Freshlyground Co-Founder Moves On

For those who have enjoyed the South Africa Afro-pop band Freshlyground, it's sad to see that one of the founding members, keyboardist Aron Turest-Swartz, has decided to move on (see gentle announcement of "new band member" here: http://www.freshlyground.com/). I met Aron several years back writing about the band's remarkable, and remarkably unintentional, knack for crossing South Africa's still strict racial lines (http://tinyurl.com/ccotrq). He was so mellow, so Zen-like, that I had trouble at first believing he was a rock star. The best part is, so did he. The only time he lost that persona was during the stage performances of their biggest hit, "Doo Be Doo," (for the uninitiated, much cooler than the title sounds: http://tinyurl.com/dml4v7), when Aron would come out from behind the keyboard and dance like a madman, complete with a few Zulu kicks. The crowd always went wild.
Luckily, the band's creative core, and especially dazzling lead singer Zolani Mahola, are still there, so I don't expect a dropoff in quality as the freshlyground begins work on its fourth album. And happily, Aron seems happy to spend more time with his wife and their young son after years of greuling, nearly constant travel. But I'll miss Aron's vibe, and I'll miss those Zulu kicks!
If you are a fan, or just want to shout-out to Aron, please hit "comments" below.

Is Jail Best for Darfur Crimes?

It's certainly hard to feel bad about Sudan's Prez al-Bashir getting indicted by the International Criminal Court. There's no real doubt about his role in the horrendous assault on his own nation's citizens. If that isn't worth jail time, I can't imagine what is. Here's the take by my Washington Post colleagues: http://tinyurl.com/bkndvw.

To all this, I offer one reservation, best outlined in this story last year by Stephanie Nolen of Canada's Globe & Mail (http://tinyurl.com/baxltr), about how the international justice movement gets in the way of actually getting an evil despot out of power. Would Charles Taylor, the best example of international justice in Africa so far, have stepped down when he did if he knew he was eventually going to end up in jail, rather than in a bungalow in the Nigerian tourist town of Calabar? I see no easy resolution to this tension. It's clear that this stuff has been on Mugabe's mind, and those of his top advisers, as they have held on so tenaciously as Zim has gone from bad to worse to catastrophic to outright hellhole. I'd rather the old man spend the rest of his life in the Ritz Carlton if it meant Zimbabweans could begin their recovery free of his influence.

(For my take on the shortcomings of international justice in Sierra Leone, see http://tinyurl.com/accd7c).

What do you think? Is justice for one man, however evil, worth the possible price of slower political resolutions to Zimbabwe-type disasters?

Drink Away the Recession Blues

On a (much) lighter note, Robyn Dixon of the L. A. Times, whose coverage of Zimbabwe has been the ballsiest anywhere, showed her range recently by catching a trend toward high-quality, value-oriented South African wines amid this disastrous economy. She even caught President Obama sipping the stuff. http://tinyurl.com/c5fnx5. It's a great read.
(Disclosure, I'm friendly with Robyn, the winemaker she wrote about Eben Sadie. Plus my brother, Sam Timberg, imports South African wine for a living. How's that for a trifecta conflict?) In any case, read away, or drink away, or both....

For my minor offering on the subject of South African wines and the perils of global warming, check out: http://tinyurl.com/czk5sf. (Wrote this before Eben and I were friends).

AIDS Prevention 2.0

Here's an idea I'm hoping will animate most of what we do on this blog: The AIDS Prevention strategies of the past have either failed, or topped out in terms of their ability to control the epidemic. This is especially true in sub-Saharan Africa. If condoms (or HIV testing, or "positive attitude" posters) were going to reverse the tide, it would already have happened in many places. If treatment was going to do it, new HIV infections would be going down quickly in Botswana, where ARVs are approaching universal levels. Sadly this hasn't happened. We need new strategies, or to better deploy old ones.
I have ideas on what might work. But I'd like to hear from the blogosphere: Out of the tools not yet deployed, or under-deployed, what should get attention now?
There's a moral obligation, I think, to have an intellectually rigorous answer to this question. That's what AIDS Prevention 2.0 should be about. As long as the average South African teenager has a 50 percent chance of catching HIV in his/her lifetime, none of us can walk away feeling like we've made enough of a difference.
So, ideas?
Hit the "comments" button at the bottom of this post to join the conversation.

New Pepfar czar?

