If you can’t beat ‘em, regulate ‘em -- that’s the Indian Supreme Court’s take on the country’s illegal sex trade.
The court’s advice came in response to an NGO’s public litigation regarding child trafficking in the country. As of 2007, UNICEF estimates 2.4 million Indians were HIV-positive (with the high estimate ranging up to 3.2 million). The sex trade is at the center of the epidemic: reportedly, a young prostitute can charge a customer just over $2, while an older woman will only receive about 65 cents – and that figure usually drops if the prostitute demands the use of a condom. And the youngest girls in the trade, forced into prostitution before 15, are at the greatest risk of contracting the virus – they work longer hours, serve more clients, and are more likely to work in multiple brothels.
A UNAIDS report issued a couple of weeks ago reports that efforts to control the spread of HIV has been effective, with HIV prevalence among female sex workers declining by more than half, from 10.3 percent to 4.9 percent, between 2003 and 2006. Still, as the court points out, there are an estimated 2 million female sex workers, and legalization would allow monitoring of the trade and further provision of medical aid.
As the judges asked, "When you say it is the world's oldest profession and you are not able to curb it by laws, why don't you legalise it?"
Photo: PRAKASH SINGH/AFP/Getty Images
When it comes to using Holocaust metaphors, the power of suggestion is a loaded and delicate thing. Striking the right chord becomes ever more slippery when, for example, you use the most recognizable image of Holocaust evil, Adolf Hitler, to illustrate the recklessness of unprotected sex. But you just about lose any hope of keeping that line clean and clear when you make a Hitler sex video for an AIDS PSA. Which is what a small German AIDS awareness group called, Regenbogen e.V, did.
While the Telegraph says the clip appears to be a "typical advert" at first glance, I imagine most American viewers won't agree. The act of intimacy being portrayed is basically soft-core porn. It shows two very naked hard-bodies engaged in some very steamy sex. (Warning: this video ain't for the kiddies and is probably not safe for work.) The commercial's obvious-to-the-point-of-insult message, that unprotected sex is very, very dangerous, is hammered home with a rather indelicate ... bang. As the couple reaches climax, the man's face is revealed -- it's Hitler. Scary, indeed.
Not surprisingly the ad, released in Britain to coincide with World AIDS day, has created a storm of controversy. A spokesman for the National AIDS Trust, the group that coordinates World AIDS Day in Britain, had this to say:
Of course there are many HIV organisations that run their own campaigns, however I think the advert is incredibly stigmatising to people living with HIV who already face much stigma and discrimination due to ignorance about the virus.
"On top of this it fails to provide any kind of actual prevention message (e.g. use a condom) and may deter people to come forward for testing.
"The advert is also inaccurate because in the UK thanks to treatment HIV is a manageable condition that does not necessary lead to AIDS.
Hans Weishäupl, creative director of das comitee, the group that created the ad for Regenbogen e.V, defended the work:
A lot of people are not aware that Aids is still murdering many people every day. They wanted a campaign which told young people that it is still a threat," he said. "In Germany, Hitler is the ugliest face you can use to show evil."
Provocative it may be, but successful? I doubt it. Would it be a gross and malicious misinterpretation to use this ad to say that people who have unprotected sex, or people with HIV or AIDS, are as evil as Hitler? Absolutely. Is it a stretch to say there are folks out there who will do just that? Nope.
Using the evil führer's personage for good is a tricky business, one that should perhaps be left to the Charlie Chaplins of the world.
229,524, according to the AIDS & Rights Alliance for Southern Africa in a PR video calling out the African Union and African leaders for not spending enough on health.
The organization also calculates that Robert Mugabe's 85th birthday party could have covered 10,501 TB treatment courses. See the rest in this video set to Akon's "I'm So Paid":
Hat tip: Jina Moore
Human Rights Watch has issued a statement asking for the removing of contentious proposals in a draft bill before the Rwandan parliament. Health and human rights director Joe Amon said that if enacted, the law would require the forced sterilization of mentally disabled persons, mandatory HIV/AIDS testing for couples who plan to wed, for married individuals at his or her spouse's request, and for children or incapacitated persons for whom it is deemed "necessary" without their consent. He said:
While Rwanda has made notable progress in fighting stigma and responding to the AIDS epidemic, and has pledged to advance the rights of persons with disability, forced sterilization and mandatory HIV testing do not contribute to those goals. These elements of the bill undermine reproductive health goals and undo decades of work to ensure respect for reproductive rights.
In recent years Rwanda has made not simply strides but rather leaps in combating HIV/AIDS. UNAIDS figures reveal a dramatic drop in national adult HIV prevalence, from nine percent in 1990 to a little under three percent in 2007.
