Stop Ignoring AIDS and Africa

Stephanie Nolen, the last Western journalist covering the AIDS beat in Africa, tells Truthdig it is unfortunate but true that the more people die, the less people care, which is why she has decided to get personal with a new book that approaches the crisis from a different perspective.

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James Harris:

This is Truthdig. James Harris sitting down with Josh Scheer, as usual. On the phone we have Stephanie Nolen. She’s the Africa bureau chief for the Toronto’s Globe and Mail. But she’s also a woman after my own heart. About six years ago, she wrote a book called “Shakespeare’s Face.” Brilliantly written. And she has a new title out called “Twenty-Eight,” and it’s 28 stories of AIDS in Africa. Stephanie, tell me … I was reading the New York Times, Nicholas Kristof. He wrote last week, “The more people die, the less we care.” In your experience, in your travels through some 40 countries around the world — 26, I believe, in Africa — do you find that to be true? If so, why?

Stephanie Nolen: It’s absolutely true. I don’t actually know why. And I know that Kristof was responding to some new research that’s just come out that pinpoints that, in fact, this is really true in people. You show people a picture of one sad-looking puppy and everyone runs for their wallet, and you tell them that 30,000 children die a day of diseases that can be prevented for less than a buck and nobody gives a rat’s ass. I don’t know what it is, what that says about us as a species, but I certainly know from a long time reporting about HIV in Africa that it’s true. And that’s actually what drove me to the book … is that I can tell you that 28 million people are living with the virus in Africa. To some degree I can understand, because that’s paralyzing, it’s numbing. I’m Canadian, right? That’s the population of my whole country. What does that even mean? You flick on the evening news, you hear someone say that, and you turn it off again.

And so what I tried to do in the book was to tell the stories of individual people. It’s 28 individual people, so one for each million. But forget about the numbers and forget about who they represent. But here’s what it is, here’s what life is like. And I think, particularly when you’re dealing with Africa, what you have to do for people is say, not just forget the numbers, but also, you know, sure their lives look different. There’s people in this book [who] live in a little grass house and they walk five miles every day to get water or firewood. And, you know, they’re raising eight kids. Their lives could not look more different in some ways than the lives of an American or a Canadian. But when you sit down in the little counselor’s booth in Malawi or Lusaka and they say to you, “You have AIDS, you’re going to die,” that doesn’t feel different than it would if you were in America. And it’s getting people to realize that those people had all — sure, they’re Africans — but they had all those same expectations around their lives. They want to graduate from high school, they want to start a little business, they want to, you know, persuade that really cute girl they’ve been eyeing for a long time to go out with them. It isn’t any different. You’ve really got to go, go really micro to make people understand that story, to get them past the numbers.

Josh Scheer: You had talked about the puppy factor, when you show one puppy, the wallets open ….

Nolen: Yeah.

Scheer: Is that why you wrote the book in this way? Because usually you get a report from like the U.N. or you get a report from WHO and it’s impersonal. Was this to make it personal so that people can be on the same page?

Nolen: Yes, it’s definitely to take people past the numbers and to say that, you know, when you talk about these crazy statistics, you’re actually talking about real people. Also, though, because there are people who are in the book whose stories are there because they help you understand the political, the economics, the medical. So there’s a truck driver and he’s a way of looking at how the virus spreads, and there’s a soldier who’s a way of looking at the relationship with conflict in Africa. But it’s also because there were individual people that I wanted to make sure … you know, people I’ve met in four years of doing this job, who have fought these amazing and courageous battles with no support, you know, ostracized by their own communities, and also with no support from the outside world. They’ve taken on their governments, our governments, big pharma. … Those go almost unrecorded and we just don’t hear those stories. There are these amazing stories of courage and resilience that are just, you know, being lost as the pandemic goes on and on. And I thought there should also be a record of those.

Scheer: You are only one of three reporters covering this, so you’d probably be the best one to answer this. But what do you think, from being there so long, can be done? And what has to be done?

Nolen: OK, well, here’s the thing: I’m now down to being one. We used to be three and, I don’t know, it must be something I said, but now I’m the last reporter, the last Western journalist covering the pandemic.

Harris: What happened to the other two guys?

Nolen: What happened to the other two? I don’t know … they just got reassigned by their newspapers.

Harris: Really?

Nolen: You know, I think we get very often this perception of it being a grim story where not very much changes. We forget that a lot of these countries were doing real well; you know, Botswana had a higher life expectancy than Russia in the early 1990s. So they’re countries that were doing really well that had the rug pulled from under them from HIV. We also don’t hear that huge progress has been made in responding. There were, for example, when I started reporting on this full-time, there were fewer than 100,000 people on treatments and today there are 1.5 million in Africa. And everybody said, “You can’t do it, there’s no way you can treat in Africa.” Well, that’s a 13-fold increase in four years, and those people have better survival rates on treatment than most Americans on treatment do. So lots of victories.

I guess in terms of what has to be done, there’s a lot more awareness than there was when I started doing this. You know, the Gap’s making a T-shirt for AIDS in Africa now, so clearly there’s progress.

