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.
Other segments from the episode on February 24, 2003
DATE February 24, 2003 ACCOUNT NUMBER N/Aâ¨ TIME 12:00 Noon-1:00 PM AUDIENCE N/Aâ¨ NETWORK NPRâ¨ PROGRAM Fresh Airâ¨â¨Interview: Stephen Lewis on the AIDS crisis in Africaâ¨TERRY GROSS, host:â¨â¨This is FRESH AIR. I'm Terry Gross.â¨â¨My guest, Stephen Lewis, is the UN's special envoy for HIV/AIDS in Africa. Heâ¨says the pandemic cannot be allowed to continue and those who watch it unfoldâ¨with a kind of pathological equanimity must be held to account. He adds,â¨`There may yet come a day when we have peacetime tribunals to deal with thisâ¨particular version of crimes against humanity.'â¨â¨Lewis was pleased with President Bush's announcement that he wants to tripleâ¨America's funding for fighting AIDS in Africa, though he worries that war withâ¨Iraq will distract world attention from the pandemic. Lewis formerly servedâ¨as Canada's ambassador to the UN, deputy head of UNICEF and special adviser onâ¨African economic recovery.â¨â¨He recently toured four countries in southern Africa: Lesotho, Zimbabwe,â¨Malawi and Zambia. I asked him to elaborate on how he thinks war with Iraqâ¨might affect the AIDS pandemic in the region.â¨â¨Former Ambassador STEPHEN LEWIS (United Nations Special Envoy for HIV/AIDS):â¨Well, war always has the effect of diverting resources, diverting attention,â¨diverting energies, diverting coverage. War is an entirely preoccupyingâ¨reality, and this looming war with Iraq is a preoccupying reality not just forâ¨the United States and its allies, but also for the rest of the world becauseâ¨there are such profound religious and political divides. And what happens inâ¨that kind of situation is that a continent like Africa gets short shrift; thatâ¨you forget the other human and moral imperatives, that they just get lost.â¨â¨It reminds me very much of what happened after the war in Afghanistan, aâ¨perfectly understandable extension of September the 11th, but nonetheless, theâ¨war in Afghanistan took away from, drew from all of the attention of the worldâ¨on other areas of human need and human predicament. So all of us who watchâ¨this unfolding and know that we're dealing with this catastrophic HIV/AIDSâ¨pandemic in Africa and know that we have built some momentum, which wasâ¨evidence in the president of the United States' State of the Union address,â¨when Mr. Bush announced that significant additional amount of money. We knowâ¨that all of that could unravel if the war begins and takes everyone'sâ¨attention away from what is happening in Africa.â¨â¨GROSS: Do you think the AIDS casualties in Africa are as bad as theâ¨casualties of most wars?â¨â¨Mr. LEWIS: They're much greater than the casualties of most wars. I don'tâ¨know, Terry, whether people fully understand this, but as the AIDS pandemicâ¨works its way through Africa and now seeping inexorably into Asia, into Russiaâ¨and the Eastern bloc, we're going to take a larger toll in human life than theâ¨famous Black Death of the 14th century. But if you want something moreâ¨contemporary, AIDS is going to take a greater toll in human life than both theâ¨wars of the 20th century, military and civilian casualties combined. We'reâ¨talking about, potentially, 70 to 100 million deaths because that's the wayâ¨the pandemic is moving.â¨â¨GROSS: You talking about just Africa or around the world?â¨â¨Mr. LEWIS: Well, Africa's already lost close to 20 million. There are 30â¨million infected. All those people are, for the moment, in the absence ofâ¨treatment, doomed. So I think Africa alone could see those numbers. If youâ¨move into the rest of the world and we don't manage to stop the pandemic inâ¨India, in China, in Russia, then I don't even want to think about the figures.â¨And I don't know to translate it in human terms because those figures are soâ¨abstract. What do they mean? What you have to think about is all the womenâ¨and the orphaned children and the families ripped apart and the extendedâ¨families lost and countries literally fighting for survival.â¨â¨GROSS: The CIA has warned that AIDS in China, India, Russia, as well asâ¨Africa, is a mounting security threat for the United States. What does theâ¨CIA mean by that?â¨â¨Mr. LEWIS: They mean that as the HIV/AIDS pandemic takes its toll, theâ¨societies begin to fall apart and all the big sectors of society are affected.â¨It's, therefore, not merely the human tragedy, it's the shredding of all theâ¨infrastructures. You're seeing that now in southern Africa with the foodâ¨shortages and the near famine in several countries in southern Africa. Andâ¨what has happened, of course, is that over the last 10 years or so, sevenâ¨million agricultural workers--overwhelmingly women because women do theâ¨farming, agricultural workers have died.â¨â¨And so many of the people have reduced immune systems because they're infectedâ¨by HIV that when you add that to the food shortages, then it means thatâ¨everything falls apart. People are subject to a much more rapid progressionâ¨of the disease and a much more rapid progression towards death. And we'reâ¨seeing that all over southern Africa.