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37th PARLIAMENT, 2nd SESSION

Standing Committee on Foreign Affairs and International Trade

EVIDENCE

CONTENTS

Tuesday, April 1, 2003

0910

The Co-Chair (Mr. Bernard Patry (Pierrefonds—Dollard, Lib.))

Mr. Stephen Lewis (Special Envoy of the Secretary-General of the United Nations on HIV/AIDS in Africa, As Individual)

0915

0920

0925

0930

The Co-Chair (Mr. Bernard Patry)

Mr. Keith Martin (Esquimalt—Juan de Fuca, Canadian Alliance)

0935

Mr. Stephen Lewis

0940

The Co-Chair (Mr. Bernard Patry)

Mr. Yves Rocheleau (Trois-Rivières, BQ)

Mr. Stephen Lewis

0945

Mr. Murray Calder (Dufferin—Peel—Wellington—Grey, Lib.)

0950

Mr. Stephen Lewis

0955

The Co-Chair (Mr. Bernard Patry)

Ms. Alexa McDonough (Halifax, NDP)

Mr. Stephen Lewis

1000

1005

The Co-Chair (Mr. Bernard Patry)

Mr. Stephen Lewis

The Co-Chair (Mr. Bernard Patry)

Mr. John Godfrey (Don Valley West, Lib.)

Mr. Stephen Lewis

1010

The Co-Chair (Mr. Bernard Patry)

Mr. Bill Casey (Cumberland—Colchester, PC)

Mr. Stephen Lewis

1015

Mr. Bill Casey

Mr. Stephen Lewis

The Co-Chair (Mr. Bernard Patry)

Mrs. Karen Kraft Sloan (York North, Lib.)

1020

Mr. Stephen Lewis

Mrs. Karen Kraft Sloan

Mr. Stephen Lewis

Mrs. Karen Kraft Sloan

Mr. Stephen Lewis

1025

The Co-Chair (Mr. Bernard Patry)

Mr. Keith Martin

Mr. Stephen Lewis

1030

Mr. Keith Martin

Mr. Stephen Lewis

The Co-Chair (Mr. Bernard Patry)

Mr. Mark Eyking (Sydney—Victoria, Lib.)

Mr. Stephen Lewis

1035

Mr. Mark Eyking

Mr. Stephen Lewis

Mr. Mark Eyking

Mr. Stephen Lewis

The Co-Chair (Mr. Bernard Patry)

Mr. Stephen Lewis

The Co-Chair (Mr. Bernard Patry)

Mr. Yves Rocheleau

Mr. Stephen Lewis

1040

The Co-Chair (Mr. Bernard Patry)

Mr. André Harvey (Chicoutimi—Le Fjord, Lib.)

1045

Mr. Stephen Lewis

1050

The Co-Chair (Mr. Bernard Patry)

Ms. Alexa McDonough

Mr. Stephen Lewis

The Co-Chair (Mr. Bernard Patry)

Mrs. Karen Kraft Sloan

Mr. Stephen Lewis

1055

The Co-Chair (Mr. Bernard Patry)

CANADA

Standing Committee on Foreign Affairs and International Trade

NUMBER 027

2nd SESSION

37th PARLIAMENT

EVIDENCE

Tuesday, April 1, 2003

[Recorded by Electronic Apparatus]

¿ (0910)

[English]

The Co-Chair (Mr. Bernard Patry (Pierrefonds—Dollard, Lib.)): With your permission, we're going to start these two orders of the day. The first one is pursuant to Standing Order 108(2), consideration of a dialogue on foreign policy of the Minister of Foreign Affairs. Then pursuant to Standing Order 108(2), consideration of the urgent matter of the humanitarian catastrophe in the African states, the subcommittee is looking in more depth at the humanitarian and other crises underway in Africa.

We have the pleasure of having as a witness this morning Mr. Stephen Lewis, who is the Special Envoy of the Secretary-General of the United Nations on HIV/AIDS in Africa.

From 1984 to 1988, Mr. Lewis was Canadian ambassador to the United Nations. In that capacity, he chaired a committee that drafted a five-year UN program on African economic recovery. He also chaired the first international conference on climate change, which drafted the first comprehensive policy on global warming. He was first appointed as special representative for UNICEF in 1990. In that capacity, he spoke and travelled regularly, acting as spokesperson for UNICEF's passionate advocacy of the rights and needs of children, especially children of the developing world. From 1995 to 1999, Mr. Lewis was deputy executive director of UNICEF. In June 2001, the UN Secretary-General, Kofi Annan, appointed Mr. Lewis as his special envoy for HIV/AIDS in Africa.

Chairing the meeting with me this morning, I have Mr. Irwin Cotler, who is the chair of the Subcommittee on Human Rights and International Development.

Mr. Lewis, the floor is yours. Welcome to our committee. Merci beaucoup.

Mr. Stephen Lewis (Special Envoy of the Secretary-General of the United Nations on HIV/AIDS in Africa, As Individual): Thank you, Mr. Chair. I much appreciate the opportunity. I was reflecting that in a somewhat curious fashion, in all the years I have been involved in Canadian activities, this is the first time I've appeared before a parliamentary committee, so I am entirely in your debt.

I want to make some informal observations, if I may, and then engage, obviously, in the discussion that will follow. I'll try to give a thumbnail sketch of the issues, which will not be unfamiliar to most of you, and end with a particular recommendation for public policy in Canada on which we can proceed.

Maybe I could take just a moment, odd though this may seem, to tell you what I do, since it may help the context of the discussion. I spend a great deal of my time in advocacy, and as a helpful friend of numbers of African countries where the prevalence rate of HIV/AIDS is particularly high, I travel from time to time to the African continent. I meet with the political leadership, meet with the leadership of civil society, meet with increasing frequency with the religious leadership, always meet with the associations of people living with AIDS, meet with the resident diplomatic community, and of course meet with the United Nations community. I attempt to spend, always, at least 50% of the time in the field seeing programs and projects on the ground.

Then I come back to New York and have the extraordinary privilege of reporting directly to the Secretary-General, who, remarkably enough, always seems to be available to discuss matters relating to the pandemic. Even in the midst of the present international crisis he does that and would continue to do it. I try to pursue with him questions of the emphasis that might be given to further initiatives the United Nations might take, the way the United Nations family is reflecting public policy in the various countries where they're active, etc.

I've been doing this job for almost two years--and, by the way, it's a part-time role, not a full-time role--and I wanted to make one passing comment at the outset. Canadians, being intensely generous and responsive in these fields of international compassionate concern, got in touch with me on a number of items when I was appointed. It was more than I could cope with, given some of the international stuff, so I actually approached CIDA directly and asked them for some help to deal with the Canadian part of the portfolio, to hire someone, part-time at least, to be able to support the responses to Canadians. CIDA did that, and did it kindly and quickly, and I want to acknowledge that in the presence of the committee.

What have I learned in the process? First, that the pandemic is overshadowing anything we know in human history, that nothing is comparable, not the 14th century Black Death nor all the loss of life, both military and civilian, in the two world wars of the 20th century. Nothing can begin to compare to the dreadful consequences of the pandemic. People now talk about a hundred million deaths down the road. I don't doubt that for a moment. The numbers may rise even higher than that.

As you know, number two, the pandemic reflects a selective decimation of the productive age group, people between 15 and 49, so you have an extraordinary skewing of population in the countries with which I'm familiar, primarily in Africa, of course. You have large numbers of people who are older and large numbers of kids who are younger, and the population in the middle gradually atrophies.

You know the numbers as well as I do. I've brought the most recent AIDS epidemic update for the end of 2002. The total number of people living with HIV/AIDS at that time were 42 million internationally, people newly infected were 5 million, the numbers of deaths were over 3 million, and that's in the year 2002 alone. All you need do is make an arithmetic extrapolation of those figures, and one can see the toll cumulatively that is taken on the human community.

¿ (0915)

Africa has suffered almost 20 million deaths. It has over 3 million new infections every year. It has over 2 million deaths every year. It now has some 14 million orphans attributable to AIDS; in Africa, “orphans” are defined as children suffering the loss of one or both parents. The figures are statistical abstractions, of course, but behind them there lies a community and family disaster that is, frankly, beyond my comprehension as I travel.

I think it's worth pointing out at this point that the millennium development goals, on which the world agreed to apply to the year 2015--and I know they have been discussed by this parliamentary committee or both these committees--will simply not be reached in virtually any country where the prevalence rate is above 5% to 7%, which is the take-off point.

In many countries in southern Africa the millennium development goals are in reverse. Infant mortality rates are going up. Maternal mortality rates are going up. Life expectancy is going down so dramatically that it takes your breath away. There are numbers of countries whose life expectancy should be 60, and it has dropped to literally 39 or 40 in the period of one decade. You can just get a sense, therefore, of what happens when your population is so profoundly and disproportionately altered.

