Stephen Lewis, the UN envoy for AIDS in Africa, talks about his anger, despair, and obligation to speak out. He tells us about the greatest tragedy in the world today. He tells us that millions are dying, tens of millions more will die, and a continent is being destroyed. He also tells us that we can prevent it.
In the comfortably cluttered living room of his house in Toronto’s elegant Forest Hill neighborhood, Stephen Lewis, politician, humanitarian, diplomat, international public servant, comes to the story of the coffins and the cabbage patch. “I tell it so often,” he says, almost as an aside to himself. It goes like this:
It is early in 2005, and Lewis, 68, the United Nations Secretary-General’s Special Envoy for HIV/AIDS in Africa, is visiting a village in rural Zambia. He is invited to inspect an income-generating project created by a group of women infected with AIDS. He is led along many dusty trodden paths to a field where the women are standing, holding up a welcoming banner.
The women are eager to talk to him about the men who have infected them, and what they think of such men. As the conversation progresses, Lewis notices he is standing beside a large cabbage patch. Gesturing to the cabbages, he says, “I take it this is your income-generating project.” The women say, “Yes, absolutely.” Lewis says, “I assume it supplements your diet, makes your immune system stronger, makes you nutritionally more secure.” The women say, “Yes, yes.”
He asks, “Do you have any of the cabbages left over?”
“Yes. Absolutely,” say the women.
He asks, “What do you do with them?”
“We take them to market and sell them,” they say. “That’s the income-generating part of the project.”
Then Lewis asks, “What do you do with the income?”
The leader of the women says, “We buy coffins, of course, Mr. Lewis. We never have enough coffins.’”
Sitting in his Toronto living room, Stephen Lewis says wearily, “That’s just a few months ago. That’s not 1990. They’re still saying we don’t have enough coffins in 2005. And every time you go to Africa, it’s so . . .” he whispers the word “. . . jolting. Always the same thing: death, death, death, and struggle.”
Of the 41 million infected with AIDS globally, 26 million live in Africa and more than three million of them were newly infected in 2004, the latest year for which statistics are available. Nearly two and a half million Africans died from AIDS in 2004, just as millions more will die before the wealthy world buys them treatment. There are 14 million African children orphaned by AIDS. There are villages across Africa where young women in their twenties and thirties have ceased to exist. There are the children who themselves have died by the millions because, until the swift, decisive intervention of the Clinton Foundation a few months ago, no pediatric treatment formulation existed.
Stephen Lewis has become the world’s advocate for swift, decisive intervention in the pandemic, the exemplar of the moral international statesman who speaks out, stripping rhetoric from fact. He is the eloquent orator and formidable former politician who has brought his heart and skills to Africa’s defense.
The cabbage-patch story captures his despair.
It captures his anger.
It explains why he has broken all the protocols of blandness meant to govern the tongues of UN bureaucrats.
It explains why he has publicly and angrily criticized the U.S. administration and several African governments by name, trashed the policies of the World Bank and International Monetary Fund, acidly accused the wealthy Group of Eight nations of miserliness and hypocrisy, blown off the razzle-dazzle rhetoric of rock-star activist Bob Geldof as so much flatulence, and verbally lashed some of the UN’s top executives (including his friend of twenty years, Secretary-General Kofi Annan, again by name) for being duplicitous and do-nothing while the HIV/AIDS pandemic, now in its twenty-fifth year, relentlessly destroys much of sub-Saharan African society.
It also explains why Lewis, a scion of Canada’s preeminent left-wing political family, having upset so many governments and important people, now finds himself threatened with being fired (the U.S. State Department went after him with a vengeance in the fall), a satisfaction he may deny his critics by quitting. Nothing, he says, is fixed, but it is on his mind to resign at the conclusion of next year’s biennial global AIDS summit, to be held in Toronto. He says he is “running out of steam.” He wonders about his continuing effectiveness. He talks about crying too easily on public platforms, and lying awake at night with images of death and dying on his mind. He says he is apprehensive now about going to Africa, “knowing what I’m going to encounter. You meet people with AIDS, you make friendships . . . and then you come back six months later and they’re gone.” He says he is tired.
