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DATE February 24, 2003 ACCOUNT NUMBER N/A⨠TIME 12:00 Noon-1:00 PM AUDIENCE N/A⨠NETWORK NPR⨠PROGRAM Fresh Airâ¨â¨Interview: Stephen Lewis on the AIDS crisis in Africaâ¨TERRY GROSS, host:â¨â¨This is FRESH AIR. I'm Terry Gross.â¨â¨My guest, Stephen Lewis, is the UN's special envoy for HIV/AIDS in Africa. Heâ¨says the pandemic cannot be allowed to continue and those who watch it unfoldâ¨with a kind of pathological equanimity must be held to account. He adds,â¨`There may yet come a day when we have peacetime tribunals to deal with thisâ¨particular version of crimes against humanity.'â¨â¨Lewis was pleased with President Bush's announcement that he wants to tripleâ¨America's funding for fighting AIDS in Africa, though he worries that war withâ¨Iraq will distract world attention from the pandemic. Lewis formerly servedâ¨as Canada's ambassador to the UN, deputy head of UNICEF and special adviser onâ¨African economic recovery.â¨â¨He recently toured four countries in southern Africa: Lesotho, Zimbabwe,â¨Malawi and Zambia. I asked him to elaborate on how he thinks war with Iraqâ¨might affect the AIDS pandemic in the region.â¨â¨Former Ambassador STEPHEN LEWIS (United Nations Special Envoy for HIV/AIDS):â¨Well, war always has the effect of diverting resources, diverting attention,â¨diverting energies, diverting coverage. War is an entirely preoccupyingâ¨reality, and this looming war with Iraq is a preoccupying reality not just forâ¨the United States and its allies, but also for the rest of the world becauseâ¨there are such profound religious and political divides. And what happens inâ¨that kind of situation is that a continent like Africa gets short shrift; thatâ¨you forget the other human and moral imperatives, that they just get lost.â¨â¨It reminds me very much of what happened after the war in Afghanistan, aâ¨perfectly understandable extension of September the 11th, but nonetheless, theâ¨war in Afghanistan took away from, drew from all of the attention of the worldâ¨on other areas of human need and human predicament. So all of us who watchâ¨this unfolding and know that we're dealing with this catastrophic HIV/AIDSâ¨pandemic in Africa and know that we have built some momentum, which wasâ¨evidence in the president of the United States' State of the Union address,â¨when Mr. Bush announced that significant additional amount of money. We knowâ¨that all of that could unravel if the war begins and takes everyone'sâ¨attention away from what is happening in Africa.â¨â¨GROSS: Do you think the AIDS casualties in Africa are as bad as theâ¨casualties of most wars?â¨â¨Mr. LEWIS: They're much greater than the casualties of most wars. I don'tâ¨know, Terry, whether people fully understand this, but as the AIDS pandemicâ¨works its way through Africa and now seeping inexorably into Asia, into Russiaâ¨and the Eastern bloc, we're going to take a larger toll in human life than theâ¨famous Black Death of the 14th century. But if you want something moreâ¨contemporary, AIDS is going to take a greater toll in human life than both theâ¨wars of the 20th century, military and civilian casualties combined. We'reâ¨talking about, potentially, 70 to 100 million deaths because that's the wayâ¨the pandemic is moving.â¨â¨GROSS: You talking about just Africa or around the world?â¨â¨Mr. LEWIS: Well, Africa's already lost close to 20 million. There are 30â¨million infected. All those people are, for the moment, in the absence ofâ¨treatment, doomed. So I think Africa alone could see those numbers. If youâ¨move into the rest of the world and we don't manage to stop the pandemic inâ¨India, in China, in Russia, then I don't even want to think about the figures.â¨And I don't know to translate it in human terms because those figures are soâ¨abstract. What do they mean? What you have to think about is all the womenâ¨and the orphaned children and the families ripped apart and the extendedâ¨families lost and countries literally fighting for survival.â¨â¨GROSS: The CIA has warned that AIDS in China, India, Russia, as well asâ¨Africa, is a mounting security threat for the United States. What does theâ¨CIA mean by that?â¨â¨Mr. LEWIS: They mean that as the HIV/AIDS pandemic takes its toll, theâ¨societies begin to fall apart and all the big sectors of society are affected.â¨It's, therefore, not merely the human tragedy, it's the shredding of all theâ¨infrastructures. You're seeing that now in southern Africa with the foodâ¨shortages and the near famine in several countries in southern Africa. Andâ¨what has happened, of course, is that over the last 10 years or so, sevenâ¨million agricultural workers--overwhelmingly women because women do theâ¨farming, agricultural workers have died.â¨â¨And so many of the people have reduced immune systems because they're infectedâ¨by HIV that when you add that to the food shortages, then it means thatâ¨everything falls apart. People are subject to a much more rapid progressionâ¨of the disease and a much more rapid progression towards death. And we'reâ¨seeing that all over southern Africa.