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Nepad and HIV/Aids

A recent speech by Stephen Lewis, HIV/AIDS Advisor to Kofi Annan, UN Secretary General
(June 2002, in the run-up to the G8 summit in Canada)
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I've wrestled with this speech for two reasons.

First, I recognize that many people here would wish this keynote to be an omnibus exploration of the perverse and destructive nature of globalization. It will be, but only in narrow part, and only in a particular way. I am appeased, however, by the recognition that you have significant numbers of plenary and panel sessions which will bare the heartless soul of this globalized world for all to see.

Second, what I intend to do instead, is to deal directly with NEPAD, the G8 Summit response and HIV/AIDS, especially HIV/AIDS. I've been travelling through Africa for more than a year now, and it's impossible to emerge unscathed, intellectually or emotionally, by the monumental devastation of the pandemic. But I must admit that to deal with these Summit matters head on raises, for me, some awkward considerations which I'd like to confront directly.

I live two lives: one is speaking within Canada to a variety of groups; the other is the role of UN Envoy on AIDS in Africa. Inevitably the two roles intermingle. But tonight, of all nights, I want to retain at least twelve degrees of separation. Tonight I'm speaking in what diplomacy elegantly calls "my personal capacity".

But of of course there's more. Implicit and explicit in my remarks will be criticism of NEPAD, which gives me some anxiety. NEPAD, after all, has been fashioned within Africa itself, indeed, four African Presidents, the Secretary-General of the United Nations and the head of the Economic Commission for Africa are here to act as advocates for NEPAD. That doesn't compromise my determination to deal with difficult issues; it would be insulting were any of us to back away from intellectual engagement just because the document and its authors are indigenous to the continent. But it does give me pause, because far too often in the past, western criticism has been gratuitous and insufferably overbearing. I should add, I guess, that some of the members of the auspicious African delegation are friends with whom I have worked closely, at one time or another, over the last several years. I have known the Secretary-General for seventeen years now, and I report to him today.

The President of Nigeria, President Obasanjo, is a man for whom I have the greatest regard, and one of the African leaders moving heaven and earth to defeat the pandemic of AIDS --- in fact we have worked together on AIDS in Nigeria --- and it pains me that we should find ourselves at odds. So I confess to all of you that on various grounds, I am somewhat clutched about some of the views I intend to disgorge. That doesn't mean I won't deliver them. It means only that beneath the rhetorical broadsides, there are heavy duty palpitations.

Let me proceed to deal with the issues.

NEPAD --- the New Partnership for African Development --- is a document driven by the fashionable current tenets of liberalized trade, governance, democratization and anti-corruption. They all sound fine in themselves, but I happen to believe that that prescription is faulty; indeed it is reminiscent of many similar analyses of Africa which have gone before, and have come to naught.

I say this with some feeling and a strong sense of history. I vividly remember chairing the first UN session ever held on a single region of the world - the Special Session on Africa in May/June of 1986. After two weeks of gruelling and relentless negotiation we emerged --- even though the western and eastern blocs were still locked into the Cold War --- with a consensus document. That document had similarities to the document of today. African governments undertook certain commitments to change, in response to which the rich nations made certain commitments to resources, trade and the dramatic reduction of debt. That document --- known by the excruciating acronym of UNPAAERD, the United Nations Programme of Action for African Economic Recovery and Development --- was betrayed within months of its embrace. The western commitments took the form of structural adjustment programmes, bogus promises on trade (witness the abject travesty of the Uruguay Round), and dismal debt relief. And that began a procession of similar programmes, within multilateralism, every five years, each and everyone of which made a mockery, on both sides, of the promises so eagerly tendered. It was a culture of willful, mutual, repetitive deceit.

And so we come to NEPAD, for the first time ever a comprehensive programme fashioned by Africa alone. I intend to withhold final judgement on NEPAD overall. I know that there are numbers of people in this hall with strong reservations, but they, as I, hope against hope that it works. I should add that there are those within Africa itself, who argue that NEPAD is intellectually scarred by the inadequate consultation or the absence of consultation at the grass roots. And that obviously gives further pause. It was the North-South Institute in Ottawa that recently produced an excellent monograph on NEPAD, vigorously making the same point about consultation.

