Q&A With Bob Levey
Washington Post Columnist
Tuesday, April 15, 2003; Noon ET
"Levey Live" appears Tuesdays at noon ET. Your host is Washington Post columnist Bob Levey. This hour is your chance to talk directly to key Washington Post reporters and editors, local officials and people in the news.
Today, Bob's guest is Paul Zeitz, executive director of the Global AIDS Alliance.
Zeitz is co-founder and executive director of the Global AIDS Alliance (GAA). The coalition of civic groups includes students, global health advocates, human rights groups, AIDS activists, religious organizations, pop stars, debt cancellation advocates and others who are supporting a campaign to stop global AIDS.
The GAA catalyzes partners in an effort to eliminate the AIDS crisis. It mobilizes public opinion, more money, and far better policies against AIDS and its causes. The GAA is playing a critical role in building a broad-based mobilization on AIDS. It is fostering the development of new policy initiatives and collaborative advocacy campaigns. Learn more about GAA.
Zeitz worked in Africa and resource-poor countries as a public health specialist for over 10 years. His experience ranges across many countries: Nigeria, Uganda, Zambia, Malawi, Kenya, Senegal, Malawi, Niger, India, Guatemala, and Bolivia. In Zambia he worked with the United Nations Special Programme on AIDS (UNAIDS), the US Agency for International Development (USAID) and the Zambian government. He has also worked for the World Health Organization, UNICEF, and the US Centers for Disease Control and Prevention (CDC).
Editor's Note: Washingtonpost.com moderators retain editorial control over Live Online discussions and choose the most relevant questions for guests and hosts; guests and hosts can decline to answer questions.
Bob Levey: Good afternoon, Dr. Zeitz, and thanks for joining us today on "Levey Live." Let's begin with a question about the President's determination to spend $10 billion on AIDS in Africa. Will Congress give him this much money when the war is costing so much? And what exactly will that money buy?
Paul Zeitz: Thanks Bob for addressing the global AIDS crisis on your chat. As you know, the global AIDS pandemic is worst epidemic in human history. Already 20 million people have needlessly died. During his State of the Union Address, President Bush outlined a historic plan for combating the disease in 14 countries, including 12 in sub-Saharan Africa. The plan calls for $15 billion to be spent over the next five years. Unfortunately, the President has not asked for any increased spending in 2003. In the President's 2004 budget request he only requests 5% of the $ 10 billion in new money. We found this request very disappointing, as we hoped that the first year would have provided at least $3 billion. Congress seems poised to approve the President's budget request, although this is far from guaranteed!
Mt. Lebanon, Pa.: Does your organization promote/educate/advance behavior modification? Abstinence. Celibacy. Protection. Monogamous relationships. Aside from blood transfusion, if you don't have unprotected sex with strangers you're very much less likely to acquire HIV and develop AIDS. After all, it makes much more sense -- economic, social, medical -- to bolt the barn door before the horse escapes. This assumes, of course, that the horse is safely in the barn and not out on Saturday night wandering around loose. True?
Paul Zeitz: Thanks Mt. Lebanon for your question. My organization is advocating for a balanced approach between abstinence, monogamy (be faithful), and appropriate condom use for those that are sexually active. We recommend that you always keep yourself protected in one of these three ways!
Bob Levey: Many politicos were amazed to hear George Bush call for a major wave of AIDS spending. Were you?
Paul Zeitz: Frankly Bob I was NOT surprised. I was happy...at least for a few hours. Myself and many AIDS advocates having been calling for a Presidential AIDS Initiative for Africa since the mid-1990s. I was surprised it has taken so long for our leaders to wake up to the devastation and impact of AIDS.
Rockville, Md.: Do you feel that the Bush administration's "war on condoms" is impeding the world's fight against preventing HIV/AIDS? How are you and other organizations working around this issue?
Paul Zeitz: The Bush Administration's policy is to promote the Abstinence, faithfulness, and condoms. There are some very right wing social conservatives that are promoting a primacy of abstinence as the solution. This is a not a consensus view in the Administration. The Administration is focussed on best practices and scientifically proven strategies. There is NO scientific evidence anywhere that I know of that shows that abstinence only programs work.
Bob Levey: You spent many years in Africa as a public health doctor. What was it like when you told individual Africans that they'd have to modify their sexual behavior or risk death? What was the response?
