Adventures of a Retired Armchair Traveler

International court rules Bemba to stay in jail

Thu, 03 Dec 2009 10:45:39 GMT

THE HAGUE, Netherlands — International Criminal Court appeals judges on Wednesday reversed a decision to release former Congo Vice President Jean-Pierre Bemba from custody, ordering him to stay in jail until his trial.
The court in August ordered Bemba freed, saying he would otherwise spend too much time in custody after his arrest in May 2008.
But appeals judge Akua Kuenyehia ruled Wednesday that there was a risk Bemba would flee if released.
"The potential length of sentence if he is convicted is a further incentive for him to abscond," Kuenyehia said. Bemba faces a possible lengthy prison sentence, although the court's statutes mention no maximum term.
Bemba did not react to the decision and said nothing at the brief hearing, but one of his lawyers told reporters they would continue to fight for his release.
"We expect this issue to be examined again by the pretrial judges," said attorney Aime Kilolo.
Bemba faces five counts of murder, rape and pillage for allegedly commanding a militia responsible for atrocities in the Central African Republic. That country's president at the time, Ange-Felix Patasse, had appealed to Bemba's militia for help in defeating a coup.
He has not entered a plea ahead of his trial, which is scheduled to start April 27 next year.
Bemba is the most senior political figure in the custody of the world's first permanent war crimes tribunal. He ruled a vast chunk of northeastern Congo during that country's 1998-2002 war, with support from neighboring Uganda. After a peace agreement ended the war, he became one of the country's four vice presidents in a reunited Congo.
Bemba was arrested in Belgium and transferred to the court in The Hague in July 2008.

Irresponsible DR Congo HIV/AIDS journalism in Le Monde

Wed, 02 Dec 2009 10:56:52 GMT

Dear Elise Vincent,

I'm not sure who you are, but if you are going to report on health statistics, it would be a great idea to learn a) how to find them, and b) how to source and interpret them. I am shocked and amazed to learn that, although UNAIDS reports HIV/AIDS prevalence for ages 15-49 at 5.4% in Uganda and 2.8% in Rwanda, you have decided that Uganda's prevalence (presumably for the population at large) is 30% and Rwanda's is 15%. Interesting math, there. I'd like to know your source for those statistics. Did you go to Goma to write this article? Was "HIV prevalence in bordering countries" one of your "man on the street" interview questions?

And what about your Goma "data"? "Officially," you say, the prevalence is 5%. I beg to differ. In the DR Congo 2008 Antenatal Surveillance Survey, Goma's prevalence among pregnant women, which is usually slighly higher than in the general population, is around 2.2%.

Not to mention that, although you cite "Medecins du Monde," you don't tell us in which hospital they operate and from whence they report their "data." You tell us that they see 200 women per month for antenatal care visits, during which these women are offered HIV counseling and testing. Apparently "10-20%" are positive. Which is it? Ten percent or 20%? If it varies month to month, don't they have enough "data" to provide an annual average? Do we know whether it is rising or falling?

Your points regarding lack of resources are valid. They are valid for everywhere in DR Congo, and many many parts of sub-Saharan Africa. That said, I think it is irresponsible to make a comment such as, "only monotherapy is available, which increases the risk of resistance." I'm not sure we're worried about the risk of resistance as much as we should be about your further comment, that doctors are only prescribing the day of delivery rather than beginning at 28 weeks. The point of this sentence, which you left out, is that ARVs prescribed at 28 weeks can be effective in reducing mother-to-child transmission of HIV/AIDS, whereas if the mother begins therapy at delivery, it will not be effective.

Not quite as bad as the sports writer that said that DR Congo's infant mortality rate was 92%, but still...

Respectfully yours,
congogirl

ps. Le Monde, if you posted "Letter to the Editor" info, I'd have copied you on this message.

Le difficile combat contre le sida à Goma, en Afrique

LE MONDE | 30.11.09 | 13h36 • Mis à jour le 30.11.09 | 13h37

Goma (République démocratique du Congo) Envoyée spéciale

S'il est un endroit abandonné au risque du VIH, en Afrique, c'est bien Goma, ville de l'est de la République démocratique du Congo (RDC). Une cité de 800 000 habitants, frontalière avec le Rwanda, où presque tout va mal. L'espérance de vie est de 47 ans et 80 % de la population vit avec moins de 1 dollar par jour. Une éruption volcanique a ravagé la ville, il y a sept ans. Les ressources minières de la région (or, diamants...) sont convoitées par une multitude de groupes armés. Et le va-et-vient des déplacés après plus de quinze ans de conflits, dont le génocide rwandais, concerne plusieurs centaines de milliers de personnes.

Il n'y avait presque rien à Goma jusqu'en 2003 pour lutter contre l'épidémie de VIH. C'est seulement depuis l'arrivée de nombreuses ONG qu'il y a le "paquet complet", comme l'appelle le médecin chef d'un dispensaire de la ville. C'est-à-dire la prise en charge de la maladie dans son ensemble : du dépistage au suivi psychosocial, en passant par le traitement antirétroviral et la détection des infections sexuellement transmissibles. Mais de nombreux blocages graves persistent et c'est dans les détails d'organisation qu'ils se trouvent.
"Débordés"
Il n'est qu'à observer le travail de Médecins du monde (MDM) sur place depuis 2003, pour comprendre les difficultés. En ville, l'ONG parraine un centre de dépistage anonyme au confort modeste mais soigné. "Une vingtaine de personnes se présentent chaque jour", explique la responsable. Un chiffre en hausse, preuve que grâce à la sensibilisation, la peur du dépistage est en train de diminuer, estime-t-elle. Mais beaucoup de personnes viennent seulement quand elles commencent à avoir les premiers signes de la maladie : amaigrissement, fatigue...
A l'hôpital, MDM apporte aussi son aide à un service ambulatoire dédié à la prise en charge de ceux déjà malades. Une avancée remarquée à l'échelle de Goma, avec une jolie salle d'attente et une photo de chalet suisse accrochée au mur. Mais le service fait face à un cruel manque de moyens. A sa création, il gérait 270 malades. Aujourd'hui, avec 60 nouveaux cas par mois, il a 3 000 personnes à charge. Or, au total, ils ne sont que deux médecins et quatre infirmiers : "On est débordés", déplore le docteur Ndaba Hweje.
Le service manque surtout de traitements antirétroviraux. Depuis janvier 2009, la structure a de quoi fournir des médicaments à 500 personnes, mais "on ne prend plus un seul nouveau cas, regrette M. Ndaba Hweje. Il y a des gens qui sont en stade 4 (le plus avancé de la maladie) et on les observe comme ça." La seule chose que le service a en quantité c'est du Bactrim - un antibiotique - donné pour éviter les surinfections, cause première de la mortalité chez les malades du sida. "On est là pour donner la vie, il est grand temps qu'il y ait une mobilisation à tous les niveaux !".
Selon le docteur, l'hôpital aurait reçu récemment plusieurs appareils pour mesurer la progression de la maladie chez les patients. Mais le personnel n'a pas la formation pour s'en servir, et il manque les réactifs pour les faire fonctionner. Le service a aussi parfois des relations compliquées avec l'hôpital. Quand un patient dont la santé s'est aggravée doit être transféré, le personnel hospitalier rechigne à le soigner. Il ne bénéficie pas, en effet, de la même rémunération que l'unité spécialisée, financée par MDM. En cas d'accident, il n'y a pas non plus d'antirétroviraux disponibles.
Même pénurie dans une maternité de la ville où l'on sensibilise les femmes enceintes aux dangers de la transmission du VIH à l'enfant. Tous les mois, près de 200 femmes sont reçues en consultation prénatale. A cette occasion, on leur propose un test de dépistage. Mais faute de place, le service est situé dans le garage de la maternité. Et pour les 10 % à 20 % de femmes séropositives, il n'y a que de la "monothérapie" à donner - ce qui amplifie les risques de résistance. Et alors qu'il est recommandé de commencer le traitement dès la 28^e semaine de grossesse, les médecins ne peuvent en prescrire que le jour de l'accouchement.
A Goma, on ne sait pas exactement le taux de prévalence de la maladie. Officiellement, il est d'environ 5 %. Mais l'Ouganda et le Rwanda voisins présentent respectivement un taux de 30 % et de 15 %. La coordination fait aussi beaucoup défaut entre les ONG. Du coup, peu de données globales sont disponibles pour évaluer les progrès ou non de tous ces engagements humanitaires. Les organisations congolaises de tutelle s'en plaignent. Selon elles, c'est ce qui perturbe, en partie, l'approvisionnement en médicaments.
Restent toujours, pour finir, les innombrables blocages sociétaux. Comme le tabou de la sexualité, qui empêche les parents d'informer leurs enfants des dangers du VIH. Comme le rejet et la stigmatisation des porteurs du virus aussi, qui poussent hommes et femmes, à souvent cacher leur séropositivité à leur conjoint.

