Interview with Dr. Chidi Achebe
Adeze Ojukwu
Wednesday, April 28, 2004
Dr. Chidi Achebe is a United States-based physician. His commitment to issues about Africa is quite remarkable. The focus of an earlier discussion with Dr Achebe was a robust review of contributions of the African Americans to the US. Just last week, Dr Achebe, who has just been appointed as the medical director of Whittier Street Health Center, Boston, granted another interview to ADEZE OJUKWU, currently in the US, on the imperatives to curb the Human Immune Deficiency Syndrome/Acquired Immune Deficiency Syndrome (HIV/AIDS), which is decimating a lot of African countries and communities. The profound expertise and eloquence he displayed in the two interviews bear credence to Achebe’s commitment to public service.
Dr. Achebe was educated at Bard College where he obtained a Bachelors degree in Natural Sciences, History, and Philosophy. He also holds two Ivy League medical degrees -- a Masters in Public Health (MPH) from the Harvard School of Public Health and an MD degree from Dartmouth Medical School. He completed postgraduate studies in both Internal Medicine and Pediatrics at the Texas Medical Center in Houston, TX. Dr Achebe is the son of world-acclaimed novelist, Prof Chinua Achebe.
Whittier Street Health Center Boston, which he now superintends, is a large Community Health Center with a solid reputation for its committed Medical staff and the provision of quality health care to the residents Of Boston. It has a staff of over 110 full time employees, and an Operating budget of about $10 million. About 50,000 patient visits are Recorded annually.
The Boston Medical Establishment is considered America's most elite And prestigious medical community. Boston is home to 3 of America's Leading Medical Institutions - Harvard University Medical School, Boston University Medical School and Tufts university Medical School, as well as numerous world-class institutions, hospitals and medical centers. It is also a city steeped in historical and civil rights milestones. The First Black Nurse Mary Eliza Mahoney, graduated here in the mid 19th century (1879, as well as several others in a myriad of medical endeavors.
It was quite intellectually stimulating to speak with Dr Achebe on his latest treatise on HIV/AIDS entitled ‘AIDS: A DISEASE OF MASS DESTRUCTION,’ where he stressed the need for government and all stakeholders to intensify efforts in fighting the disease because ‘it is an assault to our shared humanity.’
He began his treatise with an allusion to George Bernard Shaw’s The Devil’s Disciple. “The worst sin towards our fellow creatures is not to hate them, but to be indifferent to them; that is the essence of inhumanity.” Throwing more light on the spread of the disease in Africa Dr Achebe, elaborates his views with well-researched references.
Here are excerpts:
Q: Please give an overview of the AIDS pandemic as a health issue.
‘It is now impossible to view the AIDS pandemic solely from the vantage point of its health ramifications. Like a tornado wreaking havoc to everything in its path, AIDS has also torn the social, economic and political fabric of several societies to shreds.’
‘In January, 2000, while speaking at the UN Security Council session, James Wolfensohn, President of the World Bank, stated: “Many of us used to think of AIDS as a health issue. We were wrong…nothing we have seen is a greater challenge to the peace and stability of African societies (and much of the world) than the epidemic of AIDS...we face a major development crisis, and more than that, a security crisis.”
Four years and more than eight million deaths later, an equally passionate and resolute Kofi Annan, the UN Secretary General, said in reference to AIDS-“A real weapon of mass destruction”. He bemoaned the world’s relative inaction to combat this pandemic as “callousness that one would not have expected in the 21st century”…for which history would judge us all “harshly, very harshly”.
‘It might appear that Annan and Wolfensohn were echoing an ancient declaration of Bantu philosophers: “Umuntu ngumuntu ngabantu - a human is a human because of other humans.” This proclamation “represents an African communal aspiration which teaches us that our humanity is contingent on the humanity of our fellows…and that no person or group can be human alone. We rise above the animal together or not at all’, in the words of Prof Chinua Achebe.
