November/December 2000 | Contents

'YOU JUST SIGNED HIS DEATH WARRANT':
AIDS Politics and the Journalists' Role

BY LAURIE GARRETT

This article is adapted from a speech delivered by Laurie Garrett at the XIII International AIDS Conference in Durban, South Africa, on July 13, 2000.

In the early eighteenth century, Daniel Defoe penned a brilliant account of the 1665 Great Plague of London: The Journal of the Plague Year. There was just one catch -- Defoe was five years old when it happened and he wasn't ever there. Much of his account was based on renditions from a surviving uncle, as well as official records kept by London authorities during the epidemic. We actually have few accounts of any of the great plagues of the past. We know they occurred; we know they took a terrible toll. We know that between 1346 and 1351 Yersinia pestis claimed a quarter to a third of the population of Europe and Central Asia. But we know few details.

There were no journalists. Boccaccio wrote The Decameron, a collection of stories set against Florence's fourteenth century Black Death. But that's not journalism. Barbara Tuchman's A Distant Mirror, six centuries after that plague, gives a better rendition of those events. But even she was doing a lot of guesswork.

Still, from her we learned that societies were so overwhelmed by the impact that entire cultures were obliterated or turned upside down, that the Catholic Church's power was eroded, that the aristocracy came under threat for the first time, and that ultimately the Renaissance was ushered in. That was then, this is now.

Today, we can bring you death, live on TV from sub-Saharan Africa. In the comfort of your home, you can watch the plague. In Los Angeles, Paris, or Tokyo sipping Chablis while saying, "tsk, tsk, tsk, tsk," you can watch the sad images of AIDS orphans and dying families in Zimbabwe or Congo, where the real suffering is going on. From the comfort of your Western home, you can relate to it just about as emotionally deeply as you can to Barbara Tuchman's book about the plague of the fourteenth century.

Larry Gostin, of Georgetown University, who has been in this game from the very beginning, has a term for this. He calls it Death Voyeurism. We of the Northern Hemisphere watch while the South suffers, and the media provide the bridge, displaying it in the living rooms of the North.

In 1988 Jonathan Mann organized the first meeting that tried to examine the possibility of having a prevention effort for AIDS. It took place in Ixtapa, Mexico. I addressed that meeting on the subject journalists are typically asked to talk about: the media and AIDS. And I thought at the time that it was appropriate to say that it was our job to tell stories, and show the face of the epidemic. Our job was to take the reader, or the listener or viewer, into the epidemic, and display the despair.

I was already wrong.

As I spoke I did something I naively thought was absolutely terrific. I took my hat off to a colleague from Kenya, and I mentioned him by name, describing him as a bold and courageous, independent journalist working outside the government broadcasting system to bring information about AIDS to the Kenyan people at a time when virtually nobody said the word AIDS.

As soon as I stepped off the podium a Kenyan scientist approached me and said, "You just signed his death warrant." And, indeed, the journalist I had praised was arrested later that afternoon in Nairobi. For the next days, Jonathan Mann and I did everything we could to gain his release and fortunately we were successful.

And I grew up.

I think it's high time that the entire international media and press corps grow up. It's high time all of us, North and South, stop simply saying, "It's sad. It's pathetic. The numbers are huge. It's getting worse. Oh my gosh!"

We must take our jobs far more seriously than that. We must in real time do what Defoe did retrospectively about the Black Death. We have to name corrupt names, we have to demand accountability. We have to demand the truth.

Those of you who are in science and public health here in this room, and who just applauded what I said, often speak of "using the media" to get out your message. You are fools. Pardon me, but nobody "uses" journalists. Except, of course, corrupt officials, dictators, and other ne'er-do-wells. If the media are behaving properly, they are skeptical of each and every one of you in this room, every single day, and demand the truth of you. How are you spending those donated funds? What programs are you implementing with them? Are you letting your egos and your careers get in the way of doing what is best for this epidemic? Are you Northern Hemisphere scientists working in a sensitive and productive manner with Southern Hemisphere scientists?

Government officials -- if the media are doing their job, they are a thorn in your side every damned day. We are asking -- indeed, demanding -- to know how taxpayer dollars are being spent, if good science is coming out of your laboratories, and if the national leadership is doing everything it could and should do.

 

Number One Issue in the World

Richard Holbrooke, U.S. Ambassador to the United Nations, put the global AIDS epidemic in perspective in a television interview last summer: AIDS is the number one issue in the world today, the number one issue. The level of the AIDS crisis, its potential to destroy economic achievement, undermine social stability, and create more political uncertainty, and the inability of the rest of the world to contain it on only one continent -- because it can't be sealed off in Africa, it's already spreading elsewhere in the world, particularly the subcontinent of India and Pakistan -- is so enormous. It's the worst health crisis in at least six, seven centuries. And it isn't only a health crisis. The media are finally paying attention to this. I congratulate you and your colleagues for doing this, but the problem is not going to go away, and I hope the media don't go away either, because you are the key to breaking through on this issue.