On the broad economic and consultative dimensions of NEPAD, therefore, I'm going to leave the debate to others, although there is one matter I must raise. It seems to me that the element of manipulative deceit rears its head again on the question of liberalized trading arrangements. The mantra of the aristocratic patricians of the G8 countries is that trade will set you free. But how in God's name can you promise a liberalized trading regimen on the one hand, while promulgating $190 billion worth of domestic agricultural subsidies on the other? And that's just the United States. Add another $160 billion or more from the European Union, throw in other heavily protected industries, and you effectively deliver a message to Africa that the new round of trade talks under the WTO are a Machiavellian illusion.

It was the Prime Minister himself, just ten days ago in Montreal, who called the avalanche of subsidization an exercise in hypocrisy. It was the Minister of Finance himself, who three days ago took the American Secretary of the Treasury out behind the woodshed to administer a metaphysical beating, so angered was John Manley by the subsidization frenzy. Someone has to explain how the cornerstone of NEPAD, namely liberalized trade, is going to work under present circumstances. I agree with my Prime Minister: it won't work. Why then the self-congratulatory exuberance of the G8 countries? You can't have it both ways: you can't have the announcement of a stirring new partnership on the one hand, when the economic centrepiece is an illusion. You end up with orchestrated hype rather than reality.

A footnote, and I'll move on. In 1988, before I left the UN, I attended a lunch in honour of Michel Camdessus, the then Managing Director of the International Monetary Fund, who explained, in exquisite detail, to several developing country ambassadors, how the emerging Uruguay round of trade talks would be their salvation. I remember vividly to this day the Ambassador of Ghana saying to Mr. Camdessus that it was all transparent poppycock (although it's possible he didn't use those exact words). Mr. Camdessus, hand on heart, promised otherwise. Michel Camdessus was wrong. The Ghanaian Ambassador was right. The Uruguay Round did nothing for Africa. In fact, as is well-known, Africa's terms of trade declined. There is an unsettling resonance between then and now.

But allow me to get to the main burden of my remarks.

It seems to me that there's a critical flaw at the heart of the NEPAD document. For all its talk of trade, and investment, and governance, and corruption, and matters relating to financial architecture, there is only a pro forma sense of the social sectors, only modest references to the human side of the ledger. And in a fashion quite startling, in fact, disturbingly startling, NEPAD hardly mentions HIV/AIDS at all. But how can you talk about the future of sub-Saharan Africa without AIDS at the heart of the analysis? The failure to do so leads to a curious and disabling contradiction.

NEPAD has a number of stunning goals. They are essentially the Millennium Development goals: an annual growth rate of 7% for fifteen years; cutting poverty in half by the year 2015; reduce infant mortality rates by two-thirds; reduce maternal mortality rates to three-quarters of what they were before; have every child enter school who is eligible, thereby re-enforcing the principle of gender equality. A more admirable agenda could not be imagined.

But there's a dreadful conundrum. And it lies, somewhat elusively --- you might almost say in hiding --- in the middle of the document at paragraph 125. Let me quote the two key sentences: "One of the major impediments facing African development efforts is the widespread incidence of communicable diseases, in particular HIV/AIDS, tuberculosis and malaria.

Unless these epidemics are brought under control, real gains in human development will remain an impossible hope". Let me repeat --- and remember, this isn't the gentle ranting of a maniacal socialist; this is straight from the NEPAD text itself --- "Unless these epidemics are brought under control, real gains in human development will remain an impossible hope".

There's actually a faintly comic aspect to this paragraph. Until a recent revision, the original text read that real gains in human development will remain a "pipedream". The word 'pipedream' became too evocative in a text that was otherwise a model of somnambulant bureaucratese, so they dumped it in favour of 'impossible hope'. The meaning, however, remains clear: unless we deal with HIV/AIDS, all the proud declarations of NEPAD are doomed.

