Items by Simon

HIV in Kenya

• Cut Corruption, Don't Cut Aid

  Posted: March 10, 2010, 11:48 pm by Simon

  I arrived in Nakuru in September of last year expecting to work for an organisation called ICROSS (International Community for Relief of Starvation and Suffering), supposedly to work on a HIV related project. However, in my first week in Nakuru I realised they didn't have any active projects. Officially, they were waiting for funding. But as I was led from one 'site' to another, I realised there was something not quite right about ICROSS. It was hard to put a finger on, but the first thing I found strange was that only a couple of people had ever even met the guy who headed ICROSS, Mike Meegan (also known as Mike Elmore-Meegan, Dr Meegan, Fr Meegan, Br Meegan and probably a few other names not worth repeating). Some had heard of him but most didn't even recognise the name.
  
  Well, it quickly turned out that none of the 'sites', these community based organisations and support groups that I was being taken to see, had any real connection with ICROSS. ICROSS would just collect up organisations and include them in their proposals when they were looking for funding, which was all the time. The only function the organisation seemed to serve was to find funding. Anything worthwhile that was achieved was done by a handful of volunteers, along with some of these organisations that had been 'absorbed' by ICROSS. Of course, ICROSS would always take the credit.
  
  So, to those who are worried about how this work will be affected by the demise of ICROSS Ireland? For a start, it's only ICROSS Ireland that has closed. ICROSS Kenya continues its 'operations'. But even if that were to close, very little would happen on the ground in Nakuru. ICROSS simply didn't do very much here, aside from pay visits when they wanted to show potential funders or publicists around. They would take a few photos, maybe hand out something small that they had acquired from some donor or other, then head back to the Nairobi office (where none of the projects were based).
  
  The many small organisations that ICROSS claims (incorrectly) to have founded just continue as they did before ICROSS arrived. Some will be better off, some will be a small bit worse off, but most will continue as if nothing had happened. Because nothing has happened to most of them. Some of them will continue to welcome anyone from ICROSS because there is a slight chance of a handout, a few may collapse because they only got together to pick up anything being given out by organisations like ICROSS, but for most, ICROSS will be a faint memory.
  
  As to what happened to all the money ICROSS has raised over the years, these newspaper articles are silent. In addition to the one above, there is another in the Sunday Times, one in the Irish Mail on Sunday and one in the Irish Examiner. These can be added to the collection of articles on the organisation's suspect activities, going back years. For the moment, we can only guess at what the money was used for.
  
  The numerous scientific papers that have Meegan's name on them may seem suspect now, too. But judging from what I've heard, he is unlikely to have had anything to do with the data, at any level. None of the people involved in one of these projects in particular had ever met the man and he never visited the sites where the participants lived, where data was produced and collected. Let's hope that's the case, because many would not wish to rely on data that could be seriously flawed.
  
  But I wouldn't want people to think that no harm has been done, that no one has been depending on all the money donated to ICROSS over the years. After spending a few weeks finding out that ICROSS wasn't doing anything effective in Nakuru, I asked Meegan to make some money available, urgently, as people were sick and in need of help. He and I disagreed on this matter and I finished working with ICROSS before I had even started. Some of the sick people who were in dire need died and many will continue to suffer and die. Meegan likes to boast about how many people he knows have died of Aids here in Kenya. But some of them are dying because aid money is not getting to them.
  
  On a broader scale, also, it matters very much that money intended for poor people, sick people and starving people is not getting to them, regardless of whether it is diverted to repressive regimes, rich foreign contractors, greedy governments or where ever else it may go. If charities, aid organisations, governments, consultancies, commercial organisations or other parties are corrupt, that needs to be remedied. But there are too many people who would like to see aid cut or stopped altogether. Why punish the people who are already suffering because of the conduct of those who are supposed to be accountable, who are from wealthy countries, who are well off themselves? Aid is not the problem, corruption is.
  
  It is extraordinary that Meegan seems to have surrounded himself with so many prominent people. The few people I know who have met him find him utterly unconvincing and I agree with them. But he seems to have been able to fool a lot of people for a long time. Audits and investigations have been carried out over the years and both he and his organisation have been found wanting. Yet ICROSS continued their fundraising and somebody continued, presumably, spending the money. Just not in Nakuru. Hopefully this time will be different.

• Lucky Those British Choppers Happened to be in Kenya

  Posted: March 8, 2010, 12:11 am by Simon

  Apparently some tourists were rescued by helicopter when there was flash flooding in the Samburu area. The British Army and Airforce helicopters just happened to be in the area because they 'train' there. It's lucky they were able to rescue the people in the tourist areas. None of the tourists were reported as having any injuries. An elephant research centre was not so lucky. The BBC article doesn't mention if there were any non-Britons or non-tourists involved.
  
  In other areas, six people are reported to have been drowned and five others are missing. The AllAfrica.com article doesn't say if there happened to be any British helicopters there. Livestock, homes and properties have been destroyed in many areas, including Samburu. Many people have been displaced. Interestingly, Kenyan helicopters were also involved in the airlifting of tourists in Samburu. Perhaps it's easier to spot white faces against the muddy background.
  
  One of the deaths was in Mogotio, where flooding a couple of months ago displaced several hundred, many of whom are still living in tents. Another person died and one is missing just outside Nakuru town, in Kaptembwa. Three people were killed by flooding further North. While many have already been displaced in Western province, many more are threatened with flooding as rivers are close to bursting their banks. Exact figures are unclear but the number is said to be 'below 2000'. But thankfully the 600 tourists (although this number includes tourist lodge staff) said to be affected are all OK, having lost only their luggage.
  
  Many areas are being warned to prepare for more flooding and other hazards that come with the very wet conditions, such as cholera, malaria and other water related diseases. Farmers have been holding off sowing crops in many areas because the rain has been too heavy and those who have planted are in danger of losing their crops. Maize seeds are being distributed in some areas, although this is unlikely to benefit many people for some time. Let's hope those British helicopters and emergency services will still be available if and when disaster strikes.

• Political and Religious Leaders Overseeing the Spread of HIV

  Posted: March 6, 2010, 9:43 pm by Simon

  There's an interesting article on Aidsmap.com about how Ugandans who think they may be HIV positive are less likely to refer other family members for HIV testing. In a survey, people were asked before testing if they thought they were likely to be HIV positive. A majority said they thought they were likely to be. Of course, only some of them were. But most of those who are HIV positive in the country do not know their status. This doesn't bode well for a country that is said to have been so successful and progressive in its fight against the disease.
  
  The very people who are most likely to be HIV positive are least likely to go for testing. So you would think that the Ugandan government would aim to target these people, make it easier for them to get tested, increase access to HIV facilities, reduce discrimination and stigma. Instead, the government is going in the opposite direction, trying to whip up anti gay feelings and making such strong threats against people even suspected of being gay that most people will be less willing to find out their HIV status, whatever their circumstances.
  
  The Bahati Bill will make a lot of people avoid even discussing HIV or sexuality because if someone is found to be gay, HIV positive and sexually active, they will face the death sentence. In order to cover up their sexuality, many gay people are said to have heterosexual relationships, even to marry a heterosexual partner. Their partner will even face a lengthy prison sentence for not reporting that they were married to a gay person. Currently, only an estimated one quarter of HIV positive people know their status. If this bill becomes law, that figure should go down even further.
  
  Some leading American Christians are said to be behind Bahati's bill. But the Catholic church is equally adamant that condoms shouldn't be used to prevent unplanned pregnancy, HIV or other sexually transmitted infections. They even lie about the effectiveness of condoms, which would seem to be in breach of the ninth commandment. But as far as they are concerned, it is 'artificial contraception', and therefore immoral. The use of condoms is currently being debated in The Philippines, where HIV prevalence is low, but rising.
  
  You would think that political and church leaders would aim to reduce transmission of HIV and to stamp out stigma and discrimination. But, on the contrary, they seem to be against any measures that target some of the most significant channels to HIV infection. We must look beyond political and religious leadership if we are to have any hope of making progress in the fight against HIV.

• Women Are Not Mere Instruments in the Fight Against Aids

  Posted: March 4, 2010, 11:37 pm by Simon

  One of the recurring themes on this blog is my claim that HIV transmission is not just about sex. In fact, sexual transmission of HIV is not just about sex. What I mean is that there are circumstances surrounding sexual behaviour that determine whether the risk of HIV transmission is higher or lower. And if those circumstances are ignored by the many so called HIV prevention programmes, those programmes will fail.
  
  So far, most HIV prevention programmes have been designed with the assumption that reducing HIV transmission is all about influencing sexual behaviour. This is sometimes referred to as the 'behavioural paradigm'. And most HIV prevention programmes have failed. UNAIDS emphasizes the fact that HIV is now the leading cause of death in women of reproductive age. Considering current rates of maternal illness and death from non Aids related causes in developing countries, this is truly shocking.
  
  But here is the more shocking bit: "up to 70% of women worldwide have been forced to have unprotected sex". If women are subjected to violence to this extent, this is the real outrage. That women do not have the right to choose when to have sex, whether to have sex, with whom to have sex or any of the other circumstances is horrifying. These are the sorts of circumstances surrounding sexual behaviour that I am talking about.
  
  But these rights are not just about sex. If a woman doesn't have these rights, you can be sure there are many other rights she doesn't have. The problem here is that the rights of a huge proportion of women are being denied. Women do not have rights just so that they don't contract HIV or any other sexually transmitted infection. And if a woman does have these rights, the issue of whether she does or doesn't have a say in the circumstances surrounding sexual intercourse will not arise. Not everyone will make the best decisions, of course. But the problem is that at present, some parties are being denied this right.
  
  Michel Sidibe, the executive director of UNAIDS, is wrong on several counts. 'Gender issues' do not need to be addressed because this is a way of reducing transmission of HIV. Gender issues need to be addressed because they have so long been ignored. Ensuring rights for women is not just a useful way of ensuring that the Millennium Development Goals are realised. Women are not mere instruments in the fight against Aids.
  
  In Africa, 60% of the people living with Aids are women. Women are far more vulnerable to being infected than men. Yet so much HIV programming ignores the circumstances in which people live and work. The recent emphasis on mass male circumcision is a good example of an intervention that falls for this behavioural paradigm. It also purports to protect men, to some extent, from HIV. The extent to which it protects women is very unclear.
  
  But most HIV prevention programming uses the same paradigm and has done ever since HIV was found to be mainly a sexually transmitted infection. Women's rights have been mentioned, often in this instrumental way that UNAIDS seems to favour. Even economic, health and educational inequalities have been mentioned. Well these are the issues that need to be targeted, not just mentioned. But most of the big money goes into the tired old finger wagging about what people should and shouldn't do in bed.
  
  The issue of violence against women does not need to be 'integrated into HIV prevention programmes'. This is completely the wrong way around. The issue of HIV prevention needs to be integrated into programming that addresses gender inequalities in social intercourse, marriage, work, education and health. HIV is not bigger than all these and until these are successfully targeted, HIV will continue to elude our best efforts.

• It's OK, Apparently Journalists Are Supposed to Lie

  Posted: March 3, 2010, 1:54 am by Simon

  In an article about the Polish journalist and writer, Ryszard Kapuscinski, Neal Ascherson claims that "there is no floodlit wire frontier between literature and reporting". This is interesting because he feels that being a "great story teller" does not make someone a liar. Which is true, except when they are supposed to be writing an article that people assume is 'reportage'.
  
  I don't know about Kapuscinski but if there is no frontier between literature and reporting then why would anyone bother to read the daily tripe? Journalists churn out a lot of rubbish concerning things they know precious little about, but people read papers and listen to radios and TVs every day to find out what is happening in the world. When they read some jumped up hack going on about how there couldn't be global warming because it's very cold today, they think that the whole issue about climate change has been trumped up.
  
  So when it comes to genetically modified organisms (GMO), consumers of journalistic bullshit (the majority of mainstream reporting) think of Frankenstein foods, or whatever crap the 'profession' has dreamed up to ensure that the last thing people do is think or become informed in any way. Neal Ascherson may write for The Guardian, a 'moderate' paper, but lying and reporting are not the same thing and if a journalist lies, he or she is a liar.
  
  What I'm saying about GMOs will probably be of no interest to journalists because I am not opposed to them just because they may be dangerous to humans, animals, plants, water supplies, in general, the whole global ecosystem. Although, I admit it, the fact that no one knows exactly what effect long term consumption of GMOs has on those who consume them (because no credible research has been done), does seem like a glaring omission. I am opposed to the fact that a few multinationals want to control the whole of humanity's ability to provide enough food for itself. Not only do they want this but they already control a massive proportion of global food production. To cap it all, many of the most powerful idiots in the world are in favour of this, with the support of...big media owners.
  
  Ok, I've skipped past the journalists because they are just doing a job and they are paid for by some revolting Murdoch-like character who is trying to do for global media what Monsanto is trying to do for food production. But Ascherson makes a good point, don't bother reading what journalists have to say, unless you like a good read. As for science reporting in the mainstream media, forget it.
  
  Domination of global food production by a few multinationals should be bad enough but approval of GM potatoes or any other GMO in Europe (or anywhere else) will also be a disaster because such crops will contaminate other crops around them. We know that they will because the evidence is clear from every field trial of GMOs. We know that there are other dangerous drawbacks to GM crops and also that none of the promised advantages of these crops have materialised. So what they hell are we growing them for?
  
  I wouldn't wish to blame lying journalists for doing any more than following orders, or whatever it is they do, but if they want to brown-nose the bosses of companies like Monsanto, the least they could do is declare their interest. Because every time they throw in a straw man argument like 'Frankenstein foods', they are scoring a goal for the GMO industry. Monsanto can just claim to be using the crops for animal feed or biofuels. But then the problem doesn't go away. Once GMOs are used, the damage is done.
  
  There are enough arguments against the use of GMOs, aside from the dangers to human health. But these arguments are much more difficult to answer. So rather than get the biotech industry to answer them, they are presented with arguments that they have a ready prepared response to. A response that has been well sold by journalists. And have you noticed the way articles often point out how widespread GMO contamination already is, as if to say it's only a matter of time before there is no longer any point in protesting? That's how they got GM cotton into India. Thanks journalists.

• Mass Male Circumcision: Science or Politics?

  Posted: March 2, 2010, 12:19 am by Simon

  Following the claim that a drive to test Kenyans for HIV resulted in 1.5 million people being tested in three weeks, another paper claims that 36,000 (male) circumcisions were performed in two months. I have serious doubts about the first claim and I have serious worries about the future health of the 36,000. In 2004, Kenya had 16 doctors for every 100,000 people and per capita spending on health was $9.10. There were 72 hospitals in Nyanza and 30.3 beds per 100,000 people.
  
  Most of the circumcisions were performed in Nyanza because it's the only province with relatively low rates of male circumcision. In fact, it's only the part of Nyanza where the Luo tribe predominates that circumcision rates are low, standing at about 48%. HIV prevalence is high in Nyanza and especially high among the Luo. It's around double the national rate of over 7%. While this is said to be because of low rates of circumcision, it is not clear whether there are other factors that may result in high HIV prevalence among this tribe.
  
  The scientific papers claiming that mass male circumcision can significantly reduce HIV transmission are notable for the frequency with which they are cited rather than for their great number. And perhaps the evidence is overwhelming, from a scientific point of view. Perhaps this is the one big breakthrough that the world has been waiting for. But some of the areas where circumcision rates already stand at almost 100% in Kenya also have high and increasing rates of HIV transmission. For example, prevalence is rising in Coast province and it is higher than the national average, even though circumcision rates are nearly 100%.
  
  So what awaits Luos who have been circumcised? Some people I have met who are already circumcised believe that they don't need to use condoms and that seems to be a common view. Some even believe that condoms 'don't work' if you are circumcised. Apparently people who are queuing up to be circumcised now are also being given advice about using condoms once they are able to have sex again. I suspect people are getting circumcised because they think they will no longer need condoms. They may well be getting advice that says they still need to practice safe sex, but if they are heeding this advice then they could just skip the circumcision.
  
  The scientific evidence claims that being circumcised reduces the risk of HIV transmission by 60%, regardless of sexual practices, for example, whether a condom was used, whether one has multiple partners, etc. Still, I just don't see what people think they can gain from being circumcised unless they think they can dispense with the need to use a condom. And maybe a 60% reduction in transmission will make some think the risks of unsafe sex to be small enough to be worthwhile.
  
  Kenya's intention to spend $56 million on a small percentage of the population to prevent a handful of sexually transmitted diseases, given how little is spent on health per capita, seems strange. But spending this kind of money on an intervention that may not have anywhere near the effect it is expected to have is rash. Why, in a country that has so many health priorities, is so much being spent on this handful of diseases and targeting this small demographic (adult male Luos)? Yet the main funding sources, PEPFAR, the Gates Foundation and the Global Fund are all behind the initiative.
  
  I hope this mass male circumcision campaign is worth it and HIV transmission rates drop significantly in the Luo population. But I just wonder if people who have swallowed the hype know that they will only be well protected from sexual transmission of HIV (and some other sexually transmitted infections) if they always use a condom, properly. Because if there are any other factors behind high rates of HIV among the Luo, aside from those relating to sexual transmission, it could be some time before they are given any consideration.

• GMOs: You Pay Me to Shit in Your Garden

  Posted: February 28, 2010, 9:33 pm by Simon

  Supposing I were to re-engineer my domestic sewage system so that it dumps sewage from my house into my neighbour's garden, my neighbour would be quite upset, right? But supposing I were to take it a little further and sue my neighbour in court for refusing to pay me for manuring his garden, that would really add insult to injury, wouldn't it? It sounds ridiculous for me to be claiming that I am the injured party, when I have, without permission or discussion, used my neighbour's land as if it belonged to me.
  
  Well, that's how GMOs (genetically modified organisms) work. If I grow GMOs on my land and they contaminate my neighbour's land, my neighbour will have to pay royalties to the seed manufacturer, even though my neighbour may grow non-GMOs or organic crops. My neighbour's crops have been contaminated, not in some way blessed with the bountiful gift of genetically modified crops. I should be compensating my neighbour because the crops now grown on my neighbour's land will no longer be non-GMO and will no longer be organic.
  
  My choice to grow GMOs in the first place is questionable enough, because it is inevitable that they will eventually contaminate my neighbour's crops. But I have effectively also taken the decision that my neighbour should no longer have the right to grow non-GMOs or organic crops. Where did I get this right and why does my neighbour not have the same level of autonomy over their land that I have over mine?
  
  Farmers in Brazil and Argentina are facing this very absurdity, that the serial rapist is taking their victims to court for compensation for the use of their genetic input. Those contaminating the land, the land belonging to those who wish to have nothing to do with GMOs, are set to be paid for their contamination. Australia is busily trying to patch up their laws so that unwitting non-GMO farmers can be protected. But the multinationals that produce GMOs are rich and they are not going to give up easily.
  
  Absurd though this is, it is exactly what awaits any country that is tricked into allowing GMOs to be grown on their land. Individual farmers will not have the right to choose whether to fall for GMOs or not; if their neighbours accept the thirty pieces of silver, their land will also quickly become contaminated and they will also have to pay royalties, they will also be stuck with weeds that are resistant to certain pesticides, their soil will become degraded and they will be forced to buy expensive fertilizers. Their yields and crop quality will also suffer.
  
  Consumers, also, will have to pay for the greed of the few farmers who are willing buy into the plot. Eventually, consumers will not have the choice of GMO or non-GMO crops, they will all become contaminated. It is simply not possible for both GMO and non-GMO crops to be grown in the same areas. While non-GMOs may attract a premium for a while, the price will quickly rise before they become unavailable.
  
  The only solution is to hold out against GMOs, regardless of what carrots the GMO manufacturers hold up, whatever threats they make or whatever lies they propagate about 'food security' and the rest. They are interested in deciding what people grow and eat and that's the way things are in countries like Brazil and Argentina. The costs to the farmers are higher and growing, therefore the costs to consumers are also higher and growing. The only ones that benefit from GMOs are the multinationals.
  
  If anyone has seen the wonderful Italian film, The Bicycle Thieves (or the more recent Bejing Bicycle), they may notice a similar irony, where the person who has been wronged is made to pay for their victimization. How has this cruel and dangerous absurdity been allowed to arise in the first place? Why do faceless multinationals have so much power and influence that they can pay for a policy of appeasement, while they treat the defenceless as guinea pigs in their deadly experiments? And will we simply say 'never again' after conventional farming has been destroyed? There may be time to prevent this disaster in some countries, but it has to be now. The consequences cannot be reversed.

• World Domination Trumps Science in the GMO Industry

  Posted: February 27, 2010, 9:21 pm by Simon

  One of the most scary things about genetically modified organisms (GMO) is that they are not being pushed because there is scientific evidence that they are a potentially useful tool in improving global food security. Firstly, global food security is not primarily a problem of a lack of food, it is a problem of unequal access to food. Secondly, GMOs have been shown to lead to decreased food security, for several reasons. Yields are not higher, they are the same or lower. GMOs do not show any signs of being resistant to drought or pests. And overuse of pesticides has given rise to pesticide resistant weeds, just as critics predicted it would.
  
  Scientific evidence for or against GMOs is irrelevant because the GMOs are all about world domination. The issue is one of geopolitics rather than science. It is an attempt by some of the most powerful multinationals in the world to gain control of all the arable land in the world. When you grow GMOs, you use GMO seeds and GMO products. You can't save the seed for the next growing season and the amount of fertilizer you need every year will increase because of soil degradation. The amount of pesticides you will need also increases because of ever growing resistance. If you try to return to growing conventional crops, they will become contaminated and there is a risk that the GMO manufacturer will either claim royalties or prevent you from growing the crop. And you will find your markets rather limited too, as Canada has found.
  
  India may have successfully rejected the genetically modified brinjal (aubergine or egg plant) by putting a moratorium on its production. But India rejected the crop because of the flawed scientific arguments that were used to try to force it on the country. If the science is irrelevant, the moratorium is merely a political matter. Already the powerful and well paid pro GMO lobby there is busying itself with laws and regulations that will prevent people from criticizing GMOs with threats of fines and prison sentences. Ironically, they say that you are not permitted to criticize GMOs without scientific evidence.
  
  There is no scientific evidence to show that farmers should not become indentured slaves to these multinationals. It is a human rights issue, not a scientific issue. The scientific arguments against GMOs have been available for years but they are dismissed, out of hand, dismissed by a lot of sales pitch and political bluster. Those opposed to GMOs are branded Luddites and said to be anti development and denying people in developing countries access to this life saving technology. US soya farmers, Canadian cotton farmers and Indian cotton farmers know just how life threatening this technology really is.
  
  There was a facetiously titled programme on the BBC recently called 'Food Fights'. It wasn't about GMOs, specifically, it was about large scale land grabbing by rich countries, multinationals and investment portfolio administrators to grow food, biofuels and anything else they need in developing countries. It is clear that this land grabbing is not even intended to benefit those in developing countries, yet the programme gives the impression that it is a viable answer to global food insecurity. The programme is not completely biased, but it allows some palpable falsehoods to remain unscrutinized.
  
  For a start, this sort of land grabbing is said to be the only alternative to the present situation, where developing countries depend to a large extent on food and other kinds of aid. The only real alternative for developing countries is for them to become self sufficient and self reliant, which is the opposite to what this neo-colonialism offers. Rich foreigners are not looking for an alternative, they are looking out for their own interests, regardless of the costs to those in the countries where they propose to extract everything they can get.
  
  Although it is not a GM crop, the example of sugar cane fields is examined because sugar cane is one of the favoured biofuel crops planned for Kenya. Even before biofuels and stories about food insecurity started, sugar cane was grown on farms as if the farmers were nothing but indentured slaves. This is still the case. The sugar company supplies all the inputs and does all the mechanised tasks. Once they have extracted what they want, the little that is left goes to the farmer. Often, farmers produce the sugar cane at a loss but there is no other cash crop with a ready market. In some cases, they lease the crop on their land to the sugar company to get some ready cash. Come the harvest, they have nothing left after they have paid their bills.
  
  Farmers in this sort of situation already know what it means if foreign interests take over large tracts of arable land in Kenya. Hundreds of thousands of hectares of land, referred to as 'marginal' is threatened with this kind of incursion. And those who object are referred to as Luddites, anti-development, whatever. Those using this 'marginal' land will be dispossessed and the whole ecosystem that the land supports will be destroyed. And GMO manufacturers don't even need to lease or buy the land, like the sugar companies.
  
  But this is the sort of world domination that GMO manufactures want. They don't want people to be able to produce their own food or to choose what farm inputs to use. They want farmers to effectively give over their land to a multinational that will tie the land into a system that will be virtually irreversible. Yields will decrease and input costs will increase, but the farmer will be forced to continue purchasing products from that multinational, and that's the important thing. Human rights, food security and environmental destruction are irrelevant to multinationals. As for the science, it is a handy political tool sometimes, but other times, it just doesn't give the right results.
  
  [The possible contribution of GMOs to antibiotic resistance is discussed in this interesting article. While it doesn't fit into the above posting so well, it is of particular significance to countries that have a very high HIV and TB burden because these countries also have reduced access to drugs and often have to make do with older versions, for which pathogens are more likely to develop resistance in the near future.]

• The Free or Almost Free Model

  Posted: February 26, 2010, 7:19 pm by Simon

  Walking around Nakuru town today, I was thinking about why a particular project was going so slowly. The project involves showing people how to make simple solar cookers. They just require cardboard or something similar, reflective paper, glue, tape and a blade. But the main problem has been getting hold of the materials in large enough quantities at as low a cost as possible. It's all very well to say 'just buy them' but I don't have a budget and if I buy them, what use will that be to the free or almost free model.
  
  I would like to think that certain things can be constructed using free or very cheap materials. In Western countries, such as the UK, you can get all the cardboard you need by visiting a supermarket or department store. But here, you have to pay. I don't know about the lowest price yet, but I had to pay the price of half a kilo of maize for a single cardboard box. They are reused until they can no longer be called a box, and that's a very good thing. You don't see lots of cardboard box waste lying around, not until it's completely useless. Because this 'waste' is valued, it doesn't present the sort of litter problem they have here with plastic bags, say.
  
  Similarly, I wanted to find some kind of durable reflective paper. I know that lots of sweets, biscuits, chocolate and other products are wrapped in such paper. Even better, car tyres are wrapped in a very durable reflective paper. Having identified these sources, I now need to identify places where people can get the stuff in large enough quantities. I'm still working on that. Some shops I visited were reluctant to hand over any more than a small sample, others simply said they didn't have any to spare. Perhaps this stuff is also reused for something, perhaps people are just holding out for an appropriate price. Tin foil would be Ok but it's expensive and not very durable.
  
  Anyhow, I think people who are making these solar cookers should source the materials by themselves. They will get a much better price and will be better placed to source the materials for free. I just want to know that the materials are available so no one can tell me that I'm asking them to do something impossible. I'm getting closer, but I'm not there yet. Once I have found a good place to get adequate amounts of cardboard and reflective paper at a good price, hopefully free, then I can tell people where to go and get started making the cookers. I'll throw in a free pot of glue and anything else that is required!
  
  I've had similar experiences with cooking baskets (also called fireless cookers). The main material for these devices, which insulate cooking pots sufficiently to allow partially cooked food to cook completely, is some kind of stuffing. An ideal kind of stuffing is a waste product from a local blanket factory. However, this waste product is also used for furniture, pillows, quilting, etc. So, again, you have to pay for it. Enough for a medium sized cooking basket costs about the price of two kilos of maize meal, enough to feed quite a number of people. I'm sure buying it in large quantities would bring the cost down but it's a challenge to the free or almost free model. Alternative, waste from local sisal factories could be used, but this too costs money as it is used to stuff furniture.
  
  Another of our proposed projects is to construct a press that can compress briquettes made from organic waste. I spent some time looking for someone who could make such a press (it's not as easy to find someone as you might think!). When I found one, I gave him some plans I had found on the internet, a variety of wooden and metal ones. I was surprised that he recommended making the press from metal because the sort of high strength wood required would be very expensive. On the other hand, the metal could be sourced from scrap metal dealers. The labour would be cheap and I'm expecting to have a version of the press in the next week or so.
  
  The briquettes can be made out of many things, fruit and vegetable peelings, charcoal dust, sawdust, waste from food production and other sources. Getting large amounts of waste in the right form may not be so easy. Sawdust has to be paid for, though the other materials are free (unless the word gets around that they are valuable). But they will probably need to be chopped or crushed so they can be mixed in the right proportions. And chopping or crushing machines are available, but they are very expensive. Ok, expensive means tens or hundreds of dollars. But where you only stand to make a few dollars a day profit at the most, no one is going to shell out large amounts for materials.
  
  Economy of scale would make a huge difference, of course. But the aim of these projects is to be small and cheap. They need to be small enough and cheap enough for people who have very little money and probably very little education. If the money, training and education were readily available, there wouldn't be so much of a problem. So I'm looking for as many of these 'free or almost free' ways of either making money, saving money or a combination of the two.
  
  Luckily, the organisation I'm working with, Ribbon of Hope, in Nakuru, has a number of other projects. We grow crops and support people to produce things that get them an income. Some of our clients keep livestock and we are investigating the possibility of breeding rabbits for food. These are all good 'bread and butter' projects because they provide people with income or food or both. But the more we can branch out and find other ways of making money, especially ways that don't require much capital, the better. Hence my aim to work on the free or almost free model to see how far it can take us.

• Experimenting with Diversity

  Posted: February 24, 2010, 11:55 pm by Simon

  It's odd how the weather can go from very dry to very wet quite unexpectedly. During the wet season, there was sometimes too much rain all at once, which threatened to wash away crops which were about to be harvested. Rain delayed the harvest of beans, which also resulted in some losses. Then the dry season started, so after harvesting, we returned to the practice of irrigating the other crops that were planted to overlap with the harvesting, a field of watermelon. And then the dry season was interrupted by a week of torrential rain, which threatens the watermelon, due to be harvested in Late March.
  
  With any luck, the dry weather will return and what is left of the watermelon crop, hopefully most of it, will do well. But the field is waterlogged and some of the smaller fruit and plants have been overwhelmed by the thick mud that has been stirred up. All we can do is make sure water is not collecting anywhere and that any plants and fruits that can be saved are saved. Things have been looking brighter and drier for the last two days.
  
  And with the brighter, sunnier weather, we at Ribbon of Hope have been able to return to demonstrating solar cookers. We had a good day at Mogotio, North of Nakuru, last week before the heavy rains started. Over thirty people came to see the demonstration and the debate about whether it was or wasn't possible to cook with 'a piece of silver cardboard and a saucepan painted black' was noisy. Scepticism turned to interest as we checked the food's progress about one hour in; interest turned to amazement when we invited people to test out the result half an hour later.
  
  Today, we went to a town called Salgaa, also North of Nakuru. Closer to 40 people turned up and asked many questions as the rice and ugali (boiled maize meal, the staple food) and sukuma wiki (kale) cooked in the hot sun. In fact, giving a lot of time to answering questions was good because many people cook things one way and one way only. Today, they saw their beloved staple food cooked without using boiling water and without stirring. The whole thing can be put on to cook while the chef attends to other things. And that's just one of the many advantages of cooking this way!
  
  Our aim is to increase self reliance through a variety of income generation schemes and ways of reducing day to day costs. So next week, we hope to return to Salgaa and show people how to make a solar cooker. Buying one is good, because people can save a lot of money and learn a great technique. But if they could make a solar cooker themselves, they could save even more money and they would always be able to make another when the original one wears out. Someone today was asking me if it was really sustainable to sell people a solar cooker for 500 Kenyan shillings (about 4 UK pounds). Well, it is a lot more sustainable than using charcoal or wood. But being able to make these cookers, and it's not difficult, would really put the icing on the cake.
  
  On the opposite end of the scale in terms of self reliance, there is a big problem with the country's dependence on maize for almost all their food needs. It is not an indigenous crop and, for various reasons, it is becoming less productive. Because the weather has been so unpredictable lately, it would be far better to grow more resistant crops such as millet, sorghum, amaranth and many others. These do better in challenging conditions, like drought and flooding. But they also tolerate poorer soil and require less fertilizer and pesticides, substantially reducing the costs that farmers face.
  
  Many farmers remain too dependent on a government that has never actually done very much for them. The scandal of the subsidized maize scheme, which allowed well connected people to make money out of 'relief' food supplies while the costs to ordinary people continued to rise and around a quarter of the country faced serious shortages, was less than a year ago. But the failure of farmers to produce enough food is partly their own fault. Some try to produce cash crops that end up making money for someone or some industry, but don't make much for individual farmers. Others, most farmers in fact, rely on rain fed agriculture, rather than employing some relatively simple method to harvest rainwater.
  
  Small farmers are, of course, in need of ready cash, no less than non-farmers. But there are also those who produce far too little food for their own family and yet also make too little from cash crops to purchase additional food. There should be enough land in Kenya for the country to be food secure, regardless of how weather patterns are changing. True, the government should do a lot more, but perhaps people shouldn't wait for their politicians to do things that it has never done before. Hence the need for anything that increases self reliance.
  
  Sadly, I am not an experienced farmer, I have to go around asking people for advice on what to plant and how to deal with problems that arise. But I feel that the very practice of experimenting with diversity is a good thing in itself. Equally, I think people need to experiment with cooking and eating different things and cooking them in different ways. I can't claim to have many converts yet but this kind of experimenting can be done without spending very much money. And development at low cost is, I think, well worth striving for, especially given the relative lack of success with development at high cost.

• A Pill for Underdevelopment

  Posted: February 22, 2010, 11:40 pm by Simon

  An article published on the 24 of December last year claims that a three week drive to test as many people for HIV as possible succeeded in testing one and a half million people. Perhaps my scepticism is misplaced, but I find it hard to believe that over 6600 people were tested every day for three weeks. Still, if it's true that the country has the capacity to test this number of people this quickly, their aim to test 80% of the adult population by the end of 2010 should be fairly easy.
  
  Unfortunately, providing antiretroviral treatment (ART) for everyone found to be in need of it may not be so easy. The Kenyan government has only ever provided a fraction of the money needed to supply ART to everyone who needs it. Most of the money came from donor funds, such as the (US) President's Emergency Fund for Aids Relief (PEPFAR), the Global Fund and the Clinton Foundation. But they are not due to increase their funding in line with the surge in numbers being found to be HIV positive. The Global Fund has even stopped some expected funding due to serious financial irregularities.
  
  The funding gap is thought to be 2.5 billion shillings this year but will rise to many times that in the next few years. Kenya is currently almost out of stocks of some drugs and the Ministry of Health is applying for emergency funding that should tide them over for six months, if the money is forthcoming. The problem will be exacerbated by new World Health Organisation guidelines that recommend the use of more expensive drugs and putting HIV positive people on ART at an earlier stage of disease development.
  
  Meanwhile, the advocates of 'treatment as prevention' are back in the news. They claim that rolling out ART to everyone found to be HIV positive and testing every adult about once a year could prevent nine out of every ten infections. If this is true in practice, testing everyone regularly and treating everyone found to be positive would be even better than very high levels of condom use (levels that have probably never been achieved). Of course, the approach to funding would have to be completely changed as current funding would be nowhere near high enough to cover the costs of 'treatment as prevention'.
  
  Another study claims that the sort of mass screening suggested above could allow HIV to be eradicated in 40 years (in South Africa). My reaction to these articles, and I'm thinking specifically of Kenya, is that if it were possible to test many millions of people every year, it may also be feasible to put millions on treatment. And if it were possible to successfully treat so many people, then transmission rates should drop radically.
  
  But I would question the feasibility of testing most sexually active adults in Kenya every year. This is a country where health services are in very short supply and high quality services are only available to the very rich, if at all. Long term care for the chronically ill is in even shorter supply. Is the country really going to raise the money for and implement the vast improvements in health infrastructure that would be required just to make this level of HIV screening possible? And if this happens, will the country also develop its capacity to provide long term care to millions of HIV positive people for several decades to come?
  
  Even if the money is forthcoming, I find it hard to believe that Kenya's levels of health care, education, infrastructure and social services will be raised sufficiently to make anything like these predictions about 'treatment as prevention' become a reality. Maybe it is true that 1.5 million people were tested in three weeks. And maybe the sort of funding required to eradicate HIV will be provided. But I can't help remaining highly sceptical.
  
  My discomfort stems from reflecting on the fact that HIV spread rapidly in Kenya at a time of high and increasing levels of poverty and unemployment. Levels of health and education provision were low and are still decreasing. Health indicators, especially for maternal, child and infant health, were particularly poor and most have been disimproving since the 1980s. Gender inequalities have never been given very high priority and those among whom HIV spread most rapidly, women, commercial sex workers, men who have sex with men and intravenous drug users, are as vulnerable now as they were three decades ago.
  
  If it is true that HIV transmission is related to the conditions in which people live and work, as I would maintain, provision even of astronomical levels of funding to test and treat millions of people will still fail to address these conditions. Therefore, I'm suggesting, HIV could still be a problem for countries like Kenya in 40 or 50 years time. In fact, we have hardly even started to address HIV transmission because we continue to ignore the conditions mentioned. But that's just my take on it.

• Homophobia is the Problem, Not Homosexuality

  Posted: February 21, 2010, 9:16 pm by Simon

  Rabid homophobia continues in Kenya and is being actively promoted by political and religious leaders. Police had to 'rescue' three men accused of being gay in a coastal town. When you are 'rescued' by Kenyan police, you know you are in trouble. There was also a case of two men said to be getting married being arrested by police after neighbours complained about them being 'notorious gays'. Meanwhile, a Muslim and a Christian leader are united in their opposition to their town being turned into 'Sodom and Gomorrah'.
  
  These religious leaders feel that if gays are not persecuted, their community will be 'doomed'. This is odd, because Kenya currently faces numerous instances of massive criminal acts being carried out by the country's most powerful and wealthy people. The country is, in a sense, already doomed. At least, a lot of people's lives are doomed.
  
