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Tuesday, July 29, 2008

HIV/AIDS: State of a Global Epidemic

HIV/AIDS: State of the Global Epidemic

Excerpts from Lawrence K. Altman article in the NYT –July 30, 2008

A report financed in part by the Ford Foundation and the Elton John AIDS Foundation, provides a startling new perspective on an epidemic that was first recognized in 1981.

Nearly 600,000 African-Americans are living with H.I.V., the virus that causes AIDS, and up to 30,000 are becoming infected each year. When adjusted for age, their death rate is two and a half times that of infected whites, the report said. Partly as a result, the hypothetical nation of black America would rank below 104 other countries in life expectancy.

If black America were a country, it would rank 16th in the world in the number of people living with the AIDS virus, the Black AIDS Institute.

In a separate another report, the United Nations painted a somewhat more optimistic picture of the worldwide AIDS epidemic, noting that fewer people are dying of the disease since its peak in the late 1990s and that more people are receiving antiretroviral drugs.

The United Nations report said that in Rwanda and Zimbabwe, changes in sexual behavior had led to declines in the number of new H.I.V. infections.

However, the report found that progress remained uneven and that the future of the epidemic was uncertain.

These reports come in advance of the 17th International AIDS Conference, which begins this weekend in Mexico City.

Sunday, July 27, 2008

What would Jesus do?

The simplest way of describing the rupture at the heart of the 80million strong Anglican Communion is to say that the socially conservative religious traditions of Africans, traditions are at odds with socially liberal mores of the rich world, especially over the issue of same sex unions or homosexuality. This adherence to the traditional fundamentalist strain was bequeathed to the early African church by the Victorian missionaries.

Led by the fiery Archbishop Peter Akinola of Nigeria, the traditional conservative wing of the Anglican Church took the first steps towards forming an alternative pan-Anglican forum. Bishops from Kenya, Nigeria, Rwanda and Uganda are among the 230 or so prelates who are staying away from the Lambeth.

I find the position taken by the African Bishops self righteous. This seems to me like what the pious Pharisees would do. It departs from the fundamental tenets of love, forgiveness.

What would Jesus do?

Sunday, July 20, 2008

On Global Addiction to Crude Oil

This is an excerpt from Tom Friedman's column in the New York Times today.

....."We are addicted to dirty fossil fuels, and this addiction is driving a whole set of toxic trends that are harming our nation and world in many different ways. It is intensifying global warming, creating runaway global demand for oil and gas, weakening our currency by shifting huge amounts of dollars abroad to pay for oil imports, widening “energy poverty” across Africa, destroying plants and animals at record rates and fostering ever-stronger petro-dictatorships in Iran, Russia and Venezuela."

"When a person is addicted to crack cocaine, his problem is not that the price of crack is going up. His problem is what that crack addiction is doing to his whole body. The cure is not cheaper crack, which would only perpetuate the addiction and all the problems it is creating. The cure is to break the addiction."

"Ditto for us. Our cure is not cheaper gasoline, but a clean energy system. And the key to building that is to keep the price of gasoline and coal — our crack — higher, not lower, so consumers are moved to break their addiction to these dirty fuels and inventors are moved to create clean alternatives."

Friedman really nailed the global oil crisis. Friedman is an incisive global thinker. I highly recommend his book "The World is Flat".

I view the current energy crisis wrought by high crude oil prices as opportunity begging at our door. The time to innovate is now. As a global collective we can and we must.

Read Al Gore's bold and visionary plan to end addiction to oil.

Wednesday, July 16, 2008

Genetic variation increases HIV risk in Africans

A genetic variation which evolved to protect people of African descent against malaria has now been shown to increase their susceptibility to HIV infection by up to 40 per cent, according to new research. Conversely, the same variation also appears to prolong survival of those infected with HIV by approximately two years.

The discovery marks the first genetic risk factor for HIV found only in people of African descent, and sheds light on the differences in genetic makeup that play a crucial role in susceptibility to HIV and AIDS.

The research, published today in Cell Host & Microbe, was co-authored by Professor Robin Weiss, UCL Infection and Immunity, who worked with colleagues in the US to analyse data from a 25-year study of thousands of Americans of different ethnic backgrounds.

