Bush praise for Uganda AIDS policy raises interesting Qs

heheheheh ... I hate to be the one to shut up a topic.

Maybe I should have gone on about Bush's double standard, instead. But I don't know if he has one, actually. Just assuming it's there.

stasia

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OK ... these are just some little thoughts I had ... I'm developing my problem-solving skills, and this one's interesting. (I mean this problem .... )

Another thing to look at with regard to the AIDS problem in Africa is birthrates. This has to do with what NIMH said about gangs of Russian orphans and the jobs they took after they grew up. Because AIDS is so prevalent and birthrates are so high, there are going to be tons of children growing up without parents. They'll grow up with a certain type of survivor's personality, growing up in a world with neither the time nor the means to provide them with a basic sense of security. These are the future leaders of Africa, inevitably - because they'll be MIGHTY people, and that kind of power thrives in lands torn by war and poverty. It's really a vicious cycle - and I don't see anyone doing anything about it in the near future.

What can the world do to deal with this kind of thing? I think it really is a world problem - it's too big for us to ignore in this age of technology and mass transportation. The world is too small. If my neighbor's pool was a breeding ground for malaria-bearing mosquitoes, I'd think something needed to be done about it. I ask myself what I would do if my neighbor was a bedridden quadraplegic with no money to pay an exterminator. Maybe we should look at Africa that way.

I dunno.

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I was sure SOMEbody on this thread mentioned the role of truckers ...

Can't find back who it was, but I was reminded of the mention when I read the chapter on Thailand in the book I'm reading now, Robert Kaplan's The Ends of the Earth. Apparently, truckers can and do play a role of immense impact in the rapid spread of AIDS.

Which also happens to underline, again, how the reasons why AIDS has spread so very quickly in developing countries are strongly related to the initial impact of modernisation there. Rather than to any remaining 'primitive tribalness' of the area in question or anything of that sort, that is.

The quotes (this was in 1994 - emphases mine):

Quote:

"The prevalence of AIDS and HIV-positive cases is a trend that can change almost overnight. [..] In mid-1988, 0 percent of the low-fee prostitutes in Chiang Mai [a city in Northwestern Thailand] were HIV-positive. In mid-1989, 44 percent were. All it takes is a few new people in the area to change the picture. [..]"

[..] Bennett provides this frightening anecdote: "Samastipur in the northeastern state of Bihar is a junction point for the Nepal-India-Bangladesh trade route, connecting Kathmandu with Calcutta and Dacca. Around 1,400 truckers pass through each day. The sex workers there are mainly illiterate and have no familiarity with condoms. Because a clinic in Calcutta has found that at least 8 percent of these truckers are HIV-positive, we calculate that 36 percent of the prostitutes at Bihar truck stops are. Most HIV in the world is spread by land travel, by good roads. It is a disease of modernization that may slowly bring us to our knees."

Quote:

Smooth-paved roads, like those in Thailand, shrink distances and foster national unity and public order, as well as increase the flow of human vectors for sexually transmitted diseases. (Perhaps all that holds the Ivory Coast together is its modern road network, which also accounts for its high incidence of AIDS).

"Truckers are the sailors of today, with a girl in every port," says an AIDS counsellor in South Africa in an IPS report. And trekking as they do from country to country, they make national approaches to the disease harder, while at the same time introducing the illness to ever new communities.

Quote:

It is now widely recognized that there is a strong relationship between population movements and the spread of HIV/AIDS in West Africa. This phenomenon typically involves men - particularly seasonal workers and long-haul truck drivers - who travel long distances, often across borders, as part of their work or in search for better opportunities. These men usually "move" without bringing their spouses and, hence, find themselves exposed to multiple encounters with sexual partners. Upon return to their home communities, those infected [..] are very likely to spread the AIDS virus, albeit unknowingly, among their spouses [..].

(Research report).

But on the bottom line, these truckers are just faster-moving appearances of the wider phenomenon of migrant workers in newly modernized Africa. Just like Kaplan noted, in Thailand, how "Migrant laborers come from all over the surrounding provinces to work in Nong Khai [..] So many people are migrating - from Nong Khai to Bangkok, from farming villages to Nong Khai", thus in Africa villagers, driven by hunger & hope, trek to towns, and people in towns to the big cities - whether for good, or to work there for a few months and then return. Sub-Saharan Africa's urbanization rates in the 1980s were among the world's highest.

Considering how these migrant workers find shelter in their new (temporary) home towns, these are ideal conditions for (sexual) disease to spread. Take the miners in South Africa:

Quote:

Workers under contract with mining companies who live most of the year in single-sex compounds without their families remain prone to sexually-transmitted diseases [..] "mine workers in South Africa [..] come from every nation in Southern Africa. These men are away from their homes for eleven months of the year. They have sex with professional women who hang around workers hostels. These liaisons lead to infections."

(from same IPS report).

It seems that AIDS happened to hit Africa at the most vulnerable time of its development. Namely exactly at that point in time, where modernisation (urbanisation) has already succeeded in causing large-scale social and physical dislocation, but where it has not resulted in the increased prosperity that then settles people down again.

