The AIDS Crisis: Time for Action

Date: Thu, 25 Jan 2001 20:43:48 -0500 (EST)

Dear All,

The new Administration in Washington may be surprised to learn it, but combating the global HIV/AIDS pandemic will be its most important achievement. It has to be.
It is important to make clear to the new Administration from the outset that it must take dramatic steps to do its part to put a stop to the AIDS pandemic. However, the Administration and the Congress that it will be working with will not move this issue to the front of their agendas without pressure from their constituents -- that is, unless they hear from you and me.
Every day, we have a choice. We as a society can choose to say, "Enough." Enough of a world where it is taken as a given that millions of people will die every year because they happen to be poor. With the AIDS pandemic, our choice takes on a special moment. The disease is wreaking havoc in sub-Saharan Africa in unprecedented fashion, and it has the potential of visiting similar destruction on other parts of the world. If we further delay in implementing a massive response to the AIDS pandemic, we will be doing more than condemning the present; we will also be condemning the future. To no small degree, we already have.
Unlike most epidemics, AIDS strikes people at the prime of their lives. The victims of AIDS are those who form the foundations of society -- mothers and fathers, farmers and workers. The victims of AIDS are not only the millions that the disease kills, but also the millions that it leaves behind in a crippled society. Improved education and health services are central to lifting the world's most impoverished regions out of poverty, but teachers and doctors and nurses are dying. (For more information on the effect of HIV/AIDS at a societal level, see and The latter site requires PowerPoint.)
You can begin to understand how AIDS can threaten society itself by looking at some of the numbers. Botswana has the highest infection rate -- 35% of Botswanan adults (ages 15-49) are infected. Half of all 15-year-olds in Botswana, South Africa, and Zimbabwe are expected to die of AIDS (The Independent (London), 11/26/00). Indeed, if the plague continues apace, 85% of Botswana's current group of 15-year-olds will ultimately die of AIDS (Brian O'Reilly, Death of a Continent, Fortune, 11/13/00, You read that figure correctly. Elsewhere in southern Africa, about 20% of adults are infected in South Africa, Zambia, and Namibia, 25% in Zimbabwe and Swaziland, 24% in Lesotho, 16% in Malawi, and 13% in Mozambique. The Democratic Republic of Congo, Ethiopia, Kenya, Mozambique, Nigeria, South Africa, Tanzania, and Zimbabwe all have more than 1 million people infected with HIV (
Life expectancies in much of sub-Saharan Africa have plummeted -- by as much as three decades in Botswana and Zimbabwe, and by a decade or more in countries including (but not limited to) Kenya, Lesotho, Malawi, Mozambique, Rwanda, Swaziland, and Zambia (; If the epidemic continues on its present course, the life expectancy in Botswana will fall to 29 years by the end of the decade, and to under 35 years in Namibia, Swaziland, and Zimbabwe (USA Today, 7/11/00,
Worldwide, more than 36 million people are infected with HIV, about 70 percent of them in Africa. The pandemic has killed over 21 million people since it began, including 3 million people last year, about 2.4 million of them in sub-Saharan Africa. Africa is estimated to have seen 3.8 million of the world's 5.3 million new HIV cases in 2000 ( The number of orphans in Africa is rising rapidly. There are about 13 million orphans today (Fortune, 11/13/00).
The response to this crisis, both of the countries with high infection rates and of the international community, has been far too little, far too late. With several notable exceptions, such as Uganda and Senegal, countries with or threatened with high infection rates have been slow to respond to their own people's needs. This is difficult to explain. Perhaps in part it is because they are in denial, in part because of the stigma associated with HIV, in part because a full response to the crisis would require resources that the countries do not have (though redirecting money from their militaries could go a long way).
The international community's response has been unconscionable. In July 2000, Dr. Peter Piot, head of UNAIDS (the Joint United Nations Programme on HIV/AIDS), observed, "In sub-Saharan Africa alone, we need a minimum of $3 billion a year if we are to turn back the tide of the epidemic, but we are spending only a tenth of that" ( Since that time, there have been modest increases. For example, the U.S. increased its funding by about $100 million in its most recent budget -- it will spend about $315 million this year to fight AIDS internationally see the Foreign Operations, Export Financing, and Related Programs Appropriations Act, 2001). The World Bank has pledged $500 million over the next three years.