Elise Vincent

On-The-Record Briefing U.S. Global AIDS Coordinator Ambassador Eric Goosby

Wed, 02 Dec 2009 09:25:56 GMT

U.S. DEPARTMENT OF STATE
Office of the Spokesman
For Immediate Release
December 1, 2009
2009/1199

On-The-Record Briefing
U.S. Global AIDS Coordinator Ambassador Eric Goosby
On the U.S. Commitment to Fight AIDS and the
Launch of PEPFAR’s New Five-Year Strategy

December 1, 2009

Washington, D.C.

MR. DUGUID: Good afternoon, ladies and gentlemen. Welcome to the State Department this afternoon. We are with Ambassador Eric Goosby, who is the U.S. Global AIDS Coordinator. His duties include running the entire U.S. Government’s international HIV/AIDS efforts. In this role, Ambassador Goosby oversees the implementation of the U.S. President’s Emergency Plan for AIDS Relief that is, PEPFAR – as well as the U.S. Government engagement with the Global Fund to Fight AIDS, Tuberculosis and Malaria.

With that, I give you Ambassador Goosby.

AMBASSADOR GOOSBY: Well, thank you. It’s a pleasure to have an opportunity to talk to you today. I’d like to begin to – with acknowledging the efforts of many people on PEPFAR from the State Department, USAID, CDC, Department of Defense, Peace Corps, and other agencies that all contribute their expertise at field headquarters to make this program work. It’s a combination of people all over the world who support people in-country to put the programs in place, really quite an orchestration.

I’d also like to acknowledge the efforts of President Bush and members of Congress from both sides of the aisle for creating and supporting this program. I’ve been working in HIV/AIDS for 25 years, both domestically and internationally. And I can remember the days before PEPFAR was in place – they weren’t that long ago – when patients were two, three in a bed, put under the bed, on the floors, in the hallway of most of the Sub-Saharan African countries that we’re engaged in now, waiting for treatments that basically weren’t available.

Today, the situation is markedly different. PEPFAR has brought hope to millions of people across the world with its treatment and care programs. In 2009 alone, PEPFAR has supported life-saving antiretroviral therapy for more than 2.4 million people, essential care to nearly 11 million people, and counseling and testing for nearly 29 million people. And through efforts to prevent mother-to-child transmission, PEPFAR prevention of transmission from mother to child for 100,000 babies born to HIV-positive mothers in the past year alone, building upon the nearly 240,000 babies born HIV-free over the past five years.

But unmet needs are still the dominant feature of this program. We have gotten through approximately a third of the population that is in need of care and the millions who are participating in high-risk behaviors who need prevention interventions. There are an estimated 33 million people living with HIV, 2.7 million new infections occurring annually, approximately 2 million deaths annually, and for every two people we’ve put on treatment, five more have become infected. If we are to sustain the gains we’ve had and have made against this epidemic, PEPFAR must work in closer collaboration with country governments to support and mount a truly global response to the shared global burden of disease.

Today, I’m announcing the release of our five-year strategy, which will be followed later in the week by the release of several annexes with more information about specific areas within the document. Let me give you a quick overview of PEPFAR’s next phase.

First, we’re going to begin transitioning from an emergency response to a sustainable one through greater engagement with and capacity building of governments. PEPFAR has already started this with its Partnership Framework activity, which is a five-year strategic plan developed in collaboration with our partner governments. But we need to do more, especially around supporting the creation of mid-level government capacity to oversee, manage and eventually finance these programs. It is a good start.

Secondly, we’re going to focus on prevention. We’re going to scale up highly effective prevention interventions like male circumcision, prevention of mother-to-child transmission. We’re going to work with countries to determine not just how many people are infected in their communities, in their countries, but where the new infections are occurring. Geomapping and understanding that demographic relationship to geography allows you to make decisions around prevention program positioning, so you can put your programs in front of that expanding movement of the virus through the population.

With treatment, we will continue a strategic scale-up of services to more than four million people. The focus will be on certain populations – the sickest, pregnant women, pregnant women in general who are HIV-positive, and HIV/TB co-infected individuals – while we work with both our country partners in the international community to continue to lower the price of commodities and distribute the costs of treatment among multiple funders.

As we carry out these prevention, care and treatment activities, we will do so with an eye toward how these activities strengthen the broader health system. We will work not only to continue our quality delivery of services and expansion of both care, treatment and prevention services, but we will also look to create a durable response that can benefit the entire healthcare system and continue the expansion and capability of services for what are often HIV-positive populations.

I look forward to working closely with partner countries, other donors, and PEPFAR staff in the field to implement the concepts of this strategy. I’d like to thank you, and I’m open to any questions that you might have.

MR. DUGUID: Jill.

QUESTION: Mr. Goosby – Ambassador Goosby, this shift from the emergency response to this sustainable one is very controversial, as you know, in the AIDS community, because some people say it takes attention away from the people who really need it, the people with AIDS, and kind of spreads it out to people – you know, mothers, children, people with other diseases, et cetera. How do you answer that?

AMBASSADOR GOOSBY: Well, I think that 60-plus percent of the people HIV-infected are women, that the person who normally shows up in the clinic visit are women, that our ability to access children comes through our ability to access women, our ability to access their partners, their husbands, 90 percent of the time is coming from an interface initially with the woman.

Men come into care very late, usually with an opportunistic infection, when they are well into symptoms, very late stage disease. And our best chance at changing that dynamic is to target women at the earliest stages of – in prenatal context, but also as they bring their children in for well-baby visits or immunizations. We believe that it is justified on a public health basis to go through a woman conduit to the whole family.

We are not talking about decelerating our activities in care, treatment, or in prevention. Indeed, our emphasis will continue a care focus, a treatment focus. Where we have to and need to turn the volume up is in our ability to aggressively get in front of the movement of that virus through each population, the prevention activities. So it’s not an abandonment. It is an expansion of those services. So the concern around an inattentiveness to what is a burden of disease that is about one-third addressed is not part of our strategy. We are actually trying to aggress on all fronts.

QUESTION: But the money that’s spent would be apportioned differently, then?

AMBASSADOR GOOSBY: Well, to say how much your treatment prevention and care dollars go from a 30,000-foot level loses a whole lot in translating down to the actual region, city, neighborhood within the city, for how and where your opportunities present themselves. It is always a prevention treatment continuum. Some opportunities in prevention are always there, some treatment needs are always there. And it’s up to those who are in front of the epidemic to decide how they divide their resources at that level to address the needs in front of them.

We are not saying that we’re going to put X amount into prevention, treatment, and care. We are going to expand services in all areas, but we are going to become more efficient in our ability to prevent vertical transmission from mother to child. We are going to start targeting high-risk populations as opposed to general public service announcements that have dominated PEPFAR 1 as one of the central strategies – the abstinence, be faithful type of activity. We’re linking family planning, reproductive health services to our prevention efforts because they are more effective. Those needs are going largely unaddressed, and where interfaced with populations that need both, we should overlap them.