And for you in the private sector -- this meeting is, by the way, sponsored by a drug company -- whether you are a pharmaceutical manufacturer, the medical industry, an insurance company, a bank, or whatever, again, journalism is going to scrutinize you whether you like it or not. That is, if it's good journalism. It will inquire whether your medicines are as effective and safe as you claim, and demand to know why they are priced so high as to be completely unaffordable for those here in Africa who desperately need them.

You should all appreciate this scrutiny, as an asset in the overall future of our fight against this epidemic.

But first, there are some limitations on the media side. In the wealthy world most media organizations -- newspapers, radio, online -- have in the last few years been gobbled up by large corporations. It's very rare now in the wealthy world to run across family-owned, large media operations. And what that means is that now our media bosses expect us to meet a bottom line, a certain profit margin, a given stock market flow. And in order to do so we have to be catchy, be there twenty-four hours a day, be there all of the time. Total access! We are there in your living room. And what suffers in the atmosphere of immediacy is analysis. What suffers in this search for speed is depth. The media in the wealthy world are becoming increasingly simplistic, superficial, and celebrity-focused.

In the developing world much of the media is government-owned or tightly controlled. So-called independent media in the developing world are often actually owned by local business magnates, even some with rather shady criminal relationships. The infrastructure of media in the Southern Hemisphere is generally pretty poor and it takes a lot of guts to be a reporter in most of the developing world.

I was awarded a Pulitzer Prize for my coverage of the Ebola epidemic in Kikwit, Zaire. And for years people came up to me and said, "Oh my goodness, you were so courageous! You were there for three weeks in an epidemic!"

That's not guts, folks, because at any moment I had a U.S. passport, a pile of cash, a ton of credit cards, and a home base that was practically on another planet, to which I could escape. Not so for my colleagues who are citizens of the developing countries.

War-related intimidation of the press is expanding in Africa at this moment primarily because the Congo conflict is widening. Currently seven countries or guerrilla groups have combat forces on the ground in the Congo, and probably an additional six are providing safe haven in their territory to guerrillas and combatants. At least another six are actively supplying arms. There's a tremendous threat that this conflict could spread, exploding across Africa. Fought, by the way, primarily over diamonds.

The implications of this for AIDS coverage are that in such an atmosphere it takes a great deal of courage to ask questions and demand answers. In June, I was in Zimbabwe inquiring about AIDS in a rural area just before the national elections. As I was doing so, a group of ZANU thugs threatened to kill me -- simply because I was asking about government failures to stem the tide of HIV. Now, when such a threat comes down on me I have this white skin, an American passport, and the money to buy a plane ticket home. Ultimately, I had nothing to fear. I hightailed it out of town. Had I been a local reporter, I wouldn't have had that option.

The facts must be heard. A group of doctors working in East Africa recently published heartbreaking information in Daedalus describing the agony of being physicians who are utterly helpless before a plague -- a sense of frustration, of cynicism, of emotional numbing, and a higher mistake rate in the practice of all forms of medicine. On the village level, Gabriel Rugalema has chronicled the complete eradication of the tribal clan structure, with the collapse of inheritance, social fabric, morals, and agricultural production. And he describes rising lawlessness as AIDS orphans reach their teenage and young adult years.

The questions must be asked. Most important: What is the strategy? How can we slow this plague in the absence of a vaccine or cure? I know of no more important question for journalists to be asking at this moment. After all, there is no other force on Earth -- no wars, no famines, no genocides -- that is killing as many millions of people today as is this damnable microbe.

If there had been a journalist covering the fourteenth century plague, one of the questions I hope would have been asked is, "How exactly does burning another Jew at the stake stop this plague?"

Defoe told us of the corruption of London during the plague. Of doctors gouging patients with quack remedies, even fatal ones. And of the aristocracy that fled to the countryside and abandoned the poor of London. Even though he was a generation after the fact, Defoe still pointed his finger at the rich, the heartless, and the cruel.

The press and the media have, I would say, a duty to reveal those sorts of trends now, in real time, in our modern plague. Leaders must be held accountable. Corruption must be exposed. Ineptitude and careerism must be fingered. And where it exists, success must be underscored and then followed by the question, "If it works here, why not over there?"

"Let us not equivocate," Nelson Mandela said. "AIDS today in Africa is claiming more lives than the sum total of all wars, famines, and floods, and the ravages of such deadly diseases as malaria. It is devastating families and communities."

And in press parlance, that's a big story.

Laurie Garrett is a Pulitzer Prize-winning medical and science writer for Newsday and author of the 1995 bestseller The Coming Plague. Her new book, Betrayal of Trust: The Collapse of Global Public Health, has just been published.