â¨â¨I was in the four countries that are most grievously affected--Lesothos,â¨Zimbabwe, Zambia, Malawi--in December and again in January and frankly, weâ¨were horrified by what we encountered, those of us who were traveling for theâ¨UN because this wasn't a food shortage and hunger induced by drought andâ¨erratic rainfall as first was thought. This was a food shortage and hungerâ¨induced, in large part, by AIDS because AIDS had caused the whole society toâ¨fracture.â¨â¨I remember meeting with the minister of Agriculture in Zambia and he said--byâ¨way of anecdote, he said, `You know, I had a meeting, Mr. Lewis, 10 days agoâ¨with the European Commission. They brought 10 people to the meeting. Iâ¨attended the meeting alone.' And he said, `I attended it alone because soâ¨many of the senior people in my ministry were dead. I had no one to bringâ¨with me.'â¨â¨And you see, what has happened in agriculture is happening, for example, inâ¨education. Zambia loses 2,000 teachers a year. It graduates from itsâ¨teachers' colleges fewer than a thousand. How do you keep your educationâ¨system together when kids are leaving schools to look after sick and dyingâ¨parents, when the teachers are dying or they're absent because they're sick?â¨So progressively you shred the agricultural sector, the education sector, theâ¨health sector, the private sector, often the military, whose rates ofâ¨infection are inevitably higher than those of the civilian population. Andâ¨that's what the CIA means by a security risk, that the entire country is thenâ¨subject to destabilization because you've got huge number of orphans wanderingâ¨the landscape, ruthless and angry and bewildered, and you've got a societyâ¨struggling for survival. Do you know we heard the word `extinction' used moreâ¨than once as we traveled.â¨â¨GROSS: In relationship to what?â¨â¨Mr. LEWIS: In relation to the countries. We heard heads of state say theyâ¨were fighting to prevent their country from extinction. It's the first timeâ¨I've heard that word. I've heard `fighting for survival,' `fighting for ourâ¨lives,' `We don't know whether we'll make it,' `We could be a failed state.'â¨I had not before heard the word `extinction.'â¨â¨GROSS: Are there any tribes or ethnic groups within Africa that are alreadyâ¨on the verge of extinction?â¨â¨Mr. LEWIS: Well, there are countries where the prevalence rates of HIV-AIDSâ¨are so high that they really are fighting for survival. Botswana has aâ¨prevalence rate of over 38 percent amongst the 15- to 49-year-olds, so try toâ¨imagine it; one out of every three, two out of every five people who areâ¨infected. Botswana is tremendously fortunate. It has some mines and it hasâ¨diamonds and it has one of the few countries in Africa which has some surplusâ¨from previous budgets, so they're working hard at putting a treatment programâ¨into place and doing intense prevention. But frankly, they're really fightingâ¨to save the life of the country.â¨â¨Swaziland, which has a prevalence rate as high as Botswana now, doesn't haveâ¨the same resilience and the same capacity to respond. It's unbelievablyâ¨impoverished. Remember, most of these countries live on less than $1 a dayâ¨per person, so they're so poor that to find the resources to respond is justâ¨not available.â¨â¨GROSS: A lot of our listeners might be thinking, yeah the problems in Africaâ¨are very grave, but the Bush administration is recommending giving $15 billionâ¨for AIDS in Africa, so that will really help a lot. If the $15 billionâ¨actually comes through, how much of a dent will it make in helping to reverseâ¨the epidemic?â¨â¨Mr. LEWIS: Oh, it will make a dent, if it's well and intelligently used, itâ¨will make a very considerable dent, because we've just never had those kindsâ¨of figures before. But if you put it in perspective, if it's $3 billion aâ¨year for five years, everybody understands that we need a minimum of $10â¨billion to do the job now, and by the year 2007, those who study it say weâ¨will need over $15 billion. So while the American offer, the Americanâ¨commitment is a quantum leap forward and changes the pattern of indifferenceâ¨and negligence which has characterized the Western world for years, it stillâ¨doesn't begin to confront the amounts that are needed in order to turn theâ¨pandemic back.â¨â¨Now I beg you to put it in context. Ten or $15 billion over five years soundsâ¨like a lot of money; $10 billion a year sounds like a lot of money. Butâ¨people who have estimated the cost of a war in Iraq are talking about $100â¨billion and better. So in relative terms, we're asking for very small amountsâ¨of money to attempt to save the lives of over two million people a year.â¨â¨GROSS: My guest is Stephen Lewis, the UN's special envoy for HIV/AIDS inâ¨Africa. We'll talk more after our break. This is FRESH AIR.â¨â¨(Soundbite of music)â¨â¨GROSS: If you're just joining us, my guest is Stephen Lewis. He's the UNâ¨special envoy for AIDS in Africa.