In AIDS Crisis, Listen To U.N.'s Lewis

Melinda Gates speaks with her husband Bill as they listen to speakers at the opening news conference for the AIDS 2006 conference in Toronto,Canada. (AP PHOTO/CP,Adrian Wyld)
This column was written by Ezra Klein.
It's become fashionable amongst a certain genus of blustering right-winger to deride the United Nations as sclerotic, weak-willed, mealy-mouthed, and lacking sufficient moral outrage and courage in confronting the injustices and atrocities of the world. So it's perhaps understandable that while watching Stephen Lewis deliver his blistering indictment of the G-8's indefensibly lackluster response to the AIDS epidemic, I seemed nearly incapable of concentrating on his exquisite speech, finding my thoughts straying again and again to how deeply satisfying it would be to lock Lewis in a small room with America's contemptuous U.N. ambassador, John Bolton.

Lewis is the outgoing U.N. special envoy for HIV/AIDS in Africa, and this article is intended to do little except convince you to watch, or at least read, his address. It is a marvel of exquisitely crafted rhetoric, to be sure, but where so much fine oratory is the product of speechwriters skilled in making fluff soar, Lewis' speech draws on the white-hot rage of a humanitarian watching millions die agonizing, unnecessary deaths. It sounds as I always imagined the best civil-rights speeches sounded: Tragic, urgent, hardly controlled -- the barely suppressed roar of someone who knows his success relies on a composure and calm he doesn't, and shouldn't, feel.

To weep and wail over the genocide that AIDS is wreaking on Africa has become somewhat unfashionable — relegated to the purview of hemp-clad college activists and shrill scolds. That the epidemic has done incalculable damage is well-known; to reiterate its toll is to waste the speaker's energy and spoil the listener's mood. The crisis is so huge, its impact so devastating, that we who look away can't help but quietly resent those whose (self-righteous?) devotion reminds us of our cowardice. Like the slaughter in Sudan or the tsunami in Indonesia, the horror is so huge that to fully confront it would demand a commitment we can't imagine furnishing. Or so we think.

In fact, the AIDS epidemic is not like foreign massacres or God's ugliest acts. It is, instead, a public-health issue, one that already draws a significant (though still inadequate) amount of international funding with a mature infrastructure for aid delivery, in addition to a broadly accepted and well-studied set of best practices and effective prevention, treatment, and harm-reduction strategies.

That was the focus of the XVI International AIDS Conference, held between August 13 and August 18 in Toronto. The conference, attended by over 26,000 delegates, united medical researchers, foreign-aid workers, concerned political leaders, and such superstars as Richard Gere, Bill Gates, and Bill Clinton to propagate and publicize the best strategies to contain the epidemic's spread and harm.

The theme this year was "Time To Deliver" — an explicit recognition that the question is no longer one of technology or research, but how best to disseminate the information and treatments that are already proven to work to the regions and communities in need.

Consider the remarkable fact that more than 90 percent of those infected with HIV don't know of their condition. On first blush, that may seem non-significant — their death sentence will be rendered later, after all, so it all comes out in the wash. Not so. In addition to the obvious danger that the afflicted could, in their ignorance, spread the disease, retroviral treatment reduces the viral load in their blood and renders sexual transmission a near-impossibility.

This proves as true in society as it does in the laboratory — data out of British Columbia shows that after the widespread adoption of triple therapy (the standard retroviral treatment of three drugs), new cases plummeted, even while cases of syphilis rose, indicating little if any decrease in risky sexual behavior. Indeed, Julio Montaner, the director of British Columbia's AIDS center, has constructed a mathematical model showing that full identification and treatment of all AIDS cases would, by 2050, reduce new cases worldwide to nearly nothing.

But despite the efficacy of such therapies (and the heartening development of countless new ones), the world's governments are radically underfunding the response to the crisis. The United States, for all its touted concern over the catastrophe, contributed a mere $2.1 billion in 2005. And our G-8 partners, for all their humanitarian rhetoric, did no better (and some did much worse). In 2005, global contributions were $3.3 billion beneath estimated need; in 2006, there will be a $6 billion shortfall; and by 2008, that gap will reach $12.1 billion. Hopefully, extra-governmental actors, like the Bill and Melinda Gates Foundation, will make up much, or all, of the gap, but that is by no means assured, and it should not be necessary.

This is a place where, for comparatively little money, America could save literally millions of lives. Alas, the task will not be conventionally heroic; it does not involve special forces, or heavy artillery, or grueling battles. It will not make for a good Michael Bay movie. For that reason, it does not seem to excite the world's political players or popular pundits — it does not allow them to posture, or to wield moral superiority like a bludgeon against their ideological opponents. All agree that we should help Africa (not to mention China, Russia, and India); it is just that few are willing to demand it, much less keep demanding it, day after day, as many do when it comes to beating the drums of war.

It doesn't have to be that way. It shouldn't be that way. Listen to Stephen Lewis, and begin demanding.

By Ezra Klein
Reprinted with permission from The American Prospect, 5 Broad Street, Boston, MA 02109. All rights reserved