The African HIV/AIDS situation is a manifestion of inappropriate human behavior. This is an incontrovertible fact on which experts in all fields of endeavor related to the disease. No amount of anti-retroviral therapy can substitute for sound sexual practice. Early failure to educate, on the part of governments, and of social responsibility on the part of the afflicted significant. Save for this, one might as well pour water into a bucket with a hole in it.

By DAD on Mar 7, 2008

Agreed to an extent, but a major portion of the monies go toward education and associated programs aimed at alleviating what you’ve just stated is the root cause. Thanks for the comment, though.

By Billy Hallowell on Mar 7, 2008

I can’t summon any sympathy for the criminal thug who sits in the Oval Office.

The crimes committed by his administration— lying to Congress and the American people to get us in Iraq, permitting extraordinary rendition and torture, operating secret prisons abroad, enabling corporate raiding of the national treasury, undoing decades of progress in cleaning up our environment, etc.— so far overshadow any good it might have accomplished that it seems unlikely history will look kindly on his legacy.

I don’ see how anyone who pays attention to world news could be unaware of Bush’s good works in Africa— this was covered by the mainstream media.

It’s just that a majority of citizens of the U.S. don’t pay attention to news like this because they’re more interested in Britney Spear’s latest antics.

By Vince Williams on Mar 7, 2008

Vince, as usual you’re wrong. Acecdotally, this has been covered. But, in the scheme of things it is such a majoe accomplishment that it deserves a heavier coverage than has been granted.

Criminal? Please Wikipedia search your main man Clinton. He’s actually been brought up on legit charges…and he’s been debarred more than once for his horrific actions. Quit spouting liberal talking points and be realistic for once.

By Billy Hallowell on Mar 7, 2008

The U.S. government has spent over a billion dollars on federal funding for abstinence-only-until-marriage programs here at home in the states.

Title V-funded programs weren’t permitted to advocate or discuss contraceptive methods (except to emphasize their failure rates),
because the abstinence-only paradigm teaches that this only encourages sexual activity.

So the unfortunate recipients of this incomplete ‘education’ are deprived of the information they need, and many of them go out and have sex anyway, naturally, and acquire the very socially transmitted diseases that sex education is supposed to help prevent.

When it comes to human sexuality, the religious zealots who promote the abstinence-only regime have got their heads stuck in a place where there’s no daylight.

The biggest problem in combating the scourge of HIV/AIDS in Africa is overcoming the inertia of long-held social attitudes that stigmatize those who have the disease.

Anyone who was gay and out in the early days of the AIDS hysteria of the early ’80s can tell you something about that social stigma.

By Vince Williams on Mar 7, 2008

I don’t take kindly to being told to be realistic by a platitude-spouting pup who spews Limbaughesque neo-con propaganda written on such a puerile level that the Weekly Reader would certainly spike it.

This is probably the best thing you’ve written yet, but that doesn’t mean it’s good.

By Vince Williams on Mar 7, 2008

You continue to insult my writing skills, which is interesting considering that yours are lacking substance. You apparently think it is appropriate to insult, while utilizing what you think is elevated language to attack anyone who disagrees with your liberalism. While you may think that my pieces aren’t “good,” I could truly care less. You’ve provided no viable proof for anything you spout off about. Typical liberal whining.

By Billy Hallowell on Mar 7, 2008

Billy responds with his typically Republican misdirection and pretends that the liberals who comment here (the only comment action Billy gets involved in are the threads of his own posts) never write anything of substance.

I think even someone who seems to be as congenitally impervious to information as Billy knows very well that it’s not true, but he doesn’t care because he’s a Republican, and that’s what they do.

Anyone who bothers to read Billy’s previous posts here, with their comments, can see for themselves that Billy’s writing standards are often not very high.

This isn’t a formal debate– no x is resolved– Billy simply expounds his piece, which is often some sort of attack on Democrats and us dastardly liberals, or something else entirely (but he can’t help throwing in a non sequitur about us).

So I feel justified in these ad hominem critiques of his writing.

I think young Billy is arrogant and cocky, and that he really should clean up his act.

By Vince Williams on Mar 7, 2008

See how Billy inserted the bit about my “my main man Clinton”.

