Stephen Lewis
23 November 2007
(Page 2 of 2)
For me, the Epidemic Update, 2007, is simply a symbol, a symbol of insufficient leadership, within the United Nations, against the pandemic of AIDS. The time has come --- we're just a week away from another World AIDS Day --- for the new Secretary-General to throw the full weight of his office behind a campaign to subdue the pandemic, with a particular consuming focus on Africa.
The agenda lies in the UNAIDS report.
For example, one of the most startling statistics is the revelation that women now constitute 61% of the infections in Africa … close to 14 million women infected. There are no words. It's a catastrophe rooted in gender inequality, and everyone in the highest citadels of the United Nations knows it, but virtually nothing changes.
We have a report from a High-Level Panel on UN Reform, pointing out the lamentable UN record on women, and recommending the creation of a new international agency for women. The proposal lies dormant on the order paper of the General Assembly, crying out for leadership from the Secretary General. The Deputy Secretary General has spoken, strongly and bravely although, given the inevitable and nasty internal rivalries, her words are too often given to rhetorical sleight-of-tongue.
Where is the UN Secretary General when the AIDS pandemic rages, and the women of Africa need him most? No one pretends that the women's agency is the sole answer, but you can bet that things would not be so excruciatingly horrendous if women had an international vehicle to draw upon, with resources and voice.
So, too, women in conflict zones. My colleagues and I carefully watched the Security Council debate on Resolution 1325 just a couple of weeks ago, and have read carefully the proceedings of the Security Council debate this week on the protection of civilians in armed conflict. The speeches are getting better: more feeling, more informed, more urgent (that is particularly true of the Undersecretary General for Humanitarian Affairs; on the other hand, the Secretary General's speech last Tuesday on the protection of civilians in armed conflict was so pro forma as to make one weep. He managed to mention Sudan, Somalia, Afghanistan, Iraq and a passing aside to Darfur. Not a syllable on the Democratic Republic of the Congo). When you have a savage war on women, as in the DRC, with huge implications for transmission of the AIDS virus, speeches are the road to hell. When will the United Nations actually take hold? There are suggestions cited of the Secretary General leading a new campaign to eliminate violence against women. I recently saw an early draft of this potential Secretary General initiative, and I can categorically say that in more than twenty years of association with multilateralism, I've rarely seen anything more vapid, fatuous and insubstantial. It was as if the illusion of progress, dressed up in the Byzantine underworld of United Nations processes was sufficient unto itself. Public relations for inconsolable grief.
The Epidemic Update report acknowledges that only in a few instances has behaviour change played a serious role in the reduction of the numbers. In fact it says that the differences in estimates "result largely from refinements in methodology rather than in trends in the pandemic itself." There is no question that a small proportion of the decline stems from changes in behaviour, but there is equally no doubt that the vast majority of the difference lies in the methodological adjustment.
Now, then, is the perfect time to rally the UN community to the side of prevention, with much greater focus on high-risk groups; on the increasingly persuasive thesis of concurrent partners; on the roll-out of male circumcision (which should have been pursued vigorously much more quickly, but like so much else in the response to the pandemic got caught up in the overweaning proclivity for excessive scientific inquiry when the case is already clear, not to mention the faint hearts in the face of potential controversy); on harm reduction around which there has been inexcusable ambivalence; on the Prevention of Mother to Child Transmission, possibly the easiest preventive intervention of all, and therefore the most grievous emblem of multilateral negligence; on the absolute, resolute need to pursue, with unflinching tenacity the continued quest for a microbicide and a vaccine, regardless the setbacks. This is the time for a crescendo of United Nations voices.
The Epidemic Update is also shocking in the information that 76% of the overall deaths lie in Africa: one million, six hundred thousand adults and children. It tells you everything you didn't want to know about the painfully slow rollout of treatment, and how vital it is that keeping people alive not get lost in some senseless, artificial tension between treatment and prevention. Nor should we ever forget where so many of the deaths come from, and how silent were the voices of the United Nations leadership while President Mbeki pursued his fatal denialism. South Africa has far and away the highest number of HIV infections in the world: five and a half million. There are eight hundred to a thousand deaths a day. No one has ever been held to account. Talk about impunity.
And as always, there's the question of resources. It's hard to know how the donors will react to the new numbers published by UNAIDS. They may simply yawn, and give whatever they intended. They may feel bamboozled, and want to cut back. They may see possibilities in the reduced numbers, possibilities of greater progress because fewer people are involved. Whatever the reaction, we must somehow persuade the world that we're way behind, billions and billions of dollars behind, when it comes to funding all the components of the pandemic, from orphans to second-line drugs.
All of these elements, so many of them flowing generically from the Epidemic Update, are the stuff of the United Nations. UNAIDS, the Joint UN Programme on HIV/AIDS, oversees or coordinates ten co-sponsors: UNHCR, UNDP, UNICEF, WFP, UNFPA, UNODC, ILO, UNESCO, WHO and the World Bank. That's a compendium of multilateral aristocracy and power rivaled in influence only by the G8 and the International Financial Institutions. And yet, members of the UN family, in the face of the AIDS pandemic, have sometimes acted with a kind of catatonic passivity. There is no excuse for it.
More than twenty-five years into the pandemic, we have an epidemic update that is --- let's face it --- horrifying in its implications. Whether it's 40 million or 33 million, this plague continues to ravage humankind. I simply do not believe that the United Nations has done everything it can possibly do to turn the tide. And I don't mean just the member states, I mean the agencies and the secretariat.
I'm a multilateralist to the core of my being. But that doesn't mean that the UN is above criticism. And it most emphatically doesn't mean acting as an apologist for those who are chosen to lead and who have failed to lead.
* Stephen Lewis, the former UN Special Envoy for HIV/AIDS in Africa, is co-director of AIDS-Free World, a new international advocacy organization (www.aids-freeworld.org).
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