Number three, at the heart of that disproportion lie women. For me, it's the single most emotional and distressing manifestation of the pandemic, that there is this kind of reverse Darwinian natural selection focused on women. They now represent 50% of the infections throughout the world. In Africa, close to 60% of those who are living with AIDS are women. If you look at the age category 15 to 24, nine million people, 67%, are women. There has never been such an assault on one gender as there is in the instance of this communicable disease.

It speaks to massive gender inequality, of course. It speaks to all of the underlying realities such as lack of property and inheritance rights and carrying the entire burden of care. The women who are sick themselves look after others who are sick and dying, look after the orphans, don't have any kind of economic benefit, and of course suffer a sexual subservience that is annihilating. The inability to say no to sexual overtures, the inability to tell a man to wear a condom, the inability to exercise sexual autonomy, the degrees of sexual violence, the predatory male sexual behaviour, intergenerational sexual behaviour, older men-younger women, it all spreads the virus.

Incredibly enough, perhaps the greatest single danger of infection for women in the high-prevalence countries of Africa now is so-called monogamous marriages. Monogamy has to work both ways, and in Africa it doesn't. Women who think they're in monogamous marriages are frequently infected.

It brings me to the fourth simple point of what I've learned. Gradually this erodes sector by sector. In December I was in Lesotho, Zimbabwe, Zambia, and Malawi. I went back to the same four countries in January to take a look at the connection between hunger on the one hand, the food shortage, and HIV/AIDS. What I learned, what we as the United Nations community learned, was that this so-called famine, these food shortages, was not being driven by erratic rainfall and drought, as was normally assumed, but by the AIDS pandemic. It was the numbers of farmers who had died, the agricultural workers who had died, and the diminution in productivity: 7 million agricultural workers since 1985, another 16 million forecast by the Food and Agricultural Organization by roughly 2020, overwhelmingly women again. This is such a human rights assault on the rights of women in every single manifestation. So you see sectors breaking down, with not enough people to grow the crops or to take them to market.

¿ (0920)

I met with the agricultural minister of Zambia a few weeks ago--a very bright, able, energetic man. He said, “Stephen, I had a meeting with the European Community last week. They brought a delegation of 10 members; I went alone”. I said, “How do you meet the European Community alone?” He said, “Frankly, so many of my senior staff have died or are ill that I had absolutely no one to take with me”.

I think it's important we try to understand how the erosion of whole sectors cumulatively frays and shatters the society. You have agriculture, and then you have education. And in Zambia, over 2,000 teachers are dying every year. They're graduating fewer than a thousand from teachers' colleges.

It's a constant effort to hold sectors together. We know what's happened to the health sector, the private sector, the army, the security apparatus of the state. There things cascade.

Finally, the fifth point in what I've learned is the question of the orphans, these millions of kids for whom orphan care is now predominantly by grandmothers. When the grandmothers die, you then end up with sibling families, with child-headed households. The orphan problem is the area where we are most stymied, Mr. Chair. We are really frantic about how to respond to the orphans. It seems the most intractable of the problems.

Let me move on as quickly as I can. What have I absorbed about what I have learned, and what theme would I like most pronounceably to convey to the committee?

First, that we know how to turn it around. While the language is apocalyptic--as I have already been--and there is a sense of catastrophe everywhere because you're surrounded by death and the imminence of death all the time, the fact is we know what to do about care, prevention, and treatment, and we could turn this pandemic around in a few years if we were able to summon the energy and mobilize the resources and the response. There are so many initiatives, projects, programs, and models all over the continent that work at the grassroots and community level that we should never be defeated by the sense of being overwhelmed.

Second, the tremendous resilience in Africa is something I hope the committee recognizes. This is a continent where there is tremendous knowledge, resilience, and solidarity at the community and family level, particularly amongst the women who are still alive and active. It should never be depreciated. It's an enormous strength of Africa. I've been going back and forth from Africa now, a continent I love, for 44 years. The resilience and capacity at the community level is something to behold.

Third, all over the continent now, alas, there are groups of people living with AIDS. They're extremely courageous, coming out publicly, dealing with stigma, dealing with isolation and ostracism, but determined to spread the word and do the education. These people living with AIDS have a great deal of expertise. They know more about the pandemic than absolutely everyone else, and gradually governments are understanding that.

Fourth, the governments themselves are more and more committed. The period of denial and silence ended at the end of the 1990s, and we now have governments that are determined to do something about rescuing their societies. They use very cataclysmic language. In Botswana, they use the word “extinction”. In Lesotho, I heard the word “annihilation” from the most senior of political leaders. They are very frantic about what they may be facing, but they are deeply and formidably engaged.

¿ (0925)

What must happen is that we take the responses to scale. We must generalize the community responses throughout the country. If we were able to do that, millions of lives would be saved. It is partly a matter of human resources, partly a matter of infrastructure, but it is overwhelmingly a matter of financial resources. If we had the dollars, we could prolong and save millions of lives, and everyone knows it. The greatest frustration and exasperation is to move around and not have the dollars.

It leads me to the last major thing, Mr. Chair, and then I'll wind this up. Thank you for your indulgence. It has to do with a concrete recommendation.

I think internationally there is broad and growing agreement that the best vehicle to respond to the pandemic now is the global fund on AIDS, tuberculosis, and malaria--overwhelmingly focused on AIDS. It's a new multilateral financial instrument. The UN Secretary-General was its patron. It was formed in 2001. It got going in the middle of 2002. It has a board of developed nations, developing nations, NGOs, people living with AIDS, and private sector representation.

It's a fascinating process. It's not perfect, but it's fascinating. At the country level, under something called the CCM, the country coordinating mechanism, governments, in conjunction with civil society, the diplomatic community, and the UN theme groups, get together and fashion proposals. The global fund will not accept proposals that are initiated by governments only. They have to be collective so they reflect the community as a whole. The proposals come forward. They are assessed carefully by a technical review team. Then they are approved or disapproved, in whole or in part.

Kofi Annan asked for $7 billion to $10 billion a year for the global fund. We're nowhere near that. We received between $2 billion and $3 billion over four years from government, which I think is a monumental default on the part of the rich countries.

The fund is running out of money. It has done two serious rounds. It has another round scheduled for this fall. It doesn't have the money, yet they're doing remarkable stuff. They have 160 programs in 85 countries. Of those, 60% are in Africa and 60% are on AIDS. Half the programs are dominated by government, half are run by NGOs. Half are on drugs and commodities, half are on behaviour change and prevention. It's really an excellent amalgam of response.

In the process, anti-retroviral treatment will triple beyond the numbers who are being treated now in Africa. There'll be 2 million more people on tuberculosis treatment. There'll be 16 million more malaria nets over the next four years--four times the number in place at present. What the global fund is doing in the area of communicable diseases is profoundly to be appreciated.

Canada has provided $100 million U.S., roughly $150 million Canadian, over four years--2002 to 2005. Using that period for Canada, let me suggest to you what I think should be happening.

For the year 2003, the global fund needs $2.5 billion. Canada's share of that should be $55 million. We have pledged thus far for the year 2003, including some few million left over from 2002, a total of $33 million--this is in American dollars. So we are for the one year $22 million U.S. short--roughly $30 million Canadian.

Let me take it to the larger picture, because things are moving exponentially.

Between 2003 and 2005, for those three years, the global fund estimates a need of $14.5 billion. Canada's share would be $315 million overall, and our shortfall is roughly $230 million, which means our shortfall is around $350 million Canadian for 2003, 2004, and 2005. We have to at least triple the contribution we made.

¿ (0930)

How are the figures determined? The global fund targets are determined in the best possible way. They're based on proposals that have been received or proposals that are expected. The figures for Canada's contribution are based on our percentage, roughly 2% of world gross domestic product. On that pro-rated basis, all the other countries can be embraced by an intelligent formula. It's a formula that is widely used, but clearly it hasn't been widely accepted, because no G-7 country has yet met the formula.

I'm not a romantic about these things, but I have to say that Canada should give the money; that Canada should be a voice that rallies the G-7 countries, not to mention the west generally, particularly in France at the G-7 meeting in the summer, to overcome the difficulties of the global fund and respond remarkably to the pandemic.

This pandemic desperately needs a voice and it doesn't have a voice. It does not have a voice in the industrial nations. It is a perfect role for the country of Canada. We have the dollars, if we take into account the 8% increase that was announced in the budget, and we have the credibility internationally. It is painful that we're not using our voice to take the lead--forgive my putting it that way--because I think we could make an appreciable and significant difference.

The most appalling reality about all of this is that it need not be. Even without a vaccine we can save the lives of millions. I believe that historians will write with both incredulity and accusation that we could have forfeited so many millions of lives with this pattern of almost merciless insensitivity. I hope that somehow it can be overcome.

Thank you, sir.

[Translation]

The Co-Chair (Mr. Bernard Patry): Thank you, Mr. Lewis.