Who knows this guy Mark Kline, the possible new PEPFAR Czar? http://www.chron.com/disp/story.mpl/metropolitan/6286401.html
Does he get prevention? Is he an improvement on Mark Dybul? Yes? No?
The answer could hardly be more important.....
Other names tossed about, according to the Houston Chronicle, "Dr. Eric Goosby, President Clinton’s AIDS policy director; Dr. Jim Yong Kim, a Harvard professor and former World Health Organization AIDS chief; Dr. Nils Daulaire, former president of the Global Health Council; Dr. Wafaa El-Sadr, a Columbia School of Public Health epidemiologist; and Warren Buckingham III, PEPFAR’s director in Kenya."

Multiple Concurrent Madness?

Helen Epstein's teriffic "The Invisible Cure" (http://www.invisiblecure.com/) has helped push the conversation toward the essential role played by multiple concurrent partnerships in spreading HIV, especially in Africa. I don't sense a lot of serious debate about Helen's essential point. It's clear that men and women who keep more than one sex partner in a single week or month are more likely to get HIV, and to transmit it to others, including their monogamous husbands or wives. It's a point also at the core of the ideas put forth by my friend Daniel Halperin (who is the co-author on our forthcoming book "Dr. Livingstone's Children: Why We Are Losing the War on AIDS, and How To Win").
What has proven more nettlesome is translating that insight into action. The Ugandans famously did it in the late 1980s and early 1990s, but then forgot how to do it as the big AIDS money rolled in, and perhaps also as that society normalized into a more-settled postwar era (http://tinyurl.com/d7u8qe). The Zimbabweans also did it, with the help of massive economic collapse and outmigration that made keeping multiple sex partners a luxury few could afford (http://tinyurl.com/2j5kvd). But the dilemma has been, and continues to be, how do create these sorts of changes in societies not coming out of a civil war, or not going through a historic economic and social collapse?

These issues dominated a revealing conference I attended in Gaborone, Botswana in late January, and sponsored by the Harvard AIDS Prevention Research Project, UNAIDS and the World Bank. The group struggled to find a single, dominant coherent message that could be rolled out across southern Africa, a region that (aside from Zimbabwe) has been notoriously poor at talking directly about the sexual behaviors that spread HIV particularly fast there.
I've been keeping tabs on the conversations that flowed out of that conference, and the effort to draft a solid, concise document that can be distributed around the region. My old friend Francois Venter, president of the Southern African HIV Clinicians Society, blasted the original effort in a blistering blast email. His point, in short, was: Everybody is sick of being told what to do (condoms/HIV testing/etc). If you are going to come forward now with another idea, it better be rooted in rock-solid, demonstrable science, with clear guidance on how to turn it into effective programs.
On this, I mostly agree. The science has to careful, the arguments rigorous and well-explained. But I'd like to think that, thanks to Helen and others, that even Francois would agree that the most urgent questions in AIDS prevention today has to be: How can we help change the sexual behaviors that are most dangerous? As a first step, don't we have a moral responsibility to make clear what these are?
I've spent dozens upon dozens of hours in bars/shebeens all over southern Africa talking about this stuff. And inevitably I end up flipping my notebook over and drawing a simple diagram of a sexual network, with my interviewee in the center in an expanding spiderweb of interactions. Not once has somebody failed to express surprise. A quarter century into the world's response to the epidemic in African, shouldn't everybody in these hardest-hit nations be familiar with this stuff. If they aren't, whose fault is it?

The good/bad news about vaginal microbicides

I join everybody in applauding the news that the microbicide people are making progress in their quest to find a better female-controlled HIV-prevention device. But no one yet has answered the deeper and harder question: How do you get people to use it?
Elizabeth Pisani nails the happy side of the development announced last month at the CROI Conference in Montreal: http://www.wisdomofwhores.com/2009/02/10/significant-progress-in-hiv-prevention/
But at least as valuable is this piece by the gang at CADRE in Johannesburg, where they have watched the rise and fall of many of the supposed solutions to the AIDS crisis. Take a look at their reservations about microbicide research: http://www.cadre.org.za/files/Parker%20Colvin%20Microbicides%20Durban%20Conference%20A267%20low%20res.pdf
I fear that microbicides, and the one-a-day prevention pills that also are showing signs of technical success, amount to just building a better condom. Sure they stop HIV, but only if people use them almost constantly, with all sex partners, in every interaction. Microbicides certainly have the advantage of more female control, though I'm skeptical that men won't know that their sex partners suddenly are inserting a new substance in their vaginas. I can recall interviewing couples in Durban a couple of years back about Microbicide use during trials, and the men definitely could tell the difference. In most cases, they liked the extra lubrication, which might be a secret marketing advantage for microbicides IF you can get people to start using them.
In any case, the technological problems will not be the hardest ones to solve for Microbicides. As with most everything having to do with AIDS in Africa, the solutions are going to have to mesh with cultures almost totally unfamiliar to the Westerners in charge of the AIDS war.
What do you think?