Opening Address by Stephen Lewis: XIIIth International Conference on AIDS and STIs in Africa
September 21, 2003
XIIIth International Conference on AIDS and STIs in Africa, by Stephen Lewis
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Address by Stephen Lewis Your Excellency, Mr. President; Madam the First Lady of Gabon, Honourable Ministers (including the Minister of Health, who just yesterday joined the ranks of Kenya's famous long-distance runners), Distinguished Guests, Ladies and Gentlemen. I am obviously delighted to have the privilege of participating in this opening session of ICASA. But I'm also aware that the speaking list is lengthy. So quite frankly, I'm going to scrap the remarks I intended to make -- primarily on financial resources and treatment -- which would have required elaboration and time, and I will use this opportunity instead to pursue the theme of Access to Care in the context of children orphaned by AIDS, and other vulnerable children. I choose to focus on orphaned children because they remain perhaps the most intractable of all issues related to care and support. We've obviously been dealing with legions of orphaned children -- sometimes adequately, mostly inadequately -- for well over a decade But something startling is happening: the increased spiral of adult deaths in so many countries means that the numbers of children orphaned each day is expanding exponentially. Africa is staggering under the load. In late July, early August I made a trip to Uganda and Zambia with Mrs. Graça Machel. Graça Machel is, as you know, the former Minister of Education of Mozambique, the former First Lady of Mozambique, and is now married to Nelson Mandela. Graça knows every corner of Africa intimately. The trip left us both with an overwhelming sense of dismay, anxiety, even dread at the situation of orphans. Uganda and Zambia aren't unique; they are mirrors of the continent. Let me attempt to illustrate some of what we experienced with four brief anecdotes. First, in Kampala, Graça and I visited Mulago Hospital and the clinic running "Prevention of Mother to Child Transmission Plus". The 'Plus' as you're surely aware, represents overall care for the family -- not only the treatment of the mother, but where necessary, her partner and any children who are HIV-positive. It's a new initiative in Africa, with pilots in a number of countries, overseen by the Columbia University School of Public Health working in conjunction with governments, UNICEF and the Elizabeth Glazer Pediatric AIDS Foundation. The principle here -- and it's the most powerful principle that could be invoked -- is that the one foolproof way to reduce the orphan population is to keep the mothers alive. At Mulago, we met with a number of women enrolled in the programme who were on antiretroviral treatment. You will know that in most countries, eligibility for treatment requires a CD4 count below 250 or 200. We met a woman whose CD4 count had dropped to 'one' -- yes, '1' – when she was given drugs. It was unheard of. When we saw her, she was a month into treatment, looking good, feeling good, and equally important, her two lovely children played at her feet while their mother laughed with us.If ever the skyrocketing orphan population- already pushing 13 million -- is to be brought under control, then treatment is absolutely imperative to success. When WHO says three million people will be treated with anti-retrovirals by 2005, the world must make it happen. Anything less is an ethical abomination. Second, this time in Zambia, Graça and I were taken to a village where the orphan population was described as out of control. As a vivid example of that, we entered a home and encountered the following: to the immediate left of the door sat the 84-year-old patriarch, entirely blind. Inside the hut sat his two wives, visibly frail, one 76, the other 78. Between them they had given birth to nine children; eight were now dead and the ninth, alas, was clearly dying. On the floor of the hut, jammed together with barely room to move or breathe, were 32-orphaned children ranging in age from two to sixteen. Graça and I looked at each other, and wordlessly communicated the inevitable fear: What in God's name is the future for these youngsters? It is now commonplace that grandmothers are the caregivers for orphans -- I've certainly seen it in every country without exception -- but that is no solution. The grandmothers are impoverished, their days are numbered, and the decimation of families is so complete that there's often no one left in the generation coming up behind. We're all struggling to find a viable response, and there are, of course, some superb projects and initiatives in all countries, but we can't seem to take them to scale. In the meantime, millions of children live traumatized, unstable lives, robbed not just of their parents, but of their childhoods and futures. How can this be happening, in the year 2003, when we can find over $200 billion to fight a war on terrorism, but we can't find the money to prevent children from living in terror? Third, towards the end of the trip to Zambia, I visited an unplanned community of approximately five thousand people in a tiny settlement just outside Lusaka. The people were bursting with pride: they had graded a rough road and built a community centre, with two of the rooms used as a makeshift school-- albeit without benches, desks, blackboards, chalk, paper or pencils. They showed me around and then asked me to say a few words as they gathered in their hundreds on some rocky ground in front of the community centre. I looked out at the crowd, and was suddenly jolted by a shock of recognition. In the front row were a handful of young mothers, their babies at their breasts. And then, as far as the eye could see into the crowd, made up mostly of women, everyone else was elderly. I asked: "how many of you are grandmothers?" and a forest of hands shot up. I asked: "how many of you are caring for children?" and the same hands shot up. And I suddenly realized, in a vivid momentary photograph of life, that the entire middle generation seemed to be missing: there were