â¨â¨I was in the four countries that are most grievously affected--Lesothos,â¨Zimbabwe, Zambia, Malawi--in December and again in January and frankly, weâ¨were horrified by what we encountered, those of us who were traveling for theâ¨UN because this wasn't a food shortage and hunger induced by drought andâ¨erratic rainfall as first was thought. This was a food shortage and hungerâ¨induced, in large part, by AIDS because AIDS had caused the whole society toâ¨fracture.â¨â¨I remember meeting with the minister of Agriculture in Zambia and he said--byâ¨way of anecdote, he said, `You know, I had a meeting, Mr. Lewis, 10 days agoâ¨with the European Commission. They brought 10 people to the meeting. Iâ¨attended the meeting alone.' And he said, `I attended it alone because soâ¨many of the senior people in my ministry were dead. I had no one to bringâ¨with me.'â¨â¨And you see, what has happened in agriculture is happening, for example, inâ¨education. Zambia loses 2,000 teachers a year. It graduates from itsâ¨teachers' colleges fewer than a thousand. How do you keep your educationâ¨system together when kids are leaving schools to look after sick and dyingâ¨parents, when the teachers are dying or they're absent because they're sick?â¨So progressively you shred the agricultural sector, the education sector, theâ¨health sector, the private sector, often the military, whose rates ofâ¨infection are inevitably higher than those of the civilian population. Andâ¨that's what the CIA means by a security risk, that the entire country is thenâ¨subject to destabilization because you've got huge number of orphans wanderingâ¨the landscape, ruthless and angry and bewildered, and you've got a societyâ¨struggling for survival. Do you know we heard the word `extinction' used moreâ¨than once as we traveled.â¨â¨GROSS: In relationship to what?â¨â¨Mr. LEWIS: In relation to the countries. We heard heads of state say theyâ¨were fighting to prevent their country from extinction. It's the first timeâ¨I've heard that word. I've heard `fighting for survival,' `fighting for ourâ¨lives,' `We don't know whether we'll make it,' `We could be a failed state.'â¨I had not before heard the word `extinction.'â¨â¨GROSS: Are there any tribes or ethnic groups within Africa that are alreadyâ¨on the verge of extinction?â¨â¨Mr. LEWIS: Well, there are countries where the prevalence rates of HIV-AIDSâ¨are so high that they really are fighting for survival. Botswana has aâ¨prevalence rate of over 38 percent amongst the 15- to 49-year-olds, so try toâ¨imagine it; one out of every three, two out of every five people who areâ¨infected. Botswana is tremendously fortunate. It has some mines and it hasâ¨diamonds and it has one of the few countries in Africa which has some surplusâ¨from previous budgets, so they're working hard at putting a treatment programâ¨into place and doing intense prevention. But frankly, they're really fightingâ¨to save the life of the country.â¨â¨Swaziland, which has a prevalence rate as high as Botswana now, doesn't haveâ¨the same resilience and the same capacity to respond. It's unbelievablyâ¨impoverished. Remember, most of these countries live on less than $1 a dayâ¨per person, so they're so poor that to find the resources to respond is justâ¨not available.â¨â¨GROSS: A lot of our listeners might be thinking, yeah the problems in Africaâ¨are very grave, but the Bush administration is recommending giving $15 billionâ¨for AIDS in Africa, so that will really help a lot. If the $15 billionâ¨actually comes through, how much of a dent will it make in helping to reverseâ¨the epidemic?â¨â¨Mr. LEWIS: Oh, it will make a dent, if it's well and intelligently used, itâ¨will make a very considerable dent, because we've just never had those kindsâ¨of figures before. But if you put it in perspective, if it's $3 billion aâ¨year for five years, everybody understands that we need a minimum of $10â¨billion to do the job now, and by the year 2007, those who study it say weâ¨will need over $15 billion. So while the American offer, the Americanâ¨commitment is a quantum leap forward and changes the pattern of indifferenceâ¨and negligence which has characterized the Western world for years, it stillâ¨doesn't begin to confront the amounts that are needed in order to turn theâ¨pandemic back.â¨â¨Now I beg you to put it in context. Ten or $15 billion over five years soundsâ¨like a lot of money; $10 billion a year sounds like a lot of money. Butâ¨people who have estimated the cost of a war in Iraq are talking about $100â¨billion and better. So in relative terms, we're asking for very small amountsâ¨of money to attempt to save the lives of over two million people a year.â¨â¨GROSS: My guest is Stephen Lewis, the UN's special envoy for HIV/AIDS inâ¨Africa. We'll talk more after our break. This is FRESH AIR.â¨â¨(Soundbite of music)â¨â¨GROSS: If you're just joining us, my guest is Stephen Lewis. He's the UNâ¨special envoy for AIDS in Africa.