Mosquito nets, malaria prevention, and the challenge of public health.

PSI, a US-based NGO that promotes family planning and disease prevention internationally, set up a malaria education/prevention station a couple blocks from my house last week. With funding from the Global Fund to Prevent TB & Malaria and USAID (that’s YOUR tax dollars at work), they distributed free insecticide-treated bed nets to all families with children under the age of 5 and hundreds of malaria prevention pamphlets that are now half-buried in the muddy streets of the neighborhood. In the last decade, programs like this one have reduced the number of malaria-related deaths in children by the millions, but after several years of seeing these programs implemented in Africa, and after discussing the logistics of PSI’s campaign with my Kiswahili teachers, I can’t help but wonder how much more successful such programs would be if the people designing them had a better understanding of the culture of the country in which they’re working.

From an American perspective, we think that by giving people the education and resources they need to prevent themselves from getting a disease, they’ll do it. If we distribute mosquito nets to families and tell them these nets will keep their kids from dying of malaria, they’ll use them. Right? Unfortunately it’s not that simple, for a number of reasons:

1. Since the Global Fund is focusing on preventing disease in children, all the nets PSI distributes are for child-sized beds. This would work in the US, where babies sleep in bassinets and cribs and twin-sized beds, but most African under-5’s sleep in a full-sized bed with their parents or siblings. A crib-sized net is pretty much useless here.

2. Many African families sleep on foam mattresses or grass mats on the floor of a one-room house. During the day, the beds are stacked against the wall and these rooms are used for cooking, bathing, radio listening, tea drinking, homework doing, and a hundred other daily activities, so permanently installing a insecticide-stinking mosquito net in the middle of the room isn’t exactly practical. (In fact, it’s probably a fire hazard.) And taking it down and putting it back up every day gets old really quick.

3. The nets aren’t distributed with the hardware and/or ropes needed to hang them, and most families don’t have these things just lying around. Four little hooks and enough rope to hang a single net cost about 25% of an average family’s monthly income. Who can afford that?

4. There’s no way to ensure that the people receiving the nets actually need them. Families that received free nets last year collected new nets again this year, and there’s no way to prove that someone who says they have a 2-year-old doesn’t actually have a 2-year-old. Since many children are born at home, there’s no master list of all children under the age of 5, and many children aren’t counted by any government registry until they enroll in the first grade. Basically, anybody who wants a net gets a net. Or two.

5. Mosquito nets have considerable market value so many families sell them. Hotels constantly need new nets for their malaria-fearing foreign guests who expect clean, hole-less nets over their beds. Dress-makers use the tulle-like netting as a lining for dresses. Fishermen double up the netting to make low cost fishing nets. And others are just re-sold as is to the net-needing public at the local market, which is how I ended up with my not-free PSI/USAID mosquito net. 

6. Treatment for malaria is widely available and 100% free courtesy of USAID, WHO, and other organizations. At any hospital or clinic, children and adults with malaria or malaria-like symptoms gets chloroquine or primiquine, usually with a free overnight stay in a warm, comfy bed and a couple of meals. So why bother prevent it when you can treat it just as easily, plus perks? 

I can’t help but wonder if there’s a better way to prevent malaria in Africa. If PSI gave out full-sized nets, how many more malaria-related deaths would be prevented? If the nets came with a couple yards of rope, would more people hang them? If PSI distributed them door-to-door, would fewer nets be given to families that already have nets? If nets were given to new mothers at the hospital or clinic after birth or when the child is brought in for his first vaccinations, would the number of nets distributed more accurately match the number of infants in the country? If retailers found to be re-selling free nets were punished in some way, would they think twice about re-selling the nets? If parents had to pay for malaria treatment, would they try harder to protect their kids from it in the first place?

Most importantly, does the benefit of this kind of mosquito net distribution outweigh the faults of the program and warrant its continuation? I think so.

