Fr. Owen Lambert will address the committee.
AIDS Partnership with Africa: Presentation.
I wish Fr. Lambert to know that I must leave the meeting temporarily.
I welcome Fr. Owen Lambert who works with the AIDS Partnership with Africa and is the east Africa representative of Community and Volunteers for the World. Fr. Lambert has been invited to discuss the AIDS crisis facing Africa and to share some of his personal experiences with the committee. Following his presentation, there will be a question and answer session. Before we commence, I remind the meeting that, while members are covered by absolute privilege, the same privilege does not extend to persons appearing before it.
Fr. Owen Lambert
I thank the committee for inviting me to attend and providing me with the opportunity to share some of my experiences over the past three decades. I have spent most of that time in east Africa. AIDS, the subject we are addressing this evening, is probably one of the greatest global tragedies which faces the human family. There is nothing greater in my experience though I have been through quite a lot in Ethiopia.
I went to Ethiopia in 1974 at which time a revolution broke loose resulting in unbelievable human suffering, the loss of human rights, mass imprisonment and the turning upside down of the economy. In Ethiopia, we lived through civil war, revolution and the famine of the mid-1980s. I had an opportunity to speak to this House in May 1984 to explain the extent of the famine, having left Ethiopia that month to attend my sister's funeral. Over the previous three months, we had witnessed 10,000 people per month dying in south-west Ethiopia where Michael Buerk made his film "The Home of the Green Famine". I could hardly find a listening ear in this House or from the then Minister for Foreign Affairs or the Irish media. I went public with the story out of which grew the organisation Self Help Development International. The people of Ireland listened and responded tremendously to serious circumstances. Members will be aware of that and of Live Aid, Band Aid and so on.
I wish to address the committee from the perspective of my personal experience of what I have lived through and witnessed. Millions died along the roads of Ethiopia in the 1980s. There was war and revolution. While it seemed there could not be a more desperate human situation, what we are now witnessing with AIDS far outweighs anything I saw during the 20 or so years of the revolution. There is no doubt about that. I have given up all development and relief work, to which I was deeply committed, to address the issue of AIDS. I have been coming and going between Ethiopia, Kenya, Tanzania and Zanzibar in east Africa for two and a half years setting up programmes to address the AIDS issue at local, national and grassroots levels.
During the late 1980s and 1990-91, we hardly saw a single case of AIDS in Ethiopia. Later, however, when the Mengistu army dispersed, about 40% of its 400,000 soldiers were diagnosed HIV positive by the Red Cross. We are in the process of resettling about 10,000 of these. They all returned to their families in the countryside which made a huge contribution to the spread of AIDS.
By 1991 we were seeing a few cases of AIDS reported in hospitals, similar to what is experienced in Ireland at present. I visited a hospice in this country about six months ago in which six young people died in the early part of last year. I also visited a hospital in which two babies had recently been born HIV positive. The indicators for this country are the same as those we saw in Ethiopia in the early 1990s. The level of sexual activity in African countries and Ireland is exactly the same. Between 60% and 70% of young people here and in Africa are sexually active and levels of high risk behaviour are similar. Those engaged in such behaviour are unaware of the risk in which they place themselves and their partners.
In 1995 I became deeply involved in the response to the AIDS crisis. We started a programme in the west Gojam zone of the Bahir Dar area of north-west Ethiopia where the source of the Blue Nile is located. The zone has a population of 1.2 million. We used a new approach to address AIDS, namely, the multisectoral, multidimensional approach. Many individuals operate in hospitals, schools or local areas, but the only effective strategy to address AIDS and the approach mandated by the United Nations is the multisectoral approach. This means getting all the institutions of Government, religious institutions - Orthodox, Islam, Catholic, Anglican and others - private institutions and community-based organisations involved. One starts at a political level to get political support behind the approach. We co-ordinate regional, district and grassroots AIDS committees, offer a massive education and prevention programme, capacity building and training, and give people skills to work independently. We have a skeleton staff of ten to 15 people.
In 1999-2000, we expanded the programme to include six zones in the Amhara region of north-west Ethiopia, which borders Eritrea and Sudan and stretches as far south as the Blue Nile. The region covered by the programme has a population of about 9.8 million and is almost completely covered right down to grassroots level. This is done not through staff employed but through training of trainers or ToTs. More than 10,000 people have been trained as ToTs, counsellors, communicators, animators and peer group educators throughout the community, including in hospitals, schools and the ministries of education, agriculture and health. We offer clinics and peer group education in community-based organisations.