Our collective record on AIDS, clearly suggests that we have not yet tamed this ‘animal’, and should compel us to hire many more ‘animal trainers’ to rescue the world’s most vulnerable groups from the clutches of this infectious holocaust.
The Modern Day Plague: Facts and Figures
“When was such a disaster ever seen? Even heard? Houses were emptied, cities abandoned, country sides untilled, fields heaped with corpses, and a vast dreadful silence settled over all the world”. The Italian writer Francesco Petrarch wrote these immortal words in the 14th century about the Black Death or Bubonic Plague, an epidemic that eventually wiped out one fourth of Europe’s population. He could very well have been writing about the modern day plague AIDS, a pandemic that has already claimed 21 million lives around the world and promises to decimate scores of millions more. Today, there are over 42 million people worldwide infected with HIV, the virus that causes AIDS (Acquired Immune Deficiency Syndrome). Three quarters of that number or 31.5 million people live on the African continent. Last year, there were 5 million new cases of HIV infection across the globe. Of the 3.1 million people that died of this scourge in the past 12 months, 2 million were African. In several Southern African countries such as Botswana, Lesotho, Swaziland, South Africa and Zimbabwe, up to a third of the population bears the burden of HIV infection. What this means is that in the absence of safer sexual interventions, a sexually active young adult growing up in this part of the world where the life expectancy is now only about 44 years, has close to 80 percent chance of dying from this dreaded disease. A recent UN policy document provides this spine chilling snap shot of the magnitude of the devastation: “22,000 people in the mainland SADC (Southern African Development Community) region are dying every week from AIDS.”
Q: What is the situation in other regions?
The tentacles of this deadly disease extend beyond the African continent. Peter Piot, Director of UNAIDS (The joint UN program on HIV/AIDS) informs us that “AIDS is traveling along social fault lines and exploiting weakness, hurting both lives and economies” all over the world. The countries of Central Europe and the former “Communist block” such as Romania stand at the precipice of a looming AIDS catastrophe. In this region, the number of HIV infections has increased by nearly 25 percent over the past 12 months! Some of the most severely affected countries include the Baltic States of Estonia, Latvia and Lithuania as well as the Ukraine. In the Russian Federation, estimates currently place between 600,000 to 1.5 million people infected by this virulent pathogen. More recent epidemics have been reported in Kyrgyzstan and Uzbekistan, while the dissemination of HIV continues unabated in Moldova and Kazakhstan, according to UNAIDS findings.
Asia has also recorded HIV cases leap by 10 percent. The implications are huge considering that, the two most populous countries China and India, now account for nearly 5 million of the world total. Unfortunately, several experts believe that the statistics out of ‘closed societies’ such as North Korea are a gross underestimation of the true picture of HIV prevalence in this region. In Latin America and the Caribbean, there are now over 2 million people whose lives have been forever altered by HIV. The developed world has about 1.6 million HIV cases. In the wealthiest of nations, the USA, 1 in 250 people (or just about 1 million individuals) bear this yoke, although only half of this number is aware of their condition!
Q: In your views which group is most affected?
The face of AIDS/HIV belongs to our youth, women and girls – three groups that bear the burden of the pandemic. Adolescents and young adults 15-24 in age account for half of the 5 million new cases of HIV infection worldwide, as well as a third of the world’s total population of HIV positive individuals - 11.8 million people. To place this in frightening, vivid context: 7000 youth a day or one every 14 seconds become infected with HIV around the world! Contributing to this almost cataclysmic picture is the exploding population of orphans left behind as casualties of AIDS deadly toll. Clearly, orphans represent another cruel legacy of the pandemic.’
When Charles Dickens crafted his perennial classic Oliver Twist, a harrowing social commentary about an English orphan in 19th century England, he could not have possibly imagined that a disease called AIDS would emerge, and make the difficulties depicted in his astounding novel seem like “a walk in the park”. Going by UNAIDS figures, today, there are about 13.4 million children worldwide who have lost one or both parents to the AIDS pandemic. This number is expected to nearly double to 25 million by 2010.