  Hundreds of millions of dollars of funding for education, HIV and internally displaced persons have been stolen, the people behind the post election violence have yet to be tried and will probably never be punished, the power sharing government is a farce, the constitution promised in the first hundred days of 2003 is as far away as ever, millions are facing starvation while donated food is being stolen by politicians and surpluses are being destroyed because of lack of storage facilities. The list goes on and on.
  
  Facing these conditions, why are religious and political leaders so obsessed with homosexual activity? They seem to think that the practice of men having sex with men or women having sex with women is going to turn the heads of heterosexuals and make them into homosexuals too. They imagine that same sex practices are un-African and that they didn't exist before being 'imported' by colonials.
  
  They see homosexuality as a crime but who are its victims? The victims of corrupt politicians, church leaders, police, businesspeople, both foreign and indigenous, are clear enough. Most Kenyans are victims of the excesses of the wealthy and powerful. But who are the victims of the 'crime' of homosexuality?
  
  Of course, there are victims of rape and sexual assault. But perpetrators of sex crimes are already covered by the law. It's just that these laws are not usually upheld, especially when the crimes are carried out by the rich and powerful. The police, who are so quick to go after people who are accused of being gay, are not usually interested in ordinary everyday crime, unless they happen to be involved in it themselves.
  
  Just why is the public so ready to become a baying mob of vigilantes when their target is a defenceless individual or group of individuals? They would achieve a lot more by objecting to the real criminals in this country but the most they do is complain about them. Not that I'm advocating mob justice, but there seems to be no sense of proportion in people's reactions to crimes.
  
  Meanwhile, a politician in Uganda, Otto Odonga, has said he would agree to be the executioner even if the person being tried for homosexuality was his own son. Another politician there seems to think bisexuality is something that has been 'imported' into Africa. But thankfully, at the same meeting, someone else said that he had seen homosexual activity when he was young and that it was not a new thing. Like in Kenya, people in Uganda seem content to be living in one of the poorest countries in the world, made poorer by greedy leaders, as long as they can let loose their mob law against homosexuals or those thought to be homosexuals.
  
  Interestingly, the Ugandan politician who wants to introduce draconian laws against homosexual activity, even against those who witness or know about homosexuality (or who are suspected of witnessing or knowing about it), David Bahati, thinks that everyone is susceptible to being turned into a homosexual. This means that it is possible for him or his friends, colleagues or family members to be 'made into' a homosexual, given the right influences. This seems like a very odd for a homophobe to hold.
  
  What these Kenyan and Ugandan politicians should really be asking about is where the homophobia was imported from. Homosexuality exists in every country and always has, as far as anyone knows. You can't 'import' it. But homophobia is actively encouraged by religious groups, especially extreme right wing Christians. Several prominent American Christians and Christian groups are said to have been backing Bahati and people like him. No doubt they will support anyone who promotes their bigotry. Homophobia is the curse that Kenyans and Ugandans should be worried about, not homosexuality.

• Punishing Victims; Protecting Perpetrators

  Posted: February 20, 2010, 1:56 pm by Simon

  Several Christian organisations and churches in Kenya are claiming 'victory' because the draft constitution has been rewritten to specify that life begins at conception. They threatened to sabotage the whole constitution if this was not done. As a result of their threats, other clauses have also been removed. Kenyans will not now have a right to health care, in particular, reproductive health care. Also, the clause stating that no one may be refused emergency medical treatment has been removed. And there is a phrase that specifically rules out abortion unless the life of the mother is in danger.
  
  Abortion is already illegal in Kenya, but this has not prevented several hundred thousand woman and girls seeking abortion every year. The majority of these abortions, an estimated 800 per day, are unsafe, being carried out in insanitary conditions by untrained personnel. Those who go through these unsafe abortions are less likely to seek professional medical attention and less likely to receive it. As a result, over 2000 die every year, adding considerably to the thousands of maternal deaths that occur.
  
  In what sense have these Christian groups achieved a victory? They don't appear to be opposed to the fact that rape and forced sex often goes unpunished because it is carried out by the more powerful against the powerless. It is carried out by adults against young people, even children. Those who should protect the victims, church leaders, political leaders, teachers, police and others, are often the perpetrators.
  
  If, as Christians are so fond of claiming, life is sacrosanct, why are the lives of certain people so unimportant? Why are human lives so unimportant as to be denied the right to health and the right to make their own reproductive decisions? Women should be able to choose when to have children, under what conditions and with whom. Where these rights have been denied, why should they be made to pay for someone else's crime?
  
  Nothing that these Christians have done will reduce the incidence of unsafe abortions, of seriously compromised reproductive health for women, of women suffering and dying unnecessarily. Nothing that these Christians have done will reduce the incidence of rape and forced sex. Victims of crime should be entitled to protection, not punishment. Perpetrators of crime deserve punishment, especially when those perpetrators are in a position that gives them a level of power that they subsequently abuse.
  
  One priest has said 'we should not victimise the innocent unborn children' but what about the woman or girl who has already been victimised and is now to be punished, perhaps for the rest of her life? Kenya is in dire need of good leadership and the interference of interested parties, whether they be political, religious, commercial or whatever else, is frustrating this need. The country also needs good health care and equal rights for all people, regardless of gender, sexual orientation, tribe, wealth and anything else. But some of the Christian churches clearly have other ideas.

• Lack of Logic in the Received View of the HIV Pandemic

  Posted: February 19, 2010, 8:15 pm by Simon

  Something I have always found mysterious about UNAIDS' view (it's something of a received view) of the course of the HIV epidemic is that they estimate that the number of new infections peaked in Sub-Saharan Africa (SSA) some time in the mid 1990s. And they reckon that the reason new infections began to drop from then on can be put down to the success of HIV prevention and education programmes in changing the sexual behaviour of people, especially men who have sex with men (MSM), commercial sex workers (CSW), intravenous drug users (IDU) and young women.
  
  With few exceptions, most SSA countries were doing very little to treat people with HIV or to prevent the transmission of HIV in the 1990s. Treatment was in its infancy and was inaccessible to the majority of Africans. And where prevention programmes had been implemented, they consisted of little more than mass education campaigns. They had very little influence on people's behaviour in the 1990s. And why would they have much influence? They had only started and only in a few countries, Uganda being one of the countries that started HIV prevention early. But even the nature and effectiveness of Uganda's HIV prevention campaign is still being hotly debated. Prevalence there has changed little in years and sexual behaviour indicators have long been sliding in the wrong direction.
  
  What bothers me is that even if widespread prevention activities started in the mid 1990s, it would take many years for them to have much effect. That's if they actually had any effect at all. Ok, I can't research every country in SSA, but in the case of Kenya, very little was being done in the 1990s. It was only in the early 2000s that some serious work started, say 2002 or 2003. And the Kenya Aids Indicator Survey (KAIS) makes it quite clear that HIV prevalence, which had been dropping before 2003, actually increased and is now higher, after half a decade of HIV prevention work.
  
  What I'm getting at is this: if rates of HIV transmission peaked in the mid nineties, then it did so for some reason other than the fact that every country had implemented widespread prevention programmes. The reason I suggest this is because prevention just wasn't a big thing then, at least, not big enough to explain why the epidemic started to 'decline'. I'm not saying that rates of transmission didn't drop, just that they didn't drop because of prevention programmes.
  
  Another reason for thinking that prevention programmes didn't have much influence on rates of HIV transmission is because even after they did start, there is little evidence that they could have been the cause of the drop. There is plenty of evidence that most current HIV prevention programmes have little or no effect. In Kenya's case, scaling up HIV prevention programmes seem to have resulted in an increase in prevalence, the total number of people living with HIV. This doesn't tell us if transmission rates have decreased, so what about transmission? Are there still lots of people becoming newly infected?
  
  According to the KAIS, transmission patterns are changing. Numbers infected in urban areas have dropped but numbers infected in rural areas have increased, especially among men. The majority of Kenyans, 75% or more, live in rural areas. Poorer and less well educated people are now being infected in greater numbers. The majority of poor and less well educated people live in rural areas and most Kenyans are poor and badly educated. These trends all follow what KAIS refer to as a 'rapid scale up of HIV prevention, care and treatment services'.
  
  A recent article in AllAfrica.com quotes UNAIDS as claiming that their successful prevention and education programmes have *finally* begun to change the behaviour of those who are most at risk. If this is only happening in recent times, how can they claim that it had anything to do with a decline in incidence that began in the mid 1990s. But Kenya, along with many other SSA countries, have explicitly not targeted some of the groups who are thought to be most at risk, MSM, CSWs, IDUs and young women. The well presented 'Modes of Transmission Survey' for Kenya makes it quite clear that these groups are still being ignored.
  
  There may be isolated signs of people's behaviour changing in some ways. All sorts of movements may have achieved great things, especially relating to HIV treatment and increasing access to treatment. I certainly wouldn't claim that all the billions that have been poured into HIV for over two decades has been wasted. But I have yet to see clear evidence that HIV transmission has declined as a result of prevention efforts. I think the epidemic has its own dynamics, like any epidemic, but I am not convinced that the enormous Aids industry has had much influence on its course. I just hope I'm wrong.

• GMOs, the Antithesis of Sustainable Development

  Posted: February 18, 2010, 11:29 pm by Simon

  Yesterday I went to see a lovely farm in Ngubreti, just a few kilometres north of Mogotio, in Kenya's Rift Valley province. Of course, if you like farms, many of them are beautiful. But when the climate is hot and dry for most of the year with flash floods that can wash everything away, the odds could be stacked against the farm being beautiful. This farm is beautiful because the farmer has employed numerous techniques to get as much as he possibly can from a twenty acre plot.
  
  This farm has 30 or 40 orange trees, 80 or 90 mango trees, vegetable crops, grain crops, animal fodder, 20 or 30 beehives, a tree nursery (which has already produced 2000 seedlings), cattle, sheep and, most importantly, water pans for collecting and storing as much as possible from those flash floods. It's hard to believe there is so much variety on this small farm but it's encouraging to see everything doing so well, given the amount of work that has been put in over the years.
  
  One of the sickening things about institutions like the World Bank and the IMF (International Monetary Fund) is that they can (and do) produce research to show that the way forward for farmers in developing countries is to increase support for farm inputs, provide extension programmes, improve infrastructure and other somewhat obvious things.
  
  Obvious, except that the same two institutions also give loans with conditions that include reducing public sector employment, cutting expenditure on extension programmes and banning anything that could be considered a subsidy, such as grants, loans or anything else to help farmers afford farm inputs, fertilizer, pesticides and the like. Never mind that these are allowed in rich countries, that's not the point. The point is that these institutions are run for the benefit of rich countries and what is good for them would never be allowed in developing countries.
  
  Well, the new head of the UNDP (United Nations Development Program), Helen Clark, has now said that she thinks there should be more public funding for agriculture, for extension services and for research that improves productivity and yield. There should also be public funding to help farmers to reduce inputs. The last one is especially gratifying because 'modern' agriculture often involves a constantly increasing dependence on things like fertilizer and pesticide. So there would still be inputs but the financial costs would be significantly lower and the environmental costs incalculably so.
  
  In the case of the farmer in Ngubreti, I said the water pans were the most important initiative on his farm. The failure to avail of cheap water harvesting techniques in the area is quite extraordinary. But this farmer has taken heed of what the local agricultural extension officers have taught him. He has two water pans, one that is just fed directly, the other which is fed by run-off water from the main road. These supplies ensure that the farm does not run out of water, even during prolonged dry periods.
  
  I shouldn't leave out the point that the head of the UNDP was actually responding to a question about genetically modified organisms (GMO). Ms Clark said that world food security depends on getting "back to the basics" with agriculture, it does not depend on GMOs. She also said that crops for biofuel competed with crops for food, despite the lies to the contrary that we so often hear from those investing in biofuels. So congratulations to Helen Clark. She could really benefit farmers in developing countries.
  
  The farm in Ngubreti was the scene of a number of agricultural extension programmes yesterday, including improved cooking stoves, cooking baskets, solar lighting and phone charging, beekeeping, water harvesting and various other ways of increasing the productivity of small farms. I'm hoping that Ribbon of Hope can try some of the things being done there, especially water harvesting and perhaps growing tree seedlings.
  
  It is clear from visiting a farm like this that GMOs have nothing to offer, especially in the sort of dry areas that make up so much of Kenya's land. The farmers are almost all smallholders, whereas GMOs are designed for farmers with huge tracts of land (that they can afford to waste, presumably). The farmers are poor but GMO seeds cost several times more than conventional seeds. Inputs for GMOs are far higher than inputs for conventional crops and increase over time (and conventional crop farmers usually put by their own seed every year). Organic methods, which increase yields, improve resistance to pests and to bad growing conditions and therefore cost less, are inimical to GMO production.
  
  GMOs are the antithesis of organic farming, indeed, the antithesis of sustainable agriculture. And there are many other problems with GMOs, as GMWatch.org make clear. It's good to know that much of Kenya's land is, as yet, unspoiled by modern agriculture. The same is true of much of the land in most developing countries. So it's time to ensure that it stays that way by resisting GMOs and anything else that compromises the future of the world's food security.

• Generating Self Reliance

  Posted: February 15, 2010, 11:36 pm by Simon

  Sometimes I get carried away when I'm blogging and I write something quite different from what I set out to write. The other day I wrote about how food insufficiency could affect people's likelihood of transmitting or becoming infected with HIV. That's fine, but my intention was also to say why I ended up working for a community based organisation that aims to help people become more self reliant, to produce food or goods that they can sell, or to identify ways of cutting their day to day costs. But now I think the answer should be clear.
  
  Ribbon of Hope Self Help Group, Nakuru, are working on a number of projects involving both HIV positive and HIV negative people in poor communities. Those projects range from growing food crops and keeping livestock to making things for sale here and abroad, providing various services and spreading intermediate technologies, such as solar cooking. The main thing is that we find income generation activities that are easy for people to do, even if they have very little money and training. If people are able to make or save some money, they will be more self reliant and better able to cope with the many stresses of life.
  
  Today was a great day for solar cooking. The location was ideal, about one kilometer from the Equator, and the sun was hot. We got there in time to set things up, not that that takes very long, and then started to answer the numerous questions people had. We were in a conspicuous area, so groups of people would form and disperse throughout the morning. I have no idea how many people came to see food being cooked using bits of reflective cardboard and pots that were painted black and stuck in a bag. But when the food was cooked, there were around thirty people willing to taste the rice, boiled maize meal and cabbage. If I'd known so many people were coming I would have prepared something more appetizing. But there will be plenty of opportunities to go back and demonstrate again!
  
  Will this prevent HIV from spreading? Not on its own, no. But there are many intermediate technologies that can provide people with cheap or free energy, solar cookers are just one example. We will be demonstrating others when we have the equipment. There are also many ways people can make money. We are researching the ones which will be most suitable for this particular context, poor, rural, isolated, etc. We want each person or family to take on more than one way of making or saving money, in fact, as many as possible each. The Scottish say 'many a mickle makes a muckle', here in East Africa they say 'haba na haba hujaza kibaba' (little by little fills the pot).
  
  Those who collect HIV data are probably not going to note a drop in HIV transmission in this area next year, or perhaps even several years from now. HIV is going to continue to spread in an area where the disease is endemic, where people are poor and lack health facilities, where a good level of education is rare, where basic things like food and water are in scarce supply, where infrastructure is falling apart and where most people don't work.
  
  But Ribbon of Hope aims to reduce poverty to the extent that some people will be able to send their kids to school, pay for their health care and provide them with adequate nutrition and clean water. And when those children leave school, they will have a better chance of being able to find work, being better educated and healthier than the generation before them. They may even have developed some entrepreneurial skills and know good ways to make enough money to do the same for their children.
  
  Most HIV money is spent on very expensive projects that target one disease and only one aspect of that disease, sexual behaviour. As long as the contexts in which this sexual behaviour takes place are ignored, most of the money is being wasted. Health, nutrition, food security, education, infrastructure and many other things are crying out for money but unless sexual behaviour is somehow involved, they will not be funded. This approach has not worked. HIV rates have waxed and waned in certain areas and in certain demographic groups. But rates are still high and the levels of sexual practices said to spread HIV have remained relatively unaffected by the hundreds of millions of dollars that have been thrown at the problem for over two decades.
  
  People's sexual behaviour is at least partly determined by the conditions in which they live and work (in addition to physiological conditions, hormonal levels, etc). But their health seeking behaviour, their diet, the way they raise their children and their attitude towards education are also constrained by these same conditions. If you want to influence people's sexual behaviour, and especially their attitude towards sexual health and risk, you need to look beyond their sexual behaviour in isolation. This sexual behaviour is likely to be pretty much the same all over the world. But the conditions in which people live and work are very different in Kenya than they are in, say, Ireland.
  
  There are exceptions, but most people I have met who are HIV positive spend their days getting on with the same things as people who are HIV negative, and worrying about the same things, too. They need to earn money, pay bills, raise their children, support their dependents, get by and perhaps even think about the future, if there is any money or energy left over for that. That's why I think a community based organisation that helps people achieve these goals is doing more to reduce the spread of HIV than all the expensive HIV prevention programmes that UNAIDS can think up.

• There's a lot of talk these days ...

  Posted: February 14, 2010, 8:06 pm by Simon

  There's a lot of talk these days about the need for a new Green Revolution, especially in Africa. Behind this talk, there is often the assumption that the original Green Revolution was an unmixed blessing, which it was not. Countries most profoundly affected by the revolution saw land ownership patterns change to the extent that small farmers almost disappeared and small farming became uneconomic for most. Farming become more intensive, with devastating environmental impacts, it became more mechanized, generally more expensive and less scalable.
  
  Some countries in Africa did experience some of the excesses of the revolution, though you wouldn't always think that when you read about the phenomenon. So now there is AGRA, the Alliance for a Green Revolution for Africa. This is funded by some of the funders of the original revolution, a number of prominent philanthropists that includes Bill Gates and several powerful international institutions. Again, the assumption is that such an initiative is an unmixed blessing.
  
  Kenya has a number of problems at the moment relating to land ownership. There are pressures for the number of people owning land to go down and the amount of land each owner owns to go up. One of these pressures comes from the many countries and institutions that want to invest in African land to grow food for themselves. Another pressure comes from those who want to exploit cheap African land and labour for biofuels. And a third pressure comes from the desire of biotech companies to spread their genetically modified crops (GMO).
  
  All these pressures go to exacerbate the already serious problem of food shortages that millions of Kenyans face every year. The new green revolution, the 'opportunity' to grow GMOs, the great foreign direct investment (FDI) that is being 'injected' into the country, all these incursions on the country's food sovereignty are being presented as a chance for Kenya and other African countries to reverse their fortunes.
  
  What most Kenyans know and what most of the people hawking these 'solutions' wish to ignore is that hungry people need food. Those interested in investing in Kenyan land are not coming here to provide people with food, they want to grow food to export it to the highest bidder. Biofuels are being produced for the Western market. GMOs are not a gift, except in the Trojan Horse sense. Once people grow GMOs, they are effectively working for the multinational that produces the seed, fertilizer and pesticides that all necessarily go together.
  
  Kenyans need to produce their own food and the only way that can be done is if the millions of people who own or rent small farms, the vast majority of Kenyans, are enabled to do that better. They need access to information, skills, tools and techniques that will benefit them as small farmers. They need to reduce their dependence on rain fed agriculture by availing of some of the many irrigation and water harvesting techniques. They need to grow more varieties of crop, rather than depending on a few non-indigenous staples, such as maize.
  
  Malawi has been praised for its 'green revolution' but things are not so straightforward there. As in Kenya, people there still need better access to land and to more land. They need to reduce their dependence on imported fertilizers and adopt some organic methods. Countries like Malawi and Kenya simply dump tonnes of organic waste every year that could provide better sustenance to their crops than the artificial fertilizer that requires much more water than is readily available and eventually poisons the soil and water table.
  
  People here have been promised so much, they have been promised massive production levels, copious foreign markets and great wealth. These things have been promised for decades and yet all Africans have seen is greater poverty, starvation and dependence. Whatever will result in food security in Africa, it will need to arise in Africa. None of the many foreign initiatives have ever resulted in Africans being better off, probably none ever will. The sooner people see this, the better.

• HIV and Sexual Behaviour

  Posted: February 12, 2010, 8:49 pm by Simon

  It sometimes appears that it is difficult for big HIV donors and NGOs to accept that they can waste a lot of money concentrating solely on trying to influence people's sexual behaviour with a view to cutting HIV transmission. They seem to have the attitude that sexual behaviour takes place in a kind of social vacuum and that it is completely unrelated to the way people live their non-sexual lives. Perhaps these organisations don't view gender inequalities, economic inequalities, differences in educational status or social status or intergenerational differences as having any bearing on sexual behaviour.
  
  A paper entitled 'Food Insufficiency Is Associated with High-Risk Sexual Behavior among Women in Botswana and Swaziland' is part of a whole body of research that challenges the view that targeting individual sexual behaviour should be the main approach to cutting HIV transmission. This 'behavioural' view tends to imply, without arguing or demonstrating, that the cirucmstances in which people live and work are irrelevant to their behaviour, their sexual behaviour and, therefore, their relative risk of becoming infected with HIV, or of transmitting it if they are already infected.
  
  The paper finds that food insufficiency results in increased sexual risk taking, especially among women. The sorts of sexual risk are inconsistent condom use with non-regular partners, transactional sex, intergenerational sex (usually where the female is the younger party) and lack of control over the circumstances of the sexual relationship. The paper recommends targeted food aid and income generation programmes and also an improvement in women's social and legal status.
  
  The fact that HIV is sexually transmitted does not mean that transmission can successfully be reduced merely by 'teaching' people about safe sex, by distributing condoms and facile 'messages' or by lecturing people, children and adults, about right and wrong. This is not a new discovery. But as soon as HIV was found to be sexually transmitted, the whole issue was hijacked by political and religious (and later commercial) crusaders. And it's only occasionally that people have been able to wrestle back some control over HIV as a human rights, health or development issue.
  
  If the conditions under which HIV spreads are to be changed, people need health, education and social services that are accessible to all, female as well as male, rural as well as urban, poor as well as rich. People need to be enabled to ensure their own health and the health of their children and dependents. People need their rights to be recognised and upheld by the law. The right to food is particularly important.
  
  Seeing the connection between food insufficiency and risky sexual behaviour shouldn't take much genius. Surely those who think HIV is just a matter of sexual behaviour don't think that being hungry or having hungry children makes people feel a stronger sexual urge or enjoy risky sex more? So if the limit of their HIV prevention programmes consists of things like behaviour change communication, mass male circumcision and, eventually, HIV vaccines and microbicides, they will find HIV continuing to spread.

• Behaviour Change for Journalists

  Posted: February 10, 2010, 11:59 pm by Simon

  The BBC can be funny sometimes, though not very funny. The title of one of their articles runs "Is Zuma's sex life a private matter?" and they promptly answer it in the negative by writing about it. Perhaps the author would have been wiser to ask about the president's attitude towards women and equality, since they have taken the liberty of asking about his sex life. But even an organisation as well (publicly) funded as the BBC often can't resist asking the same questions as almost every other journalist in the mainstream media.
  
  The media needs to get past the connection between HIV and sex. True, HIV is mainly transmitted sexually. But rates of HIV transmission depend on many other things, such as the relative economic circumstances of the people involved, their relative levels of power in relationships (whether ephemeral or otherwise), their levels of education and access to information, their levels of health and nutrition and the like. Indeed, the nature and accuracy of the information to which people have access may also be significant; exalted claims about the role of the media in HIV publicity campaigns certainly suggest this.
  
  Studies have shown that there is no strong correlation between rates of HIV in different countries and levels of what is considered to be unsafe sexual behaviour, for example, multiple concurrent partnerships. In other words, some places where rates of multiple concurrent partnerships are low, HIV rates are high and vice versa. High rates of HIV transmission in South Africa are, to the extent that they are well understood, explained by many things other than sexual behaviour.
  
  If the BBC is really concerned about HIV transmission, it shouldn't be beyond the capacity of the corporation to research the subject a bit better than the average tabloid newspaper. They could even have discussed the fact that Zuma didn't use a condom during his extra-marital relationship and is well known for being against the use of condoms. Sadly, there is very little to HIV prevention in South Africa, or any other developing country, aside from condoms.
  
  It may never become a popular view that HIV has numerous transmission routes and that many of the circumstances in which people live and work determine whether they will be infected with HIV and whether they will go on to infect others. HIV will probably always be viewed as such an extraordinary disease that it is transmitted in isolation from people's overall health and welfare, and that issues such as gender, power and politics are completely irrelevant. But it seems unlikely that the BBC will stick its neck out and adopt an unpopular view.

• India Tells Biotech Industry Where to Put its Aubergines

  Posted: February 9, 2010, 8:54 pm by Simon

  The good news today is that India has decided to place a moratorium on subjecting the country to genetically modified aubergine (eggplant/brinjal). The usual industry 'scientists' and 'experts' did everything they could and managed to drum up (pay for) the support of some senior politicians. But this time common sense has prevailed.
  
  It remains to be seen whether the country is sensible enough to treat other genetically modified organisms (GMO) the same way. It will also be interesting to see if other developing countries are tricked into accepting GMOs based on the industry lies about their increasing yields, being more nutritious, being better for the environment, being drought resistant and whatever make-believe rubbish they come up with.
  
  Sadly, it's too late for India's cotton farmers. They were promised increased yields, but yields have stayed the same or decreased. They were promised lower costs from reduced pesticide use but pesticide use (and therefore costs) is steadily increasing. Seeds for GMOs are far more expensive than those for conventional crops. Prices have also increased far more rapidly and farmers are not permitted to store cotton seed for later planting.
  
  In addition to damaging the environment, especially through reduced biodiversity, the whole of India's cotton industry is contaminated with genetically modified cotton. It is probably not possible to reverse this process so if any farmers are still trying to grow conventional cotton crops, they will soon face demands for payments from the multinationals that sell the seeds (something already happening with Brazilian soy beans).
  
  As a result, many Indian farmers have gone bankrupt or are facing bankruptcy. The costs are so high that others have tried to pull out of cotton production. Some have found that they have no viable alternative livelihood remaining and leave farming altogether. And thousands of farmers have committed suicide because their businesses have been ruined by this genetically modified cotton, a phenomenon that has been going on for at least a decade.
  
  Only a few countries have been rash enough to grow GMOs on a large scale and only a handful of crops are available in genetically modified forms. But the industry seems to have unlimited amounts of money available to 'persuade' powerful people to support them. In addition to DfID, the Gates Foundation is also interested in GMOs. It's hard to know whether the Gates Foundation has bought into the hype or whether they have bought into the industry. Ok, it's not hard to know, they have well and truly bought into the industry.

• Why are DfID Giving 'their' Money to the Rich?

  Posted: February 8, 2010, 8:29 pm by Simon

  In many developing countries, a substantial majority of people live in rural areas. The majority of rural dwellers depend, directly or indirectly, on agriculture of some kind. And most of those engaged in agriculture are smallholders, producing food for their families, their local market and perhaps a bit beyond that. Even a lot of people who don't depend on agriculture grow some food for their own use. Small scale food crops, fodder crops and stock keeping is so widespread in Kenya, where over 80% of the population lives in rural areas, that it would be difficult to estimate their value in the overall economy.
  
  On the other hand, 'aid' from the UK's Department for International Development (DfID), seems to assume that the best way to help poor people in developing countries is to give the bulk of their money to large and wealthy sectors of agriculture. DfID favour large-scale agriculture, high use of expensive, environmentally destructive technologies, such as fertilizer, pesticide, various pharmaceutical products, heavy machinery and genetically modified organisms (GMO).
  
  Small farmers, who can't afford these technologies and who are stuck with relatively undestructive farming methods that preserve biodiversity are therefore denied the opportunity to investigate ways of increasing their yields in sustainable ways. DfID seems particularly opposed to the production of food crops and stocks, spending only 3% of their of aid on food (.3% in Sub-Saharan Africa). MPs are calling for the figure to be raised to 10%.
  
  DfID probably hasn't realised that these small farmers produce most of the food that people live on in Kenya. Many of the rich farmers in Kenya produce for export, things such as tea and coffee and a lot of non-food crops such as flowers and sisal. A lot of land is even being used to produce crops for biofuel, which, whether for export or the domestic market, is not going to help starving people very much. DfID even supports programmes that 'donate' food aid, which is just a form of dumping that suits Western countries but serves only to destroy local markets in developing countries and leaves many of the putative recipients worse off than they were before.
  
  Any institution that supports GMOs has no right to call itself an 'aid' agency. GMOs are the prerogative of wealthy and rapacious multinationals who want to control the food market in order to maximize their profits. Such institutions also have no regard for the importance of biodiversity, which is under serious enough threat but will be even more rapidly destroyed by widespread use of GMOs. An example is the current attempt to introduce genetically modified aubergine (eggplant, brinjal) into India, where there are currently several thousand varieties. If these modified aubergines are introduced, all others will either die out or become contaminated.
  
  Every few weeks there is an article about some kind of crop that will supposedly save a country or reduce levels of malnutrition or increase yields or whatever. These articles don't usually say so, but if you check further, you'll often find that the crop in question is genetically modified. The article may even talk about biodiversity and sustainability and all sorts of lovely things. But if GM is involved, then neither biodiversity nor sustainability are involved.
  
  There are many reasons why GMOs should not be grown anywhere, yet some GMOs now dominate in a few countries, such as cotton in India and maize and soya in the US. Many farmers in countries like India, the US and Canada are now regretting the fact that they bought into GM but it's very hard to get back out again. Yet the industry still churns out its lies about GM being high yielding, uses less pesticides and herbicides, is more drought resistant, grows well in marginal land, etc. It's hard to understand why so many seem to fall for their lies.
  
  But DfID, with all its money and expertise, could not possibly be in the dark about the dangers of GM or even the inappropriateness of funding only large scale, industrial agriculture in developing countries. The question is, who has nobbled them and what are they getting out of supporting the biotechnology and other industries that stand to profit from their big spending?

• Orphanages Versus Community Based Care

  Posted: February 7, 2010, 1:48 pm by Simon

  Given the numbers of orphaned, abandoned and otherwise needy children in developing countries such as Kenya, the issue of whether institutional or community based care is preferable is a difficult one. There are badly run institutions and well run ones. But there are also children who face their greatest dangers in their own homes, from their parents or from their carers. From what I can see in Kenya, social services often don't get involved in cases where things go wrong, either in institutions or in community care settings.
  
  A study with a large sample size published a couple of months ago looked at both types of care, comparing cognitive functioning, emotion, behavior, physical health, and growth. The conclusion was that community care is not better and that, for some indicators, institutions are better. The authors of the study advise against aiming to transfer as many children as possible to some kind of community care setting. This is good advice if the children are in a well run institution or if an adequate level of community care can not be guaranteed.
  
  However, the organisation I am working with, Ribbon of Hope, does not advocate merely keeping a child in their community. We advocate for children to be cared for with the support of other people in the community, in addition to their carer or carers. We would like to see children receive any state support to which they are entitled. And we would like to help provide their carer with the means to provide for the child.
  
  Many children in institutions have one living parent and many more have close relatives who are living. But there are also children who may not have any close relatives or whose relatives are unknown and untraceable. So I wouldn't argue that there is no need for institutions to care for children.
  
  But there are institutions that have been set up with the express aim of making money. I don't know how many of these bogus orphanages there are compared to legitimate orphanages. I just know that several bogus orphanages have been set up in the immediate area around Nakuru. There are also institutions that cannot cope with the number of children they are trying to provide for and conditions for the children, and even the staff, are terrible.
  
  The only well run orphanages I have seen receive very large sums of money from benefactors. It's right that institutions providing for children receive large amounts of money, of course, but most institutions are not able to attract enough money and the children can suffer as a result. Keeping children in an institution usually costs a lot more than providing assistance for them to live in a family setting. Therefore, there may be a good case for more children being raised in a family setting when that is feasible.
  
  In addition, many of these well run orphanages are funded by private donations and are at least partly administrated by foreigners. This is not a bad thing in itself but it does suggest a lack of sustainability and a high degree of dependency. It can be difficult enough for local people to confirm that children presented to them are really orphans but for non-local people it can be impossible. Some people see orphanages as an opportunity to cut their own costs by sending one or more of their children there and claiming the children belong to a deceased relative.
  
  So the stark dichotomy between institutions and community care for orphans is not helpful. Both settings have their advantages and disadvantages. It is quite true that institutions should not aim to transfer as many children as possible to community care. But I think there should be fewer orphanages and far more children should be cared for in a well supported environment. Some of the money available, both state, donor and private, could better be used to provide families with everything they need to give a good home to children who have been orphaned, abandoned or are otherwise in need of care. The study in question is a good one, with a sound methodology, but I don't think it took into account the scenario where the carer is actively supported in providing care.
  
  Incidentally, people often ask about how you can tell whether an orphanage is legitimate or not. They even ask the same question about charities, philanthropic organisations, philanthropists, NGOs, CBOs and the like. I don't have a list of things but the Information in Context blog gives advice on this and other matters. The only rule of thumb I have at the moment is that when people or organisations seem to obsess about numbers, size and quantities, to the exclusion of all other criteria, this can indicate that they are more interested in raising money than in changing things for the better. That always makes me suspicious.

• Predicting the Predictable

  Posted: February 5, 2010, 8:35 pm by Simon

  Often in natural disasters, it's not the disaster itself that causes widespread injury, loss of life and damage to property. Where people are well off enough to protect themselves and their property against whatever disasters may occur, far fewer people suffer. Therefore, the magnitude of natural disasters in developing countries is often measured in people killed, injured or displaced. But in developed countries, the magnitude is usually measured by insurance claims for damage to property.
  
  There are exceptions, of course, but generally where people are vulnerable, natural disasters have a high human cost. Where people are less vulnerable, property is more likely to be the main loss. Developed countries, such as Japan and the US, experience natural disasters without anything like the human costs experienced by developing countries, such as Haiti. The hurricane that devastated New Orleans is not an exception just because it happened in the US. A lot of the people most affected were poor, vulnerable and marginalised.
  
  When a natural disaster hits a vulnerable country, the disaster itself may not have been entirely predictable, at least, not by people in that country who were able to do anything about it. But it is pretty predictable that, when a country has little infrastructure (especially water and sanitation), minimal health services, low levels of food security and the rest, most disasters will have a huge human cost. Insurance claims may well be negligible for people who have very little to insure and no money to insure with.
  
  Kenya and most other Sub-Saharan African countries are like Haiti in many ways. They have been treated as pawns in the political and commercial games of various Western countries; they have few social services of any kind and little or no resilience to any kind of disaster; they have huge debts and widespread poverty, poor health and malnutrition. We don't know what disasters await them, we just know that there will be disasters and that the consequences will be severe. Perhaps when some disaster strikes, there will be massive press attention, pledges of money, influxes of aid agencies driving white four wheel drives and resolutions to cancel debts.
  
  But all these pledges and other post disaster phenomena won't reduce the immediate impact of the disaster. The human cost will be high. The press will bemoan the fact that the country is so poor and infrastructure is so bad and debts are so high and politicians are so corrupt and whatever else they tend to bemoan in developing countries when it's too late. The amounts of money that are pledged, and even the amounts that actually reach the country, may be far higher than the amounts that were previously needed to strengthen the country's capacity. But that doesn't result in money being spent on increasing the capacity of developing countries to increase their resilience.
  
  Kenya has what could turn out to be a pathological attachment to maize, a non-indigenous crop introduced by the colonials because it's cheap and it's easy to grow large amounts on small areas of land, it fills you up, although it has little nutritional value. This pathological attachment could be compared to Ireland's staple food in the decades before the Great Famine, though I suspect the potato may be a bit more nourishing (or perhaps I'm biased). The potato is not indigenous to Ireland and eventually the inevitable happened. The ideal conditions came together for potato blight that wiped out most of the country's crop.
  
  Much of the currently used agricultural land in Kenya is covered with crops that can not be used for sustenance, such as tea, sugar or coffee. Much is used for non-food crops, such as sisal or flowers. And much of the food that is grown is maize. For many years, maize crops have been threatened or have even failed because of the dependence on rain fed crop growing. But the country still plants mostly maize and it's still mainly rain fed.
  
  The question is not whether disaster will strike in Kenya, it is when and how bad it will be. If the crops just fail in places where there is not much rain, several million people will be affected. If places that usually get a lot of rain have problems, several million more will be affected. Some countries around Kenya, even many areas in Kenya, have recently seen army worms attack, and they can obliterate entire fields. And there are other pests and factors that can take a large area by surprise. Maybe this year most people will survive, maybe not.
  
  But one thing is certain: millions of people are vulnerable. And they are vulnerable in more than one way. If a crop fails, they risk starvation. If the aid agencies come in, the food may not get to people in time because of the infrastructure problems or because of widespread corruption. Or people may die of whatever diseases start spreading, unchecked because of the terrible health service. There's a hair's breadth between Haiti's circumstances and Kenya's circumstances.
  
  It's now that the press should be clamoring for education, health, infrastructure and other social services to be improved, now that pressure needs to be put on the government to deal with corruption, now that individual people need to stop depending on rain fed agriculture, now that they should grow (and consume) things other than maize. And now is the best time to cancel the huge debts that developing countries have been arm-twisted into amassing for decades. Recognition that these circumstances make people vulnerable to inevitable disasters doesn't need to wait until it's too late.

• Discovering Poverty

  Posted: February 4, 2010, 12:31 am by Simon

  Only a few months ago there was great excitement about the 'discovery' of oil in Isiolo, in Kenya's Eastern province. This is not the first time oil has been 'discovered' there. Tens of millions of dollars have been poured into exploration without any commercially viable discovery. A few hundred thousand dollars were put into making local people think that they will benefit from being an oil producing region and no money at all went into cleaning up the pollution and environmental damage caused over the years.
  
  A local politician was predicting that "Kenya will join Uganda in celebrating the status of a new oil producer". So far, Kenya is not celebrating. But neither is Uganda, despite discovering huge quantities of oil. This is not a new story of developing countries having enormous mineral wealth while their own people make nothing and lose a lot. It's the same old story of Nigeria, Sudan, South Africa, Botswana, Tanzania, Uganda and, indeed, Kenya. There's no reason why the story should change, as long as wealthy countries can get hold of all the oil and other resources they require.
  
