AIDS

Food as a Weapon

Seven million people could die in Zimbabwe this year, part of the 15 million at risk of starvation in southern Africa as a whole. The famine killing these people is not only due to drought, but to politics and corrupt government. During a recent stint in the country, I met scores of people who had food confiscated from them because they were not affiliated with the correct political party, that of President Robert Mugabe.

Mugabe's regime has severely restricted the distribution of food from the United States. The official reasons range from U.S. support for the political opposition to the dangers of genetically modified food to U.S. alliances with the white farmers that Zimbabwe is trying to get rid of by a brutal process of land redistribution. For Mugabe's regime, food is nothing more than a weapon of power.

Neighboring Malawi is faring marginally better. Three million people are at risk of starvation, but the country has a more stable government structure that can work with the United Nations and other organizations to bring in food. In Malawi, the problem is economics. The majority of the population consists of subsistence farmers without enough food to carry them through the dry season. Food shortages are so common that the months of January and February are called the "hungry months."

Along with rampant hunger and malnutrition, the other scourge ravaging modern Africa, of course, is AIDS. Unless the world devotes serious resources to prevention programs, by 2010 there will be nearly 6.5 million African AIDS orphans under 15, and as many as 20 million African children under 15 will have lost at least one parent to AIDS. Imagine if those numbers were in America; it's as many as if the entire state of Texas—every single city and town—were filled with AIDS orphans. What would the church in America do then?

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Sojourners Magazine March-April 2003
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A Jihad on AIDS

In June, the African Religious Leaders Assembly on Children and HIV/AIDS met in Nairobi at the request of the Hope for African Children Initiative and the World Conference of Religions and Peace. The multifaith gathering, with more than 120 representatives from 30 countries, convened to look at the role of religious leaders in fighting AIDS.

"Through our silence and denial, we have contributed to increased stigma and exclusion of people living with HIV/ AIDS," said Twaib Mukuye, deputy mufti of the Uganda Muslim Supreme Council, "but as spiritual leaders we are here to publicly launch a continent-wide jihad on AIDS."

Hajia Katoumi Mahama, of Ghana's Women Muslim Association, pushed the issue farther. "We call on our governments to abolish school fees and immediately withhold debt servicing payments to the World Bank, IMF, and wealthy G-8 governments," she challenged, "and to commit these resources to eradicate poverty and implement HIV/AIDS interventions. We call on the G-8 to donate $7-to-10 billion this year to stop AIDS." There are 28.1 million people living with AIDS in sub-Saharan Africa.

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Sojourners Magazine September-October 2002
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Good Drug Smugglers?

The French agency Doctors Without Borders and the South African AIDS activist group Treatment Action Campaign are smuggling cheaper generic versions of three anti-retroviral AIDS drugs from Brazil into South Africa, flouting local patent protection laws. "We have seen firsthand that these drugs can be used safely and effectively here in South Africa," said Eric Goemaere of Doctors Without Borders. "It is our duty to offer these benefits to as many patients as possible."

Importing the generic medications lowers the daily cost per patient from $3.20 to $1.55. Only the more expensive patented drugs are legally available in South Africa, the country with the world's largest population of people living with HIV/AIDS. Patent-holder GlaxoSmithKline said it would deal with patent infringements case by case. The death toll from AIDS will soon overtake the plague as history's most deadly pandemic.

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Sojourners Magazine May-June 2002
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Making a Home at Joseph's House

Tucked back in the quiet streets of Adams Morgan in Washington, D.C., Joseph's House looks much like every other house on its block. Its nondescript face belies the extraordinary mission of Joseph's House: to provide a home for homeless men with third- or end-stage AIDS.

Eight years ago the community of Joseph's House shifted constantly. Each man who entered the house died within a year, either from a sudden attack of infection or from the slow, predictable process of AIDS itself. "All we could hope to do was stay around and treat the complications of the disease," explains Dr. David Hilfiker, who started Joseph's House in 1990.

Advances in antiretroviral drug therapies now make it possible to treat the disease. These improvements in HIV/AIDS medication complicate Joseph's House mission. "Now we have some people who come in and get better and we have some who come in and get somewhat better, so that they become sort of chronically ill," explains Hilfiker. "They aren't well enough to live independently, but they aren't going to die any time soon."

