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Commencement Speaker Bio

Transcript of Commencement Address

Transcript of Commencement Address

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Stephen Lewis, U.N. Special Envoy for HIV/AIDS in Africa
Commencement Address, June 9, 2005
Harvard School of Public Health, Boston, MA

Dean Bloom, Tobias Vanderhook, distinguished platform colleagues, even more distinguished graduates of this School of Public Health, and the exuberant and nearly levitating families, friends, and relatives who inhabit this vast environment. I have to begin, if I may, with a confessional. I unfortunately do not deserve the title of Ambassador Lewis. You see, in Canada, alas, when you have finished your diplomatic tenure, you relinquish your title and you revert to mortal obscurity again. It's only in the United States, once an ambassador, always an ambassador, once a governor, always a governor, once a President, always a President. The United States is sustained by titular self-aggrandizement. And we Canadians look upon it with a bemused affection.

I feel enormously privileged to be part of the ceremony for this remarkable institution. I thought as I ventured here that for my remarks I'd like to set a context, if I may, with a couple of anecdotes that have pressed fiercely on my mind these last three or four years that I've been doing the envoy job. Not long ago I attended a little grade-five class at David Livingston Primary School in Harare, in Zimbabwe. The entire class was made up of ten-year-olds whose teachers wanted to counsel them, alert them, engage them in life-skills courses in order to introduce them to questions of HIV and AIDS. These were enormously sophisticated young people, because when you're living in the midst of the contagion, you're pretty familiar with questions of the way in which it is transmitted and how you protect yourself.

The teacher in this instance said, "What I'm going to do is hand out a number of slips of paper to every single individual student in the class, and then I'm going to ask you to write on each slip of paper what bothers you most. And then we'll pick up the pieces of paper and we'll look at them carefully and discuss them." And in seven out of ten cases, the children wrote the word "death." These are ten-year-olds. Death of a father, death of a mother, death of an aunt, death of an uncle, death of a friend, and when the teacher said to them somewhat urgently, "What do you do in the face of all this death which obviously consumes you?" the kids said, "We pray." And the teacher said, "You pray? To whom do you pray?" and the children said, "Well, we pray to God, of course." And there was then an animated discussion, and I left the school class with the teacher, and I said as I left, "I want to be honest with you. I didn't entirely understand the transactions around prayer and God." And she said to me, "No, Mr. Lewis, you didn't understand, because when you go to funerals at lunch hour, and when you go to funerals after school, and when you spend your entire weekend at funerals, the only solace you feel you have left is prayer and God."

And just a few weeks ago, as I was visiting a rural village in Zambia, I was asked by the local villagers to come and see a particular income-generating project which a group of women living with AIDS had created. And they took me down many dusty, trodden paths to a large field where a group of pugnacious and feisty women, holding a banner declaring their project, they were standing and they talked to me with great feeling about the men who had infected them and what they felt about such men. And then I realized I was standing beside a large cabbage patch, and I said to them, "I take it this is your income-generating project," and they said to me, "Yes, absolutely." And I said, "I assume it supplements your diet, makes your immune system stronger, makes you nutritionally more secure." And they said, "Yes," and I said, "Do you have any of the cabbages left over?" "Absolutely." "What do you do with them?" "Well, we take them to market and sell them. That's the income-generating part of the project." And I said, "What do you do with the income?" And they looked at me curiously, strangely, as though I had asked a question to which I should surely know the answer. And the leader of the women said, "Well, we buy coffins, of course, Mr. Lewis. We never have enough coffins."

I've spent the last four years of my life watching people die, and as I stand here at this class, graduating class, I want to tell you that never has the world more profoundly needed people who are schooled in and embrace the principles of public health, and the sense of interdisciplinary and intersectoral activity that all of you have absorbed over the years here, and the compassion to which Alyson spoke. Those are the things that give public health such centrality in our world. And when I think of what I see in Africa, and I mull on treatment, and prevention, and care, and gender, and orphans, and research, and the whole amalgam that it represents, I know that whether it's on that continent or anywhere else you wish to pursue your life's career, it will be ultimately invaluable.