Paul Zeitz: Thanks Bob for this question. I lived for many years in the southern African country of Zambia. 20% of adults are infected and the majority of the population lives on less that $1 dollar per day. I came to understand that when people are living in such utter poverty, they are focussed on meeting their most immediate needs, ie food! When impoverished people are told that they need to change their behavior to prevent a disease that may kill them in 7-10 years, they look back and say, "I'm not sure I'm going to live until tomorrow." We have to deal with the poverty crisis in Africa if ever hope to stop AIDS.
Tucson, Ariz.: Dr. Zeitz, what is it going to take to get Congress to really wake up the fact that AIDS is a true global emergency? I hear some members don't back the Global Fund and that it's running out of money! Is there anything Congress can do? What can I do as a citizen?
Paul Zeitz: Thanks Tucson. You are sitting in one of the most important spots in the US, as your Representative Jim Kolbe chair the House Appropriations Subcommittee on Foreign Operations. In many ways he will decide if and by how much the US will responds to the AIDS crisis.
You mention the Global Fund to Fight AIDS, TB, and Malaria. This is an extremely promising and innovative public-private international partnership designed to scale up the response based on locally determined needs. Unfortunately, the Bush administration, thus far, favors a unilateral approach rather than working through international partnership arrangements. This is a tragedy, as US investments in successful global health initiatives, such as the smallpox eradication program and the global polio eradication program all have shown the benefit of working internationally in partnership.
Bob Levey: Why should an individual donate to a group like yours when the federal government says it's willing to appropriate billions? Isn't there a point where all the money in the world doesn't buy any more progress against a disease like AIDS?
Paul Zeitz: The Global AIDS Alliance is dedicated to holding our leaders accountable for our common values. Small investments in our educational and advocacy efforts are already yielding new multi-billion investments in the global crisis. We are high value for return.
Washington, D.C.: In Africa, HIV/AIDS rates have been found to be higher in girls and women than in men and this has been attributed to the subordination of women. For example, in Zambia, it has been recently reported that HIV/AIDS rates are higher in girls than in boys of the same age, due to the abuse of these girls by older men. The government has been blamed for exacerbating this problem with indifference. What can be done to ameliorate HIV/AIDS when much of its spread may be linked to the low status of women or cultural norms that people may hold dear and see as their own. For example, many people don't see certain behaviors correlated to the spread of HIV/AIDS as unhealthy or immoral or retrogressive, even when women or girls, for example may be duly oppressed under these norms. Additionally, in scenarios where people do not want to stop retrogressive behaviors affiliated with the spread of HIV/AIDS, are NGOs, nations, etc., being asked to throw money away at persons who could have avoided HIV/AIDS?
Paul Zeitz: Women are affected more severely than men in Africa and other impoverished nations. In Zambia where I lived, I learned that many young women were forced into dangerous sexual behavior in order to feed their family or pay school fees. In other words, it was poverty-driven sex. For examples, girls would come out on the road to offer sex for money to truckers twice per year....when they had to pay school fees. Now we need to ensure that the World Bank and African governments eliminate schools fees as this is driving the epidemic.
Massapequa Park, N.Y.: I see on your Web site you advocate debt cancellation as a way of helping countries fight AIDS. But I thought the debts of poor countries were cancelled a few years ago. Do I have that wrong? And how would this help, really?
Paul Zeitz: Through the efforts of the Jubilee Campaign in the late 1990s leading to 2000, there was a expanded debt cancellation program administered by the World Bank and the IMF called the Enhanced Heavily Indebted Poor Country Initiative. This did increase debt relief for a limited number of countries. However, by the World Bank's own analysis debt sustainability has not been achieved.
In 2001, African governments paid $13.5 billion in real dollars to the IMF, World Bank, and the wealthy nations. This is outrageous in the face of AIDS, where there are no IV fluids in hospital, no drugs, and no school books for children.
The Bush Administration is not doing anything about debt relief in Africa. They have shown that debt relief can be implemented when it serves political purposes, ie Pakistan after 911 and now Iraq.
Bob Levey: The most famous person in the world who's HIV-positive is the basketball star, Magic Johnson. Yet Johnson has done very little to lend his name and face to AIDS prevention efforts. Do you think he could and should have done more? Do you think this would have helped?