A massive effort goes into delivering our message. It is broadcast on local radio, television and news media, in all the Orthodox churches - the region is 95% Orthodox - and through the Islamic community, which makes up about 4% or 5% of the population, and other institutions. This multisectoral approach involves addressing AIDS from seven different points of view, including prevention, IEC - information, education and communication - material, advocacy for vulnerable groups, especially children and young women, care for people living with AIDS, rights of children, especially orphans, and income generation for families who have lost their breadwinners. This approach was the basis on which the Ethiopian Government formulated its national policy which it launched two or three years ago. Following a three day seminar and workshop, attended by the head of the United Nations in the region and the Ethiopian Minister for Health in which we presented our approach, it was adopted as the national approach to AIDS.
We have about 15 staff, including drivers, a secretariat and facilitators, to deal with this large population and geographical area. We do not implement our programme but facilitate its implementation by the Ethiopians. We have also been invited to Tanzania and, in 2001, were invited to Zanzibar. Five members of the Prime Minister's office, the Ministers of Health and Education, the head of the Zanzibar AIDS control commission and others were invited to Ethiopia where they spent two weeks learning the approach and, in 2002, we started the programme with the revolutionary Government of Zanzibar. In the two years since, we have covered two districts in Zanzibar and opened ten new sites.
I returned from Pemba Island last month. We have moved into the Kinondony district of the Dar es Salaam region, which has a population of 1.2 million, and the Bagamoyo district, a historic area, with which many members may be familiar because it was the gateway out of east Africa for those who were taken in slavery to the markets of Zanzibar. At the start of this year, we started in four districts of the town using the same approach. The initial three year phase of the programme covers about 750,000 people and has a budget of €200,000. In Ethiopia, our budget is about €450,000 per year and covers almost 10 million people so we receive an incredible return for very little investment.
I apologise if I have delayed the sub-committee by giving a summary of where I am working and what I am doing. My time in Ireland is spent trying to raise awareness and I welcome this opportunity to speak to the sub-committee and share with it my experience. I received little or no response from the main agencies in Ireland. AIDS is the biggest issue facing Africa and the world and, if we do not get it right, there is no point in discussing education and development, whether it be in the areas of health or agriculture. The bottom is falling out of African economies.
I will give a few figures from my experience in north-west Ethiopia where we are working. In 1999, 527 teachers died of AIDS in the region, all of them graduate teachers. In one region of Tanzania alone, the Morogoro district, 400 teachers died of AIDS in 2001. In one hospital in Addis Ababa, 12 doctors died in one year. In the Bahir Dar hospital in north-west Ethiopia, where we do much work, five laboratory technicians died in 2000. I have walked through this hospital where eight out of every ten people are HIV positive, most of them with full-blown AIDS.
I visited an area close to the Sudan border where we hope to establish a new programme in 2005 if we can get the funding. The Gumuz people who live there, of whom there are about 2.5 million, are hunters and gatherers who do not know about agriculture and cannot keep livestock due to the tsetse fly. The doctors in the hospital there told me that 90% of out-patients attending the hospital were HIV positive. This means devastation.
I was back in my old mission in Soula where I had worked for years and had not been for a year and a half. It was like reading the list of the dead read years ago after masses in November. The list read out to me was unbelievable. I had known so many of them. Some had been business people, teachers, worked in government and so on. There was a long list of people who had died the previous year. When I looked out my window in Arbor Minch, another town where had I worked, every house I could see had lost at least one and up to four family members because of AIDS.
Some three years ago I attended the funeral of an MA graduate from UCD who had worked on our programme and died of AIDS. He was buried on the hillside in St. Paul's cemetery in Addis Ababa. When I was back there a year ago, there was hardly space for another grave in the cemetery which spans 10 hectares, as big as two or three football fields.
Kinondoni Hospital which can be seen from the windows of the United Nations office in Dar es Salaam was built to have 120 beds but it has over 300. In some cases there are three to a bed. Eight out of ten patients have full blown AIDS but staff are afraid to tell them because there would be pandemonium in the hospital. They have hardly any antibiotics to treat them. I have never seen as dedicated and committed a staff in any hospital but they are working with nothing. The hospital does not have any testing equipment or blood bank, yet it stands in the shadow of the United Nations headquarters in Tanzania.
