Feature Story

Stephen Lewis

"The Central Issue Of Our Age"

On May 17, 2007, Stephen Lewis delivered the following remarks upon acceptance of the Doctors of the World - USA Health and Human Rights Award:

During five and a half years spent in the role of Special Envoy for HIV/AIDS in Africa, I ricocheted between hope and despair on a constant basis.

As I look back on it now, I see some incremental progress on treatment, painfully, painfully slow. I see some marginal progress in the range of preventive interventions. I see how the world is struggling to discover preventive technologies, whether it be a vaccine or a microbicide or the use of male circumcision. I see that in the field of children and orphans, some of the international agencies are finally summoning their determination and energy to respond to these kids.

But the one place where there is virtually no progress whatsoever is what is happening to the women of Africa, the continent I know best. I can’t believe the passivity, indifference and disregard of the world. I can’t believe that people don’t understand that the single most important struggle on the face of the planet is the struggle for gender equality. You cannot marginalize 52% of the world’s population forever and expect to achieve a modicum of social justice and equality internationally.

There is a disproportionate level of infections amongst the women of Africa, particularly the young women of Africa and a hallucinatory nightmare of constant death. Women do all the work and they do all the caring, unacknowledged and uncompensated. They  struggle around sexual autonomy, which is almost always denied them by predatory male sexual entitlement, and they struggle around property rights and inheritance rights and sexual violence - sexual violence which has become a contagion in many parts of the developing world and certainly in southern and eastern Africa. The world should rally instinctively to the vulnerability of women in the face of AIDS: but recognize their enormous inherent strength and sophistication and intelligence and generosity of spirit at the grass roots. The women of Africa could subdue this pandemic if the world were not so consumed by inertia and indifference.

So many of us felt a glowing moment of elation when a high level panel of the United Nations, dealing with the area of UN reform, recommended late last fall that an international, independent, free standing, new women’s agency should be created, with an Under-Secretary-General of a rank equivalent to all of the male hotshots in the system, funded at up to a billion dollars a year, initially, as seed money with a capacity for targeted interventions on the ground so that the women activists would have some form of resource, and voice, and support to change the world.

I actually believe that though there have been nominal, rhetorical affirmations of the agency, it’s unlikely to happen, even though it was recommended by a high level panel of pretty significant people.  The panel was co-chaired by the Prime Ministers of Pakistan, Mozambique, and Norway.  Gordon Brown, soon to be prime minister of the United Kingdom, sat on the panel. The former presidents of Chile and Tanzania sat on the panel.  They recommended, without any hesitation, the creation of a new international vehicle, entity, agency for women, but it looks very much as if it’s already falling apart, and that the various nation-states are showing their usual indifference around women.

I'm arguing that this issue is the central issue of the age. It is beyond belief that we can allow so much carnage, such a continuing toll. 

I was in Mozambique not so long ago. I was in the city of Beira, the second largest city in the country, the port from which the transportation corridors move outwards - corridors that involve traders and truck drivers and commercial sex workers and forms a kind of vortex for the virus.  And I did as I often do when I visit a city, I went up to the hospital. I went to the adult women’s ward, 54 beds, but between 70-90 women in the ward. They were lying on the concrete floor of the corridor; they were lying on the concrete floor between the beds; they were lying on the concrete floor under the bed; they were lying two and three to a bed; their families were with them; there was a kind of congestion of imminent death and anguish.  It was almost Dante-esque in quality.

I stood at the door of the ward and I thought to myself, has the world gone mad?  The women were all so young.  They were in their 20’s and 30’s.  We have antiretroviral drugs now at a price that makes it possible to keep people alive.  What in God’s name is going on that this should be permitted to continue?  How is it that women represent 57% to 60% of all the infections in Africa now? And if you look at the age group 15 to 24 and the millions that are involved, 78% are young women and girls.

There was a recent report in the Medical Science Journal of the country of South Africa, looking at the new infections in South Africa in 2005 and 2006.  Of the new infections, in selected urban centers, 90% were young women and girls. And the world thumbs its nose at a new women’s agency, and the bureaucracy tells us that they are captive to the nation-states. 

They weren’t captive to the nation-states in April of 1994, when they allowed, by virtue of their own errors in judgment, a genocide of 800,000 people in one hundred days in Rwanda. That didn’t stop the Secretariat of the United Nations’ perverse involvement. But on something positive like manufacturing an omnibus response to women, everyone runs in reverse, and the running in reverse leads me to the final point I want to make.

There is a dreadful retreat on financing which is happening.  The G8 countries, having made solemn commitments in Glen Eagles at the G8 summit in July of 2005, are now, as always, dishonoring and betraying those commitments.  It’s like a Pavlovian reflex. They all get together in an orgy of triumphalism about what they’re going to achieve, and they make a promise that they’ll double aid to Africa by the year 2010 from $25 billion to $50 billion. But, it’s all falling apart and at the next G8 summit in Germany next month, we will hear the same nonsensical protestations all over again.  And then the G8 countries will default, and it will have dreadful long term consequences for Africa, and for the developing world. 

I was reading an analysis the other day of United States expenditures in Iraq and Afghanistan, which showed that by the end of this year, the United States will have spent $749 billion on those two conflicts.  Over the course of the two conflicts, that amounts to more than $15 billion a month.  We’ve never been able to raise that amount of money in one year to fight a pandemic which has taken 25 million lives and has 40 million people in its grip.  What has happened to the world’s moral anchor?  What has gone wrong in this preoccupation with conflict on the one hand, and this indifference to the human condition on the other? 

That’s why I am so glad that there are Doctors of the World, because when political leadership fails, civil society leadership intervenes and Doctors of the World rescues the planet from what would otherwise be a continuum of infamy.  That’s why I love Doctors of the World: they care in the best and the most profound sense, and I am so glad to be a part of the family.  Thank you.