The Robert Carr Memorial Lecture at the XIX International AIDS Conference,

delivered by Stephen Lewis, Co-Director of AIDS-Free World

July 25, 2012, Washington, D.C.
Before I came to this session todaythis morning in factI watched, again, Robert Carrs nowfamous Bullshit speech at the MSMGF meeting in Vienna in 2010. No matter how many viewings,
its really memorable; quite astounding in fact.
It combines a glimpse of all those facets of Roberts work and persona compressed into a brilliant
fifteen minutes of rhetorical passion: his decade and more of struggle in Jamaica and the Caribbean; his
pride in the work of J-FLAG and CVC the Caribbean Vulnerable Communities coalition; his
insensate rage over the way in which societies preach the mantra of human rights and exclude whole
groups of people from access to those rights; his impatience with the United Nations, with institutions,
government departments, parliamentarians; his scorn for the intellectual pretense of so-called religious
values; his agitation over the nonsense that homosexuality is a western invention; his frustration with
the paltry, demeaning resources provided to marginalized groups; and above all, his recognition that
AIDS will never be subdued while this pattern of inequality continues to prevail.
Let me say that I feel intensely privileged to deliver this inaugural Robert Carr lecture. I cant claim to
have known Robert as well as many people in this room, but I was drawn to him, as all of us were
drawn, by his resolute and principled presence, that calm, rooted sense of conviction that suffused his
every waking moment. Its no surprise that this conference should be honoring Robert is so many
ways, honoring him for the reach of his global contributions, setting up the Robert Carr Networks
Fund, enshrining his beliefs in what will be forever known as the Carr Doctrine.
He loved, and was loved. There was such charm, grace, integrity, wit, laughter, and above all,
intelligence, that it made Robert everyones friend. You felt better in his presence; more secure, more
confident that somehow the worlds perversities would come to a close.
Id seen him, on different occasions, in Jamaica and Trinidad, meeting with small groups of LGBT
activists listening, encouraging, embracing, always reassuring. Id seen him at the Commonwealth
Secretariat in London explaining, carefully, patiently, the cultural layers of stigma and discrimination
to people of astonishingly limited comprehension; I saw him in Amsterdam joining with activists to
solve an ongoing funding crisis, I sat with him and ICASO colleagues in New York talking anxiously
of the situation at the United Nations, I watched him on a video screen at the Caribbean regional
dialogue of the Commission on HIV and the Law, where his every word was absorbed as holy writ, in
the best sense, by everyone assembled.
There was not a forum where Robert was uncomfortable. He was ever-persuasive. He was never
intimidated by place, or rank or circumstance.
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Ive wondered to myself what he might think of this conference, and this moment in time. In the
Vienna speech, he made much of the discrepancy between the real world and what would happen at the
conference itself. That seems to me a good starting point. Interestingly, he was contemptuous of both
the real world and the conference hence the use of the word Bullshit to convey the full force of his
feelings.
Were at a climactic human rights moment in the battle against the pandemic. The struggle of the socalled marginalized or high risk groups key populations in the AIDS vocabulary is fraught with
enormous hypocrisy. The smooth ever-repetitive mantra of men who have sex with men, sex workers,
injecting drug users, transgendered persons, prison populations, migrants, seems to suggest that if you
say it often enough, somehow thats sufficient. The endless refrain becomes the endless answer.
But the point surely is that you cant keep invoking the phrase human rights as a mask behind which
to hide the worlds behavior. International figures and UN officials cant keep going to African
countries and complimenting the President or the government on their progress on HIV and AIDS,
while the country maintains homophobic laws or has gay men in jail. You cant go to a meeting of the
African Union and congratulate them on the progress against the virus of AIDS when the virus of
homophobia infects the room.
On one of the introductory pages of the just-tabled UNAIDS report, you have a full-page picture of the
President of the African Union, who happens to be the President of Benin, a country with anti-gay laws
on the books. The rationalization, as always, is that the laws arent applied spare me the intellectual
claptrap. Laws against homosexuality, whether applied or not, create an atmosphere of intolerance and
fear, of stigma and discrimination that drive the pandemic.