No public health program implemented in the developing world (or anywhere, really) is 100% effective. The eradication of polio is most often cited as an example of a successful public health initiative, but 10 minutes in any African city full of polio-crippled beggars will prove that polio hasn’t been eradicated. But if the alternative to a program that reduces new infections of HIV by 5% is no program at all, isn’t that 5% still worth working for?

I found myself asking a similar question a few years ago when I was working for A Wider Circle, a fantastic DC-based non-profit that provides nutrition education, after school programs, job training, and furniture to low-income families in DC, Maryland, and Virginia. Day after day I taught low-income seniors how to make heart-healthy fruit smoothies and helped Hurricane Katrina refugees move free furniture from Bethesda demi-mansions into their tiny FEMA-subsidized apartments, and I felt like it was worth it.

But I remember one Saturday morning when a woman with a Baby Phat track suit and a fancy cell phone rolled up in her big black Escalade, a flock of Nike- and Roca Wear-clad children in tow. We helped her load her new bedroom set into her Escalade and strapped a brand new mattress to the roof, reserved for her a dining room set and big color TV, and sent her off with a big bag of day-old high end pastries from a Georgetown bakery. The other volunteers and I couldn’t help feeling taken advantage of. Were we giving up our Saturday mornings to give free things to selfish pseudo-poor people in expensive clothes? If a woman driving an Escalade could get a free queen-sized mattress from an NGO, why was I sleeping on a broken-down twin mattress on the floor of a walk-in closet?

Mark, the organization’s director, was the only one who was still smiling. He asked us, “If 99% of the families we help actually need the help we give them, is it worth putting up with the other 1% who are like that woman?” We agreed that it was. “What if 25% of the people we help are like her, and only 75% actually need the help. Should we keep working?” Sure, we said—those 75% of families are still better off than they would be without our help. “What if 95% of the people we help are like her and only 5% actually needs us?” By our own logic, that’s still 5% of families that are better off because of our work, so we should keep working. But what’s the threshold?

With any project intended to help people, there’s going to be failures. Selfish people who don’t need help will get free stuff, and people who actually need help will be overlooked. Mosquito nets that are intended to protect a child from malaria will be sold so his mother can buy new shoes or pay school fees, and when the child gets sick his new shoe-wearing mother will take him to the hospital for free treatment. Where there’s free stuff, there’s someone waiting to take advantage. But there are also people whose lives can be saved by free food, and children whose lives can be improved by free health care, so shouldn’t we keep providing it? The only alternative is to deny help to EVERYBODY, which punishes the freeloaders of the world by refusing to help people who actually need it. That’s not really fair either, is it?

Even if the world will never be FAIR, I hope that the work that NGOs and aid agencies and I myself do at least helps make life little less UNFAIR. That’s reason enough to keep distributing mosquito nets, to keep learning a seemingly useless African language, to keep trying, right? I think so.

Corruption and the clash of cultures at the Iringa Regional Immigration Office

94 days ago I got a 90 day visa for a 108 day long stay in Tanzania. Standing at the immigration counter in the Dar Es Salaam airport, sweating profusely and exhausted from fourteen hours of travel, this 18 day discrepancy seemed much less important than taking a cold shower and finding a horizontal place suitable for sleeping. I didn’t worry about it again until about a month ago, when I paid my first visit to the regional immigration office in Iringa.

On my first visit the official on duty told me I didn’t need another visa, despite the fact that my current one would expire 18 days before my flight back to Swaziland; he recommended that I overstay my visa and beg forgiveness at the airport. The next week I went back in search of a more legal answer and was told I could either get a $200 student visa or spend a weekend in Malawi and renew my multiple entry visa by default at the border. On my third visit, after explaining my situation the official launched into a tirade about the theft of culture, which I was clearly guilty of. I smiled, nodded, and pretended to be listening while contemplating the feasibility of a weekend trip to Malawi.

