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Jewish World Review March 27, 2001 / 3 Nissan, 5761
Michael Ledeen
Brazzaville was in many ways the best place to learn about
AIDS, because an excellent hospital and the regional
headquarters of the World Heath Organization were there,
both staffed by some marvelous doctors and researchers.
Although they were very reluctant to talk about it in detail (In
those years African governments considered it an
embarrassment to confess the real dimensions of the
epidemic), over the years I learned a great deal from them,
both about the disease itself and about Africans' abilities to
cope with it. There is very little good news, and indeed the
more you learn, the sadder you become. Perhaps some of
what I learned will help our well-intentioned leaders grapple
with their conscience, now that we seem hell-bent on trying to
"solve" the problem.
The first sad bit of wisdom is that Africans' immune systems
are not ours. We are vaccinated against many common
diseases; we take vitamins; we get regular health care from
skilled professionals; and our own defenses against attack
from killer microbes are quite strong. Africans are not
vaccinated against much more than smallpox (if that), and
they are constantly assaulted by a rich variety of nasty
microbes. The assault is far more terrible than anything we
experience. An amazing percentage of Africans are infected
with malaria, and sexually transmitted diseases like syphilis
and gonorrhea (and others) are omnipresent. New
drug-resistant microbes, from tuberculosis to pneumonia, are
flourishing. This relentless assault on the human body
inevitably weakens Africans' ability to fight other diseases,
even those few who have the money and access to good
medical treatment.
It follows from this that, even if all else were equal, it would
be harder to treat AIDS in Africa than here. We fight disease
with medicine and our own resources, and their resources are
inferior to ours.
There is a further nasty footnote: The symptoms of sexually
transmitted diseases greatly facilitate the spread of viruses like
AIDS, because the genital sores break during sexual
intercourse, thereby creating a blood-to-blood exchange that
is ideal for the invading virus.
So, just as a matter of medical science, it's harder to fight
AIDS in Africa than in developed countries. And that's just
the beginning of the bad news. Chapter two of this
heartbreaking story is that African countries spend very little
money on health care. The Congo, which has long been one
of the most advanced countries in central Africa, as of a
decade ago was spending less than one health-care dollar a
year per capita. That's less than a dollar, in one of the best
countries. And for all practical intents and purposes, all that
money was spent in the two biggest cities. The rural
population coped as best it could. There is no infrastructure
capable of delivering medicine to those who need it, nor to
ensure that patients take the full course of treatment. No
matter how generously we donate medicine to Africa, a huge
bloc of Africans will never receive it, unless we also create a
vast infrastructure to deliver the medicine, to administer it,
and to advise the victims. That is a very daunting task.
Worse than daunting, it is politically explosive. For if we
come to Africa with what many of them will consider white
man's medicine, distributed and administered by Western
doctors and nurses, the entire undertaking will inevitably be
denounced as a new form of imperialism. And every time we
fail to reach a particular village or township (and this will not
be rare), we will hear cries of racism.
Chapter three is worse still. African governments have
repeatedly lied to their people about AIDS (the latest is
President Thabo Mbeki of South Africa, who denies that
HIV causes AIDS), in large part because they know they
can't do anything much to treat it. It is asking a lot of national
leaders to expect they will suddenly recant, admit that they
have misled their people and then call upon them to submit to
treatment. The leaders will fear the inevitable question: Why
didn't we hear this before?
Chapter four is grimmer yet. Those same African leaders are
famously corrupt, and they will see the arrival of under-priced
(or, better yet, free) medicine from the West as a glorious
opportunity to pad their bank accounts. If these programs are
run through African governments, they will not be medical
programs at all, but corrupt rackets.
Had enough? See Chapter five: The medicine will be used as
a political weapon, granted to allies and withheld from
opponents. Imagine the political fallout!
Is it hopeless, then? Most likely, it is, at least in the sense of
"solving the problem." That is not going to happen. We must
not create a ruinous fallout simply because our intentions are
noble. Some good things can be done, but they have to
follow the painful lesson of decades of failed foreign aid:
Don't give anything to a government. If we want to set up
some treatment centers, run by such wonderful organizations
as Doctors Without Borders, I'm all for it. If we want to give
money and supplies to WHO operations of the sort I knew
and admired in Brazzaville, by all means do it. But not one
pill, not one vial of life-saving medicine, should be sent to any
government in Africa. That will make things worse, not better.
If we're really serious about combating AIDS, we would
better spend our money on an intensive education campaign
(building on the efforts of some African governments) to try
to change the sexual behavior of the people. That will not
produce quick results, to be sure. (We haven't made
sufficient progress with our own people, why should we
expect it to work any better in Africa? And how effective can
we be in preaching monogamy to polygamous cultures, which
abound on the dark continent?). But in the long run it's the
best hope.
Alas, it seems certain that we will over-engage, at a huge cost
to our own treasury and to the countless millions of Africans
who have become the guinea pigs in one of the most dreadful
plagues in medical
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