The Pandemic and the Blue Lady
With over two dozen heads of state, hundreds of health ministers and another 2,500 representatives from civil society, nongovernmental and grassroots organizations having descended on New York for the first ever United Nations Special Session on AIDS, two things have become horrifically clear.
One is that the AIDS crisis is a global crisis. Thirty-six million people are living with HIV or AIDS today. Twenty-one million have died. Of that number, 75 percent have perished in sub-Saharan Africa. And 95 percent of those currently infected have no access to treatment, largely because their governments are poor and rich governments are stingy.
Two is that the AIDS crisis requires swift and immediate action -- and that swift and immediate action rarely comes from the United Nations. Though UN Secretary General Kofi Annan announced in April the creation of a global fund to finance the fight against AIDS -- urging governments, foundations and corporations to come up with $7-10 billion annually -- so far, a measly $500 million plus has been raised. The U.S. has pledged $200 million from foreign aid previously earmarked by the Clinton administration. France has offered $127 million; Britain $100 million. The Bill and Melinda Gates Foundation handed over $100 million in mid June.
William Roedy, president of MTV Networks International and chair of the Global Business Council on HIV/AIDS, had the courage to point out on one UN panel that western governments and businesses spent $100 billion on Y2K, whereas no more than $1 billion was expected to be raised by the same group by the end of the year for AIDS. That did not really answer the question by a youth activist from Swaziland about the intertwined problem of poverty and AIDS (or how he and his friends might find decent employment), but it did put the state of the AIDS crisis in perspective.
AIDS on its 20-year anniversary is like a tightly wound ball of thread quickly gaining girth as it gains speed on a precipitous slope. There is still no cure, but since 1987 there has been a treatment -- AZT -- and since 1996, a means to prolong life: the AIDS cocktail, which, thanks to generic drug companies like Cipla in India and pressure from activists on Big Pharma, may soon cost as little as $1 a day for poor countries, compared to the $150 daily price tag of a year ago.
Yet an available treatment has raised almost as many problems as solutions. Now that the triple cocktail has proved effective, the dark question remains: Who will get it? And if the AIDS cocktail is widely distributed, the lateral question is: Will new strains of AIDS develop should inadequate funding and decrepid health care systems result in administering the drugs incorrectly?
For the moment, in the absence of billions in aid, only the first question is being answered: those with health insurance living in wealthy countries will get the drugs. Konstantin Lezheatsev, a Ukrainian physician from Doctors without Borders, told me that of the 300,000 people in his country infected with HIV, only 50 are receiving anti-retroviral treatment. One of the untreated was standing at his side: a hallowed-out 34-year-old named Volodya Zhovtyak, who showed me, with an appropriate Russian curse, the stamp he received on his passport at U.S. customs to indicate he is infected. He said he expects to die.
AIDS workers like Lezheatsev talk quickly because, for them and their patients, time is running out. They race on with gruesome statistics, tragic anecdotes and a sense of utter frustration. But, just as rapidly, they point out that drug treatment is not the only challenge.
Participants in the UN special session tended to agree that combatting AIDS requires a three-pronged approach: drug treatment, preventative education and economic development. Should the $9 billion global AIDS fund coffers be filled this year, the UN plans to allocate half for prevention with measures like distributing condoms, educating young people and reducing mother-to-child transmission. The other $4-5 billion will go toward AIDS drug treatment and fighting opportunistic diseases like tuberculosis and malaria that occur among AIDs patients.
But there is still a lot of ambivalence, especially among AIDS workers, that the UN will be able to understand the wider dimensions of the crisis or get whatever money the superfund receives away from bureaucrats and into the hands of the needy. Martin Mosima, who came to the UN on behalf of the Botswana Network of AIDS Service Organization, made circular, sweeping motions with his arms as he talked about the need in Botswana for "universal access" -- to food, water and regular health care.
"What's missing from the UN's Declaration of Commitment on AIDS," said Mosima, referring to the central document of the UN conference, "is language that addresses all the development problems swarming around AIDS. We need debt relief from donor countries, so that we can spend more money on health care. We need funding, not just for drugs, but for food and basic amenities. We need a whole new infrastructure to adequately deal with this disease." According to the Harvard AIDS Institute, 85-90 percent of the 15-year-old boys in Botswana will die of AIDS before they reach the age of 40 "unless something is done."
