Stephen Lewis asks tough questions about the end of AIDS in Africa

Stephen Lewis sounded exhausted as he spoke on the phone from Montreal.

“I don’t know,” he said. The former UN secretary general’s special envoy for HIV/AIDS in Africa repeated the phrase several times. “It feels as if the whole world is in a tailspin of lunacy.”

The question was about the international community waiting until a point of crisis before it responds to a problem. The example was the Ebola virus in Liberia and Sierra Leone, where the disease has killed more than 2,000 people and infected thousands more. But Lewis noted it could have been in reference to Islamist militants in Iraq or civil wars in Syria and the Central African Republic.

“Every time you turn on the television or pick up the newspaper, it’s another aching reservoir of horror,” he continued. “I just can’t get over it.”

Lewis isn’t a pessimist. A few minutes later, he expressed optimism talking about his new students at McGill University, where he began teaching a class on global health the same day he was reached by the Georgia Straight.

“I’m hoping that they will emerge with a very strong sense of social justice, and that their instincts to go out and change the world will be reinforced,” Lewis said.

Having spent nearly two decades focused on HIV/AIDS in Africa, Lewis is pragmatic, which has him breaking from a refrain repeated with increasing frequency of late.

“There is a tendency now to use the phrase, ‘the end of AIDS’,” he explained. “When I hear ‘the end of AIDS’, I see a certain implausibility. I think it’s premature.”

Lewis was quick to note that progress has been substantial.

He praised Julio Montaner, for example, director of the B.C. Centre for Excellence in HIV/AIDS. In 2006, Montaner began pushing a strategy known as “treatment as prevention”. Since then, governments and nonprofits around the world have adopted highly active antiretroviral therapy as a means not only of treating the virus but of minimizing its transmission from parents to children. “I don’t think Canadians understand the impact of what Julio has done,” Lewis said.

The United Nations is presently reviewing its work on HIV/AIDS through a framework called the Millennium Development Goals (MDG), which expire in 2015. UN targets for combating HIV/AIDS are one category in which the world has made quantifiable progress.

According to the UN’s 2014 MDG report, the annual rate of new HIV infections per 100 adults was reduced by 44 percent from 2001 to 2012. It is stated there that in 2012, a total of 9.5 million people in developing regions had access to antiretroviral therapy, up from fewer than one million a decade earlier. “In 2012, an additional 1.6 million people—the largest annual increase ever—received treatment,” the report notes.

Acknowledging the significance of those gains, Lewis emphasized that addressing the consequences of HIV/AIDS in Africa is about more than getting drugs to people.

“There has to be a recognition of the ways societies have frayed as a result of the virus,” he said. “There is the extraordinary phenomenon of 17 million orphans. What do you do with societies, with countries, that have one, two, and three million orphans? What does that mean down the road?”

Lewis said those are the concerns he’s heard raised by African partners working with the nonprofit Stephen Lewis Foundation. He recounted attending a conference in Cape Town, South Africa, last December where grassroots representatives called attention to less discussed impacts of HIV/AIDS, the orphan issue specifically.

“There is so much money going to meet the slogans, the hyperbole, and not nearly enough going to those organizations on the ground that are holding life together, that are holding communities together,” Lewis said.

Although access to antiretroviral treatment continues to rise, Lewis questioned if “the end of AIDS” is, in fact, near when the disease’s long-term consequences will be felt for many years to come.

“One should not invoke assumptions that it is over when it is not over,” Lewis said. “It is going to be felt, hurtfully, for another generation at least, and probably two generations.”

Stephen Lewis will deliver a free Wall Exchange lecture at the Vogue Theatre on Wednesday (September 17). To register, go to the Peter Wall Institute For Advanced Studies website.