â¨â¨We've talked a little bit about the staggering statistics in Africa. I'mâ¨wondering if you could just give us a couple of scenes of things that youâ¨witnessed on your recent trip to Africa that would also help convey a sense ofâ¨how bad the epidemic is there.â¨â¨Mr. LEWIS: Well, the scenes haunt the mind. It's just very hard to deal withâ¨them. As I'm talking to you, I find myself--just as the images run through myâ¨mind, I find myself becoming unsettled and emotional. I think one of theâ¨worst moments I had was in the University Teaching Hospital in Lusaka, inâ¨Zambia. But frankly it's equivalent to any hospital in southern Africa at theâ¨moment.â¨â¨I was in the pediatric nutrition ward, where the HIV infection rate is roughlyâ¨56 percent, and where there was great hunger in the country as well as AIDS.â¨And you wander through the ward--I'll tell you exactly what it was. I went inâ¨with the administrator and the head of the ward and all these little morselsâ¨of infants. They were six months to two years old. Three and four to a bed.â¨Their mothers hovering anxiously around. And you walk down the corridor justâ¨so overpressed, not enough nurses, not enough doctors, not enough beds.â¨Everybody in a kind of paralysis of anxiety.â¨â¨And then suddenly as you're walking, you hear this wail breaks out. It's soâ¨shocking and so visceral. And you turn around and you suddenly understandâ¨what's happened, that one of the little infants has died and the mother, herâ¨head buried in the bed sheet beside her dead child, is weeping. And in comesâ¨a nurse and wraps up the child and takes the child out. It's all soâ¨horrifying and unexpected. And then you walk to the end of the ward trying toâ¨get the image out of your mind and suddenly there is another terrible shriekâ¨of dread and you realize that another child has died and another mother hasâ¨collapsed in sadness and the tragedy of it.â¨â¨And then we walked out of the ward into an open area going to what was theâ¨pediatric respiratory part of the hospital where the infection rate is 72â¨percent. So many of the infants have tuberculosis. And we're in the openâ¨area and through the windows of the ward we've just left comes another howl ofâ¨pain. And it's like Kafka and Dante and Poe. It's like everything wrappedâ¨into one crazed moment. You wonder, has the world gone mad? How is thisâ¨happening? Why is it happening? Why have we allowed it to happen? And, youâ¨know, you get that sense in hospitals in Africa now where 70 to 80 percent ofâ¨the admissions can be for HIV/AIDS-related cases.â¨â¨I remember when I was in the Harare Hospital in Zimbabwe a year or so ago,â¨while I was on the adult male ward they were wheeling in aluminum coffins andâ¨removing people who had just died from their beds and putting them in theâ¨coffins and wheeling them out. I mean, it's such an indignity to people.â¨â¨GROSS: And where do you come in? You're the UN special envoy for AIDS inâ¨Africa. You witness these horrors, you're able to describe these horrors inâ¨an alarmingly powerful way. So then what's within your power to do something?â¨â¨Mr. LEWIS: The power is terrifyingly limited. I feel as impotent as I doâ¨empowered. I have a job, it is to see what's happening, to talk to the Unitedâ¨Nations family in the country about the way in which we can more vigorouslyâ¨intervene and support what the government is trying to do against theâ¨pandemic, to speak to the donors, to work with civil society and all the NGOs,â¨to work with the associations of people living with AIDS. They are brave,â¨courageous people, not many in every country who have openly declared theirâ¨status but when they do, God, they are good people and they deserve support.â¨â¨And then I come back and I report directly to the secretary-general, and weâ¨get a chance to meet with heads of agencies and heads of departments andâ¨discuss collectively what more the United Nations can do to give leadership toâ¨what is happening.â¨â¨You see, if I may digress for just a moment, we should--what is happening isâ¨horrifying. The way women die in their homes in the presence of theirâ¨children is horrifying. The way in which women are disproportionatelyâ¨targeted by the virus, the way they're...â¨â¨GROSS: Yeah, and I want to say we'll get to that in a minute.â¨â¨Mr. LEWIS: OK. Well...â¨â¨GROSS: I do want to talk with you about that.â¨â¨Mr. LEWIS: Well, setting aside then for the moment that part of it, I want toâ¨say that there's no need to be annihilated by it all. It is possible toâ¨defeat this pandemic. We know what to do. I mean, that's what's important toâ¨understand. We know what to do in prevention. We know what to do inâ¨treatment. We know what to do in care. We have models and projects andâ¨proposals and interventions all over the continent. They're small. We'veâ¨never had the resources to generalize them through the country, to take themâ¨to scale. But there are some brilliant interventions and there's aâ¨tremendously strong resource at the community level to implement them.â¨â¨There are community-based organizations, faith-based organizations. We don'tâ¨have to be stymied by the horror except that for the moment in the absence ofâ¨resources and support, the horror tends to overwhelm.