AIDS in Africa

Date: Mon, 17 Jan 2000 21:32:57 -0500 (EST)

Dear All,

In Tuesdays with Morrie, a book of "an old man, a young man, and life's greatest lesson," Morrie (he is the old man) relates a story:

"The story is about a little wave, bobbing along in the ocean, having a grand old time. He's enjoying the wind and the fresh air -- until he notices the other waves in front of him, crashing against the shore.
"'My God, this is terrible,' the wave says. 'Look what's going to happen to me!'
"Then along comes another wave. It sees the first wave, looking grim, and it says to him, 'Why do you look so sad?'
"The first wave says, 'You don't understand! We're all going to crash. All of us waves are going to be nothing! Isn't it terrible?'
"The second wave says, No, *you* don't understand. You're not a wave, you're part of the ocean.'" (pp. 179-80)

Part of our ocean is dying. The red tide of AIDS threatens to suffocate much of Africa. The people who live on the continent of human origin face a catastrophe that, like any large-scale disaster, can be described in numbers, but only understood one person at a time. One death at a time. One orphan at a time. One newborn, born with AIDS, at a time.
Here are some of the numbers: The 21 countries with the highest HIV/AIDS rates are all in Africa. (See NYT, 1/16/00, A11) About 10 million Africans have died of AIDS; in 1998, 2.2 million died. Another 23.3 million Africans are now infected with HIV/AIDS. AIDS has left 10-11 million African children orphans. Life expectancy in Africa, peaked at 59, and is now in decline, is expected to fall to 45 between 2005 and 2010 because of AIDS. (See
AIDS in Africa is even more than an individual tragedy multiplied by millions of lives lost, of parents lost, of children lost, of friends lost. As UN Secretary-General Kofi Annan noted earlier this month, "By overwhelming the continent's health services, by creating millions of orphans and by decimating health workers and teachers, AIDS is causing social and economic crises which in turn threaten political stability. In already unstable societies, this cocktail of disasters is a sure recipe for more conflict. And conflict, in turn, provides fertile ground for further infections." (UN Press Release, SG/SM/7275, SC/6780, Jan. 6, 2000)
I do not much like the word "stability." It seems very impersonal, removed, hardly the real object of our concern. But in this case, instability has the most real and tragic of consequences. Instability means not only that are people dying -- it means more will die.
Instability means that the noble waves will crash against the shore before they have the chance to understand that they are a part of the ocean, and before they have an opportunity to get to know and appreciate the sea of humanity and existence in which we all swim. Instability means that the longer AIDS ravages much of Africa, the longer that too little is done to halt this epidemic, the more difficult it will become to heal the suffering AIDS brings to Africa. Instability means that society slowly (or not so slowly) begins to crumble. Families take an unnatural form -- children with no parents. Already struggling economies lose workers in their prime. More teachers die from AIDS than can be trained to replace them. In countries that are moving towards more democratic and law-based systems of government, judges and government officials are dying. (See And as the social fabric rips apart and conditions worsen, as members of organized armed forces become casualties of AIDS, leading to a security breakdown, armed conflicts will likely increase.
What can be done? Ideally, of course, there would be strong prevention efforts to keep people free of HIV/AIDS today free of HIV/AIDS tomorrow (ultimately including a vaccine), and there would be widely available, powerful medications to treat those for whom prevention efforts fail or are already too late. At present, a wide-scale treatment program is probably not feasible. The complicated pill-taking regimen, the difficulty of complying with it, the side effects, require better health infrastructure than now exists in most of Africa.
What can be done now? At the least, countries need funds to invest in their health care systems so it will become possible to use drugs effectively, and in turn, a wide-scale treatment program will become feasible. There must be increased efforts at creating an AIDS vaccine. Perhaps most importantly at present, there must be prevention efforts, which to a large degree means efforts to educate people about HIV/AIDS -- from the very practical of what it is and how to prevent it to the deeper lessons that will remove the stigma from HIV/AIDS.
Education can make a difference. No country in Africa has focused more on AIDS education than Uganda, where new HIV/AIDS cases have dropped significantly. In the 1990s, that country halved its HIV/AIDS infection rate; it is now about 10%. (See (See also -- the peak infection rate in Uganda may have been as high as 30%.)
Earlier this month, at a special UN Security Council meeting on AIDS in Africa, the U.S. pledged to increase its contribution to the worldwide campaign against AIDS by $150 million next year, to $325 million. It is a start. I do not call it a good start; would you call one bandage offered for such a gaping wound a good start?
When part of our ocean is in such critical condition, it is sad this is all we offer. The United States' own ambassador to the United Nations called AIDS the number one problem facing Africa. The number one problem in a continent that is more impoverished and has more armed conflicts than any other continent, and this is all that the richest nation in the world can offer?
According to Dr. Peter Piot, Executive Director of the Joint United Nations Programme on HIV/AIDS (UNAIDS), $1-3 billion a year is needed for effective prevention programs in sub-Saharan Africa. In 1997, all of $165 million was spent on prevention in the most affected countries. (See Perhaps never has so much been at stake -- in terms of lives and the collective future of a continent -- on the success of an education program.
The education effort must be heroic in scope. It must reach all levels of society -- including Africa's leaders. When an African conference on AIDS took place in Zambia this past September, not one of 16 invited African leaders attended. (See That many of Africa's own leaders have failed to acknowledge this horrific problem -- though more are beginning to acknowledge it -- is not a reason to give up or say, "If they don't care, why should we?" On the contrary, it is the reason for an even more vigorous education campaign, one that not only teaches facts, but also breaks down stigmas and alters social norms. (See When Ronald Reagan avoided the subject of AIDS, the answer was not to join the President in his silence, but rather to talk even louder so that our nations' leaders had to hear.
I urge you to write/e-mail President Clinton, Vice President Gore and others in our government to greatly increase American funding of the worldwide effort against AIDS, to spend what needs be spent to enable all of sub-Saharan Africa to have effective prevention programs, to speed the day scientists succeed in creating a vaccine, to spread programs that prevent mother-to-child HIV/AIDS transmission throughout Africa, to invest in the health care systems so that it will become possible not only to prevent, but also to treat. The U.S. is currently involved in all of these efforts, but to a degree that is unconscionably small when compared to the magnitude of the problem.
Will your notes to the White House or Capitol Hill have an impact? Maybe yes, maybe no. But the only way we can have even a chance of being heard -- in this or any matter -- is by speaking up, by raising our voices. For if we are silent, we know that our silence will only be met by silence, by inaction. Recall the words of the man we honor today, Martin Luther King, Jr. He said, "We will have to repent in this generation not merely for the hateful words and actions of the bad people but for the appalling silence of the good people." So do not be silent.
Since the more we speak, the louder we speak, the more of us who speak, the more likely it is that we will be heard, you are welcome to pass along this message (and other Better World e-mails). And, of course -- by e-mail, or just by talking with your friends and family -- please pass on to others your own thoughts about what is developing into one of the greatest tragedies of our lifetimes. Let your fellow waves know that part of our ocean is dying, and ask them to help you do something about it.
You can find a list of nonprofit organizations involved in the campaign against AIDS in Africa and their addresses at And as always, thank you for taking the time to read this message.



"I have only dreams: to build a better world, a world of harmony and understanding, a world in which it is a joy to live. This is not asking for too much." -- Yitzhak Rabin

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