Addis Ababa has an AIDS level of 27%. Some 33% of young mothers in the area in which we are working, Bahir Dar, are HIV positive, as are 83% of young women working in bars and hotels. We are trying to address the number of children coming onto the streets - about 1,000 per year - and get them back to their families. Five years ago there was hardly a single one. Perhaps there is no need to continue.
One of my best friends, Brother Augustine O'Keeffe from Clonmel in County Tipperary, died of cancer two and a half years ago. He worked in the CRDA, an organisation headed by an Irishman. He was one of the finest people who had ever worked in Ethiopia in the famine years. He was Ireland's greatest ambassador, the equivalent to any of the senior UN figures in Ethiopia. He had a brilliant doctor working with him with whom we had worked closely in co-ordinating AIDS work. When he felt that there was something was wrong with him, he went to Blacklion Hospital, the main hospital in Addis Ababa. When he got the diagnosis, he walked over to a fifth storey window and jumped out. Another brilliant surgeon, one of the best I knew and who worked with ALERT, the all-Africa leprosy control programme in Addis Ababa, made the same discovery. He called all of his friends for a party, then put a needle in his vein and was found dead the next morning.
This is a tragedy which is not just hitting the poor, as is the case with famine. There is a huge difference. We can deal and have dealt with famine. Self Help Development International with the help of Irish farmers sent 10,000 tonnes of seed potatoes to Ethiopia in 1986 and 1987, which number was multiplied to 40,000 in the first year. It was possible to get food, even though the West was slow to respond. Although millions had died, one dealt with famine by getting supplies of food and medicine and so on but we cannot deal with AIDS. That is the great difference. It is a silent disaster which one hardly notices. It is like going home after a period of years and getting the list of all those who have died. The first thing I get when I go back to any of the offices in Addis Ababa is a list of all the friends who have died.
I met the manager of the Dell computer company in the month of May. Ireland supplies nearly every computer to Ethiopia. When I went back to its office in September I knew something was wrong and was told the man in question had been buried that day. He was the finest technician with managerial skills one could meet.
The picture is even more devastating when one looks at the statistics produced from a study carried out by the Medical Institute for Africa and the JEEMA institutein Ethiopia. The projection for Ethiopia in respect of HIV-AIDS is that 60% of the adult population will be dead and buried by 2015. This amounts to 20 million people in one country. Between 100,000 and 200,000 people are dying each year and the mortality rate is increasing rapidly. That is the scale we are facing.
In Nairobi in Kenya I read a newspaper article which stated 25% of the student population was HIV positive. In the bigger cities such as Eldoret, Mombasa and Nairobi the figure for the student population from secondary school upwards could be as high as 50%.
I brought some data with me, not with the intention of passing it around but to show what people are saying. The document, A Millennium Decision for Ireland, contains a brilliant piece entitled, HIV-AIDs: A Challenge to Development, which is well worth reading. It states the facts.
A Broken Landscape is by one the greatest photographers of all time, Gideon Mendel, who was asked to do a pictorial representation of AIDS in south and east Africa. The photographs are frightening. The book combines photographs of people with AIDS with their stories. It depicts mass graves exactly like the ones seen in the famine in which ten or 12 people were buried on the one day. The gravediggers could not dig fast enough. One of the biggest trades is the making of coffins.
There is also documentation which gives updated statistical data on Ethiopia and on AIDS. One magazine article was written by Don McCullen, one of the most famous war photographers of all time. He introduced his article on 12 May 2001 by saying he thought he had seen everything but he was not prepared for this. What had overwhelmed him was not the war but the devastation being visited on Africa by HIV-AIDS. The article makes for tough reading.
I welcome Fr. Lambert and thank him for sharing his information and feelings with the sub-committee. He made a great impression and I only wish he had a bigger audience. I also thank the Chairman, acting Chairman and staff of the committee for facilitating us in this matter.
The most appropriate way of reacting to what has been said is to be silent and reflective. Even though we knew the statistics, what we have heard was devastating. We are present at this meeting to explore the situation, however, so I have some questions. In Ethiopia and east Africa generally, what is the cultural attitude to concepts such as virginity, celibacy or abstinence in sexual behaviour? Is the use of condoms promoted in the integrated programmes or is there an objection in principle to their use?