Let me say a word about treatment. On the African continent, country after country is now engaged in desperate treatment of its people. There are anti-retroviral drugs at generic prices, and if they can roll out the treatment, if they can find the capacity to treat people, they can keep immense numbers of people alive. The World Health Organization has proclaimed what it calls Three by Five, as all of you know, putting 3 million people into treatment by the end of this year, and although we may not make the absolute numbers, we have generated a momentum which is at this point unstoppable. But none of these countries have any capacity. They've all been stripped of their capacity. It's like taking the visceral heart out of a society, the way in which the virus has ransacked capacity. And therefore, to have people in public health who understand the value of training and of bridging the needs and of filling the gaps, and of making it possible for whole societies to endure, I cannot imagine a greater contribution.

And then there's the question of prevention, and everybody consumed with getting people tested, voluntary counseling and confidential testing, and who deals with the counselors? Who helps them break the news of their HIV-positive status to their partners? Who deals with the enormous human sensitivities and sensibilities that this virus induces, if not people who have some sense of the world of public health and the range of activities? Who but those of you, those of you in communications health like Alyson, others amongst you, who better to speak to the messages that young people between the ages of 15 and 24 propagate as they move from country to country, community to community, school to school, using all the cultural apparatus of the country, drumming, music, song, dance, drama, to convey messages so stark and so direct about sexuality as to make prevention real?

And then there's care. All the people in the country who are desperately trying to do home-based care, who are visiting the most remote environments and entering huts where you're always confronted with the same apparition, of a woman lying in agony on a fetid mat on the floor of the hut, needing some human solace and response, and who else to train the home-based care workers? Who else to give them the medical kits, who else to explain to them how to use their gloves, who else to tell them where you find an aspirin to treat an opportunistic infection, who else but people who have the entire realm of public health at their grasp?

And in the midst of all of this we're dealing with gender. If anything has troubled me more than any other aspect of exposure to this horrific pandemic, it's the disproportionate vulnerability of women. It's the dreadful, eviscerating reality of gender inequality, so that fully 60 percent of the infections in Sub-Saharan Africa are amongst the women. And if you look at the millions who are infected between the ages of 15 and 24, 76 percent are young women and girls. We are denuding parts of the continent of its women and girls. And because of the inequality, they have no capacity to say no to predatory sexual overtures. They have no capacity to negotiate safe sex. They have no capacity to say, "Wear a condom," and indeed, what is emerging, which is absolutely hallucinatory, is that one of the most dangerous environments for a woman in Africa is to be married.

The prevalence rates for HIV outside of marriage, among single, sexually active women in the community, are lower than the prevalence rates amongst the women who are married. So many of them are young. They believe they're in a monogamous marriage, and their partner brings the virus into the marriage. And the women do all of the care in the society. They maintain and hold the society together. There is so much sophistication, knowledge, solidarity, generosity at the grass roots amongst the women in these African countries, it is beyond words to convey. And this virus is killing them in numbers that are not conveyable in human terms. And then there are the orphans.

You see the beauty of your collective disciplines, the beauty of the collective education, the eclectic -- sorry -- to which you've been exposed, is that you're able to absorb all of these aspects of the human condition and make of them something real. You can respond more sensitively to gender because you understand in public-health terms what it means. And you can respond, one hopes, more sensitively to orphans that are proliferating on the planet as a result of exposure to HIV and AIDS in numbers that none of would ever have imagined. There is no precedent for this in human history: 14 million orphans under the age of 18 now in Sub-Saharan Africa, 20 million by the year 2010. Countries are reeling with the numbers. They have no way of knowing how to respond.