Essentially, Rwanda's efforts to curb the spread of HIV/AIDS need to be decoupled from any attempts at compulsory sterilization or testing. If undertaken in a widespread manner or as part of systematic practice as the bill intends, forced sterilization is regarded as a crime against humanity by the Rome Statute of the International Criminal Court to which Rwanda is party. Rwanda has also signed and ratified the UN Convention on the Rights of Persons with Disabilities and its Optional Protocol as of December 15, 2008.
Deputy speaker of the Rwandan parliament Damascene Ntawukuriryayo has subsequently denied the existence of the bill.
Brent Stirton/Getty images
Atlantic blogger and soon-to-be New York Times columnist Ross Douthat was not happy at all that my colleague David Rothkopf put Pope Benedict on his list of the world's biggest losers because of his comments on AIDS and condoms:
There are many other NGOs working in Africa that proceed from different premises, and take a different attitude toward matters sexual as a result, and if David Rothkopf prefers their approach that's perfectly understandable. But unless he's willing to tell the Catholic Church that it should fold up its charitable operations in the developing world and go home, I'd prefer to be spared the lectures on how the Pope is responsible for "massive death and suffering" among populations for whom Catholic institutions have provided lifelines beyond counting over the years, just because he isn't willing to to use his pulpit to preach the importance of playing it as safe as possible, health-wise, while you're committing what the Church considers mortal sin.
Rothkopf is more than able to defend his own posts, but I think that Douthat is missing the real reason why the Pope's comments upset so many people. As Bill Easterly pointed out, the first part of the Pope's statement, that AIDS is "a tragedy that cannot be overcome by money alone, that cannot be overcome through the distribution of condoms," is a perfectly legitimate statement. Condoms alone won't solve anything. It's his next clause, that the distribution of condoms "even aggravates the problem" which is more problematic.
Here's more Easterly:
From the standpoint of the individual, this is obvious nonsense, you are much less likely to get AIDS if you use a condom. The reason that mass condom distribution has not worked is that far too many people don’t use the condoms. One among the many possible reasons that people don’t use condoms is that religious leaders like the Pope tell them not to, or they believe unscientific statements like the Pope’s that “condoms aggravate the problem.” So it is tragically circular for the Pope to condemn the condom campaigns for not working, when one reason they don’t work is that the Pope has previously condemned condoms.
So in response to Douthat, the Pope was not "proceeding from a different premise" than those who promote condom use, he was making a statement that could at the very least be interpreted as arguing against the fact that condoms use can prevent the transmission of AIDS. Until condom proponents start telling people that they're obligated to have sex, the Pope's defenders are on shaky ground when they say he's just offering another approach.
But don't take my word for it. Roseli Tardelli, a Brazilian AIDS activist who's been educating people on these issues for over a decade, has a new piece on The Argument blog, about how the Pope's words have set her work back years.
BORIS HORVAT/AFP/Getty Images
Depending on where you stand, President Barack Obama's Friday decision to lift the Mexico City Policy, better known as the global gag rule, was either wonderful or appalling. For the last seven years, the gag rule stipulated that charities promoting and supporting abortion services could not recieve funding from the U.S. Government. Now, they can. I say: it's about time.
My position is not drawn from either side of the abortion debate. It's drawn from what I saw as a reporter and as a person living in Nigeria. HIV/AIDS is the open secret there -- a growing problem with a whispered name.
To put it politely, the gag rule created a rift -- at times gaping -- between U.S. government-funded projects and those of private NGOs trying to prevent HIV infection. The U.S. government brought the buck -- President Bush's PEPFAR program boasted $39 billion for HIV/AIDS work -- but it also brought rules about how to get the work done. The foundations brought less money and a sometimes different approach. Both sides fought to win the support of the local government for their strategies. From what I saw, that debate could get ugly. Friends working in the field were frustrated and saddened by the result: inertia and politics, instead of posters and condoms.
There was one particular problem that brought it home for me. In 2006, a Nigerian lawmaker announced that 55,000 women die in the country each year from unsafe illegal abortions. The evidence was everywhere -- from women that my colleagues and I met to Nigerian films on exactly that topic.
What was the best way to get that statistic down? Some will say abstinence. But sex is not always a choice. It's in those situations where women seek -- or are forced by their partners to seek -- unsafe abortions. Some counseling and a sterile doctor's office would go a long way.
That's just one example. The real "gag" was that you didn't hear a lot of stories about birth control or HIV prevention in Nigeria. So my few are only the beginning. Maybe now we'll start to hear a few more.
Photo: TIM SLOAN/AFP/Getty Images
What happened to the good old days when kids just used to sniff glue to get high? The BBC reports that South African teens have turned the trend of substituting prescriptions drugs for recereational drugs -- like snorting Ritalin -- into an unexpected venture: smoking anti-retroviral HIV/AIDS drugs to get lit.
