Entertainment Summit - NYC November 18, 2003

Entertainment Summit Keynote Address
Stephen Lewis

I always get a kick out of speaking in the United States because it does wonderful things for my incipient egomania. Inevitably, when I arrive people address me as “ambassador,” as two or three people did this morning and it’s a delicious, reverential note. I did serve at the United Nations for 4 years for my country, Canada, but alas in Canada, when you have finished your diplomatic tenure you lose your title and you revert to mortal obscurity. 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.

I don’t want to pretend to any particular expertise on the subject matter. I’m enormously glad to be able to address the conjunction between the AIDS pandemic on the one hand, and the interventions which can come from the world of entertainment on the other, and I want you to forgive me if I draw on anecdotal material which flows from my experience in Africa, although I fully understand that you will be dealing with all of the globe today, and I think it’s fair to say that some of the things I suggest have obvious universal application. I thought perhaps I could provide some context within which the day’s explorations could take place.

Number one:

Not very long ago I attended a little grade five class in David Livingstone Public School in Harare, Zimbabwe, made up entirely of ten-year-olds, the most sophisticated ten-year-olds I’d ever encountered. The teacher was engaged in a life skills class, trying to convey to them the risks and hazards associated with the pandemic of HIV AIDS. And in the course of doing so she invented something pretty creative. She suggested to the kids that they apply themselves to writing down on a piece of paper what it was that bothered them most about what was happening and put the papers in a little box and then they would be plucked out one-by-one and the teacher would discuss the contents. And the children laboriously and faithfully wrote the words, and eight out of every ten pieces of paper had the word “death”: Death of a mother, death of a father, death of a friend, death of an uncle, death of an aunt. These are ten-year-olds. And it speaks to a reality which all of us have to absorb, which is that we’re right on the verge of the death spiral in Africa and beyond: All the people who were infected in the late 1980s and the late 1990s are now showing evidence of full-blown AIDS. And therefore between the years 2004 and 2010 the, the intensity and ubiquity of death will be pervasive.

You drive down many a street in urban centers in southern Africa and you see a clutch of schoolchildren in lively colorful uniformed garb, and you think they’re in a schoolyard and you park for a moment and you realize they’re in a cemetery. And in order to counter that anxiety which will flow from the sudden astronomic and escalating figures, it’s tremendously important to emphasize the prevention programs that are increasingly in place. And not to underestimate the tremendous capacity for prevention across all continents, particularly developed by peer educators using drama and dance and song and drumming and poetry, and conveying messages about sexuality of astonishing straightforward honesty, so that as they move from community to community, and school to school, whatever the stage they’re on, there is this sort of ferocious identification of unfaithful men, of erect penises, of cowering schoolgirls. Wherever you go there is this, a tremendously forthright and frank fiction of what it is we’re dealing with. I’ve seen it with truck drivers in Nazareth, Ethiopia, where trained by the World Food Program, knowing that they will encounter commercial sex workers on their routes, say proudly that they are using condoms. I’ve seen it with the commercial sex workers in Habera in the slums of Nairobi, where the women who are in the sex trade wave condoms above their heads as they tell you with enormous élan and intensity that they’re devoted to as much prevention as is humanly possible.

Number two:

I had a most fascinating exchange with a group of high school students in Addis Ababa, Ethiopia, not very long ago. Several hundred of them gathered to talk about the pandemic, and what is so fascinating was the degree of mythology to which they were given, albeit knowledgeable about a number of matters.

So there was a tremendous anxiety in many of the questions about the legitimacy of using condoms, and whether they were safe and there was an assumption, largely driven by the church, destructively driven by the church, that condoms were only 30% or 50% effective, and therefore should they be wearing them.

