AFRO-NETS> Speech by Stephen Lewis at the Official Opening of 13th ICASA

[Dieter Neuvians MD <neuvians@mweb.co.za>]

Speech by Stephen Lewis at the Official Opening of 13th ICASA
-------------------------------------------------------------
 
Please find attached and below the text of the address given by 
Stephen Lewis, the UN Secretary-General's Special Envoy for 
HIV/AIDS in Africa, at the Official Opening of the International 
Conference on AIDS and STIs in Africa, on Sunday, September 21st 
in Nairobi, Kenya.
 
You are welcome to reprint, distribute, post on-line or quote 
from the speech.
 
--
Address by Stephen Lewis UN Secretary-General's Special Envoy for 
HIV/AIDS in Africa at the Official Opening of the XIIIth Interna-
tional Conference on AIDS and STIs in Africa Nairobi, 21 Septem-
ber 2003 5:00 p.m. 
 
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 run-
ners), 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 re-
sources 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 per-
haps the most intractable of all issues related to care and sup-
port We've obviously been dealing with legions of orphaned chil-
dren-- sometimes adequately, mostly inadequately - for well over 
a decade But something startling is happening: the increased spi-
ral 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 conti-
nent. 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, repre-
sents 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 in-
voked --- 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 pro-
gramme 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 skyrock-
eting 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 fol-
lowing: to the immediate left of the door sat the 84-year-old pa-
triarch, entirely blind. Inside the hut sat his two wives, visi-
bly 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 ex-
ception --- but that is no solution. The grandmothers are impov-
erished, 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 fu-
tures. 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 un-
planned 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 real-
ized, 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 ab-
stractions 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 care giving 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 emo-
tional 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 house-
holds, 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 mo-
ments 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 gen-
eration of children numbering in the millions is simply over-
whelming, and the struggle to cope is complicated fiercely by a 
lack of resources at the grass roots. There are emerging, inter-
nationally, 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. Eve-
ryone 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 as-
tonishing solidarity that exists at community level amongst women 
across this country, in providing access to care and support. De-
spite their disproportionate levels of infection, and the poison-
ous 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 inde-
fensible. 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 arro-
gance from the west; Africa needs no churlish lectures from the 
west. Africans know HIV/AIDS in all its manifestations and re-
quirements. 
 
Admittedly, no one in the world has yet developed a plan for cop-
ing 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 re-
sources for Africa to find solutions. The knowledge and human re-
sources are there: organizations of People Living With AIDS, the 
inspired youth peer counsellors, the political leadership, the 
religious leadership, the activist women s groups, the community-
based and faith-based organizations: there is overwhelming so-
phistication 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 re-
mains such tremendous determination and spirit among Africans to 
save this continent. The world need only feed that spirit, and 
Africa will prevail.

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