The Threat of AIDS In Africa
RIZ KHAN, Q&A; (voice-over): It's a killer 10 times more deadly than war. Africa's death toll to AIDS is sending shockwaves throughout the continent and fears that Africans will continue to slide downhill in the global economy. (on camera): Hello, and welcome. How much of a threat does AIDS pose to the development of the continent? Consider that in 1998, armed conflicts were responsible for 200,000 deaths throughout Africa. That same year, two million people succumbed to AIDS. And that's a toll that can be measured not only in terms of a staggering loss of life, but also lost productivity and economic potential. We have two guests to field your questions and comments on the issue. Dr. Libertine Amathila is the minister of health and social services in Namibia. She's joining us from the United Nations. Her country, independent since only 1990, is seeing the HIV-AIDS infection rate increasing by between 7,000 and 10,000 a year. She says Namibia estimates that 67 percent of the population is already infected with HIV, the virus that causes AIDS. And in Boston, we'll speak with Dr. Max Essex, the chairman of the Harvard AIDS Institute. Dr. Essex was one of the first researchers to determine that HIV could be transmitted through blood and blood products. And we'll get their reaction to the AIDS crisis in just a moment. But first, a look at the epidemic that's now holding world attention.</s>DR. MAX ESSEX, HARVARD AIDS INSTITUTE: Well, I think it will certainly have some positive impact. It was a recognition in the Security Council that a health issue can be important enough for their deliberation. It was a recognition that AIDS in Africa is just the health issue that is so disruptive to not only the economy, but security and the future potential of that region of the world that it merited concern and attention in that body.</s>KHAN: Well, Dr. Libertine Amathila, I want to get you in on this and talk to you specifically about your country, Namibia, because that's one of the key concerns obviously in sub-Saharan Africa so badly affected by this disease. Let me ask you why is it that Namibia has such a high rate of infection - 20 percent of the adult population, according to the figures I've seen?</s>DR. LIBERTINE AMATHILA, NAMIBIAN HEALTH MINISTER: Well, I think the reasons are that you know the HIV virus, once it starts, it takes about five to six, seven years before people get ill. And when the virus started in 1992, we were barely, probably only 4 percent in the highest - highest people was 4 percent. And this was people who were infected with the virus, but they were not sick. So people started dying only in 1994, 1995. And before that time, you know, this was an obscure disease. People didn't believe that anything like that is on (ph). And a few people who are dying were not known, so people felt that we are just talking. And it's only now that the virus is killing so many people, so people have started becoming serious.</s>KHAN: We're going to get a call in from Switzerland, actually show our viewers, show you all some of the figures of what's taking place in Africa. Let's get our caller in from Switzerland with your question, please.</s>CALLER: Yes, my question is why is it that the AIDS epidemic is more in Southern Africa and in East Africa, but slowly in West Africa? Why? In West Africa, it's not very much.</s>KHAN: Well, I'm going to put that to our minister. But first, let's get our viewers to have a look at exactly -- some figures we're compiled here of AIDS in Africa. And it says 2.5 million AIDS deaths worldwide. Now, 80 percent of those are in sub-Saharan Africa. We go up 510,000 AIDS deaths among children worldwide, more than 90 percent in sub-Saharan Africa. And out of 1.2 million children under 15 living with AIDS, 1 million of those are in sub-Saharan Africa. So Minister Amathila, let me just ask you -- that's -- it really does focus so much on sub-Saharan Africa. And our viewer is asking why is it so much there?</s>AMATHILA: I don't want to blame apartheid and colonialism, but I think during the apartheid system and the colonialism, there were disruption of family lives in Southern Africa. For example, the contract system whereby the men had to go and work in the mines, and they didn't go home for up to 12, 24 months. And they found their friends around there. So it became kind of apparently a habit that, you know, women were left alone and the men were away so much, they started having new families. Whereas in West Africa, I think they -- Muslim traditions are also very helpful, and they were not disrupted like us in Southern Africa. And remember, we also fought a very furious war of colonialism. And I think that disrupted the family lives. If you take the question of Namibia, for example, during the first world war, 80,000 people were killed of one tribe, and the women were pushed alone in the desert. So I think all these family disruptions are responsible for it.