RICHARD HOLBROOKE
July 13, 2000

U.N. Ambassador Richard Holbrooke addresses the international response to the AIDS epidemic in Africa. The Health Unit is a partnership with the Henry J. Kaiser Family Foundation.

Online Special: The AIDS Crisis July 12, 2000: The Staggering levels of AIDS. July 10, 2000: International AIDS Conference July 6, 2000: Botswana has one of the highest rates of AIDS in the world May 2, 2000: AIDS as a national security threat Aug. 31, 1999: Tracking AIDS in America June 3, 1999: Mbeki wins election Dec. 2, 1998: AIDS rate on the rise in South Africa July 24, 1996: A Newsmaker interview with Thabo Mbeki Browse the NewsHour's coverage of Africa and health.     Medical Research Council of South Africa Science Magazine South African government World Bank resources on HIV/AIDS World Health Organization resources on HIV/AIDS	SUSAN DENTZER: This week's international AIDS conference in South Africa has focused renewed attention on the scope and consequences of the global pandemic. SANDY THURMAN, White House AIDS Adviser: This epidemic in South Africa and around the world is out of control. The numbers are staggering, and we all ought to be mobilizing to do more. SUSAN DENTZER: Nearly 34 million people worldwide are infected with HIV, the virus that causes AIDS. A total of 25 million are in Africa, where more than 11 million have already died of AIDS. As a result, the pandemic has begun to reverse three decades of social progress in this and other parts of the developing world. In the nine hardest-hit African countries, AIDS has already caused a sharp drop in life expectancy. Between now and 2015, the disease is expected to shave 17 years off projected life spans, cutting them to an average of just 47 years by 2015. Along with the human tragedy are the economic consequences of wiping out much of an entire generation of Africans. A new World Bank report describes the consequences starkly. "The illness and impending death of up to 25 % of all adults in some countries will have an enormous impact on national productivity and earnings…Resources that would have been used for health care, orphan care and funerals…The loss of human capital will affect production and the quality of life for years to come." PETER PIOT, Executive Director, UNAIDS: AIDS has now to become the heart of the development agenda. There's no way we can hope for sustainable development without containing AIDS. SUSAN DENTZER: For all these reasons, awareness has grown that AIDS also poses a serious threat to global security and stability. At the United Nations General Assembly last September, President Clinton described how the U.S. was finally moving to help put the issue on the world's diplomatic front burner. PRESIDENT CLINTON: (September 21, 1999) We've begun a comprehensive battle against the global AIDS epidemic. This year I'm seeking another $100 million for prevention, counseling, and care in Africa. SUSAN DENTZER: Now the Clinton administration is preparing to add another $250 million this year for AIDS care and prevention in Africa. That's part of a multibillion- dollar program to be undertaken by the U.S., the World Bank, and the United Nations. America's ambassador to the UN, Richard Holbrooke, has been tapped as a major administration spokesperson on the international AIDS crisis. On his recent trips to Zimbabwe and other African countries, he's highlighted AIDS prevention in particular as a key concern, noting that ten times as many Africans are dying of AIDS as are dying in prolonged wars in the Congo, Ethiopia, and Angola.
	"The biggest problem in the world"
	GWEN IFILL: Joining us now for more on the international response to the AIDS pandemic in Africa, UN Ambassador Richard Holbrooke. Ambassador, welcome back to the program. RICHARD HOLBROOKE: Thank you, Gwen. GWEN IFILL: You have said that AIDS is the number one issue in the world today, the number one issue. Can you elaborate on that? RICHARD HOLBROOKE: I came to this conclusion because people ask me always, "what's the biggest problem in the world," expecting an answer like the Mideast or nuclear proliferation. There are dozens of big issues. But the level of the AIDS crisis, its potential to destroy economic achievement, undermine social stability and create more political uncertainty and the inability of the rest of the world to contain it on only one continent, because it can't be sealed off in Africa-- it's already spreading elsewhere in the world, particularly the subcontinent of India and Pakistan-- is so enormous. The health people think it's the worst health crisis since at least six, seven centuries. And this isn't just a health crisis, so that is my considered judgment. GWEN IFILL: And today the United States Agency for International Development released a report saying that 28 million African children will lose one parent by the year 2010. What's your reaction to that? RICHARD HOLBROOKE: More evidence of what we've been talking about, and I'm very pleased that the Durban Conference and programs like yours and Ed Bradley's wonderful CBS "60 Minutes" show two weeks ago and the series in all the newspapers are forcing people to done confront it. I'm very pleased that members of both Houses of Congress, both parties are putting in amendments and resolutions increasing the amount of resources we're going to devote to this issue. But the answer's not going to lie in resources from the West alone. It's going to take destigmatization in the countries of Africa and leadership from the African leaders and other leaders and an end to the denial in which many countries in the world argue that it isn't their problem. You know, Gwen, on Monday of next week, the Security Council will vote the first Security Council resolution in history on a health issue, and it will be on AIDS, but not just in Africa. It will be an instruction to the UN that all peacekeepers have now got to be deeply, more deeply involved in how to prevent AIDS from spreading. You know, UN peacekeepers have often brought peace to an area but spread AIDS or brought it home. But the interesting thing to us is that several countries came to us in the last few days, as we were negotiating this resolution and said, "this is great for another part of the world, but it doesn't apply to us." That kind of denial is the way to real problems. GWEN IFILL: What you're asking for, I gather, is testing of UN peacekeepers before they go abroad, something you can't impose on another country. So what effect could that have on the overall problem? RICHARD HOLBROOKE: Well, let me be clear. The resolution cannot mandatorily require countries test their peacekeepers. That is something each country must do for them itself. The United States does not send any soldier overseas unless he or she has been tested and if they test HIV-positive, they're kept in the states for treatment. That is not true of every other country in the world by a long shot, and the UN does not have the authority to impose that on other countries. But we can insist that, once they get in to the UN peacekeeping forces, condoms are made available, counseling is made, vigorous and aggressive, and that it become a core part of the UN activities. Otherwise we're in the anomalous and ironic position of spreading AIDS while trying to prevent conflicts.
