A New Kind of Crisis
The United Nations Security Council, which usually deals with armed conflict, declared on Monday that there is a new kind of threat to political stability: a disease. AIDS in Africa is killing 10 times as many people as war, sabotaging the economy, and creating a generation of orphans. Such devastation can easily lead to massive social breakdown.
But to some Africans there is another reason that the Security Council, which arbitrates on matters of ethnic conflict, should focus on AIDS. Zimbawe's minister of health, Timothy Stamps, asked the Council whether the apathy of wealthy nations toward the epidemic represents "lack of understanding or a new form of racial discrimination, another ethnic cleansing process?"
Stamps and other speakers contrasted the billions spent on "that other virus"Y2Kwith the estimated $150 million donor countries gave to AIDS in Africa during 1997, the last year for which figures are available. That's "piddling compared to the need," U.S. ambassador to the United Nations Richard Holbrooke told the Voice.
While Monday's meeting, which Holbrooke orchestrated, will not bring expensive HIV drugs to Africa's 23.3 million infected people, it does place unprecedented pressure on African governments to fight the disease more vigorously and on wealthy countries to pony up more aid and reduce Africa's staggering debt. "I don't think it will be the usual talking," says Milly Katana, an HIV-positive activist in Uganda. "It will help get the whole world to look at AIDS as their concern and increase resources."
Vice President Al Gore, who chaired the meeting, announced that the administration will ask Congress to add $100 million to international AIDS efforts, mostly in Africa, and $50 million to spur vaccine development for third-world diseases, including AIDS. That's not enough to staunch the epidemic, but Holbrooke says the U.S. has already been asking Japan and other countries to pump up their assistance, and Japan told the Council they are considering new aid. Moreover, a new UN effort, The International Partnership on AIDS, aims to raise annual spending on AIDS in Africa to about $2 billion per year.
Most of this money will go toward preventionan understandable decision, but one that will abandon those already infected to die. The debate over drug access has focused on the astronomically expensive anti-HIV drugs. Uganda's health minister, Chrispus Kiyonga, told the Council that providing them to his country's 2 million HIV patients would cost 12 times more than the nation's total annual budget. But ACT UP claimsand the director of the Joint United Nations Programme on AIDS concursthat just $1.5 billion could provide treatment and prophylaxis for common AIDS opportunistic infections to all the world's 34 million HIV patients.
Holbrooke, who made his name in war-torn Bosnia and Kosovo, says AIDS "is a direct, cancerous growth on the political, social, and economic security of Africa." He also fears that unless the stigma is lifted, AIDS "will create a unique, new untouchable caste," which could inflame violence and civil strife.
On his recent trip to Africa, Holbrooke was particularly moved by six HIV-positive Namibian women who were willing to talk with him, but who were forced "to come in a covered van to a curtained room because if they were seen in public they would lose their jobs and be ostracized." Such stigma is common throughout Africa, says former Nigerian health minister Olikoye Ransome-Kuti. "There's no reason for that, and if the Security Council makes that clear to the whole world, it would be wonderful."
Because the Security Council has never before addressed a health issue, getting AIDS on the agenda required some diplomatic footwork. Holbrooke was most worried about Russia, China, and France. But Paris and Peking signed on, Holbrooke recalls, "and then the Russians, in an act of classic Russian heavy-handedness, said they opposed it, would go along with it because everyone else wanted it, butand this had us all in the aisles laughingthey would refuse to speak. To which I was tempted to say, 'Do you promise?' "
One touchy issue was testing UN peacekeepers. Enrolling soldiers in peacekeeping forces can actually be a hard-currency moneymaker for poor countries, but some African armies have high HIV rates. Holbrooke worries that such soldiers could export AIDS. That would "create almost the greatest irony of all: in the cause of peacekeeping to spread a disease which is killing 10 times as many people as war."
So, says Holbrooke, "I believe that we should insist that the UN test. I'm again encountering enormous resistance. Do you want to know who from? Guess. The Africans." They oppose testing "because of the stigmatization issue and the privacy issue."
Potentially, there's a deeper pitfall: If armies dismiss HIV-positive soldierssomething Holbrooke adamantly opposesthat could inflame discrimination and worsen economic insecurity, hardly what the Security Council wants to accomplish. Military jobs provide some of the surest incomes in developing nations, and each African breadwinner often supports 15 or more dependents. Discharging HIV-positive soldiers would rob families of the money they desperately need to prepare for when the infected soldier dies.
Of course, HIV-positive soldiers are only half the problem. Uninfected soldiers from countries as different as Finland and Nigeria have contracted HIV on peacekeeping missions and brought it back home. Holbrooke says he and UN Secretary General Kofi Annan are committed to providing UN peacekeepers with "a massive education campaign along the lines of what the U.S. army did in World War II with gonorrhea."
WHAT AFRICANS WANT MUCH MORE THAN TESTING soldiers is increased funding for development of a preventative vaccine and treatment for the infected. Ransome-Kuti has long castigated African governments for not trying to ration the drugs. Deciding who gets treated would be "difficult, since I believe so much in equity," says Ransome-Kuti. "But treatment for none of the millions of our people who are HIV-positive, that is absolutely dreadful."
"This is a continual struggle," says Holbrooke. In East and Southern African villages, one finds grandmothers who have lost children, and so are forced to raise their orphaned grandchildren. "On Tuesday morning, life will not have changed for them," Holbrooke notes. "But we can help the next generation."
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