</s>KHAN: And I want -- yes, I want to get to Dr. Essex. Dr. Essex, do you think that the rest of the world, the developed nations, if you like, as well realize the impact that the AIDS situation in Africa will have outside the continent, outside the African continent?</s>ESSEX: No, I don't think they do, and I think it's time that they started finding out and learning. A comment I would add with respect to the last question is that I believe a difference also within different regions of Africa, on the different rates of infection is perceived today is that the epidemics within Africa really started at different times. The epidemic in Central Africa, for example, was an epidemic of the mid- and late-1980s. It had peaked and begun to go down by the mid- to late-1990s. The epidemic in Southern Africa, where Minister Libertine is from, really didn't begin until the early '90s. It's due to a different virus than the virus in Central Africa or East Africa, for example, and I think that one of the realizations the rest of the world should begin to own up to is that these are new and different viruses. These are not the same virus that caused the epidemic of the '80s in the West, and we have to allow for the possibility that new epidemics can occur elsewhere in the world due to newer HIVs.</s>KHAN: All right. We've got a call from The Netherlands I want to get in. So our caller there, what would you like to ask?</s>CALLER: Hi, Riz Khan. Good evening.</s>KHAN: Hi, good evening.</s>CALLER: Happy New Year.</s>KHAN: Thank you.</s>CALLER: My question is, looking at the press, especially CNN's announcement on AIDS issue in Africa, they seem to have so much confidence on the statistical data. And if you look at the Third World countries, you know we don't really have a high confidence level on the data, considering the poor database system there. Why place so much confidence on these numbers?</s>KHAN: Right, OK. Well, actually, I'll put that to Dr. Amathila. Let me ask you about that because we got our figures from United Nations figures, the joint AIDS program there. And obviously, we're putting our faith in that. How accurate can the measurement be of what's going on there now?</s>AMATHILA: I don't think the statistics are accurate because the figures we are having are from</s>KHAN: Well, we want to find out what's happening there and what's being done. We're going to take a short break first, though, so please don't go away. When we return, does the African continent provide any models for Namibia and other countries to follow in fighting AIDS? You can have your questions ready, too, and we'll get to those. First, one of the many comments we've received by e-mail on today's topic.</s>KHAN: Welcome back to Q&A.; That was another of your opinion on our topic, controlling the spread of AIDS in the developing world - particularly Africa, where it's most prevalent. Now we have two guests with us taking your questions. Dr. Max Essex is chairman of the Harvard AIDS Institute and one of the pioneers in researching the disease. We're also pleased to have with us Dr. Libertine Amathila, the minister of health and social services for Namibia. And let's get to some more Q&A;, and here, there's a question in our Internet chat room which I want to put to our guests. It's from Holland. It's come in and says, "Is the price of drugs for AIDS too high for most people living in Africa?" And Dr. Essex, I want to put this to you. What is the reason for the cost? And why is it -- why is there no way of making it a little less costly for those in Africa?</s>ESSEX: Well I think that there's two aspects to this. One is that the cost of treatment of an AIDS patient with what we call triple therapy regimens, the most serious drug combinations that are used in the West, is on the order of $10,000 to $20,000 a year. Certainly, it can and should be less than that, and it will be in the future. But you have to realize that in many countries in Africa where a fifth or a quarter or a tenth of the adults are infected, that leaves relatively few remaining to pay the costs of -- for those drugs. So unless support is obtained from the international community, from the West, I think we're unlikely to see real progress rapidly as we should on making available many of these drugs to people who need them most in Africa.</s>KHAN: Right. Now before I get to Benjamin in London. Benjamin, just hold on. I want to ask Dr. Amathila if there is really that feeling among African leaders that there is something of this east/west divide, north/south divide, you might call it that. And certainly this feeling of a conspiracy that Africa is being left behind -- that, you know, there isn't a care about trying to help the treatment of AIDS in Africa.