Harris: [chuckles]

Nolen: And there’s a lot more money available than there was. At the same time, the Global Fund to Fight AIDS, which is the prime funding body, is about to do another round of proposals where African countries say, “This is what we need to fight AIDS.” They need about $6.8 billion to meet those proposals, and they have, you know, like, $1.85 in change. Constantly, countries promise money and don’t deliver or don’t promise anything like what’s needed to respond. So we need money. I think, even more than money, these days we’re realizing that there are some more intractable problems that are going to need more creative solutions. So you can use that money to fly in boxes and boxes of pills. You can’t fly in nurses, doctors, pharmacists. I mean, you can fly in a few, but not enough to meet the needs of a whole, continent-wide healthcare program, right?

And especially when we talk about orphans, you’ve got 14 million kids who were orphaned by HIV. I had this conversation a little while ago with Nelson Mandela and his wife Graça Machel, because they are grandparents raising orphans, raising their orphaned grandchildren. They lost kids to HIV and, you know, they say it’s the single biggest problem and the one people just aren’t paying enough attention to. What do you do about a whole generation of kids who grow up without parents? What do they look like as adults? We don’t know. And again, that’s not an easy one. It’s not easy to raise $6.8 billion, for sure, but it’s even harder to figure what you do with 14 million kids without parents. 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.

Harris: Let me start by saying I have a good friend who’s from “South Effrica,” as he calls it. And, growing up, he would always say “TIA.” And some of you might have heard that mentioned in “Blood Diamond,” the movie, this idea that “This Is Africa,” that exists perhaps in some ghettos in America, that nothing is really a surprise when it happens in the ghetto. Nothing’s really a surprise in Africa.

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?

Harris: I had never heard that story. That’s a good story and we need to hear more like it.

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. Harris: We’re talking to Stephanie Nolen. She’s the Africa bureau chief for Toronto’s Globe and Mail, a fine paper. Let’s turn the page a little bit, because you make a good point about HIV/AIDS and Josh also makes a good point that we need to do some homework locally. But let’s talk Darfur for a minute. Here we have a chance — in my mind, at least in my mind — to learn from the mistakes of Rwanda. We’ve lost almost half a million lives — 2.5 million people, I believe, have been displaced by the tragedies going on in Darfur. Here we’re talking about genocide, we’re talking about people killing people, yet we haven’t done anything — again. Do you have any sentiments about that?

Nolen: Darfur is really complicated. I’ve been there a couple of times. I was in the first group of four journalists who went in when it all started in 2003. Darfur is interesting for a couple of reasons. One, it’s been hard to intervene. The fact that it’s on the tip of the tongue of every kid walking to school is really progress because, let me tell you, there were some lonely years when nobody wanted to hear about it. But then you’re getting into messy issues of politics. Darfur’s hard because it’s a domestic Sudanese issue. The Sudanese government is incredibly skilled at playing politics and keeping people from getting involved. Short of outright invading, what exactly are you going to do to try and keep the peace there? Well, U.N. forces are a really good idea, but Sudan is selling all kinds of oil to China now, so China has made sure that the Security Council doesn’t act on Darfur. You know, you’re getting, inevitably, into oil and all kinds of international political allegiances, so it’s not quite as simple as people saying, “Wow! We’ve woken up to Darfur being a problem. Let’s do something!” There’s a lot of things standing in the way of a good intervention there.

And, you know, it’s also interesting to talk about Darfur because, yeah, there are probably 300, 350,000 dead there and a lot of people displaced, but it is in fact a far smaller conflict than the war in northern Uganda which has been going on for 21 years. You have four times as many people displaced in northern Uganda. You have four times as many people dead. Well, when did we last hear about that one, right? I mean, Darfur is suddenly sexy because George Clooney goes there and, meanwhile, the war in northern Uganda that relies almost entirely on child soldiers … you don’t hear about that one.

Harris: Stephanie, why don’t we have troops on the ground facilitating the deployment of doctors and nurses that these people need to help solve this problem? We can put troops on the ground in Iraq, but we can’t put troops and National Guardsmen and women on the ground in Darfur, in sub-Saharan Africa to help them deal with these catastrophes.

Nolen: Yeah, well, I would hope that Iraq was a lesson in not, maybe not being the best way to try and resolve a conflict.


Nolen: Note to self: “The Iraq model: Not so good.”

Harris: Not one to repeat, but you’ve got to wonder the motivation that exists in a government who is one thing in one situation and allows another to exist. …

Nolen: Well, you know, I’ve done a lot of call-in radio lately where people call up and are yelling about the Bush administration letting people die, and here they are, spending all these billions of dollars in Iraq. Why don’t they do something in Africa? So I say to people, “Well, guess what? Actually the $15-billion, five-year program to intervene for AIDS in Africa, that the Bush administration dreamed up, has been the single greatest response to the pandemic ever.” And then there’s kind of silence on the end of the phone, you know?