It was said that little progress was being made in Ireland with the main aid organisations. Could we hear some more about this? Would Fr. Lambert indicate what work is being carried out by Irish-based non-governmental organisations in assisting in the fight against AIDS? Would he give us an indication of the level of medical awareness and the medical facilities available, both in the cities and rural communities?
I thank the sub-committee for allowing me to attend, as I am not a member. I was interested in hearing what Fr. Lambert had to say because I returned from Ethiopia last week and I have a particular interest in sexual and reproductive health, HIV and AIDS and development issues in Africa. I was delighted to hear that this group was coming before the committee.
Last week was my second visit to Ethiopia. I am glad to say that some things have changed. There appears to be a greater openness on the part of the government about the issue of AIDS, whereas previously we had met with much denial. Perhaps Fr. Lambert could speak of his experiences in this regard. Uganda is now seen as a shining example of the role governments can play when they take a positive and active decision to promote AIDS awareness and recognise the disease as a ferocious danger within their communities. The Ethiopian government is now more open to this, but official figures are often much lower than actual figures for HIV and AIDS. Could Fr. Lambert comment on the extent to which the organisation is dealing with governments in Ethiopia or east Africa generally in raising awareness?
The presentation included a very curious line, although I respect the fact that Fr. Lambert is a man of a certain faith. He said that religions would have to re-examine their role and contribution in AIDS crisis societies. I am glad to see this because if there is a good network of health and education in Africa it must be the responsibility of the churches. They have tremendous influence and, in many cases, tremendous resources. It is a network that exists and we need to work with these networks.
One difficulty I have found is the issue of condom use and sexual activity. I noticed a few statistics about sexual activity in 15 to 19 year olds. These are referred to quite a few times. This is a problem I noticed in the area. There is much denial, particularly on the part of the religious organisations. They want to pretend that sexual activity does not happen. We all know it does, however. I am glad to see in the report that it does happen and it is a major problem. We need to deal with awareness of this.
What is Fr. Lambert's own feeling about the role and contribution of religions? We have heard during Trócaire's lenten campaign about the issue of condom use. If the religious organisations are to be honest in dealing with HIV and AIDS they need to indicate sincerely that condoms are a necessary weapon against the disease.
My final question concerns harmful traditional practices, particularly those to which women are subjected. This was something we came across frequently in Ethiopia last week. I accept we must be aware that cultures evolve very slowly, but because we are faced with a crisis such as AIDS, it is imperative that we encourage and push for changes in cultural practices which ease the passage of HIV through the population. Is Fr. Lambert's organisation doing any work in this area?
I join with my colleagues in thanking and welcoming Fr. Lambert. I visited Zambia some time ago, where I saw the ravages of AIDS. It is difficult to ask questions about this because Fr. Lambert is the practitioner at the coalface. What can we in Ireland do other than giving money? It could be argued that money should perhaps be going into research, but that would be to ignore the victims. What I saw going on in Zambia was mainly treatment of the victims.
The cultural difficulties are enormous. I was told that many men suffering from AIDS thought that if they had sexual intercourse with a young female virgin they would get rid of the disease. I do not know how we can change cultural practices such as these. We might expect teachers to be able to change this, but one of Fr. Lambert's notes says that the output of the training colleges in Zambia would not even replace the numbers of teachers dying, along with 12 doctors in a particular hospital.
With respect to Fr. Lambert as a priest - I am a Catholic myself, so I can appreciate the culture, although it may not be the right one - I came to the conclusion, listening to Deputy Fiona O'Malley's contribution, that condoms could act as some kind of prevention mechanism for this disease. The Catholic Church, however, might say that they are not to be used. That may not be controversial - I have a brother who is a priest - but it is something the church may have to consider. Perhaps we will have to take a new approach rather than trying to impose our culture on one that is different. Does Fr. Lambert have any ideas about this?
I pay tribute to Fr. Lambert and his colleagues and the many nuns, priests and lay people from Ireland who are labouring in the vineyard to try to achieve something. We are sitting on the fence. Perhaps if Fr. Lambert were to give us some direction, we would be able to act.
Fr. Lambert
I thank members for their questions, some of which overlap. They come close to identifying what we face and what we work with. Practically all the work being done in Ethiopia and Tanzania is by Tanzanians, Ethiopians, Kenyans and so on. They are taking the lead. It is they who are putting in the resources and the time.