</s>AMATHILA: Yes, we have a feeling that the West has waited too long to help us with these drugs. Had we received the drugs, say, for example, three, four years ago, we should have stabilized the situation by now. But because up to now we don't have drug treatment, and people are dying. They are leaving orphans behind, and we cannot extend their lifespan. And so, we just feel that they are waiting until the last moment.</s>KHAN: Right. I'm going to get a call in from Benjamin, who's in London with a question here. Go ahead, Benjamin.</s>CALLER: Hello, this is for both the doctors. Now there's a lot of talk about HIV vaccines in the pipeline and drug treatment. And it really seems unrealistic that the West will at the time send people into Africa with these drugs and establish a relationship with the governments. Don't you think a more effective treatment for AIDS would be to actually abstain totally from premarital sex and during marriage to be faithful to one's partner? How long will it take for this message to really get through to human beings that that is the most effective treatment?</s>KHAN: Benjamin? Benjamin, let me first get Dr. Essex's view on this before we go to the minister.</s>ESSEX: Well, I think that there's absolutely no question that education and behavior is the most important thing we can do either in Africa or in Asia or the U.S. or any other place of the world at this particular moment because we can't -- no one has come forward with enough monetary resources to pay the costs of all the drugs that might be needed in Africa. We don't yet have a vaccine, and we probably won't for another four, five, or six years. So right now, that's the only costs we have. At the same time, we have to recognize that people want to have children. That's part of human nature, and it's entirely appropriate and necessary for procreation of the species. And in many instances, it's absolutely impossible to have children while using condoms because one needs insemination with sperm, and condoms don't block HIV unless they also block sperm.</s>KHAN: Right.</s>ESSEX: So for those people who are already adults, who already have lived part of their lives and want to have children, there really are relatively few options available.</s>KHAN: And this is what I want to put to Dr. Amathila is basically what do you use in your fight against the cultural attitudes? How can you persuade people, because it doesn't matter how much money you throw at the problem if the attitudes don't change?</s>AMATHILA: Well, it's an upheaval to change people's attitudes because what we are doing since independence is to talk about change of attitude, and we preach what we call ABC -- abstain -- that is for "A" - - and "B" is be faithful to one partner, and "C," last one, is condoms. But we don't seem to get through. People -- there were also some things from the churches that, you know, condoms should not be used and so and so forth. But I'm not blaming churches. I think people have difficulties to change the attitude. But we are working on it. Particularly we have started also talking to school children, and I hope at least from there on, maybe we'll get some change.</s>KHAN: Right.</s>AMATHILA: But with the adults, it's not possible. I mean, it's a hard -- as the other doctor said, I mean, this is a situation. It's a normal life -- sexual life. And it's very, very hard for couples to use condoms.</s>KHAN: Resiya (ph) is on the line in London with a question. Resiya, what would you like to ask?</s>CALLER: Hello, Riz. Yes, I'd like to say Happy New Year and</s>KHAN: Thank you.</s>CALLER: My question is that an article in the British press today stated that sub-Saharan Africa would have the highest economic growth rate this year. But don't you think that the economy will be adversely affected by the huge financial burden of AIDS?</s>KHAN: Actually, that's something I want to put to Dr. Amathila. That's really one of the key issues, the economic impact on Africa.</s>AMATHILA: Yes. Well, we don't stop what we are doing normally just because of AIDS. We are -- we are continuing with our lives. We are treating other diseases. We are continuing with our economy. We are trying as much as we can, as alongside what we are doing for HIV- AIDS. So the life is not stopping. People are continuing, and I think economy is going to grow.</s>KHAN: We're going to take another very short break. When we come back, we'll see whether our guests view the fight against AIDS in Africa with optimism. Stay tuned for that.</s>KHAN: Welcome back to the program. We've still got a few minutes left for our guests to take your questions on combating the spread of AIDS. Back to our Internet chat room here. We've got a question here that will come in for -- it's coming from Germany. Thanks very much for this. She says, "Will the UN conference also deal with the fate of the orphans left behind by AIDS victims?" I want to put that to Dr. Essex.