[English]

Many thanks for the overview of the situation of HIV/AIDS--your passionate introduction, including some very specific recommendations.

Now we'll start with questions and answers, and we'll start with Mr. Martin, please, for a five-minute round.

Mr. Keith Martin (Esquimalt—Juan de Fuca, Canadian Alliance): Thank you, Mr. Chair.

Thank you very much again, Dr. Lewis. Your comments are always so poignant and get to the heart of this catastrophe. As you eloquently said, we have not seen the likes of it in the history of our planet.

I'm also so pleased that you mentioned the issue of the resilience of the people of Africa. So many people think that the continent is a basket case, yet those like you and many others who've been there know the extraordinary capacity of the continent, the capacity of the people and their resilience.

My questions are threefold. Number one, perhaps you could again emphasize the structural problem that AIDS is going to wreak within the continent; that our failure to deal with this problem now is sowing the seeds of a structural famine, structural economic problems that completely hamstring any ability we have to engage in the long-term economic emancipation of the people of that continent.

Second, it is my understanding that there is a bottleneck in the global fund. In other words, there's difficulty getting the moneys that are there to the people. If that is so, perhaps you could enlighten us on that. There have been problems on that side with the proposal formatting for representatives of non-governmental organizations in sub-Saharan Africa. Perhaps you could suggest ways we could improve that.

Finally, on the issue of political leadership, you mentioned the great political leadership that has been shown in Botswana, Uganda, and Lesotho, but there's also an abysmal failure on the part of African leaders to come out and speak as eloquently as the president's wife in Uganda has done, and indeed President Museveni himself. Perhaps you could tell us what we could do to engage the African countries, perhaps via the NEPAD, in displaying more leadership for their people in this matter.

Thank you.

¿ (0935)

Mr. Stephen Lewis: Thank you, sir.

The answer to number one is that the structural problems in the medium and long terms are so difficult that just a couple of weeks ago at the Africa-France Summit, the Secretary-General of the United Nations announced the formation of a commission on AIDS and governance in Africa. It is being handled by the UN Economic Commission for Africa. The purpose of it is to look sector by sector at the breakdown and try to find out how governance can be handled, how ministries of finance will operate if they don't have personnel.

We've always talked about capacity building when we've discussed these developing countries--the upgrading and retraining of people to do fuller and more effective jobs--but now the language of the international community has changed. We talk about capacity replacement and capacity replenishment. We're actually talking about replacing the people who have died or are too ill to work, so capacity building becomes almost secondary to this focus on finding the additional people within the country. Therefore, I agree with you that the structural problems are severe.

I know that UNAIDS, the secretariat that coordinates the activities of several agencies, is now engaged in a series of scenario studies of what will happen 10, 15, and 20 years down the road. The question is germane. The structural defects that emerge when you lose your people and atrophy your state, and the possibilities of having failed states are very real, and everyone is trying to get a handle on them. Everyone is so obsessed with the here and now that it's hard to think down the road.

Secondly, you're also right about the global fund. There are some bottlenecks and they're very frustrating and aggravating. I've encountered them myself.

I think the global fund, in defence, would say the donor countries would be considerably irritated with us if we dispersed money without making sure there were serious systems of procurement, accountability, oversight, etc., in place. So they are imposing pretty firm conditions on the use of the money, including getting it from the centre down to the grassroots.

It's very frustrating for some of the African countries because there seem to be new regulations and conditions all the time, and it takes time, but I think it's working its way through. Even for the NGOs, if you look at their more recent comments on the global fund, they are gradually being embraced more fully into the discussions and are asserting themselves more effectively. I think that will also be resolved.

The global fund has really only been functioning since the middle of 2002. It's quite astonishing, all in all, that it's getting a lot of money out the door and has approved projects over the course of five years well in excess of $2 billion.

Finally, the numbers of political leaders who are speaking out now significantly exceed the numbers of political leaders who are silent. The majority of them are being much more vocal. Since we got rid of the former President of Zambia, the present President of Zambia, as of January 1, 2002, is speaking out much more forcefully. The change of government in Kenya resulted in the President within the last week saying “AIDS will be run out of my office”, and receiving as a result $50 million from the World Bank fund on AIDS.

As you said, the President of Botswana is particularly eloquent. The President of Uganda, President Museveni, has led the way in Uganda. The President of Rwanda is now more vocal, and the President of Malawi is more vocal. Everybody is more vocal as they get more frantic about the implications.

¿ (0940)

The Co-Chair (Mr. Bernard Patry): Monsieur Rocheleau.

[Translation]

Mr. Yves Rocheleau (Trois-Rivières, BQ) : Thank you, Mr. Chairman.

Hello Mr. Lewis. I want to thank and congratulate you on the quality of your presentation. You are obviously very passionate about this pandemic and your knowledge will help us. I have three questions for you.

You mentioned the stigma with respect to women. I would like to understand if the behaviors are changing in Africa towards people with AIDS. Here in Quebec, as in Canada, behaviors are changing in a positive manner. How about in Africa?

Secondly, an official from CARE came to testify last week. He finished his presentation by reminding us not to forget about Africa with the ongoing situation in Iraq where people are facing a terrible humanitarian crisis. Do you share his opinion that we focus mostly on Iraq these days and tend to forget the disastrous situation in Africa?

Thirdly, I would like you to expand on an American decision that you did not talk about. When we think about the world community, we have no choice but to consider American presence mainly because of the huge power they wield. Where does America stand with respect to the fight against AIDS, particularly since they made a decision on medication a few months back and it was severely criticized by the concerned parties? I hope you know what I am alluding to. I think the decision concerned generic drugs. I would like you to expand on that.

[English]

Mr. Stephen Lewis: Thank you. They're excellent questions, though a little complicated to respond to. Let me try as briefly as possible to answer them.

Certainly attitudes are changing in Africa with the very vigorous prevention campaigns. That's what I mean by taking things to scale. We have learned, for example, that for the single most vulnerable group, the age group of 15 to 19, when there are peer educators and very vigorous preventive programs directed at that age group.... And all over Africa, groups of peer educators use dance, poetry, drama, drumming, singing, moving into schools and into communities and talking about sex and sexuality in ways so stark and direct that it takes your breath away. They raise awareness wherever they go. In three countries I can think of—Namibia, Kenya, and Zambia—the prevalence rates of the 15- to 19-year-olds are beginning to decline because of the intense prevention campaigns. Certainly the intense prevention campaigns in Uganda, led by the President, managed to bring the prevalence rate down from something around 25% as recently as 1993, to something around 6% to 7% today.

So it shows that absolutely determined and tenacious work at prevention can bring things down—but it's long, it's hard, and it takes time.

In particular, it takes time to change male sexual behaviour. If you read some of the studies done by United Nations agencies on male sexual behaviour, you will see that the assumptions about sexual hegemony are absolutely staggering. Therefore, the sense of vulnerability on the part of women to this predatory sexual assumption is very, very difficult to overcome, and it takes a lot of time to work through. But the awareness is rising, although it's going to take many, many years, and it needs these intensive campaigns to stimulate.

On your second question about Iraq, I must say that I feel a little dismal about it. One can already sense that the focus is so obsessively on the war that what is happening in the rest of the developing world is getting short shrift. It was the same sense that we all had after the war in Afghanistan; you think that you're beginning to build momentum, and then suddenly these events intrude and your own momentum gets disrupted, and you have to start all over again. It's not that we're starting from scratch, but one can sense that the money, the interest, the coverage, and the focus are all consumed by the war. Everybody is working very hard to remind the world that there is this incredible pandemic and that one cannot simply let it drift as a result of Iraq.

I've talked about Africa, but let's face it, this pandemic is moving inexorably into China, India, Russia, and Eastern Europe. If we can't contain it in India and China, then the international figures I've used will be eclipsed overwhelmingly. We're talking about a catastrophe that I'm not even prepared to contemplate. I suspect that India already has the largest absolute number of AIDS cases in the world; it is said that it's South Africa, but I suspect it's India. And in China, we really don't know exactly what's happening. It's a tragedy in China that the pandemic is spread by contaminated blood. In Russia it's spread primarily by intravenous drug use. In India it's spread by heterosexual sex. But we're very worried about all of those countries and continents.

There's no question that Iraq is diverting attention—as anyone could have predicted.

¿ (0945)

Finally, you'll know that President Bush announced $15 billion over five years. It was a major and unexpected announcement in his state of the union address. Though $10 billion of it is new money, unfortunately the money is back-end loaded, not front-end loaded. So it's going to take awhile to filter out into the field. The first tranche is not likely to come until the latter part of 2004 and into 2005.