I cannot put the case too strongly. There will be no continuous seven per cent annual growth rate in the twenty-five countries where the prevalence rate of HIV is above five per cent --- considered to be the dangerous take-off point for the pandemic --- unless the pandemic is defeated. In fact, it is virtually certain that several of those countries will experience a negative rate of growth year over year under present circumstances. There will be no cutting poverty in half by the year 2015 unless the pandemic is defeated; poverty exacerbates the pandemic, but the reverse is equally true. When family income is gutted as wage earners die, as plots of land are left untended, as every penny goes to the care of the sick and the dying, it is preposterous to pretend that poverty will be halved.

There will be no reduction in infant mortality by two-thirds, unless the pandemic is defeated. How can there be? Two thousand infants a day are currently infected - a certain death warrant - maintaining or elevating the already impossibly high infant mortality rates. There will be no reduction in maternal mortality rates unless the pandemic is defeated. How can there be? We've learned over the years that maternal mortality is one of the most intractable health problems throughout the developing world; in a situation where the health systems are under assault, where hospitals and community clinics can't cope, there's no chance of reducing maternal mortality by three quarters. Seldom has the word pipedream been more applicable.

And there is certainly no chance of putting every eligible child in school, especially the girls, unless the pandemic is defeated. UNESCO has very recently released a study showing that four out of every ten primary school age children are now not in school in sub-Saharan Africa. Young girls are regularly pulled out of classrooms to look after ailing parents. There are thirteen million orphans in Africa, the numbers rising inexorably, huge cohorts of them living on the streets, or attempting to survive in child-headed households after the extended family is gone and the grandmothers are dead. These kids have nothing; they certainly have no money to afford school fees, or books, or uniforms. And it's not just the children, it's the teachers. I was in New York last month for the Children's Summit, sharing a Panel with Peter Piot, head of UNAIDS, when he used the startling figure that last year alone, a million African children lost their teachers to AIDS. The government of Mozambique just issued a statement that seventeen percent of its teachers will die of AIDS by the end of this decade. As I travel, when I speak to Ministers of Education, they haven't the faintest idea how they're going to replace the teachers that are gone, or how they will ever find trained or adequate substitute teachers to fill in for the regular classroom teachers who are off sick for extended periods of time. We're talking about an unprecedented calamity. There's nothing more noble than the objective of putting every child in school, but if the objective is not to be more than some kind of ephemeral mockery, then AIDS must be defeated.

In other words, quite simply, taken all in all, and I emphasize again, taken from NEPAD itself, the development goals of Africa are an "impossible hope" until we have turned the pandemic around.

I remember visiting a little Catholic community centre in Windhoek, Namibia, in February. It was a place where people living with AIDS could network, find a support group, have a meal, try to earn some money through an income generating project. What was the project in that instance? The Sister running the centre took me out back to show me. A group of men were making miniature paper mache coffins for infants, and as they affixed the silver handles, they said to me with a mixture of pride and anguish: "We can't keep up with the demand".

I guess that was, for me, the nadir of this last year of traveling through Africa. This is a sophisticated and knowledgeable audience; I don't have to drive the nail through the wall. It's simply self-evident truth, that in country after country where the pandemic is grievously rooted, the development process has been dealt a mortal blow. The G8 Summit next week is, in a way, the last best chance for Africa. The G8 leaders, straight jacketed in the kind of denial that afflicted the African leaders for twenty years, must make an herculean effort to break free and provide a binding commitment to the continent.

On Wednesday of this week, in the Globe and Mail, there was a brilliant piece of journalism from Malawi by Stephanie Nolen. With a profusion of images and examples which linger in the mind, Stephanie Nolen chronicled the devastation to the continent, some of it irreversible, exacted by the scourge of AIDS. Towards the end of the piece, she wrote: "Next week, when the G8 looks at Africa, the rest of the world will have a chance to look at the bigger picture. There will be much talk of the continent's wars, its corrupt governments and its disastrous economic policies, which keep it mired in poverty. And there will be just as much talk about the great hope that peace, trade, investment and better management can bring to the world's poorest continent. But to assess any of these, and to decide what role the North should play in Africa's future, the leaders of the world's richest nations must grapple with the impact of AIDS as never before. First and last, it has become the dominant force in African development. The reality of AIDS means that nothing short of a new approach to Africa will work".