â¨â¨We've talked a little bit about the staggering statistics in Africa. I'mâ¨wondering if you could just give us a couple of scenes of things that youâ¨witnessed on your recent trip to Africa that would also help convey a sense ofâ¨how bad the epidemic is there.â¨â¨Mr. LEWIS: Well, the scenes haunt the mind. It's just very hard to deal withâ¨them. As I'm talking to you, I find myself--just as the images run through myâ¨mind, I find myself becoming unsettled and emotional. I think one of theâ¨worst moments I had was in the University Teaching Hospital in Lusaka, inâ¨Zambia. But frankly it's equivalent to any hospital in southern Africa at theâ¨moment.â¨â¨I was in the pediatric nutrition ward, where the HIV infection rate is roughlyâ¨56 percent, and where there was great hunger in the country as well as AIDS.â¨And you wander through the ward--I'll tell you exactly what it was. I went inâ¨with the administrator and the head of the ward and all these little morselsâ¨of infants. They were six months to two years old. Three and four to a bed.â¨Their mothers hovering anxiously around. And you walk down the corridor justâ¨so overpressed, not enough nurses, not enough doctors, not enough beds.â¨Everybody in a kind of paralysis of anxiety.â¨â¨And then suddenly as you're walking, you hear this wail breaks out. It's soâ¨shocking and so visceral. And you turn around and you suddenly understandâ¨what's happened, that one of the little infants has died and the mother, herâ¨head buried in the bed sheet beside her dead child, is weeping. And in comesâ¨a nurse and wraps up the child and takes the child out. It's all soâ¨horrifying and unexpected. And then you walk to the end of the ward trying toâ¨get the image out of your mind and suddenly there is another terrible shriekâ¨of dread and you realize that another child has died and another mother hasâ¨collapsed in sadness and the tragedy of it.â¨â¨And then we walked out of the ward into an open area going to what was theâ¨pediatric respiratory part of the hospital where the infection rate is 72â¨percent. So many of the infants have tuberculosis. And we're in the openâ¨area and through the windows of the ward we've just left comes another howl ofâ¨pain. And it's like Kafka and Dante and Poe. It's like everything wrappedâ¨into one crazed moment. You wonder, has the world gone mad? How is thisâ¨happening? Why is it happening? Why have we allowed it to happen? And, youâ¨know, you get that sense in hospitals in Africa now where 70 to 80 percent ofâ¨the admissions can be for HIV/AIDS-related cases.â¨â¨I remember when I was in the Harare Hospital in Zimbabwe a year or so ago,â¨while I was on the adult male ward they were wheeling in aluminum coffins andâ¨removing people who had just died from their beds and putting them in theâ¨coffins and wheeling them out. I mean, it's such an indignity to people.â¨â¨GROSS: And where do you come in? You're the UN special envoy for AIDS inâ¨Africa. You witness these horrors, you're able to describe these horrors inâ¨an alarmingly powerful way. So then what's within your power to do something?â¨â¨Mr. LEWIS: The power is terrifyingly limited. I feel as impotent as I doâ¨empowered. I have a job, it is to see what's happening, to talk to the Unitedâ¨Nations family in the country about the way in which we can more vigorouslyâ¨intervene and support what the government is trying to do against theâ¨pandemic, to speak to the donors, to work with civil society and all the NGOs,â¨to work with the associations of people living with AIDS. They are brave,â¨courageous people, not many in every country who have openly declared theirâ¨status but when they do, God, they are good people and they deserve support.â¨â¨And then I come back and I report directly to the secretary-general, and weâ¨get a chance to meet with heads of agencies and heads of departments andâ¨discuss collectively what more the United Nations can do to give leadership toâ¨what is happening.â¨â¨You see, if I may digress for just a moment, we should--what is happening isâ¨horrifying. The way women die in their homes in the presence of theirâ¨children is horrifying. The way in which women are disproportionatelyâ¨targeted by the virus, the way they're...â¨â¨GROSS: Yeah, and I want to say we'll get to that in a minute.â¨â¨Mr. LEWIS: OK. Well...â¨â¨GROSS: I do want to talk with you about that.â¨â¨Mr. LEWIS: Well, setting aside then for the moment that part of it, I want toâ¨say that there's no need to be annihilated by it all. It is possible toâ¨defeat this pandemic. We know what to do. I mean, that's what's important toâ¨understand. We know what to do in prevention. We know what to do inâ¨treatment. We know what to do in care. We have models and projects andâ¨proposals and interventions all over the continent. They're small. We'veâ¨never had the resources to generalize them through the country, to take themâ¨to scale. But there are some brilliant interventions and there's aâ¨tremendously strong resource at the community level to implement them.â¨â¨There are community-based organizations, faith-based organizations. We don'tâ¨have to be stymied by the horror except that for the moment in the absence ofâ¨resources and support, the horror tends to overwhelm.