  As Uganda is finding out, deciding who gets to profit from the oil deposits is not up to them. It's up to their senior politicians, a handful of business people and a bunch of rich foreigners. If anyone who doesn't belong to one of those groups happens to have property or interests affected by work of extracting oil, that's their tough luck. Sure, some people will be employed for a while, but most of the top jobs will go to foreigners or to people who are already pretty well off. A hell of a lot more people will lose their livelihood, most of them being subsistence farmers and others who are just getting by.
  
  Local consultation, democratic accountability, sustainability, environmental impact, social impact, these are all as relevant as condoms at a USAID sponsored HIV awareness programme. Tullow Oil and that bastion of corporate social responsibility Royal Bank of Scotland will be able to wallow together in their ethical vacuum without having to worry about petty matters like human rights, environmental contamination or mass evictions of people from their land. And no one need worry, the Ugandan government will compensate the oil company if anything threatens their profit margins.
  
  Kenya should note what's happening in Uganda at the moment. Not that their politicians are likely to behave any differently if oil is discovered here. But maybe civil society groups here can start now, before the sort of secret negotiations seen in Uganda get going. It's hard to imagine what a developing country successfully extracting a natural resource would look like, where people in that country actually gained from the process rather than suffering greater poverty, disease and death.
  
  Maybe oil will not be discovered in Kenya, or perhaps not yet. It's not that natural resources are a bad thing, but as long as developed countries and multinationals always have the upper hand when they are discovered, the resources might as well remain in the ground. Some Kenyans may not know how lucky they are, but many in Isiolo would still remember the fallout from the various explorations and 'discoveries' of the last few years.

• Speaking from Inexperience...

  Posted: February 3, 2010, 12:57 am by Simon

  An old and extremely rich German wearing funny clothes and a bizarre hat who, ostensibly, has neither knowledge nor experience of sex or sexuality, is going to the UK to share his outdated, uninformed, biased and bigoted views on homosexuality with anyone there who is still prepared to listen to the current pope. One of his defenders says he is only saying what his followers believe about this subject, but that doesn't wash. He is supposed to be a leader and I think he has made his views pretty clear on other occasions.
  
  The pope feels that recent legislation in the UK runs counter to natural law. What 'natural law' is he talking about? Is he talking about the findings of a scientific community or some community of experts or is he merely using a meaningless phrase that anyone can use to support whatever prejudice they happen to be hawking? My question is merely rhetorical, by the way. I could claim that it runs counter to natural law to abstain from sex (or to purport to) but the fact that having sex is natural to many people does not preclude others from deciding to abstain. This is not because there is any 'natural law' involved, it's just that people are entitled to decide for themselves.
  
  Such laws as the ones the pope is complaining about, the Equality Bill and the like, do not "impose unjust limitations on the freedom of religious communities to act in accordance with their beliefs". They have no bearing on religious communities doing anything except things that are already illegal, such as discriminating against others on the grounds of their sexual orientation, for example. I would hate to have to list for the pope the excesses that have been perpetrated over the centuries by religious communities and the lengths that his colleagues have gone to in order to allow such excesses to continue, despite their being proscribed by (positive) law.
  
  Religious communities acting in accordance with their religious beliefs, whatever that happens to mean, doesn't itself sound like something governed by 'natural law'. Or perhaps the pope would claim otherwise. Perhaps some religions are more natural than others. Perhaps having no religion is 'unnatural', at least, according to natural law. But to be frank, the pope's defender seems to have to resort to meaningless arguments to defend his boss. For example "[the pope] wants his reasoned voice – formed by the treasures of the Christian heritage which is deeply embedded in our culture – he wants that voice to be heard", etc, blah blah.
  
  The current pope follows a long line of popes who have done everything they can to perpetuate various forms of bigotry and discrimination. I'm surprised he is intending to spread his vitriol in the UK, where I imagined most people to be fairly unswayed by any particular religion. But he has certainly done a lot of damage in African countries he visited. Perhaps he hopes for the same level of 'success' elsewhere. The man seems to have little respect for concepts like human rights and democracy and I hope he gets an appropriate reception, wherever he goes.

• Do Wealth and Power Exclude Wisdom?

  Posted: February 1, 2010, 1:01 am by Simon

  To quote the late comedian Linda Smith, "I don't mean to sound racist, but rich people are weird." The very good climate change blog, climateprogress.org has an article about Bill Gates and his maunderings on climate change and related issues. The guy seems to know very little about climate change and all his information seems to come from corporate funded mouthpieces like Bjorn Lomborg.
  
  Gates seems to think most of the current worries about climate change are pointless and that none of the proposals made by activists and experts should be considered. But he thinks that there will be a technological solution or two to the problems of clean energy, energy efficiency, etc (one of those solutions being nuclear, which he thinks is 'as good as' renewable).
  
  This would sound very familiar to Gates-watchers. He advocates technical solutions to health problems, diseases such as HIV, TB, malaria, cholera and rotavirus. He also advocates technical solutions to problems like food shortages, food insecurity and low levels of food production (in the form of biotechnology). And for climate change, he advocates bioengineering. He's certainly consistent, so far.
  
  Despite all his money and his rich and influential friends, Gates seems to be very misinformed and is falling behind on his knowledge of current research, but read the climateprogress.org article for the full details. He's into 'altering the stratosphere to reflect solar energy', filtering 'carbon dioxide directly from the atmosphere' and 'brightening ocean clouds'. Do we really want this lunatic to be let loose on the only life supporting planet we know of?
  
  There's also a very strange article on allafrica.com purporting to be about poverty eradication that is really about a deal between the richest man in the world (Gates) and one of the richest and most rapacious corporations in the world (Coca-cola). The Gates Foundation is providing most of the capital, over 10 million dollars, to allow 50,000 Kenyan and Ugandan farmers to sell fruit to Coca-cola for 'fruit-juice' production.
  
  The article is very short on detail and I don't see why Coca-cola can't get these farmers to sell fruit to them without the help of Gates. But is it really a good thing that these farmers are going to sell their healthy food products for what will be a very low price to an organisation that will convert them into an unhealthy and very expensive beverage?
  
  Coca-cola is better known for covering otherwise beautiful areas with their revolting logos and other excrescences, for marketing harmful products to people who are starving and in need of fresh water, for polluting water supplies and using up water supplies in areas where water is scarce and for maintaining a very poor record of corporate social responsibility (see corpwatch.org for further details).
  
  Rich people and organisations are weird, but they can also be sinister, completely undemocratic and downright inhumane. I'm not calling for a law against being rich or even curbs on how rich people can be. But I think rich people and organisations should be subject to the same laws as other people and organisations. And poor people should be protected from the excesses of the rich and powerful. Why should a handful of very rich people and organisations be able to dictate the future of the planet and the futures of all its inhabitants?

• Let Them Drink Sewage, As Long As They Buy Our Drugs

  Posted: January 30, 2010, 8:12 pm by Simon

  There's a suburb, a slum area, not far South of the town of Nakuru and it always smells bad. Well, perhaps all slums smell bad, but some smell worse than others. As you walk through the main street of Kaptembwa, there are deep trenches at the side of the road, apparently having something to do with the 'sewage system!. But all around, there is stagnant water and raw sewage. When there is a lot of rain, this effluent flows through the streets and even into people's houses. It also mixes with the water supply, such as it is.
  
  I don't know how long Kaptembwa has been like this. People who have been there a long time say there has never been any proper sewage disposal. Now, children play in foul smelling puddles, with terrible consequences for their health. Adults also have to walk through the mess and put up with the smell, the dirt and even the diseases.
  
  Places like Kaptembwa are ideal breeding grounds for water borne diseases. You could vaccinate every child against something like rotavirus and you would still have lots of them sickening and dying of water borne diseases. Both the children and the adults living in such areas need adequate sanitation and reliable supplies of clean water. No amount of vaccine will get rid of the health hazards caused by such conditions.
  
  But also, people are entitled to some level of dignity. They should not have to live in dreadful and threatening conditions. Those who claim to be concerned about their health should consider these conditions first, not the headline grabbing but ultimately weak solution of vaccines or drugs. People shouldn't have to drink water that smells of sewage.
  
  But for some reason, rotavirus vaccine has been much reported recently. Perhaps it's because the Gates Foundation has mentioned the development of the vaccine as one of their primary goals, perhaps it's because the pharmaceutical companies who are behind this lucrative prospect are good at issuing press releases. Journalists are certainly good at citing press releases, regardless of the levels of sales puff they may contain.
  
  Among the three articles I came across today about Gates, Glaxo Smith Kline (and others) and their rotavirus vaccines, all say very little about water and sanitation. They ooze on about how brilliant all this medical technology is but they don't mention, or are not quoted as mentioning, that vaccines will be useless without high levels of spending on water and sanitation infrastructure. It could be wondered if all these groupies care, one way or the other, about how people are forced to live.
  
  One of these articles cites an academic as saying that vaccines "represent the best hope for preventing the severe consequences of rotavirus infection". There is probably a sense in which this 'expert' is right but failing to mention water and sanitation renders the statement hot air. Vague mention is made of water and sanitation in the other articles but the focus is on the vaccine, as if children who are suffering from poor nutrition, multiple vitamin deficiencies and various parasites are going to be magically made healthy by a vaccination for one of the many water borne conditions that are endemic in developing countries.
  
  One of the articles even mentions some the problems of rolling out large scale vaccinations, and the rotavirus vaccine in particular, in countries that have poor health systems and inadequate infrastructure. This article even mentions the high cost of vaccination programmes. Why is it that the Gates Foundation and other institutions don't seem to mind high costs when the main beneficiaries are pharmaceutical companies and other rich establishments?
  
  All the articles list figures for how many lives could be saved by a rotavirus vaccine and the usual sort of stuff. But they don't list the figures for how many lives could be saved by spending money on a cheaper but far more urgent way of reducing deaths from water and sanitation related causes. I can't think why.

• Religion and Health: Interference or Complementarity

  Posted: January 28, 2010, 8:40 pm by Simon

  Following my speculations about why some people seem to imagine that they can be made very rich by a miracle, a friend sent me an article entitled Religion, Spirituality, and Medicine. This article is a "comprehensive, though not systematic, review of the empirical evidence and ethical issues" and concludes that "the evidence of an association between religion, spirituality, and health is weak and inconsistent".
  
  Perhaps more importantly, the authors question the ethics of mixing religion and medicine, a question that would still arise even if there was stronger evidence of an association between religion and health. One could ask, which religion would a doctor recommend or agree to discuss? What would they do with someone who didn't believe in any religion? Would each medical professional require special training and what kind of special training? (The authors of the paper did not raise all these questions, but they arise from considering the problems of combining medicine with religion).
  
  Even if people go to a doctor without any expectation that the doctor is, to a large extent, a scientist, that doctor is obliged to do things that are supported by scientific evidence and avoid things that are not so supported. The fields of science and religion are completely different and the practitioners of each field work in different ways. Is it even feasible for doctors to also become experts in religion (as if religion were just one thing!)?
  
  If I was renting a damp room that affected my health badly, should my doctor write a letter to my landlord and ask for my conditions to be improved? Medical advice could be brought to bear on an employer who was exposing me to health risks, but this is a matter for employment laws. The doctor doesn't intervene directly. Yet we know that environmental conditions are closely connected with people's health. We know that economic circumstances are closely connected with people's health but we don't expect our doctor to recommend a pay rise. Even government health advice about healthy eating is considered to be taking things too far by some.
  
  I accept that certain beliefs can be comforting and I certainly wouldn't suggest that people should be told what to believe and what not to believe or how to express their beliefs. If they see praying as part of their recovery from illness or as helpful in bearing an illness from which they will not recover, no one has the right to interfere. But when it comes to prescribing medication, the doctor is the expert, not the religious leader. And when it comes to praying and giving religious advice, the religious leader is the expert.
  
  In fact, I find it exasperating that there are many churches in developing countries who don't seem to be able to make that distinction. They feel they are experts in marriage, reproduction, sexual behaviour and protecting against sexually transmitted infections (STI). They are not experts, generally they know even less than lay people and should certainly have less experience. If you can't persuade someone to give up having sex or sex outside marriage, the least you can do is tell them how to avoid becoming infected with an STI, infecting someone else with one or giving rise to an unplanned pregnancy. Otherwise, these leaders are failing to do what they can to prevent serious consequences.
  
  If religious leaders wish to give medical advice, they had better know what they are talking about. As for advice about sexual behaviour, contraception and reducing the spread of STIs and unwanted pregnancies, many don't seem to have had a lot of success and should leave the job to someone who has the appropriate knowledge and training. In the same token, doctors should discuss religious matters with patients if they feel able to do so and if they are requested to do so but it should never be seen as a type of medical care or treatment.
  
  If someone has a particular set of religious beliefs, presumably they hold those beliefs regardless of their health or lack of health. It seems unlikely that they just 'adopt' those beliefs in the hope that they will get well. Whether someone is religious or not, some will suffer illnesses and injuries and all will die eventually. If the 'belief' is purely conditional on their health, the person's piety would be quite questionable. So I don't see why a religious person would be interested in whether religion is in any way connected with health outcomes in the first place.

• Poverty Breeds Religion? Religion Breeds Poverty? Both?

  Posted: January 26, 2010, 11:01 pm by Simon

  Firstly, I must make it clear that I don't mean to appear biased, that I am just writing from my point of view. But this is hard for me. I have no problem questioning the motives of very powerful people like Bill Gates or the ethics of multinational industries, such as pharmaceuticals or biotechnology or even those of international institutions, such as the World Bank, the International Monetary Fund (IMF) or UNAIDS. But when it comes to talking about the ordinary people that I meet and interact with every day, I realise I could sound like I'm making some pretty unwarranted assumptions.
  
  I am trying to understand certain things here (in the world, but also in Kenya), that's partly why I'm here. I think that we in the Western world, people and institutions and practices and other entities, do a lot to impoverish people in developing countries. I have argued the point on many occasions and will do so in the future. My whole concept of 'Development by Omission' is based on many instances of this very phenomenon. But I also wonder why some people seem to choose certain kinds of impoverishment or choose not to do things that are well within their capability that may raise their living standards and those of their dependents.
  
  Rather than giving lots of examples, though there are many, I'd like to concentrate on one. I wonder if people who see their situation as desperate turn to what can be a very extreme adherence to some religion. I'm thinking especially of Christianity, in particular the more evangelical ones, though they all seem to be evangelical here. Some people give money they can ill afford to a church, some give it to a pastor. Some even give everything they have got in the hope that a miracle will change their lives. Many pastors and churches encourage these beliefs, it's how they make their money. However, all churches depend on donations for most of their income (or wealth).
  
  Belief in miracles seems to be very widespread, not that miracles can occur, but that anyone and everyone may well have their lives transformed if they just pray a lot and, of course, send lots of money to churches and pastors who claim to be able to make this a reality. Even if I believed that miracles can occur, I don't accept that you can simply wish them to occur, pray for them to occur and least of all pay for them to occur.
  
  I don't see people's wish to have their lives transformed, even their wish to be very rich, as greed. I think if I had nothing I might be more likely to want a lot than I would be to want just enough. Perhaps it's because I've had enough for so long and generally find that fine, a lot would be great, but it's unlikely to feel that much better than enough. I don't wish to preach (God forbid!), I'd love to have an income or, at least, the guarantee that I will one day have an income. But for now, I'm getting by. But I'm not just talking about what people wish for, which can be indefinitely great; I'm talking about what some people seem to sincerely believe they may one day attain.
  
  Greed is what we see in the pastors and churches themselves who extort money out of poor people with promises of great wealth. Greed is what we see in the people who spread misleading information about pyramid schemes and the like and thereby prey on poor people. Greed is the biotechnology multinationals, who want people to think they are getting a good deal when they are in fact entering a form of indentured slavery. Greed is the pharmaceutical companies who keep their prices artificially high and lobby governments of rich countries, who obligingly use public money to subsidise these products and call it aid.
  
  Desperation could be one reason for turning to a religion, even believing quite irrational things or accepting irrational interpretations of the bible. But maybe there are many reasons. Many terrible things are being done every day in the name of religion but maybe only some of them are meant to be terrible. The people running a 'children's home' we came across recently may well believe they are following the word of the bible. They certainly say they are. True, they have stolen most of the donations to the home and put the lives of many children at risk, but it is vaguely possible they started out trying to do something good, while at the same time making enough money to keep their own households and send their children to (relatively expensive) schools.
  
  Perhaps there is just a lot of religious fervour in Kenya, for various interpretations of the bible, for various different churches and for various different religious personalities, perhaps it's not desperation at all. But similarly irrational beliefs seem to be held about foreign people and how rich they all are and how they just come here to give out money. Ok, some foreigners do that, but several times every week, sometimes several times in the day, I am asked for money, often by people who have asked me many times before. And I know others who have had the same experience.
  
  Some people seem to believe that if only they could get a scholarship or if only someone would sponsor them to go to Europe or the US (or somewhere else) or if someone would set them up in business, or if they would marry them, they would be ok, they would be very happy. Maybe people everywhere believe these things, I don't know, maybe people here are just more honest about it. But I think there is a difference between wishing for something and actually expecting it to happen.
  
  Is it desperation that fuels this apparent devotion (or whatever it is)? Or does devotion to the belief that material wealth will be thrust upon all those who pray enough or give enough to pastors and churches or ask enough foreigners keep people from doing things to change their own circumstances? They could question preachers who keep promising them what is just material wealth. They could question where all the money they give goes to when they are poor and the preachers are wealthy, often staggeringly wealthy. I'm not saying there is work aplenty for everyone, sadly, there is not. And though there is wealth enough for everyone those who have most of it, and they are few, are not likely to part with it quickly.
  
  I don't feel I'm much closer to understanding people's seemingly pathological attachment to religion, miracles, pastors and churches. Biased I may be, but I blame churches, not for poverty, but for influencing people in such a way that many people here behave quite irrationally. I blame religion for people's apparent belief that, although they can do nothing to change their own situation, someone, God, rich people, pastors or someone else, can make their lives better. I think the evidence is fairly clear that there is no one who will help most people except those people themselves. But then, when has evidence or experience ever had much impact on religion?

• Gates the Autocrat: Malignant or Benign?

  Posted: January 25, 2010, 12:15 am by Simon

  It's nice to get a long letter, except perhaps when it comes from Bill Gates and it's 14 pages long. But I feel obliged to try and keep up to date with what he and his foundation are up to. Their various concerns are very interesting but I'm always curious about the ways the foundation chooses to approach these concerns.
  
  For example, the foundation is particularly interested in vaccines for pneumonia and rotavirus and concentrates much of its attention and funding on a relatively small group of diseases. This vertical approach to health, which could better be called a vertical approach to disease, is not one that everyone would be comfortable with. Huge amounts of money and resources for a few diseases could easily result in people suffering from or dying from some of the many other diseases commonly found in developing countries.
  
  Indeed, people's health (as opposed to their diseases) have a lot to do with their environment, their living and working conditions, water and sanitation and, of course, nutrition and food security. The determinants of health are arguably more important than a few of the individual diseases that are seen as particularly worth funding. Even susceptibility to the diseases the foundation is funding is to a large extent governed by, for example, nutritional levels and food security. These, as I shall claim below, are being seriously compromised by the same foundation.
  
  When it comes to TB and HIV, especially, this vertical approach runs a high risk of widespread resistance developing to whatever drugs are made available in large enough quantities. The Gates Foundation puts a lot of faith in technology, in vaccines and the like. These are all very expensive approaches, both to prevention and treatment. It is absolutely necessary to treat people who are ill, but it could be questioned how sustainable, as a whole, the foundation's approach is. Or maybe sustainability is not an issue and resistance can be dealt with by newer round of (even more expensive) drugs.
  
  After all, rotavirus, polio, pneumonia and to a different extent malaria and HIV, are very closely related to the conditions in which poor people live, not just to a group of disease agents or pathogens. Can a high dependence on drugs for prevention and treatment of diseases work to save lives and reduce suffering when, at the same time, health services, education systems, infrastructures, food and food security and social services are almost non existent?
  
  Of course, this is not necessarily the foundation's concern. But Gates and Co. must want their expensive interventions to work. They hardly put huge amounts of money into something that doesn't work. But what results do they expect? They surely expect a lot more people to be cured of diseases and a lot more people to be vaccinated against diseases. But it could be argued that another 'result' of the foundation's work is to enrich the pharmaceutical and other companies that receive much of the money being handed out.
  
  I am not claiming that the money is just being handed over to multinationals. But the foundation's money that is not being disbursed is being invested to maximize its profit. It is being invested in pharmaceutical companies and others, regardless of their impact on poverty levels, distortion of markets, the environment, etc. There is a danger that the foundation is funding some of the problems it purports to be remedying.
  
  So much for health, I'm finding it hard to get my head around whether the foundation is doing good work or if it is, at best, diluting its possible benefits, at worst, sneakily throwing money at multinationals that are closely tied to the foundation's wealth. But when it comes to genetically modified (GM) organisms and the multinationals who produce GM products, I have less doubt about what to think.
  
  GM crops have not succeeded in giving any of the benefits claimed by industry hype. All GM crops grown on a large scale have had massive drawbacks that farmers in poor countries cannot afford. Developing country farmers are mostly subsistence farmers. They get enough from their land to eat and to trade for the following year's costs and perhaps a few other household costs. Even small additional costs will eat into money that they need for school fees, health, food and whatever else.
  
  Taking on GM crops means that the costs that have to be met every year by farmers is higher than the costs of traditional crops. But also, the costs go up every year. GM seeds have to be bought every year and they have increased in cost much faster than traditional seeds. Fertilizers need to be purchased in higher quantities every year and their cost is also much higher than organic methods of fertilizing. Pesticides are more expensive and not only do more and more have to be used every year but eventually, the farmer needs to find new ways or new pesticides to continue growing the GM crop.
  
  The Gates Foundation doesn't seem to favour sustainable ways of approaching diseases. They certainly don't favour sustainable agricultural practices (something that is flatly denied by Gates in his letter). And they don't seem to favour increasing self reliance among people in developing countries. Perhaps I'm judging the foundation too harshly but I think these questions need to be raised because there are too many people who are making so much money out of this type of philanthropy that they will never raise them.
  
  I think we'll have to wait a long time to find out who gains most from the Gates Foundation but I suspect some of the most powerful companies in the world will do very well indeed. After all, if they don't do well, the foundation's investments will not do well and it's funds will eventually be eroded away. I would question the aim to give what Gates calls 'recognition' to these multinationals when recognition usually seems to mean profits. At present, the foundation appears to be paying the inflated costs demanded by these multinationals and making it worth their while keeping their prices high.
  
  Maybe people in poor countries will gain more than they will lose from some of the foundation's projects, but it will be hard to tell. And there will certainly be huge losses for any country that buys in to the hype of GM. Countries that are already suffering from these losses, such as the US and Canada, may be able to afford them but developing countries can not. It seems as if many people in the developing world are depending on the whim of an autocrat. All they can do is hope that he is a benign one.

• Income Generation Activities Galore

  Posted: January 24, 2010, 12:12 am by Simon

  Just over a year ago I appealed to people I know, especially on Facebook, to help me to identify possible income generation activities suitable for developing countries where little capital, skills or infrastructure are available. I was overwhelmed by the slightly fewer than two responses I received and the first one didn't fly. So I set about researching on the internet, contacting people and talking to anyone who was prepared to discuss the subject. Now that I have started making a list, I decided to post it here on my blog so that others trying to research the same thing won't have to start right at the beginning. And maybe some people will even contribute to the list!
  
  The list is by no means exhaustive and the categories are just based on the way things look from here. They overlap to some extent and they are in no particular order, though I think the first two are particularly important because local acceptability can make or break an income generation activity, no matter how 'good' it may seem. And some of the activities that are already widely carried out have a lot to recommend them. The community based organisation I work with, Ribbon of Hope, already grow a number of crops and have financed several livestock programmes. But it's time to branch out, try new things, diversify and ensure that people get the maximum benefit possible.
  
  The approach we are likely to take is to ask our clients what gaps they feel there are in their local market, what local materials are available or could be made available. Also, what skills are there, what do people already know how to do. There must be local products that we don't know about and sometimes it turns out that people can make or do things but just hadn't realised the value of that skill. I'm not sure in advance what we will gain from this or how we are going to elicit the sort of information we want, but I think it could be a valuable exercise. Rather than just teaching people a skill or a few skills, we would also like them to be able to assess all the opportunities that exist and consider acquiring as many skills as possible. So that's the first category.
  
  The second category is to get people to help us make an inventory of what could be produced in the area and sold in a local market or business. I'm thinking of things like sunflower or sesame oil, peanut butter, jam from seasonal fruits, honey, butter, cheese or anything else, even things that are already produced but for which there is little or no market, yet. I'm thinking of a campsite I stayed at in Tanzania which sourced things like this in a relatively remote area. The result was spectacular because many of these products here are only available in highly processed, branded forms (which taste disgusting). They should be produced locally if at all possible.
  
  Ribbon of Hope already supports several shambas (smallholdings), which I have mentioned several times on this blog. Those smallholdings should produce everyday foods that people in the area need but they could also produce high value crops, such as sesame and sunflower seed, where clients can also produce the sesame or sunflower oil. These have the advantage of yielding highly nutritious oil cake as a by-product, which makes excellent animal feed. We should produce animal fodder, especially fodder that can be stored for use during dry periods, which are all too regular and protracted here. And there are all sorts of interesting crops we could consider growing, just to keep things diverse.
  
  Dairy cattle, goats and chickens are a well tried income generation scheme and they are usually successful. Because they are such a good bet, they can require a fair amount of capital, which some of the more risky and less well tried schemes don't. But not everyone can afford to take risks. I'd say, get the low risk schemes started first and then add the others in at leisure. We mustn't forget the hides and furs of stock such as cattle, goats and sheep, either. Certainly, there are many uses for sheep wool, regardless of the quality. But another type of livestock that you don't see so much around here is rabbits, especially the very big ones that are bred for meat. There must be many uses for their fur, too.
  
  There are good opportunities for different types of food processing here, especially food drying. Fruit and vegetables can be solar dried at very low cost. Many crops, such as mango, pineapple, banana and tomato flood the market at certain times of the year and a lot is dumped. These are all good when dried. Ribbon of Hope produced a beautiful crop of coriander in the last few weeks and this would be as good dried as fresh, except that it would be a far more viable crop if we could dry large amounts of it. Mushrooms are grown locally and are a potentially lucrative and nutritious crop that is also good dried. Yoghurt is already widely produced, cheese isn't so popular and maybe there's a reason for that. But many things could be made with local ingredients, such as biscuits, cakes, bread, cassava chips and the like.
  
  Some of the areas here are blighted with a monoculture, especially sisal. But I'm sure people could be persuaded to make things of higher value rather than rope, which is how most of the local sisal ends up. We'll see what people who have been surrounded with sisal all their lives come up with. Not too far from here, silk worms are farmed, so that's another possibility. I've mentioned before the possibility of producing reusable sanitary pads. There are probably going to be lots of objections but many people, especially young girls, can't afford disposable ones so it's worth some effort. Leather goods may be another possibility, especially if local people are successfully breeding relevant livestock. No doubt there are other artisanal products, such as pottery, candles and whatever else. Sorry for being vague but the gaps will be filled in eventually.
  
  Ribbon of Hope has already funded a successful project selling water and this raised surprisingly large amounts of money. Another possibility would be to pasteurize water using solar cookers or solar heaters and selling it. Included in this category, not many people in this dry province of Rift Valley use irrigation, nor do many people harvest rainwater. This is short-sighted and even journalists are apt to bemoan the fact that there is an unwise dependency on rain fed agriculture throughout Kenya (if journalists notice, it’s probably been a problem for decades). It's time to change this, even if it's only to a small extent. Equally, many people don't irrigate their land, even when there is a source of water close by. Since Ribbon of Hope started irrigating its fields, neighbouring farmers have started borrowing their pump. So it is catching on!
  
  One of my favourite types of income generation activity or cost saving activity relates to fuel or energy. I have mentioned solar cookers, such as simple reflective boxes or more complicated parabolic cookers. These are great for cooking food, drying food and for pasteurizing water or milk. Some of our projects involve milk production so free pasteurization would help reduce costs a lot. I've also mentioned fuel briquettes made from waste of various kinds. People could produce these for their own household but they could also produce them for sale in the local area. Wood and charcoal, the most common cooking fuels, are expensive and likely to go up in price. Solar is cheaper, cleaner and better for the environment and could be used to supplement other sources of fuel. Biogas is more difficult to produce but we are hoping to get some to train us in how to produce the stuff.
  
  Some trees and shrubs could be a useful addition to any shamba. The Kenyan government is thinking of introducing a law about people growing a certain number of trees per acre. True to form, they are not giving any advice as to what trees should be grown and which should be avoided (there are some serious problems that result from choosing the wrong trees). And people with very small, possibly rented shambas, will not want to risk reducing their yield by sticking something unproductive in their fields. But there are productive trees and ones that are good for the soil. There are some that produce fruit without compromising the field crops and others that produce oils and even animal fodder. There are trees that can benefit in various ways, so these should be carefully selected.
  
  Finally, some organisations end up with assets that they only sometimes use, such as equipment and tools. These could be rented out to neighbouring farmers or swapped for other benefits, such as labour or tools that are lacking. Tools and machinery are prohibitively expensive here, which is why so many farmers try to fly by the seat of their pants and sometimes fail. Even rainwater harvesting and irrigation involve costs that small farmers can't always meet. But they might be able to share, for a fee, of course. Ribbon of Hope's neighbours have increased their yields so much in the last few months by using their petrol pump that they could easily afford to pay a small fee.
  
  Well, that's it for the moment, but that's quite a list. I'll continue researching and noting progress (and problems) and I'll add links to further information when I can get around to it. I hope people find this list useful and if anyone has other ideas for income generation activities, please let me know. Thank you in anticipation!

• Relative Deprivation in Urban and Rural Settings

  Posted: January 21, 2010, 8:51 pm by Simon

  It's been a mixed week so far for Ribbon of Hope in Nakuru. We spent the first few days in the hot, dry Mogotio, a few hundred metres from the equator. Despite the heat and lack of rain, there is a river nearby. Ribbon of Hope purchased a petrol powered pump, and later a foot operated pump, to irrigate their fields there. The results on our fields was so good that owners of neighbouring fields have been borrowing the pump to irrigate their crops, again, with encouraging results.
  
  We have started trying to harvest the sizable crop of beans but very heavy rains at the end of the growing season resulted in extensive new growth, which means that each bean plant contains a mixture of beans that are ready to harvest and beans that are still green. The ones that are ready to harvest are starting to pop out of their pods and the green ones need to stay in the ground for another few days or even weeks. It's a bit of a dilemma and we are looking for ways to work around this. But the field has produced and continues to produce other vegetables and, in the end, it will more than pay for this year's and perhaps next year's costs.
  
  The recently rented field that has been planted with watermelons is doing well and the constant irrigation, weeding and other work required gives casual employment to several local people. Mogotio is very short of jobs, most people do casual work of some kind and that's scarce enough as well. The area has depended for a long time on the sisal industry, which dominates the area completely but product output is very low and, for some reason, the sisal factories don't seem to like paying their employees. For some employees, arrears go back years.
  
  So there are people who are happy to work in fields and there is a ready market for the produce. The soil is very good and with proper tending, seems to be well suited to quite a range of vegetables. Some of Ribbon of Hope's modest aims of reducing poverty and dependency to a small extent in Mogotio have been realised and we hope that this progress continues well into the future. It is a credit to the people there who have been so willing to work hard to ensure that things have worked out well.
  
  There are several other similar projects in other villages and they have not all worked out so well. One perfectly viable smallholding has been neglected to the extent that there is little there now but weeds. My colleague and I felt ashamed when we walked around it because it stands out from the surrounding fields, which are packed with greenery, maize, beans, fodder crops and others. This sort of wastage of money, labour, resources and opportunity needs to be avoided, but how? Lots of people say they want help but Ribbon of Hope has limited resources. The only way they can help is by starting sustainable projects, ones that require a small initial outlay that can eventually be returned to the organisation.
  
  One of my colleagues pointed out to me when I arrived in Nakuru that the rural based projects tend to do well but urban based projects, or projects involving urban based people, tend to fail. This has been demonstrated to me over and over again. Big NGOs don't tend to go to villages, even ones quite close to big towns. Villages and rural areas seem to be overlooked by funds, schemes, initiatives and projects, yet many people there welcome any opportunities that present themselves.
  
  But people who are based in urban areas seem to have NGOs knocking at their doors (beating them down, even). It is not an exaggeration to say that there are people who join each and every group in order to see what they can get from it. Some have several different group meetings every day of the working week. If they don't get something to take home, something immediate and tangible, they lose interest very quickly. Ribbon of Hope runs relatively short term projects but even three to four months is too long for some people who are used to receiving cash handouts, food, clothing, per diems, courses in making things (which they subsequently never make) and who knows what else.
  
  There is a lot of poverty in urban areas, I wouldn't wish to suggest otherwise. And I'm pretty sure there are plenty of people who know nothing about this system of 'support group hopping' and are unaware of benefits that they could really do with. But small community based organisations who can't provide people with something to take home cannot compete with organisations who can. So perhaps, given our size and means, we should concentrate on rural based groups. Perhaps we shouldn't try to box above our weight.
  
  The last remaining urban based group that we worked with may now be drifting away and I won't be shedding any tears for them. As for the remaining rural based groups, most are doing well, not as well as Mogotio, but it's early days. We have some great ideas to try out over the next year or so. There have been more encouraging signs than discouraging ones and perhaps now is a good time to do some selective pruning and simply rip out the plants that will hold back the others in the long run. Sorry for the cheesy ending but it seems apt.

• Kenyans Don't Need Rights, Especially if They Are Women

  Posted: January 20, 2010, 12:37 am by Simon

  The Kenyan MPs reviewing the draft constitution have decided that women will not have equal rights to men in marriage. They don't at present, so no change there. And a big missed opportunity in the fight against domestic violence, family impoverishment and indeed, the spread of HIV and other sexually transmitted infections (STI), along with unplanned pregnancies, including those among women who are HIV positive.
  
  These extremely well paid MPs have decided to exclude much in the constitution that relates to rights and the role of civil society. This includes religious groups (and the Kenyan National Commission on Human Rights), so I'm sure the MPs will be persuaded to change their minds about the former! But Kenyans certainly, these MPs feel, don't need rights to water, housing or food (or social security, health, founding a family, safe environment, access to quality goods or efficient administrative action). It could be wondered what rights Kenyans are deemed to be entitled to by these (Kenyan) MPs.
  
  One of the reasons that the use of condoms for reducing the spread of HIV, STIs and unplanned pregnancies has not been too successful is that women say they don't have the option to refuse to have unprotected sex with their husbands or partners. Effectively, they don't have the option to avoid becoming pregnant, even when they don't want more children or when they know they or their partners are HIV positive.
  
  The Christian churches, the ones whose part in running the country may or may not be threatened by this constitutional review, of course, object to the use of contraception. The fact that it could prevent all sorts of social problems, such as the ones mentioned above, is irrelevant. Harm reduction will probably never cut any ice with Christian dogma. But it is unlikely that women's rights will fare any better in the ultimate male dominated institution.
  
  However, on the insistence of the same Christian churches, the controversial paragraph that mentions the right to life without stating when life begins has been altered to stipulate that life begins at conception. Are all Kenyans Christians? Clearly not, but some vocal sectors of the civil society that these MPs seem to want to silence appear to have a lot more say in the new constitution than others.
  
  Abortion is already illegal in Kenya. With very few exceptions, the hundreds of thousands of abortions that take place in Kenya every year are, therefore, unsafe. These unsafe abortions contribute to the maternal death rate of 30% and an estimated 2000 women die every year from unsafe abortions.
  
  So the Christian churches are interested in the right to life of the unborn, but they don't seem to be so interested in the right of women to choose whether to become pregnant or even to choose who can make them pregnant or when. Women who know their partner or husband is HIV positive do not have the right to refuse to have sex or to insist on the use of a condom. Why are these Christian churches not as concerned about the rights of the very women who are expected to carry, give birth to and raise children where they do not choose to, perhaps because they or their partner is HIV positive?
  
  A canon who was interviewed about this matter said that 'pregnancy is God's design' and that men and women are 'responsible to control themselves and engage in sex as a husband and wife', which, if you are a Christian, may well be true. But is the canon not aware that a lot of sexual activity doesn't take place between husbands and wives, that a lot of people have sex with people other than their husbands and wives, that some people don't get to choose when, where and with whom they have sex? The Christian churches, of all churches, should be aware of things like this.
  
  If the Christian churches wish to oppose the use of contraception and a woman's right to choose, they need to pay some attention to the rights that women are currently being denied. Because it is in part the denial of these rights that is giving rise to huge numbers of unplanned pregnancies in the first place. If they sincerely want to reduce unplanned pregnancies, transmission of HIV and other STIs, sexual and gender based violence and other social problems, they would need to reconsider their position on contraception, for a start. If they are unable or unwilling to do that, these churches will find their relevance to the majority of Kenyans, especially poor Kenyans, diminishing as quickly as it has done in Western countries over the past few decades.

• Compulsory HIV Testing for Pregnant Women is Counterproductive

  Posted: January 18, 2010, 7:58 pm by Simon

  It's probably a good thing that Uganda has merged the provision of sexual and reproductive health with HIV programmes. It remains to be seen whether they do a good job of it and the fact that both functions will still be provided by two different government departments doesn't bode well.
  
  But the proposed introduction of mandatory HIV testing for pregnant women is worrying. Most countries in the world have considered mandatory testing at some time and many have resisted it. The WHO has opposed it and, as far as I know, continues to oppose it. Not only is it considered to be a human rights abuse, but it is also thought to be counterproductive.
  
  If it is a human rights abuse to carry out mandatory testing for specific groups for any disease, then it is an abuse to single out pregnant women for HIV testing. One of the dangers is that fewer women will attend ante natal clinics, with potentially disastrous consequences. But at present, Uganda is not providing ante natal care for all pregnant women. Will they start to provide it? Where will they get the money? And will ante natal care become mandatory too?
  