Aside from the obvious reasons why this recently discovered habit -- grinding up the pills into powder and then mixing it with pain killers or smoking it with marijuana -- is so distressing, teenage users are getting their "stash" from HIV/AIDS patients and health care workers responsible for distributing the medication.
This raises serious questions about the infrastructure for a crucial medical service already stunted by reluctant leaders and lack of funding. It also means that people who need these drugs to stay healthy aren't taking them as prescribed, while others, barely able to get these drugs as it is, have a new obstacle to contend with -- users who are willing to pay and the health care workers willing to sell what precious drugs they have to the highest bidder.
I hate to think that Barbara Hogan, South Africa's newly appointed health minister, upon whom many hopes have been pinned, will be wasting any energy or valuable dollars on keeping drugs away from a foolish few, when so many are in real need.
GEOFF ROBINS/AFP/Getty Images
The juxtaposition of two of today's headlines pertaining to AIDS in Africa is glaring. One touted a new strategy for HIV testing that could slow, if not altogether halt the spread of the virus, while the other released the devastating findings of a Harvard University study which linked 365,000 premature deaths to former South African President Thabo Mbeki's refusal to acknowledge scientific evidence of HIV/AIDS's viral capability.
The study's findings, published in The New York Times yesterday, blamed the South African government and, in particular Mbeki, for not only being lax in making the anti-retroviral drugs widely available but for flatly denying their importance. Mbeki's claimed that AIDS was caused by malnutrition and that treatments were toxic.
The promising new treatment model, which proposes a combo of HIV screening of every adult and treatment for all those who test positive, was published this week in the British journal Lancet.
If employed successfully, the study predicts that "transmission rates would fall from 20 new cases per 1,000 people per year to 1 case per 1,000 in about a decade." A biostatistician at WHO, Reuben M. Granich, said that if aggressively pursued, the testing-and-treatment approach could be "the greatest strategy for reducing transmission" of HIV.
While the method and implication of such widespread, regular testing (even if on a voluntary basis) has raised eyebrows and serious doubts about its viability, at least it offers a certain rational and sense of control. Treatments of this kind are part of the reason why the World Health Organization predicts fewer AIDS fatalities in the next two decades. Previous attempts at prevention techniques in many African countries -- sex education, abstaining, information about circumcision -- haven't proved successful.
And in the face of blatant ignorance like Mbeki's, why would anyone be surprised?
This is beyond disturbing:
Lawmakers in Indonesia's remote province of Papua have thrown their support behind a controversial bill requiring some HIV/AIDS patients to be implanted with microchips -- part of extreme efforts to monitor the disease.
Health workers and rights activists sharply criticized the plan Monday.
But legislator John Manangsang said by implanting small computer chips beneath the skin of ''sexually aggressive'' patients, authorities would be in a better position to identify, track and ultimately punish those who deliberately infect others with up to six months in jail or a $5,000 fine.
The idea of implanting anyone with a microchip against their will is bad enough, but I can only imagine the possibilities for abuse on a government panel tasked with deciding which patients are "sexually aggressive" enough to qualify.
AIDS activists had reason to celebrate last Friday. South Africa's Health Minister Manto Tshabalala-Msimang -- the woman FP named one of the world's worst advisors this summer -- was fired by the country's new president. In a country with one of the world's highest AIDS rates, it was Tshabalala-Msimang who stated publicly that she did not support antiretroviral medicines and that a diet of lemon, beet root, and garlic could effectively treat the disease.
Although South Africa's woeful AIDS policy hasn't been all Manto's doing, it's still good news that she's no longer at the helm. It's unclear how much health experience her successor Barbara Hogan has, but as one MP put it last week: "Anyone is better than Manto."
In a grand gesture, three government ministers and one member of parliament publicly announced this week that they had been circumcised in secret. This is a particularly bold effort to help curb the taboo against circumcision among Kenya's Luo tribe -- the third largest ethnic group in the country -- in which, unlike the Luhya community, the practice is not a rite of passage.
The hope is that this highly public display of solidarity for the scientific findings on the success circumcision has in preventing the spread of HIV and AIDS -- reducing the risk of infection by as much as 60 percent -- will spur men in the community to follow suit.
In Kenya, where nearly 2.5 of its 32 million citizens are currently living with HIV and AIDS, there is often resistance when it comes to bowing to medical findings over age-old traditions. This past July, after the ministry of health began offering free circumcision services in Nyanza Province, the Luo Council of Elders refused to sanction the practice. However, not all of the protests were in defense of culture. Some fear that those who have the surgery will no longer feel compelled to use condoms which are far and away the best method of prevention.Men in the Nyanza province have been coming out in droves for the free "cut," and the government hopes that at least two million men in the province will be circumcised. At least five other government officials have agreed to the surgerical procedure. Prime Minister Raila Odinga did his part to encourage listeners:
All there is to circumcision is availing your male organ for the foreskin to be removed, like 'ting' [snip] and it is all over."
