Farewell McGreal, Guardian's Man in Africa

For 20 years, there has been no journalist in Africa quite like Chris McGreal, the bulldog of Britain's Guardian newspaper foreign corps. Chris was everywhere, or had been everywhere, when Nelson Mandela cast his first ballot in 1994, when Hutus were slaughtering Tutsis in Rwanda, when Zimbabwe's long descent into hell picked up speed. Chris hustled. He was brave. He was tough. He took no shit. And, to top it off, he wrote pretty damn well too, better than most of us dared.
Check out his swansong today, whose only weakness is the inevitable, hackneyed headline "Out of Africa." Egad. I'm sure it's the fault of some editor somewhere. In any case, at a time when many great foreign correspondents have gone home, been laid off, or simply moved on to other parts of the world, I mourn Chris's move to the Washington bureau for the Guardian. Our understanding of our still-new president no doubt will be enriched, but our grasp of Africa certainly will suffer.

Global Recession Hits Africa

Terrific story on the front of today's Washington Post by my colleague Karin Brulliard, who took over as Johannesburg bureau chief after I left. I particularly like the lede, colorful, but sharp and to the point:

LUANSHYA, Zambia -- The global economic meltdown swept into this company town and took down the copper mine in January. It left in its wake a crisis measured in unsold tomatoes at the market, empty stomachs and desperate people lined up outside Chishimba Kambwili's pink house each morning.

Ah, Zimbabwe

There was a nice piece in the L.A. Times over the weekend comparing trying to report in Zimbabwe with similar challenges in war-torn Chechnya. Well-worth the read, with many nice touches by correspondent Robyn Dixon.
Wish I could write like this:

"The road to Gweru beckons, like a painting: a ribbon of pocked gray tar, flanked by jagged red gravel lines and wide green stripes of bush daubed on thick and wild. Nimble gray monkeys leap from red to green as you pass."

I fear it's too late for me to learn. Too much TV, not enough poetry, in my youth.

A Good AIDS Ad in Swaziland

Some readers of my Outlook piece in today's Washington Post about the AIDS problem in D.C. are asking what a good AIDS billboard would look like. Well, I thought this one from Swaziland was on point entirely. It will seem a bit preachy to some people, but it deals directly with the problem that accelerates the spread of HIV sexually. Sadly the far more prevalent billboards pushing condoms have been around so long, I'm not sure people see them any more. The small tag line at the bottom of this one is: "Casual sex is dangerous. HIV kills."
And below I'm re-posting a nice television ad from Mozambique. And here is a radio interview I did Sunday morning on WTOP radio in Washington.

Why Can't We Track HIV At Home?

I make a brief return to the Washington Post’s pages this weekend with an Outlook section piece about the AIDS problem in D.C. As I say there, and in a previous posting here, I think some of the important trends got lost in the furor after last weekend’s report about a 3 percent HIV rate in the city. And there’s not much evidence of an AIDS problem that’s actually getting worse in Washington, or one that resembles problem spots in Africa.
That said, there is something elusive about what’s happening in Washington. We simply lack the surveillance tools to know if, for example, there is a new spike of infection in the city. The report offers no evidence of one, but it also doesn’t offer much in the way of contrary evidence. Because HIV takes many years to develop in AIDS, and because the D.C. surveillance systems passively rely on reports rather than seeking out trends at sentinel testing sites as is common in Africa, we’re left guessing at the most important question: How many people are getting newly infected with HIV today?
In scientific terms, this is called HIV “incidence,” as opposed to the more commonly quoted “prevalence” that merely tracks how many people are alive with the virus, no matter whether they got it last year, or during the peak of transmission in the 1980s.
Amazingly, it was easy for me to find a pretty good estimate of HIV incidence for urban Uganda. Reasonably good studies of incidence exist for many other African countries. Yet it was impossible for me to get one for Washington, D.C.
As much as I’m wary of comparisons between AIDS epidemics in Africa and the ones here, I do think that some of the tools used to guide valuable programming there should be considered for deployment here. The new D.C. HIV/AIDS report is much better than anything we’ve had for the city before, but the risk is that because that data based on old infections, we still might miss the important trends today. If we are serious about a renewed commitment to knocking down the rate of new infections, we need to know when, where and how they are happening.

AIDS in D.C.: Getting Worse? No.