  All people have the right to medical care, to treatment for illnesses, prevention of diseases, general health, reproductive and sexual health, etc. But what Uganda is proposing is that it will no longer be a woman's right to choose to be tested for HIV if she is pregnant, nor will it be her right to choose whether to be treated or not, nor will it even be her right to keep her HIV status confidential.
  
  Ugandan health and social services are not able to cope with current levels of HIV, they have had constant problems testing people, treating people and maintaining supplies of medication. The country's health services function poorly and wouldn't function at all if it wasn't for high levels of donor support. But someone has now decided to make it even less likely that a large and vulnerable section of the population will seek health care just when they are most vulnerable. It is not just the pregnant women who are put in danger by such a proposal, it is also their unborn babies, perhaps their children, their partners and others.
  
  The Ugandan government is not able to guarantee the safety of women who have been diagnosed as HIV positive. It is not able to guarantee that they will not be rejected or even persecuted by family and neighbours. It is not even able to guarantee that women will get adequate care to live a healthy life and raise their children to be healthy and strong.
  
  HIV testing needs to remain an option to all people, including pregnant women. It needs to remain something people freely choose, something to which they can give their informed consent. That means they need to be counseled and advised before testing and supported after testing. This is the only way to ensure that the maximum number of people will agree to be tested for HIV. It is also the only way to support people in continuing to live a healthy and peaceful life in their own community and to take every step to avoid infecting others.
  
  Compulsory HIV testing will not stop HIV from spreading. It will only make people fear testing, especially those most likely to be infected. Compulsion will result in the very people who most need to be tested avoiding testing centres and any place else where they may have to face a test, such as ante natal clinics and hospitals. Then, by the time people infected with HIV are identified, they may already be at an advanced stage of the disease and may well have infected many others.
  
  The Ugandan government needs to encourage women to attend ante natal clinics when they are pregnant, not compel them to do so. People, whether pregnant or not, need to be advised to know their status, with regard to HIV and any other transmissible disease. If there is any chance of influencing people's sexual and reproductive behaviour, it is more likely to be achieved through education and support. It will certainly not be achieved through coercion, as Uganda and other countries have already spent nearly three decades finding out.

• Fiddling with Technical Fixes While People Continue to Die

  Posted: January 17, 2010, 2:17 pm by Simon

  Time reports on a study which raises concerns about HIV drug resistance. Most Kenya government documentation about HIV treatment is concerned with getting as many people on treatment as possible, or appearing to do so. Where the aim is to get as many drugs out to as many people as possible, resistance is probably not so visible. After all, you need to monitor people regularly and carefully for signs of resistance and funding doesn't always stretch to that.
  
  It's not really clear how many people in Kenya are currently on HIV treatment. Figures vary a lot and don't always make it clear whether people who were once on treatment but have since died are included. Probably a few hundred thousand are on treatment at the moment, maybe three hundred thousand. But it's even less clear how many are on second line treatment. Second line treatment is given to those who have developed resistance to first line treatment and it's prohibitively expensive.
  
  Most of the hundreds of millions of dollars of HIV money is spent on drugs, either for treatment or prevention. No one would want to deny people who are suffering from HIV/Aids access to necessary drugs, of course, but there must be a limit to how much money can be spent on drugs to the almost total exclusion of other aspects of treatment and prevention. I don't know what that limit is but there are proposals to put even more people on drugs and the sustainability of these proposals is highly questionable.
  
  At present, people whose HIV infection has reached a particular stage are usually put on antiretroviral drugs (ARV). Perhaps about half the HIV positive Kenyans who have reached this stage are currently receiving treatment. Pregnant women who are infected with HIV are put on a short course of ARVs and this results in most babies growing up HIV negative. Less frequently, people who may have been accidentally infected with HIV can be given a short course of ARV treatment called post exposure prophylaxis (PEP).
  
  But there are proposals to roll out ARV drugs to more and more people. For example, it was proposed just over a year ago to test everyone, or as many people as possible, and to put anyone found to be HIV positive on ARVs. If this could be done, the number of people on treatment would go up several hundred percent.
  
  Another proposal is to roll out what is called pre-exposure prophylaxis (PrEP). This would involve putting HIV negative people on ARVs in the hope that this would protect them from becoming infected. The target of this kind of programme would be those seen to be most at risk of contracting HIV. This could involve sex workers, men who have sex with men, prisoners, intravenous drug users and perhaps the clients of sex workers, people who have many parters and people who have concurrent sexual partners, relationships that overlap with other relationships.
  
  The number of people who would be targeted would be hard to estimate. How many men who have sex with men are there in Kenya? Is it five percent of the population or 10 percent (2-4 million)? Men who have sex with men are hardly going to identify themselves in the current homophobic climate anyway. An obvious target of PrEP is people who are HIV negative but are in a relationship of some kind with someone who is HIV positive, called discordant relationships. This could number some 350000 people.
  
  Similarly for sex workers, how many are there? Is it hundreds of thousands and does that include people who occasionally engage in sex work or who don't consider themselves to be sex workers? And what about identifying their clients, how many million would there be? Is it really feasible to identify those most at risk of becoming infected with HIV? The recently published modes of transmission survey shows that, for years, HIV programming has been seriously misdirected and also that those who are most at risk is a very mixed and constantly changing group.
  
  There are questions about the possible effectiveness of PrEP but there must also be questions about the feasibility of identifying all the people who could benefit from it, given the numbers of people who are infected with HIV and the numbers of people who are in danger of becoming infected. If resistance is a problem at current levels of ARV rollout, what kind of problem would it be if ARVs were rolled out to all people at risk or thought to be at risk of contracting or of transmitting HIV?
  
  All the uses of ARV run the risk of resistance. Those who are HIV positive and on ARVs are at risk, but so are the women who receive short courses of ARVs to prevent mother to child transmission, so are those who receive post exposure prophylaxis, so are those who receive pre exposure prophylaxis. With resistance comes increased sickness and death unless second line treatment is rolled out. And second line treatment means increases in cost of several hundred percent. Again, questions about sustainability arise.
  
  The question of whether we can treat our way out of the HIV epidemic is constantly raised but the answer is unclear. I would suggest that the answer is no and that even efforts at preventing the spread of HIV should steer clear as much as possible from technical fixes, such as ARV drugs. Drug treatment of HIV, let alone drug prevention, may not be sustainable and is already seriously affecting the amount of money available for preventing HIV transmission.
  
  Instead of the almost inconceivable amounts of money being proposed to pay for drugs for treatment and prevention, far lower sums of money could be spent on improving the overall health, education and welfare of Kenyans and of those in other high HIV prevalence countries. It is immoral to continue pretending that there is a technical fix just around the corner and that everything will be OK. As long as we continue to look for technical fixes and ignore the lives of people in underdeveloped countries, people will continue to become sick and to die from treatable and/or preventable conditions.

• Uganda Won't Allow Mere Principles to Compromise Foreign Aid

  Posted: January 15, 2010, 8:55 pm by Simon

  Uganda's President Museveni is not known for being forbearing or fair minded, especially when it comes to men who have sex with men (or, presumably, women who have sex with women). But he has decided to distance himself from David Bahati's bill, which proposes the death penalty for certain offenses relating to homosexual behaviour and prison sentences for others who fail to report homosexual behaviour. It even proposes life imprisonment for persons engaging in same sex relationships.
  
  This is not an instance of Museveni suddenly becoming softhearted, either. There are existing Ugandan laws against homosexuality with very long prison sentences. The country that claims to have had so much success in fighting the HIV epidemic continues to fail some of the people most at risk of becoming infected with HIV and of infecting others. Bahati's bill was certainly heading in the wrong direction but Museveni needs to do a lot more than oppose the work of a power crazed bigot.
  
  Sadly, the Bahati bill had a lot of popular support in Uganda. Other East African countries have similarly punitive laws and there was the fear that if Uganda passed such a law, other countries would follow. It's frightening that most African countries outlaw homosexuality but even more frightening when you hear about the level of persecution homosexuals and those suspected of being homosexuals must put up with from the public, professionals, officers of the law and just about anyone else.
  
  Museveni is said to have been reacting to international protests, especially from countries from which large amounts of donor money come. He mentions pressure from Canadian, American and British leaders and refers to the bill as a 'foreign policy issue', which it clearly is not. It's good that Museveni has decided to question the bill, but it would be more heartening to hear that he had some objection to persecution of and discrimination against homosexuals.
  
  However, earlier on in the debate, people like Bahati said the country should forgo some foreign aid if donors objected. The debate has moved on a little and there was probably never any danger of Uganda refusing foreign aid. Their HIV efforts, and those of most high prevalence African countries, are almost totally dependent on foreign donations. But even some of the American fascist evangelists who originally supported the bill have now started to criticize it.
  
  The best we can hope for right now is for Museveni to succeed in persuading Bahati to withdraw the bill or in persuading people not to support it. That would put Uganda back in the position it is in now with regard to homosexuality. That's not good, but it could be worse. But more pressure is needed, like the pressure against the Bahati bill, in order to ensure that the rights of homosexuals and other minority groups are recognised.
  
  All the talk about Ugandan's and other Africans being so Christian, right minded, conservative and the rest is just so much posturing when you view it alongside people's attitudes towards those who are seen as somehow different. There's something scary about a religion whose adherents seem to behave in ways that are directly contrary to the religion's preachings.
  
  To the Ugandans and other Africans who argue that homosexuality is an export from the West, it could be pointed out that the sort of double standards that allow avowed Christians to persecute their fellow human beings may actually be the worrying export from the West. These double standards are doing and will continue to do a lot of damage; unlike homosexuality, which has always existed in all known human societies, including African ones.
  
  And Museveni has the cheek to talk about not compromising the country's 'principles', while at the same time taking into account 'foreign policy interests', presumably referring to hundreds of millions of dollars of aid money. Yes, it would be totally unchristian to do otherwise.

• Kenya Makes a Start in Addressing the HIV Epidemic

  Posted: January 14, 2010, 12:23 am by Simon

  For the first time, I have come across an official Kenyan Government publication relating to HIV that is readable, credible and well thought out. Their survey entitled'HIV Prevention Response and Modes of Transmission Analysis' is available now (despite being dated March 2009). It address many of the worries about Kenya's HIV epidemic that have only been briefly mentioned before, but never adequately dealt with.
  
  For example, it questions the fact that a far larger percentage of HIV spending goes on treatment and care than on reducing transmission; it questions the fact that HIV prevention programmes are top down and the same everywhere, even though the HIV epidemic affects areas very differently; it questions the fact that much of the HIV prevention spending seems to go to those who are not most at risk of being infected with or of transmitting HIV; many of those who are most at risk or in need of specific prevention programming receive little or none.
  
  At last, the fact that there are men who have sex with men in Kenya and that they contribute to the epidemic is admitted and it is concluded that they need to be targetted. A recent report (too recent for this survey) shows that men who have sex with men live in all provinces and in urban and rural areas. It also shows that the clients of male sex workers providing services for other men are predominantly Kenyan. Previously, it was said that men having sex with men was a foreign phenomenon and that it mostly occurred along the coast.
  
  Indeed, HIV transmission by men who have sex with men may be even higher than estimated by the Modes of Transmission Survey. But it's good that the issue is being discussed, rather than denied or ignored. The paper also admits that much of the money that goes into prevention goes towards interventions that have not been shown to have any impact on transmission. It admits that specific interventions may not have had much impact yet, even though some indicators are positive. It acknowledges that programmes and services are concentrated in areas where the need is not greatest.
  
  So, people who are most at risk of becoming infected and of infecting others, such as men who have sex with men, commercial sex workers (and those who engage in any kind of transactional sex), intravenous drug users, long distance drivers, members of the fishing community and others are being acknowledged as being in need of prevention services. Let's hope that will be translated into the provision of these services. This survey is a very important step in Kenya's approach to HIV prevention.
  
  But before some of these groups can be targeted, there are other problems that need to be addressed. It is illegal for men to have sex with men, certain aspects of commercial sex work are illegal and intravenous drug use is illegal. Members of these groups are rightly afraid to identify themselves and to risk being identified because they are the victims of persecution by members of the public, clients, professionals, police and others. But the survey mentions these issues and makes recommendations relating to them.
  
  It remains to be seen whether any of the improvements recommended by this survey are made by the current government. But reading this survey gives me hope because maybe now there are some people in a position to do something who are willing to even discuss phenomena that have so long been ignored.

• We Don't Need Evidence that Health, Education and Other Social Services Are Good

  Posted: January 13, 2010, 9:11 pm by Simon

  You might think that HIV prevention interventions have some bearing on the context in which they are implemented. For example, you might think that interventions to persuade people to have fewer partners are concentrated in areas where it has been shown that people have many sexual partners. Or you might think that about interventions to persuade people to avoid concurrent relationships, sexual relationships with more than one person at a time.
  
  But in fact, interventions are mostly the same wherever you go, whether it's a developed country or an underdeveloped one. The little research that has been done into sexual behaviour suggests that in some places people have far more lifetime sexual partners than in others and even that in some places people have more concurrent sexual relationships. But no research shows that areas where people have more sexual partners or more concurrent sexual relationships actually correspond closely with areas of high HIV prevalence.
  
  It's just an assumption that if HIV prevalence is high, people there much have more sex, more partners and more concurrent relationships. Some of the research that has been done clearly demonstrates that areas with high levels of HIV have lower levels of multiple partnerships and concurrent partnerships. It also demonstrates that areas with high levels of multiple partnerships and concurrent partnerships have lower rates of HIV. Clearly, unsafe sex is unsafe, wherever it occurs and however, but specific prevention programmes would need to be clear about what kind of 'unsafe' sexual behaviour, precisely, is occurring and how to change that.
  
  But HIV prevention interventions are more likely to be dreamed up by those with political, religious or commercial interests, in complete isolation from anything that could be called evidence. And so far, they have almost all worked equally badly, whether it's in South Africa, which has the highest number of people living with HIV in the world or the US, which has the highest HIV prevalence in the developed world. These failures are not because of lack of available evidence about what would work and what would not work, though there is a lack of evidence. The failure is because HIV prevention funding has been seen as a matter of 'morals', petty politics and a good way to make some money.
  
  If these circumstances were to change, what hope would there be that the high rates of HIV transmission in many countries of the world could be reduced? The issue of concurrent partners is hotly debated by the foremost academics in the field. But what these people don't disagree on is whether condoms work. There is no evidence that condoms don't work, though they are not 100% efficient. There is only a prejudice against the use of condoms because people who use condoms are having sex. But if people weren't having sex there would be no HIV pandemic.
  
  I have never heard an academic, or anyone else, arguing that education, health education and sexual health education are bad and producing evidence to support their arguments. I have only heard bigoted politicians and religious leaders who seem to know little and care less about what their country's children know about sex and sexuality. Over and over again, it has been shown that children who know about sex and sexuality are more likely to delay their first sexual experience and to take precautions against unplanned pregnancy, HIV and other sexually transmitted infections.
  
  Research into sexual behaviour is not just scarce, it's hard to do and the results are rightly hotly debated. But we don't need to wait for this difficult and costly research to be completed to aim to cut the transmission of HIV. It would be immoral to wait for this research. We know now that people have sex and they need sex education and contraception. They need health services, especially sexual and reproductive health services. The majority of new cases of HIV transmission in developing countries are still sexually transmitted, so to those who say HIV prevention is difficult or that evidence is lacking: this is not completely true.
  
  Sure, there are controversies and there is research that badly needs to be done. But ignoring the efficacy of condoms, education, health and other social services in cutting the transmission is not only wrong, it is also disingenuous. Access to education, health and other social services are human rights so no 'evidence' is needed for these areas to be funded straight away. And while we're considering these human rights, we could also take a look at gender imbalances of all kinds, but especially relating to employment, family law, inheritance and marital power imbalances.
  
  High HIV prevalence relates to the broad determinants of sexual and other types of behaviour, to the overall conditions in which people live, to their levels of health, education, wealth and many other things. HIV prevention has mainly concentrated on individual sexual behaviour and this is one of the things that makes reducing HIV transmission appear to be so intractable.
  
  As the authors of a paper published in The Lancet over three years ago conclude: "No general approach to sexual-health promotion will work everywhere, and no single-component intervention will work anywhere. We need to know not only whether interventions work, but why and how they do so in particular social contexts. Comprehensive behavioural interventions are needed that take account of the social context, attempt to modify social norms to support uptake and maintenance of behaviour change, and tackle the structural factors that contribute to risky sexual behaviour."

• How Long Can We Continue to Ignore Those Who Are Still HIV Negative?

  Posted: January 12, 2010, 11:48 pm by Simon

  I was back in Mogotio with Ribbon of Hope today, weeding the watermelon beds in our latest shamba (smallholding). There were eight of us there today, three who were getting paid for the work. Others will get payment in kind. I have to be honest, I managed to do a few hard hours under the hot equatorial sun but I had to give up at lunchtime and I'm now stiff and sore. And there was at least two thirds of the field left to weed when I left!
  
  But it's good to see the project get off the ground because it will provide some casual employment in an area that sees little work and it will provide some good food crops at low prices at a time when food prices are particularly high. In the next few months the shamba will require a lot of looking after, weeding, irrigating and security. There will be plenty of people willing to do some of that work.
  
  Mogotio is only about 30 kilometers out of Nakuru, so it is by no means the most isolated place you'll find. But it feels isolated. There are very few NGOs that ever visit the place and I haven't been able to find out about anything they do. I saw a World Vision four wheel drive but none of the community leaders I asked could say what the organisation does there. UNHCR has been active in the area recently because hundreds were displaced by the heavy El Nino rains. There are over one hundred white UNHCR tents just outside the village, but that's an exception.
  
  The area is almost entirely dominated by the sisal industry. There are a few factories, most of which don't operate very much. There is little money to be made by growing sisal and people who live in these areas don't make much of that money anyway, it's mostly made by the estate owner, who lives in Nairobi and rarely visits the area. Some of the people who work for or have worked for the factories are owed wages going back many years. Every now and again they get some money, but just a fraction of what they are owed.
  
  Like a lot of parts of Kenya, HIV is widespread here but it receives little attention. Most NGOs are based in the cities and bigger towns. They work in or close to wealthy suburbs and rarely leave those areas for long. When they do, it's like a state visit, a convoy of huge, air conditioned, white, oversized vehicles, stirring up the dust and little else. HIV spreads more slowly in rural areas and that may be one of the reasons that less attention is paid to them than to urban areas. However, the majority of Kenyans, over 80%, live in rural areas.
  
  And many more people in rural areas don't go to school or don't go to school very much, many don't have access to mainstream media, they don't have access to health or other social services and they have little or no connection with the benefits of the cities and towns. They are more isolated than their distance can explain. Every now and again something comes their way, probably not much, then the project or organisation leaves and loses touch.
  
  But even some of these isolated areas have access to some HIV testing and counseling facilities and even the HIV drugs that most people are supposed to receive for free. They usually don't have access to any other kind of drugs and they are lucky if they can stay healthy, but it's a start. But treating more and more HIV positive people every year has little impact on reducing HIV transmission. Many more people become infected for every one person who gets treatment.
  
  And HIV prevention really is a strange animal. In all the time HIV has been around, few methods of HIV prevention have been developed. A fraction of the money that goes into HIV goes towards prevention, less than 25% in Kenya. About half of that goes on prevention of mother to child transmission and the 12% that's left is spent on rather dubious projects that are known to be of little or no benefit.
  
  A series of findings were presented at the 2006 Aids Conference that demonstrated that most kinds of HIV prevention programmes have a very small effect, some have a negative effect and the majority don't do anything. Consider the list: Voluntary Counseling and Testing, Condom Social Marketing, Mass Media, Abstinence-Based Interventions, Peer Education, Family Planning Counseling for HIV-Infected Women, Needle Exchange Programs, and the Effect of HIV Treatment on Risk Behavior.
  
  The only one in the above list that has proved itself is needle exchange programmes. These have been known to be effective for a long time but they are strongly disapproved of by many funders, especially US funders, who feel that they increase drug use. They don't increase drug use, they reduce it and they have an impact on HIV transmission. But such programmes are of little relevance in Kenya as a whole and of virtually no relevance in a place like Mogotio.
  
  The majority of HIV infections in Kenya come from heterosexual intercourse. A sizeable percentage comes from male to male intercourse. A debatable, possibly high percentage, comes from medical treatment, such as injections. But in rural areas, like Mogotio, people are in need of good education, health services, ordinary health services, not vertical interventions that treat HIV (or something else) alone, basic social services, infrastructure and things like that. There is no mystery about HIV transmission that makes its reduction intractable. People need a reasonable standard of living, they need security in their lives, especially food security, they need work, for which they get paid; just basic things that people in developed countries take for granted.
  
  Yet more and more money continues to be poured into programmes that are unlikely to work or even ones that have been demonstrated not to work. In the case of Mogotio, of course, they don't even get these programmes most of the time. Money intended for the constituency appears to get stuck elsewhere and people are forced to plod along without even the most basic of their rights being realized. As long as people have so many problems in their lives and so little to aspire to, HIV will continue to be low on their list of priorities. If HIV is low on their list of priorities, even effective prevention programmes, if effective programmes exist, are destined to fail.

• Ribbon of Hope's Mogotio Shamba

  Posted: January 11, 2010, 8:23 pm by Simon

  
  
  Photo: Beans, almost ready to harvest.
  
  Today was a good day for Ribbon of Hope in Nakuru. We went to the Mogotio shamba (smallholding) to see how everything was growing. Much of the one and a half acre plot is planted with beans that were put down a few months ago. It was hard work planting them because they are packed in close together. It was harder work irrigating the crop through the dry months, but it was worth is as the field became lush and green. Now the beans are almost ready to harvest in the next couple of weeks, as long as the heavy rains don't destroy them. The rains have already beaten some of the crop into the ground but we'll hope for the best.
  
  
  
  Photo: Amaranth, almost shoulder height.
  
  And there are other crops in the field, also almost ready to harvest. There's coriander, kale, amaranth, tomatoes and spinach. These were planted later than the beans, but they are growing quickly because of the heavy rains. Earlier crops that were planted, such as onions, green peppers and kunde have more or less peaked and are declining now, but they were worth the effort, especially the green peppers.
  
  
  
  Photo: In the foreground, coriander and some members of Ribbon of Hope.
  
  The idea of growing these common foods is that local people will do the work and they will then sell the produce or buy it at low prices. About five or six people have been involved in producing all this food so they will now be able to use it themselves, sell it to friends or sell it in the market. It's surprisingly reasonable to rent land in this part of Kenya and surprisingly expensive to buy land. Unfortunately, it's hard to keep up the work and provide security and the like on rented land and this has been an uphill struggle from the start. But again, we hope for the best.
  
  
  
  Photo: A fine looking bed of kale or 'sukuma wiki', as it's called here.
  
  We have rented another plot of land, also a bit over an acre, in a field nearby. This is also close to the river and so should be easy enough to irrigate. It is now completely planted with watermelon plants. It took a short time to plant the whole field but it will take a lot of work to look after this valuable crop. For now, there's not much to see in the field, a few spots of green. Actually, too many spots of green and we have to weed the whole thing tomorrow. But in a few weeks time the field should be covered in melon vines and in a few months, a beautiful and fragrant crop.
  
  
  
  Photo: A recently planted field of watermelon.
  
  Ribbon of Hope has other shambas but this one has been the most successful, so far. This is probably because the same people come to do the work, week in, week out. Other shambas don't always receive the same dedication, though they should work out, eventually.
  
  In addition to producing onions, green peppers and kunde, this shamba produced a fantastic crop of butternut squash last year. Ribbon has been able to invest in a petrol pump and, later on, a foot pump. The petrol pump is great but it does cost a lot to run and also it seems to suffer from a lot of engine problems. The foot pump is a great addition and uses no fuel (!) but we haven't had it long enough to really say how good it is. It just feels nice to have a pump that doesn't require petrol, given the disadvantages of having to use fossil fuels, as if we were fossils ourselves.
  
  
  
  Photo: Tomatoes, filling up nicely as a result of the El Nino rains.
  
  It's a bit early to say how cost effective these small economic interventions are. The amount of money spent is not huge but it remains to be seen how good the harvest is and if there is a good market for the various produce. Undoubtedly, such projects increase self-reliance considerably, even where they don't produce much. But in the long run, we would like to be able to increase the number of such projects and have more successful harvests than unsuccessful ones. I'll post up any further news and progress as and when.

• PSI: Throwing Bad Money After Bad

  Posted: January 10, 2010, 7:50 pm by Simon

  At one time, the leading paradigm of development was the control of population, the belief that poor countries would develop if they would only have fewer children. One of the foremost organizations persuading people to use condoms and employ other family planning techniques was Population Services International (PSI). They were not very successful and family planning and reproductive health in developing countries is still woeful, despite large sums of money being thrown at these problems.
  
  PSI is still a powerful organization with lots of money to throw at the problems of development. But now, much of their money goes into HIV, where they (along with various other powerful and rich organizations) have also been relatively unsuccessful. PSI's aim is to use the 'power of marketing' to persuade people to change their sexual behaviour and use condoms and other modern contraceptive methods.
  
  Strangely enough, PSI don't seem to know that the road up is also the road down, that contraception to prevent unplanned pregnancy can also prevent sexually transmitted infections (STI), such as HIV. The goal of reducing unplanned pregnancy was lost in the scramble to persuade people to change their sexual behaviour to avoid being infected with HIV (never mind about other STIs). However, many HIV positive women having babies did not plan to get pregnant in the first place. And the whole issue of sexual activity and reproduction has become so confused that people are apt to concentrate on one thing, such as unplanned pregnancy, and completely ignore two other important considerations: HIV and other STIs.
  
  Not that long ago, it was reported that many women would prefer to run the risk of contracting HIV than that of getting pregnant. They would have unprotected sex with a partner, often a person they didn't know very well, then they would resort to emergency contraception (EC). This EC is not appropriate as a general contraceptive and it does not protect from HIV or other STIs.
  
  Why would people be willing to take this risk? Is it because they simply don't see contracting HIV as a very high risk? They could be right, they may be more likely to become pregnant than to contract HIV or some other STI, but the risk is still there and the odds go against them the longer they continue to have unprotected sex. Actually, the chances of becoming pregnant also become higher the longer they continue to use EC as a substitute for more appropriate contraception.
  
  I'm singling out PSI because they have been big fans of marketing EC in developing countries and because of their dependence on marketing. Marketing may well be appropriate in the commercial world, where everything has to seem cooler or newer or better than what went before. But contraception, family planning, reproductive health and things like that are not good because they are cool or funky or with it, they are good because they work.
  
  If PSI have been successful at marketing EC, they have done so irresponsibly. After all their decades in developing countries they should know by now that what people need is good basic education, good basic health services and good sexual health services, particularly for women and girls. Fancy (and expensive) marketing is not a substitute for proper education and health. The message has now been fluffed, so that people have all sorts of muddled ideas about contraception, sexualy behaviour, pregnancy and anything else organizations like PSI have been involved in.
  
  If organizations like PSI are really interested in people's health and welfare, they should pay a little less attention to marketing expensive products and services and spend some time advocating for the levels of health and education spending that countries like Kenya really need. Contraception such as condoms is not cool, it's vital for people to be able to live their lives without risking serious disease or unplanned pregnancy.
  
  People, adults and children alike, just don't know enough about HIV, reproductive or sexual health. There is no amount of advertising and campaigning that will give them access to the information, services and products they need to ensure their sexual and reproductive health. HIV, and even high levels of unplanned pregnancies, are not emergencies. They are part of everyday life and a factor of how little has been done to improve people's health and education over the past few decades.
  
  Contraception of any kind is useless without adequate levels of spending on education and health, especially those relating to sexual and reproductive health.

• The Odds Are Not Stacked Enough in Our Favour, Say Big Pharma

  Posted: January 9, 2010, 7:06 pm by Simon

  The 'Counterfeit Act' signed by the Kenyan government last year is being challenged as unconstitutional, violating the right to health. This act was not really necessary because it was already an offense to make and distribute fake goods and there are already officials whose job it is to enforce existing laws.
  
  In fact, the act seems to have been cobbled together and rushed through parliament at the behest of big industry, especially big pharma. The last thing they would want is competition, except where the odds are well stacked in their favour. So they whinged to the government (a process called lobbying in some countries) about how things were so unfair and the government kindly came up with a piece of legislation that fails to distinguish between fake goods and generic goods.
  
  As a result, generic versions of drugs destined for Kenya have been held up in various countries on the grounds that they may not be legally distributed in Kenya. This is great for big pharma, they never wanted generic versions of drugs to be produced unless they themselves produced them, at inflated prices. But they were forced to reduce their prices when producers won the right to produce generics and big pharma have been fighting them ever since.
  
  GlaxoSmithKline has come up with the expedient of reducing a few well known products, such as some of their antibiotics, to try to undercut generic versions. However, they don't seem to understand the concept of undercutting: their prices need to be lower. They have reduced their prices, sure, but they are still far more expensive than generic versions. What they are offering are hardly loss leaders, rather some kind of token gesture, to which journalists give the expected publicity and praise. And it's still not even certain if the reductions will be passed on to consumers.
  
  The result of Kenya's self-serving piece of legislation is that there is widespread confusion about pharmaceutical products. People really have no way of knowing what is fake and what is not. The fact that something has a well known manufacturer's name on it does not guarantee that it is not fake. But if it is genuine, you are still robbed of the extra cost that going for the branded product involves.
  
  People are just not able to afford many of the branded products. Slight reductions here and there, or even substantial reductions, miss this point. What is never so clear is what people have to sacrifice if they do go for the expensive branded product. But that's of little interest to organisations like GlaxoSmithKline or to the journalists who flock to report on whatever titillating rubbish is being reported on by all other journalists.
  
  I'm glad to hear this despicable act is being challenged and hope those opposing it succeed. Because other countries, such as Uganda, are considering similar acts, no doubt in response to lobbyists for big pharma and other industry interests.

• Will PEPFAR Become a Fund for Health?

  Posted: January 8, 2010, 8:39 pm by Simon

  It sounds as if PEPFAR (President's Emergency Fund for Aids Relief) is about to change a bit under the Obama administration. These changes are all long overdue. For a start, Aids is no longer to be seen as an emergency. It wasn't an emergency before PEPFAR started, so this is good to hear.
  
  The 'exceptionalisation' of Aids, treating it as if it is a disease that is separate from health in general, should have its own institutions and funding, is to disappear. Again, this move is long overdue, but still welcome. Hopefully, it will mean that some of the huge sums that have been raised for Aids will be spent on health services. Those who think Aids issues will lose out needn't worry, people with Aids also have general health needs. So everyone will gain.
  
  The head of PEPFAR, Eric Goosby, is at last questioning the sustainability of putting everyone who is HIV positive on drugs that they will need for the rest of their lives. Of course, HIV positive people should be treated, but with far more people becoming newly infected for every one put on treatment, something really has to be done to reduce the number of new infections as well.
  
  So HIV prevention should return to the agenda. The question is, what kind of prevention programmes will be funded by PEPFAR? In the past, prevention has included little but lecturing people on their sexual behaviour. There are few prevention programmes that have had much impact on HIV transmission. Of course, most well funded programmes will tell you that they have been very successful and show evidence that whatever mindless drivel they repeated to all and sundry can be trotted out at the ring of a bell, or whatever.
  
  But rates of HIV transmission remain high in many countries, including the US, despite these questionable programmes. Does PEPFAR have anything new to bring to the table? If they don't, it would be good to hear that they are willing to talk about using condoms and employing other harm reduction approaches to HIV. For example, clean needle and syringe distribution and greater advocacy and support for sex workers, men who have sex with men and other vulnerable populations.
  
  Another change proposed is that PEPFAR funds go to governments rather than, primarily, to NGOs. While it's true that NGOs may not have done very well in many cases, I'm not sure about the wisdom of handing large amounts of money to governments. Kenya has had a particularly bad history when it comes to administrating large amounts of money intended for HIV treatment, care and prevention (or any kind of funding). Time and time again, investigations have found administration of funds wanting, only for the money to flow in again once the row has died down. PEPFAR recently announced a doubling in Aids funding, amounting to 2.7 billion dollars over the next five years.(A Ugandan writer also worries about these changes ito PEPFAR.)
  
  Disbursements of US aid for HIV don't relate to a country's need. The HIV epidemic in Kenya is by no means the worst in Africa, even in Sub-Saharan Africa but they are one of the top recipients of funding. No, disbursements seem to depend more on how cozy a country's relationship is with the US and for Kenya, the relationship has been very cozy since independence. Perhaps questions about how much of that money actually benefits people with HIV are irrelevant to PEPFAR, as long as cozy relationships remain, who knows? But let's hope the changes take place and my fears are not realised.

• Apologies for Lack of Posting

  Posted: December 27, 2009, 2:41 pm by Simon

  I haven't given up but I am in a place where I don't have much opportunity to use the internet. I will be back at work in early January and should have ample opportunity then. I wish readers a good holiday.

• Aids Denialism Doesn't Make the Disease Go Away

  Posted: December 14, 2009, 11:22 pm by Simon

  There are many controversies surrounding HIV, development in general and various other things. So, writing a blog about these can attract some controversial remarks, in theory. In practice, I have received some comments but few that are controversial. When remarks have little or nothing to do with what I have posted, I delete them. If the post is clearly just an attempt to attract attention to some site, product, issue, service or person, I am also likely to delete them.
  
  But a comment I received today, anonymous of course, purported to be about my most recent posting, which discusses levels of HIV transmission from unsafe medical practices. 'Anonymous' may have thought that in questioning certain aspects of HIV funding and the like, I am aligning myself with certain Aids sceptics, who deny that HIV causes Aids, or whatever. Whether this anonymous contributor represents AliveandWell.org or not is irrelevant; I do not agree with what the site stands for and I would not wish to have anything to do with a group of people whose only aim seems to be to further muddy these already turbid waters.
  
  My approach to HIV in Kenya has been that of a general scientist. My interest is in the overall conditions in Kenya and how they changed as HIV arrived, spread and continues to spread. Therefore, I look at history, economics, social practices, lifestyles and many other things, in addition to medical and social science aspects of the virus. I do not have the scientific expertise to address all the details of the AliveandWell site. There are plenty of people who can do that, if they deem the content of the site worth the effort.
  
  As for the idea that HIV and Aids were 'invented' by some wealthy people so they could make money (or even take over the world), I have never heard anything that could make such a hypothesis the least bit plausible. No doubt the AliveandWell site is teeming with such evidence, but I think I have more worthwhile things to spend my time on.
  
  Some of the numerous 'experts' cited on the site may well have a great deal of expertise, I really can't say. Certainly, some of them seem to have lots of letters after their name. But people can make up qualifications, or pay for them. And plenty of well qualified people come out with utter rubbish that can be used by whoever wishes to shore up some rant that they like to call 'theory' or 'hypothesis'.
  
  The anonymous poster says AliveandWell advocates 'scepticism' around HIV but the site is the work of a group of Aids denialists who encourage the use of 'alternative therapies' for HIV positive people. HIV positive people would be well advised to consider the fate of the woman who started the site, Christine Maggiore, who died of Aids, along with her infant daughter. Maggiore refused antiretroviral treatment for herself and for her daughter.
  
  To adopt the stance that Maggiore and her followers recommend is not scepticism, it is idiocy. Some adults may wish to adopt such a stance, which is regrettable. But there is no justification for imposing such idiocy on people who are unable to defend themselves. There is enough disinformation about HIV/Aids in developing countries already without this sort of deception being peddled and I hope people who visit AliveandWell see the site for what it is.
  
  Those are my thoughts on your wonderings, Anonymous.

• Don't Have Sex and Don't Go to the Hospital

  Posted: December 12, 2009, 3:26 pm by Simon

  Over the past twenty years or so, there have been a few papers pointing out that HIV transmission through unsafe medical practices, especially in Sub Saharan African countries, may be higher than previously thought. These papers don't seem to have had much impact and when modes of HIV transmission surveys have analyzed the part that such practices might have played in the current HIV pandemic, they have usually reported that heterosexual transmission is the most common, followed by things like male to male sex, intravenous drug use, commercial sex work, etc.
  
  The possibility of unsafe medical practices playing a large part in HIV transmission is being raised again, though it is hotly disputed by some. But given the amount of guesswork involved in estimating HIV prevalence in high prevalence countries, it would not be surprising if the figures were open to question. If it were established that HIV was regularly transmitted through medical practices, it would certainly dent the widely held belief that HIV can be fought purely by trying to control people's sexual behaviour.
  
  I and some others have long opposed the view that sexual behaviour alone can adequately explain the massive rates of HIV transmission in certain countries, compared to the relatively small rates in other countries. This is not to deny that sexual behaviour is an important factor in HIV transmission, just to question the idea that certain people in certain African countries have more sex or have more partners or whatever, than people in other countries around the world.
  
  But unsafe medical practices would be unsurprising in a country that spends so little on health, a country that has so few properly trained medical personnel, so few hospitals, a country where the vast majority of people can't afford to go to a health professional when they are ill and who may often be better advised not to go at all.
  
  The cries of those who claim that massive funding for HIV treatment and care is justified may be well founded, I don't know. But one thing is for sure: in the time that HIV treatment has been well funded, hospitals and clinics have not improved noticeably, rather, they have disimproved. Staff numbers have fallen. Disease rates have risen. All the indicators suggest that the disimprovements in health that started in the 1980s, before Aids had had much impact, have continued right up to the present, high Aids funding levels notwithstanding.
  
  So, as the anti circumcision lobby might say, this is not a good time to start mass male circumcision programmes. There may never be a good time, the case for mass male circumcision is still unconvincing, but no one in their right mind would opt for an operation on their penis or the penis of their child or relative until health services have been improved. People need to be confident that they will get better in hospital, not worse. Children in Swaziland whose mothers are HIV negative and who had attended hospitals and clinics a lot were found to be most likely to be HIV positive. Similar studies have been carried out in other African countries.
  
