African Women Confront Bush’s AIDS Policy

Yifat Susskind of Foreign Policy in Focus writes:

...[G]rowing numbers of people around the world know that sub-Saharan Africa is the epicenter of the AIDS pandemic: three-quarters of AIDS deaths worldwide have been in Africa, and today the continent is home to nearly two-thirds of all of those who are HIV-positive (more than 25 million people). Fewer people know that most Africans living with HIV/AIDS are women, and that young women are now being infected at a rate three to four times higher than young men. For many, this information is absorbed through a mesh of stereotypes that make human misery
seem like a natural condition of life in Africa .

But while AIDS—like the litany of this year's natural disasters—may have originated in nature, the magnitude of its destruction is a man-made catastrophe. Consider the following:

• Since the 1980s when AIDS first emerged, the United States has demanded “economic austerity measures” in impoverished countries. In Africa , these policies cut national health budgets in half just when public health systems needed to be ramped up to combat AIDS. Today, the pandemic is the single
  greatest obstacle to economic development in Africa .
• To bolster already-huge profits of U.S. pharmaceutical companies, the Bush administration has blocked the sale of affordable generic drugs that have saved millions of lives in rich countries.
• Women are made particularly vulnerable to HIV infection because they are denied the rights to refuse sex or insist on condom use. As the majority of those living in poverty and the poorest of the poor, women are more likely to contract HIV and more likely to develop symptoms of AIDS soon after they are infected.

AIDS, unjust economic policies, and women's inequality are mutually reinforcing crises; combating any one of these requires addressing them together. But too often, public health programs, government policies, and even activists compartmentalize issues, missing critical points of inter-connection that are keys to effecting change.

AIDS in DC

The press coverage yesterday was depressingly scarce. 18 years of World AIDS Days and I guess everyone just doesn't care anymore.

Today the Washington Post's Darragh Johnson talked about the Whitman Walker clinic's mobile testing unit that was out on the streets yesterday. Despite the fact that:

Washington's rate of infection is alarmingly high -- at Whitman-Walker's clinic in Southeast the positive test rate is 6 percent -- and it's not going down. In 2001, in cities with more than a half-million residents, the relative numbers of Washingtonians infected with AIDS outpaced the country's other big cities, according to a thick report on "HIV/AIDS in the Nation's Capital," released in August by D.C. Appleseed Center for Law and Justice, a public interest organization.

So. To recap. Each of the numbers below represents the number of AIDS cases per 100,000 residents in 2001:

Washington -- 119

Baltimore -- 117

San Francisco -- 67

New York -- 64

Philadelphia -- 58

In 2003, two years later, D.C.'s number had jumped to 170.

(Johnson [2005] "In a City With A Big Problem, Trying to
Turn A Corner on AIDS" The Washington Post 2Dec05 )

Noone wants to get tested. The mobile testing unit spent the day hanging out and encouraging people to come and find out their status, but to little effect.

*

Some good news: Yesterday the Guardian reported:

Europe, led by the UK, last night signalled a major split with the United States over curbing the Aids pandemic in a statement that tacitly urged African governments not to heed the abstinence-focused agenda of the Bush administration.

(Bosely [2005] "Europeans reject abstinence message
in split with US on Aids " The Guardian 1Dec05)

One of the many canals in Amsterdam, taken by the lovely Maz (while I stayed in and wrote my paper!)

Patti Smith & other Adventures in Amsterdam

On Thursday I arrived in Amsterdam... and wow. This just really seems to be the city of the future. It's kind of hard to believe that the Dutch have got it so right... I mean, what on earth are we doing in the rest of the world? Granted, I've only been here a few days, but the overall impression is one of serenity and efficiency. Public transportation is great, police presence verging on nill, and despite what you would think, no public 'scenes' so endemic of US/UK societies on a weekend.

Maz and I have had a wonderful time relaxing and catching up the past few days. On Saturday we went to see Patti Smith at Paradiso which is a converted church and must be the coolest place to see a gig ever. I've never really listened to Patti much, but she was incredible live. Despite being a living legend, she has to be the most unaffected musician ever (and yeah, I'm including all the musicians I know that aren't anywhere close to being a legend!).

The hostel is a bit dull, but clean and warm (and at 27 I think maybe that should be my main criteria for hostelling). The red light district was a strange sight, the city goes from picturesque to ummmm pornographic in a few steps. But crime seems to be a lot lower and we did find our fave hang out spot of the weekend slap bang in the middle (just in case you're concerned, I am leaving with far less money than I arrived with!).

I don't think I've ever had such a great weekend :)

Morality and AIDS

It has been far too long since I last posted... somehow every day life never seems to compare to the urgency and immediacy of travelling. I always find I am thinking much more deeply about things and write far more in a new environment than I do at 'home' - wherever that may be at the time.