â¨â¨GROSS: Now you referred to the gender inequality of AIDS in Africa and womenâ¨and girls are particularly hard hit. And I think the statistic is for girlsâ¨aged 15 to 19 it's like twice as many girls as young men who have HIV. What'sâ¨behind that gender disparity?â¨â¨Mr. LEWIS: As a matter of fact, in the age group 15 to 19 it's in some placesâ¨even worse than that. In a number of places, girls are five and six timesâ¨more susceptible to infection than boys of that age. Look, Africa is aâ¨continent steeped in gender inequality. That's the culture. It's the cultureâ¨in much of the developing world. But there isn't a single country in thisâ¨world, not on the planet, which has real gender equality.â¨â¨In Africa, gender inequality is fatal, and the predatory sexual behavior ofâ¨adult men, the intergenerational sex, older men forcing sex on younger womenâ¨and girls--you know, women and girls have no sexual autonomy; they can't sayâ¨to a man, `You must wear a condom.' They have no power over their ownâ¨sexuality. There is a cultural oppression there which is so deeply entrenchedâ¨that it's going to take a long time to overcome it.â¨â¨And that gender inequality is felt institutionally, it's felt in the world ofâ¨work, it's felt in farming. It's felt in education. It's felt everywhere.â¨It's particularly bad in the areas of sexual violence and of rape and ofâ¨marital rape, and the laws are inadequate to respond. What we really need inâ¨Africa is a massive campaign on gender equality treating every single aspectâ¨of a woman's life, from property rights and inheritance right through toâ¨sexual violence, in order to overcome it.â¨â¨GROSS: Stephen Lewis is the UN special envoy for HIV/AIDS. He'll be back inâ¨the second half of the show.â¨â¨I'm Terry Gross, and this is FRESH AIR.â¨â¨(Soundbite of music)â¨â¨(Announcements)â¨â¨GROSS: Coming up, safe sex and fatalism. We continue our conversation withâ¨Stephen Lewis, UN special envoy for AIDS in Africa. And Maureen Corriganâ¨reviews "Gilligan's Wake," a new novel by Tom Carson inspired by "Gilligan'sâ¨Island" and "Finnegans Wake."â¨â¨(Soundbite of music)â¨â¨GROSS: This is FRESH AIR. I'm Terry Gross, back with Stephen Lewis, the UN'sâ¨special envoy for HIV/AIDS in Africa and Canada's former ambassador to the UN.â¨He recently toured four countries in southern Africa. When we left off, weâ¨were talking about how gender inequality has affected the spread of AIDS inâ¨Africa.â¨â¨From very far away, it's easy to think about Africa, well, you can'tâ¨completely plead ignorance anymore because the epidemic is so widespread, youâ¨can't help but see its existence around you. So why would you haveâ¨unprotected sex in an environment like that when you know that that's the wayâ¨to get sick yourself?â¨â¨Mr. LEWIS: Well, because changing sexual behavior turns out to be the mostâ¨difficult thing in the world to achieve. Achieving awareness is not soâ¨difficult. There are some countries that claim--and I think they're right--aâ¨95 to 100 percent awareness of how the virus is transmitted heterosexually,â¨and there is even awareness of how to protect oneself. And yet, because ofâ¨sexual behavior, there isn't behavior change. There's a big gulf between theâ¨awareness on the one hand and the behavior change on the other. And weâ¨haven't yet got to the behavior change. But you can see in a country likeâ¨Uganda or a country like Senegal or progress we're making in the 15- toâ¨19-year-old age group in Kenya, Zambia and Namibia, you can see intenseâ¨prevention programs, which explain and which are graphic and which are directâ¨and, you know, you absolutely starkly set out the facts for young people inâ¨schools and through drama and music and poetry and song and dance at communityâ¨level. You can get people to change their sexual behavior, but it does take aâ¨lot of time, and in the meantime, a lot of people are being infected.â¨â¨GROSS: Do you think that there's more awareness about how AIDS is spread nowâ¨and more openness and discussion of sexuality?â¨â¨Mr. LEWIS: Oh, God, yes. It's astonishing what's happened, even in the lastâ¨two years, and it's also the political leadership in Africa, who were steepedâ¨in the 1990s in denial and in silence, except for special countries likeâ¨Uganda, where you had President Museveni, who early on understood what was atâ¨stake and just refused ever to make a speech without talking about AIDS,â¨wouldn't allow his Cabinet members to make speeches without talking aboutâ¨AIDS. And gradually, the prevention programs grew so that the prevalenceâ¨rates in Uganda, which were between 25 and 30 percent in the early '90s areâ¨now down, believe it or not, to 6 or 7 percent in 2003. That's an astonishingâ¨decline, and it shows it's possible.