AEGiS-IAPAC: Clinton's war on HIV/AIDS

Clinton's war on HIV/AIDS

IAPAC Monthly - Vol. 8, No. 1, January 2002
William Jefferson Clinton

Former US President William Jefferson Clinton accepts the 2001 Dag Hammarskjold Award from IAPAC President Jose M. Zuniga. The former president urged governments, businesses, and individuals to redouble their efforts to combat the AIDS epidemic lest predictions of 100 million potential AIDS cases by 2005 come true. Photo by Nannette Bedway © 2001.

Editor's Note: This speech was delivered December 8, 2001, by former US President William Jefferson Clinton at an International Association of Physicians in AIDS Care (IAPAC) luncheon at which he received the association's 2001 Dag Hammarskjdld Award for his leadership on HIV/AIDS throughout his eight-year presidency.

Thank you very much... Ladies and gentlemen, I thank you all for being here to support this cause...

I am delighted to be here and to receive an award named for Dag Hammarskjold. When I was a boy, he was my first United Nations Secretary-General. He was a magnificent man. He wrote a set of autobiographical sketches and insights called "Markings," that bore a remarkable resemblance to the meditations of Marcus Aurelius, written in the 2nd century AD. And when I read these Markings, they had a huge impact on me and how I thought about the nobility of public service and how people should live. And when my daughter was finishing Stanford [University], and she is in general far better read than I am, but I learned that she had never read it. So I gave her a copy of Dag Hammarskjold's book written so long ago. So I am grateful for this [award].

But most importantly, I am here because I support the work of the International Association of Physicians in AIDS Care physicians working on behalf of people living with HIV and AIDS around the world. For me, this is personal and political. I'll never forget when I was at the hospital bed of the first friend I had to die of AIDS. The last friend I had to die of AIDS died last month. And then I'll never forget the first time I went to Africa as President, and realized that in South Africa, roughly 30 percent of the adult population was HIV positive; or the first time I saw an African leader in Nigeria, President [Olusegun] Obasanjo, openly and publicly embrace a woman and her husband who were both HIV positive, to try to drive the sense of denial out of the country that has kept so many countries from adopting adequate prevention policies. So for me, this is both personal and political in the finest sense.

I want to talk a little bit about what I think our government and governments should do, and what the United Nations is trying to do under the leadership of Kofi Annan, who is a worthy successor to Dag Hammarskjold, and who won the Nobel Peace Prize this year, and richly deserved it was. But I also want to say that we cannot deal with this problem successfully without the support of people like you, and doctors like the doctors in this association.

So let me try to explain, if I might, why it's a good thing you're here, and why supporting the President [George W. Bush] and our allies in the fight in Afghanistan and in building effective domestic defenses against terrorism at home is really part of the same mission as supporting what these doctors are doing. If you look at what happened on September 11th, and if you look at the global AIDS epidemic, they both show that we live in a world without walls, an age of interdependence, where borders simply don't stop much, good or bad, anymore. Unless you want to rebuild those walls, which I doubt we could do anyway, you have to try to build a world in which we have more partners and fewer terrorists, and a world in which problems half a world away are stopped not only for humanitarian reasons, but before they come back to us.

We have spent 20 years in this country trying to get a hold of the AIDS epidemic. We got our infection rate down to under one percent of the adult population. But there are some discrete populations in America where the rates are going up again. There are some rural areas in the South that are remarkably, from a socioeconomic point of view, like some of the places we work in Latin America in Africa, where the rates are going up again. The second fastest growing AIDS rate in the world is in the Caribbean, just down on our front door. I've been in a clinic in the Dominican Republic to see what they're doing there. And, you know, Hillary [Rodham Clinton] represents New York in the [US] Senate, that we have a million Dominicans in New York. Do you really believe that we can keep the American rate down if our nearest neighbors have the second fastest growing rate in the world?

So this is a very serious part of our future. I go all around the country now talking to young people. And we have these huge crowds at college campuses because they never lived through anything like what we're going through now. You know, the Cold War was over in 1989 before most of them started thinking about politics. And it was effectively over before then. And they had no experience with Vietnam. They don't have parents who talked to them about Korea and World War II. And, unlike me, they never had any school drills where they had to go get in a fallout shelter because we're preparing for a nuclear bomb to fall on us. So all of a sudden here they are, after 10 years or so of positive experiences and sort of relative security, feeling uncertain.

We have gotten enormous benefits, enormous, out of this world without walls. It's given us an enormous part of our jobs. It's brought immigrants from all over the world to this country and into this room and made America a much more interesting, rich, diverse place. It has enabled us to do great things as a people. It's driven income up and poverty down, [and] allowed us to cut the welfare rolls in half. It made America a better place. But it made us more vulnerable. You can't take the walls down and claim all the benefits and say "I just hope the problems will never appear." And there are lots of people who worked for years and years and years, career people, hoping against hope that a day like September 11th would never come.