Paul Zeitz: Magic Johnson has done a lot to bring a human face to the problem. His Foundation is doing a lot of great work for at risk groups here in the US. It would be great if he would bring his leadership into the global crisis more aggressively.
Bob Levey: In a recent piece about AIDS in the New Yorker, Michael Specter wrote: "You can't just walk up to a stranger--in Uganda or Utah--pull out a clipboard and begin to ask about his sexual habits or health history. First, you have to lay the groundwork." Is this being done in the Third World? Or is sex still such an electric, personal subject that all sides are reluctant to see this done?
Paul Zeitz: Sex is a highly personal and private subject. Especially, it Africa, it is taboo to discuss sex except with a designated family member. However, things are changing rapidly. Africans are keen to stop AIDS and usher in the African renaissance. I've worked with many young people who are willing to talk openly about sex. More recently, I was interacting with religious leaders in Africa who were privately asking me questions about different sexual practices. While I was shocked at the time, I rejoiced in the new open dialoguing that is emerging.
St. Petersburg, Fla.: Dr. Zeitz -- I hear Congress just approved a multi-billion dollar package of assistance to countries that are relatively wealthy (like Turkey, Egypt, etc.). All this at a time when AIDS programs are starved for resources! What will it take to get Congress to see AIDS as a true security threat?
Paul Zeitz: Thanks St. Petersburg. Your representative Bill Young is the Chairperson of the House Appropriations Committee. He determines how our tax dollars are spent. It is up to citizens like you to meet with him and to encourage him to spend our resources to combat AIDS. You are right that the AIDS response in vastly underfunded. The global experts say we $10 billion per year to provide prevention, care and support, and lifesavings treatment with antiretroviral drugs. Last year only about $2 billion was spent....this is only 1/5th of the global need. No wonder the HIV virus continues to spread rapidly!!
Bob Levey: Serious question: Why don't women in the Third World refuse to have sex with men who might be infected? Why isn't it better to be alive (and childless, and perhaps economically ostracized) than it is to be dead?
Paul Zeitz: There is a serious struggle for many women in Africa and the impoverished world. They struggle for basic human rights and they struggle for power within their societies, communities, and families. Men often dictate when and where women will have sex. This is wrong and women need to be provided with the tools, education, and power to ensure that sex is consensual. They don't always have to power to say no. They don't always know if the man in their life is positive or negative.
San Francisco, Calif.: Why spend $10 billion in Africa when we have a continuing crisis in this country? The recent media story about "bug chasers," young men who have unprotected sex to join this morbid fraternity of HIV positive men, is only the latest manifestation of this problem. I, and my fellow U.S. citizens, have paid our taxes. On all of the days to be talking about taking our hard-earned cash and shipping it overseas, what, if anything, have you done to stem AIDS in the United States?
Paul Zeitz: There are many reasons why we should be taking leadership in the global fight against AIDS. As Americans, we are the wealthiest nation in human history. We have the drugs and strategies to stop the HIV virus. We have a moral obligation to uphold human rights and the pillars of democracy...life, liberty and the pursuit of happiness. The World is looking at us and asking how we can ignore the poverty and devastation being experienced. 40% of AFrican children are malnourished while 40% of American children are obese.
While we invest in the global crisis... we also can and must invest more in stopping the virus in high risk groups in the U.S.
Ultimately we will all be affected or infected by the global AIDS crisis.
Bob Levey: Why have so many children in Africa become infected with AIDS?
Paul Zeitz: During pregnancy, childbirth and through breast feeding a child can become infected with HIV. About one-third of children born from HIV-positive women in Africa are HIV-positive. In the US, transmission from the mother to child has been virtually eliminated through the widespread use of lifesaving antiretroviral drugs.
Louisville, Ky.: I have brought up the global AIDS issue at my church. People are usually eager to learn more, but sometimes I get a response like, "well, what about our own country? how can we be sending help abroad when we have our own to take care of?" Not sure how I should respond to that. Can you advise me on that?
Paul Zeitz: Thanks Louisville for this great question. We have put ourselves in context. The global economy is $30 trillion per year. The US share is $10 trillion per year. The US government budget is several trillion per year. We are asking for $3.5 billion per year as a US fair share of the global response based on our relative wealth. This level of funding is very very small compared to other things that we choose to spend money on. We could be saving millions of lives per year for a relatively small investment.