What are we supposed to believe? That an AIDS-free generation is free for some but not for all? That
weve found yet another phrase besotted with hypocrisy? Its the kind of double standard that drove
Robert Carr to distraction.
As with everyone else at this conference, I was much cheered by many of the words of Hillary Clinton.
But I have to ask myself, how do you reconcile an AIDS-free generation with a terrifying pattern of
criminalization of transmission across this country, visited significantly on gay men? How do you
reconcile an AIDS-free generation with the treatment of injecting drug users in jail; indeed with the
often pernicious and brutal treatment of injecting drug users writ large? How do you reconcile an
AIDS-free generation when sex workers and injecting drug users are denied access to the conference?
It isnt enough to applaudreverentially and adoringly, with an almost groveling pastichetreatment
as prevention when its no prevention for many and treatment for few. You dont let the principle of
exclusion slide by without comment just because some dollars relatively few, I might addare
thrown into the mix.
Im of the naming and shaming school. I want to see President Museveni of Uganda excoriated at the
Human Rights Council, excoriated in the General Assembly of the United Nations, excoriated by
UNAIDS, excoriated by some brave country at the African Union its great that he was phoned by
Hillary Clinton and Gordon Brown when the vicious legislation was moving through the Ugandan
parliament, but thats never enough: David Kato is dead, and the potential legislation lives. President
Museveni could put an end to it all with the snap of a finger, but that snap will only come with
sustained embarrassment before the world community.
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How would Robert Carr have felt about such an approach? Very comfortable: we were together at the
Commonwealth Conference in Trinidad when these strategies were discussed.
And let me add that Im not confining the argument to homophobia. I feelIm sure that Robert would
have agreed that President Putin is getting away with murder and the world seems to care not one
whit. To be sure, Russia is condemned over Syria; thats easy, and the High Commissioner for Human
Rights has criticized the Russian Federation for suppression of dissent and of civil society. But theres
not a word about the ugly and unconscionable treatment of injecting drug users. It is well to remember
that Russia has an exploding HIV epidemic; the fastest-growing in the world, and no one takes
President Putin personally to task in a way which would at least put him on the defensive and possibly
save lives.
What Im about to say, Ive said a hundred times before, but it remains germane. A similar silence,
from the United Nations and the international community, surrounded Thabo Mbeki as he refused to
roll out antiretroviral treatment, watched his people die, and in so doing, committed crimes against
humanity. The international community is at it again. But this time, the targets are marginalized
groups. And I repeat: generalized abstractions about the human rights of vulnerable communities
doesnt cut it. Throwing in a few sonorous supplications at the end of a state visit doesnt cut it.
We are drowning in statutes, criminal law, legislation, public statements that demonize whole swaths
of humankind. What Robert Carr wanted is that informed condemnation, leading to change, would
reverberate through the world community.
In the process of demonization, we give credence to other dimensions of stigma that are mentioned in
the titular description of the lecture: racism and classism. Its impossible to take a hard look at the state
of HIV and AIDS in the United Statesindeed, in Washington itselfwithout seeing race at its core.
Just today, there was a press conference held to profile the terrifying increase in AIDS amongst black
homosexual men. More, there is an indelible tie with poverty that is unmistakable. I know it is felt that
the recently-announced Presidential plan to address HIV in the United States represents significant
progress, but weve waited a very long time, and the lineups for treatment are still, in some states,
unendurable.
Ive always felt, bitterly felt, particularly in the days of my work as Envoy on AIDS in Africa, that
subterranean racism played an odious role in the slow, halting response to the pandemic. It always
feltI feel it still todaythat somehow Africans were seen to be expendable, somehow not worthy of
the best possible interventions.
This vile double standard continues to persist. In the United States, in Canada, in Western Europe, we
start treatment at very high CD4 counts in some jurisdictions we start treatment the moment a
person tests HIV-positive; in Africa we wait until the CD4 count declines to 350 or, in some
jurisdictions, even less.
On the face of this earth, there is no argument about money that justifies creating a category of lesser
mortals. When Robert said Bullshit, everyone in the room said hear, hear: weve always had the
haves and have-nots rooted in resources, and poverty, and conflict and disease. But weve never had a
disease that preys so opportunistically, and is fed so opportunistically by racism, sexism and classism.

