Recent columns by Barbara Crossette:

For Countries Big And Small, A Diplomatic Marathon (September 23, 2003)
"Over the years, autumn at the United Nations has evolved into a huge hive of diplomatic activity, making New York the capital of the world, as Rudolph Giuliani, the former mayor, used to say."

German Teacher Provides Much-Needed Guide To The U.N. (September 15, 2003)
"[For] years, scholars, journalists and interested citizens of all kinds have had to scrounge for an easy-to-understand, jargon-free compendium of information on an organization that seems to revel in making itself hard to penetrate."

Human Rights at U.N. Obscured by the Shadow of Politics (September 8, 2003)
"Human Rights Watch lists only a handful of countries (among them Canada and Mexico, leaving a big hole in between) that act out of principle and not political expediency."

UNICEF in the Crosshairs (September 2, 2003)
"The Catholic Family and Human Rights Institute, noting the appearance of frank educational materials about sex in UNICEF-supported programs and a greater emphasis on the education of girls ... worries that 'UNICEF has moved beyond simple, and universally acceptable, programs.'"

More from U.N. Notebook.

U.N. Notebook | September 29, 2003
from U. N. Wire Fighting AIDS by Changing Attitudes in Africa

by Barbara Crossette

Two weeks before the General Assembly met in special session to talk about the shortfall in resources for battling HIV/AIDS worldwide, 22 Africans who work on the front lines of the fight in cities and villages across their continent also had a meeting—in a basement conference room well out of the spotlight.

Theirs was a workshop to confront at the most practical level the alarming mortality figures and to talk about strategies to stem the epidemic. Before they arrived in New York, the participants, nearly all from national health or statistical agencies, had been asked by the U.N. Population Division, the sponsor of the workshop, to answer some questions to help set the tone and agenda for their meeting.

In their answers these Africans, mostly young men and women closest to the suffering people and the ugly statistics, were overwhelmingly preoccupied with the need for more effective prevention programs and, where necessary, changes in cultural attitudes that may be contributing to the further spread of the disease. Given a choice of five future possibilities on the questionnaire—including some positive ones such as the potential that economic growth or new cures were bound to solve the problem in due course—the workshop participants almost unanimously choose one or both of the more frightening options instead: that HIV/AIDS was a major risk to individuals and a threat to the nation, or that the epidemic was "the major issue for the survival of our society."

Outside Africa, advocates for a concerted effort to roll back HIV/AIDS have at times appeared to be concentrating more on attacking large pharmaceutical companies (however deserving the targets may be) than on pushing the industrial nations to put an equally high priority on pumping money into communications and education. Africans, seeing death all around them, cannot pause long enough to lobby for drugs to aid the already doomed when they desperately want to throw a shield around those not yet sick. Workers in government health agencies, private organizations and churches need every possible kind of logistical support to take the warning message out to people who do not know or do not believe that their own sexual behavior can save or condemn them.

Moreover, Africans must also support those who are HIV-free but burdened by responsibility to care for the sick, the dying and the orphans and elderly parents left behind, bereft of income. Grandmothers number high among them. They have lost sons and daughters who were family income earners and yet have to find money to feed and educate grandchildren.

Readily available medications and the discovery of a vaccine would be wonderful, four of the workshop participants said in a conversation over breakfast at the United Nations. But those goals, said Francis Munene of Kenya's Central Bureau of Statistics are, sadly, "still not even a dream." Few people can afford the monthly cost of treatment now running between $50 to $200, cheapest in Uganda and most expensive in Southern Africa, the experts said. Even cheaper drugs would be beyond the reach of many unless governments provide them, and governments often do not have the money.

The urgency of stopping the transmission of HIV/AIDS is palpable among those who see day to day what the epidemic is doing to their communities. According to the Geneva-based Global Fund to Fight AIDS, Tuberculosis and Malaria, of the 42 million people now living with the virus, 28 million are in Africa. Another 45 million people worldwide could be infected by the end of the decade, many if not most of them in Africa and Asia. Some African AIDS experts say that there could be 40 million orphans in Africa alone before this epidemic runs it course.