Nolen: That one … I guess because everybody’s so busy being pissed off about Iraq … but what’s been done in Africa, the Bush response program to AIDS/HIV, has not had the same response. Although, again, they insisted on using brand-name drugs instead of generics, and thousands more people could’ve been treated with generics, and in Africa that’s seen as giving in to the pharmaceutical lobby and they insist on a ban on …. they won’t fund any program that says, that doesn’t outright condemn prostitution. Well, transactional sex, as it is called, sex maybe for money but maybe for school fees, maybe for food, all over Africa, is a huge driver in the epidemic. And all these African organizations say to me, “What’s up with the U.S. government? Why would they say to us, ‘You’ve got to condemn sex work? What’s up with that language? We’ve got a program here full of girls who sell sex so that they can pay to go to school. We’re not allowed to work with them if we’re going to get your U.S. dollars? That’s really, really screwed up.’  ” And so that domestic political agenda, whether it’s people’s desire for access to oil in Darfur, access to oil in Sudan that keeps us from intervening in Darfur, or whether it’s a nod to the pro-abstinence, anti-sex-work, anti-generic-drug model in the U.S. All of that stuff tends to muddy up foreign policy.

Scheer: Well, it’s a culture clash, right? I mean that’s the way the U.S., the government’s based or the culture is based, right? In this country, prostitution is illegal.

Nolen: It’s illegal in all these countries, too, but you have AIDS organizations saying, “We’re not going …  ” — they’re not just saying that it has to be illegal, which it does — they’re saying a group that’s going to get U.S. funds to distribute condoms or put AIDS programs in schools or care for sick people, has to sign a piece of paper condemning sex work. And that’s like crazy moral language that just has no place in a place where people are selling sex to eat.

Harris: You make a very good point about the president. And this is something we can’t place squarely on his shoulders. Bush has given millions of dollars. He started PEPFAR, his emergency plan that should be his legacy. Some think that plan will save more than 9 million lives. But I’ve got to wonder, haven’t we learned from the mistakes of the Reagan administration, who solved many poor and poverty problems with money, just pouring money on the problem? I don’t think this is a problem that money can solve. I would say that it’s not necessarily up to President Bush to solve this crisis, but it’s up to us to look into ways that we can go about working on a solution together. Don’t you think it’s more of a citizen issue, a world issue, something that we need to — remember “We Are The World”? That kind of campaign, that kind of awareness that you talked about earlier, I think, is the solution. We can’t depend on governments. Clearly, governments have shown they can’t get this job done without the help of citizenry.

Nolen: I guess what I was trying to do in the book was to say, I don’t think it’s up to me to come up with … I don’t know those answers and I don’t think it should be my job to try and figure them out. But I do know there are a whole lot of Africans living in the middle of this pandemic, and it’s like, the scale of it, I think, sometimes gets lost. It’s the biggest disaster to hit humanity since the 1300s. So it’s all about Africans living in the middle of this absolute maelstrom. They have ideas about what the solutions are. They have good ideas about what they need and they have good ideas about the kind of help they want, and they would just like people to be paying attention.

Scheer: You’re talking about bringing people together. What are the African countries willing to do to kind of help? They’re willing to do anything, right? What are they offering … ?

Nolen: A lot of countries were quite slow to respond to HIV. I think that that came in part out of a pretty understandable, stubborn response. I remember when they first figured out here that HIV had originated in Africa and there were all those allegations about Africans having sex with monkeys, and it was all that kind of crazy stuff.

Scheer: There’s also dread, too. A lot of people didn’t fund it because they thought it was just gay people.

Nolen: Yeah. So there was this real response in Africa that said, “You and your racist allegations. We’re going to pretend that HIV isn’t here.” And so they were slow. And it’s about sex, right? I mean, the conversation I had with Mandela … while he was president of South Africa, the infection rate in South Africa went from 3 or 4% of the population to 15 or 16%, on his watch. And he spoke publicly about HIV maybe four times while he was in office. And he said, “For me, as an [unintelligible] elder, it’s just not appropriate to talk about sex.” And so you had lots of people who were reticent, who didn’t do what they should have for a long time, and that’s part of the reason it got as bad as it did. But now I can tell you, everywhere that I travel, governments are incredibly, passionately engaged in mounting a response to this. There are some countries with amazing, completely across the board, not just healthcare responses, but education responses and economic responses that they designed themselves, that they’re looking for the help, both the money and the people, to try and mount. And so at this point there isn’t a single place where responding effectively to AIDS is not a top priority of the government. And they just need a lot of different kinds of assistance to do that.

Harris: Well, Stephanie, continued good luck and good reporting. You’ve done some great work in your time in Africa and around the world. And we wish you the best here at Truthdig.

Nolen: Thank you so much.

Harris: So 28 million afflicted with AIDS in Africa. You can make a difference. We sit back a lot and wonder how we can make a change. Be the leader you want other people to be. For Josh Scheer, for Stephanie Nolen, the African bureau chief for the Toronto’s Globe and Mail, this is James Harris, and this is Truthdig.

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