No Time to Lose: A Life in Pursuit of Deadly Viruses (33 page)

Placing this among the 10 millennium goals had entailed yet another diplomatic battle with our sister agencies. Rumor had it that only malaria would be included—AIDS would be left out. So I went to see a phlegmatic and humorous Canadian scholar John Ruggie, who worked in a small office on the 38th floor of UN Headquarters, next to the deputy secretary-general. I introduced myself, gave all the arguments why there should be an AIDS goal, and told him I would not leave his office until he had agreed to include AIDS! He was a bit startled, as I doubt that such activist tactics are common on the well-protected 38th floor. But fortunately John was sympathetic; the head of the UN Development Programme, Mark Malloch Brown, was totally on our side; and it did not take much to convince Kofi Annan that AIDS must be on the list.

From then on, the politics of AIDS switched gears. The year 2001 was the tipping point in the fight against the epidemic. At the beginning of the year I brought many key UNAIDS staffers to a retreat. I kicked it off by saying, “From now on, think
big
. It’s time for breakthroughs. Our job now is to ensure AIDS is on the top political agenda in all regions of the world within two years. We need money to increase exponentially. By 2005 we should start seeing a 25 percent decline in HIV prevalence in Africa.” Our job was crystal clear.

While Kathleen Cravero was working 24/7 on what seemed like the impossible task of pulling off an AIDS session of the UN General Assembly in five months, I went around the world seeking support for a strong commitment of top leaders, and to ask for their participation at the event in New York in June. No country is too small to take care of its citizens, I argued, and to play an international role.

Caribbean countries were increasingly affected by HIV; following the early heterosexual epidemic in Haiti, HIV was spreading rapidly throughout the very mobile region, which hosts millions of tourists. Thanks to smooth collaboration with the brilliant Sir George Alleyne, an eloquent scholar from Barbados who headed the Pan American Health Organization, I was invited to the CARECOM Summit in Port of Spain, Barbados, on February 15, 2001. Prime Ministers Owen Arthur from Barbados, Denzil Douglas from St. Kitts and Nevis, George Alleyne, Yolanda Simon (founder of the Caribbean Regional Network of People living with HIV/AIDS), and I launched PANCAP: the Pan-Caribbean Partnership against HIV/AIDS. Collaboration among countries is crucial in a region with many small island states, few of which have the capacity to address a complex issue such as AIDS, and where there is very high mobility among the islands. At the summit, all prime ministers pledged to combat AIDS in their country and they agreed on a joint strategy for the UN summit in June, emphasizing the need to offer access to antiretroviral treatment. So the Caribbean was the first region to put AIDS top on its agenda, and we had a determined ally.

After the opening ceremony, Prime Minister Arthur invited me to a private lunch with his 12 colleagues and George Alleyne, a rare privilege. Standing in the hilly tropical garden overlooking the deep-blue Caribbean Sea, I discussed with Arthur how I could raise the issue of the “antibuggery” laws that made homosexuality illegal throughout the Caribbean. I did not want to embarrass my host, but he agreed that I could raise the issue. Most of the assembled prime ministers seemed to know each other from law school at the University of the West Indies—a unique regional university with campuses on several islands—and much of the conversation was about common acquaintances, people I did not know: this was really a personal community, as much as a political and economic one. When the discussion turned to one of the hot topics of the summit—the creation of a Caribbean High Court—I felt that my moment had arrived.

What I said was, roughly, “I commend you on establishing your own highest judicial body, so that your people and lawyers no longer have to go to London to plead their appeals. Perhaps this is also the time to abolish another obsolete law from the days of Queen Victoria. The antibuggery laws are a major obstacle to effective HIV prevention. They drive people underground and make it very difficult to reach them.” An uncomfortable silence followed. Owen Arthur broke the ice and said that whereas he disapproved of homosexuality, “Peter has a point, and perhaps we should reconsider.” A lively discussion ensued, but no conclusive agreement. I continued to raise the question at many subsequent visits, but as of today these laws are still active in the Caribbean, where homophobia can be strong.

