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HIV

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AIDS Is Not Over

Four years ago optimism was high that AIDS was in retreat, and could ultimately be eradicated. Back then the Joint United Nations Programme on HIV/AIDS (UNAIDS) was boldly predicting “the end of AIDS by 2030.” Nobody is feeling that optimistic now.

New HIV infections, after dropping steadily for the ten years to 2005, more or less stabilised at 2 million a year in the last decade, and the annual death toll from AIDS has also stabilised, at about 1.5 million a year. But the future looks grimmer than the present.

Two-thirds of all HIV-positive people (24 out of 36 million) are in Africa, and an even higher proportion of the AIDS deaths happen there. If it were not for Africa, the predictions of four years ago would still sound plausible. So what’s wrong with Africa? Two things: it’s poor, and there are “cultural practices” that facilitate the spread of the HIV virus.

The great achievement of the International AIDS Conference that was held in Durban sixteen years ago was to break the grip of the big pharmaceutical companies on the key drugs that were already making HIV-positive status a lifelong nuisance rather than a death sentence in other parts of the world. Unfortunately, the drugs were so expensive that the vast majority of Africans simply could not afford them – so they died instead.

In a diplomatic and media battle that lasted for almost a decade in the late 1990s and early 2000s, African countries managed to shame the big pharmaceutical countries into accepting the importation of much cheaper “generic” versions of the main anti-retroviral drugs, mainly from Brazil, India and Thailand, for use in poor African countries.

The Western drug companies not only dropped their collective lawsuit against the South African government in defence of their patents. Some of them even began providing their own patent drugs to the African market at one-tenth or even one-twentieth of the price they charged elsewhere. A widely used course of treatment that cost $10,000 a year in the US at the time became available to Africans at a price of about $100 a year.

Many HIV-positive Africans could not even afford that amount, but Western governments and private foundations also began providing major funding for anti-HIV programmes in Africa: $8.6 billion in 2014. (80 percent of the money comes from the United States and the United Kingdom)

Even today half of Africa’s HIV-positive population is not using the basic cocktail of anti-retroviral drugs on a regular basis. There is still a stigma attached to having the virus, and many of the non-users who have been diagnosed as positive don’t go the clinics to collect their drugs because it involves standing in line and being seen by people they know.

The continent’s death rate from AIDS went into a temporary steep decline, but it is now heading back up for a number of reasons. The main one is that resistance to the standard mix of drugs has grown into a major problem.

The second-line treatment, using newer drugs that are still available at the “African discount”, costs $300 per person per year – and resistance is also apparent in 30 percent of those cases. The third-line or “salvage” treatment costs $1,900 a year even in Africa. The governments can’t afford it, and very few Africans have medical insurance.

Drug resistance has been growing in the developed world too, of course, but the solution there is to move HIV-positive people onto newer combinations of drugs that are far more expensive. The cost of treatment in the US today can be higher than $20,000 a year, and not one African in a thousand can afford that.

African governments will probably have to wage another long diplomatic and media battle to access generic or cut-rate versions of the best new drugs. In the meantime, a great many people will die. And this is happening just as the amount of funding from Western sources for anti-HIV programmes in Africa has gone into decline: donations last year were down by almost one billion dollars.

The other specific reason for sub-Saharan Africa’s much higher rate of HIV infections is “cultural”. What that means, in plain English, is that sexual traditions are different there: pre-marital and extra-marital sex is commonplace. Moreover, older men often exploit their relative wealth and power to have unprotected sex with many young women and girls.

This may explain why in southern Africa, uniquely in the world, 60 percent of new HIV infections are among young women. And it is striking that HIV infection rates are far lower in those parts of the continent that have been Muslim for many centuries – or Christian for many centuries, like Ethiopia – and where the sexual rules of engagement are therefore much stricter.

The situation in sub-Saharan Africa is almost bound to get worse, not better, because the 15-24 age group, the most likely to become infected, is growing explosively fast. They number about 200 million now, but that will double to 400 million by 2040. Africa has long been the world capital of HIV and AIDS, and it will remain so for the foreseeable future.
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To shorten to 725 words, omit paragraphs 8 and 14. (“Even…know”; and “This…stricter”)

Sex and Violence in Africa

17 November 2009

 Sex and Violence in Africa

By Gwynne Dyer

It was ostensibly about obscenity, but it was really about corruption and censorship – and in the end, justice prevailed. On Monday a Zambian court found journalist Chansa Kabwela not guilty of “distributing obscene material with intent to corrupt public morals.” What obscene material? She had sent photographs of a woman giving birth in a hospital parking lot during a nurses’ strike to senior government officials.