	The international response
	GWEN IFILL: How did this ever problem, which every day we're hearing new and more horrible statistics about what's happening on the African continent in particular. How did this remain unaddressed internationally for so long? RICHARD HOLBROOKE: You'll have to ask yourself and your colleagues that. In August of 1992 as a private citizen, I went to Cambodia to visit friends there and to see the UN operations. I was so astonished by what I saw and what my son, who had spent the night kind of prowling the streets of Phnom Penh saw, that I wrote a letter to the UN as a private citizen saying, "I don't understand this -- the UN peacekeepers are spreading AIDS on the streets." I never got a reply. That was eight years ago. If I changed the word Cambodia to Africa, it would apply today. GWEN IFILL: But are there not also cultural hurdles which have to be overcome on the continent of Africa and many countries where talking about sexually transmitted diseases is still a taboo? RICHARD HOLBROOKE: Gwen, there are cultural issues everywhere. Let's not stigmatize one continent. You and I can both remember when people in the city of New York would not get in a taxicab if the drivers looked like they came from a certain Caribbean island. People wouldn't go to certain restaurants, people didn't know how the disease was spread and thought you could get it from a handshake. And that was in the United States just a few years ago, and we have the best communications and education system in the world. It is certainly true that in Africa, the cultural factors are much greater. For example, we know that women who are HIV-positive should not breast feed because they can cut the transmission rate enormously. The cultural pressures are that they must breast-feed and it's also an economic necessity. Education and communications are the key. The prime minister of Mozambique, Dr. Mukumbe, the only prime minister on the continent who's also a doctor, told us when he came to visit us in New York, that he tried to find out the local name for AIDS among the tribal languages of Mozambique and found to his horror that the African tribes, many of the African tribes in his country, Mozambique, called it the disease of women. Well, once you call it the women's disease, you've lost at the outset. So education is essential. And that must overcome cultural factors, which, let's be frank, exist in the U.S., as well. GWEN IFILL: Does the concern of people like the prime minister of Mozambique, does that offset the kinds of setback which a lot of AIDS activists feel happened as a result of the comments made by President Thabo Mbeki of South Africa? RICHARD HOLBROOKE: Well, I think each country has to be dealt with on its own merits. Uganda, Senegal, and Thailand are three countries where the rate has dropped substantial because of strong leadership and openness and candor. In South Africa, what has happened is a huge controversy has broken out. I have followed this from the beginning and talked to President Mbeki several times. I know he's sincere in wanting to deal with the AIDS epidemic, and I think that this controversy that has exploded around his comments may not be quite as damaging as we all think it is. I know this is a counterintuitive judgment, but I say that because I'm watching the coverage you all have giving it. And the coverage is highlighting the problem. And that is what's needed to be done. So while I certainly don't think there's any question about the causality here, HIV leads to AIDS, full stop, period -- but the debate, this controversy may not hurt us as much as we think.
	Changing sexual behavior
	GWEN IFILL: The United States is prepared to spend many million dollars more than it has been on AIDS in Africa, but still a fraction of say $1.6 billion that it's spending on anti-drug efforts in Colombia. Does that speak to our priorities? RICHARD HOLBROOKE: It's not a question of priorities. The Colombia drug issue is a huge problem. But AIDS is beyond the level of any other problem in the world today. No one country, no one set of pharmaceutical companies, no one answer exists. It's a multi-phased war across the board. I am delighted that President Clinton and Vice President Gore have led the tripling of our efforts. I'm even more pleased that members of Congress from both parties, Senator Helms chaired a hearing on this yesterday in which 11 Senators came to discuss this issue. Both parties, bipartisan, were all moving to address it. But I want to stress this: After you cut away all the other issues, it's going to take leadership and destigmatization by the leaders of Africa themselves, and meanwhile we have these appalling wars going on all over the continent, which are diverting resources and contributing, by the way, to the spread of AIDS. It's a terrible tragedy. GWEN IFILL: And finally, Ambassador Holbrooke, is there any way of knowing how a government or a collection of governments in the form of the United Nations can actually change something as basic as sexual behavior? RICHARD HOLBROOKE: I'm sorry. You want to know whether the UN can change sexual behavior? That's beyond my ability. What I think we have to do is recognize that education, massive education of how the disease is spread and destigmatizing it so people don't pretend that it's something that it isn't, is necessary. I don't think you can change human nature, but maybe you can change human practices and human understandings. It started in this country, it's got to be relentless. Let us not kid ourselves. The media is finally paying attention to this. I congratulate you and your colleagues for doing this, but the problem is not going to go away, and I hope the media doesn't go away either, because you, you are the key to breaking through in on this issue. GWEN IFILL: Ambassador Holbrooke, you for joining us. RICHARD HOLBROOKE: Thank you.