And the sense of invulnerability even during unprotected sex. And the sense among many of the girls that they could tell whether you have AIDS, or whether or not you were healthy-looking. And there were a number of misconceptions, a broad discussion about early marriage and early sexual activity. Tremendous anxiety coursing through them. The very real recognition that in youth, particularly between the ages of 12 and 20, if I could put it that way, their lives, the capacity to overcome the pandemic if only they are fully educated and the education can be provided by the entertainment industry focusing on these things just as the education can be provided by the entertainment industry in dealing with the matters I raised at the outset, questions of reproductive health at their centrality.

Number three:

I had the incredible opportunity in July and August of this year to travel to Uganda and Zambia with a very good friend and someone whom I adore, and that’s Graca Machel, who many of you will know is a former minister of education in Mozambique, the former first lady of Mozambique, now married to Nelson Mandela, a woman who is seen everywhere as “Mama Africa.” And one of the things we wanted to do was to see what was happening with orphans, because the reality of orphans is now the reality of China and India and Russia and Eastern Europe and the Caribbean, increasingly as it is in the epicenter of the pandemic in Africa.

We wanted to see something of a child-headed household. So we went to the ground zero of Uganda where the pandemic was originally rooted in the districts of Masaka, Rakai, and we entered a little hut where there were five children headed by a fourteen-year old girl in what we call a sibling family, a child-headed household where everyone else has died. The girls were 14, 12 and 10, and there were two little boys 11 and 8, and Graca and I sat down on the floor of the hut with our backs to the wall, and the little boy sat on my left and the little girl sat on Graca’s right, and she shooed everybody else out of the hut. I didn’t really know what to anticipate. There was one translator left, one community worker left, in the hut. And Graca said to the little girls, “Have you started to menstruate yet?”

And the little girls, in the most ineffably, quiet, beautiful, whispered voices, 14 and 12 year olds, said “yes.” And then Graca engaged in a conversation. She asked them. “Do you know what it means? Has anyone talked to you about it? Do you discuss it in school? Do you discuss it with your friends? Do you discuss it with your teachers?” And as I sat and listened to this extraordinarily tender and moving conversation, I suddenly realized that I was witnessing the first act of parenting which these young girls had ever experienced on what must surely be one of the most anxious and important moments of their young lives. And that speaks to something which is much broader in implication because the absence of so many mothers, of so many parents, means the lack, the loss of, of intergenerational exchange. Now children don’t learn the transfer of information from generation to generation. Things as elemental as knowing how to produce food, knowing how to engage in, in simple agricultural techniques, is lost to these kids because they don’t have the parents to convey the information to them, let alone having someone to tuck them in at night when they go to sleep. That’s something which is a sensitive and difficult issue, but an issue we somehow haven’t probed sufficiently as yet, and that’s clearly something which the entertainment industry can give, give an expression to.

Number four:

I remember being at the Kitchikira Clinic, where the mother to child transmission programs, the mother to child transmission programs, are being done in Kigali in Rwanda, but this was a couple of years ago but has lived with me forever, because in meeting with a number of women who were at the clinic, they come for voluntary counseling and testing, and when they’re tested and found to be HIV-positive, they have the option of taking nevirapine, the drug which as you all know is the drug which interrupts the transmission from mother to child in the birthing process.

And the women took me aside, outside, and said with enormous intensity, “Mr. Lewis, we’ll do anything in the world to save our children, but what about us?” I’ll come to that in a moment. But in the process of saying it, it reminded me again of my strongest single experience in the two years and four or five months I’ve done this job, which is the vulnerability of women. This is a virus, unlike any other communicable disease in human history, which has identified one sex for the most ferocious assault. It’s like some kind of perverse Darwinianism, singling out women for attack. And the absence of gender equality—the pervasive gender inequality, cultural gender inequality—means that in the presence of AIDS, for women, it’s invariably fatal.

