To Stephen Lewis, United Nations special envoy for HIV/AIDS in Africa, the "surreal" image of aluminum coffins being wheeled in to overcrowded hospitals to carry away the most recently deceased patient is all too real.
When he speaks in Africa, young women in their 20s ask: "What's going to happen to my children when I die?" And the women want to know why they don't have access to lifesaving drugs that are available in western countries.
"It is incomprehensible in the 21st century," Lewis said this past week at Salt Lake Community College, speaking for the Tanner Forum on Social Ethics.
Lewis, a Canadian citizen, started the Stephen Lewis Foundation last year to help countries in sub-Saharan Africa cope with the HIV/AIDS pandemic. A generation is growing up without parents to pass on basic life skills. The continent is losing its doctors, nurses, teachers and farmers, he said.
Women are particularly vulnerable in a society where "gender inequality is a death knell," he said.
"One of the most hazardous environments for women in Africa is marriage," he said. Wives don't have the right to say "no" or to insist on prophylactic protection, he said.
Lewis said there is hope. There is a treatment to reduce the risk of transmission from mother to infant, he said. Another treatment, still in development, would be in the form of an ointment women could use to prevent transmission, he said.
Lewis said the World Health Organization is working to treat 3 million people by the end of next year. While that's only about half of those who qualify, Lewis said it would "unleash a reservoir of hope."
The United States has pledged $15 billion over five years, and Canada has created a generic drug program, but Lewis said both programs have so many strings attached that they may be ineffective.
For at least one in the audience, the message hit home: Edith Mitko's sister, Lois Sebatane, started an HIV/AIDS home for women and children in Lesotho. Mitko, director of the state Office of Asian Affairs, said at one point an Israeli university had offered a scholarship to 11 of her sister's students. All that was required was a blood test nine of the girls tested HIV positive.