Mr. Joe Rea, the former head of the Irish Farmers Association, wrote to me in Ethiopia and I met him before I went back. He and others had collected €80,000 for agricultural development and famine prevention in Ethiopia. One of the conditions attached to this was that Irish agricultural personnel be sent to Ethiopia to implement these programmes. I wrote back to Mr. Rea to tell him that we could not accept the money under those conditions because there were already experts in Ethiopia who were much more knowledgeable about tropical agriculture who could implement those programmes. Mr. Rea graciously bowed to that and came out later to see the marvellous results.
When we leave Ireland, we must leave our cultural and traditional baggage behind and enter the culture of the African people, a culture that can vary enormously between Ethiopia, Zambia, Kenya and Sudan. We are entering countries with their own traditions and beliefs. Earlier missions to Africa were criticised because they destroyed many of those traditions, particularly marriage rites. In Uganda, 80% of people do not get married in church because they want to return to the traditional practice. They also want a child from the union. Otherwise, in Africa, there is no hope of a marriage lasting.
Ethiopia is between 40% and 55% Orthodox and is very conservative. Only 3% of the country is Catholic, up to 35% is Muslim and 5% is traditional religion. We work in north-west Ethiopia where there are 2,000 Catholics out of a population of 10 million. It is a society where traditions are strong. Orthodox and Islamic tradition reject any form of contraception so we must deal with that not from my Catholic point of view but the culture we are entering. That issue was raised in the Cairo and Beijing conferences on women.
We have, however, made great progress. We work hand in hand with the Ethiopian Government because there is no other way. If people came from Ethiopia to work in Limerick and Wicklow, they would not work in isolation but in local health or educational institutions, promoting and expanding them. In Ethiopia we go into all the structures and facilitate them and, although we are challenged by culture and traditions, we have trained 1,500 Orthodox priests and deacons as counsellors and they are doing fantastic work.
The influence of religion in combating AIDS has been ignored by the United Nations and all major organisations and NGOs. We were the first in Ethiopia to launch this programme in 1995-6 and to bring the religious fully on board. We go to the highest level of the Muslim and Orthodox communities and sit down with our colleagues from the public and private sectors to work out an action plan.
That does not mean, however, that we do not insist on all the means of prevention being taught during training. There could be a mix of Islam, Orthodox, Catholicism and no religion in a group of 30 people and the medical experts give them all the means of prevention so they can bring them back to the community. The choices are made by the people themselves.
Zanzibar is 98% Muslim, Pemba Island is 99% and Dar es Salaam and Bagamoyo are 50% to 60% Islamic. Exactly the same approach is used in those places. There is nowhere a person will not find condoms available in Ethiopia, Zambia and Tanzania. Pemba is more restricted and it is not so public in Zanzibar because of Islamic culture, but anywhere a person can buy cigarettes in Ethiopia he can buy condoms. They are freely available.
Part of the instruction is not to make value judgments about condom use. All options are offered to people to prevent AIDS and there is no value judgment, so the use of condoms is as important as any other safe practice.
Fr. Lambert
That is right. We do not make judgments. We leave it up to the people.
Are they given all options?
Fr. Lambert
Yes, they are given all the options by medical experts in all our training programmes, but we do not insist on breaking the traditions of Muslims or Orthodox believers.
Are they denied access to certain options?
Fr. Lambert
No. The Orthodox church would sometimes have a softer approach than the Catholic Church.
No Irish or European NGO puts AIDS at the top of its agenda. They incorporate it as part of agriculture, water, education and health programmes but do not put it at the forefront. We are missing an important opportunity as a result. We may shy away from AIDS because of contraception, but that is not sufficient reason for not addressing the subject.
Many, however, within their programmes are doing some work and some are taking it on full-time in schools, clinics and development areas. I do not know of any NGO addressing the issue through the multisectoral approach, however, where they support local structures to address the AIDS issue.
We were the first operation in Ethiopia and in Tanzania to use that approach and we have tremendous momentum. It is incredible how quickly we can move. We start at political level and move down through the structures, regions and zones right down to the village. There are three days' orientation and 15 days' training for all those involved. The follow-up monitoring and action plans are done with the people involved at the different levels and, within a short time, a network is in place which allows the community to address the issue and to draw up its own action plans.