Sadly, Asia with 65 million orphans, 2 million from AIDS, has the greatest number of orphans. Latin America and the Caribbean are home to about half a million AIDS orphans. Two countries alone in this region - Haiti and Brazil – possess more than 60 percent of this total. Proportionately, however, Africa faces the brunt of this crisis. The continent has 34 million orphans - a number that is expected to increase to 42 million by 2010. AIDS orphans account for a third of this total or 11 million children. Over the next 7 years, in the absence of much needed assistance, we may watch helplessly as 12 percent of all the children in the continent – 20 million – join this statistic. Three of Sub Saharan Africa’s most populous nations - Nigeria, Ethiopia and the Democratic Republic of Congo - will supply the greatest number of children to this pool. However, Zimbabwe, Lesotho, Swaziland and Botswana, are on a trajectory to witness an almost insurmountable exponential increase in the population of AIDS orphans over the next decade, as the third of their populations already infected with HIV, make the transition to AIDS, and sadly, death.
Q: What are the immediate implications of this trend?
Orphans are often cared for by extended family members such as grandparents ill prepared physically, financially and socially for this new challenge. As a consequence, these children face grim prospects. They are often stigmatized by society, live in poverty, are more likely to be malnourished, attend school less frequently than their peers, and have a greater incidence of psychological illnesses such as Post traumatic Stress Disorder, Major Depression, Anxiety and Behavioral problems. All this portends a bleak future for these ‘parents and leaders of tomorrow’. The Executive Director of UNICEF, Carol Bellamy believes that “we must respond to the devastating statistics by addressing the needs and rights of both orphans and vulnerable children whose parents are still living”. One novel strategy would be to shore up the treasuries of several of the more than 75 programs, NGOs and organizations in 22 countries such as Save the Children that work with children affected by AIDS.
Q: Can you comment on the recent UN reports indicating higher rates in conflict areas and high-traffic zones?
The conflicts in Sierra Leone and Liberia may very well be ‘life imitating art’. The international human rights groups detailed atrocities such as rape, body mutilation, and torture. New reports now indicate that child soldiers committed a number of the most violent crimes. These children, victims themselves of broken down societies, are now at the center of an upsurge of HIV cases being reported in war-ravaged countries as diverse as Angola, Sierra Leone and Cote D’Ivoire. More so, in recent years, insidious, criminal and potentially implosive practices such as Child trafficking and prostitution have gradually been mixed into this already murky, grim, pediatric milieu. Over a million children, many of them AIDS orphans, are trafficked each year and exploited as slave laborers, sex slaves and soldiers across the planet. The UN estimates this racket generates $7-10 billion annually for the traffickers. ‘This practice is endemic in certain parts of Southeast Asia such as Cambodia, Burma, Vietnam and Thailand where young women and girls are trafficked for the sex industry’. The countries of the former ‘Iron curtain’ such as Romania are particularly vulnerable. After a quarter century under the despot Ceausescu, its population of Pediatric AIDS patients and orphans has overwhelmed this impoverished nation. Some estimates place the number of orphans and street children as high as 200,000. These children have progressively become prey to an international roaster of pedophiles and pimps. Child Rights Advocates warn that child sex peddling and trafficking will destroy the social and political framework of several societies and fuel the HIV pandemic with catastrophic results!
Q: What are the gender dimensions of the pandemic?
