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UNITED NATIONS - 7 December 2005 / www.MaximsNews.com/ On the 18th annual World AIDS Day, a time for countless
statements of concern and commitment
from world leaders, there were thousands
of commemorations and remembrances, and
reams of statistics.
In a recent article, Jim Yong Kim, the highly respected
director of the HIV-AIDS Department of
the World Health Organization recounted
grim statistics — 3 million deaths in
the past year alone, 5 million new
infections this year, rising infection
rates in nearly every part of the world
and an admission that “good news is
hard to find in the new U.N. report.”
Kim also wrote that he was nonetheless
“optimistic that the epidemic can be
stopped.”
I
respect Kim and admire his commitment,
and that of every foot soldier. I share
that commitment.
With
respect, I must nonetheless mark World
AIDS Day with a word of pessimism. We
must face the truth: We’re not winning
the war on AIDS. Our current strategies
are not working.
Every year since the
first World AIDS Day, the number of
people affected has increased. The best
that can be said is that we are losing
at a slightly slower rate.
The
huge, and expensive, international
effort has saved many lives and must be
continued, indeed increased.
PREVENTION
INFORMATION NEEDED
But
Kim acknowledges, “fewer than one in
five people at risk of HIV infection has
any access to HIV prevention
information.” This must be addressed
with larger internationally supported
programs. (But remember, once a person
is on the drugs, it’s for life; to
stop taking them is to be hit with a
mutant of the original virus.)
Until a
vaccine is found, and that’s probably
more than a decade away, we must focus
on prevention and treatment. Providing
treatment is essential, of course, but
it’s also a bottomless pit as long as
the disease continues to spread so fast.
As
a strategy, losing more slowly is simply
a recipe for an ever-more-expensive,
disastrous and deadly failure, which
will require more anti-AIDS drugs at
ever-greater cost, a modern version of
the old story of the boy with his finger
in the dike.
Moreover, as Kim points
out, current policies require
“building and strengthening health
care systems in the developing world.”
This is an essential long-term task with
or without the AIDS crisis, but one so
daunting that linking it so closely to
stopping the spread of AIDS only
compounds the odds against reaching
either goal.
Only
effective prevention strategies can stop
the spread of AIDS. Yet it is precisely
here that current policies have failed
most seriously. In the long chain of
actions required to stop the spread of
AIDS, an attack on all fronts is
necessary.
But on one vital front, the
world health community has been
shamefully quiet for two decades:
testing and detection. Because of
legitimate concerns about
confidentiality and risk of
stigmatization, testing has been
voluntary, and systematically played
down as an important component of the
effort.
Results
are predictable, and fatal: According to
U.N. figures, over 90 percent of all
those who are HIV-positive in the world
do not know their status. Yet there has
never been a serious and sustained
campaign to get people tested.
That
means that over 90 percent of the
roughly 12,000 people around the world
who will be infected today — just
today! — will not know it until
roughly 2013.
That’s plenty of time
for them to spread it further, infecting
others, who will also spread it, and so
on. No wonder we’re losing the war
against AIDS: In no other epidemic in
modern history has detection been so
downgraded.
When
I first suggested that testing and
detection was the weak link in the
strategy against AIDS, I was criticized
for ignoring human rights. Having worked
in support of human rights for more than
three decades, I understand this issue
and the passion it arouses.
But the
spread of the disease cannot be stopped,
and we cannot offer drugs to those who
need them, unless people know their
status. That knowledge changes
people’s behavior; many who learn that
they are HIV-positive behave more
carefully, and they can act on the
information to save themselves and their
family members.
Isn’t this the most
important human right of all?
Quick
and reliable saliva and blood tests,
which give results within 20 minutes,
are available, increasing the
opportunity for confidentiality.
Governments have been slow to use the
tests.
In an important breakthrough,
three small countries in Africa —
Botswana, Malawi and especially Lesotho
— recently moved from purely voluntary
testing to what is called “opt-out”:
Testing becomes routine in certain
circumstances unless the patient opts
out by refusing to be tested.
This
seemingly small change had immediate,
dramatic results. With increased testing
has come increased awareness, less
stigma, safer sex practices and more
people on treatment.
Without question, a
reduction of the prevalence of HIV-AIDS
will follow. Yet the great and
influential international organizations
fighting AIDS have not yet, for the most
part, embraced “opt-out” as part of
their core strategies.
NUMBERS
DON’T LIE
On
this World AIDS Day, many empty words
and promises will be heard. I am
gratified that additional money will be
pledged and, as a result, more lives
saved.
But unless the current, failing
strategy is changed, we will have to
spend even more money later, to treat
AIDS victims who might never have been
infected had testing been more
widespread.
Numbers don’t lie:
Everyone agrees that the number of
people infected is still growing
sharply, and not just in Africa.
Widespread testing is not a
single-bullet solution — there is none
— but without knowing who is
HIV-positive and who is not, there is no
chance we can win this war.
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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