Recently a peaceful demonstration in Cape Town by AIDS patients begging for drugs to treat their otherwise fatal disease was broken up by riot police. The demonstrators, most of whom were HIV-positive women, were beaten, and 10 were shot. The next day in Moscow, people infected with HIV chained themselves to government buildings, also demanding access to life-sparing medicine.
We are entering a new stage in the world's great modern plague in which long-complacent governments are awakening to discover that the HIV virus, first noticed in 1981, now threatens to foment social unrest, undermine state authority, weaken armies, challenge economies and reverse hundreds of billions of dollars worth of development investment.
HIV is a national security concern, for both the highly-impacted societies and for those that have comparatively smaller epidemics.
Five years ago the global community took its first steps toward acknowledging the profound security dimensions of the pandemic by passing UN Security Council Resolution 1308, which states that "the HIV/AIDS pandemic, if unchecked, may pose a risk to stability and security."
Earlier this month, Peter Piot, the director of the Unaids Program, and Richard C. Holbrooke, who as the U.S. representative to the UN in 2000 authored Resolution 1308, joined me in calling upon the Security Council to declare the world's HIV/AIDS pandemic a global state of emergency. The Security Council has never previously declared any social or health issue a global emergency.
The full impact of HIV has not yet been felt. Infection rates are running at alarming levels in some of the world's armies and police forces and among highly-skilled workforces.
Countries that lack the political, infrastructural or economic wherewithal to provide anti-HIV medicines to all of their infected citizenry and to test thousands of people for infection face hideous choices.
They can, as some are now doing, provide the drugs to critical officials, such as senior military officers, legislators and physicians, thus preserving the capacity to keep the essential elements of the machinery of the state functioning. But that risks creating widespread social alienation.
A second choice is to spend an enormous percentage of a nation's GDP to create a vast drug dispersal infrastructure and provide HIV testing and treatment to the entire population. This, too, is an unsavory option as few countries in the world can afford the financial and human costs of such a massive effort.
Under prodding from Britain, the recent G-8 summit meeting in Gleneagles agreed to a debt reduction scheme and a multibillion dollar package of assistance to hard-hit nations. France doubled its commitments to supporting the Global Fund to Fight AIDS, Tuberculosis and Malaria. And the Bush administration's $15 billion AIDS, TB and malaria campaign now has some 200,000 people in poor countries on anti-HIV medicines. This is a terrific start.
Money isn't enough, of course. Countries that lack nurses and doctors or whose aging clinics lack elementary facilities can hardly be expected to provide complicated anti-HIV treatment to millions of needy citizens.
The security dimensions of HIV must be addressed with political commitments that go well beyond cash. President Vladimir Putin or Russia has yet to say a word about his country's exploding epidemic, needs to come to terms with his military's frantic cry that it cannot meet recruitment goals because about a third of would-be teenage soldiers are too sick to serve, suffering, among other things, HIV infection resulting from injection of narcotics.
President Thabo Mbeki of South Africa, whose army admits to an infection rate of 23 percent, is walking on thin ice politically by providing anti-HIV drugs to the military while continuing to block them from the general population.
The head of the Mozambican police, has warned that he is no longer capable of replacing police officers who are dying of AIDS because more than half of potential recruits also test positive.
President Festus Mogae of Botswana, noting that more than a third of his military and upwards of 40 percent of his adult general population is infected, recently declared that his country is "threatened with extinction."
A recent report by the Council on Foreign Relations, "HIV and National Security: Where Are the Links?" warned that if no effective vaccine or cure is found within the next 20 years, "areas of the world that are now witnessing explosive epidemics, or are in their second or third waves of AIDS epidemics, may well be more deeply altered than Europe was following the Black Death." If the global community genuinely hopes to avoid this, the pace of the UN and other activities must quicken radically.
Laurie Garrett is the senior fellow for global health at the Council on Foreign Relations in New York.