plot thickens.

The weather cycles for large swathes of Southern Africa are decidedly unfriendly. Even while our mission was traveling, we witnessed violent extremes in individual countries & intolerable heat and drought in one region, massive downpours and flooding in another. ...

What we're dealing with in southern Africa, entwined with everything else, make no mistake about it, is the most ominous environmental threat on the planet: climate change.

What's happening should come as no surprise. Back in June of 1988, I found myself chairing, in Canada, what became known as the first International Conference on Climate Change. It consisted of visceral exchanges between scientists and politicians, with the scientists ultimately prevailing. The conference statement began with one of the starkest pronouncements yet uttered about global warming; a pronouncement with which many would now agree: "Humanity is conducting an unintended, uncontrolled, globally pervasive experiment whose ultimate consequences could be second only to a global nuclear war". The statement then went on to identify a number of damaging consequences of climate change, amongst which two stand out: the direct peril to human health, and the diminution of food security, as a result of uncertainties in agricultural production, particularly in vulnerable regions.

Let it be understood that the findings of that original conference have since been confirmed time and again by the Intergovernmental Panel on Climate Change, a multilateral consortium of several thousand scientists whose words, carefully chosen, are seen - except by professional apologists for corporate and political interests - as definitive positions on global warming.

The 2001 "agreed statement" of the IPCC, in a section specifically devoted to Africa, raises the following concerns: Quote: "Adaptive capacity of human systems in Africa is low due to lack of economic resources and technology, and vulnerability high as a result of reliance on rainfed agriculture, frequent droughts and floods, and poverty". ,,,

These problems must be seen as global, in every sense of the word. So must the solutions be global.

Just yesterday at the White House, there was a celebratory signing of the President's laudable initiative to provide $15 billion over five years to fund the fight against HIV/AIDS. It is no caviling on my part to point out that only $200 million of that large sum is guaranteed, per year, to the Global Fund on AIDS, Tuberculosis and Malaria. The Global Fund is the best new international financial instrument in the last many years to confront these annihilating communicable diseases, AIDS in particular. It was fashioned by experts with a worldwide overview of this vast pandemic, and a clear understanding of how to address it in a coordinated way. The Global Fund has already programmed over $1.5 billion for 150 projects in 92 countries, and it's been programmed in response to proposals submitted by the countries themselves, reflecting a government/public consensus on the priorities within those countries.

And now the Global Fund is virtually out of money. According to the GAO, the Government Accounting Office here in the United States, the Fund needs at least $5 billion for 2003 and 2004 alone, and that money is nowhere in sight. A third round of proposals for the Fund is to be held this October, but you can't approve proposals without the dollars to make them real. The G8 meets in three days' time. There is not a single G8 country which has even pledged, let alone delivered, an equitable amount to the Fund. Will that change next week? I very much doubt it, and even if it marginally does, it will leave the Fund limping into next year, unable to deliver on its promises, and on the huge human expectations which hang in the balance.

It's not possible to rescue the vulnerable countries in southern Africa without the resources. The United Nations can appeal for and distribute food aid to stave off starvation, and it has magnificently done so, but everything is stop-gap, everything is ad hoc, unless the pandemic itself is turned around. What is so intolerable about the continued funding crisis - UNAIDS estimates that we will need, globally, $15 billion a year by 2007 for AIDS alone - is not just the staggering loss of life, so much of it completely unnecessary, but it's what it says about us, the donor nations, and our lamentable, incomprehensible behaviour. Is it that the price tag is simply too high for the world to bear? I think not. This week's Economist gives us a clue to our priorities: the global perfumes industry is worth $15 billion - per year. ,,,

When you're dealing with AIDS, every major international public policy has an impact, and so far those policies are a nightmare for Africa. Official Development Assistance has fallen to abysmal levels. Environmental legislation is hostage to the insatiable lust for resources. North American and European agricultural subsidies doom African agricultural trade. Debt relief for developing nations is a profound disappointment. Despite what was thought to be a breakthrough at Doha, access to pharmaceuticals remains suffocated by patents and intellectual property rights.

We know what we're doing, and we do it anyway. It's as though we have chosen to pursue and protect our own prosperity and comfort at all costs, and then have dehumanized Africa so that we can live with ourselves. It's as though the communities, families, women, children, orphans are figments, illusions, abstractions. We're not barbarians; we don't choose willfully to kill and to maim. But in watching and neglecting and allowing and, incredibly enough, abetting the cumulative loss of life in Africa, which we know we could bring to an end, we have become the latterday King Leopolds of the continent.

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Date distributed (ymd): 030530 Region: Continent-Wide Issue Areas: +security/peace+ +health+ +economy/development+


Message-Id: <> From: "Africa Action" <> Date: Fri, 30 May 2003 14:55:17 -0500 Subject: Africa: Hope and Disappointment

Editor: Ali B. Ali-Dinar

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