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Stephen Lewis

The United Nations Special Envoy for HIV/AIDS in Africa talks about the current state of the AIDS crisis there. He recently returned from a tour of Lesotho, Zimbabwe, Malawi and Zambia, where he was investigating links between hunger and AIDS. He is the former Deputy Executive Director of UNICEF and was the Canadian ambassador to the U.N. from 1984-1988.

44:46

Other segments from the episode on February 24, 2003

Fresh Air with Terry Gross, February 24, 2003: Interview with Stephen Lewis; Review of Tom Carson's new novel, "Gilligan’s Wake."

Transcript

DATE February 24, 2003 ACCOUNT NUMBER N/A
 TIME 12:00 Noon-1:00 PM AUDIENCE N/A
 NETWORK NPR
 PROGRAM Fresh Air

Interview: Stephen Lewis on the AIDS crisis in Africa
TERRY GROSS, host:

This is FRESH AIR. I'm Terry Gross.

My guest, Stephen Lewis, is the UN's special envoy for HIV/AIDS in Africa. He
says the pandemic cannot be allowed to continue and those who watch it unfold
with a kind of pathological equanimity must be held to account. He adds,
`There may yet come a day when we have peacetime tribunals to deal with this
particular version of crimes against humanity.'

Lewis was pleased with President Bush's announcement that he wants to triple
America's funding for fighting AIDS in Africa, though he worries that war with
Iraq will distract world attention from the pandemic. Lewis formerly served
as Canada's ambassador to the UN, deputy head of UNICEF and special adviser on
African economic recovery.

He recently toured four countries in southern Africa: Lesotho, Zimbabwe,
Malawi and Zambia. I asked him to elaborate on how he thinks war with Iraq
might affect the AIDS pandemic in the region.

Former Ambassador STEPHEN LEWIS (United Nations Special Envoy for HIV/AIDS):
Well, war always has the effect of diverting resources, diverting attention,
diverting energies, diverting coverage. War is an entirely preoccupying
reality, and this looming war with Iraq is a preoccupying reality not just for
the United States and its allies, but also for the rest of the world because
there are such profound religious and political divides. And what happens in
that kind of situation is that a continent like Africa gets short shrift; that
you forget the other human and moral imperatives, that they just get lost.

It reminds me very much of what happened after the war in Afghanistan, a
perfectly understandable extension of September the 11th, but nonetheless, the
war in Afghanistan took away from, drew from all of the attention of the world
on other areas of human need and human predicament. So all of us who watch
this unfolding and know that we're dealing with this catastrophic HIV/AIDS
pandemic in Africa and know that we have built some momentum, which was
evidence in the president of the United States' State of the Union address,
when Mr. Bush announced that significant additional amount of money. We know
that all of that could unravel if the war begins and takes everyone's
attention away from what is happening in Africa.

GROSS: Do you think the AIDS casualties in Africa are as bad as the
casualties of most wars?

Mr. LEWIS: They're much greater than the casualties of most wars. I don't
know, Terry, whether people fully understand this, but as the AIDS pandemic
works its way through Africa and now seeping inexorably into Asia, into Russia
and the Eastern bloc, we're going to take a larger toll in human life than the
famous Black Death of the 14th century. But if you want something more
contemporary, AIDS is going to take a greater toll in human life than both the
wars of the 20th century, military and civilian casualties combined. We're
talking about, potentially, 70 to 100 million deaths because that's the way
the pandemic is moving.

GROSS: You talking about just Africa or around the world?

Mr. LEWIS: Well, Africa's already lost close to 20 million. There are 30
million infected. All those people are, for the moment, in the absence of
treatment, doomed. So I think Africa alone could see those numbers. If you
move into the rest of the world and we don't manage to stop the pandemic in
India, in China, in Russia, then I don't even want to think about the figures.
And I don't know to translate it in human terms because those figures are so
abstract. What do they mean? What you have to think about is all the women
and the orphaned children and the families ripped apart and the extended
families lost and countries literally fighting for survival.

GROSS: The CIA has warned that AIDS in China, India, Russia, as well as
Africa, is a mounting security threat for the United States. What does the
CIA mean by that?