I just had an email asking me if I didn't think 'moral issues' were at the root of the AIDS epidemic in Africa. No - I don't. I think the root cause of AIDS is a particularly clever 'germ' that has learned to spread through sex (or human reproduction) something we humans are highly embarrassed about and something we will continue to do, furtively and otherwise, until we are extinct. I'm not a biologist and can't document the way the virus has evolved and spreads biologically, but would recommend reading Guns, Germs and Steel to see how germs develop and AIDS in the 21st Century for more on the biological transmission of the virus.

I can tell you that women are much more vulnerable to infection (both biologically and socio-economically) and that poverty is a major factor in the spread of HIV/AIDS. Conditions of poverty lead to poor nutrition, higher exposure to disease and suppressed immune responses. A compromised immune system is much less able to resist the attack of the HIV virus. Poverty also decreases options. Faced with the choice between starvation and possible illness later, most people concentrate on short-term survival. This pushes millions of women around the world into sex work, and millions more into dependent relationships.

The reason why Africa, as opposed to say the US, is the most heavily affected region is due to many, many reasons, but not 'morals.' Probably the two most important are the level of extreme poverty (in sub-Saharan Africa, 83% of children are severely deprived of at least one basic human need: food, safe drinking water, sanitation, health care, education, shelter) and that health care is minimal and treatment rare. Sub-Saharan Africa has the highest percentage of untreated STI's: it has been proven that untreated STI's increase transmission risk. HIV is far more likely to be transmitted just after infection and in the final stages of the disease (when viral loads are high), treatment reduces viral loads and thereby decreases new infections. Treatment also acts as a deterrant by reducing stigma and encouraging testing; those who have an incentive to protect themselves if HIV-negative and the knowledge to protect others if HIV-positive.

"As so many of our patients have noted, what is the motivation for learning one’s serostatus [HIV status] when there is no possibility of being treated for opportunistic infections or of access to prevention of mother-to-child transmission during pregnancy, much less of being treated with antiretrovirals when needed?"
(Castro and Farmer (2005) “Understanding and Addressing AIDS-Related Stigma: from Anthropological Theory to Clinical Practice in Haiti” American Journal of Public Health Vol. 95, No.1 pp.53-59)

It is noteworthy that the most common AIDS-related assistance to heavily burdened countries has consisted of education about the disease and condom distribution to prevent HIV transmission. Many of those at greatest risk know that HIV is a sexually transmitted disease and that condoms can prevent transmission.

Their risk stems less from ignorance and more from the precarious situations in which hundreds of millions live; gender inequality adds a special burden, and is the main reason that, globally, HIV incidence is now higher among women than among men.
(Farmer et al., (2001) “Community Based Approaches to HIV Treatment in Resource-Poor Settings” The Lancet Vol. 358 pp.404-409)

The prevention strategies currently used will not stop HIV incidence or AIDS deaths among the poorest populations, especially among poor women. It is time to focus attention on treating the millions already affected, both as a moral necessity and a wise investment in the future. Treatment, both antiretroviral and for opportunistic infections, must become integrated in the fight to combat HIV/AIDS in all countries and in all communities.

Maasai village

Between safaris in the Serengeti and Ngorongoro Crater, we stopped at a Maasai village. We visited a school and the children were really impressive - nursery class counted to 40 (made me realise how little I had taught my class!)

Thoughts, reflections and things left unsaid

I've only been back a few hours but it already feels like my time in Tanzania could have been a dream. I think the most significant lesson I learned is that maybe the most important thing in life is your attitude. It was easy to be narrow minded and not think about the struggles of people around me: to feel frustrated at hustlers trying to sell their wares instead of respect at the persistence with which they try to eke out their minimal existence. On days I allowed myself to feel irritated, everything seemed to build up becoming more and more frustrating and alien. On days I thought more about the position of people around me, I felt humbled and extremely lucky. My trip was a truly amazing experience and one that I was only able to indulge in because of my extremely privileged background.

One of the things I will remember and admire the most about Tanzanians is their kindness and generosity. Travelling by myself in a strange country was perhaps the most daunting thing I’ve ever done, but I met such astonishingly good people my journey was much easier. Everywhere I went along the way I was invited into the homes and lives of people who had to nothing to gain from their kindness. People offered to help me find hotels, meet me in air and ferry ports, take me around town and even to stay in their house when they weren’t there!