In addition, there is a great deal of debate about the conditions that will be attached to the money—the famous gag rule relating to abortion and family planning. But now even more strongly, I don't think this was fully expected. In significant measure, there is great focus on abstinence to the exclusion of condoms. Through the declaration of commitment in the UN, the international community puts emphasis on the three aspects, “ABC”, as they're called—abstinence, being faithful, and condoms. It recognizes that where young people and others are sexually active, condoms are terribly important. But there is a battle now in the U.S. Senate about the balance. The balance that is wanted is abstinence—almost to the exclusion of anything else. So the question of conditions around the money is not yet clear. Everyone is hopeful, as the money was certainly a great advance.

The drugs are a very, very difficult issue. The central piece of the issue is that in the TRIPS agreement of the World Trade Organization, we don't have an understanding of whether or not countries can export generic drugs to African countries that need and want the drugs. They are allowed compulsory licensing under the general Doha terms for indigenous manufacture in their own countries, but the battleground is around whether or not a country like Zambia can import generic drugs from another country that makes them. The question is, does that country have the right to export generic drugs to Zambia? The United States and the drug companies say no, which is what's being tousled over at the moment.

Mr. Murray Calder (Dufferin—Peel—Wellington—Grey, Lib.): Thank you very much, Mr. Chair.

Ambassador Lewis, this is really a pleasure.

I'm going to switch gears a wee bit here. I want to talk about the United Nations, in particular administration. Right now, in the United States and here in Canada too, we've heard a lot of the right wing saying that the United Nations has lost its relevancy. In fact, they're suggesting that we adopt an ad hoc approach of the coalition of the willing, led by the United States, to restore global order. I'm wondering what your response is to this. That's my first question.

I think some of this stems from the Security Council. I'll use Rwanda as an example, where the United Nations was not able to gain adequate authorization or force because of the resistance by one or more of the permanent five on the Security Council. I'm wondering if you can give any recommendations for how that problem could be fixed.

I think I know the answer to my final question, but I'd like it to be on the record. Should Canada continue to make its participation in the United Nations the foundation of its foreign policy?

¿ (0950)

Mr. Stephen Lewis: At the outset, I want to provide a disclaimer. I am now speaking in my own voice--what do they call it--in my personal position. I don't want to sully the reputation of the Secretary-General by pretending that anything I say would be attributable to him, however much Mr. Calder may wish to provoke me to do so.

Everybody's going to come back to the United Nations. Even the unilateralism of the United States, I think, is eventually going to come back to the United Nations. Willy nilly, they will not be able alone to handle the humanitarian response to the crisis in Iraq, and willy nilly, despite what is said and read, they will not alone be able to handle the reconstruction. The world, I suspect, will bridle strongly if the United States sees as part of the unilateralism the construction of a new world order made up, in part, of the “new countries” of Europe that are emerging, compared to Rumsfeld's old countries, and if they think the new democracies in the Middle East and adjacent states will bring together some kind of new world order.

These things will eventually find their way back to the UN and the Security Council, and we will have a rapprochement between France and the United States at some point, although I think there will be a lot of bitterness along the way.

What worries me, as a person who loves and believes in multilateralism, is that this continuing focus on peace and security in the Security Council is forgetting the two other pillars of the United Nations charter--one of which is development, the other of which is human rights. Development and human rights are at the heart of how most of the world sees the United Nations. They don't see the United Nations as forever tussling over war. They see the United Nations as delivering food in a desperate shortage. They see the United Nations handling immunization, girls' education, child soldiers, child labour, all of the phenomena of human interaction and all of those international human rights instruments that govern human behaviour.

So I think that's where we have to remind people that the United Nations is multi-faceted. It has three pillars. One is peace and security, but the others are development and human rights, and they must not be depreciated.

Secondly, we also have to be very careful not to use this term “United Nations” as though somehow the United Nations was a separate entity responsible for what is happening apart from the behaviour of nation-states. The United Nations is a compendium of the nation-states that comprise it. If France or the United States or anybody else wants to be bloody minded, it can bring the activities of the United Nations to a halt, but that's not the fault of the United Nations; that's the fault of the behaviour of member states. That's the way this world works.

Rwanda was a classic example. You could make a case that the United Nations failed in Rwanda. On January 11, 1994, Roméo Dallaire sent a telegram to the United Nations centre in New York effectively saying he saw a slaughter coming. He said he knew where the arms were buried and he had to be allowed to get to them. The United Nations, the department of peacekeeping operations, said no. That was a secretariat response. But the pursuit of the genocide, the 800,000 who were slaughtered in full view of the world while the United Nations refused to respond to Roméo Dallaire, was the action of the United States, France, and the U.K. on the Security Council. That was the action of individual countries, not of the UN. I don't know how you resolve that, except to get them to come to their senses.

I am a multilateralist to my core, and I think if Canada leads the rush to reassert the primacy of international, multilateral United Nations sanity, we would be playing a very strong role.

¿ (0955)

The Co-Chair (Mr. Bernard Patry): Thank you.

Mrs. McDonough, please.

Ms. Alexa McDonough (Halifax, NDP): Mr. Lewis, I think you know this committee is grappling with the question of Canada's role in today's world. In that sense, we've asked you to help us with our homework in putting forward a view from this committee to the government and the foreign affairs minister on that question. Certainly your presentation has been very helpful in that regard.

There may be others who can or would interpret this in a slightly different way, but I think at the moment we're into a bit of a circular argument in Canada in relation to the global fund, and it goes something like this. Other countries haven't met their obligations, so why should we increase our commitment? Besides, the global fund has yet to prove itself, so we're still looking at other avenues and mechanisms for contributing to this crisis in the best way we can.

My question is how much is that a problem with many other countries as well, that sort of circular argument, and how would you help us to deal with that problem?

Your presentation seemed so very compelling. I'd like to ask if you could elaborate a bit on what kinds of proposals are now before the global fund that are promising, in terms of dealing with the crisis, that may simply not get launched. Meanwhile countries, Canada among them, are trying to find other ways of contributing to a resolution, including, I think, the most recent announcement by CIDA's minister to help with the funding of the preparation of proposals for the global fund in some cases, which again seems to get us into a bit of a circular argument.

That's one question.

The second, far more brief, is on this question about the pharmaceuticals and generic drugs. Is there a role for Canada here, vis-à-vis the WTO, in which we should be taking a very strong, clear position to pave the way to get the pharmaceuticals that exist, that are known to be effective and are available, to where they can literally save millions of lives? Is that a small “p” political question that Canada should be taking on in today's world that could make a major difference?

Mr. Stephen Lewis: Mr. Chair, even though I haven't appeared before this committee, I have spent a small part of my life in parliamentary confines, and I sense your occasional impatience. I beg you to understand that your colleagues are asking questions that can't be satisfied with yes and no answers.

The circular argument you describe about the global fund is real. It is there and it's held by a number of countries. President Bush dealt the global fund a considerable blow by saying that only 10% of the $2 billion a year in new money could go to the fund, which was $200 million a year instead of the billion or more that would reflect the 33% of the international gross domestic product the United States represents. That was a considerable blow, and everybody is trying to change that, including some very, very prominent senators on both sides in the United States.

Someone has to break the log-jam. Someone has to be strong enough and courageous enough to say, look, this global fund has been up and running for nearly a year now; it has dispersed $630 million in the first round and $830 million in the second round; those are for two-year programs; they will extend into the third, fourth, and fifth years; those programs are dealing with anti-retrovirals, with behaviour change, and with care in a way that nothing else is being provided at the moment in equivalent amounts; so for heaven's sake, let's keep it going.

It's coming from the countries themselves, that's what's so important. It's not top-down, it's not dictated, it's not a reflection of Canada's bilateral policy, what we think makes sense in a country. It's coming from a country coordinating mechanism. They wrestle and fight about it, and then they make their collective proposal.

I think someone, some country, has to stand up and say, look, this is our best chance, our best response; it has to have bilateral money, NGO money, UN money; of course all those other things will continue, but what an excellent centrepiece this is; let's give to it as a proportion of our gross domestic product. I'd like to see Canada do that and stop the circularity, which is usually self-serving. It means that fundamentally you don't want to give the money.

May I just say something to the panel? I was on a panel yesterday in New York--this was one of the most fascinating times I've had--where the Gates Foundation announced a $60 million contribution to the development of microbicides. Now they have about $100 million overall. They have Norway, the Dutch, the Irish, the Danes, the World Bank, the United Nations Fund for Population Activities, and the United Kingdom. Everybody has provided a part of the other $40 million. Gates came in with $60 million.

I have to make the point. Microbicides, Mr. Chair, are a topical gel applied to the genital areas, to the vagina. It gives the woman control over the sexual transaction. The topical gel can prevent the transmission of the virus; the topical gel can reduce transmission dramatically. It's one of the great hopes. It's expected that as soon as it comes on stream, within the first two to three years 3 million infections can be avoided. It is, as it were, almost a gender issue, and Canada has not yet contributed to the microbicide partnership.