children, very young women, old women, and a handful of older men -- and almost nothing in between. We all know that that's the way the pandemic works. But there comes a moment when the statistics on paper, the intellectual abstractions suddenly hit home. And at that moment, they hit home for me with an almost visceral force. Thus it is that orphaned children are the most vexing issue related to care, because there are not enough adults left to do the caregiving – no one to hand down knowledge or experience, or -- perhaps most important of all-- values -- from one generation to another. It's appalling that so many children are growing up without the kind of emotional anchor that leads to a life of stability. The final anecdote takes place in Uganda, in Masaka Distrist, at what is known as "ground zero" in the pandemic. It was there that the first case of HIV/AIDS was diagnosed in 1982. The villagers were anxious that we visit one of the many child-headed households, in this instance headed by a fourteen-year-old girl, with two sisters, 12 and 10, and two brothers, aged 11 and 8. Theirs was not a dramatic story of sexual violence or property theft. The injustice of their young lives was much more straightforward, but as deeply compelling. We went into the children's hut, and Graça told everyone to leave: media, UN staff, hangers-on. The only people who remained behind were a translator and the local World Vision staff woman who helped tend to the village. We sat down side by side with the children, our backs to the wall, the two boys on my left, and the three girls on Graça's right. I had no idea what to expect. Graça turned to the young girls, and very gently asked: "Have you started to menstruate yet?". Very shyly, the 14-year-old and the 12-year-old girls said they had. "Do you know what it means?" said Graça. "What did you think was happening to you? Do you talk about it with other girls at school?". Do you talk about it with your teacher?". And as the two girls answered, in whispered voices, I suddenly realized that they were experiencing their first act of 'parenting' around one of the most anxious moments of a young girl's life. I couldn't get over it. I thought to myself: this is the gap that women all over Africa are trying to fill, but the ratio of children to adults is completely out of whack. (In both Uganda and Zambia, orphaned children constitute 10% or more of the population.). The depth of psychological distress that plagues an entire generation of children numbering in the millions is simply overwhelming, and the struggle to cope is complicated fiercely by a lack of resources at the grass roots. There are emerging, internationally, strong plans for dealing with orphaned children, plans focusing on the removal of school fees, on school feeding programmes, on the cultivation of school gardens, on health care for vulnerable children, on protection from sexual violence, on significant and lasting community support. Here in Kenya, there's reason for optimism. When you removed primary school fees, Mr. President, and nearly one and a half million new children turned up at school, you set a precedent for the entire continent. Everyone is talking about it, and a campaign to abolish school fees in Africa is now in the works. What is more, just yesterday, the Women's AIDS Run showed the astonishing solidarity that exists at community level amongst women across this country, in providing access to care and support. Despite their disproportionate levels of infection, and the poisonous absence of any semblance of gender equality, African women are incredibly strong. But the women can't do it alone. That's how I want to end. You can't do it alone. The women of Africa, all the people of Africa, the governments of Africa: they can't do it alone. This is a full-blown emergency; in every emergency there is a division of labour. Africa is struggling to hold up its end; the west is not. I have to say that what's happening to the continent makes me extremely angry. And I don't feel I have to apologize for being angry. The job of an Envoy isn't merely to observe and to report back, but also to identify with those he serves. And I serve Africa. And I'm enraged by the behaviour of the rich powers … how much more grievous, by their neglect, they have made the situation in Africa. That isn't to take Africa off the hook: the behaviour of many former African leaders was indefensible. But Africa has moved mountains in the last couple of years, while the western world remains mired in the foothills. Africa needs no instructions from the west; Africa needs no arrogance from the west; Africa needs no churlish lectures from the west. Africans know HIV/AIDS in all its manifestations and requirements. Admittedly, no one in the world has yet developed a plan for coping with this new phenomenon of millions of orphaned children, but Africa has vastly more experience of orphans than the rest of us, and we should simply stop barracking, and provide the resources for Africa to find solutions. The knowledge and human resources are there: organizations of People Living With AIDS, the inspired youth peer counselors, the political leadership, the religious leadership, the activist women's groups, the community-based and faith-based organizations: there is overwhelming sophistication and strength on this continent. What's missing are the tools and support to do the job. Provide those to Africa, and we can break the back of this pandemic. But that requires money. Money, for example, for the Global Fund -- and the money is not there. Africa is unrelievedly poor. In the straitjacket of poverty, whole countries are fighting for survival. And that, my friends, is morally unconscionable. There's just no time for debate: the crisis has gone on for so long that those who were once orphaned children are now young adults having children of their own. How do you bring up a child, when you've had no parenting to fall back on? It's a blessed thing that against all odds, there remains such tremendous determination and spirit among Africans to save this continent. The world need only feed that spirit, and Africa will prevail. |