I’ve read sooooo many books and studies on Africa, but nothing compares to actually seeing the everyday struggles of people. Being in a village that is only connected to minimal health care facilities through dodgy dirt roads and seeing the huge obstacles people face every day just to get to work things make much more sense. If nothing else, I come away from my stay in Tanzania with the overwhelming sense that infrastructure (roads, buildings, access to clean water) must be improved first and foremost. Children can’t go to school if they have diarreah from unsafe drinking water, the school is too far away for them to travel, or the roads are so dangerous they cause an accident that kills them on the way. Women would have more time to study if they spent less time fetching unsafe water; the more educated a woman is the less likely she is to catch HIV. I keep hearing that throwing money at the problem won’t help, which is true to a certain extent: throwing money at corrupt officials won’t help at all. But cutting off funding when so much needs to be done is not the solution either: development aid needs to be effectively spent so that people have a fighting chance of improving their lives. I’m not sure if my students learned anything during my weeks with them, but they (and everyone else I met) definitely taught me!

scooting round Stonetown

The past three days have been a blur - literally. I've had so much sand and grit in my eyes from zooming around Zanzibar on the back of a scooter that most of the time I haven't been able to see a thing. The first two days I really enjoyed it, but today, 1/2 way into the journey to Nungwi beach at the very tip of Zanzibar, I felt so sore I would have gladly given up the convenience of scooting for the "comfort" of a dalla-dalla. On the way back, I would gladly have paid big bucks for the dalla-dalla comfort, only the fear of offending my host that kept me glued to my rock-hard seat (for those of you that think I'm exaggerating - I have bruises!).

Despite my discomfort, Zanzibar really is paradise. I thought all beaches were pretty much the same, but today I was astonished. The sand was white, the water warm and turquoise, and the waves broke so gently next to the shore it was impossible not to dive in. I've never understood why people are so obsessed with going to the beach, but after Nungwi, I get it. I toured a spice farm early in the day, afterwards we 'sampled' some of the most heavenly fruits I've ever eaten. Starfruit, mangoes, tangerines and many more which I don't remember the names of, but after all the rice and beans I've eaten over the weeks, it seemed a world apart.

I keep seeing signs for WHO, ActionAid, Save the Children, et al's Zanzibar office and thinking what a blessed existence the staff must have to get posted here. It's hard to remember with the seeming abundance that poverty is much more rife than you'd at first believe. One rather sordid measure of this is the plentiful sight of middle aged muzungos cavorting with teenage prostitutes in just about any bar you go to in town.

Nungwi beach

All the way at the top of Zanzibar, Nungwi beach was gorgeous and well worth the harrowing journey.

Mtoni Palace Ruins

This is where the Sultan Said lived briefly. He kept his favourite of the 99 concubines (slaves) here to be used at his pleasure. The ones that fell out of favour would be returned to the auction block and replaced quickly.

Stonetown coast

ICC Arusha

Monday morning I sat in on the one of the courts for International Criminal Tribunal for Rwanda and heard a woman talk about the genocide. She testified that one of her family members had convinced a group of Tutsi's to come out after a week of hiding because peace had been restored. When she and the others came out and registered the men were immediately killed by machete's and clubs. The ones that had any money paid soldiers to shoot them so they would die by gunshot instead. The women and children were rounded up and handed over to armed soldiers who gang raped the women repeatedly. It was heartbreaking to hear her testimony, especially as it was continually interrupted by objections from the defense. The prosecuter asked for a closed courtroom because she was going to name people who would know her identity and it could be dangerous for her as they were out of prison. After strenuous objections from the defense it was eventually granted by the judges and I had to leave.

This morning I went back for a couple of hours before my flight left Arusha. I met Lincoln, a reseacher from NY, who saw the initial cross-examination yesterday after I had left. He told me the defense had really been badgering the witness, especially about inconsistencies in the French and English statements she signed. The witness spoke Kinyarwandan, and couldn't read or write: how she was expected to spot inconsistencies in two languages she didn't speak when she is illiterate is beyond me. Today the defense continued to berate the witness, calling her a liar and at times yelling at her. I know it's their job, but it was very frustrating to watch the defense attorney's treatment of the witness. I felt that most of the questions the lawyers asked the witness were designed to be misleading. My overall impression of watching (admittedly very little of) the trial, was that justice really fails the poor and uneducated.

the Serengeti

When I started planning my time in Tanzania, it never occured to me to go on safari. My goal was to help the children and learn as much as possible about poverty, HIV and just life in general in a developing country. After much encouragement from my mum, and a mass decision from the volunteer group, I left on Thursday morning for the Serengeti. It was a wonderful experience and something I will never forget. We spent two days in the Serengeti and a day at Ngorongoro Crater. The animals were beautiful and it was so nice to see them in the wild. I don't think I will be able to go to the zoo after seeing a lioness play with her cubs a few feet away and a herd of giraffe happily eating together on the Serengeti plain. The safari was an extremely different reality than what I had experienced for a month in Mwanza. Instead of being the only cluster of Muzungos in town, the only Tanzanians we saw were 'servants'. After being used to beans and rice (or ugali) for weeks on end, the buffet table had every Western food you could imagine. Instead of walking or catching dalladallas everywhere we had our own driver. It was quite surreal to for us (the volunteers) to be able to enjoy ourselves to such an extreme extent after witnessing the every day struggles of most people here. It was a fabulous experience, but one that I am extremely glad I had after seeing what Tanzania is really like.

The Serengeti wildebeest migration

Duma (Cheetah and Cub)
Our guide in the Serengeti told us he had been doing safari's since 1978 and never seen a Cheetah in a tree before!