"Everybody knows that pestilences have a way of recurring in the world; yet somehow we find it hard to believe in ones that crash down on our heads from a blue sky."
-- Albert Camus, "The Plague"
WASHINGTON -- A memory from the AIDS crisis. It was 2005, the year that global AIDS deaths peaked at 2.3 million. At the end of a dirt road in Kericho, Kenya, I visited Sister Placida, an energetic nun caring for a few dozen equally energetic AIDS orphans. She showed me several "memory boxes" that dying mothers had prepared for their children, holding photos, letters, a few mementos. The exercise struck me as forlorn -- a short life poured into a shoebox -- but also as defiant. Facing an absurd death sentence, these women wanted to be recalled not as victims but as humans. They wanted to leave a mark, to make a statement: Once there was such a life as mine.
As the International AIDS conference meets in Washington, D.C., the news on HIV/AIDS is not all encouraging. About 44 percent of people needing treatment still lack it. AIDS remains the world's leading cause of death for women of reproductive age.
And yet: 8 million people in lower-income countries are now on AIDS medication. This includes 6.2 million in sub-Saharan Africa -- more than a hundredfold increase in less than a decade.
How to comprehend such figures? An economist might calculate the productivity contained in more than 10 million cumulative life-years saved in the developing world by antiretroviral drugs since 1996. Not being an economist, I imagine millions of unfilled memory boxes. A lost generation, unexpectedly returned. A found generation.
In America, it is common to distrust institutions -- to express a lack of confidence in Congress, the federal government and major companies. The response to AIDS weighs on the other side of the balance.
It has brought great credit to the scientific enterprise, which first helped allay unreasoned fears, then guided evidence-based treatment and prevention. It has illustrated the power of government to do good in ways denied to individuals and private groups. Public agencies -- particularly the President's Emergency Plan for AIDS Relief (PEPFAR) -- met ambitious treatment goals, and on budget. The response to HIV/AIDS has been a reminder: The quest of politics is not big government or small government but effective government on the necessary scale.