by Dana Steinberg

On September 20, 2000, the Wilson Center hosted a Director's Forum to raise awareness of HIV/AIDS in Southern Africa, discuss obstacles to eradicating this pandemic and examine current efforts and proposed solutions. More than 150 people attended the forum and many more watched this program on local television and on the Center's first, ever, live webcast. Some viewers also submitted questions via e-mail for the panelists to address during the program.

The distinguished panel featured Her Excellency Sheila Sisulu, South African ambassador to the United States, former Congressman Ron Dellums, president of Healthcare International Management Company and chairman of the President's Advisory Council on HIV/AIDS, and Dr. Anthony Fauci, director for the National Institute of Allergy and Infectious Diseases at the National Institutes of Health (NIH). The Wilson Center's Director, Lee H. Hamilton, moderated the forum.

In the countries of Southern Africa, the number of HIV/AIDS cases continues to grow at an alarming rate. South Africa has the largest and fastest-growing population infected with HIV/AIDS, with more than 4 million infected and 25 percent of them are women between the ages of 20 and 29. In neighboring Botswana, 35 percent of adults have HIV/AIDS, and the disease has inflicted more than 10 percent of the adult populations in 15 other African countries.

Hamilton opened the forum with the staggering statistic that 70 percent of all people infected with HIV worldwide live in Southern Africa. Ambassador Sisulu attributed the high concentration and proliferation of AIDS in Southern Africa to dire poverty among the population, as well as an insufficient health budget and overall lack of funding. She stressed the need for a comprehensive approach to improve prevention efforts and build the necessary infrastructure–from roads to health initiatives–in order to collectively combat this pandemic.

Obstacles to Eradicating AIDS

Both Sisulu and Dellums emphasized the poverty and lack of resources that plague Africa and prevent proper prevention and treatment of HIV/AIDS. Sisulu said that Southern Africa lacks the necessary infrastructure to combat the problem, including the lack of proper transport, education and nutrition initiatives. Fauci agreed that HIV/AIDS cannot be addressed in a vacuum, that poverty and other conditions also must be addressed.

Sisulu warned that the approaches suitable for developed countries would not necessarily work in Africa. "When you have populations who are illiterate and you unleash on them these kinds of drugs, we unleash serious problems upon that community," she said. "Affordability aside, you need roads…clinics… doctors."

Cultural obstacles also exist. In some developing countries, women do not have the authority to request that their men use condoms during sex, but educational campaigns aimed at prevention have mainly targeted women. And throughout the world, stigmas about HIV/AIDS have cultivated denial of the problem, leading to stereotypes and a general reluctance to talk about HIV/AIDS for fear of being ostracized. Sisulu said that although legislation passed in parliament outlaws discrimination against AIDS victims, negative stereotypes abound. Dellums urged that people de-emphasize the moral aspects of HIV/AIDS such as racism, sexism, and homophobia and instead view AIDS as a global health and security issue.

Scientific obstacles to curing HIV/AIDS exist as well. The disease essentially weakens a person's immune system. Further complicating a cure, the disease inserts its own genetic code into the body's cells that hide from the mechanisms that heal common infection, said Fauci. When a person's immune system cannot properly function, simple and generally undetectable ailments can become deadly. In developed countries, drugs are available to extend life expectancy, but no drug can cure the disease and the patient requires perpetual treatment. Another obstacle Fauci raised is that of cumulative toxicity, where many patients cannot tolerate available drugs making the disease even more difficult to treat.

Efforts in South Africa and beyond

Sisulu said that a comprehensive HIV/AIDS program is in place in South Africa that focuses on prevention, treatment, care and research for vaccines, a collaborative effort with the 14 countries of the South African Development Community. She said South Africa's budget has increased seven-fold for this program in the past five years, and she expects the budget to increase by as much in the coming five years.

In addition to budget increases, South African President Thabo Mbeki has chaired the Partnership Against AIDS, a project that unites government ministers with the private sector to discuss what concrete actions each of the sectors have taken to address HIV/AIDS. Sisulu said that President Mbeki has instructed all of the departments in the Cabinet of Ministers to fund their own programs for HIV/AIDS, so that education, defense and other individual sectors sponsor programs in addition to what the government as a whole contributes. Sisulu also publicly addressed the controversy over President Mbeki's questioning of the link between HIV and AIDS earlier this year. She said that the President was misunderstood and that he was simply calling for a comprehensive solution, a theme she reiterated throughout this forum.

Some countries have succeeded in bringing HIV/AIDS rates down and can serve as models for South African programs. Fauci said that in Uganda and Senegal, private organizations have partnered with the highest levels of government from the beginning of this epidemic and have focused on education, testing and condom distribution. Senegal has implemented a comprehensive treatment program for all sexually-transmitted diseases, including HIV/AIDS.

In the United States, the NIH spends 12 percent of its entire budget, some $2.1 billion on HIV/AIDS research. Currently, 17 HIV drugs are approved and in use in the United States. Fauci said that pharmaceutical companies have paired with government agencies to increase availability of treatment.

Suggested Solutions

"I want to underscore the need to increase partnerships and collaborative action," Sisulu said, "and to respect and accept the fact that African countries…are doing the best we can with the limited resources that we have. Therefore, work with us! Work with us so that we are able to work with our people. We, as a government, cannot manage this pandemic on our own." She added that these countries oppose additional loans to deal with HIV/AIDS because loans only lead to more debt and dependency.. Instead, she urged the international community to assist the region in a sustainable way.

Sisulu also emphasized the need for HIV prevention campaigns to target men more effectively. Fauci agreed that men share the burden of prevention, adding that something must be done to help change the mindset of how men view and treat women in these countries.

Dellums suggested a Marshall Plan approach (alluding to the 1948 U.S. plan that sent billions of dollars of foreign aid to Western Europe in the wake of World War II). He proposes a large-scale public-private partnership that would infuse billions of dollars into Southern Africa to improve roads, health care, and education as well as provide training for program sustainability. His plan also contains a debt forgiveness component in order to give these countries the freedom to build a proper infrastructure to cope with HIV/AIDS and improve the quality of life in the region.

Fauci emphasized partnering with non-governmental and governmental organizations to make HIV/AIDS drugs deliverable and usable in developing countries.