That's quite a sales pitch.
South Africa might be giving its all to prepare for the 2010 World Cup, but some think it has stepped out of bounds. A proposal to legalize prostitution there before the tournamount starts has several opposition parties and religious groups in the country crying foul, both for fear that the practice could become permanent and because, in the words of one critic, it "defies the word of God."
The hullabaloo started back in January when George Lekgetho, a member of Parliament, made a pitch for legalization at a committee meeting. He pointed out that prostitution is legal in Germany, the 2006 World Cup Host, to bolster his argument, adding that legalization would mean less rape and "added tax revenue."
Though most of the other MPs laughed off the proposal, the idea has gained major ground with Durban's local government. South Africa's third largest city boasts a sizeable prostitute population, which legalization advocates claim would be better protected if the trade was allowed.
That's questionable. Legalization isn't likely to make things any better for the thousands of young girls in the trade, who are typically at the mercy of pimps and dismal working conditions in the widely impoverished country. Even in comparatively well-off Germany, legalization brought its own share of problems during the cup, including how to handle reported increases of sex-trafficking from Eastern Europe.
Nor does South Africa's astronomical AIDS rate help the argument much, since legalization probably won't be accompanied by widespread promotion of "safer-sex practices." This, after all, is a country where the likely future president "took a shower" after having sex with an HIV-positive woman to prevent infection.
In any case, South Africa has plenty of other battles to wage before 2010. The skyrocketing costs of stadium construction, constant power outages, and consistently high petty and violent crime rates in major cities are sure to keep the South African government occupied until the tournament kicks off. Or else thousands of tourists and millions of TV-watchers worldwide could get a dismal view of a country that has held so much hope.
In today's Washington Post, Mike Gerson quite rightly lambasts the "Coburn Seven" -- seven Senate Republicans who are all but blocking expanded funding for the President's Emergency Plan for AIDS Relief (PEPFAR).
Unfortunately, what Gerson ignores is the GOP's long history of failure and ignorance on the HIV/AIDS front. This sad history dates to the very founding of the contemporary conservative movement. It was Ronald Reagan, the revered Godfather, who remained silent as tens of thousands of Americans died and a pandemic was spread to more than 100 countries around the globe. Even as Reagan did nothing to combat AIDS, his surrogates in the extreme right opined that the disease was a divinely-inspired retaliation on liberalism. It was Pat Buchanan, Reagan's White House communications director, who called AIDS "nature's revenge on gay men." Such sentiments proliferated as the power of the GOP's religious right-wing coalesced in the 1990s. Former Republican presidential hopeful Mike Huckabee, for instance, famously called for those infected with HIV/AIDS to be "isolated from the general population" in 1992. He stood by the statement in his 2008 presidential campaign.
When historians sit down to assess the modern conservative movement a generation or two from now, among the most severe tarnishes on the GOP's legacy will be Guantanamo and record deficits. There also will be the string of painfully ignorant policies the party has held on HIV/AIDS. To his credit, George W. Bush has probably done more than any conservative politician of his generation to reverse this tragic legacy -- more, perhaps, than any liberal politician, too. PEPFAR has provided life-sustaining anti-AIDS drugs to 1.4 million patients in the countries hardest hit by the disease. It may be the most favorably remembered foreign policy initiative of Bush's entire tenure. And in his January State of the Union address, the President proposed a long-overdue doubling of the effort.
It looked as though the GOP had finally found its moorings on combating a disease that, in a number of African countries, now affects more than 1 in 5 adults. But a small GOP minority once again appears poised to force the United States to take a backseat in the fight. As Gerson says, it will come at a price paid in lives. Unfortunately, it won't be the first time.
In December 2006, Jeremiah S. Johnson, 25, began serving as a Peace Corps volunteer in Rozdilna, Ukraine, a town near the border with Moldova. When he started, he was HIV negative. In January of this year, he had a midservice medical exam in Kiev and agreed to an HIV test. It came back positive. The Peace Corps told him to pack his bags and return to the United States.
Johnson says the Peace Corps director for Ukraine told him he had to go home because Ukraine doesn't allow HIV-positive foreigners to work there. (If so, this isn't unique. As blogger Andrew Sullivan has pointed out repeatedly, the United States has its own fair share of restrictions on HIV-positive immigrants and tourists.)
Back in Washington, Johnson had an end-of-service medical exam and received written notification that he was being "medically separated" from the Peace Corps. He contacted the American Civil Liberties Union (ACLU), and the organization sent a demand letter to the Peace Corps saying that it is violating the Rehabilitation Act, which prohibits discrimination based on disability. (The State Department, by the way, changed its policies just this February to permit HIV-positive Americans, on a case-by-case basis, to work in the Foreign Service.)