Mount Rainier, Md.: The President called his proposal on global AIDS an emergency package. But if that's the case why did he postpone full funding of it until several years from now?? It's an outrage! When people are dying of AIDS, the President backs a go-slow approach!
Paul Zeitz: Thank Mt. Rainier. The President have used his bully-pulpit to advocate for more funding. His budget requests are less ambitious as you say...he is backloading his significant funding increases until 2007-8...this is wrong. Only if citizens like you become involved can we hope to change our leaders' policy. Please join the Stop Global AIDS Activist network at www.stopglobalaids.org
to do more!
Bob Levey: How many deaths are we talking about, worldwide, in the next decade if AIDS medication isn't widely available? One hundred million?
Paul Zeitz: Already over 20 million people have died of AIDS. Another 3 million are projected to die during 2003. Left unchecked, experts estimate that there will be 100 million infections by 2010 with at least a doubling of the number of people that will have needlessly died. Those dying in Africa are the economically productive parents...there loss is destroying families, communities and societies.
Bob Levey: AIDS began as a disease of, by and for homosexuals. It has since become a disease of intravenous drug users, surgery patients and heterosexuals, too. How does this affect the politics of this disease? Is it easier to raise money when the "field of victims" is wider?
Paul Zeitz: AIDS was branded as a gay disease and we are still trying to transcend the stigma associated with that. Many of our policymakers are still learning that the disease is primarily spread heterosexually......
Bob Levey: We live in a country that values American lives a whole lot--probably more than we value the lives of others. For example, whenever a plane crashes somewhere on the other side of the globe, the second paragraph of the story will always tell you how many Americans perished. Given this history and attitude, is it really possible for Americans (and American legislators) to muster as much of a damn about 25 million African deaths as it would be if those deaths were American?
Paul Zeitz: There are the moral and humanitarian perspectives which I've already described.
There are also self-interest perspectives which should be considered. As AIDS spreads rapidly throughout the World the virus continues to mutate and adapt--it is wholly possible that a more virulent strain could be re-introduced into the US. Also, many AIDS patients in poor countries become infected with tuberculosis. TB is rebounding around the world...with multidrug resistant strains....this have already been seen in the US and could spread.
The other self-interest is global security. The National Intelligence Council has already reported that heavily affected countries are susceptible to collapse of governments. More and more places will be able to harbor terrorists and other subversive forces....Our own government is predicting this.
Midwest: I guess I have become so wary and cynical, especially in light of some major scandals in our own big non-profit agencies. How do we know that the money raised or allocated IS going to those who need it and not someone's yacht fund and especially in third world countries where most of their governments are corrupt?
Paul Zeitz: This is a great question. As we program more money we have to ensure that the money is spent for the right purposes. The Global Fund to Fight AIDS, TB, and Malaria is innovating, for example, they are hiring a top 5 accounting firm in each of the 85 countries where they are working to oversee the use of the funds.
Bob Levey: Please analyze the economics of AIDS as they're being viewed from the boardrooms of American drug companies. Is there money in AIDS prevention?
Paul Zeitz: American pharmaceutical companies do not have a large market in Africa. They need to change their policies and allow for the generic manufacture of lifesaving drugs so that best world prices can be buy the drugs needed for the largest number of people. UN experts estimate that 5 million African are medically eligible for the antiretroviral drugs. Guess how many are currently receiving them?
ANSWER: Only 50,000 people or 1% of the need. This is mass-murder by complacency!
Chicago, Ill.: When I think of Africa I think of hunger, no access to clean water, little access to education for children. You advocate action on AIDS -- but don't we have to somehow take care of these other issues FIRST?
Paul Zeitz: Thanks Chicago! You are right there are a lot of other problems to be dealt. I don't believe that we can prioritize access to education or access to clean water over dealing with AIDS. We need to all of them and we need to do them NOW. We have the global wealth, we have the global know-how....What we are missing is the will...and the political will to do it! We need your help to call on our policymakers to take real action now. Enough of the talk...let's get on with action!!
Bob Levey: Many thanks to our guest, Dr. Paul Zeitz. Be sure to join us next Tuesday when our guest on "Levey Live" will be author Ann Crittenden. Her latest book is called "The Price of Motherhood."
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