  Whether you are going to a clinic or hospital for HIV related services or anything else, you are in danger of suffering from unsafe medical practices. The health service in Kenya is on its knees. Expensive HIV treatment or circumcision programmes either need to have their own infrastructure built from the ground up, which seems highly inefficient, or they have to wait until health services are built up in their entirety.
  
  Kenyan's are still waiting for their health service to be rebuilt. The circumcision programmes have stalled, thankfully, some would say. And the HIV treatment campaigns are seriously hampered by the condition of the country's health services. Indeed, antiretroviral treatment is probably also hampered by the low levels of health in the population, but who is going to notice that? There just aren't enough health professionals to bear witness to the chaos that exists.
  
  The whole issue is a reminder of how little is known about the true nature of different HIV epidemics in different countries. Many of the figures that are used to shape the various approaches to the disease are pure guesswork and interpretations are often strongly shaped by influences that have little to do with science or even reason, for example politics, religions and 'morality'.
  
  A sensible conclusion to draw from warnings about the safety of medical procedures would be to spend more money on health infrastructure and especially on training more health personnel. More money is probably need for HIV specifically, but it will be money thrown down the drain until health infrastructure has been improved.

• The One Trick Pony That Can't Defy Gravity

  Posted: December 10, 2009, 3:57 pm by Simon

  When debates become polarized there can be a danger that neither side can accurately characterize the view of their opponent. Thus, Gregg Gonsalves of the International Treatment Preparedness Coalition characterizes a particular view as the 'Aids backlash' and lumps together a number of views that may not even be held by any particular person or group. He characterizes the backlash thus:
  
  The belief that "the fight against AIDS has misdirected our energies towards broader goals in health and development; the provision of antiretroviral therapy is a folly, it's too expensive and isn't worth the money to continue its expansion; efforts against AIDS are destroying health systems and promoting unnecessary deaths from other simpler-to-treat diseases and conditions such as childhood diarrhea".
  
  Personally I think there is probably not enough money put into the fight against Aids and that much of that money is not being used very well. In particular, I think too little of the money is being spent on prevention and almost all of that is not being used very well. True, it took some time for the international community to face the threat that Aids presented but when they did face it, they came up with a level of funding that has never been matched by campaigns against other diseases or disease groups (such as sexually transmitted infections, water borne diseases, etc).
  
  I don't think the provision of antiretroviral therapy (ART) is a folly and I don't think people who hold the sort of sceptical view I've expressed in the last paragraph necessarily do either. The fact that there are many more people becoming infected than there are being put on ART is not an argument to reduce ART programmes, rather, it is an argument for finding out why HIV prevention is being ignored and rectifying this situation urgently. There is little point in spending nothing on people until they become infected with an incurable illness if something could be done to prevent them from becoming infected.
  
  But also, there is little point in treating people for HIV and leaving them to die of something else. There are many preventable and treatable diseases that are killing people, including people who are HIV positive. I think that this is, in part, because of poor health facilities and services and an acute shortage of personnel. But also, there is a lack of funding that goes back several decades.
  
  I am in complete agreement with Gonsalves when he points out that poor health services are not a result of the Aids pandemic. This is clearly true in Kenya and many other developing countries, where poor health services date back to the early 1980s, when Aids existed but hadn't been identified and certainly hadn't even begun to wreak the havoc that came later. Aids didn't help these ailing health services and certainly decimated the health workforce, as well as the workforce as a whole. But in short, Aids was just another nail in the coffin for public services in general, not just health.
  
  I sympathize with Gonsalves to some extent, but when is money going to be spent on HIV prevention programmes that work, as opposed to programmes that promote purely political (including religious and pseudo-religious) ends? When is money going to be spent on the things that concern the most people, the many diseases and social problems that most people face? I needn't list the diseases or even the problems, Gonsalves would be more aware of them than most.
  
  Some of the people that Gonsalves may gloss over as the 'Aids backlash' wonder how HIV positive people will benefit from a one trick pony health programme that can give them ART but nothing much else, perhaps not even the food they need to be able to take the antiretroviral drugs. They wonder why HIV positive people with certain diseases are more worthy of treatment than those who are dying of the very same easily preventable and treatable diseases. They wonder why those who are at risk of becoming infected with HIV are not entitled to very much, but if they become infected, they may receive a great deal.
  
  But, more importantly, I think: what kind of HIV programmes can be implemented successfully in countries that have inadequate health services, along with poor standards of education, hardly any social services, very little infrastructure, lack of political leadership, governance, legal systems and levels of equality that would be required for these very expensive programmes to work? Even one trick ponies can't work without any solid foundation, as the Aids one trick pony amply demonstrates.

• Foundations for HIV Prevention

  Posted: December 4, 2009, 3:06 pm by Simon

  I rarely come across articles criticizing HIV prevention programmes for their lack of success, but apparently a contributor to the Social Aspects of HIV/AIDS Research Alliance conference this year draws attention to the fact that many 'prevention' interventions were implemented without ever being tried. He may have gone on to say that ones that were tried and found to be useless continue to attract most prevention funding, but I wasn't at the conference.
  
  Professor Geoff Setswe is right that HIV took some time to be recognised and had already infected many people before the most appropriate methods of preventing its spread had been investigated. But more than 25 years later, prevention programmes continue to be rolled out that are untested or that are tested but found to have little or no benefit. But no one is counting bodies when there is money to be made.
  
  It's easy to blame health and other social problems on the global economic crisis now, but that wasn't the problem just over a year ago. In Kenya, since the 1980s, one excuse after another has been blamed on the lack of progress in education, health and other areas. If it wasn't economic, it was oil or food or political or environmental and if it wasn't a crisis it was a disaster. The HIV pandemic itself is just one of those many 'disasters' or 'crises'.
  
  But poor health in Kenya is not a disaster, nor is it a short term crisis. Health services have been reduced in Kenya at least since the early 1980s, when the Moi government depended on loans from international financial institutions to prop up his form of democracy. These institutions funded him in return for his agreement to cut spending on social services and the public sector in general. It seems unlikely he or his colleagues (who overlap considerably with the present administration) were particularly worried about the idea of reducing public spending.
  
  Health service spending in Kenya is now minimal (as are spending on education and other social services). Health infrastructure needs to be built from the ground up, more or less. Most people don't go to hospitals or clinics and many who do fare worse than they would have if they had stayed at home. It's little wonder that HIV was transmitted rapidly in Kenya during the 1980s and continues to spread today, despite the hundreds of millions of dollars spent on the disease. There are still far more people being newly infected than receiving treatment, though a lot more money is spent on treatment.
  
  Fine, Professor Setswe, clinical trials are not always appropriate for testing social and behavioural interventions. But are clinical trials needed to show that starving people need food, that those suffering from malnutrition need proper nourishment, that poor people need support, that sick people, whatever they are suffering from, need medical attention, that those without adequate supplies of water die of thirst or water borne diseases? And the list goes on. Those who pigheadedly continue to talk about how difficult HIV is to prevent seem to be uninterested in what those in high HIV prevalence countries really suffer from.
  
  HIV is a real disease. Those suffering from it need treatment and care. Those who are in danger of becoming infected need to be protected from it or to be enabled to protect themselves from it. But most people will get up in the morning and have food, water, work, school fees, day to day health and many other things on their minds. And in all the time that HIV has been around, these other concerns have been largely deprived of attention and funding.
  
  Finally, mass male circumcision is mentioned as a possible HIV prevention method that is supported by a lot of evidence but has been held up for various reasons. Perhaps one of the reasons that circumcision has been held up is because health services in Kenya and other countries who were tricked by those same international financial institutions have been reduced to the extent that it is not possible to roll out any kind of mass health programme. Some of the HIV programmes that were rolled out failed because infrastructure, education, health and many other areas have been so underfunded for so long.
  
  The same article mentions a Dr Ntanganira, who says that "We know what works". But the article doesn't say what works, unfortunately.

• The Aids Industry Sure Knows How to Blow its Own Trumpet

  Posted: December 1, 2009, 10:07 pm by Simon

  Yesterday was World Aids Day again and in Kenya you couldn't miss the copious amounts of advertising, bunting, leafleting, t-shirts, sun visors and other paraphernalia of the industry. High and not so high officials were out in strength to collect their per diem, without which, presumably, nothing important could happen. There were the mobile testing clinics in areas that already have static testing clinics and millions and millions of condoms distributed.
  
  For all it's faults, the Aids industry has published some figures that certainly look good. Botswana, which has one of the worst HIV epidemics in the world, has the highest percentage in any African country of people on antiretroviral therapy (ART), the highest rates of HIV testing and the highest number of women on ART to prevent mother to child transmission (PMTCT). They also have the third highest percentage of children on ART.
  
  Over several decades, the campaigns to recognise the rights of HIV positive people to receive treatment have been successful in a lot of countries. In many developing countries, a sizable percentage of HIV positive people in need of treatment are on treatment. In the West, very few babies born to HIV positive mothers are themselves HIV positive. Indeed, the percentage of HIV positive babies born to HIV positive mothers is declining in a number of developing countries too and should be relatively low by now in a country like Botswana, where such a high percentage of HIV positive mothers are receiving PMTCT.
  
  But rights seem to be most commonly recognised for those who are already infected with HIV. If you read various developing country HIV strategic plans (which are curiously similar, despite the epidemics being very different in quality), you will notice that the word 'rights' is rarely used except in relation to HIV positive people, mainly in relation to access to treatment. The rights of those who are not yet HIV positive, and that's most people, are rarely mentioned. Yet they have a right to the things that will ensure that they remain HIV negative.
  
  Of course, it is hard to quantify the effects of the various HIV prevention programmes that have been rolled out in Kenya and other African countryies. Most of them were run by wealthy organisations who could afford the 'research' and publicity that would make them look very successful. The reality is that very little is known about preventing HIV and, beneath the hype, few programmes have been truly successful.
  
  I would be the first one to admit that the very idea of cutting HIV transmission is fraught with difficulties. Many things have been tried, some of them perhaps even well thought out. But in the end, there is very little money to be made out of prevention and therefore very little money put into it. Condom distribution is an exception, but where there is little or no health or science education, let alone sexual and reproductive health education, condoms haven't really taken off that well. You may have heard otherwise but there are good commercial reasons for that.
  
  The problem with the majority of the prevention programmes that have received some of the relatively small amount of money that is available for HIV prevention is abstinence. Most programmes relied on the idea that if people would just abstain from sex, they would not be likely to be infected. The more liberal advocated abstinence until marriage, until it was noticed that more and more people are becoming infected by their spouse. But various programmes were cobbled together that, one way or another, advocated abstinence or what amounts to abstinence. People didn't abstain and most of them won't. This is not something peculiar about developing countries. Abstinence campaigns have failed where ever they have been tried.
  
  The reason I mention the rights of people who are HIV negative is that many of them will, sooner or later, become infected with HIV because one or several of their rights are presently being denied. People, whether adults, children, male or female, have a right to health and a right to treatment when they are sick. Yet more people in Kenya and other developing countries are dying of easily treatable and curable diseases than are dying of Aids.
  
  Children have a right to a decent education and part of that should include levels of health and science education that should give them the prerequisites to attain enough understanding of sex, sexuality and reproductive health to avoid becoming infected with HIV or other sexually transmitted diseases and to avoid unplanned pregnancies. In a word, people need education to lead healthy lives.
  
  People have a right to a decent standard of living for themselves and their children, they have a right to adequate food and nutrition, they have a right to good standards of governance and security, water, sanitation, infrastructure and many other things. They have a right to a legal system that protects them from harm and persecution and the like. Women need to be given the same rights as men, in the workplace, in the economy, in education, in health and everywhere else. Men who have sex with men, intravenous drug users and commercial sex workers need their rights protected.
  
  It is the denial of the sorts of rights mentioned above, along with various other rights, that leaves people vulnerable to becoming infected with HIV and suffering many other serious consequences. People in developing countries who are suffering from HIV now, and those who have died of it, were likely denied one or several of their rights. HIV is not transmitted in isolation from people's circumstances, from the conditions in which they live and work.
  
  Those who are HIV positive and those who are HIV negative are equally entitled to their rights, though skewed funding for Aids would suggest that this is not the case. In order to avoid transmitting HIV to others and in order to remain HIV negative, everybody's rights need to be protected. In short, everyone is entitled to these rights and without them, the treatment and care programmes for people who are HIV positive will be, to a large extent, in vain; the half hearted prevention efforts will also be in vain.
  
  Prevention has proved to be a slippery fish. But treatment and care for one disease in isolation from all the other things people can and do suffer from has also been less successful than it should have been. There is little point in treating one incurable disease and ignoring the many others that are more easily treatable and often even curable. But that is what's happening. The Aids industry is just too rich and powerful to allow people to know that.

• 'Religiosity' and Levels of Social Capital

  Posted: November 30, 2009, 12:39 am by Simon

  The work continues with Ribbon of Hope Self Help Group, Nakuru, in Kenya's Rift Valley. We have ongoing projects producing basic foods such as vegetables and staples, dairy cattle and hens, etc. And we are still hoping to spread the word about ways of saving money by using solar cookers and home made fuel briquettes for cooking and various other techniques. Any project that costs very little or nothing will be considered as long as it is appropriate for people in this area and as long as it is sustainable and not destructive or damaging in any way.
  
  As usual, some people are cooperative and hard working, otherwise, there would be no point in an organisation such as Ribbon of Hope. But sometimes it seems as if there are as many obstructive people as there are constructive people and it can be hard not to dwell on them. Especially when they so often win out and destroy projects that would have worked well without their interference. Today, we had the experience of trying to find out why some people abandoned their basic accounting and record keeping several months ago and now seem both unable and unwilling to say how they have been running their organisation.
  
  It would be unreasonable to expect everyone to be equally successful in their endeavours and it is natural for some people to get involved initially, only to step back later and contribute less than before. But, much though I'd like to think that there are more cooperative than destructive people here, the evidence suggests that this is not true. I'm sure there are all sorts of possible explanations and I would be the first to admit that the people we work with live under all sorts of stresses and pressures that can make them a bit desperate. But I'm not going to make excuses for some of the things I've seen and heard about. I'll just hope that in the long run there are more positives than negatives and that Ribbon of Hope manages to attract serious contributors rather than time and resource wasting people.
  
  There is a very interesting 'index' called The Legatum Prosperity Index, which aims to look at prosperity beyond the one dimensional Gross Domestic Product (GDP) favoured by so many economic analyses. The index looks at various economic figures, politics and governance, education, health, security, personal freedom and social capital. The whole index seems skewed by what are almost exclusively Western values but it's still an interesting exercise and their report is well worth the read.
  
  Kenya doesn't come out very well, scoring 95 overall out of 104 countries for which there was adequate data available. This is not to say that Kenya's data is particularly reliable but let's give it the benefit of the doubt. The country receives a pretty low score for almost all the various indexes and rankings available. Economically, the country is weak in many ways and is particularly dependent on raw materials. Education, health, governance, personal freedom and security rankings are very poor. Surprisingly, the country is said to have well developed democratic institutions.
  
  But the real shocker for me is that the country is ranked 25th for its level of social capital; 'most Kenyans find others to be reliable and some actively volunteer or help strangers'. Sadly, some people who 'volunteer' only do so for what they can get out of it. Apparently Kenya's social capital score is 'boosted by exceptionally high levels of religiosity'. Well, that's certainly no surprise. But many of the people who profess the loudest to be Christian, Saved, Born Again or whatever else are the ones who never miss an opportunity to get something by deceit.
  
  I think this element of the Prosperity Index begs the question about whether high levels of religiosity is an indication that Kenya is strong on social capital. The police and other officials who require a standard bribe in order to do what is just their job are often as ostentatiously religious as anyone else. An official who tried to get a 50 dollar bribe out of me asked me to pray for him when he found I wasn't going to pay. The people who dress up for church on Sundays overlap with the mob that crowded around a young homeless boy to beat him for some offence, real or imagined. This sort of mob rule, usually aimed at very vulnerable people, such as elderly people branded as 'witches' or homeless people branded as thieves, is very common. Some of the 'volunteers' I have met never miss an opportunity to mention their love for Jesus but nor do they miss an opportunity to get something that is intended for sick and dying people.
  
  This is not an attempt to bash the 'religious' people of Kenya or of any other country, just a question about what kind of connection there is between 'high levels of religiosity' and high levels of social capital. Reluctant as I am to come to this conclusion, I would say that social capital is one of the things that Kenya is most sorely lacking in. And this lack of social capital has had, and continues to have, a profound influence on high levels of HIV, sexually transmitted infections (STI), unplanned pregnancies, stigma, discrimination and probably many other problems.

• Superweeds: What Doesn't Kill Them Makes Them Stronger

  Posted: November 29, 2009, 7:04 pm by Simon

  One of the big promises of the industry that produces genetically engineered (GE) crops is that they will allow farmers to use less pesticide, thereby saving money and reducing negative impacts on the environment. But a recent paper shows that these claims don't stand up to scrutiny. On the contrary, pesticide use has increased almost every year in the thirteen years that GE crops have been planted on a large scale in the US.
  
  Crops such as cotton, corn and soybean are genetically engineered in order to withstand a particular type of pesticide. That pesticide is sprayed over a large area and kills everything but the crop. That's the theory, anyhow. So the industry has spent a lot of money trying to rubbish the claims that eventually weeds would evolve that would be resistant to the glyphosate herbicide that needs to be used in increasing amounts on GE crops; these have been dubbed 'superweeds'. But such weeds have evolved and they keep evolving to resist higher levels of glyphosate and anything else farmers try to do to keep them under control.
  
  This glyphosate is a pollutant that degrades land and contaminates water. Its serious effects on the environment, on conventional agriculture and on animals, domestic and wild, have been demonstrated many times but they have also been shown to cause health problems in humans. Reproductive, birth and neurological problems have been linked with exposure to pesticides.
  
  Those using GE crops are not permitted to collect seeds to plant the following year and are compelled to buy seeds every year from the GE industry, in addition to the pesticides and the increasing amounts of herbicide. But farmers who try to buy conventional corn, soybean and cotton seeds find that there are few stocks available. Almost all these important crops have been taken over or contaminated by GE versions in the US.
  
  And this industry wants us to believe that GE crops are the future for developing countries? Producers of GE crops in the US now have to spend so much money controlling resistant weeds that it is eating into their profits. Coupled with the costs of pesticides, it won't be long before there will be no profit at all. And the industry's claims about the increased yields from GE crops have never been demonstrated either. Yields are affected by resistant weed infestations, of course, but the yields have been no better than those of conventional crops. Sometimes they have been a lot lower.
  
  In developing countries, where conditions are far from ideal, the chances of farmers even getting normal yields from GE crops are slim. And as the costs go up farmers will be unable to continue and will be forced to try to return to conventional crops. But their land and the land of those around them will, by then, be contaminated, as will seed crops. Their land, and even land close by that never bought into GE crops, will continue to produce weeds that are resistant to pesticides and the crops will be contaminated with GE strains for many years, if not decades.
  
  It's ironic that this supposedly great technological achievement has now resulted in US farmers having to employ people to pull up weeds by hand. But this will not be an option for people in developing countries. They will not be able to withstand the pressures of increasing costs along with falling yields and GE crops will be a disaster for them, even more so than it is for industrialised countries. Monsanto and Syngenta are the main offenders mentioned in this report, names that will be familiar to those who have followed the GE industry to date. Their plan is to produce more pesticide and to produce stronger versions. That should help a lot.

• Self Destructiveness Seems Like a Strange Quality in a Church

  Posted: November 27, 2009, 1:06 am by Simon

  I've had time to read UNAIDS's 2009 HIV Epidemic Update and it's interesting, but perplexing in many ways. Take, for example, the issue of unprotected sex with multiple partners. As a result of research into different modes of transmission and their relative importance in different countries, it was found that Kenya has a particular problem with people having unprotected sex with several different partners.
  
  This didn't come as a big shock, of course. Many people, all over the world, have unprotected sex with several different partners. But the risk of transmitting or being infected with HIV is much higher in a country with high prevalence of HIV and certain other sexually transmitted infections (STI). And Kenya is such a country, with 7-8% HIV prevalence, high prevalence of STIs known to make one more susceptible to transmitting and contracting HIV (such as herpes simplex virus), very poor education and health services and an attitude towards condom use that is, I suspect, strongly influenced by conservative religion and politics.
  
  The shocking thing is how many people are willing to take such risks with their sexual partners while refusing to use condoms, coupled with the fact that tens if not hundreds of millions of dollars have been spent on HIV prevention campaigns that advocate the use of condoms. A recent campaign by the extremely wealthy, powerful and conservative Population Services International (PSI) aims at stopping relationships on the side or multiple relationships. The campaign mentions condoms too but concentrates on stopping the relationships.
  
  The trouble is that after many years of some parties campaigning for safer sex, others have been campaigning for no sex at all or no sex except inside marriage. The volume of this sort of campaigning is high and usually advocates against the use of condoms or suggests condom use only in difficult circumstances (such as where one's partner is already infected with HIV). Aside from the fact that in Kenya, Uganda and other countries, the chances of becoming infected by one's marital partner is higher than becoming infected by a casual partner, many people are not married, are no longer married or have not, as yet, been able to get married. So lecturing them about abstaining till marriage can be a rather pointless exercise.
  
  One of the apparent results of all these campaigns that have a pseudo-moral political and religious agenda is that people have internalised the message about not using condoms but they haven't given up having sex with a number of different people. Many of the people who engage in multiple partnerships are married, so they are in danger of infecting their partner or being infected by their partner. And yet the religious and political zealots keep ranting on about condoms and how they are not the solution.
  
  The Catholic pope is quite right when he says that HIV cannot be overcome by relying exclusively or primarily on the distribution of condoms. They need to be used, all the time, and properly in order to reduce the transmission of HIV. He may also be right about the importance of conjugal fidelity, but conjugal fidelity appears to be rather rare, perhaps more so among those married in the Catholic church than in many others. As for sexual abstinence, it appears to be rare in the Catholic church and is not even a foregone conclusion among those who profess to have taken a vow of chastity.
  
  If we lived in the sort of world the pope is talking about, where everyone did only what they were supposed to do with regard to sexual behaviour, there would be no need for condoms or many of the other things that he and his ilk object to so strongly. But then, nor would there be HIV or other sexually transmitted infections. Maybe people shouldn't have sex except within marriage and for the purpose of procreation, according to some moral code. But people have sex, defecate, eat, drink, sleep and play.
  
  According to the moral code of some people, having sex or exercising many other forms of human behaviour are not, in themselves, moral or immoral. Which is not to say it is not wrong to have sex with one person when you are in a relationship with someone who thinks that they are your only partner, for example. But the pope sees having sex outside the strict bounds of Catholic teaching as absolutely wrong. And using a condom to avoid an unplanned pregnancy or to protect oneself from HIV or any other STI is also wrong. Yet, in a world where people only had sex within those strict bounds, it would seem strange to even have to make a pronouncement about contraception.
  
  Maybe the pope will keep going on about abstinence until marriage and the evils of contraception. If he does, all the worse for the Catholics who choose to listen to him. And I'm talking about the Catholics who live in this world, in Africa in particular. Because a lot of them don't seem willing to take all of his advice, preferring to select the bits they like and leaving out the bits they don't like. The pope is surprisingly influential and as a result of his influence, HIV continues to spread rapidly in Kenya and other countries. It infects innocent people, through various means, young and old people, religious and non-religious people and especially people who have sex. And that's most people, as far as I know.

• Celebrate World Aids Day By Dismantling UNAIDS

  Posted: November 25, 2009, 1:40 am by Simon

  UNAIDS has never been shy about producing long and colourful documents about HIV/Aids and in the last couple of days they have released two; the Outlook Report 2010 takes a look back and compares the HIV pandemic of today with that of the mid 1990s; the second document is the yearly AIDS Epidemic Update, which I haven't had the strength to read yet.
  
  The Outlook Report, like many of the various articles commenting on one or other of the reports, sometimes takes a rosy view of how the international community and the AIDS community have dealt with the pandemic. In the sense that things have moved on, and finding that you are HIV positive no longer has the significance it once had, they are right. We have come a long way in treating what was once an untreatable illness that would lead to a certain and very unpleasant death.
  
  But the worrying thing is how the Outlook Report, like many UNAIDS and other reports in the past, talk about the importance of HIV prevention. It has been obvious that HIV prevention is so important that the amount of HIV money spent on it needs to be increased considerably. But the amount has gone down and the prevention programmes that get most of the money have little or no effect and have never had much effect.
  
  Defenders of the disproportionate amount spent on treatment and care of HIV positive people are fond of pointing out that this shouldn't be an either/or debate. True, it shouldn't, both treatment and care on the one hand and prevention on the other should receive more funding than they presently receive and the funding should be more equitably divided. Treatment and care contribute a certain amount to HIV prevention but they are not the same as prevention and they will never contribute more than a certain amount. That's why there are five new infections for every two people put on antiretroviral treatment.
  
  The report goes on to allude to the work that has been done to show that prevention programmes, such as they are, fail to target those most at risk in populations. Most of the money is spent on populations as a whole and very little on, for example, men who have sex with men, commercial sex workers, intravenous drug users, prison populations, fishing communities around Lake Victoria, mining communities and various others, who are very often at risk because of their occupation or lifestyle.
  
  The report seems aware that HIV transmission is not primarily about individual behaviour and that there are different kinds of HIV epidemic in different countries and that some people are more at risk than others. It even seems cognizant of the fact that it is the circumstances in which people live that makes them more or less likely to become infected with HIV. But it hasn't made the leap to realizing that in some countries, especially developing countries, most people live in such circumstances. Not everyone is at equal risk of becoming infected but most people live in conditions that mean they are already at high risk of becoming infected or that they will one day be at high risk of becoming infected.
  
  That makes it sound like HIV prevention is unlikely to ever have much success, but the opposite is true. Treatment and care have been to a large extent dominated by commercial interests. Products, processes and services have been developed, many by those who are in a position to profit from them. But prevention has been dominated by the party-political and pseudo-moral debates of political and religious leaders. Their aim is to further their own agenda, which are far from being concerned about millions of people becoming sick and dying.
  
  Raising awareness about HIV, sexually transmitted infections, sexual health, reproductive health and anything else is good and will go a long way towards protecting people from a number of dangers. But good overall health, healthcare, nutrition, food security, education, infrastructure and many other benefits would give people the maximum protection, not just from HIV, but from other illnesses and ills.
  
  And this brings us to another often repeated pronouncement made by various senior HIV/Aids experts. They like to deny that HIV funding has distorted health and development funding and disrupted more general programmes that aimed to benefit societies as a whole. HIV/Aids funding is not too high, it needs to be higher. But there needs to be a similar move to spend the money more equitably. HIV will not be eradicated without health services, education and other social services, no matter how much money is thrown at it.
  
  So, spending money on all other areas of development will also contribute to the fight against HIV/Aids. But continuing to spend disproportionate amounts on HIV/Aids will not benefit the many other development issues that have been hijacked by numerous commercial and political interests. HIV treatment and care is just one of many health issues that the world faces but HIV prevention is about health, not disease. Therefore it has far broader significance and affects far more people than one single disease. In fact, it affects everyone.
  
  Ultimately a self-serving and very expensive organisation, UNAIDS needs to be reabsorbed back into the overall agenda of public health, or some agenda that encompasses the health of everyone, not the sickness of a few. This is not to say that HIV positive people should not be entitled to treatment or care. Rather, they and all other sick people should be entitled to treatment and care. But people who are not sick should be enabled to stay that way. UNAIDS is good at diverting a lot of money for people once they are HIV positive but this is denying the right of HIV negative people to stay that way.

• Stop Thief, There's More!

  Posted: November 24, 2009, 12:43 am by Simon

  At present, Tanzania is Africa's third largest producer of gold but may be set to become the largest. Gold mines towards the North of the country, formerly mined by Tanzanian artisanal miners, have for a long time been making a handful of foreign mining companies very rich. But recently, gold that is still being mined by Tanzanian artisanal miners in the South of the country has attracted the interest of a handful of foreign mining companies, who can expect this to make them very rich.
  
  It's interesting how this is a 'discovery' because, as far as Tanzanian artisanal miners are concerned, they discovered the gold. It's their livelihood and not a very good one at that. But it's better than the nothing they will be left with once the big gold extractors move in. Typically, big gold miners employ a few thousand people, compared to the hundreds of thousands that will be displaced.
  
  Time and time again, such gold 'discoveries' have been trumpeted as great news for Tanzania (or Kenya or Uganda or where ever). But Tanzanians should be well aware of how much they have profited from their vast mineral resources. Or rather, they should be aware that they have been systematically impoverished because of their vast mineral resources. Uganda has had a recent opportunity to find out how gold 'discoveries' affect ordinary people and even Kenya will have an opportunity soon, as gold has also been 'discovered' in the Kenyan Mara region.
  
  The American company buying a large but very cheap interest in these recently 'discovered' gold deposits will be given all the usual benefits of non-existent oversight, few taxes, if any, minute royalty payments, most of which they will probably renege on, somehow, and the freedom to exploit Tanzania's rather loose employment and other human rights protections. In return, Tanzania will experience a large increase in unemployment and a loss of resources that will never be compensated for; Tanzania being, already, one of the poorest countries in the world.
  
  Oddly enough, there is also a recent article about safety in small mines in Tanzania. This issue is not often reported on, although the issue of safety in large mines is even less reported on. Not because large mining interests have a great safety record, they just spend more on publicity. The secrecy that surrounds big mining in Tanzania and other developing countries doesn't come cheap. Only the employees do that. It's true that safety in smaller mines has been neglected by the government for a long time but that's no excuse for giving the Americans, the South Africans and the Canadians carte blanche to plunder the country's gold. I'm just assuming the appearance of these two articles at around the same time is not a coincidence.
  
  To be fair, many mining employees earn better than average wages, though nothing to write home about. But this doesn't make up for the fact that for every one employed there could have been ten or twenty put out of a job. Nor does it excuse the mind boggling, tax free salaries that the non-Tanzanian employees get (which are usually kept secret). And it certainly doesn't make up for the fact that the country is highly dependent on foreign aid, not because it is poor, but because everything it has of value is stolen with the connivance of senior statespeople and businesspeople, Tanzanian and non-Tanzanian alike.
  
  Critics of large scale theft of gold from developing countries recommend that donor countries, international institutions and the like champion the interests of countries such as Tanzania. Well, the World Bank, the International Monetary Fund (IMF), America, Britain, Canada and many others who could be championing the interests of development are too busy fighting for the other side. The lack of regulation in Tanzania and other developing countries mainly emanates from the so-called international institutions, whose focus always appears rather national.
  
  And America, Britain and Canada may well be big donors. But the amount of money they give in aid donations is very small compared to the amount they pilfer. I don't think it's reasonable to expect thieves to just put their hands up, so it's up to the Tanzanian people, through their government, to fight this one out. It remains to be seen whether they will continue to hand over their future or whether they will demand a more equitable way of managing their resources. So far they have behaved like a person confronted by someone raping their wife and offering the rapist their mothers and children.

• Sex Workers Need Support, Not Condemnation

  Posted: November 19, 2009, 12:50 am by Simon

  Malawi's aim to give sex workers an alternative to sex work is a step in the right direction and it's certainly better than the finger wagging and moralising that passes for policy in Kenya and other African countries. Sex workers will be offered low-interest loans to start small businesses and in return they will be expected to give up sex work.
  
  But a serious problem with this approach on its own is that most small businesses fail. There is a limit to the proportion of a population that can depend on small businesses for their income. And if there are too many small businesses, even the ones that don't fail do badly.
  
  Besides, it's not just sex workers and currently unemployed people that want access to microcredit, especially to set up small businesses. Many people are just about getting by, earning tiny amounts of money some of the time and turning up to work every day in the hope of earning enough to pay the next day's fare to work.
  
  A lot of people you talk to, especially in professions such as beauty therapy and hairdressing, for example, say that their ambition is to either make or borrow enough money to set up a small business, a salon or something that is more dependable than an employer who may not even pay up the pittance that is owed.
  
  And when people have access to credit, too many of them seem to go for the very businesses that have already flooded the market. Selling second hand clothes is something of a euphemism among sex workers because there are so many people doing it, a lot have to resort to commercial sex work to make enough to survive. Many sex workers that I have met are trained in hairdressing, beauty therapy or hotel and catering in one of the numerous colleges (or rather dubious quality) that you see in even the smallest towns.
  
  Commercial sex workers, subsistence workers, homeless people, indeed, any poor or vulnerable people, face a number of problems. Not having enough money to survive is just one problem in what can be a long chain of circumstances. This substantial group of people is not exclusively female, but it is predominantly female.
  
  Girls are less likely to go to school, less likely to have adequate school attendance, less likely to complete primary education, less likely to go on to or complete secondary education and in the end, they are unlikely to have enough education to compete for the small number of jobs that are open to females. Even those who do well at school are unlikely to get a job that pays a reasonable income and this is particularly true of females.
  
  Many girls with too little education are probably poor and even if their family has some money, it is more likely to be spent on boys. So if a girl or woman decides to get some training or vocational education, finding enough money is one of the biggest problems. Commercial sex work is far better paid than any of the other options available. It would be interesting to know how many girls and women raised the money to go to hairdressing or beauty therapy school through sex work only to end up supplementing the meagre income they subsequently earn by returning to sex work.
  
  There are two points that need to be highlighted here: firstly, older women, those in their thirties and forties, are in the most urgent need of finding alternatives to sex work. For them, sex work doesn't have the many dangers that it has for younger women. Older women have to compete with younger women by resorting to more risky sexual practices and by working for less, which means they have to find more clients. But for many older women, it's just not possible for them to get clients any more. Worse still, the sex industry is currently flooded with sex workers.
  
  The second point is that commercial sex workers themselves need protection. No amount of grant money for small businesses is going to result in sex work disappearing off the face of the earth. On the contrary, if the process of enticing women away from sex work is successful, the price of commercial sex will increase. Unless governments can also banish poverty and unemployment, sex work will become an even more attractive option because the price it attracts will go up.
  
  In Kenya, sex work itself is not against the law. Living on immoral earnings is against the law and some of the people who make most out of the earnings of sex workers include the police. They persecute sex workers and get a steady income from them and because police have so much power, most sex workers are too scared to be arrested or changed. They pay up, thinking that the alternative could be a lot worse.
  
  And they are right. Sex workers face regular threats, such as beatings, arrests, rape and persecution. Although this is not always at the hands of the police, sex workers are not protected by the police or anyone else. As the aim of enticing sex workers away from commercial sex is partly to reduce the transmission of HIV, they Malawian government will also need to take measures to protect the rights of women, whether they are involved in sex work or not.
  
  In Kenya, good education about reproductive, sexual health and even health in general are rare, especially for those who don't even receive a decent level of education of any kind. Health services, including reproductive and sexual health are under funded and effectively unavailable to most people, including those who are most in need.
  
  Malawi and other countries with high HIV prevalence need to prioritize business training, low-interest loans and alternative sources of income for women who want to give up sex work, who are likely to be able to leave sex work and who will be able to make a better living by leaving sex work. Eradicating commercial sex completely will take a lot longer.
  
  Those who will continue to have to resort to commercial sex work need the protection of the law, they need to be protected from the excesses of the police and other officials and they need to be protected from the many people and bodies who treat them like criminals when they are more likely to be victims of crime and corruption. If sex workers have access to social and health services and their rights are protected, this will go a long way towards reducing the spread of HIV.
  
  Moralizing and finger wagging will continue to have little impact. The Kenyan plan to do a survey of commercial sex workers and other vulnerable people will be futile if people have no protection from the sort of prejudice and discrimination that has been whipped up by the moralizers and finger waggers. The current constitution makes no plans to provide such protection, so such changes are still a long way off.
  
  The Malawian government is to be applauded but they and other governments need to deal with the human rights issues that are involved in commercial sex work, such as poverty, vulnerability, corruption, prejudice and extreme violence. It’s not commercial sex work per se that results in high rates of HIV transmission. It’s the living and working conditions faced by those who have to resort to commercial sex work.

• When Water is Scarce, Develop Hydroelectric Power Installations

  Posted: November 17, 2009, 9:55 pm by Simon

  It hardly comes as a surprise, but electricity prices in Kenya are increasing because of unreliable rainfall patterns. Unwisely, Kenya depends to a large extent on hydroelectric power. So when there is a prolonged drought power is in short supply. Expensive, inefficient and highly polluting emergency power is generated using fossil fuels to make up some of the shortfall.
  
  Hydroelectric dams have been built in developing countries for many decades. This may have seemed like a good idea a long time ago, although it is more likely to have appealed to the Western engineering companies and others who reaped substantial profits from the building of these installations. But the multiple disadvantages of hydroelectric power are now widely recognized, disadvantages including inefficiency, expense and irreversible environmental damage.
  
  For the moment, I'll leave aside the (albeit important) question of who is profiting from the production of emergency power over such a long period of time, which makes it seem less of an emergency and more like plain stupidity. But the cost increases for electricity, said to be about 60% over the past six months, are being passed on to hard pressed consumers. This is particularly galling in a country where only a minority of households have an electricity supply.
  
  Already, well over half of Kenya's power is, ostensibly, generated by hydroelectric installations. This suggests a surprising overdependence in a country that has several viable alternatives. But there are now plans to build a new dam in Coastal Province (where most of the country's hydroelectric power is produced) to provide domestic water supplies, irrigation and electricity. Tens of millions of dollars will be spent on something that is unlikely to work very well and will have serious adverse impacts. The money is coming from the Chinese government and, while water infrastructure is badly needed, another huge dam hardly seems like the best approach given the history of such projects in developing countries.
  
  Kenya could produce enough electricity for all its citizens using sustainable and relatively cheap sources, such as wind, solar and geothermal. There are good reasons for keeping water supply and irrigation separate from electricity generation because hydroelectric power is not just inadvisable, it's also quite unnecessary in Kenya. Touting the project as being a solution to water shortages doesn't explain why such a large amount of money is being spent on it. We are not told what the Chinese government is getting in return. Oil and other natural resources, probably.