Women now comprise 50 percent of those infected with HIV across the globe. It is even higher in Africa with a figure of 58 percent. Women and girls under the age of 24 now make up nearly two thirds of those living with AIDS worldwide. In the United States, women of color account for the majority of new AIDS cases. African American women and Latinos comprise 31percent of US female population, yet they represent 77 percent of AIDS cases in women. As of December 2000, AIDS according the Center for Disease Control (CDC), had become the leading cause of death for African American women in the 25-44 year bracket! Most of these infections occur during unprotected heterosexual intercourse; a practice that bears the risk of sexually transmitted Infections (STIs) such as Gonorrhea, Chlamydia, Herpes, Syphilis as well as Hepatitis B and C. These infections in turn, can dramatically augment the probability of HIV transmission. Medically, the risk of HIV infection during unprotected sex is 2-4 times higher for women than men. Young women and girls are even more vulnerable because their reproductive tracts are still developing. I wish to emphasize this point. Sustaining tears in the tissue allow easy access to infection. Increased exposure to HIV amongst women and girls could also mean amplified numbers of HIV positive pregnancies and an escalating risk of pediatric AIDS cases through vertical transmission (mother to child) or during breast-feeding. This is already the case in many parts of Africa. Geeta Gupta, president of the International Center for Research on Women, believes that women are limited in their ability to control these infections because of their low social status in many societies and the power men yield over their sexuality. She explained: “In many countries the power imbalance in heterosexual interactions leads to a culture of silence that surrounds women’s sexuality. This restricts women’s access to information about their bodies and about sex, which in turn contributes to their inability to protect themselves against HIV infection.” It is little wonder; therefore, that marriage does not always protect women from these risks. ‘In Pune, India, a study in an STI clinic found that 25 percent of the 4000 women attending the clinic were infected with an STI and 14 percent were HIV positive and 91 percent of these women had only one partner - their husbands!’ Studies out of Kisumu, Kenya and Ndola, Zambia and released by UNICEF, indicate that ‘teenage brides 15-19 in age in these African countries are becoming infected with HIV at higher rates than sexually active unmarried girls of similar ages. The studies found that HIV rates in the husbands, who were frequently much older than their brides, were higher than in the boyfriends of sexually active teenage girls’.
Q: This is quite depressing. What is the way out of this dilemma?
Several studies in East Africa and amongst sex industry workers in Thailand have shown the precipitous drop in the rate of STIs with enhanced education of women. The race to halt the deadly march of AIDS across the globe could very well lie, in part, in addressing one of its core causes – ‘gender inequality’. Empowering our women and girls with education and the means to protect themselves from HIV – the choice of sexual abstinence, female condoms, male condoms, microbicides, routine STI check ups etc is particularly salient. Other important strategies that involve the media in this battle, as well as the funding of local women’s groups and experienced NGOs could prove not only novel but also timely. This multi-pronged effort may turn out to be a key ingredient in saving the species from this infectious nightmare.
Q: Can you shed more light on the much discussed next Wave of AIDS expected to hit Nigeria, Ethiopia, Russia, China and India.
It is alarming. We are in the midst of an anticipated decade long increasing in the number of HIV cases worldwide. Five of the world’s most populous nations - Nigeria, Ethiopia, Russia, India and China are expected to fuel this explosion. In these countries, HIV positive cases will more than double from 14-23 million combined currently, to an estimated 50-75 million by 2010. This will eclipse the 30-35 million HIV infected individuals living in Southern and Central Africa, an area considered the epicenter of the pandemic! By decade’s end, China will house between 10-15 million HIV positive individuals, Russia 5 to 8 million; Nigeria 10-15 million and Ethiopia 7-10 million people infected with the deadly virus. India will possibly be home to 20-25 million HIV positive persons by 2010, making it the highest projected increase of any country! In almost all the countries, a number of factors will fuel these projected increases. Risky sexual behavior, poor public services, complacency, misinformation and the wall of silence among the leadership surrounding AIDS, ineffectual or non-existent government policies, limited resources, and uncertain, often unstable political and social infrastructures, are among the factors that will help to drive the infection rates skyward.
Q: Can you give an over-view of the Nigerian situation.
