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Greetings from faraway Australia. We used to think that we were separated from the world's problems - at once victims and beneficiaries of the tyranny of distance. As recent events have shown, we are all liked together - all are vulnerable. Vulnerable to HIV/AIDS. To global warming. To nuclear catastrophe. To terrorism. In another September, also in dangerous times, the poet W.H. Auden wrote in New York a message for our times. His words have been remembered in recent days. This is what he wrote:
On Fifty-second Street The events of the past weeks have cast a pall of sadness and pessimism over all of us. They appear to set back for a time the global struggle for human rights, human dignity and, specifically, the human right to health. Huge sums will be poured into armaments and the business of war that might have been spent on health and relief of pain and needless death. But these events, in a sense, make this conference more important and more urgent. So I offer these thoughts in solidary and in friendship. I send them to you in Philadelphia: a city and a name that will always be linked with the idea of human rights. A city of revolutionary thoughts. Every American knows, Philadelphia is where the Declaration of Independence was drawn up and the Constitution of the United States agreed to. It is necessary, sometimes, to think revolutionary thoughts. Never so necessary as now. I want to start by recalling two great citizens of the United States. The first is Eleanor Roosevelt. I feel a link with her. At school here in Australia, in the late 1940s and early 1950s, we learned of her leadership in the adoption of the Universal Declaration of Human Rights. Later, I came to know one of the co-authors of that document, Professor John Humphrey of Canada. He told me of how, on the train to work, he would put on paper some of the ideas that, eventually, became the Universal Declaration. Every journey, in law, health or love, must begin with such little steps. Like Jefferson, alone in his room, crossing out "property" and substituting "happiness" in the immortal statement of the purposes of all human government ("life, liberty and the pursuit of happiness"), John Humphrey offered his drafts to Mrs Roosevelt. It was her steadfastness that ensured that the objects of the post-War legal order would include the attainment of human rights for all people - no exceptions. Despite the Cold War, this foundation stone for human aspirations was put firmly in place. Out of the ashes of global destruction, nuclear explosions and genocide, a new world legal order was begun. It was Mrs Roosevelt who chaired the committee that adopted the Universal Declaration of Human Rights and sent it on to the General Assembly. According to her son, every night Eleanor Roosevelt knelt beside her bed and said her own version of the Lord's Prayer : "Keep us at tasks too hard … Save us from ourselves and show us a vision of a world made new". It is to that vision that these remarks of mine beckon you. And the text for the call is, unapologetically, revolutionary. It is contained in Article 25 of Mrs Roosevelt's Universal Declaration:
"25.1 Everyone has the right to a standard of living adequate for the health and well-being of himself and his family, including … medical care … and the right to security in the event of … sickness, disability … or other lack of livelihood in circumstances beyond his control". And in Article 28 it is said:
"28 Everyone is entitled to a social and international order in which the rights and freedoms set forth in this Declaration can be realised". What are we doing, fifty-three years on, to make good these splendid commitments? What are we doing to achieve the goals of Article 12 of the International Covenant on Economic, Social and Cultural Rights that recognises "the right of everyone to the enjoyment of the highest attainable standard of physical and mental health" and commits the nations of the world to achieve "the full realisation of this right" including "the prevention, treatment and control of epidemics, endemic occupational and other diseases"? The second American hero that I would mention did a lot towards the attainment of these noble ends. Ultimately, he lost his life in the pursuit of these objectives. Jonathan Mann was living proof of the role that, even today, an individual can play in the fortunes of the world. Most of us, who are here at this conference to honour him, know of Jonathan's life's story. From 1984 to 1986 Jonathan Mann worked in Zaire, now Congo, in Central Africa on an epidemic already of frightening dynamics. The attempts to persuade President Reagan to expend foreign aid to fight this epidemic had come to grief in the simplistic assertions that "deviants" and "sin" brought just punishment from God both at home and abroad . How many wrongs have been done by men and women in the name of God. In the World Health Organisation (WHO), there was complacency about this strange new development. Fortunately, Halfdan Mahler, Director-General of WHO, visiting Africa, met Jonathan Mann. Jonathan fired this hard-nosed bureaucrat