Kinda comparable to the period of the Industrial Revolution in the West, perhaps, when the booming cities attracted masses of villagers, who initially however, merely formed a volatile proletariat in city slums - away from the village traditions, and not yet integrated in new social structures. And dirt-poor.

The drastic unevenness of economic development in Africa (and the developing world in general) means that everywhere, there are now both enough starving women and enough men with money to spend to keep the cycle going - and those men would also be the ones most likely to have travelled (and thus transmitted the disease). "Every starving girl knows she can get a meal in exchange for sex with a trucker". (Even The Trucker writes about it Wink

.

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(Just wanted to tell Anastasia that I read and appreciated her posts... still pondering them.)

Interesting info about truckers. Makes sense.

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[deleted, double post]

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sozobe wrote:

(Just wanted to tell Anastasia that I read and appreciated her posts... still pondering them.)

I liked them, too!

sozobe wrote:

Interesting info about truckers. Makes sense.

It's one more element in the equation ... Somebody was trying to tell me again, a few days ago, in something of an initial knee-jerk reaction, how the high AIDS rates in Africa had to do with how they just have sex with everyone there - because its in their nature / respectively, because they hadnt learned to restrain themselves yet like in the West. I'm really trying to get away from that kind of "culture" or "civilization" angle (in that sense I'm still arguing with steissd), because I dont think its a valid point in explaining the spread of AIDS (hey, try telling the Muslims of Nigeria about 'Western restraint' in sex Wink

- in fact, from that modernisation angle I gather that the disease could spread so quickly because of how much they already are like us.

"Development" seems a lot better a key than "culture" - economic development, social development. Both in terms of how modernising developments that already took place actually accelerated the disease, and in terms of what developments are still missing - less poverty would help, obviously, but also, connected to that - and on that score one can make a valid point about lessons that have already been learnt in the West, it's true - on women's rights, education, empowerment, control over their own lives.

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Interesting article in the NYT about the (flagging) global struggle against AIDS.

"[S]hortages of money and battles over patents have kept antiretroviral drugs from reaching more than 90 percent of the poor people who need them", says the article, pointing out that donations the WHO's Global Fund to Fight AIDS, Tuberculosis and Malaria amount only to 20% of what is needed.

There's a couple of references to Bush's much-discussed global AIDS policies, too. The first one is blatantly unfair:

Quote:

While Mr. Bush promised in his 2003 State of the Union address to spend $15 billion over five years on AIDS in Africa and the Caribbean, his budget requests have fallen far short of that goal. For the most recent donation to the Global Fund, he requested only $200 million, although Congress authorized $550 million.

This is unfair in that the suggestion is made that, while Bush promised $15 billion over five years (or roughly $3 billion a year), he actually only requested $200 million - period. Unfair because yes, Bush only requested $200 million for the Global Fund, but another 1.8 billion $ for other funds against AIDS abroad - according to this otherwise critical report, anyway. (See also this post).

Basically, Bush seems to have chosen to bypass the WHO's fund (what, with it being a UN program and all). This is widely considered unwise, as it undermines the effectiveness of the global campaign against AIDS, but still no reason to make Bush's $2 billion overall program look like a mere $0,2 billion one. $2 billion is little enough as it is, both in terms of what is needed and in ratio to the promised 5-year sum.

Anyway. The article then, however, comes with much more specific complaints that do indeed place an aspect of the President's policies in a very negative light:

Quote:

At the same time, few people in poor countries have been able to get lower-priced generic antiretroviral drugs. While the generic drugs have been approved by the W.H.O., endorsed by the World Bank and used in several African countries, the Bush administration has so far paid only for medicines that are still under patent and cost much more.

For example, Daniel Berman, co-director of the Doctors Without Borders campaign for low-cost drugs, said that in Zimbabwe his organization planned to treat 1,000 patients with drugs from two approved Indian generic makers, Cipla Ltd. and Ranbaxy Laboratories Ltd.

Both companies combine three antiretrovirals so that a day's dose is just two pills and the cost is $244 to $292 per patient per year. Meanwhile, Mr. Berman said, the Centers for Disease Control in Atlanta plans to pay for the treatment of 1,000 Zimbabweans, buying the same three drugs separately from GlaxoSmithKline, Bristol-Myers Squibb and Boehringer-Ingelheim. The best prices available in Africa from those companies, he said, add up to $562 a year, and a daily dose is six pills.

Advocates of cheap drugs say the Bush administration has yielded to pressure from the pharmaceutical lobby to find ways to reject the generics.

On Friday, Senators Edward M. Kennedy, Democrat of Massachusetts, and John McCain, Republican of Arizona, wrote a joint letter to the White House urging it to accept W.H.O.-approved generics.

In a separate letter, Representative Henry A. Waxman, Democrat of California, accused the administration of trying to set standards for Indian generics higher than those for American ones.

A spokesman for Randall L. Tobias, the administration's AIDS coordinator, said any suggestion that he was snubbing generics was "utter nonsense."