Many believe that Nigeria is ‘a disaster waiting to happen’. With a population of about 130 million inhabitants, Nigeria is Africa's most populous country. One in seven Africans is a Nigerian as is one in ten blacks on the planet. ‘It’s total area of 923,768 sq. km, makes it is slightly larger than twice the size of California.’ Nigeria is the 9th largest oil producer in the world and the principal oil producer in sub-Saharan Africa. The Nigerian economy is heavily dependent on the oil sector, which accounts for around 80 percent of government revenues, 90-95 percent of export revenues, and over 90 percent of foreign exchange earnings. I believe that the HIV epidemic threatens the social, political and economic vitality of Africa’s second largest economy and most densely populated country. The National Intelligence Council – an agency that advices the US government and the CIA – believes that “the disease is likely to negatively impact almost all sectors of Nigeria’s economy by 2010. AIDS will take a heavy economic toll by robbing the country of many key government, professional and business elites and by discouraging foreign investment, although the oil sector is unlikely to be hurt significantly.’ Current estimates place the spread of HIV in Nigeria at the rate of one person per minute! Prevalence of HIV infection in Nigeria stands at about 5.8 percent. This moderately low statistic (as compared to other African countries), which is expected to double in less than a decade, may hide the fact that Nigeria currently has over 4 million people living with HIV!
‘Heterosexual transmission of the HIV virus is the primary mode of spread in Nigeria and infections appear to be as numerous in the rural areas as in the cities.’ Like much of the developing world, the sexually active 15-24 year demographic appears to be the most vulnerable to HIV infection, with prevalence as high as 12 percent in some States. Simmering under the radar screen and shielded by a cloak of denial, is the homosexual transmission of the virus particularly in certain metropolitan areas, same sex (male) boarding institutions, the prisons, and the military. ‘The Economic Commission for Africa (ECA) estimates that 15-20 percent of Nigerian soldiers live with HIV/AIDS’ which is 3 times the national average! Other studies indicate that ‘the HIV/AIDS epidemic in Nigeria is significantly ahead of that in India, China, and Russia – already advancing well beyond high risk groups and into the general population.’ In the next 10 years, it is predicted that Nigeria will have between 10 and 15 million individuals infected. Experts warn that if aggressive action is not taken to combat HIV, Nigeria will almost certainly take over from South Africa as the country with the most HIV cases on the African continent! What this means is that Nigeria will have more HIV cases than the combined total in Mozambique, Zimbabwe, Zambia, Botswana, Namibia, Lesotho, Swaziland, and Uganda today!
HIV prevalence differs widely from region to region and from State to State in Nigeria. The North in general, has the lowest HIV prevalence in the entire country. At 0-2.5 percent, Jigawa State has the lowest recorded HIV positive inhabitants in the nation. However, the North Central Zone in which the Federal Capital Territory of Abuja is situated has an HIV prevalence of about 7percent. Garki, a suburb of Abuja, holds the dubious distinction as the home of the nation’s highest documented municipal prevalence for HIV, estimated at or above 10percent. Benue State, where some estimates place the HIV prevalence in certain villages and towns as high as 20percent, is believed to have the highest prevalence of HIV of all the states in the country. Akwa Ibom State also has an HIV prevalence that exceeds 10percent. Equally disturbing is new data about HIV in the 6-10percent-prevalence range or higher out of Cross River, Plateau, Gombe, sections of Rivers State around Port Harcourt as well as parts of Lagos State. Lagos, the nation’s commercial capital with an abundance of Red light districts, has an HIV prevalence of 6.7percent. According to the USAID, HIV prevalence among sex workers in Lagos rose from 2percent in 1988-89 to as much as 70percent by 1995-96! Kaduna, Bauchi, Taraba, Kogi, Enugu, Ebonyi, Bayelsa, Edo, and Delta States have HIV prevalence in the 5 - 7.5percent bracket, while Imo, Abia states, the Southwest and much of the extreme north have recorded HIV prevalence of about 2.5- 5percent.