The movement into other services are also logical, easy, where the medical infrastructure that’s in place to deliver the antiretrovirals should be the platform on which we expand into immunizations for the children that are coming into the clinic with their mother when they’re coming into the clinic for their antiretroviral care. We should not be afraid of immunizing the children in that setting. Looking for that kind of synergy is how we hope to expand some service constellations without dismantling the core functional component that’s already in place.

This will identify efficiencies that are considerable in our ability to move from a general population-based information system to high targeting of high-risk groups, targeting of high-risk groups as the key kind of shift in the strategy. It’s evidence-based. It’s more effective. It’s also cheaper.

MR. DUGUID: Thank you. I think Reuters is next.

QUESTION: Yeah, Andy Quinn from Reuters. Still along these lines, some critics are voicing fears that this – because of what they interpret as a funding shift may mean treatment interruptions in some cases, and particularly in some African countries – Uganda has been cited. Is the U.S. committed to preventing treatment interruptions in countries where PEPFAR is already involved? And what is the current U.S. understanding of this idea of universal access? Are we no longer thinking about ARVs as something that can be universally accessible with U.S. help?

AMBASSADOR GOOSBY: We have worked tirelessly to prevent stock-outs, which are largely not happening in PEPFAR. We are also looking to get those who are most ill lower T-cell counts coming out of opportunistic infections, those who are co-infected with tuberculosis, those who are pregnant, on antiretrovirals as early as we can meet them, stage them, remove the confounder of opportunistic infections and engage in antiretroviral therapy.

Fully committed to that, and to expand that capability, we know that we’re about a third of the way there. Uganda is no different than any of the other countries that we’re in. Uganda has about a third of the people already known who are positive and in need of antiretrovirals on antiretrovirals.

Our commitment to universal coverage, we’ve never stopped. We are a central component of that effort to get everyone who needs these drugs on these drugs. We remain committed to that. What we also realize is that the resources that are going to be needed for that need to converge at the country level to support the full realization of universal coverage. A bilateral program alone will not do that. But we are committed to work with our country partners to engage in that dialogue, to identify those resources to expand into universal coverage, completely a core commitment of our effort.

Yes, please.

QUESTION: Yeah. You know, yesterday, Secretary Clinton made a pretty strong statement against efforts by some countries to criminalize homosexuality. As you know, there’s a bill pending in Uganda, and have you considered what you’ll do if that bill passes? And more generally, how will you be working with some African countries that harbor homophobic attitudes and target gays?

AMBASSADOR GOOSBY: Well, it’s a good question. We have a similar evolution in our country. We had the legislation that was put up every year, that during the early days of Ryan White, that would – anything that promoted, quote, “homosexual” behavior was considered unacceptable and anything that did fall into that very large category was – attempts were made to not have those funded within the Ryan White context, things that promoted homosexual behavior, quote. We’re familiar with that type of mindset.

And from a public health perspective, it has no place in trying to engage and curtail movement of the virus into the population. Our collective experience, globally, in every country, both in developing and in resource-poor settings, has shown that every time you target a population in a negative way and put restraints, constrictions on their ability to reveal themselves to the society, to the community, you push that behavior further underground. When you push it further underground, individuals always come in later to care, later stage of disease, and continue in that period off of antiretrovirals to participate in high-risk behaviors that further spreads the virus through that community.

Our hope would be to – in a collegial, respectful way – to work with our colleagues in-country who are in policymaking decision places to understand that relationship, to understand the science of how the virus moves through populations and that how you need, as the public health responsible entity, to position yourself in front of each of those expanding waves of seroconversions. And until you do that, that remains a conduit for the virus to reenter the general – not high-risk behaving – population.

So our hope is that the science will lead the way and that that dialogue can stay on that level and that the governments that are involved will realize that it is in their interest and the interest of their larger population for them to develop strategies that address these populations.

Yeah.

MR. DUGUID: Thank you. Mr. Goyal.

QUESTION: Sir, as far as this disease, HIV/AIDS, is concerned, it affects also travels from and to the U.S. Whenever the ministers or foreign ministers or – other countries – lots of dignitaries visit here at the State Department, do you talk to them about this disease, as far as HIV/AIDS is concerned, how you are working with them? And finally, what kind of programs you have in South Asia, especially in India? How serious is this problem?

AMBASSADOR GOOSBY: We talk about policy positions that discriminate against populations, that deter our ability to identify, enter and retain patients in care; all of those types of issues that differentiate and separate, that discriminate, work against your ability to identify and embrace and care these individuals in a very profound way. So we do talk about that.

India’s incidence is very low. But it, at the same time, has – it competes with South Africa, but is -- probably has more people infected than any other country. The kind of decentralization of healthcare in India, as well as the state configurations of government, have put the discussion in responding to the epidemic almost as a separate discussion for each state. But India has engaged in an effective strategy for prevention especially, and has moved well along the road to educating their physicians and especially their nurse populations and the private sector to create a cadre of healthcare worker relations with backup from physicians and nurses that is effectively identifying, testing, and entering people in services. So India is well along the road of engaging to prevent and block the spread of their epidemic.

QUESTION: Thank you.

MR. DUGUID: AFP, Lachlan.

QUESTION: Yeah. Lachlan Carmichael, AFP. You talk about sustainable country programs. Is there a list of countries that were in the first roll or, you know, first priority, or is it – I mean, there are about 30 countries all together, I understand?

AMBASSADOR GOOSBY: Yes, yes. We are committed to engaging all the countries in a dialogue that moves the country leadership – usually the ministries of health, the ministry of education, the finance minister – into a position with the programs where they take over management of the program, and eventually, we hope begin to increase their financial contributions to the program.

Our commitment will not waver. We don’t think that many of these countries will be in a position to put resources towards it for many years. But we do think that the ability for the country to start to manage the program, to have a national office that oversees both the epi [epidemiology] and the prevention and the treatment efforts will better enable the country to make, I think, rational decisions around where resources are most likely to have the largest impact at any given time.

The country needs to manage these programs. The population that these programs are serving are in and of the country. The public systems need to be identified and supported in expanding their capabilities as opposed to an NGO strategy where you’re putting and creating parallel delivery systems. We now need to move to more public-centered systems of care in conjunction with NGOs systems – kind of a hybrid, not just NGO parallel, but in and amongst the public system of care that is there to deliver and serve the populations in front of them. That management shift, and the creation and expansion of mid-level management capability, will save resources and will also better ensure that these programs are there for the 25 to 30 years that we need them to be, long after PEPFAR is a memory.

So our urgency to try to put these countries in a position of managing the programs is predicated on our desire to embed the programs in the medical delivery systems of the country so they’re there for the duration.

MR. KELLY: Reuters, please.

QUESTION: I was hoping you could talk just a little bit about funding. I know that some people are saying that PEPFAR has been flat funded for the next two years. Within your five – maybe you could – could you just talk us through how much has actually been given to PEPFAR to date, what you see as allocations coming from the U.S. Government in the next – say within, your next five-year outlook? How much more money is the U.S. going to put into PEPFAR?

And you talked and just said after PEPFAR is a memory – when do you think that the need for PEPFAR will dissipate? When are we going to be able to say it’s covered by everything else? And what are going to be the metrics that allow us to say that? When you – because you’re no longer are going to have targets about how many people are under care. You’re going to be saying we have built the health system in the next country, which is a much harder thing to measure. How are you going to figure out when you’re successful?

AMBASSADOR GOOSBY: Well, those are all good questions. It’s going to be an iterative process. We will not stop looking at numbers of people that we have tested, that we have staged, that we have started on antiretrovirals. We’ll continue to look at numbers of prenatal women, patients that we have identified, tested, and started on antiretrovirals for vertical transmission purposes. We’ll continue to measure and better understand the high-risk populations, the MSMs, the interjection drug users, the sex workers who frequently are the conduit through which the virus moves into low-risk populations, the general population. Those metrics will all continue to be in place, in movement or increasing in partner countries’ ownership and of management. That will be a central piece that we will not stop because of that.