Mr. LEWIS: They mean that as the HIV/AIDS pandemic takes its toll, the
societies begin to fall apart and all the big sectors of society are affected.
It's, therefore, not merely the human tragedy, it's the shredding of all the
infrastructures. You're seeing that now in southern Africa with the food
shortages and the near famine in several countries in southern Africa. And
what has happened, of course, is that over the last 10 years or so, seven
million agricultural workers--overwhelmingly women because women do the
farming, agricultural workers have died.

And so many of the people have reduced immune systems because they're infected
by HIV that when you add that to the food shortages, then it means that
everything falls apart. People are subject to a much more rapid progression
of the disease and a much more rapid progression towards death. And we're
seeing that all over southern Africa.

I was in the four countries that are most grievously affected--Lesothos,
Zimbabwe, Zambia, Malawi--in December and again in January and frankly, we
were horrified by what we encountered, those of us who were traveling for the
UN because this wasn't a food shortage and hunger induced by drought and
erratic rainfall as first was thought. This was a food shortage and hunger
induced, in large part, by AIDS because AIDS had caused the whole society to
fracture.

I remember meeting with the minister of Agriculture in Zambia and he said--by
way of anecdote, he said, `You know, I had a meeting, Mr. Lewis, 10 days ago
with the European Commission. They brought 10 people to the meeting. I
attended the meeting alone.' And he said, `I attended it alone because so
many of the senior people in my ministry were dead. I had no one to bring
with me.'

And you see, what has happened in agriculture is happening, for example, in
education. Zambia loses 2,000 teachers a year. It graduates from its
teachers' colleges fewer than a thousand. How do you keep your education
system together when kids are leaving schools to look after sick and dying
parents, when the teachers are dying or they're absent because they're sick?
So progressively you shred the agricultural sector, the education sector, the
health sector, the private sector, often the military, whose rates of
infection are inevitably higher than those of the civilian population. And
that's what the CIA means by a security risk, that the entire country is then
subject to destabilization because you've got huge number of orphans wandering
the landscape, ruthless and angry and bewildered, and you've got a society
struggling for survival. Do you know we heard the word `extinction' used more
than once as we traveled.

GROSS: In relationship to what?

Mr. LEWIS: In relation to the countries. We heard heads of state say they
were fighting to prevent their country from extinction. It's the first time
I've heard that word. I've heard `fighting for survival,' `fighting for our
lives,' `We don't know whether we'll make it,' `We could be a failed state.'
I had not before heard the word `extinction.'

GROSS: Are there any tribes or ethnic groups within Africa that are already
on the verge of extinction?

Mr. LEWIS: Well, there are countries where the prevalence rates of HIV-AIDS
are so high that they really are fighting for survival. Botswana has a
prevalence rate of over 38 percent amongst the 15- to 49-year-olds, so try to
imagine it; one out of every three, two out of every five people who are
infected. Botswana is tremendously fortunate. It has some mines and it has
diamonds and it has one of the few countries in Africa which has some surplus
from previous budgets, so they're working hard at putting a treatment program
into place and doing intense prevention. But frankly, they're really fighting
to save the life of the country.

Swaziland, which has a prevalence rate as high as Botswana now, doesn't have
the same resilience and the same capacity to respond. It's unbelievably
impoverished. Remember, most of these countries live on less than $1 a day
per person, so they're so poor that to find the resources to respond is just
not available.

GROSS: A lot of our listeners might be thinking, yeah the problems in Africa
are very grave, but the Bush administration is recommending giving $15 billion
for AIDS in Africa, so that will really help a lot. If the $15 billion
actually comes through, how much of a dent will it make in helping to reverse
the epidemic?

Mr. LEWIS: Oh, it will make a dent, if it's well and intelligently used, it
will make a very considerable dent, because we've just never had those kinds
of figures before. But if you put it in perspective, if it's $3 billion a
year for five years, everybody understands that we need a minimum of $10
billion to do the job now, and by the year 2007, those who study it say we
will need over $15 billion. So while the American offer, the American
commitment is a quantum leap forward and changes the pattern of indifference
and negligence which has characterized the Western world for years, it still
doesn't begin to confront the amounts that are needed in order to turn the
pandemic back.

Now I beg you to put it in context. Ten or $15 billion over five years sounds
like a lot of money; $10 billion a year sounds like a lot of money. But
people who have estimated the cost of a war in Iraq are talking about $100
billion and better. So in relative terms, we're asking for very small amounts
of money to attempt to save the lives of over two million people a year.

