The Invisible Cure Part 2 Friday, May 9 2008

The second section of The Invisible Cure tells the story of South Africa and the fight against HIV there. South Africa is very distinct in the epidemic because of their president’s unique views on HIV/AIDS. Thabo Mbeki, has alienated many in the HIV/AIDS community by aligning himself with AIDS dissidents.

Thabo Mbeki was the heir apparent of post apartheid South Africa, the golden child after Mandela, who is often seen as a saint. But now, many people see him as a detriment to his people. His views on HIV/AIDS are very controversial.I told my boyfriend, who happens to be Ghanaian, that I was writing about Thabo Mbeki in my blog. he said defensively, “Why?! I hope you haven’t misunderstood him.”

What is there to misunderstand! I yelped. Thabo Mbeki exacerbated the HIV/AIDS crisis in South Africa by claiming that HIV did not cause AIDS, and in 1999 began what I see as an illicit rapport with a group of scientists called “AIDS dissidents.” AIDS dissidents believe that AIDS is caused by vitamin deficiencies, poverty, even pollution, but not Sex. Most people, scientists included, do not find their theories convincing. Thabo Mbeki is the only head of state to have taken the claims seriously. Epstein calls this a public health disaster, and I have to agree. Mbeki’s interest in these alternative views has obstructed the public health community from being able to prevent HIV, and this resulted in the unnecessary deaths of many South Africans. By claiming that HIV is not the cause of AIDS, Mbeki has taken the right to prevent the disease out of the hands of the people. In my opinion, that is not only unethical and reprehensible, but also a little crazy in the face of all the HIV/AIDS research claiming that unprotected sex can transmit HIV.

My Ghanaian friend defended Mbeki, saying that the freedom fighter in Mbeki leads him to combat poverty first in any debate. He sees economic freedom as the best way to address problems because he is a Marxist. Besides that, he added, AIDS prevalence is lower for those who are economically stable. HIV is a virus that lowers your immune system response, and Mbeki is just saying that there is not enough information to determine whether what we call AIDS defining illnesses are brought on by AIDS. They could be caused by something else.

He says this very calmly, and I am speechless for a second. I am trying to balance my indignation and graduate school self-righteousness with respect for his ideas and where he is coming from. Then, I remembered Epstein’s revelation that Mbeki and his minister of health practically had a war on antiretroviral drugs in South Africa. Antiretroviral like AZT drugs save lives. In fact, AZT is the reason why HIV positive mothers have a 98% chance of giving birth to an HIV-negative baby. The cost of preventing HIV in the womb is cheaper than out, but the public funds to buy the generic brands were canceled. Eventually Mbeki would tell parliament that the drugs made people sick, something he had learned from AIDS dissidents.

Well, desperate times call for desperate measures, and the desperation of HIV-positive people in South Africa led many to participate in at least one disastrous clinical trial in which 5 out of 500 people died at Kalafong hospital. Epstein never finds the answers to what happened there, and ends the chapter on a sickening note: Right before the 2004 election, the Ministry of Health started to offer antiretroviral drugs to all AIDS infected South Africans.

Yes, I was sickened when I read that. It seems sometimes that power rests in the hands of the corrupt and the disillusioned who revel in the power at the expense of ordinary folks. But the policy change was brought on not only by an upcoming election, but an organization not afraid to stand up to those in charge. The Treatment Action Coalition demonstrated that mobilization can be a formidable power when they organized and successfully sued the government of South Africa over its refusal to give antiretroviral drugs in maternity clinics. These kinds of successes are pertinent to me as a future program designer and manager because it shows that leadership doesn’t always have to come from the top down. There are effective ways to implement policies that are helpful and not harmful, and the best ones involve facilitating approaches from groups (like TAC) that are already doing positive work.

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The Invisible Cure Part 3 Friday, May 9 2008

Humanitarians across the world are trying their best to solve the HIV puzzle, but their methods have not had success. Humanitarian aid is failing! Epstein uses an anecdote about the “disappearance” of 54 MILLION dollars to make it clear:

Foreign Aid Is An ATM

The Global Fund gave the money to the country of Uganda as part of an HIV “package” that included HIV treatment, condoms, and counseling and testing. However, an auditing firm determined that no one knew where the money was! Similar scandals erupted in Kenya and Nigeria. In Zambia, a permanent secretary of health diverted funds to buy a “cure” for HIV from a businessman in Bulgaria. As a result of widespread corruption, not only have vast amounts of money been squandered, but a sense of good will has been demeaned. Epstein implies that the repercussions are dire for the image of Africans in general, but more importantly, that when the money is there, it isn’t achieving its goals. She writes,

As AIDS spending skyrocketed between 2000 and 2005, the HIV rate did not decline at all…

WHY isn’t the money helping? It’s true that HIV/AIDS funding is needed, and the package isn’t a bad idea! In the book, a young man thanks Epstein when he finds out she’s American because he is taking antiretroviral drugs paid for by PEPFAR. In other words, treatment for those infected is expensive and greatly appreciated. But something is going wrong. Many of the Ugandans worry that the HIV/AIDS money has helped to encourage what they call a “Pajero” culture, referencing the many big white SUVs that have appeared along with the NGOs. This culture represents how HIV/AIDS has become an industry for those in need of careers instead of a horrible disease. This is very clear to me as a student in the school of public health. Many of the students are focused on how they can help build capacity of local networks in Africa to stop the spread of HIV, and some are looking for paid travel experiences that are legitimized as humanitarian work.

However, Epstein believes that the disturbing trend of corruption in Africa is due to “many factors,” and neither the aid industry nor Africans should be blamed. She suggests that people have “grown indifferent” to the spread of AIDS, and that the money has created a “crisis of modernity” in which Africans struggle to transition to a modern bureaucratic state. Though they are transitioning, they still participate in the tribal kinship links that have always comprised their community networks. The kinship networks allow people to rely on each other, and oblige those who have money to help those without. When aid organizations like the Global Fund give money to officials in charge of HIV organizations, they may be contributing to the bureaucratization of the epidemic, thereby losing the human side of the disease. The campaigns that have decreased the incidence and prevalence of HIV were campaigns that counted on a lot of solidarity, support and empathy. The loss of humanity combined with those extensive kinship networks may have encouraged politicians, leaders, programmers, and ministers to use the funds for themselves and their personal friends. I think William Easterly says it best when he writes in White Man’s Burden that the programs create “perverse incentives” that “electrify the power grid” of those kinship links.

It is hard not to place blame on someone, though. I would rather like to blame poorly designed foreign aid programs and the officials that have not found a way to help their families by using their own money. Some believe that the answer lies in seeing the poorest people in the world as marketable; they believe in the private sector as a development actor. The private sector’s role would include encouraging entrepreneurship which would allow people to take care of themselves instead of relying on aid. I think this is a good idea for development, (micro credit is not a panacea,)but it hasn’t done much good yet. Yes, it’s empowering for people to control their means of production. Yes, women are better off when they don’t have to engage in risky behaviors to “keep a man” who will support them. But what I believe is truly needed is an approach that builds on positive networks already established that people trust. There should be participation on the part of the host country nationals at all stages of any program that is started: needs assessments, implementation, monitoring, and evaluation. Most importantly, any approach in the fight against AIDS needs to be something that the people themselves can relate to, (such as ABC in Uganda,) with options for reduction of risk all types of behaviors. People need to see, hear, and feel the message from the government, television, their doctor, the private sector, the state, and NGOs. This is not a battle that can be fought by the ATM alone.

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