I never said anything about Bill Clinton here, or elsewhere, in the comments.

So typical Republican misrepresentation.

By Vince Williams on Mar 7, 2008

“Anyone who bothers to read Billy’s previous posts here, with their comments, can see for themselves that Billy’s writing standards are often not very high.”

Dude, grow up.

I’m in syndication, which is why I don’t publish commentary on other pieces. To be frank, this is a great site, but it’s only one of the political news (blog) sites that my pieces are featured on. So, naturally…I’m going to respond to cheap commentary that finds its way onto my work.

Honestly, it’s offensive to my generation that you continue to belittle me utilizing the term “young.” Get over yourself…will you need two posts to validate yourself after this comment as well?

By Billy Hallowell on Mar 7, 2008

So Billy falsely attributes things to me I didn’t say or imply, and ignores it when I point it out.

I know you think you’re something, Billy, but you’re no good.

Get off your horse, it’s too big for you.

By Vince Williams on Mar 7, 2008

I work extensively in the field of HIV/AIDS, having been to Africa more than 50 times in the last 17 years. I would have to agree totally with the article. Is PEPFAR perfect? Not at all. First, while I agree about abstinence until marriage messages, I don’t think that every country receiving PEPFAR funds should be legislating specific levels of funding for this. I also don’t agree with the US spending excessively on high price antiretrovirals, while lower price generics are available (I don’t object to “buy American”, but I find it hard to believe that the Pharma monopoly needs another subsidy from the American taxpayer).

In the end though, what matters most has been that the US is making a big difference in Africa. People are surviving because of the generosity of the American taxpayer. I’ve seen it myself, and although I was skeptical that the world would ever be able to roll-out ARVs correctly, I’ve seen it done and I’ve seen the very positive results. GWB deserves credit for this, regardless of what you think of Iraq.

For those Clinton supporters who insist that he “cared” about Africa more, I have one word for you…Rwanda. Stop for a moments and ask yourself what Clinton did for Rwanda when nearly a million people were being killed in 100 days? Did he support the rebels to overthrow those committing genocide? No, Bill Clinton was having Prudence Bushnell call the head of the rebels (and current President of Rwanda), Paul Kagame, to tell them to back off. We should remember his very famous response to the insane attempt by Clinton to allow the genocide to continue, “Madame, they are killing my people.”

However, you can choose for yourself. Almost a million Rwandans dead under Clinton, or 1.5 million Africans receiving ARVs under GWB. Your choice.

By Steven on Mar 7, 2008

Wherever the “Clinton supporters who insist that he “caredâ€? about Africa more…” are, they’re not commenting here.

Who could deny that even the most benighted of administrations is capable of doing good in some way— the very nature of government disbursal of taxpayer supplied federal funds in this country tends to ensure it.

The executive can influence where those funds are directed— it would be surprising if the Bush administration didn’t pay some deference to the judgement of history, although its conduct of the war in Iraq and general foreign policy give an observer pause.

By Vince Williams on Mar 7, 2008

I think you missed my point Vince. My point was that while Clinton, who is hailed as the “first black President”, presided over the death of nearly a million Tutsi Rwandans. The administration’s incompetence in this regards is part of the official record.

http://www.pbs.org/wgbh/pages/frontline/shows/ghosts/interviews/kagame.html

In regards to HIV and AIDS, Clinton did very little to address this problem (you may even remember the arrogance of Vice President Gore, who travelled to South Africa to tell the government that if they purchased generic antiretrovirals, they could suffer trade sanctions from the US). I think Clinton has done a lot of good under the Clinton Foundation to help countries get access to treatment, but I can’t help but think that he could have done so much more if he had stepped up to the plate, as GWB did. How many lives were lost in Africa due to Clinton’s inaction in regards to HIV and AIDS? Perhaps as many as were lost in Rwanda.

Therefore is it a surprise that GWB doesn’t get any credit for what he did in Africa, while Bill Clinton gets credited as being the first black President? No, not really.

By Steven on Mar 7, 2008

Steven, I think saying that Clinton “presided over the death of nearly a million Tutsi Rwandans” is going a step too far in rhetoric.