GROSS: My guest is Stephen Lewis, the UN's special envoy for HIV/AIDS in
Africa. We'll talk more after our break. This is FRESH AIR.

(Soundbite of music)

GROSS: If you're just joining us, my guest is Stephen Lewis. He's the UN
special envoy for AIDS in Africa.

We've talked a little bit about the staggering statistics in Africa. I'm
wondering if you could just give us a couple of scenes of things that you
witnessed on your recent trip to Africa that would also help convey a sense of
how bad the epidemic is there.

Mr. LEWIS: Well, the scenes haunt the mind. It's just very hard to deal with
them. As I'm talking to you, I find myself--just as the images run through my
mind, I find myself becoming unsettled and emotional. I think one of the
worst moments I had was in the University Teaching Hospital in Lusaka, in
Zambia. But frankly it's equivalent to any hospital in southern Africa at the
moment.

I was in the pediatric nutrition ward, where the HIV infection rate is roughly
56 percent, and where there was great hunger in the country as well as AIDS.
And you wander through the ward--I'll tell you exactly what it was. I went in
with the administrator and the head of the ward and all these little morsels
of infants. They were six months to two years old. Three and four to a bed.
Their mothers hovering anxiously around. And you walk down the corridor just
so overpressed, not enough nurses, not enough doctors, not enough beds.
Everybody in a kind of paralysis of anxiety.

And then suddenly as you're walking, you hear this wail breaks out. It's so
shocking and so visceral. And you turn around and you suddenly understand
what's happened, that one of the little infants has died and the mother, her
head buried in the bed sheet beside her dead child, is weeping. And in comes
a nurse and wraps up the child and takes the child out. It's all so
horrifying and unexpected. And then you walk to the end of the ward trying to
get the image out of your mind and suddenly there is another terrible shriek
of dread and you realize that another child has died and another mother has
collapsed in sadness and the tragedy of it.

And then we walked out of the ward into an open area going to what was the
pediatric respiratory part of the hospital where the infection rate is 72
percent. So many of the infants have tuberculosis. And we're in the open
area and through the windows of the ward we've just left comes another howl of
pain. And it's like Kafka and Dante and Poe. It's like everything wrapped
into one crazed moment. You wonder, has the world gone mad? How is this
happening? Why is it happening? Why have we allowed it to happen? And, you
know, you get that sense in hospitals in Africa now where 70 to 80 percent of
the admissions can be for HIV/AIDS-related cases.

I remember when I was in the Harare Hospital in Zimbabwe a year or so ago,
while I was on the adult male ward they were wheeling in aluminum coffins and
removing people who had just died from their beds and putting them in the
coffins and wheeling them out. I mean, it's such an indignity to people.

GROSS: And where do you come in? You're the UN special envoy for AIDS in
Africa. You witness these horrors, you're able to describe these horrors in
an alarmingly powerful way. So then what's within your power to do something?

Mr. LEWIS: The power is terrifyingly limited. I feel as impotent as I do
empowered. I have a job, it is to see what's happening, to talk to the United
Nations family in the country about the way in which we can more vigorously
intervene and support what the government is trying to do against the
pandemic, to speak to the donors, to work with civil society and all the NGOs,
to work with the associations of people living with AIDS. They are brave,
courageous people, not many in every country who have openly declared their
status but when they do, God, they are good people and they deserve support.

And then I come back and I report directly to the secretary-general, and we
get a chance to meet with heads of agencies and heads of departments and
discuss collectively what more the United Nations can do to give leadership to
what is happening.

You see, if I may digress for just a moment, we should--what is happening is
horrifying. The way women die in their homes in the presence of their
children is horrifying. The way in which women are disproportionately
targeted by the virus, the way they're...

GROSS: Yeah, and I want to say we'll get to that in a minute.

Mr. LEWIS: OK. Well...

GROSS: I do want to talk with you about that.

Mr. LEWIS: Well, setting aside then for the moment that part of it, I want to
say that there's no need to be annihilated by it all. It is possible to
defeat this pandemic. We know what to do. I mean, that's what's important to
understand. We know what to do in prevention. We know what to do in
treatment. We know what to do in care. We have models and projects and
proposals and interventions all over the continent. They're small. We've
never had the resources to generalize them through the country, to take them
to scale. But there are some brilliant interventions and there's a
tremendously strong resource at the community level to implement them.