with a message of a task too hard. He painted the picture of AIDS as a condition that would flourish in circumstances of poverty, oppression, urban migration and social violence. In the midst of a tropical downpour, Jonathan turned his great gifts of persuasion and enthusiasm to good account. Jonathan was taken to Geneva. He threw himself in a frenzy into fighting the epidemic globally. This was truly a war against an unseen enemy that had to be won. Within months, in 1987, he had summoned the largest gathering of health ministers ever assembled . According to some reports, Jonathan was not at first particularly enlightened on matters of sexuality. He probably had the same feelings as most people of his generation, upbringing and religion. But if he did, he soon threw these feelings away as unwanted baggage. He drew upon his knowledge of the discrimination suffered by Jewish people. He ensured that not only did the initial Global Commission on AIDS include two persons openly living with HIV and AIDS but also three homosexual men who had jettisoned the absurd lies of the past. But Dr Mann's success bred envy and resistance. His evangelical zeal attracted opposition from Mahler's successor in WHO. A lesser spirit, who had not seen so clearly the peril for human health, might have played the bureaucratic games more cleverly, and survived. But Jonathan Mann had the truth. Sincerely he believed that only the truth would set the world free from this new and unexpected pandemic. In the end, he was told to clear his desk and go. His global programme was nearly mortally wounded. The efforts to fight HIV/AIDS were cut back. Great opportunities were lost. The promises of human rights for all were put on hold, in many developing countries at least. As Peter Piot, who was to be a successor of Jonathan Mann in WHO (and now leads UNAIDS) observed :
"If this would have happened in the Balkans, or in Eastern Europe, or in Mexico, with white people, the reaction would have been different". And so we have a harvest of shame. It is tragic that when another change of management occurred in WHO it coincided with Jonathan Mann's death on 3 September 1998 in the crash of Swissair Flight 111 off Canada. It is tragic that Jonathan, who had done so much and could have done so much, should die so wastefully. It is tragic for his family, friends and admirers. It is tragic for his country and the world. But we must learn from his life and from his dedication to fundamental human rights. We must learn from his personal growth and his efforts to show us a vision of a world made new. For Jonathan Mann, that world was one that fulfilled its global promises of health and human dignity for all. We cannot, by words at this conference, secure those objectives for disadvantaged peoples faced by HIV/AIDS or other health problems in the villages of Africa, Latin America, South Asia, the Pacific and elsewhere. But we can rekindle in ourselves the revolutionary spirit that made Eleanor Roosevelt and Jonathan Mann impatient with humbug, hypocrisy, obstruction, ignorance and indifference. We can deliberately infect ourselves with the greatest infection of them all: a loving concern for all our brothers and sisters, without discrimination. Like Jonathan and Eleanor, I have always believed that the spark that ignited the energy of global human rights takes its source from human love. Of human rage and human hatred and human love, love is the greatest of these. I know these things about Jonathan Mann because I knew him as a friend. I worked with him in the first Global Commission on AIDS. I learned from him and the other members of that Commission, including June Osborn, Luc Montagnier, Robert Gallo and the circle that worked with Jonathan. Some of Jonathan's collaborators like Daniel Tarantola, Ron Bayer, Stephen Marks and Larry Gostin will address this conference. They are providing leadership on the link between human rights and public health. That link represents the greatest flash of insight that Jonathan Mann bequeathed to us. It was the insight that I learned by working closely with him in the early days of AIDS. The insight included the paradox that HIV and AIDS show for all other epidemics and, indeed, for public health and human rights strategies generally. Paradoxically, the best way to fight epidemics in today's world, where there is no vaccine and no cure, is usually to defend the human rights and dignity of those at risk of infection. Paradoxically, this is the most likely way to win the confidence of those at risk and to secure their attention to health messages for themselves. Paradoxically, by protecting themselves, they will tend to protect society. So paradoxically, if we hope to protect our own health, we must become concerned in the health of others. We must be specially concerned with the epicentres of disease and suffering. Today no nook or cranny of the world is entirely safe from epidemics. No part of humanity is entirely cut off from the rest. So this is what I learned from Jonathan Mann. I share his instruction with you at the outset of this conference:
In my own life, I have embraced these values. Looking at, and learning from, Jonathan in the early days of the epidemic, I began to attend and address Australian conferences on HIV and AIDS. There I talked of the way in which the law could make positive contributions to responding to the epidemic by promoting principles of human rights. I was energized by the illness and deaths of precious friends. One of my colleagues, a distinguished judge, urged me to desist from talking about AIDS, anal sex and condoms. He said that mixing with prostitutes, intravenous drug users, homosexuals and other marginalised people would bring the judiciary into disrepute. I looked into his pale eyes and told him that I would not desist. In that instant, I remembered those who had fallen to the epidemic. There have always been homosexual judges and lawyers. In every country. But in Australia, as in the United States and virtually everywhere else, they are expected to abide by the rule learned early in life "Don't ask. Don't tell". Watching Jonathan lead a global revolution against HIV/AIDS made me appreciate how ignorant, unscientific, hypocritical and absurd this attitude to sexuality was. Urged on by my partner of three decades, we resolved to drop the contemptible pretence. In most parts of the world, HIV/AIDS is not, specifically, a "gay" disease. As Justice Edwin Cameron reminded us in his great speech in Durban, South Africa, nine-tenths of all people living with HIV/AIDS are in poor countries and two-thirds of them are in Sub-Saharan Africa. Overwhelmingly, they are heterosexual. And yet stigma, which will be examined in this conference, is still a blight of the AIDS pandemic. Jonathan Mann stood up. Edwin Cameron, as a man and judge living with HIV has stood up. All of us must stand up and confront ignorance and falsehood. By doing this we will ensure that strategies of health promotion and disease prevention are effective. But equally important, by doing this, we will uphold the human rights and human dignity of people everywhere, including our own. Do not deceive yourselves that this will be an easy struggle for truth and justice. It will not. A few months ago, in a country neighbouring Australia, I spoke to a medico-legal conference on human rights. In the course of my remarks, I referred to the issue of sexuality and the need to uphold the values of which I have spoken - promoting new attitudes, including amongst judges and lawyers. I was later thanked for my speech but asked to delete from my paper all references to homosexuality. It was explained that this would upset the conservative and religious readers of the journal for which the speech was intended. As well, I was reminded, "offences against the order of nature" were still crimes in that country - the least lovely legacy of the British Empire that astonishingly remains in place to this day in many parts of the United States. I declined this request. Remembering Jonathan, I urged publication, unexpurgated, of my remarks. Truth and honesty are the vaccines against ignorance and hypocrisy. In the strategies to marry universal human rights and global public health, we should, of course, be respectful of differing cultural values. We can be careful in the way that we express things. We must be understanding of those whose life's experience has been limited and sheltered from realities. But when we stray from scientific truth and the universal principles of human rights, we risk losing our way. These, then, are our beacons, just as Jonathan Mann taught us. They should light the way through every session in Philadelphia. And if they do, paradoxically, at the end, words will be turned to new resolve and good account not only in the struggles against HIV/AIDS but in the general endeavour to bring law, human rights and public health into a harmonious relationship. OPTIMISM OR PESSIMISM? Can we be optimistic fifteen years after Jonathan Mann took up his post in Geneva? Can we, especially, be optimistic in September 2001? Or should we be pessimistic about the lessons he tried to teach concerning the role of law and of universal human rights in upholding global public health? To the end of his life, Jonathan Mann was an optimist. In a speech just before his death, he threw down a gauntlet :
"What about the future of health and human rights? [Originally] there was widespread skepticism about health and human rights in the public health community. The phrase itself … was usually spoken with an implied questionmark … Today … the concept of health and human rights is much better accepted and is even assumed, even if its precise content remains to be more fully developed". Can we say that the concept is being fully developed? Unfortunately, there are mixed signals. In the field of HIV/AIDS, which was Jonathan Mann's special target, the pandemic continues to take its toll. Approximately 36 million people are living with HIV/AIDS, 20 million dead since the beginning of the epidemic and 5½ million infected each year. These figures are scarcely the stuff to boast of. Lamentably, even the powerful evidence that the countries which have been successful in tackling the epidemic are those that have embraced human rights