â¨â¨GROSS: Now you referred to the gender inequality of AIDS in Africa and womenâ¨and girls are particularly hard hit. And I think the statistic is for girlsâ¨aged 15 to 19 it's like twice as many girls as young men who have HIV. What'sâ¨behind that gender disparity?â¨â¨Mr. LEWIS: As a matter of fact, in the age group 15 to 19 it's in some placesâ¨even worse than that. In a number of places, girls are five and six timesâ¨more susceptible to infection than boys of that age. Look, Africa is aâ¨continent steeped in gender inequality. That's the culture. It's the cultureâ¨in much of the developing world. But there isn't a single country in thisâ¨world, not on the planet, which has real gender equality.â¨â¨In Africa, gender inequality is fatal, and the predatory sexual behavior ofâ¨adult men, the intergenerational sex, older men forcing sex on younger womenâ¨and girls--you know, women and girls have no sexual autonomy; they can't sayâ¨to a man, `You must wear a condom.' They have no power over their ownâ¨sexuality. There is a cultural oppression there which is so deeply entrenchedâ¨that it's going to take a long time to overcome it.â¨â¨And that gender inequality is felt institutionally, it's felt in the world ofâ¨work, it's felt in farming. It's felt in education. It's felt everywhere.â¨It's particularly bad in the areas of sexual violence and of rape and ofâ¨marital rape, and the laws are inadequate to respond. What we really need inâ¨Africa is a massive campaign on gender equality treating every single aspectâ¨of a woman's life, from property rights and inheritance right through toâ¨sexual violence, in order to overcome it.â¨â¨GROSS: Stephen Lewis is the UN special envoy for HIV/AIDS. He'll be back inâ¨the second half of the show.â¨â¨I'm Terry Gross, and this is FRESH AIR.â¨â¨(Soundbite of music)â¨â¨(Announcements)â¨â¨GROSS: Coming up, safe sex and fatalism. We continue our conversation withâ¨Stephen Lewis, UN special envoy for AIDS in Africa. And Maureen Corriganâ¨reviews "Gilligan's Wake," a new novel by Tom Carson inspired by "Gilligan'sâ¨Island" and "Finnegans Wake."â¨â¨(Soundbite of music)â¨â¨GROSS: This is FRESH AIR. I'm Terry Gross, back with Stephen Lewis, the UN'sâ¨special envoy for HIV/AIDS in Africa and Canada's former ambassador to the UN.â¨He recently toured four countries in southern Africa. When we left off, weâ¨were talking about how gender inequality has affected the spread of AIDS inâ¨Africa.â¨â¨From very far away, it's easy to think about Africa, well, you can'tâ¨completely plead ignorance anymore because the epidemic is so widespread, youâ¨can't help but see its existence around you. So why would you haveâ¨unprotected sex in an environment like that when you know that that's the wayâ¨to get sick yourself?â¨â¨Mr. LEWIS: Well, because changing sexual behavior turns out to be the mostâ¨difficult thing in the world to achieve. Achieving awareness is not soâ¨difficult. There are some countries that claim--and I think they're right--aâ¨95 to 100 percent awareness of how the virus is transmitted heterosexually,â¨and there is even awareness of how to protect oneself. And yet, because ofâ¨sexual behavior, there isn't behavior change. There's a big gulf between theâ¨awareness on the one hand and the behavior change on the other. And weâ¨haven't yet got to the behavior change. But you can see in a country likeâ¨Uganda or a country like Senegal or progress we're making in the 15- toâ¨19-year-old age group in Kenya, Zambia and Namibia, you can see intenseâ¨prevention programs, which explain and which are graphic and which are directâ¨and, you know, you absolutely starkly set out the facts for young people inâ¨schools and through drama and music and poetry and song and dance at communityâ¨level. You can get people to change their sexual behavior, but it does take aâ¨lot of time, and in the meantime, a lot of people are being infected.â¨â¨GROSS: Do you think that there's more awareness about how AIDS is spread nowâ¨and more openness and discussion of sexuality?â¨â¨Mr. LEWIS: Oh, God, yes. It's astonishing what's happened, even in the lastâ¨two years, and it's also the political leadership in Africa, who were steepedâ¨in the 1990s in denial and in silence, except for special countries likeâ¨Uganda, where you had President Museveni, who early on understood what was atâ¨stake and just refused ever to make a speech without talking about AIDS,â¨wouldn't allow his Cabinet members to make speeches without talking aboutâ¨AIDS. And gradually, the prevention programs grew so that the prevalenceâ¨rates in Uganda, which were between 25 and 30 percent in the early '90s areâ¨now down, believe it or not, to 6 or 7 percent in 2003. That's an astonishingâ¨decline, and it shows it's possible.â¨â¨And what's happened, I think, is that the African leadership in the last twoâ¨or three years has become so horrified by the sense of their societies fallingâ¨apart that they really are engaged, and there's much more talk about it. Andâ¨it's just amazing how frank--I did a question and answer, Terry, with about,â¨oh, eight or 900 Ethiopian high school students in Addis Ababa some monthsâ¨ago, and I was stunned by the frankness and openness of the questions. Thereâ¨wasn't the slightest embarrassment about discussing intimate sexual detail.