There are community-based organizations, faith-based organizations. We don't
have to be stymied by the horror except that for the moment in the absence of
resources and support, the horror tends to overwhelm.

GROSS: Now you referred to the gender inequality of AIDS in Africa and women
and girls are particularly hard hit. And I think the statistic is for girls
aged 15 to 19 it's like twice as many girls as young men who have HIV. What's
behind that gender disparity?

Mr. LEWIS: As a matter of fact, in the age group 15 to 19 it's in some places
even worse than that. In a number of places, girls are five and six times
more susceptible to infection than boys of that age. Look, Africa is a
continent steeped in gender inequality. That's the culture. It's the culture
in much of the developing world. But there isn't a single country in this
world, not on the planet, which has real gender equality.

In Africa, gender inequality is fatal, and the predatory sexual behavior of
adult men, the intergenerational sex, older men forcing sex on younger women
and girls--you know, women and girls have no sexual autonomy; they can't say
to a man, `You must wear a condom.' They have no power over their own
sexuality. There is a cultural oppression there which is so deeply entrenched
that it's going to take a long time to overcome it.

And that gender inequality is felt institutionally, it's felt in the world of
work, it's felt in farming. It's felt in education. It's felt everywhere.
It's particularly bad in the areas of sexual violence and of rape and of
marital rape, and the laws are inadequate to respond. What we really need in
Africa is a massive campaign on gender equality treating every single aspect
of a woman's life, from property rights and inheritance right through to
sexual violence, in order to overcome it.

GROSS: Stephen Lewis is the UN special envoy for HIV/AIDS. He'll be back in
the second half of the show.

I'm Terry Gross, and this is FRESH AIR.

(Soundbite of music)

(Announcements)

GROSS: Coming up, safe sex and fatalism. We continue our conversation with
Stephen Lewis, UN special envoy for AIDS in Africa. And Maureen Corrigan
reviews "Gilligan's Wake," a new novel by Tom Carson inspired by "Gilligan's
Island" and "Finnegans Wake."

(Soundbite of music)

GROSS: This is FRESH AIR. I'm Terry Gross, back with Stephen Lewis, the UN's
special envoy for HIV/AIDS in Africa and Canada's former ambassador to the UN.
He recently toured four countries in southern Africa. When we left off, we
were talking about how gender inequality has affected the spread of AIDS in
Africa.

From very far away, it's easy to think about Africa, well, you can't
completely plead ignorance anymore because the epidemic is so widespread, you
can't help but see its existence around you. So why would you have
unprotected sex in an environment like that when you know that that's the way
to get sick yourself?

Mr. LEWIS: Well, because changing sexual behavior turns out to be the most
difficult thing in the world to achieve. Achieving awareness is not so
difficult. There are some countries that claim--and I think they're right--a
95 to 100 percent awareness of how the virus is transmitted heterosexually,
and there is even awareness of how to protect oneself. And yet, because of
sexual behavior, there isn't behavior change. There's a big gulf between the
awareness on the one hand and the behavior change on the other. And we
haven't yet got to the behavior change. But you can see in a country like
Uganda or a country like Senegal or progress we're making in the 15- to
19-year-old age group in Kenya, Zambia and Namibia, you can see intense
prevention programs, which explain and which are graphic and which are direct
and, you know, you absolutely starkly set out the facts for young people in
schools and through drama and music and poetry and song and dance at community
level. You can get people to change their sexual behavior, but it does take a
lot of time, and in the meantime, a lot of people are being infected.

GROSS: Do you think that there's more awareness about how AIDS is spread now
and more openness and discussion of sexuality?

Mr. LEWIS: Oh, God, yes. It's astonishing what's happened, even in the last
two years, and it's also the political leadership in Africa, who were steeped
in the 1990s in denial and in silence, except for special countries like
Uganda, where you had President Museveni, who early on understood what was at
stake and just refused ever to make a speech without talking about AIDS,
wouldn't allow his Cabinet members to make speeches without talking about
AIDS. And gradually, the prevention programs grew so that the prevalence
rates in Uganda, which were between 25 and 30 percent in the early '90s are
now down, believe it or not, to 6 or 7 percent in 2003. That's an astonishing
decline, and it shows it's possible.