With up to five of the 11 men at Joseph's House seriously ill at one time, the personal care staff has doubled over the last eight years to 12 full-time employees and four full-time volunteers. Along with private donations, Joseph's House obtains funding primarily through a local D.C. government office, the Agency for HIV/AIDS. "The hardest question for us right now," Hilfiker says, "is what to do when people do get better. Services aren't magically available for them that weren't there a year ago."

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Sojourners Magazine May-June 2001
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Our Strategic Interest in Africa

Earlier this year presidential candidate George W. Bush told Sam Donaldson on ABC's This Week Sunday morning show that Africa is not in the strategic interest of the United States. Europe is, so is Asia, as are our neighbors Canada and Mexico. But Africa isn't. When pressed what he, as president, would do in the face of

another genocidal massacre such as happened in Rwanda, Bush said he would let people in the region handle it. That's what happened last time.

Now we see Bill Clinton being reticent for the United States to become very involved in resolving the current bloodbath in Sierra Leone, despite having once apologized for allowing genocide in Rwanda. Apparently, Africa is still not in our strategic interest.

In what Eugene and Jackie Rivers call a "sexual holocaust" in this issue's cover story, an unprecedented epidemic of AIDS now threatens life as we know it in sub-Saharan Africa. Eugene has done much to alert the U.S. public to this crisis in the last several months, and our country is finally starting to pay attention.

The Clinton administration recently designated AIDS as a threat to U.S. national security, pledging new initiatives in funding and education to combat the disease. White House officials said that the AIDS epidemic has become such a global catastrophe that it threatens to destabilize foreign governments, exacerbate ethnic and political rivalries, and upset developing economies.

An interagency working group has been established in the White House to develop a package of new Africa-related programs to be submitted to the president. Senate Majority Leader Trent Lott recently commented on a television news show, "I guess this is just the president trying to make an appeal to, you know, certain groups. I don't view that as a national security threat, not to our national security interests."

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Sojourners Magazine July-August 2000
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The Fight for the Living

Throughout human history, tragedies have served as opportunities for the church to be a source of hope, conscience, and witness. In the crucible of unbelievable human suffering, God offers various generations the privilege to be a light during seasons of great moral tragedy.

Fortunately, such occasions of world historical significance are rare. On such occasions, the church has too frequently failed to obey God's call to be a witness against despair and death, and then stands naked before God and the world with the blood of the innocent on its hands. The church's inadequate response to the destruction of European Jewry during World War II and the genocide in Rwanda are clear and unfortunate examples of such missed opportunities.

Admittedly, such crises are complex and do not yield to simplistic rhetoric or solutions. And on more than a few questions, well-intentioned solutions are worse than the "disease" they are intended to cure. However, even with the complexities and tragedy noted, the church is obligated to stand on the side of the poor and neglected.

At the beginning of a new century, the church in the United States has a unique challenge and opportunity to be a powerful voice of conscience and practical reason in the face of the greatest humanitarian crisis of our times: The AIDS holocaust in sub-Saharan Africa.

AIDS is the leading cause of death in sub-Saharan Africa. Consider the facts:

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Sojourners Magazine July-August 2000
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Confronting AIDS in Uganda

When I sat down to talk with Joel Arimadri Tivua in the 6-by-10 foot office he shares with two others coordinating the AIDS program at Uganda's Kuluva Hospital, I didn't expect to hear good news. One of the main reasons that AIDS has so devastated Africa is that there has been little awareness or understanding of the virus or its causes - especially in rural areas such as this, in the rolling tobacco fields of northwest Uganda.

"In African culture, it is a taboo to talk about sex," Tivua explains. "As a result, children are not exposed to their sexual rights."

In Uganda, this lack of education about the possible consequences of sexual activity has resulted in the highest number of reported AIDS cases in Africa - nearly two million in the late 1990s, according to U.N. figures. However, Uganda's government was also the first to respond to the epidemic by engaging religious and traditional leaders and other members of civil society in an effort to confront the crisis at its behavioral roots.

The core of Kuluva's program is the Philly Lutaya Initiative, named after the first Ugandan to openly reveal - in hopes of saving others - that he was HIV-positive. Through this program, people living with HIV/AIDS receive regular check-ups and meet together weekly for support and discussion. They also do outreach at schools, marketplaces, and churches, and even have a weekly broadcast on the local Christian radio station, giving testimonies about how they acquired the virus, how they are living with it, and how to prevent it.