But it got me thinking about the export of culture. For better or worse the internet, cell phones, television, air travel, and technology in general have made the world a much smaller place than it was just a decade ago. Fashion trends, political systems, religion, language, music, cuisine— things once confined to a specific country or culture are now available throughout the world. Many African radio stations broadcast American Evangelists’ sermons and programs like “Focus on the Family,” and in the afternoon every TV in Tanzania is tuned into Spanish soap operas dubbed into English with Swahili subtitles. Muslim women in Zanzibar have Gmail accounts. Swazi grocery stores sell Danish butter cookies made in Dubai and Kellog’s Corn Flakes, and just about everybody wants to learn English. While accusing me of the intellectual theft of his mother tongue, the angry immigration official was wearing dark wash Levi’s with a big knock-off Calvin Klein belt buckle and making notes with a Bic pen imported from Thailand by a South African company.

But even more than dark wash jeans and corn flakes, what amazes (and sometimes appalls) me is the IDEAS that are exported together with all of these THINGS. In Swaziland, people who watch the TV broadcast of the American Bishop T.D. Jakes’ sermon think that America is full of racist Christian fundamentalists; Swazis who watch WWE wrestling think all American women have gigantic boobs encased in vinyl like big pornographic sausages, and that all American men have funny mustaches and fight each other with folding chairs while wearing spandex. A Tanzanian woman who had seen an episode of MTV’s “Cribs” featuring the ridiculous mansion and car collection of the rapper 50 Cent asked me how many Lamborghinis my parents owned, and I have a really hard time convincing people that not everybody in America is white and wealthy. A couple months ago, when walking down the street in wide leg jeans and a ribbed tank top, an older Muslim woman asked me why I was “wearing the uniform of the prostitute,” because clearly anyone who wears pants is a hooker. The understanding of American culture that’s exported around the world is that we’re all gluttonous, wasteful fatties with mattresses stuffed with Dollars where we sleep with a different partner every night and talk about how much we hate Black people.

Every day I spend in Africa I find myself fighting this perception of Americans. Countless times, I’ve explained that not all Americans are White or rich or wear suits to work every day. I’ve explained that not all Americans are Christian, and that American culture is not monolithic; that the US is a country of immigrants and diversity and multiple political parties and socio-economic classes. I’ve tried to explain that if I knew a bunch of multi-millionaires eager to fund the higher education of strangers I wouldn’t be spending my weekends writing essays for scholarship applications, and I try to dispel myths of selfishness and gluttony through my behavior. But as I compete with the TV shows like “Cops,” bags of free food labeled “Aid from the American people,” and the ridiculously short skirts of celebrities in the Entertainment section of the newspaper, sometimes it feels like a losing battle.

In my immigration office standoff, though, I was victorious. After several return trips and many hours of practicing the argumentative tense of Kiswahili, the Regional Immigration Director locked my passport in his desk drawer and demanded that I pay him $100 to get it back. I pulled my other passport out of my bag (I have 2—one that Peace Corps gave me and my personal one) and shrugged off his threat as I showed myself to the door. Ten minutes later, I had a free 30 day visa extension and a mug of sugary tea and biscuits. And now at least one immigration official in Tanzanian knows that Americans are smart, persistent and refuse to pay bribes. Even while wearing a prostitute uniform. That’s me doing my part.

Obama lovin', dresses, and smoked grasshoppers

Africa LOVES Obama. Obama chewing gum, Obama ballpoint pens, Obama backpacks. You name it, I've seen it. A couple weeks ago, I found Obama underwear at a used clothes market, complete with airbrushed Obama on the butt and a waistband that said "Commander in Chief." Still, who buys used underwear?

It's amazing how an $8 dress with big cartoon fish on it can make me feel pretty, but it does. Fabric here is so ridiculous it's amazing. Last week I found a piece of gray and purple cloth with bright green and orange vacuums vacuuming bright yellow and blue carpets. I had to seriously restrain myself from buying it and having it made into a dress...

On Friday, I had a toasted egg and cheese sandwich with a side of smoked grasshoppers for lunch. Yum! They're super tiny this time of year, crunchy, and taste like just about anything else that's smoked. But they look scary.

In Swahili, L and R are interchangeable, so this actually means "Death Row." I love misspelled graffiti.