You’ve diverted the topic to Clinton’s incompetence and a conceit about him being the first “black president”. which is fine, but those aren’t points I was arguing.

Bush is getting notice for his work in Africa now— in Bob Geldof’s Time piece.

By Vince Williams on Mar 7, 2008

Here is what Geldof said:

Mr. Geldof praised Mr. Bush for his work in delivering billions to fight disease and poverty in Africa, and blasted the U.S. press for ignoring the achievement.

Mr. Bush, said Mr. Geldof, “has done more than any other president so far.”

“This is the triumph of American policy really,” he said. “It was probably unexpected of the man. It was expected of the nation, but not of the man, but both rose to the occasion.”

“What’s in it for ? Absolutely nothing,” Mr. Geldof said.

The point is that even in praising GWB, Geldof recognized that the press has been very unfair and should have recognized these successes.

Its interesting that you accuse me of changing the subject, when you have been the ones who changed the focus from AIDS in Africa to troops in Iraq.

However, I will grant you that the statement, “presided over the death of nearly a million Tutsi Rwandans” was a bit harsh. He did nothing while it happened, but he did not “preside” over it. Ylur point is well taken and I stand corrected.

By Steven on Mar 7, 2008

Steven, you have a reasonable attitude.

@ “…when you have been the ones who changed the focus from AIDS in Africa to troops in Iraq.”

I reviewed my comments and I don’t see where I changed the focus from AIDS in Africa to troops in Iraq.

I did mention Bush getting us into Iraq as an example of the negative side of his legacy.

But I like the way you make your points, anyway, even if I may disagree.

It’s always seemed to me that Bush has been cut way too much slack from a downright supine press since 9-11.

By Vince Williams on Mar 7, 2008

Well….we certainly did get far afield on this one didn’t we gentleman. Getting back on line to where Vince left off…the period of hysteria Vince refers to was very early in medicines understanding of the
pathophysiology, pathogenesis, and epidemiology of the disease. Not only was the disease unfortunately seen as clustered within a particular social group, one’s death sentence was guaranteed signed the disease were contracted. Thus ensued all of the economic, social, and political upheaval, and the changes which were brought about. I might remind you that one of the most signficant transmissible diseases in our society has been Hepatitis B which, fortunately, we now have a vaccine for. But Hep C which has a narrow vector of transmission between individuals is still a challenge, as is D. The argument with respect to Africa is that, not withstanding the fact that when it had been established that the HIV virus was transmitted through the intimate exchange of body fluids, social behavior was not modified to the extent that men going off to the cities where they worked and had unprotected sex with infected partners were bringing it back to their villages, infecting their wives, who ultimately gave birth to HIV+ offspring. Then we carry this phenomenon of blood-borne pathogens one step further, and that, is to the blood supply for transfusion and the ramifications of all of that.

By DAD on Mar 8, 2008

@…men… had unprotected sex with infected partners were bringing it back to their villages, infecting their wives, who ultimately gave birth to HIV+ offspring.”

D__, this is exactly why it was wrong of the moral crusaders to politicize the issue, especially after the scope of the human disaster became clear in Africa.

No one can argue that children aren’t innocent victims of the disease, and the mothers of those congenitally infected babies are often coerced into sex by husbands who refuse to wear condoms.

Billions of U.S. dollars spent on the President’s Emergency Plan for AIDS Relief in Africa and elsewhere won’t solve the problem, especially since one-third of its prevention funding is earmarked for abstinence-only-until-marriage programs.

This funding restriction actually helps spread ignorance about sexually transmitted diseases and the use of contraceptives to prevent infections and pregnancy.

And even the best-presented information, which is not part of Bush’s program, isn’t going to change ingrained social attitudes and stigmas by itself.

That’s the greatest challenge in preventing the spread of HIV/AIDS.

By Vince Williams on Mar 8, 2008

Vince: Your next to last paragraph is the core of issues in preventive health care. Vaccines, for example, take the personal committment out of disease control. Even with that, for a variety of reasons, children are not being vaccinated against the classic communicable diseases. People eschew fluoridation, oral hygiene, and regular professional care and, the arrival of an HIV vaccine would simply make “unprotected” sex “safe” again, not withstanding all the other STD’s we can enumerate. Now we are seriously looking at vaccines with respect to the etiology of autism. Damned if we do, and damned if we don’t. It’s a vicious circle we run in.