</s>ESSEX: Well, certainly the issue of orphans was addressed, and there were grave concerns expressed in relation to the orphans by Secretary-General Kofi Annan and a variety of others. How exactly that will be solved remains to be determined. The extent to which all of us throughout the world will mobilize resources to address this issue in Africa for the most part has yet to be determined. I think we need much more action now. I think we need high-level deliberations between governments and different regions of the world. There's much to do.</s>KHAN: I've got a question here that came by Internet e-mail. I want to put this to our minister from Namibia, Dr. Libertine Amathila. It says, "AIDS funding to Africa will need strict monitoring by donors. Such relief usually ends up in private pockets." Your comments on this. It's from Nigeria. I also want to put to you, how do you address these critics who say that really African leaders have let down their people?</s>AMATHILA: No, I think this is an old stereotyping of African leaders, this whole question of pocketing money in our region. There is no possibility to pocket money because the money doesn't go to the ministers. The money is given by programs. And for example, in Namibia, we have national planning commission which controls the money. We have the ministry of finance. So any donor money coming in goes first to these people and it is known, and we just make our projects. And money is released by the ministry of finance, and you've got to justify what you want to do with the money, and then it is controlled. So that question of pocketing money is an old stereotyping of African leaders, at least not in Southern Africa.</s>KHAN: Well, then Dr. Amathila, let me just get your projections -- how optimistic you are on the fight against AIDS and HIV in Africa? To what extent -- what do you see as the worst-seen scenario and what optimism do you have of overcoming it?</s>AMATHILA: I'm actually optimistic because I think that those who are already infected as we are talking, there is not much we can do about them. But the new infections can be controlled because in Namibia, for example, we have decentralized the whole question of HIV- AIDS. It's not only in the ministry of health as it used to be. It is now dealt with generally in public service, in private service. Churches have already come around -- the villages. I mean, everybody now knows about AIDS. So I am hopeful that in the next two years we'll start seeing downstream of the new infections. Of course, as I said, those who are already infected will have to -- we cannot do much about them except treating their opportunistic diseases. And I want to emphasize that what we need really is the vaccines, and what the vaccines which are now being researched, if I'm correct, are not even for Southern Africa sub-group. Sub-group in Southern Africa is apparently C, and the vaccines they are controlling are for sub-group A and B. Therefore, I think we need - yeah.</s>KHAN: Well, let me get to Dr. Max Essex on this. You're one of the pioneering researchers here, Dr. Essex. Do you feel frustration at how much progress hasn't been made in the time up to now? And what do you see as the outlook for a vaccine and perhaps some improvement?</s>ESSEX: Yes, I absolutely do feel frustrated that more hasn't been done. I would like to emphatically second the comment by Minister Libertine that we need to focus most of our attention on making a vaccine on precisely those sub-types of HIV that are most prevalent in the world. And number one is the sub-type C in Southern Africa. So we do need to re-think those projects and emphasize more that particular sub-type of the virus. I think there are, however, examples of countries in Africa where the curve has turned around. Uganda and Senegal are often mentioned as clear examples. There are clearly many examples in Africa where international input and cooperation has been used wisely and honestly and effectively in every sense.</s>KHAN: Right.</s>ESSEX: And I think one of our big mistakes is to consider Africa as a whole as opposed to individual countries, which, as in any other region of the world, vary much from one to the next.</s>KHAN: Well, Dr. Essex, I have to end it there on that note. But I thank you and Dr. Libertine Amathila for joining us as well from Namibia, as well for joining us and taking questions, too. Until next time, we bid you farewell and stay tuned. The news continues on CNN. END TO ORDER VIDEOTAPES AND TRANSCRIPTS OF CNN INTERNATIONAL PROGRAMMING, PLEASE CALL 800-CNN-NEWS OR USE THE SECURE ONLINE ORDER FROM LOCATED AT www.fdch.com