â¨And...â¨â¨GROSS: Would this have been unimaginable when you first started visitingâ¨Africa, looking at AIDS?â¨â¨Mr. LEWIS: Absolutely, absolutely unimaginable. In fact, to tell you theâ¨honest truth, I felt--as I was sitting there, it was faintly surreal. I feltâ¨it was unimaginable, even as I was hearing it, but it showed how quickly theâ¨societies are recognizing that this is an unbelievable catastrophe, and theyâ¨have to do something about it. But it's all happened late, and they've neverâ¨had the resources.â¨â¨GROSS: Are condoms readily available through Africa?â¨â¨Mr. LEWIS: The male condom is available in most countries in significantâ¨numbers. Frequently, the Ministry of Health will make them available.â¨Frequently, big NGOs will make them available. There are times when there areâ¨shortages and when they're not available, and that's usually some kind ofâ¨breakdown in the pipeline of delivery. What hasn't been available, largelyâ¨because of cost, is the female condom. It's being used more widely now inâ¨South Africa. They're making a real effort to distribute the female condom,â¨and it, of course, has the huge advantage of the woman being able to takeâ¨control over the sexual transaction.â¨â¨GROSS: Assuming she's not being raped, in which she wouldn't have kind ofâ¨control.â¨â¨Mr. LEWIS: Oh, yes, of course, of course, of course. Yeah.â¨â¨GROSS: What about prostitution? Are you seeing any changes in prostitution?â¨â¨Mr. LEWIS: Well, commercial sex work remains a very serious high-risk groupâ¨for transmission of the disease. It particularly happens at border crossingsâ¨when truck drivers are backed up overnight before they can cross. It happensâ¨when people--the migration of work forces from one country to another, if oneâ¨of the country has mines, then frequently, the workers will go to the mines,â¨they're away from their families, they go to prostitutes. The virus isâ¨transmitted. The routes that the truckers take, the work migration, theâ¨availability of commercial sex in some of the urban centers, there are thingsâ¨that drive the virus.â¨â¨There are very considerable efforts made to get commercial sex workers out ofâ¨the trade and into an alternative, but it's important to understand, I think,â¨that a lot of the women who are in commercial sex work are in what we callâ¨survival sex. It's so difficult in this society to find even pennies to keepâ¨body and soul together, that some young women are forced into sex for thatâ¨purpose. And therefore, you have to find alternatives. I was in Mombasa notâ¨long ago in Kenya where a group of 10 commercial sex workers had completelyâ¨broken from their commercial sex work because they were able to build a littleâ¨bakery and sell their baked goods in the community, and they were receiving aâ¨sufficient income from their baked goods to be able to give up commercial sexâ¨work. And while that's very tiny, those are the kinds of methodicalâ¨interventions that are being tested all over the continent. We callâ¨them--income-generating projects is the term of art.â¨â¨GROSS: Have you seen a lot of different attitudes among the people of Africaâ¨about the epidemic in terms of their own vulnerability to it and how they dealâ¨with that vulnerability? Have you seen some people who are just fatalisticâ¨about it, `I'm going to behave the way I behave, and if I get it, I get it,'â¨and seen other people try to, you know, do their best to prevent it fromâ¨happening?â¨â¨Mr. LEWIS: You see absolutely the whole range of human behavior and humanâ¨response. There are some really shocking surveys which emerged at theâ¨Barcelona International Conference on AIDS last July, surveys that wereâ¨conducted by UNICEF and UNAIDS, particularly amongst young girls and youngâ¨women between the ages of 15 and 19 in which they felt in the variousâ¨countries that they were simply not at risk. They didn't always understandâ¨how the virus was transmitted. They assumed just by looking at people, youâ¨could tell whether it was safe to have sex with them or not. There wereâ¨numbers of preconceptions and misconceptions which were very unsettling andâ¨showed the need for an intense effort at education. Amongst young boys, thereâ¨was a tremendous, smug egocentricity amongst their entitlements sexually andâ¨what they could and could not do and their indifference to the possibility ofâ¨getting the virus. So you had these various extremes in attitudes, which isâ¨based on survey data and allows us to know where to put the emphasis.