And what's happened, I think, is that the African leadership in the last two
or three years has become so horrified by the sense of their societies falling
apart that they really are engaged, and there's much more talk about it. And
it's just amazing how frank--I did a question and answer, Terry, with about,
oh, eight or 900 Ethiopian high school students in Addis Ababa some months
ago, and I was stunned by the frankness and openness of the questions. There
wasn't the slightest embarrassment about discussing intimate sexual detail.
And...

GROSS: Would this have been unimaginable when you first started visiting
Africa, looking at AIDS?

Mr. LEWIS: Absolutely, absolutely unimaginable. In fact, to tell you the
honest truth, I felt--as I was sitting there, it was faintly surreal. I felt
it was unimaginable, even as I was hearing it, but it showed how quickly the
societies are recognizing that this is an unbelievable catastrophe, and they
have to do something about it. But it's all happened late, and they've never
had the resources.

GROSS: Are condoms readily available through Africa?

Mr. LEWIS: The male condom is available in most countries in significant
numbers. Frequently, the Ministry of Health will make them available.
Frequently, big NGOs will make them available. There are times when there are
shortages and when they're not available, and that's usually some kind of
breakdown in the pipeline of delivery. What hasn't been available, largely
because of cost, is the female condom. It's being used more widely now in
South Africa. They're making a real effort to distribute the female condom,
and it, of course, has the huge advantage of the woman being able to take
control over the sexual transaction.

GROSS: Assuming she's not being raped, in which she wouldn't have kind of
control.

Mr. LEWIS: Oh, yes, of course, of course, of course. Yeah.

GROSS: What about prostitution? Are you seeing any changes in prostitution?

Mr. LEWIS: Well, commercial sex work remains a very serious high-risk group
for transmission of the disease. It particularly happens at border crossings
when truck drivers are backed up overnight before they can cross. It happens
when people--the migration of work forces from one country to another, if one
of the country has mines, then frequently, the workers will go to the mines,
they're away from their families, they go to prostitutes. The virus is
transmitted. The routes that the truckers take, the work migration, the
availability of commercial sex in some of the urban centers, there are things
that drive the virus.

There are very considerable efforts made to get commercial sex workers out of
the trade and into an alternative, but it's important to understand, I think,
that a lot of the women who are in commercial sex work are in what we call
survival sex. It's so difficult in this society to find even pennies to keep
body and soul together, that some young women are forced into sex for that
purpose. And therefore, you have to find alternatives. I was in Mombasa not
long ago in Kenya where a group of 10 commercial sex workers had completely
broken from their commercial sex work because they were able to build a little
bakery and sell their baked goods in the community, and they were receiving a
sufficient income from their baked goods to be able to give up commercial sex
work. And while that's very tiny, those are the kinds of methodical
interventions that are being tested all over the continent. We call
them--income-generating projects is the term of art.

GROSS: Have you seen a lot of different attitudes among the people of Africa
about the epidemic in terms of their own vulnerability to it and how they deal
with that vulnerability? Have you seen some people who are just fatalistic
about it, `I'm going to behave the way I behave, and if I get it, I get it,'
and seen other people try to, you know, do their best to prevent it from
happening?

Mr. LEWIS: You see absolutely the whole range of human behavior and human
response. There are some really shocking surveys which emerged at the
Barcelona International Conference on AIDS last July, surveys that were
conducted by UNICEF and UNAIDS, particularly amongst young girls and young
women between the ages of 15 and 19 in which they felt in the various
countries that they were simply not at risk. They didn't always understand
how the virus was transmitted. They assumed just by looking at people, you
could tell whether it was safe to have sex with them or not. There were
numbers of preconceptions and misconceptions which were very unsettling and
showed the need for an intense effort at education. Amongst young boys, there
was a tremendous, smug egocentricity amongst their entitlements sexually and
what they could and could not do and their indifference to the possibility of
getting the virus. So you had these various extremes in attitudes, which is
based on survey data and allows us to know where to put the emphasis.

As one wanders--and I've been doing it now for more than a year and a half
intensely in this role--you sense an increasing awareness everywhere. So if
I'm sitting in Ethiopia at a little coffee klatch in the late morning with a
group of neighborhood women, incredibly enough, as uncomfortable as they would
normally be about discussions of sexuality, and particularly in the presence
of a white Westerner, they're not uncomfortable at all. They sit over coffee
and they discuss what AIDS is doing and what should be done. But then you
meet the people living with AIDS in these various countries, and they tell you
hair-raising stories of stigma. And you realize how intense the stigma is and
how people, if they have the courage to declare their status, they're rejected
sometimes from their families, by their neighbors, by their friends.