That "something must be done" was felt by everyone milling in the airless halls of the United Nations. Roundtable discussions were held on HIV prevention and care, the socioeconomic impact of AIDS, HIV/AIDS and human rights, and international funding and cooperation. But the atmosphere tended to be as stale as the air, as government officials delivered mostly droning speeches to mostly empty auditoriums about the need to empower women, improve AIDS education, overcome prejudice and find funding.
Part of the frustration for those working at the grassroots of the AIDS crisis was that the General Assembly's plenary discussions, in which the Declaration of Commitment was being hammered out, were closed to all but a handful of civil society representatives. "Everything's already been decided," said Eric Sawyer, a New York representative of the AIDS activist group Act Up. "It's a non-meeting, a photo op by people who aren't doing anything."
During one fairly riveting General Assembly negotiation, however, in which nine Muslim countries objected to hearing testimonies from civil society representatives on the transmission of AIDS by IV drug users, sex workers and homosexuals, the UN representative from Norway said, "This is really a fight about the soul of the UN. If there is one area in which we need civil society participation, it is on the issue of AIDS."
Eventually, after hours of bureaucratic back-and-forth, the motion to prevent a representative from the International Gay and Lesbian Human Rights Commission was voted down. "We won," said Scott Long of the IGLHRC. "It is precedent-setting that homosexuality will be discussed at the General Assembly within the context of AIDS and human rights."
In this day of MTV bump-and-grind videos, Internet porn and gay television characters it may seem ironic that a disease transmitted through sex is proliferating because of taboos about sex. But for Muslim nations, as well as the U.S. government, there is tremendous fear that sexual information will lead to sexual licentiousness -- and those fears were ultimately part of the drag-down effect at the special session.
"One of the main problems with this disease and the U.S. government's policies toward it is no one is willing to talk about sex," said Ruth Messinger, the former Manhattan Borough president, who now heads the American Jewish World Service.
A good many African heads of state were in agreement. Pascoal Mocumbi, prime minister of Mozambique, argued: "We must summon the courage to talk frankly and constructively about sexuality. We must recognize the pressures on our children to have sex that is neither safe nor loving and provide them with information, communication skills and, yes, condoms."
No such explicit language was included in the final version of the UN Declaration of Commitment on HIV/AIDS, because, for example, in Mauritania condoms are all but illegal and in rural Kenya wife sharing is the norm. But the declaration is groundbreaking in that it frames AIDS not solely as a medical issue but as a political, economic and human rights threat. There is also hope, and some evidence, that the declaration will provide a foundation for future action and that the UN special session will serve as a catalyst for combatting the AIDS crisis.
On June 26, for example, the U.S. government announced it would drop its WTO litigation against Brazil for planning to make generic anti-AIDS medicine, which basically leaves pharmaceutical companies unprotected from demands to deliver drugs to poor countries. Earlier in June, the Coca-Cola Company offered to use its enormous distribution network in Africa to carry information and medicine throughout the continent. Ford Motors, which is one of the largest private employers in South Africa, where one in five adults are infected, is providing anti-retrovirals to its employees and their immediate family for free, as is Daimler Chrysler. The Credit Suisse Group recently gave the global AIDS fund $1 million, no strings attached.
So a new era may be dawning for the AIDS crisis, one of corporate initiative and responsibility. Standing in the rain at an AIDS march in New York, Juliette Beck, of the international human rights organization Global Exchange, called the AIDS crisis the "ugliest aspect of corporate globalization" and said it was high time multinationals began sharing more of their wealth.
This may not happen on the level Beck and other activists hope, but what seems possible is that wealthy corporations, free to talk about sexuality and fearful for their reputations, will respond quicker to the AIDS crisis than governments or the UN.
"As AIDS creates more poverty and deepens inequalities, it fuels the growing public backlash against globalization," said Kofi Annan in an address to the U.S. Chamber of Commerce in June. He added: "This sentiment will only get stronger and more widespread if we don't show ourselves determined to mount a really serious response."
It seems Annan will do whatever he can to tackle the global AIDS crisis. The quickly arranged UN special session, however symbolic, is testament to that. But his global AIDS fund goes beyond symbolism. He knows, as do people like Lezheatsev, who calls the fund the the "virtual Annan project," that the crisis will spiral out of control without at least $10 billion annually.
So let's hope the UN can be a sprightly blue lady rather than a drooping, middle-aged one. More than 50 years after its creation, the United Nations faces an ultimate test with AIDS. If it fails to stem the spread of the disease, it will become not just a symbol of world governance but a symbol of world inefficacy. And there will be millions of deaths to attest to that.