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The principle of exclusion leads me to an aspect of Roberts work that is rarely mentioned. In
biographic notes, it emerges that when he was Executive Director of Jamaican AIDS Support for Life,
amongst the various communities with which he engaged, were the hearing-impaired. Thats
extraordinary; theres just nothing that escaped Roberts attention.
I mention it because people with disabilities are another huge category of virtual exclusion from the
world of HIV and AIDS. Even though people with disabilities, so often impoverished and isolated, are
vulnerable to infection; even though theyre exceedingly at risk of sexual assault; even though there is
now a Convention on the Rights of Persons with Disabilities, supposedly guaranteeing the highest
attainable standard of health, even though the World Health Organization has now determined that 15%
of the worlds population is disabled that is to say, one billion people; and even though they
predictably suffer stigma of unrelieved proportions the intersection of HIV and Disabilities is almost
never acknowledged. In fact, in the most recent report of UNAIDS, there is no section on Disability
whatsoever one of my colleagues was unable to find even a mention of the word.
Frankly, its outrageous. If I may be so direct as to mention the NGO with which I work, AIDS-Free
World (and by the way, we collaborated with Robert Carr, particularly through Maurice Tomlinson, on
a number of Jamaican initiatives together) AIDS-Free World held a pre-conference Disability and
HIV Leadership Forum on Saturday on Gallaudet campus, the University for the Deaf, here in
Washington. We had twenty-three young disabled activists from twenty countries, people with vision,
hearing and mobility disabilities, accompanied in many instances by personal assistants (with a cosmic
range of sign language interpreters in several languages), and they spent the entire day immersed in the
study of techniques of advocacy to advance their cause in their respective countries.
As in every other instance of marginalization, they have to fight their way into an AIDS-free
generation, but at least they emerged with a ten-point Declaration setting out their demands. That fits
nicely with Robert Carr: throughout his speech he insisted, time and time again, that we make
demands.
Now all that Ive reconnoitered thus far, interesting though some of it might be, doesnt touch on
perhaps the most unusual dimension of Roberts realm of work and advocacy. Robert was a feminist;
an unremitting, unrepentant, unabashed feminist. Its rare, you will admit, to have such a combination
of traits and convictions embodied in one person, especially a man whom society has attempted to
exclude. His soul was open to the world.
Given that misogyny is part of the title of this first Robert Carr lecture, it emboldens me to say that the
situation of women in the pandemic remains appalling. Its never easy to get past the monolith of male
power. Lest you feel that I exaggerate, there was a fascinating example of that on Monday evening.
Cloistered in the confines of the World Bank, but available on the big screen in mini room 1, was a socalled Landmark Debate titled Global Health Funding Allocations for HIV/AIDS, sponsored by the
World Bank, USAID and The Lancet. The participant speakers in the compendium of notables were as
followsI wont provide their occupational credentials, but youll know many of themDr. Jim Kim,
Dr. Rajiv Shaw, His Excellency Mr. Festus Mogae, Dr. Charles Holmes, Dr. Richard Horton, Dr.
Roger England, Dr. Mead Over, Dr. Jeffrey Sachs, Mr. Michel Sidibe, Dr. David Serwadda and
Ambassador Eric Goosby.
Eleven speakers; eleven men.
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Now I dont for a moment diminish the formidable intellectual prowess of the males there assembled.
But I do lament that there just arent any women up to equivalent standards. At least four of the
participants were academics, so thats understandable: there are obviously no women of scholarship
from whom to choose. But even though the rest were a gaggle of CEO-types and senior bureaucrats,
you would have thought it might be possible to find a female facsimile here or there. But apparently
not. I cant help but recall a conversation with a very, very, very senior member of the UN
establishment, shortly after Kofi Annan had appointed a High-Level Panel on System-Wide UN
Coherence with twelve men and three women. My colleague and I asked him why the gender
imbalance was so stark. Oh, he said, We asked Gro Brundtland, but she was busy, and frankly there
are just not enough women around who know how to handle such a job.