Medical awareness is growing. We carried out a comparative impact assessment in north-west Ethiopia to establish the actual changes. It is difficult to measure behavioural and attitudinal change but we commissioned EU and local experts to do this. There was a remarkable difference between areas covered by our programme and those untouched by it. I can furnish a copy of that impact assessment to the committee if it would be of interest. The awareness level is growing. Few people in Ethiopia, Tanzania or Kenya do not know of AIDS because it is on posters and in all forms of media, but that does not necessarily result in a change in behaviour or attitudes.
Some of the hospital facilities are very inadequate. We have provided blood banks in several hospitals in north-west Ethiopia, funded by and through Irish Government aid. We have also provided testing equipment. The Eliza machine is no longer needed because the rapid testing is much cheaper and a double test suffices to give either two positives or two negatives. There may be a third but it remains a cheap method. Medical facilities and medication such as anti-retroviral drugs were not available until recently and now experiments are running in two areas around the Gondar area. Until maybe two years ago, only 30,000 in the whole of Africa had access to anti-retroviral drugs and no medication was available for the prevention of mother to child transmission in Ethiopia or Tanzania. A small amount of that medication was available in Uganda and Kenya. Ethiopia is now devising its plan and protocol for the administration of anti-retroviral drugs and prevention of mother to child transmission. The virus can be passed on through breast feeding which will be a tragedy for Africa where up to 80% of children are breastfed for three months or more and there are few alternatives to that.
AIDS is a great stigma. We deny it here. Neither the families nor the public said that the six people in the hospice died of AIDS. Almost no one in Ireland dies of AIDS. The same is true of Ethiopia. Some other cause is always cited. It is similar to the attitude to famine. Starvation kills no one but, when one's system is weakened, one dies of pneumonia, TB or even the common cold or malaria. The system goes into shock when the immune level drops so low and one goes on to malaria treatment. Mothers die in childbirth if their immune systems are low. The heart cannot withstand the pressure. There is significant denial. That is why we provide voluntary counselling and testing and have trained many counsellors to persuade people to go voluntarily for testing so that they know their status and act responsibly.
This is an important point. I have a strong belief in protecting life but we and the people affected must act responsibly. I doubt that any of the committee members with families would want their sons or daughters to do as they like and get off the hook by using contraceptives. We want to teach responsible behaviour and skills for life. That is needed in Irish schools too where the academic level is excellent but the training for life is lacking. Responsible behaviour and respect for one another are important values. We teach those through pedagogical science and training teachers for three weeks to get the message through to young people.
I do not want to shy away from the religious question. I mentioned briefly that we saw the importance and value of having the involvement and backing of religious institutions which took full responsibility. The greatest influence in Africa besides traditional religions is the Islamic community, where we work, and the Orthodox community in Ethiopia. Catholics are a small percentage except in some of the major cities. Their influence and impact is vital. We have not taken note of the influence that remains with traditional and religious places. The networking has worked very well in Ethiopia, where we trained Islamic leaders, and in Tanzania, where we trained Orthodox leaders. The latter would have a strong sense of condemnation, especially in Zanzibar where 96% of those trained are from Islamic mosques and the Islamic community.
When we started in Ethiopia in 1995 and 1996, there was a room full of UNICEF pamphlets in the office of the Minister of Health. They were like Dracula with his hatchet knocking on people's doors or skeletons falling from the sky in that they instilled a deep fear of AIDS in people's hearts.
In all our newsletters and information we use the symbol of a round table made like a basket onto which a plate is put where everyone eats together. It is a symbol of togetherness and caring. We turned the situation around from a negative point which had drastic effects because people were put out of their homes, lived in cemeteries or on their own, and were ostracised by society, even by parents, children, spouses and neighbours. We have broken that. In some places Islamic leaders and Orthodox deacons or priests have buried people with AIDS, and that is being publicised in the media. It has made a serious impact on people's attitudes.
I apologise but I must attend the debate on the Air Navigation and Transport Bill which resumes at 3.45 p.m. Like Deputy Fiona O'Malley, I am not a member of this committee. I asked Deputy Noonan to facilitate the meeting for Fr. Lambert who is connected to a former senator , Michael Howard, to whom Fr. Lambert wrote and who passed the correspondence to me which I, in turn, gave Deputy Noonan. I am numbed by the statistics Fr. Lambert has given us and my colleagues have asked many of the questions I wanted to ask. He paints the picture of a near-holocaust.
