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April 1, 2008

AIDS conspiracy theories

First, a belated word on Barack Obama’s minister, Jeremiah Wright, and AIDS conspiracy theories: The idea that AIDS must have some sinister, human cause has hovered in the shadows of the epidemic since the virus first came to our attention in the early 1980s. Wright’s specific allegation – that the virus was invented by America — can be traced directly to theories that emerged in Africa in the mid-1980s and were spread by Soviet propagandists.

According to Edward Hooper, in his book The River which looks at the origins of AIDS, the theory that the AIDS virus was created by American scientists at Fort Detrick in Maryland as part of bio-warfare program first appeared in 1985 in a Soviet literary weekly. A year later, a 54-page paper making similar claims, by two retired East German scientists, was distributed at a Non-Aligned Movement summit meeting in Harare, Zimbabwe. Over the next year, the allegations were widely reprinted in media across the developing world (or what was then called the Third-World) and contributed to the nearly universal denial on the continent about the growing epidemic.  

Although this may be the most widespread conspiracy theory about the origin of AIDS, there are many others that have endured with disastrous effect. Many black South Africans believed that the virus was invented by Wouter Basson — “Dr. Death” – the head of the apartheid chemical and biological weapons program (hardly a crazy belief when one considers he received money to invent a virus that would sterilize black people, and only black people). And across Africa, condoms have long been viewed suspiciously, either because they were thought to contain worms or even to spread the virus. Hooper’s own book posits that HIV was inadvertently transferred to humans by a tainted polio vaccine — a claim that most scientists say is unlikely.

We now know much more about the genetics and origin of the virus; enough to pretty roundly debunk such theories. We know, for example, that HIV is closely related to two simian immunodeficiency viruses. In the early days of the epidemic, when we still knew very little and when the climate of fear was at its peak, it’s understandable that conspiracy theories found fertile ground. Africans, still struggling to find their way in a post-colonial world, felt they were being unfairly blamed for problem that appeared to first strike America. There’s less excuse today and Rev. Wright should certainly be condemned for perpetuating such beliefs. But as Nicholas Kristof correctly points out in The New York Times, Americans of all colors believe all sorts of strange things. 

In other news, Botswana’s president, Festus Mogae, stepped down today, handing over power to his vice president — and the son of the country’s first president — Seretse Ian Khama (usually known just as Ian Khama). As he steps down, Mogae should be commended for being one of the first African leaders to take AIDS seriously and for marshalling the resources of his country to treat infected people.

 That said, the method of this political transition is worrying. This is not a democratic transfer of power, but a way for Mogae to pick his successor. Khama will face a general election in October 2009, but after more than a year in power his election is almost assured. Although Botswana has successfully changed its leader several times since independence (unlike Zimbabwe), the same party, the Botswana Democratic Party, has controlled the country since 1966.

Many people compare Botswana to neighboring Zimbabwe and say well, at least Botswana is stable and prosperous and cares for its citizens. But Botswana’s democracy is a very thin veneer. Opposition voices (in both government and civil society) are few and divided and power concentrated in a very few hands. Dissent is not really tolerated. I know more journalists who have been kicked out of Botswana — politely, I’ll admit — than almost any other African country.

This has serious implications for the long-term success of its AIDS treatment program as well as for the country’s future stability. I often found, while doing research there for my book, that the authoritarian nature deeply impacted how AIDS was addressed there. In terms of treatment, it led to the creation of an unnecessarily centralized system that is slow to adapt and change. There’s very little debate in Botswana AIDS. And despite the widespread availability of treatment in Botswana, I found the stigma there much worse than almost anywhere else I’d worked in Africa.

March 10, 2008

Update on Adeline

Adeline, who I write about in the first part of No Place Left to Bury the Dead, came to visit me in Athens this weekend. The EU sent her to Brussels for a two-week training session, so I bought her a ticket to come visit me in Athens for the weekend. This was Adeline’s first time outside of Southern Africa and certainly her first trip to Europe. In typical style, she took it all in with great composure, although it must have been overwhelming. Her main comment about Brussels was that it was very cold!

