October 2007 Archives

The lyrics to my all-time favorite Halloween-related song "Zombie Jamboree" as performed by Rockapella (and here's a performance from YouTube):

Hey, Back to back, ha ha ha ha, hey, belly to belly
Yes my friends
Hey, Back to back, ha ha ha ha, hey, belly to belly

It was a zombie jamboree
Took place in the New York cemetery
Oh, it was a zombie jamboree
Took place in the New York cemetery

Zombies from all parts of the island
Some of them are great Calypsonians
Since the season was carnival
They got together in bacchanal
And they were singing

Back to back, ghoul, belly to belly
Well, I don't give a damn 'cause I'm stone dead already
Back to back, oh oh oh, belly to belly
It's a zombie jamboree

One female zombie she wouldn't behave
See how's she's dancing out of the grave
In one hand she's holding a quart of rum
The other hand is knocking a conga drum

You know the lead singer starts to make his rhyme
While the other zombie is rockin' in time
One bystander, he had this to say
"It was a trip to see the zombies break away"
Shah! And they were singing

Back to back, mon, belly to belly
Well, I don't give a damn 'cause I'm stone dead already
Back to back, oh, belly to belly
It's a zombie jamboree

And they were singing
Back to back, mon, belly to belly
Well, I don't give a damn 'cause I'm stone dead already
Oh, back to back, oh oh oh, belly to belly
It's a zombie jamboree

Hey hey, back to back, everyone we sing, back to back
And belly to belly then back to back

I discovered this blog via the Freakonomics blog maybe a couple of months ago. It's taken me that long to post about it on here. I think the author (or artist, whatever you want to call her) has a great perspective on social issues and I love the unusual medium. The card above is one of my favorites, and probably the most appropriate to HIV.

Speaking of the distribution of wealth, I read an abstract today of a study done in Botswana and Swaziland examining the link between food security and risk of HIV infection. I don't know about others who read this, but all I could do was repeat "Duh" over and over in my head. Participants in the study were asked about the adequacy of their food intake over the previous 12 months and that data was related to condom use, sex exchange and other risky behaviors. SHOCKINGLY the researchers found that "food insufficiency was associated with increased HIV risk behaviour, and this association was much more marked in women than men." Seriously? They had to do a cross-sectional study to come to that conclusion? We (should) all know the link between poverty and a person's vulnerability to HIV infection. Isn't food security just a specific example of poverty? It's not that I have a problem with the study per se, but it seems like there are many other topics that could be examined that wouldn't be coming to conclusions that have pretty much already been proven.

Here's a link to the abstract if you want to read it for yourself http://medicine.plosjournals.org/perlserv/?request=get-document&doi=10.1371/journal.pmed.0040260

A few weeks back MeetingsNet.com did a write-up on the HIV Implementers Conference I attended in Kigali, Rwanda. The article is titled: Into Africa: Planning an international AIDS meeting in postwar Rwanda seemed like mission impossible. Here's how Sheila Stampfli and her team pulled it off. Obviously, the article is from the perspective of the event organizers, but I am quoted near the end of it on Page 3.

In fact, Rwanda is now considered one of the safest countries in Africa. “Unlike many other African capitals, the city was relatively clean and safe,” says Brian Awsumb, a peace corps volunteer from Gaborone, Botswana, who attended the PEPFAR meeting.

Like Stampfli, he observed the focus on moving forward. “I got the impression many Rwandans were tired of talking to visitors about the genocide and wanted to concentrate more on the future,” Awsumb says. He didn't encounter resentment against the U.S. for not intervening during the genocide. “The people there could not have been more friendly and helpful.”

Past and present came together during Awsumb's stay at the Hotel des Milles Collines, one of the three hotels in the PEPFAR meeting room block. The property was made famous by the 2004 film, Hotel Rwanda, starring Don Cheadle as the heroic hotel manager Paul Rusesabagina, who saved more than 1,000 people in 1994 by giving them shelter in the hotel. Some attendees and planners who stayed in the hotel described the experience as rather eerie. “I did find myself a few times looking off the balcony onto the streets below and visualizing in my mind the road blocks and carnage that made the city so infamous,” says Awsumb. “But it was also just as easy to see the hustle and bustle of the town center and all sorts of new construction projects.”

