BODY COUNT: How They Turned AIDS Into A Catastrophe
An Interview with Author Peter Gill

Interviewed by Claudette Vaughan

In twenty-five years AIDS has killed 25 million, one million for each year of the epidemic, and another 40 million have been infected. But why, when AIDS is preventable? Author Peter Gill speaks to us about his latest and important work “Body Count: How They Turned AIDS into a Catastrophe".

Abolitionist: We are 25 years on with 25 million dead from AIDS and millions more infected. Are we better off or are we worse off?

Peter Gill: We are nowhere near as advanced as we should be. For the last decade there has been treatment for people who are HIV-positive but 25 years has elapsed and we still have no cure and there’s no vaccine. What we have learnt recently is that we are also a very long way off developing microbicides for women in poor parts of the world, notably in Africa, to enable them to protect themselves during sex from getting the infection. Scientific and medical progress has simply been very disappointing and that drives commentators and AIDS experts back to the fundamental need for effective prevention strategies - because even if AIDS is not curable, it is certainly preventable. The thrust of my book is to challenge and question governments and public officials over their conduct in the past 25 years. As I see it, they have failed to grasp the nettle of effective prevention strategies.

Abolitionist: What is your analysis from your own experience and travels in Africa and India on the AIDS crisis. For example, how did religious figures tackle the AIDS crisis?

Peter Gill: The overall problem here is not exclusively religion. It’s what one might describe as ‘moralism’. Of course, in the case of the Roman Catholic Church, that ‘moralism’ has a religious foundation, but I encountered it first in India. I was working for the BBC World Service Trust which uses media for development. We had a big project in India which I was running in partnership with Indian broadcasters and health officials to raise awareness about AIDS and, crucially, to promote behaviour change in response to AIDS. What that means, whether one is straight or gay, is to use condoms. We ran into real problems with the government of India at that time (2002-03) where a lot of our condom advertisements were banned. This was at a time when US moralism was beginning to play a really significant part in the American response to the global AIDS tragedy.

You’ve got a situation in the US where George W. Bush, to his credit, has committed more money and has taken the global AIDS tragedy more seriously than any of his predecessors, including that great campaigner and communicator, Bill Clinton.

The problem with the US approach is that it is overlaid with moralizing – they’re promoting abstinence and sidelining condoms. I thought that given the connection between my Third World experiences and what was going on in the United States, there was an important book to be written.

The US program on AIDS is very significant, but it is undermined by their flawed prevention strategies. This has been a persistent historical pattern because this sort of moralism has bedeviled the international and national responses to AIDS at least for 25 years. There are some exceptions but this is the main problem. The role of the hierarchy in the Roman Catholic church, including the Vatican, in its response to the AIDS crisis has been shameful for 25 years. That’s not to diminish the hugely important work that Roman Catholic missionaries in the field are doing. My experience in Brazil and African countries is that Roman Catholic missionaries and priests at the sharp end - seeing people die around them - respond not only with great humanity, but also with great courage - sometimes by facing down their own church and getting on with encouraging people to use condoms for protection.

We now see the evangelicals supported with huge sums of US money becoming very influential on the ground in Africa. The growth of the evangelical churches in Africa is tremendous. They take the same sort of moralizing approach and that encourages governments to take a moralizing approach. Countries with strong Roman Catholic influence haven’t had a terribly good record in the AIDS field. Happily there have been some exceptions in which governments have adopted rational and non-judgmental policies towards AIDS. I point to Britain and to Australia here. In the field of intravenous drug use, for instance – and that’s a sure-fire way of getting HIV-infection through the use of dirty needles - the response here was to say ‘Look! If you’ve got an intravenous drug users at risk from AIDS, it’s better we enable these addicts to protect themselves from the infection rather than tell them ‘Just Say No’ and come off the drugs because that’s not always, indeed very rarely, is it realistic. We have had this very impressive ‘harm reduction’ tradition over the last 20 years, with Australia very much a leader in the field. The British hand out clean needles. The Dutch famously hand out clean needles and it works. In the United States there has been now a 20 year ban on any federal funding for needle exchange programs either domestically or in its overseas AIDS projects.

Back in the 1980’s in Britain, during the time of Margaret Thatcher, she may have been a stern moralizing force herself, but some very able British ministers got on with the business of informing every household about this disease and to tell them that it was largely sexually transmitted, either by gay sex or straight sex, and that people should get on with protection and start using condoms. The British, as a result, have a remarkably low HIV infection rate, in contrast to the United States of America which has an infection rate 4 or 5 times that of Britain. My contention in the book is this moralizing has bedeviled and undermined the response to the AIDS epidemic. Of course we couldn’t have prevented the AIDS epidemic but 25 million have died, 40 million are infected and my belief is that many hundreds of thousands, quite likely into the millions of lives could have been saved and many millions who are currently infected need not have been infected if governments had done their duty instead of cowering behind easy moralizing and telling people to abstain from sex or stop using drugs – all these easy get-outs instead of grappling with the AIDS crisis as a public health emergency.

Abolitionist: The million-dollar question is do they want these people to die because in the 80’s the condom was the first line of defence in combating, as a medical condition, the AIDS crisis. You have said that George W. Bush committed $15 million to fighting AIDS in Africa but most people probably don’t realise how seriously flawed that policy is.