The $3 billion per year that UNAIDS has estimated is needed for prevention and care efforts in sub-Saharan Africa is far below what actually needs to be spent. Most strikingly, it does not include treatment for the vast majority of people infected with HIV, though AIDS is treatable -- medications can enable HIV+ people to live free of AIDS possibly indefinitely. What is more, treatment is necessary for prevention, because people will tend to avoid learning their HIV status when there is nothing to be gained from this knowledge -- but with discrimination widespread and harsh, they do have much to lose. People unaware that they are HIV+ (and probably want very much to believe that they are not infected) can be expected to take fewer precautions against spreading the disease than would people who were aware of their status.
Nor does the $3 billion estimate include creating the health care infrastructure -- building clinics, training doctors, etc. -- that is necessary for treatment, both of HIV itself and of opportunistic infections. And while the crisis in sub-Saharan Africa is most pressing, funding must be made available for other poor regions of the world, such as India, where 4 or 5 million people are already infected with HIV, a number that is growing rapidly. Like sub-Saharan Africa, health infrastructures are poor and few people can afford anti-retroviral therapy at current prices.
So how much should the United States and other wealthy nations be spending on the global AIDS crisis? This is a difficult question to answer precisely, as it depends heavily on the price at which anti-retroviral medication is available and on the cost of building up the health infrastructures in Africa (and elsewhere). The price of medication must come down considerably. While the price of medication is a complicated issue, suffice it to note that special situations bring special responsibilities. What might not ordinarily be expected of even well-intentioned businesses becomes the responsibility of those businesses when so many lives are at stake, and the companies have a special capacity to produce medications that cannot alone solve the crisis, but without which the crisis cannot end. Some efforts are underway to decrease prices and expand access, but there is a very long way yet to go and not much time to get there.
Estimates of the cost of building health infrastructure are very difficult to come by. One very rough estimate notes that even if impoverished countries were to spend only about 1/10 of what wealthy nations spend on health care -- but 10 times what the impoverished countries are currently spending -- the cost would be about $150-200 per person per year, or close to $10 billion for Nigeria alone ( Nigeria has about 1/6 of the population of sub-Saharan Africa.
It is safe to say that the annual spending should be well over $10 billion, possibly five or six times this amount, or more still, depending to a large degree on how much must be spent on health infrastructures and whether medication becomes available at significantly lower prices. As the world's richest country, the United States should pay a significant share of this sum. Neither money nor the actions of wealthy nations can alone end this pandemic. But without the money, people around the world who are trying to stop this pandemic, people who would speak not just of a dying continent but, closer to their homes, of their dying communities, cannot succeed in their efforts.
Accordingly, I urge you to write/call/fax/e-mail the President (; see for phone/address/fax information), Vice-President (, your Senators and Congressperson (you can find contact information for your Senators and Representatives at, and other policymakers. Perhaps you will want to contact leaders of other countries, or of international organizations that could contribute, like the World Bank. In your communications, consider the scale of response that is required.
As you know, such communications must be sustained and widespread if they are to get the attention of government officials. So consider writing your representatives in government more than once. Write today, tomorrow, next week, next month, write again and again. Without being intrusive, I hope you will understand, then, if I send occasional reminders asking this of you.
Also, please pass along this message, either in its spirit or its words. Let your family, friends, and colleagues know about the AIDS pandemic, and ask them to write to or call their government officials to demand action. And ask your family, friends, and colleagues to spread the word to people they know.
Over six decades ago, boatloads of refugees fleeing nazi Germany were turned away from the shores of the United States and other countries. The refugees had no choice but to return to Europe, where many of them perished in the Holocaust. The AIDS pandemic, particularly as it is striking sub-Saharan Africa, represents the boatloads of refugees of our generation. We could again turn our backs. We could again say that they are not our problem, that they are Africa's problem, or India's problem. Or we can take action. We can say, "Enough." For a continent is dying on our watch.
Thank you very much for your time, your efforts, and your patience.



"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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