Our strategy is to intensify the technical assistance that we give to countries to take over the role of both understanding through epidemiologic survey systems their epidemic and responding to it. And we believe that there is enough in-country experience now and other South-South expertise that can be tapped for technical assistance and mentoring relationships.

We believe that this is the correct way to go, because we believe it will build a stronger medical delivery system that is more durable. It is not a turning away from our conviction and commitment to the burden of disease that HIV/AIDS has presented to the planet. In that same context, it’s also important that we realize that there is a responsibility that is shared by all countries on the planet to respond to the burden of disease – not just HIV, but all disease. The more we work in this area, the more the issues around human rights have shown its head, that healthcare does impact a person’s ability to not only prevent a disease process in themselves, but also for preventing them from engaging in society, politics and contributing in the larger kind of societal sense.

And those efforts need to be – a dialogue needs to be created where we begin to acknowledge the burden of disease, the unmet component of that burden, and that we need to converge our resources to look for synergies, complementary cooperative coordination of those resources to meet that unmet need, so the universal aspects of care in HIV and other diseases can be realized.

MR. DUGUID: We have time for one question if it’s short.

QUESTION: Yeah.

MR. DUGUID: Jill, it’s short?

QUESTION: Yeah, it’s short.

MR. DUGUID: Okay.

QUESTION: Could you just tell us – you mentioned where – new infections, where are they happening?

AMBASSADOR GOOSBY: Well, they’re happening everywhere, including Washington, D.C. They’re – within any given epidemic, there are many epidemics that are occurring. And for people who think about responding to an epidemic, until you click into that, you will not be effective. It is not one shoe that fits all. Even in Washington, D.C., you have many populations that you need to have different strategies to engage on the movement of that virus through that population to arrest that.

In terms of – in a general sense, just to be – to answer your question, the epidemic is moving mostly in Eastern Europe and Southeast Asia. Eastern Europe has a huge prevention opportunity. You have a population that is largely concealed in MSMs and injection drug users, and are participating in behaviors that may be illegal in their country. And there are consequences for revealing yourself to the medical institutions that hampers the person’s willingness to be tested. That has allowed this epidemic in those countries to move unchecked. And the most rapid rises we’re seeing are in those regions of the world.

MR. DUGUID: Ladies and gentlemen, that’s all we have time for today. I’m sorry we didn’t get to all the questions, but we thank you very much who attended. And I thank you, Ambassador, for being with us today.

AMBASSADOR GOOSBY: Pleasure. Pleasure. Thank you.

# # #

World AIDS Day and PEPFAR commentary from Newsweek

Tue, 01 Dec 2009 10:47:42 GMT

The PEPFAR Paradox

By Katie Paul
Newsweek
December 1, 2009
http://www.newsweek.com/id/224963
As far as storylines go, PEPFAR has had it pretty good so far. Since George W. Bush first introduced the President's Emergency Plan for AIDS Relief in 2003, the program has been able to swing around impressive credentials: more than 2 million people in 15 focus countries have started on antiretroviral treatment and more than 10 million have been supported with overall care. Thanks to the program's promising results, Congress raised the budget of PEPFAR by $4 billion over the course of its existence. With $6.7 billion to its name, PEPFAR is now the biggest public-health initiative in the world.

But after years of steady gains in funding, health experts say PEPFAR's funding will likely flatline under the Obama administration. At the same time, they expect the gap between the number of people who need treatment and the number getting it to widen. With budgets squeezed by the financial crisis, and a growing call in global health circles to move away from "AIDS exceptionalism"-defined as greater funding for AIDS programs at the expense of overall health resources-the jewel of Bush's foreign-policy portfolio is poised to start looking much less shiny.

But even though its results may not look as impressive, the program is as strong and smart as ever. Up until now, PEPFAR was defined by the "E" in its name: emergency. The emphasis was on starting up strong and making a big impact, which often meant bypassing local governments to get as many people on treatment as possible, as quickly as possible. But while that has produced impressive results, the approach is far from sustainable. The program's record on preventing transmission of HIV has been lackluster, and worldwide the number of new infections is drastically outpacing the number of people receiving treatment, according to PEPFAR's published reports. For every two patients put on antiretroviral drugs today, five others contract HIV-a rate that has remained steady even as PEPFAR money made enormous strides in bringing down the death rate.

If that doesn't change-and there is little indication it will-PEPFAR risks becoming a black hole of an entitlement program, committed to funding treatment indefinitely as more and more patients live longer and longer. "The problem is, there's no way you can treat ourselves out of this epidemic," said Dr. Stefano Bertozzi, who directs HIV work at the Bill & Melinda Gates Foundation. "As you newly start people on treatment, you need to maintain those people you started on treatment in previous years. The number of people you're sustaining next year is always going to be greater than the number of people you're sustaining this year." According to a cost analysis from the Center for Global Development, an independent research firm, maintaining present successes for the ever-increasing number of patients would cause U.S. AIDS spending to swell to $12 billion by 2016, consuming half the foreign-assistance budget and squeezing out U.S. spending on other programs, including other health initiatives.

The way out of this conundrum, according to policy experts? Shift more resources over to prevention efforts. Transfer programs to local ownership and put national governments on the hook for delivering services. Monitor and evaluate which programs are working, then report the results.

According to Eric Goosby, the U.S. global AIDS coordinator in charge of PEPFAR, those items are all on the agenda. On the prevention front, PEPFAR is pouring resources into peer-education programs and mother-to-child transmission interceptors. The program is also doubling the funding for monitoring and effectiveness studies, from $23 million this year to $40 million to $50 million in 2010. And in line with the administration's push to broaden global health and development plans beyond one disease-epitomized by a new $63 billion, six-year initiative-Goosby is looking to move away from both reliance on NGO contractors and commitment to a narrow AIDS focus. "Patients are going to need these drugs 20 to 30 years in the future, so we need to focus on sustainability. To do that, we need to work off PEPFAR platforms to expand into a broader constellation of services for each patient," he says.

That position has the support of AIDS advocates, who have had to fight off accusations that AIDS gets too much attention in the public-health realm. "It doesn't make sense for a counselor to have a discussion about contraception with a woman in one building, then have a different program in a different building about HIV prevention. People co-infected with HIV and TB shouldn't have to go to clinics across town to have those problems dealt with," says Bertozzi of the Gates Foundation. In other words: public health isn't a zero-sum game.
Of course, making the change is easier said than done. Politically, the strategy is risky. Improvements on the prevention side, which may produce the best results in the long term, are difficult to measure (you can show how someone caught a bug, but it's tougher to prove a negative and track why he didn't catch it). And while increased partnership with national governments is a worthy goal, it also carries the risk of slow transitions, less impressive results, and a loss of congressional enthusiasm when funding time comes around again. Handing off programs to local control can be a messy process, cautions Peter Navario, a global health fellow at the Council on Foreign Relations who specializes in HIV/AIDS systems in developing countries. In one case he cites, an international NGO that tried to turn over a program to doctors and administrators in South Africa ended up having to resume leadership of the program-twice.

But lower expectations and untidy transitions may be a necessary price to pay. Expensive quick fixes can't work forever; eventually, local doctors are going to need to be trained to take over from their expat counterparts. If, as the experts say, the Obama administration is putting all the right pieces into place to mold PEPFAR into a post-emergency program, then the challenge at home is to make sure congressional support doesn't wane if critics spin the numbers as evidence of ineffective leadership. The new monitoring and evaluation studies should help. They would have helped even more if they had been implemented at the start, say AIDS fund administrators. But so the proverb goes: if the best time to plant a tree is 200 years ago, the second best time is today.