I remember meeting with a group of 10 women or a dozen women in the little
town of Arusha in Tanzania just a year or so ago, and they were all living
with AIDS. And I said to them, `Yeah, that's very brave of you to be talking
so openly about living with AIDS. How does your community respond?' And they
said to me, `We never talk about it in our communities. They don't know we're
living with AIDS. We talk about it only if we're here in the urban center of
Arusha where no one knows us.'

GROSS: I know availability of drugs is an incredibly important issue in
dealing with AIDS in South Africa. Is the problem mostly money? Is the
problem mostly that people can't afford to pay for the drugs?

Mr. LEWIS: Yes, the fundamental problem there is money. There are other
problems--you have weak health systems; you don't have enough doctors, nurses
and counselors to administer the drugs and to follow the patient back to the
village and make sure that the drug regimen is followed. But overwhelmingly
the problem is dollars.

For a long time the difficulty was with the pharmaceutical industry who kept
the price of anti-retroviral drugs very high. But as President Bush pointed
out the other night in a State of the Union address, the drug costs have
dropped from $12,000 a year to roughly $300 per person per year for the
generic drugs. Now if you're living in a country where people are earning
less than a dollar a day, you can't afford $300 a year. But if there was
outside donor money, like that of the United States, coming into the country
for the purchase of the drugs and the distribution of the drugs, then you
could prolong life significantly for very large numbers of people. And that
is the desperate struggle at the moment. It doesn't mean that we should
diminish prevention for a second or diminish the care of people for a second,
but we can prolong lives.

I go back to the remarks of the president of the United States. He said,
`Four million people need treatment now, and only 50,000 are getting it.'
That's just a staggering comparison.

GROSS: My guest is Stephen Lewis, the UN special envoy for HIV/AIDS in
Africa. We'll talk more after a break. This is FRESH AIR.

(Soundbite of music)

GROSS: My guest is Stephen Lewis, the UN special envoy for HIV/AIDS in
Africa.

You've given us some pretty horrifying pictures of how AIDS is affecting
Africa. When you go home to Canada after spending time in Africa, how does it
change you?

Mr. LEWIS: Well, I've had a love affair with Africa since 1959. I've been
going back and forth, to and from the continent for 44 years now. I love the
continent--I love the people; I love the music; I love the generosity; I love
the kindness; I love the intelligence. It's an extraordinary continent,
despite the fact that it's beset by conflict and by disease and by poverty.

But, you know, it's too heartbreaking almost to cope with. I know--look, this
isn't a confessional. I don't know much about this program. We're just
chatting in a friendly way. But I know that at times I'm emotionally fraying.
I know that I'm not as sober and rational and contemplative as I should be,
because it just tears your heart out. It all seems so unnecessary. Because,
as I say again, we know how to defeat the pandemic. We could break its back
in four or five years and save millions of lives if only we can mobilize the
world.

If we mobilize the world around AIDS the way we mobilize the world around war,
then we could really overcome HIV/AIDS in a few years' time.

GROSS: And that would take--What?--anti-retroviral drugs and more sex
education?

Mr. LEWIS: Massive...

GROSS: I mean, what would it take?

Mr. LEWIS: Massive prevention programs, anti-retroviral drugs, a great deal
by way of resources from the Western world, a kind of Marshall Plan for Africa
to overcome the disease, and in the process saving the world from real agony
if it spreads inexorably to China and India, as it now seems to be doing,
which will definitely dwarf Africa in numbers.

GROSS: Is this a difficult time for you to be traveling to Africa as the UN's
special envoy for AIDS? Westerners are targets of terrorists in every part of
the world right now, and certainly in Africa.

Mr. LEWIS: Yeah.

GROSS: So what kind of problems is that causing for you, either problems in
terms of anxiety or problems in terms of restrictions that you have to deal
with?

Mr. LEWIS: Interesting question. Actually, it has caused me not a moment's
hesitation or restriction. I travel in large measure alone or sometimes with
a colleague. The UN family in the countries that I visit are the people on
whom I rely, and then the meetings with government and civil society
officials.

