Stephen Lewis, United Nations Special Envoy for HIV/AIDS in Africa
on Friday May 2 2003 delivered a powerful statement
to the UN Press Corps, on what he described as his refreshing
visit to Kenya. Full remarks below:

---

Just last weekend, I returned from a trip to Kenya, during
which I met, at length, with the new President, and
Ministers of Health, Education and Information. I also met
with the leadership of the National AIDS Control
Council, the UN country team, various representatives of
civil society and People Living with HIV/AIDS, and made a
trip to Kabera, the huge, sprawling, abject slum in
Nairobi, to meet with over a hundred commercial sex
workers, all of whom are involved in a program of HIV
prevention.

While everyone I met and everything I encountered was
fascinating, it's the political leadership I'd like to
focus on for the purposes of this press briefing.

All too often, when I report back to the media after a
visit to Africa, I'm consumed by gloom and apocalyptic
utterance. But not this time. This time I came away with a
greater degree of hope and optimism than I've felt for
months. It's hard to describe the sense of change from the
previous administration: suffice to say, where HIV/AIDS is
concerned, the change is night and day. Where before,e
senior officials' attention to AIDS was perfunctory, on
this occasion every conversation, without exception,
demonstrated a new leadership that is intense, committed to
confronting the pandemic, determined to put policies and
programmes in place, and consumed by the recognition that
every single family in Kenya is affected in some way by the
ravages of HIV/AIDS.

I guess it's a trifle presumptuous to make personal comment
on a conversation with President Kibaki, but I'm going to
do so nonetheless. The President has appointed an HIV/AIDS
Cabinet Committee of nine members, which he personally
chairs. He's providing very open and public leadership on
the issues of AIDS, and demands the same of his cabinet
colleagues. What was particularly impressive --- and
unusual --- in the meeting with the President (there were
ten senior members of the bureaucracy present) was his
refusal to accept, at face value, any reassurances that his
administration has the pandemic well in hand. President
Kibaki frequently challenged what others said, asserting
--- almost by instinct ---that the crisis is far from under
control, and insisting that the fight against the
pandemic must be intensified.

It was one of the most refreshing meetings I've attended
with a Head of State. We covered prevention, particularly
in the schools; anti-retroviral drugs, financial resources,
orphaned children, stigma, the role of religious
communities, the role of parliamentarians in their
constituencies, the effects on women and girls, the lifting
of school fees and the question of prevalence rates. The
discussion lasted well over an hour.

It was followed by a meeting with the Minister of
Education. This is the arena where the full force of the
new Government has been felt. As most people doubtless
know, the key promise of the election campaign was the
abolition of fees for primary school. No sooner was the
present Government elected, than the promise was fulfilled.
And an extraordinary thing happened: when school reconvened
in January, 1.2 million new children poured into the
educational system within one week --- an increase of over
20 per cent! --- and the numbers are still rising, expected
to reach one and a half million by June.

The implications are stunning. One million two hundred
thousand children who had not been in school turned up for
school. Kenya has an estimated one million two hundred
thousand children orphaned by AIDS. Are they identical
cohorts? Of course not. Is there a significant overlap?
Everyone agrees that the overlap is large. What, then, is
the situation on the rest of the continent for millions of
other children orphaned by AIDS, particularly in
the high prevalence countries? How is it possible that a
campaign to eliminate school fees has not been launched
across Africa? Where is the leadership to come from? Why
should such vast numbers of children, who have lost one or
both parents to AIDS, who have little if anything to eat,
who have no guarantee of shelter, no guarantee of health or
nutritional care, no guarantee of a home or of love or of
nurture . why on top of it all, should they be denied the
right to go to school and the prospect of a future simply
because they're impoverished? There's something truly
dreadful about all of this.

If the experience of Kenya proves anything, it proves that
those who have argued for the abolition of fees, as a way
of liberating the lives of millions of children, were
right. What is so distinctive about Kenya is the new
Government's determination to see the lifting of fees as
applicable to everything, including books, uniforms, or any
extraneous levy. In the view of the Minister of Education,
the policy is driven by the guarantees contained in the
Convention on the Rights of the Child and the
internationally agreed principles of "Education for All".

In one instance, in an urban slum community many miles from
Nairobi, the population of the primary school, after the
fee announcement, jumped from one thousand to five thousand
students. But when the Headmistress insisted that every
child must come to school in a uniform, the numbers dropped
to 2,600 --- a major revelation in itself. The Ministry of
Education asserted that absolutely nothing, including
uniforms, was to stand in the way of school attendance, and
the numbers are moving back up.

