World AIDS Day – December 1st

“Those who say it cannot be done should not interrupt those who are doing it.” – Chinese proverb

Nearly a year has passed since I began a HBS field study on AIDS, working with five other students to design a distribution strategy for AIDS drugs in Africa. I have to admit that I am starting to feel some frustration. AIDS continues to kill nearly 8,000 Africans each day.

There are now drugs that can significantly extend life and its quality for those infected with AIDS, and these drugs are greatly reducing AIDS deaths in the U.S. and Europe. However, only several thousand Africans are receiving treatment right now, despite an emerging consensus in the international community (including top doctors, scientists and economists at Harvard) that AIDS treatment is desperately needed in Africa. As a result, approximately 3 million Africans, of the 26 million currently infected, will die from the virus this year.

Some governments, international organizations and companies are working to develop plans to treat people with AIDS drugs in Africa, but even more seem slow or unable to move forward with the steps needed to address the problem. I have found that ideas about how governments, businesses and communities should react to the problem, to slow and eventually end the AIDS epidemic, are not lacking. The fundamental problem is pessimism. The problem too great, number infected too overwhelming, the solutions too complicated. Like any difficult problem – there are those who say it cannot be done. While the path to ending this epidemic may be uncertain, and it will take time, there are many ways that the world can better address this problem now – and save millions of lives.

So, I want to make an appeal to you for optimism. I realize that this is a difficult request, so let me first address your skepticism. You probably already know many of the statistics: 39 million persons infected with AIDS, of whom 26 million are Africans, 8,000 die daily, 13 million children are orphaned. If that alone is not enough to make you throw up your hands in despair, the more sophisticated pessimistic reasoning goes something like this:

? Africans are poor and can’t afford drugs (even the cheaper ones that are now available)
? “How about if we commit $7 – $10 billion dollars to this problem, as Kofi Annan, Secretary General of the UN, has urged the Western countries to do?” You might ask.
? “Well, the real problem isn’t the money for drugs, its infrastructure,” will be the response. Africa does not have the infrastructure or doctors to use these drugs effectively
? And, furthermore, we all know that many foreign aid programs in Africa have failed
? The seemingly undeniable conclusion of these arguments: No matter what we do, we will fail.

This leaves us where we are today. These arguments subtly, but powerfully, penetrate all discussions of what the world can and should do to react to the AIDS epidemic. The world is paralyzed by this vicious cycle. One side professing: We can’t solve AIDS in Africa, so why should we give the money or change the way we do business today? The other side, the African countries, feeling: We don’t have the money, so how can we solve AIDS?

But let me state something that is utterly simplistic. We know how to treat AIDS. AIDS drugs are benefiting patients in the U.S., Europe, and in developing countries like Brazil and Thailand. New pilot programs are now treating people in Senegal, Uganda and Botswana. These programs are rolling out tentatively, but they are starting. Furthermore, in the HBS field study in which I participated last spring, we found that there are examples of very successful programs to treat other infectious diseases like tuberculosis in Africa, even in the poorest countries. Not all public health programs in Africa have been successful, but the successful ones have saved many thousands of lives.

The real question is, what financial investment is the world willing to make to save millions of lives in Africa? How about in India (where there are now 4 million infected with AIDS), or the rapidly growing populations of infected persons in China and Eastern Europe?

It is time to stop the paralysis of pessimism and start with a new premise: We can and will stop the global AIDS epidemic. We cannot help every single person infected with AIDS, but millions of lives can be saved if we start now. The first step? Ensure that the U.S. and European governments provide the necessary funds to start moving forward in this battle. The United Nations has asked for $7bn – $10bn from the international community for a Global Fund to Fight AIDS, TB and Malaria. The U.S. tax cut was $1.6 trillion, airline bailout $15bn and the Harvard endowment is $18.3bn. The U.S. has only been asked to contribute $1bn – $2bn to the UN Global Fund, so far it has contributed $200m. As economist Jeff Sachs has emphasized, the funds required to seriously fight this crisis are minimal relative to the budgets of the world’s wealthiest nations. Western countries should not and cannot ignore this desperate need.

The need for action to address the global AIDS epidemic is not limited to Western governments, but also requires commitment by governments in Africa and other developing countries, multinational companies, international and non-governmental organizations, and local communities. There is much being done, but there is much more to do to stem the explosive growth of AIDS.

How can we, as HBS students, help to address this crisis and break the vicious cycle? The HBS community can contribute its expertise, creativity and entrepreneurial thinking to this problem. Field studies with businesses, governments and nonprofit organizations seeking to address AIDS can provide enormous value. Awareness-raising activities and advocacy efforts already occurring across Harvard also present opportunities to contribute substantively. This is a problem that requires the use of many of the tools we learn at HBS: marketing, operations and negotiations skills are all needed to develop effective solutions. Our involvement, combined with the efforts of thousands of organizations and individuals across the globe who are committed to fighting this epidemic, we can stop AIDS from taking millions of more lives.

Let us not allow pessimism to prevent progress in the fight against AIDS. Let us start now, with both optimism & action.

To learn how you might contribute your time and skills to efforts at HBS to address AIDS globally contact Daniella Ballou ( or Andrew Stern ( For more information about the global AIDS epidemic visit the UNAIDS website the Harvard AIDS Coalition Website or the Global Business Council on AIDS. Also see the Consensus Statement on Antiretroviral Treatment for AIDS in Poor Countries, signed by over 100 Harvard professors, at .

December 3, 2001
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