Brian and I have seen our share of traditional dancing in Botswana. Most often it is kids from the local CJSS (Community Junior Secondary School) performing at a local event, but we also traveled to the Kuru Dance Festival in 2005 that was very cool. The dancing, I think, it pretty much what you would expect. Lots of clapping, foot stomping, etc. One distinct feature of the music is the whistle that’s used almost as a percussion instrument. Because Botswana’s a desert they don’t have large trees to make drums out of (like other equatorial countries) so the whistle serves as a way to keep the beat steady. I have two favorite dances that you see pretty often. The first is Dance of the Gemsbok. Basically the dancers are acting out the hunting of a gemsbok, with one dancer playing the gemsbok by holding straight sticks by his head and the others dancing around as hunters. I’ve written about it before here, when I first saw it performed at the Kuru Festival. I don’t know the name of my other favorite dance but it’s pictured above. The main performer (always a male) I think gets bitten by a snake and falls to the ground writhing around. The women come to help him and then, I think, a traditional healer comes and the main performer is better and gets up and dances. I’ll try to find some video to post of traditional dancing, but for now Continue Reading to see a few more pictures.

The Washington Post published an article yesterday by David Halperin, a researcher at the Harvard School of Public Health, in response to Richard Holbrooke's op-ed that ran about two weeks ago and I talked about here. On the face of it Halperin doesn't have much in disagreement with Holbrooke - they both argue that prevention is critical to resolving the HIV crisis and the importance of testing. Halperin's point on testing, however, is that while it's important in terms of getting people started on treatment, there is ltitle evidence that knowing one's status leads to behavior change. (In fact, as Halperin notes, some studies show that people who find out they're HIV negative continue in their risky behaviors from before being tested.) One thing I learned from Halperin is that in countries and settings where there have been significant changes in the rate of HIV (Thailand, Uganda, the U.S. gay community in the 80s, Kenya, etc.) the rates fell fastest before HIV testing was very widely available. So HIV testing is important but it's not a behavior change intervention.

Another point I really appreciated by Halperin is the role multiple concurrent partnerships play in the epidemic. This is so true in Botswana. Think of a guy who's sleeping with one woman, then starts to sleep with another woman and eventually breaks up with the first. He doesn't consider himself as having "many" sexual partners. Just one at a time, so even though those women may only be sleeping with him he's passing the virus on to all of them. What's really scary about it is that people who have multiple partnerships don't really think of themselves being "high risk". Even in Botswana where 95 percent of transmission is through heterosexual sex, people think it's sex workers and their customers or caregivers of people living with AIDS that get infected.

Finally, Halperin mentioned the need to expand family planning services which is another issue I've become very passionate about. In Botswana whenever you get health workers together to talk about PMTCT the issue of "repeat PMTCT mothers" always comes up. That's women who have either participated in PMTCT before and fall pregnant again or know their HIV status and fall pregnant. Depending on your viewpoint, repeat PMTCT mothers may or may not be considered a major concern. Women have the right to bear children and we who run public health programs can't take away that right. HOWEVER, survey data in Botswana shows that 65 percent of pregnancies were unplanned and 35 percent of those were unwanted (regardless of the mother's HIV status.) Unplanned pregnancies are something that public health practitioners can and should intervene to resolve.

Full text of Halperin's article avaiable if you Continue Reading

Brian and I went to Molepolole on Saturday to watch England play South Africa in the final game of the Rugby World Cup with our friends Ben, Sheelagh, Angus and Rachel. We were all rooting for England, who won the World Cup in 2003 but were ranked 8th coming into this Cup and were serious underdogs to the 2nd or 3rd ranked Springboks. (Not to mention that no team has ever repeat/defended their World Cup or has won the World Cup after losing a game.)

We did everything in our power to show our support for England – ate pork and lamb instead of beef, drank non-South African beer and had red and white strawberries and cream for dessert. Ben sat in his lucky chair and Angus sat in his lucky chair with England’s flag draped around his shoulders. Unfortunately, after both teams failed to score a try South Africa was victorious on points scored by penalty kicks. (Although we England fans are convinced that they were robbed of a try by the officials in the second half. Look at the video!!)

I have to say that I really enjoy watching rugby; it’s fast-paced, violent and has no stoppages. What’s not to love? Personally, my favorite international team is the New Zealand All Blacks who do this cool “zulu warrior” dance (aka known as a haka) to intimidate their opponents. It’s very cool.