â¨â¨As one wanders--and I've been doing it now for more than a year and a halfâ¨intensely in this role--you sense an increasing awareness everywhere. So ifâ¨I'm sitting in Ethiopia at a little coffee klatch in the late morning with aâ¨group of neighborhood women, incredibly enough, as uncomfortable as they wouldâ¨normally be about discussions of sexuality, and particularly in the presenceâ¨of a white Westerner, they're not uncomfortable at all. They sit over coffeeâ¨and they discuss what AIDS is doing and what should be done. But then youâ¨meet the people living with AIDS in these various countries, and they tell youâ¨hair-raising stories of stigma. And you realize how intense the stigma is andâ¨how people, if they have the courage to declare their status, they're rejectedâ¨sometimes from their families, by their neighbors, by their friends.â¨â¨I remember meeting with a group of 10 women or a dozen women in the littleâ¨town of Arusha in Tanzania just a year or so ago, and they were all livingâ¨with AIDS. And I said to them, `Yeah, that's very brave of you to be talkingâ¨so openly about living with AIDS. How does your community respond?' And theyâ¨said to me, `We never talk about it in our communities. They don't know we'reâ¨living with AIDS. We talk about it only if we're here in the urban center ofâ¨Arusha where no one knows us.'â¨â¨GROSS: I know availability of drugs is an incredibly important issue inâ¨dealing with AIDS in South Africa. Is the problem mostly money? Is theâ¨problem mostly that people can't afford to pay for the drugs?â¨â¨Mr. LEWIS: Yes, the fundamental problem there is money. There are otherâ¨problems--you have weak health systems; you don't have enough doctors, nursesâ¨and counselors to administer the drugs and to follow the patient back to theâ¨village and make sure that the drug regimen is followed. But overwhelminglyâ¨the problem is dollars.â¨â¨For a long time the difficulty was with the pharmaceutical industry who keptâ¨the price of anti-retroviral drugs very high. But as President Bush pointedâ¨out the other night in a State of the Union address, the drug costs haveâ¨dropped from $12,000 a year to roughly $300 per person per year for theâ¨generic drugs. Now if you're living in a country where people are earningâ¨less than a dollar a day, you can't afford $300 a year. But if there wasâ¨outside donor money, like that of the United States, coming into the countryâ¨for the purchase of the drugs and the distribution of the drugs, then youâ¨could prolong life significantly for very large numbers of people. And thatâ¨is the desperate struggle at the moment. It doesn't mean that we shouldâ¨diminish prevention for a second or diminish the care of people for a second,â¨but we can prolong lives.â¨â¨I go back to the remarks of the president of the United States. He said,â¨`Four million people need treatment now, and only 50,000 are getting it.'â¨That's just a staggering comparison.â¨â¨GROSS: My guest is Stephen Lewis, the UN special envoy for HIV/AIDS inâ¨Africa. We'll talk more after a break. This is FRESH AIR.â¨â¨(Soundbite of music)â¨â¨GROSS: My guest is Stephen Lewis, the UN special envoy for HIV/AIDS inâ¨Africa.â¨â¨You've given us some pretty horrifying pictures of how AIDS is affectingâ¨Africa. When you go home to Canada after spending time in Africa, how does itâ¨change you?â¨â¨Mr. LEWIS: Well, I've had a love affair with Africa since 1959. I've beenâ¨going back and forth, to and from the continent for 44 years now. I love theâ¨continent--I love the people; I love the music; I love the generosity; I loveâ¨the kindness; I love the intelligence. It's an extraordinary continent,â¨despite the fact that it's beset by conflict and by disease and by poverty.â¨â¨But, you know, it's too heartbreaking almost to cope with. I know--look, thisâ¨isn't a confessional. I don't know much about this program. We're justâ¨chatting in a friendly way. But I know that at times I'm emotionally fraying.â¨I know that I'm not as sober and rational and contemplative as I should be,â¨because it just tears your heart out. It all seems so unnecessary. Because,â¨as I say again, we know how to defeat the pandemic. We could break its backâ¨in four or five years and save millions of lives if only we can mobilize theâ¨world.â¨â¨If we mobilize the world around AIDS the way we mobilize the world around war,â¨then we could really overcome HIV/AIDS in a few years' time.â¨â¨GROSS: And that would take--What?--anti-retroviral drugs and more sexâ¨education?â¨â¨Mr. LEWIS: Massive...â¨â¨GROSS: I mean, what would it take?â¨â¨Mr. LEWIS: Massive prevention programs, anti-retroviral drugs, a great dealâ¨by way of resources from the Western world, a kind of Marshall Plan for Africaâ¨to overcome the disease, and in the process saving the world from real agonyâ¨if it spreads inexorably to China and India, as it now seems to be doing,â¨which will definitely dwarf Africa in numbers.â¨â¨GROSS: Is this a difficult time for you to be traveling to Africa as the UN'sâ¨special envoy for AIDS? Westerners are targets of terrorists in every part ofâ¨the world right now, and certainly in Africa.â¨â¨Mr. LEWIS: Yeah.â¨â¨GROSS: So what kind of problems is that causing for you, either problems inâ¨terms of anxiety or problems in terms of restrictions that you have to dealâ¨with?