Elton John - Love Is the Cure: On Life, Loss, and the End of AIDS

Copyright 2012 by The Elton John AIDS Foundation

Statement by William Jefferson Clinton copyright 2012

Foreword copyright 2013 by Paul Farmer

Cover design by Lauren Harms

Cover copyright 2013 by Hachette Book Group, Inc.

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Dont Give Up words and music by Peter Gabriel 1986, reproduced by permission of EMI Music Publishing Ltd. / Real World Music Ltd., London W8 5SW.

ISBN 978-0-316-21989-1

E3

In memory of Robert Key, a dear friend and tireless advocate for those living with HIV/AIDS around the world

Paul Farmer, MD, PhD

Harvard University

Partners In Health

Thirty years after the advent of the AIDS epidemic, what have we learned about this disease and about ourselves as human beings?

On the first score, theres cause for optimism about the power of scientific advancements and the potential for a new view of global health and clinical medicine. Three decades after the first cases of AIDS were reported, we have identified the virus that causes the syndrome and can block its replication. We have developed, and continue to improve, tools to diagnose and treat the disease. Astoundingly, we have delivered some of these advances to millions of the poorest and sickest people in the worldin Africa, in Haiti, in the remotest corners of Asia.

But anyone wondering why, despite these advancements, there are still so many people living with HIV/AIDS today should read the book you now hold. Even for those familiar with the history of the epidemic, Elton Johns work is a revelation. Written by a man who helped form the soundtrack and spirit of a generation, Eltons book gives us a vision for the future that is both cautionary and inspiring.

Love Is the Cure reflects just how deeply, and for how long, Elton has been committed to eradicating AIDS in settings as diverse as the rural South in the United States, Haiti (where Eltons foundation has supported the work of Partners In Health), South Africa, and Ukraine. These are the front lines of the AIDS crisis today, and from the work in these settings around the world, we begin to see solutions emerge.

The story recounted in these pages is about this work and how a world-famous musician came to master its complexities. Love Is the Cure is an honest account, grateful and graceful, told largely through the eyes of activists, caregivers, and AIDS patients who have struggled against this disease because they live on the margins of our society. What Elton has discovered through his commitment to ending AIDS is perhaps the closest thing we have to a panacea for poverty, preventable disease, and the despair we find in frightening abundance around the world: compassion that translates into action.

Im writing this foreword at our office in Rwanda. At the close of 1994, following the genocide that took up to a million lives, Rwanda was in ruins. Many of its hospitals and clinics had been thoroughly damaged or destroyed, others were simply abandoned, and a large portion of the health workforce had been killed or languished in refugee camps. These settlements, especially those within Rwanda, were ravaged and thinned by cholera and other camp epidemics, as well as by AIDS, tuberculosis, and malaria. Child mortality rates soared to the highest in the world; malnutrition was rampant. Many development experts were ready to write off this beleaguered nation as a lost cause, a failed state.

Today, almost two decades later, Rwanda is the only country in sub-Saharan Africa on track to meet, by 2015, each of the health-related development goals that nearly all the worlds countries agreed upon thirteen years ago. More than 93 percent of Rwandan infants are inoculated against eleven vaccine-preventable illnesses. Over the past decade, death during childbirth has declined by more than 60 percent. Deaths attributed to AIDS, tuberculosis, and malaria have dropped even more sharply, as have all deaths registered among children under five. Rwanda is one of only two countries on the continent to achieve the goal of universal access to AIDS therapy; the other is far wealthier Botswana. Theres still a long way to go. But these are some of the steepest declines in mortality ever documentedanywhere and at any time in recorded history.

If thats not a big-time reversal of fortune, I dont know what is.

This has come to pass for many reasons and with the help of many partners. Some of the improvement in Rwanda has occurred because the global pandemic of neglect is also being addressed. The U.S. government is far and away the largest single funder of AIDS treatment programs in Africa. Indeed, simply by doing the math we see that many Americans now support efforts to build programs that can save lives, improve health, and prevent discrimination in all its forms.

But Rwandas rebirth has come to pass most of all because of good leadership here and sound policies in development, in public health, and in clinical medicine. It has come to pass because some of Rwandas leaders, including its health minister, have joined civil society groups to fight discrimination with legal remedies, with activism, and with an effort to realize the right to care. And much of this improvement has occurred among the poor and in the countrys rural reaches, traditionally neglected by governments and by medical professionals, but also by human rights groups and nongovernmental organizations.

Building a proper health system offers care providers the chance to be more effective and humane. Working as a doctor in places as far-ranging as a Harvard teaching hospital, a clinic in rural Haiti, and even a prison in Siberia has taught me something that Elton John learned by acting on his empathy, year after year and in country after country. Context matters and people are different, but they are much more the same. The aspirations of our patientsto receive care, to feel better, to be heard, to help friends and family members, to get back to work or to return to schoolare universal. Too many of these aspirations are dashed not only by serious illness but also by local poverty and social inequalities of many sorts. All of these pathologies need to be attacked with resolve, resources, and a clear commitment to a human rights agenda that links our quest for a right to health care to respect for the rights of everyone to live free of any sort of persecution or disdain. This is how to battle stigma, as Elton documents so well in this book.