President Rupiah Banda called a press conference and declared the photographs “pornographic.” Soon after, Kabwela was arrested on obscenity charges. She faced a five-year jail sentence if she were found guilty – but Banda’s real motive was probably the fact that the paper Kabwela works for, the Post, constantly accuses him of corruption.

The Post is probably right. Banda succeeded Levy Mwanawasa, a president of unquestioned integrity, after the latter died of a stroke last year. But unlike Mwanawasa, he has failed to pursue the previous president, Frederick Chiluba, a monumentally corrupt man who has been ordered by a British court to repay Zambia $55 million that he had stolen.

Banda has not tried to collect the $55 million from Chiluba, and has stopped any further action against him in Zambia’s courts. An unsympathetic observer might wonder if some of Chiluba’s stolen millions have bought Banda’s complicity. The Post wonders that out loud, so Banda went after its news editor, Chansa Kabwela.

The pictures Kabwela sent out were not pornographic. Rather, they were horrific: images of a woman in the midst of a breech birth, the baby’s legs dangling out between her own while its head was still inside her. It all happened in a hospital parking lot (she had already been turned away from two clinics), but nobody would help her because of the strike, and the baby suffocated.

Her appalled and furious relatives brought pictures of the scene to the Post. Kabwela did not publish them because they were so upsetting, but she sent copies to senior officials together with a letter urging them to intervene and settle the strike. That’s when Banda declared the images pornographic and had her arrested.

The courts are still independent in Zambia, and in the end Kabwela was found not guilty – but many of the witnesses were genuinely more shocked by photographs of a woman naked from the waist down than by the horror of what was actually happening. As one witness said: “We are all Zambians here. We all know this is not allowed in our culture.”

The word you’re looking for is “prudish,” and it applies to a lot of African popular culture. Never mind what’s actually happening. We don’t want to hear about it, and we certainly don’t want to see it. The Zambian elite has been devastated by HIV/Aids – the higher the social class, the worse the death rate – and yet nobody wants to talk about sex, let alone about the links between sex, power and violence.

Go a thousand kilometres (miles) south to South Africa, and the gulf between appearances and reality is even wider. Last June the country’s Medical Research Council published a study about rape and HIV which reported that 28 percent of South African men admitted to having raped a woman or a girl. (A further 3 percent said that they had raped a man or boy.)

Almost half the rapists said they had raped more than one person, and three-quarters of them said they had carried out their first assault before the age of 20. They didn’t use condoms, and they were twice as likely to be HIV-positive than non-rapists. This is a national calamity that is killing more people than a middle-sized war, and causing a huge amount of pain and grief. Yet few South Africans are even willing to talk about it.

Many Africans will be feeling very defensive at this point, but a lot of this reminds me of where I grew up. There was an amazing amount of low-level violence around – you saw it literally every day – and there was also a huge amount of sexual predation. In the boys’ school I went to, the male teachers molested the boarders on an industrial scale, although day-boys like me were fairly safe. And none of it was ever admitted or discussed in public.

Now I live in a culture where we are no longer prudes. Everything is out in the open, including trivialised, commercialised sex on a hundred channels. Around half of all marriages end in divorce, but gays, once persecuted and forced to hide, can also get married if they want to. You can still mugged in the street, but the level of casual violence – usually men beating up on women or kids – is sharply down. I bet that the real figures for rape are down a lot too.

I like the transformed culture I live in now a lot better – and it occurs to me that what we are seeing in Africa now may be as transitional as what I grew up with in Newfoundland. In which case the moral and cultural changes that socially conservative Africans see as a descent into darkness may actually be a move towards the light.

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To shorten to 725 words, omit paragraphs 3 and 4. (“The Post…Kabwela”)

Gwynne Dyer is a London-based independent journalist whose articles are published in 45 countries.