Since I finished the book, Adeline has thrived. She got a job working as a book keeper for the European Union mission in Lesotho and is now on antiretroviral drugs. George gave her an engagement ring and is planning to pay lobola soon. She bought a car. Bongy, her son, is about to turn seven. He growing like a weed now that he’s on ARVs. Adeline’s aunt Tsidi, whose son’s death from AIDS I wrote about, has come to live with her in Maseru. At least now she has a warm house and enough to eat.

It’s wonderful to see that they’re all doing so well. 

February 25, 2008

Nicole on NPR

Listen to an interview with me about my book on NPR’s News and Notes show:

http://www.npr.org/templates/story/story.php?storyId=19168019

January 4, 2008

Profile

Womens Enews, a non-profit news service focusing on womens issues, published this profile of me.

January 1, 2008

AIDS and basic health

In today’s New York Times, AIDS researcher Daniel Halperin adds his voice to those arguing that international aid for health to developing countries should focus more on basic health. As he correctly points out, its makes no sense that some African countries can offer world-class ARV drugs but don’t stock basic medications. He’s right that in many cases there is more money for AIDS programs than can be spent.  I saw this many times in all three of the communities I did research for my book in.

This theme was recently developed more fully in a LA Times investigation (which, I think unfairly, specifically identified the Gates Foundation as being particularly guilty of focusing on AIDS to the exclusion of other diseases). Using Lesotho as an example, Charles Pillar and Doug Smith identified many of the same problems — the poor basic health infrastructure, the AIDS staff brain drain — I witnessed while doing research for my book there. Although they are wrong to blame the health care chaos in Lesotho entirely on AIDS (it began to fall apart before AIDS reared its head) their basic premise is correct: AIDS has to be reintegrated into basic health care systems. AIDS drugs do little good if patients are starving and saving mothers from passing on the virus to their newborns is futile if those babies then die of other preventable diseases.  

December 19, 2007

Zuma on AIDS?

Jacob Zuma has been elected the new leader of the ANC and is now the heir apparent to be South Africa’s new president. But what does this mean for the country’s battle against AIDS? It’s hard to think of someone who could be worse than Thabo Mbeki on this particular issue. At least Zuma acknowledges that HIV does cause AIDS, that people are dying from the epidemic and that something should be done about it. And he’s promised to treat AIDS as a national emergency. But his record, on a personal level, is more than a little worrying. Acquitted of raping an HIV-positive family friend — and AIDS activist — he admitted to having unprotected sex with her but said he was not worried about being infected because he took a shower afterwards. AIDS activists in the country have been, understandably, dismayed by the choice.

Ultimately, however, Zuma will probably be better on AIDS issues than Mbeki. He may not provide the moral leadership South Africa needs at the moment — he certainly won’t tackle the issues of sexual behavior that desperately need to be discussed openly — but at least he won’t stand in the way of other governmental efforts to combat the epidemic.

Of course, the election is still a long way off and anything could happen in the next two years, especially with corruption allegations still hanging over Zuma’s head.

December 1, 2007

World AIDS Day

Today, once again, we take time to recognize the extent of the epidemic with events to commemorate World AIDS Day. The theme this year is leadership — a good one, although I would have picked mother-to-child transmission, an issue that I think is still not getting enough attention.

But the key with leadership is that it has to come from local leaders who have credibility within their own communities. They’re the only ones who have the ability to speak in a way that will really hit home. Particularly, we need more male leaders — big leaders and small leaders — who are willing to talk frankly to other men about sexual behavior that is putting themselves and their loved ones at risk.

Western AIDS efforts have generally avoided talking seriously about sexual behavior – it sounds pretty colonialist for white westerners to come to Africa and tell Africans who they should and should not sleep with. Secular AIDS activists want to talk about condoms and religious ones about abstinence. Most of the women I spoke to while researching this book were very aware that the real issue was faithfulness. They were often pretty blunt about it. But men, even ones you would have thought would be in a position to talk such issues such as priests and ministers, generally wanted to avoid the topic. They preferred to focus on issues like stigma and taking care of orphans. Those are important topics, but they’re not going to slow the spread of the virus.