I have developed mosquito-squashing skills of epic proportions. Gross, yes, but very necessary.

My life is so uneventful that I take pictures of the baby papaya inside my big papaya. That's exciting to me. (Kind of a cool picture, though.)

How I almost paid $276 for a 16-oz 7-Up

Yesterday was a typical lazy Tanzanian Sunday. I was awakened at 7:00am by the children discreetly banging on the window by my head in an attempt to wake me up so we could play. An hour later, half-way through the second showing of The Lion King in as many days, my host mother delivered a 5-gallon bucket of heavily chlorinated water from the local price-gouging water distributor (he picks up the slack when the government shuts off the neighborhood’s supply for weeks at a time). Sweet! I washed my hair for the first time in 11 days (gross, I know), threw on some reasonably clean clothes and started the 20-minute walk to town intent on some exercise and several hours of therapeutic online shoe not-buying.

After lunch, I stopped by the ATM and perusing the local market for the week’s stock of fruit and dry goods, browsing a few local wax-print fabric shops along the way. (African fabric is my kryptonite.) An hour later, tired from the hot sun, I was drawn to a tiny fabric-and-cold-drink shop on the corner of the bus rank, where I stopped for a 7-Up. Sitting down on one of the shop’s two stools, my messenger bag between my feet, I struck up a conversation with the shop’s owner and took little notice when two men walked into the shop. They dirty-fingered through the fabric hanging on the walls, and one bought a Coke and introduced himself to me. He knelt in front of me and unfolded a bright orange piece of fabric covered in yellow fish and blue flowers, mumbling something intently to his friend who was kneeling to the side of him. I returned to my conversation with the shop-keeper, sipping my awesomely cold 7-Up.

When I felt him bump my bag, my initial reaction was to reach down and move it out of his way. And then I realized that his hand was deep inside my bag, his dirty fingers wrapped around my wallet. I threw back the gaudy/fabulous fabric as he stood up, my wallet in hand. I demanded my wallet from him as he stared at me with a deer-in-the-headlights look. I lifted up my nearly empty glass 7-Up bottle like I’d seen in bar fights on TV and stared back at him menacingly while his accomplice and the shop-keeper ran out of the shop to escape the crazy white lady. Bewildered, the thief handed me back my wallet and apologized. I told him where he could go and that Jesus had seen the whole thing, stared at him with the evilest, most hateful look in my repertoire and demanded, bottle in hand, that he leave. He protested half-heartedly that he still had half a Coke left as he made his exit, and I rummaged through my bag to make sure my camera and other things were still there. (They were.) A minute later, the shop-keeper came back and apologized for abandoning me and I sat down to finish off the dregs of my 7-Up, recovering from the adrenaline rush that comes from being the almost-victim of an almost-crime and contemplating the almost-weapon in my hand.

To me, the worst thing about being robbed isn’t usually the phone or money (or the fancy Basotho blanket) or whatever I lose, it’s the feeling of being violated. In that sense, an attempted robbery is just as bad as a successful one. And I’m pretty sure those guys followed me from the bank just waiting for the perfect chance to move in, which makes the whole incident even scarier. But at least I know I can hold my own in a fabric slash soda store in the event of an attempted robbery by a pair of unarmed men, assuming I’m drinking a 7-Up. And maybe now I’ll have some sort of post-traumatic aversion to fabric stores and I’ll stop buying wax-print fabric. Probably not, but maybe.

Aside from that, my life is pretty uneventful: class every day, internet café most afternoons, homework in the evenings, and the occasional 24-hour marathon of The Office, which is what I did all day Saturday instead of writing an essay for a scholarship application. Oops.

Anyway, I’ll be home in exactly 2 months! Exciting, right? Can’t wait!

Pictures I've been trying unsuccessfully to load for a week.

I found this chicken foot on my way home from class the other day. Gross.

I buy milk in bags.

I made DELICIOUS Rice Krispies Treats for my host family, but unfortunately Tanzania only has multi-colored marshmallows and all the green, yellow, and blue ones make green. (The pink seems to be irrelevant in the color mix...)