â¨â¨Mr. LEWIS: Interesting question. Actually, it has caused me not a moment'sâ¨hesitation or restriction. I travel in large measure alone or sometimes withâ¨a colleague. The UN family in the countries that I visit are the people onâ¨whom I rely, and then the meetings with government and civil societyâ¨officials.â¨â¨You know, without seeming to be unstable, I am so seized with thisâ¨predicament, and anyone would be. This is not a characteristic of Stephenâ¨Lewis; anyone who sees and works with what is happening would be just obsessedâ¨with it. And the struggle to overcome it supercedes every otherâ¨consideration, whether it's insecurity or threats of terrorism or wars.â¨â¨GROSS: You have worked with the UN in many capacities. You're Canada'sâ¨former ambassador to the United Nations, former deputy head of UNICEF, aâ¨former special adviser on African economic recovery. What do you think of howâ¨the UN is handling now the crises of the world--North Korea, Iraq? Are youâ¨disappointed in the UN's ability to cope? Or do you feel the UN is reallyâ¨behaving in the way that it should be?â¨â¨Mr. LEWIS: The UN is two entities. It's important to recognize that. Whenâ¨it's handling an Iraq or a North Korea in the Security Council, it isâ¨fulfilling its role on peace and security, a largely political role, by whichâ¨it is overwhelmingly judged by everyone. And I think in defense of the UN,â¨the UN is then captive to the decisions of the individual countries--theâ¨United States, France, Russia, Germany. These countries, which taken togetherâ¨are the sum total of the UN, dictate the UN's terms, conditions and policies.â¨It's not Kofi Annan. He simply implements what the countries decide.â¨â¨And then there's the other UN. There's the UN which devotes itself toâ¨humanitarian priorities and to emergencies and to development. It's theâ¨UNICEFs and the population people and the World Food Program and the refugeesâ¨and the United Nations Development Program. It's all those parts of the UNâ¨which day in and day out save lives and deal with the most difficult and grimâ¨dimensions of society. That's the UN that is loved and valued and treasuredâ¨in these developing countries.â¨â¨And it's kind of schizophrenic. We think so completely of the UN and theâ¨Security Council when a France and the United States lock horns, and we forgetâ¨that the primary work of the UN beyond peace and security is with humanâ¨priorities, and that work is magnificent.â¨â¨GROSS: Before you were the UN special envoy for AIDS in Africa, you worked asâ¨an investigator on the Rwanda genocide, so you've seen the impact of genocideâ¨and you've seen the impact of the AIDS pandemic; you've witnessed, you know,â¨the impact of millions of people dying. What does this do to your sense ofâ¨proportion? I mean, how do you protect yourself of thinking, `Oh, anotherâ¨life is lost. Big deal. I've seen millions'? You know, what does it do toâ¨your sense of proportion?â¨â¨Mr. LEWIS: God, that's an interesting question. For one thing, the genocideâ¨ended. I mean, at least it had a conclusion. The thing about AIDS which isâ¨so harrowing is that it seems never to have a conclusion; it just seems to goâ¨on and on and on. And you know that the death rates are going to rise toâ¨astronomic heights in 2008, 2009, 2010, and all of the orphans willâ¨proliferate in huge numbers. It's a generational thing. It's going on. Itâ¨isn't ending.â¨â¨Proportion? Can I tell you something which interests me? I'm a person whoâ¨hasn't responded well enough to human agony and despair. It's not that Iâ¨don't feel it intensely, but it's because as a Canadian I've always beenâ¨somewhat distant from it. And like everybody else, you think of theseâ¨abstract large figures, and it's hard to put a human face to them.â¨â¨What has happened to me personally in dealing with AIDS is that rather thanâ¨seeing it in large, every single person now somehow has a vivid reality forâ¨me. And I carry in my mind a young woman living with AIDS in Lusaka who had aâ¨stroke and has lost the sight of one eye and still in her 20s is fighting toâ¨stay alive. And, you know, you carry away with you a sense of a woman in aâ¨community who's desperately tending to the sick and the dying. And you carryâ¨away with you a young orphan girl of 14 looking after four siblings, stoicallyâ¨dealing with the household. And when someone dies, you feel it very keenly.â¨â¨In an odd way, AIDS has become personalized. Every single person is like aâ¨scar on the soul, I think, because it's all unnecessary. I think it's becauseâ¨you know these people shouldn't be dying. And so each of them individuallyâ¨has a tremendous personal force.â¨â¨GROSS: Stephen Lewis, safe travels. Thank you very much for talking with us.â¨â¨Mr. LEWIS: Thank you, Terry.â¨â¨GROSS: Stephen Lewis is the UN's special envoy for HIV/AIDS.â¨â¨Coming up, Maureen Corrigan reviews Tom Carson's new novel inspired by TV andâ¨literature, "Gilligan's Wake."â¨â¨This is FRESH AIR.â¨â¨* * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * * *â¨â¨Review: Tom Carson's new novel "Gilligan's Wake"â¨TERRY GROSS, host:â¨â¨For decades critic Tom Carson has written on TV and popular culture for Theâ¨Village Voice, Esquire, Rolling Stone and other magazines and newspapers.