You know, without seeming to be unstable, I am so seized with this
predicament, and anyone would be. This is not a characteristic of Stephen
Lewis; anyone who sees and works with what is happening would be just obsessed
with it. And the struggle to overcome it supercedes every other
consideration, whether it's insecurity or threats of terrorism or wars.

GROSS: You have worked with the UN in many capacities. You're Canada's
former ambassador to the United Nations, former deputy head of UNICEF, a
former special adviser on African economic recovery. What do you think of how
the UN is handling now the crises of the world--North Korea, Iraq? Are you
disappointed in the UN's ability to cope? Or do you feel the UN is really
behaving in the way that it should be?

Mr. LEWIS: The UN is two entities. It's important to recognize that. When
it's handling an Iraq or a North Korea in the Security Council, it is
fulfilling its role on peace and security, a largely political role, by which
it is overwhelmingly judged by everyone. And I think in defense of the UN,
the UN is then captive to the decisions of the individual countries--the
United States, France, Russia, Germany. These countries, which taken together
are the sum total of the UN, dictate the UN's terms, conditions and policies.
It's not Kofi Annan. He simply implements what the countries decide.

And then there's the other UN. There's the UN which devotes itself to
humanitarian priorities and to emergencies and to development. It's the
UNICEFs and the population people and the World Food Program and the refugees
and the United Nations Development Program. It's all those parts of the UN
which day in and day out save lives and deal with the most difficult and grim
dimensions of society. That's the UN that is loved and valued and treasured
in these developing countries.

And it's kind of schizophrenic. We think so completely of the UN and the
Security Council when a France and the United States lock horns, and we forget
that the primary work of the UN beyond peace and security is with human
priorities, and that work is magnificent.

GROSS: Before you were the UN special envoy for AIDS in Africa, you worked as
an investigator on the Rwanda genocide, so you've seen the impact of genocide
and you've seen the impact of the AIDS pandemic; you've witnessed, you know,
the impact of millions of people dying. What does this do to your sense of
proportion? I mean, how do you protect yourself of thinking, `Oh, another
life is lost. Big deal. I've seen millions'? You know, what does it do to
your sense of proportion?

Mr. LEWIS: God, that's an interesting question. For one thing, the genocide
ended. I mean, at least it had a conclusion. The thing about AIDS which is
so harrowing is that it seems never to have a conclusion; it just seems to go
on and on and on. And you know that the death rates are going to rise to
astronomic heights in 2008, 2009, 2010, and all of the orphans will
proliferate in huge numbers. It's a generational thing. It's going on. It
isn't ending.

Proportion? Can I tell you something which interests me? I'm a person who
hasn't responded well enough to human agony and despair. It's not that I
don't feel it intensely, but it's because as a Canadian I've always been
somewhat distant from it. And like everybody else, you think of these
abstract large figures, and it's hard to put a human face to them.

What has happened to me personally in dealing with AIDS is that rather than
seeing it in large, every single person now somehow has a vivid reality for
me. And I carry in my mind a young woman living with AIDS in Lusaka who had a
stroke and has lost the sight of one eye and still in her 20s is fighting to
stay alive. And, you know, you carry away with you a sense of a woman in a
community who's desperately tending to the sick and the dying. And you carry
away with you a young orphan girl of 14 looking after four siblings, stoically
dealing with the household. And when someone dies, you feel it very keenly.

In an odd way, AIDS has become personalized. Every single person is like a
scar on the soul, I think, because it's all unnecessary. I think it's because
you know these people shouldn't be dying. And so each of them individually
has a tremendous personal force.

GROSS: Stephen Lewis, safe travels. Thank you very much for talking with us.

Mr. LEWIS: Thank you, Terry.

GROSS: Stephen Lewis is the UN's special envoy for HIV/AIDS.

Coming up, Maureen Corrigan reviews Tom Carson's new novel inspired by TV and
literature, "Gilligan's Wake."

This is FRESH AIR.

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *

Review: Tom Carson's new novel "Gilligan's Wake"
TERRY GROSS, host:

For decades critic Tom Carson has written on TV and popular culture for The
Village Voice, Esquire, Rolling Stone and other magazines and newspapers.
He's written a new novel called "Gilligan's Wake," which draws heavily on his
informed infatuation with classic television series, American history and
world literature. Book critic Maureen Corrigan says "Gilligan's Wake" may be
one of those novels you'd like to have with you on a desert island.