DR Congo 'warlords' trial to open at ICC

Tue, 24 Nov 2009 08:41:03 GMT

The trial of two alleged Congolese militia leaders charged with war crimes is due to begin at the International Criminal Court in The Hague.

Germain Katanga and Mathieu Ngudjolo Chui are accused of directing an attack on a village in 2003 in which more than 200 people were killed.
They face charges of ordering attacks on civilians, sexual slavery, rape, and enlisting child soldiers.
Both deny the charges and have expressed sympathy for the victims.
It is only the second trial at the ICC in The Hague. The first case - of Congolese militia leader Thomas Lubanga - began in 2008 but has been delayed by legal argument.
Prosecutors say Germain Katanga and Mathieu Ngudjolo Chui led two groups of child soldiers and militiamen who laid waste to Bogoro village in the mineral-rich Ituri province of the Democratic Republic of Congo (DRC).
Many victims were hacked to death with machetes while women were raped and killed or taken as sexual slaves by their attackers, according to the charges.
Chief prosecutor Luis Moreno Ocampo has said that the conflict in Ituri was part of a civil war that raged in DR Congo following the 1994 genocide in neighbouring Rwanda.
Prosecutors plan to call 26 witnesses although 21 of them will testify hidden from public view for fear of reprisals.
The trial is expected to take several months.

Plane misses runway in east Congo, landing in lava

Thu, 19 Nov 2009 13:56:05 GMT

By PATRICE CITERA (AP) – 36 minutes ago
KINSHASA, Congo — A U.N.-run radio station says a passenger plane overshot a
runway in eastern Congo and landed in lava, injuring 20 people.

Radio Okapi said the plane was flying from Kinshasa to Goma and passengers
had warned the crew that there were heavy clouds. One passenger told the
station that the plane had landed in lava near Goma's airport.

An official from the U.N. mission in Congo, who spoke on condition of
anonymity because he does not have permission to speak with media, said
there were 117 passengers aboard.

They included the governor of North Kivu province, who was not hurt.

In April 2008, a DC-9 crashed while failing to lift off from Goma's airport
leaving at least 40 people dead. A 2002 volcanic eruption sent lava oozing
onto Goma's runway.

Copyright © 2009 The Associated Press. All rights reserved

Ignace Arrest

Wed, 18 Nov 2009 15:27:17 GMT

Wasn't Ignace Murwanashyaka arrested in Germany before? Or maybe I'm just thinking of when he left the DRC. Either way, the President of the FDLR is now under arrest in Germany for human rights abuses and may be tried under German law.

Someone mentioned today a report that I haven't read discussing the contributions of the diaspora in keeping the conflict in the east alive. It is not surprising, but how can it be stopped?

"MONUC may not have turned Congo into heaven, but it may have prevented it from turning into hell."

Wed, 04 Nov 2009 09:15:13 GMT

Last night on BBC, I caught one of the shows during my rush hour commute
that focused on the idea of MONUC withdrawing from DR Congo. The lines were
open to take calls, and opinions ranged from a 5th year student saying that
MONUC has done nothing and should leave, to other Congolese outside the
country and even someone in Liberia saying, you may not see the positive
effects of UN presence now, but you will feel it when they leave. One person
even summed it up this way (paraphrased): "MONUC may not have turned Congo
into heaven, but it may have prevented it from turning into hell."

The local press has been covering the fact that MONUC will still provide
support to Kimia II, an operation undertaken in conjunction with the
Congolese army (FARDC) that has resulted in more civilian deaths in the east
than prior to its initiation. The FARDC has been accused of massacres since
May of this year. The local press is accusing MONUC of covering up
information related to the killings.

Some people calling in to the BBC show thought that removal of MONUC from
the east or other parts of the country would be the only way to encourage
the government of DR Congo to take responsibility for its security
situation, while others disagreed, pointing out that the country is too big
even for the current mission of 17,000 to cover. This size mission cannot
even cover the entire territory in the east where insecurity still reigns.
With or without MONUC, the government of DR Congo must make moves to bolster
the capacity and effectiveness of its uniformed forces to establish rule of
law.

At least three clashes in the east over the past week have been reported via
Radio Okapi, one between FDLR rebels and Mai Mai, one between FARDC and the
Mai Mai Yakutumba militia, and one between FARDC and recently integrated Mai
Mai combattants.

New friends

Tue, 06 Oct 2009 00:38:01 GMT

I'm not that great at making new friends but sometimes it's fun, especially when I have nothing to do with it. I went to meet one friend in DC, who brought her other friend, and these other three people sat down with them and they'd all already made friends before I arrived. So we drank for half price and talked and laughed and told us the saga of the happy hour at the gay bar across the way and I asked the guy about his freelance photography job, and then they said they were off to a drag show so my friends made plans to meet up with them next week, and I thought, now that's a good day's work.

Doctor Strike in DR Congo

Fri, 04 Sep 2009 09:44:39 GMT

This week, government doctors went on strike for higher pay, as threatened last week.

I heard on Radio Okapi this morning that they are demanding more money in increases than the current annual health budget allocation.

Here is a summary of local press from the US Embassy re: the strike from September 2:

Doctor’s Strike

“Paralysis in Public Hospitals” is how La Tempete Des Tropiques describes the ongoing doctors’ strike, with a back-page cartoon showing a doctor telling a patient that a nurse will take care of him, then telling the nurse to refer the patient to their private clinic. L’Avenir announces the end of the strike, but a close read of the article shows that while there might have been progress in talks, an agreement has yet to be reached. L’Observateur links the doctors’ strike, a potential teachers’ strike, and the recent death threats against government officials formerly linked to Jean-Paul Bemba as “A New Conspiracy against the Republic.” On its front-page, the newspaper editorializes: “More and more, we are in agreement with those who say that the young Congolese democracy is in trouble.” According to the newspaper, the strikes and death threats are evidence that “organized forces don’t want the new system … to function properly.”

Apparently there is also a teacher strike on the horizon:

Gathering Clouds

L’Observateur sees the potential teachers’ strike as the fault of the Budget Minister, who claims the government does not have the funds to pay teachers. “Clouds are gathering in the Congolese sky,” the newspaper comments. “Those who have the destiny of their country in their hands must assume their responsibilities. If not, the popular verdict will be unforgiving. National elections are not far away.”

Video footage of Mutombo Hospital during BD/UNICEF visit

Fri, 28 Aug 2009 11:31:25 GMT

Here's a link to a couple minutes of footage of the visit mentioned in the press release in the previous post. You can see some views of inside the hospital.

http://www.unmultimedia.org/tv/unifeed/d/13419.html

Press Release: NBA legend Dikembe Mutombo, UNICEF Executive Director Ann M. Veneman and BD commemor

Fri, 28 Aug 2009 10:52:12 GMT

NBA legend Dikembe Mutombo, UNICEF Executive Director Ann M. Veneman and BD commemorate opening of new center to improve HIV/AIDS treatment in the DRC

http://www.unicef.org/media/media_50959.html

NBA legend Dikembe Mutombo, UNICEF Executive Director Ann M. Veneman and BD
commemorate opening of new center to improve HIV/AIDS treatment in the DRC

*KINSHASA, DRC, 26 August 2009** –* The Biamba Marie Mutombo Hospital and
Research Center (BMMH), in Kinshasa, Democratic Republic of the Congo and BD
(Becton, Dickinson and Company) today launched two Centers of Excellence -
an Immune System Monitoring Laboratory and an Occupational Safety Centre for
Health Workers - at the state of the art medical facility founded by NBA
legend Dikembe Mutombo. The safety center will train more than 300
clinicians, and the new laboratory will improve monitoring and treatment of
patients living with HIV/AIDS.

Mr. Mutombo was joined at the opening ceremonies by UNICEF Executive
Director Ann M. Veneman, BD Executive Vice President Gary Cohen, and the DRC
Minister of Public Health, Mwami Mopipi Mukulumany. The Center is an
expansion of the BMMH, an acute care hospital which opened in 2007 and
provides care to thousands of patients each year in a region of the world
where over five million people have died from violence, hunger and disease
since 1998.