Peter Gill: Yes I think US prevention policy is profoundly flawed. You could argue that as far as US sexual abstinence campaigns are concerned (and we are talking about 1 billion US dollars being spent on abstinence-only before marriage as a public health approach to AIDS) it’s a five-year program and it ends in 2008. It is still conceivable that lots of money is being spent, lots of campaigns are going on and that this approach will make a big contribution to reversing the epidemic. We will see. I doubt it. Where all the evidence is already totally stacked up against US official attitudes is in this area of intravenous drug use. It’s been proved all over the world where it has been tried that harm reduction and needle-exchange work, but the US will still not change its views.

My exchanges with Larry Kramer, that great AIDS campaigner who did so much to mobilise the gay community, underlined the way he really took on the US establishment on this. I personally think it is going too far to attribute all these deaths in the early years of AIDS to a deliberate, cynical engineering of an epidemic that was going to kill people who were HIV-positive and in the early days disproportionably gay. I think that is stretching a point.

Abolitionist: But how does a virus find itself exclusively targeting gay white homosexual men living in New York City?

Peter Gill: I don’t think it was exclusive. What you had in the early years was the impact of a great deal of risky gay sex. We are talking about the era of the bathhouses in San Francisco and New York City with multi-partnered sex. Then certainly a significant minority would have been drug users as well. I think that, without being too Machiavellian about it, that adequately accounts for where the epidemic was first located. However I acknowledge that the moral climate in that era – the Reagan era –thought God was wrecking his vengeance upon gay people..

In my book I go into detail over the role of the U.S. Surgeon-General at that time. Dr C.Everett Koop even looks like an Old Testament prophet! He’s a formidable up- right Christian figure. He was selected by the Reaganites to be their Surgeon-General because he took a ferociously anti-abortion, so-called “pro-life” position. What alarmed the White House, as soon as the AIDS crisis blew up, was he was intent on switching his stance from abortion to the HIV drama and a pro-life stance there, saving people’s lives, which meant telling them about the dangers of HIV and getting them to protect themselves and use condoms. Famously Reagan did not mention AIDS publicly for five years into the epidemic and for most of that time Everett Koop was effectively banned from ever mentioning AIDS in public. As he said, if ever there was a health crisis for the surgeon-general’s intervention it was AIDS. For years and years he was prevented from doing his duty. Then finally he was able with great difficulty, long after some European countries, to get information out to people telling them about the threat to AIDS. But it was much too late, considering HIV/AIDS was in epidemic form originally a US phenomenon.

Abolitionist: Suddenly in the mainstream press there’s a push to blame poverty as the cause of HIV/AIDS in Africa. How much of a problem is the availability of getting HIV/AIDS drug treatments in, say, South Africa?

Peter Gill: If there is one villain in the whole AIDS drama who I identify in the book, it’s Thabo Mbeki, the President of South Africa. He is profoundly uncomfortable with acknowledging the reality of AIDS. He is content to attribute AIDS to poverty - and pretty well anything provided it’s not a sexually transmitted disease. He is fundamentally wrong in that. This virus exists. This virus is acquired mainly through sexual contact and that virus leads to AIDS. That much is scientifically established. When it comes to poverty, we have to account for why so many sub-Saharan African countries do have this desperate AIDS crisis. We are talking up to 25% and sometimes more of the adult population being infected and it is of course quite fair to say that one of magnifiers, one of the great drivers of the epidemic, is poverty. So for instance, if you are malnourished your immune system is already compromised, your immune system is incapable of warding off infections. Then if you are illiterate because there is an inadequate education system, how are you to learn about the importance of protection. If, furthermore, there is a broken down health system because of poverty in these countries, then what prospect is there of people being treated to stay alive when they are HIV Positive? Crucially and tragically, so many sub-Saharans countries are disfigured by wide gender inequalities. Women now, quite disproportionally, are falling victim to the HIV virus where those same women are almost certainly living blameless monogamous lives. It’s argued, I think entirely persuavely, that until these gender inequalities are properly tackled it’s again unlikely that AIDS will be properly dealt with. All these poverty-related issues are the product of under-development, so to that extent AIDS is a disease of poverty. But it’s idle to deny that HIV is a virus, acquired largely through sexual contact, and that governments have to grasp that nettle and also provide the treatment that is now available.

Abolitionist: What about the pharmaceutical companies and their non-allowance of cheap patents into Africa?

Peter Gill: The pharmaceutical companies have had a very poor record up until a very important court case in 2001 in South Africa which I describe in the book. There was simply no acknowledgement in the western world, let alone the pharmaceutical companies, that poor people had a right to life saving drugs. That has happily changed. At least now there’s been an acknowledgement. Although there is a lot that is suspect, a lot that is wrong in the continuing attitudes of the pharmaceutical industry, I think it’s now accepted that they’ve got to be part of the solution, not the problem. There is evidence that some Big Pharma companies countries in Europe are beginning to take their corporate responsibilities more seriously. What is also happening – and this is possibly the most important and optimistic sign in the whole field of AIDS and other diseases that impact on the Third World at present - is the huge sums of money dispersed by the likes of Bill Gates at the Bill and Melinda Gates Foundation. They are doing so much towards health and health research and pharmaceutical research in response to HIV and other sorts of tropical diseases - far, far more than western governments are doing or than what the UN can afford, and far more than local governments can afford. There are these signs of optimism but what we must not ignore is the simple fact that the pharmaceutical companies are capitalist enterprises and can’t be expected to act as charities. They’ve got nevertheless to be roped into this process. What’s happening now with the Gates millions is that they are beginning to be roped in.