“I’ve often thought to myself,” Lewis says, “that it’s possible that you need a sturdier emotional psyche than I have. I mean, you know, I just can’t take what I see on the ground. I just cannot take it. I am only one person.
“But I defy anybody to be able to take it over the long term, because—” and he pronounces each word with leaden slowness “—it is all so unnecessary. And I just can’t break through.” He slumps in his armchair with the body language of defeat. Outside, in the leafy quiet neighborhood where he lives with his wife, journalist and social activist Michele Landsberg, gardeners are tidying the lawns and shrubs and flower beds for winter while late-model European cars purr softly along the street. Inside his house, Stephen Lewis’s mind is half the planet away, immersed in the plague that he says he cannot make the world focus on.
“One out of every three children in Zambia will be orphaned by AIDS by the year 2010. How do you adjust to that?” he asks.
“Zambia has a life expectancy that goes right back to the industrial revolution in the United Kingdom in 1840. You’re born in Zambia today and you will live to 30 on average, and I don’t know how to convey these things. I do the best I can on platforms, but I don’t know how to connect—unless you tell some stories, unless you tell anecdotes that are so vivid that they live in the mind, and people then understand.”
And so he tells stories. First, always, there are stories about women. Stephen Lewis seldom strays far from stories about women. They bear the brunt of the pandemic, he says; the AIDS assault on women has no precedent in history.
“You go into a hospice, 25 beds, 23 of them filled by women in their twenties. You can’t get the drugs to them in time. You know they’re going to die in a matter of months. They all have children. You feel as though everything is out of kilter.
“Women are the pillars of family and community—the mothers, the caregivers, the farmers. The pandemic is preying on them relentlessly, threatening them in a way that the world has never before witnessed. The virus threatens the very existence of women in some countries. I can barely talk about it with equanimity.
“When I was traveling with Graca Machel, Nelson Mandela’s wife, we were going to villages where you don’t see young women. It’s so weird. There’s no one in their twenties or thirties or forties. It just bowls you over.” Why are the women disappearing? Primarily, says Lewis, because they are being infected by their husbands, and they do not have the capacity to refuse sex, cannot insist on condoms, cannot negotiate protection of their own lives. “It’s just the man’s predatory entitlement which is so widely accepted, and that gender inequality is really the most ferocious assault on one sex I’ve ever seen, and I don’t think there’s any historical precedent.”
Then there are stories about children.
“You go into a little community center for kids . . . and I remember this . . . you have a whole group of kids sitting in a little room. They look as though they’re four or five, they’re all stunted, and they’re really eight, nine, ten years old, all HIV-positive, and there are no drugs. And you know these kids are measuring their lives in minutes. And you just wonder . . . why is this? How long can it happen? How long does it have to go on incrementally?”
He tells of being in western Kenya last July, visiting a religious organization that is looking after orphans. “Suddenly all these orphans trot out to make little speeches, seven of them in a row. And they’re all in their twenties. Their parents died in ’93, ’94, ’95, ’96, and you suddenly understand that this has been going on for so long that you have a new crop of orphans who are very young, but you also have a group who have grown up without any parents in some kind of community or extended family, and now they are having kids of their own and they haven’t got a clue what to do.”
He says only five to eight percent of pregnant women in sub-Saharan Africa have access to PMTCT (Prevention of Mother-to-Child Transmission) programs. “This is a terrible deficiency. There is no excuse for this state of affairs”—except the parsimony of the wealthy world and the empty pledges of its leaders.
“Because of the low access rates, thousands upon thousands of babies are born HIV-positive who need not be infected. Most of them die—helplessly, pathetically—before the age of two. But for those HIV-positive women who have access to PMTCT, the program is a godsend. One tablet of the drug nevirapine during the birthing process, and the liquid equivalent within 72 hours of birth, and the infection rate is cut by 53 per cent.”