"We will buy whatever drug is safe and effective at the lowest possible price," said the spokesman, Dr. Mark R. Dybul. "We don't care if it's made by Cipla or Ranbaxy, in South Africa or Brazil or Nigeria."

Mr. Tobias has scheduled a meeting in Botswana for Monday to ascertain whether the W.H.O.'s approval process is rigorous enough.

Dr. Lembit Rago, who leads the W.H.O. assessments, said he used "absolutely the same principles" as the Food and Drug Administration, and borrowed his inspectors from regulatory agencies in Canada, France, Germany, Sweden and Switzerland. As soon as his office approved the Indian pills, he said, "a very cold wind began to blow from the U.S."

"It is no secret that Pharma is lobbying against us in a big way," he said. [..]

Malaysia is the only country to exercise a "compulsory license" right under trade treaties to ignore a patent and import generics, said James P. Love, director of the Consumer Project on Technology, a group that is pushing for cheaper drugs. Uganda, Mozambique and Zambia may soon do the same, he said, but China backed away from doing so for fear of American trade retaliation. "They're using older drugs that are already off patent in China," he said.

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Quote:

Bush Backs Condom Use to Prevent Spread of AIDS

PHILADELPHIA, June 23 - President Bush said on Wednesday for the first time that the United States should "learn from the experience" of countries like Uganda in fighting AIDS and embraced the use of condoms to prevent its spread, a sensitive issue among conservative groups that have fought the adoption of any strategy that does not focus on abstinence.

Read on ...

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Good for Bush. Its only sensible.

Now, will the Condom Lobby prove sensible, and see that Abstinence Education can be a good idea, taught together with protection. For older kids, abstinence is probably laughable--but sex education starts in middle school. These kids could use some straight talk about waiting.

Prevention AND protection. These kids need to be empowered with information and statistics and coping techniques for choosing not to have sex, until they feel comfortable about it.

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Actually, looking closer at the Kaiser Foundation's study, it appears abstinence played a central role in Uganda's success. Delay of onset of sexual activity, and avoidance of casual sex... "zero grazing"... A great success!
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Global Challenges | HIV Prevalence in Uganda Drops 70% Since Early 1990s Because of Public HIV/AIDS Prevention Campaign, Study Says
[Apr 30, 2004]
HIV prevalence in Uganda has dropped 70% since the early 1990s primarily because of a "successful" public HIV/AIDS prevention campaign that encourages avoiding "casual" sexual activity, according to a study published in the April 30 issue of the journal Science, BBC News reports (BBC News, 4/30). Drs. Rand Stoneburner and Daniel Low-Beer of University of Cambridge in the United Kingdom analyzed population-level HIV and behavioral data from Uganda and neighboring countries -- including Kenya, Malawi and Zambia -- to assess the validity and determinants of declines in HIV prevalence and examine the potential influences of prevention interventions. The researchers found that "important" behavioral changes occurred among the Ugandan population between 1989 and 1995, including an increase in the age of first sexual intercourse, a decrease in indicators of casual or nonregular sexual partners and an increase in condom use with both casual and regular sexual partners, according to the study. In addition, an "important and perhaps overlooked" measure of behavior change during this time was a 60% reduction in the number of people in both rural and urban areas who reported casual sexual relationships over the previous year, according to the study. The study suggests that a reduction in the number of sexual partners in the general population and a delay in onset of sexual activity among unmarried youth, especially in urban areas and among males, are the "relevant factors in reducing HIV incidence" (Stoneburner/Low-Beer, Science, 4/30). Although condom use in neighboring countries was just as common as in Uganda, condom use may not be sufficient to cut HIV incidence without a reduction in casual sex as well, according to the study, Reuters Health reports (Reuters Health, 4/29). Stoneburner and Low-Beer also suggest that communication about HIV/AIDS through social networks and personal contact with HIV-positive people or people who have died of AIDS-related causes also helped to lower HIV prevalence in Uganda.

Shift in 'Strategic Thinking'
The Ugandan government's national HIV/AIDS prevention campaign "clearly communicated the reality of the AIDS epidemic in terms of a rational fear of the risks of casual sex, which drew on and mobilized indigenous responses at the community level," according to the researchers. The government's messages that AIDS, which is also known as "slim" in Uganda, is fatal and that individuals should practice "zero grazing," or monogamy, were clearly communicated, and condoms were a "minor" component of the original strategy, according to Stoneburner and Low-Beer. The researchers say that the "substantial" reductions in Uganda's HIV prevalence -- which are equivalent to results that might be seen with a "highly effective," although as of yet undeveloped, vaccine -- "resulted from public health interventions that triggered a social process of risk avoidance manifested by radical changes in sexual behaviors." According to the researchers, the behavioral changes resulting from Uganda's prevention messages may not transfer with the same success or be appropriate for other countries. However, in order to successfully replicate the lessons learned from the Uganda model, Stoneburner and Low-Beer conclude that "a shift in strategic thinking on health policy and HIV/AIDS, with greater attention to epidemiological intelligence and communications to mobilize risk avoidance," is needed (Science, 4/30).

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Bush praise for Uganda AIDS policy raises interesting Qs

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