|
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
http://www.unaids.org/fact_sheets/files/Dev_Eng.html and
http://www.unaids.org/publications/documents/economics/agriculture/ADF_slides2.ppt.
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, http://www.fortune.com/fortune/2000/11/13/afr.html). 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
(http://www.unaids.org/epidemic_update/report/Table_E.htm).
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
(http://jama.ama-assn.org/issues/v284n5/ffull/jmn0802-5.html;
http://www.cnn.com/HEALTH/9903/18/aids.africa/). 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,
http://www.usatoday.com/life/health/aids/africa/lhafr011.htm).
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
(http://www.unaids.org/wac/2000/wad00/files/WAD_epidemic_report.htm). 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"
(http://www.unaids.org/whatsnew/press/eng/pressarc00/geneva200700.html).
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
(http://www.panos.org.uk/aids/access_media.htm). 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
(president@whitehouse.gov; see http://www.whitehouse.gov/ for
phone/address/fax information), Vice-President
(vice.president@whitehouse.gov), your Senators and Congressperson (you can
find contact information for your Senators and Representatives at
http://www.visi.com/juan/congress/), 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.
Yours,
Eric
"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
Back to Better World.
|