Stephen Lewis is a renowned and vigorously outspoken Canadian diplomat who has worked extensively to reduce the impact of HIV/Aids in Africa and to advocate for those living with the disease.
Formerly the special envoy for HIV/Aids in Africa for United Nations Secretary-General Kofi Annan, he is now chairman of the board of the Canada-based Stephen Lewis Foundation, which endeavors to ease the pain of HIV/Aids in Africa by funding grassroots projects. Lewis is also co-director of Aids-Free World, a new international Aids advocacy organization based in the United States.
In a wide-ranging interview with AllAfrica's Cindy Shiner, Lewis discussed current efforts to fight HIV/Aids and how Africans are coping. This is the second of a three-part series.
Do you feel the international community is doing enough now to address HIV/Aids in Africa?
No, they're not. It's much better than it was three to five years ago but the international community still is not galvanized enough in sufficient support of Africa to respond to the pandemic. If it were we would long ago have supplied much more help in the replenishment of the lost human resources… [and] in the repair of health infrastructures.
We would have years ago put in place the prevention of transmission from mother to child [of the virus] during the birthing process. We would have invested much more in the orphaned children. We still have millions of people in need of treatment. It's unlikely we will reach the goal of universal access to treatment by 2010.
What is your view of the President's Emergency Plan for Aids Relief (Pepfar), the 50-billion-dollar initiative of the Bush administration in the United States?
Everybody is so shocked at getting a sizeable amount of money that they forget that there are tremendous flaws in Pepfar, most of which are destructive towards women. The amount of money is not sufficient and they should be clamoring for much more instead of this endless acting as a cheerleader for the administration.
Do you have some specific examples of ways in which you say it falls short?
Pepfar still insists that up to 50 percent of the preventative monies be spent on abstinence and fidelity when abstinence clearly isn't a choice for so many women, not only young women who are already sexually active, but women in marriage. Fidelity isn't the problem of the women in marriage; it's the problem of the men in the marriage … It's an outrageous continuation of an ideological weapon wielded by an administration which is reactionary and out of touch with the real world.
Then there is the prostitution gag rule, where you can't work with sex workers when in fact they are a high-risk group with whom organizations must work. That's another attack on women. And then there's the fact that you can't do reproductive and sexual health in conjunction with work on HIV/Aids when obviously the two are inexorably linked. That's another attack on women.
Here you have a piece of legislation where the money is inadequate and the flaws are all rooted in misogyny… in attacks on women. People are applauding it as if it's some sort of contemporary Marshall Plan. That's crazy and it should be seen for what it is – both inadequate and irresponsible in many respects.
What do you think should be done?
People should demand more – much more. No one denies that when you pump several billion dollars into a response it will mean something. Of course it will; millions of people will be treated. That's terribly important.
But that's what we deserve to expect from the United States. You don't kneel down before a country because it's doing… something that the world has a right to receive. The American administration is so discredited, George Bush is such a lamentable president, that when anything of a positive kind happens people are prostrate at the unlikelihood of it and they shouldn't be.
The defining reality is that the United States is spending somewhere between 12.5 and 15 billion dollars a month on the war in Iraq and people are celebrating the fact that [it] will spend 10 billion dollars a year to fight the three worst communicable diseases in the world, which collectively have taken between 30 and 50 million lives. In the case of Aids alone there are 33 million people living with the virus.
So the distortion of priorities for conflict rather than human need is grotesque. People should not be cheering the United States for giving a pittance for fighting disease but should rather be asking: how can you be giving so little to the human condition and so much to the perpetuation of war?
How about the response of the United Nations to HIV/Aids in Africa?
There is just so much more to be done. Frankly, one of the things that is inadequate is the United Nations agencies. Some of it is bewildering.
For example, you get the Minister of Health in South Africa (Dr. Manto Tshababala-Msimang) attacking and dismissing circumcision as a preventive technology. Here you have three determinative studies, definitive studies, we have UNAIDS and WHO encouraging male circumcision as a way of reducing transmission and you get an attack on it by the minister of health in South Africa. Where is the United Nations' voice? Why haven't they taken on the minister? Why haven't they said what should be said, which is that she's effectively dooming people to death and it need not be done? You have to have a much stronger voice of advocacy from the United Nations in dealing with disease and related matters.