The gene that the research focused on encodes a binding protein found on the surface of cells, called Duffy Antigen Receptor for Chemokines (DARC). The variation of this gene, which is common in people of African descent, means that they do not express DARC on red blood cells. DARC influences the levels of inflammatory and anti-HIV blood factors called chemokines.

Discussing the findings, Professor Weiss said: "The big message here is that something that protected against malaria in the past is now leaving the host more susceptible to HIV.

"In sub-Saharan Africa, the vast majority of people do not express DARC on their red blood cells and previous research has shown that this variation seems to have evolved to protect against a particular form of malaria. However, this protective effect actually leaves those with the variation more susceptible to HIV."

Lead author of the study, Professor Sunil K. Ahuja, from The University of Texas Health Science Center at San Antonio, added: "It turns out that having this variation is a double-edged sword. The finding is another valuable piece in the puzzle of HIV-AIDS genetics."

HIV affects 25 million people in sub-Saharan Africa today, an HIV burden greater than any other region of the world. Around 90 per cent of people in Africa carry the genetic variation, meaning that it may be responsible for an estimated 11 per cent of the HIV burden there. The authors observe that sexual behaviour and other social factors do not fully explain the large discrepancy in HIV prevalence in populations around the world, which is why genetic factors are a vital field of study.


Free Schools may be a barrier to Education in Africa

Governments across Africa are scrambling to introduce free education. The abolition of school fees is largely owed to the Millennium Development Goals, which sets as one of the goals that every child should be able to complete an elementary education by 2015.

Word that education was free spread swiftly from child to child. Undeterred by poverty, million of children, many of them barefoot, clothed in rags and dizzy with hunger, streamed into schools across the continent.

The explosion in enrollments has put enormous pressure on over burdened, often ill-managed education systems. Children hurdle together on the concrete floor, rocks or out on loose dirt in the school often jostling for space. Their laps and the floor are their only desks.

Free education initiative has sent expectations soaring. But can we make it deliver for the millions of eager supplicants of knowledge? Can we make it deliver for a Kezia, a single mother who makes $0.7 a day breaking rocks but dares to believe that when her daughter in second grade finishes school and gets a job she will rest? Can we vindicate Johanna, a son of a crab trapper who quit his job as a herds’ boy, denying his family the needed income, to go to school?

Experts now worry that the drive to expand access has eclipsed the focus on learning outcomes. Cramming children into classes and thinking that is education is clearly not working. A school teacher in Kenya estimated that 100 of her 250 students would have to repeat the grade. In Malawi four out of ten of first graders repeat the year. Even Uganda, often held up as a model, also found that achievement fell as classes swelled with highly disadvantaged students.

Following the introduction of free primary education, enrollment has surged to 7.2 million in 2004 from 5.9 million in 2002. Kenya has an average ratio of one teacher for each 39 students. In the most crowded schools the ratio is one teacher to 111. Kenyan officials estimate that an additional 20,000 teachers need to be employed to address the teacher-student ratio.

The World Bank, the largest international donor supporting Kenya's education initiative, is pushing for teacher transfers as opposed to costly new hiring. Kenyan schools suffer from a severely unequal distribution of teachers. This will require not money but political will. Transferring large numbers of teachers to understaffed schools will mean taking on teachers' union, as well as communities and their political patrons who are beneficiaries of the inequitable teacher deployment.

There is a worrying gap in standardized test scores between private and public schools. Of the top 100 students in Kenya’s national standardized test for primary school leavers, only 17 % were from public schools. Conversely, 83% of the best students were from private schools and yet they comprised only 4 % of the primary student population. As long as a vast majority of children are trapped in dysfunctional, failing schools, free education we will not deliver for Kezia and Johanna.

What hangs in the balance is the future of a generation of African children and their parents desperately reaching out for education as the escape route from poverty.

Sunday, July 13, 2008

Breakthrough in fight against malaria

Malaria is preventable and curable, but can be fatal if not treated promptly. Malaria kills an estimated 3000 children each day in sub-Saharan Africa according to AMREF. The CDC estimates that there are 300-500 million cases of malaria each year, and more than 1 million people die.

