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UNITED NATIONS - 6 January 2006 / www.MaximsNews.com/ A month ago, on World AIDS
Day, I wrote that despite all the public
rhetoric about progress, "we are
not winning the war on AIDS" and
that the "very best that can be
said is that we are losing at a slightly
lower rate". [See:
Richard Holbrooke, AIDS
Strategy Not Working, MaximsNews
Network.]
I thought this was fairly
obvious, given the fact that on each
World AIDS Day since the first one 18
years ago, the number of people who are
HIV-positive has increased.
I thought it was even more
obvious from just one stunning fact:
that of the 12,000 people who will be
infected in the next 24 hours
around the world, over 90 percent will
not learn they are sick until roughly
2013, when they develop full-blown
AIDS.
Meanwhile, not knowing their
status, they will unintentionally spread
it to other people over the next eight
years, and these people will spread it
to still more, and so on.
Given this situation, I
suggested that current strategies are
clearly not working, especially on
prevention.
While continuing to support
increased funding for treatment of those
who already have AIDS, I argued that far
more emphasis should be put on detection
and testing so that people learn their
status and then, with counseling, change
their behavior if they are HIV-positive,
thus reducing the spread of the HIV
virus.
This may sound simple, even
self-evident, to those not involved with
the issue on a regular basis, but no
column I have written for this newspaper
provoked a greater reaction.
To listen to some of the
criticism you would think I had called
for mandatory testing and quarantining
of people with AIDS.
"This man is out of
control," wrote one prominent AIDS
activist under the headline,
"Someone stop this man."
I was accused of
"championing a conservative,
traditionalist public health approach,
which is simply looking to identify the
infected and contain them."
Such criticism ignored my
strong public advocacy over the past six
years of much more funding for
treatment.
But far more distressing were
the assertions of "progress"
from world leaders and editorial
pages.
Originally designed to put
pressure on public officials, World AIDS
Day has turned into an empty rhetorical
ritual in which world leaders issue
high-minded statements, after which they
let another year of living ever more
dangerously pass.
Although there were plenty of
calls for more funding for treatment, so
far as I am aware no one suggested new
prevention strategies or even admitted
that today's approaches are not
working.
Current policies on prevention
are simple enough: Conservatives
emphasize promoting abstinence (which is
why a minimum of 30 percent of the
American contribution to the effort is
earmarked for that purpose), while
liberals stress the use of condoms and
the need to avoid needle-sharing.
Of course, any of these
practices, if followed rigorously, will
prevent the spread of AIDS, but none is
ever going to be used by enough people
to reverse the spread of the
disease.
It is a classic case of
American "red state-blue
state" politics and ideology
trumping the brutal reality on the
ground, or, more accurately, in a
bedroom or alleyway.
I have been told repeatedly,
for more than four years, that the case
for testing is not proven.
But isn't it obvious that AIDS
will continue to spread more rapidly as
long as 90 percent of those affected do
not know their status?
Wouldn't greater knowledge of
one's status -- held in the strictest
confidence (an essential part of any
testing program) -- greatly modify
behavior, both for those who are
HIV-positive and for the large majority
who, even in the worst-hit areas, are
not infected?
And wouldn't the greatest
beneficiaries of widespread testing be
women, who are all too often helpless
victims but who do not know either their
own status or that of any man in their
life -- and who have no way of getting
their men to be tested?
Yet the dedicated and
committed professional community engaged
in this desperate struggle, including
UNAIDS and the World Health
Organization, still refuses to make
testing a top priority.
(One commendable exception is
Randall Tobias, the Bush
administration's special envoy on AIDS,
who makes it a practice to be publicly
tested -- if possible with a local
official -- in every country he visits;
he well may be the most tested person on
Earth.)
Why, in general, is the issue
played down?
I believe it is partly a case
of a mind-set that was locked in 20
years ago, at the dawn of the AIDS
crisis.
Stigmatization was a huge
problem then, even in the United States,
and antiretroviral drugs were not yet
available.
But times have changed, and so
has the nature of the disease and the
way it is spreading. (The greatest step
forward in prevention would be the
development of an effective microbicide
that women could self-administer, but
that goal is still eluding researchers.)
Recently there has been
encouraging action in three small
African nations -- Lesotho, Botswana and
Malawi -- which have started making
testing routine and officially
encouraged (but not mandatory).
Lesotho's new policy,
creatively called KYS, or "Know
Your Status," is especially worth
watching because it is a formal,
widespread national effort.
If it works, perhaps the high
priests of the worldwide effort on AIDS
will stop listening to their own echoes
and unexamined assumptions -- and take
action.
If ever there were a place
where an ounce of prevention was worth a
ton of cure, this is it.
Amb.Holbrooke@MaximsNews.com
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The
Honorable Richard C. Holbrooke
Former
United States Ambassador to the United
Nations
Vice Chairman, Perseus LLC
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Richard
C. Holbrooke is Vice Chairman of Perseus,
a leading private equity firm.
He most recently served as the
United States Ambassador to the United
Nations, where he was also a member of
President Clinton’s cabinet
(1999-2001).
As
Assistant Secretary of State for Europe
(1994-1996), he was the chief architect
of the 1995 Dayton peace agreement that
ended the war in Bosnia.
He later served as President
Clinton’s Special Envoy to Bosnia and
Kosovo and Special Envoy to Cyprus on a
pro-bono basis while a private citizen.
From 1993-1994, he was the US.
Ambassador to Germany.
During
the Carter Administration (1977-1981),
he served as the Assistant Secretary of
State for East Asian and Pacific
Affairs, and was in charge of U.S.
relations with China at the time
Sino-American relations were normalized
in December, 1978.
After
joining the Foreign Service in 1962, he
served in Vietnam (1963-66), including a
tour of duty in the Mekong Delta for
AID. He worked on Vietnam at the Johnson
White House (1966-68), wrote one volume
of the Pentagon Papers, and was a member
of the American delegation to the
Vietnam Peace Talks in Paris (1968-69).
He
was Peace Corps Director in Morocco
(1970-72), Managing Editor of Foreign
Policy (1972-77), and held senior
positions at two leading Wall Street
firms, Credit Suisse First Boston (Vice
Chairman) and Lehman Brothers (Managing
Director).
He has written numerous articles
and two best-selling books: To
End a War, a memoir of the Dayton
negotiations, and co-author of Counsel
to the President, Clark Clifford’s
memoir.
He
has received twenty honorary degrees and
numerous awards, including several Nobel
Peace Prize nominations. He is the
Founding Chairman of the American
Academy in Berlin, a center for
U.S.-German cultural exchange; President
and CEO of the Global Business
Coalition, the business alliance against
HIV/AIDS; and Chairman of the Asia
Society.
Corporate
board memberships: American
International Group and Quebecor World.
NGO board memberships include the
American Museum of Natural History, the
National Endowment for Democracy, The
Africa-America Institute, the Citizens
Committee for New York City, the Council
on Foreign Relations, and Refugees
International.
He is on the Advisory Board of
USA for UNHCR, and he is a Fellow of the
American Academy of Arts and Sciences.
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