The Zuma Problem

18 December 2007

The Zuma Problem

By Gwynne Dyer

“The (African National Congress) should not choose someone of whom most of us would be ashamed,” said Archbishop Desmond Tutu, who has a fair claim to being South Africa’s living conscience. But on Tuesday the ANC did choose Jacob Zuma as the new party leader, giving him an almost unbeatable advantage in the race to become the country’s next president.

The party conference was a raucous affair, with Zuma’s supporters heckling and booing President Thabo Mbeki. The law only allows Mbeki two terms in the presidency, and he wanted to hold on to the ANC leadership as a way of exerting influence over the choice of the next president after he steps down in 2009. But “most of us”, or at least most of the 4,000 ANC delegates, were not al all ashamed of choosing Zuma, who won the leadership with a 60 percent majority.

Not only that, but Zuma’s supporters made a clean sweep of all five other senior positions in the ANC leadership. Unless he dies or is convicted of some crime between now and 2009, he will be the ANC’s candidate for the presidency — and since the ANC still wins national elections almost automatically, he is very likely to be President Zuma eighteen months from now. How bad would that be?

Thabo Mbeki thinks it would be very bad. In his speech to the conference he referred repeatedly to “ethical leadership,” which was code for “not Jacob Zuma.” The two men were once close political allies despite the huge contrast between their backgrounds: Mbeki the austere intellectual with a master’s degree in economics, Zuma the charismatic demagogue with no formal education. But when Zuma was charged with corruption two years ago Mbeki dismissed him as deputy president.

The corruption charges were dismissed when a court ruled that documents seized during a raid by the National Prosecuting Authority on Zuma’s office and home could not be used against him because the search warrant was defective. He also escaped conviction in a rape case brought against him by the daughter of an old ANC comrade-in-arms who had been staying in his home. And he began his campaign for the leadership of the ANC, the surest route to the presidency itself.

He has won precisely because of what Mbeki sees as his flaws. The rank-and-file membership of the ANC (and many other South Africans, especially among the poor black majority) have grown weary of Mbeki’s distant, almost other-worldly style of leadership, whereas Zuma sings and dances and wears traditional costumes and is definitely one of the boys.

They are also sick of an economy that grows at five percent, but does not seem to spread the prosperity beyond the new black middle class to the deprived millions who still live in squalor. They take Zuma’s warm, affable personality as evidence that he cares more about the poor. And they think that backing Zuma, whatever his faults, is the best way of ensuring that Mbeki really does leave power.

On the other hand, what Mbeki, the South African middle class of all colours, and foreign investors all see in Zuma is a classic African “big man”-style leader in the making. He is not a monster, but he has little respect for the law. His populist instincts would sabotage South Africa’s economic growth, and his dependence on better-educated advisers and old cronies would open the door to massive corruption.

It is not just white South Africans who fear that the miracle of the past fifteen years is very vulnerable, and that the nation could all too easily go the way of so many other African countries if the wrong people get into power. For Mbeki, for Tutu, and one suspects even for Nelson Mandela (who chose Mbeki as his successor, after all), Zuma is the man who could wreck the dream. This may be unfair to Zuma, but he will almost certainly become president in eighteen months’ time unless the law or mortality intervenes.

The law is starting to intervene again. The Supreme Court has just declared the documents seized from Zuma admissible in court, and prosecutors have submitted an affidavit alleging that Zuma received 4 million rand (about $550,000) from a French arms company while he was deputy president. His former financial adviser is already serving a 15-year prison sentence for soliciting a bribe from that company in exchange for Zuma’s support, and if he cannot get those documents ruled out of court again he is in big trouble.

Mortality is an imponderable, of course, and Zuma is only 65. But it was striking that at his rape trial he freely admitted that he had unprotected sex with his accuser, whom he knew to be HIV-positive. He said he took a shower afterwards to avoid infection, which suggests that he is either very stupid — or that he has nothing more to fear from HIV-positive partners.

Odds are that nothing will go wrong, however. Zuma will probably become the president of South Africa in 2009, and then we will see if the fears about him are justified or not. But here’s one positive aspect of the situation: last Tuesday was the first time in 58 years that the ANC has chosen its leader by an open vote.