Tall Horse Cabernet Sauvignon is my best friend. Unfortunately I find it difficult to crave wine when it's a bazillion degrees in my house, which is actually good news for my bank account because this stuff is EXPENSIVE here.

The little shop at my school where I buy stuff during class if I'm hungry. They advertise candy bars, Pringles, Coke, Red Bull, Heinz Baked Beans, Duracell batteries, etc., but really all they sell is deep-fried doughnuts.

Furaha means "happiness." Sometimes when I'm having a bad day, I eat a large quantity of happiness. That's a healthy response to stress.

Democracy Shmemocracy: Party Politics in Tanzania

Despite a handful of predictable disputes in the voting process, election outcomes, and the fairness of the Electoral College, the US is a democratic country. Even if it’s not a PERFECT democracy—if Wyomingans are over-represented and some voting districts slightly Gerrymandered—there are still certain democratic aspects of our government that we can always count on: We will ALWAYS have an election the second Tuesday of November. The candidate declared the winner will take office, and the loser will peacefully and respectfully leave office. An opposition candidate running for public office isn’t in danger of being assassinated by the incumbent party’s not-so-secret pack of AK-47-wielding thugs. Voters are not threatened or intimidated at the polls, and our votes are confidential so we don’t fear reprisal for voting for one candidate over another. And, most importantly, we assume with pretty much 100% certainty that the number of votes counted is equal to the number of votes cast, and that the outcome of the election isn’t maliciously rigged to ensure an incumbent party victory.

On the other hand, there’s Africa. Here, elections are postponed indefinitely without reason by an incumbent who fears being ousted. When long-awaited elections actually happen, sometimes people’s votes aren’t secret and the government forces are scary enough that everyone votes for the incumbent out of fear.  If an incumbent leader happens to lose an election, he stays in office and appoints the actual winner of the election as Prime Minister (Kenya in 2007, Zimbabwe in 2009). Opposition candidates, party leaders and organizers, and vocal individuals who speak out against the government’s policies or management are “disappeared” (kidnapped and killed) or assassinated. And, in many countries, so-called “democratic” elections are more for show than anything, held only to prove to international donors like the US that the government is “trying” to democratize and is therefore worthy of aid. (There’s also an outside chance that a democratically elected leader will be assassinated by an outside force…like the CIA. Ex: Patrice Lumumba of the Congo in 1961.)

Tanzania is a great example of the strange incarnation of “democracy” in Africa. The country held its first post-independence election in 1961, shortly after independence from the British. In this election, Julius Nyerere was elected as the first president of Tanganyika and Zanzibar, which he combined into “The United Republic of Tanzania” (“Tan…ia” for Tanganyika and “…zanz…” for Zanzibar…get it?). Nyerere and his Chama Cha Mapinduzi (CCM, Party of the Revolution in English) wrote the constitution and established the foundation for modern politics in Tanzania, including the systematic suppression of opposition parties. Nyerere held the presidency  for 24 years until the country’s first “multi-party” democratic elections in 1985. Ali Hassan Mwinyi (President 1985-1995), Benjamin Mkapa (1995-2005), and Jakaya Kikwete (2005-present) have all been member of the CCM political party, and Kikwete is expected to be re-elected again this year.

On paper, Tanzania is a democracy. The country has a democratically elected leader voted for by the entire 18-and-over population of Tanzania, and elections are held every 5 years on the last Sunday of October. Opposition parties are allowed to form and operate without official legal repercussions, and the constitution allows Tanzanians the freedom of association with any party they choose. (Currently there are two serious opposition parties: CUF and Chadema. Chadema is the largest opposition party on the mainland, and CUF on Zanzibar.) On election day, people go to the polls and vote in privacy, and votes are sealed in their boxes by officers of the law before being transported to the nearest vote-counting station. The person with the most votes takes office, the other candidates are the losers. Et cetera.