He says no pediatric treatment formulation existed—25 years into the pandemic—until the Clinton Foundation went to India in 2005 and negotiated a price for a low-cost generic drug. “We lose half a million children a year. But up until now, you’ve had to break the adult tablets, take out the powder, speculate about weight and age of the child and how much powder you needed, and the same with the syrup. Why wasn’t this done before?
“It’s all just so bad. It’s so awful. How do you get people to understand? How do you get things mobilized? It’s so crazy. It’s as though the world has regressed to the Middle Ages in places. Then you hear the apocalyptic language that is used in Africa by Africans. You sit down with the president of Zambia and he starts talking about the Holocaust in his country, and he doesn’t even have prevalence rates of infection that are close to Zimbabwe’s, Lesotho’s, Swaziland’s, Namibia’s, or South Africa’s. He’s at 15 or 16 percent; they’re all way over 20 percent. So it just tears you to see what’s going on.”
Lewis writes in the opening sentence of his recently published book on the pandemic, Race Against Time (House of Anansi Press Inc., Toronto): “I have spent the last four years watching people die.”
Nothing, he writes, prepared him for the carnage of AIDS. For two years prior to his appointment as UN AIDS envoy, he sat on a commission of inquiry into the genocide in Rwanda. It was a descent into depravity, in his words: visiting sites reminiscent of Auschwitz, meeting mutilated survivors, interviewing women raped over and over and over again. But at least the Rwandan genocide had an end. Not the pandemic. Not AIDS. “I had no idea,” he admits. “I don’t know how naive I could have been. I just didn’t understand what I was walking into. And it is all so preventable.”
Preventability is the second theme Stephen Lewis dwells on, after the pandemic’s horrific assault on women. The pandemic, he says, can be stopped by money, leadership and the right policies—and without those three ingredients in the quantities required, there is nothing but the awful toll of death and social destruction.
Late last summer he all but called the U.S. government recklessly negligent for bowing to the Christian right and tying AIDS assistance money to Uganda to a condition that the country’s public health authorities stress abstinence and de-emphasize condoms in their AIDS education programs (the country’s infection rate, having been in decline, is starting to creep upwards again).
When U.S. officials denied his accusations, he stopped a hair’s breadth short of calling them liars—something UN officials just don’t do. There were persistent, well-sourced reports out of Washington and New York that the U.S. State Department wanted him removed from his post.
He has excoriated the World Bank and the IMF for imposing structural adjustment programs—dictating how much African governments can allocate to social programs in exchange for loans—that he says have crippled many countries’ health and education resources. He says these programs have resulted in one of the greatest wrongs in the global South, the imposition of user fees for public education. The result is a double penalty for the children of AIDS: orphaned by their parents’ deaths and left in the darkness of ignorance by their financial inability to afford school. In Race Against Time, Lewis writes that the World Bank and the IMF should pay the cost associated with abolishing school fees as “reparations” for the damage their policies have caused: “This is not some negotiable item. I am writing and speaking passionately about it because every time I travel to Africa I encounter orphan children who are desperate to be in school, who need friends and teachers and attention, who need one meal a day that could come from a school feeding program, who need the sense of self-worth that education could bring, who want so much to learn, and who are denied all of it because the costs of schooling are prohibitive.”
At their recent summit leaders of the world’s wealthy G8 countries pledged $50 billion in total aid for Africa by 2010. Lewis says that falls far short of what is needed and that Bob Geldof, with his Live 8 razzle-dazzle, merely played into the G8 leaders’ hands by praising the summit as a spectacular success. The conservative estimate for sustaining and introducing new AIDS programs by 2010 will be $30-billion “for AIDS and AIDS alone,” Lewis says. “Not for TB or malaria, not for health systems, not for education, not for sanitation, agriculture, the whole vast range of poverty and hunger—just for AIDS.”
Lewis has declared that there is no chance—none, not a hope in hell—that the much-touted Millennium Development Goals (which include reversing the spread of HIV/AIDS by 2015) will be attained unless all the world’s wealthy countries raise their levels of official development assistance (ODA) to 0.7 per cent of gross national product. Which he increasingly doubts they will do (ODA levels for the U.S. and Canada, for example, are both at less than a third of the goal).