Johnson doesn't have any physical symptoms of HIV. He and the ACLU say the Peace Corps did not assess him to determine if he could continue serving with reasonable accommodations. Additionally, his requests to be assigned to another country were denied.
What do you all think? A few questions come to mind:
These are the first two lines of a four-line riddle that's part of a media contest in India that aims to get men talking about sex. Launched in time for World AIDS Day on December 1, the campaign hopes the riddle is intriguing enough that it actually gets men to talk with their friends about topics that can be rather awkward to discuss.
Many HIV/AIDS prevention campaigns simply tell people to talk about sexual health, but this one actually stimulates people to do so. Additionally, to be eligible to win a prize, people have to call in and actually say the one-word answer to the riddle—no text-messaging the answer allowed! Prizes, such as mobile phones with free minutes, continue the theme of promoting talking.
The contest, sponsored by the BBC World Service Trust, targets men in four southern Indian states that have higher HIV rates. Why men? Research shows that if you can get men to talk about sex and condoms, they're more likely to be consistent condom users. (Did I just give away the answer to the riddle?)
Soaring HIV/AIDS infection rates and sexual violence have forced African nations to get creative with condoms. You've got Pronto condoms, which can be put on in less than one second, before "the mood is halfway out the window." And then there's the anti-rape condom, blogged about here at Passport, which has "razor-sharp teeth [that] fasten on the attacker's penis if he attempts penetration."
Now, in Ethiopia, where HIV/AIDS infection rates are above 2 percent, a U.S. charity has developed a coffee-flavored condom. DKT International came up with the prophylactic — which supposedly tastes like a macchiato — after receiving complaints about the smell and taste of traditional latex condoms. Despite criticism from the Ethiopian Orthodox Church, in September more than 300,000 of the condoms were sold at 10 cents a piece.
The condoms have also tapped into Ethiopian nationalism, as coffee was supposedly invented there. As one university student put it, "It is about time to use an Ethiopian flavor for beautiful Ethiopian girls."
DKT has developed similar products for other parts of the world. In China, they offer condoms that smell and taste like sweetcorn. In Indonesia, they offer a condom that smells like the durian fruit (which, incidentally, absolutely stinks, and is probably the last thing anyone would want to smell before business time).
What's next? Pilsner-flavored condoms in the Czech Republic? Plantain in the tropics? But hey, if it gets more people to have safe sex, why not?
Many Passport readers have written in questioning an assertion made in my post from yesterday that Che Guevara "assisted in the persecution of homosexuals and AIDS victims."
Some of the comments I received were rude: "Either sloppy or lazy," one reader wrote. But, as you might expect from Passport readers, a good many more were constructive: "I have some trouble believing that a person who died in 1967 could have been persecuting victims of a disease whose existence was unknown before the early 1980s," one reader questioned. "In a future post, could you elaborate on this point?" another reader requested.
Sure thing. It's not my contention that Che magically came back from the dead to persecute the victims of a disease which proliferated a decade and a half after his death. I wrote, very carefully, that Che "assisted" in the persecution of AIDS victims. And here's what I mean: The labor camp system Che founded, most notably Guanahacabibes, was the predecessor to that which confined AIDS victims — and, incidentally, a whole host of other folks. Che's successors were "assisted" by his vision, if you can call it that, and the infrastructure he developed. Peruvian writer and FP contributor Alvaro Vargas Llosa explains:
This camp was the precursor to the eventual systematic confinement, starting in 1965 in the province of Camagüey, of dissidents, homosexuals, AIDS victims, Catholics, Jehovah’s Witnesses, Afro-Cuban priests, and other such scum, under the banner of Unidades Militares de Ayuda a la Producción, or Military Units to Help Production. Herded into buses and trucks, the 'unfit' would be transported at gunpoint into concentration camps organized on the Guanahacabibes mold. Some would never return; others would be raped, beaten, or mutilated; and most would be traumatized for life...."
Thanks to all those who offered thoughtful and constructive comments.
One of the oddest cultural trends of our time is the Cult of Che Guevara. I was just down in Peru, where street vendors proudly peddle Chinese-made tapestries and t-shirts bearing Che's image to U.S. college students. Hollywood—most notably Robert Redford—has glamorized Che on screen. And in more than one European hamlet will you find a "Che Guevara Bar," inevitably attracting hipsters with the same, sad tapestries, fake Cuban cigars, and cheap rum.
Today, the Cult of Che hit a new low, when a 3-inch lock of his beard and other items went up for sale at a Dallas auction house. The starting bid? $100,000. Venezuela's President Hugo Chávez is rumored to be among the potential interested bidders. The seller is Gustavo Villoldo, a retired CIA operative of Cuban heritage who was involved in Che's capture and was present when Che was buried. Villoldo says he cut the lock of hair because, "I wanted proof that I had completed my mission." His motive for selling it now appears to be profit. (This month marks the 40th anniversary of Che's death.)