That argument mirrors the views of the recent remarkable study, from the World Health Organization, authored by Jeffrey Sachs, the noted former Harvard economist, now an advisor to Kofi Annan, entitled the "Report of the Commission on Macroeconomics and Health".

For many years now, some might say decades, the argument has always been that if you generate sufficient economic growth, the health of a society will be secured. It's essentially the old trickle-down theory. Those who explain the current G8 process are making the same argument, indeed embroidering it further to say that AIDS can soak up all our money, but until Africa has investment, trade, pays taxes, and grows, nothing will change for Africa.

In the first instance, no one has suggested it's all or nothing. Surely, even the most elemental pragmatism indicates that a mix is possible. But far more important is the argument of Sachs, based on what seems to me to be irrefutable analysis, that the existing paradigm has to be turned on its head. He says, in part: "The linkages of health to poverty reduction and to long-term economic growth are powerful, much stronger than is generally understood. The burden of disease in some low-income regions, especially sub-Saharan Africa, stands as a stark barrier to economic growth and therefore must be addressed frontally and centrally in any comprehensive development strategy. The AIDS pandemic represents a unique challenge of unprecedented urgency and intensity. This single epidemic can undermine Africa's development over the next generation S".

In this international primer of common sense development imperatives, Sachs is not about to take the developing countries off the hook. He demands of them what the African governments, in NEPAD, demand of themselves: transparency, accountability, good governance. But he requires a quid pro-quo: "The high-income countries would simultaneously commit vastly increased financial assistance, in the form of grants, especially to the countries that need help most urgently, which are concentrated in sub-Saharan Africa". Then, in the only sentence in the report which is italicized, Sachs writes: "They would resolve S i.e., the G8 S "They would resolve that lack of donor funds should not be the factor that limits the capacity to provide health services to the world's poorest peoples".

And therein lies the rub. In fact, therein lies the rot. Sadly, inexplicably, the G8 is guilty of a profound moral default. They simply will not meet the commitments which they have previously pledged - pledged as far back as 1970, when Lester Pearson chaired the committee of the OECD countries which agreed that 7/10ths of 1 percent of Gross Domestic Product, i.e. the famous .7% of GDP, should be the foreign aid quota for the wealthy nations. The present official development assistance equals .22% or $53 billion for the entire developing world. If it were at .7%, it would yield $175 billion today, and $200 billion by 2005. In other words, by any calculation, we would have enough money to staunch the fatal lacerations of AIDS, to provide free universal primary education, and to deal with nutrition, potable water and sanitation. The result would be the virtual eradication of poverty by 2015; the Millennium Development Goals would be exceeded.

Over the last months, days and weeks leading up to next week in Kananaskis, there has been such a proliferation of figures as to make the mind reel. We hear about George Bush at the Financing for Development conference in Monterrey increasing American aid by 50%; we hear about the European Union at Monterrey providing an additional $20 billion; we hear about Jean Chretien increasing the CIDA budget by 8% ad infinitum; we see a Toronto Star headline announcing $60 billion for Africa over the next decade, based on the G8 contributing half of its new foreign aid (whatever that means) to Africa; we see a headline in the Globe and Mail indicating G8 support for a schools package which, according to the World Bank, would be another $4 billion a year; we hear a new announcement from the US President of $500 million, or $300 million, depending on the interpretation, over two years, or three years, depending on the interpretation, for the prevention of mother-to-child transmission in 8 countries, or 12 countries, depending on the interpretation, and so it endlessly goes in a welter of unfathomable arithmetic configurations until the mirrors and smoke sting the eyes with incredulity.