But, in practice, it’s a lot more complicated…and a lot less democratic. Voters are discouraged from registering to vote or kept from voting by tactics similar to those used on African American voters in the 1960s. The CCM uses government funds (a LOT of government funds), government airplanes, government buildings, government workers, and government media and television outlets, and other government resources to promote itself, but the CUF and Chadema have to fund their campaigns through private donations solicited largely from a population of impoverished Tanzanians. There’s even rumor (though somewhat more substantiated than rumor…) of CCM officials buying the voter registration cards of under-35’s for as little as $4 so that they can’t vote for Chadema come election day, or “losing” entire pages of registered voters names at the polling stations. (They have two sections for voting: under 35, and over 35. Since it’s under 35’s who tend to vote Chadema, by losing just one page of voters’ names it’s very easy to eliminate non-CCM votes.) In rural areas, police (who are government employees under the CCM government) intimidate uneducated voters by hinting that their safety could be jeopardized if CCM left power, and on election day they stand outside polls with their automatic weapons so that nobody forgets who holds the power. Candidates who draw attention to CCM corruption or Kikwete’s failed policies end up in jail on “treason” charges and are no longer eligible to run for office; others running for local offices mysteriously die of “natural” causes. This year, the government announced that colleges and universities (which are usually closed until after the election) would open 3 days BEFORE election day, meaning that the largely Chadema-supporting college population will be away at school instead of at home to vote on Sunday, and there’s no option like absentee voting. And then, even if all the CCM-favoring election-skewing plots prove ineffective, there’s always the fall-back option of just tampering with the votes before they’re officially counted. After all, it’s the polling station workers (hired by CCM) and police officers (hired by CCM) who are responsible for securing the votes and certifying their validity.

On Thursday afternoon I attended a Chadema (Chama Cha Demokracia na Maendeleo, or Party of Democracy and Development) political rally for Doctor Slaa, the most popular opposition presidential candidate on the mainland. Despite the fact that he never showed up (TIA, right?) and that I only understood about 40% of what various candidates yelled crazy-African-preacher-style over the loudspeaker, it was a really interesting and enlightening experience. I made friends with two high school teachers and we discussed (in Swahili!) the election, the history of Tanzania, and the platforms and promises of various parties and candidates.

At one point, I asked them if they thought Doctor Slaa would win on Sunday and they both laughed at me like I was ridiculous. They were there to show their support, they said, for any kind of non-CCM change, but it has to happen gradually. Five years ago, an opposition rally like Thursday’s NEVER would have happened. Candidates would have been afraid to speak out against CCM, and people would have been afraid to show up to such a rally for fear that their businesses or families would be harmed as a result of their participation (or just their curiosity). “Chadema isn’t campaigning for 2010, they’re campaigning for 2015. We’re all here to show other people that if they, too, can support another party and not be killed.” They said that if on Sunday they vocally vote for Chadema and then aren’t punished by the CCM, maybe their CCM-fearing friends and neighbors will consider voting for someone other than CCM in 2015.

They also laughed when I asked if Tanzania had ever had “free and fair” elections. According to the Carter Center, which monitors this kind of thing, Tanzania’s 2000 election was fair, but 2005 was rigged in favor of the CCM, and regional elections on the island of Zanzibar have never been fair. But my teacher friends (and most everyone else I talk to about it, including Tanzanians, expats living here, and second- or third-generation immigrants) say that the country’s never had a democratic election. The concept of democracy is simply too new for anyone to trust its effectiveness and safety, so they just vote like they always have, even when CCM was the only party in the race. One of the teachers said he suspected that only about 30% of votes cast for Chadema would actually survive the ballot box long enough to make it to the official count, and that CCM had decades of experience in buying votes, fabricating ballots, and in their own special kind of less-than-impartial vote counting.