By DAD on Mar 8, 2008

I agree with you Vince that PEPFAR has some major challenges, including its emphasis on prevention until marriage. As I indicated earlier, demanding that every country spends 33% of its PEPFAR prevention resources on abstinence until marriage is not a cost-effective use of resources. Its especially insane when you see billboards that have both abstinence and condom messages, and the US government has to defend how much of the cost of the billboard should be allocated to “A” (abstinence) and how much to “C” (condoms). This is truly silly and something that needs to end.

Having said this, I will try and defend PEPFAR, despite the previous misgivings. First, I would note that of the $15 billion, only 20% is for prevention. Therefore if 33% of those resources get spent on abstinence until marriage, then we are talking “only” $1 billion out of the $15 billion. (Before anyone objects, yes, as a fiscal conservative, spending $1 billion on a failed policy is problematic to me; but I guess it could be worse).

Second, if you look at recent books on HIV and AIDS (see Helen Epstein’s new book, as well as Jim Chin’s), you’ll see that actually condoms are not likely to have a big impact on the epidemic in Africa. As they argue, “B” (be faithful) can actually be essential and has been underfunded in most HIV and AIDS programs. What makes Africa unique and appears to be most affecting the epidemic is neither the number of sexual partners (most data suggests that Africans don’t have more lifetime partners than Europeans or Americans) or their failure to use condoms. The low levels of male circumcision in Africa may contribute some to the epidemic, but male circumcision is rare in Europe as well and HIV/AIDS has not spread widely in Europe. Instead what appears to be most relevant is concurrence, or the fact that men in Africa tend to have multiple concurrent partners. In this case, messages that effectively delay the onset of sexual debut and that encourage men to be faithful (zero grazing) seem to be essential to addressing HIV prevention in Africa.

I do think though that an essential question should be addressed about PEPFAR. We have been spending $15 billion over 5 years. GWB is looking to raise this to $30 billion over the next 5 years, whereas Congress wants to shoot for $50 billion. As I said, I work in this field and I suppose that more is better from the perspective of helping countries to respond more effectively to the epidemic. However, I have some real concerns that $50 billion is actually too much and can’t be spent effectively. Personally I’m intrigued by Obama’s proposal that we spend the $50 billion on a wider set of issues affecting Africa. Alternatively I think that $30 billion on AIDS could be spent appropriately. I’d be curious if others feel that more money for HIV and AIDS has diminishing marginal returns, at least until Africa builds up its own capacity to respond more effectively.

By Steven on Mar 8, 2008

Steven: absent the obviously needed changes in humna behavior cited, you’ve pretty much answered your own question.

By DAD on Mar 8, 2008

Nice work, Steven.

I thought you might be in the foreign service when I read this— you have a gift for diplomacy.;-)

Obama’s proposal makes sense to me.

Here’s a suggestion:

Why couldn’t some of those U.S. billions be spent on empowering the women of Africa with microcredit loans to help them realize their entrepreneurial potential, if that would work in the local economic landscape?

Ingrained, but destructive social attitudes (and perhaps even some time-honored customs) that encourage the abuse of women have to be addressed before the world has any chance of ‘managing’ the HIV/AIDS epidemic.

By Vince Williams on Mar 8, 2008

Vince: Your proposal calls for social and cultural re-engineering on a grand scale; the equivalent of “terraforming” in science-fiction.

It took nearly seventy years from the time Hattie McDaniels was awarded an Oscar in a separate ceremony to Obama’s candidacy for the US Presidency.

What’s your view on the time line for the multicultural social re-engineering of Africa?

Science might likely have produced an HIV vaccine before that.

By DAD on Mar 8, 2008

Nonsense, D__.

It’s been done already in remote Pakistan

By Vince Williams on Mar 8, 2008

This sample appears to characterize a limited population size of relatively homogenous composition with respect to gender and cultural values. With Africa, the issues are far more complex. What are your thoughts?