Look, the calculations don't have to be that complicated. George Bush said, at Monterrey, that he would increase American foreign aid by $5 billion overall, annually, by the year 2006. The current level is $10 billion; hence the claim of a 50% increase. The truth is that the increase in American aid, brings them to .15% of GDP, or roughly to 20% of the target. The EU said, at Monterrey, that by the year 2006, it would add, overall, annually, another $7 billion dollars, equivalent to .39% of GDP, or roughly 50% of the target. But let's be clear about what's being said: the United States and the European Union, four to five years down the road from now, will be providing, together, an additional $12 billion is foreign aid annually. That's not today; that's in the future. In fact, if I may put it starkly, another ten million people will have died before we reach those levels of assistance. Nor, by the way, does it all go to Africa. Nor by the way, does it come without conditions.

Jean ChrР№tien said, at Monterrey, that he would increase Official Development Assistance by 8% a year until the level of aid had doubled by around 2008. Alas, our CIDA budget has been so severely cut by the present administration over the last eight or nine years, that to double it over the next eight or nine years will bring it, as a percentage of GDP, roughly back to the level of 1985! There is, to be fair, the promise of a one-shot additional $500 million for Africa, but when that will become available, and over what period of time and for what purpose, no one can figure out.

The truth is that over the next several days, we're going to witness an avalanche of competing figures and contributions, most of which would challenge the beautiful minds of the best mathematicians. Somehow we have to emerge from the G8 Summit with a true and clear accounting of what's been pledged. And I use the word "pledged' advisedly: there has so often been a chasm between promise and delivery that it is truly difficult to trust what is announced. Just look at what has happened to the debt initiative of the World Bank and the International Monetary Fund and countless G7 incarnations of debt relief; just look at what has happened to the guarantee of the eradication of hunger made back in 1996; just look at what has happened to the pledges on universal primary education, dating back to 1990; just look at the gap between promise and fulfillment of the goals which were set at the first Summit for Children twelve years ago, and to bring it right up-to-date, just look at the striking shortfall between the pledges for Afghanistan and the actual delivery.

It's painful to be so skeptical. But history dictates that judgement be suspended until we see what happens twixt cup and lip.

Except in one instance. And for me, albeit not for others, that instance will be the litmus test for the G8 Summit. What are they going to pledge to the Global Fund for AIDS, Malaria and Tuberculosis S the three communicable diseases specifically identified in NEPAD?

Let me provide the context. Last year, at the AIDS Summit in Abuja, Nigeria, the Secretary-General of the United Nations formally proposed the Global Fund, and asked for $7 to $10 billion dollars per year from all sources, but particularly from governments. After a great deal of cajoling and persuasion, the rich nations have contributed, thus far, $2.1 billion dollars, but over three years. I repeat: over three years. At the higher and more realistic level of $10 billion, it then amounts to about 7% of the need over those three years. It's a shocking piece of international financial delinquency, and it's a shocking rejection of Africa. It's so deeply disappointing that words are hard to find.

The Global Fund has an excellent apparatus for the disbursement of monies. It has a Board representing governments of South and North, and civil society, and the private sector. It has the capacity to expertly evaluate individual country proposals. It has the administrative backup of UN agencies. It is already in the process of distributing hundreds of millions of dollars of the $2.1 billion in the coffers. At present rates, it will very soon run out of money.

If the G8 Summit takes NEPAD seriously, if it wishes to make development more than an "impossible hope", if it adds to trade and investment a pledge to rescue the human condition in Africa, if it wants to redeem the Summit process, so tainted by previous posturing and irrelevance, then it will provide a guarantee, year by year, of the monies that Kofi Annan has requested for the Global Fund. In one fell swoop, the entire Summit would then be credible. Jean ChrР№tien will have his legacy, a legacy of principle, compassion and honour.

If, however, nothing, or an infinitesimal sum, is ear-marked for the Global Fund, then a number of countries in sub-Saharan Africa will be in a desperate struggle for survival. The possible neglect of the Global Fund is not conjecture. The New York Times has an editorial today pointing out that the most recent announcement from President Bush involves purely bilateral money, and in the process deals a serious blow to the prospects for the Global Fund. And by the way, the use of the word 'survival' is not mine. It's the word used by African leaders when they addressed the United Nations General Assembly Special Session on HIV/AIDS in June of last year.

