UNAIDS - July 3, 2002
This media briefing is driven, of course, by the publication yesterday of the two new startling reports on HIV/AIDS. For ease of reference, I'll refer to the omnibus Global document as the UNAIDS report, and the document relating specifically to youth as the UNICEF report.
It is not my intention to cover the ground, again, so thoroughly covered in the press conferences of yesterday, held by Peter Piot, the Executive Director of UNAIDS and Carol Bellamy, the Executive Director of UNICEF.
Rather, I want to draw attention to two particular aspects, which flow from the reports, and which relate directly to Africa. Africa is the mandate which has been assigned to me by the Secretary-General, and I quite naturally read the reports with Africa as an obsessive consideration.
First: amidst the unrelenting catalogue of horrors --- the prediction of a possible 68 million additional deaths world-wide, 55 million of them in Africa by the year 2020; the ghastly finding that the pandemic has not yet begun to level off in Africa, even in the highest prevalence countries; the bracing public assertion by Dr. Piot that the pandemic is still in its early stages overall --- to this catalogue of horrors, there must be added, in the case of Africa, that the pandemic is now, conclusively and irreversibly, a ferocious assault on women and girls.
We all understood that the percentages were rising. We all understood that women were particularly vulnerable. We all understood that the pandemic was feasting on gender inequality. I'm not sure, however, that any of us understood until now, the full magnitude of the accelerating catastrophe for women. That's where these two reports are indelibly interlinked.
The figures, carefully extracted from the various tables, tell the story. And I make no apologies for using the figures: somehow the world has to be made to understand what's happening.
According to the UNAIDS report, of the 26 million infected adults in SubSaharan Africa (that is between the ages of 15 and 49), women now constitute 15 million, or 58%. That figure is distressing enough, but look what happens when it's linked to the data from the UNICEF report. At the very outset of that document, there is a breakdown of the numbers of young people (defined as 15 to 24) living with AIDS in various regions of the world. For Sub-Saharan Africa, the total is 8.8 million, two-thirds of whom, that is to say 67% of whom, are young women. The ratio, young women to young men, is an explicit two to one.
Put in the context that more than half the new infections now occur among young people --- 6,000 a day --- and you can see what is in prospect for Africa. I'm not a statistician, but if the present reality is 58%, and the future reality is 67%, we're talking about the unthinkable ... a looming cataclysm for the women of Africa.
There are, in both reports, endless pieces of evidence to confirm the pattern. If you cull the tables at the back of the UNICEF document (confirmed in the UNAIDS document), it's hard to believe what emerges. There is a category on the percentages of young people living with AIDS at the end of 2001. The category provides a low range and a high range. For comparison purposes, I'll use the high end because that's where we appear to be heading, given the projections of the UNAIDS report.
On that basis, in Botswana, the percentage of young women living with AIDS is 45%; the comparable figure for young men is 19%. In Lesotho, young women are at 51%, young men at 23%. In South Africa, the numbers are 31% as compared to 13%. In Swaziland, 47% to 18%. In Zambia, 25% to 10%. In Zimbabwe, 40% to 15%. In Namibia, 29% to 8%. In Malawi, 18% to 8%. In Cameroon, 15% to 6%. In Central African Republic, 16% to 7%. In Rwanda, 13% to 6%. The pattern is comparable for all African countries.
Please note that in every single country, the young HIV positive women represent two to three times - or more ---- the infection rates of young men. I despair of the numbing recitation of statistics, but they reveal a relentlessy grim picture.
But let me continue, this time from the UNAIDS report. The percentage of HIV prevalence for women attending antenatal care clinics in urban settings (and again I use the high range quoted in the tables) is, for Botswana, 56%; Lesotho, 42%; Malawi, 28%; Namibia, 31%; South Africa, 36%; Swaziland, 32%; Tanzania 23%; Zambia 31% and Zimbabwe, 33%. And lest you think that's solely an urban phenomenon, here are the figures outside of major urban areas: Botswana, 51%; Kenya 31%, Lesotho, 26%; Malawi, 36%; Mozambique, 31%; Namibia 32%; South Africa 30%; Swaziland, 41%; Tanzania, 32%; Zambia, 31%; Zimbabwe 71% (I assume in one particular clinic). Let me hasten to emphasize that the median figures are of course lower, sometimes significantly lower. But regardless the percentages used, each and every one of them constitutes a nightmare for the women.