â¨He's written a new novel called "Gilligan's Wake," which draws heavily on hisâ¨informed infatuation with classic television series, American history andâ¨world literature. Book critic Maureen Corrigan says "Gilligan's Wake" may beâ¨one of those novels you'd like to have with you on a desert island.â¨â¨MAUREEN CORRIGAN reporting:â¨â¨I'm always curious about the current state of cultural literacy, so I wentâ¨into my freshman English classes the other day and asked how many studentsâ¨had ever watched the 1960s sitcom "Gilligan's Island." They all raised theirâ¨hands instantly. Then I told them about Tom Carson's new novel, "Gilligan'sâ¨Wake," which in bebop, stream-of-consciousness fashion retells highlights ofâ¨modern American history through the voices of each of the characters on theâ¨island. A few faint smiles of appreciation, but unlike the reaction I gotâ¨when I told the same plot synopsis to friends age 35 and over, no out-and-outâ¨hoots of laughter at the absurdity of the whole idea.â¨â¨My students, I realized, have only watched "Gilligan's Island" on the classicâ¨TV channel. For them, it's a canonized text, as venerable in its own way asâ¨"The Great Gatsby," "The Day of the Locust," "No Exit," "Finnegans Wake," orâ¨any of the other highbrow works Carson references throughout his hectic tale.â¨Their relative lack of elitist distinctions makes my students Carson's idealâ¨readers, because he also assumes that the boundaries are porous between highâ¨and low culture. Such is the surrealistic quality of American life, accordingâ¨to Carson's novel.â¨â¨Reading "Gilligan's Wake" and being the beneficiary of a high-culture eggheadâ¨education, I couldn't help but think of the original title of James Joyce'sâ¨"Finnegans Wake," which was "Here Comes Everybody." "Here Comes Everybody"â¨aptly captures the feel of Carson's novel. It's an inspired mumbo jumbo manicâ¨homage to the art of both James Joyce and Bob Denver. "Gilligan's Wake" isâ¨structured as a series of autobiographical reflections by the ill-fatedâ¨passengers and crew of the USS Minnow.â¨â¨The novel opens with Maynard G. Krebs, the beatnik character Bob Denver playedâ¨on his first TV show, "The Many Loves of Dobie Gillis," ranting in the Mayoâ¨Clinic's Cleaver Ward to his shrink, Dr. Kildare F. Troop. Holden Caulfield,â¨by the way, is Krebs' roommate. From Krebs' paranoid rantings, he's seen theâ¨best minds of his generation destroyed by madness, J. Edgar Hoover and tooâ¨much espresso. We go on to the skipper's adventures during World War II withâ¨"McHale's Navy" and JFK's PT-109. Then it's back in time to the rarifiedâ¨youth of Thurston Howell III, who unknowingly launches an old school chum,â¨Alger Hiss, on his dubious government career. The professor, here a bisexualâ¨narcissist, works on the Manhattan Project. Party girl Ginger recalls herâ¨one-night stand for racial equality with Sammy Davis Jr. And Mary Ann losesâ¨her all-American virginal view of the world, hobnobbing with Sartre inâ¨existentialist-infested Paris.â¨â¨My favorite chapter, however, is the one presided over by Lovey Howell, aâ¨character who, even on the original TV show, always seemed to be smarter thanâ¨she acted. After all, she was the only character who packed enough trunks ofâ¨clothes in an anticipation of possible shipwreck. In Carson's feveredâ¨imagination, Lovey is a former flapper, a morphine-popping intimate friend,â¨and I do mean intimate, of Daisy Buchanan.â¨â¨Here's Daisy confessing to Lovey her ambition to write a tell-all novel aboutâ¨Jay Gatsby: `It would be about a man, a man that everybody thinks isâ¨wonderful, because his dreams soar so high and he's so full of ardor and heâ¨loves his idea of you so much more of you than the reality of you, whichâ¨nobody else thinks deserves love anyway, and how nobody understands that thisâ¨man is a tyrant and a dictator who carries your head around on a stick, evenâ¨though he calls it his banner, because he's in love with himself, but he canâ¨never admit that. And so he makes you his idol and loves himself, adoresâ¨himself, worships himself for having one.'â¨â¨I have to admit, as many times as I've read "The Great Gatsby," that view ofâ¨Gatsby, as an overbearing emotional bully with boundary problems, neverâ¨occurred to me. But aided by Lovey's astute interjections and asides toâ¨Virginia Woolf and Betty Friedan, this clever, if repugnant, revisionaryâ¨interpretation works.â¨â¨Despite its ambitions to make a big statement about America, the wordplay'sâ¨the thing in "Gilligan's Wake." If you like reading Joyce and Eliot, enjoyâ¨the self-satisfaction of catching references, riffs and anagrams, thisâ¨language-drunk novel is for you. If you have no patience for relentlesslyâ¨illusory writing, well, to paraphrase the immortal theme song of "Gilligan'sâ¨Island," "Gilligan's Wake" will be an uphill climb.â¨â¨GROSS: Maureen Corrigan teaches literature at Georgetown University.â¨â¨(Credits)â¨â¨GROSS: I'm Terry Gross.