On the way back from our trip up north we stopped off at Tsodilo Hills (a.k.a., Mountain of the Gods). The area is listed as a UNESCO World Heritage Site and attracks thousands of visitors each year. At Tsodilo, the "male hill" rises 400 metres above the surrounding landscape to 1,395 metres above sea level. You know your in a flat country when this is your highest peak. But the hills are not know for their altitude; rather, the ancient human settlements and rock art.

Human activity at Tsodilo Hills spans nearly 100,000 years, making it one of the oldest human archaeological sites in the world. Ancient pottery and stone tools, in addition to more recent iron tools and jewelry, have been discovered. Most of the existing rock paintings are believed to be between 800-1,200 years old. The area today is home for several San and Hambukushu people, a few of whom work as hired guides.

Photo (top left-hand corner going clockwise):

Wild game and a geometric design--the most common elements in the rock art.
Climbing down from the caves (Look mom. No hands!!).
The crew on top "female hill."
The "dancing penises" painting.
Ancient grinding rock.
A whale (WTF?) - The background of this one is disputed. The area was once home to a giant lake and river system. Some say it is a really poorly drawn fish. I am with the others in believing this is a whale. It's entirely possible that people journeyed to the Namibian coast and returned to draw about it.
A view of "male hill."

The Zebras campaign made visits to Etsha-6 and Shakawe in northern Botswana in early October. The Tebelopele Voluntary Counseling & Testing mobile team was joined by national soccer star Onalethata Tshekiso who was nursing a injured ankle. In Etsha-6, we offered VCT services at a football tournament (a way to attrack men to test). In Shakawe, we provided VCT at a Youth and HIV community event where O.T. was a keynote speaker.

Photo (clockwise starting in the upper left-hand corner): O.T. greets a Zebras/Township Rollers fan who sports his "I know my status" wrist band; Tebelopele tent offering VCT at the game, U.S. Ambassador and main backer of the Zebra project Katherine Canavan at the Youth & HIV event, children watching from a nearby tree, Tebelopele public relations officer K.B. taking a quick break, new PCVs Joe and Kez, me giving local children lessons in the fist bump.

Last Saturday we went to the under-23 soccer team's game against Guinea at the Botswana National Stadium. The Young Zebras or Dream Team, as they are both called, are trying to qualify for the '08 Beijing Olympics. The Young Zebras have a plethora of talented strikers, especially considering that a few have already been tapped for the senior team, and have a big following.

The game was expected to be well fought on both sides. The Zebras were in big need of a win. And Guinea is known for its dirty play. From the beginning it was easy to see the Zebras get rattle by some missed fouls (e.g., grabbing a guy by the jersey and swinging him to the ground). They fell behind 0-1 in the first half. In the second the Zebras rallied back to tie up the score. Just when it looked like the game was headed to a disasterous 1-1 tie (the Zebras desperately need victory points after dropping a few games, not tie points), Goboyeone Selefa kicked in his second game of the game with less than a minute left in stoppage time. The fans went crazy calling out his nickname, "Shoes!" Then once the final whistle blew everyone ran, literally, out of the stadium screaming, "Shooooooooes!" Why they felt the need to run, I don't know. But high fives and celebratory hugs were abound.

For the former Trapper fans out there, the Botswana National Stadium is like more rustic version of Derks Field, but without the mountain views.

The next game for the Young Zebras is against Morocco in mid-November. A win against Morocco (and some other loses/ties) could ensure the Zebras advance.

Entoptic (adj): Relating to objects situated within the eye; esp., relating to the perception of objects in one's own eye.

Phenomenon (noun): 1. a fact, occurence or circumstance observed or observable; 2. something that is impressive or extraordinary, 3. a remarkable or exceptional person

I had to share these pictures by William Hundley that I came across today from another blog. Totally unrelated to Peace Corps and HIV, I know, but I was totally taken away by them and wanted others to see them. The photographer gets people to jump under blankets, sheets, etc. and then catches them mid-air. The results are amazing. These three are just a few of my favorites among the 112 in the set. Believe me, it was hard to pick just three. Go see the rest of his work here.

The Zebras' HIV testing campaign (note: we're involving the national soccer team, not testing wild animals) is kicking into high gear. We received some extra funding from the CDC-BOTUSA project to scale-up testing efforts and take services directly to the people. The hope is to build on the excitment surrounding the Zebras at this time of year (e.g., Castle Cup, Olympic qualifiers, African Cup of Nations) to remind people of the benefits of knowing one's HIV status.