By DAD on Mar 9, 2008

D__, I did qualify my suggestion with these words— “…if that would work in the local economic landscape.�

I think the Pakistani example is relevant because the stigma of AIDS is profound in Islamic countries, and Africa has such a large Muslim population, much of which is black, the race most affected by the disease on the continent, disproportionately.

Of course the sheer vastness of the cultural mosaic in Africa, which doesn’t necessarily correspond with national borders, complicates any attempts by outside agencies to address the attendant problems.

That’s why I believe that surely the most effective way to assist those people who need it is to empower them to help themselves, and what better way to do it than by encouraging the entrepreneurial spirit?

Seed money for local-scale capital enterprise should be made available outside the aegis of the World Bank or the IMF.

Here’s a summary of some of the ideas integral to this (apparently the link didn’t make it past your filter):

Stigma attached to AIDS in Muslim countries and how to erase it?

Kaadan A.

Aleppo University, Aleppo, Syrian Arab Republic

Issues: According to UNAIDS there are an estimated 300 000 people living with HIV in North Africa and the Middle East. Some Muslim people still think that HIV and AIDS are not issues for the community. Although AIDS has traditionally been surrounded by stigma worldwide, it is clear that this stigma for many reasons is more profound in Islamic countries. This stigma is expressed in a variety of ways, including: ostracism, rejection, discrimination and even violence against persons who are perceived to have AIDS or to be infected with HIV. The aim of this paper is to present details of stigma development in some Muslim societies, and a proposal of how could we release an enlightening campaign aiming to erase or fight stigma associated with AIDS. Description: The paper provides an analysis of the processes by which stigma has emerged and become associated with AIDS. It also explores the process by which these associations could be loosened, identifying distinctive features of stigma that may guide intervention programs; and evaluating changes in the magnitude and character of stigma in response to interventions and social changes. This will facilitate our campaign aiming to erase or fight stigma associated with AIDS. We have to recognize that in Muslim communities, any anti stigma campaign to be succeeded should be based on some Islamic concepts, which related to the issue. So, the religious men should be involved in any anti stigma campaign especially in the educational programs. Lessons learned: Stigma towards people with AIDS in Muslim countries have a detrimental effect on their ability to obtain services, their recovery, the type of treatment and support they receive, and their acceptance in the community. Recommendations: Although, research on AIDS stigma has grown dramatically over the past two decades in the west, the purpose of this paper is to stimulate more research on anti-AIDS stigma initiatives in Muslim countries.

By Vince Williams on Mar 9, 2008

Int Conf AIDS. 2004 Jul 11-16; 15: abstract no. D10757.

By Vince Williams on Mar 9, 2008

Vince, while I actually agree wholeheartedly with you about micro-loans, DAD does have a point regarding taking the cultural context into account. While microloans have been extremely popular in Iran and Pakistan, there is much to be said about exploring the differences (culturally speaking) between nations. The African continent is massive, with cultural norms that differ between the many nations that comprise it. So, while I agree to an extent, we still need to explore the most applicable method of outreach (a method that coincides with societal constructs).

By Billy Hallowell on Mar 9, 2008

Billy, I did acknowledge Dad’s point when I said, “Of course the sheer vastness of the cultural mosaic in Africa, which doesn’t necessarily correspond with national borders, complicates any attempts by outside agencies to address the attendant problems.”

I think we can all agree that big problems may need to be addressed with big ideas, but real progress happens at the local level.

Effecting any social change in such a complex geographical and socio-political situation is a delicate and tricky task, but I believe that any programs that don’t harness the energy of the local people themselves, including the HIV/AIDS infected, are doomed to fail.

By Vince Williams on Mar 9, 2008

Vince: The most mystifying observation in all of this is, not withstanding the stigmata associated with the disease and the vector of its transmission, the numbers of the infected are high. One would think that temporal and spiritual cultural values would serve as a strong deterent. Unfortunately, there is a powerful contradiction operating here. A kind of “do as I say, not as I do.”

By DAD on Mar 9, 2008

D__, part of the problem is that the low-tech infrastructure needed to support information technology is missing in the underdeveloped African countries, so information dispersal is going to be low-tech, too.

I’m under the impression that promiscuity is considered a birthright of the sexually active male, married or not, in some of the non-Muslim cultures of Africa.