In April 2001 we saw another major milestone: a special summit on AIDS, tuberculosis, and other infectious diseases (the latter a diplomatic concession to South Africa) was organized by the Organization of African Unity in Abuja, Nigeria. President Olusegun Obasanjo was the host. I had met him in Davos at the World Economic Forum and asked him, as the president of the OAU for that year, to convene his colleagues at a summit to say, loud and clear, that Africa has an AIDS problem and is ready to confront it. This was not only important for the peoples of Africa, but also because donor after donor told me that Africans never raised the question of AIDS, and therefore it must not be an important issue deserving of funds.

Kofi Annan and almost 50 African heads of state, as well as former US President Bill Clinton, who is very popular in Nigeria (in Abuja the road between the airport and town is named for him) attended the summit. That was very important: just about every head of state of Africa was talking about AIDS (and a little about TB) for two days. It was also one of the most chaotic summit meetings I’ve ever seen, with President Obasanjo even intervening to clear the security at the entrance of the conference center, and the official dinner starting after 11
P.M.
—though the waiting was amply rewarded by seeing Bill Clinton dance to Nigerian
high life
music. I’ve often reflected that I’m lucky to have started my career as an organizer in Zaire, because everything else—except Nigeria—has felt easy.

One by one, African presidents broke the silence about AIDS. It was wonderful, even if I knew that the distance between words and action can be a long one. But is it not one of the basic principles of psychoanalysis that before we take action, we need to be able to name the problem? Thus the assembled heads of state adopted a declaration that stated, “AIDS is a state of emergency in the continent.” They pledged to make the fight against AIDS “the highest priority issue in our national development plans” and to “take personal responsibility and provide leadership for the activities of national AIDS commissions.” That was truly vital, because it dissipated the thick cloud of denial about AIDS that had shrouded attempts to grapple with the problem in Africa.

The meeting also “resolved to enact and utilize appropriate legislation and international trade regulations to ensure the availability of drugs at affordable prices and technologies for treatment, care and prevention of AIDS and other infectious diseases.” Every country also made a solemn commitment to spend 15 percent of its gross domestic product on health issues, and specifically AIDS. (By 2010, only Botswana, Burkina Faso, Malawi, Niger, Rwanda, and Zambia had honored this commitment.) I always pushed for ambitious goals, but I tried also to avoid totally unrealistic ones, which can in fact be demoralizing instead of inspirational.

Kofi Annan was the keynote speaker in Abuja, and he was magnificent. We had worked hard with his speechwriter, and provided as much intelligence and data as possible. UNAIDS had estimated that we needed roughly $7 to $10 billion to stop the epidemic and Annan called for just that—a global, multibillion-dollar fund to be set up to halt and reverse the spread of AIDS in Africa. Annan called it a “war chest.” It would become the Global Fund to Fight AIDS, Tuberculosis, and Malaria, a completely new kind of public-private partnership.

The $7- to 10-billion figure did not come out of the blue. It was based on a study that Bernhard Schwartländer and colleagues (in UNAIDS and other institutions) had published in
Science
, which for the first time had established an estimate of what it would cost to turn around the epidemic and provide treatment to a majority of patients. (Importantly, they specified that one-third of these resources could come from domestic resources of the developing countries, and two-thirds from international resources—a fact often ignored by activists and journalists, who only remembered the $10 billion figure, and presented it as if all the money had to come from high-income countries.) The estimate was a breakthrough that framed the funding discussions at the UN Special Session in June, as well as many other meetings.

Annan’s speech at Abuja was a key part of our strategy of building momentum toward the special session in June. It was also the first time I was formally part of the UN secretary-general’s official delegation. This is a highly efficient self-contained unit that operates 24 hours a day, with Kofi Annan continuing to handle the political crises of the moment wherever he may be in the world. My respect for him, already high, increased considerably.