â¨â¨And what's happened, I think, is that the African leadership in the last twoâ¨or three years has become so horrified by the sense of their societies fallingâ¨apart that they really are engaged, and there's much more talk about it. Andâ¨it's just amazing how frank--I did a question and answer, Terry, with about,â¨oh, eight or 900 Ethiopian high school students in Addis Ababa some monthsâ¨ago, and I was stunned by the frankness and openness of the questions. Thereâ¨wasn't the slightest embarrassment about discussing intimate sexual detail.â¨And...â¨â¨GROSS: Would this have been unimaginable when you first started visitingâ¨Africa, looking at AIDS?â¨â¨Mr. LEWIS: Absolutely, absolutely unimaginable. In fact, to tell you theâ¨honest truth, I felt--as I was sitting there, it was faintly surreal. I feltâ¨it was unimaginable, even as I was hearing it, but it showed how quickly theâ¨societies are recognizing that this is an unbelievable catastrophe, and theyâ¨have to do something about it. But it's all happened late, and they've neverâ¨had the resources.â¨â¨GROSS: Are condoms readily available through Africa?â¨â¨Mr. LEWIS: The male condom is available in most countries in significantâ¨numbers. Frequently, the Ministry of Health will make them available.â¨Frequently, big NGOs will make them available. There are times when there areâ¨shortages and when they're not available, and that's usually some kind ofâ¨breakdown in the pipeline of delivery. What hasn't been available, largelyâ¨because of cost, is the female condom. It's being used more widely now inâ¨South Africa. They're making a real effort to distribute the female condom,â¨and it, of course, has the huge advantage of the woman being able to takeâ¨control over the sexual transaction.â¨â¨GROSS: Assuming she's not being raped, in which she wouldn't have kind ofâ¨control.â¨â¨Mr. LEWIS: Oh, yes, of course, of course, of course. Yeah.â¨â¨GROSS: What about prostitution? Are you seeing any changes in prostitution?â¨â¨Mr. LEWIS: Well, commercial sex work remains a very serious high-risk groupâ¨for transmission of the disease. It particularly happens at border crossingsâ¨when truck drivers are backed up overnight before they can cross. It happensâ¨when people--the migration of work forces from one country to another, if oneâ¨of the country has mines, then frequently, the workers will go to the mines,â¨they're away from their families, they go to prostitutes. The virus isâ¨transmitted. The routes that the truckers take, the work migration, theâ¨availability of commercial sex in some of the urban centers, there are thingsâ¨that drive the virus.â¨â¨There are very considerable efforts made to get commercial sex workers out ofâ¨the trade and into an alternative, but it's important to understand, I think,â¨that a lot of the women who are in commercial sex work are in what we callâ¨survival sex. It's so difficult in this society to find even pennies to keepâ¨body and soul together, that some young women are forced into sex for thatâ¨purpose. And therefore, you have to find alternatives. I was in Mombasa notâ¨long ago in Kenya where a group of 10 commercial sex workers had completelyâ¨broken from their commercial sex work because they were able to build a littleâ¨bakery and sell their baked goods in the community, and they were receiving aâ¨sufficient income from their baked goods to be able to give up commercial sexâ¨work. And while that's very tiny, those are the kinds of methodicalâ¨interventions that are being tested all over the continent. We callâ¨them--income-generating projects is the term of art.â¨â¨GROSS: Have you seen a lot of different attitudes among the people of Africaâ¨about the epidemic in terms of their own vulnerability to it and how they dealâ¨with that vulnerability? Have you seen some people who are just fatalisticâ¨about it, `I'm going to behave the way I behave, and if I get it, I get it,'â¨and seen other people try to, you know, do their best to prevent it fromâ¨happening?â¨â¨Mr. LEWIS: You see absolutely the whole range of human behavior and humanâ¨response. There are some really shocking surveys which emerged at theâ¨Barcelona International Conference on AIDS last July, surveys that wereâ¨conducted by UNICEF and UNAIDS, particularly amongst young girls and youngâ¨women between the ages of 15 and 19 in which they felt in the variousâ¨countries that they were simply not at risk. They didn't always understandâ¨how the virus was transmitted. They assumed just by looking at people, youâ¨could tell whether it was safe to have sex with them or not. There wereâ¨numbers of preconceptions and misconceptions which were very unsettling andâ¨showed the need for an intense effort at education. Amongst young boys, thereâ¨was a tremendous, smug egocentricity amongst their entitlements sexually andâ¨what they could and could not do and their indifference to the possibility ofâ¨getting the virus. So you had these various extremes in attitudes, which isâ¨based on survey data and allows us to know where to put the emphasis.