MAUREEN CORRIGAN reporting:

I'm always curious about the current state of cultural literacy, so I went
into my freshman English classes the other day and asked how many students
had ever watched the 1960s sitcom "Gilligan's Island." They all raised their
hands instantly. Then I told them about Tom Carson's new novel, "Gilligan's
Wake," which in bebop, stream-of-consciousness fashion retells highlights of
modern American history through the voices of each of the characters on the
island. A few faint smiles of appreciation, but unlike the reaction I got
when I told the same plot synopsis to friends age 35 and over, no out-and-out
hoots of laughter at the absurdity of the whole idea.

My students, I realized, have only watched "Gilligan's Island" on the classic
TV channel. For them, it's a canonized text, as venerable in its own way as
"The Great Gatsby," "The Day of the Locust," "No Exit," "Finnegans Wake," or
any of the other highbrow works Carson references throughout his hectic tale.
Their relative lack of elitist distinctions makes my students Carson's ideal
readers, because he also assumes that the boundaries are porous between high
and low culture. Such is the surrealistic quality of American life, according
to Carson's novel.

Reading "Gilligan's Wake" and being the beneficiary of a high-culture egghead
education, I couldn't help but think of the original title of James Joyce's
"Finnegans Wake," which was "Here Comes Everybody." "Here Comes Everybody"
aptly captures the feel of Carson's novel. It's an inspired mumbo jumbo manic
homage to the art of both James Joyce and Bob Denver. "Gilligan's Wake" is
structured as a series of autobiographical reflections by the ill-fated
passengers and crew of the USS Minnow.

The novel opens with Maynard G. Krebs, the beatnik character Bob Denver played
on his first TV show, "The Many Loves of Dobie Gillis," ranting in the Mayo
Clinic's Cleaver Ward to his shrink, Dr. Kildare F. Troop. Holden Caulfield,
by the way, is Krebs' roommate. From Krebs' paranoid rantings, he's seen the
best minds of his generation destroyed by madness, J. Edgar Hoover and too
much espresso. We go on to the skipper's adventures during World War II with
"McHale's Navy" and JFK's PT-109. Then it's back in time to the rarified
youth of Thurston Howell III, who unknowingly launches an old school chum,
Alger Hiss, on his dubious government career. The professor, here a bisexual
narcissist, works on the Manhattan Project. Party girl Ginger recalls her
one-night stand for racial equality with Sammy Davis Jr. And Mary Ann loses
her all-American virginal view of the world, hobnobbing with Sartre in
existentialist-infested Paris.

My favorite chapter, however, is the one presided over by Lovey Howell, a
character who, even on the original TV show, always seemed to be smarter than
she acted. After all, she was the only character who packed enough trunks of
clothes in an anticipation of possible shipwreck. In Carson's fevered
imagination, Lovey is a former flapper, a morphine-popping intimate friend,
and I do mean intimate, of Daisy Buchanan.

Here's Daisy confessing to Lovey her ambition to write a tell-all novel about
Jay Gatsby: `It would be about a man, a man that everybody thinks is
wonderful, because his dreams soar so high and he's so full of ardor and he
loves his idea of you so much more of you than the reality of you, which
nobody else thinks deserves love anyway, and how nobody understands that this
man is a tyrant and a dictator who carries your head around on a stick, even
though he calls it his banner, because he's in love with himself, but he can
never admit that. And so he makes you his idol and loves himself, adores
himself, worships himself for having one.'

I have to admit, as many times as I've read "The Great Gatsby," that view of
Gatsby, as an overbearing emotional bully with boundary problems, never
occurred to me. But aided by Lovey's astute interjections and asides to
Virginia Woolf and Betty Friedan, this clever, if repugnant, revisionary
interpretation works.

Despite its ambitions to make a big statement about America, the wordplay's
the thing in "Gilligan's Wake." If you like reading Joyce and Eliot, enjoy
the self-satisfaction of catching references, riffs and anagrams, this
language-drunk novel is for you. If you have no patience for relentlessly
illusory writing, well, to paraphrase the immortal theme song of "Gilligan's
Island," "Gilligan's Wake" will be an uphill climb.

GROSS: Maureen Corrigan teaches literature at Georgetown University.

(Credits)

GROSS: I'm Terry Gross.

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