• Deciding Who Gets to Eat and Who Gets to Starve

  Posted: November 15, 2009, 8:37 pm by Simon

  A curious feature of some of the big famines in history is that the countries experiencing the famine were not necessarily short of food. Likely as not, the majority of people were very poor and did not have the money to buy food, but food was being produced and exported.
  
  Many millions of people in a number of developing countries currently face food shortages, malnutrition and probably famine at a time when the world is producing record crops. The Food and Agriculture Organisation (FAO) estimates that 2008 saw the highest recorded cereal crop production figure ever. It is predicted that 2009 will see the second highest figure.
  
  Wikipedia is a great source of information but their bald statement that "[f]amine is caused by a human overpopulation relative to the available food supply" is in need of qualification. It is estimated that as many as 10 million Kenyans face serious food shortages, but this is not clearly because the country is overpopulated. There are several other significant pressures on food production and access to food.
  
  For example, many people are extremely poor, have always been poor and have little prospect of ever becoming less poor. Food prices have been driven up over the past few years by market speculation and by the use of productive land for growing biofuels. So poorer people, who could barely afford enough food before these trends began, are now facing starvation.
  
  Other pressures include droughts, often followed by serious floods, which result in poor harvests and destroy large tracts of arable land. There was also widespread unrest in Kenya in 2008 and people abandoned their land. A number of these internally displaced persons (IDP; the Kenyan government is not keen on releasing figures for just how many are still displaced) now have little means to feed themselves and no chance of returning to where they came from. And the majority of people have only a tenuous hold on land, renting it from unscrupulous landlords, who can treat tenants as they wish and sell their land at the drop of a hat.
  
  In addition to growing biofuels in Kenya, there are other trends that result in less land being used for affordable food. Land is bought up by natural resource prospectors, such as those in search of oil around Isiolo and those in search of gold in the Mara. This land will not be used to benefit any Kenyans and certainly won't be used to grow food. And much of Kenya's land is used for non food crops or for food products intended for export, such as coffee, tea, flowers, fruit and vegetables. Controversially, a lot of land comprises national parklands, preserved for use by those who can afford to visit it. Most can't.
  
  Despite all these pressures, there is a lot of food being produced in Kenya for export and a lot of arable land available for food production. The reasons people face food shortages and poor nutrition are the same as they have always been: widespread poverty and increasing levels of impoverishment along with rising food prices that mean the poorest will lose out.
  
  When things get really bad and people are dying of starvation, maybe other countries will start shipping in relief food, but this will not improve food security in Kenya. Food security refers to access to food, as well as its production. As with other countries that experienced famines throughout history, resilience will continue to be low, there will be widespread disease, many people will have abandoned rural areas and moved to cities; there will be no remaining seed to grow the next season's crops, no fertilizer, no chance of resisting whatever new pressures arise.
  
  The more I read about famine, the more it seems like a process whereby the rich systematically deny food to the poor in order to increase their profits. But that couldn't be correct, could it?

• Did Someone Say 'Final Solution'?

  Posted: November 14, 2009, 2:00 am by Simon

  I have read various articles about the proposal to carry out a 'gay census' in Kenya. But none of them shed any light on why the Kenyan government should suddenly be interested in identifying some of those most at risk of being infected with and of transmitting HIV. The best way to make gay people feel they are not being singled out is to make HIV and sexual health services available to all, without prejudice.
  
  In fact, the proposal is not just to single out men who have sex with men (MSM). The proposal also aims to identify commercial sex workers (CSW) and intravenous drug users (IDU). That's hardly going to make members of these groups feel any better. They all have several things in common: they are all doing something considered to be illegal. They are also the subject of prejudice, discrimination and condemnation by political and religious leaders.
  
  Men who have sex with men, commercial sex workers and intravenous drug users need access to sexual health services. They also need access to more general health services, the protection of the law from persecution by members of the public and by the police. But programmes involving what is often referred to as 'harm reduction' are not popular in Kenya. The possibility of decriminalising sex between people of the same gender, commercial sex work or even intravenous drug use is not even being discussed right now.
  
  So what strikes me as most suspicious about the call to carry out this gay census, or census of people who are most at risk from HIV, is that it is being funded by the President's Emergency Plan for Aids Relief (PEPFAR). PEPFAR has always been vehemently opposed to harm reduction measures, such as the use of condoms, needle exchange programmes and other activities that are known to help reduce the spread of HIV and other diseases.
  
  Why would PEPFAR now be interested in funding this particular approach? Are we supposed to believe that the initiative has changed to such an extent that harm reduction is no longer refused funding? And are we also supposed to believe that the Kenyan government has completely reconsidered its earlier views on gay sex, commercial sex work and intravenous drug use?
  
  I suspect the motives behind PEPFAR's decision to fund any kind of 'survey' of some of the most vulnerable people in the country. I suspect the Kenyan government's motives, too. I have heard rumours that a number of powerful people in the US are not completely unrelated to Uganda's current discussions of an effective pogrom against gay people. This is not the way to reduce HIV transmission and it will have numerous other human rights consequences.
  
  Unless many other things are in place that guarantee the safety of people affected by this proposed 'survey', and that will include people who don't actually fall into any of the targeted groups, the whole thing should be abandoned immediately.

• Tomorrow's Disasters Are Preventable Today

  Posted: November 13, 2009, 2:53 am by Simon

  I think most people, if they saw their child playing near a fire or in some other dangerous situation, would do something about it before an accident occurred. They wouldn't just watch and then shell out the money for hospital fees once an accident had occurred. But donor money is usually spent on clearing up after a disaster has hit.
  
  Many children (and quite a number of adults) in developing countries are severely burned because most cooking is done on open fires, close to the ground. Donor money is sometimes forthcoming for the expensive surgery and skin grafts required by people who have suffered burns. But it's not often you come across substantial projects to provide people with alternatives to cooking on open fires, using mainly wood or charcoal.
  
  Burning wood and charcoal accounts for a very large proportion of the carbon emissions from developing countries. Forests are fast disappearing and wood is getting more expensive and less viable as a fuel source. The use of wood and charcoal is part of a massive environemntal disaster. There are cheaper alternatives, such as solar cooking, biogas and the use of fuel briquettes made from combustible materials.
  
  There is a lot to be gained from not burning wood and charcoal. There are the environmental benefits and safety benefits to consider. Also, people in close proximity to wood and charcoal cookers suffer from respiratory problems, one of the top killers in developing countries. Alternative fuels are cheaper, even free. And their use can reduce the time and effort taken to collect wood and produce charcoal.
  
  But rather than see aid money go into proejcts that have these multiple advantages, we continue to direct it to big disasters. The children that suffer terrible burns, that we wish to see treated, shouldn't have to suffer these burns in the first place. The plastic and reconstructive surgeons should be concentrating on people who are not suffering from preventable injuries.
  
  Similarly, money for surgeons and health resources is spent on reconstructing the faces of children affected by noma, which affects children suffering from malnutrition. Food security and proper nutrition would prevent many other illnesses and health conditions, in addition to noma, and would also reduce deaths, especially among infants and young people. Those who don't die from illnesses arising from insufficient food and nutrition still suffer stunted growth and retarded mental development. These are all avoidable.
  
  The current debate about land grabbing in developing countries, where greedy multinationals are buying up huge tracts of land to grow food for rich countries, is an idle exercise if it does not go any way towards reducing this phenomenon substantially. By the time this land has been ravaged by industrial scale farming and contaminated by genetically modified organisms, it will be too late. What is the point knowing now what the consequences will be if we are not going to do anything about it?
  
  Much of the land being grabbed is destined for biofuel production. The ridiculousness of starving people producing crops to fuel the cars of well fed people, far away, seems to be lost on us. We, the people benefitting from the increasing impoverishment of the poor, may be willing to see our governments giving large sums of aid money to starving people in the future, but we don't seem to want to do anything to prevent the circumstances that will eventually leave people starving.
  
  Land grabbing, especially for biofuel production, results in food, water and other vital resources being exported from poor countries to rich countries. If we prevent the land grabbing now, we won't have to send aid money later to the disaster we are so busy creating.

• Widespread Environmental Contamination and Loss of Biodiversity Are 'Externalities' to the GM Industry

  Posted: November 9, 2009, 3:43 pm by Simon

  The Kenyan government has been persuaded that it can 'revive' the country's cotton industry by introducing genetically modified GM cotton varieties. The first thing that springs to mind is the principle reason for the death of cotton industries in Kenya and every other developing country in the world: subsidies for American cotton farmers. It is not possible for poor countries to produce cotton at a price that can compete with the heavily subsidized American cotton, which is why most country's cotton industries failed many years ago.
  
  Of course, these American subsidies are illegal and they are completely antithetical to the country's constant bleating about the importance of free trade. But double standards have never mattered to rich countries and they never will.
  
  There may well be theoretical benefits to GM organisms, such as cotton, it's hard to know. The GM industry has been pumping out inaccurate and misleading data on trials for so long that they probably don't even know what is true and what isn't by now, and probably don't care much, either.
  
  But the problems that will arise if farmers buy into the thirty pieces of GM silver are more obvious, for those who can be bothered about them. The GM producer in question, Monsanto, which has an unrivalled corporate social responsibility record, claims that farmers will save on pesticide costs because they have to spray less frequently. Unfortunately, they will be obliged to pay more for seeds, spray using expensive pesticides produced by Monsanto and the land they spray will be denuded of all species, from the microscopic up. Expensive Monsanto herbicides will do the same for any plant species.
  
  This is a mere externality to Monsanto and probably to the Kenyan government. The fact that the land and water surrounding land planted with this cotton will be contaminated, probably irreversibly, is also an externality and those promoting the introduction of GM cotton even have the cheek (or ignorance) to claim that it will have a positive impact on the environment and the health of those working on cotton plantations.
  
  In addition to the problem of having to buy seed every year from Monsanto, because it's not possible or even permissible to collect seed at the end of the season, it will be difficult for the farmers to get out of the grip of Monsanto, if and when they wish to. Their land and the land around will be contaminated with the GM cotton for generations and even these contaminated crops could be deemed to the be intellectual property of those generous people at Monsanto.
  
  Many of the claims put about by GM hawkers are yet to be backed up by evidence but even they make little effort now to deny that GM crops are unlikely to be of any benefit to small farmers. The vast majority of farmers in Kenya and other developing countries are subsistence farmers who aim to grow enough food to live on and sometimes grow some cash crops to supplement their income. Although various cash crops have long been foisted on small farmers, many have felt the sting of becoming locked into producing things like tea, sisal, coffee, sugar and biofuels, for example, only to find that yields and prices never match up to what they were promised.
  
  Small farmers who buy into GM crops need to ask themselves if they can afford to become locked into yet another non-food crop that will never be truly economical and may leave them worse off than before. Large scale farmers may not experience the same worries, but whole communities in Kenya and other countries need to consider what the potential effects of widespread contaminated land and water may be. They also need to consider the consequences of most of their food production being owned by a multinational that is not even bound by the country's laws.
  
  It's worthwhile for Kenyans to bear in mind that cotton industries in developing countries did not decline because of pests and other problems but because a more powerful country controls the market. This is not likely to change quickly and the Americans are not going to give up the level of control that they have cheated so hard to obtain. Similar remarks apply to other GM crops. GM is not a technology for the poor, it is a technology for the powerful, like many technologies. But of course, it's of less use to the powerful unless the poor believe that they too need GM technology.

• Lack of Sanitary Pads is a Threat to the Health of Kenya as a Whole

  Posted: November 8, 2009, 1:27 pm by Simon

  The hype about how brilliant the introduction of 'free' primary education has been in Kenya continues six years on but the reality is that most parents who couldn't afford primary education before 2003 still can't afford it. The hidden costs are endless and include levies for parent teacher associations, uniforms and overpriced books, equipment, 'extra' tuition, etc. A colleague recently pointed out to me that parents need to pay for their child's desk every year. There must be quite a surplus of desks in schools by now.
  
  While enrollment figures are high for state schools, they have dropped in many private schools and the figures for attendance and completion, even of primary school, are not so brilliant. Numbers of girls completing primary school and going on to secondary school are particularly poor. There are many reasons for girls not completing their education, including the belief that as girls will marry into another family, it is not economical to 'water ones neighbour's fields'.
  
  But a study in Uganda suggests that many girls are dropping out of school as soon as they start menstruating. Schools are not equipped to deal with girls once they start menstruating, apparently. Lack of separate sanitary facilities for girls, and even lack of water, mean that they will often stay at home, either for the duration of their period or even for good.
  
  The extremely high cost of sanitary pads mean that they are inaccessible to many girls. They have to use substitutes or stay at home. To put it in perspective, ten of the cheapest sanitary pads cost more than several days worth of the staple ground maize for a large family. The commonly advertised branded versions cost twice or three times as much and, because one or two of them are sometimes given out as promotional 'gifts', some people think they must always use this version to be really safe.
  
  As well as having to teach sex education without talking about sex, teachers are also in the position where they are usually not trained to include classes about menstruation, either. Teaching about the whole field of sex, sexuality, reproduction, sexual health and sanitation is often considered to lead to immoral behaviour in young people. This can be blamed on taboo or cultural considerations but in fact, it often has more to do with political and religious leadership and funding sources for sex education and education as a whole.
  
  In the end, large numbers of girls with little or no education means that large numbers of children will, in the future, also be brought up with little or no education, knowledge of sex or reproduction or even with the level of empowerment needed to change anything for the better. Continuing gender imbalances mean continuation of the status quo. That's a status quo where much of the population will never be able to attain a decent standard of living, while the more privileged continue to enjoy the great wealth that exists in Kenya (despite the best attempts of colonials, neo-colonials, multinationals and other assorted leeches).
  
  The introduction of 'free' primary education was a little like some of the other initiatives that only aim to tackle one or two headline indicators. (In fact, any of the millennium development goals (MDG) would be additional examples.) School fees were abolished but immediately replaced with costs that mean parents still have to pay de facto fees. There are still far too few teachers and classrooms in many areas to provide decent levels of education.
  
  When it comes to education relating to sex, reproduction, health, sanitation or anything like that, few teachers have been trained to provide these. And there is little to be gained from health and sanitation education when the health and sanitation facilities, even reliable supplies of clean water, are not available to the majority.
  
  Successive governments, along with those who dream up international 'initiatives' don't seem to have noticed that basic needs are basic for the very reason that, without any one of them, people's standard of living is compromised. Children who have little or no food for much of the time will have retarded growth and mental development, poor health and a short life. Lack of sanitary facilities reduce health but this also reduces access to education and the efficacy of education. Basic needs are connected to each other, so you can't just make a list and tick them off as you create an 'initiative' that relates to each one.

• HIV Treatment is Necessary, But Not Sufficient, For Prevention

  Posted: November 6, 2009, 2:29 pm by Simon

  Medicins Sans Frontieres (MSF) has published a report on reduced funding for HIV treatment, from the World Bank's Global Fund and the US Government's President's Emergency Fund for Aids Relief (PEPFAR) in particular. MSF have good reason to be worried.
  
  The pharmaceutical industry successfully lobbied governments and international institutions to pay huge amounts of money for antiretroviral (ARV) drugs that most of the people suffering from HIV/Aids would never be able to afford. In fact, the governments of countries with high rates of HIV/Aids would never be able to afford these drugs, either.
  
  Countries like Kenya have the option to produce generic versions of ARV drugs at a fraction of the price that is currently being paid. But most countries, including Kenya, have chosen not to exercise this right, preferring to enact laws that make it unlikely that the country can produce or even purchase such cheap generic versions. Good relations with the pharmaceutical industry seems to be more important to them than saving the lives of their citizens.
  
  MSF are right, huge ARV rollouts cannot now be stopped without endangering the lives of millions of people who are HIV positive and even people who are, as yet, HIV negative. But rather than arguing for the money to keep coming, in fast increasing amounts, they could concentrate on finding ways of reducing the cost of treatment so that it can continue and even expand.
  
  How much of the billions of dollars of aid money have been spent on building factories to produce drugs that people need in Kenya? I haven't heard of any. Most of the money has been spent in ways that don't go on to produce anything or increase the country's sustainability or self reliance. The funds have mostly been spent as if HIV is just an emergency.
  
  Well, it is something of an emergency, but there are underlying factors that are not part of an emergency. The country has a decaying health service, decaying education sector and a small and decaying infrastructure. People are poor, unhealthy, badly educated and unable to access vital services, such as clean water and proper sanitation. These are the things that face the majority of Kenyans every day, whether they are HIV positive or not.
  
  Money spent on drugs, regardless of the overall condition of health systems is, to a large extent, wasted. Many drugs go out of date before being distributed, they get to people unprepared to take them properly, they are taken by people who are dying of other, easily prevented and treated illnesses, etc. My argument is not that ARVs should not be purchased and distributed and prescribed; it is that there needs to be a proper, accessible health service for all this to happen.
  
  There is not a proper health infrastructure in Kenya, there hasn't been for a long time and increased HIV/Aids funding has not brought about a health infrastructure that serves people's needs. True, there are many clinics and institutions that were not here before HIV/Aids and wouldn't have even appeared. But these mostly deal with HIV/Aids, not other, basic health problems that people face.
  
  My argument is also directed at the emphasis on HIV/Aids treatment over prevention. MSF's Goemaere is right to object to the prevention/treatment 'dichotomy'. Of course treatment has a positive effect on prevention efforts. But it is not enough to try to treat our way out of the epidemic. This is clearly not working and much more needs to be done to prevent new infections. Otherwise, the aim to treat everyone who requires treatment becomes even less attainable and less sustainable that it is right now.
  
  People who are HIV positive need more than just drugs, or even treatment. There are a lot of threats to their health and welfare than HIV. They are dying because they are too far from the hospital, because the hospital is not up to the job of caring for them, because they are entitled to benefits they don't know about or that have been stolen by someone else, because they are poor and isolated and not considered important enough. But there just aren't the services needed to support chronically sick people and these will not just appear because the country is swamped by HIV/Aids (treatment) related institutions and programmes.
  
  Those who are HIV negative need to stay that way and this won't happen by rolling out ARVs, alone. They have needs that are far more important and urgent that the possibility that they may become infected by something that won't kill them for many years. Most won't live for very long anyway, for a huge variety of reasons that are not being addressed right now.
  
  Goemaere recognises the false dichotomy of treatment/prevention, but fails to see that increasing treatment while effectively ignoring prevention will not combat HIV/Aids in the long run. Assuming that HIV treatment will also prevent infections is not enough because it doesn't prevent enough infections and it never will. And treatment will never be as efficient as it should be if health, education, infrastructure and other social services continue to be ignored.

• Lomborg Preaching to the Converted, Again

  Posted: November 4, 2009, 1:16 am by Simon

  As we (Ribbon of Hope) go about, visiting our various clients in and around Nakuru, we see the many and fast changing problems that people here face. Some people get through these problems well enough, others don't. It's always hard to figure out if some make it through because they are better off than others or if they are better off because they are good at getting through problems or if there is a mixture of factors.
  
  The rains have come in some areas. This means that it is time to plant crops. If the right preparations have been made, the crops should grow and if the rains continue, there will be a good harvest. But now the rains are here, are people preparing to harvest rainwater in order to ensure they get through the next drought? Sadly, not many people harvest rainwater. This doesn't appear to be a government priority either. The government even talked about distributing cheap or free seeds and fertilizer but now, there appears to be a shortage of both seeds and fertilizer because, well, er, the government has bought up so much of them. They must have just forgotten to distribute them.
  
  In other areas, the rains have brought too much, too quickly, and have washed away fields, crops, roads, bridges, houses and anything else in their path. Were provisions made for flooding? It appears not. Roads that have been swept away in Coast Province were not flood proof. Floods occur with amazing regularity but flood proofing is an optional extra.
  
  There have been power cuts again recently, despite promises that these would become a thing of the past. The government, it has been claimed, have now got the extra oil they need to make up for the shortfalls in power. Perhaps they will sort it out before the next fuel shortage. But fuel shortages, like floods, droughts, famines and other disasters keep occurring and will continue to occur. They need to be planned for. Last year, politicians were talking knowingly about planning for such disasters but there is little evidence that they have achieved anything yet.
  
  The antics of the 'environmentalist' Bjorn Lomborg are well known to those who are interested in environmental issues but Nairobi appears to have the dubious pleasure of hosting a conference organised by Lomborg's 'think tank', the Copenhagen Consensus Centre.
  
  Strangely enough, Lomborg appears to make a valid point about the need to concentrate on some very cheap, efficient and vital development programmes, such as micro-nutrient deficiencies and intestinal parasite infestations, which affect billions of people. However, there is a need to ensure that these billions of people have access to a balanced diet. The cheapest and most sustainable solution to these problems is not to enhance foods with various supplements and to produce things like vitamin A enriched chewing gum and other headline grabbing stories. There are already plenty of foods rich in vitamin A and other micro-nutrients. It's just that many people are too poor to afford them.
  
  Lomborg also uses the opportunity given by this smokescreen to plug his tired old argument that climate change is not caused by human activities and that we need to adapt to it rather than trying to fight it. If the money and effort spent on denying that climate change is caused by human activities were to be spent on worthwhile causes, such as the ones Lomborg mentions, a lot of good work could have been achieved by now.
  
  Kenya can't afford to risk accepting Lomborg's puny argument. Whether climate change is caused by human activities or not, the government has to put money into sustainable sources of energy for two reasons: first, these sources of energy will still be available for the foreseeable future, unlike fossil fuels; second, the country is not able to afford these expensive and unsustainable sources of energy and they are not able to afford the costs that go with high usage of unsustainable energy sources.
  
  On the other hand, Kenya can afford to invest in wind power (as long as they produce their own generators, rather than buying the ridiculously expensive British ones that the UK government seems hell bent on selling them); they can afford hydrothermal power, solar power, biogas and probably all sorts of other ways of reducing the country's energy bill and the bill for the pollution and environmental damage that has taken place and that continues to take place.
  
  But what is the government doing? Boasting about the possibility of finding oil in the Eastern Province. Billions have been sunk in drilling for oil in Kenya but the point is not that they have diddly squat to show for it. The point is that they don't need to spend all this money on fossil fuels when there are so many alternatives available here.
  
  And the politicians will continue talking about flood proofing now the rains have come and they will surely talk about rainwater harvesting when the rains have gone away. If oil is discovered, they will rake in the money and when the oil has gone they will talk about how long term thinking is required. But I guess you can't blame Lomborg for talking the Kenyan government into stupid energy policies and development agenda. Because people who listen to such arguments seem to want to believe them.
  
  And the bit that Lomborg gets right, that we could achieve a lot by working on micro-nutrient deficiencies and intestinal parasites, has long been recognised. But these are issues that the Kenyan government has little to say about.

• Ribbon of Hope Self Help Group, Nakuru

  Posted: November 3, 2009, 12:05 am by Simon

  Having come all the way to Nakuru to work for an NGO that turned out not to have any projects at present, I was lucky enough to end up working with some people who have a lot going on. Ribbon of Hope is a community based self help organisation. It was initially set up to work with HIV positive people but quickly evolved to support people who are in need of support for whatever reason.
  
  Ribbon of Hope works with local self help groups, advising on and helping with relevant training, sources of finance, income generation schemes and ways of cutting household costs. Members of various local groups are engaged in producing food and other goods and services. Ribbon of Hope has raised the money to rent land and cover the costs of setting up a number of projects. They work closely with the local support groups, ensuring that everything is monitored and controlled adequately and they even go out into the fields to dig, plant and harvest crops.
  
  At present, Ribbon of Hope is trying out new ways of making and saving money, such as solar cookers, fuel briquettes made from organic waste, homemade, reusable sanitary towels and various other techniques. The aim is to find things that are very cheap or completely free and that people with any level of education can avail of. Some people will only want to use the cookers, briquettes and sanitary towels. But others will want to learn how to make them and then sell them on to others.
  
  In addition to these activities, people are involved in more traditional ways of making and saving money, such as growing maize and beans, rearing hens and cows and making jewellery and basketry products. In this way, people who work hard are more or less guaranteed some money, food or other goods. But the additional activities are intended to branch out from things that most self help groups are already doing, and to find some highly sustainable activities that have multiple benefits for those involved. Ribbon of Hope are researching and experimenting with anything that looks like it might help with their work.
  
  It is important to find income generation and cost saving activities that are free or very low cost for two reasons: money is in short supply, pretty much everywhere; but, more importantly, many people in countries like Kenya realise that they need to become more self reliant. Many of the poorer people here have been depending on unsustainable sources of income and support for a long time. They are tired of having to go around to one NGO after another to take advantage of what usually turns out to be a short term hand out to tide them over from one crisis to the next. They don't see Ribbon of Hope as another source of handouts but as a way of getting away from handouts.
  
  In the long term, the poorest people will need to find ways to raise their own living standards. They know that the huge amounts of aid money that come into the country usually end up in the pockets of those who are already well off, politicians, business people, churches and big NGOs. Kenyans have witnessed this over and over again and they don't expect it to change. All that the most active members of these local self help groups need is some initial assistance, in the form of small amounts of money and some good advice. They do the hard work themselves.
  
  Sadly, there are people who are neither productive not supportive. Some are even outrightly destructive. So those who put a lot of work into improving their standard of living also need people to advocate for change, so that they can enjoy the fruits of their hard work. But as they become more self reliant and better able to avoid the effects of those who don't want them to succeed, they should also become better able to advocate for themselves. This function of advocating for and supporting self help groups is one of the most vital roles that Ribbon of Hope plays.
  
  We are interested in hearing from other groups, especially community based groups, who are involved in low cost, sustainable projects that can be implemented regardless of levels of education or skills. In turn, we are happy to tell anyone who is interested about our experiences as we go along. I'll be documenting much of our day to day work on this blog but please feel free to get in touch if you have any questions.

• Reconsider the Proposed 'Census of Gay People'

  Posted: November 1, 2009, 2:04 am by Simon

  Apparently Kenya is going to carry out a census of its gay population. People are expected to volunteer information about their own sexuality and the sexuality of others they believe to be gay. I certainly wouldn't volunteer information about my sexuality or that of others in Kenya. The issue of homosexuality is often met with a tight-lipped silence or a rabid stream of abuse.
  
  The National Aids/STI Control Programme (NASCOP), which intends carrying out the census, claims that it is part of an effort to 'reach out' to the gay community. This may be so, but who will protect people's right to privacy when it comes to their sexuality? Will the police protect gay people or people suspected of being gay from persecution? This seems unlikely, given the police's reputation for being behind many kinds of persecution themselves. Police here are not known for their liberal views or even their love of peace and the rule of law.
  
  All sexually active people should have access to HIV and other sexually transmitted infection (STI) testing facilities, condoms, sexual health education, counselling and other services. But they should also have the protection of the law and this is something that is not presently guaranteed. The way commercial sex workers (CSW), and those suspected of being CSWs or accused of being CSWs, are treated is a case in point.
  
  NASCOP is worried that some people have the mistaken view that gay sex is safer than heterosexual sex, despite the fact that it is far more risky. But heterosexual anal sex is also mistakenly thought to be safer than vaginal sex. All sexually active people, and those who will soon become sexually active, need to know things like this. Men who have sex (MSM) with men may need additional services that other sexually active groups don't need. But groups who are at higher risk of contracting HIV and other STIs, such as MSM, CSWs and intravenous drug users, are all doing something currently against the law or considered to be against the law.
  
  If the very act of trying to bring HIV and related services to gay people is also going to expose them to even greater dangers than they currently face, the whole idea of a 'census of gay people' should be reconsidered. It could be replaced by the provision of services to all people who require them, as and when. It may seem helpful to NASCOP to approach the gay population this way but there are too many flaws in getting people to identify themselves and others as gay in Kenya.

• Prevention Needs to Consist of More than Good Intentions

  Posted: October 28, 2009, 12:26 am by Simon

  To continue a theme that crops up regularly in this blog, an article on AllAfrica.com argues that Kenya needs to invest more in prevention campaigns than curative ones. True enough, but this article is about non-communicable conditions, such as hypertension, diabetes, mental illnesses, asthma and cancer. Health should start with prevention, whether that involves preventing communicable conditions, non-communicable conditions or even accidents such as road traffic accidents, industrial and agricultural accidents or injury and death from criminal acts.
  
  However, realising that prevention is important is one thing, actually doing something about it is another. Take road traffic accidents (RTA), for example. All sorts of shenanigans have been put in place here recently, ostensibly to reduce RTAs. There are police checks and the rest, but what do the police do, exactly? Well, it's no mystery, they take a bribe and wave the driver on. There could be 22 people in a vehicle licensed for 14, bald tires, faulty brakes, out of date insurance or whatever, but as long as the police get their money, no further questions are asked.
  
  In a country where health spending and health infrastructure has been reduced and continues to be reduced since the early 1980s, what exactly are health professionals supposed to do about all these conditions, communicable and non-communicable? The fact that prevention is better and cheaper than cure is irrelevant when there is bugger all money, anyway. But, even where prevention is even felt to be worth the effort, such as with HIV/Aids, are the figures for HIV transmission falling? Certainly not.
  
  There is plenty of talk about preventing HIV but only 30% of HIV funding is allocated to HIV prevention. Most of that (which is probably nowhere near 30% of funding in reality) goes into a lot of mindless bullshit cobbled together by bigoted donors who don't give a damn about whether HIV transmission is really reduced as long as no one offends against their high minded but ultimately self serving interpretations of Christian morality. And it usually is Christian morality.
  
  A report by a Nairobi based institution has come up with some alarming but unsurprising figures on teenagers knowledge of sex and their sexual behaviour. A large percentage of teenagers are having sex but they know little or nothing about safe sex. Unsurprising because they have been taught little or nothing about safe sex. Where has all the tens of millions of dollars intended for HIV prevention gone? It is has gone into not teaching teenagers about safe sex. I don't know how much money can be spent on the non achievement of something; that is in serious need of investigation. But the money is gone and the knowledge is nowhere to be found.
  
  The report goes on to say that 40% of girls and 50% of boys have sex before the are 19, they believe all sorts of rubbish about sex, they fear pregnancy more than HIV, sex education is not taught in most schools, contraception is usually not mentioned (for fear of horrifying donors, politicians and church leaders, who are very sensitive people), half of the girls in a survey had exchanged sex for money, gifts or cash and 47% of the teenagers surveyed either had a child, were pregnant or had undergone an abortion. A separate study finds that 5.5 million girls between 15 and 19 give birth annually in Kenya, that's one eighth of the entire population!
  
  If the calls for investment in preventing disease were to lead to improvements in very basic goods, such as water, sanitation and infrastructure, basic living conditions, primary health, education, gender equality, legal reform and things like that, Kenya would eventually be a lot better off. But it seems more likely that if any money is provided to prevent diseases and improve health, it will be spent on following purely political, commercial and religious agenda. Once those have been attended to, there's rarely any money left for anything else.

• Funding Health is Cheaper than Paying for Disease

  Posted: October 27, 2009, 12:15 am by Simon

  To continue a theme I hit on in my last post, Reuters AlertNet lists lower respiratory infections as the top killer, accounting for more than 4 million deaths in developing countries. HIV/Aids is listed as number two, accounting for three million deaths, although serious under-reporting of HIV deaths must place a question mark over whether HIV/Aids is really number two or number one.
  
  But the number three killer is interesting because malaria is said to be responsible for between one and five million deaths every year. Added to this, diarrhoea, at number four, kills an estimated 2.2 million people every year. So if deaths caused by poor water and sanitation were added up, they could easily be a contender for 'top killer'.
  
  AllAfrica.com are excited at the possibility that diarrhoea may now get as much attention and funding as HIV/Aids. But funding and attention for a specific condition is missing the point. The number of people suffering and dying from diarrhoea is dwarfed by the number who suffer and die from water borne conditions and others that result from lack of decent standards of water and sanitation.
  
  Health is not merely a matter of curing sickness; it is primarily a matter of ensuring that people live in circumstances that will maximise their health. In other words, they need a decent standard of living. Treatment and immunisation are great but they are no substitute for prevention. A lot of disease and death could be much more cheaply prevented by providing people with good water and sanitation.
  
  Similarly, many of the lower respiratory infections that are said to comprise the top killer result from poor living and working conditions. Added together, water borne diseases and lower respiratory infections probably outnumber all other killer diseases in prevalence and mortality. So the effect of improving living and working conditions combined with improving water and sanitation would be profound.
  
  But a health strategy that effectively consists of targeting diseases, or even risk factors, and starting with the biggest, seems to miss the reasons why so many people suffer and die unnecessarily. There isn't a need to target diarrhoea, for example, because it kills more children than HIV/Aids. There is a need to provide people with a standard of living that enables them to avoid all water borne diseases. Lower respiratory infections may be the top killer but simply vaccinating everyone and treating everyone infected will still leave people living in poor conditions.
  
  To use a different example, malaria prevention is not just a matter of distributing bed nets. If you continue to ignore the festering pools of water that you find everywhere, your children will still go out and play in or near them when they wake up. Festering pools of water are not conducive to good overall health. The bed nets are vital in some areas but the risk of both malaria and other water borne diseases can be lowered by an improvement in sanitation and hygiene conditions.
  
  Luckily, the WHO recommendations to which the AllAfrica article refers includes improvements in water and sanitation. But it remains to be seen if the World Bank and the International Monetary Fund (IMF) keep in step with the WHO. Since the early 1980s, these institutions have worked to reduce health, education and infrastructure in developing countries. They have concentrated on dismantling the structures which allow people to live healthy lives.
  
  There's a sense in which health policy and funding seem to concentrate on downstream effects, particular diseases and health conditions, rather than on the upstream determinants of health.

• Towards a Vaccine for Stupidity?

  Posted: October 23, 2009, 10:49 pm by Simon

  In an article entitled 'HIV vaccine trial results raise more questions', the recent, much reported vaccine trial results are, it is suggested, open to many interpretations. But whether a HIV vaccine is still a distant hope or already close at hand, I would argue, is not what we should be concentrating on.
  
  Some of the reasons why many people are becoming infected with HIV and other sexually transmitted infections could be that they do not have access to good sex education or family planning, they do not use condoms, they are not always in a position to choose whether to have sex, when, with whom, how often and under what circumstances. True, many people know that HIV is a threat but there are so many threats that people just get on with their lives, HIV positive or otherwise. But this only partly explains high HIV prevalence.
  
  Health, education and other social services are pretty much inaccessible to the majority of Kenyans and the majority of people in all developing countries. People are, effectively, denied their rights to a decent standard of living. They live in poverty and suffer from the consequences of poverty. People experience all manner of illnesses that are easily and cheaply controlled and many die unnecessarily, often at a very young age.
  
  HIV is just one of numerous diseases that threatens the lives of people in developing countries, just one chronic disease that further impoverishes people who are already impoverished. The fact that billions of dollars are spent on finding HIV vaccines and other drugs does not make people more scared of it. Sometimes it even makes people think that a vaccine or cure is probably just around the corner.
  
  Cures and vaccines are likely to be some way off; affordable cures and vaccines are quite another story. But, as we have seen over a period of more than two decades, people certainly don't modify their behaviour in the way that health and other professionals suggest they should. This is as true of developed countries as it is of developing countries, as true of HIV as it is of obesity, dangerous driving, drinking, various kinds of exploitation, corruption, crime and drug use.
  
  What should we be concentrating on? Instead of putting such copious amounts of HIV funding into treating people already infected, a lot more money and effort needs to be put into preventing new infections from occurring. Much of the money currently spent on treatment and care of HIV positive people goes into intellectual property. In other words, there is existing legislation that would allow the costs to be cut, substantially, without reducing current levels of treatment and care.
  
  As to what measures could lead to preventing HIV infections, a lot of research is needed, research that must be carried out without the biases of power politics, pseudo moral posturing, fashion and pure greed. By now, we know a lot about what doesn't work and we need to be frank in admitting that. But perhaps we also have some insights now; perhaps the promise of greater lifetime opportunities could lead to people taking fewer risks and making better decisions that relate to their health. The promise of a better standard of living, education, employment, habitation, health and social services could achieve a lot more than the patronising rubbish that has, up to now, passed as HIV prevention programming.
  
  Most people in the world live in poverty and are denied their basic rights. They live in the majority world. Rather than putting so much of the world's aid money into a cure for one disease, some of this money could be used to change the way the minority world treats the majority of people. Indeed, much 'aid money' is used for all sorts of things aside from aid. It's used for 'technical assistance' (which usually means paying rich Western consultants and experts a little too handsomely for their advice), dumping surpluses, subsidizing the industries of rich countries, creating markets for consumer goods, etc.
  
  Kenya and other countries not far from here are used and have long been used, as sources of cheap raw materials and labour. Much of the country's land and resources are given over to producing raw materials for the minority world. Much of its workforce receives very low pay, working in conditions that would be illegal in the West, to produce raw materials and cheap goods for the West.
  
  Like all other diseases, HIV has a context, an environment. Countries with high HIV prevalence also have high rates of other diseases and other health and social problems. They suffer from extreme levels of deprivation and they are usually heavily exploited by rich and powerful countries. While a vaccine or cure for HIV may be a long way off, vaccines and cures for other diseases are not just available but cheap, for example treatment for intestinal parasites, which affect billions of people.
  
  Some of the biggest killers are things like water borne diseases and acute respiratory conditions. Perhaps as much as half of the illnesses and premature deaths in developing countries could be avoided by provision of clean water and sanitation and decent places to live. That is not beyond human ingenuity, it just doesn't seem to get the same attention as a possible vaccine for one disease that affects far fewer people.
  
  Clarification:
  
  In a recent posting I argued that "it is not poor people in developing countries who contribute the most to global warming and environmental destruction, it is rich people in rich countries." A friend complemented me on this argument but I had to admit that it comes from an article entitled 'The Population Myth', by George Monbiot. Indeed, many of my views on development are influenced by the writings of Dr Monbiot and it was not my intention to claim credit for his work.

• People Need Protection from Harm, Not Punishment for Being Harmed

  Posted: October 21, 2009, 9:53 pm by Simon

  It has been revealed at a conference in Nairobi that 60% of all new sexually transmitted infections, including HIV, occur in those aged 15-24. These are the very people who should have received, and should still be receiving in the case of those in their mid teens, the latest HIV prevention programming. The authors of the report even suggest that there may be significant under-reporting of risky sexual behaviour.
  