What assistance does the European Union give to the people working with AIDS sufferers in central Africa? Other world events have pushed AIDS off centre stage. Does the European Union provide any assistance to the prevention of AIDS in Africa?
I thank the Chairman for allowing me to contribute because I am not a member of the committee but am deputising for Senator Kitt. I am sorry I was not present for Fr. Lambert's presentation but have a copy of his notes. I was a member of an Oireachtas committee which last December visited Lesotho, a country half the size of Ireland in southern Africa. I was horrified by the epidemic level HIV-AIDS had reached in that small country. We visited an orphanage where we saw hundreds of parentless children. During that visit, we also met representatives of the UN which has HIV-AIDS at the top of its agenda. They spoke about a book they had just launched and provided to the Government there detailing their recommendations on how to arrest the problem.
The first case of HIV-AIDS in Lesotho was discovered in 1984. Due to ignorance at that time, it was not believed HIV-AIDS could be present there as it was a poor, isolated country to and from which few travelled. However, it was discovered that infected workers were returning from the mines in South Africa, bringing the disease with them.
The UN representatives spoke strongly about having a compulsory register for health status. I was interested to hear Fr. Lambert refer to voluntary health status. Is it a good idea? My colleagues point out that other issues, for example, terrorism, are higher on the agenda. However, HIV-AIDS will take more lives than terrorists ever can. Moreover, there has been a huge increase in the number of HIV-AIDS sufferers in Russia and eastern Europe.
In Lesotho in recent days, Ministers of the Government came forward to say they will be tested. It would be good if testing were compulsory because it would give a sufferer the dignity of having his or her disease treated with dignity and respect. Those who do not have the disease will have the luxury of knowing they are not ill and can continue to protect themselves. Throughout Lesotho there were billboard advertisements promoting safe sex through the use of condoms. Does that happen in Ethiopia?
Fr. Lambert
One will certainly see plenty of billboards all over Ethiopia, Tanzania and elsewhere in Africa. However, there is also a human rights question. Compulsory testing is a significant issue. I believe it was brought in by the US in the context of visas. Ethiopian Airlines tried to introduce it but had a strong reaction against it, and several companies have also tried to introduce it. Kenya has outlawed it and I was recently informed that, in Kenya, it is an offence even to advise somebody to be tested. If a person is diagnosed positive, they might then sue another for giving such advice and are entitled to do so. Only a professional counsellor or medical professional can advise a person to go for a test.
We are training counsellors to work specifically with young people and they will be registered, recognised and able to advise people to attend voluntary counselling and testing. Senator Feeney, given her visit to Lesotho, will have experience of the major fears and stigma attached to being identified as having HIV-AIDS. There is also a significant level of discrimination. In Islamic society, if a wife were discovered to have or to reveal she had HIV-AIDS, she would lose all her rights and be put out the door. There is great risk attached to this and a heavy penalty to pay.
We can only hope for a voluntary register.
Fr. Lambert
I do not know if a compulsory register could ever be put in place. I do not see it happening in Ethiopia in the immediate future, although perhaps Tanzania and Kenya are more open to it. A situation is developing in Ethiopia where partners are insisting on testing before marriage, and families are pushing for this, which is good. There is an emphasis on the promotion of fidelity. People do not trust those with multiple partners to be free of the virus, even if they use contraceptives.
The position of women is a huge issue. In the north-west of Ethiopia, we are working with the Women's Legal Association, a voluntary association established about ten years ago. With the association, we have opened an office in Bahir Dar and also in Gonder. The association has carried out tremendous work in taking many cases to court to prevent marriages of children of ten years or younger, female genital mutilation, the loss of children's inheritances following the death of parents and discrimination against those living with HIV-AIDS. The association has done marvellous work and we work closely with it across north-west Ethiopia, although we have not yet established a similar base in Tanzania or Zanzibar.
The Senator mentioned the case of Lesotho. Some 44% of adults in Botswana are HIV positive. It will almost cease to exist as a country. It is predicted that 480 million will die of HIV-AIDS in the next two decades, most in Africa, which is comparable to the total population of Europe and the United States. It is estimated that, in the coming decades, one third of the children in the continent of Africa will be parentless. In Zimbabwe and Zambia, with the percentage rising for Ethiopia and Tanzania, up to 20% of households are now headed up by children of 18 years and younger, and that figure is rising rapidly.