It's disappointing to see Che glorified in this way. The man was a Marxist-Leninist of the worst kind: He presided over the Cuban Revolution's first firing squads; he assisted in the persecution of homosexuals [see note below]; he imprisoned dissidents. Che preached a dangerous breed of martyrdom and hatred reminiscent of the most radical jihadists of today's Middle East. You may see some familiar themes in this, one of Che's choicest lines:
Hatred as an element of struggle; unbending hatred for the enemy, which pushes a human being beyond his natural limitations, making him into an effective, violent, selective and cold-blooded killing machine. This is what our soldiers must become...."
Today, we seem intent on remembering Che as a liberator in the Bolivarian vein, a freedom fighter. He was not. As Paul Berman has elegantly documented, Che inspired many middle-class Latin Americans to take up arms in insurgent campaigns that did nothing more than set the cause of Latin American democracy back decades. That a tiny lock of his hair can sell in Texas (of all places) for six figures is a sad comment indeed on just how severely his legacy has been distorted.
Editor's Note: This post was changed by the editor to avoid any confusion. It originally said that Che "assisted in the persecution of homosexuals and AIDS victims." Many readers asked about the original language. Mike explains here.
Not all archbishops are as enlightened as Desmond Tutu. Here's Archbishop Francisco Chimoio, head of the Catholic church in Mozambique, engaging in the kind of reckless lunacy that does not dignify comment:
I know that there are two countries in Europe, they are making condoms with the [HIV] virus on purpose. They want to finish with the African people. This is the programme. They want to colonise until up to now. If we are not careful we will finish in one century's time."
He also claimed some anti-retroviral drugs contain the HIV virus.
Five years ago, Botswana was an HIV/AIDS basket case. It had the highest incidence of the disease in the world. Almost 40 percent of its adult population was infected. Average life expectancy had fallen below 40 years. Botswana was battling against "extinction."
In response, the government, with help from international agencies, embarked upon a campaign to contain the spread of the virus. The results are now beginning to show, and they suggest that Africa's troubles aren't always insurmountable.
Botswana has reduced the rate of HIV transmission from mother to child to below 4 percent through vigilant testing programs followed by drug treatments for mothers who are infected. Thirty-four percent of Botwana's pregnant women—around 14,000 people—are HIV-positive, and the chances of passing on HIV to a baby is between 30 and 35 percent when there's no intervention. In other words, Botswana's effective response has saved thousands of babies from contracting the virus every year. Botswana is now within the range of the United States and Europe, where less than 2 percent of babies born to HIV-positive mothers have the virus.
Botswana is also looking up in terms of other indicators. The adult HIV/AIDS prevalence rate has dropped to around 24 percent (it's still high, but significantly better than five years ago), and life expectancy has increased 10 years, to over 50. Obviously, there's still a long way to go. But it just goes to show that smart interventions can make an enormous difference in a very short time.
I know it's the man's 89th birthday, and he did lead the fight against the crimes of apartheid, but I can't resist pointing out that the halo around former South African President Nelson Mandela ignores his shoddy record on many aspects of governance, and especially HIV/AIDS.
A recent article (free registration required) in the Lancet by Dr. Paul Zeitz, head of the Global AIDS Alliance, lays out the damning history. Although then-Vice President Thabo Mbeki (for years, an AIDS denialist) deserves most of the direct blame for South Africa's 1990s AIDS disaster, it was Mandela who was ultimately in charge at the time. In 1996, his government spent 20 percent of its annual AIDS budget on "a contract for a theatre company to produce a show with questionable public-health messages," according to Zeitz. Following that error in judgment, Mbeki pushed Virodene, an AIDS medicine produced in Africa, through the government's approval process. Virodene was later deemed to be "unfit for human consumption."
When Mandela turned over the reigns to Mbeki in 1999, 11.7 percent of South Africa's adults had HIV/AIDS. Mandela has since expressed his regret over his government's failure to grapple with this problem, and that's welcome. His own son even died of AIDS in 2005, and the elder Mandela has become a fervent advocate for AIDS causes. So what's the issue? Well, as noted in this morning's Brief, Mandela is setting himself up, along with former U.S. President Jimmy Carter, as one of the world's wise men. Backed by Richard Branson's millions, Mandela's "Elders" will rain down rhetorical thunderbolts from their Olympean heights in order to highlight the world's ignored causes. But let's not forget that when he had real power to do something, it was Mandela himself who did the ignoring.
Those hoping for a miracle need only stop by their local magic shop and look somewhere between the magic coins and the trick-card deck.
The Ghanaian "prophet" Obiri Yeboah, head of a Pentecostal church in Uganda, was caught red-handed by Ugandan police with a magic device he had used to dupe his congregation into believing they were experiencing miracles.
