Breaking the Silence

BY AUGUSTUS NASMITH, JR.

I respect the silence many
war veterans keep around
memories of the unspeakable.

I too am a survivor of world-
wide devastation. I keep pained
silence when I think of loved
ones gone. But affliction con-
tinues in horrendous magni-
tude; words, however inade-
quate, must be found.

The “unspeakable” rages for
an estimated 34 million cur-
rently infected by HIV. It rages
as action could prevent further
infection and make health care
more equitable. In this global
war, silence is death’s ally.

‘Break the Silence’ was the
cry of 12,500 leaders of world
efforts to confront HIV/AIDS
in Durban, South Africa, in
July for the XIII lntemational
AIDS Conference.

AIDS’ spread highlights
gaps between rich and poor,
educated and uneducated,
democracy and tyranny. The
late Jonathan Mann pointed out
that the already marginalized
are the most HIV-susceptible.

In the US, with a constant
annual new infection rate near
44,000, media and public pre-
fer to think of AIDS as “over.”
Deep down, we want treat-
ment advances to mean the
danger is past.

But with .6 percent adult
infection, fear of AIDS and
wishful thinking are dangerous
blind spots in our rich coun-
try’s struggle. The UN
Programme on HIV/AIDS

‘reports more and more poor

countries with 5 to 35 percent
adult infection. In most of the
developing world, the epidem-
ic is worse than predicted. We
must guard against paralysis,
educate and prevent here in the
US, and admit there is much to
be done worldwide.

Since the first international
AIDS conference in 1985,
authorities warned of HIV’s
devastating spread without
thorough national prevention
programs. The years have been
hard teachers about failed lead-
ers and societal impediments.

Disaster elsewhere under-
scores the importance of efforts
at home. Epidemic anywhere
threatens the whole modern
world. One that could wipe out
social and political structure
and decades of the developing
world’s economic gains threat-
ens regional and global stabili-
ty and hope of mutually benefi-
cial world trade.

I cringe at economic and
security arguments, but they
speak to those_ to whom human
tragedy does not. Still, if we
feel so far removed from those
facing the worst impacts of

AIDS that we cannot care, we
reveal our attitudes to a world
in which we proclaim our-
selves the only superpower.
We also mark our society.

Caring for and sharing with‘

others are part of Vermont
social fabric. Most feel stigma
from irrational fear are over,
yet old ignorant slander about
HIV became anti-civil union
rationale! Hypocrisy-about sex
and hindering effective sex
education and health measures
mean infection. Enlightened
education policy and preven-
tion promotion continue a low
infection rate, are better for
public health, and spare service
and government resources.

Durban was the first south-
ern hemisphere international
AIDS conference. It meant
increased involvement of
Africans and attention to their
plight. Sadly, President Thabo
Mbeki did not energize with
his opening address.

With 4.2 million infected,
South Africa’s 20 percent adult
infection rate is growing. One
in four women between 20 and
29 is infected, more than young
men. Young women are often
forced to partner highly infect-
ed populations of older men
who refuse protection. Women
discussed the need to counter
male cultures’ failure to con-
front HIV. Precious Sibesi
shared a teenage view that
“cute young guys” could not be
infected. Without education,
Vermont teens could make
such assumptions.

Kefiloe Ramela spoke so
softly you could feel her bro-
ken heart. Her mother had
died; her brother was dying.
HIV showed that “when days
are dark, friends are few.” “So
much is hard for me,” she said,

.\-/.v

broken English conveying her
life’s message.

These voices have clarity
from abandonment and isola-
tion. Stories show fear pro-
motes ostracism, stigma, and
denial, blocking prevention.
We have improved, but it still
happens here in marginalized,
uneducated populations. Do
Vermonters who block thor-
ough health education realize
they put children at risk?

Socio-economic, and human
rights inequities dominated
discussion in Durban, magnify-
ing US concerns. Participants
expressed frustration that
denying HIV/AIDS’ realities

November 2000 | Out in the Mountains i9
= opinion =

health crisis, fear, denial, and
cultural and moralistic barriers
to safety will have the same
consequences everywhere.