One of the interesting things about the Global Fund is that no one ever proposed a schedule of payments, including the amounts that might legitimately be expected from each of the contributing countries. So in the interest of fair play, I'd like to make such a proposal.

Some little time ago, it occurred to me that there was an obvious analogy to be employed. All of the member states of the United Nations have accepted a formula to be applied to the budget of the UN and to its peacekeeping operations. The formula is based on population, and per capita income and other relevant indices. Simply put, it provides a scale of contributions in which each country pays a given percentage of the UN budget and the UN peacekeeping budget. In the case of Canada, that's 2.579% per annum. We've accepted the calculations as valid, we've always paid the equivalent dollar amount in full and on time, as have other countries. Even the United States, although lamentably delinquent in its payments, has accepted the existing formula.

It seems to me logical, therefore, to apply the formula, universally agreed upon, to the Global Fund. After all, it is a Fund suggested by the Secretary-General of the United Nations. The calculation then becomes remarkably simple S if, for Canada, it's 2.579% of $7 billion, that amounts to 180 million US dollars per annum. If it's 2.579% of $10 billion, that amounts to 250 million US dollars per annum. As it happens, the Canadian Centre for Policy Alternatives just this week issued a statement which includes the calculations, based on the same formula, for the other G8 countries. It would be an act of extraordinary statecraft, an act that would truly revive a sense of international idealism, an act that would restore hope to an entire continent were the leaders of the world to make such a commitment.

At the end of Jeffrey Sach's stirring exegesis, he says: "There is no excuse in today's world for millions of people to suffer and die each each year for lack of 34 dollars per person needed to cover essential health services. A just and far-sighted world will not let this tragedy continue".

Alas, it is not a just and far-sighted world.

Let me be clear: while the situation feels apocalyptic, it can be addressed. AIDS has done and is doing terrible things to Africa, but we know how to defeat it. That's what drives me crazy S we know how to defeat it. We know all about voluntary counseling and testing; we simply have to train more counselors and get rapid testing kits into the hands of those who administer the tests. We know all about the prevention of mother-to-child transmission.

We know about the wonder drug nevirapine; one tablet to the mother at the onset of labour, one tablet during the birthing process, one dose of liquid equivalent to the baby within hours of birth and transmission of the virus can be reduced by up to 53%. We know about anti-retroviral treatment, the so-called drug cocktails that keep people alive. Largely as a result of competition from generic manufacturers in India, Thailand and Brazil, the cost of "ARVs" has dropped dramatically, but no matter how dramatic, the drugs are still beyond the capacity of Africans to afford when people live on less than a dollar a day. But it could be afforded through external financing, and it is one of the gruesome iniquities of the present situation that people are dying, everywhere, in huge numbers, unnecessarily. We know about prevention, particularly in the key youth communities aged 15 to 24. Through what they call peer counseling and peer education, using music, dance, drama, drums and poetry, questions of sexuality and condoms and abstinence and behaviour change are confronted in a fashion so explicit, so real, so frontal as to take your breath away. What has to be done of course, is to generalize prevention programmes throughout any given country, that is, to take prevention to scale. And it's possible if only Africa had the resources. We know about care at community level, where the sickness and the dying takes place.

The women of Africa, in particular, are incredibly sophisticated at the grass roots, with networks of community-based and faith-based organizations to provide care and compassion and love where there would otherwise exist only isolation, stigma and fear. In this instance, adequate resources would serve a two-fold purpose. Voluntary 'home-based care' as we now know it, is really conscripted labour for women, an extension of gender oppression, the kind of oppression which, along with the absence of sexual autonomy, and predatory male behaviour, has made AIDS a gender-based disease. Fifty-five percent of the new infections are amongst women. If we had the money, we could encourage a network where men and women together provided the care, and women could assert their sexual and reproductive rights. We know about the strength of the associations of People Living With AIDS; we know about National AIDS Councils and National AIDS Control Commissions; we know about five-year plans; we know about dealing with high risk groups --- truck drivers, commercial sex workers, mobile populations --- we now know about engaging political and religious leadership S we know, in short, enough about the pandemic to turn it around.