So I think that magical thinking is operative in those places— the men are socially conditioned to feel invincible by long-standing cultural tradition.

Even here in the U.S., some people, especially men who have sex with other men (Americans need to get over the fantasy that only ‘gay’ men have sex with other men), have historically indulged a fantasy that HIV/AIDS only happens to others, and the result was carnage in the ’80s.

By Vince Williams on Mar 9, 2008

Vince: My take is even more basic. It is that dogma, regardless of how rigid and restrictive, will routinely be violated, even by those who enforce it. It seems to be in human nature, to corrupt and be corrupted. THAT, in any setting, will constantly remain the weakest link in the chain. With communicable disease,immunization re-enforces that link. It alleviates the individual of accountability to anyone else but self such that, those who fail to seek immunization will fall by the wayside, and the general population will prevail and move on.

By DAD on Mar 9, 2008

One additional thought in response to your pp.2.

Some years ago it was proposed that gender behavior has been naturally selected for that which insured the survival of the species. Thus, male and female humans respond to a subliminal genetic program in kind, though not necessarily intended for that purpose.

With male and female sexuality, moral conviction or convention seeks to modify and control that behavior to the ends of a particular doctrine. The risk of contraction of disease, or an unwanted pregnancy, becomes employed as a deterrent.

Enter the ability to prevent disease or unwanted pregnancy, and exit the behavioral deterrent. This then,becomes an anathema to the ‘defenders of the faith’,who know all along, that the following respond to their primordial genetic calling….procreative activity between partners best suited to produce superior offspring having the highest possible chance of survival and continuation of the species. Humans are not sexually intimate for procreation alone, nor strictly heterosexual in that pursuit.

Thus we have policies created, not for the expediency of achieving primary goals, but for secondary gain. The prevention and prohibition of “the great thou shalt nots.”

This we have seen not only in the issue of HIV infection, but with ZPG efforts, and family planning/abortion prevention, as well.

By DAD on Mar 9, 2008

D__, when people talk about gender based sexual characteristics being hard-wired in the human brain, I wonder where those who prefer sex with their own gender fit into the evolutionary imperative.

You would think that natural selection would have suppressed any mutated genes that might incline humans that way, if it was counter-evolutionary.

When I was a teenager I pondered the fact that a couple who were completely monogamous would never get STDs—— which begged the question— how were these diseases introduced into the human chain of sexual activity in the first place?

I finally got my answer when a monk-priest (of all people) told me that it was cross-species sex that brought us these plagues— like the shepherds who copulated with their sheep and then went home to their wives, or simply enjoyed their fellow shepherds, or both.;-)

I never doubted that religious commandments that proscribed certain sexual acts often served a socially useful purpose, even if their function in the fabric of an ancient culture might not even be intelligible to us now.

Personally, I think it’s wise, as it has ever been, to maintain a healthy skepticism of the motives of the priestly class charged with enforcing the moral code.

By Vince Williams on Mar 9, 2008

…thus too, was the ‘myth’ regarding HIV’s entrance into our species.

By DAD on Mar 9, 2008

….and…Oh yes….I’d forgotten that reason I was given for having gone near-sighted at the age of eight. That one they never could quite figured out, so pre-pubescent was I. They never knew how precocious I was with girls my age.

By DAD on Mar 9, 2008

I never pictured D__ as a preternatural playboy until this.;-)

By Vince Williams on Mar 9, 2008

Goodnite, Chet!

By DAD on Mar 9, 2008

I think that’s the nicest thing anybody’s ever called me.;-)

By Vince Williams on Mar 10, 2008

Remarkable to have you say that considering the level to which you rise in your contributions to these discourses. There must be something of value that has been recognized prior to this.

By DAD on Mar 10, 2008

How many times did I hear David Brinkley say that?

Thanks, Dad, but I was just kidding.

I tell people who want to write to read the classics.

I was that weird kid who read the Encyclopedia Britannica for fun, but wasn’t too straight to rock ‘n’ roll.

Wasn’t the best Latin student, either (glad we had it, now), but my life changed when I ran away to live in a commune.

It’s a long story, but I’d still rather read Plutarch than Cormac McCarthy.;-)

By Vince Williams on Mar 10, 2008