Q: Is there a correlation between International Prostitution and the augmented threat of HIV/AIDS in Nigeria?
You are aware that since 1992, Italian authorities have compiled data on the upsurge of Nigerian women and girls who have been trafficked to that country prostitution. Their documents have unraveled an elaborate scheme that has exploited these women and girls for sex, often with the blessings of their families. The scenario is captured by a Migrant Information Program Report: “Nigerian girls and women are contracted in the suburbs of cities such as Benin City, and towns and villages all over Edo, Lagos and Delta States in particular, and in the countryside throughout the South in general. Nigerian ‘business men’ in conjunction with the Italian underground controls street prostitution of Nigerian women and girls. There are 3 levels of organizations in the trafficking of Nigerian women and girls: The first centers around the ‘Mama’ living in the country of origin; the second centers around the ‘Nigerian Mama’ in Italy; and the third, the ‘messengers’, the persons (usually men) transferring the money from Italy to Nigeria. Madams act as ‘go-betweens’ for the girls and women and the traffickers. Money is sent to the madam to pay the debt to the traffickers and to the girls’ families.”
By 1996, Nigerian sex workers had become the largest group of migrant women working as street prostitutes another study posited. A confirmation of this fact was brought vividly to light in 2000, ‘when 3000 Nigerian prostitutes were reportedly threatened by Italian authorities with deportation for ‘sex crimes’, a reproach that was buttressed by the arrival of plane loads of Nigerian daughters, sisters and mothers from Italy at Nigerian airports. Despite campaigns by Nigerian authorities, international exploitation of Nigerian sex workers has spread unabated. In France and Spain in 2003, authorities in those countries smashed elaborate prostitution rings with bases in Nigerian and Morocco, which supplied a steady stream of Nigerian girls and women for prostitution throughout the European Union.’
Public health experts throughout the world have for years been concerned about the devastating social, political and health ramifications of international sex trafficking on Nigeria and its young women. A Nigerian physician based at Yale University Medical Center, vividly describes what this development portends for Nigeria: “Nigeria already has 1 million female sex workers…that is 1 for every 60 men…..Abuja alone has over 15,000…. Increased prostitution of all kinds will mean increased cases of STIs and HIV, because we are dealing with a clientele where over 60 percent refuse to have sex with condoms. Intermingled in all of this are gender inequality and exploitation issues, the breakdown of family values, and erosion of human dignity… For the HIV/AIDS projections: ‘think of it as throwing dynamite into a Bonfire’!
Q: Can you comment on some other contributing factors?
Several other factors have contributed to the rapid spread of HIV infection in Nigeria. Some of these include “high prevalence of untreated sexually transmitted infections (STIs), low condom use, poverty, illiteracy, and the dismal quality of the health system. Some others include lack of effective leadership and/or political complacency, gender inequality, stigmatization and denial of HIV risk among vulnerable groups”. In addition, it is said that only 60 percent of Nigerians have even heard of the disease. Nigeria also has one of the worst blood transfusion safety records in the world! Dr Chinua Akukwe’s expert analysis on this subject points out that “Nigeria has one of the highest unsafe blood transfusion rates in the world, at 14 percent. In some hospitals in Nigeria, 60 percent of blood transfusions may not undergo internationally acceptable screenings!”
Q: What strategies should be adopted?
Strategies to combat the epidemic in Nigeria will involve some if not all of the following: • Strong political leadership, • Effective policy and advocacy; • Improved STI intervention and treatment; • Sex worker health and education programs; • National condom program; • Empowerment of women and women’s groups; • Promoting high risk behavior change; • Improving the health care system; • Stimulating HIV/AIDS research; • Local production of Anti retroviral medication; • Increased local and international funding for AIDS prevention and treatment; as well as safer sex prevention and education programs • Effective and concerted media campaigns; • Well organized HIV surveillance and • Creation of a reliable database for HIV/AIDS programming.
