*EPF413 07/13/00
Text: Ambassador Lewis' Keynote Address to AIDS Conference
(Emphasizes cooperation in dealing with AIDS challenge) (3190)

U.S. Ambassador to South Africa Delano E. Lewis said that AIDS cannot be dealt with only as a health issue as "it touches all of our lives," in his keynote address at the XIII International AIDS Conference in Durban, South Africa. Lewis' address on July 13, entitled "HIV and the Family," highlighted the importance of frankness and multifaceted, multinational cooperation in dealing with the challenge of HIV/AIDS.

Lewis detailed current U.S. initiatives, focusing primarily on efforts made by the U.S. Centers for Disease Control and Prevention (CDC), the United States Agency for International Development, and the Leadership and Investment in Fighting the Epidemic -- or LIFE Initiative. The LIFE Initiative will be a vehicle for greatly increased U.S. government funding and assistance to help combat AIDS.

The ambassador was quick to note, however, that U.S. involvement was only one part of a larger, international effort that is necessary to deal effectively with the disease that has claimed the lives of almost 13 million adults and three-and-a-half million children since the beginning of the epidemic. Lewis also told of new family structures created by AIDS: grandparents caring for grandchildren whose parents had died of AIDS, and children leading households alone or dropping out of school to care for sick parents.

As the primary actors in both development and the fight against AIDS, "the family and the community are the principal safety nets for children, and they are the future of the family unit. Whether donors, governments or NGOs intervene or not, families and communities must deal with the devastating impact of HIV/AIDS each and every day, often with great difficulty, and often with little outside support," Lewis said.

Lewis said political leaders, at every level of society, must understand the type of collaborative, broad-based response needed to combat and prevent HIV/AIDS.

Following is the text of the address:

(begin text)

Families and Communities
XIII International AIDS Conference, Durban, South Africa
Keynote Address - "HIV and the Family"
July 13, 2000
By Ambassador Delano E. Lewis
U.S. Ambassador to the Republic of South Africa

Good afternoon ladies and gentlemen. It is indeed a pleasure to be here today. I thank you for your warm welcome and for inviting me to share my thoughts about HIV/AIDS and the profound effect it has on the families here and around the world.

It is always a special pleasure for me to visit Durban and to be reminded of the extraordinary beauty of this very special corner of South Africa. I have had the opportunity to visit this city on numerous occasions and have always been tremendously impressed by the rich tradition and the will of the people here and throughout South Africa to actively participate in making positive change.

As President Clinton's personal representative in South Africa, I would like to comment briefly on the importance we in the U.S. place on the issue of HIV/AIDS as a fundamental development issue. But first I would like to salute you, our frontline soldiers in the battle against AIDS. As care-givers, community mobilizers, policy makers, fund raisers, advocates, researchers and people living with HIV/AIDS, you have devoted your lives to working to respond to the HIV/AIDS pandemic. You have developed creative ways to sound the alarm to the global community and to support people infected and affected by this dreadful disease. I applaud you for your efforts and pledge our ongoing commitment as partners in this fight.

As I stated to President Mbeki when I arrived here, I am new to South Africa but not new to the continent of Africa, or to the critical issues of development. As the U.S. Peace Corps' Associate Director in Nigeria and Country Director in Uganda in the late 1960s, I first came to know Africa during a time when much of the continent was trying to cope with the enormous challenges of national independence.

Although optimism abounded then, the years have proven difficult, and the struggles of the decades that followed are still far from over. Today, in South Africa, the spirit of the miraculous political transformation of the post-apartheid era abounds. Yet so much remains to be done in the social and economic transformation, with the AIDS epidemic in South Africa and around the world. AIDS threatens both the growth of individuals and the prosperity of nations. While many issues confront South Africa today, I have placed providing support for addressing the HIV/AIDS epidemic here as a top priority during
my tenure as Ambassador.

The U.S. government has committed significant resources globally and locally to combating this pandemic. For more than a decade, the U.S. government - primarily through the United States Agency for International Development and Centers for Disease Control - has provided staff, technical assistance and funding - more than $1 billion - to counter the spread of HIV/AIDS in the developing world. This investment in HIV prevention and in support for people with AIDS is critically important and has put the U.S. Government at the forefront of the global response to the epidemic.

But it has not been sufficient to meet the task, and I want to assure all of you that my government will do still more in the future. This commitment will continue through the new Leadership and Investment in Fighting the Epidemic - or 'LIFE' - initiative, which will increase U.S. government funding considerably in the coming years to assist in combating this disease.