But the larger point I want to make is that the AIDS pandemic and the fight against terrorism should be seen by you as a part of your obligation as a citizen of this country and a citizen of the world to claim the benefits and roll back the burdens of a world without walls. So we should support the President and our allies in the fight in Afghanistan. We should support the priority of constructing the most effective possible defense here at home. You should believe that, as I tell people all the time, no terrorist campaign in history has ever succeeded and this one won't either. There may be more victims and it may be some time gap before we do it, but we will prevail here.

But if you want the world I believe we want for our children and our grandchildren, then it's not enough just to support the campaign in Afghanistan and to build a defense. I mean, we don't want to build a future where everybody who makes a good living lives behind a wall and where the world becomes more divided in different ways. So if you don't, then we have to spread the benefits and reduce the burdens of the 21st century world and to go back to something that was said earlier, we have to develop a global philosophy that what we have in common is more important than our differences. And the only thing we really have in common is our humanity.

Now, that's what this whole fight against AIDS is all about. You heard the statistics earlier, but I want to repeat a couple of them. There are now 40 million people living with HIV and AIDS in the world. Twenty-five million people have had it and have perished. There are about 14,000 new infections every day. More than half of the new infections are among people between the ages of 14 and 24. If we don't do something to turn this around by the year 2005, instead of 40 million AIDS cases there will be 100 million AIDS cases. When we have World AIDS Day in December 2005, some somber person will stand up and we will all be shocked to find out that we've got 100 million AIDS cases .

. . . That's exactly what's going to happen unless we turn it around. And there cannot be 100 million AIDS cases in the world without severe, adverse, direct consequences to the United States, to Illinois, to Chicago. You have to understand that. What will they be? Assuming, first of all, since the second fastest growing rate of AIDS is on our front door in the Caribbean, more Americans will become HIV positive. They'll give it to other Americans and it will run your health care bills up and people you know will die. Children will have their futures cut off. That's the first thing.

[The] second thing is, how many countries do you think we can stand in Africa and Latin America and other places that have infection rates right at 30 percent? If you go from 40 million to 100 million AIDS cases, and the growth is in the areas where the growth is greatest now, I promise you some of these fledgling democracies will fail. There will be more wars and more violence. And you'll have all these young guys out there thinking, "Well, why shouldn't I get a machine gun and go shoot somebody? I'm not going to live more than another year anyway." A phenomenon we have already seen in tribal wars in Africa, in my time.

The third fastest growing rate of AIDS is in India, where they've got about 10 million AIDS cases and a billion people, the largest democracy in the world, but where I see so much and hear so much like I heard in Africa five years ago, where people are kind of resisting getting into the whole business of prevention, because for a lot of cultures, they're shy and culturally conservative. And they don't know how to go talk to people about how you get AIDS. But the longer we wait, the more people are going to die.

The biggest country in the world, China, just acknowledged they have literally twice as many AIDS cases as they had previously thought. And only four percent, four, f-o-u-r percent of the adult population even know how it's contracted and spread. China is trying to get in the World Trade Organization and, you know, we're trying to make all kinds of agreements so we have a peaceful future with them. The Chinese are going to be lifted out of poverty. The Indians have a chance to be lifted out of poverty. They're making half of all the software in the world in India now. And they're facing these kind of problems. We cannot expect America not to be affected by this. This is a recipe not only for human misery, explosive health care costs, but for more war, more instability and more political problems for America.

Now, the good news is none of this has to happen. Uganda, with no medicine, cut the [AIDS-related] death rate in half in five years. You heard that earlier. Just prevention. Brazil, with prevention and medicine, cut the death rate in half in three years, their hospitalization rate by 80 percent in three years. We can do this. But we have to recognize what we're up against. The fastest growing rates of AIDS are no longer in Africa, where 70 percent of the cases exist. The fastest growing rates of AIDS are in the former Soviet Union. So now, in the common fight against terrorism, we have a new alliance with Russia, a new hope that we'll have stability there. What are you going to do if in all those little countries, Russia and the countries along there, all the public health systems break down and AIDS explodes? And all the stability and partnership and peace and opportunity we hope to give those young people over there, in a way that removes from our children's generation the kinds of threats we grew up with, becomes impossible because they've got infection rates of 30 or 35 percent?

Now, I will say again, it doesn't have to be that way. I have been to Brazil and see what they do. I have been to Uganda. I've seen what they did. I have been in the townships in Soweto and other places in South Africa and seen these clinics. I've been in a little village in rural Nigeria and watched the kids put on a play about AIDS and get over their being self-conscious about talking about this, because they decided they would like to live after all.

