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Witness to Africa's 'Death Spiral'

Stephen Lewis, UN envoy to the AIDS ravaged continent, reflects on Canada's role in the face of "constant, pervasive death."

Scott Deveau 15 Jun
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Stephen Lewis was meeting with the cabinet of Swaziland when that country's minister of labour leapt to his feet. "Mr. Lewis, you don't understand. We're wall-to-wall with orphans in this country.  Do you know, Mr. Lewis, that we have a significant number of child-headed households where the age of the child leading the household is six?'"
Lewis, the UN Secretary General's special envoy for HIV/AIDS in Africa, might be excused for becoming numbed to such moments. His shock remains fresh.
"Now someone please explain to me, what kind of grotesque aberration of a society and a family is that?" Lewis recently asked a rapt audience at a convocation of social science graduates at the University of Victoria, where he was honoured with his 19th doctorate of laws.
Lewis said the people who were infected in the late 1980s and early 1990s in Africa are now dying in unprecedented numbers and crippling the continent. These people make up the bulk of what Lewis refers to as the "death spiral" in Africa.
In 2003, the UN estimates 3.5 million people died from AIDS worldwide; 2.4 million of those deaths were in Sub-Sahara Africa alone - more than 6,500 Africans a day.
Women now account for 60 per cent of the new HIV/AIDS cases diagnosed in the past two years. But perhaps the most disheartening part of the pandemic is the estimated 14 million orphaned children living in Africa.
Lewis reflected sullenly on his three years as envoy in an interview before his convocational address.
"It's not a long time, but emotionally it's a very long time.  Emotionally I was not prepared for this. I wasn't prepared for the death, the constant, pervasive death. That may have been naive on my part." The following is the rest of his conversation with The Tyee.
Do you feel like we're making progress in Africa?
There is no doubt that people are more aware and that the levels of denial and the silence and the stigma are diminishing. 
But having said that, when you travel to Africa now in the high prevalence countries it's still heartbreaking.  People are still dying in unbelievable numbers and there is a sense that treatment is always on the horizon but never yet in place. 
So, while I want to feel the optimism that I know is intellectually valid, it's really hard to feel it when you're on the ground watching people struggle to survive. 
I suppose the basic answer is that I haven't really sensed a powerful and qualitative change and I especially haven't felt it in two critical areas; one, women - the appalling vulnerability of women and the disproportionate number of infection amongst women, is for me, the worst part of the pandemic.  And then this huge number of orphans, which no one anticipated and for which the world has no preparation.  
We've dealt with all kinds of things in this world from famine to earthquakes to terrible conflicts to wars; we've never dealt with what will be 25 million orphaned kids under the age of 18 by 2010.  The more people die, and we're just on the verge of the death spiral, the more the orphan reality will be overwhelming.  These kids feel abandoned, angry, bewildered, and desperate for love and they don't have it. 
AIDS is such a complex phenomenon and its got so many ingredients and people are so pummeled by it - you lose your household income, you take a little girl out of school to take care of her sick and dying parents, a lot of orphaned kids can't get into school because they can't pay the school fees, they don't have food to eat.  Grandmothers are looking after their grandchildren after their own children. The whole rhythm of life is ripped apart.
Does Canada come close to contributing the 0.7 per cent of its GNP that it promised at the Pearson Commission in 1970 for international aid?
We're nowhere near.  We're at 0.28 (per cent) by the last count.  But the 100 million we gave to the World Health Organization for 3-by-5 (an initiative to get three million AIDS sufferers antiretroviral treatment by 2005) was truly an important thing to do, because it allows WHO to put pressure on other donors to match the Canadian contribution, which they are now doing.  They're not matching it yet, but the pressure is on.
Do you see any other contributions coming from the federal government?
Well, I don't know. They also doubled their contribution to global fund for AIDS, tuberculosis, and malaria and it also has the drug legislation (allowing for the production and sale of generic drugs). 
So, on balance, Canada has not done badly,  at least by way of intention.  But the levels of contribution are still not what they should be. But it's clear that Paul Martin is curious about this and he may still make significant contributions.
What ever happened to the rumors of you getting back into domestic politics?