â¨â¨As one wanders--and I've been doing it now for more than a year and a halfâ¨intensely in this role--you sense an increasing awareness everywhere. So ifâ¨I'm sitting in Ethiopia at a little coffee klatch in the late morning with aâ¨group of neighborhood women, incredibly enough, as uncomfortable as they wouldâ¨normally be about discussions of sexuality, and particularly in the presenceâ¨of a white Westerner, they're not uncomfortable at all. They sit over coffeeâ¨and they discuss what AIDS is doing and what should be done. But then youâ¨meet the people living with AIDS in these various countries, and they tell youâ¨hair-raising stories of stigma. And you realize how intense the stigma is andâ¨how people, if they have the courage to declare their status, they're rejectedâ¨sometimes from their families, by their neighbors, by their friends.â¨â¨I remember meeting with a group of 10 women or a dozen women in the littleâ¨town of Arusha in Tanzania just a year or so ago, and they were all livingâ¨with AIDS. And I said to them, `Yeah, that's very brave of you to be talkingâ¨so openly about living with AIDS. How does your community respond?' And theyâ¨said to me, `We never talk about it in our communities. They don't know we'reâ¨living with AIDS. We talk about it only if we're here in the urban center ofâ¨Arusha where no one knows us.'â¨â¨GROSS: I know availability of drugs is an incredibly important issue inâ¨dealing with AIDS in South Africa. Is the problem mostly money? Is theâ¨problem mostly that people can't afford to pay for the drugs?â¨â¨Mr. LEWIS: Yes, the fundamental problem there is money. There are otherâ¨problems--you have weak health systems; you don't have enough doctors, nursesâ¨and counselors to administer the drugs and to follow the patient back to theâ¨village and make sure that the drug regimen is followed. But overwhelminglyâ¨the problem is dollars.â¨â¨For a long time the difficulty was with the pharmaceutical industry who keptâ¨the price of anti-retroviral drugs very high. But as President Bush pointedâ¨out the other night in a State of the Union address, the drug costs haveâ¨dropped from $12,000 a year to roughly $300 per person per year for theâ¨generic drugs. Now if you're living in a country where people are earningâ¨less than a dollar a day, you can't afford $300 a year. But if there wasâ¨outside donor money, like that of the United States, coming into the countryâ¨for the purchase of the drugs and the distribution of the drugs, then youâ¨could prolong life significantly for very large numbers of people. And thatâ¨is the desperate struggle at the moment. It doesn't mean that we shouldâ¨diminish prevention for a second or diminish the care of people for a second,â¨but we can prolong lives.â¨â¨I go back to the remarks of the president of the United States. He said,â¨`Four million people need treatment now, and only 50,000 are getting it.'â¨That's just a staggering comparison.â¨â¨GROSS: My guest is Stephen Lewis, the UN special envoy for HIV/AIDS inâ¨Africa. We'll talk more after a break. This is FRESH AIR.â¨â¨(Soundbite of music)â¨â¨GROSS: My guest is Stephen Lewis, the UN special envoy for HIV/AIDS inâ¨Africa.â¨â¨You've given us some pretty horrifying pictures of how AIDS is affectingâ¨Africa. When you go home to Canada after spending time in Africa, how does itâ¨change you?â¨â¨Mr. LEWIS: Well, I've had a love affair with Africa since 1959. I've beenâ¨going back and forth, to and from the continent for 44 years now. I love theâ¨continent--I love the people; I love the music; I love the generosity; I loveâ¨the kindness; I love the intelligence. It's an extraordinary continent,â¨despite the fact that it's beset by conflict and by disease and by poverty.â¨â¨But, you know, it's too heartbreaking almost to cope with. I know--look, thisâ¨isn't a confessional. I don't know much about this program. We're justâ¨chatting in a friendly way. But I know that at times I'm emotionally fraying.â¨I know that I'm not as sober and rational and contemplative as I should be,â¨because it just tears your heart out. It all seems so unnecessary. Because,â¨as I say again, we know how to defeat the pandemic. We could break its backâ¨in four or five years and save millions of lives if only we can mobilize theâ¨world.â¨â¨If we mobilize the world around AIDS the way we mobilize the world around war,â¨then we could really overcome HIV/AIDS in a few years' time.â¨â¨GROSS: And that would take--What?--anti-retroviral drugs and more sexâ¨education?â¨â¨Mr. LEWIS: Massive...â¨â¨GROSS: I mean, what would it take?â¨â¨Mr. LEWIS: Massive prevention programs, anti-retroviral drugs, a great dealâ¨by way of resources from the Western world, a kind of Marshall Plan for Africaâ¨to overcome the disease, and in the process saving the world from real agonyâ¨if it spreads inexorably to China and India, as it now seems to be doing,â¨which will definitely dwarf Africa in numbers.â¨â¨GROSS: Is this a difficult time for you to be traveling to Africa as the UN'sâ¨special envoy for AIDS? Westerners are targets of terrorists in every part ofâ¨the world right now, and certainly in Africa.â¨â¨Mr. LEWIS: Yeah.â¨â¨GROSS: So what kind of problems is that causing for you, either problems inâ¨terms of anxiety or problems in terms of restrictions that you have to dealâ¨with?