This raises a number of very sensitive issues. It raises the absence of the rights to sexual autonomy, sexual independence on the part of women. It raises the questions of their inability, women and young girls, to say “no” or to say “wear a condom,” or to express sexual independence. It speaks to questions and patterns of sexual violence, which are not particularly applied purely to Africa but are true across the globe in the developing world. It speaks to the absence of property rights and inherited rights which women must have. It speaks to the appropriation of some women after the husbands have died, by the husband’s family. As though the women were owned and then taken on to be the wife of a, a brother-in-law. It speaks generally to the horror of gender inequality and to the predatory sexual behavior of men which is the driving force of the virus.

I remember recently reading a monograph done by UNFPA about male sexual attitudes in Zimbabwe and I have to tell you when I reached the end of the monograph, I felt to myself, as though there was no hope in the world. As though the male species were largely beyond redemption. And that is why it is so profoundly important to empower women and to address gender inequality as it’s never been addressed before. Because although one must engage men in this process, it will take generations to change the sexual behavior of men, but we have to empower women early because too many of them are dying. Of the women and girls between the ages of 15 and 24 in Sub-Saharan Africa and who are living with the virus, 10 million of them, 67%, sorry, of the people living with AIDS in that age category, 67%, are women and girls. It’s a distortion which has depopulated parts of the continent.

It leads me to the fifth point I wanted to make:

I was at a little unplanned community in August, just outside the capital of Zambia, Lusaka. An unplanned community of only about 10,000 people, and they gathered together because they were very proud. They had created some roads. They had built a community center. They were feeling very good about themselves. And as is always true when you have a visitor in the developing world, they, they embrace you and they gather you in and they ask you to address them.

So about a thousand people sat down on a gravelly knoll outside the community center, and when I looked at the gathering, I suddenly understood visually what I had absorbed intellectually but never thoroughly assimilated.

In the front row, there were some very young women in their late teens, I would think. Maybe in their early twenties, with their children, their infants at their breast, and everybody else was ancient. And I said to the crowd “how many of you are grandparents?” And the great majority of hands shot up, and I said “How many of you are looking after young children?” and the great majority of hands shot up, and I, I suddenly had that sense visually that I had never had before, of that whole middle generation gone, that people in their 20s and 30s and 40s and 50s, gone. Recall epidemics and famines. The toll has invariably been taken in past history on those who are very old, and those who are very young. This time, the toll was taken in the areas of the productive age years, right in the heart of the life cycle. And that’s not fully understood by the world. That’s not fully understood by the rich and industrial nations who have to respond with the resources that were suggested are lacking earlier from this, this podium. And that is something again which entertainment—video, film, radio, all the interactive activities, that are going on even now in a number of countries—Thailand, India, Nepal, Egypt, South Africa, Kenya—all these activities which this entertainment summit can give expression to and reinforce.

Number six:

When I was in Windhoek, Namibia, I met with a group of people living with AIDS, as always, primarily women. A desolate, dispirited, discouraged group of fifteen or twenty people. Very few countries have a lot of courageous people who have come forward and admitted that they’re HIV-positive.

And what had wounded these people so greatly, and they expressed it to me with such heartfelt clamor that it was quite overpowering, was the way in which when they went to the local hospital they were rejected by the nurses and doctors for treatment, even for opportunistic infections, even for aspirins to relieve some pain. And that speaks to the reality of stigma, which is absolutely pervasive everywhere in every country which has even the lowest of prevalence rates.

Your family rejects you. Your friends reject you. Your neighbors reject you. Your work colleagues reject you. Children of people who are living with AIDS are rejected at school. The apparatus of stigma is one of the most damaging and poisonous manifestations of the pandemic and what makes it so difficult to break through because even in many countries the religious leadership is engaged in stigmatization and denial of human rights. Again, the capacity of entertainment, people to deal with the complexities and subtleties and nuances and difficulties of this is just as difficult as it is to deal with questions of gender.