“The doctors and nurses at the Biamba Marie Mutombo Hospital are saving
lives every day and helping improve health care in the DRC which has been
ravaged by more than a decade of war and disease,” said Mr. Mutombo. “These
Centers of Excellence are an important milestone in improving the quality of
life for those who live with HIV/AIDS and in training new health care
workers to help prevent the spread of disease.”

The new Centers will provide laboratory equipment, reagents and training to
improve immune system monitoring, an essential component of treating people
living with HIV/AIDS. To help ensure the safety of healthcare workers at the
facility, DMF will develop a Department of Occupational Health and a
Regional Training Center at the BMMH. BD, in collaboration with the
University of Virginia, will help implement the Exposure Prevention
Information Network (EPINet™) surveillance system to monitor occupational
injuries at BMMH. BD will also provide a range of safety-engineered
injection and safety-engineered blood collection devices as well as
laboratory and occupational safety training for at least 330 healthcare
workers.

“The problems of pandemic disease prevalence and occupational risks to
health workers exist throughout sub-Saharan Africa, but pose particular
challenges in countries emerging from conflict,” said Mr. Cohen. “We are
proud to partner with Dikembe Mutombo, and to support his efforts to provide
essential medical care to the people of Kinshasa and DRC, his home country.”

The World Bank estimates that nearly 70 per cent of the population of the
DRC is living on $1.25 or less a day. Around half a million children under
the age of five die every year in the DRC. Most of these deaths are from
largely preventable causes, such as diarrhea, pneumonia, malaria,
tuberculosis and malnutrition and measles. Over one million people in DRC
are living with HIV/AIDS. Sexual violence of the most brutal form has been
carried out against tens of thousands, over half of them children.

“The Democratic Republic of Congo remains one of the poorest countries in
Africa with poverty, conflict and disease contributing to a public health
crisis for the country’s most vulnerable people,” said Ms. Veneman.
“Partnerships such as the one we recognize today are addressing this
devastating situation and help provide an infrastructure for expanded care
and services to those who otherwise would not have access to these
life-saving resources.”

The UNICEF Executive Director also commended Mr. Mutombo for his dedication
and commitment to his home country.

“It is such an honor to be here today at the hospital founded in the memory
of Dikembe’s mother,” said Ms.Veneman. “He is a true friend of UNICEF and
his dedication for his home country is an inspiration to us all. Dikembe
continues to give a voice to the voiceless people of Democratic Republic of
the Congo.”

Through the work of a broad collaboration of partners including UNICEF,
government, the private sector, NGOs, religious leaders and communities,
progress is being made in the DRC but much work remains to be done,
especially in reaching the “hard-to-reach” given the size and the limited
infrastructure of the country. Community based integrated health programs
are providing life saving interventions that include: vaccination of 5 to 7
million children each year against polio, measles and other diseases;
vitamin A supplementation for 11 million children aged between 6 and 59
months: insecticide treated mosquito nets to protect against malaria;
nutritional treatment for 320,000 acutely malnourished children, including
60,000 affected to a severe degree in 2008; de-worming tablets for 9 million
children; access to clean drinking water in rural communities; and HIV/AIDS
prevention and treatment.

*Attn broadcasters: VNS and b-roll is available at:*
www.thenewsmarket.com/unicef

# # #

*About the Dikembe Mutombo Foundation*
The Dikembe Mutombo Foundation is dedicated to improving the health,
education and quality of life for the people of the Democratic Republic of
the Congo. The Foundation strives to accomplish this goal not only by
providing comprehensive health care at the Biamba Marie Mutombo Hospital,
but also through an emphasis on primary health care and disease prevention,
the promotion of health policy, health research and increased access to
health care education for the people of the Congo. www.dmf.org

*About BD*
BD is a leading global medical technology company that develops,
manufactures and sells medical devices, instrument systems and reagents. The
Company is dedicated to improving people's health throughout the world. BD
is focused on improving drug delivery, enhancing the quality and speed of
diagnosing infectious diseases and cancers, and advancing research,
discovery and production of new drugs and vaccines. BD's capabilities are
instrumental in combating many of the world's most pressing diseases.
Founded in 1897 and headquartered in Franklin Lakes, New Jersey, BD employs
approximately 28,000 people in approximately 50 countries throughout the
world. The Company serves healthcare institutions, life science researchers,
clinical laboratories, the pharmaceutical industry and the general public.
www.bd.com

*About UNICEF*
UNICEF is on the ground in over 150 countries and territories to help
children survive and thrive, from early childhood through adolescence. The
world’s largest provider of vaccines for developing countries, UNICEF
supports child health and nutrition, good water and sanitation, quality
basic education for all boys and girls, and the protection of children from
violence, exploitation, and AIDS. UNICEF is funded entirely by the
voluntary contributions of individuals, businesses, foundations and
governments. www.unicef.org

*For more information, please contact:*
Kate Donovan, UNICEF Media, New York,
Tel + 1 212 326 7452,
E-mail: kdonovan@unicef.org

Susan M. Johnson, Dikembe Mutombo Foundation, Inc.
Tel + 866 289 2108,
E-mail: mutombo@dmf.org

Audio slideshow: Making music in Freetown

Fri, 14 Aug 2009 12:47:16 GMT

Everywhere you go in Sierra Leone's capital, Freetown, there is music. People plays songs from makeshift music shops and watch music videos on small TV screens powered by generators.

Check out Glenna Gordon's fabulous photos and listen to audio featuring local music video producer Ayouba Sidibay.

Important resources for Humanitarians

Thu, 13 Aug 2009 13:08:31 GMT

1. Visit inepd.org to find out what you can do for the global enabling of
poverty development.

2. Visit unfg.org for a great tool for generating gobbledegook for your next
annual report. No joke. For example:

The involvement of different stakeholders in the study resulted in
cross-cutting organisational Education for All policies targeted at
improving enrolment and retention rates amongst marginalized groups.

In the context of decentralization, the Chief Technical Adviser will work to
unlock clusters, through sector-wide reciprocal cost-benefit analysis
frameworks for development assistance planning.
In the context of improving the legal and regulatory framework, the Member
States will develop holistic outcome-oriented feasibility studies of
recommendations for change to be implemented.

Clinton's visit to Kinshasa

Tue, 11 Aug 2009 11:55:25 GMT

Check out Twitter for updates from yesterday's Town Hall in Kinshasa with
Hillary Rodham Clinton:

http://twitter.com/congogirl

Dear men, if you are HIV+ and you get circumcised, hold off just a few weeks for her sake.

Thu, 06 Aug 2009 15:25:54 GMT

GLOBAL: Male circumcision does not protect women

JOHANNESBURG, 17 July 2009 (PLUSNEWS) - New research suggests that
circumcising HIV-positive men does not reduce the risk of their female
partners becoming HIV-infected.

The findings, reported on 17 July in the British medical journal, The
Lancet, emerged from a clinical trial in Rakai District, southern Uganda,
involving 922 HIV-infected men and 163 of their HIV-negative female
partners.

Half the men were circumcised at the start of the two-year trial; the other
half, who made up the control group, were circumcised at the end of it.
Their uninfected female partners were followed up after six, 12 and 24
months to determine whether they had acquired HIV from their male partners.

Male circumcision has become a recommended HIV-prevention strategy since
three clinical trials, one of which was also held in Rakai, showed that the
procedure could reduce the HIV risk to men by as much as 60 percent. Until
now, little was known about whether male circumcision also reduced the risk
of HIV infection in women.

Previous observational studies suggested that the partners of circumcised
HIV-infected men were less likely to acquire HIV, but the trial in Rakai
failed to confirm this. Out of 92 couples in the circumcised group, 18
percent of the women became infected during the study period, compared to 12
percent of women in the uncircumcised control group.