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To shorten to 725 words, omit paragraphs 7 and 10. (“They arealso…power”; and “Mortality…partners”)

The South African Succession

10 May 2006

The South African Succession

By Gwynne Dyer

You couldn’t make it up. Former South African deputy president Jacob Zuma, defending himself in court against a charge of rape, explained that the woman who brought the complaint, a family friend less than half his age (she is 31, he is 64) who was staying in his home, had signalled that she wanted to have sex with him. How? By wearing a knee-length skirt and sitting with uncrossed legs. So what was a gentleman to do?

If the woman truly wanted to have sex with him, Zuma pointed out, then the rules of Zulu culture obliged him to oblige her. Not to have done so when she so clearly wanted it would, by the rules of Zulu culture, have been tantamount to raping her. In other words, he had to have sex with her in order not to rape her.

Indeed, so great was Zuma’s desire to do the right thing that he had unprotected sex with her despite the fact that she is an AIDS activist who makes no secret of the fact that she is HIV-positive. There was no condom handy, he explained, and “everybody knows” that men don’t often get the HIV virus from women, and besides, he had a shower afterwards.

Jacob Zuma has had no formal education, but he is not generally seen as a stupid man. Perhaps he really believes that heterosexual men who take showers are safe from AIDS (despite the fact that he was married for almost two decades to a medical doctor who ended up as minister of health). Or perhaps he is secretly HIV-positive himself, and so he doesn’t give a damn. We’ll never know, because the prosecutor didn’t demand a blood sample from him.

Her only justification for doing so would have been that he had recklessly endangered the health of another person (which could lead to a life sentence). But it wouldn’t have led to a stiffer sentence in Zuma’s case even if he had been convicted, since the woman he was accused of raping was known to be HIV-positive already.

In the end, on 8 May, Zuma was found not guilty by the judge, Willem van der Merwe, who explained his decision by saying that “it would be foolish for any man with a police guard at hand and his daughter not far away to surprise a sleeping woman and to start raping her without knowing whether she would shout the roof off.” Van de Merwe added that the alleged victim “has a history of making false accusations of rape.”

This history was helpfully provided by a string of defence witnesses who claimed to have been accused of raping or trying to rape the complainant, though she mostly denied knowing them. They did not face strict cross-examination, however, since by the rules of the court (not to be confused with the rules of Zulu culture) if she denied knowing them, there was no more to be said. Just choose to believe them or to believe her. The judge believed them.

Zuma emerged from the court to be greeted by the usual mob of cheering, mostly Zulu supporters, and joined them in a rousing rendition of “Awulethu Umshini Wam” (Bring Me My Machine-Gun). And although he still faces a further and quite separate trial on corruption charges in July, it already feels as if he is back on track as the leading contender for the presidency of South Africa when Thabo Mbeki retires in 2009. Goodbye “rainbow nation”, hello Zimbabwe South.

Jacob Zuma was a real hero in the anti-apartheid struggle. He spent ten years imprisoned on Robben Island and almost twenty years in exile, ending up as the Chief of the Intelligence Department of the African National Congress. As the highest-profile Zulu in an organisation whose leadership has been dominated by Xhosas (including both Nelson Mandela and Thabo Mbeki), his ascent to the posts of deputy president of South Africa and deputy leader of the ANC was swift and smooth. The problem is that he is a ruthless demagogue and, in many people’s eyes, a crook.

Last June Zuma’s financial adviser, a Durban businessman called Schabir Shaik, was sentenced to fifteen years in prison for corrupt dealings in connection with the government’s purchase of warships, a proposed waterfront development in Durban, and lavish spending on Zuma’s residence in Nkandla. The trial judge described the relationship between Shaik and Zuma as “generally corrupt”, Mbeki asked for his resignation as vice-president, and he was committed for trial this July on corruption charges.

His supporters on the left of the ANC and his devoted Zulu followers claim that the rape charge was further evidence of a plot to thwart Zuma’s presidential ambitions, but it was actually an unfortunate coincidence. The case had little chance of success (the vast majority of accused rapists in South Africa go free), but it was a huge distraction from the corruption issue, and his exoneration on the rape charge will cast doubt in the public’s mind on any subsequent conviction for corruption. So Zuma may really be back in business, with a good shot at the succession when Mbeki retires in 2009.

That would not be happy news for South Africa.

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To shorten to 725 word, omit paragraphs 4 and 5. (“Jacob…worse”)