It turns out that "The Electric Touch" is not a miracle at all, but is actually intended for budding magicians, who can use it to administer small electric shocks to their unsuspecting volunteers. (Check out a video of the device in action here.)
In a country where the average income is $280, Yeboah is said to have collected large sums of money from devout followers who had faith in these miracle performances. His church is part of the growing "miracle church" phenomenon in the turbulent east African country, where some preachers dangerously claim that they can cure HIV/AIDS through special healing powers.
When last year's UNAIDS report came out, India appeared to have overtaken South Africa as the country with the greatest number of HIV/AIDS cases—an incredible 5.7 million. But in new data released Friday, UNAIDS has more than halved that figure, to just 2.5 million Indians living with the virus.
The sharp revision has to do with a larger population sample and new methodology for data. Earlier estimates had tested blood from small samples of pregnant women and high-risk groups like prostitutes, and then extrapolated out to the general population. That method is widely accepted, but clearly problematic in determining nationwide infection levels. The new numbers put India behind South Africa, which has at least 5.5 million people living with HIV, and Nigeria, with 2.9 million.
The lower estimate is obviously great news for India. But there's a risk that Indian health officials, long accused of being in denial about the scale of the problem, might take these new results and use them as evidence that India's problem is confined to specific areas and high-risk populations. That would be a huge mistake—2.5 million infections is still nothing to sniff at, and studies have shown that the virus spreads rapidly once it gains a foothold in the general population.
So, what should Indian health officials do with these revised statistics? My advice: Breathe a sigh of relief, and then get back to work so that last year's overestimate never becomes a reality.
The president of Gambia can cure AIDS, but just on Thursdays, the only day when his healing powers work. The cure includes applying a green sludge to the skin of the patient, sprinkling a mystery liquid, having the patient swig a brown broth, and topping it all off with a banana snack. Whirling about the patient and uttering verses from the Koran are also part of the treatment.
President Yahya Jammeh says this treatment, with its seven secret herbs, can cure AIDS "with absolute certainty" if patients meet two requirements: 1) abstaining from alcohol, tea, coffee, sex, and theft during the multiweek course of treatment, and 2) ceasing to take antiviral medications.
Oh, the president also claims he can cure asthma and diabetes.
Speaking seriously, though, this "cure" for AIDS highlights the misinformation that surrounds the disease in many countries. In Africa, many aren't aware that condoms protect against HIV infection. Even if they are told, they also face anti-condom messages: Condoms are a conspiracy by whites to lower African birthrates; condoms are tainted with HIV to decrease the African population. On top of it all, traditional healers, tribal leaders, and the Catholic Church warn against using condoms. What is one to believe?
The meeting of the world's eight most powerful industrialized nations (if you don't count China) has come to an end, and the global development community isn't too happy about the outcome. At issue is the G8's pledge to give $60 billion to fight HIV/AIDS and other heath crises. It appears to be little more than Enron-style accounting.
At least half of the $60 billion figure, for instance, comes from the $30 billion U.S. President George W. Bush had already pledged last week to combat AIDS over the next five years. And, unlike the Bush administration, the G8 isn't specifying a time period during which it will deliver the aid. The development advocacy organization Oxfam had this to say:
The headlines sound impressive but ultimately mean precious little. Instead of delivering what they promised the G8 has tried to get the biggest possible headline number out of the smallest possible aid increase.... Oxfam's calculations, based on the assumption that the money will be delivered over 5 years, show that by 2010 overall aid will only have increased by $23bn."
That's well shy of the $50 billion the G8 had pledged in Gleneagles, Scotland, way back in 2005.
Democracy has proven tough enough for many African nations—poor, riddled with corruption, and bereft of functioning institutions as they are—to achieve. Now we can add one more inhibiting factor to the list: HIV/AIDS. Not only does AIDS leave voter rolls bloated with the names of people who have died, a recent study of six southern African countries found, but the disease robs political parties of their most able campaigners and deprives constituencies of their MPs. A BBC article summarizing the study reports:
In Zambia for example, in the first 20 years from 1964 to 1984 only 6% of by-elections were held as a result of death. But in the next 10 years, 60% of by-elections were because MPs had died. In Malawi, the speaker admitted that 28 deaths of MPs were Aids related.
The study, which was conducted by the Institute for Democracy in South Africa, points out that these vacancies sometimes stay open for a year, leaving parts of the population without a voice in government. And the unanticipated economic burden of special by-elections can be just as damaging—one by-election costs Zambia more than US$200,000—since the resources need to be reallocated from other parts of the national budget. Moreover, it's hard to mobilize apathetic voters during by-elections, so smaller parties with fewer resources end up losing out to the ruling party.
