May 20, 2013
Stop Ignoring AIDS and Africa
Posted on Jun 4, 2007
Scheer: Now, if you raise the money, the $6.8 billion—I was reading in one of your books about the soldier who had AIDS and then came back and was teaching people how to use condoms and things like that. Are those other things that have to be done as well? I mean, it can’t just be a money problem, right?
Nolen: That’s definitely true. There’s still a real shortfall of condoms. It’s great to go in and do HIV education programs, but if people either can’t pay the money to get in school to hear the program or can’t pay the money to buy condoms once they hear the message, then it’s kind of irrelevant. And, again, you’re getting into sort of tricky underlying issues that don’t change so easily. You know, I meet lots of young women who’ve been given information about HIV but who are selling sex down at truck stops because their parents have died, they’re raising their siblings and that’s the only option that they have. So, you know, they say, “Fine, we’ve been told about HIV in the safe-sex textbooks, but HIV might kill me in five years or 10 years and we’re all going to starve to death next week if I don’t do this.” So, you can address some of the obvious things around prevention, but unless you change the factors that drive people into risky behavior, then you haven’t achieved very much.
I guess the thing ... the conversation that needs to happen about that is the underlying things that keep people in this poverty. And there are lots of things that originate within their own countries, but, you know, whenever I speak about this issue in America, someone puts up their hand and says, “I want to get involved. What can I do?” And I say, “Well, look, you’re already involved. There’s lots of decisions made in your name every day that are having a huge impact on the pandemic.” And then people look at me kind of blankly. And I say, “Well, look, there’s lot of orphans, stories about orphans in this book, living on the streets in Africa. They’re not at school. Why are they not in school? Because Zambia or Malawi charges fees to send kids to public school. You know, you don’t pay fees to go to school in San Francisco, but you do in Malawi. And the reason is that the World Bank says that their governments have to charge school fees. That’s a World Bank policy. And if you’re going to get a World Bank loan, that’s what you have to do. Well, of course, who has the single biggest voice in policies set at the World Bank? The U.S. does.” And so I say to people, “It’s great if you want to write a check to put 10 orphans in school, but why don’t you also write a letter? Write a letter to your member of Congress. Write a letter to the World Bank about what a crazy idea charging school fees for orphans are.”
There’s lots and lots of decisions made. The big example, I guess, in the U.S., is agricultural subsidies. You know, you go on subsidizing your farmers and you make it impossible for millions of African farmers to earn a living, and consequently their kids don’t go to school, and, you know, they don’t hear the condom message, and we know that the single biggest protective factor for women, who are the majority of people infected in Africa, is education. Every year a girl stays at school, her likelihood of getting AIDS falls dramatically. So, you know, if you care about what’s happening there, take a hard look at your cotton subsidies.
Nolen: If you live in a country that already has a famine or a civil war, then what the hell?—AIDS is one more shitty thing, right?
Harris: Yeah. So do you think that, that ideology that permeates world thinking and perhaps that’s the reason? People expect people in Africa to have AIDS, they expect them to be hungry.
Nolen: They know nobody’s really paying attention. You know, as horrifying as the expression is, I think to some degree it’s rooted in reality. You know, Africans don’t think that way. You may have a flippant friend from South Africa who says it, but I can tell you that most of the people I meet in my travels do not think that it’s just the way life goes, that their lives are going to be grim and miserable. They have much higher expectations and they know things could be different. Countering that impression on the outside world is obviously more difficult, and yet when you spend a little time there, and the sorts of stories I’ve tried to tell in the book, it’s because—you know, we hear “This is Africa,” and we mean the civil war or the barbarous, you know, ruthless child soldiers hacking their families to death.
Well, you know, the biggest story out of South Africa these days is the treatment action campaign that drove big pharma and its own government to its knees and forced it to provide free AIDS treatment to now more than 200,000 people, which is the largest public sector program in the world. And those people are people who traditionally would have the least access to having a voice in political affairs. They are poor, rural women, who are the most infected, and across the country they’ve organized. They’ve put on their T-shirts that say “HIV-POSITIVE” in huge letters and they wear them proudly. They’ve staged massive campaigns of civil disobedience until, both civil disobedience campaigns and suing the government repeatedly, until they forced them into this treatment program. It’s an incredibly vibrant social movement that has totally remade the political landscape. Well, that’s Africa, that’s what’s happening in Africa today. When did you last hear that story?
Nolen: That’s what I’m here for.
Scheer: Now what about—I’m going to play a little devil’s advocate here— but what about like, say, someone who lives in the U.S.—you were talking about the ghetto—who lives in Oakland and goes to bed hungry because we have millions of people in this country that go to bed hungry. We have homelessness. We don’t have universal healthcare in this country, and we really are not the best example for AIDS because our numbers are not that great. So should the U.S. be the one setting the example in this way, or should you be going to other countries to go get help, because we’re not really the best in terms of AIDS prevention?
Nolen: People ask a really legitimate question about “Why should I care?” I spoke in Chicago a couple of nights ago and I had a guy who said, you know, “Look, I’m sorry about all these folks you talk about who can’t get drugs, but my mom has asthma and can’t afford drugs and my dad has cancer and can’t afford drugs, and I’ve got hypertension and can’t afford drugs. I don’t need to go to Zambia to hear this story, right?” And I totally understand that sentiment. And I guess the difference is that while there are a lot of people in America struggling—and that’s something that, as a country, you need to figure out—it’s not the same as having a 43% infection rate, right? The HIV infection rate in America has never topped 1%. Sure, there are other problems. But when 43% of adults have an illness that is fatal unless people get access to treatment—which they are often not—that changes everything, right? You know, your military collapses. They can’t defend your country. Swaziland went from being a nation completely taking care of itself to being now entirely reliant on food aid because everybody who used to do the farming is dead. You’ve got no one to parent these kids. There are no nurses in the hospitals. There are no teachers in the schools. You know, that country just completely collapses. You’re not talking about a mostly affluent country where a few people are struggling with a problem; you’re talking about a country on the verge of complete extinction. I mean, Swaziland’s leaders, as do Lesotho’s and Botswana’s and Zambia’s, now talk really frankly about the possibility of their country disappearing.
So, I mean, I guess the question becomes, you know, do you want to live in a world where you let that happen, where you let a lot of people die because they were black and poor and they lived in politically and economically marginal countries? And, you know, you talk about whether the U.S. are the people to lead. Well, the U.S. has led. The U.S. program to intervene for AIDS in Africa—it’s called PEPFAR—has been the most successful. It’s had the most profound impact. It’s put 850,000 people on treatment. And, yes, it’s been dogged with terrible political controversy and there’s all kinds of decisions they made that were motivated by, I think, catering to ... certainly the perception in Africa is that they were designed to cater to an evangelical Christian constituency in the U.S. and not, and not to Africans. But all of that notwithstanding, it’s had a huge impact.
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