I don't want to pretend for a moment that there isn't a
very tough, hard slog ahead. The new government and the
voters understood that abolishing school fees would be
costly in financial terms, but the free education campaign
slogan said it all: "If you think education is expensive,
try ignorance." The Ministry is scrambling to put together
the dollars to finance the policy (a government task force
announced in March that it would cost $97.1 million through
June, and another $137.1 million through the 2003-2004
school year)" a major portion of it from the Kenyan
national treasury, part of it from the World Bank, part of
it from bilateral donors.

And there are still areas of the country, particularly the
nomadic North-East, where school attendance remains
unacceptably low. Moreover, the urgent need physically to
expand the school system, and to replenish the teaching
profession, shredded by AIDS, is obviously overwhelming.
But the Government is single-minded in its determination to
guarantee the rights of every Kenyan child to education,
and to prove, in the process, that the goal can be
accomplished without sacrificing quality.

For the orphaned children of Kenya, the policy is a
salvation. Why, then, is it not in place across the
continent? The time has more than come to champion this
cause with every Government, and to champion it with
unrelenting tenacity. No one should forget that all of the
governments in question have ratified the Convention on the
Rights of the Child, article 28 of which reads, in part:
"Make primary education compulsory and available free to
all".

Let me now move to the Minister of Health. Again the
conversation was illustrative of a Government determined to
break the grip of the pandemic on Kenyan society. This
Minister speaks with passionate clarity, knowledge and
resolve about the need to proceed simultaneously on care,
prevention and treatment. More, in a fashion with few
parallels, this is a Minister who understands the appalling
toll being taken on the women of her country, and the need
to address their extreme vulnerability.

The Government of Kenya has just received money from the
Global Fund. The $56 million allocated to the next two
years will help to provide anti-retroviral treatment for
another three thousand Kenyans. There are roughly seven
thousand in treatment now, mostly in the private sector, so
that will bring the total to ten thousand. Already the new
Government has set a target of 40,000 in treatment by the
year 2005.

How will they achieve it? In four ways. First, the
Government is examining legislation to introduce a National
Health Insurance Plan. It is the intention of the Ministry
of Health that treatment for opportunistic infections, and
for (...) AIDS, be covered, at least in part, by the
Plan. In my respectful view, that's an astonishingly
enlightened and courageous position, worthy of
international support. Second, the Government hopes to
persuade the private sector to further expand its
coverage. Third, the Government has set aside, in this
fiscal year, with increased recurrent funding in mind, the
sum of $4 million for laboratory infrastructure to address
HIV/AIDS, and it is hoped that, inevitably, some of the
money will be directed to treatment. Fourth, the Government
is even now preparing its next proposal for the Global
Fund, which will include financing for the treatment of
another ten thousand people. In that regard, it should be
added that the Government will wish to purchase generic
drugs, from the WHO list of approved anti-retrovirals,
probably from India, in order to keep the prices down.
This, then, emphasizes yet again the desperate urgency of
adequate resources for the Global Fund.

While all of these intentions are truly exciting, and a
dramatic departure from the previous administration, it
must be pointed out that over two million people are living
with the virus in Kenya, and it is estimated that two
hundred thousand would qualify for immediate treatment. As
always, the gap between need and reality is measured in the
appalling foreshortening of hundreds of thousands of lives.
With additional resources, Kenya could treat thousands
more. With additional resources and a transfer of
technology, Kenya could establish an indigenous capacity to
manufacture anti-retroviral drugs. When will the resources
come? When will the needless carnage end?

Finally, a word about the Minister of Information. He's
about to take a very unusual step. Using the authority
granted to him under the Broadcasting legislation, he will
direct that a certain limited percentage of air time, on
all radio and television stations, be devoted to
programming on AIDS prevention. It's a move that will
undoubtedly attract criticism, but just as in the case of
his colleagues, the Minister is unshakeable.

It's hard to convey the startlingly changed atmosphere in
the political precincts of Nairobi and by extension, in the
population overall. If ever there was a time to turn the
pandemic around in Kenya, that time is now. There is no
reason in the world, given the commitment of the new
Government to tackle HIV/AIDS, why Kenya cannot become the
next Uganda. But they'll need lots of help: they must get
it.
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