Keynote lecture by Stephen Lewis, UN Special Envoy for HIV/AIDS in Africa

11th Conference on Retroviruses and Opportunistic Infections 8 February 2004, San Francisco, United States


And that brings me to the final two issues I want to raise, which I shall not belabour, because I have dealt with them on innumerable occasions. They flow organically from what has already been said. They are rather more personal than analytic.

There is one factor more than any other that drives me crazy in doing the Envoy job: it’s the ferocious assault of the virus on women. We’re paying a dreadful and inconsolable price for the refusal of the international community, every member of the community without exception, to embrace gender equality. And in so many parts of the world, gender inequality and AIDS is a preordained equation of death.

There’s nothing new in that. It’s irrefutably documented in encyclopedic profusion. The culture, the violence, the power, the patriarchy, the male sexual behaviour … it’s as though Darwin himself had stirred this Hecate’s brew into a potion of death for women.

Just last Monday, February 2nd, 2004, I attended the first meeting, in London, of the newly-constituted Steering Committee of the Global Coalition on Women and AIDS, a Steering committee, I might add, of undisputed intelligence, influence and reach; a Steering Committee, several of whose members are women living with HIV and AIDS. The heading on the press release to stir media interest read: “HIV Prevention and Protection Efforts are Failing Women and Girls … More young women are becoming infected by husbands and long-tem partners --- female-controlled HIV prevention methods urgently needed”. And then, during the presentations throughout the day, the ritual ghastly litany of examples defining a socio-economic-cultural gestalt that puts women at deadly risk.

Not in a million years would I challenge either the usefulness or intent of the Global Coalition. My problem, entirely independent of the Coalition, lies in the divide between the analysis and what’s happening on the ground. I read the superb studies produced by Human Rights Watch, and I know that the gap between rhetoric and reality can be tolerated no longer. In the last two and a half years, traveling extensively on the African continent, I have seen virtually no improvement in the status of women. Virtually none. It’s too painful for words. It makes me feel almost criminally complicit. I have come to the personal conclusion --- and I admit it’s personal --- that it’s time, truly and resoundingly, to take off the gloves. It’s time for the respected UN community, for example, on the ground in countries, to join with the indigenous allies and groups fighting for women’s rights to demand the visceral changes that are needed. It’s time to abandon the fawning diplomatic deference. It’s time to swallow the insufferable jargon, like ‘mainstreaming gender’ which serves to cement inequality by pretending that a process somehow transforms the lives women lead. It’s not working. In Africa, of the ten million people living with HIV/AIDS between the ages of 15 and 24, nearly two-thirds are women and girls. Please explain to me what is working.

The time has come to confront Cabinet Ministers openly, and demand that they promulgate or amend the laws on property rights and inheritance rights. It’s time to put people in jail, for a good long chunk of life, for property-grabbing. If sexual violence leads to HIV and death, then it’s time to use the entire apparatus of the state to enforce laws against rape; to stop putting the onus on the woman to fight off predatory male sexual behaviour, and move in on the oppressor with a vengeance. If male teachers molest young girls, make a spectacle of them. If early marriage is a death sentence, change the age of marriage and enforce it as though life depends on it, because life depends on it.

It’s time, in other words, country by country, to make the struggle for gender equality the cause celebre of the land. Give no quarter. Call press conferences, demand audiences with the political and religious authorities, form coalitions, take a tactical lesson from the Treatment Action Campaign in South Africa, demonstrate, boycott, rail, risk the possibility of being declared persona non grata by government, and if it happens, on this issue, wear it as a badge of honour. And should it happen, the cause of women will have been advanced.

It’s all too much: too much sickness, too much sadness, too much death. Women are the resilient force that sustains the continent, and they are being eviscerated by a virus. And the world, there and here, largely inert, is watching it happen. Shades of the genocide in Rwanda.

You see, if we can make real gains in 3 by 5, and leverage the money for the Global Fund, and raise the intensity of focus on microbicides and vaccines, and understand that the pandemic has a woman’s face, then we can begin to break the back of this appalling scourge. No one has to feel defeated. We just have to feel resolved. Doubtless it will require superhuman intervention: so much the better. It requires that level of magnitude to energize the world.

But even all of that said --- and if it came to pass, it would be incredibly exciting --- there remains one issue, growing inexorably, that is thus far intractable: the issue of orphans. I don’t want to drive the nail through the wall; I’ve spoken a long time and must wind my way to the end. But it is important to understand that the millions of orphans are perhaps the most vexing inheritance of the pandemic. There are several African countries now, with more than a million orphans: it is without historical precedent; no one quite knows how to handle it.

In the last few months, I’ve had the enviable opportunity to accompany both Graca Machel and Oprah Winfrey on trips to Africa, primarily to assess the situation of orphans and vulnerable children. Graca Machel, who is seen by everyone as “Mama Africa”, and has a formidable understanding of the continent was, I think it fair to say, overwhelmed at times by the sheer numbers and festering predicament of the orphans. Oprah, than whom it would be hard to find someone of greater worldliness, was equally shaken to her core. African communities are struggling valiantly to absorb the orphans as the families fragment and die, but given the levels of impoverishment, it’s desperately, indescribably difficult.

And it’s all becoming so strange. Now we have, pervasively, this phenomenon which AIDS has brought, of grandparents burying their children, and then living out their impoverished days looking after the orphan grandchildren. I was in Alexandra Township in Johannesburg in December, meeting with a large group of grandmothers heroically networking through their anguish: they had all lost almost all their children. It was a spirited if terribly mournful conversation. There was one grandmother who refused to speak until the end. And then, in a voice of wrenching and unendurable pain, she told us how she had lost all of her adult children, all five of her adult children, between the years 2001 and 2003. Five children in three years. She was left with four grandchildren, all of whom I later learned, are HIV positive. Two generations will disappear in an historical blink.

And where they don’t disappear, these millions of orphans wander the landscape of Africa. These lonely youngsters are bewildered, angry, sad, frantically seeking nurture and affection, often hungry, homeless, significant numbers living with grandmothers or in child-headed households, countless numbers unable to go to school, a school being the single most valuable and supportive environment they could possibly have … unable to go to school because they can’t afford the school fees or the uniforms or the books. And when you lose your parents, who then hands down the knowledge and values from generation to generation? The orphan crisis is a crisis without parallel.

Somewhere, somehow, someday, the world has to understand what AIDS hath wrought. The understanding is not yet in evidence.

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