protection, has had little or no impact on the timorous governments and officials in the countries most at risk. The shocking situation in Africa, which is an outrage to human conscience, is at last producing calls to action Nelson Mandela effectively acknowledged his own failings by admitting at the Durban conference "the most frightening thing is that all of these infections, which statistics tell us about and the attendant human suffering, could have been, can be, prevented" . Also in Durban the courageous voice of Edwin Cameron was lifted to condemn his government's mismanagement of the epidemic as "irresponsibility that borders on criminality" . Since Durban, the General Assembly of the United Nations in June 2001 called the world together in New York to intensify international action and mobilise resources to respond to the unexpected global crisis of AIDS. Kofi Annan, Secretary-General of the United Nations, declared that the session would provide the world with "an occasion as never before to face up to our responsibility to future generations, and take decisive action now" . One of the most heartening features of the post-AIDS world has been the growth of non-governmental organisations and civil society bodies that foster the links between human rights and public health and promote law reform towards these ends. At least the mistaken strategies of denial in many countries are beginning to fall to the power of unrelenting local and international civic criticism. Leaders are beginning to come out. Even in countries that have made silence and denial an artform . In countries as far apart geographically and socially as South Africa and Brazil, the courts and governments are forcing the hands of pharmaceutical multinationals to make life-saving medicines available to the poorest people with HIV/AIDS . There seems little doubt that these moves will have implications for other epidemics and diseases and for the attainment, in time, of the basic right to healthcare for all humanity. But not all of the news is good. Nelson Mandela's words, although welcome, would have been more potent if spoken when he was President. His successor flirts with strange ideas . Political leaders in developing countries are all too often harassed into inactivity by religious opponents of the strategies that have worked in developed countries. Sadly, the Roman Catholic Bishops of Southern Africa have recently condemned the distribution of condoms as "an immoral and misguided weapon in our battle against HIV/AIDS" . The declaration from the UN Special Session represented a little step forward. But there were disheartening features of that global meeting that remind us of how far we have to go. An unusual combination of nations, some with the most horrible records in human rights allied with the Holy See and others, deleted specific mention of the groups particularly vulnerable to the threat of HIV/AIDS infection. Australian reports suggest that the United States played a rather melancholy role in many sections of the special session . The outstanding address to the meeting was given by the Minister of Health of Brazil. Having adopted, as an uncompromising policy, the provision of anti-retroviral therapy to all Brazilians living with HIV or AIDS, the death rate in that country has fallen by approximately 50% and hospitalisation by 75%. Yet these achievements have been produced in a nation which, according to Amnesty International, has some of the worst rates of violence against (and especially murder of) gay men and transsexuals in the world . Attempts were made in New York to secure global endorsement of the United Nations Guidelines on HIV/AIDS and Human Rights. This was of interest to me. I had participated in the two sessions that developed that document. But it was blocked from any mention in the final conference resolution by the same unholy alliance that I have already mentioned. Falsely, the guidelines were presented as a formula for same-sex marriages and other supposed horrors. I hope that those who lie and deceive out of the ignorant unkindness may be forgiven. To think that these and other wrongs are sometimes done in the name of the world's great religions, is particularly depressing. Only steadfast adherence to universal human rights will set us free from such moral blindness. But can we take courage from the fact that the lessons that Jonathan Mann taught have at least borne fruit in those developed countries that have begun to practise what he preached? In part we can. Empirical studies show that harm reduction, condom use, needle exchange, legalisation of paid sex work, removal of laws against gays and candid educational messages can help turn around the AIDS epidemic, promote safer behaviour and result in a plateau of seroconversions . But even here, some of the developments are discouraging. They include the studies in the United States that show alarming levels of new HIV infections amongst young gay and bisexual men, particularly amongst African Americans . In Canada the Health Department has proposed HIV testing of all prospective immigrants . In Australia, there are reports of an upsurge in HIV