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Global Health Matters

May - June, 2008  |  Volume 7, Issue 3

AIDS Expert Challenges Western Apathy

Stephen Lewis, a former diplomat and co-founder of AIDS-Free World, delivered a passionate lecture on global efforts to end the pandemic at Masur Auditorium recently as part of Fogarty International Center's 40th anniversary celebration. Lewis described the plight of sub-Saharan countries struggling for survival, mired in a cycle of disease and despair both caused by and resulting from AIDS.

He cited violence against women, educational discrimination against girls, Western apathy, political barriers to the delivery of existing AIDS services along with limited and, in some instances, ideological rather than accurate prevention information as contributing to the death of 2.1 million Africans and the infection of 2.5 million in 2007 alone.

The result is millions of orphans being raised by grandmothers or no one at all. "I don't have the words sufficient to convey the sense of carnage and the toll that has been taken in sub-Saharan Africa," he told the audience of several hundred, including NIH Director Dr. Elias A. Zerhouni, Deputy Director Dr. Raynard S. Kington and Fogarty Director Dr. Roger I. Glass.

"It is beyond the capacity of the mind to absorb...It's a panorama of such heartbreaking and vexing inexplicability that the world stood by and watched the extraordinary deterioration of a continent, with millions of people dying unnecessarily," said Lewis, who has been Canadian ambassador to the United Nations, deputy executive director of UNICEF and the U.N. secretary-general's special envoy for HIV/AIDS in Africa.

Despite the gloom, Lewis said, "The beauty...of speaking here at NIH and under the auspices of Fogarty is that, necessarily, it's the research...which underpins the legitimacy of the advocacy." He suggested, for example, that learning how to communicate effectively about sexually transmitted diseases to young Africans is "a subject worthy of exploration." The U.S. contribution to the AIDS emergency in Africa, through the President's Emergency Plan for AIDS Relief (PEPFAR), which includes the U.S. contribution to the Global Fund Against AIDS, Tuberculosis and Malaria, is expected to increase to $50 billion over five years and is the largest amount from any single country. Yet Lewis said that the world's wealthiest country still isn't carrying its fair share, and in a just world, American governmental funding would be even higher. Lewis warned that AIDS, beyond threatening the survival of sub-Saharan countries, could undermine the health and social fabric of other nations as well, unless industrialized nations provide more assistance.

Uganda, the touchstone of progress when AIDS prevalence fell from 20 percent to five percent, is seeing the rate inching up again, he said. Fifty percent of African children born with HIV die before age 2, and 80 percent by age 5, he said. In the United States and other rich countries, access to drugs that can be administered during childbirth have all but eliminated transmission of the virus to newborns.

Not one to mince words, Lewis said that preventing mother-to-child transmission, which should in theory be 99-percent-effective, is not happening on a large scale, which he says raises the question, "Why is the life of an African child worth so much less than the life of a Western child?"

"I am an apologist for the United Nations but I'm also deeply, deeply disappointed in the inability of the international community to come to grips with what has happened," he said.

Lewis concluded on a positive note: "Those of you who care about these issues, particularly in an environment like NIH, with research scientists, with people who understand and bring voices to it...can make a tremendous difference." A recent report by the WHO, UNAIDS and UNICEF said that in the past four years, the number of people in low- and middle-income countries receiving antiretroviral treatment has increased more than seven-fold.

Since leaving the world of diplomacy, Lewis helped establish and co-directs AIDS-Free World, a new international AIDS advocacy organization, based in the United States. He is also a professor in global health at McMaster University and a senior advisor to the Mailman School of Public Health at Columbia University in New York.

For more information, visit www.aids-freeworld.org.