But to deal with it forthrightly and honestly you have a tremendous contribution to make. I was recently in touch, I thought a little bit about whether or not I should mention this but I decided in this crowd I would like to. I was recently in touch with a little project in Uganda, with whom for separate reasons, my family and I are constantly in contact, and the girl who runs this project, it’s in an astonishing little parish called Nbouyou, where they are doing care and treatment and prevention simultaneously in the most artful and loving ways. In this little parish they lose 2 or 3 people a week. We have a letter from the head of the parish saying they had lost five women in one day, and she then described the loss of the first four, and she said the fifth was the most painful. It was a 19-year-old woman who had had a child, who was HIV-positive, who had clearly been raped in her early years, and that’s the way the virus was transmitted. Her husband was HIV-negative and had rejected his wife when he heard that she was positive. She went back to the village in an effort to create a rapprochement, and the relatives of the husband beat her to death, and this no more than a few years ago. And I thought to myself as I absorbed the power of the story, speaking to what Sonny said about the power of storytelling, that even though it’s not the kind of story one wishes to convey, it’s reminiscent of the terrible moment in South Africa when the woman declared herself HIV-positive and was stoned.

The reality of the stigmatization at every level in every gradation of human behavior, is something which must be conveyed with power and authority. And the entertainment industry is capable of doing that.

And it brings me to the last point I wanted to make in this brief exegesis, and that is the way in which the Columbia school, a school I quite love, has developed the Prevention of Mother to Child Transmission Plus, which Allen Rosenfield spoke of, where finally those women who approached me in Kigali a couple of years ago and said “I’ll do anything to save my children, but what about me?” Finally, they are being treated. And in a number of clinics across Africa now, only a modest number, they are models which we are hoping to build upon, women are coming forward. And when it is found that they’re HIV-positive they are receiving treatment. And their partners are invited into treatment, and their children if they are HIV positive have treatment, so that suddenly there is hope. Suddenly there is the constellation and conjunction of treatment and prevention brought together. It’s an extraordinarily exhilarating process. I sat with Graca Machel, in the Prevention of Mother to Child Transmission Clinic Plus, where they were treating the women at the Malago Hospital, in Kampala, Uganda. The treatment occurs when the CD4 count, the one cell count of the women, drops below 200. That’s the average in Africa. Can you imagine a woman whose CD4 count had dropped to one? I had never met anyone who went into treatment with a CD4 count of one. I had heard of 150, 100, 50, 30, 20, never one.

And that woman, once in treatment, came back to life. She started to eat. She started to gain weight. She began to regain her enthusiasm. She went back to work. It was indeed the Lazarus effect, as they describe it. Graca and I were completely blown away by the experience. I hope the people in Columbia treasure what they’re doing because it is an astonishing contribution to human well being. And what was most beautiful about all of it was the two children playing at her feet, who would otherwise be orphans. The best way of dealing with orphans is to keep the parents alive.

So you see, there is tremendous complexity in all of this. Human dynamics around sexuality are always fraught with tension and anxiety, but the entertainment industry, the entertainment sector, its enormous creative apparatus, at its peak can do things as they can no longer otherwise be done.

And as I end I want to say to you from my own experience, that we are at the rubicon in this fight against the pandemic. We finally get a glimpse of some small modest resources although as has been said they are incomparably trivial compared to the amounts of money we spend on war and reconstruction. And we finally get a sense of potential treatment. Of the building of capacity. Of the renewing of infrastructure. One gets the sense that in this dreadful history of almost criminal negligence and delinquency on the part of the Western World and the denial which was felt in many countries suffering from the onslaught of the pandemic, that that may be past. We may be on the verge of a breakthrough. And this is the moment in time for the entertainment sector to take hold and use all of its emotive and evocative power, to raise awareness and consciousness, to inform the world, not just the countries where the pandemic is alive but in the world as a whole, of what we’re dealing with, and how you can right this pandemic because all of us know what to do. We just lack the resources and the political will to do it.

And I don’t want to end negatively, but I think I have to say that if this pandemic, as I’ve experienced it in Africa, spreads to China and South Asia, then the apocalypse will truly be upon us. And everyone in this room has the capacity to turn that around, and bring hope to a beleaguered world.

Thank you.

Back to top