The Bert and Peggy DuPont Lecture: "Love, Death, and Commitment: Twenty Three Years of HIV and Genocide Prevention in Africa" or "Passionate not equal Unhinged"

Over the last 20 years, HIV emerged as the #1 cause of death in African adults, and the Rwanda genocide became the most concentrated mass murder in recorded history. Though one catastrophe surfaced slowly and inexorably while the other smoldered for years before exploding in 1994, the lessons learned are similar. In both situations, the international community has combined moral bankruptcy with a spectacular display of incompetence. Genocide masterminds continue living in Michigan, Minneapolis and Boston, brazenly planning the final extermination of the Tutsi. Students of law, diplomacy and international development are astoundingly sanguine about this, as though our current abdication of responsibility today is mitigated by the centuries of unprincipled idiots who preceded us. If medicine operated this way we'd still be treating syphilis with arsenic. Unfortunately, medicine has lost the moral high ground in Africa through missed opportunities and misappropriation of resources. In the last five years we have spent 20% of the US bilateral foreign assistance budget putting 2.5 million Africans on anti-retroviral treatment (ART), while twice that number of new HIV infections occurred. We tested 50 million Africans for HIV without acting on the evidence and common sense: rather than—transmission happens between two people. Had we tested Africans as couples, a prevention strategy proven to be effective in multiple publications since the early '90s, we could have averted more HIV infections than we are now treating, and at a fraction of the cost.