Washington File - January 10, 2000
Judy Aita, Washington File United Nations Correspondent

The meeting was the first in the U.N.'s more than 50-year history to focus on health as a security threat. The council is given the responsibility for maintaining international peace and security by the U.N. Charter.

Ambassador Richard Holbrooke, the chief U.S. delegate to the U.N., decided to use the U.S. presidency of the council for the month of January to work on Africa's problems. AIDS is the first topic in a monthlong look at the special challenges confronting the continent.

U.S. Vice President Al Gore opened the meeting by asserting that "we tend to think of a threat to security in terms of war and peace, yet no one can doubt that the havoc wreaked and the toll extracted by HIV/AIDS do threaten our security. ... We now know that the number of people who will die of AIDS in the first decade of the 21st century will rival the number that died in all the wars in all the decades of the 20th century."

Gore said that the year 2000 offers the challenge and opportunity for nations to create a new agenda for world security, one that includes the environment, drugs and corruption, terrorism, and AIDS -- as well as new strains of old diseases that are laying waste to whole societies.

"The powerful fact that we begin by concentrating on AIDS has a still larger significance: it sets a precedent for Security Council concern and action on a broader security agenda," the vice president said. "By the power of example, this meeting demands of us that we see security through a new and wider prism, and forever after think about it according to a new, more expansive definition."

"AIDS is a global aggressor that must be defeated," Gore added. "This disease weakens work forces and saps economic strength. AIDS strikes at teachers, and denies education to their students. It strikes at the military, and subverts the forces of order and peacekeeping." The first line of defense is prevention, the vice president said.

"We must talk about AIDS not in whispers, in private meetings, in tones of secrecy and shame. We must face the threat as we are facing it right here, in one of the great forums of the earth -- openly and boldly, with urgency and compassion. Until we end the stigma of AIDS, we will never end the disease of AIDS," he said.

Gore said that the Clinton administration intends to increase the amount of money spent to combat AIDS and other infectious diseases worldwide by $100 million, to a total of $325 million in the year 2001. The money will go toward reducing the stigma and preventing the spread of AIDS, reducing mother-to-child transmission, supporting care for AIDS victims and children orphaned by AIDS, and strengthening the health infrastructure to deal with AIDS. An additional $50 million will go to the Vaccine Fund of the Global Alliance for Vaccines and Immunizations to help fund the research, purchase, and distribution of vaccines for AIDS, malaria, TB, and yellow fever in developing nations.

Secretary-General Kofi Annan pointed out that "nowhere else has AIDS yet become a threat to economic, social, and political stability on the scale that it now is in southern and eastern Africa."

In the international fight against AIDS, "Africa is an immediate priority which must be part and parcel of our work for peace and security in that continent," Annan said.

Africa suffers disproportionately from poverty, conflict, social dislocation, and food insecurity -- problems that are fueled by the equally disproportionate incidence of HIV/AIDS, according to the U.N.'s AIDS program, UNAIDS. Some 23.3 million Africans in sub-Saharan Africa are estimated to have HIV infection or AIDS.

Almost 70 percent of the world's total number of HIV/AIDS cases are in a region that accounts for 10 percent of the world's population, and the spread of the epidemic has outpaced all original projections by two to three times. As a result, life expectancy at birth in southern Africa, which rose from 44 years in the early 1950s to 59 in the early 1990s, is set to drop to 45 between 2005 and 2010. New information from UNAIDS also suggests that 12 to 13 African women are currently infected for every 10 African men.

In 1998, UNAIDS said, 200,000 people in Africa died from conflicts, but 2.2 million died from HIV/AIDS.

UNAIDS also said that the resources to fight AIDS are disproportionate to the size of the problem. In 1996 approximately $165 million was spent on AIDS prevention in 25 African countries. But UNAIDS estimates that between $800 million and $2,500 million is needed each year to mount adequate prevention programs.

Mark Malloch Brown, administrator of the U.N. Development Program (UNDP), said that HIV/AIDS has "a qualitatively different impact than a traditional health killer such as malaria," targeting young people, particularly girls; undermining economic growth and reducing future national GDP by perhaps one-third over the next 20 years; and putting huge additional demands on already weak, hard-to-access public services.

Malloch Brown told the council that the fight against AIDS must be viewed "as a three-front war: the classrooms and clinics of Africa; the families of Africa; and international action - the critical support needed to back Africa's front line."

Stressing that schools and clinics are at the heart of any defensive strategy, the UNDP administrator noted that in Uganda there is now a real prospect of an almost AIDS-free generation of high-school-age children because of the country's approach to the epidemic.

"Behavior change requires uncompromising, often painfully embarrassing honesty," he said. "For there is too often a lethal cultural double standard when it comes to AIDS of too much unsafe sex and too little willingness to talk about it or face its consequences."

"Changes can only begin by confronting the region's troubled inheritance: extensive migrant labor, social norms and gender inequality that make it hard for women and girls to deny men sex, leading to HIV incidence rates among girls three or four times higher than boys'," Malloch Brown said.

The UNDP administrator said that the international community must support Africa's frontline efforts; promote intercountry cooperation; mobilize more resources; increase basic public health research spending and work with the pharmaceutical industry to bring down treatment costs; and increase development efforts to improve Africa's schools and other public sectors.

Dr. Chrispus Kiyonga, Uganda's minister of health, discussed his country's AIDS program, which is an example for African nations to follow. One of Africa's poorest countries, Uganda saw its security and development threatened by AIDS, which claimed more than half a million Ugandans and threatened to reverse the socio-economic gains made in the recent past, Dr. Kiyonga said.

By developing a strong coalition of national and local groups, academics, and cultural and religious leaders, Uganda was able to build a program that brought the discussion of HIV/AIDS into the open.

Through radio, television, dramas, songs, public discussion, and the classroom, there is now "close to universal awareness" of HIV/AIDS, and recent surveys have indicated behavior changes, Dr. Kiyonga said.

"A large number of people are seeking one partner; more are using condoms," he said. Furthermore, people living with AIDS have made significant contributions by acknowledging and talking about prevention. Namibia's minister of health, Dr. Libertin Amathila, said that African governments must recognize that a multidimensional approach to HIV/AIDS is needed. The problem is no longer just a matter for health ministries. "The tragedy in southern Africa warrants an emergency response from the international community," she said.

"A continent which is home only to 10 percent of the world's population carries about 70 percent of the world's total HIV cases," she said. "The impact of HIV/AIDS is felt through the erosion of growth in GDP [gross domestic product], especially in the heavily affected countries. This affects the labor force and breadwinners and their families."

Dr. Amathila called on the international community to make resources available and subsidize AIDS programs. The cost of drugs in Namibia is "extremely prohibitive," she said, and governments are faced with the difficult choice of using their limited resources to help the affected or to sponsor prevention programs.

But the health minister also pointed out that "Africa has arms and weapons." African nations must channel resources to efforts to bring peace to the continent and health to the sick, she said.

Police and military must be trained and health workers in refugee camps must be briefed on AIDS prevention, and AIDS must be discussed during the demobilization programs of ex-combatants, especially child soldiers, she added.

(Note: A Web site on the U.N. Month of Africa can be accessed at the following URL: http://www.usia.gov/regional/af/unmonth/ )

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