Miriam Cassim of the South African Health Ministry's national health information directorate said that in South Africa, "The overall goal is to prevent new infections, and then second is to support individuals, families and communities infected and affected by the epidemic." Treatment, care and support are the next focus area, then the research side, she said.

In his speech to delegates at the special session on HIV/AIDS last week, U.N. Secretary General Kofi Annan drew attention to necessary changes in attitudes, not only in Africa, when he said that a third of affected countries around the world still had no policies of prevention targeted at women, who are now being infected at a faster rate than men in many places. Two-thirds of these nations do not protect the rights of HIV-infected people, allowing stigmatization and victimization to persist.

Liberal attitudes toward casual sex are often not accompanied by information on how to prevent transmission, by condom distribution or by backing women's rights to refuse unprotected sex. Roselina De Wee of the Disease Control Division of the Namibian Health and Social Services Ministry said that these factors play into the spread of HIV/AIDS.

"Unfortunately, we are still seeing a trend that is going up," she said. Now 22.5 percent of Namibians are infected, she added. In other areas of Africa, particularly where there are larger Islamic populations with more conservative rules for sexual behavior, the incidence is much lower, she said. "We are too Westernized," Cassim added, only half in jest.

In countries with strong Christian churches, the Africans said, there are diverse attitudes on whether and how to talk explicitly about sex. In Kenya, Munene said, the powerful Catholic Church has been resistant to advocating frank sex education or condom use. In Uganda, by comparison, the dominant Anglican Church has been in the forefront of community education and support, said Samuel Zirimenya of the country's Central Bureau of Statistics.

Church involvement, coupled with political leadership by President Yoweri Museveni, has led to significant progress in stopping the spread of HIV/AIDS. Zirimenya said that putting education first paid off. "Once someone is given the knowledge, then this person is likely to change his behavior. One of the major reasons why AIDS moved very fast in or country was the lack of knowledge about the disease."

Kingsley Moghalu, a Nigerian who is manager of resource mobilization and global partnerships in Geneva for the Global Fund, is outspoken in his support for cultural changes, even defending those who call for abstinence. "It is essential that cultural attitudes toward sex that pour cold water on abstinence before marriage, faithfulness to partners, or safe sex through the use of condoms—male or female—be addressed head on," he said in an email interview. Countering these negative cultural attitudes, he added, must be part of communications programs on behavior change. Most of the local programs supported by the Global Fund have strong prevention aspects fostering behavior change, he said.

But on the other hand, local cultures and practices may also be helpful, Moghalu said. "It is important not to discount the potential of traditional medicine healers in the fight against AIDS, subject, of course, to scientific verification," he said. "Let's not forget that many effective Western medicines are produced from plants and substances in the developing world of Asia, Africa and Latin America."

In a paper prepared for a recent conference of nongovernmental organizations at the United Nations, Moghalu also turned to politics. When African governments show their commitment, help from abroad may be more forthcoming, he said.

"African leaders committed in their Abuja summit in April 2001 to dedicating 15 percent of their national budgets to public health," he wrote. "Few, if any, have met this goal. Affected countries also need to make contributions to the Global Fund. This is an important symbolic demonstration of political will to fight the epidemic."

What do you think? Discuss this article in the Foreign Affairs conference of Post & Riposte.

More on foreign affairs in Atlantic Unbound and The Atlantic Monthly.

Barbara Crossette, a writer on foreign affairs and columnist for U.N. Wire, was The New York Times bureau chief at the United Nations from 1994 to 2001. U.N. Wire is a free daily online news service covering news about and related to the United Nations. It is sponsored by the U.N. Foundation and appears on the foundation site, but is produced independently by The National Journal Group. For information on National Journal Group publications, see

Copyright © 2003 by The Atlantic Monthly Group. All rights reserved.