What's going on in Congo, the terrible war on women, the terrible sexual violence and rape … you have more and more women turning up HIV positive. Where is the involvement of the United Nations? Where are they on the ground? Unicef is the only agency that appears to be doing anything of a serious kind to protect the women or to work with the women on the ground in Congo.
All of these agencies, these ten agencies that are involved in UNAIDS, why… isn't there an emergency plan being put in? It wasn't the United Nations that brought down the [antiretroviral] drug prices, it was the Bill Clinton Foundation… [which did it] by getting the generic drugs from India. Why should it have been a foundation rather than the world multilateral institution?
So when I say the international community [should do more], I mean above all the G-8, but I also mean the United Nations itself.
How would you gauge the response of the private sector to HIV/Aids?
It is very uneven. There are some major multinational corporations that do good things for their workers. They provide testing, counseling and treatment and do some work in the community. I honor them for that, salute them for that. But there are many, many companies in the private sector that refuse to get involved and won't acknowledge the impact of the virus.
And the private companies have never given to the Global Fund to Fight Aids, Tuberculosis and Malaria, what should have been given. I think this year signaled the first year that there was a significant financial contribution from a multinational company and that's from Chevron… which has given 30 million dollars over five years. Bono has raised more from the Red Campaign than has been given by the multinational corporations out of their own philanthropic envelopes and that's just ugly, frankly.
The multinationals should be much more conscious of their commitment. I've always believed that they should be giving 0.7 percent of after-tax income as part of a philanthropic contribution to mirror the target of the governments.
Will you be naming companies specifically as part of your advocacy work, pointing out which ones that you feel have not contributed sufficiently?
There is no question that we will be challenging the behavior of the private sector and multinationals. Everybody now uses the phrase "corporate social responsibility" and that seems regularly to apply to questions of climate change and global warming. It should equally apply to health and disease.
To what extent might addressing international trade practices have an impact?
If we got a fair international trading regimen, a fair set of property rights that wouldn't put the profits of pharmaceutical companies above respect for human life, if we really did forgive all of the debts that should be forgiven, then countries would have a much greater chance of reaching the Millennium Development Goals.
The crisis for Africa is compounded by the refusal of the G-8 to achieve the 0.7 percent of gross national product for foreign aid. As Jeffrey Sachs has pointed out, if we got to 0.7 percent we would generate a sufficient amount of foreign aid to be able to meet virtually all of the Millennium Development Goals… instead of falling so painfully short on everything from primary school education to maternal mortality and malaria and tuberculosis and HIV.
The basic problem is dealing with poverty, health and the consequences of conflict. All of those areas are sabotaged by the refusal to contribute the foreign aid which we committed ourselves to back in 1970 and have betrayed now for 30 years, always making promises, always betraying the promises.
I don't want to seem to be a curmudgeon. I don't want to be seen refusing to acknowledge what has been achieved. Obviously much more is going on than there was three or four years ago. But I cannot cleanse from my mind the fact that from 2000 and 2006, when death was so pervasive throughout Africa, when everything was spiraling out of control as a result of the infection, the international community responded so very slowly and so pathetically and inadequately to the carnage that should have triggered an emergency response and never did, for whatever reason. I don't understand. I'll never understand it.
Do any countries stand out as shining examples of what other nations should be doing in the battle against HIV/Aids and achieving the Millennium Development Goals?
Norway and the United Kingdom, those two in particular, and France is beginning to move up the ladder. They really set the example. If the United States was doing anything comparable to the United Kingdom we'd already be routing the diseases and the poverty, we'd be reaching the Millennium Development Goals.
The United Kingdom is moving determinedly towards 0.7 percent by 2013. They've made that commitment and they're moving towards it. They've got a huge amount of money, which they're dispensing in every direction. All of it seems to me to be intelligent. They're funding critical areas and because they have been increasing the percentage of GDP every year in every budget it's made a very significant difference.
France is moving towards the 0.7 percent. They have more and more money, which they're pouring into Francophone Africa.
Norway has just announced this billion dollar program over 10 years for maternal and child health. Norway's official development assistance is greater than Canada's, and Canada has 35 million people and Norway has 4.5 million people.