Researchers at the Walter and Eliza Hall Institute in Melbourne Australia have identified a potential treatment to combat malaria by pinpointing the process that helps the disease hijack red blood cells.

They have found the key to an adhesive that stops the parasite being flushed out to the spleen where the parasites would be destroyed. The removal of just one of these compounds is enough to bring the process to a halt.

Researchers at the Walter and Eliza Hall Institute have identified eight proteins that allow this glue-like substance onto the surface of a hijacked cell. Proteins are nature's building blocks. They are large molecules that are essential for the function of cells in the body. Targeting those proteins could be a key to fighting malaria.

Tuesday, July 8, 2008

Africa: Governance League Table

The World Bank’s 2008 political report on the political state of Africa is out.

The report suggests that Africa’s economic policies are improving, economies are growing faster, the region is more politically stable and governance is getting better. These assertions are rather audacious given the uneasy political calm in Kenya following a chilling wave of post election turmoil and the discredited poll in Zimbabwe.  

But the regional figure for government effectiveness has deteriorated some 17%, as has regulatory quality and the control of corruption. Africa's performance as regards rule of law has barely changed since 1996.

The report however notes that African aggregate indicators worsened some 7.6% between 1996, when the governance indicators were first compiled, and 2000. There has been a modest improvement since then, but the total index is still 5% lower now than in 1996.

Country performances are varied. Most of those in the top ten have made handsome gains since 1996, although Benin and to a lesser extent Namibia, Tunisia and Lesotho have all lost ground. Similarly, governance has deteriorated, usually substantially, in most of the poorest-performing countries. The Democratic Republic of Congo (DRC) and Sudan are reported to have made some headway although it is not clear exactly how,

The resource curse plays out. The more endowed a country is in terms of natural resources, the worse its governance ranking. However there are exceptions, such as Botswana and Namibia-both in the African top five in terms of governance performance-, but most resource-rich countries are down the league table: the DRC, Sudan, Chad, Equatorial Guinea, Congo (Brazzaville). Nigeria and Angola are all ranked between 34th and 46th in the World Bank's regional rankings.

The more resources a state has, the less likely it is for the ruling class to take governance reforms seriously. This observation is also supported by governance gains made by Liberia and Rwanda, two resource-poor countries emerging from political crises. For instance, they have certainly outperformed Angola, a resource-rich country whose governance record is deplorable. 

Monday, July 7, 2008

Sanitation: The Unsung Killer

This week at the G8 summit in Hokkaido Japan, WaterAid, launched a report on sanitation. The report presents evidence that suggests sanitation may be the biggest killer of children in the world and yet it is the most neglected development sector. The hope is that this report will remind the world’s wealthiest and most powerful that without addressing sanitation all other development efforts will be undermined. In Africa, not just health, but also education and economic growth are all held back by governments' neglect of water and sanitation.

It seems ironic to be discussing sanitation at a luxury resort hotel in Japan, a country where toilets have electronic sensors and heated seats. It's a different planet, light years away from the 2.6 billion people who still have no access to even basic sanitation.

In 2002, an MDG target to reduce by half the proportion of people without access to sanitation was agreed by the UN for achievement by 2015. The WaterAid report suggests that the sanitation sector is in crisis. The report indicates that 40% of the world's population lack access to even basic sanitation. At the current rate of 'progress' this global target will not be met, and in sub-Saharan Africa it will not be reached until 2076, 61 years too late.

It is clear that that investing in hygiene and sanitation offers the greatest public health returns of any development intervention. For instance investments in sanitation will bring massive gains to other areas of development too; more girls in school, less money spent on treating diarrheal diseases, more resources in hospitals to deal with other health issues.

The WaterAid report claims that poor sanitation kills more children than HIV/Aids, Malaria and Measles combined yet it remains neglected. Most donor and aid-receiving governments in developing countries have no clue about how much they spend on water and sanitation. The report asserts that lack of investment in sanitation reveals a blind spot in development policy: a failure to recognize sanitation’s integral role in reducing poverty.

The report concludes that sanitation is the single most cost-effective major public health intervention to reduce child mortality and will accelerate progress and reinforce investments in other MDG targets and goals.


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