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Sojourners Magazine July-August 2000
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Protecting Profits

Since the start of the epidemic, an estimated 34 million Africans have been infected with HIV/AIDS - a number nearly equivalent to the size of our own country's African-American population. Some 11.5 million of these people have died, a quarter of them children.

There are medicines that could prolong the lives of Africans, but they are available only to a small minority - these pharmaceuticals are reserved for the rich and the developed world. "Triple therapy," the combination of antiretroviral drugs that has cut AIDS mortality by 60 percent in the West, is virtually unaffordable in Africa.

Bernard Lemoine, director-general of France's pharmaceutical industry association, is not particularly sympathetic to the voices calling on his industry to aid the pandemic's victims. "I don't see why special effort should be demanded from the pharmaceutical industry. Nobody asks Renault to give cars to people who haven't got one," said Lemoine.

Five pharmaceutical companies announced in May that they will drastically reduce the price they charge for AIDS drugs used in developing countries. It's a positive step, if they follow through, but the industry has much to make up for. In 1998, more than 40 pharmaceutical companies operating in South Africa and the country's pharmaceutical manufacturers association filed a legal challenge to block the manufacture of cheaper generic drugs. According to James Love, director of the Consumer Project on Technology, "For decades, the U.S. government has advanced the interests of large pharmaceutical companies in its trade policy...[and] the commercial interests of companies like Merck, Bristol-Myers Squibb, [and] Pfizer."

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Sojourners Magazine July-August 2000
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Aiding and Abetting an Epidemic

Sub-Saharan African countries owe the IMF, World Bank, and rich countries more than $220 billion dollars. Such debt diverts funds from domestic needs. The disastrous impact can be seen in the lack of resources available to address the AIDS epidemic that is ravaging many of these countries. Perhaps nothing better illustrates why advocates for debt cancellation see the Jubilee 2000 movement as a vital opportunity to bring a glimmer of hope to places where it is desperately needed. Recent moves by the World Bank, IMF, and industrialized countries to improve debt relief are a start—but more is needed.

Debt: An Obstacle to Change

Ironically enough, the poverty of many people in sub-Saharan Africa has been made worse by previous efforts at debt relief. The World Bank and International Monetary Fund have linked any debt cancellation with sweeping, externally imposed economic reforms. The "HIPC Initiative" (for "heavily indebted poor countries"), drafted by the World Bank and the IMF in 1996, forces indebted nations to enact draconian economic measures in order to receive even limited debt relief.

International financial institutions insist these reforms are necessary to create economies that work. Plainly put, the managers of the global economy insist that such measures are "pain for gain." But many feel that the suffering caused in the reform process is damaging the affected societies beyond repair. Governments try to implement the reform guidelines despite harm to their citizens, in a desperate attempt to qualify for international relief.

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Sojourners Magazine November-December 1999
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A Breakthrough Provides Hope

Despite the pall that HIV-AIDS casts across Africa, a few bright spots offer some relief. One of the most promising is a new way to reduce mother-to-child transmission rates using the long-acting antiviral drug nevirapine.

While not quite as effective as the method used in Western countries, nevirapine costs just $3 per course of treatment. Unlike its far more expensive counterparts, a single dose of nevirapine is administered during labor and another during the infant’s first week after birth. AZT, the drug of choice in the West, must begin to be administered in the last two months of a woman’s pregnancy to be most effective, and the infant must continue to receive the drug for the first six weeks of life. The AZT treatment costs about $800 per mother and child, an amount beyond the means of most people in developing countries.

In a study in Uganda released this summer, babies whose infected mothers received experimental short-term courses of AZT—still a far more involved process than the nevirapine treatment—had a 25 percent HIV infection rate. Babies whose mothers were given the nevirapine regime had only a 13 percent HIV infection rate.

With counseling and HIV testing—a necessary part of any prevention program—the cost of nevirapine will be higher than just the cost of the drug. But with a discount that the manufacturer of the drug is expected to offer, nevirapine looks like a positive breakthrough for even the poorest countries, provided they use the opportunity to address their AIDS crisis. Douglas Wilson, an executive of the German company that makes nevirapine, Boehringer Ingelheim, told The Washington Post when the Ugandan study was released that the company "is committed in principle to making the drug as widely available as possible."

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Sojourners Magazine November-December 1999
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