infections following an apparent weakening of safe sex practices, particularly in the gay community . In Germany last year there was a 33% rise in HIV reports . These facts demonstrate the need for constant vigilance and tireless promotion of scientific truth about ways that encourage effective action. The trial of vaccines against HIV is continuing. There are some hopeful signs. Yet back in 1986, Robert Gallo predicted a vaccine within two years. Even the most optimistic now acknowledge that successful vaccines will take at least ten years to be available in poor countries . Whilst these mixed messages of hope and fear are placed before us, we must constantly go back to the reality that Jonathan Mann explained. HIV/AIDS remains a special peril of poor countries. Poverty and despair are the common environment for endemic illness, depression and epidemics. Discrimination provides the breeding ground for the HIV/AIDS epidemic. In an interview shortly before his death, Jonathan Mann declared, speaking of AIDS, that discrimination "Isn't just an effect, it's actually a root cause of the epidemic itself ". This is therefore an epidemic about women's disempowerment. About unprotected children and the vulnerable. About commercial sex workers. About our often ignorant and ineffective responses to drug addition and drug use. And about the continuing discrimination against people because of their sexuality. From Lucknow in India, Cairo in Egypt, from Libya and Brazil, Namibia and Zimbabwe, come daily stories of violence and discrimination against people on the ground of their sexuality and HIV status. Sadly, all too often, the law in combination with religion, afford potent instruments for furthering such discrimination. In itself this is intrinsically evil. But it is also doubly-dangerous in the age of major epidemics against whose spread our only present vaccine is knowledge, people's trust and effective behaviour modification. TOWARDS A WORLD MADE NEW So this is the global environment in which this conference comes together. Present in this hall, urging you on to boldness of thought and action, is the spirit of Jonathan Mann. He is an American of whom his fellow citizens can be proud. But he is more than that. He belongs to the world. His brilliant insight into the linkages between promoting human rights and public health had special significance for the AIDS epidemic. But its message went far wider. It concerned every aspect of public health. As he taught, we should promote human rights not only because this is the most effective strategy for health attainment that we know. But also because it has intrinsic moral goodness. It helps us, humans, to attain that harmony with each other towards which our unique facilities of consciousness, intelligence and moral perception direct us. It will not be enough, in Philadelphia, to exchange ideas, papers and email addresses. True, these are valuable things. They promote the networks. They help bind together the doers of good in public health, law and the world at large. But in this city, of all cities, it will be vital to think revolutionary thoughts. To be angry at continuing ignorant discrimination. To be angry with the slothful indifference of political leaders to the human right to health of vulnerable people. To be angry with the hypocrisy of those who defy scientific truth and promote hatred of women and minorities. To be angry at a world that continues to tolerate huge and growing afflictions of human health and which denies basic medicines to millions who need them. To be angry with the drug corporations and governments that respond inadequately to the crisis calls for lifesaving medications denied to the poor of the world. To be angry with ourselves that we have not done enough to promote human rights, to reform the law and to uphold global health. Only if anger is turned to constructive causes will the spirit of Jonathan Mann and of those who have died needlessly from disease and other deprivations of human rights, be still. Recapture in Philadelphia a revolutionary motivation. When a long train of abuses and usurpation persists, we the people of the world have the right to throw off our patient sufferance and to assert our inalienable rights. Amongst those rights most precious is the right to health. Without that right, life itself may be affliction and a burden. Law, human rights and the efforts at this conference must therefore be directed at plain speaking and follow up action. Honesty and science are our guide. And we all know that our objective is a noble one that links all people of goodwill on this blue planet. Mrs Roosevelt's prayer remains true for us today as it was in 1948. In reality, it is a natural outgrowth of the revolutionary business done in Philadelphia in 1776. It is a prayer available to people of all religions and people of no religion. It is one harmonious with the life of Jonathan Mann. It is one we can all say especially in darks times:
"Keep us at tasks too hard … Make us sure of the good we cannot see … Save us from ourselves and show us a vision of a world made new".
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