Appeal to ROTARY - 2004 There have been numerous appeals for a hugely meaningful global effort to fight HIV/AIDS, one of the most dramatically moving is that of Stephen Lewis, the UN's Special Envoy for HIV/AIDS in Africa, given to the luncheon meeting of the Rotary Club of Toronto, Canada, on January 9, 2004. The Australian AIDS Fund Incorporated and AIDS Information services is reproducing that speech on this website as a measure of our support for a special initiative - that Rotary International might take up HIV/AIDS as its next global challenge with the same magnificent spirit that it took on and helped shatter global polio. But the challenge is there for everyone and even the power of just one alone has been shown to move mountains and more. We will also seek Rotary International's President - Nigeria's Jonathan B. Majiyagbe (pictured left) for his response to Stephen Lewis's invitation.

We've acompanied this speech with a specially designed variation of the international 'red ribbon' insignia for HIV/AIDS simply using two human hands. It's the work of 25 year old Israeli artist, Shai Swissa, who offered it to us.

First: Not long ago, I had occasion to speak with an infectious disease specialist in New York City. She was telling me that she had followed the entire course of the HIV/AIDS pandemic, for its more than twenty-two years, and for the first fifteen years, what she remembers most vividly is sitting in shadowed hospital rooms, holding the hands of mothers as they watched their sons die.

And then she stopped talking, contemplatively silent for a moment or two, and added: you know, all my patients in treatment are flourishing today. They're gaining weight, feeling well, working, enjoying their families. In fact, I can't remember when I last attended the funeral of one of my patients. I thought to myself: those words capture, vividly, the greatest double standard which besets the modern world. In the west, HIV/AIDS, with drugs, has become a chronic illness. In the high HIV prevalence countries in Africa, where I do my work for the United Nations, funerals are the leitmotif of life. Attending funerals is a painful and ubiquitous national activity. Three million people died of AIDS last year, the vast majority in Africa. There are an estimated fifteen thousand new infections every day, the vast majority in Africa. Dealing with death, anticipating death, preparing for death, are eerily measurable components of a country's Gross National Product.

Photo by Stephanie Nolen

I was stunned. No one in Africa had ever said that to me before. But you see, Botswana has money. Reserves of wealth from diamonds, and it has a remarkable public-private partnership with Merck and the Gates Foundation, each of which has contributed $50 million, and it has state
of the art laboratory facilities orchestrated by Harvard, and it has a health infrastructure of reasonable integrity, and most important, it has unprecedented commitment from the government. At the Princess Marina Hospital in the capital city, Gabarone, 5,700 people are in treatment with antiretroviral drugs; the largest public sector programme of its kind on the continent. And it's free for all, because that's government policy. It's an astonishingly impressive initiative, demonstrating what can be done if the circumstances are propitious, although it must be said that even with the infrastructure and the resources, there have been lots of difficulties along the way, and for a variety of reasons, treatment has progressed far more slowly than the Government of Botswana would have wished.

The problem, however, is, that with the possible exception of parts ofSouth Africa, no other country in sub-Saharan Africa has even the approximation of the setup in Botswana. And again, with the possible exception of South Africa, no other country in Africa has the resources, let alone the infrastructure or capacity of Botswana. Botswana has shown what can be done; but at the moment, no one else comes close. So treatment is a mirage for millions.

At some point in the future, historians are going to look back at this period and ask, quite simply, how in God's name the world allowed this to happen? Over twenty million people have already perished, the vast majority in the developing world. It's of the same genre as General Romeo Dallaire's question: how did the world stand by and watch the genocide in Rwanda without lifting a finger? There seem to be these historical moments, these historical periods when moral resolve either freezes or evaporates. It's not just unconscionable; it's inexplicable.

The excruciating truth is that the pandemic need not have come to this. If the African leadership, early on, had not been consumed by denial and fear, if the industrial nations, early on, had made resources available,
if the world had been energized around the pandemic as it has been energized around Afghanistan, Iraq and terrorism - the unequal distribution of war and compassion drives me crazy - then millions of people would still be alive today, and millions of others would have a fighting chance of prolonging life, and you wouldn't have between eleven and fourteen million orphans, no different in any way from your children
and mine, from your grandchildren and mine, wandering the landscape of Africa, bewildered, forlorn, anguished, abandoned, exploited, hungry, despairing . cared for by grandmothers or older siblings or communities already reeling and further impoverished by the impact of AIDS. It's a real shock to the system to encounter these orphan kids. Early last month, improbably enough, I accompanied Oprah Winfrey on a tour of orphan settings in and around Lusaka, Zambia. Oprah wants to extend her unrivalled, powerful voice to the cause of African children orphaned by AIDS, and I could see, as we travelled from one orphan environment to another, that even Oprah Winfrey, with her cosmic sophistication, was shaken to the core by what we saw. These are children who are losing, or have lost, their childhood.

In many of the countries of east, central and southern Africa, the clock is ticking backwards. The development gains of the last decades are in reverse; the major millennium development goals which the United Nations
set for 2015 will never be reached. Life expectancy in many countries has dropped from an average age of 60 to 62, down to age 37 to 40. Can you imagine it: losing over 20 years of longevity in roughly a decade? Infant mortality rates are up; children are leaving school to care for sick and dying parents; whole sectors of society - agriculture, health, education, the private sector are diminished and compromised by the loss of the most productive age groups. It is an astonishing tribute to the people of Africa - their resilience and their determination - that countries continue to function, heroically, even as they are assaulted by the pandemic.

When you're on the ground in Africa, watching the pandemic unfold, it's hard not to be gloomy, to be despairing. People are so lovely; death is so pervasive. The needless loss of so many lives, especially the young women in their late teens, and twenties and thirties, victims of a brutal gender inequality. It's all so heartbreaking. And yet it would be wrong of me not to acknowledge the glimmers of hope as we enter 2004.