Most disturbingly, though, the study finds that the stigma attached to AIDS makes it extraordinarily difficult to get good data from political elites. How can you fix a problem if you can't measure it? Reporting these figures and calculating these costs is a vital first step towards greater openness and public disclosure about the disease. If African democracy is to avoid becoming the next victim of the AIDS pandemic, the conspiracy of silence among the continent's leaders will have to end.
Intravenous drug use represents the single largest cause of HIV transmission in China, accounting for 44.3 percent of infections. But people infected with HIV through sexual transmission are the fastest growing group. Sexual transmission accounts for 43.6 percent of total HIV/AIDS cases, but almost half the new infections. Discussing both of these causes of HIV/AIDS has traditionally been taboo in China. However, the government has quietly embarked up on a series of efforts designed to tackle the disease. A recent report published by The Lancet tracks just how far China's efforts have come. Some notable achievements:
In addition, Chinese President Hu Jintao and Premier Wen Jiabao have made special efforts to be seen publicly shaking hands and meeting with AIDS patients, helping to reduce the stigma and misinformation surrounding AIDS in China. Recently, too, the Chinese government finally allowed activist Gao Yaojie to visit the United States to accept an award for her role in exposing China’s AIDS epidemic after denying her request repeatedly before. Of course, in a country where there are still 650,000 people living with HIV/AIDS, there’s still a long way to go. The upside, though, is that there's now a better trajectory than the 10 million cases predicted for 2010 by the United Nations just a couple of years ago.
Papua New Guinea, a small group of islands east of Indonesia, is home to some of the most isolated communities on the planet. Its dense jungles and impassable mountains, however, have not been able to shield its people from one of the outside world's worst scourges: HIV. The World Health Organization estimates that as many as 1 million people, more than one-fifth of all Papua New Guineans, may be infected with the AIDS virus by 2015.
The epidemic is already exacerbating the inevitable clashes between traditional and modern in the tiny country. AIDS deaths are often attributed to witchcraft and followed by brutal retribution against those deemed responsible (usually women). The government is trying to devise a comprehensive approach to the disease, but it will have to contend with deep-grained beliefs, like this matter-of-fact justification by a farmer who killed his neighbors:
We ran after them and we chopped their heads off with an axe and a bush knife. I felt sorry for them but they were witches, they deserved to die. If they were still alive they could hurt people with their magic.
For at least the third time, the Chinese government has blocked Gao Yaojie—a Chinese doctor who has played a critical role in drawing attention to China's HIV/AIDS crisis—from leaving the country to accept an award from Vital Voices, a U.S.-based advocacy group supported by Hillary Clinton. Gao was prevented by police from leaving her house, causing her to miss her flight to Beijing (where she was planning to apply for her visa).
Gao Yaojie was one of the first people to expose the "blood scandal" in Henan province, in which local authorities knowingly allowed blood contaminated with HIV to spread throughout Henan's blood supply, which has created around 100,000 orphans. In the 1990s, local officials set up clinics and began paying peasants $5 for blood donations to meet the massive shortage of blood in local hospitals. But because donors were suffering from anemia from giving away too much blood, the collectors switched to taking only plasma, then pooling the blood of different types together, and re-injecting the remaining blood into the donors—a sure-fire way to spread diseases quickly.
Authorities have tried to cover up the scandal by arresting AIDS activists, closing down orphanages, and trying desperately to prevent the media from getting wind of it. Thanks to people like Gao, though, they haven't succeeded entirely.
(Hat tip: China Shakes the World by James Kynge)
It's already been another tough week for Pfizer, the world's largest drug company. In the face of expiring drug patents that could cost the company $14 billion in revenues this year, CEO Jeffrey Kindler announced today that 10,000 jobs would be cut across several countries including the United States, France, Germany and Japan. In addition to these problems, AIDS Healthcare Foundation, the leading American AIDS group in the United States, is suing Pfizer:
Pfizer's direct to consumer marketing of Viagra as a drug to enhance sexual performance is primarily aimed at men who don’t necessarily suffer from a clinical diagnosis of erectile dysfunction, and we believe it is not only irresponsible, but also illegal, especially in light of the drug’s known use as part of a 'circuit party cocktail' of drugs that is fueling the spread of STDs and HIV," said Michael Weinstein, President of AIDS Healthcare Foundation.
Then there's the failure of Torcetrapib, a drug developed by Pfizer to treat heart disease that was ultimately abandoned in December due to fundamental safety issues. In the same month, Pfizer saw its debt rating downgraded—making the company the last major drug producer to lose its (Moody's) AAA rating. The expiring patents are yet another blow to add to the list of troubles faced not only by Pfizer, but by other large pharmaceutical firms as well. It will be interesting to see how these companies will fare as more patents run their course and the competition from generic drug makers—particularly in developing countries—intensifies.
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