We are committed to ending this pandemic, because AIDS represents an enormous threat to our world, one that demands an effective and coordinated response from all sectors of all societies. It cannot be seen or dealt with only as a "health issue," and indeed it touches all of our lives and increasingly casts a shadow over the world's future. As Vice President Al Gore stated as head of the U.S. delegation at the opening of the United Nation's Security Council in January this year:

"We must discuss AIDS not in whispers, in private meetings, in tones of secrecy and shame, but right here in one of the great forums of the world, loudly and boldly, with a sense of urgency and concern and compassion. Until we end the stigma, we will never end the disease."

The theme for this conference is "Breaking the Silence," and our focus today is on family and community. What symbolizes family more vividly than the bond between mother and child, the circle of protection and nurturing that has defined families since the beginning of time? So it is shocking to learn that, in this province - KwaZulu Natal - it is estimated that 33% of pregnant women attending public antenatal clinics are HIV positive. Thirty-three percent - one-third of all pregnant women. And it is likely to get worse before it gets better.

Let us think about the implications of this staggering statistic for children, for women, for families. How many of these infections could have been prevented? How many of these babies and their mothers will be HIV positive and not treated because of a lack of resources? What about the fathers? How many of these parents will not live to see their children grow and develop? Who will care for the orphans? How will the communities where these women live react when they find out their secret?

I have asked myself these questions as I have traveled throughout South Africa. And I have seen new family structures emerge that were once unfamiliar: a grandmother raising her grandchildren after burying her own children; children looking after each other in child-headed households; children dropping out of school to care for their dying parents. Unfortunately, these images are now becoming more and more familiar in a world living with AIDS.

While I am not an HIV/AIDS expert, I understand that in the development context the frontline response is always the family and the community. So it is with AIDS. The family and the community are the principal safety-nets for children, and they are the future of the family unit. Whether donors, governments or NGOs intervene or not, families and communities must deal with the devastating impact of HIV/AIDS each and every day, often with great difficulty, and often with little outside support. Consequently, while interventions by governments, international organizations, NGOs, religious bodies and others, can lend support and can have significant impact - it is the family and the community in the end that provide the basis for prevention and care.

Yet, the impact of HIV/AIDS is too large for the family to deal with alone. Indeed, this epidemic is too large and too devastating for any one government, donor or multilateral institution to address alone. To make a real and lasting difference, an effective response must mobilize and coordinate the commitment and resources of all of these sectors, and channel them to the family and community level.

If we are to give families and communities the support they need, our response must be intensified and accelerated. Almost 13-million adults and more than three-and-a-half million children have died of AIDS worldwide since the beginning of the epidemic. In Africa, AIDS is now the leading cause of death. And as goes Africa, so will India, South East Asia and the Newly Independent States of the former Soviet Union. This is not a "regional" issue or a problem with geographic limits. People in Asia, Africa, Latin America and Europe must deal with AIDS, and so must we in America. In this coming decade, more than 44 million children around the world will become orphans, losing one parent or both parents to AIDS.

AIDS is already reversing hard-won gains in infant and child mortality, particularly in Africa where infection levels are the highest, access to health care is the scarcest and economic safety nets are the most frayed. Further, adult life expectancy is dropping in many countries in sub-Saharan Africa to levels that we haven't seen since the 1960s. By 2010, the U.S. Census Bureau predicts that a child born in South Africa will only live to be 35. This is a staggering decline from the current life expectancy of 51 years. And while we have seen many diseases in our lifetime, AIDS has been called the worst public health disaster since the bubonic plague.

AIDS has brought with it an unprecedented stigma that has made it far more difficult to respond to effectively. HIV/AIDS is difficult to even talk about in many places, and people living with AIDS are all too often blamed, shamed and discriminated against. This harsh reality has persuaded many HIV-positive individuals and their families to keep a low profile or to deny their status. Even in communities that have been severely affected by AIDS for years, people are frequently unwilling to talk openly - neighbor to neighbor, family member to family member - about AIDS.

Remaining silent is often an understandable course. Not far from this conference center, in December, 1998, Gugu Dlamini, a volunteer for an AIDS organization in South Africa, announced at a rally that she was HIV-positive. She hoped to dispel some of the prejudice against people living with the virus. Eleven days later, Gugu was beaten to death by her neighbors, in her community. Her brave voice helped many to begin to understand the enormous cost of silence and stigma. Overcoming this stigma - and the virtual "epidemic of fear and denial" that accompanies this disease - is an essential pre-requisite to taking action and saving lives.

This won't be easy. For although the scale of the HIV/AIDS epidemic is now immense, the final impacts are difficult to observe and document, because they occur slowly, one person at a time, one family at a time, often taking years to reveal themselves.

But there is hope. In some countries the tide against AIDS has started to turn. In Uganda, for example, the rate of new infections is declining as the result of families and communities openly confronting the issue and mobilizing to prevent new infections. In Senegal, a full-blown epidemic has been avoided and new infections averted due to concerted early action to educate their people.