He has accused the continent’s richest government, South Africa’s, of doing far less than much poorer countries to provide its AIDS-infected citizens with antiretroviral treatment. The country has an estimated 6.3 million sufferers. “The World Bank,” says Lewis, “did an econometric study of South Africa and said if they didn’t deal immediately with the pandemic the country would collapse within three generations. South Africa went nuts, but the World Bank refused to back off.”
To help, Lewis has launched his own foundation (www.stephenlewisfoundation.org) to fund community hospice care for women who are dying, so that their last weeks, days, hours are free from pain, humiliation, and indignity; to assist orphans and other AIDS-affected children with assistance ranging from the payment of school fees to the provision of food, and to support associations of people living with HIV/AIDS, so that men and women with the courage to declare openly their affliction can educate themselves and share information with the broader community on prevention, treatment, care, and the elimination of stigma.
If steam is what Stephen Lewis is running out of, it is not happening quickly. Or even visibly. Last October and November, for example, he had 28 speeches scheduled. He has become a national hero in his own country, especially to young Canadians, and he seldom turns down an invitation to speak at high schools and universities.
“The most valuable experience for the job for me was politics, not diplomacy,” he says. “I’ve learned the value of research, the value of issuing statements, the value of having press briefings. All of these things are, by and large, foreign to the UN. I’ve learned how you cast an issue in a way that will get people to care about it and respond to it. Speaking is my vocation. Advocacy became the central feature, so that I could take what I learned in Africa to public platforms in North America and Europe. I have called on my political inheritance for this job, and that has served me best, far and away.”
It is no mean inheritance. His father David was national leader of Canada’s social democratic New Democratic Party in the 1970’s. Stephen Lewis was first elected to the legislature of Ontario, Canada’s most populous province, at age 25, and led the Ontario NDP from 1970 to 1978, the last three years as leader of the official opposition. Conservative Prime Minister Brian Mulroney appointed him Canada’s ambassador to the UN in 1984, a post he served in until 1988. He was subsequently named the UN secretary-general’s special adviser on African economic recovery, deputy executive director of UNICEF, and a member of the Organization for African Unity’s international panel on the Rwandan genocide. In 2001, he became AIDS envoy to Africa, the first of four global AIDS envoys appointed by Kofi Annan.
Will he be fired?
Not likely. The UN came to his defense against the Americans. As for his criticism of the UN, everyone is doing it these days, both inside and outside of the organization.
Does he see hope in the pandemic?
Says Lewis: “I don’t have a lot of optimism about overcoming the gender inequality which I think is the greatest single horror of the pandemic, that incredible disproportion of vulnerability. They talk about behavior change among men, but that’s a couple of generations away, and the women are dying now. You don’t have time. You have to empower the women. You have to move on laws on property rights and inheritance rights and against sexual violence and focus on girls and their rights and respect for them.”
A vaccine, he says, at the very least is still ten years away. But a microbicide—a vaginal gel—is likely closer, perhaps as little as four years off, and “that means women can take control of their own sexuality because the partner need never know the gel or cream has been applied and the woman can therefore resist the virus. This can save millions of women’s lives.”
And Lewis says the program known as Three-by-Five—three million AIDS sufferers receiving treatment by 2005—is the single most dramatic intervention of the past several years. Although the target won’t be met (fewer than two million are receiving treatment), the fact that there are now goals has provided a large stimulus to hope.
But in sum, it is not much. As Lewis writes: “My own view is that the horrendous toll is yet to come. Countries will be fighting for survival in ten or fifteen years down the road. It’s simply impossible to tear the productive generations out of the heart of a country without facing an incomparable crisis.
“I’ll devote every fiber of my body to defeating this viral contagion, but I cannot abide the willful inattention of so much of the international community. I cannot expunge from my mind the heartless indifference, the criminal neglect of the last decade, during which time countless people have gone to their graves—people who should still be walking the open savannah of Africa.
“I’m not some sweet innocent. I’m 68 years old. I’ve learned something about politics, diplomacy and multilateralism. I thought I understood the way the world works. I don’t.”