I think there's something a little peculiar where a major foundation is giving more money than a series of governments put together in an initiative that will take some years, like a vaccine, to come on stream. But when it comes on stream, the opportunity it gives for a woman to control to some significant degree her sexual life is terribly important. These are the kinds of initiatives the global fund will support as it evolves, just as they are the kinds of initiatives Canada should support.

À (1000)

The Gates Foundation launch, which was yesterday at lunch, was handled by the Rockefeller people and Gates, and there are, as I said, a large number involved in it.

On the generic drugs, Alexa--no one on this committee will mind my calling you by your first name--there is again the need for a voice, the need for a major country such as Canada to take a stand and say that the agreement all of us came to, with which only the United States differs, has to find a compromise. The compromise consists of looking at the raw materials, which are based largely in China, and making sure the generic company manufacturers in India, Thailand, and Brazil have access to the raw materials and a fairly secure market for purchase and distribution. That's the struggle, and it needs a voice.

I'm going down to Atlanta at the end of this week to participate in a two-day conference on the pharmaceuticals, on generics, and on Big Pharma, and there's a terrific effort being made by a lot of the principals to try to find common ground, but they need a government.

You'll forgive me, everyone, but may I say--and it's not just because I'm working in it--I've just never seen anything like this pandemic. It's just unbelievable. We're talking about 100 million people, confidently, who will die, and the numbers may go well beyond that, yet it doesn't have to be. If you'll listen and notice, internationally there just isn't a voice. There are NGO voices, powerful voices, there are people living with AIDS, there are very, very strong movements such as the Treatment Action Campaign in South Africa, but the government voice is missing. There's just something odd and wrong about that in the context of the most savage communicable disease in human history. I dream about Canada doing it, because we have such standing everywhere in the world.

À (1005)

The Co-Chair (Mr. Bernard Patry): Thank you, Mr. Lewis.

Now, just as a point of clarification, Mr. Lewis, for our research staff, when you're talking about the Gates Foundation, it's always U.S. dollars you mention, is it?

Mr. Stephen Lewis: It's always U.S. dollars.

The Co-Chair (Mr. Bernard Patry): Thank you. I just wanted to be sure.

Mr. Godfrey.

Mr. John Godfrey (Don Valley West, Lib.): Thank you for coming.

Having heard you talk around the world on this question, I must say it's good to see you in person. We're glad you're here, and this is an appropriate place.

Your analysis focused on a particularly difficult social challenge, which is the role of men in Africa in relation to women. I suppose, and I don't want to put words in your mouth, that if there was one single factor that was producing the pandemic, if one could isolate one factor, it would be male behaviour.

In terms of addressing that as a central issue, I guess the question is--and you addressed it a bit with Mr. Rocheleau--how do you get behaviours to change? That's a generic human problem. How do you get people to stop smoking or do all the other things? I'm wondering whether emphasizing changes in human behaviour wouldn't in fact be the place to begin, but how does that work? What are the things that really are effective in changing human behaviour and getting people to confront the reality? It's also not simply a development issue and a health issue; it's clearly a rights issue too.

The delicate issue is to what extent can we, as representatives of developed countries with less than perfect records in these domains ourselves, speak frankly of these things to our African friends? How do we, in a way that is both firm and respectful...?

I remember the President of South Africa was in a period of denial, as were a number of other leaders as well. I wonder if we have the right to say firmly, out loud or in private, you want our help to deal with this, but part of it is that there has to be a massive human behaviour challenge; it may even be in some ways, some horrible way, a central part of your culture. How do we do that?

Mr. Stephen Lewis: John, we do it in part by drawing on those Africans who have already done it successfully themselves, such as Museveni in Uganda. I've now heard him speak three or four times. He's quite a platform fellow and he talks with tremendous honesty about the need for boys and men to treat women and girls with respect, and to understand what their sexual behaviour is wrecking. He does it with intense comedy and art; he's an hilarious orator to listen to, but he makes his points very vividly. Jerry Rawlings, the former president of Ghana, who I've now seen on three or four platforms, does the same extremely well. He's very, very tough about the need for men and boys to change their behaviour.

I remember doing a question-and-answer session with about 1,000 students in Addis Ababa a few months ago. At first, I was really surprised by how frank they were and was taken aback; but there was a perfect willingness to recognize the onus on the boys and the girls' sexual vulnerability. They talked about it among themselves and asked me very direct questions about it.

So I think it's increasingly possible in these societies to raise these very difficult cultural issues, as you put them, and it's possible to raise them directly with the political leadership itself. But on the other hand, you're dealing with so many things simultaneously. Yes, male behaviour has to change, but you can't wait for the behaviour to change; you have to protect the women now. So you have to work on everything at the same time.

I think that anti-retroviral treatment would make a very significant difference, because it would institute a sense of hope in a society. I don't want to overdo it, because there has to be treatment for opportunistic infections, and there has to be better nutrition, and people's lives can be prolonged without having anti-retroviral treatment—or before they get there. But if people get tested and know they are positive, they know it's a death warrant. There's no treatment. Why do you have to live with a death warrant? So people then don't get tested, particularly men, who don't feel they need to get tested. But if you knew that somehow at the end of the process there was treatment and your life could be prolonged, then you would get men caught up in the counselling process, the shared treatment process, and the sense of their own vulnerability rather more.

Therefore, we come back to the global fund. If there were a little money to do the treatment stuff.... Isn't it odd the way we drop everybody and everything into compartments: Bill Gates does some, now the Bill Clinton Foundation will do some, the private sector is doing some, and UNICEF is doing some. But there isn't an overall effort to pull it together.

Treatment would help. We're focused very much on high-risk groups and are dealing with commercial sex workers, truckers, and migrant labour, doing intensive prevention with these particularly vulnerable groups.

But I think that you can talk about it; you can raise it. There are presidents we can draw on. I haven't mentioned the President of Senegal, but President Wade--and President Diouf before him--talks very openly about the need for cultural change.

À (1010)

The Co-Chair (Mr. Bernard Patry): Thank you, Mr. Lewis.

We will go to Mr. Casey and then to Ms. Kraft Sloan.

Mr. Casey.

Mr. Bill Casey (Cumberland—Colchester, PC): Thank you very much.

You certainly stimulate a lot of questions. I'm going to ask just a couple of technical questions. You mentioned one thing, but I missed what you said. You talked about a 5% to 7% take-off point. What does that mean?

Concerning the global fund, is it used for medication or education? How does it get its benefits to the people?

Finally, of the $15 billion that the United States has committed, I think you said that a maximum of 10% can go to the global fund. Where does the rest go?

Mr. Stephen Lewis: Once you pass a 1% prevalence rate, there is the assumption that you have the potential for a more generalized epidemic in the community. When you're at 5%, there is the assumption that it could spread exponentially. Nigeria is at 5.8%. I think it would be fair to say that President Obasanjo and his minister of health are very anxious about where they stand, because there are 123 million people in that country, and if it moves from 5% to 10%, we're talking huge numbers. The 5% level is where it seems to take off through the general population. You have a terrible problem on your hands once you cross that threshold. That's what I meant by the take-off.

À (1015)

Mr. Bill Casey: What's the worst country?

Mr. Stephen Lewis: The worst country at the moment, on the evidence we have, is Botswana, which is at 38.8%. The worst country actually is Swaziland, which is probably pushing 40%. That's why I say I don't know how you can talk about avoiding failed states down the road. Lesotho, a lovely little country with 2.2 million people and very good political leadership but no money, is at 34%. Zimbabwe is over 30%. Then you have Namibia, Zambia, Malawi, and Mozambique, which are all 10% to 15% or above. So there's that constellation of 10 eastern southern African countries, Kenya and Tanzania included, that are all over 10% and where there is some stability in certain age categories, but we just haven't been able to dramatically change the prevalence rates, as, for example, they did in Uganda.

You asked what it is used for. It's used for medication. The global funds are used for anti-retroviral treatment. They're used for supporting the infrastructure for the interruption of mother-to-child transmission. There is the issue of the transmission from mother to child during the birthing process, and we have a drug called Nevirapine. You give one tablet to the mother during the birth itself and the liquid equivalent to the child within 48 hours of birth, and you can diminish transmission by up to 53%. So you go into the pediatric wards of the hospitals and you look around you, and you know that one out of every two kids doesn't have to be dying. It's heartbreaking. The drug company in that instance, Boehringer Ingelheim of Germany, has agreed to provide Nevirapine free for up to five years in any given country that asks for it, and I think there are over 40 countries now receiving it.

So what is required there is the counselling and then the prevention discussion afterwards to have safe sex thereafter.

Now a new ingredient has been introduced. The mothers in these clinics who are HIV positive always said, we'll do anything to save our babies, but what about us? Now a group of foundations, again headed by Rockefeller, using the Columbia School of Public Health, has instituted a program called Mother to Child Transmission-Plus, MTCT-Plus, and the Plus represents treatment for the mother and the partner and children in the family who may be infected. It's an effort to use the clinics that are preventing mother-to-child transmission as a treatment entry. The global fund is funding that, and it funds the prevention policies we were talking about. It funds everything because it comes from the community. Whatever is approved that the community has recommended, they fund and attempt to get the money down to the grassroots.