And in a nutshell, thats the problem. It never changes. I could give you umpteen additional examples,
chapter and versesome, believe it or not, more extreme than Monday nightthey all simply
accentuate, not so much misogyny as an assumption of male authority that has no place in the modern
world but is everywhere extant in the modern world.
Another example, rather more distressing because of what it reveals, is the global plan, launched at the
High-Level meeting at the United Nations last year, To Eliminate New HIV Infections Among
Children by 2015 and Keeping Mothers Alive. The people on the inside of this plan knowwill never
admit but knowthat the Keeping Mothers Alive part was an eleventh hour insertion because women
are always overlooked. As a matter of fact, if you take a look at the UNAIDS website today, it
highlights the Global Plan to Eliminate new HIV Infections Among Children by 2015, giving only a
subsidiary cut-line at the end for Keeping Mothers Alive.
This has been one of the scandals of the history of AIDS. Preventing vertical transmission of the virus
from mother to child is perhaps the easiest preventive intervention there is, but we marked time
between 2000 and 2005, losing five precious years, and it is only latterly that weve suddenly begun to
emphasize the importance of the mother.
Whenever women come into play in the pandemic, its a colossal struggle to give them the primacy
they must have. Weve heard ad nauseam that the pandemic has a womans face, but weve heard
hardly at all that the pandemic has a womans response. The disproportionate number of women who
are infected, the absence of sexual autonomy and gender equality, the contagion of rape and sexual
violence that continues to spread the virus all of it will doom infected women to an ominous future
unless theres a revolution in attitude. And that revolution is not merely behavior change, primarily
among men on the ground, its a revolution in urgency and commitment amongst those who call the
shots in the citadels of power.
Ive always believed in the use of the word femicide when describing rape in the Congo; it seems to me
that misogyny is absolutely applicable when describing the course of the pandemic for women.
Thats why Robert Carrs feminism was so important. He understood that every group thats been
consigned to the periphery of society is inevitably connected connected through prejudice, through
fear, through stigma.

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I sometimes despair of getting rid of the stigma. It haunts every member of every marginalized group,
and does so in a multiplicity of ways: in the family, in the schools, in the ownership of property, in the
rights to inheritance, in the community, in the market, in the workplace. Its a plague within a plague;
its a plague that sustains a plague.
And as I stand here, the only way well rid the world of stigma, and the relentless discrimination that
attends to it, is by publicly confronting it at every turn no quarter given, no apologia, no passivity,
no capitulation. There are many obstacles in the path of an AIDS-free generation: stigma is the worst of
them. Its the most venomous, elusive and annihilating.
Over and over in his speech, Robert Carr said Its Got To Stop.
I must bring these remarks to an end. There remains, for me, but one other issue that brought Robert to
near-apoplexy. The panel will doubtless have many more.
Its the question of money. At the moment when treatment proliferates, when breakthroughs in
prevention abound, when the end of AIDS is on everyones lips, when an AIDS-free generation has
become a Pavlovian chorus, the most important marginalized groups have no money.
UNAIDS says that were $7.2 billion short of what well need by 2015. Funds from the international
community have flat-lined. The Global Fund is alive but not yet well. Yet we know that trillions of
dollars traverse the globe every day, from wars and bank bailouts to stimulus packages and corporate
bonuses. The NGO community and a few governments talk of the Robin Hood Tax on international
financial transactions, but even if it ever comes into play, it will go more to climate change and paying
down budgetary deficits than it will to global public health with HIV at the center. And if it serves,
miraculously, to close the funding gap for AIDS, where are the guarantees that marginalized
populations will be, in part, the beneficiaries?
As we sit at this session, the Global Fund is going through an internal transformation that seems
destined to dismantle the gains made in addressing vulnerable communities.
What right do these governments have to decide, with such arrogant Olympian folly, who lives and
who dies? What right does the UK development agency haveholding the chairpersonship of the Fund
as it doesto attempt to dictate terms without meaningful participation of the NGO community? I tell
you, if its alleged that money goes to the heads of some projects in the field, it positively hyperventilates the cerebrums of the people back at headquarters.
Somehow, the magnificent activism of civil society that propelled whatever positive response theres
been to the pandemic has to rise and fight again.
Robert would have loved to lead it, but hes left that job to us. We cant let him down.

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