  The report calls for a 'more aggressive' educational approach, whatever that may mean. In a separate article on back street abortions in Kenya, there are some worrying remarks on sex education. Aside from concentrating on abstinence, often to the exclusion of anything else, teachers who are trained in teaching sex education are under no obligation to teach it. There is no specific time set aside for them to do so and many parents would prefer teachers not to teach their children anything about sex.
  
  Kenya has spent over 20 years resisting the call to teach their children and adults about sex, safe sex, family planning, maternal health and health in general. In particular, they have resisted advice to promote the use of condoms to prevent HIV, other sexually transmitted infections and unplanned pregnancies. The multiple uses of condoms need to be stressed.
  
  The repeated calls for abstinence, however dressed up in pointless slogans, are useless. Years of sexual transmission of HIV, other sexually transmitted infections and unplanned pregnancies show that these 'prevention' programmes have not worked. Unfortunately, the latest National Aids Strategic Plan has little new to suggest to prevent HIV from being transmitted and it still only allocates about 30% of HIV/Aids funding to prevention. But no amount of money will make a difference if abstinence is the best they can come up with.
  
  Countries with high rates of HIV transmission seem to be obsessed with abstinence campaigns, which have had no impact and will continue to have no impact. Telling young people that it is worth their while waiting till they are married is simply lying in the face of evidence that many people become infected by their spouse. They need to be told about the dangers they face and given ways to avoid those dangers. If condom use is the best we've got right now, we owe it to people to promote the use of condoms.
  
  Those who object to abortion, HIV, sexually transmitted infections, promiscuous sex, unsafe sex, sexual abuse and various other things that they rail about need to embrace comprehensive sex education for everyone, young and old. Denying the existence of risky practices, commercial sex work, men having sex with men, intravenous drug use and the rest is not going to make it go away. Moralising about it and saying how bad it all is will not make it go away either.
  
  It's very hard to legislate over people's sexual behaviour. And even behaviour that is illegal will occur, despite the threat of punishment. The least the Kenyan government can do is to reduce the amount of harm people are currently being exposed to. Many Kenyans are now experiencing the consequences of not implementing harm reduction programmes, such as the widespread promotion of condoms, decriminalisation of commercial sex work and same sex relationships, needle exchange programmes and even family planning services that would support people who end up pregnant against their wishes. People need to be protected from harm, not punished for being harmed.

• Will We Prevent the Next Genocide?

  Posted: October 20, 2009, 12:03 am by Simon

  The land grabbing orgy currently taking place in developing countries is a lot more serious than I thought. There are some countries buying up or leasing land but the biggest buyers are actually corporations. Corporations have amply demonstrated in the past that they don't care anything for the lives or livelihoods of people, they only care about maximizing profits for their shareholders and other interested parties.
  
  In addition to grabbing land and denying millions of subsistence farmers their only means of survival, this trend is part of what has been driving up the price of food, especially staple foods. These corporations can also indulge in some practices that would be more difficult or expensive or perhaps even totally illegal in other countries. For example, land in developing countries is seen as ideal for biofuel crops. It's also seen as a good place to grow genetically modified crops that have not been given the go ahead in other countries.
  
  Everyone feels the effects of rising food prices, of course. But for people who were barely able to afford enough food to eat a couple of years ago, the rush to buy up or otherwise occupy land in developing countries will push many people well below the threshold of having enough food, however lacking in nutritional value, just to survive.
  
  Developing countries are also presently experiencing severe water shortages. Rich countries growing their food in developing countries means that they are effectively exporting huge quantities of water from those who have least to those who have most.
  
  Corporate nobs may talk of 'win-win' situations, or even 'solving world hunger' but it is only people who are now rich who have any chance of winning anything and those who are now poor who face starvation. There is nothing in this for development, it is purely motivated by the need to make big profits. In addition, land and water supplies will be contaminated by the large scale agricultural practices which are absolutely necessary for this sort of investment to be really profitable.
  
  I realise that those driven purely by profit are not going to be interested in these questions: but what will people now on the brink of starvation do once they have been thrown off their land? And what will those now barely able to afford basic foods do when the price has gone just that little bit too high? What will the rest of the world do when most of the land and water that have been supplying them with food are contaminated to the extent that they are no longer productive?

• Rich Academics Talk Bollex About Climate Change

  Posted: October 18, 2009, 3:01 pm by Simon

  Academics and wannabe academics have been beating on for decades about population growth being a threat to humanity. The main paradigm for development was, for many years, population control. Extremely well funded organisations from rich countries went around developing countries trying to persuade people to adopt various birth control techniques and technologies, whether they wanted to or not.
  
  Most of these organisation in most of the countries where they worked were not very successful. In Kenya, when the British finally left, health, education, water and sanitation, infrastructure and other social services started to improve from the 1960s to the end of the 1970s. At around the same time, fertility also started to drop.
  
  However, development came to mean economic development as the World Bank and International Monetary Fund (IMF) began to, effectively, run most developing countries. All the things that had started to improve went into decline and are still declining today, nearly three decades later.
  
  Also in the late 1970s and early 1980s, HIV started to spread rapidly. Once it was identified as a sexually transmitted virus, the same organisations that had been toting condoms and contraception as a panacea for development changed their tack and tried to promote the use of condoms to protect against HIV and other sexually transmitted infections. These efforts have been even less successful than their earlier efforts.
  
  Now, the 'Optimum Population Trust', run by a collection of academics and wannabe academics, is advocating the use of condoms to curb population growth as a means of reducing climate change due to over consumption. They are suggesting that this is the most economic method of influencing climate change, too, cleverly combining those two earlier development paradigms into one.
  
  Ironically, when people have smaller families, they often become bigger consumers. In fact, many people say they want to have smaller families so they can afford things like cars, consumer durables and various other goods. So, the result of reducing family size is often an increase in consumption. In fact, there is little connection between high fertility and high consumption. On the contrary, populations with high fertility rates usually have low rates of consumption. The biggest consumers have low fertility rates.
  
  In Kenya, much of their carbon emissions result from the production of goods destined for rich, high consumption countries. Kenya produces all sorts of goods in Export Processing Zones (a posh name for sweat shops), fruit and vegetables are force grown under electric lights and transported by air and biofuel crops that are responsible for the destruction of much of the country's remaining land resources. The rich have managed to export a lot of their carbon emissions to developing countries.
  
  Contraception is a vital technology in reducing the spread of HIV and other sexually transmitted diseases. It also reduces unintended pregnancies. And many of the children who are born to HIV positive women are, in fact, unintended. There is a huge unmet need for contraception that the birth control evangelists seem to have done little to alleviate over the course of the last half century.
  
  But it is not poor people in developing countries who contribute the most to global warming and environmental destruction, it is rich people in rich countries. Fertility may be low in rich countries, thankfully. But that doesn't reduce consumption, rather, it seems to be behind much of the continued increase in consumption.
  
  Apparently this Trust is very excited by a study based on the principle that "fewer people will emit fewer tonnes of carbon dioxide". But this principle is flawed. Lower consumption (or fewer high consumers) will result in fewer tonnes of carbon dioxide. Most people in the world are low consumers. Here in Nakuru, some of the poorest are probably even negative consumers. The municipal dump is full of homeless people who derive their meager income by collecting and selling rubbish for recycling. Some even live in the dump in hovels made from waste.
  
  I'm not suggesting that it is a good thing that people live like that because it isn't. What is disgusting is the idea that very rich, well educated, well fed people are pointing the finger at the very poorest of people and saying that they are the problem when it comes to climate change and environmental degradation.
  
  So Porritt, Attenborough, Lovelock and other pompous tossers, leave your comfortable homes and offices, visit a few poor countries, or even poor people in your own countries, shut your big gobs, open your eyes and then rethink the consequences of the cooperation of a mere handful of the world's biggest consumers for the whole of humanity. Those who are condemned to a life of poverty will reduce the size of their families when they can see that it will be of direct benefit to them and people like them, but certainly not to people like you.
  
  [See George Monbiot's 'The Population Myth' for an elaboration of the above argument.]

• Homosexuality: Uganda Scores Another Own Goal

  Posted: October 17, 2009, 8:40 pm by Simon

  Uganda is busy going the wrong way again in their 'fight' against Aids. Parliament will discuss a bill to create even more offences that gay people can commit. It's already an offence to have a sexual relationship with someone of the same gender. The 'offence' will carry a seven year sentence, as will aiding, abetting, counselling or procuring another to engage in acts of homosexuality.
  
  HIV/Aids and sexual rights activists feel this sort of law will make HIV prevention, treatment and care services even less accessible that they currently are. No one is going to admit to being gay or to risk being exposed as being gay even under current circumstances. No one wants to be stigmatized or discriminated against, however unfairly.
  
  There is even a proposed death penalty for sexual assault against someone of the same gender who is under 18 or disabled. But sexual assault against anyone should always be against the law, as should sexual assault against someone who is below the age of consent, male or female, same sex or otherwise. Ugandan law considers sex between people of the same gender to be against the laws of nature. If anything is against the laws of nature, it is for a homosexual to have heterosexual sex. But what law is homosexual sex supposed to be breaking? Are these laws written down? I don't think so.
  
  Ugandan laws would be better off protecting vulnerable people, especially children, improving the status of women, targeting those who are most at risk and removing barriers to prevention, treatment and care services instead of creating new laws that make those services less accessible. The law could also give a bit of attention to reining in the power of leaders who appear to have gone crazy. And reducing the number of people who live in extreme poverty would also be a good thing.
  
  Sex itself is neither moral nor immoral. There is no moral argument that shows that homosexual sex is immoral, only an arbitrary judgment. Punishing people for behaviour that is not immoral and creating laws to legitimise this punishment, that is immoral. The law in Uganda is being misused to serve the interests of those who make arbitrary judgments about morality. Stigmatizing and discriminating against people, which supporters of this bill are doing, is immoral and should also be punishable by law.

• Al Gore's Bullshit Won't Make the Crops Grow

  Posted: October 15, 2009, 1:46 am by Simon

  Today is Blog Action Day, where lots of blogs around the world all write about some aspect of climate change. I'm all for promoting environmental and climate change issues but I noticed that, pretty late in the day, Al Gore got involved in the initiative. I'm sorry that an otherwise worthwhile sounding effort feels the need to be associated with a loudmouthed freeloader who jumped on the environmental bandwaggon when his political career went off the rails. I suppose there'll always be Gores and the like, who attach themselves to something that allows them to promote their own interests.
  
  Anyhow, developing countries like Kenya are going to bear the brunt of climate change and are probably already feeling the effects. There have been prolonged droughts in many areas for some time now. The El Nino rains are due to start soon, which may resolve some of the short term problems. But they may also increase the problems. If the rains are too heavy and result in flooding, crops that are planted could be washed away. There has already been flooding in several areas, with loss of life and livelihoods and a lot of people being displaced.
  
  The Kenyan government has done little to alleviate the problems and probably a lot to exacerbate them. The much talked about Mau Forest, where large scale logging over a long period has probably resulted in a massive reduction in water tables, is still being destroyed. True, the government has very publicly evicted small settlers in the forest but they will not quickly reverse a problem that took such a long time to develop.
  
  Over several decades, people have been persuaded to grow things for export, such as flowers, tea, coffee, fruit and vegetables. This sort of farming has done a lot of environmental damage. But also, these are cash crops and they are not used to benefit ordinary Kenyans. They will not solve the food shortages because they are produced by rich landowners, often foreigners, who expect big profits.
  
  What Kenya needs now, and what they have always needed, is food security. They need to produce enough staple crops for the domestic market and ignore the advice they seem to get from foreign interests to keep concentrating on exports. Feeding Kenyans should be the priority.
  
  The Kenyan government is belatedly talking about things like providing fertilizer at low cost. This may help some large scale farmers but it is unlikely to help small farmers, the majority, who only produce enough to provide for themselves and perhaps for a modest surplus. Some of them are planting right now in the expectation that rains will come. If the rains come, great. But if there is not enough rain, the crops will be destroyed by the use of these artificial fertilizers, just as much as they would be if the rain failed altogether.
  
  This kind of intervention is typical of the sort of short term thinking that has made small farmers increasingly vulnerable as the years go by. Small farmers need also to consider organic waste, household and farm waste, whatever is available. Artificial fertilizers may be of use in the short term, especially to large farmers, but even they eventually end up destroying their land.
  
  But small farmers can least afford this process of land degradation. To keep their costs and their losses low, they need to use cheap or free materials. Because, even if they don't have to pay much now for artificial fertilizers, they will still have to bear the costs in the long run. The production and use of artificial fertilizers is part of the problem, it will never be a sustainable solution. It may not even be a short term solution.

• Born Obsolescent But Still Around, Unfortunately

  Posted: October 14, 2009, 12:51 am by Simon

  Apparently a report has found that the IMFs (International Monetary Fund) fiscal and monetary policies have stifled Kenya's fight against HIV and TB. They concluded that restricting government spending on health resulted in poor health outcomes.
  
  That's not just a conclusion, that's almost a tautology. Poor healthcare always, everywhere, gives rise to poor health outcomes. I applaud the report writers but I wonder what influence their findings and recommendations will have in the secretive and atavistic 'Bretton Woods' institutions. The report even found that HIV/Aids work is now almost totally dependent on donor funding.
  
  Virtually anyone who has studied HIV, its spread and the almost total (but extremely expensive) failure to reduce its spread, would have, and probably have, come to the same conclusions. But what effect has research ever had on the way the IMF does its work?
  
  The report also concludes that the IMF's policies are partly to blame for Kenya's poor economic performance. But this is true of the economic performance of every country that the IMF has interfered in. In the whole history of the IMF, they do not have one single success story. They beat on about reform, democracy and accountability. Yet they have never been reformed, they are not in the least bit democratic and they are not accountable to anyone.
  
  It's odd that both the World Bank and the IMF can produce reports that, at the same time, boast of the great things that they have done and also admit the failures that, essentially, are the great things they have done. Anyhow, the full report is available, but keep a sick bag handy.

• Displaced by Violence; Resettled by Violence

  Posted: October 13, 2009, 1:23 am by Simon

  Many of the Kenyans who ended up in camps for internally displaced persons (IDP) are there because they supported or are seen to have supported Mwai Kibaki, the current president. However, Kibaki feels that it is intolerable that people should still be in IDP camps and so he announced a few weeks ago that they were all going to be resettled elsewhere.
  
  Most people tried to stay where they were until they were sure the government was really going to pay them the pittance they are getting for resettlement, about 350 dollars. But they were told they would not get the money until they dismantled the temporary accommodation they have been living in for nearly two years. The amount of money they have been given will not buy them much, certainly not land. But some promises have been made about land, too.
  
  Whether these promises will be kept and to how many people is not clear and may never be clear. But press coverage of IDP resettlements seem to be confined to the very discreet and peaceful events at the ironically named Eldoret Show Grounds. I don't know if the press was selective in what they covered but Kenyan TV coverage today included extremely violent 'resettlements' with riot police beating people with truncheons and firing tear gas on displaced people currently living in camps.
  
  Recent coverage on the BBC claims there will be 'no forcible evictions', but today's events seem to contradict that claim. You can go around from village to village here in the Rift Valley and see the remains of houses and other buildings that have been raised to the ground, often burned down. Why would people who were displaced so violently return to the neighbours who tried and even succeeded in killing and maiming so many of them?
  
  The government's response does not see reasonable, so I hope press coverage takes as much interest in the 'resettlement' programmes as they did in the original violence.

• Distance No Object, We Just Don't Go There

  Posted: October 12, 2009, 1:36 am by Simon

  The majority of HIV positive people in Kenya live in rural areas. Granted, the percentage of people who are HIV positive in urban areas is higher than the percentage in rural areas. But most people, perhaps as many as 80%, live in rural areas.
  
  So why are most big NGOs, including ones who are mainly concerned with HIV, based in urban areas? In fact, most health facilities, social services, government offices and just about anything else you can think of are based in urban or semi-urban areas.
  
  Here's an example of the ridiculousness of this phenomenon: Nairobi, the capital city, is high up and therefore not very hot. There are mosquitoes there, aplenty, but malaria is not very common. The climate is just not right for the malaria bearing mosquitoes, though there is plenty of stagnant water around to support huge colonies of insects and other disease vectors.
  
  Yet, the highest rate of mosquito net ownership is also in Nairobi. Could this be connected to the centralization of health, social services and various benefits and amenities in the capital? It's hard to tell, but it's certainly a bizarre situation. Many, perhaps most, of the mosquito nets in this country are donated by NGOs. How do so many of them end up getting stuck in the areas where they are least needed?
  
  Nakuru is not huge, by any means. But as it's only a few hours from the capital and has its own academic institutions, it also has many academic and social projects. There are numerous NGOs doing all sorts of things here. It has far more visible street children than the much bigger capital city but it is not the most neglected of areas, either.
  
  But travel an hour (or less if you have your own transport) out of town and you will come across villages where people rarely see NGOs or receive any of their largess. And in these villages, there are people needlessly suffering. They have the same problems as people in villages and towns closer to the privileged areas but they do not have the means to reach those areas.
  
  Today we saw a boy whose face is terribly disfigured from burns he received several years ago. His burns were not treated in time. When they were treated, they were not treated properly. After spending over one and half years in hospital, he now has one eye, which may also be under threat, his nose is disfigured and threatened, his mouth is deformed and, most alarmingly, his skull was fractured as a result of the medical treatment he received, the medical treatment which seems not have worked yet. And the treatment cost about the equivalent of seven years salary.
  
  There are HIV positive people who can't afford the transport to get tested, because the testing centres are in the towns and cities. There are those who know they are HIV positive but who can't afford the transport or the costs that need to be met before they can receive the, admittedly free, antiretroviral treatment (ART). There are people who need cheap drugs and treatment that they will not receive because they are in isolated areas. Many have died because of their isolation and many more will die for the same reasons.
  
  Even the organisation I was supposed to work for is based in Nairobi. Why? I have no idea. They have no projects there. They do have five road worthy vehicles and eight motor bikes. Why? I have no idea. I don't know when any of them last visited Nakuru. I don't think any of them in head office have ever visited the village we were in today, nor would they even have heard of it. Why? I have no idea. They don't respond to my emails and I am supposed to be working for them.

• Self Reliance Doesn’t Protect Against Unreliable Leaders

  Posted: October 10, 2009, 2:00 pm by Simon

  We have built a bigger parabolic cooker and are now waiting for a suitably sunny day to try it out. Some areas around here get sun all the time but the parabolic cooker is not very mobile. So we just have to wait for suitable conditions. Meantime, one of the things we are concerned about is safety. For a start, the concentrated light reflected from the device is very hard on the eyes and could potentially damage users' eyesight. We can use sunglasses but there's no guarantee that others will do the same, especially as some of the people around will not even be using the device but could still be affected.
  
  There is also the issue of safety from burns. Parabolics heat things to very high temperatures. Some of the models I've found online depict a cooking pot at about chest height. If this pot were to be turned over by accident, the user could receive dangerous burns. I would prefer a model where the pot is low and where you can move the parabola without moving the pot and vice versa. This should reduce the possible dangers. We discussed this problem with other people experimenting with parabolic cookers and they agreed. We resolved to suspend the pot from a line or large tripod, rather than trying to build a tripod inside the parabola.
  
  One of the community support groups is so interested in solar cooking that they have asked for a workshop on making the cookers. We will be doing that in the next few weeks, once we have all the materials. The members of the support groups themselves need to bring the materials because there is very little funding available. But it is a good exercise to get them to source the materials as most of them should be cheap or even free. One of the advantages of solar cooking is increased sustainability and self reliance. Therefore, recycled materials are preferable to new materials. I suspect people here will be good at finding cheap and free materials!
  
  The same people who have shown such interest in solar cookers also raised questions about home made, reusable sanitary pads. A friend kindly sent me some materials on how to make these. I also found various websites dedicated to this issue. Sanitary pads are so expensive here, compared to people's ability to buy them, that it is no wonder many never use them. This is a particular problem for young girls as they have no spending power at all. They often miss school for a few days every month, which is quite unnecessary. However, there are safety aspects relating to making reusable sanitary pads as well and I hope we can include resolutions to this problem as part of the project.
  
  We're still trying to find out about getting people to produce briquettes from organic waste as a way of reducing use of wood and charcoal, which is expensive and in short supply. It's also time consuming to collect wood and make charcoal. We have plenty of instructions for the process but lack the devices that could mix the materials and compress the mixture into a suitably compact end product. We are in touch with people at Egerton University who may be able to help us. Ultimately, the process should be cheap and small scale, but as someone near here has already done some work on this area, we'd like to see that first.
  
  We visited the local municipal dump to see what useful materials may be available there. Actually, there are many people in the dump, every day, picking up all the materials they can sell on for reuse. I think we need to spend more time finding out what reaches the dump, who is picking it up and selling it on, what materials never reaches the dump and what other recycling projects are currently taking place. There are lots of organisations here doing various things and few organisations seem to be aware of what others are doing. As we are trying to find tried and tested ways of reducing poverty and increasing self reliance, we need to know what others are doing in and around Nakuru. That is proving to be a difficult task!
  
  There's a lot of talk about closing down the camps for internally displaced persons (IDP) which were set up as a result of the post election violence. It's all very well to get people to go back home but many don't wish to return to properties from which they were forcibly ejected. Many of the properties have been burned, looted and squatted by others. The government is giving many mixed messages about how much they will pay people to return home and what they will do for people who can't go back to where they were before. Also, the IDP camp in Nakuru consists of many small plots, all of which have been purchased by the residents. People have been there for nearly two years, they have made lives for themselves. They have set up kitchen gardens, shops, community groups and what not. The 'camp' is now a village in its own right and the current government plans seem like yet another forced eviction.
  
  The support group that we are involved in at the IDP camp is interested in some of our projects and this area is in particular need of greater sustainability and self reliance. But people there are now wary of doing anything in an area that they may have to leave in the near future. There is even talk now about the next election and the possible displacement that may occur in the next few years. Far from trying to anticipate and prevent further politically motivated violence, politicians seem to be spending their time and energy planning their attack.

• Headline Grabbers and Land Grabbers

  Posted: October 9, 2009, 2:46 pm by Simon

  It's been a couple of years now since Bob Geldof made his injudicious pronouncements about biofuels. He should have known better and given the matter some thought. A little research wouldn't have done any harm either. Scepticism about biofuels didn't just appear recently. The environmentalist George Monbiot argued very cogently against biofuels nearly five years ago and has written many more articles on the subject since then.
  
  But now the issue of land grabbing is being discussed more frequently and the part that biofuel production plays in land grabbing is clearly significant. Many of the claims about biofuel crops, such as jatropha, being productive even in marginal lands, turns out to be lies. Biofuel crops can be either non-food crops or food crops that are just not being used for human consumption but they all need good land and good growing conditions. So in the Tana River basin in the East of Kenya, sugar is being grown on an industrial scale in an area of great ecological importance while millions in the country starve. There is even a shortage of sugar in some areas!
  
  Food prices have been rising for some time but producers of biofuels refuse to accept any responsibility for this trend. Good land is also in short supply here and in other developing countries. And many areas are facing drought, so growing crops that are subsequently used for biofuel production means the country is effectively exporting much of its scarce water supplies as well. It's not even as if poor Kenyans are benefiting from this, either. Many small farmers are displaced by the biofuel growers, who are all large-scale operators or connected with large-scale operators. They use factory scale production methods that require very few employees. People who formerly owned or farmed the grabbed land have either been bought off for a pittance or squeezed out some other way.
  
  Governments of developing countries usually connive with the various multinationals and rich countries who are looking for cheap land. They are of little help when it comes to protecting ecologically important areas from being destroyed. And they seem happy to allow overuse of destructive artificial fertilizers as long as that gives big landowners and users increased crops, at least temporarily.
  
  This land is also being destroyed because biodiversity is wiped out by large scale production. In the near future this land will simply be useless. If biofuels don't take off, the areas will probably be abandoned, as some operations already have been. And even when these multinationals and other parties use the huge tracts of land they 'purchase' for food production, it is produced for export, with bugger all in taxes or wages or anything else going to the developing countries. It's hard to estimate the numbers of people who have been displaced, dispossessed and otherwise abused by land grabbing, biofuel production and food production that is exclusively produced for export to rich countries.
  
  Most farmers in developing countries are small farmers. They have never made a decent living from contributing small amounts of cash crops to big operators, and they never will. They need to concentrate on producing food for themselves, their families and the local market. People such as Geldof, with little or no knowledge of the conditions under which people in developing countries live, should do some research. The man has tens of millions of dollars, he could even afford to pay someone to do the research for him. I hope in the future he will admit his mistake and campaign against land grabbing in all its forms and especially against biofuel production.
  
  Geldof and other 'philanthropists' may well boast about all the money they have raised for the developing world but they seem to have little idea of how much is being extracted from these countries. The money they claim to raise is puny compared to the amounts of money being extracted by food companies, biofuel producers, mining operations, pharmaceutical companies, healthcare companies, textile companies, sweat shops (or whatever they are now called) and just about any multinational you can name.
  
  Instead of ranting on about things they don't understand, these people could try concentrating on some of the areas where vast amounts of wealth are stolen from developing countries by multinationals, rich governments and even some of the very people who think of themselves as philanthropists. It's time for some development by omission: development through reducing the exploitation of developing countries by the rich.

• Empty Pockets Revisited

  Posted: October 7, 2009, 1:34 am by Simon

  It's nice to be able to try out some of the things I've been looking for, thinking about and researching for a long time. Not my ideas, by the way, just ideas that sound like good income generation activities and ways of saving money. Generally, they are cheap or free sustainable activities that are easy to get involved in, even for those who have few practical skills, such as myself. I'm harking back to a posting entitled 'Empty Pocket Finances', which I wrote nearly a year ago.
  
  The sort of projects I am thinking of have not changed that much. At present we are trying out solar cookers and cooking baskets but we would like to look into reusable, home-made sanitary towels, briquettes made from organic waste, solar fruit and vegetable driers and, I'm sure, many other techniques. Anything that people can fit into their day to day life with the minimum bother and the maximum benefit.
  
  In addition to persuading people to use solar cookers, cooking baskets, home-made sanitary towels and other things, we would like to get people to make these cookers, baskets and towels themselves. Perhaps they'll even go on to teach other people and convert them to the virtues of sustainability and self-reliance. Then it will be up to them to sell the ideas on to others. So, in addition to saving people money, some people should be able to go on to make money. Admittedly, just a little money, but some of our clients are making almost nothing right now.
  
  So much for the theory, anyhow. But we visited a Ministry of Agriculture office that has been involved in developing appropriate technology for several decades, apparently. One of the people we talked to had little good news to impart. He said he had long been trying to persuade people to do things that would be of benefit to them, with very little success. On the other hand, his colleague seemed to be of the opinion that people find change hard but that that's no reason not to continue to develop good ideas and try to disseminate them.
  
  We also visited Egerton University to see a parabolic style solar cooker being constructed using an umbrella, much like the one I made recently, only bigger. I want to try a bigger one now to see if they can do some things that the Cookit can't do. I'm pretty sure they can but I am worried about safety aspects as people here are not exactly safety conscious. For instance, parabolic reflectors can quickly damage your sight. And if they heat things up to high temperatures, they are potentially dangerous when it comes to spillages, especially when children are involved.
  
  But maybe this won't be a problem. When we were at Egerton, we were able to make some design suggestions that should make the parabolic cooker a lot safer. As for the difficulty of getting people to adopt new things, we hope that living close to our clients will mean we can check up on and badger them regularly. And if they tell us they are short of money or that they need something, we can ask them why they haven't adopted the wonderful techniques that various people around the world have made available, free of charge.

• What Has Solar Cooking Got to do with HIV Prevention?

  Posted: October 6, 2009, 1:20 am by Simon

  Another day courting the sunshine. I decided to try to cook githeri, a mixture of maize and beans. But it takes a very long time and after four hours of demonstrating and discussing solar cooking, I took the mixture home to finish cooking it on a jiko (charcoal cooker). However, the rice and vegetables were evidence enough to convince the group of about 15 people. So we'll get together again next week and discuss the issue further. The following week, we'll have a workshop to make our own solar cookers. The week after, who knows...
  
  This blog started off concentrating on HIV and it may seem that I have wandered off the point. But let me recap a bit. Throughout, I have argued that HIV transmission is related to many of the everyday aspects of people's lives, such as their environments, their employment status and work conditions, their levels of income and education, their health, nutrition, sanitation, infrastructure and many other things.
  
  Solar cooking, solar water pasteurization and renewable energy sources in general have the attraction of addressing many of these issues. Using renewable energy means that people use less wood, which is great news for the environment. They produce less smoke and greenhouse gases, which reduces sicknesses related to smoke inhalation. Acute respiratory infections (ARI) represent one of the biggest threats to people's health and life expectancy. ARIs combined with diarrheal conditions account for around 40% of deaths in infants and under fives.
  
  Paying for fuel is a major day to day cost that can be cut by using something like solar energy, which is very plentiful in African countries. Much time and energy is spent on collecting and preparing fuel for cooking, time that could be better spent doing other things. And there are few better ways for people to increase their self reliance than to explore renewable and sustainable resources.
  
  Food cooked on solar cookers cooks slowly and is therefore more nutritious. It also uses less water, something that is in short supply and that can take a lot of time and effort to collect. In fact, the job of collecting fuel and water often falls to women and children, especially girls. Many's the time children don't do their homework because they spend the remaining daylight hours after school doing household chores.
  
  At the moment, we are concentrating on telling people about solar cookers, why they could make their lives easier and better, how it could help them save money, etc. But in the longer term we are looking for income generating activities (IGA). For example, it's possible to make items to sell, such as cakes, roasted peanuts, ugali (boiled maize meal) and other popular foods, commonly sold on the street. Saving on fuel costs could give people the edge over their competitors. Perhaps people could also make and sell solar devices such as cookers and cooking baskets.
  
  Well, that's why we're experimenting with solar cookers and those are some of the reasons we feel they are relevant to HIV and HIV prevention.

• Donor Funding: Pseudo Worries About Pseudo Aid?

  Posted: October 5, 2009, 9:12 pm by Simon

  The parabolic solar cooker, made from an umbrella lined with tinfoil, works well when it comes to heating up water. I'll try cooking with it when I have found a suitable pot with handles and painted it black. Meantime, I wish to demonstrate the 'Cookits' that I bought from Solar Cookers International to an audience that could turn out to be as many as 20 people, far from ideal. I'd prefer very small groups of people but I've agreed to it.
  
  As I am trying to win people over to solar cooking, I'm concentrating on things that people here like to eat. Thankfully, that's quite a small range of fairly basic foods. Tomorrow I hope to cook githeri, a mixture of beans and maize. It will take some time to cook so I'm hoping for 4 or 5 hours of uninterrupted sunshine. I'll have to cook something else that doesn't take so long or my credibility could be open to question.
  
  Actually, the credibility of some Westerner lecturing people in a developing country about renewable energy and sustainable cooking techniques is pretty questionable as it is. Someone recently claimed in an email to me that people in the US have shown great interest in his solar cooker. It's a pity they couldn't show a bit more interest in reducing energy and resource consumption on a national level. And if every American family purchases one of those particular solar cookers, the amount of plastic needed to manufacture them will be phenomenal.
  
  When people ask me if we all use solar cookers in Ireland, I tell them there is not enough sun. This is true, but does everyone there use wind, wave or tidal power? I don't think so. Come to think of it, one of the more dubious gems of wisdom sent from rich countries to poor countries recently is biofuels. In addition to using up scarce land, water and other resources, people here are very unlikely to make much money from such activities. They need food, not biofuels and they need to grow food for themselves, not accept handouts in return for biofuels. Enough land in developing countries has already been destroyed in order to produce cheap raw materials for rich countries.
  
  Questions are now being raised about jatropha production, a biofuel crop that is said to grow in marginal land. Well, they say that about all biofuel crop production. Unsurprisingly, people at the Nairobi Trade Fair last week were promoting jatropha even for farmers with as little as one acre to spare for cash crops. Perhaps just about anything being hawked as good for small farmers by rich countries should be viewed with great suspicion. We in developed countries don't have a great reputation for telling the truth.
  
  Questions are also constantly being raised about the effectiveness of aid, especially now that so many wealthy countries are feeling the pinch from the current financial crisis. Personally, I'm not against all aid or all aid agencies. However, much of the money that is called foreign aid is spent on furthering the economic, strategic and political interests of wealthy countries and corporations. The most important questions should be about how much 'aid' money even leaves the donor country and what (and whom) the money that does leave is being spent on. The idea that developed countries bestow lots of goodies on developing countries and get nothing in return is pure bullshit, but sadly not the biodigestible kind.

• Nairobi Trade Fair and Solar Gadgets

  Posted: October 2, 2009, 3:45 pm by Simon

  A colleague and I went to the Nairobi Trade Fair yesterday. Many of the exhibits were the standard agricultural and small industrial production, crops, animals, goods such as rope and honey and the like. There were impressive fields of sunflowers, bananas and cabbage and well fattened cows, ostriches and sheep. And there was agricultural machinery aplenty for ploughing, preparing, irrigating, reaping and threshing.
  
  But much of what I saw looked like it was aimed at rich or relatively rich farmers. The majority of farmers in Kenya are subsistence farmers with small amounts of land. They often aim to provide their household with some food and perhaps some surplus to sell. But they would not be able to afford the high grade machinery that was on offer. Even the machinery that was specifically aimed at 'small' farmers was very expensive. We were told that it was cost effective to grow an acre of jatropha for its oil seed crop, used for biofuels. But the machinery to press the oil would put most farmers off. And no farmer with only one acre would give it over to a cash crop.
  
  Of course, farmers would be well advised to steer clear of biofuels anyhow. Their price are predicated on large scale production, which is, by definition, beyond the reach of small farmers. And producing energy products for Western countries is unlikely to make anyone in Kenya very rich, unless they are very rich already.
  
  But farmers have been hoodwinked many times in the past to produce cash crops, such as sugar, tea, sisal and coffee. Small farmers have the most to lose when they find that it is not as productive as they were told. Some are giving up on these cash crops to find an alternative or even to grow food crops that they can use and sell the surplus of. But sadly, much of the best land in Kenya is already given over to inedible cash crops which only the wealthiest of farmers and dealers make money out of.
  
  Millions face starvation because of lack of food, millions are malnourished because of the lack of variety in their diet. The current drought doesn't help but the gradual loss of land to inedible cash crops or large scale factory farming that is of little benefit and much detriment to the majority continues to push even more to the brink of starvation.
  
  There seemed to be little evidence at the Nairobi Trade Fair that the Ministry of Agriculture and other large and official bodies there were reaching out to small farmers, producers and artisans. In fact, the 250 shilling entry fee and nearly 500 shilling travel costs just from Nakuru would keep most small farmers away, when many of them are lucky to get 150 shillings a day for their work.
  
  There were exceptions. There were solar driers that allow people to save wasting much of their produce that they are unable to sell. There were solar cookers, something very close to my heart. The cookers are very affordable and can even be home made. Anyhow can make them. The driers are not so affordable but again, people can work out how to make them for themselves. There were cooking baskets which can be used to reduce use of solid fuels (and also made at home). And there were even improved cookers that claim to use less fuel or use various kinds of fuel.
  
  But even some of the low cost exhibits forget just how little money people have. One of the improved cookers was ten times the cost of an ordinary 'jiko' or charcoal burning cooker. It's great to see innovative designs but until the inventors and developers of these products find out how to really reduce the cost to one that people just can't refuse, their work will lie on shelves.
  
  Going back to solar cookers, I have tried to use a parabolic cooker, made by lining an umbrella with tinfoil. The focal point gets very hot and it should be possible to cook with it. But, alas, there has only been intermittent sun today so I just have to wait. But this design is only a prototype. Umbrellas and tinfoil are not very durable and they are not produced locally. In the long run, I'd like to be able to construct such a design using local materials, especially recycled materials.
  
  Well, as always, I'll post my progress here as soon as I make further progress.

• High Technology and Appropriate Technology

  Posted: September 30, 2009, 1:06 am by Simon

  Nakuru is not far from the equator and today we travelled to Mogotio, even closer to the equator. We were there to irrigate onions, peppers and other vegetables. The irrigation process for a small shamba (smallholding) is fiddly and time consuming. The field is beside a river. The pump is petrol operated. But the process of attaching bits of pipe so that the water reaches the farthest parts of the shamba takes several people and a lot of time.
  
  In fact, it's a process of attaching, detaching and re-attaching bits of pipe until the whole job is done. While two people add and remove pipes, two others use hoes to make furrows for the water to flow through and block furrows where adequate water has entered. Why do people not use good lengths of flexible pipe or drip irrigation?
  
  This is a one acre shamba, the kind and size that many Kenyans own. It's for growing small amounts of produce. It's labour intensive but labour is cheap, flexible pipe and other pieces of equipment are expensive. If the shamba was bigger and more productive, we could afford drip irrigation or some other form of irrigation, but this sort of technology is beyond the means of most people here.
  
  So I was pretty annoyed to come across an article about some 'clever' people who have developed a device which allows a farmer to SMS or call a number to turn on their irrigation system. Great, but people who can afford an irrigation system that can be switched on and off don't have to do much work on the shamba themselves. They employ people to do it. It's not the first time I have seen articles about how brilliant mobile phones are. They have their uses but most of the problems poor people suffer don't go away just because they have a mobile phone.
  
  I also came across an article about how Uganda is using mobile phones to spread the 'message' about HIV. Do they really think their unsuccessful and very expensive programmes over the last 20 years failed because of the medium that was used? How much evidence do they need that the problem was not just with the medium?. Many people there and in other countries know all sorts of things about HIV, not all of them true. But they still engage in the sort of behaviour that is thought to spread HIV. So why should spreading the 'message' by mobile phone change anything?
  