Your last question on the money from the United States was, if 10%--by the way, the 10% was applied to the $2 billion a year of new money--is being applied to the new money, what's the other 90% going to? It will go to bilateral programs in ten to a dozen countries that the United States has arbitrarily designated as the recipients, and there will be significant conditions applied to the use of that 90% of the money. Those conditions, as I understand it, are still being debated in Congress.

The Co-Chair (Mr. Bernard Patry): Thank you, Mr. Lewis.

We'll now go to Mrs. Kraft Sloan, Mr. Martin, then Mr. Eyking.

Mrs. Kraft Sloan.

Mrs. Karen Kraft Sloan (York North, Lib.): Thank you very much, Mr. Chair.

Mr. Lewis, I accompanied the minister for CIDA to the AIDS conference in Durban. It was a very overwhelming experience. There was an excitement in the air because South Africa was creating a new country, a new vision for itself as a people, and many peoples coming together, and yet they had this horrible problem to deal with.

There was a justice from the supreme court, a white man, who came out and let it be known that he was HIV positive. He told me at the conference that because he's a wealthy man he was allowed to live and that the sort of weekly and weekend preoccupation was going to funerals of people who were dying. Certainly, there are issues within the government itself about their ability to maintain their personnel and human resources.

I'm particularly concerned about young women and girls under the age of 15, because while you talked about 15 to 19 years of age as a high-level risk group, I would also like to hear how young those girls are. I ask this because there was some thinking at one time that if a man had sex with a virgin he would not get infected.

I'm also interested in a further clarification of Canada's position on the generic drug situation. I'm a full member of the human rights committee and we're looking at the humanitarian AIDS crisis in Africa. I'm therefore wondering if you could let us know a little bit about the implications for other issues in Africa related to humanitarian aid, particularly in light of the opportunistic diseases that are often the reasons why people end up dying, some of the water issues and things like that.

À (1020)

Mr. Stephen Lewis: The Nelson Mandela Foundation, in conjunction with the Social Science Research Council in South Africa, recently did the best prevalence rate study and were shocked to find that the infection rate was 5% to 6% below the 14-year-olds.

They're not entirely certain how all of that is constituted. Undoubtedly the overwhelming portion of it is transmission during birth. But there is reason to believe that some of it may be caused by dirty needles, and there is reason to believe that some of it may be caused by sexual violence. There are news stories. There's a pattern of sexual violence against children that is terribly, terribly worrying.

I've always believed that when a society feels itself fraying at the edges and begins to fall apart, it is children who become targets. So in Zambia, there are three women members of parliament who are bringing a private member's bill on child defilement before the parliament. I don't know why it's not called child rape, but they use the term “defilement”.

The head of the YWCA in Zambia has indicated publicly that the numbers of cases of child sexual abuse that are coming before the shelters the YWCA sets up are increasing dramatically year upon year. There is a sense that the targeting of children, when the society is frantic, is ever more pronounced. And there is a part of the mythology that sex with a virgin will somehow cleanse a person who is positive, or is safe to have.

I want to say that's a mythology that is not broadly shared across the continent, but there is no question it is shared in some places and it does result in the most hair-raising stories of rape of infants. There were a couple of cases recently in South Africa of infants so young that the depravity of it all is simply too much for the human mind to absorb. Again, everything in the world is being done to resist that, obviously, through criminal procedures.

You're right about funerals. People spend an awful lot of time going to funerals. Often have I driven down a road and seen a clutch of school children. I would think it was a schoolyard and then they would part for a moment and suddenly you'd realize it's a cemetery. Children are spending and everybody is spending an inordinate amount of time going to funerals and to graveyards.

I urge you, if you can get hold of the Nelson Mandela Foundation study, to do so. It's very, very interesting. Most of the prevalence rates are established at antenatal clinics and individual sentinel site studies, as they're called, around the country. But this was a very careful survey, yielding very interesting information.

On the question of generic drugs, I think Canada should be saying that in matters of human health, trade considerations cannot be allowed to triumph. Therefore, if a country is manufacturing generic drugs, that country should have the right of export to a country that needs them, without feeling the fear that they're going to be hauled up in contravention of TRIPS.

Mrs. Karen Kraft Sloan: Their position is that they're just not saying anything--

Mr. Stephen Lewis: As I understand it, Canada is being cautious about taking a position. Certainly that's the view of the NGO community, which would love to have Canada take a strong position.

Mrs. Karen Kraft Sloan: But they're not taking a negative position.

Mr. Stephen Lewis: No, I don't think they're taking a negative position; it's just not a position. It's a position that is utterly consistent for Canada, because we are in effect saying that human health--in this country of all countries--is central to the human condition. I remember as far back as Charlottetown we were describing human health as a defining characteristic of the people of Canada. So when you're talking about health, you shouldn't allow these prohibitions on export to affect human security.

On the humanitarian crisis, I travelled in January through the crisis countries with James Morris, the executive director of the World Food Programme. We did a report. May I ask if the committee could perhaps get hold of that report? It was filed recently, in January or February. It's only eight or ten pages with appendices, but it will give you a rather good sense of the humanitarian crisis needs.

As I said, we all went down there assuming that the hunger and the food shortages were rooted in drought and erratic rainfall. We were all taken aback at the degree to which HIV/AIDS has caused hunger and food shortages. There is a need for an obvious role for Canada in providing labour-saving agricultural devices, winter farming, irrigation, and new forms of agricultural support, from fertilizer to seeds. I think there is a lot Canada could do. It's effectively a human rights issue because it involves the human rights of the people who are affected. It's also an excellent humanitarian intervention.

We do so much in bits and pieces, and I don't want to depreciate that. As I came in the door, one of my friends gave me a copy of the Canada Fund for Africa, and I've been hauling around various CIDA publications and reading them with some appreciation. But it's all in chunks here and there.

If Canada could suddenly say to the world we are going to take two countries, set in place the treatment apparatus, provide the funding for significant treatment to supplement what will otherwise be coming, and make these countries a model for the rest of the African continent, boy, would Canada be making a contribution. So on the one hand you increase the money to the global fund, and on the other hand, instead of $5 million here and $5 million there, you go flat out, rescue two countries, and show the world what can be done.

À (1025)

The Co-Chair (Mr. Bernard Patry): Thank you, Mr. Lewis. Just to let you know, Mr. Morris appeared already in front of the committee, and we're very pleased also.

Now we'll go to Mr. Martin, Mr. Eyking, and Mr. Harvey.

Mr. Keith Martin: Thank you, Mr. Patry.

Ambassador Lewis, I've been fighting for this notion that Canada should approach the World Health Organization to purchase the patents for the relevant anti-retrovirals, and that under the WHO or the global fund, three centres be set up for the production and distribution of anti-retrovirals into China and India; another into Eastern Europe and Russia; and a third into sub-Saharan Africa.

I'd like to know your opinion on whether that would be a useful endeavour. In other words, you would be able to cheaply produce generic anti-retrovirals and distribute them into the three major sections that need them without affecting the company's ability to sell anti-retrovirals to the west.

Second, what can we do to bring together the different groups that are involved in the HIV/AIDS pandemic, globally speaking, and put them all under the fund? Do you not think the best and most efficient coordinating mechanism would be to take all these disparate groups and all of their resources and put them under one umbrella? Then they could focus, as you said, on various areas and countries, doing various things.

Mr. Stephen Lewis: Ironically, the problem really isn't so much the patents; the problem is the alleged fear the big pharmaceutical companies have that were they to relinquish any of their hold under the TRIPS agreement, it would affect their sales in Europe and North America. That's really what's at work here, and they say it openly. It's not--you will forgive me--one of my normal socialist conspiracies; it is objectively true that they themselves admit to this. Very often in many of the African countries there are no patents to deal with because the drug companies have never bothered taking out a patent. It's not worth it in terms of the market.

What you really have is the need to support the areas of generic manufacture now, chiefly in India, Brazil, and Thailand, and find a way of guaranteeing the purchase of the drugs they provide. After all, those drugs are now on the World Health Organization-approved anti-retroviral list. It isn't as though we're dealing with drugs that aren't readily acceptable or haven't had quality control and been approved; we are--by the WHO.

If the big drug companies want to compete in those prices, fine. I can give you the most recent information. To do treatment using anti-retroviral drugs produced by one of the major drug companies costs now roughly $900 per person per year. To do treatment with generic drugs, one of the triple or double therapy combinations, costs $300 per person per year. That's huge when people are earning less than a dollar a day and when governments are so strapped. If the support for the present generic manufacturer could guarantee a market and find the funding, Canada wouldn't have to buy the patents.