Even if this ISN’T true (which, honestly, who knows?), it’s frighteningly undemocratic that the people of Tanzania have so little faith in their trustworthiness of their government, and so little belief in the importance of their vote, that this kind of belief even SEEMS believable. Whether it’s true or not, if you were worried that you might be killed, injured, denied a job, or punished in some other way for voting for an opposition candidate, and were 70% sure that your Chadema/CUF vote would be thrown away anyway, wouldn’t you just vote CCM, too? It’s amazing to me that people still run for office on a non-CCM ticket, or donate to non-CCM political campaigns, or show up to non-CCM political rallies to show their support for NOT the CCM. (There’s no free food at said rallies…but sometimes there is at CCM rallies.) If there was complete political freedom in Tanzania, how many more people would support Chadema over the CCM?

Anyway, it’s something interesting to think about as we near Election Day in the US. When you cast your vote next Tuesday (and please do…especially if you’re a Democrat), you’ll be doing it without fear for your life, and you’ll be confident that your vote counts for something regardless of who you vote for. That’s a right (well, we consider it a right) that most people in the world simply don’t have, even in so-called “democracies.”

Chadema is an approximate acronym that stands for Chama Cha Demokrasia na Maendeleo, or The Party of Democracy and Development. Chadema is the largest opposition party in Tanzania (on the mainland at least), and this is their flag.

Chadema supporters holding up peace signs to show their support of Doctor Slaa, the main challenge to the incumbent President Kikwete in Sunday's election. The sign there translates to "Doctor Slaa--You are our only hope. We believe in you, and we need Chadema!"

Vuvuzelas have taken over the world! This guy is also wearing a Chadema flag as a shirt and his sweet dance moves kept me entertained during long speeches I only partially understood.

A little boy toting around a pro-Chadema sign at the political rally on Thursday afternoon. It translates as "We believe in you, we need you Doctor Slaa! Doctor Slaa is the lion of the war!" And then there's a sentence I can't read because all the letters are crammed together.

The HQ for the Chama Cha Mapinduzi (CCM) party for the Iringa Region. That guy is President Kikwete.

What's newsworthy, anyway?

As part of my ongoing quest to reconnect myself with the developed world, I’ve been checking out CNN.com and downloading NPR podcasts and trying to compensate for 2.5 years of being out of the current events loop. In the last month, I’ve learned about the suicides of gay teens in the US, the kidnapping and subsequent release of an aid worker in Somalia, earthquakes and tsunamis in Southeast Asia, the rescue of 33 miners in Chile, an outbreak of cholera in Haiti, a Pennsylvania woman who allegedly killed her 4 children, etc. These things matter.

But right next to those stories I see others about Lindsey Lohan’s most recent “tweets” about her drug problem, rapper TI’s parole violations (he tried to buy several machine guns from the trunk of an undercover cop car in a grocery store parking lot, got out on parole, and then rolled up next to a cop at a stop light while smoking something illegal...), $8000 bejeweled i-phones, and all sorts of things that are of absolutely no consequence to 99.99% of the world.

And I start to wonder: Is this really NEWS? And, more importantly: WHO CARES? Aren’t there more IMPORTANT things going on in the world?

Then yesterday I stumbled across the most recent annual report of UNAIDS (the UN Agency for AIDS) at the UNAIDS Blog (www.unaidstoday.org). Arguably, AIDS is a little bit more important than Sandra Bullock’s most recent beach vacation with her adopted baby boy (especially since it directly affects at least 35 million more people than does their vacation) but stories about HIV/AIDS aren’t really news anymore. And I understand why…it’s depressing and showing no real signs of improvement. Since the “discovery” of the virus in 1981, there have been very few changes in the world of HIV: developments in anti-retroviral drugs that slow the progression of the disease, increases in funding and efforts by humanitarian organizations and governments to thwart the pandemic or mitigate its impact, countless failed vaccine trials and curative drugs for the disease, and a steadily increasing rate of infection with the largest concentration in Sub-Saharan Africa.

But, for the 33.4 million people in the world currently living with HIV, their friends, their families, and their communities, it’s a pretty big deal.

As Americans, HIV is something that we’re able to easily write off as being someone else’s problem. We believe that it’s something that affects people who have casual sex or use drugs, or affects poor Africans that we have no relation to whatsoever, and most of us don’t know anyone who is HIV-positive or who has been affected by HIV in some significant way.