I think whatever happened was they were just rumors.  I want to do this job until there is a breakthrough.
Given the federal election underway, which party do you think would best represent Canada in your cause?
I don't want to be drawn in politically. I don't want to do that.  I do, obviously, vote New Democrat and I will vote New Democrat until they lay me in the grave.  But I'm not going to allow my ideology to stop me from acknowledging that the government did a good and important thing.  And I think a lot of people from my party acknowledged it at the time.  And so it should be.
But the truth is, as much as Canada might do, you have to get a lot of other countries onside.  You have to want to persuade the world that we have a calamity the likes of which we have never seen before, and we're headed for a catastrophe - I mean we already have a catastrophe - we're heading for an apocalypse if we don't turn it around because it is spreading to China to India to Russia to the Central Asian Republic to the Caribbean, Haiti, Dominican Republic, and Jamaica.
When does it come to the point that Western nations can no longer turn a blind-eye to what's going on?
I think we're getting there, I think we're really close.  I don't know why it's taken so long; it has taken more than 20 years.  I think that governments in the West are suddenly aware that you can't simply wipe off a continent. 
I mean what's going on here? Six or seven hundred million people suddenly don't count for anything.  It reminds me a little of the Rwandan genocide you watch while 800,000 people are slaughtered in 100 days and the world raises not a finger.
Or in Sudan now?
And Sudan.  In Darfur in Sudan.  The Eastern Congo.  There are dreadful things happening in northern Uganda and the world is not fully engaged.  The Security Council for the first time in the last day or two commented on Darfur and asked for the laying down of arms.
The world has been paralyzed on these issues and it's been paralyzed because essentially the international community is run by one dominant power, which is entirely preoccupied with Iraq.  When its not run by the dominant power, it is run by the five permanent members of the Security Council, who have many competing interests and its hard sometimes to get their attention to the human condition.
Is about raising awareness or about raising resources?
It's about everything.  It's about raising awareness every time you have the opportunity to do so.  It's about hammering governments to free resources because if they gave 1/100 of what they are giving to the war on Afghanistan, Iraq, and the reconstruction of Iraq - they're spending over $200 billion by the end 2005 - and you can get a minute fraction of that for the pandemic. 
It's about hammering away relentlessly until finally you break through.  You never know, no one would have predicted that Canada would amended the patent legislation on the manufacturing of generic drugs.  No one could have predicted that.
Are we focusing too much on war?
We are preoccupied with war, and that's a mistake because there is something else happening in the world that is far more dangerous in the long term. 
Why do you bring celebrities into the fold?
You do that when everything else fails.  If you can't get your political leaders to get engaged, then you get Oprah Winfrey and Bono and Clinton and Mandela and you attempt to raise the consciousness of the world by drawing on your celebrity figures.
After bringing in people like Oprah, do you see spikes in contributions?
Mostly what happens with the Oprah stuff is what happens with Oprah.  After she made her two visits to South Africa and Zambia, they got $6.5 million after airing their one-hour program. 
Why isn't Canada carrying a larger international presence?
You do get a sense from Paul Martin that he wants to play a greater role. I think Chrétien was largely indifferent. It was hit or miss.  It was ad hoc. If the occasion demanded a foreign policy speech, he made it. If there was a meeting of the G8, he did it.
But Martin has more international experience through the UN.  He has chaired the group of nations called the G20.  He has had some significant experience.  You get the sense that he wants to do more in a variety of ways.  I don't know if I would agree with the policies, but you get a sense that he wants to do more. 
But it will take a long time for us to restore our place in the world, because it was the same Paul Martin, who, as finance minister, dramatically reduced our foreign aid contribution. So dramatically over so many years that we lost the respect of a lot of developing nations, we lost our voice. He would argue that it was necessary, as he did.
I'm pleased to see that he has decided in his incarnation as Prime Minister rather than Finance Minister that what he is doing is repairing this… There is a clear indication that he's going to take the foreign policy role seriously, and I say all that not knowing the outcome of the election.
Do you see Stephen Harper doing the same?
I don't want to talk about that.

Scott Deveau, a Victoria based journalist writes regularly for The Tyee and has contributed to the CBC, the Courier, and the Vancouver Island Newsgroup's papers.

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