  Anyhow, as well as hoeing and irrigating the shamba, we were in Mogotio to demonstrate the process of solar cooking to some people there. We cooked rice, ugali (boiled maize meal) and sukuma wiki (a popular collard green). Sounds a bit starchy but Kenyans like a fair bit of starch. The result was excellent. The area is so hot that things cooked quickly. So the workers in the field were impressed at the large amount of food they were provided with and even more impressed that no charcoal or wood had been used in the cooking process.
  
  I had my worries about the ugali. It is almost worshiped here and getting it wrong could be fatal. But it turned out pretty solid and sticky. I have tried a few other things, stew, various vegetables, even soda bread. They are very good, as long as the sun lasts. So it's time to be more adventurous and do a bit of experimenting. I have no doubt that some 'genius' will be able to invent a device that pulls a screen across the solar cooker when the food is cooked. Until then, I'll just use the time honoured process of looking at the food.

• Selling Sunlight on the Equator

  Posted: September 28, 2009, 6:29 pm by Simon

  We have been trying out the solar cookers. Having faced the problem of too much wind, too much dust, too little sun and too much rain, yesterday started off well and sunny. But half way through the cooking, the sky clouded over and stayed that way. We hadn't even taken the precaution of having some charcoal handy. After a lengthy walk, we got the charcoal and finished cooking the partially cooked food. It was good but not good enough to sell solar cooking to a sceptical audience.
  
  Today was very sunny and, starting earlier, the food was cooked to perfection in less than two hours. The only thermostat available here is experience and I must admit, I left it all on for a bit too long. The food tastes good but is a bit drier than it should be. As it was so sunny, I slipped in a soda bread loaf, which is browning nicely right now. But the sun has again slipped behind the clouds.
  
  So, as a precaution, we could take some cooking baskets with us when we go out in the field. We were hoping to find people to make these baskets for us as they are very expensive in the supermarkets. But we'll get to all that eventually. And we need to make sure that we start early in the morning and that there is charcoal available if things go wrong.
  
  While I cooked today, some people in the house next to me were cooking with charcoal. They were cooking the whole time I was cooking, so it's not just solar cooking that takes a long time. While I cooked, I also washed the clothes, read some articles and wrote a blog entry. I'm just trying to anticipate the comments I'll get!
  
  Well, it could be worse. We are now pretty much prepared to face the hungry mob and demonstrate the process of cooking on a solar cooker. Now that we've tried it out a few times, I feel far more confident. Let's see if I still feel the same way after a few demonstrations. But I love the idea of selling sunlight on the equator.

• Some Things Change, Some Stay the Same

  Posted: September 27, 2009, 1:18 pm by Simon

  The Preliminary Report of the Kenya Aids Indicator Survey (KAIS) was released last July and was based on data collected in 2007. Prevalence was estimated to be 7.8% among 15-49 year olds (7.4% among 15-64 year olds). Many parties expressed surprise that HIV prevalence had increased since 2003, when the Demographic and Health Survey estimated prevalence to be 6.7% among 15-49 year olds.
  
  HIV prevalence in Kenya peaked in the late 1990s and fell rapidly thereafter into the early 2000s. Prevalence fell because death rates were very high. But death rates peaked in the early to mid 2000s. If there had been few new HIV infections in the early to mid 2000s, HIV should have stabilized at a fairly low level. This didn't happen. Instead, prevalence increased.
  
  One possible reason that HIV prevalence has been increasing throughout this decade is that antiretroviral therapy (ART) has been keeping many HIV positive people alive. However, the number of Kenyans on ART by 2005 was very small. Numbers have increased since then, although it's not yet clear what effect this will have on national prevalence figures.
  
  Another possible reason why HIV prevalence has been increasing is that there are many people becoming newly infected every year. While huge sums of money have been poured into treatment and care for HIV positive people and their dependents, very little has been spent on prevention. What has been spent on prevention has been wasted on pointless finger-wagging about how people should and shouldn't lead their sex lives.
  
  The final KAIS report was launched in the last few days. I can't find a copy of it online but there have been many articles about it and they all, like this one, talk about the report as if these figures are new and surprising. It is not surprising that there are more people living in rural areas infected with HIV. The vast majority of Kenyans live in rural areas. Prevalence is lower in rural areas than in urban areas but the absolute numbers are higher. This is not a new trend.
  
  Various commentators in various articles have resolved to deal with trends noted by the KAIS report but many of these trends go back many years. Even the KAIS figures are already two years out of date. And there are likely to be quite different trends now because, in case these commentators haven't noticed, some profound changes have taken place in the lives of all Kenyans. There was a violent election campaign, a violent election and a particularly violent post election period, during which many people were killed, injured and displaced. There have been energy shortages, food shortages, water shortages, a global economic collapse, increasing unemployment and, no doubt, countless other pressures on people's lives.
  
  Some things are not the same now as they were two years ago, when data was collected for KAIS. They are certainly not the same as they were in 2003. But the HIV prevention work that is being carried out by Kenya's health and HIV agencies is pretty much unaffected by anything that has happened in the last ten and perhaps even twenty years.
  
  Consequently, HIV prevention continues to be given low priority and takes forms that continue to have little or no impact. That's why a recent survey of 13-19 year olds shows that, many years and tens of millions of dollars later, less than 50% understand what abstinence means. More importantly, only 20% understand what being faithful means and only 7% fully comprehend condom use. The question is, do the 48% who can say what abstinence means really understand sex and safe sex? I think the answer is clearly 'no'; all they have taken in is a definition. They will not be able to protect themselves adequately, despite being able to parrot definitions of abstinence and the like.
  
  HIV prevention work in Kenya needs to do new things, not continue with the failed, dogmatic activities of the past. Children (and adults) need to know what sex and safe sex are, they need to know how to protect themselves and often, they need protection. There are young people pouring into Nairobi and other cities now, they are desperate for work and until they find work, countless thousands will become involved in some form of transactional sex. People's living conditions need to be changed so that they don't face such dangers.
  
  HIV policy needs to be based on what is happening now, not what was happening, or what someone thought was happening, years ago. And policies that failed years ago need to be changed, not shored up with excuses. HIV trends can change very quickly and all Kenyans are at risk of becoming infected, though some are at higher risk than others. There is no point in just concentrating on high prevalence areas, as one Kenyan WHO representative suggests; low prevalence areas can quickly become high prevalence areas. Also, absolute numbers can be a far better indicator than percentages when it comes to describing how an epidemic is spreading.
  
  But the Kenyan government needs also to concentrate on people's lives, livelihoods, environments and opportunities. People still need the things they have always needed, health, education, social services, infrastructure, good housing, employment and protection from harm. Relevant authorities such as the National Aids Control Council and, indeed UNAIDS, need to be able to distinguish between the things that change and the things that don't change.

• Painting Pots Black

  Posted: September 25, 2009, 10:33 pm by Simon

  This is not to stir up the long running dispute between the pots and the kettles. We're painting pots black so we can use them with the solar cookers we purchased during the week from Solar Cookers International. We've talked to people who work with, make and research solar devices and we've talked to those who want to buy them and use them. Now it's time to go out and demonstrate them and, hopefully, persuade people to part with the $6 or so that they need to invest.
  
  Of course, people need to invest a little time and, god forbid, they need to embrace change, just a tiny bit of change! We can make ourselves some food over the weekend and decide on the best ways to demonstrate these devices. I'm looking forward to it but I'm also a bit apprehensive. After all, much of what I believe about development could be severely tested over the next week or so.
  
  We will be working in and around Nakuru. My colleagues have been working here for some time and they have introduced me to various community support groups. Most of these groups have grown around the need to support people who are HIV positive, people who are directly affected by HIV and, particularly, those who are on antiretroviral therapy (ART).
  
  Some of the groups are very active, with volunteers making regular visits to those who need support of various kinds, who need to be taken to hospital, who are having problems affording school fees or rent and whatever. Many of the groups are already exploring ways of making some money, such as growing and selling fruit, vegetables, milk, eggs and the like. Others make things and sell them.
  
  Solar cookers are a bit different from other activities these groups are involved in. If someone buys a solar cooker, they have the means of saving money they would spend on charcoal. They may save the time they spend collecting firewood. They can use the cookers to cook food, dry food and boil water, the last being particularly important for people who are HIV positive.
  
  People who are HIV positive need to be very careful about how they live their lives, what they eat and drink, what dangers they may be exposing themselves to. Their immune system is damaged by HIV and, even though many are on treatment, they still have to be careful. It is hoped that one more way of pasteurising water will be of great help in reducing exposure to diarrhoea and other water borne diseases.
  
  Today, my colleague and I went to a support group at the camp for internally displaced persons (IDP) just outside town. People there are just trying to get by, some doing well, some not so well. We were accompanied by a woman who works for an agency that gives microloans to help people set up small businesses. Hopefully, they will see the benefits of solar cooking and, if they can come up with the money, also buy some cookers. And maybe some of them will want to take things further and use the cookers to produce something they can cook and sell.
  
  That's the hope, anyhow. I'll write up what happens here, even if it shatters my heartfelt beliefs!

• International Policy Network Partly Right and Partly Wrong About HIV/Aids

  Posted: September 23, 2009, 1:22 am by Simon

  Philip Stevens of the International Policy Network questions the wisdom of spending so much money on a single illness, HIV/Aids, and asks if this can do more harm than good. I have long been asking the same question. My feelings are that it has done very little good and has probably done a lot of harm, especially to HIV prevention efforts.
  
  The health of a nation is unlikely to be made or broken by one, single health condition. Even when there is a serious epidemic, there are probably always more people suffering from and dying from ordinary, every day things than from that epidemic disease. Health depends on people's lifestyles, living conditions, levels of nutrition and food security, education and economic circumstances, for example.
  
  Stevens rightly criticizes UNAIDS's prioritization of treatment over prevention. Since treatments for HIV have been developed, far more money has always been spent on that than on prevention. So while many have been treated, millions more have become infected. Greater emphasis on prevention could have made a lot of difference, although precious few effective prevention interventions have been developed and implemented in any high HIV prevalence countries.
  
  Stevens also mentions the poor and declining state of health infrastructure in high HIV prevalence countries. Indeed, some of the major funding bodies involved in pouring money into HIV treatment and care (and a little prevention) were, at the same time, urging developing countries to reduce spending on health, education and other social services.
  
  If it is the case that some parties have claimed that everyone in the world is at equal risk of becoming infected with HIV, then this is truly shameful. I think the message was that every sexually active person is at risk, which is true. But it is not true that everyone faces equal risk. Perhaps this message has been confused by publicists, politicians, church leaders and various money grabbers who knew nothing about health, least of all HIV, but still wanted to get on the bandwaggon for their own ends.
  
  And Stevens is wrong to claim that UNAIDS exaggerated the numbers of people infected and were 'embarrassingly forced to revise down the estimates for dozens of countries'. Methods of estimating numbers were improved, that's why the figures went down. Many figures are still very doubtful in that they could be higher or lower than presently estimated. Kenya was one of the countries for whom figures were revised down. A short time later they had to be revised up again.
  
  Stephens' analysis, I think, is misleading. He makes it sound as if HIV/Aids is still a problem, but less of a problem that it was. I disagree. I believe that we neither have enough data to support his view nor directly to refute it. But there is plenty of evidence that people in high HIV prevalence countries still face serious and perhaps increasing risk of becoming infected.
  
  I hope Stevens is right that donors have finally realized the folly of directing so much money towards one disease. However, I don't think he is right. I think he has allowed himself to be fooled by all the rhetoric about strengthening primary health care and health systems. If that is ever going to happen, I'll believe it when I see it.

• There is Always More Than One Way to Prevent a Disease from Spreading

  Posted: September 22, 2009, 1:07 am by Simon

  A church spokesperson in Botswana has said that the only way to win the battle against HIV is to change people's behaviour. It's true that people need to change their behaviour but that is by no means the only way to fight against HIV.
  
  The church leaders could consider Botswana's main source of revenue. It's not very difficult, mining accounts for something like 70% of the country's total revenue. Areas around extractive industries in African countries have some of the highest rates of HIV anywhere.
  
  Why is this? Well, most of the extractive industries are controlled by a few, extremely rich firms, who are usually foreign and absentee. They pay as little as possible in taxes and they are usually able to keep their costs low with the help of obligingly lax labour laws.
  
  So millions of poor people migrate for long periods to the slums that grow around the mines. These slums are mostly inhabited by male workers, without their wives and families. Some mining firms even provide accommodation for their employees but it is almost always dormitory accommodation and of a very low standard.
  
  Unsurprisingly, some women also move to these slums to find work, mainly as sex workers. There is little to do in dormitory accommodation during free time, aside from going to bars and sleeping with sex workers. People become infected, people infect other people.
  
  Extractive industries come with many hazards, poor health and disease being just some of these hazards. TB, for example, is very common, as are other occupational conditions. So some healthy and some sick people all come together and the result is many sick people who then return to their home areas to infect their wives and families.
  
  Rather than just praying for people to change their behaviour, they could approach the owners of extractive industries, many of whom, I'm sure, are Christians. They could also lobby politicians, another group that should contain some Christians. And here are a few things they could ask them to do:
  
  - Improve labour laws so that workers, including migrants and seasonal migrants, are protected
  - Improve health services and health screening and allow access to all employees
  - Improve working conditions for those in and around the mines
  - Improve living conditions, perhaps by providing proper housing and infrastructure
  - Provide married/family accommodation for those who need it
  - Provide sources of entertainment for people, things to do aside from drink
  - Provide subsidized transport for husbands/fathers to visit families or for families to visit husbands/fathers
  - Provide decent wages and benefits for miners and other workers
  - Protect small landowners and artisanal miners who are affected by big mining operations moving in
  
  Apparently substantial amounts of gold have just been found in Kenya. So there is plenty that church leaders here can do to avoid their future mining areas experiencing the sort of HIV transmission levels as those found in Botswana.
  
  Diseases are not just spread by individual behaviour. The conditions in which people live, in which the behaviour takes place, are also important. These conditions can and must be influenced and changed.

• Meaningless Figures and Empty Achievements

  Posted: September 21, 2009, 1:22 pm by Simon

  Because the Kenyan government is so busy concentrating on the Millennium Development Goal (MDG) to ensure that all children complete primary school education, goal 2, they seem to have forgotten that schools require teachers. It is is estimated that they are short of about 65,000 teachers, mostly in the primary sector.
  
  This demonstrates the futility of aiming at some defined 'goal' at all costs. Since Kibaki announced that there would be free primary education in 2003, the enabling conditions for providing this education have been ignored. Millions more children have since been enrolled, often into hopelessly large classes.
  
  But many of them will not complete primary education. There will be times they are not able to attend school, for various reasons, often related to poverty. Many will eventually drop out. And part of the aim of MDG 2, to ensure that girls as well as boys are enrolled, will also be frustrated. Girls are usually more affected than boys when families have to take their children out of school.
  
  Then, yet another aim of MDG 2, to increase the literacy rate of 15-24 year olds, is also likely to be missed. But if you go to the MDG monitor site, you will be fed 'good' news, if there is any. There just doesn't happen to be any data at all for Kenya. But having good figures for enrollment is not really good news if many are not attending school or have dropped out, or if there are such serious shortages of teachers and resources.
  
  Achieving MDG 2 is not just a matter of bumping up the enrollment figures, so let's not be deceived by these good news stories. Unless the country can fill the huge gap in teacher training and recruitment and also provide genuinely free primary education, the goal will never be achieved. At present, it will not be achieved by 2015, so if the country claims to achieve it we need to scrutinize the figures very carefully.

• Solar Cookers and Cooking Baskets

  Posted: September 20, 2009, 5:10 pm by Simon

  
  
  Photo: An IDP camp in Molo, Rift Valley.
  
  Yesterday, myself and two members of a local community based organisation, that I'll be revealing more about in the near future, went to a camp for internally displaced people (IDP), just outside Nakuru. This tent city was set up by the United Nations High Commission for Refugees (UNHCR) following the post election violence more than one and a half years ago. The UNHCR has now left the camp and people there are getting by as best they can.
  
  It's disgraceful that the Kenyan government has yet to resettle people properly after all this time. Many of those in the camp find it difficult to get to services and facilities as they are an expensive bus journey away from the town. Even health facilities are hard to get at and people on antiretroviral therapy (ART) are in a particularly precarious position. ART is nominally free in Kenya but there are logistical problems relating to getting to health centres, buying other medicines and the like.
  
  Anyhow, many people in IDP camps see themselves being there for some time. They have planted fields of fruit and vegetables and done their best to be more self reliant. Unfortunately, a herd of buffalo came recently and destroyed much of what they had grown. And the current drought doesn't help either, many crops are stunted or withered because of the lack of rain. But there are also green and flourishing gardens that must have required a lot of care and attention.
  
  Some aid agencies have been to the IDP camp and have given some assistance. But much of that assistance is in the form of handouts of goods and money, which is not sustainable and does not allow people to be self reliant. This community based organisation are advising people on ways of saving in order to be able to access microcredit facilities. They are also advising on potential income generation schemes so that people can get some money for their work or, at least, find out about ways of spending less.
  
  One technique we are hoping to introduce to people is the use of solar cookers for cooking food. The area gets a lot of sun and solar cookers could be used for much of the year. There are numerous advantages to using solar cookers but the advantage we want to make clearest is the cost saving. Charcoal and wood, which people use now, are expensive. They are also in short supply and becoming scarcer. Cutting the amount of smoke people inhale on a daily basis also springs to mind, and the list goes on. Oh, and it's a great way of pasteurising water!
  
  Complementary to solar cookers would be cooking baskets, which are best explained on the Cooking in a Basket blog. These are insulated baskets that cook food which has been partially cooked, thus saving a lot of time and fuel.
  
  In principle, it should be possible to source the materials and makers of these two tools, the solar cooker and the cooking basket, locally. That may take time and we can use ready made ones in the meantime. It may also be possible to get some of the materials free or almost free. Currently, a local sisal unit dumps large amounts of material that would make great insulation padding. But we'll spend the next few weeks working out the logistics and I'll post up our progress as we go along.

• Does Everyone at the World Bank Share the Same Brain Cell?

  Posted: September 19, 2009, 11:52 am by Simon

  The World Bank certainly knows how to give mixed messages. The overfed, overpaid over there now admit the dangers of climate change, especially for developing countries, and they are urging industrialised countries to reduce carbon emissions. This took many years of arguing against the climate change denialists, who dominated industry and finance, so this was no mean feat.
  
  But the World Bank is also financing massive coal fired electricity plants in developing countries that will pump out greenhouse gases for decades. In a country like Kenya, where they don't produce coal in large quantities, this will also mean an unwanted increase in dependence on imported energy.
  
  Dearest World Bank people, we never expected genius to emanate from among you, but nor did we expect such total idiocy. Right now, foreign governments are gagging to get their hands on Kenyan land so they can grow crops for biofuels, even though one quarter or more Kenyans face food shortages and the country is experiencing prolonged drought. This will also increase the countries carbon emissions. And there are plenty of other things happening here that are inimical to emission reduction.
  
  Perhaps the people at the World Bank have heard of solar energy? To this piece of knowledge, perhaps they could add the fact that Kenya and other African countries get a lot of sun? Or maybe I'm overloading your thought faculties a bit? Well, there's also something here called geothermal energy, which also emits little or no carbon. There's also wind energy, which I'm sure even World Bank people would have some understanding of.
  
  So why, with these abundant sources of renewable, not polluting energy, does the World Bank choose a non-renewable, polluting source of energy that will cripple poor countries with debt and swell their balance of payments deficit?
  
  Would it be an exaggeration to suggest that the people at the World Bank have completely lost it and shouldn't be trusted with a piggy bank, let alone the billions they propose wasting on increasing the potential catastrophes brought about by climate change?

• Good Leadership and Facing the Realities Around HIV/Aids

  Posted: September 18, 2009, 12:03 pm by Simon

  
  
  Still trying to familiarize myself with the area around Nakuru, the towns, villages and rural areas. More importantly, I'm trying to get a picture of the organisations and initiatives that I hope to work with, their members, leaders, qualities, interests and levels of activity.
  
  Some are very active and productive, with keen participants and strong projects. I couldn't help agreeing with the home based care worker I met yesterday who said he thought leadership is the key. I don't believe for a moment he was talking about himself as he is a very modest man. But in Salgaa, he gives excellent leadership and gets excellent results. Leadership does appear to have a vital bearing on the success or failure of support groups and their activities.
  
  Peter knows all of the people in his two community support groups very well because he lives near many and pays regular visits to others, travelling many kilometers every week on his bike, on a hired motorbike or on public transport. There is no substitute for covering as much of this large area as possible, as often as possible.
  
  But the results of his work include regular meetings, high levels of support given to and given by participants; Peter and others working in the area can tell you all about each participant and they know when someone is sick or in trouble. Not everyone takes an equally active part, of course, but compared to some other support groups that don't even meet most of the time, Salgaa has a very healthy community.
  
  Most importantly, people there who are on antiretroviral therapy (ART) are taking their medication as they should. This means they gradually become as healthy as they were before they were affected by the opportunistic infections that appear in people in advanced stages of HIV. This is one of the primary aims of the support groups and in that respect, they are doing very well.
  
  As for HIV prevention, the area has not been so lucky. The Kenya National Aids Control Council has never really spent much time, effort or money on HIV prevention. They talk about it a lot but neither Kenya, nor any country in the world, have really implemented programmes that demonstrably reduce HIV transmission. Calling their programmes, such as they are, 'evidence based', does not mean they have had any effect.
  
  And some organisations never learn. After many years of bleating about sexual abstinence and how it reduces transmission, even though it clearly does not, many of those involved in HIV prevention are still coming out with the same tripe.
  
  Yes, young people need to know they can refuse those who try to persuade them to have sex. And those who are in a position to refuse either don't have sex or they only have sex under circumstances they choose. That's great for people who have freedom of choice but fails to address those who, for many reasons, don't have the choice or don't have much choice.
  
  Children (and adults) need to know the reality of sex and choice and many other things. Abstinence campaigns, even ones that include partner reduction and condom use, do not have a history of teaching realities. There are still many adults who believe all sorts of rubbish about condoms, circumcision, reproduction and other vital matters. And there are still people who use the word 'abstain' all the time and have very little useful knowledge about what they are supposed to be abstaining from. It's sex, it's a big subject and it goes far beyond a few over used slogans.
  
  These bogus HIV prevention campaigns demonstrate something else, besides leadership, that is missing from initiatives that fail: reality. There is plenty of money and therefore plenty of 'leadership' behind abstinence and the related sanctimonious parphenalia. But because they are not rooted in the realities of people's lives, they have little or no impact on their lives.
  
  In Salgaa, the support groups don't just have good leadership. The groups arose from the realities of living with HIV/Aids. People need to get on with their lives, facing the same realities that may well have resulted in their becoming infected. They don't survive by refusing to accept the realities, rather, those who refuse to accept the realities become sick and die.

• How Many Mobile Phones Does it Take to Change a Bandage?

  Posted: September 17, 2009, 11:50 am by Simon

  
  
  Photo: This donkey is more likely to save lives than a mobile phone.
  
  The media never tire of writing self-satisfied articles about how brilliant technology is and how so many things can be done now because of technological advances. No doubt, there have been remarkable advances and we can now do things that were never dreamed of a few decades or even a few years ago.
  
  Despite this, there is an increasing number of poor and undernourished people. Most, if not all the Millennium Development Goals are going to be missed by most developing countries. People are dying of preventable and curable diseases. Yes, preventable and curable. They can be prevented and they can be cured but, for some reason, they are neither prevented nor cured.
  
  There is a whole rash of articles on the use of mobile phones for HIV care and prevention, articles written with all the confidence you would expect of suit-wearing, job-holding academics and consultants. But all these articles appear to be based on anecdote rather than on comprehensive data. You can support adherence, send prevention and health messages, even diagnose diseases and perhaps issue prescriptions.
  
  But that's only if there is some kind of infrastructure available. There's little point in issuing a prescription to people who can't afford the medicine or the trip to the pharmacy or where the pharmacy has run out of supplies or if there's no public transport or if there is no clean water to take pills or...etc, etc. Even where the infrastructure is in place, Kenya is not blessed with adequate numbers of trained health personnel.
  
  I'm not running down technology, I agree mobile phones are great, as are handheld computers, laptops, mobile internet and anything else that can be dreamed up. But ultimately, people also need the basic things that the survival of the human race up till now has depended on.
  
  That's what's missing, food, water, sanitation, basic health, basic education. Missing are the education, health and social service facilities and, more importantly, the trained, skilled and well equipped people who provide services.
  
  All of the health care workers I've met recently have mobile phones. Notably, they are also all volunteers, with very little training. There are not too many people they can call, least of all skilled medical personnel, as they are in very short supply. And if someone calls them late at night, most of them don't even have a bicycle to get to the client. If the client needs to be moved, they might have a wheelbarrow or a cart to get the client to the nearest public transport vehicle. This is not a joke.
  
  There is also a shortage of electricity here and a shortage of money for credit. Many handsets don't work or don't work very well because of the heat and dust or because they are cheap handsets that don't function for very long. True, people can use solar energy to charge their phones but most don't because this particular technology is too expensive.
  
  Mobile services could even be paid for by the state. But the state doesn't provide the few pennies necessary to treat and prevent intestinal parasites that stunt the physical growth and mental development of vast numbers of children every year.
  
  I'm sure people are very happy that we 'can' do all these marvelous things with technology but they'll be a whole lot happier if their immediate needs are attended to, whether they require technology or not.

• The Extended Family and Other Myths

  Posted: September 16, 2009, 11:30 am by Simon

  
  
  
  Sometimes people write about developing countries as if they are all very similar and they may throw in terms like 'extended family' and 'coping strategies', as if this makes poverty, illness and unemployment less of a burden. They write about 'incongruities', such as drought and famine, but lots of smiling children, playing happily in the dust.
  
  Some people do 'cope', because they have no other option. Many live in large families and they do co-operate, with the sick, young and old being looked after by the able bodied. And of course, children play happily in the dust or mud or whatever.
  
  However, such commentators may not see or may choose to ignore the children and adults lying in bed or the ones who never come out because their disabilities are too great or because they are too stigmatised, for example.
  
  The fact is, people in developing countries have family disagreements, neighbourly jealousies, local spats and far more serious eruptions of discontent and outright violence, just as they do in other countries.
  
  Here in Nakuru, there are differences and perceived differences that make it unlikely that some people will agree to work with some others and that community based organisations with members who see themselves as essentially different from other members can be prone to failure, sometimes quickly, sometimes slowly. Merely setting up a group that consists of members from different groups does not mean people will work happily together.
  
  I don't believe this situation is all that different from wealthier countries. But crucially, many people in developing countries need support, perhaps many different kinds of support, right away and often for a very long period.
  
  There is a severe shortage of most basic resources in developing countries, food, clean water, education, employment, etc. These are some of the things that allow them to be characterised as underdeveloped. When there is a shortage of resources, knowing that your neighbour has plenty when you have none is bound to cause discontent, no matter how friendly you have been in the past.
  
  When people are under extreme pressure, they can do extreme things. Some don't, perhaps most people don't. But community based organisations and various initiatives are often set up when people are already under extreme pressure and they are therefore already precarious.
  
  The majority of people in developing countries have been waiting for much or all of their lives for the most basic of goods. I suspect that that is why now, some people seem to grasp at anything that comes their way, even if it is intended to be shared with others. I think if I were starving, or if my children were, I would do pretty much anything to get food.
  
  This doesn't explain why some of the richest people in the country, politicians, business people, colonials who remained after independence and various other organisations, also grab what they can. Some of them have been stealing vast sums of money and resources intended for people who were in dire need.
  
  It doesn't explain why large multinationals exploit developing countries and see them as vast markets, why international organisations pretend to help developing countries when they are really enriching themselves at the expense of those countries, why huge 'pro-poor' initiatives are really about making rich people richer, selling arms, 'national security' or some other agenda, completely unrelated to development.
  
  It would be nice to think that poverty is really quite a happy, fortunate state, given that the majority of people in the world live in poverty, many in absolute poverty. But it's not true. It's not true that everyone in developing countries live in 'extended families' that make sure no one 'falls through the net'. We just don't see those who fall through the net. It's not true that people 'cope', they either survive or they die, often after a lot of suffering.
  
  Those who see and write about 'extended families' and people 'coping' may just miss or choose to miss those who have fallen through the net, because those who have fallen are no longer visible.

• Free Education, For Those Who Can Afford It

  Posted: September 15, 2009, 11:58 am by Simon

  
  
  
  If you follow the official literature and commentaries on Kenyan education, you may think that all primary school age children get free schooling. If you go into it in a little more depth, you will find that there are many hidden costs such as 'extra' tuition, which the children have to attend, shoes and uniforms, which have to be worn, exams, materials and various other items.
  
  Therefore, many poorer children fall through the loop. Having no school fees is irrelevant for the parents who are unable to meet the additional costs. Unknown numbers of children don't go to school or don't go to school very much because their families are too poor. The Kenyan government is not too keen to admit to the existence of these children, of course. They enjoy the praise they receive from the press and from foreign donors.
  
  Added to these children of poor families, there are orphans and other children who have been abandoned or who don't have people to provide everything they need. There are well over one million, perhaps as many as two million. There are street children, children who start school so late that they will never catch up and will drop out early, there are children who are sent out to work for much or all of the time they are supposed to be at school.
  
  All in all, the Kenyan government is quite shy about anything that could be called bad news. The recent census may not even account for all the children in this country. It may remain difficult to know how many children are not at school or who don't receive much schooling before they become too old to attend school.
  
  Yesterday, we were in Rhonda again, this time to visit a children's home. There are 120 children being schooled there, 20 of whom live there all the time. Because this children's home is not a public school, they receive nothing towards the children's schooling. There are many such homes around the country. No one has any idea how many, exactly. And the government will not be so keen to talk about these either.
  
  So, for all the money that is said to be spent on 'free' primary education, if would be interesting to know how many really benefit, how many don't get anything and if it's true, as it appears to be, that only the better off get to go to school. It appears that those with least and those who are under the most pressure are also least likely to be able to afford the costs of 'free' education.

• Differing Mindsets: a Goal or a Way of Life?

  Posted: September 12, 2009, 6:30 pm by Simon

  
  
  Western Non Governmental Organisations (NGO), funders and most Western volunteers tend to think in terms of projects, programmes, lengths of time, numbers of participants, amounts of money, outcomes, objectives, goals and targets. Of course, there needs to be accountability, there needs be a good level of monitoring and evaluation and all that. Things need to be managed.
  
  But it's remarkable how differently local Community Based Organisations (CBO) and Kenyan volunteers work. Much of the work is never ending so things are not viewed as projects or programmes. Lengths of time are irrelevant, as are numbers and stated goals and targets. People are very pragmatic. Orphans are looked after until they grow up, sick people are looked after till they recover, if they recover, old people are looked after till they die.
  
  There is no need to ask what a good or bad outcome is, either an intervention works, in which case it will be continued or it doesn't work, in which case it will not be continued. Of course, there are exceptions, foreign volunteers who become very pragmatic and Kenyans who become sticklers for measureable things, exclusively.
  
  When it comes to money, attitudes vary also. Of course, people who have no money look for ways of making some. Everyone would prefer a job that is not too strenuous or stressful and one that is better paid. But some CBOs just get on with whatever it is they set out to do. Others get on with writing a proposal and waiting around for money. If they get money they may get on with the job, or they may see getting the money as an end in itself.
  
  But some of the CBOs that just get on with the job and see funding as a longer term requirement often do amazing work before raising a single dollar. Even volunteers working for a small amount of money for a period often continue working just as hard when the money stops coming in.
  
  Today, we interviewed four people to volunteer to work perhaps half a day, five or six days a week for six months. All of them said they would be willing to work for as long as required, a year, several years. After all, they have already worked as volunteers for three to five years. They were all asking for very little in allowances. And that's just as well because the allowance on offer is very small.
  
  For some people, the work they volunteer to do is more of a way of life than just a job that has measurable, countable outcomes. Perhaps these differing mindsets explain some of the friction between those who always insist on targets and results and those whose aim seems to be to bring about some kind of change for the better.

• Support Groups May Need Support Too

  Posted: September 11, 2009, 8:21 pm by Simon

  
  
  To Lanet, not far from Nakuru. We turned up for a support group meeting for people with HIV. It's not unusual for people to be very late for meetings but an hour after it was due to start it was clear that people were not going to come. I wouldn't blame them if the rumour I heard was true; that one of the local churches was distributing free maize! Well, after a while three people drifted in. They wanted some medicines that we were able to distribute. Two got their medicines and drifted out.
  
  One man sat and talked for a while. Although many people who need antiretroviral drugs in Kenya are not getting them, perhaps as many as 65%, some of those who do get them are very happy to have arrested the disease. This man is healthy and fit to work. Unfortunately, there is no work for him to do. And it's difficult staying fit and healthy with no guaranteed income.
  
  I also met an 11 year old girl who had had meningitis. She had known that she was HIV positive but she was not receiving enough medical attention to catch the meningitis in time and now she is blind. Her mother refuses to believe that her daughter's eyes could be permanently damaged and has yet to take her to be assessed. Perhaps her sight could be saved. If not, she needs to get back to her education as soon as possible and to get her specific needs attended to.
  
  Some kind of support group may well be able to help the two people I met today, I don't know. But several people I have spoken to have alluded to the fact that there are so many groups and meetings that they can sometimes interfere with each other. Perhaps there's a case for a bit of networking, so support groups can support each other as sell as supporting their members.

• Some Signs of Prosperity in Kaptembwa?

  Posted: September 10, 2009, 9:12 pm by Simon

  
  
  Kaptembwa is not that far from Nakuru but, for some reason, there was a more prosperous feel about some of the homesteads and fields. We were there to visit people who are HIV positive and taking antiretrovirals (ARV). But people taking ARVs can, in most cases, go back to the work they were doing before they became ill. One woman we visited kept hens, goats and sheep. She also grew maize and various vegetables and had a small shop, a hole in the side of the house, to sell food and other day to day items to neighbours. It is a long way from the nearest big shops, but that is handy for people who can be enterprising, as this woman is.
  
  The picture is not as rosy for many people because once they have Aids, they can suffer a lot of illness. ARVs don't work as well for some people as they do for others. One family we visited had to move from a bigger house when the father and mother found they were both HIV positive and in need of treatment. The father of the family is unemployed, as is his wife. His young boy is also HIV positive and suffering from various illnesses as a result. The youngest in the family, a three month old girl, may turn out to be HIV negative, it's not always certain at that age.
  
  It's no secret that catching HIV early, before it results in people losing their livelihoods, is something worth concentrating on. But for people who are very poor and perhaps unemployed before they become infected, an early diagnosis may not help much. The family with no income get free drugs but can't always afford trips to health centres to collect drugs and for other visits. They can't afford a good variety of food to keep themselves and the children healthy. Children need a good diet, especially. But also, people who are on ARV treatment suffer side effects if they don't have a good level of nutrition. Some suffer so badly that they just stop taking their drugs.
  
  Much of the money spent on HIV/Aids goes to drugs but many people infected and affected by this disease need a lot more than drugs. They need good food, clean water, proper housing, health, education and social services. Some people are doing well despite being HIV positive. But some are doing no better than they were before becoming infected while most are a lot worse.

• Athenai and the Plague of Monoculture

  Posted: September 9, 2009, 11:56 pm by Simon

  
  
  Like Rhonda, mentioned a couple of days ago, it's not an accident that Athenai sounds like Athens. This huge area is 'owned' by a Greek who lives somewhere in Nairobi. There is little to see but sisal. Sisal is one of the disastrous monocultures that dominates parts of Kenya. The crop was introduced by the colonials before petrochemical products made plastics much cheaper than sisal based ropes, string, matting, etc.
  
  The sisal estate dates back to the 1950s, when labour was dirt cheap. Luckily for the owner, labour is still dirt cheap, but it's hard to make much money from the product now. But it's an enormous holding and there is little else for people to do there but work for a pittance in the fields or in the factory. It's as if the colonial days never ended, really.
  
  The factory is quite a museum piece, all in working order. The sisal is crushed, dried, brushed and turned by machines from the fifties, still in working order. They are not working today because of power rationing. There is a shortage of the oil that generates so much of Kenya's electricity. Never mind the long hours of sunshine or even the ample winds that blow through this area.
  
  HIV rates are high in this area, as they are in all the hubs of monocultures. Rates are high around the sugar factory in Mumias, the tea plantations in Kericho and the flower producing units in Naivasha. Many people in Athenai are too sick to work and are unable to afford medical care, let alone food, education or other social services.
  
  I'm unsure what would be a long term option: do people continue to work with sisal, as they have done for decades, or do they diversify? If they diversify, what would be the best things for this relatively isolated area to get involved in?

• Support Group Meeting, Bondeni

  Posted: September 8, 2009, 12:52 am by Simon

  
  
  There has been rain on most days for the past couple of weeks so maybe the short rains have started in earnest. At least a bit of rain is better than none. There are many crops that are at the stage where they need rain badly. But some areas, apparently, are threatened with flooding. It's so disconcerting to be in a place where a long drought can turn into a devastating flood.
  
  But we were in Bondeni for a meeting of members of a support group. They get together to discuss matters of common interest and share experiences and advice about things like microcredit, farming, income generating schemes and anything else that can be of help to the group. Well, it was a long haul for me, I admit. The meeting was due to start at ten but I was assured that if I turned up at 11 it would just be taking off. We got there before 11, started at 1130 and it was nearly 1400 by the time we finished. That's a long time to sit on a bench made for very small children.
  
  As for the income generation schemes discussed, they included the usual things: hens, cows, bead jewellery, crochet and market gardening. Apparently hens are old hat and people are being advised to buy dairy cows. Of course, most income generation schemes only really get off the ground if the person or people involved work very hard and have a fair amount of luck. Some of these ingredients can be in short supply. But I'd like to come across people who are doing something different to generate income, something that people all across the country are not doing. But when I come across such schemes, I'll be sure to post them up here.

Blah blah blah

Fish cakes

Alas a fish cake.

Yet more fish cakes

Guess what ... yeah ... fish cakes.

The end of the fish cakes