In background papers, prepared by UNAIDS, it is said that one-third to almost one-half of new mothers in the worst-affected countries, could die of AIDS. And then as if all of this isn't bad enough, we have the UNICEF document, based, I would emphasize, on more than 60 new national surveys --- the most up-to-date definitive material now available --- which shows, in alarming page after page, the astonishing lack of knowledge about AIDS, and transmission, and prevention and sexuality among the young people surveyed.
In the course of those pages, there are the following representative glimpses of reality: in Cameroon, Central African Republic, Equatorial Guinea, Lesotho and Sierra Leone, more than 80% of young women, ages 15 to 24, do not have good knowledge about sex; in Nigeria, 95% of girls, age 15 to 19, perceive their risk of contracting AIDS to be minimal or non-existent; in Nigeria again, 61% of unmarried sexually active young men, 15 to 24, did not use a condom at the last episode of sexual intercourse, and, incredibly enough, 93% of these young men felt no risk or a small risk of contracting HIV; in a large number of African countries, specifically, Somalia, Burundi, Comoros, Uganda, Zimbabwe, Rwanda, Tanzania, Sierra Leone, Chad, Niger, Mauritania, Cote d'Ivoire, Guinea-Bissau, Senegal, Central African Republic, Sao Tome and Principe, Gambia, Togo, a majority of the girls surveyed did not know where to get tested; and in corroboration of what I have already noted, 17% to 22% of girls age 15 to 19 in major urban areas of East and Southern Africa are already infected. In Ethiopia, 14% of young women surveyed, said that they had had sex before the age of 15; in Nigeria the figure is 17%. These two countries, with a combined population of nearly two hundred million, stand at the very precipice of an explosion in the pandemic.
The report also chronicles the sexual violence, the predatory sexual behaviour of older men, the girls pulled out of school to care for sick and dying parents, the complicating malevolence of the sex trade, the growth of the orphan population, and much more. It is a true and full compendium.
If it can be said, as it can, that by the year 2020, the number of deaths from AIDS in Africa will approximate the number of deaths, military and civilian combined, in both world wars of the 20th century, then it should also be said that a pronounced majority of those deaths will be women and girls. The toll on women and girls is beyond human imagining; it presents Africa and the world with a practical and moral challenge which places gender at the centre of the human condition. The practice of ignoring a gender analysis has turned out to be lethal.
And that brings me to the second point I want to make, albeit far more briefly. I listened carefully yesterday to Peter Piot and to Jeffrey Sachs, advisor to the Secretary-General, both of them speaking to the high-level session of the Economic and Social Council. They both made the same unanswerable points: AIDS is wrecking human havoc in every sector of a steadily-increasing number of African countries; we have all the knowledge we need to turn the pandemic around, but to do it, there must be a huge quantum leap in financial resources. On those truths, there seems to be an international consensus. At the recent G8 Summit, the New Partnership for African Development, or NEPAD, included a strong paragraph which said, unequivocally, that unless the communicable diseases are defeated (and by that they meant primarily AIDS), economic and social development in Africa would be an "impossible hope".
In the formal G8 response to NEPAD, called the Africa Action Plan, under the section titled "Improving Health and Confronting HIV/AIDS", there appears this language: "To this burden (meaning other communicable diseases) has been added the devastating personal and societal costs resulting from AIDS, the consequences of which stand to undermine all efforts to promote development in Africa ... Therefore, recognizing that HIV/AIDS affects all aspects of Africa's future development and should therefore be a factor in all aspects of our support for Africa, we commit to ...". And then there follows a series of predictable commitments which resonate with goodwill and purpose.
What has not yet resonated are the dollars to meet the commitment. The shortfall is staggering: billions and billions of dollars meant to prolong and save human life in Africa over the next generation. The Global Fund is desperately underfunded. The Secretary-General has asked for $7 to $10 billion a year to fight the pandemic. This year the Fund has roughly $800 million. Peter Piot uses the figure of $10 billion overall from all sources. Everyone agrees on that range or higher. This year we're closing in on $3 billion.
Jeffrey Sachs says the necessary money is readily available; it's a simple matter of arithmetic. He argues, as the MacroEconomic Commission on Health argues, that to reach the Millenium Goals for Health would require setting aside, annually, one penny of every ten dollars of income in the rich countries ($25 billion required out of a $25 trillion pot). But the penny won't drop. These two reports make as eloquent an argument as we're ever likely to hear for the world to come to its senses. For the African continent, it means economic and social survival. For the women and girls of Africa, it's a matter of life or death.
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