Male circumcision may actually have increased the HIV risk to some of the
women in the intervention group. After six months, women whose partners
ignored advice to abstain from sex for at least six weeks after the
circumcision procedure had an HIV acquisition rate of 27.8 percent,
compared to 9.5 percent among women whose male partners delayed sex until
healing was complete, and 7.9 percent among women with uncircumcised
partners.

The trial was stopped early because of "futility", meaning that the
accumulation of further data was unlikely to produce substantially different
results.

The findings are likely to have important implications for the male
circumcision programmes being rolled out in a number of countries with high
rates of HIV, including Zambia, Swaziland, Kenya and Uganda. The programmes
have received substantial backing from governments, international donors and
UN agencies.

In an accompanying comment in The Lancet, Jared Baeten, of the University
of Washington's Departments of Global Health and Medicine, cautioned that
the results of the Rakai trial "should in no way hinder programmes working
to scale up circumcision services for men at risk for HIV".

Circumcising HIV-positive men may not directly reduce HIV risk to their
female partners, but large-scale male circumcision programmes would benefit
women in the long term by bringing down overall HIV prevalence in
communities.

Baeten also agreed with the study authors that the results should not
prevent HIV-infected men from qualifying for the procedure, because
excluding them could lead to stigmatization and deny them other health
benefits, including a reduction in genital ulcer diseases.

The findings reinforced the need for men undergoing the procedure to
receive extensive counselling about the importance of delaying sex for at
least six weeks afterwards, the continued need to use condoms, and to reduce
partner numbers.

ks/he

See also: AFRICA: Mass male circumcision - what will it mean for
women?[END]

Check the most popular PlusNews articles:
http://www.plusnews.org/report.aspx?ReportID=79416

© IRIN. All rights reserved. HIV/AIDS news and analysis:
http://www.plusnews.org

[This item comes to you from PlusNews, part of IRIN, the humanitarian news
and analysis service of the UN Office for the Coordination of Humanitarian
Affairs. The opinions expressed do not necessarily reflect those of the
United Nations or its Member States. Reposting or reproduction, with
attribution, for non-commercial purposes is permitted. Terms and conditions:
http://www.irinnews.org/copyright.aspx

Wronging Rights Blog

Thu, 06 Aug 2009 11:27:58 GMT

How did I not discover this blog sooner???

http://wrongingrights.blogspot.com/

It's worse than "sexual violence," and men are targeted, too.

Wed, 05 Aug 2009 08:50:16 GMT

This snippet is from a blog entry from last week, which continues to briefly
describe the nature of the violence and its results on women's bodies.

http://www.usnews.com/blogs/erbe/2009/07/30/hillary-clintons-congo-trip-will-shed-light-on-sexual-violence.html

"Sexual violence as thought of in the West does not begin to describe what
the Congolese women endure. Not only are they raped repeated and physically
brutalized, they are forced to watch their infants slaughtered upon birth."

Last week, someone told me that 22% of men in the military in DRC have been
raped, and it seems that the militia in the east are raping men at a rate
almost as alarming as that of women, with similar disastrous psychological
and physical ramifications that current aid projects and local resources
cannot begin to address.

The NYT article published yesterday is worth a read but could be
triggering. Here's a relatively neutral summary paragraph:

"According to Oxfam, Human Rights Watch, United Nations officials and
several Congolese aid organizations, the number of men who have been raped
has risen sharply in recent months, a consequence of joint Congo-Rwanda
military operations against rebels that have uncapped an appalling level of
violence against civilians."

http://www.nytimes.com/2009/08/05/world/africa/05congo.html?emc=tnt&tntemail1=y

Secretary of State to visit DRC

Wed, 05 Aug 2009 08:23:12 GMT

*Clinton's Africa tour to highlight US
commitments<http://www.google.com/hostednews/ap/article/aleqm5hyyd5hji2indko01yp8hbyxiy1zwd99rokt00>
*
*The Associated Press – August 4, 2009*
Secretary of State Hillary Rodham Clinton's seven-nation tour of Africa
seeks to affirm a commitment by the Obama administration to tackle trouble
spots from Somalia and Zimbabwe to the Democratic Republic of the Congo and
Liberia. Clinton kicked off the 11-day trip — her longest overseas journey
to date as the top U.S. diplomat — by flying Monday night to Kenya where she
will address an African trade and development forum, meet top Kenyan
officials and see the beleaguered president of lawless Somalia's interim
government. …In Pretoria, Johannesburg and Capetown, Clinton will also
underscore the importance of efforts to combat HIV/AIDS and pledge
continuing U.S. backing for health care initiatives in Africa, some of which
have been led by her husband's private foundation.

*Congolese press regarding Clinton visit (Compiled by US EMB Aug 4)*
L’Observateur runs the half-page, front-page headline: “Hillary Clinton Will
Urge More Efforts to Combat Sexual Violence.” Noting that the U.S.
Government is deeply concerned about sexual and gender-based violence (SGBV)
in the DRC, the paper says that Secretary Clinton will highlight U.S.
commitment to helping the Congolese government fight SGBV, and will urge
MONUC to play a more active role in the effort. According to L’Observateur,
Clinton will also encourage DRC Government efforts aimed at consolidating
democracy, eradicating corruption, and implementing sound economic and
budget policies. The paper says that the DRC Government might seek U.S.
support to secure an IMF poverty reduction and growth facility loan in
coming days.

Focusing on the reasons behind Secretary Clinton’s Africa visit, La
Prosperite comments that the choice of countries demonstrates that the tour
is motivated by business concerns, even though “the Obama administration
denies being concerned about China’s increasing influence across the
continent.” The paper says that Secretary Clinton will develop new ties to
regional economic powers such as South Africa, Nigeria, Angola, and the DRC,
as part of a visit that will begin in Nairobi “to alleviate Kenyans’
disappointment,” that the American president delivered his historic address
to Africa from Ghana. Clinton is also expected make her trademark visits to
students, women, and hospital staff, reports La Prosperite.

The independent Le Climat Tempere carries a front-page article titled “An
American in the Congo: Strategic Partnership.” It echoes the widespread
perception that the U.S. was one of the chief instigators behind the Congo
War while hailing a shift in U.S. foreign policy toward the DRC. According
to the article, the U.S. no longer needs to use Rwanda and Uganda as proxies
to protect its interests in the DRC, and the Rwandan Government has
difficulty accepting this new U.S. approach. The Obama administration
“rejects the logics of war,” as it understands “there are no military
solutions to Africa’s problems,” comments the paper. Le Climat Tempere also
runs an editorial arguing that the U.S. is attempting to regain ground it
lost in Central Africa to other powers, including China, over the years
“because of its arrogance and its warmongering.” On the other hand, the
paper urges the DRC Government to present a clear strategic agenda and
demonstrate its ability to govern and defend the Congolese territory in
order to counter attempts to Balkanize it by “those who believe that its
central geographical position and large size are an obstacle to global good
governance.” The weekly newspaper was launched in February of this year by
veteran journalists who want to report news with an independent perspective.

SMS action for drug stockouts; Photo montage of Congolese women's hairstyles; Why more women should

Tue, 04 Aug 2009 11:07:47 GMT

1. Mobiles Help Put a Stop to Drug Stock-outs
http://www.pcworld.com/businesscenter/article/169416/mobiles_help_put_a_stop_to_drug_stockouts.html

2. Perhaps it could be called 'Congo chic'
http://www.globalpost.com/dispatch/africa/090330/perhaps-it-could-be-called-congo-chic

3. Why more young women should start using IUDs.
http://www.slate.com/id/2223840

Science Blogs post about malaria's jump from chimps to humans

Tue, 04 Aug 2009 08:31:24 GMT

"One jump from chimps to humans - the origin of malaria"

Local Kinshasa press summary 7/30/09

Fri, 31 Jul 2009 07:20:13 GMT

Local Kinshasa Press Summary 7/30/2009

Secretary of State Visit

Secretary Clinton’s imminent visit made the front page of the pro-government
Le Palmares. Under the main headline “Here are the Secrets Behind Hillary
Clinton’s DRC Trip,” the newspaper continues its tabloid-like coverage of
serious political issues. Despite the fact that no meeting between
Secretary Clinton and President Kabila has been announced, Le Palmares
expects it will be “decisive.” And the paper claims that American policy
toward the DRC has completely changed with the Obama Administration. “After
several attempts to divide and destroy the Congolese nation, all these
international stratagems have only shown that the Congolese giant refuses to
disappear. Finally, in Washington, they understand.”