Q: Apart from the current WHO-driven 3x5 initiative can you identify other viable therapies?
A lot is being done in the health community to produce and provide the vital medications for patients and the list includes the following:
Who’s 3 x 5 Initiative Of the 5-6 million individuals infected with HIV in the developing world, only 400,000 have access to antiretroviral therapy (ART). The World Health Organization and UNAIDS have launched the laudable “the 3 by 5 Initiative” that aims to place 3 million HIV patients on ARTs by 2005”
Local production and/or distribution of Anti retroviral medication is crucial in the most severely affected countries. South Africa, Botswana and Nigeria (not very successfully), have started pilot programs aimed at providing these life-sustaining medications to their HIV infected citizens.
Research and development of new HIV therapies. New classes of drugs such as Non-nucleoside reverse transcriptase inhibitors (NNRTIs), as well as a new generation of protease inhibitors have shown great promise in the treatment of HIV. The Food and Drug Administration (FDA) last year announced the accelerated approval of a new class of medications called fusion inhibitors. Fuzeon (enfuvirtide), the first of what is expected to be several other drugs in this class, is designed to be used in combination with other anti-HIV medications to treat advanced HIV-1 infection in adults and children ages 6 years and older. Improved STI intervention and treatment (see above under prevention)
Finally, the war against HIV/AIDS will require an integrated battle on all fronts - funding, leadership, prevention and treatment in order to be truly successful.
Without a concerted effort to aggressively curb this pandemic, one can expect cases of this dreaded disease to grow exponentially, leaving unimaginable death, despair and destitution in its wake. It is therefore essential that we strive to realize Dr. Peter Piot’s dream of a world where ‘the next generation, our children, are free of HIV and grow up in a world without AIDS; where those who are living with HIV receive the care and support that they are entitled to; and finally, where the stigma and discrimination against people living with HIV/AIDS is finally defeated.
Q: Funding is another contentious issue. What is your candid opinion on this?
It is clear that more money should be allocated to eradicate AIDS and its co-morbidity threats TB, Malaria. In the past 12 months, about $4.7 billion was spent on AIDS treatment and prevention in the most affected countries, which is a 50 percent increase from last year. This is still half of the projected $10 billion needed annually to fight the disease according to the World health Organization (WHO). America has led the way by spending more than $32 billion on AIDS in one form or the other – research and development of medications, direct aid to countries, NGOs, programs, agencies and prostates, since the pandemic began. The Bill and Melinda Gates Foundation with its $26 billion endowment, has compassionately allocated billions towards this fight. Under James Wolfensohn, the World Bank has more than quadrupled its AIDS funding. The aforementioned $15 billion AIDS initiative announced by the Bush Administration further highlights America’s great generosity.
Having said that, much more funding is needed. The twenty-year old goal that the UN set of asking developed countries to spend 0.7percentof GNP on foreign aid annually is reasonable. It still means that the US, with an 8 trillion dollar economy, could spend $56 billion comfortably every year for this purpose. In practical terms, it means that the US could allocate several billion dollars every single year to the fight against AIDS. The European Union and Japan, countries that benefited from the US backed largesse of the “Marshall Plan” after World War II, have, up till now, a dismal record of AIDS funding. With a combined GNP of over $11 trillion, these countries could easily afford $77 billion annually for foreign aid. A fraction of this amount will be enough to fund the much-needed war against AIDS, TB and Malaria. As the G-8 meeting approaches later this year, and with the historically generous and compassionate Dutch taking over the helm of the EU, it is hoped that AIDS, TB and Malaria funding will take center stage of the global agenda. There is no better time than under these present circumstances to cancel Africa’s foreign debt. Finally, countries most severely affected by the pandemic must raise their own funds internally to fight HIV/AIDS and increasingly harness and utilize their resources efficiently.