The new, innovative effort is being dubbed, Itshupe ka Botala. We want all Zebras supporters to unite in Tebelopele's effort to empower every Batswana to know their HIV status. I am really proud of the campaign and happy with the press coverage we've received:

Botswana Sunday Standard: Tebelopele VCT makes use of Zebras’ popularity
Botswana Daily News: Zebras for life HIV/AIDS campaign expands to Go Blue

On an interesting note: In Setswana, the colors blue and green share the same word, tala. The campaign roughly translates to Show Your Blue or Go Blue (though it could just as easily be Show Your Green or Go Green).

Lots of interesting articles in the news lately. Here's another NY Times article, "In U.S. Poll, Most Fail a Quiz on Global Causes of Child Deaths." Most people think its AIDS or malaria. Honestly, I probably would have guessed the same thing. Apparently it's really childbirth complications, pneumonia, and diarrhea. I agree with what the article is saying, basically that people think AIDS and malaria kill more because they get more coverage in the press. I found the article very thought provoking because I realized that I don't know what the most common causes of death are in Botswana for children under 5. I'm thinking that AIDS probably plays a bigger role here than the worldwide stats because of the high prevalence rate. Diarrhea is not normally a problem because Bots is a dry country, but I wonder how big of a role childbirth and pneumonia play? Definitely something I'm going to have to ask others about.

Incidentally, did you know that the number one cause of death among women worldwide is complications during childbirth? Not something you think about beause it's the problem has basically been eradicated in the U.S. I read that in a Newsweek we received a while ago and thought it was interesting. Definitely something that motivates my interest in studying women's and reproductive heatlh in graduate school.

A great NY Times article today on my favorite non-candidate entitled "Gore Supporter's Movement Lacks a Candidate." How cool is it that he may be nominated for a Nobel Peace Prize? I especially like this line from the movement's treasurer "“I want to hear him say, ‘If called, I will not serve my country.'" Amen sister.

An update on my efforts to to reduce, reuse, recycle:

1) Using the recycling facilities down the street. I am still working on this. Some of it relates to #2 below because we have fewer bags and therefore seem to avoid using them to collect recyclables.

2) Use reusable shopping bags. This isn't going as well as I'd hoped. Honestly, we need the plastic bags for our garbage. With the 25t that's charged for bags we're definitely accumulating far fewer bags than before, but they're ultimately cheaper than buying plastic garbage bags.

3) Also not going as well as I hoped. Need to talk about it with our landlady. I think she'd be a big fan of the idea with her garden. The rainy season seems to have started too so that would make it easier.

Now that I've talked about this TWICE publicly guess I'm going to have to stick to my word better ...

To read the full text of the article click Continue Reading.

Everyone working in HIV in developing countries should hang this on their wall:

"We certainly must avoid a situation in which, as treatment access expands, increase in risky behaviors occur, while resource commitment to and visibility of prevention programmes diminish.

"Prevention is critical in all our interventions. Without strong and accessible prevention interventions, treatment will continually increase, making the response unsustainable."

-His Excellency, Botswana President Festus Mogae

Botswana is unique in its political will to stop the stread of HIV and care for those infected and affected. Unfortunately, prevention is still very difficult to address in Botswana. The government has such a strong presence in providing for its citizens' needs that it really inhibits the growth of civil society organizations. In terms of HIV this means that it is relatively easy to train health workers in HIV, roll out new treatment guidelines and distribute medications and supplies. So Botswana is very good at treatment and care.

Botswana, however, lacks vibrant, capable NGOs that can meet other HIV needs, particularly in the area prevention. Of course, I could fill a large bowl with an "alphabet soup" of NGOs and innovative government efforts that are doing HIV prevention. It’s not that nothing is getting done; rather, there are few organizations capable of leading effective HIV prevention campaigns that a government, any government, is ill-suited to do.

Even more unfortunately, the U.S. government’s President’s Emergency Plan for AIDS Relief (PEPFAR) makes this problem worse in Botswana. PEPFAR stipulates that recipient countries spend specific percentages on treatment, care, support and prevention. Keep in mind that approximately 90 percent of Botswana government funds go to treatment, care and support. So the arbitrary percentages imposed by Congress and the administration, and the low overall percentage dedicated to primary prevention, doesn’t allow countries to meet their large programmatic gaps in prevention. (And I’m not even getting into whole the “A, AB, B or Other” issue.)