To be sure, there are vexing, sometimes overwhelming problems of infrastructure, and overwhelming problems of finding the human capacity to do the job. When funerals are more pervasive than any other form of social gathering, when hospital wards are chambers of horrors, the life force of a society is slowly being strangled. But as I stand here, I genuinely believe, to the depths of my being, that we could save and prolong millions of lives, if only we had the resources to do so.

Let me end on an intensely personal note. Over the last few days, people have told me --- not unpleasantly --- that I get very emotional about the subject of AIDS in Africa. Some of my good friends worry about my psychological equanimity. I guess, in part, men are supposed to be stoic and bravely unfeeling, or at least self-contained.

I make no apologies for the occasional emotional catharsis. I can't help it. All my adult life, along with countless colleagues, sometimes in partnership with people of other ideological beliefs, I've raged against injustice. But I've never seen anything like this. I don't know how to get a grip on it. I don't know how to make sense of it. Is the behaviour of the western world just appalling insensitivity, is it unacknowledged racism, is it sheer unbridled indifference, is it the comfortable assumption of hopelessness in order to avoid contributing money; is it possible that the political leadership is completely out of touch with the vast populations --- like the people of Canada --- over whom it holds sway?

I feel so angry and so impotent simultaneously. I privately wish that the African leadership had openly confronted the G8 on the issue of AIDS, rather than muting its impact within NEPAD. I know how tough it is to ask for money --- Africa is asking for $64 billion a year, most of it from outside --- to finance NEPAD, so it's intensely human and political not to want to disconcert your donors. But that makes it far too easy for the donor nations.

I carry around with me the images of young mothers, sitting on makeshift benches, in the shade under a tree, fifteen or twenty at a time, all of them exhibiting AIDS-related symptoms, and urgently, with great dignity, asking who will care for their soon-to-be-orphaned children, asking about medicines for straightforward opportunistic infections, asking about treatment, and so help me, I can't give any answers.

Somehow, this G8 Summit has to be a turning-point. Africa is coming to us, pledging reform, asking for help. If we raise it to the intellectual and academic level, it really does become a question of globalization. Can globalization respond to global issues? If we see it at a human level, it demands from all of us the best we have to give. I note that the Secretary-General of the United Nations has recently written to the G8 leaders saying, in part, "The peoples of the developing world (will be) bitterly disappointed if your meeting confined itself to offering them good advice and solemn exhortations, rather than firm pledges of action in areas where your own contribution can be decisive". And by contribution, he includes dollars.

On another occasion, writing the preface to the Declaration of Commitment which emerged from the HIV/AIDS Special Session last year, the Secretary-General said:

"In the war against HIV/AIDS, there is no us and them, no developed and developing countries, no rich and poor --- only a common enemy that knows no frontiers and threatens all peoples. But we must all remember that while HIV/AIDS affects both rich and poor, the poor are much more vulnerable to infection, and much less able to cope with he disease once infected. The leadership and commitment shown in this declaration will (allow) the millions of suffering (to) know that the world is finally summoning the will --- and committing the resources to win this war for all humanity".

Interesting that he uses the metaphor of war. In times of war, everything is a national emergency. In times of war, every apparatus of the state is conscripted into battle. In times of war, resources are somehow found that are thought not to exist --- just think of the so-called war on terrorism, with scores of billions of dollars hurled into the fray overnight to avenge the horrendous deaths of three thousand people. So explain to me why we have to grovel to extract a few billion dollars to prevent the deaths of over two million people every year, year after year after year?

Why is the war against terrorism sacrosanct, and the war against AIDS equivocal?

In the answer to that question lies the challenge for NEPAD and the true test for the G8.

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