The closing session of the summit was surreal. For protocol reasons, it fell to Moammar Kadhafi to deliver the vote of thanks in the hot and overcrowded conference hall. What is normally a brief formality turned into a 50-minute tirade against the “great Satan” (America) that had fabricated this virus to wipe out Africa. This man was not a drunk in a bar, but head of an oil-rich state, among the most senior of Africa’s leaders. I found it profoundly upsetting that I and over 40 presidents had to listen to this insulting nonsense. After a while, Clinton and many Western delegates walked out in protest—rightly so. But I must say that Kadhafi was a great showman, speaking softly, almost in a whisper, and then crescendo with fervor, dominating the audience in his sunglasses and long brown Bedouin robe. Still, it was remarkable that the diplomatic niceties should dictate that such a clearly disturbed man could demand the attention of the leaders of an entire continent.

A few weeks later, in May, during a visit to Washington by Nigeria’s President Obasanjo, US President George W. Bush hosted an event at the White House where he pledged $200 million for a global AIDS fund. Annan, also in attendance, donated the $100,000 prize for the Philadelphia Liberty Medal that he would soon receive. This was extraordinary: multimillion-dollar pledges to something that did not even exist yet. But the wind had changed: there was now a robust determination to come to grips with AIDS.

With the UN summit in June looming large, we were in nearly daily contact with two formidable women, Deputy Secretary-General Louise Frechette and Marta Mauras, her chief of staff, and received regular advice from Kofi Annan at critical moments. Kathleen Cravero, Jim Sherry, As Sy—who I had asked to move from South Africa to New York to lead our office—and many others did not sleep much during the first half of 2001. I went to New York every few weeks, and fell in love with one of the greatest cities in the world.

While there was generally strong support for a major effort on AIDS, there were also major disagreements on what to do and how to do it. After some initial skirmishes about secondary issues, basically four thorny topics remained: mentioning homosexuality, drug use, and prostitution in the declaration; access to antiretroviral treatment and associated intellectual property issues; a financial commitment; and participation of AIDS activists. We had to de-mine them one by one. Contrary to a common belief, political decisions in the United Nations are not made by the organizations or the secretary-general but by the 192 member states, which have divergent and often mutually exclusive interests to defend. UNAIDS could only provide technical advice and logistic support.

The president of the General Assembly, then the Finnish diplomat Harri Holkeri (the function rotates annually), had appointed two “facilitators”—ambassadors who would lead negotiations behind the scenes. We were very lucky with his choices: Ambassador Penny Wensley from Australia and Ambassador Ibrahim Ka from Senegal. I knew Penny from Geneva, where she was the Australian ambassador to the United Nations and an early and firm supporter of the AIDS cause. A hardworking and multilingual perfectionist, she was one of the most respected ambassadors in New York and worked tirelessly to forge consensus on a strong declaration in June.

Another, even more formidable, force intervened: “civil society,” the accepted term for all sorts of AIDS activists and interest groups. They too wanted to influence the negotiations. Many diplomats were disturbed by these intruders, with their poor manners and constant demands for more. But I was adamant that they had the right to speak up, and though we might have disagreed—sometimes quite strongly—I did feel that we shared a language. Besides, I’d read the UN charter, drafted by Eleonor Roosevelt: “We the people . . .” These
were
“the people.” Such involvement of nonstate actors is now increasingly common in international forums. It represents a new form of democracy outside the formal national and international institutions, with no obvious leader, often transnational and connected by rapid communication. UNAIDS made it possible for them to be in the room; once again, AIDS was exceptional, a trailblazer.

Again, Kofi Annan came to our aid. He personally phoned heads of state and urged them to attend. Every time he met a head of state or government, or ambassador, he would talk about AIDS and he always made time to see me. On another, much later occasion, in the midst of the Iraq crisis, when I entered his office I could feel the strain coming off him. I said, “Secretary-General, I won’t take any more of your time—I know you have important things to deal with.” But Annan responded, “More people are dying of AIDS today than they are in any war.” He shared with Nelson Mandela that precious quality that consists in giving you the impression of caring, of pure concentration on your issue and on you as a person: you might only see him for a half hour, but that half hour was completely yours.

Also, in terms of working within the UN system, Annan was an operator of the highest order. But he was also a very demanding boss, with far less patience than his soft voice and gentle manners express, and cut in no time to the heart of a problem.