NEAL CONAN, host:
On this, the 18th annual World AIDS Day, the numbers are grim. Three million deaths last year, nearly five million new infections. Total number of deaths from AIDS and AIDS-related diseases, more than 25 million. Nearly a quarter century since AIDS was discovered, billions of dollars worldwide have been spent on research, education and treatment, but there is still no vaccine and no cure. Former United Nations Ambassador Richard Holbrooke is president of the Global Business Coalition on HIV/AIDS, a non-governmental organization. In an op-ed piece in Tuesday's Washington Post, Ambassador Holbrooke argued for much wider testing for HIV/AIDS. And he joins us now on the phone from Miami Airport, where he's just about to depart for a trip overseas.
And we appreciate you taking the time out just before you leave to speak with us, Ambassador.
Former Ambassador RICHARD HOLBROOKE (President, Global Business Coalition on HIV/AIDS): I'm delighted to be with you. If you hear a noise in the background, it's the airport announcements.
CONAN: Oh, they're probably announcing your flight, so we'll try to make it quick. Ambassador, as you know, a proposal for more widespread testing is controversial. People complain that it could lead to discrimination, it could lead to invasions of privacy.
Mr. HOLBROOKE: Well, I've heard all those arguments and they're legitimate concerns, but there is no chance, in my view, that we can ever stop the spread of AIDS with our current strategies. This is the 18th World AIDS Day today. In each one of the 18 years, the numbers have gotten worse. And in each one of the 18 years, we've put more money into the effort. I am all for treatment and I cannot emphasize that too much, because several people have misinterpreted my article. I'm not calling for testing as a panacea. I'm saying that testing is the weak link.
Look, under the current system, the testing is very limited and totally underutilized except in three countries--Lesotho, Malawi and Botswana, three small African countries where testing--other than those three countries, testing isn't very emphasized. OK, today, just today, while your listeners are listening, 12,000 people will become HIV positive around the world, according to UN figures. OK? Twelve thousand just today. And 90 percent of those people will not know their status and they won't know they have the disease until roughly 2013. So for the next eight years, the 12,000 people infected today will unintentionally, unknowingly be passing the disease to other people--they're passing it to other people in silence. This is a disastrous situation.
I want to see the amount of money we put into the AIDS effort increase dramatically. I've supported it, I've lobbied for it, and I support a bipartisan effort to combat the disease. But we have to emphasize prevention more. And in the prevention field, we have to emphasize protection.
CONAN: We're talking...
Mr. HOLBROOKE: Let me ask you something. Have you ever heard of any other disease in which there isn't a systematic effort made to know who has it? Of course not. So we are caught in a mythology here. You've raised the two big issues: stigmatization and confidentiality. Those must be ensured. But those are being used by people to downgrade testing as a part of the strategy. I'd emphasize, I'm not saying testing's the answer. I'm saying it's the missing component in the current strategy.
CONAN: We're talking with Ambassador Richard Holbrooke and you're listening to TALK OF THE NATION from NPR News.
Ambassador Holbrooke, would such a testing program be--the best one, in our view, be mandatory?
Mr. HOLBROOKE: No, we can't make it mandatory. And is it clear to your listeners that I'm not talking about the United States so much as I'm talking about the affected areas of the world--Africa, India. Do you know where the three countries in the world with the fastest-growing rate of AIDS is right now? Russia, Ukraine and Estonia. And China has a serious problem and India has the greatest number of cases of all. So be sure your listeners understand too things. I'm talking about the rest of the world much more than the United States, where testing is much more widespread. And secondly--and treatment is more available. And secondly, it's not just an African disease. And to ignore the detection part of the effort is to risk everything. And to stress abstinence as the Bush administration does or condoms is fine. It's great if people don't have sex if they want to avoid AIDS. But in the real world, they're going to have sex. And it's great if people use condoms because that protects them, but not everyone will use condoms. So you've got to know your status.
CONAN: Would this require a large-scale education program to urge people to be tested?
Mr. HOLBROOKE: Absolutely. And one country has started that today--Lesotho, the small, landlocked southern African country--which today has launched a Know Your Status, K-Y-S, KYS campaign, nationwide. And they're training people to give counseling, encourage testing. And to go back to your question about mandatory, the Lesotho program, which is by far the best in the world--it starts today--the Lesotho program gives each person the option of refusing to be tested. They can opt out. So even Lesotho, which is the most advanced in the world, it's not mandatory. But it is encouraged, heavily encouraged, and that changes everything. Once people know their status, three things happen: the three-quarters of them who are not HIV positive, who are not infected, those people, knowing their status, some of them at least, will practice safer sex practices. Of the people who are infected, they may be more careful in infecting other people, particularly their spouses, and they will be encouraged to get treatment.
Now I know the argument--they'll be stigmatized, they'll be thrown out of their families and lose their jobs. All of that is partially true and it needs to be dealt with aggressively. So when you start pushing testing, you also have to push very strict anti-stigmatization, anti-discrimination laws that protect you from losing your job and so on.
CONAN: Ambassador Holbrooke, have a good trip.
Mr. HOLBROOKE: Thank you very much.
CONAN: Richard Holbrooke is president of the Global Business Coalition on HIV/AIDS, and he joined us from Miami Airport.
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