Citing their erroneous publication in May of an article claiming to detail
the conversation between UN Ambassador Susan Rice and President Kabila, Le
Palmares says, “The day after that meeting, many things began to change
between Kinshasa and Washington.” The paper sees a change in U.S. policy as
it moves away from former allies Rwanda and Uganda, and toward the DRC.
While this perception is not based on facts, it does resonate in certain
quarters of the press and public in Kinshasa.

Violence in the East

Le Potential focuses on Operation Umoja Wetu II, saying it “smells like a
trap.” The front page headline is accompanied by a cartoon showing Rwandan
President Paul Kagame standing at the DRC border, wielding an RPG and
telling MONUC and FARDC soldiers: “Let me help you, I know how to fight the
FDLR. And I have new passports for each of you.” In addition to the
jump-page article, there is also a front page editorial on the latest
MONUC-FARDC efforts against the FLDR. The editorial lays the blame for
violence in Eastern Congo at the feet of Rwanda and the West: “Peace will
not be restored so long as things remain the same in the neighboring state.
Western powers refuse to involve themselves in an inter-Rwandan dialogue
that might bring peace. ‘If there needs to be an inter-Rwandan dialogue,
that’s for Rwandans to decide,’ is what Western diplomats invariably say in
Kinshasa.”

LRA

La Reference Plus reports that a coalition of DRC and Ugandan soldiers
launched a series of attacks on LRA positions in Dungu, Orientale Province,
on July 22-25, killing 23 rebels and dislodging others from neighboring
villages. The article, taken from Radio Okapi’s website, suggests that LRA’s
capability to harm has been greatly reduced as a consequence.

SGBV

L’Avenir runs a half-page, front-page headline: “Sexual Violence: 10 FARDC
Soldiers Get Heavy Sentences.” Although sentenced soldiers include
rank-and-file as well as officers, the paper says that the Government’s
effort to end gender-based violence committed by FARDC troops should be
become a tangible, lasting commitment. MONUC said that this effort should be
supported at the highest level of the DRC government. Le Palmares echoes
MONUC’s call, noting, however, that the UN mission considers the conviction
of these soldiers a sign of progress in the fight against impunity.

Pro-Justice

Le Phare, La Tempete des Tropiques, and Forum des As report on the launching
of USAID-funded “Projustice,” a program aimed at supporting the
establishment of new judicial institutions and promoting judicial
transparency in the DRC. Under this program, civil society’s
justice-oriented projects will be funded at with $210,000 in Kinshasa and in
other cities.

New Sleeping Sickness combination showing positive results

Mon, 13 Jul 2009 17:48:29 GMT

Clinical trials in the Republic of Congo and Democratic Republic of Congo have reached Phase III in a search to develop an effective and non-toxic cure for sleeping sickness, or trypanosomiasis.

I spoke with Rose Hoban last week, who told me that there has been a successful negotiation with drug company Sanofi to convince them to produce enough of one of the drugs in the combination to make it available for the trial and hopefully to people suffering from the disease in the future. More info here.

Sleeping sickness is one of many diseases categorized these days as "neglected and forgotten diseases," those that aren't currently sexy and don't have their own funds named after them. They affect hundreds of thousands of people a year, but usually there is no incentive for drug companies to produce the cures. Hopefully the results of this clinical trial will lead not only to protocol changes in national health programs but also to availability of the required drugs.

New Drug Combo Highly Effective Against Sleeping Sickness
By Rose Hoban
Durham, North Carolina
09 July 2009

African sleeping sickness is almost a joke in the West. Films depict explorers being bitten by the tsetse fly and then falling into a slumber. But sleeping sickness, or Human African trypanosomiasis, is no joke to the hundreds of thousands of people it affects annually.

Dr. Gerardo Priotto explains that when the tsetse fly bites, it transmits a parasite into the blood, which, if left untreated, eventually makes its way to the brain.

"And when this happens, there are a series of neurological signs and symptoms that progress, and they show this sleepiness that gives the name to sleeping sickness," he explains.

"But also it will progress into severe mental confusion and coma and death, and it will eventually kill all of the persons that are infected by the parasite."

[Follow link for rest of article, link to Lancet publication, and audio report.]

Humanitarian Mad Libs.

Fri, 05 Jun 2009 16:39:24 GMT

Ganked from ticklethepear .

Humanitarian Mad Libs (fill in the blanks)

Yet again, bad times in _____ (country). Surprise, surprise. Given that _____ (number between five and ten) previous peace deals have fallen through, perhaps it was naive to assume that the _____ (name of random, medium-sized city in random third-world country) Agreements would hold.

(Then again, UN mediators and peace-building experts need work, too.)

In the meantime, renewed fighting between the _____ (four-letter acronym of rebel / insurgent group - extra point if it's MILF) and government forces threaten to push an already-precarious humanitarian situation over the edge.

In just the past _____ (number between one and four) weeks, as many as _____ (number between 500 and 5,000) civilians have been killed; another _____ (number between 50,000 and 500,000) people have fled their homes.

A UN spokesman in _____ (country) has described the situation as a "humanitarian _____ (catastrophe / crisis / disaster / shit-storm)". According to an aid worker with _____ (three or four letter NGO acronym):

"The camps are overwhelmed; the situation is even worse for those caught in the _____ (bush, inaccessible geographic feature, "no fire zone"). We're hearing that people have already started dying of _____ (cholera, hunger, thirst)."

Another aid worker added:

"The _____ (government forces, rebels, government and rebels) are shooting at anyone that tries to flee the area. We're seeing more and more civilians with _____ (gunshot wounds, shrapnel wounds, massive psychological trauma). It's a _____ (bloodbath / massacre / slaughter / shit-storm)."

The government has denied firing on civilians. According to a government spokesman: "These are our people, we are doing everything we can to save them."

Being ever-mindful of their public image, the rebels have also strenuously denied using civilians as human shields.

Those who have made it to the camps tell a different story. _____ (man's name - preferably African, Asian or Muslim), a _____ (carpenter, farmer, shopkeeper, taxi-driver) from _____ (name of completely insignificant village) reported seeing _____ (number between 5 and 10) bodies laying on the road as he fled.

"They are shooting everyone," he said. "The _____ (government, rebels) killed my _____ (family member) last week. It took us _____ (number between 1 and 5) days to reach the camp. My _____ (family member) is now very ill."

Another facet of the disaster

Mon, 18 May 2009 20:58:11 GMT

There is so much bad news in eastern DRC that I can't even keep up with it, and it's demoralizing to think about posting everything that I read. But this short article from the Atlantic shows a (perhaps simplified but relevant) causal relationship that is yet another negative manifestation of the conflict.

Here's how it works: Soldiers / rebel militia kill hippos --> hippo defecation reduced --> food supply (hippo shit) for plankton/larvae reduced --> fish food supply (plankton/larvae) reduced --> fish reduced --> fishermen permitted to fish reduced --> people can't eat. This is complicated by the fact that more refugees have settled in this area, and by the fact that European environmentalists have calculated the number of fishermen that should legally be allowed to fish based on the fish supply.

Results - fewer hippos, fewer fish, more arrests, and not many people are eating.

Final quote:

The environmental activist fires questions at the two, demanding to know why they were fishing without licenses.

“Because,” the wiry man says, “we were hungry.”