The Caribbean already mim-
ics Africa. Except for the
wealthy, there are no treat-
ments, hospitals, or care ‘for
the infected. Women and chil-
dren are abandoned by death or
flight. There is no work for
women supporting families.

India’s 3 million infected are
.7 percent of its huge popula-
tion; HIV is growing where it
was ignored it until recently. A
slide showed results: a shabby
straw hut, miles from any
dwelling, to which a village

The reality: in most of the developing world,
the epidemic is worse than predicted.

included denying equitable
health care.

“Available treatments are
denied to those who need
them,” said South Africa High
Court Justice Edwin Cameron,
“for the sake of aggregating
corporate wealth for sharehold-
ers who, by African standards,
are already unimaginably afflu-
ent. No more than Germans in
the Nazi era,‘ nor more than
white South Africans during
apartheid, can we at this
Conference say we bear no
responsibility for 30 million
people in resource-poor coun-
tries who face death from
AIDS unless medical care and
treatment is made accessible.”

Many decried prices that
deny treatment to 95 percent of
infected people. Think of
Vermont demands for fair drug
costs; are we not in solidarity
with those with but hundreds of
dollars’ annual income?

To spread the alarm about
Africa is to tell the world what
awaits. Without national lead-
ership to deal with public

\ ~.

Whatever you take along for pleasure, consider this:
We may feel safe in Vermont, but we’re not immune
to AIDS and other sexually transmitted diseases.

Don’t take a chance...

take a condom

exiled an AIDS casualty’s
widow. Such fear, denial and
lack of compassion guarantee
the viral march: HIV lives and
spreads back in the village.

Adult infection tops one per-
cent in Cambodia, Myanmar,
and Thailand. In China,
Indonesia, Malaysia and
Nepal, shared needles in rising
drug use transmit HIV. In the
former Soviet Union, with col-
lapsed health and social struc-
tures, prostitution, and related
activities also spread it.
Without the difficult US awak-
ening and intelligent Vermont
public health policy, we, too,
would see such explosion.

The Durban conference
joined champions to “do some-
thing,” even those whose
poverty and history might fos-
ter fatalism. Rather than accept
death sentences of ignorance
and fear, they tell liberating
truth. Rather than take the con-
sequences of individual, soci-
etal, and governmental irre-
sponsibility, they define and
demand responsibility. The

«fix \ $2 Nxxx ~.. .

conference was a mass demon-
stration of rich and poor
demanding that humankind
reach its potential.

Since the 19805, American
experts have been in the fore-
front, defining the disease, -try-
ing to stop its spread, develop-
ing treatment, seeking cures.
We have seen the best of our
capacity to research, educate,
and lead, learned humility
through limited progress, and
admitted health care inequities.

Might the world HIV/AIDS
crisis recall us to international
cooperation? To protect all
from HIV (or any disease) is to
protect ourselves. To work for
the planet’s health to work for
our own. To confront AIDS is
to reset goals of development
and democratic societal evolu-
tion behind the UN Charter and
ideals to ensure universal
human rights. US leadership in
commitment to a better world
can still show others what is
right. But we must commit to
what is right ourselves, includ-
ing our UN responsibilities and
assistance programs abroad.

Nelson Mandela inspired
with his closing address at
Durban. “Others will not save
us if we do not primarily com-
mit ourselves,” he said.
“Partnership with the interna-
tional community is vital... in
this inter-dependent and glob-
alised world, we have indeed
again -become the. keepers of
our brother and sister. That
cannot bemore graphically the
case than in the common fight
against HIV/AIDS.”

Mandela reminded us how
exhilarating it is to commit
ourselves, how immune
enhancing to identify with
what is right and good. How
beneficial to break the silence!

Augustus Nasmith has lived
with HIV since 1983. He lives
in Rutland.V

Vermont AIDS Hotline 1.800.882.AIDS

TTY 1.800.319.3141