Let’s hope that efforts to reauthorize PEPFAR will provide countries with greater flexibility to meet their needs for primary prevention.

There was a really good article in the Washington Post yesterday titled "Still to Losing the AIDS Fight by Richard Holbrooke. Basically Holbrooke is arguing to support something that may seem to be a fundamental part of the HIV response - prevention and testing. Unfortunately this is not always the case, even in a relatively successful country like Botswana. First, let me say (again?) that Botswana IS a success story in many areas. There is a lot of political will to fighting HIV. That can't be said for a lot of other African countries. There is a lot of financial support to back up their words (I believe that nearly 90 percent of the HIV funding in Botswana comes from the government. That's just astounding.) In terms of care and treatment, Botswana's got a big lead on nearly every other African country. For example, of an estimated 270,000 people living with HIV/AIDS, approximately 90,000 are receiving free antiretroviral therapy. That's almost 100 percent coverage and in July there were less than 550 people on the waiting list. There is a lot of psychosocial and financial support for orphans and vulnerable children. Furthermore, as I've mentioned before, the national PMTCT program has reduced transmission from mother-to-child by nearly 90 percent to less than 5 percent of infants born to infected mothers. Altogether Botswana is doing an amazing job providing care and treatment to those who are already infected or affected (and preventing infant infections). Ultimately, however, the number of people becoming infected each year is not going down and that, quoting Holbrooke, is the "only criterion that ultimately matters."

Prevention is something that I really started to become passionate about in Kweneng District with the Young Women's Empowerment Project. The first goal of PMTCT is to prevent infection among women of childbearing age. That's the best and most cost effective way to prevent infant infections. Unfortunately very little time and resources are spent by the national program on primary prevention. It's a difficult subject because I understand the human and financial resource constraints of the PMTCT program. They can't do everything and there definitely needs to be a larger push for prevention from other national programs. However, I would love to see the PMTCT program do more at least in terms of reaching women and especially catching women who are pregnant but test negative. Data from the Sentinel Surveillance consistently shows that the more pregnancies a woman has the more likely she is to be HIV infected. I think the answer to the question of "what do we do for pregnant women who test HIV-negative?" could have big impacts for the PMTCT program.

I also wanted to briefly discuss something that Holbrooke mentions at the end of his article - Botswana's successful opt-out testing policy. I know first hand from the data I analyzed in Kweneng District and my exposure to the national PMTCT program just how big of an impact the opt-out testing policy has had on the number of people testing. In Kweneng District the number of people testing nearly doubled in the year after the opt-out policy was announced. In addition, the percent of women delivering in hospital who were tested for HIV during pregnancy or postpartum skyrocketed from 79 percent in 2004 to 94 percent in 2005 to 97 percent in 2006. Somebody once told me that in the weeks and months immediately after President Mogae announced HIV testing as routine they literally had people coming to the clinic asking to have their "routine test" done. The mind-set shift from making HIV testing a routine part of medical care in the country has made a huge difference.

So a resounding AMEN from me to Richard Holbrooke. A very timely and relevant article. As usual, to read the full text of his article click on the Continue Reading link.

There was a great article in the NY Times (thanks Mom) about the filming of an adaptation of Alexander McCall Smith's book "The No. 1 Ladies Detective Agency." We've heard quite a bit about the filming since it's taking place here in Bots (thanks to the Government contributing $5 million for the production.) Since coming to Bots I've imagined Mma Ramotswa to look like Brian's old counterpart in Molepolole - Beauty (Mma Mahatelo). During casting there were rumors that the Minister of Health, Prof. Sheila Tlou, would be picked because she's played the part in a local production (we knew that would never happen.) There were also rumors of Oprah and Queen Latifah being interested in the part, but ultimately I think the choice to go with Jill Scott will be perfect. For me, she's unknown enough that you won't be thinking "That's Jill Scott" the whole time you watch the movie and I think she really looks the part. (Although it will be difficult to read books in the future and not keep myself from imagining Beauty.) I'm just bummed to learn that the film is probably going to show on BBC first and then be broadcast on TV in America, and not be a major film production. It would have been fun to go see it on the big screen here in Gabs.

For full text of the NY Times article click "Continue Reading."