A crisis of economies flatlining, people struggling to survive, more children born into poverty than ever before. A crisis of hunger, of conflict, of a world falling apart. We face a global crisis. A crisis of conscience.

I’m in Addis Ababa, attending the largest regional conference on HIV/AIDS in the world (second in number of attendees only to the global International AIDS Conference)- ICASA2011. If you follow my @rishie_ account, you’ll have seen me flooding your timeline with tweets from sessions and other inane, but related, commentary.

Stephen Lewis, former UN Special Envoy on HIV/AIDS; Knight Commander of the Most Dignified Order of Moshoeshoe; and now of aids-free world, spoke at yesterday’s plenary session and my heart is still breaking; my lower lip is still a little wobbly; and I am still filled with an overwhelming sense of despair, dismay, and bafflement.

I’m not sure that the Global Fund to Fight AIDS, Tuberculosis, and Malaria is something that makes the news, or is something that people who aren’t impacted by HIV/AIDS know about.. but, it’s a really; really; really big deal. Governments made a commitment to fund initiatives and to scale-up responses to HIV/AIDS. And now, they’ve cancelled an entire round of funding until 2014 because governments did not fulfill their promises. They have, in effect, condemned hundreds of thousands of people to death.

The anger, fear, heartbreak is hard to escape here. People are upset, they’re scared, they’re angry. And who can blame them? We have been failed by our leaders, failed on a colossal level; and how are we to hold them accountable when it feels as though they, quite simply, do not care?

Stephen Lewis’ speech left many members of the audience wiping away tears surreptitiously, nodding emphatically, and plain breaking into applause every few minutes. My colleague, an African, remarked, ‘It makes me sad that we needed someone else to speak for us. Where are our African leaders? Why didn’t any of them ask these questions?’. And, I’ll be honest, it made me a unbearably sad- not because African leaders weren’t asking these questions; making these comments; or prioritising their people, but because it seems as though nobody is. Nobody in power is prioritising peoples’ lives, their health, or their rights. Nobody.

Lewis’ anger and frustration has mirrored so much of my own annoyance:

I’m thrilled at the creation of UN Women, and the possibility, once they join as a formal co-sponsor of UNAIDS, that the focus on women will be given a new lease on life. But I can’t dislodge from my mind the experience of my years in the role as Envoy, and subsequently working with AIDS-Free World, when it became clear that in every aspect of the pandemic women were rendered subordinate. Gender inequality doomed their lives. Sexual violence fed and feeds the virus. The entire survival of communities and families was placed on their shoulders. Men were the social determinants of women’s health, and men simply didn’t care. As we come to this thrilling moment of potential progress, I can’t avoid the spectral faces of stigma, discrimination, isolation, and pain, and they are the faces of women. That doesn’t mean that women aren’t the core of courage and strength in this pandemic; it simply means that they have to struggle valiantly to challenge the phalanx of male privilege, of male hegemony. Just a few days ago, coincident with World AIDS Day, the Harvard School of Public Health held a symposium called AIDS@30 to assess the past and plot the future. The symposium had a Global Advisory Council of nineteen eminent experts on the pandemic: 17 men and 2 women. It is ever thus.  It’s the rare woman indeed who doesn’t ultimately report to a man in the world of HIV, or who can command, ever-so-rarely, the place and presence that legions of men command automatically.

He perfectly reflected my own anger, disbelief, shock, and as always, disappointment, with the world:

I’m thrilled with the turnaround in South Africa. The dramatic roll-out of treatment is nothing short of miraculous. But I remember all those years of denialism, and not a single voice at the most senior levels of the United Nations—Under-Secretaries-General, the Secretary-General himself. Not one of them said publicly to Thabo Mbeki, “You’re killing your people”. Oh, to be sure, it was said in private by everyone. They took Thabo Mbeki aside and begged him to reverse course. He didn’t budge an inch. Around him, in every community in South Africa, and in communities throughout a continent heavily influenced by South Africa, were the killing fields of AIDS. As we come to this thrilling moment of progress, I can’t forget the millions who died on Thabo Mbeki’s watch, while those who should have confronted him before the eyes of the world stood mute.

He was able to articulate the thoughts of thousands of advocates who work with these numbers on a daily basis, doctors who have to choose who to put on ARVs because the medicines are in short supply, people who have to beg donors for a little bit more money, or turn away people because we just don’t have the resources to help.

So if you sense a certain impatience in me, you’re right. We don’t have another day to lose. Peter Piot did the arithmetic yesterday … 1,350,000 put on treatment in 2010; 2,700,000 new infections, exactly double the number in treatment in the same year. It works out to 7,397 new infections every day. And it’s 2011, for God’s sake. It’s appalling that such numbers continue to haunt us; it’s heart-breaking beyond endurance to contemplate further exponential agony. We cannot delay another minute in putting the ‘prevention combination’ to work.

And I think, judging from the mood in the corridors, that’s what seizes this conference. But right at the moment when we know, irrefutably, that we can defeat this pandemic, we’re sucker-punched at the Global Fund.

What’s a sucker punch? It’s when a boxer in the ring gets a punch below the belt that he doesn’t see coming. No one expected a complete cancellation of Round Eleven, with new money unavailable for implementation until 2014.

It’s just the latest blow in a long list of betrayals on the part of the donor countries, in this instance the Europeans in particular. I’ve heard from several people that the politics of the Global Fund meeting in Accra two weeks ago, when the decision was made, were not just complicated, but amounted to miserable internecine warfare. Certain governments on the Board of the Global Fund simply discredited themselves. They give a soiled name to the principle of international solidarity. The Chair of the Board, in a remarkably convoluted effort, tried to explain things in a press release. He would have done far better to remain silent.

The decision on the part of the donor countries is unforgiveable. In a speech a few days ago, I addressed the Global Fund predicament by talking of the moral implications of a decision that you know will result in death … death on the African continent.

I won’t copy and paste the rest of his speech (despite the contentious numbers on whether Africa gets less money than it pours out), but it speaks to me on so many levels and it sucker-punched me in the best way- in the way that I never saw it coming; I never expected it; but it smashed into me in a way that made me explode. I can’t ‘this!’ his speech enough. I recommend you read it.