I was asked what the EU is doing. I do not think anybody is doing enough, and that is what I am here to say. Why did 2 million to 3 million people have to die in Ethiopia before we responded? Why did people have to see Michael Buerk's film on television before they responded? Why must we present the facts again before we respond? There are countless pictures of devastation available. We have seen them in regard to Lesotho, Zambia and elsewhere.
We must respond massively to this situation. We are doing nothing. Up to the end of 1999, less than €300 million was being provided to Africa to prevent HIV-AIDS. That would not run St. Vincent's Hospital in Dublin for one year. At the same time, we were considering spending €700 million on a stadium. The United States could withdraw €50 billion from its bank to invest in the Iraq war, another €50 billion for home security and it has added another €50 billion to that. Kofi Annan said the spread of AIDS could be contained and controlled with a budget of about $10 billion per year. The world response to the global fund so far has been to provide less than $2 billion.
Africa is dying. About 60% of the adult population is infected with AIDS. We must pull out all the stops. That is why the AIDS Partnership with Africa, small as it is, is involved. We have to be in partnership with the people of Africa because what is happening is tragic. Why go through more figures and statistics? There is no way Ethiopia or Tanzania can have the resources to provide for mother to child AIDS prevention schemes, to provide anti-retro-viral treatment for its peoples, unless there is help from outside.
On the debt issue and trading balances, more funds are being paid from Africa into western financial institutions than are being given to Africa in total combined world aid.
I wish to ask a direct question. President Bush has stopped the payment of moneys to the UNFPA because he does not believe in its prevention measures. He has set up another fund to address the problem in the way he believes it should be dealt with. It has a lot to do with giving money to people preaching abstinence. Has Fr. Lambert's organisation received any of this money, or applied for it?
Fr. Lambert
No. We applied to the global fund for which I spent about ten days preparing the documentation in Zanzibar a year and a half ago. We applied for a sum of €150,000 but when the cheering was over we were allocated €7,000. Later we had to show receipts in the global fund office in Zanzibar. The expense involved in making the application outweighed the funding we received as the conditions imposed are very severe.
I have heard of the Bush and Clinton funds but no money has come our way. It may be government to government funding. NGOs would probably find it very difficult to access such funds. EU funds are also very difficult to access as there are only two or three people in Brussels dealing with applications. It is an absolute disgrace that one can wait one year before even hearing that one's project will be looked at.
We have made presentations with the SCIAF - Scottish Catholic International Aid Fund - Trócaire and, in Italy, CVM, Community of Volunteers for the World. We have made joint presentations with four or five NGOs but the process is very slow, and the bureaucracy incredible. We have presented first-class projects to Brussels, yet it takes one year to get a response.
In the words of Bono:
What can we do, or should we do? Can we afford to let so many people die, and still call ourselves human beings? Is not our humanity also frighteningly diminished and frighteningly exclusive, turning to a jungle-type economics approach to humanity if we allow this to happen? Absolutely. We cannot let this happen in our name.
Chairman
We thank Fr. Lambert for appearing before the sub-committee today and making a very important presentation, sad and disturbing though it may have been at times, but it is something which needed to be said. I wish him well in his work.
We spoke at length today about the position in Ethiopia and Addis Ababa. A number of years ago I attended the African development conference on behalf of the Minister for Foreign Affairs when I spoke on behalf of the European Union. The South African Minister for Health spoke on behalf of African development agencies to try to highlight the need for awareness. We will certainly report to the Joint Committee on Foreign Affairs and the Minister for Foreign Affairs.
I hope Fr. Lambert's attendance today will be of some assistance to him in his work. We will help in any way we can.
I propose that we ask the Department of Foreign Affairs for our next meeting to brief us fully on what assistance is being provided directly to combat the spread of AIDS, particularly in Africa, and for NGOs earmarked for the fight against AIDS. The sub-committee needs a kick-off point. If we could get that information, we could use it as the basis for a discussion.
Chairman
Is that agreed? Agreed. I suggest that for our next meeting we should invite officials from the development co-operation unit to brief us on the overseas development aid programme and discuss progress towards reaching the UN target of 0.7% of GNP by 2007. Is that agreed? Agreed.
The sub-committee adjourned at 3.55 p.m., sine die.