We look to countries such as Uganda, Thailand and Senegal, where they have learned that the crucial factor in preventing and stopping the impact of this disease, is the open, unwavering political commitment by governments, at every level, to confront the epidemic forthrightly. They have learned to shatter the silence and the stigma associated with AIDS. In Uganda, when President Museveni took office in 1986, he recognized the serious nature of the epidemic and mounted a vigorous campaign that encouraged frank, public debate and discussion of the issue. Aware of the potential for catastrophic losses in their country, Thai officials attacked the epidemic at an early stage and targeted their young population with open and honest prevention campaigns. Similarly in Senegal. This West African country has worked hard, openly and successfully to prevent HIV from spreading. However, the continuing reluctance of many national leaders, worldwide, to speak out and break the silence about this pandemic continues to contribute to the devastating impact of HIV/AIDS on the family, community and the nation. Leadership and commitment at every level of society is needed to deal with this issue, to encourage people to speak openly about the disease and to ultimately turn the tide against it.

Thankfully, we see other political leaders worldwide commit to a more vocal role in speaking out about HIV/AIDS. In 1999, African Heads of State pledged themselves to action through the new International Partnership against AIDS in Africa. And here in South Africa, President Thabo Mbeki stated as he launched the South African Partnership Against AIDS in October 1998:

"For too long we have closed our eyes as a nation, hoping the truth was not real. For many years, we have allowed the human immunodeficiency virus to spread...at times we did not know we were burying people who had died from AIDS. At other times we knew, but we chose to remain silent. Now we face the danger that half of our youth will not reach adulthood. Their education will be wasted. The economy will shrink. There will be a large number of sick people whom the health system will not be able to maintain. Our dreams as people will be shattered."

However, the political commitment that must drive the effort to destigmatize and address this disease is still not sufficient or visible enough. After years of denial and avoidance on the part of political leaders, it is now imperative to build widespread recognition of the impact of HIV on all of us. At this juncture, awareness alone is not enough. Awareness must be linked with major efforts to change the behaviors, which transmit the disease, and to create a broadly shared sense of responsibility to support and protect those affected by it. Leaders must convey a clear vision of a fully mobilized society - a vision backed by a practical reality-based strategy developed to prevent new infections to care for those who are sick and to support the children left behind.

We must further develop and scale up our interventions, and learn from successes in neighboring countries. Certainly, we must be aware that the nature and intensity of problems that families face vary from continent to continent, country to country, community to community, and family to family. Any strategy that is developed to benefit families and communities must be based on a full and realistic understanding of their particular situation. The fundamental challenge for all of us is to develop interventions that make a real difference to families affected by HIV/AIDS over the long haul of the epidemic. While broad-based public awareness and prevention campaigns are important measures, we must work at local levels to help communities and families find the best way to respond to the epidemic which has hit them, in ways which are consistent with their culture.

No single intervention and no single individual will make a substantial impact on the full range of problems that HIV/AIDS is causing for families and communities worldwide. Political leaders, at every level of society, must understand the type of collaborative, broad-based, response needed to combat and prevent HIV/AIDS. The effects of HIV/AIDS are pervasive, and the impact of this epidemic can no longer be considered solely a health issue. Countries around the world are recognizing that HIV/AIDS is best understood as a multi-faceted issue - a social and economic issue - because the epidemic poses a significant and complex threat to the health and to the wealth of society as a whole. The epidemic will have an enormous impact on national productivity; earnings, labor and educational benefits will be lost; resources for investment will be diverted to health care. HIV/AIDS poses a severe threat to the economic future of countries. As the economist Jeffrey Sachs at Harvard University said, "A frontal attack on AIDS in Africa may now be the single most important strategy for economic development."

Many here in this room have experiences of what works. We must all learn your lessons and benefit from your experiences - positive and negative. And we must act on them now, from national-level commitments and campaigns, to community-based efforts to support communities and families. The cost of inaction is devastating and growing fast. If we act, we can bring hope to millions of people who have none. If we act, we can build futures for our children.

Our commitment in South Africa is to its government, to its civil society, and to its people; and we will do all that we can to support efforts at all levels. Indeed, I'm pleased to announce that the U.S. government - through the United States Agency for International Development -- will sign a grant agreement tomorrow with former President Nelson Mandela to work with his Children's Fund, in an effort to focus greater attention and support on community- and family-based efforts at the local level.

Opportunities for assisting the families and communities to confront HIV/AIDS are there, but it is a difficult task. However, future generations will not look kindly on us if we do not seize the day, today, and act to the best of our abilities to address this scourge. We can all stay silent, passive, seeking excuses, avoiding the truth, until those with AIDS everywhere cry out in the words of Dr. Martin Luther King, Jr. "In the end we died not at the hands of our enemies but in the silence of our friends." Break that silence. Thank you.

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(Distributed by the Office of International Information Programs, U.S. Department of State. Web site: http://usinfo.state.gov)

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