The idea of setting up indigenous manufacture, yes, that's an excellent idea. It would be great if South Africa could manufacture generic drugs not only for itself but for dispersal through the southern part of the continent. If you can pull that off, then the world community will be at your feet, but I've yet to see it done.

You asked a second question, I think, but I can't recall what it was.

À (1030)

Mr. Keith Martin: It was the coordinating.

Mr. Stephen Lewis: Oh yes, the coordinating. I don't give up on that, but that's very difficult. It's like persuading a country to give up its bilateral programs.

Well, you say, UNICEF. You know, the UN agencies are pretty tough when it comes to turf battling as well. They're not angels around this business of holding their own preserves tightly. I think increasingly the fund is being seen, if it doesn't collapse for lack of money, as the vehicle to which people attach themselves. But it's not yet the rallying cry in the way you're putting it, nor, I think, would it be; it would be premature.

The Co-Chair (Mr. Bernard Patry): Mr. Eyking.

Mr. Mark Eyking (Sydney—Victoria, Lib.): There are two recurring issues I often hear about the UN, and one is its inefficiency or its bureaucracy not being able to react quickly enough. Also, you hear about the member nations not giving continuously to commitment. I was just thinking, what if we changed the UN's role or structure to be more of a facilitator for its member countries?

For example, with Africa, what if we had, just for numbers' sake, 20 countries that were willing and could give and we had 20 countries in Africa that were desperately in need? What if we had it that these countries would adopt a country or take responsibility for that country, dealing with their social behaviour, food production, disease prevention, and democracy?

For instance, what if Canada took a country and said, okay, we're going to help this country and deal with this country with the UN kind of helping us through it? I think the citizens of Canada would see where their money was going, there'd be a sense of pride, and we would also have a relationship back and forth with that country instead of trying to do everybody.

What is your opinion on the different model? Has anybody ever talked about it?

Mr. Stephen Lewis: Oh yes, everybody is talking about different models in the United Nations. One of the problems about reforming the United Nations is that five countries have a veto, and every time you suggest more fundamental arrangements such as converting an organization from a forum to a facilitator, any one of those five countries can tell you, go peddle your papers; we're not going to change the charter and we're not going to change the operation; we're not prepared to permit that. That's why the United Nations Secretary-General tried through his own reforms, social and economic reforms, to change the functioning of the United Nations to make it more efficient.

By the way, I don't know whether you've had Louise Fréchette before the committee, have you? She is the Deputy Secretary-General. She's also the leading Canadian in the UN system, and she is really excellent because in fact she is managing the administration of the entire apparatus. She does the work, and it might be of very great value as an insight into the UN to have Louise Fréchette here at some point.

But I think it's just very difficult to make those more fundamental changes in the UN system, very difficult, and the Secretary-General and Louise would be the first to say so, although they've accomplished more than some might have imagined.

Around Canada and the adoption of a country? There are 190-odd countries now. I suspect the other 188 would be envious. I think we are big enough and strong enough to have relations with a number of countries simultaneously, and to do the twinning you talk of and the sort of adoption simultaneously with a number of countries, well, I don't think I'd opt for one, to tell you the truth.

À (1035)

Mr. Mark Eyking: No, no. It was just as an example.

Mr. Stephen Lewis: You were just thinking in those terms, 20-20 making the sort of choice--

Mr. Mark Eyking: This was for a part of Africa. You'd say, it has been done in the world before. After World War II there were areas that were desperate, and they divided it up--now, you take care of that area, and--

Mr. Stephen Lewis: Well, if with the G-7 partners we were able to agree that particular investments would be made in Africa, India, and China for the purpose of dealing, for example, with the pandemic--or let me broaden it, for the purpose of dealing with communicable disease generally, global health generally--I could see Canada playing that role.

Mr. Chair, it strikes me.... May I recommend one other thing to the committee, if it isn't presumptuous?

The Co-Chair (Mr. Bernard Patry): The floor is yours. We're happy to have you. Go ahead.

Mr. Stephen Lewis: Well, you gather materials, I know. There is what is called the Commission on Macroeconomics and Health, which was chaired and whose report was authored by Jeffrey Sachs, the former Harvard economist now with the Earth Institute of Columbia University, and sponsored by the World Health Organization. I think it was released in January 2002. It is a remarkable document. It's no more than about 110 pages with a few appendices. It's a very careful analysis of what the disease burden, broadly defined--coming back to the point, I think, Karen Kraft Sloan made about water, sanitation, and nutrition, all the things that surround health. It made a powerful argument about how the disease burden is so intense in these countries that you can't get to economic growth.

The underlying economic assumption of most of us in the western world has been that if you have economic growth in place, you will eventually improve health, education, etc. Sachs and company argue--this is an interesting position for him; it hasn't always been his position--that the disease burden is so pronounced that the possibilities of economic growth are permanently impaired if you don't deal with the diseases first, if you don't deal with health first. There's a fascinating argument about costs and priorities, all of it laid out in quite an eloquent narrative.

Sachs is one of the most formidable minds I've ever encountered. He drives me crazy because I don't agree with him ideologically, but he is remarkable in his analysis and his grasp.

The Co-Chair (Mr. Bernard Patry): Thank you, Mr. Lewis.

Now we'll go back to Monsieur Rocheleau.

[Translation]

Mr. Yves Rocheleau : Thank you, Mr. Chairman.

I would like to go back to the issue of behavior and stigma. With respect to perceptions about the people affected by the disease, are they usually rejected or supported by their communities? Are the communities compassionate about their situation?

Secondly, do we have statistics about whether the illness is propagating faster in urban or rural settings? Is it propagating more with rich or poor people, with muslins or Christians communities, within French or English countries? Do we know if it is propagating faster in the North, center or South? Can we get any of these statistics or are all these dimensions blurred and not usable as targets or criteria?

[English]

Mr. Stephen Lewis: Thank you, Mr. Rocheleau. Those are very interesting questions.

The question of stigma haunts all of the responses to the pandemic. The stigma continues to be so intense and so difficult that it compromises a great many of the responses. Women are afraid to get tested because they're afraid to be isolated in their communities if they are found to be positive. Many people, particularly women, who admit that they are positive are then rejected by their families, rejected by their neighbours, rejected by their communities, rejected in their workplaces. It's very, very painful. There was even one example of a woman being killed in South Africa when she declared herself to be positive.

The stigma has strangled the churches. The churches and the mosques can often be anxious about matters of sexuality and matters of condoms, as we all know, but the question of stigma has further complicated that because it says, oh, you're dealing with a pariah issue, in a number of areas.

The best way we've learned to overcome stigma is when the political leadership in a country and the religious leadership take public stands. It's also overcome when the people living with AIDS have a voice and a centrality in the country.

If you had before this committee someone who is vastly more knowledgeable than I am, Peter Piot, the executive director of UNAIDS, Peter would probably argue that stigma is the single greatest problem. He passionately tries to get political leaders to talk about the human rights of people living with AIDS and the way in which stigma and discrimination are compromising the interventions.

The statistic stuff is also germane, and by asking the questions you imply the answers.

The pandemic is higher in the urban areas, although it's beginning to spread more fully to the rural areas. But it's higher in the urban areas, where there is such a concentration of people and where multiple partners and the early onset of sexual experience and early marriage, all these things, are more pronounced. In fact, very often men are infected in the urban sectors and go back to their villages to die. That is a common pattern.

It's a very interesting question about Muslim populations. Muslim populations have much lower prevalence rates, generally speaking. That may be a cultural phenomenon, or it may be a matter of time. But certainly if you look at the Middle East, for example, and compare it to Africa, or if you look at the very strong Muslim countries--the Mauritanias, the Malis, and so on--they have much, much lower prevalence rates than in east and southern Africa. That may be accounted for by truck routes, by migrant patterns, by commercial sex workers along the routes, but it would seem to be sufficiently different to speak to cultural differences as well.

Regarding francophones, that's also interesting--and I'm very glad you raised these things, because I should have mentioned them and didn't.

West Africa, until now, has had much lower prevalence rates than east and southern Africa. The prevalence rates have tended to be well below 5%. People couldn't entirely understand that. Was it a different strain of the virus, which seemed to be, in part, an explanation? But in fact, what is now happening is that in Côte d’Ivoire, in Cameroon, in Burkina Faso, the rates are rising. In all those countries, they are now significantly over 5%.

In Rwanda, they're over 13%, although in Rwanda there's very strong evidence to suggest that all the raping and sexual violence during the genocide has resulted in accelerated prevalence rates now. In fact, it's an unbelievable tragedy. It's like having one genocide after another in that little country. But the rates are going up in west Africa in way that suggests that was a difference of time rather than a difference of culture, although by and large they're still lower than the worst countries in southern Africa.

