Not Just Numbers

ONE Stubborn Thing + a Moment of Clarity: At the 2026 International AIDS Conference, attendees learned that HIV-related deaths in Africa fell below 400,000 in 2024. They also learned that the dismantling of global health budgets and institutions by the U.S. and Europe in 2025 had caused the closure of 1,700 AIDS health centers.

In my days as Ambassador to Tanzania (2007-09), I invited my parents to come and stay with us in Dar es Salaam. My dad, a practicing physician for more than fifty years, joined me and a small number of US and Tanzanian health officials in making home visits to families that had been ravaged by the scourge of HIV/AIDS that still burned bright in many parts of the country.

Our purpose was to check on those families, bring some basic food and medicine, and generally help them realize that they hadn’t been entirely abandoned or forgotten.

One of our stops was a rickety structure on the outskirts of town. It looked more like an abandoned farm shed than a place where human beings could live. There were no windows, but a few rays of sunlight reached in through holes in the walls. The floor was dirt.

As we entered the house, and after our eyes adjusted to the darkness, we saw an old lady, and wearing threadbare clothes, sitting on an old crate. She was a little overwhelmed by our visit, even though she knew we were coming, but she seemed to relax as we opened our boxes of food. A few of her children, dressed in tattered shorts and shirts, stood by, eyeing us carefully.

The poor woman’s breathing was labored and noisy as she sat on that old crate, but she wanted to talk. Through a translator, and little emotion, she told us that her husband and one child were already dead from AIDS and, as Dad would later confirm, she was in the homestretch herself. She went on to explain that she was once a successful businesswoman, but now she was down to her final shillings.

Through that translator, and with little emotion, she said to me, “Ambassador, I have a question.” She was looking off into the distance as she spoke. “With this last little money, should I buy books for my children who are healthy or medicine for the ones who are not?”

She wasn’t asking her question for effect… it was a sincere question from a woman deflated by life’s challenges. And, of course, I had no answer. None.

As Dad and I quietly walked back to our car, he said to me, “Mark, can’t the government do something?”

“Dad,” I answered, “There’s no Medicaid here or disability or welfare. If we don’t do this, it won’t happen. That’s the simple truth.”

It’s never been about the numbers.

Note: A version of this essay ran on the blog in February 2026.