Kudos to my Washington Post colleagues Jose Antonio Vargas and Darryl Fears for helping turn the spotlight on the unnervingly high HIV rate in our nation’s capital. This is a place very close to my heart. I covered D.C. politics for several years before going to Africa, and my wife and I still own a home on Capitol Hill to which we will be returning later this year.
But I am a bit uneasy with the way D.C. officials (Mayor Adrian Fenty pictured to the right) seem to be portraying what’s happening there. The 3 percent HIV rate certainly is cause for concern, but the comparisons to rates in African countries are misleading.
Here's the quote that caught my eye: "Our rates are higher than West Africa," said Shannon L. Hader, director of the District's HIV/AIDS Administration. "They're on par with Uganda and some parts of Kenya."
Those African rates are national ones, not one for a geographically compact city like Washington, D.C. If you compared to core urban rates in Uganda and Kenya they are substantially higher than what D.C. is showing. That’s even more true at the epicenter in Botswana, South Africa and Swaziland.
More importantly, the numbers of NEW AIDS cases in Washington appears to be falling fairly steadily, and has been for several years according to both last year’s AIDS report, and the new one officially released today. Check out page 22 in the 2007 report. AIDS deaths are steeply down as well.
How could this be? People with AIDS aren’t dying at such a high rate anymore, at least not in places like the United States where effective treatment with antiretroviral drugs is universally available. In places with effective treatment, the number of people LIVING with HIV will keep going up for years even if the numbers of people getting HIV is going down. In that scenario, a rising rate of people with AIDS is good news, not bad.
To my eye, the most important elements of these reports are their potential ability to guide an effective response. Not surprisingly, gay men have high infection rates. But the rates among African Americans are eye-openers and remind us of the need for more effective prevention strategies. Condoms and HIV testing are not enough.
Mayor Fenty’s push to block transmission by infected mothers to their babies is urgent. Let’s hope, however, he doesn’t shy away from discussing the sexual behaviors—especially multiple, concurrent partnerships—that drive HIV so efficiently.
Even more broadly, let’s not mistake our new awareness of the AIDS problem in D.C. with being a problem that’s truly new, or truly getting worse. I’ve watched how sloppy portrayals of the epidemics in Africa have led to poorly targeted responses. Our nation’s capital shouldn’t make the same mistakes.

The Real Problem With Female Condoms

Few HIV prevention tools have generated more hype and less demonstrated success in Africa than the female condom. The Chicago Tribune reports in a blog today about a new one approved by the FDA that is made from a different material (synthetic rubber instead of polyurethane) and hence is cheaper to make. For those who want to use the female condom, this obviously is good news.
But who are these people? In four years in Africa, I never met a single woman who said she regularly used this device. The cheaper, easier and vastly more plentiful male condoms had at least become routine (if not always consistently used) for bar hookups or encounters with sex workers. But the female condom has not yet caught on. The Tribune article blames this on price. My gut is that different problems are at play: Those who have tried them say they are uncomfortable and also squeak during sex. One woman compared it to stuffing a garbage bag into her body. The Tribute article doesn't address these issues, though other reports suggest that the newer generation of female condoms are indeed less squeaky, if not less like bags. (Here's a nice piece from the NYT on newer female condoms: http://tinyurl.com/2vf2gn)
But remember that a woman using a female condom is still taking a stand, and risking a fight or abuse from her husband or boyfriend, because he surely will know that it's there. Many will perceive this as a sign of distrust, which has been a key barrier in keeping male condoms from being used more widely, and hence more effectively, in long-term relationships. In the end, are the dynamics so different between male and female condoms?
No one doubts the need to give women more control over their sex lives, especially in African societies where they don't traditionally have much. And we've all heard story about faithful wives getting HIV from their unfaithful husbands. But is the best answer a new product?
Let's remember that the core issue here is the nature of loving relationships, and the disastrous disruptions in traditional sexual rules wrought by colonialism and its aftermath. This is surely a tricky subject, but in societies where multiple sexual relationships are widely accepted, maybe more energy needs to go into making women feel like they have the right to demand mutual fidelity from their husbands or boyfriends. Or better yet, more energy could go toward helping men see that having lots of sex partners is deadly, as South Africa's Soul City soap opera recently has tried to do. Even more direct is this add from Mozambique. It's in Portuguese, but the message is clear enough...