Finally, resources are inching upwards from many sources; finally, we're going to have a concerted programme of treatment, led by a rejuvenated World Health Organization, determined to put three million people into
treatment by 2005 (3 by 5 is the catch-phrase). It's indescribably exciting, finally we've moved the price of anti-retroviral drugs, generic drugs, down to a level of roughly $150 per person per year, so that African governments, with the help of external resources, can begin prolonging human life; finally, the superb examples of successful prevention initiatives, in Uganda and Senegal, have captured the imagination of the continent; finally, the issue of orphans is being addressed, even if not yet solved; finally, finally, there is a growing,
irreversible recognition that the pandemic has a woman's face, and that if women and girls are not empowered, above all in the control of their own sexuality, the pandemic will never be broken; finally, there is a new energy within the international community, almost palpable, which suggests that this year may see a breakthrough.

But there's something else I want to say that I've never addressed in a speech before, and for which omission, I am deeply self-conscious. I feel frankly ashamed that I haven't yet embraced the full logic of certain arguments. I think inevitably one gets so caught up in the emergency of the here and now, that perspective is dimmed. The terrible reality is that with the best prevention programmes in the world - and many of them are truly inspired at community level - we're still facing several million new infections all over the planet, not just Africa, every year. And an equal reality, which must be faced, is that it's going to take generations to change male sexual behaviour, if ever. And as everyone surely by now understands, treatment itself will prolong life, but it's not a cure. So so much of what we're doing in response to the pandemic, while monumentally vital, will not, ultimately, subdue it. The question then that must be asked is why such limited focus, in speeches and advocacy, is given to the matter of a vaccine? I'm going to try to deal with that in speeches over the next number of weeks and months, but for the moment allow me merely to say the chillingly obvious: only a vaccine will write an end to the pandemic. Until that day comes, we will forever count the bodies.

Stephen Lewis, the UN's Special Envoy for HIV/AIDS in Africa. Photo by Brenda Barton, WFP

Just yesterday, in New York, I visited the offices of IAVI, the International AIDS Vaccine Initiative, headed by its creator, a remarkably intelligent and charismatic CEO, Seth Berkley by name. IAVI is actually an NGO - non-governmental organization - which in only five years has managed to put together the largest number of
public/private vaccine trials on the ground in developing countries.

Only the pharmaceutical company Merck, rivals IAVI in the energy with which a vaccine is currently being pursued. Seth Berkley points out that in the 23 years of the pandemic, only one potential vaccine has gone to
phase three, human trials (unsuccessful by the way), a situation which he describes as crazy. And when you begin to probe the reasons, it's not simply because of the huge scientific complexity - although that is
undoubtedly a major factor - but like so much else with AIDS, it's also a matter of resources and priorities and political will, although it must be said in this forum that Canada to its credit is one of the largest contributors to the Vaccine Initiative (which is not to say that the contribution is sufficient).

As things now stand, even with the best possible results of the various trials underway, we're still several years away from a vaccine. And every year the infections mount and the lives are lost in the millions. It seems to me a matter of the most elemental logic that the political and scientific establishments, in developed and developing countries alike, should be maniacally obsessed with the quest for a vaccine.
Despite the magnificent efforts of IAVI, the issue still lacks the profile it must have. Something, somewhere, is deeply, profoundly, out of whack.

And that brings me to the conclusion of these remarks, with special reference to Rotary. The current issue of the New Yorker magazine carries an article titled "The End of Polio; a disease on the edge of extinction". The article, in fascinating exposition, describes how, over fifteen years, millions of lives have been rescued from death and paralysis by the unremitting campaign of immunization, led by WHO and UNICEF, to wipe polio from the face of the earth. It will be achieved by 2005. But the article also faithfully points out that Rotary has contributed well over half a billion dollars to the campaign, earning the kudos and recognition which accompanies a magnificent contribution to human well-being.

Rotary International needs another cause. Forgive my presumption if I say that the cause should be HIV/AIDS, and Rotary Canada could well be the advocate body that makes the case at the international level. And if you want a focus, in addition to the inevitable work on the ground, perhaps that focus can be on a vaccine. I know that there are already Canadian members of Rotary who are pursuing the international possibilities.

But I can add, in an intensely personal way, that you are also making an extraordinary contribution to the Foundation which bears my name. When my daughter and I decided to establish the Foundation in March/April of last year, we had no idea that Rotary, and the unions and the churches, and what feels like a legion of individuals would be so profoundly generous. The Foundation has now received in that relatively brief space of time, over a million dollars, with minimal solicitation, and we're getting the money out as responsibly and quickly as possible to a number of grass-roots projects in several countries, addressing issues of palliative care, and orphans, and yes, grandmothers, and associations of people living with AIDS . fundamentally all of the groups who are so vulnerable and so incredibly poor, and yet can perform miracles of human intervention with a few thousand dollars.

It makes me proud to be a Canadian. There's a real yearning in this country often expressed through Rotary to extend a hand of help to the uprooted and disinherited of the world. People are so intensely caring, so intensely generous, wanting to make a personal difference as a kind of antidote to the cynicism about governments. I hope that that cynicism changes, and quickly, but until it does, all of the wonderful Canadian NGOs and Foundations, who make such a difference in the lives people lead in developing countries, are truly worthy of support.

In terms of the Stephen Lewis Foundation, I can't thank you enough. I'm 66 years old; I've had the privilege of working in politics, diplomacy and multilateralism: I've never encountered a cause more consuming than
the battle against HIV/AIDS.

Thank you.

For information about the Stephen Lewis Foundation, please visit:
www.stephenlewisfoundation.org