It does not have to be this way. We have to have more prevention and more treatment. We have to have more doctors out there. The drug case, the case the drug companies brought against South Africa to try to stop them from putting out generic drugs, was resolved successfully earlier this year. And one of the things I particularly appreciated was that the incoming [Bush] Administration, which had taken a different position a year ago, stuck with our position and told the drug companies we had to give people with HIV in poor countries free or reduced [cost] drugs so they could stay alive. So we resolved the case. Now it's just a question of working out the contracts in all these countries and getting the medicine out there. That's going to happen. So that's good.

We also, however, need more doctors, more nurses, more health clinics, and that's where this group comes in. The efforts of these IAPAC physicians who are working around the world against AIDS with care and with advocacy are critical. And now here's where you come in. So we need the medicine. It's coming. We need the prevention programs. We have models. We need the people in the local areas to get their act together and get out of denial, otherwise there's nothing the rest of us can do. Right? And we need the doctors, the nurses, [and] the clinics.

All right. What else do we need to do? We need to prevent the mother-to-child transmission. We have that. We need effective treatments for the kind of opportunistic infections that come with AIDS. And we need to lobby to continue to develop a vaccine and a cure. All of this is very important. Where do we come in? The Secretary-General of the United Nations has asked us, as a world, both governments and as citizens, to come up with [US]$7 to [US]$10 billion a year for AIDS and the other infectious diseases that together claim one in four of all the people who will perish this year. AIDS, tuberculosis, malaria, and infections related to diarrhea cause one in four of the deaths in the whole world every year.

So Kofi Annan says, for [US]$7 to [US]$10 billion, we could make a real dent in this. Let's take the high number, [US]$10 billion. Our share of that, based on our share of the world's gross domestic product would be about [US]$2.2 billion. That sounds like a lot of money. That is one-eighth of one percent of the [United States'] federal budget .... one-eighth of one percent of the federal budget. It is a lot of money, but it's also a lot cheaper than going to war. The current conflict in Afghanistan, I read somewhere, I don't know this, but I read somewhere that it costs about [US]$1 billion a month, which sounds about right because we don't have many troops on the ground there-the Northern Alliance cleared out the Taliban and now we have our Special Forces there who are looking for Mr. [Osama] bin Laden-and because we didn't have to have an enormously heavy bombing campaign, because there weren't all that many strategic targets. So let's assume it's [US]$1 billion a month. That's five times on an annual basis what it would take us to pay our share of the battle against AIDS, which has already infected 40 million people and killed 25 million. Do you think it's worth it? I do.

And some of it can be given with tax dollars. Some of it can be given as you're giving it here to support these doctors. But the point I want you to understand more than anything else is we've got to do it. We have the money. Do you remember the guy who said, "I rob banks because that's where the money is?" You might wish some other country would help pay for this. But [the United States] is where the money is. And this is where the AIDS problems will be ultimately residing unless we turn this around.

I think about all these people I know who have worked for 20 years to turn the AIDS epidemic around in America. And to think it could come right back into America because we didn't do what it took to keep it out of the Caribbean, out of the former Soviet Union, out of India, out of all these other places. And we know from Brazil, from Uganda, from Senegal, from all these places, we know that these developing countries can turn it around. It is not inevitable that we'll have 100 million cases. That's what all this is about.

So these doctors, you know, these doctors could be doing something else. They could be out here and making a good living, doing something else. But they're going to go out there and try to save these lives. And the contribution you gave is going to enable them to do it. But when you leave here, I want you to think about what I'm telling you. And I want you to tell your congressmen and your senators that you will support America paying its fair share of the United Nations Secretary-General's [Global AIDS and Health Fund]. That it sounds like a lot of money, but it's a lot cheaper than going to war, and it's a lot cheaper than what we're going to pay if we don't deal with it. It is the morally right thing to do because we live in a world without walls.

Let me just say parenthetically, the same argument applies to our fair share of getting 100 million kids in school that never go to school. Or our fair share of trying to control the chemical and biological and nuclear products around the world that terrorists are trying to steal. We just can't avoid the fact that if we live in a world without walls, we have to be part of dealing with the challenges, spreading the benefits like the economy, and reducing the burdens.

But there is no more urgent thing than dealing with AIDS. I'm telling you, I know, I have been in these places. I know what is going to happen if we have 100 million AIDS cases in five years. It would be the biggest health problem since the plague killed one-quarter of Europe in the 14th century. In 750 years, it would be the biggest health problem. We don't have to put up with this. We can do better. These doctors are giving their lives to do better. So thank you for supporting them. But also support your political leaders, so that America can pay its part of turning this around.

Thank you and God bless you.

William Jefferson Clinton was the 42nd President of the United States, serving from 1992-2000.

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