The grandmothers are looking after orphan children as the families are decimated, looking after five, ten, 15 orphaned kids. These grandmothers, they have no finances to pay the school fees for the children so they can go to school and have a meal. They can't find food. They barely have shelter. And then the grandmothers die and there's no one coming up behind, and you have this bizarre phenomenon of child-headed households, where the oldest sibling in the family looks after the younger siblings. I've seen child-headed households where the age of the child heading the household is eight. And I want to remind you that these orphan kids don't become orphans when their parents die. They become orphans while their parents are dying. They look after their parents. They clean up their parents. They try to find some drug which will appease the pain of their parents. And then they stand in the huts and they watch their parents die. How do you overcome the trauma of that in a lifetime? How do you repair that little, fragile psyche of a child?

And it requires a compassion, and a decency, and a knowledge of response which all of you collectively have at your hand. And then there's the research, which so many of you have done in attendance here at the School of Public Health. In this case there's so much research now focused on the discovery of what we call prevention technologies, of the desperate effort to find a vaccine. But alas, it still seems to be ten or 11 years away, so there's an even more urgent effort now to try to find a microbicide, and it is suggested that a microbicide might be discovered within the next four to seven years. And if we do discover a cream or a gel as a microbicide which the woman can apply to herself, and which prevents the transmission of the virus, and the partner need not even know, then we have given to the woman control over her own sexuality which will frankly prevent millions upon millions of infections.

You see, the role of public health as I see it in the modern world is absolutely indispensable. It goes beyond all the boundaries of the particular professional discipline, and you bring so much more. And I see it in the context of HIV and AIDS, and I see it in the context of Africa, and I think to myself how wondrous it might be if even a small handful of you participated in what the School of Public Health and Harvard already know so well in so many countries. It also touches, if I may say, as I bring these remarks to an end, on the great moral issues of our time. It's good to have ethicists in the School of Public Health, because you're touching on questions which strike right at the heart of the human condition.

I can't tell you how often young women, with their children in tow, come up to me as I'm visiting a country, and they say, "Mr. Lewis, what's going to happen to my children when I die?" They're all in their 20s and 30s, and I don't know how to answer that question. I've never known how to answer that question. And then they say to me -- they don't use these exact words, but this is what they mean -- "You, Mr. White Man, you have drugs in your country to keep your people alive. Why can't we have drugs to keep ourselves alive?" And I can't answer that question, either, because it speaks directly to the disparity which Dean Bloom talked about, the grotesque disparity between the developed and the developing worlds, and the way in which we have assigned and marginalized hundreds of millions of people to the sidelines of the human condition.

All eyes, three to four weeks from now, will be on the G8 Summit in England. Everybody will be waiting to see whether or not the Western countries who belong to the G8 Summit will double the foreign aid, the official development assistance, in order to make it possible to respond adequately to infant mortality, maternal mortality, gender equality, putting kids into school, environmental sustainability, the approximation of gender equality, and above all, to eliminate poverty and hunger. The target is the famous .7 percent, seven-tenths of 1 percent of gross national product, which it is anticipated that every donor nation will achieve. I say to you with heavy heart that it would appear that the United States has not yet come to the conclusion that it would reach that target. That .7 target for the United States, and it is only at .1 at the moment, would represent some $80 billion a year. The Senate of the United States just ratified $80 billion as an additional supplement for the war in Iraq.

That is a decision which a country has every right in the world to make, of course, but one would wish that we had as much money for the human vulnerability as we always are able to find money for conflict. And I beg you, collectively, you lovely, principled, uncompromising students, who have reached a certain moment in your careers of which you're justly proud, to think of devoting a chunk of your life, however limited, to redeeming the desperate situation in much of the developing world. It will change your life forever. I've always believed -- and this isn't some romantic Pollyannaism -- I've always believed that when there is one part of the human community under siege, it is necessary for us in the privileged part of the human community to respond, with decency, with justice, with urgency, and with compassion. I hope you can find a way at some point to do some of that. I truly and deeply salute all of you. Thank you for having me.