Speaking of stigma, in his AIDS day statement today, UN Secretary-General Ban Ki-moon says the biggest issue is still stigma. I think the biggest issue is actually FEAR of stigma. With the good intention of trying to combat stigma, we’ve actually made people so afraid of it that people are now unwilling to disclose their status or even get tested. I’m not saying that stigma doesn’t exist and that HIV-positive people haven’t experienced terrible, even deadly, discrimination. But for every negative incident, there are hundreds of mothers who have lovingly nursed their children, friends who have lent their support and strangers who have offered a helping hand. We need to focus on that rather than continuing to scare people about stigma.

Also, many thanks to Annie Lennox who had some kind words to say about my book on her blog. I wish her the best of luck for her AIDS day concert today in Johannesburg. For more information on her new record SING, in support of the Treatment Action Campaign in South Africa go to www.annielennoxsing.com.

November 30, 2007

Events in the New York area

I just wanted to let everyone know that I’ll be appearing at a couple of events in the New York area over the next few days:

* Sunday, Dec. 2, at 12:30 to 2:00 pm: Book signing at a World AIDS Day event at Riverside church, on Claremont Avenue between 120th and 122nd.

* Monday, Dec. 3, at 4:00 pm: Master’s Tea at Saybrook College, Yale University, in New Haven, Connecticut.

* Wednesday, Dec. 5 at 6:30 pm: Book party hosted by Women’s eNews and globalinfo.org. At the Global Information Network, located at 146 W. 29th Street, Suite 7E. Please RSVP at 212 244 3123 or ipsgin@igc.org.

November 29, 2007

New HIV/AIDS Statistics

The revised AIDS statistics recently released by UNAIDS didn’t come as much of a surprise to anyone who has been working on AIDS issues. As better data has come in — based, for example, on household surveys rather surveillance of pregnant women at antenatal clinics — the UN has slowly reduced its estimates of the number of infected people. Most experts believe the numbers will continue to be reduced in coming years as better data comes in.

There’s definately good news in these numbers. UNAIDS has reduced its estimate of the number of HIV-positive people around the world from 39.5 million to around 33.2 million people. Globally, the number of new infections appears to have peaked in the late 1990s — although that just means that there are FEWER people being infected each year. It also appears that the infection rate in large countries like India and Nigeria is not as high as previously estimated. And the UN has confirmed that in most places in the world, except in sub-Saharan Africa, the epidemic is remaining largely confined to specific high-risk groups like men who have sex with men, sex workers (and their customers), and iv drug users.

But the challenges of addressing the epidemic remain huge, especially in Africa. Millions of people are still being infected every year — UNAIDS estimates there were 2.5 million new infections last year, 1.7 million of them in sub-Saharan Africa. Africa is a young continent and there is a generation of young people, like the Mathenjwas who I profiled in my book, who are still at high risk. And too few women have access to programs to reduce mother-to-child transmission — even though such programs are comparatively cheap and easy to administer, especially when compared to the challenges of treating someone with antiretroviral drugs for a lifetime. 

Even if the epidimic is no longer growing as fast as it was a decade ago, for the countries of Southern Africa, the burden of dealing with the number of people already infected remains overwhelming. The report indicates that the number of deaths in Africa is falling due to wider availability of antiretrovirals. But millions still don’t have access to the life-prolonging medication and it will require a sustained commitment from African governments and the international community to make sure that those who have begun to recieve treatment can continue to do so.

November 17, 2007

Welcome!

No Place Left to Bury the Dead: Denial, Despair, and Hope in the African AIDS Pandemic is now available on Amazon and at local booksellers. Many thanks to everyone who has helped make this book a reality, especially Adeline, the Mathenjwa family and Seeletso, who shared their stories with me.

I will be traveling in the United States between Nov. 16 and Dec. 6 and can be reached during that period on my US cell phone at +1 414 737 8782.

Please help me get the word out!

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