À (1040)

What precisely accounts for that, I don't think anyone knows, and everyone is worried at the rise in west Africa now amongst the francophone countries. So statistically it is necessary to disaggregate gender and to disaggregate rural, urban, francophone, anglophone, and so on.

[Translation]

The Co-Chair (Mr. Bernard Patry) : Thank you,

Mr. Harvey, please.

Mr. André Harvey (Chicoutimi—Le Fjord, Lib.) : Thank you, Mr. Chairman.

Let me first thank Mr. Lewis for his testimony, particularly with respect with the role he attributes to Canada in the increasingly global village in which we live. I believe that Canada’s role of reinforcing multilateral organizations will become even more important. When we see you answering questions with such energy, we have to conclude that working for the under privileged must be inspiring. It does not render one ill, now does it? And I am glad to see it.

You are aware of the significant challenges in the world. There are roughly one billion people living in extreme poverty. It is linked with health care, education, governance and multiple global challenges. I wonder if there is a country that donates where the citizens are engaged more than the average western country where the politicians often act only sporadically. We can easily get people mobilized here against the war but how come it is so hard to get them to notice problems as crucial as AIDS or the daily death of 8,000 to 10,000 kids of malnutrition?

If you had to develop a strategy to mobilize the people, what would you do? For all sorts of issues, the governments act under community lobbying. Budget allocations are made in an objective fashion but the role of citizens remains vital. We may analyze the last budget where CIDA has important actions tabled. It is certainly not incompatible with the massive needs out there. I would like to know if there exists a country in the world where citizens actually mobilize for humanitarian causes.

À (1045)

[English]

Mr. Stephen Lewis: I think there are four or five donor countries where the public is more deeply engaged. In all of the Nordic countries—Norway, Sweden, Denmark, and Finland—the public is much more engaged in supporting official development assistance. All of them have over 1% or close to 1% of gross national product, or way above Canada's present percentage of GNP, which I suspect must hover around 0.3%. I haven't looked at it recently, but it's probably around 0.29% or 0.30%. All of the Nordic countries are between 0.8% and over 1%, as is the Netherlands, where there is very, very strong support for interventions in the whole realm of the human predicament. And increasingly, so is the case in the United Kingdom, which has set a target of 0.7%, produced a white paper three years ago, and has been going up significantly every year towards that 0.7% target. Because their gross national product is very large, any small incremental increase reflects a huge additional amount of money. They have a very powerful minister in Clare Short, and a very powerful development apparatus in DFID, the Department for International Development. But I think that the U.K., the Netherlands, and the Nordic countries are those where the public is very strongly involved.

Can I presume to say to the second part of the question that whenever it's possible to establish contact with rank-and-file Canadians to talk about these issues, I've always found them to be tremendously responsive and generous. At one point, I felt so despairing about what I was seeing in Africa that I came back and set up a little foundation, which is in process, to try to respond at the grassroots—mostly to the way in which women die, because women so often die alone and in agony, with their children watching. It just sears the soul. It will also deal with orphans and people living with AIDS. I've been astounded at the responsiveness of people when they are engaged in the problem and recognize it. On these huge issues, I've often thought that the Government of Canada might call more strongly on the generosity and support of the public, because I firmly believe it's there. Everything I've seen says to me that it's there. It's more there today than it was several years ago.

But it is as though government is somehow abstract from or disassociated from intense contact with the public. If cabinet ministers or members of Parliament went to Africa on an intermittent basis and saw what I see, and came back and talked about it to Canadians, I'm telling you that there would be an outpouring. It's impossible not to have it. I genuinely believe that it's there in the public. I think we have not adequately tapped or called upon it.

À (1050)

The Co-Chair (Mr. Bernard Patry): Thank you, Ambassador.

Madame McDonough, one question without a preamble, if possible.

Ms. Alexa McDonough: Stephen, you spoke about the fact that under certain conditions there is no way that the millennium development fund's goals can be met. As you know, the Canadian government has launched the so-called NEPAD program, which barely acknowledged the HIV/AIDS pandemic.

I'm struck by your comments about Jeffrey Sachs, because I know that he's not normally a hero that you would identify. I'm wondering whether we need to hear from someone like Jeffrey Sachs and others about rounding out our Canadian notion of development, to take into account this whole issue Jeffrey Sachs talks about. I just wonder if you have any recommendations along these lines.

Mr. Stephen Lewis: Mr. Chair, Jeffrey Sachs would probably have much more affection for the NEPAD document than I do, because it's a neo-liberal document focusing on investment and trade, which Jeffrey would be comfortable with. If you ever thought about it, he would be an elixir to the committee. The committee would be really taken with the extraordinary range, knowledge, and intellectual capacity of this guy, who is excellent in simple discourse. I mean he's not at all difficult to understand, and he's terrifically knowledgeable.

I spent an entire day in Washington, lobbying Congress on the question of more money. I went with Jeffrey. It was the first time in my life that I felt like an extra in a Hollywood movie; I really had the sense of being an addendum, because the guy is so forceful. So if it ever happened, Mr. Chair, for whatever use it's worth...because his knowledge of public policy around global health is huge.

The other person, whom I met recently and who doesn't carry Jeffrey's eloquence but carries Jeffrey's knowledge, is Dr. Alan Rosenfield, the dean of the School of Public Health at Columbia.

If you had Jeffrey and Alan Rosenfield together, you would get a sense of global health and possibly of Canada's potential place—which the committee would thoroughly enjoy. They're close to us; it's not a big deal to come up from New York. I came up from New York.

The Co-Chair (Mr. Bernard Patry): Thank you.

I must say that Ms. McDonough has already given the name of Mr. Sachs to appear before the committee.

The last question is for Mrs. Kraft Sloan.

Mrs. Karen Kraft Sloan: I'm very concerned about the kinds of medical services that are provided to people once they come down with AIDS. I'm wondering if you could maybe just point to some resources that the committee could use in responding to questions about the hospital infrastructure available, medical services from doctors and nurses, and any kind of home care. I'm not using the term “home care” in our sense of home care but in the sense of clinic availability, and that sort of thing. What is the state of these?

Mr. Stephen Lewis: It varies strongly from country to country. Basically, the health infrastructure is tremendously weak and there simply isn't the staff.

It's heartbreaking. You go to an adult ward in the Lilongwe hospital in Malawi and you'll see literally one overnight nurse for 8 hours, for a patient load of 100, many of whom are in extremis. It's simply not possible. It's similar in the university teaching hospital in Lusaka in Zambia. The demands we make on the professional staff--they're tiny in number and they're overwhelmed--are huge.

When I started out, I talked to you about CIDA having given me support, and that support is reflected in the presence of a colleague, Anne Bains, who is here with me. Anne has been looking at the question of professional staff--doctors, nurses, pharmacists--many of whom have been poached by western countries. It's odd, even though there are no professionals in these developing countries, they're poached by the western countries. It is said that there are more Zambian doctors practising in Birmingham, England, than there are in Zambia. It's that kind of crazy inconsistency. So if you look at these hospital apparatuses, you'll see a desperate need for staff.

There are many community-based organizations and faith-based organizations that do what we call “voluntary home care”. There's nothing voluntary about it; it's conscripted labour. The women do it. It is unacknowledged and unpaid, but they do it. There is a tremendous apparatus at the grassroots for home care, people looking after each other--an extraordinary apparatus. But the health system generally is in bad shape.

One of the things that have excited me is the number of hospitals in Canada--four that I'm aware of now--that have approached me or that I've had contact with that want to twin with a major hospital in Africa to support training of the staff, and sometimes to train them over here. Before we close off, Mr. Chair, I want to mention one particular example I really want the committee to know about.

After I received the appointment, a woman named Mary Coyle got in touch with me. She heads the Coady International Institute at St. Francis Xavier University. She said the university wanted to get involved in HIV/AIDS--the alumni, the students, the professors, and the support staff. Within a matter of weeks, they had established something called “extending care” in St. Francis Xavier. They had a delegation of four and they wanted to know where to go.

I suggested Botswana to them, because it's the highest prevalence rate, and I suggested Rwanda to use their bilingual capacity. Now they have interns in both countries doing astonishing work, mostly training, done by St. Francis Xavier.

I can't get over it. When I travel, people from Botswana, including the minister of health and others, come up to me and thank me as a Canadian for what St. Francis Xavier is doing in their countries. This is just one little university producing some people where the gap is so intense.

I do believe that at a human level in Canada, university to university, hospital to hospital, there is so much we can do. At a political level, we could do--forgive me, I hope this isn't inappropriate--a great deal more than we are doing, because Canada carries that status and that clout internationally.

À (1055)

The Co-Chair (Mr. Bernard Patry): Ambassador Lewis, many thanks for your outstanding efforts this morning. Your experience over the last two decades with the United Nations is a great asset for our country. It was your first visit in front of a House of Commons committee, but after this morning's appearance, I'm sure it will not be the last one.

Thank you very much again. Merci beaucoup.

The meeting is adjourned.