â¨â¨Mr. LEWIS: Interesting question. Actually, it has caused me not a moment'sâ¨hesitation or restriction. I travel in large measure alone or sometimes withâ¨a colleague. The UN family in the countries that I visit are the people onâ¨whom I rely, and then the meetings with government and civil societyâ¨officials.â¨â¨You know, without seeming to be unstable, I am so seized with thisâ¨predicament, and anyone would be. This is not a characteristic of Stephenâ¨Lewis; anyone who sees and works with what is happening would be just obsessedâ¨with it. And the struggle to overcome it supercedes every otherâ¨consideration, whether it's insecurity or threats of terrorism or wars.â¨â¨GROSS: You have worked with the UN in many capacities. You're Canada'sâ¨former ambassador to the United Nations, former deputy head of UNICEF, aâ¨former special adviser on African economic recovery. What do you think of howâ¨the UN is handling now the crises of the world--North Korea, Iraq? Are youâ¨disappointed in the UN's ability to cope? Or do you feel the UN is reallyâ¨behaving in the way that it should be?â¨â¨Mr. LEWIS: The UN is two entities. It's important to recognize that. Whenâ¨it's handling an Iraq or a North Korea in the Security Council, it isâ¨fulfilling its role on peace and security, a largely political role, by whichâ¨it is overwhelmingly judged by everyone. And I think in defense of the UN,â¨the UN is then captive to the decisions of the individual countries--theâ¨United States, France, Russia, Germany. These countries, which taken togetherâ¨are the sum total of the UN, dictate the UN's terms, conditions and policies.â¨It's not Kofi Annan. He simply implements what the countries decide.â¨â¨And then there's the other UN. There's the UN which devotes itself toâ¨humanitarian priorities and to emergencies and to development. It's theâ¨UNICEFs and the population people and the World Food Program and the refugeesâ¨and the United Nations Development Program. It's all those parts of the UNâ¨which day in and day out save lives and deal with the most difficult and grimâ¨dimensions of society. That's the UN that is loved and valued and treasuredâ¨in these developing countries.â¨â¨And it's kind of schizophrenic. We think so completely of the UN and theâ¨Security Council when a France and the United States lock horns, and we forgetâ¨that the primary work of the UN beyond peace and security is with humanâ¨priorities, and that work is magnificent.â¨â¨GROSS: Before you were the UN special envoy for AIDS in Africa, you worked asâ¨an investigator on the Rwanda genocide, so you've seen the impact of genocideâ¨and you've seen the impact of the AIDS pandemic; you've witnessed, you know,â¨the impact of millions of people dying. What does this do to your sense ofâ¨proportion? I mean, how do you protect yourself of thinking, `Oh, anotherâ¨life is lost. Big deal. I've seen millions'? You know, what does it do toâ¨your sense of proportion?â¨â¨Mr. LEWIS: God, that's an interesting question. For one thing, the genocideâ¨ended. I mean, at least it had a conclusion. The thing about AIDS which isâ¨so harrowing is that it seems never to have a conclusion; it just seems to goâ¨on and on and on. And you know that the death rates are going to rise toâ¨astronomic heights in 2008, 2009, 2010, and all of the orphans willâ¨proliferate in huge numbers. It's a generational thing. It's going on. Itâ¨isn't ending.â¨â¨Proportion? Can I tell you something which interests me? I'm a person whoâ¨hasn't responded well enough to human agony and despair. It's not that Iâ¨don't feel it intensely, but it's because as a Canadian I've always beenâ¨somewhat distant from it. And like everybody else, you think of theseâ¨abstract large figures, and it's hard to put a human face to them.â¨â¨What has happened to me personally in dealing with AIDS is that rather thanâ¨seeing it in large, every single person now somehow has a vivid reality forâ¨me. And I carry in my mind a young woman living with AIDS in Lusaka who had aâ¨stroke and has lost the sight of one eye and still in her 20s is fighting toâ¨stay alive. And, you know, you carry away with you a sense of a woman in aâ¨community who's desperately tending to the sick and the dying. And you carryâ¨away with you a young orphan girl of 14 looking after four siblings, stoicallyâ¨dealing with the household. And when someone dies, you feel it very keenly.â¨â¨In an odd way, AIDS has become personalized. Every single person is like aâ¨scar on the soul, I think, because it's all unnecessary. I think it's becauseâ¨you know these people shouldn't be dying. And so each of them individuallyâ¨has a tremendous personal force.â¨â¨GROSS: Stephen Lewis, safe travels. Thank you very much for talking with us.â¨â¨Mr. LEWIS: Thank you, Terry.â¨â¨GROSS: Stephen Lewis is the UN's special envoy for HIV/AIDS.â¨â¨Coming up, Maureen Corrigan reviews Tom Carson's new novel inspired by TV andâ¨literature, "Gilligan's Wake."â¨â¨This is FRESH AIR.â¨â¨* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *â¨â¨Review: Tom Carson's new novel "Gilligan's Wake"â¨TERRY GROSS, host:â¨â¨For decades critic Tom Carson has written on TV and popular culture for Theâ¨Village Voice, Esquire, Rolling Stone and other magazines and newspapers.