In reality, though, it’s something that affects everyone, not just gay men and drug users and prostitutes you’ll never meet. It affects women who are raped in the Congo. And children of women who are HIV-positive. And people who undergo traditional blood-letting ceremonies as rites of passage, during which they’re cut with shared razor blades. And it affects people of all races, all religions, all nationalities and ethnicities, and in all countries.

Here are the statistics I found most sobering:

There are 1.4 million people in North America living with HIV, and an estimated 55,000 people were infected in 2008 alone. In 2008, there were 25,000 AIDS-related deaths in the US. Though the adult prevalence rate is only 0.4% in the US, some cities (like San Francisco and Washington, DC) have rates higher than those of African countries.

Since the beginning of the epidemic in the 1980s, 60 million people have been infected with the virus, and 25 million have died of AIDS-related causes.

Each year there are an estimated 2.7 million new infections in the world, 40% of which are in young people aged 15-24. Another 430,000 children born with HIV each year.

Sub-Saharan Africa is home to 67% of global HIV infections (22.4 million people), and 91% of new infections among children, and the epidemic has orphaned more than 14 million children in Africa alone.

Less than 40% of people who are HIV-positive know that they are HIV-positive, and unless they know they can’t get treatment or protect their partners and unborn babies.

For every two people starting treatment for HIV, another five are infected with the virus.

Only 38% of HIV-positive children in need of treatment are currently receiving it.

One in three HIV-positive people also suffers from tuberculosis, which is the leading cause of death among HIV-positive people. (Yet TB is both preventable and curable.)

And it’s not just the 33.4 million infected who are affected: it’s the families that take care of them, the children they orphaned, the friends who have to watch them go through depression and eventual decline, the employers who suffer the effects of absenteeism, insurance companies that have to cover the cost of exorbitantly expensive anti-retroviral drugs, the communities that suffer in the absence after their death (especially in the developing world), and everyone else in the world who pays taxes to a government that provides aid for HIV-positive people. (That last category probably includes you.)

See, it’s way more important than Vince Vaughn’s slightly homophobic one-liner in his latest movie, which happened to be the second “Most Popular” story on CNN.com sometime last week…right after “How to make your YouTube video go viral.” Hard-hitting, life-changing stuff, right?

And it’s not just the lack of caring about HIV that gets me, it’s also the KINDS of HIV and AIDS-related things that are deemed newsworthy. (And I’m guilty of it too in this blog post…) All the news is negative. It’s about failures and wasted money and deaths and new infections. There’s nothing about the fact that this year there are 10 times as many people on ARVs than there were just 5 years ago, which means less deaths and less orphans than before. Stories about the rate of HIV infection stabilizing in countries like Botswana and Lesotho are relegated to the bottom of the Africa section on CNN.com, even though for Botswanans and Lesothoans that’s a big deal. Stories about people working to change the lives of HIV-positive children or NGOs that are making headway in preventing new infections are relegated to local newspapers even though those individuals and NGOs are a big part of the reason that the pandemic seems to be slowing in a lot of countries. And every failed drug trial or failed vaccine really is a step closer than the one before, but all we see in the news is that YET ANOTHER drug has failed to prevent/cure HIV.

So, yes, HIV is bad. It’s horrible. I actually can’t imagine anything worse than a virus with a 100% fatality rate that disproportionately affects poor women and children in developing countries. But every step taken against HIV is a step in the right direction. Every 15-year-old HIV-positive child who is still alive thanks to ARVs from WHO is progress. Every teenager who chooses to use condoms to protect himself from HIV infection like his MSF-funded summer camp taught him is one more person who will be spared infection. Every pregnant woman who learns her HIV status at her local free clinic and follows all the rule of PMTCT gives birth to one more HIV-negative baby. Many governments and international organizations, and countless NGOs and individuals are working hard on a regional or individual level, changing future of the pandemic a little bit each day. And researchers are much more familiar with the HIV virus than they were 30 years ago when this whole pandemic started.

So that’s what I call “news.”