Early this afternoon, I finished reading the compilation of the Massey Lectures delivered by Stephen Lewis in 2005, on HIV/AIDS in Africa. It’s overwhelming stuff – to be confronted with a problem on such a scale, where perfectly viable means of mitigation, treatment, and control exist, but where the overpowering lack of will on the part of those who possess such means keep appropriate and necessary actions from being taken.
There is nothing inevitable about the continuation of the AIDS pandemic. Through combined strategies of nutrition, education, and treatment we could squeeze it down to a tiny fraction of its present size. A 24-week course of nevirapine can cut the transmission rate from mother to child to under 2%. The viral loads of those already infected can be reduced through a combination of anti-retroviral therapies and improved overall health and nutrition, to the point where they are dramatically less infectious. The widespread use of condoms, the management of intravenous drug use, and the proper maintenance of hygiene in medical facilities could slash the vectors by which the infection spreads. Public education could make the avenues through which the disease travels known, as well as empower people to make choices that would protect them and their families.
Of course, there are lots of other factors that require examination: working out how to deal with millions of orphans, many of them now the heads of their families and responsible for younger siblings and, of course, the need to deal with conflict: the eternal spreader of disorder and disease. The danger exists of being overwhelmed by the toughest problems, or using them as an excuse for not taking the easiest and cheapest steps, as part of a progression towards improvement.
When the problem is presented as a cliff face, it seems impossible to climb. Much more accurately, the problem is like a difficult piece of terrain, but one in which we can maneuver if we marshall the skills, the equipment, and the will. As Lewis demonstrates eloquently, the potential benefits of doing so are as enormous as the moral obligation that should compel us to achieve them. Even without a cure or vaccine, it seems obvious that the toll of HIV/AIDS can be reduced enormously; all it would take is political will, backed with money, and the keeping of promises long-made but rarely honoured.
Lewis’ short book is an eloquent and worthwhile expansion upon the above ideas, complete with a huge number of stories and examples from his own experiences in Africa and the corridors of the multi-national institutions. HIV/AIDS is certainly an area in which he speaks with authority. His final chapter, entitled “A Gallery of Alternatives in Good Faith,” includes some excellent suggestions. I quite like the pique of suggesting that, if Japan gets the seat it seeks in the Security Council, it should be forced to live up to the promise it made – of doubling aid to Africa – in order to secure support for its campaign. Quite simply, Lewis suggests, they should forfeit the seat if they fail to live up to their promise. Other ideas, including giving the concerns of women an enormously more prominent place in the UN architecture through the creation of a powerful and permanent body with that mandate, are long overdue for implementation.
In short, I highly recommend the book. I am lending my copy to Emily now, but others in Oxford can borrow it subsequently. I also have Jeffrey Sachs’ The End of Poverty to lend.