â¨He's written a new novel called "Gilligan's Wake," which draws heavily on hisâ¨informed infatuation with classic television series, American history andâ¨world literature. Book critic Maureen Corrigan says "Gilligan's Wake" may beâ¨one of those novels you'd like to have with you on a desert island.â¨â¨MAUREEN CORRIGAN reporting:â¨â¨I'm always curious about the current state of cultural literacy, so I wentâ¨into my freshman English classes the other day and asked how many studentsâ¨had ever watched the 1960s sitcom "Gilligan's Island." They all raised theirâ¨hands instantly. Then I told them about Tom Carson's new novel, "Gilligan'sâ¨Wake," which in bebop, stream-of-consciousness fashion retells highlights ofâ¨modern American history through the voices of each of the characters on theâ¨island. A few faint smiles of appreciation, but unlike the reaction I gotâ¨when I told the same plot synopsis to friends age 35 and over, no out-and-outâ¨hoots of laughter at the absurdity of the whole idea.â¨â¨My students, I realized, have only watched "Gilligan's Island" on the classicâ¨TV channel. For them, it's a canonized text, as venerable in its own way asâ¨"The Great Gatsby," "The Day of the Locust," "No Exit," "Finnegans Wake," orâ¨any of the other highbrow works Carson references throughout his hectic tale.â¨Their relative lack of elitist distinctions makes my students Carson's idealâ¨readers, because he also assumes that the boundaries are porous between highâ¨and low culture. Such is the surrealistic quality of American life, accordingâ¨to Carson's novel.â¨â¨Reading "Gilligan's Wake" and being the beneficiary of a high-culture eggheadâ¨education, I couldn't help but think of the original title of James Joyce'sâ¨"Finnegans Wake," which was "Here Comes Everybody." "Here Comes Everybody"â¨aptly captures the feel of Carson's novel. It's an inspired mumbo jumbo manicâ¨homage to the art of both James Joyce and Bob Denver. "Gilligan's Wake" isâ¨structured as a series of autobiographical reflections by the ill-fatedâ¨passengers and crew of the USS Minnow.â¨â¨The novel opens with Maynard G. Krebs, the beatnik character Bob Denver playedâ¨on his first TV show, "The Many Loves of Dobie Gillis," ranting in the Mayoâ¨Clinic's Cleaver Ward to his shrink, Dr. Kildare F. Troop. Holden Caulfield,â¨by the way, is Krebs' roommate. From Krebs' paranoid rantings, he's seen theâ¨best minds of his generation destroyed by madness, J. Edgar Hoover and tooâ¨much espresso. We go on to the skipper's adventures during World War II withâ¨"McHale's Navy" and JFK's PT-109. Then it's back in time to the rarifiedâ¨youth of Thurston Howell III, who unknowingly launches an old school chum,â¨Alger Hiss, on his dubious government career. The professor, here a bisexualâ¨narcissist, works on the Manhattan Project. Party girl Ginger recalls herâ¨one-night stand for racial equality with Sammy Davis Jr. And Mary Ann losesâ¨her all-American virginal view of the world, hobnobbing with Sartre inâ¨existentialist-infested Paris.â¨â¨My favorite chapter, however, is the one presided over by Lovey Howell, aâ¨character who, even on the original TV show, always seemed to be smarter thanâ¨she acted. After all, she was the only character who packed enough trunks ofâ¨clothes in an anticipation of possible shipwreck. In Carson's feveredâ¨imagination, Lovey is a former flapper, a morphine-popping intimate friend,â¨and I do mean intimate, of Daisy Buchanan.â¨â¨Here's Daisy confessing to Lovey her ambition to write a tell-all novel aboutâ¨Jay Gatsby: `It would be about a man, a man that everybody thinks isâ¨wonderful, because his dreams soar so high and he's so full of ardor and heâ¨loves his idea of you so much more of you than the reality of you, whichâ¨nobody else thinks deserves love anyway, and how nobody understands that thisâ¨man is a tyrant and a dictator who carries your head around on a stick, evenâ¨though he calls it his banner, because he's in love with himself, but he canâ¨never admit that. And so he makes you his idol and loves himself, adoresâ¨himself, worships himself for having one.'â¨â¨I have to admit, as many times as I've read "The Great Gatsby," that view ofâ¨Gatsby, as an overbearing emotional bully with boundary problems, neverâ¨occurred to me. But aided by Lovey's astute interjections and asides toâ¨Virginia Woolf and Betty Friedan, this clever, if repugnant, revisionaryâ¨interpretation works.â¨â¨Despite its ambitions to make a big statement about America, the wordplay'sâ¨the thing in "Gilligan's Wake." If you like reading Joyce and Eliot, enjoyâ¨the self-satisfaction of catching references, riffs and anagrams, thisâ¨language-drunk novel is for you. If you have no patience for relentlesslyâ¨illusory writing, well, to paraphrase the immortal theme song of "Gilligan'sâ¨Island," "Gilligan's Wake" will be an uphill climb.â¨â¨GROSS: Maureen Corrigan teaches literature at Georgetown University.â¨â¨(Credits)â¨â¨GROSS: I'm Terry Gross.